[Congressional Bills 103th Congress]
[From the U.S. Government Printing Office]
[H.R. 5252 Received in Senate (RDS)]
103d CONGRESS
2d Session
H. R. 5252
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
October 8 (legislative day, September 12), 1994
Received
_______________________________________________________________________
AN ACT
To amend the Social Security Act and related Acts to make miscellaneous
and technical amendments, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

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This Act may be cited as the ``Social Security Act Amendments of
1994''.

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(a) Amendments to Social Security Act.--Except as otherwise
specifically provided, whenever in this Act an amendment is expressed
in terms of an amendment to or repeal of a section or other provision,
the reference shall be considered to be made to that section or other
provision of the Social Security Act.
(b) References to OBRA.--In this Act, the terms ``OBRA-1986'',
``OBRA-1987'', ``OBRA-1989'', ``OBRA-1990'', and ``OBRA-1993'' refer to
the Omnibus Budget Reconciliation Act of 1986 (Public Law 99-509), the
Omnibus Budget Reconciliation Act of 1987 (Public Law 100-203), the
Omnibus Budget Reconciliation Act of 1989 (Public Law 101-239), the
Omnibus Budget Reconciliation Act of 1990 (Public Law 101-508), and the
Omnibus Budget Reconciliation Act of 1993 (Public Law 103-66),
respectively.
(c) Table of Contents.--The table of contents is as follows:

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Subtitle A--Provisions Relating to Part A

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TITLE I

-MEDICARE PROVISIONS

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Prospective Payment Assessment Commission.

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and technical corrections.
Subtitle B--Provisions Relating to Part B
Part I--Physicians' Services

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with clinical trials of new cancer
therapies.

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outpatient physical therapy and
occupational therapy services.

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Subtitle C--Provisions Relating to Parts A and B

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intermediaries and carriers on other than a
cost basis.

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Subtitle D--Provisions Relating to Medicare Supplemental Insurance
Policies

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policies.
Subtitle A--Child Welfare, Foster Care, Adoption

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and Child Health Services Block Grant
Program.

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TITLE II

-MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT PROGRAM

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transfer unused foster care funds to child
welfare services programs.

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parent locator service.
Subtitle C--Supplemental Security Income

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all individuals under age 18.
Subtitle D--Aid to Families With Dependent Children

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in the JOBS program.
Subtitle F--Other Provisions

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FOR WAGES AND WAGE-RELATED COSTS.
(a) Use of Occupational Mix in Guidelines for Determination of Area
Wage Index.--
(1) In general.--Section 1886(d)(10)(D)(i)(I) (42 U.S.C.
1395ww(d)(10)(D)(i)(I)) is amended by inserting ``(to the
extent the Secretary determines appropriate)'' after ``taking
into account''.
(2) Effective date.--The amendment made by paragraph (1)
shall take effect as if included in the enactment of OBRA-1989.
(b) Conforming Amendments Relating to Geographic Area Used to
Determine Wage Index Applicable to Hospital.--(1) Section 1886(d)(8)(C)
(42 U.S.C. 1395ww(d)(8)(C)), as amended by section 13501(b)(1) of OBRA-
1993, is amended--
(A) in clause (iv), by striking ``paragraph (1)'' and
inserting ``paragraph (10)''; and
(B) by adding at the end the following new clause:
``(v) This subparagraph shall apply with respect to discharges
occurring in a fiscal year only if the Secretary uses a method for
making adjustments to the DRG prospective payment rate for area
differences in hospital wage levels under paragraph (3)(E) for the
fiscal year that is based on the use of Metropolitan Statistical Area
classifications.''.
(2) Section 1886(d)(10) (42 U.S.C. 1395ww(d)(10)) is amended--
(A) in subparagraph (C)(i)(II), by striking ``the area wage
index applicable'' and inserting ``the factor used to adjust
the DRG prospective payment rate for area differences in
hospital wage levels that applies''; and
(B) in subparagraph (D)--
(i) by redesignating clause (ii) as clause (iii),
and
(ii) by inserting after clause (i) the following
new clause:
``(ii) Notwithstanding clause (i), if the Secretary uses a method
for making adjustments to the DRG prospective payment rate for area
differences in hospital wage levels under paragraph (3)(E) that is not
based on the use of Metropolitan Statistical Area classifications, the
Secretary may revise the guidelines published under clause (i) to the
extent such guidelines are used to determine the appropriateness of the
geographic area in which the hospital is determined to be located for
purposes of making such adjustments.''.
(c) Adjustment of Labor and Non-Labor Portions of Standardized
Amounts.--Section 1886(d)(3)(A)(iii) (42 U.S.C. 1395ww(d)(3)(A)(iii))
is amended by adding at the end the following: ``For discharges
occurring on or after October 1, 1994, the Secretary shall adjust the
ratio of the labor portion to non-labor portion of each average
standardized amount to equal such ratio for the national average of all
standardized amounts.''.

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(a) Treatment of Inpatient Hospital Services Provided in Rural
Primary Care Hospitals.--
(1) In general.--Section 1820(f)(1)(F) (42 U.S.C. 1395i-
4(f)(1)(F)) is amended to read as follows:
``(F) subject to paragraph (4), provides not more
than 6 inpatient beds (meeting such conditions as the
Secretary may establish) for providing inpatient care
to patients requiring stabilization before discharge or
transfer to a hospital, except that the facility may
not provide any inpatient hospital services--
``(i) to any patient whose attending
physician does not certify that the patient may
reasonably be expected to be discharged or
transferred to a hospital within 72 hours of
admission to the facility; or
``(ii) consisting of surgery or any other
service requiring the use of general anesthesia
(other than surgical procedures specified by
the Secretary under section 1833(i)(1)(A)),
unless the attending physician certifies that
the risk associated with transferring the
patient to a hospital for such services
outweighs the benefits of transferring the
patient to a hospital for such services.''.
(2) Limitation on average length of stay.--Section 1820(f)
(42 U.S.C. 1395i-4(f)) is amended by adding at the end the
following new paragraph:
``(4) Limitation on average length of inpatient stays.--The
Secretary may terminate a designation of a rural primary care
hospital under paragraph (1) if the Secretary finds that the
average length of stay for inpatients at the facility during
the previous year in which the designation was in effect
exceeded 72 hours. In determining the compliance of a facility
with the requirement of the previous sentence, there shall not
be taken into account periods of stay of inpatients in excess
of 72 hours to the extent such periods exceed 72 hours because
transfer to a hospital is precluded because of inclement
weather or other emergency conditions.''.
(3) Conforming amendment.--Section 1814(a)(8) (42 U.S.C.
1395f(a)(8)) is amended by striking ``such services'' and all
that follows and inserting ``the individual may reasonably be
expected to be discharged or transferred to a hospital within
72 hours after admission to the rural primary care hospital.''.
(4) GAO reports.--Not later than 2 years after the date of
the enactment of this Act, the Comptroller General shall submit
reports to Congress on--
(A) the application of the requirements under
section 1820(f) of the Social Security Act (as amended
by this subsection) that rural primary care hospitals
provide inpatient care only to those individuals whose
attending physicians certify may reasonably be expected
to be discharged within 72 hours after admission and
maintain an average length of inpatient stay during a
year that does not exceed 72 hours; and
(B) the extent to which such requirements have
resulted in such hospitals providing inpatient care
beyond their capabilities or have limited the ability
of such hospitals to provide needed services.
(b) Designation of Hospitals.--
(1) Permitting designation of hospitals located in urban
areas.--
(A) In general.--Section 1820 (42 U.S.C. 1395i-4)
is amended--
(i) by striking paragraph (1) of subsection
(e) and redesignating paragraphs (2) through
(6) as paragraphs (1) through (5);
(ii) in subsection (e)(1)(A) (as
redesignated by subparagraph (A))--
(I) by striking ``is located'' and
inserting ``except in the case of a
hospital located in an urban area, is
located'',
(II) by striking ``, (ii)'' and
inserting ``or (ii)'', and
(III) by striking ``or (iii)'' and
all that follows through ``section,'';
and
(iii) in subsection (i)(1)(B), by striking
``paragraph (3)'' and inserting ``paragraph
(2)''.
(B) No change in medicare prospective payment.--
Section 1886(d)(5)(D) (42 U.S.C. 1395ww(d)(5)(D)) is
amended--
(i) in clause (iii)(III), by inserting
``located in a rural area and'' after ``that
is'', and
(ii) in clause (v), by inserting ``located
in a rural area and'' after ``in the case of a
hospital''.
(2) Permitting hospitals located in adjoining states to
participate in state program.--
(A) In general.--Section 1820 (42 U.S.C. 1395i-4)
is amended--
(i) by redesignating subsection (k) as
subsection (l); and
(ii) by inserting after subsection (j) the
following new subsection:
``(k) Eligibility of Hospitals Not Located in Participating
States.--Notwithstanding any other provision of this section--
``(1) for purposes of including a hospital or facility as a
member institution of a rural health network, a State may
designate a hospital or facility that is not located in the
State as an essential access community hospital or a rural
primary care hospital if the hospital or facility is located in
an adjoining State and is otherwise eligible for designation as
such a hospital;
``(2) the Secretary may designate a hospital or facility
that is not located in a State receiving a grant under
subsection (a)(1) as an essential access community hospital or
a rural primary care hospital if the hospital or facility is a
member institution of a rural health network of a State
receiving a grant under such subsection; and
``(3) a hospital or facility designated pursuant to this
subsection shall be eligible to receive a grant under
subsection (a)(2).''.
(B) Conforming amendments.--(i) Section 1820(c)(1)
(42 U.S.C. 1395i-4(c)(1)) is amended by striking
``paragraph (3)'' and inserting ``paragraph (3) or
subsection (k)''.
(ii) Paragraphs (1)(A) and (2)(A) of section
1820(i) (42 U.S.C. 1395i-4(i)) are each amended--
(I) in clause (i), by striking ``(a)(1)''
and inserting ``(a)(1) (except as provided in
subsection (k))'', and
(II) in clause (ii), by striking
``subparagraph (B)'' and inserting
``subparagraph (B) or subsection (k)''.
(c) Skilled Nursing Services in Rural Primary Care Hospitals.--
Section 1820(f)(3) (42 U.S.C. 1395i-4(f)(3)) is amended by striking
``because the facility'' and all that follows and inserting the
following: ``because, at the time the facility applies to the State for
designation as a rural primary care hospital, there is in effect an
agreement between the facility and the Secretary under section 1883
under which the facility's inpatient hospital facilities are used for
the furnishing of extended care services, except that the number of
beds used for the furnishing of such services may not exceed the total
number of licensed inpatient beds at the time the facility applies to
the State for such designation (minus the number of inpatient beds used
for providing inpatient care pursuant to paragraph (1)(F)). For
purposes of the previous sentence, the number of beds of the facility
used for the furnishing of extended care services shall not include any
beds of a unit of the facility that is licensed as a distinct-part
skilled nursing facility at the time the facility applies to the State
for designation as a rural primary care hospital.''.
(d) Deadline for Development of Prospective Payment System for
Inpatient Rural Primary Care Hospital Services.--Section 1814(l)(2) (42
U.S.C. 1395f(l)(2)) is amended by striking ``January 1, 1993'' and
inserting ``January 1, 1996''.
(e) Payment for Outpatient Rural Primary Care Hospital Services.--
(1) Implementation of prospective payment system.--Section
1834(g) (42 U.S.C. 1395m(g)) is amended--
(A) in paragraph (1), by striking ``during a year
before 1993'' and inserting ``during a year before the
prospective payment system described in paragraph (2)
is in effect''; and
(B) in paragraph (2), by striking ``January 1,
1993,'' and inserting ``January 1, 1996,''.
(2) No use of customary charge in determining payment.--
Section 1834(g)(1) (42 U.S.C. 1395m(g)(1)) is amended by adding
at the end the following new flush sentence:
``The amount of payment shall be determined under either method
without regard to the amount of the customary or other
charge.''.
(f) Clarification of Physician Staffing Requirement for Rural
Primary Care Hospitals.--Section 1820(f)(1)(H) (42 U.S.C. 1395i-
4(f)(1)(H)) is amended by striking the period and inserting the
following: ``, except that in determining whether a facility meets the
requirements of this subparagraph, subparagraphs (E) and (F) of that
paragraph shall be applied as if any reference to a `physician' is a
reference to a physician as defined in section 1861(r)(1).''.
(g) Technical Amendments Relating to Part A Deductible,
Coinsurance, and Spell of Illness.--(1) Section 1812(a)(1) (42 U.S.C.
1395d(a)(1)) is amended--
(A) by striking ``inpatient hospital services'' the first
place it appears and inserting ``inpatient hospital services or
inpatient rural primary care hospital services'';
(B) by striking ``inpatient hospital services'' the second
place it appears and inserting ``such services''; and
(C) by striking ``and inpatient rural primary care hospital
services''.
(2) Sections 1813(a) and 1813(b)(3)(A) (42 U.S.C. 1395e(a),
1395e(b)(3)(A)) are each amended by striking ``inpatient hospital
services'' each place it appears and inserting ``inpatient hospital
services or inpatient rural primary care hospital services''.
(3) Section 1813(b)(3)(B) (42 U.S.C. 1395e(b)(3)(B)) is amended by
striking ``inpatient hospital services'' and inserting ``inpatient
hospital services, inpatient rural primary care hospital services''.
(4) Section 1861(a) (42 U.S.C. 1395x(a)) is amended--
(A) in paragraph (1), by striking ``inpatient hospital
services'' and inserting ``inpatient hospital services,
inpatient rural primary care hospital services''; and
(B) in paragraph (2), by striking ``hospital'' and
inserting ``hospital or rural primary care hospital''.
(h) Authorization of Appropriations.--Section 1820(l) (42 U.S.C.
1395i-4(l)), as redesignated by subsection (c)(2)(A), is amended by
striking ``1990, 1991, and 1992'' and inserting ``1990 through 1997''.
(i) Effective Date.--The amendments made by this section shall take
effect on the date of the enactment of this Act.

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(a) Eligibility of Rural Primary Care Hospitals for Grants.--
(1) In general.--Section 4005(e)(2) of OBRA-1987 is amended
in the matter preceding subparagraph (A) by inserting ``any
rural primary care hospital designated by the Secretary under
section 1820(i)(2) of the Social Security Act, or'' after
``means''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to grants made on or after October 1, 1994.
(b) Extension of Authorization of Appropriations.--Section
4005(e)(9) of OBRA-1987 is amended--
(1) by striking ``1989 and'' and inserting ``1989,''; and
(2) by striking ``1992'' and inserting ``1992 and
$30,000,000 for each of fiscal years 1993 through 1997''.
(c) Frequency of Required Reports.--Section 4008(e)(8)(B) of OBRA-
1987 is amended by striking ``every 6 months'' and inserting ``every 12
months''.

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Section 1861(e)(4) (42 U.S.C. 1395x(e)(4)) is amended by striking
``physician;'' and inserting ``physician, except that a patient
receiving qualified psychologist services (as defined in subsection
(ii)) may be under the care of a clinical psychologist with respect to
such services to the extent permitted under State law;''.

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HOSPITALS.
(a) Medicare Dependent, Small Rural Hospitals.--
(1) Clarification of additional payment.--Section
1886(d)(5)(G)(ii)(I) (42 U.S.C. 1395ww(d)(5)(G)(ii)(I)), as
amended by section 13501(e)(1) of OBRA-1993, is amended by
striking ``the first 3 12-month cost reporting periods that
begin'' and inserting ``the 36-month period beginning with the
first day of the cost reporting period that begins''.
(2) Conforming target amounts to extension of additional
payments.--Section 1886(b)(3)(D) (42 U.S.C. 1395ww(b)(3)(D)) is
amended in the matter preceding clause (i) by striking ``March
31, 1993'' and inserting ``September 30, 1994''.
(b) Clarification of Updates.--Section 1886(b)(3)(B)(iv)(II) (42
U.S.C. 1395ww(b)(3)(B)(iv)(II)), as added by section 13501(a)(2) of
OBRA-1993, is amended by striking ``(taking into account'' and all that
follows through ``1994)'' and inserting ``(adjusted to exclude any
portion of a cost reporting period beginning during fiscal year 1993
for which the applicable percentage increase is determined under
subparagraph (I))''.

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(a) Construction of Wage Index.--Not later than 1 year after the
date of the enactment of this Act, the Secretary of Health and Human
Services shall begin to collect data on employee compensation and paid
hours of employment in skilled nursing facilities for the purpose of
constructing a skilled nursing facility wage index adjustment to the
routine service cost limits required under section 1888(a)(4) of the
Social Security Act.
(b) Clarification of Repeal of Utilization Review Requirements.--
(1) In general.--(A) Section 1814(a)(5) (42 U.S.C.
1395f(a)(5)) is amended--
(i) by striking ``and with respect'' and all that
follows through ``regulations'';
(ii) by striking ``or skilled nursing facility, as
the case may be''; and
(iii) by striking ``or facility''.
(B) Section 1866(d) (42 U.S.C. 1395cc(d)) is amended--
(i) by striking ``or skilled nursing facility'';
(ii) by striking ``or facility'' each place it
appears;
(iii) by striking ``or for post-hospital'' and all
that follows through ``the case may be''; and
(iv) by striking ``, or (in the case of'' and all
that follows through ``transfer agreement,''.
(2) Effective date.--The amendments made by paragraph (1)
shall take effect as if included in the enactment of OBRA-1987.
(c) Conforming Amendments to Nursing Home Reform.--
(1) Suspension of decertification of nurses aide training
and competency evaluation programs based on extended surveys.--
(A) In general.--Section 1819(f)(2)(B)(iii)(I)(b)
(42 U.S.C. 1395i-3(f)(2)(B)(iii)(I)(b)) is amended by
striking the semicolon and inserting the following: ``,
unless the survey shows that the facility is in
compliance with the requirements of subsections (b),
(c), and (d) of this section;''.
(B) Effective date.--The amendment made by
subparagraph (A) shall take effect as if included in
the enactment of OBRA-1990.
(2) Requirements for consultants conducting reviews on use
of drugs.--
(A) In general.--Section 1819(c)(1)(D) (42 U.S.C.
1395i-3(c)(1)(D)) is amended by adding at the end the
following sentence: ``In determining whether such a
consultant is qualified to conduct reviews under the
preceding sentence, the Secretary shall take into
account the needs of nursing facilities under this
title to have access to the services of such a
consultant on a timely basis.''.
(B) Effective date.--The amendment made by
subparagraph (A) shall take effect as if included in
the enactment of OBRA-1987.
(3) Increase in minimum amount required for separate
deposit of personal funds.--
(A) In general.--Section 1819(c)(6)(B)(i) (42
U.S.C. 1395i-3(c)(6)(B)(i)) is amended by striking
``$50'' and inserting ``$100''.
(B) Effective date.--The amendment made by
subparagraph (A) shall take effect January 1, 1995.
(4) Due process protections for nurse aides.--
(A) Prohibiting state from including undocumented
allegations in nurses aide registry.--Section
1819(e)(2)(B) (42 U.S.C. 1395i-3(e)(2)(B)) is amended
by striking the period at the end of the first sentence
and inserting the following: ``, but shall not include
any allegations of resident abuse or neglect or
misappropriation of resident property that are not
specifically documented by the State under such
subsection.''.
(B) Due process requirements for rebutting
allegations.--Section 1819(g)(1)(C) (42 U.S.C. 1395i-
3(g)(1)(C)) is amended by striking the second sentence
and inserting the following: ``The State shall, after
providing the individual involved with a written notice
of the allegations (including a statement of the
availability of a hearing for the individual to rebut
the allegations) and the opportunity for a hearing on
the record, make a written finding as to the accuracy
of the allegations.''.
(C) Effective date.--The amendments made by this
paragraph shall take effect January 1, 1995.
(d) Corrections Relating to Section 4008.--
(1) Section 1819(b)(5)(D) (42 U.S.C. 1395i-3(b)(5)(D)), as
amended by section 4008(h)(1)(D) of OBRA-1990, is amended by
striking the comma before ``or a new competency evaluation
program.''.
(2) Section 1819(b)(5)(G) (42 U.S.C. 1395i-3(b)(5)(G)) is
amended by striking ``or licensed or certified social worker''
and inserting ``licensed or certified social worker, registered
respiratory therapist, or certified respiratory therapy
technician''.
(3) Section 1819(f)(2)(B)(i) (42 U.S.C. 1395i-
3(f)(2)(B)(i)) is amended by striking ``facilities,'' and
inserting ``facilities (subject to clause (iii)),''.
(4) Section 1819(f)(2)(B)(iii)(I)(c) (42 U.S.C. 1395i-
3(f)(2)(B)(iii)(I)(c)) is amended by striking ``clauses'' each
place it appears and inserting ``clause''.
(5) Section 1819(g)(5)(B) (42 U.S.C. 1395i-3(g)(5)(B)) is
amended by striking ``paragraphs'' and inserting ``paragraph''.
(6) Section 4008(h)(1)(F)(ii) of OBRA-1990 is amended--
(A) by striking ``The amendments'' and inserting
``(I) The amendments'';
(B) by striking ``nursing facility'' each place it
appears and inserting ``skilled nursing facility'';
(C) by redesignating subclauses (I) through (V) as
items (aa) through (ee); and
(D) by adding at the end the following new
subclause:
``(II) Notwithstanding subclause (I) and
subject to section 1819(f)(2)(B)(iii)(I) of the
Social Security Act (as amended by clause (i)),
a State may approve a training and competency
evaluation program or a competency evaluation
program offered by or in a skilled nursing
facility described in subclause (I) if, during
the previous 2 years, item (aa), (bb), (cc),
(dd), or (ee) of subclause (I) did not apply to
the facility.''.
(7) Effective date.--The amendments made by this subsection
shall take effect as if included in the enactment of OBRA-1990.

ea46fe882755b94595b9ef75750b657119a2b47d043d2c620b64a623c1d14bcb

(a) In General.--Section 1861(ee)(2)(D) (42 U.S.C. 1395x(ee)(2)(D))
is amended by inserting ``, including hospice services,'' after ``post-
hospital services''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to services furnished on or after the first day of the first
month beginning more than one year after the date of the enactment of
this Act.

fc4ea1f95bd0c65c938227641be9ce72b58d863b9b50653f8b96d005d6c4af31

PROSPECTIVE PAYMENT ASSESSMENT COMMISSION.
Section 1886(e)(6)(B) (42 U.S.C. 1395ww(e)(6)(B)) is amended by
striking ``hospital reimbursement, hospital financial management'' and
inserting ``health facility management, reimbursement of health
facilities or other providers of services which reflect the scope of
the Commission's responsibilities''.

d34f53fed63162305e5977351247edfa8a6169c738feb9aa8df69e7110928865

PAYMENT AMOUNTS FOR TRANSFER CASES.
Section 1886(d)(5)(I) (42 U.S.C. 1395ww(d)(5)) is amended--
(1) by inserting ``(i)'' after ``(I)''; and
(2) by adding at the end the following new clause:
``(ii) In making adjustments under clause (i) for transfer cases
(as defined by the Secretary) in a fiscal year, the Secretary may make
adjustments to each of the average standardized amounts determined
under paragraph (3) to assure that the aggregate payments made under
this subsection for such fiscal year are not greater or lesser than
those that would have otherwise been made in such fiscal year.''.

42355e81bfedb7525374523c6944d099836ca52c27b81cb06bf2a07626b5e067

AND TECHNICAL CORRECTIONS.
(a) Clarification of DRG Payment Window Expansion.--The first
sentence of section 1886(a)(4) (42 U.S.C. 1395ww(a)(4)) is amended by
inserting ``(or, in the case of a hospital that is not a subsection (d)
hospital, during the 1 day)'' after ``3 days''.
(b) Technical Correction Relating to Resident Assessment in Nursing
Homes.--Section 1819(b)(3)(C)(i)(I) (42 U.S.C. 1395i-3(b)(3)(C)(i)(I))
is amended by striking ``not later than'' before ``14 days''.
(c) Technical Correction Relating to Applicable Adjustment Factor
for Indirect Medical Education Adjustment.--Section 1886(d)(5)(B)(ii)
(42 U.S.C. 1395ww(d)(5)(B)(ii)) is amended by striking ``May 1, 1986,''
and inserting ``October 1, 1988,''.
(d) Clerical Corrections.--(1) Section 1814(i)(1)(C)(i) (42 U.S.C.
1395f(i)(1)(C)(i)) is amended by striking ``September 30, 1990,,'' and
inserting ``September 30, 1990,''.
(2) Section 1816(f)(2)(A)(ii) (42 U.S.C. 1396h(f)(2)(A)(ii)) is
amended by striking ``such agency'' and inserting ``such agency's''.
Subtitle B--Provisions Relating to Part B
PART I--PHYSICIANS' SERVICES

668cc11197d8242861cd30511f8f09f7d9615aa512832f507c251ef0d9501130

FOR PRACTICE EXPENSES.
(a) Development.--
(1) In general.--The Secretary of Health and Human Services
shall develop a methodology for implementing in 1998 a
resource-based system for determining practice expense relative
value units for each physicians' service. The methodology
utilized shall recognize the staff, equipment, and supplies
used in the provision of various medical and surgical services
in various settings.
(2) Report.--The Secretary shall transmit a report by June
30, 1996, on the methodology developed under paragraph (1) to
the Committees on Ways and Means and Energy and Commerce of the
House of Representatives and the Committee on Finance of the
Senate. The report shall include a presentation of data
utilized in developing the methodology and an explanation of
the methodology.
(b) Implementation.--
(1) In general.--Section 1848(c)(2)(C)(ii) (42 U.S.C.
1395w-4(c)(2)(C)(ii)) is amended--
(A) by inserting ``for the service for years before
1998'' before ``equal to'',
(B) by striking the period at the end of subclause
(II) and inserting a comma, and
(C) by adding after and below subclause (II) the
following:
``and for years beginning with 1998 based on
the relative practice expense resources
involved in furnishing the service.''.
(2) Conforming amendment.--Section 1848(c)(3)(C)(ii) (42
U.S.C. 1395w-4(c)(3)(C)(ii)) is amended by striking ``The
practice'' and inserting ``For years before 1998, the
practice''.
(3) Application of certain provisions.--In implementing the
amendment made by paragraph (1)(C), the provisions of clauses
(ii)(II) and (iii) of section 1848(c)(2)(B) of the Social
Security Act shall apply in the same manner as they apply to
adjustments under clause (ii)(I) of such section.

304c49ff74329efc1b53e48bdcd55fce88db93bf31e195f0b1ef30418ae12a7c

(a) Requiring Consultation with Representatives of Physicians in
Reviewing Geographic Adjustment Factors.--Section 1848(e)(1)(C) (42
U.S.C. 1395w-4(e)(1)(C)) is amended by striking ``shall review'' and
inserting ``shall, in consultation with appropriate representatives of
physicians, review''.
(b) Use of Most Recent Data In Geographic Adjustment.--Section
1848(e)(1) (42 U.S.C. 1395w-4(e)(1)) is amended by adding at the end
the following new subparagraph:
``(D) Use of recent data.--In establishing indices
and index values under this paragraph, the Secretary
shall use the most recent data available relating to
practice expenses, malpractice expenses, and physician
work effort in different fee schedule areas.''.
(c) Report on Review Process.--Not later than 1 year after the date
of the enactment of this Act, the Secretary of Health and Human
Services shall study and report to the Committee on Finance of the
Senate and the Committee on Ways and Means and the Committee on Energy
and Commerce of the House of Representatives on--
(1) the data necessary to review and revise the indices
established under section 1848(e)(1)(A) of the Social Security
Act, including--
(A) the shares allocated to physicians' work
effort, practice expenses (other than malpractice
expenses), and malpractice expenses;
(B) the weights assigned to the input components of
such shares; and
(C) the index values assigned to such components;
(2) any limitations on the availability of data necessary
to review and revise such indices at least every three years;
(3) ways of addressing such limitations, with particular
attention to the development of alternative data sources for
input components for which current index values are based on
data collected less frequently than every three years; and
(4) the costs of developing more accurate and timely data.

240d85aee5f35b7fff2496e4db8177913b2b1483121dbd94906534fe17957ea0

(a) Enforcement of Limits.--Section 1848(g) (42 U.S.C. 1395w-4(g)),
as amended by section 13517(a) of OBRA-1993, is amended--
(1) by amending paragraph (1) to read as follows:
``(1) Limitation on actual charges.--
``(A) In general.--In the case of a
nonparticipating physician or nonparticipating supplier
or other person (as defined in section 1842(i)(2)) who
does not accept payment on an assignment-related basis
for a physician's service furnished with respect to an
individual enrolled under this part, the following
rules apply:
``(i) Application of limiting charge.--No
person may bill or collect an actual charge for
the service in excess of the limiting charge
described in paragraph (2) for such service.
``(ii) No liability for excess charges.--No
person is liable for payment of any amounts
billed for the service in excess of such
limiting charge.
``(iii) Correction of excess charges.--If
such a physician, supplier, or other person
bills, but does not collect, an actual charge
for a service in violation of clause (i), the
physician, supplier, or other person shall
reduce on a timely basis the actual charge
billed for the service to an amount not to
exceed the limiting charge for the service.
``(iv) Refund of excess collections.--If
such a physician, supplier, or other person
collects an actual charge for a service in
violation of clause (i), the physician,
supplier, or other person shall provide on a
timely basis a refund to the individual charged
in the amount by which the amount collected
exceeded the limiting charge for the service.
The amount of such a refund shall be reduced to
the extent the individual has an outstanding
balance owed by the individual to the
physician.
``(B) Sanctions.--If a physician, supplier, or
other person--
``(i) knowingly and willfully bills or
collects for services in violation of
subparagraph (A)(i) on a repeated basis, or
``(ii) fails to comply with clause (iii) or
(iv) of subparagraph (A) on a timely basis,
the Secretary may apply sanctions against the
physician, supplier, or other person in accordance with
paragraph (2) of section 1842(j). In applying this
subparagraph, paragraph (4) of such section applies in
the same manner as such paragraph applies to such
section and any reference in such section to a
physician is deemed also to include a reference to a
supplier or other person under this subparagraph.
``(C) Timely basis.--For purposes of this
paragraph, a correction of a bill for an excess charge
or refund of an amount with respect to a violation of
subparagraph (A)(i) in the case of a service is
considered to be provided `on a timely basis', if the
reduction or refund is made not later than 30 days
after the date the physician, supplier, or other person
is notified by the carrier under this part of such
violation and of the requirements of subparagraph
(A).''; and
(2) in paragraph (3)(B)--
(A) by inserting after the first sentence the
following: ``No person is liable for payment of any
amounts billed for such a service in violation of the
previous sentence.'', and
(B) in the last sentence, by striking ``previous
sentence'' and inserting ``first sentence''.
(b) Clarification of Mandatory Assignment Rules for Certain
Practitioners.--
(1) In general.--Section 1842(b) (42 U.S.C. 1395u(b)), as
amended by section 126(e), is amended by adding at the end the
following new paragraph:
``(18)(A) Payment for any service furnished by a practitioner
described in subparagraph (C) and for which payment may be made under
this part on a reasonable charge or fee schedule basis may only be made
under this part on an assignment-related basis.
``(B) A practitioner described in subparagraph (C) or other person
may not bill (or collect any amount from) the individual or another
person for any service described in subparagraph (A), except for
deductible and coinsurance amounts applicable under this part. No
person is liable for payment of any amounts billed for such a service
in violation of the previous sentence. If a practitioner or other
person knowingly and willfully bills (or collects an amount) for such a
service in violation of such sentence, the Secretary may apply
sanctions against the practitioner or other person in the same manner
as the Secretary may apply sanctions against a physician in accordance
with subsection (j)(2) in the same manner as such section applies with
respect to a physician. Paragraph (4) of subsection (j) shall apply in
this subparagraph in the same manner as such paragraph applies to such
section.
``(C) A practitioner described in this subparagraph is any of the
following:
``(i) A physician assistant, nurse practitioner, or
clinical nurse specialist (as defined in section 1861(aa)(5)).
``(ii) A certified registered nurse anesthetist (as defined
in section 1861(bb)(2)).
``(iii) A certified nurse-midwife (as defined in section
1861(gg)(2)).
``(iv) A clinical social worker (as defined in section
1861(hh)(1)).
``(v) A clinical psychologist (as defined by the Secretary
for purposes of section 1861(ii)).
``(D) For purposes of this paragraph, a service furnished by a
practitioner described in subparagraph (C) includes any services and
supplies furnished as incident to the service as would otherwise be
covered under this part if furnished by a physician or as incident to a
physician's service.''.
(2) Conforming amendments.--
(A) Section 1833 (42 U.S.C. 1395l) is amended--
(i) in subsection (l)(5), by striking
subparagraph (B) and redesignating subparagraph
(C) as subparagraph (B);
(ii) by striking subsection (p); and
(iii) in subsection (r), by striking
paragraph (3) and redesignating paragraph (4)
as paragraph (3).
(B) Section 1842(b)(12) (42 U.S.C. 1395u(b)(12)) is
amended by striking subparagraph (C).
(c) Information on Extra-Billing Limits.--
(1) Part of explanation of medicare benefits.--Section
1842(h)(7) (42 U.S.C. 1395u(h)(7)) is amended--
(A) by striking ``and'' at the end of subparagraph
(B),
(B) in subparagraph (C), by striking ``shall
include'',
(C) in subparagraph (C), by striking the period at
the end and inserting ``, and'', and
(D) by adding at the end the following new
subparagraph:
``(D) in the case of services for which the billed amount
exceeds the limiting charge imposed under section 1848(g),
information regarding such applicable limiting charge
(including information concerning the right to a refund under
section 1848(g)(1)(A)(iv)).''.
(2) Determinations by carriers.--Subparagraph (G) of
section 1842(b)(3) (42 U.S.C. 1395u(b)(3)) is amended to read
as follows:
``(G) will, for a service that is furnished with respect to
an individual enrolled under this part, that is not paid on an
assignment-related basis, and that is subject to a limiting
charge under section 1848(g)--
``(i) determine, prior to making payment, whether
the amount billed for such service exceeds the limiting
charge applicable under section 1848(g)(2);
``(ii) notify the physician, supplier, or other
person periodically (but not less often than once every
30 days) of determinations that amounts billed exceeded
such applicable limiting charges; and
``(iii) provide for prompt response to inquiries of
physicians, suppliers, and other persons concerning the
accuracy of such limiting charges for their
services;''.
(d) Report on Charges in Excess of Limiting Charge.--Section
1848(g)(6)(B) (42 U.S.C. 1395w-4(g)(6)(B)) is amended by inserting
``information on the extent to which actual charges exceed limiting
charges, the number and types of services involved, and the average
amount of excess charges and information'' after ``report to the
Congress''.
(e) Miscellaneous and Technical Amendments.--Section 1833(h)(5)(D)
(42 U.S.C. 1395l(h)(5)(D)) is amended--
(1) by striking ``paragraphs (2) and (3)'' and by inserting
``paragraph (2)''; and
(2) by adding at the end the following: ``Paragraph (4) of
such section shall apply in this subparagraph in the same
manner as such paragraph applies to such section.''.
(f) Effective Dates.--
(1) Enforcement; miscellaneous and technical amendments.--
The amendments made by subsections (a) and (e) shall apply to
services furnished on or after the date of the enactment of
this Act; except that the amendments made by subsection (a)
shall not apply to services of a nonparticipating supplier or
other person furnished before January 1, 1995.
(2) Practitioners.--The amendments made by subsection (b)
shall apply to services furnished on or after January 1, 1995.
(3) EOMBs.--The amendments made by subsection (c)(1) shall
apply to explanations of benefits provided on or after July 1,
1995.
(4) Carrier determinations.--The amendments made by
subsection (c)(2) shall apply to contracts as of January 1,
1995.
(5) Report.--The amendment made by subsection (d) shall
apply to reports for years beginning with 1995.

df5e84afd076f0cf642ed8fe14657b3b3761ff57dcd1fd3c9ddbce016254bb5d

(a) In General.--The Secretary of Health and Human Services shall
fully develop, by not later than July 1, 1995, relative values for the
full range of pediatric physicians' services which are consistent with
the relative values developed for other physicians' services under
section 1848(c) of the Social Security Act. In developing such values,
the Secretary shall conduct such refinements as may be necessary to
produce appropriate estimates for such relative values.
(b) Study.--
(1) In general.--The Secretary shall conduct a study of the
relative values for pediatric and other services to determine
whether there are significant variations in the resources used
in providing similar services to different populations. In
conducting such study, the Secretary shall consult with
appropriate organizations representing pediatricians and other
physicians and physical and occupational therapists.
(2) Report.--Not later than July 1, 1995, the Secretary
shall submit to Congress a report on the study conducted under
paragraph (1). Such report shall include any appropriate
recommendations regarding needed changes in coding or other
payment policies to ensure that payments for pediatric services
appropriately reflect the resources required to provide these
services.

9dfff961dbe450064bb8639ee8adb11d70202054fbf5318b32b21adaff28dd39

(a) Limitation on Carrier User Fees.--Section 1842(c) (42 U.S.C.
1395u(c)) is amended by adding at the end the following new paragraph:
``(4) Neither a carrier nor the Secretary may impose a fee under
this title--
``(A) for the filing of claims related to physicians'
services,
``(B) for an error in filing a claim relating to
physicians' services or for such a claim which is denied,
``(C) for any appeal under this title with respect to
physicians' services,
``(D) for applying for (or obtaining) a unique identifier
under subsection (r), or
``(E) for responding to inquiries respecting physicians'
services or for providing information with respect to medical
review of such services.''.
(b) Clarification of Permissible Substitute Billing Arrangements.--
(1) In general.--Clause (D) of section 1842(b)(6) (42
U.S.C. 1395u(b)(6)) is amended to read as follows: ``(D)
payment may be made to a physician for physicians' services
(and services furnished incident to such services) furnished by
a second physician to patients of the first physician if (i)
the first physician is unavailable to provide the services;
(ii) the services are furnished pursuant to an arrangement
between the two physicians that (I) is informal and reciprocal,
or (II) involves per diem or other fee-for-time compensation
for such services; (iii) the services are not provided by the
second physician over a continuous period of more than 60 days;
and (iv) the claim form submitted to the carrier for such
services includes the second physician's unique identifier
(provided under the system established under subsection (r))
and indicates that the claim meets the requirements of this
subparagraph for payment to the first physician''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to services furnished on or after the first day of
the first month beginning more than 60 days after the date of
the enactment of this Act.

913529c839f7b31e7d71910c215795780d109dedd5d26a66dba7c9112712e56c

(a) Overvalued Procedures.--(1) Section 1842(b)(16)(B)(iii) (42
U.S.C. 1395u(b)(16)(B)(iii)) is amended--
(A) by striking ``, simple and subcutaneous'',
(B) by striking ``; small'' and inserting ``and small'',
(C) by striking ``treatments;'' the first place it appears
and inserting ``and'',
(D) by striking ``lobectomy;'',
(E) by striking ``enterectomy; colectomy;
cholecystectomy;'',
(F) by striking ``; transurerethral resection'' and
inserting ``and resection'', and
(G) by striking ``sacral laminectomy;''.
(2) Section 4101(b)(2) of OBRA-1990 is amended--
(A) in the matter before subparagraph (A), by striking
``1842(b)(16)'' and inserting ``1842(b)(16)(B)'', and
(B) in subparagraph (B)--
(i) by striking ``, simple and subcutaneous'',
(ii) by striking ``(HCPCS codes 19160 and 19162)''
and inserting ``(HCPCS code 19160)'', and
(iii) by striking all that follows ``(HCPCS codes
92250'' and inserting ``and 92260).''.
(b) Radiology Services.--(1) Section 1834(b)(4) (42 U.S.C.
1395m(b)(4)) is amended by redesignating the subparagraphs (E) and (F)
redesignated by section 4102(a)(1) of OBRA-1990 as subparagraphs (F)
and (G), respectively.
(2) Section 1834(b)(4)(D) (42 U.S.C. 1395m(b)(4)(D)) is amended--
(A) in the matter before clause (i), by striking ``shall be
determined as follows:'' and inserting ``shall, subject to
clause (vii), be reduced to the adjusted conversion factor for
the locality determined as follows:'',
(B) in clause (iv), by striking ``Local adjustment.--
Subject to clause (vii), the conversion factor to be applied
to'' and inserting ``Adjusted conversion factor.--The adjusted
conversion factor for'',
(C) in clause (vii), by striking ``under this
subparagraph'', and
(D) in clause (vii), by inserting ``reduced under this
subparagraph by'' after ``shall not be''.
(3) Section 4102(c)(2) of OBRA-1990 is amended by striking
``radiology services'' and all that follows and inserting ``nuclear
medicine services.''.
(4) Section 4102(d) of OBRA-1990 is amended by striking ``new
paragraph'' and inserting ``new subparagraph''.
(5) Section 1834(b)(4)(E) (42 U.S.C. 1395m(b)(4)(E)) is amended by
inserting ``Rule for certain scanning services.--'' after ``(E)''.
(6) Section 1848(a)(2)(D)(iii) (42 U.S.C. 1395w-4(a)(2)(D)(iii)) is
amended by striking ``that are subject to section 6105(b) of the
Omnibus Budget Reconciliation Act of 1989'' and by striking ``provided
under such section'' and inserting ``provided under section 6105(b) of
the Omnibus Budget Reconciliation Act of 1989''.
(c) Anesthesia Services.--(1) Section 4103(a) of OBRA-1990 is
amended by striking ``Reduction in Fee Schedule'' and inserting
``Reduction in Prevailing Charges''.
(2) Section 1842(q)(1)(B) (42 U.S.C. 1395u(q)(1)(B)) is amended--
(A) in the matter before clause (i), by striking ``shall be
determined as follows:'' and inserting ``shall, subject to
clause (iv), be reduced to the adjusted prevailing charge
conversion factor for the locality determined as follows:'',
and
(B) in clause (iii), by striking ``Subject to clause (iv),
the prevailing charge conversion factor to be applied in'' and
inserting ``The adjusted prevailing charge conversion factor
for''.
(d) Assistants at Surgery.--(1) Section 4107(c) of OBRA-1990 is
amended by inserting ``(a)(1)'' after ``subsection''.
(2) Section 4107(a)(2) of OBRA-1990 is amended by adding at the end
the following: ``In applying section 1848(g)(2)(D) of the Social
Security Act for services of an assistant-at-surgery furnished during
1991, the recognized payment amount shall not exceed the maximum amount
specified under section 1848(i)(2)(A) of such Act (as applied under
this paragraph in such year).''.
(e) Technical Components of Diagnostic Services.--Section 1842(b)
(42 U.S.C. 1395u(b)) is amended by redesignating paragraph (18), as
added by section 4108(a) of OBRA-1990, as paragraph (17) and, in such
paragraph, by inserting ``, tests specified in paragraph (14)(C)(i),''
after ``diagnostic laboratory tests''.
(f) Statewide Fee Schedules.--Section 4117 of OBRA-1990 is
amended--
(1) in subsection (a)--
(A) by striking ``(a) In General.--'', and
(B) by striking ``, if the'' and all that follows
through ``1991,''; and
(2) by striking subsections (b), (c), and (d).
(g) Other Miscellaneous and Technical Amendments.--(1) The heading
of section 1834(f) (42 U.S.C. 1395m(f)) is amended by striking ``Fiscal
Year''.
(2)(A) Section 4105(b) of OBRA-1990 is amended--
(i) in paragraph (2), by striking ``amendments'' and
inserting ``amendment'', and
(ii) in paragraph (3), by striking ``amendments made by
paragraphs (1) and (2)'' and inserting ``amendment made by
paragraph (1)''.
(B) Section 1848(f)(2)(C) (42 U.S.C. 1395w-4(f)(2)(C)) is amended
by inserting ``Performance standard rates of increase for fiscal year
1991.--'' after ``(C)''.
(C) Section 4105(d) of OBRA-1990 is amended by inserting
``Publication of Performance Standard Rates.--'' after ``(d)''.
(3) Section 4106(c) of OBRA-1990 is amended by inserting ``of the
Social Security Act'' after ``1848(d)(1)(B)''.
(4) Section 4114 of OBRA-1990 is amended by striking ``patients''
the second place it appears.
(5) Section 1848(e)(1)(C) (42 U.S.C. 1395w-4(e)(1)(C)) is amended
by inserting ``date of the'' after ``since the''.
(6) Section 4118(f)(1)(D) of OBRA-1990 is amended by striking ``is
amended''.
(7) Section 4118(f)(1)(N)(ii) of OBRA-1990 is amended by striking
``subsection (f)(5)(A)'' and inserting ``subsection (f)(5)(A))''.
(8) Section 1845(e) (42 U.S.C. 1395w-1(e)) is amended--
(A) by striking paragraph (2); and
(B) by redesignating paragraphs (3), (4), and (5) as
paragraphs (2), (3), and (4).
(9) Section 4118(j)(2) of OBRA-1990 is amended by striking ``In
section'' and inserting ``Section''.
(10)(A) Section 1848(i)(3) (42 U.S.C. 1395w-4(i)(3)) is amended by
striking the space before the period at the end.
(B) Section 1834(a)(10)(B) (42 U.S.C. 1395m(a)(10)(B)) is amended--
(i) by striking ``apply to'' and inserting ``would
otherwise apply to'', and
(ii) by inserting before the period at the end ``but for
the application of section 1848(i)(3)''.
(h) Other Corrections.--(1) Effective on the date of the enactment
of this Act, section 6102(d)(4) of OBRA-1989 is amended by striking all
that follows the first sentence.
(2) Effective for payments for fiscal years beginning with fiscal
year 1994, section 1842(c)(1) (42 U.S.C. 1395u(c)(1)) is amended--
(A) in subparagraph (A), by striking ``(A) Any contract''
and inserting ``Any contract''; and
(B) by striking subparagraph (B).
(i) Effective Date.--Except as provided in subsection (i), the
amendments made by this section and the provisions of this section
shall take effect as if included in the enactment of OBRA-1990.
PART II--DURABLE MEDICAL EQUIPMENT

18a52ee18ab0658eea5927d2a88c20e0eb4fc8a9ba300696f1025ec2cf9f0848

(a) Requirements.--
(1) In general.--Section 1834 (42 U.S.C. 1395m), as amended
by section 13544(b)(1) of OBRA-1993, is amended by adding at
the end the following new subsection:
``(j) Requirements for Suppliers of Medical Equipment and
Supplies.--
``(1) Issuance and renewal of supplier number.--
``(A) Payment.--Except as provided in subparagraph
(C), no payment may be made under this part after the
date of the enactment of the Social Security Act
Amentments of 1994 for items furnished by a supplier of
medical equipment and supplies unless such supplier
obtains (and renews at such intervals as the Secretary
may require) a supplier number.
``(B) Standards for possessing a supplier number.--
A supplier may not obtain a supplier number unless--
``(i) for medical equipment and supplies
furnished on or after the date of enactment of
the Social Security Act Amendments of 1994, and
before January 1, 1996, the supplier meets
standards prescribed by the Secretary in
regulations issued on June 18, 1992; and
``(ii) for medical equipment and supplies
furnished on or after January 1, 1996, the
supplier meets revised standards prescribed by
the Secretary (in consultation with
representatives of suppliers of medical
equipment and supplies, carriers, and
consumers) that shall include requirements that
the supplier--
``(I) comply with all applicable
State and Federal licensure and
regulatory requirements;
``(II) maintain a physical facility
on an appropriate site;
``(III) have proof of appropriate
liability insurance; and
``(IV) meet such other requirements
as the Secretary may specify.
``(C) Exception for items furnished as incident to
a physician's service.--Subparagraph (A) shall not
apply with respect to medical equipment and supplies
furnished incident to a physician's service.
``(D) Prohibition against multiple supplier
numbers.--The Secretary may not issue more than one
supplier number to any supplier of medical equipment
and supplies unless the issuance of more than one
number is appropriate to identify subsidiary or
regional entities under the supplier's ownership or
control.
``(E) Prohibition against delegation of supplier
determinations.--The Secretary may not delegate (other
than by contract under section 1842) the responsibility
to determine whether suppliers meet the standards
necessary to obtain a supplier number.
``(2) Certificates of medical necessity.--
``(A) Limitation on information provided by
suppliers on certificates of medical necessity.--
``(i) In general.--Effective 60 days after
the date of enactment of the Social Security
Act Amendments of 1994, a supplier of medical
equipment and supplies may distribute to
physicians, or to individuals entitled to
benefits under this part, a certificate of
medical necessity for commercial purposes which
contains no more than the following information
completed by the supplier:
``(I) An identification of the
supplier and the beneficiary to whom
such medical equipment and supplies are
furnished.
``(II) A description of such
medical equipment and supplies.
``(III) Any product code
identifying such medical equipment and
supplies.
``(IV) Any other administrative
information (other than information
relating to the beneficiary's medical
condition) identified by the Secretary.
``(ii) Information on payment amount and
charges.--If a supplier distributes a
certificate of medical necessity containing any
of the information permitted to be supplied
under clause (i), the supplier shall also list
on the certificate of medical necessity the fee
schedule amount and the supplier's charge for
the medical equipment or supplies being
furnished prior to distribution of such
certificate to the physician.
``(iii) Penalty.--Any supplier of medical
equipment and supplies who knowingly and
willfully distributes a certificate of medical
necessity in violation of clause (i) or fails
to provide the information required under
clause (ii) is subject to a civil money penalty
in an amount not to exceed $1,000 for each such
certificate of medical necessity so
distributed. The provisions of section 1128A
(other than subsections (a) and (b)) shall
apply to civil money penalties under this
subparagraph in the same manner as they apply
to a penalty or proceeding under section
1128A(a).
``(B) Definition.--For purposes of this paragraph,
the term `certificate of medical necessity' means a
form or other document containing information required
by the carrier to be submitted to show that an item is
reasonable and necessary for the diagnosis or treatment
of illness or injury or to improve the functioning of a
malformed body member.
``(3) Coverage and review criteria.--The Secretary shall
annually review the coverage and utilization of items of
medical equipment and supplies to determine whether such items
should be made subject to coverage and utilization review
criteria, and if appropriate, shall develop and apply such
criteria to such items.
``(4) Definition.--The term `medical equipment and
supplies' means--
``(A) durable medical equipment (as defined in
section 1861(n));
``(B) prosthetic devices (as described in section
1861(s)(8));
``(C) orthotics and prosthetics (as described in
section 1861(s)(9));
``(D) surgical dressings (as described in section
1861(s)(5));
``(E) such other items as the Secretary may
determine; and
``(F) for purposes of paragraphs (1) and (3)--
``(i) home dialysis supplies and equipment
(as described in section 1861(s)(2)(F)),
``(ii) immunosuppressive drugs (as
described in section 1861(s)(2)(J)),
``(iii) therapeutic shoes for diabetics (as
described in section 1861(s)(12)),
``(iv) oral drugs prescribed for use as an
anticancer therapeutic agent (as described in
section 1861(s)(2)(Q)), and
``(v) self-administered erythropoetin (as
described in section 1861(s)(2)(P)).''.
(2) Conforming amendment.--Effective 60 days after the date
of enactment of the Social Security Act Amendments of 1994,
paragraph (16) of section 1834(a) (42 U.S.C. 1395m(a)) is
repealed.
(b) Use of Covered Items by Disabled Beneficiaries.--
(1) In general.--The Secretary of Health and Human
Services, in consultation with representatives of suppliers of
durable medical equipment under part B of the medicare program
and individuals entitled to benefits under such program on the
basis of disability, shall conduct a study of the effects of
the methodology for determining payments for items of such
equipment under such part on the ability of such individuals to
obtain items of such equipment, including customized items.
(2) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary shall submit a report to
Congress on the study conducted under paragraph (1), and shall
include in the report such recommendations as the Secretary
considers appropriate to assure that disabled medicare
beneficiaries have access to items of durable medical
equipment.
(c) Criteria for Treatment of Items as Prosthetic Devices or
Orthotics and Prosthetics.--Not later than one year after the date of
the enactment of this Act, the Secretary of Health and Human Services
shall submit a report to the Committees on Ways and Means and Energy
and Commerce of the House of Representatives and the Committee on
Finance of the Senate describing prosthetic devices or orthotics and
prosthetics covered under part B of the medicare program that do not
require individualized or custom fitting and adjustment to be used by a
patient. Such report shall include recommendations for an appropriate
methodology for determining the amount of payment for such items under
such program.

be8d1fb2b17de9dce61904e6c399936f35e5764fe96e05e074ca04ff7334e33e

(a) Prohibiting Unsolicited Telephone Contacts From Suppliers of
Durable Medical Equipment to Medicare Beneficiaries.--
(1) In general.--Section 1834(a) (42 U.S.C. 1395m(a)) is
amended by adding at the end the following new paragraph:
``(17) Prohibition against unsolicited telephone contacts
by suppliers.--
``(A) In general.--A supplier of a covered item
under this subsection may not contact an individual
enrolled under this part by telephone regarding the
furnishing of a covered item to the individual unless 1
of the following applies:
``(i) The individual has given written
permission to the supplier to make contact by
telephone regarding the furnishing of a covered
item.
``(ii) The supplier has furnished a covered
item to the individual and the supplier is
contacting the individual only regarding the
furnishing of such covered item.
``(iii) If the contact is regarding the
furnishing of a covered item other than a
covered item already furnished to the
individual, the supplier has furnished at least
1 covered item to the individual during the 15-
month period preceding the date on which the
supplier makes such contact.
``(B) Prohibiting payment for items furnished
subsequent to unsolicited contacts.--If a supplier
knowingly contacts an individual in violation of
subparagraph (A), no payment may be made under this
part for any item subsequently furnished to the
individual by the supplier.
``(C) Exclusion from program for suppliers engaging
in pattern of unsolicited contacts.--If a supplier
knowingly contacts individuals in violation of
subparagraph (A) to such an extent that the supplier's
conduct establishes a pattern of contacts in violation
of such subparagraph, the Secretary shall exclude the
supplier from participation in the programs under this
Act, in accordance with the procedures set forth in
subsections (c), (f), and (g) of section 1128.''.
(2) Requiring refund of amounts collected for disallowed
items.--Section 1834(a) (42 U.S.C. 1395m(a)), as amended by
paragraph (1), is amended by adding at the end the following
new paragraph:
``(18) Refund of amounts collected for certain disallowed
items.--
``(A) In general.--If a nonparticipating supplier
furnishes to an individual enrolled under this part a
covered item for which no payment may be made under
this part by reason of paragraph (17)(B), the supplier
shall refund on a timely basis to the patient (and
shall be liable to the patient for) any amounts
collected from the patient for the item, unless--
``(i) the supplier establishes that the
supplier did not know and could not reasonably
have been expected to know that payment may not
be made for the item by reason of paragraph
(17)(B), or
``(ii) before the item was furnished, the
patient was informed that payment under this
part may not be made for that item and the
patient has agreed to pay for that item.
``(B) Sanctions.--If a supplier knowingly and
willfully fails to make refunds in violation of
subparagraph (A), the Secretary may apply sanctions
against the supplier in accordance with section
1842(j)(2).
``(C) Notice.--Each carrier with a contract in
effect under this part with respect to suppliers of
covered items shall send any notice of denial of
payment for covered items by reason of paragraph
(17)(B) and for which payment is not requested on an
assignment-related basis to the supplier and the
patient involved.
``(D) Timely basis defined.--A refund under
subparagraph (A) is considered to be on a timely basis
only if--
``(i) in the case of a supplier who does
not request reconsideration or seek appeal on a
timely basis, the refund is made within 30 days
after the date the supplier receives a denial
notice under subparagraph (C), or
``(ii) in the case in which such a
reconsideration or appeal is taken, the refund
is made within 15 days after the date the
supplier receives notice of an adverse
determination on reconsideration or appeal.''.
(b) Conforming Amendment.--Section 1834(h)(3) (42 U.S.C.
1395m(h)(3)) is amended by striking ``Paragraph (12)'' and inserting
``Paragraphs (12) and (17)''.
(c) Effective Date.--The amendments made by subsections (a) and (b)
shall apply to items furnished after the expiration of the 60-day
period that begins on the date of the enactment of this Act.

b2fe98ceb7575debcf74da20b17b5b6801ca4b29b788e7fee1e2cc5f8161273d

(a) Unassigned Claims.--
(1) In general.--Section 1834(j) (42 U.S.C. 1395m(i)), as
added by section 131(a)(1), is amended--
(A) by redesignating paragraph (4) as paragraph
(5), and
(B) by inserting after paragraph (3) the following
new paragraph:
``(4) Limitation on patient liability.--If a supplier of
medical equipment and supplies (as defined in paragraph (5))--
``(A) furnishes an item or service to a beneficiary
for which no payment may be made by reason of paragraph
(1);
``(B) furnishes an item or service to a beneficiary
for which payment is denied in advance under subsection
(a)(15); or
``(C) furnishes an item or service to a beneficiary
for which payment is denied under section 1862(a)(1);
any expenses incurred for items and services furnished to an
individual by such a supplier not on an assigned basis shall be
the responsibility of such supplier. The individual shall have
no financial responsibility for such expenses and the supplier
shall refund on a timely basis to the individual (and shall be
liable to the individual for) any amounts collected from the
individual for such items or services. The provisions of
subsection (a)(18) shall apply to refunds required under the
previous sentence in the same manner as such provisions apply
to refunds under such subsection.''.
(2) Conforming amendment.--Section 1128B(b)(3)(B) (42
U.S.C. 1320a-7b(b)(3)(B)), as amended by section 134(a), is
amended by striking ``1834(j)(4)'' and inserting
``1834(j)(5)''.
(b) Assigned Claims.--Section 1879 (42 U.S.C. 1395pp) is amended by
adding at the end the following new subsection:
``(h) If a supplier of medical equipment and supplies (as defined
in section 1834(j)(5))--
``(1) furnishes an item or service to a beneficiary for
which no payment may be made by reason of section 1834(j)(1);
``(2) furnishes an item or service to a beneficiary for
which payment is denied in advance under section 1834(a)(15);
or
``(3) furnishes an item or service to a beneficiary for
which no payment may be made by reason of section
1834(a)(17)(B),
any expenses incurred for items and services furnished to an individual
by such a supplier on an assignment-related basis shall be the
responsibility of such supplier. The individual shall have no financial
responsibility for such expenses and the supplier shall refund on a
timely basis to the individual (and shall be liable to the individual
for) any amounts collected from the individual for such items or
services. The provisions of section 1834(a)(18) shall apply to refunds
required under the previous sentence in the same manner as such
provisions apply to refunds under such section.''.
(c) Effective Date.--The amendments made by this section shall
apply to items or services furnished on or after January 1, 1995.

daa6b10f4508c10617a975a68d4bab1ef0aac36c0f5d02d2e423806eb9648f65

(a) Adjustments Made to Final Payment Amounts.--
(1) In general.--Section 1834(a)(10)(B) (42 U.S.C.
1395m(a)(10)(B)) is amended by adding at the end the following:
``In applying such provisions to payments for an item under
this subsection, the Secretary shall make adjustments to the
payment basis for the item described in paragraph (1)(B) if the
Secretary determines (in accordance with such provisions and on
the basis of prices and costs applicable at the time the item
is furnished) that such payment basis is not inherently
reasonable.''.
(2) Effective date.--The amendment made by paragraph (1)
shall take effect on the date of the enactment of this Act.
(b) Adjustment Required for Certain Items.--
(1) In general.--In accordance with section 1834(a)(10)(B)
of the Social Security Act (as amended by subsection (a)), the
Secretary of Health and Human Services shall determine whether
the payment amounts for the items described in paragraph (2)
are not inherently reasonable, and shall adjust such amounts in
accordance with such section if the amounts are not inherently
reasonable.
(2) Items described.--The items referred to in paragraph
(1) are decubitus care equipment, transcutaneous electrical
nerve stimulators, and any other items considered appropriate
by the Secretary.

dccb77899399a9d6ec58223ffe97b3f0ee9467ce7beb817de10545980b167a2a

(a) Updates to Payment Amounts.--(1) Subparagraph (A) of section
1834(a)(14) (42 U.S.C. 1395m(a)(14)) is amended to read as follows:
``(A) for 1991 and 1992, the percentage increase in
the consumer price index for all urban consumers (U.S.
city average) for the 12-month period ending with June
of the previous year reduced by 1 percentage point;
and''.
(2) The amendment made by paragraph (1) shall be effective on the
date of the enactment of this Act.
(b) Advance Determinations of Coverage.--(1) Effective on the date
of the enactment of this Act, section 1834(a)(15) (42 U.S.C.
1395m(a)(15)) is amended to read as follows:
``(15) Advance determinations of coverage for certain
items.--
``(A) Development of lists of items by Secretary.--
The Secretary may develop and periodically update a
list of items for which payment may be made under this
subsection that the Secretary determines, on the basis
of prior payment experience, are frequently subject to
unnecessary utilization throughout a carrier's entire
service area or a portion of such area.
``(B) Development of lists of suppliers by
Secretary.--The Secretary may develop and periodically
update a list of suppliers of items for which payment
may be made under this subsection with respect to
whom--
``(i) the Secretary has found that a
substantial number of claims for payment under
this part for items furnished by the supplier
have been denied on the basis of the
application of section 1862(a)(1); or
``(ii) the Secretary has identified a
pattern of overutilization resulting from the
business practice of the supplier.
``(C) Determinations of coverage in advance.--A
carrier shall determine in advance of delivery of an
item whether payment for the item may not be made
because the item is not covered or because of the
application of section 1862(a)(1) if--
``(i) the item is included on the list
developed by the Secretary under subparagraph
(A);
``(ii) the item is furnished by a supplier
included on the list developed by the Secretary
under subparagraph (B); or
``(iii) the item is a customized item
(other than inexpensive items specified by the
Secretary) and the patient to whom the item is
to be furnished or the supplier requests that
such advance determination be made.''.
(2) Effective for standards applied for contract years beginning
after the date of the enactment of this Act, section 1842(c) (42 U.S.C.
1395u(c)), as amended by section 125(a), is amended by adding at the
end the following new paragraph:
``(5) Each contract under this section which provides for the
disbursement of funds, as described in subsection (a)(1)(B), shall
require the carrier to meet criteria developed by the Secretary to
measure the timeliness of carrier responses to requests for payment of
items described in section 1834(a)(15)(C).''.
(3) Effective on the date of the enactment of this Act, section
1834(h)(3) (42 U.S.C. 1395m(h)(3)), as amended by section 133(b), is
amended by striking ``(12) and (17)'' and inserting ``(12), (15), and
(17)''.
(c) Study of Variations in Durable Medical Equipment Supplier
Costs.--
(1) Collection and analysis of supplier cost data.--The
Administrator of the Health Care Financing Administration
shall, in consultation with appropriate organizations, collect
data on supplier costs of durable medical equipment for which
payment may be made under part B of the medicare program, and
shall analyze such data to determine the proportions of such
costs attributable to the service and product components of
furnishing such equipment and the extent to which such
proportions vary by type of equipment and by the geographic
region in which the supplier is located.
(2) Development of geographic adjustment index; reports.--
Not later than July 1, 1995--
(A) the Administrator shall submit a report to the
Committees on Energy and Commerce and Ways and Means of
the House of Representatives and the Committee on
Finance of the Senate on the data collected and the
analysis conducted under paragraph (1), and shall
include in such report the Administrator's
recommendations for a geographic cost adjustment index
for suppliers of durable medical equipment under the
medicare program and an analysis of the impact of such
proposed index on payments under the medicare program;
and
(B) the Comptroller General shall submit a report
to the Committees on Energy and Commerce and Ways and
Means of the House of Representatives and the Committee
on Finance of the Senate analyzing on a geographic
basis the supplier costs of durable medical equipment
under the medicare program.
(d) Oxygen Retesting.--(1) Section 1834(a)(5)(E) (42 U.S.C.
1395m(a)(5)(E)) is amended by striking ``55'' and inserting ``56''.
(2) The amendment made by paragraph (1) shall be effective on the
date of the enactment of this Act.
(e) Other Miscellaneous and Technical Amendments.--(1) Section
4152(a)(3) of OBRA-1990 is amended by striking ``amendment made by
subsection (a)'' and inserting ``amendments made by this subsection''.
(2) Section 4152(c)(2) of OBRA-1990 is amended by striking
``1395m(a)(7)(A)'' and inserting ``1395m(a)(7)''.
(3) Section 1834(a)(7)(A)(iii)(II) (42 U.S.C.
1395m(a)(7)(A)(iii)(II)) is amended by striking ``clause (v)'' and
inserting ``clause (vi)''.
(4) Section 1834(a)(7)(C)(i) (42 U.S.C. 1395m(a)(7)(C)(i)) is
amended by striking ``or paragraph (3)''.
(5) Section 1834(a)(3) (42 U.S.C. 1395m(a)(3)) is amended by
striking subparagraph (D).
(6) Section 4153(c)(1) of OBRA-1990 is amended by striking
``1834(a)'' and inserting ``1834(h)''.
(7) Section 4153(d)(2) of OBRA-1990 is amended by striking
``Reconiliation'' and inserting ``Reconciliation''.
(8) The amendments made by this subsection shall take effect as if
included in the enactment of OBRA-1990.
PART III--OTHER ITEMS AND SERVICES

6805e659276e7bf2a839cb46d5cc629e5ff6b466ad319900f1f461fcd9f12ed1

(a) Payment Amounts for Services Furnished in Ambulatory Surgical
Centers.--
(1) Use of survey to determine incurred costs.--Section
1833(i)(2)(A)(i) (42 U.S.C. 1395l(i)(2)(A)(i)) is amended by
striking the comma at the end and inserting the following: ``,
as determined in accordance with a survey (based upon a
representative sample of procedures and facilities) taken not
later than January 1, 1995, and every 5 years thereafter, of
the actual audited costs incurred by such centers in providing
such services,''.
(2) Automatic application of inflation adjustment.--Section
1833(i)(2) (42 U.S.C. 1395l(i)(2)) is amended--
(A) in the second sentence of subparagraph (A) and
the second sentence of subparagraph (B), by striking
``and may be adjusted by the Secretary, when
appropriate,''; and
(B) by adding at the end the following new
subparagraph:
``(C) Notwithstanding the second sentence of subparagraph (A) or
the second sentence of subparagraph (B), if the Secretary has not
updated amounts established under such subparagraphs with respect to
facility services furnished during a fiscal year (beginning with fiscal
year 1996), such amounts shall be increased by the percentage increase
in the consumer price index for all urban consumers (U.S. city average)
as estimated by the Secretary for the 12-month period ending with the
midpoint of the year involved.''.
(3) Consultation requirement.--The second sentence of
section 1833(i)(1) (42 U.S.C. 1395l(i)(1)) is amended by
striking the period and inserting the following: ``, in
consultation with appropriate trade and professional
organizations.''.
(b) Adjustments to Payment Amounts for New Technology Intraocular
Lenses.--
(1) Establishment of process for review of amounts.--Not
later than 1 year after the date of the enactment of this Act,
the Secretary of Health and Human Services (in this subsection
referred to as the ``Secretary'') shall develop and implement a
process under which interested parties may request review by
the Secretary of the appropriateness of the reimbursement
amount provided under section 1833(i)(2)(A)(iii) of the Social
Security Act with respect to a class of new technology
intraocular lenses. For purposes of the preceding sentence, an
intraocular lens may not be treated as a new technology lens
unless it has been approved by the Food and Drug
Administration.
(2) Factors considered.--In determining whether to provide
an adjustment of payment with respect to a particular lens
under paragraph (1), the Secretary shall take into account
whether use of the lens is likely to result in reduced risk of
intraoperative or postoperative complication or trauma,
accelerated postoperative recovery, reduced induced
astigmatism, improved postoperative visual acuity, more stable
postoperative vision, or other comparable clinical advantages.
(3) Notice and comment.--The Secretary shall publish notice
in the Federal Register from time to time (but no less often
than once each year) of a list of the requests that the
Secretary has received for review under this subsection, and
shall provide for a 30-day comment period on the lenses that
are the subjects of the requests contained in such notice. The
Secretary shall publish a notice of the Secretary's
determinations with respect to intraocular lenses listed in the
notice within 90 days after the close of the comment period.
(4) Effective date of adjustment.--Any adjustment of a
payment amount (or payment limit) made under this subsection
shall become effective not later than 30 days after the date on
which the notice with respect to the adjustment is published
under paragraph (3).
(c) Technical Correction Relating to Blend Amounts for Ambulatory
Surgical Center Payments.--
(1) In general.--Subclauses (I) and (II) of section
1833(i)(3)(B)(ii) (42 U.S.C. 1395l(i)(3)(B)(ii)) are each
amended--
(A) by striking ``for reporting'' and inserting
``for portions of cost reporting''; and
(B) by striking ``and on or before'' and inserting
``and ending on or before''.
(2) Effective date.--The amendments made by paragraph (1)
shall take effect as if included in the enactment of OBRA-1990.
(d) Technical Correction Related to Cataract Surgery.--Effective as
if included in the enactment of OBRA-1990, section 4151(c)(3) of such
Act is amended by striking ``for the insertion of an intraocular lens''
and inserting ``for an intraocular lens inserted''.

13d4ff051f46a3a14e22f85e5ecfc5695d5d77d019b4a5a2e8c8eacda2ede535

WITH CLINICAL TRIALS OF NEW CANCER THERAPIES.
(a) Study.--The Secretary of Health and Human Services shall
conduct a study of the effects of expressly covering under the medicare
program the patient care costs for beneficiaries enrolled in clinical
trials of new cancer therapies, where the protocol for the trial has
been approved by the National Cancer Institute or meets similar
scientific and ethical standards, including approval by an
institutional review board. The study shall include--
(1) an estimate of the cost of such coverage, taking into
account the extent to which medicare currently pays for such
patient care costs in practice;
(2) an assessment of the extent to which such clinical
trials represent the best available treatment for the patients
involved and of the effects of participation in the trials on
the health of such patients;
(3) an assessment of whether progress in developing new
anticancer therapies would be assisted by medicare coverage of
such patient care costs; and
(4) an evaluation of whether there should be special
criteria for the admission of medicare beneficiaries (on
account of their age or physical condition) to clinical trials
for which medicare would pay the patient care costs.
(b) Report.--Not later than 2 years after the date of the enactment
of this Act, the Secretary of Health and Human Services shall submit a
report on the study conducted under subsection (a) to the Committee on
Ways and Means and the Committee on Energy and Commerce of the House of
Representatives and the Committee on Finance of the Senate. Such report
shall include recommendations as to the coverage under the medicare
program of patient care costs of beneficiaries enrolled in clinical
trials of new cancer therapies.

e3214aa60c2ca3b74aebb6ef831861f20d7ecb7df30ed22828b46cb0b3cdb078

OUTPATIENT PHYSICAL THERAPY AND OCCUPATIONAL THERAPY
SERVICES.
(a) Study.--The Secretary of Health and Human Services shall
conduct a study of the appropriateness of continuing an annual
limitation on the amount of payment for outpatient services of
independently practicing physical and occupational therapists under the
medicare program.
(b) Report.--By not later than January 1, 1996, the Secretary shall
submit to the Committees on Energy and Commerce and Ways and Means of
the House of Representatives and the Committee on Finance of the Senate
a report on the study conducted under subsection (a). Such report shall
include such recommendations for changes in such annual limitation as
the Secretary finds appropriate.

61507e66b9b43f28d6149fb9d5eb20863913825f5baa5d232acfe529d9cee42c

STATES.
Section 1839 (42 U.S.C. 1395r) is amended by adding at the end the
following new subsection:
``(g)(1) Upon the request of a State, the Secretary may enter into
an agreement with the State under which the State agrees to pay on a
quarterly or other periodic basis to the Secretary (to be deposited in
the Treasury to the credit of the Federal Supplementary Medical
Insurance Trust Fund) an amount equal to the amount of the part B late
enrollment premium increases with respect to the premiums for eligible
individuals (as defined in paragraph (3)(A)).
``(2) No part B late enrollment premium increase shall apply to an
eligible individual for premiums for months for which the amount of
such an increase is payable under an agreement under paragraph (1).
``(3) In this subsection:
``(A) The term `eligible individual' means an individual
who is enrolled under this part B and who is within a class of
individuals specified in the agreement under paragraph (1).
``(B) The term `part B late enrollment premium increase'
means any increase in a premium as a result of the application
of subsection (b).''.

786a983fefc1b68a07b0dbd6f084dd7b3cbc59b6908bc6df8928d7c39dd82a40

(a) Screening Mammography.--Section 1834(c) (42 U.S.C. 1395m(c)) is
amended--
(1) in paragraph (1)(B), by striking ``meets the quality
standards established under paragraph (3)'' and inserting ``is
conducted by a facility that has a certificate (or provisional
certificate) issued under section 354 of the Public Health
Service Act'';
(2) in paragraph (1)(C)(iii), by striking ``paragraph (4)''
and inserting ``paragraph (3)'';
(3) by striking paragraph (3); and
(4) by redesignating paragraphs (4) and (5) as paragraphs
(3) and (4).
(b) Diagnostic Mammography.--Section 1861(s)(3) (42 U.S.C.
1395x(s)(3)) is amended by inserting ``and including diagnostic
mammography if conducted by a facility that has a certificate (or
provisional certificate) issued under section 354 of the Public Health
Service Act'' after ``necessary''.
(c) Conforming Amendments.--(1) Section 1862(a)(1)(F) (42 U.S.C.
1395y(a)(1)(F)) is amended by striking ``or which does not meet the
standards established under section 1834(c)(3)'' and inserting ``or
which is not conducted by a facility described in section
1834(c)(1)(B)''.
(2) Section 1863 (42 U.S.C. 1395z) is amended by striking ``or
whether screening mammography meets the standards established under
section 1834(c)(3),''.
(3) The first sentence of section 1864(a) (42 U.S.C. 1395aa(a)) is
amended by striking ``, or whether screening mammography meets the
standards established under section 1834(c)(3)''.
(4) The third sentence of section 1865(a) (42 U.S.C. 1395bb(a)) is
amended by striking ``1834(c)(3),''.
(d) Effective Date.--The amendments made by this section shall
apply to mammography furnished by a facility on and after the first
date that the certificate requirements of section 354(b) of the Public
Health Service Act apply to such mammography conducted by such
facility.

bc6c7e635934423876f18e1f7422b7d32473080f1d1d8bf712823d81edcc67b5

AUDIOLOGISTS.
(a) Services Defined.--Section 1861 (42 U.S.C. 1395x), as amended
by section 148(f)(6)(E), is amended by inserting after subsection (kk)
the following new subsection:
``Speech-Language Pathology Services; Audiology Services
``(ll)(1) The term `speech-language pathology services' means such
speech, language, and related function assessment and rehabilitation
services furnished by a qualified speech-language pathologist as the
speech-language pathologist is legally authorized to perform under
State law (or the State regulatory mechanism provided by State law) as
would otherwise be covered if furnished by a physician.
``(2) The term `audiology services' means such hearing and balance
assessment services furnished by a qualified audiologist as the
audiologist is legally authorized to perform under State law (or the
State regulatory mechanism provided by State law), as would otherwise
be covered if furnished by a physician.
``(3) In this subsection:
``(A) The term `qualified speech-language pathologist'
means an individual with a master's or doctoral degree in
speech-language pathology who--
``(i) is licensed as a speech-language pathologist
by the State in which the individual furnishes such
services, or
``(ii) in the case of an individual who furnishes
services in a State which does not license speech-
language pathologists, has successfully completed 350
clock hours of supervised clinical practicum (or is in
the process of accumulating such supervised clinical
experience), performed not less than 9 months of
supervised full-time speech-language pathology services
after obtaining a master's or doctoral degree in
speech-language pathology or a related field, and
successfully completed a national examination in
speech-language pathology approved by the Secretary.
``(B) The term `qualified audiologist' means an individual
with a master's or doctoral degree in audiology who--
``(i) is licensed as an audiologist by the State in
which the individual furnishes such services, or
``(ii) in the case of an individual who furnishes
services in a State which does not license audiologists
has successfully completed 350 clock hours of
supervised clinical practicum (or is in the process of
accumulating such supervised clinical experience),
performed not less than 9 months of supervised full-
time audiology services after obtaining a master's or
doctoral degree in audiology or a related field, and
successfully completed a national examination in
audiology approved by the Secretary.''.
(b) Conforming Amendments Relating to Medicare Treatment of Speech
and Language Services.--
(1) Extended care services.--Section 1861(h)(3) (42 U.S.C.
1395x(h)(3)) is amended by striking ``, occupational, or speech
therapy'' and inserting ``or occupational therapy or speech-
language pathology services''.
(2) Home health services.--Section 1861(m)(2) (42 U.S.C.
1395x(m)(2)) is amended by striking ``, occupational, or speech
therapy'' and inserting ``or occupational therapy or speech-
language pathology services''.
(3) Outpatient physical therapy services.--The fourth
sentence of section 1861(p) (42 U.S.C. 1395x(p)) is amended by
striking ``speech pathology services'' and inserting ``speech-
language pathology services''.
(4) Comprehensive outpatient rehabilitation facility
services.--Section 1861(cc)(1)(B) (42 U.S.C. 1395x(cc)(1)(B))
is amended by striking ``speech pathology services'' and
inserting ``speech-language pathology services''.
(5) Hospice care.--Section 1861(dd)(1)(B) (42 U.S.C.
1395x(dd)(1)(B)) is amended by striking ``therapy or speech-
language pathology'' and inserting ``therapy, or speech-
language pathology services''.
(c) Effective Date.--The amendments made by this section shall take
effect on January 1, 1995.

ef01dbb62e3eb9e44e54e6944919526825b550599dfd5fbbf783aff889b86b5a

(a) Revision of Information on Part B Claims Forms.--Section
1833(q)(1) (42 U.S.C. 1395l(q)(1)) is amended--
(1) by striking ``provider number'' and inserting ``unique
physician identification number''; and
(2) by striking ``and indicate whether or not the referring
physician is an interested investor (within the meaning of
section 1877(h)(5))''.
(b) Consultation for Social Workers.--Effective with respect to
services furnished on or after January 1, 1991, section 6113(c) of
OBRA-1989 is amended--
(1) by inserting ``and clinical social worker services''
after ``psychologist services''; and
(2) by striking ``psychologist'' the second and third place
it appears and inserting ``psychologist or clinical social
worker''.
(c) Reports on Hospital Outpatient Payment.--(1) OBRA-1989 is
amended by striking section 6137.
(2) Section 1135(d) (42 U.S.C. 1320b-5(d)) is amended--
(A) by striking paragraph (6); and
(B) in paragraph (7)--
(i) by striking ``systems'' each place it appears
and inserting ``system''; and
(ii) by striking ``paragraphs (1) and (6)'' and
inserting ``paragraph (1)''.
(d) Radiology and Diagnostic Services Provided in Hospital
Outpatient Departments.--(1) Effective as if included in the enactment
of OBRA-1989, section 1833(n)(1)(B)(i)(II) (42 U.S.C.
1395l(n)(1)(B)(i)(II)) is amended--
(A) by inserting ``and for services described in subsection
(a)(2)(E)(ii) furnished on or after January 1, 1992'' after
``1989''; and
(B) by striking ``1842(b)'' and inserting ``1842(b) (or, in
the case of services furnished on or after January 1, 1992,
under section 1848)''.
(2) Effective as if included in the enactment of OBRA-1989, section
1833(n)(1)(B)(i)(II) (42 U.S.C. 1395l(n)(1)(B)(i)(II)) is amended by
striking ``January 1, 1989'' and inserting ``April 1, 1989''.
(e) Payments to Nurse Practitioners in Rural Areas (Section 4155 of
OBRA-1990).--(1) Section 1861(s)(2)(K)(iii) (42 U.S.C.
1395x(s)(2)(K)(iii)) is amended--
(A) by striking ``subsection (aa)(3)'' and inserting
``subsection (aa)(5)''; and
(B) by striking ``subsection (aa)(4)'' and inserting
``subsection (aa)(6)''.
(2) Section 1833(r)(1) (42 U.S.C. 1395l(r)(1)) is amended--
(A) by striking ``ambulatory'' each place it appears and
inserting ``or ambulatory''; and
(B) by striking ``center,'' and inserting ``center''.
(3) Section 1833(r)(2)(A) (42 U.S.C. 1395l(r)(2)(A)) is amended by
striking ``subsection (a)(1)(M)'' and inserting ``subsection
(a)(1)(O)''.
(4) Section 1861(b)(4) (42 U.S.C. 1395x(b)(4)) is amended by
striking ``subsection (s)(2)(K)(i)'' and inserting ``clauses (i) or
(iii) of subsection (s)(2)(K)''.
(5) Section 1861(aa)(5) (42 U.S.C. 1395x(aa)(5)) is amended by
striking ``this Act'' and inserting ``this title''.
(6) Section 1862(a)(14) (42 U.S.C. 1395y(a)(14)) is amended by
striking ``1861(s)(2)(K)(i)'' and inserting ``1861(s)(2)(K)(i) or
1861(s)(2)(K)(iii)''.
(7) Section 1866(a)(1)(H) (42 U.S.C. 1395cc(a)(1)(H)) is amended by
striking ``1861(s)(2)(K)(i)'' and inserting ``1861(s)(2)(K)(i) or
1861(s)(2)(K)(iii)''.
(f) Other Miscellaneous and Technical Amendments.--
(1) Immediate enrollment in part b by individuals covered
by an employment-based plan.--(A) Subparagraphs (A) and (B) of
section 1837(i)(3) (42 U.S.C. 1395p(i)(3)) are each amended--
(i) by striking ``beginning with the first day of
the first month in which the individual is no longer
enrolled'' and inserting ``including each month during
any part of which the individual is enrolled''; and
(ii) by striking ``and ending seven months later''
and inserting ``ending with the last day of the eighth
consecutive month in which the individual is at no time
so enrolled''.
(B) Paragraphs (1) and (2) of section 1838(e) (42 U.S.C.
1395q(e)) are amended to read as follows:
``(1) in any month of the special enrollment period in
which the individual is at any time enrolled in a plan
(specified in subparagraph (A) or (B), as applicable, of
section 1837(i)(3)) or in the first month following such a
month, the coverage period shall begin on the first day of the
month in which the individual so enrolls (or, at the option of
the individual, on the first day of any of the following three
months), or
``(2) in any other month of the special enrollment period,
the coverage period shall begin on the first day of the month
following the month in which the individual so enrolls.''.
(C) The amendments made by subparagraphs (A) and (B) shall
take effect on the first day of the first month that begins
after the expiration of the 120-day period that begins on the
date of the enactment of this Act.
(2) Clinical diagnostic laboratory tests.--Section
4154(e)(5) of OBRA-1990 is amended by striking ``(1)(A)'' and
inserting ``(1)(A),''.
(3) Separate payment under part b for certain services.--
Section 4157(a) of OBRA-1990 is amended by striking ``(a)
Services of'' and all that follows through ``Section'' and
inserting ``(a) Treatment of Services of Certain Health
Practitioners.--Section''.
(4) Community health centers and rural health clinics.--(A)
The fourth sentence of section 1861(aa)(2) (42 U.S.C.
1395x(aa)(2)) is amended--
(i) by striking ``certification'' the first place
it appears and inserting ``approval''; and
(ii) by striking ``the Secretary's approval or
disapproval of the certification'' and inserting
``Secretary's approval or disapproval''.
(B) Section 4161(a)(7)(B) of OBRA-1990 is amended by
inserting ``and to the Committee on Finance of the Senate''
after ``Representatives''.
(5) Screening mammography.--Section 4163 of OBRA-1990 is
amended--
(A) by adding at the end of subsection (d) the
following new paragraph:
``(3) The amendment made by paragraph (2)(A)(iv) shall
apply to screening pap smears performed on or after July 1,
1990.''; and
(B) in subsection (e), by striking ``The
amendments'' and inserting ``Except as provided in
subsection (d)(3), the amendments''.
(6) Injectable drugs for treatment of osteoporosis.--
(A) Clarification of drugs covered.--The section
1861(jj) (42 U.S.C. 1395x(jj)) inserted by section
4156(a)(2) of OBRA-1990 is amended--
(i) in the matter preceding paragraph (1),
by striking ``a bone fracture related to''; and
(ii) in paragraph (1), by striking
``patient'' and inserting ``individual has
suffered a bone fracture related to post-
menopausal osteoporosis and that the
individual''.
(B) Limiting coverage to drugs provided by home
health agencies.--(i) The section 1861(jj) (42 U.S.C.
1395x(jj)) inserted by section 4156(a)(2) of OBRA-1990
is amended by striking ``if'' and inserting ``by a home
health agency if''.
(ii) Section 1861(m)(5) (42 U.S.C. 1395x(m)(5)) is
amended by striking ``but excluding'' and inserting
``and a covered osteoporosis drug (as defined in
subsection (kk), but excluding other''.
(iii) Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is
amended--
(I) by adding ``and'' at the end of
subparagraph (N), and
(II) by striking subparagraph (O) and
redesignating subparagraph (P) as subparagraph
(O).
(C) Payment based on reasonable cost.--Section
1833(a)(2) (42 U.S.C. 1395l(a)(2)) is amended--
(i) in subparagraph (A), by striking
``health services'' and inserting ``health
services (other than a covered osteoporosis
drug (as defined in section 1861(kk)))'';
(ii) by striking ``and'' at the end of
subparagraph (D);
(iii) by striking the semicolon at the end
of subparagraph (E) and inserting ``; and'';
and
(iv) by adding at the end the following new
subparagraph:
``(F) with respect to a covered osteoporosis drug
(as defined in section 1861(kk)) furnished by a home
health agency, 80 percent of the reasonable cost of
such service, as determined under section 1861(v);''.
(D) Application of part b deductible.--Section
1833(b)(2) (42 U.S.C. 1395l(b)(2)) is amended by
striking ``services'' and inserting ``services (other
than a covered osteoporosis drug (as defined in section
1861(kk)))''.
(E) Covered osteoporosis drug (section 4156 of
obra-1990).--Section 1861 (42 U.S.C. 1395x) is amended,
in the subsection (jj) inserted by section 4156(a)(2)
of OBRA-1990, by striking ``(jj) The term'' and
inserting ``(kk) The term''.
(7) Other miscellaneous and technical corrections.--
(A) Ownership disclosure requirements.--(i) Section
1124A(a)(2)(A) (42 U.S.C. 1320a-3a(a)(2)(A)) is amended
by striking ``of the Social Security Act''.
(ii) Section 4164(b)(4) of OBRA-1990 is amended by
striking ``paragraph'' and inserting ``paragraphs''.
(B) Directory of unique physician identifier
numbers.--Section 4164(c) of OBRA-1990 is amended by
striking ``publish'' and inserting ``publish, and shall
periodically update,''.
(g) Effective Date.--Except as otherwise provided in this section,
the amendments made by this section shall take effect as if included in
the enactment of OBRA-1990.
Subtitle C--Provisions Relating to Parts A and B

fdb19538fa6de450dceb5767ef5ad1ac4c1061970d839abb585b1e83387d7bcf

(a) Improving Identification of Medicare Secondary Payer
Situations.--
(1) Survey of beneficiaries.--
(A) In general.--Section 1862(b)(5) (42 U.S.C.
1395y(b)(5)) is amended by adding at the end the
following new subparagraph:
``(D) Obtaining information from beneficiaries.--
Before an individual applies for benefits under part A
or enrolls under part B, the Administrator shall mail
the individual a questionnaire to obtain information on
whether the individual is covered under a primary plan
and the nature of the coverage provided under the plan,
including the name, address, and identifying number of
the plan.''.
(B) Distribution of questionnaire by contractor.--
The Secretary of Health and Human Services shall enter
into an agreement with an entity not later than 60 days
after the date of enactment of the Social Security Act
Amendments of 1994, to distribute the questionnaire
described in section 1862(b)(5)(D) of the Social
Security Act (as added by subparagraph (A)).
(C) No medicare secondary payer denial based on
failure to complete questionnaire.--Section 1862(b)(2)
(42 U.S.C. 1395y(b)(2)) is amended by adding at the end
the following new subparagraph:
``(C) Treatment of questionnaires.--The Secretary
may not fail to make payment under subparagraph (A)
solely on the ground that an individual failed to
complete a questionnaire concerning the existence of a
primary plan.''.
(2) Mandatory screening by providers and suppliers under
part b.--
(A) In general.--Section 1862(b) (42 U.S.C.
1395y(b)) is amended by adding at the end the following
new paragraph:
``(6) Screening requirements for providers and suppliers.--
``(A) In general.--Notwithstanding any other
provision of this title, no payment may be made for any
item or service furnished under part B unless the
entity furnishing such item or service completes (to
the best of its knowledge and on the basis of
information obtained from the individual to whom the
item or service is furnished) the portion of the claim
form relating to the availability of other health
benefit plans.
``(B) Penalties.--An entity that knowingly,
willfully, and repeatedly fails to complete a claim
form in accordance with subparagraph (A) or provides
inaccurate information relating to the availability of
other health benefit plans on a claim form under such
subparagraph shall be subject to a civil money penalty
of not to exceed $2,000 for each such incident. The
provisions of section 1128A (other than subsections (a)
and (b)) shall apply to a civil money penalty under the
previous sentence in the same manner as such provisions
apply to a penalty or proceeding under section
1128A(a).''.
(B)  Effective date.--The amendment made by
subparagraph (A) shall apply with respect to items and
services furnished on or after the expiration of the
120-day period beginning on the date of enactment of
this Act.
(b) Improvements in Recovery of Payments From Primary Payers.--
(1) Submission of reports on efforts to recover erroneous
payments.--
(A) Fiscal intermediaries under part a.--Section
1816 (42 U.S.C. 1396h) is amended by adding at the end
the following new subsection:
``(k) An agreement with an agency or organization under this
section shall require that such agency or organization submit an annual
report to the Secretary describing the steps taken to recover payments
made for items or services for which payment has been or could be made
under a primary plan (as defined in section 1862(b)(2)(A)).''.
(B) Carriers under part b.--Section 1842(b)(3) (42
U.S.C. 1395u(b)(3)) is amended--
(i) by striking ``and'' at the end of
subparagraph (G);
(ii) by striking ``and'' at the end of
subparagraph (H); and
(iii) by inserting after subparagraph (H)
the following new subparagraph:
``(I) will submit annual reports to the Secretary
describing the steps taken to recover payments made under this
part for items or services for which payment has been or could
be made under a primary plan (as defined in section
1862(b)(2)(A)); and''.
(2) Requirements under carrier performance evaluation
program.--
(A) Fiscal intermediaries under part a.--Section
1816(f)(1)(A) (42 U.S.C. 1396h(f)(1)(A)) is amended by
striking ``processing'' and inserting ``processing
(including the agency's or organization's success in
recovering payments made under this title for services
for which payment has been or could be made under a
primary plan (as defined in section 1862(b)(2)(A)))''.
(B) Carriers under part b.--Section 1842(b)(2) (42
U.S.C. 1395u(b)(2)) is amended by adding at the end the
following new subparagraph:
``(D) In addition to any other standards and criteria established
by the Secretary for evaluating carrier performance under this
paragraph relating to avoiding erroneous payments, the carrier shall be
subject to standards and criteria relating to the carrier's success in
recovering payments made under this part for items or services for
which payment has been or could be made under a primary plan (as
defined in section 1862(b)(2)(A)).''.
(3) Deadline for reimbursement by primary plans.--
(A) In general.--Section 1862(b)(2)(B)(i) (42
U.S.C. 1395y(b)(2)(B)(i)) is amended by adding at the
end the following sentence: ``If reimbursement is not
made to the appropriate Trust Fund before the
expiration of the 60-day period that begins on the date
such notice or other information is received, the
Secretary may charge interest (beginning with the date
on which the notice or other information is received)
on the amount of the reimbursement until reimbursement
is made (at a rate determined by the Secretary in
accordance with regulations of the Secretary of the
Treasury applicable to charges for late payments).''.
(B) Conforming amendment.--The heading of clause
(i) of section 1862(b)(2)(B) is amended to read as
follows: ``Repayment required.--''.
(C) Effective date.--The amendments made by this
paragraph shall apply to payments for items and
services furnished on or after the date of the
enactment of this Act.
(4) Effective date.--The amendments made by paragraphs (1)
and (2) shall apply to contracts with fiscal intermediaries and
carriers under title XVIII of the Social Security Act for
contract years beginning with 1995.
(c) Miscellaneous and Technical Corrections.--
(1) Effective as if included in the enactment of OBRA-1993,
section 1862(b)(1)(A) (42 U.S.C. 1395y(b)(1)(A)), as amended by
section 13561(e)(1) of OBRA-1993, is amended--
(A) in clause (i)(II), by striking ``over (and the
individual's spouse age 65 or older) who is covered
under the plan by virtue of the individual's current
employment status with an employer'' and inserting
``older (and the spouse age 65 or older of any
individual) who has current employment status with an
employer''; and
(B) in clause (ii), by striking ``or employee
organization that has 20 or more individuals in current
employment status'' and inserting ``that has 20 or more
employees''.
(2) Effective as if included in the enactment of OBRA-1993,
section 1837(i) (42 U.S.C. 1395p(i)) is amended--
(A) by striking ``as an active individual (as those
terms are defined in section 1862(b)(1)(B)(iv))'' each
place it appears in the second sentence of paragraph
(1), and the second sentence of paragraph (2) and
inserting ``(as that term is defined in section
1862(b)(1)(B)(iv)) by reason of the individual's
current employment status (or the current employment
status of a family member of the individual)'';
(B) in paragraph (3)(B), by striking ``as an active
individual in a large group health plan (as such terms
are defined in section 1862(b)(1)(B)(iv))'' and
inserting ``in a large group health plan (as that term
is defined in section 1862(b)(1)(B)(iv)) by reason of
the individual's current employment status (or the
current employment status of a family member of the
individual)'';
(C) in the second sentence of paragraph (2) (as
amended by subparagraph (A)), by striking ``as an
active individual'' and inserting ``by reason of the
individual's current employment status (or the current
employment status of a family member of the
individual)''; and
(D) by inserting ``status'' after ``current
employment'' each place it appears in paragraphs
(1)(A), (2)(B), (2)(C), and (3)(A).
(3) Effective as if included in the enactment of OBRA-1993,
the second sentence of section 1839(b) (42 U.S.C. 1395r(b)) is
amended--
(A) by inserting ``status'' after ``current
employment'', and
(B) by striking ``as an active individual (as those
terms are defined in section 1862(b)(1)(B)(iv))'' and
inserting ``(as that term is defined in section
1862(b)(1)(B)(iv)) by reason of the individual's
current employment status (or the current employment
status of a family member of the individual)''.
(4) Effective as if included in the enactment of OBRA-1990,
the sentence in section 1862(b)(1)(C) added by section
4203(c)(1)(B) of OBRA-1990 is amended by striking ``clauses (i)
and (ii)'' and inserting ``this subparagraph''.
(5) Effective as if included in the enactment of OBRA-1989,
section 1862(b)(1)(C) is amended in the matter after clause
(ii), by striking ``taking into account that'' and inserting
``paying benefits secondary to this title when''.
(6) Effective as if included in the enactment of OBRA-1989,
section 1862(b)(5)(C)(i) (42 U.S.C. 1395y(b)(5)(C)(i)) is
amended by striking ``6103(l)(12)(D)(iii)'' and inserting
``6103(l)(12)(E)(iii)''.
(7) Effective as if included in the enactment of OBRA-1990,
section 4203(c)(2) of such Act is amended--
(A) by striking ``the application of clause (iii)''
and inserting ``the second sentence'';
(B) by striking ``on individuals'' and all that
follows through ``section 226A of such Act'';
(C) in clause (ii), by striking ``clause'' and
inserting ``sentence'';
(D) in clause (v), by adding ``and'' at the end;
and
(E) in clause (vi)--
(i) by inserting ``of such Act'' after
``1862(b)(1)(C)'', and
(ii) by striking the period at the end and
inserting the following: ``, without regard to
the number of employees covered by such
plans.''.
(8) Effective as if included in the enactment of OBRA-1990,
section 4203(d) of OBRA-1990 is amended by striking ``this
subsection'' and inserting ``this section''.
(9) Effective as if included in the enactment of OBRA-1993,
section 13561(e)(1)(D) of OBRA-1993 is amended--
(A) by inserting ``effective as if included in the
enactment of OBRA-1989,'' after ``(D)'', and
(B) by striking ``of each subparagraph''.
(10) The amendment made by section 13561(e)(1)(G) of OBRA-
1993, to the extent it relates to the definition of large group
health plan, shall be effective as if included in the enactment
of OBRA-1989.

420add4f3ca559564eb89cf7416a9b241e970d608d8ceafd2c9dad38d65cc8bd

(a) In General.--Section 1877(f) (42 U.S.C. 1395nn) is amended--
(1) in the matter before paragraph (1), by inserting ``,
investment, and compensation'' after ``ownership'';
(2) in paragraph (2), by inserting ``, or with a
compensation arrangement (as described in subsection
(a)(2)(B)),'' after ``investment interest (as described in
subsection (a)(2)(A))'';
(3) in paragraph (2), by inserting ``interest or who have
such a compensation relationship with the entity'' before the
period at the end;
(4) in the fourth sentence, by striking ``covered items
and'' and inserting ``designated health''; and
(5) by striking the third and fifth sentences.
(b) Radiology Services.--Section 1877(h)(6) (42 U.S.C.
1395nn(h)(6)), as amended by section 13562(a)(2) of OBRA-1993, is
amended--
(1) in subparagraph (D), by striking ``or other diagnostic
services'' and inserting ``services, including magnetic
resonance imaging, computerized axial tomography scans, and
ultrasound services''; and
(2) in subparagraphs (E), (F), and (H), by inserting ``and
supplies'' before the period at the end.
(c) Revision of Effective Date Exception Provision.--Section
13562(b)(2) of OBRA-1993 is amended by striking subparagraphs (A) and
(B) and inserting the following:
``(A) the second sentence of subsection (a)(2), and
subsections (b)(2)(B) and (d)(2), of section 1877 of
the Social Security Act (as in effect on the day before
the date of the enactment of this Act) shall apply
instead of the corresponding provisions in section 1877
(as amended by this Act);
``(B) section 1877(b)(4) of the Social Security Act
(as in effect on the day before the date of the
enactment of this Act) shall apply;
``(C) the requirements of section 1877(c)(2) of the
Social Security Act (as amended by this Act) shall not
apply to any securities of a corporation that meets the
requirements of section 1877(c)(2) of the Social
Security Act (as in effect on the day before the date
of the enactment of this Act);
``(D) section 1877(e)(3) of the Social Security Act
(as amended by this Act) shall apply, except that it
shall not apply to any arrangement that meets the
requirements of subsection (e)(2) or subsection (e)(3)
of section 1877 of the Social Security Act (as in
effect on the day before the date of the enactment of
this Act);
``(E) the requirements of clauses (iv) and (v) of
section 1877(h)(4)(A), and of clause (i) of section
1877(h)(4)(B), of the Social Security Act (as amended
by this Act) shall not apply; and
``(F) section 1877(h)(4)(B) of the Social Security
Act (as in effect on the day before the date of the
enactment of this Act) shall apply instead of section
1877(h)(4)(A)(ii) of such Act (as amended by this
Act).''.
(d) Effective Dates.--
(1) The amendments made by subsections (a) and (b) shall
apply to referrals made on or after January 1, 1995.
(2) The amendment made by subsection (c) shall apply as if
included in the enactment of OBRA-1993.

791faf945fda0a57e2b5d4edd64f72b59ca02d3ff384b97ebe199d8fdffffb47

GRADUATE MEDICAL EDUCATION.
(a) In General.--Section 1886(h)(5)(E) (42 U.S.C. 1395ww(h)(5)(E))
is amended by inserting ``or any successor examination'' after
``Medical Sciences''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply as if included in the enactment of the Consolidated Omnibus
Budget Reconciliation Act of 1985 (Public Law 99-272).

68a443024a0704bfb275a982634599df1aaffaa38e5a0c329be6f744272cd5c3

Not later than 1 year after the date of the enactment of this Act,
the Secretary of Health and Human Services shall establish and
implement a method for obtaining information from newly eligible
medicare beneficiaries that may be used to determine whether such
beneficiaries may be eligible for medical assistance for medicare cost-
sharing under State medicaid plans as qualified medicare beneficiaries,
and for transmitting such information to the State in which such a
beneficiary resides.

c00f4f8b42c183726c9aa012766ecb9caef39dd02d430c7c2f0c42145a786bf7

(a) Hospital Agreements.--
(1) In general.--
(A) Identification of organ donors.--Section
1138(a)(1)(A)(iii) (42 U.S.C. 1320b-8(a)(1)(A)(iii)) is
amended to read as follows:
``(iii) require that such hospital's designated
organ procurement agency (as defined in paragraph
(3)(B)) is notified of potential organ donors;''.
(B) Agreements with designated organ procurement
agencies.--Section 1138(a)(1) (42 U.S.C. 1320b-8(a)(1))
is amended--
(i) by striking the period at the end of
subparagraph (B) and inserting ``; and''; and
(ii) by adding at the end the following new
subparagraph:
``(C) the hospital or rural primary care hospital has an
agreement (as defined in paragraph (3)(A)) only with such
hospital's designated organ procurement agency.''.
(C) Waiver of requirements related to agreements.--
Section 1138(a) (42 U.S.C. 1320b-8(a)) is amended--
(i) by redesignating paragraph (2) as
paragraph (3); and
(ii) by inserting after paragraph (1) the
following new paragraph:
``(2)(A) The Secretary shall grant a waiver of the requirements
under subparagraphs (A)(iii) and (C) of paragraph (1) to a hospital or
rural primary care hospital desiring to enter into an agreement with an
organ procurement agency other than such hospital's designated organ
procurement agency if the Secretary determines that--
``(i) the waiver is expected to increase organ donation;
and
``(ii) the waiver will assure equitable treatment of
patients referred for transplants within the service area
served by such hospital's designated organ procurement agency
and within the service area served by the organ procurement
agency with which the hospital seeks to enter into an agreement
under the waiver.
``(B) In making a determination under subparagraph (A), the
Secretary may consider factors that would include, but not be limited
to--
``(i) cost effectiveness;
``(ii) improvements in quality;
``(iii) whether there has been any change in a hospital's
designated organ procurement agency due to a change made on or
after December 28, 1992, in the definitions for metropolitan
statistical areas (as established by the Office of Management
and Budget); and
``(iv) the length and continuity of a hospital's
relationship with an organ procurement agency other than the
hospital's designated organ procurement agency;
except that nothing in this subparagraph shall be construed to permit
the Secretary to grant a waiver that does not meet the requirements of
subparagraph (A).
``(C) Any hospital or rural primary care hospital seeking a waiver
under subparagraph (A) shall submit an application to the Secretary
containing such information as the Secretary determines appropriate.
``(D) The Secretary shall--
``(i) publish a public notice of any waiver application
received from a hospital or rural primary care hospital under
this paragraph within 30 days of receiving such application;
and
``(ii) prior to making a final determination on such
application under subparagraph (A), offer interested parties
the opportunity to submit written comments to the Secretary
during the 60-day period beginning on the date such notice is
published.''.
(D) Definitions.--Section 1138(a)(3) (42 U.S.C.
1320b-8(a)(3)), as redesignated by subparagraph (C), is
amended to read as follows:
``(3) For purposes of this subsection--
``(A) the term `agreement' means an agreement described in
section 371(b)(3)(A) of the Public Health Service Act;
``(B) the term `designated organ procurement agency' means,
with respect to a hospital or rural primary care hospital, the
organ procurement agency designated pursuant to subsection (b)
for the service area in which such hospital is located; and
``(C) the term `organ' means a human kidney, liver, heart,
lung, pancreas, and any other human organ or tissue specified
by the Secretary for purposes of this subsection.''.
(2) Existing agreements.--Any hospital or rural primary
care hospital which has an agreement (as defined in section
1138(a)(3)(A) of the Social Security Act) with an organ
procurement agency other than such hospital's designated organ
procurement agency (as defined in section 1138(a)(3)(B) of such
Act) on the date of the enactment of this section shall, if
such hospital desires to continue such agreement on and after
the effective date of the amendments made by paragraph (1),
submit an application to the Secretary for a waiver under
section 1138(a)(2) of such Act not later than January 1, 1996,
and such agreement may continue in effect pending the
Secretary's determination with respect to such application.
(3) Effective date.--The amendments made by paragraph (1)
shall apply to hospitals and rural primary care hospitals
participating in the programs under titles XVIII and XIX of the
Social Security Act beginning January 1, 1996.
(b) Study on Hospital Agreements with Organ Procurement Agencies.--
(1) In general.--The Office of Technology Assessment
(referred to in this section as the ``OTA'') shall, pursuant to
the approval of the Technology Assessment Board of the OTA,
conduct a study to determine the efficacy and fairness of
requiring a hospital to enter into an agreement under section
371(b)(3)(A) of the Public Health Service Act with the organ
procurement agency designated pursuant to section 1138(b) of
the Social Security Act for the service area in which such
hospital is located and the impact of such requirement on the
efficacy and fairness of organ procurement and distribution.
(2) Report.--Not later than 2 years after the date of the
enactment of this Act, the OTA shall complete the study
required under paragraph (1) and prepare and submit to the
Committee on Finance and the Committee on Labor and Human
Resources of the Senate and the Committee on Ways and Means and
the Committee on Energy and Commerce of the House of
Representatives a report containing the findings of such study
and the implications of such findings with respect to policies
affecting organ procurement and distribution.

46448af262288ed9ca853bf50f1aa814297ba5c2ce7fad3971f0a8a71e1ed7e3

(a) Repeal of PRO Precertification Requirement for Certain Surgical
Procedures.--
(1) In general.--Section 1164 (42 U.S.C. 1320c-13) is
repealed.
(2) Conforming amendments.--
(A) Section 1154 (42 U.S.C. 1320c-3) is amended--
(i) in subsection (a), by striking
paragraph (12), and
(ii) in subsection (d), by striking ``(and
except as provided in section 1164)''.
(B) Section 1833 (42 U.S.C. 1395l) is amended--
(i) in subsection (a)(1)(D)(i), by striking
``, or for tests furnished in connection with
obtaining a second opinion required under
section 1164(c)(2) (or a third opinion, if the
second opinion was in disagreement with the
first opinion)'';
(ii) in subsection (a)(1), by striking
subparagraph (G);
(iii) in subsection (a)(2)(A), by striking
``, to items and services (other than clinical
diagnostic laboratory tests) furnished in
connection with obtaining a second opinion
required under section 1164(c)(2) (or a third
opinion, if the second opinion was in
disagreement with the first opinion),'';
(iv) in subsection (a)(2)(D)(i)--
(I) by striking ``basis,'' and
inserting ``basis or'', and
(II) by striking ``, or for tests
furnished in connection with obtaining
a second opinion required under section
1164(c)(2) (or a third opinion, if the
second opinion was in disagreement with
the first opinion)'';
(v) in subsection (a)(3), by striking ``and
for items and services furnished in connection
with obtaining a second opinion required under
section 1164(c)(2), or a third opinion, if the
second opinion was in disagreement with the
first opinion''; and
(vi) in the first sentence of subsection
(b), by striking ``(4)'' and all that follows
through ``and (5)'' and inserting ``and (4)''.
(C) Section 1834(g)(1)(B) (42 U.S.C.
1395m(g)(1)(B)) is amended by striking ``and for items
and services furnished in connection with obtaining a
second opinion required under section 1164(c)(2), or a
third opinion, if the second opinion was in
disagreement with the first opinion''.
(D) Section 1862(a) (42 U.S.C. 1395y(a)) is
amended--
(i) by adding ``or'' at the end of
paragraph (14),
(ii) by striking ``; or'' at the end of
paragraph (15) and inserting a period, and
(iii) by striking paragraph (16).
(E) The third sentence of section 1866(a)(2)(A) (42
U.S.C. 1395w(a)(2)(A)) is amended by striking ``, with
respect to items and services furnished in connection
with obtaining a second opinion required under section
1164(c)(2) (or a third opinion, if the second opinion
was in disagreement with the first opinion),''.
(3) Effective date.--The amendments made by this subsection
shall apply to services provided on or after the date of the
enactment of this Act.
(b) Miscellaneous and Technical Corrections.--(1) The third
sentence of section 1156(b)(1) (42 U.S.C. 1320c-5(b)(1)) is amended by
striking ``whehter'' and inserting ``whether''.
(2)(A) Section 1154(a)(9)(B) (42 U.S.C. 1320c-3(a)(9)(B)) is
amended to read as follows:
``(B) If the organization finds, after reasonable notice to
and opportunity for discussion with the physician or
practitioner concerned, that the physician or practitioner has
furnished services in violation of section 1156(a) and the
organization determines that the physician or practitioner
should enter into a corrective action plan under section
1156(b)(1), the organization shall notify the State board or
boards responsible for the licensing or disciplining of the
physician or practitioner of its finding and of any action
taken as a result of the finding.''.
(B) Subparagraph (D) of section 1160(b)(1) (42 U.S.C. 1320c-
9(b)(1)) is amended to read as follows:
``(D) to provide notice in accordance with section
1154(a)(9)(B);''.
(3) Section 4205(d)(2)(B) of OBRA-1990 is amended by striking
``amendments'' and inserting ``amendment''.
(4) Section 1160(d) (42 U.S.C. 1320c-9(d)) is amended by striking
``subpena'' and inserting ``subpoena''.
(5) Section 4205(e)(2) of OBRA-1990 is amended by striking
``amendments'' and inserting ``amendment'' and by striking ``all''.
(6)(A) Except as provided in subparagraph (B), the amendments made
by this subsection shall take effect as if included in the enactment of
OBRA-1990.
(B) The amendments made by paragraph (2) (relating to the
requirement on reporting of information to State boards) shall take
effect on the date of the enactment of this Act.

eaf4cb2c90cef991f516af753dc0bfb7da8e18c30fec7d9c8b1694bebfca489d

(a) Revisions in the Payment Methodology for Risk Contractors.--
Section 4204(b) of OBRA-1990 is amended to read as follows:
``(b) Revisions in the Payment Methodology for Risk Contractors.--
(1)(A) Not later than October 1, 1995, the Secretary of Health and
Human Services (in this subsection referred to as the `Secretary')
shall submit a proposal to the Congress that provides for revisions to
the payment method to be applied in years beginning with 1997 for
organizations with a risk-sharing contract under section 1876(g) of the
Social Security Act.
``(B) In proposing the revisions required under subparagraph (A),
the Secretary shall consider--
``(i) the difference in costs associated with medicare
beneficiaries with differing health status and demographic
characteristics; and
``(ii) the effects of using alternative geographic
classifications on the determinations of costs associated with
beneficiaries residing in different areas.
``(2) Not later than 3 months after the date of submittal of the
proposal under paragraph (1), the Comptroller General shall review the
proposal and shall report to Congress on the appropriateness of the
proposed modifications.''.
(b) Miscellaneous and Technical Corrections.--(1) Section
1876(a)(3) (42 U.S.C. 1395mm(a)(3)) is amended by striking ``subsection
(c)(7)'' and inserting ``subsections (c)(2)(B)(ii) and (c)(7)''.
(2) Section 4204(c)(3) of OBRA-1990 is amended by striking ``for
1991'' and inserting ``for years beginning with 1991''.
(3) Section 4204(d)(2) of OBRA-1990 is amended by striking
``amendment'' and inserting ``amendments''.
(4) Section 1876(a)(1)(E)(ii)(I) (42 U.S.C. 1395mm(a)(1)(E)(ii)(I))
is amended by striking the comma after ``contributed to''.
(5) Section 4204(e)(2) of OBRA-1990 is amended by striking ``(which
has a risk-sharing contract under section 1876 of the Social Security
Act)''.
(6) Section 4204(f)(4) of OBRA-1990 is amended by striking
``final''.
(7) Section 1862(b)(3)(C) (42 U.S.C. 1395y(b)(3)(C)) is amended--
(A) in the heading, by striking ``plan'' and inserting
``plan or a large group health plan'';
(B) by striking ``group health plan'' and inserting ``group
health plan or a large group health plan'';
(C) by striking ``, unless such incentive is also offered
to all individuals who are eligible for coverage under the
plan''; and
(D) by striking ``the first sentence of subsection (a) and
other than subsection (b)'' and inserting ``subsections (a) and
(b)''.
(8) The amendments made by this subsection shall take effect as if
included in the enactment of OBRA-1990.

17d2fc934cd6cfd5e14bd4fe20c47aac7925954bd16f5ab7a713e5e304efe70a

(a) Use of Most Current Data in Determining Wage Index.--
(1) In general.--Section 1861(v)(1)(L)(iii) (42 U.S.C.
1395x(v)(1)(L)(iii)) is amended by striking ``as of such date
to'' and inserting ``and determined using the survey of the
most recent available wages and wage-related costs of''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply with respect to cost reporting periods beginning on
or after July 1, 1996.
(b) Clarification of Extension of Waiver of Liability.--
(1) In general.--The second sentence of section 9205 of the
Consolidated Omnibus Budget Reconciliation Act of 1985 is
amended by striking ``November 1, 1990'' and inserting
``December 31, 1995''.
(2) Effective date.--The amendment made by paragraph (1)
shall take effect as if included in the enactment of OBRA-1990.

868acb3df26a9688f818b5de7650b4bd67000ae4fc18df394993babe6ca83406

INTERMEDIARIES AND CARRIERS ON OTHER THAN A COST BASIS.
(a) In General.--Section 2326(a) of the Deficit Reduction Act of
1984, as amended by section 6215 of OBRA-1989, is amended in the third
sentence by striking ``during such period'' and inserting ``beginning
with fiscal year 1990 and any subsequent fiscal year''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply beginning with fiscal year 1994.

b8e3e24239234eb52434a8393815e21633930d22e8aa18a0ddbc9be1d8f346aa

(a) Survey and Certification Requirements.--(1) Section 1864 (42
U.S.C. 1395aa) is amended--
(A) in subsection (e), by striking ``title'' and inserting
``title (other than any fee relating to section 353 of the
Public Health Service Act)''; and
(B) in the first sentence of subsection (a), by striking
``1861(s) or'' and all that follows through ``Service Act,''
and inserting ``1861(s),''.
(2) An agreement made by the Secretary of Health and Human Services
with a State under section 1864(a) of the Social Security Act may
include an agreement that the services of the State health agency or
other appropriate State agency (or the appropriate local agencies) will
be utilized by the Secretary for the purpose of determining whether a
laboratory meets the requirements of section 353 of the Public Health
Service Act.
(b) Home Dialysis Demonstration Technical Corrections.--Section
4202 of OBRA-1990 is amended--
(1) in subsection (b)(1)(A), by striking ``home
hemodialysis staff assistant'' and inserting ``qualified home
hemodialysis staff assistant (as described in subsection
(d))'';
(2) in subsection (b)(2)(B)(ii)(I), by striking ``(as
adjusted to reflect differences in area wage levels)'';
(3) in subsection (c)(1)(A), by striking ``skilled''; and
(4) in subsection (c)(1)(E), by striking ``(b)(4)'' and
inserting ``(b)(2)''.
(c) Technical Correction to Revisions of Coverage for
Immunosuppressive Drug Therapy.--The Secretary of Health and Human
Services may administer section 1861(s)(2)(J) of the Social Security
Act (42 U.S.C. 1395x(s)(2)(J)) in a manner such that the months of
coverage of drugs described in such section are provided consecutively,
so long as the total number of months of coverage provided is the same
as the number of months described in such section.
(d) Other Miscellaneous and Technical Provisions.--(1) Section 1833
(42 U.S.C. 1395l) is amended by redesignating the subsection (r) added
by section 4206(b)(2) of OBRA-1990 as subsection (s).
(2) Section 1866(f)(1) (42 U.S.C. 1395cc(f)(1)) is amended by
striking ``1833(r)'' and inserting ``1833(s)''.
(3) Section 4201(d)(2) of OBRA-1990 is amended by striking ``(B) by
striking'', ``(C) by striking'', and ``(3) by adding'' and inserting
``(i) by striking'', ``(ii) by striking'', and ``(B) by adding'',
respectively.
(4) The section following section 4206 of OBRA-1990 is amended by
striking ``Sec. 4027.'' and inserting ``Sec. 4207.'', and in this
subtitle is referred to as section 4207 of OBRA-1990.
(5)(A) Section 4207(a)(1) of OBRA-1990 is amended by adding closing
quotation marks and a period after ``such review.''.
(B) Section 4207(a)(4) of OBRA-1990 is amended by striking ``this
subsection'' and inserting ``paragraphs (2) and (3)''.
(C) Section 4207(b)(1) of OBRA-1990 is amended by striking
``section 3(7)'' and inserting ``section 601(a)(1)''.
(6) Section 2355(b)(1)(B) of the Deficit Reduction Act of 1984, as
amended by section 4207(b)(4)(B)(ii) of OBRA-1990, is amended--
(A) by striking ``12907(c)(4)(A)'' and inserting
``4207(b)(4)(B)(i)'', and
(B) by striking ``feasibilitly'' and inserting
``feasibility''.
(7) Section 4207(b)(4)(B)(iii)(III) of OBRA-1990 is amended by
striking the period at the end and inserting a semicolon.
(8) Subsections (c)(3) and (e) of section 2355 of the Deficit
Reduction Act of 1984, as amended by section 4207(b)(4)(B) of OBRA-
1990, are each amended by striking ``12907(c)(4)(A)'' each place it
appears and inserting ``4207(b)(4)(B)''.
(9) Section 4207(c)(2) of OBRA-1990 is amended by striking ``the
Committee on Ways and Means'' each place it appears and inserting ``the
Committees on Ways and Means and Energy and Commerce''.
(10) Section 4207(d) of OBRA-1990 is amended by redesignating the
second paragraph (3) (relating to effective date) as paragraph (4).
(11) Section 4207(i)(2) of OBRA-1990 is amended--
(A) by striking the period at the end of clause (iii) and
inserting a semicolon, and
(B) in clause (v), by striking ``residents'' and inserting
``patients''.
(12) Section 4207(j) of OBRA-1990 is amended by striking ``title''
each place it appears and inserting ``subtitle''.
Subtitle D--Provisions Relating to Medicare Supplemental Insurance
Policies

96abc523ad00631ac3b025cad7671cffdf58f8f0fd7ddf97dd15842f90378979

b537c960fbd54b54092bd720cbc06187f0615e9758100e37f7d2104aa62799f3

POLICIES.
(a) In General.--Section 4358(c) of the Omnibus Budget
Reconciliation Act of 1990 (42 U.S.C. 1320c-3 note) is amended by
striking ``3-year'' and inserting ``3\1/2\-year''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect as if included in the enactment of the Omnibus Budget
Reconciliation Act of 1990.
Subtitle A--Child Welfare, Foster Care, Adoption

0c82b79a316077beea3363e567eeccadfe699853cc1553c46307889d43054293

AND CHILD HEALTH SERVICES BLOCK GRANT PROGRAM.
Section 501(a) (42 U.S.C. 701(a)) is amended by striking
``$686,000,000 for fiscal year 1990'' and inserting ``$705,000,000 for
fiscal year 1994''.
SEC. 202 REQUIRED PROTECTIONS FOR FOSTER CHILDREN.
(a) In General.--Section 422(b) (42 U.S.C. 622(b)) is amended--
(1) by striking ``and'' at the end of paragraph (7);
(2) by striking the period at the end of paragraph (8) and
inserting ``; and''; and
(3) by adding at the end the following:
``(9) provide assurances that the State--
``(A) since June 17, 1980, has completed an
inventory of all children who, before the inventory,
had been in foster care under the responsibility of the
State for 6 months or more, which determined--
``(i) the appropriateness of, and necessity
for, the foster care placement;
``(ii) whether the child could or should be
returned to the parents of the child or should
be freed for adoption or other permanent
placement; and
``(iii) the services necessary to
facilitate the return of the child or the
placement of the child for adoption or legal
guardianship;
``(B) is operating, to the satisfaction of the
Secretary--
``(i) a statewide information system from
which can be readily determined the status,
demographic characteristics, location, and
goals for the placement of every child who is
(or, within the immediately preceding 12
months, has been) in foster care;
``(ii) a case review system (as defined in
section 475(5)) for each child receiving foster
care under the supervision of the State;
``(iii) a service program designed to help
children--
``(I) where appropriate, return to
families from which they have been
removed; or
``(II) be placed for adoption, with
a legal guardian, or, if adoption or
legal guardianship is determined not to
be appropriate for a child, in some
other planned, permanent living
arrangement; and
``(iv) a preplacement preventive services
program designed to help children at risk of
foster care placement remain with their
families; and
``(C)(i) has reviewed (or within 12 months after
the date of the enactment of this paragraph will
review) State policies and administrative and judicial
procedures in effect for children abandoned at or
shortly after birth (including policies and procedures
providing for legal representation of such children);
and
``(ii) is implementing (or within 24 months after
the date of the enactment of this paragraph will
implement) such policies and procedures as the State
determines, on the basis of the review described in
clause (i), to be necessary to enable permanent
decisions to be made expeditiously with respect to the
placement of such children.''.
(b) Restriction on Reallotment.--Section 424 (42 U.S.C. 624) is
amended--
(1) in the first sentence, by striking ``The amount'' and
inserting the following:
``(a) In General.--Subject to subsection (b), the amount''; and
(2) by adding at the end the following:
``(b) Exception Relating to Foster Child Protections.--The
Secretary shall not reallot under subsection (a) of this section any
amount that is withheld or recovered from a State due to the failure of
the State to meet the requirements of section 422(b)(9).''.
(c) Repeal.--Section 427 (42 U.S.C. 627) is hereby repealed.
(d) Conforming Amendments.--
(1) Section 423(a) (42 U.S.C. 623(a)) is amended by
striking ``and in section 427''.
(2) Section 425(a)(2) (42 U.S.C. 625(a)(2)) is amended by
striking ``the statistical report required by section'' and
inserting ``section 422(b)(9) or''.
(3) Section 472(d) (42 U.S.C. 672(d)) is amended by
striking ``427(b)'' and inserting ``422(b)(9)''.
(e) Effective Date.--The amendments and repeal made by this section
shall be effective with respect to fiscal years beginning on or after
April 1, 1995.

2c7f64b27c47957d7a04db65c4adf938c0ac75cf650a222e55b6da528f3caa02

(a) In General.--Part A of title XI (42 U.S.C. 1301-1320b-13) is
amended by inserting after section 1122 the following:
``reviews of child and family services programs, and of foster care and
adoption assistance programs, for conformity with state plan
requirements
``Sec. 1123. (a) In General.--The Secretary, in consultation with
the State agencies administering the State programs under parts B and E
of title IV, shall promulgate regulations for the review of such
programs to determine whether such programs are in substantial
conformity with--
``(1) State plan requirements under such parts B and E,
``(2) implementing regulations promulgated by the
Secretary, and
``(3) the relevant approved State plans.
``(b) Elements of Review System.--The regulations referred to in
subsection (a) shall--
``(1) specify the timetable for conformity reviews of State
programs, including--
``(A) an initial review of each State program;
``(B) a timely review of a State program following
a review in which such program was found not to be in
substantial conformity; and
``(C) less frequent reviews of State programs which
have been found to be in substantial conformity, but
such regulations shall permit the Secretary to
reinstate more frequent reviews based on information
which indicates that a State program may not be in
conformity;
``(2) specify the requirements subject to review, and the
criteria to be used to measure conformity with such
requirements and to determine whether there is a substantial
failure to so conform;
``(3) specify the method to be used to determine the amount
of any Federal matching funds to be withheld (subject to
paragraph (4)) due to the State program's failure to so
conform, which ensures that--
``(A) such funds will not be withheld with respect
to a program, unless it is determined that the program
fails substantially to so conform;
``(B) such funds will not be withheld for a failure
to so conform resulting from the State's reliance upon
and correct use of formal written statements of Federal
law or policy provided to the State by the Secretary;
and
``(C) the amount of such funds withheld is related
to the extent of the failure to so conform; and
``(4) require the Secretary, with respect to any State
program found to have failed substantially to so conform--
``(A) to afford the State an opportunity to adopt
and implement a corrective action plan, approved by the
Secretary, designed to end the failure to so conform;
``(B) to make technical assistance available to the
State to the extent feasible to enable the State to
develop and implement such a corrective action plan;
``(C) to suspend the withholding of any Federal
matching funds under this section while such a
corrective action plan is in effect; and
``(D) to rescind any such withholding if the
failure to so conform is ended by successful completion
of such a corrective action plan.
``(c) Provisions for Administrative and Judicial Review.--The
regulations referred to in subsection (a) shall--
``(1) require the Secretary, not later than 10 days after a
final determination that a program of the State is not in
conformity, to notify the State of--
``(A) the basis for the determination; and
``(B) the amount of the Federal matching funds (if
any) to be withheld from the State;
``(2) afford the State an opportunity to appeal the
determination to the Departmental Appeals Board within 60 days
after receipt of the notice described in paragraph (1) (or, if
later, after failure to continue or to complete a corrective
action plan); and
``(3) afford the State an opportunity to obtain judicial
review of an adverse decision of the Board, within 60 days
after the State receives notice of the decision of the Board,
by appeal to the district court of the United States for the
judicial district in which the principal or headquarters office
of the agency responsible for administering the program is
located.''.
(b) Conforming Amendment.--Section 471(b) (42 U.S.C. 671(b)) is
amended by striking all that follows the first sentence.
(c) Effective Dates.--
(1) In general.--The amendment made by subsection (a) shall
take effect on the date of the enactment of this Act.
(2) Conforming amendment.--The amendment made by subsection
(b) shall take effect on October 1, 1995.
(3) Regulations.--The Secretary shall promulgate the
regulations referred to in section 1123(a) of the Social
Security Act (as added by this section) not later than July 1,
1995, to take effect on April 1, 1996.

460083db09df4aaeace2eb18fde17155261e3bd64917391ef980dabea64a346a

THE INDIAN CHILD WELFARE ACT.
(a) State Plan Requirement.--Section 422(b) (42 U.S.C. 622(b)), as
amended by section 301(a), is amended--
(1) by striking ``and'' at the end of paragraph (8);
(2) by striking the period at the end of paragraph (9) and
inserting ``; and''; and
(3) by adding at the end the following:
``(10) contain a description, developed after consultation
with tribal organizations (as defined in section 4 of the
Indian Self-Determination and Education Assistance Act) in the
State, of the specific measures taken by the State to comply
with the Indian Child Welfare Act.''.
(b) Effective Date.--The amendments made by subsection (a) shall be
effective with respect to fiscal years beginning on or after October 1,
1995.

5c6acd2be053b033c8481ea2deeb8f35b4fd526293a6c3608a4b7c70732539fc

(a) In General.--Subpart 1 of part B of title IV (42 U.S.C. 620-
628) is amended by inserting after section 428 the following:
``child welfare traineeships
``Sec. 429. The Secretary may approve an application for a grant to
a public or nonprofit institution for higher learning to provide
traineeships with stipends under section 426(a)(1)(C) only if the
application--
``(1) provides assurances that each individual who receives
a stipend with such traineeship (in this section referred to as
a `recipient') will enter into an agreement with the
institution under which the recipient agrees--
``(A) to participate in training at a public or
private nonprofit child welfare agency on a regular
basis (as determined by the Secretary) for the period
of the traineeship;
``(B) to be employed for a period of years
equivalent to the period of the traineeship, in a
public or private nonprofit child welfare agency in any
State, within a period of time (determined by the
Secretary in accordance with regulations) after
completing the postsecondary education for which the
traineeship was awarded;
``(C) to furnish to the institution and the
Secretary evidence of compliance with subparagraphs (A)
and (B); and
``(D) if the recipient fails to comply with
subparagraph (A) or (B) and does not qualify for any
exception to this subparagraph which the Secretary may
prescribe in regulations, to repay to the Secretary all
(or an appropriately prorated part) of the amount of
the stipend, plus interest, and, if applicable,
reasonable collection fees (in accordance with
regulations promulgated by the Secretary);
``(2) provides assurances that the institution will--
``(A) enter into agreements with child welfare
agencies for onsite training of recipients;
``(B) permit an individual who is employed in the
field of child welfare services to apply for a
traineeship with a stipend if the traineeship furthers
the progress of the individual toward the completion of
degree requirements; and
``(C) develop and implement a system that, for the
3-year period that begins on the date any recipient
completes a child welfare services program of study,
tracks the employment record of the recipient, for the
purpose of determining the percentage of recipients who
secure employment in the field of child welfare
services and remain employed in the field.''.
(b) Conforming Amendment.--Section 426(a)(1)(C) (42 U.S.C.
626(a)(1)(C)) is amended by inserting ``described in section 429''
after ``including traineeships''.
(c) Applicability.--The amendments made by this section shall apply
to grants awarded on or after October 1, 1995

9d8b77809754f095bb0b782246c0513166184f20bae5868713b5af909817e1c1

(a) Most Appropriate Setting.--Section 475(5)(A) (42 U.S.C.
675(5)(A)) is amended by inserting ``and most appropriate'' after
``(most family like)''.
(b) Timing of Subsequent Review.--Section 475(5)(C) (42 U.S.C.
675(5)(C)) is amended by striking ``periodically'' and inserting ``not
less frequently than every 12 months''.
(c) Effective Date.--The amendments made by this section shall take
effect on October 1, 1995.

3cddc687760f9f50dbe4e1e1dca026c58068cc646358382ea1e029671f545c37

TRANSFER UNUSED FOSTER CARE FUNDS TO CHILD WELFARE
SERVICES PROGRAMS.
(a) Repeal.--Subsections (b) and (c) of section 474 (42 U.S.C. 674
(b) and (c)) are hereby repealed.
(b) Conforming Amendments.--Section 474 (42 U.S.C. 674) is
amended--
(1) in subsection (d)(1)--
(A) by striking ``subsections (a), (b), and (c)''
and inserting ``subsection (a)''; and
(B) by striking ``the provisions of such
subsections'' and inserting ``subsection (a)''; and
(2) by redesignating subsection (d) as subsection (b).
(c) Effective Date.--The amendments and repeals made by this
section shall apply to payments for calendar quarters beginning on or
after October 1, 1993.

7a6b8db17c8241693c1436780d776d5672c1bf2a9eb7cd27cbf2c368126c4532

Part A of title XI (42 U.S.C. 1301-1320b-13) is amended by
inserting after section 1128B the following:
``demonstration projects
``Sec. 1129. (a) In General.--The Secretary may authorize not more
than 10 States to conduct demonstration projects pursuant to this
section which the Secretary finds are likely to promote the objectives
of part B or E of title IV.
``(b) Waiver Authority.--The Secretary may waive compliance with
any requirement of part B or E of title IV which (if applied) would
prevent a State from carrying out a demonstration project under this
section or prevent the State from effectively achieving the purpose of
such a project, except that the Secretary may not waive--
``(1) any provision of section 427 (as in effect before
April 1, 1996), section 422(b)(9) (as in effect after such
date), or section 479; or
``(2) any provision of such part E, to the extent that the
waiver would impair the entitlement of any qualified child or
family to benefits under a State plan approved under such part
E.
``(c) Treatment as Program Expenditures.--For purposes of parts B
and E of title IV, the Secretary shall consider the expenditures of any
State to conduct a demonstration project under this section to be
expenditures under subpart 1 or 2 of such part B, or under such part E,
as the State may elect.
``(d) Duration of Demonstration.--A demonstration project under
this section may be conducted for not more than 5 years.
``(e) Application.--Any State seeking to conduct a demonstration
project under this section shall submit to the Secretary an
application, in such form as the Secretary may require, which
includes--
``(1) a description of the proposed project, the geographic
area in which the proposed project would be conducted, the
children or families who would be served by the proposed
project, and the services which would be provided by the
proposed project (which shall provide, where appropriate, for
random assignment of children and families to groups served
under the project and to control groups);
``(2) a statement of the period during which the proposed
project would be conducted;
``(3) a discussion of the benefits that are expected from
the proposed project (compared to a continuation of activities
under the approved plan or plans of the State);
``(4) an estimate of the costs or savings of the proposed
project;
``(5) a statement of program requirements for which waivers
would be needed to permit the proposed project to be conducted;
``(6) a description of the proposed evaluation design; and
``(7) such additional information as the Secretary may
require.
``(f) Evaluations; Report.--Each State authorized to conduct a
demonstration project under this section shall--
``(1) obtain an evaluation by an independent contractor of
the effectiveness of the project, using an evaluation design
approved by the Secretary which provides for--
``(A) comparison of methods of service delivery
under the project, and such methods under a State plan
or plans, with respect to efficiency, economy, and any
other appropriate measures of program management;
``(B) comparison of outcomes for children and
families (and groups of children and families) under
the project, and such outcomes under a State plan or
plans, for purposes of assessing the effectiveness of
the project in achieving program goals; and
``(C) any other information that the Secretary may
require; and
``(2) provide interim and final evaluation reports to the
Secretary, at such times and in such manner as the Secretary
may require.
``(g) Cost Neutrality.--The Secretary may not authorize a State to
conduct a demonstration project under this section unless the Secretary
determines that the total amount of Federal funds that will be expended
under (or by reason of) the project over its approved term (or such
portion thereof or other period as the Secretary may find appropriate)
will not exceed the amount of such funds that would be expended by the
State under the State plans approved under parts B and E of title IV if
the project were not conducted.''.

200b446124d8012f050016659bc035334ea123ff0c96d3f7246dd2f07e735b0c

(a) Case Plan Requirements.--Section 475(5)(A) (42 U.S.C.
675(5)(A)), as amended by section 305(a), is amended by adding at the
end the following: ``which--
``(i) if the child has been placed in a
foster family home or child-care institution a
substantial distance from the home of the
parents of the child, or in a State different
from the State in which such home is located,
sets forth the reasons why such placement is in
the best interests of the child, and
``(ii) if the child has been placed in
foster care outside the State in which the home
of the parents of the child is located,
requires that, periodically, but not less
frequently than every 12 months, a caseworker
on the staff of the State agency of the State
in which the home of the parents of the child
is located, or of the State in which the child
has been placed, visit such child in such home
or institution and submit a report on such
visit to the State agency of the State in which
the home of the parents of the child is
located,''.
(b) Dispositional Hearing.--Section 475(5)(C) (42 U.S.C.
675(5)(C)), as amended by section 305(b), is amended by inserting
``and, in the case of a child described in subparagraph (A)(ii),
whether the out-of-State placement continues to be appropriate and in
the best interests of the child,'' after ``long-term basis)''.
(c) Data Collection.--Section 479(c)(3)(C) (42 U.S.C. 679(c)(3)(C))
is amended--
(1) by striking ``and'' at the end of clause (i); and
(2) by adding at the end the following:
``(iii) children placed in foster care
outside the State which has placement and care
responsibility, and''.
(d) Effective Dates.--The amendments made by this section shall be
effective with respect to fiscal years beginning on or after October 1,
1995.

b9fc3802de1a3d399049f9824da2460937b6f89452a65618a02145c460550afc

ASSISTANCE.
(a) In General.--Section 474(b) (42 U.S.C. 674(b)), as redesignated
by section 306(b)(2), is amended by adding at the end the following:
``(4)(A) Within 60 days after receipt of a State claim for
expenditures pursuant to subsection (a), the Secretary shall allow,
disallow, or defer such claim.
``(B) Within 15 days after a decision to defer such a State claim,
the Secretary shall notify the State of the reasons for the deferral
and of the additional information necessary to determine the
allowability of the claim.
``(C) Within 90 days after receiving such necessary information (in
readily reviewable form), the Secretary shall--
``(i) disallow the claim, if able to complete the review
and determine that the claim is not allowable, or
``(ii) in any other case, allow the claim, subject to
disallowance (as necessary)--
``(I) upon completion of the review, if it is
determined that the claim is not allowable; or
``(II) on the basis of findings of an audit or
financial management review.''.
(b) Effective Date.--The amendment made by subsection (a) shall be
effective with respect to claims made on or after the date of the
enactment of this Act.

56dfcfcbfe8c39b860c428a7826a416d99f896cf7441bda6eef36e91b7e7c9e1

(a) In General.--Part A of title XI (42 U.S.C. 1301-1320b-13), as
amended by section 307, is amended by inserting after section 1129 the
following:
``effect of failure to carry out state plan
``Sec. 1130. In an action brought to enforce a provision of the
Social Security Act, such provision is not to be deemed unenforceable
because of its inclusion in a section of the Act requiring a State plan
or specifying the required contents of a State plan. This section is
not intended to limit or expand the grounds for determining the
availability of private actions to enforce State plan requirements
other than by overturning any such grounds applied in Suter v. Artist
M., 112 S. Ct. 1360 (1992), but not applied in prior Supreme Court
decisions respecting such enforceability: Provided, however, That this
section is not intended to alter the holding in Suter v. Artist M. that
section 471(a)(15) of the Act is not enforceable in a private right of
action.''.
(b) Applicability.--The amendment made by subsection (a) shall
apply to actions pending on the date of the enactment of this Act and
to actions brought on or after such date of enactment.
Subtitle B--Child Support Enforcement

9de5ccd0c70eb46e5a2808079e0d6ecfa1b3a5f781d097cf9b67420368f23206

SUPPORT PAYMENTS.
(a) In General.--Section 466(a)(7) (42 U.S.C. 666(a)(7)) is
amended--
(1) by striking ``Procedures'' and all that follows through
``request of such agency'' and inserting ``Procedures which
require the State to periodically report to consumer reporting
agencies (as defined in section 603(f) of the Fair Credit
Reporting Act (15 U.S.C. 1681a(f))) the name of any parent who
owes overdue support and is at least 2 months delinquent in the
payment of such support and the amount of such delinquency; and
(2) by striking ``(C) a fee'' and all that follows through
``by the State'' and inserting ``(C) such information shall not
be made available to (i) a consumer reporting agency which the
State determines does not have sufficient capability to
systematically and timely make accurate use of such
information, or (ii) an entity which has not furnished evidence
satisfactory to the State that the entity is a consumer
reporting agency''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on October 1, 1995.

c3c6750531b3b4a271efe9d3834f1ff3a9eb7196394390a4a72c2d39bdd468e5

ESTABLISHMENT PROGRAMS.
Section 452(g)(2)(A) (42 U.S.C. 652(g)(2)(A)), as amended by
section 13721(a) of OBRA-1993, is amended--
(1) in clause (i), by striking ``during the fiscal year'';
(2) in subclause (I) of clause (ii), by striking ``as of
the end of the fiscal year'' and inserting ``in the fiscal year
or, at the option of the State, as of the end of such year'';
(3) in subclause (II) of clause (ii), by striking ``or (E)
as of the end of the fiscal year'' and inserting ``in the
fiscal year or, at the option of the State, as of the end of
such year'';
(4) in clause (iii), by striking ``during the fiscal
year''; and
(5) in the matter following clause (iii)--
(A) by striking ``who were born out of wedlock
during the immediately preceding fiscal year'' and
inserting ``born out of wedlock'';
(B) by striking ``such preceding fiscal year'' both
places it appears and inserting ``the preceding fiscal
year''; and
(C) by striking ``or E'' the second place it
appears.

f10923b41a01386e1ca6842bbc6d5c9cf352c63c1819dc2f83fda04027b9a616

PARENT LOCATOR SERVICE.
(a) In General.--Section 463 (42 U.S.C. 663) is amended by adding
at the end the following new subsection:
``(f) The Secretary shall enter into an agreement with the Attorney
General of the United States, under which the services of the Parent
Locator Service established under section 453 shall be made available
to the Office of Juvenile Justice and Delinquency Prevention upon its
request to locate any parent or child on behalf of such Office for the
purpose of--
``(1) enforcing any State or Federal law with respect to
the unlawful taking or restraint of a child, or
``(2) making or enforcing a child custody determination.
The Parent Locator Service shall charge no fees for services requested
pursuant to this subsection.''.
(b) Conforming Amendment.--Section 463(c) (42 U.S.C. 663(c)) is
amended by striking ``(a), (b), or (e)'' and inserting ``(a), (b), (e),
or (f)''.
(c) Effective Date.--The amendments made by this section shall take
effect on October 1, 1995.
Subtitle C--Supplemental Security Income

72e13f09986043af7f7485664e5618c9d82d6125a93e57fb90cb3350e0ed7838

ALL INDIVIDUALS UNDER AGE 18.
(a) In General.--Section 1614(a)(3) (42 U.S.C. 1382c(a)(3)) is
amended--
(1) in subparagraphs (A) and (H), by striking ``a child''
each place it appears and inserting ``an individual''; and
(2) in subparagraph (H), by striking ``child'' the second
and third place it appears and inserting ``individual''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to determinations made on or after the date of the enactment of
this Act.
Subtitle D--Aid to Families With Dependent Children

325b9e79d590efe39c92320a8696b7333bffc15f2f402b4e5668ce518433273b

Paragraph (1)(A) of section 1137(d) (42 U.S.C. 1320b-7(d)) is
amended to read as follows:
``(1)(A) The State shall require, as a condition of an
individual's eligibility for benefits under a program listed in
subsection (b), a declaration in writing, under penalty of
perjury--
``(i) by the individual,
``(ii) in the case in which eligibility for program
benefits is determined on a family or household basis,
by any adult member of such individual's family or
household (as applicable), or
``(iii) in the case of an individual born into a
family or household receiving benefits under such
program, by any adult member of such family or
household no later than the next redetermination of
eligibility of such family or household following the
birth of such individual,
stating whether the individual is a citizen or national of the
United States, and, if that individual is not a citizen or
national of the United States, that the individual is in a
satisfactory immigration status.''.

545538b2313a816810e5ac45554397d10ef2c9b1174c40aacb907c861647fe45

(a) Congressional Policy.--The Congress hereby declares that--
(1) it is the policy and responsibility of the Federal
Government to reduce the rate at which and the degree to which
families depend on income from welfare programs and the
duration of welfare receipt, consistent with other essential
national goals;
(2) it is the policy of the United States to strengthen
families, to ensure that children grow up in families that are
economically self-sufficient and that the life prospects of
children are improved, and to underscore the responsibility of
parents to support their children;
(3) the Federal Government should help welfare recipients
as well as individuals at risk of welfare receipt to improve
their education and job skills, to obtain child care and other
necessary support services, and to take such other steps as may
be necessary to assist them to become financially independent;
and
(4) it is the purpose of this section to provide the public
with generally accepted measures of welfare receipt so that it
can track such receipt over time and determine whether progress
is being made in reducing the rate at which and, to the extent
feasible, the degree to which, families depend on income from
welfare programs and the duration of welfare receipt.
(b) Development of Welfare Indicators and Predictors.--The
Secretary of Health and Human Services (in this section referred to as
the ``Secretary'') in consultation with the Secretary of Agriculture
shall--
(1) develop--
(A) indicators of the rate at which and, to the
extent feasible, the degree to which, families depend
on income from welfare programs and the duration of
welfare receipt; and
(B) predictors of welfare receipt;
(2) assess the data needed to report annually on the
indicators and predictors, including the ability of existing
data collection efforts to provide such data and any additional
data collection needs; and
(3) not later than 2 years after the date of the enactment
of this section, provide an interim report containing
conclusions resulting from the development and assessment
described in paragraphs (1) and (2), to--
(A) the Committee on Ways and Means of the House of
Representatives;
(B) the Committee on Education and Labor of the
House of Representatives;
(C) the Committee on Agriculture of the House of
Representatives;
(D) the Committee on Energy and Commerce of the
House of Representatives;
(E) the Committee on Finance of the Senate;
(F) the Committee on Labor and Human Resources of
the Senate; and
(G) the Committee on Agriculture, Nutrition, and
Forestry of the Senate.
(c) Advisory Board on Welfare Indicators.--
(1) Establishment.--There is established an Advisory Board
on Welfare Indicators (in this subsection referred to as the
``Board'').
(2) Composition.--The Board shall be composed of 12 members
with equal numbers to be appointed by the House of
Representatives, the Senate, and the President. The Board shall
be composed of experts in the fields of welfare research and
welfare statistical methodology, representatives of State and
local welfare agencies, and organizations concerned with
welfare issues.
(3) Vacancies.--Any vacancy occurring in the membership of
the Board shall be filled in the same manner as the original
appointment for the position being vacated. The vacancy shall
not affect the power of the remaining members to execute the
duties of the Board.
(4) Duties.--Duties of the Board shall include--
(A) providing advice and recommendations to the
Secretary on the development of indicators of the rate
at which and, to the extent feasible, the degree to
which, families depend on income from welfare programs
and the duration of welfare receipt; and
(B) providing advice on the development and
presentation of annual reports required under
subsection (d).
(5) Travel expenses.--Members of the Board shall not be
compensated, but shall receive travel expenses, including per
diem in lieu of subsistence, at rates authorized for employees
of agencies under subchapter I of chapter 57 of title 5, United
States Code, for each day the member is engaged in the
performance of duties away from the home or regular place of
business of the member.
(6) Detail of federal employees.--The Secretary shall
detail, without reimbursement, any of the personnel of the
Department of Health and Human Services to the Board to assist
the Board in carrying out its duties. Any detail shall not
interrupt or otherwise affect the civil service status or
privileges of the Federal employee.
(7) Voluntary service.--Notwithstanding section 1342 of
title 31, United States Code, the Board may accept the
voluntary services provided by a member of the Board.
(8) Termination of board.--The Board shall be terminated at
such time as the Secretary determines the duties described in
paragraph (4) have been completed, but in any case prior to the
submission of the first report required under subsection (d).
(d) Annual Welfare Indicators Report.--
(1) Preparation.--The Secretary shall prepare annual
reports on welfare receipt in the United States.
(2) Coverage.--The report shall include analysis of
families and individuals receiving assistance under means-
tested benefit programs, including the program of aid to
families with dependent children under part A of title IV of
the Social Security Act (42 U.S.C. 601 et seq.), the food stamp
program under the Food Stamp Act of 1977 (7 U.S.C. 2011 et
seq.), and the Supplemental Security Income program under title
XVI of the Social Security Act (42 U.S.C. 1381 et seq.), or as
general assistance under programs administered by State and
local governments.
(3) Contents.--Each report shall set forth for each of the
means-tested benefit programs described in paragraph (2)--
(A) indicators of--
(i) the rate at which and, to the extent
feasible, the degree to which, families depend
on income from welfare programs, and
(ii) the duration of welfare receipt;
(B) trends in indicators;
(C) predictors of welfare receipt;
(D) the causes of welfare receipt;
(E) patterns of multiple program receipt;
(F) such other information as the Secretary deems
relevant; and
(G) such recommendations for legislation, which
shall not include proposals to reduce eligibility
levels or impose barriers to program access, as the
Secretary may determine to be necessary or desirable to
reduce--
(i) the rate at which and the degree to
which families depend on income from welfare
programs, and
(ii) the duration of welfare receipt.
(4) Submission.--The Secretary shall submit such a report
not later than 3 years after the date of the enactment of this
section and annually thereafter, to the committees specified in
subsection (b)(3)(C). Each such report shall be transmitted
during the first 60 days of each regular session of Congress.
(e) Short Title.--This section may be cited as the ``Welfare
Indicators Act of 1994''.

b899a0bb2bab78ed73dfc65bf1cccc2a0b784e15c7ae1d3626d0699ccee5a1fa

(a) In General.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall provide for a
demonstration project for a qualified program to be conducted in
Milwaukee, Wisconsin, in accordance with this section.
(b) Payments.--For each calendar quarter in which there is a
qualified program approved under this subsection, the Secretary shall
pay to the operator of the qualified program, for no more than 20
calendar quarters, an amount equal to the aggregate amount that would
otherwise have been payable to the State with respect to participants
in the program for such calendar quarter, in the absence of the
program, for cash assistance and child care under part A of title IV of
the Social Security Act, for medical assistance under title XIX of such
Act, and for administrative expenses related to such assistance. The
amount payable to the operator of the program under this section shall
not include the costs of evaluating the effects of the program.
(c) Demonstration Project Described.--For purposes of this section,
the term ``qualified program'' means a program operated--
(1) by The New Hope Project, Inc., a private, not-for-
profit corporation incorporated under the laws of the State of
Wisconsin (in this section referred to as the ``operator''),
which offers low-income residents of Milwaukee, Wisconsin,
employment, wage supplements, child care, health care, and
counseling and training for job retention or advancement; and
(2) in accordance with an application submitted by the
operator of the program and approved by the Secretary based on
the Secretary's determination that the application satisfies
the requirements of subsection (d).
(d) Contents of Application.--The operator of the qualified program
shall provide, in its application to conduct a demonstration project
for the program, that the following terms and conditions will be met:
(1) The operator will develop and implement an evaluation
plan designed to provide valid and reliable information on the
impact and implementation of the program. The evaluation plan
will include adequately sized groups of project participants
and control groups assigned at random.
(2) The operator will develop and implement a plan
addressing the services and assistance to be provided by the
program, the timing and determination of payments from the
Secretary to the operator of the program, and the roles and
responsibilities of the Secretary and the operator with respect
to meeting the requirements of this paragraph.
(3) The operator will specify a reliable methodology for
determining expenditures to be paid to the operator by the
Secretary, with assistance from the Secretary in calculating
the amount that would otherwise have been payable to the State
in the absence of the program, pursuant to subsection (b).
(4) The operator will issue an interim and final report on
the results of the evaluation described in paragraph (1) to the
Secretary at such times as required by the Secretary.
(e) Effective Date.--This section shall take effect on the first
day of the first calendar quarter that begins after the date of the
enactment of this Act.

7e329de8c28f388d96da8fb572299dd120479e2402a034689051be22d4bd5d49

PROGRAM.
(a) In General.--Section 401(g)(2) of the Family Support Act of
1988 (42 U.S.C. 602 note; 102 Stat. 2396) is amended by striking
``October 1, 1992'' and inserting ``the date of the repeal of the
limitations contained in section 1108(a) of the Social Security Act on
payments to such jurisdictions for purposes of making maintenance
payments under parts A and E of title IV of such Act''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect as if included in the provision of the Family Support Act
of 1988 to which the amendment relates at the time such provision
became law.

3469b19831a45c552b06a14537b0f23a45a02b84ea2fe0e40e252071559f6f08

REPORTING.
(a) In General.--Section 402(a)(13) (42 U.S.C. 602(a)(13)) is
amended--
(1) by striking all that precedes subparagraph (A) and
inserting the following:
``(13) provide, at the option of the State and with respect
to such category or categories as the State may select and
identify in the State plan, that--''; and
(2) in each of subparagraphs (A) and (B), by striking ``,
in the case of families who are required to report monthly to
the State agency pursuant to paragraph (14)''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on October 1, 1994, and shall apply to payments under part
A of title IV of the Social Security Act for fiscal year 1994 and such
payments for succeeding fiscal years.
Subtitle E--JOBS Program

4f7a2a27f2ab5970ee7b81ae7bd480f7d5d310e6e4eabf4de26df2dbdad56c63

(a) In General.--Section 482(i)(2)(A) (42 U.S.C. 682(i)(2)(A)) is
amended by striking ``members of such Indian tribe receiving aid to
families with dependent children'' and inserting ``Indians receiving
aid to families with dependent children who reside on the reservation
or within the designated service area''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on October 1, 1995.

6594bf5bd99104d4e23112bc7cdfb71473e6ddfab09678e86fc824943296c1f0

IN THE JOBS PROGRAM.
Section 487(a) (42 U.S.C. 687(a)) is amended--
(1) by striking ``3'' and inserting ``4'';
(2) in paragraph (1), by inserting ``criteria for'' after
``develop'';
(3) in paragraph (2), by striking ``for'' and inserting
``with respect to''; and
(4) in the second sentence, by striking ``under this
subsection'' and inserting ``with respect to the program under
this part''.
Subtitle F--Other Provisions

4400d7e1d8f823198557a93210d2ef6462067c11bd82b8f095cfa78a4f06d67f

Social Security Act Amendments of 1994

Other Sections

TITLE I

TITLE II

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