I

105TH CONGRESS

1ST SESSION H. R. 560

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

insurance for children under 18 years of age and for mothers-to-be.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 4, 1997

Mr. STARK 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 18 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 1997’’.
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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 18 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 18

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

2 other qualified health professionals as the Sec3 retary may designate) on the basis of such tests

4 or procedures as the Secretary may specify,

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

6 Secretary shall specify, and

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

8 manner specified by the Secretary.

9 ‘‘(2) REGISTRATION.—The Secretary shall es10 tablish a process for the registration of pregnant

11 women in connection with the filing of a certification

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

13 ‘‘SEC. 2103. COVERAGE PERIOD.

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

15 under this part with respect to the expenses of an individ16 ual unless such expenses were incurred by such individual

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

18 a coverage period under this section.

19 ‘‘(b) CHILDREN.—With respect to an individual enti20 tled to benefits under this title as a child, the coverage

21 period shall begin on the first date (on or after the effec22 tive date of benefits under this title) on which the individ23 ual meets the requirements for such entitlement under

24 section 2101(a) and shall end on the day before the first
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1 month in which the individual no longer meets such re2 quirements.

3 ‘‘(c) PREGNANT WOMEN.—With respect to an indi4 vidual entitled to benefits under this title as a pregnant

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

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

7 on which the individual meets the requirements for such

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

9 day before the first month in which the individual no

10 longer meets such requirements.

11 ‘‘PART B—BENEFITS

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

13 ‘‘(a) IN GENERAL.—Except as provided in the suc14 ceeding provisions of this section, the benefits provided to

15 an individual by the program established by this part shall

16 consist of the same benefits that are available under title

17 XVIII to individuals entitled to benefits under part A of

18 that title and enrolled under part B of that title plus a

19 benefit for prescription drugs and biologicals necessary to

20 meet catastrophic costs for such drugs and biologicals, as

21 determined by the Secretary.

22 ‘‘(b) WELL CHILD SERVICES.—

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

24 described in subsection (a), in the case of an individ25 ual entitled to benefits under this title as a child, the
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1 benefits under this title shall include entitlement to

2 have payment made (in the same manner as for phy3 sicians’ services under part B of title XVIII) for the

4 following, without the application of deductibles, co5 insurance, or copayments, subject to the periodicity

6 schedule established with respect to the services

7 under paragraph (2):

8 ‘‘(A) Newborn and well-baby care, includ9 ing normal newborn care and pediatrician serv10 ices for high-risk deliveries.

11 ‘‘(B) Well-child care, including routine of12 fice visits, routine immunizations (including the

13 vaccine itself), routine laboratory tests, and pre14 ventive dental care.

15 ‘‘(C) Early and periodic screening, diag16 nostic, and treatment services (as defined in

17 section 1905(r) of the Social Security Act).

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

19 in consultation with the American Academy of Pedi20 atrics, shall establish a schedule of periodicity which

21 reflects the general, appropriate frequency with

22 which services listed in paragraph (1) should be pro23 vided to healthy children.
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1 ‘‘SEC. 2112. SCOPE OF BENEFITS FOR PREGNANT WOMEN.

2 ‘‘(a) IN GENERAL.—In the case of an individual enti3 tled to benefits under this title as a pregnant woman, the

4 benefits under this title shall consist of entitlement to have

5 payment made for the following, without the application

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

7 periodicity schedule established with respect to the serv8 ices under subsection (b):

9 ‘‘(1) Prenatal care, including care for all com10 plications of pregnancy.

11 ‘‘(2) Inpatient labor and delivery services.

12 ‘‘(3) Postnatal care.

13 ‘‘(4) Postnatal family planning services.

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

15 consultation with the American College of Obstetrics and

16 Gynecology, shall establish a schedule of periodicity which

17 reflects the general, appropriate frequency with which

18 services listed in subsection (a) should be provided to preg19 nant women without complications of pregnancy.

20 ‘‘SEC. 2113. EXCLUSIONS.

21 ‘‘(a) IN GENERAL.—Except as provided in sub22 sections (b) and (c), section 1862 shall apply to expenses

23 incurred for items and services provided under this title

24 the same manner as such section applies to items and

25 services provided under title XVIII.

26 ‘‘(b) BENEFITS EXCEPTION.—
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1 ‘‘(1) CHILDREN’S SERVICES.—In applying sec2 tion 1862(a) with respect to services described in

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

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

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

6 are provided in accordance with the periodicity

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

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

9 applying section 1862(a) with respect to services de10 scribed in section 2112(a) (other than paragraph (2)

11 thereof), payment shall not be denied under para12 graph (1) or (7) of such section 1862(a) if the serv13 ices are provided in accordance with the periodicity

14 schedule described in section 2112(b).

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

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

17 the extent that payment for such benefits may be made

18 under title XVIII.

19 ‘‘PART C—PAYMENT FOR BENEFITS AND FINANCING

20 ‘‘SEC. 2121. PAYMENTS FOR BENEFITS.

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

22 this section—

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

24 respect to benefits shall be made in the same

25 amounts and on the same basis as payment may be
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1 made with respect to such benefits under title

2 XVIII, and

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

4 1842, 1848, and 1886 shall apply to payment of

5 benefits under this title in the same manner as they

6 apply to benefits under title XVIII.

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

8 No deductibles, coinsurance, copayments, or other cost9 sharing shall be imposed with respect to—

10 ‘‘(1) well-child care services described in section

11 2111(b)(1), and

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

13 is entitled under this title as a pregnant woman.

14 ‘‘(c) ADJUSTMENT OF PAYMENTS.—

15 ‘‘(1) ESTABLISHMENT OF NEW DRGS AND

16 WEIGHTS.—In making payment under this title with

17 respect to inpatient hospital services, the Secretary

18 shall make such adjustments in the diagnosis-related

19 groups and weighting factors with respect to dis20 charges within such groups, otherwise established

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

22 ‘‘(A) to reflect the types of discharges oc23 curring under this title which are not occurring

24 under title XVIII, and
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1 ‘‘(B) to provide for a weighting factor, for

2 cesarean section deliveries, which is 95 percent

3 of the weighting factor that otherwise would be

4 established.

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

6 ‘‘(A) GLOBAL FEE.—In making payment

7 under this title with respect to the group of ob8 stetrical services typical of treatment through9 out a course of pregnancy, the Secretary shall

10 establish, as a schedule under section 1848, a

11 global fee with respect to such group of serv12 ices.

13 ‘‘(B) BONUS FOR EARLY PRESEN14 TATION.—The fee schedule amount with respect

15 to obstetrical services under this title shall be

16 increased by 5 percent in the case of services

17 furnished to women who have presented for pre18 natal care during the first trimester.

19 ‘‘(C) DISINCENTIVE FOR CESAREAN SEC20 TIONS.—The fee schedule amount otherwise es21 tablished with respect to a cesarean section

22 shall be 95 percent of the fee schedule amount

23 otherwise established.

24 ‘‘(c) CONDITIONS OF AND LIMITATIONS ON PAY25 MENTS.—The provisions of sections 1814 and 1835 shall
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1 apply to payment for services under this title in the same

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

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

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

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

6 be treated as a reference to the Children Health Insurance

7 Trust Fund established under section 2122.

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

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

10 on the books of the Treasury of the United States a trust

11 fund to be known as the ‘Children Health Insurance Trust

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

13 The Trust Fund shall consist of such gifts and bequests

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

15 amounts appropriated under paragraph (2).

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

17 Fund amounts equivalent to 100 percent of the premium

18 taxes imposed by section 59B of the Internal Revenue

19 Code of 1986, and such additional amounts as the Con20 gress provides. The amounts appropriated by the preced21 ing sentence in relation to premium taxes shall be trans22 ferred from time to time from the general fund in the

23 Treasury to the Trust Fund, such amounts to be deter24 mined on the basis of estimates by the Secretary of the
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1 Treasury of the taxes, paid to or deposited into the Treas2 ury; and proper adjustments shall be made in amounts

3 subsequently transferred to the extent prior estimates

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

5 such sentence.

6 ‘‘(b) INCORPORATION OF PROVISIONS.—

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

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

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

10 Fund in the same manner as they apply to the Fed11 eral Hospital Insurance Trust Fund.

12 ‘‘(2) EXCEPTIONS.—In applying paragraph

13 (1)—

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

15 Trustee of the Trust Fund shall be composed of

16 the members of the Board of Trustees and the

17 Managing Trustee, respectively, of the Federal

18 Hospital Insurance Trust Fund; and

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

20 Federal Hospital Insurance Trust Fund or to

21 title XVIII (or part A thereof) is deemed a ref22 erence to the Trust Fund under this section

23 and this title, respectively.
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1 ‘‘SEC. 2123. APPLICABLE TITLE XXI PREMIUM.

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

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

4 each year (beginning with 1998), determine a title XXI

5 applicable premium for months in the succeeding calendar

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

7 amount as the Secretary estimates so that—

8 ‘‘(1) 12 times the product of such amount and

9 the average number of families with individuals enti10 tled to benefits under section 2101 in any month in

11 the year, is equal to

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

13 costs which the Secretary estimates will be payable

14 from the Children Health Insurance Trust Fund for

15 services performed and related administrative costs

16 incurred in such year.

17 In calculating the amount under paragraph (2), the Sec18 retary shall include an appropriate amount for a contin19 gency margin.

20 ‘‘PART D—GENERAL PROVISIONS

21 ‘‘SEC. 2131. INCORPORATION OF CERTAIN MEDICARE PRO22 VISIONS.

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

24 Secretary shall provide for the administration of this title

25 through the use of fiscal intermediaries and carriers in
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1 the same manner as title XVIII is carried out through

2 the use of such fiscal intermediaries and carriers.

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

4 this title, the definitions contained in section 1861 shall

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

6 apply for purposes of title XVIII.

7 ‘‘(c) CERTIFICATION, PROVIDER QUALIFICATION,

8 ETC.—The provisions of sections 1863 through 1875, sec9 tions 1878 through 1880, section 1883, section 1885, and

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

11 same manner as they apply to title XVIII.

12 ‘‘(d) HEALTH MAINTENANCE ORGANIZATIONS AND

13 COMPETITIVE MEDICAL PLANS.—

14 ‘‘(1) IN GENERAL.—Except as provided in this

15 subsection, section 1876 shall apply to individuals

16 entitled to benefits under this title in the same man17 ner as such section applies to individuals entitled to

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

19 title XVIII.

20 ‘‘(2) LIMITATION TO REASONABLE COST REIM21 BURSEMENT CONTRACTS FOR PREGNANT WOMEN.—

22 ‘‘(A) IN GENERAL.—The provisions of sec23 tion 1876 relating only to risk-sharing contracts

24 (and not to reasonable cost reimbursement con25 tracts) shall not apply to individuals entitled to
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1 benefits under this title only as pregnant

2 women.

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

4 1997, the Secretary shall submit to the Con5 gress a report concerning recommendations on

6 how the provisions of section 1876 relating to

7 risk-sharing contracts may be adapted to apply

8 to benefits provided under this title to pregnant

9 women.

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

11 under this section—

12 ‘‘(A) the provisions of such section relating

13 only to individuals enrolled under part B of title

14 XVIII shall not apply;

15 ‘‘(B) any reference to a Trust Fund estab16 lished under title XVIII and to benefits under

17 such title is deemed a reference to the Children

18 Health Insurance Trust Fund and to benefits

19 under this title;

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

21 and the adjusted community rate shall be deter22 mined on the basis of benefits under this title;

23 and

24 ‘‘(D) subsection (f) shall not apply.
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1 ‘‘SEC. 2132. INCORPORATION OF PEER REVIEW PROVISIONS

2 AND FRAUD AND ABUSE PROVISIONS.

3 ‘‘The provisions of sections 1121 through 1126, sec4 tions 1128 through 1128B, section 1134, section 1138,

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

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

7 (b) CONFORMING AMENDMENTS.—

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

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

10 ‘‘and the Federal Supplementary Medical Insurance

11 Trust Fund’’ and inserting ‘‘, Federal Supple12 mentary Medical Insurance Trust Fund, and the

13 Children Health Insurance Trust Fund’’.

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

15 401(i)(1)) is amended by striking ‘‘and the Federal

16 Supplementary Medical Insurance Trust Fund’’ and

17 inserting ‘‘, Federal Supplementary Medical Insur18 ance Trust Fund, and the Children Health Insur19 ance Trust Fund’’.

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

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

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

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

24 furnished before January 1, 1999.
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1 SEC. 3. PREMIUM FOR COVERAGE OF UNINSURED CHIL2 DREN AND MOTHERS-TO-BE.

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

4 the Internal Revenue Code of 1986 (relating to determina5 tion of tax liability) is amended by adding at the end the

6 following new part:

7 ‘‘PART VIII—PREMIUM FOR COVERAGE OF

8 UNINSURED CHILDREN AND MOTHERS-TO-BE

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

mothers-to-be.

9 ‘‘SEC. 59B. PREMIUM FOR COVERAGE OF UNINSURED CHIL10 DREN AND MOTHERS-TO-BE.

11 ‘‘(a) IMPOSITION OF TAX.—In the case of an individ12 ual, there is hereby imposed (in addition to any other tax

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

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

15 of such individual for such taxable year.

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

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

18 subsection (a) on any taxpayer whose modified ad19 justed gross income for the taxable year does not ex20 ceed the threshold amount.

21 ‘‘(2) PHASE-IN OF TAX.—

22 ‘‘(A) IN GENERAL.—If the modified ad23 justed gross income of the taxpayer for the tax24 able year exceeds the threshold amount by less
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1 than $10,000, the amount of the tax imposed

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

3 the phase-in percentage of the title XXI pre4 mium liability of such taxpayer for such taxable

5 year.

6 ‘‘(B) PHASE-IN PERCENTAGE.—For pur7 poses of subparagraph (A), the phase-in per8 centage shall be determined under tables pre9 scribed by the Secretary which—

10 ‘‘(i) shall have income brackets of not

11 more than $50, and

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

13 the amount of tax imposed by subsection

14 (a) for modified adjusted gross incomes be15 tween the threshold amount and the sum

16 of the threshold amount and $10,000.

17 ‘‘(c) TITLE XXI PREMIUM LIABILITY.—For pur18 poses of this section—

19 ‘‘(1) IN GENERAL.—The title XXI premium li20 ability of any individual for any taxable year is the

21 sum of—

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

23 each month of the taxable year as of the first

24 day of which any dependent of the individual is
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1 a title XXI covered individual who has not at2 tained age 13, and

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

4 the month of the taxable year during which the

5 taxpayer (or spouse of the taxpayer) gives birth

6 to any child if for such month the individual

7 giving birth is a title XXI covered individual.

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

9 term ‘applicable title XXI premium’ means, with re10 spect to a month, such premium as determined

11 under section 2123 of the Social Security Act for

12 that month.

13 ‘‘(d) TITLE XXI COVERED INDIVIDUAL.—For pur14 poses of this section—

15 ‘‘(1) IN GENERAL.—A dependent shall be treat16 ed as a title XXI covered individual for any month

17 unless—

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

19 covered under a qualified health plan, and

20 ‘‘(B) the taxpayer furnishes to the Sec21 retary (at such time and in such manner as the

22 Secretary may prescribe) the required certifi23 cation of such coverage for such month.

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

25 in which such woman gives birth to a child.
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1 ‘‘(2) QUALIFIED HEALTH PLAN.—The term

2 ‘qualified health plan’ means a plan of health insur3 ance or coverage, an employee welfare benefit plan

4 that provides health benefits, or other plan (other

5 than under title XXI of the Social Security Act)

6 under Federal or State law that provides coverage of

7 benefits which the Secretary of Health and Human

8 Services determines is substantially equivalent to the

9 coverage of benefits provided under title XXI of the

10 Social Security Act.

11 ‘‘(e) OTHER DEFINITIONS AND SPECIAL RULES.—

12 For purposes of this section—

13 ‘‘(1) THRESHOLD AMOUNT.—

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

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

16 means—

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

18 with respect to which 3 or fewer personal

19 exemptions are allowable under section

20 151, and

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

22 with respect to which 4 or more personal

23 exemptions are allowable under section

24 151.
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1 ‘‘(B) CERTAIN SEPARATE RETURNS.—The

2 threshold amount shall be zero in the case of a

3 taxpayer who—

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

5 taxable year but does not file a joint return

6 for such taxable year, and

7 ‘‘(ii) does not live apart from his

8 spouse at all times during the last 6

9 months of the taxable year.

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

11 case of a taxable year beginning in a calendar

12 year after 1999, each dollar amount contained

13 in subparagraph (A) shall be increased by an

14 amount equal to—

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

16 ‘‘(ii) the cost-of-living adjustment de17 termined under section 1(f)(3) for the cal18 endar year in which the taxable year be19 gins, by substituting ‘calendar year 1998’

20 for ‘calendar year 1992’ in subparagraph

21 (B) thereof.

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

23 The term ‘modified adjusted gross income’ means

24 adjusted gross income—
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1 ‘‘(A) determined without regard to sections

2 911, 931, and 933, and

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

4 received or accrued by the individual during the

5 taxable year which is exempt from tax.

6 The determination under the preceding sentence

7 shall be made without regard to any carryover or

8 carryback.

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

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

11 any individual if an exemption is allowable under

12 section 151(c) with respect to such individual to the

13 taxpayer for a taxable year beginning in such cal14 endar year.

15 ‘‘(4) REQUIRED CERTIFICATION.—The term ‘re16 quired certification’ means the statement required to

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

18 thereof) or any other statement approved by the

19 Secretary for purposes of this section.

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

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

22 purposes of section 213, the tax imposed by this sec23 tion for any taxable year shall be treated as an ex24 pense paid during such taxable year for medical care

25 of the taxpayer.
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1 ‘‘(2) NOT TREATED AS TAX FOR CERTAIN PUR2 POSES.—The tax imposed by this section shall not

3 be treated as a tax imposed by this chapter for pur4 poses of determining—

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

6 under this chapter, or

7 ‘‘(B) the amount of the minimum tax im8 posed by section 55.

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

10 purposes of subtitle F, the tax imposed by this sec11 tion shall be treated as if it were a tax imposed by

12 section 1.

13 ‘‘(g) EXEMPTIONS.—

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

15 this section on any individual for any taxable year

16 if such individual is a nonresident alien.

17 ‘‘(2) CERTAIN INDIVIDUALS NOT TAKEN INTO

18 ACCOUNT IN DETERMINING AMOUNT OF TAX.—For

19 purposes of this section, an individual shall be treat20 ed as not being a title XXI covered individual for

21 any month if—

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

23 individual as of the first day of such month is

24 outside the United States, or
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1 ‘‘(B) as of the first day of such month,

2 there is in effect for such individual a qualified

3 religious exemption.

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

5 purposes of paragraph (2)—

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

7 religious exemption’ means an exemption grant8 ed by the Secretary of Health and Human

9 Services to an individual—

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

11 religious sect or division thereof with re12 spect to which such Secretary makes the

13 findings referred to in subparagraphs (C),

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

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

16 tenets or teachings of such sect or division

17 as described in such section, and

18 ‘‘(iii) who submits an application for

19 such exemption which contains or is ac20 companied by the evidence described in

21 section 1402(g)(1)(A) and a waiver de22 scribed in section 1402(g)(1)(B).

23 For purposes of the clause (iii), section

24 1402(g)(1)(B) shall be treated as including a
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1 reference to title XXI of the Social Security

2 Act.

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

4 under this paragraph shall cease to apply begin5 ning on the date such Secretary determines

6 that the individual, or the sect or division,

7 ceased to meet the requirements of subpara8 graph (A).

9 ‘‘(4) SPECIAL RULE FOR INDIVIDUALS RESID10 ING ABROAD WHO RECEIVE TITLE XXI SERVICES.—

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

12 for any taxable year if, at any time during such tax13 able year, such individual receives services under

14 title XXI of the Social Security Act.

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

16 such regulations as may be appropriate to carry out the

17 purposes of this section, including regulations, prescribed

18 after consultation with the Secretary of Health and

19 Human Services, treating health plans of foreign govern20 ments or foreign employers outside the United States as

21 qualified health plans.’’

22 (b) TECHNICAL AMENDMENTS.—

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

24 is amended by inserting after paragraph (9) the fol25 lowing new paragraph:
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1 ‘‘(10) Every individual who has a title XXI pre2 mium liability (as defined in section 59B) for the

3 taxable year.’’

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

5 Code is amended by inserting ‘‘section

6 59B(e)(1)(C),’’ after paragraph (2)(A),’’.

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

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

9 end the following new item:

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

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

11 this section shall apply to months beginning after Decem12 ber 31, 1998, in taxable years ending after such date.

13 SEC. 4. REPORTING REQUIREMENTS.

14 (a) IN GENERAL.—Subpart B of part III of sub15 chapter A of chapter 61 of the Internal Revenue Code of

16 1986 (relating to information concerning transactions

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

18 new sections:

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

20 PLANS.

21 ‘‘(a) REQUIREMENT OF REPORTING.—The adminis22 trator of any qualified health plan (as defined in section

23 59B(d)) shall make a return for each calendar year setting

24 forth—
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1 ‘‘(1) the name and TIN of each individual cov2 ered under such plan or program at any time during

3 such taxable year as a primary insured or as the

4 spouse of a primary insured,

5 ‘‘(2) the name and TIN (to the extent avail6 able) of each individual covered under such plan or

7 program at any time during such taxable year as a

8 dependent (as defined in section 59B(e)(3)) of a pri9 mary insured, and

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

11 which such individuals were so covered.

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

13 as the Secretary may by regulations prescribe.

14 ‘‘(b) STATEMENTS TO PRIMARY INSURED INDIVID15 UALS.—Every administrator required to make a return

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

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

18 of being a primary insured a written statement showing—

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

20 the address of its administrator, and

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

22 the return with respect to such primary insured.
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1 The written statement required under the preceding sen2 tence shall be furnished to the person on or before Janu3 ary 31 of the year following the calendar year for which

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

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

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

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

8 the spouse or a dependent (as defined in section

9 59B(e)(3)) of a primary insured who is required to receive

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

11 such administrator shall furnish to such individual a copy

12 of such statement with respect to such insured for such

13 calendar year.’’

14 (b) UNIFORM PENALTY PROVISIONS MADE APPLICA15 BLE.—

16 (1) Subparagraph (B) of section 6724(d)(1) of

17 such Code is amended by inserting after the item re18 lating to clause (viii) the following new item (and re19 designating the following clauses accordingly):

20 ‘‘(ix) section 6050Q(a) (relating to re21 turns regarding qualified health plans),’’.

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

23 Code is amended by inserting after subparagraph

24 (P) the following new subparagraph (and by redesig25 nating the following subparagraphs accordingly):
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1 ‘‘(Q) subsection (b) or (c) of section

2 6050Q (relating to returns regarding qualified

3 health plans),’’.

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

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

6 of such Code is amended by adding at the end the follow7 ing new item:

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

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

9 this section shall apply to calendar years after 1998.

Æ