In applying subparagraph (B) for a year, if the dol-
lar amount computed under such subparagraph is
not a multiple of $10, it shall be rounded to the next
highest multiple of $10.
SEC. 224. FUNDING OF PROGRAM.
(a) LIMITATIONS ON PREMIUMS.—
(1) IN GENERAL.—The applicable premium es-
tablished under a State high-risk program may not
exceed 135 percent of the applicable standard risk
rate, except as provided in paragraph (2).
(2) SURCHARGE
FOR
AVOIDABLE
HEALTH
RISKS.—A State high-risk program may impose a
surcharge on premiums for individuals with avoid-
able high risks, such as smoking.
(b) FLEXIBILITY
IN
ADDITIONAL
FUNDING.—A
State high-risk program shall provide for additional fund-
ing through other means specified under State law. Such
means may include—
(1) an assessment on all insurers in the State
through a nonprofit association consisting of all
health benefits insurers doing business in the State
on an equitable and pro rata basis,
(2) a designated tax source, or
(3) general revenues of the State.
SEC. 225. ADMINISTRATION.
A State high-risk program shall be administered
through a contract with one or more insurers operating
in the State.
TITLE III—MEDICAID REFORM
SEC. 301. PROVIDING COVERAGE FOR OUT-OF-POCKET EX-
PENSES UNDER PRIVATE HEALTH PLANS.
(a) STATE OPTION.—Section 1902(a) of the Social
Security Act (42 U.S.C. 1396a(a)) is amended—
(1) by striking ‘‘and’’ at the end of paragraph
(61);
(2) by striking the period at the end of para-
graph (62) and inserting ‘‘; and’’; and
(3) by adding at the end the following new
paragraph:
‘‘(63) at the option of the State, provide that
an individual eligible for medical assistance under
the State plan has the option to receive medical as-
sistance through enrollment with a health plan
under a program described in section 1931.’’.
(b) PROGRAM FOR ENROLLMENT DESCRIBED.—Title
XIX of such Act (42 U.S.C. 1396 et seq.) is amended by
redesignating section 1931 as section 1932 and by insert-
ing after section 1930 the following new section:
‘‘OPTIONAL STATE PROGRAM TO ENROLL INDIVIDUALS IN
PRIVATE HEALTH PLANS
‘‘SEC. 1931. (a) IN GENERAL.—For purposes of sec-
tion 1902(a)(63), a program under this section is a pro-
gram under which the State makes payments to health
plans that provide qualified health insurance coverage
under section 223 of the Bipartisan Health Security Re-
form Act for enrolling individuals for coverage under such
plans, including all necessary payments of premiums,
copayments, and deductibles applicable under such a plan
on behalf of such an individual.
‘‘(b) TREATMENT OF PAYMENTS AS MEDICAL AS-
SISTANCE.—Subject to paragraph (3), for purposes of de-
termining the amount of Federal financial participation
for a State under section 1903 in a quarter, any payments
made by a State under the program under this section
shall be treated as expenditures for medical assistance
under the State plan for such quarter.
‘‘(c) OPTIONAL USE OF CONTRIBUTIONS TO MEDI-
CAL SAVINGS ACCOUNTS OR VOUCHERS TO OBTAIN COV-
ERAGE.—Under a program under this section, a State
may provide for the enrollment of individuals in health
plans—
‘‘(1) by making contributions to an individual’s
medical savings account established under section
220 of the Internal Revenue Code of 1986; or
‘‘(2) by providing the individual with a voucher
that may be used toward the payment of the costs
of enrollment in a health plan (as determined under
an agreement between the State and the plan).’’.
(c) EFFECTIVE DATE.—The amendments made by
subsections (a) and (b) shall apply to quarters beginning
on or after January 1, 1996.
TITLE IV—MEDICAL CHARGE
DISCLOSURE
SEC. 401. REQUIRING PROVIDERS OF MEDICAL SERVICES
TO DISCLOSE MAXIMUM CHARGES
(a) REQUIREMENT DESCRIBED.—Each individual or
entity providing a medical procedure or diagnostic test
shall post (at a place and in a manner that will be visible
to the individuals receiving the procedures or tests)—
(1) the maximum charge assessed for the proce-
dure or test; and
(2) the costs to the individual or entity that are
associated with the procedure or test.
(b) PROHIBITION AGAINST CHARGING IN EXCESS OF
POSTED MAXIMUM CHARGE.—An individual or entity may
not charge an amount for a medical procedure or diag-
nostic test in excess of the maximum charge posted for
the procedure or test pursuant to paragraph (1).
(c) RECOMMENDATIONS FOR ENFORCEMENT.—Not
later than April 1, 1995, the Secretary of Health and
Human Services shall submit to Congress specific rec-
ommendations for sanctions that should be imposed on in-
dividuals and entities that fail to meet the requirements
of this section.
(d) EFFECTIVE DATE.—This section shall apply to
medical procedures and diagnostic tests provided on or
after January 1, 1996.
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