H. R. 2264—297
SEC. 13567. EXTENSION 
OF 
SOCIAL 
HEALTH 
MAINTENANCE
ORGANIZATION DEMONSTRATIONS.
(a) EXTENSION
OF
CURRENT
WAIVERS.—Section 4018(b) of
OBRA–1987, as amended by section 4207(b)(4)(B) of OBRA–1990,
is amended—
(1) in paragraph (1) by striking ‘‘December 31, 1995’’ and
inserting ‘‘December 31, 1997’’; and
(2) in paragraph (4) by striking ‘‘March 31, 1996’’ and
inserting ‘‘March 31, 1998’’.
(b) EXPANSION OF DEMONSTRATIONS.—Section 2355 of the Defi-
cit Reduction Act of 1984 is amended—
(1) in the last sentence of subsection (a) by striking ‘‘12
months’’ and inserting ‘‘36 months’’; and
(2) in subsection (b)(1)(B)—
(A) by striking ‘‘or’’ at the end of clause (iii); and
(B) by redesignating clause (iv) as clause (v) and insert-
ing after clause (iii) the following new clause:
‘‘(iv) integrating acute and chronic care manage-
ment for patients with end-stage renal disease through
expanded community care case management services
(and for purposes of a demonstration project conducted
under this clause, any requirement under a waiver
granted under this section that a project disenroll
individuals who develop end-stage renal disease shall
not apply); or’’.
(c) EXPANSION OF NUMBER OF MEMBERS PER SITE.—The Sec-
retary of Health and Human Services may not impose a limit
of less than 12,000 on the number of individuals that may partici-
pate in a project conducted under section 2355 of the Deficit Reduc-
tion Act of 1984.
(d) EFFECTIVE DATE.—The amendments made by this section
shall take effect as if included in the enactment of OBRA–1990.
SEC. 13568. TIMING OF CLAIMS PAYMENT.
(a) 
IN
GENERAL.—Sections 
1816(c)(3)(B) 
(42 
U.S.C.
1395h(c)(3)(B)) and 1842(c)(3)(B) (42 U.S.C. 1395u(c)(3)(B)) are each
amended by striking clauses (i) and (ii) and inserting the following:
‘‘(i) with respect to claims submitted electronically as pre-
scribed by the Secretary, 13 days, and
‘‘(ii) with respect to claims submitted otherwise, 26 days.’’.
(b) TIME LIMIT
OF 30 DAYS
FOR CLEAN CLAIMS.—Sections
1816(c)(2)(B)(ii) (42 U.S.C. 1395h(c)(2)(B)(ii)) and 1842(c)(2)(B)(ii)
(42 U.S.C. 1395u(c)(2)(B)(ii)) are each amended—
(1) in subclause (IV), by striking ‘‘period,’’ and inserting
‘‘period ending on or before September 30, 1993,’’, and
(2) by adding at the end the following new subclause:
‘‘(V) with respect to claims received in the 12-month
period beginning October 1, 1993, and claims received in
any succeeding 12-month period, 30 calendar days.’’.
(c) EFFECTIVE DATE.—The amendments made by this section
shall apply to claims received on or after October 1, 1993.
SEC. 13569. EXTENSION OF WAIVER FOR WATTS HEALTH FOUNDATION.
Section 9312(c)(3)(D) of OBRA–1986, as added by section
4018(d) of OBRA–1987 and as amended by section 6212(a)(1) of
OBRA–1989, is amended by striking ‘‘1994’’ and inserting ‘‘1996’’.
H. R. 2264—298
PART IV—PROVISION RELATING TO PART B
PREMIUM
SEC. 13571. PART B PREMIUM.
Section 1839 (42 U.S.C. 1395r) is amended—
(1) in subsection (e)(1)(A), by striking ‘‘December 1983 and
prior to January 1991 shall be an amount equal to 50 percent’’
and inserting ‘‘after December 1995 and prior to January 1999
shall be an amount equal to 50 percent’’, and
(2) in subsection (e)(2), by striking ‘‘1991’’ and inserting
‘‘1998’’.
PART V—PROVISION RELATING TO DATA
BANK
SEC. 13581. MEDICARE AND MEDICAID COVERAGE DATA BANK.
(a) ESTABLISHMENT
OF MEDICARE
AND MEDICAID COVERAGE
DATA BANK.—Part A of title XI (42 U.S.C. 1301 et seq.) is amended
by adding at the end the following new section:
‘‘MEDICARE AND MEDICAID COVERAGE DATA BANK
‘‘SEC. 1144. (a) ESTABLISHMENT OF DATA BANK.—The Secretary
shall establish a Medicare and Medicaid Coverage Data Bank
(hereafter in this section referred to as the ‘Data Bank’) to—
‘‘(1) further the purposes of section 1862(b) in the identifica-
tion of, and collection from, third parties responsible for
payment for health care items and services furnished to medi-
care beneficiaries, and
‘‘(2) assist in the identification of, and the collection from,
third parties responsible for the reimbursement of costs
incurred by any State plan under title XIX with respect to
medicaid beneficiaries, upon request by the State agency
described in section 1902(a)(5) administering such plan.
‘‘(b) INFORMATION IN DATA BANK.—
‘‘(1) IN GENERAL.—The Data Bank shall contain information
obtained pursuant to section 6103(l)(12) of the Internal Revenue
Code of 1986 and subsection (c).
‘‘(2) DISCLOSURE OF INFORMATION IN DATA BANK.—The Sec-
retary is authorized until September 30, 1998—
‘‘(A) (subject to the restriction in subparagraph (D)(i)
of section 6103(l)(12) of the Internal Revenue Code of 1986)
to disclose any information in the Data Bank obtained
pursuant to such section solely for the purposes of such
section, and
‘‘(B) (subject to the restriction in subsection (c)(7)) to
disclose any other information in the Data Bank to any
State agency described in section 1902(a)(5), employer, or
group health plan solely for the purposes described in
subsection (a).
‘‘(c) REQUIREMENT THAT EMPLOYERS REPORT INFORMATION.—
‘‘(1) REPORTING REQUIREMENT.—
‘‘(A) IN GENERAL.—Any employer described in para-
graph (2) shall report to the Secretary (in such form and
manner as the Secretary determines will minimize the
burden of such reporting) with respect to each electing
H. R. 2264—299
individual the information required under paragraph (5)
for each calendar year beginning on or after January 1,
1994, and before January 1, 1998.
‘‘(B) SPECIAL RULE.—To the extent a group health plan
provides information required under paragraph (5) in a
form and manner specified by the Secretary (in consultation
with the Secretary of Labor) on behalf of an employer
in accordance with section 101(f) of the Employee Retire-
ment Income Security Act of 1974, the employer has com-
plied with the reporting requirement under subparagraph
(A) with respect to the reporting of such information.
‘‘(2) EMPLOYER DESCRIBED.—An employer is described in
this paragraph if such employer has, or contributes to, a group
health plan, with respect to which at least 1 employee of
such employer is an electing individual.
‘‘(3) ELECTING INDIVIDUAL.—For purposes of this subsection,
the term ‘electing individual’ means an individual associated
or formerly associated with the employer in a business relation-
ship who elects coverage under the employer’s group health
plan.
‘‘(4) CERTAIN INDIVIDUALS EXCLUDED.—For purposes of this
subsection, an individual providing service referred to in section
3121(a)(7)(B) of the Internal Revenue Code of 1986 shall not
be considered an employee or electing individual with respect
to an employer.
‘‘(5) INFORMATION REQUIRED.—For purposes of paragraph
(1), each employer shall provide the following information:
‘‘(A) The name and TIN of the electing individual.
‘‘(B) The type of group health plan coverage (single
or family) elected by the electing individual.
‘‘(C) The name, address, and identifying number of
the group health plan elected by such electing individual.
‘‘(D) The name and TIN of each other individual cov-
ered under the group health plan pursuant to such election.
‘‘(E) The period during which such coverage is elected.
‘‘(F) The name, address, and TIN of the employer.
‘‘(6) TIME OF FILING.—For purposes of determining the date
for filing the report under paragraph (1), such report shall
be treated as a statement described in section 6051(d) of the
Internal Revenue Code of 1986.
‘‘(7) LIMITS ON DISCLOSURE OF INFORMATION REPORTED.—
‘‘(A) IN GENERAL.—The disclosure of the information
reported under paragraph (1) shall be restricted by the
Secretary under rules similar to the rules of subsections
(a) and (p) of section 6103 of the Internal Revenue Code
of 1986.
‘‘(B) PENALTY FOR UNAUTHORIZED WILLFUL DISCLOSURE
OF
INFORMATION.—The unauthorized disclosure of any
information reported under paragraph (1) shall be subject
to the penalty described in paragraph (1), (2), (3), or (4)
of section 7213(a) of such Code.
‘‘(9) PENALTY FOR FAILURE TO REPORT.—In the case of the
failure of an employer (other than a Federal or other govern-
mental entity) to report under paragraph (1)(A) with respect
to each electing individual, the Secretary shall impose a penalty
as described in part II of subchapter B of chapter 68 of the
Internal Revenue Code of 1986.
H. R. 2264—300
‘‘(d) FEES
FOR DATA BANK SERVICES.—The Secretary shall
establish fees for services provided under this section which shall
remain available, without fiscal year limitation, to the Secretary
to cover the administrative costs to the Data Bank of providing
such services.
‘‘(f) DEFINITIONS.—In this section:
‘‘(1) MEDICARE
BENEFICIARY.—The term ‘medicare bene-
ficiary’ means an individual entitled to benefits under part
A, or enrolled under part B, of title XVIII, but does not include
such an individual enrolled in part A under section 1818.
‘‘(2) MEDICAID
BENEFICIARY.—The term ‘medicaid bene-
ficiary’ means an individual entitled to benefits under a State
plan for medical assistance under title XIX (including a State
plan operating under a statewide waiver under section 1115).
‘‘(3) GROUP HEALTH PLAN.—The term ‘group health plan’
shall have the meaning given to such term by section 5000(b)(1)
of the Internal Revenue Code of 1986.
‘‘(4) TIN.—The term ‘TIN’ shall have the meaning given
to such term by section 7701(a)(41) of such Code.’’.
(b) CONFORMING AMENDMENTS.—
(1) MEDICARE.—Section 1862(b)(5) (42 U.S.C. 1395y(b)(5))
is amended—
(A) in subparagraph (B), by striking ‘‘under subpara-
graph (A)’’ and all that follows and inserting ‘‘under—
‘‘(i) subparagraph (A), and
‘‘(ii) section 1144,
for purposes of carrying out this subsection.’’, and
(B) in subparagraph (C)(i), by striking ‘‘subparagraph
(B)’’ and inserting ‘‘subparagraph (B)(i)’’.
(2) 
MEDICAID.—Section 
1902(a)(25)(A)(i) 
(42 
U.S.C.
1396a(a)(25)(A)(i)) is amended by striking ‘‘(as specified’’ and
inserting ‘‘(including the use of information collected by the
Medicare and Medicaid Coverage Data Bank under section
1144 and any additional measures as specified’’.
(c) CONFORMING AMENDMENT RELATING TO DATA MATCHES.—
Subsection (a)(8)(B) of section 552a of title 5, United States Code,
is amended—
(1) in clause (v), by striking ‘‘; or’’ at the end;
(2) in clause (vi), by striking the semicolon at the end
and inserting ‘‘; or’’; and
(3) by adding at the end the following new clause:
‘‘(vii) matches performed pursuant to section
6103(l)(12) of the Internal Revenue Code of 1986 and
section 1144 of the Social Security Act;’’.
(d) EFFECTIVE DATE.—The amendments made by this section
shall take effect on January 1, 1994.
Subchapter B—Medicaid
SEC. 13600. REFERENCES IN SUBCHAPTER; TABLE OF CONTENTS OF
SUBCHAPTER.
(a) AMENDMENTS TO SOCIAL SECURITY ACT.—Except as other-
wise specifically provided, whenever in this subchapter an amend-
ment 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 that section or other provision of the Social Security
Act.
H. R. 2264—301
(b) REFERENCES
TO OBRA.—In this subchapter, the terms
‘‘OBRA–1986’’, ‘‘OBRA–1987’’, ‘‘OBRA–1989’’, and ‘‘OBRA–1990’’
refer to the Omnibus Budget Reconciliation Act of 1986 (Public
Law 99–509), the Omnibus Budget Reconciliation Act of 1987 (Pub-
lic Law 100–203), the Omnibus Budget Reconciliation Act of 1989
(Public Law 101–239), and the Omnibus Budget Reconciliation Act
of 1990 (Public Law 101–508), respectively.
(c) TABLE OF CONTENTS OF SUBCHAPTER.—The table of contents
of this subchapter is as follows:
Sec. 13600. References in subchapter; table of contents of subchapter.
PART I—SERVICES
Sec. 13601. Personal care services furnished outside the home as optional benefit.
Sec. 13602. Additional Federal savings through modifications to drug rebate pro-
gram.
Sec. 13603. Optional medicaid coverage of TB-related services for certain TB-in-
fected individuals.
Sec. 13604. Limiting Federal medicaid matching payment to bona fide emergency
services for undocumented aliens.
Sec. 13605. Coverage of nurse-midwife services performed outside the maternity
cycle.
Sec. 13606. Treatment of certain clinics as Federally-qualified health centers.
PART II—ELIGIBILITY
Sec. 13611. Transfers of assets; treatment of certain trusts.
Sec. 13612. Medicaid estate recoveries.
PART III—PAYMENTS
Sec. 13621. Assuring proper payments to disproportionate share hospitals.
Sec. 13622. Liability of third parties to pay for care and services.
Sec. 13623. Medical child support.
Sec. 13624. Application of medicare rules limiting certain physician referrals.
Sec. 13625. State medicaid fraud control.
PART IV—IMMUNIZATIONS
Sec. 13631. Medicaid pediatric immunization provisions.
Sec. 13632. National Vaccine Injury Compensation Program amendments.
PART V—MISCELLANEOUS
Sec. 13641. Increase in limit on Federal medicaid matching payments to Puerto
Rico and other territories.
Sec. 13642. Extension of moratorium on treatment of certain facilities as institu-
tions for mental diseases.
Sec. 13643. Demonstration projects.
Sec. 13644. Extension of period of applicability of enrollment mix requirement to
certain health maintenance organizations providing services under
Dayton Area Health Plan.
PART I—SERVICES
SEC. 13601. PERSONAL CARE SERVICES FURNISHED OUTSIDE THE
HOME AS OPTIONAL BENEFIT.
(a) IN GENERAL.—Section 1905(a) (42 U.S.C. 1396d(a)) is
amended—
(1) in paragraph (7), by striking ‘‘including personal care
services’’ and all that follows through ‘‘nursing facility’’;
(2) by striking ‘‘and’’ at the end of paragraph (21);
(3) in paragraph (24), by striking the comma at the end
and inserting a semicolon;
(4) by redesignating paragraphs (22), (23), and (24) as
paragraphs (25), (22), and (23), respectively, by striking the
semicolon at the end of paragraph (25), as so redesignated,
and inserting a period, and by transferring and inserting para-
graph (25) after paragraph (23), as so redesignated; and
H. R. 2264—302
(5) by inserting after paragraph (23), as so redesignated,
the following new paragraph:
‘‘(24) personal care services furnished to an individual who
is not an inpatient or resident of a hospital, nursing facility,
intermediate care facility for the mentally retarded, or institu-
tion for mental disease that are (A) authorized for the individual
by a physician in accordance with a plan of treatment or
(at the option of the State) otherwise authorized for the individ-
ual in accordance with a service plan approved by the State,
(B) provided by an individual who is qualified to provide such
services and who is not a member of the individual’s family,
and (C) furnished in a home or other location; and’’.
(b) CONFORMING AMENDMENTS.—(1) Section 1902(a)(10)(C)(iv)
(42 U.S.C. 1396a(a)(10)(C)(iv)) is amended by striking ‘‘through
(21)’’ and inserting ‘‘through (24)’’.
(2) Section 1902(j) (42 U.S.C. 1396a(j)) is amended by striking
‘‘through (22)’’ and inserting ‘‘through (25)’’.
(c) EFFECTIVE DATE.—The amendments made by subsections
(a) and (b) shall take effect as if included in the enactment of
section 4721(a) of OBRA–1990.
SEC. 13602. ADDITIONAL FEDERAL SAVINGS THROUGH MODIFICA-
TIONS TO DRUG REBATE PROGRAM.
(a) CHANGES IN REBATE PROGRAM.—
(1) IN
GENERAL.—Section 1927 (42 U.S.C. 1396r–8) is
amended by striking subsection (c) and all that follows through
‘‘(2)’’ in subsection (f)(2) and inserting the following:
‘‘(c) DETERMINATION OF AMOUNT OF REBATE.—
‘‘(1) BASIC REBATE FOR SINGLE SOURCE DRUGS AND INNOVA-
TOR MULTIPLE SOURCE DRUGS.—
‘‘(A) IN GENERAL.—Except as provided in paragraph
(2), the amount of the rebate specified in this subsection
for a rebate period (as defined in subsection (k)(8)) with
respect to each dosage form and strength of a single source
drug or an innovator multiple source drug shall be equal
to the product of—
‘‘(i) the total number of units of each dosage form
and strength paid for under the State plan in the
rebate period (as reported by the State); and
‘‘(ii) subject to subparagraph (B)(ii), the greater
of—
‘‘(I) the difference between the average manu-
facturer price and the best price (as defined in
subparagraph (C)) for the dosage form and
strength of the drug, or
‘‘(II) the minimum rebate percentage (specified
in subparagraph (B)(i)) of such average manufac-
turer price,
for the rebate period.
‘‘(B) RANGE OF REBATES REQUIRED.—
‘‘(i) MINIMUM REBATE PERCENTAGE.—For purposes
of subparagraph (A)(ii)(II), the ‘minimum rebate
percentage’ for rebate periods beginning—
‘‘(I) after December 31, 1990, and before Octo-
ber 1, 1992, is 12.5 percent;
‘‘(II) after September 30, 1992, and before
January 1, 1994, is 15.7 percent;
H. R. 2264—303
‘‘(III) after December 31, 1993, and before
January 1, 1995, is 15.4 percent;
‘‘(IV) after December 31, 1994, and before
January 1, 1996, is 15.2 percent; and
‘‘(V) after December 31, 1995, is 15.1 percent.
‘‘(ii) TEMPORARY LIMITATION ON MAXIMUM REBATE
AMOUNT.—In no case shall the amount applied under
subparagraph (A)(ii) for a rebate period beginning—
‘‘(I) before January 1, 1992, exceed 25 percent
of the average manufacturer price; or
‘‘(II) after December 31, 1991, and before Janu-
ary 1, 1993, exceed 50 percent of the average
manufacturer price.
‘‘(C) BEST
PRICE
DEFINED.—For purposes of this
section—
‘‘(i) IN GENERAL.—The term ‘best price’ means, with
respect to a single source drug or innovator multiple
source drug of a manufacturer, the lowest price avail-
able from the manufacturer during the rebate period
to any wholesaler, retailer, provider, health mainte-
nance organization, nonprofit entity, or governmental
entity within the United States, excluding—
‘‘(I) any prices charged on or after October
1, 1992, to the Indian Health Service, the Depart-
ment of Veterans Affairs, a State home receiving
funds under section 1741 of title 38, United States
Code, the Department of Defense, the Public
Health Service, or a covered entity described in
subsection (a)(5)(B);
‘‘(II) any prices charged under the Federal
Supply Schedule of the General Services Adminis-
tration;
‘‘(III) any prices used under a State pharma-
ceutical assistance program; and
‘‘(IV) any depot prices and single award con-
tract prices, as defined by the Secretary, of any
agency of the Federal Government.
‘‘(ii) SPECIAL RULES.—The term ‘best price’—
‘‘(I) shall be inclusive of cash discounts, free
goods that are contingent on any purchase require-
ment, volume discounts, and rebates (other than
rebates under this section);
‘‘(II) shall be determined without regard to
special packaging, labeling, or identifiers on the
dosage form or product or package; and
‘‘(III) shall not take into account prices that
are merely nominal in amount.
‘‘(2) ADDITIONAL REBATE FOR SINGLE SOURCE AND INNOVA-
TOR MULTIPLE SOURCE DRUGS.—
‘‘(A) IN GENERAL.—The amount of the rebate specified
in this subsection for a rebate period, with respect to each
dosage form and strength of a single source drug or an
innovator multiple source drug, shall be increased by an
amount equal to the product of—
‘‘(i) the total number of units of such dosage form
and strength dispensed after December 31, 1990, for
H. R. 2264—304
which payment was made under the State plan for
the rebate period; and
‘‘(ii) the amount (if any) by which—
‘‘(I) the average manufacturer price for the
dosage form and strength of the drug for the
period, exceeds
‘‘(II) the average manufacturer price for such
dosage form and strength for the calendar quarter
beginning July 1, 1990 (without regard to whether
or not the drug has been sold or transferred to
an entity, including a division or subsidiary of
the manufacturer, after the first day of such quar-
ter), increased by the percentage by which the
consumer price index for all urban consumers
(United States city average) for the month before
the month in which the rebate period begins
exceeds such index for September 1990.
‘‘(B) TREATMENT OF SUBSEQUENTLY APPROVED DRUGS.—
In the case of a covered outpatient drug approved by the
Food and Drug Administration after October 1, 1990, clause
(ii)(II) of subparagraph (A) shall be applied by substituting
‘the first full calendar quarter after the day on which
the drug was first marketed’ for ‘the calendar quarter
beginning July 1, 1990’ and ‘the month prior to the first
month of the first full calendar quarter after the day on
which the drug was first marketed’ for ‘September 1990’.
‘‘(3) REBATE FOR OTHER DRUGS.—
‘‘(A) IN GENERAL.—The amount of the rebate paid to
a State for a rebate period with respect to each dosage
form and strength of covered outpatient drugs (other than
single source drugs and innovator multiple source drugs)
shall be equal to the product of—
‘‘(i) the applicable percentage (as described in
subparagraph (B)) of the average manufacturer price
for the dosage form and strength for the rebate period,
and
‘‘(ii) the total number of units of such dosage form
and strength dispensed after December 31, 1990, for
which payment was made under the State plan for
the rebate period.
‘‘(B) APPLICABLE PERCENTAGE DEFINED.—For purposes
of subparagraph (A)(i), the ‘applicable percentage’ for rebate
periods beginning—
‘‘(i) before January 1, 1994, is 10 percent, and
‘‘(ii) after December 31, 1993, is 11 percent.
‘‘(d) LIMITATIONS ON COVERAGE OF DRUGS.—
‘‘(1) PERMISSIBLE RESTRICTIONS.—(A) A State may subject
to prior authorization any covered outpatient drug. Any such
prior authorization program shall comply with the requirements
of paragraph (5).
‘‘(B) A State may exclude or otherwise restrict coverage
of a covered outpatient drug if—
‘‘(i) the prescribed use is not for a medically accepted
indication (as defined in subsection (k)(6));
‘‘(ii) the drug is contained in the list referred to in
paragraph (2);
H. R. 2264—305
‘‘(iii) the drug is subject to such restrictions pursuant
to an agreement between a manufacturer and a State
authorized by the Secretary under subsection (a)(1) or in
effect pursuant to subsection (a)(4); or
‘‘(iv) the State has excluded coverage of the drug from
its formulary established in accordance with paragraph
(4).
‘‘(2) LIST OF DRUGS SUBJECT TO RESTRICTION.—The follow-
ing drugs or classes of drugs, or their medical uses, may be
excluded from coverage or otherwise restricted:
‘‘(A) Agents when used for anorexia, weight loss, or
weight gain.
‘‘(B) Agents when used to promote fertility.
‘‘(C) Agents when used for cosmetic purposes or hair
growth.
‘‘(D) Agents when used for the symptomatic relief of
cough and colds.
‘‘(E) Agents when used to promote smoking cessation.
‘‘(F) Prescription vitamins and mineral products, except
prenatal vitamins and fluoride preparations.
‘‘(G) Nonprescription drugs.
‘‘(H) Covered outpatient drugs which the manufacturer
seeks to require as a condition of sale that associated
tests or monitoring services be purchased exclusively from
the manufacturer or its designee.
‘‘(I) Barbiturates.
‘‘(J) Benzodiazepines.
‘‘(3) UPDATE OF DRUG LISTINGS.—The Secretary shall, by
regulation, periodically update the list of drugs or classes of
drugs described in paragraph (2) or their medical uses, which
the Secretary has determined, based on data collected by
surveillance and utilization review programs of State medical
assistance programs, to be subject to clinical abuse or inappro-
priate use.
‘‘(4) REQUIREMENTS FOR FORMULARIES.—A State may estab-
lish a formulary if the formulary meets the following
requirements:
‘‘(A) The formulary is developed by a committee consist-
ing of physicians, pharmacists, and other appropriate
individuals appointed by the Governor of the State (or,
at the option of the State, the State’s drug use review
board established under subsection (g)(3)).
‘‘(B) Except as provided in subparagraph (C), the for-
mulary includes the covered outpatient drugs of any
manufacturer which has entered into and complies with
an agreement under subsection (a) (other than any drug
excluded from coverage or otherwise restricted under para-
graph (2)).
‘‘(C) A covered outpatient drug may be excluded with
respect to the treatment of a specific disease or condition
for an identified population (if any) only if, based on the
drug’s labeling (or, in the case of a drug the prescribed
use of which is not approved under the Federal Food,
Drug, and Cosmetic Act but is a medically accepted indica-
tion, based on information from the appropriate compendia
described in subsection (k)(6)), the excluded drug does not
have a significant, clinically meaningful therapeutic advan-
H. R. 2264—306
tage in terms of safety, effectiveness, or clinical outcome
of such treatment for such population over other drugs
included in the formulary and there is a written expla-
nation (available to the public) of the basis for the exclu-
sion.
‘‘(D) The State plan permits coverage of a drug
excluded from the formulary (other than any drug excluded
from coverage or otherwise restricted under paragraph (2))
pursuant to a prior authorization program that is consistent
with paragraph (5).
‘‘(E) The formulary meets such other requirements as
the Secretary may impose in order to achieve program
savings consistent with protecting the health of program
beneficiaries.
A prior authorization program established by a State under
paragraph (5) is not a formulary subject to the requirements
of this paragraph.
‘‘(5) REQUIREMENTS OF PRIOR AUTHORIZATION PROGRAMS.—
A State plan under this title may require, as a condition of
coverage or payment for a covered outpatient drug for which
Federal financial participation is available in accordance with
this section, with respect to drugs dispensed on or after July
1, 1991, the approval of the drug before its dispensing for
any medically accepted indication (as defined in subsection
(k)(6)) only if the system providing for such approval—
‘‘(A) provides response by telephone or other tele-
communication device within 24 hours of a request for
prior authorization; and
‘‘(B) except with respect to the drugs on the list referred
to in paragraph (2), provides for the dispensing of at least
72-hour supply of a covered outpatient prescription drug
in an emergency situation (as defined by the Secretary).
‘‘(6) OTHER
PERMISSIBLE
RESTRICTIONS.—A State may
impose limitations, with respect to all such drugs in a thera-
peutic class, on the minimum or maximum quantities per
prescription or on the number of refills, if such limitations
are necessary to discourage waste, and may address instances
of fraud or abuse by individuals in any manner authorized
under this Act.
‘‘(e) TREATMENT OF PHARMACY REIMBURSEMENT LIMITS.—
‘‘(1) IN GENERAL.—During the period beginning on January
1, 1991, and ending on December 31, 1994—
‘‘(A) a State may not reduce the payment limits estab-
lished by regulation under this title or any limitation
described in paragraph (3) with respect to the ingredient
cost of a covered outpatient drug or the dispensing fee
for such a drug below the limits in effect as of January
1, 1991, and
‘‘(B) except as provided in paragraph (2), the Secretary
may not modify by regulation the formula established
under sections 447.331 through 447.334 of title 42, Code
of Federal Regulations, in effect on November 5, 1990,
to reduce the limits described in subparagraph (A).
‘‘(2) SPECIAL RULE.—If a State is not in compliance with
the regulations described in paragraph (1)(B), paragraph (1)(A)
shall not apply to such State until such State is in compliance
with such regulations.
H. R. 2264—307
‘‘(3) EFFECT ON STATE MAXIMUM ALLOWABLE COST LIMITA-
TIONS.—This section shall not supersede or affect provisions
in effect prior to January 1, 1991, or after December 31, 1994,
relating to any maximum allowable cost limitation established
by a State for payment by the State for covered outpatient
drugs, and rebates shall be made under this section without
regard to whether or not payment by the State for such drugs
is subject to such a limitation or the amount of such a limita-
tion.’’.
(2) CONFORMING AMENDMENTS.—Section 1927 (42 U.S.C.
1396r–8) is amended as follows:
(A) In subsection (b)—
(i) in paragraph (1)(A)—
(I) by striking ‘‘each calendar quarter (or
periodically in accordance with a schedule specified
by the Secretary)’’ and inserting ‘‘for a rebate
period’’, and
(II) by striking ‘‘dispensed under the plan dur-
ing the quarter (or other period as the Secretary
may specify)’’ and inserting ‘‘dispensed after
December 31, 1990, for which payment was made
under the State plan for such period’’;
(ii) in paragraph (2)(A)—
(I) by striking ‘‘calendar quarter’’ and ‘‘the
quarter’’ and inserting ‘‘rebate period’’ and ‘‘the
period’’, respectively,
(II) by striking ‘‘dosage units’’ and inserting
‘‘units of each dosage form and strength and pack-
age size’’, and
(III) by inserting ‘‘after December 31, 1990,
for which payment was made’’ after ‘‘dispensed’’;
and
(iii) in paragraph (3)(A)(i), by striking ‘‘quarter’’
each place it appears and inserting ‘‘rebate period
under the agreement’’.
(B) In subsection (k)—
(i) in paragraph (1)—
(I) by striking ‘‘calendar quarter’’ and inserting
‘‘rebate period’’, and
(II) by inserting before the period at the end
the following: ‘‘, after deducting customary prompt
pay discounts’’;
(ii) in paragraph (3)—
(I) in subparagraph (E), by striking ‘‘* * * *
emergency room visits’’,
(II) in subparagraph (F), by striking ‘‘services’’
and inserting ‘‘services and services provided by
an intermediate care facility for the mentally
retarded’’, and
(III) in the matter following subparagraph
(H)—
(aa) by striking ‘‘which is used’’ and insert-
ing ‘‘for which a National Drug Code number
is not required by the Food and Drug Adminis-
tration or a drug or biological used’’; and
H. R. 2264—308
(bb) by adding at the end the following:
‘‘Any drug, biological product, or insulin
excluded from the definition of such term as
a result of this paragraph shall be treated
as a covered outpatient drug for purposes of
determining the best price (as defined in sub-
section (c)(1)(C)) for such drug, biological prod-
uct, or insulin.’’;
(iii) in paragraph (6), by striking ‘‘, which appears’’
and all that follows and inserting ‘‘or the use of which
is supported by one or more citations included or
approved for inclusion in any of the compendia
described in subsection (g)(1)(B)(i).’’;
(iv) in paragraph (7)(A)(i), by striking ‘‘calendar
quarter’’ and inserting ‘‘rebate period’’; and
(v) by redesignating paragraph (8) as paragraph
(9) and by inserting after paragraph (7) the following
new paragraph:
‘‘(8) REBATE PERIOD.—The term ‘rebate period’ means, with
respect to an agreement under subsection (a), a calendar quar-
ter or other period specified by the Secretary with respect
to the payment of rebates under such agreement.’’.
(b) LIMITING FEDERAL PAYMENTS FOR CERTAIN DRUGS.—Para-
graph (10) of section 1903(i) (42 U.S.C. 1396b(i)) (as inserted by
section 4401(a)(1)(B) of OBRA–1990) is amended to read as follows:
‘‘(10)(A) with respect to covered outpatient drugs unless
there is a rebate agreement in effect under section 1927 with
respect to such drugs or unless section 1927(a)(3) applies, and
‘‘(B) with respect to any amount expended for an innovator
multiple source drug (as defined in section 1927(k)) dispensed
on or after July 1, 1991, if, under applicable State law, a
less expensive multiple source drug could have been dispensed,
but only to the extent that such amount exceeds the upper
payment limit for such multiple source drug;’’.
(c) ELIMINATION
OF
PROHIBITION
AGAINST
STATE
USE
OF
FORMULARIES TO ACHIEVE FEDERAL SAVINGS.—Paragraph (54) of
section 1902(a) (42 U.S.C. 1396a(a)) is amended to read as follows:
‘‘(54) in the case of a State plan that provides medical
assistance for covered outpatient drugs (as defined in section
1927(k)), comply with the applicable requirements of section
1927;’’.
(d) EFFECTIVE DATES.—(1) Except as provided in paragraph
(2), the amendments made by this section shall take effect as
if included in the enactment of OBRA–1990.
(2) The amendment made by subsection (a)(1) (insofar as such
subsection amends section 1927(d) of the Social Security Act) and
the amendment made by subsection (c) shall apply to calendar
quarters beginning on or after October 1, 1993, without regard
to whether or not regulations to carry out such amendments have
been promulgated by such date.
SEC. 13603. OPTIONAL MEDICAID COVERAGE OF TB-RELATED SERV-
ICES FOR CERTAIN TB-INFECTED INDIVIDUALS.
(a) COVERAGE AS OPTIONAL, CATEGORICALLY NEEDY GROUP.—
Section 
1902(a)(10)(A)(ii) 
(42 
U.S.C. 
1396a(a)(10)(A)(ii)) 
is
amended—
(1) by striking ‘‘or’’ at the end of subclause (X),
H. R. 2264—309
(2) by adding ‘‘or’’ at the end of subclause (XI), and
(3) by adding at the end the following new subclause:
‘‘(XII) who are described in subsection (z)(1)
(relating to certain TB-infected individuals);’’.
(b) GROUP AND BENEFIT DESCRIBED.—Section 1902 is amended
by adding at the end the following new subsection:
‘‘(z)(1) Individuals described in this paragraph are individuals
not described in subsection (a)(10)(A)(i)—
‘‘(A) who are infected with tuberculosis;
‘‘(B) whose income (as determined under the State plan
under this title with respect to disabled individuals) does not
exceed the maximum amount of income a disabled individual
described in subsection (a)(10)(A)(i) may have and obtain medi-
cal assistance under the plan; and
‘‘(C) whose resources (as determined under the State plan
under this title with respect to disabled individuals) do not
exceed the maximum amount of resources a disabled individual
described in subsection (a)(10)(A)(i) may have and obtain medi-
cal assistance under the plan.
‘‘(2) For purposes of subsection (a)(10), the term ‘TB-related
services’ means each of the following services relating to treatment
of infection with tuberculosis:
‘‘(A) Prescribed drugs.
‘‘(B) Physicians’ services and services described in section
1905(a)(2).
‘‘(C) Laboratory and X-ray services (including services to
confirm the presence of infection).
‘‘(D) Clinic services and Federally-qualified health center
services.
‘‘(E) Case management services (as defined in section
1915(g)(2)).
‘‘(F) Services (other than room and board) designed to
encourage completion of regimens of prescribed drugs by out-
patients, including services to observe directly the intake of
prescribed drugs.’’.
(c) LIMITATION ON BENEFITS.—Section 1902(a)(10) (42 U.S.C.
1396a(a)(10)) is amended in the matter following subparagraph
(F)—
(1) by striking ‘‘; and (XI)’’ and inserting ‘‘, (XI)’’,
(2) by striking ‘‘individuals, and (XI)’’ and inserting
‘‘individuals, (XII)’’, and
(3) by inserting before the semicolon at the end the follow-
ing: ‘‘, and (XIII) the medical assistance made available to
an individual described in subsection (z)(1) who is eligible for
medical assistance only because of subparagraph (A)(ii)(XII)
shall be limited to medical assistance for TB-related services
(described in subsection (z)(2))’’.
(d) CONFORMING EXPANSION OF CASE MANAGEMENT SERVICES
OPTION.—Section 1915(g)(1) (42 U.S.C. 1396n(g)(1)) is amended by
inserting ‘‘or to individuals described in section 1902(z)(1)(A)’’ after
‘‘or with either,’’.
(e) CONFORMING
AMENDMENT.—Section 1905(a) (42 U.S.C.
1396d(a)) is amended—
(1) by striking ‘‘or’’ at the end of clause (ix),
(2) by adding ‘‘or’’ at the end of clause (x),
(3) by inserting after clause (x) the following new clause:
‘‘(xi) individuals described in section 1902(z)(1),’’, and
H. R. 2264—310
(4) by amending paragraph (19) to read as follows:
‘‘(19) case management services (as defined in section
1915(g)(2)) and TB-related services described in section
1902(z)(2)(F);’’.
(f) EFFECTIVE DATE.—The amendments made by this section
shall apply to medical assistance furnished on or after January
1, 1994, without regard to whether or not final regulations to
carry out such amendments have been promulgated by such date.
SEC. 13604. LIMITING FEDERAL MEDICAID MATCHING PAYMENT TO
BONA 
FIDE 
EMERGENCY 
SERVICES 
FOR 
UNDOCU-
MENTED ALIENS.
(a) IN GENERAL.—Section 1903(v)(2) (42 U.S.C. 1396b(v)(2))
is amended—
(1) by striking ‘‘and’’ at the end of subparagraph (A),
(2) by striking the period at the end of subparagraph (B)
and inserting ‘‘, and’’, and
(3) by adding at the end the following new subparagraph:
‘‘(C) such care and services are not related to an organ
transplant procedure.’’.
(b) EFFECTIVE DATES.—(1) Subject to paragraph (2), the amend-
ments made by subsection (a) shall apply as if included in the
enactment of OBRA–1986.
(2) The Secretary of Health and Human Services shall not
disallow expenditures made for the care and services described
in section 1903(v)(2)(C) of the Social Security Act, as added by
subsection (a), furnished before the date of the enactment of this
Act.
SEC. 13605. COVERAGE OF NURSE-MIDWIFE SERVICES PERFORMED
OUTSIDE THE MATERNITY CYCLE.
(a) IN GENERAL.—Section 1905(a)(17) (42 U.S.C. 1396d(a)(17))
is amended by inserting before the semicolon at the end the follow-
ing: ‘‘, and without regard to whether or not the services are
performed in the area of management of the care of mothers and
babies throughout the maternity cycle’’.
(b) EFFECTIVE DATE.—The amendment made by subsection (a)
shall apply to services furnished on or after October 1, 1993.
SEC. 13606. TREATMENT OF CERTAIN CLINICS AS FEDERALLY-QUALI-
FIED HEALTH CENTERS.
(a) 
IN
GENERAL.—Section 
1905(l)(2)(B) 
(42 
U.S.C.
1396d(l)(2)(B)) is amended—
(1) by striking ‘‘or’’ at the end of clause (i),
(2) by striking the semicolon at the end of clause (ii)(II)
and inserting a comma,
(3) by moving clause (ii) 4 ems to the left,
(4) by adding ‘‘or’’ at the end of clause (iii), and
(5) by inserting after clause (iii) the following new clause:
‘‘(iv) was treated by the Secretary, for purposes of part
B of title XVIII, as a comprehensive Federally funded health
center as of January 1, 1990;’’.
(b) EFFECTIVE DATE.—The amendments made by subsection
(a) shall apply to calendar quarters beginning on or after July
1, 1993.
H. R. 2264—311
PART II—ELIGIBILITY
SEC. 13611. TRANSFERS OF ASSETS; TREATMENT OF CERTAIN TRUSTS.
(a) PERIODS
OF INELIGIBILITY
FOR TRANSFERS
OF ASSETS.—
(1) IN GENERAL.—Section 1917(c)(1) (42 U.S.C. 1396p(c)(1))
is amended to read as follows:
‘‘(1)(A) In order to meet the requirements of this subsection
for purposes of section 1902(a)(18), the State plan must provide
that if an institutionalized individual or the spouse of such an
individual (or, at the option of a State, a noninstitutionalized
individual or the spouse of such an individual) disposes of assets
for less than fair market value on or after the look-back date
specified in subparagraph (B)(i), the individual is ineligible for
medical assistance for services described in subparagraph (C)(i)
(or, in the case of a noninstitutionalized individual, for the services
described in subparagraph (C)(ii)) during the period beginning on
the date specified in subparagraph (D) and equal to the number
of months specified in subparagraph (E).
‘‘(B)(i) The look-back date specified in this subparagraph is
a date that is 36 months (or, in the case of payments from a
trust or portions of a trust that are treated as assets disposed
of by the individual pursuant to paragraph (3)(A)(iii) or (3)(B)(ii)
of subsection (d), 60 months) before the date specified in clause
(ii).
‘‘(ii) The date specified in this clause, with respect to—
‘‘(I) an institutionalized individual is the first date as of
which the individual both is an institutionalized individual
and has applied for medical assistance under the State plan,
or
‘‘(II) a noninstitutionalized individual is the date on which
the individual applies for medical assistance under the State
plan or, if later, the date on which the individual disposes
of assets for less than fair market value.
‘‘(C)(i) The services described in this subparagraph with respect
to an institutionalized individual are the following:
‘‘(I) Nursing facility services.
‘‘(II) A level of care in any institution equivalent to that
of nursing facility services.
‘‘(III) Home or community-based services furnished under
a waiver granted under subsection (c) or (d) of section 1915.
‘‘(ii) The services described in this subparagraph with respect
to a noninstitutionalized individual are services (not including any
services described in clause (i)) that are described in paragraph
(7), (22), or (24) of section 1905(a), and, at the option of a State,
other long-term care services for which medical assistance is other-
wise available under the State plan to individuals requiring long-
term care.
‘‘(D) The date specified in this subparagraph is the first day
of the first month during or after which assets have been transferred
for less than fair market value and which does not occur in any
other periods of ineligibility under this subsection.
‘‘(E)(i) With respect to an institutionalized individual, the num-
ber of months of ineligibility under this subparagraph for an individ-
ual shall be equal to—
‘‘(I) the total, cumulative uncompensated value of all assets
transferred by the individual (or individual’s spouse) on or
H. R. 2264—312
after the look-back date specified in subparagraph (B)(i), divided
by
‘‘(II) the average monthly cost to a private patient of nurs-
ing facility services in the State (or, at the option of the State,
in the community in which the individual is institutionalized)
at the time of application.
‘‘(ii) With respect to a noninstitutionalized individual, the num-
ber of months of ineligibility under this subparagraph for an individ-
ual shall not be greater than a number equal to—
‘‘(I) the total, cumulative uncompensated value of all assets
transferred by the individual (or individual’s spouse) on or
after the look-back date specified in subparagraph (B)(i), divided
by
‘‘(II) the average monthly cost to a private patient of nurs-
ing facility services in the State (or, at the option of the State,
in the community in which the individual is institutionalized)
at the time of application.
‘‘(iii) The number of months of ineligibility otherwise deter-
mined under clause (i) or (ii) with respect to the disposal of an
asset shall be reduced—
‘‘(I) in the case of periods of ineligibility determined under
clause (i), by the number of months of ineligibility applicable
to the individual under clause (ii) as a result of such disposal,
and
‘‘(II) in the case of periods of ineligibility determined under
clause (ii), by the number of months of ineligibility applicable
to the individual under clause (i) as a result of such disposal.
(2) EXCEPTIONS.—Section 1917(c) is amended—
(A) in paragraph (2)(A), by striking ‘‘resources’’ and
inserting ‘‘assets’’;
(B) by amending paragraph (2)(B) to read as follows:
‘‘(B) the assets—
‘‘(i) were transferred to the individual’s spouse or to
another for the sole benefit of the individual’s spouse,
‘‘(ii) were transferred from the individual’s spouse to
another for the sole benefit of the individual’s spouse,
‘‘(iii) were transferred to, or to a trust (including a
trust described in subsection (d)(4)) established solely for
the benefit of, the individual’s child described in subpara-
graph (A)(ii)(II), or
‘‘(iv) were transferred to a trust (including a trust
described in subsection (d)(4)) established solely for the
benefit of an individual under 65 years of age who is
disabled (as defined in section 1614(a)(3));’’;
(C) in paragraph (2)(C)—
(i) by striking ‘‘resources’’ each place it appears
and inserting ‘‘assets’’,
(ii) by striking ‘‘any’’,
(iii) by striking ‘‘or (ii)’’ and inserting ‘‘(ii)’’, and
(iv) by striking ‘‘; or’’ and inserting ‘‘, or (iii) all
assets transferred for less than fair market value have
been returned to the individual; or’’;
(D) by amending paragraph (2)(D) to read as follows:
‘‘(D) the State determines, under procedures established
by the State (in accordance with standards specified by the
Secretary), that the denial of eligibility would work an undue
H. R. 2264—313
hardship as determined on the basis of criteria established
by the Secretary;’’;
(E) by striking paragraph (3) and inserting the
following:
‘‘(3) For purposes of this subsection, in the case of an asset
held by an individual in common with another person or persons
in a joint tenancy, tenancy in common, or similar arrangement,
the asset (or the affected portion of such asset) shall be considered
to be transferred by such individual when any action is taken,
either by such individual or by any other person, that reduces
or eliminates such individual’s ownership or control of such asset.’’;
and
(F) by adding at the end of paragraph (4) the following:
‘‘In the case of a transfer by the spouse of an individual
which results in a period of ineligibility for medical assist-
ance under a State plan for such individual, a State shall,
using a reasonable methodology (as specified by the Sec-
retary), apportion such period of ineligibility (or any portion
of such period) among the individual and the individual’s
spouse if the spouse otherwise becomes eligible for medical
assistance under the State plan.’’.
(b) TREATMENT OF TRUST AMOUNTS.—Section 1917 (42 U.S.C.
1396p) is amended by adding at the end the following:
‘‘(d)(1) For purposes of determining an individual’s eligibility
for, or amount of, benefits under a State plan under this title,
subject to paragraph (4), the rules specified in paragraph (3) shall
apply to a trust established by such individual.
‘‘(2)(A) For purposes of this subsection, an individual shall
be considered to have established a trust if assets of the individual
were used to form all or part of the corpus of the trust and
if any of the following individuals established such trust other
than by will:
‘‘(i) The individual.
‘‘(ii) The individual’s spouse.
‘‘(iii) A person, including a court or administrative body,
with legal authority to act in place of or on behalf of the
individual or the individual’s spouse.
‘‘(iv) A person, including any court or administrative body,
acting at the direction or upon the request of the individual
or the individual’s spouse.
‘‘(B) In the case of a trust the corpus of which includes assets
of an individual (as determined under subparagraph (A)) and assets
of any other person or persons, the provisions of this subsection
shall apply to the portion of the trust attributable to the assets
of the individual.
‘‘(C) Subject to paragraph (4), this subsection shall apply with-
out regard to—
‘‘(i) the purposes for which a trust is established,
‘‘(ii) whether the trustees have or exercise any discretion
under the trust,
‘‘(iii) any restrictions on when or whether distributions
may be made from the trust, or
‘‘(iv) any restrictions on the use of distributions from the
trust.
‘‘(3)(A) In the case of a revocable trust—
‘‘(i) the corpus of the trust shall be considered resources
available to the individual,
H. R. 2264—314
‘‘(ii) payments from the trust to or for the benefit of the
individual shall be considered income of the individual, and
‘‘(iii) any other payments from the trust shall be considered
assets disposed of by the individual for purposes of sub-
section (c).
‘‘(B) In the case of an irrevocable trust—
‘‘(i) if there are any circumstances under which payment
from the trust could be made to or for the benefit of the
individual, the portion of the corpus from which, or the income
on the corpus from which, payment to the individual could
be made shall be considered resources available to the individ-
ual, and payments from that portion of the corpus or income—
‘‘(I) to or for the benefit of the individual, shall be
considered income of the individual, and
‘‘(II) for any other purpose, shall be considered a trans-
fer of assets by the individual subject to subsection (c);
and
‘‘(ii) any portion of the trust from which, or any income
on the corpus from which, no payment could under any cir-
cumstances be made to the individual shall be considered,
as of the date of establishment of the trust (or, if later, the
date on which payment to the individual was foreclosed) to
be assets disposed by the individual for purposes of subsection
(c), and the value of the trust shall be determined for purposes
of such subsection by including the amount of any payments
made from such portion of the trust after such date.
‘‘(4) This subsection shall not apply to any of the following
trusts:
‘‘(A) A trust containing the assets of an individual under
age 65 who is disabled (as defined in section 1614(a)(3)) and
which is established for the benefit of such individual by a
parent, grandparent, legal guardian of the individual, or a
court if the State will receive all amounts remaining in the
trust upon the death of such individual up to an amount equal
to the total medical assistance paid on behalf of the individual
under a State plan under this title.
‘‘(B) A trust established in a State for the benefit of an
individual if—
‘‘(i) the trust is composed only of pension, Social Secu-
rity, and other income to the individual (and accumulated
income in the trust),
‘‘(ii) the State will receive all amounts remaining in
the trust upon the death of such individual up to an amount
equal to the total medical assistance paid on behalf of
the individual under a State plan under this title, and
‘‘(iii) the State makes medical assistance available to
individuals described in section 1902(a)(10)(A)(ii)(V), but
does not make such assistance available to individuals
for nursing facility services under section 1902(a)(10)(C).
‘‘(C) A trust containing the assets of an individual who
is disabled (as defined in section 1614(a)(3)) that meets the
following conditions:
‘‘(i) The trust is established and managed by a non-
profit association.
‘‘(ii) A separate account is maintained for each bene-
ficiary of the trust, but, for purposes of investment and
management of funds, the trust pools these accounts.
H. R. 2264—315
‘‘(iii) Accounts in the trust are established solely for
the benefit of individuals who are disabled (as defined
in section 1614(a)(3)) by the parent, grandparent, or legal
guardian of such individuals, by such individuals, or by
a court.
‘‘(iv) To the extent that amounts remaining in the
beneficiary’s account upon the death of the beneficiary
are not retained by the trust, the trust pays to the State
from such remaining amounts in the account an amount
equal to the total amount of medical assistance paid on
behalf of the beneficiary under the State plan under this
title.
‘‘(5) The State agency shall establish procedures (in accordance
with standards specified by the Secretary) under which the agency
waives the application of this subsection with respect to an individ-
ual if the individual establishes that such application would work
an undue hardship on the individual as determined on the basis
of criteria established by the Secretary.’’.
‘‘(6) The term ‘trust’ includes any legal instrument or device
that is similar to a trust but includes an annuity only to such
extent and in such manner as the Secretary specifies.’’.
(c) DEFINITIONS.—Section 1917 (42 U.S.C. 1396p), as amended
by subsection (b), is further amended by adding at the end the
following new subsection:
‘‘(e) In this section, the following definitions shall apply:
‘‘(1) The term ‘assets’, with respect to an individual,
includes all income and resources of the individual and of
the individual’s spouse, including any income or resources
which the individual or such individual’s spouse is entitled
to but does not receive because of action—
‘‘(A) by the individual or such individual’s spouse,
‘‘(B) by a person, including a court or administrative
body, with legal authority to act in place of or on behalf
of the individual or such individual’s spouse, or
‘‘(C) by any person, including any court or administra-
tive body, acting at the direction or upon the request of
the individual or such individual’s spouse.
‘‘(2) The term ‘income’ has the meaning given such term
in section 1612.
‘‘(3) The term ‘institutionalized individual’ means an
individual who is an inpatient in a nursing facility, who is
an inpatient in a medical institution and with respect to whom
payment is made based on a level of care provided in a nursing
facility, or who is described in section 1902(a)(10)(A)(ii)(VI).
‘‘(4) The term ‘noninstitutionalized individual’ means an
individual receiving any of the services specified in subsection
(c)(1)(C)(ii).
‘‘(5) The term ‘resources’ has the meaning given such term
in section 1613, without regard (in the case of an institutional-
ized individual) to the exclusion described in subsection (a)(1)
of such section.’’.
(d) CONFORMING AMENDMENTS.—
(1) Section 1902 (42 U.S.C. 1396a) is amended—
(A) in subsection (a)(18), by striking ‘‘and transfers
of assets’’ and inserting ‘‘, transfers of assets, and treatment
of certain trusts’’;
(B) in subsection (a)(51)—
H. R. 2264—316
(i) by striking ‘‘(A)’’; and
(ii) by striking ‘‘, and (B)’’ and all that follows
and inserting a semicolon; and
(C) by striking subsection (k).
(2) Section 1924(b)(2)(B)(i) (42 U.S.C. 1396r–5(b)(2)(B)(i))
is amended by striking ‘‘1902(k)’’ and inserting ‘‘1917(d)’’.
(e) EFFECTIVE DATES.—(1) The amendments made by this sec-
tion shall apply, except as provided in this subsection, to payments
under title XIX of the Social Security Act for calendar quarters
beginning on or after October 1, 1993, without regard to whether
or not final regulations to carry out such amendments have been
promulgated by such date.
(2) The amendments made by this section shall not apply—
(A) to medical assistance provided for services furnished
before October 1, 1993,
(B) with respect to assets disposed of on or before the
date of the enactment of this Act, or
(C) with respect to trusts established on or before the
date of the enactment of this Act.
(3) In the case of a State plan for medical assistance under
title XIX of the Social Security Act which the Secretary of Health
and Human Services determines requires State legislation (other
than legislation appropriating funds) in order for the plan to meet
the additional requirements imposed by the amendment made by
subsection (b), the State plan shall not be regarded as failing
to comply with the requirements imposed by such amendment solely
on the basis of its failure to meet these additional requirements
before the first day of the first calendar quarter beginning after
the close of the first regular session of the State legislature that
begins after the date of the enactment of this Act. For purposes
of the preceding sentence, in the case of a State that has a 2-
year legislative session, each year of such session shall be deemed
to be a separate regular session of the State legislature.
SEC. 13612. MEDICAID ESTATE RECOVERIES.
(a) MANDATE
TO
SEEK
RECOVERY.—Section 1917(b)(1) (42
U.S.C. 1396p(b)(1)) is amended by striking ‘‘except—’’ and all that
follows and inserting the following: ‘‘except that the State shall
seek adjustment or recovery of any medical assistance correctly
paid on behalf of an individual under the State plan in the case
of the following individuals:
‘‘(A) In the case of an individual described in subsection
(a)(1)(B), the State shall seek adjustment or recovery from
the individual’s estate or upon sale of the property subject
to a lien imposed on account of medical assistance paid on
behalf of the individual.
‘‘(B) In the case of an individual who was 55 years of
age or older when the individual received such medical assist-
ance, the State shall seek adjustment or recovery from the
individual’s estate, but only for medical assistance consisting
of—
‘‘(i) nursing facility services, home and community-
based services, and related hospital and prescription drug
services, or
‘‘(ii) at the option of the State, any items or services
under the State plan.
H. R. 2264—317
‘‘(C)(i) In the case of an individual who has received (or
is entitled to receive) benefits under a long-term care insurance
policy in connection with which assets or resources are dis-
regarded in the manner described in clause (ii), except as
provided in such clause, the State shall seek adjustment or
recovery from the individual’s estate on account of medical
assistance paid on behalf of the individual for nursing facility
and other long-term care services.
‘‘(ii) Clause (i) shall not apply in the case of an individual
who received medical assistance under a State plan of a State
which had a State plan amendment approved as of May 14,
1993, which provided for the disregard of any assets or
resources—
‘‘(I) to the extent that payments are made under a
long-term care insurance policy; or
‘‘(II) because an individual has received (or is entitled
to receive) benefits under a long-term care insurance
policy.’’.
(b) HARDSHIP WAIVER.—Section 1917(b) (42 U.S.C. 1396p(b))
is amended by adding at the end the following new paragraph:
‘‘(3) The State agency shall establish procedures (in accordance
with standards specified by the Secretary) under which the agency
shall waive the application of this subsection (other than paragraph
(1)(C)) if such application would work an undue hardship as deter-
mined on the basis of criteria established by the Secretary.’’.
(c) DEFINITION
OF
ESTATE.—Section 1917(b) (42 U.S.C.
1396p(b)), as amended by subsection (b), is amended by adding
at the end the following new paragraph:
‘‘(4) For purposes of this subsection, the term ‘estate’, with
respect to a deceased individual—
‘‘(A) shall include all real and personal property and other
assets included within the individual’s estate, as defined for
purposes of State probate law; and
‘‘(B) may include, at the option of the State (and shall
include, in the case of an individual to whom paragraph (1)(C)(i)
applies), any other real and personal property and other assets
in which the individual had any legal title or interest at the
time of death (to the extent of such interest), including such
assets conveyed to a survivor, heir, or assign of the deceased
individual through joint tenancy, tenancy in common, survivor-
ship, life estate, living trust, or other arrangement.’’.
(d) EFFECTIVE DATES.—(1)(A) Except as provided in subpara-
graph (B), the amendments made by this section shall apply to
payments under title XIX of the Social Security Act for calendar
quarters beginning on or after October 1, 1993, without regard
to whether or not final regulations to carry out such amendments
have been promulgated by such date.
(B) In the case of a State plan for medical assistance under
title XIX of the Social Security Act which the Secretary of Health
and Human Services determines requires State legislation (other
than legislation appropriating funds) in order for the plan to meet
the additional requirements imposed by the amendments made
by this section, the State plan shall not be regarded as failing
to comply with the requirements imposed by such amendments
solely on the basis of its failure to meet these additional require-
ments before the first day of the first calendar quarter beginning
after the close of the first regular session of the State legislature
H. R. 2264—318
that begins after the date of the enactment of this Act. For purposes
of the preceding sentence, in the case of a State that has a 2-
year legislative session, each year of such session shall be deemed
to be a separate regular session of the State legislature.
(2) The amendments made by this section shall not apply
to individuals who died before October 1, 1993.
PART III—PAYMENTS
SEC. 13621. ASSURING PROPER PAYMENTS TO DISPROPORTIONATE
SHARE HOSPITALS.
(a) DISPROPORTIONATE SHARE HOSPITALS REQUIRED TO PROVIDE
MINIMUM LEVEL OF SERVICES TO MEDICAID PATIENTS.—
(1) IN
GENERAL.—Section 1923 (42 U.S.C. 1396r–4) is
amended—
(A) in subsection (a)(1)(A), by striking ‘‘requirement’’
and inserting ‘‘requirements’’;
(B) in subsection (b)(1), by striking ‘‘requirement’’ and
inserting ‘‘requirements’’;
(C) in the heading to subsection (d), by striking
‘‘REQUIREMENT’’ and inserting ‘‘REQUIREMENTS’’;
(D) by adding at the end of subsection (d) the following
new paragraph:
‘‘(3) No hospital may be defined or deemed as a dispropor-
tionate share hospital under a State plan under this title or
under subsection (b) or (e) of this section unless the hospital
has a medicaid inpatient utilization rate (as defined in sub-
section (b)(2)) of not less than 1 percent.’’;
(E) in subsection (e)(1)—
(i) by striking ‘‘and’’ before ‘‘(B)’’, and
(ii) by inserting before the period at the end the
following: ‘‘, and (C) the plan meets the requirement
of subsection (d)(3) and such payment adjustments are
made consistent with the last sentence of subsection
(c)’’; and
(F) in subsection (e)(2)—
(i) in subparagraph (A), by inserting ‘‘(other than
the last sentence of subsection (c))’’ after ‘‘(c)’’,
(ii) by striking ‘‘and’’ at the end of subparagraph
(A),
(iii) by striking the period at the end of subpara-
graph (B) and inserting ‘‘, and’’, and
(iv) by adding at the end the following new
subparagraph:
‘‘(C) subsection (d)(3) shall apply.’’.
(2) EFFECTIVE DATE.—The amendments made by this sub-
section shall apply to payments to States under section 1903(a)
of the Social Security Act for payments to hospitals made
under State plans after—
(A) the end of the State fiscal year that ends during
1994, or
(B) in the case of a State with a State legislature
which is not scheduled to have a regular legislative session
in 1994, the end of the State fiscal year that ends during
1995;
H. R. 2264—319
without regard to whether or not final regulations to carry
out such amendments have been promulgated by either such
date.
(b) LIMITING AMOUNT OF HOSPITAL PAYMENT ADJUSTMENT TO
UNCOVERED COSTS.—
(1) IN
GENERAL.—Section 1923 (42 U.S.C. 1396r–4) is
amended by adding at the end the following new subsection:
‘‘(g) LIMIT ON AMOUNT OF PAYMENT TO HOSPITAL.—
‘‘(1) AMOUNT OF ADJUSTMENT SUBJECT TO UNCOMPENSATED
COSTS.—
‘‘(A) IN
GENERAL.—A payment adjustment during a
fiscal year shall not be considered to be consistent with
subsection (c) with respect to a hospital if the payment
adjustment exceeds the costs incurred during the year of
furnishing hospital services (as determined by the Sec-
retary and net of payments under this title, other than
under this section, and by uninsured patients) by the hos-
pital to individuals who either are eligible for medical
assistance under the State plan or have no health insurance
(or other source of third party coverage) for services pro-
vided during the year. For purposes of the preceding sen-
tence, payments made to a hospital for services provided
to indigent patients made by a State or a unit of local
government within a State shall not be considered to be
a source of third party payment.
‘‘(B) LIMIT TO PUBLIC HOSPITALS DURING TRANSITION
PERIOD.—With respect to payment adjustments during a
State fiscal year that begins before January 1, 1995,
subparagraph (A) shall apply only to hospitals owned or
operated by a State (or by an instrumentality or a unit
of government within a State).
‘‘(C) MODIFICATIONS
FOR
PRIVATE
HOSPITALS.—With
respect to hospitals that are not owned or operated by
a State (or by an instrumentality or a unit of government
within a State), the Secretary may make such modifications
to the manner in which the limitation on payment adjust-
ments is applied to such hospitals as the Secretary consid-
ers appropriate.
‘‘(2) ADDITIONAL AMOUNT DURING TRANSITION PERIOD FOR
CERTAIN HOSPITALS WITH HIGH DISPROPORTIONATE SHARE.—
‘‘(A) IN GENERAL.—In the case of a hospital with high
disproportionate share (as defined in subparagraph (B)),
a payment adjustment during a State fiscal year that
begins before January 1, 1995, shall be considered consist-
ent with subsection (c) if the payment adjustment does
not exceed 200 percent of the costs of furnishing hospital
services described in paragraph (1)(A) during the year,
but only if the Governor of the State certifies to the satisfac-
tion of the Secretary that the hospital’s applicable mini-
mum amount is used for health services during the year.
In determining the amount that is used for such services
during a year, there shall be excluded any amounts received
under the Public Health Service Act, title V, title XVIII,
or from third party payors (not including the State plan
under this title) that are used for providing such services
during the year.
H. R. 2264—320
‘‘(B) HOSPITALS WITH HIGH DISPROPORTIONATE SHARE
DEFINED.—In subparagraph (A), a hospital is a ‘hospital
with high disproportionate share’ if—
‘‘(i) the hospital is owned or operated by a State
(or by an instrumentality or a unit of government
within a State); and
‘‘(ii) the hospital—
‘‘(I) meets the requirement described in sub-
section (b)(1)(A), or
‘‘(II) has the largest number of inpatient days
attributable to individuals entitled to benefits
under the State plan of any hospital in such State
for the previous State fiscal year.
‘‘(C) APPLICABLE
MINIMUM
AMOUNT
DEFINED.—In
subparagraph (A), the ‘applicable minimum amount’ for
a hospital for a fiscal year is equal to the difference between
the amount of the hospital’s payment adjustment for the
fiscal year and the costs to the hospital of furnishing hos-
pital services described in paragraph (1)(A) during the fiscal
year.’’.
(2) CONFORMING AMENDMENTS.—Section 1923 is amended—
(A) in subsection (c) in the matter preceding paragraph
(1), by striking ‘‘subsection (f)’’ and inserting ‘‘subsections
(f) and (g)’’; and
(B) in subsection (e)(2) (as amended by subsection
(a)(1)(F))—
(i) by striking ‘‘and’’ at the end of subparagraph
(B);
(ii) by striking the period at the end of subpara-
graph (C) and inserting ‘‘, and’’; and
(iii) by adding at the end the following new
subparagraph:
‘‘(D) subsection (g) shall apply.’’.
(3) EFFECTIVE DATE.—
(A) IN GENERAL.—Except as provided in subparagraph
(B), the amendments made by this subsection shall apply
to payments to States under section 1903(a) of the Social
Security Act for payments to hospitals made under State
plans after—
(i) the end of the State fiscal year that ends during
1994, or
(ii) in the case of a State with a State legislature
which is not scheduled to have a regular legislative
session in 1994, the end of the State fiscal year that
ends during 1995;
without regard to whether or not final regulations to carry
out such amendments have been promulgated by either
such date.
(B) DELAY
IN
IMPLEMENTATION
FOR
PRIVATE
HOS-
PITALS.—With respect to a hospital that is not owned or
operated by a State (or by an instrumentality or a unit
of government within a State), the amendments made by
this subsection shall apply to payments to States under
section 1903(a) for payments to hospitals made under State
plans for State fiscal years that begin during or after
1995, without regard to whether or not final regulations
H. R. 2264—321
to carry out such amendments have been promulgated
by such date.
SEC. 13622. LIABILITY OF THIRD PARTIES TO PAY FOR CARE AND
SERVICES.
(a) LIABILITY OF ERISA PLANS.—(1) Section 1902(a)(25)(A) (42
U.S.C. 1396a(a)(25)(A)) is amended by striking ‘‘insurers)’’ and
inserting ‘‘insurers, group health plans (as defined in section 607(1)
of the Employee Retirement Income Security Act of 1974), service
benefit plans, and health maintenance organizations)’’.
(2) Section 1903(o) (42 U.S.C. 1396b(o)) is amended by striking
‘‘regulation)’’ and inserting ‘‘regulation and including a group health
plan (as defined in section 607(1) of the Employee Retirement
Income Security Act of 1974)), a service benefit plan, and a health
maintenance organization)’’.
(b) REQUIRING STATE TO PROHIBIT INSURERS FROM TAKING
MEDICAID STATUS INTO ACCOUNT.—Section 1902(a)(25) (42 U.S.C.
1396a(a)(25)) is amended—
(1) by striking ‘‘and’’ at the end of subparagraph (F);
(2) by adding ‘‘and’’ at the end of subparagraph (G); and
(3) by adding after subparagraph (G) the following new
subparagraph:
‘‘(H) that the State prohibits any health insurer (includ-
ing a group health plan, as defined in section 607(1) of
the Employee Retirement Income Security Act of 1974,
a service benefit plan, and a health maintenance organiza-
tion), in enrolling an individual or in making any payments
for benefits to the individual or on the individual’s behalf,
from taking into account that the individual is eligible
for or is provided medical assistance under a plan under
this title for such State, or any other State;’’.
(c) 
STATE
RIGHT
TO
THIRD
PARTY
PAYMENTS.—Section
1902(a)(25) (42 U.S.C. 1396a(a)(25)), as amended by subsection
(b), is amended—
(1) by striking ‘‘and’’ at the end of subparagraph (G);
(2) by adding ‘‘and’’ at the end of subparagraph (H); and
(3) by adding after subparagraph (H) the following new
subparagraph:
‘‘(I) that to the extent that payment has been made
under the State plan for medical assistance in any case
where a third party has a legal liability to make payment
for such assistance, the State has in effect laws under
which, to the extent that payment has been made under
the State plan for medical assistance for health care items
or services furnished to an individual, the State is consid-
ered to have acquired the rights of such individual to
payment by any other party for such health care items
or services;’’.
(d) EFFECTIVE DATE.—(1) Except as provided in paragraph (2),
the amendments made by subsections (a)(1), (b), and (c) shall apply
to calendar quarters beginning on or after October 1, 1993, without
regard to whether or not final regulations to carry out such amend-
ments have been promulgated by such date.
(2) In the case of a State plan for medical assistance under
title XIX of the Social Security Act which the Secretary of Health
and Human Services determines requires State legislation (other
than legislation appropriating funds) in order for the plan to meet
H. R. 2264—322
the additional requirements imposed by the amendments made
by subsections (a) and (b), the State plan shall not be regarded
as failing to comply with the requirements of such title solely
on the basis of its failure to meet these additional requirements
before the first day of the first calendar quarter beginning after
the close of the first regular session of the State legislature that
begins after the date of the enactment of this Act. For purposes
of the preceding sentence, in the case of a State that has a 2-
year legislative session, each year of such session shall be deemed
to be a separate regular session of the State legislature.
(3) The amendment made by subsection (a)(2) shall apply to
items and services furnished on or after October 1, 1993.
SEC. 13623. MEDICAL CHILD SUPPORT.
(a) STATE PLAN REQUIREMENT.—Section 1902(a) (42 U.S.C.
1396a(a)) is amended—
(1) by striking ‘‘and’’ at the end of paragraph (54);
(2) in the paragraph (55) inserted by section 4602(a)(3)
of OBRA–1990, by striking the period at the end and inserting
a semicolon;
(3) by redesignating the paragraph (55) inserted by section
4604(b)(3) of OBRA–1990 as paragraph (56), by transferring
and inserting it after the paragraph (55) inserted by section
4602(a)(3) of such Act, and by striking the period at the end
and inserting a semicolon;
(4) by placing paragraphs (57) and (58), inserted by section
4751(a)(1)(C) of OBRA–1990, immediately after paragraph (56),
as redesignated by paragraph (3);
(5) in the paragraph (58) inserted by section 4751(a)(1)(C)
of OBRA–1990, by striking the period at the end and inserting
a semicolon;
(6) by redesignating the paragraph (58) inserted by section
4752(c)(1)(C) of OBRA–1990 as paragraph (59) and by transfer-
ring and inserting it after the paragraph (58) inserted by section
4751(a)(1)(C) of such Act, and by striking the period at the
end and inserting ‘‘; and’’; and
(7) by inserting after paragraph (59) the following new
paragraph:
‘‘(60) provide that the State agency shall provide assurances
satisfactory to the Secretary that the State has in effect the
laws relating to medical child support required under section
1908.’’.
(b) MEDICAL CHILD SUPPORT LAWS.—Title XIX (42 U.S.C 1936
et seq.) is amended by inserting after section 1907 the following
new section:
‘‘REQUIRED LAWS RELATING TO MEDICAL CHILD SUPPORT
‘‘SEC. 1908. (a) IN GENERAL.—The laws relating to medical
child support, which a State is required to have in effect under
section 1902(a)(60), are as follows:
‘‘(1) A law that prohibits an insurer from denying enroll-
ment of a child under the health coverage of the child’s parent
on the ground that—
‘‘(A) the child was born out of wedlock,
‘‘(B) the child is not claimed as a dependent on the
parent’s Federal income tax return, or
H. R. 2264—323
‘‘(C) the child does not reside with the parent or in
the insurer’s service area.
‘‘(2) In any case in which a parent is required by a court
or administrative order to provide health coverage for a child
and the parent is eligible for family health coverage through
an insurer, a law that requires such insurer—
‘‘(A) to permit such parent to enroll under such family
coverage any such child who is otherwise eligible for such
coverage (without regard to any enrollment season restric-
tions);
‘‘(B) if such a parent is enrolled but fails to make
application to obtain coverage of such child, to enroll such
child under such family coverage upon application by the
child’s other parent or by the State agency administering
the program under this title or part D of title IV; and
‘‘(C) not to disenroll (or eliminate coverage of) such
a child unless the insurer is provided satisfactory written
evidence that—
‘‘(i) such court or administrative order is no longer
in effect, or
‘‘(ii) the child is or will be enrolled in comparable
health coverage through another insurer which will
take effect not later than the effective date of such
disenrollment.
‘‘(3) In any case in which a parent is required by a court
or administrative order to provide health coverage for a child
and the parent is eligible for family health coverage through
an employer doing business in the State, a law that requires
such employer—
‘‘(A) to permit such parent to enroll under such family
coverage any such child who is otherwise eligible for such
coverage (without regard to any enrollment season restric-
tions);
‘‘(B) if such a parent is enrolled but fails to make
application to obtain coverage of such child, to enroll such
child under such family coverage upon application by the
child’s other parent or by the State agency administering
the program under this title or part D of title IV; and
‘‘(C) not to disenroll (or eliminate coverage of) any
such child unless—
‘‘(i) the employer is provided satisfactory written
evidence that—
‘‘(I) such court or administrative order is no
longer in effect, or
‘‘(II) the child is or will be enrolled in com-
parable health coverage which will take effect not
later than the effective date of such disenrollment,
or
‘‘(ii) the employer has eliminated family health
coverage for all of its employees; and
‘‘(D) to withhold from such employee’s compensation
the employee’s share (if any) of premiums for health cov-
erage (except that the amount so withheld may not exceed
the maximum amount permitted to be withheld under sec-
tion 303(b) of the Consumer Credit Protection Act), and
to pay such share of premiums to the insurer, except that
the Secretary may provide by regulation for appropriate
H. R. 2264—324
circumstances under which an employer may withhold less
than such employee’s share of such premiums.
‘‘(4) A law that prohibits an insurer from imposing require-
ments on a State agency, which has been assigned the rights
of an individual eligible for medical assistance under this title
and covered for health benefits from the insurer, that are
different from requirements applicable to an agent or assignee
of any other individual so covered.
‘‘(5) A law that requires an insurer, in any case in which
a child has health coverage through the insurer of a
noncustodial parent—
‘‘(A) to provide such information to the custodial parent
as may be necessary for the child to obtain benefits through
such coverage;
‘‘(B) to permit the custodial parent (or provider, with
the custodial parent’s approval) to submit claims for cov-
ered services without the approval of the noncustodial
parent; and
‘‘(C) to make payment on claims submitted in accord-
ance with subparagraph (B) directly to such custodial
parent, the provider, or the State agency.
‘‘(6) A law that permits the State agency under this title
to garnish the wages, salary, or other employment income
of, and requires withholding amounts from State tax refunds
to, any person who—
‘‘(A) is required by court or administrative order to
provide coverage of the costs of health services to a child
who is eligible for medical assistance under this title,
‘‘(B) has received payment from a third party for the
costs of such services to such child, but
‘‘(C) has not used such payments to reimburse, as
appropriate, either the other parent or guardian of such
child or the provider of such services,
to the extent necessary to reimburse the State agency for
expenditures for such costs under its plan under this title,
but any claims for current or past-due child support shall
take priority over any such claims for the costs of such services.
‘‘(b) DEFINITION.—For purposes of this section, the term ‘insurer’
includes a group health plan, as defined in section 607(1) of the
Employee Retirement Income Security Act of 1974, a health mainte-
nance organization, and an entity offering a service benefit plan.’’.
(c) EFFECTIVE DATE.—(1) Except as provided in paragraph (2),
the amendments made by this section apply to calendar quarters
beginning on or after April 1, 1994, without regard to whether
or not final regulations to carry out such amendments have been
promulgated by such date.
(2) In the case of a State plan under title XIX of the Social
Security Act which the Secretary of Health and Human Services
determines requires State legislation in order for the plan to meet
the additional requirements imposed by the amendments made
by this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the basis
of its failure to meet these additional requirements before the
first day of the first calendar quarter beginning after the close
of the first regular session of the State legislature that begins
after the date of enactment of this Act. For purposes of the preceding
sentence, in the case of a State that has a 2-year legislative session,
H. R. 2264—325
each year of such session shall be deemed to be a separate regular
session of the State legislature.
SEC. 13624. APPLICATION OF MEDICARE RULES LIMITING CERTAIN
PHYSICIAN REFERRALS.
(a) IN GENERAL.—Section 1903 (42 U.S.C.1396b) is amended
by inserting after subsection (r) the following new subsection:
‘‘(s) Notwithstanding the preceding provisions of this section,
no payment shall be made to a State under this section for expendi-
tures for medical assistance under the State plan consisting of
a designated health service (as defined in subsection (h)(6) of section
1877) furnished to an individual on the basis of a referral that
would result in the denial of payment for the service under title
XVIII if such title provided for coverage of such service to the
same extent and under the same terms and conditions as under
the State plan, and subsections (f) and (g)(5) of such section shall
apply to a provider of such a designated health service for which
payment may be made under this title in the same manner as
such subsections apply to a provider of such a service for which
payment may be made under such title.’’.
(b) EFFECTIVE DATE.—The amendment made by subsection (a)
shall apply to referrals made on or after December 31, 1994.
SEC. 13625. STATE MEDICAID FRAUD CONTROL.
(a) IN GENERAL.—Section 1902(a) (42 U.S.C. 1396a(a)), as
amended by section 13623(a), is amended—
(1) by striking ‘‘and’’ at the end of paragraph (59);
(2) by striking the period at the end of paragraph (60)
and inserting ‘‘; and’’; and
(3) by inserting after paragraph (60) the following new
paragraph:
‘‘(61) provide that the State must demonstrate that it oper-
ates a medicaid fraud and abuse control unit described in
section 1903(q) that effectively carries out the functions and
requirements described in such section, as determined in
accordance with standards established by the Secretary, unless
the State demonstrates to the satisfaction of the Secretary
that the effective operation of such a unit in the State would
not be cost-effective because minimal fraud exists in connection
with the provision of covered services to eligible individuals
under the State plan, and that beneficiaries under the plan
will be protected from abuse and neglect in connection with
the provision of medical assistance under the plan without
the existence of such a unit.’’.
(b) EFFECTIVE DATE.—Section 1902(a)(61) of the Social Security
Act (as added by subsection (a)) shall take effect January 1, 1995,
and the standards referred to in such section shall be established
not later than March 31, 1994.
PART IV—IMMUNIZATIONS
SEC. 13631. MEDICAID PEDIATRIC IMMUNIZATION PROVISIONS.
(a) STATE PLAN REQUIREMENT FOR PEDIATRIC IMMUNIZATION
DISTRIBUTION PROGRAM.—Section 1902(a) (42 U.S.C. 1396a(a)), as
amended by sections 13623(a) and 13625(a), is amended—
(1) by striking ‘‘and’’ at the end of paragraph (60);
(2) by striking the period at the end of paragraph (61)
and inserting ‘‘; and’’; and
H. R. 2264—326
(3) by adding at the end the following new paragraph:
‘‘(62) provide for a program for the distribution of pediatric
vaccines to program-registered providers for the immunization
of vaccine-eligible children in accordance with section 1928.’’.
(b) DESCRIPTION
OF
REQUIRED
PROGRAM.—Title XIX is
amended—
(1) by redesignating section 1928 as section 1931 and by
moving such section to the end of such title, and
(2) by inserting after section 1927 the following new section:
‘‘PROGRAM FOR DISTRIBUTION OF PEDIATRIC VACCINES
‘‘SEC. 1928. (a) ESTABLISHMENT OF PROGRAM.—
‘‘(1) IN
GENERAL.—In order to meet the requirement of
section 1902(a)(62), each State shall establish a pediatric vac-
cine distribution program (which may be administered by the
State department of health), consistent with the requirements
of this section, under which—
‘‘(A) each vaccine-eligible child (as defined in subsection
(b)), in receiving an immunization with a qualified pediatric
vaccine (as defined in subsection (h)(8)) from a program-
registered provider (as defined in subsection (c)) on or
after October 1, 1994, is entitled to receive the immuniza-
tion without charge for the cost of such vaccine; and
‘‘(B)(i) each program-registered provider who admin-
isters such a pediatric vaccine to a vaccine-eligible child
on or after such date is entitled to receive such vaccine
under the program without charge either for the vaccine
or its delivery to the provider, and (ii) no vaccine is distrib-
uted under the program to a provider unless the provider
is a program-registered provider.
‘‘(2) DELIVERY OF SUFFICIENT QUANTITIES OF PEDIATRIC VAC-
CINES TO IMMUNIZE FEDERALLY VACCINE-ELIGIBLE CHILDREN.—
‘‘(A) IN GENERAL.—The Secretary shall provide under
subsection (d) for the purchase and delivery on behalf of
each State meeting the requirement of section 1902(a)(62)
(or, with respect to vaccines administered by an Indian
tribe or tribal organization to Indian children, directly to
the tribe or organization), without charge to the State,
of such quantities of qualified pediatric vaccines as may
be necessary for the administration of such vaccines to
all federally vaccine-eligible children in the State on or
after October 1, 1994. This paragraph constitutes budget
authority in advance of appropriations Acts, and represents
the obligation of the Federal Government to provide for
the purchase and delivery to States of the vaccines (or
payment under subparagraph (C)) in accordance with this
paragraph.
‘‘(B) SPECIAL RULES WHERE VACCINE IS UNAVAILABLE.—
To the extent that a sufficient quantity of a vaccine is
not available for purchase or delivery under subsection
(d), the Secretary shall provide for the purchase and deliv-
ery of the available vaccine in accordance with priorities
established by the Secretary, with priority given to feder-
ally vaccine-eligible children unless the Secretary finds
there are other public health considerations.
‘‘(C) SPECIAL
RULES
WHERE
STATE
IS
A
MANUFAC-
TURER.—
H. R. 2264—327
‘‘(i) PAYMENTS IN LIEU OF VACCINES.—In the case
of a State that manufactures a pediatric vaccine the
Secretary, instead of providing the vaccine on behalf
of a State under subparagraph (A), shall provide to
the State an amount equal to the value of the quantity
of such vaccine that otherwise would have been deliv-
ered on behalf of the State under such subparagraph,
but only if the State agrees that such payments will
only be used for purposes relating to pediatric
immunizations.
‘‘(ii) DETERMINATION
OF
VALUE.—In determining
the amount to pay a State under clause (i) with respect
to a pediatric vaccine, the value of the quantity of
vaccine shall be determined on the basis of the price
in effect for the qualified pediatric vaccine under con-
tracts under subsection (d). If more than 1 such con-
tract is in effect, the Secretary shall determine such
value on the basis of the average of the prices under
the contracts, after weighting each such price in rela-
tion to the quantity of vaccine under the contract
involved.
‘‘(b) VACCINE-ELIGIBLE CHILDREN.—For purposes of this section:
‘‘(1) IN GENERAL.—The term ‘vaccine-eligible child’ means
a child who is a federally vaccine-eligible child (as defined
in paragraph (2)) or a State vaccine-eligible child (as defined
in paragraph (3)).
‘‘(2) FEDERALLY VACCINE-ELIGIBLE CHILD.—
‘‘(A) IN GENERAL.—The term ‘federally vaccine-eligible
child’ means any of the following children:
‘‘(i) A medicaid-eligible child.
‘‘(ii) A child who is not insured.
‘‘(iii) A child who (I) is administered a qualified
pediatric vaccine by a federally-qualified health center
(as defined in section 1905(l)(2)(B)) or a rural health
clinic (as defined in section 1905(l)(1)), and (II) is not
insured with respect to the vaccine.
‘‘(iv) A child who is an Indian (as defined in sub-
section (h)(3)).
‘‘(B) DEFINITIONS.—In subparagraph (A):
‘‘(i) The term ‘medicaid-eligible’ means, with
respect to a child, a child who is entitled to medical
assistance under a state plan approved under this
title.
‘‘(ii) The term ‘insured’ means, with respect to
a child—
‘‘(I) for purposes of subparagraph (A)(ii), that
the child is enrolled under, and entitled to benefits
under, a health insurance policy or plan, including
a group health plan, a prepaid health plan, or
an employee welfare benefit plan under the
Employee Retirement Income Security Act of 1974;
and
‘‘(II) for purposes of subparagraph (A)(iii)(II)
with respect to a pediatric vaccine, that the child
is entitled to benefits under such a health insur-
ance policy or plan, but such benefits are not
H. R. 2264—328
available with respect to the cost of the pediatric
vaccine.
‘‘(3) STATE VACCINE-ELIGIBLE CHILD.—The term ‘State vac-
cine-eligible child’ means, with respect to a State and a qualified
pediatric vaccine, a child who is within a class of children
for which the State is purchasing the vaccine pursuant to
subsection (d)(4)(B).
‘‘(c) PROGRAM-REGISTERED PROVIDERS.—
‘‘(1) DEFINED.—In this section, except as otherwise pro-
vided, the term ‘program-registered provider’ means, with
respect to a State, any health care provider that—
‘‘(A) is licensed or otherwise authorized for administra-
tion of pediatric vaccines under the law of the State in
which the administration occurs (subject to section 333(e)
of the Public Health Service Act), without regard to
whether or not the provider participates in the plan under
this title;
‘‘(B) submits to the State an executed provider agree-
ment described in paragraph (2); and
‘‘(C) has not been found, by the Secretary or the State,
to have violated such agreement or other applicable
requirements established by the Secretary or the State
consistent with this section.
‘‘(2) PROVIDER AGREEMENT.—A provider agreement for a
provider under this paragraph is an agreement (in such form
and manner as the Secretary may require) that the provider
agrees as follows:
‘‘(A)(i) Before administering a qualified pediatric vac-
cine to a child, the provider will ask a parent of the child
such questions as are necessary to determine whether the
child is a vaccine-eligible child, but the provider need not
independently verify the answers to such questions.
‘‘(ii) The provider will, for a period of time specified
by the Secretary, maintain records of responses made to
the questions.
‘‘(iii) The provider will, upon request, make such
records available to the State and to the Secretary, subject
to section 1902(a)(7).
‘‘(B)(i) Subject to clause (ii), the provider will comply
with the schedule, regarding the appropriate periodicity,
dosage, and contraindications applicable to pediatric vac-
cines, that is established and periodically reviewed and,
as appropriate, revised by the advisory committee referred
to in subsection (e), except in such cases as, in the provid-
er’s medical judgment subject to accepted medical practice,
such compliance is medically inappropriate.
‘‘(ii) The provider will provide pediatric vaccines in
compliance with applicable State law, including any such
law relating to any religious or other exemption.
‘‘(C)(i) In administering a qualified pediatric vaccine
to a vaccine-eligible child, the provider will not impose
a charge for the cost of the vaccine. A program-registered
provider is not required under this section to administer
such a vaccine to each child for whom an immunization
with the vaccine is sought from the provider.
‘‘(ii) The provider may impose a fee for the administra-
tion of a qualified pediatric vaccine so long as the fee
H. R. 2264—329
in the case of a federally vaccine-eligible child does not
exceed the costs of such administration (as determined
by the Secretary based on actual regional costs for such
administration).
‘‘(iii) The provider will not deny administration of a
qualified pediatric vaccine to a vaccine-eligible child due
to the inability of the child’s parent to pay an administra-
tion fee.
‘‘(3) ENCOURAGING INVOLVEMENT OF PROVIDERS.—Each pro-
gram under this section shall provide, in accordance with cri-
teria established by the Secretary—
‘‘(A) for encouraging the following to become program-
registered providers: private health care providers, the
Indian Health Service, health care providers that receive
funds under title V of the Indian Health Care Improvement
Act, and health programs or facilities operated by Indian
tribes or tribal organizations; and
‘‘(B) for identifying, with respect to any population
of vaccine-eligible children a substantial portion of whose
parents have a limited ability to speak the English lan-
guage, those program-registered providers who are able
to communicate with the population involved in the lan-
guage and cultural context that is most appropriate.
‘‘(4) STATE REQUIREMENTS.—Except as the Secretary may
permit in order to prevent fraud and abuse and for related
purposes, a State may not impose additional qualifications or
conditions, in addition to the requirements of paragraph (1),
in order that a provider qualify as a program-registered pro-
vider under this section. This subsection does not limit the
exercise of State authority under section 1915(b).
‘‘(d) NEGOTIATION OF CONTRACTS WITH MANUFACTURERS.—
‘‘(1) IN GENERAL.—For the purpose of meeting obligations
under this section, the Secretary shall negotiate and enter
into contracts with manufacturers of pediatric vaccines consist-
ent with the requirements of this subsection and, to the maxi-
mum extent practicable, consolidate such contracting with any
other contracting activities conducted by the Secretary to pur-
chase vaccines. The Secretary may enter into such contracts
under which the Federal Government is obligated to make
outlays, the budget authority for which is not provided for
in advance in appropriations Acts, for the purchase and delivery
of pediatric vaccines under subsection (a)(2)(A).
‘‘(2) AUTHORITY
TO
DECLINE
CONTRACTS.—The Secretary
may decline to enter into such contracts and may modify or
extend such contracts.
‘‘(3) CONTRACT PRICE.—
‘‘(A) IN GENERAL.—The Secretary, in negotiating the
prices at which pediatric vaccines will be purchased and
delivered from a manufacturer under this subsection, shall
take into account quantities of vaccines to be purchased
by States under the option under paragraph (4)(B).
‘‘(B) NEGOTIATION OF DISCOUNTED PRICE FOR CURRENT
VACCINES.—With respect to contracts entered into under
this subsection for a pediatric vaccine for which the Centers
for Disease Control and Prevention has a contract in effect
under section 317(j)(1) of the Public Health Service Act
as of May 1, 1993, no price for the purchase of such
H. R. 2264—330
vaccine for vaccine-eligible children shall be agreed to by
the Secretary under this subsection if the price per dose
of such vaccine (including delivery costs and any applicable
excise tax established under section 4131 of the Internal
Revenue Code of 1986) exceeds the price per dose for the
vaccine in effect under such a contract as of such date
increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States
city average) from May 1993 to the month before the month
in which such contract is entered into.
‘‘(C) NEGOTIATION OF DISCOUNTED PRICE FOR NEW VAC-
CINES.—With respect to contracts entered into for a pedi-
atric vaccine not described in subparagraph (B), the price
for the purchase of such vaccine shall be a discounted
price negotiated by the Secretary that may be established
without regard to such subparagraph.
‘‘(4) QUANTITIES
AND
TERMS
OF
DELIVERY.—Under such
contracts—
‘‘(A) the Secretary shall provide, consistent with para-
graph (6), for the purchase and delivery on behalf of States
(and tribes and tribal organizations) of quantities of pedi-
atric vaccines for federally vaccine-eligible children; and
‘‘(B) each State, at the option of the State, shall be
permitted to obtain additional quantities of pediatric vac-
cines (subject to amounts specified to the Secretary by
the State in advance of negotiations) through purchasing
the vaccines from the manufacturers at the applicable price
negotiated by the Secretary consistent with paragraph (3),
if (i) the State agrees that the vaccines will be used to
provide immunizations only for children who are not feder-
ally vaccine-eligible children and (ii) the State provides
to the Secretary such information (at a time and manner
specified by the Secretary, including in advance of negotia-
tions under paragraph (1)) as the Secretary determines
to be necessary, to provide for quantities of pediatric vac-
cines for the State to purchase pursuant to this subsection
and to determine annually the percentage of the vaccine
market that is purchased pursuant to this section and
this subparagraph.
The Secretary shall enter into the initial negotiations under
the preceding sentence not later than 180 days after the date
of the enactment of the Omnibus Budget Reconciliation Act
of 1993.
‘‘(5) CHARGES FOR SHIPPING AND HANDLING.—The Secretary
may enter into a contract referred to in paragraph (1) only
if the manufacturer involved agrees to submit to the Secretary
such reports as the Secretary determines to be appropriate
to assure compliance with the contract and if, with respect
to a State program under this section that does not provide
for the direct delivery of qualified pediatric vaccines, the manu-
facturer involved agrees that the manufacturer will provide
for the delivery of the vaccines on behalf of the State in accord-
ance with such program and will not impose any charges for
the costs of such delivery (except to the extent such costs
are provided for in the price established under paragraph (3)).
‘‘(6) ASSURING ADEQUATE SUPPLY OF VACCINES.—The Sec-
retary, in negotiations under paragraph (1), shall negotiate
H. R. 2264—331
for quantities of pediatric vaccines such that an adequate sup-
ply of such vaccines will be maintained to meet unanticipated
needs for the vaccines. For purposes of the preceding sentence,
the Secretary shall negotiate for a 6-month supply of vaccines
in addition to the quantity that the Secretary otherwise would
provide for in such negotiations. In carrying out this paragraph,
the Secretary shall consider the potential for outbreaks of the
diseases with respect to which the vaccines have been devel-
oped.
‘‘(7) MULTIPLE
SUPPLIERS.—In the case of the pediatric
vaccine involved, the Secretary shall, as appropriate, enter
into a contract referred to in paragraph (1) with each manufac-
turer of the vaccine that meets the terms and conditions of
the Secretary for an award of such a contract (including terms
and conditions regarding safety and quality). With respect to
multiple contracts entered into pursuant to this paragraph,
the Secretary may have in effect different prices under each
of such contracts and, with respect to a purchase by States
pursuant to paragraph (4)(B), the Secretary shall determine
which of such contracts will be applicable to the purchase.
‘‘(e) USE OF PEDIATRIC VACCINES LIST.—The Secretary shall
use, for the purpose of the purchase, delivery, and administration
of pediatric vaccines under this section, the list established (and
periodically reviewed and as appropriate revised) by the Advisory
Committee on Immunization Practices (an advisory committee
established by the Secretary, acting through the Director of the
Centers for Disease Control and Prevention).
‘‘(f) REQUIREMENT OF STATE MAINTENANCE OF IMMUNIZATION
LAWS.—In the case of a State that had in effect as of May 1,
1993, a law that requires some or all health insurance policies
or plans to provide some coverage with respect to a pediatric vac-
cine, a State program under this section does not comply with
the requirements of this section unless the State certifies to the
Secretary that the State has not modified or repealed such law
in a manner that reduces the amount of coverage so required.
‘‘(g) TERMINATION.—This section, and the requirement of section
1902(a)(62), shall cease to be in effect beginning on such date
as may be prescribed in Federal law providing for immunization
services for all children as part of a broad-based reform of the
national health care system.
‘‘(h) DEFINITIONS.—For purposes of this section:
‘‘(1) The term ‘child’ means an individual 18 years of age
or younger.
‘‘(2) The term ‘immunization’ means an immunization
against a vaccine-preventable disease.
‘‘(3) The terms ‘Indian’, ‘Indian tribe’ and ‘tribal organiza-
tion’ have the meanings given such terms in section 4 of the
Indian Health Care Improvement Act.
‘‘(4) The term ‘manufacturer’ means any corporation,
organization, or institution, whether public or private (including
Federal, State, and local departments, agencies, and instrumen-
talities), which manufactures, imports, processes, or distributes
under its label any pediatric vaccine. The term ‘manufacture’
means to manufacture, import, process, or distribute a vaccine.
‘‘(5) The term ‘parent’ includes, with respect to a child,
an individual who qualifies as a legal guardian under State
law.
H. R. 2264—332
‘‘(6) The term ‘pediatric vaccine’ means a vaccine included
on the list under subsection (e).
‘‘(7) The term ‘program-registered provider’ has the mean-
ing given such term in subsection (c).
‘‘(8) The term ‘qualified pediatric vaccine’ means a pediatric
vaccine with respect to which a contract is in effect under
subsection (d).
‘‘(9) The terms ‘vaccine-eligible child’, ‘federally vaccine-
eligible child’, and ‘State vaccine-eligible child’ have the mean-
ing given such terms in subsection (b).’’.
(c) LIMITATION ON MEDICAID PAYMENTS.—Section 1903(i) (42
U.S.C. 1396b(i)), as amended by section 2(b)(2) of the Medicaid
Voluntary Contribution and Provider-Specific Tax Amendments of
1991, is amended—
(1) in the paragraph (10) inserted by section 4401(a)(1)(B)
of OBRA–1990, by striking all that follows ‘‘1927(g)’’ and insert-
ing a semicolon;
(2) by redesignating the paragraph (12) inserted by section
4752(a)(2) of OBRA–1990 as paragraph (11), by transferring
and inserting it after the paragraph (10) inserted by section
4401(a)(1)(B) of OBRA–1990, and by striking the period at
the end and inserting a semicolon;
(3) by redesignating the paragraph (14) inserted by section
4752(e) of OBRA–1990 as paragraph (12), by transferring and
inserting it after paragraph (11), as redesignated by paragraph
(2), and by striking the period at the end and inserting a
semicolon;
(4) by redesignating the paragraph (11) inserted by section
4801(e)(16)(A) of OBRA–1990 as paragraph (13), by transferring
and inserting it after paragraph (12), as redesignated by para-
graph (3), and by striking the period at the end and inserting
‘‘; or’’; and
(5) by inserting after paragraph (13), as so redesignated,
the following new paragraph:
‘‘(14) with respect to any amount expended on administra-
tive costs to carry out the program under section 1928.’’.
(d) CONTINUED COVERAGE OF COSTS OF A PEDIATRIC VACCINE
UNDER CERTAIN GROUP HEALTH PLANS.—
(1) REQUIREMENT.—The requirement of this paragraph,
with respect to a group health plan for plan years beginning
after the date of the enactment of this Act, is that the group
health plan not reduce its coverage of the costs of pediatric
vaccines (as defined under section 1928(h)(6) of the Social Secu-
rity Act) below the coverage it provided as of May 1, 1993.
(2) ENFORCEMENT.—For purposes of section 2207 of the
Public Health Service Act, the requirement of paragraph (1)
is deemed a requirement of title XXII of such Act.
(e) AVAILABILITY OF MEDICAID PAYMENTS FOR CHILDHOOD VAC-
CINE REPLACEMENT PROGRAMS.—
(1) 
IN
GENERAL.—Section 
1902(a)(32) 
(42 
U.S.C.
1396a(a)(32)) is amended—
(A) by striking ‘‘and’’ at the end of subparagraph (B),
(B) by striking the period at the end of subparagraph
(C) and inserting ‘‘; and’’, and
(C) by adding at the end the following new subpara-
graph:
H. R. 2264—333
‘‘(D) in the case of payment for a childhood vaccine
administered before October 1, 1994, to individuals entitled
to medical assistance under the State plan, the State plan
may make payment directly to the manufacturer of the
vaccine under a voluntary replacement program agreed
to by the State pursuant to which the manufacturer (i)
supplies doses of the vaccine to providers administering
the vaccine, (ii) periodically replaces the supply of the
vaccine, and (iii) charges the State the manufacturer’s price
to the Centers for Disease Control and Prevention for the
vaccine so administered (which price includes a reasonable
amount to cover shipping and the handling of returns);’’.
(2) EFFECTIVE DATE.—The amendments made by paragraph
(1) shall take effect on the date of the enactment of this Act.
(f) OUTREACH AND EDUCATION.—
(1) IN GENERAL.—Section 1902(a) (42 U.S.C. 1396a(a)) is
amended—
(A) in paragraph (11)(B)—
(i) by striking ‘‘effective July 1, 1969,’’,
(ii) by striking ‘‘and’’ before ‘‘(ii)’’, and
(iii) by striking ‘‘to him under section 1903’’ and
inserting ‘‘to the individual under section 1903, and
(iii) providing for coordination of information and edu-
cation on pediatric vaccinations and delivery of
immunization services’’;
(B) in paragraph (11)(C), by inserting ‘‘, including the
provision of information and education on pediatric vaccina-
tions and the delivery of immunization services,’’ after
‘‘operations under this title’’; and
(C) in paragraph (43)(A), by inserting before the comma
at the end the following: ‘‘and the need for age-appropriate
immunizations against vaccine-preventable diseases’’.
(2) COVERAGE OF PUBLIC HOUSING HEALTH CENTERS AND
CERTAIN INDIAN HEALTH CARE PROVIDERS AS FEDERALLY-QUALI-
FIED
HEALTH
CENTERS.—Section 1905(l)(2)(B) (42 U.S.C.
1396d(l)(2)(B)) is amended—
(A) by striking ‘‘or 340’’ each place it appears and
inserting ‘‘340, or 340A’’, and
(B) by inserting ‘‘or by an urban Indian organization
receiving funds under title V of the Indian Health Care
Improvement Act for the provision of primary health serv-
ices’’ after ‘‘93–638)’’.
(3) EFFECTIVE DATES.—(A) Except as provided in subpara-
graph (B), the amendments made by this subsection shall apply
to calendar quarters beginning on or after October 1, 1993,
without regard to whether or not final regulations to carry
out such amendments have been promulgated by such date.
(B) In the case of a State plan for medical assistance
under title XIX of the Social Security Act which the Secretary
of Health and Human Services determines requires State legis-
lation (other than legislation appropriating funds) in order for
the plan to meet the additional requirements imposed by the
amendments made by this subsection, the State plan shall
not be regarded as failing to comply with the requirements
of such title solely on the basis of its failure to meet these
additional requirements before the first day of the first calendar
quarter beginning after the close of the first regular session
H. R. 2264—334
of the State legislature that begins after the date of the enact-
ment of this Act. For purposes of the previous sentence, in
the case of a State that has a 2-year legislative session, each
year of such session shall be deemed to be a separate regular
session of the State legislature.
(g) SCHEDULE OF IMMUNIZATIONS UNDER EPSDT.—
(1) IN GENERAL.—Section 1905(r)(1) (42 U.S.C. 1396d(r)(1))
is amended—
(A) in subparagraph (A)(i), by inserting ‘‘and, with
respect to immunizations under subparagraph (B)(iii), in
accordance with the schedule referred to in section
1928(c)(2)(B)(i) for pediatric vaccines’’ after ‘‘child health
care’’; and
(B) in subparagraph (B)(iii), by inserting ‘‘(according
to the schedule referred to in section 1928(c)(2)(B)(i) for
pediatric vaccines)’’ after ‘‘appropriate immunizations’’.
(2) EFFECTIVE DATE.—The amendments made by subpara-
graphs (A) and (B) of paragraph (1) shall first apply 90 days
after the date the schedule referred to in subparagraphs (A)(i)
and subparagraph (B)(iii) of section 1905(r)(1) of the Social
Security Act (as amended by such respective subparagraphs)
is first established.
(h) DENIAL OF FEDERAL FINANCIAL PARTICIPATION FOR INAPPRO-
PRIATE ADMINISTRATION OF SINGLE-ANTIGEN VACCINE.—
(1) IN GENERAL.—Section 1903(i) (42 U.S.C. 1396b(i)), as
amended by subsection (c), is amended—
(A) in paragraph (13), by striking ‘‘or’’ at the end,
(B) in paragraph (14), by striking the period at the
end and inserting ‘‘; or’’, and
(C) by inserting after paragraph (14) the following
new paragraph:
‘‘(15) with respect to any amount expended for a single-
antigen vaccine and its administration in any case in which
the administration of a combined-antigen vaccine was medically
appropriate (as determined by the Secretary).’’.
(2) EFFECTIVE DATE.—The amendments made by paragraph
(1) shall apply to amounts expended for vaccines administered
on or after October 1, 1993.
(i) EFFECTIVE DATE.—Except as otherwise provided in this sec-
tion, the amendments made by this section shall apply to payments
under State plans approved under title XIX of the Social Security
Act for calendar quarters beginning on or after October 1, 1994.
SEC. 13632. NATIONAL VACCINE INJURY COMPENSATION PROGRAM
AMENDMENTS.
(a) AMENDMENT OF VACCINE INJURY TABLE.—
(1) FILING.—Section 2116(b) of the Public Health Service
Act (42 U.S.C. 300aa–16(b)) is amended by striking ‘‘such per-
son may file’’ and inserting ‘‘or to significantly increase the
likelihood of obtaining compensation, such person may, notwith-
standing section 2111(b)(2), file’’.
(2) ADDITIONAL VACCINES.—Section 2114(e) of the Public
Health Service Act (42 U.S.C. 300aa–14) is amended to read
as follows:
‘‘(e) ADDITIONAL VACCINES.—
H. R. 2264—335
‘‘(1) VACCINES
RECOMMENDED
BEFORE
AUGUST
1, 1993.—
By August 1, 1995, the Secretary shall revise the Vaccine
Injury Table included in subsection (a) to include—
‘‘(A) vaccines which are recommended to the Secretary
by the Centers for Disease Control and Prevention before
August 1, 1993, for routine administration to children,
‘‘(B) the injuries, disabilities, illnesses, conditions, and
deaths associated with such vaccines, and
‘‘(C) the time period in which the first symptoms or
manifestations of onset or other significant aggravation
of such injuries, disabilities, illnesses, conditions, and
deaths associated with such vaccines may occur.
‘‘(2) VACCINES RECOMMENDED AFTER AUGUST 1, 1993.—When
after August 1, 1993, the Centers for Disease Control and
Prevention recommends a vaccine to the Secretary for routine
administration to children, the Secretary shall, within 2 years
of such recommendation, amend the Vaccine Injury Table
included in subsection (a) to include—
‘‘(A) vaccines which were recommended for routine
administration to children,
‘‘(B) the injuries, disabilities, illnesses, conditions, and
deaths associated with such vaccines, and
‘‘(C) the time period in which the first symptoms or
manifestations of onset or other significant aggravation
of such injuries, disabilities, illnesses, conditions, and
deaths associated with such vaccines may occur.’’.
(3) EFFECTIVE DATE.—A revision by the Secretary under
section 2114(e) of the Public Health Service Act (42 U.S.C.
300aa–14(e)) (as amended by paragraph (2)) shall take effect
upon the effective date of a tax enacted to provide funds for
compensation paid with respect to the vaccine to be added
to the vaccine injury table in section 2114(a) of the Public
Health Service Act (42 U.S.C. 300aa–14(a)).
(b) INCREASED SPENDING.—Section 2115(j) of the Public Health
Service Act (42 U.S.C. 300aa–15(j)) is amended by striking
‘‘$80,000,000 for each succeeding fiscal year’’ and inserting in lieu
thereof ‘‘$110,000,000 for each succeeding fiscal year’’.
(c) EXTENSION OF TIME FOR DECISION.—Section 2112(d)(3)(D)
of the Public Health Service Act (42 U.S.C. 300aa–12(d)(3)(D)) is
amended by striking ‘‘540 days’’ and inserting ‘‘30 months (but
for not more than 6 months at a time)’’.
PART V—MISCELLANEOUS
SEC. 13641. INCREASE IN LIMIT ON FEDERAL MEDICAID MATCHING
PAYMENTS TO PUERTO RICO AND OTHER TERRITORIES.
(a) IN GENERAL.—Paragraphs (1) through (5) of section 1108(c)
(42 U.S.C. 1308(c)) are amended to read as follows:
‘‘(1) Puerto Rico shall not exceed (A) $116,500,000 for fiscal
year 1994 and (B) for each succeeding fiscal year the amount
provided in this paragraph for the preceding fiscal year
increased by the percentage increase in the medical care compo-
nent of the consumer price index for all urban consumers
(as published by the Bureau of Labor Statistics) for the twelve-
month period ending in March preceding the beginning of the
fiscal year, rounded to the nearest $100,000;
H. R. 2264—336
‘‘(2) the Virgin Islands shall not exceed (A) $3,837,500
for fiscal year 1994, and (B) for each succeeding fiscal year
the amount provided in this paragraph for the preceding fiscal
year increased by the percentage increase referred to in para-
graph (1)(B), rounded to the nearest $10,000;
‘‘(3) Guam shall not exceed (A) $3,685,000 for fiscal year
1994, and (B) for each succeeding fiscal year the amount pro-
vided in this paragraph for the preceding fiscal year increased
by the percentage increase referred to in paragraph (1)(B),
rounded to the nearest $10,000;
‘‘(4) Northern Mariana Islands shall not exceed (A)
$1,110,000 for fiscal year 1994, and (B) for each succeeding
fiscal year the amount provided in this paragraph for the
preceding fiscal year increased by the percentage increase
referred to in paragraph (1)(B), rounded to the nearest $10,000;
and
‘‘(5) American Samoa shall not exceed (A) $2,140,000 for
fiscal year 1994, and (B) for each succeeding fiscal year the
amount provided in this paragraph for the preceding fiscal
year increased by the percentage increase referred to in para-
graph (1)(B), rounded to the nearest $10,000.’’.
(b) EFFECTIVE DATE.—The amendment made by subsection (a)
shall apply beginning with fiscal year 1994.
SEC. 13642. EXTENSION OF MORATORIUM ON TREATMENT OF CER-
TAIN FACILITIES AS INSTITUTIONS FOR MENTAL DIS-
EASES.
Effective as if included in the enactment of OBRA–1989, section
6408(a)(3) of such Act is amended by striking ‘‘180 days’’ and
all that follows and inserting ‘‘December 31, 1995.’’.
SEC. 13643. DEMONSTRATION PROJECTS.
(a) EXTENSION OF DEMONSTRATION PROJECT ON THE EFFECT
OF ALLOWING STATES TO EXTEND MEDICAID COVERAGE TO CERTAIN
LOW-INCOME FAMILIES.—Effective as if included in the enactment
of OBRA–1990, section 4745 of such Act is amended—
(1) in paragraph (1) of subsection (e), by striking
‘‘$12,000,000 in each of fiscal years 1991, 1992, and 1993,
and to no more than $4,000,000 in fiscal year 1994’’ and insert-
ing ‘‘$40,000,000’’; and
(2) in paragraph (2) of subsection (f) by striking ‘‘January
1, 1995’’ and inserting ‘‘one year after the termination of the
projects’’.
(b) RENEWAL OF UNFUNDED DEMONSTRATION PROJECT FOR LOW-
INCOME PREGNANT WOMEN AND CHILDREN.—Effective as if included
in the enactment of OBRA–1989, section 6407 of such Act is
amended—
(1) in subsection (f), by striking ‘‘$10,000,000 in each of
fiscal years 1990, 1991, and 1992’’ and inserting ‘‘$30,000,000’’;
and
(2) in subsection (g)(2), by striking ‘‘January 1, 1994’’ and
inserting ‘‘one year after the termination of the demonstration
projects’’.
(c) APPLICATION OF SPOUSAL IMPOVERISHMENT RULES TO THE
ON LOK FRAIL ELDERLY DEMONSTRATION PROJECT.—(1) Section
1924(a)(5), as added by section 4744(b)(1) of OBRA–1990, is amend-
ed by striking ‘‘1986.’’ and inserting ‘‘1986 or a waiver under section
603(c) of the Social Security Amendments of 1983.’’.
H. R. 2264—337
(2) Section 603(c) of the Social Security Amendments of 1983
is amended—
(A) by striking ‘‘(c)’’ and inserting ‘‘(c)(1)’’;
(B) by redesignating paragraphs (1) and (2) as subpara-
graphs (A) and (B); and
(C) by adding at the end the following new paragraph:
‘‘(2) Section 1924 of the Social Security Act shall apply to
any individual receiving services from an organization receiving
a waiver under this subsection.’’.
SEC. 13644. EXTENSION OF PERIOD OF APPLICABILITY OF ENROLL-
MENT MIX REQUIREMENT TO CERTAIN HEALTH MAINTE-
NANCE ORGANIZATIONS PROVIDING SERVICES UNDER
DAYTON AREA HEALTH PLAN.
Section 2 of Public Law 102–276 is amended by striking ‘‘Janu-
ary 31, 1994’’ and inserting ‘‘December 31, 1995’’.
Subchapter C—Human Resources and Income Security
Amendments
SEC. 13701. TABLE OF CONTENTS.
The table of contents of this subchapter is as follows:
Subchapter C—Human Resources and Income Security Amendments
Sec. 13701. Table of contents.
Sec. 13702. References.
PART I—CHILD WELFARE SERVICES, FOSTER CARE, AND ADOPTION ASSISTANCE
Sec. 13711. Entitlement funding for services designed to strengthen and preserve
families.
Sec. 13712. Entitlement funding for State courts to assess and improve handling of
proceedings relating to foster care and adoption.
Sec. 13713. Enhanced match for automated data systems.
Sec. 13714. Permanent extension of independent living program.
Sec. 13715. Training of agency staff and foster and adoptive parents.
Sec. 13716. Moratorium on collection of disallowances.
PART II—CHILD SUPPORT ENFORCEMENT
Sec. 13721. State paternity establishment programs.
PART III—SUPPLEMENTAL SECURITY INCOME
Sec. 13731. Fees for Federal administration of State supplementary payments.
Sec. 13732. Exclusion from income and resources of State relocation assistance.
Sec. 13733. Prevention of adverse effects on eligibility for, and amount of, benefits
when spouse or parent of beneficiary is absent from the household
due to active military service.
Sec. 13734. Eligibility for children of Armed Forces personnel residing outside the
United States other than in foreign countries.
Sec. 13735. Valuation of certain in-kind support and maintenance when there is a
cost of living adjustment in benefits.
Sec. 13736. Exclusion from income of certain amounts received by Indians from in-
terests held in trust.
PART IV—AID TO FAMILIES WITH DEPENDENT CHILDREN
Sec. 13741. 50 percent Federal match of State administrative costs.
Sec. 13742. Increase in stepparent income disregard.
PART V—UNEMPLOYMENT INSURANCE
Sec. 13751. Extension of current Federal unemployment rate.
PART VI—SOCIAL SERVICES IN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES
Sec. 13761. Increase in block grants to States for social services.
SEC. 13702. REFERENCES.
Except as otherwise expressly provided, wherever in this sub-
chapter an amendment or repeal is expressed in terms of an amend-
H. R. 2264—338
ment to, or repeal of, a section or other provision, the reference
shall be considered to be made to a section or other provision
of the Social Security Act.
PART I—CHILD WELFARE SERVICES, FOSTER
CARE, AND ADOPTION ASSISTANCE
SEC. 13711. ENTITLEMENT FUNDING FOR SERVICES DESIGNED TO
STRENGTHEN AND PRESERVE FAMILIES.
(a) IN GENERAL.—Part B of title IV (42 U.S.C. 620–628) is
amended—
(1) by striking the heading and inserting the following:
‘‘PART B—CHILD AND FAMILY SERVICES
‘‘Subpart 1—Child Welfare Services’’; and
(2) by adding at the end the following:
‘‘Subpart 2—Family Preservation and Support
Services
‘‘SEC. 430. PURPOSES; LIMITATIONS ON AUTHORIZATIONS OF APPRO-
PRIATIONS; RESERVATION OF CERTAIN AMOUNTS.
‘‘(a) PURPOSES; LIMITATIONS ON AUTHORIZATION OF APPROPRIA-
TIONS.—For the purpose of encouraging and enabling each State
to develop and establish, or expand, and to operate a program
of family preservation services and community-based family support
services, there are authorized to be appropriated to the Secretary
the amounts described in subsection (b) for the fiscal years specified
in subsection (b).
‘‘(b) DESCRIPTION OF AMOUNTS.—The amount described in this
subsection is—
‘‘(1) for fiscal year 1994, $60,000,000;
‘‘(2) for fiscal year 1995, $150,000,000;
‘‘(3) for fiscal year 1996, $225,000,000;
‘‘(4) for fiscal year 1997, $240,000,000; or
‘‘(5) for fiscal year 1998, the greater of—
‘‘(A) $255,000,000; or
‘‘(B) the amount described in this subsection for fiscal
year 1997, increased by the inflation percentage applicable
to fiscal year 1998.
‘‘(c) INFLATION
PERCENTAGE.—For purposes of subsection
(b)(5)(B) of this section, the inflation percentage applicable to any
fiscal year is the percentage (if any) by which—
‘‘(1) the average of the Consumer Price Index (as defined
in section 1(f)(5) of the Internal Revenue Code of 1986) for
the 12-month period ending on December 31 of the immediately
preceding fiscal year; exceeds
‘‘(2) the average of the Consumer Price Index (as so defined)
for the 12-month period ending on December 31 of the 2nd
preceding fiscal year.
‘‘(d) RESERVATION OF CERTAIN AMOUNTS.—
‘‘(1) EVALUATION, RESEARCH, TRAINING, AND
TECHNICAL
ASSISTANCE.—The Secretary shall reserve $2,000,000 of the
amount described in subsection (b) for fiscal year 1994, and
H. R. 2264—339
$6,000,000 of the amounts so described for each of fiscal years
1995, 1996, 1997, and 1998, for expenditure by the Secretary—
‘‘(A) for research, training, and technical assistance
related to the program under this subpart; and
‘‘(B) for evaluation of State programs funded under
this subpart and any other Federal, State, or local program,
regardless of whether federally assisted, that is designed
to achieve the same purposes as the program under this
subpart.
‘‘(2) STATE
COURT
ASSESSMENTS.—The Secretary shall
reserve $5,000,000 of the amount described in subsection (b)
for fiscal year 1995, and $10,000,000 of the amounts so
described for each of fiscal years 1996, 1997, and 1998, for
grants under section 13712 of the Omnibus Budget Reconcili-
ation Act of 1993.
‘‘(3) INDIAN TRIBES.—The Secretary shall reserve 1 percent
of the amounts described in subsection (b) for each fiscal year,
for allotment to Indian tribes in accordance with section 433(a).
‘‘SEC. 431. DEFINITIONS.
‘‘(a) IN GENERAL.—As used in this subpart:
‘‘(1) FAMILY
PRESERVATION
SERVICES.—The term ‘family
preservation services’ means services for children and families
designed to help families (including adoptive and extended
families) at risk or in crisis, including—
‘‘(A) service programs designed to help children—
‘‘(i) where appropriate, return to families from
which they have been removed; or
‘‘(ii) be placed for adoption, with a legal guardian,
or, if adoption or legal guardianship is determined
not to be appropriate for a child, in some other planned,
permanent living arrangement;
‘‘(B) preplacement preventive services programs, such
as intensive family preservation programs, designed to help
children at risk of foster care placement remain with their
families;
‘‘(C) service programs designed to provide followup care
to families to whom a child has been returned after a
foster care placement;
‘‘(D) respite care of children to provide temporary relief
for parents and other caregivers (including foster parents);
and
‘‘(E) services designed to improve parenting skills (by
reinforcing parents’ confidence in their strengths, and help-
ing them to identify where improvement is needed and
to obtain assistance in improving those skills) with respect
to matters such as child development, family budgeting,
coping with stress, health, and nutrition.
‘‘(2) FAMILY SUPPORT SERVICES.—The term ‘family support
services’ means community-based services to promote the well-
being of children and families designed to increase the strength
and stability of families (including adoptive, foster, and
extended families), to increase parents’ confidence and com-
petence in their parenting abilities, to afford children a stable
and supportive family environment, and otherwise to enhance
child development.
H. R. 2264—340
‘‘(3) STATE AGENCY.—The term ‘State agency’ means the
State agency responsible for administering the program under
subpart 1.
‘‘(4) STATE.—The term ‘State’ includes an Indian tribe or
tribal organization, in addition to the meaning given such term
for purposes of subpart 1.
‘‘(5) TRIBAL ORGANIZATION.—The term ‘tribal organization’
means the recognized governing body of any Indian tribe.
‘‘(6) INDIAN
TRIBE.—The term ‘Indian tribe’ means any
Indian tribe (as defined in section 482(i)(5)) and any Alaska
Native organization (as defined in section 482(i)(7)(A)).
‘‘(b) OTHER TERMS.—For other definitions of other terms used
in this subpart, see section 475.
‘‘SEC. 432. STATE PLANS.
‘‘(a) PLAN REQUIREMENTS.—A State plan meets the require-
ments of this subsection if the plan—
‘‘(1) provides that the State agency shall administer, or
supervise the administration of, the State program under this
subpart;
‘‘(2)(A)(i) sets forth the goals intended to be accomplished
under the plan by the end of the 5th fiscal year in which
the plan is in operation in the State, and (ii) is updated periodi-
cally to set forth the goals intended to be accomplished under
the plan by the end of each 5th fiscal year thereafter;
‘‘(B) describes the methods to be used in measuring
progress toward accomplishment of the goals;
‘‘(C) contains assurances that the State—
‘‘(i) after the end of each of the 1st 4 fiscal years
covered by a set of goals, will perform an interim review
of progress toward accomplishment of the goals, and on
the basis of the interim review will revise the statement
of goals in the plan, if necessary, to reflect changed cir-
cumstances; and
‘‘(ii) after the end of the last fiscal year covered by
a set of goals, will perform a final review of progress
toward accomplishment of the goals, and on the basis of
the final review (I) will prepare, transmit to the Secretary,
and make available to the public a final report on progress
toward accomplishment of the goals, and (II) will develop
(in consultation with the entities required to be consulted
pursuant to subsection (b)) and add to the plan a statement
of the goals intended to be accomplished by the end of
the 5th succeeding fiscal year;
‘‘(3) provides for coordination, to the extent feasible and
appropriate, of the provision of services under the plan and
the provision of services or benefits under other Federal or
federally assisted programs serving the same populations;
‘‘(4) contains assurances that not more than 10 percent
of expenditures under the plan for any fiscal year with respect
to which the State is eligible for payment under section 434
for the fiscal year shall be for administrative costs, and that
the remaining expenditures shall be for programs of family
preservation services and community-based family support
services with significant portions of such expenditures for each
such program;
‘‘(5) contains assurances that the State will—
H. R. 2264—341
‘‘(A) annually prepare, furnish to the Secretary, and
make available to the public a description (including sepa-
rate descriptions with respect to family preservation serv-
ices and community-based family support services) of—
‘‘(i) the service programs to be made available
under the plan in the immediately succeeding fiscal
year;
‘‘(ii) the populations which the programs will serve;
and
‘‘(iii) the geographic areas in the State in which
the services will be available; and
‘‘(B) perform the activities described in subparagraph
(A)—
‘‘(i) in the case of the 1st fiscal year under the
plan, at the time the State submits its initial plan;
and
‘‘(ii) in the case of each succeeding fiscal year,
by the end of the 3rd quarter of the immediately
preceding fiscal year;
‘‘(6) provides for such methods of administration as the
Secretary finds to be necessary for the proper and efficient
operation of the plan;
‘‘(7)(A) contains assurances that Federal funds provided
to the State under this subpart will not be used to supplant
Federal or non-Federal funds for existing services and activities
which promote the purposes of this subpart; and
‘‘(B) provides that the State will furnish reports to the
Secretary, at such times, in such format, and containing such
information as the Secretary may require, that demonstrate
the State’s compliance with the prohibition contained in
subparagraph (A); and
‘‘(8) provides that the State agency will furnish such
reports, containing such information, and participate in such
evaluations, as the Secretary may require.
‘‘(b) APPROVAL OF PLANS.—
‘‘(1) IN GENERAL.—The Secretary shall approve a plan that
meets the requirements of subsection (a) only if the plan was
developed jointly by the Secretary and the State, after consulta-
tion by the State agency with appropriate public and nonprofit
private agencies and community-based organizations with
experience in administering programs of services for children
and families (including family preservation and family support
services).
‘‘(2) PLANS OF INDIAN TRIBES.—
‘‘(A) 
EXEMPTION
FROM
INAPPROPRIATE
REQUIRE-
MENTS.—The Secretary may exempt a plan submitted by
an Indian tribe from any requirement of this section that
the Secretary determines would be inappropriate to apply
to the Indian tribe, taking into account the resources,
needs, and other circumstances of the Indian tribe.
‘‘(B) SPECIAL
RULE.—Notwithstanding subparagraph
(A) of this paragraph, the Secretary may not approve a
plan of an Indian tribe under this subpart to which (but
for this subparagraph) an allotment of less than $10,000
would be made under section 433(a) if allotments were
made under section 433(a) to all Indian tribes with plans
H. R. 2264—342
approved under this subpart with the same or larger num-
bers of children.
‘‘SEC. 433. ALLOTMENTS TO STATES.
‘‘(a) INDIAN TRIBES.—From the amount reserved pursuant to
section 430(d)(3) for any fiscal year, the Secretary shall allot to
each Indian tribe with a plan approved under this subpart an
amount that bears the same ratio to such reserved amount as
the number of children in the Indian tribe bears to the total number
of children in all Indian tribes with State plans so approved, as
determined by the Secretary on the basis of the most current
and reliable information available to the Secretary.
‘‘(b) TERRITORIES.—From the amount described in section 430(b)
for any fiscal year that remains after applying section 430(d) for
the fiscal year, the Secretary shall allot to each of the jurisdictions
of Puerto Rico, Guam, the Virgin Islands, the Northern Mariana
Islands, and American Samoa an amount determined in the same
manner as the allotment to each of such jurisdictions is determined
under section 421.
‘‘(c) OTHER STATES.—
‘‘(1) IN GENERAL.—From the amount described in section
430(b) for any fiscal year that remains after applying section
430(d) and subsection (b) of this section for the fiscal year,
the Secretary shall allot to each State (other than an Indian
tribe) which is not specified in subsection (b) of this section
an amount equal to such remaining amount multiplied by the
food stamp percentage of the State for the fiscal year.
‘‘(2) FOOD STAMP PERCENTAGE DEFINED.—
‘‘(A) IN GENERAL.—As used in paragraph (1) of this
subsection, the term ‘food stamp percentage’ means, with
respect to a State and a fiscal year, the average monthly
number of children receiving food stamp benefits in the
State for months in the 3 fiscal years referred to in subpara-
graph (B) of this paragraph, as determined from sample
surveys made under section 16(c) of the Food Stamp Act
of 1977, expressed as a percentage of the average monthly
number of children receiving food stamp benefits in the
States described in such paragraph (1) for months in such
3 fiscal years, as so determined.
‘‘(B) FISCAL YEARS USED IN CALCULATION.—For pur-
poses of the calculation pursuant to subparagraph (A),
the Secretary shall use data for the 3 most recent fiscal
years, preceding the fiscal year for which the State’s allot-
ment is calculated under this subsection, for which such
data are available to the Secretary.
‘‘SEC. 434. PAYMENTS TO STATES.
‘‘(a) ENTITLEMENT.—
‘‘(1) GENERAL RULE.—Except as provided in paragraph (2)
of this subsection, each State which has a plan approved under
this subpart shall be entitled to payment of the lesser of—
‘‘(A) 75 percent of the total expenditures by the State
for activities under the plan during the fiscal year or the
immediately succeeding fiscal year; or
‘‘(B) the allotment of the State under section 433 for
the fiscal year.
‘‘(2) SPECIAL RULE.—Upon submission by a State to the
Secretary during fiscal year 1994 of an application in such
H. R. 2264—343
form and containing such information as the Secretary may
require (including, if the State is seeking payment of an amount
pursuant to subparagraph (B) of this paragraph, a description
of the services to be provided with the amount), the State
shall be entitled to payment of an amount equal to the sum
of—
‘‘(A) such amount, not exceeding $1,000,000, from the
allotment of the State under section 433 for fiscal year
1994, as the State may require to develop and submit
a plan for approval under section 432; and
‘‘(B) an amount equal to the lesser of—
‘‘(i) 75 percent of the expenditures by the State
for services to children and families in accordance with
the application and the expenditure rules of section
432(a)(4); or
‘‘(ii) the allotment of the State under section 433
for fiscal year 1994, reduced by any amount paid to
the State pursuant to subparagraph (A) of this para-
graph.
‘‘(b) PROHIBITIONS.—
‘‘(1) NO USE OF OTHER FEDERAL FUNDS FOR STATE MATCH.—
Each State receiving an amount paid under paragraph (1)
or (2)(B) of subsection (a) may not expend any Federal funds
to meet the costs of services described in this subpart not
covered by the amount so paid.
‘‘(2) AVAILABILITY OF FUNDS.—A State may not expend any
amount paid under subsection (a)(1) for any fiscal year after
the end of the immediately succeeding fiscal year.
‘‘(c) DIRECT PAYMENTS TO TRIBAL ORGANIZATIONS OF INDIAN
TRIBES.—The Secretary shall pay any amount to which an Indian
tribe is entitled under this section directly to the tribal organization
of the Indian tribe.
‘‘SEC. 435. EVALUATIONS.
‘‘(a) EVALUATIONS.—
‘‘(1) IN
GENERAL.—The Secretary shall evaluate the
effectiveness of the programs carried out pursuant to this sub-
part in accomplishing the purposes of this subpart, and may
evaluate any other Federal, State, or local program, regardless
of whether federally assisted, that is designed to achieve the
same purposes as the program under this subpart, in accord-
ance with criteria established in accordance with paragraph
(2).
‘‘(2) CRITERIA TO BE USED.—In developing the criteria to
be used in evaluations under paragraph (1), the Secretary shall
consult with appropriate parties, such as—
‘‘(A) State agencies administering programs under this
part and part E;
‘‘(B) persons administering child and family services
programs (including family preservation and family support
programs) for private, nonprofit organizations with an
interest in child welfare; and
‘‘(C) other persons with recognized expertise in the
evaluation of child and family services programs (including
family preservation and family support programs) or other
related programs.
H. R. 2264—344
‘‘(b) COORDINATION
OF
EVALUATIONS.—The Secretary shall
develop procedures to coordinate evaluations under this section,
to the extent feasible, with evaluations by the States of the effective-
ness of programs under this subpart.’’.
(b) CONFORMING AMENDMENTS.—
(1) Section 422 (42 U.S.C. 622) is amended—
(A) in subsection (a), by striking ‘‘this part’’ and insert-
ing ‘‘this subpart’’;
(B) in subsection (b), by striking ‘‘this part’’ each place
such term appears and inserting ‘‘this subpart’’; and
(C) in subsection (b)(2), by inserting ‘‘under the State
plan approved under subpart 2 of this part,’’ after ‘‘part
A of this title,’’.
(2) Section 423(a) (42 U.S.C. 623(a)) is amended by striking
‘‘this part’’ and inserting ‘‘this subpart’’.
(3) Section 428(a) (42 U.S.C. 628(a)) is amended by striking
‘‘this part’’ each place such term appears and inserting ‘‘this
subpart’’.
(4) Section 471(a)(2) (42 U.S.C. 671(a)(2)) is amended by
inserting ‘‘subpart 1 of’’ before ‘‘part B’’.
(c) EFFECTIVE DATE.—The amendments made by this section
shall be effective with respect to calendar quarters beginning on
or after October 1, 1993.
SEC. 13712. ENTITLEMENT FUNDING FOR STATE COURTS TO ASSESS
AND IMPROVE HANDLING OF PROCEEDINGS RELATING
TO FOSTER CARE AND ADOPTION.
(a) IN GENERAL.—The Secretary shall make grants, in accord-
ance with this section, to the highest State courts in States partici-
pating in the program under part E of title IV of the Social Security
Act, for the purpose of enabling such courts—
(1) to conduct assessments, in accordance with such
requirements as the Secretary shall publish, of the role, respon-
sibilities, and effectiveness of State courts in carrying out State
laws requiring proceedings (conducted by or under the super-
vision of the courts)—
(A) that implement parts B and E of title IV of such
Act;
(B) that determine the advisability or appropriateness
of foster care placement;
(C) that determine whether to terminate parental
rights; and
(D) that determine whether to approve the adoption
or other permanent placement of a child; and
(2) to implement changes deemed necessary as a result
of the assessments.
(b) APPLICATIONS.—In order to be eligible for a grant under
this section, a highest State court shall submit to the Secretary
an application at such time, in such form, and including such
information and assurances as the Secretary shall require.
(c) ALLOTMENTS.—
(1) IN GENERAL.—Each highest State court which has an
application approved under subsection (b), and is conducting
assessment activities in accordance with this section, shall be
entitled to payment, for each of fiscal years 1995 through
1998, from amounts reserved pursuant to section 430(d)(2) of
the Social Security Act, of an amount equal to the sum of—
H. R. 2264—345
(A) for fiscal year 1995, $75,000 plus the amount
described in paragraph (2) for fiscal year 1995; and
(B) for each of fiscal years 1996 through 1998, $85,000
plus the amount described in paragraph (2) for each of
such fiscal years.
(2) FORMULA.—The amount described in this paragraph
for any fiscal year is the amount that bears the same ratio
to the amount reserved pursuant to section 430(d)(2) of the
Social Security Act for the fiscal year (reduced by the dollar
amount specified in paragraph (1) of this subsection for the
fiscal year) as the number of individuals in the State who
have not attained 21 years of age bears to the total number
of such individuals in all States the highest State courts of
which have approved applications under subsection (b).
(d) USE OF GRANT FUNDS.—Each highest State court which
receives funds paid under this section may use such funds to
pay—
(1) any or all costs of activities under this section in fiscal
year 1995; and
(2) not more than 75 percent of the cost of activities under
this section in each of fiscal years 1996, 1997, and 1998.
SEC. 13713. ENHANCED MATCH FOR AUTOMATED DATA SYSTEMS.
(a) PAYMENTS TO STATES.—
(1) IN
GENERAL.—Section 474(a)(3) (42 U.S.C. 674(a)(3))
is amended—
(A) by striking ‘‘and’’ at the end of subparagraph (B);
(B) by redesignating subparagraph (C) as subpara-
graph (E); and
(C) by inserting after subparagraph (B) the following:
‘‘(C) 75 percent of so much of such expenditures as
are for the planning, design, development, or installation
of statewide mechanized data collection and information
retrieval systems (including 75 percent of the full amount
of expenditures for hardware components for such systems)
but only to the extent that such systems—
‘‘(i) meet the requirements imposed by regulations
promulgated pursuant to section 479(b)(2);
‘‘(ii) to the extent practicable, are capable of inter-
facing with the State data collection system that col-
lects information relating to child abuse and neglect;
‘‘(iii) to the extent practicable, have the capability
of interfacing with, and retrieving information from,
the State data collection system that collects informa-
tion relating to the eligibility of individuals under part
A (for the purposes of facilitating verification of eligi-
bility of foster children); and
‘‘(iv) are determined by the Secretary to be likely
to provide more efficient, economical, and effective
administration of the programs carried out under a
State plan approved under part B or this part; and
‘‘(D) 50 percent of so much of such expenditures as
are for the operation of the statewide mechanized data
collection and information retrieval systems referred to
in subparagraph (C); and’’.
H. R. 2264—346
(2) TREATMENT OF STATE EXPENDITURES FOR DATA COLLEC-
TION AND INFORMATION RETRIEVAL SYSTEMS.—Section 474 (42
U.S.C. 674) is amended by adding at the end the following:
‘‘(e) AUTOMATED DATA COLLECTION EXPENDITURES.—The Sec-
retary shall treat as necessary for the proper and efficient adminis-
tration of the State plan all expenditures of a State necessary
in order for the State to plan, design, develop, install, and operate
data collection and information retrieval systems described in sub-
section (a)(3)(C), without regard to whether the systems may be
used with respect to foster or adoptive children other than those
on behalf of whom foster care maintenance payments or adoption
assistance payments may be made under this part.’’.
(3) EFFECTIVE DATE.—The amendments made by this sub-
section shall take effect on October 1, 1993.
(b) TERMINATION OF ENHANCED MATCH.—
(1) 
IN
GENERAL.—Section 
474(a)(3)(C) 
(42 
U.S.C.
674(a)(3)(C)), as amended by subsection (a) of this section,
is amended by striking ‘‘75 percent’’ each place such term
appears and inserting ‘‘50 percent’’.
(2) EFFECTIVE DATE.—The amendment made by paragraph
(1) shall apply to expenditures during fiscal years beginning
on or after October 1, 1996.
SEC. 13714. PERMANENT EXTENSION OF INDEPENDENT LIVING PRO-
GRAM.
(a) IN GENERAL.—Section 477 (42 U.S.C. 677) is amended—
(1) in subsection (a)(1), by striking the 3rd sentence;
(2) in subsection (c), by striking ‘‘of the fiscal years 1988
through 1992’’ and inserting ‘‘succeeding fiscal year’’;
(3) in subsection (e)(1)(A), by striking ‘‘each of the fiscal
years 1987 through 1992’’ and inserting ‘‘fiscal year 1987 and
any succeeding fiscal year’’;
(4) in subsection (e)(1)(B), by striking ‘‘fiscal years 1991
and 1992’’ and inserting ‘‘fiscal year 1991 and any succeeding
fiscal year’’; and
(5) in subsection (e)(1)(C)(ii), by striking ‘‘fiscal year 1992’’
and inserting ‘‘any succeeding fiscal year’’.
(b) EFFECTIVE DATE.—The amendments made by subsection
(a) shall apply to activities engaged in, on, or after October 1,
1992.
SEC. 13715. TRAINING OF AGENCY STAFF AND FOSTER AND ADOPTIVE
PARENTS.
Section 8006(b) of the Omnibus Budget Reconciliation Act of
1989 (42 U.S.C. 674 note) is amended by inserting ‘‘, and to expendi-
tures made on or after October 1, 1993’’ before the period.
SEC. 13716. MORATORIUM ON COLLECTION OF DISALLOWANCES.
The Secretary of Health and Human Services shall not, before
October 1, 1994—
(1) reduce any payment to, withhold any payment from,
or seek any repayment from any State under part B or E
of title IV of the Social Security Act by reason of a determina-
tion made in connection with a review of State compliance
with section 427 of such Act for any Federal fiscal year before
fiscal year 1995; or
(2) reduce any payment to, withhold any payment from,
or seek any repayment from any State under such part E
H. R. 2264—347
by reason of a determination made in connection with any
on-site Federal financial review, or any audit conducted by
the Inspector General using similar methodologies.
PART II—CHILD SUPPORT ENFORCEMENT
SEC. 13721. STATE PATERNITY ESTABLISHMENT PROGRAMS.
(a) PERFORMANCE
STANDARDS.—Section 452(g) (42 U.S.C.
652(g)) is amended—
(1) in paragraph (1)—
(A) by striking ‘‘1991’’ and inserting ‘‘1994’’;
(B) by inserting ‘‘is based on reliable data and’’ before
‘‘equals or exceeds’’;
(C) by inserting ‘‘(rounded to the nearest whole percent-
age point)’’ before ‘‘equals’’; and
(D) by striking subparagraphs (A), (B), and (C) and
inserting the following:
‘‘(A) 75 percent;
‘‘(B) for a State with a paternity establishment percentage
of not less than 50 percent but less than 75 percent for such
fiscal year, the paternity establishment percentage of the State
for the immediately preceding fiscal year plus 3 percentage
points;
‘‘(C) for a State with a paternity establishment percentage
of not less than 45 percent but less than 50 percent for such
fiscal year, the paternity establishment percentage of the State
for the immediately preceding fiscal year plus 4 percentage
points;
‘‘(D) for a State with a paternity establishment percentage
of not less than 40 percent but less than 45 percent for such
fiscal year, the paternity establishment percentage of the State
for the immediately preceding fiscal year plus 5 percentage
points; or
‘‘(E) for a State with a paternity establishment percentage
of less than 40 percent for such fiscal year, the paternity
establishment percentage of the State for the immediately
preceding fiscal year plus 6 percentage points.’’; and
(2) in paragraph (2)—
(A) in subparagraph (A)—
(i) by striking ‘‘(or under all such plans)’’ each
place such term appears and inserting ‘‘or E’’;
(ii) in clause (i), by inserting ‘‘during the fiscal
year’’ before the comma;
(iii) in clause (ii)—
(I) in subclause (I), by striking ‘‘for such’’ and
inserting ‘‘as of the end of the’’; and
(II) in subclause (II), by striking ‘‘for the’’ and
inserting ‘‘as of the end of the’’;
(iv) in clause (iii), by inserting ‘‘or acknowledged
during the fiscal year’’ before the comma; and
(v) in the matter following clause (iii)—
(I) by striking ‘‘have been’’ and inserting
‘‘were’’;
(II) by inserting ‘‘during the immediately
preceding fiscal year’’ after ‘‘wedlock’’;
(III) by striking ‘‘is being’’ and inserting ‘‘was
being’’;
H. R. 2264—348
(IV) by striking ‘‘for such’’ and inserting ‘‘as
of the end of such preceding’’;
(V) by striking ‘‘are being’’ and inserting ‘‘were
being’’; and
(VI) by striking ‘‘for the’’ and inserting ‘‘as
of the end of such preceding’’;
(B) by striking subparagraph (B) and inserting the
following:
‘‘(B) the term ‘reliable data’ means the most recent
data available which are found by the Secretary to be
reliable for purposes of this section.’’;
(C) by inserting ‘‘unless paternity is established for
such child’’ after ‘‘the death of a parent’’; and
(D) by inserting ‘‘or any child with respect to whom
the State agency administering the plan under part E
determines (as provided in section 454(4)(B)) that it is
against the best interests of such child to do so’’ after
‘‘cooperate under section 402(a)(26)’’.
(b) STATE PLAN REQUIREMENTS FOR THE ESTABLISHMENT OF
PATERNITY.—Section 466(a) (42 U.S.C. 666(a)) is amended—
(1) in paragraph (2)—
(A) by striking ‘‘at the option of the State,’’; and
(B) by inserting ‘‘or paternity establishment’’ after
‘‘support order issuance and enforcement’’;
(2) in paragraph (5), by adding at the end the following:
‘‘(C) Procedures for a simple civil process for voluntarily
acknowledging paternity under which the State must pro-
vide that the rights and responsibilities of acknowledging
paternity are explained and ensure that due process safe-
guards are afforded. Such procedures must include a hos-
pital-based program for the voluntary acknowledgment of
paternity during the period immediately before or after
the birth of a child.
‘‘(D) Procedures under which the voluntary acknowl-
edgment of paternity creates a rebuttable, or at the option
of the State, conclusive presumption of paternity, and under
which such voluntary acknowledgment is admissible as
evidence of paternity.
‘‘(E) Procedures under which the voluntary acknowl-
edgment of paternity must be recognized as a basis for
seeking a support order without requiring any further
proceedings to establish paternity.
‘‘(F) Procedures which provide that (i) any objection
to genetic testing results must be made in writing within
a specified number of days before any hearing at which
such results may be introduced into evidence, and (ii) if
no objection is made, the test results are admissible as
evidence of paternity without the need for foundation testi-
mony or other proof of authenticity or accuracy.
‘‘(G) Procedures which create a rebuttable or, at the
option of the State, conclusive presumption of paternity
upon genetic testing results indicating a threshold prob-
ability that the alleged father is the father of the child.
‘‘(H) Procedures requiring a default order to be entered
in a paternity case upon a showing of service of process
on the defendent and any additional showing required by
State law.’’; and
H. R. 2264—349
(3) by inserting after paragraph (10) the following new
paragraph:
‘‘(11) Procedures under which a State must give full faith
and credit to a determination of paternity made by any other
State, whether established through voluntary acknowledgment
or through administrative or judicial processes.’’.
(c) EFFECTIVE DATE.—The amendments made by this section
shall become effective with respect to a State on the later of—
(1) October 1, 1993 or,
(2) the date of enactment by the legislature of such State
of all laws required by such amendments,
but in no event later than the first day of the first calendar
quarter beginning after the close of the first regular session of
the State legislature that begins after the date of enactment of
this Act. For purposes of the previous sentence, in the case of
a State that has a 2-year legislative session, each year of such
session shall be deemed to be a separate regular session of the
State legislature.
PART III—SUPPLEMENTAL SECURITY INCOME
SEC. 13731. FEES FOR FEDERAL ADMINISTRATION OF STATE SUPPLE-
MENTARY PAYMENTS.
(a) IN GENERAL.—
(1) OPTIONAL STATE SUPPLEMENTARY PAYMENTS.—Section
1616(d) (42 U.S.C. 1382e(d)) is amended—
(A) by inserting ‘‘(1)’’ after ‘‘(d)’’;
(B) by inserting ‘‘, plus an administration fee assessed
in accordance with paragraph (2) and any additional serv-
ices fee charged in accordance with paragraph (3)’’ before
the period; and
(C) by adding after and below the end the following:
‘‘(2)(A) The Secretary shall assess each State an administration
fee in an amount equal to—
‘‘(i) the number of supplementary payments made by the
Secretary on behalf of the State under this section for any
month in a fiscal year; multiplied by
‘‘(ii) the applicable rate for the fiscal year.
‘‘(B) As used in subparagraph (A), the term ‘applicable rate’
means—
‘‘(i) for fiscal year 1994, $1.67;
‘‘(ii) for fiscal year 1995, $3.33;
‘‘(iii) for fiscal year 1996, $5.00; and
‘‘(iv) for fiscal year 1997 and each succeeding fiscal year,
$5.00, or such different rate as the Secretary determines is
appropriate for the State.
‘‘(C) Upon making a determination under subparagraph (B)(iv),
the Secretary shall promulgate the determination in regulations,
which may take into account the complexity of administering the
State’s supplementary payment program.
‘‘(D) All fees assessed pursuant to this paragraph shall be
transferred to the Secretary at the same time that amounts for
such supplementary payments are required to be so transferred.
‘‘(3)(A) The Secretary may charge a State an additional services
fee if, at the request of the State, the Secretary provides additional
services beyond the level customarily provided, in the administra-
tion of State supplementary payments pursuant to this section.
H. R. 2264—350
‘‘(B) The additional services fee shall be in an amount that
the Secretary determines is necessary to cover all costs (including
indirect costs) incurred by the Federal Government in furnishing
the additional services referred to in subparagraph (A).
‘‘(4) All administration fees and additional services fees collected
pursuant to this subsection shall be deposited in the general fund
of the Treasury of the United States as miscellaneous receipts.’’.
(2) MANDATORY STATE SUPPLEMENTARY PAYMENTS.—Section
212(b)(3) of Public Law 93–66 (42 U.S.C. 1382 note) is
amended—
(A) by inserting ‘‘(A)’’ after ‘‘(3)’’;
(B) by inserting ‘‘, plus an administration fee assessed
in accordance with subparagraph (B) and any additional
services fee charged in accordance with subparagraph (C)’’
before the period; and
(C) by adding after and below the end the following:
‘‘(B)(i) The Secretary shall assess each State an administration
fee in an amount equal to—
‘‘(I) the number of supplementary payments made by the
Secretary on behalf of the State under this subsection for
any month in a fiscal year; multiplied by
‘‘(II) the applicable rate for the fiscal year.
‘‘(ii) As used in clause (i), the term ‘applicable rate’ means—
‘‘(I) for fiscal year 1994, $1.67;
‘‘(II) for fiscal year 1995, $3.33;
‘‘(III) for fiscal year 1996, $5.00; and
‘‘(IV) for fiscal year 1997 and each succeeding fiscal year,
$5.00, or such different rate as the Secretary determines is
appropriate for the State, taking into account the complexity
of administering the State’s supplementary payment program.
‘‘(iii) Upon making a determination under clause (ii)(IV), the
Secretary shall promulgate the determination in regulations, which
may take into account the complexity of administering the State’s
supplementary payment program.
‘‘(iv) All fees assessed pursuant to this subparagraph shall
be transferred to the Secretary at the same time that amounts
for such supplementary payments are required to be so transferred.
‘‘(C)(i) The Secretary may charge a State an additional services
fee if, at the request of the State, the Secretary provides additional
services beyond the level customarily provided, in the administra-
tion of State supplementary payments pursuant to this subsection.
‘‘(ii) The additional services fee shall be in an amount that
the Secretary determines is necessary to cover all costs (including
indirect costs) incurred by the Federal Government in furnishing
the additional services referred to in clause (i).
‘‘(D) All administration fees and additional services fees col-
lected pursuant to this paragraph shall be deposited in the general
fund of the Treasury of the United States as miscellaneous
receipts.’’.
(b) EFFECTIVE DATE.—The amendments made by this section
shall apply to supplementary payments made pursuant to section
1616(a) of the Social Security Act or section 212(a) of Public Law
93–66 for any calendar month beginning after September 30, 1993,
and to services furnished after such date, regardless of whether
regulations to implement such amendments have been promulgated
by such date, or whether any agreement entered into under such
section 1616(a) or such section 212(a) has been modified.
H. R. 2264—351
SEC. 13732. EXCLUSION FROM INCOME AND RESOURCES OF STATE
RELOCATION ASSISTANCE.
Section 5035(c) of the Omnibus Budget Reconciliation Act of
1990 (42 U.S.C. 1382a note; 104 Stat. 1388–225) is amended by
striking ‘‘in the 3-year period that begins on’’ and inserting ‘‘on
or after’’.
SEC. 13733. PREVENTION OF ADVERSE EFFECTS ON ELIGIBILITY FOR,
AND AMOUNT OF, BENEFITS WHEN SPOUSE OR PARENT
OF BENEFICIARY IS ABSENT FROM THE HOUSEHOLD
DUE TO ACTIVE MILITARY SERVICE.
(a) ABSENT PERSON GENERALLY DEEMED TO BE LIVING IN THE
HOUSEHOLD.—Section 1614(f) (42 U.S.C. 1382c(f)) is amended by
adding at the end the following:
‘‘(4) For purposes of paragraphs (1) and (2), a spouse or parent
(or spouse of such a parent) who is absent from the household
in which the individual lives due solely to a duty assignment
as a member of the Armed Forces on active duty shall, in the
absence of evidence to the contrary, be deemed to be living in
the same household as the individual.’’.
(b) EXCLUSION FROM INCOME OF HOSTILE FIRE PAY RECEIVED
WHILE IN ACTIVE MILITARY SERVICE.—Section 1612(b) (42 U.S.C.
1382a(b)) is amended—
(1) in paragraph (18), by striking ‘‘and’’ the 2nd place
such term appears;
(2) in paragraph (19), by striking the period and inserting
‘‘; and’’; and
(3) by adding at the end the following:
‘‘(20) special pay received pursuant to section 310 of title
37, United States Code.’’.
(c) EFFECTIVE DATE.—The amendments made by this section
shall take effect on the 1st day of the 2nd month that begins
after the date of the enactment of this Act.
SEC. 13734. ELIGIBILITY FOR CHILDREN OF ARMED FORCES PERSON-
NEL RESIDING OUTSIDE THE UNITED STATES OTHER
THAN IN FOREIGN COUNTRIES.
(a) 
IN
GENERAL.—Section 
1614(a)(1)(B)(ii) 
(42 
U.S.C.
1382c(a)(1)(B)(ii)) is amended by striking ‘‘the District of Columbia’’
and all that follows to the period and inserting ‘‘and who, for
the month before the parent reported for such assignment, received
a benefit under this title’’.
(b) EFFECTIVE DATE.—The amendment made by subsection (a)
shall take effect on the 1st day of the 3rd month that begins
after the date of the enactment of this Act.
SEC. 13735. VALUATION OF CERTAIN IN-KIND SUPPORT AND MAINTE-
NANCE WHEN THERE IS A COST OF LIVING ADJUSTMENT
IN BENEFITS.
(a) IN
GENERAL.—Section 1611(c) (42 U.S.C. 1382(c)) is
amended—
(1) in paragraph (1), by striking ‘‘and (5)’’ and inserting
‘‘(5), and (6)’’; and
(2) by redesignating paragraphs (6) and (7) as paragraphs
(7) and (8), respectively; and
(3) by inserting after paragraph (5) the following:
‘‘(6) The dollar amount in effect under subsection (b) as a
result of any increase in benefits under this title by reason of
H. R. 2264—352
section 1617 shall be used to determine the value of any in-kind
support and maintenance required to be taken into account in
determining the benefit payable under this title to an individual
(and the eligible spouse, if any, of the individual) for the 1st 2
months for which the increase in benefits applies.’’.
(b) EFFECTIVE DATE.—The amendments made by subsection
(a) shall apply to benefits paid for months after the calendar year
1994.
SEC. 13736. EXCLUSION 
FROM 
INCOME 
OF 
CERTAIN 
AMOUNTS
RECEIVED BY INDIANS FROM INTERESTS HELD IN
TRUST.
(a) IN GENERAL.—Section 8 of the Act of October 19, 1973,
(25 U.S.C. 1408) is amended by inserting ‘‘, and up to $2,000
per year of income received by individual Indians that is derived
from such interests shall not be considered income,’’ after ‘‘resource’’.
(b) EFFECTIVE DATE.—The amendment made by this section
shall take effect on January 1, 1994.
PART IV—AID TO FAMILIES WITH DEPENDENT
CHILDREN
SEC. 13741. 50 PERCENT FEDERAL MATCH OF STATE ADMINISTRATIVE
COSTS.
(a) AFDC MATCHING.—Section 403(a)(3) (42 U.S.C. 603(a)(3))
is amended to read as follows:
‘‘(3) in the case of any State, 50 percent of the total amounts
expended during such quarter as found necessary by the Sec-
retary for the proper and efficient administration of the State
plan, except that no payment shall be made with respect to
amounts expended in connection with the provision of any
service described in section 2002(a) other than services fur-
nished pursuant to section 402(g); and’’.
(b) TERRITORIAL PROGRAMS FOR AGED, BLIND, AND DISABLED.—
Sections 3(a)(4), 1003(a)(3), 1403(a)(3), and 1603(a)(4) (42 U.S.C.
303(a)(3), 1203(a)(3), 1353(a)(3), and 1383 note) (as in effect as
provided by section 303 of the Social Security Amendments of
1972) are each amended by striking ‘‘the sum of’’ and all that
follows and inserting ‘‘50 percent of the total amounts expended
during such quarter as found necessary by the Secretary for the
proper and efficient administration of the State plan.’’.
(c) EFFECTIVE DATES.—
(1) IN GENERAL.—Except as provided in paragraph (2) of
this subsection, the amendments made by subsections (a) and
(b) shall be effective with respect to calendar quarters beginning
on or after April 1, 1994.
(2) SPECIAL RULE.—In the case of a State whose legislature
meets biennially, and does not have a regular session scheduled
in calendar year 1994, the amendments made by subsections
(a) and (b) shall be effective no later than the first day of
the first calendar quarter beginning after the close of the first
regular session of the State legislature that begins after the
date of enactment of this Act.
SEC. 13742. INCREASE IN STEPPARENT INCOME DISREGARD.
(a) IN GENERAL.—Section 402(a)(31) (42 U.S.C. 602(a)(31)) is
amended by striking ‘‘$75’’ and inserting ‘‘$90’’.
H. R. 2264—353
(b) EFFECTIVE DATE.—The amendment made by subsection (a)
shall take effect on October 1, 1993, and shall apply to payments
under part A of title IV of the Social Security Act for fiscal year
1994 and such payments for succeeding fiscal years.
PART V—UNEMPLOYMENT INSURANCE
SEC. 13751. EXTENSION OF CURRENT FEDERAL UNEMPLOYMENT
RATE.
Section 3301 of the Internal Revenue Code of 1986 is
amended—
(1) by striking ‘‘1996’’ in paragraph (1) and inserting ‘‘1998’’,
and
(2) by striking ‘‘1997’’ in paragraph (2) and inserting ‘‘1999’’.
PART 
VI—SOCIAL 
SERVICES 
IN 
EM-
POWERMENT ZONES AND ENTERPRISE COM-
MUNITIES
SEC. 13761. INCREASE IN BLOCK GRANTS TO STATES FOR SOCIAL
SERVICES.
Title XX (42 U.S.C. 1397–1397e) is amended by adding at
the end the following:
‘‘SEC. 2007. ADDITIONAL GRANTS.
‘‘(a) ENTITLEMENT.—
‘‘(1) IN GENERAL.—In addition to any payment under section
2002, each State shall be entitled to—
‘‘(A) 2 grants under this section for each qualified
empowerment zone in the State; and
‘‘(B) 1 grant under this section for each qualified enter-
prise community in the State.
‘‘(2) AMOUNT OF GRANTS.—
‘‘(A) EMPOWERMENT
GRANTS.—The amount of each
grant to a State under this section for a qualified
empowerment zone shall be—
‘‘(i) if the zone is designated in an urban area,
$50,000,000, multiplied by that proportion of the popu-
lation of the zone that resides in the State; or
‘‘(ii) if the zone is designated in a rural area,
$20,000,000, multiplied by such proportion.
‘‘(B) ENTERPRISE GRANTS.—The amount of the grant
to a State under this section for a qualified enterprise
community shall be 1⁄95 of $280,000,000, multiplied by that
proportion of the population of the community that resides
in the State.
‘‘(C) POPULATION
DETERMINATIONS.—The Secretary
shall make population determinations for purposes of this
paragraph based on the most recent decennial census data
available.
‘‘(3) TIMING OF GRANTS.—
‘‘(A) QUALIFIED EMPOWERMENT ZONES.—With respect
to each qualified empowerment zone, the Secretary shall
make—
‘‘(i) 1 grant under this section to each State in
which the zone lies, on the date of the designation
H. R. 2264—354
of the zone under part I of subchapter U of chapter
1 of the Internal Revenue Code of 1986; and
‘‘(ii) 1 grant under this section to each such State,
on the 1st day of the 1st fiscal year that begins after
the date of the designation.
‘‘(B) 
QUALIFIED
ENTERPRISE
COMMUNITIES.—With
respect to each qualified enterprise community, the Sec-
retary shall make 1 grant under this section to each State
in which the community lies, on the date of the designation
of the community under part I of subchapter U of chapter
1 of the Internal Revenue Code of 1986.
‘‘(4) FUNDING.—$1,000,000,000 shall be made available to
the Secretary for grants under this section.
‘‘(b) PROGRAM OPTIONS.—Notwithstanding section 2005(a):
‘‘(1) In order to prevent and remedy the neglect and abuse
of children, a State may use amounts paid under this section
to make grants to, or enter into contracts with, entities to
provide residential or nonresidential drug and alcohol preven-
tion and treatment programs that offer comprehensive services
for pregnant women and mothers, and their children.
‘‘(2) In order to assist disadvantaged adults and youths
in achieving and maintaining self-sufficiency, a State may use
amounts paid under this section to make grants to, or enter
into contracts with—
‘‘(A) organizations operated for profit or not for profit,
for the purpose of training and employing disadvantaged
adults and youths in construction, rehabilitation, or
improvement of affordable housing, public infrastructure,
and community facilities; and
‘‘(B) nonprofit organizations and community or junior
colleges, for the purpose of enabling such entities to provide
short-term training courses in entrepreneurism and self-
employment, and other training that will promote individ-
ual self-sufficiency and the interests of the community.
‘‘(3) A State may use amounts paid under this section
to make grants to, or enter into contracts with, nonprofit
community-based organizations to enable such organizations
to provide activities designed to promote and protect the
interests of children and families, outside of school hours,
including keeping schools open during evenings and weekends
for mentoring and study.
‘‘(4) In order to assist disadvantaged adults and youths
in achieving and maintaining economic self-support, a State
may use amounts paid under this section to—
‘‘(A) fund services designed to promote community and
economic development in qualified empowerment zones and
qualified enterprise communities, such as skills training,
job counseling, transportation services, housing counseling,
financial management, and business counseling;
‘‘(B) assist in emergency and transitional shelter for
disadvantaged families and individuals; or
‘‘(C) support programs that promote home ownership,
education, or other routes to economic independence for
low-income families and individuals.
‘‘(c) USE OF GRANTS.—
H. R. 2264—355
‘‘(1) IN GENERAL.—Subject to subsection (d) of this section,
each State that receives a grant under this section with respect
to an area shall use the grant—
‘‘(A) for services directed only at the goals set forth
in paragraphs (1), (2), and (3) of section 2001;
‘‘(B) in accordance with the strategic plan for the area;
and
‘‘(C) for activities that benefit residents of the area
for which the grant is made.
‘‘(2) TECHNICAL ASSISTANCE.—A State may use a portion
of any grant made under this section in the manner described
in section 2002(e).
‘‘(d) REMITTANCE OF CERTAIN AMOUNTS.—
‘‘(1) PORTION OF GRANT UPON TERMINATION OF DESIGNA-
TION.—Each State to which an amount is paid under this
subsection during a fiscal year with respect to an area the
designation of which under part I of subchapter U of chapter
1 of the Internal Revenue Code of 1986 ends before the end
of the fiscal year shall remit to the Secretary an amount equal
to the total of the amounts so paid with respect to the area,
multiplied by that proportion of the fiscal year remaining after
the designation ends.
‘‘(2) AMOUNTS PAID TO THE STATES AND NOT OBLIGATED
WITHIN 2 YEARS.—Each State shall remit to the Secretary any
amount paid to the State under this section that is not obligated
by the end of the 2-year period that begins with the date
of the payment.
‘‘(e) DEFINITIONS.—As used in this section:
‘‘(1) QUALIFIED EMPOWERMENT ZONE.—The term ‘qualified
empowerment zone’ means, with respect to a State, an area—
‘‘(A) which has been designated (other than by the
Secretary of the Interior) as an empowerment zone under
part I of subchapter U of chapter 1 of the Internal Revenue
Code of 1986;
‘‘(B) with respect to which the designation is in effect;
‘‘(C) the strategic plan for which is a qualified plan;
and
‘‘(D) part or all of which is in the State.
‘‘(2) QUALIFIED ENTERPRISE COMMUNITY.—The term ‘quali-
fied enterprise community’ means, with respect to a State,
an area—
‘‘(A) which has been designated (other than by the
Secretary of the Interior) as an enterprise community under
part I of subchapter U of chapter 1 of the Internal Revenue
Code of 1986;
‘‘(B) with respect to which the designation is in effect;
‘‘(C) the strategic plan for which is a qualified plan;
and
‘‘(D) part or all of which is in the State.
‘‘(3) STRATEGIC
PLAN.—The term ‘strategic plan’ means,
with respect to an area, the plan contained in the application
for designation of the area under part I of subchapter U of
chapter 1 of the Internal Revenue Code of 1986.
‘‘(4) QUALIFIED
PLAN.—The term ‘qualified plan’ means,
with respect to an area, a plan that—
H. R. 2264—356
‘‘(A) includes a detailed description of the activities
proposed for the area that are to be funded with amounts
provided under this section;
‘‘(B) contains a commitment that the amounts provided
under this section to any State for the area will not be
used to supplant Federal or non-Federal funds for services
and activities which promote the purposes of this section;
‘‘(C) was developed in cooperation with the local govern-
ment or governments with jurisdiction over the area; and
‘‘(D) to the extent that any State will not use the
amounts provided under this section for the area in the
manner described in subsection (b), explains the reasons
why not.
‘‘(5) RURAL AREA.—The term ‘rural area’ has the meaning
given such term in section 1393(a)(2) of the Internal Revenue
Code of 1986.
‘‘(6) URBAN AREA.—The term ‘urban area’ has the meaning
given such term in section 1393(a)(3) of the Internal Revenue
Code of 1986.’’.
Subchapter D—Customs and Trade Provisions
SEC. 13800. TABLE OF CONTENTS.
SUBCHAPTER D—CUSTOMS AND TRADE PROVISIONS
Sec. 13800. Table of contents.
PART I—EXTENSION OF CUSTOMS USER FEE, GSP, AND TRADE ADJUSTMENT
ASSISTANCE PROGRAMS
Sec. 13801. Extension of authority to levy customs user fees.
Sec. 13802. Generalized system of preferences.
Sec. 13803. Extension of trade adjustment assistance program.
PART II—CUSTOMS OFFICER PAY REFORM
Sec. 13811. Overtime and premium pay for customs officers.
Sec. 13812. Additional benefits for customs officers.
Sec. 13813. Reimbursements from the customs user fee account.
PART I—EXTENSION OF CUSTOMS USER FEE,
GSP, AND TRADE ADJUSTMENT ASSISTANCE
PROGRAMS
SEC. 13801. EXTENSION OF AUTHORITY TO LEVY CUSTOMS USER FEES.
Section 13031(j)(3) of the Consolidated Omnibus Budget Rec-
onciliation Act of 1985 (19 U.S.C. 58c(j)(3)) is amended by striking
out ‘‘1995’’ and inserting ‘‘1998’’.
SEC. 13802. GENERALIZED SYSTEM OF PREFERENCES.
(a) TREATMENT OF COUNTRIES FORMERLY WITHIN THE UNION
OF SOVIET SOCIALIST REPUBLICS.—The table in section 502(b) of
the Trade Act of 1974 (19 U.S.C. 2462(b)) is amended by striking
out ‘‘Union of Soviet Socialist Republics’’.
(b) EXTENSION OF DUTY-FREE TREATMENT UNDER SYSTEM.—
(1) IN GENERAL.—Section 505(a) of the Trade Act of 1974
(19 U.S.C. 2465(a)) is amended by striking out ‘‘July 4, 1993’’
and inserting ‘‘September 30, 1994’’.
(2) RETROACTIVE APPLICATION FOR CERTAIN LIQUIDATIONS
AND RELIQUIDATIONS.—Notwithstanding section 514 of the Tar-
H. R. 2264—357
iff Act of 1930 or any other provision of law, upon proper
request filed with the appropriate customs officer within 180
days after the date of the enactment of this Act, the entry—
(A) of any article to which duty-free treatment under
title V of the Trade Act of 1974 would have applied if
the entry had been made on July 4, 1993, and
(B) that was made after July 4, 1993, and before such
date of enactment,
shall be liquidated or reliquidated as free of duty, and the
Secretary of the Treasury shall refund any duty paid with
respect to such entry. As used in this paragraph, the term
‘‘entry’’ includes a withdrawal from warehouse for consumption.
SEC. 13803. EXTENSION OF TRADE ADJUSTMENT ASSISTANCE PRO-
GRAM.
(a) EXTENSION.—
(1) Section 285 of the Trade Act of 1974 (19 U.S.C. 2271,
preceding note) is amended—
(A) by striking ‘‘No’’ and all that follows through ‘‘and
no duty’’ in subsection (b) and inserting ‘‘No duty’’; and
(B) by adding at the end the following new subsection:
‘‘(c) No assistance, vouchers, allowances, or other payments
may be provided under chapter 2, and no technical assistance
may be provided under chapter 3, after September 30, 1998.’’.
(2) Sections 245 and 256(b) of the Trade Act of 1974 (19
U.S.C. 2317 and 2346(b)) are each amended by striking ‘‘1988,
1989, 1990, 1991, 1992, and 1993’’ and inserting ‘‘1993, 1994,
1995, 1996, 1997, and 1998’’.
(b) TRAINING.—Section 236(a)(2)(A) of the Trade Act of 1974
(19 U.S.C. 2296(a)(2)(A)) is amended by inserting before the end
period ‘‘, except that for fiscal year 1997, the total amount of
payments made under paragraph (1) shall not exceed $70,000,000’’.
PART II—CUSTOMS OFFICER PAY REFORM
SEC. 13811. OVERTIME AND PREMIUM PAY FOR CUSTOMS OFFICERS.
(a) IN GENERAL.—Section 5 of the Act of February 13, 1911
(19 U.S.C. 261 and 267) is amended to read as follows:
‘‘SEC. 5. OVERTIME AND PREMIUM PAY FOR CUSTOMS OFFICERS.
‘‘(a) OVERTIME PAY.—
‘‘(1) IN GENERAL.—Subject to paragraph (2) and subsection
(c), a customs officer who is officially assigned to perform work
in excess of 40 hours in the administrative workweek of the
officer or in excess of 8 hours in a day shall be compensated
for that work at an hourly rate of pay that is equal to 2
times the hourly rate of the basic pay of the officer. For purposes
of this paragraph, the hourly rate of basic pay for a customs
officer does not include any premium pay provided for under
subsection (b).
‘‘(2) SPECIAL PROVISIONS RELATING TO OVERTIME WORK ON
CALLBACK BASIS.—
‘‘(A) MINIMUM DURATION.—Any work for which com-
pensation is authorized under paragraph (1) and for which
the customs officer is required to return to the officer’s
place of work shall be treated as being not less than 2
hours in duration; but only if such work begins at least
1 hour after the end of any previous regularly scheduled
H. R. 2264—358
work assignment and ends at least 1 hour before the begin-
ning of the following regularly scheduled work assignment.
‘‘(B) COMPENSATION FOR COMMUTING TIME.—
‘‘(i) IN
GENERAL.—Except as provided in clause
(ii), in addition to the compensation authorized under
paragraph (1) for work to which subparagraph (A)
applies, the customs officer is entitled to be paid, as
compensation for commuting time, an amount equal
to 3 times the hourly rate of basic pay of the officer.
‘‘(ii) EXCEPTION.—Compensation for commuting
time is not payable under clause (i) if the work for
which compensation is authorized under paragraph
(1)—
‘‘(I) does not commence within 16 hours of
the customs officer’s last regularly scheduled work
assignment, or
‘‘(II) commences within 2 hours of the next
regularly scheduled work assignment of the cus-
toms officer.
‘‘(b) PREMIUM PAY FOR CUSTOMS OFFICERS.—
‘‘(1) NIGHT WORK DIFFERENTIAL.—
‘‘(A) 3 P.M. TO MIDNIGHT SHIFTWORK.—If the majority
of the hours of regularly scheduled work of a customs
officer occurs during the period beginning at 3 p.m. and
ending at 12 a.m., the officer is entitled to pay for work
during such period (except for work to which paragraph
(2) or (3) applies) at the officer’s hourly rate of basic pay
plus premium pay amounting to 15 percent of that basic
rate.
‘‘(B) 11 P.M. TO 8 A.M. SHIFTWORK.—If the majority
of the hours of regularly scheduled work of a customs
officer occurs during the period beginning at 11 p.m. and
ending at 8 a.m., the officer is entitled to pay for work
during such period (except for work to which paragraph
(2) or (3) applies) at the officer’s hourly rate of basic pay
plus premium pay amounting to 20 percent of that basic
rate.
‘‘(C) 7:30 P.M. TO 3:30 A.M. SHIFTWORK.—If the regularly
scheduled work assignment of a customs officer is 7:30
p.m. to 3:30 a.m., the officer is entitled to pay for work
during such period (except for work to which paragraph
(2) or (3) applies) at the officer’s hourly rate of basic pay
plus premium pay amounting to 15 percent of that basic
rate for the period from 7:30 p.m. to 11:30 p.m. and at
the officer’s hourly rate of basic pay plus premium pay
amounting to 20 percent of that basic rate for the period
from 11:30 p.m. to 3:30 a.m.
‘‘(2) SUNDAY
DIFFERENTIAL.—A customs officer who per-
forms any regularly scheduled work on a Sunday that is not
a holiday is entitled to pay for that work at the officer’s hourly
rate of basic pay plus premium pay amounting to 50 percent
of that basic rate.
‘‘(3) HOLIDAY DIFFERENTIAL.—A customs officer who per-
forms any regularly scheduled work on a holiday is entitled
to pay for that work at the officer’s hourly rate of basic pay
plus premium pay amounting to 100 percent of that basic
rate.
H. R. 2264—359
‘‘(4) TREATMENT OF PREMIUM PAY.—Premium pay provided
for under this subsection may not be treated as being overtime
pay or compensation for any purpose.
‘‘(c) LIMITATIONS.—
‘‘(1) FISCAL
YEAR
CAP.—The aggregate of overtime pay
under subsection (a) (including commuting compensation under
subsection (a)(2)(B)) and premium pay under subsection (b)
that a customs officer may be paid in any fiscal year may
not exceed $25,000; except that the Commissioner of Customs
or his designee may waive this limitation in individual cases
in order to prevent excessive costs or to meet emergency
requirements of the Customs Service.
‘‘(2) EXCLUSIVITY OF PAY UNDER THIS SECTION.—A customs
officer who receives overtime pay under subsection (a) or pre-
mium pay under subsection (b) for time worked may not receive
pay or other compensation for that work under any other provi-
sion of law.
‘‘(d) REGULATIONS.—The Secretary of the Treasury shall
promulgate regulations to prevent—
‘‘(1) abuse of callback work assignments and commuting
time compensation authorized under subsection (a)(2); and
‘‘(2) the disproportionately more frequent assignment of
overtime work to customs officers who are near to retirement.
‘‘(e) DEFINITIONS.—As used in this section:
‘‘(1) The term ‘customs officer’ means an individual perform-
ing those functions specified by regulation by the Secretary
of the Treasury for a customs inspector or canine enforcement
officer. Such functions shall be consistent with such applicable
standards as may be promulgated by the Office of Personnel
Management.
‘‘(2) The term ‘holiday’ means any day designated as a
holiday under a Federal statute or Executive order.’’.
(b) NECESSARY CONFORMING AMENDMENTS.—
(1) Section 2 of the Act of June 3, 1944 (19 U.S.C. 1451a),
is repealed.
(2) Section 450 of the Tariff Act of 1930 (19 U.S.C. 1450)
is amended—
(A) by striking out ‘‘at night’’ in the section heading
and inserting ‘‘during overtime hours’’;
(B) by striking out ‘‘at night’’ and inserting ‘‘during
overtime hours’’; and
(C) by inserting ‘‘aircraft,’’ immediately before ‘‘vessel’’.
(c) EFFECTIVE DATE.—The amendments made by subsections
(a) and (b) apply to customs inspectional services provided on or
after January 1, 1994.
SEC. 13812. ADDITIONAL BENEFITS FOR CUSTOMS OFFICERS.
(a) TREATMENT OF CERTAIN PAY FOR RETIREMENT PURPOSES.—
Section 8331(3) of title 5, United States Code, is amended—
(1) by striking out ‘‘and’’ at the end of subparagraph (C);
(2) by striking out the semicolon at the end of subparagraph
(D) and inserting ‘‘; and’’;
(3) by adding after subparagraph (D) the following:
‘‘(E) with respect to a customs officer (referred to in
subsection (e)(1) of section 5 of the Act of February 13,
1911), compensation for overtime inspectional services pro-
vided for under subsection (a) of such section 5, but not
H. R. 2264—360
to exceed 50 percent of any statutory maximum in overtime
pay for customs officers which is in effect for the year
involved;’’; and
(4) by striking out ‘‘subparagraphs (B), (C), and (D) of
this paragraph,’’ and inserting ‘‘subparagraphs (B), (C), (D),
and (E) of this paragraph’’.
(b) FOREIGN LANGUAGE PROFICIENCY AWARDS.—Cash awards
for foreign language proficiency may, under regulations prescribed
by the Secretary of the Treasury, be paid to customs officers (as
referred to in section 5(e)(1) of the Act of February 13, 1911)
to the same extent and in the same manner as would be allowable
under subchapter III of chapter 45 of title 5, United States Code,
with respect to law enforcement officers (as defined by section
4521 of such title).
(c) EFFECTIVE DATES.—
(1) SUBSECTION (a) AMENDMENTS.—The amendments made
by subsection (a) take effect on January 1, 1994, and apply
only with respect to service performed on or after such date.
(2) SUBSECTION (b).—Subsection (b) takes effect on January
1, 1994.
SEC. 13813. REIMBURSEMENTS 
FROM 
THE 
CUSTOMS 
USER 
FEE
ACCOUNT.
Section 13031(f)(3) of the Consolidated Omnibus Budget Rec-
onciliation Act of 1985 (19 U.S.C. 58c(f)(3)) is amended—
(1) by amending clause (i) of subparagraph (A) to read
as follows: ‘‘(i) in—
‘‘(I) paying overtime compensation under section 5(a)
of the Act of February 13, 1911,
‘‘(II) paying premium pay under section 5(b) of the
Act of February 13, 1911, but the amount for which
reimbursement may be made under this subclause may
not, for any fiscal year, exceed the difference between the
cost of the premium pay for that year calculated under
such section 5(b) as amended by section 13811 of the Omni-
bus Budget Reconciliation Act of 1993 and the cost of
such pay calculated under subchapter V of chapter 55
of title 5, United States Code,
‘‘(III) paying agency contributions to the Civil Service
Retirement and Disability Fund to match deductions from
the overtime compensation paid under subclause (I),
‘‘(IV) providing all preclearance services for which the
recipients of such services are not required to reimburse
the Secretary of the Treasury, and
‘‘(V) paying foreign language proficiency awards under
section 13812(b) of the Omnibus Budget Reconciliation Act
of 1993, and’’;
(2) by inserting before the flush sentence appearing after
clause (ii) of subparagraph (A) the following sentence: ‘‘The
transfer of funds required under subparagraph (C)(iii) has prior-
ity over reimbursements under this subparagraph to carry out
subclauses (II), (III), (IV), and (V) of clause (i).’’;
(3) by striking out ‘‘except for costs described in subpara-
graph (A)(i) (I) and (II),’’ in subparagraph (B)(i); and
(4) by amending subparagraph (C)—
H. R. 2264—361
(A) by striking out ‘‘to fully reimburse inspectional
overtime and preclearance costs’’ in clause (i) and inserting
‘‘to reimburse costs described in subparagraph (A)(i)’’; and
(B) by inserting after clause (ii) of subparagraph (C)
the following:
‘‘(iii) For each fiscal year, the Secretary of the Treasury
shall calculate the difference between—
‘‘(I) the estimated cost for overtime compensation that
would have been incurred during that fiscal year for
inspectional services if section 5 of the Act of February
13, 1911 (19 U.S.C. 261 and 267), as in effect before the
enactment of section 13811 of the Omnibus Budget Rec-
onciliation Act of 1993, had governed such costs, and
‘‘(II) the actual cost for overtime compensation, pre-
mium pay, and agency retirement contributions that is
incurred during that fiscal year in regard to inspectional
services under section 5 of the Act of February 13, 1911,
as amended by section 13811 of the Omnibus Budget Rec-
onciliation Act of 1993, and under section 8331(3) of title
5, United States Code, as amended by section 13812(a)(1)
of such Act of 1993, plus the actual cost that is incurred
during that fiscal year for foreign language proficiency
awards under section 13812(b) of such Act of 1993,
and shall transfer from the Customs User Fee Account to
the General Fund of the Treasury an amount equal to the
difference calculated under this clause, or $18,000,000, which-
ever amount is less. Transfers shall be made under this clause
at least quarterly and on the basis of estimates to the same
extent as are reimbursements under subparagraph (B)(iii).’’.
CHAPTER 3—FOOD STAMP PROGRAM
SEC. 13901. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This chapter may be cited as the ‘‘Mickey
Leland Childhood Hunger Relief Act’’.
(b) TABLE OF CONTENTS.—The table of contents of this chapter
is as follows:
CHAPTER 3—FOOD STAMP PROGRAM
Sec. 13901. Short title; table of contents.
Sec. 13902. References to Act.
SUBCHAPTER A—ENSURING ADEQUATE FOOD ASSISTANCE
Sec. 13911. Helping low-income high school students.
Sec. 13912. Families with high shelter expenses.
Sec. 13913. Resource exclusion for earned income tax credits.
Sec. 13914. Homeless families in transitional housing.
Sec. 13915. Households benefiting from general assistance vendor payments.
Sec. 13916. Continuing benefits to eligible households.
Sec. 13917. Improving the nutritional status of children in Puerto Rico.
SUBCHAPTER B—PROMOTING SELF-SUFFICIENCY
Sec. 13921. Child support payments to nonhousehold members.
Sec. 13922. Improving access to employment and training activities.
Sec. 13923. Vehicles needed to seek and continue employment and for household
transportation.
Sec. 13924. Vehicles necessary to carry fuel or water.
Sec. 13925. Testing resource accumulation.
SUBCHAPTER C—SIMPLIFYING THE PROVISION OF FOOD ASSISTANCE
Sec. 13931. Simplifying the household definition for households with children and
others.
H. R. 2264—362
Sec. 13932. Eligibility of children of parents participating in drug or alcohol treat-
ment programs.
SUBCHAPTER D—IMPROVING PROGRAM INTEGRITY
Sec. 13941. Additional means of claims collection.
Sec. 13942. Disqualification of recipients for trading firearms, ammunition, explo-
sives, or controlled substances for coupons.
Sec. 13943. Increased cap for civil money penalty for trafficking in coupons.
Sec. 13944. Increased cap for civil money penalty for selling firearms, ammunition,
explosives, or controlled substances for coupons.
SUBCHAPTER E—IMPROVING FOOD STAMP PROGRAM MANAGEMENT
Sec. 13951. Expedited claim collection; adjustments to error rate calculations.
SUBCHAPTER F—UNIFORM REIMBURSEMENT RATES
Sec. 13961. Uniform reimbursement rates.
Sec. 13962. Mandatory funding for nutrition programs.
SUBCHAPTER G—IMPLEMENTATION AND EFFECTIVE DATES
Sec. 13971. Implementation and effective dates.
SEC. 13902. REFERENCES TO THE ACT.
Except as otherwise provided in this chapter, references in
this chapter to ‘‘the Act’’ and sections of the Act shall be deemed
to be references to the Food Stamp Act of 1977 (7 U.S.C. 2011
et seq.) and the sections of such Act.
Subchapter A—Ensuring Adequate Food Assistance
SEC. 13911. HELPING LOW-INCOME HIGH SCHOOL STUDENTS.
Section 5(d)(7) of the Act (7 U.S.C. 2014(d)(7)) is amended
by striking ‘‘who is a student, and who has not attained his eight-
eenth birthday’’ and inserting ‘‘who is an elementary or secondary
school student, and who is 21 years of age or younger’’.
SEC. 13912. FAMILIES WITH HIGH SHELTER EXPENSES.
(a) COMPUTATION.—Section 5(e) of the Act (7 U.S.C. 2014(e))
is amended—
(1) in the fourth sentence by striking ‘‘: Provided, That
the amount’’ and all that follows through ‘‘June 30’’; and
(2) in the fifth sentence by striking ‘‘under clause (2) of
the preceding sentence’’.
(b) LIMITATIONS.—
(1) INTERIM CAPS.—Section 5(e) of the Act (7 U.S.C. 2014(e))
is amended by inserting after the fourth sentence the following:
‘‘In the 15-month period ending September 30, 1995, such excess
shelter expense deduction shall not exceed $231 a month in the
48 contiguous States and the District of Columbia, and shall not
exceed, in Alaska, Hawaii, Guam, and the Virgin Islands of the
United States, $402, $330, $280, and $171 a month, respectively.
In the 15-month period ending December 31, 1996, such excess
shelter expense deduction shall not exceed $247 a month in the
48 contiguous States and the District of Columbia, and shall not
exceed, in Alaska, Hawaii, Guam, and the Virgin Islands of the
United States, $429, $353, $300, and $182 a month, respectively.’’.
(2) SUBSEQUENT REMOVAL OF CAP.—Section 5(e) of the Act
(7 U.S.C. 2014(e)), as amended by paragraph (1), is amended
by striking the fifth and sixth sentences.
SEC. 13913. RESOURCE EXCLUSION FOR EARNED INCOME TAX CRED-
ITS.
Section 5(g)(3) of the Act (7 U.S.C. 2014(g)(3)) is amended
by adding at the end the following:
H. R. 2264—363
‘‘The Secretary shall also exclude from financial resources any
earned income tax credits received by any member of the household
for a period of 12 months from receipt if such member was partici-
pating in the food stamp program at the time the credits were
received and participated in such program continuously during
the 12-month period.’’.
SEC. 13914. HOMELESS FAMILIES IN TRANSITIONAL HOUSING.
Section 5(k)(2)(F) of the Act (7 U.S.C. 2014(k)(2)(F)) is amended
to read as follows:
‘‘(F) housing assistance payments made to a third party
on behalf of the household residing in transitional housing
for the homeless;’’.
SEC. 13915. HOUSEHOLDS BENEFITING FROM GENERAL ASSISTANCE
VENDOR PAYMENTS.
Section 5(k)(1)(B) of the Act (7 U.S.C. 2014(k)(1)(B)) is amended
by striking ‘‘living expenses’’ and inserting ‘‘housing expenses, not
including energy or utility-cost assistance,’’.
SEC. 13916. CONTINUING BENEFITS TO ELIGIBLE HOUSEHOLDS.
Section 8(c)(2)(B) of the Act (7 U.S.C. 2017(c)(2)(B)) is amended
by inserting ‘‘of more than one month in’’ after ‘‘following any
period’’.
SEC. 13917. IMPROVING THE NUTRITIONAL STATUS OF CHILDREN IN
PUERTO RICO.
Section 19(a)(1)(A) of the Act (7 U.S.C. 2028(a)(1)(A)) is
amended—
(1) 
by 
striking 
‘‘$1,091,000,000’’ 
and 
inserting
‘‘$1,097,000,000’’; and
(2) 
by 
striking 
‘‘$1,133,000,000’’ 
and 
inserting
‘‘$1,143,000,000’’.
Subchapter B—Promoting Self-Sufficiency
SEC. 13921. CHILD SUPPORT PAYMENTS TO NON-HOUSEHOLD MEM-
BERS.
Section 5(e) of the Act (7 U.S.C. 2014(e)) is amended by adding
at the end the following:
‘‘Before determining the excess shelter expense deduction, all house-
holds shall be entitled to a deduction for child support payments
made by a household member to or for an individual who is not
a member of the household if such household member was legally
obligated to make such payments, except that the Secretary is
authorized to prescribe by regulation the methods, including calcula-
tion on a retrospective basis, that State agencies shall use to deter-
mine the amount of the deduction for child support payments.’’.
SEC. 13922. IMPROVING ACCESS TO EMPLOYMENT AND TRAINING
ACTIVITIES.
(a) DEPENDENT CARE DEDUCTION.—Section 5(e) of the Act (7
U.S.C. 2014(e)) is amended in clause (1) of the fourth sentence—
(1) by striking ‘‘$160 a month for each dependent’’ and
inserting ‘‘$200 a month for each dependent child under 2
years of age and $175 a month for each other dependent’’;
and
(2) by striking ‘‘, regardless of the dependent’s age,’’.
H. R. 2264—364
(b) REIMBURSEMENTS TO PARTICIPANTS IN EMPLOYMENT AND
TRAINING PROGRAMS.—Section 6(d)(4)(I)(i)(II) of the Act (7 U.S.C.
2015(d)(4)(I)(i)(II)) is amended to read as follows:
‘‘(II) the actual costs of such dependent care expenses that
are determined by the State agency to be necessary for the
participation of an individual in the program (other than an
individual who is the caretaker relative of a dependent in
a family receiving benefits under part A of title IV of the
Social Security Act (42 U.S.C. 601 et seq.) in a local area
where an employment, training, or education program under
title IV of such Act is in operation, or was in operation, on
the date of enactment of the Hunger Prevention Act of 1988)
up to any limit set by the State agency (which limit shall
not be less than the limit for the dependent care deduction
under section 5(e)), but in no event shall such payment or
reimbursements exceed the applicable local market rate as
determined by procedures consistent with any such determina-
tion under the Social Security Act. Individuals subject to the
program under this paragraph may not be required to partici-
pate if dependent costs exceed the limit established by the
State agency under this subclause or other actual costs exceed
any limit established under subclause (I).’’.
(c) CONFORMING AMENDMENT.—Section 16(h)(3) of the Act (7
U.S.C. 2025(h)(3)) is amended by striking ‘‘representing $160 per
month per dependent’’ and inserting ‘‘equal to the payment made
under section 6(d)(4)(I)(i)(II) but not more than the applicable local
market rate,’’.
SEC. 13923. VEHICLES NEEDED TO SEEK AND CONTINUE EMPLOY-
MENT AND FOR HOUSEHOLD TRANSPORTATION.
Section 5(g)(2) of the Act (7 U.S.C. 2014(g)(2)) is amended
by striking ‘‘$4,500’’ and inserting the following:
‘‘a level set by the Secretary, which shall be $4,500 through August
31, 1994, $4,550 beginning September 1, 1994, through September
30, 1995, $4,600 beginning October 1, 1995, through September
30, 1996, and $5,000 beginning October 1, 1996, as adjusted on
such date and on each October 1 thereafter to reflect changes
in the new car component of the Consumer Price Index for All
Urban Consumers published by the Bureau of Labor Statistics
for the 12-month period ending on June 30 preceding the date
of such adjustment and rounded to the nearest $50’’.
SEC. 13924. VEHICLES NECESSARY TO CARRY FUEL OR WATER.
Section 5(g)(2) of the Act (7 U.S.C. 2014(g)(2)) is amended
by adding at the end the following:
‘‘The Secretary shall exclude from financial resources the value
of a vehicle that a household depends upon to carry fuel for heating
or water for home use when such transported fuel or water is
the primary source of fuel or water for the household.’’.
SEC. 13925. TESTING RESOURCE ACCUMULATION.
Section 17 of the Act (7 U.S.C. 2026) is amended by adding
at the end the following:
‘‘(k) The Secretary shall conduct, under such terms and condi-
tions as the Secretary shall prescribe, for a period not to exceed
4 years, projects to test allowing not more than 11,000 eligible
households, in the aggregate, to accumulate resources up to $10,000
each (which shall be excluded from consideration as a resource)
H. R. 2264—365
for later expenditure for a purpose directly related to improving
the education, training, or employability (including self-employ-
ment) of household members, for the purchase of a home for the
household, for a change of the household’s residence, or for making
major repairs to the household’s home.’’.
Subchapter C—Simplifying the Provision of Food Assistance
SEC. 13931. SIMPLIFYING THE HOUSEHOLD DEFINITION FOR HOUSE-
HOLDS WITH CHILDREN AND OTHERS.
Section 3(i) of the Act (7 U.S.C. 2012(i)) is amended—
(1) in the first sentence—
(A) by striking ‘‘(2)’’ and inserting ‘‘or (2)’’;
(B) by striking ‘‘, or (3) a parent of minor children
and that parent’s children’’ and all that follows through
‘‘parents and children, or siblings, who live together’’, and
inserting the following:
‘‘. Spouses who live together, parents and their children 21
years of age or younger (who are not themselves parents living
with their children or married and living with their spouses)
who live together, and children (excluding foster children) under
18 years of age who live with and are under the parental
control of a person other than their parent together with the
person exercising parental control’’; and
(C) striking ‘‘, unless one of ’’ and all that follows
through ‘‘disabled member’’; and
(2) in the second sentence by striking ‘‘clause (1) of the
preceding sentence’’ and inserting ‘‘the preceding sentences’’.
SEC. 13932. ELIGIBILITY OF CHILDREN OF PARENTS PARTICIPATING
IN DRUG OR ALCOHOL ABUSE TREATMENT PROGRAMS.
Section 3 of the Act (7 U.S.C. 2012) is amended—
(1) in the last sentence of subsection (i) by inserting ‘‘,
together with their children,’’ after ‘‘narcotics addicts or alcohol-
ics’’; and
(2) in subsection (g)(5) by inserting ‘‘, and their children,’’
after ‘‘or alcoholics’’.
Subchapter D—Improving Program Integrity
SEC. 13941. ADDITIONAL MEANS OF CLAIMS COLLECTION.
(a) SAFEGUARDS.—Section 11(e)(8) of the Act (7 U.S.C.
2020(e)(8)) is amended—
(1) by striking ‘‘and (B)’’ and inserting ‘‘(B)’’; and
(2) by striking the semicolon at the end and inserting
the following:
‘‘, and (C) such safeguards shall not prevent the use by, or
disclosure of such information, to agencies of the Federal
Government (including the United States Postal Service) for
purposes of collecting the amount of an overissuance of coupons,
as determined under section 13(b) of this Act and excluding
claims arising from an error of the State agency, that has
not been recovered pursuant to such section, from Federal
pay (including salaries and pensions) as authorized pursuant
to section 5514 of title 5 of the United States Code;’’.
(b) RECOVERY.—Section 13 of the Act (7 U.S.C. 2022) is
amended by adding at the end the following:
H. R. 2264—366
‘‘(d) The amount of an overissuance of coupons as determined
under subsection (b) and except for claims arising from an error
of the State agency, that has not been recovered pursuant to such
subsection may be recovered from Federal pay (including salaries
and pensions) as authorized by section 5514 of title 5 of the United
States Code.’’.
SEC. 13942. DISQUALIFICATION OF RECIPIENTS FOR TRADING FIRE-
ARMS, AMMUNITION, EXPLOSIVES, OR CONTROLLED
SUBSTANCES FOR COUPONS.
Section 6(b)(1) of the Act (7 U.S.C. 2015(b)(1)) is amended
by striking subdivisions (ii) and (iii) and inserting the following:
‘‘(ii) for a period of 1 year upon—
‘‘(I) the second occasion of any such determination;
or
‘‘(II) the first occasion of a finding by a Federal, State,
or local court of the trading of a controlled substance (as
defined in section 102 of the Controlled Substances Act
(21 U.S.C. 802)) for coupons; and
‘‘(iii) permanently upon—
‘‘(I) the third occasion of any such determination;
‘‘(II) the second occasion of a finding by a Federal,
State, or local court of the trading of a controlled substance
(as defined in section 102 of the Controlled Substances
Act (21 U.S.C. 802)) for coupons; or
‘‘(III) the first occasion of a finding by a Federal, State,
or local court of the trading of firearms, ammunition, or
explosives for coupons.’’.
SEC. 13943. INCREASED 
CAP 
FOR 
CIVIL 
MONEY 
PENALTY 
FOR
TRAFFICKING IN COUPONS.
Section 12(b)(3)(B) of the Act (7 U.S.C. 2021(b)(3)(B)) is
amended by striking ‘‘during a 2-year period’’ and inserting ‘‘for
violations occurring during a single investigation’’.
SEC. 13944. INCREASED CAP FOR CIVIL MONEY PENALTY FOR SELL-
ING FIREARMS, AMMUNITION, EXPLOSIVES, OR CON-
TROLLED SUBSTANCES FOR COUPONS.
Section 12(b)(3)(C) of the Act (7 U.S.C. 2021(b)(3)(C)) is
amended—
(1) by striking ‘‘substances (as the term is’’ and inserting
‘‘substance (as’’; and
(2) by striking ‘‘during a 2-year period’’ and inserting ‘‘for
violations occurring during a single investigation’’.
Subchapter E—Improving Food Stamp Program
Management
SEC. 13951. EXPEDITED 
CLAIM 
COLLECTION; 
ADJUSTMENTS 
TO
ERROR RATE CALCULATIONS.
(a) COLLECTION AND DISPOSITION OF CLAIMS.—Section 13(a)(1)
of the Act (7 U.S.C. 2022(a)(1)) is amended—
(1) in the fifth sentence by striking ‘‘(after a determination
on any request for a waiver for good cause related to the
claim has been made by the Secretary)’’; and
(2) in the sixth sentence by striking ‘‘2 years’’ and inserting
‘‘1 year’’.
H. R. 2264—367
(b) ADMINISTRATIVE AND JUDICIAL REVIEW.—Section 14(a) of
the Act (7 U.S.C. 2023(a)) is amended—
(1) in the sixth sentence by inserting after ‘‘pursuant to
section 16(c)’’ the following: ‘‘(including determinations as to
whether there is good cause for not imposing all or a portion
of the penalty)’’; and
(2) by striking the last sentence.
(c) QUALITY CONTROL SYSTEM.—Section 16(c) of the Act (7
U.S.C. 2025(c)) is amended—
(1) in paragraph (1)(C)—
(A) by striking ‘‘payment error tolerance level’’ and
inserting ‘‘national performance measure’’; and
(B) by striking ‘‘equal to’’ and all that follows through
the first period and inserting the following: ‘‘equal to—
‘‘(i) the product of—
‘‘(I) the value of all allotments issued by the State
agency in the fiscal year; times
‘‘(II) the lesser of—
‘‘(aa) the ratio of—
‘‘(aaa) the amount by which the payment
error rate of the State agency for the fiscal
year exceeds the national performance meas-
ure for the fiscal year; to
‘‘(bbb) the national performance measure
for the fiscal year, or
‘‘(bb) 1; times
‘‘(III) the amount by which the payment error rate
of the State agency for the fiscal year exceeds the
national performance measure for the fiscal year.’’;
(2) in paragraph (3)(A) by striking ‘‘60 days (or 90 days
at the discretion of the Secretary)’’ and inserting ‘‘120 days’’;
(3) in paragraph (6) by striking ‘‘shall be used to establish’’
and all that follows through ‘‘level’’ the last place it appears;
and
(4) by adding at the end the following:
‘‘(8)(A) This paragraph applies to the determination of whether
a payment is due by a State agency for a fiscal year under para-
graph (1)(C).
‘‘(B) Not later than 180 days after the end of the fiscal year,
the case review and all arbitrations of State-Federal difference
cases shall be completed.
‘‘(C) Not later than 30 days thereafter, the Secretary shall—
‘‘(i) determine final error rates, the national average pay-
ment error rate, and the amounts of payment claimed against
State agencies; and
‘‘(ii) notify State agencies of the payment claims.
‘‘(D) A State agency desiring to appeal a payment claim deter-
mined under subparagraph (C) shall submit to an administrative
law judge—
‘‘(i) a notice of appeal, not later than 10 days after receiving
a notice of the claim; and
‘‘(ii) evidence in support of the appeal of the State agency,
not later than 60 days after receiving a notice of the claim.
‘‘(E) Not later than 60 days after a State agency submits
evidence in support of the appeal, the Secretary shall submit respon-
sive evidence to the administrative law judge to the extent such
evidence exists.