[Congressional Record Volume 146, Number 87 (Monday, July 10, 2000)]
[Senate]
[Pages S6356-S6397]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
                 RELATED AGENCIES APPROPRIATIONS, 2001

  On June 30, 2000, the Senate amended and passed H.R. 4577, as 
follows:

         Resolved, That the bill from the House of Representatives 
     (H.R. 4577) entitled ``An Act making appropriations for the 
     Departments of Labor, Health and Human Services, and 
     Education, and related agencies for the fiscal year ending 
     September 30, 2001, and for other purposes.'', do pass with 
     the following amendment:
Strike out all after the enacting clause and insert:

   DIVISION A--DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND 
                    EDUCATION, AND RELATED AGENCIES

       That the following sums are appropriated, out of any money 
     in the Treasury not otherwise appropriated, for the 
     Departments of Labor, Health and Human Services, and 
     Education, and related agencies for the fiscal year ending 
     September 30, 2001, and for other purposes, namely:

                      TITLE I--DEPARTMENT OF LABOR

                 Employment and Training Administration


                    Training and Employment Services

       For necessary expenses of the Workforce Investment Act, 
     including the purchase and hire of passenger motor vehicles, 
     the construction, alteration, and repair of buildings and 
     other facilities, and the purchase of real property for 
     training centers as authorized by the Workforce Investment 
     Act and the National Skill Standards Act of 1994; 
     $2,990,141,000 plus reimbursements, of which $1,718,801,000 
     is available for obligation for the period July 1, 2001 
     through June 30, 2002, of which $1,250,965,000 is available 
     for obligation for the period April 1, 2001 through June 30, 
     2002, including $1,000,965,000 to carry out chapter 4 of the 
     Workforce Investment Act and $250,000,000 to carry out 
     section 169 of such Act; and of which $20,375,000 is 
     available for the period July 1, 2001 through June 30, 2004 
     for necessary expenses of construction, rehabilitation, and 
     acquisition of Job Corps centers: Provided, That $9,098,000 
     shall be for carrying out section 172 of the Workforce 
     Investment Act, and $3,500,000 shall be for carrying out the 
     National Skills Standards Act of 1994: Provided further, That 
     no funds from any other appropriation shall be used to 
     provide meal services at or for Job Corps centers: Provided 
     further, That funds provided to carry out section 171(d) of 
     such Act may be used for demonstration projects that provide 
     assistance to new entrants in the workforce and incumbent 
     workers: Provided further, That funding provided to carry out 
     projects under section 171 of the Workforce Investment Act of 
     1998 that are identified in the Conference Agreement, shall 
     not be subject to the requirements of section 171(b)(2)(B) of 
     such Act, the requirements of section 171(c)(4)(D) of such 
     Act, or the joint funding requirements of sections 
     171(b)(2)(A) and 171(c)(4)(A) of such Act: Provided further, 
     That funding appropriated herein for Dislocated Worker 
     Employment and Training Activities under section 132(a)(2)(A) 
     of the Workforce Investment Act of 1998 may be distributed 
     for Dislocated Worker Projects under section 171(d) of the 
     Act without regard to the 10 percent limitation contained in 
     section 171(d) of the Act.
       For necessary expenses of the Workforce Investment Act, 
     including the purchase and hire of passenger motor vehicles, 
     the construction, alteration, and repair of buildings and 
     other facilities, and the purchase of real property for 
     training centers as authorized by the Workforce Investment 
     Act; $2,463,000,000 plus reimbursements, of which 
     $2,363,000,000 is available for obligation for the period 
     October 1, 2001 through June 30, 2002, and of which 
     $100,000,000 is available for the period October 1, 2001 
     through June 30, 2004, for necessary expenses of 
     construction, rehabilitation, and acquisition of Job Corps 
     centers.


            Community Service Employment for Older Americans

       To carry out the activities for national grants or 
     contracts with public agencies and public or private 
     nonprofit organizations under paragraph (1)(A) of section 
     506(a) of title V of the Older Americans Act of 1965, as 
     amended, or to carry out older worker activities as 
     subsequently authorized, $343,356,000.
       To carry out the activities for grants to States under 
     paragraph (3) of section 506(a) of title V of the Older 
     Americans Act of 1965, as amended, or to carry out older 
     worker activities as subsequently authorized, $96,844,000.


              Federal Unemployment Benefits and Allowances

       For payments during the current fiscal year of trade 
     adjustment benefit payments and allowances under part I; and 
     for training, allowances for job search and relocation, and 
     related State administrative expenses under part II, 
     subchapters B and D, chapter 2, title II of the Trade Act of 
     1974, as amended, $406,550,000, together with such amounts as 
     may be necessary to be charged to the subsequent 
     appropriation for payments for any period subsequent to 
     September 15 of the current year.

[[Page S6357]]

     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

[[Page S6358]]

     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--

[[Page S6359]]

       (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.

[[Page S6360]]

         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

[[Page S6361]]

     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

[[Page S6362]]

     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;

[[Page S6363]]

       (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

[[Page S6364]]

     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.

[[Page S6365]]

           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.

[[Page S6366]]

                        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.

[[Page S6367]]

                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.

[[Page S6368]]

                      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.

[[Page S6369]]

       ``(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

[[Page S6370]]

     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:

[[Page S6371]]

       ``(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.

[[Page S6372]]

       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.''.

[[Page S6373]]

       (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.--

[[Page S6374]]

       ``(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:

[[Page S6375]]

       ``(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

[[Page S6376]]

     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).

[[Page S6377]]

       (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

[[Page S6378]]

       ``(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

[[Page S6379]]

     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

[[Page S6380]]

     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

[[Page S6381]]

     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.

[[Page S6382]]

     ``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--

[[Page S6383]]

       ``(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.

[[Page S6384]]

       ``(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

[[Page S6385]]

     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

[[Page S6386]]

     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.--

[[Page S6387]]

       ``(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.

[[Page S6388]]

       ``(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.--

[[Page S6389]]

       ``(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

[[Page S6390]]

     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:

[[Page S6391]]

       ``(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.

[[Page S6392]]

       ``(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;

[[Page S6393]]

       ``(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.''.

[[Page S6394]]

       (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)

[[Page S6395]]

     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;

[[Page S6396]]

       ``(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.

[[Page S6397]]

       ``(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''.

                          ____________________