THIS SEARCH THIS DOCUMENT THIS CR ISSUE GO TO
Next Hit Forward Next Document New CR Search
Prev Hit Back Prev Document HomePage
Hit List Best Sections Daily Digest Help
Doc Contents
(a) IN GENERAL.--Section 162(l)(1) of the Internal Revenue Code of 1986 (relating to allowance of deductions) is amended to read as follows:
[Page: S918] GPO's PDF
``(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 the amount paid during the taxable year for insurance which constitutes medical care fo r the taxpayer, his spouse, and his dependents.''
(b) EFFECTIVE DATE.--The amendments made by this section shall apply to taxable years beginning after December 31, 1999.
SEC. 502. FULL AVAILABILITY OF MEDICAL SAVINGS ACCOUNTS.
(a) AVAILABILITY NOT LIMITED TO ACCOUNTS FOR EMPLOYEES OF SMALL EMPLOYERS AND SELF-EMPLOYED INDIVIDUALS.--
(1) IN GENERAL.--Section 220(c)(1)(A) of the Internal Revenue Code of 1986 (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 subparagraphs (C) and (D).
(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.
(b) REMOVAL OF LIMITATION ON NUMBER OF TAXPAYERS HAVING MEDICAL SAVINGS ACCOUNTS.--
(1) IN GENERAL.--Section 220 of the Internal Revenue Code of 1986 (relating to medical savings accounts) is amended by striking subsections (i) and (j).
(2) MEDICARE+CHOICE.--Section 138 of such Code (relating to Medicare+Choice MSA) is amended by striking subsection (f).
(c) REDUCTION IN HIGH DEDUCTIBLE PLAN MINIMUM ANNUAL DEDUCTIBLE.--Section 220(c)(2)(A) of the Internal Revenue Code of 1986 (relating to high deductible health plan) is amended--
(1) by striking ``$1,500'' in clause (i) and inserting ``$1,000'', and
(2) by striking ``$3,000'' in clause (ii) and inserting ``$2,000''.
(d) INCREASE IN CONTRIBUTION LIMIT TO 100 PERCENT OF ANNUAL DEDUCTIBLE.--
(1) IN GENERAL.--Section 220(b)(2) of the Internal Revenue Code of 1986 (relating to monthly limitation) 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 of the high deductible health plan of the individual.''
(2) CONFORMING AMENDMENT.--Section 220(d)(1)(A) of such Code is amended by striking ``75 percent of''.
(e) LIMITATION ON ADDITIONAL TAX ON DISTRIBUTIONS NOT USED FOR QUALIFIED MEDICAL EXPENSES.--Section 220(f)(4) of the Internal Revenue Code of 1986 (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 January 1 of the calendar year in which the taxable year begins).''.
(f) EFFECTIVE DATE.--The amendments made by this section shall apply to taxable years beginning after December 31, 1999.
SEC. 503. 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 fl exible 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 theextent 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 1999, 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, 1998, 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, 1999.''
(b) EFFECTIVE DATE.--The amendments made by this section shall apply to taxable years beginning after December 31, 1999.
SEC. 504. PERMITTING CONTRIBUTION TOWARDS MEDICAL SAVINGS ACCOUNT THROUGH FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM (FEHBP).
(a) GOVERNMENT CONTRIBUTION TO MEDICAL SAVINGS ACCOUNT.--
(1) IN GENERAL.--Section 8906 of title 5, United States Code, is amended by adding at the end the following:
``(j)(1) In the case of an employee or annuitant who is enrolled in a catastrophic plan described by section 8903(5), there shall be a Government contribution under this subsection to a medical savings account established or maintained for the benefit of the individual. The contribution under this subsection shall be in addition to the Government contribution under subsection (b).
``(2) The amount of the Government contribution under this subsection with respect to an individual is equal to the amount by which--
``(A) the maximum contribution allowed under subsection (b)(1) with respect to any employee or annuitant, exceeds
``(B) the amount of the Government contribution actually made with respect to the individual under subsection (b) for coverage under the catastrophic plan.
``(3) The Government contributions under this subsection shall be paid into a medical savings account (designated by the individual involved) in a manner that is specified by the Office and consistent with the timing of contributions under subsection (b).
``(4) Subsections (f) and (g) shall apply to contributions under this section in the same manner as they apply to contributions under subsection (b).
``(5) For the purpose of this subsection, the term `medical savings account' has the meaning given such term by section 220(d) of the Internal Revenue Code of 1986.''.
(2) ALLOWING PAYMENT OF FULL AMOUNT OF CHARGE FOR CATASTROPHIC PLAN.--Section 8906(b)(2) of such title is amended by inserting ``(or 100 percent of the subscription charge in the case of a catastrophic plan)'' after ``75 percent of the subscription charge''.
(b) OFFERING OF CATASTROPHIC PLANS.--
(1) IN GENERAL.--Section 8903 of title 5, United States Code, is amended by adding at the end the following:
``(5) CATASTROPHIC PLANS.--One or more plans described in paragraph (1), (2), or (3), but which provide benefits of the types referred to by paragraph (5) of section 8904(a), instead of the types referred to in paragraphs (1), (2), and (3) of such section.''.
(2) TYPES OF BENEFITS.--Section 8904(a) of such title is amended by inserting after paragraph (4) the following new paragraph:
``(5) CATASTROPHIC PLANS.--Benefits of the types named under paragraph (1) or (2) of this subsection or both, to the extent expenses covered by the plan exceed $500.''.
(3) DETERMINING LEVEL OF GOVERNMENT CONTRIBUTIONS.--Section 8906(b) of such title is amended by adding at the end the following: ``Subscription charges for medical savings accounts shall be deemed to be the amount of Government contributions made under subsection (j)(2).''.
(c) EFFECTIVE DATE.--The amendments made by this section shall apply to contract terms beginning on or after January 1, 2000.
--
Summary of Senate Republican Patients' Bill of Rights
The Senate Republican bill has six major components that will provide consumer protections, enhance health care qu ality and increase access. These are:
1. Consumer protection standards for self-funded plans.
2. Appeals standards for all group health plans.
3. Access to and confidentiality of medical information.
4. Ban on the use of genetic information for all plans.
5. New quality focus and expended research activities for the Agency for Health Care Po licy and Research.
6. Improved access to health insurance coverage by allowing full deduction of health insurance for the self-employed and expansion of MSAs.
The following summarizes the key aspects of the bill:
1. Consumer protection standards for self-funded plans: Since States are responsible for regulating insured health plans, the bill provides that the following standards would apply only to self-funded plans governed by ERISA.
Emergency Care: P lans would be required to use the ``prudent layperson'' standard for providing initial emergency screening exams and ``additional emergency services'' determined necessary by a ``prudent emergency medical professional.''
Mandatory Point of Service: Plans that offer network-only plans would be required to offer enrollees the option to purchase point-of-service coverage. Small employers with 50 or fewer workers would be exempt. Also exempt would be group plans that offer a choice of two or more health insurance options or two or more options with significantly different providers. Plans could charge higher premiums and cost sharing for the POS option.
OB-GYN/Pediatricians: Health plans would be required to allow direct access to obstetricians/gynecologist and pediatricians without referrals.
Continuity of Care: P lans who terminate or non renew providers from their networks would be required to notify enrollees and allow continued use of the provider (at the same payment and cost-sharing rates) for up to 90 days if: the enrollee is receiving institutional care, i s in the second (or late) trimester of pregnancy, or is terminally ill.
Gag Rules: Plans would be prohibited from including ``gag rules'' in providers' contracts.
Comparative Information: Plans would be required to provide a wide range of information about health insurance options, such as descriptions of the networks, premium and cost-sharing information. Quality outcomes data and information is not mandated.
Effective Dates: The new rules would become effective for group plan years beginning on or after January 1 of the second calendar year following the date of enactment. In other words, the effective date would be January, 2001, assuming enactment in 1999.
2. Grievance and Appeals: Plans would be required to have written grievance procedures and have both an internal and external appeals procedure. Grievances would not be appealable.
Prior Authorization: Routine requests would need to be completed within 30 days, and expedited requests for care th at could jeopardize enrollee's health would have to be handled within 72 hours.
Qualification of Doctors for Internal Appeals: Appeals for coverage determinations based on lack of medical necessity or experimental treatment must be by a doctor ``with appropriate expertise in field of medicine involved'' who was not involved in the initial decision.
External Appeals: Enrollees and providers could appeal to independent medical reviewers for amounts above a significant financial threshold for issues based on medical necessity or for services that involve an experimental treatment where the enrollees' life is in jeopardy. External reviews could include those licensed by the State or under Federal contract for this purpose, a teaching hospital, or entities meeting specific criteria. External review is binding on plans and issuers.
3. Patient medical records: Plans, providers, schools, and others would be required to:
Permit enrollees to inspect and copy their own medical records, except when such information could endanger a person's physical safety.
Disclose their confidentiality practices and to establish appropriate safeguards for patient information.
Civil money penalties would be imposed for violations.
4. Genetic Information: All plans--self-funded and insured group plans, as well as individual plans--would be prohibited from denying coverage, or adjusting premiums or contribution amounts based on ``predictive genetic information.'' The term ``predictive genetic information'' includes individual's genetic tests, genetic tests of family members, or information about family medical history.
5. Refocusing AHCPR on Quality Improvement: The bill would refocus AHCPR (and rename it the Agency for Healthcare Quality Research) to encourage overall improvement of quality in the nation's health care sy stems. The new agency would facilitate support of state-of-the-art information systems, support of primary care re search, technology assessment and coordination of the Federal Government's own quality improvement efforts.
6. Improved Access to Health Insurance: The bill includes three provisions to improve access:
Allows full deduction of health insurance for self-employed individuals.
Gives individuals the ability to carry forward up to $500 in their flexible spending accounts from one year to the next or to be deposited into an IRA, and MSA, or a 401(k) plan.
Lifts the caps for MSAs and would allow all individuals, including Federal employees, the option to purchase these plans.
Ms. COLLINS. Mr. President, I am pleased to be joining my colleagues in introducing this Patients' Bill of Rights, which is the product of more than a year's worth of intensive work and negotiations by the Senate Republican Health Care Ta sk Force on which I serve.
This comprehensive legislation has three major purposes. First, it will protect patients' rights and hold HMOs accountable for providing the care th ey have promised. Second, it will expand consumer choice and access to affordable care. A nd third, it will improve health care qu ality and outcomes.
Mr. President, there is a growing unease across our country about changes in how we receive our health care. P eople worry that if they or their loved ones become seriously ill, their HMO will deny them coverage and force them to accept either inadequate care or financial ruin--or perhaps both.
They feel that vital decisions affecting their lives will be made, not by a supportive family doctor, but by an unfeeling bureaucracy. The American people, known for taking charge of their destiny, feel increasingly powerless about their health care. O ur bill will ensure that medical decisions remain in the hands of patients and physicians, not HMO accountants and trial lawyers.
All of us agree that medically-necessary patient care sh ould not be sacrificed to the bottom line. However, according to a 1997 study by Lewin, every one percent increase in health care pr emiums results in as many as 400,000 uninsured Americans. I have therefore been alarmed by reports that American businesses everywhere--from large multinational corporations to the corner store--are facing huge hikes in health insurance premiums in 1999, ranging from about 8 percent on average, to 20 percent or more. This is a remarkable contrast to the last few years, when premiums rose less than 2 or 3 percent, if at all.
THIS SEARCH THIS DOCUMENT THIS CR ISSUE GO TO
Next Hit Forward Next Document New CR Search
Prev Hit Back Prev Document HomePage
Hit List Best Sections Daily Digest Help
Doc Contents