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workweek bears to the average number of hours in the
regularly scheduled workweek of an employee serving in
a comparable position on a full-time career basis (as deter-
mined under regulations prescribed by the Office).’’.
(b) CONFORMING AMENDMENT.—Subsection (c) of
section 613 of the Alaska Railroad Transfer Act of 1982
(45 U.S.C. 1212(c)) is repealed.
(c) EFFECTIVE DATE.—This section shall take effect
at the beginning of contract year 1997.
TITLE XII—MEDICARE
Subtitle A—Copayment Reform
SEC. 12001. IMPOSITION OF 20 PERCENT COINSURANCE ON
HOME HEALTH SERVICES.
(a) IN GENERAL.—
(1) PART A.—Section 1813(a) of the Social Se-
curity Act (42 U.S.C. 1395e(a)) is amended by add-
ing at the end the following new paragraph:
‘‘(5) The amount payable for a home health service
furnished to an individual under this part shall be reduced
by a copayment amount equal to 20 percent of the average
of all the per visit costs for such service furnished under
this title determined under section 1861(v)(1)(L) (as de-
termined by the Secretary on a prospective basis for serv-
ices furnished during a calendar year).’’.
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(2) PART B.—Section 1833(a)(2) of such Act
(42 U.S.C. 1395l(a)(2)), as amended by section
147(f)(6)(C) of the Social Security Act Amendments
of 1994, is amended—
(A) in subparagraph (A)—
(i) by striking ‘‘to home health serv-
ices’’ 
and 
all 
that 
follows 
through
‘‘1861(kk))),’’, and
(ii) by striking the comma after
‘‘opinion)’’;
(B) in subparagraph (E), by striking
‘‘and’’ at the end;
(C) in subparagraph (F), by striking the
semicolon at the end and inserting ‘‘; and’’; and
(D) by adding at the end the following new
subparagraph:
‘‘(G) with respect to any home health serv-
ice other than a covered osteoporosis drug (as
defined in section 1861(kk))—
‘‘(i) the lesser of —
‘‘(I) the reasonable cost of such
service, as determined under section
1861(v), or
‘‘(II) the customary charges with
respect to such service,
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less the amount a provider may charge as
described 
in 
clause 
(ii) 
of 
section
1866(a)(2)(A), or
‘‘(ii) if such service is furnished by a
public provider of services, or by another
provider which demonstrates to the satis-
faction of the Secretary that a significant
portion of its patients are low-income (and
requests that payment be made under this
clause), free of charge or at nominal
charges to the public, the amount deter-
mined 
in 
accordance 
with 
section
1814(b)(2),
less a copayment amount equal to 20 percent of
the average of all per visit costs for such service
furnished under this title determined under sec-
tion 1861(v)(1)(L) (as determined by the Sec-
retary on a prospective basis for services fur-
nished during a calendar year);’’.
(3) 
PROVIDER
CHARGES.—Section
1866(a)(2)(A)(i) 
of 
such 
Act 
(42 
U.S.C.
1395cc(a)(2)(A)(i)) is amended—
(A) by striking ‘‘deduction or coinsurance’’
and inserting 
‘‘deduction, 
coinsurance, 
or
copayment’’; and
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(B) by striking ‘‘or (a)(4)’’ and inserting
‘‘(a)(4), or (a)(5)’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to home health services fur-
nished on or after October 1, 1995.
SEC. 12002. IMPOSITION OF 20 PERCENT COINSURANCE ON
CLINICAL LABORATORY SERVICES.
(a) IN GENERAL.—Section 1833(a) of the Social Se-
curity Act (42 U.S.C. 1395l(a)), as amended by section
156(a)(2)(B) of the Social Security Act Amendments of
1994, is amended—
(1) in paragraph (1)(D)—
(A) by striking ‘‘(or 100 percent’’ and all
that follows through ‘‘basis)’’, and
(B) by striking ‘‘100 percent of such nego-
tiated rate’’ and inserting ‘‘80 percent of such
negotiated rate’’; and
(2) in paragraph (2)(D)—
(A) by striking ‘‘(or 100 percent’’ and all
that follows through ‘‘section 1866)’’, and
(B) by striking ‘‘100 percent of such nego-
tiated rate’’ and inserting ‘‘80 percent of such
negotiated rate’’.
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(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to tests furnished on or after
October 1, 1995.
Subtitle B—Part B Premium
SEC. 12101. RELATING MEDICARE PART B PREMIUM TO IN-
COME FOR CERTAIN HIGH INCOME INDIVID-
UALS.
(a) INCREASE IN PREMIUM.—
(1) IN GENERAL.—Section 1839 of the Social
Security Act (42 U.S.C. 1395r), as amended by sec-
tion 144 of the Social Security Act Amendments of
1994, is amended by adding at the end the follow-
ing:
‘‘(h)(1) Notwithstanding the previous subsections of
this section, in the case of an individual whose modified
adjusted gross income in a taxable year ending with or
within a calendar year (as reported by the individual under
section 1893(a)) is equal to or exceeds the sum of the
threshold amount described in paragraph (4) and
$25,000, the amount of the monthly premium for the cal-
endar year shall be increased by an amount such that the
total monthly premium (determined without regard to sub-
section (b)) is equal to 200 percent of the monthly actuar-
ial rate for enrollees age 65 and over as determined under
subsection (a)(1) for that calendar year. The preceding
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sentence shall not apply to any individual whose threshold
amount is zero.
‘‘(2) Notwithstanding the previous subsections of this
section, in the case of an individual not described in para-
graph (1) whose modified adjusted gross income in a tax-
able year ending with or within a calendar year (as re-
ported by the individual under section 1893(a)) exceeds
the threshold amount described in paragraph (4), the
amount of the monthly premium for the calendar year
shall be increased by an amount which bears the same
ratio to the amount of the increase determined under
paragraph (1) as such excess bears to $25,000. The pre-
ceding sentence shall not apply to any individual whose
threshold amount is zero.
‘‘(3) Using information provided by the Secretary of
the Treasury under section 6103(l)(14) of the Internal
Revenue Code of 1986, the Secretary shall determine the
actual modified adjusted gross income of individuals en-
rolled in this part during a taxable year and adjust the
monthly premium applicable to an individual during a cal-
endar year to take into account any overpayments or un-
derpayments in the premium during the previous calendar
year resulting from the application of this subsection.
‘‘(4) In this subsection and section 1813(c), the term
‘threshold amount’ means—