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II of the Domestic Volunteer Service Act of 1973 shall be
used to provide stipends or other monetary incentives to vol-
unteers or volunteer leaders whose incomes exceed 125 per-
cent of the national poverty level.
CORPORATION FOR PUBLIC BROADCASTING
For payment to the Corporation for Public Broad-
casting, as authorized by the Communications Act of 1934,
an amount which shall be available within limitations spec-
ified by that Act, for the fiscal year 2003, $365,000,000:
Provided, That no funds made available to the Corporation
for Public Broadcasting by this Act shall be used to pay
for receptions, parties, or similar forms of entertainment
for Government officials or employees: Provided further,
That none of the funds contained in this paragraph shall
be available or used to aid or support any program or activ-
ity from which any person is excluded, or is denied benefits,
or is discriminated against, on the basis of race, color, na-
tional origin, religion, or sex: Provided further, That in ad-
dition to the amounts provided above, $20,000,000, to re-
main available until expended, shall be for digitalization,
pending enactment of authorizing legislation.
FEDERAL MEDIATION AND CONCILIATION SERVICE
SALARIES AND EXPENSES
For expenses necessary for the Federal Mediation and
Conciliation Service to carry out the functions vested in
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it by the Labor Management Relations Act, 1947 (29 U.S.C.
171–180, 182–183), including hire of passenger motor vehi-
cles; for expenses necessary for the Labor-Management Co-
operation Act of 1978 (29 U.S.C. 175a); and for expenses
necessary for the Service to carry out the functions vested
in it by the Civil Service Reform Act, Public Law 95–454
(5 U.S.C. ch. 71), $38,200,000, including $1,500,000, to re-
main available through September 30, 2002, for activities
authorized by the Labor-Management Cooperation Act of
1978 (29 U.S.C. 175a): Provided, That notwithstanding 31
U.S.C. 3302, fees charged, up to full-cost recovery, for spe-
cial training activities and other conflict resolution services
and technical assistance, including those provided to foreign
governments and international organizations, and for arbi-
tration services shall be credited to and merged with this
account, and shall remain available until expended: Pro-
vided further, That fees for arbitration services shall be
available only for education, training, and professional de-
velopment of the agency workforce: Provided further, That
the Director of the Service is authorized to accept and use
on behalf of the United States gifts of services and real, per-
sonal, or other property in the aid of any projects or func-
tions within the Director’s jurisdiction.
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FEDERAL MINE SAFETY AND HEALTH REVIEW
COMMISSION
SALARIES AND EXPENSES
For expenses necessary for the Federal Mine Safety
and Health Review Commission (30 U.S.C. 801 et seq.),
$6,320,000.
INSTITUTE OF MUSEUM AND LIBRARY SERVICES
OFFICE OF LIBRARY SERVICES: GRANTS AND
ADMINISTRATION
For carrying out subtitle B of the Museum and Li-
brary Services Act, $168,000,000, to remain available until
expended.
MEDICARE PAYMENT ADVISORY COMMISSION
SALARIES AND EXPENSES
For expenses necessary to carry out section 1805 of the
Social Security Act, $8,000,000, to be transferred to this
appropriation from the Federal Hospital Insurance and the
Federal Supplementary Medical Insurance Trust Funds.
NATIONAL COMMISSION ON LIBRARIES AND INFORMATION
SCIENCE
SALARIES AND EXPENSES
For necessary expenses for the National Commission
on Libraries and Information Science, established by the
Act of July 20, 1970 (Public Law 91–345, as amended),
$1,495,000.
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NATIONAL COUNCIL ON DISABILITY
SALARIES AND EXPENSES
For expenses necessary for the National Council on
Disability as authorized by title IV of the Rehabilitation
Act of 1973, as amended, $2,615,000.
NATIONAL EDUCATION GOALS PANEL
For expenses necessary for the National Education
Goals Panel, as authorized by title II, part A of the Goals
2000: Educate America Act, $2,350,000.
NATIONAL LABOR RELATIONS BOARD
SALARIES AND EXPENSES
For expenses necessary for the National Labor Rela-
tions Board to carry out the functions vested in it by the
Labor-Management Relations Act, 1947, as amended (29
U.S.C. 141–167), and other laws, $216,438,000: Provided,
That no part of this appropriation shall be available to or-
ganize or assist in organizing agricultural laborers or used
in connection with investigations, hearings, directives, or
orders concerning bargaining units composed of agricul-
tural laborers as referred to in section 2(3) of the Act of
July 5, 1935 (29 U.S.C. 152), and as amended by the
Labor-Management Relations Act, 1947, as amended, and
as defined in section 3(f) of the Act of June 25, 1938 (29
U.S.C. 203), and including in said definition employees en-
gaged in the maintenance and operation of ditches, canals,
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reservoirs, and waterways when maintained or operated on
a mutual, nonprofit basis and at least 95 percent of the
water stored or supplied thereby is used for farming pur-
poses.
NATIONAL MEDIATION BOARD
SALARIES AND EXPENSES
For expenses necessary to carry out the provisions of
the Railway Labor Act, as amended (45 U.S.C. 151–188),
including emergency boards appointed by the President,
$10,400,000.
OCCUPATIONAL SAFETY AND HEALTH REVIEW
COMMISSION
SALARIES AND EXPENSES
For expenses necessary for the Occupational Safety
and Health Review Commission (29 U.S.C. 661),
$8,720,000.
RAILROAD RETIREMENT BOARD
DUAL BENEFITS PAYMENTS ACCOUNT
For payment to the Dual Benefits Payments Account,
authorized under section 15(d) of the Railroad Retirement
Act of 1974, $160,000,000, which shall include amounts be-
coming available in fiscal year 2001 pursuant to section
224(c)(1)(B) of Public Law 98–76; and in addition, an
amount, not to exceed 2 percent of the amount provided
herein, shall be available proportional to the amount by
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which the product of recipients and the average benefit re-
ceived exceeds $160,000,000: Provided, That the total
amount provided herein shall be credited in 12 approxi-
mately equal amounts on the first day of each month in
the fiscal year.
FEDERAL PAYMENTS TO THE RAILROAD RETIREMENT
ACCOUNTS
For payment to the accounts established in the Treas-
ury for the payment of benefits under the Railroad Retire-
ment Act for interest earned on unnegotiated checks,
$150,000, to remain available through September 30, 2002,
which shall be the maximum amount available for payment
pursuant to section 417 of Public Law 98–76.
LIMITATION ON ADMINISTRATION
For necessary expenses for the Railroad Retirement
Board for administration of the Railroad Retirement Act
and 
the 
Railroad 
Unemployment 
Insurance 
Act,
$92,500,000, to be derived in such amounts as determined
by the Board from the railroad retirement accounts and
from moneys credited to the railroad unemployment insur-
ance administration fund.
LIMITATION ON THE OFFICE OF INSPECTOR GENERAL
For expenses necessary for the Office of Inspector Gen-
eral for audit, investigatory and review activities, as au-
thorized by the Inspector General Act of 1978, as amended,
not more than $5,700,000, to be derived from the railroad
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retirement accounts and railroad unemployment insurance
account: Provided, That none of the funds made available
in any other paragraph of this Act may be transferred to
the Office; used to carry out any such transfer; used to pro-
vide any office space, equipment, office supplies, commu-
nications facilities or services, maintenance services, or ad-
ministrative services for the Office; used to pay any salary,
benefit, or award for any personnel of the Office; used to
pay any other operating expense of the Office; or used to
reimburse the Office for any service provided, or expense
incurred, by the Office.
SOCIAL SECURITY ADMINISTRATION
PAYMENTS TO SOCIAL SECURITY TRUST FUNDS
For payment to the Federal Old-Age and Survivors In-
surance and the Federal Disability Insurance trust funds,
as provided under sections 201(m), 228(g), and 1131(b)(2)
of the Social Security Act, $20,400,000.
SPECIAL BENEFITS FOR DISABLED COAL MINERS
For carrying out title IV of the Federal Mine Safety
and Health Act of 1977, $365,748,000, to remain available
until expended.
For making, after July 31 of the current fiscal year,
benefit payments to individuals under title IV of the Fed-
eral Mine Safety and Health Act of 1977, for costs incurred
in the current fiscal year, such amounts as may be nec-
essary.
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For making benefit payments under title IV of the Fed-
eral Mine Safety and Health Act of 1977 for the first quar-
ter of fiscal year 2002, $114,000,000, to remain available
until expended.
SUPPLEMENTAL SECURITY INCOME PROGRAM
For carrying out titles XI and XVI of the Social Secu-
rity Act, section 401 of Public Law 92–603, section 212
of Public Law 93–66, as amended, and section 405 of Public
Law 95–216, including payment to the Social Security
trust funds for administrative expenses incurred pursuant
to 
section 
201(g)(1) 
of 
the 
Social 
Security 
Act,
$23,053,000,000, to remain available until expended: Pro-
vided, That any portion of the funds provided to a State
in the current fiscal year and not obligated by the State
during that year shall be returned to the Treasury.
From funds provided under the previous paragraph,
not less than $100,000,000 shall be available for payment
to the Social Security trust funds for administrative ex-
penses for conducting continuing disability reviews.
In addition, $210,000,000, to remain available until
September 30, 2002, for payment to the Social Security
trust funds for administrative expenses for continuing dis-
ability reviews as authorized by section 103 of Public Law
104–121 and section 10203 of Public Law 105–33. The term
‘‘continuing disability reviews’’ means reviews and redeter-
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minations as defined under section 201(g)(1)(A) of the So-
cial Security Act, as amended.
For making, after June 15 of the current fiscal year,
benefit payments to individuals under title XVI of the So-
cial Security Act, for unanticipated costs incurred for the
current fiscal year, such sums as may be necessary.
For making benefit payments under title XVI of the
Social Security Act for the first quarter of fiscal year 2002,
$10,470,000,000, to remain available until expended.
LIMITATION ON ADMINISTRATIVE EXPENSES
For necessary expenses, including the hire of two pas-
senger motor vehicles, and not to exceed $10,000 for official
reception and representation expenses, not more than
$6,469,800,000 may be expended, as authorized by section
201(g)(1) of the Social Security Act, from any one or all
of the trust funds referred to therein: Provided, That not
less than $1,800,000 shall be for the Social Security Advi-
sory Board: Provided further, That unobligated balances at
the end of fiscal year 2001 not needed for fiscal year 2001
shall remain available until expended to invest in the So-
cial Security Administration information technology and
telecommunications hardware and software infrastructure,
including related equipment and non-payroll administra-
tive expenses
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From funds provided under the first paragraph, not
less than $200,000,000 shall be available for conducting
continuing disability reviews.
In addition to funding already available under this
heading, and subject to the same terms and conditions,
$450,000,000, to remain available until September 30,
2002, for continuing disability reviews as authorized by sec-
tion 103 of Public Law 104–121 and section 10203 of Pub-
lic Law 105–33. The term ‘‘continuing disability reviews’’
means reviews and redeterminations as defined under sec-
tion 201(g)(1)(A) of the Social Security Act, as amended.
In addition, $91,000,000 to be derived from adminis-
tration fees in excess of $5.00 per supplementary payment
collected pursuant to section 1616(d) of the Social Security
Act or section 212(b)(3) of Public Law 93–66, which shall
remain available until expended. To the extent that the
amounts collected pursuant to such section 1616(d) or
212(b)(3) in fiscal year 2001 exceed $91,000,000, the
amounts shall be available in fiscal year 2002 only to the
extent provided in advance in appropriations Acts.
From funds previously appropriated for this purpose,
any unobligated balances at the end of fiscal year 2000 shall
be available to continue Federal-State partnerships which
will evaluate means to promote Medicare buy-in programs
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targeted to elderly and disabled individuals under titles
XVIII and XIX of the Social Security Act.
OFFICE OF INSPECTOR GENERAL
(INCLUDING TRANSFER OF FUNDS)
For expenses necessary for the Office of Inspector Gen-
eral in carrying out the provisions of the Inspector General
Act of 1978, as amended, $16,944,000, together with not to
exceed $52,500,000, to be transferred and expended as au-
thorized by section 201(g)(1) of the Social Security Act from
the Federal Old-Age and Survivors Insurance Trust Fund
and the Federal Disability Insurance Trust Fund.
In addition, an amount not to exceed 3 percent of the
total provided in this appropriation may be transferred
from the ‘‘Limitation on Administrative Expenses’’, Social
Security Administration, to be merged with this account,
to be available for the time and purposes for which this
account is available: Provided, That notice of such transfers
shall be transmitted promptly to the Committees on Appro-
priations of the House and Senate.
UNITED STATES INSTITUTE OF PEACE
OPERATING EXPENSES
For necessary expenses of the United States Institute
of Peace as authorized in the United States Institute of
Peace Act, $12,951,000.
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TITLE V—GENERAL PROVISIONS
SEC. 501. The Secretaries of Labor, Health and
Human Services, and Education are authorized to transfer
unexpended balances of prior appropriations to accounts
corresponding to current appropriations provided in this
Act: Provided, That such transferred balances are used for
the same purpose, and for the same periods of time, for
which they were originally appropriated.
SEC. 502. No part of any appropriation contained in
this Act shall remain available for obligation beyond the
current fiscal year unless expressly so provided herein.
SEC. 503. (a) No part of any appropriation contained
in this Act shall be used, other than for normal and recog-
nized executive-legislative relationships, for publicity or
propaganda purposes, for the preparation, distribution, or
use of any kit, pamphlet, booklet, publication, radio, tele-
vision, or video presentation designed to support or defeat
legislation pending before the Congress or any State legisla-
ture, except in presentation to the Congress or any State
legislature itself.
(b) No part of any appropriation contained in this
Act shall be used to pay the salary or expenses of any grant
or contract recipient, or agent acting for such recipient, re-
lated to any activity designed to influence legislation or ap-
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propriations pending before the Congress or any State legis-
lature.
SEC. 504. The Secretaries of Labor and Education are
authorized to make available not to exceed $20,000 and
$15,000, respectively, from funds available for salaries and
expenses under titles I and III, respectively, for official re-
ception and representation expenses; the Director of the
Federal Mediation and Conciliation Service is authorized
to make available for official reception and representation
expenses not to exceed $2,500 from the funds available for
‘‘Salaries and expenses, Federal Mediation and Concilia-
tion Service’’; and the Chairman of the National Mediation
Board is authorized to make available for official reception
and representation expenses not to exceed $2,500 from funds
available for ‘‘Salaries and expenses, National Mediation
Board’’.
SEC. 505. Notwithstanding any other provision of this
Act, no funds appropriated under this Act shall be used to
carry out any program of distributing sterile needles or sy-
ringes for the hypodermic injection of any illegal drug un-
less the Secretary of Health and Human Services deter-
mines that such programs are effective in preventing the
spread of HIV and do not encourage the use of illegal drugs.
SEC. 506. (a) PURCHASE OF AMERICAN-MADE EQUIP-
MENT AND PRODUCTS.—It is the sense of the Congress that,
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to the greatest extent practicable, all equipment and prod-
ucts purchased with funds made available in this Act should
be American-made.
(b) NOTICE REQUIREMENT.—In providing financial
assistance to, or entering into any contract with, any entity
using funds made available in this Act, the head of each
Federal agency, to the greatest extent practicable, shall pro-
vide to such entity a notice describing the statement made
in subsection (a) by the Congress.
(c) PROHIBITION
OF CONTRACTS WITH PERSONS
FALSELY LABELING PRODUCTS AS MADE IN AMERICA.—
If it has been finally determined by a court or Federal agen-
cy that any person intentionally affixed a label bearing a
‘‘Made in America’’ inscription, or any inscription with
the same meaning, to any product sold in or shipped to
the United States that is not made in the United States,
the person shall be ineligible to receive any contract or sub-
contract made with funds made available in this Act, pur-
suant to the debarment, suspension, and ineligibility proce-
dures described in sections 9.400 through 9.409 of title 48,
Code of Federal Regulations.
SEC. 507. When issuing statements, press releases, re-
quests for proposals, bid solicitations and other documents
describing projects or programs funded in whole or in part
with Federal money, all grantees receiving Federal funds
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included in this Act, including but not limited to State and
local governments and recipients of Federal research grants,
shall clearly state: (1) the percentage of the total costs of
the program or project which will be financed with Federal
money; (2) the dollar amount of Federal funds for the
project or program; and (3) percentage and dollar amount
of the total costs of the project or program that will be fi-
nanced by non-governmental sources.
SEC. 508. (a) None of the funds appropriated under
this Act, and none of the funds in any trust fund to which
funds are appropriated under this Act, shall be expended
for any abortion.
(b) None of the funds appropriated under this Act, and
none of the funds in any trust fund to which funds are
appropriated under this Act, shall be expended for health
benefits coverage that includes coverage of abortion.
(c) The term ‘‘health benefits coverage’’ means the
package of services covered by a managed care provider or
organization pursuant to a contract or other arrangement.
SEC. 509. (a) The limitations established in the pre-
ceding section shall not apply to an abortion—
(1) if the pregnancy is the result of an act of
rape or incest; or
(2) in the case where a woman suffers from a
physical disorder, physical injury, or physical illness,
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including a life-endangering physical condition
caused by or arising from the pregnancy itself, that
would, as certified by a physician, place the woman
in danger of death unless an abortion is performed.
(b) Nothing in the preceding section shall be construed
as prohibiting the expenditure by a State, locality, entity,
or private person of State, local, or private funds (other
than a State’s or locality’s contribution of Medicaid match-
ing funds).
(c) Nothing in the preceding section shall be construed
as restricting the ability of any managed care provider
from offering abortion coverage or the ability of a State or
locality to contract separately with such a provider for such
coverage with State funds (other than a State’s or locality’s
contribution of Medicaid matching funds).
SEC. 510. (a) None of the funds made available in this
Act may be used for—
(1) the creation of a human embryo or embryos
for research purposes; or
(2) research in which a human embryo or em-
bryos are destroyed, discarded, or knowingly subjected
to risk of injury or death greater than that allowed
for research on fetuses in utero under 45 CFR
46.208(a)(2) and section 498(b) of the Public Health
Service Act (42 U.S.C. 289g(b)).
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(b) For purposes of this section, the term ‘‘human em-
bryo or embryos’’ includes any organism, not protected as
a human subject under 45 CFR 46 as of the date of the
enactment of this Act, that is derived by fertilization, par-
thenogenesis, cloning, or any other means from one or more
human gametes or human diploid cells.
SEC. 511. (a) LIMITATION ON USE OF FUNDS FOR
PROMOTION
OF LEGALIZATION
OF CONTROLLED SUB-
STANCES.—None of the funds made available in this Act
may be used for any activity that promotes the legalization
of any drug or other substance included in schedule I of
the schedules of controlled substances established by section
202 of the Controlled Substances Act (21 U.S.C. 812).
(b) EXCEPTIONS.—The limitation in subsection (a)
shall not apply when there is significant medical evidence
of a therapeutic advantage to the use of such drug or other
substance or that federally sponsored clinical trials are
being conducted to determine therapeutic advantage.
SEC. 512. None of the funds made available in this
Act may be obligated or expended to enter into or renew
a contract with an entity if—
(1) such entity is otherwise a contractor with the
United States and is subject to the requirement in
section 4212(d) of title 38, United States Code, re-
garding submission of an annual report to the Sec-
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retary of Labor concerning employment of certain vet-
erans; and
(2) such entity has not submitted a report as re-
quired by that section for the most recent year for
which such requirement was applicable to such entity.
SEC. 513. Except as otherwise specifically provided by
law, unobligated balances remaining available at the end
of fiscal year 2000 from appropriations made available for
salaries and expenses for fiscal year 2000 in this Act, shall
remain available through December 31, 2001, for each such
account for the purposes authorized: Provided, That the
House and Senate Committees on Appropriations shall be
notified at least 15 days prior to the obligation of such
funds.
SEC. 514. None of the funds made available in this
Act may be used to promulgate or adopt any final standard
under section 1173(b) of the Social Security Act (42 U.S.C.
1320d–2(b)) providing for, or providing for the assignment
of, a unique health identifier for an individual (except in
an individual’s capacity as an employer or a health care
provider), until legislation is enacted specifically approving
the standard.
SEC. 515. Section 410(b) of The Ticket to Work and
Work Incentives Improvement Act of 1999 (Public Law
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106–170) is amended by striking ‘‘2009’’ both places it ap-
pears and inserting ‘‘2001’’.
SEC. 516. Amounts made available under this Act for
the administrative and related expenses for departmental
management for the Department of Labor, the Department
of Health and Human Services, and the Department of
Education shall be reduced on pro rata basis by
$50,000,000.
SEC. 517. (a) None of the funds appropriated under
this Act to carry out section 330 or title X of the Public
Health Service Act (42 U.S.C. 254b, 300 et seq.), title V
or XIX of the Social Security Act (42 U.S.C. 701 et seq.,
1396 et seq.), or any other provision of law, shall be used
for the distribution or provision of postcoital emergency
contraception, or the provision of a prescription for
postcoital emergency contraception, to an unemancipated
minor, on the premises or in the facilities of any elementary
school or secondary school.
(b) This section takes effect 1 day after the date of en-
actment of this Act.
(c) In this section:
(1) The terms ‘‘elementary school’’ and ‘‘sec-
ondary school’’ have the meanings given the terms in
section 14101 of the Elementary and Secondary Edu-
cation Act of 1965 (20 U.S.C. 8801).
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(2) The term ‘‘unemancipated minor’’ means an
unmarried individual who is 17 years of age or
younger and is a dependent, as defined in section
152(a) of the Internal Revenue Code of 1986.
SEC. 518. Title V of the Public Health Service Act (42
U.S.C. 290aa et seq.) is amended by adding at the end the
following:
‘‘PART G—REQUIREMENT RELATING TO THE
RIGHTS OF RESIDENTS OF CERTAIN FACILITIES
‘‘SEC. 581. REQUIREMENT RELATING TO THE RIGHTS OF
RESIDENTS OF CERTAIN FACILITIES.
‘‘(a) IN GENERAL.—A public or private general hos-
pital, nursing facility, intermediate care facility, residen-
tial treatment center, or other health care facility, that re-
ceives support in any form from any program supported
in whole or in part with funds appropriated to any Federal
department or agency shall protect and promote the rights
of each resident of the facility, including the right to be
free from physical or mental abuse, corporal punishment,
and any restraints or involuntary seclusions imposed for
purposes of discipline or convenience.
‘‘(b) REQUIREMENTS.—Restraints and seclusion may
only be imposed on a resident of a facility described in sub-
section (a) if—
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‘‘(1) the restraints or seclusion are imposed to
ensure the physical safety of the resident, a staff
member, or others; and
‘‘(2) the restraints or seclusion are imposed only
upon the written order of a physician, or other li-
censed independent practitioner permitted by the
State and the facility to order such restraint or seclu-
sion, that specifies the duration and circumstances
under which the restraints are to be used (except in
emergency circumstances specified by the Secretary
until such an order could reasonably be obtained).
‘‘(c) DEFINITIONS.—In this section:
‘‘(1) 
RESTRAINTS.—The 
term 
‘restraints’
means—
‘‘(A) any physical restraint that is a me-
chanical or personal restriction that immobilizes
or reduces the ability of an individual to move
his or her arms, legs, or head freely, not includ-
ing devices, such as orthopedically prescribed de-
vices, surgical dressings or bandages, protective
helmets, or any other methods that involves the
physical holding of a resident for the purpose of
conducting routine physical examinations or
tests or to protect the resident from falling out
of bed or to permit the resident to participate in
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activities without the risk of physical harm to
the resident; and
‘‘(B) a drug or medication that is used as
a restraint to control behavior or restrict the
resident’s freedom of movement that is not a
standard treatment for the resident’s medical or
psychiatric condition.
‘‘(2) SECLUSION.—The term ‘seclusion’ means
any separation of the resident from the general popu-
lation of the facility that prevents the resident from
returning to such population if he or she desires.
‘‘SEC. 582. REPORTING REQUIREMENT.
‘‘(a) IN GENERAL.— Each facility to which the Protec-
tion and Advocacy for Mentally Ill Individuals Act of 1986
applies shall notify the appropriate agency, as determined
by the Secretary, of each death that occurs at each such
facility while a patient is restrained or in seclusion, of each
death occurring within 24 hours after the patient has been
removed from restraints and seclusion, or where it is rea-
sonable to assume that a patient’s death is a result of such
seclusion or restraint. A notification under this section shall
include the name of the resident and shall be provided not
later than 7 days after the date of the death of the indi-
vidual involved.
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‘‘(b) FACILITY.—In this section, the term ‘facility’ has
the meaning given the term ‘facilities’ in section 102(3) of
the Protection and Advocacy for Mentally Ill Individuals
Act of 1986 (42 U.S.C. 10802(3)).’’.
‘‘SEC. 583. REGULATIONS AND ENFORCEMENT.
‘‘(a) TRAINING.—Not later than 1 year after the date
of enactment of this part, the Secretary, after consultation
with appropriate State and local protection and advocacy
organizations, physicians, facilities, and other health care
professionals and patients, shall promulgate regulations
that require facilities to which the Protection and Advocacy
for Mentally Ill Individuals Act of 1986 (42 U.S.C. 10801
et seq.) applies, to meet the requirements of subsection (b).
‘‘(b) REQUIREMENTS.—The regulations promulgated
under subsection (a) shall require that—
‘‘(1) facilities described in subsection (a) ensure
that there is an adequate number of qualified profes-
sional and supportive staff to evaluate patients, for-
mulate written individualized, comprehensive treat-
ment plans, and to provide active treatment meas-
ures;
‘‘(2) appropriate training be provided for the
staff of such facilities in the use of restraints and any
alternatives to the use of restraints; and
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‘‘(3) such facilities provide complete and accu-
rate notification of deaths, as required under section
582(a).
‘‘(c) ENFORCEMENT.—A facility to which this part ap-
plies that fails to comply with any requirement of this part,
including a failure to provide appropriate training, shall
not be eligible for participation in any program supported
in whole or in part by funds appropriated to any Federal
department or agency.’’.
SEC. 519. It is the sense of the Senate that each entity
carrying out an Early Head Start program under the Head
Start Act should—
(1) determine whether a child eligible to partici-
pate in the Early Head Start program has received
a blood lead screening test, using a test that is appro-
priate for age and risk factors, upon the enrollment
of the child in the program; and
(2) in the case of an child who has not received
such a blood lead screening test, ensure that each en-
rolled child receives such a test either by referral or
by performing the test (under contract or otherwise).
SEC. 520. (a) Whereas sexual abuse in schools between
a student and a member of the school staff or a student
and another student is a cause for concern in America;
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(b) Whereas relatively few studies have been conducted
on sexual abuse in schools and the extent of this problem
is unknown;
(c) Whereas according to the Child Abuse and Neglect
Reporting Act, a school administrator is required to report
any allegation of sexual abuse to the appropriate authori-
ties;
(d) Whereas an individual who is falsely accused of
sexual misconduct with a student deserves appropriate legal
and professional protections;
(e) Whereas it is estimated that many cases of sexual
abuse in schools are not reported;
(f) Whereas many of the accused staff quietly resign
at their present school district and are then rehired at a
new district which has no knowledge of their alleged abuse;
(g) Therefore, it is the Sense of the Senate that the
Secretary of Education should initiate a study and make
recommendations to Congress and State and local govern-
ments on the issue of sexual abuse in schools.
TITLE VI—CHILDREN’S INTERNET PROTECTION
SEC. 601. SHORT TITLE. This title may be cited as
the ‘‘Childrens’ Internet Protection Act’’.
SEC. 602. REQUIREMENT FOR SCHOOLS AND LIBRAR-
IES TO IMPLEMENT FILTERING OR BLOCKING TECHNOLOGY
FOR COMPUTERS WITH INTERNET ACCESS AS CONDITION
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OF UNIVERSAL SERVICE DISCOUNTS. (a) SCHOOLS.—Sec-
tion 254(h) of the Communications Act of 1934 (47 U.S.C.
254(h)) is amended—
(1) by redesignating paragraph (5) as para-
graph (7); and
(2) by inserting after paragraph (4) the fol-
lowing new paragraph (5):
‘‘(5) REQUIREMENTS
FOR
CERTAIN
SCHOOLS
WITH COMPUTERS HAVING INTERNET ACCESS.—
‘‘(A) INTERNET FILTERING.—
‘‘(i) IN GENERAL.—Except as provided
in clause (ii), an elementary or secondary
school having computers with Internet ac-
cess may not receive services at discount
rates under paragraph (1)(B) unless the
school, school board, or other authority with
responsibility for administration of the
school—
‘‘(I) submits to the Commission a
certification described in subparagraph
(B); and
‘‘(II) ensures the use of such com-
puters in accordance with the certifi-
cation.
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‘‘(ii) APPLICABILITY.—The prohibition
in paragraph (1) shall not apply with re-
spect to a school that receives services at
discount rates under paragraph (1)(B) only
for purposes other than the provision of
Internet access, Internet service, or internal
connections.
‘‘(B) 
CERTIFICATION.—A 
certification
under this subparagraph is a certification that
the school, school board, or other authority with
responsibility for administration of the school—
‘‘(i) has selected a technology for its
computers with Internet access in order to
filter or block Internet access through such
computers to—
‘‘(I) material that is obscene; and
‘‘(II) child pornography; and
‘‘(ii) is enforcing a policy to ensure the
operation of the technology during any use
of such computers by minors.
‘‘(C) ADDITIONAL USE OF TECHNOLOGY.—A
school, school board, or other authority may also
use a technology covered by a certification under
subparagraph (B) to filter or block Internet ac-
cess through the computers concerned to any ma-
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terial in addition to the material specified in
that subparagraph that the school, school board,
or other authority determines to be inappro-
priate for minors.
‘‘(D) TIMING OF CERTIFICATIONS.—
‘‘(i) SCHOOLS
WITH
COMPUTERS
ON
EFFECTIVE DATE.—
‘‘(I) IN
GENERAL.—Subject to
subclause (II), in the case of any school
covered by this paragraph as of the ef-
fective date of this paragraph under
section 602(h) of the Childrens’ Inter-
net Protection Act, the certification
under subparagraph (B) shall be made
not later than 30 days after such effec-
tive date.
‘‘(II) DELAY.—A certification for
a school covered by subclause (I) may
be made at a date that is later than is
otherwise required by that subclause if
State or local procurement rules or reg-
ulations or competitive bidding re-
quirements prevent the making of the
certification on the date otherwise re-
quired by that subclause. A school,
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school board, or other authority with
responsibility for administration of the
school shall notify the Commission of
the applicability of this subclause to
the school. Such notice shall specify the
date on which the certification with re-
spect to the school shall be effective for
purposes of this clause.
‘‘(ii) SCHOOLS ACQUIRING COMPUTERS
AFTER
EFFECTIVE
DATE.—In the case of
any school that first becomes covered by this
paragraph after such effective date, the cer-
tification under subparagraph (B) shall be
made not later than 10 days after the date
on which the school first becomes so covered.
‘‘(iii) NO
REQUIREMENT
FOR
ADDI-
TIONAL CERTIFICATIONS.—A school that has
submitted a certification under subpara-
graph (B) shall not be required for purposes
of this paragraph to submit an additional
certification under that subparagraph with
respect to any computers having Internet
access that are acquired by the school after
the submittal of the certification.
‘‘(E) NONCOMPLIANCE.—
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‘‘(i) FAILURE
TO
SUBMIT
CERTIFI-
CATION.—Any school that knowingly fails to
submit a certification required by this
paragraph 
shall 
reimburse 
each 
tele-
communications carrier that provided such
school services at discount rates under para-
graph (1)(B) after the effective date of this
paragraph under section 602(h) of the Chil-
drens’ Internet Protection Act in an
amount equal to the amount of the discount
provided such school by such carrier for
such services during the period beginning
on such effective date and ending on the
date on which the provision of such services
at discount rates under paragraph (1)(B) is
determined to cease under subparagraph
(F).
‘‘(ii) FAILURE TO COMPLY WITH CER-
TIFICATION.—Any school that knowingly
fails to ensure the use of its computers in
accordance with a certification under sub-
paragraph (B) shall reimburse each tele-
communications carrier that provided such
school services at discount rates under para-
graph (1)(B) after the date of such certifi-
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cation in an amount equal to the amount of
the discount provided such school by such
carrier for such services during the period
beginning on the date of such certification
and ending on the date on which the provi-
sion of such services at discount rates under
paragraph (1)(B) is determined to cease
under subparagraph (F).
‘‘(iii) TREATMENT
OF
REIMBURSE-
MENT.—The receipt by a telecommuni-
cations carrier of any reimbursement under
this subparagraph shall not affect the car-
rier’s treatment of the discount on which
such reimbursement was based in accord-
ance with the third sentence of paragraph
(1)(B).
‘‘(F) CESSATION DATE.—
‘‘(i) DETERMINATION.—The Commis-
sion shall determine the date on which the
provision of services at discount rates under
paragraph (1)(B) shall cease under this
paragraph by reason of the failure of a
school to comply with the requirements of
this paragraph.
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‘‘(ii) NOTIFICATION.—The Commission
shall notify telecommunications carriers of
each school determined to have failed to
comply with the requirements of this para-
graph and of the period for which such
school shall be liable to make reimbursement
under subparagraph (E).
‘‘(G) RECOMMENCEMENT OF DISCOUNTS.—
‘‘(i) RECOMMENCEMENT.—Upon sub-
mittal to the Commission of a certification
under subparagraph (B) with respect to a
school to which clause (i) or (ii) of subpara-
graph (E) applies, the school shall be enti-
tled to services at discount rates under
paragraph (1)(B).
‘‘(ii) NOTIFICATION.—The Commission
shall notify the school and telecommuni-
cations carriers of the recommencement of
the school’s entitlement to services at dis-
count rates under this subparagraph and of
the date on which such recommencement be-
gins.
‘‘(iii) ADDITIONAL NONCOMPLIANCE.—
The provisions of subparagraphs (E) and
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(F) shall apply to any certification sub-
mitted under clause (i).
‘‘(H) PUBLIC AVAILABILITY OF POLICY.—A
school, school board, or other authority that en-
forces a policy under subparagraph (B)(ii) shall
take appropriate actions to ensure the ready
availability to the public of information on such
policy and on its policy, if any, relating to the
use of technology under subparagraph (C).
‘‘(I) LIMITATION ON FEDERAL ACTION.—
‘‘(i) IN GENERAL.—No agency or in-
strumentality of the United States Govern-
ment may—
‘‘(I) establish any criteria for
making a determination under sub-
paragraph (C);
‘‘(II) 
review 
a 
determination
made by a school, school board, or
other authority for purposes of a cer-
tification under subparagraph (B); or
‘‘(III) consider the criteria em-
ployed by a school, school board, or
other authority for purposes of deter-
mining the eligibility of a school for
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services at discount rates under para-
graph (1)(B).
‘‘(ii) ACTION
BY
COMMISSION.—The
Commission may not take any action
against a school, school board, or other au-
thority for a violation of a provision of this
paragraph if the school, school board, or
other authority, as the case may be, has
made a good faith effort to comply with
such provision.’’.
(b) LIBRARIES.—Such section 254(h) is further
amended by inserting after paragraph (5), as amended by
subsection (a) of this section, the following new paragraph:
‘‘(6) REQUIREMENTS
FOR
CERTAIN
LIBRARIES
WITH COMPUTERS HAVING INTERNET ACCESS.—
‘‘(A) INTERNET FILTERING.—
‘‘(i) IN GENERAL.—A library having
one or more computers with Internet access
may not receive services at discount rates
under 
paragraph 
(1)(B) 
unless 
the
library—
‘‘(I) submits to the Commission a
certification described in subparagraph
(B); and
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‘‘(II) ensures the use of such com-
puters in accordance with the certifi-
cation.
‘‘(ii) APPLICABILITY.—The prohibition
in paragraph (1) shall not apply with re-
spect to a library that receives services at
discount rates under paragraph (1)(B) only
for purposes other than the provision of
Internet access, Internet service, or internal
connections.
‘‘(B) CERTIFICATION.—
‘‘(i) ACCESS OF MINORS TO CERTAIN
MATERIAL.—A certification under this sub-
paragraph is a certification that the
library—
‘‘(I) has selected a technology for
its computer or computers with Inter-
net access in order to filter or block
Internet access through such computer
or computers to—
‘‘(aa) material that is ob-
scene;
‘‘(bb) child pornography; and
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‘‘(cc) any other material that
the library determines to be inap-
propriate for minors; and
‘‘(II) is enforcing a policy to en-
sure the operation of the technology
during any use of such computer or
computers by minors.
‘‘(ii) ACCESS TO CHILD PORNOGRAPHY
GENERALLY.—
‘‘(I) IN GENERAL.—A certification
under this subparagraph with respect
to a library is also a certification that
the library—
‘‘(aa) has selected a tech-
nology for its computer or com-
puters with Internet access in
order to filter or block Internet ac-
cess through such computer or
computers to child pornography;
and
‘‘(bb) is enforcing a policy to
ensure the operation of the tech-
nology during any use of such
computer or computers.
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‘‘(II) SCOPE.—For purposes of
identifying child pornography under
subclause (I), a library may utilize the
definition of that term in section
2256(8) of title 18, United States Code.
‘‘(III) RELATIONSHIP TO OTHER
CERTIFICATIONS.—The 
certification
under this clause is in addition to any
other certification applicable with re-
spect to a library under this subpara-
graph.
‘‘(C) ADDITIONAL USE OF TECHNOLOGY.—A
library may also use a technology covered by a
certification under subparagraph (B) to filter or
block Internet access through the computers con-
cerned to any material in addition to the mate-
rial specified in that subparagraph that the li-
brary determines to be inappropriate for minors.
‘‘(D) TIMING OF CERTIFICATIONS.—
‘‘(i) LIBRARIES WITH COMPUTERS ON
EFFECTIVE DATE.—
‘‘(I) IN GENERAL.—In the case of
any library covered by this paragraph
as of the effective date of this para-
graph under section 602(h) of the Chil-
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drens’ Internet Protection Act, the cer-
tifications under subparagraph (B)
shall be made not later than 30 days
after such effective date.
‘‘(II) DELAY.—The certifications
for a library covered by subclause (I)
may be made at a date than is later
than is otherwise required by that sub-
clause if State or local procurement
rules or regulations or competitive bid-
ding requirements prevent the making
of the certifications on the date other-
wise required by that subclause. A li-
brary shall notify the Commission of
the applicability of this subclause to
the library. Such notice shall specify
the date on which the certifications
with respect to the library shall be ef-
fective for purposes of this clause.
‘‘(ii) 
LIBRARIES
ACQUIRING
COM-
PUTERS AFTER EFFECTIVE DATE.—In the
case of any library that first becomes subject
to the certifications under subparagraph
(B) after such effective date, the certifi-
cations under that subparagraph shall be
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made not later than 10 days after the date
on which the library first becomes so sub-
ject.
‘‘(iii) NO
REQUIREMENT
FOR
ADDI-
TIONAL
CERTIFICATIONS.—A library that
has submitted the certifications under sub-
paragraph (B) shall not be required for
purposes of this paragraph to submit an ad-
ditional certifications under that subpara-
graph with respect to any computers having
Internet access that are acquired by the li-
brary after the submittal of such certifi-
cations.
‘‘(E) NONCOMPLIANCE.—
‘‘(i) FAILURE
TO
SUBMIT
CERTIFI-
CATION.—Any library that knowingly fails
to submit the certifications required by this
paragraph 
shall 
reimburse 
each 
tele-
communications carrier that provided such
library services at discount rates under
paragraph (1)(B) after the effective date of
this paragraph under section 602(h) of the
Childrens’ Internet Protection Act in an
amount equal to the amount of the discount
provided such library by such carrier for
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such services during the period beginning
on such effective date and ending on the
date on which the provision of such services
at discount rates under paragraph (1)(B) is
determined to cease under subparagraph
(F).
‘‘(ii) FAILURE TO COMPLY WITH CER-
TIFICATION.—Any library that knowingly
fails to ensure the use of its computers in
accordance with a certification under sub-
paragraph (B) shall reimburse each tele-
communications carrier that provided such
library services at discount rates under
paragraph (1)(B) after the date of such cer-
tification in an amount equal to the
amount of the discount provided such li-
brary by such carrier for such services dur-
ing the period beginning on the date of such
certification and ending on the date on
which the provision of such services at dis-
count rates under paragraph (1)(B) is de-
termined to cease under subparagraph (F).
‘‘(iii) TREATMENT
OF
REIMBURSE-
MENT.—The receipt by a telecommuni-
cations carrier of any reimbursement under
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this subparagraph shall not affect the car-
rier’s treatment of the discount on which
such reimbursement was based in accord-
ance with the third sentence of paragraph
(1)(B).
‘‘(F) CESSATION DATE.—
‘‘(i) DETERMINATION.—The Commis-
sion shall determine the date on which the
provision of services at discount rates under
paragraph (1)(B) shall cease under this
paragraph by reason of the failure of a li-
brary to comply with the requirements of
this paragraph.
‘‘(ii) NOTIFICATION.—The Commission
shall notify telecommunications carriers of
each library determined to have failed to
comply with the requirements of this para-
graph and of the period for which such li-
brary shall be liable to make reimbursement
under subparagraph (E).
‘‘(G) RECOMMENCEMENT OF DISCOUNTS.—
‘‘(i) RECOMMENCEMENT.—Upon sub-
mittal to the Commission of a certification
under subparagraph (B) with respect to a
library to which clause (i) or (ii) of sub-
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paragraph (E) applies, the library shall be
entitled to services at discount rates under
paragraph (1)(B).
‘‘(ii) NOTIFICATION.—The Commission
shall notify the library and telecommuni-
cations carriers of the recommencement of
the library’s entitlement to services at dis-
count rates under this paragraph and of the
date on which such recommencement begins.
‘‘(iii) ADDITIONAL NONCOMPLIANCE.—
The provisions of subparagraphs (E) and
(F) shall apply to any certification sub-
mitted under clause (i).
‘‘(H) PUBLIC AVAILABILITY OF POLICY.—A
library that enforces a policy under clause (i)(II)
or (ii)(I)(bb) of subparagraph (B) shall take ap-
propriate actions to ensure the ready availability
to the public of information on such policy and
on its policy, if any, relating to the use of tech-
nology under subparagraph (C).
‘‘(I) LIMITATION ON FEDERAL ACTION.—
‘‘(i) IN GENERAL.—No agency or in-
strumentality of the United States Govern-
ment may—
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‘‘(I) establish any criteria for
making a determination under sub-
paragraph (C);
‘‘(II) 
review 
a 
determination
made by a library for purposes of a
certification under subparagraph (B);
or
‘‘(III) consider the criteria em-
ployed by a library purposes of deter-
mining the eligibility of the library for
services at discount rates under para-
graph (1)(B).
‘‘(ii) ACTION
BY
COMMISSION.—The
Commission may not take any action
against a library for a violation of a provi-
sion of this paragraph if the library has
made a good faith effort to comply with
such provision.’’.
(c) MINOR DEFINED.—Paragraph (7) of such section,
as redesignated by subsection (a)(1) of this section, is
amended by adding at the end the following:
‘‘(D) MINOR.—The term ‘minor’ means any
individual who has not attained the age of 17
years.’’.
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(d) CONFORMING AMENDMENT.—Paragraph (4) of
such section is amended by striking ‘‘paragraph (5)(A)’’
and inserting ‘‘paragraph (7)(A)’’.
(e) SEPARABILITY.—If any provision of paragraph (5)
or (6) of section 254(h) of the Communications Act of 1934,
as amended by this section, or the application thereof to
any person or circumstance is held invalid, the remainder
of such paragraph and the application of such paragraph
to other persons or circumstances shall not be affected there-
by.
(f) REGULATIONS.—
(1) REQUIREMENT.—The Federal Communica-
tions Commission shall prescribe regulations for pur-
poses of administering the provisions of paragraphs
(5) and (6) of section 254(h) of the Communications
Act of 1934, as amended by this section.
(2) DEADLINE.—Notwithstanding any other pro-
vision of law, the requirements prescribed under
paragraph (1) shall take effect 120 days after the date
of the enactment of this Act.
(g) AVAILABILITY OF RATES.—Discounted rates under
section 254(h)(1)(B) of the Communications Act of 1934 (47
U.S.C. 254(h)(1)(B))—
(1) shall be available in amounts up to the an-
nual cap on Federal universal service support for
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schools and libraries only for services covered by Fed-
eral Communications Commission regulations on pri-
orities for funding telecommunications services, Inter-
net access, Internet services, and Internet connections
that assign priority for available funds for the poorest
schools; and
(2) to the extent made available under para-
graph (1), may be used for the purchase or acquisi-
tion of filtering or blocking products necessary to
meet the requirements of section 254(h)(5) and (6) of
that Act, but not for the purchase of software or other
technology other than what is required to meet those
requirements.
(h) EFFECTIVE DATE.—The amendments made by this
section shall take effect 120 days after the date of the enact-
ment of this Act.
SEC. 603. FETAL TISSUE. The General Accounting Of-
fice shall conduct a comprehensive study into Federal in-
volvement in the use of fetal tissue for research purposes
within the scope of this Act to be completed by September
1, 2000. The study shall include but not be limited to—
(1) the annual number of orders for fetal tissue
filled in conjunction with federally funded fetal tissue
research or programs over the last 3 years;
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(2) the costs associated with the procurement,
dissemination, and other use of fetal tissue, including
but not limited to the costs associated with the proc-
essing, transportation, preservation, quality control,
and storage of such tissue;
(3) the manner in which Federal agencies ensure
that intramural and extramural research facilities
and their employees comply with Federal fetal tissue
law;
(4) the number of fetal tissue procurement con-
tractors and tissue resource sources, or other entities
or individuals that are used to obtain, transport,
process, preserve, or store fetal tissue, which receive
Federal funds and the quantity, form, and nature of
the services provided and the amount of Federal funds
received by such entities;
(5) the number and identity of all Federal agen-
cies within the scope of this Act expending or ex-
changing Federal funds in connection with obtaining
or processing fetal tissue or the conduct of research
using such tissue;
(6) the extent to which Federal fetal tissue pro-
curement policies and guidelines adhere to Federal
law;
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(7) the criteria that Federal fetal tissue research
facilities use for selecting their fetal tissue sources,
and the manner in which the facilities ensure that
such sources comply with Federal law.
SEC. 604. PROVISION OF INTERNET FILTERING OR
SCREENING SOFTWARE BY CERTAIN INTERNET SERVICE
PROVIDERS. (a) REQUIREMENT TO PROVIDE.—Each Inter-
net service provider shall at the time of entering an agree-
ment with a residential customer for the provision of Inter-
net access services, provide to such customer, either at no
fee or at a fee not in excess of the amount specified in sub-
section (c), computer software or other filtering or blocking
system that allows the customer to prevent the access of mi-
nors to material on the Internet.
(b) SURVEYS OF PROVISION OF SOFTWARE OR SYS-
TEMS.—
(1) SURVEYS.—The Office of Juvenile Justice
and Delinquency Prevention of the Department of
Justice and the Federal Trade Commission shall
jointly conduct surveys of the extent to which Internet
service providers are providing computer software or
systems described in subsection (a) to their sub-
scribers. In performing such surveys, neither the De-
partment nor the Commission shall collect personally
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identifiable information of subscribers of the Internet
service providers.
(2) FREQUENCY.—The surveys required by para-
graph (1) shall be completed as follows:
(A) One shall be completed not later than
one year after the date of the enactment of this
Act.
(B) One shall be completed not later than
two years after that date.
(C) One shall be completed not later than
three years after that date.
(c) FEES.—The fee, if any, charged and collected by
an Internet service provider for providing computer soft-
ware or a system described in subsection (a) to a residential
customer shall not exceed the amount equal to the cost of
the provider in providing the software or system to the sub-
scriber, including the cost of the software or system and of
any license required with respect to the software or system.
(d) APPLICABILITY.—The requirement described in
subsection (a) shall become effective only if—
(1) 1 year after the date of the enactment of this
Act, the Office and the Commission determine as a re-
sult of the survey completed by the deadline in sub-
section (b)(2)(A) that less than 75 percent of the total
number of residential subscribers of Internet service
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providers as of such deadline are provided computer
software or systems described in subsection (a) by
such providers;
(2) 2 years after the date of enactment of this
Act, the Office and the Commission determine as a re-
sult of the survey completed by the deadline in sub-
section (b)(2)(B) that less than 85 percent of the total
number of residential subscribers of Internet service
providers as of such deadline are provided such soft-
ware or systems by such providers; or
(3) 3 years after the date of the enactment of this
Act, if the Office and the Commission determine as a
result of the survey completed by the deadline in sub-
section (b)(2)(C) that less than 100 percent of the
total number of residential subscribers of Internet
service providers as of such deadline are provided
such software or systems by such providers.
(e) INTERNET SERVICE PROVIDER DEFINED.—In this
section, the term ‘‘Internet service provider’’ means a serv-
ice provider as defined in section 512(k)(1)(A) of title 17,
United States Code, which has more than 50,000 sub-
scribers.
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TITLE VII—UNIVERSAL SERVICE FOR SCHOOLS
AND LIBRARIES
SEC. 701. SHORT TITLE. This title may be cited as
the ‘‘Neighborhood Children’s Internet Protection Act’’.
SEC. 702. NO UNIVERSAL SERVICE FOR SCHOOLS OR
LIBRARIES THAT FAIL TO IMPLEMENT A FILTERING OR
BLOCKING SYSTEM FOR COMPUTERS WITH INTERNET AC-
CESS OR ADOPT INTERNET USE POLICIES. (a) NO UNI-
VERSAL SERVICE.—
(1) IN GENERAL.—Section 254 of the Commu-
nications Act of 1934 (47 U.S.C. 254) is amended by
adding at the end the following:
‘‘(l) IMPLEMENTATION OF INTERNET FILTERING OR
BLOCKING SYSTEM OR USE POLICIES.—
‘‘(1) IN GENERAL.—No services may be provided
under subsection (h)(1)(B) to any elementary or sec-
ondary school, or any library, unless it provides the
certification required by paragraph (2) to the Com-
mission or its designee.
‘‘(2) CERTIFICATION.—A certification under this
paragraph with respect to a school or library is a cer-
tification by the school, school board, or other author-
ity with responsibility for administration of the
school, or the library, or any other entity representing
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the school or library in applying for universal service
assistance, that the school or library—
‘‘(A) has—
‘‘(i) selected a system for its computers
with Internet access that are dedicated to
student use in order to filter or block Inter-
net access to matter considered to be inap-
propriate for minors; and
‘‘(ii) installed on such computers, or
upon obtaining such computers will install
on such computers, a system to filter or
block Internet access to such matter; or
‘‘(B)(i) has adopted and implemented an
Internet use policy that addresses—
‘‘(I) access by minors to inappropriate
matter on the Internet and World Wide
Web;
‘‘(II) the safety and security of minors
when using electronic mail, chat rooms, and
other forms of direct electronic communica-
tions;
‘‘(III) unauthorized access, including
so-called ‘hacking’, and other unlawful ac-
tivities by minors online;
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‘‘(IV) unauthorized disclosure, use, and
dissemination of personal identification in-
formation regarding minors; and
‘‘(V) whether the school or library, as
the case may be, is employing hardware,
software, or other technological means to
limit, monitor, or otherwise control or guide
Internet access by minors; and
‘‘(ii) provided reasonable public notice and
held at least one public hearing or meeting which
addressed the proposed Internet use policy.
‘‘(3) LOCAL DETERMINATION OF CONTENT.—For
purposes of a certification under paragraph (2), the
determination regarding what matter is inappro-
priate for minors shall be made by the school board,
library, or other authority responsible for making the
determination. No agency or instrumentality of the
United States Government may—
‘‘(A) establish criteria for making such de-
termination;
‘‘(B) review the determination made by the
certifying school, school board, library, or other
authority; or
‘‘(C) consider the criteria employed by the
certifying school, school board, library, or other
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authority in the administration of subsection
(h)(1)(B).
‘‘(4) EFFECTIVE
DATE.—This subsection shall
apply with respect to schools and libraries seeking
universal 
service 
assistance 
under 
subsection
(h)(1)(B) on or after July 1, 2001.’’.
(2) 
CONFORMING
AMENDMENT.—Subsection
(h)(1)(B) of that section is amended by striking ‘‘All
telecommunications’’ and inserting ‘‘Except as pro-
vided by subsection (l), all telecommunications’’.
(b) STUDY.—Not later than 150 days after the date
of the enactment of this Act, the National Telecommuni-
cations and Information Administration shall initiate a
notice and comment proceeding for purposes of—
(1) evaluating whether or not currently available
commercial Internet blocking, filtering, and moni-
toring software adequately addresses the needs of edu-
cational institutions;
(2) making recommendations on how to foster
the development of products which meet such needs;
and
(3) evaluating the development and effectiveness
of local Internet use policies that are currently in op-
eration after community input.
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SEC. 703. IMPLEMENTING REGULATIONS. Not later
than 100 days after the date of the enactment of this Act,
the Federal Communications Commission shall adopt rules
implementing this title and the amendments made by this
title.
TITLE VIII—SOCIAL SECURITY AND MEDICARE
OFF-BUDGET LOCKBOX ACT OF 2000
SEC. 801. SHORT TITLE. This title may be cited as
the ‘‘Social Security and Medicare Off-Budget Lockbox Act
of 2000’’.
SEC. 802. STRENGTHENING SOCIAL SECURITY POINTS
OF ORDER. (a) IN GENERAL.—Section 312 of the Congres-
sional Budget Act of 1974 (2 U.S.C. 643) is amended by
inserting at the end the following:
‘‘(g) STRENGTHENING SOCIAL SECURITY POINT OF
ORDER.—It shall not be in order in the House of Represent-
atives or the Senate to consider a concurrent resolution on
the budget (or any amendment thereto or conference report
thereon) or any bill, joint resolution, amendment, motion,
or conference report that would violate or amend section
13301 of the Budget Enforcement Act of 1990.’’.
(b) SUPER MAJORITY REQUIREMENT.—
(1) POINT OF ORDER.—Section 904(c)(1) of the
Congressional Budget Act of 1974 is amended by in-
serting ‘‘312(g),’’ after ‘‘310(d)(2),’’.
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(2) WAIVER.—Section 904(d)(2) of the Congres-
sional Budget Act of 1974 is amended by inserting
‘‘312(g),’’ after ‘‘310(d)(2),’’.
(c) ENFORCEMENT IN EACH FISCAL YEAR.—The Con-
gressional Budget Act of 1974 is amended in—
(1) section 301(a)(7) (2 U.S.C. 632(a)(7)), by
striking ‘‘for the fiscal year’’ through the period and
inserting ‘‘for each fiscal year covered by the resolu-
tion’’; and
(2) section 311(a)(3) (2 U.S.C. 642(a)(3)), by
striking beginning with ‘‘for the first fiscal year’’
through the period and insert the following: ‘‘for any
of the fiscal years covered by the concurrent resolu-
tion.’’.
Sec. 803. MEDICARE TRUST FUND OFF-BUDGET. (a)
IN GENERAL.—
(1) GENERAL EXCLUSION FROM ALL BUDGETS.—
Title III of the Congressional Budget Act of 1974 is
amended by adding at the end the following:
‘‘EXCLUSION OF MEDICARE TRUST FUND FROM ALL
BUDGETS
‘‘SEC. 316. (a) EXCLUSION
OF MEDICARE TRUST
FUND FROM ALL BUDGETS.—Notwithstanding any other
provision of law, the receipts and disbursements of the Fed-
eral Hospital Insurance Trust Fund shall not be counted
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as new budget authority, outlays, receipts, or deficit or sur-
plus for purposes of—
‘‘(1) the budget of the United States Government
as submitted by the President;
‘‘(2) the congressional budget; or
‘‘(3) the Balanced Budget and Emergency Deficit
Control Act of 1985.
‘‘(b) STRENGTHENING MEDICARE POINT OF ORDER.—
It shall not be in order in the House of Representatives or
the Senate to consider a concurrent resolution on the budget
(or any amendment thereto or conference report thereon)
or any bill, joint resolution, amendment, motion, or con-
ference report that would violate or amend this section.’’.
(2) SUPER MAJORITY REQUIREMENT.—
(A) POINT OF ORDER.—Section 904(c)(1) of
the Congressional Budget Act of 1974 is amended
by inserting ‘‘316,’’ after ‘‘313,’’.
(B) WAIVER.—Section 904(d)(2) of the Con-
gressional Budget Act of 1974 is amended by in-
serting ‘‘316,’’ after ‘‘313,’’.
(b) EXCLUSION OF MEDICARE TRUST FUND FROM
CONGRESSIONAL BUDGET.—Section 301(a) of the Congres-
sional Budget Act of 1974 (2 U.S.C. 632(a)) is amended
by adding at the end the following: ‘‘The concurrent resolu-
tion shall not include the outlays and revenue totals of the
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Federal Hospital Insurance Trust Fund in the surplus or
deficit totals required by this subsection or in any other
surplus or deficit totals required by this title.’’
(c) BUDGET TOTALS.—Section 301(a) of the Congres-
sional Budget Act of 1974 (2 U.S.C. 632(a)) is amended
by inserting after paragraph (7) the following:
‘‘(8) For purposes of Senate enforcement under
this title, revenues and outlays of the Federal Hos-
pital Insurance Trust Fund for each fiscal year cov-
ered by the budget resolution.’’.
(d) BUDGET
RESOLUTIONS.—Section 301(i) of the
Congressional Budget Act of 1974 (2 U.S.C. 632(i)) is
amended by—
(1) striking ‘‘SOCIAL
SECURITY
POINT
OF
ORDER.—It shall’’ and inserting ‘‘SOCIAL SECURITY
AND MEDICARE POINTS OF ORDER.—
‘‘(1) SOCIAL SECURITY.—It shall’’; and
(2) inserting at the end the following:
‘‘(2) MEDICARE.—It shall not be in order in the
House of Representatives or the Senate to consider
any concurrent resolution on the budget (or amend-
ment, motion, or conference report on the resolution)
that would decrease the excess of the Federal Hospital
Insurance Trust Fund revenues over Federal Hospital
Insurance Trust Fund outlays in any of the fiscal
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years covered by the concurrent resolution. This para-
graph shall not apply to amounts to be expended from
the Hospital Insurance Trust Fund for purposes re-
lating to programs within part A of Medicare as pro-
vided in law on the date of enactment of this para-
graph.’’.
(e) MEDICARE FIREWALL.—Section 311(a) of the Con-
gressional Budget Act of 1974 (2 U.S.C. 642(a)) is amended
by adding after paragraph (3), the following:
‘‘(4) ENFORCEMENT
OF
MEDICARE
LEVELS
IN
THE SENATE.—After a concurrent resolution on the
budget is agreed to, it shall not be in order in the
Senate to consider any bill, joint resolution, amend-
ment, motion, or conference report that would cause
a decrease in surpluses or an increase in deficits of
the Federal Hospital Insurance Trust Fund in any
year relative to the levels set forth in the applicable
resolution. This paragraph shall not apply to
amounts to be expended from the Hospital Insurance
Trust Fund for purposes relating to programs within
part A of Medicare as provided in law on the date
of enactment of this paragraph.’’.
(f) BASELINE
TO EXCLUDE HOSPITAL INSURANCE
TRUST FUND.—Section 257(b)(3) of the Balanced Budget
and Emergency Deficit Control Act of 1985 is amended by
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striking ‘‘shall be included in all’’ and inserting ‘‘shall not
be included in any’’.
(g) MEDICARE TRUST FUND EXEMPT FROM SEQUES-
TERS.—Section 255(g)(1)(B) of the Balanced Budget and
Emergency Deficit Control Act of 1985 is amended by add-
ing at the end the following:
‘‘Medicare as funded through the Federal Hos-
pital Insurance Trust Fund.’’.
(h) BUDGETARY TREATMENT OF HOSPITAL INSUR-
ANCE TRUST FUND.—Section 710(a) of the Social Security
Act (42 U.S.C. 911(a)) is amended—
(1) by striking ‘‘and’’ the second place it appears
and inserting a comma; and
(2) by inserting after ‘‘Federal Disability Insur-
ance Trust Fund’’ the following: ‘‘, Federal Hospital
Insurance Trust Fund’’.
SEC. 804. PREVENTING ON-BUDGET DEFICITS. (a)
POINTS OF ORDER TO PREVENT ON-BUDGET DEFICITS.—
Section 312 of the Congressional Budget Act of 1974 (2
U.S.C. 643) is amended by adding at the end the following:
‘‘(h) POINTS OF ORDER TO PREVENT ON-BUDGET
DEFICITS.—
‘‘(1) CONCURRENT RESOLUTIONS ON THE BUDG-
ET.—It shall not be in order in the House of Rep-
resentatives or the Senate to consider any concurrent
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resolution on the budget, or conference report thereon
or amendment thereto, that would cause or increase
an on-budget deficit for any fiscal year.
‘‘(2) SUBSEQUENT
LEGISLATION.—Except as
provided by paragraph (3), it shall not be in order
in the House of Representatives or the Senate to con-
sider any bill, joint resolution, amendment, motion,
or conference report if—
‘‘(A) the enactment of that bill or resolution
as reported;
‘‘(B) the adoption and enactment of that
amendment; or
‘‘(C) the enactment of that bill or resolution
in the form recommended in that conference re-
port,
would cause or increase an on-budget deficit for any
fiscal year.’’.
(b) SUPER MAJORITY REQUIREMENT.—
(1) POINT OF ORDER.—Section 904(c)(1) of the
Congressional Budget Act of 1974 is amended by in-
serting ‘‘312(h),’’ after ‘‘312(g),’’.
(2) WAIVER.—Section 904(d)(2) of the Congres-
sional Budget Act of 1974 is amended by inserting
‘‘312(h),’’ after ‘‘312(g),’’.
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SEC. 805. SOCIAL SECURITY AND MEDICARE SAFE
DEPOSIT BOX ACT OF 2000. (a) SHORT TITLE.—This sec-
tion may be cited as the ‘‘Social Security and Medicare
Safe Deposit Box Act of 2000’’.
(b) PROTECTION OF SOCIAL SECURITY AND MEDICARE
SURPLUSES.—
(1) MEDICARE SURPLUSES OFF-BUDGET.—Not-
withstanding any other provision of law, the net sur-
plus of any trust fund for part A of Medicare shall
not be counted as a net surplus for purposes of—
(A) the budget of the United States Govern-
ment as submitted by the President;
(B) the congressional budget; or
(C) the Balanced Budget and Emergency
Deficit Control Act of 1985.
(2) POINTS OF ORDER TO PROTECT SOCIAL SE-
CURITY AND MEDICARE SURPLUSES.—Section 312 of
the Congressional Budget Act of 1974 is amended by
adding at the end the following new subsection:
‘‘(g) POINTS OF ORDER TO PROTECT SOCIAL SECU-
RITY AND MEDICARE SURPLUSES.—
‘‘(1) CONCURRENT RESOLUTIONS ON THE BUDG-
ET.—It shall not be in order in the House of Rep-
resentatives or the Senate to consider any concurrent
resolution on the budget, or conference report thereon
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or amendment thereto, that would set forth an on-
budget deficit for any fiscal year.
‘‘(2) SUBSEQUENT LEGISLATION.—It shall not be
in order in the House of Representatives or the Senate
to consider any bill, joint resolution, amendment, mo-
tion, or conference report if—
‘‘(A) the enactment of that bill or resolution
as reported;
‘‘(B) the adoption and enactment of that
amendment; or
‘‘(C) the enactment of that bill or resolution
in the form recommended in that conference re-
port,
would cause or increase an on-budget deficit for any
fiscal year.
‘‘(3) DEFINITION.—For purposes of this section,
the term ‘on-budget deficit’, when applied to a fiscal
year, means the deficit in the budget as set forth in
the most recently agreed to concurrent resolution on
the budget pursuant to section 301(a)(3) for that fis-
cal year.’’.
(3) SUPER MAJORITY REQUIREMENT.—
(A) POINT OF ORDER.—Section 904(c)(1) of
the Congressional Budget Act of 1974 is amended
by inserting ‘‘312(g),’’ after ‘‘310(d)(2),’’.
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(B) WAIVER.—Section 904(d)(2) of the Con-
gressional Budget Act of 1974 is amended by in-
serting ‘‘312(g),’’ after ‘‘310(d)(2),’’.
(c) PROTECTION OF SOCIAL SECURITY AND MEDICARE
SURPLUSES.—
(1) IN GENERAL.—Chapter 11 of subtitle II of
title 31, United States Code, is amended by adding
before section 1101 the following:
‘‘§ 1100. Protection of social security and medicare
surpluses
‘‘The budget of the United States Government sub-
mitted by the President under this chapter shall not rec-
ommend an on-budget deficit for any fiscal year covered
by that budget.’’.
(2) CHAPTER ANALYSIS.—The chapter analysis
for chapter 11 of title 31, United States Code, is
amended by inserting before the item for section 1101
the following:
‘‘1100. Protection of social security and medicare surpluses.’’.
(d) EFFECTIVE DATE.—This section shall take effect
upon the date of its enactment and the amendments made
by this section shall apply to fiscal year 2001 and subse-
quent fiscal years.
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TITLE IX—GENETIC INFORMATION AND
SERVICES
SEC. 901. SHORT TITLE. This title may be cited as
the ‘‘Genetic Information Nondiscrimination in Health In-
surance Act of 2000’’.
SEC. 902. AMENDMENTS TO EMPLOYEE RETIREMENT
INCOME SECURITY ACT
OF 1974. (a) PROHIBITION
OF
HEALTH DISCRIMINATION ON THE BASIS OF GENETIC IN-
FORMATION OR GENETIC SERVICES.—
(1) NO ENROLLMENT RESTRICTION FOR GENETIC
SERVICES.—Section 702(a)(1)(F) of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C.
1182(a)(1)(F)) is amended by inserting before the pe-
riod the following: ‘‘(including information about a
request for or receipt of genetic services)’’.
(2) NO
DISCRIMINATION
IN
GROUP
PREMIUMS
BASED ON PREDICTIVE GENETIC INFORMATION.—Sub-
part B of part 7 of subtitle B of title I of the Em-
ployee Retirement Income Security Act of 1974 is
amended by adding at the end the following:
‘‘SEC. 
714. 
PROHIBITING 
PREMIUM 
DISCRIMINATION
AGAINST GROUPS ON THE BASIS OF PRE-
DICTIVE GENETIC INFORMATION.
‘‘A group health plan, or a health insurance issuer of-
fering group health insurance coverage in connection with
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a group health plan, shall not adjust premium or contribu-
tion amounts for a group on the basis of predictive genetic
information concerning any individual (including a de-
pendent) or family member of the individual (including in-
formation about a request for or receipt of genetic serv-
ices).’’.
(3) CONFORMING AMENDMENTS.—
(A) IN
GENERAL.—Section 702(b) of the
Employee Retirement Income Security Act of
1974 (29 U.S.C. 1182(b)) is amended by adding
at the end the following:
‘‘(3) REFERENCE TO RELATED PROVISION.—For
a provision prohibiting the adjustment of premium or
contribution amounts for a group under a group
health plan on the basis of predictive genetic informa-
tion (including information about a request for or re-
ceipt of genetic services), see section 714.’’.
(B) TABLE
OF
CONTENTS.—The table of
contents in section 1 of the Employee Retirement
Income Security Act of 1974 is amended by in-
serting after the item relating to section 713 the
following new item:
‘‘Sec. 714. Prohibiting premium discrimination against groups on the basis of
predictive genetic information.’’.
(b) LIMITATION ON COLLECTION OF PREDICTIVE GE-
NETIC INFORMATION.—Section 702 of the Employee Retire-
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ment Income Security Act of 1974 (29 U.S.C. 1182) is
amended by adding at the end the following:
‘‘(c) COLLECTION OF PREDICTIVE GENETIC INFORMA-
TION.—
‘‘(1) LIMITATION ON REQUESTING OR REQUIRING
PREDICTIVE GENETIC INFORMATION.—Except as pro-
vided in paragraph (2), a group health plan, or a
health insurance issuer offering health insurance cov-
erage in connection with a group health plan, shall
not request or require predictive genetic information
concerning any individual (including a dependent) or
family member of the individual (including informa-
tion about a request for or receipt of genetic services).
‘‘(2) INFORMATION
NEEDED
FOR
DIAGNOSIS,
TREATMENT, OR PAYMENT.—
‘‘(A) IN GENERAL.—Notwithstanding para-
graph (1), a group health plan, or a health in-
surance issuer offering health insurance coverage
in connection with a group health plan, that
provides health care items and services to an in-
dividual or dependent may request (but may not
require) that such individual or dependent dis-
close, or authorize the collection or disclosure of,
predictive genetic information for purposes of di-
agnosis, treatment, or payment relating to the
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provision of health care items and services to
such individual or dependent.
‘‘(B) NOTICE
OF
CONFIDENTIALITY
PRAC-
TICES AND DESCRIPTION OF SAFEGUARDS.—As a
part of a request under subparagraph (A), the
group health plan, or a health insurance issuer
offering health insurance coverage in connection
with a group health plan, shall provide to the in-
dividual or dependent a description of the proce-
dures in place to safeguard the confidentiality,
as described in subsection (d), of such predictive
genetic information.
‘‘(d) CONFIDENTIALITY
WITH
RESPECT
TO
PRE-
DICTIVE GENETIC INFORMATION.—
‘‘(1) NOTICE OF CONFIDENTIALITY PRACTICES.—
‘‘(A) PREPARATION OF WRITTEN NOTICE.—
A group health plan, or a health insurance
issuer offering health insurance coverage in con-
nection with a group health plan, shall post or
provide, in writing and in a clear and con-
spicuous manner, notice of the plan or issuer’s
confidentiality practices, that shall include—
‘‘(i) a description of an individual’s
rights with respect to predictive genetic in-
formation;
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‘‘(ii) the procedures established by the
plan or issuer for the exercise of the individ-
ual’s rights; and
‘‘(iii) the right to obtain a copy of the
notice of the confidentiality practices re-
quired under this subsection.
‘‘(B) MODEL
NOTICE.—The Secretary, in
consultation with the National Committee on
Vital and Health Statistics and the National As-
sociation of Insurance Commissioners, and after
notice and opportunity for public comment, shall
develop and disseminate model notices of con-
fidentiality practices. Use of the model notice
shall serve as a defense against claims of receiv-
ing inappropriate notice.
‘‘(2) 
ESTABLISHMENT
OF
SAFEGUARDS.—A
group health plan, or a health insurance issuer offer-
ing health insurance coverage in connection with a
group health plan, shall establish and maintain ap-
propriate administrative, technical, and physical
safeguards to protect the confidentiality, security, ac-
curacy, and integrity of predictive genetic informa-
tion created, received, obtained, maintained, used,
transmitted, or disposed of by such plan or issuer.’’.
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(c) DEFINITIONS.—Section 733(d) of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C. 1191b(d))
is amended by adding at the end the following:
‘‘(5) FAMILY MEMBER.—The term ‘family mem-
ber’ means with respect to an individual—
‘‘(A) the spouse of the individual;
‘‘(B) a dependent child of the individual,
including a child who is born to or placed for
adoption with the individual; and
‘‘(C) all other individuals related by blood
to the individual or the spouse or child described
in subparagraph (A) or (B).
‘‘(6) GENETIC INFORMATION.—The term ‘genetic
information’ means information about genes, gene
products, or inherited characteristics that may derive
from an individual or a family member (including
information about a request for or receipt of genetic
services).
‘‘(7) GENETIC
SERVICES.—The term ‘genetic
services’ means health services provided to obtain, as-
sess, or interpret genetic information for diagnostic
and therapeutic purposes, and for genetic education
and counseling.
‘‘(8) PREDICTIVE GENETIC INFORMATION.—
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‘‘(A) IN GENERAL.—The term ‘predictive ge-
netic information’ means, in the absence of
symptoms, clinical signs, or a diagnosis of the
condition related to such information—
‘‘(i) information about an individual’s
genetic tests;
‘‘(ii) information about genetic tests of
family members of the individual; or
‘‘(iii) information about the occurrence
of a disease or disorder in family members.
‘‘(B) EXCEPTIONS.—The term ‘predictive
genetic information’ shall not include—
‘‘(i) information about the sex or age of
the individual;
‘‘(ii) information derived from phys-
ical tests, such as the chemical, blood, or
urine analyses of the individual including
cholesterol tests; and
‘‘(iii) 
information 
about 
physical
exams of the individual.
‘‘(9) GENETIC
TEST.—The term ‘genetic test’
means the analysis of human DNA, RNA, chro-
mosomes, proteins, and certain metabolites, including
analysis of genotypes, mutations, phenotypes, or
karyotypes, for the purpose of predicting risk of dis-
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ease in asymptomatic or undiagnosed individuals.
Such term does not include physical tests, such as the
chemical, blood, or urine analyses of the individual
including cholesterol tests, and physical exams of the
individual, in order to detect symptoms, clinical
signs, or a diagnosis of disease.’’.
(d) EFFECTIVE DATE.—Except as provided in this sec-
tion, this section and the amendments made by this section
shall apply with respect to group health plans for plan
years beginning 1 year after the date of the enactment of
this Act.
SEC. 903. AMENDMENTS TO THE PUBLIC HEALTH
SERVICE ACT. (a) AMENDMENTS RELATING TO THE GROUP
MARKET.—
(1) PROHIBITION
OF
HEALTH
DISCRIMINATION
ON
THE
BASIS
OF
GENETIC
INFORMATION
IN
THE
GROUP MARKET.—
(A) NO ENROLLMENT RESTRICTION FOR GE-
NETIC SERVICES.—Section 2702(a)(1)(F) of the
Public Health Service Act (42 U.S.C. 300gg–
1(a)(1)(F)) is amended by inserting before the
period the following: ‘‘(including information
about a request for or receipt of genetic serv-
ices)’’.
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(B) NO
DISCRIMINATION
IN
PREMIUMS
BASED ON PREDICTIVE GENETIC INFORMATION.—
Subpart 2 of part A of title XXVII of the Public
Health Service Act (42 U.S.C. 300gg–4 et seq.)
is amended by adding at the end the following
new section:
‘‘SEC. 
2707. 
PROHIBITING 
PREMIUM 
DISCRIMINATION
AGAINST GROUPS ON THE BASIS OF PRE-
DICTIVE 
GENETIC 
INFORMATION 
IN 
THE
GROUP MARKET.
‘‘A group health plan, or a health insurance issuer of-
fering group health insurance coverage in connection with
a group health plan shall not adjust premium or contribu-
tion amounts for a group on the basis of predictive genetic
information concerning any individual (including a de-
pendent) or family member of the individual (including in-
formation about a request for or receipt of genetic serv-
ices).’’.
(C) 
CONFORMING
AMENDMENT.—Section
2702(b) of the Public Health Service Act (42
U.S.C. 300gg–1(b)) is amended by adding at the
end the following:
‘‘(3) REFERENCE TO RELATED PROVISION.—For
a provision prohibiting the adjustment of premium or
contribution amounts for a group under a group
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health plan on the basis of predictive genetic informa-
tion (including information about a request for or re-
ceipt of genetic services), see section 2707.’’.
(D) LIMITATION ON COLLECTION AND DIS-
CLOSURE
OF
PREDICTIVE
GENETIC
INFORMA-
TION.—Section 2702 of the Public Health Service
Act (42 U.S.C. 300gg–1) is amended by adding
at the end the following:
‘‘(c) COLLECTION OF PREDICTIVE GENETIC INFORMA-
TION.—
‘‘(1) LIMITATION ON REQUESTING OR REQUIRING
PREDICTIVE GENETIC INFORMATION.—Except as pro-
vided in paragraph (2), a group health plan, or a
health insurance issuer offering health insurance cov-
erage in connection with a group health plan, shall
not request or require predictive genetic information
concerning any individual (including a dependent) or
a family member of the individual (including infor-
mation about a request for or receipt of genetic serv-
ices).
‘‘(2) INFORMATION
NEEDED
FOR
DIAGNOSIS,
TREATMENT, OR PAYMENT.—
‘‘(A) IN GENERAL.—Notwithstanding para-
graph (1), a group health plan, or a health in-
surance issuer offering health insurance coverage
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in connection with a group health plan, that
provides health care items and services to an in-
dividual or dependent may request (but may not
require) that such individual or dependent dis-
close, or authorize the collection or disclosure of,
predictive genetic information for purposes of di-
agnosis, treatment, or payment relating to the
provision of health care items and services to
such individual or dependent.
‘‘(B) NOTICE
OF
CONFIDENTIALITY
PRAC-
TICES AND DESCRIPTION OF SAFEGUARDS.—As a
part of a request under subparagraph (A), the
group health plan, or a health insurance issuer
offering health insurance coverage in connection
with a group health plan, shall provide to the in-
dividual or dependent a description of the proce-
dures in place to safeguard the confidentiality,
as described in subsection (d), of such predictive
genetic information.
‘‘(d) CONFIDENTIALITY
WITH
RESPECT
TO
PRE-
DICTIVE GENETIC INFORMATION.—
‘‘(1) NOTICE OF CONFIDENTIALITY PRACTICES.—
‘‘(A) PREPARATION OF WRITTEN NOTICE.—
A group health plan, or a health insurance
issuer offering health insurance coverage in con-
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nection with a group health plan, shall post or
provide, in writing and in a clear and con-
spicuous manner, notice of the plan or issuer’s
confidentiality practices, that shall include—
‘‘(i) a description of an individual’s
rights with respect to predictive genetic in-
formation;
‘‘(ii) the procedures established by the
plan or issuer for the exercise of the individ-
ual’s rights; and
‘‘(iii) the right to obtain a copy of the
notice of the confidentiality practices re-
quired under this subsection.
‘‘(B) MODEL
NOTICE.—The Secretary, in
consultation with the National Committee on
Vital and Health Statistics and the National As-
sociation of Insurance Commissioners, and after
notice and opportunity for public comment, shall
develop and disseminate model notices of con-
fidentiality practices. Use of the model notice
shall serve as a defense against claims of receiv-
ing inappropriate notice.
‘‘(2) 
ESTABLISHMENT
OF
SAFEGUARDS.—A
group health plan, or a health insurance issuer offer-
ing health insurance coverage in connection with a
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group health plan, shall establish and maintain ap-
propriate administrative, technical, and physical
safeguards to protect the confidentiality, security, ac-
curacy, and integrity of predictive genetic informa-
tion created, received, obtained, maintained, used,
transmitted, or disposed of by such plan or issuer.’’.
(2) DEFINITIONS.—Section 2791(d) of the Public
Health Service Act (42 U.S.C. 300gg–91(d)) is
amended by adding at the end the following:
‘‘(15) FAMILY MEMBER.—The term ‘family mem-
ber’ means, with respect to an individual—
‘‘(A) the spouse of the individual;
‘‘(B) a dependent child of the individual,
including a child who is born to or placed for
adoption with the individual; and
‘‘(C) all other individuals related by blood
to the individual or the spouse or child described
in subparagraph (A) or (B).
‘‘(16) GENETIC
INFORMATION.—The term ‘ge-
netic information’ means information about genes,
gene products, or inherited characteristics that may
derive from an individual or a family member (in-
cluding information about a request for or receipt of
genetic services).
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‘‘(17) GENETIC
SERVICES.—The term ‘genetic
services’ means health services provided to obtain, as-
sess, or interpret genetic information for diagnostic
and therapeutic purposes, and for genetic education
and counseling.
‘‘(18) PREDICTIVE GENETIC INFORMATION.—
‘‘(A) IN GENERAL.—The term ‘predictive ge-
netic information’ means, in the absence of
symptoms, clinical signs, or a diagnosis of the
condition related to such information—
‘‘(i) information about an individual’s
genetic tests;
‘‘(ii) information about genetic tests of
family members of the individual; or
‘‘(iii) information about the occurrence
of a disease or disorder in family members.
‘‘(B) EXCEPTIONS.—The term ‘predictive
genetic information’ shall not include—
‘‘(i) information about the sex or age of
the individual;
‘‘(ii) information derived from phys-
ical tests, such as the chemical, blood, or
urine analyses of the individual including
cholesterol tests; and
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‘‘(iii) 
information 
about 
physical
exams of the individual.
‘‘(19) GENETIC TEST.—The term ‘genetic test’
means the analysis of human DNA, RNA, chro-
mosomes, proteins, and certain metabolites, including
analysis of genotypes, mutations, phenotypes, or
karyotypes, for the purpose of predicting risk of dis-
ease in asymptomatic or undiagnosed individuals.
Such term does not include physical tests, such as the
chemical, blood, or urine analyses of the individual
including cholesterol tests, and physical exams of the
individual, in order to detect symptoms, clinical
signs, or a diagnosis of disease.’’.
(e) AMENDMENTS TO PHSA RELATING TO THE INDI-
VIDUAL MARKET.—The first subpart 3 of part B of title
XXVII of the Public Health Service Act (42 U.S.C. 300gg–
51 et seq.) (relating to other requirements) (42 U.S.C.
300gg–51 et seq.) is amended by adding at the end the fol-
lowing:
‘‘SEC. 2753. PROHIBITION OF HEALTH DISCRIMINATION ON
THE BASIS OF PREDICTIVE GENETIC INFOR-
MATION.
‘‘(a) PROHIBITION ON PREDICTIVE GENETIC INFORMA-
TION AS A CONDITION OF ELIGIBILITY.—A health insurance
issuer offering health insurance coverage in the individual
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market may not use predictive genetic information as a
condition of eligibility of an individual to enroll in indi-
vidual health insurance coverage (including information
about a request for or receipt of genetic services).
‘‘(b) PROHIBITION ON PREDICTIVE GENETIC INFORMA-
TION IN SETTING PREMIUM RATES.—A health insurance
issuer offering health insurance coverage in the individual
market shall not adjust premium rates for individuals on
the basis of predictive genetic information concerning such
an individual (including a dependent) or a family member
of the individual (including information about a request
for or receipt of genetic services).
‘‘(c) COLLECTION OF PREDICTIVE GENETIC INFORMA-
TION.—
‘‘(1) LIMITATION ON REQUESTING OR REQUIRING
PREDICTIVE GENETIC INFORMATION.—Except as pro-
vided in paragraph (2), a health insurance issuer of-
fering health insurance coverage in the individual
market shall not request or require predictive genetic
information concerning any individual (including a
dependent) or a family member of the individual (in-
cluding information about a request for or receipt of
genetic services).
‘‘(2) INFORMATION
NEEDED
FOR
DIAGNOSIS,
TREATMENT, OR PAYMENT.—
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‘‘(A) IN GENERAL.—Notwithstanding para-
graph (1), a health insurance issuer offering
health insurance coverage in the individual mar-
ket that provides health care items and services
to an individual or dependent may request (but
may not require) that such individual or de-
pendent disclose, or authorize the collection or
disclosure of, predictive genetic information for
purposes of diagnosis, treatment, or payment re-
lating to the provision of health care items and
services to such individual or dependent.
‘‘(B) NOTICE
OF
CONFIDENTIALITY
PRAC-
TICES AND DESCRIPTION OF SAFEGUARDS.—As a
part of a request under subparagraph (A), the
health insurance issuer offering health insurance
coverage in the individual market shall provide
to the individual or dependent a description of
the procedures in place to safeguard the con-
fidentiality, as described in subsection (d), of
such predictive genetic information.
‘‘(d) CONFIDENTIALITY
WITH
RESPECT
TO
PRE-
DICTIVE GENETIC INFORMATION.—
‘‘(1) NOTICE OF CONFIDENTIALITY PRACTICES.—
‘‘(A) PREPARATION OF WRITTEN NOTICE.—
A health insurance issuer offering health insur-
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ance coverage in the individual market shall post
or provide, in writing and in a clear and con-
spicuous manner, notice of the issuer’s confiden-
tiality practices, that shall include—
‘‘(i) a description of an individual’s
rights with respect to predictive genetic in-
formation;
‘‘(ii) the procedures established by the
issuer for the exercise of the individual’s
rights; and
‘‘(iii) the right to obtain a copy of the
notice of the confidentiality practices re-
quired under this subsection.
‘‘(B) MODEL
NOTICE.—The Secretary, in
consultation with the National Committee on
Vital and Health Statistics and the National As-
sociation of Insurance Commissioners, and after
notice and opportunity for public comment, shall
develop and disseminate model notices of con-
fidentiality practices. Use of the model notice
shall serve as a defense against claims of receiv-
ing inappropriate notice.
‘‘(2) 
ESTABLISHMENT
OF
SAFEGUARDS.—A
health insurance issuer offering health insurance cov-
erage in the individual market shall establish and
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maintain appropriate administrative, technical, and
physical safeguards to protect the confidentiality, se-
curity, accuracy, and integrity of predictive genetic
information created, received, obtained, maintained,
used, transmitted, or disposed of by such issuer.’’.
(c) EFFECTIVE DATE.—The amendments made by this
section shall apply with respect to—
(1) group health plans, and health insurance
coverage offered in connection with group health
plans, for plan years beginning after 1 year after the
date of enactment of this Act; and
(2) health insurance coverage offered, sold,
issued, renewed, in effect, or operated in the indi-
vidual market after 1 year after the date of enactment
of this Act.
SEC. 904. AMENDMENTS TO THE INTERNAL REVENUE
CODE OF 1986. (a) PROHIBITION OF HEALTH DISCRIMINA-
TION ON THE BASIS OF GENETIC INFORMATION OR GE-
NETIC SERVICES.—
(1) NO ENROLLMENT RESTRICTION FOR GENETIC
SERVICES.—Section 9802(a)(1)(F) of the Internal
Revenue Code of 1986 is amended by inserting before
the period the following: ‘‘(including information
about a request for or receipt of genetic services)’’.
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(2) NO
DISCRIMINATION
IN
GROUP
PREMIUMS
BASED ON PREDICTIVE GENETIC INFORMATION.—
(A) IN GENERAL.—Subchapter B of chapter
100 of the Internal Revenue Code of 1986 is fur-
ther amended by adding at the end the following:
‘‘SEC. 
9813. 
PROHIBITING 
PREMIUM 
DISCRIMINATION
AGAINST GROUPS ON THE BASIS OF PRE-
DICTIVE GENETIC INFORMATION.
‘‘A group health plan shall not adjust premium or con-
tribution amounts for a group on the basis of predictive
genetic information concerning any individual (including
a dependent) or a family member of the individual (includ-
ing information about a request for or receipt of genetic
services).’’.
(B) 
CONFORMING
AMENDMENT.—Section
9802(b) of the Internal Revenue Code of 1986 is
amended by adding at the end the following:
‘‘(3) REFERENCE TO RELATED PROVISION.—For
a provision prohibiting the adjustment of premium or
contribution amounts for a group under a group
health plan on the basis of predictive genetic informa-
tion (including information about a request for or the
receipt of genetic services), see section 9813.’’.
(C) AMENDMENT TO TABLE OF SECTIONS.—
The table of sections for subchapter B of chapter
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100 of the Internal Revenue Code of 1986 is
amended by adding at the end the following:
‘‘Sec. 9813. Prohibiting premium discrimination against groups on the basis of
predictive genetic information.’’.
(b) LIMITATION ON COLLECTION OF PREDICTIVE GE-
NETIC INFORMATION.—Section 9802 of the Internal Rev-
enue Code of 1986 is amended by adding at the end the
following:
‘‘(d) COLLECTION OF PREDICTIVE GENETIC INFORMA-
TION.—
‘‘(1) LIMITATION ON REQUESTING OR REQUIRING
PREDICTIVE GENETIC INFORMATION.—Except as pro-
vided in paragraph (2), a group health plan shall not
request or require predictive genetic information con-
cerning any individual (including a dependent) or a
family member of the individual (including informa-
tion about a request for or receipt of genetic services).
‘‘(2) INFORMATION
NEEDED
FOR
DIAGNOSIS,
TREATMENT, OR PAYMENT.—
‘‘(A) IN GENERAL.—Notwithstanding para-
graph (1), a group health plan that provides
health care items and services to an individual
or dependent may request (but may not require)
that such individual or dependent disclose, or
authorize the collection or disclosure of, pre-
dictive genetic information for purposes of diag-
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nosis, treatment, or payment relating to the pro-
vision of health care items and services to such
individual or dependent.
‘‘(B) NOTICE
OF
CONFIDENTIALITY
PRAC-
TICES; DESCRIPTION
OF
SAFEGUARDS.—As a
part of a request under subparagraph (A), the
group health plan shall provide to the individual
or dependent a description of the procedures in
place to safeguard the confidentiality, as de-
scribed in subsection (e), of such predictive ge-
netic information.
‘‘(e) CONFIDENTIALITY WITH RESPECT TO PREDICTIVE
GENETIC INFORMATION.—
‘‘(1) NOTICE OF CONFIDENTIALITY PRACTICES.—
‘‘(A) PREPARATION OF WRITTEN NOTICE.—
A group health plan shall post or provide, in
writing and in a clear and conspicuous manner,
notice of the plan’s confidentiality practices, that
shall include—
‘‘(i) a description of an individual’s
rights with respect to predictive genetic in-
formation;
‘‘(ii) the procedures established by the
plan for the exercise of the individual’s
rights; and
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‘‘(iii) the right to obtain a copy of the
notice of the confidentiality practices re-
quired under this subsection.
‘‘(B) MODEL
NOTICE.—The Secretary, in
consultation with the National Committee on
Vital and Health Statistics and the National As-
sociation of Insurance Commissioners, and after
notice and opportunity for public comment, shall
develop and disseminate model notices of con-
fidentiality practices. Use of the model notice
shall serve as a defense against claims of receiv-
ing inappropriate notice.
‘‘(2) 
ESTABLISHMENT
OF
SAFEGUARDS.—A
group health plan shall establish and maintain ap-
propriate administrative, technical, and physical
safeguards to protect the confidentiality, security, ac-
curacy, and integrity of predictive genetic informa-
tion created, received, obtained, maintained, used,
transmitted, or disposed of by such plan.’’.
(c) DEFINITIONS.—Section 9832(d) of the Internal
Revenue Code of 1986 is amended by adding at the end
the following:
‘‘(6) FAMILY MEMBER.—The term ‘family mem-
ber’ means, with respect to an individual—
‘‘(A) the spouse of the individual;
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‘‘(B) a dependent child of the individual,
including a child who is born to or placed for
adoption with the individual; and
‘‘(C) all other individuals related by blood
to the individual or the spouse or child described
in subparagraph (A) or (B).
‘‘(7) GENETIC INFORMATION.—The term ‘genetic
information’ means information about genes, gene
products, or inherited characteristics that may derive
from an individual or a family member (including
information about a request for or receipt of genetic
services).
‘‘(8) GENETIC
SERVICES.—The term ‘genetic
services’ means health services provided to obtain, as-
sess, or interpret genetic information for diagnostic
and therapeutic purposes, and for genetic education
and counseling.
‘‘(9) PREDICTIVE GENETIC INFORMATION.—
‘‘(A) IN GENERAL.—The term ‘predictive ge-
netic information’ means, in the absence of
symptoms, clinical signs, or a diagnosis of the
condition related to such information—
‘‘(i) information about an individual’s
genetic tests;
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‘‘(ii) information about genetic tests of
family members of the individual; or
‘‘(iii) information about the occurrence
of a disease or disorder in family members.
‘‘(B) EXCEPTIONS.—The term ‘predictive
genetic information’ shall not include—
‘‘(i) information about the sex or age of
the individual;
‘‘(ii) information derived from phys-
ical tests, such as the chemical, blood, or
urine analyses of the individual including
cholesterol tests; and
‘‘(iii) 
information 
about 
physical
exams of the individual.
‘‘(10) GENETIC TEST.—The term ‘genetic test’
means the analysis of human DNA, RNA, chro-
mosomes, proteins, and certain metabolites, including
analysis of genotypes, mutations, phenotypes, or
karyotypes, for the purpose of predicting risk of dis-
ease in asymptomatic or undiagnosed individuals.
Such term does not include physical tests, such as the
chemical, blood, or urine analyses of the individual
including cholesterol tests, and physical exams of the
individual, in order to detect symptoms, clinical
signs, or a diagnosis of disease.’’.
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(d) EFFECTIVE DATE.—Except as provided in this sec-
tion, this section and the amendments made by this section
shall apply with respect to group health plans for plan
years beginning after 1 year after the date of the enactment
of this Act.
DIVISION B—HEALTH CARE AC-
CESS AND PROTECTIONS FOR
CONSUMERS
SEC. 2001. SHORT TITLE.
This division may be cited as the ‘‘Patients’ Bill of
Rights Plus Act’’.
TITLE XXI—TAX-RELATED
HEALTH CARE PROVISIONS
Subtitle A—Health Care and Long-
Term Care
SEC. 2101. DEDUCTION FOR HEALTH AND LONG-TERM CARE
INSURANCE COSTS OF INDIVIDUALS NOT
PARTICIPATING 
IN 
EMPLOYER-SUBSIDIZED
HEALTH PLANS.
(a) IN GENERAL.—Part VII of subchapter B of chapter
1 of the Internal Revenue Code of 1986 is amended by redes-
ignating section 222 as section 223 and by inserting after
section 221 the following new section:
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‘‘SEC. 222. HEALTH AND LONG-TERM CARE INSURANCE
COSTS.
‘‘(a) IN GENERAL.—In the case of an individual, there
shall be allowed as a deduction an amount equal to the ap-
plicable percentage of the amount paid during the taxable
year for insurance which constitutes medical care for the
taxpayer and the taxpayer’s spouse and dependents.
‘‘(b) APPLICABLE PERCENTAGE.—
‘‘(1) IN GENERAL.—For purposes of subsection
(a), the applicable percentage shall be determined in
accordance with the following table:
‘‘For taxable years beginning
The applicable
in calendar year—
percentage is—
2002 and 2003 ...................................................................................
2004 .....................................................................................................
2005 .....................................................................................................
2006 and thereafter ............................................................................
100.
‘‘(2) LONG-TERM CARE INSURANCE FOR INDIVID-
UALS 60 YEARS OR OLDER.—In the case of amounts
paid for a qualified long-term care insurance contract
for an individual who has attained age 60 before the
close of the taxable year, the applicable percentage is
100.
‘‘(c) LIMITATION BASED ON OTHER COVERAGE.—
‘‘(1) COVERAGE
UNDER
CERTAIN
SUBSIDIZED
EMPLOYER PLANS.—
‘‘(A) IN GENERAL.—Subsection (a) shall not
apply to any taxpayer for any calendar month
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for which the taxpayer participates in any
health plan maintained by any employer of the
taxpayer or of the spouse of the taxpayer if 50
percent or more of the cost of coverage under
such plan (determined under section 4980B and
without regard to payments made with respect to
any coverage described in subsection (e)) is paid
or incurred by the employer.
‘‘(B) EMPLOYER CONTRIBUTIONS TO CAFE-
TERIA
PLANS, FLEXIBLE
SPENDING
ARRANGE-
MENTS, AND MEDICAL SAVINGS ACCOUNTS.—Em-
ployer contributions to a cafeteria plan, a flexi-
ble spending or similar arrangement, or a med-
ical savings account which are excluded from
gross income under section 106 shall be treated
for purposes of subparagraph (A) as paid by the
employer.
‘‘(C) AGGREGATION
OF
PLANS
OF
EM-
PLOYER.—A health plan which is not otherwise
described in subparagraph (A) shall be treated as
described in such subparagraph if such plan
would be so described if all health plans of per-
sons treated as a single employer under sub-
section (b), (c), (m), or (o) of section 414 were
treated as one health plan.
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‘‘(D) SEPARATE APPLICATION TO HEALTH
INSURANCE AND LONG-TERM CARE INSURANCE.—
Subparagraphs (A) and (C) shall be applied sep-
arately with respect to—
‘‘(i) plans which include primarily
coverage for qualified long-term care serv-
ices or are qualified long-term care insur-
ance contracts, and
‘‘(ii) plans which do not include such
coverage and are not such contracts.
‘‘(2) COVERAGE UNDER CERTAIN FEDERAL PRO-
GRAMS.—
‘‘(A) IN GENERAL.—Subsection (a) shall not
apply to any amount paid for any coverage for
an individual for any calendar month if, as of
the first day of such month, the individual is
covered under any medical care program de-
scribed in—
‘‘(i) title XVIII, XIX, or XXI of the So-
cial Security Act,
‘‘(ii) chapter 55 of title 10, United
States Code,
‘‘(iii) chapter 17 of title 38, United
States Code,
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‘‘(iv) chapter 89 of title 5, United
States Code, or
‘‘(v) the Indian Health Care Improve-
ment Act.
‘‘(B) EXCEPTIONS.—
‘‘(i) QUALIFIED
LONG-TERM
CARE.—
Subparagraph (A) shall not apply to
amounts paid for coverage under a qualified
long-term care insurance contract.
‘‘(ii) CONTINUATION
COVERAGE
OF
FEHBP.—Subparagraph (A)(iv) shall not
apply to coverage which is comparable to
continuation coverage under section 4980B.
‘‘(d) LONG-TERM CARE DEDUCTION LIMITED
TO
QUALIFIED LONG-TERM CARE INSURANCE CONTRACTS.—
In the case of a qualified long-term care insurance contract,
only eligible long-term care premiums (as defined in section
213(d)(10)) may be taken into account under subsection (a).
‘‘(e) DEDUCTION NOT AVAILABLE FOR PAYMENT OF
ANCILLARY COVERAGE PREMIUMS.—Any amount paid as
a premium for insurance which provides for—
‘‘(1) coverage for accidents, disability, dental
care, vision care, or a specified illness, or
‘‘(2) making payments of a fixed amount per
day (or other period) by reason of being hospitalized,
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shall not be taken into account under subsection (a).
‘‘(f) SPECIAL RULES.—
‘‘(1) COORDINATION
WITH
DEDUCTION
FOR
HEALTH INSURANCE COSTS OF SELF-EMPLOYED INDI-
VIDUALS.—The amount taken into account by the tax-
payer in computing the deduction under section
162(l) shall not be taken into account under this sec-
tion.
‘‘(2) COORDINATION
WITH
MEDICAL
EXPENSE
DEDUCTION.—The amount taken into account by the
taxpayer in computing the deduction under this sec-
tion shall not be taken into account under section
213.
‘‘(g) REGULATIONS.—The Secretary shall prescribe
such regulations as may be appropriate to carry out this
section, including regulations requiring employers to report
to their employees and the Secretary such information as
the Secretary determines to be appropriate.’’.
(b) DEDUCTION ALLOWED WHETHER OR NOT TAX-
PAYER ITEMIZES OTHER DEDUCTIONS.—Subsection (a) of
section 62 of such Code is amended by inserting after para-
graph (17) the following new item:
‘‘(18) HEALTH
AND
LONG-TERM
CARE
INSUR-
ANCE
COSTS.—The deduction allowed by section
222.’’.
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(c) CLERICAL AMENDMENT.—The table of sections for
part VII of subchapter B of chapter 1 of such Code is
amended by striking the last item and inserting the fol-
lowing new items:
‘‘Sec. 222. Health and long-term care insurance costs.
‘‘Sec. 223. Cross reference.’’.
(d) EFFECTIVE DATE.—The amendments made by this
section shall apply to taxable years beginning after Decem-
ber 31, 2001.
SEC. 2102. DEDUCTION FOR 100 PERCENT OF HEALTH IN-
SURANCE COSTS OF SELF-EMPLOYED INDI-
VIDUALS.
(a) IN GENERAL.—Paragraph (1) of section 162(l) of
the Internal Revenue Code of 1986 is amended to read as
follows:
‘‘(1) ALLOWANCE OF DEDUCTION.—In the case of
an individual who is an employee within the mean-
ing of section 401(c)(1), there shall be allowed as a
deduction under this section an amount equal to 100
percent of the amount paid during the taxable year
for insurance which constitutes medical care for the
taxpayer and the taxpayer’s spouse and dependents.’’.
(b) CLARIFICATION OF LIMITATIONS ON OTHER COV-
ERAGE.—The first sentence of section 162(l)(2)(B) of such
Code is amended to read as follows: ‘‘Paragraph (1) shall
not apply to any taxpayer for any calendar month for
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which the taxpayer participates in any subsidized health
plan maintained by any employer (other than an employer
described in section 401(c)(4)) of the taxpayer or the spouse
of the taxpayer.’’.
(c) EFFECTIVE DATE.—The amendments made by this
section shall apply to taxable years beginning after Decem-
ber 31, 2001.
SEC. 2103. LONG-TERM CARE INSURANCE PERMITTED TO BE
OFFERED UNDER CAFETERIA PLANS AND
FLEXIBLE SPENDING ARRANGEMENTS.
(a) CAFETERIA PLANS.—
(1) IN GENERAL.—Subsection (f) of section 125
of the Internal Revenue Code of 1986 (defining quali-
fied benefits) is amended by inserting before the pe-
riod at the end ‘‘; except that such term shall include
the payment of premiums for any qualified long-term
care insurance contract (as defined in section 7702B)
to the extent the amount of such payment does not ex-
ceed the eligible long-term care premiums (as defined
in section 213(d)(10)) for such contract’’.
(b) FLEXIBLE SPENDING ARRANGEMENTS.—Section
106 of such Code (relating to contributions by employer to
accident and health plans) is amended by striking sub-
section (c).
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(c) EFFECTIVE DATE.—The amendments made by this
section shall apply to taxable years beginning after Decem-
ber 31, 2001.
SEC. 2104. ADDITIONAL PERSONAL EXEMPTION FOR TAX-
PAYER CARING FOR ELDERLY FAMILY MEM-
BER IN TAXPAYER’S HOME.
(a) IN GENERAL.—Section 151 of the Internal Revenue
Code of 1986 (relating to allowance of deductions for per-
sonal exemptions) is amended by redesignating subsection
(e) as subsection (f) and by inserting after subsection (d)
the following new subsection:
‘‘(e) ADDITIONAL EXEMPTION FOR CERTAIN ELDERLY
FAMILY MEMBERS RESIDING WITH TAXPAYER.—
‘‘(1) IN GENERAL.—An exemption of the exemp-
tion amount for each qualified family member of the
taxpayer.
‘‘(2) QUALIFIED FAMILY MEMBER.—For purposes
of this subsection, the term ‘qualified family member’
means, with respect to any taxable year, any
individual—
‘‘(A) who is an ancestor of the taxpayer or
of the taxpayer’s spouse or who is the spouse of
any such ancestor,
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‘‘(B) who is a member for the entire taxable
year of a household maintained by the taxpayer,
and
‘‘(C) who has been certified, before the due
date for filing the return of tax for the taxable
year (without extensions), by a physician (as de-
fined in section 1861(r)(1) of the Social Security
Act) as being an individual with long-term care
needs described in paragraph (3) for a period—
‘‘(i) which is at least 180 consecutive
days, and
‘‘(ii) a portion of which occurs within
the taxable year.
Such term shall not include any individual otherwise
meeting the requirements of the preceding sentence
unless within the 391⁄2 month period ending on such
due date (or such other period as the Secretary pre-
scribes) a physician (as so defined) has certified that
such individual meets such requirements.
‘‘(3) 
INDIVIDUALS
WITH
LONG-TERM
CARE
NEEDS.—An individual is described in this para-
graph if the individual—
‘‘(A) is unable to perform (without substan-
tial assistance from another individual) at least
two activities of daily living (as defined in sec-
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tion 7702B(c)(2)(B)) due to a loss of functional
capacity, or
‘‘(B) requires substantial supervision to
protect such individual from threats to health
and safety due to severe cognitive impairment
and is unable to perform, without reminding or
cuing assistance, at least one activity of daily
living (as so defined) or to the extent provided
in regulations prescribed by the Secretary (in
consultation with the Secretary of Health and
Human Services), is unable to engage in age ap-
propriate activities.
‘‘(4) SPECIAL RULES.—Rules similar to the rules
of paragraphs (1), (2), (3), (4), and (5) of section
21(e) shall apply for purposes of this subsection.’’.
(b) EFFECTIVE DATE.—The amendments made by this
section shall apply to taxable years beginning after Decem-
ber 31, 2001.
SEC. 2105. STUDY OF LONG-TERM CARE NEEDS IN THE 21ST
CENTURY.
(a) IN GENERAL.—The Secretary of Health and
Human Services (referred to in this section as the ‘‘Sec-
retary’’) shall on or after October 1, 2001, provide, in ac-
cordance with this section, for a study in order to
determine—
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(1) future demand for long-term health care serv-
ices (including institutional and home and commu-
nity-based services) in the United States in order to
meet the needs in the 21st century; and
(2) long-term options to finance the provision of
such services.
(b) DETAILS.—The study conducted under subsection
(a) shall include the following:
(1) An identification of the relevant demographic
characteristics affecting demand for long-term health
care services, at least through the year 2030.
(2) The viability and capacity of community-
based and other long-term health care services under
different federal programs, including through the
medicare and medicaid programs, grants to States,
housing services, and changes in tax policy.
(3) How to improve the quality of long-term
health care services.
(4) The integration of long-term health care serv-
ices for individuals between different classes of health
care providers (such as hospitals, nursing facilities,
and home care agencies) and different Federal pro-
grams (such as the medicare and medicaid pro-
grams).
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(5) The possibility of expanding private sector
initiatives, including long-term care insurance, to
meet the need to finance such services.
(6) An examination of the effect of enactment of
the Health Insurance Portability and Accountability
Act of 1996 on the provision and financing of long-
term health care services, including on portability
and affordability of private long-term care insurance,
the impact of insurance options on low-income older
Americans, and the options for eligibility to improve
access to such insurance.
(7) The financial impact of the provision of
long-term health care services on caregivers and other
family members.
(c) REPORT AND RECOMMENDATIONS.—
(1) IN GENERAL.—October 1, 2002, the Secretary
shall provide for a report on the study under this sec-
tion.
(2) 
RECOMMENDATIONS.—The 
report 
under
paragraph (1) shall include findings and rec-
ommendations regarding each of the following:
(A) The most effective and efficient manner
that the Federal Government may use its re-
sources to educate the public on planning for
needs for long-term health care services.
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(B) The public, private, and joint public-
private strategies for meeting identified needs for
long-term health care services.
(C) The role of States and local commu-
nities in the financing of long-term health care
services.
(3) INCLUSION OF COST ESTIMATES.—The report
under paragraph (1) shall include cost estimates of
the various options for which recommendations are
made.
(d) CONDUCT OF STUDY.—
(1) USE OF INSTITUTE OF MEDICINE.—The Sec-
retary of Health and Human Services shall seek to
enter into an appropriate arrangement with the In-
stitute of Medicine of the National Academy of
Sciences to conduct the study under this section. If
such an arrangement cannot be made, the Secretary
may provide for the conduct of the study by any other
qualified non-governmental entity.
(2) CONSULTATION.—The study should be con-
ducted under this section in consultation with experts
from a wide-range of groups from the public and pri-
vate sectors.
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Subtitle B—Medical Savings
Accounts
SEC. 2111. EXPANSION OF AVAILABILITY OF MEDICAL SAV-
INGS ACCOUNTS.
(a) REPEAL OF LIMITATIONS ON NUMBER OF MEDICAL
SAVINGS ACCOUNTS.—
(1) IN GENERAL.—Subsections (i) and (j) of sec-
tion 220 of the Internal Revenue Code of 1986 are
hereby repealed.
(2) CONFORMING AMENDMENTS.—
(A) Paragraph (1) of section 220(c) of such
Code is amended by striking subparagraph (D).
(B) Section 138 of such Code is amended by
striking subsection (f).
(b) AVAILABILITY NOT LIMITED TO ACCOUNTS FOR
EMPLOYEES OF SMALL EMPLOYERS AND SELF-EMPLOYED
INDIVIDUALS.—
(1) IN GENERAL.—Section 220(c)(1)(A) of such
Code (relating to eligible individual) is amended to
read as follows:
‘‘(A) IN GENERAL.—The term ‘eligible indi-
vidual’ means, with respect to any month, any
individual if—
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‘‘(i) such individual is covered under a
high deductible health plan as of the 1st day
of such month, and
‘‘(ii) such individual is not, while cov-
ered under a high deductible health plan,
covered under any health plan—
‘‘(I) which is not a high deduct-
ible health plan, and
‘‘(II) which provides coverage for
any benefit which is covered under the
high deductible health plan.’’.
(2) CONFORMING AMENDMENTS.—
(A) Section 220(c)(1) of such Code is
amended by striking subparagraph (C).
(B) Section 220(c) of such Code is amended
by striking paragraph (4) (defining small em-
ployer) and by redesignating paragraph (5) as
paragraph (4).
(C) Section 220(b) of such Code is amended
by striking paragraph (4) (relating to deduction
limited by compensation) and by redesignating
paragraphs (5), (6), and (7) as paragraphs (4),
(5), and (6), respectively.
(c) INCREASE IN AMOUNT OF DEDUCTION ALLOWED
FOR CONTRIBUTIONS TO MEDICAL SAVINGS ACCOUNTS.—
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(1) IN
GENERAL.—Paragraph (2) of section
220(b) of such Code is amended to read as follows:
‘‘(2) MONTHLY LIMITATION.—The monthly limi-
tation for any month is the amount equal to 1⁄12 of
the annual deductible (as of the first day of such
month) of the individual’s coverage under the high de-
ductible health plan.’’.
(2) CONFORMING
AMENDMENT.—Clause (ii) of
section 220(d)(1)(A) of such Code is amended by
striking ‘‘75 percent of’’.
(d) BOTH EMPLOYERS AND EMPLOYEES MAY CON-
TRIBUTE
TO MEDICAL SAVINGS ACCOUNTS.—Paragraph
(4) of section 220(b) of such Code (as redesignated by sub-
section (b)(2)(C)) is amended to read as follows:
‘‘(4) COORDINATION WITH EXCLUSION FOR EM-
PLOYER
CONTRIBUTIONS.—The 
limitation 
which
would (but for this paragraph) apply under this sub-
section to the taxpayer for any taxable year shall be
reduced (but not below zero) by the amount which
would (but for section 106(b)) be includible in the
taxpayer’s gross income for such taxable year.’’.
(e) REDUCTION OF PERMITTED DEDUCTIBLES UNDER
HIGH DEDUCTIBLE HEALTH PLANS.—
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(1) IN GENERAL.—Subparagraph (A) of section
220(c)(2) of such Code (defining high deductible
health plan) is amended—
(A) by striking ‘‘$1,500’’ in clause (i) and
inserting ‘‘$1,000’’;
(B) by striking ‘‘$3,000’’ in clause (ii) and
inserting ‘‘$2,000’’; and
(C) by striking the matter preceding sub-
clause (I) in clause (iii) and inserting ‘‘pursuant
to which the annual out-of-pocket expenses (in-
cluding deductibles and co-payments) are re-
quired to be paid under the plan (other than for
premiums) for covered benefits and may not ex-
ceed—’’.
(2) CONFORMING
AMENDMENT.—Subsection (g)
of section 220 of such Code is amended to read as fol-
lows:
‘‘(g) COST-OF-LIVING ADJUSTMENT.—
‘‘(1) IN GENERAL.—In the case of any taxable
year beginning in a calendar year after 2002, each
dollar amount in subsection (c)(2) shall be increased
by an amount equal to—
‘‘(A) such dollar amount, multiplied by
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar year
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in which such taxable year begins by sub-
stituting ‘calendar year 2001’ for ‘calendar year
1992’ in subparagraph (B) thereof.
‘‘(2) SPECIAL RULES.—In the case of the $1,000
amount in subsection (c)(2)(A)(i) and the $2,000
amount in subsection (c)(2)(A)(ii), paragraph (1)(B)
shall be applied by substituting ‘calendar year 2002’
for ‘calendar year 2001’.
‘‘(3) ROUNDING.—If any increase under para-
graph (1) or (2) is not a multiple of $50, such in-
crease shall be rounded to the nearest multiple of
$50.’’.
(f) LIMITATION ON ADDITIONAL TAX ON DISTRIBU-
TIONS NOT USED FOR QUALIFIED MEDICAL EXPENSES.—
Section 220(f)(4) of such Code (relating to additional tax
on distributions not used for qualified medical expenses) is
amended by adding at the end the following:
‘‘(D) EXCEPTION IN CASE OF SUFFICIENT
ACCOUNT
BALANCE.—Subparagraph (A) shall
not apply to any payment or distribution in
any taxable year, but only to the extent such
payment or distribution does not reduce the fair
market value of the assets of the medical savings
account to an amount less than the annual de-
ductible for the high deductible health plan of the
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account holder (determined as of the earlier of
January 1 of the calendar year in which the tax-
able year begins or January 1 of the last cal-
endar year in which the account holder is cov-
ered under a high deductible health plan).’’.
(g) TREATMENT OF NETWORK-BASED MANAGED CARE
PLANS.—Section 220(c)(2)(B) of such Code (relating to spe-
cial rules for high deductible health plans) is amended by
adding at the end the following:
‘‘(iii) TREATMENT OF NETWORK-BASED
MANAGED CARE PLANS.—A plan which pro-
vides health care services through a network
of contracted or affiliated health care pro-
viders, if the benefits provided when services
are obtained through network providers
meet the requirements of subparagraph (A),
shall not fail to be treated as a high deduct-
ible health plan by reason of providing ben-
efits for services rendered by providers who
are not members of the network, so long as
the annual deductible and annual limit on
out-of-pocket expenses applicable to services
received from non-network providers are not
lower than those applicable to services re-
ceived from the network providers.’’.
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(h) MEDICAL SAVINGS ACCOUNTS MAY BE OFFERED
UNDER CAFETERIA PLANS.—Subsection (f) of section 125
of such Code is amended by striking ‘‘106(b),’’.
(i) EFFECTIVE DATE.—
(1) IN GENERAL.—Except as provided by para-
graph (2), the amendments made by this section shall
apply to taxable years beginning after December 31,
2001.
(2) LIMITATION ON ADDITIONAL TAX ON DIS-
TRIBUTIONS NOT USED
FOR QUALIFIED MEDICAL
EXPENSES.—The amendment made by subsection (f)
shall apply to taxable years beginning after December
31, 2005.
SEC. 2112. AMENDMENTS TO TITLE 5, UNITED STATES
CODE, RELATING TO MEDICAL SAVINGS AC-
COUNTS AND HIGH DEDUCTIBLE HEALTH
PLANS UNDER FEHBP.
(a) MEDICAL SAVINGS ACCOUNTS.—
(1) CONTRIBUTIONS.—Title 5, United States
Code, is amended by redesignating section 8906a as
section 8906c and by inserting after section 8906 the
following:
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‘‘§ 8906a. Government contributions to medical sav-
ings accounts
‘‘(a) An employee or annuitant enrolled in a high de-
ductible health plan is entitled, in addition to the Govern-
ment contribution under section 8906(b) toward the sub-
scription charge for such plan, to have a Government con-
tribution made, in accordance with succeeding provisions
of this section, to a medical savings account of such em-
ployee or annuitant.
‘‘(b)(1) The biweekly Government contribution under
this section shall, in the case of any such employee or annu-
itant, be equal to the amount (if any) by which—
‘‘(A) the biweekly equivalent of the maximum
Government contribution for the contract year in-
volved (as defined by paragraph (2)), exceeds
‘‘(B) the amount of the biweekly Government
contribution payable on such employee’s or annu-
itant’s behalf under section 8906(b) for the period in-
volved.
‘‘(2) For purposes of this section, the term ‘maximum
Government contribution’ means, with respect to a contract
year, the maximum Government contribution that could be
made for health benefits for an employee or annuitant for
such contract year, as determined under section 8906(b)
(disregarding paragraph (2) thereof).
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‘‘(3) Notwithstanding any other provision of this sec-
tion, no contribution under this section shall be payable to
any medical savings account of an employee or annuitant
for any period—
‘‘(A) if, as of the first day of the month before
the month in which such period commences, such em-
ployee or annuitant (or the spouse of such employee
or annuitant, if coverage is for self and family) is en-
titled to benefits under part A of title XVIII of the
Social Security Act;
‘‘(B) to the extent that such contribution, when
added to previous contributions made under this sec-
tion for that same year with respect to such employee
or annuitant, would cause the total to exceed—
‘‘(i) the limitation under paragraph (1) of
section 220(b) of the Internal Revenue Code of
1986 (determined without regard to paragraph
(3) thereof) which is applicable to such employee
or annuitant for the calendar year in which such
period commences; or
‘‘(ii) such lower amount as the employee or
annuitant may specify in accordance with regu-
lations of the Office, including an election not to
receive contributions under this section for a
year or the remainder of a year; or
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‘‘(C) for which any information (or documenta-
tion) under subsection (d) that is needed in order to
make such contribution has not been timely sub-
mitted.
‘‘(4) Notwithstanding any other provision of this sec-
tion, no contribution under this section shall be payable to
any medical savings account of an employee for any period
in a contract year unless that employee was enrolled in a
health benefits plan under this chapter as an employee for
not less than—
‘‘(A) the 1 year of service immediately before the
start of such contract year, or
‘‘(B) the full period or periods of service between
the last day of the first period, as prescribed by regu-
lations of the Office of Personnel Management, in
which he is eligible to enroll in the plan and the day
before the start of such contract year,
whichever is shorter.
‘‘(5) The Office shall provide for the conversion of bi-
weekly rates of contributions specified by paragraph (1) to
rates for employees and annuitants whose pay or annuity
is provided on other than a biweekly basis, and for this
purpose may provide for the adjustment of the converted
rate to the nearest cent.
‘‘(c) A Government contribution under this section—
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‘‘(1) shall be made at the same time that, and
the same frequency with which, Government contribu-
tions under section 8906(b) are made for the benefit
of the employee or annuitant involved; and
‘‘(2) shall be payable from the same appropria-
tion, fund, account, or other source as would any
Government contributions under section 8906(b) with
respect to the employee or annuitant involved.
‘‘(d) The Office shall by regulation prescribe the time,
form, and manner in which an employee or annuitant shall
submit any information (and supporting documentation)
necessary to identify any medical savings account to which
contributions under this section are requested to be made.
‘‘(e) Nothing in this section shall be considered to enti-
tle an employee or annuitant to any Government contribu-
tion under this section with respect to any period for which
such employee or annuitant is ineligible for a Government
contribution under section 8906(b).
‘‘§ 8906b. Individual contributions to medical savings
accounts
‘‘(a) Upon the written request of an employee or annu-
itant enrolled in a high deductible health plan, there shall
be withheld from the pay or annuity of such employee or
annuitant and contributed to the medical savings account
identified by such employee or annuitant in accordance
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with applicable regulations under subsection (c) such
amount as the employee or annuitant may specify.
‘‘(b) Notwithstanding subsection (a), no withholding
under this section may be made from the pay or annuity
of an employee or annuitant for any period—
‘‘(1) if, or to the extent that, a Government con-
tribution for such period under section 8906a would
not be allowable by reason of subparagraph (A) or
(B)(i) of subsection (b)(3) thereof;
‘‘(2) for which any information (or documenta-
tion) that is needed in order to make such contribu-
tion has not been timely submitted; or
‘‘(3) if the employee or annuitant submits a re-
quest for termination of withholdings, beginning on
or after the effective date of the request and before the
end of the year.
‘‘(c) The Office of Personnel Management shall pre-
scribe any regulations necessary to carry out this section,
including provisions relating to the time, form, and manner
in which any request for withholdings under this section
may be made, changed, or terminated.’’.
(2) RULES OF CONSTRUCTION.—Nothing in this
section or in any amendment made by this section
shall be considered—
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(A) to permit or require that any contribu-
tions to a medical savings account (whether by
the Government or through withholdings from
pay or annuity) be paid into the Employees
Health Benefits Fund; or
(B) to affect any authority under section
1005(f) of title 39, United States Code, to vary,
add to, or substitute for any provision of chapter
89 of title 5, United States Code, as amended by
this section.
(3) CONFORMING AMENDMENTS.—
(A) The table of sections at the beginning of
chapter 89 of title 5, United States Code, is
amended by striking the item relating to section
8906a and inserting the following:
‘‘8906a. Government contributions to medical savings accounts.
‘‘8906b. Individual contributions to medical savings accounts.
‘‘8906c. Temporary employees.’’.
(B) Section 8913(b)(4) of title 5, United
States Code, is amended by striking ‘‘8906a(a)’’
and inserting ‘‘8906c(a)’’.
(b) INFORMATIONAL REQUIREMENTS.—Section 8907 of
title 5, United States Code, is amended by adding at the
end the following:
‘‘(c) In addition to any information otherwise required
under this section, the Office shall make available to all em-
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ployees and annuitants eligible to enroll in a high deduct-
ible health plan, information relating to—
‘‘(1) the conditions under which Government
contributions under section 8906a shall be made to a
medical savings account;
‘‘(2) the amount of any Government contribu-
tions under section 8906a to which an employee or
annuitant may be entitled (or how such amount may
be ascertained);
‘‘(3) the conditions under which contributions to
a medical savings account may be made under section
8906b through withholdings from pay or annuity;
and
‘‘(4) any other matter the Office considers appro-
priate in connection with medical savings accounts.’’.
(c) HIGH DEDUCTIBLE HEALTH PLAN AND MEDICAL
SAVINGS ACCOUNT DEFINED.—Section 8901 of title 5,
United States Code, is amended—
(1) in paragraph (10) by striking ‘‘and’’ after
the semicolon;
(2) in paragraph (11) by striking the period and
inserting a semicolon; and
(3) by adding at the end the following:
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‘‘(12) the term ‘high deductible health plan’
means a plan described by section 8903(5) or section
8903a(d); and
‘‘(13) the term ‘medical savings account’ has the
meaning given such term by section 220(d) of the In-
ternal Revenue Code of 1986.’’.
(d) AUTHORITY TO CONTRACT FOR HIGH DEDUCT-
IBLE HEALTH PLANS, ETC.—
(1) CONTRACTS FOR HIGH DEDUCTIBLE HEALTH
PLANS.—Section 8902 of title 5, United States Code,
is amended by adding at the end the following:
‘‘(p)(1) The Office shall contract under this chapter for
a high deductible health plan with any qualified carrier
that offers such a plan and, as of the date of enactment
of this subsection, offers a health benefits plan under this
chapter.
‘‘(2) The Office may contract under this chapter for
a high deductible health plan with any qualified carrier
that offers such a plan, but does not, as of the date of enact-
ment of this subsection, offer a health benefits plan under
this chapter.’’.
(2) COMPUTATION OF GOVERNMENT CONTRIBU-
TIONS TO PLANS UNDER CHAPTER 89 NOT AFFECTED
BY HIGH DEDUCTIBLE HEALTH PLANS.—Paragraph
(2) of section 8906(a) of title 5, United States Code,
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is amended by striking ‘‘(2)’’ and inserting ‘‘(2)(A)’’,
and adding at the end the following:
‘‘(B) Notwithstanding any other provision of this sec-
tion, the subscription charges for, and the number of enroll-
ees enrolled in, high deductible health plans shall be dis-
regarded for purposes of determining any weighted average
under paragraph (1).’’.
(e) DESCRIPTION
OF HIGH DEDUCTIBLE HEALTH
PLANS AND BENEFITS TO BE PROVIDED THEREUNDER.—
(1) IN
GENERAL.—Section 8903 of title 5,
United States Code, is amended by adding at the end
the following:
‘‘(5) HIGH DEDUCTIBLE HEALTH PLANS.—(A)
One or more plans described by paragraph (1), (2),
(3), or (4), which—
‘‘(i) are high deductible health plans (as de-
fined by section 220(c)(2) of the Internal Rev-
enue Code of 1986); and
‘‘(ii) provide benefits of the types referred to
by section 8904(a)(5).
‘‘(B) 
Nothing 
in 
this 
section 
shall 
be
considered—
‘‘(i) to prevent a carrier from simulta-
neously offering a plan described by subpara-
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graph (A) and a plan described by paragraph
(1) or (2); or
‘‘(ii) to require that a high deductible health
plan offer two levels of benefits.’’.
(2) TYPES
OF
BENEFITS.—Section 8904(a) of
title 5, United States Code, is amended by inserting
after paragraph (4) the following:
‘‘(5) HIGH DEDUCTIBLE HEALTH PLANS.—Ben-
efits of the types named under paragraph (1) or (2)
of this subsection or both.’’.
(3) CONFORMING AMENDMENTS.—
(A) Section 8903a of title 5, United States
Code, is amended by redesignating subsection (d)
as subsection (e) and by inserting after sub-
section (c) the following:
‘‘(d) The plans under this section may include one or
more plans, otherwise allowable under this section, that sat-
isfy the requirements of clauses (i) and (ii) of section
8903(5)(A).’’.
(B) Section 8909(d) of title 5, United States
Code, is amended by striking ‘‘8903a(d)’’ and in-
serting ‘‘8903a(e)’’.
(4) REFERENCES.—Section 8903 of title 5,
United States Code, is amended by adding after para-
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graph (5) (as added by paragraph (1) of this sub-
section) as a flush left sentence, the following:
‘‘The Office shall prescribe regulations in accordance with
which the requirements of section 8902(c), 8902(n), 8909(e),
and any other provision of this chapter that applies with
respect to a plan described by paragraph (1), (2), (3), or
(4) of this section shall apply with respect to the cor-
responding plan under paragraph (5) of this section. Simi-
lar regulations shall be prescribed with respect to any plan
under section 8903a(d).’’.
(f) EFFECTIVE DATE.—The amendments made by this
section shall apply with respect to contract years beginning
on or after October 1, 2001. The Office of Personnel Man-
agement shall take appropriate measures to ensure that cov-
erage under a high deductible health plan under chapter
89 of title 5, United States Code (as amended by this sec-
tion) shall be available as of the beginning of the first con-
tract year described in the preceding sentence.
SEC. 2113. RULE WITH RESPECT TO CERTAIN PLANS.
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, health insurance issuers may offer, and eligible
individuals may purchase, high deductible health plans de-
scribed in section 220(c)(2)(A) of the Internal Revenue Code
of 1986. Effective for the 5-year period beginning on Octo-
ber 1, 2001, such health plans shall not be required to pro-
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vide payment for any health care items or services that are
exempt from the plan’s deductible.
(b) EXISTING STATE LAWS.—A State law relating to
payment for health care items and services in effect on the
date of enactment of this Act that is preempted under para-
graph (1), shall not apply to high deductible health plans
after the expiration of the 5-year period described in such
paragraph unless the State reenacts such law after such pe-
riod.
Subtitle C—Other Health-Related
Provisions
SEC. 2121. EXPANDED HUMAN CLINICAL TRIALS QUALI-
FYING FOR ORPHAN DRUG CREDIT.
(a) 
IN
GENERAL.—Subclause 
(I) 
of 
section
45C(b)(2)(A)(ii) of the Internal Revenue Code of 1986 is
amended to read as follows:
‘‘(I) after the date that the appli-
cation is filed for designation under
such section 526, and’’.
(b) CONFORMING AMENDMENT.—Clause (i) of section
45C(b)(2)(A) of such Code is amended by inserting ‘‘which
is’’ before ‘‘being’’ and by inserting before the comma at
the end ‘‘and which is designated under section 526 of such
Act’’.
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(c) EFFECTIVE DATE.—The amendments made by this
section shall apply to amounts paid or incurred after De-
cember 31, 2001.
SEC. 2122. CARRYOVER OF UNUSED BENEFITS FROM CAFE-
TERIA 
PLANS, 
FLEXIBLE 
SPENDING 
AR-
RANGEMENTS, 
AND 
HEALTH 
FLEXIBLE
SPENDING ACCOUNTS.
(a) IN GENERAL.—Section 125 of the Internal Revenue
Code of 1986 (relating to cafeteria plans) is amended by
redesignating subsections (h) and (i) as subsections (i) and
(j) and by inserting after subsection (g) the following new
subsection:
‘‘(h) ALLOWANCE OF CARRYOVERS OF UNUSED BENE-
FITS TO LATER TAXABLE YEARS.—
‘‘(1) IN GENERAL.—For purposes of this title—
‘‘(A) notwithstanding subsection (d)(2), a
plan or other arrangement shall not fail to be
treated as a cafeteria plan or flexible spending or
similar arrangement, and
‘‘(B) no amount shall be required to be in-
cluded in gross income by reason of this section
or any other provision of this chapter,
solely because under such plan or other arrangement
any nontaxable benefit which is unused as of the close
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of a taxable year may be carried forward to 1 or more
succeeding taxable years.
‘‘(2) LIMITATION.—Paragraph (1) shall not
apply to amounts carried from a plan to the extent
such amounts exceed $500 (applied on an annual
basis). For purposes of this paragraph, all plans and
arrangements maintained by an employer or any re-
lated person shall be treated as 1 plan.
‘‘(3) ALLOWANCE OF ROLLOVER.—
‘‘(A) IN GENERAL.—In the case of any un-
used benefit described in paragraph (1) which
consists of amounts in a health flexible spending
account or dependent care flexible spending ac-
count, the plan or arrangement shall provide
that a participant may elect, in lieu of such car-
ryover, to have such amounts distributed to the
participant.
‘‘(B) AMOUNTS
NOT
INCLUDED
IN
IN-
COME.—Any distribution under subparagraph
(A) shall not be included in gross income to the
extent that such amount is transferred in a
trustee-to-trustee transfer, or is contributed with-
in 60 days of the date of the distribution, to—
‘‘(i) a qualified cash or deferred ar-
rangement described in section 401(k),
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‘‘(ii) a plan under which amounts are
contributed by an individual’s employer for
an annuity contract described in section
403(b),
‘‘(iii) an eligible deferred compensation
plan described in section 457, or
‘‘(iv) a medical savings account (with-
in the meaning of section 220).
Any amount rolled over under this subparagraph
shall be treated as a rollover contribution for the
taxable year from which the unused amount
would otherwise be carried.
‘‘(C) 
TREATMENT
OF
ROLLOVER.—Any
amount rolled over under subparagraph (B)
shall be treated as an eligible rollover under sec-
tion 220, 401(k), 403(b), or 457, whichever is ap-
plicable, and shall be taken into account in ap-
plying any limitation (or participation require-
ment) on employer or employee contributions
under such section or any other provision of this
chapter for the taxable year of the rollover.
‘‘(4) COST-OF-LIVING ADJUSTMENT.—In the case
of any taxable year beginning in a calendar year
after 2002, the $500 amount under paragraph (2)
shall be adjusted at the same time and in the same
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manner as under section 415(d)(2), except that the
base period taken into account shall be the calendar
quarter beginning October 1, 2001, and any increase
which is not a multiple of $50 shall be rounded to the
next lowest multiple of $50.
‘‘(5) 
APPLICABILITY.—This 
subsection 
shall
apply to taxable years beginning after December 31,
2001.’’.
(b) EFFECTIVE DATE.—The amendments made by this
section shall apply to taxable years beginning after Decem-
ber 31, 2001.
SEC. 2123. REDUCTION IN TAX ON VACCINES.
(a) IN GENERAL.—Paragraph (1) of section 4131(b)
of the Internal Revenue Code of 1986 (relating to amount
of tax) is amended by striking ‘‘75 cents’’ and inserting
‘‘50 cents’’.
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall take effect on January 1, 2002.
Subtitle D—Miscellaneous
Provisions
SEC. 2131. NO IMPACT ON SOCIAL SECURITY TRUST FUND.
(a) IN GENERAL.—Nothing in this division (or an
amendment made by this division) shall be construed to
alter or amend the Social Security Act (or any regulation
promulgated under that Act).
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(b) TRANSFERS.—
(1) ESTIMATE OF SECRETARY.—The Secretary of
the Treasury shall annually estimate the impact that
the enactment of this division has on the income and
balances of the trust funds established under section
201 of the Social Security Act (42 U.S.C. 401).
(2) TRANSFER OF FUNDS.—If, under paragraph
(1), the Secretary of the Treasury estimates that the
enactment of this division has a negative impact on
the income and balances of the trust funds established
under section 201 of the Social Security Act (42
U.S.C. 401), the Secretary shall transfer, not less fre-
quently than quarterly, from the general revenues of
the Federal Government an amount sufficient so as to
ensure that the income and balances of such trust
funds are not reduced as a result of the enactment of
such division.
SEC. 2132. CUSTOMS USER FEES.
Section 13031(j)(3) of the Consolidated Omnibus
Budget Reconciliation Act of 1985 (19 U.S.C. 58c(j)(3)) is
amended by striking ‘‘2003’’ and inserting ‘‘2010’’.
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SEC. 2133. ESTABLISHMENT OF MEDICARE ADMINISTRA-
TIVE 
FEE 
FOR 
SUBMISSION 
OF 
PAPER
CLAIMS.
(a) IMPOSITION OF FEE.—Notwithstanding any other
provision of law and subject to subsection (b), the Secretary
of Health and Human Services shall establish (in the form
of a separate fee or reduction of payment otherwise made
under the medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.)) an administrative
fee of $1 for the submission of a claim in a paper or non-
electronic form for items or services for which payment is
sought under such title.
(b) EXCEPTION AUTHORITY.—The Secretary of Health
and Human Services shall waive the imposition of the fee
under subsection (a)—
(1) in cases in which there is no method avail-
able for the submission of claims other than in a
paper or non-electronic form; and
(2) for rural providers and small providers that
the Secretary determines, under procedures established
by the Secretary, are unable to purchase the necessary
hardware in order to submit claims electronically.
(c) TREATMENT OF FEES FOR PURPOSES OF COST RE-
PORTS.—An entity may not include a fee assessed pursuant
to this section as an allowable item on a cost report under
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title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) or title XIX of such Act (42 U.S.C. 1396 et seq.).
(d) EFFECTIVE DATE.—The provisions of this section
apply to claims submitted on or after January 1, 2002.
SEC. 2134. ESTABLISHMENT OF MEDICARE ADMINISTRA-
TIVE FEE FOR SUBMISSION OF DUPLICATE
AND UNPROCESSABLE CLAIMS.
(a) IMPOSITION OF FEE.—Notwithstanding any other
provision of law, the Secretary of Health and Human Serv-
ices shall establish (in the form of a separate fee or reduc-
tion of payment otherwise made under the medicare pro-
gram under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.)) an administrative fee of $2 for the
submission of a claim described in subsection (b).
(b) CLAIMS SUBJECT TO FEE.—A claim described in
this subsection is a claim that—
(1) is submitted by an individual or entity for
items or services for which payment is sought under
title XVIII of the Social Security Act; and
(2) either—
(A) duplicates, in whole or in part, another
claim submitted by the same individual or enti-
ty; or
(B) is a claim that cannot be processed and
must, in accordance with the Secretary of Health
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and Human Service’s instructions, be returned
by the fiscal intermediary or carrier to the indi-
vidual or entity for completion.
(c) TREATMENT OF FEES FOR PURPOSES OF COST RE-
PORTS.—An entity may not include a fee assessed pursuant
to this section as an allowable item on a cost report under
title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) or title XIX of such Act (42 U.S.C. 1396 et seq.).
(d) EFFECTIVE DATE.—The provisions of this section
apply to claims submitted on or after January 1, 2002.
TITLE XXII—PATIENTS’ BILL OF
RIGHTS
Subtitle A—Right to Advice and
Care
SEC. 2201. PATIENT RIGHT TO MEDICAL ADVICE AND CARE.
(a) IN GENERAL.—Part 7 of subtitle B of title I of
the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1181 et seq.) is amended—
(1) by redesignating subpart C as subpart D;
and
(2) by inserting after subpart B the following:
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‘‘Subpart C—Patient Right to Medical Advice and
Care
‘‘SEC. 721. ACCESS TO EMERGENCY MEDICAL CARE.
‘‘(a) COVERAGE
OF EMERGENCY SERVICES.—If a
group health plan (other than a fully insured group health
plan) provides coverage for any benefits consisting of emer-
gency medical care, except for items or services specifically
excluded from coverage, the plan shall, without regard to
prior authorization or provider participation—
‘‘(1) provide coverage for emergency medical
screening examinations to the extent that a prudent
layperson, who possesses an average knowledge of
health and medicine, would determine such examina-
tions to be necessary; and
‘‘(2) provide coverage for additional emergency
medical care to stabilize an emergency medical condi-
tion following an emergency medical screening exam-
ination (if determined necessary), pursuant to the
definition of stabilize under section 1867(e)(3) of the
Social Security Act (42 U.S.C. 1395dd(e)(3)).
‘‘(b) COVERAGE OF EMERGENCY AMBULANCE SERV-
ICES.—If a group health plan (other than a fully insured
group health plan) provides coverage for any benefits con-
sisting of emergency ambulance services, except for items
or services specifically excluded from coverage, the plan
shall, without regard to prior authorization or provider
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participation, provide coverage for emergency ambulance
services to the extent that a prudent layperson, who pos-
sesses an average knowledge of health and medicine, would
determine such emergency ambulance services to be nec-
essary.
‘‘(c) CARE AFTER STABILIZATION.—
‘‘(1) IN GENERAL.—In the case of medically nec-
essary and appropriate items or services related to the
emergency medical condition that may be provided to
a participant or beneficiary by a nonparticipating
provider after the participant or beneficiary is sta-
bilized, the nonparticipating provider shall contact
the plan as soon as practicable, but not later than 2
hours after stabilization occurs, with respect to
whether—
‘‘(A) the provision of items or services is ap-
proved;
‘‘(B) the participant or beneficiary will be
transferred; or
‘‘(C) other arrangements will be made con-
cerning the care and treatment of the partici-
pant or beneficiary.
‘‘(2) FAILURE TO RESPOND AND MAKE ARRANGE-
MENTS.—If a group health plan fails to respond and
make arrangements within 2 hours of being contacted
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in accordance with paragraph (1), then the plan shall
be responsible for the cost of any additional items or
services provided by the nonparticipating provider
if—
‘‘(A) coverage for items or services of the
type furnished by the nonparticipating provider
is available under the plan;
‘‘(B) the items or services are medically nec-
essary and appropriate and related to the emer-
gency medical condition involved; and
‘‘(C) the timely provision of the items or
services is medically necessary and appropriate.
‘‘(3) RULE OF CONSTRUCTION.—Nothing in this
subsection shall be construed to apply to a group
health plan that does not require prior authorization
for items or services provided to a participant or ben-
eficiary after the participant or beneficiary is sta-
bilized.
‘‘(d) REIMBURSEMENT TO A NON-PARTICIPATING PRO-
VIDER.—The responsibility of a group health plan to pro-
vide reimbursement to a nonparticipating provider under
this section shall cease accruing upon the earlier of—
‘‘(1) the transfer or discharge of the participant
or beneficiary; or
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‘‘(2) the completion of other arrangements made
by the plan and the nonparticipating provider.
‘‘(e) RESPONSIBILITY OF PARTICIPANT.—With respect
to items or services provided by a nonparticipating pro-
vider under this section, the participant or beneficiary shall
not be responsible for amounts that exceed the amounts (in-
cluding co-insurance, co-payments, deductibles or any other
form of cost-sharing) that would be incurred if the care was
provided by a participating health care provider with prior
authorization.
‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to prohibit a group health plan from
negotiating reimbursement rates with a nonparticipating
provider for items or services provided under this section.
‘‘(g) DEFINITIONS.—In this section:
‘‘(1) EMERGENCY
AMBULANCE
SERVICES.—The
term ‘emergency ambulance services’ means, with re-
spect to a participant or beneficiary under a group
health plan (other than a fully insured group health
plan), ambulance services furnished to transport an
individual who has an emergency medical condition
to a treating facility for receipt of emergency medical
care if—
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‘‘(A) the emergency services are covered
under the group health plan (other than a fully
insured group health plan) involved; and
‘‘(B) a prudent layperson who possesses an
average knowledge of health and medicine could
reasonably expect the absence of such transport
to result in placing the health of the participant
or beneficiary (or, with respect to a pregnant
woman, the health of the woman or her unborn
child) in serious jeopardy, serious impairment to
bodily functions, or serious dysfunction of any
bodily organ or part.
‘‘(2) EMERGENCY
MEDICAL
CARE.—The term
‘emergency medical care’ means, with respect to a
participant or beneficiary under a group health plan
(other than a fully insured group health plan), cov-
ered inpatient and outpatient items or services that—
‘‘(A) are furnished by any provider, includ-
ing a nonparticipating provider, that is quali-
fied to furnish such items or services; and
‘‘(B) are needed to evaluate or stabilize (as
such term is defined in section 1867(e)(3) of the
Social Security Act (42 U.S.C. 1395dd(e)(3)) an
emergency medical condition.
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‘‘(3) EMERGENCY
MEDICAL
CONDITION.—The
term ‘emergency medical condition’ means a medical
condition manifesting itself by acute symptoms of suf-
ficient severity (including severe pain) such that a
prudent layperson, who possesses an average knowl-
edge of health and medicine, could reasonably expect
the absence of immediate medical attention to result
in placing the health of the participant or beneficiary
(or, with respect to a pregnant woman, the health of
the woman or her unborn child) in serious jeopardy,
serious impairment to bodily functions, or serious
dysfunction of any bodily organ or part.
‘‘SEC. 722. OFFERING OF CHOICE OF COVERAGE OPTIONS.
‘‘(a) REQUIREMENT.—If a group health plan (other
than a fully insured group health plan) provides coverage
for benefits only through a defined set of participating
health care professionals, the plan shall offer the participant
the option to purchase point-of-service coverage (as defined
in subsection (b)) for all such benefits for which coverage
is otherwise so limited. Such option shall be made available
to the participant at the time of enrollment under the plan
and at such other times as the plan offers the participant
a choice of coverage options.
‘‘(b) POINT-OF-SERVICE
COVERAGE
DEFINED.—In
this section, the term ‘point-of-service coverage’ means, with
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respect to benefits covered under a group health plan (other
than a fully insured group health plan), coverage of such
benefits when provided by a nonparticipating health care
professional.
‘‘(c) SMALL EMPLOYER EXEMPTION.—
‘‘(1) IN GENERAL.—This section shall not apply
to any group health plan (other than a fully insured
group health plan) of a small employer.
‘‘(2) SMALL EMPLOYER.—For purposes of para-
graph (1), the term ‘small employer’ means, in con-
nection with a group health plan (other than a fully
insured group health plan) with respect to a calendar
year and a plan year, an employer who employed an
average of at least 2 but not more than 50 employees
on business days during the preceding calendar year
and who employs at least 2 employees on the first day
of the plan year. For purposes of this paragraph, the
provisions of subparagraph (C) of section 712(c)(1)
shall apply in determining employer size.
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed—
‘‘(1) as requiring coverage for benefits for a par-
ticular type of health care professional;
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‘‘(2) as requiring an employer to pay any costs
as a result of this section or to make equal contribu-
tions with respect to different health coverage options;
‘‘(3) as preventing a group health plan (other
than a fully insured group health plan) from impos-
ing higher premiums or cost-sharing on a participant
for the exercise of a point-of-service coverage option;
or
‘‘(4) to require that a group health plan (other
than a fully insured group health plan) include cov-
erage of health care professionals that the plan ex-
cludes because of fraud, quality of care, or other simi-
lar reasons with respect to such professionals.
‘‘SEC. 723. PATIENT ACCESS TO OBSTETRIC AND GYNECO-
LOGICAL CARE.
‘‘(a) GENERAL RIGHTS.—
‘‘(1) DIRECT ACCESS.—A group health plan de-
scribed in subsection (b) may not require authoriza-
tion or referral by the primary care provider de-
scribed in subsection (b)(2) in the case of a female
participant or beneficiary who seeks coverage for ob-
stetrical or gynecological care provided by a partici-
pating physician who specializes in obstetrics or gyn-
ecology.
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‘‘(2) OBSTETRICAL AND GYNECOLOGICAL CARE.—
A group health plan described in subsection (b) shall
treat the provision of obstetrical and gynecological
care, and the ordering of related obstetrical and gyne-
cological items and services, pursuant to the direct ac-
cess described under paragraph (1), by a partici-
pating health care professional who specializes in ob-
stetrics or gynecology as the authorization of the pri-
mary care provider.
‘‘(b) APPLICATION OF SECTION.—A group health plan
described in this subsection is a group health plan (other
than a fully insured group health plan), that—
‘‘(1) 
provides 
coverage 
for 
obstetric 
or
gynecologic care; and
‘‘(2) requires the designation by a participant or
beneficiary of a participating primary care provider
other than a physician who specializes in obstetrics or
gynecology.
‘‘(c) RULES OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed—
‘‘(1) to require that a group health plan approve
or provide coverage for—
‘‘(A) any items or services that are not cov-
ered under the terms and conditions of the group
health plan;
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‘‘(B) any items or services that are not
medically necessary and appropriate; or
‘‘(C) any items or services that are pro-
vided, ordered, or otherwise authorized under
subsection (a)(2) by a physician unless such
items or services are related to obstetric or
gynecologic care;
‘‘(2) to preclude a group health plan from re-
quiring that the physician described in subsection (a)
notify the designated primary care professional or
case manager of treatment decisions in accordance
with a process implemented by the plan, except that
the group health plan shall not impose such a notifi-
cation requirement on the participant or beneficiary
involved in the treatment decision;
‘‘(3) to preclude a group health plan from re-
quiring authorization, including prior authorization,
for certain items and services from the physician de-
scribed in subsection (a) who specializes in obstetrics
and gynecology if the designated primary care pro-
vider of the participant or beneficiary would other-
wise be required to obtain authorization for such
items or services;
‘‘(4) to require that the participant or bene-
ficiary described in subsection (a)(1) obtain author-
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ization or a referral from a primary care provider in
order to obtain obstetrical or gynecological care from
a health care professional other than a physician if
the provision of obstetrical or gynecological care by
such professional is permitted by the group health
plan 
and 
consistent 
with 
State 
licensure,
credentialing, and scope of practice laws and regula-
tions; or
‘‘(5) to preclude the participant or beneficiary
described in subsection (a)(1) from designating a
health care professional other than a physician as a
primary care provider if such designation is per-
mitted by the group health plan and the treatment by
such professional is consistent with State licensure,
credentialing, and scope of practice laws and regula-
tions.
‘‘SEC. 724. ACCESS TO PEDIATRIC CARE.
‘‘(a) PEDIATRIC CARE.—If a group health plan (other
than a fully insured group health plan) requires or provides
for a participant or beneficiary to designate a participating
primary care provider for a child of such participant or
beneficiary, the plan shall permit the participant or bene-
ficiary to designate a physician who specializes in pediat-
rics as the child’s primary care provider if such provider
participates in the network of the plan.
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‘‘(b) RULES OF CONSTRUCTION.—With respect to the
child of a participant or beneficiary, nothing in subsection
(a) shall be construed to—
‘‘(1) require that the participant or beneficiary
obtain prior authorization or a referral from a pri-
mary care provider in order to obtain pediatric care
from a health care professional other than a physi-
cian if the provision of pediatric care by such profes-
sional is permitted by the plan and consistent with
State licensure, credentialing, and scope of practice
laws and regulations; or
‘‘(2) preclude the participant or beneficiary from
designating a health care professional other than a
physician as a primary care provider for the child if
such designation is permitted by the plan and the
treatment by such professional is consistent with
State licensure, credentialing, and scope of practice
laws.
‘‘SEC. 725. TIMELY ACCESS TO SPECIALISTS.
‘‘(a) TIMELY ACCESS.—
‘‘(1) IN GENERAL.—A group health plan (other
than a fully insured group health plan) shall ensure
that participants and beneficiaries receive timely cov-
erage for access to specialists who are appropriate to
the medical condition of the participant or bene-
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ficiary, when such specialty care is a covered benefit
under the plan.
‘‘(2) RULE
OF
CONSTRUCTION.—Nothing in
paragraph (1) shall be construed—
‘‘(A) to require the coverage under a group
health plan (other than a fully insured group
health plan) of benefits or services;
‘‘(B) to prohibit a plan from including pro-
viders in the network only to the extent necessary
to meet the needs of the plan’s participants and
beneficiaries;
‘‘(C) to prohibit a plan from establishing
measures designed to maintain quality and con-
trol costs consistent with the responsibilities of
the plan; or
‘‘(D) to override any State licensure or
scope-of-practice law.
‘‘(3) ACCESS TO CERTAIN PROVIDERS.—
‘‘(A) PARTICIPATING PROVIDERS.—Nothing
in this section shall be construed to prohibit a
group health plan (other than a fully insured
group health plan) from requiring that a partic-
ipant or beneficiary obtain specialty care from a
participating specialist.
‘‘(B) NONPARTICIPATING PROVIDERS.—
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‘‘(i) IN GENERAL.—With respect to spe-
cialty care under this section, if a group
health plan (other than a fully insured
group health plan) determines that a par-
ticipating specialist is not available to pro-
vide such care to the participant or bene-
ficiary, the plan shall provide for coverage
of such care by a nonparticipating spe-
cialist.
‘‘(ii) 
TREATMENT
OF
NONPARTICI-
PATING PROVIDERS.—If a group health plan
(other than a fully insured group health
plan) refers a participant or beneficiary to
a nonparticipating specialist pursuant to
clause (i), such specialty care shall be pro-
vided at no additional cost to the partici-
pant or beneficiary beyond what the partic-
ipant or beneficiary would otherwise pay
for such specialty care if provided by a par-
ticipating specialist.
‘‘(b) REFERRALS.—
‘‘(1) AUTHORIZATION.—Nothing in this section
shall be construed to prohibit a group health plan
(other than a fully insured group health plan) from
requiring an authorization in order to obtain cov-
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erage for specialty services so long as such authoriza-
tion is for an appropriate duration or number of re-
ferrals.
‘‘(2) REFERRALS FOR ONGOING SPECIAL CONDI-
TIONS.—
‘‘(A) IN GENERAL.—A group health plan
(other than a fully insured group health plan)
shall permit a participant or beneficiary who
has an ongoing special condition (as defined in
subparagraph (B)) to receive a referral to a spe-
cialist for the treatment of such condition and
such specialist may authorize such referrals, pro-
cedures, tests, and other medical services with re-
spect to such condition, or coordinate the care for
such condition, subject to the terms of a treat-
ment plan referred to in subsection (c) with re-
spect to the condition.
‘‘(B) ONGOING
SPECIAL
CONDITION
DE-
FINED.—In this subsection, the term ‘ongoing
special condition’ means a condition or disease
that—
‘‘(i) is life-threatening, degenerative, or
disabling; and
‘‘(ii) requires specialized medical care
over a prolonged period of time.
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‘‘(c) TREATMENT PLANS.—
‘‘(1) IN GENERAL.—Nothing in this section shall
be construed to prohibit a group health plan (other
than a fully insured group health plan) from requir-
ing that specialty care be provided pursuant to a
treatment plan so long as the treatment plan is—
‘‘(A) developed by the specialist, in con-
sultation with the case manager or primary care
provider, and the participant or beneficiary;
‘‘(B) approved by the plan in a timely
manner if the plan requires such approval; and
‘‘(C) in accordance with the applicable
quality assurance and utilization review stand-
ards of the plan.
‘‘(2) NOTIFICATION.—Nothing in paragraph (1)
shall be construed as prohibiting a plan from requir-
ing the specialist to provide the plan with regular up-
dates on the specialty care provided, as well as all
other necessary medical information.
‘‘(d) SPECIALIST DEFINED.—For purposes of this sec-
tion, the term ‘specialist’ means, with respect to the medical
condition of the participant or beneficiary, a health care
professional, facility, or center (such as a center of excel-
lence) that has adequate expertise (including age-appro-
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priate expertise) through appropriate training and experi-
ence.
‘‘(e) RIGHT TO EXTERNAL REVIEW.—Pursuant to the
requirements of section 503B, a participant or beneficiary
shall have the right to an independent external review if
the denial of an item or service or condition that is required
to be covered under this section is eligible for such review.
‘‘SEC. 726. CONTINUITY OF CARE.
‘‘(a) TERMINATION OF PROVIDER.—If a contract be-
tween a group health plan (other than a fully insured group
health plan) and a treating health care provider is termi-
nated (as defined in paragraph (e)(4)), or benefits or cov-
erage provided by a health care provider are terminated
because of a change in the terms of provider participation
in such plan, and an individual who is a participant or
beneficiary in the plan is undergoing an active course of
treatment for a serious and complex condition, institutional
care, pregnancy, or terminal illness from the provider at
the time the plan receives or provides notice of such termi-
nation, the plan shall—
‘‘(1) notify the individual, or arrange to have the
individual notified pursuant to subsection (d)(2), on
a timely basis of such termination;
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‘‘(2) provide the individual with an opportunity
to notify the plan of the individual’s need for transi-
tional care; and
‘‘(3) subject to subsection (c), permit the indi-
vidual to elect to continue to be covered with respect
to the active course of treatment with the provider’s
consent during a transitional period (as provided for
under subsection (b)).
‘‘(b) TRANSITIONAL PERIOD.—
‘‘(1) SERIOUS AND COMPLEX CONDITIONS.—The
transitional period under this section with respect to
a serious and complex condition shall extend for up
to 90 days from the date of the notice described in
subsection (a)(1) of the provider’s termination.
‘‘(2) INSTITUTIONAL OR INPATIENT CARE.—
‘‘(A) IN GENERAL.—The transitional period
under this section for institutional or non-elec-
tive inpatient care from a provider shall extend
until the earlier of—
‘‘(i) the expiration of the 90-day period
beginning on the date on which the notice
described in subsection (a)(1) of the pro-
vider’s termination is provided; or
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‘‘(ii) the date of discharge of the indi-
vidual from such care or the termination of
the period of institutionalization.
‘‘(B) SCHEDULED CARE.—The 90 day limi-
tation described in subparagraph (A)(i) shall in-
clude post-surgical follow-up care relating to
non-elective surgery that has been scheduled be-
fore the date of the notice of the termination of
the provider under subsection (a)(1).
‘‘(3) PREGNANCY.—If—
‘‘(A) a participant or beneficiary has en-
tered the second trimester of pregnancy at the
time of a provider’s termination of participa-
tion; and
‘‘(B) the provider was treating the preg-
nancy before the date of the termination;
the transitional period under this subsection with re-
spect to provider’s treatment of the pregnancy shall
extend through the provision of post-partum care di-
rectly related to the delivery.
‘‘(4) TERMINAL ILLNESS.—If—
‘‘(A) a participant or beneficiary was deter-
mined to be terminally ill (as determined under
section 1861(dd)(3)(A) of the Social Security
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Act) at the time of a provider’s termination of
participation; and
‘‘(B) the provider was treating the terminal
illness before the date of termination;
the transitional period under this subsection shall ex-
tend for the remainder of the individual’s life for care
that is directly related to the treatment of the ter-
minal illness.
‘‘(c) PERMISSIBLE TERMS AND CONDITIONS.—A group
health plan (other than a fully insured group health plan)
may condition coverage of continued treatment by a pro-
vider under this section upon the provider agreeing to the
following terms and conditions:
‘‘(1) The treating health care provider agrees to
accept reimbursement from the plan and individual
involved (with respect to cost-sharing) at the rates ap-
plicable prior to the start of the transitional period
as payment in full (or at the rates applicable under
the replacement plan after the date of the termination
of the contract with the group health plan) and not
to impose cost-sharing with respect to the individual
in an amount that would exceed the cost-sharing that
could have been imposed if the contract referred to in
this section had not been terminated.
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‘‘(2) The treating health care provider agrees to
adhere to the quality assurance standards of the plan
responsible for payment under paragraph (1) and to
provide to such plan necessary medical information
related to the care provided.
‘‘(3) The treating health care provider agrees
otherwise to adhere to such plan’s policies and proce-
dures, including procedures regarding referrals and
obtaining prior authorization and providing services
pursuant to a treatment plan (if any) approved by
the plan.
‘‘(d) RULES OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed—
‘‘(1) to require the coverage of benefits which
would not have been covered if the provider involved
remained a participating provider; or
‘‘(2) with respect to the termination of a contract
under subsection (a) to prevent a group health plan
from requiring that the health care provider—
‘‘(A) notify participants or beneficiaries of
their rights under this section; or
‘‘(B) provide the plan with the name of
each participant or beneficiary who the provider
believes is eligible for transitional care under
this section.
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‘‘(e) DEFINITIONS.—In this section:
‘‘(1) CONTRACT.—The term ‘contract between a
plan and a treating health care provider’ shall in-
clude a contract between such a plan and an orga-
nized network of providers.
‘‘(2) 
HEALTH
CARE
PROVIDER.—The 
term
‘health care provider’ or ‘provider’ means—
‘‘(A) any individual who is engaged in the
delivery of health care services in a State and
who is required by State law or regulation to be
licensed or certified by the State to engage in the
delivery of such services in the State; and
‘‘(B) any entity that is engaged in the de-
livery of health care services in a State and that,
if it is required by State law or regulation to be
licensed or certified by the State to engage in the
delivery of such services in the State, is so li-
censed.
‘‘(3) SERIOUS AND COMPLEX CONDITION.—The
term ‘serious and complex condition’ means, with re-
spect to a participant or beneficiary under the plan,
a condition that is medically determinable and—
‘‘(A) in the case of an acute illness, is a
condition serious enough to require specialized
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medical treatment to avoid the reasonable possi-
bility of death or permanent harm; or
‘‘(B) in the case of a chronic illness or con-
dition, is an illness or condition that—
‘‘(i) is complex and difficult to man-
age;
‘‘(ii) is disabling or life-threatening;
and
‘‘(iii) requires—
‘‘(I) frequent monitoring over a
prolonged period of time and requires
substantial on-going specialized med-
ical care; or
‘‘(II) frequent ongoing specialized
medical care across a variety of do-
mains of care.
‘‘(4) TERMINATED.—The term ‘terminated’ in-
cludes, with respect to a contract (as defined in para-
graph (1)), the expiration or nonrenewal of the con-
tract by the group health plan, but does not include
a termination of the contract by the plan for failure
to meet applicable quality standards or for fraud.
‘‘(f) RIGHT TO EXTERNAL REVIEW.—Pursuant to the
requirements of section 503B, a participant or beneficiary
shall have the right to an independent external review if
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the denial of an item or service or condition that is required
to be covered under this section is eligible for such review.
‘‘SEC. 727. PROTECTION OF PATIENT-PROVIDER COMMU-
NICATIONS.
‘‘(a) IN GENERAL.—Subject to subsection (b), a group
health plan (other than a fully insured group health plan
and in relation to a participant or beneficiary) shall not
prohibit or otherwise restrict a health care professional from
advising such a participant or beneficiary who is a patient
of the professional about the health status of the participant
or beneficiary or medical care or treatment for the condition
or disease of the participant or beneficiary, regardless of
whether coverage for such care or treatment are provided
under the contract, if the professional is acting within the
lawful scope of practice.
‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed as requiring a group health plan
(other than a fully insured group health plan) to provide
specific benefits under the terms of such plan.
‘‘SEC. 728. PATIENT’S RIGHT TO PRESCRIPTION DRUGS.
‘‘(a) IN GENERAL.—To the extent that a group health
plan (other than a fully insured group health plan) pro-
vides coverage for benefits with respect to prescription
drugs, and limits such coverage to drugs included in a for-
mulary, the plan shall—
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‘‘(1) ensure the participation of physicians and
pharmacists in developing and reviewing such for-
mulary; and
‘‘(2) in accordance with the applicable quality
assurance and utilization review standards of the
plan, provide for exceptions from the formulary limi-
tation when a non-formulary alternative is medically
necessary and appropriate.
‘‘(b) RIGHT TO EXTERNAL REVIEW.—Pursuant to the
requirements of section 503B, a participant or beneficiary
shall have the right to an independent external review if
the denial of an item or service or condition that is required
to be covered under this section is eligible for such review.
‘‘SEC. 729. SELF-PAYMENT FOR BEHAVIORAL HEALTH CARE
SERVICES.
‘‘(a) IN GENERAL.—A group health plan (other than
a fully insured group health plan) may not—
‘‘(1) prohibit or otherwise discourage a partici-
pant or beneficiary from self-paying for behavioral
health care services once the plan has denied coverage
for such services; or
‘‘(2) terminate a health care provider because
such provider permits participants or beneficiaries to
self-pay for behavioral health care services—
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‘‘(A) that are not otherwise covered under
the plan; or
‘‘(B) for which the group health plan pro-
vides limited coverage, to the extent that the
group health plan denies coverage of the services.
‘‘(b) RULE OF CONSTRUCTION.—Nothing in subsection
(a)(2)(B) shall be construed as prohibiting a group health
plan from terminating a contract with a health care pro-
vider for failure to meet applicable quality standards or
for fraud.
‘‘SEC. 730. COVERAGE FOR INDIVIDUALS PARTICIPATING IN
APPROVED CANCER CLINICAL TRIALS.
‘‘(a) COVERAGE.—
‘‘(1) IN GENERAL.—If a group health plan (other
than a fully insured group health plan) provides cov-
erage to a qualified individual (as defined in sub-
section (b)), the plan—
‘‘(A) may not deny the individual partici-
pation in the clinical trial referred to in sub-
section (b)(2);
‘‘(B) subject to subsections (b), (c), and (d)
may not deny (or limit or impose additional
conditions on) the coverage of routine patient
costs for items and services furnished in connec-
tion with participation in the trial; and
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‘‘(C) may not discriminate against the in-
dividual on the basis of the participant’s or
beneficiaries participation in such trial.
‘‘(2) EXCLUSION OF CERTAIN COSTS.—For pur-
poses of paragraph (1)(B), routine patient costs do
not include the cost of the tests or measurements con-
ducted primarily for the purpose of the clinical trial
involved.
‘‘(3) USE OF IN-NETWORK PROVIDERS.—If one or
more participating providers is participating in a
clinical trial, nothing in paragraph (1) shall be con-
strued as preventing a plan from requiring that a
qualified individual participate in the trial through
such a participating provider if the provider will ac-
cept the individual as a participant in the trial.
‘‘(b) QUALIFIED INDIVIDUAL DEFINED.—For purposes
of subsection (a), the term ‘qualified individual’ means an
individual who is a participant or beneficiary in a group
health plan and who meets the following conditions:
‘‘(1)(A) The individual has been diagnosed with
cancer for which no standard treatment is effective.
‘‘(B) The individual is eligible to participate in
an approved clinical trial according to the trial pro-
tocol with respect to treatment of such illness.
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‘‘(C) The individual’s participation in the trial
offers meaningful potential for significant clinical
benefit for the individual.
‘‘(2) Either—
‘‘(A) the referring physician is a partici-
pating health care professional and has con-
cluded that the individual’s participation in
such trial would be appropriate based upon the
individual meeting the conditions described in
paragraph (1); or
‘‘(B) the participant or beneficiary provides
medical and scientific information establishing
that the individual’s participation in such trial
would be appropriate based upon the individual
meeting the conditions described in paragraph
(1).
‘‘(c) PAYMENT.—
‘‘(1) IN GENERAL.—Under this section a group
health plan (other than a fully insured group health
plan) shall provide for payment for routine patient
costs described in subsection (a)(2) but is not required
to pay for costs of items and services that are reason-
ably expected to be paid for by the sponsors of an ap-
proved clinical trial.
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‘‘(2) STANDARDS
FOR
DETERMINING
ROUTINE
PATIENT
COSTS
ASSOCIATED
WITH
CLINICAL
TRIAL
PARTICIPATION.—
‘‘(A) IN GENERAL.—The Secretary shall, in
accordance with this paragraph, establish stand-
ards relating to the coverage of routine patient
costs for individuals participating in clinical
trials that group health plans must meet under
this section.
‘‘(B) FACTORS.—In establishing routine pa-
tient cost standards under subparagraph (A), the
Secretary shall consult with interested parties
and take into account —
‘‘(i) quality of patient care;
‘‘(ii) routine patient care costs versus
costs associated with the conduct of clinical
trials, including unanticipated patient care
costs as a result of participation in clinical
trials; and
‘‘(iii) previous and on-going studies re-
lating to patient care costs associated with
participation in clinical trials.
‘‘(C) APPOINTMENT AND MEETINGS OF NE-
GOTIATED RULEMAKING COMMITTEE.—
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‘‘(i) PUBLICATION
OF
NOTICE.—Not
later than November 15, 2000, the Secretary
shall publish notice of the establishment of
a negotiated rulemaking committee, as pro-
vided for under section 564(a) of title 5,
United States Code, to develop the stand-
ards described in subparagraph (A), which
shall include—
‘‘(I) the proposed scope of the
committee;
‘‘(II) the interests that may be
impacted by the standards;
‘‘(iii) a list of the proposed mem-
bership of the committee;
‘‘(iv) the proposed meeting sched-
ule of the committee;
‘‘(v) a solicitation for public com-
ment on the committee; and
‘‘(vi) the procedures under which
an individual may apply for member-
ship on the committee.
‘‘(ii) 
COMMENT
PERIOD.—Notwith-
standing section 564(c) of title 5, United
States Code, the Secretary shall provide for
a period, beginning on the date on which
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the notice is published under clause (i) and
ending on November 30, 2000, for the sub-
mission of public comments on the com-
mittee under this subparagraph.
‘‘(iii) APPOINTMENT OF COMMITTEE.—
Not later than December 30, 2000, the Sec-
retary shall appoint the members of the ne-
gotiated rulemaking committee under this
subparagraph.
‘‘(iv) FACILITATOR.—Not later than
January 10, 2001, the negotiated rule-
making 
committee 
shall 
nominate 
a
facilitator under section 566(c) of title 5,
United States Code, to carry out the activi-
ties described in subsection (d) of such sec-
tion.
‘‘(v) MEETINGS.—During the period
beginning on the date on which the
facilitator is nominated under clause (iv)
and ending on March 30, 2001, the nego-
tiated rulemaking committee shall meet to
develop the standards described in subpara-
graph (A).
‘‘(D) PRELIMINARY COMMITTEE REPORT.—
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‘‘(i) IN
GENERAL.—The negotiated
rulemaking committee appointed under sub-
paragraph (C) shall report to the Secretary,
by not later than March 30, 2001, regard-
ing the committee’s progress on achieving a
consensus with regard to the rulemaking
proceedings and whether such consensus is
likely to occur before the target date de-
scribed in subsection (F).
‘‘(ii) TERMINATION OF PROCESS AND
PUBLICATION OF RULE BY SECRETARY.—If
the committee reports under clause (i) that
the committee has failed to make significant
progress towards such consensus or is un-
likely to reach such consensus by the target
date described in subsection (F), the Sec-
retary shall terminate such process and pro-
vide for the publication in the Federal Reg-
ister, by not later than June 30, 2001, of a
rule under this paragraph through such
other methods as the Secretary may provide.
‘‘(E) FINAL COMMITTEE REPORT AND PUB-
LICATION OR RULE BY SECRETARY.—
‘‘(i) IN GENERAL.—If the rulemaking
committee is not terminated under subpara-
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graph (D)(ii), the committee shall submit to
the Secretary, by not later than May 30,
2001, a report containing a proposed rule.
‘‘(ii) PUBLICATION OF RULE.—If the
Secretary receives a report under clause (i),
the Secretary shall provide for the publica-
tion in the Federal Register, by not later
than June 30, 2001, of the proposed rule.
‘‘(F) TARGET DATE FOR PUBLICATION OF
RULE.—As part of the notice under subpara-
graph (C)(i), and for purposes of this paragraph,
the ‘target date for publication’ (referred to in
section 564(a)(5) of title 5, United States Code)
shall be June 30, 2001.
‘‘(G) EFFECTIVE DATE.—The provisions of
this paragraph shall apply to group health plans
(other than a fully insured group health plan)
for plan years beginning on or after January 1,
2002.
‘‘(3) PAYMENT
RATE.—In the case of covered
items and services provided by—
‘‘(A) a participating provider, the payment
rate shall be at the agreed upon rate, or
‘‘(B) a nonparticipating provider, the pay-
ment rate shall be at the rate the plan would
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normally pay for comparable services under sub-
paragraph (A).
‘‘(d) APPROVED CLINICAL TRIAL DEFINED.—
‘‘(1) IN GENERAL.—In this section, the term ‘ap-
proved clinical trial’ means a cancer clinical research
study or cancer clinical investigation approved or
funded (which may include funding through in-kind
contributions) by one or more of the following:
‘‘(A) The National Institutes of Health.
‘‘(B) A cooperative group or center of the
National Institutes of Health.
‘‘(C) The Food and Drug Administration.
‘‘(D) Either of the following if the condi-
tions described in paragraph (2) are met:
‘‘(i) The Department of Veterans Af-
fairs.
‘‘(ii) The Department of Defense.
‘‘(2) CONDITIONS FOR DEPARTMENTS.—The con-
ditions described in this paragraph, for a study or in-
vestigation conducted by a Department, are that the
study or investigation has been reviewed and ap-
proved through a system of peer review that the Sec-
retary determines—
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‘‘(A) to be comparable to the system of peer
review of studies and investigations used by the
National Institutes of Health, and
‘‘(B) assures unbiased review of the highest
scientific standards by qualified individuals who
have no interest in the outcome of the review.
‘‘(e) CONSTRUCTION.—Nothing in this section shall be
construed to limit a plan’s coverage with respect to clinical
trials.
‘‘(f) PLAN SATISFACTION OF CERTAIN REQUIREMENTS;
RESPONSIBILITIES OF FIDUCIARIES.—
‘‘(1) IN GENERAL.—For purposes of this section,
insofar as a group health plan provides benefits in the
form of health insurance coverage through a health in-
surance issuer, the plan shall be treated as meeting
the requirements of this section with respect to such
benefits and not be considered as failing to meet such
requirements because of a failure of the issuer to meet
such requirements so long as the plan sponsor or its
representatives did not cause such failure by the
issuer.
‘‘(2) CONSTRUCTION.—Nothing in this section
shall be construed to affect or modify the responsibil-
ities of the fiduciaries of a group health plan under
part 4 of subtitle B.
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‘‘(g) STUDY AND REPORT.—
‘‘(1) STUDY.—The Secretary shall study the im-
pact on group health plans for covering routine pa-
tient care costs for individuals who are entitled to
benefits under this section and who are enrolled in an
approved cancer clinical trial program.
‘‘(2) REPORT
TO
CONGRESS.—Not later than
January 1, 2005, the Secretary shall submit a report
to Congress that contains an assessment of—
‘‘(A) any incremental cost to group health
plans resulting from the provisions of this sec-
tion;
‘‘(B) a projection of expenditures to such
plans resulting from this section; and
‘‘(C) any impact on premiums resulting
from this section.
‘‘(h) RIGHT TO EXTERNAL REVIEW.—Pursuant to the
requirements of section 503B, a participant or beneficiary
shall have the right to an independent external review if
the denial of an item or service or condition that is required
to be covered under this section is eligible for such review.
‘‘SEC. 730A. PROHIBITION OF DISCRIMINATION AGAINST
PROVIDERS BASED ON LICENSURE.
‘‘(a) IN GENERAL.—A group health plan (other than
a fully insured group health plan) shall not discriminate
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with respect to participation or indemnification as to any
provider who is acting within the scope of the provider’s
license or certification under applicable State law, solely
on the basis of such license or certification.
‘‘(b) CONSTRUCTION.—Subsection (a) shall not be
construed—
‘‘(1) as requiring the coverage under a group
health plan of a particular benefit or service or to
prohibit a plan from including providers only to the
extent necessary to meet the needs of the plan’s par-
ticipants or beneficiaries or from establishing any
measure designed to maintain quality and control
costs consistent with the responsibilities of the plan;
‘‘(2) to override any State licensure or scope-of-
practice law; or
‘‘(3) as requiring a plan that offers network cov-
erage to include for participation every willing pro-
vider who meets the terms and conditions of the plan.
‘‘SEC. 730B. GENERALLY APPLICABLE PROVISION.
‘‘In the case of a group health plan that provides bene-
fits under 2 or more coverage options, the requirements of
this subpart shall apply separately with respect to each cov-
erage option.’’.
(b) RULE WITH RESPECT TO CERTAIN PLANS.—
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(1) IN
GENERAL.—Notwithstanding any other
provision of law, health insurance issuers may offer,
and eligible individuals may purchase, high deduct-
ible health plans described in section 220(c)(2)(A) of
the Internal Revenue Code of 1986. Effective for the
5-year period beginning on the date of the enactment
of this Act, such health plans shall not be required to
provide payment for any health care items or services
that are exempt from the plan’s deductible.
(2) EXISTING STATE LAWS.—A State law relat-
ing to payment for health care items and services in
effect on the date of enactment of this Act that is pre-
empted under paragraph (1), shall not apply to high
deductible health plans after the expiration of the 5-
year period described in such paragraph unless the
State reenacts such law after such period.
(c) DEFINITION.—Section 733(a) of the Employee Re-
tirement Income Security Act of 1974 (42 U.S.C. 1191(a))
is amended by adding at the end the following:
‘‘(3) FULLY INSURED GROUP HEALTH PLAN.—
The term ‘fully insured group health plan’ means a
group health plan where benefits under the plan are
provided pursuant to the terms of an arrangement be-
tween a group health plan and a health insurance
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issuer and are guaranteed by the health insurance
issuer under a contract or policy of insurance.’’.
(d) CONFORMING AMENDMENT.—The table of contents
in section 1 of the Employee Retirement Income Security
Act of 1974 is amended—
(1) in the item relating to subpart C of part 7
of subtitle B of title I, by striking ‘‘Subpart C’’ and
inserting ‘‘Subpart D’’; and
(2) by adding at the end of the items relating to
subpart B of part 7 of subtitle B of title I, the fol-
lowing:
‘‘SUBPART C—PATIENT RIGHT TO MEDICAL ADVICE AND CARE
‘‘Sec. 721. Access to emergency medical care.
‘‘Sec. 722. Offering of choice of coverage options.
‘‘Sec. 723. Patient access to obstetric and gynecological care.
‘‘Sec. 724. Access to pediatric care.
‘‘Sec. 725. Timely access to specialists.
‘‘Sec. 726. Continuity of care.
‘‘Sec. 727. Protection of patient-provider communications.
‘‘Sec. 728. Patient’s right to prescription drugs.
‘‘Sec. 729. Self-payment for behavioral health care services.
‘‘Sec. 730. Coverage for individuals participating in approved cancer clinical
trials.
‘‘Sec. 730A. Prohibition of discrimination against providers based on licensure.
‘‘Sec. 730B. Generally applicable provision.’’.
SEC. 2202. CONFORMING AMENDMENT TO THE INTERNAL
REVENUE CODE OF 1986.
Subchapter B of chapter 100 of the Internal Revenue
Code of 1986 is amended—
(1) in the table of sections, by inserting after the
item relating to section 9812 the following new item:
‘‘Sec. 9813. Standard relating to patient’s bill of rights.’’;
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and
(2) by inserting after section 9812 the following:
‘‘SEC. 9813. STANDARD RELATING TO PATIENTS’ BILL OF
RIGHTS.
‘‘A group health plan (other than a fully insured group
health plan) shall comply with the requirements of subpart
C of part 7 of subtitle B of title I of the Employee Retire-
ment Income Security Act of 1974, as added by section 2201
of the Patients’ Bill of Rights Plus Act, and such require-
ments shall be deemed to be incorporated into this section.’’.
SEC. 2203. EFFECTIVE DATE AND RELATED RULES.
(a) IN GENERAL.—The amendments made by this sub-
title shall apply with respect to plan years beginning on
or after January 1 of the second calendar year following
the date of the enactment of this Act. The Secretary shall
issue all regulations necessary to carry out the amendments
made by this section before the effective date thereof.
(b) LIMITATION ON ENFORCEMENT ACTIONS.—No en-
forcement action shall be taken, pursuant to the amend-
ments made by this subtitle, against a group health plan
with respect to a violation of a requirement imposed by such
amendments before the date of issuance of regulations issued
in connection with such requirement, if the plan has sought
to comply in good faith with such requirement.
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Subtitle B—Right to Information
About Plans and Providers
SEC. 2211. INFORMATION ABOUT PLANS.
(a) EMPLOYEE RETIREMENT INCOME SECURITY ACT
OF 1974.—Subpart B of part 7 of subtitle B of title I of
the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1185 et seq.) is amended by adding at the end the
following:
‘‘SEC. 714. HEALTH PLAN INFORMATION.
‘‘(a) REQUIREMENT—
‘‘(1) DISCLOSURE.—
‘‘(A) IN GENERAL.—A group health plan,
and a health insurance issuer that provides cov-
erage in connection with group health insurance
coverage, shall provide for the disclosure of the
information described in subsection (b) to par-
ticipants and beneficiaries—
‘‘(i) at the time of the initial enroll-
ment of the participant or beneficiary
under the plan or coverage;
‘‘(ii) 
on 
an 
annual 
basis 
after
enrollment—
‘‘(I) in conjunction with the elec-
tion period of the plan or coverage if
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the plan or coverage has such an elec-
tion period; or
‘‘(II) in the case of a plan or cov-
erage that does not have an election pe-
riod, in conjunction with the beginning
of the plan or coverage year; and
‘‘(iii) in the case of any material re-
duction to the benefits or information de-
scribed in paragraphs (1), (2) and (3) of
subsection (b), in the form of a summary
notice provided not later than the date on
which the reduction takes effect.
‘‘(B) PARTICIPANTS AND BENEFICIARIES.—
The disclosure required under subparagraph (A)
shall be provided—
‘‘(i) jointly to each participant and
beneficiary who reside at the same address;
or
‘‘(ii) in the case of a beneficiary who
does not reside at the same address as the
participant, separately to the participant
and such beneficiary.
‘‘(2) RULE OF CONSTRUCTION.—Nothing in this
section shall be construed to prevent a group health
plan sponsor and health insurance issuer from enter-
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ing into an agreement under which either the plan
sponsor or the issuer agrees to assume responsibility
for compliance with the requirements of this section,
in whole or in part, and the party delegating such re-
sponsibility is released from liability for compliance
with the requirements that are assumed by the other
party, to the extent the party delegating such respon-
sibility did not cause such noncompliance.
‘‘(3) PROVISION OF INFORMATION.—Information
shall be provided to participants and beneficiaries
under this section at the last known address main-
tained by the plan or issuer with respect to such par-
ticipants or beneficiaries, to the extent that such in-
formation is provided to participants or beneficiaries
via the United States Postal Service or other private
delivery service.
‘‘(b) REQUIRED INFORMATION.—The informational
materials to be distributed under this section shall include
for each option available under the group health plan or
health insurance coverage the following:
‘‘(1) BENEFITS.—A description of the covered
benefits, including—
‘‘(A) any in- and out-of-network benefits;
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‘‘(B) specific preventative services covered
under the plan or coverage if such services are
covered;
‘‘(C) any benefit limitations, including any
annual or lifetime benefit limits and any mone-
tary limits or limits on the number of visits,
days, or services, and any specific coverage ex-
clusions; and
‘‘(D) any definition of medical necessity
used in making coverage determinations by the
plan, issuer, or claims administrator.
‘‘(2) COST SHARING.—A description of any cost-
sharing requirements, including—
‘‘(A) any premiums, deductibles, coinsur-
ance, copayment amounts, and liability for bal-
ance billing above any reasonable and customary
charges, for which the participant or beneficiary
will be responsible under each option available
under the plan;
‘‘(B) any maximum out-of-pocket expense
for which the participant or beneficiary may be
liable;
‘‘(C) any cost-sharing requirements for out-
of-network benefits or services received from non-
participating providers; and
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‘‘(D) any additional cost-sharing or charges
for benefits and services that are furnished with-
out meeting applicable plan or coverage require-
ments, 
such 
as 
prior 
authorization 
or
precertification.
‘‘(3) SERVICE AREA.—A description of the plan
or issuer’s service area, including the provision of any
out-of-area coverage.
‘‘(4) PARTICIPATING PROVIDERS.—A directory of
participating providers (to the extent a plan or issuer
provides coverage through a network of providers)
that includes, at a minimum, the name, address, and
telephone number of each participating provider, and
information about how to inquire whether a partici-
pating provider is currently accepting new patients.
‘‘(5) CHOICE OF PRIMARY CARE PROVIDER.—A
description of any requirements and procedures to be
used by participants and beneficiaries in selecting,
accessing, or changing their primary care provider,
including providers both within and outside of the
network (if the plan or issuer permits out-of-network
services), and the right to select a pediatrician as a
primary care provider under section 724 for a partic-
ipant or beneficiary who is a child if such section ap-
plies.
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‘‘(6) PREAUTHORIZATION
REQUIREMENTS.—A
description of the requirements and procedures to be
used to obtain preauthorization for health services, if
such preauthorization is required.
‘‘(7) 
EXPERIMENTAL
AND
INVESTIGATIONAL
TREATMENTS.—A description of the process for deter-
mining whether a particular item, service, or treat-
ment is considered experimental or investigational,
and the circumstances under which such treatments
are covered by the plan or issuer.
‘‘(8) SPECIALTY CARE.—A description of the re-
quirements and procedures to be used by participants
and beneficiaries in accessing specialty care and ob-
taining referrals to participating and nonpartici-
pating specialists, including the right to timely cov-
erage for access to specialists care under section 725
if such section applies.
‘‘(9) CLINICAL TRIALS.—A description the cir-
cumstances and conditions under which participation
in clinical trials is covered under the terms and con-
ditions of the plan or coverage, and the right to ob-
tain coverage for approved cancer clinical trials
under section 729 if such section applies.
‘‘(10) PRESCRIPTION DRUGS.—To the extent the
plan or issuer provides coverage for prescription
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drugs, a statement of whether such coverage is limited
to drugs included in a formulary, a description of
any provisions and cost-sharing required for obtain-
ing on- and off-formulary medications, and a descrip-
tion of the rights of participants and beneficiaries in
obtaining access to access to prescription drugs under
section 727 if such section applies.
‘‘(11) EMERGENCY
SERVICES.—A summary of
the rules and procedures for accessing emergency serv-
ices, including the right of a participant or bene-
ficiary to obtain emergency services under the pru-
dent layperson standard under section 721, if such
section applies, and any educational information that
the plan or issuer may provide regarding the appro-
priate use of emergency services.
‘‘(12) CLAIMS AND APPEALS.—A description of
the plan or issuer’s rules and procedures pertaining
to claims and appeals, a description of the rights of
participants and beneficiaries under sections 503,
503A and 503B in obtaining covered benefits, filing
a claim for benefits, and appealing coverage decisions
internally and externally (including telephone num-
bers and mailing addresses of the appropriate author-
ity), and a description of any additional legal rights
and remedies available under section 502.
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‘‘(13) ADVANCE DIRECTIVES AND ORGAN DONA-
TION.—A description of procedures for advance direc-
tives and organ donation decisions if the plan or
issuer maintains such procedures.
‘‘(14) INFORMATION ON PLANS AND ISSUERS.—
The name, mailing address, and telephone number or
numbers of the plan administrator and the issuer to
be used by participants and beneficiaries seeking in-
formation about plan or coverage benefits and serv-
ices, payment of a claim, or authorization for services
and treatment. The name of the designated decision-
maker (or decision-makers) appointed under section
502(n)(2) for purposes of making final determina-
tions under section 503A and approving coverage
pursuant to the written determination of an inde-
pendent medical reviewer under section 503B. Notice
of whether the benefits under the plan are provided
under a contract or policy of insurance issued by an
issuer, or whether benefits are provided directly by the
plan sponsor who bears the insurance risk.
‘‘(15) TRANSLATION SERVICES.—A summary de-
scription of any translation or interpretation services
(including the availability of printed information in
languages other than English, audio tapes, or infor-
mation in Braille) that are available for non-English
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speakers and participants and beneficiaries with com-
munication disabilities and a description of how to
access these items or services.
‘‘(16) ACCREDITATION INFORMATION.—Any in-
formation that is made public by accrediting organi-
zations in the process of accreditation if the plan or
issuer is accredited, or any additional quality indica-
tors (such as the results of enrollee satisfaction sur-
veys) that the plan or issuer makes public or makes
available to participants and beneficiaries.
‘‘(17) NOTICE OF REQUIREMENTS.—A descrip-
tion of any rights of participants and beneficiaries
that are established by the Patients’ Bill of Rights
Plus Act (excluding those described in paragraphs (1)
through (16)) if such sections apply. The description
required under this paragraph may be combined with
the notices required under sections 711(d), 713(b), or
606(a)(1), and with any other notice provision that
the Secretary determines may be combined.
‘‘(18) AVAILABILITY
OF
ADDITIONAL
INFORMA-
TION.—A statement that the information described in
subsection (c), and instructions on obtaining such in-
formation (including telephone numbers and, if avail-
able, Internet websites), shall be made available upon
request.
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‘‘(c) ADDITIONAL INFORMATION.—The informational
materials to be provided upon the request of a participant
or beneficiary shall include for each option available under
a group health plan or health insurance coverage the fol-
lowing:
‘‘(1) STATUS OF PROVIDERS.—The State licen-
sure status of the plan or issuer’s participating health
care professionals and participating health care fa-
cilities, and, if available, the education, training, spe-
cialty qualifications or certifications of such profes-
sionals.
‘‘(2) COMPENSATION METHODS.—A summary de-
scription of the methods (such as capitation, fee-for-
service, salary, bundled payments, per diem, or a
combination thereof) used for compensating partici-
pating health care professionals (including primary
care providers and specialists) and facilities in con-
nection with the provision of health care under the
plan or coverage. The requirement of this paragraph
shall not be construed as requiring plans or issuers to
provide information concerning proprietary payment
methodology.
‘‘(3) PRESCRIPTION DRUGS.—Information about
whether a specific prescription medication is included
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in the formulary of the plan or issuer, if the plan or
issuer uses a defined formulary.
‘‘(4) EXTERNAL APPEALS INFORMATION.—Aggre-
gate information on the number and outcomes of ex-
ternal medical reviews, relative to the sample size
(such as the number of covered lives) determined for
the plan or issuer’s book of business.
‘‘(d) MANNER OF DISCLOSURE.—The information de-
scribed in this section shall be disclosed in an accessible me-
dium and format that is calculated to be understood by the
average participant.
‘‘(e) RULES OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to prohibit a group health plan, or
a health insurance issuer in connection with group health
insurance coverage, from—
‘‘(1) distributing any other additional informa-
tion determined by the plan or issuer to be important
or necessary in assisting participants and bene-
ficiaries in the selection of a health plan; and
‘‘(2) complying with the provisions of this sec-
tion by providing information in brochures, through
the Internet or other electronic media, or through
other similar means, so long as participants and
beneficiaries are provided with an opportunity to re-