126
to as the ‘‘Secretary’’), to achieve the national goals
specified in subsection (b);
(2) overseeing the health professional education
expenditures of the State health security programs
from the account established under section 602(c);
(3) developing and maintaining, in cooperation
with the Secretary, a system to monitor the number
and specialties of individuals through their health
professional education, any postgraduate training,
and professional practice; and
(4) developing, coordinating, and promoting
other policies that expand the number of primary
care practitioners.
(b) NATIONAL GOALS.—The national goals specified
in this subsection are as follows:
(1) GRADUATE MEDICAL EDUCATION.—By not
later than 5 years after the date of the enactment
of this Act, at least 50 percent of the residents in
medical residency education programs (as defined in
subsection (e)(1)) are primary care residents (as
defined in subsection (e)(3)).
(2) MIDLEVEL
PRIMARY
CARE
PRACTITION-
ERS.—To assure an adequate supply of primary care
practitioners, there shall be a number, specified by
the Board, of midlevel primary care practitioners (as
127
defined in subsection (e)(2)) employed in the health
care system as of January 1, 2003.
(c) METHOD FOR ATTAINMENT OF NATIONAL GOAL
FOR
GRADUATE
MEDICAL
EDUCATION; 
PROGRAM
GOALS.—
(1) IN GENERAL.—The Board shall establish a
method of applying the national goal in subsection
(b)(1) to program goals for each medical residency
education program or to medical residency education
consortia.
(2) 
CONSIDERATION.—The 
program 
goals
under paragraph (1) shall be based on the distribu-
tion of medical schools and other teaching facilities
within each State health security program, and the
number of positions for graduate medical education.
(3) MEDICAL RESIDENCY EDUCATION CONSOR-
TIUM.—In this subsection, the term ‘‘medical resi-
dency education consortium’’ means a consortium of
medical residency education programs in a contig-
uous geographic area (which may be an interstate
area) if the consortium—
(A) includes at least one medical school
with a teaching hospital and related teaching
settings, and
128
(B) has an affiliation with qualified com-
munity-based primary health service providers
described in section 202(a) and with at least
one comprehensive health service organization
established under section 303.
(4) ENFORCEMENT THROUGH STATE HEALTH
SECURITY
BUDGETS.—The Board shall develop a
formula for reducing payments to State health secu-
rity programs (that provide for payments to a medi-
cal residency education program) that failed to meet
the goal for the program established under this sub-
section.
(d) METHOD FOR ATTAINMENT OF NATIONAL GOAL
FOR MIDLEVEL PRIMARY CARE PRACTITIONERS.—To as-
sist in attaining the national goal identified in subsection
(b)(2), the Board shall—
(1) advise the Public Health Service on alloca-
tions of funding under titles VII and VIII of the
Public Health Service Act, the National Health
Service Corps, and other programs in order to in-
crease the supply of midlevel primary care practi-
tioners, and
(2) commission a study of the potential benefits
and disadvantages of expanding the scope of practice
129
authorized under State laws for any class of midlevel
primary care practitioners.
(e) DEFINITIONS.—In this title:
(1) MEDICAL
RESIDENCY
EDUCATION
PRO-
GRAM.—The term ‘‘medical residency education pro-
gram’’ means a program that provides education
and training to graduates of medical schools in order
to meet requirements for licensing and certification
as a physician, and includes the medical school su-
pervising the program and includes the hospital or
other facility in which the program is operated.
(2) 
MIDLEVEL
PRIMARY
CARE
PRACTI-
TIONER.—The term ‘‘midlevel primary care practi-
tioner’’ means a clinical nurse practitioner, certified
nurse midwife, physician assistance, or other non-
physician practitioner, specified by the Board, as
authorized to practice under State law.
(3) PRIMARY CARE RESIDENT.—The term ‘‘pri-
mary care resident’’ means (in accordance with cri-
teria established by the Board) a resident being
trained in a distinct program of family practice med-
icine, general practice, general internal medicine, or
general pediatrics.
130
SEC. 702. ESTABLISHMENT OF ADVISORY COMMITTEE ON
HEALTH PROFESSIONAL EDUCATION.
(a) IN GENERAL.—The Board shall provide for an
Advisory Committee on Health Professional Education (in
this section referred to as the ‘‘Committee’’) to advise the
Board on its activities under section 701.
(b) MEMBERSHIP.—The Committee shall be com-
posed of—
(1) the Chair of the Board, who shall serve as
Chair of the Committee, and
(2) 12 members, not otherwise in the employ of
the United States, appointed by the Board without
regard to the provisions of title 5, United States
Code, governing appointments in the competitive
service.
The appointed members shall provide a balanced point of
view with respect to health professional education, primary
care disciplines, and health care policy and shall include
individuals who are representative of medical schools,
other health professional schools, residency programs, pri-
mary care practitioners, teaching hospitals, professional
associations, public health organizations, State health
security programs, and consumers.
(c) TERMS OF MEMBERS.—Each appointed member
shall hold office for a term of five years, except that—
131
(1) any member appointed to fill a vacancy oc-
curring during the term for which the member’s
predecessor was appointed shall be appointed for the
remainder of that term; and
(2) the terms of the members first taking office
shall expire, as designated by the Board at the time
of appointment, two at the end of the second year,
two at the end of the third year, two at the end of
the fourth year, and three at the end of the fifth
year after the date of enactment of this Act.
(d) VACANCIES.—
(1) IN GENERAL.—The Board shall fill any va-
cancy in the membership of the Committee in the
same manner as the original appointment. The va-
cancy shall not affect the power of the remaining
members to execute the duties of the Committee.
(2) VACANCY
APPOINTMENTS.—Any member
appointed to fill a vacancy shall serve for the re-
mainder of the term for which the predecessor of the
member was appointed.
(3) REAPPOINTMENT.—The Board may re-
appoint an appointed member of the Committee for
a second term in the same manner as the original
appointment.
132
(e) DUTIES.—It shall be the duty of the Committee
to advise the Board concerning graduate medical edu-
cation policies under this title.
(f) STAFF.—The Committee, its members, and any
committees of the Committee shall be provided with such
secretarial, clerical, or other assistance as may be author-
ized by the Board for carrying out their respective
functions.
(g) MEETINGS.—The Committee shall meet as fre-
quently as the Board deems necessary, but not less than
4 times each year. Upon request by four or more members
it shall be the duty of the Chair to call a meeting of the
Committee.
(h) COMPENSATION.—Members of the Committee
shall be reimbursed by the Board for travel and per diem
in lieu of subsistence expenses during the performance of
duties of the Board in accordance with subchapter I of
chapter 57 of title 5, United States Code.
(i) FACA NOT APPLICABLE.—The provisions of the
Federal Advisory Committee Act shall not apply to the
Committee.
133
SEC. 703. GRANTS FOR HEALTH PROFESSIONS EDUCATION,
NURSE 
EDUCATION, 
AND 
THE 
NATIONAL
HEALTH SERVICE CORPS.
(a) TRANSFERS
TO PUBLIC HEALTH SERVICE.—
From the amounts provided under subsection (c), the
Board shall make transfers from the American Health Se-
curity Trust Fund to the Public Health Service under sub-
part II of part D of title III, title VII, and title VIII of
the Public Health Service Act for the support of the Na-
tional Health Service Corps, health professions education,
and nursing education, including education of clinical
nurse practitioners, certified registered nurse anesthetists,
certified nurse midwives, and physician assistants. Of the
amounts so transferred in each year, not less than 50 per-
cent shall be expended for the support of the National
Health Service Corps.
(b) RANGE OF FUNDS.—The amount of transfers
under subsection (a) for any fiscal year shall be an amount
(specified by the Board each year) not less than 4⁄100 per-
cent and not to exceed 6⁄100 percent of the amounts the
Board estimates will be expended from the Trust Fund
in the fiscal year.
(c) FUNDS SUPPLEMENTAL TO OTHER FUNDS.—The
funds provided under this section with respect to provision
of services are in addition to, and not in replacement of,
funds made available under the provisions referred to in
134
subsection (a) and shall be administered in accordance
with the terms of such provisions. The Board shall make
no transfer of funds under this section for any fiscal year
for which the total appropriations for the programs au-
thorized by such provisions are less than the total amount
appropriated for such programs in fiscal year 1996.
Subtitle B—Direct Health Care
Delivery
SEC. 711. SETASIDE FOR PUBLIC HEALTH.
(a) TRANSFERS
TO PUBLIC HEALTH SERVICE.—
From the amounts provided under subsection (c), the
Board shall make transfers from the American Health Se-
curity Trust Fund to the Public Health Service for the
following purposes (other than payment for services cov-
ered under title II):
(1) For payments to States under the maternal
and child health block grants under title V of the
Social Security Act.
(2) For prevention and treatment of tuber-
culosis under section 317 of the Public Health Serv-
ice Act.
(3) For the prevention and treatment of sexu-
ally transmitted diseases under section 318 of the
Public Health Service Act.
135
(4) Preventive health block grants under part A
of title XIX of the Public Health Service Act.
(5) Grants to States for community mental
health services under subpart I of part B of title
XIX of the Public Health Service Act.
(6) Grants to States for prevention and treat-
ment of substance abuse under subpart II of part B
of title XIX of the Public Health Service Act.
(7) Grants for HIV health care services under
parts A, B, and C of title XXVI of the Public
Health Service Act.
(8) Public health formula grants described in
subsection (d).
(b) RANGE OF FUNDS.—The amount of transfers
under subsection (a) for any fiscal year shall be an amount
(specified by the Board each year) not less than 1⁄10 per-
cent and not to exceed 14⁄100 percent of the amounts the
Board estimates will be expended from the Trust Fund
in the fiscal year.
(c) FUNDS SUPPLEMENTAL TO OTHER FUNDS.—The
funds provided under this section with respect to provision
of services are in addition to, and not in replacement of,
funds made available under the programs referred to in
subsection (a) and shall be administered in accordance
with the terms of such programs.
136
(d) REQUIRED REPORTS ON HEALTH STATUS.—The
Secretary shall require each State receiving funds under
this section to submit annual reports to the Secretary on
the health status of the population and measurable objec-
tives for improving the health of the public in the State.
Such reports shall include the following:
(1) A comparison of the measures of the State
and local public health system compared to relevant
objectives set forth in ‘‘Health People 2000’’ or sub-
sequent national objectives set by the Secretary.
(2) A description of health status measures to
be improved within the State (at the State and local
levels) through expanded public health functions and
health promotion and disease prevention programs.
(3) Measurable outcomes and process objectives
for improving health status, and a report on out-
comes from the previous year.
(4) Information regarding how Federal funding
has improved population-based prevention activities
and programs.
(5) A description of the core public health func-
tions to be carried out at the local level.
(6) A description of the relationship between
the State’s public health system, community-based
137
health promotion and disease prevention providers,
and the State health security program.
(e) LIMITATION ON FUND TRANSFERS.—The Board
shall make no transfer of funds under this section for any
fiscal year for which the total appropriations for such pro-
grams are less than the total amount appropriated for
such programs in fiscal year 1996.
(f) PUBLIC HEALTH FORMULA GRANTS.—The Sec-
retary shall provide stable funds to States through for-
mula grants for the purpose of carrying out core public
health functions to monitor and protect the health of com-
munities from communicable diseases and exposure to
toxic environmental pollutants, occupational hazards,
harmful products, and poor health outcomes. Such func-
tions include the following:
(1) Data collection, analysis, and assessment of
public health data, vital statistics, and personal
health data to assess community health status and
outcomes reporting. This function includes the ac-
quisition and installation of hardware and software,
and personnel training and technical assistance to
operate and support automated and integrated infor-
mation systems.
138
(2) Activities to protect the environment and to
assure the safety of housing, workplaces, food, and
water.
(3) Investigation and control of adverse health
conditions, and threats to the health status of indi-
viduals and the community. This function includes
the identification and control of outbreaks of infec-
tious disease, patterns of chronic disease and injury,
and cooperative activities to reduce the levels of vio-
lence.
(4) Health promotion and disease prevention
activities for which there is a significant need and a
high priority of the Public Health Service.
(5) The provision of public health laboratory
services to complement private clinical laboratory
services, including—
(A) screening tests for metabolic diseases
in newborns,
(B) toxicology assessments of blood lead
levels and other environmental toxins,
(C) tuberculosis and other disease requir-
ing partner notification, and
(D) testing for infectious and food-borne
diseases.
139
(6) Training and education for the public
health professions.
(7) Research on effective and cost-effective pub-
lic health practices. This function includes the devel-
opment, testing, evaluation, and publication of re-
sults of new prevention and public health control
interventions.
(8) Integration and coordination of the preven-
tion programs and services of community-based pro-
viders, local and State health departments, and
other sectors of State and local government that af-
fect health.
SEC. 712. SETASIDE FOR PRIMARY HEALTH CARE DELIV-
ERY.
(a) TRANSFERS
TO PUBLIC HEALTH SERVICE.—
From the amounts provided under subsection (c), the
Board shall make transfers from the American Health Se-
curity Trust Fund to the Public Health Service for the
program of primary care service expansion grants under
subpart V of part D of title III of the Public Health
Service Act (as added by section 713 of this Act).
(b) RANGE OF FUNDS.—The amount of transfers
under subsection (a) for any fiscal year shall be an amount
(specified by the Board each year) not less than 6⁄100 per-
cent and not to exceed 1⁄10 percent of the amounts the
140
Board estimates will be expended from the Trust Fund
in the fiscal year.
(c) FUNDS SUPPLEMENTAL TO OTHER FUNDS.—The
funds provided under this section with respect to provision
of services are in addition to, and not in replacement of,
funds made available under the sections 329, 330, 340,
340A, 1001, and 2655 of the Public Health Service Act.
The Board shall make no transfer of funds under this sec-
tion for any fiscal year for which the total appropriations
for such sections are less than the total amount appro-
priated under such sections in fiscal year 1996.
SEC. 713. PRIMARY CARE SERVICE EXPANSION GRANTS.
Part D of title III of the Public Health Service Act
(42 U.S.C. 254b et seq.) is amended by adding at the end
thereof the following new subpart:
‘‘Subpart IX—Primary Care Expansion
‘‘SEC. 340E. EXPANDING PRIMARY CARE DELIVERY CAPAC-
ITY IN URBAN AND RURAL AREAS.
‘‘(a) GRANTS FOR PRIMARY CARE CENTERS.—From
the amounts described in subsection (c), the American
Health Security Standards Board shall make grants to
public and nonprofit private entities for projects to plan
and develop primary care centers which will serve medi-
cally underserved populations (as defined in section
330(b)(3)) in urban and rural areas and to deliver primary
141
care services to such populations in such areas. The funds
provided under such a grant may be used for the same
purposes for which a grant may be made under subsection
(c), (e), (f), (g), (h), or (i) of section 330.
‘‘(b) PROCESS OF AWARDING GRANTS.—The provi-
sions of subsection (j)(1) of section 330 shall apply to a
grant under this section in the same manner as they apply
to a grant under the corresponding subsection of such sec-
tion. The provisions of subsection (l)(2)(A) of such section
shall apply to grants for projects to plan and develop pri-
mary care centers under this section in the same manner
as they apply to grants under such section.
‘‘(c) FUNDING AS SET-ASIDE FROM TRUST FUND.—
Funding to carry out this section is provided from the
American Health Security Trust Fund in accordance with
section 912 of the American Health Security Act.
‘‘(d) PRIMARY CARE CENTER DEFINED.—In this sec-
tion, the term ‘primary care center’ means—
‘‘(1) a health center (as defined in section
330(1)),
‘‘(2) an entity qualified to receive a grant under
section 330, 1001 or 2655, or
‘‘(3) a Federally-qualified health center (as de-
fined in section 1905(l)(2)(B) of the Social Security
Act).’’.
142
Subtitle C—Primary Care and
Outcomes Research
SEC. 721. SET-ASIDE FOR OUTCOMES RESEARCH.
(a) GRANTS
FOR
OUTCOMES
RESEARCH.—The
Board shall make transfers from the American Health Se-
curity Trust Fund to the Agency for Health Care Policy
and Research under title IX of the Public Health Service
Act for the purpose of carrying out activities under such
title. The Secretary shall assure that there is a special em-
phasis placed on pediatric outcomes research.
(b) RANGE OF FUNDS.—The amount of transfers
under subsection (a) for any fiscal year shall be an amount
(specified by the Board each year) not less than 1⁄100 per-
cent and not to exceed 2⁄100 percent of the amounts the
Board estimates will be expended from the Trust Fund
in the fiscal year.
(c) FUNDS SUPPLEMENTAL TO OTHER FUNDS.—The
funds provided under this section with respect to provision
of services are in addition to, and not in replacement of,
funds made available to the Agency for Health Care Policy
and Research under section 926 of the Public Health
Service Act. The Board shall make no transfer of funds
under this section for any fiscal year for which the total
appropriations under such section are less than the total
143
amount appropriated under such section and title in fiscal
year 1996.
(d) CONFORMING AMENDMENT.—Section 926(a) of
the Public Health Service Act (42 U.S.C. 299c–5(a)) is
amended by striking ‘‘$115,000,000’’ and all that follows
and inserting ‘‘for each fiscal year (beginning with fiscal
year 1998) such sums as may be necessary.’’.
SEC. 722. OFFICE OF PRIMARY CARE AND PREVENTION RE-
SEARCH.
(a) IN GENERAL.—Title IV of the Public Health
Service Act is amended—
(1) by redesignating parts G through I as parts
H through J, respectively; and
(2) by inserting after part F the following new
part:
‘‘PART G—RESEARCH ON PRIMARY CARE AND
PREVENTION
‘‘SEC. 486E. OFFICE OF PRIMARY CARE AND PREVENTION
RESEARCH.
‘‘(a) ESTABLISHMENT.—There is established within
the Office of the Director of NIH an office to be known
as the Office of Primary Care and Prevention Research
(in this part referred to as the ‘Office’). The Office shall
be headed by a director, who shall be appointed by the
Director of NIH.
144
‘‘(b) PURPOSE.—The Director of the Office shall—
‘‘(1) identify projects of research on primary
care and prevention, for children as well as adults,
that should be conducted or supported by the na-
tional research institutes, with particular emphasis
on—
‘‘(A) clinical patient care, with special em-
phasis on pediatric clinical care and diagnosis,
‘‘(B) diagnostic effectiveness,
‘‘(C) primary care education,
‘‘(D) health and family planning services,
‘‘(E) medical effectiveness outcomes of pri-
mary care procedures and interventions,
‘‘(F) the use of multidisciplinary teams of
health care practitioners.
‘‘(2) identify multidisciplinary research related
to primary care and prevention that should be so
conducted;
‘‘(3) promote coordination and collaboration
among entities conducting research identified under
any of paragraphs (1) and (2);
‘‘(4) encourage the conduct of such research by
entities receiving funds from the national research
institutes;
145
‘‘(5) recommend an agenda for conducting and
supporting such research;
‘‘(6) promote the sufficient allocation of the re-
sources of the national research institutes for con-
ducting and supporting such research; and
‘‘(7) prepare the report required in section
486G.
‘‘(c) PRIMARY CARE AND PREVENTION RESEARCH
DEFINED.—For purposes of this part, the term ‘primary
care and prevention research’ means research on improve-
ment of the practice of family medicine, general internal
medicine, and general pediatrics, and includes research
relating to—
‘‘(1) obstetrics and gynecology, dentistry, or
mental health or substance abuse treatment when
provided by a primary care physician or other
primary care practitioner, and
‘‘(2) primary care provided by multidisciplinary
teams.
‘‘SEC. 486F. NATIONAL DATA SYSTEM AND CLEARINGHOUSE
ON PRIMARY CARE AND PREVENTION RE-
SEARCH.
‘‘(a) DATA SYSTEM.—The Director of NIH, in con-
sultation with the Director of the Office, shall establish
a data system for the collection, storage, analysis, re-
146
trieval, and dissemination of information regarding pri-
mary care and prevention research that is conducted or
supported by the national research institutes. Information
from the data system shall be available through informa-
tion systems available to health care professionals and pro-
viders, researchers, and members of the public.
‘‘(b) CLEARINGHOUSE.—The Director of NIH, in
consultation with the Director of the Office and with the
National Library of Medicine, shall establish, maintain,
and operate a program to provide, and encourage the use
of, information on research and prevention activities of the
national research institutes that relate to primary care
and prevention research.
‘‘SEC. 486G. BIENNIAL REPORT.
‘‘(a) IN GENERAL.—With respect to primary care
and prevention research, the Director of the Office shall,
not later than one year after the date of the enactment
of this part, and biennially thereafter, prepare a report—
‘‘(1) describing and evaluating the progress
made during the preceding two fiscal years in re-
search and treatment conducted or supported by the
National Institutes of Health;
‘‘(2) summarizing and analyzing expenditures
made by the agencies of such Institutes (and by
147
such Office) during the preceding two fiscal years;
and
‘‘(3) making such recommendations for legisla-
tive and administrative initiatives as the Director of
the Office determines to be appropriate.
‘‘(b) INCLUSION IN BIENNIAL REPORT OF DIRECTOR
OF NIH.—The Director of the Office shall submit each
report prepared under subsection (a) to the Director of
NIH for inclusion in the report submitted to the President
and the Congress under section 403.
‘‘SEC. 486H. AUTHORIZATION OF APPROPRIATIONS.
‘‘For the Office of Primary Care and Prevention Re-
search, 
there 
are 
authorized 
to 
be 
appropriated
$150,000,000 for fiscal year 1998, $180,000,000 for fis-
cal year 1999, and $216,000,000 for fiscal year 2000.’’.
(b) REQUIREMENT OF SUFFICIENT ALLOCATION OF
RESOURCES OF INSTITUTES.—Section 402(b) of the Pub-
lic Health Service Act (42 U.S.C. 282(b)) is amended—
(1) in paragraph (11), by striking ‘‘and’’ after
the semicolon at the end;
(2) in paragraph (12), by striking the period at
the end and inserting ‘‘; and’’; and
(3) by inserting after paragraph (12) the fol-
lowing new paragraph:
148
‘‘(13) after consultation with the Director of
the Office of Primary Care and Prevention Re-
search, shall ensure that resources of the National
Institutes of Health are sufficiently allocated for
projects on primary care and prevention research
that are identified under section 486E(b).’’.
Subtitle D—School-Related Health
Services
SEC. 731. AUTHORIZATIONS OF APPROPRIATIONS.
(a) FUNDING FOR SCHOOL-RELATED HEALTH SERV-
ICES.—For the purpose of carrying out this subtitle, there
are authorized to be appropriated $100,000,000 for fiscal
year 
2000, 
$275,000,000 
for 
fiscal 
year 
2001,
$350,000,000 for fiscal year 2002, and $400,000,000 for
each of the fiscal years 2003 and 2004.
(b) RELATION TO OTHER FUNDS.—The authoriza-
tions of appropriations established in subsection (a) are
in addition to any other authorizations of appropriations
that are available for the purpose described in such sub-
section.
SEC. 732. ELIGIBILITY FOR DEVELOPMENT AND OPER-
ATION GRANTS.
(a) IN GENERAL.—Entities eligible to apply for and
receive grants under section 734 or 735 are the following:
149
(1) State health agencies that apply on behalf
of local community partnerships and other commu-
nities in need of health services for school-aged chil-
dren within the State.
(2) Local community partnerships in States in
which health agencies have not applied.
(b) LOCAL COMMUNITY PARTNERSHIPS.—
(1) IN GENERAL.—A local community partner-
ship under subsection (a)(2) is an entity that, at a
minimum, includes—
(A) a local health care provider with expe-
rience in delivering services to school-aged chil-
dren;
(B) one or more local public schools; and
(C) at least one community based organi-
zation located in the community to be served
that has a history of providing services to
school-aged children in the community who are
at-risk.
(2) PARTICIPATION.—A partnership described
in paragraph (1) shall, to the maximum extent fea-
sible, involve broad based community participation
from parents and adolescent children to be served,
health and social service providers, teachers and
other public school and school board personnel, de-
150
velopment and service organizations for adolescent
children, and interested business leaders. Such par-
ticipation may be evidenced through an expanded
partnership, or an advisory board to such partner-
ship.
(c) DEFINITIONS REGARDING CHILDREN.—For pur-
poses of this subtitle:
(1) The term ‘‘adolescent children’’ means
school-aged children who are adolescents.
(2) The term ‘‘school-aged children’’ means in-
dividuals who are between the ages of 4 and 19 (in-
clusive).
SEC. 733. PREFERENCES.
(a) IN GENERAL.—In making grants under sections
734 and 735, the Secretary shall give preference to appli-
cants whose communities to be served show the most sub-
stantial level of need for such services among school-aged
children, as measured by indicators of community health
including the following:
(1) High levels of poverty.
(2) The presence of a medically underserved
population.
(3) The presence of a health professional short-
age area.
151
(4) High rates of indicators of health risk
among school-aged children, including a high propor-
tion of such children receiving services through the
Individuals with Disabilities Education Act, adoles-
cent pregnancy, sexually transmitted disease (includ-
ing infection with the human immunodeficiency
virus), preventable disease, communicable disease,
intentional and unintentional injuries, community
and gang violence, unemployment among adolescent
children, juvenile justice involvement, and high rates
of drug and alcohol exposure.
(b) LINKAGE TO COMMUNITY HEALTH CENTERS.—
In making grants under sections 734 and 735, the Sec-
retary shall give preference to applicants that demonstrate
a linkage to community health centers.
SEC. 734. GRANTS FOR DEVELOPMENT OF PROJECTS.
(a) IN GENERAL.—The Secretary may make grants
to State health agencies or to local community partner-
ships to develop school health service sites.
(b) USE OF FUNDS.—A project for which a grant
may be made under subsection (a) may include but not
be limited to the cost of the following:
(1) Planning for the provision of school health
services.
152
(2) Recruitment, compensation, and training of
health and administrative staff.
(3) The development of agreements, and the ac-
quisition and development of equipment and infor-
mation services, necessary to support information
exchange between school health service sites and
health plans, health providers, and other entities au-
thorized to collect information under this Act.
(4) Other activities necessary to assume oper-
ational status.
(c) APPLICATION FOR GRANT.—
(1) IN GENERAL.—Applicants shall submit ap-
plications in a form and manner prescribed by the
Secretary.
(2) APPLICATIONS
BY
STATE
HEALTH
AGEN-
CIES.—
(A) In the case of applicants that are State
health agencies, the application shall contain
assurances that the State health agency is ap-
plying for funds—
(i) on behalf of at least one local com-
munity partnership; and
(ii) on behalf of at least one other
community identified by the State as in
need of the services funded under this sub-
153
title but without a local community part-
nership.
(B) In the case of the communities identi-
fied in applications submitted by State health
agencies that do not yet have local community
partnerships (including the community identi-
fied under subparagraph (A)(ii)), the State
shall describe the steps that will be taken to aid
the communities in developing a local commu-
nity partnership.
(C) A State applying on behalf of local
community partnerships and other communities
may retain not more than 10 percent of grants
awarded under this subtitle for administrative
costs.
(d) CONTENTS OF APPLICATION.—In order to receive
a grant under this section, an applicant must include in
the application the following information:
(1) An assessment of the need for school health
services in the communities to be served, using the
latest available health data and health goals and ob-
jectives established by the Secretary.
(2) A description of how the applicant will de-
sign the proposed school health services to reach the
154
maximum number of school-aged children who are at
risk.
(3) An explanation of how the applicant will in-
tegrate its services with those of other health and
social service programs within the community.
(4) A description of a quality assurance pro-
gram which complies with standards that the Sec-
retary may prescribe.
(e) NUMBER OF GRANTS.—Not more than one plan-
ning grant may be made to a single applicant. A planning
grant may not exceed two years in duration.
SEC. 735. GRANTS FOR OPERATION OF PROJECTS.
(a) IN GENERAL.—The Secretary may make grants
to State health agencies or to local community partner-
ships for the cost of operating school health service sites.
(b) USE OF GRANT.—The costs for which a grant
may be made under this section include but are not limited
to the following:
(1) The cost of furnishing health services that
are not otherwise covered under this Act or by any
other public or private insurer.
(2) The cost of furnishing services whose pur-
pose is to increase the capacity of individuals to uti-
lize available health services, including transpor-
tation, community and patient outreach, patient
155
education, translation services, and such other serv-
ices as the Secretary determines to be appropriate in
carrying out such purpose.
(3) Training, recruitment and compensation of
health professionals and other staff.
(4) Outreach services to school-aged children
who are at risk and to the parents of such children.
(5) Linkage of individuals to health plans, com-
munity health services and social services.
(6) Other activities deemed necessary by the
Secretary.
(c) APPLICATION FOR GRANT.—Applicants shall sub-
mit applications in a form and manner prescribed by the
Secretary. In order to receive a grant under this section,
an applicant must include in the application the following
information:
(1) A description of the services to be furnished
by the applicant.
(2) The amounts and sources of funding that
the applicant will expend, including estimates of the
amount of payments the applicant will receive from
sources other than the grant.
(3) Such other information as the Secretary de-
termines to be appropriate.
156
(d) ADDITIONAL CONTENTS OF APPLICATION.—In
order to receive a grant under this section, an applicant
must meet the following conditions:
(1) The applicant furnishes the following serv-
ices:
(A) Diagnosis and treatment of simple ill-
nesses and minor injuries.
(B) Preventive health services, including
health screenings.
(C) Services provided for the purpose de-
scribed in subsection (b)(2).
(D) Referrals and followups in situations
involving illness or injury.
(E) Health and social services, counseling
services, and necessary referrals, including re-
ferrals regarding mental health and substance
abuse.
(F) Such other services as the Secretary
determines to be appropriate.
(2) The applicant is a participating provider in
the State’s program for medical assistance under
title XIX of the Social Security Act.
(3) The applicant does not impose charges on
students or their families for services (including col-
lection of any cost-sharing for services under the
157
comprehensive benefit package that otherwise would
be required).
(4) The applicant has reviewed and will periodi-
cally review the needs of the population served by
the applicant in order to ensure that its services are
accessible to the maximum number of school-aged
children in the area, and that, to the maximum ex-
tent possible, barriers to access to services of the ap-
plicant are removed (including barriers resulting
from the area’s physical characteristics, its eco-
nomic, social and cultural grouping, the health care
utilization patterns of such children, and available
transportation).
(5) In the case of an applicant which serves a
population that includes a substantial proportion of
individuals of limited English speaking ability, the
applicant has developed a plan to meet the needs of
such population to the extent practicable in the lan-
guage and cultural context most appropriate to such
individuals.
(6) The applicant will provide non-Federal con-
tributions toward the cost of the project in an
amount determined by the Secretary.
(7) The applicant will operate a quality assur-
ance program consistent with section 734(d).
158
(e) DURATION OF GRANT.—A grant under this sec-
tion shall be for a period determined by the Secretary.
(f) REPORTS.—A recipient of funding under this sec-
tion shall provide such reports and information as are re-
quired in regulations of the Secretary.
SEC. 736. FEDERAL ADMINISTRATIVE COSTS.
Of the amounts made available under section 731, the
Secretary may reserve not more than 5 percent for admin-
istrative expenses regarding this subtitle.
SEC. 737. DEFINITIONS.
For purposes of this subtitle:
(1) The term ‘‘adolescent children’’ has the
meaning given such term in section 732(c).
(2) The term ‘‘at risk’’ means at-risk with re-
spect to health.
(3) The term ‘‘community health center’’ has
the meaning given such term in section 330 of the
Public Health Service Act.
(4) The term ‘‘health professional shortage
area’’ means a health professional shortage area des-
ignated under section 332 of the Public Health Serv-
ice Act.
(5) The term ‘‘medically underserved popu-
lation’’ has the meaning given such term in section
330 of the Public Health Service Act.
159
(6) The term ‘‘school-aged children’’ has the
meaning given such term in section 732(c).
TITLE VIII—FINANCING PROVI-
SIONS; 
AMERICAN 
HEALTH
SECURITY TRUST FUND
SEC. 800. AMENDMENT OF 1986 CODE; SECTION 15 NOT TO
APPLY.
(a) AMENDMENT OF 1986 CODE.—Except as other-
wise expressly provided, whenever in this title an amend-
ment or repeal is expressed in terms of an amendment
to, or repeal of, a section or other provision, the reference
shall be considered to be made to a section or other provi-
sion of the Internal Revenue Code of 1986.
(b) SECTION 15 NOT TO APPLY.—The amendments
made by subtitle B shall not be treated as a change in
a rate of tax for purposes of section 15 of the Internal
Revenue Code of 1986.
Subtitle A—American Health
Security Trust Fund
SEC. 801. AMERICAN HEALTH SECURITY TRUST FUND.
(a) IN GENERAL.—There is hereby created on the
books of the Treasury of the United States a trust fund
to be known as the American Health Security Trust Fund
(in this section referred to as the ‘‘Trust Fund’’). The
Trust Fund shall consist of such gifts and bequests as
160
may be made and such amounts as may be deposited in,
or appropriated to, such Trust Fund as provided in this
Act.
(b) APPROPRIATIONS INTO TRUST FUND.—
(1) TAXES.—There are hereby appropriated to
the Trust Fund for each fiscal year (beginning with
fiscal year 1998), out of any moneys in the Treasury
not otherwise appropriated, amounts equivalent to
100 percent of the aggregate increase in tax liabil-
ities under the Internal Revenue Code of 1986 which
is attributable to the application of the amendments
made by this title. The amounts appropriated by the
preceding sentence shall be transferred from time to
time (but not less frequently than monthly) from the
general fund in the Treasury to the Trust Fund,
such amounts to be determined on the basis of esti-
mates by the Secretary of the Treasury of the taxes
paid to or deposited into the Treasury; and proper
adjustments shall be made in amounts subsequently
transferred to the extent prior estimates were in ex-
cess of or were less than the amounts that should
have been so transferred.
(2) CURRENT
PROGRAM
RECEIPTS.—Notwith-
standing any other provision of law, there are hereby
appropriated to the Trust Fund for each fiscal year
161
(beginning with fiscal year 1998) the amounts that
would otherwise have been appropriated to carry out
the following programs:
(A) The medicare program, under parts A
and B of title XVIII of the Social Security Act
(other than amounts attributable to any pre-
miums under such parts).
(B) The medicaid program, under State
plans approved under title XIX of such Act.
(C) The Federal employees health benefit
program, under chapter 89 of title 5, United
States Code.
(D) The CHAMPUS program, under chap-
ter 55 of title 10, United States Code.
(E) The maternal and child health pro-
gram (under title V of the Social Security Act),
vocational rehabilitation programs, programs
for drug abuse and mental health services
under the Public Health Service Act, programs
providing general hospital or medical assistance,
and any other Federal program identified by
the Board, in consultation with the Secretary of
the Treasury, to the extent the programs pro-
vide for payment for health services the pay-
ment of which may be made under this Act.
162
(c) INCORPORATION OF PROVISIONS.—The provisions
of subsections (b) through (i) of section 1817 of the Social
Security Act shall apply to the Trust Fund under this Act
in the same manner as they applied to the Federal Hos-
pital Insurance Trust Fund under part A of title XVIII
of such Act, except that the American Health Security
Standards Board shall constitute the Board of Trustees
of the Trust Fund.
(d) TRANSFER OF FUNDS.—Any amounts remaining
in the Federal Hospital Insurance Trust Fund or the Fed-
eral Supplementary Medical Insurance Trust Fund after
the settlement of claims for payments under title XVIII
have been completed, shall be transferred into the Amer-
ican Health Security Trust Fund.
Subtitle B—Taxes Based on Income
and Wages
SEC. 811. PAYROLL TAX ON EMPLOYERS.
(a) IN GENERAL.—Section 3111 (relating to tax on
employers) is amended by redesignating subsection (c) as
subsection (d) and by inserting after subsection (b) the
following new subsection:
‘‘(c) HEALTH CARE.—In addition to other taxes,
there is hereby imposed on every employer an excise tax,
with respect to having individuals in his employ, equal to
8.7 percent of the wages (as defined in section 3121(a))
163
paid by him with respect to employment (as defined in
section 3121(b)).’’
(b) SELF-EMPLOYMENT INCOME.—Section 1401 (re-
lating to rate of tax on self-employment income) is amend-
ed by redesignating subsection (c) as subsection (d) and
by inserting after subsection (b) the following new sub-
section:
‘‘(c) HEALTH CARE.—In addition to other taxes,
there shall be imposed for each taxable year, on the self-
employment income of every individual, a tax equal to 8.7
percent of the amount of the self-employment income for
such taxable year.’’
(c) COMPARABLE
TAXES
FOR
RAILROAD
SERV-
ICES.—
(1) TAX
ON
EMPLOYERS.—Section 3221 is
amended by redesignating subsections (c), (d), and
(e) as subsections (d), (e), and (f), respectively, and
by inserting after subsection (b) the following new
subsection:
‘‘(c) HEALTH CARE.—In addition to other taxes,
there is hereby imposed on every employer an excise tax,
with respect to having individuals in his employ, equal to
8.7 percent of the compensation paid by such employer
for services rendered to such employer.’’
164
(2) TAX ON EMPLOYEE REPRESENTATIVES.—
Subsection (a) of section 3211 (relating to tax on
employee representatives) is amended by redesignat-
ing paragraph (3) as paragraph (4) and by inserting
after paragraph (2) the following new paragraph:
‘‘(3) HEALTH
CARE.—In addition to other
taxes, there is hereby imposed on the income of each
employee representative a tax equal to 8.7 percent of
the compensation received during the calendar year
by such employee representative for services ren-
dered by such employee representative.’’
(3) NO APPLICABLE BASE.—Subparagraph (A)
of section 3231(e)(2) is amended by adding at the
end thereof the following new clause:
‘‘(iv) HEALTH CARE TAXES.—Clause
(i) shall not apply to the taxes imposed by
sections 3221(c) and 3211(a)(3).’’
(4) TECHNICAL AMENDMENTS.—
(A) Paragraph (4) of section 3211, as re-
designated by paragraph (2), is amended by
striking ‘‘and (2)’’ and inserting ‘‘, (2), and
(3)’’.
(B) Subsection (f) of section 3221, as re-
designated by paragraph (1), is amended by
165
striking ‘‘and (b)’’ and inserting ‘‘, (b), and
(c)’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to remuneration paid after Decem-
ber 31, 1998.
SEC. 812. HEALTH CARE INCOME TAX.
(a) GENERAL RULE.—Subchapter A of chapter 1 (re-
lating to determination of tax liability) is amended by add-
ing at the end thereof the following new part:
‘‘PART VIII—HEALTH CARE INCOME TAX ON
INDIVIDUALS
‘‘Sec. 59B. Health care income tax.
‘‘SEC. 59B. HEALTH CARE INCOME TAX.
‘‘(a) IMPOSITION OF TAX.—In the case of an individ-
ual, there is hereby imposed a tax (in addition to any other
tax imposed by this subtitle) equal to 2.2 percent of the
taxable income of the taxpayer for the taxable year.
‘‘(b) NO CREDITS AGAINST TAX; NO EFFECT ON
MINIMUM TAX.—The tax imposed by this section shall not
be treated as a tax imposed by this chapter for purposes
of determining—
‘‘(1) the amount of any credit allowable under
this chapter, or
‘‘(2) the amount of the minimum tax imposed
by section 55.
166
‘‘(c) SPECIAL RULES.—
‘‘(1) TAX TO BE WITHHELD, ETC.—For pur-
poses of this title, the tax imposed by this section
shall be treated as imposed by section 1.
‘‘(2) REIMBURSEMENT OF TAX BY EMPLOYER
NOT INCLUDIBLE IN GROSS INCOME.—The gross in-
come of an employee shall not include any payment
by his employer to reimburse the employee for the
tax paid by the employee under this section.
‘‘(3) OTHER
RULES.—The rules of section
59A(d) shall apply to the tax imposed by this sec-
tion.’’
(b) CLERICAL AMENDMENT.—The table of parts for
subchapter A of chapter 1 is amended by adding at the
end the following new item:
‘‘Part VIII. Health care income tax on individuals.’’
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to taxable years beginning after
December 31, 1998.
Subtitle C—Increase in Excise
Taxes on Tobacco Products
SEC. 821. INCREASE IN EXCISE TAXES ON TOBACCO PROD-
UCTS.
(a) CIGARETTES.—Subsection (b) of section 5701 is
amended—
167
(1) by striking ‘‘$12 per thousand ($10 per
thousand on cigarettes removed during 1991 or
1992)’’ in paragraph (1) and inserting ‘‘$22.50 per
thousand’’, and
(2) by striking ‘‘$25.20 per thousand ($21 per
thousand on cigarettes removed during 1991 or
1992)’’ in paragraph (2) and inserting ‘‘$47.25 per
thousand’’.
(b) CIGARS.—Subsection (a) of section 5701 is
amended—
(1) by striking ‘‘$1.125 cents per thousand
(93.75 cents per thousand on cigars removed during
1991 or 1992)’’ in paragraph (1) and inserting
‘‘$2.11 per thousand’’, and
(2) by striking ‘‘equal to’’ and all that follows
in paragraph (2) and inserting ‘‘equal to 23.91 per-
cent of the price for which sold but not more than
$56.25 per thousand.’’
(c) CIGARETTE PAPERS.—Subsection (c) of section
5701 is amended by striking ‘‘0.75 cent (0.625 cent on
cigarette papers removed during 1991 or 1992)’’ and in-
serting ‘‘1.41 cents’’.
(d) CIGARETTE TUBES.—Subsection (d) of section
5701 is amended by striking ‘‘1.5 cents (1.25 cents on
168
cigarette tubes removed during 1991 or 1992)’’ and in-
serting ‘‘2.81 cents’’.
(e) SMOKELESS TOBACCO.—Subsection (e) of section
5701 is amended—
(1) by striking ‘‘36 cents (30 cents on snuff re-
moved during 1991 or 1992)’’ in paragraph (1) and
inserting ‘‘67.5 cents’’, and
(2) by striking ‘‘12 cents (10 cents on chewing
tobacco removed during 1991 or 1992)’’ in para-
graph (2) and inserting ‘‘22.5 cents’’.
(f) PIPE TOBACCO.—Subsection (f) of section 5701
is amended by striking ‘‘67.5 cents (56.25 cents on pipe
tobacco removed during 1991 or 1992)’’ and inserting
‘‘$1.27’’.
(g) EFFECTIVE DATE.—The amendments made by
this section shall apply to articles removed (as defined in
section 5702(k) of the Internal Revenue Code of 1986)
after December 31, 1998.
(h) FLOOR STOCKS TAXES.—
(1) IMPOSITION OF TAX.—On tobacco products
and cigarette papers and tubes manufactured in or
imported into the United States which are removed
before January 1, 1999, and held on such date for
sale by any person, there is hereby imposed a tax in
an amount equal to the excess of—
169
(A) the tax which would be imposed under
section 5701 of the Internal Revenue Code of
1986 on the article if the article had been re-
moved on such date, over
(B) the prior tax (if any) imposed under
section 5701 or 7652 of such Code on such ar-
ticle.
(2) AUTHORITY TO EXEMPT CIGARETTES HELD
IN VENDING MACHINES.—To the extent provided in
regulations prescribed by the Secretary, no tax shall
be imposed by paragraph (1) on cigarettes held for
retail sale on January 1, 1999, by any person in any
vending machine. If the Secretary provides such a
benefit with respect to any person, the Secretary
may reduce the $500 amount in paragraph (3) with
respect to such person.
(3) CREDIT AGAINST TAX.—Each person shall
be allowed as a credit against the taxes imposed by
paragraph (1) an amount equal to $500. Such credit
shall not exceed the amount of taxes imposed by
paragraph (1) for which such person is liable.
(4) LIABILITY FOR TAX AND METHOD OF PAY-
MENT.—
(A) LIABILITY FOR TAX.—A person hold-
ing any article on January 1, 1999, to which
170
any tax imposed by paragraph (1) applies shall
be liable for such tax.
(B) METHOD OF PAYMENT.—The tax im-
posed by paragraph (1) shall be paid in such
manner as the Secretary shall prescribe by reg-
ulations.
(C) TIME
FOR
PAYMENT.—The tax im-
posed by paragraph (1) shall be paid on or be-
fore July 31, 1999.
(5) ARTICLES
IN
FOREIGN
TRADE
ZONES.—
Notwithstanding the Act of June 18, 1934 (48 Stat.
998, 19 U.S.C. 81a) and any other provision of law,
any article which is located in a foreign trade zone
on January 1, 1999, shall be subject to the tax im-
posed by paragraph (1) if—
(A) internal revenue taxes have been deter-
mined, or customs duties liquidated, with re-
spect to such article before such date pursuant
to a request made under the 1st proviso of sec-
tion 3(a) of such Act, or
(B) such article is held on such date under
the supervision of a customs officer pursuant to
the 2d proviso of such section 3(a).
(6) DEFINITIONS.—For purposes of this sub-
section—
171
(A) IN GENERAL.—Terms used in this sub-
section which are also used in section 5702 of
the Internal Revenue Code of 1986 shall have
the respective meanings such terms have in
such section.
(B) SECRETARY.—The term ‘‘Secretary’’
means the Secretary of the Treasury or his del-
egate.
(7) CONTROLLED
GROUPS.—Rules similar to
the rules of section 5061(e)(3) of such Code shall
apply for purposes of this subsection.
(8) OTHER LAWS APPLICABLE.—All provisions
of law, including penalties, applicable with respect to
the taxes imposed by section 5701 of such Code
shall, insofar as applicable and not inconsistent with
the provisions of this subsection, apply to the floor
stocks taxes imposed by paragraph (1), to the same
extent as if such taxes were imposed by such section
5701. The Secretary may treat any person who bore
the ultimate burden of the tax imposed by para-
graph (1) as the person to whom a credit or refund
under such provisions may be allowed or made.
172
TITLE IX—CONFORMING AMEND-
MENTS TO THE EMPLOYEE
RETIREMENT INCOME SECU-
RITY ACT OF 1974
SEC. 901. ERISA INAPPLICABLE TO HEALTH COVERAGE AR-
RANGEMENTS UNDER STATE HEALTH SECU-
RITY PROGRAMS.
Section 4 of the Employee Retirement Income Secu-
rity Act of 1974 (29 U.S.C. 1003) is amended—
(1) in subsection (a), by striking ‘‘subsection
(b)’’ and inserting ‘‘subsections (b) and (c)’’; and
(2) by adding at the end the following new sub-
section:
‘‘(c) The provisions of this title shall not apply to any
arrangement forming a part of a State health security pro-
gram established pursuant to section 101(b) of the Amer-
ican Health Security Act of 1997.’’.
SEC. 902. EXEMPTION OF STATE HEALTH SECURITY PRO-
GRAMS FROM ERISA PREEMPTION.
Section 514(b) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1144(b)) is amended by
adding at the end the following new paragraph:
‘‘(9) Subsection (a) of this section shall not apply to
State health security programs established pursuant to
173
section 101(b) of the American Health Security Act of
1997.’’.
SEC. 903. PROHIBITION OF EMPLOYEE BENEFITS DUPLICA-
TIVE OF BENEFITS UNDER STATE HEALTH
SECURITY 
PROGRAMS; 
COORDINATION 
IN
CASE OF WORKERS’ COMPENSATION.
(a) IN GENERAL.—Part 5 of subtitle B of title I of
the Employee Retirement Income Security Act of 1974 is
amended by adding at the end the following new section:
‘‘PROHIBITION OF EMPLOYEE BENEFITS DUPLICATIVE OF
STATE HEALTH SECURITY PROGRAM BENEFITS; CO-
ORDINATION IN CASE OF WORKERS’ COMPENSATION
‘‘SEC. 516. (a) Subject to subsection (b), no employee
benefit plan may provide benefits which duplicate payment
for any items or services for which payment may be made
under a State health security program established pursu-
ant to section 101(b) of the American Health Security Act
of 1997.
‘‘(b)(1) Each workers compensation carrier that is
liable (or would be liable but for the enactment of the
American Health Security Act) for payment for workers
compensation services furnished in a State shall reimburse
the State health security plan for the State in which the
services are furnished for the cost of such services.
‘‘(2) In this subsection:
174
‘‘(A) The term ‘workers compensation carrier’
means an insurance company that underwrites work-
ers compensation medical benefits with respect to
one or more employers and includes an employer or
fund that is financially at risk for the provision of
workers compensation medical benefits.
‘‘(B) The term ‘workers compensation medical
benefits’ means, with respect to an enrollee who is
an employee subject to the workers compensation
laws of a State, the comprehensive medical benefits
for work-related injuries and illnesses provided for
under such laws with respect to such an employee.
‘‘(C) The term ‘workers compensation services’
means items and services included in workers com-
pensation medical benefits and includes items and
services (including rehabilitation services and long-
term-care services) commonly used for treatment of
work-related injuries and illnesses.’’.
(b) CLERICAL AMENDMENT.—The table of contents
in section 1 of such Act is amended by inserting after the
item relating to section 514 the following new items:
‘‘Sec. 515. Delinquent contributions.
‘‘Sec. 516. Prohibition of employee benefits duplicative of State health security
program benefits.’’.
175
SEC. 904. REPEAL OF CONTINUATION COVERAGE REQUIRE-
MENTS UNDER ERISA AND CERTAIN OTHER
REQUIREMENTS 
RELATING 
TO 
GROUP
HEALTH PLANS.
(a) IN GENERAL.—Part 6 of subtitle B of title I of
the Employee Retirement Income Security Act of 1974
(29 U.S.C. 1161 et seq.) is repealed.
(b) CONFORMING AMENDMENTS.—
(1) Section 502(a) of such Act (29 U.S.C.
1132(a)) is amended—
(A) by striking paragraph (7); and
(B) by redesignating paragraph (8) as
paragraph (7).
(2) Section 502(c)(1) of such Act (29 U.S.C.
1132(c)(1)) is amended by striking ‘‘paragraph (1)
or (4) of section 606 or’’.
(3) Section 4301(c)(4) of the Omnibus Budget
Reconciliation Act of 1993 (Public Law 103–66; 107
Stat. 377) and the amendments made thereby are
repealed.
(4) The table of contents in section 1 of the
Employee Retirement Income Security Act of 1974
is amended by striking the items relating to part 6
of subtitle B of title I of such Act.
176
SEC. 905. EFFECTIVE DATE OF TITLE.
The amendments made by this title shall take effect
January 1, 1999.
TITLE X—ADDITIONAL
CONFORMING AMENDMENTS
SEC. 1001. REPEAL OF CERTAIN PROVISIONS IN INTERNAL
REVENUE CODE OF 1986.
(a) The provisions of titles III and IV of the Health
Insurance Portability and Accountability Act, other than
subtitles D and H and section 342, are repealed and the
provisions of law that were amended or repealed by such
provisions are hereby restored as if such provisions had
not been enacted.
(b) RELATED AMENDMENTS.—Strike subsections (l)
and (m) of section 401 of the Health Insurance Portability
and Accountability Act of 1996.
SEC. 1002. REPEAL OF CERTAIN PROVISIONS IN THE EM-
PLOYEE 
RETIREMENT 
INCOME 
SECURITY
ACT OF 1974.
(a) IN GENERAL.—Part 7 of subtitle B of title I of
the Employee Retirement Income Security Act of 1974 is
repealed and the items relating to such part in the table
of contents in section 1 of such Act are repealed.
(b) ADDITIONAL AMENDMENTS.—Section 514(b) of
such Act (29 U.S.C. 1144(b)) is amended by striking
paragraph (9).
177
SEC. 1003. REPEAL OF CERTAIN PROVISIONS IN THE PUB-
LIC HEALTH SERVICE ACT AND RELATED
PROVISIONS.
(a) IN GENERAL.—Titles XXII and XXVII of the
Public Health Service Act are repealed.
(b) 
ADDITIONAL
AMENDMENTS.—(1) 
Section
1301(b) of such Act (42 U.S.C. 300e(b)) is amended by
striking paragraph (6).
(2) Sections 104 and 191 of the Health Insurance
Portability and Accountability Act of 1996 are repealed.
SEC. 1004. EFFECTIVE DATE OF TITLE.
The amendments made by this title shall take effect
January 1, 1999.
Æ