Out Commission as submitted by the
Commission on lllllll’’, the
blank space being filled in with the
appropriate date; and
(II) the title of which is as fol-
lows: ‘‘Joint Resolution approving the
recommendation of the Benefits Cash
Out Commission’’.
(iii) 
INTRODUCTION
AND
REFER-
RAL.—On the day on which the rec-
ommendation of the Commission is trans-
mitted to the House of Representatives
and the Senate, an approval resolution
with respect to such recommendation shall
be introduced (by request) in the House of
Representatives by the Majority Leader of
the House, for himself or herself and the
Minority Leader of the House, or by Mem-
bers of the House designated by the Ma-
jority Leader and Minority Leader of the
House; and shall be introduced (by re-
quest) in the Senate by the Majority Lead-
er of the Senate, for himself or herself and
the Minority Leader of the Senate, or by
Members of the Senate designated by the
Majority Leader and Minority Leader of
the Senate. If either House is not in ses-
sion on the day on which such rec-
ommendation is transmitted, the approval
resolution with respect to such rec-
ommendation shall be introduced in the
House, as provided in the preceding sen-
tence, on the first day thereafter on which
the House is in session. The approval reso-
lution introduced in the House of Rep-
resentatives and the Senate shall be re-
ferred to the appropriate committees of
each House.
(iv) AMENDMENTS PROHIBITED.—No
amendment to an approval resolution shall
be in order in either the House of Rep-
resentatives or the Senate; and no motion
to suspend the application of this clause
shall be in order in either House, nor shall
it be in order in either House for the Pre-
siding Officer to entertain a request to sus-
pend the application of this clause by
unanimous consent.
(v) PERIOD
FOR
COMMITTEE
AND
FLOOR CONSIDERATION.—
(I) IN GENERAL.—Except as pro-
vided in subclause (II), if the commit-
tee or committees of either House to
which an approval resolution has been
referred have not reported it at the
close of the 30th day after its intro-
duction, such committee or commit-
tees shall be automatically discharged
from further consideration of the ap-
proval resolution and it shall be
placed on the appropriation calendar.
A vote on final passage of the ap-
proval resolution shall be taken in
each House on or before the close of
the 30th day after the approval reso-
lution is reported by the committees
or committee of that House to which
it was referred, or after such commit-
tee or committees have been dis-
charged from further consideration of
the approval resolution. If prior to the
passage by 1 House of an approval
resolution of that House, that House
receives the same approval resolution
from the other House then the proce-
dure in that House shall be the same
as if no approval resolution had been
received from the other House, but
the vote on final passage shall be on
the approval resolution of the other
House.
(II) COMPUTATION
OF
DAYS.—
For purposes of subclause (I), in com-
puting a number of days in either
House, there shall be excluded any
day on which the House is not in ses-
sion.
(vi) FLOOR CONSIDERATION IN THE
HOUSE OF REPRESENTATIVES.—
(I) MOTION
TO
PROCEED.—A
motion in the House of Representa-
tives to proceed to the consideration
of an approval resolution shall be
highly privileged and not debatable.
An amendment to the motion shall
not be in order, nor shall it be in
order to move to reconsider the vote
by which the motion is agreed to or
disagreed to.
(II) DEBATE.—Debate in the
House of Representatives on an ap-
proval resolution shall be limited to
not more than 20 hours, which shall
be divided equally between those fa-
voring and those opposing the bill or
resolution. A motion further to limit
debate shall not be debatable. It shall
not be in order to move to recommit
an approval resolution or to move to
reconsider the vote by which an ap-
proval resolution is agreed to or dis-
agreed to.
(III) MOTION
TO
POSTPONE.—
Motions to postpone, made in the
House of Representatives with respect
to the consideration of an approval
resolution, and motions to proceed to
the consideration of other business,
shall be decided without debate.
(IV) APPEALS.—All appeals from
the decisions of the Chair relating to
the application of the Rules of the
House of Representatives to the pro-
cedure relating to an approval resolu-
tion shall be decided without debate.
(V) GENERAL
RULES
APPLY.—
Except to the extent specifically pro-
vided in the preceding provisions of
this clause, consideration of an ap-
proval resolution shall be governed by
the Rules of the House of Representa-
tives applicable to other bills and reso-
lutions in similar circumstances.
(vii) FLOOR CONSIDERATION IN THE
SENATE.—
(I) MOTION
TO
PROCEED.—A
motion in the Senate to proceed to the
consideration of an approval resolu-
tion shall be privileged and not debat-
able. An amendment to the motion
shall not be in order, nor shall it be
in order to move to reconsider the
vote by which the motion is agreed to
or disagreed to.
(II) GENERAL DEBATE.—Debate
in the Senate on an approval resolu-
tion, and all debatable motions and
appeals in connection therewith, shall
be limited to not more than 20 hours.
The time shall be equally divided be-
tween, and controlled by, the Majority
Leader and the Minority Leader or
their designees.
(III) DEBATE OF MOTIONS AND
APPEALS.—Debate in the Senate on
any debatable motion or appeal in
connection with an approval resolution
shall be limited to not more than 1
hour, to be equally divided between,
and controlled by, the mover and the
manager of the approval resolution,
except that in the event the manager
of the approval resolution is in favor
of any such motion or appeal, the
time in opposition thereto, shall be
controlled by the Minority Leader or
his designee. Such leaders, or either of
them, may, from time under their
control on the passage of an approval
resolution, allot additional time to any
Senator during the consideration of
any debatable motion or appeal.
(IV) OTHER
MOTIONS.—A mo-
tion in the Senate to further limit de-
bate is not debatable. A motion to re-
commit an approval resolution is not
in order.
SEC. 126. ENFORCEMENT.
(a) IN GENERAL.—Chapter 47 of the Internal Reve-
nue Code of 1986 (relating to excise taxes on qualified
pension, etc. plans) is amended by inserting after section
5000 the following new sections:
‘‘SEC. 5000A. FAILURE OF EMPLOYERS WITH RESPECT TO
HEALTH INSURANCE.
‘‘(a) GENERAL RULE.—There is hereby imposed a
tax on the failure of any person to comply with the re-
quirements of sections 121 and 125(a) of the Consumer
Choice Health Reform Act of 1995 with respect to any
employee of the person.
‘‘(b) AMOUNT OF TAX.—
‘‘(1) IN GENERAL.—The amount of the tax im-
posed by subsection (a) on any failure with respect
to an employee shall be $50 for each day in the non-
compliance period with respect to such failure.
‘‘(2) NONCOMPLIANCE PERIOD.—For purposes
of this section, the term ‘noncompliance period’
means, with respect to any failure, the period—
‘‘(A) beginning on the date such failure
first occurs, and
‘‘(B) ending on the date such failure is
corrected.
‘‘(3) CORRECTION.—A failure of a person to
comply with the requirements of section 121 or
125(a) of the Consumer Choice Health Reform Act
of 1995 with respect to any employee of the person
shall be treated as corrected if—
‘‘(A) such failure is retroactively undone to
the extent possible, and
‘‘(B) the employee is placed in a financial
position which is as good as such employee
would have been in had such failure not oc-
curred.
‘‘(c) LIMITATIONS ON AMOUNT OF TAX.—
‘‘(1) TAX NOT TO APPLY WHERE FAILURE NOT
DISCOVERED
EXERCISING
REASONABLE
DILI-
GENCE.—No tax shall be imposed by subsection (a)
on any failure during any period for which it is es-
tablished to the satisfaction of the Secretary that
none of the persons referred to in subsection (d)
knew, or exercising reasonable diligence would have
known, that such failure existed.
‘‘(2) TAX NOT TO APPLY TO FAILURES COR-
RECTED WITHIN 30 DAYS.—No tax shall be imposed
by subsection (a) on any failure if—
‘‘(A) such failure was due to reasonable
cause and not to willful neglect, and
‘‘(B) such failure is corrected during the
30-day period beginning on the first date any of
the persons referred to in subsection (d) knew,
or exercising reasonable diligence would have
known, that such failure existed.
‘‘(3) WAIVER BY SECRETARY.—In the case of a
failure which is due to reasonable cause and not to
willful neglect, the Secretary may waive part or all
of the tax imposed by subsection (a) to the extent
that the payment of such tax would be excessive rel-
ative to the failure involved.
‘‘(d) LIABILITY FOR TAX.—
‘‘(1) IN GENERAL.—Except as otherwise pro-
vided in this subsection, the following shall be liable
for the tax imposed by subsection (a) on a failure:
‘‘(A) In the case of a health insurance plan
other than a multiemployer plan, the employer.
‘‘(B) In the case of a multiemployer plan,
the plan.
‘‘(C) Each person who is responsible (other
than in a capacity as an employee) for admin-
istering or providing benefits under the health
insurance plan and whose act or failure to act
caused (in whole or in part) the failure.
‘‘(2) SPECIAL RULES FOR PERSONS DESCRIBED
IN PARAGRAPH (1)(C).—A person described in sub-
paragraph (C) (and not in subparagraphs (A) and
(B)) of paragraph (1) shall be liable for the tax im-
posed by subsection (a) on any failure only if such
person assumed (under a legally enforceable written
agreement) responsibility for the performance of the
act to which the failure relates.
‘‘SEC. 5000B. FAILURE OF CARRIERS WITH RESPECT TO
HEALTH INSURANCE.
‘‘(a) GENERAL RULE.—There is hereby imposed a
tax on the failure of any carrier offering any health insur-
ance plan to comply with the requirements of sections 122
and 123 of the Consumer Choice Health Reform Act of
1995.
‘‘(b) AMOUNT OF TAX.—
‘‘(1) IN GENERAL.—The amount of tax imposed
by subsection (a) by reason of 1 or more failures
during a taxable year shall be equal to 50 percent
of the gross premiums received during such taxable
year with respect to all health insurance plans issued
by the carrier on whom such tax is imposed.
‘‘(2) GROSS PREMIUMS.—For purposes of para-
graph (1), gross premiums shall include any consid-
eration received with respect to any health insurance
contract.
‘‘(3) CONTROLLED GROUPS.—For purposes of
paragraph (1)—
‘‘(A) CONTROLLED
GROUP
OF
CORPORA-
TIONS.—All corporations which are members of
the same controlled group of corporations shall
be treated as 1 carrier. For purposes of the pre-
ceding sentence, the term ‘controlled group of
corporations’ has the meaning given to such
term by section 1563(a), except that—
‘‘(i) ‘more than 50 percent’ shall be
substituted for ‘at least 80 percent’ each
place it appears in section 1563(a)(1), and
‘‘(ii) the determination shall be made
without regard to subsections (a)(4) and
(e)(3)(C) of section 1563.
‘‘(B) PARTNERSHIPS, PROPRIETORSHIPS,
ETC., WHICH ARE UNDER COMMON CONTROL.—
Under regulations prescribed by the Secretary,
all trades or business (whether or not incor-
porated) which are under common control shall
be treated as 1 carrier. The regulations pre-
scribed under this subparagraph shall be based
on principles similar to the principles which
apply in the case of subparagraph (A).
‘‘(c) LIMITATION ON TAX.—
‘‘(1) TAX NOT TO APPLY WHERE FAILURE NOT
DISCOVERED
EXERCISING
REASONABLE
DILI-
GENCE.—No tax shall be imposed by subsection (a)
with respect to any failure for which it is established
to the satisfaction of the Secretary that the carrier
on whom the tax is imposed did not know, and exer-
cising reasonable diligence would not have known,
that such failure existed.
‘‘(2) TAX
NOT
TO
APPLY
WHERE
FAILURES
CORRECTED WITHIN 30 DAYS.—No tax shall be im-
posed by subsection (a) with respect to any failure
if—
‘‘(A) such failure was due to reasonable
cause and not to willful neglect, and
‘‘(B) such failure is corrected during the
30-day period beginning on the 1st date any of
the carriers on whom the tax is imposed knew,
or exercising reasonable diligence would have
known, that such failure existed.
‘‘(3) WAIVER BY SECRETARY.—In the case of a
failure which is due to reasonable cause and not to
willful neglect, the Secretary may waive part or all
of the tax imposed by subsection (a) to the extent
that the payment of such tax would be excessive rel-
ative to the failure involved.’’.
(b) CLERICAL AMENDMENTS.—The table of sections
for such chapter 47 is amended by adding at the end
thereof the following new items:
‘‘Sec. 5000A. Failure of employers with respect to health insur-
ance.
‘‘Sec. 5000B. Failure of carriers with respect to health insur-
ance.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall take effect on January 1, 1998.
Subtitle D—Federal Preemption
SEC. 131. FEDERAL PREEMPTION OF CERTAIN STATE LAWS.
All State laws in existence on January 1, 1999, in
the following areas are preempted:
(1) MANDATED INSURANCE BENEFIT LAWS.—
Laws requiring health insurance policies to cover
specific diseases, services, or providers.
(2) ANTI-MANAGED
CARE
LAWS.—Laws re-
stricting the ability of managed care plans to selec-
tively contract with providers of their choice.
(3) MANDATED
COST-SHARING
LAWS.—Laws
restricting the extent to which insurers may require
enrollee cost sharing as part of their plans, or re-
stricting the extent to which managed care plans
may impose different levels of cost sharing on en-
rollee claims for treatment by providers not partici-
pating in the plan.
TITLE II—ADMINISTRATIVE
COST SAVINGS
Subtitle A—Standardization of
Claims Processing
SEC. 
201. 
ADOPTION 
OF 
DATA 
ELEMENTS, 
UNIFORM
CLAIMS, AND UNIFORM ELECTRONIC TRANS-
MISSION STANDARDS.
(a) IN GENERAL.—The Secretary shall adopt stand-
ards relating to each of the following:
(1) Data elements for use in paper and elec-
tronic claims processing under health insurance
plans, as well as for use in utilization review and
management of care (including data fields, formats,
and medical nomenclature, and including plan bene-
fit and insurance information).
(2) Uniform claims forms (including uniform
procedure and billing codes for uses with such forms
and including information on other health insurance
plans that may be liable for benefits).
(3) Uniform electronic transmission of the data
elements (for purposes of billing and utilization re-
view).
Standards under paragraph (3) relating to electronic
transmission of data elements for claims for services shall
supersede (to the extent specified in such standards) the
standards adopted under paragraph (2) relating to the
submission of paper claims for such services. Standards
under paragraph (3) shall include protections to assure
the confidentiality of patient-specific information and to
protect against the unauthorized use and disclosure of in-
formation.
(b) USE OF TASK FORCES.—In adopting standards
under this section—
(1) the Secretary shall take into account the
recommendations of current task forces, including at
least the Workgroup on Electronic Data Inter-
change, National Uniform Billing Committee, the
Uniform Claim Task Force, and the Computer-based
Patient Record Institute;
(2) the Secretary shall consult with the Na-
tional Association of Insurance Commissioners (and,
with respect to standards under subsection (a)(3),
the American National Standards Institute); and
each participation agreement under section 1866 of the
Social Security Act, shall—
(1) maintain clinical data included in the set of
comprehensive 
data 
elements 
under 
section
211(b)(2) in electronic form on all inpatients,
(2) upon request of the Secretary or of a utili-
zation and quality control peer review organization
(with which the Secretary has entered into a con-
tract under part B of title XI of such Act), transmit
electronically the data set, and
(3) upon request of the Secretary, or of a fiscal
intermediary or carrier, transmit electronically any
data (with respect to a claim) from such data set,
in accordance with the standards promulgated under sec-
tion 211(a).
(b) WAIVER AUTHORITY.—Until January 1, 2000:
(1) The Secretary may waive the application of
the requirements of subsection (a) for a hospital
that is a small rural hospital, for such period as the
hospital demonstrates compliance with such require-
ments would constitute an undue financial hardship.
(2) The Secretary may waive the application of
the requirements of subsection (a) for a hospital
that is in the process of developing a system to pro-
vide the required data set and executes agreements