1042
‘‘(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.’’.
(c) 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’’.
(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)’’.
1043
(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.
SEC. 13560. MEDICARE ADMINISTRATION BUDGET PROC-
ESS.
(a) A DJUSTMENTS.—Section 251(b)(2) of the Bal-
anced Budget and Emergency Deficit Control Act of 1985
is amended by redesignating subparagraphs (E) and (F)
as subparagraphs (F) and (G), respectively, and by insert-
ing after subparagraph (D) the following new subpara-
graph:
1044
‘‘(E) 
MEDICARE
ADMINISTRATIVE
COSTS.—To the extent that appropriations are
enacted that provide additional new budget au-
thority (as compared with a base level of
$1,526,000,000 for new budget authority) for
the administration of the Medicare program by
fiscal intermediaries and carriers pursuant to
sections 1816 and 1842(a) of title XVIII of the
Social Security Act, the adjustment for that
year shall be that amount, but shall not ex-
ceed—
‘‘(i) 
for 
fiscal 
year 
1994,
$198,000,000 in new budget authority and
$198,000,000 in outlays; and
‘‘(ii) 
for 
fiscal 
year 
1995,
$220,000,000 in new budget authority and
$220,000,000 in outlays; and
the prior-year outlays resulting from these appro-
priations of budget authority and additional adjust-
ments equal to the sum of the maximum adjust-
ments that could have been made in preceding fiscal
years under this subparagraph.’’.
(b) CONFORMING AMENDMENTS.—
(1) Section 603(a) of the Congressional Budget
Act of 1974 is amended by striking ‘‘section
1045
251(b)(2)(E)(i)’’ 
and 
inserting 
‘‘section
251(b)(2)(F)(i)’’.
(2) Section 606(d) of the Congressional Budget
Act of 1974 is amended—
(A) in paragraph (1)(A) by striking ‘‘sec-
tion 251(b)(2)(E)(i)’’ and inserting ‘‘section
251(b)(2)(F)(i)’’; and
(B) 
in 
paragraph 
(2), 
by 
inserting
‘‘251(b)(2)(E),’’ after ‘‘251(b)(2)(D),’’.
SEC. 13561. OTHER PROVISIONS.
(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
1046
whether a laboratory meets the requirements of section
353 of the Public Health Service Act.
(b) H OME DIALYSIS DEMONSTRATION TECHNICAL
CORRECTION.—Section 4202 of OBRA–1990 is amend-
ed—
(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) O THER TECHNICAL AMENDMENTS.—(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).
(2) Section 1866(f)(1) (42 U.S.C. 1395cc(f)(1)) is
amended by striking ‘‘1833(r)’’ and inserting ‘‘1833(s)’’.
(3) Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is
amended by moving subparagraph (O), as redesignated by
1047
section 13478(f)(8)(B)(iii)(II) of this title, two ems to the
left.
(4) 
Section 
1881(b)(1)(C) 
(42 
U.S.C.
1395rr(b)(1)(C)) is amended by striking ‘‘1861(s)(2)(Q)’’
and inserting ‘‘1861(s)(2)(P)’’.
(5) 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.
(6)(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)’’.
(d) E FFECTIVE DATE.—The amendments made by
this section shall take effect as if included in the enact-
ment of OBRA–1990.
1048
CHAPTER 4—MEDICARE SUPPLEMENTAL
INSURANCE POLICIES
SEC. 13571. STANDARDS FOR MEDICARE SUPPLEMENTAL
INSURANCE POLICIES.
(a) S IMPLIFICATION OF MEDICARE SUPPLEMENTAL
POLICIES.—
(1) Section 4351 of OBRA–1990 is amended by
striking ‘‘(a) I N 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
‘‘were a reference to the revised NAIC
Model Regulation as changed under this
subparagraph (such changed regulation re-
1060
(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 13571(m)(4) of the Omnibus Budget
Reconciliation Act of 1993.’’;
(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;
(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