H. R. 2491—826
(4) Assistance or benefits under the Child Nutrition Act
of 1966.
(5)(A) Public health assistance for immunizations.
(B) Public health assistance for testing and treatment of
a serious communicable disease if the Secretary of Health and
Human Services determines that it is necessary to prevent
the spread of such disease.
(6) Payments for foster care and adoption assistance under
part B of title IV of the Social Security Act for a child who
would, in the absence of subsection (a), be eligible to have
such payments made on the child’s behalf under such part,
but only if the foster or adoptive parent or parents of such
child are not described under subsection (a).
(7) Programs, services, or assistance (such as soup kitchens,
crisis counseling and intervention, and short-term shelter)
specified by the Attorney General, in the Attorney General’s
sole and unreviewable discretion after consultation with appro-
priate Federal agencies and departments, which (A) deliver
in-kind services at the community level, including through pub-
lic or private nonprofit agencies; (B) do not condition the provi-
sion of assistance, the amount of assistance provided, or the
cost of assistance provided on the individual recipient’s income
or resources; and (C) are necessary for the protection of life
or safety.
(8) Programs of student assistance under titles IV, V, IX,
and X of the Higher Education Act of 1965.
SEC. 12423. COSIGNATURE OF ALIEN STUDENT LOANS.
Section 484(b) of the Higher Education Act of 1965 (20 U.S.C.
1091(b)) is amended by adding at the end the following new para-
graph:
‘‘(6) 
Notwithstanding 
sections 
427(a)(2)(C), 
428B(a),
428C(b)(4)(A), and 464(c)(1)(E), a student who is an alien law-
fully admitted for permanent residence under the Immigration
and Nationality Act shall not be eligible for a loan under
this title unless the loan is endorsed and cosigned by the
alien’s sponsor under section 213A of the Immigration and
Nationality Act or by another individual who is a United States
citizen.’’.
CHAPTER 3—GENERAL PROVISIONS
SEC. 12431. DEFINITIONS.
(a) IN GENERAL.—Except as otherwise provided in this subtitle,
the terms used in this subtitle have the same meaning given
such terms in section 101(a) of the Immigration and Nationality
Act.
(b) QUALIFIED ALIEN.—For purposes of this subtitle, the term
‘‘qualified alien’’ means an alien who, at the time the alien applies
for, receives, or attempts to receive a Federal public benefit, is—
(1) an alien who is lawfully admitted for permanent resi-
dence under the Immigration and Nationality Act,
(2) an alien who is granted asylum under section 208
of such Act,
(3) a refugee who is admitted to the United States under
section 207 of such Act,
H. R. 2491—827
(4) an alien who is paroled into the United States under
section 212(d)(5) of such Act for a period of at least 1 year,
(5) an alien whose deportation is being withheld under
section 243(h) of such Act, or
(6) an alien who is granted conditional entry pursuant
to section 203(a)(7) of such Act as in effect prior to April
1, 1980.
SEC. 12432. REAPPLICATION FOR SSI BENEFITS.
(a) APPLICATION
AND
NOTICE.—Notwithstanding any other
provision of law, in the case of an individual who is receiving
supplemental security income benefits under title XVI of the Social
Security Act as of the date of the enactment of this Act and
whose eligibility for such benefits would terminate by reason of
the application of section 12402(a)(2)(D), the Commissioner of Social
Security shall so notify the individual not later than 90 days after
the date of the enactment of this Act.
(b) REAPPLICATION.—
(1) IN GENERAL.—Not later than 120 days after the date
of the enactment of this Act, each individual notified pursuant
to subsection (a) who desires to reapply for benefits under
title XVI of the Social Security Act shall reapply to the Commis-
sioner of Social Security.
(2) DETERMINATION OF ELIGIBILITY.—Not later than 1 year
after the date of the enactment of this Act, the Commissioner
of Social Security shall determine the eligibility of each individ-
ual who reapplies for benefits under paragraph (1) pursuant
to the procedures of such title XVI.
SEC. 12433. STATUTORY CONSTRUCTION.
(a) LIMITATION.—
(1) Nothing in this subtitle may be construed as an entitle-
ment or a determination of an individual’s eligibility or fulfill-
ment of the requisite requirements for any Federal, State,
or local governmental program, assistance, or benefits. For
purposes of this subtitle, eligibility relates only to the general
issue of eligibility or ineligibility on the basis of alienage.
(2) Nothing in this subtitle may be construed as addressing
alien eligibility for a basic public education as determined by
the Supreme Court of the United States under Plyler v. Doe
(457 U.S. 202)(1982).
(b) NOT APPLICABLE TO FOREIGN ASSISTANCE.—This subtitle
does not apply to any Federal, State, or local governmental program,
assistance, or benefits provided to an alien under any program
of foreign assistance as determined by the Secretary of State in
consultation with the Attorney General.
(c) SEVERABILITY.—If any provision of this subtitle or the
application of such provision to any person or circumstance is
held to be unconstitutional, the remainder of this subtitle and
the application of the provisions of such to any person or cir-
cumstance shall not be affected thereby.
H. R. 2491—828
Subtitle E—Teaching Hospital and
Graduate Medical Education Trust Fund
CHAPTER 1—TRUST FUND
SEC. 12501. ESTABLISHMENT OF FUND; PAYMENTS TO TEACHING HOS-
PITALS.
The Social Security Act (42 U.S.C. 300 et seq.) is amended
by adding after title XXI the following title:
‘‘TITLE XXII—TEACHING HOSPITAL AND GRADUATE
MEDICAL EDUCATION TRUST FUND
‘‘TABLE OF CONTENTS OF TITLE
‘‘PART A—ESTABLISHMENT OF FUND
‘‘Sec. 2201. Establishment of Fund.
‘‘PART B—PAYMENTS TO TEACHING HOSPITALS
‘‘Subpart 1—Requirement of Payments
‘‘Sec. 2211. Formula payments to teaching hospitals.
‘‘Sec. 2212. Additional provisions regarding annual payment document.
‘‘Subpart 2—Amount Relating to MedicarePlus Program
‘‘Sec. 2221. Determination of amount relating to MedicarePlus program.
‘‘Subpart 3—Amount Relating to Indirect Costs of Graduate Medical Education
‘‘Sec. 2231. Determination of amount relating to indirect costs.
‘‘Sec. 2232. Indirect costs; special rules regarding payments from general ac-
count.
‘‘Subpart 4—Amount Relating to Direct Costs of Graduate Medical Education
‘‘Sec. 2241. Determination of amount relating to direct costs.
‘‘Sec. 2242. Direct costs; special rules regarding payments from general ac-
count.
‘‘Sec. 2243. Direct costs; authority for payments to consortia of providers.
‘‘PART A—ESTABLISHMENT OF FUND
‘‘SEC. 2201. ESTABLISHMENT OF FUND.
‘‘(a) IN GENERAL.—There is established in the Treasury of the
United States a fund to be known as the Teaching Hospital and
Graduate Medical Education Trust Fund (in this title referred to
as the ‘Fund’), consisting of amounts appropriated to the Fund
in subsections (d), (f)(3), and (g), and amounts transferred to the
Fund under section 1886(j). Amounts in the Fund are available
until expended.
‘‘(b) EXPENDITURES FROM FUND.—Amounts in the Fund are
available to the Secretary for making payments under section 2211.
‘‘(c) ACCOUNTS
IN FUND.—There are established within the
Fund the following accounts:
‘‘(1) The General MedicarePlus Incentive Account.
‘‘(2) The General Indirect-Costs Medical Education Account.
‘‘(3) The General Direct-Costs Medical Education Account.
‘‘(4) The Medicare Indirect-Costs Medical Education
Account.
‘‘(5) The Medicare Direct-Costs Medical Education Account.
H. R. 2491—829
‘‘(d) GENERAL TRANSFERS TO FUND.—
‘‘(1) IN GENERAL.—For fiscal year 1997 and each subsequent
fiscal year, there are appropriated to the Fund (effective on
the date specified in paragraph (2)), out of any money in the
Treasury not otherwise appropriated, the following amounts
(as applicable to the fiscal year involved):
‘‘(A) For fiscal year 1997, $1,100,000,000.
‘‘(B) For fiscal year 1998, $1,300,000,000.
‘‘(C) For fiscal year 1999, $2,000,000,000.
‘‘(D) For fiscal year 2000, $2,600,000,000.
‘‘(E) For fiscal year 2001, $3,100,000,000.
‘‘(F) For fiscal year 2002, $3,400,000,000.
‘‘(G) For fiscal year 2003 and each subsequent fiscal
year, the greater of the amount appropriated for the preced-
ing fiscal year or an amount equal to the product of—
‘‘(i) the amount appropriated for the preceding fis-
cal year; and
‘‘(ii) 1 plus the percentage increase in the nominal
gross domestic product for the one-year period ending
upon July 1 of such preceding fiscal year.
‘‘(2) EFFECTIVE DATE FOR ANNUAL APPROPRIATION.—For pur-
poses of paragraph (1), the date specified in this paragraph
for a fiscal year is the first day of the fiscal year.
‘‘(3) ALLOCATION FOR GENERAL MEDICAREPLUS INCENTIVE
ACCOUNT.—Of the amount appropriated in paragraph (1) for
a fiscal year, there shall be allocated to the General
MedicarePlus Incentive Account the following percentage (as
applicable to the fiscal year involved):
‘‘(A) For fiscal year 1997, 20 percent.
‘‘(B) For fiscal year 1998, 30 percent.
‘‘(C) For fiscal year 1999, 40 percent.
‘‘(D) For fiscal year 2000 and each subsequent fiscal
year, 50 percent.
‘‘(4) ALLOCATIONS
FOR
GENERAL
MEDICAL
EDUCATION
ACCOUNTS.—
‘‘(A) IN GENERAL.—Of the amount appropriated in para-
graph (1) for a fiscal year and remaining after the allocation
required in paragraph (3) for the year has been made—
‘‘(i) there shall be allocated to the General Indirect-
Costs Medical Education Account the percentage deter-
mined under subparagraph (B)(ii); and
‘‘(ii) there shall be allocated to the General Direct-
Costs Medical Education Account the percentage deter-
mined under subparagraph (B)(iii).
‘‘(B) DETERMINATION OF FIXED PERCENTAGES.—The Sec-
retary of Health and Human Services, acting through the
Administrator of the Health Care Financing Administra-
tion, shall determine the following:
‘‘(i) The total amount of payments that were made
under subsections (d)(5)(B) and (h) of section 1886
for fiscal year 1994.
‘‘(ii) The percentage of such total that was con-
stituted by payments under subsection (d)(5)(B) of such
section.
‘‘(iii) The percentage of such total that was con-
stituted by payments under subsection (h) of such sec-
tion.
H. R. 2491—830
‘‘(e) TRANSFERS FROM MEDICARE PROGRAM.—Amounts shall,
in accordance with section 1886(j), be transferred to the Fund
from the trust funds established under parts A and B of title
XVIII.
‘‘(f) INVESTMENT.—
‘‘(1) IN
GENERAL.—The Secretary of the Treasury shall
invest such amounts of the Fund as such Secretary determines
are not required to meet current withdrawals from the Fund.
Such investments may be made only in interest-bearing obliga-
tions of the United States. For such purpose, such obligations
may be acquired on original issue at the issue price, or by
purchase of outstanding obligations at the market price.
‘‘(2) SALE OF OBLIGATIONS.—Any obligation acquired by the
Fund may be sold by the Secretary of the Treasury at the
market price.
‘‘(3) AVAILABILITY OF INCOME.—Any interest derived from
obligations acquired by the Fund, and proceeds from any sale
or redemption of such obligations, are hereby appropriated
to the Fund.
‘‘(g) MONETARY GIFTS TO FUND.—There are appropriated to
the Fund such amounts as may be unconditionally donated to
the Federal Government as gifts to the Fund.
‘‘PART B—PAYMENTS TO TEACHING HOSPITALS
‘‘Subpart 1—Requirement of Payments
‘‘SEC. 2211. FORMULA PAYMENTS TO TEACHING HOSPITALS.
‘‘(a) IN GENERAL.—Subject to subsection (d), in the case of
each teaching hospital that in accordance with subsection (b) sub-
mits to the Secretary a payment document for fiscal year 1997
or any subsequent fiscal year, the Secretary shall make payments
for the year to the teaching hospital for the direct and indirect
costs of operating approved medical residency training programs.
Such payments shall be made from the Fund, and the total of
the payments to the hospital for the fiscal year shall equal the
sum of the following:
‘‘(1) An amount determined under section 2221 (relating
to the MedicarePlus program).
‘‘(2) An amount determined under section 2231 (relating
to the indirect costs of graduate medical education).
‘‘(3) An amount determined under section 2241 (relating
to the direct costs of graduate medical education).
‘‘(b) PAYMENT DOCUMENT.—For purposes of subsection (a), a
payment document is a document containing such information as
may be necessary for the Secretary to make payments under such
subsection to a teaching hospital during a fiscal year. The document
is submitted in accordance with this subsection if the document
is submitted not later than the date specified by the Secretary,
and the document is in such form and is made in such manner
as the Secretary may require. This subsection is subject to section
2212.
‘‘(c) PERIODIC PAYMENTS.—Payments under subsection (a) for
a teaching hospital for a fiscal year shall be made periodically,
at such intervals and in such amounts as the Secretary determines
to be appropriate (subject to applicable Federal law regarding Fed-
eral payments).
H. R. 2491—831
‘‘(d) SPECIAL RULES.—
‘‘(1) PAYMENTS TO CONSORTIA OF PROVIDERS.—In the case
of payments under subsection (a) that are determined under
section 2241:
‘‘(A) The requirement under such subsection to make
the payments to teaching hospitals is subject to the author-
ity of the Secretary under section 2243(a) to make pay-
ments to qualifying consortia.
‘‘(B) If the Secretary authorizes payments to a consor-
tium under section 2243(a), subsections (a) and (b) of this
section (other than subsection (a)(2)) apply to the consor-
tium to the same extent and in the same manner as the
subsections apply to teaching hospitals.
‘‘(2) HOSPITALS IN STATES WITH CERTAIN DEMONSTRATION
PROJECTS.—Paragraph (2) of subsection (a) is subject to section
2232(d)(1)(B), and paragraph (3) of such subsection is subject
to section 2242(d)(1)(B).
‘‘(e) ADMINISTRATOR OF PROGRAMS.—This part, and the subse-
quent parts of this title, shall be carried out by the Secretary
acting through the Administrator of the Health Care Financing
Administration.
‘‘(f) APPROVED MEDICAL RESIDENCY TRAINING PROGRAM.—For
purposes of this title, the term ‘approved medical residency training
program’ has the meaning given such term in section 1886(h)(5)(A).
‘‘SEC. 2212. ADDITIONAL PROVISIONS REGARDING ANNUAL PAYMENT
DOCUMENT.
‘‘(a) PERIODIC REPORTS.—In collecting information under section
2211(b), the Secretary may require that information be submitted
to the Secretary in periodic reports.
‘‘(b) INFORMATION RELATING TO MEDICARE PROGRAM.—Informa-
tion collected by the Secretary under section 2211(b) with respect
to a teaching hospital for a fiscal year shall include information
on the following:
‘‘(1) The number of inpatient discharges for the fiscal year
attributable to individuals enrolled in the MedicarePlus pro-
gram under part C of title XVIII.
‘‘(2) For each discharge with respect to which payment
is received from the Secretary pursuant to part A of title
XVIII, the diagnosis-related group within which the discharge
is classified (as determined in accordance with section
1886(d)(4)(A)).
‘‘(3) The medicare patient load of the hospital (as defined
in section 1886(h)(3)(C)).
‘‘Subpart 2—Amount Relating to MedicarePlus Program
‘‘SEC. 
2221. 
DETERMINATION 
OF 
AMOUNT 
RELATING 
TO
MEDICAREPLUS PROGRAM.
‘‘(a) IN GENERAL.—For purposes of section 2211(a)(1), the
amount determined under this section for a teaching hospital for
a fiscal year is the product of—
‘‘(1) the amount in the General MedicarePlus Incentive
Account on the date specified in section 2201(d)(2) (once the
appropriation under such section is made); and
‘‘(2) the percentage determined for the hospital under sub-
section (b) for the fiscal year.
H. R. 2491—832
‘‘(b) ANNUAL HOSPITAL-SPECIFIC PERCENTAGE.—For purposes
of subsection (a)(2), the percentage determined under this sub-
section for a teaching hospital for a fiscal year is the percentage
constituted by the ratio of—
‘‘(1) the number of inpatient discharges for the fiscal year
attributable to individuals enrolled in the MedicarePlus pro-
gram under part C of title XVIII; to
‘‘(2) the sum of the respective numbers determined under
paragraph (1) for the fiscal year for all teaching hospitals.
‘‘Subpart 3—Amount Relating to Indirect Costs of Graduate
Medical Education
‘‘SEC. 2231. DETERMINATION OF AMOUNT RELATING TO INDIRECT
COSTS.
‘‘(a) IN GENERAL.—For purposes of section 2211(a)(2), the
amount determined under this section for a teaching hospital for
a fiscal year is the sum of—
‘‘(1) the amount determined under subsection (b) (relating
to the General Indirect-Costs Medical Education Account); and
‘‘(2) the amount determined under subsection (c) (relating
to the Medicare Indirect-Costs Medical Education Account),
subject to section 2232(d)(1)(B).
‘‘(b) PAYMENT FROM GENERAL ACCOUNT.—
‘‘(1) IN GENERAL.—For purposes of subsection (a)(1), the
amount determined under this subsection for a teaching hos-
pital for a fiscal year is the product of—
‘‘(A) the amount in the General Indirect-Costs Medical
Education Account on the date specified in section
2201(d)(2) (once the appropriation under such section is
made); and
‘‘(B) the percentage determined for the hospital under
paragraph (2).
‘‘(2) FIXED HOSPITAL-SPECIFIC PERCENTAGE.—
‘‘(A) IN GENERAL.—For purposes of paragraph (1)(B),
the percentage determined under this paragraph for a
teaching hospital is the mean average of the respective
percentages determined under subparagraph (C) for each
fiscal year of the applicable period (as defined in subpara-
graph (B)), adjusted by the Secretary (upward or down-
ward, as the case may be) on a pro rata basis to the
extent necessary to ensure that the sum of the percentages
determined under this paragraph for all teaching hospitals
is equal to 100 percent. The preceding sentence is subject
to section 2232.
‘‘(B) APPLICABLE PERIOD REGARDING RELEVANT DATA;
FISCAL
YEARS
1992
THROUGH
1994.—For purposes of this
part, the term ‘applicable period’ means the period begin-
ning on the first day of fiscal year 1992 and continuing
through the end of fiscal year 1994.
‘‘(C) RESPECTIVE DETERMINATIONS FOR FISCAL YEARS
OF APPLICABLE PERIOD.—For purposes of subparagraph (A),
the percentage determined under this subparagraph for
a teaching hospital for a fiscal year of the applicable period
is the percentage constituted by the ratio of—
H. R. 2491—833
‘‘(i) the total amount of payments received by the
hospital under section 1886(d)(5)(B) for discharges
occurring during the fiscal year involved; to
‘‘(ii) the sum of the respective amounts determined
under clause (i) for the fiscal year for all teaching
hospitals.
‘‘(3) AVAILABILITY OF DATA.—If a teaching hospital received
the payments specified in paragraph (2)(C)(i) during the
applicable period but a complete set of the relevant data is
not available to the Secretary for purposes of determining an
amount under such paragraph for the fiscal year involved,
the Secretary shall for purposes of such subsection make an
estimate on the basis of such data as are available to the
Secretary for the applicable period.
‘‘(c) PAYMENT FROM MEDICARE ACCOUNT.—For purposes of sub-
section (a)(2), the amount determined under this subsection for
a teaching hospital for a fiscal year is an amount determined
in accordance with the methodology in effect under section
1886(d)(5)(B) for such year. Payments made under section 2211
pursuant to the preceding sentence shall be made from the Medicare
Indirect-Costs Medical Education Account.
‘‘SEC. 2232. INDIRECT COSTS; SPECIAL RULES REGARDING PAYMENTS
FROM GENERAL ACCOUNT.
‘‘(a) SPECIAL RULE REGARDING FISCAL YEARS 1995 AND 1996.—
‘‘(1) IN GENERAL.—In the case of a teaching hospital whose
first payments under section 1886(d)(5)(B) were for discharges
occurring in fiscal year 1995 or in fiscal year 1996 (referred
to in this subsection individually as a ‘first payment year’),
the percentage determined under paragraph (2) for the hospital
is deemed to be the percentage applicable under section
2231(b)(2) to the hospital, subject to paragraph (3).
‘‘(2) DETERMINATION OF FIXED PERCENTAGE.—For purposes
of paragraph (1), the percentage determined under this para-
graph for a teaching hospital is the percentage constituted
by the ratio of the amount determined under subparagraph
(A) to the amount determined under subparagraph (B), as
follows:
‘‘(A)(i) If the first payment year for the hospital is
fiscal year 1995, the amount determined under this
subparagraph is the total amount of payments received
by the hospital under section 1886(d)(5)(B) for discharges
occurring during fiscal year 1995.
‘‘(ii) If the first payment year for the hospital is fiscal
year 1996, the amount determined under this subpara-
graph is an amount equal to an estimate by the Secretary
of the total amount of payments that would have been
paid to the hospital under section 1886(d)(5)(B) for dis-
charges occurring during fiscal year 1995 if such section,
as in effect for fiscal year 1996, had applied to the hospital
for discharges occurring during fiscal year 1995.
‘‘(B)(i) If the first payment year for the hospital is
fiscal year 1995, the amount determined under this
subparagraph is the aggregate total of the payments
received by teaching hospitals under section 1886(d)(5)(B)
for discharges occurring during fiscal year 1995.
H. R. 2491—834
‘‘(ii) If the first payment year for the hospital is fiscal
year 1996—
‘‘(I) the Secretary shall make an estimate in accord-
ance with subparagraph (A)(ii) for all teaching hos-
pitals; and
‘‘(II) the amount determined under this subpara-
graph is the sum of the estimates made by the Sec-
retary under subclause (I).
‘‘(3) ADJUSTMENT OF PERCENTAGE.—The percentage deter-
mined under paragraph (2) shall be adjusted by the Secretary
in accordance with section 2231(b)(2)(A) to the extent deter-
mined by the Secretary to be necessary with respect to a
sum that equals 100 percent.
‘‘(b) NEW TEACHING HOSPITALS.—
‘‘(1) IN GENERAL.—In the case of a teaching hospital that
did not receive payments under section 1886(d)(5)(B) for any
of the fiscal years 1992 through 1996, the percentage deter-
mined under paragraph (3) for the hospital is deemed to be
the percentage applicable under section 2231(b)(2) to the hos-
pital, subject to paragraphs (4) and (5).
‘‘(2) DESIGNATED FISCAL YEAR REGARDING DATA.—The deter-
mination under paragraph (3) of a percentage for a teaching
hospital described in paragraph (1) shall be made for the most
recent fiscal year for which the Secretary has sufficient data
to make the determination (referred to in this subsection as
the ‘designated fiscal year’).
‘‘(3) DETERMINATION OF FIXED PERCENTAGE.—For purposes
of paragraph (1), the percentage determined under this para-
graph for the teaching hospital involved is the percentage con-
stituted by the ratio of the amount determined under subpara-
graph (A) to the amount determined under subparagraph (B),
as follows:
‘‘(A) The amount determined under this subparagraph
is an amount equal to an estimate by the Secretary of
the total amount of payments that would have been paid
to the hospital under section 1886(d)(5)(B) for the des-
ignated fiscal year if such section, as in effect for the
first fiscal year for which payments pursuant to this sub-
section are to be made to the hospital, had applied to
the hospital for the designated fiscal year.
‘‘(B) The Secretary shall make an estimate in accord-
ance with subparagraph (A) for all teaching hospitals. The
amount determined under this subparagraph is the sum
of the estimates made by the Secretary under the preceding
sentence.
‘‘(4) ADJUSTMENT OF PERCENTAGE.—The percentage deter-
mined under paragraph (3) shall be adjusted by the Secretary
in accordance with section 2231(b)(2)(A) to the extent deter-
mined by the Secretary to be necessary with respect to a
sum that equals 100 percent.
‘‘(5) LIMITATION.—This subsection does not apply to a teach-
ing hospital described in paragraph (1) if the hospital is in
a State for which a demonstration project under section
1814(b)(3) is in effect.
‘‘(c) CONSOLIDATIONS
AND MERGERS.—In the case of two or
more teaching hospitals that have each received payments pursuant
to section 2231 for one or more fiscal years and that undergo
H. R. 2491—835
a consolidation or merger, the percentage applicable to the resulting
teaching hospital for purposes of section 2231(b)(2) is the sum
of the respective percentages that would have applied pursuant
to such section if the hospitals had not undergone the consolidation
or merger.
‘‘(d) STATES WITH CERTAIN DEMONSTRATION PROJECTS.—
‘‘(1) IN GENERAL.—In the case of a teaching hospital in
a State for which a demonstration project under section
1814(b)(3) is in effect—
‘‘(A) the percentage determined under paragraph (2)
for the hospital is deemed to be the percentage applicable
under section 2231(b)(2) to the hospital; and
‘‘(B) the hospital is not eligible for any payments from
the Medicare Indirect-Costs Medical Education Account.
‘‘(2) DETERMINATION OF FIXED PERCENTAGE.—For purposes
of paragraph (1)(A):
‘‘(A) The Secretary shall make an estimate of the total
amount of payments that would have been received under
section 1886(d)(5)(B) by the hospital involved with respect
to each of the fiscal years of the applicable period if such
section (as in effect for such fiscal years) had applied to
the hospital for such years.
‘‘(B) The percentage determined under this paragraph
for the hospital for a fiscal year is a mean average percent-
age determined for the hospital in accordance with the
methodology of section 2231(b)(2), except that the estimate
made by the Secretary under subparagraph (A) of this
paragraph for a fiscal year of the applicable period is
deemed to be the amount that applies for purposes of
section 2231(b)(2)(C)(i) for such year.
‘‘Subpart 4—Amount Relating to Direct Costs of Graduate Medical
Education
‘‘SEC. 2241. DETERMINATION OF AMOUNT RELATING TO DIRECT COSTS.
‘‘(a) IN GENERAL.—For purposes of section 2211(a)(3), the
amount determined under this section for a teaching hospital for
a fiscal year is the sum of—
‘‘(1) the amount determined under subsection (b) (relating
to the General Direct-Costs Medical Education Account); and
‘‘(2) the amount determined under subsection (c) (relating
to the Medicare Direct-Costs Medical Education Account), sub-
ject to section 2242(d)(1)(B).
‘‘(b) PAYMENT FROM GENERAL ACCOUNT.—
‘‘(1) IN GENERAL.—For purposes of subsection (a)(1), the
amount determined under this subsection for a teaching hos-
pital for a fiscal year is the product of—
‘‘(A) the amount in the General Direct-Costs Medical
Education Account on the applicable date under section
2201(d)(2) (once the appropriation under such section is
made); and
‘‘(B) the percentage determined for the hospital under
paragraph (2).
‘‘(2) FIXED HOSPITAL-SPECIFIC PERCENTAGE.—
‘‘(A) IN GENERAL.—For purposes of paragraph (1)(B),
the percentage determined under this paragraph for a
teaching hospital is the mean average of the respective
H. R. 2491—838
of the estimates made by the Secretary under the preceding
sentence.
‘‘(4) ADJUSTMENT OF PERCENTAGE.—The percentage deter-
mined under paragraph (3) shall be adjusted by the Secretary
in accordance with section 2223(b)(2)(A) to the extent deter-
mined by the Secretary to be necessary with respect to a
sum that equals 100 percent.
‘‘(5) LIMITATION.—This subsection does not apply to a teach-
ing hospital described in paragraph (1) if the hospital is in
a State for which a demonstration project under section
1814(b)(3) is in effect.
‘‘(c) CONSOLIDATIONS
AND MERGERS.—In the case of two or
more teaching hospitals that have each received payments pursuant
to section 2241 for one or more fiscal years and that undergo
a consolidation or merger, the percentage applicable to the resulting
teaching hospital for purposes of section 2241(b)(2) is the sum
of the respective percentages that would have applied pursuant
to such section if the hospitals had not undergone the consolidation
or merger.
‘‘(d) STATES WITH CERTAIN DEMONSTRATION PROJECTS.—
‘‘(1) IN GENERAL.—In the case of a teaching hospital in
a State for which a demonstration project under section
1814(b)(3) is in effect—
‘‘(A) the percentage determined under paragraph (2)
for the hospital is deemed to be the percentage applicable
under section 2241(b)(2) to the hospital; and
‘‘(B) the hospital is not eligible for any payments from
the Medicare Direct-Costs Medical Education Account.
‘‘(2) DETERMINATION OF FIXED PERCENTAGE.—For purposes
of paragraph (1)(A):
‘‘(A) The Secretary shall make an estimate of the total
amount of payments that would have been received under
section 1886(h) by the hospital involved with respect to
each of the fiscal years of the applicable period if such
section (as in effect for such fiscal years) had applied to
the hospital for such years.
‘‘(B) The percentage determined under this paragraph
for the hospital for a fiscal year is a mean average percent-
age determined for the hospital in accordance with the
methodology of section 2241(b)(2), except that the estimate
made by the Secretary under subparagraph (A) of this
paragraph for a fiscal year of the applicable period is
deemed to be the amount that applies for purposes of
section 2241(b)(2)(B)(i) for such year.
‘‘SEC. 2243. DIRECT COSTS; AUTHORITY FOR PAYMENTS TO CONSORTIA
OF PROVIDERS.
‘‘(a) IN GENERAL.—In lieu of making payments to teaching
hospitals pursuant to sections 2221 and 2241, the Secretary may
make payments under this section to consortia that meet the
requirements of subsection (b).
‘‘(b) QUALIFYING CONSORTIUM.—For purposes of subsection (a),
a consortium meets the requirements of this subsection if the
consortium is in compliance with the following:
‘‘(1) The consortium consists of a teaching hospital and
one or more of the following entities:
H. R. 2491—839
‘‘(A) Schools of allopathic medicine or osteopathic medi-
cine.
‘‘(B) Other teaching hospitals.
‘‘(C) Approved medical residency training programs.
‘‘(D) Federally qualified health centers.
‘‘(E) Medical group practices.
‘‘(F) Managed care entities.
‘‘(G) Entities furnishing outpatient services.
‘‘(H) Such other entities as the Secretary determines
to be appropriate.
‘‘(2) The members of the consortium have agreed to collabo-
rate in the programs of graduate medical education that are
operated by such members.
‘‘(3) With respect to the receipt by the consortium of pay-
ments made pursuant to this section, the members of the
consortium have agreed on a method for allocating the pay-
ments among the members.
‘‘(4) The consortium meets such additional requirements
as the Secretary may establish.
‘‘(c) PAYMENTS FROM ACCOUNTS.—The total amount of pay-
ments to a qualifying consortium for a fiscal year pursuant to
subsection (a) shall be the sum of—
‘‘(1) the aggregate amount determined for the teaching
hospitals of the consortium pursuant to section 2221(a) (relating
to the General MedicarePlus Incentive Account);
‘‘(2) the aggregate amount determined for the teaching
hospitals of the consortium pursuant to section 2241(a)(1) (relat-
ing to the General Direct-Costs Account); and
‘‘(3) an amount determined for the consortium in accordance
with the methodology in effect under section 1886(j)(2)(C)(i)
for the fiscal year (relating to the Medicare Direct-Costs
Account).
‘‘(d) DEFINITION.—For purposes of this title, the term ‘qualifying
consortium’ means a consortium that meets the requirements of
subsection (b).’’.
CHAPTER 2—AMENDMENTS TO MEDICARE PROGRAM
SEC. 12511. TRANSFER OF FUNDS.
Section 1886 (42 U.S.C. 1395ww) is amended—
(1) in subsection (d)(5)(B), in the matter preceding clause
(i), by striking ‘‘The Secretary shall provide’’ and inserting
the following: ‘‘For discharges occurring on or before September
30, 1996, the Secretary shall provide’’;
(2) in subsection (h)—
(A) in paragraph (1), in the first sentence, by striking
‘‘the Secretary shall provide’’ and inserting ‘‘the Secretary
shall, subject to paragraph (6), provide’’; and
(B) by adding at the end the following paragraph:
‘‘(6) LIMITATION.—
‘‘(A) IN GENERAL.—The authority to make payments
under this subsection applies only with respect to cost
reporting periods ending on or before September 30, 1996,
except as provided in subparagraph (B).
‘‘(B) RULE REGARDING PORTION OF LAST COST REPORTING
PERIOD.—In the case of a cost reporting period that extends
beyond September 30, 1996, payments under this sub-
H. R. 2491—840
section shall be made with respect to such portion of the
period as has lapsed as of such date.
‘‘(C) RULE OF CONSTRUCTION.—This paragraph may not
be construed as authorizing any payment under section
1861(v) with respect to graduate medical education.’’; and
(3) by adding at the end the following subsection:
‘‘(j) TRANSFERS TO TEACHING HOSPITAL AND GRADUATE MEDICAL
EDUCATION TRUST FUND.—
‘‘(1) INDIRECT COSTS OF MEDICAL EDUCATION.—
‘‘(A) IN GENERAL.—From the Federal Hospital Insur-
ance Trust Fund, the Secretary shall, for fiscal year 1997
and each subsequent fiscal year, transfer to the Medicare
Indirect-Costs Medical Education Account under section
2201 an amount determined by the Secretary in accordance
with subparagraph (B).
‘‘(B) DETERMINATION
OF
AMOUNTS.—The Secretary
shall make an estimate for the fiscal year involved of
the nationwide total of the amounts that would have been
paid under subsection (d)(5)(B) to hospitals during the fiscal
year if such payments had not been terminated for dis-
charges occurring after September 30, 1996. For purposes
of subparagraph (A), the amount determined under this
subparagraph for the fiscal year is the estimate made by
the Secretary under the preceding sentence.
‘‘(C) SUPPLEMENTAL
TRANSFERS.—If the Secretary
determines that the amount of a transfer under subpara-
graph (A) for a fiscal year is insufficient for making pay-
ments in the amounts required pursuant to section
2231(a)(2) for the year, the Secretary shall make such
additional transfers for the year between the funds and
accounts involved as the Secretary determines to be nec-
essary for making the payments.
‘‘(2) DIRECT COSTS OF MEDICAL EDUCATION.—
‘‘(A) IN GENERAL.—From the Federal Hospital Insur-
ance Trust Fund and the Federal Supplementary Medical
Insurance Trust Fund, the Secretary shall, for fiscal year
1997 and each subsequent fiscal year, transfer to the Medi-
care Direct-Costs Medical Education Account (under section
2201) the sum of—
‘‘(i) an amount determined by the Secretary in
accordance with subparagraph (B); and
‘‘(ii) as applicable, an amount determined by the
Secretary in accordance with subparagraph (C)(ii).
‘‘(B) DETERMINATION OF AMOUNTS.—For each hospital
(other than a hospital that is a member of a qualifying
consortium referred to in subparagraph (C)), the Secretary
shall make an estimate for the fiscal year involved of
the amount that would have been paid under subsection
(h) to the hospital during the fiscal year if such payments
had not been terminated for cost reporting periods ending
on or before September 30, 1996. For purposes of subpara-
graph (A)(i), the amount determined under this subpara-
graph for the fiscal year is the sum of all estimates made
by the Secretary under the preceding sentence.
‘‘(C) ESTIMATES REGARDING QUALIFYING CONSORTIA.—
If the Secretary authorizes payments under section 2243(a)
H. R. 2491—841
to one or more qualifying consortia, the Secretary shall
carry out the following:
‘‘(i) The Secretary shall establish a methodology
for making payments to qualifying consortia with
respect to the reasonable direct costs of such consortia
in carrying out programs of graduate medical edu-
cation. The methodology shall be the methodology
established in subsection (h), modified to the extent
necessary to take into account the participation in
such programs of entities other than hospitals.
‘‘(ii) For each qualifying consortium, the Secretary
shall make an estimate for the fiscal year involved
of the amount that would have been paid to the consor-
tium during the fiscal year if, using the methodology
under clause (i), payments had been made to the
consortium for the fiscal year as reimbursements with
respect to cost reporting periods. For purposes of
subparagraph (A)(ii), the amount determined under
this clause for the fiscal year is the sum of all estimates
made by the Secretary under the preceding sentence.
‘‘(D) ALLOCATION BETWEEN FUNDS.—In providing for
a transfer under subparagraph (A) for a fiscal year, the
Secretary shall provide for an allocation of the amounts
involved between part A and part B (and the trust funds
established under the respective parts) as reasonably
reflects the proportion of direct graduate medical education
costs of hospitals associated with the provision of services
under each respective part.
‘‘(E) SUPPLEMENTAL
TRANSFERS.—If the Secretary
determines that the amount of a transfer under subpara-
graph (A) for a fiscal year is insufficient for making pay-
ments in the amounts required pursuant to sections
2241(a)(2) and 2243(c)(3) for the year, the Secretary shall
make such additional transfers for the year between the
funds and accounts involved as the Secretary determines
to be necessary for making the payments.
‘‘(3) APPLICABILITY
OF
CERTAIN
AMENDMENTS.—Amend-
ments made to subsection (d)(5)(B) and subsection (h) that
are effective on or after October 1, 1996, apply only for purposes
of estimates under paragraphs (1) and (2) and for purposes
of determining the amount of payments under section 2211.
Such amendments do not require any adjustment to amounts
paid under subsection (d)(5)(B) or (h) with respect to fiscal
year 1996 or any prior fiscal year.
‘‘(4) RELATIONSHIP TO CERTAIN DEMONSTRATION PROJECTS.—
In the case of a State for which a demonstration project under
section 1814(b)(3) is in effect, the Secretary, in making deter-
minations of the rates of increase under such section, shall
include all amounts transferred under this subsection. Such
amounts shall be so included to the same extent and in the
same manner as amounts determined under subsections
(d)(5)(B) and (h) were included in such determination under
the provisions of this title in effect on September 30, 1996.’’.
H. R. 2491—842
Subtitle F—National Defense Stockpile
SEC. 12601. DISPOSAL OF CERTAIN MATERIALS IN NATIONAL DEFENSE
STOCKPILE FOR DEFICIT REDUCTION.
(a) DISPOSALS REQUIRED.—(1) During fiscal year 1996, the
President shall dispose of all cobalt contained in the National
Defense Stockpile that, as of the date of the enactment of this
Act, is authorized for disposal under any law (other than this
Act).
(2) In addition to the disposal of cobalt under paragraph (1),
the President shall dispose of additional quantities of cobalt and
quantities of other materials contained in the National Defense
Stockpile and specified in the table in subsection (b) so as to
result in receipts to the United States in amounts equal to—
(A) $21,000,000 during the fiscal year ending September
30, 1996;
(B) $338,000,000 during the five-fiscal year period ending
on September 30, 2000; and
(C) $649,000,000 during the seven-fiscal year period ending
on September 30, 2002.
(b) LIMITATION ON DISPOSAL QUANTITY.—The total quantities
of materials authorized for disposal by the President under sub-
section (a)(2) may not exceed the amounts set forth in the following
table:
Authorized Stockpile Disposals
Material for disposal
Quantity
Aluminum .................................................................
62,881 short tons
Cobalt ........................................................................
30,000,000 pounds
contained
Columbium Ferro .....................................................
930,911 pounds con-
tained
Germanium Metal ....................................................
40,000 kilograms
Indium ......................................................................
35,000 troy ounces
Palladium .................................................................
15,000 troy ounces
Platinum ...................................................................
10,000 troy ounces
Rubber, Natural .......................................................
125,138 long tons
Tantalum, Carbide Powder .....................................
6,000 pounds con-
tained
Tantalum, Minerals .................................................
750,000 pounds con-
tained
Tantalum, Oxide ......................................................
40,000 pounds con-
tained
(c) DEPOSIT OF RECEIPTS.—Notwithstanding section 9 of the
Strategic and Critical Materials Stock Piling Act (50 U.S.C. 98h),
funds received as a result of the disposal of materials under sub-
section (a)(2) shall be deposited into the general fund of the Treas-
ury for the purpose of deficit reduction.
(d) RELATIONSHIP TO OTHER DISPOSAL AUTHORITY.—The dis-
posal authority provided in subsection (a)(2) is new disposal author-
ity and is in addition to, and shall not affect, any other disposal
H. R. 2491—843
authority provided by law regarding the materials specified in such
subsection.
(e) TERMINATION OF DISPOSAL AUTHORITY.—The President may
not use the disposal authority provided in subsection (a)(2) after
the date on which the total amount of receipts specified in subpara-
graph (C) of such subsection is achieved.
(f) DEFINITION.—The term ‘‘National Defense Stockpile’’ means
the National Defense Stockpile provided for in section 4 of the
Strategic and Critical Materials Stock Piling Act (50 U.S.C. 98c).
Subtitle G—Child Protection Block Grant
Program and Foster Care and Adoption
Assistance
SEC. 12701. ESTABLISHMENT OF PROGRAM.
Title IV of the Social Security Act (42 U.S.C. 601 et seq.)
is amended by striking subpart 2 of part B and inserting the
following:
‘‘Subpart 2—Block Grants to States for the Protec-
tion of Children and Matching Payments for
Foster Care and Adoption Assistance
‘‘SEC. 430. ELIGIBLE STATES.
‘‘(a) IN GENERAL.—As used in this subpart, the term ‘eligible
State’ means a State that has submitted to the Secretary, not
later than October 1, 1996, and every 3 years thereafter, a plan
which has been signed by the chief executive officer of the State
and that includes the following:
‘‘(1) OUTLINE OF CHILD PROTECTION PROGRAM.—A written
document that outlines the activities the State intends to con-
duct to achieve the child protection goals of the program funded
under this subpart, including the procedures to be used for—
‘‘(A) receiving and assessing reports of child abuse
or neglect;
‘‘(B) investigating such reports;
‘‘(C) with respect to families in which abuse or neglect
has been confirmed, providing services or referral for serv-
ices for families and children where the State makes a
determination that the child may safely remain with the
family;
‘‘(D) protecting children by removing them from dan-
gerous settings and ensuring their placement in a safe
environment;
‘‘(E) providing training for individuals mandated to
report suspected cases of child abuse or neglect;
‘‘(F) protecting children in foster care;
‘‘(G) promoting timely adoptions;
‘‘(H) protecting the rights of families, using adult rel-
atives as the preferred placement for children separated
from their parents where such relatives meet the relevant
State child protection standards;
‘‘(I) providing services to individuals, families, or
communities, either directly or through referral, that are
H. R. 2491—844
aimed at preventing the occurrence of child abuse and
neglect; and
‘‘(J) establishing and responding to citizen review pan-
els under section 434.
‘‘(2) CERTIFICATION OF STATE LAW REQUIRING THE REPORT-
ING OF CHILD ABUSE AND NEGLECT.—A certification that the
State has in effect laws that require public officials and other
professionals to report, in good faith, actual or suspected
instances of child abuse or neglect.
‘‘(3) CERTIFICATION OF PROCEDURES FOR SCREENING, SAFETY
ASSESSMENT, AND PROMPT INVESTIGATION.—A certification that
the State has in effect procedures for receiving and responding
to reports of child abuse or neglect, including the reports
described in paragraph (2), and for the immediate screening,
safety assessment, and prompt investigation of such reports.
‘‘(4) CERTIFICATION OF STATE PROCEDURES FOR REMOVAL
AND PLACEMENT OF ABUSED OR NEGLECTED CHILDREN.—A cer-
tification that the State has in effect procedures for the removal
from families and placement of abused or neglected children
and of any other child in the same household who may also
be in danger of abuse or neglect.
‘‘(5) CERTIFICATION
OF
PROVISIONS
FOR
IMMUNITY
FROM
PROSECUTION.—A certification that the State has in effect laws
requiring immunity from prosecution under State and local
laws and regulations for individuals making good faith reports
of suspected or known instances of child abuse or neglect.
‘‘(6) CERTIFICATION OF PROVISIONS AND PROCEDURES FOR
EXPUNGEMENT OF CERTAIN RECORDS.—A certification that the
State has in effect laws and procedures requiring the facilitation
of the prompt expungement of any records that are accessible
to the general public or are used for purposes of employment
or other background checks in cases determined to be
unsubstantiated or false.
‘‘(7) CERTIFICATION OF PROVISIONS AND PROCEDURES RELAT-
ING TO APPEALS.—A certification that not later then 2 years
after the date of the enactment of this subpart, the State
shall have laws and procedures in effect affording individuals
an opportunity to appeal an official finding of abuse or neglect.
‘‘(8) CERTIFICATION OF STATE PROCEDURES FOR DEVELOPING
AND REVIEWING WRITTEN PLANS FOR PERMANENT PLACEMENT
OF REMOVED CHILDREN.—A certification that the State has in
effect procedures for ensuring that a written plan is prepared
for children who have been removed from their families. Such
plan shall specify the goals for achieving a permanent place-
ment for the child in a timely fashion, for ensuring that the
written plan is reviewed every 6 months (until such placement
is achieved), and for ensuring that information about such
children is collected regularly and recorded in case records,
and include a description of such procedures.
‘‘(9) CERTIFICATION
OF
STATE
PROGRAM
TO
PROVIDE
INDEPENDENT LIVING SERVICES.—A certification that the State
has in effect a program to provide independent living services,
for assistance in making the transition to self-sufficient adult-
hood, to individuals in the child protection program of the
State who are 16, but who are not 20 (or, at the option of
the State, 22), years of age, and who do not have a family
to which to be returned.
H. R. 2491—845
‘‘(10) CERTIFICATION
OF
STATE
PROCEDURES
TO
RESPOND
TO REPORTING OF MEDICAL NEGLECT OF DISABLED INFANTS.—
‘‘(A) IN GENERAL.—A certification that the State has
in place for the purpose of responding to the reporting
of medical neglect of infants (including instances of
withholding of medically indicated treatment from disabled
infants with life-threatening conditions), procedures or pro-
grams, or both (within the State child protective services
system), to provide for—
‘‘(i) coordination and consultation with individuals
designated by and within appropriate health-care
facilities;
‘‘(ii) prompt notification by individuals designated
by and within appropriate health-care facilities of cases
of suspected medical neglect (including instances of
withholding of medically indicated treatment from dis-
abled infants with life-threatening conditions); and
‘‘(iii) authority, under State law, for the State child
protective service to pursue any legal remedies, includ-
ing the authority to initiate legal proceedings in a
court of competent jurisdiction, as may be necessary
to prevent the withholding of medically indicated treat-
ment from disabled infants with life-threatening condi-
tions.
‘‘(B) WITHHOLDING
OF
MEDICALLY
INDICATED
TREAT-
MENT.—As used in subparagraph (A), the term ‘withholding
of medically indicated treatment’ means the failure to
respond to the infant’s life-threatening conditions by
providing treatment (including appropriate nutrition,
hydration, and medication) which, in the treating physi-
cian’s or physicians’ reasonable medical judgment, will be
most likely to be effective in ameliorating or correcting
all such conditions, except that such term does not include
the failure to provide treatment (other than appropriate
nutrition, hydration, or medication) to an infant when,
in the treating physician’s or physicians’ reasonable medi-
cal judgment—
‘‘(i) the infant is chronically and irreversibly coma-
tose;
‘‘(ii) the provision of such treatment would—
‘‘(I) merely prolong dying;
‘‘(II) not be effective in ameliorating or correct-
ing all of the infant’s life-threatening conditions;
or
‘‘(III) otherwise be futile in terms of the sur-
vival of the infant; or
‘‘(iii) the provision of such treatment would be
virtually futile in terms of the survival of the infant
and the treatment itself under such circumstances
would be inhumane.
‘‘(11) IDENTIFICATION OF CHILD PROTECTION GOALS.—The
quantitative goals of the State child protection program.
‘‘(12) CERTIFICATION OF CHILD PROTECTION STANDARDS.—
With respect to fiscal years beginning on or after April 1,
1996, a certification that the State—
‘‘(A) has completed an inventory of all children who,
before the inventory, had been in foster care under the
H. R. 2491—846
responsibility of the State for 6 months or more, which
determined—
‘‘(i) the appropriateness of, and necessity 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 permanent placement; and
‘‘(iii) the services necessary to facilitate the return
of the child or the placement 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, location, 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 for each child receiving
foster care under the supervision of the State;
‘‘(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 guard-
ian, or if adoption or legal guardianship is deter-
mined not to be appropriate for a child, in some
other planned, permanent living arrangement; and
‘‘(iv) a preplacement preventive services program
designed to help children at risk for foster care place-
ment remain with their families; and
‘‘(C)(i) has reviewed (or not later than October 1, 1997,
will review) State policies and administrative and judicial
procedures in effect for children abandoned at or shortly
after birth (including policies and procedures providing for
legal representation of such children); and
‘‘(ii) is implementing (or not later than October 1, 1997,
will implement) such policies and procedures as the State
determines, on the basis of the review described in clause
(i), to be necessary to enable permanent decisions to be
made expeditiously with respect to the placement of such
children.
‘‘(13) CERTIFICATION
OF
REASONABLE
EFFORTS
BEFORE
PLACEMENT OF CHILDREN IN FOSTER CARE.—A certification that
the State in each case will—
‘‘(A) make reasonable efforts prior to the placement
of a child in foster care, to prevent or eliminate the need
for removal of the child from the child’s home, and to
make it possible for the child to return home; and
‘‘(B) with respect to families in which abuse or neglect
has been confirmed, provide services or referral for services
for families and children where the State makes a deter-
mination that the child may safely remain with the family.
‘‘(14) CERTIFICATION OF COOPERATIVE EFFORTS.—A certifi-
cation by the State, where appropriate, that all steps will
be taken, including cooperative efforts with the State agencies
administering the plans approved under parts A and D, to
secure an assignment to the State of any rights to support
on behalf of each child receiving foster care maintenance pay-
ments under this subpart.