[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 728 Introduced in Senate (IS)]

103d CONGRESS
  1st Session
                                 S. 728

To provide for a comprehensive health care plan for all Americans, and 
                          for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                April 1 (legislative day, March 3), 1993

 Mr. McConnell introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To provide for a comprehensive health care plan for all Americans, and 
                          for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

Sec. 1. Short title; table of contents.
  TITLE I--HEALTH CARE ACCESS FOR UNINSURED AND MEDICALLY UNDERSERVED 
                              INDIVIDUALS

    Subtitle A--Tax Credits for Low and Moderate Income Individuals

Sec. 101. Credit for health insurance expenses.
                  Subtitle B--Rural Health Initiatives

Sec. 111. Elimination of separate average standardized amounts for 
                            hospitals in different areas.
Sec. 112. Scholarship and loan repayment program priorities.
Sec. 113. National health service corps loan repayments excluded from 
                            gross income.
Sec. 114. Demonstration project to evaluate availability of prenatal 
                            care services in rural areas.
Sec. 115. Preventive health services.
Sec. 116. Review of hospital regulations with respect to rural 
                            hospitals.
Sec. 117. Review of existing barriers to voluntary service by 
                            physicians in underserved areas.
    Subtitle C--Certified Model Health Care Insurance Benefits Plans

Sec. 121. Model health care insurance benefits plans.
                   TITLE II--HEALTH CARE COST CONTROL

                 Subtitle A--Medical Malpractice Reform

Sec. 201. Findings and purpose.
Sec. 202. Applicability. 
Sec. 203. Joint and several liability.
Sec. 204. Alternative dispute resolution.
Sec. 205. Definitions.
Sec. 206. Effective date.
Sec. 207. Severability.
            Subtitle B--Standardization of Claims Processing

Sec. 211. Adoption of data elements, uniform claims, and uniform 
                            electronic transmission standards.
Sec. 212. Application of standards.
Sec. 213. Periodic review and revision of standards.
Sec. 214. Health benefit plan defined.
             Subtitle C--Electronic Medical Data Standards

Sec. 221. Medical data standards for hospitals and other providers.
Sec. 222. Application of electronic data standards to certain 
                            hospitals.
Sec. 223. Electronic transmission to Federal agencies.
Sec. 224. Limitation on data requirements where standards are in 
                            effect.
Sec. 225. Advisory commission.
           Subtitle D--Preventive Health Practices Promotion

Sec. 231. Distribution of information on recommended preventive health 
                            practices.
         TITLE III--LONG-TERM CARE AND SENIOR HEALTH PROMOTION

             Subtitle A--Long-Term Care Insurance Promotion

Sec. 301. Treatment of long-term care insurance or plans.
Sec. 302. Qualified long-term services treated as medical care.
Sec. 303. Employer payments for long-term care insurance not treated as 
                            deferred compensation.
Sec. 304. Long-term care insurance tax credit.
Sec. 305. Exemption from 10-percent additional tax; certain exchanges 
                            not taxable.
Sec. 306. Effective date.
               Subtitle B--Medicare Benefit Improvements

Sec. 311. In-home respite care for certain chronically dependent 
                            individuals.
Sec. 312. Coverage of home intravenous drug therapy services.
Sec. 313. Extending home health services.
        Subtitle C--Senior Health Insurance Consumer Protection

Sec. 321. Certification of health insurance policies for the elderly.

  TITLE I--HEALTH CARE ACCESS FOR UNINSURED AND MEDICALLY UNDERSERVED 
                              INDIVIDUALS

    Subtitle A--Tax Credits for Low and Moderate Income Individuals

SEC. 101. CREDIT FOR HEALTH INSURANCE EXPENSES.

    (a) In General.--Subpart C of part IV of subchapter A of chapter 1 
of the Internal Revenue Code of 1986 (relating to refundable personal 
credits) is amended by inserting after section 34 the following new 
section:

``SEC. 34A. HEALTH INSURANCE EXPENSES.

    ``(a) Allowance of Credit.--
            ``(1) In general.--In the case of an eligible individual, 
        there shall be allowed as a credit against the tax imposed by 
        this subtitle for the taxable year an amount equal to--
                    ``(A) the applicable percentage of the qualified 
                health insurance expenses paid by such individual 
                during the taxable year, less
                    ``(B) the amount of the health insurance credit 
                allowable to such individual for such taxable year 
                under section 32.
            ``(2) Applicable percentage.--For purposes of paragraph 
        (1)--

  
                                                         The applicable
``If adjusted gross income is:
                                                         percentage is:
  Less than $25,000..................................                70
  $25,000 but less than $30,000......................                50
  $30,000 but less than $35,000......................                30
  $35,000 but less than $40,000......................                10
  $40,000 or more....................................                0.
    ``(b) Qualified Health Insurance Expenses.--For purposes of this 
section--
            ``(1) In general.--The term `qualified health insurance 
        expenses' means amounts paid during the taxable year for 
        insurance which constitutes medical care (within the meaning of 
        section 213(d)(1)(C)). For purposes of the preceding sentence, 
        the rules of section 213(d)(6) shall apply.
            ``(2) Dollar limit on qualified health insurance 
        expenses.--The amount of the qualified health insurance 
        expenses paid during any taxable year which may be taken into 
        account under subsection (a)(1) shall not exceed $2,500.
            ``(3) Election not to take credit.--A taxpayer may elect 
        for any taxable year to have amounts described in paragraph (1) 
        not treated as qualified health insurance expenses.
    ``(c) Eligible Individual.--For purposes of this section, the term 
`eligible individual' means, with respect to any period, an individual 
who is not covered during such period by a health plan maintained by an 
employer of such individual or such individual's spouse.
    ``(d) Coordination with Advance Payments of Credit.--
            ``(1) Recapture of excess advance payments.--If any payment 
        is made to the individual under section 101(b) of the 
        Comprehensive American Health Care Act during any calendar 
        year, then the tax imposed by this chapter for the individual's 
        last taxable year beginning in such calendar year shall be 
        increased by the aggregate amount of such payments.
            ``(2) Reconciliation of payments advanced and credit 
        allowed.--Any increase in tax under paragraph (1) shall not be 
        treated as tax imposed by this chapter for purposes of 
        determining the amount of any credit (other than the credit 
        allowed by subsection (a)) allowable under this subpart.
    ``(e) Special Rules.--For purposes of this section--
            ``(1) Medicare-eligible individuals.--No expense shall be 
        treated as a qualified health insurance expense if it is an 
        amount paid for insurance for an individual for any period with 
        respect to which such individual is entitled (or, on 
        application without the payment of an additional premium, would 
        be entitled to) benefits under part A of title XVIII of the 
        Social Security Act.
            ``(2) Subsidized expenses.--No expense shall be treated as 
        a qualified health insurance expense to the extent--
                    ``(A) such expense is paid, reimbursed, or 
                subsidized (whether by being disregarded for purposes 
                of another program or otherwise) by the Federal 
                Government, a State or local government, or any agency 
                or instrumentality thereof, and
                    ``(B) the payment, reimbursement, or subsidy of 
                such expense is not includible in the gross income of 
                the recipient.
            ``(3) Coordination with minimum tax.--Rules similar to the 
        rules of subsection (h) of section 32 shall apply to any credit 
        to which this section applies.
    ``(f) Regulations.--The Secretary shall prescribe such regulations 
as may be necessary to carry out the purposes of this section.''.
    (b) Advance Payments of Credit for Some Individuals.--
            (1) In general.--The Secretary of the Treasury, in 
        consultation with the Secretary of Health and Human Services, 
        shall enter into an agreement with each State to provide for 
        advance payments of the credit provided by section 34A of the 
        Internal Revenue Code of 1986 (as added by this subtitle) to 
        eligible individuals in the form of certificates usable for the 
        purchase of health insurance. The certificates shall be 
        available at such locations as the Secretary determines will 
        ensure the widest distribution.
            (2) Eligible individuals.--
                    (A) In general.--An individual shall be eligible 
                for advance payments described in paragraph (1) if such 
                individual--
                            (i) has income for the taxable year which 
                        results in a poverty ratio of not more than 
                        1.49, and
                            (ii) has filed a certificate with the 
                        Secretary of the Treasury or the Secretary's 
                        delegate described in subparagraph (C).
                    (B) Poverty ratio.--For purposes of subparagraph 
                (A)(i), the poverty ratio for any individual shall be 
                determined by dividing such individual's family income 
                for the taxable year (as determined for purposes of 
                title XIX of the Social Security Act) by the income 
                official poverty line for such year (as defined by the 
                Office of Management and Budget, and revised annually 
                in accordance with section 673(2) of the Omnibus Budget 
                Reconciliation Act of 1981) applicable to a family of 
                the size involved.
                    (C) Certificate of eligibility.--A certificate 
                described in this subparagraph is a statement furnished 
                by the individual which--
                            (i) certifies that the individual will be 
                        eligible to receive the credit provided by 
                        section 34A of the Internal Revenue Code of 
                        1986 for the taxable year,
                            (ii) certifies that the poverty ratio of 
                        the individual for such year will be not more 
                        than 1.49,
                            (iii) certifies that the individual does 
                        not have another certificate with respect to 
                        such credit in effect for such year,
                            (iv) estimates the amount of qualified 
                        health insurance expenses (as defined in 
                        section 34A(b) of such Code) for such year, and
                            (v) estimates the amount of health 
                        insurance credit under section 32 of such Code 
                        allowed for such year.
    (c) Program To Increase Public Awareness.--Not later than the first 
day of the first calendar year following the date of enactment of this 
Act, the Secretary of the Treasury, or the Secretary's delegate, in 
consultation with the Secretary of Health and Human Services, shall 
establish a public awareness program to inform the public of the 
availability of the credit for health insurance expenses allowed under 
section 34A of the Internal Revenue Code of 1986 (as added by this 
subtitle) and the coordination of such credit with the health insurance 
credit allowed under section 32 of such Code. Such public awareness 
program shall be designed to assure that individuals who may be 
eligible are informed of the availability of such credit and filing 
procedures.
    (d) Coordination With Deductions for Health Insurance Expenses.--
            (1) Self-employed individuals.--Subparagraph (B) of section 
        162(l)(3) of the Internal Revenue Code of 1986 is amended by 
        inserting ``or section 34A'' after ``section 32''.
            (2) Medical, dental, etc., expenses.--Subsection (f) of 
        section 213 of such Code is amended--
                    (A) by inserting ``or section 34A'' after ``section 
                32'', and
                    (B) by inserting ``or section 34A'' in the heading 
                thereof after ``section 32''.
    (e) Clerical Amendment.--The table of sections for subpart A of 
part IV of subchapter A of chapter 1 of the Internal Revenue Code of 
1986 is amended by inserting after the item relating to section 34 the 
following new item:

                              ``Sec. 34A. Health insurance expenses.''.
    (f) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after the date of enactment of this 
Act.

                  Subtitle B--Rural Health Initiatives

SEC. 111. ELIMINATION OF SEPARATE AVERAGE STANDARDIZED AMOUNTS FOR 
              HOSPITALS IN DIFFERENT AREAS.

    Section 1886 of the Social Security Act (42 U.S.C. 1395ww) is 
amended by adding at the end thereof the following new subsection:
    ``(j)(1) On or before September 1, 1993, the Secretary and the 
Prospective Payment Assessment Commission established under subsection 
(e) (in this subsection referred to as the `Commission') shall each 
submit to the Congress a report recommending a methodology that 
provides for the elimination of the system of determining separate 
average standardized amounts for subsection (d) hospitals (as defined 
in subsection (d)(1)(B)) located in large urban, other urban, or rural 
areas under subsection (d)(2)(D). The methodologies set forth in such 
reports shall provide for the complete elimination of the average 
standardized amounts applicable to large urban, other urban, or rural 
area hospitals for discharges occurring on or after January 1, 1994. 
Such methodologies may provide for such changes to any of the 
adjustments, reductions, and special payments otherwise authorized or 
required by this section as the Secretary or the Commission determines 
to be necessary and appropriate to carry out the purposes of this 
subsection. But in no case may the Secretary or the Commission 
recommend or provide for a methodology that will result in total 
payments under part A of this title to hospitals at a level less than 
such hospitals were receiving on October 1, 1993.
    ``(2) Not later than October 1, 1993, the Secretary shall 
promulgate interim final regulations to implement the recommendations 
of the Secretary under paragraph (1) (including any recommended changes 
in the adjustments, reductions, and special payments otherwise 
authorized or required by this section).
    ``(3) If the Congress does not enact legislation after the date of 
enactment of this subsection and before December 1, 1993, with respect 
to the average standardized amounts applicable to large urban, other 
urban, or rural area hospitals, then, notwithstanding any other 
provision of this section, the average standardized amounts for such 
hospitals for discharges occurring on or after January 1, 1994, shall 
be determined in accordance with the interim final regulations 
promulgated under paragraph (2).
    ``(4) On or before July 1, 1994, the Secretary and the Commission 
shall each submit to the Congress a report specifying the manner in 
which the average standardized amounts determined under the regulations 
and which became effective in accordance with paragraph (3) should be 
adjusted appropriately to reflect differences in the operating costs of 
providing inpatient hospital services (as defined in subsection (a)(4)) 
for different categories of subsection (d) hospitals.''.

SEC. 112. SCHOLARSHIP AND LOAN REPAYMENT PROGRAM PRIORITIES.

    (a) Scholarship Program.--Section 338A(d)(2) of the Public Health 
Service Act (42 U.S.C. 254l(d)(2)) is amended--
            (1) in subparagraph (B), by striking ``and'' at the end 
        thereof;
            (2) in subparagraph (C), by striking the period and 
        inserting a semicolon; and
                    (3) by adding at the end thereof the following new 
                subparagraphs:
                    ``(D) fourth, to individuals who reside in health 
                manpower shortage areas;
                    ``(E) fifth, to disadvantaged individuals and 
                minorities;
                    ``(F) sixth, to individuals who attend or plan to 
                attend health professions schools that have records of 
                training graduates who then intend to work in primary 
                care fields and with underserved populations;
                    ``(G) seventh, to nurses, nurse midwives, nurse 
                practitioners, and physician assistants to increase 
                access to perinatal care; and
                    ``(H) eighth, to physicians who are willing to 
                serve in a Health Manpower Shortage Area that has been 
                identified by the Corps as having difficulties in 
                attracting physicians.''.
    (b) Loan Repayment Program.--Section 338B(d)(2) of the Public 
Health Service Act (42 U.S.C. 254l-1(d)(2)) is amended--
            (1) in subparagraph (B), by striking ``and'' at the end 
        thereof;
            (2) in subparagraph (C), by striking the period and 
        inserting a semicolon; and
            (3) by adding at the end thereof the following new 
        subparagraphs:
                    ``(D) to applications from individuals who are 
                legal residents of health manpower shortage areas or 
                who, at the time of the submission of the application, 
                reside in a health manpower shortage area;
                    ``(E) to applications from disadvantaged 
                individuals and minorities;
                    ``(F) to applications from individuals who have 
                demonstrated an interest in providing primary care 
                service for the underserved through the participation 
                of such individuals in internship and externship 
                programs such as the commissioned officer, student 
                training and extern program, and other programs;
                    ``(G) to applications from nurses, nurse midwives, 
                nurse practitioners, and physicians assistants to 
                increase access to perinatal care and other essential 
                primary care health services; and
                    ``(H) to applications from physicians in the 
                primary care fields of pediatrics, general internal 
                medicine, general practice, and obstetrics and 
                gynecology who are willing to serve in a health 
                manpower shortage area that has been identified by the 
                Corps as having difficulties in attracting such 
                physicians.''.

SEC. 113. NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENTS EXCLUDED FROM 
              GROSS INCOME.

    (a) In General.--Part III of subchapter B of chapter 1 of the 
Internal Revenue Code of 1986 (relating to items specifically excluded 
from gross income) is amended by redesignating section 136 as section 
137 and by inserting after section 135 the following new section:

``SEC. 136. NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENTS.

    ``(a) General Rule.--Gross income shall not include any qualified 
loan repayment.
    ``(b) Qualified Loan Repayment.--For purposes of this section, the 
term `qualified loan repayment' means any payment made on behalf of the 
taxpayer by the National Health Service Corps Loan Repayment Program 
under section 338B(g) of the Public Health Service Act.''.
    (b) Clerical Amendment.--The table of sections for part III of 
subchapter B of chapter 1 of the Internal Revenue Code of 1986 is 
amended by striking the item relating to section 136 and inserting the 
following:

                              ``Sec. 136. National Health Service Corps 
                                        loan repayments.
                              ``Sec. 137. Cross references to other 
                                        Acts.''.
    (c) Effective Date.--The amendments made by subsection (a) shall 
apply to payments made under section 338B(g) of the Public Health 
Service Act after the date of enactment of this Act.

SEC. 114. DEMONSTRATION PROJECT TO EVALUATE AVAILABILITY OF PRENATAL 
              CARE SERVICES IN RURAL AREAS.

    (a) In General.--Notwithstanding any other provision of law, the 
Secretary of Health and Human Services (in this section referred to as 
the ``Secretary'') shall from amounts retained by the Secretary under 
section 502(b)(1)(A) of the Social Security Act (42 U.S.C. 
702(b)(1)(A)) provide for a demonstration project evaluating the 
availability, accessibility, and use of prenatal care services by 
pregnant women residing in rural areas (as defined in section 
1886(d)(2)(D) of the Social Security Act).
    (b) Effective Dates.--(1) The Secretary shall conduct the 
demonstration project described in subsection (a) within 18 months of 
the date of enactment of this Act.
    (2) The Secretary shall transmit a summary of the demonstration 
project conducted under subsection (a) to relevant committees of 
Congress no later than 3 months after the date of completion of such 
project as provided in paragraph (1).

SEC. 115. PREVENTIVE HEALTH SERVICES.

    Part A of title XIX of the Public Health Service Act (42 U.S.C. 
300w et seq.) is amended--
            (1) in section 1901, by adding at the end thereof the 
        following new subsection:
    ``(c) Of the amounts appropriated for each fiscal year under 
subsection (a), the Secretary shall make available not less than 
$25,000,000 in each such fiscal year to carry out section 1910A.''; and
            (2) by adding at the end thereof the following new section:

``SEC. 1910A. PREVENTIVE GRANTS FOR COUNTY HEALTH DEPARTMENTS.

    ``(a) In General.--From amounts made available under section 
1901(c), the Secretary shall make grants to county health departments 
to enable such departments to provide preventive health services.
    ``(b) Application.--To be eligible to receive a grant under 
subsection (a), a county health department shall prepare and submit, to 
the Secretary, an application at such time, in such form, and 
containing such information as the Secretary shall require.
    ``(c) Use of Funds.--A county health department shall use amounts 
provided through a grant received under this section to--
            ``(1) provide immunization services to control the spread 
        of infectious diseases;
            ``(2) improve maternal and infant health;
            ``(3) reduce adolescent pregnancy and improve reproductive 
        health;
            ``(4) improve health education and the access of 
        individuals to preventive health services; and
            ``(5) provide such other services as the Secretary 
        determines appropriate.
    ``(d) Definition.--Not later than 30 days after the date of 
enactment of this section, the Secretary shall promulgate regulations 
that define `county health department' for purposes of this section.''.

SEC. 116. REVIEW OF HOSPITAL REGULATIONS WITH RESPECT TO RURAL 
              HOSPITALS.

    (a) In General.--Within 12 months of the date of enactment of this 
Act, the Secretary of Health and Human Services shall review the 
requirements in regulations developed pursuant to section 1861(e) of 
the Social Security Act to determine which requirements could be made 
less administratively and economically burdensome for hospitals defined 
in section 1886(d)(1)(B) of the Social Security Act that are located in 
a rural area as defined in section 1886(d)(2)(D) of the Social Security 
Act without diminishing the quality of care provided by such hospitals 
to individuals entitled to receive benefits under part A of title XVIII 
of the Social Security Act. Such review shall specifically include 
standards related to staffing requirements.
    (b) Report.--The Secretary of Health and Human Services shall 
report to Congress by April 1, 1994, on the results of the review 
conducted under subsection (a), and include recommendations on which 
regulations if any, should be modified with respect to hospitals 
located outside a metropolitan statistical area as described in 
subsection (a).

SEC. 117. REVIEW OF EXISTING BARRIERS TO VOLUNTARY SERVICE BY 
              PHYSICIANS IN UNDERSERVED AREAS.

    (a) Study.--The Secretary of Health and Human Services shall 
conduct a study to determine any and all factors preventing or 
discouraging physicians (both active and retired) from volunteering to 
provide health care services in underserved areas.
    (b) Reports.--
            (1) Interim report.--Within 18 months of the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services shall submit a report to Congress on the study 
        conducted under subsection (a).
            (2) Final recommendations.--Not later than 2 years after 
        the date of enactment of this Act, the Secretary of Health and 
        Human Services shall submit recommendations for actions to 
        increase the number of physicians volunteering to provide 
        health care services in medically underserved areas.

    Subtitle C--Certified Model Health Care Insurance Benefits Plans

SEC. 121. MODEL HEALTH CARE INSURANCE BENEFITS PLANS.

    (a) In General.--Within 18 months of the date of enactment of this 
Act, the Secretary of Health and Human Services (in this section 
referred to as the ``Secretary''), in conjunction with the National 
Association of Insurance Commissioners, business leaders, consumer 
advocates, and such other individuals possessing substantial knowledge 
or expertise in health care delivery, health care insurance, or health 
care economics, shall develop model health care insurance benefits 
plans.
    (b) Elements of Plans.--The model benefits plans shall include--
            (1) an affordable catastrophic health care insurance plan 
        for basic hospital, medical, and surgical services;
            (2) an affordable health care insurance plan for basic 
        hospital, medical, and surgical services, including 
        preventative care services deemed appropriate by the Secretary;
            (3) reasonable cost sharing of beneficiaries under such 
        plans; and
            (4) appropriate co-payments and deductibles.
    (c) Certification.--
            (1) In general.--The Secretary shall no later than 6 months 
        after the date of enactment of this Act establish a procedure 
        certifying health insurance policies as meeting the standards 
        and requirements set forth in this section.
            (2) Duration.--The certification described in paragraph (1) 
        shall remain in effect if the insurer files a notarized 
        statement with the Secretary no later than June 30 of each year 
        stating that the policy continues to meet such standards and 
        requirements and if the insurer submits such additional data as 
        the Secretary finds necessary to verify independently the 
        accuracy of such notarized statement. If the Secretary 
        determines that such policy meets (or continues to meet) such 
        standards and requirements, the Secretary shall authorize the 
        insurer to have printed on such policy (but only in accordance 
        with such requirements and conditions as the Secretary may 
        require) an emblem which the Secretary shall cause to be 
        designed for use as an indication that a policy has received 
        the Secretary's certification.
            (3) List of policies certified.--The Secretary shall 
        provide each State commissioner or superintendent of insurance 
        with a list of all the policies which have received 
        certification under this section.

                   TITLE II--HEALTH CARE COST CONTROL

                 Subtitle A--Medical Malpractice Reform

SEC. 201. FINDINGS AND PURPOSE.

    (a) Findings.--Congress finds that--
            (1) there are serious flaws in the civil justice system 
        under which tort claims are filed and resolved, including 
        spiraling costs, unpredictability, impediments to United States 
        competitiveness and inefficient use of the civil justice 
        system;
            (2) the cost of litigation has risen at a dramatic rate 
        over the past 25 years and threatens to continue to rise at a 
        similar rate for the foreseeable future;
            (3) the rising cost of litigation has a direct and 
        undesirable effect on interstate commerce and international 
        competitiveness, and decreases the availability of products and 
        services in commerce;
            (4) excessive litigation has contributed to health care 
        inflation through defensive medical practices and the high cost 
        of medical malpractice insurance accounting for an estimated 
        $25,000,000,000 of the health care bill of the United States in 
        1987;
            (5) the medical malpractice crisis has contributed to the 
        diminution of the availability of health care across the 
        country, particularly in rural areas;
            (6) there is a need for reasonable limits on the potential 
        exposure of health care providers to liability for damages 
        resulting from the provision of medical services, which 
        contributes to the availability of health care, the net output 
        of the economy of the United States, to the American consumer, 
        and the general welfare; and
            (7) because of the interstate nature of commerce and the 
        pervasive nature of the involvement of the Federal Government 
        in the provision of health care, no single State can act to 
        address flaws in the civil justice system without threatening 
        to inflict disparate and potentially discriminatory burdens, 
        thereby diminishing the general welfare of the Nation and of 
        the several States.
    (b) Purpose.--It is the purpose of this subtitle to establish 
uniform rules of medical malpractice law, to encourage alternate means 
of dispute resolution, to provide fair and reasonable compensation for 
accident or injury, and to promote the free flow of commerce and the 
availability and affordability of liability insurance.

SEC. 202. APPLICABILITY.

    (a) In General.--Except as provided in subsection (b) or (c), this 
subtitle shall apply to any civil action against any individual based 
on professional medical malpractice, in any State or Federal court, in 
which damages are sought for physical injury or for physical or mental 
pain or suffering or for economic loss.
    (b) Preemption.--This subtitle shall preempt and supersede Federal 
or State law only to the extent such law is inconsistent with this 
subtitle. Any issue arising under the provisions of this subtitle that 
is not governed by the provisions of this subtitle shall be governed by 
applicable State or Federal law.
    (c) Construction.--Nothing in this subtitle shall be construed to--
            (1) waive or affect any defense of sovereign immunity 
        asserted by any State under any provision of law;
            (2) waive or affect any defense of sovereign immunity 
        asserted by the United States;
            (3) supersede any Federal law, except the Federal Employees 
        Compensation Act and the Longshoremen's and Harborworkers' 
        Compensation Act;
            (4) affect the applicability of any provision of chapter 97 
        of title 28, United States Code, commonly known as the Foreign 
        Sovereign Immunities Act of 1976;
            (5) preempt State choice-of-law rules with respect to 
        claims brought by a foreign nation or a citizen of a foreign 
        nation; or
            (6) affect the right of any court to transfer venue or to 
        apply the law of a foreign nation or to dismiss a claim of a 
        foreign nation on the ground of inconvenient forum.
    (d) Attorney's Fees.--
            (1) In general.--Subject to paragraph (3), and except as 
        provided in paragraph (2), in any action brought pursuant to 
        the provisions of this subtitle, the court shall provide for an 
        award of costs and reasonable attorney's fees to be paid to the 
        prevailing party by the other parties to such action.
            (2) Exception.--Paragraph (1) shall not apply in any case 
        in which the losing party was qualified for assistance by the 
        Legal Services Corporation, in the State in which such party 
        resides, pursuant to the limits and guidelines described in 
        part 1611 of title 45, Code of Federal Regulations.
            (3) Limitation.--The amount of attorney fees ordered to be 
        paid to the prevailing party under this subsection shall be 
        limited to either--
                    (A) a percentage of the prevailing party's costs 
                and fees equal to the percentage of any damage award 
                such losing party had agreed to pay as a contingency 
                fee to the attorney of such party if such party had 
                prevailed, if the attorney for such losing party was to 
                receive compensation based on a percentage of the 
                recovery; or
                    (B) an amount that does not exceed the amount of 
                attorney's fees such party is paying the attorney of 
                such party in such matter, if the attorney for such 
                losing party was not receiving compensation based on a 
                percentage of the recovery.

SEC. 203. JOINT AND SEVERAL LIABILITY.

    (a) In General.--Except as provided in subsection (b), joint and 
several liability shall not be applied to a civil liability action that 
is subject to this subtitle. A person found liable for damages in any 
such action may--
            (1) be found liable, if at all, only for those damages 
        directly attributable to the pro rata share of fault or 
        responsibility of such person for the injury; and
            (2) not be found liable for damages attributable to the pro 
        rata share of fault or responsibility of any other person 
        (without regard to whether that person is a party to the 
        action) for the injury, including any person bringing the 
        action.
    (b) Concerted Action.--
            (1) Application.--This section shall not apply as between 
        persons acting in concert where the concerted action 
        proximately caused the injury for which one or more persons are 
        found liable for damages.
            (2) Definition.--As used in this section, the terms 
        ``concerted action'' and ``acting in concert'' mean the 
        participation in joint conduct by two or more persons who agree 
        to jointly participate in such conduct with actual knowledge of 
        the wrongfulness of the conduct.

SEC. 204. ALTERNATIVE DISPUTE RESOLUTION.

    (a) Policy.--Because the traditional litigation process is not 
always suited to the timely, efficient, and inexpensive resolution of 
civil actions, it is the policy of the United States to encourage the 
creation and use of alternative dispute resolution techniques, and to 
promote the expeditious resolution of such actions.
    (b) Existence of Options.--In any action to which this subtitle 
applies, each attorney who has made an appearance in the case and who 
represents one or more of the parties to such action shall, with 
respect to each party separately represented, advise the party of the 
existence and availability of alternative dispute resolution options, 
including extrajudicial proceedings such as minitrials, third-party 
mediation, court supervised arbitration, and summary jury trial 
proceedings.
    (c) Certification.--Each attorney described in subsection (b) 
shall, at the time of the filing of the complaint or a responsive 
pleading, file notice with the court certifying that the attorney has 
so advised the client or clients of the attorney as required under 
subsection (b), and indicating whether such client will agree to one or 
more of the alternative dispute resolution techniques.
    (d) Order Governing Further Proceedings.--If all parties to an 
action agree to proceed with one or more alternative dispute resolution 
proceedings, the court shall issue an appropriate order governing the 
conduct of such proceedings. The issuance of an order governing such 
further proceedings shall constitute a waiver, by each party subject to 
the order, of the right to proceed further in court.

SEC. 205. DEFINITIONS.

    (a) Definitions.--As used in this subtitle:
            (1) Claimant.--The term ``claimant'' means any person who 
        brings a civil action under this subtitle, and any person on 
        whose behalf such action is brought, and, if such an action is 
        brought through or on behalf of an estate, such term includes 
        the decedent of the claimant, or, if it is brought through or 
        on behalf of a minor or incompetent, such term includes the 
        parent or guardian of the claimant.
            (2) Harm.--The term ``harm'' means any harm recognized 
        under the law of the State in which the civil action is 
        maintained.
            (3) State.--The term ``State'' means any State of the 
        United States, the District of Columbia, the Commonwealth of 
        Puerto Rico, the Virgin Islands, Guam, American Samoa, the 
        Northern Mariana Islands, the Trust Territory of the Pacific 
        Islands, and any other territory or possession of the United 
        States, or any political subdivision thereof.

SEC. 206. EFFECTIVE DATE.

    (a) In General.--This subtitle shall become effective on the date 
of enactment of this Act, and shall apply to all civil actions filed on 
or after such date, including any civil action in which the harm or the 
conduct complained of occurred before such effective date.
    (b) Applicable Time Period.--If any such provision of this subtitle 
would shorten the period during which a person would otherwise be 
exposed to liability, the plaintiff may, notwithstanding the otherwise 
applicable time period, bring any civil action pursuant to this 
subtitle not later than within 1 year after the effective date of this 
subtitle.

SEC. 207. SEVERABILITY.

    If any provision of this subtitle or the application of any such 
provision to any person or circumstance is held to be unconstitutional, 
the remainder of this subtitle and the application of the provisions of 
such to any person or circumstance shall not be affected thereby.

            Subtitle B--Standardization of Claims Processing

SEC. 211. ADOPTION OF DATA ELEMENTS, UNIFORM CLAIMS, AND UNIFORM 
              ELECTRONIC TRANSMISSION STANDARDS.

    (a) In General.--The Secretary of Health and Human Services (in 
this subtitle referred to as the ``Secretary'') shall adopt standards 
relating to each of the following:
            (1) Data elements for use in paper and electronic claims 
        processing under health benefit plans, as well as for use in 
        utilization review and management of care (including data 
        fields, formats, and medical nomenclature, and including plan 
        benefit and insurance information).
            (2) Uniform claims forms (including uniform procedure and 
        billing codes for uses with such forms and including 
        information on other health benefit plans that may be liable 
        for benefits).
            (3) Uniform electronic transmission of the data elements 
        (for purposes of billing and utilization review).
Standards under paragraph (3) relating to electronic transmission of 
data elements for claims for services shall supersede (to the extent 
specified in such standards) the standards adopted under paragraph (2) 
relating to the submission of paper claims for such services. Standards 
under paragraph (3) shall include protections to assure the 
confidentiality of patient-specific information and to protect against 
the unauthorized use and disclosure of information.
    (b) Use of Task Forces.--In adopting standards under this section--
            (1) the Secretary shall take into account the 
        recommendations of current task forces, including at least the 
        Workgroup on Electronic Data Interchange, National Uniform 
        Billing Committee, the Uniform Claim Task Force, and the 
        Computer-based Patient Record Institute;
            (2) the Secretary shall consult with the National 
        Association of Insurance Commissioners (and, with respect to 
        standards under subsection (a)(3), the American National 
        Standards Institute); and
            (3) the Secretary shall, to the maximum extent practicable, 
        seek to make the standards consistent with any uniform clinical 
        data sets which have been adopted and are widely recognized.
    (c) Deadlines for Promulgation.--The Secretary shall promulgate the 
standards under--
            (1) subsection (a)(1) relating to claims processing data, 
        by not later than 12 months after the date of enactment of this 
        Act;
            (2) subsection (a)(2) (relating to uniform claims forms) by 
        not later than 12 months after the date of enactment of this 
        Act; and
            (3)(A) subsection (a)(3) relating to transmission of 
        information concerning hospital and physicians services, by not 
        later than 24 months after the date of enactment of this Act, 
        and
            (B) subsection (a)(3) relating to transmission of 
        information on other services, by such later date as the 
        Secretary may determine it to be feasible.
    (d) Report to Congress.--Not later than 3 years after the date of 
enactment of this Act, the Secretary shall report to Congress 
recommendations regarding restructuring the medicare peer review 
quality assurance program given the availability of hospital data in 
electronic form.

SEC. 212. APPLICATION OF STANDARDS.

    (a) In General.--If the Secretary determines, at the end of the 2-
year period beginning on the date that standards are adopted under 
section 211 with respect to classes of services, that a significant 
number of claims for benefits for such services under health benefit 
plans are not being submitted in accordance with such standards, the 
Secretary may require, after notice in the Federal Register of not less 
than 6 months, that all providers of such services must submit claims 
to health benefit plans in accordance with such standards. The 
Secretary may waive the application of such a requirement in such cases 
as the Secretary finds that the imposition of the requirement would not 
be economically practicable.
    (b) Significant Number.--The Secretary shall make an affirmative 
determination described in subsection (a) for a class of services only 
if the Secretary finds that there would be a significant, measurable 
additional gain in efficiencies in the health care system that would be 
obtained by imposing the requirement described in such paragraph with 
respect to such services.
    (c) Application of Requirement.--
            (1) In general.--If the Secretary imposes the requirement 
        under subsection (a)--
                    (A) in the case of a requirement that imposes the 
                standards relating to electronic transmission of claims 
                for a class of services, each health care provider that 
                furnishes such services for which benefits are payable 
                under a health benefit plan shall transmit 
                electronically and directly to the plan on behalf of 
                the beneficiary involved a claim for such services in 
                accordance with such standards;
                    (B) any health benefit plan may reject any claim 
                subject to the standards adopted under section 211 but 
                which is not submitted in accordance with such 
                standards;
                    (C) it is unlawful for a health benefit plan (i) to 
                reject any such claim on the basis of the form in which 
                it is submitted if it is submitted in accordance with 
                such standards or (ii) to require, for the purpose of 
                utilization review or as a condition of providing 
                benefits under the plan, a provider to transmit medical 
                data elements that are inconsistent with the standards 
                established under section 211(a)(1); and
                    (D) the Secretary may impose a civil money penalty 
                on any provider that knowingly and repeatedly submits 
                claims in violation of such standards or on any health 
                benefit plan (other than a health benefit plan 
                described in paragraph (2)) that knowingly and 
                repeatedly rejects claims in violation of subparagraph 
                (B), in an amount not to exceed $100 for each such 
                claim.
        The provisions of section 1128A of the Social Security Act 
        (other than the first sentence of subsection (a) and other than 
        subsection (b)) shall apply to a civil money penalty under 
        subparagraph (D) in the same manner as such provisions apply to 
        a penalty or proceeding under section 1128A(a) of such Act.
            (2) Plans subject to effective state regulation.--A plan 
        described in this paragraph is a health benefit plan--
                    (A) that is subject to regulation by a State, and
                    (B) with respect to which the Secretary finds 
                that--
                            (i) the State provides for application of 
                        the standards established under section 211, 
                        and
                            (ii) the State regulatory program provides 
                        for the appropriate and effective enforcement 
                        of such standards.
    (d) Treatment of Rejections.--If a plan rejects a claim pursuant to 
subsection (c)(1), the plan shall permit the person submitting the 
claim a reasonable opportunity to resubmit the claim on a form or in an 
electronic manner that meets the requirements for acceptance of the 
claim under such subsection.

SEC. 213. PERIODIC REVIEW AND REVISION OF STANDARDS.

    (a) In General.--The Secretary shall--
            (1) provide for the ongoing receipt and review of comments 
        and suggestions for changes in the standards adopted and 
        promulgated under section 211;
            (2) establish a schedule for the periodic review of such 
        standards; and
            (3) based upon such comments, suggestions, and review, 
        revise such standards and promulgate such revisions.
    (b) Application of Revised Standards.--If the Secretary under 
subsection (a) revises the standards described in 211, then, in the 
case of any claim for benefits submitted under a health benefit plan 
more than the minimum period (of not less than 6 months specified by 
the Secretary) after the date the revision is promulgated under 
subsection (a)(3), such standards shall apply under section 212 instead 
of the standards previously promulgated.

SEC. 214. HEALTH BENEFIT PLAN DEFINED.

    In this subtitle, the term ``health benefit plan''--
            (1) means--
                    (A) any hospital or medical expense incurred policy 
                or certificate, hospital or medical service plan 
                contract, or health maintenance subscriber contract,
                    (B) the medicare program (under title XVIII of the 
                Social Security Act) and medicare supplemental health 
                insurance, and
                    (C) a State medicaid plan (approved under title XIX 
                of such Act), but
            (2) does not include--
                    (A) accident-only, credit, dental, or disability 
                income insurance,
                    (B) coverage issued as a supplement to liability 
                insurance,
                    (C) worker's compensation or similar insurance, or
                    (D) automobile medical-payment insurance.

             Subtitle C--Electronic Medical Data Standards

SEC. 221. MEDICAL DATA STANDARDS FOR HOSPITALS AND OTHER PROVIDERS.

    (a) Promulgation of Hospital Data Standards.--
            (1) In general.--Between July 1, 1995, and January 1, 1996, 
        the Secretary of Health and Human Services (in this subtitle 
        referred to as the ``Secretary'') shall promulgate standards 
        described in subsection (b) for hospitals concerning electronic 
        medical data.
            (2) Revision.--The Secretary may from time to time revise 
        the standards promulgated under this subsection.
    (b) Contents of Data Standards.--The standards promulgated under 
subsection (a) shall include at least the following:
            (1) A definition of a standard set of data elements for use 
        by utilization and quality control peer review organizations.
            (2) A definition of the set of comprehensive data elements, 
        which set shall include for hospitals the standard set of data 
        elements defined under paragraph (1).
            (3) Standards for an electronic patient care information 
        system with data obtained at the point of care, including 
        standards to protect against the unauthorized use and 
        disclosure of information.
            (4) A specification of, and manner of presentation of, the 
        individual data elements of the sets and system under this 
        subsection.
            (5) Standards concerning the transmission of electronic 
        medical data.
            (6) Standards relating to confidentiality of patient-
        specific information.
The standards under this section shall be consistent with standards for 
data elements established under section 211.
    (c) Optional Data Standards for Other Providers.--
            (1) In general.--The Secretary may promulgate standards 
        described in paragraph (2) concerning electronic medical data 
        for providers that are not hospitals. The Secretary may from 
        time to time revise the standards promulgated under this 
        subsection.
            (2) Contents of data standards.--The standards promulgated 
        under paragraph (1) for non-hospital providers may include 
        standards comparable to the standards described in paragraphs 
        (2), (4), and (5) of subsection (b) for hospitals.
    (d) Consultation.--In promulgating and revising standards under 
this section, the Secretary shall--
            (1) consult with the American National Standards Institute, 
        hospitals, with the advisory commission established under 
        section 225, and with other affected providers, health benefit 
        plans, and other interested parties, and
            (2) take into consideration, in developing standards under 
        subsection (b)(1), the data set used by the utilization and 
        quality control peer review program under part B of title XI of 
        the Social Security Act.

SEC. 222. APPLICATION OF ELECTRONIC DATA STANDARDS TO CERTAIN 
              HOSPITALS.

    (a) Medicare Requirement for Sharing of Hospital Information.--As 
of January 1, 1997, subject to paragraph (2), each hospital, as a 
requirement of each participation agreement under section 1866 of the 
Social Security Act, shall--
            (1) maintain clinical data included in the set of 
        comprehensive data elements under section 221(b)(2) in 
        electronic form on all inpatients,
            (2) upon request of the Secretary or of a utilization and 
        quality control peer review organization (with which the 
        Secretary has entered into a contract under part B of title XI 
        of such Act), transmit electronically the data set, and
            (3) upon request of the Secretary, or of a fiscal 
        intermediary or carrier, transmit electronically any data (with 
        respect to a claim) from such data set, in accordance with the 
        standards promulgated under section 221(a).
    (b) Waiver Authority.--Until January 1, 2000:
            (1) The Secretary may waive the application of the 
        requirements of subsection (a) for a hospital that is a small 
        rural hospital, for such period as the hospital demonstrates 
        compliance with such requirements would constitute an undue 
        financial hardship.
            (2) The Secretary may waive the application of the 
        requirements of subsection (a) for a hospital that is in the 
        process of developing a system to provide the required data set 
        and executes agreements with its fiscal intermediary and its 
        utilization and quality control peer review organization that 
        the hospital will meet the requirements of subsection (a) by a 
        specified date (not later than January 1, 2000).
            (3) The Secretary may waive the application of the 
        requirement of subsection (a)(1) for a hospital that agrees to 
        obtain from its records the data elements that are needed to 
        meet the requirements of paragraphs (2) and (3) of subsection 
        (a) and agrees to subject its data transfer process to a 
        quality assurance program specified by the Secretary.
    (c) Application to Hospitals of the Department of Veterans 
Affairs.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        provide that each hospital of the Department of Veterans 
        Affairs shall comply with the requirements of subsection (a) in 
        the same manner as such requirements would apply to the 
        hospital if it were participating in the medicare program.
            (2) Waiver.--Such Secretary may waive the application of 
        such requirements to a hospital in the same manner as the 
        Secretary of Health and Human Services may waive under 
        subsection (b) the application of the requirements of 
        subsection (a).

SEC. 223. ELECTRONIC TRANSMISSION TO FEDERAL AGENCIES.

    (a) In General.--Effective January 1, 2000, if a provider is 
required under a Federal program to transmit a data element that is 
subject to a presentation or transmission standard (as defined in 
subsection (b)), the head of the Federal agency responsible for such 
program (if not otherwise authorized) is authorized to require the 
provider to present and transmit the data element electronically in 
accordance with such a standard.
    (b) Presentation or Transmission Standard Defined.--In subsection 
(a), the term ``presentation or transmission standard'' means a 
standard, promulgated under subsection (b) or (c) of section 221, 
described in paragraph (4) or (5) of section 221(b).

SEC. 224. LIMITATION ON DATA REQUIREMENTS WHERE STANDARDS ARE IN 
              EFFECT.

    (a) In General.--If standards with respect to data elements are 
promulgated under section 221 with respect to a class of provider, a 
health benefit plan may not require, for the purpose of utilization 
review or as a condition of providing benefits under the plan, that a 
provider in the class--
            (1) provide any data element not in the set of 
        comprehensive data elements specified under such standards, or
            (2) transmit or present any such data element in a manner 
        inconsistent with the applicable standards for such 
        transmission or presentation.
    (b) Compliance.--
            (1) In general.--The Secretary may impose a civil money 
        penalty on any health benefit plan (other than a health benefit 
        plan described in paragraph (2)) that fails to comply with 
        subsection (a) in an amount not to exceed $100 for each such 
        failure. The provisions of section 1128A of the Social Security 
        Act (other than the first sentence of subsection (a) and other 
        than subsection (b)) shall apply to a civil money penalty under 
        this paragraph in the same manner as such provisions apply to a 
        penalty or proceeding under section 1128A(a) of such Act.
            (2) Plans subject to effective state regulation.--A plan 
        described in this paragraph is a health benefit plan that is 
        subject to regulation by a State, if the Secretary finds that--
                    (A) the State provides for application of the 
                requirement of subsection (a), and
                    (B) the State regulatory program provides for the 
                appropriate and effective enforcement of such 
                requirement with respect to such plans.

SEC. 225. ADVISORY COMMISSION.

    (a) In General.--The Secretary shall establish an advisory 
commission including hospital executives, hospital data base managers, 
physicians, health services researchers, and technical experts in 
collection and use of data and operation of data systems. Such 
commission shall include, as ex officio members, a representative of 
the Director of the National Institutes of Health, the Administrator 
for Health Care Policy and Research, the Secretary of Veterans Affairs, 
and the Director of the Centers for Disease Control.
    (b) Functions.--The advisory commission shall monitor and advise 
the Secretary concerning--
            (1) the standards established under this subtitle, and
            (2) operational concerns about the implementation of such 
        standards under this subtitle.
    (c) Staff.--From the amounts appropriated under subsection (d), the 
Secretary shall provide sufficient staff to assist the advisory 
commission in its activities under this section.
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated $2,000,000 for each of fiscal years 1994 through 1998 to 
carry out this section.

           Subtitle D--Preventive Health Practices Promotion

SEC. 231. DISTRIBUTION OF INFORMATION ON RECOMMENDED PREVENTIVE HEALTH 
              PRACTICES.

    (a) In General.--Section 1804 of the Social Security Act (42 U.S.C. 
1396b-2) is amended--
            (1) in the heading, by inserting ``and distribution of 
        preventive health information'' after ``medicare benefits'';
            (2) by inserting ``(a)'' after ``Sec. 1804.''; and
            (3) by adding at the end the following new subsection:
    ``(b)(1) The Secretary shall develop (and, from time to time, shall 
revise) a summary of recommended preventive health care practices for 
elderly individuals entitled to benefits under this title.
    ``(2) The summary shall be developed in consultation with national 
physician, consumer, and other health-related groups and shall be based 
on recommendations of any appropriate task force or similar group 
established by the Secretary.
            ``(3) The Secretary shall provide for the distribution of--
                    ``(A) the summary developed under paragraph (1) to 
                each individual at the time of the individual's first 
                becoming eligible for benefits under part A under 
                section 226(a) or section 1818, as part of other 
                materials sent to such an individual at such a time, 
                and
                    ``(B) the summary developed under paragraph (1) to 
                individuals entitled to benefits under this title in 
                conjunction with general mailings sent under this title 
                to such individuals.''.
    (b) Development of Summary and Form.--The Secretary of Health and 
Human Services shall initially develop the summary described in section 
1804(b) of the Social Security Act (as added by subsection (a)) not 
later than April 1, 1994, and shall first provide for the distribution 
of such summaries by not later than October 1, 1994.

         TITLE III--LONG-TERM CARE AND SENIOR HEALTH PROMOTION

             Subtitle A--Long-Term Care Insurance Promotion

SEC. 301. TREATMENT OF LONG-TERM CARE INSURANCE OR PLANS.

    (a) General Rule.--Chapter 79 of the Internal Revenue Code of 1986 
(relating to definitions) is amended by inserting after section 7702 
the following new section:

``SEC. 7702A. TREATMENT OF LONG-TERM CARE INSURANCE OR PLANS.

    ``(a) General Rule.--For purposes of this title--
            ``(1) a long-term care insurance contract shall be treated 
        as a health insurance contract,
            ``(2) amounts received under such a contract with respect 
        to qualified long-term care services shall be treated as 
        amounts received for personal injuries or sickness, and
            ``(3) any plan of an employer providing qualified long-term 
        care services shall be treated as an accident or health plan.
    ``(b) Long-Term Care Insurance Contract.--For purposes of this 
title, the term `long-term care insurance contract' means any insurance 
contract if--
            ``(1) the only insurance protection provided under such 
        contract is coverage of qualified long-term care services,
            ``(2) such contract does not cover expenses incurred for 
        services or items to the extent that such expenses are 
        reimbursable under title XVIII of the Social Security Act or 
        would be so reimbursable but for the application of a 
        deductible or coinsurance amount,
            ``(3) such contract is guaranteed renewable,
            ``(4) such contract does not have any surrender value, and
            ``(5) all refunds of premiums, and all policyholder 
        dividends or similar amounts, under such contract are to be 
        applied as a reduction in future premiums or to increase future 
        benefits.
    ``(c) Qualified Long-Term Care Services.--For purposes of this 
section--
            ``(1) In general.--The term `qualified long-term care 
        services' means necessary diagnostic, preventive, therapeutic, 
        and rehabilitative services, and maintenance or personal care 
        services, which--
                    ``(A) are required by a chronically ill individual 
                in a qualified facility, and
                    ``(B) are provided pursuant to a plan of care 
                prescribed by a physician.
            ``(2) Chronically ill individual.--
                    ``(A) In general.--The term `chronically ill 
                individual' means any individual who has been certified 
                by a physician as--
                            ``(i) being unable to perform (without 
                        substantial assistance from another individual) 
                        at least 2 activities of daily living (as 
                        defined in subparagraph (B)), or
                            ``(ii) having a similar level of disability 
                        due to cognitive impairment.
                    ``(B) Activities of daily living.--For purposes of 
                subparagraph (A), each of the following is an activity 
                of daily living:
                            ``(i) Bathing.--The overall complex 
                        behavior of getting water and cleansing the 
                        whole body, including turning on the water for 
                        a bath, shower, or sponge bath, getting to, in, 
                        and out of a tub or shower, and washing and 
                        drying oneself.
                            ``(ii) Dressing.--The overall complex 
                        behavior of getting clothes from closets and 
                        drawers and then getting dressed.
                            ``(iii) Toileting.--The act of going to the 
                        toilet room for bowel and bladder function, 
                        transferring on and off the toilet, cleaning 
                        after elimination, and arranging clothes.
                            ``(iv) Transfer.--The process of getting in 
                        and out of bed or in and out of a chair or 
                        wheelchair.
                            ``(v) Eating.--The process of getting food 
                        from a plate or its equivalent into the mouth.
            ``(3) Qualified facility.--The term `qualified facility' 
        means--
                    ``(A) a nursing, rehabilitative, hospice, or adult 
                day care facility, including a hospital, retirement 
                home, nursing home, skilled nursing facility, 
                intermediate care facility, or similar institution, 
                licensed under State law, or
                    ``(B) an individual's home if a physician, 
                certifies that without home care the individual would 
                have to be cared for in a facility described in 
                subparagraph (A), except that such home shall be 
                treated as a qualified facility only to the extent the 
                cost of such services is not greater than the cost of 
                similar services provided in a facility described in 
                subparagraph (A).
            ``(4) Maintenance or personal care services.--The term 
        `maintenance or personal care services' means any service the 
        primary purpose of which is to provide needed assistance with 
        any of the activities of daily living described in paragraph 
        (2)(B).
            ``(5) Physician.--The term `physician' has the meaning 
        given to such term by section 213(d)(4).''.
    (b) Clerical Amendment.--The table of sections for chapter 79 of 
such Code is amended by inserting after the item relating to section 
7702 the following new item:

                              ``Sec. 7702A. Treatment of long-term care 
                                        insurance or plans.''.

SEC. 302. QUALIFIED LONG-TERM SERVICES TREATED AS MEDICAL CARE.

    (a) General Rule.--Paragraph (1) of section 213(d) of the Internal 
Revenue Code of 1986 (defining medical care) is amended by striking 
``or'' at the end of subparagraph (B), by redesignating subparagraph 
(C) as subparagraph (D), and by inserting after subparagraph (B) the 
following new subparagraph:
                    ``(C) for qualified long-term care services (as 
                defined in section 7702A(c)), or''.
    (b) Technical Amendment.--
            (1) Subparagraph (D) of section 213(d)(1) of such Code (as 
        amended by subsection (a)) is amended by striking 
        ``subparagraphs (A) and (B)'' and inserting ``subparagraphs 
        (A), (B), and (C)''.
            (2) Paragraph (6) of section 213(d) of such Code is 
        amended--
                    (A) by striking ``subparagraphs (A) and (B)'' and 
                inserting ``subparagraphs (A), (B), and (C)'', and
                    (B) by striking ``paragraph (1)(C)'' in 
                subparagraph (A) and inserting ``paragraph (1)(D)''.
            (3) Paragraph (7) of section 213(d) of such Code is amended 
        by striking ``subparagraphs (A) and (B)'' and inserting 
        ``subparagraphs (A), (B), and (C)''.

SEC. 303. EMPLOYER PAYMENTS FOR LONG-TERM CARE INSURANCE NOT TREATED AS 
              DEFERRED COMPENSATION.

    (a) General Rule.--Subparagraph (B) of section 404(b)(2) of the 
Internal Revenue Code of 1986 (relating to plans providing certain 
deferred benefits) is amended to read as follows:
                    ``(B) Exceptions.--
                            ``(i) Welfare benefit funds.--Subparagraph 
                        (A) shall not apply to any benefit provided 
                        through a welfare benefit fund (as defined in 
                        section 419(e)).
                            ``(ii) Premiums for long-term insurance 
                        contracts.--
                                    ``(I) In general.--Except as 
                                provided in subclause (II), 
                                subparagraph (A) shall not apply to any 
                                amount paid or incurred for any long-
                                term care insurance contract.
                                    ``(II) Exception.--Subclause (I) 
                                shall not apply to any amount paid or 
                                incurred by the taxpayer during any 
                                taxable year to the extent such amount 
                                exceeds the premium which would have 
                                been payable under the contract for 
                                such year under a level premium 
                                structure.''.
    (b) Cafeteria Plans.--Paragraph (2) of section 125(c) of such Code 
(relating to deferred compensation plans excluded) is amended by adding 
at the end thereof the following new subparagraph:
                    ``(D) Exception for long-term care insurance 
                contracts.--For purposes of subparagraph (A), amounts 
                paid or incurred for any long-term care insurance 
                contract shall not be treated as deferred compensation 
                to the extent section 404(b)(2)(A) does not apply to 
                such amounts by reason of section 404(b)(2)(B)(ii).''.

SEC. 304. LONG-TERM CARE INSURANCE TAX CREDIT.

    (a) General Rule.--Subpart C of part IV of subchapter A of chapter 
1 of the Internal Revenue Code of 1986 (relating to refundable 
credits), as amended by section 101, is amended by redesignating 
section 35 as section 36 and by inserting after section 34A the 
following new section:

``SEC. 35. LONG-TERM CARE INSURANCE CREDIT.

    ``(a) General Rule.--In the case of an individual, there shall be 
allowed as a credit against the tax imposed by this subtitle for the 
taxable year an amount equal to applicable percentage of the qualified 
long-term care premiums paid during such taxable year.
    ``(b) Applicable Percentage.--For purposes of subsection (a)--

  
                                                         The applicable
``If adjusted gross income is:
                                                         percentage is:
  Less than $25,000..................................                70
  $25,000 but less than $30,000......................                50
  $30,000 but less than $35,000......................                30
  $35,000 but less than $40,000......................                10
  $40,000 or more....................................                0.
    ``(c) Dollar Limitation on Amount Deductible.--
            ``(1) In general.--The amount of the qualified long-term 
        care premiums taken to account under subsection (a) for any 
        taxable year shall not exceed the limitation determined under 
        the following table:

        ``In the case of an
                                                                       
          individual with an attained
                                                                       
          age before the close of the taxable
                                                         The limitation
          year of:
                                                                    is:
                40 or less...........................              $600
                More than 40 but not more than 50....             1,200
                More than 50 but not more than 60....             1,800
                More than 60 but not more than 70....             2,400
                More than 70.........................            3,000.
In the case of a joint return, the limitation of this paragraph shall 
be applied separately with respect to each spouse.
            ``(2) Indexing.--
                    ``(A) In general.--In the case of any taxable year 
                beginning after December 31, 1994, each dollar amount 
                contained in paragraph (1) shall be increased by the 
                medical care cost adjustment for such taxable year. If 
                any increase determined under the preceding sentence is 
                not a multiple of $10, such increase shall be rounded 
                to the nearest multiple of $10.
                    ``(B) Medical care cost adjustment.--For purposes 
                of subparagraph (A), the medical care cost adjustment 
                for any taxable year is the percentage (if any) by 
                which--
                            ``(i) the medical care component of the 
                        Consumer Price Index (as defined in section 
                        1(f)(5)) for August of the calendar year 
                        preceding the calendar year in which the 
                        taxable year begins, exceeds
                            ``(ii) such component for August of 1992.
    ``(d) Qualified Long-Term Care Premiums.--For purposes of this 
section, the term `qualified long-term care premiums' means the amount 
paid by the taxpayer during the taxable year for any long-term care 
insurance contract covering the taxpayer, but only to the extent the 
amount so paid does not exceed the premiums which would have been 
payable under the contract for such taxable year under a level premium 
structure.
    ``(e) Coordination with Advance Payments of Credit.--
            ``(1) Recapture of excess advance payments.--If any payment 
        is made to the individual under section 304(b) of the 
        Comprehensive American Health Care Act during any calendar 
        year, then the tax imposed by this chapter for the individual's 
        last taxable year beginning in such calendar year shall be 
        increased by the aggregate amount of such payments.
            ``(2) Reconciliation of payments advanced and credit 
        allowed.--Any increase in tax under paragraph (1) shall not be 
        treated as tax imposed by this chapter for purposes of 
        determining the amount of any credit (other than the credit 
        allowed by subsection (a)) allowable under this subpart.
    ``(f) Coordination with Minimum Tax.--Rules similar to the rules of 
subsection (h) of section 32 shall apply to any credit to which this 
section applies.
    ``(g) Regulations.--The Secretary shall prescribe such regulations 
as may be necessary to carry out the purposes of this section.''.
    (b) Advance Payments of Credit for Some Individuals.--
            (1) In general.--The Secretary of the Treasury, in 
        consultation with the Secretary of Health and Human Services, 
        shall enter into an agreement with each State to provide for 
        advance payments of the credit provided by section 35 of the 
        Internal Revenue Code of 1986 (as added by this subtitle) to 
        eligible individuals in the form of certificates usable for the 
        purchase of long-term care insurance. The certificates shall be 
        available at such locations as the Secretary determines will 
        ensure the widest distribution.
            (2) Eligible individuals.--
                    (A) In general.--An individual shall be eligible 
                for advance payments described in paragraph (1) if such 
                individual--
                            (i) has income for the taxable year which 
                        results in a poverty ratio of not more than 
                        1.49, and
                            (ii) has filed a certificate with the 
                        Secretary of the Treasury described in 
                        subparagraph (C).
                    (B) Poverty ratio.--For purposes of subparagraph 
                (A)(i), the poverty ratio for any individual shall be 
                determined by dividing such individual's family income 
                for the taxable year (as determined for purposes of 
                title XIX of the Social Security Act) by the income 
                official poverty line for such year (as defined by the 
                Office of Management and Budget, and revised annually 
                in accordance with section 673(2) of the Omnibus Budget 
                Reconciliation Act of 1981) applicable to a family of 
                the size involved.
                    (C) Certificate of eligibility.--A certificate 
                described in this subparagraph is a statement furnished 
                by the individual which--
                            (i) certifies that the individual will be 
                        eligible to receive the credit provided by 
                        section 35 of the Internal Revenue Code of 1986 
                        for the taxable year,
                            (ii) certifies that the poverty ratio of 
                        the individual for such year will be not more 
                        than 1.49,
                            (iii) certifies that the individual does 
                        not have another certificate with respect to 
                        such credit in effect for such year, and
                            (iv) estimates the amount of qualified 
                        long-term care premiums (as defined in section 
                        35(d) of such Code) for such year.
    (c) Program To Increase Public Awareness.--Not later than the first 
day of the first calendar year following the date of enactment of this 
Act, the Secretary of the Treasury, or the Secretary's delegate, in 
consultation with the Secretary of Health and Human Services, shall 
establish a public awareness program to inform the public of the 
availability of the credit for long-term care insurance expenses 
allowed under section 35 of the Internal Revenue Code of 1986 (as added 
by this subtitle). Such public awareness program shall be designed to 
assure that individuals who may be eligible are informed of the 
availability of such credit and filing procedures.
    (d) Clerical Amendment.--The table of sections for subpart C of 
part IV of subchapter A of chapter 1 of such Code is amended by 
striking the item relating to section 35 and inserting the following:

                              ``Sec. 35. Long-term care insurance 
                                        credit.
                              ``Sec. 36. Overpayments of tax.''.

SEC. 305. EXEMPTION FROM 10-PERCENT ADDITIONAL TAX; CERTAIN EXCHANGES 
              NOT TAXABLE.

    (a) Exemption From Additional Tax.--
            (1) In general.--Paragraph (2) of section 72(t) of the 
        Internal Revenue Code of 1986 (relating to additional tax not 
        to apply to certain distributions) is amended by adding at the 
        end thereof the following new subparagraph:
                    ``(E) Distributions used to pay for long-term care 
                insurance contracts.--Any distribution made on or after 
                the date on which the employee attains age 50 to the 
                extent such distribution is used, not later than the 
                day 60 days after the day on which such distribution is 
                made, to pay premiums on a long-term care insurance 
                contract for such employee.''.
            (2) Technical amendment.--Subparagraph (B) of section 
        72(t)(2) of such Code is amended--
                    (A) by striking ``subparagraph (A) or (C)'' and 
                inserting ``subparagraph (A), (C), or (E)'',
                    (B) by adding at the end thereof the following new 
                sentence: ``For purposes of the preceding sentence, any 
                premiums paid on a long-term care insurance contract 
                shall not be treated as paid for medical care to the 
                extent such premiums are taken into account under 
                subparagraph (E).''.
    (b) Certain Exchanges Not Taxable.--Subsection (a) of section 1035 
of such Code (relating to certain exchanges of insurance contracts) is 
amended by striking the period at the end of paragraph (3) and 
inserting ``; or'', and by adding at the end thereof the following new 
paragraph:
            ``(4) in the case of an individual who has attained age 50, 
        a contract of life insurance or an endowment or annuity 
        contract for a long-term care insurance contract.''.

SEC. 306. EFFECTIVE DATE.

    The amendments made by this subtitle shall apply to taxable years 
beginning after the date of enactment of this Act.

               Subtitle B--Medicare Benefit Improvements

SEC. 311. IN-HOME RESPITE CARE FOR CERTAIN CHRONICALLY DEPENDENT 
              INDIVIDUALS.

    (a) In General.--Section 1832(a) of the Social Security Act (42 
U.S.C. 1395k(a)) is amended--
            (1) in paragraph (2)(A)--
                    (A) by inserting ``(i)'' after ``(A)'', and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (ii) in-home respite care for a 
                chronically dependent individual for up to 80 hours in 
                any 12-month period described in section 1861(kk)(4), 
                but not to exceed 80 hours in any calendar year''; and
            (2) by adding at the end the following new sentence:
``In the case of in-home respite care (described in paragraph 
(2)(A)(ii)) provided to a chronically dependent individual on any day, 
such care provided for 3 hours or less on the day shall be counted (for 
purposes of the limitation in such paragraph) as 3 hours of such 
care.''.
    (b) In-Home Respite Care for Chronically Dependent Individual 
Defined.--Section 1861 of such Act (42 U.S.C. 1395x) is amended by 
inserting after subsection (jj) the following new subsection:

        ``In-Home Respite Care; Chronically Dependent Individual

    ``(kk)(1) The term `in-home respite care' means the following items 
and services furnished, under the supervision of a registered 
professional nurse, to a chronically dependent individual (as defined 
in paragraph (2)) during the period described in paragraph (4) by a 
home health agency or by others under arrangements with them made by 
such agency in a place of residence used as such individual's home:
            ``(A) Services of a homemaker/home health aide (who has 
        successfully completed a training program approved by the 
        Secretary).
            ``(B) Personal care services.
            ``(C) Nursing care provided by a licensed professional 
        nurse.
    ``(2) The term `chronically dependent individual' means an 
individual who has been certified by a physician as--
            ``(A) being unable to perform (without substantial 
        assistance from another individual) at least 2 activities of 
        daily living (as defined in paragraph (3)), or
            ``(B) having a similar level of disability due to cognitive 
        impairment.
    ``(3) The `activities of daily living', referred to in paragraph 
(2), are as follows:
            ``(i) Eating.
            ``(ii) Bathing.
            ``(iii) Dressing.
            ``(iv) Toileting.
            ``(v) Transferring in and out of a bed or in and out of a 
        chair.
    ``(4)(A) The 12-month period described in this paragraph is the 1-
year period beginning on the date that the Secretary determines that a 
chronically dependent individual has incurred out-of-pocket part B cost 
sharing (as defined in paragraph (5)(A)) in an amount equal to the part 
B limit (as determined under paragraph (5)(B)) for the year.
    ``(B) In the case of an individual who qualifies under subparagraph 
(A) within 12 months after previously qualifying, the subsequent 
qualification shall begin a new 12-month period under this paragraph.
    ``(5) For purposes of this subsection:
            ``(A) The term `out-of-pocket part B cost sharing' means, 
        with respect to an individual covered under part B, the amounts 
        of expenses that the individual incurs that are attributable 
        to--
                    ``(i) the deductions established under section 
                1833(b), and
                    ``(ii) the difference between the payment amount 
                provided under part B and the payment amount that would 
                be provided under part B if `100 percent' and `0 
                percent' were substituted for `80 percent' and `20 
                percent', respectively, each place either appears in 
                sections 1833(a), 1833(i)(2), 1834(c)(1)(C), 
                1835(b)(2), 1866(a)(2)(A), 1881(b)(2), and 1881(b)(3).
            ``(B)(i) The part B limit for 1994 is $1,780. The part B 
        limit for any succeeding year shall be such an amount (rounded 
        to the nearest multiple of $1) as the Secretary estimates, for 
        that succeeding year, will reflect a level of out-of-pocket 
        part B expenses that only 5.5 percent of the average number of 
        individuals enrolled under part B (other than individuals 
        enrolled with an eligible organization under section 1876 or an 
        organization described in section 1833(a)(1)(A)) will equal or 
        exceed in that succeeding year.
            ``(ii) Not later than September 1 of each year (beginning 
        with 1994), the Secretary shall promulgate the part B limit 
        under this subparagraph for the succeeding year.''.
    (c) Payment.--Section 1833(a) of such Act (42 U.S.C. 1395l(a)) is 
amended--
            (1) in paragraph (2), by inserting ``(A)(ii),'' after 
        ``subparagraphs'' the first place it appears,
            (2) in paragraph (3), by striking ``(D)'' and inserting 
        ``(A)(ii), (D),'', and
            (3) by adding at the end the following:
``Payment for in-home respite care for chronically dependent 
individuals shall be paid on the basis of an hour of such care 
provided. In applying paragraph (2) in the case of an organization 
receiving payment under clause (A) of paragraph (1) or under a 
reasonable cost reimbursement contract under section 1876 and providing 
coverage of in-home respite care, the Secretary shall provide for an 
appropriate adjustment in the payment amounts otherwise made to reflect 
the aggregate increase in payments that would otherwise be made with 
respect to enrollees in the organization if payments were made other 
than under such clause or such a contract if payments were to be made 
on an individual-by-individual basis.''.
    (d) Certification.--Section 1835(a)(2) of such Act (42 U.S.C. 
1395n(a)(2)) is amended--
            (1) in subparagraph (E), by striking ``and'' at the end;
            (2) in subparagraph (F), by striking the period at the end 
        and inserting ``; and''; and
            (3) by inserting after subparagraph (F) the following new 
        subparagraph:
                    ``(G) in the case of in-home respite care provided 
                to a chronically dependent individual during a 12-month 
                period, the individual was a chronically dependent 
                individual during the 3-month period immediately 
                preceding the beginning of the 12-month period.''.
    (e) Standards for Utilization.--
            (1) Section 1862(a) (42 U.S.C. 1395y(a)) is amended--
                    (A) in paragraph (1)--
                            (i) in subparagraph (E), by striking 
                        ``and'' at the end,
                            (ii) in subparagraph (F), by striking the 
                        semicolon at the end and inserting ``, and'', 
                        and
                            (iii) by adding at the end the following 
                        new subparagraph:
            ``(G) in the case of in-home respite care for chronically 
        dependent individuals, which is not reasonable and necessary to 
        assure the health and condition of the individual is maintained 
        in the individual's noninstitutional residence;''; and
                    (B) in paragraph (6), by inserting ``and except, in 
                the case of in-home respite care, as is otherwise 
                permitted under paragraph (1)(G)'' after ``paragraph 
                (1)(C)''.
            (2) The Secretary of Health and Human Services shall take 
        appropriate efforts to assure the quality, and provide for 
        appropriate utilization of, in-home respite care for 
        chronically dependent individuals under the amendments made by 
        this section.
    (f) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 1994.

SEC. 312. COVERAGE OF HOME INTRAVENOUS DRUG THERAPY SERVICES.

    (a) In General.--Section 1832(a)(2)(A) of the Social Security Act 
(42 U.S.C. 1395k(a)(2)(A)), as amended by section 311(a) of this Act, 
is further amended--
            (1) by striking ``, and (ii)'' and inserting ``, (ii)''; 
        and
            (2) by striking ``calendar year'' before the semicolon and 
        inserting ``, calendar year, and (iii) home intravenous drug 
        therapy services''.
    (b) Home Intravenous Drug Therapy Services Defined.--Section 1861 
of such Act (42 U.S.C. 1395x), as amended by section 311(b) of this 
Act, is further amended by adding at the end the following new 
subsection:

                ``Home Intravenous Drug Therapy Services

    ``(ll)(1) The term `home intravenous drug therapy services' means 
the items and services described in paragraph (2) furnished to an 
individual who is under the care of a physician--
            ``(A) in a place of residence used as such individual's 
        home;
            ``(B) by a qualified home intravenous drug therapy provider 
        (as defined in paragraph (4)) or by another person under 
        arrangements with such person made by such provider; and
            ``(C) under a plan established and periodically reviewed by 
        a physician.
    ``(2) The items and services described in this paragraph are such 
nursing, pharmacy, and related services and products (including 
pharmaceutical products, medical supplies, intravenous fluids, 
delivery, and equipment) as are necessary to conduct safely and 
effectively an intravenously administered drug regimen through use of a 
covered home intravenous drug.
    ``(3)(A) The term `covered home intravenous drug' means an approved 
drug dispensed to an individual that the Secretary of Health and Human 
Services has determined can generally be administered safely and 
effectively in a home setting.
    ``(B) Not later than January 1, 1994, and periodically thereafter, 
the Secretary shall publish a list of covered home intravenous drugs 
that may be used in conjunction with the provision of home intravenous 
drug therapy services under this title.
    ``(4) The term `qualified home intravenous drug therapy provider' 
means any entity that the Secretary determines meets the following 
requirements:
            ``(i) The entity is capable of providing or arranging for 
        the items and services described in paragraph (2) of this 
        subsection and covered home intravenous drugs.
            ``(ii) The entity maintains clinical records for each 
        patient.
            ``(iii) The entity adheres to written protocols and 
        policies with respect to the provision of items and services.
            ``(iv) The entity makes services available, as needed, 7 
        days a week on a 24-hour basis.
            ``(v) The entity coordinates all services provided to a 
        patient with the physician of such patient.
            ``(vi) The entity conducts a quality assessment and 
        assurance program, including a drug regimen review and the 
        coordination of patient care.
            ``(vii) The entity assures that only trained personnel 
        provide--
                    ``(A) covered home intravenous drugs; and
                    ``(B) any other service for which training is 
                required to safely provide the service.
            ``(viii) The entity assumes responsibility for the quality 
        of services provided by another person under arrangements with 
        a State agency (or the appropriate agency or department of a 
        political subdivision of a State) or the entity.
            ``(ix) In the case where the State or a political 
        subdivision of the State in which the entity operates has a 
        licensing program applicable to such entity, such entity--
                    ``(A) is licensed pursuant to applicable laws; or
                    ``(B) has been approved by the State agency or 
                department (or the appropriate agency or department of 
                the political subdivision of the State) responsible for 
                conducting such licensing program as meeting the 
                standards for licensing under such program.
            ``(x) The entity meets such other requirements as the 
        Secretary may determine are necessary to assure the safe and 
        effective provision of home intravenous drug therapy services 
        and the efficient administration of such services under this 
        title.''.
    (c) Payment.--
            (1) In general.--Part B of title XVIII of such Act (42 
        U.S.C. 1395j et seq.) is amended--
                    (A) in section 1833--
                            (i) in paragraph (2) of subsection (a)--
                                    (I) in subparagraph (D), by 
                                striking ``and'' at the end of the 
                                subparagraph;
                                    (II) in subparagraph (E), by 
                                striking the semicolon and inserting 
                                ``; and''; and
                                    (III) by adding at the end of the 
                                paragraph the following new 
                                subparagraph:
            ``(F) with respect to home intravenous drug therapy 
        services, the amounts described in section 1834(d)(1);''; and
                            (ii) in subsection (b) of such section, by 
                        striking ``services, (3)'' and inserting 
                        ``services and home intravenous drug therapy 
                        services, (3)''; and
                    (B) by adding at the end of section 1834, the 
                following new subsection:
    ``(d) Home Intravenous Drug Therapy Services.--
            ``(1) In general.--With respect to home intravenous drug 
        therapy services, payment under this part shall be made in an 
        amount equal to the lesser of the actual charges for such 
        services or the fee determined under the fee schedule 
        established under paragraph (2).
            ``(2) Establishment of Fee Schedule.--Not later than 
        January 1, 1994, and annually thereafter, the Secretary shall 
        establish by regulation, with respect to each calendar year, a 
        fee schedule for home intravenous drug therapy services for 
        which payment is made under this part. Each fee schedule 
        established under this subsection shall be on an illness-
        specific basis.''.
    (d) Certification.--
            (1) In general.--Section 1835(a)(2) of such Act (42 U.S.C. 
        1395n(a)(2)), as amended by section 311(d) of this Act, is 
        further amended--
                    (A) by striking ``and'' at the end of subparagraph 
                (F);
                    (B) by inserting ``and'' at the end of subparagraph 
                (G); and
                    (C) by inserting after subparagraph (G) the 
                following new subparagraph:
                    ``(H) in the case of home intravenous drug therapy 
                services--
                            ``(i) such services are or were required 
                        because the individual needed such services for 
                        the administration of a covered home 
                        intravenous drug;
                            ``(ii) a plan for furnishing such services 
                        has been established and is reviewed 
                        periodically by a physician;
                            ``(iii) such services are or were furnished 
                        while the individual is or was under the care 
                        of a physician;
                            ``(iv) such services are administered in a 
                        place or residence used as the home of such 
                        individual; and
                            ``(v) with respect to such services 
                        initiated before January 1, 1996, such services 
                        have been reviewed and approved by a 
                        utilization and peer review organization under 
                        section 1154(a)(16) before the date such 
                        services were initiated (or, in the case of 
                        services initiated on an outpatient basis, 
                        within 1 working day (as used in section 1154) 
                        of the date of initiation of the services, 
                        except in exceptional circumstances, as 
                        determined by the Secretary).''.
            (2) Prior Approval Required.--Section 1154(a) of such Act 
        (42 U.S.C. 1320-c3(a)), is amended by adding at the end the 
        following new paragraph:
    ``(16) The organization shall conduct a review described in 
paragraph (1) with respect to home intravenous drug therapy services 
(as defined in section 1861(ll)(1)) initiated before January 1, 1996, 
within 1 working day of the date of the receipt of a request for such 
review. The Secretary shall establish criteria to be used by the 
organization in conducting a review of the appropriateness of home 
intravenous drug therapy services pursuant to this paragraph.''.
    (e) Certification of Home Intravenous Drug Therapy Providers; 
Intermediate Sanctions for Noncompliance.--
            (1) Treatment as provider of services.--Section 1861(u) of 
        such Act (42 U.S.C. 1395x(u)) is amended by inserting 
        ``qualified home intravenous drug therapy provider,'' after 
        ``hospice program,''.
            (2) Consultation with state agencies and other 
        organizations.--Section 1863 of such Act (42 U.S.C. 1395z), is 
        amended by striking ``and (dd)(2)'' and inserting ``(dd)(2), 
        and (ll)(4)''.
            (3) Use of state agencies in determining compliance.--
        Section 1864(a) of such Act (42 U.S.C. 1395aa(a)), as amended 
        by section 4163(c)(2) of the Omnibus Budget Reconciliation Act 
        of 1990, is amended--
                    (A) in the first sentence, by inserting ``or a 
                qualified home intravenous drug therapy provider,'' 
                after ``hospice program'', and
                    (B) in the second sentence, by striking ``or 
                hospice program'' and inserting ``hospice program, or 
                qualified home intravenous drug therapy provider''.
            (4) Application of intermediate sanctions.--Section 1846 of 
        such Act (42 U.S.C. 1395w-2), as amended by section 4154(e)(2) 
        of the Omnibus Budget Reconciliation Act of 1990, is amended--
                    (A) in the heading, by adding at the end ``and for 
                qualified home intravenous drug therapy providers'';
                    (B) in subsection (a), by inserting ``or that a 
                qualified home intravenous drug therapy provider that 
                is certified for participation under this title no 
                longer substantially meets the requirements described 
                in clauses (i) through (x) of section 1861(ll)(4)'' 
                after ``under this part''; and
                    (C) in subsection (b)(2)(A)(iv), by inserting ``or 
                home intravenous drug therapy service'' after 
                ``clinical diagnostic laboratory tests''.
    (f) Use of Regional Intermediaries in Administration of Benefit.--
Section 1816 of such Act (42 U.S.C. 1395h) is amended by adding at the 
end the following new subsection:
    ``(k) With respect to carrying out functions relating to payment 
for home intravenous drug therapy services, the Secretary may enter 
into contracts with agencies or organizations under this section to 
perform such functions on a regional basis.''.
    (g) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 1994.

SEC. 313. EXTENDING HOME HEALTH SERVICES.

    (a) In General.--Section 1861(m) of the Social Security Act (42 
U.S.C. 1395x(m)) is amended by adding at the end the following new 
sentence: ``For purposes of paragraphs (1) and (4) and sections 
1814(a)(2)(C) and 1835(a)(2)(A), nursing care and home health aide 
services shall be considered to be provided or needed on an 
`intermittent' basis if they are provided or needed less than 7 days 
each week and, in the case they are provided or needed for 7 days each 
week, if they are provided or needed for a period of up to 38 
consecutive days.''.
    (b) Payment Under Part B.--Section 1833(d) of such Act (42 U.S.C. 
1395l(d)) is amended--
            (1) by striking ``(d) No payment'' and inserting ``(d)(1) 
        Except as provided in paragraph (2), no payment''; and
            (2) by adding at the end the following new paragraph:
    ``(2) In the case of home health services furnished to an 
individual enrolled under this part for which payment is made only as a 
result of the application of the last sentence of section 1861(m), 
payment shall be made under this part.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services furnished in cases of initial periods of home health 
services beginning on or after January 1, 1994.

        Subtitle C--Senior Health Insurance Consumer Protection

SEC. 321. CERTIFICATION OF HEALTH INSURANCE POLICIES FOR THE ELDERLY.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall no later than 90 
days after the date of enactment of this Act establish a procedure 
whereby health insurance policies for the elderly may be certified by 
the Secretary as meeting minimum standards and requirements set forth 
in subsection (b). Such certification shall remain in effect if the 
insurer files a notarized statement with the Secretary no later than 
June 30 of each year stating that the policy continues to meet such 
standards and requirements and if the insurer submits such additional 
data as the Secretary finds necessary to verify independently the 
accuracy of such notarized statement. Where the Secretary determines 
such policy meets (or continues to meet) such standards and 
requirements, the Secretary shall authorize the insurer to have printed 
on such policy (but only in accordance with such requirements and 
conditions as the Secretary may require) an emblem which the Secretary 
shall cause to be designed for use as an indication that a policy has 
received the Secretary's certification. The Secretary shall provide 
each State commissioner or superintendent of insurance with a list of 
all the policies which have received the Secretary's certification.
    (b) Certification and Requirements.--The Secretary shall certify 
under this section any health insurance policies for the elderly, or 
continue certification of such a policy, only if the Secretary finds 
that such policy--
            (1) meets or exceeds the National Association of Insurance 
        Commissioners Model Act Standards;
            (2) is guaranteed to be renewable on the basis of the same 
        premium rate (or, if a different rate, a rate that is adjusted 
        on a class basis);
            (3) limits the exclusion of preexisting conditions in 
        accordance with regulations prescribed by the Secretary;
            (4) allows any purchaser 30 days to rescind the purchase of 
        the policy by such purchaser;
            (5) provides that policies of such health insurance be 
        written in simplified language which can be understood by 
        purchasers, as specified in regulations prescribed by the 
        Secretary; and
            (6) meets or exceeds such other requirements as the 
        Secretary (in consultation with State commissioners or 
        superintendents of insurance) shall by regulation prescribe.
    (c) Study and Report.--The Secretary shall 3 years after the date 
of enactment of this Act conduct a study and issue a report to Congress 
on health insurance policies for the elderly. Such study and report 
shall be conducted and issued no later than 6 months after the 3-year 
period commencing after the date of enactment of this Act.

                                 <all>

S 728 IS----2
S 728 IS----3
S 728 IS----4
S 728 IS----5
S 728 IS----6