    [Congressional Bills 106th Congress]
    [From the U.S. Government Publishing Office]
    [H.R. 4577 Public Print (PP)]

      2d Session
                                    H. R. 4577

    _______________________________________________________________________

                        IN THE HOUSE OF REPRESENTATIVES

                                 June 30, 2000

        Ordered to be printed with the amendments of the Senate numbered

    _______________________________________________________________________

                                     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.

        Be it enacted by the Senate and House of Representatives of the
    United States of America in Congress assembled, (1)<DELETED>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:

                <DELETED>TITLE I--DEPARTMENT OF LABOR</DELETED>

           <DELETED>Employment and Training Administration</DELETED>

              <DELETED>training and employment services</DELETED>

    <DELETED>    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; the Women in Apprenticeship and
    Nontraditional Occupations Act; and the National Skill Standards Act of
    1994, $2,552,495,000 plus reimbursements, of which $1,340,155,000 is
    available for obligation for the period July 1, 2001 through June 30,
    2002; of which $1,175,965,000 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 $175,000,000 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.</DELETED>
    <DELETED>    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.</DELETED>

      <DELETED>community service employment for older americans</DELETED>

    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>

        <DELETED>federal unemployment benefits and allowances</DELETED>

    <DELETED>    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.</DELETED>

         <DELETED>state unemployment insurance and employment service
                              operations</DELETED>

    <DELETED>    For authorized administrative expenses, $43,452,000,
    together with not to exceed $3,054,338,000 (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 $43,452,000, together with not
    to exceed $738,283,000 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.</DELETED>

          <DELETED>advances to the unemployment trust fund and other
                                funds</DELETED>

    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>

                   <DELETED>program administration</DELETED>

    <DELETED>    For expenses of administering employment and training
    programs, $100,944,000, 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 $45,056,000, which may be expended
    from the Employment Security Administration account in the Unemployment
    Trust Fund.</DELETED>

         <DELETED>Pension and Welfare Benefits Administration</DELETED>

                    <DELETED>salaries and expenses</DELETED>

    <DELETED>    For necessary expenses for the Pension and Welfare
    Benefits Administration, $98,934,000.</DELETED>

            <DELETED>Pension Benefit Guaranty Corporation</DELETED>

          <DELETED>pension benefit guaranty corporation fund</DELETED>

    <DELETED>    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 $11,148,000 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.</DELETED>

             <DELETED>Employment Standards Administration</DELETED>

                    <DELETED>salaries and expenses</DELETED>

    <DELETED>    For necessary expenses for the Employment Standards
    Administration, including reimbursement to State, Federal, and local
    agencies and their employees for inspection services rendered,
    $337,030,000, together with $1,740,000 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 as 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.).</DELETED>

                      <DELETED>special benefits</DELETED>

                <DELETED>(including transfer of funds)</DELETED>

    <DELETED>    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.</DELETED>

              <DELETED>black lung disability trust fund</DELETED>

                <DELETED>(including transfer of funds)</DELETED>

    <DELETED>    For payments from the Black Lung Disability Trust Fund,
    $1,028,000,000, of which $975,343,000 shall be available until
    September 30, 2002, for payment of all benefits as 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, and of which $30,393,000 shall be available for
    transfer to 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 payment into miscellaneous receipts
    for the expenses of the Department of Treasury, for expenses of
    operation and administration of the Black Lung Benefits program as
    authorized by section 9501(d)(5) of that Act: Provided, That, in
    addition, such amounts as may be necessary may be charged to the
    subsequent year appropriation for the payment of compensation,
    interest, or other benefits for any period subsequent to August 15 of
    the current year.</DELETED>

        <DELETED>Occupational Safety and Health Administration</DELETED>

                    <DELETED>salaries and expenses</DELETED>

    <DELETED>    For necessary expenses for the Occupational Safety and
    Health Administration, $381,620,000, including not to exceed
    $83,771,000 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, 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--</DELETED>
            <DELETED>    (1) to provide, as authorized by such Act,
            consultation, technical assistance, educational and training
            services, and to conduct surveys and studies;</DELETED>
            <DELETED>    (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;</DELETED>
            <DELETED>    (3) to take any action authorized by such Act with
            respect to imminent dangers;</DELETED>
            <DELETED>    (4) to take any action authorized by such Act with
            respect to health hazards;</DELETED>
            <DELETED>    (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</DELETED>
            <DELETED>    (6) to take any action authorized by such Act with
            respect to complaints of discrimination against employees for
            exercising rights under such Act:</DELETED>
    <DELETED>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.</DELETED>

            <DELETED>Mine Safety and Health Administration</DELETED>

                    <DELETED>salaries and expenses</DELETED>

    <DELETED>    For necessary expenses for the Mine Safety and Health
    Administration, $233,000,000, including purchase and bestowal of
    certificates and trophies in connection with mine rescue and first-aid
    work, and the hire of passenger motor vehicles; and, 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; 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.</DELETED>

                 <DELETED>Bureau of Labor Statistics</DELETED>

                    <DELETED>salaries and expenses</DELETED>

    <DELETED>    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, $372,743,000,
    together with not to exceed $67,257,000, which may be expended from the
    Employment Security Administration account in the Unemployment Trust
    Fund.</DELETED>

                   <DELETED>Departmental Management</DELETED>

                    <DELETED>salaries and expenses</DELETED>

    <DELETED>    For necessary expenses for Departmental Management,
    including the hire of three sedans, and including up to $7,241,000 for
    the President's Committee on Employment of People With Disabilities,
    and including the management or operation of Departmental bilateral and
    multilateral foreign technical assistance, $244,579,000; together with
    not to exceed $310,000, which may be expended from the Employment
    Security Administration account in the Unemployment Trust Fund:
    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.).</DELETED>

           <DELETED>assistant secretary for veterans employment and
                               training</DELETED>

    <DELETED>    Not to exceed $184,341,000 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, $16,936,000, of which $7,300,000
    shall be available for obligation for the period July 1, 2001, through
    June 30, 2002.</DELETED>

                 <DELETED>office of inspector general</DELETED>

    <DELETED>    For salaries and expenses of the Office of Inspector
    General in carrying out the provisions of the Inspector General Act of
    1978, as amended, $48,095,000, together with not to exceed $3,830,000,
    which may be expended from the Employment Security Administration
    account in the Unemployment Trust Fund.</DELETED>

                     <DELETED>GENERAL PROVISIONS</DELETED>

    <DELETED>    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.</DELETED>

                     <DELETED>(transfer of funds)</DELETED>

    <DELETED>    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.</DELETED>
    <DELETED>    Sec. 103. 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.</DELETED>
    <DELETED>    This title may be cited as the ``Department of Labor
    Appropriations Act, 2001''.</DELETED>

      <DELETED>TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES</DELETED>

        <DELETED>Health Resources and Services Administration</DELETED>

                <DELETED>health resources and services</DELETED>

    <DELETED>    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, $4,684,232,000, 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: 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 for the collection of fees
    authorized by section 1128E(d)(2) of the Health Insurance Portability
    and Accountability Act of 1996 for the full disclosure of information
    under the Act sufficient to recover the full costs of operating the
    Healthcare Integrity and Protection Data Bank, and shall remain
    available until expended to carry out that Act: 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, $238,932,000 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 $554,000,000 shall be for State
    AIDS Drug Assistance Programs authorized by section 2616 of the Public
    Health Service Act: Provided further, That, notwithstanding section
    502(a)(1) of the Social Security Act, not to exceed $109,148,000 is
    available for carrying out special projects of regional and national
    significance pursuant to section 501(a)(2) of such Act.</DELETED>
    <DELETED>    For special projects of regional and national significance
    under section 501(a)(2) of the Social Security Act, $30,000,000, which
    shall become available on October 1, 2001, and shall remain available
    until September 30, 2002: Provided, That such amount shall not be
    counted toward compliance with the allocation required in section
    502(a)(1) of such Act: Provided further, That such amount shall be used
    only for making competitive grants to provide abstinence education (as
    defined in section 510(b)(2) of such Act) to adolescents and for
    evaluations (including longitudinal evaluations) of activities under
    the grants and for Federal costs of administering the grants: Provided
    further, That grants shall be made only to public and private entities
    which agree that, with respect to an adolescent to whom the entities
    provide abstinence education under such grant, the entities will not
    provide to that adolescent any other education regarding sexual
    conduct, except that, in the case of an entity expressly required by
    law to provide health information or services the adolescent shall not
    be precluded from seeking health information or services from the
    entity in a different setting than the setting in which the abstinence
    education was provided: Provided further, That the funds expended for
    such evaluations may not exceed 3.5 percent of such amount.</DELETED>

          <DELETED>health education assistance loans program</DELETED>

    <DELETED>    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.</DELETED>

       <DELETED>vaccine injury compensation program trust fund</DELETED>

    <DELETED>    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.</DELETED>

         <DELETED>Centers for Disease Control and Prevention</DELETED>

           <DELETED>disease control, research, and training</DELETED>

    <DELETED>    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, $3,290,369,000, of which
    $145,000,000 shall remain available until expended 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: Provided, That in addition to amounts provided herein, up
    to $71,690,000 shall be available from amounts available under section
    241 of the Public Health Service Act, to carry out the National Center
    for Health Statistics surveys: 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 notwithstanding any other
    provision of law, a single contract or related contracts for the
    development and construction of laboratory building 18 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 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 10
    States.</DELETED>

                <DELETED>National Institutes of Health</DELETED>

                  <DELETED>national cancer institute</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to cancer, $3,793,587,000.</DELETED>

          <DELETED>national heart, lung, and blood institute</DELETED>

    <DELETED>    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, $2,321,320,000.</DELETED>

            <DELETED>national institute of dental and craniofacial
                               research</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to dental disease,
    $309,007,000.</DELETED>

       <DELETED>national institute of diabetes and digestive and kidney
                               diseases</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to diabetes and digestive and kidney
    disease, $1,315,530,000.</DELETED>

           <DELETED>national institute of neurological disorders and
                                stroke</DELETED>

    <DELETED>     For carrying out section 301 and title IV of the Public
    Health Service Act with respect to neurological disorders and stroke,
    $1,185,767,000.</DELETED>

             <DELETED>national institute of allergy and infectious
                               diseases</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to allergy and infectious diseases,
    $2,062,126,000.</DELETED>

       <DELETED>national institute of general medical sciences</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to general medical sciences,
    $1,548,313,000.</DELETED>

             <DELETED>national institute of child health and human
                             development</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to child health and human development,
    $984,300,000.</DELETED>

                   <DELETED>national eye institute</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to eye diseases and visual disorders,
    $514,673,000.</DELETED>

     <DELETED>national institute of environmental health sciences</DELETED>

    <DELETED>    For carrying out sections 301 and 311 and title IV of the
    Public Health Service Act with respect to environmental health
    sciences, $506,730,000.</DELETED>

                 <DELETED>national institute on aging</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to aging, $790,299,000.</DELETED>

     <DELETED>national institute of arthritis and musculoskeletal and skin
                               diseases</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to arthritis and musculoskeletal and
    skin diseases, $400,025,000.</DELETED>

        <DELETED>national institute on deafness and other communication
                              disorders</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to deafness and other communication
    disorders, $301,787,000.</DELETED>

           <DELETED>national institute of nursing research</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to nursing research,
    $102,312,000.</DELETED>

     <DELETED>national institute on alcohol abuse and alcoholism</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to alcohol abuse and alcoholism,
    $349,216,000.</DELETED>

              <DELETED>national institute on drug abuse</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to drug abuse, $788,201,000.</DELETED>

             <DELETED>national institute of mental health</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to mental health,
    $1,114,638,000.</DELETED>

          <DELETED>national human genome research institute</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to human genome research,
    $386,410,000.</DELETED>

           <DELETED>national center for research resources</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to research resources and general
    research support grants, $832,027,000: 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.</DELETED>

            <DELETED>john e. fogarty international center</DELETED>

    <DELETED>    For carrying out the activities at the John E. Fogarty
    International Center, $50,299,000.</DELETED>

                <DELETED>national library of medicine</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to health information communications,
    $256,281,000, 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.</DELETED>

          <DELETED>national center for complementary and alternative
                               medicine</DELETED>

    <DELETED>    For carrying out section 301 and title IV of the Public
    Health Service Act with respect to complementary and alternative
    medicine, $78,880,000.</DELETED>

                   <DELETED>office of the director</DELETED>

                <DELETED>(including transfer of funds)</DELETED>

    <DELETED>    For carrying out the responsibilities of the Office of the
    Director, National Institutes of Health, $342,307,000, 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 1 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.</DELETED>

                  <DELETED>buildings and facilities</DELETED>

    <DELETED>    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, $178,700,000, to
    remain available until expended, of which $47,300,000 shall be for the
    National 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.</DELETED>

              <DELETED>Substance Abuse and Mental Health Services
                            Administration</DELETED>

         <DELETED>substance abuse and mental health services</DELETED>

    <DELETED>    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, $2,727,626,000.</DELETED>

         <DELETED>Agency for Healthcare Research and Quality</DELETED>

               <DELETED>healthcare research and quality</DELETED>

    <DELETED>    For carrying out titles III and IX of the Public Health
    Service Act, and part A of title XI of the Social Security Act,
    $123,669,000; in addition, 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
    $99,980,000.</DELETED>

            <DELETED>Health Care Financing Administration</DELETED>

                <DELETED>grants to states for medicaid</DELETED>

    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>

             <DELETED>payments to health care trust funds</DELETED>

    <DELETED>    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.</DELETED>

                     <DELETED>program management</DELETED>

    <DELETED>    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 $1,866,302,000, 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 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, for the current
    fiscal year, not more that $630,000,000 may be made available under
    section 1817(k)(4) of the Social Security Act (42 U.S.C. 1395i(k)(4))
    from the Health Care Fraud and Abuse Control Account of the Federal
    Hospital Insurance Trust Fund to carry out the Medicare Integrity
    Program under section 1893 of such Act.</DELETED>

       <DELETED>health maintenance organization loan and loan guarantee
                                 fund</DELETED>

    <DELETED>    For carrying out subsections (d) and (e) of section 1308
    of the Public Health Service Act, any amounts received by the Secretary
    in connection with loans and loan guarantees under title XIII of the
    Public Health Service Act, to be available without fiscal year
    limitation for the payment of outstanding obligations. During fiscal
    year 2001, no commitments for direct loans or loan guarantees shall be
    made.</DELETED>

          <DELETED>Administration for Children and Families</DELETED>

     <DELETED>payments to states for child support enforcement and family
                           support programs</DELETED>

    <DELETED>    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),
    $2,473,800,000, to remain available until expended; and for such
    purposes for the first quarter of fiscal year 2002,
    $1,000,000,000.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>

              <DELETED>low income home energy assistance</DELETED>

    <DELETED>    For making payments under title XXVI of the Omnibus Budget
    Reconciliation Act of 1981, $1,100,000,000, to be available for
    obligation in the period October 1, 2001 through September 30,
    2002.</DELETED>
    <DELETED>    For making payments under title XXVI of such Act,
    $300,000,000: Provided, That these funds are hereby designated by
    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 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 the Balanced Budget and Emergency
    Deficit Control Act of 1985.</DELETED>

               <DELETED>refugee and entrant assistance</DELETED>

    <DELETED>    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), $423,109,000: Provided, That funds appropriated
    pursuant to section 414(a) of the Immigration and Nationality Act for
    fiscal year 2001 shall be available for the costs of assistance
    provided and other activities through September 30, 2003.</DELETED>
    <DELETED>    For carrying out section 5 of the Torture Victims Relief
    Act of 1998 (Public Law 105-320), $10,000,000.</DELETED>

     <DELETED>payments to states for the child care and development block
                                grant</DELETED>

    <DELETED>    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, $400,000,000; and to become available on October 1,
    2001 and remain available through September 30, 2002, $2,000,000,000:
    Provided, That of the funds appropriated for each of fiscal years 2001
    and 2002, $19,120,000 shall be available for child care resource and
    referral and school-aged child care activities: Provided further, That
    of the funds provided for fiscal year 2002, $172,672,000 shall be
    reserved by the States for activities authorized under section 658G of
    the Omnibus Budget Reconciliation Act of 1981 (The Child Care and
    Development Block Grant Act of 1990), such funds to be in addition to
    the amounts required to be reserved by the States under section
    658G.</DELETED>

                 <DELETED>social services block grant</DELETED>

    <DELETED>    For making grants to States pursuant to section 2002 of
    the Social Security Act, $1,700,000,000: 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
    $1,700,000,000.</DELETED>

           <DELETED>children and families services programs</DELETED>

                   <DELETED>(including rescissions)</DELETED>

    <DELETED>    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, and sections 40155,
    40211, and 40241 of Public law 103-322; 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, $7,231,253,000, of which $43,000,000, 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 $595,376,000
    shall be for making payments under the Community Services Block Grant
    Act; and of which $5,667,000,000 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.</DELETED>
    <DELETED>    Funds appropriated for fiscal year 2001 under section
    429A(e), part B of title IV of the Social Security Act shall be reduced
    by $6,000,000.</DELETED>
    <DELETED>    Funds appropriated for fiscal year 2001 under section
    413(h)(1) of the Social Security Act shall be reduced by
    $15,000,000.</DELETED>

             <DELETED>promoting safe and stable families</DELETED>

    <DELETED>    For carrying out section 430 of the Social Security Act,
    $305,000,000.</DELETED>

           <DELETED>payments to states for foster care and adoption
                              assistance</DELETED>

    <DELETED>    For making payments to States or other non-Federal
    entities under title IV-E of the Social Security Act,
    $4,863,100,000.</DELETED>
    <DELETED>    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.</DELETED>

                   <DELETED>Administration on Aging</DELETED>

                   <DELETED>aging services programs</DELETED>

    <DELETED>    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, $925,805,000: 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.</DELETED>

                   <DELETED>Office of the Secretary</DELETED>

               <DELETED>general departmental management</DELETED>

    <DELETED>    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,
    $206,780,000, 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.</DELETED>

                 <DELETED>office of inspector general</DELETED>

    <DELETED>    For expenses necessary for the Office of Inspector General
    in carrying out the provisions of the Inspector General Act of 1978, as
    amended, $31,394,000: Provided, That, for the current fiscal year, not
    more than $120,000,000 may be made available under section
    1817(k)(3)(A) of the Social Security Act (42 U.S.C. 1395i(k)(3)(A))
    from the Health Care Fraud and Abuse Control Account of the Federal
    Hospital Insurance Trust Fund for purposes of the activities of the
    Office of Inspector General with respect to the Medicare and Medicaid
    programs.</DELETED>

                   <DELETED>office for civil rights</DELETED>

    <DELETED>    For expenses necessary for the Office for Civil Rights,
    $18,774,000, 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.</DELETED>

                       <DELETED>policy research</DELETED>

    <DELETED>    For carrying out, to the extent not otherwise provided,
    research studies under section 1110 of the Social Security Act,
    $16,738,000.</DELETED>

         <DELETED>retirement pay and medical benefits for commissioned
                               officers</DELETED>

    <DELETED>    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.</DELETED>

      <DELETED>public health and social services emergency fund</DELETED>

    <DELETED>    For expenses necessary to support activities related to
    countering potential biological, disease and chemical threats to
    civilian populations, $236,600,000: Provided, That this amount is
    distributed as follows: Centers for Disease Control and Prevention,
    $182,000,000, of which $30,000,000 shall be for the Health Alert
    Network; and Office of Emergency Preparedness, $54,600,000. In
    addition, $114,040,000 shall be available to the Centers for Disease
    Control and Prevention for the following activities: $61,000,000 for
    international HIV/AIDS programs, $25,000,000 for global polio
    eradication activities, $18,040,000 for continued study of the anthrax
    vaccine; and $10,000,000 for activities related to the West Nile-like
    virus. In addition, $100,000,000 shall be available to support the
    Ricky Ray Hemophilia Relief Fund Act of 1988: Provided further, That,
    notwithstanding any other provision of law, up to $8,000,000 of the
    amount provided for the Ricky Ray Hemophilia Relief Fund Act may be
    available for administrative expenses of the Health Resources and
    Services Administration. In addition, $50,000,000 shall be available to
    the Office of the Secretary for minority AIDS prevention and treatment
    activities: Provided further, That no funds shall be obligated until
    the Department of Health and Human Services submits an operating plan
    to the House and Senate Committees on Appropriations.</DELETED>

                     <DELETED>GENERAL PROVISIONS</DELETED>

    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    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 I.</DELETED>
    <DELETED>    Sec. 205. None of the funds appropriated in this Act may
    be expended pursuant to section 241 of the Public Health Service Act,
    except for funds specifically provided for in this Act, or for other
    taps and assessments made by any office located in the Department of
    Health and Human Services, prior to the Secretary's preparation and
    submission of a report to the Committee on Appropriations of the Senate
    and of the House detailing the planned uses of such funds.</DELETED>

                     <DELETED>(transfer of funds)</DELETED>

    <DELETED>    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: Provided further, That
    this section shall not apply to funds appropriated under the heading
    ``Centers for Disease Control and Prevention-Disease Control, Research,
    and Training'', funds made available to the Centers for Disease Control
    and Prevention under the heading ``Public Health and Social Services
    Emergency Fund'', or any other funds made available in this Act to the
    Centers for Disease Control and Prevention.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    Sec. 211. With respect to fiscal year 2001, the amount of
    an allotment of a State under section 1921 of the Public Health
    Services Act shall not be less than the amount the State received under
    such section for fiscal year 2000 increased by 33.33 percent of the
    percentage by which the amount allotted to the States for fiscal year
    2001 exceeds the amount allotted to the States for fiscal year
    2000.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    Sec. 213. None of the funds in this Act or any other Act
    may be used to obligate funds for the National Institutes of Health in
    excess of the total amount identified for this purpose for fiscal year
    2001 in the President's budget request (H. Doc. 106-162): Provided,
    That none of the funds made available for each Institute, Center,
    Office, or Buildings and Facilities shall be reduced below the amounts
    shown in the budget request column of the table printed in the report
    accompanying the bill making appropriations for the Departments of
    Labor, Health and Human Services, Education, and Related Agencies for
    fiscal year 2001.</DELETED>
    <DELETED>    This title may be cited as the ``Department of Health and
    Human Services Appropriations Act, 2001''.</DELETED>

             <DELETED>TITLE III--DEPARTMENT OF EDUCATION</DELETED>

                      <DELETED>education reform</DELETED>

    <DELETED>    For carrying out activities authorized by sections 3122,
    3132, 3136, and 3141, parts B and C of title III, and part I of title X
    of the Elementary and Secondary Education Act of 1965, $1,505,000,000,
    of which $119,500,000 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.</DELETED>

               <DELETED>education for the disadvantaged</DELETED>

    <DELETED>    For carrying out title I of the Elementary and Secondary
    Education Act of 1965, and section 418A of the Higher Education Act of
    1965, $8,816,986,000, of which $2,569,823,000 shall become available on
    July 1, 2001, and shall remain available through September 30, 2002,
    and of which $6,204,763,000 shall become available on October 1, 2001
    and shall remain available through September 30, 2002, for academic
    year 2001-2002: Provided, That $6,783,000,000 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 $1,158,397,000 shall be available for concentration grants under
    section 1124A: Provided further, That $8,900,000 shall be available for
    evaluations under section 1501 and not more than $8,500,000 shall be
    reserved for section 1308, of which not more than $3,000,000 shall be
    reserved for section 1308(d): Provided further, That $190,000,000 shall
    be available under section 1002(g)(2) to demonstrate effective
    approaches to comprehensive school reform to be allocated and expended
    in accordance with the instructions relating to this activity in the
    statement of the managers on the conference report accompanying Public
    Law 105-78 and in the statement of the managers on the conference
    report accompanying Public Law 105-277: Provided further, That in
    carrying out this initiative, the Secretary and the States shall
    support only approaches that show the most promise of enabling children
    served by title I to meet challenging State content standards and
    challenging State student performance standards based on reliable
    research and effective practices, and include an emphasis on basic
    academics and parental involvement.</DELETED>

                         <DELETED>impact aid</DELETED>

    <DELETED>    For carrying out programs of financial assistance to
    federally affected schools authorized by title VIII of the Elementary
    and Secondary Education Act of 1965, $985,000,000, of which
    $780,000,000 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), $25,000,000 shall be for
    construction under section 8007, $40,000,000 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.</DELETED>

                 <DELETED>school improvement programs</DELETED>

    <DELETED>    For carrying out school improvement activities authorized
    by titles 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; the Civil Rights Act of 1964; and part B of
    title VIII of the Higher Education Act of 1965, $3,165,334,000, of
    which $1,073,500,000 shall become available on July 1, 2001, and remain
    available through September 30, 2002, and of which $1,515,000,000 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, $1,750,000,000 shall be for the Teacher
    Empowerment Act, if such legislation is enacted.</DELETED>

                     <DELETED>reading excellence</DELETED>

    <DELETED>    For necessary expenses to carry out the Reading Excellence
    Act, $65,000,000, 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.</DELETED>

                      <DELETED>indian education</DELETED>

    <DELETED>    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, $107,765,000.</DELETED>

              <DELETED>bilingual and immigrant education</DELETED>

    <DELETED>    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), $406,000,000: Provided, That State educational
    agencies may use all, or any part of, their part C allocation for
    competitive grants to local educational agencies.</DELETED>

                      <DELETED>special education</DELETED>

    <DELETED>    For carrying out the Individuals with Disabilities
    Education Act, $6,550,161,000, of which $2,557,885,000 shall become
    available for obligation on July 1, 2001, and shall remain available
    through September 30, 2002, and of which $3,742,000,000 shall become
    available on October 1, 2001 and shall remain available through
    September 30, 2002, for academic year 2001-2002: Provided, That
    $9,500,000 shall be for Recording for the Blind and Dyslexic to support
    the development, production, and circulation of recorded educational
    materials.</DELETED>

       <DELETED>rehabilitation services and disability research</DELETED>

    <DELETED>    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, $2,776,803,000: 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.</DELETED>

     <DELETED>Special Institutions for Persons With Disabilities</DELETED>

            <DELETED>american printing house for the blind</DELETED>

    <DELETED>    For carrying out the Act of March 3, 1879, as amended (20
    U.S.C. 101 et seq.), $11,000,000.</DELETED>

          <DELETED>national technical institute for the deaf</DELETED>

    <DELETED>    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.), $54,000,000, of which $6,000,000 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.</DELETED>

                    <DELETED>gallaudet university</DELETED>

    <DELETED>    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.), $89,400,000: Provided, That from the
    total amount available, the University may at its discretion use funds
    for the endowment program as authorized under section 207.</DELETED>

               <DELETED>vocational and adult education</DELETED>

    <DELETED>    For carrying out, to the extent not otherwise provided,
    the Carl D. Perkins Vocational and Technical Education Act and the
    Adult Education and Family Literacy Act, $1,718,600,000, of which
    $1,000,000 shall remain available until expended, and of which
    $923,000,000 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, $4,600,000
    shall be for tribally controlled vocational institutions under section
    117: Provided further, That of the amount provided for Adult Education
    State Grants, $25,500,000 shall be made available for integrated
    English literacy and civics education services to immigrants and other
    limited English proficient populations: Provided further, That of the
    amount reserved for integrated English literacy and civics education,
    half shall be allocated to the States with the largest absolute need
    for such services and half shall be allocated to the States with the
    largest recent growth in need for such services, based on the best
    available data, notwithstanding section 211 of the Adult Education and
    Family Literacy Act: 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.</DELETED>

                <DELETED>student financial assistance</DELETED>

    <DELETED>    For carrying out subparts 1 and 3 of part A, part C and
    part E of title IV of the Higher Education Act of 1965, as amended,
    $10,198,000,000 (reduced by $48,000,000), which shall remain available
    through September 30, 2002.</DELETED>
    <DELETED>    The maximum Pell Grant for which a student shall be
    eligible during award year 2001-2002 shall be $3,500: 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.</DELETED>

        <DELETED>federal family education loan program account</DELETED>

    <DELETED>    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.</DELETED>

                      <DELETED>higher education</DELETED>

    <DELETED>    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, $1,688,081,000, 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
    $10,000,000, to remain available through September 30, 2002, shall be
    available to fund fellowships for academic year 2002-2003 under part A,
    subpart 1 of title VII of said Act, under the terms and conditions of
    part A, subpart 1: 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.</DELETED>

                      <DELETED>howard university</DELETED>

    <DELETED>    For partial support of Howard University (20 U.S.C. 121 et
    seq.), $226,474,000, of which not less than $3,600,000 shall be for a
    matching endowment grant pursuant to the Howard University Endowment
    Act (Public Law 98-480) and shall remain available until
    expended.</DELETED>

            <DELETED>college housing and academic facilities loans
                               program</DELETED>

    <DELETED>    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.</DELETED>

     <DELETED>historically black college and university capital financing
                           program account</DELETED>

    <DELETED>    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.</DELETED>
    <DELETED>    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, $207,000.</DELETED>

       <DELETED>education research, statistics, and improvement</DELETED>

    <DELETED>    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 sections 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, $494,367,000: Provided, That
    $50,000,000 shall be available to demonstrate effective approaches to
    comprehensive school reform, to be allocated and expended in accordance
    with the instructions relating to this activity in the statement of
    managers on the conference report accompanying Public Law 105-78 and in
    the statement of the managers on the conference report accompanying
    Public Law 105-277: Provided further, That the funds made available for
    comprehensive school reform shall become available on July 1, 2001, and
    remain available through September 30, 2002, and in carrying out this
    initiative, the Secretary and the States shall support only approaches
    that show the most promise of enabling children to meet challenging
    State content standards and challenging State student performance
    standards based on reliable research and effective practices, and
    include an emphasis on basic academics and parental involvement:
    Provided further, That $30,000,000 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: Provided further, That
    $45,000,000 shall be available to support activities under section
    10105 of part A of title X of the Elementary and Secondary Education
    Act of 1965, of which up to $2,250,000 may be available for evaluation,
    technical assistance, and school networking activities: Provided
    further, That funds made available to local educational agencies under
    this section shall be used only for activities related to establishing
    smaller learning communities in high schools: Provided further, That
    funds made available for section 10105 of part A of title X of the
    Elementary and Secondary Education Act of 1965 shall become available
    on July 1, 2001, and remain available through September 30,
    2002.</DELETED>

                   <DELETED>Departmental Management</DELETED>

                   <DELETED>program administration</DELETED>

    <DELETED>    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, $382,934,000.</DELETED>

                   <DELETED>office for civil rights</DELETED>

    <DELETED>    For expenses necessary for the Office for Civil Rights, as
    authorized by section 203 of the Department of Education Organization
    Act, $71,200,000.</DELETED>

                 <DELETED>office of inspector general</DELETED>

    <DELETED>    For expenses necessary for the Office of Inspector
    General, as authorized by section 212 of the Department of Education
    Organization Act, $34,000,000.</DELETED>

                     <DELETED>GENERAL PROVISIONS</DELETED>

    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    Sec. 304. (a) Internet Filtering.--No funds made available
    under title III of the Elementary and Secondary Education Act of 1965
    to a local educational agency or elementary or secondary school may be
    used to purchase computers used to access the Internet, or to pay for
    direct costs associated with accessing the Internet, unless such agency
    or school has in place, on computers that are accessible to minors, and
    during use by such minors, technology which filters or blocks--
    </DELETED>
            <DELETED>    (1) material that is obscene;</DELETED>
            <DELETED>    (2) child pornography; and</DELETED>
            <DELETED>    (3) material harmful to minors.</DELETED>
    <DELETED>    (b) Disabling During Adult Use.--An administrator,
    supervisor, or other authority may disable the technology described in
    subsection (a) during use by an adult, to enable unfiltered access for
    bona fide research or other lawful purposes.</DELETED>
    <DELETED>    (c) Rule of Construction.--Nothing in this section shall
    be construed to prohibit a local educational agency or elementary or
    secondary school from filtering or blocking materials other than those
    referred to in paragraph (1), (2), or (3) of subsection (a).</DELETED>
    <DELETED>    (d) Definitions.--</DELETED>
            <DELETED>    (1) Material harmful to minors.--The term
            ``material harmful to minors'' has the meaning given such term
            in section 231(e)(6) of the Communications Act of
            1934.</DELETED>
            <DELETED>    (2) Child pornography.--The term ``child
            pornography'' has the meaning given such term in section
            2256(8) of title 18, United States Code.</DELETED>
            <DELETED>    (3) Minor.--The term ``minor'' has the meaning
            given such term in section 2256(1) of title 18, United States
            Code.</DELETED>
    <DELETED>    (e) Severability.--If any provision of this section is
    held invalid, the remainder of such section and this Act shall not be
    affected thereby.</DELETED>
    <DELETED>    Sec. 305. None of the funds made available in this Act may
    be used to carry out any activities related to any federally sponsored
    national test in reading, mathematics, or any other subject that is not
    specifically and explicitly provided for in authorizing legislation
    enacted into law, except that such limitation shall not apply to the
    Third International Mathematics and Science Study or other
    international comparative assessments developed under the authority of
    section 404(a)(6) of the National Education Statistics Act of 1994 (20
    U.S.C. 9003(a)(6) et seq.) and administered to only a representative
    sample of pupils in the United States and in foreign nations.</DELETED>
    <DELETED>    This title may be cited as the ``Department of Education
    Appropriations Act, 2001''.</DELETED>

                 <DELETED>TITLE IV--RELATED AGENCIES</DELETED>

                <DELETED>armed forces retirement home</DELETED>

    <DELETED>    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.</DELETED>

       <DELETED>Corporation for National and Community Service</DELETED>

            <DELETED>domestic volunteer service programs, operating
                               expenses</DELETED>

    <DELETED>    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, $294,527,000: 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.</DELETED>

             <DELETED>Corporation for Public Broadcasting</DELETED>

    <DELETED>    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.</DELETED>

         <DELETED>Federal Mediation and Conciliation Service</DELETED>

                    <DELETED>salaries and expenses</DELETED>

    <DELETED>    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), $37,500,000, 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.</DELETED>

      <DELETED>Federal Mine Safety and Health Review Commission</DELETED>

                    <DELETED>salaries and expenses</DELETED>

    <DELETED>    For expenses necessary for the Federal Mine Safety and
    Health Review Commission (30 U.S.C. 801 et seq.), $6,200,000.</DELETED>

          <DELETED>Institute of Museum and Library Services</DELETED>

                <DELETED>Office of Library Services: Grants and
                            Administration</DELETED>

    <DELETED>    For carrying out subtitle B of the Museum and Library
    Services Act, $170,000,000.</DELETED>

            <DELETED>Medicare Payment Advisory Commission</DELETED>

                    <DELETED>salaries and expenses</DELETED>

    <DELETED>    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.</DELETED>

           <DELETED>National Commission on Libraries and Information
                               Science</DELETED>

                    <DELETED>salaries and expenses</DELETED>

    <DELETED>    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), $1,400,000.</DELETED>

               <DELETED>National Council on Disability</DELETED>

                    <DELETED>salaries and expenses</DELETED>

    <DELETED>    For expenses necessary for the National Council on
    Disability as authorized by title IV of the Rehabilitation Act of 1973,
    as amended, $2,450,000.</DELETED>

               <DELETED>National Labor Relations Board</DELETED>

                    <DELETED>salaries and expenses</DELETED>

    <DELETED>    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,
    $205,717,000: 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.</DELETED>

                  <DELETED>National Mediation Board</DELETED>

                    <DELETED>salaries and expenses</DELETED>

    <DELETED>    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, $9,800,000.</DELETED>

      <DELETED>Occupational Safety and Health Review Commission</DELETED>

                    <DELETED>salaries and expenses</DELETED>

    <DELETED>    For expenses necessary for the Occupational Safety and
    Health Review Commission (29 U.S.C. 661), $8,600,000.</DELETED>

                  <DELETED>Railroad Retirement Board</DELETED>

               <DELETED>dual benefits payments account</DELETED>

    <DELETED>    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.</DELETED>

    <DELETED>federal payments to the railroad retirement accounts</DELETED>

    <DELETED>    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.</DELETED>

                <DELETED>limitation on administration</DELETED>

    <DELETED>    For necessary expenses for the Railroad Retirement Board
    for administration of the Railroad Retirement Act and the Railroad
    Unemployment Insurance Act, $95,000,000, 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.</DELETED>

        <DELETED>limitation on the office of inspector general</DELETED>

    <DELETED>    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 $5,380,000, 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.</DELETED>

               <DELETED>Social Security Administration</DELETED>

           <DELETED>payments to social security trust funds</DELETED>

    <DELETED>    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.</DELETED>

          <DELETED>special benefits for disabled coal miners</DELETED>

    <DELETED>    For carrying out title IV of the Federal Mine Safety and
    Health Act of 1977, $365,748,000, to remain available until
    expended.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>

            <DELETED>supplemental security income program</DELETED>

    <DELETED>    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,
    $22,791,000,000 (increased by $35,000,000), 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.</DELETED>
    <DELETED>    In addition, $245,000,000 (reduced by $35,000,000), 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.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>

            <DELETED>limitation on administrative expenses</DELETED>

    <DELETED>    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 $6,367,036,000
    (increased by $70,000,000) 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 associated
    solely with this information technology and telecommunications
    infrastructure: Provided further, That reimbursement to the trust funds
    under this heading for expenditures for official time for employees of
    the Social Security Administration pursuant to section 7131 of title 5,
    United States Code, and for facilities or support services for labor
    organizations pursuant to policies, regulations, or procedures referred
    to in section 7135(b) of such title shall be made by the Secretary of
    the Treasury, with interest, from amounts in the general fund not
    otherwise appropriated, as soon as possible after such expenditures are
    made.</DELETED>
    <DELETED>    From funds provided under the first paragraph, not less
    than $130,000,000 (increased by $70,000,000) shall be available for
    conducting continuing disability reviews.</DELETED>
    <DELETED>    In addition to funding already available under this
    heading, and subject to the same terms and conditions, $520,000,000
    (reduced by $70,000,000), 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.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>

                 <DELETED>office of inspector general</DELETED>

                <DELETED>(including transfer of funds)</DELETED>

    <DELETED>    For expenses necessary for the Office of Inspector General
    in carrying out the provisions of the Inspector General Act of 1978, as
    amended, $14,944,000, together with not to exceed $50,808,000, 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.</DELETED>
    <DELETED>    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.</DELETED>

              <DELETED>United States Institute of Peace</DELETED>

                     <DELETED>operating expenses</DELETED>

    <DELETED>    For necessary expenses of the United States Institute of
    Peace as authorized in the United States Institute of Peace Act,
    $15,000,000.</DELETED>

                 <DELETED>TITLE V--GENERAL PROVISIONS</DELETED>

    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    (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.</DELETED>
    <DELETED>    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''.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    (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.</DELETED>
    <DELETED>    (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.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    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.</DELETED>
    <DELETED>    (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.</DELETED>
    <DELETED>    (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.</DELETED>
    <DELETED>    Sec. 509. (a) The limitations established in the preceding
    section shall not apply to an abortion--</DELETED>
            <DELETED>    (1) if the pregnancy is the result of an act of
            rape or incest; or</DELETED>
            <DELETED>    (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.</DELETED>
    <DELETED>    (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).</DELETED>
    <DELETED>    (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).</DELETED>
    <DELETED>    Sec. 510. (a) None of the funds made available in this Act
    may be used for--</DELETED>
            <DELETED>    (1) the creation of a human embryo or embryos for
            research purposes; or</DELETED>
            <DELETED>    (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)).</DELETED>
    <DELETED>    (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.</DELETED>
    <DELETED>    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).</DELETED>
    <DELETED>    (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.</DELETED>
    <DELETED>    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--</DELETED>
            <DELETED>    (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</DELETED>
            <DELETED>    (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.</DELETED>
    <DELETED>    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, 2000, 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:
    Provided further, That the provisions of this section shall not apply
    to any funds appropriated to the Centers for Disease Control and
    Prevention or to the Department of Education.</DELETED>
    <DELETED>    Sec. 514. Section 5527 of Public Law 105-33, The Balanced
    Budget Act of 1997, is repealed.</DELETED>
    <DELETED>    Sec. 515. (a) Dates for Evaluation.--Section
    403(a)(5)(H)(iii) of the Social Security Act (42 U.S.C.
    603(a)(5)(H)(iii)) is amended by striking ``2001'' and inserting
    ``2005''.</DELETED>
    <DELETED>    (b) Interim Report Required.--Section 403(a)(5)(H) of such
    Act (42 U.S.C. 603(a)(5)(G)) is amended by adding at the end the
    following:</DELETED>
                            <DELETED>    ``(iv) Interim Report.--Not later
                            than January 1, 2002, the Secretary shall
                            submit to the Congress an interim report on the
                            evaluations referred to in clause
                            (i).''.</DELETED>
    <DELETED>    Sec. 516. Section 403(a)(3)(A) (42 U.S.C. 603(a)(3)(A)) is
    amended--</DELETED>
            <DELETED>    (1) in clause (i), by striking ``and'' at the
            end;</DELETED>
            <DELETED>    (2) in clause (ii)--</DELETED>
                    <DELETED>    (A) by striking ``1999, 2000, and 2001''
                    and inserting ``1999 and 2000''; and</DELETED>
                    <DELETED>    (B) by striking the period at the end and
                    inserting ``; and''; and</DELETED>
            <DELETED>    (3) by adding at the end the following new
            clause:</DELETED>
                            <DELETED>    ``(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.''.</DELETED>
    <DELETED>    Sec. 517. Section 410(b) of The Ticket to Work and Work
    Incentives Improvement Act of 1999 (Public Law 106-170) is amended by
    striking ``2009'' each place it appears and inserting
    ``2001''.</DELETED>
    <DELETED>    Sec. 518. If the total level of discretionary advance
    appropriations for fiscal year 2002 and subsequent fiscal years
    provided in general appropriation Acts for fiscal year 2001 exceeds
    $23,500,000,000, there shall be rescinded from the amount made
    available in this Act for fiscal year 2002 under the heading
    ``Administration for Children and Families--payments to states for the
    child care and development block grant'' an amount sufficient to reduce
    the total level of such discretionary advance appropriations to
    $23,500,000,000: Provided, That the rescission shall not exceed an
    amount that would cause the amount provided under such heading to be
    less than the amount provided for fiscal year 2001 in 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).</DELETED>
    <DELETED>    Sec. 519. 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)).</DELETED>
    <DELETED>    Sec. 520. None of the funds made available in this Act may
    be used to prohibit military recruiting at secondary schools.</DELETED>
    <DELETED>    Sec. 521. None of the funds made available in this Act for
    the National Institutes of Health may be used to grant an exclusive or
    partially exclusive license pursuant to chapter 18 of title 35, United
    States Code, except in accordance with section 209 of such title
    (relating to the availability to the public of an invention and its
    benefits on reasonable terms).</DELETED>
    <DELETED>    This Act may be cited as the ``Departments of Labor,
    Health and Human Services, and Education, and Related Agencies
    Appropriations Act, 2001''.</DELETED>

       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''.

                Passed the House of Representatives June 14, 2000.

                Attest:

                                                     JEFF TRANDAHL,

                                                                     Clerk.

                Passed the Senate June 30, 2000.

                Attest:

                                                        GARY SISCO,

                                                                 Secretary.