‘‘(h)(1) Any provider of health care services or supplies
that is the subject of an adverse determination by the Office
under this section shall be entitled to reasonable notice and
an opportunity to request a hearing of record, and to judi-
cial review as provided in this subsection after the Office
renders a final decision. The Office shall grant a request
for a hearing upon a showing that due process rights have
not previously been afforded with respect to any finding
of fact which is relied upon as a cause for an adverse deter-
mination under this section. Such hearing shall be con-
ducted without regard to subchapter II of chapter 5 and
chapter 7 of this title by a hearing officer who shall be des-
ignated by the Director of the Office and who shall not oth-
erwise have been involved in the adverse determination
being appealed. A request for a hearing under this sub-
section shall be filed within such period and in accordance
with such procedures as the Office shall prescribe by regula-
tion.
‘‘(2) Any provider adversely affected by a final deci-
sion under paragraph (1) made after a hearing to which
such provider was a party may seek review of such decision
in the United States District Court for the District of Co-
lumbia or for the district in which the plaintiff resides or
has his or her principal place of business by filing a notice
of appeal in such court within 60 days after the date the
decision is issued, and by simultaneously sending copies of
such notice by certified mail to the Director of the Office
and to the Attorney General. In answer to the appeal, the
Director of the Office shall promptly file in such court a
certified copy of the transcript of the record, if the Office
conducted a hearing, and other evidence upon which the
findings and decision complained of are based. The court
shall have power to enter, upon the pleadings and evidence
of record, a judgment affirming, modifying, or setting aside,
in whole or in part, the decision of the Office, with or with-
out remanding the case for a rehearing. The district court
shall not set aside or remand the decision of the Office un-
less there is not substantial evidence on the record, taken
as whole, to support the findings by the Office of a cause
for action under this section or unless action taken by the
Office constitutes an abuse of discretion.’’; and
(8) in subsection (i) (as so redesignated by para-
graph (3))—
(A) by striking ‘‘subsection (c)’’ and insert-
ing ‘‘subsection (d)’’; and
(B) by adding at the end the following:
‘‘The amount of a penalty or assessment as fi-
nally determined by the Office, or other amount
the Office may agree to in compromise, may be
deducted from any sum then or later owing by
the United States to the party against whom the
penalty or assessment has been levied.’’.
(b) EFFECTIVE DATE.—
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section shall
take effect on the date of the enactment of this Act.
(2) EXCEPTIONS.—(A) Paragraphs (2), (3), and
(5) of section 8902a(c) of title 5, United States Code,
as amended by subsection (a)(3), shall apply only to
the extent that the misconduct which is the basis for
debarment under such paragraph (2), (3), or (5), as
applicable, occurs after the date of the enactment of
this Act.
(B) Paragraph (1)(B) of section 8902a(d) of title
5, United States Code, as amended by subsection
(a)(4), shall apply only with respect to charges which
violate section 8904(b) of such title for items or serv-
ices furnished after the date of the enactment of this
Act.
(C) Paragraph (3) of section 8902a(g) of title 5,
United States Code, as amended by subsection
(a)(6)(B), shall apply only with respect to debarments
based on convictions occurring after the date of the
enactment of this Act.
SEC. 3. MISCELLANEOUS AMENDMENTS RELATING TO THE
HEALTH BENEFITS PROGRAM FOR FEDERAL
EMPLOYEES.
(a) DEFINITION OF A CARRIER.—Paragraph (7) of sec-
tion 8901 of title 5, United States Code, is amended by
striking ‘‘organization;’’ and inserting ‘‘organization and
an association of organizations or other entities described
in this paragraph sponsoring a health benefits plan;’’.
(b) SERVICE BENEFIT PLAN.—Paragraph (1) of sec-
tion 8903 of title 5, United States Code, is amended by
striking ‘‘plan,’’ and inserting ‘‘plan, which may be under-
written by participating affiliates licensed in any number
of States,’’.
(c) PREEMPTION.—Section 8902(m) of title 5, United
States Code, is amended by striking ‘‘(m)(1)’’ and all that
follows through the end of paragraph (1) and inserting the
following:
‘‘(m)(1) The terms of any contract under this chapter
which relate to the nature, provision, or extent of coverage
or benefits (including payments with respect to benefits)
shall supersede and preempt any State or local law, or any
regulation issued thereunder, which relates to health insur-
ance or plans.’’.
SEC. 4. CONTINUED HEALTH INSURANCE COVERAGE FOR
CERTAIN INDIVIDUALS.
(a) ENROLLMENT IN CHAPTER 89 PLAN.—For pur-
poses of chapter 89 of title 5, United States Code, any pe-
riod of enrollment—
(1) in a health benefits plan administered by the
Federal Deposit Insurance Corporation before the ter-
mination of such plan on January 3, 1998, or
(2) subject to subsection (c), in a health benefits
plan (not under chapter 89 of such title) with respect
to which the eligibility of any employees or retired
employees of the Board of Governors of the Federal
Reserve System terminates on January 3, 1998,
shall be deemed to be a period of enrollment in a health
benefits plan under chapter 89 of such title.
(b) CONTINUED COVERAGE.—(1) Subject to subsection
(c), any individual who, on January 3, 1998, is enrolled
in a health benefits plan described in subsection (a) (1) or
(2) may enroll in an approved health benefits plan under
chapter 89 of title 5, United States Code, either as an indi-
vidual or for self and family, if, after taking into account
the provisions of subsection (a), such individual—
(A) meets the requirements of such chapter for
eligibility to become so enrolled as an employee, an-
nuitant, or former spouse (within the meaning of such
chapter); or
(B) would meet those requirements if, to the ex-
tent such requirements involve either retirement sys-
tem under such title 5, such individual satisfies simi-
lar requirements or provisions of the Retirement Plan
for Employees of the Federal Reserve System.
Any determination under subparagraph (B) shall be made
under guidelines which the Office of Personnel Management
shall establish in consultation with the Board of Governors
of the Federal Reserve System.
(2) Subject to subsection (c), any individual who, on
January 3, 1998, is entitled to continued coverage under
a health benefits plan described in subsection (a) (1) or (2)
shall be deemed to be entitled to continued coverage under
section 8905a of title 5, United States Code, but only for
the same remaining period as would have been allowable
under the health benefits plan in which such individual was
enrolled on January 3, 1998, if—
(A) such individual had remained enrolled in
such plan; and
(B) such plan did not terminate, or the eligi-
bility of such individual with respect to such plan did
not terminate, as described in subsection (a).
(3) Subject to subsection (c), any individual (other
than an individual under paragraph (2)) who, on January
3, 1998, is covered under a health benefits plan described
in subsection (a) (1) or (2) as an unmarried dependent
child, but who does not then qualify for coverage under
chapter 89 of title 5, United States Code, as a family mem-
ber (within the meaning of such chapter) shall be deemed
to be entitled to continued coverage under section 8905a of
such title, to the same extent and in the same manner as
if such individual had, on January 3, 1998, ceased to meet
the requirements for being considered an unmarried de-
pendent child of an enrollee under such chapter.
(4) Coverage under chapter 89 of title 5, United States
Code, pursuant to an enrollment under this section shall
become effective on January 4, 1998.
(c) ELIGIBILITY FOR FEHBP LIMITED TO INDIVID-
UALS
LOSING
ELIGIBILITY
UNDER
FORMER
HEALTH
PLAN.—Nothing in subsection (a)(2) or any paragraph of
subsection (b) (to the extent such paragraph relates to the
plan described in subsection (a)(2)) shall be considered to
apply with respect to any individual whose eligibility for
coverage under such plan does not involuntarily terminate
on January 3, 1998.
(d) TRANSFERS TO THE EMPLOYEES HEALTH BENE-
FITS FUND.—The Federal Deposit Insurance Corporation
and the Board of Governors of the Federal Reserve System
shall transfer to the Employees Health Benefits Fund under
section 8909 of title 5, United States Code, amounts deter-
mined by the Director of the Office of Personnel Manage-
ment, after consultation with the Federal Deposit Insurance
Corporation and the Board of Governors of the Federal Re-
serve System, to be necessary to reimburse the Fund for the
cost of providing benefits under this section not otherwise
paid for by the individuals covered by this section. The
amounts so transferred shall be held in the Fund and used
by the Office in addition to amounts available under section
8906(g)(1) of such title.
(e) ADMINISTRATION AND REGULATIONS.—The Office
of Personnel Management—
(1) shall administer the provisions of this section
to provide for—
(A) a period of notice and open enrollment
for individuals affected by this section; and
(B) no lapse of health coverage for individ-
uals who enroll in a health benefits plan under
chapter 89 of title 5, United States Code, in ac-
cordance with this section; and
(2) may prescribe regulations to implement this
section.
SEC. 5. FULL DISCLOSURE IN HEALTH PLAN CONTRACTS.
The Office of Personnel Management shall encourage
carriers offering health benefits plans described by section
8903 or section 8903a of title 5, United States Code, with
respect to contractual arrangements made by such carriers
with any person for purposes of obtaining discounts from
providers for health care services or supplies furnished to
individuals enrolled in such plan, to seek assurance that
the conditions for such discounts are fully disclosed to the
providers who grant them.
SEC. 6. PROVISIONS RELATING TO CERTAIN PLANS THAT
HAVE DISCONTINUED THEIR PARTICIPATION
IN FEHBP.
(a) AUTHORITY TO READMIT.—
(1) IN GENERAL.—Chapter 89 of title 5, United
States Code, is amended by inserting after section
8903a the following:
‘‘§ 8903b. Authority to readmit an employee organiza-
tion plan
‘‘(a) In the event that a plan described by section
8903(3) or 8903a is discontinued under this chapter (other
than in the circumstance described in section 8909(d)), that
discontinuation shall be disregarded, for purposes of any
determination as to that plan’s eligibility to be considered
an approved plan under this chapter, but only for purposes
of any contract year later than the third contract year be-
ginning after such plan is so discontinued.
‘‘(b) A contract for a plan approved under this section
shall require the carrier—
‘‘(1) to demonstrate experience in service delivery
within a managed care system (including provider
networks) throughout the United States; and
‘‘(2) if the carrier involved would not otherwise
be subject to the requirement set forth in section
8903a(c)(1), to satisfy such requirement.’’.
(2) CONFORMING AMENDMENT.—The analysis for
chapter 89 of title 5, United States Code, is amended
by inserting after the item relating to section 8903a
the following:
‘‘8903b. Authority to readmit an employee organization plan.’’.
(3) APPLICABILITY.—
(A) IN GENERAL.—The amendments made
by this subsection shall apply as of the date of
enactment of this Act, including with respect to
any plan which has been discontinued as of such
date.
(B) TRANSITION
RULE.—For purposes of
applying section 8903b(a) of title 5, United
States Code (as amended by this subsection) with
respect to any plan seeking to be readmitted for
purposes of any contract year beginning before
January 1, 2000, such section shall be applied
by substituting ‘‘second contract year’’ for ‘‘third
contract year’’.
(b) TREATMENT OF THE CONTINGENCY RESERVE OF
A DISCONTINUED PLAN.—
(1) IN GENERAL.—Subsection (e) of section 8909
of title 5, United States Code, is amended by striking
‘‘(e)’’ and inserting ‘‘(e)(1)’’ and by adding at the end
the following:
‘‘(2) Any crediting required under paragraph (1) pur-
suant to the discontinuation of any plan under this chapter
shall be completed by the end of the second contract year
beginning after such plan is so discontinued.
‘‘(3) The Office shall prescribe regulations in accord-
ance with which this subsection shall be applied in the case
of any plan which is discontinued before being credited with
the full amount to which it would otherwise be entitled
based on the discontinuation of any other plan.’’.
(2) TRANSITION
RULE.—In the case of any
amounts remaining as of the date of enactment of this
Act in the contingency reserve of a discontinued plan,
such amounts shall be disposed of in accordance with
section 8909(e) of title 5, United States Code, as
amended by this subsection, by—
(A) the deadline set forth in section 8909(e)
of such title (as so amended); or
(B) if later, the end of the 6-month period
beginning on such date of enactment.
SEC. 7. MAXIMUM PHYSICIANS COMPARABILITY ALLOW-
ANCE PAYABLE.
(a) IN GENERAL.—Paragraph (2) of section 5948(a)
of title 5, United States Code, is amended by striking
‘‘$20,000’’ and inserting ‘‘$30,000’’.
(b) AUTHORITY
TO
MODIFY
EXISTING
AGREE-
MENTS.—
(1) IN GENERAL.—Any service agreement under
section 5948 of title 5, United States Code, which is
in effect on the date of enactment of this Act may,
with respect to any period of service remaining in
such agreement, be modified based on the amendment
made by subsection (a).
(2) LIMITATION.—A modification taking effect
under this subsection in any year shall not cause an
allowance to be increased to a rate which, if applied
throughout such year, would cause the limitation
under section 5948(a)(2) of such title (as amended by
this section), or any other applicable limitation, to be
exceeded.
(c) RULE OF CONSTRUCTION.—Nothing in this section
shall be considered to authorize additional or supplemental
appropriations for the fiscal year in which occurs the date
of enactment of this Act.
SEC. 8. CLARIFICATION RELATING TO SECTION 8902(k).
Section 8902(k) of title 5, United States Code, is
amended—
(1) by redesignating paragraph (2) as para-
graph (3); and
(2) by inserting after paragraph (1) the follow-
ing:
‘‘(2) Nothing in this subsection shall be considered to
preclude a health benefits plan from providing direct access
or direct payment or reimbursement to a provider in a
health care practice or profession other than a practice or
profession listed in paragraph (1), if such provider is li-
censed or certified as such under Federal or State law.’’.