‘‘(3) LONG-TERM CARE SERVICES.—The term
‘long-term care services’ means the following care
and services furnished to individuals eligible under a
State plan under this title:
‘‘(A) Nursing facility services (as defined
in section 1905(f)).
‘‘(B) Intermediate care facility for the
mentally retarded services (as defined in section
1905(d)).
‘‘(C) Personal care services (as described
in section 1905(a)(24)).
‘‘(D) Private duty nursing services (as re-
ferred to in section 1905(a)(8)).
‘‘(E) Home or community-based services
furnished under a waiver granted under sub-
section (c), (d), or (e) of section 1915.
‘‘(F) Home and community care furnished
to functionally disabled elderly individuals
under section 1929.
‘‘(G) Community supported living arrange-
ments services under section 1930.
‘‘(H) Case-management services (as de-
scribed in section 1915(g)(2)).
‘‘(I) Home health care services (as referred
to in section 1905(a)(7)).
‘‘(J) Hospice care.
‘‘(4) MEDICAL CONSUMER PRICE INDEX.—The
term ‘medical consumer price index’ means the
consumer price index for medical services as deter-
mined by the Bureau of Labor Statistics.’’
(b) REQUIRING STATE MAINTENANCE OF EFFORT.—
Section 1902(a) (42 U.S.C. 1369a(a)) is amended—
(1) by striking ‘‘and’’ at the end of paragraph
(61);
(2) by striking the period at the end of para-
graph (62) and inserting ‘‘; and’’; and
(3) by adding at the end the following new
paragraph:
‘‘(63) provide that the State will continue to
make eligible for medical assistance under section
1902(a)(10) any class or category of individuals eli-
gible for medical assistance under such section dur-
ing fiscal year 1993.’’
(c) EFFECTIVE DATE.—The amendments made by
this section shall be effective with respect to fiscal years
beginning on or after October 1, 1994.
SEC. 902. WAIVERS FOR FURNISHING MEDICAL ASSIST-
ANCE UNDER THE MEDICAID PROGRAM.
(a) IN GENERAL.—Title XIX of the Social Security
Act (42 U.S.C. 1396 et seq.), as amended by section 901,
is amended by redesignating section 1932 as section 1933
and by inserting after section 1931 the following new sec-
tion:
‘‘WAIVERS FOR FURNISHING MEDICAL ASSISTANCE
UNDER THE MEDICAID PROGRAM
‘‘SEC. 1932. (a) IN GENERAL.—The Secretary shall
establish a process under which a State with a State plan
approved under this title may apply for waivers of any
of the requirements under this title in order to establish
innovative and cost-effective programs for furnishing med-
ical assistance to eligible individuals (as defined in section
1931(e)(2)).
‘‘(b) APPLICATION FOR WAIVERS.—
‘‘(1) IN GENERAL.—In order to receive a waiver
under subsection (a), a State shall submit an appli-
cation to the Secretary at such time and containing
such information as the Secretary determines appro-
priate.
‘‘(2) APPROVAL OF APPLICATION.—
‘‘(A) INITIAL
REVIEW.—Within 60 days
after an application is submitted by the State
under this subsection, the Secretary shall review
and approve such application or provide the
State with a list of the modifications that are
necessary for such application to be approved.
‘‘(B) ADDITIONAL
REVIEW.—Within 60
days after a State resubmits any application
under this subsection, the Secretary shall review
and approve such application or provide the
State with a summary of which items included
on the list provided to the State under subpara-
graph (A) remain unsatisfied. A State may re-
submit an application under this subparagraph
as many times as necessary to gain approval.
‘‘(c) DURATION OF WAIVERS.—Except as provided in
subsection (d), any waiver under this section shall be
granted for a period of 5 years, and renewed for subse-
quent 5-year periods, unless the Secretary determines that
the State has failed to furnish medical assistance in ac-
cordance with the terms of the waiver and any provisions
of this title with respect to which the Secretary has not
granted a waiver.
‘‘(d) TERMINATION
OF WAIVERS.—The Secretary
may terminate a waiver granted under this section at any
time if the Secretary determines that the State has failed
to furnish medical assistance in accordance with the terms
of the waiver and any provisions of this title with respect
to which the Secretary has not granted a waiver.
‘‘(e) REPORTS.—The State shall evaluate the pro-
grams operated under a waiver granted under this section
and submit reports to the Secretary at such times and
containing such information as the Secretary shall re-
quire.’’
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall be effective with respect to fiscal years
beginning on or after October 1, 1994.
Subtitle B—Medicare
SEC. 951. INDIVIDUAL ELECTION FOR TYPE OF COVERAGE.
(a) ELECTION FOR NEW ELIGIBLES.—
(1) IN GENERAL.—Title XVIII of the Social Se-
curity Act (42 U.S.C. 1395 et seq.) is amended by
adding after section 1804 the following new section:
‘‘INDIVIDUAL ELECTION FOR TYPE OF COVERAGE
‘‘SEC. 1805. (a) An individual may enroll with a pri-
vate health care arrangement under section 1893 or an
eligible organization under section 1876 only if such indi-
vidual has elected to enroll with such an arrangement or
organization within 1 year after the date that the individ-
ual—
‘‘(1) becomes entitled to benefits under part A
of this title, or
‘‘(2) foregoes a health benefit plan operated,
sponsored, or contributed to, by the individual’s em-
ployer or former employer (or the employer or
former employer of the individual’s spouse) where
such plan was the individual’s primary insurer.
‘‘(b) If an individual makes an election under sub-
section (a), such individual shall be entitled to payment
under this title only if such individual remains enrolled
with an arrangement or organization described in such
subsection.’’
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall apply with respect to individ-
uals who become entitled to benefits under part A of
title XVIII of the Social Security Act on or after Oc-
tober 1, 1994.
(b) ELECTION FOR CURRENT ELIGIBLES.—
(1) ENROLLMENT
WITH
A
PRIVATE
HEALTH
CARE
ARRANGEMENT
OR
ELIGIBLE
ORGANIZA-
TION.—
(A) IN GENERAL.—If an individual is enti-
tled to benefits under part A of title XVIII of
the Social Security Act on or before September
30, 1994, such individual may elect to enroll
with a private health care arrangement under
section 1893 of such Act or an eligible organi-
zation under section 1876 of such Act only if
such election is made on or before March 31,
1995.
(B) PAYMENT.—If an individual makes an
election under subparagraph (A), such individ-
ual shall be entitled to payment under title
XVIII of the Social Security Act only if such
individual remains enrolled with an arrange-
ment or organization described in such subpara-
graph.
(2) DECISION TO RETURN TO FEE FOR SERVICE
PLAN.—If an individual is enrolled with an eligible
organization under section 1876 of the Social Secu-
rity Act (42 U.S.C. 1395mm) on or before Septem-
ber 30, 1994, such individual may terminate the in-
dividual’s enrollment with such organization on or
before March 31, 1995, without being subject to the
payment limitation described in paragraph (1)(B).
(3) EFFECTIVE
DATE.—This subsection shall
take effect on October 1, 1994.
SEC. 952. HEALTH CARE COVERAGE UNDER A PRIVATE
HEALTH CARE ARRANGEMENT.
(a) IN GENERAL.—Part C of title XVIII of the Social
Security Act (42 U.S.C. 1395x et seq.) is amended by add-
ing at the end the following new section:
‘‘PAYMENTS TO PRIVATE HEALTH CARE ARRANGEMENTS
‘‘SEC. 1893. (a) PAYMENTS.—
‘‘(1) IN GENERAL.—The Secretary shall make
payment as specified in subsection (c) for each indi-
vidual who is enrolled with a private health care ar-
rangement.
‘‘(2) SOLE PAYMENTS.—Payments to an indi-
vidual under this section shall be in lieu of the
amounts that would otherwise be payable pursuant
to sections 1814(b) and 1833(a).
‘‘(b) CERTIFICATION.—
‘‘(1) IN GENERAL.—An individual who is en-
rolled with a private health care arrangement shall
certify to the Secretary, by not later than December
15 of each year, the individual’s enrollment for the
coming calendar year. Such certification shall indi-
cate the individual’s annual premium amount.
‘‘(2) FAILURE TO CERTIFY.—For purposes of
determining payment under subsection (c), an indi-
vidual who fails to provide the certification described
in paragraph (1) shall be deemed to be enrolled with
the private health care arrangement at the same
premium for which the Secretary last received a cer-
tification.
‘‘(c) PAYMENT AMOUNT SPECIFIED.—
‘‘(1) PRIVATE HEALTH CARE ARRANGEMENT.—
‘‘(A) IN GENERAL.—In January of each
year, the Secretary shall pay the private health
care arrangement certified by the individual
under subsection (b)(1), the lesser of—
‘‘(i) the individual’s annual premium
amount, or
‘‘(ii) the per capita amount specified
under paragraph (2).
‘‘(B) RETURN OF PAYMENT.—In the event
of the death of an individual, the private health
care arrangement certified by the individual
under subsection (b)(1) shall reimburse the Sec-
retary for a prorated portion of the amount re-
ceived under subparagraph (A), less any
amount expended by the private health care ar-
rangement for the health care expenses for such
individual. Such amount (if any) shall be depos-
ited in the Federal Hospital Insurance Trust
Fund and the Federal Supplementary Medical
Insurance Trust Fund in the same proportion
as such payment was paid by each trust fund
under subsection (e).
‘‘(2) PER CAPITA AMOUNT.—
‘‘(A) IN
GENERAL.—The Secretary shall
annually determine, and shall announce (in a
manner intended to provide notice to interested
parties) not later than September 7 before the
calendar year concerned, the per capita amount.
‘‘(B) DETERMINATION
OF
PER
CAPITA
RATE OF PAYMENT.—The per capita amount
for each group of individuals (based on resi-
dency, age, and gender) is equal to—
‘‘(i) the total estimated government
expenditures for all benefits under parts A
and B of this title in the coming calendar
year for such group (excluding any pre-
miums, deductibles, and copayments paid
by individuals for benefits under part B),
divided by
‘‘(ii) the total estimated number of in-
dividuals in such group expected to be enti-
tled to benefits under part A and enrolled
in part B in the coming calendar year.
‘‘(3) ADDITIONAL AMOUNTS FOR CERTAIN INDI-
VIDUALS.—
‘‘(A) LOW-COST
PLANS.—The Secretary
shall pay annually to an individual enrolled with
a private health care arrangement one-half of
the excess (if any) of—
‘‘(i) the per capita amount under
paragraph (2), over
‘‘(ii) the annual premium for the indi-
vidual’s private health care arrangement
(or in the case of a private health care ar-
rangement that is a catastrophic health in-
surance plan, the annual premium for such
plan and the annual deductible amount for
such plan).
‘‘(B) LONG TERM CARE PLAN.—The Sec-
retary shall pay annually to an individual who
has received payment under subparagraph (A)
and is enrolled with a long term care plan, an
additional payment equal to the amount re-
ceived by such individual under subparagraph
(A).
‘‘(d) DEFINITIONS.—For purposes of this section:
‘‘(1) 
CATASTROPHIC
HEALTH
INSURANCE
PLAN.—The term ‘catastrophic health insurance
plan’ has the meaning given to such term by section
220(c)(2)(A) of the Internal Revenue Code of 1986.
‘‘(2) LONG TERM CARE PLAN.—The term ‘long
term care plan’ means a plan which covers services
of the type identified in section 1931(e)(3).
‘‘(3) MEDICAL SAVINGS ACCOUNT.—The term
‘medical savings account’ has the meaning given to
such term by section 220(d)(1) of the Internal Reve-
nue Code of 1986.
‘‘(4) PRIVATE HEALTH CARE ARRANGEMENT.—
The term ‘private health care arrangement’ means—
‘‘(A) any arrangement which offers at least
the health care services described in section
1876(b)(2)(A), or
‘‘(B) a catastrophic health insurance plan
in connection with a medical savings account.
‘‘(e) SOURCE OF PAYMENT.—The payment to an in-
dividual under this section shall be made from the Federal
Hospital Insurance Trust Fund and the Federal Supple-
mentary Medical Insurance Trust Fund. The proportion
of the payment to be paid by each trust fund shall be de-
termined each year by the Secretary based on the relative
proportion of government expenditures that benefits from
each fund contribute to the per capita amount determined
under subsection (b)(2)(B).’’
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply to payments made on or after
October 1, 1994.
TITLE 
X—ENHANCED 
EFFI-
CIENCY 
THROUGH 
PAPER-
WORK REDUCTION
SEC. 1001. FEDERAL PAPERWORK REDUCTION AND EFFI-
CIENCY REQUIREMENTS.
(a) IN GENERAL.—The Secretary of Health and
Human Services (hereafter referred to in this title as the
‘‘Secretary’’) shall, in consultation with the Director of the
Office of Management and Budget, the Secretary of Veter-
ans Affairs, the Secretary of Defense, the Director of Per-
sonnel Management, and other appropriate Federal offi-
cials, adopt standards to reduce the administrative and
paperwork burdens of all Federal health care programs
by—
(1) 50 percent within the 2-year period follow-
ing the date of the enactment of this Act, and
(2) an additional 50 percent reduction from the
balance specified in (1) over a subsequent 3-year pe-
riod,
for a total reduction of 75 percent over the 5-year period
following the date of the enactment of this Act.
(b) INITIAL REDUCTION.—In order to achieve a pa-
perwork reduction described in subsection (a)(1), the Sec-
retary, shall adopt standards for Federal health care pro-
grams relating to each of the following: