I
104TH CONGRESS
2D SESSION
H. R. 3787
To amend the Social Security Act to provide for a program of health
insurance for children under 13 years of age and for mothers-to-be.
IN THE HOUSE OF REPRESENTATIVES
JULY 11, 1996
Mr. GIBBONS (for himself, Mr. RANGEL, Mr. STARK, Mr. MILLER of Califor-
nia, Mr. LAFALCE, Mr. LANTOS, Mr. HILLIARD, and Ms. NORTON) intro-
duced the following bill; which was referred to the Committee on Ways
and Means, and in addition to the Committee on Commerce, for a period
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee
concerned
A BILL
To amend the Social Security Act to provide for a program
of health insurance for children under 13 years of age
and for mothers-to-be.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Healthy Start Act of
1996’’.
SEC. 2. HEALTH INSURANCE FOR CHILDREN AND MOTH-
ERS-TO-BE.
(a) IN GENERAL.—The Social Security Act is amend-
ed by adding at the end the following new title:
‘‘TITLE XXI—HEALTHY START
‘‘SEC. 2100. ESTABLISHMENT OF PROGRAM OF HEALTH IN-
SURANCE FOR CHILDREN AND MOTHERS-TO-
BE.
‘‘There is hereby established a program of health in-
surance for children under 13 years of age and mothers-
to-be.
‘‘PART A—ELIGIBILITY
‘‘SEC. 2101. GENERAL ELIGIBILITY.
‘‘(a) CHILDREN.—
‘‘(1) IN GENERAL.—Every individual—
‘‘(A) who is a child (as defined in para-
graph (2)),
‘‘(B) whose principal place of abode is in
the United States,
‘‘(C) who is a citizen or national of the
United States or a permanent resident alien (as
defined in subsection (d)), and
‘‘(D) who is not covered under a qualified
health plan (as defined in subsection (e)),
is, upon registration under section 2102, entitled to
benefits under this title as a child.
‘‘(2) CHILD DEFINED.—In this title, the term
‘child’ means an individual from birth until the end
of the month in which the individual attains 13
years of age.
‘‘(b) MOTHERS.—
‘‘(1) IN GENERAL.—Every woman—
‘‘(A) who is a pregnant woman (as defined
in paragraph (2)),
‘‘(B) whose principal place of abode is in
the United States,
‘‘(C) who is a citizen or national of the
United States or a permanent resident alien (as
defined in subsection (d)), and
‘‘(D) who is not covered under a qualified
health plan (as defined in subsection (e)),
is entitled to benefits under this title as a pregnant
woman.
‘‘(2) PREGNANT
WOMAN
DEFINED.—In this
title, the term ‘pregnant woman’ means a woman
during the period—
‘‘(A) beginning on the date she receives the
examination or test which forms the basis for
the certification of pregnancy under section
2102(b)(1), and
‘‘(B) ending on the last day of the month
in which the 60-day period (beginning on the
date of termination of the pregnancy) ends.
‘‘(c) PREGNANT CHILDREN.—In the case of an indi-
vidual who is entitled under this section to benefits under
this title as a child and as a pregnant woman, the individ-
ual is entitled to benefits as both.
‘‘(d) PERMANENT RESIDENT ALIEN DEFINED.—In
this section, the term ‘permanent resident alien’ means an
alien lawfully admitted for permanent residence or other-
wise permanently residing in the United States under
color of law, and includes an alien granted asylum under
section 208 of the Immigration and Nationality Act or
lawfully admitted as a temporary resident under section
210, 210A, or 245A of such Act.)
‘‘(e) QUALIFIED HEALTH PLAN.—In this section, the
term ‘qualified health plan’ means a plan of health insur-
ance or coverage, an employee welfare benefit plan that
provides health benefits, or other plan (other than under
this title) under Federal or State law that provides cov-
erage of benefits which the Secretary of Health and
Human Services determines is substantially equivalent to
the coverage of benefits provided under this title.
‘‘SEC. 2102. REGISTRATION; CERTIFICATION OF PREG-
NANCY.
‘‘(a) REGISTRATION OF CHILDREN.—
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a process for the registration of children at the
time of birth in the United States or at the time of
immigration into the United States or other acquisi-
tion of lawful permanent resident status in the Unit-
ed States.
‘‘(2) TRANSITIONAL REGISTRATION.—The Sec-
retary also shall establish a process for the registra-
tion of children born before the effective date of ben-
efits under this title.
‘‘(3) EFFECT OF FAILURE TO REGISTER.—The
failure of a child to be registered under this sub-
section shall not be considered to deny the child’s
entitlement to benefits under this title, but merely to
delay payment with respect to such benefits under
this title.
‘‘(b) CERTIFICATION OF PREGNANCY AND REGISTRA-
TION OF PREGNANT WOMEN.—
‘‘(1) CERTIFICATION OF PREGNANCY.—A cer-
tification of pregnancy for purposes of this title—
‘‘(A) may be made by a physician (or such
other qualified health professionals as the Sec-
‘‘(c) PREGNANT WOMEN.—With respect to an indi-
vidual entitled to benefits under this title as a pregnant
woman, the coverage period shall begin on the first date
(on or after the effective date of benefits under this title)
on which the individual meets the requirements for such
entitlement under section 2101(b) and shall end on the
day before the first month in which the individual no
longer meets such requirements.
‘‘PART B—BENEFITS
‘‘SEC. 2111. SCOPE OF BENEFITS FOR CHILDREN.
‘‘(a) IN GENERAL.—Except as provided in the suc-
ceeding provisions of this section, the benefits provided to
an individual by the program established by this part shall
consist of the same benefits that are available under title
XVIII to individuals entitled to benefits under part A of
that title and enrolled under part B of that title.
‘‘(b) WELL CHILD SERVICES.—
‘‘(1) IN GENERAL.—In addition to the benefits
described in subsection (a), in the case of an individ-
ual entitled to benefits under this title as a child, the
benefits under this title shall include entitlement to
have payment made (in the same manner as for phy-
sicians’ services under part B of title XVIII) for the
following, without the application of deductibles, co-
insurance, or copayments, subject to the periodicity
schedule established with respect to the services
under paragraph (2):
‘‘(A) Newborn and well-baby care, includ-
ing normal newborn care and pediatrician serv-
ices for high-risk deliveries.
‘‘(B) Well-child care, including routine of-
fice visits, routine immunizations (including the
vaccine itself), routine laboratory tests, and pre-
ventive dental care.
‘‘(2) PERIODICITY SCHEDULE.—The Secretary,
in consultation with the American Academy of Pedi-
atrics, shall establish a schedule of periodicity which
reflects the general, appropriate frequency with
which services listed in paragraph (1) should be pro-
vided to healthy children.
‘‘SEC. 2112. SCOPE OF BENEFITS FOR PREGNANT WOMEN.
‘‘(a) IN GENERAL.—In the case of an individual enti-
tled to benefits under this title as a pregnant woman, the
benefits under this title shall consist of entitlement to have
payment made for the following, without the application
of deductibles, coinsurance, or copayments, subject to the
periodicity schedule established with respect to the serv-
ices under subsection (b):
‘‘(1) Prenatal care, including care for all com-
plications of pregnancy.
‘‘(2) Inpatient labor and delivery services.
‘‘(3) Postnatal care.
‘‘(4) Postnatal family planning services.
‘‘(b) PERIODICITY SCHEDULE.—The Secretary, in
consultation with the American College of Obstetrics and
Gynecology, shall establish a schedule of periodicity which
reflects the general, appropriate frequency with which
services listed in subsection (a) should be provided to preg-
nant women without complications of pregnancy.
‘‘SEC. 2113. EXCLUSIONS.
‘‘(a) IN GENERAL.—Except as provided in sub-
sections (b) and (c), section 1862 shall apply to expenses
incurred for items and services provided under this title
the same manner as such section applies to items and
services provided under title XVIII.
‘‘(b) BENEFITS EXCEPTION.—
‘‘(1) CHILDRENS’ SERVICES.—In applying sec-
tion 1862(a) with respect to services described in
section 2111(b)(1) (relating to well-child services),
payment shall not be denied under paragraph (1),
(7), or (12) of such section 1862(a) if the services
are provided in accordance with the periodicity
schedule described in section 2111(b)(2).
‘‘(2) SERVICES
FOR
PREGNANT
WOMEN.—In
applying section 1862(a) with respect to services de-
scribed in section 2112(a) (other than paragraph (2)
thereof), payment shall not be denied under para-
graph (1) or (7) of such section 1862(a) if the serv-
ices are provided in accordance with the periodicity
schedule described in section 2112(b).
‘‘(c) COORDINATION OF PAYMENTS.—Payment shall
not be made under this title with respect to benefits to
the extent that payment for such benefits may be made
under title XVIII.
‘‘PART C—PAYMENT FOR BENEFITS AND FINANCING
‘‘SEC. 2121. PAYMENTS FOR BENEFITS.
‘‘(a) IN GENERAL.—Except as otherwise provided in
this section—
‘‘(1) payment of benefits under this title with
respect to benefits shall be made in the same
amounts and on the same basis as payment may be
made with respect to such benefits under title
XVIII, and
‘‘(2) the provisions of sections 1814, 1833,
1842, 1848, and 1886 shall apply to payment of
benefits under this title in the same manner as they
apply to benefits under title XVIII.
‘‘(b) NO COST-SHARING FOR CERTAIN SERVICES.—
No deductibles, coinsurance, copayments, or other cost-
sharing shall be imposed with respect to—
‘‘(1) well-child care services described in section
2111(b)(1), and
‘‘(2) items and services for which an individual
is entitled under this title as a pregnant woman.
‘‘(c) ADJUSTMENT OF PAYMENTS.—
‘‘(1) ESTABLISHMENT
OF
NEW
DRGS
AND
WEIGHTS.—In making payment under this title with
respect to inpatient hospital services, the Secretary
shall make such adjustments in the diagnosis-related
groups and weighting factors with respect to dis-
charges within such groups, otherwise established
under section 1886(d)(4) as may be necessary—
‘‘(A) to reflect the types of discharges oc-
curring under this title which are not occurring
under title XVIII, and
‘‘(B) to provide for a weighting factor, for
cesarean section deliveries, which is 95 percent
of the weighting factor that otherwise would be
established.
‘‘(2) PAYMENT FOR OBSTETRICAL SERVICES.—
‘‘(A) GLOBAL FEE.—In making payment
under this title with respect to the group of ob-
stetrical services typical of treatment through-
out a course of pregnancy, the Secretary shall
establish, as a schedule under section 1848, a
global fee with respect to such group of serv-
ices.
‘‘(B) 
BONUS
FOR
EARLY
PRESEN-
TATION.—The fee schedule amount with respect
to obstetrical services under this title shall be
increased by 5 percent in the case of services
furnished to women who have presented for pre-
natal care during the first trimester.
‘‘(C) DISINCENTIVE FOR CESAREAN SEC-
TIONS.—The fee schedule amount otherwise es-
tablished with respect to a cesarean section
shall be 95 percent of the fee schedule amount
otherwise established.
‘‘(c) CONDITIONS
OF
AND LIMITATIONS
ON PAY-
MENTS.—The provisions of sections 1814 and 1835 shall
apply to payment for services under this title in the same
manner as they apply t±o payment for services under
parts A and B, respectively, of title XVIII.
‘‘(d) USE OF TRUST FUND.—In carrying out this
section, any reference in title XVIII to a trust fund shall
be treated as a reference to the Children Health Insurance
Trust Fund established under section 2122.
‘‘SEC. 2122. CHILDREN HEALTH INSURANCE TRUST FUND.
‘‘(a) ESTABLISHMENT.—(1) There is hereby created
on the books of the Treasury of the United States a trust
fund to be known as the ‘Children Health Insurance Trust
Fund’ (in this section referred to as the ‘Trust Fund’).
The Trust Fund shall consist of such gifts and bequests
as may be made as provided in section 201(i)(1) and
amounts appropriated under paragraph (2).
‘‘(2) There are hereby appropriated to the Trust
Fund amounts equivalent to 100 percent of the premium
taxes imposed by section 59B of the Internal Revenue
Code of 1986, and such additional amounts as the Con-
gress provides. The amounts appropriated by the preced-
ing sentence in relation to premium taxes shall be trans-
ferred from time to time from the general fund in the
Treasury to the Trust Fund, such amounts to be deter-
mined on the basis of estimates by the Secretary of the
Treasury of the taxes, paid to or deposited into the Treas-
ury; and proper adjustments shall be made in amounts
subsequently transferred to the extent prior estimates
were in excess of or were less than the taxes specified in
such sentence.
‘‘(b) INCORPORATION OF PROVISIONS.—
‘‘(1) IN GENERAL.—Subject to paragraph (2),
the provisions of subsections (b) through (e) and (g)
through (j) of section 1817 shall apply to the Trust
Fund in the same manner as they apply to the Fed-
eral Hospital Insurance Trust Fund.
from the Children Health Insurance Trust Fund for
services performed and related administrative costs
incurred in such year.
In calculating the amount under paragraph (2), the Sec-
retary shall include an appropriate amount for a contin-
gency margin.
‘‘PART D—GENERAL PROVISIONS
‘‘SEC. 2131. INCORPORATION OF CERTAIN MEDICARE PRO-
VISIONS.
‘‘(a) USE OF CARRIERS AND INTERMEDIARIES.—The
Secretary shall provide for the administration of this title
through the use of fiscal intermediaries and carriers in
the same manner as title XVIII is carried out through
the use of such fiscal intermediaries and carriers.
‘‘(b) DEFINITIONS.—Except as otherwise provided in
this title, the definitions contained in section 1861 shall
apply for purposes of this title in the same manner as they
apply for purposes of title XVIII.
‘‘(c) CERTIFICATION, PROVIDER
QUALIFICATION,
ETC.—The provisions of sections 1863 through 1875, sec-
tions 1878 through 1880, section 1883, section 1885, and
sections 1887 through 1892 shall apply to this title in the
same manner as they apply to title XVIII.
‘‘(d) HEALTH MAINTENANCE ORGANIZATIONS AND
COMPETITIVE MEDICAL PLANS.—
‘‘(1) IN GENERAL.—Except as provided in this
subsection, section 1876 shall apply to individuals
entitled to benefits under this title in the same man-
ner as such section applies to individuals entitled to
benefits under part A, and enrolled under part B, of
title XVIII.
‘‘(2) LIMITATION TO REASONABLE COST REIM-
BURSEMENT CONTRACTS FOR PREGNANT WOMEN.—
‘‘(A) IN GENERAL.—The provisions of sec-
tion 1876 relating only to risk-sharing contracts
(and not to reasonable cost reimbursement con-
tracts) shall not apply to individuals entitled to
benefits under this title only as pregnant
women.
‘‘(B) REPORT.—Not later than January 1,
1997, the Secretary shall submit to the Con-
gress a report concerning recommendations on
how the provisions of section 1876 relating to
risk-sharing contracts may be adapted to apply
to benefits provided under this title to pregnant
women.
‘‘(3) APPLICATION.—In applying section 1876
under this section—
‘‘(A) the provisions of such section relating
only to individuals enrolled under part B of title
XVIII shall not apply;
‘‘(B) any reference to a Trust Fund estab-
lished under title XVIII and to benefits under
such title is deemed a reference to the Children
Health Insurance Trust Fund and to benefits
under this title;
‘‘(C) the adjusted average per capita cost
and the adjusted community rate shall be deter-
mined on the basis of benefits under this title;
and
‘‘(D) subsection (f) shall not apply.
‘‘SEC. 2132. INCORPORATION OF PEER REVIEW PROVISIONS
AND FRAUD AND ABUSE PROVISIONS.
‘‘The provisions of sections 1121 through 1126, sec-
tions 1128 through 1128B, section 1134, section 1138,
and part B of title XI shall apply to this title in the same
manner as they apply to title XVIII.’’.
(b) CONFORMING AMENDMENTS.—
(1) Section 201(g)(1)(A) of the Social Security
Act (42 U.S.C. 401(g)(1)(A)) is amended by striking
‘‘and the Federal Supplementary Medical Insurance
Trust Fund’’ and inserting ‘‘, Federal Supple-
mentary Medical Insurance Trust Fund, and the
Children Health Insurance Trust Fund’’.
(2) Section 201(i)(1) of such Act (42 U.S.C.
401(i)(1)) is amended by striking ‘‘and the Federal
Supplementary Medical Insurance Trust Fund’’ and
inserting ‘‘, Federal Supplementary Medical Insur-
ance Trust Fund, and the Children Health Insur-
ance Trust Fund’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall take effect on the date of the enactment
of this Act, except that no benefits shall be available under
title XXI of the Social Security Act for items or services
furnished before January 1, 1998.
SEC. 3. PREMIUM FOR COVERAGE OF UNINSURED CHIL-
DREN AND MOTHERS-TO-BE.
(a) GENERAL RULE.—Subchapter A of chapter 1 of
the Internal Revenue Code of 1986 (relating to determina-
tion of tax liability) is amended by adding at the end the
following new part:
‘‘PART VIII—PREMIUM FOR COVERAGE OF
UNINSURED CHILDREN AND MOTHERS-TO-BE
‘‘Sec. 59B. Premium for coverage of uninsured children and
mothers-to-be.
‘‘SEC. 59B. PREMIUM FOR COVERAGE OF UNINSURED CHIL-
DREN AND MOTHERS-TO-BE.
‘‘(a) IMPOSITION OF TAX.—In the case of an individ-
ual, there is hereby imposed (in addition to any other tax
imposed by this subtitle) a tax for the taxable year in the
amount equal to the title XXI premium liability (if any)
of such individual for such taxable year.
‘‘(b) EXEMPTION FOR LOW-INCOME INDIVIDUALS.—
‘‘(1) IN GENERAL.—No tax shall be imposed by
subsection (a) on any taxpayer whose modified ad-
justed gross income for the taxable year does not ex-
ceed the threshold amount.
‘‘(2) PHASE-IN OF TAX.—
‘‘(A) IN
GENERAL.—If the modified ad-
justed gross income of the taxpayer for the tax-
able year exceeds the threshold amount by less
than $10,000, the amount of the tax imposed
by subsection (a) for such taxable year shall be
the phase-in percentage of the title XXI pre-
mium liability of such taxpayer for such taxable
year.
‘‘(B) PHASE-IN
PERCENTAGE.—For pur-
poses of subparagraph (A), the phase-in per-
centage shall be determined under tables pre-
scribed by the Secretary which—
‘‘(i) shall have income brackets of not
more than $50, and
‘‘(ii) provide for a ratable increase in
the amount of tax imposed by subsection
(a) for modified adjusted gross incomes be-
tween the threshold amount and the sum
of the threshold amount and $10,000.
‘‘(c) TITLE XXI PREMIUM LIABILITY.—For pur-
poses of this section—
‘‘(1) IN GENERAL.—The title XXI premium li-
ability of any individual for any taxable year is the
sum of—
‘‘(A) the applicable title XXI premiums for
each month of the taxable year as of the first
day of which any dependent of the individual is
a title XXI covered individual who has not at-
tained age 13, and
‘‘(B) the applicable title XXI premium for
the month of the taxable year during which the
taxpayer (or spouse of the taxpayer) gives birth
to any child if for such month the individual
giving birth is a title XXI covered individual.
‘‘(2) APPLICABLE TITLE XXI PREMIUM.—The
term ‘applicable title XXI premium’ means, with re-
spect to a month, such premium as determined
under section 2123 of the Social Security Act for
that month.
‘‘(d) TITLE XXI COVERED INDIVIDUAL.—For pur-
poses of this section—
‘‘(1) IN GENERAL.—A dependent shall be treat-
ed as a title XXI covered individual for any month
unless—
‘‘(A) for such month, such dependent is
covered under a qualified health plan, and
‘‘(B) the taxpayer furnishes to the Sec-
retary (at such time and in such manner as the
Secretary may prescribe) the required certifi-
cation of such coverage for such month.
A similar rule shall apply to a woman for the month
in which such woman gives birth to a child.
‘‘(2) QUALIFIED
HEALTH
PLAN.—The term
‘qualified health plan’ means a plan of health insur-
ance or coverage, an employee welfare benefit plan
that provides health benefits, or other plan (other
than under title XXI of the Social Security Act)
under Federal or State law that provides coverage of
benefits which the Secretary of Health and Human
Services determines is substantially equivalent to the
coverage of benefits provided under title XXI of the
Social Security Act.
‘‘(e) OTHER DEFINITIONS AND SPECIAL RULES.—
For purposes of this section—
‘‘(1) THRESHOLD AMOUNT.—
‘‘(A) IN GENERAL.—Except as provided in
subparagraph (B), the term ‘threshold amount’
means—
‘‘(i) $20,000 in the case of a return
with respect to which 3 or fewer personal
exemptions are allowable under section
151, and
‘‘(ii) $25,000 in the case of a return
with respect to which 4 or more personal
exemptions are allowable under section
151.
‘‘(B) CERTAIN SEPARATE RETURNS.—The
threshold amount shall be zero in the case of a
taxpayer who—
‘‘(i) is married as of the close of the
taxable year but does not file a joint return
for such taxable year, and
‘‘(ii) does not live apart from his
spouse at all times during the last 6
months of the taxable year.
‘‘(C) INFLATION
ADJUSTMENTS.—In the
case of a taxable year beginning in a calendar
year after 1998, each dollar amount contained
in subparagraph (A) shall be increased by an
amount equal to—
‘‘(i) such dollar amount, multiplied by
‘‘(ii) the cost-of-living adjustment de-
termined under section 1(f)(3) for the cal-
endar year in which the taxable year be-
gins, by substituting ‘calendar year 1997’
for ‘calendar year 1992’ in subparagraph
(B) thereof.
‘‘(2) MODIFIED
ADJUSTED
GROSS
INCOME.—
The term ‘modified adjusted gross income’ means
adjusted gross income—
‘‘(A) determined without regard to sections
911, 931, and 933, and
‘‘(B) increased by the amount of interest
received or accrued by the individual during the
taxable year which is exempt from tax.
The determination under the preceding sentence
shall be made without regard to any carryover or
carryback.
‘‘(3) 
DEPENDENT.—The 
term 
‘dependent’
means, with respect to periods in any calendar year,
any individual if an exemption is allowable under
section 151(c) with respect to such individual to the
taxpayer for a taxable year beginning in such cal-
endar year.
‘‘(4) REQUIRED CERTIFICATION.—The term ‘re-
quired certification’ means the statement required to
be provided under section 6050Q(b) (or a copy
thereof) or any other statement approved by the
Secretary for purposes of this section.
‘‘(f) COORDINATION WITH OTHER PROVISIONS.—
‘‘(1) TREATMENT AS MEDICAL EXPENSE.—For
purposes of section 213, the tax imposed by this sec-
tion for any taxable year shall be treated as an ex-
pense paid during such taxable year for medical care
of the taxpayer.
‘‘(2) NOT TREATED AS TAX FOR CERTAIN PUR-
POSES.—The tax imposed by this section shall not
be treated as a tax imposed by this chapter for pur-
poses of determining—
‘‘(A) the amount of any credit allowable
under this chapter, or
‘‘(B) the amount of the minimum tax im-
posed by section 55.
‘‘(3) TREATMENT
UNDER
SUBTITLE
F.—For
purposes of subtitle F, the tax imposed by this sec-
tion shall be treated as if it were a tax imposed by
section 1.
‘‘(g) EXEMPTIONS.—
‘‘(1) IN GENERAL.—No tax shall be imposed by
this section on any individual for any taxable year
if such individual is a nonresident alien.
‘‘(2) CERTAIN INDIVIDUALS NOT TAKEN INTO
ACCOUNT IN DETERMINING AMOUNT OF TAX.—For
purposes of this section, an individual shall be treat-
ed as not being a title XXI covered individual for
any month if—
‘‘(A) the principal place of abode of such
individual as of the first day of such month is
outside the United States, or
‘‘(B) as of the first day of such month,
there is in effect for such individual a qualified
religious exemption.
‘‘(3) QUALIFIED RELIGIOUS EXEMPTION.—For
purposes of paragraph (2)—
‘‘(A) IN
GENERAL.—The term ‘qualified
religious exemption’ means an exemption grant-
ed by the Secretary of Health and Human
Services to an individual—
‘‘(i) who is a member of a recognized
religious sect or division thereof with re-
spect to which such Secretary makes the
findings referred to in subparagraphs (C),
(D), and (E) of section 1402(g)(1),
‘‘(ii) who is an adherent of established
tenets or teachings of such sect or division
as described in such section, and
‘‘(iii) who submits an application for
such exemption which contains or is ac-
companied by the evidence described in
section 1402(g)(1)(A) and a waiver de-
scribed in section 1402(g)(1)(B).
For purposes of the clause (iii), section
1402(g)(1)(B) shall be treated as including a
reference to title XXI of the Social Security
Act.
‘‘(B) LIMITATION.—An exemption granted
under this paragraph shall cease to apply begin-
ning on the date such Secretary determines
that the individual, or the sect or division,
ceased to meet the requirements of subpara-
graph (A).
‘‘(4) SPECIAL RULE FOR INDIVIDUALS RESID-
ING ABROAD WHO RECEIVE TITLE XXI SERVICES.—
Paragraph (2)(A) shall not apply to any individual
for any taxable year if, at any time during such tax-