[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 560 Introduced in House (IH)]







105th CONGRESS
  1st Session
                                H. R. 560

  To amend the Social Security Act to provide for a program of health 
  insurance for children under 18 years of age and for mothers-to-be.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            February 4, 1997

  Mr. Stark introduced the following bill; which was referred to the 
   Committee on Ways and Means, and in addition to the Committee on 
Commerce, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend the Social Security Act to provide for a program of health 
  insurance for children under 18 years of age and for mothers-to-be.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Healthy Start Act of 1997''.

SEC. 2. HEALTH INSURANCE FOR CHILDREN AND MOTHERS-TO-BE.

    (a) In General.--The Social Security Act is amended by adding at 
the end the following new title:

                       ``TITLE XXI--HEALTHY START

``SEC. 2100. ESTABLISHMENT OF PROGRAM OF HEALTH INSURANCE FOR CHILDREN 
              AND MOTHERS-TO-BE.

    ``There is hereby established a program of health insurance for 
children under 18 years of age and mothers-to-be.

                         ``Part A--Eligibility

``SEC. 2101. GENERAL ELIGIBILITY.

    ``(a) Children.--
            ``(1) In general.--Every individual--
                    ``(A) who is a child (as defined in paragraph (2)),
                    ``(B) whose principal place of abode is in the 
                United States,
                    ``(C) who is a citizen or national of the United 
                States or a permanent resident alien (as defined in 
                subsection (d)), and
                    ``(D) who is not covered under a qualified health 
                plan (as defined in subsection (e)),
        is, upon registration under section 2102, entitled to benefits 
        under this title as a child.
            ``(2) Child defined.--In this title, the term `child' means 
        an individual from birth until the end of the month in which 
        the individual attains 18 years of age.
    ``(b) Mothers.--
            ``(1) In general.--Every woman--
                    ``(A) who is a pregnant woman (as defined in 
                paragraph (2)),
                    ``(B) whose principal place of abode is in the 
                United States,
                    ``(C) who is a citizen or national of the United 
                States or a permanent resident alien (as defined in 
                subsection (d)), and
                    ``(D) who is not covered under a qualified health 
                plan (as defined in subsection (e)),
        is entitled to benefits under this title as a pregnant woman.
            ``(2) Pregnant woman defined.--In this title, the term 
        `pregnant woman' means a woman during the period--
                    ``(A) beginning on the date she receives the 
                examination or test which forms the basis for the 
                certification of pregnancy under section 2102(b)(1), 
                and
                    ``(B) ending on the last day of the month in which 
                the 60-day period (beginning on the date of termination 
                of the pregnancy) ends.
    ``(c) Pregnant Children.--In the case of an individual who is 
entitled under this section to benefits under this title as a child and 
as a pregnant woman, the individual is entitled to benefits as both.
    ``(d) Permanent Resident Alien Defined.--In this section, the term 
`permanent resident alien' means an alien lawfully admitted for 
permanent residence or otherwise permanently residing in the United 
States under color of law, and includes an alien granted asylum under 
section 208 of the Immigration and Nationality Act or lawfully admitted 
as a temporary resident under section 210, 210A, or 245A of such Act.)
    ``(e) Qualified Health Plan.--In this section, the term `qualified 
health plan' means a plan of health insurance or coverage, an employee 
welfare benefit plan that provides health benefits, or other plan 
(other than under this title) under Federal or State law that provides 
coverage of benefits which the Secretary of Health and Human Services 
determines is substantially equivalent to the coverage of benefits 
provided under this title.

``SEC. 2102. REGISTRATION; CERTIFICATION OF PREGNANCY.

    ``(a) Registration of Children.--
            ``(1) In general.--The Secretary shall establish a process 
        for the registration of children at the time of birth in the 
        United States or at the time of immigration into the United 
        States or other acquisition of lawful permanent resident status 
        in the United States.
            ``(2) Transitional registration.--The Secretary also shall 
        establish a process for the registration of children born 
        before the effective date of benefits under this title.
            ``(3) Effect of failure to register.--The failure of a 
        child to be registered under this subsection shall not be 
        considered to deny the child's entitlement to benefits under 
        this title, but merely to delay payment with respect to such 
        benefits under this title.
    ``(b) Certification of Pregnancy and Registration of Pregnant 
Women.--
            ``(1) Certification of pregnancy.--A certification of 
        pregnancy for purposes of this title--
                    ``(A) may be made by a physician (or such other 
                qualified health professionals as the Secretary may 
                designate) on the basis of such tests or procedures as 
                the Secretary may specify,
                    ``(B) shall be stated on such form as the Secretary 
                shall specify, and
                    ``(C) shall be filed with the Secretary in a manner 
                specified by the Secretary.
            ``(2) Registration.--The Secretary shall establish a 
        process for the registration of pregnant women in connection 
        with the filing of a certification of pregnancy under paragraph 
        (1)(C).

``SEC. 2103. COVERAGE PERIOD.

    ``(a) In General.--No payments may be made under this part with 
respect to the expenses of an individual unless such expenses were 
incurred by such individual during a period which, with respect to the 
individual, is a coverage period under this section.
    ``(b) Children.--With respect to an individual entitled to benefits 
under this title as a child, the coverage period shall begin on the 
first date (on or after the effective date of benefits under this 
title) on which the individual meets the requirements for such 
entitlement under section 2101(a) and shall end on the day before the 
first month in which the individual no longer meets such requirements.
    ``(c) Pregnant Women.--With respect to an individual entitled to 
benefits under this title as a pregnant woman, the coverage period 
shall begin on the first date (on or after the effective date of 
benefits under this title) on which the individual meets the 
requirements for such entitlement under section 2101(b) and shall end 
on the day before the first month in which the individual no longer 
meets such requirements.

                           ``Part B--Benefits

``SEC. 2111. SCOPE OF BENEFITS FOR CHILDREN.

    ``(a) In General.--Except as provided in the succeeding provisions 
of this section, the benefits provided to an individual by the program 
established by this part shall consist of the same benefits that are 
available under title XVIII to individuals entitled to benefits under 
part A of that title and enrolled under part B of that title plus a 
benefit for prescription drugs and biologicals necessary to meet 
catastrophic costs for such drugs and biologicals, as determined by the 
Secretary.
    ``(b) Well Child Services.--
            ``(1) In general.--In addition to the benefits described in 
        subsection (a), in the case of an individual entitled to 
        benefits under this title as a child, the benefits under this 
        title shall include entitlement to have payment made (in the 
        same manner as for physicians' services under part B of title 
        XVIII) for the following, without the application of 
        deductibles, coinsurance, or copayments, subject to the 
        periodicity schedule established with respect to the services 
        under paragraph (2):
                    ``(A) Newborn and well-baby care, including normal 
                newborn care and pediatrician services for high-risk 
                deliveries.
                    ``(B) Well-child care, including routine office 
                visits, routine immunizations (including the vaccine 
                itself), routine laboratory tests, and preventive 
                dental care.
                    ``(C) Early and periodic screening, diagnostic, and 
                treatment services (as defined in section 1905(r) of 
                the Social Security Act).
            ``(2) Periodicity schedule.--The Secretary, in consultation 
        with the American Academy of Pediatrics, shall establish a 
        schedule of periodicity which reflects the general, appropriate 
        frequency with which services listed in paragraph (1) should be 
        provided to healthy children.

``SEC. 2112. SCOPE OF BENEFITS FOR PREGNANT WOMEN.

    ``(a) In General.--In the case of an individual entitled to 
benefits under this title as a pregnant woman, the benefits under this 
title shall consist of entitlement to have payment made for the 
following, without the application of deductibles, coinsurance, or 
copayments, subject to the periodicity schedule established with 
respect to the services under subsection (b):
            ``(1) Prenatal care, including care for all complications 
        of pregnancy.
            ``(2) Inpatient labor and delivery services.
            ``(3) Postnatal care.
            ``(4) Postnatal family planning services.
    ``(b) Periodicity Schedule.--The Secretary, in consultation with 
the American College of Obstetrics and Gynecology, shall establish a 
schedule of periodicity which reflects the general, appropriate 
frequency with which services listed in subsection (a) should be 
provided to pregnant women without complications of pregnancy.

``SEC. 2113. EXCLUSIONS.

    ``(a) In General.--Except as provided in subsections (b) and (c), 
section 1862 shall apply to expenses incurred for items and services 
provided under this title the same manner as such section applies to 
items and services provided under title XVIII.
    ``(b) Benefits Exception.--
            ``(1) Children's services.--In applying section 1862(a) 
        with respect to services described in section 2111(b)(1) 
        (relating to well-child services), payment shall not be denied 
        under paragraph (1), (7), or (12) of such section 1862(a) if 
        the services are provided in accordance with the periodicity 
        schedule described in section 2111(b)(2).
            ``(2) Services for pregnant women.--In applying section 
        1862(a) with respect to services described in section 2112(a) 
        (other than paragraph (2) thereof), payment shall not be denied 
        under paragraph (1) or (7) of such section 1862(a) if the 
        services are provided in accordance with the periodicity 
        schedule described in section 2112(b).
    ``(c) Coordination of Payments.--Payment shall not be made under 
this title with respect to benefits to the extent that payment for such 
benefits may be made under title XVIII.

              ``Part C--Payment for Benefits and Financing

``SEC. 2121. PAYMENTS FOR BENEFITS.

    ``(a) In General.--Except as otherwise provided in this section--
            ``(1) payment of benefits under this title with respect to 
        benefits shall be made in the same amounts and on the same 
        basis as payment may be made with respect to such benefits 
        under title XVIII, and
            ``(2) the provisions of sections 1814, 1833, 1842, 1848, 
        and 1886 shall apply to payment of benefits under this title in 
        the same manner as they apply to benefits under title XVIII.
    ``(b) No Cost-Sharing for Certain Services.--No deductibles, 
coinsurance, copayments, or other cost-sharing shall be imposed with 
respect to--
            ``(1) well-child care services described in section 
        2111(b)(1), and
            ``(2) items and services for which an individual is 
        entitled under this title as a pregnant woman.
    ``(c) Adjustment of Payments.--
            ``(1) Establishment of new drgs and weights.--In making 
        payment under this title with respect to inpatient hospital 
        services, the Secretary shall make such adjustments in the 
        diagnosis-related groups and weighting factors with respect to 
        discharges within such groups, otherwise established under 
        section 1886(d)(4) as may be necessary--
                    ``(A) to reflect the types of discharges occurring 
                under this title which are not occurring under title 
                XVIII, and
                    ``(B) to provide for a weighting factor, for 
                cesarean section deliveries, which is 95 percent of the 
                weighting factor that otherwise would be established.
            ``(2) Payment for obstetrical services.--
                    ``(A) Global fee.--In making payment under this 
                title with respect to the group of obstetrical services 
                typical of treatment throughout a course of pregnancy, 
                the Secretary shall establish, as a schedule under 
                section 1848, a global fee with respect to such group 
                of services.
                    ``(B) Bonus for early presentation.--The fee 
                schedule amount with respect to obstetrical services 
                under this title shall be increased by 5 percent in the 
                case of services furnished to women who have presented 
                for prenatal care during the first trimester.
                    ``(C) Disincentive for cesarean sections.--The fee 
                schedule amount otherwise established with respect to a 
                cesarean section shall be 95 percent of the fee 
                schedule amount otherwise established.
    ``(c) Conditions of and Limitations on Payments.--The provisions of 
sections 1814 and 1835 shall apply to payment for services under this 
title in the same manner as they apply t<plus-minus>o payment for 
services under parts A and B, respectively, of title XVIII.
    ``(d) Use of Trust Fund.--In carrying out this section, any 
reference in title XVIII to a trust fund shall be treated as a 
reference to the Children Health Insurance Trust Fund established under 
section 2122.

``SEC. 2122. CHILDREN HEALTH INSURANCE TRUST FUND.

    ``(a) Establishment.--(1) There is hereby created on the books of 
the Treasury of the United States a trust fund to be known as the 
`Children Health Insurance Trust Fund' (in this section referred to as 
the `Trust Fund'). The Trust Fund shall consist of such gifts and 
bequests as may be made as provided in section 201(i)(1) and amounts 
appropriated under paragraph (2).
    ``(2) There are hereby appropriated to the Trust Fund amounts 
equivalent to 100 percent of the premium taxes imposed by section 59B 
of the Internal Revenue Code of 1986, and such additional amounts as 
the Congress provides. The amounts appropriated by the preceding 
sentence in relation to premium taxes shall be transferred from time to 
time from the general fund in the Treasury to the Trust Fund, such 
amounts to be determined on the basis of estimates by the Secretary of 
the Treasury of the taxes, paid to or deposited into the Treasury; and 
proper adjustments shall be made in amounts subsequently transferred to 
the extent prior estimates were in excess of or were less than the 
taxes specified in such sentence.
    ``(b) Incorporation of Provisions.--
            ``(1) In general.--Subject to paragraph (2), the provisions 
        of subsections (b) through (e) and (g) through (j) of section 
        1817 shall apply to the Trust Fund in the same manner as they 
        apply to the Federal Hospital Insurance Trust Fund.
            ``(2) Exceptions.--In applying paragraph (1)--
                    ``(A) the Board of Trustees and Managing Trustee of 
                the Trust Fund shall be composed of the members of the 
                Board of Trustees and the Managing Trustee, 
                respectively, of the Federal Hospital Insurance Trust 
                Fund; and
                    ``(B) any reference in section 1817 to the Federal 
                Hospital Insurance Trust Fund or to title XVIII (or 
                part A thereof) is deemed a reference to the Trust Fund 
                under this section and this title, respectively.

``SEC. 2123. APPLICABLE TITLE XXI PREMIUM.

    ``For purposes of section 59B of the Internal Revenue Code of 1986, 
the Secretary shall, during September of each year (beginning with 
1998), determine a title XXI applicable premium for months in the 
succeeding calendar year. Such premium for months in a year shall be 
such amount as the Secretary estimates so that--
            ``(1) 12 times the product of such amount and the average 
        number of families with individuals entitled to benefits under 
        section 2101 in any month in the year, is equal to
            ``(2) the total of the benefits and administrative costs 
        which the Secretary estimates will be payable from the Children 
        Health Insurance Trust Fund for services performed and related 
        administrative costs incurred in such year.
In calculating the amount under paragraph (2), the Secretary shall 
include an appropriate amount for a contingency margin.

                      ``Part D--General Provisions

``SEC. 2131. INCORPORATION OF CERTAIN MEDICARE PROVISIONS.

    ``(a) Use of Carriers and Intermediaries.--The Secretary shall 
provide for the administration of this title through the use of fiscal 
intermediaries and carriers in the same manner as title XVIII is 
carried out through the use of such fiscal intermediaries and carriers.
    ``(b) Definitions.--Except as otherwise provided in this title, the 
definitions contained in section 1861 shall apply for purposes of this 
title in the same manner as they apply for purposes of title XVIII.
    ``(c) Certification, Provider Qualification, Etc.--The provisions 
of sections 1863 through 1875, sections 1878 through 1880, section 
1883, section 1885, and sections 1887 through 1892 shall apply to this 
title in the same manner as they apply to title XVIII.
    ``(d) Health Maintenance Organizations and Competitive Medical 
Plans.--
            ``(1) In general.--Except as provided in this subsection, 
        section 1876 shall apply to individuals entitled to benefits 
        under this title in the same manner as such section applies to 
        individuals entitled to benefits under part A, and enrolled 
        under part B, of title XVIII.
            ``(2) Limitation to reasonable cost reimbursement contracts 
        for pregnant women.--
                    ``(A) In general.--The provisions of section 1876 
                relating only to risk-sharing contracts (and not to 
                reasonable cost reimbursement contracts) shall not 
                apply to individuals entitled to benefits under this 
                title only as pregnant women.
                    ``(B) Report.--Not later than January 1, 1997, the 
                Secretary shall submit to the Congress a report 
                concerning recommendations on how the provisions of 
                section 1876 relating to risk-sharing contracts may be 
                adapted to apply to benefits provided under this title 
                to pregnant women.
            ``(3) Application.--In applying section 1876 under this 
        section--
                    ``(A) the provisions of such section relating only 
                to individuals enrolled under part B of title XVIII 
                shall not apply;
                    ``(B) any reference to a Trust Fund established 
                under title XVIII and to benefits under such title is 
                deemed a reference to the Children Health Insurance 
                Trust Fund and to benefits under this title;
                    ``(C) the adjusted average per capita cost and the 
                adjusted community rate shall be determined on the 
                basis of benefits under this title; and
                    ``(D) subsection (f) shall not apply.

``SEC. 2132. INCORPORATION OF PEER REVIEW PROVISIONS AND FRAUD AND 
              ABUSE PROVISIONS.

    ``The provisions of sections 1121 through 1126, sections 1128 
through 1128B, section 1134, section 1138, and part B of title XI shall 
apply to this title in the same manner as they apply to title XVIII.''.
    (b) Conforming Amendments.--
            (1) Section 201(g)(1)(A) of the Social Security Act (42 
        U.S.C. 401(g)(1)(A)) is amended by striking ``and the Federal 
        Supplementary Medical Insurance Trust Fund'' and inserting ``, 
        Federal Supplementary Medical Insurance Trust Fund, and the 
        Children Health Insurance Trust Fund''.
            (2) Section 201(i)(1) of such Act (42 U.S.C. 401(i)(1)) is 
        amended by striking ``and the Federal Supplementary Medical 
        Insurance Trust Fund'' and inserting ``, Federal Supplementary 
        Medical Insurance Trust Fund, and the Children Health Insurance 
        Trust Fund''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on the date of the enactment of this Act, except that no 
benefits shall be available under title XXI of the Social Security Act 
for items or services furnished before January 1, 1999.

SEC. 3. PREMIUM FOR COVERAGE OF UNINSURED CHILDREN AND MOTHERS-TO-BE.

    (a) General Rule.--Subchapter A of chapter 1 of the Internal 
Revenue Code of 1986 (relating to determination of tax liability) is 
amended by adding at the end the following new part:

``PART VIII--PREMIUM FOR COVERAGE OF UNINSURED CHILDREN AND MOTHERS-TO-
                                   BE

                              ``Sec. 59B. Premium for coverage of 
                                        uninsured children and mothers-
                                        to-be.

``SEC. 59B. PREMIUM FOR COVERAGE OF UNINSURED CHILDREN AND MOTHERS-TO-
              BE.

    ``(a) Imposition of Tax.--In the case of an individual, there is 
hereby imposed (in addition to any other tax imposed by this subtitle) 
a tax for the taxable year in the amount equal to the title XXI premium 
liability (if any) of such individual for such taxable year.
    ``(b) Exemption for Low-Income Individuals.--
            ``(1) In general.--No tax shall be imposed by subsection 
        (a) on any taxpayer whose modified adjusted gross income for 
        the taxable year does not exceed the threshold amount.
            ``(2) Phase-in of tax.--
                    ``(A) In general.--If the modified adjusted gross 
                income of the taxpayer for the taxable year exceeds the 
                threshold amount by less than $10,000, the amount of 
                the tax imposed by subsection (a) for such taxable year 
                shall be the phase-in percentage of the title XXI 
                premium liability of such taxpayer for such taxable 
                year.
                    ``(B) Phase-in percentage.--For purposes of 
                subparagraph (A), the phase-in percentage shall be 
                determined under tables prescribed by the Secretary 
                which--
                            ``(i) shall have income brackets of not 
                        more than $50, and
                            ``(ii) provide for a ratable increase in 
                        the amount of tax imposed by subsection (a) for 
                        modified adjusted gross incomes between the 
                        threshold amount and the sum of the threshold 
                        amount and $10,000.
    ``(c) Title XXI Premium Liability.--For purposes of this section--
            ``(1) In general.--The title XXI premium liability of any 
        individual for any taxable year is the sum of--
                    ``(A) the applicable title XXI premiums for each 
                month of the taxable year as of the first day of which 
                any dependent of the individual is a title XXI covered 
                individual who has not attained age 13, and
                    ``(B) the applicable title XXI premium for the 
                month of the taxable year during which the taxpayer (or 
                spouse of the taxpayer) gives birth to any child if for 
                such month the individual giving birth is a title XXI 
                covered individual.
            ``(2) Applicable title xxi premium.--The term `applicable 
        title XXI premium' means, with respect to a month, such premium 
        as determined under section 2123 of the Social Security Act for 
        that month.
    ``(d) Title XXI Covered Individual.--For purposes of this section--
            ``(1) In general.--A dependent shall be treated as a title 
        XXI covered individual for any month unless--
                    ``(A) for such month, such dependent is covered 
                under a qualified health plan, and
                    ``(B) the taxpayer furnishes to the Secretary (at 
                such time and in such manner as the Secretary may 
                prescribe) the required certification of such coverage 
                for such month.
        A similar rule shall apply to a woman for the month in which 
        such woman gives birth to a child.
            ``(2) Qualified health plan.--The term `qualified health 
        plan' means a plan of health insurance or coverage, an employee 
        welfare benefit plan that provides health benefits, or other 
        plan (other than under title XXI of the Social Security Act) 
        under Federal or State law that provides coverage of benefits 
        which the Secretary of Health and Human Services determines is 
        substantially equivalent to the coverage of benefits provided 
        under title XXI of the Social Security Act.
    ``(e) Other Definitions and Special Rules.--For purposes of this 
section--
            ``(1) Threshold amount.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), the term `threshold amount' means--
                            ``(i) $20,000 in the case of a return with 
                        respect to which 3 or fewer personal exemptions 
                        are allowable under section 151, and
                            ``(ii) $25,000 in the case of a return with 
                        respect to which 4 or more personal exemptions 
                        are allowable under section 151.
                    ``(B) Certain separate returns.--The threshold 
                amount shall be zero in the case of a taxpayer who--
                            ``(i) is married as of the close of the 
                        taxable year but does not file a joint return 
                        for such taxable year, and
                            ``(ii) does not live apart from his spouse 
                        at all times during the last 6 months of the 
                        taxable year.
                    ``(C) Inflation adjustments.--In the case of a 
                taxable year beginning in a calendar year after 1999, 
                each dollar amount contained in subparagraph (A) shall 
                be increased by an amount equal to--
                            ``(i) such dollar amount, multiplied by
                            ``(ii) the cost-of-living adjustment 
                        determined under section 1(f)(3) for the 
                        calendar year in which the taxable year begins, 
                        by substituting `calendar year 1998' for 
                        `calendar year 1992' in subparagraph (B) 
                        thereof.
            ``(2) Modified adjusted gross income.--The term `modified 
        adjusted gross income' means adjusted gross income--
                    ``(A) determined without regard to sections 911, 
                931, and 933, and
                    ``(B) increased by the amount of interest received 
                or accrued by the individual during the taxable year 
                which is exempt from tax.
        The determination under the preceding sentence shall be made 
        without regard to any carryover or carryback.
            ``(3) Dependent.--The term `dependent' means, with respect 
        to periods in any calendar year, any individual if an exemption 
        is allowable under section 151(c) with respect to such 
        individual to the taxpayer for a taxable year beginning in such 
calendar year.
            ``(4) Required certification.--The term `required 
        certification' means the statement required to be provided 
        under section 6050Q(b) (or a copy thereof) or any other 
        statement approved by the Secretary for purposes of this 
        section.
    ``(f) Coordination With Other Provisions.--
            ``(1) Treatment as medical expense.--For purposes of 
        section 213, the tax imposed by this section for any taxable 
        year shall be treated as an expense paid during such taxable 
        year for medical care of the taxpayer.
            ``(2) Not treated as tax for certain purposes.--The tax 
        imposed by this section shall not be treated as a tax imposed 
        by this chapter for purposes of determining--
                    ``(A) the amount of any credit allowable under this 
                chapter, or
                    ``(B) the amount of the minimum tax imposed by 
                section 55.
            ``(3) Treatment under subtitle f.--For purposes of subtitle 
        F, the tax imposed by this section shall be treated as if it 
        were a tax imposed by section 1.
    ``(g) Exemptions.--
            ``(1) In general.--No tax shall be imposed by this section 
        on any individual for any taxable year if such individual is a 
        nonresident alien.
            ``(2) Certain individuals not taken into account in 
        determining amount of tax.--For purposes of this section, an 
        individual shall be treated as not being a title XXI covered 
        individual for any month if--
                    ``(A) the principal place of abode of such 
                individual as of the first day of such month is outside 
                the United States, or
                    ``(B) as of the first day of such month, there is 
                in effect for such individual a qualified religious 
                exemption.
            ``(3) Qualified religious exemption.--For purposes of 
        paragraph (2)--
                    ``(A) In general.--The term `qualified religious 
                exemption' means an exemption granted by the Secretary 
                of Health and Human Services to an individual--
                            ``(i) who is a member of a recognized 
                        religious sect or division thereof with respect 
                        to which such Secretary makes the findings 
                        referred to in subparagraphs (C), (D), and (E) 
                        of section 1402(g)(1),
                            ``(ii) who is an adherent of established 
                        tenets or teachings of such sect or division as 
                        described in such section, and
                            ``(iii) who submits an application for such 
                        exemption which contains or is accompanied by 
                        the evidence described in section 1402(g)(1)(A) 
                        and a waiver described in section 
                        1402(g)(1)(B).
                For purposes of the clause (iii), section 1402(g)(1)(B) 
                shall be treated as including a reference to title XXI 
                of the Social Security Act.
                    ``(B) Limitation.--An exemption granted under this 
                paragraph shall cease to apply beginning on the date 
                such Secretary determines that the individual, or the 
                sect or division, ceased to meet the requirements of 
                subparagraph (A).
            ``(4) Special rule for individuals residing abroad who 
        receive title xxi services.--Paragraph (2)(A) shall not apply 
        to any individual for any taxable year if, at any time during 
        such taxable year, such individual receives services under 
        title XXI of the Social Security Act.
    ``(h) Regulations.--The Secretary may prescribe such regulations as 
may be appropriate to carry out the purposes of this section, including 
regulations, prescribed after consultation with the Secretary of Health 
and Human Services, treating health plans of foreign governments or 
foreign employers outside the United States as qualified health 
plans.''
    (b) Technical Amendments.--
            (1) Subsection (a) of section 6012 of such Code is amended 
        by inserting after paragraph (9) the following new paragraph:
            ``(10) Every individual who has a title XXI premium 
        liability (as defined in section 59B) for the taxable year.''
            (2) Subparagraph (A) of section 1(f)(6) of such Code is 
        amended by inserting ``section 59B(e)(1)(C),'' after paragraph 
        (2)(A),''.
    (c) Clerical Amendment.--The table of parts for subchapter A of 
chapter 1 is amended by adding at the end the following new item:

                              ``Part VIII. Individual share of title 
                                        XXI premiums.''
    (d) Effective Date.--The amendments made by this section shall 
apply to months beginning after December 31, 1998, in taxable years 
ending after such date.

SEC. 4. REPORTING REQUIREMENTS.

    (a) In General.--Subpart B of part III of subchapter A of chapter 
61 of the Internal Revenue Code of 1986 (relating to information 
concerning transactions with others) is amended by adding at the end 
the following new sections:

``SEC. 6050Q. RETURNS RELATING TO QUALIFIED HEALTH PLANS.

    ``(a) Requirement of Reporting.--The administrator of any qualified 
health plan (as defined in section 59B(d)) shall make a return for each 
calendar year setting forth--
            ``(1) the name and TIN of each individual covered under 
        such plan or program at any time during such taxable year as a 
        primary insured or as the spouse of a primary insured,
            ``(2) the name and TIN (to the extent available) of each 
        individual covered under such plan or program at any time 
        during such taxable year as a dependent (as defined in section 
        59B(e)(3)) of a primary insured, and
            ``(3) the months during such calendar year for which such 
        individuals were so covered.
Such return shall be made at such time and in such form as the 
Secretary may by regulations prescribe.
    ``(b) Statements to Primary Insured Individuals.--Every 
administrator required to make a return under subsection (a) shall 
furnish to each individual whose name is required to be set forth in 
such return by reason of being a primary insured a written statement 
showing--
            ``(1) the name of the qualified health plan and the address 
        of its administrator, and
            ``(2) the information required to be shown on the return 
        with respect to such primary insured.
The written statement required under the preceding sentence shall be 
furnished to the person on or before January 31 of the year following 
the calendar year for which the return under subsection (a) was 
required to be made.
    ``(c) Statement to Spouse or Dependents of Primary Insured on 
Request.--At the request of an individual who, at any time during a 
calendar year, was the spouse or a dependent (as defined in section 
59B(e)(3)) of a primary insured who is required to receive a statement 
under subsection (b) from an administrator, such administrator shall 
furnish to such individual a copy of such statement with respect to 
such insured for such calendar year.''
    (b) Uniform Penalty Provisions Made Applicable.--
            (1) Subparagraph (B) of section 6724(d)(1) of such Code is 
        amended by inserting after the item relating to clause (viii) 
        the following new item (and redesignating the following clauses 
        accordingly):
                            ``(ix) section 6050Q(a) (relating to 
                        returns regarding qualified health plans),''.
            (2) Paragraph (2) of section 6724(d) of such Code is 
        amended by inserting after subparagraph (P) the following new 
        subparagraph (and by redesignating the following subparagraphs 
        accordingly):
                    ``(Q) subsection (b) or (c) of section 6050Q 
                (relating to returns regarding qualified health 
                plans),''.
    (c) Clerical Amendment.--The table of sections for subpart B of 
part III of subchapter A of chapter 61 of such Code is amended by 
adding at the end the following new item:

                              ``Sec. 6050Q. Returns relating to 
                                        qualified health plans.''
    (d) Effective Date.--The amendments made by this section shall 
apply to calendar years after 1998.
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