HR 4577 PP
106th CONGRESS
2d Session
H. R. 4577
IN THE HOUSE OF REPRESENTATIVES
June 30, 2000
Ordered to be printed with the amendments of the Senate numbered
AN ACT
Making appropriations for the Departments of Labor, Health and Human
Services, and Education, and related agencies for the fiscal year ending
September 30, 2001, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled, (1) [Struck out->] 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:
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[Struck out->] TITLE I--DEPARTMENT OF LABOR
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[Struck out->] Employment and Training Administration
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[Struck out->] TRAINING AND EMPLOYMENT SERVICES
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[Struck out->] For necessary expenses of the Workforce Investment
Act, including the purchase and hire of passenger motor vehicles, the
construction, alteration, and repair of buildings and other facilities, and
the purchase of real property for training centers as authorized by the
Workforce Investment Act; the Women in Apprenticeship and Nontraditional
Occupations Act; and the National Skill Standards Act of 1994, $2,552,495,000
plus reimbursements, of which $1,340,155,000 is available for obligation for
the period July 1, 2001 through June 30, 2002; of which $1,175,965,000 is
available for obligation for the period April 1, 2001 through June 30, 2002,
including $1,000,965,000 to carry out chapter 4 of the Workforce Investment
Act and $175,000,000 to carry out section 169 of such Act; and of which
$20,375,000 is available for the period July 1, 2001 through June 30, 2004 for
necessary expenses of construction, rehabilitation, and acquisition of Job
Corps centers: Provided, That $9,098,000 shall be for carrying out
section 172 of the Workforce Investment Act, and $3,500,000 shall be for
carrying out the National Skills Standards Act of 1994: Provided
further, That no funds from any other appropriation shall be used to
provide meal services at or for Job Corps centers.
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[Struck out->] 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.
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[Struck out->] COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS
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[Struck out->] 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.
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[Struck out->] 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.
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[Struck out->] FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES
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[Struck out->] 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.
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[Struck out->] STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE
OPERATIONS
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[Struck out->] For authorized administrative expenses,
$43,452,000, together with not to exceed $3,054,338,000 (including not to
exceed $1,228,000 which may be used for amortization payments to States which
had independent retirement plans in their State employment service agencies
prior to 1980), which may be expended from the Employment Security
Administration account in the Unemployment Trust Fund including the cost of
administering section 51 of the Internal Revenue Code of 1986, as amended,
section 7(d) of the Wagner-Peyser Act, as amended, the Trade Act of 1974, as
amended, the Immigration Act of 1990, and the Immigration and Nationality Act,
as amended, and of which the sums available in the allocation for activities
authorized by title III of the Social Security Act, as amended (42 U.S.C.
502-504), and the sums available in the allocation for necessary
administrative expenses for carrying out 5 U.S.C. 8501-8523, shall be
available for obligation by the States through December 31, 2001, except that
funds used for automation acquisitions shall be available for obligation by
the States through September 30, 2003; and of which $43,452,000, together with
not to exceed $738,283,000 of the amount which may be expended from said trust
fund, shall be available for obligation for the period July 1, 2001 through
June 30, 2002, to fund activities under the Act of June 6, 1933, as amended,
including the cost of penalty mail authorized under 39 U.S.C. 3202(a)(1)(E)
made available to States in lieu of allotments for such purpose:
Provided, That to the extent that the Average Weekly Insured
Unemployment (AWIU) for fiscal year 2001 is projected by the Department of
Labor to exceed 2,396,000, an additional $28,600,000 shall be available for
obligation for every 100,000 increase in the AWIU level (including a pro rata
amount for any increment less than 100,000) from the Employment Security
Administration account of the Unemployment Trust Fund: Provided
further, That funds appropriated in this Act which are used to establish
a national one-stop career center system, or which are used to support the
national activities of the Federal-State unemployment insurance programs, may
be obligated in contracts, grants or agreements with non-State entities:
Provided further, That funds appropriated under this Act for
activities authorized under the Wagner-Peyser Act, as amended, and title III
of the Social Security Act, may be used by the States to fund integrated
Employment Service and Unemployment Insurance automation efforts,
notwithstanding cost allocation principles prescribed under Office of
Management and Budget Circular A-87.
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[Struck out->] ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER
FUNDS
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[Struck out->] 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.
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[Struck out->] 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.
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[Struck out->] PROGRAM ADMINISTRATION
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[Struck out->] For expenses of administering employment and
training programs, $100,944,000, including $6,431,000 to support up to 75
full-time equivalent staff, the majority of which will be term Federal
appointments lasting no more than 1 year, to administer welfare-to-work
grants, together with not to exceed $45,056,000, which may be expended from
the Employment Security Administration account in the Unemployment Trust Fund.
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[Struck out->] Pension and Welfare Benefits Administration
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[Struck out->] SALARIES AND EXPENSES
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[Struck out->] For necessary expenses for the Pension and Welfare
Benefits Administration, $98,934,000.
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[Struck out->] Pension Benefit Guaranty Corporation
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[Struck out->] PENSION BENEFIT GUARANTY CORPORATION FUND
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[Struck out->] The Pension Benefit Guaranty Corporation is
authorized to make such expenditures, including financial assistance
authorized by section 104 of Public Law 96-364, within limits of funds and
borrowing authority available to such Corporation, and in accord with law, and
to make such contracts and commitments without regard to fiscal year
limitations as provided by section 104 of the Government Corporation Control
Act, as amended (31 U.S.C. 9104), as may be necessary in carrying out the
program through September 30, 2001, for such Corporation: Provided,
That not to exceed $11,148,000 shall be available for administrative expenses
of the Corporation: Provided further, That expenses of such
Corporation in connection with the termination of pension plans, for the
acquisition, protection or management, and investment of trust assets, and for
benefits administration services shall be considered as non-administrative
expenses for the purposes hereof, and excluded from the above limitation.
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[Struck out->] Employment Standards Administration
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[Struck out->] SALARIES AND EXPENSES
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[Struck out->] For necessary expenses for the Employment
Standards Administration, including reimbursement to State, Federal, and local
agencies and their employees for inspection services rendered, $337,030,000,
together with $1,740,000 which may be expended from the Special Fund in
accordance with sections 39(c), 44(d) and 44(j) of the Longshore and Harbor
Workers' Compensation Act: Provided, That $2,000,000 shall be for the
development of an alternative system for the electronic submission of reports
as required to be filed under the Labor-Management Reporting and Disclosure
Act of 1959, as amended, and for a computer database of the information for
each submission by whatever means, that is indexed and easily searchable by
the public via the Internet: Provided further, That the Secretary of
Labor is authorized to accept, retain, and spend, until expended, in the name
of the Department of Labor, all sums of money ordered to be paid to the
Secretary of Labor, in accordance with the terms of the Consent Judgment in
Civil Action No. 91-0027 of the United States District Court for the District
of the Northern Mariana Islands (May 21, 1992): Provided further,
That the Secretary of Labor is authorized to establish and, in accordance with
31 U.S.C. 3302, collect and deposit in the Treasury fees for processing
applications and issuing certificates under sections 11(d) and 14 of the Fair
Labor Standards Act of 1938, as amended (29 U.S.C. 211(d) and 214) and for
processing applications and issuing registrations under title I of the Migrant
and Seasonal Agricultural Worker Protection Act (29 U.S.C. 1801 et seq.).
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[Struck out->] SPECIAL BENEFITS
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[Struck out->] (INCLUDING TRANSFER OF FUNDS)
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[Struck out->] 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.
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[Struck out->] BLACK LUNG DISABILITY TRUST FUND
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[Struck out->] (INCLUDING TRANSFER OF FUNDS)
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[Struck out->] For payments from the Black Lung Disability Trust
Fund, $1,028,000,000, of which $975,343,000 shall be available until September
30, 2002, for payment of all benefits as authorized by section 9501(d)(1),
(2), (4), and (7) of the Internal Revenue Code of 1954, as amended, and
interest on advances as authorized by section 9501(c)(2) of that Act, and of
which $30,393,000 shall be available for transfer to Employment Standards
Administration, Salaries and Expenses, $21,590,000 for transfer to
Departmental Management, Salaries and Expenses, $318,000 for transfer to
Departmental Management, Office of Inspector General, and $356,000 for payment
into miscellaneous receipts for the expenses of the Department of Treasury,
for expenses of operation and administration of the Black Lung Benefits
program as authorized by section 9501(d)(5) of that Act: Provided,
That, in addition, such amounts as may be necessary may be charged to the
subsequent year appropriation for the payment of compensation, interest, or
other benefits for any period subsequent to August 15 of the current year.
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[Struck out->] Occupational Safety and Health Administration
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[Struck out->] SALARIES AND EXPENSES
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[Struck out->] For necessary expenses for the Occupational Safety
and Health Administration, $381,620,000, including not to exceed $83,771,000
which shall be the maximum amount available for grants to States under section
23(g) of the Occupational Safety and Health Act, which grants shall be no less
than 50 percent of the costs of State occupational safety and health programs
required to be incurred under plans approved by the Secretary under section 18
of the Occupational Safety and Health Act of 1970; and, in addition,
notwithstanding 31 U.S.C. 3302, the Occupational Safety and Health
Administration may retain up to $750,000 per fiscal year of training institute
course tuition fees, otherwise authorized by law to be collected, and may
utilize such sums for occupational safety and health training and education
grants: Provided, That, notwithstanding 31 U.S.C. 3302, the Secretary
of Labor is authorized, during the fiscal year ending September 30, 2001, to
collect and retain fees for services provided to Nationally Recognized Testing
Laboratories, and may utilize such sums, in accordance with the provisions of
29 U.S.C. 9a, to administer national and international laboratory recognition
programs that ensure the safety of equipment and products used by workers in
the workplace: Provided further, That none of the funds appropriated
under this paragraph shall be obligated or expended to prescribe, issue,
administer, or enforce any standard, rule, regulation, or order under the
Occupational Safety and Health Act of 1970 which is applicable to any person
who is engaged in a farming operation which does not maintain a temporary
labor camp and employs 10 or fewer employees: Provided further, That
no funds appropriated under this paragraph shall be obligated or expended to
administer or enforce any standard, rule, regulation, or order under the
Occupational Safety and Health Act of 1970 with respect to any employer of 10
or fewer employees who is included within a category having an occupational
injury lost workday case rate, at the most precise Standard Industrial
Classification Code for which such data are published, less than the national
average rate as such rates are most recently published by the Secretary,
acting through the Bureau of Labor Statistics, in accordance with section 24
of that Act (29 U.S.C. 673), except--
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[Struck out->] (1) to provide, as authorized by such Act,
consultation, technical assistance, educational and training services, and
to conduct surveys and studies;
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[Struck out->] (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;
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[Struck out->] (3) to take any action authorized by such Act
with respect to imminent dangers;
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[Struck out->] (4) to take any action authorized by such Act
with respect to health hazards;
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[Struck out->] (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
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[Struck out->] (6) to take any action authorized by such Act
with respect to complaints of discrimination against employees for
exercising rights under such Act:
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[Struck out->] 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.
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[Struck out->] Mine Safety and Health Administration
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[Struck out->] SALARIES AND EXPENSES
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[Struck out->] For necessary expenses for the Mine Safety and
Health Administration, $233,000,000, including purchase and bestowal of
certificates and trophies in connection with mine rescue and first-aid work,
and the hire of passenger motor vehicles; and, in addition, not to exceed
$750,000 may be collected by the National Mine Health and Safety Academy for
room, board, tuition, and the sale of training materials, otherwise authorized
by law to be collected, to be available for mine safety and health education
and training activities, notwithstanding 31 U.S.C. 3302; the Secretary is
authorized to accept lands, buildings, equipment, and other contributions from
public and private sources and to prosecute projects in cooperation with other
agencies, Federal, State, or private; the Mine Safety and Health
Administration is authorized to promote health and safety education and
training in the mining community through cooperative programs with States,
industry, and safety associations; and any funds available to the department
may be used, with the approval of the Secretary, to provide for the costs of
mine rescue and survival operations in the event of a major disaster.
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[Struck out->] Bureau of Labor Statistics
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[Struck out->] SALARIES AND EXPENSES
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[Struck out->] For necessary expenses for the Bureau of Labor
Statistics, including advances or reimbursements to State, Federal, and local
agencies and their employees for services rendered, $372,743,000, together
with not to exceed $67,257,000, which may be expended from the Employment
Security Administration account in the Unemployment Trust Fund.
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[Struck out->] Departmental Management
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[Struck out->] SALARIES AND EXPENSES
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[Struck out->] For necessary expenses for Departmental
Management, including the hire of three sedans, and including up to $7,241,000
for the President's Committee on Employment of People With Disabilities, and
including the management or operation of Departmental bilateral and
multilateral foreign technical assistance, $244,579,000; together with not to
exceed $310,000, which may be expended from the Employment Security
Administration account in the Unemployment Trust Fund: Provided, That
no funds made available by this Act may be used by the Solicitor of Labor to
participate in a review in any United States court of appeals of any decision
made by the Benefits Review Board under section 21 of the Longshore and Harbor
Workers' Compensation Act (33 U.S.C. 921) where such participation is
precluded by the decision of the United States Supreme Court in Director,
Office of Workers' Compensation Programs v. Newport News Shipbuilding, 115 S.
Ct. 1278 (1995), notwithstanding any provisions to the contrary contained in
rule 15 of the Federal Rules of Appellate Procedure: Provided
further, That no funds made available by this Act may be used by the
Secretary of Labor to review a decision under the Longshore and Harbor
Workers' Compensation Act (33 U.S.C. 901 et seq.) that has been appealed and
that has been pending before the Benefits Review Board for more than 12
months: Provided further, That any such decision pending a review by
the Benefits Review Board for more than 1 year shall be considered affirmed by
the Benefits Review Board on the 1-year anniversary of the filing of the
appeal, and shall be considered the final order of the Board for purposes of
obtaining a review in the United States courts of appeals: Provided
further, That these provisions shall not be applicable to the review or
appeal of any decision issued under the Black Lung Benefits Act (30 U.S.C. 901
et seq.).
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[Struck out->] ASSISTANT SECRETARY FOR VETERANS EMPLOYMENT AND
TRAINING
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[Struck out->] Not to exceed $184,341,000 may be derived from the
Employment Security Administration account in the Unemployment Trust Fund to
carry out the provisions of 38 U.S.C. 4100-4110A, 4212, 4214, and 4321-4327,
and Public Law 103-353, and which shall be available for obligation by the
States through December 31, 2001. To carry out the Stewart B. McKinney
Homeless Assistance Act and section 168 of the Workforce Investment Act of
1998, $16,936,000, of which $7,300,000 shall be available for obligation for
the period July 1, 2001, through June 30, 2002.
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[Struck out->] OFFICE OF INSPECTOR GENERAL
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[Struck out->] For salaries and expenses of the Office of
Inspector General in carrying out the provisions of the Inspector General Act
of 1978, as amended, $48,095,000, together with not to exceed $3,830,000,
which may be expended from the Employment Security Administration account in
the Unemployment Trust Fund.
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[Struck out->] GENERAL PROVISIONS
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[Struck out->] 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.
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[Struck out->] (TRANSFER OF FUNDS)
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[Struck out->] 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.
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[Struck out->] SEC. 103. None of the funds made available in this
Act may be used by the Occupational Safety and Health Administration to
promulgate, issue, implement, administer, or enforce any proposed, temporary,
or final standard on ergonomic protection.
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[Struck out->] This title may be cited as the `Department of
Labor Appropriations Act, 2001'.
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[Struck out->] TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES
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[Struck out->] Health Resources and Services Administration
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[Struck out->] HEALTH RESOURCES AND SERVICES
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[Struck out->] For carrying out titles II, III, VII, VIII, X,
XII, XIX, and XXVI of the Public Health Service Act, section 427(a) of the
Federal Coal Mine Health and Safety Act, title V and section 1820 of the
Social Security Act, the Health Care Quality Improvement Act of 1986, as
amended, and the Native Hawaiian Health Care Act of 1988, as amended,
$4,684,232,000, of which $25,000,000 from general revenues, notwithstanding
section 1820(j) of the Social Security Act, shall be available for carrying
out the Medicare rural hospital flexibility grants program under section 1820
of such Act: Provided, That the Division of Federal Occupational
Health may utilize personal services contracting to employ professional
management/administrative and occupational health professionals: Provided
further, That of the funds made available under this heading, $250,000
shall be available until expended for facilities renovations at the Gillis W.
Long Hansen's Disease Center: Provided further, That in addition to
fees authorized by section 427(b) of the Health Care Quality Improvement Act
of 1986, fees shall be collected for the full disclosure of information under
the Act sufficient to recover the full costs of operating the National
Practitioner Data Bank, and shall remain available until expended to carry out
that Act: Provided further, That for the collection of fees
authorized by section 1128E(d)(2) of the Health Insurance Portability and
Accountability Act of 1996 for the full disclosure of information under the
Act sufficient to recover the full costs of operating the Healthcare Integrity
and Protection Data Bank, and shall remain available until expended to carry
out that Act: Provided further, That no more than $5,000,000 is
available for carrying out the provisions of Public Law 104-73: Provided
further, That of the funds made available under this heading,
$238,932,000 shall be for the program under title X of the Public Health
Service Act to provide for voluntary family planning projects: Provided
further, That amounts provided to said projects under such title shall
not be expended for abortions, that all pregnancy counseling shall be
nondirective, and that such amounts shall not be expended for any activity
(including the publication or distribution of literature) that in any way
tends to promote public support or opposition to any legislative proposal or
candidate for public office: Provided further, That $554,000,000
shall be for State AIDS Drug Assistance Programs authorized by section 2616 of
the Public Health Service Act: Provided further, That,
notwithstanding section 502(a)(1) of the Social Security Act, not to exceed
$109,148,000 is available for carrying out special projects of regional and
national significance pursuant to section 501(a)(2) of such Act.
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[Struck out->] For special projects of regional and national
significance under section 501(a)(2) of the Social Security Act, $30,000,000,
which shall become available on October 1, 2001, and shall remain available
until September 30, 2002: Provided, That such amount shall not be
counted toward compliance with the allocation required in section 502(a)(1) of
such Act: Provided further, That such amount shall be used only for
making competitive grants to provide abstinence education (as defined in
section 510(b)(2) of such Act) to adolescents and for evaluations (including
longitudinal evaluations) of activities under the grants and for Federal costs
of administering the grants: Provided further, That grants shall be
made only to public and private entities which agree that, with respect to an
adolescent to whom the entities provide abstinence education under such grant,
the entities will not provide to that adolescent any other education regarding
sexual conduct, except that, in the case of an entity expressly required by
law to provide health information or services the adolescent shall not be
precluded from seeking health information or services from the entity in a
different setting than the setting in which the abstinence education was
provided: Provided further, That the funds expended for such
evaluations may not exceed 3.5 percent of such amount.
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[Struck out->] HEALTH EDUCATION ASSISTANCE LOANS PROGRAM
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[Struck out->] 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.
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[Struck out->] VACCINE INJURY COMPENSATION PROGRAM TRUST FUND
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[Struck out->] 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.
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[Struck out->] Centers for Disease Control and Prevention
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[Struck out->] DISEASE CONTROL, RESEARCH, AND TRAINING
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[Struck out->] To carry out titles II, III, VII, XI, XV, XVII,
XIX, and XXVI of the Public Health Service Act, sections 101, 102, 103, 201,
202, 203, 301, and 501 of the Federal Mine Safety and Health Act of 1977,
sections 20, 21, and 22 of the Occupational Safety and Health Act of 1970,
title IV of the Immigration and Nationality Act, and section 501 of the
Refugee Education Assistance Act of 1980; including insurance of official
motor vehicles in foreign countries; and hire, maintenance, and operation of
aircraft, $3,290,369,000, of which $145,000,000 shall remain available until
expended for equipment and construction and renovation of facilities, and in
addition, such sums as may be derived from authorized user fees, which shall
be credited to this account: Provided, That in addition to amounts
provided herein, up to $71,690,000 shall be available from amounts available
under section 241 of the Public Health Service Act, to carry out the National
Center for Health Statistics surveys: Provided further, That none of
the funds made available for injury prevention and control at the Centers for
Disease Control and Prevention may be used to advocate or promote gun control:
Provided further, That the Director may redirect the total amount
made available under authority of Public Law 101-502, section 3, dated
November 3, 1990, to activities the Director may so designate: Provided
further, That the Congress is to be notified promptly of any such
transfer: Provided further, That notwithstanding any other provision
of law, a single contract or related contracts for the development and
construction of laboratory building 18 may be employed which collectively
include the full scope of the project: Provided further, That the
solicitation and contract shall contain the clause `availability of funds'
found at 48 CFR 52.232-18: Provided further, That not to exceed
$10,000,000 may be available for making grants under section 1509 of the
Public Health Service Act to not more than 10 States.
[<-Struck
out]
[Struck out->] National Institutes of Health
[<-Struck
out]
[Struck out->] NATIONAL CANCER INSTITUTE
[<-Struck
out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to cancer, $3,793,587,000.
[<-Struck out]
[Struck out->] NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
[<-Struck out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to cardiovascular, lung, and blood
diseases, and blood and blood products, $2,321,320,000.
[<-Struck
out]
[Struck out->] NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL
RESEARCH
[<-Struck out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to dental disease, $309,007,000.
[<-Struck out]
[Struck out->] NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND
KIDNEY DISEASES
[<-Struck out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to diabetes and digestive and kidney
disease, $1,315,530,000.
[<-Struck out]
[Struck out->] NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND
STROKE
[<-Struck out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to neurological disorders and stroke,
$1,185,767,000.
[<-Struck out]
[Struck out->] NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS
DISEASES
[<-Struck out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to allergy and infectious diseases,
$2,062,126,000.
[<-Struck out]
[Struck out->] NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES
[<-Struck out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to general medical sciences,
$1,548,313,000.
[<-Struck out]
[Struck out->] NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN
DEVELOPMENT
[<-Struck out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to child health and human development,
$984,300,000.
[<-Struck out]
[Struck out->] NATIONAL EYE INSTITUTE
[<-Struck out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to eye diseases and visual disorders,
$514,673,000.
[<-Struck out]
[Struck out->] NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES
[<-Struck out]
[Struck out->] For carrying out sections 301 and 311 and title IV
of the Public Health Service Act with respect to environmental health
sciences, $506,730,000.
[<-Struck out]
[Struck out->] NATIONAL INSTITUTE ON AGING
[<-Struck
out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to aging, $790,299,000.
[<-Struck out]
[Struck out->] NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL
AND SKIN DISEASES
[<-Struck out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to arthritis and musculoskeletal and
skin diseases, $400,025,000.
[<-Struck out]
[Struck out->] NATIONAL INSTITUTE ON DEAFNESS AND OTHER
COMMUNICATION DISORDERS
[<-Struck out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to deafness and other communication
disorders, $301,787,000.
[<-Struck out]
[Struck out->] NATIONAL INSTITUTE OF NURSING RESEARCH
[<-Struck out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to nursing research, $102,312,000.
[<-Struck out]
[Struck out->] NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM
[<-Struck out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to alcohol abuse and alcoholism,
$349,216,000.
[<-Struck out]
[Struck out->] NATIONAL INSTITUTE ON DRUG ABUSE
[<-Struck
out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to drug abuse, $788,201,000.
[<-Struck out]
[Struck out->] NATIONAL INSTITUTE OF MENTAL HEALTH
[<-Struck out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to mental health, $1,114,638,000.
[<-Struck out]
[Struck out->] NATIONAL HUMAN GENOME RESEARCH INSTITUTE
[<-Struck out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to human genome research, $386,410,000.
[<-Struck out]
[Struck out->] NATIONAL CENTER FOR RESEARCH RESOURCES
[<-Struck out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to research resources and general
research support grants, $832,027,000: Provided, That none of these
funds shall be used to pay recipients of the general research support grants
program any amount for indirect expenses in connection with such grants:
Provided further, That $75,000,000 shall be for extramural facilities
construction grants.
[<-Struck out]
[Struck out->] JOHN E. FOGARTY INTERNATIONAL CENTER
[<-Struck out]
[Struck out->] For carrying out the activities at the John E.
Fogarty International Center, $50,299,000.
[<-Struck out]
[Struck out->] NATIONAL LIBRARY OF MEDICINE
[<-Struck
out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to health information communications,
$256,281,000, of which $4,000,000 shall be available until expended for
improvement of information systems: Provided, That in fiscal year
2001, the Library may enter into personal services contracts for the provision
of services in facilities owned, operated, or constructed under the
jurisdiction of the National Institutes of Health.
[<-Struck out]
[Struck out->] NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE
MEDICINE
[<-Struck out]
[Struck out->] For carrying out section 301 and title IV of the
Public Health Service Act with respect to complementary and alternative
medicine, $78,880,000.
[<-Struck out]
[Struck out->] OFFICE OF THE DIRECTOR
[<-Struck out]
[Struck out->] (INCLUDING TRANSFER OF FUNDS)
[<-Struck
out]
[Struck out->] For carrying out the responsibilities of the
Office of the Director, National Institutes of Health, $342,307,000, of which
$48,271,000 shall be for the Office of AIDS Research: Provided, That
funding shall be available for the purchase of not to exceed 20 passenger
motor vehicles for replacement only: Provided further, That the
Director may direct up to 1 percent of the total amount made available in this
or any other Act to all National Institutes of Health appropriations to
activities the Director may so designate: Provided further, That no
such appropriation shall be decreased by more than 1 percent by any such
transfers and that the Congress is promptly notified of the transfer:
Provided further, That the National Institutes of Health is
authorized to collect third party payments for the cost of clinical services
that are incurred in National Institutes of Health research facilities and
that such payments shall be credited to the National Institutes of Health
Management Fund: Provided further, That all funds credited to the
National Institutes of Health Management Fund shall remain available for 1
fiscal year after the fiscal year in which they are deposited: Provided
further, That up to $500,000 shall be available to carry out section 499
of the Public Health Service Act: Provided further, That,
notwithstanding section 499(k)(10) of the Public Health Service Act, funds
from the Foundation for the National Institutes of Health may be transferred
to the National Institutes of Health.
[<-Struck out]
[Struck out->] BUILDINGS AND FACILITIES
[<-Struck
out]
[Struck out->] For the study of, construction of, and acquisition
of equipment for, facilities of or used by the National Institutes of Health,
including the acquisition of real property, $178,700,000, to remain available
until expended, of which $47,300,000 shall be for the National Neuroscience
Research Center: Provided, That notwithstanding any other provision
of law, a single contract or related contracts for the development and
construction of the first phase of the National Neuroscience Research Center
may be employed which collectively include the full scope of the project:
Provided further, That the solicitation and contract shall contain
the clause `availability of funds' found at 48 CFR 52.232-18.
[<-Struck out]
[Struck out->] Substance Abuse and Mental Health Services
Administration
[<-Struck out]
[Struck out->] SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES
[<-Struck out]
[Struck out->] For carrying out titles V and XIX of the Public
Health Service Act with respect to substance abuse and mental health services,
the Protection and Advocacy for Mentally Ill Individuals Act of 1986, and
section 301 of the Public Health Service Act with respect to program
management, $2,727,626,000.
[<-Struck out]
[Struck out->] Agency for Healthcare Research and Quality
[<-Struck out]
[Struck out->] HEALTHCARE RESEARCH AND QUALITY
[<-Struck
out]
[Struck out->] For carrying out titles III and IX of the Public
Health Service Act, and part A of title XI of the Social Security Act,
$123,669,000; in addition, amounts received from Freedom of Information Act
fees, reimbursable and interagency agreements, and the sale of data shall be
credited to this appropriation and shall remain available until expended:
Provided, That the amount made available pursuant to section 926(b)
of the Public Health Service Act shall not exceed $99,980,000.
[<-Struck out]
[Struck out->] Health Care Financing Administration
[<-Struck out]
[Struck out->] GRANTS TO STATES FOR MEDICAID
[<-Struck
out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] PAYMENTS TO HEALTH CARE TRUST FUNDS
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] PROGRAM MANAGEMENT
[<-Struck out]
[Struck out->] For carrying out, except as otherwise provided,
titles XI, XVIII, XIX, and XXI of the Social Security Act, titles XIII and
XXVII of the Public Health Service Act, and the Clinical Laboratory
Improvement Amendments of 1988, not to exceed $1,866,302,000, to be
transferred from the Federal Hospital Insurance and the Federal Supplementary
Medical Insurance Trust Funds, as authorized by section 201(g) of the Social
Security Act; together with all funds collected in accordance with section 353
of the Public Health Service Act and such sums as may be collected from
authorized user fees and the sale of data, which shall remain available until
expended, and together with administrative fees collected relative to Medicare
overpayment recovery activities, which shall remain available until expended:
Provided, That all funds derived in accordance with 31 U.S.C. 9701
from organizations established under title XIII of the Public Health Service
Act shall be credited to and available for carrying out the purposes of this
appropriation: Provided further, That $18,000,000 appropriated under
this heading for the managed care system redesign shall remain available until
expended: Provided further, That the Secretary of Health and Human
Services is directed to collect fees in fiscal year 2001 from Medicare+Choice
organizations pursuant to section 1857(e)(2) of the Social Security Act and
from eligible organizations with risk-sharing contracts under section 1876 of
that Act pursuant to section 1876(k)(4)(D) of that Act: Provided
further, That, for the current fiscal year, not more that $630,000,000
may be made available under section 1817(k)(4) of the Social Security Act (42
U.S.C. 1395i(k)(4)) from the Health Care Fraud and Abuse Control Account of
the Federal Hospital Insurance Trust Fund to carry out the Medicare Integrity
Program under section 1893 of such Act.
[<-Struck out]
[Struck out->] HEALTH MAINTENANCE ORGANIZATION LOAN AND LOAN
GUARANTEE FUND
[<-Struck out]
[Struck out->] For carrying out subsections (d) and (e) of
section 1308 of the Public Health Service Act, any amounts received by the
Secretary in connection with loans and loan guarantees under title XIII of the
Public Health Service Act, to be available without fiscal year limitation for
the payment of outstanding obligations. During fiscal year 2001, no
commitments for direct loans or loan guarantees shall be made.
[<-Struck out]
[Struck out->] Administration for Children and Families
[<-Struck out]
[Struck out->] PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND
FAMILY SUPPORT PROGRAMS
[<-Struck out]
[Struck out->] For making payments to States or other non-Federal
entities under titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act
and the Act of July 5, 1960 (24 U.S.C. ch. 9), $2,473,800,000, to remain
available until expended; and for such purposes for the first quarter of
fiscal year 2002, $1,000,000,000.
[<-Struck out]
[Struck out->] 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.
[<-Struck
out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] LOW INCOME HOME ENERGY ASSISTANCE
[<-Struck out]
[Struck out->] For making payments under title XXVI of the
Omnibus Budget Reconciliation Act of 1981, $1,100,000,000, to be available for
obligation in the period October 1, 2001 through September 30, 2002.
[<-Struck out]
[Struck out->] For making payments under title XXVI of such Act,
$300,000,000: Provided, That these funds are hereby designated by
Congress to be emergency requirements pursuant to section 251(b)(2)(A) of the
Balanced Budget and Emergency Deficit Control Act of 1985: Provided
further, That these funds shall be made available only after submission
to Congress of a formal budget request by the President that includes
designation of the entire amount of the request as an emergency requirement as
defined in the Balanced Budget and Emergency Deficit Control Act of 1985.
[<-Struck out]
[Struck out->] REFUGEE AND ENTRANT ASSISTANCE
[<-Struck
out]
[Struck out->] For making payments for refugee and entrant
assistance activities authorized by title IV of the Immigration and
Nationality Act and section 501 of the Refugee Education Assistance Act of
1980 (Public Law 96-422), $423,109,000: Provided, That funds
appropriated pursuant to section 414(a) of the Immigration and Nationality Act
for fiscal year 2001 shall be available for the costs of assistance provided
and other activities through September 30, 2003.
[<-Struck out]
[Struck out->] For carrying out section 5 of the Torture Victims
Relief Act of 1998 (Public Law 105-320), $10,000,000.
[<-Struck
out]
[Struck out->] PAYMENTS TO STATES FOR THE CHILD CARE AND
DEVELOPMENT BLOCK GRANT
[<-Struck out]
[Struck out->] For carrying out sections 658A through 658R of the
Omnibus Budget Reconciliation Act of 1981 (The Child Care and Development
Block Grant Act of 1990), in addition to amounts already appropriated for
fiscal year 2001, $400,000,000; and to become available on October 1, 2001 and
remain available through September 30, 2002, $2,000,000,000:
Provided, That of the funds appropriated for each of fiscal years
2001 and 2002, $19,120,000 shall be available for child care resource and
referral and school-aged child care activities: Provided further,
That of the funds provided for fiscal year 2002, $172,672,000 shall be
reserved by the States for activities authorized under section 658G of the
Omnibus Budget Reconciliation Act of 1981 (The Child Care and Development
Block Grant Act of 1990), such funds to be in addition to the amounts required
to be reserved by the States under section 658G.
[<-Struck out]
[Struck out->] SOCIAL SERVICES BLOCK GRANT
[<-Struck
out]
[Struck out->] For making grants to States pursuant to section
2002 of the Social Security Act, $1,700,000,000: Provided, That
notwithstanding section 2003(c) of such Act, as amended, the amount specified
for allocation under such section for fiscal year 2001 shall be
$1,700,000,000.
[<-Struck out]
[Struck out->] CHILDREN AND FAMILIES SERVICES PROGRAMS
[<-Struck out]
[Struck out->] (INCLUDING RESCISSIONS)
[<-Struck
out]
[Struck out->] For carrying out, except as otherwise provided,
the Runaway and Homeless Youth Act, the Developmental Disabilities Assistance
and Bill of Rights Act, the Head Start Act, the Child Abuse Prevention and
Treatment Act, the Native American Programs Act of 1974, title II of Public
Law 95-266 (adoption opportunities), the Adoption and Safe Families Act of
1997 (Public Law 105-89), the Abandoned Infants Assistance Act of 1988, part
B(1) of title IV and sections 413, 429A, 1110, and 1115 of the Social Security
Act, and sections 40155, 40211, and 40241 of Public law 103-322; for making
payments under the Community Services Block Grant Act, section 473A of the
Social Security Act, and title IV of Public Law 105-285; and for necessary
administrative expenses to carry out said Acts and titles I, IV, X, XI, XIV,
XVI, and XX of the Social Security Act, the Act of July 5, 1960 (24 U.S.C. ch.
9), the Omnibus Budget Reconciliation Act of 1981, title IV of the Immigration
and Nationality Act, section 501 of the Refugee Education Assistance Act of
1980, section 5 of the Torture Victims Relief Act of 1998 (Public Law
105-320), sections 40155, 40211, and 40241 of Public Law 103-322 and section
126 and titles IV and V of Public Law 100-485, $7,231,253,000, of which
$43,000,000, to remain available until September 30, 2002, shall be for grants
to States for adoption incentive payments, as authorized by section 473A of
title IV of the Social Security Act (42 U.S.C. 670-679); of which $595,376,000
shall be for making payments under the Community Services Block Grant Act; and
of which $5,667,000,000 shall be for making payments under the Head Start Act,
of which $1,400,000,000 shall become available October 1, 2001 and remain
available through September 30, 2002: Provided, That to the extent
Community Services Block Grant funds are distributed as grant funds by a State
to an eligible entity as provided under the Act, and have not been expended by
such entity, they shall remain with such entity for carryover into the next
fiscal year for expenditure by such entity consistent with program purposes.
[<-Struck out]
[Struck out->] Funds appropriated for fiscal year 2001 under
section 429A(e), part B of title IV of the Social Security Act shall be
reduced by $6,000,000.
[<-Struck out]
[Struck out->] Funds appropriated for fiscal year 2001 under
section 413(h)(1) of the Social Security Act shall be reduced by $15,000,000.
[<-Struck out]
[Struck out->] PROMOTING SAFE AND STABLE FAMILIES
[<-Struck out]
[Struck out->] For carrying out section 430 of the Social
Security Act, $305,000,000.
[<-Struck out]
[Struck out->] PAYMENTS TO STATES FOR FOSTER CARE AND ADOPTION
ASSISTANCE
[<-Struck out]
[Struck out->] For making payments to States or other non-Federal
entities under title IV-E of the Social Security Act, $4,863,100,000.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] Administration on Aging
[<-Struck
out]
[Struck out->] AGING SERVICES PROGRAMS
[<-Struck
out]
[Struck out->] For carrying out, to the extent not otherwise
provided, the Older Americans Act of 1965, as amended, and section 398 of the
Public Health Service Act, $925,805,000: Provided, That
notwithstanding section 308(b)(1) of the Older Americans Act of 1965, as
amended, the amounts available to each State for administration of the State
plan under title III of such Act shall be reduced not more than 5 percent
below the amount that was available to such State for such purpose for fiscal
year 1995: Provided further, That in considering grant applications
for nutrition services for elder Indian recipients, the Assistant Secretary
shall provide maximum flexibility to applicants who seek to take into account
subsistence, local customs, and other characteristics that are appropriate to
the unique cultural, regional, and geographic needs of the American Indian,
Alaska and Hawaiian Native communities to be served.
[<-Struck
out]
[Struck out->] Office of the Secretary
[<-Struck
out]
[Struck out->] GENERAL DEPARTMENTAL MANAGEMENT
[<-Struck
out]
[Struck out->] For necessary expenses, not otherwise provided,
for general departmental management, including hire of six sedans, and for
carrying out titles III, XVII, and XX of the Public Health Service Act, and
the United States-Mexico Border Health Commission Act, $206,780,000, together
with $5,851,000, to be transferred and expended as authorized by section
201(g)(1) of the Social Security Act from the Hospital Insurance Trust Fund
and the Supplemental Medical Insurance Trust Fund.
[<-Struck out]
[Struck out->] OFFICE OF INSPECTOR GENERAL
[<-Struck
out]
[Struck out->] For expenses necessary for the Office of Inspector
General in carrying out the provisions of the Inspector General Act of 1978,
as amended, $31,394,000: Provided, That, for the current fiscal year,
not more than $120,000,000 may be made available under section 1817(k)(3)(A)
of the Social Security Act (42 U.S.C. 1395i(k)(3)(A)) from the Health Care
Fraud and Abuse Control Account of the Federal Hospital Insurance Trust Fund
for purposes of the activities of the Office of Inspector General with respect
to the Medicare and Medicaid programs.
[<-Struck out]
[Struck out->] OFFICE FOR CIVIL RIGHTS
[<-Struck
out]
[Struck out->] For expenses necessary for the Office for Civil
Rights, $18,774,000, together with not to exceed $3,314,000, to be transferred
and expended as authorized by section 201(g)(1) of the Social Security Act
from the Hospital Insurance Trust Fund and the Supplemental Medical Insurance
Trust Fund.
[<-Struck out]
[Struck out->] POLICY RESEARCH
[<-Struck out]
[Struck out->] For carrying out, to the extent not otherwise
provided, research studies under section 1110 of the Social Security Act,
$16,738,000.
[<-Struck out]
[Struck out->] RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED
OFFICERS
[<-Struck out]
[Struck out->] For retirement pay and medical benefits of Public
Health Service Commissioned Officers as authorized by law, for payments under
the Retired Serviceman's Family Protection Plan and Survivor Benefit Plan, for
medical care of dependents and retired personnel under the Dependents' Medical
Care Act (10 U.S.C. ch. 55), and for payments pursuant to section 229(b) of
the Social Security Act (42 U.S.C. 429(b)), such amounts as may be required
during the current fiscal year.
[<-Struck out]
[Struck out->] PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND
[<-Struck out]
[Struck out->] For expenses necessary to support activities
related to countering potential biological, disease and chemical threats to
civilian populations, $236,600,000: Provided, That this amount is
distributed as follows: Centers for Disease Control and Prevention,
$182,000,000, of which $30,000,000 shall be for the Health Alert Network; and
Office of Emergency Preparedness, $54,600,000. In addition, $114,040,000 shall
be available to the Centers for Disease Control and Prevention for the
following activities: $61,000,000 for international HIV/AIDS programs,
$25,000,000 for global polio eradication activities, $18,040,000 for continued
study of the anthrax vaccine; and $10,000,000 for activities related to the
West Nile-like virus. In addition, $100,000,000 shall be available to support
the Ricky Ray Hemophilia Relief Fund Act of 1988: Provided further,
That, notwithstanding any other provision of law, up to $8,000,000 of the
amount provided for the Ricky Ray Hemophilia Relief Fund Act may be available
for administrative expenses of the Health Resources and Services
Administration. In addition, $50,000,000 shall be available to the Office of
the Secretary for minority AIDS prevention and treatment activities:
Provided further, That no funds shall be obligated until the
Department of Health and Human Services submits an operating plan to the House
and Senate Committees on Appropriations.
[<-Struck out]
[Struck out->] GENERAL PROVISIONS
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] SEC. 204. None of the funds appropriated in this
Act for the National Institutes of Health and the Substance Abuse and Mental
Health Services Administration shall be used to pay the salary of an
individual, through a grant or other extramural mechanism, at a rate in excess
of Executive Level I.
[<-Struck out]
[Struck out->] SEC. 205. None of the funds appropriated in this
Act may be expended pursuant to section 241 of the Public Health Service Act,
except for funds specifically provided for in this Act, or for other taps and
assessments made by any office located in the Department of Health and Human
Services, prior to the Secretary's preparation and submission of a report to
the Committee on Appropriations of the Senate and of the House detailing the
planned uses of such funds.
[<-Struck out]
[Struck out->] (TRANSFER OF FUNDS)
[<-Struck out]
[Struck out->] SEC. 206. Not to exceed 1 percent of any
discretionary funds (pursuant to the Balanced Budget and Emergency Deficit
Control Act of 1985, as amended) which are appropriated for the current fiscal
year for the Department of Health and Human Services in this Act may be
transferred between appropriations, but no such appropriation shall be
increased by more than 3 percent by any such transfer: Provided, That
the Appropriations Committees of both Houses of Congress are notified at least
15 days in advance of any transfer: Provided further, That this
section shall not apply to funds appropriated under the heading `Centers for
Disease Control and Prevention-Disease Control, Research, and Training', funds
made available to the Centers for Disease Control and Prevention under the
heading `Public Health and Social Services Emergency Fund', or any other funds
made available in this Act to the Centers for Disease Control and Prevention.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] SEC. 211. With respect to fiscal year 2001, the
amount of an allotment of a State under section 1921 of the Public Health
Services Act shall not be less than the amount the State received under such
section for fiscal year 2000 increased by 33.33 percent of the percentage by
which the amount allotted to the States for fiscal year 2001 exceeds the
amount allotted to the States for fiscal year 2000.
[<-Struck
out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] SEC. 213. None of the funds in this Act or any
other Act may be used to obligate funds for the National Institutes of Health
in excess of the total amount identified for this purpose for fiscal year 2001
in the President's budget request (H. Doc. 106-162): Provided, That
none of the funds made available for each Institute, Center, Office, or
Buildings and Facilities shall be reduced below the amounts shown in the
budget request column of the table printed in the report accompanying the bill
making appropriations for the Departments of Labor, Health and Human Services,
Education, and Related Agencies for fiscal year 2001.
[<-Struck
out]
[Struck out->] This title may be cited as the `Department of
Health and Human Services Appropriations Act, 2001'.
[<-Struck
out]
[Struck out->] TITLE III--DEPARTMENT OF EDUCATION
[<-Struck out]
[Struck out->] EDUCATION REFORM
[<-Struck out]
[Struck out->] For carrying out activities authorized by sections
3122, 3132, 3136, and 3141, parts B and C of title III, and part I of title X
of the Elementary and Secondary Education Act of 1965, $1,505,000,000, of
which $119,500,000 shall be for section 3122: Provided, That up to
one-half of 1 percent of the amount available under section 3132 shall be set
aside for the outlying areas, to be distributed on the basis of their relative
need as determined by the Secretary in accordance with the purposes of the
program: Provided further, That if any State educational agency does
not apply for a grant under section 3132, that State's allotment under section
3131 shall be reserved by the Secretary for grants to local educational
agencies in that State that apply directly to the Secretary according to the
terms and conditions published by the Secretary in the Federal Register.
[<-Struck out]
[Struck out->] EDUCATION FOR THE DISADVANTAGED
[<-Struck
out]
[Struck out->] For carrying out title I of the Elementary and
Secondary Education Act of 1965, and section 418A of the Higher Education Act
of 1965, $8,816,986,000, of which $2,569,823,000 shall become available on
July 1, 2001, and shall remain available through September 30, 2002, and of
which $6,204,763,000 shall become available on October 1, 2001 and shall
remain available through September 30, 2002, for academic year 2001-2002:
Provided, That $6,783,000,000 shall be available for basic grants
under section 1124: Provided further, That up to $3,500,000 of these
funds shall be available to the Secretary on October 1, 2000, to obtain
updated local-educational-agency-level census poverty data from the Bureau of
the Census: Provided further, That $1,158,397,000 shall be available
for concentration grants under section 1124A: Provided further, That
$8,900,000 shall be available for evaluations under section 1501 and not more
than $8,500,000 shall be reserved for section 1308, of which not more than
$3,000,000 shall be reserved for section 1308(d): Provided further,
That $190,000,000 shall be available under section 1002(g)(2) to demonstrate
effective approaches to comprehensive school reform to be allocated and
expended in accordance with the instructions relating to this activity in the
statement of the managers on the conference report accompanying Public Law
105-78 and in the statement of the managers on the conference report
accompanying Public Law 105-277: Provided further, That in carrying
out this initiative, the Secretary and the States shall support only
approaches that show the most promise of enabling children served by title I
to meet challenging State content standards and challenging State student
performance standards based on reliable research and effective practices, and
include an emphasis on basic academics and parental involvement.
[<-Struck out]
[Struck out->] IMPACT AID
[<-Struck out]
[Struck out->] For carrying out programs of financial assistance
to federally affected schools authorized by title VIII of the Elementary and
Secondary Education Act of 1965, $985,000,000, of which $780,000,000 shall be
for basic support payments under section 8003(b), $50,000,000 shall be for
payments for children with disabilities under section 8003(d), $82,000,000, to
remain available until expended, shall be for payments under section 8003(f),
$25,000,000 shall be for construction under section 8007, $40,000,000 shall be
for Federal property payments under section 8002, and $8,000,000, to remain
available until expended, shall be for facilities maintenance under section
8008.
[<-Struck out]
[Struck out->] SCHOOL IMPROVEMENT PROGRAMS
[<-Struck
out]
[Struck out->] For carrying out school improvement activities
authorized by titles IV, V-A and B, VI, IX, X, and XIII of the Elementary and
Secondary Education Act of 1965 (`ESEA'); the Stewart B. McKinney Homeless
Assistance Act; the Civil Rights Act of 1964; and part B of title VIII of the
Higher Education Act of 1965, $3,165,334,000, of which $1,073,500,000 shall
become available on July 1, 2001, and remain available through September 30,
2002, and of which $1,515,000,000 shall become available on October 1, 2001
and shall remain available through September 30, 2002 for academic year
2001-2002: Provided, That of the amount appropriated, $1,750,000,000
shall be for the Teacher Empowerment Act, if such legislation is enacted.
[<-Struck out]
[Struck out->] READING EXCELLENCE
[<-Struck out]
[Struck out->] For necessary expenses to carry out the Reading
Excellence Act, $65,000,000, which shall become available on July 1, 2001 and
shall remain available through September 30, 2002 and $195,000,000 which shall
become available on October 1, 2001 and remain available through September 30,
2002.
[<-Struck out]
[Struck out->] INDIAN EDUCATION
[<-Struck out]
[Struck out->] For expenses necessary to carry out, to the extent
not otherwise provided, title IX, part A of the Elementary and Secondary
Education Act of 1965, as amended, $107,765,000.
[<-Struck out]
[Struck out->] BILINGUAL AND IMMIGRANT EDUCATION
[<-Struck out]
[Struck out->] For carrying out, to the extent not otherwise
provided, bilingual, foreign language and immigrant education activities
authorized by parts A and C and section 7203 of title VII of the Elementary
and Secondary Education Act of 1965, without regard to section 7103(b),
$406,000,000: Provided, That State educational agencies may use all,
or any part of, their part C allocation for competitive grants to local
educational agencies.
[<-Struck out]
[Struck out->] SPECIAL EDUCATION
[<-Struck out]
[Struck out->] For carrying out the Individuals with Disabilities
Education Act, $6,550,161,000, of which $2,557,885,000 shall become available
for obligation on July 1, 2001, and shall remain available through September
30, 2002, and of which $3,742,000,000 shall become available on October 1,
2001 and shall remain available through September 30, 2002, for academic year
2001-2002: Provided, That $9,500,000 shall be for Recording for the
Blind and Dyslexic to support the development, production, and circulation of
recorded educational materials.
[<-Struck out]
[Struck out->] REHABILITATION SERVICES AND DISABILITY RESEARCH
[<-Struck out]
[Struck out->] For carrying out, to the extent not otherwise
provided, the Rehabilitation Act of 1973, the Assistive Technology Act of
1998, and the Helen Keller National Center Act, $2,776,803,000:
Provided, That notwithstanding section 105(b)(1) of the Assistive
Technology Act of 1998 (`the AT Act'), each State shall be provided $50,000
for activities under section 102 of the AT Act.
[<-Struck out]
[Struck out->] Special Institutions for Persons With Disabilities
[<-Struck out]
[Struck out->] AMERICAN PRINTING HOUSE FOR THE BLIND
[<-Struck out]
[Struck out->] For carrying out the Act of March 3, 1879, as
amended (20 U.S.C. 101 et seq.), $11,000,000.
[<-Struck out]
[Struck out->] NATIONAL TECHNICAL INSTITUTE FOR THE DEAF
[<-Struck out]
[Struck out->] For the National Technical Institute for the Deaf
under titles I and II of the Education of the Deaf Act of 1986 (20 U.S.C. 4301
et seq.), $54,000,000, of which $6,000,000 shall be for construction and shall
remain available until expended: Provided, That from the total amount
available, the Institute may at its discretion use funds for the endowment
program as authorized under section 207.
[<-Struck out]
[Struck out->] GALLAUDET UNIVERSITY
[<-Struck out]
[Struck out->] For the Kendall Demonstration Elementary School,
the Model Secondary School for the Deaf, and the partial support of Gallaudet
University under titles I and II of the Education of the Deaf Act of 1986 (20
U.S.C. 4301 et seq.), $89,400,000: Provided, That from the total
amount available, the University may at its discretion use funds for the
endowment program as authorized under section 207.
[<-Struck out]
[Struck out->] VOCATIONAL AND ADULT EDUCATION
[<-Struck
out]
[Struck out->] For carrying out, to the extent not otherwise
provided, the Carl D. Perkins Vocational and Technical Education Act and the
Adult Education and Family Literacy Act, $1,718,600,000, of which $1,000,000
shall remain available until expended, and of which $923,000,000 shall become
available on July 1, 2001 and shall remain available through September 30,
2002 and of which $791,000,000 shall become available on October 1, 2001 and
shall remain available through September 30, 2002: Provided, That of
the amounts made available for the Carl D. Perkins Vocational and Technical
Education Act, $4,600,000 shall be for tribally controlled vocational
institutions under section 117: Provided further, That of the amount
provided for Adult Education State Grants, $25,500,000 shall be made available
for integrated English literacy and civics education services to immigrants
and other limited English proficient populations: Provided further,
That of the amount reserved for integrated English literacy and civics
education, half shall be allocated to the States with the largest absolute
need for such services and half shall be allocated to the States with the
largest recent growth in need for such services, based on the best available
data, notwithstanding section 211 of the Adult Education and Family Literacy
Act: Provided further, That of the amounts made available for the
Adult Education and Family Literacy Act, $14,000,000 shall be for national
leadership activities under section 243 and $6,500,000 shall be for the
National Institute for Literacy under section 242.
[<-Struck out]
[Struck out->] STUDENT FINANCIAL ASSISTANCE
[<-Struck
out]
[Struck out->] For carrying out subparts 1 and 3 of part A, part
C and part E of title IV of the Higher Education Act of 1965, as amended,
$10,198,000,000 (reduced by $48,000,000), which shall remain available through
September 30, 2002.
[<-Struck out]
[Struck out->] The maximum Pell Grant for which a student shall
be eligible during award year 2001-2002 shall be $3,500: Provided,
That notwithstanding section 401(g) of the Act, if the Secretary determines,
prior to publication of the payment schedule for such award year, that the
amount included within this appropriation for Pell Grant awards in such award
year, and any funds available from the fiscal year 2000 appropriation for Pell
Grant awards, are insufficient to satisfy fully all such awards for which
students are eligible, as calculated under section 401(b) of the Act, the
amount paid for each such award shall be reduced by either a fixed or variable
percentage, or by a fixed dollar amount, as determined in accordance with a
schedule of reductions established by the Secretary for this purpose.
[<-Struck out]
[Struck out->] FEDERAL FAMILY EDUCATION LOAN PROGRAM ACCOUNT
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] HIGHER EDUCATION
[<-Struck out]
[Struck out->] For carrying out, to the extent not otherwise
provided, section 121 and titles II, III, IV, V, VI, VII, and VIII of the
Higher Education Act of 1965, as amended, and the Mutual Educational and
Cultural Exchange Act of 1961, $1,688,081,000, of which $10,000,000 for
interest subsidies authorized by section 121 of the Higher Education Act of
1965, shall remain available until expended: Provided, That
$10,000,000, to remain available through September 30, 2002, shall be
available to fund fellowships for academic year 2002-2003 under part A,
subpart 1 of title VII of said Act, under the terms and conditions of part A,
subpart 1: Provided further, That $3,000,000 is for data collection
and evaluation activities for programs under the Higher Education Act of 1965,
including such activities needed to comply with the Government Performance and
Results Act of 1993.
[<-Struck out]
[Struck out->] HOWARD UNIVERSITY
[<-Struck out]
[Struck out->] For partial support of Howard University (20
U.S.C. 121 et seq.), $226,474,000, of which not less than $3,600,000 shall be
for a matching endowment grant pursuant to the Howard University Endowment Act
(Public Law 98-480) and shall remain available until expended.
[<-Struck out]
[Struck out->] COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS
PROGRAM
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL
FINANCING PROGRAM ACCOUNT
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] For administrative expenses to carry out the
Historically Black College and University Capital Financing Program entered
into pursuant to title III, part D of the Higher Education Act of 1965, as
amended, $207,000.
[<-Struck out]
[Struck out->] EDUCATION RESEARCH, STATISTICS, AND IMPROVEMENT
[<-Struck out]
[Struck out->] For carrying out activities authorized by the
Educational Research, Development, Dissemination, and Improvement Act of 1994,
including part E; the National Education Statistics Act of 1994, including
sections 411 and 412; section 2102 of title II, and parts A, B, and K and
sections 10105 and 10601 of title X, and part C of title XIII of the
Elementary and Secondary Education Act of 1965, as amended, and title VI of
Public Law 103-227, $494,367,000: Provided, That $50,000,000 shall be
available to demonstrate effective approaches to comprehensive school reform,
to be allocated and expended in accordance with the instructions relating to
this activity in the statement of managers on the conference report
accompanying Public Law 105-78 and in the statement of the managers on the
conference report accompanying Public Law 105-277: Provided further,
That the funds made available for comprehensive school reform shall become
available on July 1, 2001, and remain available through September 30, 2002,
and in carrying out this initiative, the Secretary and the States shall
support only approaches that show the most promise of enabling children to
meet challenging State content standards and challenging State student
performance standards based on reliable research and effective practices, and
include an emphasis on basic academics and parental involvement: Provided
further, That $30,000,000 of the funds provided for the national
education research institutes shall be allocated notwithstanding section
912(m)(1)(B-F) and subparagraphs (B) and (C) of section 931(c)(2) of Public
Law 103-227: Provided further, That $45,000,000 shall be available to
support activities under section 10105 of part A of title X of the Elementary
and Secondary Education Act of 1965, of which up to $2,250,000 may be
available for evaluation, technical assistance, and school networking
activities: Provided further, That funds made available to local
educational agencies under this section shall be used only for activities
related to establishing smaller learning communities in high schools:
Provided further, That funds made available for section 10105 of part
A of title X of the Elementary and Secondary Education Act of 1965 shall
become available on July 1, 2001, and remain available through September 30,
2002.
[<-Struck out]
[Struck out->] Departmental Management
[<-Struck
out]
[Struck out->] PROGRAM ADMINISTRATION
[<-Struck out]
[Struck out->] For carrying out, to the extent not otherwise
provided, the Department of Education Organization Act, including rental of
conference rooms in the District of Columbia and hire of two passenger motor
vehicles, $382,934,000.
[<-Struck out]
[Struck out->] OFFICE FOR CIVIL RIGHTS
[<-Struck
out]
[Struck out->] For expenses necessary for the Office for Civil
Rights, as authorized by section 203 of the Department of Education
Organization Act, $71,200,000.
[<-Struck out]
[Struck out->] OFFICE OF INSPECTOR GENERAL
[<-Struck
out]
[Struck out->] For expenses necessary for the Office of Inspector
General, as authorized by section 212 of the Department of Education
Organization Act, $34,000,000.
[<-Struck out]
[Struck out->] GENERAL PROVISIONS
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] SEC. 304. (a) INTERNET FILTERING- No funds made
available under title III of the Elementary and Secondary Education Act of
1965 to a local educational agency or elementary or secondary school may be
used to purchase computers used to access the Internet, or to pay for direct
costs associated with accessing the Internet, unless such agency or school has
in place, on computers that are accessible to minors, and during use by such
minors, technology which filters or blocks--
[<-Struck out]
[Struck out->] (1) material that is obscene;
[<-Struck out]
[Struck out->] (2) child pornography; and
[<-Struck
out]
[Struck out->] (3) material harmful to minors.
[<-Struck out]
[Struck out->] (b) DISABLING DURING ADULT USE- An administrator,
supervisor, or other authority may disable the technology described in
subsection (a) during use by an adult, to enable unfiltered access for bona
fide research or other lawful purposes.
[<-Struck out]
[Struck out->] (c) RULE OF CONSTRUCTION- Nothing in this section
shall be construed to prohibit a local educational agency or elementary or
secondary school from filtering or blocking materials other than those
referred to in paragraph (1), (2), or (3) of subsection (a).
[<-Struck out]
[Struck out->] (d) DEFINITIONS-
[<-Struck out]
[Struck out->] (1) MATERIAL HARMFUL TO MINORS- The term
`material harmful to minors' has the meaning given such term in section
231(e)(6) of the Communications Act of 1934.
[<-Struck out]
[Struck out->] (2) CHILD PORNOGRAPHY- The term `child
pornography' has the meaning given such term in section 2256(8) of title 18,
United States Code.
[<-Struck out]
[Struck out->] (3) MINOR- The term `minor' has the meaning
given such term in section 2256(1) of title 18, United States Code.
[<-Struck out]
[Struck out->] (e) SEVERABILITY- If any provision of this section
is held invalid, the remainder of such section and this Act shall not be
affected thereby.
[<-Struck out]
[Struck out->] SEC. 305. None of the funds made available in this
Act may be used to carry out any activities related to any federally sponsored
national test in reading, mathematics, or any other subject that is not
specifically and explicitly provided for in authorizing legislation enacted
into law, except that such limitation shall not apply to the Third
International Mathematics and Science Study or other international comparative
assessments developed under the authority of section 404(a)(6) of the National
Education Statistics Act of 1994 (20 U.S.C. 9003(a)(6) et seq.) and
administered to only a representative sample of pupils in the United States
and in foreign nations.
[<-Struck out]
[Struck out->] This title may be cited as the `Department of
Education Appropriations Act, 2001'.
[<-Struck out]
[Struck out->] TITLE IV--RELATED AGENCIES
[<-Struck
out]
[Struck out->] ARMED FORCES RETIREMENT HOME
[<-Struck
out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] Corporation for National and Community Service
[<-Struck out]
[Struck out->] DOMESTIC VOLUNTEER SERVICE PROGRAMS, OPERATING
EXPENSES
[<-Struck out]
[Struck out->] For expenses necessary for the Corporation for
National and Community Service to carry out the provisions of the Domestic
Volunteer Service Act of 1973, as amended, $294,527,000: Provided,
That none of the funds made available to the Corporation for National and
Community Service in this Act for activities authorized by part E of title II
of the Domestic Volunteer Service Act of 1973 shall be used to provide
stipends or other monetary incentives to volunteers or volunteer leaders whose
incomes exceed 125 percent of the national poverty level.
[<-Struck
out]
[Struck out->] Corporation for Public Broadcasting
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] Federal Mediation and Conciliation Service
[<-Struck out]
[Struck out->] SALARIES AND EXPENSES
[<-Struck out]
[Struck out->] For expenses necessary for the Federal Mediation
and Conciliation Service to carry out the functions vested in it by the Labor
Management Relations Act, 1947 (29 U.S.C. 171-180, 182-183), including hire of
passenger motor vehicles; for expenses necessary for the Labor-Management
Cooperation Act of 1978 (29 U.S.C. 175a); and for expenses necessary for the
Service to carry out the functions vested in it by the Civil Service Reform
Act, Public Law 95-454 (5 U.S.C. ch. 71), $37,500,000, including $1,500,000,
to remain available through September 30, 2002, for activities authorized by
the Labor-Management Cooperation Act of 1978 (29 U.S.C. 175a):
Provided, That notwithstanding 31 U.S.C. 3302, fees charged, up to
full-cost recovery, for special training activities and other conflict
resolution services and technical assistance, including those provided to
foreign governments and international organizations, and for arbitration
services shall be credited to and merged with this account, and shall remain
available until expended: Provided further, That fees for arbitration
services shall be available only for education, training, and professional
development of the agency workforce: Provided further, That the
Director of the Service is authorized to accept and use on behalf of the
United States gifts of services and real, personal, or other property in the
aid of any projects or functions within the Director's jurisdiction.
[<-Struck out]
[Struck out->] Federal Mine Safety and Health Review Commission
[<-Struck out]
[Struck out->] SALARIES AND EXPENSES
[<-Struck out]
[Struck out->] For expenses necessary for the Federal Mine Safety
and Health Review Commission (30 U.S.C. 801 et seq.), $6,200,000.
[<-Struck out]
[Struck out->] Institute of Museum and Library Services
[<-Struck out]
[Struck out->] Office of Library Services: Grants and
Administration
[<-Struck out]
[Struck out->] For carrying out subtitle B of the Museum and
Library Services Act, $170,000,000.
[<-Struck out]
[Struck out->] Medicare Payment Advisory Commission
[<-Struck out]
[Struck out->] SALARIES AND EXPENSES
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] National Commission on Libraries and Information
Science
[<-Struck out]
[Struck out->] SALARIES AND EXPENSES
[<-Struck out]
[Struck out->] For necessary expenses for the National Commission
on Libraries and Information Science, established by the Act of July 20, 1970
(Public Law 91-345, as amended), $1,400,000.
[<-Struck out]
[Struck out->] National Council on Disability
[<-Struck
out]
[Struck out->] SALARIES AND EXPENSES
[<-Struck out]
[Struck out->] For expenses necessary for the National Council on
Disability as authorized by title IV of the Rehabilitation Act of 1973, as
amended, $2,450,000.
[<-Struck out]
[Struck out->] National Labor Relations Board
[<-Struck
out]
[Struck out->] SALARIES AND EXPENSES
[<-Struck out]
[Struck out->] For expenses necessary for the National Labor
Relations Board to carry out the functions vested in it by the
Labor-Management Relations Act, 1947, as amended (29 U.S.C. 141-167), and
other laws, $205,717,000: Provided, That no part of this
appropriation shall be available to organize or assist in organizing
agricultural laborers or used in connection with investigations, hearings,
directives, or orders concerning bargaining units composed of agricultural
laborers as referred to in section 2(3) of the Act of July 5, 1935 (29 U.S.C.
152), and as amended by the Labor-Management Relations Act, 1947, as amended,
and as defined in section 3(f) of the Act of June 25, 1938 (29 U.S.C. 203),
and including in said definition employees engaged in the maintenance and
operation of ditches, canals, reservoirs, and waterways when maintained or
operated on a mutual, nonprofit basis and at least 95 percent of the water
stored or supplied thereby is used for farming purposes.
[<-Struck
out]
[Struck out->] National Mediation Board
[<-Struck
out]
[Struck out->] SALARIES AND EXPENSES
[<-Struck out]
[Struck out->] For expenses necessary to carry out the provisions
of the Railway Labor Act, as amended (45 U.S.C. 151-188), including emergency
boards appointed by the President, $9,800,000.
[<-Struck out]
[Struck out->] Occupational Safety and Health Review Commission
[<-Struck out]
[Struck out->] SALARIES AND EXPENSES
[<-Struck out]
[Struck out->] For expenses necessary for the Occupational Safety
and Health Review Commission (29 U.S.C. 661), $8,600,000.
[<-Struck
out]
[Struck out->] Railroad Retirement Board
[<-Struck
out]
[Struck out->] DUAL BENEFITS PAYMENTS ACCOUNT
[<-Struck
out]
[Struck out->] 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.
[<-Struck
out]
[Struck out->] FEDERAL PAYMENTS TO THE RAILROAD RETIREMENT ACCOUNTS
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] LIMITATION ON ADMINISTRATION
[<-Struck
out]
[Struck out->] For necessary expenses for the Railroad Retirement
Board for administration of the Railroad Retirement Act and the Railroad
Unemployment Insurance Act, $95,000,000, to be derived in such amounts as
determined by the Board from the railroad retirement accounts and from moneys
credited to the railroad unemployment insurance administration fund.
[<-Struck out]
[Struck out->] LIMITATION ON THE OFFICE OF INSPECTOR GENERAL
[<-Struck out]
[Struck out->] For expenses necessary for the Office of Inspector
General for audit, investigatory and review activities, as authorized by the
Inspector General Act of 1978, as amended, not more than $5,380,000, to be
derived from the railroad retirement accounts and railroad unemployment
insurance account: Provided, That none of the funds made available in
any other paragraph of this Act may be transferred to the Office; used to
carry out any such transfer; used to provide any office space, equipment,
office supplies, communications facilities or services, maintenance services,
or administrative services for the Office; used to pay any salary, benefit, or
award for any personnel of the Office; used to pay any other operating expense
of the Office; or used to reimburse the Office for any service provided, or
expense incurred, by the Office.
[<-Struck out]
[Struck out->] Social Security Administration
[<-Struck
out]
[Struck out->] PAYMENTS TO SOCIAL SECURITY TRUST FUNDS
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] SPECIAL BENEFITS FOR DISABLED COAL MINERS
[<-Struck out]
[Struck out->] For carrying out title IV of the Federal Mine
Safety and Health Act of 1977, $365,748,000, to remain available until
expended.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] SUPPLEMENTAL SECURITY INCOME PROGRAM
[<-Struck out]
[Struck out->] For carrying out titles XI and XVI of the Social
Security Act, section 401 of Public Law 92-603, section 212 of Public Law
93-66, as amended, and section 405 of Public Law 95-216, including payment to
the Social Security trust funds for administrative expenses incurred pursuant
to section 201(g)(1) of the Social Security Act, $22,791,000,000 (increased by
$35,000,000), to remain available until expended: Provided, That any
portion of the funds provided to a State in the current fiscal year and not
obligated by the State during that year shall be returned to the Treasury.
[<-Struck out]
[Struck out->] In addition, $245,000,000 (reduced by
$35,000,000), to remain available until September 30, 2002, for payment to the
Social Security trust funds for administrative expenses for continuing
disability reviews as authorized by section 103 of Public Law 104-121 and
section 10203 of Public Law 105-33. The term `continuing disability reviews'
means reviews and redeterminations as defined under section 201(g)(1)(A) of
the Social Security Act, as amended.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] 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.
[<-Struck
out]
[Struck out->] LIMITATION ON ADMINISTRATIVE EXPENSES
[<-Struck out]
[Struck out->] For necessary expenses, including the hire of two
passenger motor vehicles, and not to exceed $10,000 for official reception and
representation expenses, not more than $6,367,036,000 (increased by
$70,000,000) may be expended, as authorized by section 201(g)(1) of the Social
Security Act, from any one or all of the trust funds referred to therein:
Provided, That not less than $1,800,000 shall be for the Social
Security Advisory Board: Provided further, That unobligated balances
at the end of fiscal year 2001 not needed for fiscal year 2001 shall remain
available until expended to invest in the Social Security Administration
information technology and telecommunications hardware and software
infrastructure, including related equipment and non-payroll administrative
expenses associated solely with this information technology and
telecommunications infrastructure: Provided further, That
reimbursement to the trust funds under this heading for expenditures for
official time for employees of the Social Security Administration pursuant to
section 7131 of title 5, United States Code, and for facilities or support
services for labor organizations pursuant to policies, regulations, or
procedures referred to in section 7135(b) of such title shall be made by the
Secretary of the Treasury, with interest, from amounts in the general fund not
otherwise appropriated, as soon as possible after such expenditures are made.
[<-Struck out]
[Struck out->] From funds provided under the first paragraph, not
less than $130,000,000 (increased by $70,000,000) shall be available for
conducting continuing disability reviews.
[<-Struck out]
[Struck out->] In addition to funding already available under
this heading, and subject to the same terms and conditions, $520,000,000
(reduced by $70,000,000), to remain available until September 30, 2002, for
continuing disability reviews as authorized by section 103 of Public Law
104-121 and section 10203 of Public Law 105-33. The term `continuing
disability reviews' means reviews and redeterminations as defined under
section 201(g)(1)(A) of the Social Security Act, as amended.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] 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.
[<-Struck
out]
[Struck out->] OFFICE OF INSPECTOR GENERAL
[<-Struck
out]
[Struck out->] (INCLUDING TRANSFER OF FUNDS)
[<-Struck
out]
[Struck out->] For expenses necessary for the Office of Inspector
General in carrying out the provisions of the Inspector General Act of 1978,
as amended, $14,944,000, together with not to exceed $50,808,000, to be
transferred and expended as authorized by section 201(g)(1) of the Social
Security Act from the Federal Old-Age and Survivors Insurance Trust Fund and
the Federal Disability Insurance Trust Fund.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] United States Institute of Peace
[<-Struck
out]
[Struck out->] OPERATING EXPENSES
[<-Struck out]
[Struck out->] For necessary expenses of the United States
Institute of Peace as authorized in the United States Institute of Peace Act,
$15,000,000.
[<-Struck out]
[Struck out->] TITLE V--GENERAL PROVISIONS
[<-Struck
out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] (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.
[<-Struck out]
[Struck out->] 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'.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] (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.
[<-Struck out]
[Struck out->] (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.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] 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.
[<-Struck out]
[Struck out->] (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.
[<-Struck out]
[Struck out->] (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.
[<-Struck out]
[Struck out->] SEC. 509. (a) The limitations established in the
preceding section shall not apply to an abortion--
[<-Struck out]
[Struck out->] (1) if the pregnancy is the result of an act of
rape or incest; or
[<-Struck out]
[Struck out->] (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.
[<-Struck out]
[Struck out->] (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).
[<-Struck
out]
[Struck out->] (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).
[<-Struck out]
[Struck out->] SEC. 510. (a) None of the funds made available in
this Act may be used for--
[<-Struck out]
[Struck out->] (1) the creation of a human embryo or embryos
for research purposes; or
[<-Struck out]
[Struck out->] (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)).
[<-Struck out]
[Struck out->] (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.
[<-Struck out]
[Struck out->] 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).
[<-Struck out]
[Struck out->] (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.
[<-Struck out]
[Struck out->] 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--
[<-Struck out]
[Struck out->] (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
[<-Struck out]
[Struck out->] (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.
[<-Struck out]
[Struck out->] SEC. 513. Except as otherwise specifically
provided by law, unobligated balances remaining available at the end of fiscal
year 2000 from appropriations made available for salaries and expenses for
fiscal year 2000 in this Act, shall remain available through December 31,
2000, for each such account for the purposes authorized: Provided,
That the House and Senate Committees on Appropriations shall be notified at
least 15 days prior to the obligation of such funds: Provided
further, That the provisions of this section shall not apply to any funds
appropriated to the Centers for Disease Control and Prevention or to the
Department of Education.
[<-Struck out]
[Struck out->] SEC. 514. Section 5527 of Public Law 105-33, The
Balanced Budget Act of 1997, is repealed.
[<-Struck out]
[Struck out->] SEC. 515. (a) DATES FOR EVALUATION- Section
403(a)(5)(H)(iii) of the Social Security Act (42 U.S.C. 603(a)(5)(H)(iii)) is
amended by striking `2001' and inserting `2005'.
[<-Struck out]
[Struck out->] (b) INTERIM REPORT REQUIRED- Section 403(a)(5)(H)
of such Act (42 U.S.C. 603(a)(5)(G)) is amended by adding at the end the
following:
[<-Struck out]
[Struck out->] `(iv) INTERIM REPORT- Not later than January
1, 2002, the Secretary shall submit to the Congress an interim report on
the evaluations referred to in clause (i).'.
[<-Struck
out]
[Struck out->] SEC. 516. Section 403(a)(3)(A) (42 U.S.C.
603(a)(3)(A)) is amended--
[<-Struck out]
[Struck out->] (1) in clause (i), by striking `and' at the end;
[<-Struck out]
[Struck out->] (2) in clause (ii)--
[<-Struck
out]
[Struck out->] (A) by striking `1999, 2000, and 2001' and
inserting `1999 and 2000'; and
[<-Struck out]
[Struck out->] (B) by striking the period at the end and
inserting `; and'; and
[<-Struck out]
[Struck out->] (3) by adding at the end the following new
clause:
[<-Struck out]
[Struck out->] `(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.'.
[<-Struck out]
[Struck out->] SEC. 517. Section 410(b) of The Ticket to Work and
Work Incentives Improvement Act of 1999 (Public Law 106-170) is amended by
striking `2009' each place it appears and inserting `2001'.
[<-Struck out]
[Struck out->] SEC. 518. If the total level of discretionary
advance appropriations for fiscal year 2002 and subsequent fiscal years
provided in general appropriation Acts for fiscal year 2001 exceeds
$23,500,000,000, there shall be rescinded from the amount made available in
this Act for fiscal year 2002 under the heading `ADMINISTRATION FOR CHILDREN
AND FAMILIES--PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT BLOCK
GRANT' an amount sufficient to reduce the total level of such discretionary
advance appropriations to $23,500,000,000: Provided, That the
rescission shall not exceed an amount that would cause the amount provided
under such heading to be less than the amount provided for fiscal year 2001 in
the Departments of Labor, Health and Human Services, and Education, and
Related Agencies Appropriations Act, 2000 (as enacted into law by section
1000(a)(4) of Public Law 106-113).
[<-Struck out]
[Struck out->] SEC. 519. None of the funds made available in this
Act may be used to promulgate or adopt any final standard under section
1173(b) of the Social Security Act (42 U.S.C. 1320d-2(b)).
[<-Struck
out]
[Struck out->] SEC. 520. None of the funds made available in this
Act may be used to prohibit military recruiting at secondary schools.
[<-Struck out]
[Struck out->] SEC. 521. None of the funds made available in this
Act for the National Institutes of Health may be used to grant an exclusive or
partially exclusive license pursuant to chapter 18 of title 35, United States
Code, except in accordance with section 209 of such title (relating to the
availability to the public of an invention and its benefits on reasonable
terms).
[<-Struck out]
[Struck out->] This Act may be cited as the `Departments of
Labor, Health and Human Services, and Education, and Related Agencies
Appropriations Act, 2001'.
[<-Struck out]
DIVISION A--DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND
EDUCATION, AND RELATED AGENCIES
That the following sums are appropriated, out of any money in the
Treasury not otherwise appropriated, for the Departments of Labor, Health and
Human Services, and Education, and related agencies for the fiscal year ending
September 30, 2001, and for other purposes, namely:
TITLE I--DEPARTMENT OF LABOR
Employment and Training Administration
TRAINING AND EMPLOYMENT SERVICES
For necessary expenses of the Workforce Investment Act, including the
purchase and hire of passenger motor vehicles, the construction, alteration,
and repair of buildings and other facilities, and the purchase of real
property for training centers as authorized by the Workforce Investment Act
and the National Skill Standards Act of 1994; $2,990,141,000 plus
reimbursements, of which $1,718,801,000 is available for obligation for the
period July 1, 2001 through June 30, 2002, of which $1,250,965,000 is
available for obligation for the period April 1, 2001 through June 30, 2002,
including $1,000,965,000 to carry out chapter 4 of the Workforce Investment
Act and $250,000,000 to carry out section 169 of such Act; and of which
$20,375,000 is available for the period July 1, 2001 through June 30, 2004 for
necessary expenses of construction, rehabilitation, and acquisition of Job
Corps centers: Provided, That $9,098,000 shall be for carrying out
section 172 of the Workforce Investment Act, and $3,500,000 shall be for
carrying out the National Skills Standards Act of 1994: Provided
further, That no funds from any other appropriation shall be
used to provide meal services at or for Job Corps centers: Provided
further, That funds provided to carry out section 171(d) of such Act may
be used for demonstration projects that provide assistance to new entrants in
the workforce and incumbent workers: Provided further, That funding
provided to carry out projects under section 171 of the Workforce Investment
Act of 1998 that are identified in the Conference Agreement, shall not be
subject to the requirements of section 171(b)(2)(B) of such Act, the
requirements of section 171(c)(4)(D) of such Act, or the joint funding
requirements of sections 171(b)(2)(A) and 171(c)(4)(A) of such Act:
Provided further, That funding appropriated herein for Dislocated
Worker Employment and Training Activities under section 132(a)(2)(A) of the
Workforce Investment Act of 1998 may be distributed for Dislocated Worker
Projects under section 171(d) of the Act without regard to the 10 percent
limitation contained in section 171(d) of the Act.
For necessary expenses of the Workforce Investment Act, including the
purchase and hire of passenger motor vehicles, the construction, alteration,
and repair of buildings and other facilities, and the purchase of real
property for training centers as authorized by the Workforce Investment Act;
$2,463,000,000 plus reimbursements, of which $2,363,000,000 is available for
obligation for the period October 1, 2001 through June 30, 2002, and of which
$100,000,000 is available for the period October 1, 2001 through June 30,
2004, for necessary expenses of construction, rehabilitation, and acquisition
of Job Corps centers.
COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS
To carry out the activities for national grants or contracts with
public agencies and public or private nonprofit organizations under paragraph
(1)(A) of section 506(a) of title V of the Older Americans Act of 1965, as
amended, or to carry out older worker activities as subsequently authorized,
$343,356,000.
To carry out the activities for grants to States under paragraph (3)
of section 506(a) of title V of the Older Americans Act of 1965, as amended,
or to carry out older worker activities as subsequently authorized,
$96,844,000.
FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES
For payments during the current fiscal year of trade adjustment
benefit payments and allowances under part I; and for training, allowances for
job search and relocation, and related State administrative expenses under
part II, subchapters B and D, chapter 2, title II of the Trade Act of 1974, as
amended, $406,550,000, together with such amounts as may be necessary to be
charged to the subsequent appropriation for payments for any period subsequent
to September 15 of the current year.
STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS
For authorized administrative expenses, $153,452,000, together with
not to exceed $3,095,978,000 (including not to exceed $1,228,000 which may be
used for amortization payments to States which had independent retirement
plans in their State employment service agencies prior to 1980), which may be
expended from the Employment Security Administration account in the
Unemployment Trust Fund including the cost of administering section 51 of the
Internal Revenue Code of 1986, as amended, section 7(d) of the Wagner-Peyser
Act, as amended, the Trade Act of 1974, as amended, the Immigration Act of
1990, and the Immigration and Nationality Act, as amended, and of which the
sums available in the allocation for activities authorized by title III of the
Social Security Act, as amended (42 U.S.C. 502-504), and the sums available in
the allocation for necessary administrative expenses for carrying out 5 U.S.C.
8501-8523, shall be available for obligation by the States through December
31, 2001, except that funds used for automation acquisitions shall be
available for obligation by the States through September 30, 2003; and of
which $153,452,000, together with not to exceed $763,283,000 of the amount
which may be expended from said trust fund, shall be available for obligation
for the period July 1, 2001 through June 30, 2002, to fund activities under
the Act of June 6, 1933, as amended, including the cost of penalty mail
authorized under 39 U.S.C. 3202(a)(1)(E) made available to States in lieu of
allotments for such purpose: Provided, That to the extent that the
Average Weekly Insured Unemployment (AWIU) for fiscal year 2001 is projected
by the Department of Labor to exceed 2,396,000, an additional $28,600,000
shall be available for obligation for every 100,000 increase in the AWIU level
(including a pro rata amount for any increment less than 100,000) from the
Employment Security Administration Account of the Unemployment Trust Fund:
Provided further, That funds appropriated in this Act which are used
to establish a national one-stop career center system, or which are used to
support the national activities of the Federal-State unemployment insurance
programs, may be obligated in contracts, grants or agreements with non-State
entities: Provided further, That funds appropriated under this Act
for activities authorized under the Wagner-Peyser Act, as amended, and title
III of the Social Security Act, may be used by the States to fund integrated
Employment Service and Unemployment Insurance automation efforts,
notwithstanding cost allocation principles prescribed under Office of
Management and Budget Circular A-87.
ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS
For repayable advances to the Unemployment Trust Fund as authorized by
sections 905(d) and 1203 of the Social Security Act, as amended, and to the
Black Lung Disability Trust Fund as authorized by section 9501(c)(1) of the
Internal Revenue Code of 1954, as amended; and for nonrepayable advances to
the Unemployment Trust Fund as authorized by section 8509 of title 5, United
States Code, and to the `Federal unemployment benefits and allowances'
account, to remain available until September 30, 2002, $435,000,000.
In addition, for making repayable advances to the Black Lung
Disability Trust Fund in the current fiscal year after September 15, 2001, for
costs incurred by the Black Lung Disability Trust Fund in the current fiscal
year, such sums as may be necessary.
PROGRAM ADMINISTRATION
For expenses of administering employment and training programs,
$107,651,000, including $6,431,000 to support up to 75 full-time equivalent
staff, the majority of which will be term Federal appointments lasting no more
than 1 year, to administer welfare-to-work grants, together with not to exceed
$48,507,000, which may be expended from the Employment Security Administration
account in the Unemployment Trust Fund.
Pension and Welfare Benefits Administration
SALARIES AND EXPENSES
For necessary expenses for the Pension and Welfare Benefits
Administration, $103,342,000.
Pension Benefit Guaranty Corporation
PENSION BENEFIT GUARANTY CORPORATION FUND
The Pension Benefit Guaranty Corporation is authorized to make such
expenditures, including financial assistance authorized by section 104 of
Public Law 96-364, within limits of funds and borrowing authority available to
such Corporation, and in accord with law, and to make such contracts and
commitments without regard to fiscal year limitations as provided by section
104 of the Government Corporation Control Act, as amended (31 U.S.C. 9104), as
may be necessary in carrying out the program through September 30, 2001, for
such Corporation: Provided, That not to exceed $11,652,000 shall be
available for administrative expenses of the Corporation: Provided
further, That expenses of such Corporation in connection with the
termination of pension plans, for the acquisition, protection or management,
and investment of trust assets, and for benefits administration services shall
be considered as non-administrative expenses for the purposes hereof, and
excluded from the above limitation.
Employment Standards Administration
SALARIES AND EXPENSES
For necessary expenses for the Employment Standards Administration,
including reimbursement to State, Federal, and local agencies and their
employees for inspection services rendered, $350,779,000, together with
$1,985,000 which may be expended from the Special Fund in accordance with
sections 39(c), 44(d) and 44(j) of the Longshore and Harbor Workers'
Compensation Act: Provided, That $2,000,000 shall be for the
development of an alternative system for the electronic submission of reports
required to be filed under the Labor-Management Reporting and Disclosure Act
of 1959, as amended, and for a computer database of the information for each
submission by whatever means, that is indexed and easily searchable by the
public via the Internet: Provided further, That the Secretary of
Labor is authorized to accept, retain, and spend, until expended, in the name
of the Department of Labor, all sums of money ordered to be paid to the
Secretary of Labor, in accordance with the terms of the Consent Judgment in
Civil Action No. 91-0027 of the United States District Court for the District
of the Northern Mariana Islands (May 21, 1992): Provided further,
That the Secretary of Labor is authorized to establish and, in accordance with
31 U.S.C. 3302, collect and deposit in the Treasury fees for processing
applications and issuing certificates under sections 11(d) and 14 of the Fair
Labor Standards Act of 1938, as amended (29 U.S.C. 211(d) and 214) and for
processing applications and issuing registrations under title I of the Migrant
and Seasonal Agricultural Worker Protection Act (29 U.S.C. 1801 et
seq.).
SPECIAL BENEFITS
(INCLUDING TRANSFER OF FUNDS)
For the payment of compensation, benefits, and expenses (except
administrative expenses) accruing during the current or any prior fiscal year
authorized by title 5, chapter 81 of the United States Code; continuation of
benefits as provided for under the heading `Civilian War Benefits' in the
Federal Security Agency Appropriation Act, 1947; the Employees' Compensation
Commission Appropriation Act, 1944; sections 4(c) and 5(f) of the War Claims
Act of 1948 (50 U.S.C. App. 2012); and 50 percent of the additional
compensation and benefits required by section 10(h) of the Longshore and
Harbor Workers' Compensation Act, as amended, $56,000,000 together with such
amounts as may be necessary to be charged to the subsequent year appropriation
for the payment of compensation and other benefits for any period subsequent
to August 15 of the current year: Provided, That amounts appropriated
may be used under section 8104 of title 5, United States Code, by the
Secretary of Labor to reimburse an employer, who is not the employer at the
time of injury, for portions of the salary of a reemployed, disabled
beneficiary: Provided further, That balances of reimbursements
unobligated on September 30, 2000, shall remain available until expended for
the payment of compensation, benefits, and expenses: Provided
further, That in addition there shall be transferred to this
appropriation from the Postal Service and from any other corporation or
instrumentality required under section 8147(c) of title 5, United States Code,
to pay an amount for its fair share of the cost of administration, such sums
as the Secretary determines to be the cost of administration for employees of
such fair share entities through September 30, 2001: Provided
further, That of those funds transferred to this account from the fair
share entities to pay the cost of administration, $30,510,000 shall be made
available to the Secretary as follows: (1) for the operation of and
enhancement to the automated data processing systems, including document
imaging, medical bill review, and periodic roll management, in support of
Federal Employees' Compensation Act administration, $19,971,000; (2) for
conversion to a paperless office, $7,005,000; (3) for communications redesign,
$750,000; (4) for information technology maintenance and support, $2,784,000;
and (5) the remaining funds shall be paid into the Treasury as miscellaneous
receipts: Provided further, That the Secretary may require that any
person filing a notice of injury or a claim for benefits under chapter 81 of
title 5, United States Code, or 33 U.S.C. 901 et seq., provide as part of such
notice and claim, such identifying information (including Social Security
account number) as such regulations may prescribe.
BLACK LUNG DISABILITY TRUST FUND
(INCLUDING TRANSFER OF FUNDS)
Beginning in fiscal year 2001 and thereafter, such sums as may be
necessary from the Black Lung Disability Trust Fund, to remain available until
expended, for payment of all benefits authorized by section 9501(d)(1) (2) (4)
and (7) of the Internal Revenue Code of 1954, as amended; and interest on
advances as authorized by section 9501(c)(2) of that Act. In addition, the
following amounts shall be available from the Fund for fiscal year 2001 for
expenses of operation and administration of the Black Lung Benefits program as
authorized by section 9501(d)(5) of that Act: $30,393,000 for transfer to the
Employment Standards Administration, `Salaries and Expenses'; $21,590,000 for
transfer to Departmental Management, `Salaries and Expenses'; $318,000 for
transfer to Departmental Management, `Office of Inspector General'; and
$356,000 for payments into Miscellaneous Receipts for the expenses of the
Department of Treasury.
Occupational Safety and Health Administration
SALARIES AND EXPENSES
For necessary expenses for the Occupational Safety and Health
Administration, $425,983,000, including not to exceed $88,493,000 which shall
be the maximum amount available for grants to States under section 23(g) of
the Occupational Safety and Health Act, which grants shall be no less than 50
percent of the costs of State occupational safety and health programs required
to be incurred under plans approved by the Secretary under section 18 of the
Occupational Safety and Health Act of 1970; and, in addition, notwithstanding
31 U.S.C. 3302, the Occupational Safety and Health Administration may retain
up to $750,000 per fiscal year of training institute course tuition fees,
otherwise authorized by law to be collected, and may utilize such sums for
occupational safety and health training and education grants:
Provided, That of the amount appropriated under this heading that is
in excess of the amount appropriated for such purposes for fiscal year 2000,
at least $22,200,000 shall be used to carry out education, training, and
consultation activities as described in subsections (c) and (d) of section 21
of the Occupational Safety and Health Act of 1970 (29 U.S.C. 670(c) and (d)):
Provided further, That, notwithstanding 31 U.S.C. 3302, the Secretary
of Labor is authorized, during the fiscal year ending September 30, 2001, to
collect and retain fees for services provided to Nationally Recognized Testing
Laboratories, and may utilize such sums, in accordance with the provisions of
29 U.S.C. 9a, to administer national and international laboratory recognition
programs that ensure the safety of equipment and products used by workers in
the workplace: Provided further, That none of the funds appropriated
under this paragraph shall be obligated or expended to prescribe, issue,
administer, or enforce any standard, rule, regulation, or order under the
Occupational Safety and Health Act of 1970 which is applicable to any person
who is engaged in a farming operation which does not maintain a temporary
labor camp and employs 10 or fewer employees: Provided further, That
no funds appropriated under this paragraph shall be obligated or expended to
administer or enforce any standard, rule, regulation, or order under the
Occupational Safety and Health Act of 1970 with respect to any employer of 10
or fewer employees who is included within a category having an occupational
injury lost workday case rate, at the most precise Standard Industrial
Classification Code for which such data are published, less than the national
average rate as such rates are most recently published by the Secretary,
acting through the Bureau of Labor Statistics, in accordance with section 24
of that Act (29 U.S.C. 673), except--
(1) to provide, as authorized by such Act, consultation, technical
assistance, educational and training services, and to conduct surveys and
studies;
(2) to conduct an inspection or investigation in response to an
employee complaint, to issue a citation for violations found during such
inspection, and to assess a penalty for violations which are not corrected
within a reasonable abatement period and for any willful violations
found;
(3) to take any action authorized by such Act with respect to
imminent dangers;
(4) to take any action authorized by such Act with respect to health
hazards;
(5) to take any action authorized by such Act with respect to a
report of an employment accident which is fatal to one or more employees or
which results in hospitalization of two or more employees, and to take any
action pursuant to such investigation authorized by such Act; and
(6) to take any action authorized by such Act with respect to
complaints of discrimination against employees for exercising rights under
such Act:
Provided further, That the foregoing proviso shall not apply
to any person who is engaged in a farming operation which does not maintain a
temporary labor camp and employs 10 or fewer employees.
Mine Safety and Health Administration
SALARIES AND EXPENSES
For necessary expenses for the Mine Safety and Health Administration,
$244,747,000, including purchase and bestowal of certificates and trophies in
connection with mine rescue and first-aid work, and the hire of passenger
motor vehicles; including up to $1,000,000 for mine rescue and recovery
activities, which shall be available only to the extent that fiscal year 2001
obligations for these activities exceed $1,000,000; in addition, not to exceed
$750,000 may be collected by the National Mine Health and Safety Academy for
room, board, tuition, and the sale of training materials, otherwise authorized
by law to be collected, to be available for mine safety and health education
and training activities, notwithstanding 31 U.S.C. 3302; and, in addition, the
Administration may retain up to $1,000,000 from fees collected for the
approval and certification of equipment, materials, and explosives for use in
mines, and may utilize such sums for such activities; the Secretary is
authorized to accept lands, buildings, equipment, and other contributions from
public and private sources and to prosecute projects in cooperation with other
agencies, Federal, State, or private; the Mine Safety and Health
Administration is authorized to promote health and safety education and
training in the mining community through cooperative programs with States,
industry, and safety associations; and any funds available to the department
may be used, with the approval of the Secretary, to provide for the costs of
mine rescue and survival operations in the event of a major disaster.
Bureau of Labor Statistics
SALARIES AND EXPENSES
For necessary expenses for the Bureau of Labor Statistics, including
advances or reimbursements to State, Federal, and local agencies and their
employees for services rendered, $369,327,000, together with not to exceed
$67,257,000, which may be expended from the Employment Security Administration
account in the Unemployment Trust Fund; and $10,000,000 which shall be
available for obligation for the period July 1, 2001 through June 30, 2002,
for Occupational Employment Statistics.
Departmental Management
SALARIES AND EXPENSES
For necessary expenses for Departmental Management, including the hire
of three sedans, and including the management or operation, through contracts,
grants or other arrangements, of Departmental bilateral and multilateral
foreign technical assistance, of which the funds designated to carry out
bilateral assistance under the international child labor initiative shall be
available for obligation through September 30, 2002, $30,000,000 for the
acquisition of Departmental information technology, architecture,
infrastructure, equipment, software and related needs which will be allocated
by the Department's Chief Information Officer in accordance with the
Department's capital investment management process to assure a sound
investment strategy; $337,964,000: Provided, That no funds made
available by this Act may be used by the Solicitor of Labor to participate in
a review in any United States court of appeals of any decision made by the
Benefits Review Board under section 21 of the Longshore and Harbor Workers'
Compensation Act (33 U.S.C. 921) where such participation is precluded by the
decision of the United States Supreme Court in Director, Office of Workers'
Compensation Programs v. Newport News Shipbuilding, 115 S. Ct. 1278 (1995),
notwithstanding any provisions to the contrary contained in Rule 15 of the
Federal Rules of Appellate Procedure: Provided further, That no funds
made available by this Act may be used by the Secretary of Labor to review a
decision under the Longshore and Harbor Workers' Compensation Act (33 U.S.C.
901 et seq.) that has been appealed and that has been pending before the
Benefits Review Board for more than 12 months: Provided further, That
any such decision pending a review by the Benefits Review Board for more than
1 year shall be considered affirmed by the Benefits Review Board on the 1-year
anniversary of the filing of the appeal, and shall be considered the final
order of the Board for purposes of obtaining a review in the United States
courts of appeals: Provided further, That these provisions shall not
be applicable to the review or appeal of any decision issued under the Black
Lung Benefits Act (30 U.S.C. 901 et seq.): Provided further, That
beginning in fiscal year 2001, there is established in the Department of Labor
an office of disability employment policy which shall, under the overall
direction of the Secretary, provide leadership, develop policy and
initiatives, and award grants furthering the objective of eliminating barriers
to the training and employment of people with disabilities. Such office shall
be headed by an assistant secretary: Provided further, That of
amounts provided under this head, not more than $23,002,000 is for this
purpose.
VETERANS EMPLOYMENT AND TRAINING
Not to exceed $186,913,000 may be derived from the Employment Security
Administration account in the Unemployment Trust Fund to carry out the
provisions of 38 U.S.C. 4100-4110A, 4212, 4214, and 4321-4327, and Public Law
103-353, and which shall be available for obligation by the States through
December 31, 2001. To carry out the Stewart B. McKinney Homeless Assistance
Act and section 168 of the Workforce Investment Act of 1998, $19,800,000, of
which $7,300,000 shall be available for obligation for the period July 1,
2001, through June 30, 2002.
OFFICE OF INSPECTOR GENERAL
For salaries and expenses of the Office of Inspector General in
carrying out the provisions of the Inspector General Act of 1978, as amended,
$50,015,000, together with not to exceed $4,770,000, which may be expended
from the Employment Security Administration account in the Unemployment Trust
Fund.
GENERAL PROVISIONS
SEC. 101. None of the funds appropriated in this title for the Job
Corps shall be used to pay the compensation of an individual, either as direct
costs or any proration as an indirect cost, at a rate in excess of Executive
Level II.
(TRANSFER OF FUNDS)
SEC. 102. Not to exceed 1 percent of any discretionary funds (pursuant
to the Balanced Budget and Emergency Deficit Control Act of 1985, as amended)
which are appropriated for the current fiscal year for the Department of Labor
in this Act may be transferred between appropriations, but no such
appropriation shall be increased by more than 3 percent by any such transfer:
Provided, That the Appropriations Committees of both Houses of
Congress are notified at least 15 days in advance of any transfer.
SEC. 103. EXTENDED DEADLINE FOR EXPENDITURE. Section
403(a)(5)(C)(viii) of the Social Security Act (42 U.S.C. 603(a)(5)(C)(viii))
(as amended by section 806(b) of the Departments of Labor, Health and Human
Services, and Education, and Related Agencies Appropriations Act, 2000 (as
enacted into law by section 1000(a)(4) of Public Law 106-113)) is amended by
striking `3 years' and inserting `5 years'.
SEC. 104. ELIMINATION OF SET-ASIDE OF PORTION OF WELFARE-TO-WORK FUNDS
FOR PERFORMANCE BONUSES. (a) IN GENERAL- Section 403(a)(5) of the Social
Security Act (as amended by section 806(b) of the Departments of Labor, Health
and Human Services, and Education, and Related Agencies Appropriations Act,
2000 (as enacted into law by section 1000(a)(4) of Public Law 106-113)) is
amended by striking subparagraph (E) and redesignating subparagraphs (F)
through (K) as subparagraphs (E) through (J), respectively.
(b) CONFORMING AMENDMENTS- The Social Security Act (as amended by
section 806(b) of the Departments of Labor, Health and Human Services, and
Education, and Related Agencies Appropriations Act, 2000 (as enacted into law
by section 1000(a)(4) of Public Law 106-113)) is further amended as
follows:
(1) Section 403(a)(5)(A)(i) (42 U.S.C. 603(a)(5)(A)(i)) is amended
by striking `subparagraph (I)' and inserting `subparagraph (H)'.
(2) Subclause (I) of each of subparagraphs (A)(iv) and (B)(v) of
section 403(a)(5) (42 U.S.C. 603(a)(5)(A)(iv)(I) and (B)(v)(I)) is
amended--
(i) by striking `(I)' and inserting `(H)'; and
(ii) by striking `(G), and (H)' and inserting `and (G)';
and
(B) in item (bb), by striking `(F)' and inserting
`(E)'.
(3) Section 403(a)(5)(B)(v) (42 U.S.C. 603(a)(5)(B)(v)) is amended
in the matter preceding subclause (I) by striking `(I)' and inserting
`(H)'.
(4) Subparagraphs (E), (F), and (G)(i) of section 403(a)(5) (42
U.S.C. 603(a)(5)), as so redesignated by subsection (a) of this section, are
each amended by striking `(I)' and inserting `(H)'.
(5) Section 412(a)(3)(A) (42 U.S.C. 612(a)(3)(A)) is amended by
striking `403(a)(5)(I)' and inserting `403(a)(5)(H)'.
(c) FUNDING AMENDMENT- Section 403(a)(5)(H)(i)(II) of such Act (42
U.S.C. 603(a)(5)(H)(i))(II) (as redesignated by subsection (a) of this section
and as amended by section 806(b) of the Departments of Labor, Health and Human
Services, and Education, and Related Agencies Appropriations Act, 2000 (as
enacted into law by section 1000(a)(4) of Public Law 106-113)) is further
amended by striking `$1,450,000,000' and inserting `$1,400,000,000'.
(d) EFFECTIVE DATE- The amendments made by subsections (a), (b), and
(c) of this section shall take effect on October 1, 2000.
SEC. 105. None of the funds made available in this Act may be used by
the Occupational Safety and Health Administration to promulgate, issue,
implement, administer, or enforce any proposed, temporary, or final standard
on ergonomic protection.
TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
HEALTH RESOURCES AND SERVICES
For carrying out titles II, III, VII, VIII, X, XII, XIX, and XXVI of
the Public Health Service Act, section 427(a) of the Federal Coal Mine Health
and Safety Act, title V and section 1820 of the Social Security Act, the
Health Care Quality Improvement Act of 1986, as amended, and the Native
Hawaiian Health Care Act of 1988, as amended, $4,572,424,000, of which
$150,000 shall remain available until expended for interest subsidies on loan
guarantees made prior to fiscal year 1981 under part B of title VII of the
Public Health Service Act, of which $10,000,000 shall be available for the
construction and renovation of health care and other facilities, of which
$25,000,000 from general revenues, notwithstanding section 1820(j) of the
Social Security Act, shall be available for carrying out the Medicare rural
hospital flexibility grants program under section 1820 of such Act, and of
which $4,000,000 shall be provided to the Rural Health Outreach Office of the
Health Resources and Services Administration for the awarding of grants to
community partnerships in rural areas for the purchase of automated external
defibrillators and the training of individuals in basic cardiac life support:
Provided, That the Division of Federal Occupational Health may
utilize personal services contracting to employ professional
management/administrative and occupational health professionals: Provided
further, That of the funds made available under this heading, $250,000
shall be available until expended for facilities renovations at the Gillis W.
Long Hansen's Disease Center: Provided further, That in addition to
fees authorized by section 427(b) of the Health Care Quality Improvement Act
of 1986, fees shall be collected for the full disclosure of information under
the Act sufficient to recover the full costs of operating the National
Practitioner Data Bank, and shall remain available until expended to carry out
that Act: Provided further, That fees collected for the full
disclosure of information under the `Health Care Fraud and Abuse Data
Collection Program', authorized by section 221 of the Health Insurance
Portability and Accountability Act of 1996, shall be sufficient to recover the
full costs of operating the Program, and shall remain available to carry out
that Act until expended: Provided further, That no more than
$5,000,000 is available for carrying out the provisions of Public Law 104-73:
Provided further, That of the funds made available under this
heading, $253,932,000 shall be for the program under title X of the Public
Health Service Act to provide for voluntary family planning projects:
Provided further, That amounts provided to said projects under such
title shall not be expended for abortions, that all pregnancy counseling shall
be nondirective, and that such amounts shall not be expended for any activity
(including the publication or distribution of literature) that in any way
tends to promote public support or opposition to any legislative proposal or
candidate for public office: Provided further, That $538,000,000
shall be for State AIDS Drug Assistance Programs authorized by section 2616 of
the Public Health Service Act.
RICKY RAY HEMOPHILIA RELIEF FUND PROGRAM
For payment to the Ricky Ray Hemophilia Relief Fund, as provided by
Public Law 105-369, $85,000,000, of which $10,000,000 shall be for program
management.
HEALTH EDUCATION ASSISTANCE LOANS PROGRAM ACCOUNT
Such sums as may be necessary to carry out the purpose of the program,
as authorized by title VII of the Public Health Service Act, as amended. For
administrative expenses to carry out the guaranteed loan program, including
section 709 of the Public Health Service Act, $3,679,000.
VACCINE INJURY COMPENSATION PROGRAM TRUST FUND
For payments from the Vaccine Injury Compensation Program Trust Fund,
such sums as may be necessary for claims associated with vaccine-related
injury or death with respect to vaccines administered after September 30,
1988, pursuant to subtitle 2 of title XXI of the Public Health Service Act, to
remain available until expended: Provided, That for necessary
administrative expenses, not to exceed $2,992,000 shall be available from the
Trust Fund to the Secretary of Health and Human Services.
Centers for Disease Control and Prevention
DISEASE CONTROL, RESEARCH, AND TRAINING
To carry out titles II, III, VII, XI, XV, XVII, XIX and XXVI of the
Public Health Service Act, sections 101, 102, 103, 201, 202, 203, 301, and 501
of the Federal Mine Safety and Health Act of 1977, sections 20, 21, and 22 of
the Occupational Safety and Health Act of 1970, title IV of the Immigration
and Nationality Act and section 501 of the Refugee Education Assistance Act of
1980; including insurance of official motor vehicles in foreign countries; and
hire, maintenance, and operation of aircraft, $3,204,496,000, of which
$20,000,000 shall be made available to carry out children's asthma programs
and $4,000,000 of such $20,000,000 shall be utilized to carry out improved
asthma surveillance and tracking systems and the remainder shall be used to
carry out diverse community-based childhood asthma programs including both
school- and community-based grant programs, except that not to exceed 5
percent of such funds may be used by the Centers for Disease Control and
Prevention for administrative costs or reprogramming, and of which
$175,000,000 shall remain available until expended for the facilities master
plan for equipment and construction and renovation of facilities, and in
addition, such sums as may be derived from authorized user fees, which shall
be credited to this account, and of which $25,000,000 shall be made available
through such Centers for the establishment of partnerships between the Federal
Government and academic institutions and State and local public health
departments to carry out pilot programs for antimicrobial resistance
detection, surveillance, education and prevention and to conduct research on
resistance mechanisms and new or more effective antimicrobial compounds, and
of which $10,000,000 shall remain available until expended to carry out the
Fetal Alcohol Syndrome prevention and services program: Provided,
That in addition to amounts provided herein, up to $91,129,000 shall be
available from amounts available under section 241 of the Public Health
Service Act: Provided further, That none of the funds made available
for injury prevention and control at the Centers for Disease Control and
Prevention may be used to advocate or promote gun control: Provided
further, That the Director may redirect the total amount made available
under authority of Public Law 101-502, section 3, dated November 3, 1990, to
activities the Director may so designate: Provided further, That the
Congress is to be notified promptly of any such transfer: Provided
further, That not to exceed $10,000,000 may be available for making
grants under section 1509 of the Public Health Service Act to not more than 15
States: Provided further, That notwithstanding any other provision of
law, a single contract or related contracts for development and construction
of facilities may be employed which collectively include the full scope of the
project: Provided further, That the solicitation and contract shall
contain the clause `availability of funds' found at 48 CFR 52.232-18:
Provided further, That in addition to amounts made available under
this heading for the National Program of Cancer Registries, an additional
$15,000,000 shall be made available for such Program and special emphasis in
carrying out such Program shall be given to States with the highest number of
the leading causes of cancer mortality: Provided further, That
amounts made available under this Act for the administrative and related
expenses of the Centers for Disease Control and Prevention shall be reduced by
$15,000,000: Provided further, That the funds made available under
this heading for section 317A of the Public Health Service Act may be made
available for programs operated in accordance with a strategy (developed and
implemented by the Director for the Centers for Disease Control and
Prevention) to identify and target resources for childhood lead poisoning
prevention to high-risk populations, including ensuring that any individual or
entity that receives a grant under that section to carry out activities
relating to childhood lead poisoning prevention may use a portion of the grant
funds awarded for the purpose of funding screening assessments and referrals
at sites of operation of the Early Head Start programs under the Head Start
Act.
National Institutes of Health
NATIONAL CANCER INSTITUTE
For carrying out section 301 and title IV of the Public Health Service
Act with respect to cancer, $3,804,084,000.
NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
For carrying out section 301 and title IV of the Public Health Service
Act with respect to cardiovascular, lung, and blood diseases, and blood and
blood products, $2,328,102,000.
NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH
For carrying out section 301 and title IV of the Public Health Service
Act with respect to dental disease, $309,923,000.
NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY
DISEASES
For carrying out section 301 and title IV of the Public Health Service
Act with respect to diabetes and digestive and kidney disease,
$1,318,106,000.
NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE
For carrying out section 301 and title IV of the Public Health Service
Act with respect to neurological disorders and stroke, $1,189,425,000.
NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES
For carrying out section 301 and title IV of the Public Health Service
Act with respect to allergy and infectious diseases, $2,066,526,000.
NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES
For carrying out section 301 and title IV of the Public Health Service
Act with respect to general medical sciences, $1,554,176,000.
NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT
For carrying out section 301 and title IV of the Public Health Service
Act with respect to child health and human development, $986,069,000.
NATIONAL EYE INSTITUTE
For carrying out section 301 and title IV of the Public Health Service
Act with respect to eye diseases and visual disorders, $516,605,000.
NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES
For carrying out sections 301 and 311 and title IV of the Public
Health Service Act with respect to environmental health sciences,
$508,263,000.
NATIONAL INSTITUTE ON AGING
For carrying out section 301 and title IV of the Public Health Service
Act with respect to aging, $794,625,000.
NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN
DISEASES
For carrying out section 301 and title IV of the Public Health Service
Act with respect to arthritis and musculoskeletal and skin diseases,
$401,161,000.
NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION
DISORDERS
For carrying out section 301 and title IV of the Public Health Service
Act with respect to deafness and other communication disorders,
$303,541,000.
NATIONAL INSTITUTE OF NURSING RESEARCH
For carrying out section 301 and title IV of the Public Health Service
Act with respect to nursing research, $106,848,000.
NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM
For carrying out section 301 and title IV of the Public Health Service
Act with respect to alcohol abuse and alcoholism, $336,848,000.
NATIONAL INSTITUTE ON DRUG ABUSE
For carrying out section 301 and title IV of the Public Health Service
Act with respect to drug abuse, $790,038,000.
NATIONAL INSTITUTE OF MENTAL HEALTH
For carrying out section 301 and title IV of the Public Health Service
Act with respect to mental health, $1,117,928,000.
NATIONAL HUMAN GENOME RESEARCH INSTITUTE
For carrying out section 301 and title IV of the Public Health Service
Act with respect to human genome research, $385,888,000.
NATIONAL CENTER FOR RESEARCH RESOURCES
For carrying out section 301 and title IV of the Public Health Service
Act with respect to research resources and general research support grants,
$775,212,000: Provided, That none of these funds shall be used to pay
recipients of the general research support grants program any amount for
indirect expenses in connection with such grants: Provided further,
That $75,000,000 shall be for extramural facilities construction
grants.
NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE
For carrying out section 301 and title IV of the Public Health Service
Act with respect to complementary and alternative medicine,
$100,089,000.
JOHN E. FOGARTY INTERNATIONAL CENTER
For carrying out the activities at the John E. Fogarty International
Center, $61,260,000.
NATIONAL LIBRARY OF MEDICINE
For carrying out section 301 and title IV of the Public Health Service
Act with respect to health information communications, $256,953,000, of which
$4,000,000 shall be available until expended for improvement of information
systems: Provided, That in fiscal year 2001, the Library may enter
into personal services contracts for the provision of services in facilities
owned, operated, or constructed under the jurisdiction of the National
Institutes of Health.
OFFICE OF THE DIRECTOR
(INCLUDING TRANSFER OF FUNDS)
For carrying out the responsibilities of the Office of the Director,
National Institutes of Health, $352,165,000, of which $48,271,000 shall be for
the Office of AIDS Research: Provided, That funding shall be
available for the purchase of not to exceed 20 passenger motor vehicles for
replacement only: Provided further, That the Director may direct up
to 1 percent of the total amount made available in this or any other Act to
all National Institutes of Health appropriations to activities the Director
may so designate: Provided further, That no such appropriation shall
be decreased by more than 1 percent by any such transfers and that the
Congress is promptly notified of the transfer: Provided further, That
the National Institutes of Health is authorized to collect third party
payments for the cost of clinical services that are incurred in National
Institutes of Health research facilities and that such payments shall be
credited to the National Institutes of Health Management Fund: Provided
further, That all funds credited to the National Institutes of Health
Management Fund shall remain available for one fiscal year after the fiscal
year in which they are deposited: Provided further, That up to
$500,000 shall be available to carry out section 499 of the Public Health
Service Act: Provided further, That, notwithstanding section
499(k)(10) of the Public Health Service Act, funds from the Foundation for the
National Institutes of Health may be transferred to the National Institutes of
Health.
BUILDINGS AND FACILITIES
For the study of, construction of, and acquisition of equipment for,
facilities of or used by the National Institutes of Health, including the
acquisition of real property, $148,900,000, to remain available until
expended, of which $47,300,000 shall be for the neuroscience research center:
Provided, That notwithstanding any other provision of law, a single
contract or related contracts for the development and construction of the
first phase of the National Neuroscience Research Center may be employed which
collectively include the full scope of the project: Provided further,
That the solicitation and contract shall contain the clause `availability of
funds' found at 48 CFR 52.232-18.
Substance Abuse and Mental Health Services Administration
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES
For carrying out titles V and XIX of the Public Health Service Act
with respect to substance abuse and mental health services, the Protection and
Advocacy for Mentally Ill Individuals Act of 1986, and section 301 of the
Public Health Service Act with respect to program management, $2,730,757,000,
of which $15,000,000 shall remain available until expended to carry out the
Fetal Alcohol Syndrome prevention and services program, of which $10,000,000
shall be used to provide grants to local non-profit private and public
entities to enable such entities to develop and expand activities to provide
substance abuse services to homeless individuals: Provided, That in
addition to amounts provided herein, $12,000,000 shall be available from
amounts available under section 241 of the Public Health Services Act, to
carry out the National Household Survey on Drug Abuse: Provided
further, That within the amounts provided herein, $3,000,000 shall be
available for the Center for Mental Health Services to support through grants
a certification program to improve and evaluate the effectiveness and
responsiveness of suicide hotlines and crisis centers in the United States and
to help support and evaluate a national hotline and crisis center
network.
Agency for Healthcare Research and Quality
HEALTHCARE RESEARCH AND QUALITY
For carrying out titles III and IX of the Public Health Service Act,
amounts received from Freedom of Information Act fees, reimbursable and
interagency agreements, and the sale of data shall be credited to this
appropriation and shall remain available until expended: Provided,
That the amount made available pursuant to section 926(b) of the Public Health
Service Act shall not exceed $269,943,000.
Health Care Financing Administration
GRANTS TO STATES FOR MEDICAID
For carrying out, except as otherwise provided, titles XI and XIX of
the Social Security Act, $93,586,251,000, to remain available until
expended.
For making, after May 31, 2001, payments to States under title XIX of
the Social Security Act for the last quarter of fiscal year 2001 for
unanticipated costs, incurred for the current fiscal year, such sums as may be
necessary.
For making payments to States or in the case of section 1928 on behalf
of States under title XIX of the Social Security Act for the first quarter of
fiscal year 2002, $36,207,551,000, to remain available until expended.
Payment under title XIX may be made for any quarter with respect to a
State plan or plan amendment in effect during such quarter, if submitted in or
prior to such quarter and approved in that or any subsequent quarter.
PAYMENTS TO HEALTH CARE TRUST FUNDS
For payment to the Federal Hospital Insurance and the Federal
Supplementary Medical Insurance Trust Funds, as provided under sections 217(g)
and 1844 of the Social Security Act, sections 103(c) and 111(d) of the Social
Security Amendments of 1965, section 278(d) of Public Law 97-248, and for
administrative expenses incurred pursuant to section 201(g) of the Social
Security Act, $70,381,600,000.
PROGRAM MANAGEMENT
For carrying out, except as otherwise provided, titles XI, XVIII, XIX,
and XXI of the Social Security Act, titles XIII and XXVII of the Public Health
Service Act, and the Clinical Laboratory Improvement Amendments of 1988, not
to exceed $2,018,500,000, to be transferred from the Federal Hospital
Insurance and the Federal Supplementary Medical Insurance Trust Funds, as
authorized by section 201(g) of the Social Security Act; together with all
funds collected in accordance with section 353 of the Public Health Service
Act and such sums as may be collected from authorized user fees and the sale
of data, which shall remain available until expended, and together with
administrative fees collected relative to Medicare overpayment recovery
activities, which shall remain available until expended: Provided,
That all funds derived in accordance with 31 U.S.C. 9701 from organizations
established under title XIII of the Public Health Service Act shall be
credited to and available for carrying out the purposes of this appropriation:
Provided further, That $18,000,000 appropriated under this heading
for the managed care system redesign shall remain available until expended:
Provided further, That $3,000,000 of the amount available for
research, demonstration, and evaluation activities shall be available to
continue carrying out demonstration projects on Medicaid coverage of
community-based attendant care services for people with disabilities which
ensures maximum control by the consumer to select and manage their attendant
care services: Provided further, That the Secretary of Health and
Human Services is directed to collect fees in fiscal year 2001 from
Medicare+Choice organizations pursuant to section 1857(e)(2) of the Social
Security Act and from eligible organizations with risk-sharing contracts under
section 1876 of that Act pursuant to section 1876(k)(4)(D) of that Act:
Provided further, That administrative fees collected relative to
Medicare overpayment recovery activities shall be transferred to the Health
Care Fraud and Abuse Control (HCFAC) account, to be used for Medicare
Integrity Program (MIP) activities in addition to the amounts already
specified, and shall remain available until expended.
Administration for Children and Families
LOW INCOME HOME ENERGY ASSISTANCE
For making payments under title XXVI of the Omnibus Reconciliation Act
of 1981, $300,000,000: Provided, That these funds are hereby
designated by the Congress to be emergency requirements pursuant to section
251(b)(2)(A) of the Balanced Budget and Emergency Deficit Control Act of 1985:
Provided further, That these funds shall be made available only after
submission to the Congress of a formal budget request by the President that
includes designation of the entire amount of the request as an emergency
requirement as defined in such Act.
REFUGEE AND ENTRANT ASSISTANCE
For making payments for refugee and entrant assistance activities
authorized by title IV of the Immigration and Nationality Act and section 501
of the Refugee Education Assistance Act of 1980 (Public Law 96-422),
$418,321,000, to remain available through September 30, 2003.
For carrying out section 5 of the Torture Victims Relief Act of 1998
(Public Law 105-320), $7,265,000.
PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT
PROGRAMS
For making payments to States or other non-Federal entities under
titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the Act of
July 5, 1960 (24 U.S.C. ch. 9), $2,473,880,000, to remain available until
expended; and for such purposes for the first quarter of fiscal year 2002,
$1,000,000,000, to remain available until expended.
For making payments to each State for carrying out the program of Aid
to Families with Dependent Children under title IV-A of the Social Security
Act before the effective date of the program of Temporary Assistance to Needy
Families (TANF) with respect to such State, such sums as may be necessary:
Provided, That the sum of the amounts available to a State with
respect to expenditures under such title IV-A in fiscal year 1997 under this
appropriation and under such title IV-A as amended by the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996 shall not
exceed the limitations under section 116(b) of such Act.
For making, after May 31 of the current fiscal year, payments to
States or other non-Federal entities under titles I, IV-D, X, XI, XIV, and XVI
of the Social Security Act and the Act of July 5, 1960 (24 U.S.C. ch. 9), for
the last 3 months of the current year for unanticipated costs, incurred for
the current fiscal year, such sums as may be necessary.
PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT BLOCK
GRANT
For carrying out sections 658A through 658R of the Omnibus Budget
Reconciliation Act of 1981 (The Child Care and Development Block Grant Act of
1990), in addition to amounts already appropriated for fiscal year 2001,
$817,328,000: Provided, That of the funds appropriated for fiscal
year 2001, $19,120,000 shall be available for child care resource and referral
and school-aged child care activities: Provided further, That of the
funds appropriated for fiscal year 2001, in addition to the amounts required
to be reserved by the States under section 658G, $222,672,000 shall be
reserved by the States for activities authorized under section 658G, of which
$100,000,000 shall be for activities that improve the quality of infant and
toddler child care.
SOCIAL SERVICES BLOCK GRANT
For making grants to States pursuant to section 2002 of the Social
Security Act, $600,000,000: Provided, That notwithstanding section
2003(c) of such Act, as amended, the amount specified for allocation under
such section for fiscal year 2001 shall be $600,000,000.
CHILDREN AND FAMILIES SERVICES PROGRAMS
(INCLUDING RESCISSIONS)
For carrying out, except as otherwise provided, the Runaway and
Homeless Youth Act, the Developmental Disabilities Assistance and Bill of
Rights Act, the Head Start Act, the Child Abuse Prevention and Treatment Act,
the Native American Programs Act of 1974, title II of Public Law 95-266
(adoption opportunities), the Adoption and Safe Families Act of 1997 (Public
Law 105-89), the Abandoned Infants Assistance Act of 1988, part B(1) of title
IV and sections 413, 429A, 1110, and 1115 of the Social Security Act; for
making payments under the Community Services Block Grant Act, section 473A of
the Social Security Act, and title IV of Public Law 105-285; and for necessary
administrative expenses to carry out said Acts and titles I, IV, X, XI, XIV,
XVI, and XX of the Social Security Act, the Act of July 5, 1960 (24 U.S.C. ch.
9), the Omnibus Budget Reconciliation Act of 1981, title IV of the Immigration
and Nationality Act, section 501 of the Refugee Education Assistance Act of
1980, section 5 of the Torture Victims Relief Act of 1998 (Public Law
105-320), sections 40155, 40211, and 40241 of Public Law 103-322 and section
126 and titles IV and V of Public Law 100-485, $7,895,723,000, of which
$5,000,000 shall be made available to provide grants for early childhood
learning for young children, of which $55,928,000, to remain available until
September 30, 2002, shall be for grants to States for adoption incentive
payments, as authorized by section 473A of title IV of the Social Security Act
(42 U.S.C. 670-679); of which $134,074,000, to remain available until
expended, shall be for activities authorized by sections 40155, 40211, and
40241 of Public Law 103-322; of which $606,676,000 shall be for making
payments under the Community Services Block Grant Act; and of which
$6,267,000,000 shall be for making payments under the Head Start Act, of which
$1,400,000,000 shall become available October 1, 2001 and remain available
through September 30, 2002: Provided, That to the extent Community
Services Block Grant funds are distributed as grant funds by a State to an
eligible entity as provided under the Act, and have not been expended by such
entity, they shall remain with such entity for carryover into the next fiscal
year for expenditure by such entity consistent with program purposes:
Provided further, That the Secretary shall establish procedures
regarding the disposition of intangible property which permits grant funds, or
intangible assets acquired with funds authorized under section 680 of the
Community Services Block Grant Act, as amended, to become the sole property of
such grantees after a period of not more than 12 years after the end of the
grant for purposes and uses consistent with the original grant: Provided
further, That amounts made available under this Act for the
administrative and related expenses of the Department of Health and Human
Services, the Department of Labor, and the Department of Education shall be
further reduced on a pro rata basis by $14,137,000.
Funds appropriated for fiscal year 2000 under section 429A(e), part B
of title IV of the Social Security Act shall be reduced by $6,000,000.
Funds appropriated for fiscal year 2000 under section 413(h)(1) of the
Social Security Act shall be reduced by $15,000,000.
PROMOTING SAFE AND STABLE FAMILIES
For carrying out section 430 of the Social Security Act,
$305,000,000.
PAYMENTS TO STATES FOR FOSTER CARE AND ADOPTION ASSISTANCE
For making payments to States or other non-Federal entities under
title IV-E of the Social Security Act, $4,868,100,000.
For making payments to States or other non-Federal entities under
title IV-E of the Social Security Act, for the first quarter of fiscal year
2002, $1,735,900,000.
Administration on Aging
AGING SERVICES PROGRAMS
For carrying out, to the extent not otherwise provided, the Older
Americans Act of 1965, as amended, and section 398 of the Public Health
Service Act, $954,619,000, of which $5,000,000 shall be available for
activities regarding medication management, screening, and education to
prevent incorrect medication and adverse drug reactions: Provided,
That notwithstanding section 308(b)(1) of the Older Americans Act of
1965, as amended, the amounts available to each State for administration of
the State plan under title III of such Act shall be reduced not more than 5
percent below the amount that was available to such State for such purpose for
fiscal year 1995: Provided further, That in considering grant
applications for nutrition services for elder Indian recipients, the Assistant
Secretary shall provide maximum flexibility to applicants who seek to take
into account subsistence, local customs, and other characteristics that are
appropriate to the unique cultural, regional, and geographic needs of the
American Indian, Alaska and Hawaiian Native communities to be served.
Office of the Secretary
GENERAL DEPARTMENTAL MANAGEMENT
For necessary expenses, not otherwise provided, for general
departmental management, including hire of six sedans, and for carrying out
titles III, XVII, and XX of the Public Health Service Act, and the United
States-Mexico Border Health Commission Act, $206,766,000, together with
$5,851,000, to be transferred and expended as authorized by section 201(g)(1)
of the Social Security Act from the Hospital Insurance Trust Fund and the
Supplemental Medical Insurance Trust Fund: Provided further, That of
the funds made available under this heading for carrying out title XX of the
Public Health Service Act, $10,569,000 shall be for activities specified under
section 2003(b)(2), of which $9,131,000 shall be for prevention service
demonstration grants under section 510(b)(2) of title V of the Social Security
Act, as amended, without application of the limitation of section 2010(c) of
said title XX.
OFFICE OF INSPECTOR GENERAL
For expenses necessary for the Office of Inspector General in carrying
out the provisions of the Inspector General Act of 1978, as amended,
$33,849,000.
OFFICE FOR CIVIL RIGHTS
For expenses necessary for the Office for Civil Rights, $20,742,000,
together with not to exceed $3,314,000, to be transferred and expended as
authorized by section 201(g)(1) of the Social Security Act from the Hospital
Insurance Trust Fund and the Supplemental Medical Insurance Trust Fund:
Provided, That an additional $2,500,000 shall be made available for
the Office for Civil Rights: Provided further, That amounts made
available under this title for the administrative and related expenses of the
Department of Health and Human Services shall be reduced by
$2,500,000'.
POLICY RESEARCH
For carrying out, to the extent not otherwise provided, research
studies under section 1110 of the Social Security Act, $16,738,000.
RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS
For retirement pay and medical benefits of Public Health Service
Commissioned Officers as authorized by law, for payments under the Retired
Serviceman's Family Protection Plan and Survivor Benefit Plan, for medical
care of dependents and retired personnel under the Dependents' Medical Care
Act (10 U.S.C. ch. 55), and for payments pursuant to section 229(b) of the
Social Security Act (42 U.S.C. 429(b)), such amounts as may be required during
the current fiscal year.
Public Health and Social Services Emergency Fund
For public health and social services, $264,600,000.
GENERAL PROVISIONS
SEC. 201. Funds appropriated in this title shall be available for not
to exceed $37,000 for official reception and representation expenses when
specifically approved by the Secretary.
SEC. 202. The Secretary shall make available through assignment not
more than 60 employees of the Public Health Service to assist in child
survival activities and to work in AIDS programs through and with funds
provided by the Agency for International Development, the United Nations
International Children's Emergency Fund or the World Health
Organization.
SEC. 203. None of the funds appropriated under this Act may be used to
implement section 399L(b) of the Public Health Service Act or section 1503 of
the National Institutes of Health Revitalization Act of 1993, Public Law
103-43.
SEC. 204. None of the funds appropriated in this Act for the National
Institutes of Health and the Substance Abuse and Mental Health Services
Administration shall be used to pay the salary of an individual, through a
grant or other extramural mechanism, at a rate in excess of Executive Level
II.
SEC. 205. Notwithstanding section 241(a) of the Public Health Service
Act, such portion as the Secretary shall determine, but not more than 1.6
percent, of any amounts appropriated for programs authorized under the PHS Act
shall be made available for the evaluation (directly or by grants or
contracts) of the implementation and effectiveness of such programs.
(TRANSFER OF FUNDS)
SEC. 206. Not to exceed 1 percent of any discretionary funds (pursuant
to the Balanced Budget and Emergency Deficit Control Act of 1985, as amended)
which are appropriated for the current fiscal year for the Department of
Health and Human Services in this Act may be transferred between
appropriations, but no such appropriation shall be increased by more than 3
percent by any such transfer: Provided, That the Appropriations
Committees of both Houses of Congress are notified at least 15 days in advance
of any transfer.
SEC. 207. The Director of the National Institutes of Health, jointly
with the Director of the Office of AIDS Research, may transfer up to 3 percent
among institutes, centers, and divisions from the total amounts identified by
these two Directors as funding for research pertaining to the human
immunodeficiency virus: Provided, That the Congress is promptly
notified of the transfer.
SEC. 208. Of the amounts made available in this Act for the National
Institutes of Health, the amount for research related to the human
immunodeficiency virus, as jointly determined by the Director of the National
Institutes of Health and the Director of the Office of AIDS Research, shall be
made available to the `Office of AIDS Research' account. The Director of the
Office of AIDS Research shall transfer from such account amounts necessary to
carry out section 2353(d)(3) of the Public Health Service Act.
SEC. 209. None of the funds appropriated in this Act may be made
available to any entity under title X of the Public Health Service Act unless
the applicant for the award certifies to the Secretary that it encourages
family participation in the decision of minors to seek family planning
services and that it provides counseling to minors on how to resist attempts
to coerce minors into engaging in sexual activities.
SEC. 210. None of the funds appropriated by this Act (including funds
appropriated to any trust fund) may be used to carry out the Medicare+Choice
program if the Secretary denies participation in such program to an otherwise
eligible entity (including a Provider Sponsored Organization) because the
entity informs the Secretary that it will not provide, pay for, provide
coverage of, or provide referrals for abortions: Provided, That the
Secretary shall make appropriate prospective adjustments to the capitation
payment to such an entity (based on an actuarially sound estimate of the
expected costs of providing the service to such entity's enrollees):
Provided further, That nothing in this section shall be construed to
change the Medicare program's coverage for such services and a Medicare+Choice
organization described in this section shall be responsible for informing
enrollees where to obtain information about all Medicare covered
services.
SEC. 211. (a) MENTAL HEALTH- Section 1918(b) of the Public Health
Service Act (42 U.S.C. 300x-7(b)) is amended to read as follows:
`(b) MINIMUM ALLOTMENTS FOR STATES- Each State's allotment for fiscal
year 2001 for programs under this subpart shall not be less than such State's
allotment for such programs for fiscal year 2000.'.
(b) SUBSTANCE ABUSE- Section 1933(b) of the Public Health Service Act
(42 U.S.C. 300x-33(b)) is amended to read as follows:
`(b) MINIMUM ALLOTMENTS FOR STATES- Each State's allotment for fiscal
year 2001 for programs under this subpart shall not be less than such State's
allotment for such programs for fiscal year 2000.'.
SEC. 212. Notwithstanding any other provision of law, no provider of
services under title X of the Public Health Service Act shall be exempt from
any State law requiring notification or the reporting of child abuse, child
molestation, sexual abuse, rape, or incest.
SEC. 213. EXTENSION OF CERTAIN ADJUDICATION PROVISIONS- The Foreign
Operations, Export Financing, and Related Programs Appropriations Act, 1990
(Public Law 101-167) is amended--
(1) in section 599D (8 U.S.C. 1157 note)--
(A) in subsection (b)(3), by striking `1997, 1998, 1999, and 2000'
and inserting `1997, 1998, 1999, 2000 and 2001'; and
(B) in subsection (e), by striking `October 1, 2000' each place it
appears and inserting `October 1, 2001'; and
(2) in section 599E (8 U.S.C. 1255 note) in subsection (b)(2), by
striking `September 30, 2000' and inserting `September 30, 2001'.
SEC. 214. None of the funds provided in this Act or in any other Act
making appropriations for fiscal year 2001 may be used to administer or
implement in Arizona or in the Kansas City, Missouri or in the Kansas City,
Kansas area the Medicare Competitive Pricing Demonstration Project (operated
by the Secretary of Health and Human Services).
SEC. 215. WITHHOLDING OF SUBSTANCE ABUSE FUNDS. (a) IN GENERAL- Except
as provided by subsection (e) none of the funds appropriated by this Act may
be used to withhold substance abuse funding from a State pursuant to section
1926 of the Public Health Service Act (42 U.S.C. 300x-26) if such State
certifies to the Secretary of Health and Human Services by March 1, 2001 that
the State will commit additional State funds, in accordance with subsection
(b), to ensure compliance with State laws prohibiting the sale of tobacco
products to individuals under 18 years of age.
(b) AMOUNT OF STATE FUNDS- The amount of funds to be committed by a
State under subsection (a) shall be equal to 1 percent of such State's
substance abuse block grant allocation for each percentage point by which the
State misses the retailer compliance rate goal established by the Secretary of
Health and Human Services under section 1926 of such Act.
(c) ADDITIONAL STATE FUNDS- The State is to maintain State
expenditures in fiscal year 2001 for tobacco prevention programs and for
compliance activities at a level that is not less than the level of such
expenditures maintained by the State for fiscal year 2000, and adding to that
level the additional funds for tobacco compliance activities required under
subsection (a). The State is to submit a report to the Secretary on all fiscal
year 2000 State expenditures and all fiscal year 2001 obligations for tobacco
prevention and compliance activities by program activity by July 31,
2001.
(d) ENFORCEMENT OF STATE OBLIGATIONS- The Secretary shall exercise
discretion in enforcing the timing of the State obligation of the additional
funds required by the certification described in subsection (a) as late as
July 31, 2001.
(e) TERRITORIES- None of the funds appropriated by this Act may be
used to withhold substance abuse funding pursuant to section 1926 from a
territory that receives less than $1,000,000.
SEC. 216. Section 403(a)(3) of the Social Security Act (42 U.S.C.
603(a)(3)) is amended--
(1) in subparagraph (A)--
(A) in clause (i), by striking `and' at the end;
(i) by striking `1999, 2000, and 2001' and inserting `1999 and
2000'; and
(ii) by striking the period at the end and inserting `; and';
and
(C) by adding at the end the following new clause:
`(iii) for fiscal year 2001, a grant in an amount equal to the
amount of the grant to the State under clause (i) for fiscal year 1998.'
and
(2) in subparagraph (G), by inserting at the end, `Upon enactment,
the provisions of this Act that would have been estimated by the Director of
the Office of Management and Budget as changing direct spending and receipts
for fiscal year 2001 under section 252 of the Balanced Budget and Emergency
Deficit Control Act of 1985 (Public Law 99-177), to the extent such changes
would have been estimated to result in savings in fiscal year 2001 of
$240,000,000 in budget authority and $122,000,000 in outlays, shall be
treated as if enacted in an appropriations act pursuant to Rule 3 of the
Budget Scorekeeping Guidelines set forth in the Joint Explanatory Statement
of the Committee of Conference accompanying Conference Report No. 105-217,
thereby changing discretionary spending under section 251 of that
Act.'.
SEC. 217. (a) Notwithstanding Section 2104(f) of the Social Security
Act (the Act), the Secretary of Health and Human Services shall reduce the
amounts allotted to a State under subsection (b) of the Act for fiscal year
1998 by the applicable amount with respect to the State; and
(b) Notwithstanding Section 2104(a) of the Act, the Secretary shall
increase the amount otherwise payable to each State under such subsection for
fiscal year 2003 by the amount of the reduction made under paragraph (a) of
this section. Funds made available under this subsection shall remain
available through September 30, 2004.
(c) APPLICABLE AMOUNT DEFINED- In subsection (a), with respect to a
State, the term `applicable amount' means, with respect to a State, an amount
bearing the same proportion to $1,900,000,000 as the unexpended balance of its
fiscal year 1998 allotment as of September 30, 2000, which would otherwise be
redistributed to States in fiscal year 2001 under Section 2104(f) of the Act,
bears to the sum of the unexpended balances of fiscal year 1998 allotments for
all States as of September 30, 2000: Provided, That, the applicable
amount for a State shall not exceed the unexpended balance of its fiscal year
1998 allotment as of September 30, 2000.
SEC. 218. SENSE OF THE SENATE ON PREVENTION OF NEEDLESTICK INJURIES.
(a) FINDINGS- The Senate finds that--
(1) the Centers for Disease Control and Prevention reports that
American health care workers report 600,000 to 800,000 needlestick and
sharps injuries each year;
(2) the occurrence of needlestick injuries is believed to be widely
under-reported;
(3) needlestick and sharps injuries result in at least 1,000 new
cases of health care workers with HIV, hepatitis C or hepatitis B every
year;
(4) more than 80 percent of needlestick injuries can be prevented
through the use of safer devices; and
(5) the Occupational Safety and Health Administration's November
1999 Compliance Directive has helped clarify the duty of employers to use
safer needle devices to protect their workers. However, millions of State
and local government employees are not covered by OSHA's bloodborne pathogen
standards and are not protected against the hazards of
needlesticks.
(b) SENSE OF THE SENATE- It is the sense of the Senate that the Senate
should pass legislation that would eliminate or minimize the significant risk
of needlestick injury to health care workers.
SEC. 219. (a) IN GENERAL- There is appropriated $10,000,000 that may
be used by the Director of the National Institute for Occupational Safety and
Health to--
(1) establish and maintain a national database on existing
needleless systems and sharps with engineered sharps injury
protections;
(2) develop a set of evaluation criteria for use by employers,
employees, and other persons when they are evaluating and selecting
needleless systems and sharps with engineered sharps injury
protections;
(3) develop a model training curriculum to train employers,
employees, and other persons on the process of evaluating needleless systems
and sharps with engineered sharps injury protections and to the extent
feasible to provide technical assistance to persons who request such
assistance; and
(4) establish a national system to collect comprehensive data on
needlestick injuries to health care workers, including data on mechanisms to
analyze and evaluate prevention interventions in relation to needlestick
injury occurrence.
(b) DEFINITIONS- In this section:
(1) EMPLOYER- The term `employer' means each employer having an
employee with occupational exposure to human blood or other material
potentially containing bloodborne pathogens.
(2) ENGINEERED SHARPS INJURY PROTECTIONS- The term `engineered
sharps injury protections' means--
(A) a physical attribute built into a needle device used for
withdrawing body fluids, accessing a vein or artery, or administering
medications or other fluids, that effectively reduces the risk of an
exposure incident by a mechanism such as barrier creation, blunting,
encapsulation, withdrawal, retraction, destruction, or other effective
mechanisms; or
(B) a physical attribute built into any other type of needle
device, or into a nonneedle sharp, which effectively reduces the risk of
an exposure incident.
(3) NEEDLELESS SYSTEM- The term `needleless system' means a device
that does not use needles for--
(A) the withdrawal of body fluids after initial venous or arterial
access is established;
(B) the administration of medication or fluids; and
(C) any other procedure involving the potential for an exposure
incident.
(4) SHARP- The term `sharp' means any object used or encountered in
a health care setting that can be reasonably anticipated to penetrate the
skin or any other part of the body, and to result in an exposure incident,
including, but not limited to, needle devices, scalpels, lancets, broken
glass, broken capillary tubes, exposed ends of dental wires and dental
knives, drills, and burs.
(5) SHARPS INJURY- The term `sharps injury' means any injury caused
by a sharp, including cuts, abrasions, or needlesticks.
(c) OFFSET- Amounts made available under this Act for the travel,
consulting, and printing services for the Department of Labor, the Department
of Health and Human Services, and the Department of Education shall be reduced
on a pro rata basis by $10,000,000.
SEC. 220. None of the funds made available under this Act may be made
available to any entity under the Public Health Service Act after September 1,
2001, unless the Director of the National Institutes of Health has provided to
the Chairman and Ranking Member of the Senate Committees on Appropriations,
and Health, Education, Labor, and Pensions a proposal to require a reasonable
rate of return on both intramural and extramural research by March 31,
2001.
SEC. 221. (a) STUDY- The Secretary of Health and Human Services shall
conduct a study to examine--
(1) the experiences of hospitals in the United States in obtaining
reimbursement from foreign health insurance companies whose enrollees
receive medical treatment in the United States;
(2) the identity of the foreign health insurance companies that do
not cooperate with or reimburse (in whole or in part) United States health
care providers for medical services rendered in the United States to
enrollees who are foreign nationals;
(3) the amount of unreimbursed services that hospitals in the United
States provide to foreign nationals described in paragraph (2);
and
(4) solutions to the problems identified in the study.
(b) REPORT- Not later than March 31, 2001, the Secretary of Health and
Human Services shall prepare and submit to the Committee on Health, Education,
Labor, and Pensions of the Senate and the Committee on Appropriations, a
report concerning the results of the study conducted under subsection (a),
including the recommendations described in paragraph (4) of such
subsection.
SEC. 222. NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT.
Section 448 of the Public Health Service Act (42 U.S.C. 285g) is amended by
inserting `gynecologic health,' after `with respect to'.
SEC. 223. In addition to amounts otherwise appropriated under this
title for the Centers for Disease Control and Prevention, $37,500,000, to be
utilized to provide grants to States and political subdivisions of States
under section 317 of the Public Health Service Act to enable such States and
political subdivisions to carry out immunization infrastructure and operations
activities: Provided, That of the total amount made available in this
Act for infrastructure funding for the Centers for Disease Control and
Prevention, not less than 10 percent shall be used for immunization projects
in areas with low or declining immunization rates or areas that are
particularly susceptible to disease outbreaks, and not more than 14 percent
shall be used to carry out the incentive bonus program: Provided
further, That amounts made available under this Act for the
administrative and related expenses of the Department of Health and Human
Services, the Department of Labor, and the Department of Education shall be
further reduced on a pro rata basis by $37,500,000.
Sec. 224. None of the funds appropriated under this Act shall be
expended by the National Institutes of Health on a contract for the care of
the 288 chimpanzees acquired by the National Institutes of Health from the
Coulston Foundation, unless the contractor is accredited by the Association
for the Assessment and Accreditation of Laboratory Animal Care International
or has a Public Health Services assurance, and has not been charged multiple
times with egregious violations of the Animal Welfare Act.
SEC. 225. (a) In addition to amounts made available under the heading
`Health Resources and Services Administration-Health Resources and Services'
for poison prevention and poison control center activities, there shall be
available an additional $20,000,000 to provide assistance for such activities
and to stabilize the funding of regional poison control centers as provided
for pursuant to the Poison Control Center Enhancement and Awareness Act
(Public Law 106-174).
(b) Amounts made available under this Act for the administrative and
related expenses of the Department of Health and Human Services, the
Department of Labor, and the Department of Education shall be further reduced
on a pro rata basis by $20,000,000.
Sec. 226. SENSE OF THE SENATE REGARDING THE DELIVERY OF EMERGENCY
MEDICAL SERVICES. (a) FINDINGS- The Senate finds the following:
(1) Several States have developed and implemented a unique 2-tiered
emergency medical services system that effectively provides services to the
residents of those States.
(2) These 2-tiered systems include volunteer and for-profit
emergency medical technicians who provide basic life support and
hospital-based paramedics who provide advanced life support.
(3) These 2-tiered systems have provided universal access for
residents of those States to affordable emergency services, while
simultaneously ensuring that those persons in need of the most advanced care
receive such care from the proper authorities.
(4) One State's 2-tiered system currently has an estimated 20,000
emergency medical technicians providing ambulance transportation for basic
life support and advanced life support emergencies, over 80 percent of which
are handled by volunteers who are not reimbursed under the medicare program
under title XVIII of the Social Security Act.
(5) The hospital-based paramedics, also known as mobile intensive
care units, are reimbursed under the medicare program when they respond to
advanced life support emergencies.
(6) These 2-tiered State health systems save the lives of thousands
of residents of those States each year, while saving the medicare program,
in some instances, as much as $39,000,000 in reimbursement fees.
(7) When Congress requested that the Health Care Financing
Administration enact changes to the emergency medical services fee schedule
as a result of the Balanced Budget Act of 1997, including a general overhaul
of reimbursement rates and administrative costs, it was in the spirit of
streamlining the agency, controlling skyrocketing health care costs, and
lengthening the solvency of the medicare program.
(8) The Health Care Financing Administration is considering
implementing new emergency medical services reimbursement guidelines that
may destabilize the 2-tier system that has developed in these
States.
(b) SENSE OF THE SENATE- It is the sense of the Senate that the Health
Care Financing Administration should--
(1) consider the unique nature of 2-tiered emergency medical
services delivery systems when implementing new reimbursement guidelines for
paramedics and hospitals under the medicare program under title XVIII of the
Social Security Act; and
(2) promote innovative emergency medical service systems enacted by
States that reduce reimbursement costs to the medicare program while
ensuring that all residents receive quick and appropriate emergency care
when needed.
Sec. 227. Sense of the Senate Regarding Impacts of the Balanced Budget
Act of 1997. (a) FINDINGS- The Senate makes the following findings:
(1) Since its passage in 1997, the Balanced Budget Act of 1997 has
drastically cut payments under the medicare program under title XVIII of the
Social Security Act in the areas of hospital, home health, and skilled
nursing care, among others. While Congress intended to cut approximately
$100,000,000,000 from the medicare program over 5 years, recent estimates
put the actual cut at over $200,000,000,000.
(2) A recent study on home health care found that nearly 70 percent
of hospital discharge planners surveyed reported a greater difficulty
obtaining home health services for medicare beneficiaries as a result of the
Balanced Budget Act of 1997.
(3) According to the Medicare Payment Advisory Commission, rural
hospitals were disproportionately affected by the Balanced Budget Act of
1997, dropping the inpatient margins of such hospitals over 4 percentage
points in 1998.
(b) SENSE OF SENATE- It is the sense of the Senate that Congress and
the President should act expeditiously to alleviate the adverse impacts of the
Balanced Budget Act of 1997 on beneficiaries under the medicare program under
title XVIII of the Social Security Act and health care providers participating
in such program.
TITLE III--DEPARTMENT OF EDUCATION
Office of Elementary and Secondary Education
EDUCATION REFORM
For carrying out activities authorized by title IV of the Goals 2000:
Educate America Act as in effect prior to September 30, 2000, and sections
3122, 3132, 3136, and 3141, parts B, C, and D of title III, and part I of
title X of the Elementary and Secondary Education Act of 1965, $1,434,500,000,
of which $40,000,000 shall be for the Goals 2000: Educate America Act, and of
which $192,000,000 shall be for section 3122: Provided, That up to
one-half of 1 percent of the amount available under section 3132 shall be set
aside for the outlying areas, to be distributed on the basis of their relative
need as determined by the Secretary in accordance with the purposes of the
program: Provided further, That if any State educational agency does
not apply for a grant under section 3132, that State's allotment under section
3131 shall be reserved by the Secretary for grants to local educational
agencies in that State that apply directly to the Secretary according to the
terms and conditions published by the Secretary in the Federal Register:
Provided further, That, notwithstanding part I of title X of the
Elementary and Secondary Education Act of 1965 or any other provision of law,
a community-based organization that has experience in providing before- and
after-school services shall be eligible to receive a grant under that part, on
the same basis as a school or consortium described in section 10904 of that
Act, and the Secretary shall give priority to any application for such a grant
that is submitted jointly by such a community-based organization and such a
school or consortium.
EDUCATION FOR THE DISADVANTAGED
For carrying out title I of the Elementary and Secondary Education Act
of 1965, and section 418A of the Higher Education Act of 1965, $8,986,800,000,
of which $2,729,958,000 shall become available on July 1, 2001, and shall
remain available through September 30, 2002, and of which $6,223,342,000 shall
become available on October 1, 2001 and shall remain available through
September 30, 2002, for academic year 2000-2001: Provided, That
$7,113,403,000 shall be available for basic grants under section 1124:
Provided further, That up to $3,500,000 of these funds shall be
available to the Secretary on October 1, 2000, to obtain updated local
educational agency level census poverty data from the Bureau of the Census:
Provided further, That $1,222,397,000 shall be available for
concentration grants under section 1124A: Provided further, That
grant awards under sections 1124 and 1124A of title I of the Elementary and
Secondary Education Act of 1965 shall be made to each State and local
educational agency at no less than 100 percent of the amount such State or
local educational agency received under this authority for fiscal year 2000:
Provided further, That notwithstanding any other provision of law,
grant awards under section 1124A of title I of the Elementary and Secondary
Education Act of 1965 shall be made to those local educational agencies that
received a Concentration Grant under the Department of Education
Appropriations Act, 2000, but are not eligible to receive such a grant for
fiscal year 2001: Provided further, That each such local educational
agency shall receive an amount equal to the Concentration Grant the agency
received in fiscal year 2000, ratably reduced, if necessary, to ensure that
these local educational agencies receive no greater share of their
hold-harmless amounts than other local educational agencies: Provided
further, That notwithstanding any other provision of law, in calculating
the amount of Federal assistance awarded to a State or local educational
agency under any program under title I of the Elementary and Secondary
Education Act of 1965 (20 U.S.C. 6301 et seq.) on the basis of a formula
described in section 1124 or 1124A of such Act (20 U.S.C. 6333, 6334), any
funds appropriated for the program in excess of the amount appropriated for
the program for fiscal year 2000 shall be awarded according to the formula,
except that, for such purposes, the formula shall be applied only to States or
local educational agencies that experience a reduction under the program for
fiscal year 2001 as a result of the application of the 100 percent hold
harmless provisions under the heading `Education for the Disadvantaged':
Provided further, That the Secretary shall not take into account the
hold harmless provisions in this section in determining State allocations
under any other program administered by the Secretary in any fiscal
year.
IMPACT AID
For carrying out programs of financial assistance to federally
affected schools authorized by title VIII of the Elementary and Secondary
Education Act of 1965, $1,030,000,000, of which $818,000,000 shall be for
basic support payments under section 8003(b), $50,000,000 shall be for
payments for children with disabilities under section 8003(d), $82,000,000, to
remain available until expended, shall be for payments under section 8003(f),
$35,000,000 shall be for construction under section 8007, $47,000,000 shall be
for Federal property payments under section 8002 and $8,000,000 to remain
available until expended shall be for facilities maintenance under section
8008: Provided, That amounts made available under this Act for the
administrative and related expenses of the Department of Health and Human
Services, the Department of Labor, and the Department of Education shall be
further reduced on a pro rata basis by $10,000,000.
SCHOOL IMPROVEMENT PROGRAMS
For carrying out school improvement activities authorized by titles
II, IV, V-A and B, VI, IX, X, and XIII of the Elementary and Secondary
Education Act of 1965 (`ESEA'); the Stewart B. McKinney Homeless Assistance
Act; and the Civil Rights Act of 1964 and part B of title VIII of the Higher
Education Act of 1965; $4,672,534,000, of which $1,100,200,000 shall become
available on July 1, 2001, and remain available through September 30, 2002,
and of which $2,915,000,000 shall become available on October 1, 2001 and
shall remain available through September 30, 2002 for academic year 2001-2002:
Provided, That of the amount appropriated, $435,000,000 shall be for
Eisenhower professional development State grants under title II-B and
$3,100,000,000 shall be for title VI and up to $750,000 shall be for an
evaluation of comprehensive regional assistance centers under title XIII of
ESEA: Provided further, That of the amount made available for Title
VI, $2,700,000,000 shall be available, notwithstanding any other provision of
law, for purposes consistent with title VI to be determined by the local
education agency as part of a local strategy for improving academic
achievement: Provided further, That these funds may also be used to
address the shortage of highly qualified teachers to reduce class size,
particularly in early grades, using highly qualified teachers to improve
educational achievement for regular and special needs children; to support
efforts to recruit, train and retrain highly qualified teachers; to carry out
part B of the Individuals with Disabilities Education Act (20 U.S.C. 1411 et
seq.); or for school construction and renovation of facilities, at the sole
discretion of the local educational agency: Provided further, That
funds made available under this heading to carry out section 6301(b) of the
Elementary and Secondary Education Act of 1965 shall be available for
education reform projects that provide same gender schools and classrooms,
consistent with applicable law: Provided further, That of the amount
made available under this heading for activities carried out through the Fund
for the Improvement of Education under part A of title X, $10,000,000 shall be
made available to enable the Secretary of Education to award grants to develop
and implement school dropout prevention programs.
READING EXCELLENCE
For necessary expenses to carry out the Reading Excellence Act,
$91,000,000, which shall become available on July 1, 2001 and shall remain
available through September 30, 2002 and $195,000,000 which shall become
available on October 1, 2001 and remain available through September 30,
2002.
INDIAN EDUCATION
For expenses necessary to carry out, to the extent not otherwise
provided, title IX, part A of the Elementary and Secondary Education Act of
1965, as amended, $115,500,000.
Office of Bilingual Education and Minority Languages Affairs
BILINGUAL AND IMMIGRANT EDUCATION
For carrying out, to the extent not otherwise provided, bilingual,
foreign language and immigrant education activities authorized by parts A and
C and section 7203 of title VII of the Elementary and Secondary Education Act
of 1965, without regard to section 7103(b), $443,000,000: Provided,
That State educational agencies may use all, or any part of, their part C
allocation for competitive grants to local educational agencies.
Office of Special Education and Rehabilitative Services
SPECIAL EDUCATION
For carrying out the Individuals with Disabilities Education Act,
$7,352,341,000, of which $2,464,452,000 shall become available for obligation
on July 1, 2001, and shall remain available through September 30, 2002, and of
which $4,624,000,000 shall become available on October 1, 2001 and shall
remain available through September 30, 2002, for academic year 2001-2002:
Provided, That $1,500,000 shall be for the recipient of funds
provided by Public Law 105-78 under section 687(b)(2)(G) of the Act to provide
information on diagnosis, intervention, and teaching strategies for children
with disabilities: Provided further, That the amount for section
611(c) of the Act shall be equal to the amount available for that section
under Public Law 106-113, increased by the rate of inflation as specified in
section 611(f)(1)(B)(ii) of the Act.
REHABILITATION SERVICES AND DISABILITY RESEARCH
For carrying out, to the extent not otherwise provided, the
Rehabilitation Act of 1973, the Assistive Technology Act of 1998, and the
Helen Keller National Center Act, $2,799,519,000: Provided, That
notwithstanding section 105(b)(1) of the Assistive Technology Act of 1998
(`the AT Act'), each State shall be provided $50,000 for activities under
section 102 of the AT Act: Provided further, That notwithstanding
section 105(b)(1) and section 101(f)(2) and (3) of the Assistive Technology
Act of 1998, each State shall be provided a minimum of $500,000 for activities
under section 101: Provided further, That $7,000,000 shall be used to
support grants for up to three years to states under title III of the AT Act,
of which the Federal share shall not exceed 75 percent in the first year, 50
percent in the second year, and 25 percent in the third year, and that the
requirements in section 301(c)(2) and section 302 of that Act shall not apply
to such grants.
Special Institutions for Persons With Disabilities
AMERICAN PRINTING HOUSE FOR THE BLIND
For carrying out the Act of March 3, 1879, as amended (20 U.S.C. 101
et seq.), $12,500,000.
NATIONAL TECHNICAL INSTITUTE FOR THE DEAF
For the National Technical Institute for the Deaf under titles I and
II of the Education of the Deaf Act of 1986 (20 U.S.C. 4301 et seq.),
$54,366,000, of which $7,176,000 shall be for construction and shall remain
available until expended: Provided, That from the total amount
available, the Institute may at its discretion use funds for the endowment
program as authorized under section 207.
GALLAUDET UNIVERSITY
For the Kendall Demonstration Elementary School, the Model Secondary
School for the Deaf, and the partial support of Gallaudet University under
titles I and II of the Education of the Deaf Act of 1986 (20 U.S.C. 4301 et
seq.), $87,650,000: Provided, That from the total amount available,
the University may at its discretion use funds for the endowment program as
authorized under section 207.
Office of Vocational and Adult Education
VOCATIONAL AND ADULT EDUCATION
For carrying out, to the extent not otherwise provided, the Carl D.
Perkins Vocational and Technical Education Act, the Adult Education and Family
Literacy Act, and title VIII-D of the Higher Education Act of 1965, as
amended, and Public Law 102-73, $1,726,600,000, of which $1,000,000 shall
remain available until expended, and of which $929,000,000 shall become
available on July 1, 2001 and shall remain available through September 30,
2002 and of which $791,000,000 shall become available on October 1, 2001 and
shall remain available through September 30, 2002: Provided, That of
the amounts made available for the Carl D. Perkins Vocational and Technical
Education Act, $5,600,000 shall be for tribally controlled postsecondary
vocational and technical institutions under section 117: Provided
further, That $9,000,000 shall be for carrying out section 118 of such
Act: Provided further, That up to 15 percent of the funds provided
may be used by the national entity designated under section 118(a) to cover
the cost of authorized activities and operations, including Federal salaries
and expenses: Provided further, That the national entity is
authorized, effective upon enactment, to charge fees for publications,
training, and technical assistance developed by that national entity:
Provided further, That revenues received from publications and
delivery of technical assistance and training, notwithstanding 31 U.S.C. 3302,
may be credited to the national entity's account and shall be available to the
national entity, without fiscal year limitation, so long as such revenues are
used for authorized activities and operations of the national entity:
Provided further, That of the funds made available to carry out
section 204 of the Perkins Act, all funds that a State receives in excess of
its prior-year allocation shall be competitively awarded: Provided
further, That in making these awards, each State shall give priority to
consortia whose applications most effectively integrate all components under
section 204(c): Provided further, That of the amounts made available
for the Carl D. Perkins Vocational and Technical Education Act, $5,000,000
shall be for demonstration activities authorized by section 207: Provided
further, That of the amounts made available for the Adult Education and
Family Literacy Act, $14,000,000 shall be for national leadership activities
under section 243 and $6,500,000 shall be for the National Institute for
Literacy under section 242: Provided further, That $22,000,000 shall
be for Youth Offender Grants, of which $5,000,000 shall be used in accordance
with section 601 of Public Law 102-73 as that section was in effect prior to
the enactment of Public Law 105-220: Provided further, That of the
amounts made available for title I of the Perkins Act, the Secretary may
reserve up to 0.54 percent for incentive grants under section 503 of the
Workforce Investment Act, without regard to section 111(a)(1)(C) of the
Perkins Act: Provided further, That of the amounts made available for
the Adult Education and Family Literacy Act, the Secretary may reserve up to
0.54 percent for incentive grants under section 503 of the Workforce
Investment Act, without regard to section 211(a)(3) of the Adult Education and
Family Literacy Act.
Office of Student Financial Assistance
STUDENT FINANCIAL ASSISTANCE
For carrying out subparts 1, 3 and 4 of part A, part C and part E of
title IV of the Higher Education Act of 1965, as amended, $10,624,000,000,
which shall remain available through September 30, 2002.
The maximum Pell Grant for which a student shall be eligible during
award year 2001-2002 shall be $3,650: Provided, That notwithstanding
section 401(g) of the Act, if the Secretary determines, prior to publication
of the payment schedule for such award year, that the amount included within
this appropriation for Pell Grant awards in such award year, and any funds
available from the fiscal year 2000 appropriation for Pell Grant awards, are
insufficient to satisfy fully all such awards for which students are eligible,
as calculated under section 401(b) of the Act, the amount paid for each such
award shall be reduced by either a fixed or variable percentage, or by a fixed
dollar amount, as determined in accordance with a schedule of reductions
established by the Secretary for this purpose.
FEDERAL FAMILY EDUCATION LOAN PROGRAM ACCOUNT
For Federal administrative expenses to carry out guaranteed student
loans authorized by title IV, part B, of the Higher Education Act of 1965, as
amended, $48,000,000.
Office of Postsecondary Education
HIGHER EDUCATION
For carrying out, to the extent not otherwise provided, section 121
and titles II, III, IV, V, VI, VII, and VIII of the Higher Education Act of
1965, as amended, and the Mutual Educational and Cultural Exchange Act of
1961; $1,694,520,000, of which $10,000,000 for interest subsidies authorized
by section 121 of the Higher Education Act of 1965, shall remain available
until expended: Provided, That $11,000,000, to remain available
through September 30, 2002, shall be available to fund fellowships under part
A, subpart 1 of title VII of said Act, of which up to $1,000,000 shall be
available to fund fellowships for academic year 2001-2002, and the remainder
shall be available to fund fellowships for academic year 2002-2003:
Provided further, That $3,000,000 is for data collection and
evaluation activities for programs under the Higher Education Act of 1965,
including such activities needed to comply with the Government Performance and
Results Act of 1993: Provided further, That section 404F(a) of the
Higher Education Amendments of 1998 is amended by striking out `using funds
appropriated under section 404H that do not exceed $200,000' and inserting in
lieu thereof `using not more than 0.2 percent of the funds appropriated under
section 404H'.
HOWARD UNIVERSITY
For partial support of Howard University (20 U.S.C. 121 et seq.),
$224,000,000, of which not less than $3,530,000 shall be for a matching
endowment grant pursuant to the Howard University Endowment Act (Public Law
98-480) and shall remain available until expended.
COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM
For Federal administrative expenses authorized under section 121 of
the Higher Education Act of 1965, $737,000 to carry out activities related to
existing facility loans entered into under the Higher Education Act of
1965.
HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL FINANCING PROGRAM
ACCOUNT
The total amount of bonds insured pursuant to section 344 of title
III, part D of the Higher Education Act of 1965 shall not exceed $357,000,000,
and the cost, as defined in section 502 of the Congressional Budget Act of
1974, of such bonds shall not exceed zero.
For administrative expenses to carry out the Historically Black
College and University Capital Financing Program entered into pursuant to
title III, part D of the Higher Education Act of 1965, as amended,
$208,000.
Office of Educational Research and Improvement
EDUCATION RESEARCH, STATISTICS, AND IMPROVEMENT
For carrying out activities authorized by the Educational Research,
Development, Dissemination, and Improvement Act of 1994, including part E; the
National Education Statistics Act of 1994, including sections 411 and 412;
section 2102 of title II, and parts A, B, and K and section 10102, section
10105, and 10601 of title X, and part C of title XIII of the Elementary and
Secondary Education Act of 1965, as amended, and title VI of Public Law
103-227, $506,519,000, of which $250,000 shall be for the Web-Based Education
Commission: Provided, That of the funds appropriated under section
10601 of title X of the Elementary and Secondary Education Act of 1965, as
amended, $1,500,000 shall be used to conduct a violence prevention
demonstration program: Provided further, That of the funds
appropriated $5,000,000 shall be made available for a high school State grant
program to improve academic performance and provide technical skills training,
$5,000,000 shall be made available to provide grants to enable elementary and
secondary schools to provide physical education and improve physical fitness:
Provided further, That $50,000,000 of the funds provided for the
national education research institutes shall be allocated notwithstanding
section 912(m)(1)(B-F) and subparagraphs (B) and (C) of section 931(c)(2) of
Public Law 103-227 and $20,000,000 of that $50,000,000 shall be made available
for the Interagency Education Research Initiative: Provided further,
That the amounts made available under this Act for the administrative and
related expenses of the Department of Health and Human Services, the
Department of Labor, and the Department of Education shall be further reduced
on a pro rata basis by $10,000,000: Provided further, That of the
funds available for section 10601 of title X of the Elementary and Secondary
Education Act of 1965, as amended, $150,000 shall be awarded to the Center for
Educational Technologies to complete production and distribution of an
effective CD-ROM product that would complement the `We the People: The Citizen
and the Constitution' curriculum: Provided further, That, in addition
to the funds for title VI of Public Law 103-227 and notwithstanding the
provisions of section 601(c)(1)(C) of that Act, $1,000,000 shall be available
to the Center for Civic Education to conduct a civic education program with
Northern Ireland and the Republic of Ireland and, consistent with the civics
and Government activities authorized in section 601(c)(3) of Public Law
103-227, to provide civic education assistance to democracies in developing
countries. The term `developing countries' shall have the same meaning as the
term `developing country' in the Education for the Deaf Act: Provided
further, That of the amount made available under this heading for
activities carried out through the Fund for the Improvement of Education under
part A of title X, $50,000,000 shall be made available to enable the Secretary
of Education to award grants to develop, implement, and strengthen programs to
teach American history (not social studies) as a separate subject within
school curricula.
Departmental Management
PROGRAM ADMINISTRATION
For carrying out, to the extent not otherwise provided, the Department
of Education Organization Act, including rental of conference rooms in the
District of Columbia and hire of two passenger motor vehicles,
$396,671,000.
OFFICE FOR CIVIL RIGHTS
For expenses necessary for the Office for Civil Rights, as authorized
by section 203 of the Department of Education Organization Act,
$73,224,000.
OFFICE OF THE INSPECTOR GENERAL
For expenses necessary for the Office of Inspector General, as
authorized by section 212 of the Department of Education Organization Act,
$35,456,000.
GENERAL PROVISIONS
SEC. 301. No funds appropriated in this Act may be used for the
transportation of students or teachers (or for the purchase of equipment for
such transportation) in order to overcome racial imbalance in any school or
school system, or for the transportation of students or teachers (or for the
purchase of equipment for such transportation) in order to carry out a plan of
racial desegregation of any school or school system.
SEC. 302. None of the funds contained in this Act shall be used to
require, directly or indirectly, the transportation of any student to a school
other than the school which is nearest the student's home, except for a
student requiring special education, to the school offering such special
education, in order to comply with title VI of the Civil Rights Act of 1964.
For the purpose of this section an indirect requirement of transportation of
students includes the transportation of students to carry out a plan involving
the reorganization of the grade structure of schools, the pairing of schools,
or the clustering of schools, or any combination of grade restructuring,
pairing or clustering. The prohibition described in this section does not
include the establishment of magnet schools.
SEC. 303. No funds appropriated under this Act may be used to prevent
the implementation of programs of voluntary prayer and meditation in the
public schools.
(TRANSFER OF FUNDS)
SEC. 304. Not to exceed 1 percent of any discretionary funds (pursuant
to the Balanced Budget and Emergency Deficit Control Act of 1985, as amended)
which are appropriated for the Department of Education in this Act may be
transferred between appropriations, but no such appropriation shall be
increased by more than 3 percent by any such transfer: Provided, That
the Appropriations Committees of both Houses of Congress are notified at least
15 days in advance of any transfer.
SEC. 305. IMPACT AID. Notwithstanding any other provision of this
Act--
(1) the total amount appropriated under this title to carry out
title VIII of the Elementary and Secondary Education Act of 1965 shall be
$1,075,000,000;
(2) the total amount appropriated under this title for basic support
payments under section 8003(b) of the Elementary and Secondary Education Act
of 1965 shall be $853,000,000; and
(3) amounts made available for the administrative and related
expenses of the Department of Labor, Health and Human Services, and
Education, shall be further reduced on a pro rata basis by
$35,000,000.
Sec. 306. (a) In addition to any amounts appropriated under this title
for the loan forgiveness for child care providers program under section 428K
of the Higher Education Act of 1965 (20 U.S.C. 1078-11), an additional
$10,000,000 is appropriated to carry out such program.
(b) Notwithstanding any other provision of this Act, amounts made
available under titles I and II, and this title, for salaries and expenses at
the Departments of Labor, Health and Human Services, and Education,
respectively, shall be reduced on a pro rata basis by $10,000,000.
Sec. 307. Technology and Media Services. Notwithstanding any other
provision of this Act--
(1) the total amount appropriated under this title under the heading
`OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES' under the heading
`SPECIAL EDUCATION' to carry out the Individuals with Disabilities Education
Act shall be $7,353,141,000, of which $35,323,000 shall be available for
technology and media services; and
(2) the total amount appropriated under this title under the heading
`DEPARTMENTAL MANAGEMENT' under the heading `PROGRAM ADMINISTRATION' shall
be further reduced by $800,000.
SEC. 308. (a) In addition to any amounts appropriated under this title
for the Perkin's loan cancellation program under section 465 of the Higher
Education Act of 1965 (20 U.S.C. 1087ee), an additional $15,000,000 is
appropriated to carry out such program.
(b) Notwithstanding any other provision of this Act, amounts made
available under titles I and II, and this title, for salaries and expenses at
the Departments of Labor, Health and Human Services, and Education,
respectively, shall be further reduced on a pro rata basis by
$15,000,000.
Sec. 309. The Comptroller General of the United States shall evaluate
the extent to which funds made available under part A of title I of the
Elementary and Secondary Education Act of 1965 are allocated to schools and
local educational agencies with the greatest concentrations of school-age
children from low-income families, the extent to which allocations of such
funds adjust to shifts in concentrations of pupils from low-income families in
different regions, States, and substate areas, the extent to which the
allocation of such funds encourages the targeting of State funds to areas with
higher concentrations of children from low-income families, the implications
of current distribution methods for such funds, and formula and other policy
recommendations to improve the targeting of such funds to more effectively
serve low-income children in both rural and urban areas, and for preparing
interim and final reports based on the results of the study, to be submitted
to Congress not later than February 1, 2001, and April 1, 2001.
Sec. 310. The amount made available under this title under the heading
`OFFICE OF POSTSECONDARY EDUCATION' under the heading `HIGHER EDUCATION' to
carry out section 316 of the Higher Education Act of 1965 is increased by
$5,000,000, which increase shall be used for construction and renovation
projects under such section; and the amount made available under this title
under the heading `OFFICE OF POSTSECONDARY EDUCATION' under the heading
`HIGHER EDUCATION' to carry out part B of title VII of the Higher Education
Act of 1965 is decreased by $5,000,000.
TITLE IV--RELATED AGENCIES
Armed Forces Retirement Home
ARMED FORCES RETIREMENT HOME
For expenses necessary for the Armed Forces Retirement Home to operate
and maintain the United States Soldiers' and Airmen's Home and the United
States Naval Home, to be paid from funds available in the Armed Forces
Retirement Home Trust Fund, $69,832,000, of which $9,832,000 shall remain
available until expended for construction and renovation of the physical
plants at the United States Soldiers' and Airmen's Home and the United States
Naval Home: Provided, That, notwithstanding any other provision of
law, a single contract or related contracts for development and construction,
to include construction of a long-term care facility at the United States
Naval Home, may be employed which collectively include the full scope of the
project: Provided further, That the solicitation and contract shall
contain the clause `availability of funds' found at 48 CFR 52.232-18 and
252.232-7007, Limitation of Government Obligations. In addition, for
completion of the long-term care facility at the United States Naval Home,
$6,228,000 to become available on October 1, 2001, and remain available until
expended.
Corporation for National and Community Service
DOMESTIC VOLUNTEER SERVICE PROGRAMS, OPERATING EXPENSES
For expenses necessary for the Corporation for National and Community
Service to carry out the provisions of the Domestic Volunteer Service Act of
1973, as amended, $302,504,000: Provided, That none of the funds made
available to the Corporation for National and Community Service in this Act
for activities authorized by part E of title II of the Domestic Volunteer
Service Act of 1973 shall be used to provide stipends or other monetary
incentives to volunteers or volunteer leaders whose incomes exceed 125 percent
of the national poverty level.
Corporation for Public Broadcasting
For payment to the Corporation for Public Broadcasting, as authorized
by the Communications Act of 1934, an amount which shall be available within
limitations specified by that Act, for the fiscal year 2003, $365,000,000:
Provided, That no funds made available to the Corporation for Public
Broadcasting by this Act shall be used to pay for receptions, parties, or
similar forms of entertainment for Government officials or employees:
Provided further, That none of the funds contained in this paragraph
shall be available or used to aid or support any program or activity from
which any person is excluded, or is denied benefits, or is discriminated
against, on the basis of race, color, national origin, religion, or sex:
Provided further, That in addition to the amounts provided above,
$20,000,000, to remain available until expended, shall be for digitalization,
pending enactment of authorizing legislation.
Federal Mediation and Conciliation Service
SALARIES AND EXPENSES
For expenses necessary for the Federal Mediation and Conciliation
Service to carry out the functions vested in it by the Labor Management
Relations Act, 1947 (29 U.S.C. 171-180, 182-183), including hire of passenger
motor vehicles; for expenses necessary for the Labor-Management Cooperation
Act of 1978 (29 U.S.C. 175a); and for expenses necessary for the Service to
carry out the functions vested in it by the Civil Service Reform Act, Public
Law 95-454 (5 U.S.C. ch. 71), $38,200,000, including $1,500,000, to remain
available through September 30, 2002, for activities authorized by the
Labor-Management Cooperation Act of 1978 (29 U.S.C. 175a): Provided,
That notwithstanding 31 U.S.C. 3302, fees charged, up to full-cost recovery,
for special training activities and other conflict resolution services and
technical assistance, including those provided to foreign governments and
international organizations, and for arbitration services shall be credited to
and merged with this account, and shall remain available until expended:
Provided further, That fees for arbitration services shall be
available only for education, training, and professional development of the
agency workforce: Provided further, That the Director of the Service
is authorized to accept and use on behalf of the United States gifts of
services and real, personal, or other property in the aid of any projects or
functions within the Director's jurisdiction.
Federal Mine Safety and Health Review Commission
SALARIES AND EXPENSES
For expenses necessary for the Federal Mine Safety and Health Review
Commission (30 U.S.C. 801 et seq.), $6,320,000.
Institute of Museum and Library Services
OFFICE OF LIBRARY SERVICES: GRANTS AND ADMINISTRATION
For carrying out subtitle B of the Museum and Library Services Act,
$168,000,000, to remain available until expended.
Medicare Payment Advisory Commission
SALARIES AND EXPENSES
For expenses necessary to carry out section 1805 of the Social
Security Act, $8,000,000, to be transferred to this appropriation from the
Federal Hospital Insurance and the Federal Supplementary Medical Insurance
Trust Funds.
National Commission on Libraries and Information Science
SALARIES AND EXPENSES
For necessary expenses for the National Commission on Libraries and
Information Science, established by the Act of July 20, 1970 (Public Law
91-345, as amended), $1,495,000.
National Council on Disability
SALARIES AND EXPENSES
For expenses necessary for the National Council on Disability as
authorized by title IV of the Rehabilitation Act of 1973, as amended,
$2,615,000.
National Education Goals Panel
For expenses necessary for the National Education Goals Panel, as
authorized by title II, part A of the Goals 2000: Educate America Act,
$2,350,000.
National Labor Relations Board
SALARIES AND EXPENSES
For expenses necessary for the National Labor Relations Board to carry
out the functions vested in it by the Labor-Management Relations Act, 1947, as
amended (29 U.S.C. 141-167), and other laws, $216,438,000: Provided,
That no part of this appropriation shall be available to organize or assist in
organizing agricultural laborers or used in connection with investigations,
hearings, directives, or orders concerning bargaining units composed of
agricultural laborers as referred to in section 2(3) of the Act of July 5,
1935 (29 U.S.C. 152), and as amended by the Labor-Management Relations Act,
1947, as amended, and as defined in section 3(f) of the Act of June 25, 1938
(29 U.S.C. 203), and including in said definition employees engaged in the
maintenance and operation of ditches, canals, reservoirs, and waterways when
maintained or operated on a mutual, nonprofit basis and at least 95 percent of
the water stored or supplied thereby is used for farming purposes.
National Mediation Board
SALARIES AND EXPENSES
For expenses necessary to carry out the provisions of the Railway
Labor Act, as amended (45 U.S.C. 151-188), including emergency boards
appointed by the President, $10,400,000.
Occupational Safety and Health Review Commission
SALARIES AND EXPENSES
For expenses necessary for the Occupational Safety and Health Review
Commission (29 U.S.C. 661), $8,720,000.
Railroad Retirement Board
DUAL BENEFITS PAYMENTS ACCOUNT
For payment to the Dual Benefits Payments Account, authorized under
section 15(d) of the Railroad Retirement Act of 1974, $160,000,000, which
shall include amounts becoming available in fiscal year 2001 pursuant to
section 224(c)(1)(B) of Public Law 98-76; and in addition, an amount, not to
exceed 2 percent of the amount provided herein, shall be available
proportional to the amount by which the product of recipients and the average
benefit received exceeds $160,000,000: Provided, That the total
amount provided herein shall be credited in 12 approximately equal amounts on
the first day of each month in the fiscal year.
FEDERAL PAYMENTS TO THE RAILROAD RETIREMENT ACCOUNTS
For payment to the accounts established in the Treasury for the
payment of benefits under the Railroad Retirement Act for interest earned on
unnegotiated checks, $150,000, to remain available through September 30, 2002,
which shall be the maximum amount available for payment pursuant to section
417 of Public Law 98-76.
LIMITATION ON ADMINISTRATION
For necessary expenses for the Railroad Retirement Board for
administration of the Railroad Retirement Act and the Railroad Unemployment
Insurance Act, $92,500,000, to be derived in such amounts as determined by the
Board from the railroad retirement accounts and from moneys credited to the
railroad unemployment insurance administration fund.
LIMITATION ON THE OFFICE OF INSPECTOR GENERAL
For expenses necessary for the Office of Inspector General for audit,
investigatory and review activities, as authorized by the Inspector General
Act of 1978, as amended, not more than $5,700,000, to be derived from the
railroad retirement accounts and railroad unemployment insurance account:
Provided, That none of the funds made available in any other
paragraph of this Act may be transferred to the Office; used to carry out any
such transfer; used to provide any office space, equipment, office supplies,
communications facilities or services, maintenance services, or administrative
services for the Office; used to pay any salary, benefit, or award for any
personnel of the Office; used to pay any other operating expense of the
Office; or used to reimburse the Office for any service provided, or expense
incurred, by the Office.
Social Security Administration
PAYMENTS TO SOCIAL SECURITY TRUST FUNDS
For payment to the Federal Old-Age and Survivors Insurance and the
Federal Disability Insurance trust funds, as provided under sections 201(m),
228(g), and 1131(b)(2) of the Social Security Act, $20,400,000.
SPECIAL BENEFITS FOR DISABLED COAL MINERS
For carrying out title IV of the Federal Mine Safety and Health Act of
1977, $365,748,000, to remain available until expended.
For making, after July 31 of the current fiscal year, benefit payments
to individuals under title IV of the Federal Mine Safety and Health Act of
1977, for costs incurred in the current fiscal year, such amounts as may be
necessary.
For making benefit payments under title IV of the Federal Mine Safety
and Health Act of 1977 for the first quarter of fiscal year 2002,
$114,000,000, to remain available until expended.
SUPPLEMENTAL SECURITY INCOME PROGRAM
For carrying out titles XI and XVI of the Social Security Act, section
401 of Public Law 92-603, section 212 of Public Law 93-66, as amended, and
section 405 of Public Law 95-216, including payment to the Social Security
trust funds for administrative expenses incurred pursuant to section 201(g)(1)
of the Social Security Act, $23,053,000,000, to remain available until
expended: Provided, That any portion of the funds provided to a State
in the current fiscal year and not obligated by the State during that year
shall be returned to the Treasury.
From funds provided under the previous paragraph, not less than
$100,000,000 shall be available for payment to the Social Security trust funds
for administrative expenses for conducting continuing disability
reviews.
In addition, $210,000,000, to remain available until September 30,
2002, for payment to the Social Security trust funds for administrative
expenses for continuing disability reviews as authorized by section 103 of
Public Law 104-121 and section 10203 of Public Law 105-33. The term
`continuing disability reviews' means reviews and redeterminations as defined
under section 201(g)(1)(A) of the Social Security Act, as amended.
For making, after June 15 of the current fiscal year, benefit payments
to individuals under title XVI of the Social Security Act, for unanticipated
costs incurred for the current fiscal year, such sums as may be
necessary.
For making benefit payments under title XVI of the Social Security Act
for the first quarter of fiscal year 2002, $10,470,000,000, to remain
available until expended.
LIMITATION ON ADMINISTRATIVE EXPENSES
For necessary expenses, including the hire of two passenger motor
vehicles, and not to exceed $10,000 for official reception and representation
expenses, not more than $6,469,800,000 may be expended, as authorized by
section 201(g)(1) of the Social Security Act, from any one or all of the trust
funds referred to therein: Provided, That not less than $1,800,000
shall be for the Social Security Advisory Board: Provided further,
That unobligated balances at the end of fiscal year 2001 not needed for fiscal
year 2001 shall remain available until expended to invest in the Social
Security Administration information technology and telecommunications hardware
and software infrastructure, including related equipment and non-payroll
administrative expenses
From funds provided under the first paragraph, not less than
$200,000,000 shall be available for conducting continuing disability
reviews.
In addition to funding already available under this heading, and
subject to the same terms and conditions, $450,000,000, to remain available
until September 30, 2002, for continuing disability reviews as authorized by
section 103 of Public Law 104-121 and section 10203 of Public Law 105-33. The
term `continuing disability reviews' means reviews and redeterminations as
defined under section 201(g)(1)(A) of the Social Security Act, as
amended.
In addition, $91,000,000 to be derived from administration fees in
excess of $5.00 per supplementary payment collected pursuant to section
1616(d) of the Social Security Act or section 212(b)(3) of Public Law 93-66,
which shall remain available until expended. To the extent that the amounts
collected pursuant to such section 1616(d) or 212(b)(3) in fiscal year 2001
exceed $91,000,000, the amounts shall be available in fiscal year 2002 only to
the extent provided in advance in appropriations Acts.
From funds previously appropriated for this purpose, any unobligated
balances at the end of fiscal year 2000 shall be available to continue
Federal-State partnerships which will evaluate means to promote Medicare
buy-in programs targeted to elderly and disabled individuals under titles
XVIII and XIX of the Social Security Act.
OFFICE OF INSPECTOR GENERAL
(INCLUDING TRANSFER OF FUNDS)
For expenses necessary for the Office of Inspector General in carrying
out the provisions of the Inspector General Act of 1978, as amended,
$16,944,000, together with not to exceed $52,500,000, to be transferred and
expended as authorized by section 201(g)(1) of the Social Security Act from
the Federal Old-Age and Survivors Insurance Trust Fund and the Federal
Disability Insurance Trust Fund.
In addition, an amount not to exceed 3 percent of the total provided
in this appropriation may be transferred from the `Limitation on
Administrative Expenses', Social Security Administration, to be merged with
this account, to be available for the time and purposes for which this account
is available: Provided, That notice of such transfers shall be
transmitted promptly to the Committees on Appropriations of the House and
Senate.
United States Institute of Peace
OPERATING EXPENSES
For necessary expenses of the United States Institute of Peace as
authorized in the United States Institute of Peace Act, $12,951,000.
TITLE V--GENERAL PROVISIONS
SEC. 501. The Secretaries of Labor, Health and Human Services, and
Education are authorized to transfer unexpended balances of prior
appropriations to accounts corresponding to current appropriations provided in
this Act: Provided, That such transferred balances are used for the
same purpose, and for the same periods of time, for which they were originally
appropriated.
SEC. 502. No part of any appropriation contained in this Act shall
remain available for obligation beyond the current fiscal year unless
expressly so provided herein.
SEC. 503. (a) No part of any appropriation contained in this Act shall
be used, other than for normal and recognized executive-legislative
relationships, for publicity or propaganda purposes, for the preparation,
distribution, or use of any kit, pamphlet, booklet, publication, radio,
television, or video presentation designed to support or defeat legislation
pending before the Congress or any State legislature, except in presentation
to the Congress or any State legislature itself.
(b) No part of any appropriation contained in this Act shall be used
to pay the salary or expenses of any grant or contract recipient, or agent
acting for such recipient, related to any activity designed to influence
legislation or appropriations pending before the Congress or any State
legislature.
SEC. 504. The Secretaries of Labor and Education are authorized to
make available not to exceed $20,000 and $15,000, respectively, from funds
available for salaries and expenses under titles I and III, respectively, for
official reception and representation expenses; the Director of the Federal
Mediation and Conciliation Service is authorized to make available for
official reception and representation expenses not to exceed $2,500 from the
funds available for `Salaries and expenses, Federal Mediation and Conciliation
Service'; and the Chairman of the National Mediation Board is authorized to
make available for official reception and representation expenses not to
exceed $2,500 from funds available for `Salaries and expenses, National
Mediation Board'.
SEC. 505. Notwithstanding any other provision of this Act, no funds
appropriated under this Act shall be used to carry out any program of
distributing sterile needles or syringes for the hypodermic injection of any
illegal drug unless the Secretary of Health and Human Services determines that
such programs are effective in preventing the spread of HIV and do not
encourage the use of illegal drugs.
SEC. 506. (a) PURCHASE OF AMERICAN-MADE EQUIPMENT AND PRODUCTS- It is
the sense of the Congress that, to the greatest extent practicable, all
equipment and products purchased with funds made available in this Act should
be American-made.
(b) NOTICE REQUIREMENT- In providing financial assistance to, or
entering into any contract with, any entity using funds made available in this
Act, the head of each Federal agency, to the greatest extent practicable,
shall provide to such entity a notice describing the statement made in
subsection (a) by the Congress.
(c) PROHIBITION OF CONTRACTS WITH PERSONS FALSELY LABELING PRODUCTS AS
MADE IN AMERICA- If it has been finally determined by a court or Federal
agency that any person intentionally affixed a label bearing a `Made in
America' inscription, or any inscription with the same meaning, to any product
sold in or shipped to the United States that is not made in the United States,
the person shall be ineligible to receive any contract or subcontract made
with funds made available in this Act, pursuant to the debarment, suspension,
and ineligibility procedures described in sections 9.400 through 9.409 of
title 48, Code of Federal Regulations.
SEC. 507. When issuing statements, press releases, requests for
proposals, bid solicitations and other documents describing projects or
programs funded in whole or in part with Federal money, all grantees receiving
Federal funds included in this Act, including but not limited to State and
local governments and recipients of Federal research grants, shall clearly
state: (1) the percentage of the total costs of the program or project which
will be financed with Federal money; (2) the dollar amount of Federal funds
for the project or program; and (3) percentage and dollar amount of the total
costs of the project or program that will be financed by non-governmental
sources.
SEC. 508. (a) None of the funds appropriated under this Act, and none
of the funds in any trust fund to which funds are appropriated under this Act,
shall be expended for any abortion.
(b) None of the funds appropriated under this Act, and none of the
funds in any trust fund to which funds are appropriated under this Act, shall
be expended for health benefits coverage that includes coverage of
abortion.
(c) The term `health benefits coverage' means the package of services
covered by a managed care provider or organization pursuant to a contract or
other arrangement.
SEC. 509. (a) The limitations established in the preceding section
shall not apply to an abortion--
(1) if the pregnancy is the result of an act of rape or incest;
or
(2) in the case where a woman suffers from a physical disorder,
physical injury, or physical illness, including a life-endangering physical
condition caused by or arising from the pregnancy itself, that would, as
certified by a physician, place the woman in danger of death unless an
abortion is performed.
(b) Nothing in the preceding section shall be construed as prohibiting
the expenditure by a State, locality, entity, or private person of State,
local, or private funds (other than a State's or locality's contribution of
Medicaid matching funds).
(c) Nothing in the preceding section shall be construed as restricting
the ability of any managed care provider from offering abortion coverage or
the ability of a State or locality to contract separately with such a provider
for such coverage with State funds (other than a State's or locality's
contribution of Medicaid matching funds).
SEC. 510. (a) None of the funds made available in this Act may be used
for--
(1) the creation of a human embryo or embryos for research purposes;
or
(2) research in which a human embryo or embryos are destroyed,
discarded, or knowingly subjected to risk of injury or death greater than
that allowed for research on fetuses in utero under 45 CFR 46.208(a)(2) and
section 498(b) of the Public Health Service Act (42 U.S.C.
289g(b)).
(b) For purposes of this section, the term `human embryo or embryos'
includes any organism, not protected as a human subject under 45 CFR 46 as of
the date of the enactment of this Act, that is derived by fertilization,
parthenogenesis, cloning, or any other means from one or more human gametes or
human diploid cells.
SEC. 511. (a) LIMITATION ON USE OF FUNDS FOR PROMOTION OF LEGALIZATION
OF CONTROLLED SUBSTANCES- None of the funds made available in this Act may be
used for any activity that promotes the legalization of any drug or other
substance included in schedule I of the schedules of controlled substances
established by section 202 of the Controlled Substances Act (21 U.S.C.
812).
(b) EXCEPTIONS- The limitation in subsection (a) shall not apply when
there is significant medical evidence of a therapeutic advantage to the use of
such drug or other substance or that federally sponsored clinical trials are
being conducted to determine therapeutic advantage.
SEC. 512. None of the funds made available in this Act may be
obligated or expended to enter into or renew a contract with an entity
if--
(1) such entity is otherwise a contractor with the United States and
is subject to the requirement in section 4212(d) of title 38, United States
Code, regarding submission of an annual report to the Secretary of Labor
concerning employment of certain veterans; and
(2) such entity has not submitted a report as required by that
section for the most recent year for which such requirement was applicable
to such entity.
SEC. 513. Except as otherwise specifically provided by law,
unobligated balances remaining available at the end of fiscal year 2000 from
appropriations made available for salaries and expenses for fiscal year 2000
in this Act, shall remain available through December 31, 2001, for each such
account for the purposes authorized: Provided, That the House and
Senate Committees on Appropriations shall be notified at least 15 days prior
to the obligation of such funds.
SEC. 514. None of the funds made available in this Act may be used to
promulgate or adopt any final standard under section 1173(b) of the Social
Security Act (42 U.S.C. 1320d-2(b)) providing for, or providing for the
assignment of, a unique health identifier for an individual (except in an
individual's capacity as an employer or a health care provider), until
legislation is enacted specifically approving the standard.
SEC. 515. Section 410(b) of The Ticket to Work and Work Incentives
Improvement Act of 1999 (Public Law 106-170) is amended by striking `2009'
both places it appears and inserting `2001'.
SEC. 516. Amounts made available under this Act for the administrative
and related expenses for departmental management for the Department of Labor,
the Department of Health and Human Services, and the Department of Education
shall be reduced on pro rata basis by $50,000,000.
SEC. 517. (a) None of the funds appropriated under this Act to carry
out section 330 or title X of the Public Health Service Act (42 U.S.C. 254b,
300 et seq.), title V or XIX of the Social Security Act (42 U.S.C. 701 et
seq., 1396 et seq.), or any other provision of law, shall be used for the
distribution or provision of postcoital emergency contraception, or the
provision of a prescription for postcoital emergency contraception, to an
unemancipated minor, on the premises or in the facilities of any elementary
school or secondary school.
(b) This section takes effect 1 day after the date of enactment of
this Act.
(1) The terms `elementary school' and `secondary school' have the
meanings given the terms in section 14101 of the Elementary and Secondary
Education Act of 1965 (20 U.S.C. 8801).
(2) The term `unemancipated minor' means an unmarried individual who
is 17 years of age or younger and is a dependent, as defined in section
152(a) of the Internal Revenue Code of 1986.
SEC. 518. Title V of the Public Health Service Act (42 U.S.C. 290aa et
seq.) is amended by adding at the end the following:
`PART G--REQUIREMENT RELATING TO THE RIGHTS OF RESIDENTS OF CERTAIN
FACILITIES
`SEC. 581. REQUIREMENT RELATING TO THE RIGHTS OF RESIDENTS OF CERTAIN
FACILITIES.
`(a) IN GENERAL- A public or private general hospital, nursing
facility, intermediate care facility, residential treatment center, or other
health care facility, that receives support in any form from any program
supported in whole or in part with funds appropriated to any Federal
department or agency shall protect and promote the rights of each resident of
the facility, including the right to be free from physical or mental abuse,
corporal punishment, and any restraints or involuntary seclusions imposed for
purposes of discipline or convenience.
`(b) REQUIREMENTS- Restraints and seclusion may only be imposed on a
resident of a facility described in subsection (a) if--
`(1) the restraints or seclusion are imposed to ensure the physical
safety of the resident, a staff member, or others; and
`(2) the restraints or seclusion are imposed only upon the written
order of a physician, or other licensed independent practitioner permitted
by the State and the facility to order such restraint or seclusion, that
specifies the duration and circumstances under which the restraints are to
be used (except in emergency circumstances specified by the Secretary until
such an order could reasonably be obtained).
`(c) DEFINITIONS- In this section:
`(1) RESTRAINTS- The term `restraints' means--
`(A) any physical restraint that is a mechanical or personal
restriction that immobilizes or reduces the ability of an individual to
move his or her arms, legs, or head freely, not including devices, such as
orthopedically prescribed devices, surgical dressings or bandages,
protective helmets, or any other methods that involves the physical
holding of a resident for the purpose of conducting routine physical
examinations or tests or to protect the resident from falling out of bed
or to permit the resident to participate in activities without the risk of
physical harm to the resident; and
`(B) a drug or medication that is used as a restraint to control
behavior or restrict the resident's freedom of movement that is not a
standard treatment for the resident's medical or psychiatric
condition.
`(2) SECLUSION- The term `seclusion' means any separation of the
resident from the general population of the facility that prevents the
resident from returning to such population if he or she desires.
`SEC. 582. REPORTING REQUIREMENT.
`(a) IN GENERAL- Each facility to which the Protection and Advocacy
for Mentally Ill Individuals Act of 1986 applies shall notify the appropriate
agency, as determined by the Secretary, of each death that occurs at each such
facility while a patient is restrained or in seclusion, of each death
occurring within 24 hours after the patient has been removed from restraints
and seclusion, or where it is reasonable to assume that a patient's death is a
result of such seclusion or restraint. A notification under this section shall
include the name of the resident and shall be provided not later than 7 days
after the date of the death of the individual involved.
`(b) FACILITY- In this section, the term `facility' has the meaning
given the term `facilities' in section 102(3) of the Protection and Advocacy
for Mentally Ill Individuals Act of 1986 (42 U.S.C. 10802(3)).'.
`SEC. 583. REGULATIONS AND ENFORCEMENT.
`(a) TRAINING- Not later than 1 year after the date of enactment of
this part, the Secretary, after consultation with appropriate State and local
protection and advocacy organizations, physicians, facilities, and other
health care professionals and patients, shall promulgate regulations that
require facilities to which the Protection and Advocacy for Mentally Ill
Individuals Act of 1986 (42 U.S.C. 10801 et seq.) applies, to meet the
requirements of subsection (b).
`(b) REQUIREMENTS- The regulations promulgated under subsection (a)
shall require that--
`(1) facilities described in subsection (a) ensure that there is an
adequate number of qualified professional and supportive staff to evaluate
patients, formulate written individualized, comprehensive treatment plans,
and to provide active treatment measures;
`(2) appropriate training be provided for the staff of such
facilities in the use of restraints and any alternatives to the use of
restraints; and
`(3) such facilities provide complete and accurate notification of
deaths, as required under section 582(a).
`(c) ENFORCEMENT- A facility to which this part applies that fails to
comply with any requirement of this part, including a failure to provide
appropriate training, shall not be eligible for participation in any program
supported in whole or in part by funds appropriated to any Federal department
or agency.'.
SEC. 519. It is the sense of the Senate that each entity carrying out
an Early Head Start program under the Head Start Act should--
(1) determine whether a child eligible to participate in the Early
Head Start program has received a blood lead screening test, using a test
that is appropriate for age and risk factors, upon the enrollment of the
child in the program; and
(2) in the case of an child who has not received such a blood lead
screening test, ensure that each enrolled child receives such a test either
by referral or by performing the test (under contract or
otherwise).
Sec. 520. (a) Whereas sexual abuse in schools between a student and a
member of the school staff or a student and another student is a cause for
concern in America;
(b) Whereas relatively few studies have been conducted on sexual abuse
in schools and the extent of this problem is unknown;
(c) Whereas according to the Child Abuse and Neglect Reporting Act, a
school administrator is required to report any allegation of sexual abuse to
the appropriate authorities;
(d) Whereas an individual who is falsely accused of sexual misconduct
with a student deserves appropriate legal and professional
protections;
(e) Whereas it is estimated that many cases of sexual abuse in schools
are not reported;
(f) Whereas many of the accused staff quietly resign at their present
school district and are then rehired at a new district which has no knowledge
of their alleged abuse;
(g) Therefore, it is the Sense of the Senate that the Secretary of
Education should initiate a study and make recommendations to Congress and
State and local governments on the issue of sexual abuse in schools.
TITLE VI--CHILDREN'S INTERNET PROTECTION
SEC. 601. SHORT TITLE. This title may be cited as the `Childrens'
Internet Protection Act'.
SEC. 602. REQUIREMENT FOR SCHOOLS AND LIBRARIES TO IMPLEMENT FILTERING
OR BLOCKING TECHNOLOGY FOR COMPUTERS WITH INTERNET ACCESS AS CONDITION OF
UNIVERSAL SERVICE DISCOUNTS. (a) SCHOOLS- Section 254(h) of the Communications
Act of 1934 (47 U.S.C. 254(h)) is amended--
(1) by redesignating paragraph (5) as paragraph (7); and
(2) by inserting after paragraph (4) the following new paragraph
(5):
`(5) REQUIREMENTS FOR CERTAIN SCHOOLS WITH COMPUTERS HAVING INTERNET
ACCESS-
`(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.
`(i) FAILURE TO SUBMIT CERTIFICATION- Any school that knowingly
fails to submit a certification required by this paragraph shall
reimburse each telecommunications carrier that provided such school
services at discount rates under paragraph (1)(B) after the effective
date of this paragraph under section 602(h) of the Childrens' Internet
Protection Act in an amount equal to the amount of the discount provided
such school by such carrier for such services during the period
beginning on such effective date and ending on the date on which the
provision of such services at discount rates under paragraph (1)(B) is
determined to cease under subparagraph (F).
`(ii) FAILURE TO COMPLY WITH CERTIFICATION- Any school that
knowingly fails to ensure the use of its computers in accordance with a
certification under subparagraph (B) shall reimburse each
telecommunications carrier that provided such school services at
discount rates under paragraph (1)(B) after the date of such
certification in an amount equal to the amount of the discount provided
such school by such carrier for such services during the period
beginning on the date of such certification and ending on the date on
which the provision of such services at discount rates under paragraph
(1)(B) is determined to cease under subparagraph (F).
`(iii) TREATMENT OF REIMBURSEMENT- The receipt by a
telecommunications carrier of any reimbursement under this subparagraph
shall not affect the carrier's treatment of the discount on which such
reimbursement was based in accordance with the third sentence of
paragraph (1)(B).
`(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-
`(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.
`(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.
`(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).
`(i) DETERMINATION- The Commission shall determine the date on
which the provision of services at discount rates under paragraph (1)(B)
shall cease under this paragraph by reason of the failure of a library
to comply with the requirements of this paragraph.
`(ii) NOTIFICATION- The Commission shall notify
telecommunications carriers of each library determined to have failed to
comply with the requirements of this paragraph and of the period for
which such library shall be liable to make reimbursement under
subparagraph (E).
`(G) RECOMMENCEMENT OF DISCOUNTS-
`(i) RECOMMENCEMENT- Upon submittal to the Commission of a
certification under subparagraph (B) with respect to a library to which
clause (i) or (ii) of subparagraph (E) applies, the library shall be
entitled to services at discount rates under paragraph
(1)(B).
`(ii) NOTIFICATION- The Commission shall notify the library and
telecommunications carriers of the recommencement of the library's
entitlement to services at discount rates under this paragraph and of
the date on which such recommencement begins.
`(iii) ADDITIONAL NONCOMPLIANCE- The provisions of subparagraphs
(E) and (F) shall apply to any certification submitted under clause
(i).
`(H) PUBLIC AVAILABILITY OF POLICY- A library that enforces a
policy under clause (i)(II) or (ii)(I)(bb) of subparagraph (B) shall take
appropriate actions to ensure the ready availability to the public of
information on such policy and on its policy, if any, relating to the use
of technology under subparagraph (C).
`(I) LIMITATION ON FEDERAL ACTION-
`(i) IN GENERAL- No agency or instrumentality of the United
States Government may--
`(I) establish any criteria for making a determination under
subparagraph (C);
`(II) review a determination made by a library for purposes of
a certification under subparagraph (B); or
`(III) consider the criteria employed by a library purposes of
determining the eligibility of the library for services at discount
rates under paragraph (1)(B).
`(ii) ACTION BY COMMISSION- The Commission may not take any
action against a library for a violation of a provision of this
paragraph if the library has made a good faith effort to comply with
such provision.'.
(c) MINOR DEFINED- Paragraph (7) of such section, as redesignated by
subsection (a)(1) of this section, is amended by adding at the end the
following:
`(D) MINOR- The term `minor' means any individual who has not
attained the age of 17 years.'.
(d) CONFORMING AMENDMENT- Paragraph (4) of such section is amended by
striking `paragraph (5)(A)' and inserting `paragraph (7)(A)'.
(e) SEPARABILITY- If any provision of paragraph (5) or (6) of section
254(h) of the Communications Act of 1934, as amended by this section, or the
application thereof to any person or circumstance is held invalid, the
remainder of such paragraph and the application of such paragraph to other
persons or circumstances shall not be affected thereby.
(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--
`(i) selected a system for its computers with Internet access
that are dedicated to student use in order to filter or block Internet
access to matter considered to be inappropriate for minors;
and
`(ii) installed on such computers, or upon obtaining such
computers will install on such computers, a system to filter or block
Internet access to such matter; or
`(B)(i) has adopted and implemented an Internet use policy that
addresses--
`(I) access by minors to inappropriate matter on the Internet
and World Wide Web;
`(II) the safety and security of minors when using electronic
mail, chat rooms, and other forms of direct electronic
communications;
`(III) unauthorized access, including so-called `hacking', and
other unlawful activities by minors online;
`(IV) unauthorized disclosure, use, and dissemination of
personal identification information regarding minors;
and
`(V) whether the school or library, as the case may be, is
employing hardware, software, or other technological means to limit,
monitor, or otherwise control or guide Internet access by minors;
and
`(ii) provided reasonable public notice and held at least one
public hearing or meeting which addressed the proposed Internet use
policy.
`(3) LOCAL DETERMINATION OF CONTENT- For purposes of a certification
under paragraph (2), the determination regarding what matter is
inappropriate for minors shall be made by the school board, library, or
other authority responsible for making the determination. No agency or
instrumentality of the United States Government may--
`(A) establish criteria for making such
determination;
`(B) review the determination made by the certifying school,
school board, library, or other authority; or
`(C) consider the criteria employed by the certifying school,
school board, library, or other authority in the administration of
subsection (h)(1)(B).
`(4) EFFECTIVE DATE- This subsection shall apply with respect to
schools and libraries seeking universal service assistance under subsection
(h)(1)(B) on or after July 1, 2001.'.
(2) CONFORMING AMENDMENT- Subsection (h)(1)(B) of that section is
amended by striking `All telecommunications' and inserting `Except as
provided by subsection (l), all telecommunications'.
(b) STUDY- Not later than 150 days after the date of the enactment of
this Act, the National Telecommunications and Information Administration shall
initiate a notice and comment proceeding for purposes of--
(1) evaluating whether or not currently available commercial
Internet blocking, filtering, and monitoring software adequately addresses
the needs of educational institutions;
(2) making recommendations on how to foster the development of
products which meet such needs; and
(3) evaluating the development and effectiveness of local Internet
use policies that are currently in operation after community
input.
SEC. 703. IMPLEMENTING REGULATIONS. Not later than 100 days after the
date of the enactment of this Act, the Federal Communications Commission shall
adopt rules implementing this title and the amendments made by this
title.
TITLE VIII--SOCIAL SECURITY AND MEDICARE OFF-BUDGET LOCKBOX ACT OF
2000
SEC. 801. SHORT TITLE. This title may be cited as the `Social Security
and Medicare Off-Budget Lockbox Act of 2000'.
SEC. 802. STRENGTHENING SOCIAL SECURITY POINTS OF ORDER. (a) IN
GENERAL- Section 312 of the Congressional Budget Act of 1974 (2 U.S.C. 643) is
amended by inserting at the end the following:
`(g) STRENGTHENING SOCIAL SECURITY POINT OF ORDER- It shall not be in
order in the House of Representatives or the Senate to consider a concurrent
resolution on the budget (or any amendment thereto or conference report
thereon) or any bill, joint resolution, amendment, motion, or conference
report that would violate or amend section 13301 of the Budget Enforcement Act
of 1990.'.
(b) SUPER MAJORITY REQUIREMENT-
(1) POINT OF ORDER- Section 904(c)(1) of the Congressional Budget
Act of 1974 is amended by inserting `312(g),' after `310(d)(2),'.
(2) WAIVER- Section 904(d)(2) of the Congressional Budget Act of
1974 is amended by inserting `312(g),' after `310(d)(2),'.
(c) ENFORCEMENT IN EACH FISCAL YEAR- The Congressional Budget Act of
1974 is amended in--
(1) section 301(a)(7) (2 U.S.C. 632(a)(7)), by striking `for the
fiscal year' through the period and inserting `for each fiscal year covered
by the resolution'; and
(2) section 311(a)(3) (2 U.S.C. 642(a)(3)), by striking beginning
with `for the first fiscal year' through the period and insert the
following: `for any of the fiscal years covered by the concurrent
resolution.'.
Sec. 803. MEDICARE TRUST FUND OFF-BUDGET. (a) IN GENERAL-
(1) GENERAL EXCLUSION FROM ALL BUDGETS- Title III of the
Congressional Budget Act of 1974 is amended by adding at the end the
following:
`EXCLUSION OF MEDICARE TRUST FUND FROM ALL BUDGETS
`SEC. 316. (a) EXCLUSION OF MEDICARE TRUST FUND FROM ALL BUDGETS-
Notwithstanding any other provision of law, the receipts and disbursements of
the Federal Hospital Insurance Trust Fund shall not be counted as new budget
authority, outlays, receipts, or deficit or surplus for purposes of--
`(1) the budget of the United States Government as submitted by the
President;
`(2) the congressional budget; or
`(3) the Balanced Budget and Emergency Deficit Control Act of
1985.
`(b) STRENGTHENING MEDICARE POINT OF ORDER- It shall not be in order
in the House of Representatives or the Senate to consider a concurrent
resolution on the budget (or any amendment thereto or conference report
thereon) or any bill, joint resolution, amendment, motion, or conference
report that would violate or amend this section.'.
(2) SUPER MAJORITY REQUIREMENT-
(A) POINT OF ORDER- Section 904(c)(1) of the Congressional Budget
Act of 1974 is amended by inserting `316,' after `313,'.
(B) WAIVER- Section 904(d)(2) of the Congressional Budget Act of
1974 is amended by inserting `316,' after `313,'.
(b) EXCLUSION OF MEDICARE TRUST FUND FROM CONGRESSIONAL BUDGET-
Section 301(a) of the Congressional Budget Act of 1974 (2 U.S.C. 632(a)) is
amended by adding at the end the following: `The concurrent resolution shall
not include the outlays and revenue totals of the Federal Hospital Insurance
Trust Fund in the surplus or deficit totals required by this subsection or in
any other surplus or deficit totals required by this title.'
(c) BUDGET TOTALS- Section 301(a) of the Congressional Budget Act of
1974 (2 U.S.C. 632(a)) is amended by inserting after paragraph (7) the
following:
`(8) For purposes of Senate enforcement under this title, revenues
and outlays of the Federal Hospital Insurance Trust Fund for each fiscal
year covered by the budget resolution.'.
(d) BUDGET RESOLUTIONS- Section 301(i) of the Congressional Budget Act
of 1974 (2 U.S.C. 632(i)) is amended by--
(1) striking `SOCIAL SECURITY POINT OF ORDER- It shall' and
inserting `SOCIAL SECURITY AND MEDICARE POINTS OF ORDER-
`(1) SOCIAL SECURITY- It shall'; and
(2) inserting at the end the following:
`(2) MEDICARE- It shall not be in order in the House of
Representatives or the Senate to consider any concurrent resolution on the
budget (or amendment, motion, or conference report on the resolution) that
would decrease the excess of the Federal Hospital Insurance Trust Fund
revenues over Federal Hospital Insurance Trust Fund outlays in any of the
fiscal years covered by the concurrent resolution. This paragraph shall not
apply to amounts to be expended from the Hospital Insurance Trust Fund for
purposes relating to programs within part A of Medicare as provided in law
on the date of enactment of this paragraph.'.
(e) MEDICARE FIREWALL- Section 311(a) of the Congressional Budget Act
of 1974 (2 U.S.C. 642(a)) is amended by adding after paragraph (3), the
following:
`(4) ENFORCEMENT OF MEDICARE LEVELS IN THE SENATE- After a
concurrent resolution on the budget is agreed to, it shall not be in order
in the Senate to consider any bill, joint resolution, amendment, motion, or
conference report that would cause a decrease in surpluses or an increase in
deficits of the Federal Hospital Insurance Trust Fund in any year relative
to the levels set forth in the applicable resolution. This paragraph shall
not apply to amounts to be expended from the Hospital Insurance Trust Fund
for purposes relating to programs within part A of Medicare as provided in
law on the date of enactment of this paragraph.'.
(f) BASELINE TO EXCLUDE HOSPITAL INSURANCE TRUST FUND- Section
257(b)(3) of the Balanced Budget and Emergency Deficit Control Act of 1985 is
amended by striking `shall be included in all' and inserting `shall not be
included in any'.
(g) MEDICARE TRUST FUND EXEMPT FROM SEQUESTERS- Section 255(g)(1)(B)
of the Balanced Budget and Emergency Deficit Control Act of 1985 is amended by
adding at the end the following:
`Medicare as funded through the Federal Hospital Insurance Trust
Fund.'.
(h) BUDGETARY TREATMENT OF HOSPITAL INSURANCE TRUST FUND- Section
710(a) of the Social Security Act (42 U.S.C. 911(a)) is amended--
(1) by striking `and' the second place it appears and inserting a
comma; and
(2) by inserting after `Federal Disability Insurance Trust Fund' the
following: `, Federal Hospital Insurance Trust Fund'.
SEC. 804. PREVENTING ON-BUDGET DEFICITS. (a) POINTS OF ORDER TO
PREVENT ON-BUDGET DEFICITS- Section 312 of the Congressional Budget Act of
1974 (2 U.S.C. 643) is amended by adding at the end the following:
`(h) POINTS OF ORDER TO PREVENT ON-BUDGET DEFICITS-
`(1) CONCURRENT RESOLUTIONS ON THE BUDGET- It shall not be in order
in the House of Representatives or the Senate to consider any concurrent
resolution on the budget, or conference report thereon or amendment thereto,
that would cause or increase an on-budget deficit for any fiscal
year.
`(2) SUBSEQUENT LEGISLATION- Except as provided by paragraph (3), it
shall not be in order in the House of Representatives or the Senate to
consider any bill, joint resolution, amendment, motion, or conference report
if--
`(A) the enactment of that bill or resolution as
reported;
`(B) the adoption and enactment of that amendment;
or
`(C) the enactment of that bill or resolution in the form
recommended in that conference report,
would cause or increase an on-budget deficit for any fiscal
year.'.
(b) SUPER MAJORITY REQUIREMENT-
(1) POINT OF ORDER- Section 904(c)(1) of the Congressional Budget
Act of 1974 is amended by inserting `312(h),' after `312(g),'.
(2) WAIVER- Section 904(d)(2) of the Congressional Budget Act of
1974 is amended by inserting `312(h),' after `312(g),'.
Sec. 805. Social Security and Medicare Safe Deposit Box Act of 2000.
(a) SHORT TITLE- This section may be cited as the `Social Security and
Medicare Safe Deposit Box Act of 2000'.
(b) PROTECTION OF SOCIAL SECURITY AND MEDICARE SURPLUSES-
(1) MEDICARE SURPLUSES OFF-BUDGET- Notwithstanding any other
provision of law, the net surplus of any trust fund for part A of Medicare
shall not be counted as a net surplus for purposes of--
(A) the budget of the United States Government as submitted by the
President;
(B) the congressional budget; or
(C) the Balanced Budget and Emergency Deficit Control Act of
1985.
(2) POINTS OF ORDER TO PROTECT SOCIAL SECURITY AND MEDICARE
SURPLUSES- Section 312 of the Congressional Budget Act of 1974 is amended by
adding at the end the following new subsection:
`(g) POINTS OF ORDER TO PROTECT SOCIAL SECURITY AND MEDICARE
SURPLUSES-
`(1) CONCURRENT RESOLUTIONS ON THE BUDGET- It shall not be in order
in the House of Representatives or the Senate to consider any concurrent
resolution on the budget, or conference report thereon or amendment thereto,
that would set forth an on-budget deficit for any fiscal year.
`(2) SUBSEQUENT LEGISLATION- It shall not be in order in the House
of Representatives or the Senate to consider any bill, joint resolution,
amendment, motion, or conference report if--
`(A) the enactment of that bill or resolution as
reported;
`(B) the adoption and enactment of that amendment;
or
`(C) the enactment of that bill or resolution in the form
recommended in that conference report,
would cause or increase an on-budget deficit for any fiscal
year.
`(3) DEFINITION- For purposes of this section, the term `on-budget
deficit', when applied to a fiscal year, means the deficit in the budget as
set forth in the most recently agreed to concurrent resolution on the budget
pursuant to section 301(a)(3) for that fiscal year.'.
(3) SUPER MAJORITY REQUIREMENT-
(A) POINT OF ORDER- Section 904(c)(1) of the Congressional Budget
Act of 1974 is amended by inserting `312(g),' after
`310(d)(2),'.
(B) WAIVER- Section 904(d)(2) of the Congressional Budget Act of
1974 is amended by inserting `312(g),' after `310(d)(2),'.
(c) PROTECTION OF SOCIAL SECURITY AND MEDICARE SURPLUSES-
(1) IN GENERAL- Chapter 11 of subtitle II of title 31, United States
Code, is amended by adding before section 1101 the following:
`Sec. 1100. Protection of social security and medicare
surpluses
`The budget of the United States Government submitted by the President
under this chapter shall not recommend an on-budget deficit for any fiscal
year covered by that budget.'.
(2) CHAPTER ANALYSIS- The chapter analysis for chapter 11 of title
31, United States Code, is amended by inserting before the item for section
1101 the following:
`1100. Protection of social security and medicare
surpluses.'.
(d) EFFECTIVE DATE- This section shall take effect upon the date of
its enactment and the amendments made by this section shall apply to fiscal
year 2001 and subsequent fiscal years.
TITLE IX--GENETIC INFORMATION AND SERVICES
SEC. 901. SHORT TITLE. This title may be cited as the `Genetic
Information Nondiscrimination in Health Insurance Act of 2000'.
SEC. 902. AMENDMENTS TO EMPLOYEE RETIREMENT INCOME SECURITY ACT OF
1974. (a) PROHIBITION OF HEALTH DISCRIMINATION ON THE BASIS OF GENETIC
INFORMATION OR GENETIC SERVICES-
(1) NO ENROLLMENT RESTRICTION FOR GENETIC SERVICES- Section
702(a)(1)(F) of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1182(a)(1)(F)) is amended by inserting before the period the
following: `(including information about a request for or receipt of genetic
services)'.
(2) NO DISCRIMINATION IN GROUP PREMIUMS BASED ON PREDICTIVE GENETIC
INFORMATION- Subpart B of part 7 of subtitle B of title I of the Employee
Retirement Income Security Act of 1974 is amended by adding at the end the
following:
`SEC. 714. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE
BASIS OF PREDICTIVE GENETIC INFORMATION.
`A group health plan, or a health insurance issuer offering group
health insurance coverage in connection with a group health plan, shall not
adjust premium or contribution amounts for a group on the basis of predictive
genetic information concerning any individual (including a dependent) or
family member of the individual (including information about a request for or
receipt of genetic services).'.
(3) CONFORMING AMENDMENTS-
(A) IN GENERAL- Section 702(b) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1182(b)) is amended by adding at the end
the following:
`(3) REFERENCE TO RELATED PROVISION- For a provision prohibiting the
adjustment of premium or contribution amounts for a group under a group
health plan on the basis of predictive genetic information (including
information about a request for or receipt of genetic services), see section
714.'.
(B) TABLE OF CONTENTS- The table of contents in section 1 of the
Employee Retirement Income Security Act of 1974 is amended by inserting
after the item relating to section 713 the following new
item:
`Sec. 714. Prohibiting premium discrimination against groups on the
basis of predictive genetic information.'.
(b) LIMITATION ON COLLECTION OF PREDICTIVE GENETIC INFORMATION-
Section 702 of the Employee Retirement Income Security Act of 1974 (29 U.S.C.
1182) is amended by adding at the end the following:
`(c) COLLECTION OF PREDICTIVE GENETIC INFORMATION-
`(1) LIMITATION ON REQUESTING OR REQUIRING PREDICTIVE GENETIC
INFORMATION- Except as provided in paragraph (2), a group health plan, or a
health insurance issuer offering health insurance coverage in connection
with a group health plan, shall not request or require predictive genetic
information concerning any individual (including a dependent) or family
member of the individual (including information about a request for or
receipt of genetic services).
`(2) INFORMATION NEEDED FOR DIAGNOSIS, TREATMENT, OR PAYMENT-
`(A) IN GENERAL- Notwithstanding paragraph (1), a group health
plan, or a health insurance issuer offering health insurance coverage in
connection with a group health plan, that provides health care items and
services to an individual or dependent may request (but may not require)
that such individual or dependent disclose, or authorize the collection or
disclosure of, predictive genetic information for purposes of diagnosis,
treatment, or payment relating to the provision of health care items and
services to such individual or dependent.
`(B) NOTICE OF CONFIDENTIALITY PRACTICES AND DESCRIPTION OF
SAFEGUARDS- As a part of a request under subparagraph (A), the group
health plan, or a health insurance issuer offering health insurance
coverage in connection with a group health plan, shall provide to the
individual or dependent a description of the procedures in place to
safeguard the confidentiality, as described in subsection (d), of such
predictive genetic information.
`(d) CONFIDENTIALITY WITH RESPECT TO PREDICTIVE GENETIC INFORMATION-
`(1) NOTICE OF CONFIDENTIALITY PRACTICES-
`(A) PREPARATION OF WRITTEN NOTICE- A group health plan, or a
health insurance issuer offering health insurance coverage in connection
with a group health plan, shall post or provide, in writing and in a clear
and conspicuous manner, notice of the plan or issuer's confidentiality
practices, that shall include--
`(i) a description of an individual's rights with respect to
predictive genetic information;
`(ii) the procedures established by the plan or issuer for the
exercise of the individual's rights; and
`(iii) the right to obtain a copy of the notice of the
confidentiality practices required under this
subsection.
`(B) MODEL NOTICE- The Secretary, in consultation with the
National Committee on Vital and Health Statistics and the National
Association of Insurance Commissioners, and after notice and opportunity
for public comment, shall develop and disseminate model notices of
confidentiality practices. Use of the model notice shall serve as a
defense against claims of receiving inappropriate notice.
`(2) ESTABLISHMENT OF SAFEGUARDS- A group health plan, or a health
insurance issuer offering health insurance coverage in connection with a
group health plan, shall establish and maintain appropriate administrative,
technical, and physical safeguards to protect the confidentiality, security,
accuracy, and integrity of predictive genetic information created, received,
obtained, maintained, used, transmitted, or disposed of by such plan or
issuer.'.
(c) DEFINITIONS- Section 733(d) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1191b(d)) is amended by adding at the end the
following:
`(5) FAMILY MEMBER- The term `family member' means with respect to
an individual--
`(A) the spouse of the individual;
`(B) a dependent child of the individual, including a child who is
born to or placed for adoption with the individual; and
`(C) all other individuals related by blood to the individual or
the spouse or child described in subparagraph (A) or (B).
`(6) GENETIC INFORMATION- The term `genetic information' means
information about genes, gene products, or inherited characteristics that
may derive from an individual or a family member (including information
about a request for or receipt of genetic services).
`(7) GENETIC SERVICES- The term `genetic services' means health
services provided to obtain, assess, or interpret genetic information for
diagnostic and therapeutic purposes, and for genetic education and
counseling.
`(8) PREDICTIVE GENETIC INFORMATION-
`(A) IN GENERAL- The term `predictive genetic information' means,
in the absence of symptoms, clinical signs, or a diagnosis of the
condition related to such information--
`(i) information about an individual's genetic
tests;
`(ii) information about genetic tests of family members of the
individual; or
`(iii) information about the occurrence of a disease or disorder
in family members.
`(B) EXCEPTIONS- The term `predictive genetic information' shall
not include--
`(i) information about the sex or age of the
individual;
`(ii) information derived from physical tests, such as the
chemical, blood, or urine analyses of the individual including
cholesterol tests; and
`(iii) information about physical exams of the
individual.
`(9) GENETIC TEST- The term `genetic test' means the analysis of
human DNA, RNA, chromosomes, proteins, and certain metabolites, including
analysis of genotypes, mutations, phenotypes, or karyotypes, for the purpose
of predicting risk of disease in asymptomatic or undiagnosed individuals.
Such term does not include physical tests, such as the chemical, blood, or
urine analyses of the individual including cholesterol tests, and physical
exams of the individual, in order to detect symptoms, clinical signs, or a
diagnosis of disease.'.
(d) EFFECTIVE DATE- Except as provided in this section, this section
and the amendments made by this section shall apply with respect to group
health plans for plan years beginning 1 year after the date of the enactment
of this Act.
SEC. 903. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT. (a) AMENDMENTS
RELATING TO THE GROUP MARKET-
(1) PROHIBITION OF HEALTH DISCRIMINATION ON THE BASIS OF GENETIC
INFORMATION IN THE GROUP MARKET-
(A) NO ENROLLMENT RESTRICTION FOR GENETIC SERVICES- Section
2702(a)(1)(F) of the Public Health Service Act (42 U.S.C.
300gg-1(a)(1)(F)) is amended by inserting before the period the following:
`(including information about a request for or receipt of genetic
services)'.
(B) NO DISCRIMINATION IN PREMIUMS BASED ON PREDICTIVE GENETIC
INFORMATION- Subpart 2 of part A of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-4 et seq.) is amended by adding at the end
the following new section:
`SEC. 2707. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE
BASIS OF PREDICTIVE GENETIC INFORMATION IN THE GROUP MARKET.
`A group health plan, or a health insurance issuer offering group
health insurance coverage in connection with a group health plan shall not
adjust premium or contribution amounts for a group on the basis of predictive
genetic information concerning any individual (including a dependent) or
family member of the individual (including information about a request for or
receipt of genetic services).'.
(C) CONFORMING AMENDMENT- Section 2702(b) of the Public Health
Service Act (42 U.S.C. 300gg-1(b)) is amended by adding at the end the
following:
`(3) REFERENCE TO RELATED PROVISION- For a provision prohibiting the
adjustment of premium or contribution amounts for a group under a group
health plan on the basis of predictive genetic information (including
information about a request for or receipt of genetic services), see section
2707.'.
(D) LIMITATION ON COLLECTION AND DISCLOSURE OF PREDICTIVE GENETIC
INFORMATION- Section 2702 of the Public Health Service Act (42 U.S.C.
300gg-1) is amended by adding at the end the following:
`(c) COLLECTION OF PREDICTIVE GENETIC INFORMATION-
`(1) LIMITATION ON REQUESTING OR REQUIRING PREDICTIVE GENETIC
INFORMATION- Except as provided in paragraph (2), a group health plan, or a
health insurance issuer offering health insurance coverage in connection
with a group health plan, shall not request or require predictive genetic
information concerning any individual (including a dependent) or a family
member of the individual (including information about a request for or
receipt of genetic services).
`(2) INFORMATION NEEDED FOR DIAGNOSIS, TREATMENT, OR PAYMENT-
`(A) IN GENERAL- Notwithstanding paragraph (1), a group health
plan, or a health insurance issuer offering health insurance coverage in
connection with a group health plan, that provides health care items and
services to an individual or dependent may request (but may not require)
that such individual or dependent disclose, or authorize the collection or
disclosure of, predictive genetic information for purposes of diagnosis,
treatment, or payment relating to the provision of health care items and
services to such individual or dependent.
`(B) NOTICE OF CONFIDENTIALITY PRACTICES AND DESCRIPTION OF
SAFEGUARDS- As a part of a request under subparagraph (A), the group
health plan, or a health insurance issuer offering health insurance
coverage in connection with a group health plan, shall provide to the
individual or dependent a description of the procedures in place to
safeguard the confidentiality, as described in subsection (d), of such
predictive genetic information.
`(d) CONFIDENTIALITY WITH RESPECT TO PREDICTIVE GENETIC INFORMATION-
`(1) NOTICE OF CONFIDENTIALITY PRACTICES-
`(A) PREPARATION OF WRITTEN NOTICE- A group health plan, or a
health insurance issuer offering health insurance coverage in connection
with a group health plan, shall post or provide, in writing and in a clear
and conspicuous manner, notice of the plan or issuer's confidentiality
practices, that shall include--
`(i) a description of an individual's rights with respect to
predictive genetic information;
`(ii) the procedures established by the plan or issuer for the
exercise of the individual's rights; and
`(iii) the right to obtain a copy of the notice of the
confidentiality practices required under this
subsection.
`(B) MODEL NOTICE- The Secretary, in consultation with the
National Committee on Vital and Health Statistics and the National
Association of Insurance Commissioners, and after notice and opportunity
for public comment, shall develop and disseminate model notices of
confidentiality practices. Use of the model notice shall serve as a
defense against claims of receiving inappropriate notice.
`(2) ESTABLISHMENT OF SAFEGUARDS- A group health plan, or a health
insurance issuer offering health insurance coverage in connection with a
group health plan, shall establish and maintain appropriate administrative,
technical, and physical safeguards to protect the confidentiality, security,
accuracy, and integrity of predictive genetic information created, received,
obtained, maintained, used, transmitted, or disposed of by such plan or
issuer.'.
(2) DEFINITIONS- Section 2791(d) of the Public Health Service Act
(42 U.S.C. 300gg-91(d)) is amended by adding at the end the
following:
`(15) FAMILY MEMBER- The term `family member' means, with respect to
an individual--
`(A) the spouse of the individual;
`(B) a dependent child of the individual, including a child who is
born to or placed for adoption with the individual; and
`(C) all other individuals related by blood to the individual or
the spouse or child described in subparagraph (A) or (B).
`(16) GENETIC INFORMATION- The term `genetic information' means
information about genes, gene products, or inherited characteristics that
may derive from an individual or a family member (including information
about a request for or receipt of genetic services).
`(17) GENETIC SERVICES- The term `genetic services' means health
services provided to obtain, assess, or interpret genetic information for
diagnostic and therapeutic purposes, and for genetic education and
counseling.
`(18) PREDICTIVE GENETIC INFORMATION-
`(A) IN GENERAL- The term `predictive genetic information' means,
in the absence of symptoms, clinical signs, or a diagnosis of the
condition related to such information--
`(i) information about an individual's genetic
tests;
`(ii) information about genetic tests of family members of the
individual; or
`(iii) information about the occurrence of a disease or disorder
in family members.
`(B) EXCEPTIONS- The term `predictive genetic information' shall
not include--
`(i) information about the sex or age of the
individual;
`(ii) information derived from physical tests, such as the
chemical, blood, or urine analyses of the individual including
cholesterol tests; and
`(iii) information about physical exams of the
individual.
`(19) GENETIC TEST- The term `genetic test' means the analysis of
human DNA, RNA, chromosomes, proteins, and certain metabolites, including
analysis of genotypes, mutations, phenotypes, or karyotypes, for the purpose
of predicting risk of disease in asymptomatic or undiagnosed individuals.
Such term does not include physical tests, such as the chemical, blood, or
urine analyses of the individual including cholesterol tests, and physical
exams of the individual, in order to detect symptoms, clinical signs, or a
diagnosis of disease.'.
(e) AMENDMENTS TO PHSA RELATING TO THE INDIVIDUAL MARKET- The first
subpart 3 of part B of title XXVII of the Public Health Service Act (42 U.S.C.
300gg-51 et seq.) (relating to other requirements) (42 U.S.C. 300gg-51 et
seq.) is amended by adding at the end the following:
`SEC. 2753. PROHIBITION OF HEALTH DISCRIMINATION ON THE BASIS OF
PREDICTIVE GENETIC INFORMATION.
`(a) PROHIBITION ON PREDICTIVE GENETIC INFORMATION AS A CONDITION OF
ELIGIBILITY- A health insurance issuer offering health insurance coverage in
the individual market may not use predictive genetic information as a
condition of eligibility of an individual to enroll in individual health
insurance coverage (including information about a request for or receipt of
genetic services).
`(b) PROHIBITION ON PREDICTIVE GENETIC INFORMATION IN SETTING PREMIUM
RATES- A health insurance issuer offering health insurance coverage in the
individual market shall not adjust premium rates for individuals on the basis
of predictive genetic information concerning such an individual (including a
dependent) or a family member of the individual (including information about a
request for or receipt of genetic services).
`(c) COLLECTION OF PREDICTIVE GENETIC INFORMATION-
`(1) LIMITATION ON REQUESTING OR REQUIRING PREDICTIVE GENETIC
INFORMATION- Except as provided in paragraph (2), a health insurance issuer
offering health insurance coverage in the individual market shall not
request or require predictive genetic information concerning any individual
(including a dependent) or a family member of the individual (including
information about a request for or receipt of genetic services).
`(2) INFORMATION NEEDED FOR DIAGNOSIS, TREATMENT, OR PAYMENT-
`(A) IN GENERAL- Notwithstanding paragraph (1), a health insurance
issuer offering health insurance coverage in the individual market that
provides health care items and services to an individual or dependent may
request (but may not require) that such individual or dependent disclose,
or authorize the collection or disclosure of, predictive genetic
information for purposes of diagnosis, treatment, or payment relating to
the provision of health care items and services to such individual or
dependent.
`(B) NOTICE OF CONFIDENTIALITY PRACTICES AND DESCRIPTION OF
SAFEGUARDS- As a part of a request under subparagraph (A), the health
insurance issuer offering health insurance coverage in the individual
market shall provide to the individual or dependent a description of the
procedures in place to safeguard the confidentiality, as described in
subsection (d), of such predictive genetic information.
`(d) CONFIDENTIALITY WITH RESPECT TO PREDICTIVE GENETIC INFORMATION-
`(1) NOTICE OF CONFIDENTIALITY PRACTICES-
`(A) PREPARATION OF WRITTEN NOTICE- A health insurance issuer
offering health insurance coverage in the individual market shall post or
provide, in writing and in a clear and conspicuous manner, notice of the
issuer's confidentiality practices, that shall include--
`(i) a description of an individual's rights with respect to
predictive genetic information;
`(ii) the procedures established by the issuer for the exercise
of the individual's rights; and
`(iii) the right to obtain a copy of the notice of the
confidentiality practices required under this
subsection.
`(B) MODEL NOTICE- The Secretary, in consultation with the
National Committee on Vital and Health Statistics and the National
Association of Insurance Commissioners, and after notice and opportunity
for public comment, shall develop and disseminate model notices of
confidentiality practices. Use of the model notice shall serve as a
defense against claims of receiving inappropriate notice.
`(2) ESTABLISHMENT OF SAFEGUARDS- A health insurance issuer offering
health insurance coverage in the individual market shall establish and
maintain appropriate administrative, technical, and physical safeguards to
protect the confidentiality, security, accuracy, and integrity of predictive
genetic information created, received, obtained, maintained, used,
transmitted, or disposed of by such issuer.'.
(c) EFFECTIVE DATE- The amendments made by this section shall apply
with respect to--
(1) group health plans, and health insurance coverage offered in
connection with group health plans, for plan years beginning after 1 year
after the date of enactment of this Act; and
(2) health insurance coverage offered, sold, issued, renewed, in
effect, or operated in the individual market after 1 year after the date of
enactment of this Act.
SEC. 904. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986. (a)
PROHIBITION OF HEALTH DISCRIMINATION ON THE BASIS OF GENETIC INFORMATION OR
GENETIC SERVICES-
(1) NO ENROLLMENT RESTRICTION FOR GENETIC SERVICES- Section
9802(a)(1)(F) of the Internal Revenue Code of 1986 is amended by inserting
before the period the following: `(including information about a request for
or receipt of genetic services)'.
(2) NO DISCRIMINATION IN GROUP PREMIUMS BASED ON PREDICTIVE GENETIC
INFORMATION-
(A) IN GENERAL- Subchapter B of chapter 100 of the Internal
Revenue Code of 1986 is further amended by adding at the end the
following:
`SEC. 9813. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE
BASIS OF PREDICTIVE GENETIC INFORMATION.
`A group health plan shall not adjust premium or contribution amounts
for a group on the basis of predictive genetic information concerning any
individual (including a dependent) or a family member of the individual
(including information about a request for or receipt of genetic
services).'.
(B) CONFORMING AMENDMENT- Section 9802(b) of the Internal Revenue
Code of 1986 is amended by adding at the end the following:
`(3) REFERENCE TO RELATED PROVISION- For a provision prohibiting the
adjustment of premium or contribution amounts for a group under a group
health plan on the basis of predictive genetic information (including
information about a request for or the receipt of genetic services), see
section 9813.'.
(C) AMENDMENT TO TABLE OF SECTIONS- The table of sections for
subchapter B of chapter 100 of the Internal Revenue Code of 1986 is
amended by adding at the end the following:
`Sec. 9813. Prohibiting premium discrimination against groups on the
basis of predictive genetic information.'.
(b) LIMITATION ON COLLECTION OF PREDICTIVE GENETIC INFORMATION-
Section 9802 of the Internal Revenue Code of 1986 is amended by adding at the
end the following:
`(d) COLLECTION OF PREDICTIVE GENETIC INFORMATION-
`(1) LIMITATION ON REQUESTING OR REQUIRING PREDICTIVE GENETIC
INFORMATION- Except as provided in paragraph (2), a group health plan shall
not request or require predictive genetic information concerning any
individual (including a dependent) or a family member of the individual
(including information about a request for or receipt of genetic
services).
`(2) INFORMATION NEEDED FOR DIAGNOSIS, TREATMENT, OR PAYMENT-
`(A) IN GENERAL- Notwithstanding paragraph (1), a group health
plan that provides health care items and services to an individual or
dependent may request (but may not require) that such individual or
dependent disclose, or authorize the collection or disclosure of,
predictive genetic information for purposes of diagnosis, treatment, or
payment relating to the provision of health care items and services to
such individual or dependent.
`(B) NOTICE OF CONFIDENTIALITY PRACTICES; DESCRIPTION OF
SAFEGUARDS- As a part of a request under subparagraph (A), the group
health plan shall provide to the individual or dependent a description of
the procedures in place to safeguard the confidentiality, as described in
subsection (e), of such predictive genetic information.
`(e) CONFIDENTIALITY WITH RESPECT TO PREDICTIVE GENETIC INFORMATION-
`(1) NOTICE OF CONFIDENTIALITY PRACTICES-
`(A) PREPARATION OF WRITTEN NOTICE- A group health plan shall post
or provide, in writing and in a clear and conspicuous manner, notice of
the plan's confidentiality practices, that shall include--
`(i) a description of an individual's rights with respect to
predictive genetic information;
`(ii) the procedures established by the plan for the exercise of
the individual's rights; and
`(iii) the right to obtain a copy of the notice of the
confidentiality practices required under this
subsection.
`(B) MODEL NOTICE- The Secretary, in consultation with the
National Committee on Vital and Health Statistics and the National
Association of Insurance Commissioners, and after notice and opportunity
for public comment, shall develop and disseminate model notices of
confidentiality practices. Use of the model notice shall serve as a
defense against claims of receiving inappropriate notice.
`(2) ESTABLISHMENT OF SAFEGUARDS- A group health plan shall
establish and maintain appropriate administrative, technical, and physical
safeguards to protect the confidentiality, security, accuracy, and integrity
of predictive genetic information created, received, obtained, maintained,
used, transmitted, or disposed of by such plan.'.
(c) DEFINITIONS- Section 9832(d) of the Internal Revenue Code of 1986
is amended by adding at the end the following:
`(6) FAMILY MEMBER- The term `family member' means, with respect to
an individual--
`(A) the spouse of the individual;
`(B) a dependent child of the individual, including a child who is
born to or placed for adoption with the individual; and
`(C) all other individuals related by blood to the individual or
the spouse or child described in subparagraph (A) or (B).
`(7) GENETIC INFORMATION- The term `genetic information' means
information about genes, gene products, or inherited characteristics that
may derive from an individual or a family member (including information
about a request for or receipt of genetic services).
`(8) GENETIC SERVICES- The term `genetic services' means health
services provided to obtain, assess, or interpret genetic information for
diagnostic and therapeutic purposes, and for genetic education and
counseling.
`(9) PREDICTIVE GENETIC INFORMATION-
`(A) IN GENERAL- The term `predictive genetic information' means,
in the absence of symptoms, clinical signs, or a diagnosis of the
condition related to such information--
`(i) information about an individual's genetic
tests;
`(ii) information about genetic tests of family members of the
individual; or
`(iii) information about the occurrence of a disease or disorder
in family members.
`(B) EXCEPTIONS- The term `predictive genetic information' shall
not include--
`(i) information about the sex or age of the
individual;
`(ii) information derived from physical tests, such as the
chemical, blood, or urine analyses of the individual including
cholesterol tests; and
`(iii) information about physical exams of the
individual.
`(10) GENETIC TEST- The term `genetic test' means the analysis of
human DNA, RNA, chromosomes, proteins, and certain metabolites, including
analysis of genotypes, mutations, phenotypes, or karyotypes, for the purpose
of predicting risk of disease in asymptomatic or undiagnosed individuals.
Such term does not include physical tests, such as the chemical, blood, or
urine analyses of the individual including cholesterol tests, and physical
exams of the individual, in order to detect symptoms, clinical signs, or a
diagnosis of disease.'.
(d) EFFECTIVE DATE- Except as provided in this section, this section
and the amendments made by this section shall apply with respect to group
health plans for plan years beginning after 1 year after the date of the
enactment of this Act.
DIVISION B--HEALTH CARE ACCESS AND PROTECTIONS FOR
CONSUMERS
SEC. 2001. SHORT TITLE.
This division may be cited as the `Patients' Bill of Rights Plus
Act'.
TITLE XXI--TAX-RELATED HEALTH CARE PROVISIONS
Subtitle A--Health Care and Long-Term Care
SEC. 2101. DEDUCTION FOR HEALTH AND LONG-TERM CARE INSURANCE COSTS OF
INDIVIDUALS NOT PARTICIPATING IN EMPLOYER-SUBSIDIZED HEALTH PLANS.
(a) IN GENERAL- Part VII of subchapter B of chapter 1 of the Internal
Revenue Code of 1986 is amended by redesignating section 222 as section 223
and by inserting after section 221 the following new section:
`SEC. 222. HEALTH AND LONG-TERM CARE INSURANCE COSTS.
`(a) IN GENERAL- In the case of an individual, there shall be allowed
as a deduction an amount equal to the applicable percentage of the amount paid
during the taxable year for insurance which constitutes medical care for the
taxpayer and the taxpayer's spouse and dependents.
`(b) APPLICABLE PERCENTAGE-
`(1) IN GENERAL- For purposes of subsection (a), the applicable
percentage shall be determined in accordance with the following
table:
`For taxable years beginning
--The applicable
in calendar year--
--percentage is--
--25
--35
--65
--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.
`(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).
`(1) COORDINATION WITH DEDUCTION FOR HEALTH INSURANCE COSTS OF
SELF-EMPLOYED INDIVIDUALS- The amount taken into account by the taxpayer in
computing the deduction under section 162(l) shall not be taken into account
under this section.
`(2) COORDINATION WITH MEDICAL EXPENSE DEDUCTION- The amount taken
into account by the taxpayer in computing the deduction under this section
shall not be taken into account under section 213.
`(g) REGULATIONS- The Secretary shall prescribe such regulations as
may be appropriate to carry out this section, including regulations requiring
employers to report to their employees and the Secretary such information as
the Secretary determines to be appropriate.'.
(b) DEDUCTION ALLOWED WHETHER OR NOT TAXPAYER ITEMIZES OTHER
DEDUCTIONS- Subsection (a) of section 62 of such Code is amended by inserting
after paragraph (17) the following new item:
`(18) HEALTH AND LONG-TERM CARE INSURANCE COSTS- The deduction
allowed by section 222.'.
(c) CLERICAL AMENDMENT- The table of sections for part VII of
subchapter B of chapter 1 of such Code is amended by striking the last item
and inserting the following new items:
`Sec. 222. Health and long-term care insurance costs.
`Sec. 223. Cross reference.'.
(d) EFFECTIVE DATE- The amendments made by this section shall apply to
taxable years beginning after December 31, 2001.
SEC. 2102. DEDUCTION FOR 100 PERCENT OF HEALTH INSURANCE COSTS OF
SELF-EMPLOYED INDIVIDUALS.
(a) IN GENERAL- Paragraph (1) of section 162(l) of the Internal
Revenue Code of 1986 is amended to read as follows:
`(1) ALLOWANCE OF DEDUCTION- In the case of an individual who is an
employee within the meaning of section 401(c)(1), there shall be allowed as
a deduction under this section an amount equal to 100 percent of the amount
paid during the taxable year for insurance which constitutes medical care
for the taxpayer and the taxpayer's spouse and dependents.'.
(b) CLARIFICATION OF LIMITATIONS ON OTHER COVERAGE- The first sentence
of section 162(l)(2)(B) of such Code is amended to read as follows: `Paragraph
(1) shall not apply to any taxpayer for any calendar month for which the
taxpayer participates in any subsidized health plan maintained by any employer
(other than an employer described in section 401(c)(4)) of the taxpayer or the
spouse of the taxpayer.'.
(c) EFFECTIVE DATE- The amendments made by this section shall apply to
taxable years beginning after December 31, 2001.
SEC. 2103. LONG-TERM CARE INSURANCE PERMITTED TO BE OFFERED UNDER
CAFETERIA PLANS AND FLEXIBLE SPENDING ARRANGEMENTS.
(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.
(1) USE OF INSTITUTE OF MEDICINE- The Secretary of Health and Human
Services shall seek to enter into an appropriate arrangement with the
Institute of Medicine of the National Academy of Sciences to conduct the
study under this section. If such an arrangement cannot be made, the
Secretary may provide for the conduct of the study by any other qualified
non-governmental entity.
(2) CONSULTATION- The study should be conducted under this section
in consultation with experts from a wide-range of groups from the public and
private sectors.
Subtitle B--Medical Savings Accounts
SEC. 2111. EXPANSION OF AVAILABILITY OF MEDICAL SAVINGS
ACCOUNTS.
(a) REPEAL OF LIMITATIONS ON NUMBER OF MEDICAL SAVINGS ACCOUNTS-
(1) IN GENERAL- Subsections (i) and (j) of section 220 of the
Internal Revenue Code of 1986 are hereby repealed.
(2) CONFORMING AMENDMENTS-
(A) Paragraph (1) of section 220(c) of such Code is amended by
striking subparagraph (D).
(B) Section 138 of such Code is amended by striking subsection
(f).
(b) AVAILABILITY NOT LIMITED TO ACCOUNTS FOR EMPLOYEES OF SMALL
EMPLOYERS AND SELF-EMPLOYED INDIVIDUALS-
(1) IN GENERAL- Section 220(c)(1)(A) of such Code (relating to
eligible individual) is amended to read as follows:
`(A) IN GENERAL- The term `eligible individual' means, with
respect to any month, any individual if--
`(i) such individual is covered under a high deductible health
plan as of the 1st day of such month, and
`(ii) such individual is not, while covered under a high
deductible health plan, covered under any health plan--
`(I) which is not a high deductible health plan,
and
`(II) which provides coverage for any benefit which is covered
under the high deductible health plan.'.
(2) CONFORMING AMENDMENTS-
(A) Section 220(c)(1) of such Code is amended by striking
subparagraph (C).
(B) Section 220(c) of such Code is amended by striking paragraph
(4) (defining small employer) and by redesignating paragraph (5) as
paragraph (4).
(C) Section 220(b) of such Code is amended by striking paragraph
(4) (relating to deduction limited by compensation) and by redesignating
paragraphs (5), (6), and (7) as paragraphs (4), (5), and (6),
respectively.
(c) INCREASE IN AMOUNT OF DEDUCTION ALLOWED FOR CONTRIBUTIONS TO
MEDICAL SAVINGS ACCOUNTS-
(1) IN GENERAL- Paragraph (2) of section 220(b) of such Code is
amended to read as follows:
`(2) MONTHLY LIMITATION- The monthly limitation for any month is the
amount equal to 1/12 of the annual deductible (as of the first day of such
month) of the individual's coverage under the high deductible health
plan.'.
(2) CONFORMING AMENDMENT- Clause (ii) of section 220(d)(1)(A) of
such Code is amended by striking `75 percent of'.
(d) BOTH EMPLOYERS AND EMPLOYEES MAY CONTRIBUTE TO MEDICAL SAVINGS
ACCOUNTS- Paragraph (4) of section 220(b) of such Code (as redesignated by
subsection (b)(2)(C)) is amended to read as follows:
`(4) COORDINATION WITH EXCLUSION FOR EMPLOYER CONTRIBUTIONS- The
limitation which would (but for this paragraph) apply under this subsection
to the taxpayer for any taxable year shall be reduced (but not below zero)
by the amount which would (but for section 106(b)) be includible in the
taxpayer's gross income for such taxable year.'.
(e) REDUCTION OF PERMITTED DEDUCTIBLES UNDER HIGH DEDUCTIBLE HEALTH
PLANS-
(1) IN GENERAL- Subparagraph (A) of section 220(c)(2) of such Code
(defining high deductible health plan) is amended--
(A) by striking `$1,500' in clause (i) and inserting
`$1,000';
(B) by striking `$3,000' in clause (ii) and inserting `$2,000';
and
(C) by striking the matter preceding subclause (I) in clause (iii)
and inserting `pursuant to which the annual out-of-pocket expenses
(including deductibles and co-payments) are required to be paid under the
plan (other than for premiums) for covered benefits and may not
exceed--'.
(2) CONFORMING AMENDMENT- Subsection (g) of section 220 of such Code
is amended to read as follows:
`(g) COST-OF-LIVING ADJUSTMENT-
`(1) IN GENERAL- In the case of any taxable year beginning in a
calendar year after 2002, each dollar amount in subsection (c)(2) shall be
increased by an amount equal to--
`(A) such dollar amount, multiplied by
`(B) the cost-of-living adjustment determined under section
1(f)(3) for the calendar year in which such taxable year begins by
substituting `calendar year 2001' for `calendar year 1992' in subparagraph
(B) thereof.
`(2) SPECIAL RULES- In the case of the $1,000 amount in subsection
(c)(2)(A)(i) and the $2,000 amount in subsection (c)(2)(A)(ii), paragraph
(1)(B) shall be applied by substituting `calendar year 2002' for `calendar
year 2001'.
`(3) ROUNDING- If any increase under paragraph (1) or (2) is not a
multiple of $50, such increase shall be rounded to the nearest multiple of
$50.'.
(f) LIMITATION ON ADDITIONAL TAX ON DISTRIBUTIONS NOT USED FOR
QUALIFIED MEDICAL EXPENSES- Section 220(f)(4) of such Code (relating to
additional tax on distributions not used for qualified medical expenses) is
amended by adding at the end the following:
`(D) EXCEPTION IN CASE OF SUFFICIENT ACCOUNT BALANCE- Subparagraph
(A) shall not apply to any payment or distribution in any taxable year,
but only to the extent such payment or distribution does not reduce the
fair market value of the assets of the medical savings account to an
amount less than the annual deductible for the high deductible health plan
of the account holder (determined as of the earlier of January 1 of the
calendar year in which the taxable year begins or January 1 of the last
calendar year in which the account holder is covered under a high
deductible health plan).'.
(g) TREATMENT OF NETWORK-BASED MANAGED CARE PLANS- Section
220(c)(2)(B) of such Code (relating to special rules for high deductible
health plans) is amended by adding at the end the following:
`(iii) TREATMENT OF NETWORK-BASED MANAGED CARE PLANS- A plan
which provides health care services through a network of contracted or
affiliated health care providers, if the benefits provided when services
are obtained through network providers meet the requirements of
subparagraph (A), shall not fail to be treated as a high deductible
health plan by reason of providing benefits for services rendered by
providers who are not members of the network, so long as the annual
deductible and annual limit on out-of-pocket expenses applicable to
services received from non-network providers are not lower than those
applicable to services received from the network
providers.'.
(h) MEDICAL SAVINGS ACCOUNTS MAY BE OFFERED UNDER CAFETERIA PLANS-
Subsection (f) of section 125 of such Code is amended by striking
`106(b),'.
(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,
`(5) The Office shall provide for the conversion of biweekly rates of
contributions specified by paragraph (1) to rates for employees and annuitants
whose pay or annuity is provided on other than a biweekly basis, and for this
purpose may provide for the adjustment of the converted rate to the nearest
cent.
`(c) A Government contribution under this section--
`(1) shall be made at the same time that, and the same frequency
with which, Government contributions under section 8906(b) are made for the
benefit of the employee or annuitant involved; and
`(2) shall be payable from the same appropriation, fund, account, or
other source as would any Government contributions under section 8906(b)
with respect to the employee or annuitant involved.
`(d) The Office shall by regulation prescribe the time, form, and
manner in which an employee or annuitant shall submit any information (and
supporting documentation) necessary to identify any medical savings account to
which contributions under this section are requested to be made.
`(e) Nothing in this section shall be considered to entitle an
employee or annuitant to any Government contribution under this section with
respect to any period for which such employee or annuitant is ineligible for a
Government contribution under section 8906(b).
`Sec. 8906b. Individual contributions to medical savings
accounts
`(a) Upon the written request of an employee or annuitant enrolled in
a high deductible health plan, there shall be withheld from the pay or annuity
of such employee or annuitant and contributed to the medical savings account
identified by such employee or annuitant in accordance with applicable
regulations under subsection (c) such amount as the employee or annuitant may
specify.
`(b) Notwithstanding subsection (a), no withholding under this section
may be made from the pay or annuity of an employee or annuitant for any
period--
`(1) if, or to the extent that, a Government contribution for such
period under section 8906a would not be allowable by reason of subparagraph
(A) or (B)(i) of subsection (b)(3) thereof;
`(2) for which any information (or documentation) that is needed in
order to make such contribution has not been timely submitted; or
`(3) if the employee or annuitant submits a request for termination
of withholdings, beginning on or after the effective date of the request and
before the end of the year.
`(c) The Office of Personnel Management shall prescribe any
regulations necessary to carry out this section, including provisions relating
to the time, form, and manner in which any request for withholdings under this
section may be made, changed, or terminated.'.
(2) RULES OF CONSTRUCTION- Nothing in this section or in any
amendment made by this section shall be considered--
(A) to permit or require that any contributions to a medical
savings account (whether by the Government or through withholdings from
pay or annuity) be paid into the Employees Health Benefits Fund;
or
(B) to affect any authority under section 1005(f) of title 39,
United States Code, to vary, add to, or substitute for any provision of
chapter 89 of title 5, United States Code, as amended by this
section.
(3) CONFORMING AMENDMENTS-
(A) The table of sections at the beginning of chapter 89 of title
5, United States Code, is amended by striking the item relating to section
8906a and inserting the following:
`8906a. Government contributions to medical savings
accounts.
`8906b. Individual contributions to medical savings
accounts.
`8906c. Temporary employees.'.
(B) Section 8913(b)(4) of title 5, United States Code, is amended
by striking `8906a(a)' and inserting `8906c(a)'.
(b) INFORMATIONAL REQUIREMENTS- Section 8907 of title 5, United States
Code, is amended by adding at the end the following:
`(c) In addition to any information otherwise required under this
section, the Office shall make available to all employees and annuitants
eligible to enroll in a high deductible health plan, information relating
to--
`(1) the conditions under which Government contributions under
section 8906a shall be made to a medical savings account;
`(2) the amount of any Government contributions under section 8906a
to which an employee or annuitant may be entitled (or how such amount may be
ascertained);
`(3) the conditions under which contributions to a medical savings
account may be made under section 8906b through withholdings from pay or
annuity; and
`(4) any other matter the Office considers appropriate in connection
with medical savings accounts.'.
(c) HIGH DEDUCTIBLE HEALTH PLAN AND MEDICAL SAVINGS ACCOUNT DEFINED-
Section 8901 of title 5, United States Code, is amended--
(1) in paragraph (10) by striking `and' after the
semicolon;
(2) in paragraph (11) by striking the period and inserting a
semicolon; and
(3) by adding at the end the following:
`(12) the term `high deductible health plan' means a plan described
by section 8903(5) or section 8903a(d); and
`(13) the term `medical savings account' has the meaning given such
term by section 220(d) of the Internal Revenue Code of 1986.'.
(d) AUTHORITY TO CONTRACT FOR HIGH DEDUCTIBLE HEALTH PLANS, ETC-
(1) CONTRACTS FOR HIGH DEDUCTIBLE HEALTH PLANS- Section 8902 of
title 5, United States Code, is amended by adding at the end the
following:
`(p)(1) The Office shall contract under this chapter for a high
deductible health plan with any qualified carrier that offers such a plan and,
as of the date of enactment of this subsection, offers a health benefits plan
under this chapter.
`(2) The Office may contract under this chapter for a high deductible
health plan with any qualified carrier that offers such a plan, but does not,
as of the date of enactment of this subsection, offer a health benefits plan
under this chapter.'.
(2) COMPUTATION OF GOVERNMENT CONTRIBUTIONS TO PLANS UNDER CHAPTER
89 NOT AFFECTED BY HIGH DEDUCTIBLE HEALTH PLANS- Paragraph (2) of section
8906(a) of title 5, United States Code, is amended by striking `(2)' and
inserting `(2)(A)', and adding at the end the following:
`(B) Notwithstanding any other provision of this section, the
subscription charges for, and the number of enrollees enrolled in, high
deductible health plans shall be disregarded for purposes of determining any
weighted average under paragraph (1).'.
(e) DESCRIPTION OF HIGH DEDUCTIBLE HEALTH PLANS AND BENEFITS TO BE
PROVIDED THEREUNDER-
(1) IN GENERAL- Section 8903 of title 5, United States Code, is
amended by adding at the end the following:
`(5) HIGH DEDUCTIBLE HEALTH PLANS- (A) One or more plans described
by paragraph (1), (2), (3), or (4), which--
`(i) are high deductible health plans (as defined by section
220(c)(2) of the Internal Revenue Code of 1986); and
`(ii) provide benefits of the types referred to by section
8904(a)(5).
`(B) Nothing in this section shall be considered--
`(i) to prevent a carrier from simultaneously offering a plan
described by subparagraph (A) and a plan described by paragraph (1) or
(2); or
`(ii) to require that a high deductible health plan offer two
levels of benefits.'.
(2) TYPES OF BENEFITS- Section 8904(a) of title 5, United States
Code, is amended by inserting after paragraph (4) the following:
`(5) HIGH DEDUCTIBLE HEALTH PLANS- Benefits of the types named under
paragraph (1) or (2) of this subsection or both.'.
(3) CONFORMING AMENDMENTS-
(A) Section 8903a of title 5, United States Code, is amended by
redesignating subsection (d) as subsection (e) and by inserting after
subsection (c) the following:
`(d) The plans under this section may include one or more plans,
otherwise allowable under this section, that satisfy the requirements of
clauses (i) and (ii) of section 8903(5)(A).'.
(B) Section 8909(d) of title 5, United States Code, is amended by
striking `8903a(d)' and inserting `8903a(e)'.
(4) REFERENCES- Section 8903 of title 5, United States Code, is
amended by adding after paragraph (5) (as added by paragraph (1) of this
subsection) as a flush left sentence, the following:
`The Office shall prescribe regulations in accordance with which the
requirements of section 8902(c), 8902(n), 8909(e), and any other provision of
this chapter that applies with respect to a plan described by paragraph (1),
(2), (3), or (4) of this section shall apply with respect to the corresponding
plan under paragraph (5) of this section. Similar regulations shall be
prescribed with respect to any plan under section 8903a(d).'.
(f) EFFECTIVE DATE- The amendments made by this section shall apply
with respect to contract years beginning on or after October 1, 2001. The
Office of Personnel Management shall take appropriate measures to ensure that
coverage under a high deductible health plan under chapter 89 of title 5,
United States Code (as amended by this section) shall be available as of the
beginning of the first contract year described in the preceding
sentence.
SEC. 2113. RULE WITH RESPECT TO CERTAIN PLANS.
(a) IN GENERAL- Notwithstanding any other provision of law, health
insurance issuers may offer, and eligible individuals may purchase, high
deductible health plans described in section 220(c)(2)(A) of the Internal
Revenue Code of 1986. Effective for the 5-year period beginning on October 1,
2001, such health plans shall not be required to provide payment for any
health care items or services that are exempt from the plan's
deductible.
(b) EXISTING STATE LAWS- A State law relating to payment for health
care items and services in effect on the date of enactment of this Act that is
preempted under paragraph (1), shall not apply to high deductible health plans
after the expiration of the 5-year period described in such paragraph unless
the State reenacts such law after such period.
Subtitle C--Other Health-Related Provisions
SEC. 2121. EXPANDED HUMAN CLINICAL TRIALS QUALIFYING FOR ORPHAN DRUG
CREDIT.
(a) IN GENERAL- Subclause (I) of section 45C(b)(2)(A)(ii) of the
Internal Revenue Code of 1986 is amended to read as follows:
`(I) after the date that the application is filed for
designation under such section 526, and'.
(b) CONFORMING AMENDMENT- Clause (i) of section 45C(b)(2)(A) of such
Code is amended by inserting `which is' before `being' and by inserting before
the comma at the end `and which is designated under section 526 of such
Act'.
(c) EFFECTIVE DATE- The amendments made by this section shall apply to
amounts paid or incurred after December 31, 2001.
SEC. 2122. CARRYOVER OF UNUSED BENEFITS FROM CAFETERIA PLANS, FLEXIBLE
SPENDING ARRANGEMENTS, AND HEALTH FLEXIBLE SPENDING ACCOUNTS.
(a) IN GENERAL- Section 125 of the Internal Revenue Code of 1986
(relating to cafeteria plans) is amended by redesignating subsections (h) and
(i) as subsections (i) and (j) and by inserting after subsection (g) the
following new subsection:
`(h) ALLOWANCE OF CARRYOVERS OF UNUSED BENEFITS TO LATER TAXABLE
YEARS-
`(1) IN GENERAL- For purposes of this title--
`(A) notwithstanding subsection (d)(2), a plan or other
arrangement shall not fail to be treated as a cafeteria plan or flexible
spending or similar arrangement, and
`(B) no amount shall be required to be included in gross income by
reason of this section or any other provision of this
chapter,
solely because under such plan or other arrangement any nontaxable
benefit which is unused as of the close of a taxable year may be carried
forward to 1 or more succeeding taxable years.
`(2) LIMITATION- Paragraph (1) shall not apply to amounts carried
from a plan to the extent such amounts exceed $500 (applied on an annual
basis). For purposes of this paragraph, all plans and arrangements
maintained by an employer or any related person shall be treated as 1
plan.
`(3) ALLOWANCE OF ROLLOVER-
`(A) IN GENERAL- In the case of any unused benefit described in
paragraph (1) which consists of amounts in a health flexible spending
account or dependent care flexible spending account, the plan or
arrangement shall provide that a participant may elect, in lieu of such
carryover, to have such amounts distributed to the
participant.
`(B) AMOUNTS NOT INCLUDED IN INCOME- Any distribution under
subparagraph (A) shall not be included in gross income to the extent that
such amount is transferred in a trustee-to-trustee transfer, or is
contributed within 60 days of the date of the distribution,
to--
`(i) a qualified cash or deferred arrangement described in
section 401(k),
`(ii) a plan under which amounts are contributed by an
individual's employer for an annuity contract described in section
403(b),
`(iii) an eligible deferred compensation plan described in
section 457, or
`(iv) a medical savings account (within the meaning of section
220).
Any amount rolled over under this subparagraph shall be treated as
a rollover contribution for the taxable year from which the unused amount
would otherwise be carried.
`(C) TREATMENT OF ROLLOVER- Any amount rolled over under
subparagraph (B) shall be treated as an eligible rollover under section
220, 401(k), 403(b), or 457, whichever is applicable, and shall be taken
into account in applying any limitation (or participation requirement) on
employer or employee contributions under such section or any other
provision of this chapter for the taxable year of the
rollover.
`(4) COST-OF-LIVING ADJUSTMENT- In the case of any taxable year
beginning in a calendar year after 2002, the $500 amount under paragraph (2)
shall be adjusted at the same time and in the same manner as under section
415(d)(2), except that the base period taken into account shall be the
calendar quarter beginning October 1, 2001, and any increase which is not a
multiple of $50 shall be rounded to the next lowest multiple of
$50.
`(5) APPLICABILITY- This subsection shall apply to taxable years
beginning after December 31, 2001.'.
(b) EFFECTIVE DATE- The amendments made by this section shall apply to
taxable years beginning after December 31, 2001.
SEC. 2123. REDUCTION IN TAX ON VACCINES.
(a) IN GENERAL- Paragraph (1) of section 4131(b) of the Internal
Revenue Code of 1986 (relating to amount of tax) is amended by striking `75
cents' and inserting `50 cents'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall take
effect on January 1, 2002.
Subtitle D--Miscellaneous Provisions
SEC. 2131. NO IMPACT ON SOCIAL SECURITY TRUST FUND.
(a) IN GENERAL- Nothing in this division (or an amendment made by this
division) shall be construed to alter or amend the Social Security Act (or any
regulation promulgated under that Act).
(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
(A) duplicates, in whole or in part, another claim submitted by
the same individual or entity; or
(B) is a claim that cannot be processed and must, in accordance
with the Secretary of Health and Human Service's instructions, be returned
by the fiscal intermediary or carrier to the individual or entity for
completion.
(c) TREATMENT OF FEES FOR PURPOSES OF COST REPORTS- An entity may not
include a fee assessed pursuant to this section as an allowable item on a cost
report under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.)
or title XIX of such Act (42 U.S.C. 1396 et seq.).
(d) EFFECTIVE DATE- The provisions of this section apply to claims
submitted on or after January 1, 2002.
TITLE XXII--PATIENTS' BILL OF RIGHTS
Subtitle A--Right to Advice and Care
SEC. 2201. PATIENT RIGHT TO MEDICAL ADVICE AND CARE.
(a) IN GENERAL- Part 7 of subtitle B of title I of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1181 et seq.) is
amended--
(1) by redesignating subpart C as subpart D; and
(2) by inserting after subpart B the following:
`Subpart C--Patient Right to Medical Advice and Care
`SEC. 721. ACCESS TO EMERGENCY MEDICAL CARE.
`(a) COVERAGE OF EMERGENCY SERVICES- If a group health plan (other
than a fully insured group health plan) provides coverage for any benefits
consisting of emergency medical care, except for items or services
specifically excluded from coverage, the plan shall, without regard to prior
authorization or provider participation--
`(1) provide coverage for emergency medical screening examinations
to the extent that a prudent layperson, who possesses an average knowledge
of health and medicine, would determine such examinations to be necessary;
and
`(2) provide coverage for additional emergency medical care to
stabilize an emergency medical condition following an emergency medical
screening examination (if determined necessary), pursuant to the definition
of stabilize under section 1867(e)(3) of the Social Security Act (42 U.S.C.
1395dd(e)(3)).
`(b) COVERAGE OF EMERGENCY AMBULANCE SERVICES- If a group health plan
(other than a fully insured group health plan) provides coverage for any
benefits consisting of emergency ambulance services, except for items or
services specifically excluded from coverage, the plan shall, without regard
to prior authorization or provider participation, provide coverage for
emergency ambulance services to the extent that a prudent layperson, who
possesses an average knowledge of health and medicine, would determine such
emergency ambulance services to be necessary.
`(c) CARE AFTER STABILIZATION-
`(1) IN GENERAL- In the case of medically necessary and appropriate
items or services related to the emergency medical condition that may be
provided to a participant or beneficiary by a nonparticipating provider
after the participant or beneficiary is stabilized, the nonparticipating
provider shall contact the plan as soon as practicable, but not later than 2
hours after stabilization occurs, with respect to whether--
`(A) the provision of items or services is approved;
`(B) the participant or beneficiary will be transferred;
or
`(C) other arrangements will be made concerning the care and
treatment of the participant or beneficiary.
`(2) FAILURE TO RESPOND AND MAKE ARRANGEMENTS- If a group health
plan fails to respond and make arrangements within 2 hours of being
contacted in accordance with paragraph (1), then the plan shall be
responsible for the cost of any additional items or services provided by the
nonparticipating provider if--
`(A) coverage for items or services of the type furnished by the
nonparticipating provider is available under the plan;
`(B) the items or services are medically necessary and appropriate
and related to the emergency medical condition involved; and
`(C) the timely provision of the items or services is medically
necessary and appropriate.
`(3) RULE OF CONSTRUCTION- Nothing in this subsection shall be
construed to apply to a group health plan that does not require prior
authorization for items or services provided to a participant or beneficiary
after the participant or beneficiary is stabilized.
`(d) REIMBURSEMENT TO A NON-PARTICIPATING PROVIDER- The responsibility
of a group health plan to provide reimbursement to a nonparticipating provider
under this section shall cease accruing upon the earlier of--
`(1) the transfer or discharge of the participant or beneficiary;
or
`(2) the completion of other arrangements made by the plan and the
nonparticipating provider.
`(e) RESPONSIBILITY OF PARTICIPANT- With respect to items or services
provided by a nonparticipating provider under this section, the participant or
beneficiary shall not be responsible for amounts that exceed the amounts
(including co-insurance, co-payments, deductibles or any other form of
cost-sharing) that would be incurred if the care was provided by a
participating health care provider with prior authorization.
`(f) RULE OF CONSTRUCTION- Nothing in this section shall be construed
to prohibit a group health plan from negotiating reimbursement rates with a
nonparticipating provider for items or services provided under this
section.
`(g) DEFINITIONS- In this section:
`(1) EMERGENCY AMBULANCE SERVICES- The term `emergency ambulance
services' means, with respect to a participant or beneficiary under a group
health plan (other than a fully insured group health plan), ambulance
services furnished to transport an individual who has an emergency medical
condition to a treating facility for receipt of emergency medical care
if--
`(A) the emergency services are covered under the group health
plan (other than a fully insured group health plan) involved;
and
`(B) a prudent layperson who possesses an average knowledge of
health and medicine could reasonably expect the absence of such transport
to result in placing the health of the participant or beneficiary (or,
with respect to a pregnant woman, the health of the woman or her unborn
child) in serious jeopardy, serious impairment to bodily functions, or
serious dysfunction of any bodily organ or part.
`(2) EMERGENCY MEDICAL CARE- The term `emergency medical care'
means, with respect to a participant or beneficiary under a group health
plan (other than a fully insured group health plan), covered inpatient and
outpatient items or services that--
`(A) are furnished by any provider, including a nonparticipating
provider, that is qualified to furnish such items or services;
and
`(B) are needed to evaluate or stabilize (as such term is defined
in section 1867(e)(3) of the Social Security Act (42 U.S.C. 1395dd(e)(3))
an emergency medical condition.
`(3) EMERGENCY MEDICAL CONDITION- The term `emergency medical
condition' means a medical condition manifesting itself by acute symptoms of
sufficient severity (including severe pain) such that a prudent layperson,
who possesses an average knowledge of health and medicine, could reasonably
expect the absence of immediate medical attention to result in placing the
health of the participant or beneficiary (or, with respect to a pregnant
woman, the health of the woman or her unborn child) in serious jeopardy,
serious impairment to bodily functions, or serious dysfunction of any bodily
organ or part.
`SEC. 722. OFFERING OF CHOICE OF COVERAGE OPTIONS.
`(a) REQUIREMENT- If a group health plan (other than a fully insured
group health plan) provides coverage for benefits only through a defined set
of participating health care professionals, the plan shall offer the
participant the option to purchase point-of-service coverage (as defined in
subsection (b)) for all such benefits for which coverage is otherwise so
limited. Such option shall be made available to the participant at the time of
enrollment under the plan and at such other times as the plan offers the
participant a choice of coverage options.
`(b) POINT-OF-SERVICE COVERAGE DEFINED- In this section, the term
`point-of-service coverage' means, with respect to benefits covered under a
group health plan (other than a fully insured group health plan), coverage of
such benefits when provided by a nonparticipating health care
professional.
`(c) SMALL EMPLOYER EXEMPTION-
`(1) IN GENERAL- This section shall not apply to any group health
plan (other than a fully insured group health plan) of a small
employer.
`(2) SMALL EMPLOYER- For purposes of paragraph (1), the term `small
employer' means, in connection with a group health plan (other than a fully
insured group health plan) with respect to a calendar year and a plan year,
an employer who employed an average of at least 2 but not more than 50
employees on business days during the preceding calendar year and who
employs at least 2 employees on the first day of the plan year. For purposes
of this paragraph, the provisions of subparagraph (C) of section 712(c)(1)
shall apply in determining employer size.
`(d) RULE OF CONSTRUCTION- Nothing in this section shall be
construed--
`(1) as requiring coverage for benefits for a particular type of
health care professional;
`(2) as requiring an employer to pay any costs as a result of this
section or to make equal contributions with respect to different health
coverage options;
`(3) as preventing a group health plan (other than a fully insured
group health plan) from imposing higher premiums or cost-sharing on a
participant for the exercise of a point-of-service coverage option;
or
`(4) to require that a group health plan (other than a fully insured
group health plan) include coverage of health care professionals that the
plan excludes because of fraud, quality of care, or other similar reasons
with respect to such professionals.
`SEC. 723. PATIENT ACCESS TO OBSTETRIC AND GYNECOLOGICAL CARE.
`(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.
`(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.
`(1) AUTHORIZATION- Nothing in this section shall be construed to
prohibit a group health plan (other than a fully insured group health plan)
from requiring an authorization in order to obtain coverage for specialty
services so long as such authorization is for an appropriate duration or
number of referrals.
`(2) REFERRALS FOR ONGOING SPECIAL CONDITIONS-
`(A) IN GENERAL- A group health plan (other than a fully insured
group health plan) shall permit a participant or beneficiary who has an
ongoing special condition (as defined in subparagraph (B)) to receive a
referral to a specialist for the treatment of such condition and such
specialist may authorize such referrals, procedures, tests, and other
medical services with respect to such condition, or coordinate the care
for such condition, subject to the terms of a treatment plan referred to
in subsection (c) with respect to the condition.
`(B) ONGOING SPECIAL CONDITION DEFINED- In this subsection, the
term `ongoing special condition' means a condition or disease
that--
`(i) is life-threatening, degenerative, or disabling;
and
`(ii) requires specialized medical care over a prolonged period
of time.
`(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).
`(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
`(I) frequent monitoring over a prolonged period of time and
requires substantial on-going specialized medical care;
or
`(II) frequent ongoing specialized medical care across a
variety of domains of care.
`(4) TERMINATED- The term `terminated' includes, with respect to a
contract (as defined in paragraph (1)), the expiration or nonrenewal of the
contract by the group health plan, but does not include a termination of the
contract by the plan for failure to meet applicable quality standards or for
fraud.
`(f) RIGHT TO EXTERNAL REVIEW- Pursuant to the requirements of section
503B, a participant or beneficiary shall have the right to an independent
external review if the denial of an item or service or condition that is
required to be covered under this section is eligible for such review.
`SEC. 727. PROTECTION OF PATIENT-PROVIDER COMMUNICATIONS.
`(a) IN GENERAL- Subject to subsection (b), a group health plan (other
than a fully insured group health plan and in relation to a participant or
beneficiary) shall not prohibit or otherwise restrict a health care
professional from advising such a participant or beneficiary who is a patient
of the professional about the health status of the participant or beneficiary
or medical care or treatment for the condition or disease of the participant
or beneficiary, regardless of whether coverage for such care or treatment are
provided under the contract, if the professional is acting within the lawful
scope of practice.
`(b) RULE OF CONSTRUCTION- Nothing in this section shall be construed
as requiring a group health plan (other than a fully insured group health
plan) to provide specific benefits under the terms of such plan.
`SEC. 728. PATIENT'S RIGHT TO PRESCRIPTION DRUGS.
`(a) IN GENERAL- To the extent that a group health plan (other than a
fully insured group health plan) provides coverage for benefits with respect
to prescription drugs, and limits such coverage to drugs included in a
formulary, the plan shall--
`(1) ensure the participation of physicians and pharmacists in
developing and reviewing such formulary; and
`(2) in accordance with the applicable quality assurance and
utilization review standards of the plan, provide for exceptions from the
formulary limitation when a non-formulary alternative is medically necessary
and appropriate.
`(b) RIGHT TO EXTERNAL REVIEW- Pursuant to the requirements of section
503B, a participant or beneficiary shall have the right to an independent
external review if the denial of an item or service or condition that is
required to be covered under this section is eligible for such review.
`SEC. 729. SELF-PAYMENT FOR BEHAVIORAL HEALTH CARE SERVICES.
`(a) IN GENERAL- A group health plan (other than a fully insured group
health plan) may not--
`(1) prohibit or otherwise discourage a participant or beneficiary
from self-paying for behavioral health care services once the plan has
denied coverage for such services; or
`(2) terminate a health care provider because such provider permits
participants or beneficiaries to self-pay for behavioral health care
services--
`(A) that are not otherwise covered under the plan;
or
`(B) for which the group health plan provides limited coverage, to
the extent that the group health plan denies coverage of the
services.
`(b) RULE OF CONSTRUCTION- Nothing in subsection (a)(2)(B) shall be
construed as prohibiting a group health plan from terminating a contract with
a health care provider for failure to meet applicable quality standards or for
fraud.
`SEC. 730. COVERAGE FOR INDIVIDUALS PARTICIPATING IN APPROVED CANCER
CLINICAL TRIALS.
`(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.
`(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).
`(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.
`(1) STUDY- The Secretary shall study the impact on group health
plans for covering routine patient care costs for individuals who are
entitled to benefits under this section and who are enrolled in an approved
cancer clinical trial program.
`(2) REPORT TO CONGRESS- Not later than January 1, 2005, the
Secretary shall submit a report to Congress that contains an assessment
of--
`(A) any incremental cost to group health plans resulting from the
provisions of this section;
`(B) a projection of expenditures to such plans resulting from
this section; and
`(C) any impact on premiums resulting from this
section.
`(h) RIGHT TO EXTERNAL REVIEW- Pursuant to the requirements of section
503B, a participant or beneficiary shall have the right to an independent
external review if the denial of an item or service or condition that is
required to be covered under this section is eligible for such review.
`SEC. 730A. PROHIBITION OF DISCRIMINATION AGAINST PROVIDERS BASED ON
LICENSURE.
`(a) IN GENERAL- A group health plan (other than a fully insured group
health plan) shall not discriminate with respect to participation or
indemnification as to any provider who is acting within the scope of the
provider's license or certification under applicable State law, solely on the
basis of such license or certification.
`(b) CONSTRUCTION- Subsection (a) shall not be construed--
`(1) as requiring the coverage under a group health plan of a
particular benefit or service or to prohibit a plan from including providers
only to the extent necessary to meet the needs of the plan's participants or
beneficiaries or from establishing any measure designed to maintain quality
and control costs consistent with the responsibilities of the
plan;
`(2) to override any State licensure or scope-of-practice law;
or
`(3) as requiring a plan that offers network coverage to include for
participation every willing provider who meets the terms and conditions of
the plan.
`SEC. 730B. GENERALLY APPLICABLE PROVISION.
`In the case of a group health plan that provides benefits under 2 or
more coverage options, the requirements of this subpart shall apply separately
with respect to each coverage option.'.
(b) RULE WITH RESPECT TO CERTAIN PLANS-
(1) IN GENERAL- Notwithstanding any other provision of law, health
insurance issuers may offer, and eligible individuals may purchase, high
deductible health plans described in section 220(c)(2)(A) of the Internal
Revenue Code of 1986. Effective for the 5-year period beginning on the date
of the enactment of this Act, such health plans shall not be required to
provide payment for any health care items or services that are exempt from
the plan's deductible.
(2) EXISTING STATE LAWS- A State law relating to payment for health
care items and services in effect on the date of enactment of this Act that
is preempted under paragraph (1), shall not apply to high deductible health
plans after the expiration of the 5-year period described in such paragraph
unless the State reenacts such law after such period.
(c) DEFINITION- Section 733(a) of the Employee Retirement Income
Security Act of 1974 (42 U.S.C. 1191(a)) is amended by adding at the end the
following:
`(3) FULLY INSURED GROUP HEALTH PLAN- The term `fully insured group
health plan' means a group health plan where benefits under the plan are
provided pursuant to the terms of an arrangement between a group health plan
and a health insurance issuer and are guaranteed by the health insurance
issuer under a contract or policy of insurance.'.
(d) CONFORMING AMENDMENT- The table of contents in section 1 of the
Employee Retirement Income Security Act of 1974 is amended--
(1) in the item relating to subpart C of part 7 of subtitle B of
title I, by striking `Subpart C' and inserting `Subpart D'; and
(2) by adding at the end of the items relating to subpart B of part
7 of subtitle B of title I, the following:
`SUBPART C--PATIENT RIGHT TO MEDICAL ADVICE AND CARE
`Sec. 721. Access to emergency medical care.
`Sec. 722. Offering of choice of coverage options.
`Sec. 723. Patient access to obstetric and gynecological
care.
`Sec. 724. Access to pediatric care.
`Sec. 725. Timely access to specialists.
`Sec. 726. Continuity of care.
`Sec. 727. Protection of patient-provider communications.
`Sec. 728. Patient's right to prescription drugs.
`Sec. 729. Self-payment for behavioral health care
services.
`Sec. 730. Coverage for individuals participating in approved cancer
clinical trials.
`Sec. 730A. Prohibition of discrimination against providers based on
licensure.
`Sec. 730B. Generally applicable provision.'.
SEC. 2202. CONFORMING AMENDMENT TO THE INTERNAL REVENUE CODE OF
1986.
Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is
amended--
(1) in the table of sections, by inserting after the item relating
to section 9812 the following new item:
`Sec. 9813. Standard relating to patient's bill of rights.';
(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) IN GENERAL- A group health plan, and a health insurance
issuer that provides coverage in connection with group health insurance
coverage, shall provide for the disclosure of the information described in
subsection (b) to participants and beneficiaries--
`(i) at the time of the initial enrollment of the participant or
beneficiary under the plan or coverage;
`(ii) on an annual basis after enrollment--
`(I) in conjunction with the election period of the plan or
coverage if the plan or coverage has such an election period;
or
`(II) in the case of a plan or coverage that does not have an
election period, in conjunction with the beginning of the plan or
coverage year; and
`(iii) in the case of any material reduction to the benefits or
information described in paragraphs (1), (2) and (3) of subsection (b),
in the form of a summary notice provided not later than the date on
which the reduction takes effect.
`(B) PARTICIPANTS AND BENEFICIARIES- The disclosure required under
subparagraph (A) shall be provided--
`(i) jointly to each participant and beneficiary who reside at
the same address; or
`(ii) in the case of a beneficiary who does not reside at the
same address as the participant, separately to the participant and such
beneficiary.
`(2) RULE OF CONSTRUCTION- Nothing in this section shall be
construed to prevent a group health plan sponsor and health insurance issuer
from entering into an agreement under which either the plan sponsor or the
issuer agrees to assume responsibility for compliance with the requirements
of this section, in whole or in part, and the party delegating such
responsibility is released from liability for compliance with the
requirements that are assumed by the other party, to the extent the party
delegating such responsibility did not cause such noncompliance.
`(3) PROVISION OF INFORMATION- Information shall be provided to
participants and beneficiaries under this section at the last known address
maintained by the plan or issuer with respect to such participants or
beneficiaries, to the extent that such information is provided to
participants or beneficiaries via the United States Postal Service or other
private delivery service.
`(b) REQUIRED INFORMATION- The informational materials to be
distributed under this section shall include for each option available under
the group health plan or health insurance coverage the following:
`(1) BENEFITS- A description of the covered benefits,
including--
`(A) any in- and out-of-network benefits;
`(B) specific preventative services covered under the plan or
coverage if such services are covered;
`(C) any benefit limitations, including any annual or lifetime
benefit limits and any monetary limits or limits on the number of visits,
days, or services, and any specific coverage exclusions; and
`(D) any definition of medical necessity used in making coverage
determinations by the plan, issuer, or claims administrator.
`(2) COST SHARING- A description of any cost-sharing requirements,
including--
`(A) any premiums, deductibles, coinsurance, copayment amounts,
and liability for balance billing above any reasonable and customary
charges, for which the participant or beneficiary will be responsible
under each option available under the plan;
`(B) any maximum out-of-pocket expense for which the participant
or beneficiary may be liable;
`(C) any cost-sharing requirements for out-of-network benefits or
services received from nonparticipating providers; and
`(D) any additional cost-sharing or charges for benefits and
services that are furnished without meeting applicable plan or coverage
requirements, such as prior authorization or
precertification.
`(3) SERVICE AREA- A description of the plan or issuer's service
area, including the provision of any out-of-area coverage.
`(4) PARTICIPATING PROVIDERS- A directory of participating providers
(to the extent a plan or issuer provides coverage through a network of
providers) that includes, at a minimum, the name, address, and telephone
number of each participating provider, and information about how to inquire
whether a participating provider is currently accepting new
patients.
`(5) CHOICE OF PRIMARY CARE PROVIDER- A description of any
requirements and procedures to be used by participants and beneficiaries in
selecting, accessing, or changing their primary care provider, including
providers both within and outside of the network (if the plan or issuer
permits out-of-network services), and the right to select a pediatrician as
a primary care provider under section 724 for a participant or beneficiary
who is a child if such section applies.
`(6) PREAUTHORIZATION REQUIREMENTS- A description of the
requirements and procedures to be used to obtain preauthorization for health
services, if such preauthorization is required.
`(7) EXPERIMENTAL AND INVESTIGATIONAL TREATMENTS- A description of
the process for determining whether a particular item, service, or treatment
is considered experimental or investigational, and the circumstances under
which such treatments are covered by the plan or issuer.
`(8) SPECIALTY CARE- A description of the requirements and
procedures to be used by participants and beneficiaries in accessing
specialty care and obtaining referrals to participating and nonparticipating
specialists, including the right to timely coverage for access to
specialists care under section 725 if such section applies.
`(9) CLINICAL TRIALS- A description the circumstances and conditions
under which participation in clinical trials is covered under the terms and
conditions of the plan or coverage, and the right to obtain coverage for
approved cancer clinical trials under section 729 if such section
applies.
`(10) PRESCRIPTION DRUGS- To the extent the plan or issuer provides
coverage for prescription drugs, a statement of whether such coverage is
limited to drugs included in a formulary, a description of any provisions
and cost-sharing required for obtaining on- and off-formulary medications,
and a description of the rights of participants and beneficiaries in
obtaining access to access to prescription drugs under section 727 if such
section applies.
`(11) EMERGENCY SERVICES- A summary of the rules and procedures for
accessing emergency services, including the right of a participant or
beneficiary to obtain emergency services under the prudent layperson
standard under section 721, if such section applies, and any educational
information that the plan or issuer may provide regarding the appropriate
use of emergency services.
`(12) CLAIMS AND APPEALS- A description of the plan or issuer's
rules and procedures pertaining to claims and appeals, a description of the
rights of participants and beneficiaries under sections 503, 503A and 503B
in obtaining covered benefits, filing a claim for benefits, and appealing
coverage decisions internally and externally (including telephone numbers
and mailing addresses of the appropriate authority), and a description of
any additional legal rights and remedies available under section
502.
`(13) ADVANCE DIRECTIVES AND ORGAN DONATION- A description of
procedures for advance directives and organ donation decisions if the plan
or issuer maintains such procedures.
`(14) INFORMATION ON PLANS AND ISSUERS- The name, mailing address,
and telephone number or numbers of the plan administrator and the issuer to
be used by participants and beneficiaries seeking information about plan or
coverage benefits and services, payment of a claim, or authorization for
services and treatment. The name of the designated decision-maker (or
decision-makers) appointed under section 502(n)(2) for purposes of making
final determinations under section 503A and approving coverage pursuant to
the written determination of an independent medical reviewer under section
503B. Notice of whether the benefits under the plan are provided under a
contract or policy of insurance issued by an issuer, or whether benefits are
provided directly by the plan sponsor who bears the insurance
risk.
`(15) TRANSLATION SERVICES- A summary description of any translation
or interpretation services (including the availability of printed
information in languages other than English, audio tapes, or information in
Braille) that are available for non-English speakers and participants and
beneficiaries with communication disabilities and a description of how to
access these items or services.
`(16) ACCREDITATION INFORMATION- Any information that is made public
by accrediting organizations in the process of accreditation if the plan or
issuer is accredited, or any additional quality indicators (such as the
results of enrollee satisfaction surveys) that the plan or issuer makes
public or makes available to participants and beneficiaries.
`(17) NOTICE OF REQUIREMENTS- A description of any rights of
participants and beneficiaries that are established by the Patients' Bill of
Rights Plus Act (excluding those described in paragraphs (1) through (16))
if such sections apply. The description required under this paragraph may be
combined with the notices required under sections 711(d), 713(b), or
606(a)(1), and with any other notice provision that the Secretary determines
may be combined.
`(18) AVAILABILITY OF ADDITIONAL INFORMATION- A statement that the
information described in subsection (c), and instructions on obtaining such
information (including telephone numbers and, if available, Internet
websites), shall be made available upon request.
`(c) ADDITIONAL INFORMATION- The informational materials to be
provided upon the request of a participant or beneficiary shall include for
each option available under a group health plan or health insurance coverage
the following:
`(1) STATUS OF PROVIDERS- The State licensure status of the plan or
issuer's participating health care professionals and participating health
care facilities, and, if available, the education, training, specialty
qualifications or certifications of such professionals.
`(2) COMPENSATION METHODS- A summary description of the methods
(such as capitation, fee-for-service, salary, bundled payments, per diem, or
a combination thereof) used for compensating participating health care
professionals (including primary care providers and specialists) and
facilities in connection with the provision of health care under the plan or
coverage. The requirement of this paragraph shall not be construed as
requiring plans or issuers to provide information concerning proprietary
payment methodology.
`(3) PRESCRIPTION DRUGS- Information about whether a specific
prescription medication is included in the formulary of the plan or issuer,
if the plan or issuer uses a defined formulary.
`(4) EXTERNAL APPEALS INFORMATION- Aggregate information on the
number and outcomes of external medical reviews, relative to the sample size
(such as the number of covered lives) determined for the plan or issuer's
book of business.
`(d) MANNER OF DISCLOSURE- The information described in this section
shall be disclosed in an accessible medium and format that is calculated to be
understood by the average participant.
`(e) RULES OF CONSTRUCTION- Nothing in this section shall be construed
to prohibit a group health plan, or a health insurance issuer in connection
with group health insurance coverage, from--
`(1) distributing any other additional information determined by the
plan or issuer to be important or necessary in assisting participants and
beneficiaries in the selection of a health plan; and
`(2) complying with the provisions of this section by providing
information in brochures, through the Internet or other electronic media, or
through other similar means, so long as participants and beneficiaries are
provided with an opportunity to request that informational materials be
provided in printed form.
`(f) CONFORMING REGULATIONS- The Secretary shall issue regulations to
coordinate the requirements on group health plans and health insurance issuers
under this section with the requirements imposed under part 1, to reduce
duplication with respect to any information that is required to be provided
under any such requirements.
`(g) SECRETARIAL ENFORCEMENT AUTHORITY-
`(1) IN GENERAL- The Secretary may assess a civil monetary penalty
against the administrator of a plan or issuer in connection with the failure
of the plan or issuer to comply with the requirements of this
section.
`(A) IN GENERAL- The amount of the penalty to be imposed under
paragraph (1) shall not exceed $100 for each day for each participant and
beneficiary with respect to which the failure to comply with the
requirements of this section occurs.
`(B) INCREASE IN AMOUNT- The amount referred to in subparagraph
(A) shall be increased or decreased, for each calendar year that ends
after December 31, 2000, by the same percentage as the percentage by which
the medical care expenditure category of the Consumer Price Index for All
Urban Consumers (United States city average), published by the Bureau of
Labor Statistics, for September of the preceding calendar year has
increased or decreased from the such Index for September of
2000.
`(3) FAILURE DEFINED- For purposes of this subsection, a plan or
issuer shall have failed to comply with the requirements of this section
with respect to a participant or beneficiary if the plan or issuer failed or
refused to comply with the requirements of this section within 30
days--
`(A) of the date described in subsection
(a)(1)(A)(i);
`(B) of the date described in subsection (a)(1)(A)(ii);
or
`(C) of the date on which additional information was requested
under subsection (c).'.
(b) CONFORMING AMENDMENTS-
(1) Section 732(a) of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1191a(a)) is amended by striking `section 711' and inserting
`sections 711 and 714'.
(2) The table of contents in section 1 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1001) is amended by inserting after
the item relating to section 713, the following:
`Sec 714. Health plan comparative information.'.
(3) Section 502(b)(3) of the Employee Retirement Income Security Act
of 1974 (29 U.S.C. 1132(b)(3)) is amended by striking `733(a)(1))' and
inserting `733(a)(1)), except with respect to the requirements of section
714'.
SEC. 2212. INFORMATION ABOUT PROVIDERS.
(a) STUDY- The Secretary of Health and Human Services shall enter into
a contract with the Institute of Medicine for the conduct of a study, and the
submission to the Secretary of a report, that includes--
(1) an analysis of information concerning health care professionals
that is currently available to patients, consumers, States, and professional
societies, nationally and on a State-by-State basis, including patient
preferences with respect to information about such professionals and their
competencies;
(2) an evaluation of the legal and other barriers to the sharing of
information concerning health care professionals; and
(3) recommendations for the disclosure of information on health care
professionals, including the competencies and professional qualifications of
such practitioners, to better facilitate patient choice, quality
improvement, and market competition.
(b) REPORT- Not later than 18 months after the date of enactment of
this Act, the Secretary of Health and Human Services shall forward to the
appropriate committees of Congress a copy of the report and study conducted
under subsection (a).
Subtitle C--Right to Hold Health Plans
Accountable
SEC. 2221. AMENDMENTS TO EMPLOYEE RETIREMENT INCOME SECURITY ACT OF
1974.
(a) IN GENERAL- Part 5 of subtitle B of title I of the Employee
Retirement Income Security Act of 1974 is amended by inserting after section
503 (29 U.S.C. 1133) the following:
`SEC. 503A. CLAIMS AND INTERNAL APPEALS PROCEDURES FOR GROUP HEALTH
PLANS.
`(a) INITIAL CLAIM FOR BENEFITS UNDER GROUP HEALTH PLANS-
`(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.
`(A) IN GENERAL- A review of a denial of a claim for benefits
under this subsection shall be conducted by an individual with appropriate
expertise who was not directly involved in the initial
determination.
`(B) REVIEW OF MEDICAL DECISIONS BY PHYSICIANS- A review of an
appeal of a denial of a claim for benefits that is based on a lack of
medical necessity and appropriateness, or based on an experimental or
investigational treatment, or requires an evaluation of medical facts,
shall be made by a physician with appropriate expertise, including
age-appropriate expertise, who was not involved in the initial
determination.
`(4) NOTICE OF DETERMINATION-
`(A) IN GENERAL- Written notice of a determination made under an
internal appeal of a denial of a claim for benefits shall be issued to the
participant or beneficiary (or authorized representative) and the treating
health care professional not later than 2 business days after the
completion of the review (or within the 72-hour or 24-hour period referred
to in paragraph (2) if applicable).
`(B) FINAL DETERMINATION- The decision by a plan or issuer under
this subsection shall be treated as the final determination of the plan or
issuer on a denial of a claim for benefits. The failure of a plan or
issuer to issue a determination on an appeal of a denial of a claim for
benefits under this subsection within the applicable timeline established
for such a determination shall be treated as a final determination on an
appeal of a denial of a claim for benefits for purposes of proceeding to
external review under section 503B.
`(C) REQUIREMENTS OF NOTICE- With respect to a determination made
under this subsection, the notice described in subparagraph (A) shall
include--
`(i) the reasons for the determination (including a summary of
the clinical or scientific-evidence based rationale used in making the
determination and instruction on obtaining a more complete description
written in a manner calculated to be understood by the average
participant);
`(ii) the procedures for obtaining additional information
concerning the determination; and
`(iii) notification of the right to an independent external
review under section 503B and instructions on how to initiate such a
review.
`(c) DEFINITIONS- The definitions contained in section 503B(i) shall
apply for purposes of this section.
`SEC. 503B. INDEPENDENT EXTERNAL APPEALS PROCEDURES FOR GROUP HEALTH
PLANS.
`(a) RIGHT TO EXTERNAL APPEAL- A group health plan, and a health
insurance issuer offering health insurance coverage in connection with a group
health plan, shall provide in accordance with this section participants and
beneficiaries (or authorized representatives) with access to an independent
external review for any denial of a claim for benefits.
`(b) INITIATION OF THE INDEPENDENT EXTERNAL REVIEW PROCESS-
`(1) TIME TO FILE- A request for an independent external review
under this section shall be filed with the plan or issuer not later than 60
business days after the date on which the participant or beneficiary
receives notice of the denial under section 503A(b)(4) or the date on which
the internal review is waived by the plan or issuer under section
503A(b)(1)(D).
`(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).
`(i) IN GENERAL- The thresholds described in this subparagraph
are that--
`(I) the total amount payable under the plan or coverage for
the item or service that was the subject of such denial exceeds a
significant financial threshold (as determined under guidelines
established by the Secretary); or
`(II) a physician has asserted in writing that there is a
significant risk of placing the life, health, or development of the
participant or beneficiary in jeopardy if the denial of the claim for
benefits is sustained.
`(ii) THRESHOLDS NOT APPLIED- The thresholds described in this
subparagraph shall not apply if the plan or issuer involved waives the
internal appeals process with respect to the denial of a claim for
benefits involved under section 503A(b)(1)(D).
`(C) PROCESS FOR MAKING DETERMINATIONS-
`(i) NO DEFERENCE TO PRIOR DETERMINATIONS- In making
determinations under subparagraph (A), there shall be no deference given
to determinations made by the plan or issuer under section 503A or the
recommendation of a treating health care professional (if
any).
`(ii) USE OF APPROPRIATE PERSONNEL- A qualified external review
entity shall use appropriately qualified personnel to make
determinations under this section.
`(D) NOTICES AND GENERAL TIMELINES FOR DETERMINATION-
`(i) NOTICE IN CASE OF DENIAL OF REFERRAL- If the entity under
this paragraph does not make a referral to an independent medical
reviewer, the entity shall provide notice to the plan or issuer, the
participant or beneficiary (or authorized representative) filing the
request, and the treating health care professional (if any) that the
denial is not subject to independent medical review. Such
notice--
`(I) shall be written (and, in addition, may be provided
orally) in a manner calculated to be understood by an average
participant;
`(II) shall include the reasons for the determination;
and
`(III) include any relevant terms and conditions of the plan
or coverage.
`(ii) GENERAL TIMELINE FOR DETERMINATIONS- Upon receipt of
information under paragraph (2), the qualified external review entity,
and if required the independent medical reviewer, shall make a
determination within the overall timeline that is applicable to the case
under review as described in subsection (e), except that if the entity
determines that a referral to an independent medical reviewer is not
required, the entity shall provide notice of such determination to the
participant or beneficiary (or authorized representative) within 2
business days of such determination.
`(d) INDEPENDENT MEDICAL REVIEW-
`(1) IN GENERAL- If a qualified external review entity determines
under subsection (c) that a denial of a claim for benefits is eligible for
independent medical review, the entity shall refer the denial involved to an
independent medical reviewer for the conduct of an independent medical
review under this subsection.
`(2) MEDICALLY REVIEWABLE DECISIONS- A denial described in this
paragraph is one for which the item or service that is the subject of the
denial would be a covered benefit under the terms and conditions of the plan
or coverage but for one (or more) of the following
determinations:
`(A) DENIALS BASED ON MEDICAL NECESSITY AND APPROPRIATENESS- The
basis of the determination is that the item or service is not medically
necessary and appropriate.
`(B) DENIALS BASED ON EXPERIMENTAL OR INVESTIGATIONAL TREATMENT-
The basis of the determination is that the item or service is experimental
or investigational.
`(C) DENIALS OTHERWISE BASED ON AN EVALUATION OF MEDICAL FACTS- A
determination that the item or service or condition is not covered but an
evaluation of the medical facts by a health care professional in the
specific case involved is necessary to determine whether the item or
service or condition is required to be provided under the terms and
conditions of the plan or coverage.
`(3) INDEPENDENT MEDICAL REVIEW DETERMINATION-
`(A) IN GENERAL- An independent medical reviewer under this
section shall make a new independent determination with respect
to--
`(i) whether the item or service or condition that is the
subject of the denial is covered under the terms and conditions of the
plan or coverage; and
`(ii) based upon an affirmative determination under clause (i),
whether or not the denial of a claim for a benefit that is the subject
of the review should be upheld or reversed.
`(B) STANDARD FOR DETERMINATION- The independent medical
reviewer's determination relating to the medical necessity and
appropriateness, or the experimental or investigation nature, or the
evaluation of the medical facts of the item, service, or condition shall
be based on the medical condition of the participant or beneficiary
(including the medical records of the participant or beneficiary) and the
valid, relevant scientific evidence and clinical evidence, including
peer-reviewed medical literature or findings and including expert
consensus.
`(C) NO COVERAGE FOR EXCLUDED BENEFITS- Nothing in this subsection
shall be construed to permit an independent medical reviewer to require
that a group health plan, or health insurance issuer offering health
insurance coverage in connection with a group health plan, provide
coverage for items or services that are specifically excluded or expressly
limited under the plan or coverage and that are not covered regardless of
any determination relating to medical necessity and appropriateness,
experimental or investigational nature of the treatment, or an evaluation
of the medical facts in the case involved.
`(D) EVIDENCE AND INFORMATION TO BE USED IN MEDICAL REVIEWS- In
making a determination under this subsection, the independent medical
reviewer shall also consider appropriate and available evidence and
information, including the following:
`(i) The determination made by the plan or issuer with respect
to the claim upon internal review and the evidence or guidelines used by
the plan or issuer in reaching such determination.
`(ii) The recommendation of the treating health care
professional and the evidence, guidelines, and rationale used by the
treating health care professional in reaching such
recommendation.
`(iii) Additional evidence or information obtained by the
reviewer or submitted by the plan, issuer, participant or beneficiary
(or an authorized representative), or treating health care
professional.
`(iv) The plan or coverage document.
`(E) INDEPENDENT DETERMINATION- In making the determination, the
independent medical reviewer shall--
`(i) consider the claim under review without deference to the
determinations made by the plan or issuer under section 503A or the
recommendation of the treating health care professional (if
any);
`(ii) consider, but not be bound by the definition used by the
plan or issuer of `medically necessary and appropriate', or
`experimental or investigational', or other equivalent terms that are
used by the plan or issuer to describe medical necessity and
appropriateness or experimental or investigational nature of the
treatment; and
`(iii) notwithstanding clause (ii), adhere to the definition
used by the plan or issuer of `medically necessary and appropriate', or
`experimental or investigational' if such definition is the same as the
definition of such term--
`(I) that has been adopted pursuant to a State statute or
regulation; or
`(II) that is used for purposes of the program established
under titles XVIII or XIX of the Social Security Act or under chapter
89 of title 5, United States Code.
`(F) DETERMINATION OF INDEPENDENT MEDICAL REVIEWER- An independent
medical reviewer shall, in accordance with the deadlines described in
subsection (e), prepare a written determination to uphold or reverse the
denial under review. Such written determination shall include the specific
reasons of the reviewer for such determination, including a summary of the
clinical or scientific-evidence based rationale used in making the
determination. The reviewer may provide the plan or issuer and the
treating health care professional with additional recommendations in
connection with such a determination, but any such recommendations shall
not be treated as part of the determination.
`(e) TIMELINES AND NOTIFICATIONS-
`(1) TIMELINES FOR INDEPENDENT MEDICAL REVIEW-
`(A) PRIOR AUTHORIZATION DETERMINATION-
`(i) IN GENERAL- The independent medical reviewer (or reviewers)
shall make a determination on a denial of a claim for benefits that is
referred to the reviewer under subsection (c)(3) not later than 14
business days after the receipt of information under subsection (c)(2)
if the review involves a prior authorization of items or
services.
`(ii) EXPEDITED DETERMINATION- Notwithstanding clause (i), the
independent medical reviewer (or reviewers) shall make an expedited
determination on a denial of a claim for benefits described in clause
(i), when a request for such an expedited determination is made by a
participant or beneficiary (or authorized representative) at any time
during the process for making a determination, and the treating health
care professional substantiates, with the request, that a determination
under the timeline described in clause (i) would seriously jeopardize
the life or health of the participant or beneficiary. Such determination
shall be made not later than 72 hours after the receipt of information
under subsection (c)(2).
`(iii) CONCURRENT DETERMINATION- Notwithstanding clause (i), a
review described in such subclause shall be completed not later than 24
hours after the receipt of information under subsection (c)(2) if the
review involves a discontinuation of inpatient care.
`(B) RETROSPECTIVE DETERMINATION- The independent medical reviewer
(or reviewers) shall complete a review in the case of a retrospective
determination on an appeal of a denial of a claim for benefits that is
referred to the reviewer under subsection (c)(3) not later than 30
business days after the receipt of information under subsection
(c)(2).
`(2) NOTIFICATION OF DETERMINATION- The external review entity shall
ensure that the plan or issuer, the participant or beneficiary (or
authorized representative) and the treating health care professional (if
any) receives a copy of the written determination of the independent medical
reviewer prepared under subsection (d)(3)(F). Nothing in this paragraph
shall be construed as preventing an entity or reviewer from providing an
initial oral notice of the reviewer's determination.
`(3) FORM OF NOTICES- Determinations and notices under this
subsection shall be written in a manner calculated to be understood by an
average participant.
`(4) TERMINATION OF EXTERNAL REVIEW PROCESS IF APPROVAL OF A CLAIM
FOR BENEFITS DURING PROCESS-
`(A) IN GENERAL- If a plan or issuer--
`(i) reverses a determination on a denial of a claim for
benefits that is the subject of an external review under this section
and authorizes coverage for the claim or provides payment of the claim;
and
`(ii) provides notice of such reversal to the participant or
beneficiary (or authorized representative) and the treating health care
professional (if any), and the external review entity responsible for
such review,
the external review process shall be terminated with respect to
such denial and any filing fee paid under subsection (b)(2)(A)(iv) shall
be refunded.
`(B) TREATMENT OF TERMINATION- An authorization of coverage under
subparagraph (A) by the plan or issuer shall be treated as a written
determination to reverse a denial under section (d)(3)(F) for purposes of
liability under section 502(n)(1)(B).
`(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.
`(A) IN GENERAL- Where a participant or beneficiary obtains items
or services in accordance with paragraph (2), the plan or issuer involved
shall provide for reimbursement of the costs of such items of services.
Such reimbursement shall be made to the treating health care professional
or to the participant or beneficiary (in the case of a participant or
beneficiary who pays for the costs of such items or
services).
`(B) AMOUNT- The plan or issuer shall fully reimburse a
professional, participant or beneficiary under subparagraph (A) for the
total costs of the items or services provided (regardless of any plan
limitations that may apply to the coverage of such items of services) so
long as--
`(i) the items or services would have been covered under the
terms of the plan or coverage if provided by the plan or issuer;
and
`(ii) the items or services were provided in a manner consistent
with the determination of the independent medical
reviewer.
`(4) FAILURE TO REIMBURSE- Where a plan or issuer fails to provide
reimbursement to a professional, participant or beneficiary in accordance
with this subsection, the professional, participant or beneficiary may
commence a civil action (or utilize other remedies available under law) to
recover only the amount of any such reimbursement that is unpaid and any
necessary legal costs or expenses (including attorneys' fees) incurred in
recovering such reimbursement.
`(g) QUALIFICATIONS OF INDEPENDENT MEDICAL REVIEWERS-
`(1) IN GENERAL- In referring a denial to 1 or more individuals to
conduct independent medical review under subsection (c), the qualified
external review entity shall ensure that--
`(A) each independent medical reviewer meets the qualifications
described in paragraphs (2) and (3);
`(B) with respect to each review at least 1 such reviewer meets
the requirements described in paragraphs (4) and (5); and
`(C) compensation provided by the entity to the reviewer is
consistent with paragraph (6).
`(2) LICENSURE AND EXPERTISE- Each independent medical reviewer
shall be a physician or health care professional who--
`(A) is appropriately credentialed or licensed in 1 or more States
to deliver health care services; and
`(B) typically treats the diagnosis or condition or provides the
type or treatment under review.
`(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.
`(A) IN GENERAL- In this section, the term `qualified external
review entity' means, in relation to a plan or issuer, an entity that is
initially certified (and periodically recertified) under subparagraph (C)
as meeting the following requirements:
`(i) The entity has (directly or through contracts or other
arrangements) sufficient medical, legal, and other expertise and
sufficient staffing to carry out duties of a qualified external review
entity under this section on a timely basis, including making
determinations under subsection (b)(2)(A) and providing for independent
medical reviews under subsection (d).
`(ii) The entity is not a plan or issuer or an affiliate or a
subsidiary of a plan or issuer, and is not an affiliate or subsidiary of
a professional or trade association of plans or issuers or of health
care providers.
`(iii) The entity has provided assurances that it will conduct
external review activities consistent with the applicable requirements
of this section and standards specified in subparagraph (C), including
that it will not conduct any external review activities in a case unless
the independence requirements of subparagraph (B) are met with respect
to the case.
`(iv) The entity has provided assurances that it will provide
information in a timely manner under subparagraph (D).
`(v) The entity meets such other requirements as the Secretary
provides by regulation.
`(B) INDEPENDENCE REQUIREMENTS-
`(i) IN GENERAL- Subject to clause (ii), an entity meets the
independence requirements of this subparagraph with respect to any case
if the entity--
`(I) is not a related party (as defined in subsection
(g)(7));
`(II) does not have a material familial, financial, or
professional relationship with such a party; and
`(III) does not otherwise have a conflict of interest with
such a party (as determined under regulations).
`(ii) EXCEPTION FOR REASONABLE COMPENSATION- Nothing in clause
(i) shall be construed to prohibit receipt by a qualified external
review entity of compensation from a plan or issuer for the conduct of
external review activities under this section if the compensation is
provided consistent with clause (iii).
`(iii) LIMITATIONS ON ENTITY COMPENSATION- Compensation provided
by a plan or issuer to a qualified external review entity in connection
with reviews under this section shall--
`(I) not exceed a reasonable level; and
`(II) not be contingent on the decision rendered by the entity
or by any independent medical reviewer.
`(C) CERTIFICATION AND RECERTIFICATION PROCESS-
`(i) IN GENERAL- The initial certification and recertification
of a qualified external review entity shall be made--
`(I) under a process that is recognized or approved by the
Secretary; or
`(II) by a qualified private standard-setting organization
that is approved by the Secretary under clause
(iii).
`(ii) PROCESS- The Secretary shall not recognize or approve a
process under clause (i)(I) unless the process applies standards (as
promulgated in regulations) that ensure that a qualified external review
entity--
`(I) will carry out (and has carried out, in the case of
recertification) the responsibilities of such an entity in accordance
with this section, including meeting applicable
deadlines;
`(II) will meet (and has met, in the case of recertification)
appropriate indicators of fiscal integrity;
`(III) will maintain (and has maintained, in the case of
recertification) appropriate confidentiality with respect to
individually identifiable health information obtained in the course of
conducting external review activities; and
`(IV) in the case recertification, shall review the matters
described in clause (iv).
`(iii) APPROVAL OF QUALIFIED PRIVATE STANDARD-SETTING
ORGANIZATIONS- For purposes of clause (i)(II), the Secretary may approve
a qualified private standard-setting organization if the Secretary finds
that the organization only certifies (or recertifies) external review
entities that meet at least the standards required for the certification
(or recertification) of external review entities under clause
(ii).
`(iv) CONSIDERATIONS IN RECERTIFICATIONS- In conducting
recertifications of a qualified external review entity under this
paragraph, the Secretary or organization conducting the recertification
shall review compliance of the entity with the requirements for
conducting external review activities under this section, including the
following:
`(I) Provision of information under subparagraph
(D).
`(II) Adherence to applicable deadlines (both by the entity
and by independent medical reviewers it refers cases
to).
`(III) Compliance with limitations on compensation (with
respect to both the entity and independent medical reviewers it refers
cases to).
`(IV) Compliance with applicable independence
requirements.
`(v) PERIOD OF CERTIFICATION OR RECERTIFICATION- A certification
or recertification provided under this paragraph shall extend for a
period not to exceed 5 years.
`(vi) REVOCATION- A certification or recertification under this
paragraph may be revoked by the Secretary or by the organization
providing such certification upon a showing of cause.
`(D) PROVISION OF INFORMATION-
`(i) IN GENERAL- A qualified external review entity shall
provide to the Secretary, in such manner and at such times as the
Secretary may require, such information (relating to the denials which
have been referred to the entity for the conduct of external review
under this section) as the Secretary determines appropriate to assure
compliance with the independence and other requirements of this section
to monitor and assess the quality of its external review activities and
lack of bias in making determinations. Such information shall include
information described in clause (ii) but shall not include individually
identifiable medical information.
`(ii) INFORMATION TO BE INCLUDED- The information described in
this subclause with respect to an entity is as follows:
`(I) The number and types of denials for which a request for
review has been received by the entity.
`(II) The disposition by the entity of such denials, including
the number referred to a independent medical reviewer and the reasons
for such dispositions (including the application of exclusions), on a
plan or issuer-specific basis and on a health care specialty-specific
basis.
`(III) The length of time in making determinations with
respect to such denials.
`(IV) Updated information on the information required to be
submitted as a condition of certification with respect to the entity's
performance of external review activities.
`(iii) INFORMATION TO BE PROVIDED TO CERTIFYING ORGANIZATION-
`(I) IN GENERAL- In the case of a qualified external review
entity which is certified (or recertified) under this subsection by a
qualified private standard-setting organization, at the request of the
organization, the entity shall provide the organization with the
information provided to the Secretary under clause
(i).
`(II) ADDITIONAL INFORMATION- Nothing in this subparagraph
shall be construed as preventing such an organization from requiring
additional information as a condition of certification or
recertification of an entity.
`(iv) USE OF INFORMATION- Information provided under this
subparagraph may be used by the Secretary and qualified private
standard-setting organizations to conduct oversight of qualified
external review entities, including recertification of such entities,
and shall be made available to the public in an appropriate
manner.
`(E) LIMITATION ON LIABILITY- No qualified external review entity
having a contract with a plan or issuer, and no person who is employed by
any such entity or who furnishes professional services to such entity
(including as an independent medical reviewer), shall be held by reason of
the performance of any duty, function, or activity required or authorized
pursuant to this section, to be civilly liable under any law of the United
States or of any State (or political subdivision thereof) if there was no
actual malice or gross misconduct in the performance of such duty,
function, or activity.
`(i) DEFINITIONS- In this section:
`(1) AUTHORIZED REPRESENTATIVE- The term `authorized representative'
means, with respect to a participant or beneficiary--
`(A) a person to whom a participant or beneficiary has given
express written consent to represent the participant or beneficiary in any
proceeding under this section;
`(B) a person authorized by law to provide substituted consent for
the participant or beneficiary; or
`(C) a family member of the participant or beneficiary (or the
estate of the participant or beneficiary) or the participant's or
beneficiary's treating health care professional when the participant or
beneficiary is unable to provide consent.
`(2) CLAIM FOR BENEFITS- The term `claim for benefits' means any
request by a participant or beneficiary (or authorized representative) for
benefits (including requests that are subject to authorization of coverage
or utilization review), for eligibility, or for payment in whole or in part,
for an item or service under a group health plan or health insurance
coverage offered by a health insurance issuer in connection with a group
health plan.
`(3) GROUP HEALTH PLAN- The term `group health plan' shall have the
meaning given such term in section 733(a). In applying this paragraph,
excepted benefits described in section 733(c) shall not be treated as
benefits consisting of medical care.
`(4) HEALTH INSURANCE COVERAGE- The term `health insurance coverage'
has the meaning given such term in section 733(b)(1). In applying this
paragraph, excepted benefits described in section 733(c) shall not be
treated as benefits consisting of medical care.
`(5) HEALTH INSURANCE ISSUER- The term `health insurance issuer' has
the meaning given such term in section 733(b)(2).
`(6) PRIOR AUTHORIZATION DETERMINATION- The term `prior
authorization determination' means a determination by the group health plan
or health insurance issuer offering health insurance coverage in connection
with a group health plan prior to the provision of the items and services as
a condition of coverage of the items and services under the terms and
conditions of the plan or coverage.
`(7) TREATING HEALTH CARE PROFESSIONAL- The term `treating health
care professional' with respect to a group health plan, health insurance
issuer or provider sponsored organization means a physician (medical doctor
or doctor of osteopathy) or other health care practitioner who is acting
within the scope of his or her State licensure or certification for the
delivery of health care services and who is primarily responsible for
delivering those services to the participant or beneficiary.
`(8) UTILIZATION REVIEW- The term `utilization review' with respect
to a group health plan or health insurance coverage means procedures used in
the determination of coverage for a participant or beneficiary, such as
procedures to evaluate the medical necessity, appropriateness, efficacy,
quality, or efficiency of health care services, procedures or settings, and
includes prospective review, concurrent review, second opinions, case
management, discharge planning, or retrospective review.'.
(b) CONFORMING AMENDMENT- The table of contents in section 1 of the
Employee Retirement Income Security Act of 1974 is amended by inserting after
the item relating to section 503 the following:
`Sec. 503A. Claims and internal appeals procedures for group health
plans.
`Sec. 503B. Independent external appeals procedures for group health
plans.'.
(c) EFFECTIVE DATE- The amendments made by this section shall apply
with respect to plan years beginning on or after 2 years after the date of
enactment of this Act. The Secretary shall issue all regulations necessary to
carry out the amendments made by this section before the effective date
thereof.
SEC. 2222. ENFORCEMENT.
Section 502(c) of the Employee Retirement Income Security Act of 1974
(29 U.S.C. 1132(c)) is amended by adding at the end the following:
`(8) The Secretary may assess a civil penalty against any plan of up
to $10,000 for the plan's failure or refusal to comply with any deadline
applicable under section 503B or any determination under such section, except
that in any case in which treatment was not commenced by the plan in
accordance with the determination of an independent external reviewer, the
Secretary shall assess a civil penalty of $10,000 against the plan and the
plan shall pay such penalty to the participant or beneficiary
involved.'.
Subtitle D--Remedies
SEC. 2231. AVAILABILITY OF COURT REMEDIES.
(a) IN GENERAL- Section 502 of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1132) is amended by adding at the end the
following:
`(n) CAUSE OF ACTION RELATING TO DENIAL OF A CLAIM FOR HEALTH
BENEFITS-
`(A) FAILURE TO COMPLY WITH EXTERNAL MEDICAL REVIEW- In any case
in which--
`(i) a designated decision-maker described in paragraph (2)
fails to exercise ordinary care in approving coverage pursuant to the
written determination of an independent medical reviewer under section
503B(d)(3)(F) that reverses a denial of a claim for benefits;
and
`(ii) the failure described in clause (i) is the proximate cause
of substantial harm to, or the wrongful death of, the participant or
beneficiary;
such designated decision-maker shall be liable to the participant
or beneficiary (or the estate of such participant or beneficiary) for
economic and noneconomic damages in connection with such failure and such
injury or death (subject to paragraph (4)).
`(B) WRONGFUL DETERMINATION RESULTING IN DELAY IN PROVIDING
BENEFITS- In any case in which--
`(i) a designated decision-maker described in paragraph (2) acts
in bad faith in making a final determination denying a claim for
benefits under section 503A(b);
`(ii) the denial described in clause (i) is reversed by an
independent medical reviewer under section 503B(d); and
`(iii) the delay attributable to the failure described in clause
(i) is the proximate cause of substantial harm to, or the wrongful death
of, the participant or beneficiary;
such designated decision-maker shall be liable to the participant
or beneficiary (or the estate of such participant or beneficiary) for
economic and noneconomic damages in connection with such failure and such
injury or death (subject to paragraph (4)).
`(2) DESIGNATED DECISION-MAKERS FOR PURPOSES OF LIABILITY- An
employer or plan sponsor shall not be liable under any cause of action
described in paragraph (1) if the employer or plan sponsor complies with the
following provisions:
`(A) APPOINTMENT- A group health plan may designate one or more
persons to serve as the designated decision-maker for purposes of
paragraph (1). Such designated decision-makers shall have the exclusive
authority under the group health plan (or under the health insurance
coverage in the case of a health insurance issuer offering coverage in
connection with a group health plan) to make determinations described in
section 503A with respect to claims for benefits and determination to
approve coverage pursuant to written determination of independent medical
reviewers under section 503B, except that the plan documents may expressly
provide that the designated decision-maker is subject to the direction of
a named fiduciary.
`(B) PROCEDURES- A designated decision-maker shall--
`(i) be a person who is named in the plan or coverage documents,
or who, pursuant to procedures specified in the plan or coverage
documents, is identified as the designated decision-maker
by--
`(I) a person who is an employer or employee organization with
respect to the plan or issuer;
`(II) a person who is such an employer and such an employee
organization acting jointly; or
`(III) a person who is a named fiduciary;
`(ii) agree to accept appointment as a designated
decision-maker; and
`(iii) be identified in the plan or coverage documents as
required under section 714(b)(14).
`(C) QUALIFICATIONS- To be appointed as a designated
decision-maker under this paragraph, a person shall be--
`(ii) a group health plan;
`(iii) a health insurance issuer; or
`(iv) any other person who can provide adequate evidence, in
accordance with regulations promulgated by the Secretary, of the ability
of the person to--
`(I) carry out the responsibilities set forth in the plan or
coverage documents;
`(II) carry out the applicable requirements of this
subsection; and
`(III) meet other applicable requirements under this Act,
including any financial obligation for liability under this
subsection.
`(D) FLEXIBILITY IN ADMINISTRATION- A group health plan, or health
insurance issuer offering coverage in connection with a group health plan,
may provide--
`(i) that any person or group of persons may serve in more than
one capacity with respect to the plan or coverage (including service as
a designated decision-maker, administrator, and named fiduciary);
or
`(ii) that a designated decision-maker may employ one or more
persons to provide advice with respect to any responsibility of such
decision-maker under the plan or coverage.
`(E) FAILURE TO DESIGNATE- In any case in which a designated
decision-maker is not appointed under this paragraph, the group health
plan (or health insurance issuer offering coverage in connection with the
group health plan), the administrator, or the party or parties that bears
the sole responsibility for making the final determination under section
503A(b) (with respect to an internal review), or for approving coverage
pursuant to the written determination of an independent medical reviewer
under section 503B, with respect to a denial of a claim for benefits shall
be treated as the designated decision-maker for purposes of liability
under this section.
`(3) REQUIREMENT OF EXHAUSTION OF INDEPENDENT MEDICAL REVIEW-
Paragraph (1) shall apply only if a final determination denying a claim for
benefits under section 503A(b) has been referred for independent medical
review under section 503B(d) and a written determination by an independent
medical reviewer to reverse such final determination has been issued with
respect to such review.
`(4) LIMITATIONS ON RECOVERY OF DAMAGES-
`(A) MAXIMUM AWARD OF NONECONOMIC DAMAGES- The aggregate amount of
liability for noneconomic loss in an action under paragraph (1) may not
exceed $350,000.
`(B) INCREASE IN AMOUNT- The amount referred to in subparagraph
(A) shall be increased or decreased, for each calendar year that ends
after December 31, 2001, by the same percentage as the percentage by which
the Consumer Price Index for All Urban Consumers (United States city
average), published by the Bureau of Labor Statistics, for September of
the preceding calendar year has increased or decreased from the such Index
for September of 2001.
`(C) JOINT AND SEVERAL LIABILITY- In the case of any action
commenced pursuant to paragraph (1), the defendant shall be liable only
for the amount of noneconomic damages attributable to such defendant in
direct proportion to such defendant's share of fault or responsibility for
the injury suffered by the participant or beneficiary. In all such cases,
the liability of a defendant for noneconomic damages shall be several and
not joint.
`(D) TREATMENT OF COLLATERAL SOURCE PAYMENTS-
`(i) IN GENERAL- In the case of any action commenced pursuant to
paragraph (1), the total amount of damages received by a participant or
beneficiary under such action shall be reduced, in accordance with
clause (ii), by any other payment that has been, or will be, made to
such participant or beneficiary to compensate such participant or
beneficiary for the injury that was the subject of such
action.
`(ii) AMOUNT OF REDUCTION- The amount by which an award of
damages to a participant or beneficiary for an injury shall be reduced
under clause (i) shall be--
`(I) the total amount of any payments (other than such award)
that have been made or that will be made to such participant or
beneficiary to pay costs of or compensate such participant or
beneficiary for the injury that was the subject of the action;
less
`(II) the amount paid by such participant or beneficiary (or
by the spouse, parent, or legal guardian of such participant or
beneficiary) to secure the payments described in subclause
(I).
`(iii) DETERMINATION OF AMOUNTS FROM COLLATERAL SOURCES- The
reduction required under clause (ii) shall be determined by the court in
a pretrial proceeding. At the subsequent trial no evidence shall be
admitted as to the amount of any charge, payments, or damage for which a
participant or beneficiary--
`(I) has received payment from a collateral source or the
obligation for which has been assured by a third party;
or
`(II) is, or with reasonable certainty, will be eligible to
receive from a collateral source which will, with reasonable
certainty, be assumed by a third party.
`(5) AFFIRMATIVE DEFENSES- In the case of any cause of action under
paragraph (1), it shall be an affirmative defense that--
`(A) the group health plan, or health insurance issuer offering
health insurance coverage in connection with a group health plan, involved
did not receive from the participant or beneficiary (or authorized
representative) or the treating health care professional (if any),
sufficient information regarding the medical condition of the participant
or beneficiary that was necessary to make a final determination on a claim
for benefits under section 503A(b);
`(B) the participant or beneficiary (or authorized
representative)--
`(i) was in possession of facts that were sufficient to enable
the participant or beneficiary (or authorized representative) to know
that an expedited review under section 503A or 503B would have prevented
the harm that is the subject of the action; and
`(ii) failed to notify the plan or issuer of the need for such
an expedited review; or
`(C) the cause of action is based solely on the failure of a
qualified external review entity or an independent medical reviewer to
meet the timelines applicable under section 503B.
Nothing in this paragraph shall be construed to limit the
application of any other affirmative defense that may be applicable to the
cause of action involved.
`(6) WAIVER OF INTERNAL REVIEW- In the case of any cause of action
under paragraph (1), the waiver or nonwaiver of internal review under
section 503A(b)(1)(D) by the group health plan, or health insurance issuer
offering health insurance coverage in connection with a group health plan,
shall not be used in determining liability.
`(7) LIMITATIONS ON ACTIONS- Paragraph (1) shall not apply in
connection with any action that is commenced more than 1 year
after--
`(A) the date on which the last act occurred which constituted a
part of the failure referred to in such paragraph; or
`(B) in the case of an omission, the last date on which the
decision-maker could have cured the failure.
`(8) LIMITATION ON RELIEF WHERE DEFENDANT'S POSITION PREVIOUSLY
SUPPORTED UPON EXTERNAL REVIEW- In any case in which the court finds the
defendant to be liable in an action under this subsection, to the extent
that such liability is based on a finding by the court of a particular
failure described in paragraph (1) and such finding is contrary to a
previous determination by an independent medical reviewer under section
503B(d) with respect to such defendant, no relief shall be available under
this subsection in addition to the relief otherwise available under
subsection (a)(1)(B).
`(9) CONSTRUCTION- Nothing in this subsection shall be construed as
authorizing a cause of action under paragraph (1) for--
`(A) the failure of a group health plan or health insurance issuer
to provide an item or service that is specifically excluded under the plan
or coverage; or
`(B) any denial of a claim for benefits that was not eligible for
independent medical review under section 503B(d).
`(10) FEDERAL JURISDICTION- In the case of any action commenced
pursuant to paragraph (1) the district courts of the United States shall
have exclusive jurisdiction.
`(11) DEFINITIONS- In this subsection:
`(A) AUTHORIZED REPRESENTATIVE- The term `authorized
representative' has the meaning given such term in section
503B(i).
`(B) CLAIM FOR BENEFITS- The term `claim for benefits' shall have
the meaning given such term in section 503B(i), except that such term
shall only include claims for prior authorization determinations (as such
term is defined in section 503B(i)).
`(C) GROUP HEALTH PLAN- The term `group health plan' shall have
the meaning given such term in section 733(a).
`(D) HEALTH INSURANCE COVERAGE- The term `health insurance
coverage' has the meaning given such term in section
733(b)(1).
`(E) HEALTH INSURANCE ISSUER- The term `health insurance issuer'
has the meaning given such term in section 733(b)(2) (including health
maintenance organizations as defined in section 733(b)(3)).
`(F) ORDINARY CARE- The term `ordinary care' means the care,
skill, prudence, and diligence under the circumstances prevailing at the
time the care is provided that a prudent individual acting in a like
capacity and familiar with the care being provided would use in providing
care of a similar character.
`(G) SUBSTANTIAL HARM- The term `substantial harm' means the loss
of life, loss or significant impairment of limb or bodily function,
significant disfigurement, or severe and chronic physical
pain.
`(12) EFFECTIVE DATE- The provisions of this subsection shall apply
to acts and omissions occurring on or after the date of enactment of this
subsection.'.
(b) IMMUNITY FROM LIABILITY FOR PROVISION OF INSURANCE OPTIONS-
(1) IN GENERAL- Section 502 of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1132), as amended by subsection (a), is
further amended by adding at the end the following:
`(o) IMMUNITY FROM LIABILITY FOR PROVISION OF INSURANCE OPTIONS-
`(1) IN GENERAL- No liability shall arise under subsection (n) with
respect to a participant or beneficiary against a group health plan (other
than a fully insured group health plan) if such plan offers the participant
or beneficiary the coverage option described in paragraph (2).
`(2) COVERAGE OPTION- The coverage option described in this
paragraph is one under which the group health plan (other than a fully
insured group health plan), at the time of enrollment or as provided for in
paragraph (3), provides the participant or beneficiary with the option
to--
`(A) enroll for coverage under a fully insured health plan;
or
`(B) receive an individual benefit payment, in an amount equal to
the amount that would be contributed on behalf of the participant or
beneficiary by the plan sponsor for enrollment in the group health plan,
for use by the participant or beneficiary in obtaining health insurance
coverage in the individual market.
`(3) TIME OF OFFERING OF OPTION- The coverage option described in
paragraph (2) shall be offered to a participant or beneficiary--
`(A) during the first period in which the individual is eligible
to enroll under the group health plan; or
`(B) during any special enrollment period provided by the group
health plan after the date of enactment of the Patients' Bill of Rights
Plus Act for purposes of offering such coverage option.'.
(2) AMENDMENTS TO INTERNAL REVENUE CODE-
(A) EXCLUSION FROM INCOME- Section 106 of the Internal Revenue
Code of 1986 (relating to contributions by employer to accident and health
plans) is amended by adding at the end the following:
`(d) TREATMENT OF CERTAIN COVERAGE OPTION UNDER SELF-INSURED PLANS- No
amount shall be included in the gross income of an individual by reason
of--
`(1) the individual's right to elect a coverage option described in
section 502(o)(2) of the Employee Retirement Income Security Act of 1974,
or
`(2) the receipt by the individual of an individual benefit payment
described in section 502(o)(2)(A) of such Act.'
(B) NONDISCRIMINATION RULES- Section 105(h) of such Code (relating
to self-insured medical expense reimbursement plans) is amended by adding
at the end the following:
`(11) TREATMENT OF CERTAIN COVERAGE OPTIONS- If a self-insured
medical reimbursement plan offers the coverage option described in section
502(o)(2) of the Employee Retirement Income Security Act of 1974, employees
who elect such option shall be treated as eligible to benefit under the plan
and the plan shall be treated as benefiting such employees.'
(c) CONFORMING AMENDMENT- Section 502(a)(1)(A) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1132(a)(1)(A)) is amended by
inserting `or (n)' after `subsection (c)'.
SEC. 2232. LIMITATION ON CERTAIN CLASS ACTION LITIGATION.
(a) ERISA- Section 502 of the Employee Retirement Income Security Act
of 1974 (29 U.S.C. 1132), as amended by section 2231, is further amended by
adding at the end the following:
`(p) LIMITATION ON CLASS ACTION LITIGATION- A claim or cause of action
under section 502(n) may not be maintained as a class action.'.
(b) RICO- Section 1964(c) of title 18, United States Code, is
amended--
(1) by inserting `(1)' after the subsection designation;
and
(2) by adding at the end the following:
`(2) No action may be brought under this subsection, or alleging any
violation of section 1962, against any person where the action seeks relief
for which a remedy may be provided under section 502 of the Employee
Retirement Income Security Act of 1974.'.
(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.
(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.
`(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--
`(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;
`(d) SECONDARY CONSULTATIONS-
`(1) IN GENERAL- A group health plan, and a health insurance issuer
providing health insurance coverage in connection with a group health plan,
that provides coverage with respect to medical and surgical services
provided in relation to the diagnosis and treatment of cancer shall ensure
that full coverage is provided for secondary consultations by specialists in
the appropriate medical fields (including pathology, radiology, and
oncology) to confirm or refute such diagnosis. Such plan or issuer shall
ensure that full coverage is provided for such secondary consultation
whether such consultation is based on a positive or negative initial
diagnosis. In any case in which the attending physician certifies in writing
that services necessary for such a secondary consultation are not
sufficiently available from specialists operating under the plan with
respect to whose services coverage is otherwise provided under such plan or
by such issuer, such plan or issuer shall ensure that coverage is provided
with respect to the services necessary for the secondary consultation with
any other specialist selected by the attending physician for such purpose at
no additional cost to the individual beyond that which the individual would
have paid if the specialist was participating in the network of the
plan.
`(2) EXCEPTION- Nothing in paragraph (1) shall be construed as
requiring the provision of secondary consultations where the patient
determines not to seek such a consultation.
`(e) PROHIBITION ON PENALTIES OR INCENTIVES- A group health plan, and
a health insurance issuer providing health insurance coverage in connection
with a group health plan, may not--
`(1) penalize or otherwise reduce or limit the reimbursement of a
provider or specialist because the provider or specialist provided care to a
participant or beneficiary in accordance with this section;
`(2) provide financial or other incentives to a physician or
specialist to induce the physician or specialist to keep the length of
inpatient stays of patients following a mastectomy, lumpectomy, or a lymph
node dissection for the treatment of breast cancer below certain limits or
to limit referrals for secondary consultations; or
`(3) provide financial or other incentives to a physician or
specialist to induce the physician or specialist to refrain from referring a
participant or beneficiary for a secondary consultation that would otherwise
be covered by the plan or coverage involved under subsection
(d).'.
(2) CLERICAL AMENDMENT- The table of contents in section 1 of the
Employee Retirement Income Security Act of 1974 is amended by inserting
after the item relating to section 714 the following new item:
`Sec. 715. Required coverage for minimum hospital stay for
mastectomies and lymph node dissections for the treatment of breast cancer
and coverage for secondary consultations.'.
(d) AMENDMENTS TO PHSA RELATING TO THE GROUP MARKET- Subpart 2 of part
A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg-4 et seq.)
is amended by adding at the end the following new section:
`SEC. 2707. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR MASTECTOMIES
AND LYMPH NODE DISSECTIONS FOR THE TREATMENT OF BREAST CANCER AND COVERAGE FOR
SECONDARY CONSULTATIONS.
`(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--
`(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;
`(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.
`(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--
`(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;
`(d) SECONDARY CONSULTATIONS-
`(1) IN GENERAL- A group health plan that provides coverage with
respect to medical and surgical services provided in relation to the
diagnosis and treatment of cancer shall ensure that full coverage is
provided for secondary consultations by specialists in the appropriate
medical fields (including pathology, radiology, and oncology) to confirm or
refute such diagnosis. Such plan or issuer shall ensure that full coverage
is provided for such secondary consultation whether such consultation is
based on a positive or negative initial diagnosis. In any case in which the
attending physician certifies in writing that services necessary for such a
secondary consultation are not sufficiently available from specialists
operating under the plan with respect to whose services coverage is
otherwise provided under such plan or by such issuer, such plan or issuer
shall ensure that coverage is provided with respect to the services
necessary for the secondary consultation with any other specialist selected
by the attending physician for such purpose at no additional cost to the
individual beyond that which the individual would have paid if the
specialist was participating in the network of the plan.
`(2) EXCEPTION- Nothing in paragraph (1) shall be construed as
requiring the provision of secondary consultations where the patient
determines not to seek such a consultation.
`(e) PROHIBITION ON PENALTIES- A group health plan may not--
`(1) penalize or otherwise reduce or limit the reimbursement of a
provider or specialist because the provider or specialist provided care to a
participant or beneficiary in accordance with this section;
`(2) provide financial or other incentives to a physician or
specialist to induce the physician or specialist to keep the length of
inpatient stays of patients following a mastectomy, lumpectomy, or a lymph
node dissection for the treatment of breast cancer below certain limits or
to limit referrals for secondary consultations; or
`(3) provide financial or other incentives to a physician or
specialist to induce the physician or specialist to refrain from referring a
participant or beneficiary for a secondary consultation that would otherwise
be covered by the plan involved under subsection (d).'.
(2) CLERICAL AMENDMENT- The table of contents for chapter 100 of
such Code is amended by inserting after the item relating to section 9813
the following new item:
`Sec. 9814. Required coverage for minimum hospital stay for
mastectomies and lymph node dissections for the treatment of breast cancer
and coverage for secondary consultations.'.
TITLE XXIV--GENETIC INFORMATION AND SERVICES
SEC. 2401. SHORT TITLE.
This title may be cited as the `Genetic Information Nondiscrimination
in Health Insurance Act of 2000'.
SEC. 2402. AMENDMENTS TO EMPLOYEE RETIREMENT INCOME SECURITY ACT OF
1974.
(a) PROHIBITION OF HEALTH DISCRIMINATION ON THE BASIS OF GENETIC
INFORMATION OR GENETIC SERVICES-
(1) NO ENROLLMENT RESTRICTION FOR GENETIC SERVICES- Section
702(a)(1)(F) of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1182(a)(1)(F)) is amended by inserting before the period the
following: `(including information about a request for or receipt of genetic
services)'.
(2) NO DISCRIMINATION IN GROUP PREMIUMS BASED ON PREDICTIVE GENETIC
INFORMATION- Subpart B of part 7 of subtitle B of title I of the Employee
Retirement Income Security Act of 1974, as amended by section 2301(c), is
further amended by adding at the end the following:
`SEC. 716. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE
BASIS OF PREDICTIVE GENETIC INFORMATION.
`A group health plan, or a health insurance issuer offering group
health insurance coverage in connection with a group health plan, shall not
adjust premium or contribution amounts for a group on the basis of predictive
genetic information concerning any individual (including a dependent) or
family member of the individual (including information about a request for or
receipt of genetic services).'.
(3) CONFORMING AMENDMENTS-
(A) IN GENERAL- Section 702(b) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1182(b)) is amended by adding at the end
the following:
`(3) REFERENCE TO RELATED PROVISION- For a provision prohibiting the
adjustment of premium or contribution amounts for a group under a group
health plan on the basis of predictive genetic information (including
information about a request for or receipt of genetic services), see section
716.'.
(B) TABLE OF CONTENTS- The table of contents in section 1 of the
Employee Retirement Income Security Act of 1974, as amended by section
2301, is further amended by inserting after the item relating to section
715 the following new item:
`Sec. 716. Prohibiting premium discrimination against groups on the
basis of predictive genetic information.'.
(b) LIMITATION ON COLLECTION OF PREDICTIVE GENETIC INFORMATION-
Section 702 of the Employee Retirement Income Security Act of 1974 (29 U.S.C.
1182) is amended by adding at the end the following:
`(c) COLLECTION OF PREDICTIVE GENETIC INFORMATION-
`(1) LIMITATION ON REQUESTING OR REQUIRING PREDICTIVE GENETIC
INFORMATION- Except as provided in paragraph (2), a group health plan, or a
health insurance issuer offering health insurance coverage in connection
with a group health plan, shall not request or require predictive genetic
information concerning any individual (including a dependent) or family
member of the individual (including information about a request for or
receipt of genetic services).
`(2) INFORMATION NEEDED FOR DIAGNOSIS, TREATMENT, OR PAYMENT-
`(A) IN GENERAL- Notwithstanding paragraph (1), a group health
plan, or a health insurance issuer offering health insurance coverage in
connection with a group health plan, that provides health care items and
services to an individual or dependent may request (but may not require)
that such individual or dependent disclose, or authorize the collection or
disclosure of, predictive genetic information for purposes of diagnosis,
treatment, or payment relating to the provision of health care items and
services to such individual or dependent.
`(B) NOTICE OF CONFIDENTIALITY PRACTICES AND DESCRIPTION OF
SAFEGUARDS- As a part of a request under subparagraph (A), the group
health plan, or a health insurance issuer offering health insurance
coverage in connection with a group health plan, shall provide to the
individual or dependent a description of the procedures in place to
safeguard the confidentiality, as described in subsection (d), of such
predictive genetic information.
`(d) CONFIDENTIALITY WITH RESPECT TO PREDICTIVE GENETIC INFORMATION-
`(1) NOTICE OF CONFIDENTIALITY PRACTICES-
`(A) PREPARATION OF WRITTEN NOTICE- A group health plan, or a
health insurance issuer offering health insurance coverage in connection
with a group health plan, shall post or provide, in writing and in a clear
and conspicuous manner, notice of the plan or issuer's confidentiality
practices, that shall include--
`(i) a description of an individual's rights with respect to
predictive genetic information;
`(ii) the procedures established by the plan or issuer for the
exercise of the individual's rights; and
`(iii) the right to obtain a copy of the notice of the
confidentiality practices required under this
subsection.
`(B) MODEL NOTICE- The Secretary, in consultation with the
National Committee on Vital and Health Statistics and the National
Association of Insurance Commissioners, and after notice and opportunity
for public comment, shall develop and disseminate model notices of
confidentiality practices. Use of the model notice shall serve as a
defense against claims of receiving inappropriate notice.
`(2) ESTABLISHMENT OF SAFEGUARDS- A group health plan, or a health
insurance issuer offering health insurance coverage in connection with a
group health plan, shall establish and maintain appropriate administrative,
technical, and physical safeguards to protect the confidentiality, security,
accuracy, and integrity of predictive genetic information created, received,
obtained, maintained, used, transmitted, or disposed of by such plan or
issuer.'.
(c) DEFINITIONS- Section 733(d) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1191b(d)) is amended by adding at the end the
following:
`(5) FAMILY MEMBER- The term `family member' means with respect to
an individual--
`(A) the spouse of the individual;
`(B) a dependent child of the individual, including a child who is
born to or placed for adoption with the individual; and
`(C) all other individuals related by blood to the individual or
the spouse or child described in subparagraph (A) or (B).
`(6) GENETIC INFORMATION- The term `genetic information' means
information about genes, gene products, or inherited characteristics that
may derive from an individual or a family member (including information
about a request for or receipt of genetic services).
`(7) GENETIC SERVICES- The term `genetic services' means health
services provided to obtain, assess, or interpret genetic information for
diagnostic and therapeutic purposes, and for genetic education and
counseling.
`(8) PREDICTIVE GENETIC INFORMATION-
`(A) IN GENERAL- The term `predictive genetic information' means,
in the absence of symptoms, clinical signs, or a diagnosis of the
condition related to such information--
`(i) information about an individual's genetic
tests;
`(ii) information about genetic tests of family members of the
individual; or
`(iii) information about the occurrence of a disease or disorder
in family members.
`(B) EXCEPTIONS- The term `predictive genetic information' shall
not include--
`(i) information about the sex or age of the
individual;
`(ii) information derived from physical tests, such as the
chemical, blood, or urine analyses of the individual including
cholesterol tests; and
`(iii) information about physical exams of the
individual.
`(9) GENETIC TEST- The term `genetic test' means the analysis of
human DNA, RNA, chromosomes, proteins, and certain metabolites, including
analysis of genotypes, mutations, phenotypes, or karyotypes, for the purpose
of predicting risk of disease in asymptomatic or undiagnosed individuals.
Such term does not include physical tests, such as the chemical, blood, or
urine analyses of the individual including cholesterol tests, and physical
exams of the individual, in order to detect symptoms, clinical signs, or a
diagnosis of disease.'.
(d) EFFECTIVE DATE- Except as provided in this section, this section
and the amendments made by this section shall apply with respect to group
health plans for plan years beginning 1 year after the date of the enactment
of this Act.
SEC. 2403. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.
(a) AMENDMENTS RELATING TO THE GROUP MARKET-
(1) PROHIBITION OF HEALTH DISCRIMINATION ON THE BASIS OF GENETIC
INFORMATION IN THE GROUP MARKET-
(A) NO ENROLLMENT RESTRICTION FOR GENETIC SERVICES- Section
2702(a)(1)(F) of the Public Health Service Act (42 U.S.C.
300gg-1(a)(1)(F)) is amended by inserting before the period the following:
`(including information about a request for or receipt of genetic
services)'.
(B) NO DISCRIMINATION IN PREMIUMS BASED ON PREDICTIVE GENETIC
INFORMATION- Subpart 2 of part A of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-4 et seq.), as amended by section 2301(d), is
amended by adding at the end the following new section:
`SEC. 2708. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE
BASIS OF PREDICTIVE GENETIC INFORMATION IN THE GROUP MARKET.
`A group health plan, or a health insurance issuer offering group
health insurance coverage in connection with a group health plan shall not
adjust premium or contribution amounts for a group on the basis of predictive
genetic information concerning any individual (including a dependent) or
family member of the individual (including information about a request for or
receipt of genetic services).'.
(C) CONFORMING AMENDMENT- Section 2702(b) of the Public Health
Service Act (42 U.S.C. 300gg-1(b)) is amended by adding at the end the
following:
`(3) REFERENCE TO RELATED PROVISION- For a provision prohibiting the
adjustment of premium or contribution amounts for a group under a group
health plan on the basis of predictive genetic information (including
information about a request for or receipt of genetic services), see section
2708.'.
(D) LIMITATION ON COLLECTION AND DISCLOSURE OF PREDICTIVE GENETIC
INFORMATION- Section 2702 of the Public Health Service Act (42 U.S.C.
300gg-1) is amended by adding at the end the following:
`(c) COLLECTION OF PREDICTIVE GENETIC INFORMATION-
`(1) LIMITATION ON REQUESTING OR REQUIRING PREDICTIVE GENETIC
INFORMATION- Except as provided in paragraph (2), a group health plan, or a
health insurance issuer offering health insurance coverage in connection
with a group health plan, shall not request or require predictive genetic
information concerning any individual (including a dependent) or a family
member of the individual (including information about a request for or
receipt of genetic services).
`(2) INFORMATION NEEDED FOR DIAGNOSIS, TREATMENT, OR PAYMENT-
`(A) IN GENERAL- Notwithstanding paragraph (1), a group health
plan, or a health insurance issuer offering health insurance coverage in
connection with a group health plan, that provides health care items and
services to an individual or dependent may request (but may not require)
that such individual or dependent disclose, or authorize the collection or
disclosure of, predictive genetic information for purposes of diagnosis,
treatment, or payment relating to the provision of health care items and
services to such individual or dependent.
`(B) NOTICE OF CONFIDENTIALITY PRACTICES AND DESCRIPTION OF
SAFEGUARDS- As a part of a request under subparagraph (A), the group
health plan, or a health insurance issuer offering health insurance
coverage in connection with a group health plan, shall provide to the
individual or dependent a description of the procedures in place to
safeguard the confidentiality, as described in subsection (d), of such
predictive genetic information.
`(d) CONFIDENTIALITY WITH RESPECT TO PREDICTIVE GENETIC INFORMATION-
`(1) NOTICE OF CONFIDENTIALITY PRACTICES-
`(A) PREPARATION OF WRITTEN NOTICE- A group health plan, or a
health insurance issuer offering health insurance coverage in connection
with a group health plan, shall post or provide, in writing and in a clear
and conspicuous manner, notice of the plan or issuer's confidentiality
practices, that shall include--
`(i) a description of an individual's rights with respect to
predictive genetic information;
`(ii) the procedures established by the plan or issuer for the
exercise of the individual's rights; and
`(iii) the right to obtain a copy of the notice of the
confidentiality practices required under this
subsection.
`(B) MODEL NOTICE- The Secretary, in consultation with the
National Committee on Vital and Health Statistics and the National
Association of Insurance Commissioners, and after notice and opportunity
for public comment, shall develop and disseminate model notices of
confidentiality practices. Use of the model notice shall serve as a
defense against claims of receiving inappropriate notice.
`(2) ESTABLISHMENT OF SAFEGUARDS- A group health plan, or a health
insurance issuer offering health insurance coverage in connection with a
group health plan, shall establish and maintain appropriate administrative,
technical, and physical safeguards to protect the confidentiality, security,
accuracy, and integrity of predictive genetic information created, received,
obtained, maintained, used, transmitted, or disposed of by such plan or
issuer.'.
(2) DEFINITIONS- Section 2791(d) of the Public Health Service Act
(42 U.S.C. 300gg-91(d)) is amended by adding at the end the
following:
`(15) FAMILY MEMBER- The term `family member' means, with respect to
an individual--
`(A) the spouse of the individual;
`(B) a dependent child of the individual, including a child who is
born to or placed for adoption with the individual; and
`(C) all other individuals related by blood to the individual or
the spouse or child described in subparagraph (A) or (B).
`(16) GENETIC INFORMATION- The term `genetic information' means
information about genes, gene products, or inherited characteristics that
may derive from an individual or a family member (including information
about a request for or receipt of genetic services).
`(17) GENETIC SERVICES- The term `genetic services' means health
services provided to obtain, assess, or interpret genetic information for
diagnostic and therapeutic purposes, and for genetic education and
counseling.
`(18) PREDICTIVE GENETIC INFORMATION-
`(A) IN GENERAL- The term `predictive genetic information' means,
in the absence of symptoms, clinical signs, or a diagnosis of the
condition related to such information--
`(i) information about an individual's genetic
tests;
`(ii) information about genetic tests of family members of the
individual; or
`(iii) information about the occurrence of a disease or disorder
in family members.
`(B) EXCEPTIONS- The term `predictive genetic information' shall
not include--
`(i) information about the sex or age of the
individual;
`(ii) information derived from physical tests, such as the
chemical, blood, or urine analyses of the individual including
cholesterol tests; and
`(iii) information about physical exams of the
individual.
`(19) GENETIC TEST- The term `genetic test' means the analysis of
human DNA, RNA, chromosomes, proteins, and certain metabolites, including
analysis of genotypes, mutations, phenotypes, or karyotypes, for the purpose
of predicting risk of disease in asymptomatic or undiagnosed individuals.
Such term does not include physical tests, such as the chemical, blood, or
urine analyses of the individual including cholesterol tests, and physical
exams of the individual, in order to detect symptoms, clinical signs, or a
diagnosis of disease.'.
(e) AMENDMENTS TO PHSA RELATING TO THE INDIVIDUAL MARKET- The first
subpart 3 of part B of title XXVII of the Public Health Service Act (42 U.S.C.
300gg-51 et seq.) (relating to other requirements) (42 U.S.C. 300gg-51 et
seq.), as amended by section 2301(e), is further amended by adding at the end
the following:
`SEC. 2754. PROHIBITION OF HEALTH DISCRIMINATION ON THE BASIS OF
PREDICTIVE GENETIC INFORMATION.
`(a) PROHIBITION ON PREDICTIVE GENETIC INFORMATION AS A CONDITION OF
ELIGIBILITY- A health insurance issuer offering health insurance coverage in
the individual market may not use predictive genetic information as a
condition of eligibility of an individual to enroll in individual health
insurance coverage (including information about a request for or receipt of
genetic services).
`(b) PROHIBITION ON PREDICTIVE GENETIC INFORMATION IN SETTING PREMIUM
RATES- A health insurance issuer offering health insurance coverage in the
individual market shall not adjust premium rates for individuals on the basis
of predictive genetic information concerning such an individual (including a
dependent) or a family member of the individual (including information about a
request for or receipt of genetic services).
`(c) COLLECTION OF PREDICTIVE GENETIC INFORMATION-
`(1) LIMITATION ON REQUESTING OR REQUIRING PREDICTIVE GENETIC
INFORMATION- Except as provided in paragraph (2), a health insurance issuer
offering health insurance coverage in the individual market shall not
request or require predictive genetic information concerning any individual
(including a dependent) or a family member of the individual (including
information about a request for or receipt of genetic services).
`(2) INFORMATION NEEDED FOR DIAGNOSIS, TREATMENT, OR PAYMENT-
`(A) IN GENERAL- Notwithstanding paragraph (1), a health insurance
issuer offering health insurance coverage in the individual market that
provides health care items and services to an individual or dependent may
request (but may not require) that such individual or dependent disclose,
or authorize the collection or disclosure of, predictive genetic
information for purposes of diagnosis, treatment, or payment relating to
the provision of health care items and services to such individual or
dependent.
`(B) NOTICE OF CONFIDENTIALITY PRACTICES AND DESCRIPTION OF
SAFEGUARDS- As a part of a request under subparagraph (A), the health
insurance issuer offering health insurance coverage in the individual
market shall provide to the individual or dependent a description of the
procedures in place to safeguard the confidentiality, as described in
subsection (d), of such predictive genetic information.
`(d) CONFIDENTIALITY WITH RESPECT TO PREDICTIVE GENETIC INFORMATION-
`(1) NOTICE OF CONFIDENTIALITY PRACTICES-
`(A) PREPARATION OF WRITTEN NOTICE- A health insurance issuer
offering health insurance coverage in the individual market shall post or
provide, in writing and in a clear and conspicuous manner, notice of the
issuer's confidentiality practices, that shall include--
`(i) a description of an individual's rights with respect to
predictive genetic information;
`(ii) the procedures established by the issuer for the exercise
of the individual's rights; and
`(iii) the right to obtain a copy of the notice of the
confidentiality practices required under this
subsection.
`(B) MODEL NOTICE- The Secretary, in consultation with the
National Committee on Vital and Health Statistics and the National
Association of Insurance Commissioners, and after notice and opportunity
for public comment, shall develop and disseminate model notices of
confidentiality practices. Use of the model notice shall serve as a
defense against claims of receiving inappropriate notice.
`(2) ESTABLISHMENT OF SAFEGUARDS- A health insurance issuer offering
health insurance coverage in the individual market shall establish and
maintain appropriate administrative, technical, and physical safeguards to
protect the confidentiality, security, accuracy, and integrity of predictive
genetic information created, received, obtained, maintained, used,
transmitted, or disposed of by such issuer.'.
(c) EFFECTIVE DATE- The amendments made by this section shall apply
with respect to--
(1) group health plans, and health insurance coverage offered in
connection with group health plans, for plan years beginning after 1 year
after the date of enactment of this Act; and
(2) health insurance coverage offered, sold, issued, renewed, in
effect, or operated in the individual market after 1 year after the date of
enactment of this Act.
SEC. 2404. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.
(a) PROHIBITION OF HEALTH DISCRIMINATION ON THE BASIS OF GENETIC
INFORMATION OR GENETIC SERVICES-
(1) NO ENROLLMENT RESTRICTION FOR GENETIC SERVICES- Section
9802(a)(1)(F) of the Internal Revenue Code of 1986 is amended by inserting
before the period the following: `(including information about a request for
or receipt of genetic services)'.
(2) NO DISCRIMINATION IN GROUP PREMIUMS BASED ON PREDICTIVE GENETIC
INFORMATION-
(A) IN GENERAL- Subchapter B of chapter 100 of the Internal
Revenue Code of 1986, as amended by section 2301(f), is further amended by
adding at the end the following:
`SEC. 9815. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE
BASIS OF PREDICTIVE GENETIC INFORMATION.
`A group health plan shall not adjust premium or contribution amounts
for a group on the basis of predictive genetic information concerning any
individual (including a dependent) or a family member of the individual
(including information about a request for or receipt of genetic
services).'.
(B) CONFORMING AMENDMENT- Section 9802(b) of the Internal Revenue
Code of 1986 is amended by adding at the end the following:
`(3) REFERENCE TO RELATED PROVISION- For a provision prohibiting the
adjustment of premium or contribution amounts for a group under a group
health plan on the basis of predictive genetic information (including
information about a request for or the receipt of genetic services), see
section 9815.'.
(C) AMENDMENT TO TABLE OF SECTIONS- The table of sections for
subchapter B of chapter 100 of the Internal Revenue Code of 1986, as
amended by section 2301(f), is further amended by adding at the end the
following:
`Sec. 9815. Prohibiting premium discrimination against groups on the
basis of predictive genetic information.'.
(b) LIMITATION ON COLLECTION OF PREDICTIVE GENETIC INFORMATION-
Section 9802 of the Internal Revenue Code of 1986 is amended by adding at the
end the following:
`(d) COLLECTION OF PREDICTIVE GENETIC INFORMATION-
`(1) LIMITATION ON REQUESTING OR REQUIRING PREDICTIVE GENETIC
INFORMATION- Except as provided in paragraph (2), a group health plan shall
not request or require predictive genetic information concerning any
individual (including a dependent) or a family member of the individual
(including information about a request for or receipt of genetic
services).
`(2) INFORMATION NEEDED FOR DIAGNOSIS, TREATMENT, OR PAYMENT-
`(A) IN GENERAL- Notwithstanding paragraph (1), a group health
plan that provides health care items and services to an individual or
dependent may request (but may not require) that such individual or
dependent disclose, or authorize the collection or disclosure of,
predictive genetic information for purposes of diagnosis, treatment, or
payment relating to the provision of health care items and services to
such individual or dependent.
`(B) NOTICE OF CONFIDENTIALITY PRACTICES; DESCRIPTION OF
SAFEGUARDS- As a part of a request under subparagraph (A), the group
health plan shall provide to the individual or dependent a description of
the procedures in place to safeguard the confidentiality, as described in
subsection (e), of such predictive genetic information.
`(e) CONFIDENTIALITY WITH RESPECT TO PREDICTIVE GENETIC INFORMATION-
`(1) NOTICE OF CONFIDENTIALITY PRACTICES-
`(A) PREPARATION OF WRITTEN NOTICE- A group health plan shall post
or provide, in writing and in a clear and conspicuous manner, notice of
the plan's confidentiality practices, that shall include--
`(i) a description of an individual's rights with respect to
predictive genetic information;
`(ii) the procedures established by the plan for the exercise of
the individual's rights; and
`(iii) the right to obtain a copy of the notice of the
confidentiality practices required under this
subsection.
`(B) MODEL NOTICE- The Secretary, in consultation with the
National Committee on Vital and Health Statistics and the National
Association of Insurance Commissioners, and after notice and opportunity
for public comment, shall develop and disseminate model notices of
confidentiality practices. Use of the model notice shall serve as a
defense against claims of receiving inappropriate notice.
`(2) ESTABLISHMENT OF SAFEGUARDS- A group health plan shall
establish and maintain appropriate administrative, technical, and physical
safeguards to protect the confidentiality, security, accuracy, and integrity
of predictive genetic information created, received, obtained, maintained,
used, transmitted, or disposed of by such plan.'.
(c) DEFINITIONS- Section 9832(d) of the Internal Revenue Code of 1986
is amended by adding at the end the following:
`(6) FAMILY MEMBER- The term `family member' means, with respect to
an individual--
`(A) the spouse of the individual;
`(B) a dependent child of the individual, including a child who is
born to or placed for adoption with the individual; and
`(C) all other individuals related by blood to the individual or
the spouse or child described in subparagraph (A) or (B).
`(7) GENETIC INFORMATION- The term `genetic information' means
information about genes, gene products, or inherited characteristics that
may derive from an individual or a family member (including information
about a request for or receipt of genetic services).
`(8) GENETIC SERVICES- The term `genetic services' means health
services provided to obtain, assess, or interpret genetic information for
diagnostic and therapeutic purposes, and for genetic education and
counseling.
`(9) PREDICTIVE GENETIC INFORMATION-
`(A) IN GENERAL- The term `predictive genetic information' means,
in the absence of symptoms, clinical signs, or a diagnosis of the
condition related to such information--
`(i) information about an individual's genetic
tests;
`(ii) information about genetic tests of family members of the
individual; or
`(iii) information about the occurrence of a disease or disorder
in family members.
`(B) EXCEPTIONS- The term `predictive genetic information' shall
not include--
`(i) information about the sex or age of the
individual;
`(ii) information derived from physical tests, such as the
chemical, blood, or urine analyses of the individual including
cholesterol tests; and
`(iii) information about physical exams of the
individual.
`(10) GENETIC TEST- The term `genetic test' means the analysis of
human DNA, RNA, chromosomes, proteins, and certain metabolites, including
analysis of genotypes, mutations, phenotypes, or karyotypes, for the purpose
of predicting risk of disease in asymptomatic or undiagnosed individuals.
Such term does not include physical tests, such as the chemical, blood, or
urine analyses of the individual including cholesterol tests, and physical
exams of the individual, in order to detect symptoms, clinical signs, or a
diagnosis of disease.'.
(d) EFFECTIVE DATE- Except as provided in this section, this section
and the amendments made by this section shall apply with respect to group
health plans for plan years beginning after 1 year after the date of the
enactment of this Act.
TITLE XXV--PATIENT SAFETY AND ERRORS REDUCTION
SEC. 2501. SHORT TITLE.
This title may be cited as the `Patient Safety and Errors Reduction
Act'.
SEC. 2502. PURPOSES.
It is the purpose of this title to--
(1) promote the identification, evaluation, and reporting of medical
errors;
(2) raise standards and expectations for improvements in patient
safety;
(3) reduce deaths, serious injuries, and other medical errors
through the implementation of safe practices at the delivery
level;
(4) develop error reduction systems with legal protections to
support the collection of information under such systems;
(5) extend existing confidentiality and peer review protections to
the reports relating to medical errors that are reported under such systems
that are developed for safety and quality improvement purposes;
and
(6) provide for the establishment of systems of information
collection, analysis, and dissemination to enhance the knowledge base
concerning patient safety.
SEC. 2503. AMENDMENT TO PUBLIC HEALTH SERVICE ACT.
Title IX of the Public Health Service Act (42 U.S.C. 299 et seq.) is
amended--
(1) by redesignating part C as part D;
(2) by redesignating sections 921 through 928, as sections 931
through 938, respectively;
(3) in section 938(1) (as so redesignated), by striking `921' and
inserting `931'; and
(4) by inserting after part B the following:
`PART C--REDUCING ERRORS IN HEALTH CARE
`SEC. 921. DEFINITIONS.
`(1) ADVERSE EVENT- The term `adverse event' means, with respect to
the patient of a provider of services, an untoward incident, therapeutic
misadventure, or iatrogenic injury directly associated with the provision of
health care items and services by a health care provider or provider of
services.
`(2) CENTER- The term `Center' means the Center for Quality
Improvement and Patient Safety established under section 922(b).
`(3) CLOSE CALL- The term `close call' means, with respect to the
patient of a provider of services, any event or situation that--
`(A) but for chance or a timely intervention, could have resulted
in an accident, injury, or illness; and
`(B) is directly associated with the provision of health care
items and services by a provider of services.
`(4) EXPERT ORGANIZATION- The term `expert organization' means a
third party acting on behalf of, or in conjunction with, a provider of
services to collect information about, or evaluate, a medical
event.
`(5) HEALTH CARE OVERSIGHT AGENCY- The term `health care oversight
agency' means an agency, entity, or person, including the employees and
agents thereof, that performs or oversees the performance of any activities
necessary to ensure the safety of the health care system.
`(6) HEALTH CARE PROVIDER- The term `health care provider'
means--
`(A) any provider of services (as defined in section 1861(u) of
the Social Security Act); and
`(B) any person furnishing any medical or other health care
services as defined in section 1861(s)(1) and (2) of such Act through, or
under the authority of, a provider of services described in subparagraph
(A).
`(7) PROVIDER OF SERVICES- The term `provider of services' means a
hospital, skilled nursing facility, comprehensive outpatient rehabilitation
facility, home health agency, renal dialysis facility, ambulatory surgical
center, or hospice program, and any other entity specified in regulations
promulgated by the Secretary after public notice and comment.
`(8) PUBLIC HEALTH AUTHORITY- The term `public health authority'
means an agency or authority of the United States, a State, a territory, a
political subdivision of a State or territory, and an Indian tribe that is
responsible for public health matters as part of its official
mandate.
`(9) MEDICAL EVENT- The term `medical event' means, with respect to
the patient of a provider of services, any sentinel event, adverse event, or
close call.
`(10) MEDICAL EVENT ANALYSIS ENTITY- The term `medical event
analysis entity' means an entity certified under section 923(a).
`(11) ROOT CAUSE ANALYSIS-
`(A) IN GENERAL- The term `root cause analysis' means a process
for identifying the basic or contributing causal factors that underlie
variation in performance associated with medical events
that--
`(i) has the characteristics described in subparagraph
(B);
`(ii) includes participation by the leadership of the provider
of services and individuals most closely involved in the processes and
systems under review;
`(iii) is internally consistent; and
`(iv) includes the consideration of relevant
literature.
`(B) CHARACTERISTICS- The characteristics described in this
subparagraph include the following:
`(i) The analysis is interdisciplinary in nature and involves
those individuals who are responsible for administering the reporting
systems.
`(ii) The analysis focuses primarily on systems and processes
rather than individual performance.
`(iii) The analysis involves a thorough review of all aspects of
the process and all contributing factors involved.
`(iv) The analysis identifies changes that could be made in
systems and processes, through either redesign or development of new
processes or systems, that would improve performance and reduce the risk
of medical events.
`(12) SENTINEL EVENT- The term `sentinel event' means, with respect
to the patient of a provider of services, an unexpected occurrence
that--
`(A) involves death or serious physical or psychological injury
(including loss of a limb); and
`(B) is directly associated with the provision of health care
items and services by a health care provider or provider of
services.
`SEC. 922. RESEARCH TO IMPROVE THE QUALITY AND SAFETY OF PATIENT
CARE.
`(a) IN GENERAL- To improve the quality and safety of patient care,
the Director shall--
`(1) conduct and support research, evaluations and training, support
demonstration projects, provide technical assistance, and develop and
support partnerships that will identify and determine the causes of medical
errors and other threats to the quality and safety of patient
care;
`(2) identify and evaluate interventions and strategies for
preventing or reducing medical errors and threats to the quality and safety
of patient care;
`(3) identify, in collaboration with experts from the public and
private sector, reporting parameters to provide consistency throughout the
errors reporting system;
`(4) identify approaches for the clinical management of
complications from medical errors; and
`(5) establish mechanisms for the rapid dissemination of
interventions and strategies identified under this section for which there
is scientific evidence of effectiveness.
`(b) CENTER FOR QUALITY IMPROVEMENT AND PATIENT SAFETY-
`(1) ESTABLISHMENT- The Director shall establish a center to be
known as the Center for Quality Improvement and Patient Safety to assist the
Director in carrying out the requirements of subsection (a).
`(2) MISSION- The Center shall--
`(A) provide national leadership for research and other
initiatives to improve the quality and safety of patient
care;
`(B) build public-private sector partnerships to improve the
quality and safety of patient care; and
`(C) serve as a national resource for research and learning from
medical errors.
`(A) IN GENERAL- In carrying out this section, the Director,
acting through the Center, shall consult and build partnerships, as
appropriate, with all segments of the health care industry, including
health care practitioners and patients, those who manage health care
facilities, systems and plans, peer review organizations, health care
purchasers and policymakers, and other users of health care
research.
`(B) REQUIRED DUTIES- In addition to the broad responsibilities
that the Director may assign to the Center for research and related
activities that are designed to improve the quality of health care, the
Director shall ensure that the Center--
`(i) builds scientific knowledge and understanding of the causes
of medical errors in all health care settings and identifies or develops
and validates effective interventions and strategies to reduce errors
and improve the safety and quality of patient care;
`(ii) promotes public and private sector research on patient
safety by--
`(I) developing a national patient safety research
agenda;
`(II) identifying promising opportunities for preventing or
reducing medical errors; and
`(III) tracking the progress made in addressing the highest
priority research questions with respect to patient
safety;
`(iii) facilitates the development of voluntary national patient
safety goals by convening all segments of the health care industry and
tracks the progress made in meeting those goals;
`(iv) analyzes national patient safety data for inclusion in the
annual report on the quality of health care required under section
913(b)(2);
`(v) strengthens the ability of the United States to learn from
medical errors by--
`(I) developing the necessary tools and advancing the
scientific techniques for analysis of errors;
`(II) providing technical assistance as appropriate to
reporting systems; and
`(III) entering into contracts to receive and analyze
aggregate data from public and private sector reporting
systems;
`(vi) supports dissemination and communication activities to
improve patient safety, including the development of tools and methods
for educating consumers about patient safety; and
`(vii) undertakes related activities that the Director
determines are necessary to enable the Center to fulfill its
mission.
`(C) LIMITATION- Aggregate data gathered for the purposes
described in this section shall not include specific patient, health care
provider, or provider of service identifiers.
`(c) LEARNING FROM MEDICAL ERRORS-
`(1) IN GENERAL- To enhance the ability of the health care community
in the United States to learn from medical events, the Director
shall--
`(A) carry out activities to increase scientific knowledge and
understanding regarding medical error reporting systems;
`(B) carry out activities to advance the scientific knowledge
regarding the tools and techniques for analyzing medical events and
determining their root causes;
`(C) carry out activities in partnership with experts in the field
to increase the capacity of the health care community in the United States
to analyze patient safety data;
`(D) develop a confidential national safety database of medical
event reports;
`(E) conduct and support research, using the database developed
under subparagraph (D), into the causes and potential interventions to
decrease the incidence of medical errors and close calls;
and
`(F) ensure that information contained in the national database
developed under subparagraph (D) does not include specific patient, health
care provider, or provider of service identifiers.
`(2) NATIONAL PATIENT SAFETY DATABASE- The Director shall, in
accordance with paragraph (1)(D), establish a confidential national safety
database (to be known as the National Patient Safety Database) of reports of
medical events that can be used only for research to improve the quality and
safety of patient care. In developing and managing the National Patient
Safety Database, the Director shall--
`(A) ensure that the database is only used for its intended
purpose;
`(B) ensure that the database is only used by the Agency, medical
event analysis entities, and other qualified entities or individuals as
determined appropriate by the Director and in accordance with paragraph
(3) or other criteria applied by the Director;
`(C) ensure that the database is as comprehensive as possible by
aggregating data from Federal, State, and private sector patient safety
reporting systems;
`(D) conduct and support research on the most common medical
errors and close calls, their causes, and potential interventions to
reduce medical errors and improve the quality and safety of patient
care;
`(E) disseminate findings made by the Director, based on the data
in the database, to clinicians, individuals who manage health care
facilities, systems, and plans, patients, and other individuals who can
act appropriately to improve patient safety; and
`(F) develop a rapid response capacity to provide alerts when
specific health care practices pose an imminent threat to patients or
health care practitioners, or other providers of health care items or
services.
`(3) CONFIDENTIALITY AND PEER REVIEW PROTECTIONS- Notwithstanding
any other provision of law any information (including any data, reports,
records, memoranda, analyses, statements, and other communications)
developed by or on behalf of a health care provider or provider of services
with respect to a medical event, that is contained in the National Patient
Safety Database shall be confidential in accordance with section
925.
`(4) PATIENT SAFETY REPORTING SYSTEMS- The Director shall identify
public and private sector patient safety reporting systems and build
scientific knowledge and understanding regarding the most
effective--
`(A) components of patient safety reporting systems;
`(B) incentives intended to increase the rate of error
reporting;
`(C) approaches for undertaking root cause analyses;
`(D) ways to provide feedback to those filing error
reports;
`(E) techniques and tools for collecting, integrating, and
analyzing patient safety data; and
`(F) ways to provide meaningful information to patients,
consumers, and purchasers that will enhance their understanding of patient
safety issues.
`(5) TRAINING- The Director shall support training initiatives to
build the capacity of the health care community in the United States to
analyze patient safety data and to act on that data to improve patient
safety.
`(d) EVALUATION- The Director shall recommend strategies for measuring
and evaluating the national progress made in implementing safe practices
identified by the Center through the research and analysis required under
subsection (b) and through the voluntary reporting system established under
subsection (c).
`(e) IMPLEMENTATION- In implementing strategies to carry out the
functions described in subsections (b), (c), and (d), the Director may
contract with public or private entities on a national or local level with
appropriate expertise.
`SEC. 923. MEDICAL EVENT ANALYSIS ENTITIES.
`(a) IN GENERAL- The Director, based on information collected under
section 922(c), shall provide for the certification of entities to collect and
analyze information on medical errors, and to collaborate with health care
providers or providers of services in collecting information about, or
evaluating, certain medical events.
`(b) COMPATIBILITY OF COLLECTED DATA- To ensure that data reported to
the National Patient Safety Database under section 922(c)(2) concerning
medical errors and close calls are comparable and useful on an analytic basis,
the Director shall require that the entities described in subsection (c)
follow the recommendations regarding a common set of core measures for
reporting that are developed by the National Forum for Health Care Quality
Measurement and Reporting, or other voluntary private standard-setting
organization that is designated by the Director taking into account existing
measurement systems and in collaboration with experts from the public and
private sector.
`(c) DUTIES OF CERTIFIED ENTITIES-
`(1) IN GENERAL- An entity that is certified under subsection (a)
shall collect and analyze information, consistent with the requirement of
subsection (b), provided to the entity under section 924(a)(4) to improve
patient safety.
`(2) INFORMATION TO BE REPORTED TO THE ENTITY- A medical event
analysis entity shall, on a periodic basis and in a format that is specified
by the Director, submit to the Director a report that contains--
`(A) a description of the medical events that were reported to the
entity during the period covered under the report;
`(B) a description of any corrective action taken by providers of
services with respect to such medical events or any other measures that
are necessary to prevent similar events from occurring in the future;
and
`(C) a description of the systemic changes that entities have
identified, through an analysis of the medical events included in the
report, as being needed to improve patient safety.
`(3) COLLABORATION- A medical event analysis entity that is
collaborating with a health care provider or provider of services to address
close calls and adverse events may, at the request of the health care
provider or provider of services--
`(A) provide expertise in the development of root cause analyses
and corrective action plan relating to such close calls and adverse
events; or
`(B) collaborate with such provider of services to identify
on-going risk reduction activities that may enhance patient
safety.
`(d) CONFIDENTIALITY AND PEER REVIEW PROTECTIONS- Notwithstanding any
other provision of law, any information (including any data, reports, records,
memoranda, analyses, statements, and other communications) collected by a
medical event analysis entity or developed by or on behalf of such an entity
under this part shall be confidential in accordance with section 925.
`(e) TERMINATION AND RENEWAL-
`(1) IN GENERAL- The certification of an entity under this section
shall terminate on the date that is 3 years after the date on which such
certification was provided. Such certification may be renewed at the
discretion of the Director.
`(2) NONCOMPLIANCE- The Director may terminate the certification of
a medical event analysis entity if the Director determines that such entity
has failed to comply with this section.
`(f) IMPLEMENTATION- In implementing strategies to carry out the
functions described in subsection (c), the Director may contract with public
or private entities on a national or local level with appropriate
expertise.
`SEC. 924. PROVIDER OF SERVICES SYSTEMS FOR REPORTING MEDICAL
EVENTS.
`(a) INTERNAL MEDICAL EVENT REPORTING SYSTEMS- Each provider of
services that elects to participate in a medical error reporting system under
this part shall--
`(1) establish a system for--
`(A) identifying, collecting information about, and evaluating
medical events that occur with respect to a patient in the care of the
provider of services or a practitioner employed by the provider of
services, that may include--
`(i) the provision of a medically coherent description of each
event so identified;
`(ii) the provision of a clear and thorough accounting of the
results of the investigation of such event under the system;
and
`(iii) a description of all corrective measures taken in
response to the event; and
`(B) determining appropriate follow-up actions to be taken with
respect to such events;
`(2) establish policies and procedures with respect to when and to
whom such events are to be reported;
`(3) take appropriate follow-up action with respect to such events;
and
`(4) submit to the appropriate medical event analysis entity
information that contains descriptions of the medical events identified
under paragraph (1)(A).
`(b) PROMOTING IDENTIFICATION, EVALUATION, AND REPORTING OF CERTAIN
MEDICAL EVENTS-
`(1) IN GENERAL- Notwithstanding any other provision of law any
information (including any data, reports, records, memoranda, analyses,
statements, and other communications) developed by or on behalf of a
provider of services with respect to a medical event pursuant to a system
established under subsection (a) shall be privileged in accordance with
section 925.
`(2) RULES OF CONSTRUCTION- Nothing in this subsection shall be
construed as prohibiting--
`(A) disclosure of a patient's medical record to the
patient;
`(B) a provider of services from complying with the requirements
of a health care oversight agency or public health authority;
or
`(C) such an agency or authority from disclosing information
transferred by a provider of services to the public in a form that does
not identify or permit the identification of the health care provider or
provider of services or patient.
`SEC. 925. CONFIDENTIALITY.
`(a) CONFIDENTIALITY AND PEER REVIEW PROTECTIONS- Notwithstanding any
other provision of law--
`(1) any information (including any data, reports, records,
memoranda, analyses, statements, and other communications) developed by or
on behalf of a health care provider or provider of services with respect to
a medical event, that is contained in the National Patient Safety Database,
collected by a medical event analysis entity, or developed by or on behalf
of such an entity, or collected by a health care provider or provider or
services for use under systems that are developed for safety and quality
improvement purposes under this part--
`(A) shall be privileged, strictly confidential, and may not be
disclosed by any other person to which such information is transferred
without the authorization of the health care provider or provider of
services; and
`(i) be protected from disclosure by civil, criminal, or
administrative subpoena;
`(ii) not be subject to discovery or otherwise discoverable in
connection with a civil, criminal, or administrative
proceeding;
`(iii) not be subject to disclosure pursuant to section 552 of
title 5, United States Code (the Freedom of Information Act) and any
other similar Federal or State statute or regulation;
and
`(iv) not be admissible as evidence in any civil, criminal, or
administrative proceeding;
without regard to whether such information is held by the provider
or by another person to which such information was
transferred;
`(2) the transfer of any such information by a provider of services
to a health care oversight agency, an expert organization, a medical event
analysis entity, or a public health authority, shall not be treated as a
waiver of any privilege or protection established under paragraph (1) or
established under State law.
`(b) PENALTY- It shall be unlawful for any person to disclose any
information described in subsection (a) other than for the purposes provided
in such subsection. Any person violating the provisions of this section shall,
upon conviction, be fined in accordance with title 18, United States Code, and
imprisoned for not more than 6 months, or both.
`(c) APPLICATION OF PROVISIONS- The protections provided under
subsection (a) and the penalty provided for under subsection (b) shall apply
to any information (including any data, reports, memoranda, analyses,
statements, and other communications) collected or developed pursuant to
research, including demonstration projects, with respect to medical error
reporting supported by the Director under this part.
`SEC. 926. AUTHORIZATION OF APPROPRIATIONS.
`There is authorized to be appropriated to carry out this part,
$50,000,000 for fiscal year 2001, and such sums as may be necessary for
subsequent fiscal years.'.
SEC. 2504. EFFECTIVE DATE.
The amendments made by section 2503 shall become effective on the date
of the enactment of this Act.
This Act may be cited as the `Departments of Labor, Health and Human
Services, and Education, and Related Agencies Appropriations Act,
2001'.
Passed the House of Representatives June 14, 2000.
Attest:
JEFF TRANDAHL,
Clerk.
Passed the Senate June 30, 2000.
Attest:
GARY SISCO,
Secretary.
END