legislation: 103-s-2374
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| 103-s-2374 | 103 | s | 2374 | Veterans Health Care Administrative Flexibility Act of 1994 | Health | 1994-08-09 | 1994-08-11 | Read the second time. Placed on Senate Legislative Calendar under General Orders. Calendar No. 562. | Senate | Sen. Dole, Robert J. [R-KS] | KS | R | D000401 | 1 | TABLE OF CONTENTS: Title I: Affordable Health Insurance Coverage Subtitle A: Tax Incentives Subtitle B: Premium Assistance Title II: Health Insurance and Delivery Systems Reform Subtitle A: Federal Standards for State Certification Programs Subtitle B: Consolidation of Federal Research Subtitle C: Self-Employed Individual and Small Employer Participation in Federal Employees Health Benefits Plans Subtitle D: Report on Health Care System Title III: Special Assistance for Rural, Frontier and Underserved Urban Areas Subtitle A: Planning, Demonstrations, and Grants Subtitle B: Technical Assistance Grants Subtitle C: Capital Assistance Loans and Loan Guarantees Subtitle D: Increasing Primary Care Providers Subtitle E: Payment Flexibility Subtitle F: Emergency Medical Systems Subtitle G: Studies and Reports Title IV: Long-Term Care Provisions Subtitle A: Long-Term Care Services and Contracts Subtitle B: Tax Treatment of Accelerated Death Benefits Subtitle C: Credit for Personal Assistance Title V: Health Care Providers Subtitle A: Education and Research Subtitle B: Health Care Liability Reform Subtitle C: Health Care Antitrust Improvements Title VI: Administrative Simplification and Privacy Title VII: Enhanced Penalties for Health Care Fraud Subtitle A: All-Payer Fraud and Abuse Control Program Subtitle B: Revisions to Current Sanctions for Fraud and Abuse Subtitle C: Administrative and Miscellaneous Provisions Subtitle D: Amendments to Criminal Law Subtitle E: Amendments to Civil False Claims Act Title VIII: Medicare and Medicaid Subtitle A: Medicare Subtitle B: Medicaid Program Title IX: Department of Veterans Affairs Title I: Affordable Health Insurance Coverage - Subtitle A: Tax Incentives - Amends the Internal Revenue Code to allow a deduction for the qualified health insurance costs of individuals (including self-employed individuals) that provide their own health insurance. (Sec. 111) Allows individuals a tax deduction for contributions made to a medical care savings account established for the benefit of one or more eligible individuals. Limits the amount of such deduction to specified amounts (dependent upon the tax filing category) or the high deductible health plan differential. Allows such deduction whether or not an individual itemizes deductions. (Sec. 112) Excludes employer contributions to medical savings accounts from the gross income of the employee, with a dollar limitation or the high deductible health plan differential. Excludes employer contributions to such accounts from employment taxes. (Sec. 113) Provides for the establishment of medical savings accounts. Sets contribution limitations, including that the individual on whose behalf such contributions are made is covered under a high deductible health plan. Subjects the account beneficiary to taxation as owner of the account. Imposes a penalty for distributions that are not used for qualified medical expenses. Subtitle B: Premium Assistance - Amends title XIX (Medicaid) of the Social Security Act (SSA) to require States with approved Medicaid plans to provide for State programs for furnishing certain low-income families with assistance in regard to certified health plan premiums. Establishes annual limitations on premium assistance spending. Requires the President's budget to include estimates of premium assistance expenditures under Medicare and Medicaid. Title II: Health Insurance and Delivery Systems Reform - Subtitle A: Federal Standards for State Certification Programs - Amends SSA title XIX to require State Medicaid plans to provide for State programs under a new SSA title XXI for certifying insured health plans in the State that meet certain Federal standards and delivery system guidelines developed by the Secretary of Health and Human Services (HHS) incorporating specified requirements pertaining, among other things, to guarantee issue and renewal, preexisting condition exclusions, minimum benefit packages, quality assurance, and access to health care services, as certified health plans. Requires State programs also to provide consumers in the State with comparative value information on the performance of all health plans in each community rating area established in the State. Requires risk adjustment programs. Authorizes appropriations. Requires the Secretary of Labor to develop similar standards and guidelines for Federal certification of self-insured health plans. Provides for: (1) the treatment of certain State laws with regard to health plans; and (2) expanded access to health plans through purchasing cooperatives, the Federal Employee Health Benefits Program in the case of small businesses, and certain multiple employer welfare arrangements maintained by qualified associations; (3) special rules for church, multiemployer, and certain rural cooperative plans; and (4) general employer responsibilities with regard to payroll deductions for certified health plan premiums. Subtitle B: Consolidation of Federal Research - Establishes the Agency for Quality Assurance and Consumer Information within the Department of Health and Human Services. Creates an Administrator for Quality Assurance and Consumer Information to head the Agency. (Sec. 211) Directs the Secretary of Health and Human Services, acting through the Administrator, to consolidate Federal research activities relating to quality and consumer information in health care to enable States to gain access to the results of such research from a central source. Lists current Federal responsibilities to be assumed by the Administrator. Authorizes appropriations. Subtitle C: Self-Employed Individual and Small Employer Participation in Federal Employees Health Benefits Plans - Amends Federal civil service law to require the Office of Personnel Management (OPM) to promulgate regulations applying the Federal Employees Health Benefits Program (FEHBP) to self-employed individuals and businesses employing 50 or fewer employees, allowing required enrollee and Government contributions to be made by the State or small business involved or else be made in full by the self-employed or small business enrollee. (Sec. 221) Extends continued coverage under FEHBP. Requires carriers under FEHBP and the small business health insurance program to submit periodic reports to OPM comparing costs between the programs. (Sec. 222) Prohibits the FEHBP and the program described by this subtitle from being offered exclusively to Members of the Congress and congressional employees. (Sec. 223) Directs the Secretary to study and report to the Congress on nonworker and noncovered employee buy-ins for FEHBP coverage. Subtitle D: Report on Health Care System - Directs the President to report to the Congress on specified aspects of the health care system. Title III: Special Assistance for Rural, Frontier and Underserved Urban Areas - Authorizes States to designate certain rural, frontier, or urban areas as underserved areas based on the lack of access to health plans, quality health providers, and health care facilities. (Sec. 302) Requires the Secretary, upon a State's request, to establish a procedure to certify such areas as underserved areas. Directs the Secretary to give priority in awarding assistance to applicants that serve such areas except with respect to assistance provisions that explicitly direct assistance to areas currently designated as underserved. Subtitle A: Planning, Demonstrations, and Grants - Authorizes the Secretary to conduct a demonstration project and grant program to encourage the development and operation of health networks. Authorizes appropriations. (Sec. 312) Amends title XX (Block Grants to States for Social Services) of the Social Security Act to provide for grants to private entities for developing health networks or health plans to serve underserved areas certified under section 302 of this Act. Authorizes appropriations. (Sec. 313) Amends the Public Health Service Act to establish a program of allotments to States for grants for community-based primary health services to low-income or medically underserved populations. Earmarks funding for such grants. Subtitle B: Technical Assistance Grants - Directs the Secretary to award technical assistance grants to public and private entities for establishing infrastructure for health networks and plans in underserved areas certified under section 302 of this Act. Authorizes appropriations. Subtitle C: Capital Assistance Loans and Loan Guarantees - Directs the Secretary to make loans to health networks, health plans that cover individuals residing in rural, frontier, or urban underserved areas, or health care providers that serve such areas for the capital costs of developing health delivery systems and expanding existing health delivery sites to make health care services available in underserved areas certified under section 302. Subtitle D: Increasing Primary Care Providers - Amends the Internal Revenue Code to: (1) allow a nonrefundable credit for certain primary health services providers for mandatory service periods in health professional shortage areas; and (2) increase the dollar limitation allowed for expensing medical equipment used in such areas. (Sec. 343) Mandates grants to federally qualified health centers (FQHCs) and other entities for providing access to services for medically underserved populations or in high impact areas not currently being served by a FQHC. Authorizes appropriations. (Sec. 345) Authorizes the Secretary to award grants to States for primary health care and social service programs targeted to pregnant women and infants. Authorizes appropriations. (Sec. 346) Amends the Elementary and Secondary Education Act of 1965 to revise provisions regarding the improvement of school health education. Requires the Secretary of Education to award grants to States for local programs of health education and prevention, early health intervention, and health education in pre-schools and elementary schools and to carry out other related activities. Authorizes appropriations. (Sec. 347) Authorizes frontier States (including Alaska, Wyoming, and Montana) to implement proposals to: (1) offer preventive services, including mobile preventive health centers; and (2) participate in demonstration projects to improve recruitment, retention, and training of rural providers. (Sec. 348) Authorizes specified amounts of appropriations for the National Health Service Corps Scholarship Program through FY 2000. (Currently, such sums as necessary are authorized to be appropriated.) Extends the authorization of appropriations for area health education centers through FY 2000. (Sec. 349) Directs the Secretary of Health and Human Services to establish the Interagency Task Force on Rural Telemedicine. (Sec. 350) Requires the Secretary, acting through the Office of Rural Health, to award grants to eligible entities to promote the use of telemedicine to strengthen health care in rural areas. Authorizes appropriations. Subtitle E: Payment Flexibility - Amends SSA title XVIII (Medicare) to: (1) make various specified changes in essential access community hospital (EACH) program provisions, including changes allowing an unlimited number of States to participate in the program, and eliminating grant tie-in requirements for EACH or rural primary care hospital designation. Extends the deadline for development of a prospective payment system (PPS) for inpatient rural primary care hospital services. Provides for the implementation of a PPS for outpatient rural primary care hospital services. Revises the physician staffing requirements for rural primary care hospitals. Authorizes increased appropriations for the EACH program. (Sec. 352) Amends Medicare part A to provide for medical assistance facility and emergency access care hospital demonstration projects for improving access to health care in rural areas. Authorizes appropriations. (Sec. 353) Makes various specified changes with regard to Medicare-dependent, small rural hospitals. (Sec. 354) Provides for expanded coverage for physician assistants and nurse practitioners. Subtitle F: Emergency Medical Systems - Amends the Public Health Service Act to prove for grants to States for systems to transport rural victims of medical emergencies by air. Authorizes appropriations. Subtitle G: Studies and Reports - Amends SSA title VII (Administration) to: (1) provide for the appointment of an Assistant Secretary for Rural Health in the Office of Rural Health Policy; and (2) make administrative changes respecting the Office and duties of the new assistant secretary. (Sec. 372) Requires: (1) the Prospective Parent Assessment Commission to study and report to the Congress on the need for legislation or regulations to ensure that vulnerable populations have adequate access to health plans and health care providers and services; and (2) the Secretary of HHS to study and report to the Congress on expanding the benefits under health plans for individuals residing in rural areas. Title IV: Long-Term Care Provisions - Subtitle A: Long-Term Care Services and Contracts - Amends the Internal Revenue Code to treat qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 402) Provides for the treatment long-term care insurance as accident or health insurance. Excludes qualified long-term care insurance contracts from cafeteria plans. (Sec. 406) Sets forth consumer protection provisions to be satisfied by qualified long-term care insurance contracts, including the model regulation and model Act promulgated by the National Association of Insurance Commissioners (NAIC). (Sec. 407) Imposes an excise tax on insurers who fail to meet requirements for long-term care insurance policies. (Sec. 409) Requires NAIC to promulgate standards for the use of uniform language and definitions in such policies, with certain variations permitted. Subtitle B: Tax Treatment of Accelerated Death Benefits - Provides for the exclusion as a death benefit of any amount received under a life insurance contract because such individual is terminally ill. Allows insurance companies to issue accelerated death benefit riders on life insurance contracts. Subtitle C: Credit for Personal Assistance - Allows a tax credit for the cost of personal assistance services required by certain individuals. Describes such individuals as those who, by reason of a medically determinable physical impairment which can be expected to last for a continuous period of not less than 12 months, are unable to engage in any substantial gainful employment activity without personal assistance services appropriate to carry out activities of daily living. Limits the amount of such credit and provides a cost-of- living adjustment. Title V: Health Care Providers - Subtitle A: Education and Research - Amends SSA title XVIII to: (1) require the Director of the Office of Technology Assessment to provide for the appointment of an Advisory Commission on Workforce to develop recommendations and assessments with regard to national health care workforce policy and payment for a report to the Congress. Authorizes appropriations. (Sec. 502) Requires the Secretary of HHS to provide for a consortium demonstration program for testing and evaluating mechanisms for increasing the number of medical students entering primary care practice through the use of funds available for direct graduate medical education (GME) costs. Authorizes appropriations. (Sec. 503) Requires that residency training time spent in nonhospital-owned facilities be counted in determining full-time- equivalent residents for direct and indirect GME payments. (Sec. 504) Amends the Internal Revenue Code to create in the Treasury the National Fund for Medical Research consisting of designated overpayments and cash contributions for use by the National Institutes for Health (NIH) for medical research and construction and acquisition of equipment and facilities for NIH, and for health information communications under the Public Health Service Act. Subtitle B: Health Care Liability Reform - Amends SSA title XI part A to provide for various specified changes with regard to civil actions in State or Federal court for damages arising out of alleged injuries caused by health care providers or payors, including among such changes: (1) limitations on noneconomic damages, attorney contingency fees, and action time frames; (2) requirements for pleading of punitive damages, periodic damage payments, and risk management programs for health care providers; and (3) providing for State health care quality assurance programs funded out of a portion of all punitive damages awarded in the State. Subtitle C: Health Care Antitrust Improvements - Exempts from all antitrust claims an activity relating to the provision of health care services that is: (1) within a "safe harbor" designated by the Attorney General, except for claims for injunctive relief asserted by the Attorney General or the Chair of the Federal Trade Commission in extraordinary circumstances; and (2) specified in and in compliance with the terms of a certificate of review issued by the Attorney General, where the activity occurs while the certificate is in effect, except for claims for injunctive relief. Sets forth provisions regarding the award of attorney fees and costs of suit to the prevailing party in an action based on a claim involving an activity found to be exempt. (Sec. 522) Directs the Attorney General to develop and designate specified safe harbors relating to the following, as well as to such other categories of activities as the Attorney General may designate (subject to specified requirements): (1) joint purchasing of health care services; (2) small hospital mergers; (3) startup and operation of collaborations between State-licensed providers through partial or full integration; (4) standard-setting and enforcement activities by medical self-regulatory entities; (5) health care providers collectively supplying non-price medical information to buyers and consumers; (6) health care provider participation in surveys; (7) health care joint venture's purchase or use of new or existing high technology or costly equipment or the provision of advanced tertiary care services; (8) provision of market power screens at appropriate levels below which combinations of providers are too small to pose a realistic antitrust threat; (9) joint purchasing arrangements; and (10) good faith negotiations relating to legitimate collaborative activities. Directs the Attorney General to publish a notice in the Federal Register soliciting proposals for additional safe harbors. Authorizes the Attorney General to modify or remove a safe harbor following notice and comment upon a determination that the safe harbor does not meet specified required criteria. Sets forth criteria to be considered in establishing safe harbors, including: (1) the extent to which a competitive or collaborative activity will accomplish an increase in health care access and quality, the establishment of cost efficiencies, and increased ability of health care facilities to provide services in medically underserved areas or to underserved populations; and (2) whether designation as a safe harbor will result in specified desirable outcomes. (Sec. 523) Directs the Attorney General to issue certificates of review for providers of health care services and to assist persons in applying for such certificates. Sets forth procedures regarding applications for, revocation of, and review of determinations regarding such certificates. Limits the disclosure of information. (Sec. 524) Sets forth provisions regarding notifications providing for a reduction in certain penalties under the antitrust laws for health care cooperative ventures. (Sec. 525) Directs the Attorney General to: (1) periodically review the safe harbors, certificates of review, and notifications; and (2) publish, and periodically update, specified guidelines intended to promote greater certainty regarding the application of the antitrust laws to activities in the health care market. Title VI: Administrative Simplification and Privacy - Amends SSA title XI to provide for administrative simplification in the health care system including Medicare and Medicaid, by directing the Secretary of HHS to adopt specified standards for: (1) data elements and information transactions to electronic transmission of certain health information; (2) locating and accessing for authorized purposes health information available through the health information network developed through requirements under this title for electronic transmission of such information; and (3) certifying such information networks. Provides penalties for failure to comply with such standards and requirements. Authorizes appropriations. Establishes a Health Care Information Advisory Committee to advise the Secretary of HHS and the Congress on the status of the network. Authorizes appropriations. Directs the Secretary to make grants for electronically integrated demonstration projects for community-based clinical information systems and computerized patient medical records. (Sec. 601) Makes amendments with regard to the Medicare and Medicaid Coverage Data Bank and related identification processes. (Sec. 602) Provides for the establishment of a mechanism for protecting the privacy of individuals with respect to individually identifiable health care information that is created or maintained as part of health treatment, enrollment, payment, testing, or research processes. Establishes civil and criminal penalties for violations of such privacy protections. Authorizes appropriations. Title VII: Enhanced Penalties for Health Care Fraud - Subtitle A: All-Payer Fraud and Abuse Control Program - Directs the Secretary of HHS to establish a program to: (1) coordinate Federal, State, and local law enforcement programs to control fraud and abuse with respect to the delivery of and payment for health care; and (2) perform other specified tasks applicable to controlling health care fraud and abuse. (Sec. 701) Creates in the Treasury the Anti-Fraud and Abuse Trust Fund for use in conjunction with such program. (Sec. 702) Amends SSA title XI to provide for the application of Federal health anti-fraud and abuse sanctions to all fraud and abuse against any health care plan. (Sec. 703) Directs the Secretary of HHS to publish notice in the Federal Register soliciting proposals for certain: (1) safe harbor activities related to payment for health care services; and (2) interpretive rulings and special alerts concerning health care fraud and abuse. (Sec. 704) Directs the Secretary to establish a program through which individuals entitled to Medicare benefits may report to the Secretary on a confidential basis instances of suspected Medicare fraud by program providers. Subtitle B: Revisions to Current Sanctions for Fraud and Abuse - Amends SSA title XI to revise current sanctions for fraud and abuse involving Medicare and State health care programs, providing for: (1) program exclusion for individuals convicted of a felony relating to fraud or the unlawful manufacture or dispensing or a controlled substance; (2) new offenses under civil monetary penalty provisions, such as the offering of inducements to program-eligible individuals and the misuse of health security cards or unique health identifiers; (3) establishment of a minimum period of exclusion for practitioners and persons who fail to meet statutory obligations; (4) intermediate sanctions on eligible HMOs for program violations; and (5) procedures for imposing such sanctions. Subtitle C: Administrative and Miscellaneous Provisions - Directs the Secretary to establish a national health care fraud and abuse data collection program for the reporting by government health care providers, suppliers, and practitioners. Requires program information to be made available to Federal and State governments, subject to a possible fee. Subtitle D: Amendments to Criminal Law - Amends the Federal criminal code to set penalties for knowingly executing a scheme or artifice to: (1) defraud any health care plan in connection with the delivery of, or payment for, health care benefits, items, or services; or (2) obtain, by means of false or fraudulent pretenses, representations, or promises, money or property owned by, or under the custody or control of, any health care plan or person in connection with delivery of or payment for health care benefits. (Sec. 731) Requires the Secretary of the Treasury to deposit into the Anti-Fraud and Abuse Trust Fund an amount equal to criminal fines imposed. (Sec. 732) Makes other specified criminal law changes with regard to forfeitures and injunctive relief with respect to Federal health care offenses and provides for similar deposits into the Anti-Fraud and Abuse Trust Fund. Subtitle E: Amendments to Civil False Claims Act - Makes provisions of the Civil False Claims Act applicable to the use of false records or statements made to a health care plan. Includes within the definition of "claim" for purposes of such Act, a request or demand for money or property which is made or presented to a health care plan. Provides for deposits into the Anti-Fraud and Abuse Trust Fund of amounts equal to penalties and damages imposed under the Civil False Claims Act. Title VIII: Medicare and Medicaid - Subtitle A: Medicare - Directs the Secretary to study and report to the Congress on allowing payment under Medicare for certain Medicare beneficiaries enrolled in either private or other Federal health care plans. (Sec. 802) Revises Medicare provisions on payments to HMOs and competitive medical plans. Directs the Secretary of HHS to establish certain demonstration projects in designated areas for paying such organizations on the basis of a special payment methodology. Amends the Omnibus Budget Reconciliation Act of 1987 to provide for an extension of social health maintenance organizations. (Sec. 803) Amends: (1) the Omnibus Budget Reconciliation Act of 1990 (OMBRA '90) to permit Medicare supplemental policies to be offered in all States; and (2) SSA title XVIII to make technical corrections to provisions on Medicare supplemental policies. (Sec. 811) Makes specified changes with regard to Medicare part A (Hospital Insurance) provisions with regard to: (1) inpatient hospital services updates for PPS hospitals; (2) payment reductions for capital-related costs for inpatient hospital services; (3) payment adjustments for disproportionate share hospitals in participating States; (4) moratoriums on new long-term hospitals; (5) adjustment reductions for indirect medical education; and (6) routine service cost limit reductions for skilled nursing facilities. (Sec. 821) Makes specified changes with regard to Medicare part B (Supplementary Medical Insurance) provisions with regard to: (1) physicians' services updates and payments; (2) establishment of hospital outpatient PPS for hospital outpatient departments; and (3) general Medicare part B premiums. (Sec. 831) Makes specified changes with regard to Medicare parts A and B provisions with regard to: (1) Medicare as secondary payer; and (2) routine cost limit reductions for home health services. Subtitle B: Medicaid Program - Provides for coordination of the Medicaid program with the new health care system established under this Act through such changes as: (1) establishing a cap on payments for certain acute medical services furnished under Medicaid; (2) providing for the integration of certain Medicaid eligibles into the new system; (3) providing for State programs for supplemental benefits; and (4) providing for optional coverage under certified health plans of SSI-eligible individuals. (Sec. 861) Amends SSA title XIX to modify Federal requirements to allow State flexibility in contracting for coordinated care services under Medicaid. (Sec. 871) Amends: (1) Medicaid long-term care provisions, permitting certain demonstration projects and relief from third party liability requirements when cost-effective, among other changes; and (2) the Omnibus Budget Reconciliation Act of 1986 with regard to frail elderly demonstration projects. (Sec. 878) Modifies Medicaid provisions on case management services and home and community-based waivers. (Sec. 881) Makes specified changes in provisions concerning: (1) disproportionate share hospital (DSH) payment adjustments; (2) the Federal medical assistance percentage for certain States; and (3) criteria for determining the amount of disallowances. (Sec. 882) Directs the Secretary to submit recommendations to the Congress on a phased-in elimination of Medicaid DSH payment adjustments. (Sec. 885) Makes technical corrections relating to OMBRA '90 provisions on physicians' services. Title IX: Department of Veterans Affairs - Veterans Health Care Administrative Flexibility Act of 1994 - Expresses as the intent of the Congress that Department of Veterans Affairs health care facilities participate as health care providers recognized under health care reform legislation enacted by the States. Directs the Secretary of Veterans Affairs to provide health care services in a State enacting such reform legislation. Prohibits any State from denying Department participation as a health care provider under such legislation unless the State's chief executive officer certifies that: (1) the benefits to be provided by the Department do not meet the State quality benefits standard; or (2) the location of Department facilities does not meet State proximity requirements. Authorizes the Secretary, in order to facilitate the provision of Department health care services in a manner that is responsive to local market and regulatory conditions, to designate Department health care facilities which shall be exempt from specified Federal regulatory provisions. Allows exempted Department facilities to enter into contracts and agreements for the provision of health care and related services under a State health care reform plan. Exempts such contracts and agreements for less than $250,000 from prior review by the Department's Central Office. Provides for review of contracts or agreements of such amount or greater. Authorizes the Secretary to utilize Department personnel to provide necessary health care services under this title. Provides funding by establishing in the Treasury a Department of Veterans Affairs Health Care Reform Fund, into which shall be deposited certain funds collected by the Secretary from third party payers to defray the costs of providing health care services to veterans. Requires a separate account to be maintained in the Fund for each exempted Department health care facility. Allows exempted Department facilities to expend funds to cover marketing, advertising, legal, acquisition, construction, repair, and renovation costs. | 2025-08-26T13:48:57Z |