[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 491 Introduced in Senate (IS)]

103d CONGRESS
  1st Session
                                 S. 491

 To provide health care for every American and to control the cost of 
                        the health care system.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 3, 1993

Mr. Wellstone (for himself, Mr. Metzenbaum, Mr. Simon, and Mr. Inouye) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To provide health care for every American and to control the cost of 
                        the health care system.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``American Health 
Security Act of 1993''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
   TITLE I--ESTABLISHMENT OF A STATE-BASED AMERICAN HEALTH SECURITY 
               PROGRAM; UNIVERSAL ENTITLEMENT; ENROLLMENT

Sec. 101. Establishment of a State-based American Health Security 
                            Program.
Sec. 102. Universal entitlement.
Sec. 103. Enrollment.
Sec. 104. Portability of benefits.
Sec. 105. Effective date of benefits.
Sec. 106. Relationship to existing Federal health programs.
  TITLE II--COMPREHENSIVE BENEFITS, INCLUDING PREVENTIVE BENEFITS AND 
                      BENEFITS FOR LONG TERM CARE

Sec. 201. Comprehensive benefits.
Sec. 202. Definitions relating to services.
Sec. 203. Special rules for home and community-based long term care 
                            services.
Sec. 204. Exclusions and limitations.
                   TITLE III--PROVIDER PARTICIPATION

Sec. 301. Provider participation and standards.
Sec. 302. Qualifications for providers.
Sec. 303. Qualifications for comprehensive health service 
                            organizations.
Sec. 304. Limitation on certain physician referrals.
                        TITLE IV--ADMINISTRATION

             Subtitle A--General Administrative Provisions

Sec. 401. American Health Security Standards Board.
Sec. 402. American Health Security Advisory Council.
Sec. 403. Professional, technical, and temporary advisory committees.
Sec. 404. American Health Security Quality Council.
Sec. 405. State health security programs.
Sec. 406. District health advisory councils.
Sec. 407. Complementary conduct of related health programs.
                Subtitle B--Control Over Fraud and Abuse

Sec. 411. Application of Federal sanctions to all fraud and abuse under 
                            American Health Security Program.
Sec. 412. National health care fraud data base.
Sec. 413. Requirements for operation of State health care fraud and 
                            abuse control units.
Sec. 414. Assignment of unique provider and patient identifiers.
                      TITLE V--QUALITY ASSESSMENT

Sec. 501. Functions of Quality Council; development of practice 
                            guidelines and application to outliers.
Sec. 502. State quality review programs.
Sec. 503. Certification; utilization review; plans of care.
Sec. 504. Development of national electronic data base.
 TITLE VI--HEALTH SECURITY BUDGET; PAYMENTS; COST CONTAINMENT MEASURES

              Subtitle A--Budgeting and Payments to States

Sec. 601. American health security budget.
Sec. 602. Computation of individual and State capitation amounts.
Sec. 603. State health security budgets.
Sec. 604. Federal payments to States.
Sec. 605. Required approval process for capital expenditures.
              Subtitle B--Payments by States to Providers

Sec. 611. Payments to hospitals and nursing facility services for 
                            operating expenses on the basis of approved 
                            global budgets.
Sec. 612. Payments for other facility-based services.
Sec. 613. Payments to health care practitioners based on prospective 
                            fee schedule.
Sec. 614. Payments to comprehensive health service organizations.
Sec. 615. Payments for community-based primary health facilities.
Sec. 616. Payments for prescription drugs.
Sec. 617. Payments for approved devices and equipment.
Sec. 618. Payments for other items and services.
Sec. 619. Role of commissions in establishing payment rates.
Sec. 620. Payment incentives for medically underserved areas.
Sec. 621. Waiver authority for alternative payment methodologies.
     Subtitle C--Mandatory Assignment and Administrative Provisions

Sec. 631. Mandatory assignment.
Sec. 632. Procedures for reimbursement; appeals.
  TITLE VII--PROMOTION OF PRIMARY HEALTH CARE; DEVELOPMENT OF HEALTH 
     SERVICE CAPACITY; PROGRAMS TO ASSIST THE MEDICALLY UNDERSERVED

   Subtitle A--Promotion and Expansion of Primary Care Professional 
                                Training

Sec. 701. Role of Board; establishment of primary care professional 
                            output goals.
Sec. 702. Establishment of Advisory Committee on Health Professional 
                            Education.
Sec. 703. Grants for health professions education, nurse education, and 
                            the national health service corps.
                Subtitle B--Direct Health Care Delivery

Sec. 711. Setaside for public health block grants.
Sec. 712. Setaside for primary health care delivery.
Sec. 713. Primary care service expansion grants.
             Subtitle C--Primary Care and Outcomes Research

Sec. 721. Set-aside for outcomes research.
Sec. 722. Office of Primary Care and Prevention Research.
 TITLE VIII--FINANCING PROVISIONS; AMERICAN HEALTH SECURITY TRUST FUND

Sec. 800. Amendment of 1986 code; section 15 not to apply.
            Subtitle A--AMERICAN HEALTH SECURITY TRUST FUND

Sec. 801. American Health Security Trust Fund.
  Subtitle B--Increases in Corporate and Individual Income Tax Rates; 
 Health Security Premium; and Surtax on Individuals With Incomes Over 
                               $1,000,000

Sec. 811. Increases in regular income tax rates.
Sec. 812. Increases in minimum tax rates.
Sec. 813. Health security premium.
Sec. 814. Surtax on individuals with incomes over $1,000,000.
                   Subtitle C--Employment Tax Changes

Sec. 821. Modifications of certain employment tax provisions.
  Subtitle D--Other Revenue Increases Primarily Affecting Individuals

Sec. 831. Overall limitation on itemized deductions for high-income 
                            taxpayers made permanent.
Sec. 832. Phaseout of personal exemption of high-income taxpayers made 
                            permanent.
Sec. 833. Modifications to deductions for certain moving expenses.
Sec. 834. Top estate and gift tax rates made permanent.
Sec. 835. Elimination of deduction for club membership fees.
Sec. 836. Increase of Social Security benefits included in income.
Sec. 837. Long-term health care premium for the elderly.
   Subtitle E--Other Revenue Increases Primarily Affecting Businesses

Sec. 841. Mark to market accounting method for securities dealers.
Sec. 842. Increase in recovery period for nonresidential real property.
Sec. 843. Taxation of income of controlled foreign corporations 
                            attributable to imported property.
Sec. 844. Repeal of deduction for intangible drilling and development 
                            costs.
Sec. 845. Repeal of percentage depletion for oil and gas wells.
Sec. 846. Repeal of application of like-kind exchange rules to real 
                            property.
Sec. 847. Amortization of portion of advertising expenses.
                  Subtitle F--Estimated Tax Provisions

Sec. 851. Individual estimated tax provisions.
Sec. 852. Corporate estimated tax provisions.
                 Subtitle G--Alternative Taxable Years

Sec. 861. Election of taxable year other than required taxable year.
Sec. 862. Required payments for entities electing not to have required 
                            taxable year.
   Subtitle H--Deduction for Charitable Contribution of Appreciated 
                   Property Limited To Adjusted Basis

Sec. 871. Deduction for charitable contribution of appreciated property 
                            limited to adjusted basis.
 Subtitle I--Minimum 5 Percent Rate of Tax on Interest Paid To Foreign 
                                Persons

Sec. 881. Minimum 5 percent rate of tax on interest paid to foreign 
                            persons.

   TITLE I--ESTABLISHMENT OF A STATE-BASED AMERICAN HEALTH SECURITY 
               PROGRAM; UNIVERSAL ENTITLEMENT; ENROLLMENT

SEC. 101. ESTABLISHMENT OF A STATE-BASED AMERICAN HEALTH SECURITY 
              PROGRAM.

    (a) In General.--There is hereby established in the United States a 
State-based American Health Security Program to be administered by the 
individual States in accordance with Federal standards specified in, or 
established under, this Act.
    (b) State Health Security Programs.--In order for a State to be 
eligible to receive payment under section 604, a State must establish a 
State health security program in accordance with this Act.
    (c) State Defined.--
            (1) In general.--In this Act, subject to paragraph (2), the 
        term ``State'' means each of the fifty States and the District 
        of Columbia.
            (2) Election.--If the Governor of Puerto Rico, the Virgin 
        Islands, Guam, American Samoa, or the Northern Mariana Islands 
        certifies to the President that the legislature of the 
        Commonwealth or territory has enacted legislation desiring that 
        the Commonwealth or territory be included as a State under the 
        provisions of this Act, such Commonwealth or territory shall be 
        included as a ``State'' under this Act beginning January 1 of 
        the first year beginning ninety days after the President 
        receives the notification.

SEC. 102. UNIVERSAL ENTITLEMENT.

    (a) In General.--Every individual who is a resident of the United 
States and is a citizen or national of the United States or lawful 
resident alien (as defined in subsection (d) is entitled to benefits 
for health care services under this Act under the appropriate State 
health security program. In this section, the term ``appropriate State 
health security program'' means, with respect to an individual, the 
State health security program for the State in which the individual 
maintains a primary residence.
    (b) Treatment of Certain Nonimmigrants.--
            (1) In general.--The American Health Security Standards 
        Board (in this Act referred to as the ``Board'') may make 
        eligible for benefits for health care services under the 
        appropriate State health security program under this Act such 
        classes of aliens admitted to the United States as 
        nonimmigrants as the Board may provide.
            (2) Consideration.--In providing for eligibility under 
        paragraph (1), the Board shall consider reciprocity in health 
        care services offered to United States citizens who are 
        nonimmigrants in other foreign states, and such other factors 
        as the Board determines to be appropriate.
    (c) Treatment of Other Individuals.--
            (1) By board.--The Board also may make eligible for 
        benefits for health care services under the appropriate State 
        health security program under this Act other individuals not 
        described in subsection (a) or (b), and regulate the nature of 
        the eligibility of such individuals, in order--
                    (A) to preserve the public health of communities,
                    (B) to compensate States for the additional health 
                care financing burdens created by such individuals, and
                    (C) to prevent adverse financial and medical 
                consequences of uncompensated care,
        while inhibiting travel and immigration to the United States 
        for the sole purpose of obtaining health care services.
            (2) By states.--Any State health security program may make 
        individuals described in paragraph (1) eligible for benefits at 
        the expense of the State.
    (d) Lawful Resident Alien Defined.--For purposes of this section, 
the term ``lawful resident alien'' means an alien lawfully admitted for 
permanent residence and any other alien lawfully residing permanently 
in the United States under color of law, including an alien with lawful 
temporary resident status under section 210, 210A, or 234A of the 
Immigration and Nationality Act (8 U.S.C. 1160, 1161, or 1255a).

SEC. 103. ENROLLMENT.

    (a) In General.--Each State health security program shall provide a 
mechanism for the enrollment of individuals entitled or eligible for 
benefits under this Act. The mechanism shall--
            (1) include a process for the automatic enrollment of 
        individuals at the time of birth in the United States and at 
        the time of immigration into the United States or other 
        acquisition of lawful resident status in the United States,
            (2) provide for the enrollment, as of January 1, 1995, of 
        all individuals who are eligible to be enrolled as of such 
        date, and
            (3) include a process for the enrollment of individuals 
        made eligible for health care services under subsections (b) 
        and (c) of section 102.
    (b) Availability of Applications.--Each State health security 
program shall make applications for enrollment under the program 
available--
            (1) at local offices of the Social Security Administration,
            (2) at social services locations,
            (3) at out-reach sites (such as provider and practitioner 
        locations), and
            (4) at other locations (including post offices and schools) 
        accessible to a broad cross-section of individuals eligible to 
        enroll.
    (c) Issuance of Health Security Cards.--In conjunction with an 
individual's enrollment for benefits under this Act, the State health 
security program shall provide for the issuance of a health security 
card which shall be used for purposes of identification and processing 
of claims for benefits under the program.

SEC. 104. PORTABILITY OF BENEFITS.

    (a) In General.--To ensure continuous access to benefits for health 
care services covered under this Act, each State health security 
program--
            (1) shall not impose any minimum period of residence in the 
        State, or waiting period, in excess of three months before 
        residents of the State are entitled to, or eligible for, such 
        benefits under the program;
            (2) shall provide continuation of payment for covered 
        health care services to individuals who have terminated their 
        residence in the State and established their residence in 
        another State, for the duration of any waiting period imposed 
        in the State of new residency for establishing entitlement to, 
        or eligibility for, such services; and
            (3) shall provide for the payment for health care services 
        covered under this Act provided to individuals while 
        temporarily absent from the State, for reasons other than to 
        obtain the services, based on the following principles:
                    (A) Payment for such health care services is at the 
                rate that is approved by the State health security 
                program in the State in which the services are 
                provided, unless the States concerned agree to 
                apportion the cost between them in a different manner.
                    (B)(i) Except as provided in clause (ii), payment 
                for such health care services provided outside the 
                United States is made on the basis of the amount that 
                would have been paid by the State health security 
                program for similar services rendered in the State, 
                with due regard, in the case of hospital services, to 
                the size of the hospital, standards of service, and 
                other relevant factors.
                    (ii) Payment for services described under clause 
                (i) which are elective services shall be subject to 
                prior consent of the agency that administers and 
                operates the State health security program if such 
                elective services are available on a substantially 
                similar basis in the State.
                    (iii) For the purposes of this subparagraph, the 
                term ``elective services'' means health care services 
                covered under this Act other than services that are 
                provided in an emergency or in any other circumstance 
                in which medical care is required without delay.
    (b) Cross-border Arrangements.--A State health security program for 
a State may negotiate with such a program in an adjacent State a 
reciprocal arrangement for the coverage under such other program of 
health care services to enrollees residing in the border region.

SEC. 105. EFFECTIVE DATE OF BENEFITS.

    Benefits shall first be available under this Act for items and 
services furnished on or after January 1, 1995.

SEC. 106. RELATIONSHIP TO EXISTING FEDERAL HEALTH PROGRAMS.

    (a) Medicare and Medicaid.--
            (1) In general.--Notwithstanding any other provision of 
        law, subject to paragraph (2)--
                    (A) no benefits shall be available under title 
                XVIII of the Social Security Act for any item or 
                service furnished after December 31, 1994,
                    (B) no individual is entitled to medical assistance 
                under a State plan approved under title XIX of such Act 
                for any item or service furnished after such date, and
                    (C) no payment shall be made to a State under 
                section 1903(a) of such Act with respect to medical 
                assistance for any item or service furnished after such 
                date.
            (2) Transition.--In the case of inpatient hospital services 
        and extended care services during a continuous period of stay 
        which began before January 1, 1995, and which had not ended as 
        of such date, for which benefits are provided under title 
        XVIII, or under a State plan under title XIX, of the Social 
        Security Act, the Secretary of Health and Human Services and 
        each State plan, respectively, shall provide for continuation 
        of benefits under such title or plan until the end of the 
        period of stay.
    (b) Federal Employees Health Benefits Program.--No benefits shall 
be made available under chapter 89 of title 5, United States Code, for 
any part of a coverage period occurring after December 31, 1994.
    (c) CHAMPUS.--No benefits shall be made available under sections 
1079 and 1086 of title 10, United States Code, for items or services 
furnished after December 31, 1994.
    (d) Treatment of Benefits for Veterans and Native Americans.--
Nothing in this Act shall affect the eligibility of veterans for the 
medical benefits and services provided under title 38, United States 
Code, or of Indians for the medical benefits and services provided by 
or through the Indian Health Service.

  TITLE II--COMPREHENSIVE BENEFITS, INCLUDING PREVENTIVE BENEFITS AND 
                      BENEFITS FOR LONG TERM CARE

SEC. 201. COMPREHENSIVE BENEFITS.

    (a) In General.--Subject to the succeeding provisions of this 
title, individuals enrolled for benefits under this Act are entitled to 
have payment made under a State health security program for the 
following items and services if medically necessary and appropriate for 
the maintenance of health or for the diagnosis, treatment, or 
rehabilitation of a health condition:
            (1) Hospital services.--Inpatient and outpatient hospital 
        care, including 24-hour a day emergency services.
            (2) Professional services.--Professional services of health 
        care practitioners authorized to provide health care services 
        under State law.
            (3) Community-based primary health services.--Community-
        based primary health services (as defined in section 202(a)).
            (4) Preventive services.--Preventive services (as defined 
        in section 202(b)).
            (5) Long-term and chronic care services.--
                    (A) Nursing facility services.
                    (B) Home health services.
                    (C) Home and community-based long term care 
                services (as defined in section 202(c)) for individuals 
                described in section 203(a).
                    (D) Hospice care.
            (6) Prescription drugs, biologicals, insulin, medical 
        foods.--
                    (A) Outpatient prescription drugs and biologicals, 
                as specified by the Board consistent with section 616.
                    (B) Insulin.
                    (C) Medical foods (as defined in section 202(d)).
            (7) Mental health services.--Mental health services (as 
        defined in section 202(e)), subject to the requirements of 
        section 204(b).
            (8) Substance Abuse treatment services.--Substance abuse 
        treatment services (as defined in section 202(f)), subject to 
        the requirements of section 204(b).
            (9) Diagnostic tests.--Diagnostic tests.
            (10) Other items and services.--
                    (A) Outpatient therapy.--Outpatient physical 
                therapy services, outpatient speech pathology services, 
                and outpatient occupational therapy services in all 
                settings.
                    (B) Durable medical equipment.--Durable medical 
                equipment.
                    (C) Home dialysis.--Home dialysis supplies and 
                equipment.
                    (D) Ambulance.--Emergency ambulance service.
                    (E) Prosthetic devices.--Prosthetic devices, 
                including replacements of such devices.
                    (F) Additional items and services.--Such other 
                medical or health care items or services as the Board 
                may specify.
    (b) No Cost-Sharing.--There are no deductibles, coinsurance, or 
copayments applicable to benefits provided under this title.
    (c) Prohibition of Balance Billing.--As provided in section 631, no 
person may impose a charge for covered services for which benefits are 
provided under this Act.
    (d) No Duplicate Health Insurance.--Each State health security 
program shall prohibit the sale of health insurance in the State if 
payment under the insurance duplicates payment for any items or 
services for which payment may be made under such a program.
    (e) State Program May Provide Additional Benefits.--Nothing in this 
Act shall be construed as limiting the benefits that may be made 
available under a State health security program to residents of the 
State at the expense of the State.
    (f) Employers May Provide Additional Benefits.--Nothing in this Act 
shall be construed as limiting the additional benefits that an employer 
may provide to employees or their dependents, or to former employees or 
their dependents.

SEC. 202. DEFINITIONS RELATING TO SERVICES.

    (a) Community-based Primary Health Services.--In this title, the 
term ``community-based primary health services'' means ambulatory 
health services furnished--
            (1) by a rural health clinic;
            (2) by a Federally-qualified health center, and which, for 
        purposes of this Act, include services furnished by State and 
        local health agencies;
            (3) in a school-based setting;
            (4) by public educational agencies and other providers of 
        services to children entitled to assistance under the 
        Individuals with Disabilities Education Act for services 
        furnished pursuant to a written Individualized Family Services 
        Plan or Individual Education Plan under such Act; and
            (5) public and private non-profit entities receiving 
        Federal assistance under the Public Health Service Act.
    (b) Preventive Services.--
            (1) In general.--In this title, the term ``preventive 
        services'' means items and services--
                    (A) which--
                            (i) are specified in paragraph (2), or
                            (ii) the Board determines to be effective 
                        in the maintenance and promotion of health and 
                        minimizing the effect of illness, disease, or 
                        medical condition or to be effective in 
                        preventing further deterioration due to 
                        disability; and
                    (B) which are provided consistent with the 
                periodicity schedule established under paragraph (3).
            (2) Specified preventive services.--The services specified 
        in this paragraph are as follows:
                    (A) Basic immunizations.
                    (B) Prenatal and well-baby care (for infants under 
                one year of age).
                    (C) Well-child care (including periodic physical 
                examinations, hearing and vision screening, and 
                developmental screening and examinations) for 
                individuals under 18 years of age.
                    (D) Periodic screening mammography, Pap smears, and 
                colorectal examinations and examinations for prostate 
                cancer.
                    (E) Routine dental examinations and prophylaxis.
                    (F) Physical examinations.
                    (G) Family planning services.
                    (H) Routine eye examinations, eyeglasses, and 
                contact lenses.
                    (I) Hearing aids, but only upon a determination of 
                a certified audiologist or physician that a hearing 
                problem exists and is caused by a condition that can be 
                corrected by use of a hearing aid.
            (3) Schedule.--The Board shall establish, in consultation 
        with experts in preventive medicine and public health and 
        taking into consideration those preventive services recommended 
        by the Preventive Services Task Force and published as the 
        Guide to Clinical Preventive Services, a periodicity schedule 
        for the coverage of preventive services under paragraph (1). 
        Such schedule shall take into consideration the cost-
        effectiveness of appropriate preventive care and shall be 
        revised not less frequently than once every 5 years, in 
        consultation with experts in preventive medicine and public 
        health.
    (c) Home and Community-based Long Term Care Services.--In this 
title, the term ``home and community-based long term care services'' 
means services provided to an individual and to enable the individual 
to function independently to the extent possible and to remain in such 
individual's place of residence within the community and includes care 
coordination services (as defined in subsection (g)(1)).
    (d) Medical Foods.--In this title, the term ``medical foods'' means 
foods which are formulated to be consumed or administered enterally 
under the supervision of a physician and which are intended for the 
specific dietary management of a disease or condition for which 
distinctive nutritional requirements, based on recognized scientific 
principles, are established by medical evaluation.
    (e) Mental Health Services.--In this title, the term ``mental 
health services'' means services related to the prevention, diagnosis, 
treatment, and rehabilitation of mental illness and promotion of mental 
health, including the following services:
            (1) Crisis intervention.
            (2) Outpatient mental health services.
            (3) Partial hospitalization and day and evening treatment 
        programs.
            (4) Psychosocial rehabilitation services.
            (5) Pharmacotherapeutic interventions.
            (6) Other rehabilitation services, including halfway and 
        three-quarter-way house care.
            (7) Inpatient mental health services.
            (8) Care coordination services (as defined in subsection 
        (g)(1)).
    (f) Substance Abuse Treatment Services.--In this title, the term 
``substance abuse treatment services'' means services related to the 
prevention, diagnosis, treatment, and rehabilitation of dependency on 
alcohol or controlled substances provided through a treatment program 
meeting State qualification standards and includes the following 
services:
            (1) Crisis intervention, including assessment, diagnosis, 
        and referral.
            (2) Detoxification services, in ambulatory and inpatient 
        settings.
            (3) Outpatient services, including intensive day and 
        evening programs, continuing care, and family services.
            (4) Short-term residential services in a hospital or free-
        standing program.
            (5) Long-term residential services, including therapeutic 
        communities and halfway houses.
            (6) Pharmacotherapeutic interventions.
            (7) Care coordination services (as defined in subsection 
        (g)(1)).
    (g) Care Coordination Services.--
            (1) Definition.--
                    (A) In general.--In this title, the term ``care 
                coordination services'' means services provided by care 
                coordinators (as defined in paragraph (2))--
                            (i) to individuals described in paragraph 
                        (3) for the coordination and monitoring of 
                        mental health services, substance abuse 
                        treatment services, and home and community-
                        based long term care services, and
                            (ii) to individuals who require services to 
                        prevent secondary disabilities for the 
                        coordination and monitoring of home and 
                        community-based long term care services and 
                        preventive services,
                to ensure appropriate, cost-effective utilization of 
                such services in a comprehensive and continuous manner, 
                and includes the services described in subparagraph 
                (B).
                    (B) Services included.--The services described in 
                this subparagraph are--
                            (i) transition management between inpatient 
                        facilities and community-based services, 
                        including assisting patients in identifying and 
                        gaining access to appropriate ancillary 
                        services; and
                            (ii) evaluating and recommending 
                        appropriate treatment services, in cooperation 
                        with patients and other providers and in 
                        conjunction with any quality review program or 
                        plan of care under title V.
            (2) Care coordinator.--
                    (A) In general.--In this title, the term ``care 
                coordinator'' means an individual or nonprofit or 
                public agency or organization which the State health 
                security program determines--
                            (i) is capable of performing directly, 
                        efficiently, and effectively the duties of a 
                        care coordinator described in paragraph (1), 
                        and
                            (ii) demonstrates capability in 
                        establishing and periodically reviewing and 
                        revising plans of care, and in arranging for 
                        and monitoring the provision and quality of 
                        services under any plan.
                    (B) Independence.--State health security programs 
                shall establish safeguards to assure that care 
                coordinators have no financial interest in treatment 
                decisions or placements. Care coordination may not be 
                provided through any structure or mechanism through 
                which utilization review is performed.
            (3) Eligible individuals.--An individual described in this 
        paragraph is an individual--
                    (A) described in section 203 (relating to 
                individuals qualifying for long term and chronic care 
                services); or
                    (B) determined (in a manner specified by the 
                Board)--
                            (i) to have a serious mental illness (as 
                        defined by the Board), or
                            (ii) to have a history of substance abuse 
                        displaying severe associated illness or 
                        previous treatment failure (as defined by the 
                        Board).
    (h) Nursing facility; nursing facility services.--Except as may be 
provided by the Board, the terms ``nursing facility'' and ``nursing 
facility services'' have the meanings given such terms in sections 
1919(a) and 1905(f), respectively, of the Social Security Act.
    (i) Other Terms.--Except as may be provided by the Board, the 
definitions contained in section 1861 of the Social Security Act shall 
apply.

SEC. 203. SPECIAL RULES FOR HOME AND COMMUNITY-BASED LONG TERM CARE 
              SERVICES.

    (a) Qualifying Individuals.--For purposes of section 201(a)(5)(C), 
individuals described in this subsection are the following individuals:
            (1) Adults.--Individuals 18 years of age or older 
        determined (in a manner specified by the Board)--
                    (A) to be unable to perform, without the assistance 
                of an individual, at least 2 of the following 5 
                activities of daily living (or who has a similar level 
                of disability due to cognitive impairment)--
                            (i) bathing;
                            (ii) eating;
                            (iii) dressing;
                            (iv) toileting; and
                            (v) transferring in and out of a bed or in 
                        and out of a chair; or
                    (B) due to cognitive or mental impairments, 
                requires supervision because the individual behaves in 
                a manner that poses health or safety hazards to himself 
                or herself or others.
            (2) Children.--Individuals under 18 years of age determined 
        (in a manner specified by the Board) to meet such alternative 
        standard of disability for children as the Board develops.
    (b) Limit on Services.--
            (1) In general.--No individual is entitled to receive 
        benefits under a State health security program with respect to 
        home and community-based long term care services in a period 
        (specified by the Board) to the extent the amount of payments 
        for such benefits exceeds 65 percent (or such alternative ratio 
        as the Board establishes under paragraph (2)) of the average of 
        amount of payment that would have been made under the program 
        during the period if the individual were a resident of a 
        nursing facility in the same area in which the services were 
        provided.
            (2) Alternative ratio.--The Board may establish for 
        purposes of paragraph (1) an alternative ratio (of payments for 
        home and community-based long term care services to payments 
        for nursing facility services) as the Board determines to be 
        more consistent with the goal of providing cost-effective long-
        term care in the most appropriate and least restrictive 
        setting.

SEC. 204. EXCLUSIONS AND LIMITATIONS.

    (a) In General.--Subject to section 201(e), benefits for service 
are not available under this Act unless the services meet the standards 
specified in section 201(a).
    (b) Mental Health Services and Substance Abuse Treatment 
Services.--
            (1) In general.--Mental health services and substance abuse 
        treatment services furnished for an individual in excess of a 
        threshold specified in paragraph (2) are not covered services 
        unless the services are determined under a utilization review 
        program to meet the standards specified in section 201(a) and, 
        with respect to inpatient or residential treatment services, to 
        be provided in the least restrictive and most appropriate 
        setting.
            (2) Utilization review threshold.--
                    (A) In general.--Subject to subparagraphs (B) and 
                (C), the thresholds specified in this paragraph are--
                            (i) 20 outpatient visits in a year, and
                            (ii) 15 days of inpatient services in a 
                        year.
                    (B) Alternative national thresholds.--The Board may 
                specify alternative thresholds to those specified in 
                subparagraph (A).
                    (C) Additional state thresholds.--A State health 
                security program may specify thresholds in addition to 
                those established under the previous subparagraphs, 
                which thresholds may be higher or lower than the number 
                of outpatient visits or days of inpatient services 
                otherwise specified.
    (c) Treatment of Experimental Services.--In applying subsection 
(a), the Board shall make, after consultation with a technical advisory 
committee, national coverage determinations with respect to those 
services that are experimental in nature. Such determinations shall be 
made consistent with a process that provides for professional input and 
public comment.
    (d) Application of National Practice Guidelines.--In the case of 
services for which the Board has recognized national practice 
guidelines, the services are considered to meet the standards specified 
in section 201(a) only if they have been provided in accordance with 
such guidelines or in accordance with such exceptions process as may be 
established by the Board consistent with such guidelines.
    (e) Specific Limitations.--
            (1) Limitations on eyeglasses, contact lenses, hearing 
        aids, and durable medical equipment.--Subject to section 
        201(e), the Board may impose such limits relating to the costs 
        and frequency of replacement of eyeglasses, contact lenses, 
        hearing aids, and durable medical equipment to which 
        individuals enrolled for benefits under this Act are entitled 
        to have payment made under a State health security program as 
        the Board deems appropriate.
            (2) Overlap with preventive services.--The coverage of 
        services described in section 201(a) (other than paragraph (3)) 
        which also are preventive services are required to be covered 
        only to the extent that they are required to be covered as 
        preventive services.
            (3) Miscellaneous exclusions from covered services.--
        Covered services under this Act do not include the following:
                    (A) Surgery and other procedures (such as 
                orthodontia) performed solely for cosmetic purposes (as 
                defined in regulations) and hospital or other services 
                incident thereto, unless--
                            (i) required to correct a congenital 
                        anomaly;
                            (ii) required to restore or correct a part 
                        of the body which has been altered as a result 
                        of accidental injury, disease, or surgery; or
                            (iii) otherwise determined to be medically 
                        necessary and appropriate under section 201(a).
                    (B) Personal comfort items or private rooms in 
                inpatient facilities, unless determined to be medically 
                necessary and appropriate under section 201(a).
                    (C) The services of a professional practitioner if 
                they are furnished in a hospital or other facility 
                which is not a participating provider.
    (f) Nursing Facility Services and Home Health Services.--Nursing 
facility services and home health services (other than post-hospital 
services, as defined by the Board) furnished to an individual who is 
not described in section 203(a) are not covered services unless the 
services are determined to meet the standards specified in section 
201(a) and, with respect to nursing facility services, to be provided 
in the least restrictive and most appropriate setting.
    (g) Services Involving Unapproved Capital Expenditures.--Benefits 
are not available under this Act with respect to a service which 
involves the use of equipment, facility, or plant if the capital 
expenditure for the equipment, facility, or plant was subject to, but 
was not approved under, the process described in section 605.

                   TITLE III--PROVIDER PARTICIPATION

SEC. 301. PROVIDER PARTICIPATION AND STANDARDS.

    (a) In General.--An individual or other entity furnishing any 
covered service under a State health security program under this Act is 
not a qualified provider unless the individual or entity--
            (1) is a qualified provider of the services under section 
        302;
            (2) has filed with the State health security program a 
        participation agreement described in subsection (b); and
            (3) meets such other qualifications and conditions as are 
        established by the Board or the State health security program 
        under this Act.
    (b) Requirements in Participation Agreement.--
            (1) In general.--A participation agreement described in 
        this subsection between a State health security program and a 
        provider shall provide at least for the following:
                    (A) Services to eligible persons will be furnished 
                by the provider without discrimination on the ground of 
                race, national origin, income, religion, age, sex or 
                sexual orientation, disability, handicapping condition, 
                or (subject to the professional qualifications of the 
                provider) illness. Nothing in this subparagraph shall 
                be construed as requiring the provision of a type or 
                class of services which services are outside the scope 
                of the provider's normal practice.
                    (B) No charge will be made for any covered services 
                other than for payment authorized by this Act.
                    (C) The provider agrees to furnish such information 
                as may be reasonably required by the Board or a State 
                health security program, in accordance with uniform 
                reporting standards established under section 
                401(g)(1), for--
                            (i) quality assurance and utilization 
                        review by professional peers and consumers;
                            (ii) the making of payments under this Act 
                        (including the examination of records as may be 
                        necessary for the verification of information 
                        on which payments are based);
                            (iii) statistical or other studies required 
                        for the implementation of this Act; and
                            (iv) such other purposes as the Board or 
                        State may specify.
                    (D) The provider agrees not to expend any amounts 
                on capital expenditures (as defined in section 605(c)) 
                relating to the provision of covered services unless 
                the purchase of such items has been approved under 
                section 605 and agrees not to bill the program for any 
                services for which benefits are not available because 
                of section 204(g).
                    (E) In the case of a provider that is not an 
                individual, the provider agrees not to employ or use 
                for the provision of health services any individual or 
                other provider who or which has had a participation 
                agreement under this subsection terminated for cause.
                    (F) In the case of a provider paid under a fee-for-
                service basis under section 613, the provider agrees to 
                submit bills and any required supporting documentation 
                relating to the provision of covered services within 30 
                days (or such shorter period as a State health security 
                program may require) after the date of providing such 
                services.
            (2) Termination of participation agreements.--
                    (A) In general.--Participation agreements may be 
                terminated, with appropriate notice--
                            (i) by the Board or a State health security 
                        program for failure to meet the requirements of 
                        this title, or
                            (ii) by a provider.
                    (B) Termination process.--Providers shall be 
                provided notice and a reasonable opportunity to correct 
                deficiencies before the Board or a State health 
                security program terminates an agreement unless a more 
                immediate termination is required for public safety or 
                similar reasons.

SEC. 302. QUALIFICATIONS FOR PROVIDERS.

    (a) In General.--A health care provider is considered to be 
qualified to provide covered services if the provider is licensed or 
certified and meets--
            (1) all the requirements of State law to provide such 
        services,
            (2) applicable requirements of Federal law to provide such 
        services, and
            (3) any applicable standards established under subsection 
        (b).
    (b) Minimum Provider Standards.--
            (1) In general.--The Board shall establish, evaluate, and 
        update national minimum standards to assure the quality of 
        services provided under this Act and to monitor efforts by 
        State health security programs to assure the quality of such 
        services. A State health security program may also establish 
        additional minimum standards which providers must meet.
            (2) National minimum standards.--The national minimum 
        standards under paragraph (1) shall be established for 
        institutional providers of services, individual health care 
        practitioners, and comprehensive health service organizations. 
        Except as the Board may specify in order to carry out this 
        title, a hospital, nursing facility, or other institutional 
        provider of services shall meet standards (including having in 
        effect a utilization review plan) for such a facility under the 
        medicare program under title XVIII of the Social Security Act. 
        Such standards also may include, where appropriate, elements 
        relating to--
                    (A) adequacy and quality of facilities;
                    (B) training and competence of personnel (including 
                continuing education requirements);
                    (C) comprehensiveness of service;
                    (D) continuity of service;
                    (E) patient satisfaction (including waiting time 
                and access to services); and
                    (F) performance standards (including organization, 
                facilities, structure of services, efficiency of 
                operation, and outcome in palliation, improvement of 
                health, stabilization, cure, or rehabilitation).
            (3) Transition in application.--If the Board provides for 
        additional requirements for providers under this subsection, 
        any such additional requirement shall be implemented in a 
        manner that provides for a reasonable period during which a 
        previously qualified provider is permitted to meet such an 
        additional requirement.
            (4) Exchange of information.--The Board shall provide for 
        an exchange, at least annually, among State health security 
        programs of information with respect to quality assurance and 
        cost containment.

SEC. 303. QUALIFICATIONS FOR COMPREHENSIVE HEALTH SERVICE 
              ORGANIZATIONS.

    (a) In General.--For purposes of this Act, a comprehensive health 
service organization (in this section referred to as a ``CHSO'') is a 
public or private organization which, in return for payment under 
section 613(a), undertakes to furnish, arrange for the provision of, or 
provide payment with respect to--
            (1) a full range of health services (as identified by the 
        Board), including at least hospital services and physicians 
        services, and
            (2) out-of-area coverage in the case of urgently needed 
        services,
to an identified population which is living in or near a specified 
service area and which enrolls voluntarily in the organization.
    (b) Enrollment.--
            (1) In general.--All eligible persons living in or near the 
        specified service area of a CHSO are eligible to enroll in the 
        organization; except that the number of enrollees may be 
        limited to avoid overtaxing the resources of the organization.
            (2) Minimum enrollment period.--Subject to paragraph (3), 
        the minimum period of enrollment with a CHSO shall be twelve 
        months, unless the enrolled individual becomes ineligible to 
        enroll with the organization.
            (3) Withdrawal for cause.--Each CHSO shall permit an 
        enrolled individual to disenroll from the organization for 
        cause at any time.
            (4) Broad marketing.--Each CHSO must provide for the 
        marketing of its services (including dissemination of marketing 
        materials) to potential enrollees in a manner that is designed 
        to enroll individuals representative of the different 
        population groups and geographic areas included within its 
        service area and meets such requirements as the Board or a 
        State health security program may specify.
    (c) Requirements for CHSOs.--
            (1) Accessible services.--Each CHSO, to the maximum extent 
        feasible, shall make all services readily and promptly 
        accessible to enrollees who live in the specified service area.
            (2) Continuity of care.--Each CHSO shall furnish services 
        in such manner as to provide continuity of care and (when 
        services are furnished by different providers) shall provide 
        ready referral of patients to such services and at such times 
        as may be medically appropriate.
            (3) Board of directors.--In the case of a CHSO that is a 
        private organization--
                    (A) Consumer representation.--At least one-third of 
                the members of the CHSO's board of directors must be 
                consumer members with no direct or indirect, personal 
                or family financial relationship to the organization.
                    (B) Provider representation.--The CHSO's board of 
                directors must include at least one member who 
                represents health care providers.
            (4) Patient grievance program.--Each CHSO must have in 
        effect a patient grievance program and must conduct regularly 
        surveys of the satisfaction of members with services provided 
        by or through the organization.
            (5) Health education.--Each CHSO must encourage health 
        education of its enrollees and the development and use of 
        preventive health services, health promotion and wellness, 
        self-care, and, if applicable, independent living arrangements.
            (6) Medical standards.--Each CHSO must provide that a 
        committee or committees of health care practitioners associated 
        with the organization will promulgate medical standards, 
        oversee the professional aspects of the delivery of care, 
        perform the functions of a pharmacy and drug therapeutics 
        committee, and monitor and review the quality of all health 
        services (including drugs, education, and preventive services).
            (7) Use of allied health professionals.--Each CHSO must, to 
        the extent practicable and consistent with good medical 
        practice, employ allied health personnel and paraprofessional 
        persons in the furnishing of services.
            (8) Premiums.--Premiums or other charges by a CHSO for any 
        services not paid for under this Act must be reasonable.
            (9) Utilization and bonus information.--Each CHSO must--
                    (A) comply with the requirements of section 
                1876(i)(8) of the Social Security Act (relating to 
                prohibiting physician incentive plans that provide 
                specific inducements to reduce or limit medically 
                necessary services), and
                    (B) make available to its membership utilization 
                information and data regarding financial performance, 
                including bonus or incentive payment arrangements to 
                practitioners.
            (10) Provision of services to enrollees at institutions 
        operating under global budgets.--The organization shall arrange 
        to reimburse for hospital services and other facility-based 
        services (as identified by the Board) for services provided to 
        members of the organization in accordance with the global 
        operating budget of the hospital or nursing facility approved 
        under section 611.
            (11) Limitation on capital expenditures.--The organization 
        agrees--
                    (A) not to expend any amounts on capital 
                expenditures (as defined in section 605(c)) relating to 
                the provision of covered services unless the purchase 
                of such items has been approved under section 605,
                    (B) that any amounts attributable to a reasonable 
                rate of return on equity capital shall not be used for 
                any capital expenditures, and
                    (C) agrees not to bill the program for any services 
                for which benefits are not available because of section 
                204(g).
            (12) Additional requirements.--Each CHSO must meet--
                    (A) such requirements relating to minimum 
                enrollment,
                    (B) such requirements relating to financial 
                solvency,
                    (C) such requirements relating to quality and 
                availability of care, and
                    (D) such other requirements,
        as the Board or a State health security program may specify.
    (d) Provision of Emergency Services to Nonenrollees.--A CHSO may 
furnish emergency services to persons who are not enrolled in the 
organization. Payment for such services, if they are covered services 
to eligible persons, shall be made to the organization unless the 
organization requests that it be made to the individual practitioner 
who furnished the services.

SEC. 304. LIMITATION ON CERTAIN PHYSICIAN REFERRALS.

    (a) Application to American Health Security Program.--Section 1877 
of the Social Security Act, as amended by subsections (b) and (c), 
shall apply under this Act in the same manner as it applies under title 
XVIII of the Social Security Act; except that in applying such section 
under this Act any references in such section to the Secretary or title 
XVIII of the Social Security Act are deemed references to the Board and 
the American Health Security Program under this Act, respectively.
    (b) Expansion of Prohibition to Certain Designated Services.--
Section 1877 of the Social Security Act (42 U.S.C. 1395nn) is amended--
            (1) by striking ``clinical laboratory services'' and 
        ``clinical laboratory services'' and inserting ``designated 
        health services'' and ``designated health services'', 
        respectively, each place either appears in subsections (a)(1), 
        (b)(2)(A)(ii)(I), (b)(4), (d)(1), (d)(2), and (d)(3);
            (2) by adding at the end of such section the following new 
        subsection:
    ``(i) Designated Health Services Defined.--In this section, the 
term `designated health services' means--
            ``(1) clinical laboratory services;
            ``(2) physical therapy services;
            ``(3) radiology services, including magnetic resonance 
        imaging, computerized axial tomography scans, and ultrasound 
        services;
            ``(4) radiation therapy services;
            ``(5) the furnishing of durable medical equipment;
            ``(6) the furnishing of parenteral and enteral nutrition 
        equipment and supplies;
            ``(7) the furnishing of outpatient prescription drugs;
            ``(8) ambulance services;
            ``(9) home infusion therapy services;
            ``(10) occupational therapy services;
            ``(11) inpatient and outpatient hospital services 
        (including services furnished at a psychiatric or 
        rehabilitation hospital); and
            ``(12) other services or technologies as defined by the 
        American Health Security Standards Board.'';
            (3) in subsection (d)(2), by striking ``laboratory'' and by 
        inserting ``entity'';
            (4) in subsection (g)(1), by striking ``clinical laboratory 
        service'' and by inserting ``designated health service''; and
            (5) in subsection (h)(7)(B), by striking ``clinical 
        laboratory service'' and by inserting ``designated health 
        service''.
    (c) Conforming Amendments.--Such section is further amended--
            (1) in subsection (a)(1)(A), by striking ``for which 
        payment otherwise may be made under this title'' and by 
        inserting ``for which a charge is imposed'';
            (2) in subsection (a)(1)(B), by striking ``under this 
        title'';
            (3) by amending paragraph (1) of subsection (g) to read as 
        follows:
            ``(1) Denial of payment.--No payment may be made under a 
        State health security program for a designated health service 
        for which a claim is presented in violation of subsection 
        (a)(1)(B). No individual, third party payor, or other entity is 
        liable for payment for designated health services for which a 
        claim is presented in violation of such subsection.''; and
            (4) In subsection (g)(3), by striking ``for which payment 
        may not be made under paragraph (1)'' and by inserting ``for 
        which such a claim may not be presented under subsection 
        (a)(1)''.

                        TITLE IV--ADMINISTRATION

             Subtitle A--General Administrative Provisions

SEC. 401. AMERICAN HEALTH SECURITY STANDARDS BOARD.

    (a) Establishment.--There is hereby established an American Health 
Security Standards Board.
    (b) Appointment and Terms of Members.--
            (1) In general.--The Board shall be composed of--
                    (A) the Secretary of Health and Human Services, and
                    (B) 6 other individuals (described in paragraph 
                (2)) appointed by the President with the advice and 
                consent of the Senate.
        The President shall first nominate individuals under 
        subparagraph (B) on a timely basis so as to provide for the 
        operation of the Board by not later than January 1, 1994.
            (2) Selection of appointed members.--With respect to the 
        individuals appointed under paragraph (1)(B):
                    (A) They shall be chosen on the basis of 
                backgrounds in health policy, health economics, the 
                healing professions, and the administration of health 
                care institutions.
                    (B) They shall provide a balanced point of view 
                with respect to the various health care interests and 
                at least two of them shall represent the interests of 
                individual consumers.
                    (C) Not more than three of them shall be from the 
                same political party.
            (3) Terms of appointed members.--Individuals appointed 
        under paragraph (1)(B) shall serve for a term of 6 years, 
        except that the terms of 5 of the individuals initially 
        appointed shall be, as designated by the President at the time 
        of their appointment, for 1, 2, 3, 4, and 5 years. During a 
        term of membership on the Board, no member shall engage in any 
        other business, vocation or employment.
    (c) Vacancies.--
            (1) In general.--The President shall fill any vacancy in 
        the membership of the Board in the same manner as the original 
        appointment. The vacancy shall not affect the power of the 
        remaining members to execute the duties of the Board.
            (2) Vacancy appointments.--Any member appointed to fill a 
        vacancy shall serve for the remainder of the term for which the 
        predecessor of the member was appointed.
            (3) Reappointment.--The President may reappoint an 
        appointed member of the Board for a second term in the same 
        manner as the original appointment. A member who has served for 
        two consecutive 6-year terms shall not be eligible for 
        reappointment until two years after the member has ceased to 
        serve.
            (4) Removal for cause.--Upon confirmation, members of the 
        Board may not be removed except by the President for cause.
    (d) Chair.--The President shall designate one of the members of the 
Board, other than the Secretary, to serve at the will of the President 
as Chair of the Board.
    (e) Compensation.--Members of the Board (other than the Secretary) 
shall be entitled to compensation at a level equivalent to level II of 
the Executive Schedule, in accordance with section 5313 of title 5, 
United States Code.
    (f) General Duties of the Board.--
            (1) In general.--The Board shall develop policies, 
        procedures, guidelines, and requirements to carry out this Act, 
        including those related to--
                    (A) eligibility;
                    (B) enrollment;
                    (C) benefits;
                    (D) provider participation standards and 
                qualifications, as defined in title III;
                    (E) national and State funding levels;
                    (F) methods for determining amounts of payments to 
                providers of covered services, consistent with subtitle 
                B of title VI;
                    (G) the determination of medical necessity and 
                appropriateness (including the coverage of new 
                technologies and the application of medical practice 
                guidelines);
                    (H) quality assurance;
                    (I) assisting State health security programs with 
                planning for capital expenditures and service delivery;
                    (J) planning for health professional education 
                funding (as specified in title VII);
                    (K) allocating funds provided under title VII; and
                    (L) encouraging States to develop regional planning 
                mechanisms (described in section 405(a)(3)).
            (2) Regulations.--Regulations authorized by this Act shall 
        be issued by the Board in accordance with the provisions of 
        section 553 of title 5, United States Code.
    (g) Uniform Reporting Standards; Annual Report; Studies.--
            (1) Uniform reporting standards.--
                    (A) In general.--The Board shall establish uniform 
                reporting requirements and standards to ensure an 
                adequate national data base regarding health services 
                practitioners, services and finances of State health 
                security programs, approved plans, providers, and the 
                costs of facilities and practitioners providing 
                services. Such standards shall include, to the maximum 
                extent feasible, health outcome measures.
                    (B) Reports.--The Board shall analyze regularly 
                information reported to it, and to State health 
                security programs pursuant to such requirements and 
                standards.
            (2) Annual report.--Beginning January 1, of the second year 
        beginning after the date of the enactment of this Act, the 
        Board shall annually report to Congress on the following:
                    (A) The status of implementation of the Act.
                    (B) Enrollment under this Act.
                    (C) Benefits under this Act.
                    (D) Expenditures and financing under this Act.
                    (E) Cost-containment measures and achievements 
                under this Act.
                    (F) Quality assurance.
                    (G) The planning and approval process for 
                determining capital expenditures under this Act, and 
                the effects of decisions made under this provision.
                    (H) Health care utilization patterns, including any 
                changes attributable to the program.
                    (I) Long-range plans and goals for the delivery of 
                health services.
                    (J) Differences in the health status of the 
                populations of the different States, including income 
                and racial characteristics.
                    (K) Necessary changes in the education of health 
                personnel.
                    (L) Plans for improving service to medically 
                underserved populations.
                    (M) Transition problems as a result of 
                implementation of this Act.
                    (N) Opportunities for improvements under this Act.
            (3) Statistical analyses and other studies.--The Board may, 
        either directly or by contract--
                    (A) make statistical and other studies, on a 
                nationwide, regional, state, or local basis, of any 
                aspect of the operation of this Act, including studies 
                of the effect of the Act upon the health of the people 
                of the United States and the effect of comprehensive 
                health services upon the health of persons receiving 
                such services;
                    (B) develop and test methods of providing through 
                payment for services or otherwise, additional 
                incentives for adherence by providers to standards of 
                adequacy, access, and quality; methods of consumer and 
                peer review and peer control of the utilization of 
                drugs, of laboratory services, and of other services; 
                and methods of consumer and peer review of the quality 
                of services;
                    (C) develop and test, for use by the Board, records 
                and information retrieval systems and budget systems 
                for health services administration, and develop and 
                test model systems for use by providers of services;
                    (D) develop and test, for use by providers of 
                services, records and information retrieval systems 
                useful in the furnishing of preventive or diagnostic 
                services;
                    (E) develop, in collaboration with the 
                pharmaceutical profession, and test, improved 
                administrative practices or improved methods for the 
                reimbursement of independent pharmacies for the cost of 
                furnishing drugs as a covered service; and
                    (F) make such other studies as it may consider 
                necessary or promising for the evaluation, or for the 
                improvement, of the operation of this Act.
            (4) Report on use of existing federal health care 
        facilities.--Not later than one year after the date of the 
        enactment of this Act, the Board shall recommend to the 
        Congress one or more proposals for the treatment of health care 
        facilities of the Federal Government.
    (h) Executive Director.--
            (1) Appointment.--There is hereby established the position 
        of Executive Director of the Board. The Director shall be 
        appointed by the Board and shall serve as secretary to the 
        Board and perform such duties in the administration of this 
        title as the Board may assign.
            (2) Delegation.--The Board is authorized to delegate to the 
        Director or to any other officer or employee of the Board or, 
        with the approval of the Secretary of Health and Human Services 
        (and subject to reimbursement of identifiable costs), to any 
        other officer or employee of the Department of Health and Human 
        Services, any of its functions or duties under this Act other 
        than--
                    (A) the issuance of regulations; or
                    (B) the determination of the availability of funds 
                and their allocation to implement this Act.
            (3) Compensation.--The Executive Director of the Board 
        shall be entitled to compensation at a level equivalent to 
        level III of the Executive Schedule, in accordance with section 
        5314 of title 5, United States Code.
    (i) Inspector General.--The Inspector General Act of 1978 (5 U.S.C. 
App.) is amended--
            (1) in section 11(1) by inserting after ``Corporation;'' 
        the following: ``the Chair of the American Health Security 
        Standards Board;'';
            (2) in section 11(2) by inserting after ``Information 
        Agency,'' the following: ``the American Health Security 
        Standards Board,''; and
            (3) by inserting after section 8F the following:
``Sec. 8G. Special provisions concerning American Health Security 
              Standards Board
    ``The Inspector General of the American Health Security Standards 
Board, in addition to the other authorities vested by this Act, shall 
have the same authority, with respect to the Board and the American 
Health Security Program under this Act, as the Inspector General for 
the Department of Health and Human Services has with respect to the 
Secretary of Health and Human Services and the medicare and medicaid 
programs, respectively.''.
    (j) Staff.--The Board shall employ such staff as the Board may deem 
necessary.
    (k) Access to Information.--The Secretary of Health and Human 
Services shall make available to the Board all information available 
from sources within the Department or from other sources, pertaining to 
the duties of the Board.

SEC. 402. AMERICAN HEALTH SECURITY ADVISORY COUNCIL.

    (a) In General.--The Board shall provide for an American Health 
Security Advisory Council (in this section referred to as the 
``Council'') to advise the Board on its activities.
    (b) Membership.--The Council shall be composed of--
            (1) the Chair of the Board, who shall serve as Chair of the 
        Council, and
            (2) twenty members, not otherwise in the employ of the 
        United States, appointed by the Board without regard to the 
        provisions of title 5, United States Code, governing 
        appointments in the competitive service.
The appointed members shall include, in accordance with subsection (e), 
individuals who are representative of State health security programs, 
public health professionals, providers of health services, and of 
individuals (who shall constitute a majority of the Council) who are 
representative of consumers of such services, including a balanced 
representation of employers, unions, consumer organizations, and 
population groups with special health care needs.
    (c) Terms of Members.--Each appointed member shall hold office for 
a term of four years, except that--
            (1) any member appointed to fill a vacancy occurring during 
        the term for which the member's predecessor was appointed shall 
        be appointed for the remainder of that term; and
            (2) the terms of the members first taking office shall 
        expire, as designated by the Board at the time of appointment, 
        five at the end of the first year, five at the end of the 
        second year, five at the end of the third year, and five at the 
        end of the fourth year after the date of enactment of this Act.
    (d) Vacancies.--
            (1) In general.--The Board shall fill any vacancy in the 
        membership of the Council in the same manner as the original 
        appointment. The vacancy shall not affect the power of the 
        remaining members to execute the duties of the Council.
            (2) Vacancy appointments.--Any member appointed to fill a 
        vacancy shall serve for the remainder of the term for which the 
        predecessor of the member was appointed.
            (3) Reappointment.--The Board may reappoint an appointed 
        member of the Council for a second term in the same manner as 
        the original appointment.
    (e) Qualifications.--
            (1) Public health representatives.--Members of the Council 
        who are representative of State health security programs and 
        public health professionals shall be individuals who have 
        extensive experience in the financing and delivery of care 
        under public health programs.
            (2) Providers.--Members of the Council who are 
        representative of providers of health care shall be individuals 
        who are outstanding in fields related to medical, hospital, or 
        other health activities, or who are representative of 
        organizations or associations of professional health 
        practitioners.
            (3) Consumers.--Members who are representative of consumers 
        of such care shall be individuals, not engaged in and having no 
        financial interest in the furnishing of health services, who 
        are familiar with the needs of various segments of the 
        population for personal health services and are experienced in 
        dealing with problems associated with the consumption of such 
        services.
    (f) Duties.--
            (1) In general.--It shall be the duty of the Council--
                    (A) to advise the Board on matters of general 
                policy in the administration of this Act, in the 
                formulation of regulations, and in the performance of 
                the Board's duties under section 401; and
                    (B) to study the operation of this Act and the 
                utilization of health services under it, with a view to 
                recommending any changes in the administration of the 
                Act or in its provisions which may appear desirable.
            (2) Report.--The Council shall make an annual report to the 
        Board on the performance of its functions, including any 
        recommendations it may have with respect thereto, and the Board 
        shall promptly transmit the report to the Congress, together 
        with a report by the Board on any recommendations of the 
        Council that have not been followed.
    (g) Staff.--The Council, its members, and any committees of the 
Council shall be provided with such secretarial, clerical, or other 
assistance as may be authorized by the Board for carrying out their 
respective functions.
    (h) Meetings.--The Council shall meet as frequently as the Board 
deems necessary, but not less than four times each year. Upon request 
by seven or more members it shall be the duty of the Chair to call a 
meeting of the Council.
    (i) Compensation.--Members of the Council shall be reimbursed by 
the Board for travel and per diem in lieu of subsistence expenses 
during the performance of duties of the Board in accordance with 
subchapter I of chapter 57 of title 5, United States Code.
    (j) FACA Not Applicable.--The provisions of the Federal Advisory 
Committee Act shall not apply to the Council.

SEC. 403. PROFESSIONAL, TECHNICAL, AND TEMPORARY ADVISORY COMMITTEES.

    (a) In General.--The Board shall appoint the standing advisory 
committees specified in subsections (b) through (g), and such other 
standing professional and technical committees in order to advise it in 
carrying out its duties under this Act.
    (b) Advisory Committee on Benefits.--
            (1) In general.--The Board shall appoint a standing 
        Advisory Committee on Benefits to advise it with respect to the 
        several classes of covered services under this Act.
            (2) Membership.--The membership of the committee shall 
        include individuals (in such number as the Board may determine) 
        drawn from the health professions, from consumers of health 
        services, from providers of health services (including non-
        medical licensed and non-licensed providers), or from other 
        sources, whom the Board deems best qualified to advise it with 
        respect to the professional and technical aspects of the 
        furnishing and utilization of, and the evaluation of, a class 
        of covered services designated by the Board, and with respect 
        to the relationship of that class of services to other covered 
        services. In appointing such individuals, the Board shall 
        assure significant representation of consumers of health 
        services and providers of health services.
    (c) Advisory Committee on Cost Containment.--
            (1) In general.--The Board shall appoint a standing 
        Advisory Committee on Cost Containment to advise it with 
        respect to the payments and cost containment measures contained 
        in title VI of this Act.
            (2) Membership.--The membership of the committee shall 
        include individuals (in such number as the Board may determine) 
        with national recognition for their expertise in health 
        economics, health care financing, provider reimbursement, and 
        related fields. In appointing individuals the Board shall 
        assure significant representation of consumers of health 
        services and providers of health services.
    (d) Advisory Committee on Primary Care and the Medically 
Underserved.--
            (1) In general.--The Board shall appoint a standing 
        Advisory Committee on Primary Care and the Medically 
        Underserved to advise it with respect to title VII of this Act, 
        including with respect to the delivery of services and the 
        education and training of health professionals, and to consider 
        means of increasing the supply and expanding the scope of 
        practice of mid-level professionals and the use of community 
        health outreach workers and other non-professional health care 
        workers.
            (2) Membership.--The membership of the committee shall 
        include individuals (in such number as the Board may determine) 
        from the health professions and health services with expertise 
        in--
                    (A) primary care services;
                    (B) the education and training of primary care 
                practitioners;
                    (C) the special health needs of medically 
                underserved populations;
                    (D) the training, educational, and financial 
                incentives that would encourage health practitioners to 
                serve in medically underserved areas;
                    (E) the delivery of health services through 
                community-based and public facilities; and
                    (F) developing alternative models of delivering 
                primary health services to medically underserved 
                populations.
        In appointing such individuals, the Board shall assure 
        significant representation of consumers of health services and 
        providers of health services.
    (e) Advisory Committee on Mental Health and Substance Abuse 
Treatment Services.--
            (1) In general.--The Board shall appoint a standing 
        Advisory Committee on Mental Health and Substance Abuse 
        Treatment Services to advise it with respect to the manner in 
        which the benefits under this Act for mental health services 
        and substance abuse treatment services should be modified to 
        best meet the objectives of this Act.
            (2) Membership.--The membership of the committee shall 
        include individuals (in such number as the Board may determine) 
        with expertise in health care economics, who are representative 
        of the multi-disciplinary range of providers of such services, 
        who are consumers of such services, and who represent advocacy 
        groups representing consumers of such services.
            (3) Responsibilities.--The committee shall--
                    (A) study changes in the utilization patterns and 
                costs which accompany the provision of mental health 
                services and substance abuse treatment services;
                    (B) study and make recommendations on any changes 
                that may be advisable in the utilization review 
                thresholds specified in section 204(b)(2)(A);
                    (C) make recommendations on ways to create a 
                continuum of care and encourage the provision of care 
                in the least restrictive appropriate setting;
                    (D) develop a standard set of practices for care 
                coordination services, including--
                            (i) the range of care coordination services 
                        that should be offered for a specific target 
                        population,
                            (ii) the organizational structure in which 
                        care coordination services should be based,
                            (iii) the minimum training requirements for 
                        care coordinators, and
                            (iv) the standards for the clinical 
                        necessity of care coordination services,
                and study (and make recommendations concerning) peer 
                care coordination services; and
                    (E) report any initial recommendations to the Board 
                by January 1, 1995.
            (4) Role of substance abuse and mental health services 
        administration.--The Board shall consult with the Administrator 
        of the Substance Abuse and Mental Health Services 
        Administration in the appointment of members to, and operation 
        of, the committee.
    (f) Advisory Committee on Prescription Drugs.--
            (1) In general.--The Board shall appoint a standing 
        Advisory Committee on Prescription Drugs to advise it with 
        respect to the classification of prescription drugs and 
        biologicals under section 616(a)(1) and other matters relating 
        to the coverage of prescription drugs under this Act.
            (2) Membership.--
                    (A) In general.--The membership of the committee 
                shall include individuals (in such number as the Board 
                may determine) with expertise in appropriate 
                utilization of prescription and nonprescription drug 
                and biological therapies and of the relative safety and 
                efficacy of prescription drugs and biologicals.
                    (B) Areas of expertise.--A majority of the members 
                of the committee shall be physicians. Members of the 
                committee shall include at least a dentist, a nurse, 
                and a pharmacist, and individuals with special 
                knowledge or expertise in at least the following areas: 
                geriatric, obstetric, pediatric, psychiatric, and 
                neurological problems associated with drug therapies; 
                clinical pharmacology; pharmacoepidemiology; and 
                comparative clinical trials of drugs (including 
                statisticians and biopharmaceutic specialists).
                    (C) Conflict of interest prohibition.--No 
                individual who is an employee of a manufacturer of a 
                drug or biological or who otherwise has a material 
                financial interest directly or indirectly with respect 
                to such a manufacturer, or who has an immediate family 
                member (as defined by the Board) who is such an 
                employee or has such an interest, shall serve as a 
                member of the committee.
            (3) Responsibilities.--The committee shall--
                    (A) continuously review scientific and medical 
                information pertaining to the relative safety and 
                efficacy, and the comparability, of prescription drugs 
                and biologicals approved for marketing in the United 
                States; and
                    (B) recommend drug use classifications and 
                identify, within such a classification, drugs that are 
                therapeutic alternates for a given indication and 
                indications for which particular drugs are superior 
                based on safety and efficacy.
        The committee is not authorized to engage in drug price 
        negotiations nor define acceptable costs for any product.
            (4) Consumer input.--In conducting its activities, the 
        committee shall solicit advice and comments from a panel of 
        consumer advocates.
    (g) Advisory Committee on Rehabilitation and Chronic Care 
Management.--
            (1) In general.--The Board shall appoint a standing 
        Advisory Committee on Rehabilitation and Chronic Care 
        Management to advise the Board on ways to increase the 
        effectiveness and efficiency of rehabilitation and chronic care 
        management in the health care system.
            (2) Membership.--The membership of the committee shall 
        include rehabilitation professionals, consumers, and health 
        policy professionals.
    (h) Temporary Committees.--The Board is authorized to appoint such 
temporary professional and technical committees as it deems necessary 
to advise it on special problems not encompassed in the assignments of 
standing committees appointed under this section or to supplement the 
advice of standing committees.
    (i) Reporting.--Committees appointed under this section shall 
report from time to time (but not less often than biannually) to the 
Board, and copies of their reports shall be transmitted by the Board to 
the American Health Security Advisory Council and be made readily 
available to the public.
    (j) Compensation.--All members of the committees established under 
this section shall be reimbursed by the Board for travel and per diem 
in lieu of subsistence expenses during the performance of duties of the 
Board in accordance with subchapter I of chapter 57 of title 5, United 
States Code.
    (k) Advice From Prospective Payment Assessment Commission, 
Practitioner Payment Review Commission, Etc.--For provisions relating 
to role of certain commissions in reviewing payment rates, see section 
620.

SEC. 404. AMERICAN HEALTH SECURITY QUALITY COUNCIL.

    (a) Establishment.--There is hereby established an American Health 
Security Quality Council.
    (b) Appointment and Terms of Members.--
            (1) In general.--The Council shall be composed of 10 
        members appointed by the President. The President shall first 
        appoint individuals on a timely basis so as to provide for the 
        operation of the Council by not later than January 1, 1994.
            (2) Selection of members.--The majority of members of the 
        Council shall be members of a health profession. No more than 
        five members of the Council shall be physicians. Physician 
        members of the Council shall be appointed to the Council on the 
        basis of national reputations for clinical and academic 
        excellence. In appointing individuals, the President shall 
        assure significant representation of consumers of health 
        services.
            (3) Terms of members.--Individuals appointed to the Council 
        shall serve for a term of 5 years, except that the terms of 4 
        of the individuals initially appointed shall be, as designated 
        by the President at the time of their appointment, for 1, 2, 3, 
        and 4 years.
    (c) Vacancies.--
            (1) In general.--The President shall fill any vacancy in 
        the membership of the Council in the same manner as the 
        original appointment. The vacancy shall not affect the power of 
        the remaining members to execute the duties of the Council.
            (2) Vacancy appointments.--Any member appointed to fill a 
        vacancy shall serve for the remainder of the term for which the 
        predecessor of the member was appointed.
            (3) Reappointment.--The President may reappoint a member of 
        the Council for a second term in the same manner as the 
        original appointment. A member who has served for two 
        consecutive 5-year terms shall not be eligible for 
        reappointment until two years after the member has ceased to 
        serve.
    (d) Chair.--The President shall designate one of the members of the 
Council to serve at the will of the President as Chair of the Council.
    (e) Compensation.--Members of the Council who are not employees of 
the Federal Government shall be entitled to compensation at a level 
equivalent to level III of the Executive Schedule, in accordance with 
section 5313 of title 5, United States Code.
    (f) General Duties of the Council.--The Council is responsible for 
quality review activities under title V. The Council shall report to 
the Board annually on the conduct of activities under such title.

SEC. 405. STATE HEALTH SECURITY PROGRAMS.

    (a) Submission of Plans.--
            (1) In general.--Each State shall submit to the Board a 
        plan for a State health security program for providing for 
        health care services to the residents of the State in 
        accordance with this Act.
            (2) Regional programs.--A State may join with one or more 
        neighboring States to submit to the Board a plan for a regional 
        health security program instead of separate State health 
        security programs.
            (3) Regional planning mechanisms.--The Board shall provide 
        incentives for States to develop regional planning mechanisms 
        to promote the rational distribution of, adequate access to, 
        and efficient use of, tertiary care facilities, equipment, and 
        services.
    (b) Review and Approval of Plans.--
            (1) In general.--The Board shall review plans submitted 
        under subsection (a) and determine whether such plans meet the 
        requirements for approval. The Board shall not approve such a 
        plan unless it finds that the plan (or State law) provides, 
        consistent with the provisions of this Act, for the following:
                    (A) Payment for required health services for 
                eligible individuals in the State in accordance with 
                this Act.
                    (B) Establishment of a State Health Security 
                Advisory Council, in accordance with subsection (d).
                    (C) Adequate administration, including the 
                designation of a single State agency responsible for 
                the administration (or supervision of the 
                administration) of the program.
                    (D) The establishment of a State health security 
                budget and establishment of an approval process for 
                capital expenditures.
                    (E) Establishment of payment methodologies 
                (consistent with subtitle B of title VI).
                    (F) Assurances that individuals have the freedom to 
                choose practitioners and other health care providers 
                for services covered under this Act.
                    (G) A procedure for carrying out long-term regional 
                management and planning functions, including 
                establishment of District Health Advisory Councils in 
                accordance with section 406, with respect to the 
                delivery and distribution of health care services 
                that--
                            (i) ensures participation of consumers of 
                        health services and providers of health 
                        services,
                            (ii) takes into account the recommendations 
                        of District Health Advisory Councils under 
                        section 406, and
                            (iii) gives priority to the most acute 
                        shortages and maldistributions of health 
                        personnel and facilities and the most serious 
                        deficiencies in the delivery of covered 
                        services and to the means for the speedy 
                        alleviation of these shortcomings, and
                            (iv) encourages the integration of 
                        preventive public health and primary care 
                        services, incorporating epidemiologic data and 
                        community-based clinical results.
                    (H) The licensure and regulation of all health 
                providers and facilities to ensure compliance with 
                Federal and State laws and to promote quality of care.
                    (I) Establishment of a quality review system in 
                accordance with section 502.
                    (J) Establishment of an independent ombudsman for 
                consumers to register complaints about the organization 
                and administration of the State health security program 
                and to help resolve complaints and disputes between 
                consumers and providers.
                    (K) Publication of an annual report on the 
                operation of the State health security program, which 
                report shall include information on cost, progress 
                towards achieving full enrollment, public access to 
                health services, quality improvement, health outcomes, 
                health professional training, and the needs of 
                medically underserved populations.
                    (L) Provision of a fraud and abuse prevention and 
                control unit that the Inspector General determines 
                meets the requirements of section 413(a).
                    (M) Provision that--
                            (i) all claims or requests for payment for 
                        services shall be accompanied by the unique 
                        provider identifier assigned under section 
                        414(a) to the provider and the unique patient 
                        identifier assigned to the individual under 
                        section 414(b);
                            (ii) no payment shall be made under the 
                        program for the provision of health care 
                        services by any provider unless the provider 
                        has furnished the program with the unique 
                        provider identifier assigned under section 
                        414(a);
                            (iii) the plan shall use the unique patient 
                        identifier assigned under section 414(b) to an 
                        individual as the identifier of the individual 
                        in the processing of claims and other purposes 
                        (as specified by the Board); and
                            (iv) queries made under section 412(c)(2) 
                        shall be made using the unique provider 
                        identifier specified under section 414(a).
                    (N) Prohibit payment in cases of prohibited 
                physician referrals under section 304.
                    (O) Effective January 1, 2000, provide for use of a 
                uniform electronic data base in accordance with section 
                504(a).
            (2) Consequences of failure to comply.--If the Board finds 
        that a State plan submitted under paragraph (1) does not meet 
        the requirements for approval under this section or that a 
        State health security program or specific portion of such 
        program, the plan for which was previously approved, no longer 
        meets such requirements, the Board shall provide notice to the 
        State of such failure and that unless corrective action is 
        taken within a period specified by the Board, the Board shall 
        place the State health security program (or specific portions 
        of such program) in receivership under the jurisdiction of the 
        Board.
    (c) State Health Security Advisory Councils.--
            (1) In general.--For each State, the Governor shall provide 
        for appointment of a State Health Security Advisory Council to 
        advise and make recommendations to the Governor and State with 
        respect to the implementation of the State health security 
        program in the State.
            (2) Membership.--Each State Health Security Advisory 
        Council shall be composed of at least 11 individuals. The 
        appointed members shall include individuals who are 
        representative of the State health security program, public 
        health professionals, providers of health services, and of 
        individuals (who shall constitute a majority) who are 
        representative of consumers of such services, including a 
        balanced representation of employers, unions and consumer 
        organizations.
            (3) Duties.--
                    (A) In general.--Each State Health Security 
                Advisory Council shall review, and submit comments to 
                the Governor concerning the implementation of the State 
                health security program in the State.
                    (B) Assistance.--Each State Health Security 
                Advisory Council shall provide assistance and technical 
                support to community organizations and public and 
                private non-profit agencies submitting applications for 
                funding under appropriate State and Federal public 
                health programs, with particular emphasis placed on 
                assisting those applicants with broad consumer 
                representation.
    (d) State Use of Fiscal Agents.--
            (1) In general.--Each State health security program, using 
        competitive bidding procedures, may enter into such contracts 
        with qualified entities, such as voluntary associations, as the 
        State determines to be appropriate to process claims and to 
        perform other related functions of fiscal agents under the 
        State health security program.
            (2) Restriction.--Except as the Board may provide for good 
        cause shown, in no case may more than one contract described in 
        paragraph (1) be entered into under a State health security 
        program.

SEC. 406. DISTRICT HEALTH ADVISORY COUNCILS.

    (a) In General.--Subject to subsection (d), each State health 
security program shall establish district health advisory councils 
covering distinct geographic areas for the purposes of--
            (1) advising and making recommendations to the State with 
        respect to implementation of the program in the geographic area 
        served by a council;
            (2) receiving and investigating complaints by eligible 
        persons and by providers of services concerning the 
        administration of the program and of taking or recommending 
        appropriate corrective action; and
            (3) carrying out district management and planning functions 
        with the State health security program, including--
                    (A) assessing the health needs of the district;
                    (B) assessing the quality, supply, and distribution 
                of health resources, including acute care hospitals, 
                specialized inpatient facilities, outpatient 
                facilities, trained health care personnel, the 
                availability of specialized medical equipment, and home 
                and community-based health programs;
                    (C) assessing the need for services to medically 
                underserved areas to achieve equitable access to care;
                    (D) advising on restructuring the health delivery 
                system, including reductions in excess capacity, 
                shifting from institutional to ambulatory care, and 
                other means of achieving efficiencies;
                    (E) advising on funding for new and expanded 
                programs, including capital expenditures;
                    (F) meeting at least biannually with 
                representatives of the State health security program 
                (i) to determine the goals and priorities for meeting 
                health care needs and (ii) to plan for the efficient 
                and effective use of health resources within the 
                district; and
                    (G) establishing a strategy to implement such goals 
                and priorities.
    (b) Membership.--Each district health advisory council shall be 
composed of individuals, appointed by the Governor of the State, who 
include representatives of local public health programs, public health 
professionals, providers of health services, and of persons (who shall 
constitute a majority) who are representative of consumers of such 
services, including a balanced representation of employers, unions, and 
consumer organizations and population groups with special health needs. 
The Governor shall consult with the State Health Security Advisory 
Council and local officials in the appointment of district health 
advisory councils.
    (c) Grant Assistance.--Each district health advisory council shall 
provide assistance and technical support to community organizations and 
public and private non-profit agencies submitting applications for 
funding under appropriate State and Federal public health programs, 
with particular emphasis placed on assisting those applicants with 
broad consumer representation.
    (d) Use of State Health Security Advisory Council.--
            (1) In general.--Subject to paragraph (2), the Board may 
        waive the requirement that a State establish district health 
        advisory councils if the State demonstrates to the satisfaction 
        of the Board that--
                    (A) the establishment of such councils in the State 
                is unnecessary because of the State's size or 
                population;
                    (B) the membership of the State Health Security 
                Advisory Council established under section 405(d) is 
                consistent with the requirements for membership of such 
                a council under subsection (b); and
                    (C) such Council will perform the functions of a 
                district health advisory council under subsections (a) 
                and (c).
            (2) Performance of council functions.--If the Board waives 
        requirements with respect to a State under paragraph (1), the 
        State Health Security Advisory Council shall perform, with 
        respect to the entire State, the functions of a district health 
        advisory council under subsections (a) and (c).

SEC. 407. COMPLEMENTARY CONDUCT OF RELATED HEALTH PROGRAMS.

    In performing functions with respect to health personnel education 
and training, health research, environmental health, disability 
insurance, vocational rehabilitation, the regulation of food and drugs, 
and all other matters pertaining to health, the Secretary of Health and 
Human Services shall direct all activities of the Department of Health 
and Human Services toward contributions to the health of the people 
complementary to this Act.

                Subtitle B--Control Over Fraud and Abuse

SEC. 411. APPLICATION OF FEDERAL SANCTIONS TO ALL FRAUD AND ABUSE UNDER 
              AMERICAN HEALTH SECURITY PROGRAM.

    The following sections of the Social Security Act shall apply to 
State health security programs in the same manner as they apply to 
State medical assistance plans under title XIX of such Act (except that 
in applying such provisions any reference to the Secretary is deemed a 
reference to the Board):
            (1) Section 1128 (relating to exclusion of individuals and 
        entities).
            (2) Section 1128A (civil monetary penalties).
            (3) Section 1128B (criminal penalties).
            (4) Section 1124 (relating to disclosure of ownership and 
        related information).
            (5) Section 1126 (relating to disclosure of certain 
        owners).

SEC. 412. NATIONAL HEALTH CARE FRAUD DATA BASE.

    (a) Establishment.--The American Health Security Standards Board, 
through the Inspector General, shall establish a national data base (in 
this section referred to as the ``data base'') containing information 
relating to health care fraud and abuse.
    (b) Data Included.--
            (1) In general.--The data base shall include such 
        information as the Inspector General, in consultation with the 
        Board, shall specify, and shall include at least the 
        information described in paragraph (2).
            (2) Specified information.--The information specified in 
        this paragraph is, with respect to providers of health care 
        services, the identity of any provider--
                    (A) that has been convicted of a crime for which 
                the provider may be excluded from participation under a 
                health program (as defined in paragraph (3));
                    (B) whose license to provide health care has been 
                revoked or suspended (as described in section 
                1128(b)(5) of the Social Security Act);
                    (C) that has been excluded or suspended from a 
                health program under section 1128 of the Social 
                Security Act or from any other Federal or State health 
                care program;
                    (D) with respect to whom a civil money penalty has 
                been imposed under this Act or the Social Security Act; 
                or
                    (E) that otherwise is subject to exclusion from 
                participation under a health program .
            (3) Health program defined.--In this section, the term 
        ``health program'' means a State health security program and 
        includes the medicare program (under title XVIII of the Social 
        Security Act) and a State health care program (as defined in 
        section 1128(h) of such Act).
    (c) Reporting Requirement.--
            (1) Reporting.--Each State health security program shall 
        provide such information to the Inspector General as the 
        Inspector General may require in order to carry out fraud and 
        abuse control activities and for purposes of maintaining the 
        data base.
            (2) Querying.--In accordance with rules established by the 
        Board (in consultation with the Inspector General), each State 
        health security program shall query periodically (as specified 
        by the Inspector General)--
                    (A) the data base to determine if providers of 
                health services for which the program makes payment are 
                not disqualified from providing such services, and
                    (B) the Secretary of Health and Human Services, 
                concerning information obtained by the Secretary under 
                part B of the Health Care Quality Improvement Act of 
                1986 relating to practitioners.
            (3) Coordination with malpractice data base.--The Secretary 
        of Health and Human Services shall provide for the coordination 
        of the reporting and disclosure of information under this 
        section with information under part B of the Health Care 
        Quality Improvement Act of 1986.
            (4) Uniform manner.--Information shall be reported under 
        this subsection in a uniform manner (in accordance with 
        standards of the Inspector General) that permits aggregation of 
        reported information.
            (5) Access for audit.--Each State health security program 
        shall provide the Inspector General such access to information 
        as may be required to verify the information reported under 
        this subsection.
            (6) Penalty for false information.--Any person that submits 
        false information required to be provided under this subsection 
        or that denies access to information under paragraph (5) may be 
        imprisoned for not more than 5 years, or fined, or both, in 
        accordance with title 18, United States Code.
            (7) Confidentiality.--The Board shall establish rules that 
        protect the confidentiality of the information in the data 
        base.

SEC. 413. REQUIREMENTS FOR OPERATION OF STATE HEALTH CARE FRAUD AND 
              ABUSE CONTROL UNITS.

    (a) Requirement.--In order to meet the requirement of section 
405(b)(1)(L), each State health security program must establish and 
maintain a health care fraud and abuse control unit (in this section 
referred to as a ``fraud unit'') that meets requirements of this 
section and other requirements of the Board. Such a unit may be a State 
medicaid fraud control unit (described in section 1903(q) of the Social 
Security Act).
    (b) Structure of Unit.--The fraud unit must--
            (1) be a single identifiable entity of the State 
        government;
            (2) be separate and distinct from the State agency with 
        principal responsibility for the administration of the State 
        health security program; and
            (3) meet 1 of the following requirements:
                    (A) It must be a unit of the office of the State 
                Attorney General or of another department of State 
                government which possesses statewide authority to 
                prosecute individuals for criminal violations.
                    (B) If it is in a State the constitution of which 
                does not provide for the criminal prosecution of 
                individuals by a statewide authority and has formal 
                procedures, approved by the Board, that (i) assure its 
                referral of suspected criminal violations relating to 
                the State health insurance plan to the appropriate 
                authority or authorities in the States for prosecution, 
                and (ii) assure its assistance of, and coordination 
                with, such authority or authorities in such 
                prosecutions.
                    (C) It must have a formal working relationship with 
                the office of the State Attorney General and have 
                formal procedures (including procedures for its 
                referral of suspected criminal violations to such 
                office) which are approved by the Board and which 
                provide effective coordination of activities between 
                the fraud unit and such office with respect to the 
                detection, investigation, and prosecution of suspected 
                criminal violations relating to the State health 
                insurance plan.
    (c) Functions.--The fraud unit must--
            (1) have the function of conducting a statewide program for 
        the investigation and prosecution of violations of all 
        applicable State laws regarding any and all aspects of fraud in 
        connection with any aspect of the provision of health care 
        services and activities of providers of such services under the 
        State health security program;
            (2) have procedures for reviewing complaints of the abuse 
        and neglect of patients of providers and facilities that 
        receive payments under the State health security program, and, 
        where appropriate, for acting upon such complaints under the 
        criminal laws of the State or for referring them to other State 
        agencies for action; and
            (3) provide for the collection, or referral for collection 
        to a single State agency, of overpayments that are made under 
        the State health security program to providers and that are 
        discovered by the fraud unit in carrying out its activities.
    (d) Resources.--The fraud unit must--
            (1) employ such auditors, attorneys, investigators, and 
        other necessary personnel,
            (2) be organized in such a manner, and
            (3) provide sufficient resources (as specified by the 
        Board),
as is necessary to promote the effective and efficient conduct of the 
unit's activities.
    (e) Cooperative Agreements.--The fraud unit must have cooperative 
agreements (as specified by the Board) with--
            (1) similar fraud units in other States,
            (2) the Inspector General, and
            (3) the Attorney General of the United States.
    (f) Reports.--The fraud unit must submit to the Inspector General 
an application and annual reports containing such information as the 
Inspector General determines to be necessary to determine whether the 
unit meets the previous requirements of this section.

SEC. 414. ASSIGNMENT OF UNIQUE PROVIDER AND PATIENT IDENTIFIERS.

    (a) Provider Identifiers.--
            (1) In general.--The Board shall provide for the 
        assignment, to each individual or entity providing health care 
        services under a State health security program, of a unique 
        provider identifier.
            (2) Response to queries.--Upon the request of a State 
        health security program with respect to a provider, the Board 
        shall provide the program with the unique provider identifier 
        (if any) assigned to the provider under paragraph (1).
    (b) Patient Identifiers.--The Board shall provide for the 
assignment, to each eligible individual, of a unique patient 
identifier. The identifier so assigned may be the Social Security 
account number of the individual.
    (c) Requirement to Use Identifiers.--Each State health security 
program is required under section 405(b)(1)(M) to use the unique 
identifiers assigned under this section.

                      TITLE V--QUALITY ASSESSMENT

SEC. 501. FUNCTIONS OF QUALITY COUNCIL; DEVELOPMENT OF PRACTICE 
              GUIDELINES AND APPLICATION TO OUTLIERS.

    (a) Development of Practice Guidelines.--The American Health 
Security Quality Council (in this title referred to as the 
``Council'')--
            (1) shall collect data from outcomes research (whether 
        conducted by the Federal Government or other entities), and
            (2) on the basis of such data and existing clinical 
        knowledge, shall develop practice guidelines.
Such guidelines may vary based upon the area in which the services are 
provided and the degree of training, specialization, or similar 
characteristics of providers.
    (b) Profiling of Patterns of Practice; Identification of 
Outliers.--The Council shall adopt methodologies for profiling the 
patterns of practice of health care professionals and for identifying 
outliers (as defined in subsection (f)).
    (c) Centers of Excellence.--The Council shall develop guidelines 
for certain medical procedures designated by the Board to be performed 
at tertiary care centers which can meet standards for frequency of 
procedure performance and intensity of support mechanisms that are 
consistent with the high probability of desired patient outcome. The 
Board shall develop incentives to encourage such procedures to be 
performed at centers that meet such standards.
    (d) Remedial Actions.--The Council shall develop standards for 
education and sanctions with respect to outliers so as to assure the 
quality of health care services provided under this Act.
    (e) Dissemination.--The Council shall disseminate to the State 
health security program--
            (1) the guidelines developed under subsections (a) and (c),
            (2) the methodologies adopted under subsection (b), and
            (3) the standards developed under subsection (d),
for use by the States under section 502.
    (f) Outlier Defined.--In this title, the term ``outlier'' means a 
health care practitioner whose pattern of practice, relative to 
applicable practice guidelines, suggests deficiencies in the quality of 
health care services being provided.

SEC. 502. STATE QUALITY REVIEW PROGRAMS.

    (a) Requirement.--In order to meet the requirement of section 
405(b)(1)(I), each State health security program shall establish one or 
more qualified entities to conduct quality reviews of persons providing 
covered services under the program, in accordance with standards 
established under subsection (b)(1) (except as provided in subsection 
(b)(2)) and subsection (d).
    (b) Federal Standards.--
            (1) In general.--The Board shall establish standards with 
        respect to--
                    (A) the adoption of practice guidelines (developed 
                under section 501(a)),
                    (B) the identification of outliers (consistent with 
                methodologies adopted under section 501(b)),
                    (C) the development of remedial programs and 
                monitoring for outliers, and
                    (D) the application of sanctions (consistent with 
                the standards developed under section 501(d)).
            (2) State discretion.--A State may apply under subsection 
        (a) standards other than those established under paragraph (1) 
        so long as the State demonstrates to the satisfaction of the 
        Council on an annual basis that the standards applied have been 
        as efficacious in promoting and achieving quality of care as 
        the application of the standards established under paragraph 
        (1).
    (c) Qualifications.--An entity is not qualified to conduct quality 
reviews under subsection (a) unless the entity--
            (1) is administratively independent of the individual or 
        board that administers the State health security program, and
            (2) does not provide any financial incentive to reviewers 
        to favor one pattern of practice over another.

SEC. 503. CERTIFICATION; UTILIZATION REVIEW; PLANS OF CARE.

    (a) Certifications.--State health security programs may require, as 
a condition of payment for institutional health care services and other 
services of the type described in such sections 1814(a) and 1835(a) of 
the Social Security Act, periodic professional certifications of the 
kind described in such sections.
    (b) Requirements and Standards for Utilization Review.--
            (1) Use of utilization review permitted.--A State health 
        security program may--
                    (A) establish a utilization review program (as 
                defined in paragraph (4)), and
                    (B) deny coverage (and payment) for services to the 
                extent the services are determined under such a 
                utilization review program not to meet the coverage 
                standards specified in section 201(a),
        but only if the program meets the standards established by the 
        Board under paragraph (2).
            (2) Standards for utilization review programs.--
                    (A) In general.--The Board shall provide, by 
                regulation, for the establishment of Federal standards 
                for utilization review programs conducted by State 
                health security programs. Such standards shall be 
                designed to assure the cost-effective and medically 
                appropriate use of services consistent with coverage 
                standards specified in section 201(a).
                    (B) Types of standards.--Such standards shall be 
                established, consistent with subparagraph (C), with 
                respect to at least each of the following aspects of 
                utilization review programs:
                            (i) The qualification of those who may 
                        perform utilization review activities.
                            (ii) The standards to be applied in 
                        performing utilization review.
                            (iii) The timeliness in which utilization 
                        review determinations (and appeals with respect 
                        to such determinations) are to be made.
                            (iv) An appeals (or alternative dispute 
                        resolution) process which provides a fair 
                        opportunity for individuals adversely affected 
                        by a utilization review determination (or their 
                        families or care coordinators) to have such a 
                        determination reviewed.
                            (v) Protection for the confidentiality of 
                        individually-identifiable information used in 
                        the process, consistent with Federal and State 
                        laws.
                    (C) Standards.--The standards established under 
                this paragraph shall include the following:
                            (i) The individuals making final 
                        determinations (and determining appeals) 
                        concerning the utilization of services provided 
                        by members of a health profession shall be 
                        members of the same profession (or in an 
                        associated field, as determined by the Board).
                            (ii) The utilization criteria to be applied 
                        shall be provided to patients, providers, and 
                        care coordinators upon request and a written 
                        explanation of the basis for any denial of 
                        payment based upon such a review shall be 
                        provided to the patient, provider, or care 
                        coordinator upon request.
                            (iii) Utilization review and appeals shall 
                        be conducted promptly in order not to disrupt a 
                        course of treatment and providers shall not 
                        deny necessary care while a review or appeal is 
                        pending.
                            (iv) The system may not provide a monetary 
                        incentive for those conducting utilization 
                        review activities to deny or reduce payment for 
                        services.
                            (v) The medical personnel performing 
                        reviews shall be accessible by telephone to the 
                        providers whose services they review.
                    (D) Use of guidelines.--Such standards shall be 
                consistent with the provisions of section 204(d) 
                (relating to application of national practice 
                guidelines).
            (3) No requirement for routine utilization review.--Nothing 
        in this title shall be construed to require or authorize a 
        State health security program to provide for utilization review 
        as a routine practice in all cases.
            (4)  Utilization review program.--In this title, the term 
        ``utilization review program'' means a system of reviewing the 
        medical necessity and appropriateness (including the 
        appropriateness of the setting) of patient services (which may 
        include inpatient and outpatient services) using specified 
        guidelines. Such a system may include preadmission 
        certification, the application of practice guidelines, the 
        profiling of practice patterns, continued stay review, 
        discharge planning, preauthorization of ambulatory procedures, 
        and retrospective review.
    (c) Plan of Care Requirements.--A State health security program may 
require, consistent with standards established by the Board, that 
payment for services exceeding specified levels or duration be provided 
only as consistent with a plan of care or treatment formulated by one 
or more providers of the services or other qualified professionals. 
Such a plan may include, consistent with subsection (b), utilization 
review at specified intervals as a further condition of payment for 
services.

SEC. 504. DEVELOPMENT OF NATIONAL ELECTRONIC DATA BASE.

    (a) Use by States.--In order to meet the requirement of this 
section, for purposes of section 405(b)(1)( ), each State health 
security program shall develop and use a uniform electronic data base 
which uses the software designated under subsection (b) and which 
assures confidentiality under subsection (c), for all patient records 
in order to enable systematic quality review and outcomes analysis. 
Subject to subsection (c), data in such data base shall be made 
available, under rules established by the Board, in order to facilitate 
the portability of patient records and comparative outcomes research 
analysis.
    (b) Uniform Software.--The Board shall designate the 
characteristics of the software that shall be used by States in the 
operation of their electronic data bases, in order to ensure the 
portability of patient records and comparative outcomes research 
analysis. The Board shall not grant any waiver of the requirement of 
the previous sentence.
    (c) Confidentiality.--The Board shall establish standards that are 
designed to protect the privacy and otherwise shield the identity of 
the patients whose records are included in the data base. Under such 
standards, government agencies shall not have access to information in 
the data base that will identify individual patients except in cases of 
quality review procedures which require that individual patients be 
informed of necessary changes in their treatment.

 TITLE VI--HEALTH SECURITY BUDGET; PAYMENTS; COST CONTAINMENT MEASURES

              Subtitle A--Budgeting and Payments to States

SEC. 601. AMERICAN HEALTH SECURITY BUDGET.

    (a) American Health Security Budget.--
            (1) In general.--By not later than September 1 before the 
        beginning of each year (beginning with 1995), the Board shall 
        establish an American health security budget, which--
                    (A) specifies the total expenditures (including 
                expenditures for administrative costs) to be made by 
                the Federal Government and the States for covered 
                health care services under this Act, and
                    (B) allocates those expenditures among the States 
                consistent with section 604.
        Pursuant to subsection (b), such budget for a year shall not 
        exceed the budget for the preceding year increased by the 
        percentage increase in gross domestic product.
            (2) Division of budget into components.--The American 
        health security budget shall consist of 4 components:
                    (A) A component for capital expenditures.
                    (B) A component for administrative costs.
                    (C) A component (in this title referred to as the 
                ``operating component'') for operating and other 
                expenditures not described in subparagraphs (A) through 
                (C) consisting of amounts not included in the other 
                components.
            (3) Allocation among components.--Taking into account the 
        State health security budgets established and submitted under 
        section 603, the Board shall allocate the American health 
        security budget among the components in a manner that assures 
        that the capital expenditure component is sufficient to meet 
        the need for covered health care services (consistent with the 
        national health security spending growth limit); and
    (b) Basis for Total Expenditures.--
            (1) In general.--The total expenditures specified in such 
        budget shall be the sum of the capitation amounts computed 
        under section 602(a) and the amount of Federal administrative 
        expenditures needed to carry out this Act.
            (2) National health security spending growth limit.--For 
        purposes of this subtitle, the national health security 
        spending growth limit described in this paragraph for a year is 
        zero, or, if greater, the percentage increase in the gross 
        domestic product (in current dollars) from the first quarter of 
        the second previous year to the first quarter of the previous 
        year.
    (c) Definition.--In this title the term ``capital expenditures'' 
means expenses for the purchase, lease, construction, or renovation of 
capital facilities and for equipment and includes return on equity 
capital.

SEC. 602. COMPUTATION OF INDIVIDUAL AND STATE CAPITATION AMOUNTS.

    (a) Capitation Amounts.--
            (1) Individual capitation amounts.--In establishing the 
        American health security budget under section 601(a) and in 
        computing the national average per capita cost under subsection 
        (b) for each year, the Board shall establish a method for 
        computing the capitation amount for each eligible individual 
        residing in each State. The capitation amount for an eligible 
        individual in a State classified within a risk group 
        (established under subsection (d)(2)) is the product of--
                    (A) a national average per capita cost for all 
                covered health care services (computed under subsection 
                (b)),
                    (B) the State adjustment factor (established under 
                subsection (c)) for the State, and
                    (C) the risk adjustment factor (established under 
                subsection (d)) for the risk group.
            (2) State capitation amount.--
                    (A) In general.--For purposes of this title, the 
                term ``State capitation amount'' means, for a State for 
                a year, the sum of the capitation amounts computed 
                under paragraph (1) for all the residents of the State 
                in the year, as estimated by the Board before the 
                beginning of the year involved.
                    (B) Use of statistical model.--The Board may 
                provide for the computation of State capitation amounts 
                based on statistical models that fairly reflect the 
                elements that comprise the State capitation amount 
                described in subparagraph (A).
                    (C) Population information.--The Bureau of the 
                Census shall assist the Board in determining the 
                number, place of residence, and risk group 
                classification of eligible individuals.
    (b) Computation of National Average Per Capita Cost.--
            (1) For 1995.--For 1995, the national average per capita 
        cost under this paragraph is equal to--
                    (A) the average per capita health care expenditures 
                in the United States in 1993 (as estimated by the 
                Board),
                    (B) increased to 1994 by the Board's estimate of 
                the actual amount of such per capita expenditures 
                during 1994, and
                    (C) updated to 1995 by the national health security 
                spending growth limit specified in section 601(b)(2) 
                for 1995.
            (2) For succeeding years.--For each succeeding year, the 
        national average per capita cost under this subsection is equal 
        to the national average per capita cost computed under this 
        subsection for the previous year increased by the national 
        health security spending growth limit (specified in section 
        601(b)(2)) for the year involved.
    (c) State Adjustment Factors.--
            (1) In general.--Subject to the succeeding paragraphs of 
        this subsection, the Board shall develop for each State a 
        factor to adjust the national average per capita costs to 
        reflect differences between the State and the United States 
        in--
                    (A) average labor and nonlabor costs that are 
                necessary to provide covered health services;
                    (B) any social, environmental, or geographic 
                condition affecting health status or the need for 
                health care services, to the extent such a condition is 
                not taken into account in the establishment of risk 
                groups under subsection (d);
                    (C) the geographic distribution of the State's 
                population, particularly the proportion of the 
                population residing in medically underserved areas, to 
                the extent such a condition is not taken into account 
                in the establishment of risk groups under subsection 
                (d); and
                    (D) any other factor relating to operating costs 
                required to assure equitable distribution of funds 
                among the States.
            (2) Modification of capital expenditure component.--With 
        respect to the portion of the national budget allocated to 
        capital expenditures, the Board shall modify the State 
        adjustment factors so as to take into account differences among 
        States in their relative need for capital expenditures among 
        the States and the availability of tertiary care centers and 
        centers of excellence in neighboring States, taking into 
        account the capital expenditures proposed in State health 
        security budgets under section 603(a).
            (3) Budget neutrality.--The State adjustment factors, as 
        modified under paragraph (2), shall be applied under this 
        subsection in a manner that results in neither an increase nor 
        a decrease in the total amount of the Federal contributions to 
        all State health security programs under subsection (b) as a 
        result of the application of such factors.
            (4) Phase-in.--In applying State adjustment factors under 
        this subsection during the five-year period beginning with 
        1995, the Board shall phase-in, over such period, the use of 
        factors described in paragraph (1) in a manner so that the 
        adjustment factor for a State is based on a blend of such 
        factors and a factor that reflects the relative actual average 
        per capita costs of health services of the different States as 
        of the time of enactment of this Act.
            (5) Periodic adjustment.--In establishing the national 
        health security budget before the beginning of each year, the 
        Board shall provide for appropriate adjustments in the State 
        adjustment factors under this subsection.
    (d) Adjustments for Risk Group Classification.--
            (1) In general.--The Board shall develop an adjustment 
        factor to the national average per capita costs computed under 
        subsection (b) for individuals classified in each risk group 
        (as designated under paragraph (2)) to reflect the difference 
        between the average national average per capita costs and the 
        national average per capita cost for individuals classified in 
        the risk group.
            (2) Risk groups.--The Board shall designate a series of 
        risk groups, determined by age, health indicators, and other 
        factors that represent distinct patterns of health care 
        services utilization and costs.
            (3) Periodic adjustment.--In establishing the national 
        health security budget before the beginning of each year, the 
        Board shall provide for appropriate adjustments in the risk 
        adjustment factors under this subsection.

SEC. 603. STATE HEALTH SECURITY BUDGETS.

    (a) Establishment and Submission of Budgets.--
            (1) In general.--Each State health security program shall 
        establish and submit to the Board for each year a proposed and 
        a final State health security budget, which specifies the 
        following:
                    (A) The total expenditures (including expenditures 
                for administrative costs) to be made under the program 
                in the State for covered health care services under 
                this Act, consistent with subsection (b), broken down 
                as follows:
                            (i) By the 3 components (described in 
                        section 601(a)(2)), consistent with subsection 
                        (b).
                            (ii) Within the operating component--
                                    (I) expenditures for operating 
                                costs of hospitals, nursing facilities, 
                                and other facility-based services in 
                                the State,
                                    (II) expenditures for payment to 
                                comprehensive health service 
                                organizations,
                                    (III) expenditures for payment of 
                                services provided by health care 
                                practitioners, and
                                    (IV) expenditures for other covered 
                                items and services.
                    (B) The total revenues required to meet the State 
                health security expenditures.
            (2) Proposed budget deadline.--The proposed budget for a 
        year shall be submitted under paragraph (1) not later than June 
        1 before the year.
            (3) Final budget.--The final budget for a year shall--
                    (A) be established and submitted under paragraph 
                (1) not later than October 1 before the year, and
                    (B) take into account the amounts established under 
                the national health security budget under section 601 
                for the year.
            (4) Adjustment in allocations permitted.--
                    (A) In general.--Subject to subparagraphs (B) and 
                (C), in the case of a final budget, a State may change 
                the allocation of amounts among components.
                    (B) Notice.--No such change may be made unless the 
                State has provided prior notice of the change to the 
                Board.
                    (C) Denial.--Such a change may not be made if the 
                Board, within such time period as the Board specifies, 
                disapproves such change.
    (b) Expenditure Limits.--
            (1) In general.--The total expenditures specified in each 
        State health security budget under subsection (a)(1) shall take 
        into account Federal contributions made under section 604.
            (2) Limit on claims processing and billing expenditures.--
        Each State health security budget shall provide that State 
        administrative expenditures, including expenditures for claims 
        processing and billing, shall not exceed 3 percent of the total 
        expenditures under the State health security program, unless 
        the Board determines, on a case-by-case basis, that additional 
        administrative expenditures would improve health care quality 
        and cost effectiveness.
            (3) Worker assistance.--A State health security program may 
        provide that, for budgets for years before 2000, up to 1 
        percent of the budget may be used for purposes of programs 
        providing assistance to workers who are currently performing 
        functions in the administration of the health insurance system 
        and who may experience economic dislocation as a result of the 
        implementation of the program.

SEC. 604. FEDERAL PAYMENTS TO STATES.

    (a) In General.--Each State with an approved State health security 
program is entitled to receive, from amounts in the American Health 
Security Trust Fund, on a monthly basis each year, of an amount equal 
to one-twelfth of the product of--
            (1) the State capitation amount (computed under section 
        602(a)(2)) for the State for the year, and
            (2) the Federal contribution percentage (established under 
        subsection (b)).
    (b) Federal Contribution Percentage.--The Board shall establish a 
formula for the establishment of a Federal contribution percentage for 
each State. Such formula shall take into consideration a State's per 
capita income and revenue capacity and such other relevant economic 
indicators as the Board determines to be appropriate. In addition, 
during the 5-year period beginning with 1995, the Board may provide for 
a transition adjustment to the formula in order to take into account 
current expenditures by the State (and local governments thereof) for 
health services covered under the State health security program. The 
weighted-average Federal contribution percentage for all States shall 
equal 86 percent and in no event shall such percentage be less than 81 
percent nor more than 91 percent.
    (c) Use of Payments.--All payments made under this section may only 
be used to carry out the State health security program.
    (d) Effect of Spending Excess or Surplus.--
            (1) Spending Excess.--If a State exceeds its budget in a 
        given year, the State shall continue to fund covered health 
        services from its own revenues.
            (2) Surplus.--If a State provides all covered health 
        services for less than the budgeted amount for a year, it may 
        retain its Federal payment for that year for uses consistent 
        with this Act.

SEC. 605. REQUIRED APPROVAL PROCESS FOR CAPITAL EXPENDITURES.

    (a) Process.--
            (1) In general.--Consistent with standards established 
        under subsection (b), each State health security program shall 
        provide for a process for the approval of capital expenditures 
        (as defined in subsection (c)) in order--
                    (A) to meet the need for covered health care 
                services consistent with State budgets and the 
                development of medical technology,
                    (B) to establish an efficient balance between the 
                need for services and the delivery of services, and
                    (C) to expand the delivery of services in medically 
                underserved areas.
            (2) Conditions for approval.--No expenditures (including 
        operating costs, rent, depreciation, and interest) may be 
        approved by a State health security program to the extent they 
        are attributable to a capital expenditure which was subject to, 
        but was not approved under, such process.
    (b) Standards for Capital Approval Process.--
            (1) In general.--The Board shall specify standards for the 
        process, to be implemented under each State health security 
        program, for the approval of capital expenditures.
            (2) Requirements.--Under such standards, such process--
                    (A) if there is a limit on capital expenditures, 
                shall assure that such expenditures are distributed 
                geographically within a State taking into account at 
                least the factors described in paragraph (3);
                    (B) shall assure that health care providers and 
                consumers are provided reasonable opportunities for 
                involvement in the process;
                    (C) may provide for such special consideration as 
                the Board specifies in the case of institutions of 
                national repute or other institutions 
                disproportionately serving interstate populations;
                    (D) may provide for the special consideration of 
                religious and charitable organizations that have raised 
                voluntary contributions for such capital expenditures;
                    (E) may provide for such priorities for 
                comprehensive health service organizations as the Board 
                specifies; and
                    (F) may provide for limits on the distribution 
                among different types of facilities or capital projects 
                as the Board may find necessary in order to prevent 
                significant maldistributions while retaining the 
                maximum flexibility of States to provide for covered 
                health services in each State.
            (3) Factors.--The factors to be taken into account under 
        this paragraph in the distribution of capital expenditures are 
        as follows:
                    (A) The population of the different geographic 
                areas within the State, its dispersion, and the risk 
                characteristics (measured by health indicators), based 
                on the risk factors described in section 603(d).
                    (B) The capital needs of the different geographic 
                areas of the State in order to ensure adequate access 
                to general and specialty services and technologies and 
                to ensure medical effectiveness.
                    (C) The need to correct for historical 
                maldistribution in the allocation of health care 
                capital that preceded the enactment of this Act.
    (c) Capital Expenditures Defined.--
            (1) In general.--In this Act, the term ``capital 
        expenditures'' means expenses for the purchase, lease, 
        construction, or renovation of capital facilities and for 
        equipment valued at at least an amount (specified by the Board) 
        or of a kind specified by the Board.
            (2) Inclusion of additional expenditures.--A State health 
        security program may require approval of capital expenditures 
        not described in paragraph (1).

              Subtitle B--Payments by States to Providers

SEC. 611. PAYMENTS TO HOSPITALS AND NURSING FACILITY SERVICES FOR 
              OPERATING EXPENSES ON THE BASIS OF APPROVED GLOBAL 
              BUDGETS.

    (a) Direct Payment Under Global Budget.--Payment for operating 
expenses for hospital services and nursing facility services under 
State health security programs shall be made directly to each hospital 
or nursing facility by each State health security program under an 
annual prospective global budget approved under the program. Such a 
budget shall include payment for outpatient care and non-facility-based 
care that is furnished by or through the facility. In the case of a 
hospital that is wholly owned (or controlled) by a comprehensive health 
service organization that is paid under section 614 on the basis of a 
global budget, the global budget of the organization shall include the 
budget for the hospital.
    (b) Annual Negotiations; Budget Approval.--
            (1) In general.--The prospective global budget for a 
        hospital or nursing facility shall be developed through annual 
        negotiations between the State health security program and the 
        hospital or nursing facility and be based on a nationally 
        uniform system of cost accounting established under standards 
        of the Board.
            (2) Considerations.--In developing a budget through 
        negotiations, there shall be taken into account at least the 
        following:
                    (A) With respect to inpatient hospital services, 
                the number, and classification by diagnosis-related 
                group, of discharges.
                    (B) A hospital's or nursing facility's past 
                expenditures.
                    (C) Change in the consumer price index and other 
                price indices.
                    (D) The cost of reasonable compensation to health 
                care practitioners.
                    (E) The compensation level of the hospital's or 
                nursing facility's workforce.
                    (F) The extent to which the hospital or nursing 
                facility is providing health care services to meet the 
                needs of residents in the area served by the hospital 
                or nursing facility, including the hospital's or 
                nursing facility's occupancy level.
                    (G) The hospital's or nursing facility's previous 
                financial and clinical performance, based on 
                utilization and outcomes data provided under this Act.
                    (H) The type of hospital or nursing facility, 
                including whether the hospital or nursing facility is 
                part of a clinical education program or serves a health 
                professional education, research or other training 
                purpose.
                    (I) Technological advances or changes.
                    (J) Costs of the hospital or nursing facility 
                associated with meeting Federal and State regulations.
                    (K) The costs associated with necessary public 
                outreach activities.
                    (L) In the case of a for-profit hospital or nursing 
                facility, a reasonable rate of return on equity 
                capital, independent of those operating expenses 
                necessary to fulfill the objectives of this Act, 
                reduced (consistent with subparagraph (M)) by any 
                operating profit.
                    (M) Incentives to facilities that maintain costs 
                below previous reasonable budgeted levels without 
                reducing the care provided.
                    (N) With respect to hospitals or nursing facilities 
                that provide mental health services and substance abuse 
                treatment services, any additional costs involved in 
                the treatment of dually diagnosed individuals.
            (3) Approval required of capital expenditures.--No 
        expenditures may be approved as part of a budget of a hospital 
        or nursing facility under this section to the extent they are 
        attributable to an expenditure for a capital expenditure that 
        was subject to, but was not approved under, the process 
        described in section 605.
            (4) Review by advisory councils.--A State shall not approve 
        a budget of a hospital or nursing facility unless, prior to 
        such approval, the State Health Security Advisory Council and 
        the appropriate district health advisory council have had an 
        opportunity to review and submit any comments concerning the 
        budget.
            (5) Provision of required information; diagnosis-related 
        group.--No budget for a hospital or nursing facility for a year 
        may be approved unless the hospital or nursing facility has 
        submitted on a timely basis to the State health security 
        program such information as the program or the Board shall 
        specify, including in the case of hospitals information on 
        discharges classified by diagnosis-related group.
    (c) Adjustments in Approved Budgets.--
            (1) Adjustments to global budgets that contract with 
        comprehensive health service organizations.--Each State health 
        security program shall develop an administrative mechanism for 
        reducing operating funds to hospitals or nursing facilities in 
        proportion to payments made to such hospitals or nursing 
        facilities for services contracted for by a comprehensive 
        health service organization.
            (2) Amendments.--In accordance with standards established 
        by the Board, an operating and capital budget approved under 
        this section for a year may be amended before, during, or after 
        the year if there is a substantial change in any of the factors 
        relevant to budget approval.
    (d) Donations Permissible.--The Board shall promulgate regulations 
permitting hospitals and nursing facilities to raise funds from private 
sources to pay for newly constructed facilities, major renovations, and 
equipment. The expenditure of such funds, whether for operating or 
capital expenditures, does not obligate the State health security 
program to provide for continued support for such expenditures unless 
included in an approved global budget and, in the case of capital 
expenditures, unless approved under the process described in section 
605.

SEC. 612. PAYMENTS FOR OTHER FACILITY-BASED SERVICES.

    (a) In General.--Payments under a State health security program for 
home health services, hospice care, home and community-based long-term 
care services, and facility-based outpatient services (other than those 
described in section 611) shall be based on--
            (1) a global budget (described in section 611),
            (2) a capitation amount (described in subsection (c)),
            (3) a fee schedule under section 613, or
            (4) an alternative prospective payment method that is 
        approved by the State health security program.
Such payments shall not include payments for capital expenditures, 
except as provided in subsection (b).
    (b) Consideration in Establishment of Capitation Amounts.--A 
capitation amount, fee schedule, or alternative prospective payment 
method established under subsection (a) for facility-based services 
shall--
            (1) take into account the payment amounts established under 
        section 613 for any related professional services, and
            (2) be consistent with section 605(a)(2).
    (c) Capitation Amount.--
            (1) In general.--The capitation amount described in this 
        subsection for an enrollee with a provider of services 
        described in subsection (a), with respect to such services, 
        shall be determined by the State health security program on the 
        basis of the average amount of expenditures that is estimated 
        would be made under the State health security program for such 
        an enrollee, based on actuarial characteristics (as defined by 
        the State health security program).
            (2) Adjustment for special health needs.--The State health 
        security program shall adjust such average amounts to take into 
        account the special health needs, including a disproportionate 
        number of medically underserved individuals, of populations 
        served by the provider.
            (3) Adjustment for services not provided.--The State health 
        security program shall adjust such average amounts to take into 
        account the cost of services covered by such enrollment that 
        are not provided by the provider.

SEC. 613. PAYMENTS TO HEALTH CARE PRACTITIONERS BASED ON PROSPECTIVE 
              FEE SCHEDULE.

    (a) Fee for Service.--
            (1) In general.--Every independent health care practitioner 
        is entitled to be paid, for the provision of covered health 
        services under the State health security program, a fee for 
        each billable covered service.
            (2) Global fee payment methodologies.--The Board shall 
        establish models and encourage State health security programs 
        to implement alternative payment methodologies that incorporate 
        global fees for related services (such as all outpatient 
        procedures for treatment of a condition) or for a basic group 
        of services (such as primary care services) furnished to an 
        individual over a period of time, in order to encourage 
        continuity and efficiency in the provision of services. Such 
        methodologies shall be designed to ensure a high quality of 
        care.
            (3) Billing deadlines; electronic billing.--A State health 
        security program may deny payment for any service of an 
        independent health care practitioner for which it did not 
        receive a bill and appropriate supporting documentation (which 
        had been previously specified) within 30 days after the date 
        the service was provided. Such a program may require that bills 
        for services for which payment may be made under this section, 
        or for any class of such services, be submitted electronically.
            (4) Denial of Payment for Certain Services.--Payment shall 
        not be made under a State health security program for any 
        service attributable to a capital expenditure subject to 
        approval under section 605 which has not been approved under 
        that section. A practitioner may not impose a charge for a 
        service for which payment is denied under the previous 
        sentence.
    (b) Payment Rates Based on Prospective Fee Schedules.--
            (1) In general.--With respect to any payment method for a 
        class of services of practitioners, the State health security 
        program shall establish, on a prospective basis, a payment 
        schedule. The State health security program shall establish 
        such a schedule only after negotiations with organizations 
        representing the practitioners involved. Such a fee schedule 
        shall be designed to provide incentives for practitioners to 
        choose primary care medicine, including general internal 
        medicine and pediatrics, over medical specialization.
            (2) Fee for service schedules based on national relative 
        value scale.--The amount under the fee schedule shall--
                    (A) be based on a relative value scale, developed 
                by the State consistent with the standards established 
                under section 1848 of the Social Security Act, as in 
                effect on the day before the date of the enactment of 
                this Act, including such updates and modifications as 
                the Board may undertake;
                    (B) be based on conversion factors established by 
                each State consistent with the State health security 
                budget;
                    (C) provide for the application of volume 
                performance standards, in accordance with standards 
                established by the Board, based on class of service 
                (specified under paragraph (3)) and geographic area (as 
                specified under the State health security program); and
                    (D) provide, based on such class and area, for 
                quarterly adjustments in present or future payment 
                rates depending on whether expenditures are below or 
                above such performance standards.
        In applying volume performance standards under subparagraphs 
        (C) and (D), State health security programs may provide for 
        adjustment of rates on a practitioner-specific basis to reflect 
        utilization patterns of individual practitioners and may 
        publicly disclose such utilization patterns for individual 
        practitioners (but only in a manner that does not identify 
        individual patients).
            (3) Class of services.--In paragraph (2), each of the 
        following shall be considered to be a separate class of 
        services:
                    (A) Mental health services.
                    (B) Substance abuse treatment services.
                    (C) Dental services.
                    (D) Home and community-based long-term care 
                services.
                    (E) Other practitioner services (or such classes of 
                such services as a State may establish).
    (c) Billable Covered Service Defined.--In this section, the term 
``billable covered service'' means a service covered under section 201 
for which a practitioner is entitled to compensation by payment of a 
fee determined under this section.

SEC. 614. PAYMENTS TO COMPREHENSIVE HEALTH SERVICE ORGANIZATIONS.

    (a) In General.--Payment under a State health security program to a 
comprehensive health service organization to its enrollees shall be 
determined by the State--
            (1) based on a global budget described in section 611, or
            (2) subject to subsection (c), based on the basic 
        capitation amount described in subsection (b) for each of its 
        enrollees plus an amount equal to the amount of capital 
        expenditures that have been approved under section 605.
In applying paragraph (1), any reference in section 611 to a hospital 
shall be deemed a reference to a comprehensive health service 
organization.
    (b) Basic Capitation Amount.--
            (1) In general.--The basic capitation amount described in 
        this subsection for an enrollee shall be determined by the 
        State health security program on the basis of the average 
        amount of expenditures (not including expenditures attributable 
        to capital expenditures) that is estimated would be made under 
        the State health security program for covered health care 
        services for an enrollee, based on actuarial characteristics 
        (as defined by the State health security program).
            (2) Adjustment for special health needs.--The State health 
        security program shall adjust such average amounts to take into 
        account the special health needs, including a disproportionate 
        number of medically underserved individuals, of populations 
        served by the organization.
            (3) Adjustment for services not provided.--The State health 
        security program shall adjust such average amounts to take into 
        account the cost of covered health care services that are not 
        provided by the comprehensive health service organization under 
        section 303(a).
    (c) Special Rule for For-Profit Organizations.--In the case of a 
for-profit comprehensive health service organization, the total amount 
of capitation payments under subsection (a)(2) in a period shall be 
reduced by operating profit for the period less a reasonable rate of 
return on equity capital and such profit shall be additionally limited 
to such amounts as the Board determines are attributable to operating 
efficiencies and not to any reduction of care provided.

SEC. 615. PAYMENTS FOR COMMUNITY-BASED PRIMARY HEALTH FACILITIES.

    (a) In General.--In the case of community-based primary health 
facilities, subject to subsection (b), payments under a State health 
security program shall be based on--
            (1) a global budget described in section 611,
            (2) the basic primary care capitation amount described in 
        subsection (c) for each individual enrolled with the provider 
        of such services,
            (3) a fee schedule under section 613, or
            (4) an alternative prospective payment method that is 
        approved by the State health security program.
    (b) Payment Adjustment.--Payments under subsection (a) may include, 
consistent with the budgets developed under this title--
            (1) an additional amount, as set by the Board, to cover the 
        costs incurred by a provider which serves persons not covered 
        by this Act whose health care is essential to overall community 
        health and the control of communicable disease, and for whom 
        the cost of such care is otherwise uncompensated,
            (2) an additional amount, as set by the Board, to cover the 
        reasonable costs incurred by a provider that furnishes case 
        management services (as defined in section 1915(g)(2) of the 
        Social Security Act), transportation services, and translation 
        services, and
            (3) an additional amount, as set by the Board, to cover the 
        costs incurred by a provider in conducting health professional 
        education programs in connection with the provision of such 
        services.
    (c) Basic Primary Care Capitation Amount.--
            (1) In general.--The basic primary care capitation amount 
        described in this subsection for an enrollee with a provider of 
        community-based primary health services shall be determined by 
        the State health security program on the basis of the average 
        amount of expenditures that is estimated would be made under 
        the State health security program for such an enrollee, based 
        on actuarial characteristics (as defined by the State health 
        security program).
            (2) Adjustment for special health needs.--The State health 
        security program shall adjust such average amounts to take into 
        account the special health needs, including a disproportionate 
        number of medically underserved individuals, of populations 
        served by the provider.
            (3) Adjustment for services not provided.--The State health 
        security program shall adjust such average amounts to take into 
        account the cost of community-based primary health services 
        that are not provided by the provider.
    (d) Community-based Primary Health Services Defined.--In this 
section, the term ``community-based primary health services'' has the 
meaning given such term in section 202(a).

SEC. 616. PAYMENTS FOR PRESCRIPTION DRUGS.

    (a) Establishment of Classification.--
            (1) In general.--Based upon the recommendations of the 
        Advisory Committee on Prescription Drugs under section 403(f), 
        the Board shall establish classifications of prescription drugs 
        and biologicals that the Board determines are necessary for the 
        maintenance or restoration of health or of employability or 
        self-management and eligible for coverage under this Act.
            (2) Exclusions.--The Board may exclude reimbursement under 
        this Act for ineffective, unsafe, or over-priced products where 
        better alternatives are determined to be available.
    (b) Prices.--For each such classified prescription drug or 
biological covered under this Act, for insulin, and for medical foods, 
the Board shall from time to time determine a product price or prices 
which shall constitute the maximum to be recognized under this Act as 
the cost of a drug to a provider thereof. The Board may conduct 
negotiations, on behalf of State health security programs, with product 
manufacturers and distributors in determining the applicable product 
price or prices.
    (c) Charges by Independent Pharmacies.--Each State health security 
program shall provide for payment for a prescription drug or biological 
or insulin furnished by an independent pharmacy based on the drug's 
cost to the pharmacy (not in excess of the applicable product price 
established under subsection (b)) plus a dispensing fee. In accordance 
with standards established by the Board, each State health security 
program, after consultation with representatives of the pharmaceutical 
profession, shall establish schedules of dispensing fees, designed to 
afford reasonable compensation to independent pharmacies after taking 
into account variations in their cost of operation resulting from 
regional differences, differences in the volume of prescription drugs 
dispensed, differences in services provided, the need to maintain 
expenditures within the budgets established under this title, and other 
relevant factors.

SEC. 617. PAYMENTS FOR APPROVED DEVICES AND EQUIPMENT.

    (a) Establishment of List.--The Board shall establish a list of 
approved durable medical equipment and therapeutic devices and 
equipment (including eyeglasses, hearing aids, and prosthetic 
appliances), that the Board determines are necessary for the 
maintenance or restoration of health or of employability or self-
management and eligible for coverage under this Act.
    (b) Considerations and Conditions.--In establishing the list under 
subsection (a), the Board shall take into consideration the efficacy, 
safety, and cost of each item contained on such list, and shall attach 
to any item such conditions as the Board determines appropriate with 
respect to the circumstances under which, or the frequency with which, 
the item may be prescribed.
    (c) Prices.--For each such listed item covered under this Act, the 
Board shall from time to time determine a product price or prices which 
shall constitute the maximum to be recognized under this Act as the 
cost of the item to a provider thereof. The Board may conduct 
negotiations, on behalf of State health security programs, with 
equipment and device manufacturers and distributors in determining the 
applicable product price or prices.
    (d) Exclusions.--The Board may exclude from coverage under this Act 
ineffective, unsafe, or overpriced products where better alternatives 
are determined to be available.

SEC. 618. PAYMENTS FOR OTHER ITEMS AND SERVICES.

    In the case of payment for other covered health services, the 
amount of payment under a State health security program shall be 
established by the program--
            (1) in accordance with payment methodologies which are 
        specified by the Board after consultation with the American 
        Health Security Advisory Council and the Board's standing 
        Advisory Committee on Cost Containment, and
            (2) consistent with the State health security budget.

SEC. 619. ROLE OF COMMISSIONS IN ESTABLISHING PAYMENT RATES.

    (a) Role of the Prospective Payment Assessment Commission.--The 
Prospective Payment Assessment Commission, instead of conducting 
activities described in section 1886 of the Social Security Act, shall 
advise the Board concerning the approval of prospective global budgets 
for hospitals and nursing facilities under section 611 and shall 
annually prepare and submit to the Congress and the Board a report 
containing the recommendations of the Commission concerning the most 
appropriate manner in which the budget approval process should be 
modified to best meet the objectives of this title.
    (b) Role of the Practitioner Payment Review Commission.--
            (1) Redesignation.--The Commission established under 
        section 1845 of the Social Security Act is renamed the 
        ``Practitioner Payment Review Commission'' (hereafter referred 
        to in this subsection as the ``Commission'') and is continued 
        for purposes of carrying out this subsection.
            (2) Additional members.--The Director of the Congressional 
        Office of Technology Assessment shall increase the membership 
        of the Commission to such number as may be necessary to include 
        the representation of nurses and other health care 
        professionals whose services are paid for on the basis of a 
        relative-value fee schedule established under section 613, and 
        shall consult with the General Health Care Payment Review 
        Commission and other appropriate provider organizations.
            (3) Alternative functions.--The Commission, instead of 
        conducting activities of the type described in section 1845 of 
        the Social Security Act, shall advise the Board concerning the 
        fee schedules established under section 613 and shall annually 
        prepare and submit to Congress and the Board a report 
        containing recommendations concerning the manner in which 
        payment schedules under subsection (b) of such section should 
        be modified to best meet the objectives of this title.
    (c) General Health Care Payment Review Commission.--
            (1) Establishment.--
                    (A) In general.--The Director of the Congressional 
                Office of Technology Assessment shall provide for the 
                appointment of a General Health Care Payment Review 
                Commission (hereafter referred to in this subsection as 
                the ``Commission''), to be composed of individuals with 
                national recognition for their expertise in health care 
                economics and related fields for items and services for 
                which payment is made under section 616, 617, 618, or 
                620(a), representatives of providers and manufacturers 
                of such items and services, and representatives of 
                consumers of these items and services.
                    (B) Appointments.--Members of the Commission shall 
                first be appointed not later than January 1, 1994, for 
                a term of 3 years, except that the Director may provide 
                initially for such shorter terms as will insure that 
                (on a continuing basis) the terms of no more than one-
                third of the number of members expire in any year. 
                Appointments shall be made without regard to the 
                provisions of title 5, United States Code, governing 
                appointments in the competitive service.
                    (C) Membership.--Membership on the Commission shall 
                include health care economists, representatives of 
                providers and manufacturers of such items and services, 
                and representatives of consumers of these items and 
                services.
            (2) Functions.--The Commission shall advise the Board 
        concerning the payment amounts established under sections 616, 
        617, 618, and 620(a) and shall annually prepare and submit to 
        Congress and the Board a report containing recommendations on 
        the manner in which such payment amounts should be modified to 
        best meet the objectives of this title.
    (d) Long-Term Care Payment Review Commission--
            (1) Establishment.--
                    (A) In general.--The Director of the Congressional 
                Office of Technology Assessment shall provide for the 
                appointment of a Long-Term Care Payment Review 
                Commission (hereafter referred to in this subsection as 
                the ``Commission'') to be composed of individuals with 
                national recognition for their expertise in health care 
                economics and related fields for nursing facility 
                services, home health services, hospice care, and home 
                and community-based long-term care services.
                    (B) Appointments.--Members of the Commission shall 
                first be appointed not later than January 1, 1994, for 
                a term of 3 years, except that the Director may provide 
                initially for such shorter terms as will insure that 
                (on a continuing basis) the terms of no more than one-
                third of the number of members expire in any year. 
                Appointments shall be made without regard to the 
                provisions of title 5, United States Code, governing 
                appointments in the competitive service.
                    (C) Membership.--Members of the Commission shall 
                include health care economists, representatives of 
                providers and manufacturers of such services, and 
                consumers of such services.
            (2) Functions.--The Commission shall advise the Board 
        concerning the payment amounts for long-term care established 
        under this subtitle and shall annually prepare and submit to 
        Congress and the Board an annual report containing the 
        recommendations of the Commission concerning the manner in 
        which global budgets and payment methodologies should be 
        modified to best meet the objectives of this title.

SEC. 620. PAYMENT INCENTIVES FOR MEDICALLY UNDERSERVED AREAS.

    (a) Model Payment Methodologies.--In addition to the payment 
amounts otherwise provided in this title, the Board shall establish 
model payment methodologies and other incentives that promote the 
provision of covered health care services in medically underserved 
areas, particularly in rural and inner-city underserved areas.
    (b) Construction.--Nothing in this title shall be construed as 
limiting the authority of State health security programs to increase 
payment amounts or otherwise provide additional incentives, consistent 
with the State health security budget, to encourage the provision of 
medically necessary and appropriate services in underserved areas.

SEC. 621. WAIVER AUTHORITY FOR ALTERNATIVE PAYMENT METHODOLOGIES.

    (a) In General.--Upon application of a State health security 
program as part of its plan under section 405(a), the Board may waive a 
required payment methodology under this subtitle as it may be necessary 
to allow alternative payment methodologies or to conduct experiments 
and demonstration projects, consistent with the State health security 
budget.
    (b) Conditions for Approval.--The Board may not approve a request 
for such a waiver unless the Board determines that such payment 
methodology does not adversely affect the entitlement of individuals to 
coverage, the benefits covered under the program, the quality of 
services provided under the program, the ability of individuals to 
choose among qualified providers, the weighting of fee schedules to 
encourage an increase in the number of primary care practitioners, or 
the compliance of the program with the State health security budget 
under subtitle A.
    (c) Periodic Reports.--The continued approval of such a waiver is 
conditioned upon the program submitting periodic reports to the Board 
showing the operation and effectiveness of the alternative methodology, 
in order for the Board to evaluate the appropriateness of the 
alternative methodology.

     Subtitle C--Mandatory Assignment and Administrative Provisions

SEC. 631. MANDATORY ASSIGNMENT.

    (a) No Balance Billing.--Payments for benefits under this Act shall 
constitute payment in full for such benefits and the entity furnishing 
an item or service for which payment is made under this Act shall 
accept such payment as payment in full for the item or service and may 
not accept any payment or impose any charge for any such item or 
service other than accepting payment from the State health security 
program in accordance with this Act.
    (b) Enforcement.--If an entity knowingly and willfully bills for an 
item or service or accepts payment in violation of subsection (a), the 
Board may apply sanctions against the entity in the same manner as 
sanctions could have been imposed under section 1842(j)(2) of the 
Social Security Act for a violation of section 1842(j)(1) of such Act. 
Such sanctions are in addition to any sanctions that a State may impose 
under its State health security program.

SEC. 632. PROCEDURES FOR REIMBURSEMENT; APPEALS.

    (a) Procedures for Reimbursement.--In accordance with standards 
issued by the Board, a State health security program shall establish a 
timely and administratively simple procedure to assure payment within 
60 days of the date of submission of clean claims by providers under 
this Act.
    (b) Appeals Process.--Each State health security program shall 
establish an appeals process to handle all grievances pertaining to 
payment to providers under this title.

  TITLE VII--PROMOTION OF PRIMARY HEALTH CARE; DEVELOPMENT OF HEALTH 
     SERVICE CAPACITY; PROGRAMS TO ASSIST THE MEDICALLY UNDERSERVED

   Subtitle A--Promotion and Expansion of Primary Care Professional 
                                Training

SEC. 701. ROLE OF BOARD; ESTABLISHMENT OF PRIMARY CARE PROFESSIONAL 
              OUTPUT GOALS.

    (a) In General.--The Board is responsible for--
            (1) coordinating health professional education policies and 
        goals, in consultation with the Secretary of Health and Human 
        Services (in this title referred to as the ``Secretary''), to 
        achieve the national goals specified in subsection (b);
            (2) developing and maintaining, in cooperation with the 
        Secretary, a system to monitor the number and specialties of 
        individuals through their health professional education, any 
        postgraduate training, and professional practice; and
            (3) developing, coordinating, and promoting other policies 
        that expand the number of primary care practitioners.
    (b) National Goals.--The national goals specified in this 
subsection are as follows:
            (1) Graduate medical education.--By not later than 5 years 
        after the date of the enactment of this Act, at least 50 
        percent of the residents in medical residency education 
        programs (as defined in subsection (e)(1)) are primary care 
        residents (as defined in subsection (e)(2)).
            (2) Midlevel primary care practitioners.--To assure an 
        adequate supply of primary care pratitioners, there shall be a 
        number, specified by the Board, of midlevel primary care 
        practitioners (as defined in subsection (e)(3)) employed in the 
        health care system as of January 1, 2000.
    (c) Method for Attainment of National Goal for Graduate Medical 
Education; Program Goals.--
            (1) In general.--The Board shall establish a method of 
        applying the national goal in subsection (b)(1) to program 
        goals for each medical residency education program or to 
        medical residency education consortia.
            (2) Consideration.--The program goals under paragraph (1) 
        shall be based on the distribution of medical schools and other 
        teaching facilities within each State health security program, 
        and the number of positions for graduate medical education.
            (3) Medical Residency Education Consortium.--In this 
        subsection, the term ``medical residency education consortium'' 
        means a consortium of medical residency education programs in a 
        contiguous geographic area (which may be an interstate area) if 
        the consortium--
                    (A) includes at least one medical school with a 
                teaching hospital and related teaching settings, and
                    (B) has an affiliation with qualified community-
                based primary health service providers described in 
                section 202(a) and with at least one comprehensive 
                health service organization established under section 
                303.
            (4) Enforcement through state health security budgets.--The 
        Board shall develop a formula for reducing payments to State 
        health security programs (that provide for payments to a 
        medical residency education program) that failed to meet the 
        goal for the program established under this subsection.
    (d) Method for Attainment of National Goal for Midlevel Primary 
Care Practitioners.--To assist in attaining the national goal 
identified in subsection (b)(2), the Board shall--
            (1) advise the Public Health Service on allocations of 
        funding under titles VII and VIII of the Public Health Service 
        Act, the National Health Service Corps, and other programs in 
        order to increase the supply of midlevel primary care 
        practitioners, and
            (2) commission a study of the potential benefits and 
        disadvantages of expanding the scope of practice authorized 
        under State laws for any class of midlevel primary care 
        practitioners.
    (e) Definitions.--In this title:
            (1) Medical residency education program.--The term 
        ``medical residency education program'' means a program that 
        provides education and training to graduates of medical schools 
        in order to meet requirements for licensing and certification 
        as a physician, and includes the medical school supervising the 
        program and includes the hospital or other facility in which 
        the program is operated.
            (2) Primary care resident.--The term ``primary care 
        resident'' means (in accordance with criteria established by 
        the Board) a resident being trained in a distinct program of 
        family practice medicine, general practice, general internal 
        medicine, or general pediatrics.
            (3) Midlevel primary care practitioner.--The term 
        ``midlevel primary care practitioner'' means a clinical nurse 
        practitioner, certified nurse midwife, physician assistant, or 
        other non-physician practitioner, specified by the Board, as 
        authorized to practice under State law.

SEC. 702. ESTABLISHMENT OF ADVISORY COMMITTEE ON HEALTH PROFESSIONAL 
              EDUCATION.

    (a) In General.--The Board shall provide for an Advisory Committee 
on Health Professional Education (in this section referred to as the 
``Committee'') to advise the Board on its activities under section 701.
    (b) Membership.--The Committee shall be composed of--
            (1) the Chair of the Board, who shall serve as Chair of the 
        Committee, and
            (2) 12 members, not otherwise in the employ of the United 
        States, appointed by the Board without regard to the provisions 
        of title 5, United States Code, governing appointments in the 
        competitive service.
The appointed members shall provide a balanced point of view with 
respect to health professional education, primary care disciplines, and 
health care policy and shall include individuals who are representative 
of medical schools, other health professional schools, residency 
programs, primary care practitioners, teaching hospitals, professional 
associations, public health organizations, State health security 
programs, and consumers.
    (c) Terms of Members.--Each appointed member shall hold office for 
a term of five years, except that--
            (1) any member appointed to fill a vacancy occurring during 
        the term for which the member's predecessor was appointed shall 
        be appointed for the remainder of that term; and
            (2) the terms of the members first taking office shall 
        expire, as designated by the Board at the time of appointment, 
        two at the end of the second year, two at the end of the third 
        year, two at the end of the fourth year, and three at the end 
        of the fifth year after the date of enactment of this Act.
    (d) Vacancies.--
            (1) In general.--The Board shall fill any vacancy in the 
        membership of the Committee in the same manner as the original 
        appointment. The vacancy shall not affect the power of the 
        remaining members to execute the duties of the Committee.
            (2) Vacancy appointments.--Any member appointed to fill a 
        vacancy shall serve for the remainder of the term for which the 
        predecessor of the member was appointed.
            (3) Reappointment.--The Board may reappoint an appointed 
        member of the Committee for a second term in the same manner as 
        the original appointment.
    (e) Duties.--It shall be the duty of the Committee to advise the 
Board concerning graduate medical education policies under this title.
    (f) Staff.--The Committee, its members, and any committees of the 
Committee shall be provided with such secretarial, clerical, or other 
assistance as may be authorized by the Board for carrying out their 
respective functions.
    (g) Meetings.--The Committee shall meet as frequently as the Board 
deems necessary, but not less than 4 times each year. Upon request by 
four or more members it shall be the duty of the Chair to call a 
meeting of the Committee.
    (h) Compensation.--Members of the Committee shall be reimbursed by 
the Board for travel and per diem in lieu of subsistence expenses 
during the performance of duties of the Board in accordance with 
subchapter I of chapter 57 of title 5, United States Code.
    (i) FACA Not Applicable.--The provisions of the Federal Advisory 
Committee Act shall not apply to the Committee.

SEC. 703. GRANTS FOR HEALTH PROFESSIONS EDUCATION, NURSE EDUCATION, AND 
              THE NATIONAL HEALTH SERVICE CORPS.

    (a) Transfers to Public Health Service.--From the amounts provided 
under subsection (c), the Board shall make transfers from the American 
Health Security Trust Fund to the Public Health Service under subpart 
II of part D of title III, title VII, and title VIII of the Public 
Health Service Act for the support of the National Health Service 
Corps, health professions education, and nursing education, including 
education of clinical nurse practitioners, certified registered nurse 
anesthetists, certified nurse midwives, and physician assistants. Of 
the amounts so transferred in each year, not less than 50 percent shall 
be expended for the support of the National Health Service Corps.
    (b) Range of Funds.--The amount of transfers under subsection (a) 
for any fiscal year shall be an amount (specified by the Board each 
year) not less than \4/100\ percent and not to exceed \6/100\ percent 
of the amounts the Board estimates will be expended from the Trust Fund 
in the fiscal year.
    (c) Funds Supplemental to Other Funds.--The funds provided under 
this section with respect to provision of services are in addition to, 
and not in replacement of, funds made available under the provisions 
referred to in subsection (a) and shall be administered in accordance 
with the terms of such provisions. The Board shall make no transfer of 
funds under this section for any fiscal year for which the total 
appropriations for the programs authorized by such provisions are less 
than the total amount appropriated for such programs in fiscal year 
1993.

                Subtitle B--Direct Health Care Delivery

SEC. 711. SETASIDE FOR PUBLIC HEALTH BLOCK GRANTS.

    (a) Transfers to Public Health Service.--From the amounts provided 
under subsection (c), the Board shall make transfers from the American 
Health Security Trust Fund to the Public Health Service for the 
following purposes:
            (1) For payments to States under the maternal and child 
        health block grants under title V of the Social Security Act.
            (2) Preventive health block grants under part A of title 
        XIX of the Public Health Service Act.
            (3) Grants to States for community mental health services 
        under subpart I of part B of title XIX of the Public Health 
        Service Act.
            (4) Grants to States for prevention and treatment of 
        substance abuse under subpart II of part B of title XIX of the 
        Public Health Service Act.
            (5) Grants for HIV health care services under parts A, B, 
        and C of title XXVI of the Public Health Service Act.
    (b) Range of Funds.--The amount of transfers under subsection (a) 
for any fiscal year shall be an amount (specified by the Board each 
year) not less than \1/10\ percent and not to exceed \14/100\ percent 
of the amounts the Board estimates will be expended from the Trust Fund 
in the fiscal year.
    (c) Funds Supplemental to Other Funds.--The funds provided under 
this section with respect to provision of services are in addition to, 
and not in replacement of, funds made available under the programs 
referred to in subsection (a) and shall be administered in accordance 
with the terms of such programs. The Board shall make no transfer of 
funds under this section for any fiscal year for which the total 
appropriations for such programs are less than the total amount 
appropriated for such programs in fiscal year 1993.

SEC. 712. SETASIDE FOR PRIMARY HEALTH CARE DELIVERY.

    (a) Transfers to Public Health Service.--From the amounts provided 
under subsection (c), the Board shall make transfers from the American 
Health Security Trust Fund to the Public Health Service for the program 
of primary care service expansion grants under subpart V of part D of 
title III of the Public Health Service Act (as added by section 713 of 
this Act).
    (b) Range of Funds.--The amount of transfers under subsection (a) 
for any fiscal year shall be an amount (specified by the Board each 
year) not less than \6/100\ percent and not to exceed \1/10\ percent of 
the amounts the Board estimates will be expended from the Trust Fund in 
the fiscal year.
    (c) Funds Supplemental to Other Funds.--The funds provided under 
this section with respect to provision of services are in addition to, 
and not in replacement of, funds made available under the sections 329, 
330, 340, 340A, 1001, and 2655 of the Public Health Service Act. The 
Board shall make no transfer of funds under this section for any fiscal 
year for which the total appropriations for such sections are less than 
the total amount appropriated under such sections in fiscal year 1993.

SEC. 713. PRIMARY CARE SERVICE EXPANSION GRANTS.

    Part D of title III of the Public Health Service Act (42 U.S.C. 
254b et seq.) is amended by adding at the end thereof the following new 
subpart:

                  ``Subpart V--Primary Care Expansion

``SEC. 340D. EXPANDING PRIMARY CARE DELIVERY CAPACITY IN URBAN AND 
              RURAL AREAS.

    ``(a) Grants for Primary Care Centers.--From the amounts described 
in subsection (c), the American Health Security Standards Board shall 
make grants to public and nonprofit private entities for projects to 
plan, develop, and operate primary care centers which will serve 
medically underserved populations (as defined in section 330(b)(3)) in 
urban and rural areas and to deliver primary care services to such 
populations in such areas. The funds provided under such a grant may be 
used for the same purposes for which a grant may be made under 
subsection (c) or (d) of section 330.
    ``(b) Process of Awarding Grants.--The provisions of subsection 
(e)(1) of section 330 shall apply to a grant under this section in the 
same manner as they apply to a grant under subsection (c) of such 
section. The provisions of subsection (g)(3) of such section shall 
apply to grants for projects to plan and develop primary care centers 
under this section in the same manner as they apply to grants under 
such section.
    ``(c) Funding as Set-Aside From Trust Fund.--Funding to carry out 
this section is provided from the American Health Security Trust Fund 
in accordance with section 712 of the American Health Security Act.
    ``(d) Primary Care Center Defined.--In this section, the term 
`primary care center' means--
            ``(1) a migrant health center (as defined in section 
        329(a)(1)),
            ``(2) a community health center (as defined in section 
        330(a)),
            ``(3) an entity qualified to receive a grant under section 
        340, 340A, 1001, or 2655, or
            ``(4) a Federally-qualified health center (as defined in 
        section 1905(l)(2)(B) of the Social Security Act).''.

             Subtitle C--Primary Care and Outcomes Research

SEC. 721. SET-ASIDE FOR OUTCOMES RESEARCH.

    (a) Grants for Outcomes Research.--From the amounts provided under 
subsection (c), the Board shall make transfers from the Trust Fund to 
the Agency for Health Care Policy and Research under title IX of the 
Public Health Service Act for the purpose of carrying out activities 
under such title.
    (b) Range of Funds.--The amount of transfers under subsection (a) 
for any fiscal year shall be an amount (specified by the Board each 
year) not less than \1/100\ percent and not to exceed \2/100\ percent 
of the amounts the Board estimates will be expended from the Trust Fund 
in the fiscal year.
    (c) Funds Supplemental to Other Funds.--The funds provided under 
this section with respect to provision of services are in addition to, 
and not in replacement of, funds made available to the Agency for 
Health Care Policy and Research under section 926 of the Public Health 
Service Act. The Board shall make no transfer of funds under this 
section for any fiscal year for which the total appropriations under 
such section are less than the total amount appropriated under such 
section and title in fiscal year 1993.
    (d) Conforming Amendment.--Section 926(a) of the Public Health 
Service Act (42 U.S.C. 299c-5(a)) is amended by striking 
``$35,000,000'' and all that follows through the end and inserting 
``for each fiscal year (beginning with fiscal year 1994) such sums as 
may be necessary.''.

SEC. 722. OFFICE OF PRIMARY CARE AND PREVENTION RESEARCH.

    (a) In General.--Title IV of the Public Health Service Act, as 
amended by section 2 of Public Law 101-613, is amended--
                    (1) by redesignating section 486 as section 485A;
                    (2) by redesignating parts F through H as parts G 
                through I, respectively; and
                    (3) by inserting after part E the following new 
                part:

           ``Part F--Research on Primary Care and Prevention

``SEC. 486. OFFICE OF PRIMARY CARE AND PREVENTION RESEARCH.

    ``(a) Establishment.--There is established within the Office of the 
Director of NIH an office to be known as the Office of Primary Care and 
Prevention Research (in this part referred to as the `Office'). The 
Office shall be headed by a director, who shall be appointed by the 
Director of NIH.
    ``(b) Purpose.--The Director of the Office shall--
            ``(1) identify projects of research on primary care and 
        prevention that should be conducted or supported by the 
        national research institutes, with particular emphasis on--
                    ``(A) clinical patient care,
                    ``(B) diagnostic effectiveness,
                    ``(C) primary care education,
                    ``(D) health and family planning services,
                    ``(E) medical effectiveness outcomes of primary 
                care procedures and interventions, including effects on 
                populations within the community, district, State, or 
                the United States, and
                    ``(F) the use of multidisciplinary teams of health 
                care practitioners;
            ``(2) identify multidisciplinary research related to 
        primary care and prevention that should be so conducted;
            ``(3) promote coordination and collaboration among entities 
        conducting research identified under any of paragraphs (1) and 
        (2);
            ``(4) encourage the conduct of such research by entities 
        receiving funds from the national research institutes;
            ``(5) recommend an agenda for conducting and supporting 
        such research;
            ``(6) promote the sufficient allocation of the resources of 
        the national research institutes for conducting and supporting 
        such research; and
            ``(7) prepare the report required in section 486B.
    ``(c) Coordinating Committee.--
            ``(1) In carrying out subsection (b), the Director of the 
        Office shall establish a committee to be known as the 
        Coordinating Committee on Research on Primary Care and 
        Prevention Research (in this subsection referred to as the 
        `Coordinating Committee').
            ``(2) The Coordinating Committee shall be composed of the 
        Directors of the national research institutes (or the designees 
        of the Directors).
            ``(3) The Director of the Office shall serve as the Chair 
        of the Coordinating Committee.
            ``(4) With respect to research on primary care and 
        prevention, the Coordinating Committee shall assist the 
        Director of the Office in--
                    ``(A) identifying the need for such research, and 
                making an estimate each fiscal year of the funds needed 
                to adequately support the research; and
                    ``(B) identifying needs regarding the coordination 
                of research activities, including intramural and 
                extramural multidisciplinary activities.
    ``(d) Advisory Committee.--
            ``(1) In carrying out subsection (b), the Director of the 
        Office shall establish an advisory committee to be known as the 
        Advisory Committee on Research on Primary Care and Prevention 
        Research (in this subsection referred to as the `Advisory 
        Committee').
            ``(2) The Advisory Committee shall be composed of 14 
        individuals who are not officers or employees of the Federal 
        Government. The Director of the Office shall make appointments 
        to the Advisory Committee from among physicians, practitioners, 
        scientists, and other health professionals whose clinical 
        practice, research specialization, or professional expertise 
        includes a significant focus on research on primary care and 
        prevention.
            ``(3) The Director of the Office shall serve as the Chair 
        of the Advisory Committee.
            ``(4) The Advisory Committee shall--
                    ``(A) advise the Director of the Office on 
                appropriate research activities to be undertaken by the 
                national research institutes with respect to--
                            ``(i) primary care and prevention, and
                            ``(ii) research on primary care and 
                        prevention which requires a multidisciplinary 
                        approach;
                    ``(B) report to the Director of the Office on such 
                research; and
                    ``(C) provide recommendations to such Director 
                regarding activities of the Office (including 
                recommendations on priorities in carrying out research 
                described in subparagraph (A)).
            ``(5)(A) The Advisory Committee shall prepare a biennial 
        report describing the activities of the Committee, including 
        findings made by the Committee regarding--
                    ``(i) the extent of expenditures made for research 
                on primary care and prevention by the agencies of the 
                National Institutes of Health; and
                    ``(ii) the level of funding needed for such 
                research.
            ``(B) The report required in subparagraph (A) shall be 
        submitted to the Director of NIH for inclusion in the report 
        required in section 403.
    ``(e) Primary Care and Prevention Research Defined.--For purposes 
of this part, the term `primary care and prevention research' means 
research on improvement of the practice of family medicine, general 
internal medicine, and general pediatrics, and includes research 
relating to--
            ``(1) obstetrics and gynecology, dentistry, or mental 
        health or substance abuse treatment when provided by a primary 
        care physician or other primary care practitioner, and
            ``(2) primary care provided by multidisciplinary teams.

``SEC. 486A. NATIONAL DATA SYSTEM AND CLEARINGHOUSE ON PRIMARY CARE AND 
              PREVENTION RESEARCH.

    ``(a) Data System.--The Director of NIH, in consultation with the 
Director of the Office, shall establish a data system for the 
collection, storage, analysis, retrieval, and dissemination of 
information regarding primary care and prevention research that is 
conducted or supported by the national research institutes. Information 
from the data system shall be available through information systems 
available to health care professionals and providers, researchers, and 
members of the public.
    ``(b) Clearinghouse.--The Director of NIH, in consultation with the 
Director of the Office and with the National Library of Medicine, shall 
establish, maintain, and operate a program to provide, and encourage 
the use of, information on research and prevention activities of the 
national research institutes that relate to primary care and prevention 
research.

``SEC. 486B. BIENNIAL REPORT.

    ``(a) In General.--With respect to primary care and prevention 
research, the Director of the Office shall, not later than one year 
after the date of the enactment of this part, and biennially 
thereafter, prepare a report--
            ``(1) describing and evaluating the progress made during 
        the preceding two fiscal years in research and treatment 
        conducted or supported by the National Institutes of Health;
            ``(2) summarizing and analyzing expenditures made by the 
        agencies of such Institutes (and by such Office) during the 
        preceding two fiscal years; and
            ``(3) making such recommendations for legislative and 
        administrative initiatives as the Director of the Office 
        determines to be appropriate.
    ``(b) Inclusion in Biennial Report of Director of NIH.--The 
Director of the Office shall submit each report prepared under 
subsection (a) to the Director of NIH for inclusion in the report 
submitted to the President and the Congress under section 403.''.
    (b) Requirement of Sufficient Allocation of Resources of 
Institutes.--Section 402(b) of the Public Health Service Act (42 U.S.C. 
282(b)) is amended--
            (1) in paragraph (10), by striking ``and'' after the 
        semicolon at the end;
            (2) in paragraph (11), by striking the period at the end 
        and inserting ``; and''; and
            (3) by inserting after paragraph (11) the following new 
        paragraph:
            ``(12) after consultation with the Director of the Office 
        of Primary Care and Prevention Research, shall ensure that 
        resources of the National Institutes of Health are sufficiently 
        allocated for projects on primary care and prevention research 
        that are identified under section 486(b).''.
    (c) Authorization of Appropriations.--Section 408 of the Public 
Health Service Act (42 U.S.C. 284(a)) is amended by adding at the end 
the following new paragraph:
            ``(3) For the Office of Primary Care and Prevention 
        Research, there are authorized to be appropriated $150,000,000 
        for fiscal year 1994, $180,000,000 for fiscal year 1995, and 
        $216,000,000 for fiscal year 1996.''.
    (d) Conforming Amendment.--Section 485(g) of the Public Health 
Service Act (42 U.S.C. 287c-2(g)) is amended by striking ``section 
486'' and inserting ``section 485A''.

 TITLE VIII--FINANCING PROVISIONS; AMERICAN HEALTH SECURITY TRUST FUND

SEC. 800. AMENDMENT OF 1986 CODE; SECTION 15 NOT TO APPLY.

    (a) Amendment of 1986 Code.--Except as otherwise expressly 
provided, whenever in this title an amendment or repeal 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 a section or other 
provision of the Internal Revenue Code of 1986.
    (b) Section 15 Not To Apply.--The amendments made by subtitle B 
shall not be treated as a change in a rate of tax for purposes of 
section 15 of the Internal Revenue Code of 1986.

            Subtitle A--AMERICAN HEALTH SECURITY TRUST FUND

SEC. 801. AMERICAN HEALTH SECURITY TRUST FUND.

    (a) In General.--There is hereby created on the books of the 
Treasury of the United States a trust fund to be known as the American 
Health Security Trust Fund (in this section referred to as the ``Trust 
Fund''). The Trust Fund shall consist of such gifts and bequests as may 
be made and such amounts as may be deposited in, or appropriated to, 
such Trust Fund as provided in this Act.
    (b) Appropriations Into Trust Fund.--
            (1) Taxes.--There are hereby appropriated to the Trust Fund 
        for each fiscal year (beginning with fiscal year 1995), out of 
        any moneys in the Treasury not otherwise appropriated, amounts 
        equivalent to 100 percent of the aggregate increase in tax 
        liabilities under the Internal Revenue Code of 1986 which is 
        attributable to the application of the amendments made by this 
        title. The amounts appropriated by the preceding sentence shall 
        be transferred from time to time (but not less frequently than 
        monthly) from the general fund in the Treasury to the Trust 
        Fund, such amounts to be determined on the basis of estimates 
        by the Secretary of the Treasury of the taxes paid to or 
        deposited into the Treasury; and proper adjustments shall be 
        made in amounts subsequently transferred to the extent prior 
        estimates were in excess of or were less than the amounts that 
        should have been so transferred.
            (2) Current program receipts.--Notwithstanding any other 
        provision of law, there are hereby appropriated to the Trust 
        Fund for each fiscal year (beginning with fiscal year 1995) the 
        amounts that would otherwise have been appropriated to carry 
        out the following programs (and any other Federal program 
        identified by the Board, in consultation with the Secretary of 
        the Treasury, as providing for payment for health services the 
        payment of which may be made under this Act):
                    (A) The medicare program, under parts A and B of 
                title XVIII of the Social Security Act (other than 
                amounts attributable to any premiums under such parts).
                    (B) The medicaid program, under State plans 
                approved under title XIX of such Act.
                    (C) The Federal employees health benefit program, 
                under chapter 89 of title 5, United States Code.
                    (D) The CHAMPUS program, under chapter 55 of title 
                10, United States Code.
    (c) Incorporation of Provisions.--The provisions of subsections (b) 
through (i) of section 1817 of the Social Security Act shall apply to 
the Trust Fund under this Act in the same manner as they applied to the 
Federal Hospital Insurance Trust Fund under part A of title XVIII of 
such Act, except that the American Health Security Standards Board 
shall constitute the Board of Trustees of the Trust Fund.
    (d) Transfer of Funds.--Any amounts remaining in the Federal 
Hospital Insurance Trust Fund or the Federal Supplementary Medical 
Insurance Trust Fund after the settlement of claims for payments under 
title XVIII have been completed, shall be transferred into the American 
Health Security Trust Fund.

  Subtitle B--Increases in Corporate and Individual Income Tax Rates; 
   Health Security Premium; Surtax on Individuals With Incomes Over 
                               $1,000,000

SEC. 811. INCREASES IN REGULAR INCOME TAX RATES.

    (a) Increase in Top Corporate Income Tax Rate.--Subparagraph (C) of 
section 1(b)(1) (relating to tax imposed on corporations) is amended by 
striking ``34 percent'' and inserting ``38 percent''.
    (b) Increase in Individual Income Taxes.--Section 1 (relating to 
tax imposed) as amended by striking subsections (a) through (e) and 
inserting the following:
    ``(a) Married Individuals Filing Joint Returns and Surviving 
Spouses.--There is hereby imposed on the taxable income of--
            ``(1) every married individual (as defined in section 7703) 
        who makes a single return jointly with his spouse under section 
        6013, and
            ``(2) every surviving spouse (as defined in section 2(a)), 
        a tax determined in accordance with the following table:

``If taxable income is:             The tax is:
    Not over $38,000...............
                                        15% of taxable income.
    Over $38,000 but not over 
        $91,900.
                                        $5,700, plus 30% of the excess 
                                                over $38,000.
    Over $91,900 but not over 
        $200,000.
                                        $22,409, plus 34% of the excess 
                                                over $91,900.
    Over $200,000..................
                                        $59,163, plus 38% of the excess 
                                                over $200,000.
    ``(b) Heads of Households.--There is hereby imposed on the taxable 
income of every head of a household (as defined in section 2(b)) a tax 
determined in accordance with the following table:

``If taxable income is:             The tax is:
    Not over $30,500...............
                                        15% of taxable income.
    Over $30,500 but not over 
        $78,750.
                                        $4,575, plus 30% of the excess 
                                                over $30,500.
    Over $78,750 but not over 
        $172,000.
                                        $19,532.50, plus 34% of the 
                                                excess over $78,750.
    Over $172,000..................
                                        $51,237.50, plus 38% of the 
                                                excess over $172,000.
    ``(c) Unmarried Individuals (Other Than Surviving Spouses and Heads 
of Households).--There is hereby imposed on the taxable income of every 
individual (other than a surviving spouse as defined in section 2(a) or 
the head of a household as defined in section 2(b)) who is not a 
married individual (as defined in section 770) a tax determined in 
accordance with the following table:

``If taxable income is:             The tax is:
    Not over $22,750...............
                                        15% of taxable income.
    Over $22,750 but not over 
        $55,150.
                                        $3,412.50, plus 30% of the 
                                                excess over $22,750.
    Over $55,150 but not over 
        $120,000.
                                        $13,456.50, plus 34% of the 
                                                excess over $55,150.
    Over $120,000..................
                                        $35,505, plus 38% of the excess 
                                                over $120,000.
    ``(d) Married Individuals Filing Separate Returns.--There is hereby 
imposed on the taxable income of every married individual (as defined 
in section 7703) who does not make a single return jointly with his 
spouse under section 6013, a tax determined in accordance with the 
following table:

``If taxable income is:             The tax is:
    Not over $19,000...............
                                        15% of taxable income.
    Over $19,000 but not over 
        $45,950.
                                        $2,850, plus 30% of the excess 
                                                over $19,000.
    Over $45,950 but not over 
        $100,000.
                                        $11,204.50, plus 34% of the 
                                                excess over $45,950.
    Over $100,000..................
                                        $29,581.50, plus 38% of the 
                                                excess over $100,000.
    ``(e) Estates and Trusts.--There is hereby imposed on the taxable 
income of--
            ``(1) every estate, and
            ``(2) every trust,
taxable under this subsection a tax determined in accordance with the 
following table:

``If taxable income is:             The tax is:
    Not over $3,000................
                                        15% of taxable income.
    Over $3,000 but not over $5,000
                                        $450, plus 30% of the excess 
                                                over $3,000.
    Over $5,000 but not over $7,000
                                        $1,070, plus 34% of the excess 
                                                over $5,000.
    Over $7,000....................
                                        $1,750, plus 38% of the excess 
                                                over $7,000.''.
    (c) Conforming Amendments.--
            (1) Section 541 is amended by striking ``28 percent'' and 
        inserting ``30 percent''.
            (2)(A) Subsection (f) of section 1 is amended--
                    (i) by striking ``1990'' in paragraph (1) and 
                inserting ``1995'', and
                    (ii) by striking ``1989'' in paragraph (3)(B) and 
                inserting ``1994''.
            (B) Subparagraph (B) of section 32(i)(1) is amended by 
        striking ``1989'' and inserting ``1994''.
            (C) Subparagraph (C) of section 41(e)(5) is amended by 
        striking ``1989'' each place it appears and inserting ``1994''.
            (D) Subparagraph (B) of section 63(c)(4) is amended by 
        striking ``1989'' and inserting ``1994''.
            (E) Subparagraph (B) of section 68(b)(2) is amended by 
        striking ``1989'' and inserting ``1994''.
            (F) Subparagraphs (A)(ii) and (B)(ii) of section 151(d)(4) 
        are each amended by striking ``1989'' and inserting ``1994''.
            (G) Clause (ii) of section 513(h)(2)(C) is amended by 
        striking ``1989'' and inserting ``1994''.
            (H) Subsection (a) of section 1201 is amended by striking 
        ``34 percent'' each place it appears and inserting ``38 
        percent''.
    (d) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 1994.

SEC. 812. INCREASES IN MINIMUM TAX RATES.

    (a) In General.--Subparagraph (A) of section 55(b)(1) (relating to 
tentative minimum tax) is amended by striking ``20 percent (24 
percent'' and inserting ``25 percent (28 percent''.
    (b) Conforming Amendment.--Paragraph (2) of section 897(a) is 
amended by striking ``21'' in the heading of such paragraph and in 
subparagraph (A) and inserting ``28''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 1994.

SEC. 813. HEALTH SECURITY PREMIUM.

    (a) General Rule.--Subchapter A of chapter 1 (relating to 
determination of tax liability) is amended by adding at the end thereof 
the following new part:

                  ``PART VIII--HEALTH SECURITY PREMIUM

                              ``Sec. 59B. Imposition of premium.

``SEC. 59B. IMPOSITION OF PREMIUM.

    ``(a) General Rule.--In the case of an individual--
            ``(1) the amount of the tax imposed under section 1 for 
        such taxable year shall be increased by 7.5 percent of the tax 
        imposed under section 1 for such taxable year (determined 
        without regard to this paragraph and section 59C), and
            ``(2) the amount of the tentative minimum tax determined 
        under section 55 for such taxable year shall be increased by 
        7.5 percent of the amount of the tentative minimum tax for such 
        taxable year (determined without regard to this paragraph and 
        59D).
    ``(b) Special Rules.--
            ``(1) Surtax to apply to estates and trusts.--For purposes 
        of this section, the term `individual' includes any estate or 
        trust taxable under section 1.
            ``(2) Coordination with other provisions.--The provisions 
        of this section shall be applied--
                    ``(A) shall be applied after the application of 
                section 1(h), but
                    ``(B) before the application of any other provision 
                of this title which refers to the amount of tax imposed 
                by section 1 or 55, as the case may be.''.
    (b) Clerical Amendment.--The table of parts for subchapter A of 
chapter 1 is amended by adding at the end the following new item:

                              ``Part VIII. Health security premium.''
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 1993.

SEC. 814. SURTAX ON INDIVIDUALS WITH INCOMES OVER $1,000,000.

    (a) General Rule.--Subchapter A of chapter 1 (relating to 
determination of tax liability) is amended by adding at the end thereof 
the following new part:

     ``PART IX--SURTAX ON INDIVIDUALS WITH INCOMES OVER $1,000,000

                              ``Sec. 59C. Surtax on section 1 tax.
                              ``Sec. 59D. Surtax on minimum tax.
                              ``Sec. 59E. Special rules.

``SEC. 59C. SURTAX ON SECTION 1 TAX.

    ``In the case of an individual who has taxable income for the 
taxable year in excess of $1,000,000, the amount of the tax imposed 
under section 1 for such taxable year shall be increased by 10 percent 
of the amount which bears the same ratio to the tax imposed under 
section 1 (determined without regard to this section and section 59B) 
as--
            ``(1) the amount by which the taxable income of such 
        individual for such taxable year exceeds $1,000,000, bears to
            ``(2) the total amount of such individual's taxable income 
        for such taxable year.

``SEC. 59D. SURTAX ON MINIMUM TAX.

    ``In the case of an individual who has alternative minimum taxable 
income for the taxable year in excess of $1,000,000, the amount of the 
tentative minimum tax determined under section 55 for such taxable year 
shall be increased by 2.8 percent of the amount by which the 
alternative minimum taxable income of such taxpayer for the taxable 
year exceeds $1,000,000.

``SEC. 59E. SPECIAL RULES.

    ``(a) Surtax To Apply to Estates and Trusts.--For purposes of this 
part, the term `individual' includes any estate or trust taxable under 
section 1.
    ``(b) Treatment of Married Individuals Filing Separate Returns.--In 
the case of a married individual (within the meaning of section 7703) 
filing a separate return for the taxable year, sections 59C and 59D 
shall be applied by substituting `$500,000' for `$1,000,000'.
    ``(c) Coordination With Other Provisions.--The provisions of this 
part--
            ``(1) shall be applied after the application of sections 
        1(h) and 59B, but
            ``(2) before the application of any other provision of this 
        title which refers to the amount of tax imposed by section 1 or 
        55, as the case may be.''.
    (b) Clerical Amendment.--The table of parts for subchapter A of 
chapter 1 is amended by adding at the end the following new item:

                              ``Part IX. Surtax on individuals with 
                                        incomes over $1,000,000.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 1994.

                   Subtitle C--Employment Tax Changes

SEC. 821. MODIFICATIONS OF CERTAIN EMPLOYMENT TAX PROVISIONS.

    (a) Increase in Employer Hospital Insurance Tax; Repeal of Dollar 
Limitation on Amount of Wages Subject to Employee and Employer Hospital 
Insurance Taxes.--
            (1) Employee tax.--Subsection (b) of section 3101 is 
        amended by striking ``equal to'' and all that follows and 
        inserting ``equal to 1.45 percent of the wages (as defined in 
        section 3121(a) without regard to paragraph (1) thereof) 
        received by him with respect to employment (as defined in 
        section 3121(b))''.
            (2) Employer tax.--Subsection (b) of section 3111 is 
        amended by striking ``equal to'' and all that follows and 
        inserting ``equal to 7.9 percent of the wages (as defined in 
        section 3121(a) without regard to paragraph (1) thereof) paid 
        by him with respect to employment (as defined in section 
        3121(b))''.
            (3) Self-employment tax.--Subsection (b) of section 1401 is 
        amended by striking ``a tax as follows:'' and all that follows 
        and inserting ``a tax equal to 8.35 percent of the amount of 
        the self-employment income (as defined in section 1402(b) 
        without regard to paragraph (1) thereof) for such taxable 
        year''.
            (4) Railroad retirement taxes.--Subparagraph (A) of section 
        3231(e)(2) is amended by adding at the end thereof the 
        following new clause:
                            ``(iii) Limitation not to apply to taxes 
                        equivalent to hospital insurance taxes.--Clause 
                        (i) shall not apply to--
                                    ``(I) so much of the rate 
                                applicable under section 3201(a) or 
                                3221(a) (as the case may be) as does 
                                not exceed the rate of tax in effect 
                                under section 3101(b), and
                                    ``(II) so much of the rate of tax 
                                applicable under section 3211(a)(1) as 
                                does not exceed the rate of tax in 
                                effect under section 1401(b).''.
            (5) Technical amendments.--
                    (A) Subsection (b) of section 1402 is amended by 
                striking ``the applicable contribution base (as 
                determined under subsection (k))'' and inserting ``the 
                contribution and benefit base (as determined under 
                section 231 of the Social Security Act)''.
                    (B) Section 1402 is amended by striking subsection 
                (k).
                    (C) Paragraph (1) of section 3121(a) is amended--
                            (i) by striking ``applicable contribution 
                        base (as determined under subsection (x))'' 
                        each place it appears and inserting 
                        ``contribution and benefit base (as determined 
                        under section 230 of the Social Security 
                        Act)'', and
                            (ii) by striking ``such applicable 
                        contribution base'' and inserting ``such 
                        contribution and benefit base''.
                    (D) Section 3121 is amended by striking subsection 
                (x).
                    (E) Clause (i) of section 3231(e)(2)(B) is amended 
                to read as follows:
                            ``(i) Tier 1 taxes.--Except as provided in 
                        clause (ii), the term `applicable base' means 
                        for any calendar year the contribution and 
                        benefit base determined under section 230 of 
                        the Social Security Act for such calendar 
                        year.''
                    (F) Paragraph (3) of section 6413(c) is amended to 
                read as follows:
            ``(3) Separate application for hospital insurance taxes.--
        Paragraphs (1) and (2) shall not apply to--
                    ``(A) the tax imposed by section 3101(b) (or any 
                amount equivalent to such tax), and
                    ``(B) so much of the tax imposed by section 3201 as 
                is determined at a rate not greater than the rate in 
                effect under section 3101(b).''.
                    (G) Sections 3122 and 3125 are each amended--
                            (i) by striking ``section 3111'' each place 
                        it appears and inserting ``section 3111(a)'', 
                        and
                            (ii) by striking ``applicable contribution 
                        base limitation'' and inserting ``contribution 
                        and benefit base limitation''.
            (6) Effective date.--The amendments made by this subsection 
        shall apply to 1994 and later calendar years.
    (b) Additional State and Local Employees Subject To Hospital 
Insurance Tax.--
            (1) In general.--Paragraph (2) of section 3121(u) is 
        amended by striking subparagraphs (C) and (D).
            (2) Effective date.--The amendment made by this subsection 
        shall apply to remuneration paid after December 31, 1994.

  Subtitle D--Other Revenue Increases Primarily Affecting Individuals

SEC. 831. OVERALL LIMITATION ON ITEMIZED DEDUCTIONS FOR HIGH-INCOME 
              TAXPAYERS MADE PERMANENT.

    Subsection (f) of section 68 (relating to overall limitation on 
itemized deductions) is hereby repealed.

SEC. 832. PHASEOUT OF PERSONAL EXEMPTION OF HIGH-INCOME TAXPAYERS MADE 
              PERMANENT.

    Section 151(d)(3) (relating to phaseout of personal exemption) is 
amended by striking subparagraph (E).

SEC. 833. MODIFICATIONS TO DEDUCTIONS FOR CERTAIN MOVING EXPENSES.

    (a) Repeal of Deduction for Qualified Residence Sale, Etc., 
Expenses.--
            (1) In general.--Paragraph (1) of section 217(b) (defining 
        moving expenses) is amended by inserting ``or'' at the end of 
        subparagraph (C), by striking ``, or'' at the end of 
        subparagraph (D) and inserting a period, and by striking 
        subparagraph (E).
            (2) Conforming amendments.--
                    (A) Subsection (b) of section 217 is amended by 
                striking paragraph (2) and redesignating paragraph (3) 
                as paragraph (2).
                    (B) Section 217 is amended by striking subsection 
                (e).
    (b) Deduction Disallowed for Meal Expenses.--Paragraph (1) of 
section 217(b) is amended--
            (1) by striking ``meals and lodging'' in subparagraphs (B), 
        (C) and (D) and inserting ``lodging'', and
            (2) by adding at the end thereof the following new 
        sentence:
        ``Such term shall not include any expenses for meals.''.
    (c) Overall Limitation.--
            (1) In general.--Subparagraph (A) of section 217(b)(2) (as 
        redesignated by subsection (a)) is amended to read as follows:
                    ``(A) Dollar limits.--The aggregate amount 
                allowable as a deduction under subsection (a) in 
                connection with a commencement of work shall not exceed 
                $5,000. The aggregate amount allowable as a deduction 
                under subsection (a) in connection with a commencement 
                of work which is attributable to expenses described in 
                subparagraphs (C) or (D) of paragraph (1) shall not 
                exceed $1,500.''.
            (2) Conforming amendments.--
                    (A) Subparagraph (B) of section 217(b)(2) (as so 
                redesignated) is amended by striking the second 
                sentence and inserting the following: ``In the case of 
                a husband and wife filing separate returns, 
                subparagraph (A) shall be applied by substituting 
                `$750' for `$1,500', and by substituting `$2,500' for 
                `$5,000'.''.
                    (B) Paragraph (1) of section 217(h) is amended by 
                striking subparagraphs (B) and (C) and inserting the 
                following:
                    ``(B) subsection (b)(2)(A) shall be applied by 
                substituting `$4,500' for `$1,500', and
                    ``(C) appropriate adjustments to the application of 
                the last sentence of subsection (b)(2)(B) shall be made 
                to take into account the provisions of subparagraph (B) 
                of this paragraph.''.
    (d) Increase in Mileage Requirements.--Paragraph (1) of section 
217(c) is amended by striking ``35 miles'' each place it appears and 
inserting ``60 miles''.
    (e) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 1994.

SEC. 834. TOP ESTATE AND GIFT TAX RATES MADE PERMANENT.

    (a) General Rule.--The table contained in paragraph (1) of section 
2001(c) is amended by striking the last item and inserting the 
following new items:

    ``Over $2,500,000 but not over 
        $3,000,000.
                                        $1,025,800, plus 53% of the 
                                                excess over $2,500,000.
    Over $3,000,000................
                                        $1,290,800, plus 55% of the 
                                                excess over 
                                                $3,000,000.''.
    (b) Conforming Amendments.--
            (1) Subsection (c) of section 2001 is amended by striking 
        paragraph (2) and by redesignating paragraph (3) as paragraph 
        (2).
            (2) Paragraph (2) of section 2001(c), as redesignated by 
        paragraph (1), is amended by striking ``($18,340,000 in the 
        case of decedents dying, and gifts made, after 1992)''.
    (c) Effective Date.--The amendments made by this section shall 
apply in the case of decedents dying, and gifts made, after December 
31, 1994.

SEC. 835. ELIMINATION OF DEDUCTION FOR CLUB MEMBERSHIP FEES.

    (a) In General.--Subsection (a) of section 274 (relating to 
disallowance of certain entertainment, etc., expenses) is amended by 
adding at the end thereof the following new paragraph:
            ``(3) Denial of deduction for club dues.--Notwithstanding 
        the preceding provisions of this subsection, no deduction shall 
        be allowed under this chapter for amounts paid or incurred for 
        membership in any club organized for business, pleasure, 
        recreation, or other social purpose.''.
    (b) Effective Date.--The amendment made by this section shall apply 
to amounts paid or incurred after December 31, 1994.

SEC. 836. INCREASE OF SOCIAL SECURITY BENEFITS INCLUDED IN INCOME.

    (a) In General.--Subsections (a) and (b) of section 86 are each 
amended by striking ``one-half'' each place it appears and inserting 
``85 percent''.
    (b) Effective Date.--The amendment made by this section shall apply 
to taxable years beginning after December 31, 1994.

SEC. 837. LONG-TERM HEALTH CARE PREMIUM FOR THE ELDERLY.

    (a) In General.--Except as provided in subsection (b), each 
individual who at any time in a month is 65 years of age or older and 
is eligible for benefits under title XXI of the Social Security Act in 
the month shall pay a long-term care/health care premium for the month 
of $65.
    (b) Exception For Low-Income Elderly.--The Secretary of Health and 
Human Services shall provide a process whereby individuals with an 
adjusted gross income which does not exceed $8,500 (or $10,700 in the 
case of joint adjusted gross income in the case of a married 
individual) are not liable for the premium imposed under paragraph (1).
    (c) Collection of Premium.--The premium imposed under this section 
shall be collected in the same manner (including deduction from Social 
Security checks) as the premium imposed under part B of title XVIII of 
the Social Security Act was collected under section 1840 of such Act as 
of the date of the enactment of this Act.
    (d) Deposit Into National Health Trust Fund.--Premiums collected 
under this section shall be transferred to and deposited into the 
National Health Trust Fund in the same manner as premiums collected 
under section 1840 of the Social Security Act were transferred and 
deposited into the Federal Supplementary Medical Insurance Trust Fund.
    (e) Cost-of-Living Adjustment.--In the case of months beginning in 
any calendar year after 1996, each of the dollar amounts contained in 
subsections (a) and (b) shall be increased by an amount equal to such 
dollar amount, multiplied by the cost-of-living adjustment determined 
under section 1(f)(3) of the Internal Revenue Code of 1986 for the 
calendar year in which the month begins.
    (f) Application of Section.--This section shall apply to months 
beginning after December 31, 1994.

   Subtitle E--Other Revenue Increases Primarily Affecting Businesses

SEC. 841. MARK TO MARKET ACCOUNTING METHOD FOR SECURITIES DEALERS.

    (a) General Rule.--Subpart D of part II of subchapter E of chapter 
1 (relating to inventories) is amended by adding at the end thereof the 
following new section:

``SEC. 475. MARK TO MARKET ACCOUNTING METHOD FOR DEALERS IN SECURITIES.

    ``(a) General Rule.--Notwithstanding any other provision of this 
subpart, the following rules shall apply to securities held by a dealer 
in securities:
            ``(1) Any security which is inventory in the hands of the 
        dealer shall be included in inventory at its fair market value.
            ``(2) In the case of any security which is not inventory in 
        the hands of the dealer and which is held at the close of any 
        taxable year--
                    ``(A) the dealer shall recognize gain or loss as if 
                such security were sold for its fair market value on 
                the last business day of such taxable year, and
                    ``(B) any gain or loss shall be taken into account 
                for such taxable year.
        Proper adjustment shall be made in the amount of any gain or 
        loss subsequently realized for gain or loss taken into account 
        under the preceding sentence. The Secretary may provide by 
        regulations for the application of this paragraph at times 
        other than the times provided in this paragraph.
    ``(b) Exceptions.--
            ``(1) In general.--Subsection (a) shall not apply to--
                    ``(A) any security held for investment,
                    ``(B)(i) any security described in subsection 
                (c)(2)(C) which is acquired (including originated) by 
                the taxpayer in the ordinary course of a trade or 
                business of the taxpayer and which is not held for 
                sale, and (ii) any obligation to acquire a security 
                described in clause (i) if such obligation is entered 
                into in the ordinary course of such trade or business 
                and is not held for sale, and
                    ``(C) any security which is a hedge with respect 
                to--
                            ``(i) a security to which subsection (a) 
                        does not apply, or
                            ``(ii) a position, right to income, or a 
                        liability which is not a security in the hands 
                        of the taxpayer.
        To the extent provided in regulations, subparagraph (C) shall 
        not apply to any security held by a person in its capacity as a 
        dealer in securities.
            ``(2) Identification required.--A security shall not be 
        treated as described in subparagraph (A), (B), or (C) of 
        paragraph (1), as the case may be, unless such security is 
        clearly identified in the dealer's records as being described 
        in such subparagraph before the close of the day on which it 
        was acquired, originated, or entered into (or such other time 
        as the Secretary may by regulations prescribe).
            ``(3) Securities subsequently not exempt.--If a security 
        ceases to be described in paragraph (1) at any time after it 
        was identified as such under paragraph (2), subsection (a) 
        shall apply to any changes in value of the security occurring 
        after the cessation.
            ``(4) Special rule for property held for investment.--To 
        the extent provided in regulations, subparagraph (A) of 
        paragraph (1) shall not apply to any security described in 
        subparagraph (D) or (E) of subsection (c)(2) which is held by a 
        dealer in such securities.
    ``(c) Definitions.--For purposes of this section--
            ``(1) Dealer in securities defined.--The term `dealer in 
        securities' means a taxpayer who--
                    ``(A) regularly purchases securities from or sells 
                securities to customers in the ordinary course of a 
                trade or business; or
                    ``(B) regularly offers to enter into, assume, 
                offset, assign or otherwise terminate positions in 
                securities with customers in the ordinary course of a 
                trade or business.
            ``(2) Security defined.--The term `security' means any--
                    ``(A) share of stock in a corporation;
                    ``(B) partnership or beneficial ownership interest 
                in a widely held or publicly traded partnership or 
                trust;
                    ``(C) note, bond, debenture, or other evidence of 
                indebtedness;
                    ``(D) interest rate, currency, or equity notional 
                principal contract;
                    ``(E) evidence of an interest in, or a derivative 
                financial instrument in, any security described in 
                subparagraph (A), (B), (C), or (D), or any currency, 
                including any option, forward contract, short position, 
                and any similar financial instrument in such a security 
                or currency; and
                    ``(F) position which--
                            ``(i) is not a security described in 
                        subparagraph (A), (B), (C), (D), or (E),
                            ``(ii) is a hedge with respect to such a 
                        security, and
                            ``(iii) is clearly identified in the 
                        dealer's records as being described in this 
                        subparagraph before the close of the day on 
                        which it was acquired or entered into (or such 
                        other time as the Secretary may by regulations 
                        prescribe).
        Subparagraph (E) shall not include any contract to which 
        section 1256(a) applies.
            ``(3) Hedge.--The term `hedge' means any position which 
        reduces the dealer's risk of interest rate or price changes or 
        currency fluctuations, including any position which is 
        reasonably expected to become a hedge within 60 days after the 
        acquisition of the position.
    ``(d) Special Rules.--For purposes of this section--
            ``(1) Coordination with certain rules.--The rules of 
        sections 263(g), 263A, and 1256(a) shall not apply to 
        securities to which subsection (a) applies, and section 1091 
        shall not apply (and section 1092 shall apply) to any loss 
        recognized under subsection (a).
            ``(2) Improper identification.--If a taxpayer--
                    ``(A) identifies any security under subsection 
                (b)(2) as being described in subsection (b)(1) and such 
                security is not so described, or
                    ``(B) fails under subsection (c)(2)(F)(iii) to 
                identify any position which is described in subsection 
                (c)(2)(F) (without regard to clause (iii) thereof) at 
                the time such identification is required,
        the provisions of subsection (a) shall apply to such security 
        or position, except that any loss under this section prior to 
        the disposition of the security or position shall be recognized 
        only to the extent of gain previously recognized under this 
        section (and not previously taken into account under this 
        paragraph) with respect to such security or position.
            ``(3) Character of gain or loss.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B) or section 1236(b)--
                            ``(i) In general.--Any gain or loss with 
                        respect to a security under subsection (a)(2) 
                        shall be treated as ordinary income or loss.
                            ``(ii) Special rule for dispositions.--If--
                                    ``(I) gain or loss is recognized 
                                with respect to a security before the 
                                close of the taxable year, and
                                    ``(II) subsection (a)(2) would have 
                                applied if the security were held as of 
                                the close of the taxable year,
                        such gain or loss shall be treated as ordinary 
                        income or loss.
                    ``(B) Exception.--Subparagraph (A) shall not apply 
                to any gain or loss which is allocable to a period 
                during which--
                            ``(i) the security is described in 
                        subsection (b)(1)(C) (without regard to 
                        subsection (b)(2)),
                            ``(ii) the security is held by a person 
                        other than in connection with its activities as 
                        a dealer in securities, or
                            ``(iii) the security is improperly 
                        identified (within the meaning of subparagraph 
                        (A) or (B) of paragraph (2)).
    ``(e) Regulatory Authority.--The Secretary shall prescribe such 
regulations as may be necessary or appropriate to carry out the 
purposes of this section, including rules--
            ``(1) to prevent the use of year-end transfers, related 
        parties, or other arrangements to avoid the provisions of this 
        section, and
            ``(2) to provide for the application of this section to any 
        security which is a hedge which cannot be identified with a 
        specific security, position, right to income, or liability.''.
    (b) Conforming Amendments.--
            (1) Paragraph (1) of section 988(d) is amended--
                    (A) by striking ``section 1256'' and inserting 
                ``section 475 or 1256'', and
                    (B) by striking ``1092 and 1256'' and inserting 
                ``475, 1092, and 1256''.
            (2) The table of sections for subpart D of part II of 
        subchapter E of chapter 1 is amended by adding at the end 
        thereof the following new item:

                              ``Sec. 475. Mark to market accounting 
                                        method for dealers in 
                                        securities.''.
    (c) Effective Date.--
            (1) In general.--The amendments made by this section shall 
        apply to all taxable years ending on or after December 31, 
        1994.
            (2) Change in method of accounting.--In the case of any 
        taxpayer required by this section to change its method of 
        accounting for any taxable year--
                    (A) such change shall be treated as initiated by 
                the taxpayer,
                    (B) such change shall be treated as made with the 
                consent of the Secretary, and
                    (C) the net amount of the adjustments required to 
                be taken into account by the taxpayer under section 481 
                of the Internal Revenue Code of 1986 shall be taken 
                into account ratably over the 4-taxable year period 
                beginning with the first taxable year ending on or 
                after December 31, 1994.

SEC. 842. INCREASE IN RECOVERY PERIOD FOR NONRESIDENTIAL REAL PROPERTY.

    (a) General Rule.--Paragraph (1) of section 168(c) (relating to 
applicable recovery period) is amended by striking the item relating to 
nonresidential real property and inserting the following:

    ``Nonresidential real property................         40 years.''.
    (b) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendment made by subsection (a) shall apply to property placed 
        in service by the taxpayer after December 31, 1994.
            (2) Exception.--The amendments made by this section shall 
        not apply to property placed in service by the taxpayer before 
        January 1, 1996, if--
                    (A) the taxpayer or a qualified person entered into 
                a binding written contract to purchase or construct 
                such property before December 31, 1994, or
                    (B) the construction of such property was commenced 
                by or for the taxpayer or a qualified person before 
                December 31, 1994.
        For purposes of this paragraph, the term ``qualified person'' 
        means any person who transfers his rights in such a contract or 
        such property to the taxpayer but only if the property is not 
        placed in service by such person before such rights are 
        transferred to the taxpayer.

SEC. 843. TAXATION OF INCOME OF CONTROLLED FOREIGN CORPORATIONS 
              ATTRIBUTABLE TO IMPORTED PROPERTY.

    (a) General Rule.--Subsection (a) of section 954 (defining foreign 
base company income) is amended by striking ``and'' at the end of 
paragraph (4), by striking the period at the end of paragraph (5) and 
inserting ``, and'', and by adding at the end thereof the following new 
paragraph:
            ``(6) imported property income for the taxable year 
        (determined under subsection (h) and reduced as provided in 
        subsection (b)(5)).''.
    (b) Definition of Imported Property Income.--Section 954 is amended 
by adding at the end thereof the following new subsection:
    ``(h) Imported Property Income.--
            ``(1) In general.--For purposes of subsection (a)(6), the 
        term `imported property income' means income (whether in the 
        form of profits, commissions, fees, or otherwise) derived in 
        connection with--
                    ``(A) manufacturing, producing, growing, or 
                extracting imported property,
                    ``(B) the sale, exchange, or other disposition of 
                imported property, or
                    ``(C) the lease, rental, or licensing of imported 
                property.
        Such term shall not include any foreign oil and gas extraction 
        income (within the meaning of section 907(c)) or any foreign 
        oil related income (within the meaning of section 907(c)).
            ``(2) Imported property.--For purposes of this subsection--
                    ``(A) In general.--Except as otherwise provided in 
                this paragraph, the term `imported property' means 
                property which is imported into the United States by 
                the controlled foreign corporation or a related person.
                    ``(B) Imported property includes certain property 
                imported by unrelated persons.--The term `imported 
                property' includes any property imported into the 
                United States by an unrelated person if, when such 
                property was sold to the unrelated person by the 
                controlled foreign corporation (or a related person), 
                it was reasonable to expect that--
                            ``(i) such property would be imported into 
                        the United States, or
                            ``(ii) such property would be used as a 
                        component in other property which would be 
                        imported into the United States.
                    ``(C) Exception for property subsequently 
                exported.--The term `imported property' does not 
                include any property which is imported into the United 
                States and which--
                            ``(i) before substantial use in the United 
                        States, is sold, leased, or rented by the 
                        controlled foreign corporation or a related 
                        person for direct use, consumption, or 
                        disposition outside the United States, or
                            ``(ii) is used by the controlled foreign 
                        corporation or a related person as a component 
                        in other property which is so sold, leased, or 
                        rented.
            ``(3) Definitions and special rules.--
                    ``(A) Import.--For purposes of this subsection, the 
                term `import' means entering, or withdrawal from 
                warehouse, for consumption or use. Such term includes 
                any grant of the right to use an intangible (as defined 
                in section 936(b)(3)(B)) in the United States.
                    ``(B) Unrelated person.--For purposes of this 
                subsection, the term `unrelated person' means any 
                person who is not a related person with respect to the 
                controlled foreign corporation.
                    ``(C) Coordination with foreign base company sales 
                income.--For purposes of this section, the term 
                `foreign base company sales income' shall not include 
                any imported property income.''.
    (c) Separate Application of Limitations on Foreign Tax Credit for 
Imported Property Income.--
            (1) In general.--Paragraph (1) of section 904(d) (relating 
        to separate application of section with respect to certain 
        categories of income) is amended by striking ``and'' at the end 
        of subparagraph (H), by redesignating subparagraph (I) as 
        subparagraph (J), and by inserting after subparagraph (H) the 
        following new subparagraph:
                    ``(I) imported property income, and''.
            (2) Imported property income defined.--Paragraph (2) of 
        section 904(d) is amended by redesignating subparagraphs (H) 
        and (I) as subparagraphs (I) and (J), respectively, and by 
        inserting after subparagraph (G) the following new 
        subparagraph:
                    ``(H) Imported property income.--The term `imported 
                property income' means any income received or accrued 
                by any person which is of a kind which would be 
                imported property income (as defined in section 
                954(h)).''
            (3) Look-thru rules to apply.--Subparagraph (F) of section 
        904(d)(3) is amended by striking ``or (E)'' and inserting 
        ``(E), or (H)''.
    (d) Technical Amendments.--
            (1) Clause (iii) of section 952(c)(1)(B) (relating to 
        certain prior year deficits may be taken into account) is 
        amended by inserting the following subclause after subclause 
        (II) (and by redesignating the following subclauses 
        accordingly):
                            ``(III) imported property income,''.
            (2) Paragraph (5) of section 954(b) (relating to deductions 
        to be taken into account) is amended by striking ``and the 
        foreign base company oil related income'' and inserting ``the 
        foreign base company oil related income, and the imported 
        property income''.
    (e) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section shall apply to taxable years of 
        foreign corporations beginning after December 31, 1994, and to 
        taxable years of United States shareholders within which or 
        with which such taxable years of such foreign corporations end.
            (2) Subsection (c).--The amendments made by subsection (c) 
        shall apply to taxable years beginning after December 31, 1994.

SEC. 844. REPEAL OF DEDUCTION FOR INTANGIBLE DRILLING AND DEVELOPMENT 
              COSTS.

    (a) In General.--Subsection (c) of section 263 (relating to capital 
expenditures) is hereby repealed.
    (b) Conforming Amendment.--Section 57 (relating to items of tax 
preference) is amended by striking subsections (a)(2) and (b).
    (c) Effective Date.--The amendments made by this section shall 
apply to costs paid or incurred after December 31, 1994, in taxable 
years ending after such date.

SEC. 845. REPEAL OF PERCENTAGE DEPLETION FOR OIL AND GAS WELLS.

    (a) In General.--Section 613A is hereby repealed.
    (b) Conforming Amendments.--
            (1) Subsection (d) of section 613 (relating to percentage 
        depletion) is amended by striking ``Except as provided in 
        section 613A, in'' and inserting ``In''.
            (2) Paragraph (1) of section 57(a) is amended by striking 
        the last sentence.
            (3) The table of sections for part I of subchapter I of 
        chapter 1 is amended by striking the item relating to section 
        613A.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 1994.

SEC. 846. REPEAL OF APPLICATION OF LIKE-KIND EXCHANGE RULES TO REAL 
              PROPERTY.

    (a) In General.--Paragraph (2) of section 1031(a) (relating to 
exchange of property held for productive use or investment) is amended 
by striking ``or'' at the end of subparagraph (E), by striking the 
period at the end of subparagraph (F) and inserting ``, or'', and by 
adding at the end thereof the following new subparagraph:
                    ``(G) real property.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to transfers after December 31, 1994.

SEC. 847. AMORTIZATION OF PORTION OF ADVERTISING EXPENSES.

    (a) In General.--Part IX of subchapter B of chapter 1 (relating to 
items not deductible) is amended by inserting after section 263A the 
following new section:

``SEC. 263B. CAPITALIZATION OF PORTION OF ADVERTISING EXPENSES.

    ``(a) 20 Percent of Advertising Expenses Required To Be 
Capitalized.--
            ``(1) Disallowance.--Except as provided in paragraph (2), 
        no deduction shall be allowed for 20 percent of the advertising 
        expenses paid or incurred by the taxpayer during the taxable 
        year.
            ``(2) Amortization of disallowed amount.--The amount not 
        allowed as a deduction under paragraph (1) for any taxable 
        year--
                    ``(A) shall be treated as chargeable to capital 
                account with respect to the trade or business (or 
                activity described in section 212) in which incurred, 
                and
                    ``(B) shall be allowed as a deduction ratably over 
                the 48-month period beginning with the 1st month of the 
                following taxable year.
    ``(b) Advertising Expenses.--For purposes of this section--
            ``(1) In general.--The term `advertising expense' means any 
        amount--
                    ``(A) which (without regard to this section) is 
                allowable as a deduction under section 162 or 212 for 
                the taxable year in which paid or incurred, and
                    ``(B) which is paid or incurred in connection with 
                an attempt to encourage the purchase or sale, lease, or 
                use of any product or service for the benefit of the 
                taxpayer or a related person by means of any media.
            ``(2) Amounts deductible as depreciation or amortization 
        treated as expenses.--The amount allowable as a deduction under 
        this chapter for the taxable year for depreciation or 
        amortization shall be treated for purposes of this section as 
        an expense paid or incurred during such year which is described 
        in paragraph (1).''.
    (b) Clerical Amendment.--The table of sections for such part IX is 
amended by inserting after the item relating to section 263A the 
following new item:

                              ``Sec. 263B. Capitalization of portion of 
                                        advertising expenses.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to amounts paid or incurred after December 31, 1994, in taxable 
years ending after such date.

                  Subtitle F--Estimated Tax Provisions

SEC. 851. INDIVIDUAL ESTIMATED TAX PROVISIONS.

    (a) General Rule.--Paragraph (1) of section 6654(d) (relating to 
amount of required installment) is amended--
            (1) by striking ``100 percent'' in subparagraph (B)(ii) and 
        inserting ``120 percent'', and
            (2) by striking subparagraphs (C), (D), (E), and (F).
    (b) Conforming Amendments.--
            (1) Subparagraph (C) of section 6654(i)(1) is amended by 
        striking ``and without regard to subparagraph (C) of subsection 
        (d)(1)''.
            (2) Subparagraph (A) of section 6654(j)(3) is amended by 
        striking ``and subsection (d)(1)(C)(iii) shall not apply''.
            (3) Paragraph (4) of section 6654(l) is amended by striking 
        ``paragraphs (1)(C)(iv) and (2)(B)(i) of subsection (d)'' and 
        inserting ``subsection (d)(2)(B)(i)''.
    (c) Effective Date.--The amendments made by this subsection shall 
apply to taxable years beginning after December 31, 1994.

SEC. 852. CORPORATE ESTIMATED TAX PROVISIONS.

    (a) Increase in Estimated Tax.--
            (1) In general.--Subsection (d) of section 6655 (relating 
        to amount of required installments) is amended--
                    (A) by striking ``91 percent'' each place it 
                appears in paragraph (1)(B)(i) and inserting ``100 
                percent'',
                    (B) by striking ``91 percent'' in the heading of 
                paragraph (2) and inserting ``100 percent'', and
                    (C) by striking paragraph (3).
            (2) Conforming amendments.--
                    (A) Clause (ii) of section 6655(e)(2)(B) is amended 
                by striking the table contained therein and inserting 
                the following new table:

                    
                                                                    The
                    ``In the case of the following
                                                             applicable
                      required installments:
                                                         percentage is:
                            1st......................                25
                            2nd......................                50
                            3rd......................                75
                            4th......................           100.''.

                    (B) Clause (i) of section 6655(e)(3)(A) is amended 
                by striking ``91 percent'' and inserting ``100 
                percent''.
    (b) Modification of Periods for Applying Annualization.--
            (1) Clause (i) of section 6655(e)(2)(A) is amended--
                    (A) by striking ``or for the first 5 months'' in 
                subclause (II),
                    (B) by striking ``or for the first 8 months'' in 
                subclause (III), and
                    (C) by striking ``or for the first 11 months'' in 
                subclause (IV).
            (2) Paragraph (2) of section 6655(e) is amended by adding 
        at the end thereof the following new subparagraph:
                    ``(C) Election for different annualization 
                periods.--
                            ``(i) If the taxpayer makes an election 
                        under this clause--
                                    ``(I) subclause (II) of 
                                subparagraph (A)(i) shall be applied by 
                                substituting `4 months' for `3 months',
                                    ``(II) subclause (III) of 
                                subparagraph (A)(i) shall be applied by 
                                substituting `7 months' for `6 months', 
                                and
                                    ``(III) subclause (IV) of 
                                subparagraph (A)(i) shall be applied by 
                                substituting `10 months' for `9 
                                months'.
                            ``(ii) If the taxpayer makes an election 
                        under this clause--
                                    ``(I) subclause (II) of 
                                subparagraph (A)(i) shall be applied by 
                                substituting `5 months' for `3 months',
                                    ``(II) subclause (III) of 
                                subparagraph (A)(i) shall be applied by 
                                substituting `8 months' for `6 months', 
                                and
                                    ``(III) subclause (IV) of 
                                subparagraph (A)(i) shall be applied by 
                                substituting `11 months' for `9 
                                months'.
                            ``(iii) An election under clause (i) or 
                        (ii) shall apply to the taxable year for which 
                        made and such an election shall be effective 
                        only if made on or before the date required for 
                        the payment of the second required installment 
                        for such taxable year.''.
            (3) The last sentence of section 6655(f)(3)(A) is amended 
        by striking ``and subsection (e)(2)(A)'' and inserting ``and, 
        except in the case of an election under subsection (e)(2)(C), 
        subsection (e)(2)(A)''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 1994.

                 Subtitle G--Alternative Taxable Years

SEC. 861. ELECTION OF TAXABLE YEAR OTHER THAN REQUIRED TAXABLE YEAR.

    (a) Limitations on Taxable Years Which May Be Elected.--Subsection 
(b) of section 444 (relating to limitations on taxable years which may 
be elected) is amended to read as follows:
    ``(b) Taxable Year Must Be Same as Reporting Period.--If an entity 
has annual reports or statements--
            ``(1) which ascertain income, profit, or loss of the 
        entity, and
            ``(2) which are--
                    ``(A) provided to shareholders, partners, or other 
                proprietors, or
                    ``(B) used for credit purposes,
the entity may make an election under subsection (a) only if the 
taxable year elected covers the same period as such reports or 
statements.''.
    (b) Period of Election.--Section 444(d)(2) (relating to period of 
election) is amended to read as follows:
            ``(2) Period of election.--
                    ``(A) In general.--An election under subsection (a) 
                shall remain in effect until the partnership, S 
                corporation, or personal service corporation terminates 
                the election and adopts the required taxable year.
                    ``(B) Change not treated as termination.--For 
                purposes of subparagraph (A), a change from a taxable 
                year which is not a required taxable year to another 
                such taxable year shall not be treated as a 
                termination.''.
    (c) Exception for Trusts.--Section 444(d)(3) (relating to tiered 
structures) is amended by adding at the end thereof the following new 
subparagraph:
                    ``(C) Exception for certain structures that include 
                trusts.--An entity shall not be considered to be part 
                of a tiered structure to which subparagraph (A) applies 
                solely because a trust owning an interest in such 
                entity is a trust all of the beneficiaries of which use 
                a calendar year for their taxable year.''.
    (d) Regulations.--Subsection (g) of section 444 (relating to 
regulations) is amended to read as follows:
    ``(g) Regulations.--The Secretary shall prescribe such regulations 
as may be necessary to carry out the provisions of this section, 
including regulations--
            ``(1) to prevent the avoidance of the provisions of this 
        section through a change in entity or form of an entity,
            ``(2) to prevent the carryback to any preceding taxable 
        year of a net operating loss (or similar item) arising in any 
        short taxable year created pursuant to an election or 
        termination of an election under this section, and
            ``(3) to provide for the termination of an election under 
        subsection (a) if an entity does not continue to meet the 
        requirements of subsection (b).''

SEC. 862. REQUIRED PAYMENTS FOR ENTITIES ELECTING NOT TO HAVE REQUIRED 
              TAXABLE YEAR.

    (a) Additional Required Payment.--
            (1) In general.--Section 7519(b) (defining required 
        payment) is amended to read as follows:
    ``(b) Required Payment.--For purposes of this section--
            ``(1) In general.--The term `required payment' means, with 
        respect to any applicable election year of a partnership or S 
        corporation, an amount equal to the excess (if any) of--
                    ``(A) the adjusted highest section 1 rate, 
                multiplied by the net base year income of the entity, 
                over
                    ``(B) the net required payment balance.
        For purposes of paragraph (1)(A), the term `adjusted highest 
        section 1 rate' means the highest rate of tax in effect under 
        section 1 as of the close of the first required taxable year 
        ending within such year, plus 2 percentage points.
            ``(2) Additional payment for new applicable election 
        years.--
                    ``(A) In general.--In the case of a new applicable 
                election year, the required payment shall include, in 
                addition to any amount determined under paragraph (1), 
                the amount determined under subparagraph (C).
                    ``(B) New applicable election year.--For purposes 
                of this section, the term `new applicable election 
                year' means any applicable election year--
                            ``(i) with respect to which the preceding 
                        taxable year was not an applicable election 
                        year, or
                            ``(ii) which covers a different period than 
                        the preceding taxable year by reason of a 
                        change described in section 444(d)(2)(B).
                If any year described in the preceding sentence is a 
                short taxable year which does not include the last day 
                of the required taxable year, the new applicable 
                election year shall be the taxable year following the 
                short taxable year.
                    ``(C) Additional amount.--For purposes of 
                subparagraph (A), the amount determined under this 
                subparagraph shall be--
                            ``(i) in the case of a year described in 
                        subparagraph (B)(i), 75 percent of the required 
                        payment for the year, and
                            ``(ii) in the case of a year described in 
                        subparagraph (B)(ii), 75 percent of the excess 
                        (if any) of--
                                    ``(I) the required payment for the 
                                year, over
                                    ``(II) the required payment for the 
                                year which would have been computed if 
                                the change described in subparagraph 
                                (B)(ii) had not occurred.
                    ``(D) Required payment.--For purposes of this 
                paragraph, the term `required payment' means the 
                payment required by this section (determined without 
                regard to this paragraph).''.
            (2) Due date.--Paragraph (2) of section 7519(f) (defining 
        due date) is amended to read as follows:
            ``(2) Due date.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), the amount of any required payment 
                for any applicable election year shall be paid on or 
                before May 15 of the calendar year following the 
                calendar year in which the applicable election year 
                begins.
                    ``(B) Special rule where new applicable election 
                year adopted.--In the case of a new applicable election 
                year, the portion of any required payment determined 
                under subsection (b)(2) shall be paid on or before 
                September 15 of the calendar year in which the 
                applicable election year begins.''.
            (3) Penalties.--
                    (A) In general.--Section 7519(f)(4) (relating to 
                penalties) is amended by adding at the end thereof the 
                following new subparagraph:
                    ``(D) Failure to pay additional amount.--In the 
                case of any failure by any entity to pay on the date 
                prescribed therefore the portion of any required 
                payment described in subsection (b)(2) for any 
                applicable election year--
                            ``(i) subparagraph (A) shall not apply, but
                            ``(ii) the entity shall, for purposes of 
                        this title, be treated as having terminated the 
                        election under section 444 for such year and 
                        changed to the required taxable year.''.
                    (B) Conforming amendment.--Section 7519(f)(4)(A) is 
                amended by striking ``In'' and inserting ``Except as 
                provided in subparagraph (D), in''.
            (4) Refunds.--Section 7519(c)(2)(A) (relating to refund of 
        payments) is amended to read as follows:
                    ``(A) an election under section 444 is not in 
                effect for any year but was in effect for the preceding 
                year, or''.
            (5) Conforming amendments.--
                    (A) Paragraph (1) of section 7519(c) is amended--
                            (i) by striking ``subsection (b)(2)'' and 
                        inserting ``subsection (b)(1)(B)'', and
                            (ii) by striking ``subsection (b)(1)'' and 
                        inserting ``subsection (b)(1)(A)''.
                    (B) Subsection (d) of section 7519 is amended by 
                striking paragraph (4) and redesignating paragraph (5) 
                as paragraph (4).
    (b) Other Definitions and Special Rules.--
            (1) Refund.--Paragraph (3) of section 7519(c) (relating to 
        date on which refund is payable) is amended in the matter 
        preceding subparagraph (A) by striking ``on the later of'' and 
        inserting ``by the later of''.
            (2) Deferral ratio.--The last sentence of paragraph (1) of 
        section 7519(d) is amended to read as follows: ``Except as 
        provided in regulations, the term `deferral ratio' means the 
        ratio which the number of months in the deferral period of the 
        applicable election year bears to the number of months in the 
        applicable election year.''.
            (3) Net income.--Paragraph (2) of section 7519(d) is 
        amended by adding at the end the following new subparagraph:
                    ``(D) Excess applicable payments for base year.--In 
                the case of any new applicable election year, the net 
                income for the base year shall be increased by the 
                excess (if any) of--
                            ``(i) the applicable payments taken into 
                        account in determining net income for the base 
                        year, over
                            ``(ii) 120 percent of the average amount of 
                        applicable payments made during the first 3 
                        taxable years preceding the base year.''
            (4) Deferral period.--Paragraph (1) of section 7519(e) 
        (defining deferral period) is amended to read as follows:
            ``(1) Deferral period.--Except as provided in regulations, 
        the term `deferral period' means, with respect to any taxable 
        year of the entity, the months between--
                    ``(A) the beginning of such year, and
                    ``(B) the close of the first required taxable year 
                (as defined in section 444(e)) ending within such 
                year.''.
            (5) Base year.--
                    (A) In general.--Paragraph (2)(A) of section 
                7519(e) (defining base year) is amended to read as 
                follows:
                    ``(A) Base year.--The term `base year' means, with 
                respect to any applicable election year, the first 
                taxable year of 12 months (or 52-53 weeks) of the 
                partnership or S corporation preceding such applicable 
                election year.''.
                    (B) Conforming amendment.--Paragraph (2) of 
                subsection (g) of section 7519 is amended to read as 
                follows:
            ``(2) there is no base year described in subsection 
        (e)(2)(A) or no preceding taxable year described in section 
        280H(c)(1)(A)(i).''.
    (c) Interest.--Section 7519(f)(3) (relating to interest) is amended 
to read as follows:
            ``(3) Interest.--For purposes of determining interest, any 
        payment required by this section shall be treated as a tax, 
        except that interest shall be allowed with respect to any 
        refund of a payment under this section only for the period from 
        the latest date specified in subsection (c)(3) for such refund 
        to the actual date of payment of such refund.''.

   Subtitle H--Deduction for Charitable Contribution of Appreciated 
                   Property Limited To Adjusted Basis

SEC. 871. DEDUCTION FOR CHARITABLE CONTRIBUTION OF APPRECIATED PROPERTY 
              LIMITED TO ADJUSTED BASIS.

    (a) In General.--The first sentence of section 170(e) (relating to 
contributions of ordinary income and capital gain property) is amended 
to read as follows: ``The amount of any charitable contribution of 
property otherwise taken into account under this section shall be 
reduced by the amount which would have been gain had the property been 
sold by the taxpayer at its fair market value (determined at the time 
of such contribution).''.
    (b) Conforming Amendments.--
            (1) Subsection (e) of section 170 is amended by striking 
        paragraphs (3), (4), and (5).
            (2) Subsection (a) of section 57 is amended by striking 
        paragraph (7).
            (3) Subsection (c) of section 642 is amended by adding at 
        the end thereof the following new paragraph:
            ``(7) Limitation on deduction for contribution of 
        appreciated property.--''.
    (c) Effective Date.--The amendments made by this section shall 
apply to contributions and gifts made after December 31, 1994.

 Subtitle I--Minimum 5 Percent Rate of Tax on Interest Paid To Foreign 
                                Persons

SEC. 881. MINIMUM 5 PERCENT RATE OF TAX ON INTEREST PAID TO FOREIGN 
              PERSONS.

    (a) Individuals.--
            (1) Paragraph (1) of section 871(a) is amended by adding at 
        the end thereof the following new sentence: ``Notwithstanding 
        any treaty obligation of the United States, the rate of tax 
        imposed under paragraph (1)(A) or (1)(C) shall not be less than 
        5 percent.''.
            (2)(A) Paragraph (1) of section 871(h) (relating to repeal 
        of tax on interest of nonresident alien individuals received 
        from certain portfolio debt investments) is amended by striking 
        ``no tax shall be imposed under paragraph (1)(A) or (1)(C) of 
        subsection (a).'' and inserting ``the rate of tax imposed under 
        paragraph (1)(A) or (1)(C) of subsection (a) shall be 5 
        percent. The preceding sentence shall apply notwithstanding any 
        treaty obligation of the United States.''.
            (B) Paragraph (2) of section 861(h) is amended by striking 
        ``which would be subject to tax under subsection (a) but for 
        this subsection and'' and inserting ``subject to tax under 
        subsection (a)''.
            (C) The heading of section 871(h) is amended by striking 
        ``Repeal of Tax'' and inserting ``5 Percent Rate of Tax''.
    (b) Corporations.--
            (1) Subsection (a) of section 881 is amended by adding at 
        the end thereof the following new sentence: ``Notwithstanding 
        any treaty obligation of the United States, the rate of tax 
        imposed under paragraph (1) or (2) shall not be less than 5 
        percent.''
            (2)(A) Paragraph (1) of section 881(c) (relating to repeal 
        of tax on interest of foreign corporations received from 
        certain portfolio debt investments) is amended by striking ``no 
        tax shall be imposed under paragraph (1) or (3) of subsection 
        (a).'' and inserting ``the rate of tax imposed under paragraph 
        (1) or (3) of subsection (a) shall be 5 percent. The preceding 
        sentence shall apply notwithstanding any treaty obligation of 
        the United States.''.
            (B) Paragraph (2) of section 881(c) is amended by striking 
        ``which would be subject to tax under subsection (a) but for 
        this subsection and'' and inserting ``subject to tax under 
        subsection (a)''.
            (C) The heading of section 881(c) is amended by striking 
        ``Repeal of Tax'' and inserting ``5 Percent Rate of Tax''.
    (c) Effective Date.--The amendments made by this section shall 
apply to interest received after December 31, 1994, in taxable years 
ending after such date.

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