sicians’ services which are consistent with the relative val-
ues developed for other physicians’ services under section
1848(c) of the Social Security Act. In developing such val-
ues, the Secretary shall conduct such refinements as may
be necessary to produce appropriate estimates for such rel-
ative values.
(b) STUDY.—
(1) IN GENERAL.—The Secretary shall conduct
a study of the relative values for pediatric and other
services to determine whether there are significant
variations in the resources used in providing similar
services to different populations. In conducting such
study, the Secretary shall consult with appropriate
organizations representing pediatricians and other
physicians and physical and occupational therapists.
(2) REPORT.—Not later than July 1, 1995, the
Secretary shall submit to Congress a report on the
study conducted under paragraph (1). Such report
shall include any appropriate recommendations re-
garding needed changes in coding or other payment
policies to ensure that payments for pediatric serv-
ices appropriately reflect the resources required to
provide these services.
SEC. 125. ADMINISTRATION OF CLAIMS RELATING TO PHY-
SICIANS’ SERVICES.
(a) LIMITATION ON CARRIER USER FEES.—Section
1842(c) (42 U.S.C. 1395u(c)) is amended by adding at
the end the following new paragraph:
‘‘(4) Neither a carrier nor the Secretary may impose
a fee under this title—
‘‘(A) for the filing of claims related to physi-
cians’ services,
‘‘(B) for an error in filing a claim relating to
physicians’ services or for such a claim which is de-
nied,
‘‘(C) for any appeal under this title with respect
to physicians’ services,
‘‘(D) for applying for (or obtaining) a unique
identifier under subsection (r), or
‘‘(E) for responding to inquiries respecting phy-
sicians’ services or for providing information with re-
spect to medical review of such services.’’.
(b) CLARIFICATION OF PERMISSIBLE SUBSTITUTE
BILLING ARRANGEMENTS.—
(1) IN
GENERAL.—Clause (D) of section
1842(b)(6) (42 U.S.C. 1395u(b)(6)) is amended to
read as follows: ‘‘(D) payment may be made to a
physician for physicians’ services (and services fur-
nished incident to such services) furnished by a sec-
ond physician to patients of the first physician if (i)
the first physician is unavailable to provide the serv-
ices; (ii) the services are furnished pursuant to an
arrangement between the two physicians that (I) is
informal and reciprocal, or (II) involves per diem or
other fee-for-time compensation for such services;
(iii) the services are not provided by the second phy-
sician over a continuous period of more than 60
days; and (iv) the claim form submitted to the car-
rier for such services includes the second physician’s
unique identifier (provided under the system estab-
lished under subsection (r)) and indicates that the
claim meets the requirements of this subparagraph
for payment to the first physician’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall apply to services furnished on
or after the first day of the first month beginning
more than 60 days after the date of the enactment
of this Act.
SEC. 126. MISCELLANEOUS AND TECHNICAL CORRECTIONS.
(a) 
OVERVALUED
PROCEDURES.—(1) 
Section
1842(b)(16)(B)(iii) (42 U.S.C. 1395u(b)(16)(B)(iii)) is
amended—
(A) by striking ‘‘, simple and subcutaneous’’,
(B) by striking ‘‘; small’’ and inserting ‘‘and
small’’,
(C) by striking ‘‘treatments;’’ the first place it
appears and inserting ‘‘and’’,
(D) by striking ‘‘lobectomy;’’,
(E) by striking ‘‘enterectomy; colectomy; chole-
cystectomy;’’,
(F) by striking ‘‘; transurerethral resection’’
and inserting ‘‘and resection’’, and
(G) by striking ‘‘sacral laminectomy;’’.
(2) Section 4101(b)(2) of OBRA–1990 is amended—
(A) in the matter before subparagraph (A), by
striking 
‘‘1842(b)(16)’’ 
and 
inserting
‘‘1842(b)(16)(B)’’, and
(B) in subparagraph (B)—
(i) by striking ‘‘, simple and subcutane-
ous’’,
(ii) by striking ‘‘(HCPCS codes 19160 and
19162)’’ and inserting ‘‘(HCPCS code 19160)’’,
and
(iii) by striking all that follows ‘‘(HCPCS
codes 92250’’ and inserting ‘‘and 92260).’’.
(b) RADIOLOGY SERVICES.—(1) Section 1834(b)(4)
(42 U.S.C. 1395m(b)(4)) is amended by redesignating the
subparagraphs (E) and (F) redesignated by section
4102(a)(1) of OBRA–1990 as subparagraphs (F) and
(G), respectively.
(2) 
Section 
1834(b)(4)(D) 
(42 
U.S.C.
1395m(b)(4)(D)) is amended—
(A) in the matter before clause (i), by striking
‘‘shall be determined as follows:’’ and inserting
‘‘shall, subject to clause (vii), be reduced to the ad-
justed conversion factor for the locality determined
as follows:’’,
(B) in clause (iv), by striking ‘‘LOCAL ADJUST-
MENT.—Subject to clause (vii), the conversion factor
to be applied to’’ and inserting ‘‘ADJUSTED CONVER-
SION FACTOR.—The adjusted conversion factor for’’,
(C) in clause (vii), by striking ‘‘under this sub-
paragraph’’, and
(D) in clause (vii), by inserting ‘‘reduced under
this subparagraph by’’ after ‘‘shall not be’’.
(3) Section 4102(c)(2) of OBRA–1990 is amended
by striking ‘‘radiology services’’ and all that follows and
inserting ‘‘nuclear medicine services.’’.
(4) Section 4102(d) of OBRA–1990 is amended by
striking ‘‘new paragraph’’ and inserting ‘‘new subpara-
graph’’.
(5) 
Section 
1834(b)(4)(E) 
(42 
U.S.C.
1395m(b)(4)(E)) is amended by inserting ‘‘RULE FOR
CERTAIN SCANNING SERVICES.—’’ after ‘‘(E)’’.
(6) Section 1848(a)(2)(D)(iii) (42 U.S.C. 1395w–
4(a)(2)(D)(iii)) is amended by striking ‘‘that are subject
to section 6105(b) of the Omnibus Budget Reconciliation
Act of 1989’’ and by striking ‘‘provided under such sec-
tion’’ and inserting ‘‘provided under section 6105(b) of the
Omnibus Budget Reconciliation Act of 1989’’.
(c) ANESTHESIA SERVICES.—(1) Section 4103(a) of
OBRA–1990 is amended by striking ‘‘REDUCTION IN FEE
SCHEDULE’’ and inserting ‘‘REDUCTION IN PREVAILING
CHARGES’’.
(2) 
Section 
1842(q)(1)(B) 
(42 
U.S.C.
1395u(q)(1)(B)) is amended—
(A) in the matter before clause (i), by striking
‘‘shall be determined as follows:’’ and inserting
‘‘shall, subject to clause (iv), be reduced to the ad-
justed prevailing charge conversion factor for the lo-
cality determined as follows:’’, and
(B) in clause (iii), by striking ‘‘Subject to
clause (iv), the prevailing charge conversion factor to
be applied in’’ and inserting ‘‘The adjusted prevail-
ing charge conversion factor for’’.
(d) ASSISTANTS AT SURGERY.—(1) Section 4107(c)
of OBRA–1990 is amended by inserting ‘‘(a)(1)’’ after
‘‘subsection’’.
(2) Section 4107(a)(2) of OBRA–1990 is amended
by adding at the end the following: ‘‘In applying section
1848(g)(2)(D) of the Social Security Act for services of
an assistant-at-surgery furnished during 1991, the recog-
nized payment amount shall not exceed the maximum
amount specified under section 1848(i)(2)(A) of such Act
(as applied under this paragraph in such year).’’.
(e) TECHNICAL COMPONENTS OF DIAGNOSTIC SERV-
ICES.—Section 1842(b) (42 U.S.C. 1395u(b)) is amended
by redesignating paragraph (18), as added by section
4108(a) of OBRA–1990, as paragraph (17) and, in such
paragraph, by inserting ‘‘, tests specified in paragraph
(14)(C)(i),’’ after ‘‘diagnostic laboratory tests’’.
(f) STATEWIDE FEE SCHEDULES.—Section 4117 of
OBRA–1990 is amended—
(1) in subsection (a)—
(A) by striking ‘‘(a) IN GENERAL.—’’, and
(B) by striking ‘‘, if the’’ and all that fol-
lows through ‘‘1991,’’; and
(2) by striking subsections (b), (c), and (d).
(g) 
OTHER
MISCELLANEOUS
AND
TECHNICAL
AMENDMENTS.—(1) The heading of section 1834(f) (42
U.S.C. 1395m(f)) is amended by striking ‘‘FISCAL YEAR’’.
(2)(A) Section 4105(b) of OBRA–1990 is amended—
(i) in paragraph (2), by striking ‘‘amendments’’
and inserting ‘‘amendment’’, and
(ii) in paragraph (3), by striking ‘‘amendments
made by paragraphs (1) and (2)’’ and inserting
‘‘amendment made by paragraph (1)’’.
(B) Section 1848(f)(2)(C) (42 U.S.C. 1395w–
4(f)(2)(C)) is amended by inserting ‘‘PERFORMANCE
STANDARD
RATES
OF
INCREASE
FOR
FISCAL
YEAR
1991.—’’ after ‘‘(C)’’.
(C) Section 4105(d) of OBRA–1990 is amended by
inserting ‘‘PUBLICATION OF PERFORMANCE STANDARD
RATES.—’’ after ‘‘(d)’’.
(3) Section 4106(c) of OBRA–1990 is amended by
inserting 
‘‘of 
the 
Social 
Security 
Act’’ 
after
‘‘1848(d)(1)(B)’’.
(4) Section 4114 of OBRA–1990 is amended by
striking ‘‘patients’’ the second place it appears.
(5) Section 1848(e)(1)(C) (42 U.S.C. 1395w–
4(e)(1)(C)) is amended by inserting ‘‘date of the’’ after
‘‘since the’’.
(6) Section 4118(f)(1)(D) of OBRA–1990 is amend-
ed by striking ‘‘is amended’’.
(7) Section 4118(f)(1)(N)(ii) of OBRA–1990 is
amended by striking ‘‘subsection (f)(5)(A)’’ and inserting
‘‘subsection (f)(5)(A))’’.
(8) Section 1845(e) (42 U.S.C. 1395w–1(e)) is
amended—
(A) by striking paragraph (2); and
(B) by redesignating paragraphs (3), (4), and
(5) as paragraphs (2), (3), and (4).
(9) Section 4118(j)(2) of OBRA–1990 is amended by
striking ‘‘In section’’ and inserting ‘‘Section’’.
(10)(A) Section 1848(i)(3) (42 U.S.C. 1395w–
4(i)(3)) is amended by striking the space before the period
at the end.
(B) 
Section 
1834(a)(10)(B) 
(42 
U.S.C.
1395m(a)(10)(B)) is amended—
(i) by striking ‘‘apply to’’ and inserting ‘‘would
otherwise apply to’’, and
(ii) by inserting before the period at the end
‘‘but for the application of section 1848(i)(3)’’.
(h) OTHER CORRECTIONS.—(1) Effective on the date
of the enactment of this Act, section 6102(d)(4) of
OBRA–1989 is amended by striking all that follows the
first sentence.
(2) Effective for payments for fiscal years beginning
with fiscal year 1994, section 1842(c)(1) (42 U.S.C.
1395u(c)(1)) is amended—
(A) in subparagraph (A), by striking ‘‘(A) Any
contract’’ and inserting ‘‘Any contract’’; and
(B) by striking subparagraph (B).
(i) EFFECTIVE DATE.—Except as provided in sub-
section (i), the amendments made by this section and the
provisions of this section shall take effect as if included
in the enactment of OBRA–1990.
PART II—DURABLE MEDICAL EQUIPMENT
SEC. 131. CERTIFICATION OF SUPPLIERS.
(a) REQUIREMENTS.—
(1) IN
GENERAL.—Section 1834 (42 U.S.C.
1395m), as amended by section 13544(b)(1) of
OBRA–1993, is amended by adding at the end the
following new subsection:
‘‘(j) REQUIREMENTS FOR SUPPLIERS OF MEDICAL
EQUIPMENT AND SUPPLIES.—
‘‘(1) ISSUANCE
AND
RENEWAL
OF
SUPPLIER
NUMBER.—
‘‘(A) PAYMENT.—Except as provided in
subparagraph (C), no payment may be made
under this part after the date of the enactment
of the Social Security Act Amentments of 1994
for items furnished by a supplier of medical
equipment and supplies unless such supplier ob-
tains (and renews at such intervals as the Sec-
retary may require) a supplier number.
‘‘(B) STANDARDS FOR POSSESSING A SUP-
PLIER NUMBER.—A supplier may not obtain a
supplier number unless—
‘‘(i) for medical equipment and sup-
plies furnished on or after the date of en-
actment of the Social Security Act Amend-
ments of 1994, and before January 1,
1996, the supplier meets standards pre-
scribed by the Secretary in regulations is-
sued on June 18, 1992; and
‘‘(ii) for medical equipment and sup-
plies furnished on or after January 1,
1996, the supplier meets revised standards
prescribed by the Secretary (in consulta-
tion with representatives of suppliers of
medical equipment and supplies, carriers,
and consumers) that shall include require-
ments that the supplier—
‘‘(I) comply with all applicable
State and Federal licensure and regu-
latory requirements;
‘‘(II) maintain a physical facility
on an appropriate site;
‘‘(III) have proof of appropriate
liability insurance; and
‘‘(IV) meet such other require-
ments as the Secretary may specify.
‘‘(C) EXCEPTION FOR ITEMS FURNISHED
AS
INCIDENT
TO
A
PHYSICIAN’S
SERVICE.—
Subparagraph (A) shall not apply with respect
to medical equipment and supplies furnished in-
cident to a physician’s service.
‘‘(D) PROHIBITION
AGAINST
MULTIPLE
SUPPLIER NUMBERS.—The Secretary may not
issue more than one supplier number to any
supplier of medical equipment and supplies un-
less the issuance of more than one number is
appropriate to identify subsidiary or regional
entities under the supplier’s ownership or con-
trol.
‘‘(E) PROHIBITION AGAINST DELEGATION
OF
SUPPLIER
DETERMINATIONS.—The Sec-
retary may not delegate (other than by contract
under section 1842) the responsibility to deter-
mine whether suppliers meet the standards nec-
essary to obtain a supplier number.
‘‘(2) CERTIFICATES OF MEDICAL NECESSITY.—
‘‘(A) LIMITATION ON INFORMATION PRO-
VIDED
BY
SUPPLIERS
ON
CERTIFICATES
OF
MEDICAL NECESSITY.—
‘‘(i) IN GENERAL.—Effective 60 days
after the date of enactment of the Social
Security Act Amendments of 1994, a sup-
plier of medical equipment and supplies
may distribute to physicians, or to individ-
uals entitled to benefits under this part, a
certificate of medical necessity for commer-
cial purposes which contains no more than
the following information completed by the
supplier:
‘‘(I) An identification of the sup-
plier and the beneficiary to whom
such medical equipment and supplies
are furnished.
‘‘(II) A description of such medi-
cal equipment and supplies.
‘‘(III) Any product code identify-
ing such medical equipment and sup-
plies.
‘‘(IV) Any other administrative
information (other than information
relating to the beneficiary’s medical
condition) identified by the Secretary.
‘‘(ii) 
INFORMATION
ON
PAYMENT
AMOUNT AND CHARGES.—If a supplier dis-
tributes a certificate of medical necessity
containing any of the information per-
mitted to be supplied under clause (i), the
supplier shall also list on the certificate of
medical necessity the fee schedule amount
and the supplier’s charge for the medical
equipment or supplies being furnished
prior to distribution of such certificate to
the physician.
‘‘(iii) PENALTY.—Any supplier of
medical equipment and supplies who know-
ingly and willfully distributes a certificate
of medical necessity in violation of clause
(i) or fails to provide the information re-
quired under clause (ii) is subject to a civil
money penalty in an amount not to exceed
$1,000 for each such certificate of medical
necessity so distributed. The provisions of
section 1128A (other than subsections (a)
and (b)) shall apply to civil money pen-
alties under this subparagraph in the same
manner as they apply to a penalty or pro-
ceeding under section 1128A(a).
‘‘(B) DEFINITION.—For purposes of this
paragraph, the term ‘certificate of medical ne-
cessity’ means a form or other document con-
taining information required by the carrier to
be submitted to show that an item is reasonable
and necessary for the diagnosis or treatment of
illness or injury or to improve the functioning
of a malformed body member.
‘‘(3) COVERAGE AND REVIEW CRITERIA.—The
Secretary shall annually review the coverage and uti-
lization of items of medical equipment and supplies
to determine whether such items should be made
subject to coverage and utilization review criteria,
and if appropriate, shall develop and apply such cri-
teria to such items.
‘‘(4) DEFINITION.—The term ‘medical equip-
ment and supplies’ means—
‘‘(A) durable medical equipment (as de-
fined in section 1861(n));
‘‘(B) prosthetic devices (as described in
section 1861(s)(8));
‘‘(C) orthotics and prosthetics (as de-
scribed in section 1861(s)(9));
‘‘(D) surgical dressings (as described in
section 1861(s)(5));
‘‘(E) such other items as the Secretary
may determine; and
‘‘(F) for purposes of paragraphs (1) and
(3)—
‘‘(i) home dialysis supplies and equip-
ment 
(as 
described 
in 
section
1861(s)(2)(F)),
‘‘(ii) immunosuppressive drugs (as de-
scribed in section 1861(s)(2)(J)),
‘‘(iii) therapeutic shoes for diabetics
(as described in section 1861(s)(12)),
‘‘(iv) oral drugs prescribed for use as
an anticancer therapeutic agent (as de-
scribed in section 1861(s)(2)(Q)), and
‘‘(v) self-administered erythropoetin
(as described in section 1861(s)(2)(P)).’’.
(2) CONFORMING
AMENDMENT.—Effective 60
days after the date of enactment of the Social Secu-
rity Act Amendments of 1994, paragraph (16) of
section 1834(a) (42 U.S.C. 1395m(a)) is repealed.
(b) USE OF COVERED ITEMS BY DISABLED BENE-
FICIARIES.—
(1) IN GENERAL.—The Secretary of Health and
Human Services, in consultation with representa-
tives of suppliers of durable medical equipment
under part B of the medicare program and individ-
uals entitled to benefits under such program on the
basis of disability, shall conduct a study of the ef-
fects of the methodology for determining payments
for items of such equipment under such part on the
ability of such individuals to obtain items of such
equipment, including customized items.
(2) REPORT.—Not later than one year after the
date of the enactment of this Act, the Secretary
shall submit a report to Congress on the study con-
ducted under paragraph (1), and shall include in the
report such recommendations as the Secretary con-
siders appropriate to assure that disabled medicare
beneficiaries have access to items of durable medical
equipment.
(c) CRITERIA FOR TREATMENT OF ITEMS AS PROS-
THETIC DEVICES OR ORTHOTICS AND PROSTHETICS.—
Not later than one year after the date of the enactment
of this Act, the Secretary of Health and Human Services
shall submit a report to the Committees on Ways and
Means and Energy and Commerce of the House of Rep-
resentatives and the Committee on Finance of the Senate
describing prosthetic devices or orthotics and prosthetics
covered under part B of the medicare program that do
not require individualized or custom fitting and adjust-
ment to be used by a patient. Such report shall include
recommendations for an appropriate methodology for de-
termining the amount of payment for such items under
such program.
SEC. 132. RESTRICTIONS ON CERTAIN MARKETING AND
SALES ACTIVITIES.
(a) PROHIBITING UNSOLICITED TELEPHONE CON-
TACTS FROM SUPPLIERS OF DURABLE MEDICAL EQUIP-
MENT TO MEDICARE BENEFICIARIES.—
(1) IN GENERAL.—Section 1834(a) (42 U.S.C.
1395m(a)) is amended by adding at the end the fol-
lowing new paragraph:
‘‘(17) PROHIBITION
AGAINST
UNSOLICITED
TELEPHONE CONTACTS BY SUPPLIERS.—
‘‘(A) IN GENERAL.—A supplier of a cov-
ered item under this subsection may not contact
an individual enrolled under this part by tele-
phone regarding the furnishing of a covered
item to the individual unless 1 of the following
applies:
‘‘(i) The individual has given written
permission to the supplier to make contact
by telephone regarding the furnishing of a
covered item.
‘‘(ii) The supplier has furnished a cov-
ered item to the individual and the supplier
is contacting the individual only regarding
the furnishing of such covered item.
‘‘(iii) If the contact is regarding the
furnishing of a covered item other than a
covered item already furnished to the indi-
vidual, the supplier has furnished at least
1 covered item to the individual during the
15-month period preceding the date on
which the supplier makes such contact.
‘‘(B) PROHIBITING PAYMENT FOR ITEMS
FURNISHED
SUBSEQUENT
TO
UNSOLICITED
CONTACTS.—If a supplier knowingly contacts
an individual in violation of subparagraph (A),
no payment may be made under this part for
any item subsequently furnished to the individ-
ual by the supplier.
‘‘(C) EXCLUSION
FROM
PROGRAM
FOR
SUPPLIERS ENGAGING IN PATTERN OF UNSO-
LICITED
CONTACTS.—If a supplier knowingly
contacts individuals in violation of subpara-
graph (A) to such an extent that the supplier’s
conduct establishes a pattern of contacts in vio-
lation of such subparagraph, the Secretary shall
exclude the supplier from participation in the
programs under this Act, in accordance with
the procedures set forth in subsections (c), (f),
and (g) of section 1128.’’.
(2) REQUIRING
REFUND
OF
AMOUNTS
COL-
LECTED FOR DISALLOWED ITEMS.—Section 1834(a)
(42 U.S.C. 1395m(a)), as amended by paragraph
(1), is amended by adding at the end the following
new paragraph:
‘‘(18) REFUND OF AMOUNTS COLLECTED FOR
CERTAIN DISALLOWED ITEMS.—
‘‘(A) IN GENERAL.—If a nonparticipating
supplier furnishes to an individual enrolled
under this part a covered item for which no
payment may be made under this part by rea-
son of paragraph (17)(B), the supplier shall re-
fund on a timely basis to the patient (and shall
be liable to the patient for) any amounts col-
lected from the patient for the item, unless—
‘‘(i) the supplier establishes that the
supplier did not know and could not rea-
sonably have been expected to know that
payment may not be made for the item by
reason of paragraph (17)(B), or
‘‘(ii) before the item was furnished,
the patient was informed that payment
under this part may not be made for that
item and the patient has agreed to pay for
that item.
‘‘(B) SANCTIONS.—If a supplier knowingly
and willfully fails to make refunds in violation
of subparagraph (A), the Secretary may apply
sanctions against the supplier in accordance
with section 1842(j)(2).
‘‘(C) NOTICE.—Each carrier with a con-
tract in effect under this part with respect to
suppliers of covered items shall send any notice
of denial of payment for covered items by rea-
son of paragraph (17)(B) and for which pay-
ment is not requested on an assignment-related
basis to the supplier and the patient involved.
‘‘(D) TIMELY BASIS DEFINED.—A refund
under subparagraph (A) is considered to be on
a timely basis only if—
‘‘(i) in the case of a supplier who does
not request reconsideration or seek appeal
on a timely basis, the refund is made with-
in 30 days after the date the supplier re-
ceives a denial notice under subparagraph
(C), or
‘‘(ii) in the case in which such a re-
consideration or appeal is taken, the re-
fund is made within 15 days after the date
the supplier receives notice of an adverse
determination on reconsideration or ap-
peal.’’.
(b) CONFORMING AMENDMENT.—Section 1834(h)(3)
(42 U.S.C. 1395m(h)(3)) is amended by striking ‘‘Para-
graph (12)’’ and inserting ‘‘Paragraphs (12) and (17)’’.
(c) EFFECTIVE DATE.—The amendments made by
subsections (a) and (b) shall apply to items furnished after
the expiration of the 60-day period that begins on the date
of the enactment of this Act.
SEC. 133. BENEFICIARY LIABILITY FOR NONCOVERED
SERVICES.
(a) UNASSIGNED CLAIMS.—
(1) IN GENERAL.—Section 1834(j) (42 U.S.C.
1395m(i)), as added by section 131(a)(1), is amend-
ed—
(A) by redesignating paragraph (4) as
paragraph (5), and
(B) by inserting after paragraph (3) the
following new paragraph:
‘‘(4) LIMITATION ON PATIENT LIABILITY.—If a
supplier of medical equipment and supplies (as de-
fined in paragraph (5))—
‘‘(A) furnishes an item or service to a ben-
eficiary for which no payment may be made by
reason of paragraph (1);
‘‘(B) furnishes an item or service to a ben-
eficiary for which payment is denied in advance
under subsection (a)(15); or
‘‘(C) furnishes an item or service to a ben-
eficiary for which payment is denied under sec-
tion 1862(a)(1);
any expenses incurred for items and services fur-
nished to an individual by such a supplier not on an
assigned basis shall be the responsibility of such
supplier. The individual shall have no financial re-
sponsibility for such expenses and the supplier shall
refund on a timely basis to the individual (and shall
be liable to the individual for) any amounts collected
from the individual for such items or services. The
provisions of subsection (a)(18) shall apply to re-
funds required under the previous sentence in the
same manner as such provisions apply to refunds
under such subsection.’’.
(2) 
CONFORMING
AMENDMENT.—Section
1128B(b)(3)(B) (42 U.S.C. 1320a–7b(b)(3)(B)), as
amended by section 134(a), is amended by striking
‘‘1834(j)(4)’’ and inserting ‘‘1834(j)(5)’’.
(b) ASSIGNED CLAIMS.—Section 1879 (42 U.S.C.
1395pp) is amended by adding at the end the following
new subsection:
‘‘(h) If a supplier of medical equipment and supplies
(as defined in section 1834(j)(5))—
‘‘(1) furnishes an item or service to a bene-
ficiary for which no payment may be made by reason
of section 1834(j)(1);
‘‘(2) furnishes an item or service to a bene-
ficiary for which payment is denied in advance under
section 1834(a)(15); or
‘‘(3) furnishes an item or service to a bene-
ficiary for which no payment may be made by reason
of section 1834(a)(17)(B),
any expenses incurred for items and services furnished to
an individual by such a supplier on an assignment-related
basis shall be the responsibility of such supplier. The indi-
vidual shall have no financial responsibility for such ex-
penses and the supplier shall refund on a timely basis to
the individual (and shall be liable to the individual for)
any amounts collected from the individual for such items
or services. The provisions of section 1834(a)(18) shall
apply to refunds required under the previous sentence in
the same manner as such provisions apply to refunds
under such section.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to items or services furnished on
or after January 1, 1995.
SEC. 134. ADJUSTMENTS FOR INHERENT REASONABLE-
NESS.
(a) ADJUSTMENTS
MADE
TO
FINAL
PAYMENT
AMOUNTS.—
(1) IN GENERAL.—Section 1834(a)(10)(B) (42
U.S.C. 1395m(a)(10)(B)) is amended by adding at
the end the following: ‘‘In applying such provisions
to payments for an item under this subsection, the
Secretary shall make adjustments to the payment
basis for the item described in paragraph (1)(B) if
the Secretary determines (in accordance with such
provisions and on the basis of prices and costs appli-
cable at the time the item is furnished) that such
payment basis is not inherently reasonable.’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall take effect on the date of the
enactment of this Act.
(b) ADJUSTMENT REQUIRED FOR CERTAIN ITEMS.—
(1) IN GENERAL.—In accordance with section
1834(a)(10)(B) of the Social Security Act (as
amended by subsection (a)), the Secretary of Health
and Human Services shall determine whether the
payment amounts for the items described in para-
graph (2) are not inherently reasonable, and shall
adjust such amounts in accordance with such section
if the amounts are not inherently reasonable.
(2) ITEMS DESCRIBED.—The items referred to
in paragraph (1) are decubitus care equipment,
transcutaneous electrical nerve stimulators, and any
other items considered appropriate by the Secretary.
SEC. 135. MISCELLANEOUS AND TECHNICAL CORRECTIONS.
(a) UPDATES TO PAYMENT AMOUNTS.—(1) Subpara-
graph 
(A) 
of 
section 
1834(a)(14) 
(42 
U.S.C.
1395m(a)(14)) is amended to read as follows:
‘‘(A) for 1991 and 1992, the percentage
increase in the consumer price index for all
urban consumers (U.S. city average) for the 12-
month period ending with June of the previous
year reduced by 1 percentage point; and’’.
(2) The amendment made by paragraph (1) shall be
effective on the date of the enactment of this Act.
(b) ADVANCE DETERMINATIONS OF COVERAGE.—(1)
Effective on the date of the enactment of this Act, section
1834(a)(15) (42 U.S.C. 1395m(a)(15)) is amended to
read as follows:
‘‘(15) ADVANCE
DETERMINATIONS
OF
COV-
ERAGE FOR CERTAIN ITEMS.—
‘‘(A) DEVELOPMENT OF LISTS OF ITEMS
BY SECRETARY.—The Secretary may develop
and periodically update a list of items for which
payment may be made under this subsection
that the Secretary determines, on the basis of
prior payment experience, are frequently subject
to unnecessary utilization throughout a carrier’s
entire service area or a portion of such area.
‘‘(B) DEVELOPMENT OF LISTS OF SUPPLI-
ERS BY SECRETARY.—The Secretary may de-
velop and periodically update a list of suppliers
of items for which payment may be made under
this subsection with respect to whom—
‘‘(i) the Secretary has found that a
substantial number of claims for payment
under this part for items furnished by the
supplier have been denied on the basis of
the application of section 1862(a)(1); or
‘‘(ii) the Secretary has identified a
pattern of overutilization resulting from
the business practice of the supplier.
‘‘(C) DETERMINATIONS OF COVERAGE IN
ADVANCE.—A carrier shall determine in ad-
vance of delivery of an item whether payment
for the item may not be made because the item
is not covered or because of the application of
section 1862(a)(1) if—
‘‘(i) the item is included on the list
developed by the Secretary under subpara-
graph (A);
‘‘(ii) the item is furnished by a sup-
plier included on the list developed by the
Secretary under subparagraph (B); or
‘‘(iii) the item is a customized item
(other than inexpensive items specified by
the Secretary) and the patient to whom the
item is to be furnished or the supplier re-
quests that such advance determination be
made.’’.
(2) Effective for standards applied for contract years
beginning after the date of the enactment of this Act, sec-
tion 1842(c) (42 U.S.C. 1395u(c)), as amended by section
125(a), is amended by adding at the end the following new
paragraph:
‘‘(5) Each contract under this section which provides
for the disbursement of funds, as described in subsection
(a)(1)(B), shall require the carrier to meet criteria devel-
oped by the Secretary to measure the timeliness of carrier
responses to requests for payment of items described in
section 1834(a)(15)(C).’’.
(3) Effective on the date of the enactment of this Act,
section 1834(h)(3) (42 U.S.C. 1395m(h)(3)), as amended
by section 133(b), is amended by striking ‘‘(12) and (17)’’
and inserting ‘‘(12), (15), and (17)’’.
(c) STUDY OF VARIATIONS IN DURABLE MEDICAL
EQUIPMENT SUPPLIER COSTS.—
(1) COLLECTION AND ANALYSIS OF SUPPLIER
COST DATA.—The Administrator of the Health Care
Financing Administration shall, in consultation with
appropriate organizations, collect data on supplier
costs of durable medical equipment for which pay-
ment may be made under part B of the medicare
program, and shall analyze such data to determine
the proportions of such costs attributable to the
service and product components of furnishing such
equipment and the extent to which such proportions
vary by type of equipment and by the geographic re-
gion in which the supplier is located.
(2) DEVELOPMENT
OF
GEOGRAPHIC
ADJUST-
MENT
INDEX; REPORTS.—Not later than July 1,
1995—
(A) the Administrator shall submit a re-
port to the Committees on Energy and Com-
merce and Ways and Means of the House of
Representatives and the Committee on Finance
of the Senate on the data collected and the
analysis conducted under paragraph (1), and
shall include in such report the Administrator’s
recommendations for a geographic cost adjust-
ment index for suppliers of durable medical
equipment under the medicare program and an
analysis of the impact of such proposed index
on payments under the medicare program; and
(B) the Comptroller General shall submit a
report to the Committees on Energy and Com-
merce and Ways and Means of the House of
Representatives and the Committee on Finance
of the Senate analyzing on a geographic basis
the supplier costs of durable medical equipment
under the medicare program.
(d) 
OXYGEN
RETESTING.—(1) 
Section
1834(a)(5)(E) (42 U.S.C. 1395m(a)(5)(E)) is amended by
striking ‘‘55’’ and inserting ‘‘56’’.
(2) The amendment made by paragraph (1) shall be
effective on the date of the enactment of this Act.
(e) 
OTHER
MISCELLANEOUS
AND
TECHNICAL
AMENDMENTS.—(1) Section 4152(a)(3) of OBRA–1990
is amended by striking ‘‘amendment made by subsection
(a)’’ and inserting ‘‘amendments made by this sub-
section’’.
(2) Section 4152(c)(2) of OBRA–1990 is amended
by 
striking 
‘‘1395m(a)(7)(A)’’ 
and 
inserting
‘‘1395m(a)(7)’’.
(3) 
Section 
1834(a)(7)(A)(iii)(II) 
(42 
U.S.C.
1395m(a)(7)(A)(iii)(II)) is amended by striking ‘‘clause
(v)’’ and inserting ‘‘clause (vi)’’.
(4) 
Section 
1834(a)(7)(C)(i) 
(42 
U.S.C.
1395m(a)(7)(C)(i)) is amended by striking ‘‘or paragraph
(3)’’.
(5) Section 1834(a)(3) (42 U.S.C. 1395m(a)(3)) is
amended by striking subparagraph (D).
(6) Section 4153(c)(1) of OBRA–1990 is amended
by striking ‘‘1834(a)’’ and inserting ‘‘1834(h)’’.
(7) Section 4153(d)(2) of OBRA–1990 is amended
by striking ‘‘Reconiliation’’ and inserting ‘‘Reconcili-
ation’’.
(8) The amendments made by this subsection shall
take effect as if included in the enactment of OBRA–1990.
PART III—OTHER ITEMS AND SERVICES
SEC. 141. AMBULATORY SURGICAL CENTER SERVICES.
(a) PAYMENT AMOUNTS FOR SERVICES FURNISHED
IN AMBULATORY SURGICAL CENTERS.—
(1) USE OF SURVEY TO DETERMINE INCURRED
COSTS.—Section 
1833(i)(2)(A)(i) 
(42 
U.S.C.
1395l(i)(2)(A)(i)) is amended by striking the comma
at the end and inserting the following: ‘‘, as deter-
mined in accordance with a survey (based upon a
representative sample of procedures and facilities)
taken not later than January 1, 1995, and every 5
years thereafter, of the actual audited costs incurred
by such centers in providing such services,’’.
(2) AUTOMATIC
APPLICATION
OF
INFLATION
ADJUSTMENT.—Section 
1833(i)(2) 
(42 
U.S.C.
1395l(i)(2)) is amended—
(A) in the second sentence of subpara-
graph (A) and the second sentence of subpara-
graph (B), by striking ‘‘and may be adjusted by
the Secretary, when appropriate,’’; and
(B) by adding at the end the following new
subparagraph:
‘‘(C) Notwithstanding the second sentence of sub-
paragraph (A) or the second sentence of subparagraph
(B), if the Secretary has not updated amounts established
under such subparagraphs with respect to facility services
furnished during a fiscal year (beginning with fiscal year
1996), such amounts shall be increased by the percentage
increase in the consumer price index for all urban consum-
ers (U.S. city average) as estimated by the Secretary for
the 12-month period ending with the midpoint of the year
involved.’’.
(3) CONSULTATION
REQUIREMENT.—The sec-
ond sentence of section 1833(i)(1) (42 U.S.C.
1395l(i)(1)) is amended by striking the period and
inserting the following: ‘‘, in consultation with ap-
propriate trade and professional organizations.’’.
(b) ADJUSTMENTS TO PAYMENT AMOUNTS FOR NEW
TECHNOLOGY INTRAOCULAR LENSES.—
(1) ESTABLISHMENT OF PROCESS FOR REVIEW
OF AMOUNTS.—Not later than 1 year after the date
of the enactment of this Act, the Secretary of
Health and Human Services (in this subsection re-
ferred to as the ‘‘Secretary’’) shall develop and im-
plement a process under which interested parties
may request review by the Secretary of the appro-
priateness of the reimbursement amount provided
under section 1833(i)(2)(A)(iii) of the Social Secu-
rity Act with respect to a class of new technology
intraocular lenses. For purposes of the preceding
sentence, an intraocular lens may not be treated as
a new technology lens unless it has been approved
by the Food and Drug Administration.
(2) FACTORS
CONSIDERED.—In determining
whether to provide an adjustment of payment with
respect to a particular lens under paragraph (1), the
Secretary shall take into account whether use of the
lens is likely to result in reduced risk of
intraoperative or postoperative complication or trau-
ma, accelerated postoperative recovery, reduced in-
duced astigmatism, improved postoperative visual
acuity, more stable postoperative vision, or other
comparable clinical advantages.
(3) NOTICE
AND
COMMENT.—The Secretary
shall publish notice in the Federal Register from
time to time (but no less often than once each year)
of a list of the requests that the Secretary has re-
ceived for review under this subsection, and shall
provide for a 30-day comment period on the lenses
that are the subjects of the requests contained in
such notice. The Secretary shall publish a notice of
the Secretary’s determinations with respect to intra-
ocular lenses listed in the notice within 90 days after
the close of the comment period.
(4) EFFECTIVE DATE OF ADJUSTMENT.—Any
adjustment of a payment amount (or payment limit)
made under this subsection shall become effective
not later than 30 days after the date on which the
notice with respect to the adjustment is published
under paragraph (3).
(c) TECHNICAL CORRECTION RELATING TO BLEND
AMOUNTS FOR AMBULATORY SURGICAL CENTER PAY-
MENTS.—
(1) IN GENERAL.—Subclauses (I) and (II) of
section 
1833(i)(3)(B)(ii) 
(42 
U.S.C.
1395l(i)(3)(B)(ii)) are each amended—
(A) by striking ‘‘for reporting’’ and insert-
ing ‘‘for portions of cost reporting’’; and
(B) by striking ‘‘and on or before’’ and in-
serting ‘‘and ending on or before’’.
(2) EFFECTIVE DATE.—The amendments made
by paragraph (1) shall take effect as if included in
the enactment of OBRA–1990.
(d) TECHNICAL CORRECTION RELATED TO CATA-
RACT SURGERY.—Effective as if included in the enact-
ment of OBRA–1990, section 4151(c)(3) of such Act is
amended by striking ‘‘for the insertion of an intraocular
lens’’ and inserting ‘‘for an intraocular lens inserted’’.
SEC. 142. STUDY OF MEDICARE COVERAGE OF PATIENT
CARE COSTS ASSOCIATED WITH CLINICAL
TRIALS OF NEW CANCER THERAPIES.
(a) STUDY.—The Secretary of Health and Human
Services shall conduct a study of the effects of expressly
covering under the medicare program the patient care
costs for beneficiaries enrolled in clinical trials of new can-
cer therapies, where the protocol for the trial has been
approved by the National Cancer Institute or meets simi-
lar scientific and ethical standards, including approval by
an institutional review board. The study shall include—
(1) an estimate of the cost of such coverage,
taking into account the extent to which medicare
currently pays for such patient care costs in prac-
tice;
(2) an assessment of the extent to which such
clinical trials represent the best available treatment
for the patients involved and of the effects of partici-
pation in the trials on the health of such patients;
(3) an assessment of whether progress in devel-
oping new anticancer therapies would be assisted by
medicare coverage of such patient care costs; and
(4) an evaluation of whether there should be
special criteria for the admission of medicare bene-
ficiaries (on account of their age or physical condi-
tion) to clinical trials for which medicare would pay
the patient care costs.
(b) REPORT.—Not later than 2 years after the date
of the enactment of this Act, the Secretary of Health and
Human Services shall submit a report on the study con-
ducted under subsection (a) to the Committee on Ways
and Means and the Committee on Energy and Commerce
of the House of Representatives and the Committee on
Finance of the Senate. Such report shall include rec-
ommendations as to the coverage under the medicare pro-
gram of patient care costs of beneficiaries enrolled in clini-
cal trials of new cancer therapies.
SEC. 143. STUDY OF ANNUAL CAP ON AMOUNT OF MEDI-
CARE PAYMENT FOR OUTPATIENT PHYSICAL
THERAPY 
AND 
OCCUPATIONAL 
THERAPY
SERVICES.
(a) STUDY.—The Secretary of Health and Human
Services shall conduct a study of the appropriateness of
continuing an annual limitation on the amount of payment
for outpatient services of independently practicing physical
and occupational therapists under the medicare program.
(b) REPORT.—By not later than January 1, 1996,
the Secretary shall submit to the Committees on Energy
and Commerce and Ways and Means of the House of Rep-
resentatives and the Committee on Finance of the Senate
a report on the study conducted under subsection (a).
Such report shall include such recommendations for
changes in such annual limitation as the Secretary finds
appropriate.
SEC. 144. PAYMENT OF PART B PREMIUM LATE ENROLL-
MENT PENALTIES BY STATES.
Section 1839 (42 U.S.C. 1395r) is amended by add-
ing at the end the following new subsection:
‘‘(g)(1) Upon the request of a State, the Secretary
may enter into an agreement with the State under which
the State agrees to pay on a quarterly or other periodic
basis to the Secretary (to be deposited in the Treasury
to the credit of the Federal Supplementary Medical Insur-
ance Trust Fund) an amount equal to the amount of the
part B late enrollment premium increases with respect to
the premiums for eligible individuals (as defined in para-
graph (3)(A)).
‘‘(2) No part B late enrollment premium increase
shall apply to an eligible individual for premiums for
months for which the amount of such an increase is pay-
able under an agreement under paragraph (1).
‘‘(3) In this subsection:
‘‘(A) The term ‘eligible individual’ means an in-
dividual who is enrolled under this part B and who
is within a class of individuals specified in the agree-
ment under paragraph (1).
‘‘(B) The term ‘part B late enrollment premium
increase’ means any increase in a premium as a re-
sult of the application of subsection (b).’’.
SEC. 
145. 
APPLICATION 
OF 
MAMMOGRAPHY 
CERTIFI-
CATION REQUIREMENTS.
(a) SCREENING MAMMOGRAPHY.—Section 1834(c)
(42 U.S.C. 1395m(c)) is amended—
(1) in paragraph (1)(B), by striking ‘‘meets the
quality standards established under paragraph (3)’’
and inserting ‘‘is conducted by a facility that has a
certificate (or provisional certificate) issued under
section 354 of the Public Health Service Act’’;
(2) in paragraph (1)(C)(iii), by striking ‘‘para-
graph (4)’’ and inserting ‘‘paragraph (3)’’;
(3) by striking paragraph (3); and
(4) by redesignating paragraphs (4) and (5) as
paragraphs (3) and (4).
(b) 
DIAGNOSTIC
MAMMOGRAPHY.—Section
1861(s)(3) (42 U.S.C. 1395x(s)(3)) is amended by insert-
ing ‘‘and including diagnostic mammography if conducted
by a facility that has a certificate (or provisional certifi-
cate) issued under section 354 of the Public Health Serv-
ice Act’’ after ‘‘necessary’’.
(c) 
CONFORMING
AMENDMENTS.—(1) 
Section
1862(a)(1)(F) (42 U.S.C. 1395y(a)(1)(F)) is amended by
striking ‘‘or which does not meet the standards established
under section 1834(c)(3)’’ and inserting ‘‘or which is not
conducted 
by 
a 
facility 
described 
in 
section
1834(c)(1)(B)’’.
(2) Section 1863 (42 U.S.C. 1395z) is amended by
striking ‘‘or whether screening mammography meets the
standards established under section 1834(c)(3),’’.
(3) The first sentence of section 1864(a) (42 U.S.C.
1395aa(a)) is amended by striking ‘‘, or whether screening
mammography meets the standards established under sec-
tion 1834(c)(3)’’.
(4) The third sentence of section 1865(a) (42 U.S.C.
1395bb(a)) is amended by striking ‘‘1834(c)(3),’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to mammography furnished by a
facility on and after the first date that the certificate re-
quirements of section 354(b) of the Public Health Service
Act apply to such mammography conducted by such facil-
ity.
SEC. 146. COVERAGE OF SERVICES OF SPEECH-LANGUAGE
PATHOLOGISTS AND AUDIOLOGISTS.
(a) SERVICES DEFINED.—Section 1861 (42 U.S.C.
1395x), as amended by section 148(f)(6)(E), is amended
by inserting after subsection (kk) the following new sub-
section:
‘‘Speech-Language Pathology Services; Audiology
Services
‘‘(ll)(1) The term ‘speech-language pathology serv-
ices’ means such speech, language, and related function
assessment and rehabilitation services furnished by a
qualified speech-language pathologist as the speech-lan-
guage pathologist is legally authorized to perform under
State law (or the State regulatory mechanism provided by
State law) as would otherwise be covered if furnished by
a physician.
‘‘(2) The term ‘audiology services’ means such hear-
ing and balance assessment services furnished by a quali-
fied audiologist as the audiologist is legally authorized to
perform under State law (or the State regulatory mecha-
nism provided by State law), as would otherwise be cov-
ered if furnished by a physician.
‘‘(3) In this subsection:
‘‘(A) The term ‘qualified speech-language pa-
thologist’ means an individual with a master’s or
doctoral degree in speech-language pathology who—
‘‘(i) is licensed as a speech-language pa-
thologist by the State in which the individual
furnishes such services, or
‘‘(ii) in the case of an individual who fur-
nishes services in a State which does not license
speech-language pathologists, has successfully
completed 350 clock hours of supervised clinical
practicum (or is in the process of accumulating
such supervised clinical experience), performed
not less than 9 months of supervised full-time
speech-language pathology services after obtain-
ing a master’s or doctoral degree in speech-lan-
guage pathology or a related field, and success-
fully completed a national examination in
speech-language pathology approved by the Sec-
retary.
‘‘(B) The term ‘qualified audiologist’ means an
individual with a master’s or doctoral degree in
audiology who—
‘‘(i) is licensed as an audiologist by the
State in which the individual furnishes such
services, or
‘‘(ii) in the case of an individual who fur-
nishes services in a State which does not license
audiologists has successfully completed 350
clock hours of supervised clinical practicum (or
is in the process of accumulating such super-
vised clinical experience), performed not less
than 9 months of supervised full-time audiology
services after obtaining a master’s or doctoral
degree in audiology or a related field, and suc-
cessfully completed a national examination in
audiology approved by the Secretary.’’.
(b) CONFORMING AMENDMENTS RELATING TO MED-
ICARE TREATMENT OF SPEECH AND LANGUAGE SERV-
ICES.—
(1) 
EXTENDED
CARE
SERVICES.—Section
1861(h)(3) (42 U.S.C. 1395x(h)(3)) is amended by
striking ‘‘, occupational, or speech therapy’’ and in-
serting ‘‘or occupational therapy or speech-language
pathology services’’.
(2) 
HOME
HEALTH
SERVICES.—Section
1861(m)(2) (42 U.S.C. 1395x(m)(2)) is amended by
striking ‘‘, occupational, or speech therapy’’ and in-
serting ‘‘or occupational therapy or speech-language
pathology services’’.
(3) OUTPATIENT
PHYSICAL
THERAPY
SERV-
ICES.—The fourth sentence of section 1861(p) (42
U.S.C. 1395x(p)) is amended by striking ‘‘speech
pathology services’’ and inserting ‘‘speech-language
pathology services’’.
(4) COMPREHENSIVE OUTPATIENT REHABILITA-
TION FACILITY SERVICES.—Section 1861(cc)(1)(B)
(42 U.S.C. 1395x(cc)(1)(B)) is amended by striking
‘‘speech pathology services’’ and inserting ‘‘speech-
language pathology services’’.
(5) HOSPICE
CARE.—Section 1861(dd)(1)(B)
(42 U.S.C. 1395x(dd)(1)(B)) is amended by striking
‘‘therapy or speech-language pathology’’ and insert-
ing ‘‘therapy, or speech-language pathology serv-
ices’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall take effect on January 1, 1995.
SEC. 147. MISCELLANEOUS AND TECHNICAL CORRECTIONS.
(a) REVISION OF INFORMATION ON PART B CLAIMS
FORMS.—Section 1833(q)(1) (42 U.S.C. 1395l(q)(1)) is
amended—
(1) by striking ‘‘provider number’’ and inserting
‘‘unique physician identification number’’; and
(2) by striking ‘‘and indicate whether or not the
referring physician is an interested investor (within
the meaning of section 1877(h)(5))’’.
(b) CONSULTATION FOR SOCIAL WORKERS.—Effec-
tive with respect to services furnished on or after January
1, 1991, section 6113(c) of OBRA–1989 is amended—
(1) by inserting ‘‘and clinical social worker
services’’ after ‘‘psychologist services’’; and
(2) by striking ‘‘psychologist’’ the second and
third place it appears and inserting ‘‘psychologist or
clinical social worker’’.
(c) REPORTS
ON
HOSPITAL
OUTPATIENT
PAY-
MENT.—(1) OBRA–1989 is amended by striking section
6137.
(2) Section 1135(d) (42 U.S.C. 1320b–5(d)) is
amended—
(A) by striking paragraph (6); and
(B) in paragraph (7)—
(i) by striking ‘‘systems’’ each place it ap-
pears and inserting ‘‘system’’; and
(ii) by striking ‘‘paragraphs (1) and (6)’’
and inserting ‘‘paragraph (1)’’.
(d) RADIOLOGY AND DIAGNOSTIC SERVICES PRO-
VIDED IN HOSPITAL OUTPATIENT DEPARTMENTS.—(1)
Effective as if included in the enactment of OBRA–1989,
section 
1833(n)(1)(B)(i)(II) 
(42 
U.S.C.
1395l(n)(1)(B)(i)(II)) is amended—
(A) by inserting ‘‘and for services described in
subsection (a)(2)(E)(ii) furnished on or after Janu-
ary 1, 1992’’ after ‘‘1989’’; and
(B) by striking ‘‘1842(b)’’ and inserting
‘‘1842(b) (or, in the case of services furnished on or
after January 1, 1992, under section 1848)’’.
(2) Effective as if included in the enactment of
OBRA–1989, section 1833(n)(1)(B)(i)(II) (42 U.S.C.
1395l(n)(1)(B)(i)(II)) is amended by striking ‘‘January 1,
1989’’ and inserting ‘‘April 1, 1989’’.
(e) PAYMENTS TO NURSE PRACTITIONERS IN RURAL
AREAS (SECTION 4155 OF OBRA–1990).—(1) Section
1861(s)(2)(K)(iii) (42 U.S.C. 1395x(s)(2)(K)(iii)) is
amended—
(A) by striking ‘‘subsection (aa)(3)’’ and insert-
ing ‘‘subsection (aa)(5)’’; and
(B) by striking ‘‘subsection (aa)(4)’’ and insert-
ing ‘‘subsection (aa)(6)’’.
(2) Section 1833(r)(1) (42 U.S.C. 1395l(r)(1)) is
amended—
(A) by striking ‘‘ambulatory’’ each place it ap-
pears and inserting ‘‘or ambulatory’’; and
(B) by striking ‘‘center,’’ and inserting ‘‘cen-
ter’’.
(3) Section 1833(r)(2)(A) (42 U.S.C. 1395l(r)(2)(A))
is amended by striking ‘‘subsection (a)(1)(M)’’ and insert-
ing ‘‘subsection (a)(1)(O)’’.
(4) Section 1861(b)(4) (42 U.S.C. 1395x(b)(4)) is
amended by striking ‘‘subsection (s)(2)(K)(i)’’ and insert-
ing ‘‘clauses (i) or (iii) of subsection (s)(2)(K)’’.
(5) Section 1861(aa)(5) (42 U.S.C. 1395x(aa)(5)) is
amended by striking ‘‘this Act’’ and inserting ‘‘this title’’.
(6) Section 1862(a)(14) (42 U.S.C. 1395y(a)(14)) is
amended by striking ‘‘1861(s)(2)(K)(i)’’ and inserting
‘‘1861(s)(2)(K)(i) or 1861(s)(2)(K)(iii)’’.
(7) 
Section 
1866(a)(1)(H) 
(42 
U.S.C.
1395cc(a)(1)(H)) 
is 
amended 
by 
striking
‘‘1861(s)(2)(K)(i)’’ and inserting ‘‘1861(s)(2)(K)(i) or
1861(s)(2)(K)(iii)’’.
(f) 
OTHER
MISCELLANEOUS
AND
TECHNICAL
AMENDMENTS.—
(1) IMMEDIATE ENROLLMENT IN PART B BY IN-
DIVIDUALS
COVERED
BY
AN
EMPLOYMENT-BASED
PLAN.—(A) Subparagraphs (A) and (B) of section
1837(i)(3) (42 U.S.C. 1395p(i)(3)) are each amend-
ed—
(i) by striking ‘‘beginning with the first
day of the first month in which the individual
is no longer enrolled’’ and inserting ‘‘including
each month during any part of which the indi-
vidual is enrolled’’; and
(ii) by striking ‘‘and ending seven months
later’’ and inserting ‘‘ending with the last day
of the eighth consecutive month in which the in-
dividual is at no time so enrolled’’.
(B) Paragraphs (1) and (2) of section 1838(e)
(42 U.S.C. 1395q(e)) are amended to read as fol-
lows:
‘‘(1) in any month of the special enrollment pe-
riod in which the individual is at any time enrolled
in a plan (specified in subparagraph (A) or (B), as
applicable, of section 1837(i)(3)) or in the first
month following such a month, the coverage period
shall begin on the first day of the month in which
the individual so enrolls (or, at the option of the in-
dividual, on the first day of any of the following
three months), or
‘‘(2) in any other month of the special enroll-
ment period, the coverage period shall begin on the
first day of the month following the month in which
the individual so enrolls.’’.
(C) The amendments made by subparagraphs
(A) and (B) shall take effect on the first day of the
first month that begins after the expiration of the
120-day period that begins on the date of the enact-
ment of this Act.
(2) 
CLINICAL
DIAGNOSTIC
LABORATORY
TESTS.—Section 4154(e)(5) of OBRA–1990 is
amended 
by 
striking 
‘‘(1)(A)’’ 
and 
inserting
‘‘(1)(A),’’.
(3) SEPARATE PAYMENT UNDER PART B FOR
CERTAIN
SERVICES.—Section 4157(a) of OBRA–
1990 is amended by striking ‘‘(a) SERVICES OF’’
and all that follows through ‘‘Section’’ and inserting
‘‘(a) TREATMENT
OF
SERVICES
OF
CERTAIN
HEALTH PRACTITIONERS.—Section’’.
(4) COMMUNITY HEALTH CENTERS AND RURAL
HEALTH CLINICS.—(A) The fourth sentence of sec-
tion 1861(aa)(2) (42 U.S.C. 1395x(aa)(2)) is
amended—
(i) by striking ‘‘certification’’ the first
place it appears and inserting ‘‘approval’’; and
(ii) by striking ‘‘the Secretary’s approval
or disapproval of the certification’’ and insert-
ing ‘‘Secretary’s approval or disapproval’’.
(B) Section 4161(a)(7)(B) of OBRA–1990 is
amended by inserting ‘‘and to the Committee on Fi-
nance of the Senate’’ after ‘‘Representatives’’.
(5) SCREENING MAMMOGRAPHY.—Section 4163
of OBRA–1990 is amended—
(A) by adding at the end of subsection (d)
the following new paragraph:
‘‘(3) The amendment made by paragraph
(2)(A)(iv) shall apply to screening pap smears per-
formed on or after July 1, 1990.’’; and
(B) in subsection (e), by striking ‘‘The
amendments’’ and inserting ‘‘Except as pro-
vided in subsection (d)(3), the amendments’’.
(6) INJECTABLE DRUGS FOR TREATMENT OF
OSTEOPOROSIS.—
(A) 
CLARIFICATION
OF
DRUGS
COV-
ERED.—The 
section 
1861(jj) 
(42 
U.S.C.
1395x(jj)) inserted by section 4156(a)(2) of
OBRA–1990 is amended—
(i) in the matter preceding paragraph
(1), by striking ‘‘a bone fracture related
to’’; and
(ii) in paragraph (1), by striking ‘‘pa-
tient’’ and inserting ‘‘individual has suf-
fered a bone fracture related to post-meno-
pausal osteoporosis and that the individ-
ual’’.
(B) LIMITING COVERAGE TO DRUGS PRO-
VIDED BY HOME HEALTH AGENCIES.—(i) The
section 1861(jj) (42 U.S.C. 1395x(jj)) inserted
by section 4156(a)(2) of OBRA–1990 is
amended by striking ‘‘if’’ and inserting ‘‘by a
home health agency if’’.
(ii) 
Section 
1861(m)(5) 
(42 
U.S.C.
1395x(m)(5)) is amended by striking ‘‘but ex-
cluding’’ 
and 
inserting 
‘‘and 
a 
covered
osteoporosis drug (as defined in subsection
(kk), but excluding other’’.
(iii) 
Section 
1861(s)(2) 
(42 
U.S.C.
1395x(s)(2)) is amended—
(I) by adding ‘‘and’’ at the end of
subparagraph (N), and
(II) by striking subparagraph (O) and
redesignating subparagraph (P) as sub-
paragraph (O).
(C) PAYMENT
BASED
ON
REASONABLE
COST.—Section 
1833(a)(2) 
(42 
U.S.C.
1395l(a)(2)) is amended—
(i) in subparagraph (A), by striking
‘‘health services’’ and inserting ‘‘health
services (other than a covered osteoporosis
drug (as defined in section 1861(kk)))’’;
(ii) by striking ‘‘and’’ at the end of
subparagraph (D);
(iii) by striking the semicolon at the
end of subparagraph (E) and inserting ‘‘;
and’’; and
(iv) by adding at the end the following
new subparagraph:
‘‘(F) with respect to a covered osteoporosis
drug (as defined in section 1861(kk)) furnished
by a home health agency, 80 percent of the rea-
sonable cost of such service, as determined
under section 1861(v);’’.
(D) APPLICATION
OF
PART
B
DEDUCT-
IBLE.—Section 
1833(b)(2) 
(42 
U.S.C.
1395l(b)(2)) is amended by striking ‘‘services’’
and inserting ‘‘services (other than a covered
osteoporosis 
drug 
(as 
defined 
in 
section
1861(kk)))’’.
(E) COVERED OSTEOPOROSIS DRUG (SEC-
TION 4156 OF OBRA–1990).—Section 1861 (42
U.S.C. 1395x) is amended, in the subsection
(jj) inserted by section 4156(a)(2) of OBRA–
1990, by striking ‘‘(jj) The term’’ and inserting
‘‘(kk) The term’’.
(7) OTHER
MISCELLANEOUS
AND
TECHNICAL
CORRECTIONS.—
(A) OWNERSHIP
DISCLOSURE
REQUIRE-
MENTS.—(i) 
Section 
1124A(a)(2)(A) 
(42
U.S.C. 1320a–3a(a)(2)(A)) is amended by
striking ‘‘of the Social Security Act’’.
(ii) Section 4164(b)(4) of OBRA–1990 is
amended by striking ‘‘paragraph’’ and inserting
‘‘paragraphs’’.
(B) DIRECTORY
OF
UNIQUE
PHYSICIAN
IDENTIFIER
NUMBERS.—Section 4164(c) of
OBRA–1990 is amended by striking ‘‘publish’’
and inserting ‘‘publish, and shall periodically
update,’’.
(g) EFFECTIVE DATE.—Except as otherwise provided
in this section, the amendments made by this section shall
take effect as if included in the enactment of OBRA–1990.
Subtitle C—Provisions Relating to
Parts A and B
SEC. 151. MEDICARE SECONDARY PAYER REFORMS.
(a) IMPROVING IDENTIFICATION OF MEDICARE SEC-
ONDARY PAYER SITUATIONS.—
(1) SURVEY OF BENEFICIARIES.—
(A) IN GENERAL.—Section 1862(b)(5) (42
U.S.C. 1395y(b)(5)) is amended by adding at
the end the following new subparagraph:
‘‘(D) 
OBTAINING
INFORMATION
FROM
BENEFICIARIES.—Before an individual applies
for benefits under part A or enrolls under part
B, the Administrator shall mail the individual a
questionnaire to obtain information on whether
the individual is covered under a primary plan
and the nature of the coverage provided under
the plan, including the name, address, and iden-
tifying number of the plan.’’.
(B) DISTRIBUTION OF QUESTIONNAIRE BY
CONTRACTOR.—The Secretary of Health and
Human Services shall enter into an agreement
with an entity not later than 60 days after the
date of enactment of the Social Security Act
Amendments of 1994, to distribute the ques-
tionnaire described in section 1862(b)(5)(D) of
the Social Security Act (as added by subpara-
graph (A)).
(C) NO MEDICARE SECONDARY PAYER DE-
NIAL BASED ON FAILURE TO COMPLETE QUES-
TIONNAIRE.—Section 1862(b)(2) (42 U.S.C.
1395y(b)(2)) is amended by adding at the end
the following new subparagraph:
‘‘(C) TREATMENT OF QUESTIONNAIRES.—
The Secretary may not fail to make payment
under subparagraph (A) solely on the ground
that an individual failed to complete a question-
naire concerning the existence of a primary
plan.’’.
(2) MANDATORY
SCREENING
BY
PROVIDERS
AND SUPPLIERS UNDER PART B.—
(A) IN
GENERAL.—Section 1862(b) (42
U.S.C. 1395y(b)) is amended by adding at the
end the following new paragraph:
‘‘(6) SCREENING REQUIREMENTS FOR PROVID-
ERS AND SUPPLIERS.—
‘‘(A) IN GENERAL.—Notwithstanding any
other provision of this title, no payment may be
made for any item or service furnished under
part B unless the entity furnishing such item or
service completes (to the best of its knowledge
and on the basis of information obtained from
the individual to whom the item or service is
furnished) the portion of the claim form relat-
ing to the availability of other health benefit
plans.
‘‘(B) PENALTIES.—An entity that know-
ingly, willfully, and repeatedly fails to complete
a claim form in accordance with subparagraph
(A) or provides inaccurate information relating
to the availability of other health benefit plans
on a claim form under such subparagraph shall
be subject to a civil money penalty of not to ex-
ceed $2,000 for each such incident. The provi-
sions of section 1128A (other than subsections
(a) and (b)) shall apply to a civil money penalty
under the previous sentence in the same man-
ner as such provisions apply to a penalty or
proceeding under section 1128A(a).’’.
(B) EFFECTIVE
DATE.—The amendment
made by subparagraph (A) shall apply with re-
spect to items and services furnished on or
after the expiration of the 120-day period be-
ginning on the date of enactment of this Act.
(b) IMPROVEMENTS
IN RECOVERY
OF PAYMENTS
FROM PRIMARY PAYERS.—
(1) SUBMISSION OF REPORTS ON EFFORTS TO
RECOVER ERRONEOUS PAYMENTS.—
(A) FISCAL INTERMEDIARIES UNDER PART
A.—Section 1816 (42 U.S.C. 1396h) is amend-
ed by adding at the end the following new sub-
section:
‘‘(k) An agreement with an agency or organization
under this section shall require that such agency or orga-
nization submit an annual report to the Secretary describ-
ing the steps taken to recover payments made for items
or services for which payment has been or could be made
under 
a 
primary 
plan 
(as 
defined 
in 
section
1862(b)(2)(A)).’’.
(B) CARRIERS
UNDER
PART
B.—Section
1842(b)(3) (42 U.S.C. 1395u(b)(3)) is amend-
ed—
(i) by striking ‘‘and’’ at the end of
subparagraph (G);
(ii) by striking ‘‘and’’ at the end of
subparagraph (H); and
(iii) by inserting after subparagraph
(H) the following new subparagraph:
‘‘(I) will submit annual reports to the Secretary
describing the steps taken to recover payments made
under this part for items or services for which pay-
ment has been or could be made under a primary
plan (as defined in section 1862(b)(2)(A)); and’’.
(2) REQUIREMENTS UNDER CARRIER PERFORM-
ANCE EVALUATION PROGRAM.—
(A) FISCAL INTERMEDIARIES UNDER PART
A.—Section 
1816(f)(1)(A) 
(42 
U.S.C.
1396h(f)(1)(A)) is amended by striking ‘‘proc-
essing’’ and inserting ‘‘processing (including the
agency’s or organization’s success in recovering
payments made under this title for services for
which payment has been or could be made
under a primary plan (as defined in section
1862(b)(2)(A)))’’.
(B) CARRIERS
UNDER
PART
B.—Section
1842(b)(2) (42 U.S.C. 1395u(b)(2)) is amended
by adding at the end the following new sub-
paragraph:
‘‘(D) In addition to any other standards and criteria
established by the Secretary for evaluating carrier per-
formance under this paragraph relating to avoiding erro-
neous payments, the carrier shall be subject to standards
and criteria relating to the carrier’s success in recovering
payments made under this part for items or services for
which payment has been or could be made under a pri-
mary plan (as defined in section 1862(b)(2)(A)).’’.
(3) DEADLINE FOR REIMBURSEMENT BY PRI-
MARY PLANS.—
(A) 
IN
GENERAL.—Section
1862(b)(2)(B)(i) (42 U.S.C. 1395y(b)(2)(B)(i))
is amended by adding at the end the following
sentence: ‘‘If reimbursement is not made to the
appropriate Trust Fund before the expiration of
the 60-day period that begins on the date such
notice or other information is received, the Sec-
retary may charge interest (beginning with the
date on which the notice or other information
is received) on the amount of the reimburse-
ment until reimbursement is made (at a rate
determined by the Secretary in accordance with
regulations of the Secretary of the Treasury
applicable to charges for late payments).’’.
(B) 
CONFORMING
AMENDMENT.—The
heading of clause (i) of section 1862(b)(2)(B) is
amended to read as follows: ‘‘REPAYMENT RE-
QUIRED.—’’.
(C) EFFECTIVE DATE.—The amendments
made by this paragraph shall apply to payments
for items and services furnished on or after the
date of the enactment of this Act.
(4) EFFECTIVE DATE.—The amendments made
by paragraphs (1) and (2) shall apply to contracts
with fiscal intermediaries and carriers under title
XVIII of the Social Security Act for contract years
beginning with 1995.
(c) MISCELLANEOUS
AND
TECHNICAL
CORREC-
TIONS.—
(1) Effective as if included in the enactment of
OBRA–1993, section 1862(b)(1)(A) (42 U.S.C.
1395y(b)(1)(A)), as amended by section 13561(e)(1)
of OBRA–1993, is amended—
(A) in clause (i)(II), by striking ‘‘over (and
the individual’s spouse age 65 or older) who is
covered under the plan by virtue of the individ-
ual’s current employment status with an em-
ployer’’ and inserting ‘‘older (and the spouse
age 65 or older of any individual) who has cur-
rent employment status with an employer’’; and
(B) in clause (ii), by striking ‘‘or employee
organization that has 20 or more individuals in
current employment status’’ and inserting ‘‘that
has 20 or more employees’’.
(2) Effective as if included in the enactment of
OBRA–1993, section 1837(i) (42 U.S.C. 1395p(i))
is amended—
(A) by striking ‘‘as an active individual (as
those 
terms 
are 
defined 
in 
section
1862(b)(1)(B)(iv))’’ each place it appears in the
second sentence of paragraph (1), and the sec-
ond sentence of paragraph (2) and inserting
100
‘‘(as 
that 
term 
is 
defined 
in 
section
1862(b)(1)(B)(iv)) by reason of the individual’s
current employment status (or the current em-
ployment status of a family member of the indi-
vidual)’’;
(B) in paragraph (3)(B), by striking ‘‘as
an active individual in a large group health plan
(as 
such 
terms 
are 
defined 
in 
section
1862(b)(1)(B)(iv))’’ and inserting ‘‘in a large
group health plan (as that term is defined in
section 1862(b)(1)(B)(iv)) by reason of the in-
dividual’s current employment status (or the
current employment status of a family member
of the individual)’’;
(C) in the second sentence of paragraph
(2) (as amended by subparagraph (A)), by
striking ‘‘as an active individual’’ and inserting
‘‘by reason of the individual’s current employ-
ment status (or the current employment status
of a family member of the individual)’’; and
(D) by inserting ‘‘status’’ after ‘‘current
employment’’ each place it appears in para-
graphs (1)(A), (2)(B), (2)(C), and (3)(A).
101
(3) Effective as if included in the enactment of
OBRA–1993, the second sentence of section 1839(b)
(42 U.S.C. 1395r(b)) is amended—
(A) by inserting ‘‘status’’ after ‘‘current
employment’’, and
(B) by striking ‘‘as an active individual (as
those 
terms 
are 
defined 
in 
section
1862(b)(1)(B)(iv))’’ and inserting ‘‘(as that
term is defined in section 1862(b)(1)(B)(iv)) by
reason of the individual’s current employment
status (or the current employment status of a
family member of the individual)’’.
(4) Effective as if included in the enactment of
OBRA–1990, the sentence in section 1862(b)(1)(C)
added by section 4203(c)(1)(B) of OBRA–1990 is
amended by striking ‘‘clauses (i) and (ii)’’ and in-
serting ‘‘this subparagraph’’.
(5) Effective as if included in the enactment of
OBRA–1989, section 1862(b)(1)(C) is amended in
the matter after clause (ii), by striking ‘‘taking into
account that’’ and inserting ‘‘paying benefits second-
ary to this title when’’.
(6) Effective as if included in the enactment of
OBRA–1989, section 1862(b)(5)(C)(i) (42 U.S.C.
1395y(b)(5)(C)(i)) 
is 
amended 
by 
striking
102
‘‘6103(l)(12)(D)(iii)’’ 
and 
inserting
‘‘6103(l)(12)(E)(iii)’’.
(7) Effective as if included in the enactment of
OBRA–1990, section 4203(c)(2) of such Act is
amended—
(A) by striking ‘‘the application of clause
(iii)’’ and inserting ‘‘the second sentence’’;
(B) by striking ‘‘on individuals’’ and all
that follows through ‘‘section 226A of such
Act’’;
(C) in clause (ii), by striking ‘‘clause’’ and
inserting ‘‘sentence’’;
(D) in clause (v), by adding ‘‘and’’ at the
end; and
(E) in clause (vi)—
(i) by inserting ‘‘of such Act’’ after
‘‘1862(b)(1)(C)’’, and
(ii) by striking the period at the end
and inserting the following: ‘‘, without re-
gard to the number of employees covered
by such plans.’’.
(8) Effective as if included in the enactment of
OBRA–1990, section 4203(d) of OBRA–1990 is
amended by striking ‘‘this subsection’’ and inserting
‘‘this section’’.
103
(9) Effective as if included in the enactment of
OBRA–1993, section 13561(e)(1)(D) of OBRA–
1993 is amended—
(A) by inserting ‘‘effective as if included in
the enactment of OBRA–1989,’’ after ‘‘(D)’’,
and
(B) by striking ‘‘of each subparagraph’’.
(10) 
The 
amendment 
made 
by 
section
13561(e)(1)(G) of OBRA–1993, to the extent it re-
lates to the definition of large group health plan,
shall be effective as if included in the enactment of
OBRA–1989.
SEC. 152. PHYSICIAN OWNERSHIP AND REFERRAL.
(a) IN
GENERAL.—Section 1877(f) (42 U.S.C.
1395nn) is amended—
(1) in the matter before paragraph (1), by in-
serting ‘‘, investment, and compensation’’ after
‘‘ownership’’;
(2) in paragraph (2), by inserting ‘‘, or with a
compensation arrangement (as described in sub-
section (a)(2)(B)),’’ after ‘‘investment interest (as
described in subsection (a)(2)(A))’’;
(3) in paragraph (2), by inserting ‘‘interest or
who have such a compensation relationship with the
entity’’ before the period at the end;
104
(4) in the fourth sentence, by striking ‘‘covered
items and’’ and inserting ‘‘designated health’’; and
(5) by striking the third and fifth sentences.
(b) RADIOLOGY SERVICES.—Section 1877(h)(6) (42
U.S.C. 1395nn(h)(6)), as amended by section 13562(a)(2)
of OBRA–1993, is amended—
(1) in subparagraph (D), by striking ‘‘or other
diagnostic services’’ and inserting ‘‘services, includ-
ing magnetic resonance imaging, computerized axial
tomography scans, and ultrasound services’’; and
(2) in subparagraphs (E), (F), and (H), by in-
serting ‘‘and supplies’’ before the period at the end.
(c) REVISION OF EFFECTIVE DATE EXCEPTION PRO-
VISION.—Section 13562(b)(2) of OBRA–1993 is amended
by striking subparagraphs (A) and (B) and inserting the
following:
‘‘(A) the second sentence of subsection
(a)(2), and subsections (b)(2)(B) and (d)(2), of
section 1877 of the Social Security Act (as in
effect on the day before the date of the enact-
ment of this Act) shall apply instead of the cor-
responding provisions in section 1877 (as
amended by this Act);
105
‘‘(B) section 1877(b)(4) of the Social Se-
curity Act (as in effect on the day before the
date of the enactment of this Act) shall apply;
‘‘(C) 
the 
requirements 
of 
section
1877(c)(2) of the Social Security Act (as
amended by this Act) shall not apply to any se-
curities of a corporation that meets the require-
ments of section 1877(c)(2) of the Social Secu-
rity Act (as in effect on the day before the date
of the enactment of this Act);
‘‘(D) section 1877(e)(3) of the Social Secu-
rity Act (as amended by this Act) shall apply,
except that it shall not apply to any arrange-
ment that meets the requirements of subsection
(e)(2) or subsection (e)(3) of section 1877 of
the Social Security Act (as in effect on the day
before the date of the enactment of this Act);
‘‘(E) the requirements of clauses (iv) and
(v) of section 1877(h)(4)(A), and of clause (i)
of section 1877(h)(4)(B), of the Social Security
Act (as amended by this Act) shall not apply;
and
‘‘(F) section 1877(h)(4)(B) of the Social
Security Act (as in effect on the day before the
date of the enactment of this Act) shall apply
106
instead of section 1877(h)(4)(A)(ii) of such Act
(as amended by this Act).’’.
(d) EFFECTIVE DATES.—
(1) The amendments made by subsections (a)
and (b) shall apply to referrals made on or after
January 1, 1995.
(2) The amendment made by subsection (c)
shall apply as if included in the enactment of
OBRA–1993.
SEC. 153. DEFINITION OF FMGEMS EXAMINATION FOR PAY-
MENT OF DIRECT GRADUATE MEDICAL EDU-
CATION.
(a) IN GENERAL.—Section 1886(h)(5)(E) (42 U.S.C.
1395ww(h)(5)(E)) is amended by inserting ‘‘or any suc-
cessor examination’’ after ‘‘Medical Sciences’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply as if included in the enactment
of the Consolidated Omnibus Budget Reconciliation Act
of 1985 (Public Law 99–272).
SEC. 154. QUALIFIED MEDICARE BENEFICIARY OUTREACH.
Not later than 1 year after the date of the enactment
of this Act, the Secretary of Health and Human Services
shall establish and implement a method for obtaining in-
formation from newly eligible medicare beneficiaries that
may be used to determine whether such beneficiaries may
107
be eligible for medical assistance for medicare cost-sharing
under State medicaid plans as qualified medicare bene-
ficiaries, and for transmitting such information to the
State in which such a beneficiary resides.
SEC. 155. HOSPITAL AGREEMENTS WITH ORGAN PROCURE-
MENT ORGANIZATIONS.
(a) HOSPITAL AGREEMENTS.—
(1) IN GENERAL.—
(A) 
IDENTIFICATION
OF
ORGAN
DO-
NORS.—Section 1138(a)(1)(A)(iii) (42 U.S.C.
1320b–8(a)(1)(A)(iii)) is amended to read as
follows:
‘‘(iii) require that such hospital’s des-
ignated organ procurement agency (as defined
in paragraph (3)(B)) is notified of potential
organ donors;’’.
(B) 
AGREEMENTS
WITH
DESIGNATED
ORGAN
PROCUREMENT
AGENCIES.—Section
1138(a)(1) 
(42 
U.S.C. 
1320b–8(a)(1)) 
is
amended—
(i) by striking the period at the end of
subparagraph (B) and inserting ‘‘; and’’;
and
(ii) by adding at the end the following
new subparagraph:
108
‘‘(C) the hospital or rural primary care hospital
has an agreement (as defined in paragraph (3)(A))
only with such hospital’s designated organ procure-
ment agency.’’.
(C) WAIVER OF REQUIREMENTS RELATED
TO AGREEMENTS.—Section 1138(a) (42 U.S.C.
1320b–8(a)) is amended—
(i) by redesignating paragraph (2) as
paragraph (3); and
(ii) by inserting after paragraph (1)
the following new paragraph:
‘‘(2)(A) The Secretary shall grant a waiver of the re-
quirements under subparagraphs (A)(iii) and (C) of para-
graph (1) to a hospital or rural primary care hospital de-
siring to enter into an agreement with an organ procure-
ment agency other than such hospital’s designated organ
procurement agency if the Secretary determines that—
‘‘(i) the waiver is expected to increase organ do-
nation; and
‘‘(ii) the waiver will assure equitable treatment
of patients referred for transplants within the serv-
ice area served by such hospital’s designated organ
procurement agency and within the service area
served by the organ procurement agency with which
109
the hospital seeks to enter into an agreement under
the waiver.
‘‘(B) In making a determination under subparagraph
(A), the Secretary may consider factors that would in-
clude, but not be limited to—
‘‘(i) cost effectiveness;
‘‘(ii) improvements in quality;
‘‘(iii) whether there has been any change in a
hospital’s designated organ procurement agency due
to a change made on or after December 28, 1992,
in the definitions for metropolitan statistical areas
(as established by the Office of Management and
Budget); and
‘‘(iv) the length and continuity of a hospital’s
relationship with an organ procurement agency other
than the hospital’s designated organ procurement
agency;
except that nothing in this subparagraph shall be con-
strued to permit the Secretary to grant a waiver that does
not meet the requirements of subparagraph (A).
‘‘(C) Any hospital or rural primary care hospital
seeking a waiver under subparagraph (A) shall submit an
application to the Secretary containing such information
as the Secretary determines appropriate.
‘‘(D) The Secretary shall—
110
‘‘(i) publish a public notice of any waiver appli-
cation received from a hospital or rural primary care
hospital under this paragraph within 30 days of re-
ceiving such application; and
‘‘(ii) prior to making a final determination on
such application under subparagraph (A), offer in-
terested parties the opportunity to submit written
comments to the Secretary during the 60-day period
beginning on the date such notice is published.’’.
(D) 
DEFINITIONS.—Section 
1138(a)(3)
(42 U.S.C. 1320b–8(a)(3)), as redesignated by
subparagraph (C), is amended to read as fol-
lows:
‘‘(3) For purposes of this subsection—
‘‘(A) the term ‘agreement’ means an agreement
described in section 371(b)(3)(A) of the Public
Health Service Act;
‘‘(B) the term ‘designated organ procurement
agency’ means, with respect to a hospital or rural
primary care hospital, the organ procurement agency
designated pursuant to subsection (b) for the service
area in which such hospital is located; and
‘‘(C) the term ‘organ’ means a human kidney,
liver, heart, lung, pancreas, and any other human
111
organ or tissue specified by the Secretary for pur-
poses of this subsection.’’.
(2) EXISTING AGREEMENTS.—Any hospital or
rural primary care hospital which has an agreement
(as defined in section 1138(a)(3)(A) of the Social
Security Act) with an organ procurement agency
other than such hospital’s designated organ procure-
ment agency (as defined in section 1138(a)(3)(B) of
such Act) on the date of the enactment of this sec-
tion shall, if such hospital desires to continue such
agreement on and after the effective date of the
amendments made by paragraph (1), submit an ap-
plication to the Secretary for a waiver under section
1138(a)(2) of such Act not later than January 1,
1996, and such agreement may continue in effect
pending the Secretary’s determination with respect
to such application.
(3) EFFECTIVE DATE.—The amendments made
by paragraph (1) shall apply to hospitals and rural
primary care hospitals participating in the programs
under titles XVIII and XIX of the Social Security
Act beginning January 1, 1996.
(b) STUDY ON HOSPITAL AGREEMENTS WITH ORGAN
PROCUREMENT AGENCIES.—
112
(1) IN
GENERAL.—The Office of Technology
Assessment (referred to in this section as the
‘‘OTA’’) shall, pursuant to the approval of the Tech-
nology Assessment Board of the OTA, conduct a
study to determine the efficacy and fairness of re-
quiring a hospital to enter into an agreement under
section 371(b)(3)(A) of the Public Health Service
Act with the organ procurement agency designated
pursuant to section 1138(b) of the Social Security
Act for the service area in which such hospital is lo-
cated and the impact of such requirement on the ef-
ficacy and fairness of organ procurement and dis-
tribution.
(2) REPORT.—Not later than 2 years after the
date of the enactment of this Act, the OTA shall
complete the study required under paragraph (1)
and prepare and submit to the Committee on Fi-
nance and the Committee on Labor and Human Re-
sources of the Senate and the Committee on Ways
and Means and the Committee on Energy and Com-
merce of the House of Representatives a report con-
taining the findings of such study and the implica-
tions of such findings with respect to policies affect-
ing organ procurement and distribution.
113
SEC. 156. PEER REVIEW ORGANIZATIONS.
(a) REPEAL OF PRO PRECERTIFICATION REQUIRE-
MENT FOR CERTAIN SURGICAL PROCEDURES.—
(1) IN
GENERAL.—Section 1164 (42 U.S.C.
1320c–13) is repealed.
(2) CONFORMING AMENDMENTS.—
(A) Section 1154 (42 U.S.C. 1320c–3) is
amended—
(i) in subsection (a), by striking para-
graph (12), and
(ii) in subsection (d), by striking
‘‘(and except as provided in section
1164)’’.
(B) Section 1833 (42 U.S.C. 1395l) is
amended—
(i) in subsection (a)(1)(D)(i), by strik-
ing ‘‘, or for tests furnished in connection
with obtaining a second opinion required
under section 1164(c)(2) (or a third opin-
ion, if the second opinion was in disagree-
ment with the first opinion)’’;
(ii) in subsection (a)(1), by striking
subparagraph (G);
(iii) in subsection (a)(2)(A), by strik-
ing ‘‘, to items and services (other than
clinical diagnostic laboratory tests) fur-
114
nished in connection with obtaining a sec-
ond 
opinion 
required 
under 
section
1164(c)(2) (or a third opinion, if the sec-
ond opinion was in disagreement with the
first opinion),’’;
(iv) in subsection (a)(2)(D)(i)—
(I) by striking ‘‘basis,’’ and in-
serting ‘‘basis or’’, and
(II) by striking ‘‘, or for tests
furnished in connection with obtaining
a second opinion required under sec-
tion 1164(c)(2) (or a third opinion, if
the second opinion was in disagree-
ment with the first opinion)’’;
(v) in subsection (a)(3), by striking
‘‘and for items and services furnished in
connection with obtaining a second opinion
required under section 1164(c)(2), or a
third opinion, if the second opinion was in
disagreement with the first opinion’’; and
(vi) in the first sentence of subsection
(b), by striking ‘‘(4)’’ and all that follows
through ‘‘and (5)’’ and inserting ‘‘and
(4)’’.
115
(C) Section 1834(g)(1)(B) (42 U.S.C.
1395m(g)(1)(B)) is amended by striking ‘‘and
for items and services furnished in connection
with obtaining a second opinion required under
section 1164(c)(2), or a third opinion, if the
second opinion was in disagreement with the
first opinion’’.
(D) Section 1862(a) (42 U.S.C. 1395y(a))
is amended—
(i) by adding ‘‘or’’ at the end of para-
graph (14),
(ii) by striking ‘‘; or’’ at the end of
paragraph (15) and inserting a period, and
(iii) by striking paragraph (16).
(E) 
The 
third 
sentence 
of 
section
1866(a)(2)(A) (42 U.S.C. 1395w(a)(2)(A)) is
amended by striking ‘‘, with respect to items
and services furnished in connection with ob-
taining a second opinion required under section
1164(c)(2) (or a third opinion, if the second
opinion was in disagreement with the first opin-
ion),’’.
(3) EFFECTIVE DATE.—The amendments made
by this subsection shall apply to services provided on
or after the date of the enactment of this Act.
116
(b) MISCELLANEOUS
AND
TECHNICAL
CORREC-
TIONS.—(1) The third sentence of section 1156(b)(1) (42
U.S.C. 1320c–5(b)(1)) is amended by striking ‘‘whehter’’
and inserting ‘‘whether’’.
(2)(A) Section 1154(a)(9)(B) (42 U.S.C. 1320c–
3(a)(9)(B)) is amended to read as follows:
‘‘(B) If the organization finds, after reasonable
notice to and opportunity for discussion with the
physician or practitioner concerned, that the physi-
cian or practitioner has furnished services in viola-
tion of section 1156(a) and the organization deter-
mines that the physician or practitioner should enter
into 
a 
corrective 
action 
plan 
under 
section
1156(b)(1), the organization shall notify the State
board or boards responsible for the licensing or dis-
ciplining of the physician or practitioner of its find-
ing and of any action taken as a result of the find-
ing.’’.
(B) Subparagraph (D) of section 1160(b)(1) (42
U.S.C. 1320c–9(b)(1)) is amended to read as follows:
‘‘(D) to provide notice in accordance with
section 1154(a)(9)(B);’’.
(3) Section 4205(d)(2)(B) of OBRA–1990 is amend-
ed by striking ‘‘amendments’’ and inserting ‘‘amend-
ment’’.
117
(4) Section 1160(d) (42 U.S.C. 1320c–9(d)) is
amended by striking ‘‘subpena’’ and inserting ‘‘subpoena’’.
(5) Section 4205(e)(2) of OBRA–1990 is amended
by striking ‘‘amendments’’ and inserting ‘‘amendment’’
and by striking ‘‘all’’.
(6)(A) Except as provided in subparagraph (B), the
amendments made by this subsection shall take effect as
if included in the enactment of OBRA–1990.
(B) The amendments made by paragraph (2) (relat-
ing to the requirement on reporting of information to
State boards) shall take effect on the date of the enact-
ment of this Act.
SEC. 157. HEALTH MAINTENANCE ORGANIZATIONS.
(a) REVISIONS
IN
THE PAYMENT METHODOLOGY
FOR RISK CONTRACTORS.—Section 4204(b) of OBRA–
1990 is amended to read as follows:
‘‘(b) REVISIONS IN THE PAYMENT METHODOLOGY
FOR RISK CONTRACTORS.—(1)(A) Not later than October
1, 1995, the Secretary of Health and Human Services (in
this subsection referred to as the ‘Secretary’) shall submit
a proposal to the Congress that provides for revisions to
the payment method to be applied in years beginning with
1997 for organizations with a risk-sharing contract under
section 1876(g) of the Social Security Act.
118
‘‘(B) In proposing the revisions required under sub-
paragraph (A), the Secretary shall consider—
‘‘(i) the difference in costs associated with med-
icare beneficiaries with differing health status and
demographic characteristics; and
‘‘(ii) the effects of using alternative geographic
classifications on the determinations of costs associ-
ated with beneficiaries residing in different areas.
‘‘(2) Not later than 3 months after the date of sub-
mittal of the proposal under paragraph (1), the Comptrol-
ler General shall review the proposal and shall report to
Congress on the appropriateness of the proposed modifica-
tions.’’.
(b) MISCELLANEOUS
AND
TECHNICAL
CORREC-
TIONS.—(1) 
Section 
1876(a)(3) 
(42 
U.S.C.
1395mm(a)(3)) is amended by striking ‘‘subsection
(c)(7)’’ and inserting ‘‘subsections (c)(2)(B)(ii) and
(c)(7)’’.
(2) Section 4204(c)(3) of OBRA–1990 is amended
by striking ‘‘for 1991’’ and inserting ‘‘for years beginning
with 1991’’.
(3) Section 4204(d)(2) of OBRA–1990 is amended
by striking ‘‘amendment’’ and inserting ‘‘amendments’’.
119
(4) 
Section 
1876(a)(1)(E)(ii)(I) 
(42 
U.S.C.
1395mm(a)(1)(E)(ii)(I)) is amended by striking the
comma after ‘‘contributed to’’.
(5) Section 4204(e)(2) of OBRA–1990 is amended
by striking ‘‘(which has a risk-sharing contract under sec-
tion 1876 of the Social Security Act)’’.
(6) Section 4204(f)(4) of OBRA–1990 is amended by
striking ‘‘final’’.
(7) 
Section 
1862(b)(3)(C) 
(42 
U.S.C.
1395y(b)(3)(C)) is amended—
(A) in the heading, by striking ‘‘PLAN’’ and in-
serting ‘‘PLAN OR A LARGE GROUP HEALTH PLAN’’;
(B) by striking ‘‘group health plan’’ and insert-
ing ‘‘group health plan or a large group health
plan’’;
(C) by striking ‘‘, unless such incentive is also
offered to all individuals who are eligible for cov-
erage under the plan’’; and
(D) by striking ‘‘the first sentence of subsection
(a) and other than subsection (b)’’ and inserting
‘‘subsections (a) and (b)’’.
(8) The amendments made by this subsection shall
take effect as if included in the enactment of OBRA–1990.
120
SEC. 158. HOME HEALTH AGENCIES.
(a) USE OF MOST CURRENT DATA IN DETERMINING
WAGE INDEX.—
(1) IN
GENERAL.—Section 1861(v)(1)(L)(iii)
(42 U.S.C. 1395x(v)(1)(L)(iii)) is amended by strik-
ing ‘‘as of such date to’’ and inserting ‘‘and deter-
mined using the survey of the most recent available
wages and wage-related costs of’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall apply with respect to cost re-
porting periods beginning on or after July 1, 1996.
(b) CLARIFICATION OF EXTENSION OF WAIVER OF
LIABILITY.—
(1) IN GENERAL.—The second sentence of sec-
tion 9205 of the Consolidated Omnibus Budget Rec-
onciliation Act of 1985 is amended by striking ‘‘No-
vember 1, 1990’’ and inserting ‘‘December 31,
1995’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall take effect as if included in
the enactment of OBRA–1990.
SEC. 159. PERMANENT EXTENSION OF AUTHORITY TO CON-
TRACT WITH FISCAL INTERMEDIARIES AND
CARRIERS ON OTHER THAN A COST BASIS.
(a) IN GENERAL.—Section 2326(a) of the Deficit Re-
duction Act of 1984, as amended by section 6215 of
121
OBRA–1989, is amended in the third sentence by striking
‘‘during such period’’ and inserting ‘‘beginning with fiscal
year 1990 and any subsequent fiscal year’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply beginning with fiscal year 1994.
SEC. 160. MISCELLANEOUS AND TECHNICAL CORRECTIONS.
(a) SURVEY AND CERTIFICATION REQUIREMENTS.—
(1) Section 1864 (42 U.S.C. 1395aa) is amended—
(A) in subsection (e), by striking ‘‘title’’ and in-
serting ‘‘title (other than any fee relating to section
353 of the Public Health Service Act)’’; and
(B) in the first sentence of subsection (a), by
striking ‘‘1861(s) or’’ and all that follows through
‘‘Service Act,’’ and inserting ‘‘1861(s),’’.
(2) An agreement made by the Secretary of Health
and Human Services with a State under section 1864(a)
of the Social Security Act may include an agreement that
the services of the State health agency or other appro-
priate State agency (or the appropriate local agencies) will
be utilized by the Secretary for the purpose of determining
whether a laboratory meets the requirements of section
353 of the Public Health Service Act.
(b) HOME DIALYSIS DEMONSTRATION TECHNICAL
CORRECTIONS.—Section 4202 of OBRA–1990 is amend-
ed—
122
(1) in subsection (b)(1)(A), by striking ‘‘home
hemodialysis staff assistant’’ and inserting ‘‘quali-
fied home hemodialysis staff assistant (as described
in subsection (d))’’;
(2) in subsection (b)(2)(B)(ii)(I), by striking
‘‘(as adjusted to reflect differences in area wage
levels)’’;
(3) 
in 
subsection 
(c)(1)(A), 
by 
striking
‘‘skilled’’; and
(4) in subsection (c)(1)(E), by striking ‘‘(b)(4)’’
and inserting ‘‘(b)(2)’’.
(c) TECHNICAL CORRECTION TO REVISIONS OF COV-
ERAGE FOR IMMUNOSUPPRESSIVE DRUG THERAPY.—The
Secretary of Health and Human Services may administer
section 1861(s)(2)(J) of the Social Security Act (42
U.S.C. 1395x(s)(2)(J)) in a manner such that the months
of coverage of drugs described in such section are provided
consecutively, so long as the total number of months of
coverage provided is the same as the number of months
described in such section.
(d) OTHER MISCELLANEOUS AND TECHNICAL PRO-
VISIONS.—(1) Section 1833 (42 U.S.C. 1395l) is amended
by redesignating the subsection (r) added by section
4206(b)(2) of OBRA–1990 as subsection (s).
123
(2) Section 1866(f)(1) (42 U.S.C. 1395cc(f)(1)) is
amended by striking ‘‘1833(r)’’ and inserting ‘‘1833(s)’’.
(3) Section 4201(d)(2) of OBRA–1990 is amended
by striking ‘‘(B) by striking’’, ‘‘(C) by striking’’, and ‘‘(3)
by adding’’ and inserting ‘‘(i) by striking’’, ‘‘(ii) by strik-
ing’’, and ‘‘(B) by adding’’, respectively.
(4) The section following section 4206 of OBRA–
1990 is amended by striking ‘‘SEC. 4027.’’ and inserting
‘‘SEC. 4207.’’, and in this subtitle is referred to as section
4207 of OBRA–1990.
(5)(A) Section 4207(a)(1) of OBRA–1990 is amend-
ed by adding closing quotation marks and a period after
‘‘such review.’’.
(B) Section 4207(a)(4) of OBRA–1990 is amended
by striking ‘‘this subsection’’ and inserting ‘‘paragraphs
(2) and (3)’’.
(C) Section 4207(b)(1) of OBRA–1990 is amended
by striking ‘‘section 3(7)’’ and inserting ‘‘section
601(a)(1)’’.
(6) Section 2355(b)(1)(B) of the Deficit Reduction
Act of 1984, as amended by section 4207(b)(4)(B)(ii) of
OBRA–1990, is amended—
(A) by striking ‘‘12907(c)(4)(A)’’ and inserting
‘‘4207(b)(4)(B)(i)’’, and
124
(B) by striking ‘‘feasibilitly’’ and inserting ‘‘fea-
sibility’’.
(7) Section 4207(b)(4)(B)(iii)(III) of OBRA–1990 is
amended by striking the period at the end and inserting
a semicolon.
(8) Subsections (c)(3) and (e) of section 2355 of the
Deficit Reduction Act of 1984, as amended by section
4207(b)(4)(B) of OBRA–1990, are each amended by
striking ‘‘12907(c)(4)(A)’’ each place it appears and in-
serting ‘‘4207(b)(4)(B)’’.
(9) Section 4207(c)(2) of OBRA–1990 is amended
by striking ‘‘the Committee on Ways and Means’’ each
place it appears and inserting ‘‘the Committees on Ways
and Means and Energy and Commerce’’.
(10) Section 4207(d) of OBRA–1990 is amended by
redesignating the second paragraph (3) (relating to effec-
tive date) as paragraph (4).
(11) Section 4207(i)(2) of OBRA–1990 is amend-
ed—
(A) by striking the period at the end of clause
(iii) and inserting a semicolon, and
(B) in clause (v), by striking ‘‘residents’’ and
inserting ‘‘patients’’.
125
(12) Section 4207(j) of OBRA–1990 is amended by
striking ‘‘title’’ each place it appears and inserting ‘‘sub-
title’’.
Subtitle D—Provisions Relating to
Medicare Supplemental Insur-
ance Policies
SEC. 171. STANDARDS FOR MEDICARE SUPPLEMENTAL IN-
SURANCE POLICIES.
(a) SIMPLIFICATION OF MEDICARE SUPPLEMENTAL
POLICIES.—
(1) Section 4351 of OBRA–1990 is amended by
striking ‘‘(a) IN GENERAL.—’’.
(2) Section 1882(p) (42 U.S.C. 1395ss(p)) is
amended—
(A) in paragraph (1)(A)—
(i) by striking ‘‘promulgates’’ and in-
serting ‘‘changes the revised NAIC Model
Regulation (described in subsection (m)) to
incorporate’’,
(ii) by striking ‘‘(such limitations, lan-
guage, definitions, format, and standards
referred to collectively in this subsection as
‘NAIC standards’),’’, and
(iii) by striking ‘‘included a reference
to the NAIC standards’’ and inserting
126
‘‘were a reference to the revised NAIC
Model Regulation as changed under this
subparagraph (such changed regulation re-
ferred to in this section as the ‘1991 NAIC
Model Regulation’)’’;
(B) in paragraph (1)(B)—
(i) by striking ‘‘promulgate NAIC
standards’’ 
and 
inserting 
‘‘make 
the
changes in the revised NAIC Model Regu-
lation’’,
(ii) by striking ‘‘limitations, language,
definitions, format, and standards de-
scribed in clauses (i) through (iv) of such
subparagraph (in this subsection referred
to collectively as ‘Federal standards’)’’ and
inserting ‘‘a regulation’’, and
(iii) by striking ‘‘included a reference
to the Federal standards’’ and inserting
‘‘were a reference to the revised NAIC
Model Regulation as changed by the Sec-
retary under this subparagraph (such
changed regulation referred to in this sec-
tion as the ‘1991 Federal Regulation’)’’;
(C) in paragraph (1)(C)(i), by striking
‘‘NAIC standards or the Federal standards’’
127
and inserting ‘‘1991 NAIC Model Regulation or
1991 Federal Regulation’’;
(D) in paragraphs (1)(C)(ii)(I), (1)(E),
(2), and (9)(B), by striking ‘‘NAIC or Federal
standards’’ and inserting ‘‘1991 NAIC Model
Regulation or 1991 Federal Regulation’’;
(E) in paragraph (2)(C), by striking
‘‘(5)(B)’’ and inserting ‘‘(4)(B)’’;
(F) in paragraph (4)(A)(i), by inserting
‘‘or paragraph (6)’’ after ‘‘(B)’’;
(G) in paragraph (4), by striking ‘‘applica-
ble standards’’ each place it appears and insert-
ing ‘‘applicable 1991 NAIC Model Regulation
or 1991 Federal Regulation’’;
(H) in paragraph (6), by striking ‘‘in re-
gard to the limitation of benefits described in
paragraph (4)’’ and inserting ‘‘described in
clauses (i) through (iii) of paragraph (1)(A)’’;
(I) in paragraph (7), by striking ‘‘policy-
holder’’ and inserting ‘‘policyholders’’;
(J) in paragraph (8), by striking ‘‘after the
effective date of the NAIC or Federal standards
with respect to the policy, in violation of the
previous requirements of this subsection’’ and
inserting ‘‘on and after the effective date speci-
128
fied in paragraph (1)(C) (but subject to para-
graph (10)), in violation of the applicable 1991
NAIC Model Regulation or 1991 Federal Regu-
lation insofar as such regulation relates to the
requirements of subsection (o) or (q) or clause
(i), (ii), or (iii) of paragraph (1)(A)’’;
(K) in paragraph (9), by adding at the end
the following new subparagraph:
‘‘(D) Subject to paragraph (10), this paragraph shall
apply to sales of policies occurring on or after the effective
date specified in paragraph (1)(C).’’; and
(L) in paragraph (10), by striking ‘‘this
subsection’’ 
and 
inserting 
‘‘paragraph
(1)(A)(i)’’.
(b) GUARANTEED RENEWABILITY.—Section 1882(q)
(42 U.S.C. 1395ss(q)) is amended—
(1) in paragraph (2), by striking ‘‘paragraph
(2)’’ and inserting ‘‘paragraph (4)’’, and
(2) in paragraph (4), by striking ‘‘the succeed-
ing issuer’’ and inserting ‘‘issuer of the replacement
policy’’.
(c) ENFORCEMENT OF STANDARDS.—
(1) 
Section 
1882(a)(2) 
(42 
U.S.C.
1395ss(a)(2)) is amended—
129
(A) in subparagraph (A), by striking
‘‘NAIC standards or the Federal standards’’
and inserting ‘‘1991 NAIC Model Regulation or
1991 Federal Regulation’’, and
(B) by striking ‘‘after the effective date of
the NAIC or Federal standards with respect to
the policy’’ and inserting ‘‘on and after the ef-
fective date specified in subsection (p)(1)(C)’’.
(2) The sentence in section 1882(b)(1) added
by section 4353(c)(5) of OBRA–1990 is amended—
(A) by striking ‘‘The report’’ and inserting
‘‘Each report’’,
(B) by inserting ‘‘and requirements’’ after
‘‘standards’’,
(C) by striking ‘‘and’’ after ‘‘compliance,’’,
and
(D) by striking the comma after ‘‘Commis-
sioners’’.
(3) 
Section 
1882(g)(2)(B) 
(42 
U.S.C.
1395ss(g)(2)(B)) is amended by striking ‘‘Panel’’
and inserting ‘‘Secretary’’.
(4) 
Section 
1882(b)(1) 
(42 
U.S.C.
1395ss(b)(1)) is amended by striking ‘‘the the Sec-
retary’’ and inserting ‘‘the Secretary’’.
(d) PREVENTING DUPLICATION.—
130
(1) 
Section 
1882(d)(3)(A) 
(42 
U.S.C.
1395ss(d)(3)(A)) is amended—
(A) by amending the first sentence to read
as follows:
‘‘(i) It is unlawful for a person to sell or issue to an
individual entitled to benefits under part A or enrolled
under part B of this title—
‘‘(I) a health insurance policy with knowledge
that the policy duplicates health benefits to which
the individual is otherwise entitled under this title or
title XIX,
‘‘(II) a medicare supplemental policy with
knowledge that the individual is entitled to benefits
under another medicare supplemental policy, or
‘‘(III) a health insurance policy (other than a
medicare supplemental policy) with knowledge that
the policy duplicates health benefits to which the in-
dividual is otherwise entitled, other than benefits to
which the individual is entitled under a requirement
of State or Federal law.’’;
(B) by designating the second sentence as
clause (ii) and, in such clause, by striking ‘‘the
previous sentence’’ and inserting ‘‘clause (i)’’;
(C) by designating the third sentence as
clause (iii) and, in such clause—
131
(i) by striking ‘‘the previous sentence’’
and inserting ‘‘clause (i) with respect to
the sale of a medicare supplemental pol-
icy’’, and
(ii) by striking ‘‘and the statement’’
and all that follows up to the period at the
end; and
(D) by striking the last sentence.
(2) 
Section 
1882(d)(3)(B) 
(42 
U.S.C.
1395ss(d)(3)(B)) is amended—
(A) in clause (ii)(II), by striking ‘‘65 years
of age or older’’,
(B) in clause (iii)(I), by striking ‘‘another
medicare’’ and inserting ‘‘a medicare’’,
(C) in clause (iii)(I), by striking ‘‘such a
policy’’ and inserting ‘‘a medicare supplemental
policy’’,
(D) in clause (iii)(II), by striking ‘‘another
policy’’ and inserting ‘‘a medicare supplemental
policy’’, and
(E) by amending subclause (III) of clause
(iii) to read as follows:
‘‘(III) If the statement required by clause (i) is ob-
tained and indicates that the individual is entitled to any
medical assistance under title XIX, the sale of the policy
132
is not in violation of clause (i) (insofar as such clause re-
lates to such medical assistance), if (aa) a State medicaid
plan under such title pays the premiums for the policy,
(bb) in the case of a qualified medicare beneficiary de-
scribed in section 1905(p)(1), the policy provides for cov-
erage of outpatient prescription drugs, or (cc) the only
medical assistance to which the individual is entitled under
the State plan is medicare cost sharing described in sec-
tion 1905(p)(3)(A)(ii).’’.
(3)(A) 
Section 
1882(d)(3)(C) 
(42 
U.S.C.
1395ss(d)(3)(C)) is amended—
(i) by striking ‘‘the selling’’ and inserting
‘‘(i) the sale or issuance’’, and
(ii) by inserting before the period at the
end the following: ‘‘, (ii) the sale or issuance of
a policy or plan described in subparagraph
(A)(i)(I) (other than a medicare supplemental
policy to an individual entitled to any medical
assistance under title XIX) under which all the
benefits are fully payable directly to or on be-
half of the individual without regard to other
health benefit coverage of the individual but
only if (for policies sold or issued more than 60
days after the date the statements are pub-
lished or promulgated under subparagraph (D))
133
there is disclosed in a prominent manner as
part of (or together with) the application the
applicable statement (specified under subpara-
graph (D)) of the extent to which benefits pay-
able under the policy or plan duplicate benefits
under this title, or (iii) the sale or issuance of
a policy or plan described in subparagraph
(A)(i)(III) under which all the benefits are fully
payable directly to or on behalf of the individual
without regard to other health benefit coverage
of the individual’’.
(B) 
Section 
1882(d)(3) 
(42 
U.S.C.
1395ss(d)(3)) is amended by adding at the end the
following:
‘‘(D)(i) If—
‘‘(I) within the 90-day period beginning on the
date of the enactment of this subparagraph, the Na-
tional Association of Insurance Commissioners devel-
ops (after consultation with consumer and insurance
industry representatives) and submits to the Sec-
retary a statement for each of the types of health in-
surance policies (other than medicare supplemental
policies and including, but not limited to, as sepa-
rate types of policies, policies paying directly to the
beneficiary fixed, cash benefits, and policies that
134
limit benefit payments to specific diseases) which are
sold or issued to persons entitled to health benefits
under this title, of the extent to which benefits pay-
able under the policy or plan duplicate benefits
under this title, and
‘‘(II) the Secretary approves all the statements
submitted as meeting the requirements of subclause
(I),
each such statement shall be (for purposes of subpara-
graph (C)) the statement specified under this subpara-
graph for the type of policy involved. The Secretary shall
review and approve (or disapprove) all the statements sub-
mitted under subclause (I) within 30 days after the date
of their submittal. Upon approval of such statements, the
Secretary shall publish such statements.
‘‘(ii) If the Secretary does not approve the statements
under clause (i) or the statements are not submitted with-
in the 90-day period specified in such clause, the Secretary
shall promulgate (after consultation with consumer and
insurance industry representatives and not later than 90
days after the date of disapproval or the end of such 90-
day period (as the case may be)) a statement for each
of the types of health insurance policies (other than medi-
care supplemental policies and including, but not limited
to, as separate types of policies, policies paying directly
135
to the beneficiary fixed, cash benefits, and policies that
limit benefit payments to specific diseases) which are sold
or issued to persons entitled to health benefits under this
title, of the extent to which benefits payable under the pol-
icy or plan duplicate benefits under this title, and each
such statement shall be (for purposes of subparagraph
(C)) the statement specified under this subparagraph for
the type of policy involved.’’.
(C) The requirement of a disclosure under sec-
tion 1882(d)(3)(C)(ii) of the Social Security Act
shall not apply to an application made for a policy
or plan before 60 days after the date the Secretary
of Health and Human Services publishes or promul-
gates 
all 
the 
statements 
under 
section
1882(d)(3)(D) of such Act.
(4) Subparagraphs (A) and (B) of section
1882(q)(5) are amended by striking ‘‘of the Social
Security Act’’.
(e) LOSS RATIOS AND REFUNDS OF PREMIUMS.—
(1) Section 1882(r) (42 U.S.C. 1395ss(r)) is
amended—
(A) in paragraph (1), by striking ‘‘or sold’’
and inserting ‘‘or renewed (or otherwise provide
coverage after the date described in subsection
(p)(1)(C))’’;
136
(B) in paragraph (1)(A), by inserting ‘‘for
periods after the effective date of these provi-
sions’’ after ‘‘the policy can be expected’’;
(C) in paragraph (1)(A), by striking
‘‘Commissioners,’’ 
and 
inserting 
‘‘Commis-
sioners)’’;
(D) in paragraph (1)(B), by inserting be-
fore the period at the end the following: ‘‘,
treating policies of the same type as a single
policy for each standard package’’;
(E) by adding at the end of paragraph (1)
the following: ‘‘For the purpose of calculating
the refund or credit required under paragraph
(1)(B) for a policy issued before the date speci-
fied in subsection (p)(1)(C), the refund or cred-
it calculation shall be based on the aggregate
benefits provided and premiums collected under
all such policies issued by an insurer in a State
(separated as to individual and group policies)
and shall be based only on aggregate benefits
provided and premiums collected under such
policies after the date specified in section
171(m)(4) of the Social Security Act Amend-
ments of 1994.’’;
137
(F) in the first sentence of paragraph
(2)(A), by striking ‘‘by policy number’’ and in-
serting ‘‘by standard package’’;
(G) by striking the second sentence of
paragraph (2)(A) and inserting the following:
‘‘Paragraph (1)(B) shall not apply to a policy
until 12 months following issue.’’;
(H) in the last sentence of paragraph
(2)(A), by striking ‘‘in order’’ and all that fol-
lows through ‘‘are effective’’;
(I) by adding at the end of paragraph
(2)(A), the following new sentence: ‘‘In the case
of a policy issued before the date specified in
subsection (p)(1)(C), paragraph (1)(B) shall
not apply until 1 year after the date specified
in section 171(m)(4) of the Social Security Act
Amendments of 1994.’’;
(J) in paragraph (2), by striking ‘‘policy
year’’ each place it appears and inserting ‘‘cal-
endar year’’;
(K) in paragraph (4), by striking ‘‘Feb-
ruary’’, ‘‘disllowance’’, ‘‘loss-ratios’’ each place
it appears, and ‘‘loss-ratio’’ and inserting ‘‘Oc-
tober’’, ‘‘disallowance’’, ‘‘loss ratios’’, and ‘‘loss
ratio’’, respectively;
138
(L) in paragraph (6)(A), by striking ‘‘is-
sues a policy in violation of the loss ratio re-
quirements of this subsection’’ and ‘‘such viola-
tion’’ and inserting ‘‘fails to provide refunds or
credits as required in paragraph (1)(B)’’ and
‘‘policy issued for which such failure occurred’’,
respectively; and
(M) in paragraph (6)(B), by striking ‘‘to
policyholders’’ and inserting ‘‘to the policy-
holder or, in the case of a group policy, to the
certificate holder’’.
(2) 
Section 
1882(b)(1) 
(42 
U.S.C.
1395ss(b)(1)) is amended, in the matter after sub-
paragraph (H), by striking ‘‘subsection (F)’’ and in-
serting ‘‘subparagraph (F)’’.
(3) Section 4355(d) of OBRA–1990 is amended
by striking ‘‘sold or issued’’ and all that follows and
inserting ‘‘issued or renewed (or otherwise providing
coverage after the date described in section
1882(p)(1)(C) of the Social Security Act) on or after
the date specified in section 1882(p)(1)(C) of the
Social Security Act.’’.
(f) TREATMENT OF HMO’S.—
(1) 
Section 
1882(g)(1) 
(42 
U.S.C.
1395ss(g)(1)) is amended by striking ‘‘a health
139
maintenance organization or other direct service or-
ganization’’ and all that follows through ‘‘1833’’ and
inserting ‘‘an eligible organization (as defined in sec-
tion 1876(b)) if the policy or plan provides benefits
pursuant to a contract under section 1876 or an ap-
proved demonstration project described in section
603(c) of the Social Security Amendments of 1983,
section 2355 of the Deficit Reduction Act of 1984,
or section 9412(b) of the Omnibus Budget Reconcili-
ation Act of 1986, or, during the period beginning
on the date specified in subsection (p)(1)(C) and
ending on December 31, 1995, a policy or plan of
an organization if the policy or plan provides bene-
fits pursuant to an agreement under section
1833(a)(1)(A)’’.
(2) Section 4356(b) of OBRA–1990 is amended
by striking ‘‘on the date of the enactment of this
Act’’ and inserting ‘‘on the date specified in section
1882(p)(1)(C) of the Social Security Act’’.
(g) PRE-EXISTING CONDITION LIMITATIONS.—Sec-
tion 1882(s) (42 U.S.C. 1395ss(s)) is amended—
(1) in paragraph (2)(A), by striking ‘‘for which
an application is submitted’’ and inserting ‘‘in the
case of an individual for whom an application is sub-
mitted prior to or’’,
140
(2) in paragraph (2)(A), by striking ‘‘in which
the individual (who is 65 years of age or older) first
is enrolled for benefits under part B’’ and inserting
‘‘as of the first day on which the individual is 65
years of age or older and is enrolled for benefits
under part B’’, and
(3) in paragraph (2)(B), by striking ‘‘before it’’
and inserting ‘‘before the policy’’.
(h) MEDICARE SELECT POLICIES.—
(1) Section 1882(t) (42 U.S.C. 1395ss(t)) is
amended—
(A) in paragraph (1), by inserting ‘‘medi-
care supplemental’’ after ‘‘If a’’,
(B) in paragraph (1), by striking ‘‘NAIC
Model Standards’’ and inserting ‘‘1991 NAIC
Model Regulation or 1991 Federal Regulation’’,
(C) in paragraph (1)(A), by inserting ‘‘or
agreements’’ after ‘‘contracts’’,
(D) in subparagraphs (E)(i) and (F) of
paragraph (1), by striking ‘‘NAIC standards’’
and inserting ‘‘standards in the 1991 NAIC
Model Regulation or 1991 Federal Regulation’’,
and
141
(E) in paragraph (2), by inserting ‘‘the is-
suer’’ before ‘‘is subject to a civil money pen-
alty’’.
(2) Section 1154(a)(4)(B) (42 U.S.C. 1320c–
3(a)(4)(B)) is amended—
(A) by inserting ‘‘that is’’ after ‘‘(or’’, and
(B) by striking ‘‘1882(t)’’ and inserting
‘‘1882(t)(3)’’.
(i) HEALTH
INSURANCE
COUNSELING.—Section
4360 of OBRA–1990 is amended—
(1) in subsection (b)(2)(A)(ii), by striking
‘‘Act’’ and inserting ‘‘Act)’’;
(2) in subsection (b)(2)(D), by striking ‘‘serv-
ices’’ and inserting ‘‘counseling’’;
(3) in subsection (b)(2)(I), by striking ‘‘assist-
ance’’ and inserting ‘‘referrals’’;
(4) in subsection (c)(1), by striking ‘‘and that
such activities will continue to be maintained at such
level’’;
(5) in subsection (d)(3), by striking ‘‘to the
rural areas’’ and inserting ‘‘eligible individuals resid-
ing in rural areas’’;
(6) in subsection (e)—
(A) by striking ‘‘subsection (c) or (d)’’ and
inserting ‘‘this section’’,
142
(B) by striking ‘‘and annually thereafter,
issue an annual report’’ and inserting ‘‘and an-
nually thereafter during the period of the grant,
issue a report’’, and
(C) in paragraph (1), by striking ‘‘State-
wide’’;
(7) in subsection (f), by striking paragraph (2)
and by redesignating paragraphs (3) through (5) as
paragraphs (2) through (4), respectively; and
(8) in the second subsection (f) (relating to au-
thorization of appropriations for grants)—
(A) by striking ‘‘and 1993’’ and inserting
‘‘1993, 1994, 1995, and 1996’’; and
(B) by redesignating such subsection as
subsection (g).
(j) TELEPHONE INFORMATION SYSTEM.—
(1) Section 1804 (42 U.S.C. 1395b–2) is
amended—
(A) by adding at the end of the heading
the following: ‘‘; MEDICARE AND MEDIGAP IN-
FORMATION’’,
(B) by inserting ‘‘(a)’’ after ‘‘1804.’’, and
(C) by adding at the end the following new
subsection:
143
‘‘(b) The Secretary shall provide information via a
toll-free telephone number on the programs under this
title.’’.
(2) Section 1882(f) (42 U.S.C. 1395ss(f)) is
amended by adding at the end the following new
paragraph:
‘‘(3) The Secretary shall provide information via a
toll-free telephone number on medicare supplemental poli-
cies (including the relationship of State programs under
title XIX to such policies).’’.
(3) Section 1889 is repealed.
(k) MAILING OF POLICIES.—Section 1882(d)(4) (42
U.S.C. 1395ss(d)(4)) is amended—
(1) in subparagraph (D), by striking ‘‘, if such
policy’’ and all that follows up to the period at the
end, and
(2) by adding at the end the following new sub-
paragraph:
‘‘(E) Subparagraph (A) shall not apply in the case
of an issuer who mails or causes to be mailed a policy,
certificate, or other matter solely to comply with the re-
quirements of subsection (q).’’.
(l) EFFECTIVE DATE.—The amendments made by
this section shall be effective as if included in the enact-
ment of OBRA–1990; except that—
144
(1) the amendments made by subsection (d)(1)
shall take effect on the date of the enactment of this
Act, but no penalty shall be imposed under section
1882(d)(3)(A) of the Social Security Act (for an ac-
tion occurring after the effective date of the amend-
ments made by section 4354 of OBRA–1990 and be-
fore the date of the enactment of this Act) with re-
spect to the sale or issuance of a policy which is not
unlawful under section 1882(d)(3)(A)(i)(II) of the
Social Security Act (as amended by this section);
(2) the amendments made by subsection
(d)(2)(A) and by subparagraphs (A), (B), and (E)
of subsection (e)(1) shall be effective on the date
specified in subsection (m)(4); and
(3) the amendment made by subsection (g)(2)
shall take effect on January 1, 1995, and shall apply
to individuals who attain 65 years of age or older on
or after the effective date of section 1882(s)(2) of
the Social Security Act (and, in the case of individ-
uals who attained 65 years of age after such effec-
tive date and before January 1, 1995, and who were
not covered under such section before January 1,
1995, the 6-month period specified in that section
shall begin January 1, 1995).
(m) TRANSITION PROVISIONS.—
145
(1) IN GENERAL.—If the Secretary of Health
and Human Services identifies a State as requiring
a change to its statutes or regulations to conform its
regulatory program to the changes made by this sec-
tion, the State regulatory program shall not be con-
sidered to be out of compliance with the require-
ments of section 1882 of the Social Security Act due
solely to failure to make such change until the date
specified in paragraph (4).
(2) NAIC STANDARDS.—If, within 6 months
after the date of the enactment of this Act, the Na-
tional Association of Insurance Commissioners (in
this subsection referred to as the ‘‘NAIC’’) modifies
its 1991 NAIC Model Regulation (adopted in July
1991) to conform to the amendments made by this
section and to delete from section 15C the exception
which begins with ‘‘unless’’, such revised regulation
incorporating the modifications shall be considered
to be the 1991 Regulation for the purposes of sec-
tion 1882 of the Social Security Act.
(3) SECRETARY
STANDARDS.—If the NAIC
does not make the modifications described in para-
graph (2) within the period specified in such para-
graph, the Secretary of Health and Human Services
shall make the modifications described in such para-
146
graph and such revised regulation incorporating the
modifications shall be considered to be the 1991
Regulation for the purposes of section 1882 of the
Social Security Act.
(4) DATE SPECIFIED.—
(A) IN
GENERAL.—Subject to subpara-
graph (B), the date specified in this paragraph
for a State is the earlier of—
(i) the date the State changes its stat-
utes or regulations to conform its regu-
latory program to the changes made by
this section, or
(ii) 1 year after the date the NAIC or
the Secretary first makes the modifications
under paragraph (2) or (3), respectively.
(B) ADDITIONAL LEGISLATIVE ACTION RE-
QUIRED.—In the case of a State which the Sec-
retary identifies as—
(i) requiring State legislation (other
than legislation appropriating funds) to
conform its regulatory program to the
changes made in this section, but
(ii) having a legislature which is not
scheduled to meet in 1996 in a legislative
147
session in which such legislation may be
considered,
the date specified in this paragraph is the first
day of the first calendar quarter beginning after
the close of the first legislative session of the
State legislature that begins on or after Janu-
ary 1, 1996. For purposes of the previous sen-
tence, 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. 172. 6-MONTH EXTENSION OF PERIOD FOR ISSUANCE
OF MEDICARE SELECT POLICIES.
(a) IN GENERAL.—Section 4358(c) of the Omnibus
Budget Reconciliation Act of 1990 (42 U.S.C. 1320c–3
note) is amended by striking ‘‘3-year’’ and inserting ‘‘31⁄2-
year’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall take effect as if included in the enact-
ment of the Omnibus Budget Reconciliation Act of 1990.
148
TITLE 
II—MATERNAL 
AND
CHILD 
HEALTH 
SERVICES
BLOCK GRANT PROGRAM
Subtitle A—Child Welfare, Foster
Care, Adoption
SEC. 201. INCREASE IN AUTHORIZATION OF APPROPRIA-
TIONS FOR THE MATERNAL AND CHILD
HEALTH SERVICES BLOCK GRANT PROGRAM.
Section 501(a) (42 U.S.C. 701(a)) is amended by
striking ‘‘$686,000,000 for fiscal year 1990’’ and insert-
ing ‘‘$705,000,000 for fiscal year 1994’’.
SEC. 202 REQUIRED PROTECTIONS FOR FOSTER CHIL-
DREN.
(a) IN
GENERAL.—Section 422(b) (42 U.S.C.
622(b)) is amended—
(1) by striking ‘‘and’’ at the end of paragraph
(7);
(2) by striking the period at the end of para-
graph (8) and inserting ‘‘; and’’; and
(3) by adding at the end the following:
‘‘(9) provide assurances that the State—
‘‘(A) since June 17, 1980, has completed
an inventory of all children who, before the in-
ventory, had been in foster care under the re-
149
sponsibility of the State for 6 months or more,
which determined—
‘‘(i) the appropriateness of, and neces-
sity for, the foster care placement;
‘‘(ii) whether the child could or should
be returned to the parents of the child or
should be freed for adoption or other per-
manent placement; and
‘‘(iii) the services necessary to facili-
tate the return of the child or the place-
ment of the child for adoption or legal
guardianship;
‘‘(B) is operating, to the satisfaction of the
Secretary—
‘‘(i) a statewide information system
from which can be readily determined the
status, demographic characteristics, loca-
tion, and goals for the placement of every
child who is (or, within the immediately
preceding 12 months, has been) in foster
care;
‘‘(ii) a case review system (as defined
in section 475(5)) for each child receiving
foster care under the supervision of the
State;
150
‘‘(iii) a service program 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 ar-
rangement; and
‘‘(iv) a preplacement preventive serv-
ices program designed to help children at
risk of foster care placement remain with
their families; and
‘‘(C)(i) has reviewed (or within 12 months
after the date of the enactment of this para-
graph will review) State policies and adminis-
trative and judicial procedures in effect for chil-
dren abandoned at or shortly after birth (in-
cluding policies and procedures providing for
legal representation of such children); and
‘‘(ii) is implementing (or within 24 months
after the date of the enactment of this para-
graph will implement) such policies and proce-
151
dures as the State determines, on the basis of
the review described in clause (i), to be nec-
essary to enable permanent decisions to be
made expeditiously with respect to the place-
ment of such children.’’.
(b) RESTRICTION ON REALLOTMENT.—Section 424
(42 U.S.C. 624) is amended—
(1) in the first sentence, by striking ‘‘The
amount’’ and inserting the following:
‘‘(a) IN GENERAL.—Subject to subsection (b), the
amount’’; and
(2) by adding at the end the following:
‘‘(b) EXCEPTION RELATING TO FOSTER CHILD PRO-
TECTIONS.—The Secretary shall not reallot under sub-
section (a) of this section any amount that is withheld or
recovered from a State due to the failure of the State to
meet the requirements of section 422(b)(9).’’.
(c) REPEAL.—Section 427 (42 U.S.C. 627) is hereby
repealed.
(d) CONFORMING AMENDMENTS.—
(1) Section 423(a) (42 U.S.C. 623(a)) is
amended by striking ‘‘and in section 427’’.
(2) Section 425(a)(2) (42 U.S.C. 625(a)(2)) is
amended by striking ‘‘the statistical report required
by section’’ and inserting ‘‘section 422(b)(9) or’’.
152
(3) Section 472(d) (42 U.S.C. 672(d)) is
amended 
by 
striking 
‘‘427(b)’’ 
and 
inserting
‘‘422(b)(9)’’.
(e) EFFECTIVE DATE.—The amendments and repeal
made by this section shall be effective with respect to fiscal
years beginning on or after April 1, 1995.
SEC. 203. CONFORMITY REVIEWS.
(a) IN GENERAL.—Part A of title XI (42 U.S.C.
1301–1320b–13) is amended by inserting after section
1122 the following:
‘‘REVIEWS OF CHILD AND FAMILY SERVICES PROGRAMS,
AND OF FOSTER CARE AND ADOPTION ASSISTANCE
PROGRAMS, FOR CONFORMITY WITH STATE PLAN RE-
QUIREMENTS
‘‘SEC. 1123. (a) IN GENERAL.—The Secretary, in
consultation with the State agencies administering the
State programs under parts B and E of title IV, shall pro-
mulgate regulations for the review of such programs to
determine whether such programs are in substantial con-
formity with—
‘‘(1) State plan requirements under such parts
B and E,
‘‘(2) implementing regulations promulgated by
the Secretary, and
‘‘(3) the relevant approved State plans.
153
‘‘(b) ELEMENTS OF REVIEW SYSTEM.—The regula-
tions referred to in subsection (a) shall—
‘‘(1) specify the timetable for conformity re-
views of State programs, including—
‘‘(A) an initial review of each State pro-
gram;
‘‘(B) a timely review of a State program
following a review in which such program was
found not to be in substantial conformity; and
‘‘(C) less frequent reviews of State pro-
grams which have been found to be in substan-
tial conformity, but such regulations shall per-
mit the Secretary to reinstate more frequent re-
views based on information which indicates that
a State program may not be in conformity;
‘‘(2) specify the requirements subject to review,
and the criteria to be used to measure conformity
with such requirements and to determine whether
there is a substantial failure to so conform;
‘‘(3) specify the method to be used to determine
the amount of any Federal matching funds to be
withheld (subject to paragraph (4)) due to the State
program’s failure to so conform, which ensures
that—
154
‘‘(A) such funds will not be withheld with
respect to a program, unless it is determined
that the program fails substantially to so con-
form;
‘‘(B) such funds will not be withheld for a
failure to so conform resulting from the State’s
reliance upon and correct use of formal written
statements of Federal law or policy provided to
the State by the Secretary; and
‘‘(C) the amount of such funds withheld is
related to the extent of the failure to so con-
form; and
‘‘(4) require the Secretary, with respect to any
State program found to have failed substantially to
so conform—
‘‘(A) to afford the State an opportunity to
adopt and implement a corrective action plan,
approved by the Secretary, designed to end the
failure to so conform;
‘‘(B) to make technical assistance available
to the State to the extent feasible to enable the
State to develop and implement such a correc-
tive action plan;
155
‘‘(C) to suspend the withholding of any
Federal matching funds under this section while
such a corrective action plan is in effect; and
‘‘(D) to rescind any such withholding if the
failure to so conform is ended by successful
completion of such a corrective action plan.
‘‘(c) PROVISIONS FOR ADMINISTRATIVE AND JUDI-
CIAL REVIEW.—The regulations referred to in subsection
(a) shall—
‘‘(1) require the Secretary, not later than 10
days after a final determination that a program of
the State is not in conformity, to notify the State
of—
‘‘(A) the basis for the determination; and
‘‘(B) the amount of the Federal matching
funds (if any) to be withheld from the State;
‘‘(2) afford the State an opportunity to appeal
the determination to the Departmental Appeals
Board within 60 days after receipt of the notice de-
scribed in paragraph (1) (or, if later, after failure to
continue or to complete a corrective action plan);
and
‘‘(3) afford the State an opportunity to obtain
judicial review of an adverse decision of the Board,
within 60 days after the State receives notice of the
156
decision of the Board, by appeal to the district court
of the United States for the judicial district in which
the principal or headquarters office of the agency re-
sponsible for administering the program is located.’’.
(b) CONFORMING AMENDMENT.—Section 471(b) (42
U.S.C. 671(b)) is amended by striking all that follows the
first sentence.
(c) EFFECTIVE DATES.—
(1) IN
GENERAL.—The amendment made by
subsection (a) shall take effect on the date of the en-
actment of this Act.
(2) CONFORMING
AMENDMENT.—The amend-
ment made by subsection (b) shall take effect on Oc-
tober 1, 1995.
(3) REGULATIONS.—The Secretary shall pro-
mulgate the regulations referred to in section
1123(a) of the Social Security Act (as added by this
section) not later than July 1, 1995, to take effect
on April 1, 1996.
SEC. 204. STATES REQUIRED TO REPORT ON MEASURES
TAKEN TO COMPLY WITH THE INDIAN CHILD
WELFARE ACT.
(a) STATE PLAN REQUIREMENT.—Section 422(b)
(42 U.S.C. 622(b)), as amended by section 301(a), is
amended—
157
(1) by striking ‘‘and’’ at the end of paragraph
(8);
(2) by striking the period at the end of para-
graph (9) and inserting ‘‘; and’’; and
(3) by adding at the end the following:
‘‘(10) contain a description, developed after
consultation with tribal organizations (as defined in
section 4 of the Indian Self-Determination and Edu-
cation Assistance Act) in the State, of the specific
measures taken by the State to comply with the In-
dian Child Welfare Act.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall be effective with respect to fiscal years
beginning on or after October 1, 1995.
SEC. 205. CHILD WELFARE TRAINEESHIPS.
(a) IN GENERAL.—Subpart 1 of part B of title IV
(42 U.S.C. 620–628) is amended by inserting after section
428 the following:
‘‘CHILD WELFARE TRAINEESHIPS
‘‘SEC. 429. The Secretary may approve an applica-
tion for a grant to a public or nonprofit institution for
higher learning to provide traineeships with stipends
under section 426(a)(1)(C) only if the application—
‘‘(1) provides assurances that each individual
who receives a stipend with such traineeship (in this
section referred to as a ‘recipient’) will enter into an
159
lection fees (in accordance with regulations pro-
mulgated by the Secretary);
‘‘(2) provides assurances that the institution
will—
‘‘(A) enter into agreements with child wel-
fare agencies for onsite training of recipients;
‘‘(B) permit an individual who is employed
in the field of child welfare services to apply for
a traineeship with a stipend if the traineeship
furthers the progress of the individual toward
the completion of degree requirements; and
‘‘(C) develop and implement a system that,
for the 3-year period that begins on the date
any recipient completes a child welfare services
program of study, tracks the employment
record of the recipient, for the purpose of deter-
mining the percentage of recipients who secure
employment in the field of child welfare services
and remain employed in the field.’’.
(b) 
CONFORMING
AMENDMENT.—Section
426(a)(1)(C) (42 U.S.C. 626(a)(1)(C)) is amended by in-
serting ‘‘described in section 429’’ after ‘‘including
traineeships’’.
160
(c) APPLICABILITY.—The amendments made by this
section shall apply to grants awarded on or after October
1, 1995
SEC. 206. DISPOSITIONAL HEARING.
(a) 
MOST
APPROPRIATE
SETTING.—Section
475(5)(A) (42 U.S.C. 675(5)(A)) is amended by inserting
‘‘and most appropriate’’ after ‘‘(most family like)’’.
(b) TIMING
OF
SUBSEQUENT
REVIEW.—Section
475(5)(C) (42 U.S.C. 675(5)(C)) is amended by striking
‘‘periodically’’ and inserting ‘‘not less frequently than
every 12 months’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall take effect on October 1, 1995.
SEC. 207. ELIMINATION OF FOSTER CARE CEILINGS AND
OF AUTHORITY TO TRANSFER UNUSED FOS-
TER CARE FUNDS TO CHILD WELFARE SERV-
ICES PROGRAMS.
(a) REPEAL.—Subsections (b) and (c) of section 474
(42 U.S.C. 674 (b) and (c)) are hereby repealed.
(b) CONFORMING AMENDMENTS.—Section 474 (42
U.S.C. 674) is amended—
(1) in subsection (d)(1)—
(A) by striking ‘‘subsections (a), (b), and
(c)’’ and inserting ‘‘subsection (a)’’; and
161
(B) by striking ‘‘the provisions of such
subsections’’ and inserting ‘‘subsection (a)’’;
and
(2) by redesignating subsection (d) as sub-
section (b).
(c) EFFECTIVE DATE.—The amendments and re-
peals made by this section shall apply to payments for cal-
endar quarters beginning on or after October 1, 1993.
SEC. 208. DEMONSTRATION PROJECTS.
Part A of title XI (42 U.S.C. 1301–1320b–13) is
amended by inserting after section 1128B the following:
‘‘DEMONSTRATION PROJECTS
‘‘SEC. 1129. (a) IN GENERAL.—The Secretary may
authorize not more than 10 States to conduct demonstra-
tion projects pursuant to this section which the Secretary
finds are likely to promote the objectives of part B or E
of title IV.
‘‘(b) WAIVER
AUTHORITY.—The Secretary may
waive compliance with any requirement of part B or E
of title IV which (if applied) would prevent a State from
carrying out a demonstration project under this section
or prevent the State from effectively achieving the purpose
of such a project, except that the Secretary may not
waive—
162
‘‘(1) any provision of section 427 (as in effect
before April 1, 1996), section 422(b)(9) (as in effect
after such date), or section 479; or
‘‘(2) any provision of such part E, to the extent
that the waiver would impair the entitlement of any
qualified child or family to benefits under a State
plan approved under such part E.
‘‘(c) TREATMENT AS PROGRAM EXPENDITURES.—
For purposes of parts B and E of title IV, the Secretary
shall consider the expenditures of any State to conduct
a demonstration project under this section to be expendi-
tures under subpart 1 or 2 of such part B, or under such
part E, as the State may elect.
‘‘(d) DURATION
OF
DEMONSTRATION.—A dem-
onstration project under this section may be conducted for
not more than 5 years.
‘‘(e) APPLICATION.—Any State seeking to conduct a
demonstration project under this section shall submit to
the Secretary an application, in such form as the Sec-
retary may require, which includes—
‘‘(1) a description of the proposed project, the
geographic area in which the proposed project would
be conducted, the children or families who would be
served by the proposed project, and the services
which would be provided by the proposed project
163
(which shall provide, where appropriate, for random
assignment of children and families to groups served
under the project and to control groups);
‘‘(2) a statement of the period during which the
proposed project would be conducted;
‘‘(3) a discussion of the benefits that are ex-
pected from the proposed project (compared to a
continuation of activities under the approved plan or
plans of the State);
‘‘(4) an estimate of the costs or savings of the
proposed project;
‘‘(5) a statement of program requirements for
which waivers would be needed to permit the pro-
posed project to be conducted;
‘‘(6) a description of the proposed evaluation
design; and
‘‘(7) such additional information as the Sec-
retary may require.
‘‘(f) EVALUATIONS; REPORT.—Each State authorized
to conduct a demonstration project under this section
shall—
‘‘(1) obtain an evaluation by an independent
contractor of the effectiveness of the project, using
an evaluation design approved by the Secretary
which provides for—
164
‘‘(A) comparison of methods of service de-
livery under the project, and such methods
under a State plan or plans, with respect to ef-
ficiency, economy, and any other appropriate
measures of program management;
‘‘(B) comparison of outcomes for children
and families (and groups of children and fami-
lies) under the project, and such outcomes
under a State plan or plans, for purposes of as-
sessing the effectiveness of the project in
achieving program goals; and
‘‘(C) any other information that the Sec-
retary may require; and
‘‘(2) provide interim and final evaluation re-
ports to the Secretary, at such times and in such
manner as the Secretary may require.
‘‘(g) COST NEUTRALITY.—The Secretary may not
authorize a State to conduct a demonstration project
under this section unless the Secretary determines that
the total amount of Federal funds that will be expended
under (or by reason of) the project over its approved term
(or such portion thereof or other period as the Secretary
may find appropriate) will not exceed the amount of such
funds that would be expended by the State under the State
165
plans approved under parts B and E of title IV if the
project were not conducted.’’.
SEC. 209. PLACEMENT ACCOUNTABILITY.
(a) CASE PLAN REQUIREMENTS.—Section 475(5)(A)
(42 U.S.C. 675(5)(A)), as amended by section 305(a), is
amended by adding at the end the following: ‘‘which—
‘‘(i) if the child has been placed in a
foster family home or child-care institution
a substantial distance from the home of
the parents of the child, or in a State dif-
ferent from the State in which such home
is located, sets forth the reasons why such
placement is in the best interests of the
child, and
‘‘(ii) if the child has been placed in
foster care outside the State in which the
home of the parents of the child is located,
requires that, periodically, but not less fre-
quently than every 12 months, a case-
worker on the staff of the State agency of
the State in which the home of the parents
of the child is located, or of the State in
which the child has been placed, visit such
child in such home or institution and sub-
mit a report on such visit to the State
166
agency of the State in which the home of
the parents of the child is located,’’.
(b) DISPOSITIONAL HEARING.—Section 475(5)(C)
(42 U.S.C. 675(5)(C)), as amended by section 305(b), is
amended by inserting ‘‘and, in the case of a child de-
scribed in subparagraph (A)(ii), whether the out-of-State
placement continues to be appropriate and in the best in-
terests of the child,’’ after ‘‘long-term basis)’’.
(c) DATA COLLECTION.—Section 479(c)(3)(C) (42
U.S.C. 679(c)(3)(C)) is amended—
(1) by striking ‘‘and’’ at the end of clause (i);
and
(2) by adding at the end the following:
‘‘(iii) children placed in foster care
outside the State which has placement and
care responsibility, and’’.
(d) EFFECTIVE DATES.—The amendments made by
this section shall be effective with respect to fiscal years
beginning on or after October 1, 1995.
SEC. 210. PAYMENTS OF STATE CLAIMS FOR FOSTER CARE
AND ADOPTION ASSISTANCE.
(a) IN
GENERAL.—Section 474(b) (42 U.S.C.
674(b)), as redesignated by section 306(b)(2), is amended
by adding at the end the following:
167
‘‘(4)(A) Within 60 days after receipt of a State claim
for expenditures pursuant to subsection (a), the Secretary
shall allow, disallow, or defer such claim.
‘‘(B) Within 15 days after a decision to defer such
a State claim, the Secretary shall notify the State of the
reasons for the deferral and of the additional information
necessary to determine the allowability of the claim.
‘‘(C) Within 90 days after receiving such necessary
information (in readily reviewable form), the Secretary
shall—
‘‘(i) disallow the claim, if able to complete the
review and determine that the claim is not allowable,
or
‘‘(ii) in any other case, allow the claim, subject
to disallowance (as necessary)—
‘‘(I) upon completion of the review, if it is
determined that the claim is not allowable; or
‘‘(II) on the basis of findings of an audit
or financial management review.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall be effective with respect to claims
made on or after the date of the enactment of this Act.
168
SEC. 211. EFFECT OF FAILURE TO CARRY OUT STATE
PLAN.
(a) IN GENERAL.—Part A of title XI (42 U.S.C.
1301–1320b–13), as amended by section 307, is amended
by inserting after section 1129 the following:
‘‘EFFECT OF FAILURE TO CARRY OUT STATE PLAN
‘‘SEC. 1130. In an action brought to enforce a provi-
sion of the Social Security Act, such provision is not to
be deemed unenforceable because of its inclusion in a sec-
tion of the Act requiring a State plan or specifying the
required contents of a State plan. This section is not in-
tended to limit or expand the grounds for determining the
availability of private actions to enforce State plan re-
quirements other than by overturning any such grounds
applied in Suter v. Artist M., 112 S. Ct. 1360 (1992),
but not applied in prior Supreme Court decisions respect-
ing such enforceability: Provided, however, That this sec-
tion is not intended to alter the holding in Suter v. Artist
M. that section 471(a)(15) of the Act is not enforceable
in a private right of action.’’.
(b) APPLICABILITY.—The amendment made by sub-
section (a) shall apply to actions pending on the date of
the enactment of this Act and to actions brought on or
after such date of enactment.
169
Subtitle B—Child Support
Enforcement
SEC. 212. REPORTS TO CREDIT BUREAUS ON PERSONS DE-
LINQUENT IN CHILD SUPPORT PAYMENTS.
(a) IN GENERAL.—Section 466(a)(7) (42 U.S.C.
666(a)(7)) is amended—
(1) by striking ‘‘Procedures’’ and all that fol-
lows through ‘‘request of such agency’’ and inserting
‘‘Procedures which require the State to periodically
report to consumer reporting agencies (as defined in
section 603(f) of the Fair Credit Reporting Act (15
U.S.C. 1681a(f))) the name of any parent who owes
overdue support and is at least 2 months delinquent
in the payment of such support and the amount of
such delinquency; and
(2) by striking ‘‘(C) a fee’’ and all that follows
through ‘‘by the State’’ and inserting ‘‘(C) such in-
formation shall not be made available to (i) a
consumer reporting agency which the State deter-
mines does not have sufficient capability to system-
atically and timely make accurate use of such infor-
mation, or (ii) an entity which has not furnished evi-
dence satisfactory to the State that the entity is a
consumer reporting agency’’.
170
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall take effect on October 1, 1995.
SEC. 213. TECHNICAL AMENDMENTS TO PROVISION ON
STATE 
PATERNITY 
ESTABLISHMENT 
PRO-
GRAMS.
Section 452(g)(2)(A) (42 U.S.C. 652(g)(2)(A)), as
amended by section 13721(a) of OBRA–1993, is amend-
ed—
(1) in clause (i), by striking ‘‘during the fiscal
year’’;
(2) in subclause (I) of clause (ii), by striking
‘‘as of the end of the fiscal year’’ and inserting ‘‘in
the fiscal year or, at the option of the State, as of
the end of such year’’;
(3) in subclause (II) of clause (ii), by striking
‘‘or (E) as of the end of the fiscal year’’ and insert-
ing ‘‘in the fiscal year or, at the option of the State,
as of the end of such year’’;
(4) in clause (iii), by striking ‘‘during the fiscal
year’’; and
(5) in the matter following clause (iii)—
(A) by striking ‘‘who were born out of wed-
lock during the immediately preceding fiscal
year’’ and inserting ‘‘born out of wedlock’’;
171
(B) by striking ‘‘such preceding fiscal
year’’ both places it appears and inserting ‘‘the
preceding fiscal year’’; and
(C) by striking ‘‘or E’’ the second place it
appears.
SEC. 214. AGREEMENT TO ASSIST IN LOCATING MISSING
CHILDREN UNDER THE PARENT LOCATOR
SERVICE.
(a) IN GENERAL.—Section 463 (42 U.S.C. 663) is
amended by adding at the end the following new sub-
section:
‘‘(f) The Secretary shall enter into an agreement with
the Attorney General of the United States, under which
the services of the Parent Locator Service established
under section 453 shall be made available to the Office
of Juvenile Justice and Delinquency Prevention upon its
request to locate any parent or child on behalf of such
Office for the purpose of—
‘‘(1) enforcing any State or Federal law with
respect to the unlawful taking or restraint of a child,
or
‘‘(2) making or enforcing a child custody deter-
mination.
The Parent Locator Service shall charge no fees for serv-
ices requested pursuant to this subsection.’’.
172
(b) CONFORMING AMENDMENT.—Section 463(c) (42
U.S.C. 663(c)) is amended by striking ‘‘(a), (b), or (e)’’
and inserting ‘‘(a), (b), (e), or (f)’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall take effect on October 1, 1995.
Subtitle C—Supplemental Security
Income
SEC. 221. DEFINITION 
OF 
DISABILITY 
FOR 
CHILDREN
UNDER AGE 18 APPLIED TO ALL INDIVIDUALS
UNDER AGE 18.
(a) IN GENERAL.—Section 1614(a)(3) (42 U.S.C.
1382c(a)(3)) is amended—
(1) in subparagraphs (A) and (H), by striking
‘‘a child’’ each place it appears and inserting ‘‘an in-
dividual’’; and
(2) in subparagraph (H), by striking ‘‘child’’
the second and third place it appears and inserting
‘‘individual’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to determinations made on or
after the date of the enactment of this Act.
173
Subtitle D—Aid to Families With
Dependent Children
SEC. 231. SIMPLIFICATION OF INCOME AND ELIGIBILITY
VERIFICATION SYSTEM.
Paragraph (1)(A) of section 1137(d) (42 U.S.C.
1320b–7(d)) is amended to read as follows:
‘‘(1)(A) The State shall require, as a condition
of an individual’s eligibility for benefits under a pro-
gram listed in subsection (b), a declaration in writ-
ing, under penalty of perjury—
‘‘(i) by the individual,
‘‘(ii) in the case in which eligibility for pro-
gram benefits is determined on a family or
household basis, by any adult member of such
individual’s family or household (as applicable),
or
‘‘(iii) in the case of an individual born into
a family or household receiving benefits under
such program, by any adult member of such
family or household no later than the next rede-
termination of eligibility of such family or
household following the birth of such individual,
stating whether the individual is a citizen or national
of the United States, and, if that individual is not
174
a citizen or national of the United States, that the
individual is in a satisfactory immigration status.’’.
SEC. 232. MEASUREMENT AND REPORTING OF WELFARE
RECEIPT.
(a) CONGRESSIONAL POLICY.—The Congress hereby
declares that—
(1) it is the policy and responsibility of the
Federal Government to reduce the rate at which and
the degree to which families depend on income from
welfare programs and the duration of welfare re-
ceipt, consistent with other essential national goals;
(2) it is the policy of the United States to
strengthen families, to ensure that children grow up
in families that are economically self-sufficient and
that the life prospects of children are improved, and
to underscore the responsibility of parents to sup-
port their children;
(3) the Federal Government should help welfare
recipients as well as individuals at risk of welfare re-
ceipt to improve their education and job skills, to ob-
tain child care and other necessary support services,
and to take such other steps as may be necessary to
assist them to become financially independent; and
(4) it is the purpose of this section to provide
the public with generally accepted measures of wel-
175
fare receipt so that it can track such receipt over
time and determine whether progress is being made
in reducing the rate at which and, to the extent fea-
sible, the degree to which, families depend on income
from welfare programs and the duration of welfare
receipt.
(b) DEVELOPMENT OF WELFARE INDICATORS AND
PREDICTORS.—The Secretary of Health and Human Serv-
ices (in this section referred to as the ‘‘Secretary’’) in con-
sultation with the Secretary of Agriculture shall—
(1) develop—
(A) indicators of the rate at which and, to
the extent feasible, the degree to which, families
depend on income from welfare programs and
the duration of welfare receipt; and
(B) predictors of welfare receipt;
(2) assess the data needed to report annually
on the indicators and predictors, including the abil-
ity of existing data collection efforts to provide such
data and any additional data collection needs; and
(3) not later than 2 years after the date of the
enactment of this section, provide an interim report
containing conclusions resulting from the develop-
ment and assessment described in paragraphs (1)
and (2), to—
176
(A) the Committee on Ways and Means of
the House of Representatives;
(B) the Committee on Education and
Labor of the House of Representatives;
(C) the Committee on Agriculture of the
House of Representatives;
(D) the Committee on Energy and Com-
merce of the House of Representatives;
(E) the Committee on Finance of the Sen-
ate;
(F) the Committee on Labor and Human
Resources of the Senate; and
(G) the Committee on Agriculture, Nutri-
tion, and Forestry of the Senate.
(c) ADVISORY BOARD ON WELFARE INDICATORS.—
(1) ESTABLISHMENT.—There is established an
Advisory Board on Welfare Indicators (in this sub-
section referred to as the ‘‘Board’’).
(2) COMPOSITION.—The Board shall be com-
posed of 12 members with equal numbers to be ap-
pointed by the House of Representatives, the Senate,
and the President. The Board shall be composed of
experts in the fields of welfare research and welfare
statistical methodology, representatives of State and
177
local welfare agencies, and organizations concerned
with welfare issues.
(3) VACANCIES.—Any vacancy occurring in the
membership of the Board shall be filled in the same
manner as the original appointment for the position
being vacated. The vacancy shall not affect the
power of the remaining members to execute the du-
ties of the Board.
(4) DUTIES.—Duties of the Board shall in-
clude—
(A) providing advice and recommendations
to the Secretary on the development of indica-
tors of the rate at which and, to the extent fea-
sible, the degree to which, families depend on
income from welfare programs and the duration
of welfare receipt; and
(B) providing advice on the development
and presentation of annual reports required
under subsection (d).
(5) TRAVEL
EXPENSES.—Members of the
Board shall not be compensated, but shall receive
travel expenses, including per diem in lieu of subsist-
ence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United
States Code, for each day the member is engaged in
178
the performance of duties away from the home or
regular place of business of the member.
(6) DETAIL
OF
FEDERAL
EMPLOYEES.—The
Secretary shall detail, without reimbursement, any
of the personnel of the Department of Health and
Human Services to the Board to assist the Board in
carrying out its duties. Any detail shall not interrupt
or otherwise affect the civil service status or privi-
leges of the Federal employee.
(7) 
VOLUNTARY
SERVICE.—Notwithstanding
section 1342 of title 31, United States Code, the
Board may accept the voluntary services provided by
a member of the Board.
(8) TERMINATION OF BOARD.—The Board shall
be terminated at such time as the Secretary deter-
mines the duties described in paragraph (4) have
been completed, but in any case prior to the submis-
sion of the first report required under subsection
(d).
(d) ANNUAL WELFARE INDICATORS REPORT.—
(1) PREPARATION.—The Secretary shall pre-
pare annual reports on welfare receipt in the United
States.
(2) COVERAGE.—The report shall include anal-
ysis of families and individuals receiving assistance
179
under means-tested benefit programs, including the
program of aid to families with dependent children
under part A of title IV of the Social Security Act
(42 U.S.C. 601 et seq.), the food stamp program
under the Food Stamp Act of 1977 (7 U.S.C. 2011
et seq.), and the Supplemental Security Income pro-
gram under title XVI of the Social Security Act (42
U.S.C. 1381 et seq.), or as general assistance under
programs administered by State and local govern-
ments.
(3) CONTENTS.—Each report shall set forth for
each of the means-tested benefit programs described
in paragraph (2)—
(A) indicators of—
(i) the rate at which and, to the ex-
tent feasible, the degree to which, families
depend on income from welfare programs,
and
(ii) the duration of welfare receipt;
(B) trends in indicators;
(C) predictors of welfare receipt;
(D) the causes of welfare receipt;
(E) patterns of multiple program receipt;
(F) such other information as the Sec-
retary deems relevant; and
180
(G) such recommendations for legislation,
which shall not include proposals to reduce eli-
gibility levels or impose barriers to program ac-
cess, as the Secretary may determine to be nec-
essary or desirable to reduce—
(i) the rate at which and the degree to
which families depend on income from wel-
fare programs, and
(ii) the duration of welfare receipt.
(4) SUBMISSION.—The Secretary shall submit
such a report not later than 3 years after the date
of the enactment of this section and annually there-
after, to the committees specified in subsection
(b)(3)(C). Each such report shall be transmitted
during the first 60 days of each regular session of
Congress.
(e) SHORT TITLE.—This section may be cited as the
‘‘Welfare Indicators Act of 1994’’.
SEC. 233. NEW HOPE DEMONSTRATION PROJECT.
(a) IN GENERAL.—The Secretary of Health and
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall provide for a demonstration project for a
qualified program to be conducted in Milwaukee, Wiscon-
sin, in accordance with this section.