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tablished under such title for the class of serv-
ices.
(2) INDIRECT APPLICATION TO HEALTH MAIN-
TENANCE
ORGANIZATIONS.—Nothing in this sub-
section shall be construed as affecting the payment
of amounts to health maintenance organizations
under the medicare program under a risk-sharing
contract under section 1876 of the Social Security
Act. However, adjustments in payment rates under
paragraph (1) may affect the computation of the av-
erage adjusted per capita cost under such section.
(c) PUBLICATIONS.—In publishing payment rates
under the medicare program, the Secretary shall take into
account the adjustment in rates under this section.
SEC. 206. ADJUSTMENTS TO MEDICARE PAYMENTS FOR
GRADUATE MEDICAL EDUCATION.
(a) DETERMINATION
OF FULL-TIME-EQUIVALENT
RESIDENTS DURING INITIAL RESIDENCY PERIOD.—
(1) EMPHASIS ON PRIMARY CARE.—Paragraph
(4)(C)(ii) of section 1886(h) of the Social Security
Act (42 U.S.C. 1395ww(h)) is amended by striking
‘‘is 1.00,’’ and inserting the following: ‘‘is—
‘‘(I) 1.1, in the case of a resident
who is a primary care resident (as de-
fined in paragraph (5)(H)),
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‘‘(II) 1.0, in the case of a resi-
dent who is not a primary care resi-
dent and who specializes in internal
medicine or pediatrics,
‘‘(III) .9, in the case of a resi-
dent who is not described in subclause
(I) or (II) and who is in the initial 3
years of the residency period, or
‘‘(IV) .8, in the case of a resident
not described in subclause (I), (II), or
(III),’’.
(2) PRIMARY CARE RESIDENT DEFINED.—Para-
graph (5) of such section is amended—
(A) by redesignating subparagraph (H) as
subparagraph (I), and
(B) by inserting after subparagraph (G)
the following new subparagraph:
‘‘(H) PRIMARY
CARE
RESIDENT.—The
term ‘primary care resident’ means (in accord-
ance with criteria established by the Secretary)
a resident being trained in a distinct program
of family practice medicine, general practice,
general internal medicine, or general pediat-
rics.’’.
110
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to cost reporting periods begin-
ning on or after October 1, 1993.
SEC. 207. DEFINITIONS.
In this title:
(1) APPLICABLE COMMISSION.—The term ‘‘ap-
plicable Commission’’ means—
(A) with respect to services included in a
class of services furnished by a hospital, other
institutional provider, or home health provider,
the Prospective Payment Assessment Commis-
sion, and
(B) with respect to other health care serv-
ices, the Physician Payment Review Commis-
sion.
(2) CLASS
OF
SERVICES.—The term ‘‘class’’
means, with respect to health care services, a class
established under section 202.
(3) 
HEALTH
CARE
SERVICES.—The 
term
‘‘health care services’’ means the items and services
described in section 202(a)(2).
(4) HEALTH
MAINTENANCE
ORGANIZATION.—
The term ‘‘health maintenance organization’’ means
an eligible organization with a contract under sec-
tion 1876 of the Social Security Act or a qualified
111
health maintenance organization (as defined in sec-
tion 1310(d) of the Public Health Service Act).
(5) MEDICARE
PROGRAM; MEDICARE
BENE-
FICIARY.—(A) The term ‘‘medicare program’’ means
the programs established under parts A and B of
title XVIII of the Social Security Act.
(B) The term ‘‘medicare beneficiary’’ means an
individual entitled to benefits under part A or B, or
both, of the medicare program.
(6) MEDICAID PROGRAM.—The term ‘‘medicaid
program’’ means any State plan approved under title
XIX of the Social Security Act and includes a State
program operating under a waiver under section
1115 of such Act.
(7) NATIONAL MEDIPLAN EXPENDITURE BUDG-
ET.—The term ‘‘national Mediplan expenditure
budget’’ means the budget established under section
201.
(8) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services.
(9) STATE.—The term ‘‘State’’ means the 50
States and the District of Columbia.
(10) UNITED
STATES.—The term ‘‘United
States’’ means the 50 States and the District of
Columbia.
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TITLE III—FINANCING
PROVISIONS
SEC. 301. INCOME TAXES FOR MEDIPLAN HEALTH CARE.
(a) IN GENERAL.—Subchapter A of chapter 1 of the
Internal Revenue Code of 1986 is amended by adding at
the end thereof the following new part:
‘‘PART VIII—INCOME TAXES FOR MEDIPLAN
HEALTH CARE
‘‘Sec. 59B. Tax on individuals.
‘‘Sec. 59C. Tax on gross receipts of health service providers from
providing covered benefits.
‘‘SEC. 59B. TAX ON INDIVIDUALS.
‘‘(a) IMPOSITION OF TAX.—In the case of an individ-
ual, there is hereby imposed (in addition to other taxes)
for each taxable year on the modified gross income of the
taxpayer a tax equal to the Mediplan health care premium
determined under subsection (b) for such year.
‘‘(b) MEDIPLAN HEALTH CARE PREMIUM.—The
Mediplan health care premium for the taxable year shall
be equal the lesser of—
‘‘(1) $1,500 ($3,000 in the case of a joint re-
turn), or
‘‘(2) 12.5 percent of the excess (if any) of the
modified gross income of the taxpayer over $8,000
($16,000 in the case of a joint return).