[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4577 Engrossed Amendment Senate (EAS)]
In the Senate of the United States,
June 30, 2000.
Resolved, That the bill from the House of Representatives (H.R.
4577) entitled ``An Act making appropriations for the Departments of
Labor, Health and Human Services, and Education, and related agencies
for the fiscal year ending September 30, 2001, and for other
purposes.'', do pass with the following
AMENDMENT:
Strike out all after the enacting clause and insert:
DIVISION A--DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND
EDUCATION, AND RELATED AGENCIES
That the following sums are appropriated, out of any money in the
Treasury not otherwise appropriated, for the Departments of Labor,
Health and Human Services, and Education, and related agencies for the
fiscal year ending September 30, 2001, and for other purposes, namely:
TITLE I--DEPARTMENT OF LABOR
Employment and Training Administration
training and employment services
For necessary expenses of the Workforce Investment Act, including
the purchase and hire of passenger motor vehicles, the construction,
alteration, and repair of buildings and other facilities, and the
purchase of real property for training centers as authorized by the
Workforce Investment Act and the National Skill Standards Act of 1994;
$2,990,141,000 plus reimbursements, of which $1,718,801,000 is
available for obligation for the period July 1, 2001 through June 30,
2002, of which $1,250,965,000 is available for obligation for the
period April 1, 2001 through June 30, 2002, including $1,000,965,000 to
carry out chapter 4 of the Workforce Investment Act and $250,000,000 to
carry out section 169 of such Act; and of which $20,375,000 is
available for the period July 1, 2001 through June 30, 2004 for
necessary expenses of construction, rehabilitation, and acquisition of
Job Corps centers: Provided, That $9,098,000 shall be for carrying out
section 172 of the Workforce Investment Act, and $3,500,000 shall be
for carrying out the National Skills Standards Act of 1994: Provided
further, That no funds from any other appropriation shall be used to
provide meal services at or for Job Corps centers: Provided further,
That funds provided to carry out section 171(d) of such Act may be used
for demonstration projects that provide assistance to new entrants in
the workforce and incumbent workers: Provided further, That funding
provided to carry out projects under section 171 of the Workforce
Investment Act of 1998 that are identified in the Conference Agreement,
shall not be subject to the requirements of section 171(b)(2)(B) of
such Act, the requirements of section 171(c)(4)(D) of such Act, or the
joint funding requirements of sections 171(b)(2)(A) and 171(c)(4)(A) of
such Act: Provided further, That funding appropriated herein for
Dislocated Worker Employment and Training Activities under section
132(a)(2)(A) of the Workforce Investment Act of 1998 may be distributed
for Dislocated Worker Projects under section 171(d) of the Act without
regard to the 10 percent limitation contained in section 171(d) of the
Act.
For necessary expenses of the Workforce Investment Act, including
the purchase and hire of passenger motor vehicles, the construction,
alteration, and repair of buildings and other facilities, and the
purchase of real property for training centers as authorized by the
Workforce Investment Act; $2,463,000,000 plus reimbursements, of which
$2,363,000,000 is available for obligation for the period October 1,
2001 through June 30, 2002, and of which $100,000,000 is available for
the period October 1, 2001 through June 30, 2004, for necessary
expenses of construction, rehabilitation, and acquisition of Job Corps
centers.
community service employment for older americans
To carry out the activities for national grants or contracts with
public agencies and public or private nonprofit organizations under
paragraph (1)(A) of section 506(a) of title V of the Older Americans
Act of 1965, as amended, or to carry out older worker activities as
subsequently authorized, $343,356,000.
To carry out the activities for grants to States under paragraph
(3) of section 506(a) of title V of the Older Americans Act of 1965, as
amended, or to carry out older worker activities as subsequently
authorized, $96,844,000.
federal unemployment benefits and allowances
For payments during the current fiscal year of trade adjustment
benefit payments and allowances under part I; and for training,
allowances for job search and relocation, and related State
administrative expenses under part II, subchapters B and D, chapter 2,
title II of the Trade Act of 1974, as amended, $406,550,000, together
with such amounts as may be necessary to be charged to the subsequent
appropriation for payments for any period subsequent to September 15 of
the current year.
state unemployment insurance and employment service operations
For authorized administrative expenses, $153,452,000, together with
not to exceed $3,095,978,000 (including not to exceed $1,228,000 which
may be used for amortization payments to States which had independent
retirement plans in their State employment service agencies prior to
1980), which may be expended from the Employment Security
Administration account in the Unemployment Trust Fund including the
cost of administering section 51 of the Internal Revenue Code of 1986,
as amended, section 7(d) of the Wagner-Peyser Act, as amended, the
Trade Act of 1974, as amended, the Immigration Act of 1990, and the
Immigration and Nationality Act, as amended, and of which the sums
available in the allocation for activities authorized by title III of
the Social Security Act, as amended (42 U.S.C. 502-504), and the sums
available in the allocation for necessary administrative expenses for
carrying out 5 U.S.C. 8501-8523, shall be available for obligation by
the States through December 31, 2001, except that funds used for
automation acquisitions shall be available for obligation by the States
through September 30, 2003; and of which $153,452,000, together with
not to exceed $763,283,000 of the amount which may be expended from
said trust fund, shall be available for obligation for the period July
1, 2001 through June 30, 2002, to fund activities under the Act of June
6, 1933, as amended, including the cost of penalty mail authorized
under 39 U.S.C. 3202(a)(1)(E) made available to States in lieu of
allotments for such purpose: Provided, That to the extent that the
Average Weekly Insured Unemployment (AWIU) for fiscal year 2001 is
projected by the Department of Labor to exceed 2,396,000, an additional
$28,600,000 shall be available for obligation for every 100,000
increase in the AWIU level (including a pro rata amount for any
increment less than 100,000) from the Employment Security
Administration Account of the Unemployment Trust Fund: Provided
further, That funds appropriated in this Act which are used to
establish a national one-stop career center system, or which are used
to support the national activities of the Federal-State unemployment
insurance programs, may be obligated in contracts, grants or agreements
with non-State entities: Provided further, That funds appropriated
under this Act for activities authorized under the Wagner-Peyser Act,
as amended, and title III of the Social Security Act, may be used by
the States to fund integrated Employment Service and Unemployment
Insurance automation efforts, notwithstanding cost allocation
principles prescribed under Office of Management and Budget Circular A-
87.
advances to the unemployment trust fund and other funds
For repayable advances to the Unemployment Trust Fund as authorized
by sections 905(d) and 1203 of the Social Security Act, as amended, and
to the Black Lung Disability Trust Fund as authorized by section
9501(c)(1) of the Internal Revenue Code of 1954, as amended; and for
nonrepayable advances to the Unemployment Trust Fund as authorized by
section 8509 of title 5, United States Code, and to the ``Federal
unemployment benefits and allowances'' account, to remain available
until September 30, 2002, $435,000,000.
In addition, for making repayable advances to the Black Lung
Disability Trust Fund in the current fiscal year after September 15,
2001, for costs incurred by the Black Lung Disability Trust Fund in the
current fiscal year, such sums as may be necessary.
program administration
For expenses of administering employment and training programs,
$107,651,000, including $6,431,000 to support up to 75 full-time
equivalent staff, the majority of which will be term Federal
appointments lasting no more than 1 year, to administer welfare-to-work
grants, together with not to exceed $48,507,000, which may be expended
from the Employment Security Administration account in the Unemployment
Trust Fund.
Pension and Welfare Benefits Administration
salaries and expenses
For necessary expenses for the Pension and Welfare Benefits
Administration, $103,342,000.
Pension Benefit Guaranty Corporation
pension benefit guaranty corporation fund
The Pension Benefit Guaranty Corporation is authorized to make such
expenditures, including financial assistance authorized by section 104
of Public Law 96-364, within limits of funds and borrowing authority
available to such Corporation, and in accord with law, and to make such
contracts and commitments without regard to fiscal year limitations as
provided by section 104 of the Government Corporation Control Act, as
amended (31 U.S.C. 9104), as may be necessary in carrying out the
program through September 30, 2001, for such Corporation: Provided,
That not to exceed $11,652,000 shall be available for administrative
expenses of the Corporation: Provided further, That expenses of such
Corporation in connection with the termination of pension plans, for
the acquisition, protection or management, and investment of trust
assets, and for benefits administration services shall be considered as
non-administrative expenses for the purposes hereof, and excluded from
the above limitation.
Employment Standards Administration
salaries and expenses
For necessary expenses for the Employment Standards Administration,
including reimbursement to State, Federal, and local agencies and their
employees for inspection services rendered, $350,779,000, together with
$1,985,000 which may be expended from the Special Fund in accordance
with sections 39(c), 44(d) and 44(j) of the Longshore and Harbor
Workers' Compensation Act: Provided, That $2,000,000 shall be for the
development of an alternative system for the electronic submission of
reports required to be filed under the Labor-Management Reporting and
Disclosure Act of 1959, as amended, and for a computer database of the
information for each submission by whatever means, that is indexed and
easily searchable by the public via the Internet: Provided further,
That the Secretary of Labor is authorized to accept, retain, and spend,
until expended, in the name of the Department of Labor, all sums of
money ordered to be paid to the Secretary of Labor, in accordance with
the terms of the Consent Judgment in Civil Action No. 91-0027 of the
United States District Court for the District of the Northern Mariana
Islands (May 21, 1992): Provided further, That the Secretary of Labor
is authorized to establish and, in accordance with 31 U.S.C. 3302,
collect and deposit in the Treasury fees for processing applications
and issuing certificates under sections 11(d) and 14 of the Fair Labor
Standards Act of 1938, as amended (29 U.S.C. 211(d) and 214) and for
processing applications and issuing registrations under title I of the
Migrant and Seasonal Agricultural Worker Protection Act (29 U.S.C. 1801
et seq.).
special benefits
(including transfer of funds)
For the payment of compensation, benefits, and expenses (except
administrative expenses) accruing during the current or any prior
fiscal year authorized by title 5, chapter 81 of the United States
Code; continuation of benefits as provided for under the heading
``Civilian War Benefits'' in the Federal Security Agency Appropriation
Act, 1947; the Employees' Compensation Commission Appropriation Act,
1944; sections 4(c) and 5(f) of the War Claims Act of 1948 (50 U.S.C.
App. 2012); and 50 percent of the additional compensation and benefits
required by section 10(h) of the Longshore and Harbor Workers'
Compensation Act, as amended, $56,000,000 together with such amounts as
may be necessary to be charged to the subsequent year appropriation for
the payment of compensation and other benefits for any period
subsequent to August 15 of the current year: Provided, That amounts
appropriated may be used under section 8104 of title 5, United States
Code, by the Secretary of Labor to reimburse an employer, who is not
the employer at the time of injury, for portions of the salary of a
reemployed, disabled beneficiary: Provided further, That balances of
reimbursements unobligated on September 30, 2000, shall remain
available until expended for the payment of compensation, benefits, and
expenses: Provided further, That in addition there shall be transferred
to this appropriation from the Postal Service and from any other
corporation or instrumentality required under section 8147(c) of title
5, United States Code, to pay an amount for its fair share of the cost
of administration, such sums as the Secretary determines to be the cost
of administration for employees of such fair share entities through
September 30, 2001: Provided further, That of those funds transferred
to this account from the fair share entities to pay the cost of
administration, $30,510,000 shall be made available to the Secretary as
follows: (1) for the operation of and enhancement to the automated data
processing systems, including document imaging, medical bill review,
and periodic roll management, in support of Federal Employees'
Compensation Act administration, $19,971,000; (2) for conversion to a
paperless office, $7,005,000; (3) for communications redesign,
$750,000; (4) for information technology maintenance and support,
$2,784,000; and (5) the remaining funds shall be paid into the Treasury
as miscellaneous receipts: Provided further, That the Secretary may
require that any person filing a notice of injury or a claim for
benefits under chapter 81 of title 5, United States Code, or 33 U.S.C.
901 et seq., provide as part of such notice and claim, such identifying
information (including Social Security account number) as such
regulations may prescribe.
black lung disability trust fund
(including transfer of funds)
Beginning in fiscal year 2001 and thereafter, such sums as may be
necessary from the Black Lung Disability Trust Fund, to remain
available until expended, for payment of all benefits authorized by
section 9501(d)(1) (2) (4) and (7) of the Internal Revenue Code of
1954, as amended; and interest on advances as authorized by section
9501(c)(2) of that Act. In addition, the following amounts shall be
available from the Fund for fiscal year 2001 for expenses of operation
and administration of the Black Lung Benefits program as authorized by
section 9501(d)(5) of that Act: $30,393,000 for transfer to the
Employment Standards Administration, ``Salaries and Expenses'';
$21,590,000 for transfer to Departmental Management, ``Salaries and
Expenses''; $318,000 for transfer to Departmental Management, ``Office
of Inspector General''; and $356,000 for payments into Miscellaneous
Receipts for the expenses of the Department of Treasury.
Occupational Safety and Health Administration
salaries and expenses
For necessary expenses for the Occupational Safety and Health
Administration, $425,983,000, including not to exceed $88,493,000 which
shall be the maximum amount available for grants to States under
section 23(g) of the Occupational Safety and Health Act, which grants
shall be no less than 50 percent of the costs of State occupational
safety and health programs required to be incurred under plans approved
by the Secretary under section 18 of the Occupational Safety and Health
Act of 1970; and, in addition, notwithstanding 31 U.S.C. 3302, the
Occupational Safety and Health Administration may retain up to $750,000
per fiscal year of training institute course tuition fees, otherwise
authorized by law to be collected, and may utilize such sums for
occupational safety and health training and education grants: Provided,
That of the amount appropriated under this heading that is in excess of
the amount appropriated for such purposes for fiscal year 2000, at
least $22,200,000 shall be used to carry out education, training, and
consultation activities as described in subsections (c) and (d) of
section 21 of the Occupational Safety and Health Act of 1970 (29 U.S.C.
670(c) and (d)): Provided further, That, notwithstanding 31 U.S.C.
3302, the Secretary of Labor is authorized, during the fiscal year
ending September 30, 2001, to collect and retain fees for services
provided to Nationally Recognized Testing Laboratories, and may utilize
such sums, in accordance with the provisions of 29 U.S.C. 9a, to
administer national and international laboratory recognition programs
that ensure the safety of equipment and products used by workers in the
workplace: Provided further, That none of the funds appropriated under
this paragraph shall be obligated or expended to prescribe, issue,
administer, or enforce any standard, rule, regulation, or order under
the Occupational Safety and Health Act of 1970 which is applicable to
any person who is engaged in a farming operation which does not
maintain a temporary labor camp and employs 10 or fewer employees:
Provided further, That no funds appropriated under this paragraph shall
be obligated or expended to administer or enforce any standard, rule,
regulation, or order under the Occupational Safety and Health Act of
1970 with respect to any employer of 10 or fewer employees who is
included within a category having an occupational injury lost workday
case rate, at the most precise Standard Industrial Classification Code
for which such data are published, less than the national average rate
as such rates are most recently published by the Secretary, acting
through the Bureau of Labor Statistics, in accordance with section 24
of that Act (29 U.S.C. 673), except--
(1) to provide, as authorized by such Act, consultation,
technical assistance, educational and training services, and to
conduct surveys and studies;
(2) to conduct an inspection or investigation in response
to an employee complaint, to issue a citation for violations
found during such inspection, and to assess a penalty for
violations which are not corrected within a reasonable
abatement period and for any willful violations found;
(3) to take any action authorized by such Act with respect
to imminent dangers;
(4) to take any action authorized by such Act with respect
to health hazards;
(5) to take any action authorized by such Act with respect
to a report of an employment accident which is fatal to one or
more employees or which results in hospitalization of two or
more employees, and to take any action pursuant to such
investigation authorized by such Act; and
(6) to take any action authorized by such Act with respect
to complaints of discrimination against employees for
exercising rights under such Act:
Provided further, That the foregoing proviso shall not apply to any
person who is engaged in a farming operation which does not maintain a
temporary labor camp and employs 10 or fewer employees.
Mine Safety and Health Administration
salaries and expenses
For necessary expenses for the Mine Safety and Health
Administration, $244,747,000, including purchase and bestowal of
certificates and trophies in connection with mine rescue and first-aid
work, and the hire of passenger motor vehicles; including up to
$1,000,000 for mine rescue and recovery activities, which shall be
available only to the extent that fiscal year 2001 obligations for
these activities exceed $1,000,000; in addition, not to exceed $750,000
may be collected by the National Mine Health and Safety Academy for
room, board, tuition, and the sale of training materials, otherwise
authorized by law to be collected, to be available for mine safety and
health education and training activities, notwithstanding 31 U.S.C.
3302; and, in addition, the Administration may retain up to $1,000,000
from fees collected for the approval and certification of equipment,
materials, and explosives for use in mines, and may utilize such sums
for such activities; the Secretary is authorized to accept lands,
buildings, equipment, and other contributions from public and private
sources and to prosecute projects in cooperation with other agencies,
Federal, State, or private; the Mine Safety and Health Administration
is authorized to promote health and safety education and training in
the mining community through cooperative programs with States,
industry, and safety associations; and any funds available to the
department may be used, with the approval of the Secretary, to provide
for the costs of mine rescue and survival operations in the event of a
major disaster.
Bureau of Labor Statistics
salaries and expenses
For necessary expenses for the Bureau of Labor Statistics,
including advances or reimbursements to State, Federal, and local
agencies and their employees for services rendered, $369,327,000,
together with not to exceed $67,257,000, which may be expended from the
Employment Security Administration account in the Unemployment Trust
Fund; and $10,000,000 which shall be available for obligation for the
period July 1, 2001 through June 30, 2002, for Occupational Employment
Statistics.
Departmental Management
salaries and expenses
For necessary expenses for Departmental Management, including the
hire of three sedans, and including the management or operation,
through contracts, grants or other arrangements, of Departmental
bilateral and multilateral foreign technical assistance, of which the
funds designated to carry out bilateral assistance under the
international child labor initiative shall be available for obligation
through September 30, 2002, $30,000,000 for the acquisition of
Departmental information technology, architecture, infrastructure,
equipment, software and related needs which will be allocated by the
Department's Chief Information Officer in accordance with the
Department's capital investment management process to assure a sound
investment strategy; $337,964,000: Provided, That no funds made
available by this Act may be used by the Solicitor of Labor to
participate in a review in any United States court of appeals of any
decision made by the Benefits Review Board under section 21 of the
Longshore and Harbor Workers' Compensation Act (33 U.S.C. 921) where
such participation is precluded by the decision of the United States
Supreme Court in Director, Office of Workers' Compensation Programs v.
Newport News Shipbuilding, 115 S. Ct. 1278 (1995), notwithstanding any
provisions to the contrary contained in Rule 15 of the Federal Rules of
Appellate Procedure: Provided further, That no funds made available by
this Act may be used by the Secretary of Labor to review a decision
under the Longshore and Harbor Workers' Compensation Act (33 U.S.C. 901
et seq.) that has been appealed and that has been pending before the
Benefits Review Board for more than 12 months: Provided further, That
any such decision pending a review by the Benefits Review Board for
more than 1 year shall be considered affirmed by the Benefits Review
Board on the 1-year anniversary of the filing of the appeal, and shall
be considered the final order of the Board for purposes of obtaining a
review in the United States courts of appeals: Provided further, That
these provisions shall not be applicable to the review or appeal of any
decision issued under the Black Lung Benefits Act (30 U.S.C. 901 et
seq.): Provided further, That beginning in fiscal year 2001, there is
established in the Department of Labor an office of disability
employment policy which shall, under the overall direction of the
Secretary, provide leadership, develop policy and initiatives, and
award grants furthering the objective of eliminating barriers to the
training and employment of people with disabilities. Such office shall
be headed by an assistant secretary: Provided further, That of amounts
provided under this head, not more than $23,002,000 is for this
purpose.
veterans employment and training
Not to exceed $186,913,000 may be derived from the Employment
Security Administration account in the Unemployment Trust Fund to carry
out the provisions of 38 U.S.C. 4100-4110A, 4212, 4214, and 4321-4327,
and Public Law 103-353, and which shall be available for obligation by
the States through December 31, 2001. To carry out the Stewart B.
McKinney Homeless Assistance Act and section 168 of the Workforce
Investment Act of 1998, $19,800,000, of which $7,300,000 shall be
available for obligation for the period July 1, 2001, through June 30,
2002.
office of inspector general
For salaries and expenses of the Office of Inspector General in
carrying out the provisions of the Inspector General Act of 1978, as
amended, $50,015,000, together with not to exceed $4,770,000, which may
be expended from the Employment Security Administration account in the
Unemployment Trust Fund.
GENERAL PROVISIONS
Sec. 101. None of the funds appropriated in this title for the Job
Corps shall be used to pay the compensation of an individual, either as
direct costs or any proration as an indirect cost, at a rate in excess
of Executive Level II.
(transfer of funds)
Sec. 102. Not to exceed 1 percent of any discretionary funds
(pursuant to the Balanced Budget and Emergency Deficit Control Act of
1985, as amended) which are appropriated for the current fiscal year
for the Department of Labor in this Act may be transferred between
appropriations, but no such appropriation shall be increased by more
than 3 percent by any such transfer: Provided, That the Appropriations
Committees of both Houses of Congress are notified at least 15 days in
advance of any transfer.
Sec. 103. Extended Deadline for Expenditure. Section
403(a)(5)(C)(viii) of the Social Security Act (42 U.S.C.
603(a)(5)(C)(viii)) (as amended by section 806(b) of the Departments of
Labor, Health and Human Services, and Education, and Related Agencies
Appropriations Act, 2000 (as enacted into law by section 1000(a)(4) of
Public Law 106-113)) is amended by striking ``3 years'' and inserting
``5 years''.
Sec. 104. Elimination of Set-Aside of Portion of Welfare-to-Work
Funds for Performance Bonuses. (a) In General.--Section 403(a)(5) of
the Social Security Act (as amended by section 806(b) of the
Departments of Labor, Health and Human Services, and Education, and
Related Agencies Appropriations Act, 2000 (as enacted into law by
section 1000(a)(4) of Public Law 106-113)) is amended by striking
subparagraph (E) and redesignating subparagraphs (F) through (K) as
subparagraphs (E) through (J), respectively.
(b) Conforming Amendments.--The Social Security Act (as amended by
section 806(b) of the Departments of Labor, Health and Human Services,
and Education, and Related Agencies Appropriations Act, 2000 (as
enacted into law by section 1000(a)(4) of Public Law 106-113)) is
further amended as follows:
(1) Section 403(a)(5)(A)(i) (42 U.S.C. 603(a)(5)(A)(i)) is
amended by striking ``subparagraph (I)'' and inserting
``subparagraph (H)''.
(2) Subclause (I) of each of subparagraphs (A)(iv) and
(B)(v) of section 403(a)(5) (42 U.S.C. 603(a)(5)(A)(iv)(I) and
(B)(v)(I)) is amended--
(A) in item (aa)--
(i) by striking ``(I)'' and inserting
``(H)''; and
(ii) by striking ``(G), and (H)'' and
inserting ``and (G)''; and
(B) in item (bb), by striking ``(F)'' and inserting
``(E)''.
(3) Section 403(a)(5)(B)(v) (42 U.S.C. 603(a)(5)(B)(v)) is
amended in the matter preceding subclause (I) by striking
``(I)'' and inserting ``(H)''.
(4) Subparagraphs (E), (F), and (G)(i) of section 403(a)(5)
(42 U.S.C. 603(a)(5)), as so redesignated by subsection (a) of
this section, are each amended by striking ``(I)'' and
inserting ``(H)''.
(5) Section 412(a)(3)(A) (42 U.S.C. 612(a)(3)(A)) is
amended by striking ``403(a)(5)(I)'' and inserting
``403(a)(5)(H)''.
(c) Funding Amendment.--Section 403(a)(5)(H)(i)(II) of such Act (42
U.S.C. 603(a)(5)(H)(i))(II) (as redesignated by subsection (a) of this
section and as amended by section 806(b) of the Departments of Labor,
Health and Human Services, and Education, and Related Agencies
Appropriations Act, 2000 (as enacted into law by section 1000(a)(4) of
Public Law 106-113)) is further amended by striking ``$1,450,000,000''
and inserting ``$1,400,000,000''.
(d) Effective Date.--The amendments made by subsections (a), (b),
and (c) of this section shall take effect on October 1, 2000.
Sec. 105. None of the funds made available in this Act may be used
by the Occupational Safety and Health Administration to promulgate,
issue, implement, administer, or enforce any proposed, temporary, or
final standard on ergonomic protection.
TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
health resources and services
For carrying out titles II, III, VII, VIII, X, XII, XIX, and XXVI
of the Public Health Service Act, section 427(a) of the Federal Coal
Mine Health and Safety Act, title V and section 1820 of the Social
Security Act, the Health Care Quality Improvement Act of 1986, as
amended, and the Native Hawaiian Health Care Act of 1988, as amended,
$4,572,424,000, of which $150,000 shall remain available until expended
for interest subsidies on loan guarantees made prior to fiscal year
1981 under part B of title VII of the Public Health Service Act, of
which $10,000,000 shall be available for the construction and
renovation of health care and other facilities, of which $25,000,000
from general revenues, notwithstanding section 1820(j) of the Social
Security Act, shall be available for carrying out the Medicare rural
hospital flexibility grants program under section 1820 of such Act, and
of which $4,000,000 shall be provided to the Rural Health Outreach
Office of the Health Resources and Services Administration for the
awarding of grants to community partnerships in rural areas for the
purchase of automated external defibrillators and the training of
individuals in basic cardiac life support: Provided, That the Division
of Federal Occupational Health may utilize personal services
contracting to employ professional management/administrative and
occupational health professionals: Provided further, That of the funds
made available under this heading, $250,000 shall be available until
expended for facilities renovations at the Gillis W. Long Hansen's
Disease Center: Provided further, That in addition to fees authorized
by section 427(b) of the Health Care Quality Improvement Act of 1986,
fees shall be collected for the full disclosure of information under
the Act sufficient to recover the full costs of operating the National
Practitioner Data Bank, and shall remain available until expended to
carry out that Act: Provided further, That fees collected for the full
disclosure of information under the ``Health Care Fraud and Abuse Data
Collection Program'', authorized by section 221 of the Health Insurance
Portability and Accountability Act of 1996, shall be sufficient to
recover the full costs of operating the Program, and shall remain
available to carry out that Act until expended: Provided further, That
no more than $5,000,000 is available for carrying out the provisions of
Public Law 104-73: Provided further, That of the funds made available
under this heading, $253,932,000 shall be for the program under title X
of the Public Health Service Act to provide for voluntary family
planning projects: Provided further, That amounts provided to said
projects under such title shall not be expended for abortions, that all
pregnancy counseling shall be nondirective, and that such amounts shall
not be expended for any activity (including the publication or
distribution of literature) that in any way tends to promote public
support or opposition to any legislative proposal or candidate for
public office: Provided further, That $538,000,000 shall be for State
AIDS Drug Assistance Programs authorized by section 2616 of the Public
Health Service Act.
ricky ray hemophilia relief fund program
For payment to the Ricky Ray Hemophilia Relief Fund, as provided by
Public Law 105-369, $85,000,000, of which $10,000,000 shall be for
program management.
health education assistance loans program account
Such sums as may be necessary to carry out the purpose of the
program, as authorized by title VII of the Public Health Service Act,
as amended. For administrative expenses to carry out the guaranteed
loan program, including section 709 of the Public Health Service Act,
$3,679,000.
vaccine injury compensation program trust fund
For payments from the Vaccine Injury Compensation Program Trust
Fund, such sums as may be necessary for claims associated with vaccine-
related injury or death with respect to vaccines administered after
September 30, 1988, pursuant to subtitle 2 of title XXI of the Public
Health Service Act, to remain available until expended: Provided, That
for necessary administrative expenses, not to exceed $2,992,000 shall
be available from the Trust Fund to the Secretary of Health and Human
Services.
Centers for Disease Control and Prevention
disease control, research, and training
To carry out titles II, III, VII, XI, XV, XVII, XIX and XXVI of the
Public Health Service Act, sections 101, 102, 103, 201, 202, 203, 301,
and 501 of the Federal Mine Safety and Health Act of 1977, sections 20,
21, and 22 of the Occupational Safety and Health Act of 1970, title IV
of the Immigration and Nationality Act and section 501 of the Refugee
Education Assistance Act of 1980; including insurance of official motor
vehicles in foreign countries; and hire, maintenance, and operation of
aircraft, $3,204,496,000, of which $20,000,000 shall be made available
to carry out children's asthma programs and $4,000,000 of such
$20,000,000 shall be utilized to carry out improved asthma surveillance
and tracking systems and the remainder shall be used to carry out
diverse community-based childhood asthma programs including both
school- and community-based grant programs, except that not to exceed 5
percent of such funds may be used by the Centers for Disease Control
and Prevention for administrative costs or reprogramming, and of which
$175,000,000 shall remain available until expended for the facilities
master plan for equipment and construction and renovation of
facilities, and in addition, such sums as may be derived from
authorized user fees, which shall be credited to this account, and of
which $25,000,000 shall be made available through such Centers for the
establishment of partnerships between the Federal Government and
academic institutions and State and local public health departments to
carry out pilot programs for antimicrobial resistance detection,
surveillance, education and prevention and to conduct research on
resistance mechanisms and new or more effective antimicrobial
compounds, and of which $10,000,000 shall remain available until
expended to carry out the Fetal Alcohol Syndrome prevention and
services program: Provided, That in addition to amounts provided
herein, up to $91,129,000 shall be available from amounts available
under section 241 of the Public Health Service Act: Provided further,
That none of the funds made available for injury prevention and control
at the Centers for Disease Control and Prevention may be used to
advocate or promote gun control: Provided further, That the Director
may redirect the total amount made available under authority of Public
Law 101-502, section 3, dated November 3, 1990, to activities the
Director may so designate: Provided further, That the Congress is to be
notified promptly of any such transfer: Provided further, That not to
exceed $10,000,000 may be available for making grants under section
1509 of the Public Health Service Act to not more than 15 States:
Provided further, That notwithstanding any other provision of law, a
single contract or related contracts for development and construction
of facilities may be employed which collectively include the full scope
of the project: Provided further, That the solicitation and contract
shall contain the clause ``availability of funds'' found at 48 CFR
52.232-18: Provided further, That in addition to amounts made available
under this heading for the National Program of Cancer Registries, an
additional $15,000,000 shall be made available for such Program and
special emphasis in carrying out such Program shall be given to States
with the highest number of the leading causes of cancer mortality:
Provided further, That amounts made available under this Act for the
administrative and related expenses of the Centers for Disease Control
and Prevention shall be reduced by $15,000,000: Provided further, That
the funds made available under this heading for section 317A of the
Public Health Service Act may be made available for programs operated
in accordance with a strategy (developed and implemented by the
Director for the Centers for Disease Control and Prevention) to
identify and target resources for childhood lead poisoning prevention
to high-risk populations, including ensuring that any individual or
entity that receives a grant under that section to carry out activities
relating to childhood lead poisoning prevention may use a portion of
the grant funds awarded for the purpose of funding screening
assessments and referrals at sites of operation of the Early Head Start
programs under the Head Start Act.
National Institutes of Health
national cancer institute
For carrying out section 301 and title IV of the Public Health
Service Act with respect to cancer, $3,804,084,000.
national heart, lung, and blood institute
For carrying out section 301 and title IV of the Public Health
Service Act with respect to cardiovascular, lung, and blood diseases,
and blood and blood products, $2,328,102,000.
national institute of dental and craniofacial research
For carrying out section 301 and title IV of the Public Health
Service Act with respect to dental disease, $309,923,000.
national institute of diabetes and digestive and kidney diseases
For carrying out section 301 and title IV of the Public Health
Service Act with respect to diabetes and digestive and kidney disease,
$1,318,106,000.
national institute of neurological disorders and stroke
For carrying out section 301 and title IV of the Public Health
Service Act with respect to neurological disorders and stroke,
$1,189,425,000.
national institute of allergy and infectious diseases
For carrying out section 301 and title IV of the Public Health
Service Act with respect to allergy and infectious diseases,
$2,066,526,000.
national institute of general medical sciences
For carrying out section 301 and title IV of the Public Health
Service Act with respect to general medical sciences, $1,554,176,000.
national institute of child health and human development
For carrying out section 301 and title IV of the Public Health
Service Act with respect to child health and human development,
$986,069,000.
national eye institute
For carrying out section 301 and title IV of the Public Health
Service Act with respect to eye diseases and visual disorders,
$516,605,000.
national institute of environmental health sciences
For carrying out sections 301 and 311 and title IV of the Public
Health Service Act with respect to environmental health sciences,
$508,263,000.
national institute on aging
For carrying out section 301 and title IV of the Public Health
Service Act with respect to aging, $794,625,000.
national institute of arthritis and musculoskeletal and skin diseases
For carrying out section 301 and title IV of the Public Health
Service Act with respect to arthritis and musculoskeletal and skin
diseases, $401,161,000.
national institute on deafness and other communication disorders
For carrying out section 301 and title IV of the Public Health
Service Act with respect to deafness and other communication disorders,
$303,541,000.
national institute of nursing research
For carrying out section 301 and title IV of the Public Health
Service Act with respect to nursing research, $106,848,000.
national institute on alcohol abuse and alcoholism
For carrying out section 301 and title IV of the Public Health
Service Act with respect to alcohol abuse and alcoholism, $336,848,000.
national institute on drug abuse
For carrying out section 301 and title IV of the Public Health
Service Act with respect to drug abuse, $790,038,000.
national institute of mental health
For carrying out section 301 and title IV of the Public Health
Service Act with respect to mental health, $1,117,928,000.
national human genome research institute
For carrying out section 301 and title IV of the Public Health
Service Act with respect to human genome research, $385,888,000.
national center for research resources
For carrying out section 301 and title IV of the Public Health
Service Act with respect to research resources and general research
support grants, $775,212,000: Provided, That none of these funds shall
be used to pay recipients of the general research support grants
program any amount for indirect expenses in connection with such
grants: Provided further, That $75,000,000 shall be for extramural
facilities construction grants.
national center for complementary and alternative medicine
For carrying out section 301 and title IV of the Public Health
Service Act with respect to complementary and alternative medicine,
$100,089,000.
john e. fogarty international center
For carrying out the activities at the John E. Fogarty
International Center, $61,260,000.
national library of medicine
For carrying out section 301 and title IV of the Public Health
Service Act with respect to health information communications,
$256,953,000, of which $4,000,000 shall be available until expended for
improvement of information systems: Provided, That in fiscal year 2001,
the Library may enter into personal services contracts for the
provision of services in facilities owned, operated, or constructed
under the jurisdiction of the National Institutes of Health.
office of the director
(including transfer of funds)
For carrying out the responsibilities of the Office of the
Director, National Institutes of Health, $352,165,000, of which
$48,271,000 shall be for the Office of AIDS Research: Provided, That
funding shall be available for the purchase of not to exceed 20
passenger motor vehicles for replacement only: Provided further, That
the Director may direct up to 1 percent of the total amount made
available in this or any other Act to all National Institutes of Health
appropriations to activities the Director may so designate: Provided
further, That no such appropriation shall be decreased by more than 1
percent by any such transfers and that the Congress is promptly
notified of the transfer: Provided further, That the National
Institutes of Health is authorized to collect third party payments for
the cost of clinical services that are incurred in National Institutes
of Health research facilities and that such payments shall be credited
to the National Institutes of Health Management Fund: Provided further,
That all funds credited to the National Institutes of Health Management
Fund shall remain available for one fiscal year after the fiscal year
in which they are deposited: Provided further, That up to $500,000
shall be available to carry out section 499 of the Public Health
Service Act: Provided further, That, notwithstanding section 499(k)(10)
of the Public Health Service Act, funds from the Foundation for the
National Institutes of Health may be transferred to the National
Institutes of Health.
buildings and facilities
For the study of, construction of, and acquisition of equipment
for, facilities of or used by the National Institutes of Health,
including the acquisition of real property, $148,900,000, to remain
available until expended, of which $47,300,000 shall be for the
neuroscience research center: Provided, That notwithstanding any other
provision of law, a single contract or related contracts for the
development and construction of the first phase of the National
Neuroscience Research Center may be employed which collectively include
the full scope of the project: Provided further, That the solicitation
and contract shall contain the clause ``availability of funds'' found
at 48 CFR 52.232-18.
Substance Abuse and Mental Health Services Administration
substance abuse and mental health services
For carrying out titles V and XIX of the Public Health Service Act
with respect to substance abuse and mental health services, the
Protection and Advocacy for Mentally Ill Individuals Act of 1986, and
section 301 of the Public Health Service Act with respect to program
management, $2,730,757,000, of which $15,000,000 shall remain available
until expended to carry out the Fetal Alcohol Syndrome prevention and
services program, of which $10,000,000 shall be used to provide grants
to local non-profit private and public entities to enable such entities
to develop and expand activities to provide substance abuse services to
homeless individuals: Provided, That in addition to amounts provided
herein, $12,000,000 shall be available from amounts available under
section 241 of the Public Health Services Act, to carry out the
National Household Survey on Drug Abuse: Provided further, That within
the amounts provided herein, $3,000,000 shall be available for the
Center for Mental Health Services to support through grants a
certification program to improve and evaluate the effectiveness and
responsiveness of suicide hotlines and crisis centers in the United
States and to help support and evaluate a national hotline and crisis
center network.
Agency for Healthcare Research and Quality
healthcare research and quality
For carrying out titles III and IX of the Public Health Service
Act, amounts received from Freedom of Information Act fees,
reimbursable and interagency agreements, and the sale of data shall be
credited to this appropriation and shall remain available until
expended: Provided, That the amount made available pursuant to section
926(b) of the Public Health Service Act shall not exceed $269,943,000.
Health Care Financing Administration
grants to states for medicaid
For carrying out, except as otherwise provided, titles XI and XIX
of the Social Security Act, $93,586,251,000, to remain available until
expended.
For making, after May 31, 2001, payments to States under title XIX
of the Social Security Act for the last quarter of fiscal year 2001 for
unanticipated costs, incurred for the current fiscal year, such sums as
may be necessary.
For making payments to States or in the case of section 1928 on
behalf of States under title XIX of the Social Security Act for the
first quarter of fiscal year 2002, $36,207,551,000, to remain available
until expended.
Payment under title XIX may be made for any quarter with respect to
a State plan or plan amendment in effect during such quarter, if
submitted in or prior to such quarter and approved in that or any
subsequent quarter.
payments to health care trust funds
For payment to the Federal Hospital Insurance and the Federal
Supplementary Medical Insurance Trust Funds, as provided under sections
217(g) and 1844 of the Social Security Act, sections 103(c) and 111(d)
of the Social Security Amendments of 1965, section 278(d) of Public Law
97-248, and for administrative expenses incurred pursuant to section
201(g) of the Social Security Act, $70,381,600,000.
program management
For carrying out, except as otherwise provided, titles XI, XVIII,
XIX, and XXI of the Social Security Act, titles XIII and XXVII of the
Public Health Service Act, and the Clinical Laboratory Improvement
Amendments of 1988, not to exceed $2,018,500,000, to be transferred
from the Federal Hospital Insurance and the Federal Supplementary
Medical Insurance Trust Funds, as authorized by section 201(g) of the
Social Security Act; together with all funds collected in accordance
with section 353 of the Public Health Service Act and such sums as may
be collected from authorized user fees and the sale of data, which
shall remain available until expended, and together with administrative
fees collected relative to Medicare overpayment recovery activities,
which shall remain available until expended: Provided, That all funds
derived in accordance with 31 U.S.C. 9701 from organizations
established under title XIII of the Public Health Service Act shall be
credited to and available for carrying out the purposes of this
appropriation: Provided further, That $18,000,000 appropriated under
this heading for the managed care system redesign shall remain
available until expended: Provided further, That $3,000,000 of the
amount available for research, demonstration, and evaluation activities
shall be available to continue carrying out demonstration projects on
Medicaid coverage of community-based attendant care services for people
with disabilities which ensures maximum control by the consumer to
select and manage their attendant care services: Provided further, That
the Secretary of Health and Human Services is directed to collect fees
in fiscal year 2001 from Medicare+Choice organizations pursuant to
section 1857(e)(2) of the Social Security Act and from eligible
organizations with risk-sharing contracts under section 1876 of that
Act pursuant to section 1876(k)(4)(D) of that Act: Provided further,
That administrative fees collected relative to Medicare overpayment
recovery activities shall be transferred to the Health Care Fraud and
Abuse Control (HCFAC) account, to be used for Medicare Integrity
Program (MIP) activities in addition to the amounts already specified,
and shall remain available until expended.
Administration for Children and Families
low income home energy assistance
For making payments under title XXVI of the Omnibus Reconciliation
Act of 1981, $300,000,000: Provided, That these funds are hereby
designated by the Congress to be emergency requirements pursuant to
section 251(b)(2)(A) of the Balanced Budget and Emergency Deficit
Control Act of 1985: Provided further, That these funds shall be made
available only after submission to the Congress of a formal budget
request by the President that includes designation of the entire amount
of the request as an emergency requirement as defined in such Act.
refugee and entrant assistance
For making payments for refugee and entrant assistance activities
authorized by title IV of the Immigration and Nationality Act and
section 501 of the Refugee Education Assistance Act of 1980 (Public Law
96-422), $418,321,000, to remain available through September 30, 2003.
For carrying out section 5 of the Torture Victims Relief Act of
1998 (Public Law 105-320), $7,265,000.
payments to states for child support enforcement and family support
programs
For making payments to States or other non-Federal entities under
titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the
Act of July 5, 1960 (24 U.S.C. ch. 9), $2,473,880,000, to remain
available until expended; and for such purposes for the first quarter
of fiscal year 2002, $1,000,000,000, to remain available until
expended.
For making payments to each State for carrying out the program of
Aid to Families with Dependent Children under title IV-A of the Social
Security Act before the effective date of the program of Temporary
Assistance to Needy Families (TANF) with respect to such State, such
sums as may be necessary: Provided, That the sum of the amounts
available to a State with respect to expenditures under such title IV-A
in fiscal year 1997 under this appropriation and under such title IV-A
as amended by the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 shall not exceed the limitations under
section 116(b) of such Act.
For making, after May 31 of the current fiscal year, payments to
States or other non-Federal entities under titles I, IV-D, X, XI, XIV,
and XVI of the Social Security Act and the Act of July 5, 1960 (24
U.S.C. ch. 9), for the last 3 months of the current year for
unanticipated costs, incurred for the current fiscal year, such sums as
may be necessary.
payments to states for the child care and development block grant
For carrying out sections 658A through 658R of the Omnibus Budget
Reconciliation Act of 1981 (The Child Care and Development Block Grant
Act of 1990), in addition to amounts already appropriated for fiscal
year 2001, $817,328,000: Provided, That of the funds appropriated for
fiscal year 2001, $19,120,000 shall be available for child care
resource and referral and school-aged child care activities: Provided
further, That of the funds appropriated for fiscal year 2001, in
addition to the amounts required to be reserved by the States under
section 658G, $222,672,000 shall be reserved by the States for
activities authorized under section 658G, of which $100,000,000 shall
be for activities that improve the quality of infant and toddler child
care.
social services block grant
For making grants to States pursuant to section 2002 of the Social
Security Act, $600,000,000: Provided, That notwithstanding section
2003(c) of such Act, as amended, the amount specified for allocation
under such section for fiscal year 2001 shall be $600,000,000.
children and families services programs
(including rescissions)
For carrying out, except as otherwise provided, the Runaway and
Homeless Youth Act, the Developmental Disabilities Assistance and Bill
of Rights Act, the Head Start Act, the Child Abuse Prevention and
Treatment Act, the Native American Programs Act of 1974, title II of
Public Law 95-266 (adoption opportunities), the Adoption and Safe
Families Act of 1997 (Public Law 105-89), the Abandoned Infants
Assistance Act of 1988, part B(1) of title IV and sections 413, 429A,
1110, and 1115 of the Social Security Act; for making payments under
the Community Services Block Grant Act, section 473A of the Social
Security Act, and title IV of Public Law 105-285; and for necessary
administrative expenses to carry out said Acts and titles I, IV, X, XI,
XIV, XVI, and XX of the Social Security Act, the Act of July 5, 1960
(24 U.S.C. ch. 9), the Omnibus Budget Reconciliation Act of 1981, title
IV of the Immigration and Nationality Act, section 501 of the Refugee
Education Assistance Act of 1980, section 5 of the Torture Victims
Relief Act of 1998 (Public Law 105-320), sections 40155, 40211, and
40241 of Public Law 103-322 and section 126 and titles IV and V of
Public Law 100-485, $7,895,723,000, of which $5,000,000 shall be made
available to provide grants for early childhood learning for young
children, of which $55,928,000, to remain available until September 30,
2002, shall be for grants to States for adoption incentive payments, as
authorized by section 473A of title IV of the Social Security Act (42
U.S.C. 670-679); of which $134,074,000, to remain available until
expended, shall be for activities authorized by sections 40155, 40211,
and 40241 of Public Law 103-322; of which $606,676,000 shall be for
making payments under the Community Services Block Grant Act; and of
which $6,267,000,000 shall be for making payments under the Head Start
Act, of which $1,400,000,000 shall become available October 1, 2001 and
remain available through September 30, 2002: Provided, That to the
extent Community Services Block Grant funds are distributed as grant
funds by a State to an eligible entity as provided under the Act, and
have not been expended by such entity, they shall remain with such
entity for carryover into the next fiscal year for expenditure by such
entity consistent with program purposes: Provided further, That the
Secretary shall establish procedures regarding the disposition of
intangible property which permits grant funds, or intangible assets
acquired with funds authorized under section 680 of the Community
Services Block Grant Act, as amended, to become the sole property of
such grantees after a period of not more than 12 years after the end of
the grant for purposes and uses consistent with the original grant:
Provided further, That amounts made available under this Act for the
administrative and related expenses of the Department of Health and
Human Services, the Department of Labor, and the Department of
Education shall be further reduced on a pro rata basis by $14,137,000.
Funds appropriated for fiscal year 2000 under section 429A(e), part
B of title IV of the Social Security Act shall be reduced by
$6,000,000.
Funds appropriated for fiscal year 2000 under section 413(h)(1) of
the Social Security Act shall be reduced by $15,000,000.
promoting safe and stable families
For carrying out section 430 of the Social Security Act,
$305,000,000.
payments to states for foster care and adoption assistance
For making payments to States or other non-Federal entities under
title IV-E of the Social Security Act, $4,868,100,000.
For making payments to States or other non-Federal entities under
title IV-E of the Social Security Act, for the first quarter of fiscal
year 2002, $1,735,900,000.
Administration on Aging
aging services programs
For carrying out, to the extent not otherwise provided, the Older
Americans Act of 1965, as amended, and section 398 of the Public Health
Service Act, $954,619,000, of which $5,000,000 shall be available for
activities regarding medication management, screening, and education to
prevent incorrect medication and adverse drug reactions: Provided,
That notwithstanding section 308(b)(1) of the Older Americans Act of
1965, as amended, the amounts available to each State for
administration of the State plan under title III of such Act shall be
reduced not more than 5 percent below the amount that was available to
such State for such purpose for fiscal year 1995: Provided further,
That in considering grant applications for nutrition services for elder
Indian recipients, the Assistant Secretary shall provide maximum
flexibility to applicants who seek to take into account subsistence,
local customs, and other characteristics that are appropriate to the
unique cultural, regional, and geographic needs of the American Indian,
Alaska and Hawaiian Native communities to be served.
Office of the Secretary
general departmental management
For necessary expenses, not otherwise provided, for general
departmental management, including hire of six sedans, and for carrying
out titles III, XVII, and XX of the Public Health Service Act, and the
United States-Mexico Border Health Commission Act, $206,766,000,
together with $5,851,000, to be transferred and expended as authorized
by section 201(g)(1) of the Social Security Act from the Hospital
Insurance Trust Fund and the Supplemental Medical Insurance Trust Fund:
Provided further, That of the funds made available under this heading
for carrying out title XX of the Public Health Service Act, $10,569,000
shall be for activities specified under section 2003(b)(2), of which
$9,131,000 shall be for prevention service demonstration grants under
section 510(b)(2) of title V of the Social Security Act, as amended,
without application of the limitation of section 2010(c) of said title
XX.
office of inspector general
For expenses necessary for the Office of Inspector General in
carrying out the provisions of the Inspector General Act of 1978, as
amended, $33,849,000.
office for civil rights
For expenses necessary for the Office for Civil Rights,
$20,742,000, together with not to exceed $3,314,000, to be transferred
and expended as authorized by section 201(g)(1) of the Social Security
Act from the Hospital Insurance Trust Fund and the Supplemental Medical
Insurance Trust Fund: Provided, That an additional $2,500,000 shall be
made available for the Office for Civil Rights: Provided further, That
amounts made available under this title for the administrative and
related expenses of the Department of Health and Human Services shall
be reduced by $2,500,000''.
policy research
For carrying out, to the extent not otherwise provided, research
studies under section 1110 of the Social Security Act, $16,738,000.
retirement pay and medical benefits for commissioned officers
For retirement pay and medical benefits of Public Health Service
Commissioned Officers as authorized by law, for payments under the
Retired Serviceman's Family Protection Plan and Survivor Benefit Plan,
for medical care of dependents and retired personnel under the
Dependents' Medical Care Act (10 U.S.C. ch. 55), and for payments
pursuant to section 229(b) of the Social Security Act (42 U.S.C.
429(b)), such amounts as may be required during the current fiscal
year.
Public Health and Social Services Emergency Fund
For public health and social services, $264,600,000.
GENERAL PROVISIONS
Sec. 201. Funds appropriated in this title shall be available for
not to exceed $37,000 for official reception and representation
expenses when specifically approved by the Secretary.
Sec. 202. The Secretary shall make available through assignment not
more than 60 employees of the Public Health Service to assist in child
survival activities and to work in AIDS programs through and with funds
provided by the Agency for International Development, the United
Nations International Children's Emergency Fund or the World Health
Organization.
Sec. 203. None of the funds appropriated under this Act may be used
to implement section 399L(b) of the Public Health Service Act or
section 1503 of the National Institutes of Health Revitalization Act of
1993, Public Law 103-43.
Sec. 204. None of the funds appropriated in this Act for the
National Institutes of Health and the Substance Abuse and Mental Health
Services Administration shall be used to pay the salary of an
individual, through a grant or other extramural mechanism, at a rate in
excess of Executive Level II.
Sec. 205. Notwithstanding section 241(a) of the Public Health
Service Act, such portion as the Secretary shall determine, but not
more than 1.6 percent, of any amounts appropriated for programs
authorized under the PHS Act shall be made available for the evaluation
(directly or by grants or contracts) of the implementation and
effectiveness of such programs.
(transfer of funds)
Sec. 206. Not to exceed 1 percent of any discretionary funds
(pursuant to the Balanced Budget and Emergency Deficit Control Act of
1985, as amended) which are appropriated for the current fiscal year
for the Department of Health and Human Services in this Act may be
transferred between appropriations, but no such appropriation shall be
increased by more than 3 percent by any such transfer: Provided, That
the Appropriations Committees of both Houses of Congress are notified
at least 15 days in advance of any transfer.
Sec. 207. The Director of the National Institutes of Health,
jointly with the Director of the Office of AIDS Research, may transfer
up to 3 percent among institutes, centers, and divisions from the total
amounts identified by these two Directors as funding for research
pertaining to the human immunodeficiency virus: Provided, That the
Congress is promptly notified of the transfer.
Sec. 208. Of the amounts made available in this Act for the
National Institutes of Health, the amount for research related to the
human immunodeficiency virus, as jointly determined by the Director of
the National Institutes of Health and the Director of the Office of
AIDS Research, shall be made available to the ``Office of AIDS
Research'' account. The Director of the Office of AIDS Research shall
transfer from such account amounts necessary to carry out section
2353(d)(3) of the Public Health Service Act.
Sec. 209. None of the funds appropriated in this Act may be made
available to any entity under title X of the Public Health Service Act
unless the applicant for the award certifies to the Secretary that it
encourages family participation in the decision of minors to seek
family planning services and that it provides counseling to minors on
how to resist attempts to coerce minors into engaging in sexual
activities.
Sec. 210. None of the funds appropriated by this Act (including
funds appropriated to any trust fund) may be used to carry out the
Medicare+Choice program if the Secretary denies participation in such
program to an otherwise eligible entity (including a Provider Sponsored
Organization) because the entity informs the Secretary that it will not
provide, pay for, provide coverage of, or provide referrals for
abortions: Provided, That the Secretary shall make appropriate
prospective adjustments to the capitation payment to such an entity
(based on an actuarially sound estimate of the expected costs of
providing the service to such entity's enrollees): Provided further,
That nothing in this section shall be construed to change the Medicare
program's coverage for such services and a Medicare+Choice organization
described in this section shall be responsible for informing enrollees
where to obtain information about all Medicare covered services.
Sec. 211. (a) Mental Health.--Section 1918(b) of the Public Health
Service Act (42 U.S.C. 300x-7(b)) is amended to read as follows:
``(b) Minimum Allotments for States.--Each State's allotment for
fiscal year 2001 for programs under this subpart shall not be less than
such State's allotment for such programs for fiscal year 2000.''.
(b) Substance Abuse.--Section 1933(b) of the Public Health Service
Act (42 U.S.C. 300x-33(b)) is amended to read as follows:
``(b) Minimum Allotments for States.--Each State's allotment for
fiscal year 2001 for programs under this subpart shall not be less than
such State's allotment for such programs for fiscal year 2000.''.
Sec. 212. Notwithstanding any other provision of law, no provider
of services under title X of the Public Health Service Act shall be
exempt from any State law requiring notification or the reporting of
child abuse, child molestation, sexual abuse, rape, or incest.
Sec. 213. Extension of Certain Adjudication Provisions.--The
Foreign Operations, Export Financing, and Related Programs
Appropriations Act, 1990 (Public Law 101-167) is amended--
(1) in section 599D (8 U.S.C. 1157 note)--
(A) in subsection (b)(3), by striking ``1997, 1998,
1999, and 2000'' and inserting ``1997, 1998, 1999, 2000
and 2001''; and
(B) in subsection (e), by striking ``October 1,
2000'' each place it appears and inserting ``October 1,
2001''; and
(2) in section 599E (8 U.S.C. 1255 note) in subsection
(b)(2), by striking ``September 30, 2000'' and inserting
``September 30, 2001''.
Sec. 214. None of the funds provided in this Act or in any other
Act making appropriations for fiscal year 2001 may be used to
administer or implement in Arizona or in the Kansas City, Missouri or
in the Kansas City, Kansas area the Medicare Competitive Pricing
Demonstration Project (operated by the Secretary of Health and Human
Services).
Sec. 215. Withholding of Substance Abuse Funds. (a) In General.--
Except as provided by subsection (e) none of the funds appropriated by
this Act may be used to withhold substance abuse funding from a State
pursuant to section 1926 of the Public Health Service Act (42 U.S.C.
300x-26) if such State certifies to the Secretary of Health and Human
Services by March 1, 2001 that the State will commit additional State
funds, in accordance with subsection (b), to ensure compliance with
State laws prohibiting the sale of tobacco products to individuals
under 18 years of age.
(b) Amount of State Funds.--The amount of funds to be committed by
a State under subsection (a) shall be equal to 1 percent of such
State's substance abuse block grant allocation for each percentage
point by which the State misses the retailer compliance rate goal
established by the Secretary of Health and Human Services under section
1926 of such Act.
(c) Additional State Funds.--The State is to maintain State
expenditures in fiscal year 2001 for tobacco prevention programs and
for compliance activities at a level that is not less than the level of
such expenditures maintained by the State for fiscal year 2000, and
adding to that level the additional funds for tobacco compliance
activities required under subsection (a). The State is to submit a
report to the Secretary on all fiscal year 2000 State expenditures and
all fiscal year 2001 obligations for tobacco prevention and compliance
activities by program activity by July 31, 2001.
(d) Enforcement of State Obligations.--The Secretary shall exercise
discretion in enforcing the timing of the State obligation of the
additional funds required by the certification described in subsection
(a) as late as July 31, 2001.
(e) Territories.--None of the funds appropriated by this Act may be
used to withhold substance abuse funding pursuant to section 1926 from
a territory that receives less than $1,000,000.
Sec. 216. Section 403(a)(3) of the Social Security Act (42 U.S.C.
603(a)(3)) is amended--
(1) in subparagraph (A)--
(A) in clause (i), by striking ``and'' at the end;
(B) in clause (ii)--
(i) by striking ``1999, 2000, and 2001''
and inserting ``1999 and 2000''; and
(ii) by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following new clause:
``(iii) for fiscal year 2001, a grant in an
amount equal to the amount of the grant to the
State under clause (i) for fiscal year 1998.''
and
(2) in subparagraph (G), by inserting at the end, ``Upon
enactment, the provisions of this Act that would have been
estimated by the Director of the Office of Management and
Budget as changing direct spending and receipts for fiscal year
2001 under section 252 of the Balanced Budget and Emergency
Deficit Control Act of 1985 (Public Law 99-177), to the extent
such changes would have been estimated to result in savings in
fiscal year 2001 of $240,000,000 in budget authority and
$122,000,000 in outlays, shall be treated as if enacted in an
appropriations act pursuant to Rule 3 of the Budget
Scorekeeping Guidelines set forth in the Joint Explanatory
Statement of the Committee of Conference accompanying
Conference Report No. 105-217, thereby changing discretionary
spending under section 251 of that Act.''.
Sec. 217. (a) Notwithstanding Section 2104(f) of the Social
Security Act (the Act), the Secretary of Health and Human Services
shall reduce the amounts allotted to a State under subsection (b) of
the Act for fiscal year 1998 by the applicable amount with respect to
the State; and
(b) Notwithstanding Section 2104(a) of the Act, the Secretary shall
increase the amount otherwise payable to each State under such
subsection for fiscal year 2003 by the amount of the reduction made
under paragraph (a) of this section. Funds made available under this
subsection shall remain available through September 30, 2004.
(c) Applicable Amount Defined.--In subsection (a), with respect to
a State, the term ``applicable amount'' means, with respect to a State,
an amount bearing the same proportion to $1,900,000,000 as the
unexpended balance of its fiscal year 1998 allotment as of September
30, 2000, which would otherwise be redistributed to States in fiscal
year 2001 under Section 2104(f) of the Act, bears to the sum of the
unexpended balances of fiscal year 1998 allotments for all States as of
September 30, 2000: Provided, That, the applicable amount for a State
shall not exceed the unexpended balance of its fiscal year 1998
allotment as of September 30, 2000.
Sec. 218. Sense of the Senate on Prevention of Needlestick
Injuries. (a) Findings.--The Senate finds that--
(1) the Centers for Disease Control and Prevention reports
that American health care workers report 600,000 to 800,000
needlestick and sharps injuries each year;
(2) the occurrence of needlestick injuries is believed to
be widely under-reported;
(3) needlestick and sharps injuries result in at least
1,000 new cases of health care workers with HIV, hepatitis C or
hepatitis B every year;
(4) more than 80 percent of needlestick injuries can be
prevented through the use of safer devices; and
(5) the Occupational Safety and Health Administration's
November 1999 Compliance Directive has helped clarify the duty
of employers to use safer needle devices to protect their
workers. However, millions of State and local government
employees are not covered by OSHA's bloodborne pathogen
standards and are not protected against the hazards of
needlesticks.
(b) Sense of the Senate.--It is the sense of the Senate that the
Senate should pass legislation that would eliminate or minimize the
significant risk of needlestick injury to health care workers.
Sec. 219. (a) In General.--There is appropriated $10,000,000 that
may be used by the Director of the National Institute for Occupational
Safety and Health to--
(1) establish and maintain a national database on existing
needleless systems and sharps with engineered sharps injury
protections;
(2) develop a set of evaluation criteria for use by
employers, employees, and other persons when they are
evaluating and selecting needleless systems and sharps with
engineered sharps injury protections;
(3) develop a model training curriculum to train employers,
employees, and other persons on the process of evaluating
needleless systems and sharps with engineered sharps injury
protections and to the extent feasible to provide technical
assistance to persons who request such assistance; and
(4) establish a national system to collect comprehensive
data on needlestick injuries to health care workers, including
data on mechanisms to analyze and evaluate prevention
interventions in relation to needlestick injury occurrence.
(b) Definitions.--In this section:
(1) Employer.--The term ``employer'' means each employer
having an employee with occupational exposure to human blood or
other material potentially containing bloodborne pathogens.
(2) Engineered sharps injury protections.--The term
``engineered sharps injury protections'' means--
(A) a physical attribute built into a needle device
used for withdrawing body fluids, accessing a vein or
artery, or administering medications or other fluids,
that effectively reduces the risk of an exposure
incident by a mechanism such as barrier creation,
blunting, encapsulation, withdrawal, retraction,
destruction, or other effective mechanisms; or
(B) a physical attribute built into any other type
of needle device, or into a nonneedle sharp, which
effectively reduces the risk of an exposure incident.
(3) Needleless system.--The term ``needleless system''
means a device that does not use needles for--
(A) the withdrawal of body fluids after initial
venous or arterial access is established;
(B) the administration of medication or fluids; and
(C) any other procedure involving the potential for
an exposure incident.
(4) Sharp.--The term ``sharp'' means any object used or
encountered in a health care setting that can be reasonably
anticipated to penetrate the skin or any other part of the
body, and to result in an exposure incident, including, but not
limited to, needle devices, scalpels, lancets, broken glass,
broken capillary tubes, exposed ends of dental wires and dental
knives, drills, and burs.
(5) Sharps injury.--The term ``sharps injury'' means any
injury caused by a sharp, including cuts, abrasions, or
needlesticks.
(c) Offset.--Amounts made available under this Act for the travel,
consulting, and printing services for the Department of Labor, the
Department of Health and Human Services, and the Department of
Education shall be reduced on a pro rata basis by $10,000,000.
Sec. 220. None of the funds made available under this Act may be
made available to any entity under the Public Health Service Act after
September 1, 2001, unless the Director of the National Institutes of
Health has provided to the Chairman and Ranking Member of the Senate
Committees on Appropriations, and Health, Education, Labor, and
Pensions a proposal to require a reasonable rate of return on both
intramural and extramural research by March 31, 2001.
Sec. 221. (a) Study.--The Secretary of Health and Human Services
shall conduct a study to examine--
(1) the experiences of hospitals in the United States in
obtaining reimbursement from foreign health insurance companies
whose enrollees receive medical treatment in the United States;
(2) the identity of the foreign health insurance companies
that do not cooperate with or reimburse (in whole or in part)
United States health care providers for medical services
rendered in the United States to enrollees who are foreign
nationals;
(3) the amount of unreimbursed services that hospitals in
the United States provide to foreign nationals described in
paragraph (2); and
(4) solutions to the problems identified in the study.
(b) Report.--Not later than March 31, 2001, the Secretary of Health
and Human Services shall prepare and submit to the Committee on Health,
Education, Labor, and Pensions of the Senate and the Committee on
Appropriations, a report concerning the results of the study conducted
under subsection (a), including the recommendations described in
paragraph (4) of such subsection.
Sec. 222. National Institute of Child Health and Human Development.
Section 448 of the Public Health Service Act (42 U.S.C. 285g) is
amended by inserting ``gynecologic health,'' after ``with respect to''.
Sec. 223. In addition to amounts otherwise appropriated under this
title for the Centers for Disease Control and Prevention, $37,500,000,
to be utilized to provide grants to States and political subdivisions
of States under section 317 of the Public Health Service Act to enable
such States and political subdivisions to carry out immunization
infrastructure and operations activities: Provided, That of the total
amount made available in this Act for infrastructure funding for the
Centers for Disease Control and Prevention, not less than 10 percent
shall be used for immunization projects in areas with low or declining
immunization rates or areas that are particularly susceptible to
disease outbreaks, and not more than 14 percent shall be used to carry
out the incentive bonus program: Provided further, That amounts made
available under this Act for the administrative and related expenses of
the Department of Health and Human Services, the Department of Labor,
and the Department of Education shall be further reduced on a pro rata
basis by $37,500,000.
Sec. 224. None of the funds appropriated under this Act shall be
expended by the National Institutes of Health on a contract for the
care of the 288 chimpanzees acquired by the National Institutes of
Health from the Coulston Foundation, unless the contractor is
accredited by the Association for the Assessment and Accreditation of
Laboratory Animal Care International or has a Public Health Services
assurance, and has not been charged multiple times with egregious
violations of the Animal Welfare Act.
Sec. 225. (a) In addition to amounts made available under the
heading ``Health Resources and Services Administration-Health Resources
and Services'' for poison prevention and poison control center
activities, there shall be available an additional $20,000,000 to
provide assistance for such activities and to stabilize the funding of
regional poison control centers as provided for pursuant to the Poison
Control Center Enhancement and Awareness Act (Public Law 106-174).
(b) Amounts made available under this Act for the administrative
and related expenses of the Department of Health and Human Services,
the Department of Labor, and the Department of Education shall be
further reduced on a pro rata basis by $20,000,000.
Sec. 226. Sense of the Senate Regarding the Delivery of Emergency
Medical Services. (a) Findings.--The Senate finds the following:
(1) Several States have developed and implemented a unique
2-tiered emergency medical services system that effectively
provides services to the residents of those States.
(2) These 2-tiered systems include volunteer and for-profit
emergency medical technicians who provide basic life support
and hospital-based paramedics who provide advanced life
support.
(3) These 2-tiered systems have provided universal access
for residents of those States to affordable emergency services,
while simultaneously ensuring that those persons in need of the
most advanced care receive such care from the proper
authorities.
(4) One State's 2-tiered system currently has an estimated
20,000 emergency medical technicians providing ambulance
transportation for basic life support and advanced life support
emergencies, over 80 percent of which are handled by volunteers
who are not reimbursed under the medicare program under title
XVIII of the Social Security Act.
(5) The hospital-based paramedics, also known as mobile
intensive care units, are reimbursed under the medicare program
when they respond to advanced life support emergencies.
(6) These 2-tiered State health systems save the lives of
thousands of residents of those States each year, while saving
the medicare program, in some instances, as much as $39,000,000
in reimbursement fees.
(7) When Congress requested that the Health Care Financing
Administration enact changes to the emergency medical services
fee schedule as a result of the Balanced Budget Act of 1997,
including a general overhaul of reimbursement rates and
administrative costs, it was in the spirit of streamlining the
agency, controlling skyrocketing health care costs, and
lengthening the solvency of the medicare program.
(8) The Health Care Financing Administration is considering
implementing new emergency medical services reimbursement
guidelines that may destabilize the 2-tier system that has
developed in these States.
(b) Sense of the Senate.--It is the sense of the Senate that the
Health Care Financing Administration should--
(1) consider the unique nature of 2-tiered emergency
medical services delivery systems when implementing new
reimbursement guidelines for paramedics and hospitals under the
medicare program under title XVIII of the Social Security Act;
and
(2) promote innovative emergency medical service systems
enacted by States that reduce reimbursement costs to the
medicare program while ensuring that all residents receive
quick and appropriate emergency care when needed.
Sec. 227. Sense of the Senate Regarding Impacts of the Balanced
Budget Act of 1997. (a) Findings.--The Senate makes the following
findings:
(1) Since its passage in 1997, the Balanced Budget Act of
1997 has drastically cut payments under the medicare program
under title XVIII of the Social Security Act in the areas of
hospital, home health, and skilled nursing care, among others.
While Congress intended to cut approximately $100,000,000,000
from the medicare program over 5 years, recent estimates put
the actual cut at over $200,000,000,000.
(2) A recent study on home health care found that nearly 70
percent of hospital discharge planners surveyed reported a
greater difficulty obtaining home health services for medicare
beneficiaries as a result of the Balanced Budget Act of 1997.
(3) According to the Medicare Payment Advisory Commission,
rural hospitals were disproportionately affected by the
Balanced Budget Act of 1997, dropping the inpatient margins of
such hospitals over 4 percentage points in 1998.
(b) Sense of Senate.--It is the sense of the Senate that Congress
and the President should act expeditiously to alleviate the adverse
impacts of the Balanced Budget Act of 1997 on beneficiaries under the
medicare program under title XVIII of the Social Security Act and
health care providers participating in such program.
TITLE III--DEPARTMENT OF EDUCATION
Office of Elementary and Secondary Education
education reform
For carrying out activities authorized by title IV of the Goals
2000: Educate America Act as in effect prior to September 30, 2000, and
sections 3122, 3132, 3136, and 3141, parts B, C, and D of title III,
and part I of title X of the Elementary and Secondary Education Act of
1965, $1,434,500,000, of which $40,000,000 shall be for the Goals 2000:
Educate America Act, and of which $192,000,000 shall be for section
3122: Provided, That up to one-half of 1 percent of the amount
available under section 3132 shall be set aside for the outlying areas,
to be distributed on the basis of their relative need as determined by
the Secretary in accordance with the purposes of the program: Provided
further, That if any State educational agency does not apply for a
grant under section 3132, that State's allotment under section 3131
shall be reserved by the Secretary for grants to local educational
agencies in that State that apply directly to the Secretary according
to the terms and conditions published by the Secretary in the Federal
Register: Provided further, That, notwithstanding part I of title X of
the Elementary and Secondary Education Act of 1965 or any other
provision of law, a community-based organization that has experience in
providing before- and after-school services shall be eligible to
receive a grant under that part, on the same basis as a school or
consortium described in section 10904 of that Act, and the Secretary
shall give priority to any application for such a grant that is
submitted jointly by such a community-based organization and such a
school or consortium.
education for the disadvantaged
For carrying out title I of the Elementary and Secondary Education
Act of 1965, and section 418A of the Higher Education Act of 1965,
$8,986,800,000, of which $2,729,958,000 shall become available on July
1, 2001, and shall remain available through September 30, 2002, and of
which $6,223,342,000 shall become available on October 1, 2001 and
shall remain available through September 30, 2002, for academic year
2000-2001: Provided, That $7,113,403,000 shall be available for basic
grants under section 1124: Provided further, That up to $3,500,000 of
these funds shall be available to the Secretary on October 1, 2000, to
obtain updated local educational agency level census poverty data from
the Bureau of the Census: Provided further, That $1,222,397,000 shall
be available for concentration grants under section 1124A: Provided
further, That grant awards under sections 1124 and 1124A of title I of
the Elementary and Secondary Education Act of 1965 shall be made to
each State and local educational agency at no less than 100 percent of
the amount such State or local educational agency received under this
authority for fiscal year 2000: Provided further, That notwithstanding
any other provision of law, grant awards under section 1124A of title I
of the Elementary and Secondary Education Act of 1965 shall be made to
those local educational agencies that received a Concentration Grant
under the Department of Education Appropriations Act, 2000, but are not
eligible to receive such a grant for fiscal year 2001: Provided
further, That each such local educational agency shall receive an
amount equal to the Concentration Grant the agency received in fiscal
year 2000, ratably reduced, if necessary, to ensure that these local
educational agencies receive no greater share of their hold-harmless
amounts than other local educational agencies: Provided further, That
notwithstanding any other provision of law, in calculating the amount
of Federal assistance awarded to a State or local educational agency
under any program under title I of the Elementary and Secondary
Education Act of 1965 (20 U.S.C. 6301 et seq.) on the basis of a
formula described in section 1124 or 1124A of such Act (20 U.S.C. 6333,
6334), any funds appropriated for the program in excess of the amount
appropriated for the program for fiscal year 2000 shall be awarded
according to the formula, except that, for such purposes, the formula
shall be applied only to States or local educational agencies that
experience a reduction under the program for fiscal year 2001 as a
result of the application of the 100 percent hold harmless provisions
under the heading ``Education for the Disadvantaged'': Provided
further, That the Secretary shall not take into account the hold
harmless provisions in this section in determining State allocations
under any other program administered by the Secretary in any fiscal
year.
impact aid
For carrying out programs of financial assistance to federally
affected schools authorized by title VIII of the Elementary and
Secondary Education Act of 1965, $1,030,000,000, of which $818,000,000
shall be for basic support payments under section 8003(b), $50,000,000
shall be for payments for children with disabilities under section
8003(d), $82,000,000, to remain available until expended, shall be for
payments under section 8003(f), $35,000,000 shall be for construction
under section 8007, $47,000,000 shall be for Federal property payments
under section 8002 and $8,000,000 to remain available until expended
shall be for facilities maintenance under section 8008: Provided, That
amounts made available under this Act for the administrative and
related expenses of the Department of Health and Human Services, the
Department of Labor, and the Department of Education shall be further
reduced on a pro rata basis by $10,000,000.
school improvement programs
For carrying out school improvement activities authorized by titles
II, IV, V-A and B, VI, IX, X, and XIII of the Elementary and Secondary
Education Act of 1965 (``ESEA''); the Stewart B. McKinney Homeless
Assistance Act; and the Civil Rights Act of 1964 and part B of title
VIII of the Higher Education Act of 1965; $4,672,534,000, of which
$1,100,200,000 shall become available on July 1, 2001, and remain
available through September 30, 2002, and of which $2,915,000,000 shall
become available on October 1, 2001 and shall remain available through
September 30, 2002 for academic year 2001-2002: Provided, That of the
amount appropriated, $435,000,000 shall be for Eisenhower professional
development State grants under title II-B and $3,100,000,000 shall be
for title VI and up to $750,000 shall be for an evaluation of
comprehensive regional assistance centers under title XIII of ESEA:
Provided further, That of the amount made available for Title VI,
$2,700,000,000 shall be available, notwithstanding any other provision
of law, for purposes consistent with title VI to be determined by the
local education agency as part of a local strategy for improving
academic achievement: Provided further, That these funds may also be
used to address the shortage of highly qualified teachers to reduce
class size, particularly in early grades, using highly qualified
teachers to improve educational achievement for regular and special
needs children; to support efforts to recruit, train and retrain highly
qualified teachers; to carry out part B of the Individuals with
Disabilities Education Act (20 U.S.C. 1411 et seq.); or for school
construction and renovation of facilities, at the sole discretion of
the local educational agency: Provided further, That funds made
available under this heading to carry out section 6301(b) of the
Elementary and Secondary Education Act of 1965 shall be available for
education reform projects that provide same gender schools and
classrooms, consistent with applicable law: Provided further, That of
the amount made available under this heading for activities carried out
through the Fund for the Improvement of Education under part A of title
X, $10,000,000 shall be made available to enable the Secretary of
Education to award grants to develop and implement school dropout
prevention programs.
reading excellence
For necessary expenses to carry out the Reading Excellence Act,
$91,000,000, which shall become available on July 1, 2001 and shall
remain available through September 30, 2002 and $195,000,000 which
shall become available on October 1, 2001 and remain available through
September 30, 2002.
indian education
For expenses necessary to carry out, to the extent not otherwise
provided, title IX, part A of the Elementary and Secondary Education
Act of 1965, as amended, $115,500,000.
Office of Bilingual Education and Minority Languages Affairs
bilingual and immigrant education
For carrying out, to the extent not otherwise provided, bilingual,
foreign language and immigrant education activities authorized by parts
A and C and section 7203 of title VII of the Elementary and Secondary
Education Act of 1965, without regard to section 7103(b), $443,000,000:
Provided, That State educational agencies may use all, or any part of,
their part C allocation for competitive grants to local educational
agencies.
Office of Special Education and Rehabilitative Services
special education
For carrying out the Individuals with Disabilities Education Act,
$7,352,341,000, of which $2,464,452,000 shall become available for
obligation on July 1, 2001, and shall remain available through
September 30, 2002, and of which $4,624,000,000 shall become available
on October 1, 2001 and shall remain available through September 30,
2002, for academic year 2001-2002: Provided, That $1,500,000 shall be
for the recipient of funds provided by Public Law 105-78 under section
687(b)(2)(G) of the Act to provide information on diagnosis,
intervention, and teaching strategies for children with disabilities:
Provided further, That the amount for section 611(c) of the Act shall
be equal to the amount available for that section under Public Law 106-
113, increased by the rate of inflation as specified in section
611(f)(1)(B)(ii) of the Act.
rehabilitation services and disability research
For carrying out, to the extent not otherwise provided, the
Rehabilitation Act of 1973, the Assistive Technology Act of 1998, and
the Helen Keller National Center Act, $2,799,519,000: Provided, That
notwithstanding section 105(b)(1) of the Assistive Technology Act of
1998 (``the AT Act''), each State shall be provided $50,000 for
activities under section 102 of the AT Act: Provided further, That
notwithstanding section 105(b)(1) and section 101(f)(2) and (3) of the
Assistive Technology Act of 1998, each State shall be provided a
minimum of $500,000 for activities under section 101: Provided further,
That $7,000,000 shall be used to support grants for up to three years
to states under title III of the AT Act, of which the Federal share
shall not exceed 75 percent in the first year, 50 percent in the second
year, and 25 percent in the third year, and that the requirements in
section 301(c)(2) and section 302 of that Act shall not apply to such
grants.
Special Institutions for Persons With Disabilities
american printing house for the blind
For carrying out the Act of March 3, 1879, as amended (20 U.S.C.
101 et seq.), $12,500,000.
national technical institute for the deaf
For the National Technical Institute for the Deaf under titles I
and II of the Education of the Deaf Act of 1986 (20 U.S.C. 4301 et
seq.), $54,366,000, of which $7,176,000 shall be for construction and
shall remain available until expended: Provided, That from the total
amount available, the Institute may at its discretion use funds for the
endowment program as authorized under section 207.
gallaudet university
For the Kendall Demonstration Elementary School, the Model
Secondary School for the Deaf, and the partial support of Gallaudet
University under titles I and II of the Education of the Deaf Act of
1986 (20 U.S.C. 4301 et seq.), $87,650,000: Provided, That from the
total amount available, the University may at its discretion use funds
for the endowment program as authorized under section 207.
Office of Vocational and Adult Education
vocational and adult education
For carrying out, to the extent not otherwise provided, the Carl D.
Perkins Vocational and Technical Education Act, the Adult Education and
Family Literacy Act, and title VIII-D of the Higher Education Act of
1965, as amended, and Public Law 102-73, $1,726,600,000, of which
$1,000,000 shall remain available until expended, and of which
$929,000,000 shall become available on July 1, 2001 and shall remain
available through September 30, 2002 and of which $791,000,000 shall
become available on October 1, 2001 and shall remain available through
September 30, 2002: Provided, That of the amounts made available for
the Carl D. Perkins Vocational and Technical Education Act, $5,600,000
shall be for tribally controlled postsecondary vocational and technical
institutions under section 117: Provided further, That $9,000,000 shall
be for carrying out section 118 of such Act: Provided further, That up
to 15 percent of the funds provided may be used by the national entity
designated under section 118(a) to cover the cost of authorized
activities and operations, including Federal salaries and expenses:
Provided further, That the national entity is authorized, effective
upon enactment, to charge fees for publications, training, and
technical assistance developed by that national entity: Provided
further, That revenues received from publications and delivery of
technical assistance and training, notwithstanding 31 U.S.C. 3302, may
be credited to the national entity's account and shall be available to
the national entity, without fiscal year limitation, so long as such
revenues are used for authorized activities and operations of the
national entity: Provided further, That of the funds made available to
carry out section 204 of the Perkins Act, all funds that a State
receives in excess of its prior-year allocation shall be competitively
awarded: Provided further, That in making these awards, each State
shall give priority to consortia whose applications most effectively
integrate all components under section 204(c): Provided further, That
of the amounts made available for the Carl D. Perkins Vocational and
Technical Education Act, $5,000,000 shall be for demonstration
activities authorized by section 207: Provided further, That of the
amounts made available for the Adult Education and Family Literacy Act,
$14,000,000 shall be for national leadership activities under section
243 and $6,500,000 shall be for the National Institute for Literacy
under section 242: Provided further, That $22,000,000 shall be for
Youth Offender Grants, of which $5,000,000 shall be used in accordance
with section 601 of Public Law 102-73 as that section was in effect
prior to the enactment of Public Law 105-220: Provided further, That of
the amounts made available for title I of the Perkins Act, the
Secretary may reserve up to 0.54 percent for incentive grants under
section 503 of the Workforce Investment Act, without regard to section
111(a)(1)(C) of the Perkins Act: Provided further, That of the amounts
made available for the Adult Education and Family Literacy Act, the
Secretary may reserve up to 0.54 percent for incentive grants under
section 503 of the Workforce Investment Act, without regard to section
211(a)(3) of the Adult Education and Family Literacy Act.
Office of Student Financial Assistance
student financial assistance
For carrying out subparts 1, 3 and 4 of part A, part C and part E
of title IV of the Higher Education Act of 1965, as amended,
$10,624,000,000, which shall remain available through September 30,
2002.
The maximum Pell Grant for which a student shall be eligible during
award year 2001-2002 shall be $3,650: Provided, That notwithstanding
section 401(g) of the Act, if the Secretary determines, prior to
publication of the payment schedule for such award year, that the
amount included within this appropriation for Pell Grant awards in such
award year, and any funds available from the fiscal year 2000
appropriation for Pell Grant awards, are insufficient to satisfy fully
all such awards for which students are eligible, as calculated under
section 401(b) of the Act, the amount paid for each such award shall be
reduced by either a fixed or variable percentage, or by a fixed dollar
amount, as determined in accordance with a schedule of reductions
established by the Secretary for this purpose.
federal family education loan program account
For Federal administrative expenses to carry out guaranteed student
loans authorized by title IV, part B, of the Higher Education Act of
1965, as amended, $48,000,000.
Office of Postsecondary Education
higher education
For carrying out, to the extent not otherwise provided, section 121
and titles II, III, IV, V, VI, VII, and VIII of the Higher Education
Act of 1965, as amended, and the Mutual Educational and Cultural
Exchange Act of 1961; $1,694,520,000, of which $10,000,000 for interest
subsidies authorized by section 121 of the Higher Education Act of
1965, shall remain available until expended: Provided, That
$11,000,000, to remain available through September 30, 2002, shall be
available to fund fellowships under part A, subpart 1 of title VII of
said Act, of which up to $1,000,000 shall be available to fund
fellowships for academic year 2001-2002, and the remainder shall be
available to fund fellowships for academic year 2002-2003: Provided
further, That $3,000,000 is for data collection and evaluation
activities for programs under the Higher Education Act of 1965,
including such activities needed to comply with the Government
Performance and Results Act of 1993: Provided further, That section
404F(a) of the Higher Education Amendments of 1998 is amended by
striking out ``using funds appropriated under section 404H that do not
exceed $200,000'' and inserting in lieu thereof ``using not more than
0.2 percent of the funds appropriated under section 404H''.
howard university
For partial support of Howard University (20 U.S.C. 121 et seq.),
$224,000,000, of which not less than $3,530,000 shall be for a matching
endowment grant pursuant to the Howard University Endowment Act (Public
Law 98-480) and shall remain available until expended.
college housing and academic facilities loans program
For Federal administrative expenses authorized under section 121 of
the Higher Education Act of 1965, $737,000 to carry out activities
related to existing facility loans entered into under the Higher
Education Act of 1965.
historically black college and university capital financing program
account
The total amount of bonds insured pursuant to section 344 of title
III, part D of the Higher Education Act of 1965 shall not exceed
$357,000,000, and the cost, as defined in section 502 of the
Congressional Budget Act of 1974, of such bonds shall not exceed zero.
For administrative expenses to carry out the Historically Black
College and University Capital Financing Program entered into pursuant
to title III, part D of the Higher Education Act of 1965, as amended,
$208,000.
Office of Educational Research and Improvement
education research, statistics, and improvement
For carrying out activities authorized by the Educational Research,
Development, Dissemination, and Improvement Act of 1994, including part
E; the National Education Statistics Act of 1994, including sections
411 and 412; section 2102 of title II, and parts A, B, and K and
section 10102, section 10105, and 10601 of title X, and part C of title
XIII of the Elementary and Secondary Education Act of 1965, as amended,
and title VI of Public Law 103-227, $506,519,000, of which $250,000
shall be for the Web-Based Education Commission: Provided, That of the
funds appropriated under section 10601 of title X of the Elementary and
Secondary Education Act of 1965, as amended, $1,500,000 shall be used
to conduct a violence prevention demonstration program: Provided
further, That of the funds appropriated $5,000,000 shall be made
available for a high school State grant program to improve academic
performance and provide technical skills training, $5,000,000 shall be
made available to provide grants to enable elementary and secondary
schools to provide physical education and improve physical fitness:
Provided further, That $50,000,000 of the funds provided for the
national education research institutes shall be allocated
notwithstanding section 912(m)(1)(B-F) and subparagraphs (B) and (C) of
section 931(c)(2) of Public Law 103-227 and $20,000,000 of that
$50,000,000 shall be made available for the Interagency Education
Research Initiative: Provided further, That the amounts made available
under this Act for the administrative and related expenses of the
Department of Health and Human Services, the Department of Labor, and
the Department of Education shall be further reduced on a pro rata
basis by $10,000,000: Provided further, That of the funds available for
section 10601 of title X of the Elementary and Secondary Education Act
of 1965, as amended, $150,000 shall be awarded to the Center for
Educational Technologies to complete production and distribution of an
effective CD-ROM product that would complement the ``We the People: The
Citizen and the Constitution'' curriculum: Provided further, That, in
addition to the funds for title VI of Public Law 103-227 and
notwithstanding the provisions of section 601(c)(1)(C) of that Act,
$1,000,000 shall be available to the Center for Civic Education to
conduct a civic education program with Northern Ireland and the
Republic of Ireland and, consistent with the civics and Government
activities authorized in section 601(c)(3) of Public Law 103-227, to
provide civic education assistance to democracies in developing
countries. The term ``developing countries'' shall have the same
meaning as the term ``developing country'' in the Education for the
Deaf Act: Provided further, That of the amount made available under
this heading for activities carried out through the Fund for the
Improvement of Education under part A of title X, $50,000,000 shall be
made available to enable the Secretary of Education to award grants to
develop, implement, and strengthen programs to teach American history
(not social studies) as a separate subject within school curricula.
Departmental Management
program administration
For carrying out, to the extent not otherwise provided, the
Department of Education Organization Act, including rental of
conference rooms in the District of Columbia and hire of two passenger
motor vehicles, $396,671,000.
office for civil rights
For expenses necessary for the Office for Civil Rights, as
authorized by section 203 of the Department of Education Organization
Act, $73,224,000.
office of the inspector general
For expenses necessary for the Office of Inspector General, as
authorized by section 212 of the Department of Education Organization
Act, $35,456,000.
GENERAL PROVISIONS
Sec. 301. No funds appropriated in this Act may be used for the
transportation of students or teachers (or for the purchase of
equipment for such transportation) in order to overcome racial
imbalance in any school or school system, or for the transportation of
students or teachers (or for the purchase of equipment for such
transportation) in order to carry out a plan of racial desegregation of
any school or school system.
Sec. 302. None of the funds contained in this Act shall be used to
require, directly or indirectly, the transportation of any student to a
school other than the school which is nearest the student's home,
except for a student requiring special education, to the school
offering such special education, in order to comply with title VI of
the Civil Rights Act of 1964. For the purpose of this section an
indirect requirement of transportation of students includes the
transportation of students to carry out a plan involving the
reorganization of the grade structure of schools, the pairing of
schools, or the clustering of schools, or any combination of grade
restructuring, pairing or clustering. The prohibition described in this
section does not include the establishment of magnet schools.
Sec. 303. No funds appropriated under this Act may be used to
prevent the implementation of programs of voluntary prayer and
meditation in the public schools.
(transfer of funds)
Sec. 304. Not to exceed 1 percent of any discretionary funds
(pursuant to the Balanced Budget and Emergency Deficit Control Act of
1985, as amended) which are appropriated for the Department of
Education in this Act may be transferred between appropriations, but no
such appropriation shall be increased by more than 3 percent by any
such transfer: Provided, That the Appropriations Committees of both
Houses of Congress are notified at least 15 days in advance of any
transfer.
Sec. 305. Impact Aid. Notwithstanding any other provision of this
Act--
(1) the total amount appropriated under this title to carry
out title VIII of the Elementary and Secondary Education Act of
1965 shall be $1,075,000,000;
(2) the total amount appropriated under this title for
basic support payments under section 8003(b) of the Elementary
and Secondary Education Act of 1965 shall be $853,000,000; and
(3) amounts made available for the administrative and
related expenses of the Department of Labor, Health and Human
Services, and Education, shall be further reduced on a pro rata
basis by $35,000,000.
Sec. 306. (a) In addition to any amounts appropriated under this
title for the loan forgiveness for child care providers program under
section 428K of the Higher Education Act of 1965 (20 U.S.C. 1078-11),
an additional $10,000,000 is appropriated to carry out such program.
(b) Notwithstanding any other provision of this Act, amounts made
available under titles I and II, and this title, for salaries and
expenses at the Departments of Labor, Health and Human Services, and
Education, respectively, shall be reduced on a pro rata basis by
$10,000,000.
Sec. 307. Technology and Media Services. Notwithstanding any other
provision of this Act--
(1) the total amount appropriated under this title under
the heading ``Office of Special Education and Rehabilitative
Services'' under the heading ``special education'' to carry out
the Individuals with Disabilities Education Act shall be
$7,353,141,000, of which $35,323,000 shall be available for
technology and media services; and
(2) the total amount appropriated under this title under
the heading ``Departmental Management'' under the heading
``program administration'' shall be further reduced by
$800,000.
Sec. 308. (a) In addition to any amounts appropriated under this
title for the Perkin's loan cancellation program under section 465 of
the Higher Education Act of 1965 (20 U.S.C. 1087ee), an additional
$15,000,000 is appropriated to carry out such program.
(b) Notwithstanding any other provision of this Act, amounts made
available under titles I and II, and this title, for salaries and
expenses at the Departments of Labor, Health and Human Services, and
Education, respectively, shall be further reduced on a pro rata basis
by $15,000,000.
Sec. 309. The Comptroller General of the United States shall
evaluate the extent to which funds made available under part A of title
I of the Elementary and Secondary Education Act of 1965 are allocated
to schools and local educational agencies with the greatest
concentrations of school-age children from low-income families, the
extent to which allocations of such funds adjust to shifts in
concentrations of pupils from low-income families in different regions,
States, and substate areas, the extent to which the allocation of such
funds encourages the targeting of State funds to areas with higher
concentrations of children from low-income families, the implications
of current distribution methods for such funds, and formula and other
policy recommendations to improve the targeting of such funds to more
effectively serve low-income children in both rural and urban areas,
and for preparing interim and final reports based on the results of the
study, to be submitted to Congress not later than February 1, 2001, and
April 1, 2001.
Sec. 310. The amount made available under this title under the
heading ``Office of Postsecondary Education'' under the heading
``higher education'' to carry out section 316 of the Higher Education
Act of 1965 is increased by $5,000,000, which increase shall be used
for construction and renovation projects under such section; and the
amount made available under this title under the heading ``Office of
Postsecondary Education'' under the heading ``higher education'' to
carry out part B of title VII of the Higher Education Act of 1965 is
decreased by $5,000,000.
TITLE IV--RELATED AGENCIES
Armed Forces Retirement Home
armed forces retirement home
For expenses necessary for the Armed Forces Retirement Home to
operate and maintain the United States Soldiers' and Airmen's Home and
the United States Naval Home, to be paid from funds available in the
Armed Forces Retirement Home Trust Fund, $69,832,000, of which
$9,832,000 shall remain available until expended for construction and
renovation of the physical plants at the United States Soldiers' and
Airmen's Home and the United States Naval Home: Provided, That,
notwithstanding any other provision of law, a single contract or
related contracts for development and construction, to include
construction of a long-term care facility at the United States Naval
Home, may be employed which collectively include the full scope of the
project: Provided further, That the solicitation and contract shall
contain the clause ``availability of funds'' found at 48 CFR 52.232-18
and 252.232-7007, Limitation of Government Obligations. In addition,
for completion of the long-term care facility at the United States
Naval Home, $6,228,000 to become available on October 1, 2001, and
remain available until expended.
Corporation for National and Community Service
domestic volunteer service programs, operating expenses
For expenses necessary for the Corporation for National and
Community Service to carry out the provisions of the Domestic Volunteer
Service Act of 1973, as amended, $302,504,000: Provided, That none of
the funds made available to the Corporation for National and Community
Service in this Act for activities authorized by part E of title II of
the Domestic Volunteer Service Act of 1973 shall be used to provide
stipends or other monetary incentives to volunteers or volunteer
leaders whose incomes exceed 125 percent of the national poverty level.
Corporation for Public Broadcasting
For payment to the Corporation for Public Broadcasting, as
authorized by the Communications Act of 1934, an amount which shall be
available within limitations specified by that Act, for the fiscal year
2003, $365,000,000: Provided, That no funds made available to the
Corporation for Public Broadcasting by this Act shall be used to pay
for receptions, parties, or similar forms of entertainment for
Government officials or employees: Provided further, That none of the
funds contained in this paragraph shall be available or used to aid or
support any program or activity from which any person is excluded, or
is denied benefits, or is discriminated against, on the basis of race,
color, national origin, religion, or sex: Provided further, That in
addition to the amounts provided above, $20,000,000, to remain
available until expended, shall be for digitalization, pending
enactment of authorizing legislation.
Federal Mediation and Conciliation Service
salaries and expenses
For expenses necessary for the Federal Mediation and Conciliation
Service to carry out the functions vested in it by the Labor Management
Relations Act, 1947 (29 U.S.C. 171-180, 182-183), including hire of
passenger motor vehicles; for expenses necessary for the Labor-
Management Cooperation Act of 1978 (29 U.S.C. 175a); and for expenses
necessary for the Service to carry out the functions vested in it by
the Civil Service Reform Act, Public Law 95-454 (5 U.S.C. ch. 71),
$38,200,000, including $1,500,000, to remain available through
September 30, 2002, for activities authorized by the Labor-Management
Cooperation Act of 1978 (29 U.S.C. 175a): Provided, That
notwithstanding 31 U.S.C. 3302, fees charged, up to full-cost recovery,
for special training activities and other conflict resolution services
and technical assistance, including those provided to foreign
governments and international organizations, and for arbitration
services shall be credited to and merged with this account, and shall
remain available until expended: Provided further, That fees for
arbitration services shall be available only for education, training,
and professional development of the agency workforce: Provided further,
That the Director of the Service is authorized to accept and use on
behalf of the United States gifts of services and real, personal, or
other property in the aid of any projects or functions within the
Director's jurisdiction.
Federal Mine Safety and Health Review Commission
salaries and expenses
For expenses necessary for the Federal Mine Safety and Health
Review Commission (30 U.S.C. 801 et seq.), $6,320,000.
Institute of Museum and Library Services
office of library services: grants and administration
For carrying out subtitle B of the Museum and Library Services Act,
$168,000,000, to remain available until expended.
Medicare Payment Advisory Commission
salaries and expenses
For expenses necessary to carry out section 1805 of the Social
Security Act, $8,000,000, to be transferred to this appropriation from
the Federal Hospital Insurance and the Federal Supplementary Medical
Insurance Trust Funds.
National Commission on Libraries and Information Science
salaries and expenses
For necessary expenses for the National Commission on Libraries and
Information Science, established by the Act of July 20, 1970 (Public
Law 91-345, as amended), $1,495,000.
National Council on Disability
salaries and expenses
For expenses necessary for the National Council on Disability as
authorized by title IV of the Rehabilitation Act of 1973, as amended,
$2,615,000.
National Education Goals Panel
For expenses necessary for the National Education Goals Panel, as
authorized by title II, part A of the Goals 2000: Educate America Act,
$2,350,000.
National Labor Relations Board
salaries and expenses
For expenses necessary for the National Labor Relations Board to
carry out the functions vested in it by the Labor-Management Relations
Act, 1947, as amended (29 U.S.C. 141-167), and other laws,
$216,438,000: Provided, That no part of this appropriation shall be
available to organize or assist in organizing agricultural laborers or
used in connection with investigations, hearings, directives, or orders
concerning bargaining units composed of agricultural laborers as
referred to in section 2(3) of the Act of July 5, 1935 (29 U.S.C. 152),
and as amended by the Labor-Management Relations Act, 1947, as amended,
and as defined in section 3(f) of the Act of June 25, 1938 (29 U.S.C.
203), and including in said definition employees engaged in the
maintenance and operation of ditches, canals, reservoirs, and waterways
when maintained or operated on a mutual, nonprofit basis and at least
95 percent of the water stored or supplied thereby is used for farming
purposes.
National Mediation Board
salaries and expenses
For expenses necessary to carry out the provisions of the Railway
Labor Act, as amended (45 U.S.C. 151-188), including emergency boards
appointed by the President, $10,400,000.
Occupational Safety and Health Review Commission
salaries and expenses
For expenses necessary for the Occupational Safety and Health
Review Commission (29 U.S.C. 661), $8,720,000.
Railroad Retirement Board
dual benefits payments account
For payment to the Dual Benefits Payments Account, authorized under
section 15(d) of the Railroad Retirement Act of 1974, $160,000,000,
which shall include amounts becoming available in fiscal year 2001
pursuant to section 224(c)(1)(B) of Public Law 98-76; and in addition,
an amount, not to exceed 2 percent of the amount provided herein, shall
be available proportional to the amount by which the product of
recipients and the average benefit received exceeds $160,000,000:
Provided, That the total amount provided herein shall be credited in 12
approximately equal amounts on the first day of each month in the
fiscal year.
federal payments to the railroad retirement accounts
For payment to the accounts established in the Treasury for the
payment of benefits under the Railroad Retirement Act for interest
earned on unnegotiated checks, $150,000, to remain available through
September 30, 2002, which shall be the maximum amount available for
payment pursuant to section 417 of Public Law 98-76.
limitation on administration
For necessary expenses for the Railroad Retirement Board for
administration of the Railroad Retirement Act and the Railroad
Unemployment Insurance Act, $92,500,000, to be derived in such amounts
as determined by the Board from the railroad retirement accounts and
from moneys credited to the railroad unemployment insurance
administration fund.
limitation on the office of inspector general
For expenses necessary for the Office of Inspector General for
audit, investigatory and review activities, as authorized by the
Inspector General Act of 1978, as amended, not more than $5,700,000, to
be derived from the railroad retirement accounts and railroad
unemployment insurance account: Provided, That none of the funds made
available in any other paragraph of this Act may be transferred to the
Office; used to carry out any such transfer; used to provide any office
space, equipment, office supplies, communications facilities or
services, maintenance services, or administrative services for the
Office; used to pay any salary, benefit, or award for any personnel of
the Office; used to pay any other operating expense of the Office; or
used to reimburse the Office for any service provided, or expense
incurred, by the Office.
Social Security Administration
payments to social security trust funds
For payment to the Federal Old-Age and Survivors Insurance and the
Federal Disability Insurance trust funds, as provided under sections
201(m), 228(g), and 1131(b)(2) of the Social Security Act, $20,400,000.
special benefits for disabled coal miners
For carrying out title IV of the Federal Mine Safety and Health Act
of 1977, $365,748,000, to remain available until expended.
For making, after July 31 of the current fiscal year, benefit
payments to individuals under title IV of the Federal Mine Safety and
Health Act of 1977, for costs incurred in the current fiscal year, such
amounts as may be necessary.
For making benefit payments under title IV of the Federal Mine
Safety and Health Act of 1977 for the first quarter of fiscal year
2002, $114,000,000, to remain available until expended.
supplemental security income program
For carrying out titles XI and XVI of the Social Security Act,
section 401 of Public Law 92-603, section 212 of Public Law 93-66, as
amended, and section 405 of Public Law 95-216, including payment to the
Social Security trust funds for administrative expenses incurred
pursuant to section 201(g)(1) of the Social Security Act,
$23,053,000,000, to remain available until expended: Provided, That any
portion of the funds provided to a State in the current fiscal year and
not obligated by the State during that year shall be returned to the
Treasury.
From funds provided under the previous paragraph, not less than
$100,000,000 shall be available for payment to the Social Security
trust funds for administrative expenses for conducting continuing
disability reviews.
In addition, $210,000,000, to remain available until September 30,
2002, for payment to the Social Security trust funds for administrative
expenses for continuing disability reviews as authorized by section 103
of Public Law 104-121 and section 10203 of Public Law 105-33. The term
``continuing disability reviews'' means reviews and redeterminations as
defined under section 201(g)(1)(A) of the Social Security Act, as
amended.
For making, after June 15 of the current fiscal year, benefit
payments to individuals under title XVI of the Social Security Act, for
unanticipated costs incurred for the current fiscal year, such sums as
may be necessary.
For making benefit payments under title XVI of the Social Security
Act for the first quarter of fiscal year 2002, $10,470,000,000, to
remain available until expended.
limitation on administrative expenses
For necessary expenses, including the hire of two passenger motor
vehicles, and not to exceed $10,000 for official reception and
representation expenses, not more than $6,469,800,000 may be expended,
as authorized by section 201(g)(1) of the Social Security Act, from any
one or all of the trust funds referred to therein: Provided, That not
less than $1,800,000 shall be for the Social Security Advisory Board:
Provided further, That unobligated balances at the end of fiscal year
2001 not needed for fiscal year 2001 shall remain available until
expended to invest in the Social Security Administration information
technology and telecommunications hardware and software infrastructure,
including related equipment and non-payroll administrative expenses
From funds provided under the first paragraph, not less than
$200,000,000 shall be available for conducting continuing disability
reviews.
In addition to funding already available under this heading, and
subject to the same terms and conditions, $450,000,000, to remain
available until September 30, 2002, for continuing disability reviews
as authorized by section 103 of Public Law 104-121 and section 10203 of
Public Law 105-33. The term ``continuing disability reviews'' means
reviews and redeterminations as defined under section 201(g)(1)(A) of
the Social Security Act, as amended.
In addition, $91,000,000 to be derived from administration fees in
excess of $5.00 per supplementary payment collected pursuant to section
1616(d) of the Social Security Act or section 212(b)(3) of Public Law
93-66, which shall remain available until expended. To the extent that
the amounts collected pursuant to such section 1616(d) or 212(b)(3) in
fiscal year 2001 exceed $91,000,000, the amounts shall be available in
fiscal year 2002 only to the extent provided in advance in
appropriations Acts.
From funds previously appropriated for this purpose, any
unobligated balances at the end of fiscal year 2000 shall be available
to continue Federal-State partnerships which will evaluate means to
promote Medicare buy-in programs targeted to elderly and disabled
individuals under titles XVIII and XIX of the Social Security Act.
office of inspector general
(including transfer of funds)
For expenses necessary for the Office of Inspector General in
carrying out the provisions of the Inspector General Act of 1978, as
amended, $16,944,000, together with not to exceed $52,500,000, to be
transferred and expended as authorized by section 201(g)(1) of the
Social Security Act from the Federal Old-Age and Survivors Insurance
Trust Fund and the Federal Disability Insurance Trust Fund.
In addition, an amount not to exceed 3 percent of the total
provided in this appropriation may be transferred from the ``Limitation
on Administrative Expenses'', Social Security Administration, to be
merged with this account, to be available for the time and purposes for
which this account is available: Provided, That notice of such
transfers shall be transmitted promptly to the Committees on
Appropriations of the House and Senate.
United States Institute of Peace
operating expenses
For necessary expenses of the United States Institute of Peace as
authorized in the United States Institute of Peace Act, $12,951,000.
TITLE V--GENERAL PROVISIONS
Sec. 501. The Secretaries of Labor, Health and Human Services, and
Education are authorized to transfer unexpended balances of prior
appropriations to accounts corresponding to current appropriations
provided in this Act: Provided, That such transferred balances are used
for the same purpose, and for the same periods of time, for which they
were originally appropriated.
Sec. 502. No part of any appropriation contained in this Act shall
remain available for obligation beyond the current fiscal year unless
expressly so provided herein.
Sec. 503. (a) No part of any appropriation contained in this Act
shall be used, other than for normal and recognized executive-
legislative relationships, for publicity or propaganda purposes, for
the preparation, distribution, or use of any kit, pamphlet, booklet,
publication, radio, television, or video presentation designed to
support or defeat legislation pending before the Congress or any State
legislature, except in presentation to the Congress or any State
legislature itself.
(b) No part of any appropriation contained in this Act shall be
used to pay the salary or expenses of any grant or contract recipient,
or agent acting for such recipient, related to any activity designed to
influence legislation or appropriations pending before the Congress or
any State legislature.
Sec. 504. The Secretaries of Labor and Education are authorized to
make available not to exceed $20,000 and $15,000, respectively, from
funds available for salaries and expenses under titles I and III,
respectively, for official reception and representation expenses; the
Director of the Federal Mediation and Conciliation Service is
authorized to make available for official reception and representation
expenses not to exceed $2,500 from the funds available for ``Salaries
and expenses, Federal Mediation and Conciliation Service''; and the
Chairman of the National Mediation Board is authorized to make
available for official reception and representation expenses not to
exceed $2,500 from funds available for ``Salaries and expenses,
National Mediation Board''.
Sec. 505. Notwithstanding any other provision of this Act, no funds
appropriated under this Act shall be used to carry out any program of
distributing sterile needles or syringes for the hypodermic injection
of any illegal drug unless the Secretary of Health and Human Services
determines that such programs are effective in preventing the spread of
HIV and do not encourage the use of illegal drugs.
Sec. 506. (a) Purchase of American-Made Equipment and Products.--It
is the sense of the Congress that, to the greatest extent practicable,
all equipment and products purchased with funds made available in this
Act should be American-made.
(b) Notice Requirement.--In providing financial assistance to, or
entering into any contract with, any entity using funds made available
in this Act, the head of each Federal agency, to the greatest extent
practicable, shall provide to such entity a notice describing the
statement made in subsection (a) by the Congress.
(c) Prohibition of Contracts With Persons Falsely Labeling Products
as Made in America.--If it has been finally determined by a court or
Federal agency that any person intentionally affixed a label bearing a
``Made in America'' inscription, or any inscription with the same
meaning, to any product sold in or shipped to the United States that is
not made in the United States, the person shall be ineligible to
receive any contract or subcontract made with funds made available in
this Act, pursuant to the debarment, suspension, and ineligibility
procedures described in sections 9.400 through 9.409 of title 48, Code
of Federal Regulations.
Sec. 507. When issuing statements, press releases, requests for
proposals, bid solicitations and other documents describing projects or
programs funded in whole or in part with Federal money, all grantees
receiving Federal funds included in this Act, including but not limited
to State and local governments and recipients of Federal research
grants, shall clearly state: (1) the percentage of the total costs of
the program or project which will be financed with Federal money; (2)
the dollar amount of Federal funds for the project or program; and (3)
percentage and dollar amount of the total costs of the project or
program that will be financed by non-governmental sources.
Sec. 508. (a) None of the funds appropriated under this Act, and
none of the funds in any trust fund to which funds are appropriated
under this Act, shall be expended for any abortion.
(b) None of the funds appropriated under this Act, and none of the
funds in any trust fund to which funds are appropriated under this Act,
shall be expended for health benefits coverage that includes coverage
of abortion.
(c) The term ``health benefits coverage'' means the package of
services covered by a managed care provider or organization pursuant to
a contract or other arrangement.
Sec. 509. (a) The limitations established in the preceding section
shall not apply to an abortion--
(1) if the pregnancy is the result of an act of rape or
incest; or
(2) in the case where a woman suffers from a physical
disorder, physical injury, or physical illness, including a
life-endangering physical condition caused by or arising from
the pregnancy itself, that would, as certified by a physician,
place the woman in danger of death unless an abortion is
performed.
(b) Nothing in the preceding section shall be construed as
prohibiting the expenditure by a State, locality, entity, or private
person of State, local, or private funds (other than a State's or
locality's contribution of Medicaid matching funds).
(c) Nothing in the preceding section shall be construed as
restricting the ability of any managed care provider from offering
abortion coverage or the ability of a State or locality to contract
separately with such a provider for such coverage with State funds
(other than a State's or locality's contribution of Medicaid matching
funds).
Sec. 510. (a) None of the funds made available in this Act may be
used for--
(1) the creation of a human embryo or embryos for research
purposes; or
(2) research in which a human embryo or embryos are
destroyed, discarded, or knowingly subjected to risk of injury
or death greater than that allowed for research on fetuses in
utero under 45 CFR 46.208(a)(2) and section 498(b) of the
Public Health Service Act (42 U.S.C. 289g(b)).
(b) For purposes of this section, the term ``human embryo or
embryos'' includes any organism, not protected as a human subject under
45 CFR 46 as of the date of the enactment of this Act, that is derived
by fertilization, parthenogenesis, cloning, or any other means from one
or more human gametes or human diploid cells.
Sec. 511. (a) Limitation on Use of Funds for Promotion of
Legalization of Controlled Substances.--None of the funds made
available in this Act may be used for any activity that promotes the
legalization of any drug or other substance included in schedule I of
the schedules of controlled substances established by section 202 of
the Controlled Substances Act (21 U.S.C. 812).
(b) Exceptions.--The limitation in subsection (a) shall not apply
when there is significant medical evidence of a therapeutic advantage
to the use of such drug or other substance or that federally sponsored
clinical trials are being conducted to determine therapeutic advantage.
Sec. 512. None of the funds made available in this Act may be
obligated or expended to enter into or renew a contract with an entity
if--
(1) such entity is otherwise a contractor with the United
States and is subject to the requirement in section 4212(d) of
title 38, United States Code, regarding submission of an annual
report to the Secretary of Labor concerning employment of
certain veterans; and
(2) such entity has not submitted a report as required by
that section for the most recent year for which such
requirement was applicable to such entity.
Sec. 513. Except as otherwise specifically provided by law,
unobligated balances remaining available at the end of fiscal year 2000
from appropriations made available for salaries and expenses for fiscal
year 2000 in this Act, shall remain available through December 31,
2001, for each such account for the purposes authorized: Provided, That
the House and Senate Committees on Appropriations shall be notified at
least 15 days prior to the obligation of such funds.
Sec. 514. None of the funds made available in this Act may be used
to promulgate or adopt any final standard under section 1173(b) of the
Social Security Act (42 U.S.C. 1320d-2(b)) providing for, or providing
for the assignment of, a unique health identifier for an individual
(except in an individual's capacity as an employer or a health care
provider), until legislation is enacted specifically approving the
standard.
Sec. 515. Section 410(b) of The Ticket to Work and Work Incentives
Improvement Act of 1999 (Public Law 106-170) is amended by striking
``2009'' both places it appears and inserting ``2001''.
Sec. 516. Amounts made available under this Act for the
administrative and related expenses for departmental management for the
Department of Labor, the Department of Health and Human Services, and
the Department of Education shall be reduced on pro rata basis by
$50,000,000.
Sec. 517. (a) None of the funds appropriated under this Act to
carry out section 330 or title X of the Public Health Service Act (42
U.S.C. 254b, 300 et seq.), title V or XIX of the Social Security Act
(42 U.S.C. 701 et seq., 1396 et seq.), or any other provision of law,
shall be used for the distribution or provision of postcoital emergency
contraception, or the provision of a prescription for postcoital
emergency contraception, to an unemancipated minor, on the premises or
in the facilities of any elementary school or secondary school.
(b) This section takes effect 1 day after the date of enactment of
this Act.
(c) In this section:
(1) The terms ``elementary school'' and ``secondary
school'' have the meanings given the terms in section 14101 of
the Elementary and Secondary Education Act of 1965 (20 U.S.C.
8801).
(2) The term ``unemancipated minor'' means an unmarried
individual who is 17 years of age or younger and is a
dependent, as defined in section 152(a) of the Internal Revenue
Code of 1986.
Sec. 518. Title V of the Public Health Service Act (42 U.S.C. 290aa
et seq.) is amended by adding at the end the following:
``PART G--REQUIREMENT RELATING TO THE RIGHTS OF RESIDENTS OF CERTAIN
FACILITIES
``SEC. 581. REQUIREMENT RELATING TO THE RIGHTS OF RESIDENTS OF CERTAIN
FACILITIES.
``(a) In General.--A public or private general hospital, nursing
facility, intermediate care facility, residential treatment center, or
other health care facility, that receives support in any form from any
program supported in whole or in part with funds appropriated to any
Federal department or agency shall protect and promote the rights of
each resident of the facility, including the right to be free from
physical or mental abuse, corporal punishment, and any restraints or
involuntary seclusions imposed for purposes of discipline or
convenience.
``(b) Requirements.--Restraints and seclusion may only be imposed
on a resident of a facility described in subsection (a) if--
``(1) the restraints or seclusion are imposed to ensure the
physical safety of the resident, a staff member, or others; and
``(2) the restraints or seclusion are imposed only upon the
written order of a physician, or other licensed independent
practitioner permitted by the State and the facility to order
such restraint or seclusion, that specifies the duration and
circumstances under which the restraints are to be used (except
in emergency circumstances specified by the Secretary until
such an order could reasonably be obtained).
``(c) Definitions.--In this section:
``(1) Restraints.--The term `restraints' means--
``(A) any physical restraint that is a mechanical
or personal restriction that immobilizes or reduces the
ability of an individual to move his or her arms, legs,
or head freely, not including devices, such as
orthopedically prescribed devices, surgical dressings
or bandages, protective helmets, or any other methods
that involves the physical holding of a resident for
the purpose of conducting routine physical examinations
or tests or to protect the resident from falling out of
bed or to permit the resident to participate in
activities without the risk of physical harm to the
resident; and
``(B) a drug or medication that is used as a
restraint to control behavior or restrict the
resident's freedom of movement that is not a standard
treatment for the resident's medical or psychiatric
condition.
``(2) Seclusion.--The term `seclusion' means any separation
of the resident from the general population of the facility
that prevents the resident from returning to such population if
he or she desires.
``SEC. 582. REPORTING REQUIREMENT.
``(a) In General.-- Each facility to which the Protection and
Advocacy for Mentally Ill Individuals Act of 1986 applies shall notify
the appropriate agency, as determined by the Secretary, of each death
that occurs at each such facility while a patient is restrained or in
seclusion, of each death occurring within 24 hours after the patient
has been removed from restraints and seclusion, or where it is
reasonable to assume that a patient's death is a result of such
seclusion or restraint. A notification under this section shall include
the name of the resident and shall be provided not later than 7 days
after the date of the death of the individual involved.
``(b) Facility.--In this section, the term `facility' has the
meaning given the term `facilities' in section 102(3) of the Protection
and Advocacy for Mentally Ill Individuals Act of 1986 (42 U.S.C.
10802(3)).''.
``SEC. 583. REGULATIONS AND ENFORCEMENT.
``(a) Training.--Not later than 1 year after the date of enactment
of this part, the Secretary, after consultation with appropriate State
and local protection and advocacy organizations, physicians,
facilities, and other health care professionals and patients, shall
promulgate regulations that require facilities to which the Protection
and Advocacy for Mentally Ill Individuals Act of 1986 (42 U.S.C. 10801
et seq.) applies, to meet the requirements of subsection (b).
``(b) Requirements.--The regulations promulgated under subsection
(a) shall require that--
``(1) facilities described in subsection (a) ensure that
there is an adequate number of qualified professional and
supportive staff to evaluate patients, formulate written
individualized, comprehensive treatment plans, and to provide
active treatment measures;
``(2) appropriate training be provided for the staff of
such facilities in the use of restraints and any alternatives
to the use of restraints; and
``(3) such facilities provide complete and accurate
notification of deaths, as required under section 582(a).
``(c) Enforcement.--A facility to which this part applies that
fails to comply with any requirement of this part, including a failure
to provide appropriate training, shall not be eligible for
participation in any program supported in whole or in part by funds
appropriated to any Federal department or agency.''.
Sec. 519. It is the sense of the Senate that each entity carrying
out an Early Head Start program under the Head Start Act should--
(1) determine whether a child eligible to participate in
the Early Head Start program has received a blood lead
screening test, using a test that is appropriate for age and
risk factors, upon the enrollment of the child in the program;
and
(2) in the case of an child who has not received such a
blood lead screening test, ensure that each enrolled child
receives such a test either by referral or by performing the
test (under contract or otherwise).
Sec. 520. (a) Whereas sexual abuse in schools between a student and
a member of the school staff or a student and another student is a
cause for concern in America;
(b) Whereas relatively few studies have been conducted on sexual
abuse in schools and the extent of this problem is unknown;
(c) Whereas according to the Child Abuse and Neglect Reporting Act,
a school administrator is required to report any allegation of sexual
abuse to the appropriate authorities;
(d) Whereas an individual who is falsely accused of sexual
misconduct with a student deserves appropriate legal and professional
protections;
(e) Whereas it is estimated that many cases of sexual abuse in
schools are not reported;
(f) Whereas many of the accused staff quietly resign at their
present school district and are then rehired at a new district which
has no knowledge of their alleged abuse;
(g) Therefore, it is the Sense of the Senate that the Secretary of
Education should initiate a study and make recommendations to Congress
and State and local governments on the issue of sexual abuse in
schools.
TITLE VI--CHILDREN'S INTERNET PROTECTION
Sec. 601. Short Title. This title may be cited as the ``Childrens'
Internet Protection Act''.
Sec. 602. Requirement for Schools and Libraries to Implement
Filtering or Blocking Technology for Computers with Internet Access as
Condition of Universal Service Discounts. (a) Schools.--Section 254(h)
of the Communications Act of 1934 (47 U.S.C. 254(h)) is amended--
(1) by redesignating paragraph (5) as paragraph (7); and
(2) by inserting after paragraph (4) the following new
paragraph (5):
``(5) Requirements for certain schools with computers
having internet access.--
``(A) Internet filtering.--
``(i) In general.--Except as provided in
clause (ii), an elementary or secondary school
having computers with Internet access may not
receive services at discount rates under
paragraph (1)(B) unless the school, school
board, or other authority with responsibility
for administration of the school--
``(I) submits to the Commission a
certification described in subparagraph
(B); and
``(II) ensures the use of such
computers in accordance with the
certification.
``(ii) Applicability.--The prohibition in
paragraph (1) shall not apply with respect to a
school that receives services at discount rates
under paragraph (1)(B) only for purposes other
than the provision of Internet access, Internet
service, or internal connections.
``(B) Certification.--A certification under this
subparagraph is a certification that the school, school
board, or other authority with responsibility for
administration of the school--
``(i) has selected a technology for its
computers with Internet access in order to
filter or block Internet access through such
computers to--
``(I) material that is obscene; and
``(II) child pornography; and
``(ii) is enforcing a policy to ensure the
operation of the technology during any use of
such computers by minors.
``(C) Additional use of technology.--A school,
school board, or other authority may also use a
technology covered by a certification under
subparagraph (B) to filter or block Internet access
through the computers concerned to any material in
addition to the material specified in that subparagraph
that the school, school board, or other authority
determines to be inappropriate for minors.
``(D) Timing of certifications.--
``(i) Schools with computers on effective
date.--
``(I) In general.--Subject to
subclause (II), in the case of any
school covered by this paragraph as of
the effective date of this paragraph
under section 602(h) of the Childrens'
Internet Protection Act, the
certification under subparagraph (B)
shall be made not later than 30 days
after such effective date.
``(II) Delay.--A certification for
a school covered by subclause (I) may
be made at a date that is later than is
otherwise required by that subclause if
State or local procurement rules or
regulations or competitive bidding
requirements prevent the making of the
certification on the date otherwise
required by that subclause. A school,
school board, or other authority with
responsibility for administration of
the school shall notify the Commission
of the applicability of this subclause
to the school. Such notice shall
specify the date on which the
certification with respect to the
school shall be effective for purposes
of this clause.
``(ii) Schools acquiring computers after
effective date.--In the case of any school that
first becomes covered by this paragraph after
such effective date, the certification under
subparagraph (B) shall be made not later than
10 days after the date on which the school
first becomes so covered.
``(iii) No requirement for additional
certifications.--A school that has submitted a
certification under subparagraph (B) shall not
be required for purposes of this paragraph to
submit an additional certification under that
subparagraph with respect to any computers
having Internet access that are acquired by the
school after the submittal of the
certification.
``(E) Noncompliance.--
``(i) Failure to submit certification.--Any
school that knowingly fails to submit a
certification required by this paragraph shall
reimburse each telecommunications carrier that
provided such school services at discount rates
under paragraph (1)(B) after the effective date
of this paragraph under section 602(h) of the
Childrens' Internet Protection Act in an amount
equal to the amount of the discount provided
such school by such carrier for such services
during the period beginning on such effective
date and ending on the date on which the
provision of such services at discount rates
under paragraph (1)(B) is determined to cease
under subparagraph (F).
``(ii) Failure to comply with
certification.--Any school that knowingly fails
to ensure the use of its computers in
accordance with a certification under
subparagraph (B) shall reimburse each
telecommunications carrier that provided such
school services at discount rates under
paragraph (1)(B) after the date of such
certification in an amount equal to the amount
of the discount provided such school by such
carrier for such services during the period
beginning on the date of such certification and
ending on the date on which the provision of
such services at discount rates under paragraph
(1)(B) is determined to cease under
subparagraph (F).
``(iii) Treatment of reimbursement.--The
receipt by a telecommunications carrier of any
reimbursement under this subparagraph shall not
affect the carrier's treatment of the discount
on which such reimbursement was based in
accordance with the third sentence of paragraph
(1)(B).
``(F) Cessation date.--
``(i) Determination.--The Commission shall
determine the date on which the provision of
services at discount rates under paragraph
(1)(B) shall cease under this paragraph by
reason of the failure of a school to comply
with the requirements of this paragraph.
``(ii) Notification.--The Commission shall
notify telecommunications carriers of each
school determined to have failed to comply with
the requirements of this paragraph and of the
period for which such school shall be liable to
make reimbursement under subparagraph (E).
``(G) Recommencement of discounts.--
``(i) Recommencement.--Upon submittal to
the Commission of a certification under
subparagraph (B) with respect to a school to
which clause (i) or (ii) of subparagraph (E)
applies, the school shall be entitled to
services at discount rates under paragraph
(1)(B).
``(ii) Notification.--The Commission shall
notify the school and telecommunications
carriers of the recommencement of the school's
entitlement to services at discount rates under
this subparagraph and of the date on which such
recommencement begins.
``(iii) Additional noncompliance.--The
provisions of subparagraphs (E) and (F) shall
apply to any certification submitted under
clause (i).
``(H) Public availability of policy.--A school,
school board, or other authority that enforces a policy
under subparagraph (B)(ii) shall take appropriate
actions to ensure the ready availability to the public
of information on such policy and on its policy, if
any, relating to the use of technology under
subparagraph (C).
``(I) Limitation on federal action.--
``(i) In general.--No agency or
instrumentality of the United States Government
may--
``(I) establish any criteria for
making a determination under
subparagraph (C);
``(II) review a determination made
by a school, school board, or other
authority for purposes of a
certification under subparagraph (B);
or
``(III) consider the criteria
employed by a school, school board, or
other authority for purposes of
determining the eligibility of a school
for services at discount rates under
paragraph (1)(B).
``(ii) Action by commission.--The
Commission may not take any action against a
school, school board, or other authority for a
violation of a provision of this paragraph if
the school, school board, or other authority,
as the case may be, has made a good faith
effort to comply with such provision.''.
(b) Libraries.--Such section 254(h) is further amended by inserting
after paragraph (5), as amended by subsection (a) of this section, the
following new paragraph:
``(6) Requirements for certain libraries with computers
having internet access.--
``(A) Internet filtering.--
``(i) In general.--A library having one or
more computers with Internet access may not
receive services at discount rates under
paragraph (1)(B) unless the library--
``(I) submits to the Commission a
certification described in subparagraph
(B); and
``(II) ensures the use of such
computers in accordance with the
certification.
``(ii) Applicability.--The prohibition in
paragraph (1) shall not apply with respect to a
library that receives services at discount
rates under paragraph (1)(B) only for purposes
other than the provision of Internet access,
Internet service, or internal connections.
``(B) Certification.--
``(i) Access of minors to certain
material.--A certification under this
subparagraph is a certification that the
library--
``(I) has selected a technology for
its computer or computers with Internet
access in order to filter or block
Internet access through such computer
or computers to--
``(aa) material that is
obscene;
``(bb) child pornography;
and
``(cc) any other material
that the library determines to
be inappropriate for minors;
and
``(II) is enforcing a policy to
ensure the operation of the technology
during any use of such computer or
computers by minors.
``(ii) Access to child pornography
generally.--
``(I) In general.--A certification
under this subparagraph with respect to
a library is also a certification that
the library--
``(aa) has selected a
technology for its computer or
computers with Internet access
in order to filter or block
Internet access through such
computer or computers to child
pornography; and
``(bb) is enforcing a
policy to ensure the operation
of the technology during any
use of such computer or
computers.
``(II) Scope.--For purposes of
identifying child pornography under
subclause (I), a library may utilize
the definition of that term in section
2256(8) of title 18, United States
Code.
``(III) Relationship to other
certifications.--The certification
under this clause is in addition to any
other certification applicable with
respect to a library under this
subparagraph.
``(C) Additional use of technology.--A library may
also use a technology covered by a certification under
subparagraph (B) to filter or block Internet access
through the computers concerned to any material in
addition to the material specified in that subparagraph
that the library determines to be inappropriate for
minors.
``(D) Timing of certifications.--
``(i) Libraries with computers on effective
date.--
``(I) In general.--In the case of
any library covered by this paragraph
as of the effective date of this
paragraph under section 602(h) of the
Childrens' Internet Protection Act, the
certifications under subparagraph (B)
shall be made not later than 30 days
after such effective date.
``(II) Delay.--The certifications
for a library covered by subclause (I)
may be made at a date than is later
than is otherwise required by that
subclause if State or local procurement
rules or regulations or competitive
bidding requirements prevent the making
of the certifications on the date
otherwise required by that subclause. A
library shall notify the Commission of
the applicability of this subclause to
the library. Such notice shall specify
the date on which the certifications
with respect to the library shall be
effective for purposes of this clause.
``(ii) Libraries acquiring computers after
effective date.--In the case of any library
that first becomes subject to the
certifications under subparagraph (B) after
such effective date, the certifications under
that subparagraph shall be made not later than
10 days after the date on which the library
first becomes so subject.
``(iii) No requirement for additional
certifications.--A library that has submitted
the certifications under subparagraph (B) shall
not be required for purposes of this paragraph
to submit an additional certifications under
that subparagraph with respect to any computers
having Internet access that are acquired by the
library after the submittal of such
certifications.
``(E) Noncompliance.--
``(i) Failure to submit certification.--Any
library that knowingly fails to submit the
certifications required by this paragraph shall
reimburse each telecommunications carrier that
provided such library services at discount
rates under paragraph (1)(B) after the
effective date of this paragraph under section
602(h) of the Childrens' Internet Protection
Act in an amount equal to the amount of the
discount provided such library by such carrier
for such services during the period beginning
on such effective date and ending on the date
on which the provision of such services at
discount rates under paragraph (1)(B) is
determined to cease under subparagraph (F).
``(ii) Failure to comply with
certification.--Any library that knowingly
fails to ensure the use of its computers in
accordance with a certification under
subparagraph (B) shall reimburse each
telecommunications carrier that provided such
library services at discount rates under
paragraph (1)(B) after the date of such
certification in an amount equal to the amount
of the discount provided such library by such
carrier for such services during the period
beginning on the date of such certification and
ending on the date on which the provision of
such services at discount rates under paragraph
(1)(B) is determined to cease under
subparagraph (F).
``(iii) Treatment of reimbursement.--The
receipt by a telecommunications carrier of any
reimbursement under this subparagraph shall not
affect the carrier's treatment of the discount
on which such reimbursement was based in
accordance with the third sentence of paragraph
(1)(B).
``(F) Cessation date.--
``(i) Determination.--The Commission shall
determine the date on which the provision of
services at discount rates under paragraph
(1)(B) shall cease under this paragraph by
reason of the failure of a library to comply
with the requirements of this paragraph.
``(ii) Notification.--The Commission shall
notify telecommunications carriers of each
library determined to have failed to comply
with the requirements of this paragraph and of
the period for which such library shall be
liable to make reimbursement under subparagraph
(E).
``(G) Recommencement of discounts.--
``(i) Recommencement.--Upon submittal to
the Commission of a certification under
subparagraph (B) with respect to a library to
which clause (i) or (ii) of subparagraph (E)
applies, the library shall be entitled to
services at discount rates under paragraph
(1)(B).
``(ii) Notification.--The Commission shall
notify the library and telecommunications
carriers of the recommencement of the library's
entitlement to services at discount rates under
this paragraph and of the date on which such
recommencement begins.
``(iii) Additional noncompliance.--The
provisions of subparagraphs (E) and (F) shall
apply to any certification submitted under
clause (i).
``(H) Public availability of policy.--A library
that enforces a policy under clause (i)(II) or
(ii)(I)(bb) of subparagraph (B) shall take appropriate
actions to ensure the ready availability to the public
of information on such policy and on its policy, if
any, relating to the use of technology under
subparagraph (C).
``(I) Limitation on federal action.--
``(i) In general.--No agency or
instrumentality of the United States Government
may--
``(I) establish any criteria for
making a determination under
subparagraph (C);
``(II) review a determination made
by a library for purposes of a
certification under subparagraph (B);
or
``(III) consider the criteria
employed by a library purposes of
determining the eligibility of the
library for services at discount rates
under paragraph (1)(B).
``(ii) Action by commission.--The
Commission may not take any action against a
library for a violation of a provision of this
paragraph if the library has made a good faith
effort to comply with such provision.''.
(c) Minor Defined.--Paragraph (7) of such section, as redesignated
by subsection (a)(1) of this section, is amended by adding at the end
the following:
``(D) Minor.--The term `minor' means any individual
who has not attained the age of 17 years.''.
(d) Conforming Amendment.--Paragraph (4) of such section is amended
by striking ``paragraph (5)(A)'' and inserting ``paragraph (7)(A)''.
(e) Separability.--If any provision of paragraph (5) or (6) of
section 254(h) of the Communications Act of 1934, as amended by this
section, or the application thereof to any person or circumstance is
held invalid, the remainder of such paragraph and the application of
such paragraph to other persons or circumstances shall not be affected
thereby.
(f) Regulations.--
(1) Requirement.--The Federal Communications Commission
shall prescribe regulations for purposes of administering the
provisions of paragraphs (5) and (6) of section 254(h) of the
Communications Act of 1934, as amended by this section.
(2) Deadline.--Notwithstanding any other provision of law,
the requirements prescribed under paragraph (1) shall take
effect 120 days after the date of the enactment of this Act.
(g) Availability of Rates.--Discounted rates under section
254(h)(1)(B) of the Communications Act of 1934 (47 U.S.C.
254(h)(1)(B))--
(1) shall be available in amounts up to the annual cap on
Federal universal service support for schools and libraries
only for services covered by Federal Communications Commission
regulations on priorities for funding telecommunications
services, Internet access, Internet services, and Internet
connections that assign priority for available funds for the
poorest schools; and
(2) to the extent made available under paragraph (1), may
be used for the purchase or acquisition of filtering or
blocking products necessary to meet the requirements of section
254(h)(5) and (6) of that Act, but not for the purchase of
software or other technology other than what is required to
meet those requirements.
(h) Effective Date.--The amendments made by this section shall take
effect 120 days after the date of the enactment of this Act.
Sec. 603. Fetal Tissue. The General Accounting Office shall conduct
a comprehensive study into Federal involvement in the use of fetal
tissue for research purposes within the scope of this Act to be
completed by September 1, 2000. The study shall include but not be
limited to--
(1) the annual number of orders for fetal tissue filled in
conjunction with federally funded fetal tissue research or
programs over the last 3 years;
(2) the costs associated with the procurement,
dissemination, and other use of fetal tissue, including but not
limited to the costs associated with the processing,
transportation, preservation, quality control, and storage of
such tissue;
(3) the manner in which Federal agencies ensure that
intramural and extramural research facilities and their
employees comply with Federal fetal tissue law;
(4) the number of fetal tissue procurement contractors and
tissue resource sources, or other entities or individuals that
are used to obtain, transport, process, preserve, or store
fetal tissue, which receive Federal funds and the quantity,
form, and nature of the services provided and the amount of
Federal funds received by such entities;
(5) the number and identity of all Federal agencies within
the scope of this Act expending or exchanging Federal funds in
connection with obtaining or processing fetal tissue or the
conduct of research using such tissue;
(6) the extent to which Federal fetal tissue procurement
policies and guidelines adhere to Federal law;
(7) the criteria that Federal fetal tissue research
facilities use for selecting their fetal tissue sources, and
the manner in which the facilities ensure that such sources
comply with Federal law.
Sec. 604. Provision of Internet Filtering or Screening Software by
Certain Internet Service Providers. (a) Requirement To Provide.--Each
Internet service provider shall at the time of entering an agreement
with a residential customer for the provision of Internet access
services, provide to such customer, either at no fee or at a fee not in
excess of the amount specified in subsection (c), computer software or
other filtering or blocking system that allows the customer to prevent
the access of minors to material on the Internet.
(b) Surveys of Provision of Software or Systems.--
(1) Surveys.--The Office of Juvenile Justice and
Delinquency Prevention of the Department of Justice and the
Federal Trade Commission shall jointly conduct surveys of the
extent to which Internet service providers are providing
computer software or systems described in subsection (a) to
their subscribers. In performing such surveys, neither the
Department nor the Commission shall collect personally
identifiable information of subscribers of the Internet service
providers.
(2) Frequency.--The surveys required by paragraph (1) shall
be completed as follows:
(A) One shall be completed not later than one year
after the date of the enactment of this Act.
(B) One shall be completed not later than two years
after that date.
(C) One shall be completed not later than three
years after that date.
(c) Fees.--The fee, if any, charged and collected by an Internet
service provider for providing computer software or a system described
in subsection (a) to a residential customer shall not exceed the amount
equal to the cost of the provider in providing the software or system
to the subscriber, including the cost of the software or system and of
any license required with respect to the software or system.
(d) Applicability.--The requirement described in subsection (a)
shall become effective only if--
(1) 1 year after the date of the enactment of this Act, the
Office and the Commission determine as a result of the survey
completed by the deadline in subsection (b)(2)(A) that less
than 75 percent of the total number of residential subscribers
of Internet service providers as of such deadline are provided
computer software or systems described in subsection (a) by
such providers;
(2) 2 years after the date of enactment of this Act, the
Office and the Commission determine as a result of the survey
completed by the deadline in subsection (b)(2)(B) that less
than 85 percent of the total number of residential subscribers
of Internet service providers as of such deadline are provided
such software or systems by such providers; or
(3) 3 years after the date of the enactment of this Act, if
the Office and the Commission determine as a result of the
survey completed by the deadline in subsection (b)(2)(C) that
less than 100 percent of the total number of residential
subscribers of Internet service providers as of such deadline
are provided such software or systems by such providers.
(e) Internet Service Provider Defined.--In this section, the term
``Internet service provider'' means a service provider as defined in
section 512(k)(1)(A) of title 17, United States Code, which has more
than 50,000 subscribers.
TITLE VII--UNIVERSAL SERVICE FOR SCHOOLS AND LIBRARIES
Sec. 701. Short Title. This title may be cited as the
``Neighborhood Children's Internet Protection Act''.
Sec. 702. No Universal Service for Schools or Libraries That Fail
to Implement a Filtering or Blocking System for Computers with Internet
Access or Adopt Internet Use Policies. (a) No Universal Service.--
(1) In general.--Section 254 of the Communications Act of
1934 (47 U.S.C. 254) is amended by adding at the end the
following:
``(l) Implementation of Internet Filtering or Blocking System or
Use Policies.--
``(1) In general.--No services may be provided under
subsection (h)(1)(B) to any elementary or secondary school, or
any library, unless it provides the certification required by
paragraph (2) to the Commission or its designee.
``(2) Certification.--A certification under this paragraph
with respect to a school or library is a certification by the
school, school board, or other authority with responsibility
for administration of the school, or the library, or any other
entity representing the school or library in applying for
universal service assistance, that the school or library--
``(A) has--
``(i) selected a system for its computers
with Internet access that are dedicated to
student use in order to filter or block
Internet access to matter considered to be
inappropriate for minors; and
``(ii) installed on such computers, or upon
obtaining such computers will install on such
computers, a system to filter or block Internet
access to such matter; or
``(B)(i) has adopted and implemented an Internet
use policy that addresses--
``(I) access by minors to inappropriate
matter on the Internet and World Wide Web;
``(II) the safety and security of minors
when using electronic mail, chat rooms, and
other forms of direct electronic
communications;
``(III) unauthorized access, including so-
called `hacking', and other unlawful activities
by minors online;
``(IV) unauthorized disclosure, use, and
dissemination of personal identification
information regarding minors; and
``(V) whether the school or library, as the
case may be, is employing hardware, software,
or other technological means to limit, monitor,
or otherwise control or guide Internet access
by minors; and
``(ii) provided reasonable public notice and held
at least one public hearing or meeting which addressed
the proposed Internet use policy.
``(3) Local determination of content.--For purposes of a
certification under paragraph (2), the determination regarding
what matter is inappropriate for minors shall be made by the
school board, library, or other authority responsible for
making the determination. No agency or instrumentality of the
United States Government may--
``(A) establish criteria for making such
determination;
``(B) review the determination made by the
certifying school, school board, library, or other
authority; or
``(C) consider the criteria employed by the
certifying school, school board, library, or other
authority in the administration of subsection
(h)(1)(B).
``(4) Effective date.--This subsection shall apply with
respect to schools and libraries seeking universal service
assistance under subsection (h)(1)(B) on or after July 1,
2001.''.
(2) Conforming amendment.--Subsection (h)(1)(B) of that
section is amended by striking ``All telecommunications'' and
inserting ``Except as provided by subsection (l), all
telecommunications''.
(b) Study.--Not later than 150 days after the date of the enactment
of this Act, the National Telecommunications and Information
Administration shall initiate a notice and comment proceeding for
purposes of--
(1) evaluating whether or not currently available
commercial Internet blocking, filtering, and monitoring
software adequately addresses the needs of educational
institutions;
(2) making recommendations on how to foster the development
of products which meet such needs; and
(3) evaluating the development and effectiveness of local
Internet use policies that are currently in operation after
community input.
Sec. 703. Implementing Regulations. Not later than 100 days after
the date of the enactment of this Act, the Federal Communications
Commission shall adopt rules implementing this title and the amendments
made by this title.
TITLE VIII--SOCIAL SECURITY AND MEDICARE OFF-BUDGET LOCKBOX ACT OF 2000
Sec. 801. Short Title. This title may be cited as the ``Social
Security and Medicare Off-Budget Lockbox Act of 2000''.
Sec. 802. Strengthening Social Security Points of Order. (a) In
General.--Section 312 of the Congressional Budget Act of 1974 (2 U.S.C.
643) is amended by inserting at the end the following:
``(g) Strengthening Social Security Point of Order.--It shall not
be in order in the House of Representatives or the Senate to consider a
concurrent resolution on the budget (or any amendment thereto or
conference report thereon) or any bill, joint resolution, amendment,
motion, or conference report that would violate or amend section 13301
of the Budget Enforcement Act of 1990.''.
(b) Super Majority Requirement.--
(1) Point of order.--Section 904(c)(1) of the Congressional
Budget Act of 1974 is amended by inserting ``312(g),'' after
``310(d)(2),''.
(2) Waiver.--Section 904(d)(2) of the Congressional Budget
Act of 1974 is amended by inserting ``312(g),'' after
``310(d)(2),''.
(c) Enforcement in Each Fiscal Year.--The Congressional Budget Act
of 1974 is amended in--
(1) section 301(a)(7) (2 U.S.C. 632(a)(7)), by striking
``for the fiscal year'' through the period and inserting ``for
each fiscal year covered by the resolution''; and
(2) section 311(a)(3) (2 U.S.C. 642(a)(3)), by striking
beginning with ``for the first fiscal year'' through the period
and insert the following: ``for any of the fiscal years covered
by the concurrent resolution.''.
Sec. 803. Medicare Trust Fund Off-Budget. (a) In General.--
(1) General exclusion from all budgets.--Title III of the
Congressional Budget Act of 1974 is amended by adding at the
end the following:
``exclusion of medicare trust fund from all budgets
``Sec. 316. (a) Exclusion of Medicare Trust Fund From All
Budgets.--Notwithstanding any other provision of law, the receipts and
disbursements of the Federal Hospital Insurance Trust Fund shall not be
counted as new budget authority, outlays, receipts, or deficit or
surplus for purposes of--
``(1) the budget of the United States Government as
submitted by the President;
``(2) the congressional budget; or
``(3) the Balanced Budget and Emergency Deficit Control Act
of 1985.
``(b) Strengthening Medicare Point of Order.--It shall not be in
order in the House of Representatives or the Senate to consider a
concurrent resolution on the budget (or any amendment thereto or
conference report thereon) or any bill, joint resolution, amendment,
motion, or conference report that would violate or amend this
section.''.
(2) Super majority requirement.--
(A) Point of Order.--Section 904(c)(1) of the
Congressional Budget Act of 1974 is amended by
inserting ``316,'' after ``313,''.
(B) Waiver.--Section 904(d)(2) of the Congressional
Budget Act of 1974 is amended by inserting ``316,''
after ``313,''.
(b) Exclusion of Medicare Trust Fund From Congressional Budget.--
Section 301(a) of the Congressional Budget Act of 1974 (2 U.S.C.
632(a)) is amended by adding at the end the following: ``The concurrent
resolution shall not include the outlays and revenue totals of the
Federal Hospital Insurance Trust Fund in the surplus or deficit totals
required by this subsection or in any other surplus or deficit totals
required by this title.''
(c) Budget Totals.--Section 301(a) of the Congressional Budget Act
of 1974 (2 U.S.C. 632(a)) is amended by inserting after paragraph (7)
the following:
``(8) For purposes of Senate enforcement under this title,
revenues and outlays of the Federal Hospital Insurance Trust
Fund for each fiscal year covered by the budget resolution.''.
(d) Budget resolutions.--Section 301(i) of the Congressional Budget
Act of 1974 (2 U.S.C. 632(i)) is amended by--
(1) striking ``Social Security Point of Order.--It shall''
and inserting ``Social Security and Medicare Points of Order.--
``(1) Social security.--It shall''; and
(2) inserting at the end the following:
``(2) Medicare.--It shall not be in order in the House of
Representatives or the Senate to consider any concurrent
resolution on the budget (or amendment, motion, or conference
report on the resolution) that would decrease the excess of the
Federal Hospital Insurance Trust Fund revenues over Federal
Hospital Insurance Trust Fund outlays in any of the fiscal
years covered by the concurrent resolution. This paragraph
shall not apply to amounts to be expended from the Hospital
Insurance Trust Fund for purposes relating to programs within
part A of Medicare as provided in law on the date of enactment
of this paragraph.''.
(e) Medicare Firewall.--Section 311(a) of the Congressional Budget
Act of 1974 (2 U.S.C. 642(a)) is amended by adding after paragraph (3),
the following:
``(4) Enforcement of medicare levels in the senate.--After
a concurrent resolution on the budget is agreed to, it shall
not be in order in the Senate to consider any bill, joint
resolution, amendment, motion, or conference report that would
cause a decrease in surpluses or an increase in deficits of the
Federal Hospital Insurance Trust Fund in any year relative to
the levels set forth in the applicable resolution. This
paragraph shall not apply to amounts to be expended from the
Hospital Insurance Trust Fund for purposes relating to programs
within part A of Medicare as provided in law on the date of
enactment of this paragraph.''.
(f) Baseline to Exclude Hospital Insurance Trust Fund.--Section
257(b)(3) of the Balanced Budget and Emergency Deficit Control Act of
1985 is amended by striking ``shall be included in all'' and inserting
``shall not be included in any''.
(g) Medicare Trust Fund Exempt From Sequesters.--Section
255(g)(1)(B) of the Balanced Budget and Emergency Deficit Control Act
of 1985 is amended by adding at the end the following:
``Medicare as funded through the Federal Hospital Insurance
Trust Fund.''.
(h) Budgetary Treatment of Hospital Insurance Trust Fund.--Section
710(a) of the Social Security Act (42 U.S.C. 911(a)) is amended--
(1) by striking ``and'' the second place it appears and
inserting a comma; and
(2) by inserting after ``Federal Disability Insurance Trust
Fund'' the following: ``, Federal Hospital Insurance Trust
Fund''.
Sec. 804. Preventing On-Budget Deficits. (a) Points of Order To
Prevent On-Budget Deficits.--Section 312 of the Congressional Budget
Act of 1974 (2 U.S.C. 643) is amended by adding at the end the
following:
``(h) Points of Order To Prevent On-Budget Deficits.--
``(1) Concurrent resolutions on the budget.--It shall not
be in order in the House of Representatives or the Senate to
consider any concurrent resolution on the budget, or conference
report thereon or amendment thereto, that would cause or
increase an on-budget deficit for any fiscal year.
``(2) Subsequent legislation.--Except as provided by
paragraph (3), it shall not be in order in the House of
Representatives or the Senate to consider any bill, joint
resolution, amendment, motion, or conference report if--
``(A) the enactment of that bill or resolution as
reported;
``(B) the adoption and enactment of that amendment;
or
``(C) the enactment of that bill or resolution in
the form recommended in that conference report,
would cause or increase an on-budget deficit for any fiscal
year.''.
(b) Super Majority Requirement.--
(1) Point of Order.--Section 904(c)(1) of the Congressional
Budget Act of 1974 is amended by inserting ``312(h),'' after
``312(g),''.
(2) Waiver.--Section 904(d)(2) of the Congressional Budget
Act of 1974 is amended by inserting ``312(h),'' after
``312(g),''.
Sec. 805. Social Security and Medicare Safe Deposit Box Act of
2000. (a) Short Title.--This section may be cited as the ``Social
Security and Medicare Safe Deposit Box Act of 2000''.
(b) Protection of Social Security and Medicare Surpluses.--
(1) Medicare surpluses off-budget.--Notwithstanding any
other provision of law, the net surplus of any trust fund for
part A of Medicare shall not be counted as a net surplus for
purposes of--
(A) the budget of the United States Government as
submitted by the President;
(B) the congressional budget; or
(C) the Balanced Budget and Emergency Deficit
Control Act of 1985.
(2) Points of order to protect social security and medicare
surpluses.--Section 312 of the Congressional Budget Act of 1974
is amended by adding at the end the following new subsection:
``(g) Points of Order To Protect Social Security and Medicare
Surpluses.--
``(1) Concurrent resolutions on the budget.--It shall not
be in order in the House of Representatives or the Senate to
consider any concurrent resolution on the budget, or conference
report thereon or amendment thereto, that would set forth an
on-budget deficit for any fiscal year.
``(2) Subsequent legislation.--It shall not be in order in
the House of Representatives or the Senate to consider any
bill, joint resolution, amendment, motion, or conference report
if--
``(A) the enactment of that bill or resolution as
reported;
``(B) the adoption and enactment of that amendment;
or
``(C) the enactment of that bill or resolution in
the form recommended in that conference report,
would cause or increase an on-budget deficit for any fiscal
year.
``(3) Definition.--For purposes of this section, the term
`on-budget deficit', when applied to a fiscal year, means the
deficit in the budget as set forth in the most recently agreed
to concurrent resolution on the budget pursuant to section
301(a)(3) for that fiscal year.''.
(3) Super majority requirement.--
(A) Point of order.--Section 904(c)(1) of the
Congressional Budget Act of 1974 is amended by
inserting ``312(g),'' after ``310(d)(2),''.
(B) Waiver.--Section 904(d)(2) of the Congressional
Budget Act of 1974 is amended by inserting ``312(g),''
after ``310(d)(2),''.
(c) Protection of Social Security and Medicare Surpluses.--
(1) In general.--Chapter 11 of subtitle II of title 31,
United States Code, is amended by adding before section 1101
the following:
``Sec. 1100. Protection of social security and medicare surpluses
``The budget of the United States Government submitted by the
President under this chapter shall not recommend an on-budget deficit
for any fiscal year covered by that budget.''.
(2) Chapter analysis.--The chapter analysis for chapter 11
of title 31, United States Code, is amended by inserting before
the item for section 1101 the following:
``1100. Protection of social security and medicare surpluses.''.
(d) Effective Date.--This section shall take effect upon the date
of its enactment and the amendments made by this section shall apply to
fiscal year 2001 and subsequent fiscal years.
TITLE IX--GENETIC INFORMATION AND SERVICES
Sec. 901. Short Title. This title may be cited as the ``Genetic
Information Nondiscrimination in Health Insurance Act of 2000''.
Sec. 902. Amendments to Employee Retirement Income Security Act of
1974. (a) Prohibition of Health Discrimination on the Basis of Genetic
Information or Genetic Services.--
(1) No enrollment restriction for genetic services.--
Section 702(a)(1)(F) of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1182(a)(1)(F)) is amended by inserting
before the period the following: ``(including information about
a request for or receipt of genetic services)''.
(2) No discrimination in group premiums based on predictive
genetic information.--Subpart B of part 7 of subtitle B of
title I of the Employee Retirement Income Security Act of 1974
is amended by adding at the end the following:
``SEC. 714. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE
BASIS OF PREDICTIVE GENETIC INFORMATION.
``A group health plan, or a health insurance issuer offering group
health insurance coverage in connection with a group health plan, shall
not adjust premium or contribution amounts for a group on the basis of
predictive genetic information concerning any individual (including a
dependent) or family member of the individual (including information
about a request for or receipt of genetic services).''.
(3) Conforming amendments.--
(A) In general.--Section 702(b) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C.
1182(b)) is amended by adding at the end the following:
``(3) Reference to related provision.--For a provision
prohibiting the adjustment of premium or contribution amounts
for a group under a group health plan on the basis of
predictive genetic information (including information about a
request for or receipt of genetic services), see section
714.''.
(B) Table of contents.--The table of contents in
section 1 of the Employee Retirement Income Security
Act of 1974 is amended by inserting after the item
relating to section 713 the following new item:
``Sec. 714. Prohibiting premium discrimination against groups on the
basis of predictive genetic information.''.
(b) Limitation on Collection of Predictive Genetic Information.--
Section 702 of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1182) is amended by adding at the end the following:
``(c) Collection of Predictive Genetic Information.--
``(1) Limitation on requesting or requiring predictive
genetic information.--Except as provided in paragraph (2), a
group health plan, or a health insurance issuer offering health
insurance coverage in connection with a group health plan,
shall not request or require predictive genetic information
concerning any individual (including a dependent) or family
member of the individual (including information about a request
for or receipt of genetic services).
``(2) Information needed for diagnosis, treatment, or
payment.--
``(A) In general.--Notwithstanding paragraph (1), a
group health plan, or a health insurance issuer
offering health insurance coverage in connection with a
group health plan, that provides health care items and
services to an individual or dependent may request (but
may not require) that such individual or dependent
disclose, or authorize the collection or disclosure of,
predictive genetic information for purposes of
diagnosis, treatment, or payment relating to the
provision of health care items and services to such
individual or dependent.
``(B) Notice of confidentiality practices and
description of safeguards.--As a part of a request
under subparagraph (A), the group health plan, or a
health insurance issuer offering health insurance
coverage in connection with a group health plan, shall
provide to the individual or dependent a description of
the procedures in place to safeguard the
confidentiality, as described in subsection (d), of
such predictive genetic information.
``(d) Confidentiality with Respect to Predictive Genetic
Information.--
``(1) Notice of confidentiality practices.--
``(A) Preparation of written notice.--A group
health plan, or a health insurance issuer offering
health insurance coverage in connection with a group
health plan, shall post or provide, in writing and in a
clear and conspicuous manner, notice of the plan or
issuer's confidentiality practices, that shall
include--
``(i) a description of an individual's
rights with respect to predictive genetic
information;
``(ii) the procedures established by the
plan or issuer for the exercise of the
individual's rights; and
``(iii) the right to obtain a copy of the
notice of the confidentiality practices
required under this subsection.
``(B) Model notice.--The Secretary, in consultation
with the National Committee on Vital and Health
Statistics and the National Association of Insurance
Commissioners, and after notice and opportunity for
public comment, shall develop and disseminate model
notices of confidentiality practices. Use of the model
notice shall serve as a defense against claims of
receiving inappropriate notice.
``(2) Establishment of safeguards.--A group health plan, or
a health insurance issuer offering health insurance coverage in
connection with a group health plan, shall establish and
maintain appropriate administrative, technical, and physical
safeguards to protect the confidentiality, security, accuracy,
and integrity of predictive genetic information created,
received, obtained, maintained, used, transmitted, or disposed
of by such plan or issuer.''.
(c) Definitions.--Section 733(d) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1191b(d)) is amended by adding at the
end the following:
``(5) Family member.--The term `family member' means with
respect to an individual--
``(A) the spouse of the individual;
``(B) a dependent child of the individual,
including a child who is born to or placed for adoption
with the individual; and
``(C) all other individuals related by blood to the
individual or the spouse or child described in
subparagraph (A) or (B).
``(6) Genetic information.--The term `genetic information'
means information about genes, gene products, or inherited
characteristics that may derive from an individual or a family
member (including information about a request for or receipt of
genetic services).
``(7) Genetic services.--The term `genetic services' means
health services provided to obtain, assess, or interpret
genetic information for diagnostic and therapeutic purposes,
and for genetic education and counseling.
``(8) Predictive genetic information.--
``(A) In general.--The term `predictive genetic
information' means, in the absence of symptoms,
clinical signs, or a diagnosis of the condition related
to such information--
``(i) information about an individual's
genetic tests;
``(ii) information about genetic tests of
family members of the individual; or
``(iii) information about the occurrence of
a disease or disorder in family members.
``(B) Exceptions.--The term `predictive genetic
information' shall not include--
``(i) information about the sex or age of
the individual;
``(ii) information derived from physical
tests, such as the chemical, blood, or urine
analyses of the individual including
cholesterol tests; and
``(iii) information about physical exams of
the individual.
``(9) Genetic test.--The term `genetic test' means the
analysis of human DNA, RNA, chromosomes, proteins, and certain
metabolites, including analysis of genotypes, mutations,
phenotypes, or karyotypes, for the purpose of predicting risk
of disease in asymptomatic or undiagnosed individuals. Such
term does not include physical tests, such as the chemical,
blood, or urine analyses of the individual including
cholesterol tests, and physical exams of the individual, in
order to detect symptoms, clinical signs, or a diagnosis of
disease.''.
(d) Effective Date.--Except as provided in this section, this
section and the amendments made by this section shall apply with
respect to group health plans for plan years beginning 1 year after the
date of the enactment of this Act.
Sec. 903. Amendments to the Public Health Service Act. (a)
Amendments Relating to the Group Market.--
(1) Prohibition of health discrimination on the basis of
genetic information in the group market.--
(A) No enrollment restriction for genetic
services.--Section 2702(a)(1)(F) of the Public Health
Service Act (42 U.S.C. 300gg-1(a)(1)(F)) is amended by
inserting before the period the following: ``(including
information about a request for or receipt of genetic
services)''.
(B) No discrimination in premiums based on
predictive genetic information.--Subpart 2 of part A of
title XXVII of the Public Health Service Act (42 U.S.C.
300gg-4 et seq.) is amended by adding at the end the
following new section:
``SEC. 2707. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE
BASIS OF PREDICTIVE GENETIC INFORMATION IN THE GROUP
MARKET.
``A group health plan, or a health insurance issuer offering group
health insurance coverage in connection with a group health plan shall
not adjust premium or contribution amounts for a group on the basis of
predictive genetic information concerning any individual (including a
dependent) or family member of the individual (including information
about a request for or receipt of genetic services).''.
(C) Conforming amendment.--Section 2702(b) of the
Public Health Service Act (42 U.S.C. 300gg-1(b)) is
amended by adding at the end the following:
``(3) Reference to related provision.--For a provision
prohibiting the adjustment of premium or contribution amounts
for a group under a group health plan on the basis of
predictive genetic information (including information about a
request for or receipt of genetic services), see section
2707.''.
(D) Limitation on collection and disclosure of
predictive genetic information.--Section 2702 of the
Public Health Service Act (42 U.S.C. 300gg-1) is
amended by adding at the end the following:
``(c) Collection of Predictive Genetic Information.--
``(1) Limitation on requesting or requiring predictive
genetic information.--Except as provided in paragraph (2), a
group health plan, or a health insurance issuer offering health
insurance coverage in connection with a group health plan,
shall not request or require predictive genetic information
concerning any individual (including a dependent) or a family
member of the individual (including information about a request
for or receipt of genetic services).
``(2) Information needed for diagnosis, treatment, or
payment.--
``(A) In general.--Notwithstanding paragraph (1), a
group health plan, or a health insurance issuer
offering health insurance coverage in connection with a
group health plan, that provides health care items and
services to an individual or dependent may request (but
may not require) that such individual or dependent
disclose, or authorize the collection or disclosure of,
predictive genetic information for purposes of
diagnosis, treatment, or payment relating to the
provision of health care items and services to such
individual or dependent.
``(B) Notice of confidentiality practices and
description of safeguards.--As a part of a request
under subparagraph (A), the group health plan, or a
health insurance issuer offering health insurance
coverage in connection with a group health plan, shall
provide to the individual or dependent a description of
the procedures in place to safeguard the
confidentiality, as described in subsection (d), of
such predictive genetic information.
``(d) Confidentiality with Respect to Predictive Genetic
Information.--
``(1) Notice of confidentiality practices.--
``(A) Preparation of written notice.--A group
health plan, or a health insurance issuer offering
health insurance coverage in connection with a group
health plan, shall post or provide, in writing and in a
clear and conspicuous manner, notice of the plan or
issuer's confidentiality practices, that shall
include--
``(i) a description of an individual's
rights with respect to predictive genetic
information;
``(ii) the procedures established by the
plan or issuer for the exercise of the
individual's rights; and
``(iii) the right to obtain a copy of the
notice of the confidentiality practices
required under this subsection.
``(B) Model notice.--The Secretary, in consultation
with the National Committee on Vital and Health
Statistics and the National Association of Insurance
Commissioners, and after notice and opportunity for
public comment, shall develop and disseminate model
notices of confidentiality practices. Use of the model
notice shall serve as a defense against claims of
receiving inappropriate notice.
``(2) Establishment of safeguards.--A group health plan, or
a health insurance issuer offering health insurance coverage in
connection with a group health plan, shall establish and
maintain appropriate administrative, technical, and physical
safeguards to protect the confidentiality, security, accuracy,
and integrity of predictive genetic information created,
received, obtained, maintained, used, transmitted, or disposed
of by such plan or issuer.''.
(2) Definitions.--Section 2791(d) of the Public Health
Service Act (42 U.S.C. 300gg-91(d)) is amended by adding at the
end the following:
``(15) Family member.--The term `family member' means, with
respect to an individual--
``(A) the spouse of the individual;
``(B) a dependent child of the individual,
including a child who is born to or placed for adoption
with the individual; and
``(C) all other individuals related by blood to the
individual or the spouse or child described in
subparagraph (A) or (B).
``(16) Genetic information.--The term `genetic information'
means information about genes, gene products, or inherited
characteristics that may derive from an individual or a family
member (including information about a request for or receipt of
genetic services).
``(17) Genetic services.--The term `genetic services' means
health services provided to obtain, assess, or interpret
genetic information for diagnostic and therapeutic purposes,
and for genetic education and counseling.
``(18) Predictive genetic information.--
``(A) In general.--The term `predictive genetic
information' means, in the absence of symptoms,
clinical signs, or a diagnosis of the condition related
to such information--
``(i) information about an individual's
genetic tests;
``(ii) information about genetic tests of
family members of the individual; or
``(iii) information about the occurrence of
a disease or disorder in family members.
``(B) Exceptions.--The term `predictive genetic
information' shall not include--
``(i) information about the sex or age of
the individual;
``(ii) information derived from physical
tests, such as the chemical, blood, or urine
analyses of the individual including
cholesterol tests; and
``(iii) information about physical exams of
the individual.
``(19) Genetic test.--The term `genetic test' means the
analysis of human DNA, RNA, chromosomes, proteins, and certain
metabolites, including analysis of genotypes, mutations,
phenotypes, or karyotypes, for the purpose of predicting risk
of disease in asymptomatic or undiagnosed individuals. Such
term does not include physical tests, such as the chemical,
blood, or urine analyses of the individual including
cholesterol tests, and physical exams of the individual, in
order to detect symptoms, clinical signs, or a diagnosis of
disease.''.
(e) Amendments to PHSA Relating to the Individual Market.--The
first subpart 3 of part B of title XXVII of the Public Health Service
Act (42 U.S.C. 300gg-51 et seq.) (relating to other requirements) (42
U.S.C. 300gg-51 et seq.) is amended by adding at the end the following:
``SEC. 2753. PROHIBITION OF HEALTH DISCRIMINATION ON THE BASIS OF
PREDICTIVE GENETIC INFORMATION.
``(a) Prohibition on Predictive Genetic Information as a Condition
of Eligibility.--A health insurance issuer offering health insurance
coverage in the individual market may not use predictive genetic
information as a condition of eligibility of an individual to enroll in
individual health insurance coverage (including information about a
request for or receipt of genetic services).
``(b) Prohibition on Predictive Genetic Information in Setting
Premium Rates.--A health insurance issuer offering health insurance
coverage in the individual market shall not adjust premium rates for
individuals on the basis of predictive genetic information concerning
such an individual (including a dependent) or a family member of the
individual (including information about a request for or receipt of
genetic services).
``(c) Collection of Predictive Genetic Information.--
``(1) Limitation on requesting or requiring predictive
genetic information.--Except as provided in paragraph (2), a
health insurance issuer offering health insurance coverage in
the individual market shall not request or require predictive
genetic information concerning any individual (including a
dependent) or a family member of the individual (including
information about a request for or receipt of genetic
services).
``(2) Information needed for diagnosis, treatment, or
payment.--
``(A) in general.--Notwithstanding paragraph (1), a
health insurance issuer offering health insurance
coverage in the individual market that provides health
care items and services to an individual or dependent
may request (but may not require) that such individual
or dependent disclose, or authorize the collection or
disclosure of, predictive genetic information for
purposes of diagnosis, treatment, or payment relating
to the provision of health care items and services to
such individual or dependent.
``(B) Notice of confidentiality practices and
description of safeguards.--As a part of a request
under subparagraph (A), the health insurance issuer
offering health insurance coverage in the individual
market shall provide to the individual or dependent a
description of the procedures in place to safeguard the
confidentiality, as described in subsection (d), of
such predictive genetic information.
``(d) Confidentiality with Respect to Predictive Genetic
Information.--
``(1) Notice of confidentiality practices.--
``(A) Preparation of written notice.--A health
insurance issuer offering health insurance coverage in
the individual market shall post or provide, in writing
and in a clear and conspicuous manner, notice of the
issuer's confidentiality practices, that shall
include--
``(i) a description of an individual's
rights with respect to predictive genetic
information;
``(ii) the procedures established by the
issuer for the exercise of the individual's
rights; and
``(iii) the right to obtain a copy of the
notice of the confidentiality practices
required under this subsection.
``(B) Model notice.--The Secretary, in consultation
with the National Committee on Vital and Health
Statistics and the National Association of Insurance
Commissioners, and after notice and opportunity for
public comment, shall develop and disseminate model
notices of confidentiality practices. Use of the model
notice shall serve as a defense against claims of
receiving inappropriate notice.
``(2) Establishment of safeguards.--A health insurance
issuer offering health insurance coverage in the individual
market shall establish and maintain appropriate administrative,
technical, and physical safeguards to protect the
confidentiality, security, accuracy, and integrity of
predictive genetic information created, received, obtained,
maintained, used, transmitted, or disposed of by such
issuer.''.
(c) Effective Date.--The amendments made by this section shall
apply with respect to--
(1) group health plans, and health insurance coverage
offered in connection with group health plans, for plan years
beginning after 1 year after the date of enactment of this Act;
and
(2) health insurance coverage offered, sold, issued,
renewed, in effect, or operated in the individual market after
1 year after the date of enactment of this Act.
Sec. 904. Amendments to the Internal Revenue Code of 1986. (a)
Prohibition of Health Discrimination on the Basis of Genetic
Information or Genetic Services.--
(1) No enrollment restriction for genetic services.--
Section 9802(a)(1)(F) of the Internal Revenue Code of 1986 is
amended by inserting before the period the following:
``(including information about a request for or receipt of
genetic services)''.
(2) No discrimination in group premiums based on predictive
genetic information.--
(A) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is further amended by
adding at the end the following:
``SEC. 9813. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE
BASIS OF PREDICTIVE GENETIC INFORMATION.
``A group health plan shall not adjust premium or contribution
amounts for a group on the basis of predictive genetic information
concerning any individual (including a dependent) or a family member of
the individual (including information about a request for or receipt of
genetic services).''.
(B) Conforming amendment.--Section 9802(b) of the
Internal Revenue Code of 1986 is amended by adding at
the end the following:
``(3) Reference to related provision.--For a provision
prohibiting the adjustment of premium or contribution amounts
for a group under a group health plan on the basis of
predictive genetic information (including information about a
request for or the receipt of genetic services), see section
9813.''.
(C) Amendment to table of sections.--The table of
sections for subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended by adding at
the end the following:
``Sec. 9813. Prohibiting premium discrimination against groups on the
basis of predictive genetic information.''.
(b) Limitation on Collection of Predictive Genetic Information.--
Section 9802 of the Internal Revenue Code of 1986 is amended by adding
at the end the following:
``(d) Collection of Predictive Genetic Information.--
``(1) Limitation on requesting or requiring predictive
genetic information.--Except as provided in paragraph (2), a
group health plan shall not request or require predictive
genetic information concerning any individual (including a
dependent) or a family member of the individual (including
information about a request for or receipt of genetic
services).
``(2) Information needed for diagnosis, treatment, or
payment.--
``(A) In general.--Notwithstanding paragraph (1), a
group health plan that provides health care items and
services to an individual or dependent may request (but
may not require) that such individual or dependent
disclose, or authorize the collection or disclosure of,
predictive genetic information for purposes of
diagnosis, treatment, or payment relating to the
provision of health care items and services to such
individual or dependent.
``(B) Notice of confidentiality practices;
description of safeguards.--As a part of a request
under subparagraph (A), the group health plan shall
provide to the individual or dependent a description of
the procedures in place to safeguard the
confidentiality, as described in subsection (e), of
such predictive genetic information.
``(e) Confidentiality with Respect to Predictive Genetic
Information.--
``(1) Notice of confidentiality practices.--
``(A) Preparation of written notice.--A group
health plan shall post or provide, in writing and in a
clear and conspicuous manner, notice of the plan's
confidentiality practices, that shall include--
``(i) a description of an individual's
rights with respect to predictive genetic
information;
``(ii) the procedures established by the
plan for the exercise of the individual's
rights; and
``(iii) the right to obtain a copy of the
notice of the confidentiality practices
required under this subsection.
``(B) Model notice.--The Secretary, in consultation
with the National Committee on Vital and Health
Statistics and the National Association of Insurance
Commissioners, and after notice and opportunity for
public comment, shall develop and disseminate model
notices of confidentiality practices. Use of the model
notice shall serve as a defense against claims of
receiving inappropriate notice.
``(2) Establishment of safeguards.--A group health plan
shall establish and maintain appropriate administrative,
technical, and physical safeguards to protect the
confidentiality, security, accuracy, and integrity of
predictive genetic information created, received, obtained,
maintained, used, transmitted, or disposed of by such plan.''.
(c) Definitions.--Section 9832(d) of the Internal Revenue Code of
1986 is amended by adding at the end the following:
``(6) Family member.--The term `family member' means, with
respect to an individual--
``(A) the spouse of the individual;
``(B) a dependent child of the individual,
including a child who is born to or placed for adoption
with the individual; and
``(C) all other individuals related by blood to the
individual or the spouse or child described in
subparagraph (A) or (B).
``(7) Genetic information.--The term `genetic information'
means information about genes, gene products, or inherited
characteristics that may derive from an individual or a family
member (including information about a request for or receipt of
genetic services).
``(8) Genetic services.--The term `genetic services' means
health services provided to obtain, assess, or interpret
genetic information for diagnostic and therapeutic purposes,
and for genetic education and counseling.
``(9) Predictive genetic information.--
``(A) In general.--The term `predictive genetic
information' means, in the absence of symptoms,
clinical signs, or a diagnosis of the condition related
to such information--
``(i) information about an individual's
genetic tests;
``(ii) information about genetic tests of
family members of the individual; or
``(iii) information about the occurrence of
a disease or disorder in family members.
``(B) Exceptions.--The term `predictive genetic
information' shall not include--
``(i) information about the sex or age of
the individual;
``(ii) information derived from physical
tests, such as the chemical, blood, or urine
analyses of the individual including
cholesterol tests; and
``(iii) information about physical exams of
the individual.
``(10) Genetic test.--The term `genetic test' means the
analysis of human DNA, RNA, chromosomes, proteins, and certain
metabolites, including analysis of genotypes, mutations,
phenotypes, or karyotypes, for the purpose of predicting risk
of disease in asymptomatic or undiagnosed individuals. Such
term does not include physical tests, such as the chemical,
blood, or urine analyses of the individual including
cholesterol tests, and physical exams of the individual, in
order to detect symptoms, clinical signs, or a diagnosis of
disease.''.
(d) Effective Date.--Except as provided in this section, this
section and the amendments made by this section shall apply with
respect to group health plans for plan years beginning after 1 year
after the date of the enactment of this Act.
DIVISION B--HEALTH CARE ACCESS AND PROTECTIONS FOR CONSUMERS
SEC. 2001. SHORT TITLE.
This division may be cited as the ``Patients' Bill of Rights Plus
Act''.
TITLE XXI--TAX-RELATED HEALTH CARE PROVISIONS
Subtitle A--Health Care and Long-Term Care
SEC. 2101. DEDUCTION FOR HEALTH AND LONG-TERM CARE INSURANCE COSTS OF
INDIVIDUALS NOT PARTICIPATING IN EMPLOYER-SUBSIDIZED
HEALTH PLANS.
(a) In General.--Part VII of subchapter B of chapter 1 of the
Internal Revenue Code of 1986 is amended by redesignating section 222
as section 223 and by inserting after section 221 the following new
section:
``SEC. 222. HEALTH AND LONG-TERM CARE INSURANCE COSTS.
``(a) In General.--In the case of an individual, there shall be
allowed as a deduction an amount equal to the applicable percentage of
the amount paid during the taxable year for insurance which constitutes
medical care for the taxpayer and the taxpayer's spouse and dependents.
``(b) Applicable Percentage.--
``(1) In general.--For purposes of subsection (a), the
applicable percentage shall be determined in accordance with
the following table:
``For taxable years beginning
The applicable
in calendar year--
percentage is--
2002 and 2003.......................................... 25
2004................................................... 35
2005................................................... 65
2006 and thereafter.................................... 100.
``(2) Long-term care insurance for individuals 60 years or
older.--In the case of amounts paid for a qualified long-term
care insurance contract for an individual who has attained age
60 before the close of the taxable year, the applicable
percentage is 100.
``(c) Limitation Based on Other Coverage.--
``(1) Coverage under certain subsidized employer plans.--
``(A) In general.--Subsection (a) shall not apply
to any taxpayer for any calendar month for which the
taxpayer participates in any health plan maintained by
any employer of the taxpayer or of the spouse of the
taxpayer if 50 percent or more of the cost of coverage
under such plan (determined under section 4980B and
without regard to payments made with respect to any
coverage described in subsection (e)) is paid or
incurred by the employer.
``(B) Employer contributions to cafeteria plans,
flexible spending arrangements, and medical savings
accounts.--Employer contributions to a cafeteria plan,
a flexible spending or similar arrangement, or a
medical savings account which are excluded from gross
income under section 106 shall be treated for purposes
of subparagraph (A) as paid by the employer.
``(C) Aggregation of plans of employer.--A health
plan which is not otherwise described in subparagraph
(A) shall be treated as described in such subparagraph
if such plan would be so described if all health plans
of persons treated as a single employer under
subsection (b), (c), (m), or (o) of section 414 were
treated as one health plan.
``(D) Separate application to health insurance and
long-term care insurance.--Subparagraphs (A) and (C)
shall be applied separately with respect to--
``(i) plans which include primarily
coverage for qualified long-term care services
or are qualified long-term care insurance
contracts, and
``(ii) plans which do not include such
coverage and are not such contracts.
``(2) Coverage under certain federal programs.--
``(A) In general.--Subsection (a) shall not apply
to any amount paid for any coverage for an individual
for any calendar month if, as of the first day of such
month, the individual is covered under any medical care
program described in--
``(i) title XVIII, XIX, or XXI of the
Social Security Act,
``(ii) chapter 55 of title 10, United
States Code,
``(iii) chapter 17 of title 38, United
States Code,
``(iv) chapter 89 of title 5, United States
Code, or
``(v) the Indian Health Care Improvement
Act.
``(B) Exceptions.--
``(i) Qualified long-term care.--
Subparagraph (A) shall not apply to amounts
paid for coverage under a qualified long-term
care insurance contract.
``(ii) Continuation coverage of fehbp.--
Subparagraph (A)(iv) shall not apply to
coverage which is comparable to continuation
coverage under section 4980B.
``(d) Long-Term Care Deduction Limited to Qualified Long-Term Care
Insurance Contracts.--In the case of a qualified long-term care
insurance contract, only eligible long-term care premiums (as defined
in section 213(d)(10)) may be taken into account under subsection (a).
``(e) Deduction Not Available for Payment of Ancillary Coverage
Premiums.--Any amount paid as a premium for insurance which provides
for--
``(1) coverage for accidents, disability, dental care,
vision care, or a specified illness, or
``(2) making payments of a fixed amount per day (or other
period) by reason of being hospitalized,
shall not be taken into account under subsection (a).
``(f) Special Rules.--
``(1) Coordination with deduction for health insurance
costs of self-employed individuals.--The amount taken into
account by the taxpayer in computing the deduction under
section 162(l) shall not be taken into account under this
section.
``(2) Coordination with medical expense deduction.--The
amount taken into account by the taxpayer in computing the
deduction under this section shall not be taken into account
under section 213.
``(g) Regulations.--The Secretary shall prescribe such regulations
as may be appropriate to carry out this section, including regulations
requiring employers to report to their employees and the Secretary such
information as the Secretary determines to be appropriate.''.
(b) Deduction Allowed Whether or Not Taxpayer Itemizes Other
Deductions.--Subsection (a) of section 62 of such Code is amended by
inserting after paragraph (17) the following new item:
``(18) Health and long-term care insurance costs.--The
deduction allowed by section 222.''.
(c) Clerical Amendment.--The table of sections for part VII of
subchapter B of chapter 1 of such Code is amended by striking the last
item and inserting the following new items:
``Sec. 222. Health and long-term care
insurance costs.
``Sec. 223. Cross reference.''.
(d) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2001.
SEC. 2102. DEDUCTION FOR 100 PERCENT OF HEALTH INSURANCE COSTS OF SELF-
EMPLOYED INDIVIDUALS.
(a) In General.--Paragraph (1) of section 162(l) of the Internal
Revenue Code of 1986 is amended to read as follows:
``(1) Allowance of deduction.--In the case of an individual
who is an employee within the meaning of section 401(c)(1),
there shall be allowed as a deduction under this section an
amount equal to 100 percent of the amount paid during the
taxable year for insurance which constitutes medical care for
the taxpayer and the taxpayer's spouse and dependents.''.
(b) Clarification of Limitations on Other Coverage.--The first
sentence of section 162(l)(2)(B) of such Code is amended to read as
follows: ``Paragraph (1) shall not apply to any taxpayer for any
calendar month for which the taxpayer participates in any subsidized
health plan maintained by any employer (other than an employer
described in section 401(c)(4)) of the taxpayer or the spouse of the
taxpayer.''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2001.
SEC. 2103. LONG-TERM CARE INSURANCE PERMITTED TO BE OFFERED UNDER
CAFETERIA PLANS AND FLEXIBLE SPENDING ARRANGEMENTS.
(a) Cafeteria Plans.--
(1) In general.--Subsection (f) of section 125 of the
Internal Revenue Code of 1986 (defining qualified benefits) is
amended by inserting before the period at the end ``; except
that such term shall include the payment of premiums for any
qualified long-term care insurance contract (as defined in
section 7702B) to the extent the amount of such payment does
not exceed the eligible long-term care premiums (as defined in
section 213(d)(10)) for such contract''.
(b) Flexible Spending Arrangements.--Section 106 of such Code
(relating to contributions by employer to accident and health plans) is
amended by striking subsection (c).
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2001.
SEC. 2104. ADDITIONAL PERSONAL EXEMPTION FOR TAXPAYER CARING FOR
ELDERLY FAMILY MEMBER IN TAXPAYER'S HOME.
(a) In General.--Section 151 of the Internal Revenue Code of 1986
(relating to allowance of deductions for personal exemptions) is
amended by redesignating subsection (e) as subsection (f) and by
inserting after subsection (d) the following new subsection:
``(e) Additional Exemption for Certain Elderly Family Members
Residing With Taxpayer.--
``(1) In general.--An exemption of the exemption amount for
each qualified family member of the taxpayer.
``(2) Qualified family member.--For purposes of this
subsection, the term `qualified family member' means, with
respect to any taxable year, any individual--
``(A) who is an ancestor of the taxpayer or of the
taxpayer's spouse or who is the spouse of any such
ancestor,
``(B) who is a member for the entire taxable year
of a household maintained by the taxpayer, and
``(C) who has been certified, before the due date
for filing the return of tax for the taxable year
(without extensions), by a physician (as defined in
section 1861(r)(1) of the Social Security Act) as being
an individual with long-term care needs described in
paragraph (3) for a period--
``(i) which is at least 180 consecutive
days, and
``(ii) a portion of which occurs within the
taxable year.
Such term shall not include any individual otherwise meeting
the requirements of the preceding sentence unless within the
39\1/2\ month period ending on such due date (or such other
period as the Secretary prescribes) a physician (as so defined)
has certified that such individual meets such requirements.
``(3) Individuals with long-term care needs.--An individual
is described in this paragraph if the individual--
``(A) is unable to perform (without substantial
assistance from another individual) at least two
activities of daily living (as defined in section
7702B(c)(2)(B)) due to a loss of functional capacity,
or
``(B) requires substantial supervision to protect
such individual from threats to health and safety due
to severe cognitive impairment and is unable to
perform, without reminding or cuing assistance, at
least one activity of daily living (as so defined) or
to the extent provided in regulations prescribed by the
Secretary (in consultation with the Secretary of Health
and Human Services), is unable to engage in age
appropriate activities.
``(4) Special rules.--Rules similar to the rules of
paragraphs (1), (2), (3), (4), and (5) of section 21(e) shall
apply for purposes of this subsection.''.
(b) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2001.
SEC. 2105. STUDY OF LONG-TERM CARE NEEDS IN THE 21ST CENTURY.
(a) In General.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary'') shall on or after
October 1, 2001, provide, in accordance with this section, for a study
in order to determine--
(1) future demand for long-term health care services
(including institutional and home and community-based services)
in the United States in order to meet the needs in the 21st
century; and
(2) long-term options to finance the provision of such
services.
(b) Details.--The study conducted under subsection (a) shall
include the following:
(1) An identification of the relevant demographic
characteristics affecting demand for long-term health care
services, at least through the year 2030.
(2) The viability and capacity of community-based and other
long-term health care services under different federal
programs, including through the medicare and medicaid programs,
grants to States, housing services, and changes in tax policy.
(3) How to improve the quality of long-term health care
services.
(4) The integration of long-term health care services for
individuals between different classes of health care providers
(such as hospitals, nursing facilities, and home care agencies)
and different Federal programs (such as the medicare and
medicaid programs).
(5) The possibility of expanding private sector
initiatives, including long-term care insurance, to meet the
need to finance such services.
(6) An examination of the effect of enactment of the Health
Insurance Portability and Accountability Act of 1996 on the
provision and financing of long-term health care services,
including on portability and affordability of private long-term
care insurance, the impact of insurance options on low-income
older Americans, and the options for eligibility to improve
access to such insurance.
(7) The financial impact of the provision of long-term
health care services on caregivers and other family members.
(c) Report and Recommendations.--
(1) In general.--October 1, 2002, the Secretary shall
provide for a report on the study under this section.
(2) Recommendations.--The report under paragraph (1) shall
include findings and recommendations regarding each of the
following:
(A) The most effective and efficient manner that
the Federal Government may use its resources to educate
the public on planning for needs for long-term health
care services.
(B) The public, private, and joint public-private
strategies for meeting identified needs for long-term
health care services.
(C) The role of States and local communities in the
financing of long-term health care services.
(3) Inclusion of cost estimates.--The report under
paragraph (1) shall include cost estimates of the various
options for which recommendations are made.
(d) Conduct of Study.--
(1) Use of institute of medicine.--The Secretary of Health
and Human Services shall seek to enter into an appropriate
arrangement with the Institute of Medicine of the National
Academy of Sciences to conduct the study under this section. If
such an arrangement cannot be made, the Secretary may provide
for the conduct of the study by any other qualified non-
governmental entity.
(2) Consultation.--The study should be conducted under this
section in consultation with experts from a wide-range of
groups from the public and private sectors.
Subtitle B--Medical Savings Accounts
SEC. 2111. EXPANSION OF AVAILABILITY OF MEDICAL SAVINGS ACCOUNTS.
(a) Repeal of Limitations on Number of Medical Savings Accounts.--
(1) In general.--Subsections (i) and (j) of section 220 of
the Internal Revenue Code of 1986 are hereby repealed.
(2) Conforming amendments.--
(A) Paragraph (1) of section 220(c) of such Code is
amended by striking subparagraph (D).
(B) Section 138 of such Code is amended by striking
subsection (f).
(b) Availability Not Limited to Accounts For Employees of Small
Employers and Self-employed Individuals.--
(1) In general.--Section 220(c)(1)(A) of such Code
(relating to eligible individual) is amended to read as
follows:
``(A) In general.--The term `eligible individual'
means, with respect to any month, any individual if--
``(i) such individual is covered under a
high deductible health plan as of the 1st day
of such month, and
``(ii) such individual is not, while
covered under a high deductible health plan,
covered under any health plan--
``(I) which is not a high
deductible health plan, and
``(II) which provides coverage for
any benefit which is covered under the
high deductible health plan.''.
(2) Conforming amendments.--
(A) Section 220(c)(1) of such Code is amended by
striking subparagraph (C).
(B) Section 220(c) of such Code is amended by
striking paragraph (4) (defining small employer) and by
redesignating paragraph (5) as paragraph (4).
(C) Section 220(b) of such Code is amended by
striking paragraph (4) (relating to deduction limited
by compensation) and by redesignating paragraphs (5),
(6), and (7) as paragraphs (4), (5), and (6),
respectively.
(c) Increase in Amount of Deduction Allowed for Contributions to
Medical Savings Accounts.--
(1) In general.--Paragraph (2) of section 220(b) of such
Code is amended to read as follows:
``(2) Monthly limitation.--The monthly limitation for any
month is the amount equal to \1/12\ of the annual deductible
(as of the first day of such month) of the individual's
coverage under the high deductible health plan.''.
(2) Conforming amendment.--Clause (ii) of section
220(d)(1)(A) of such Code is amended by striking ``75 percent
of''.
(d) Both Employers and Employees May Contribute to Medical Savings
Accounts.--Paragraph (4) of section 220(b) of such Code (as
redesignated by subsection (b)(2)(C)) is amended to read as follows:
``(4) Coordination with exclusion for employer
contributions.--The limitation which would (but for this
paragraph) apply under this subsection to the taxpayer for any
taxable year shall be reduced (but not below zero) by the
amount which would (but for section 106(b)) be includible in
the taxpayer's gross income for such taxable year.''.
(e) Reduction of Permitted Deductibles Under High Deductible Health
Plans.--
(1) In general.--Subparagraph (A) of section 220(c)(2) of
such Code (defining high deductible health plan) is amended--
(A) by striking ``$1,500'' in clause (i) and
inserting ``$1,000'';
(B) by striking ``$3,000'' in clause (ii) and
inserting ``$2,000''; and
(C) by striking the matter preceding subclause (I)
in clause (iii) and inserting ``pursuant to which the
annual out-of-pocket expenses (including deductibles
and co-payments) are required to be paid under the plan
(other than for premiums) for covered benefits and may
not exceed--''.
(2) Conforming amendment.--Subsection (g) of section 220 of
such Code is amended to read as follows:
``(g) Cost-of-Living Adjustment.--
``(1) In general.--In the case of any taxable year
beginning in a calendar year after 2002, each dollar amount in
subsection (c)(2) shall be increased by an amount equal to--
``(A) such dollar amount, multiplied by
``(B) the cost-of-living adjustment determined
under section 1(f)(3) for the calendar year in which
such taxable year begins by substituting `calendar year
2001' for `calendar year 1992' in subparagraph (B)
thereof.
``(2) Special rules.--In the case of the $1,000 amount in
subsection (c)(2)(A)(i) and the $2,000 amount in subsection
(c)(2)(A)(ii), paragraph (1)(B) shall be applied by
substituting `calendar year 2002' for `calendar year 2001'.
``(3) Rounding.--If any increase under paragraph (1) or (2)
is not a multiple of $50, such increase shall be rounded to the
nearest multiple of $50.''.
(f) Limitation on Additional Tax on Distributions Not Used for
Qualified Medical Expenses.--Section 220(f)(4) of such Code (relating
to additional tax on distributions not used for qualified medical
expenses) is amended by adding at the end the following:
``(D) Exception in case of sufficient account
balance.--Subparagraph (A) shall not apply to any
payment or distribution in any taxable year, but only
to the extent such payment or distribution does not
reduce the fair market value of the assets of the
medical savings account to an amount less than the
annual deductible for the high deductible health plan
of the account holder (determined as of the earlier of
January 1 of the calendar year in which the taxable
year begins or January 1 of the last calendar year in
which the account holder is covered under a high
deductible health plan).''.
(g) Treatment of Network-Based Managed Care Plans.--Section
220(c)(2)(B) of such Code (relating to special rules for high
deductible health plans) is amended by adding at the end the following:
``(iii) Treatment of network-based managed
care plans.--A plan which provides health care
services through a network of contracted or
affiliated health care providers, if the
benefits provided when services are obtained
through network providers meet the requirements
of subparagraph (A), shall not fail to be
treated as a high deductible health plan by
reason of providing benefits for services
rendered by providers who are not members of
the network, so long as the annual deductible
and annual limit on out-of-pocket expenses
applicable to services received from non-
network providers are not lower than those
applicable to services received from the
network providers.''.
(h) Medical Savings Accounts May Be Offered Under Cafeteria
Plans.--Subsection (f) of section 125 of such Code is amended by
striking ``106(b),''.
(i) Effective Date.--
(1) In general.--Except as provided by paragraph (2), the
amendments made by this section shall apply to taxable years
beginning after December 31, 2001.
(2) Limitation on Additional Tax on Distributions Not Used
for Qualified Medical Expenses.--The amendment made by
subsection (f) shall apply to taxable years beginning after
December 31, 2005.
SEC. 2112. AMENDMENTS TO TITLE 5, UNITED STATES CODE, RELATING TO
MEDICAL SAVINGS ACCOUNTS AND HIGH DEDUCTIBLE HEALTH PLANS
UNDER FEHBP.
(a) Medical Savings Accounts.--
(1) Contributions.--Title 5, United States Code, is amended
by redesignating section 8906a as section 8906c and by
inserting after section 8906 the following:
``Sec. 8906a. Government contributions to medical savings accounts
``(a) An employee or annuitant enrolled in a high deductible health
plan is entitled, in addition to the Government contribution under
section 8906(b) toward the subscription charge for such plan, to have a
Government contribution made, in accordance with succeeding provisions
of this section, to a medical savings account of such employee or
annuitant.
``(b)(1) The biweekly Government contribution under this section
shall, in the case of any such employee or annuitant, be equal to the
amount (if any) by which--
``(A) the biweekly equivalent of the maximum Government
contribution for the contract year involved (as defined by
paragraph (2)), exceeds
``(B) the amount of the biweekly Government contribution
payable on such employee's or annuitant's behalf under section
8906(b) for the period involved.
``(2) For purposes of this section, the term `maximum Government
contribution' means, with respect to a contract year, the maximum
Government contribution that could be made for health benefits for an
employee or annuitant for such contract year, as determined under
section 8906(b) (disregarding paragraph (2) thereof).
``(3) Notwithstanding any other provision of this section, no
contribution under this section shall be payable to any medical savings
account of an employee or annuitant for any period--
``(A) if, as of the first day of the month before the month
in which such period commences, such employee or annuitant (or
the spouse of such employee or annuitant, if coverage is for
self and family) is entitled to benefits under part A of title
XVIII of the Social Security Act;
``(B) to the extent that such contribution, when added to
previous contributions made under this section for that same
year with respect to such employee or annuitant, would cause
the total to exceed--
``(i) the limitation under paragraph (1) of section
220(b) of the Internal Revenue Code of 1986 (determined
without regard to paragraph (3) thereof) which is
applicable to such employee or annuitant for the
calendar year in which such period commences; or
``(ii) such lower amount as the employee or
annuitant may specify in accordance with regulations of
the Office, including an election not to receive
contributions under this section for a year or the
remainder of a year; or
``(C) for which any information (or documentation) under
subsection (d) that is needed in order to make such
contribution has not been timely submitted.
``(4) Notwithstanding any other provision of this section, no
contribution under this section shall be payable to any medical savings
account of an employee for any period in a contract year unless that
employee was enrolled in a health benefits plan under this chapter as
an employee for not less than--
``(A) the 1 year of service immediately before the start of
such contract year, or
``(B) the full period or periods of service between the
last day of the first period, as prescribed by regulations of
the Office of Personnel Management, in which he is eligible to
enroll in the plan and the day before the start of such
contract year,
whichever is shorter.
``(5) The Office shall provide for the conversion of biweekly rates
of contributions specified by paragraph (1) to rates for employees and
annuitants whose pay or annuity is provided on other than a biweekly
basis, and for this purpose may provide for the adjustment of the
converted rate to the nearest cent.
``(c) A Government contribution under this section--
``(1) shall be made at the same time that, and the same
frequency with which, Government contributions under section
8906(b) are made for the benefit of the employee or annuitant
involved; and
``(2) shall be payable from the same appropriation, fund,
account, or other source as would any Government contributions
under section 8906(b) with respect to the employee or annuitant
involved.
``(d) The Office shall by regulation prescribe the time, form, and
manner in which an employee or annuitant shall submit any information
(and supporting documentation) necessary to identify any medical
savings account to which contributions under this section are requested
to be made.
``(e) Nothing in this section shall be considered to entitle an
employee or annuitant to any Government contribution under this section
with respect to any period for which such employee or annuitant is
ineligible for a Government contribution under section 8906(b).
``Sec. 8906b. Individual contributions to medical savings accounts
``(a) Upon the written request of an employee or annuitant enrolled
in a high deductible health plan, there shall be withheld from the pay
or annuity of such employee or annuitant and contributed to the medical
savings account identified by such employee or annuitant in accordance
with applicable regulations under subsection (c) such amount as the
employee or annuitant may specify.
``(b) Notwithstanding subsection (a), no withholding under this
section may be made from the pay or annuity of an employee or annuitant
for any period--
``(1) if, or to the extent that, a Government contribution
for such period under section 8906a would not be allowable by
reason of subparagraph (A) or (B)(i) of subsection (b)(3)
thereof;
``(2) for which any information (or documentation) that is
needed in order to make such contribution has not been timely
submitted; or
``(3) if the employee or annuitant submits a request for
termination of withholdings, beginning on or after the
effective date of the request and before the end of the year.
``(c) The Office of Personnel Management shall prescribe any
regulations necessary to carry out this section, including provisions
relating to the time, form, and manner in which any request for
withholdings under this section may be made, changed, or terminated.''.
(2) Rules of construction.--Nothing in this section or in
any amendment made by this section shall be considered--
(A) to permit or require that any contributions to
a medical savings account (whether by the Government or
through withholdings from pay or annuity) be paid into
the Employees Health Benefits Fund; or
(B) to affect any authority under section 1005(f)
of title 39, United States Code, to vary, add to, or
substitute for any provision of chapter 89 of title 5,
United States Code, as amended by this section.
(3) Conforming amendments.--
(A) The table of sections at the beginning of
chapter 89 of title 5, United States Code, is amended
by striking the item relating to section 8906a and
inserting the following:
``8906a. Government contributions to medical savings accounts.
``8906b. Individual contributions to medical savings accounts.
``8906c. Temporary employees.''.
(B) Section 8913(b)(4) of title 5, United States
Code, is amended by striking ``8906a(a)'' and inserting
``8906c(a)''.
(b) Informational Requirements.--Section 8907 of title 5, United
States Code, is amended by adding at the end the following:
``(c) In addition to any information otherwise required under this
section, the Office shall make available to all employees and
annuitants eligible to enroll in a high deductible health plan,
information relating to--
``(1) the conditions under which Government contributions
under section 8906a shall be made to a medical savings account;
``(2) the amount of any Government contributions under
section 8906a to which an employee or annuitant may be entitled
(or how such amount may be ascertained);
``(3) the conditions under which contributions to a medical
savings account may be made under section 8906b through
withholdings from pay or annuity; and
``(4) any other matter the Office considers appropriate in
connection with medical savings accounts.''.
(c) High Deductible Health Plan and Medical Savings Account
Defined.--Section 8901 of title 5, United States Code, is amended--
(1) in paragraph (10) by striking ``and'' after the
semicolon;
(2) in paragraph (11) by striking the period and inserting
a semicolon; and
(3) by adding at the end the following:
``(12) the term `high deductible health plan' means a plan
described by section 8903(5) or section 8903a(d); and
``(13) the term `medical savings account' has the meaning
given such term by section 220(d) of the Internal Revenue Code
of 1986.''.
(d) Authority To Contract for High Deductible Health Plans, Etc.--
(1) Contracts for high deductible health plans.--Section
8902 of title 5, United States Code, is amended by adding at
the end the following:
``(p)(1) The Office shall contract under this chapter for a high
deductible health plan with any qualified carrier that offers such a
plan and, as of the date of enactment of this subsection, offers a
health benefits plan under this chapter.
``(2) The Office may contract under this chapter for a high
deductible health plan with any qualified carrier that offers such a
plan, but does not, as of the date of enactment of this subsection,
offer a health benefits plan under this chapter.''.
(2) Computation of government contributions to plans under
chapter 89 not affected by high deductible health plans.--
Paragraph (2) of section 8906(a) of title 5, United States
Code, is amended by striking ``(2)'' and inserting ``(2)(A)'',
and adding at the end the following:
``(B) Notwithstanding any other provision of this section, the
subscription charges for, and the number of enrollees enrolled in, high
deductible health plans shall be disregarded for purposes of
determining any weighted average under paragraph (1).''.
(e) Description of High Deductible Health Plans and Benefits To Be
Provided Thereunder.--
(1) In general.--Section 8903 of title 5, United States
Code, is amended by adding at the end the following:
``(5) High Deductible Health Plans.--(A) One or more plans
described by paragraph (1), (2), (3), or (4), which--
``(i) are high deductible health plans (as defined
by section 220(c)(2) of the Internal Revenue Code of
1986); and
``(ii) provide benefits of the types referred to by
section 8904(a)(5).
``(B) Nothing in this section shall be considered--
``(i) to prevent a carrier from simultaneously
offering a plan described by subparagraph (A) and a
plan described by paragraph (1) or (2); or
``(ii) to require that a high deductible health
plan offer two levels of benefits.''.
(2) Types of benefits.--Section 8904(a) of title 5, United
States Code, is amended by inserting after paragraph (4) the
following:
``(5) High Deductible Health Plans.--Benefits of the types
named under paragraph (1) or (2) of this subsection or both.''.
(3) Conforming amendments.--
(A) Section 8903a of title 5, United States Code,
is amended by redesignating subsection (d) as
subsection (e) and by inserting after subsection (c)
the following:
``(d) The plans under this section may include one or more plans,
otherwise allowable under this section, that satisfy the requirements
of clauses (i) and (ii) of section 8903(5)(A).''.
(B) Section 8909(d) of title 5, United States Code,
is amended by striking ``8903a(d)'' and inserting
``8903a(e)''.
(4) References.--Section 8903 of title 5, United States
Code, is amended by adding after paragraph (5) (as added by
paragraph (1) of this subsection) as a flush left sentence, the
following:
``The Office shall prescribe regulations in accordance with which the
requirements of section 8902(c), 8902(n), 8909(e), and any other
provision of this chapter that applies with respect to a plan described
by paragraph (1), (2), (3), or (4) of this section shall apply with
respect to the corresponding plan under paragraph (5) of this section.
Similar regulations shall be prescribed with respect to any plan under
section 8903a(d).''.
(f) Effective Date.--The amendments made by this section shall
apply with respect to contract years beginning on or after October 1,
2001. The Office of Personnel Management shall take appropriate
measures to ensure that coverage under a high deductible health plan
under chapter 89 of title 5, United States Code (as amended by this
section) shall be available as of the beginning of the first contract
year described in the preceding sentence.
SEC. 2113. RULE WITH RESPECT TO CERTAIN PLANS.
(a) In General.--Notwithstanding any other provision of law, health
insurance issuers may offer, and eligible individuals may purchase,
high deductible health plans described in section 220(c)(2)(A) of the
Internal Revenue Code of 1986. Effective for the 5-year period
beginning on October 1, 2001, such health plans shall not be required
to provide payment for any health care items or services that are
exempt from the plan's deductible.
(b) Existing State Laws.--A State law relating to payment for
health care items and services in effect on the date of enactment of
this Act that is preempted under paragraph (1), shall not apply to high
deductible health plans after the expiration of the 5-year period
described in such paragraph unless the State reenacts such law after
such period.
Subtitle C--Other Health-Related Provisions
SEC. 2121. EXPANDED HUMAN CLINICAL TRIALS QUALIFYING FOR ORPHAN DRUG
CREDIT.
(a) In General.--Subclause (I) of section 45C(b)(2)(A)(ii) of the
Internal Revenue Code of 1986 is amended to read as follows:
``(I) after the date that the
application is filed for designation
under such section 526, and''.
(b) Conforming Amendment.--Clause (i) of section 45C(b)(2)(A) of
such Code is amended by inserting ``which is'' before ``being'' and by
inserting before the comma at the end ``and which is designated under
section 526 of such Act''.
(c) Effective Date.--The amendments made by this section shall
apply to amounts paid or incurred after December 31, 2001.
SEC. 2122. CARRYOVER OF UNUSED BENEFITS FROM CAFETERIA PLANS, FLEXIBLE
SPENDING ARRANGEMENTS, AND HEALTH FLEXIBLE SPENDING
ACCOUNTS.
(a) In General.--Section 125 of the Internal Revenue Code of 1986
(relating to cafeteria plans) is amended by redesignating subsections
(h) and (i) as subsections (i) and (j) and by inserting after
subsection (g) the following new subsection:
``(h) Allowance of Carryovers of Unused Benefits to Later Taxable
Years.--
``(1) In general.--For purposes of this title--
``(A) notwithstanding subsection (d)(2), a plan or
other arrangement shall not fail to be treated as a
cafeteria plan or flexible spending or similar
arrangement, and
``(B) no amount shall be required to be included in
gross income by reason of this section or any other
provision of this chapter,
solely because under such plan or other arrangement any
nontaxable benefit which is unused as of the close of a taxable
year may be carried forward to 1 or more succeeding taxable
years.
``(2) Limitation.--Paragraph (1) shall not apply to amounts
carried from a plan to the extent such amounts exceed $500
(applied on an annual basis). For purposes of this paragraph,
all plans and arrangements maintained by an employer or any
related person shall be treated as 1 plan.
``(3) Allowance of rollover.--
``(A) In general.--In the case of any unused
benefit described in paragraph (1) which consists of
amounts in a health flexible spending account or
dependent care flexible spending account, the plan or
arrangement shall provide that a participant may elect,
in lieu of such carryover, to have such amounts
distributed to the participant.
``(B) Amounts not included in income.--Any
distribution under subparagraph (A) shall not be
included in gross income to the extent that such amount
is transferred in a trustee-to-trustee transfer, or is
contributed within 60 days of the date of the
distribution, to--
``(i) a qualified cash or deferred
arrangement described in section 401(k),
``(ii) a plan under which amounts are
contributed by an individual's employer for an
annuity contract described in section 403(b),
``(iii) an eligible deferred compensation
plan described in section 457, or
``(iv) a medical savings account (within
the meaning of section 220).
Any amount rolled over under this subparagraph shall be
treated as a rollover contribution for the taxable year
from which the unused amount would otherwise be
carried.
``(C) Treatment of rollover.--Any amount rolled
over under subparagraph (B) shall be treated as an
eligible rollover under section 220, 401(k), 403(b), or
457, whichever is applicable, and shall be taken into
account in applying any limitation (or participation
requirement) on employer or employee contributions
under such section or any other provision of this
chapter for the taxable year of the rollover.
``(4) Cost-of-living adjustment.--In the case of any
taxable year beginning in a calendar year after 2002, the $500
amount under paragraph (2) shall be adjusted at the same time
and in the same manner as under section 415(d)(2), except that
the base period taken into account shall be the calendar
quarter beginning October 1, 2001, and any increase which is
not a multiple of $50 shall be rounded to the next lowest
multiple of $50.
``(5) Applicability.--This subsection shall apply to
taxable years beginning after December 31, 2001.''.
(b) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2001.
SEC. 2123. REDUCTION IN TAX ON VACCINES.
(a) In General.--Paragraph (1) of section 4131(b) of the Internal
Revenue Code of 1986 (relating to amount of tax) is amended by striking
``75 cents'' and inserting ``50 cents''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on January 1, 2002.
Subtitle D--Miscellaneous Provisions
SEC. 2131. NO IMPACT ON SOCIAL SECURITY TRUST FUND.
(a) In General.--Nothing in this division (or an amendment made by
this division) shall be construed to alter or amend the Social Security
Act (or any regulation promulgated under that Act).
(b) Transfers.--
(1) Estimate of secretary.--The Secretary of the Treasury
shall annually estimate the impact that the enactment of this
division has on the income and balances of the trust funds
established under section 201 of the Social Security Act (42
U.S.C. 401).
(2) Transfer of funds.--If, under paragraph (1), the
Secretary of the Treasury estimates that the enactment of this
division has a negative impact on the income and balances of
the trust funds established under section 201 of the Social
Security Act (42 U.S.C. 401), the Secretary shall transfer, not
less frequently than quarterly, from the general revenues of
the Federal Government an amount sufficient so as to ensure
that the income and balances of such trust funds are not
reduced as a result of the enactment of such division.
SEC. 2132. CUSTOMS USER FEES.
Section 13031(j)(3) of the Consolidated Omnibus Budget
Reconciliation Act of 1985 (19 U.S.C. 58c(j)(3)) is amended by striking
``2003'' and inserting ``2010''.
SEC. 2133. ESTABLISHMENT OF MEDICARE ADMINISTRATIVE FEE FOR SUBMISSION
OF PAPER CLAIMS.
(a) Imposition of Fee.--Notwithstanding any other provision of law
and subject to subsection (b), the Secretary of Health and Human
Services shall establish (in the form of a separate fee or reduction of
payment otherwise made under the medicare program under title XVIII of
the Social Security Act (42 U.S.C. 1395 et seq.)) an administrative fee
of $1 for the submission of a claim in a paper or non-electronic form
for items or services for which payment is sought under such title.
(b) Exception Authority.--The Secretary of Health and Human
Services shall waive the imposition of the fee under subsection (a)--
(1) in cases in which there is no method available for the
submission of claims other than in a paper or non-electronic
form; and
(2) for rural providers and small providers that the
Secretary determines, under procedures established by the
Secretary, are unable to purchase the necessary hardware in
order to submit claims electronically.
(c) Treatment of Fees for Purposes of Cost Reports.--An entity may
not include a fee assessed pursuant to this section as an allowable
item on a cost report under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) or title XIX of such Act (42 U.S.C. 1396 et seq.).
(d) Effective Date.--The provisions of this section apply to claims
submitted on or after January 1, 2002.
SEC. 2134. ESTABLISHMENT OF MEDICARE ADMINISTRATIVE FEE FOR SUBMISSION
OF DUPLICATE AND UNPROCESSABLE CLAIMS.
(a) Imposition of Fee.--Notwithstanding any other provision of law,
the Secretary of Health and Human Services shall establish (in the form
of a separate fee or reduction of payment otherwise made under the
medicare program under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.)) an administrative fee of $2 for the submission of
a claim described in subsection (b).
(b) Claims subject to fee.--A claim described in this subsection is
a claim that--
(1) is submitted by an individual or entity for items or
services for which payment is sought under title XVIII of the
Social Security Act; and
(2) either--
(A) duplicates, in whole or in part, another claim
submitted by the same individual or entity; or
(B) is a claim that cannot be processed and must,
in accordance with the Secretary of Health and Human
Service's instructions, be returned by the fiscal
intermediary or carrier to the individual or entity for
completion.
(c) Treatment of Fees for Purposes of Cost Reports.--An entity may
not include a fee assessed pursuant to this section as an allowable
item on a cost report under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) or title XIX of such Act (42 U.S.C. 1396 et seq.).
(d) Effective Date.--The provisions of this section apply to claims
submitted on or after January 1, 2002.
TITLE XXII--PATIENTS' BILL OF RIGHTS
Subtitle A--Right to Advice and Care
SEC. 2201. PATIENT RIGHT TO MEDICAL ADVICE AND CARE.
(a) In General.--Part 7 of subtitle B of title I of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1181 et seq.) is
amended--
(1) by redesignating subpart C as subpart D; and
(2) by inserting after subpart B the following:
``Subpart C--Patient Right to Medical Advice and Care
``SEC. 721. ACCESS TO EMERGENCY MEDICAL CARE.
``(a) Coverage of Emergency Services.--If a group health plan
(other than a fully insured group health plan) provides coverage for
any benefits consisting of emergency medical care, except for items or
services specifically excluded from coverage, the plan shall, without
regard to prior authorization or provider participation--
``(1) provide coverage for emergency medical screening
examinations to the extent that a prudent layperson, who
possesses an average knowledge of health and medicine, would
determine such examinations to be necessary; and
``(2) provide coverage for additional emergency medical
care to stabilize an emergency medical condition following an
emergency medical screening examination (if determined
necessary), pursuant to the definition of stabilize under
section 1867(e)(3) of the Social Security Act (42 U.S.C.
1395dd(e)(3)).
``(b) Coverage of Emergency Ambulance Services.--If a group health
plan (other than a fully insured group health plan) provides coverage
for any benefits consisting of emergency ambulance services, except for
items or services specifically excluded from coverage, the plan shall,
without regard to prior authorization or provider participation,
provide coverage for emergency ambulance services to the extent that a
prudent layperson, who possesses an average knowledge of health and
medicine, would determine such emergency ambulance services to be
necessary.
``(c) Care After Stabilization.--
``(1) In general.--In the case of medically necessary and
appropriate items or services related to the emergency medical
condition that may be provided to a participant or beneficiary
by a nonparticipating provider after the participant or
beneficiary is stabilized, the nonparticipating provider shall
contact the plan as soon as practicable, but not later than 2
hours after stabilization occurs, with respect to whether--
``(A) the provision of items or services is
approved;
``(B) the participant or beneficiary will be
transferred; or
``(C) other arrangements will be made concerning
the care and treatment of the participant or
beneficiary.
``(2) Failure to respond and make arrangements.--If a group
health plan fails to respond and make arrangements within 2
hours of being contacted in accordance with paragraph (1), then
the plan shall be responsible for the cost of any additional
items or services provided by the nonparticipating provider
if--
``(A) coverage for items or services of the type
furnished by the nonparticipating provider is available
under the plan;
``(B) the items or services are medically necessary
and appropriate and related to the emergency medical
condition involved; and
``(C) the timely provision of the items or services
is medically necessary and appropriate.
``(3) Rule of construction.--Nothing in this subsection
shall be construed to apply to a group health plan that does
not require prior authorization for items or services provided
to a participant or beneficiary after the participant or
beneficiary is stabilized.
``(d) Reimbursement to a Non-Participating Provider.--The
responsibility of a group health plan to provide reimbursement to a
nonparticipating provider under this section shall cease accruing upon
the earlier of--
``(1) the transfer or discharge of the participant or
beneficiary; or
``(2) the completion of other arrangements made by the plan
and the nonparticipating provider.
``(e) Responsibility of Participant.--With respect to items or
services provided by a nonparticipating provider under this section,
the participant or beneficiary shall not be responsible for amounts
that exceed the amounts (including co-insurance, co-payments,
deductibles or any other form of cost-sharing) that would be incurred
if the care was provided by a participating health care provider with
prior authorization.
``(f) Rule of Construction.--Nothing in this section shall be
construed to prohibit a group health plan from negotiating
reimbursement rates with a nonparticipating provider for items or
services provided under this section.
``(g) Definitions.--In this section:
``(1) Emergency ambulance services.--The term `emergency
ambulance services' means, with respect to a participant or
beneficiary under a group health plan (other than a fully
insured group health plan), ambulance services furnished to
transport an individual who has an emergency medical condition
to a treating facility for receipt of emergency medical care
if--
``(A) the emergency services are covered under the
group health plan (other than a fully insured group
health plan) involved; and
``(B) a prudent layperson who possesses an average
knowledge of health and medicine could reasonably
expect the absence of such transport to result in
placing the health of the participant or beneficiary
(or, with respect to a pregnant woman, the health of
the woman or her unborn child) in serious jeopardy,
serious impairment to bodily functions, or serious
dysfunction of any bodily organ or part.
``(2) Emergency medical care.--The term `emergency medical
care' means, with respect to a participant or beneficiary under
a group health plan (other than a fully insured group health
plan), covered inpatient and outpatient items or services
that--
``(A) are furnished by any provider, including a
nonparticipating provider, that is qualified to furnish
such items or services; and
``(B) are needed to evaluate or stabilize (as such
term is defined in section 1867(e)(3) of the Social
Security Act (42 U.S.C. 1395dd(e)(3)) an emergency
medical condition.
``(3) Emergency medical condition.--The term `emergency
medical condition' means a medical condition manifesting itself
by acute symptoms of sufficient severity (including severe
pain) such that a prudent layperson, who possesses an average
knowledge of health and medicine, could reasonably expect the
absence of immediate medical attention to result in placing the
health of the participant or beneficiary (or, with respect to a
pregnant woman, the health of the woman or her unborn child) in
serious jeopardy, serious impairment to bodily functions, or
serious dysfunction of any bodily organ or part.
``SEC. 722. OFFERING OF CHOICE OF COVERAGE OPTIONS.
``(a) Requirement.--If a group health plan (other than a fully
insured group health plan) provides coverage for benefits only through
a defined set of participating health care professionals, the plan
shall offer the participant the option to purchase point-of-service
coverage (as defined in subsection (b)) for all such benefits for which
coverage is otherwise so limited. Such option shall be made available
to the participant at the time of enrollment under the plan and at such
other times as the plan offers the participant a choice of coverage
options.
``(b) Point-of-Service Coverage Defined.--In this section, the term
`point-of-service coverage' means, with respect to benefits covered
under a group health plan (other than a fully insured group health
plan), coverage of such benefits when provided by a nonparticipating
health care professional.
``(c) Small Employer Exemption.--
``(1) In general.--This section shall not apply to any
group health plan (other than a fully insured group health
plan) of a small employer.
``(2) Small employer.--For purposes of paragraph (1), the
term `small employer' means, in connection with a group health
plan (other than a fully insured group health plan) with
respect to a calendar year and a plan year, an employer who
employed an average of at least 2 but not more than 50
employees on business days during the preceding calendar year
and who employs at least 2 employees on the first day of the
plan year. For purposes of this paragraph, the provisions of
subparagraph (C) of section 712(c)(1) shall apply in
determining employer size.
``(d) Rule of Construction.--Nothing in this section shall be
construed--
``(1) as requiring coverage for benefits for a particular
type of health care professional;
``(2) as requiring an employer to pay any costs as a result
of this section or to make equal contributions with respect to
different health coverage options;
``(3) as preventing a group health plan (other than a fully
insured group health plan) from imposing higher premiums or
cost-sharing on a participant for the exercise of a point-of-
service coverage option; or
``(4) to require that a group health plan (other than a
fully insured group health plan) include coverage of health
care professionals that the plan excludes because of fraud,
quality of care, or other similar reasons with respect to such
professionals.
``SEC. 723. PATIENT ACCESS TO OBSTETRIC AND GYNECOLOGICAL CARE.
``(a) General Rights.--
``(1) Direct access.--A group health plan described in
subsection (b) may not require authorization or referral by the
primary care provider described in subsection (b)(2) in the
case of a female participant or beneficiary who seeks coverage
for obstetrical or gynecological care provided by a
participating physician who specializes in obstetrics or
gynecology.
``(2) Obstetrical and gynecological care.--A group health
plan described in subsection (b) shall treat the provision of
obstetrical and gynecological care, and the ordering of related
obstetrical and gynecological items and services, pursuant to
the direct access described under paragraph (1), by a
participating health care professional who specializes in
obstetrics or gynecology as the authorization of the primary
care provider.
``(b) Application of Section.--A group health plan described in
this subsection is a group health plan (other than a fully insured
group health plan), that--
``(1) provides coverage for obstetric or gynecologic care;
and
``(2) requires the designation by a participant or
beneficiary of a participating primary care provider other than
a physician who specializes in obstetrics or gynecology.
``(c) Rules of Construction.--Nothing in this section shall be
construed--
``(1) to require that a group health plan approve or
provide coverage for--
``(A) any items or services that are not covered
under the terms and conditions of the group health
plan;
``(B) any items or services that are not medically
necessary and appropriate; or
``(C) any items or services that are provided,
ordered, or otherwise authorized under subsection
(a)(2) by a physician unless such items or services are
related to obstetric or gynecologic care;
``(2) to preclude a group health plan from requiring that
the physician described in subsection (a) notify the designated
primary care professional or case manager of treatment
decisions in accordance with a process implemented by the plan,
except that the group health plan shall not impose such a
notification requirement on the participant or beneficiary
involved in the treatment decision;
``(3) to preclude a group health plan from requiring
authorization, including prior authorization, for certain items
and services from the physician described in subsection (a) who
specializes in obstetrics and gynecology if the designated
primary care provider of the participant or beneficiary would
otherwise be required to obtain authorization for such items or
services;
``(4) to require that the participant or beneficiary
described in subsection (a)(1) obtain authorization or a
referral from a primary care provider in order to obtain
obstetrical or gynecological care from a health care
professional other than a physician if the provision of
obstetrical or gynecological care by such professional is
permitted by the group health plan and consistent with State
licensure, credentialing, and scope of practice laws and
regulations; or
``(5) to preclude the participant or beneficiary described
in subsection (a)(1) from designating a health care
professional other than a physician as a primary care provider
if such designation is permitted by the group health plan and
the treatment by such professional is consistent with State
licensure, credentialing, and scope of practice laws and
regulations.
``SEC. 724. ACCESS TO PEDIATRIC CARE.
``(a) Pediatric Care.--If a group health plan (other than a fully
insured group health plan) requires or provides for a participant or
beneficiary to designate a participating primary care provider for a
child of such participant or beneficiary, the plan shall permit the
participant or beneficiary to designate a physician who specializes in
pediatrics as the child's primary care provider if such provider
participates in the network of the plan.
``(b) Rules of Construction.--With respect to the child of a
participant or beneficiary, nothing in subsection (a) shall be
construed to--
``(1) require that the participant or beneficiary obtain
prior authorization or a referral from a primary care provider
in order to obtain pediatric care from a health care
professional other than a physician if the provision of
pediatric care by such professional is permitted by the plan
and consistent with State licensure, credentialing, and scope
of practice laws and regulations; or
``(2) preclude the participant or beneficiary from
designating a health care professional other than a physician
as a primary care provider for the child if such designation is
permitted by the plan and the treatment by such professional is
consistent with State licensure, credentialing, and scope of
practice laws.
``SEC. 725. TIMELY ACCESS TO SPECIALISTS.
``(a) Timely Access.--
``(1) In general.--A group health plan (other than a fully
insured group health plan) shall ensure that participants and
beneficiaries receive timely coverage for access to specialists
who are appropriate to the medical condition of the participant
or beneficiary, when such specialty care is a covered benefit
under the plan.
``(2) Rule of construction.--Nothing in paragraph (1) shall
be construed--
``(A) to require the coverage under a group health
plan (other than a fully insured group health plan) of
benefits or services;
``(B) to prohibit a plan from including providers
in the network only to the extent necessary to meet the
needs of the plan's participants and beneficiaries;
``(C) to prohibit a plan from establishing measures
designed to maintain quality and control costs
consistent with the responsibilities of the plan; or
``(D) to override any State licensure or scope-of-
practice law.
``(3) Access to certain providers.--
``(A) Participating providers.--Nothing in this
section shall be construed to prohibit a group health
plan (other than a fully insured group health plan)
from requiring that a participant or beneficiary obtain
specialty care from a participating specialist.
``(B) Nonparticipating providers.--
``(i) In general.--With respect to
specialty care under this section, if a group
health plan (other than a fully insured group
health plan) determines that a participating
specialist is not available to provide such
care to the participant or beneficiary, the
plan shall provide for coverage of such care by
a nonparticipating specialist.
``(ii) Treatment of nonparticipating
providers.--If a group health plan (other than
a fully insured group health plan) refers a
participant or beneficiary to a
nonparticipating specialist pursuant to clause
(i), such specialty care shall be provided at
no additional cost to the participant or
beneficiary beyond what the participant or
beneficiary would otherwise pay for such
specialty care if provided by a participating
specialist.
``(b) Referrals.--
``(1) Authorization.--Nothing in this section shall be
construed to prohibit a group health plan (other than a fully
insured group health plan) from requiring an authorization in
order to obtain coverage for specialty services so long as such
authorization is for an appropriate duration or number of
referrals.
``(2) Referrals for ongoing special conditions.--
``(A) In general.--A group health plan (other than
a fully insured group health plan) shall permit a
participant or beneficiary who has an ongoing special
condition (as defined in subparagraph (B)) to receive a
referral to a specialist for the treatment of such
condition and such specialist may authorize such
referrals, procedures, tests, and other medical
services with respect to such condition, or coordinate
the care for such condition, subject to the terms of a
treatment plan referred to in subsection (c) with
respect to the condition.
``(B) Ongoing special condition defined.--In this
subsection, the term `ongoing special condition' means
a condition or disease that--
``(i) is life-threatening, degenerative, or
disabling; and
``(ii) requires specialized medical care
over a prolonged period of time.
``(c) Treatment Plans.--
``(1) In general.--Nothing in this section shall be
construed to prohibit a group health plan (other than a fully
insured group health plan) from requiring that specialty care
be provided pursuant to a treatment plan so long as the
treatment plan is--
``(A) developed by the specialist, in consultation
with the case manager or primary care provider, and the
participant or beneficiary;
``(B) approved by the plan in a timely manner if
the plan requires such approval; and
``(C) in accordance with the applicable quality
assurance and utilization review standards of the plan.
``(2) Notification.--Nothing in paragraph (1) shall be
construed as prohibiting a plan from requiring the specialist
to provide the plan with regular updates on the specialty care
provided, as well as all other necessary medical information.
``(d) Specialist Defined.--For purposes of this section, the term
`specialist' means, with respect to the medical condition of the
participant or beneficiary, a health care professional, facility, or
center (such as a center of excellence) that has adequate expertise
(including age-appropriate expertise) through appropriate training and
experience.
``(e) Right to External Review.--Pursuant to the requirements of
section 503B, a participant or beneficiary shall have the right to an
independent external review if the denial of an item or service or
condition that is required to be covered under this section is eligible
for such review.
``SEC. 726. CONTINUITY OF CARE.
``(a) Termination of Provider.--If a contract between a group
health plan (other than a fully insured group health plan) and a
treating health care provider is terminated (as defined in paragraph
(e)(4)), or benefits or coverage provided by a health care provider are
terminated because of a change in the terms of provider participation
in such plan, and an individual who is a participant or beneficiary in
the plan is undergoing an active course of treatment for a serious and
complex condition, institutional care, pregnancy, or terminal illness
from the provider at the time the plan receives or provides notice of
such termination, the plan shall--
``(1) notify the individual, or arrange to have the
individual notified pursuant to subsection (d)(2), on a timely
basis of such termination;
``(2) provide the individual with an opportunity to notify
the plan of the individual's need for transitional care; and
``(3) subject to subsection (c), permit the individual to
elect to continue to be covered with respect to the active
course of treatment with the provider's consent during a
transitional period (as provided for under subsection (b)).
``(b) Transitional Period.--
``(1) Serious and complex conditions.--The transitional
period under this section with respect to a serious and complex
condition shall extend for up to 90 days from the date of the
notice described in subsection (a)(1) of the provider's
termination.
``(2) Institutional or inpatient care.--
``(A) In general.--The transitional period under
this section for institutional or non-elective
inpatient care from a provider shall extend until the
earlier of--
``(i) the expiration of the 90-day period
beginning on the date on which the notice
described in subsection (a)(1) of the
provider's termination is provided; or
``(ii) the date of discharge of the
individual from such care or the termination of
the period of institutionalization.
``(B) Scheduled care.--The 90 day limitation
described in subparagraph (A)(i) shall include post-
surgical follow-up care relating to non-elective
surgery that has been scheduled before the date of the
notice of the termination of the provider under
subsection (a)(1).
``(3) Pregnancy.--If--
``(A) a participant or beneficiary has entered the
second trimester of pregnancy at the time of a
provider's termination of participation; and
``(B) the provider was treating the pregnancy
before the date of the termination;
the transitional period under this subsection with respect to
provider's treatment of the pregnancy shall extend through the
provision of post-partum care directly related to the delivery.
``(4) Terminal illness.--If--
``(A) a participant or beneficiary was determined
to be terminally ill (as determined under section
1861(dd)(3)(A) of the Social Security Act) at the time
of a provider's termination of participation; and
``(B) the provider was treating the terminal
illness before the date of termination;
the transitional period under this subsection shall extend for
the remainder of the individual's life for care that is
directly related to the treatment of the terminal illness.
``(c) Permissible Terms and Conditions.--A group health plan (other
than a fully insured group health plan) may condition coverage of
continued treatment by a provider under this section upon the provider
agreeing to the following terms and conditions:
``(1) The treating health care provider agrees to accept
reimbursement from the plan and individual involved (with
respect to cost-sharing) at the rates applicable prior to the
start of the transitional period as payment in full (or at the
rates applicable under the replacement plan after the date of
the termination of the contract with the group health plan) and
not to impose cost-sharing with respect to the individual in an
amount that would exceed the cost-sharing that could have been
imposed if the contract referred to in this section had not
been terminated.
``(2) The treating health care provider agrees to adhere to
the quality assurance standards of the plan responsible for
payment under paragraph (1) and to provide to such plan
necessary medical information related to the care provided.
``(3) The treating health care provider agrees otherwise to
adhere to such plan's policies and procedures, including
procedures regarding referrals and obtaining prior
authorization and providing services pursuant to a treatment
plan (if any) approved by the plan.
``(d) Rules of Construction.--Nothing in this section shall be
construed--
``(1) to require the coverage of benefits which would not
have been covered if the provider involved remained a
participating provider; or
``(2) with respect to the termination of a contract under
subsection (a) to prevent a group health plan from requiring
that the health care provider--
``(A) notify participants or beneficiaries of their
rights under this section; or
``(B) provide the plan with the name of each
participant or beneficiary who the provider believes is
eligible for transitional care under this section.
``(e) Definitions.--In this section:
``(1) Contract.--The term `contract between a plan and a
treating health care provider' shall include a contract between
such a plan and an organized network of providers.
``(2) Health care provider.--The term `health care
provider' or `provider' means--
``(A) any individual who is engaged in the delivery
of health care services in a State and who is required
by State law or regulation to be licensed or certified
by the State to engage in the delivery of such services
in the State; and
``(B) any entity that is engaged in the delivery of
health care services in a State and that, if it is
required by State law or regulation to be licensed or
certified by the State to engage in the delivery of
such services in the State, is so licensed.
``(3) Serious and complex condition.--The term `serious and
complex condition' means, with respect to a participant or
beneficiary under the plan, a condition that is medically
determinable and--
``(A) in the case of an acute illness, is a
condition serious enough to require specialized medical
treatment to avoid the reasonable possibility of death
or permanent harm; or
``(B) in the case of a chronic illness or
condition, is an illness or condition that--
``(i) is complex and difficult to manage;
``(ii) is disabling or life-threatening;
and
``(iii) requires--
``(I) frequent monitoring over a
prolonged period of time and requires
substantial on-going specialized
medical care; or
``(II) frequent ongoing specialized
medical care across a variety of
domains of care.
``(4) Terminated.--The term `terminated' includes, with
respect to a contract (as defined in paragraph (1)), the
expiration or nonrenewal of the contract by the group health
plan, but does not include a termination of the contract by the
plan for failure to meet applicable quality standards or for
fraud.
``(f) Right to External Review.--Pursuant to the requirements of
section 503B, a participant or beneficiary shall have the right to an
independent external review if the denial of an item or service or
condition that is required to be covered under this section is eligible
for such review.
``SEC. 727. PROTECTION OF PATIENT-PROVIDER COMMUNICATIONS.
``(a) In General.--Subject to subsection (b), a group health plan
(other than a fully insured group health plan and in relation to a
participant or beneficiary) shall not prohibit or otherwise restrict a
health care professional from advising such a participant or
beneficiary who is a patient of the professional about the health
status of the participant or beneficiary or medical care or treatment
for the condition or disease of the participant or beneficiary,
regardless of whether coverage for such care or treatment are provided
under the contract, if the professional is acting within the lawful
scope of practice.
``(b) Rule of Construction.--Nothing in this section shall be
construed as requiring a group health plan (other than a fully insured
group health plan) to provide specific benefits under the terms of such
plan.
``SEC. 728. PATIENT'S RIGHT TO PRESCRIPTION DRUGS.
``(a) In General.--To the extent that a group health plan (other
than a fully insured group health plan) provides coverage for benefits
with respect to prescription drugs, and limits such coverage to drugs
included in a formulary, the plan shall--
``(1) ensure the participation of physicians and
pharmacists in developing and reviewing such formulary; and
``(2) in accordance with the applicable quality assurance
and utilization review standards of the plan, provide for
exceptions from the formulary limitation when a non-formulary
alternative is medically necessary and appropriate.
``(b) Right to External Review.--Pursuant to the requirements of
section 503B, a participant or beneficiary shall have the right to an
independent external review if the denial of an item or service or
condition that is required to be covered under this section is eligible
for such review.
``SEC. 729. SELF-PAYMENT FOR BEHAVIORAL HEALTH CARE SERVICES.
``(a) In General.--A group health plan (other than a fully insured
group health plan) may not--
``(1) prohibit or otherwise discourage a participant or
beneficiary from self-paying for behavioral health care
services once the plan has denied coverage for such services;
or
``(2) terminate a health care provider because such
provider permits participants or beneficiaries to self-pay for
behavioral health care services--
``(A) that are not otherwise covered under the
plan; or
``(B) for which the group health plan provides
limited coverage, to the extent that the group health
plan denies coverage of the services.
``(b) Rule of Construction.--Nothing in subsection (a)(2)(B) shall
be construed as prohibiting a group health plan from terminating a
contract with a health care provider for failure to meet applicable
quality standards or for fraud.
``SEC. 730. COVERAGE FOR INDIVIDUALS PARTICIPATING IN APPROVED CANCER
CLINICAL TRIALS.
``(a) Coverage.--
``(1) In general.--If a group health plan (other than a
fully insured group health plan) provides coverage to a
qualified individual (as defined in subsection (b)), the plan--
``(A) may not deny the individual participation in
the clinical trial referred to in subsection (b)(2);
``(B) subject to subsections (b), (c), and (d) may
not deny (or limit or impose additional conditions on)
the coverage of routine patient costs for items and
services furnished in connection with participation in
the trial; and
``(C) may not discriminate against the individual
on the basis of the participant's or beneficiaries
participation in such trial.
``(2) Exclusion of certain costs.--For purposes of
paragraph (1)(B), routine patient costs do not include the cost
of the tests or measurements conducted primarily for the
purpose of the clinical trial involved.
``(3) Use of in-network providers.--If one or more
participating providers is participating in a clinical trial,
nothing in paragraph (1) shall be construed as preventing a
plan from requiring that a qualified individual participate in
the trial through such a participating provider if the provider
will accept the individual as a participant in the trial.
``(b) Qualified Individual Defined.--For purposes of subsection
(a), the term `qualified individual' means an individual who is a
participant or beneficiary in a group health plan and who meets the
following conditions:
``(1)(A) The individual has been diagnosed with cancer for
which no standard treatment is effective.
``(B) The individual is eligible to participate in an
approved clinical trial according to the trial protocol with
respect to treatment of such illness.
``(C) The individual's participation in the trial offers
meaningful potential for significant clinical benefit for the
individual.
``(2) Either--
``(A) the referring physician is a participating
health care professional and has concluded that the
individual's participation in such trial would be
appropriate based upon the individual meeting the
conditions described in paragraph (1); or
``(B) the participant or beneficiary provides
medical and scientific information establishing that
the individual's participation in such trial would be
appropriate based upon the individual meeting the
conditions described in paragraph (1).
``(c) Payment.--
``(1) In general.--Under this section a group health plan
(other than a fully insured group health plan) shall provide
for payment for routine patient costs described in subsection
(a)(2) but is not required to pay for costs of items and
services that are reasonably expected to be paid for by the
sponsors of an approved clinical trial.
``(2) Standards for determining routine patient costs
associated with clinical trial participation.--
``(A) In general.--The Secretary shall, in
accordance with this paragraph, establish standards
relating to the coverage of routine patient costs for
individuals participating in clinical trials that group
health plans must meet under this section.
``(B) Factors.--In establishing routine patient
cost standards under subparagraph (A), the Secretary
shall consult with interested parties and take into
account --
``(i) quality of patient care;
``(ii) routine patient care costs versus
costs associated with the conduct of clinical
trials, including unanticipated patient care
costs as a result of participation in clinical
trials; and
``(iii) previous and on-going studies
relating to patient care costs associated with
participation in clinical trials.
``(C) Appointment and meetings of negotiated
rulemaking committee.--
``(i) Publication of notice.--Not later
than November 15, 2000, the Secretary shall
publish notice of the establishment of a
negotiated rulemaking committee, as provided
for under section 564(a) of title 5, United
States Code, to develop the standards described
in subparagraph (A), which shall include--
``(I) the proposed scope of the
committee;
``(II) the interests that may be
impacted by the standards;
``(iii) a list of the proposed
membership of the committee;
``(iv) the proposed meeting
schedule of the committee;
``(v) a solicitation for public
comment on the committee; and
``(vi) the procedures under which
an individual may apply for membership
on the committee.
``(ii) Comment period.--Notwithstanding
section 564(c) of title 5, United States Code,
the Secretary shall provide for a period,
beginning on the date on which the notice is
published under clause (i) and ending on
November 30, 2000, for the submission of public
comments on the committee under this
subparagraph.
``(iii) Appointment of committee.--Not
later than December 30, 2000, the Secretary
shall appoint the members of the negotiated
rulemaking committee under this subparagraph.
``(iv) Facilitator.--Not later than January
10, 2001, the negotiated rulemaking committee
shall nominate a facilitator under section
566(c) of title 5, United States Code, to carry
out the activities described in subsection (d)
of such section.
``(v) Meetings.--During the period
beginning on the date on which the facilitator
is nominated under clause (iv) and ending on
March 30, 2001, the negotiated rulemaking
committee shall meet to develop the standards
described in subparagraph (A).
``(D) Preliminary committee report.--
``(i) In general.--The negotiated
rulemaking committee appointed under
subparagraph (C) shall report to the Secretary,
by not later than March 30, 2001, regarding the
committee's progress on achieving a consensus
with regard to the rulemaking proceedings and
whether such consensus is likely to occur
before the target date described in subsection
(F).
``(ii) Termination of process and
publication of rule by secretary.--If the
committee reports under clause (i) that the
committee has failed to make significant
progress towards such consensus or is unlikely
to reach such consensus by the target date
described in subsection (F), the Secretary
shall terminate such process and provide for
the publication in the Federal Register, by not
later than June 30, 2001, of a rule under this
paragraph through such other methods as the
Secretary may provide.
``(E) Final committee report and publication or
rule by secretary.--
``(i) In general.--If the rulemaking
committee is not terminated under subparagraph
(D)(ii), the committee shall submit to the
Secretary, by not later than May 30, 2001, a
report containing a proposed rule.
``(ii) Publication of rule.--If the
Secretary receives a report under clause (i),
the Secretary shall provide for the publication
in the Federal Register, by not later than June
30, 2001, of the proposed rule.
``(F) Target date for publication of rule.--As part
of the notice under subparagraph (C)(i), and for
purposes of this paragraph, the `target date for
publication' (referred to in section 564(a)(5) of title
5, United States Code) shall be June 30, 2001.
``(G) Effective date.--The provisions of this
paragraph shall apply to group health plans (other than
a fully insured group health plan) for plan years
beginning on or after January 1, 2002.
``(3) Payment rate.--In the case of covered items and
services provided by--
``(A) a participating provider, the payment rate
shall be at the agreed upon rate, or
``(B) a nonparticipating provider, the payment rate
shall be at the rate the plan would normally pay for
comparable services under subparagraph (A).
``(d) Approved Clinical Trial Defined.--
``(1) In general.--In this section, the term `approved
clinical trial' means a cancer clinical research study or
cancer clinical investigation approved or funded (which may
include funding through in-kind contributions) by one or more
of the following:
``(A) The National Institutes of Health.
``(B) A cooperative group or center of the National
Institutes of Health.
``(C) The Food and Drug Administration.
``(D) Either of the following if the conditions
described in paragraph (2) are met:
``(i) The Department of Veterans Affairs.
``(ii) The Department of Defense.
``(2) Conditions for departments.--The conditions described
in this paragraph, for a study or investigation conducted by a
Department, are that the study or investigation has been
reviewed and approved through a system of peer review that the
Secretary determines--
``(A) to be comparable to the system of peer review
of studies and investigations used by the National
Institutes of Health, and
``(B) assures unbiased review of the highest
scientific standards by qualified individuals who have
no interest in the outcome of the review.
``(e) Construction.--Nothing in this section shall be construed to
limit a plan's coverage with respect to clinical trials.
``(f) Plan Satisfaction of Certain Requirements; Responsibilities
of Fiduciaries.--
``(1) In general.--For purposes of this section, insofar as
a group health plan provides benefits in the form of health
insurance coverage through a health insurance issuer, the plan
shall be treated as meeting the requirements of this section
with respect to such benefits and not be considered as failing
to meet such requirements because of a failure of the issuer to
meet such requirements so long as the plan sponsor or its
representatives did not cause such failure by the issuer.
``(2) Construction.--Nothing in this section shall be
construed to affect or modify the responsibilities of the
fiduciaries of a group health plan under part 4 of subtitle B.
``(g) Study and Report.--
``(1) Study.--The Secretary shall study the impact on group
health plans for covering routine patient care costs for
individuals who are entitled to benefits under this section and
who are enrolled in an approved cancer clinical trial program.
``(2) Report to congress.--Not later than January 1, 2005,
the Secretary shall submit a report to Congress that contains
an assessment of--
``(A) any incremental cost to group health plans
resulting from the provisions of this section;
``(B) a projection of expenditures to such plans
resulting from this section; and
``(C) any impact on premiums resulting from this
section.
``(h) Right to External Review.--Pursuant to the requirements of
section 503B, a participant or beneficiary shall have the right to an
independent external review if the denial of an item or service or
condition that is required to be covered under this section is eligible
for such review.
``SEC. 730A. PROHIBITION OF DISCRIMINATION AGAINST PROVIDERS BASED ON
LICENSURE.
``(a) In General.--A group health plan (other than a fully insured
group health plan) shall not discriminate with respect to participation
or indemnification as to any provider who is acting within the scope of
the provider's license or certification under applicable State law,
solely on the basis of such license or certification.
``(b) Construction.--Subsection (a) shall not be construed--
``(1) as requiring the coverage under a group health plan
of a particular benefit or service or to prohibit a plan from
including providers only to the extent necessary to meet the
needs of the plan's participants or beneficiaries or from
establishing any measure designed to maintain quality and
control costs consistent with the responsibilities of the plan;
``(2) to override any State licensure or scope-of-practice
law; or
``(3) as requiring a plan that offers network coverage to
include for participation every willing provider who meets the
terms and conditions of the plan.
``SEC. 730B. GENERALLY APPLICABLE PROVISION.
``In the case of a group health plan that provides benefits under 2
or more coverage options, the requirements of this subpart shall apply
separately with respect to each coverage option.''.
(b) Rule With Respect to Certain Plans.--
(1) In general.--Notwithstanding any other provision of
law, health insurance issuers may offer, and eligible
individuals may purchase, high deductible health plans
described in section 220(c)(2)(A) of the Internal Revenue Code
of 1986. Effective for the 5-year period beginning on the date
of the enactment of this Act, such health plans shall not be
required to provide payment for any health care items or
services that are exempt from the plan's deductible.
(2) Existing state laws.--A State law relating to payment
for health care items and services in effect on the date of
enactment of this Act that is preempted under paragraph (1),
shall not apply to high deductible health plans after the
expiration of the 5-year period described in such paragraph
unless the State reenacts such law after such period.
(c) Definition.--Section 733(a) of the Employee Retirement Income
Security Act of 1974 (42 U.S.C. 1191(a)) is amended by adding at the
end the following:
``(3) Fully insured group health plan.--The term `fully
insured group health plan' means a group health plan where
benefits under the plan are provided pursuant to the terms of
an arrangement between a group health plan and a health
insurance issuer and are guaranteed by the health insurance
issuer under a contract or policy of insurance.''.
(d) Conforming Amendment.--The table of contents in section 1 of
the Employee Retirement Income Security Act of 1974 is amended--
(1) in the item relating to subpart C of part 7 of subtitle
B of title I, by striking ``Subpart C'' and inserting ``Subpart
D''; and
(2) by adding at the end of the items relating to subpart B
of part 7 of subtitle B of title I, the following:
``subpart c--patient right to medical advice and care
``Sec. 721. Access to emergency medical care.
``Sec. 722. Offering of choice of coverage options.
``Sec. 723. Patient access to obstetric and gynecological care.
``Sec. 724. Access to pediatric care.
``Sec. 725. Timely access to specialists.
``Sec. 726. Continuity of care.
``Sec. 727. Protection of patient-provider communications.
``Sec. 728. Patient's right to prescription drugs.
``Sec. 729. Self-payment for behavioral health care services.
``Sec. 730. Coverage for individuals participating in approved cancer
clinical trials.
``Sec. 730A. Prohibition of discrimination against providers based on
licensure.
``Sec. 730B. Generally applicable provision.''.
SEC. 2202. CONFORMING AMENDMENT TO THE INTERNAL REVENUE CODE OF 1986.
Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is
amended--
(1) in the table of sections, by inserting after the item
relating to section 9812 the following new item:
``Sec. 9813. Standard relating to
patient's bill of rights.'';
and
(2) by inserting after section 9812 the following:
``SEC. 9813. STANDARD RELATING TO PATIENTS' BILL OF RIGHTS.
``A group health plan (other than a fully insured group health
plan) shall comply with the requirements of subpart C of part 7 of
subtitle B of title I of the Employee Retirement Income Security Act of
1974, as added by section 2201 of the Patients' Bill of Rights Plus
Act, and such requirements shall be deemed to be incorporated into this
section.''.
SEC. 2203. EFFECTIVE DATE AND RELATED RULES.
(a) In General.--The amendments made by this subtitle shall apply
with respect to plan years beginning on or after January 1 of the
second calendar year following the date of the enactment of this Act.
The Secretary shall issue all regulations necessary to carry out the
amendments made by this section before the effective date thereof.
(b) Limitation on Enforcement Actions.--No enforcement action shall
be taken, pursuant to the amendments made by this subtitle, against a
group health plan with respect to a violation of a requirement imposed
by such amendments before the date of issuance of regulations issued in
connection with such requirement, if the plan has sought to comply in
good faith with such requirement.
Subtitle B--Right to Information About Plans and Providers
SEC. 2211. INFORMATION ABOUT PLANS.
(a) Employee Retirement Income Security Act of 1974.--Subpart B of
part 7 of subtitle B of title I of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at
the end the following:
``SEC. 714. HEALTH PLAN INFORMATION.
``(a) Requirement--
``(1) Disclosure.--
``(A) In general.--A group health plan, and a
health insurance issuer that provides coverage in
connection with group health insurance coverage, shall
provide for the disclosure of the information described
in subsection (b) to participants and beneficiaries--
``(i) at the time of the initial enrollment
of the participant or beneficiary under the
plan or coverage;
``(ii) on an annual basis after
enrollment--
``(I) in conjunction with the
election period of the plan or coverage
if the plan or coverage has such an
election period; or
``(II) in the case of a plan or
coverage that does not have an election
period, in conjunction with the
beginning of the plan or coverage year;
and
``(iii) in the case of any material
reduction to the benefits or information
described in paragraphs (1), (2) and (3) of
subsection (b), in the form of a summary notice
provided not later than the date on which the
reduction takes effect.
``(B) Participants and beneficiaries.--The
disclosure required under subparagraph (A) shall be
provided--
``(i) jointly to each participant and
beneficiary who reside at the same address; or
``(ii) in the case of a beneficiary who
does not reside at the same address as the
participant, separately to the participant and
such beneficiary.
``(2) Rule of construction.--Nothing in this section shall
be construed to prevent a group health plan sponsor and health
insurance issuer from entering into an agreement under which
either the plan sponsor or the issuer agrees to assume
responsibility for compliance with the requirements of this
section, in whole or in part, and the party delegating such
responsibility is released from liability for compliance with
the requirements that are assumed by the other party, to the
extent the party delegating such responsibility did not cause
such noncompliance.
``(3) Provision of information.--Information shall be
provided to participants and beneficiaries under this section
at the last known address maintained by the plan or issuer with
respect to such participants or beneficiaries, to the extent
that such information is provided to participants or
beneficiaries via the United States Postal Service or other
private delivery service.
``(b) Required Information.--The informational materials to be
distributed under this section shall include for each option available
under the group health plan or health insurance coverage the following:
``(1) Benefits.--A description of the covered benefits,
including--
``(A) any in- and out-of-network benefits;
``(B) specific preventative services covered under
the plan or coverage if such services are covered;
``(C) any benefit limitations, including any annual
or lifetime benefit limits and any monetary limits or
limits on the number of visits, days, or services, and
any specific coverage exclusions; and
``(D) any definition of medical necessity used in
making coverage determinations by the plan, issuer, or
claims administrator.
``(2) Cost sharing.--A description of any cost-sharing
requirements, including--
``(A) any premiums, deductibles, coinsurance,
copayment amounts, and liability for balance billing
above any reasonable and customary charges, for which
the participant or beneficiary will be responsible
under each option available under the plan;
``(B) any maximum out-of-pocket expense for which
the participant or beneficiary may be liable;
``(C) any cost-sharing requirements for out-of-
network benefits or services received from
nonparticipating providers; and
``(D) any additional cost-sharing or charges for
benefits and services that are furnished without
meeting applicable plan or coverage requirements, such
as prior authorization or precertification.
``(3) Service area.--A description of the plan or issuer's
service area, including the provision of any out-of-area
coverage.
``(4) Participating providers.--A directory of
participating providers (to the extent a plan or issuer
provides coverage through a network of providers) that
includes, at a minimum, the name, address, and telephone number
of each participating provider, and information about how to
inquire whether a participating provider is currently accepting
new patients.
``(5) Choice of primary care provider.--A description of
any requirements and procedures to be used by participants and
beneficiaries in selecting, accessing, or changing their
primary care provider, including providers both within and
outside of the network (if the plan or issuer permits out-of-
network services), and the right to select a pediatrician as a
primary care provider under section 724 for a participant or
beneficiary who is a child if such section applies.
``(6) Preauthorization requirements.--A description of the
requirements and procedures to be used to obtain
preauthorization for health services, if such preauthorization
is required.
``(7) Experimental and investigational treatments.--A
description of the process for determining whether a particular
item, service, or treatment is considered experimental or
investigational, and the circumstances under which such
treatments are covered by the plan or issuer.
``(8) Specialty care.--A description of the requirements
and procedures to be used by participants and beneficiaries in
accessing specialty care and obtaining referrals to
participating and nonparticipating specialists, including the
right to timely coverage for access to specialists care under
section 725 if such section applies.
``(9) Clinical trials.--A description the circumstances and
conditions under which participation in clinical trials is
covered under the terms and conditions of the plan or coverage,
and the right to obtain coverage for approved cancer clinical
trials under section 729 if such section applies.
``(10) Prescription drugs.--To the extent the plan or
issuer provides coverage for prescription drugs, a statement of
whether such coverage is limited to drugs included in a
formulary, a description of any provisions and cost-sharing
required for obtaining on- and off-formulary medications, and a
description of the rights of participants and beneficiaries in
obtaining access to access to prescription drugs under section
727 if such section applies.
``(11) Emergency services.--A summary of the rules and
procedures for accessing emergency services, including the
right of a participant or beneficiary to obtain emergency
services under the prudent layperson standard under section
721, if such section applies, and any educational information
that the plan or issuer may provide regarding the appropriate
use of emergency services.
``(12) Claims and appeals.--A description of the plan or
issuer's rules and procedures pertaining to claims and appeals,
a description of the rights of participants and beneficiaries
under sections 503, 503A and 503B in obtaining covered
benefits, filing a claim for benefits, and appealing coverage
decisions internally and externally (including telephone
numbers and mailing addresses of the appropriate authority),
and a description of any additional legal rights and remedies
available under section 502.
``(13) Advance directives and organ donation.--A
description of procedures for advance directives and organ
donation decisions if the plan or issuer maintains such
procedures.
``(14) Information on plans and issuers.--The name, mailing
address, and telephone number or numbers of the plan
administrator and the issuer to be used by participants and
beneficiaries seeking information about plan or coverage
benefits and services, payment of a claim, or authorization for
services and treatment. The name of the designated decision-
maker (or decision-makers) appointed under section 502(n)(2)
for purposes of making final determinations under section 503A
and approving coverage pursuant to the written determination of
an independent medical reviewer under section 503B. Notice of
whether the benefits under the plan are provided under a
contract or policy of insurance issued by an issuer, or whether
benefits are provided directly by the plan sponsor who bears
the insurance risk.
``(15) Translation services.--A summary description of any
translation or interpretation services (including the
availability of printed information in languages other than
English, audio tapes, or information in Braille) that are
available for non-English speakers and participants and
beneficiaries with communication disabilities and a description
of how to access these items or services.
``(16) Accreditation information.--Any information that is
made public by accrediting organizations in the process of
accreditation if the plan or issuer is accredited, or any
additional quality indicators (such as the results of enrollee
satisfaction surveys) that the plan or issuer makes public or
makes available to participants and beneficiaries.
``(17) Notice of requirements.--A description of any rights
of participants and beneficiaries that are established by the
Patients' Bill of Rights Plus Act (excluding those described in
paragraphs (1) through (16)) if such sections apply. The
description required under this paragraph may be combined with
the notices required under sections 711(d), 713(b), or
606(a)(1), and with any other notice provision that the
Secretary determines may be combined.
``(18) Availability of additional information.--A statement
that the information described in subsection (c), and
instructions on obtaining such information (including telephone
numbers and, if available, Internet websites), shall be made
available upon request.
``(c) Additional Information.--The informational materials to be
provided upon the request of a participant or beneficiary shall include
for each option available under a group health plan or health insurance
coverage the following:
``(1) Status of providers.--The State licensure status of
the plan or issuer's participating health care professionals
and participating health care facilities, and, if available,
the education, training, specialty qualifications or
certifications of such professionals.
``(2) Compensation methods.--A summary description of the
methods (such as capitation, fee-for-service, salary, bundled
payments, per diem, or a combination thereof) used for
compensating participating health care professionals (including
primary care providers and specialists) and facilities in
connection with the provision of health care under the plan or
coverage. The requirement of this paragraph shall not be
construed as requiring plans or issuers to provide information
concerning proprietary payment methodology.
``(3) Prescription drugs.--Information about whether a
specific prescription medication is included in the formulary
of the plan or issuer, if the plan or issuer uses a defined
formulary.
``(4) External appeals information.--Aggregate information
on the number and outcomes of external medical reviews,
relative to the sample size (such as the number of covered
lives) determined for the plan or issuer's book of business.
``(d) Manner of Disclosure.--The information described in this
section shall be disclosed in an accessible medium and format that is
calculated to be understood by the average participant.
``(e) Rules of Construction.--Nothing in this section shall be
construed to prohibit a group health plan, or a health insurance issuer
in connection with group health insurance coverage, from--
``(1) distributing any other additional information
determined by the plan or issuer to be important or necessary
in assisting participants and beneficiaries in the selection of
a health plan; and
``(2) complying with the provisions of this section by
providing information in brochures, through the Internet or
other electronic media, or through other similar means, so long
as participants and beneficiaries are provided with an
opportunity to request that informational materials be provided
in printed form.
``(f) Conforming Regulations.--The Secretary shall issue
regulations to coordinate the requirements on group health plans and
health insurance issuers under this section with the requirements
imposed under part 1, to reduce duplication with respect to any
information that is required to be provided under any such
requirements.
``(g) Secretarial Enforcement Authority.--
``(1) In general.--The Secretary may assess a civil
monetary penalty against the administrator of a plan or issuer
in connection with the failure of the plan or issuer to comply
with the requirements of this section.
``(2) Amount of penalty.--
``(A) In general.--The amount of the penalty to be
imposed under paragraph (1) shall not exceed $100 for
each day for each participant and beneficiary with
respect to which the failure to comply with the
requirements of this section occurs.
``(B) Increase in amount.--The amount referred to
in subparagraph (A) shall be increased or decreased,
for each calendar year that ends after December 31,
2000, by the same percentage as the percentage by which
the medical care expenditure category of the Consumer
Price Index for All Urban Consumers (United States city
average), published by the Bureau of Labor Statistics,
for September of the preceding calendar year has
increased or decreased from the such Index for
September of 2000.
``(3) Failure defined.--For purposes of this subsection, a
plan or issuer shall have failed to comply with the
requirements of this section with respect to a participant or
beneficiary if the plan or issuer failed or refused to comply
with the requirements of this section within 30 days--
``(A) of the date described in subsection
(a)(1)(A)(i);
``(B) of the date described in subsection
(a)(1)(A)(ii); or
``(C) of the date on which additional information
was requested under subsection (c).''.
(b) Conforming Amendments.--
(1) Section 732(a) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1191a(a)) is amended by
striking ``section 711'' and inserting ``sections 711 and
714''.
(2) The table of contents in section 1 of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1001) is
amended by inserting after the item relating to section 713,
the following:
``Sec 714. Health plan comparative information.''.
(3) Section 502(b)(3) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1132(b)(3)) is amended by
striking ``733(a)(1))'' and inserting ``733(a)(1)), except with
respect to the requirements of section 714''.
SEC. 2212. INFORMATION ABOUT PROVIDERS.
(a) Study.--The Secretary of Health and Human Services shall enter
into a contract with the Institute of Medicine for the conduct of a
study, and the submission to the Secretary of a report, that includes--
(1) an analysis of information concerning health care
professionals that is currently available to patients,
consumers, States, and professional societies, nationally and
on a State-by-State basis, including patient preferences with
respect to information about such professionals and their
competencies;
(2) an evaluation of the legal and other barriers to the
sharing of information concerning health care professionals;
and
(3) recommendations for the disclosure of information on
health care professionals, including the competencies and
professional qualifications of such practitioners, to better
facilitate patient choice, quality improvement, and market
competition.
(b) Report.--Not later than 18 months after the date of enactment
of this Act, the Secretary of Health and Human Services shall forward
to the appropriate committees of Congress a copy of the report and
study conducted under subsection (a).
Subtitle C--Right to Hold Health Plans Accountable
SEC. 2221. AMENDMENTS TO EMPLOYEE RETIREMENT INCOME SECURITY ACT OF
1974.
(a) In General.--Part 5 of subtitle B of title I of the Employee
Retirement Income Security Act of 1974 is amended by inserting after
section 503 (29 U.S.C. 1133) the following:
``SEC. 503A. CLAIMS AND INTERNAL APPEALS PROCEDURES FOR GROUP HEALTH
PLANS.
``(a) Initial Claim for Benefits Under Group Health Plans.--
``(1) Procedures.--
``(A) In general.--A group health plan, or health
insurance issuer offering health insurance coverage in
connection with a group health plan, shall ensure that
procedures are in place for--
``(i) making a determination on an initial
claim for benefits by a participant or
beneficiary (or authorized representative)
regarding payment or coverage for items or
services under the terms and conditions of the
plan or coverage involved, including any cost-
sharing amount that the participant or
beneficiary is required to pay with respect to
such claim for benefits; and
``(ii) notifying a participant or
beneficiary (or authorized representative) and
the treating health care professional involved
regarding a determination on an initial claim
for benefits made under the terms and
conditions of the plan or coverage, including
any cost-sharing amounts that the participant
or beneficiary may be required to make with
respect to such claim for benefits, and of the
right of the participant or beneficiary to an
internal appeal under subsection (b).
``(B) Access to information.--With respect to an
initial claim for benefits, the participant or
beneficiary (or authorized representative) and the
treating health care professional (if any) shall
provide the plan or issuer with access to information
necessary to make a determination relating to the
claim, not later than 5 business days after the date on
which the claim is filed or to meet the applicable
timelines under clauses (ii) and (iii) of paragraph
(2)(A).
``(C) Oral requests.--In the case of a claim for
benefits involving an expedited or concurrent
determination, a participant or beneficiary (or
authorized representative) may make an initial claim
for benefits orally, but a group health plan, or health
insurance issuer offering health insurance coverage in
connection with a group health plan, may require that
the participant or beneficiary (or authorized
representative) provide written confirmation of such
request in a timely manner.
``(2) Timeline for making determinations.--
``(A) Prior authorization determination.--
``(i) In general.--A group health plan, or
health insurance issuer offering health
insurance coverage in connection with a group
health plan, shall maintain procedures to
ensure that a prior authorization determination
on a claim for benefits is made within 14
business days from the date on which the plan
or issuer receives information that is
reasonably necessary to enable the plan or
issuer to make a determination on the request
for prior authorization, but in no case shall
such determination be made later than 28
business days after the receipt of the claim
for benefits.
``(ii) Expedited determination.--
Notwithstanding clause (i), a group health
plan, or health insurance issuer offering
health insurance coverage in connection with a
group health plan, shall maintain procedures
for expediting a prior authorization
determination on a claim for benefits described
in such clause when a request for such an
expedited determination is made by a
participant or beneficiary (or authorized
representative) at any time during the process
for making a determination and the treating
health care professional substantiates, with
the request, that a determination under the
procedures described in clause (i) would
seriously jeopardize the life or health of the
participant or beneficiary. Such determination
shall be made within 72 hours after a request
is received by the plan or issuer under this
clause.
``(iii) Concurrent determinations.--A group
health plan, or health insurance issuer
offering health insurance coverage in
connection with a group health plan, shall
maintain procedures to ensure that a concurrent
determination on a claim for benefits that
results in a discontinuation of inpatient care
is made within 24 hours after the receipt of
the claim for benefits.
``(B) Retrospective determination.--A group health
plan, or health insurance issuer offering health
insurance coverage in connection with a group health
plan, shall maintain procedures to ensure that a
retrospective determination on a claim for benefits is
made within 30 business days of the date on which the
plan or issuer receives information that is reasonably
necessary to enable the plan or issuer to make a
determination on the claim, but in no case shall such
determination be made later than 60 business days after
the receipt of the claim for benefits.
``(3) Notice of a denial of a claim for benefits.--Written
notice of a denial made under an initial claim for benefits
shall be issued to the participant or beneficiary (or
authorized representative) and the treating health care
professional not later than 2 business days after the
determination (or within the 72-hour or 24-hour period referred
to in clauses (ii) and (iii) of paragraph (2)(A) if
applicable).
``(4) Requirements of notice of determinations.--The
written notice of a denial of a claim for benefits
determination under paragraph (3) shall include--
``(A) the reasons for the determination (including
a summary of the clinical or scientific-evidence based
rationale used in making the determination and
instruction on obtaining a more complete description
written in a manner calculated to be understood by the
average participant);
``(B) the procedures for obtaining additional
information concerning the determination; and
``(C) notification of the right to appeal the
determination and instructions on how to initiate an
appeal in accordance with subsection (b).
``(b) Internal Appeal of a Denial of a Claim for Benefits.--
``(1) Right to internal appeal.--
``(A) In general.--A participant or beneficiary (or
authorized representative) may appeal any denial of a
claim for benefits under subsection (a) under the
procedures described in this subsection.
``(B) Time for appeal.--A group health plan, or
health insurance issuer offering health insurance
coverage in connection with a group health plan, shall
ensure that a participant or beneficiary (or authorized
representative) has a period of not less than 60 days
beginning on the date of a denial of a claim for
benefits under subsection (a) in which to appeal such
denial under this subsection.
``(C) Failure to act.--The failure of a plan or
issuer to issue a determination on a claim for benefits
under subsection (a) within the applicable timeline
established for such a determination under such
subsection shall be treated as a denial of a claim for
benefits for purposes of proceeding to internal review
under this subsection.
``(D) Plan waiver of internal review.--A group
health plan, or health insurance issuer offering health
insurance coverage in connection with a group health
plan, may waive the internal review process under this
subsection and permit a participant or beneficiary (or
authorized representative) to proceed directly to
external review under section 503B.
``(2) Timelines for making determinations.--
``(A) Oral requests.--In the case of an appeal of a
denial of a claim for benefits under this subsection
that involves an expedited or concurrent determination,
a participant or beneficiary (or authorized
representative) may request such appeal orally, but a
group health plan, or health insurance issuer offering
health insurance coverage in connection with a group
health plan, may require that the participant or
beneficiary (or authorized representative) provide
written confirmation of such request in a timely
manner.
``(B) Access to information.--With respect to an
appeal of a denial of a claim for benefits, the
participant or beneficiary (or authorized
representative) and the treating health care
professional (if any) shall provide the plan or issuer
with access to information necessary to make a
determination relating to the appeal, not later than 5
business days after the date on which the request for
the appeal is filed or to meet the applicable timelines
under clauses (ii) and (iii) of subparagraph (C).
``(C) Prior authorization determinations.--
``(i) In general.--A group health plan, or
health insurance issuer offering health
insurance coverage in connection with a group
health plan, shall maintain procedures to
ensure that a determination on an appeal of a
denial of a claim for benefits under this
subsection is made within 14 business days
after the date on which the plan or issuer
receives information that is reasonably
necessary to enable the plan or issuer to make
a determination on the appeal, but in no case
shall such determination be made later than 28
business days after the receipt of the request
for the appeal.
``(ii) Expedited determination.--
Notwithstanding clause (i), a group health
plan, or health insurance issuer offering
health insurance coverage in connection with a
group health plan, shall maintain procedures
for expediting a prior authorization
determination on an appeal of a denial of a
claim for benefits described in clause (i),
when a request for such an expedited
determination is made by a participant or
beneficiary (or authorized representative) at
any time during the process for making a
determination and the treating health care
professional substantiates, with the request,
that a determination under the procedures
described in clause (i) would seriously
jeopardize the life or health of the
participant or beneficiary. Such determination
shall be made not later than 72 hours after the
request for such appeal is received by the plan
or issuer under this clause.
``(iii) Concurrent determinations.--A group
health plan, or health insurance issuer
offering health insurance coverage in
connection with a group health plan, shall
maintain procedures to ensure that a concurrent
determination on an appeal of a denial of a
claim for benefits that results in a
discontinuation of inpatient care is made
within 24 hours after the receipt of the
request for appeal.
``(B) Retrospective determination.--A group health
plan, or health insurance issuer offering health
insurance coverage in connection with a group health
plan, shall maintain procedures to ensure that a
retrospective determination on an appeal of a claim for
benefits is made within 30 business days of the date on
which the plan or issuer receives necessary information
that is reasonably required by the plan or issuer to
make a determination on the appeal, but in no case
shall such determination be made later than 60 business
days after the receipt of the request for the appeal.
``(3) Conduct of review.--
``(A) In general.--A review of a denial of a claim
for benefits under this subsection shall be conducted
by an individual with appropriate expertise who was not
directly involved in the initial determination.
``(B) Review of medical decisions by physicians.--A
review of an appeal of a denial of a claim for benefits
that is based on a lack of medical necessity and
appropriateness, or based on an experimental or
investigational treatment, or requires an evaluation of
medical facts, shall be made by a physician with
appropriate expertise, including age-appropriate
expertise, who was not involved in the initial
determination.
``(4) Notice of determination.--
``(A) In general.--Written notice of a
determination made under an internal appeal of a denial
of a claim for benefits shall be issued to the
participant or beneficiary (or authorized
representative) and the treating health care
professional not later than 2 business days after the
completion of the review (or within the 72-hour or 24-
hour period referred to in paragraph (2) if
applicable).
``(B) Final determination.--The decision by a plan
or issuer under this subsection shall be treated as the
final determination of the plan or issuer on a denial
of a claim for benefits. The failure of a plan or
issuer to issue a determination on an appeal of a
denial of a claim for benefits under this subsection
within the applicable timeline established for such a
determination shall be treated as a final determination
on an appeal of a denial of a claim for benefits for
purposes of proceeding to external review under section
503B.
``(C) Requirements of notice.--With respect to a
determination made under this subsection, the notice
described in subparagraph (A) shall include--
``(i) the reasons for the determination
(including a summary of the clinical or
scientific-evidence based rationale used in
making the determination and instruction on
obtaining a more complete description written
in a manner calculated to be understood by the
average participant);
``(ii) the procedures for obtaining
additional information concerning the
determination; and
``(iii) notification of the right to an
independent external review under section 503B
and instructions on how to initiate such a
review.
``(c) Definitions.--The definitions contained in section 503B(i)
shall apply for purposes of this section.
``SEC. 503B. INDEPENDENT EXTERNAL APPEALS PROCEDURES FOR GROUP HEALTH
PLANS.
``(a) Right to External Appeal.--A group health plan, and a health
insurance issuer offering health insurance coverage in connection with
a group health plan, shall provide in accordance with this section
participants and beneficiaries (or authorized representatives) with
access to an independent external review for any denial of a claim for
benefits.
``(b) Initiation of the Independent External Review Process.--
``(1) Time to file.--A request for an independent external
review under this section shall be filed with the plan or
issuer not later than 60 business days after the date on which
the participant or beneficiary receives notice of the denial
under section 503A(b)(4) or the date on which the internal
review is waived by the plan or issuer under section
503A(b)(1)(D).
``(2) Filing of request.--
``(A) In general.--Subject to the succeeding
provisions of this subsection, a group health plan, and
a health insurance issuer offering health insurance
coverage in connection with a group health plan, may--
``(i) except as provided in subparagraph
(B)(i), require that a request for review be in
writing;
``(ii) limit the filing of such a request
to the participant or beneficiary involved (or
an authorized representative);
``(iii) except if waived by the plan or
issuer under section 503A(b)(1)(D), condition
access to an independent external review under
this section upon a final determination of a
denial of a claim for benefits under the
internal review procedure under section 503A;
``(iv) except as provided in subparagraph
(B)(ii), require payment of a filing fee to the
plan or issuer of a sum that does not exceed
$50; and
``(v) require that a request for review
include the consent of the participant or
beneficiary (or authorized representative) for
the release of medical information or records
of the participant or beneficiary to the
qualified external review entity for purposes
of conducting external review activities.
``(B) Requirements and exception relating to
general rule.--
``(i) Oral requests permitted in expedited
or concurrent cases.--In the case of an
expedited or concurrent external review as
provided for under subsection (e), the request
may be made orally. In such case a written
confirmation of such request shall be made in a
timely manner. Such written confirmation shall
be treated as a consent for purposes of
subparagraph (A)(v).
``(ii) Exception to filing fee
requirement.--
``(I) Indigency.--Payment of a
filing fee shall not be required under
subparagraph (A)(iv) where there is a
certification (in a form and manner
specified in guidelines established by
the Secretary) that the participant or
beneficiary is indigent (as defined in
such guidelines). In establishing
guidelines under this subclause, the
Secretary shall ensure that the
guidelines relating to indigency are
consistent with the poverty guidelines
used by the Secretary of Health and
Human Services under title XIX of the
Social Security Act.
``(II) Fee not required.--Payment
of a filing fee shall not be required
under subparagraph (A)(iv) if the plan
or issuer waives the internal appeals
process under section 503A(b)(1)(D).
``(III) Refunding of fee.--The
filing fee paid under subparagraph
(A)(iv) shall be refunded if the
determination under the independent
external review is to reverse the
denial which is the subject of the
review.
``(IV) Increase in amount.--The
amount referred to in subclause (I)
shall be increased or decreased, for
each calendar year that ends after
December 31, 2001, by the same
percentage as the percentage by which
the Consumer Price Index for All Urban
Consumers (United States city average),
published by the Bureau of Labor
Statistics, for September of the
preceding calendar year has increased
or decreased from the such Index for
September of 2001.
``(c) Referral to Qualified External Review Entity Upon Request.--
``(1) In general.--Upon the filing of a request for
independent external review with the group health plan, or
health insurance issuer offering coverage in connection with a
group health plan, the plan or issuer shall refer such request
to a qualified external review entity selected in accordance
with this section.
``(2) Access to plan or issuer and health professional
information.--With respect to an independent external review
conducted under this section, the participant or beneficiary
(or authorized representative), the plan or issuer, and the
treating health care professional (if any) shall provide the
external review entity with access to information that is
necessary to conduct a review under this section, as determined
by the entity, not later than 5 business days after the date on
which a request is referred to the qualified external review
entity under paragraph (1), or earlier as determined
appropriate by the entity to meet the applicable timelines
under clauses (ii) and (iii) of subsection (e)(1)(A).
``(3) Screening of requests by qualified external review
entities.--
``(A) In general.--With respect to a request
referred to a qualified external review entity under
paragraph (1) relating to a denial of a claim for
benefits, the entity shall refer such request for the
conduct of an independent medical review unless the
entity determines that--
``(i) any of the conditions described in
subsection (b)(2)(A) have not been met;
``(ii) the thresholds described in
subparagraph (B) have not been met;
``(iii) the denial of the claim for
benefits does not involve a medically
reviewable decision under subsection (d)(2);
``(iv) the denial of the claim for benefits
relates to a decision regarding whether an
individual is a participant or beneficiary who
is enrolled under the terms of the plan or
coverage (including the applicability of any
waiting period under the plan or coverage); or
``(v) the denial of the claim for benefits
is a decision as to the application of cost-
sharing requirements or the application of a
specific exclusion or express limitation on the
amount, duration, or scope of coverage of items
or services under the terms and conditions of
the plan or coverage unless the decision is a
denial described in subsection (d)(2)(C);
Upon making a determination that any of clauses (i)
through (v) applies with respect to the request, the
entity shall determine that the denial of a claim for
benefits involved is not eligible for independent
medical review under subsection (d), and shall provide
notice in accordance with subparagraph (D).
``(B) Thresholds.--
``(i) In general.--The thresholds described
in this subparagraph are that--
``(I) the total amount payable
under the plan or coverage for the item
or service that was the subject of such
denial exceeds a significant financial
threshold (as determined under
guidelines established by the
Secretary); or
``(II) a physician has asserted in
writing that there is a significant
risk of placing the life, health, or
development of the participant or
beneficiary in jeopardy if the denial
of the claim for benefits is sustained.
``(ii) Thresholds not applied.--The
thresholds described in this subparagraph shall
not apply if the plan or issuer involved waives
the internal appeals process with respect to
the denial of a claim for benefits involved
under section 503A(b)(1)(D).
``(C) Process for making determinations.--
``(i) No deference to prior
determinations.--In making determinations under
subparagraph (A), there shall be no deference
given to determinations made by the plan or
issuer under section 503A or the recommendation
of a treating health care professional (if
any).
``(ii) Use of appropriate personnel.--A
qualified external review entity shall use
appropriately qualified personnel to make
determinations under this section.
``(D) Notices and general timelines for
determination.--
``(i) Notice in case of denial of
referral.--If the entity under this paragraph
does not make a referral to an independent
medical reviewer, the entity shall provide
notice to the plan or issuer, the participant
or beneficiary (or authorized representative)
filing the request, and the treating health
care professional (if any) that the denial is
not subject to independent medical review. Such
notice--
``(I) shall be written (and, in
addition, may be provided orally) in a
manner calculated to be understood by
an average participant;
``(II) shall include the reasons
for the determination; and
``(III) include any relevant terms
and conditions of the plan or coverage.
``(ii) General timeline for
determinations.--Upon receipt of information
under paragraph (2), the qualified external
review entity, and if required the independent
medical reviewer, shall make a determination
within the overall timeline that is applicable
to the case under review as described in
subsection (e), except that if the entity
determines that a referral to an independent
medical reviewer is not required, the entity
shall provide notice of such determination to
the participant or beneficiary (or authorized
representative) within 2 business days of such
determination.
``(d) Independent Medical Review.--
``(1) In general.--If a qualified external review entity
determines under subsection (c) that a denial of a claim for
benefits is eligible for independent medical review, the entity
shall refer the denial involved to an independent medical
reviewer for the conduct of an independent medical review under
this subsection.
``(2) Medically reviewable decisions.--A denial described
in this paragraph is one for which the item or service that is
the subject of the denial would be a covered benefit under the
terms and conditions of the plan or coverage but for one (or
more) of the following determinations:
``(A) Denials based on medical necessity and
appropriateness.--The basis of the determination is
that the item or service is not medically necessary and
appropriate.
``(B) Denials based on experimental or
investigational treatment.--The basis of the
determination is that the item or service is
experimental or investigational.
``(C) Denials otherwise based on an evaluation of
medical facts.--A determination that the item or
service or condition is not covered but an evaluation
of the medical facts by a health care professional in
the specific case involved is necessary to determine
whether the item or service or condition is required to
be provided under the terms and conditions of the plan
or coverage.
``(3) Independent medical review determination.--
``(A) In general.--An independent medical reviewer
under this section shall make a new independent
determination with respect to--
``(i) whether the item or service or
condition that is the subject of the denial is
covered under the terms and conditions of the
plan or coverage; and
``(ii) based upon an affirmative
determination under clause (i), whether or not
the denial of a claim for a benefit that is the
subject of the review should be upheld or
reversed.
``(B) Standard for determination.--The independent
medical reviewer's determination relating to the
medical necessity and appropriateness, or the
experimental or investigation nature, or the evaluation
of the medical facts of the item, service, or condition
shall be based on the medical condition of the
participant or beneficiary (including the medical
records of the participant or beneficiary) and the
valid, relevant scientific evidence and clinical
evidence, including peer-reviewed medical literature or
findings and including expert consensus.
``(C) No coverage for excluded benefits.--Nothing
in this subsection shall be construed to permit an
independent medical reviewer to require that a group
health plan, or health insurance issuer offering health
insurance coverage in connection with a group health
plan, provide coverage for items or services that are
specifically excluded or expressly limited under the
plan or coverage and that are not covered regardless of
any determination relating to medical necessity and
appropriateness, experimental or investigational nature
of the treatment, or an evaluation of the medical facts
in the case involved.
``(D) Evidence and information to be used in
medical reviews.--In making a determination under this
subsection, the independent medical reviewer shall also
consider appropriate and available evidence and
information, including the following:
``(i) The determination made by the plan or
issuer with respect to the claim upon internal
review and the evidence or guidelines used by
the plan or issuer in reaching such
determination.
``(ii) The recommendation of the treating
health care professional and the evidence,
guidelines, and rationale used by the treating
health care professional in reaching such
recommendation.
``(iii) Additional evidence or information
obtained by the reviewer or submitted by the
plan, issuer, participant or beneficiary (or an
authorized representative), or treating health
care professional.
``(iv) The plan or coverage document.
``(E) Independent determination.--In making the
determination, the independent medical reviewer shall--
``(i) consider the claim under review
without deference to the determinations made by
the plan or issuer under section 503A or the
recommendation of the treating health care
professional (if any);
``(ii) consider, but not be bound by the
definition used by the plan or issuer of
`medically necessary and appropriate', or
`experimental or investigational', or other
equivalent terms that are used by the plan or
issuer to describe medical necessity and
appropriateness or experimental or
investigational nature of the treatment; and
``(iii) notwithstanding clause (ii), adhere
to the definition used by the plan or issuer of
`medically necessary and appropriate', or
`experimental or investigational' if such
definition is the same as the definition of
such term--
``(I) that has been adopted
pursuant to a State statute or
regulation; or
``(II) that is used for purposes of
the program established under titles
XVIII or XIX of the Social Security Act
or under chapter 89 of title 5, United
States Code.
``(F) Determination of independent medical
reviewer.--An independent medical reviewer shall, in
accordance with the deadlines described in subsection
(e), prepare a written determination to uphold or
reverse the denial under review. Such written
determination shall include the specific reasons of the
reviewer for such determination, including a summary of
the clinical or scientific-evidence based rationale
used in making the determination. The reviewer may
provide the plan or issuer and the treating health care
professional with additional recommendations in
connection with such a determination, but any such
recommendations shall not be treated as part of the
determination.
``(e) Timelines and Notifications.--
``(1) Timelines for independent medical review.--
``(A) Prior authorization determination.--
``(i) In general.--The independent medical
reviewer (or reviewers) shall make a
determination on a denial of a claim for
benefits that is referred to the reviewer under
subsection (c)(3) not later than 14 business
days after the receipt of information under
subsection (c)(2) if the review involves a
prior authorization of items or services.
``(ii) Expedited determination.--
Notwithstanding clause (i), the independent
medical reviewer (or reviewers) shall make an
expedited determination on a denial of a claim
for benefits described in clause (i), when a
request for such an expedited determination is
made by a participant or beneficiary (or
authorized representative) at any time during
the process for making a determination, and the
treating health care professional
substantiates, with the request, that a
determination under the timeline described in
clause (i) would seriously jeopardize the life
or health of the participant or beneficiary.
Such determination shall be made not later than
72 hours after the receipt of information under
subsection (c)(2).
``(iii) Concurrent determination.--
Notwithstanding clause (i), a review described
in such subclause shall be completed not later
than 24 hours after the receipt of information
under subsection (c)(2) if the review involves
a discontinuation of inpatient care.
``(B) Retrospective determination.--The independent
medical reviewer (or reviewers) shall complete a review
in the case of a retrospective determination on an
appeal of a denial of a claim for benefits that is
referred to the reviewer under subsection (c)(3) not
later than 30 business days after the receipt of
information under subsection (c)(2).
``(2) Notification of determination.--The external review
entity shall ensure that the plan or issuer, the participant or
beneficiary (or authorized representative) and the treating
health care professional (if any) receives a copy of the
written determination of the independent medical reviewer
prepared under subsection (d)(3)(F). Nothing in this paragraph
shall be construed as preventing an entity or reviewer from
providing an initial oral notice of the reviewer's
determination.
``(3) Form of notices.--Determinations and notices under
this subsection shall be written in a manner calculated to be
understood by an average participant.
``(4) Termination of external review process if approval of
a claim for benefits during process.--
``(A) In general.--If a plan or issuer--
``(i) reverses a determination on a denial
of a claim for benefits that is the subject of
an external review under this section and
authorizes coverage for the claim or provides
payment of the claim; and
``(ii) provides notice of such reversal to
the participant or beneficiary (or authorized
representative) and the treating health care
professional (if any), and the external review
entity responsible for such review,
the external review process shall be terminated with
respect to such denial and any filing fee paid under
subsection (b)(2)(A)(iv) shall be refunded.
``(B) Treatment of termination.--An authorization
of coverage under subparagraph (A) by the plan or
issuer shall be treated as a written determination to
reverse a denial under section (d)(3)(F) for purposes
of liability under section 502(n)(1)(B).
``(f) Compliance.--
``(1) Application of determinations.--
``(A) External review determinations binding on
plan.--The determinations of an external review entity
and an independent medical reviewer under this section
shall be binding upon the plan or issuer involved.
``(B) Compliance with determination.--If the
determination of an independent medical reviewer is to
reverse the denial, the plan or issuer, upon the
receipt of such determination, shall authorize coverage
to comply with the medical reviewer's determination in
accordance with the timeframe established by the
medical reviewer.
``(2) Failure to comply.--If a plan or issuer fails to
comply with the timeframe established under paragraph (1)(B)(i)
with respect to a participant or beneficiary, where such
failure to comply is caused by the plan or issuer, the
participant or beneficiary may obtain the items or services
involved (in a manner consistent with the determination of the
independent external reviewer) from any provider regardless of
whether such provider is a participating provider under the
plan or coverage.
``(3) Reimbursement.--
``(A) In general.--Where a participant or
beneficiary obtains items or services in accordance
with paragraph (2), the plan or issuer involved shall
provide for reimbursement of the costs of such items of
services. Such reimbursement shall be made to the
treating health care professional or to the participant
or beneficiary (in the case of a participant or
beneficiary who pays for the costs of such items or
services).
``(B) Amount.--The plan or issuer shall fully
reimburse a professional, participant or beneficiary
under subparagraph (A) for the total costs of the items
or services provided (regardless of any plan
limitations that may apply to the coverage of such
items of services) so long as--
``(i) the items or services would have been
covered under the terms of the plan or coverage
if provided by the plan or issuer; and
``(ii) the items or services were provided
in a manner consistent with the determination
of the independent medical reviewer.
``(4) Failure to reimburse.--Where a plan or issuer fails
to provide reimbursement to a professional, participant or
beneficiary in accordance with this subsection, the
professional, participant or beneficiary may commence a civil
action (or utilize other remedies available under law) to
recover only the amount of any such reimbursement that is
unpaid and any necessary legal costs or expenses (including
attorneys' fees) incurred in recovering such reimbursement.
``(g) Qualifications of Independent Medical Reviewers.--
``(1) In general.--In referring a denial to 1 or more
individuals to conduct independent medical review under
subsection (c), the qualified external review entity shall
ensure that--
``(A) each independent medical reviewer meets the
qualifications described in paragraphs (2) and (3);
``(B) with respect to each review at least 1 such
reviewer meets the requirements described in paragraphs
(4) and (5); and
``(C) compensation provided by the entity to the
reviewer is consistent with paragraph (6).
``(2) Licensure and expertise.--Each independent medical
reviewer shall be a physician or health care professional who--
``(A) is appropriately credentialed or licensed in
1 or more States to deliver health care services; and
``(B) typically treats the diagnosis or condition
or provides the type or treatment under review.
``(3) Independence.--
``(A) In general.--Subject to subparagraph (B),
each independent medical reviewer in a case shall--
``(i) not be a related party (as defined in
paragraph (7));
``(ii) not have a material familial,
financial, or professional relationship with
such a party; and
``(iii) not otherwise have a conflict of
interest with such a party (as determined under
regulations).
``(B) Exception.--Nothing in this subparagraph (A)
shall be construed to--
``(i) prohibit an individual, solely on the
basis of affiliation with the plan or issuer,
from serving as an independent medical reviewer
if--
``(I) a non-affiliated individual
is not reasonably available;
``(II) the affiliated individual is
not involved in the provision of items
or services in the case under review;
and
``(III) the fact of such an
affiliation is disclosed to the plan or
issuer and the participant or
beneficiary (or authorized
representative) and neither party
objects;
``(ii) prohibit an individual who has staff
privileges at the institution where the
treatment involved takes place from serving as
an independent medical reviewer if the
affiliation is disclosed to the plan or issuer
and the participant or beneficiary (or
authorized representative), and neither party
objects;
``(iii) permit an employee of a plan or
issuer, or an individual who provides services
exclusively or primarily to or on behalf of a
plan or issuer, from serving as an independent
medical reviewer; or
``(iv) prohibit receipt of compensation by
an independent medical reviewer from an entity
if the compensation is provided consistent with
paragraph (6).
``(4) Practicing health care professional in same field.--
``(A) In general.--The requirement of this
paragraph with respect to a reviewer in a case
involving treatment, or the provision of items or
services, by--
``(i) a physician, is that the reviewer be
a practicing physician of the same or similar
specialty, when reasonably available, as a
physician who typically treats the diagnosis or
condition or provides such treatment in the
case under review; or
``(ii) a health care professional (other
than a physician), is that the reviewer be a
practicing physician or, if determined
appropriate by the qualified external review
entity, a health care professional (other than
a physician), of the same or similar specialty
as the health care professional who typically
treats the diagnosis or condition or provides
the treatment in the case under review.
``(B) Practicing defined.--For purposes of
this paragraph, the term `practicing' means,
with respect to an individual who is a
physician or other health care professional
that the individual provides health care
services to individual patients on average at
least 1 day per week.
``(5) Age-appropriate expertise.--The independent medical
reviewer shall have expertise under paragraph (2) that is age-
appropriate to the participant or beneficiary involved.
``(6) Limitations on reviewer compensation.--Compensation
provided by a qualified external review entity to an
independent medical reviewer in connection with a review under
this section shall--
``(A) not exceed a reasonable level; and
``(B) not be contingent on the decision rendered by
the reviewer.
``(7) Related party defined.--For purposes of this section,
the term `related party' means, with respect to a denial of a
claim under a plan or coverage relating to a participant or
beneficiary, any of the following:
``(A) The plan, plan sponsor, or issuer involved,
or any fiduciary, officer, director, or employee of
such plan, plan sponsor, or issuer.
``(B) The participant or beneficiary (or authorized
representative).
``(C) The health care professional that provides
the items of services involved in the denial.
``(D) The institution at which the items or
services (or treatment) involved in the denial are
provided.
``(E) The manufacturer of any drug or other item
that is included in the items or services involved in
the denial.
``(F) Any other party determined under any
regulations to have a substantial interest in the
denial involved.
``(h) Qualified External Review Entities.--
``(1) Selection of qualified external review entities.--
``(A) Limitation on plan or issuer selection.--The
Secretary shall implement procedures with respect to
the selection of qualified external review entities by
a plan or issuer to assure that the selection process
among qualified external review entities will not
create any incentives for external review entities to
make a decision in a biased manner.
``(B) State authority with respect to qualified
external review entities for health insurance
issuers.--With respect to health insurance issuers
offering health insurance coverage in connection with a
group health plan in a State, the State may, pursuant
to a State law that is enacted after the date of
enactment of the Patients' Bill of Rights Plus Act,
provide for the designation or selection of qualified
external review entities in a manner determined by the
State to assure an unbiased determination in conducting
external review activities. In conducting reviews under
this section, an entity designated or selected under
this subparagraph shall comply with the provision of
this section.
``(2) Contract with qualified external review entity.--
Except as provided in paragraph (1)(B), the external review
process of a plan or issuer under this section shall be
conducted under a contract between the plan or issuer and 1 or
more qualified external review entities (as defined in
paragraph (4)(A)).
``(3) Terms and conditions of contract.--The terms and
conditions of a contract under paragraph (2) shall--
``(A) be consistent with the standards the
Secretary shall establish to assure there is no real or
apparent conflict of interest in the conduct of
external review activities; and
``(B) provide that the costs of the external review
process shall be borne by the plan or issuer.
Subparagraph (B) shall not be construed as applying to the
imposition of a filing fee under subsection (b)(2)(A)(iv) or
costs incurred by the participant or beneficiary (or authorized
representative) or treating health care professional (if any)
in support of the review, including the provision of additional
evidence or information.
``(4) Qualifications.--
``(A) In general.--In this section, the term
`qualified external review entity' means, in relation
to a plan or issuer, an entity that is initially
certified (and periodically recertified) under
subparagraph (C) as meeting the following requirements:
``(i) The entity has (directly or through
contracts or other arrangements) sufficient
medical, legal, and other expertise and
sufficient staffing to carry out duties of a
qualified external review entity under this
section on a timely basis, including making
determinations under subsection (b)(2)(A) and
providing for independent medical reviews under
subsection (d).
``(ii) The entity is not a plan or issuer
or an affiliate or a subsidiary of a plan or
issuer, and is not an affiliate or subsidiary
of a professional or trade association of plans
or issuers or of health care providers.
``(iii) The entity has provided assurances
that it will conduct external review activities
consistent with the applicable requirements of
this section and standards specified in
subparagraph (C), including that it will not
conduct any external review activities in a
case unless the independence requirements of
subparagraph (B) are met with respect to the
case.
``(iv) The entity has provided assurances
that it will provide information in a timely
manner under subparagraph (D).
``(v) The entity meets such other
requirements as the Secretary provides by
regulation.
``(B) Independence requirements.--
``(i) In general.--Subject to clause (ii),
an entity meets the independence requirements
of this subparagraph with respect to any case
if the entity--
``(I) is not a related party (as
defined in subsection (g)(7));
``(II) does not have a material
familial, financial, or professional
relationship with such a party; and
``(III) does not otherwise have a
conflict of interest with such a party
(as determined under regulations).
``(ii) Exception for reasonable
compensation.--Nothing in clause (i) shall be
construed to prohibit receipt by a qualified
external review entity of compensation from a
plan or issuer for the conduct of external
review activities under this section if the
compensation is provided consistent with clause
(iii).
``(iii) Limitations on entity
compensation.--Compensation provided by a plan
or issuer to a qualified external review entity
in connection with reviews under this section
shall--
``(I) not exceed a reasonable
level; and
``(II) not be contingent on the
decision rendered by the entity or by
any independent medical reviewer.
``(C) Certification and recertification process.--
``(i) In general.--The initial
certification and recertification of a
qualified external review entity shall be
made--
``(I) under a process that is
recognized or approved by the
Secretary; or
``(II) by a qualified private
standard-setting organization that is
approved by the Secretary under clause
(iii).
``(ii) Process.--The Secretary shall not
recognize or approve a process under clause
(i)(I) unless the process applies standards (as
promulgated in regulations) that ensure that a
qualified external review entity--
``(I) will carry out (and has
carried out, in the case of
recertification) the responsibilities
of such an entity in accordance with
this section, including meeting
applicable deadlines;
``(II) will meet (and has met, in
the case of recertification)
appropriate indicators of fiscal
integrity;
``(III) will maintain (and has
maintained, in the case of
recertification) appropriate
confidentiality with respect to
individually identifiable health
information obtained in the course of
conducting external review activities;
and
``(IV) in the case recertification,
shall review the matters described in
clause (iv).
``(iii) Approval of qualified private
standard-setting organizations.--For purposes
of clause (i)(II), the Secretary may approve a
qualified private standard-setting organization
if the Secretary finds that the organization
only certifies (or recertifies) external review
entities that meet at least the standards
required for the certification (or
recertification) of external review entities
under clause (ii).
``(iv) Considerations in
recertifications.--In conducting
recertifications of a qualified external review
entity under this paragraph, the Secretary or
organization conducting the recertification
shall review compliance of the entity with the
requirements for conducting external review
activities under this section, including the
following:
``(I) Provision of information
under subparagraph (D).
``(II) Adherence to applicable
deadlines (both by the entity and by
independent medical reviewers it refers
cases to).
``(III) Compliance with limitations
on compensation (with respect to both
the entity and independent medical
reviewers it refers cases to).
``(IV) Compliance with applicable
independence requirements.
``(v) Period of certification or
recertification.--A certification or
recertification provided under this paragraph
shall extend for a period not to exceed 5
years.
``(vi) Revocation.--A certification or
recertification under this paragraph may be
revoked by the Secretary or by the organization
providing such certification upon a showing of
cause.
``(D) Provision of information.--
``(i) In general.--A qualified external
review entity shall provide to the Secretary,
in such manner and at such times as the
Secretary may require, such information
(relating to the denials which have been
referred to the entity for the conduct of
external review under this section) as the
Secretary determines appropriate to assure
compliance with the independence and other
requirements of this section to monitor and
assess the quality of its external review
activities and lack of bias in making
determinations. Such information shall include
information described in clause (ii) but shall
not include individually identifiable medical
information.
``(ii) Information to be included.--The
information described in this subclause with
respect to an entity is as follows:
``(I) The number and types of
denials for which a request for review
has been received by the entity.
``(II) The disposition by the
entity of such denials, including the
number referred to a independent
medical reviewer and the reasons for
such dispositions (including the
application of exclusions), on a plan
or issuer-specific basis and on a
health care specialty-specific basis.
``(III) The length of time in
making determinations with respect to
such denials.
``(IV) Updated information on the
information required to be submitted as
a condition of certification with
respect to the entity's performance of
external review activities.
``(iii) Information to be provided to
certifying organization.--
``(I) In general.--In the case of a
qualified external review entity which
is certified (or recertified) under
this subsection by a qualified private
standard-setting organization, at the
request of the organization, the entity
shall provide the organization with the
information provided to the Secretary
under clause (i).
``(II) Additional information.--
Nothing in this subparagraph shall be
construed as preventing such an
organization from requiring additional
information as a condition of
certification or recertification of an
entity.
``(iv) Use of information.--Information
provided under this subparagraph may be used by
the Secretary and qualified private standard-
setting organizations to conduct oversight of
qualified external review entities, including
recertification of such entities, and shall be
made available to the public in an appropriate
manner.
``(E) Limitation on liability.--No qualified
external review entity having a contract with a plan or
issuer, and no person who is employed by any such
entity or who furnishes professional services to such
entity (including as an independent medical reviewer),
shall be held by reason of the performance of any duty,
function, or activity required or authorized pursuant
to this section, to be civilly liable under any law of
the United States or of any State (or political
subdivision thereof) if there was no actual malice or
gross misconduct in the performance of such duty,
function, or activity.
``(i) Definitions.--In this section:
``(1) Authorized representative.--The term `authorized
representative' means, with respect to a participant or
beneficiary--
``(A) a person to whom a participant or beneficiary
has given express written consent to represent the
participant or beneficiary in any proceeding under this
section;
``(B) a person authorized by law to provide
substituted consent for the participant or beneficiary;
or
``(C) a family member of the participant or
beneficiary (or the estate of the participant or
beneficiary) or the participant's or beneficiary's
treating health care professional when the participant
or beneficiary is unable to provide consent.
``(2) Claim for benefits.--The term `claim for benefits'
means any request by a participant or beneficiary (or
authorized representative) for benefits (including requests
that are subject to authorization of coverage or utilization
review), for eligibility, or for payment in whole or in part,
for an item or service under a group health plan or health
insurance coverage offered by a health insurance issuer in
connection with a group health plan.
``(3) Group health plan.--The term `group health plan'
shall have the meaning given such term in section 733(a). In
applying this paragraph, excepted benefits described in section
733(c) shall not be treated as benefits consisting of medical
care.
``(4) Health insurance coverage.--The term `health
insurance coverage' has the meaning given such term in section
733(b)(1). In applying this paragraph, excepted benefits
described in section 733(c) shall not be treated as benefits
consisting of medical care.
``(5) Health insurance issuer.--The term `health insurance
issuer' has the meaning given such term in section 733(b)(2).
``(6) Prior authorization determination.--The term `prior
authorization determination' means a determination by the group
health plan or health insurance issuer offering health
insurance coverage in connection with a group health plan prior
to the provision of the items and services as a condition of
coverage of the items and services under the terms and
conditions of the plan or coverage.
``(7) Treating health care professional.--The term
`treating health care professional' with respect to a group
health plan, health insurance issuer or provider sponsored
organization means a physician (medical doctor or doctor of
osteopathy) or other health care practitioner who is acting
within the scope of his or her State licensure or certification
for the delivery of health care services and who is primarily
responsible for delivering those services to the participant or
beneficiary.
``(8) Utilization review.--The term `utilization review'
with respect to a group health plan or health insurance
coverage means procedures used in the determination of coverage
for a participant or beneficiary, such as procedures to
evaluate the medical necessity, appropriateness, efficacy,
quality, or efficiency of health care services, procedures or
settings, and includes prospective review, concurrent review,
second opinions, case management, discharge planning, or
retrospective review.''.
(b) Conforming Amendment.--The table of contents in section 1 of
the Employee Retirement Income Security Act of 1974 is amended by
inserting after the item relating to section 503 the following:
``Sec. 503A. Claims and internal appeals procedures for group health
plans.
``Sec. 503B. Independent external appeals procedures for group health
plans.''.
(c) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after 2 years after
the date of enactment of this Act. The Secretary shall issue all
regulations necessary to carry out the amendments made by this section
before the effective date thereof.
SEC. 2222. ENFORCEMENT.
Section 502(c) of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1132(c)) is amended by adding at the end the following:
``(8) The Secretary may assess a civil penalty against any plan of
up to $10,000 for the plan's failure or refusal to comply with any
deadline applicable under section 503B or any determination under such
section, except that in any case in which treatment was not commenced
by the plan in accordance with the determination of an independent
external reviewer, the Secretary shall assess a civil penalty of
$10,000 against the plan and the plan shall pay such penalty to the
participant or beneficiary involved.''.
Subtitle D--Remedies
SEC. 2231. AVAILABILITY OF COURT REMEDIES.
(a) In General.--Section 502 of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1132) is amended by adding at the end
the following:
``(n) Cause of Action Relating to Denial of a Claim for Health
Benefits.--
``(1) In general.--
``(A) Failure to comply with external medical
review.--In any case in which--
``(i) a designated decision-maker described
in paragraph (2) fails to exercise ordinary
care in approving coverage pursuant to the
written determination of an independent medical
reviewer under section 503B(d)(3)(F) that
reverses a denial of a claim for benefits; and
``(ii) the failure described in clause (i)
is the proximate cause of substantial harm to,
or the wrongful death of, the participant or
beneficiary;
such designated decision-maker shall be liable to the
participant or beneficiary (or the estate of such
participant or beneficiary) for economic and
noneconomic damages in connection with such failure and
such injury or death (subject to paragraph (4)).
``(B) Wrongful determination resulting in delay in
providing benefits.--In any case in which--
``(i) a designated decision-maker described
in paragraph (2) acts in bad faith in making a
final determination denying a claim for
benefits under section 503A(b);
``(ii) the denial described in clause (i)
is reversed by an independent medical reviewer
under section 503B(d); and
``(iii) the delay attributable to the
failure described in clause (i) is the
proximate cause of substantial harm to, or the
wrongful death of, the participant or
beneficiary;
such designated decision-maker shall be liable to the
participant or beneficiary (or the estate of such
participant or beneficiary) for economic and
noneconomic damages in connection with such failure and
such injury or death (subject to paragraph (4)).
``(2) Designated decision-makers for purposes of
liability.--An employer or plan sponsor shall not be liable
under any cause of action described in paragraph (1) if the
employer or plan sponsor complies with the following
provisions:
``(A) Appointment.--A group health plan may
designate one or more persons to serve as the
designated decision-maker for purposes of paragraph
(1). Such designated decision-makers shall have the
exclusive authority under the group health plan (or
under the health insurance coverage in the case of a
health insurance issuer offering coverage in connection
with a group health plan) to make determinations
described in section 503A with respect to claims for
benefits and determination to approve coverage pursuant
to written determination of independent medical
reviewers under section 503B, except that the plan
documents may expressly provide that the designated
decision-maker is subject to the direction of a named
fiduciary.
``(B) Procedures.--A designated decision-maker
shall--
``(i) be a person who is named in the plan
or coverage documents, or who, pursuant to
procedures specified in the plan or coverage
documents, is identified as the designated
decision-maker by--
``(I) a person who is an employer
or employee organization with respect
to the plan or issuer;
``(II) a person who is such an
employer and such an employee
organization acting jointly; or
``(III) a person who is a named
fiduciary;
``(ii) agree to accept appointment as a
designated decision-maker; and
``(iii) be identified in the plan or
coverage documents as required under section
714(b)(14).
``(C) Qualifications.--To be appointed as a
designated decision-maker under this paragraph, a
person shall be--
``(i) a plan sponsor;
``(ii) a group health plan;
``(iii) a health insurance issuer; or
``(iv) any other person who can provide
adequate evidence, in accordance with
regulations promulgated by the Secretary, of
the ability of the person to--
``(I) carry out the
responsibilities set forth in the plan
or coverage documents;
``(II) carry out the applicable
requirements of this subsection; and
``(III) meet other applicable
requirements under this Act, including
any financial obligation for liability
under this subsection.
``(D) Flexibility in administration.--A group
health plan, or health insurance issuer offering
coverage in connection with a group health plan, may
provide--
``(i) that any person or group of persons
may serve in more than one capacity with
respect to the plan or coverage (including
service as a designated decision-maker,
administrator, and named fiduciary); or
``(ii) that a designated decision-maker may
employ one or more persons to provide advice
with respect to any responsibility of such
decision-maker under the plan or coverage.
``(E) Failure to designate.--In any case in which a
designated decision-maker is not appointed under this
paragraph, the group health plan (or health insurance
issuer offering coverage in connection with the group
health plan), the administrator, or the party or
parties that bears the sole responsibility for making
the final determination under section 503A(b) (with
respect to an internal review), or for approving
coverage pursuant to the written determination of an
independent medical reviewer under section 503B, with
respect to a denial of a claim for benefits shall be
treated as the designated decision-maker for purposes
of liability under this section.
``(3) Requirement of exhaustion of independent medical
review.--Paragraph (1) shall apply only if a final
determination denying a claim for benefits under section
503A(b) has been referred for independent medical review under
section 503B(d) and a written determination by an independent
medical reviewer to reverse such final determination has been
issued with respect to such review.
``(4) Limitations on recovery of damages.--
``(A) Maximum award of noneconomic damages.--The
aggregate amount of liability for noneconomic loss in
an action under paragraph (1) may not exceed $350,000.
``(B) Increase in amount.--The amount referred to
in subparagraph (A) shall be increased or decreased,
for each calendar year that ends after December 31,
2001, by the same percentage as the percentage by which
the Consumer Price Index for All Urban Consumers
(United States city average), published by the Bureau
of Labor Statistics, for September of the preceding
calendar year has increased or decreased from the such
Index for September of 2001.
``(C) Joint and several liability.--In the case of
any action commenced pursuant to paragraph (1), the
defendant shall be liable only for the amount of
noneconomic damages attributable to such defendant in
direct proportion to such defendant's share of fault or
responsibility for the injury suffered by the
participant or beneficiary. In all such cases, the
liability of a defendant for noneconomic damages shall
be several and not joint.
``(D) Treatment of collateral source payments.--
``(i) In general.--In the case of any
action commenced pursuant to paragraph (1), the
total amount of damages received by a
participant or beneficiary under such action
shall be reduced, in accordance with clause
(ii), by any other payment that has been, or
will be, made to such participant or
beneficiary to compensate such participant or
beneficiary for the injury that was the subject
of such action.
``(ii) Amount of reduction.--The amount by
which an award of damages to a participant or
beneficiary for an injury shall be reduced
under clause (i) shall be--
``(I) the total amount of any
payments (other than such award) that
have been made or that will be made to
such participant or beneficiary to pay
costs of or compensate such participant
or beneficiary for the injury that was
the subject of the action; less
``(II) the amount paid by such
participant or beneficiary (or by the
spouse, parent, or legal guardian of
such participant or beneficiary) to
secure the payments described in
subclause (I).
``(iii) Determination of amounts from
collateral sources.--The reduction required
under clause (ii) shall be determined by the
court in a pretrial proceeding. At the
subsequent trial no evidence shall be admitted
as to the amount of any charge, payments, or
damage for which a participant or beneficiary--
``(I) has received payment from a
collateral source or the obligation for
which has been assured by a third
party; or
``(II) is, or with reasonable
certainty, will be eligible to receive
from a collateral source which will,
with reasonable certainty, be assumed
by a third party.
``(5) Affirmative defenses.--In the case of any cause of
action under paragraph (1), it shall be an affirmative defense
that--
``(A) the group health plan, or health insurance
issuer offering health insurance coverage in connection
with a group health plan, involved did not receive from
the participant or beneficiary (or authorized
representative) or the treating health care
professional (if any), sufficient information regarding
the medical condition of the participant or beneficiary
that was necessary to make a final determination on a
claim for benefits under section 503A(b);
``(B) the participant or beneficiary (or authorized
representative)--
``(i) was in possession of facts that were
sufficient to enable the participant or
beneficiary (or authorized representative) to
know that an expedited review under section
503A or 503B would have prevented the harm that
is the subject of the action; and
``(ii) failed to notify the plan or issuer
of the need for such an expedited review; or
``(C) the cause of action is based solely on the
failure of a qualified external review entity or an
independent medical reviewer to meet the timelines
applicable under section 503B.
Nothing in this paragraph shall be construed to limit the
application of any other affirmative defense that may be
applicable to the cause of action involved.
``(6) Waiver of internal review.--In the case of any cause
of action under paragraph (1), the waiver or nonwaiver of
internal review under section 503A(b)(1)(D) by the group health
plan, or health insurance issuer offering health insurance
coverage in connection with a group health plan, shall not be
used in determining liability.
``(7) Limitations on actions.--Paragraph (1) shall not
apply in connection with any action that is commenced more than
1 year after--
``(A) the date on which the last act occurred which
constituted a part of the failure referred to in such
paragraph; or
``(B) in the case of an omission, the last date on
which the decision-maker could have cured the failure.
``(8) Limitation on relief where defendant's position
previously supported upon external review.--In any case in
which the court finds the defendant to be liable in an action
under this subsection, to the extent that such liability is
based on a finding by the court of a particular failure
described in paragraph (1) and such finding is contrary to a
previous determination by an independent medical reviewer under
section 503B(d) with respect to such defendant, no relief shall
be available under this subsection in addition to the relief
otherwise available under subsection (a)(1)(B).
``(9) Construction.--Nothing in this subsection shall be
construed as authorizing a cause of action under paragraph (1)
for--
``(A) the failure of a group health plan or health
insurance issuer to provide an item or service that is
specifically excluded under the plan or coverage; or
``(B) any denial of a claim for benefits that was
not eligible for independent medical review under
section 503B(d).
``(10) Federal jurisdiction.--In the case of any action
commenced pursuant to paragraph (1) the district courts of the
United States shall have exclusive jurisdiction.
``(11) Definitions.--In this subsection:
``(A) Authorized representative.--The term
`authorized representative' has the meaning given such
term in section 503B(i).
``(B) Claim for benefits.--The term `claim for
benefits' shall have the meaning given such term in
section 503B(i), except that such term shall only
include claims for prior authorization determinations
(as such term is defined in section 503B(i)).
``(C) Group health plan.--The term `group health
plan' shall have the meaning given such term in section
733(a).
``(D) Health insurance coverage.--The term `health
insurance coverage' has the meaning given such term in
section 733(b)(1).
``(E) Health insurance issuer.--The term `health
insurance issuer' has the meaning given such term in
section 733(b)(2) (including health maintenance
organizations as defined in section 733(b)(3)).
``(F) Ordinary care.--The term `ordinary care'
means the care, skill, prudence, and diligence under
the circumstances prevailing at the time the care is
provided that a prudent individual acting in a like
capacity and familiar with the care being provided
would use in providing care of a similar character.
``(G) Substantial harm.--The term `substantial
harm' means the loss of life, loss or significant
impairment of limb or bodily function, significant
disfigurement, or severe and chronic physical pain.
``(12) Effective date.--The provisions of this subsection
shall apply to acts and omissions occurring on or after the
date of enactment of this subsection.''.
(b) Immunity from Liability for Provision of Insurance Options.--
(1) In general.--Section 502 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1132), as amended by
subsection (a), is further amended by adding at the end the
following:
``(o) Immunity from Liability for Provision of Insurance Options.--
``(1) In general.--No liability shall arise under
subsection (n) with respect to a participant or beneficiary
against a group health plan (other than a fully insured group
health plan) if such plan offers the participant or beneficiary
the coverage option described in paragraph (2).
``(2) Coverage option.--The coverage option described in
this paragraph is one under which the group health plan (other
than a fully insured group health plan), at the time of
enrollment or as provided for in paragraph (3), provides the
participant or beneficiary with the option to--
``(A) enroll for coverage under a fully insured
health plan; or
``(B) receive an individual benefit payment, in an
amount equal to the amount that would be contributed on
behalf of the participant or beneficiary by the plan
sponsor for enrollment in the group health plan, for
use by the participant or beneficiary in obtaining
health insurance coverage in the individual market.
``(3) Time of offering of option.--The coverage option
described in paragraph (2) shall be offered to a participant or
beneficiary--
``(A) during the first period in which the
individual is eligible to enroll under the group health
plan; or
``(B) during any special enrollment period provided
by the group health plan after the date of enactment of
the Patients' Bill of Rights Plus Act for purposes of
offering such coverage option.''.
(2) Amendments to Internal Revenue Code.--
(A) Exclusion from income.--Section 106 of the
Internal Revenue Code of 1986 (relating to
contributions by employer to accident and health plans)
is amended by adding at the end the following:
``(d) Treatment of Certain Coverage Option Under Self-Insured
Plans.--No amount shall be included in the gross income of an
individual by reason of--
``(1) the individual's right to elect a coverage option
described in section 502(o)(2) of the Employee Retirement
Income Security Act of 1974, or
``(2) the receipt by the individual of an individual
benefit payment described in section 502(o)(2)(A) of such
Act.''
(B) Nondiscrimination rules.--Section 105(h) of
such Code (relating to self-insured medical expense
reimbursement plans) is amended by adding at the end
the following:
``(11) Treatment of certain coverage options.--If a self-
insured medical reimbursement plan offers the coverage option
described in section 502(o)(2) of the Employee Retirement
Income Security Act of 1974, employees who elect such option
shall be treated as eligible to benefit under the plan and the
plan shall be treated as benefiting such employees.''
(c) Conforming Amendment.--Section 502(a)(1)(A) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1132(a)(1)(A)) is
amended by inserting ``or (n)'' after ``subsection (c)''.
SEC. 2232. LIMITATION ON CERTAIN CLASS ACTION LITIGATION.
(a) ERISA.--Section 502 of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1132), as amended by section 2231, is further
amended by adding at the end the following:
``(p) Limitation on Class Action Litigation.--A claim or cause of
action under section 502(n) may not be maintained as a class action.''.
(b) RICO.--Section 1964(c) of title 18, United States Code, is
amended--
(1) by inserting ``(1)'' after the subsection designation;
and
(2) by adding at the end the following:
``(2) No action may be brought under this subsection, or alleging
any violation of section 1962, against any person where the action
seeks relief for which a remedy may be provided under section 502 of
the Employee Retirement Income Security Act of 1974.''.
(c) Effective Date.--
(1) In general.--The amendments made by this section shall
apply to all civil actions that are filed on or after the date
of enactment of this Act.
(2) Pending civil actions.--Notwithstanding section 502(p)
of the Employee Retirement Income Security Act of 1974 and
section 1964(c)(2) of title 18, United States Code, such
sections 502(p) and 1964(c)(2) shall apply to civil actions
that are pending and have not been finally determined by
judgment or settlement prior to the date of enactment of this
Act if such actions are substantially similar in nature to the
claims or causes of actions referred to in such sections 502(p)
and 1964(c)(2).
SEC. 2233. SEVERABILITY.
If any provision of this subtitle, an amendment made by this
subtitle, or the application of such provision or amendment to any
person or circumstance is held to be unconstitutional, the remainder of
this subtitle, the amendments made by this subtitle, and the
application of the provisions of such to any person or circumstance
shall not be affected thereby.
TITLE XXIII--WOMEN'S HEALTH AND CANCER RIGHTS
SEC. 2301. WOMEN'S HEALTH AND CANCER RIGHTS.
(a) Short Title.--This section may be cited as the ``Women's Health
and Cancer Rights Act of 2000''.
(b) Findings.--Congress finds that--
(1) the offering and operation of health plans affect
commerce among the States;
(2) health care providers located in a State serve patients
who reside in the State and patients who reside in other
States; and
(3) in order to provide for uniform treatment of health
care providers and patients among the States, it is necessary
to cover health plans operating in 1 State as well as health
plans operating among the several States.
(c) Amendments to ERISA.--
(1) In general.--Subpart B of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of 1974, as
amended by section 2211(a), is further amended by adding at the
end the following:
``SEC. 715. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR
MASTECTOMIES AND LYMPH NODE DISSECTIONS FOR THE TREATMENT
OF BREAST CANCER AND COVERAGE FOR SECONDARY
CONSULTATIONS.
``(a) Inpatient Care.--
``(1) In general.--A group health plan, and a health
insurance issuer providing health insurance coverage in
connection with a group health plan, that provides medical and
surgical benefits shall ensure that inpatient coverage with
respect to the treatment of breast cancer is provided for a
period of time as is determined by the attending physician, in
consultation with the patient, to be medically necessary and
appropriate following--
``(A) a mastectomy;
``(B) a lumpectomy; or
``(C) a lymph node dissection for the treatment of
breast cancer.
``(2) Exception.--Nothing in this section shall be
construed as requiring the provision of inpatient coverage if
the attending physician and patient determine that a shorter
period of hospital stay is medically appropriate.
``(b) Prohibition on Certain Modifications.--In implementing the
requirements of this section, a group health plan, and a health
insurance issuer providing health insurance coverage in connection with
a group health plan, may not modify the terms and conditions of
coverage based on the determination by a participant or beneficiary to
request less than the minimum coverage required under subsection (a).
``(c) Notice.--A group health plan, and a health insurance issuer
providing health insurance coverage in connection with a group health
plan shall provide notice to each participant and beneficiary under
such plan regarding the coverage required by this section in accordance
with regulations promulgated by the Secretary. Such notice shall be in
writing and prominently positioned in any literature or correspondence
made available or distributed by the plan or issuer and shall be
transmitted--
``(1) in the next mailing made by the plan or issuer to the
participant or beneficiary;
``(2) as part of any yearly informational packet sent to
the participant or beneficiary; or
``(3) not later than January 1, 2001;
whichever is earlier.
``(d) Secondary Consultations.--
``(1) In general.--A group health plan, and a health
insurance issuer providing health insurance coverage in
connection with a group health plan, that provides coverage
with respect to medical and surgical services provided in
relation to the diagnosis and treatment of cancer shall ensure
that full coverage is provided for secondary consultations by
specialists in the appropriate medical fields (including
pathology, radiology, and oncology) to confirm or refute such
diagnosis. Such plan or issuer shall ensure that full coverage
is provided for such secondary consultation whether such
consultation is based on a positive or negative initial
diagnosis. In any case in which the attending physician
certifies in writing that services necessary for such a
secondary consultation are not sufficiently available from
specialists operating under the plan with respect to whose
services coverage is otherwise provided under such plan or by
such issuer, such plan or issuer shall ensure that coverage is
provided with respect to the services necessary for the
secondary consultation with any other specialist selected by
the attending physician for such purpose at no additional cost
to the individual beyond that which the individual would have
paid if the specialist was participating in the network of the
plan.
``(2) Exception.--Nothing in paragraph (1) shall be
construed as requiring the provision of secondary consultations
where the patient determines not to seek such a consultation.
``(e) Prohibition on Penalties or Incentives.--A group health plan,
and a health insurance issuer providing health insurance coverage in
connection with a group health plan, may not--
``(1) penalize or otherwise reduce or limit the
reimbursement of a provider or specialist because the provider
or specialist provided care to a participant or beneficiary in
accordance with this section;
``(2) provide financial or other incentives to a physician
or specialist to induce the physician or specialist to keep the
length of inpatient stays of patients following a mastectomy,
lumpectomy, or a lymph node dissection for the treatment of
breast cancer below certain limits or to limit referrals for
secondary consultations; or
``(3) provide financial or other incentives to a physician
or specialist to induce the physician or specialist to refrain
from referring a participant or beneficiary for a secondary
consultation that would otherwise be covered by the plan or
coverage involved under subsection (d).''.
(2) Clerical amendment.--The table of contents in section 1
of the Employee Retirement Income Security Act of 1974 is
amended by inserting after the item relating to section 714 the
following new item:
``Sec. 715. Required coverage for minimum hospital stay for
mastectomies and lymph node dissections for
the treatment of breast cancer and coverage
for secondary consultations.''.
(d) Amendments to PHSA Relating to the Group Market.--Subpart 2 of
part A of title XXVII of the Public Health Service Act (42 U.S.C.
300gg-4 et seq.) is amended by adding at the end the following new
section:
``SEC. 2707. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR
MASTECTOMIES AND LYMPH NODE DISSECTIONS FOR THE TREATMENT
OF BREAST CANCER AND COVERAGE FOR SECONDARY
CONSULTATIONS.
``(a) Inpatient Care.--
``(1) In general.--A group health plan, and a health
insurance issuer providing health insurance coverage in
connection with a group health plan, that provides medical and
surgical benefits shall ensure that inpatient coverage with
respect to the treatment of breast cancer is provided for a
period of time as is determined by the attending physician, in
consultation with the patient, to be medically necessary and
appropriate following--
``(A) a mastectomy;
``(B) a lumpectomy; or
``(C) a lymph node dissection for the treatment of
breast cancer.
``(2) Exception.--Nothing in this section shall be
construed as requiring the provision of inpatient coverage if
the attending physician and patient determine that a shorter
period of hospital stay is medically appropriate.
``(b) Prohibition on Certain Modifications.--In implementing the
requirements of this section, a group health plan, and a health
insurance issuer providing health insurance coverage in connection with
a group health plan, may not modify the terms and conditions of
coverage based on the determination by a participant or beneficiary to
request less than the minimum coverage required under subsection (a).
``(c) Notice.--A group health plan, and a health insurance issuer
providing health insurance coverage in connection with a group health
plan shall provide notice to each participant and beneficiary under
such plan regarding the coverage required by this section in accordance
with regulations promulgated by the Secretary. Such notice shall be in
writing and prominently positioned in any literature or correspondence
made available or distributed by the plan or issuer and shall be
transmitted--
``(1) in the next mailing made by the plan or issuer to the
participant or beneficiary;
``(2) as part of any yearly informational packet sent to
the participant or beneficiary; or
``(3) not later than January 1, 2001;
whichever is earlier.
``(d) Secondary Consultations.--
``(1) In general.--A group health plan, and a health
insurance issuer providing health insurance coverage in
connection with a group health plan that provides coverage with
respect to medical and surgical services provided in relation
to the diagnosis and treatment of cancer shall ensure that full
coverage is provided for secondary consultations by specialists
in the appropriate medical fields (including pathology,
radiology, and oncology) to confirm or refute such diagnosis.
Such plan or issuer shall ensure that full coverage is provided
for such secondary consultation whether such consultation is
based on a positive or negative initial diagnosis. In any case
in which the attending physician certifies in writing that
services necessary for such a secondary consultation are not
sufficiently available from specialists operating under the
plan with respect to whose services coverage is otherwise
provided under such plan or by such issuer, such plan or issuer
shall ensure that coverage is provided with respect to the
services necessary for the secondary consultation with any
other specialist selected by the attending physician for such
purpose at no additional cost to the individual beyond that
which the individual would have paid if the specialist was
participating in the network of the plan.
``(2) Exception.--Nothing in paragraph (1) shall be
construed as requiring the provision of secondary consultations
where the patient determines not to seek such a consultation.
``(e) Prohibition on Penalties or Incentives.--A group health plan,
and a health insurance issuer providing health insurance coverage in
connection with a group health plan, may not--
``(1) penalize or otherwise reduce or limit the
reimbursement of a provider or specialist because the provider
or specialist provided care to a participant or beneficiary in
accordance with this section;
``(2) provide financial or other incentives to a physician
or specialist to induce the physician or specialist to keep the
length of inpatient stays of patients following a mastectomy,
lumpectomy, or a lymph node dissection for the treatment of
breast cancer below certain limits or to limit referrals for
secondary consultations; or
``(3) provide financial or other incentives to a physician
or specialist to induce the physician or specialist to refrain
from referring a participant or beneficiary for a secondary
consultation that would otherwise be covered by the plan or
coverage involved under subsection (d).''.
(e) Amendments to PHSA Relating to the Individual Market.--The
first subpart 3 of part B of title XXVII of the Public Health Service
Act (42 U.S.C. 300gg-51 et seq.) (relating to other requirements) (42
U.S.C. 300gg-51 et seq.) is amended--
(1) by redesignating such subpart as subpart 2; and
(2) by adding at the end the following:
``SEC. 2753. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR
MASTECTOMIES AND LYMPH NODE DISSECTIONS FOR THE TREATMENT
OF BREAST CANCER AND SECONDARY CONSULTATIONS.
``The provisions of section 2707 shall apply to health insurance
coverage offered by a health insurance issuer in the individual market
in the same manner as they apply to health insurance coverage offered
by a health insurance issuer in connection with a group health plan in
the small or large group market.''.
(f) Amendments to the IRC.--
(1) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986, as amended by section 2202, is
further amended by inserting after section 9813 the following:
``SEC. 9814. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR
MASTECTOMIES AND LYMPH NODE DISSECTIONS FOR THE TREATMENT
OF BREAST CANCER AND COVERAGE FOR SECONDARY
CONSULTATIONS.
``(a) Inpatient Care.--
``(1) In general.--A group health plan that provides
medical and surgical benefits shall ensure that inpatient
coverage with respect to the treatment of breast cancer is
provided for a period of time as is determined by the attending
physician, in consultation with the patient, to be medically
necessary and appropriate following--
``(A) a mastectomy;
``(B) a lumpectomy; or
``(C) a lymph node dissection for the treatment of
breast cancer.
``(2) Exception.--Nothing in this section shall be
construed as requiring the provision of inpatient coverage if
the attending physician and patient determine that a shorter
period of hospital stay is medically appropriate.
``(b) Prohibition on Certain Modifications.--In implementing the
requirements of this section, a group health plan may not modify the
terms and conditions of coverage based on the determination by a
participant or beneficiary to request less than the minimum coverage
required under subsection (a).
``(c) Notice.--A group health plan shall provide notice to each
participant and beneficiary under such plan regarding the coverage
required by this section in accordance with regulations promulgated by
the Secretary. Such notice shall be in writing and prominently
positioned in any literature or correspondence made available or
distributed by the plan and shall be transmitted--
``(1) in the next mailing made by the plan to the
participant or beneficiary;
``(2) as part of any yearly informational packet sent to
the participant or beneficiary; or
``(3) not later than January 1, 2000;
whichever is earlier.
``(d) Secondary Consultations.--
``(1) In general.--A group health plan that provides
coverage with respect to medical and surgical services provided
in relation to the diagnosis and treatment of cancer shall
ensure that full coverage is provided for secondary
consultations by specialists in the appropriate medical fields
(including pathology, radiology, and oncology) to confirm or
refute such diagnosis. Such plan or issuer shall ensure that
full coverage is provided for such secondary consultation
whether such consultation is based on a positive or negative
initial diagnosis. In any case in which the attending physician
certifies in writing that services necessary for such a
secondary consultation are not sufficiently available from
specialists operating under the plan with respect to whose
services coverage is otherwise provided under such plan or by
such issuer, such plan or issuer shall ensure that coverage is
provided with respect to the services necessary for the
secondary consultation with any other specialist selected by
the attending physician for such purpose at no additional cost
to the individual beyond that which the individual would have
paid if the specialist was participating in the network of the
plan.
``(2) Exception.--Nothing in paragraph (1) shall be
construed as requiring the provision of secondary consultations
where the patient determines not to seek such a consultation.
``(e) Prohibition on Penalties.--A group health plan may not--
``(1) penalize or otherwise reduce or limit the
reimbursement of a provider or specialist because the provider
or specialist provided care to a participant or beneficiary in
accordance with this section;
``(2) provide financial or other incentives to a physician
or specialist to induce the physician or specialist to keep the
length of inpatient stays of patients following a mastectomy,
lumpectomy, or a lymph node dissection for the treatment of
breast cancer below certain limits or to limit referrals for
secondary consultations; or
``(3) provide financial or other incentives to a physician
or specialist to induce the physician or specialist to refrain
from referring a participant or beneficiary for a secondary
consultation that would otherwise be covered by the plan
involved under subsection (d).''.
(2) Clerical amendment.--The table of contents for chapter
100 of such Code is amended by inserting after the item
relating to section 9813 the following new item:
``Sec. 9814. Required coverage for minimum hospital stay for
mastectomies and lymph node dissections for
the treatment of breast cancer and coverage
for secondary consultations.''.
TITLE XXIV--GENETIC INFORMATION AND SERVICES
SEC. 2401. SHORT TITLE.
This title may be cited as the ``Genetic Information
Nondiscrimination in Health Insurance Act of 2000''.
SEC. 2402. AMENDMENTS TO EMPLOYEE RETIREMENT INCOME SECURITY ACT OF
1974.
(a) Prohibition of Health Discrimination on the Basis of Genetic
Information or Genetic Services.--
(1) No enrollment restriction for genetic services.--
Section 702(a)(1)(F) of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1182(a)(1)(F)) is amended by inserting
before the period the following: ``(including information about
a request for or receipt of genetic services)''.
(2) No discrimination in group premiums based on predictive
genetic information.--Subpart B of part 7 of subtitle B of
title I of the Employee Retirement Income Security Act of 1974,
as amended by section 2301(c), is further amended by adding at
the end the following:
``SEC. 716. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE
BASIS OF PREDICTIVE GENETIC INFORMATION.
``A group health plan, or a health insurance issuer offering group
health insurance coverage in connection with a group health plan, shall
not adjust premium or contribution amounts for a group on the basis of
predictive genetic information concerning any individual (including a
dependent) or family member of the individual (including information
about a request for or receipt of genetic services).''.
(3) Conforming amendments.--
(A) In general.--Section 702(b) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C.
1182(b)) is amended by adding at the end the following:
``(3) Reference to related provision.--For a provision
prohibiting the adjustment of premium or contribution amounts
for a group under a group health plan on the basis of
predictive genetic information (including information about a
request for or receipt of genetic services), see section
716.''.
(B) Table of contents.--The table of contents in
section 1 of the Employee Retirement Income Security
Act of 1974, as amended by section 2301, is further
amended by inserting after the item relating to section
715 the following new item:
``Sec. 716. Prohibiting premium discrimination against groups on the
basis of predictive genetic information.''.
(b) Limitation on Collection of Predictive Genetic Information.--
Section 702 of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1182) is amended by adding at the end the following:
``(c) Collection of Predictive Genetic Information.--
``(1) Limitation on requesting or requiring predictive
genetic information.--Except as provided in paragraph (2), a
group health plan, or a health insurance issuer offering health
insurance coverage in connection with a group health plan,
shall not request or require predictive genetic information
concerning any individual (including a dependent) or family
member of the individual (including information about a request
for or receipt of genetic services).
``(2) Information needed for diagnosis, treatment, or
payment.--
``(A) In general.--Notwithstanding paragraph (1), a
group health plan, or a health insurance issuer
offering health insurance coverage in connection with a
group health plan, that provides health care items and
services to an individual or dependent may request (but
may not require) that such individual or dependent
disclose, or authorize the collection or disclosure of,
predictive genetic information for purposes of
diagnosis, treatment, or payment relating to the
provision of health care items and services to such
individual or dependent.
``(B) Notice of confidentiality practices and
description of safeguards.--As a part of a request
under subparagraph (A), the group health plan, or a
health insurance issuer offering health insurance
coverage in connection with a group health plan, shall
provide to the individual or dependent a description of
the procedures in place to safeguard the
confidentiality, as described in subsection (d), of
such predictive genetic information.
``(d) Confidentiality with Respect to Predictive Genetic
Information.--
``(1) Notice of confidentiality practices.--
``(A) Preparation of written notice.--A group
health plan, or a health insurance issuer offering
health insurance coverage in connection with a group
health plan, shall post or provide, in writing and in a
clear and conspicuous manner, notice of the plan or
issuer's confidentiality practices, that shall
include--
``(i) a description of an individual's
rights with respect to predictive genetic
information;
``(ii) the procedures established by the
plan or issuer for the exercise of the
individual's rights; and
``(iii) the right to obtain a copy of the
notice of the confidentiality practices
required under this subsection.
``(B) Model notice.--The Secretary, in consultation
with the National Committee on Vital and Health
Statistics and the National Association of Insurance
Commissioners, and after notice and opportunity for
public comment, shall develop and disseminate model
notices of confidentiality practices. Use of the model
notice shall serve as a defense against claims of
receiving inappropriate notice.
``(2) Establishment of safeguards.--A group health plan, or
a health insurance issuer offering health insurance coverage in
connection with a group health plan, shall establish and
maintain appropriate administrative, technical, and physical
safeguards to protect the confidentiality, security, accuracy,
and integrity of predictive genetic information created,
received, obtained, maintained, used, transmitted, or disposed
of by such plan or issuer.''.
(c) Definitions.--Section 733(d) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1191b(d)) is amended by adding at the
end the following:
``(5) Family member.--The term `family member' means with
respect to an individual--
``(A) the spouse of the individual;
``(B) a dependent child of the individual,
including a child who is born to or placed for adoption
with the individual; and
``(C) all other individuals related by blood to the
individual or the spouse or child described in
subparagraph (A) or (B).
``(6) Genetic information.--The term `genetic information'
means information about genes, gene products, or inherited
characteristics that may derive from an individual or a family
member (including information about a request for or receipt of
genetic services).
``(7) Genetic services.--The term `genetic services' means
health services provided to obtain, assess, or interpret
genetic information for diagnostic and therapeutic purposes,
and for genetic education and counseling.
``(8) Predictive genetic information.--
``(A) In general.--The term `predictive genetic
information' means, in the absence of symptoms,
clinical signs, or a diagnosis of the condition related
to such information--
``(i) information about an individual's
genetic tests;
``(ii) information about genetic tests of
family members of the individual; or
``(iii) information about the occurrence of
a disease or disorder in family members.
``(B) Exceptions.--The term `predictive genetic
information' shall not include--
``(i) information about the sex or age of
the individual;
``(ii) information derived from physical
tests, such as the chemical, blood, or urine
analyses of the individual including
cholesterol tests; and
``(iii) information about physical exams of
the individual.
``(9) Genetic test.--The term `genetic test' means the
analysis of human DNA, RNA, chromosomes, proteins, and certain
metabolites, including analysis of genotypes, mutations,
phenotypes, or karyotypes, for the purpose of predicting risk
of disease in asymptomatic or undiagnosed individuals. Such
term does not include physical tests, such as the chemical,
blood, or urine analyses of the individual including
cholesterol tests, and physical exams of the individual, in
order to detect symptoms, clinical signs, or a diagnosis of
disease.''.
(d) Effective Date.--Except as provided in this section, this
section and the amendments made by this section shall apply with
respect to group health plans for plan years beginning 1 year after the
date of the enactment of this Act.
SEC. 2403. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.
(a) Amendments Relating to the Group Market.--
(1) Prohibition of health discrimination on the basis of
genetic information in the group market.--
(A) No enrollment restriction for genetic
services.--Section 2702(a)(1)(F) of the Public Health
Service Act (42 U.S.C. 300gg-1(a)(1)(F)) is amended by
inserting before the period the following: ``(including
information about a request for or receipt of genetic
services)''.
(B) No discrimination in premiums based on
predictive genetic information.--Subpart 2 of part A of
title XXVII of the Public Health Service Act (42 U.S.C.
300gg-4 et seq.), as amended by section 2301(d), is
amended by adding at the end the following new section:
``SEC. 2708. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE
BASIS OF PREDICTIVE GENETIC INFORMATION IN THE GROUP
MARKET.
``A group health plan, or a health insurance issuer offering group
health insurance coverage in connection with a group health plan shall
not adjust premium or contribution amounts for a group on the basis of
predictive genetic information concerning any individual (including a
dependent) or family member of the individual (including information
about a request for or receipt of genetic services).''.
(C) Conforming amendment.--Section 2702(b) of the
Public Health Service Act (42 U.S.C. 300gg-1(b)) is
amended by adding at the end the following:
``(3) Reference to related provision.--For a provision
prohibiting the adjustment of premium or contribution amounts
for a group under a group health plan on the basis of
predictive genetic information (including information about a
request for or receipt of genetic services), see section
2708.''.
(D) Limitation on collection and disclosure of
predictive genetic information.--Section 2702 of the
Public Health Service Act (42 U.S.C. 300gg-1) is
amended by adding at the end the following:
``(c) Collection of Predictive Genetic Information.--
``(1) Limitation on requesting or requiring predictive
genetic information.--Except as provided in paragraph (2), a
group health plan, or a health insurance issuer offering health
insurance coverage in connection with a group health plan,
shall not request or require predictive genetic information
concerning any individual (including a dependent) or a family
member of the individual (including information about a request
for or receipt of genetic services).
``(2) Information needed for diagnosis, treatment, or
payment.--
``(A) In general.--Notwithstanding paragraph (1), a
group health plan, or a health insurance issuer
offering health insurance coverage in connection with a
group health plan, that provides health care items and
services to an individual or dependent may request (but
may not require) that such individual or dependent
disclose, or authorize the collection or disclosure of,
predictive genetic information for purposes of
diagnosis, treatment, or payment relating to the
provision of health care items and services to such
individual or dependent.
``(B) Notice of confidentiality practices and
description of safeguards.--As a part of a request
under subparagraph (A), the group health plan, or a
health insurance issuer offering health insurance
coverage in connection with a group health plan, shall
provide to the individual or dependent a description of
the procedures in place to safeguard the
confidentiality, as described in subsection (d), of
such predictive genetic information.
``(d) Confidentiality with Respect to Predictive Genetic
Information.--
``(1) Notice of confidentiality practices.--
``(A) Preparation of written notice.--A group
health plan, or a health insurance issuer offering
health insurance coverage in connection with a group
health plan, shall post or provide, in writing and in a
clear and conspicuous manner, notice of the plan or
issuer's confidentiality practices, that shall
include--
``(i) a description of an individual's
rights with respect to predictive genetic
information;
``(ii) the procedures established by the
plan or issuer for the exercise of the
individual's rights; and
``(iii) the right to obtain a copy of the
notice of the confidentiality practices
required under this subsection.
``(B) Model notice.--The Secretary, in consultation
with the National Committee on Vital and Health
Statistics and the National Association of Insurance
Commissioners, and after notice and opportunity for
public comment, shall develop and disseminate model
notices of confidentiality practices. Use of the model
notice shall serve as a defense against claims of
receiving inappropriate notice.
``(2) Establishment of safeguards.--A group health plan, or
a health insurance issuer offering health insurance coverage in
connection with a group health plan, shall establish and
maintain appropriate administrative, technical, and physical
safeguards to protect the confidentiality, security, accuracy,
and integrity of predictive genetic information created,
received, obtained, maintained, used, transmitted, or disposed
of by such plan or issuer.''.
(2) Definitions.--Section 2791(d) of the Public Health
Service Act (42 U.S.C. 300gg-91(d)) is amended by adding at the
end the following:
``(15) Family member.--The term `family member' means, with
respect to an individual--
``(A) the spouse of the individual;
``(B) a dependent child of the individual,
including a child who is born to or placed for adoption
with the individual; and
``(C) all other individuals related by blood to the
individual or the spouse or child described in
subparagraph (A) or (B).
``(16) Genetic information.--The term `genetic information'
means information about genes, gene products, or inherited
characteristics that may derive from an individual or a family
member (including information about a request for or receipt of
genetic services).
``(17) Genetic services.--The term `genetic services' means
health services provided to obtain, assess, or interpret
genetic information for diagnostic and therapeutic purposes,
and for genetic education and counseling.
``(18) Predictive genetic information.--
``(A) In general.--The term `predictive genetic
information' means, in the absence of symptoms,
clinical signs, or a diagnosis of the condition related
to such information--
``(i) information about an individual's
genetic tests;
``(ii) information about genetic tests of
family members of the individual; or
``(iii) information about the occurrence of
a disease or disorder in family members.
``(B) Exceptions.--The term `predictive genetic
information' shall not include--
``(i) information about the sex or age of
the individual;
``(ii) information derived from physical
tests, such as the chemical, blood, or urine
analyses of the individual including
cholesterol tests; and
``(iii) information about physical exams of
the individual.
``(19) Genetic test.--The term `genetic test' means the
analysis of human DNA, RNA, chromosomes, proteins, and certain
metabolites, including analysis of genotypes, mutations,
phenotypes, or karyotypes, for the purpose of predicting risk
of disease in asymptomatic or undiagnosed individuals. Such
term does not include physical tests, such as the chemical,
blood, or urine analyses of the individual including
cholesterol tests, and physical exams of the individual, in
order to detect symptoms, clinical signs, or a diagnosis of
disease.''.
(e) Amendments to PHSA Relating to the Individual Market.--The
first subpart 3 of part B of title XXVII of the Public Health Service
Act (42 U.S.C. 300gg-51 et seq.) (relating to other requirements) (42
U.S.C. 300gg-51 et seq.), as amended by section 2301(e), is further
amended by adding at the end the following:
``SEC. 2754. PROHIBITION OF HEALTH DISCRIMINATION ON THE BASIS OF
PREDICTIVE GENETIC INFORMATION.
``(a) Prohibition on Predictive Genetic Information as a Condition
of Eligibility.--A health insurance issuer offering health insurance
coverage in the individual market may not use predictive genetic
information as a condition of eligibility of an individual to enroll in
individual health insurance coverage (including information about a
request for or receipt of genetic services).
``(b) Prohibition on Predictive Genetic Information in Setting
Premium Rates.--A health insurance issuer offering health insurance
coverage in the individual market shall not adjust premium rates for
individuals on the basis of predictive genetic information concerning
such an individual (including a dependent) or a family member of the
individual (including information about a request for or receipt of
genetic services).
``(c) Collection of Predictive Genetic Information.--
``(1) Limitation on requesting or requiring predictive
genetic information.--Except as provided in paragraph (2), a
health insurance issuer offering health insurance coverage in
the individual market shall not request or require predictive
genetic information concerning any individual (including a
dependent) or a family member of the individual (including
information about a request for or receipt of genetic
services).
``(2) Information needed for diagnosis, treatment, or
payment.--
``(A) in general.--Notwithstanding paragraph (1), a
health insurance issuer offering health insurance
coverage in the individual market that provides health
care items and services to an individual or dependent
may request (but may not require) that such individual
or dependent disclose, or authorize the collection or
disclosure of, predictive genetic information for
purposes of diagnosis, treatment, or payment relating
to the provision of health care items and services to
such individual or dependent.
``(B) Notice of confidentiality practices and
description of safeguards.--As a part of a request
under subparagraph (A), the health insurance issuer
offering health insurance coverage in the individual
market shall provide to the individual or dependent a
description of the procedures in place to safeguard the
confidentiality, as described in subsection (d), of
such predictive genetic information.
``(d) Confidentiality with Respect to Predictive Genetic
Information.--
``(1) Notice of confidentiality practices.--
``(A) Preparation of written notice.--A health
insurance issuer offering health insurance coverage in
the individual market shall post or provide, in writing
and in a clear and conspicuous manner, notice of the
issuer's confidentiality practices, that shall
include--
``(i) a description of an individual's
rights with respect to predictive genetic
information;
``(ii) the procedures established by the
issuer for the exercise of the individual's
rights; and
``(iii) the right to obtain a copy of the
notice of the confidentiality practices
required under this subsection.
``(B) Model notice.--The Secretary, in consultation
with the National Committee on Vital and Health
Statistics and the National Association of Insurance
Commissioners, and after notice and opportunity for
public comment, shall develop and disseminate model
notices of confidentiality practices. Use of the model
notice shall serve as a defense against claims of
receiving inappropriate notice.
``(2) Establishment of safeguards.--A health insurance
issuer offering health insurance coverage in the individual
market shall establish and maintain appropriate administrative,
technical, and physical safeguards to protect the
confidentiality, security, accuracy, and integrity of
predictive genetic information created, received, obtained,
maintained, used, transmitted, or disposed of by such
issuer.''.
(c) Effective Date.--The amendments made by this section shall
apply with respect to--
(1) group health plans, and health insurance coverage
offered in connection with group health plans, for plan years
beginning after 1 year after the date of enactment of this Act;
and
(2) health insurance coverage offered, sold, issued,
renewed, in effect, or operated in the individual market after
1 year after the date of enactment of this Act.
SEC. 2404. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.
(a) Prohibition of Health Discrimination on the Basis of Genetic
Information or Genetic Services.--
(1) No enrollment restriction for genetic services.--
Section 9802(a)(1)(F) of the Internal Revenue Code of 1986 is
amended by inserting before the period the following:
``(including information about a request for or receipt of
genetic services)''.
(2) No discrimination in group premiums based on predictive
genetic information.--
(A) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986, as amended by section
2301(f), is further amended by adding at the end the
following:
``SEC. 9815. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE
BASIS OF PREDICTIVE GENETIC INFORMATION.
``A group health plan shall not adjust premium or contribution
amounts for a group on the basis of predictive genetic information
concerning any individual (including a dependent) or a family member of
the individual (including information about a request for or receipt of
genetic services).''.
(B) Conforming amendment.--Section 9802(b) of the
Internal Revenue Code of 1986 is amended by adding at
the end the following:
``(3) Reference to related provision.--For a provision
prohibiting the adjustment of premium or contribution amounts
for a group under a group health plan on the basis of
predictive genetic information (including information about a
request for or the receipt of genetic services), see section
9815.''.
(C) Amendment to table of sections.--The table of
sections for subchapter B of chapter 100 of the
Internal Revenue Code of 1986, as amended by section
2301(f), is further amended by adding at the end the
following:
``Sec. 9815. Prohibiting premium discrimination against groups on the
basis of predictive genetic information.''.
(b) Limitation on Collection of Predictive Genetic Information.--
Section 9802 of the Internal Revenue Code of 1986 is amended by adding
at the end the following:
``(d) Collection of Predictive Genetic Information.--
``(1) Limitation on requesting or requiring predictive
genetic information.--Except as provided in paragraph (2), a
group health plan shall not request or require predictive
genetic information concerning any individual (including a
dependent) or a family member of the individual (including
information about a request for or receipt of genetic
services).
``(2) Information needed for diagnosis, treatment, or
payment.--
``(A) In general.--Notwithstanding paragraph (1), a
group health plan that provides health care items and
services to an individual or dependent may request (but
may not require) that such individual or dependent
disclose, or authorize the collection or disclosure of,
predictive genetic information for purposes of
diagnosis, treatment, or payment relating to the
provision of health care items and services to such
individual or dependent.
``(B) Notice of confidentiality practices;
description of safeguards.--As a part of a request
under subparagraph (A), the group health plan shall
provide to the individual or dependent a description of
the procedures in place to safeguard the
confidentiality, as described in subsection (e), of
such predictive genetic information.
``(e) Confidentiality with Respect to Predictive Genetic
Information.--
``(1) Notice of confidentiality practices.--
``(A) Preparation of written notice.--A group
health plan shall post or provide, in writing and in a
clear and conspicuous manner, notice of the plan's
confidentiality practices, that shall include--
``(i) a description of an individual's
rights with respect to predictive genetic
information;
``(ii) the procedures established by the
plan for the exercise of the individual's
rights; and
``(iii) the right to obtain a copy of the
notice of the confidentiality practices
required under this subsection.
``(B) Model notice.--The Secretary, in consultation
with the National Committee on Vital and Health
Statistics and the National Association of Insurance
Commissioners, and after notice and opportunity for
public comment, shall develop and disseminate model
notices of confidentiality practices. Use of the model
notice shall serve as a defense against claims of
receiving inappropriate notice.
``(2) Establishment of safeguards.--A group health plan
shall establish and maintain appropriate administrative,
technical, and physical safeguards to protect the
confidentiality, security, accuracy, and integrity of
predictive genetic information created, received, obtained,
maintained, used, transmitted, or disposed of by such plan.''.
(c) Definitions.--Section 9832(d) of the Internal Revenue Code of
1986 is amended by adding at the end the following:
``(6) Family member.--The term `family member' means, with
respect to an individual--
``(A) the spouse of the individual;
``(B) a dependent child of the individual,
including a child who is born to or placed for adoption
with the individual; and
``(C) all other individuals related by blood to the
individual or the spouse or child described in
subparagraph (A) or (B).
``(7) Genetic information.--The term `genetic information'
means information about genes, gene products, or inherited
characteristics that may derive from an individual or a family
member (including information about a request for or receipt of
genetic services).
``(8) Genetic services.--The term `genetic services' means
health services provided to obtain, assess, or interpret
genetic information for diagnostic and therapeutic purposes,
and for genetic education and counseling.
``(9) Predictive genetic information.--
``(A) In general.--The term `predictive genetic
information' means, in the absence of symptoms,
clinical signs, or a diagnosis of the condition related
to such information--
``(i) information about an individual's
genetic tests;
``(ii) information about genetic tests of
family members of the individual; or
``(iii) information about the occurrence of
a disease or disorder in family members.
``(B) Exceptions.--The term `predictive genetic
information' shall not include--
``(i) information about the sex or age of
the individual;
``(ii) information derived from physical
tests, such as the chemical, blood, or urine
analyses of the individual including
cholesterol tests; and
``(iii) information about physical exams of
the individual.
``(10) Genetic test.--The term `genetic test' means the
analysis of human DNA, RNA, chromosomes, proteins, and certain
metabolites, including analysis of genotypes, mutations,
phenotypes, or karyotypes, for the purpose of predicting risk
of disease in asymptomatic or undiagnosed individuals. Such
term does not include physical tests, such as the chemical,
blood, or urine analyses of the individual including
cholesterol tests, and physical exams of the individual, in
order to detect symptoms, clinical signs, or a diagnosis of
disease.''.
(d) Effective Date.--Except as provided in this section, this
section and the amendments made by this section shall apply with
respect to group health plans for plan years beginning after 1 year
after the date of the enactment of this Act.
TITLE XXV--PATIENT SAFETY AND ERRORS REDUCTION
SEC. 2501. SHORT TITLE.
This title may be cited as the ``Patient Safety and Errors
Reduction Act''.
SEC. 2502. PURPOSES.
It is the purpose of this title to--
(1) promote the identification, evaluation, and reporting
of medical errors;
(2) raise standards and expectations for improvements in
patient safety;
(3) reduce deaths, serious injuries, and other medical
errors through the implementation of safe practices at the
delivery level;
(4) develop error reduction systems with legal protections
to support the collection of information under such systems;
(5) extend existing confidentiality and peer review
protections to the reports relating to medical errors that are
reported under such systems that are developed for safety and
quality improvement purposes; and
(6) provide for the establishment of systems of information
collection, analysis, and dissemination to enhance the
knowledge base concerning patient safety.
SEC. 2503. AMENDMENT TO PUBLIC HEALTH SERVICE ACT.
Title IX of the Public Health Service Act (42 U.S.C. 299 et seq.)
is amended--
(1) by redesignating part C as part D;
(2) by redesignating sections 921 through 928, as sections
931 through 938, respectively;
(3) in section 938(1) (as so redesignated), by striking
``921'' and inserting ``931''; and
(4) by inserting after part B the following:
``PART C--REDUCING ERRORS IN HEALTH CARE
``SEC. 921. DEFINITIONS.
``In this part:
``(1) Adverse event.--The term `adverse event' means, with
respect to the patient of a provider of services, an untoward
incident, therapeutic misadventure, or iatrogenic injury
directly associated with the provision of health care items and
services by a health care provider or provider of services.
``(2) Center.--The term `Center' means the Center for
Quality Improvement and Patient Safety established under
section 922(b).
``(3) Close call.--The term `close call' means, with
respect to the patient of a provider of services, any event or
situation that--
``(A) but for chance or a timely intervention,
could have resulted in an accident, injury, or illness;
and
``(B) is directly associated with the provision of
health care items and services by a provider of
services.
``(4) Expert organization.--The term `expert organization'
means a third party acting on behalf of, or in conjunction
with, a provider of services to collect information about, or
evaluate, a medical event.
``(5) Health care oversight agency.--The term `health care
oversight agency' means an agency, entity, or person, including
the employees and agents thereof, that performs or oversees the
performance of any activities necessary to ensure the safety of
the health care system.
``(6) Health care provider.--The term `health care
provider' means--
``(A) any provider of services (as defined in
section 1861(u) of the Social Security Act); and
``(B) any person furnishing any medical or other
health care services as defined in section 1861(s)(1)
and (2) of such Act through, or under the authority of,
a provider of services described in subparagraph (A).
``(7) Provider of services.--The term `provider of
services' means a hospital, skilled nursing facility,
comprehensive outpatient rehabilitation facility, home health
agency, renal dialysis facility, ambulatory surgical center, or
hospice program, and any other entity specified in regulations
promulgated by the Secretary after public notice and comment.
``(8) Public health authority.--The term `public health
authority' means an agency or authority of the United States, a
State, a territory, a political subdivision of a State or
territory, and an Indian tribe that is responsible for public
health matters as part of its official mandate.
``(9) Medical event.--The term `medical event' means, with
respect to the patient of a provider of services, any sentinel
event, adverse event, or close call.
``(10) Medical event analysis entity.--The term `medical
event analysis entity' means an entity certified under section
923(a).
``(11) Root cause analysis.--
``(A) In general.--The term `root cause analysis'
means a process for identifying the basic or
contributing causal factors that underlie variation in
performance associated with medical events that--
``(i) has the characteristics described in
subparagraph (B);
``(ii) includes participation by the
leadership of the provider of services and
individuals most closely involved in the
processes and systems under review;
``(iii) is internally consistent; and
``(iv) includes the consideration of
relevant literature.
``(B) Characteristics.--The characteristics
described in this subparagraph include the following:
``(i) The analysis is interdisciplinary in
nature and involves those individuals who are
responsible for administering the reporting
systems.
``(ii) The analysis focuses primarily on
systems and processes rather than individual
performance.
``(iii) The analysis involves a thorough
review of all aspects of the process and all
contributing factors involved.
``(iv) The analysis identifies changes that
could be made in systems and processes, through
either redesign or development of new processes
or systems, that would improve performance and
reduce the risk of medical events.
``(12) Sentinel event.--The term `sentinel event' means,
with respect to the patient of a provider of services, an
unexpected occurrence that--
``(A) involves death or serious physical or
psychological injury (including loss of a limb); and
``(B) is directly associated with the provision of
health care items and services by a health care
provider or provider of services.
``SEC. 922. RESEARCH TO IMPROVE THE QUALITY AND SAFETY OF PATIENT CARE.
``(a) In General.--To improve the quality and safety of patient
care, the Director shall--
``(1) conduct and support research, evaluations and
training, support demonstration projects, provide technical
assistance, and develop and support partnerships that will
identify and determine the causes of medical errors and other
threats to the quality and safety of patient care;
``(2) identify and evaluate interventions and strategies
for preventing or reducing medical errors and threats to the
quality and safety of patient care;
``(3) identify, in collaboration with experts from the
public and private sector, reporting parameters to provide
consistency throughout the errors reporting system;
``(4) identify approaches for the clinical management of
complications from medical errors; and
``(5) establish mechanisms for the rapid dissemination of
interventions and strategies identified under this section for
which there is scientific evidence of effectiveness.
``(b) Center for Quality Improvement and Patient Safety.--
``(1) Establishment.--The Director shall establish a center
to be known as the Center for Quality Improvement and Patient
Safety to assist the Director in carrying out the requirements
of subsection (a).
``(2) Mission.--The Center shall--
``(A) provide national leadership for research and
other initiatives to improve the quality and safety of
patient care;
``(B) build public-private sector partnerships to
improve the quality and safety of patient care; and
``(C) serve as a national resource for research and
learning from medical errors.
``(3) Duties.--
``(A) In general.--In carrying out this section,
the Director, acting through the Center, shall consult
and build partnerships, as appropriate, with all
segments of the health care industry, including health
care practitioners and patients, those who manage
health care facilities, systems and plans, peer review
organizations, health care purchasers and policymakers,
and other users of health care research.
``(B) Required duties.--In addition to the broad
responsibilities that the Director may assign to the
Center for research and related activities that are
designed to improve the quality of health care, the
Director shall ensure that the Center--
``(i) builds scientific knowledge and
understanding of the causes of medical errors
in all health care settings and identifies or
develops and validates effective interventions
and strategies to reduce errors and improve the
safety and quality of patient care;
``(ii) promotes public and private sector
research on patient safety by--
``(I) developing a national patient
safety research agenda;
``(II) identifying promising
opportunities for preventing or
reducing medical errors; and
``(III) tracking the progress made
in addressing the highest priority
research questions with respect to
patient safety;
``(iii) facilitates the development of
voluntary national patient safety goals by
convening all segments of the health care
industry and tracks the progress made in
meeting those goals;
``(iv) analyzes national patient safety
data for inclusion in the annual report on the
quality of health care required under section
913(b)(2);
``(v) strengthens the ability of the United
States to learn from medical errors by--
``(I) developing the necessary
tools and advancing the scientific
techniques for analysis of errors;
``(II) providing technical
assistance as appropriate to reporting
systems; and
``(III) entering into contracts to
receive and analyze aggregate data from
public and private sector reporting
systems;
``(vi) supports dissemination and
communication activities to improve patient
safety, including the development of tools and
methods for educating consumers about patient
safety; and
``(vii) undertakes related activities that
the Director determines are necessary to enable
the Center to fulfill its mission.
``(C) Limitation.--Aggregate data gathered for the
purposes described in this section shall not include
specific patient, health care provider, or provider of
service identifiers.
``(c) Learning From Medical Errors.--
``(1) In general.--To enhance the ability of the health
care community in the United States to learn from medical
events, the Director shall--
``(A) carry out activities to increase scientific
knowledge and understanding regarding medical error
reporting systems;
``(B) carry out activities to advance the
scientific knowledge regarding the tools and techniques
for analyzing medical events and determining their root
causes;
``(C) carry out activities in partnership with
experts in the field to increase the capacity of the
health care community in the United States to analyze
patient safety data;
``(D) develop a confidential national safety
database of medical event reports;
``(E) conduct and support research, using the
database developed under subparagraph (D), into the
causes and potential interventions to decrease the
incidence of medical errors and close calls; and
``(F) ensure that information contained in the
national database developed under subparagraph (D) does
not include specific patient, health care provider, or
provider of service identifiers.
``(2) National patient safety database.--The Director
shall, in accordance with paragraph (1)(D), establish a
confidential national safety database (to be known as the
National Patient Safety Database) of reports of medical events
that can be used only for research to improve the quality and
safety of patient care. In developing and managing the National
Patient Safety Database, the Director shall--
``(A) ensure that the database is only used for its
intended purpose;
``(B) ensure that the database is only used by the
Agency, medical event analysis entities, and other
qualified entities or individuals as determined
appropriate by the Director and in accordance with
paragraph (3) or other criteria applied by the
Director;
``(C) ensure that the database is as comprehensive
as possible by aggregating data from Federal, State,
and private sector patient safety reporting systems;
``(D) conduct and support research on the most
common medical errors and close calls, their causes,
and potential interventions to reduce medical errors
and improve the quality and safety of patient care;
``(E) disseminate findings made by the Director,
based on the data in the database, to clinicians,
individuals who manage health care facilities, systems,
and plans, patients, and other individuals who can act
appropriately to improve patient safety; and
``(F) develop a rapid response capacity to provide
alerts when specific health care practices pose an
imminent threat to patients or health care
practitioners, or other providers of health care items
or services.
``(3) Confidentiality and peer review protections.--
Notwithstanding any other provision of law any information
(including any data, reports, records, memoranda, analyses,
statements, and other communications) developed by or on behalf
of a health care provider or provider of services with respect
to a medical event, that is contained in the National Patient
Safety Database shall be confidential in accordance with
section 925.
``(4) Patient safety reporting systems.--The Director shall
identify public and private sector patient safety reporting
systems and build scientific knowledge and understanding
regarding the most effective--
``(A) components of patient safety reporting
systems;
``(B) incentives intended to increase the rate of
error reporting;
``(C) approaches for undertaking root cause
analyses;
``(D) ways to provide feedback to those filing
error reports;
``(E) techniques and tools for collecting,
integrating, and analyzing patient safety data; and
``(F) ways to provide meaningful information to
patients, consumers, and purchasers that will enhance
their understanding of patient safety issues.
``(5) Training.--The Director shall support training
initiatives to build the capacity of the health care community
in the United States to analyze patient safety data and to act
on that data to improve patient safety.
``(d) Evaluation.--The Director shall recommend strategies for
measuring and evaluating the national progress made in implementing
safe practices identified by the Center through the research and
analysis required under subsection (b) and through the voluntary
reporting system established under subsection (c).
``(e) Implementation.--In implementing strategies to carry out the
functions described in subsections (b), (c), and (d), the Director may
contract with public or private entities on a national or local level
with appropriate expertise.
``SEC. 923. MEDICAL EVENT ANALYSIS ENTITIES.
``(a) In General.--The Director, based on information collected
under section 922(c), shall provide for the certification of entities
to collect and analyze information on medical errors, and to
collaborate with health care providers or providers of services in
collecting information about, or evaluating, certain medical events.
``(b) Compatibility of Collected Data.--To ensure that data
reported to the National Patient Safety Database under section
922(c)(2) concerning medical errors and close calls are comparable and
useful on an analytic basis, the Director shall require that the
entities described in subsection (c) follow the recommendations
regarding a common set of core measures for reporting that are
developed by the National Forum for Health Care Quality Measurement and
Reporting, or other voluntary private standard-setting organization
that is designated by the Director taking into account existing
measurement systems and in collaboration with experts from the public
and private sector.
``(c) Duties of Certified Entities.--
``(1) In general.--An entity that is certified under
subsection (a) shall collect and analyze information,
consistent with the requirement of subsection (b), provided to
the entity under section 924(a)(4) to improve patient safety.
``(2) Information to be reported to the entity.--A medical
event analysis entity shall, on a periodic basis and in a
format that is specified by the Director, submit to the
Director a report that contains--
``(A) a description of the medical events that were
reported to the entity during the period covered under
the report;
``(B) a description of any corrective action taken
by providers of services with respect to such medical
events or any other measures that are necessary to
prevent similar events from occurring in the future;
and
``(C) a description of the systemic changes that
entities have identified, through an analysis of the
medical events included in the report, as being needed
to improve patient safety.
``(3) Collaboration.--A medical event analysis entity that
is collaborating with a health care provider or provider of
services to address close calls and adverse events may, at the
request of the health care provider or provider of services--
``(A) provide expertise in the development of root
cause analyses and corrective action plan relating to
such close calls and adverse events; or
``(B) collaborate with such provider of services to
identify on-going risk reduction activities that may
enhance patient safety.
``(d) Confidentiality and Peer Review Protections.--Notwithstanding
any other provision of law, any information (including any data,
reports, records, memoranda, analyses, statements, and other
communications) collected by a medical event analysis entity or
developed by or on behalf of such an entity under this part shall be
confidential in accordance with section 925.
``(e) Termination and Renewal.--
``(1) In general.--The certification of an entity under
this section shall terminate on the date that is 3 years after
the date on which such certification was provided. Such
certification may be renewed at the discretion of the Director.
``(2) Noncompliance.--The Director may terminate the
certification of a medical event analysis entity if the
Director determines that such entity has failed to comply with
this section.
``(f) Implementation.--In implementing strategies to carry out the
functions described in subsection (c), the Director may contract with
public or private entities on a national or local level with
appropriate expertise.
``SEC. 924. PROVIDER OF SERVICES SYSTEMS FOR REPORTING MEDICAL EVENTS.
``(a) Internal Medical Event Reporting Systems.--Each provider of
services that elects to participate in a medical error reporting system
under this part shall--
``(1) establish a system for--
``(A) identifying, collecting information about,
and evaluating medical events that occur with respect
to a patient in the care of the provider of services or
a practitioner employed by the provider of services,
that may include--
``(i) the provision of a medically coherent
description of each event so identified;
``(ii) the provision of a clear and
thorough accounting of the results of the
investigation of such event under the system;
and
``(iii) a description of all corrective
measures taken in response to the event; and
``(B) determining appropriate follow-up actions to
be taken with respect to such events;
``(2) establish policies and procedures with respect to
when and to whom such events are to be reported;
``(3) take appropriate follow-up action with respect to
such events; and
``(4) submit to the appropriate medical event analysis
entity information that contains descriptions of the medical
events identified under paragraph (1)(A).
``(b) Promoting Identification, Evaluation, and Reporting of
Certain Medical Events.--
``(1) In general.--Notwithstanding any other provision of
law any information (including any data, reports, records,
memoranda, analyses, statements, and other communications)
developed by or on behalf of a provider of services with
respect to a medical event pursuant to a system established
under subsection (a) shall be privileged in accordance with
section 925.
``(2) Rules of construction.--Nothing in this subsection
shall be construed as prohibiting--
``(A) disclosure of a patient's medical record to
the patient;
``(B) a provider of services from complying with
the requirements of a health care oversight agency or
public health authority; or
``(C) such an agency or authority from disclosing
information transferred by a provider of services to
the public in a form that does not identify or permit
the identification of the health care provider or
provider of services or patient.
``SEC. 925. CONFIDENTIALITY.
``(a) Confidentiality and Peer Review Protections.--Notwithstanding
any other provision of law--
``(1) any information (including any data, reports,
records, memoranda, analyses, statements, and other
communications) developed by or on behalf of a health care
provider or provider of services with respect to a medical
event, that is contained in the National Patient Safety
Database, collected by a medical event analysis entity, or
developed by or on behalf of such an entity, or collected by a
health care provider or provider or services for use under
systems that are developed for safety and quality improvement
purposes under this part--
``(A) shall be privileged, strictly confidential,
and may not be disclosed by any other person to which
such information is transferred without the
authorization of the health care provider or provider
of services; and
``(B) shall--
``(i) be protected from disclosure by
civil, criminal, or administrative subpoena;
``(ii) not be subject to discovery or
otherwise discoverable in connection with a
civil, criminal, or administrative proceeding;
``(iii) not be subject to disclosure
pursuant to section 552 of title 5, United
States Code (the Freedom of Information Act)
and any other similar Federal or State statute
or regulation; and
``(iv) not be admissible as evidence in any
civil, criminal, or administrative proceeding;
without regard to whether such information is held by
the provider or by another person to which such
information was transferred;
``(2) the transfer of any such information by a provider of
services to a health care oversight agency, an expert
organization, a medical event analysis entity, or a public
health authority, shall not be treated as a waiver of any
privilege or protection established under paragraph (1) or
established under State law.
``(b) Penalty.--It shall be unlawful for any person to disclose any
information described in subsection (a) other than for the purposes
provided in such subsection. Any person violating the provisions of
this section shall, upon conviction, be fined in accordance with title
18, United States Code, and imprisoned for not more than 6 months, or
both.
``(c) Application of provisions.--The protections provided under
subsection (a) and the penalty provided for under subsection (b) shall
apply to any information (including any data, reports, memoranda,
analyses, statements, and other communications) collected or developed
pursuant to research, including demonstration projects, with respect to
medical error reporting supported by the Director under this part.
``SEC. 926. AUTHORIZATION OF APPROPRIATIONS.
``There is authorized to be appropriated to carry out this part,
$50,000,000 for fiscal year 2001, and such sums as may be necessary for
subsequent fiscal years.''.
SEC. 2504. EFFECTIVE DATE.
The amendments made by section 2503 shall become effective on the
date of the enactment of this Act.
This Act may be cited as the ``Departments of Labor, Health and
Human Services, and Education, and Related Agencies Appropriations Act,
2001''.
Attest:
Secretary.
106th CONGRESS
2d Session
H. R. 4577
_______________________________________________________________________
AMENDMENT