[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