I

104TH CONGRESS

2D SESSION H. R. 3787

To amend the Social Security Act to provide for a program of health

insurance for children under 13 years of age and for mothers-to-be.

IN THE HOUSE OF REPRESENTATIVES

JULY 11, 1996

Mr. GIBBONS (for himself, Mr. RANGEL, Mr. STARK, Mr. MILLER of California, Mr. LAFALCE, Mr. LANTOS, Mr. HILLIARD, and Ms. NORTON) introduced the following bill; which was referred to the Committee on Ways

and Means, and in addition to the Committee on Commerce, for a period

to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee

concerned

A BILL

To amend the Social Security Act to provide for a program

of health insurance for children under 13 years of age

and for mothers-to-be.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Healthy Start Act of

5 1996’’.
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1 SEC. 2. HEALTH INSURANCE FOR CHILDREN AND MOTH2 ERS-TO-BE.

3 (a) IN GENERAL.—The Social Security Act is amend4 ed by adding at the end the following new title:

5 ‘‘TITLE XXI—HEALTHY START

6 ‘‘SEC. 2100. ESTABLISHMENT OF PROGRAM OF HEALTH IN7 SURANCE FOR CHILDREN AND MOTHERS-TO8 BE.

9 ‘‘There is hereby established a program of health in10 surance for children under 13 years of age and mothers11 to-be.

12 ‘‘PART A—ELIGIBILITY

13 ‘‘SEC. 2101. GENERAL ELIGIBILITY.

14 ‘‘(a) CHILDREN.—

15 ‘‘(1) IN GENERAL.—Every individual—

16 ‘‘(A) who is a child (as defined in para17 graph (2)),

18 ‘‘(B) whose principal place of abode is in

19 the United States,

20 ‘‘(C) who is a citizen or national of the

21 United States or a permanent resident alien (as

22 defined in subsection (d)), and

23 ‘‘(D) who is not covered under a qualified

24 health plan (as defined in subsection (e)),

25 is, upon registration under section 2102, entitled to

26 benefits under this title as a child.
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1 ‘‘(2) CHILD DEFINED.—In this title, the term

2 ‘child’ means an individual from birth until the end

3 of the month in which the individual attains 13

4 years of age.

5 ‘‘(b) MOTHERS.—

6 ‘‘(1) IN GENERAL.—Every woman—

7 ‘‘(A) who is a pregnant woman (as defined

8 in paragraph (2)),

9 ‘‘(B) whose principal place of abode is in

10 the United States,

11 ‘‘(C) who is a citizen or national of the

12 United States or a permanent resident alien (as

13 defined in subsection (d)), and

14 ‘‘(D) who is not covered under a qualified

15 health plan (as defined in subsection (e)),

16 is entitled to benefits under this title as a pregnant

17 woman.

18 ‘‘(2) PREGNANT WOMAN DEFINED.—In this

19 title, the term ‘pregnant woman’ means a woman

20 during the period—

21 ‘‘(A) beginning on the date she receives the

22 examination or test which forms the basis for

23 the certification of pregnancy under section

24 2102(b)(1), and
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1 ‘‘(B) ending on the last day of the month

2 in which the 60-day period (beginning on the

3 date of termination of the pregnancy) ends.

4 ‘‘(c) PREGNANT CHILDREN.—In the case of an indi5 vidual who is entitled under this section to benefits under

6 this title as a child and as a pregnant woman, the individ7 ual is entitled to benefits as both.

8 ‘‘(d) PERMANENT RESIDENT ALIEN DEFINED.—In

9 this section, the term ‘permanent resident alien’ means an

10 alien lawfully admitted for permanent residence or other11 wise permanently residing in the United States under

12 color of law, and includes an alien granted asylum under

13 section 208 of the Immigration and Nationality Act or

14 lawfully admitted as a temporary resident under section

15 210, 210A, or 245A of such Act.)

16 ‘‘(e) QUALIFIED HEALTH PLAN.—In this section, the

17 term ‘qualified health plan’ means a plan of health insur18 ance or coverage, an employee welfare benefit plan that

19 provides health benefits, or other plan (other than under

20 this title) under Federal or State law that provides cov21 erage of benefits which the Secretary of Health and

22 Human Services determines is substantially equivalent to

23 the coverage of benefits provided under this title.
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1 ‘‘SEC. 2102. REGISTRATION; CERTIFICATION OF PREG2 NANCY.

3 ‘‘(a) REGISTRATION OF CHILDREN.—

4 ‘‘(1) IN GENERAL.—The Secretary shall estab5 lish a process for the registration of children at the

6 time of birth in the United States or at the time of

7 immigration into the United States or other acquisi8 tion of lawful permanent resident status in the Unit9 ed States.

10 ‘‘(2) TRANSITIONAL REGISTRATION.—The Sec11 retary also shall establish a process for the registra12 tion of children born before the effective date of ben13 efits under this title.

14 ‘‘(3) EFFECT OF FAILURE TO REGISTER.—The

15 failure of a child to be registered under this sub16 section shall not be considered to deny the child’s

17 entitlement to benefits under this title, but merely to

18 delay payment with respect to such benefits under

19 this title.

20 ‘‘(b) CERTIFICATION OF PREGNANCY AND REGISTRA21 TION OF PREGNANT WOMEN.—

22 ‘‘(1) CERTIFICATION OF PREGNANCY.—A cer23 tification of pregnancy for purposes of this title—

24 ‘‘(A) may be made by a physician (or such

25 other qualified health professionals as the Sec-
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1 retary may designate) on the basis of such tests

2 or procedures as the Secretary may specify,

3 ‘‘(B) shall be stated on such form as the

4 Secretary shall specify, and

5 ‘‘(C) shall be filed with the Secretary in a

6 manner specified by the Secretary.

7 ‘‘(2) REGISTRATION.—The Secretary shall es8 tablish a process for the registration of pregnant

9 women in connection with the filing of a certification

10 of pregnancy under paragraph (1)(C).

11 ‘‘SEC. 2103. COVERAGE PERIOD.

12 ‘‘(a) IN GENERAL.—No payments may be made

13 under this part with respect to the expenses of an individ14 ual unless such expenses were incurred by such individual

15 during a period which, with respect to the individual, is

16 a coverage period under this section.

17 ‘‘(b) CHILDREN.—With respect to an individual enti18 tled to benefits under this title as a child, the coverage

19 period shall begin on the first date (on or after the effec20 tive date of benefits under this title) on which the individ21 ual meets the requirements for such entitlement under

22 section 2101(a) and shall end on the day before the first

23 month in which the individual no longer meets such re24 quirements.
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1 ‘‘(c) PREGNANT WOMEN.—With respect to an indi2 vidual entitled to benefits under this title as a pregnant

3 woman, the coverage period shall begin on the first date

4 (on or after the effective date of benefits under this title)

5 on which the individual meets the requirements for such

6 entitlement under section 2101(b) and shall end on the

7 day before the first month in which the individual no

8 longer meets such requirements.

9 ‘‘PART B—BENEFITS

10 ‘‘SEC. 2111. SCOPE OF BENEFITS FOR CHILDREN.

11 ‘‘(a) IN GENERAL.—Except as provided in the suc12 ceeding provisions of this section, the benefits provided to

13 an individual by the program established by this part shall

14 consist of the same benefits that are available under title

15 XVIII to individuals entitled to benefits under part A of

16 that title and enrolled under part B of that title.

17 ‘‘(b) WELL CHILD SERVICES.—

18 ‘‘(1) IN GENERAL.—In addition to the benefits

19 described in subsection (a), in the case of an individ20 ual entitled to benefits under this title as a child, the

21 benefits under this title shall include entitlement to

22 have payment made (in the same manner as for phy23 sicians’ services under part B of title XVIII) for the

24 following, without the application of deductibles, co25 insurance, or copayments, subject to the periodicity
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1 schedule established with respect to the services

2 under paragraph (2):

3 ‘‘(A) Newborn and well-baby care, includ4 ing normal newborn care and pediatrician serv5 ices for high-risk deliveries.

6 ‘‘(B) Well-child care, including routine of7 fice visits, routine immunizations (including the

8 vaccine itself), routine laboratory tests, and pre9 ventive dental care.

10 ‘‘(2) PERIODICITY SCHEDULE.—The Secretary,

11 in consultation with the American Academy of Pedi12 atrics, shall establish a schedule of periodicity which

13 reflects the general, appropriate frequency with

14 which services listed in paragraph (1) should be pro15 vided to healthy children.

16 ‘‘SEC. 2112. SCOPE OF BENEFITS FOR PREGNANT WOMEN.

17 ‘‘(a) IN GENERAL.—In the case of an individual enti18 tled to benefits under this title as a pregnant woman, the

19 benefits under this title shall consist of entitlement to have

20 payment made for the following, without the application

21 of deductibles, coinsurance, or copayments, subject to the

22 periodicity schedule established with respect to the serv23 ices under subsection (b):

24 ‘‘(1) Prenatal care, including care for all com25 plications of pregnancy.
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1 ‘‘(2) Inpatient labor and delivery services.

2 ‘‘(3) Postnatal care.

3 ‘‘(4) Postnatal family planning services.

4 ‘‘(b) PERIODICITY SCHEDULE.—The Secretary, in

5 consultation with the American College of Obstetrics and

6 Gynecology, shall establish a schedule of periodicity which

7 reflects the general, appropriate frequency with which

8 services listed in subsection (a) should be provided to preg9 nant women without complications of pregnancy.

10 ‘‘SEC. 2113. EXCLUSIONS.

11 ‘‘(a) IN GENERAL.—Except as provided in sub12 sections (b) and (c), section 1862 shall apply to expenses

13 incurred for items and services provided under this title

14 the same manner as such section applies to items and

15 services provided under title XVIII.

16 ‘‘(b) BENEFITS EXCEPTION.—

17 ‘‘(1) CHILDRENS’ SERVICES.—In applying sec18 tion 1862(a) with respect to services described in

19 section 2111(b)(1) (relating to well-child services),

20 payment shall not be denied under paragraph (1),

21 (7), or (12) of such section 1862(a) if the services

22 are provided in accordance with the periodicity

23 schedule described in section 2111(b)(2).

24 ‘‘(2) SERVICES FOR PREGNANT WOMEN.—In

25 applying section 1862(a) with respect to services de-
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1 scribed in section 2112(a) (other than paragraph (2)

2 thereof), payment shall not be denied under para3 graph (1) or (7) of such section 1862(a) if the serv4 ices are provided in accordance with the periodicity

5 schedule described in section 2112(b).

6 ‘‘(c) COORDINATION OF PAYMENTS.—Payment shall

7 not be made under this title with respect to benefits to

8 the extent that payment for such benefits may be made

9 under title XVIII.

10 ‘‘PART C—PAYMENT FOR BENEFITS AND FINANCING

11 ‘‘SEC. 2121. PAYMENTS FOR BENEFITS.

12 ‘‘(a) IN GENERAL.—Except as otherwise provided in

13 this section—

14 ‘‘(1) payment of benefits under this title with

15 respect to benefits shall be made in the same

16 amounts and on the same basis as payment may be

17 made with respect to such benefits under title

18 XVIII, and

19 ‘‘(2) the provisions of sections 1814, 1833,

20 1842, 1848, and 1886 shall apply to payment of

21 benefits under this title in the same manner as they

22 apply to benefits under title XVIII.

23 ‘‘(b) NO COST-SHARING FOR CERTAIN SERVICES.—

24 No deductibles, coinsurance, copayments, or other cost25 sharing shall be imposed with respect to—
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1 ‘‘(1) well-child care services described in section

2 2111(b)(1), and

3 ‘‘(2) items and services for which an individual

4 is entitled under this title as a pregnant woman.

5 ‘‘(c) ADJUSTMENT OF PAYMENTS.—

6 ‘‘(1) ESTABLISHMENT OF NEW DRGS AND

7 WEIGHTS.—In making payment under this title with

8 respect to inpatient hospital services, the Secretary

9 shall make such adjustments in the diagnosis-related

10 groups and weighting factors with respect to dis11 charges within such groups, otherwise established

12 under section 1886(d)(4) as may be necessary—

13 ‘‘(A) to reflect the types of discharges oc14 curring under this title which are not occurring

15 under title XVIII, and

16 ‘‘(B) to provide for a weighting factor, for

17 cesarean section deliveries, which is 95 percent

18 of the weighting factor that otherwise would be

19 established.

20 ‘‘(2) PAYMENT FOR OBSTETRICAL SERVICES.—

21 ‘‘(A) GLOBAL FEE.—In making payment

22 under this title with respect to the group of ob23 stetrical services typical of treatment through24 out a course of pregnancy, the Secretary shall

25 establish, as a schedule under section 1848, a
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1 global fee with respect to such group of serv2 ices.

3 ‘‘(B) BONUS FOR EARLY PRESEN4 TATION.—The fee schedule amount with respect

5 to obstetrical services under this title shall be

6 increased by 5 percent in the case of services

7 furnished to women who have presented for pre8 natal care during the first trimester.

9 ‘‘(C) DISINCENTIVE FOR CESAREAN SEC10 TIONS.—The fee schedule amount otherwise es11 tablished with respect to a cesarean section

12 shall be 95 percent of the fee schedule amount

13 otherwise established.

14 ‘‘(c) CONDITIONS OF AND LIMITATIONS ON PAY15 MENTS.—The provisions of sections 1814 and 1835 shall

16 apply to payment for services under this title in the same

17 manner as they apply t±o payment for services under

18 parts A and B, respectively, of title XVIII.

19 ‘‘(d) USE OF TRUST FUND.—In carrying out this

20 section, any reference in title XVIII to a trust fund shall

21 be treated as a reference to the Children Health Insurance

22 Trust Fund established under section 2122.

23 ‘‘SEC. 2122. CHILDREN HEALTH INSURANCE TRUST FUND.

24 ‘‘(a) ESTABLISHMENT.—(1) There is hereby created

25 on the books of the Treasury of the United States a trust
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1 fund to be known as the ‘Children Health Insurance Trust

2 Fund’ (in this section referred to as the ‘Trust Fund’).

3 The Trust Fund shall consist of such gifts and bequests

4 as may be made as provided in section 201(i)(1) and

5 amounts appropriated under paragraph (2).

6 ‘‘(2) There are hereby appropriated to the Trust

7 Fund amounts equivalent to 100 percent of the premium

8 taxes imposed by section 59B of the Internal Revenue

9 Code of 1986, and such additional amounts as the Con10 gress provides. The amounts appropriated by the preced11 ing sentence in relation to premium taxes shall be trans12 ferred from time to time from the general fund in the

13 Treasury to the Trust Fund, such amounts to be deter14 mined on the basis of estimates by the Secretary of the

15 Treasury of the taxes, paid to or deposited into the Treas16 ury; and proper adjustments shall be made in amounts

17 subsequently transferred to the extent prior estimates

18 were in excess of or were less than the taxes specified in

19 such sentence.

20 ‘‘(b) INCORPORATION OF PROVISIONS.—

21 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

22 the provisions of subsections (b) through (e) and (g)

23 through (j) of section 1817 shall apply to the Trust

24 Fund in the same manner as they apply to the Fed25 eral Hospital Insurance Trust Fund.
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1 ‘‘(2) EXCEPTIONS.—In applying paragraph

2 (1)—

3 ‘‘(A) the Board of Trustees and Managing

4 Trustee of the Trust Fund shall be composed of

5 the members of the Board of Trustees and the

6 Managing Trustee, respectively, of the Federal

7 Hospital Insurance Trust Fund; and

8 ‘‘(B) any reference in section 1817 to the

9 Federal Hospital Insurance Trust Fund or to

10 title XVIII (or part A thereof) is deemed a ref11 erence to the Trust Fund under this section

12 and this title, respectively.

13 ‘‘SEC. 2123. APPLICABLE TITLE XXI PREMIUM.

14 ‘‘For purposes of section 59B of the Internal Revenue

15 Code of 1986, the Secretary shall, during September of

16 each year (beginning with 1997), determine a title XXI

17 applicable premium for months in the succeeding calendar

18 year. Such premium for months in a year shall be such

19 amount as the Secretary estimates so that—

20 ‘‘(1) 12 times the product of such amount and

21 the average number of families with individuals enti22 tled to benefits under section 2101 in any month in

23 the year, is equal to

24 ‘‘(2) the total of the benefits and administrative

25 costs which the Secretary estimates will be payable
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1 from the Children Health Insurance Trust Fund for

2 services performed and related administrative costs

3 incurred in such year.

4 In calculating the amount under paragraph (2), the Sec5 retary shall include an appropriate amount for a contin6 gency margin.

7 ‘‘PART D—GENERAL PROVISIONS

8 ‘‘SEC. 2131. INCORPORATION OF CERTAIN MEDICARE PRO9 VISIONS.

10 ‘‘(a) USE OF CARRIERS AND INTERMEDIARIES.—The

11 Secretary shall provide for the administration of this title

12 through the use of fiscal intermediaries and carriers in

13 the same manner as title XVIII is carried out through

14 the use of such fiscal intermediaries and carriers.

15 ‘‘(b) DEFINITIONS.—Except as otherwise provided in

16 this title, the definitions contained in section 1861 shall

17 apply for purposes of this title in the same manner as they

18 apply for purposes of title XVIII.

19 ‘‘(c) CERTIFICATION, PROVIDER QUALIFICATION,

20 ETC.—The provisions of sections 1863 through 1875, sec21 tions 1878 through 1880, section 1883, section 1885, and

22 sections 1887 through 1892 shall apply to this title in the

23 same manner as they apply to title XVIII.

24 ‘‘(d) HEALTH MAINTENANCE ORGANIZATIONS AND

25 COMPETITIVE MEDICAL PLANS.—
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1 ‘‘(1) IN GENERAL.—Except as provided in this

2 subsection, section 1876 shall apply to individuals

3 entitled to benefits under this title in the same man4 ner as such section applies to individuals entitled to

5 benefits under part A, and enrolled under part B, of

6 title XVIII.

7 ‘‘(2) LIMITATION TO REASONABLE COST REIM8 BURSEMENT CONTRACTS FOR PREGNANT WOMEN.—

9 ‘‘(A) IN GENERAL.—The provisions of sec10 tion 1876 relating only to risk-sharing contracts

11 (and not to reasonable cost reimbursement con12 tracts) shall not apply to individuals entitled to

13 benefits under this title only as pregnant

14 women.

15 ‘‘(B) REPORT.—Not later than January 1,

16 1997, the Secretary shall submit to the Con17 gress a report concerning recommendations on

18 how the provisions of section 1876 relating to

19 risk-sharing contracts may be adapted to apply

20 to benefits provided under this title to pregnant

21 women.

22 ‘‘(3) APPLICATION.—In applying section 1876

23 under this section—
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1 ‘‘(A) the provisions of such section relating

2 only to individuals enrolled under part B of title

3 XVIII shall not apply;

4 ‘‘(B) any reference to a Trust Fund estab5 lished under title XVIII and to benefits under

6 such title is deemed a reference to the Children

7 Health Insurance Trust Fund and to benefits

8 under this title;

9 ‘‘(C) the adjusted average per capita cost

10 and the adjusted community rate shall be deter11 mined on the basis of benefits under this title;

12 and

13 ‘‘(D) subsection (f) shall not apply.

14 ‘‘SEC. 2132. INCORPORATION OF PEER REVIEW PROVISIONS

15 AND FRAUD AND ABUSE PROVISIONS.

16 ‘‘The provisions of sections 1121 through 1126, sec17 tions 1128 through 1128B, section 1134, section 1138,

18 and part B of title XI shall apply to this title in the same

19 manner as they apply to title XVIII.’’.

20 (b) CONFORMING AMENDMENTS.—

21 (1) Section 201(g)(1)(A) of the Social Security

22 Act (42 U.S.C. 401(g)(1)(A)) is amended by striking

23 ‘‘and the Federal Supplementary Medical Insurance

24 Trust Fund’’ and inserting ‘‘, Federal Supple-
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1 mentary Medical Insurance Trust Fund, and the

2 Children Health Insurance Trust Fund’’.

3 (2) Section 201(i)(1) of such Act (42 U.S.C.

4 401(i)(1)) is amended by striking ‘‘and the Federal

5 Supplementary Medical Insurance Trust Fund’’ and

6 inserting ‘‘, Federal Supplementary Medical Insur7 ance Trust Fund, and the Children Health Insur8 ance Trust Fund’’.

9 (c) EFFECTIVE DATE.—The amendments made by

10 this section shall take effect on the date of the enactment

11 of this Act, except that no benefits shall be available under

12 title XXI of the Social Security Act for items or services

13 furnished before January 1, 1998.

14 SEC. 3. PREMIUM FOR COVERAGE OF UNINSURED CHIL15 DREN AND MOTHERS-TO-BE.

16 (a) GENERAL RULE.—Subchapter A of chapter 1 of

17 the Internal Revenue Code of 1986 (relating to determina18 tion of tax liability) is amended by adding at the end the

19 following new part:

20 ‘‘PART VIII—PREMIUM FOR COVERAGE OF

21 UNINSURED CHILDREN AND MOTHERS-TO-BE

‘‘Sec. 59B. Premium for coverage of uninsured children and

mothers-to-be.
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1 ‘‘SEC. 59B. PREMIUM FOR COVERAGE OF UNINSURED CHIL2 DREN AND MOTHERS-TO-BE.

3 ‘‘(a) IMPOSITION OF TAX.—In the case of an individ4 ual, there is hereby imposed (in addition to any other tax

5 imposed by this subtitle) a tax for the taxable year in the

6 amount equal to the title XXI premium liability (if any)

7 of such individual for such taxable year.

8 ‘‘(b) EXEMPTION FOR LOW-INCOME INDIVIDUALS.—

9 ‘‘(1) IN GENERAL.—No tax shall be imposed by

10 subsection (a) on any taxpayer whose modified ad11 justed gross income for the taxable year does not ex12 ceed the threshold amount.

13 ‘‘(2) PHASE-IN OF TAX.—

14 ‘‘(A) IN GENERAL.—If the modified ad15 justed gross income of the taxpayer for the tax16 able year exceeds the threshold amount by less

17 than $10,000, the amount of the tax imposed

18 by subsection (a) for such taxable year shall be

19 the phase-in percentage of the title XXI pre20 mium liability of such taxpayer for such taxable

21 year.

22 ‘‘(B) PHASE-IN PERCENTAGE.—For pur23 poses of subparagraph (A), the phase-in per24 centage shall be determined under tables pre25 scribed by the Secretary which—
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1 ‘‘(i) shall have income brackets of not

2 more than $50, and

3 ‘‘(ii) provide for a ratable increase in

4 the amount of tax imposed by subsection

5 (a) for modified adjusted gross incomes be6 tween the threshold amount and the sum

7 of the threshold amount and $10,000.

8 ‘‘(c) TITLE XXI PREMIUM LIABILITY.—For pur9 poses of this section—

10 ‘‘(1) IN GENERAL.—The title XXI premium li11 ability of any individual for any taxable year is the

12 sum of—

13 ‘‘(A) the applicable title XXI premiums for

14 each month of the taxable year as of the first

15 day of which any dependent of the individual is

16 a title XXI covered individual who has not at17 tained age 13, and

18 ‘‘(B) the applicable title XXI premium for

19 the month of the taxable year during which the

20 taxpayer (or spouse of the taxpayer) gives birth

21 to any child if for such month the individual

22 giving birth is a title XXI covered individual.

23 ‘‘(2) APPLICABLE TITLE XXI PREMIUM.—The

24 term ‘applicable title XXI premium’ means, with re25 spect to a month, such premium as determined
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1 under section 2123 of the Social Security Act for

2 that month.

3 ‘‘(d) TITLE XXI COVERED INDIVIDUAL.—For pur4 poses of this section—

5 ‘‘(1) IN GENERAL.—A dependent shall be treat6 ed as a title XXI covered individual for any month

7 unless—

8 ‘‘(A) for such month, such dependent is

9 covered under a qualified health plan, and

10 ‘‘(B) the taxpayer furnishes to the Sec11 retary (at such time and in such manner as the

12 Secretary may prescribe) the required certifi13 cation of such coverage for such month.

14 A similar rule shall apply to a woman for the month

15 in which such woman gives birth to a child.

16 ‘‘(2) QUALIFIED HEALTH PLAN.—The term

17 ‘qualified health plan’ means a plan of health insur18 ance or coverage, an employee welfare benefit plan

19 that provides health benefits, or other plan (other

20 than under title XXI of the Social Security Act)

21 under Federal or State law that provides coverage of

22 benefits which the Secretary of Health and Human

23 Services determines is substantially equivalent to the

24 coverage of benefits provided under title XXI of the

25 Social Security Act.
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1 ‘‘(e) OTHER DEFINITIONS AND SPECIAL RULES.—

2 For purposes of this section—

3 ‘‘(1) THRESHOLD AMOUNT.—

4 ‘‘(A) IN GENERAL.—Except as provided in

5 subparagraph (B), the term ‘threshold amount’

6 means—

7 ‘‘(i) $20,000 in the case of a return

8 with respect to which 3 or fewer personal

9 exemptions are allowable under section

10 151, and

11 ‘‘(ii) $25,000 in the case of a return

12 with respect to which 4 or more personal

13 exemptions are allowable under section

14 151.

15 ‘‘(B) CERTAIN SEPARATE RETURNS.—The

16 threshold amount shall be zero in the case of a

17 taxpayer who—

18 ‘‘(i) is married as of the close of the

19 taxable year but does not file a joint return

20 for such taxable year, and

21 ‘‘(ii) does not live apart from his

22 spouse at all times during the last 6

23 months of the taxable year.

24 ‘‘(C) INFLATION ADJUSTMENTS.—In the

25 case of a taxable year beginning in a calendar
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1 year after 1998, each dollar amount contained

2 in subparagraph (A) shall be increased by an

3 amount equal to—

4 ‘‘(i) such dollar amount, multiplied by

5 ‘‘(ii) the cost-of-living adjustment de6 termined under section 1(f)(3) for the cal7 endar year in which the taxable year be8 gins, by substituting ‘calendar year 1997’

9 for ‘calendar year 1992’ in subparagraph

10 (B) thereof.

11 ‘‘(2) MODIFIED ADJUSTED GROSS INCOME.—

12 The term ‘modified adjusted gross income’ means

13 adjusted gross income—

14 ‘‘(A) determined without regard to sections

15 911, 931, and 933, and

16 ‘‘(B) increased by the amount of interest

17 received or accrued by the individual during the

18 taxable year which is exempt from tax.

19 The determination under the preceding sentence

20 shall be made without regard to any carryover or

21 carryback.

22 ‘‘(3) DEPENDENT.—The term ‘dependent’

23 means, with respect to periods in any calendar year,

24 any individual if an exemption is allowable under

25 section 151(c) with respect to such individual to the
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1 taxpayer for a taxable year beginning in such cal2 endar year.

3 ‘‘(4) REQUIRED CERTIFICATION.—The term ‘re4 quired certification’ means the statement required to

5 be provided under section 6050Q(b) (or a copy

6 thereof) or any other statement approved by the

7 Secretary for purposes of this section.

8 ‘‘(f) COORDINATION WITH OTHER PROVISIONS.—

9 ‘‘(1) TREATMENT AS MEDICAL EXPENSE.—For

10 purposes of section 213, the tax imposed by this sec11 tion for any taxable year shall be treated as an ex12 pense paid during such taxable year for medical care

13 of the taxpayer.

14 ‘‘(2) NOT TREATED AS TAX FOR CERTAIN PUR15 POSES.—The tax imposed by this section shall not

16 be treated as a tax imposed by this chapter for pur17 poses of determining—

18 ‘‘(A) the amount of any credit allowable

19 under this chapter, or

20 ‘‘(B) the amount of the minimum tax im21 posed by section 55.

22 ‘‘(3) TREATMENT UNDER SUBTITLE F.—For

23 purposes of subtitle F, the tax imposed by this sec24 tion shall be treated as if it were a tax imposed by

25 section 1.
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1 ‘‘(g) EXEMPTIONS.—

2 ‘‘(1) IN GENERAL.—No tax shall be imposed by

3 this section on any individual for any taxable year

4 if such individual is a nonresident alien.

5 ‘‘(2) CERTAIN INDIVIDUALS NOT TAKEN INTO

6 ACCOUNT IN DETERMINING AMOUNT OF TAX.—For

7 purposes of this section, an individual shall be treat8 ed as not being a title XXI covered individual for

9 any month if—

10 ‘‘(A) the principal place of abode of such

11 individual as of the first day of such month is

12 outside the United States, or

13 ‘‘(B) as of the first day of such month,

14 there is in effect for such individual a qualified

15 religious exemption.

16 ‘‘(3) QUALIFIED RELIGIOUS EXEMPTION.—For

17 purposes of paragraph (2)—

18 ‘‘(A) IN GENERAL.—The term ‘qualified

19 religious exemption’ means an exemption grant20 ed by the Secretary of Health and Human

21 Services to an individual—

22 ‘‘(i) who is a member of a recognized

23 religious sect or division thereof with re24 spect to which such Secretary makes the
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1 findings referred to in subparagraphs (C),

2 (D), and (E) of section 1402(g)(1),

3 ‘‘(ii) who is an adherent of established

4 tenets or teachings of such sect or division

5 as described in such section, and

6 ‘‘(iii) who submits an application for

7 such exemption which contains or is ac8 companied by the evidence described in

9 section 1402(g)(1)(A) and a waiver de10 scribed in section 1402(g)(1)(B).

11 For purposes of the clause (iii), section

12 1402(g)(1)(B) shall be treated as including a

13 reference to title XXI of the Social Security

14 Act.

15 ‘‘(B) LIMITATION.—An exemption granted

16 under this paragraph shall cease to apply begin17 ning on the date such Secretary determines

18 that the individual, or the sect or division,

19 ceased to meet the requirements of subpara20 graph (A).

21 ‘‘(4) SPECIAL RULE FOR INDIVIDUALS RESID22 ING ABROAD WHO RECEIVE TITLE XXI SERVICES.—

23 Paragraph (2)(A) shall not apply to any individual

24 for any taxable year if, at any time during such tax-
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1 able year, such individual receives services under

2 title XXI of the Social Security Act.

3 ‘‘(h) REGULATIONS.—The Secretary may prescribe

4 such regulations as may be appropriate to carry out the

5 purposes of this section, including regulations, prescribed

6 after consultation with the Secretary of Health and

7 Human Services, treating health plans of foreign govern8 ments or foreign employers outside the United States as

9 qualified health plans.’’

10 (b) TECHNICAL AMENDMENTS.—

11 (1) Subsection (a) of section 6012 of such Code

12 is amended by inserting after paragraph (9) the fol13 lowing new paragraph:

14 ‘‘(10) Every individual who has a title XXI pre15 mium liability (as defined in section 59B) for the

16 taxable year.’’

17 (2) Subparagraph (A) of section 1(f)(6) of such

18 Code is amended by inserting ‘‘section

19 59B(e)(1)(C),’’ after paragraph (2)(A),’’.

20 (c) CLERICAL AMENDMENT.—The table of parts for

21 subchapter A of chapter 1 is amended by adding at the

22 end the following new item:

‘‘Part VIII. Individual share of title XXI premiums.’’

23 (d) EFFECTIVE DATE.—The amendments made by

24 this section shall apply to months beginning after Decem25 ber 31, 1997, in taxable years ending after such date.
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1 SEC. 4. REPORTING REQUIREMENTS.

2 (a) IN GENERAL.—Subpart B of part III of sub3 chapter A of chapter 61 of the Internal Revenue Code of

4 1986 (relating to information concerning transactions

5 with others) is amended by adding at the end the following

6 new sections:

7 ‘‘SEC. 6050Q. RETURNS RELATING TO QUALIFIED HEALTH

8 PLANS.

9 ‘‘(a) REQUIREMENT OF REPORTING.—The adminis10 trator of any qualified health plan (as defined in section

11 59B(d)) shall make a return for each calendar year setting

12 forth—

13 ‘‘(1) the name and TIN of each individual cov14 ered under such plan or program at any time during

15 such taxable year as a primary insured or as the

16 spouse of a primary insured,

17 ‘‘(2) the name and TIN (to the extent avail18 able) of each individual covered under such plan or

19 program at any time during such taxable year as a

20 dependent (as defined in section 59B(e)(3)) of a pri21 mary insured, and

22 ‘‘(3) the months during such calendar year for

23 which such individuals were so covered.

24 Such return shall be made at such time and in such form

25 as the Secretary may by regulations prescribe.
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1 ‘‘(b) STATEMENTS TO PRIMARY INSURED INDIVID2 UALS.—Every administrator required to make a return

3 under subsection (a) shall furnish to each individual whose

4 name is required to be set forth in such return by reason

5 of being a primary insured a written statement showing—

6 ‘‘(1) the name of the qualified health plan and

7 the address of its administrator, and

8 ‘‘(2) the information required to be shown on

9 the return with respect to such primary insured.

10 The written statement required under the preceding sen11 tence shall be furnished to the person on or before Janu12 ary 31 of the year following the calendar year for which

13 the return under subsection (a) was required to be made.

14 ‘‘(c) STATEMENT TO SPOUSE OR DEPENDENTS OF

15 PRIMARY INSURED ON REQUEST.—At the request of an

16 individual who, at any time during a calendar year, was

17 the spouse or a dependent (as defined in section

18 59B(e)(3)) of a primary insured who is required to receive

19 a statement under subsection (b) from an administrator,

20 such administrator shall furnish to such individual a copy

21 of such statement with respect to such insured for such

22 calendar year.’’

23 (b) UNIFORM PENALTY PROVISIONS MADE APPLICA24 BLE.—
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1 (1) Subparagraph (B) of section 6724(d)(1) of

2 such Code is amended by inserting after the item re3 lating to clause (viii) the following new item (and re4 designating the following clauses accordingly):

5 ‘‘(ix) section 6050Q(a) (relating to re6 turns regarding qualified health plans),’’.

7 (2) Paragraph (2) of section 6724(d) of such

8 Code is amended by inserting after subparagraph

9 (P) the following new subparagraph (and by redesig10 nating the following subparagraphs accordingly):

11 ‘‘(Q) subsection (b) or (c) of section

12 6050Q (relating to returns regarding qualified

13 health plans),’’.

14 (c) CLERICAL AMENDMENT.—The table of sections

15 for subpart B of part III of subchapter A of chapter 61

16 of such Code is amended by adding at the end the follow17 ing new item:

‘‘Sec. 6050Q. Returns relating to qualified health plans.’’

18 (d) EFFECTIVE DATE.—The amendments made by

19 this section shall apply to calendar years after 1997.

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