In this task, you are given text for US Congressional and California state bills, your task is to generate a summary for this bill.

[EX Q]: SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Student Non-Discrimination Act of 
2011''.

SEC. 2. FINDINGS AND PURPOSES.

    (a) Findings.--The Congress finds the following:
            (1) Public school students who are lesbian, gay, bisexual 
        or transgender (LGBT), or are perceived to be LGBT, or who 
        associate with LGBT people, have been and are subjected to 
        pervasive discrimination, including harassment, bullying, 
        intimidation and violence, and have been deprived of equal 
        educational opportunities, in schools in every part of our 
        Nation.
            (2) While discrimination, including harassment, bullying, 
        intimidation and violence, of any kind is harmful to students 
        and to our education system, actions that target students based 
        on sexual orientation or gender identity represent a distinct 
        and especially severe problem.
            (3) Numerous social science studies demonstrate that 
        discrimination, including harassment, bullying, intimidation 
        and violence, at school has contributed to high rates of 
        absenteeism, dropout, adverse health consequences, and academic 
        underachievement among LGBT youth.
            (4) When left unchecked, discrimination, including 
        harassment, bullying, intimidation and violence, in schools 
        based on sexual orientation or gender identity can lead, and 
        has lead to, life-threatening violence and to suicide.
            (5) Public school students enjoy a variety of 
        constitutional rights, including rights to equal protection, 
        privacy, and free expression, which are infringed when school 
        officials engage in discriminatory treatment or are indifferent 
        to discrimination, including harassment, bullying, intimidation 
        and violence, on the basis of sexual orientation or gender 
        identity.
            (6) While Federal statutory protections expressly address 
        discrimination on the basis of race, color, sex, religion, 
        disability, and national origin, Federal civil rights statutes 
        do not expressly include ``sexual orientation'' or ``gender 
        identity''. As a result, students and parents have often had 
        limited legal recourse to redress for discrimination on the 
        basis of sexual orientation or gender identity.
    (b) Purposes.--The purposes of this Act are--
            (1) to ensure that all students have access to public 
        education in a safe environment free from discrimination, 
        including harassment, bullying, intimidation and violence, on 
        the basis of sexual orientation or gender identity;
            (2) to provide a comprehensive Federal prohibition of 
        discrimination in public schools based on actual or perceived 
        sexual orientation or gender identity;
            (3) to provide meaningful and effective remedies for 
        discrimination in public schools based on actual or perceived 
        sexual orientation or gender identity;
            (4) to invoke congressional powers, including but not 
        limited to the power to enforce the 14th Amendment to the 
        Constitution and to provide for the general welfare pursuant to 
        section 8 of article I of the Constitution and the power to 
        enact all laws necessary and proper for the execution of the 
        foregoing powers pursuant to section 8 of article I of the 
        Constitution, in order to prohibit discrimination in public 
        schools on the basis of sexual orientation or gender identity; 
        and
            (5) to allow the Department of Education to effectively 
        combat discrimination based on sexual orientation or gender 
        identity in public schools through regulation and enforcement, 
        as the Department has issued regulations under and enforced 
        title IX of the Education Amendments of 1972 and other 
        nondiscrimination laws in a manner that effectively addresses 
        discrimination.

SEC. 3. DEFINITIONS.

    For purposes of this Act:
            (1) Program or activity.--The terms ``program or activity'' 
        and ``program'' have same meanings given such terms as applied 
        under section 606 of the Civil Rights Act of 1964 (42 U.S.C. 
        2000d-4a) to the operations of public entities under paragraph 
        (2)(B) of such section.
            (2) Gender identity.--The term ``gender identity'' means 
        the gender-related identity, appearance, or mannerisms or other 
        gender-related characteristics of an individual, with or 
        without regard to the individual's designated sex at birth.
            (3) Harassment.--The term ``harassment'' means conduct that 
        is sufficiently severe, persistent, or pervasive to limit a 
        student's ability to participate in or benefit from a public 
        school education program or activity, or to create a hostile or 
        abusive educational environment at a public school, including 
        acts of verbal, nonverbal, or physical aggression, 
        intimidation, or hostility, if such conduct is based on--
                    (A) a student's actual or perceived sexual 
                orientation or gender identity; or
                    (B) the actual or perceived sexual orientation or 
                gender identity of a person or persons with whom a 
                student associates or has associated.
            (4) Public schools.--The term ``public schools'' means 
        public elementary and secondary schools, including local 
        educational agencies, educational service agencies, and State 
        educational agencies, as defined in section 9101 of the 
        Elementary and Secondary Education Act of 1965.
            (5) Sexual orientation.--The term ``sexual orientation'' 
        means homosexuality, heterosexuality, or bisexuality.
            (6) Student.--The term ``student'' means an individual who 
        is enrolled in a public school or who, regardless of official 
        enrollment status, attends classes or participates in a public 
        school's programs or educational activities.

SEC. 4. PROHIBITION AGAINST DISCRIMINATION; EXCEPTIONS.

    (a) In General.--No student shall, on the basis of actual or 
perceived sexual orientation or gender identity of such individual or 
of a person with whom the student associates or has associated, be 
excluded from participation in, or be denied the benefits of, or be 
subjected to discrimination under any program or activity receiving 
Federal financial assistance.
    (b) Harassment.--For purposes of this Act, discrimination includes, 
but is not limited to, harassment of a student on the basis of actual 
or perceived sexual orientation or gender identity of such student or 
of a person with whom the student associates or has associated.
    (c) Retaliation Prohibited.--
            (1) Prohibition.--No person shall be excluded from 
        participation in, be denied the benefits of, or be subjected to 
        discrimination, retaliation, or reprisal under any program or 
        activity receiving Federal financial assistance based on his or 
        her opposition to conduct made unlawful by this Act.
            (2) Definition.--For purposes of this subsection, 
        ``opposition to conduct made unlawful by this Act'' includes, 
        but is not limited to--
                    (A) opposition to conduct reasonably believed to be 
                made unlawful by this Act,
                    (B) any formal or informal report, whether oral or 
                written, to any governmental entity, including public 
                schools and employees thereof, regarding conduct made 
                unlawful by this Act or reasonably believed to be made 
                unlawful by this Act,
                    (C) participation in any investigation, proceeding, 
                or hearing related to conduct made unlawful by this Act 
                or reasonably believed to be made unlawful by this Act, 
                and
                    (D) assistance or encouragement provided to any 
                other person in the exercise or enjoyment of any right 
                granted or protected by this Act,
        if in the course of that expression, the person involved does 
        not purposefully provide information known to be false to any 
        public school or other governmental entity regarding a 
        violation, or alleged violation, of this Act.

SEC. 5. FEDERAL ADMINISTRATIVE ENFORCEMENT; REPORT TO CONGRESSIONAL 
              COMMITTEES.

    Each Federal department and agency which is empowered to extend 
Federal financial assistance to any education program or activity, by 
way of grant, loan, or contract other than a contract of insurance or 
guaranty, is authorized and directed to effectuate the provisions of 
section 4 of this Act with respect to such program or activity by 
issuing rules, regulations, or orders of general applicability which 
shall be consistent with achievement of the objectives of the Act 
authorizing the financial assistance in connection with which the 
action is taken. No such rule, regulation, or order shall become 
effective unless and until approved by the President. Compliance with 
any requirement adopted pursuant to this section may be effected--
            (1) by the termination of or refusal to grant or to 
        continue assistance under such program or activity to any 
        recipient as to whom there has been an express finding on the 
        record, after opportunity for hearing, of a failure to comply 
        with such requirement, but such termination or refusal shall be 
        limited to the particular political entity, or part thereof, or 
        other recipient as to whom such a finding has been made, and 
        shall be limited in its effect to the particular program, or 
        part thereof, in which such noncompliance has been so found, or
            (2) by any other means authorized by law,
except that no such action shall be taken until the department or 
agency concerned has advised the appropriate person or persons of the 
failure to comply with the requirement and has determined that 
compliance cannot be secured by voluntary means. In the case of any 
action terminating, or refusing to grant or continue, assistance 
because of failure to comply with a requirement imposed pursuant to 
this section, the head of the Federal department or agency shall file 
with the committees of the House and Senate having legislative 
jurisdiction over the program or activity involved a full written 
report of the circumstances and the grounds for such action. No such 
action shall become effective until 30 days have elapsed after the 
filing of such report.

SEC. 6. CAUSE OF ACTION.

    (a) Cause of Action.--Subject to subsection (c) of this section, an 
aggrieved individual may assert a violation of this Act in a judicial 
proceeding. Aggrieved persons may be awarded all appropriate relief, 
including but not limited to equitable relief, compensatory damages, 
cost of the action, and remedial action.
    (b) Rule of Construction.--This section shall not be construed to 
preclude an aggrieved individual from obtaining other remedies under 
any other provision of law or to require such individual to exhaust any 
administrative complaint process or notice-of-claim requirement before 
seeking redress under this section.
    (c) Statute of Limitations.--For actions brought pursuant to this 
section, the statute of limitations period shall be determined in 
accordance with section 1658(a) of title 28 of the United States Code. 
The tolling of any such limitations period shall be determined in 
accordance with the law governing actions under section 1979 of the 
Revised Statutes (42 U.S.C. 1983) in the forum State.

SEC. 7. STATE IMMUNITY.

    (a) State Immunity.--A State shall not be immune under the 11th 
Amendment to the Constitution of the United States from suit in Federal 
court for a violation of this Act.
    (b) Waiver.--A State's receipt or use of Federal financial 
assistance for any program or activity of a State shall constitute a 
waiver of sovereign immunity, under the 11th Amendment to the 
Constitution or otherwise, to a suit brought by an aggrieved individual 
for a violation of section 4 of this Act.
    (c) Remedies.--In a suit against a State for a violation of this 
Act, remedies (including remedies both at law and in equity) are 
available for such a violation to the same extent as such remedies are 
available for such a violation in the suit against any public or 
private entity other than a State.

SEC. 8. ATTORNEY'S FEES.

    Section 722(b) of the Revised Statutes (42 U.S.C. 1988(b)) is 
amended by inserting ``the Student Nondiscrimination Act of 2011,'' 
after ``Religious Land Use and Institutionalized Persons Act of 
2000,''.

SEC. 9. EFFECT ON OTHER LAWS.

    (a) Federal and State Nondiscrimination Laws.--Nothing in this Act 
shall be construed to preempt, invalidate, or limit rights, remedies, 
procedures, or legal standards available to victims of discrimination 
or retaliation under any other Federal law or law of a State or 
political subdivision of a State, including title VI of the Civil 
Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the Education 
Amendments of 1972 (20 U.S.C. 1681 et seq.), section 504 of the 
Rehabilitation Act of 1973 (29 U.S.C. 794), the Americans with 
Disabilities Act of 1990 (42 U.S.C. 12101 et seq.), or section 1979 of 
the Revised Statutes (42 U.S.C. 1983). The obligations imposed by this 
Act are in addition to those imposed by title IX of the Education 
Amendments of 1972 (20 U.S.C. 1681 et seq.), title VI of the Civil 
Rights Act of 1964 (42 U.S.C. 2000d et seq.), and the Americans with 
Disabilities Act of 1990 (42 U.S.C. 12101 et seq.).
    (b) Free Speech and Expression Laws and Religious Student Groups.--
Nothing in this Act shall be construed to alter legal standards 
regarding, or affect the rights available to individuals or groups 
under, other Federal laws that establish protections for freedom of 
speech and expression, such as legal standards and rights available to 
religious and other student groups under the 1st Amendment to the 
Constitution and the Equal Access Act (20 U.S.C. 4071 et seq.).

SEC. 10. SEVERABILITY.

    If any provision of this Act, or any application of such provision 
to any person or circumstance, is held to be unconstitutional, the 
remainder of this Act, and the application of the provision to any 
other person or circumstance shall not be affected.

SEC. 11. EFFECTIVE DATE.

    This Act shall take effect 60 days after the date of the enactment 
of this Act and shall not apply to conduct occurring before the 
effective date of this Act.
[EX A]: Student Non-Discrimination Act of 2011 - Prohibits public school students from being excluded from participating in, or subject to discrimination under, any federally-assisted educational program on the basis of their actual or perceived sexual orientation or gender identity or that of their associates.

Considers harassment to be a form of discrimination.

Prohibits retaliation against anyone for opposing conduct they reasonably believe to be unlawful under this Act.

Authorizes federal departments and agencies to enforce these prohibitions by cutting off the educational assistance of recipients found to be violating them.

Allows an aggrieved individual to assert a violation of this Act in a judicial proceeding and recover reasonable attorney's fees should they prevail.

Deems a state's receipt of federal educational assistance for a program to constitute a waiver of sovereign immunity for conduct prohibited under this Act regarding such program.

[EX Q]: SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    This Act may be cited as the ``Wildland Firefighters Health 
Protection Act''.

SEC. 2. DEFINITIONS.

    For the purposes of this Act--
            (1) the term ``wildland firefighter'' means an employee of 
        a Federal land management agency, the duties of whose position 
        are primarily to perform work directly related to the 
        prevention, control, suppression, and management of wildfires, 
        including--
                    (A) an employee of a Federal land management agency 
                who is assigned to support wildland fire suppression 
                activities; and
                    (B) an employee who is transferred to a supervisory 
                or administrative position from a position of wildland 
                firefighter (as defined by the preceding provisions of 
                this paragraph);
            (2) the term ``Federal land management agency'' means--
                    (A) within the Department of the Interior, the 
                Bureau of Land Management, the Bureau of Indian 
                Affairs, the National Park Service, and the Fish and 
                Wildlife Service; and
                    (B) within the Department of Agriculture, the 
                Forest Service; and
            (3) the term ``employee'' has the meaning given such term 
        by section 2105 of title 5, United States Code.

SEC. 3. CLASSIFICATION OF WILDLAND FIREFIGHTERS.

    (a) Requirements.--
            (1) In general.--Within 30 days after the date of the 
        enactment of this Act, the Office of Personnel Management, in 
        cooperation with the Federal land management agencies, shall 
        commence development of a separate and distinct wildland 
        firefighter occupational series that will more accurately 
        reflect the variety of duties performed by wildland 
        firefighters.
            (2) Designation.--The official title assigned to any 
        occupational series established pursuant to paragraph (1) shall 
        include the designation of ``Wildland Firefighter''.
            (3) Positions described.--Paragraph (1) applies with 
        respect to any class or other category of positions that 
        consists primarily or exclusively of forestry technician 
        positions, range technician positions, or any other positions 
        the duties and responsibilities of which include--
                    (A) significant wildfire preparedness and 
                suppression activities; or
                    (B) activities necessary to meet any other 
                emergency incident to which assigned.
            (4) Consultation.--Congress encourages the Office of 
        Personnel Management to consult with recognized employee 
        organizations, employee associations, and any other groups that 
        represent Federal wildland firefighters in carrying out this 
        subsection.
    (b) Hazardous Duty Differential Not Affected.--Section 5545(d)(1) 
of title 5, United States Code, is amended by striking all after 
``except'' and inserting an em dash and the following:
                    ``(A) an employee in an occupational series 
                covering positions for which the primary duties are 
                wildland firefighting, as determined by the Office; and
                    ``(B) in such other circumstances as the Office may 
                by regulation prescribe; and''.
    (c) Employees Currently in 401 Series.--Any individual who, as of 
the date of the enactment of this Act, holds a position of wildland 
firefighter shall have the option of either remaining in the 401 series 
(as in effect on such date under chapter 51 of title 5, United States 
Code) or being included in the new wildland firefighter series, as 
established pursuant to subsection (a).

SEC. 4. PAY AND BENEFITS.

    (a) In General.--In the case of a wildland firefighter, for full-
time, part-time, and intermittent tours of duty, hours of work 
officially ordered or approved in excess of 40 hours per week or 8 
hours per day shall be considered overtime work, inclusive of all time 
the firefighter is away from their official duty station assigned to an 
emergency incident, in support of an emergency incident, or pre-
positioned for emergency response, and shall be compensable as work 
time in accordance with section 5542(a) of title 5, United States Code, 
as amended by subsection (b)(1).
    (b) Requirements.--
            (1) Amendment to title 5.--Section 5542(a) of title 5, 
        United States Code, is amended by adding at the end (as a flush 
        left sentence) the following:
``Notwithstanding paragraphs (1) and (2), for a wildland firefighter 
assigned to an emergency incident, assigned in support of an emergency 
incident, or pre-positioned for emergency response, the overtime hourly 
rate of pay is an amount equal to one and one-half times the hourly 
rate of the basic pay of the employee, and that entire amount is 
premium pay.''.
            (2) Fair labor standards act of 1938.--For the purpose of 
        applying the provisions of the Fair Labor Standards Act of 1938 
        (29 U.S.C. 201, et seq.) with respect to wildland firefighters, 
        no violation referred to in such provisions shall be considered 
        to have occurred if the requirements described in paragraph (1) 
        are met.
    (c) Portal-to-Portal Compensation Pilot Program.--
            (1) Funding.--There is authorized to be appropriated 
        $25,000,000 to initiate a portal-to-portal pilot program under 
        this subsection, commencing with the 2013 wildfire season. Any 
        sums required in addition to amounts appropriated pursuant to 
        the preceding sentence may be secured from the existing 
        wildfire suppression budget for the fiscal year in which the 
        season occurs.
            (2) Duration.--The pilot program shall be carried out by 
        the Department of the Interior and the Department of 
        Agriculture for a period not to exceed 3 calendar years 
        beginning as of the start of the 2013 wildfire season.
            (3) Report.--No later than 90 days after the completion of 
        the pilot program, the Secretary of the Interior and the 
        Secretary of Agriculture shall submit to Congress a joint 
        report on the effectiveness of the pilot program. Such report 
        shall address the effect of the program with respect to--
                    (A) recruitment and retention of wildland 
                firefighters; and
                    (B) any cost savings.
            (4) Additional requirements.--To ensure adequate funding 
        and to realize maximum wildfire suppression savings, the 
        Secretary of the Interior and the Secretary of Agriculture 
        shall take appropriate measures to ensure that total funding 
        for non-Federal fire suppression personnel and other resources, 
        by their respective Departments--
                    (A) for the first year of the pilot program, do not 
                exceed 90 percent of their combined non-Federal fire 
                suppression costs for the 2011 and 2012 wildfire 
                seasons;
                    (B) for the second year of the pilot program, do 
                not exceed 75 percent of their combined non-Federal 
                fire suppression costs for the 2011 and 2012 wildfire 
                seasons; and
                    (C) for the third year of the pilot program, do not 
                exceed 65 percent of their combined non-Federal fire 
                suppression costs for the 2011 and 2012 wildfire 
                seasons.
    (d) Hazardous Duty Differential To Be Treated as Part of a Wildland 
Firefighter's Base Pay for Retirement Purposes.--
            (1) In general.--Section 8331(3) of title 5, United States 
        Code is amended--
                    (A) in subparagraph (G), by striking ``and'' at the 
                end;
                    (B) in subparagraph (H), by inserting ``and'' at 
                the end; and
                    (C) by adding after subparagraph (H) the following:
                    ``(I) with respect to a wildland firefighter (as 
                defined by section 2 of the Wildland Firefighters 
                Health Protection Act), any pay differential received 
                under section 5545(d);''.
            (2) Conforming amendment.--Such section 8331(3) is further 
        amended, in the matter following subparagraph (I) (as added by 
        paragraph (1)(C)), by striking ``subparagraphs (B) through (H) 
        of this paragraph'' and inserting ``subparagraphs (B) through 
        (I),''.
    (e) Hazardous Duty Differential.--
            (1) In general.--In the administration of section 5545(d) 
        of title 5, United States Code, the Office of Personnel 
        Management shall take such measures as may be necessary to 
        ensure that, under the schedule or schedules of pay 
        differentials for duty involving unusual physical hardship or 
        hazard, a pay differential of 25 percent shall be payable to an 
        individual while serving as a member of a wildland firefighting 
        crew.
            (2) Definition.--For purposes of this subsection, the term 
        ``wildland firefighting crew'' includes ground (hand crew, 
        hotshot, engine, and other fire apparatus personnel) and 
        airborne (smoke jumper or helitack) firefighting personnel on 
        the fire line of any wildfire or prescribed fuel treatment burn 
        or fire, as further defined in regulations of the Office of 
        Personnel Management.
    (f) Benefits for Seasonal Wildland Firefighters.--
            (1) Provisions relating to life insurance.--Section 8716(b) 
        of title 5, United States Code, is amended--
                    (A) in paragraph (2), by striking ``or'' at the 
                end;
                    (B) in paragraph (3), by striking the period at the 
                end and inserting ``; or''; and
                    (C) by adding after paragraph (3) the following:
            ``(4) a wildland firefighter within the meaning of section 
        2 of the Wildland Firefighters Health Protection Act.''.
            (2) Provisions relating to health benefits.--Section 
        8913(b) of title 5, United States Code, is amended--
                    (A) in paragraph (3), by striking ``or'' at the 
                end;
                    (B) in paragraph (4), by striking the period at the 
                end and inserting ``; or''; and
                    (C) by adding after paragraph (4) the following:
            ``(5) a wildland firefighter within the meaning of section 
        2 of the Wildland Firefighters Health Protection Act.''.
    (g) Buy Back of Civilian Time After 1989.--
            (1) In general.--Any individual who is subject to the 
        Federal Employees' Retirement System as a firefighter (within 
        the meaning of section 8401 of title 5, United States Code) on 
        the date of the enactment of this Act shall be entitled to have 
        any qualifying firefighter service treated as creditable 
        service under section 8411 of such title.
            (2) Qualifying firefighter service.--For purposes of this 
        subsection, the term ``qualifying firefighter service'' means, 
        in connection with an individual, any service--
                    (A) which was performed by such individual, as a 
                wildland firefighter, after 1989 and before the date of 
                the enactment of this Act; and
                    (B) for which such individual was not allowed to 
                receive retirement credit by reason of section 8347(g) 
                or 8402(c) of such title 5.
            (3) Deposit requirement.--Credit for a period of service 
        may not be given under this subsection unless the individual 
        involved makes a deposit, in such manner as the Office of 
        Personnel Management may by regulation require, equal to the 
        employee contributions that would have been required (in the 
        case of a firefighter) for such period under section 8334(c) or 
        8422(a) of such title 5, with interest.
            (4) Certification.--The Office of Personnel Management 
        shall accept the certification of the Secretary of the Interior 
        or the Secretary of Agriculture, as the case may be, concerning 
        whether an individual performed qualifying firefighter service 
        and the length of the period of such service the individual 
        performed.
[EX A]: Wildland Firefighters Health Protection Act - Defines "wildland firefighter" as an employee of a federal land management agency who performs work directly related to the prevention, control, suppression, and management of wildfires, including an employee who is assigned to support wildland fire suppression activities and an employee who is transferred to a supervisory or administrative position.

Directs the Office of Personnel Management (OPM), in cooperation with such agencies, to commence development of a separate wildland firefighter occupational series that will more accurately reflect the variety of duties performed.

Requires a wildland firefighter's hours of work officially ordered or approved in excess of 40 hours per week or 8 hours per day to be considered overtime work. Makes time the firefighter is away from his or her official duty station assigned to an emergency incident, in support of an emergency incident, or pre-positioned for emergency response compensable as work time. Includes hazardous duty differentials as basic pay for retirement purposes.

Prohibits OPM from excluding wildland firefighters from federal employees' group life insurance (FEGLI) and from federal health care benefits.

[EX Q]: SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Home Health Access 
Restoration Act of 1999''.

SEC. 2. ADJUSTMENT TO PER BENEFICIARY LIMITS.

    (a) Increase in Payment Amount to Agencies With Limits Under the 
National Average.--Section 1861(v)(1)(L) of the Social Security Act (42 
U.S.C. 1395x(v)(1)(L)), as amended by section 5101(a) of the Tax and 
Trade Relief Extension Act of 1998 (Public Law 105-277), is amended--
            (1) in clause (v)(I), by inserting ``, clause (ix)'' after 
        ``subject to clause (viii)(I)'';
            (2) in clause (viii)(I), by striking ``during or after 
        fiscal year 1999'' and inserting ``during fiscal year 1999'';
            (3) by redesignating clause (ix) as clause (xii); and
            (4) by inserting after clause (viii) the following new 
        clause:
    ``(ix) In the case of a provider with a 12-month cost reporting 
period ending in fiscal year 1994, if the limit imposed under clause 
(v) (determined without regard to this subclause) for a cost reporting 
period beginning after fiscal year 1999 is less than the median 
described in clause (vi)(I) (but determined as if any reference in 
clause (v) to `98 percent' were a reference to `100 percent'), the 
payment limit for such provider and period shall be equal to--
            ``(I) for cost reporting periods beginning during fiscal 
        year 2000, 90 percent of such median;
            ``(II) for cost reporting periods beginning during fiscal 
        year 2001, 95 percent of such median; and
            ``(III) for cost reporting periods beginning during or 
        after fiscal year 2002, such median.
Each of the amounts specified in subclauses (I) through (III) are such 
amounts as adjusted under clause (iii) to reflect variations in wages 
among different areas.''.
    (b) Establishment of Per Beneficiary Cap; Waiver.--
            (1) In general.--Section 1861(v)(1)(L) of such Act (42 
        U.S.C. 1395x(v)(1)(L)), as amended in subsection (a), is 
        further amended--
                    (A) in clause (v)(I), by inserting ``, and clause 
                (x)'' after ``clause (ix)''; and
                    (B) by inserting after clause (ix), the following 
                new clause:
    ``(x) In the case of a provider with a 12-month cost reporting 
period ending in fiscal year 1994, if the limit imposed under clause 
(v) (determined without regard to this subclause) for a cost reporting 
period beginning after fiscal year 1999 exceeds the median described in 
clause (vi)(I) (but determined as if any reference in clause (v) to `98 
percent' were a reference to `100 percent'), the payment limit for such 
provider and period may not exceed--
            ``(I) for cost reporting periods beginning during fiscal 
        year 2000, an amount equal to 250 percent of such median;
            ``(II) for cost reporting periods beginning during fiscal 
        year 2001, an amount equal to 225 percent of such median; and
            ``(III) for cost reporting periods beginning during or 
        after fiscal year 2002, an amount equal to 200 percent of such 
        median.
Notwithstanding the previous sentence, in the case of such a provider 
that demonstrates to the Secretary (in such form and using such data as 
the Secretary requires) that, for a cost reporting period, the 
provider, or a unit of the provider, specializes in the treatment of 
individuals who, because of age, diagnosis, or other criteria specified 
by the Secretary are substantially more costly-than-average to treat, 
the amount of payment to that provider or unit for such an individual 
for that period is the limitation determined under clause (v).''.
            (2) Consultation.--The Secretary of Health and Human 
        Services shall consult with appropriate organizations, 
        including such organizations representing providers of home 
        health services, physicians, and patients in determining the 
        criteria required for special payment provisions under the 
        second sentence of clause (x) and under clause (xi) of section 
        1861(v)(1)(L) of the Social Security Act (42 U.S.C. 
        1395x(v)(1)(L)), including descriptions of the type of patient, 
        patient condition, unusual variations, and home health service 
        that qualifies for such payment.
    (c) Waiver of Per Beneficiary Limit for Outliers.--
            (1) In general.--Section 1861(v)(1)(L) of such Act (42 
        U.S.C. 1395x(v)(1)(L)), as amended in subsections (a) and (b), 
        is further amended by inserting after clause (x), the following 
        new clause:
    ``(xi)(I) Notwithstanding the applicable limit under clause (v), 
(vi), (viii), (ix), or (x), in the case of a provider that demonstrates 
to the Secretary that with respect to an individual to whom the 
provider furnishes home health services that are appropriate to the 
individual's condition (as determined by the Secretary) at a reasonable 
cost (as determined by the Secretary), and that such reasonable cost 
significantly exceeded such applicable limit because of unusual 
variations in the type or amount of medically necessary care (outliers) 
required to treat the individual, the Secretary, upon application by 
the provider, shall pay to such provider for such individual such 
reasonable cost.
    ``(II) The Secretary shall establish such criteria as is required 
for payment under this clause, including a description of the type of 
patient, patient condition, unusual variations, and home health service 
that qualifies for such payment.
    ``(III) In making determinations under subclause (I), the Secretary 
shall use data from the cost report, or from other data collected by 
the Secretary, of the provider for such year.
    ``(IV) A provider may make an application for payment under this 
clause for a fiscal year no earlier than the end of the provider's cost 
reporting period beginning in such fiscal year.
    ``(V) In the case of an application for payment under this clause 
that is approved by the Secretary, a provider may elect to receive 
payment on a quarterly basis.''.
            (2) Effective date.--The amendment made by subsection (a) 
        takes effect six months after the date of the enactment of this 
        Act, and applies with respect to applications by home health 
        agencies for payment of reasonable costs for outliers for cost 
        reporting periods ending on or after such date.
    (d) Reports to Congress.--
            (1) Initial report.--Not later than one year after the date 
        of the enactment of this Act, the Secretary of Health and Human 
        Services shall submit to Congress a report describing the 
        effect of the special payment provisions provided for under the 
        second sentence of clause (x) and under clause (xi) of section 
        1861(v)(1)(L) of the Social Security Act (42 U.S.C. 
        1395x(v)(1)(L)). Such report shall include information with 
        respect to the number of home health agencies that requested 
        payment under such provisions and the number of such agencies 
        that received payment under such provisions.
            (2) Final report.--Not later than three years after the 
        date of the enactment of this Act, the Secretary shall submit 
        to Congress a report that updates the report submitted under 
        paragraph (1), including additional information with respect to 
        the illnesses, and the characteristics of such illnesses, of 
        the patients for whom payment under such special provisions was 
        requested, and the characteristics of the home health agencies 
        furnishing home health services to such patients for such 
        illnesses.

SEC. 3. REVISION OF PER VISIT LIMITS.

    Section 1861(v)(1)(L)(i) of the Social Security Act (42 U.S.C. 
1395x(v)(1)(L)(i)), as amended by section 5101(b) of the Tax and Trade 
Relief Extension Act of 1998 (Public Law 105-277), is amended--
            (1) in subclause (IV), by striking ``or'';
            (2) in subclause (V)--
                    (A) by inserting ``and before October 1, 1999,'' 
                after ``October 1, 1998,''; and
                    (B) by striking the period at the end and inserting 
                ``, or''; and
            (3) by adding at the end the following new subclause:
            ``(V) October 1, 1999, 110 percent of such median.''.

SEC. 4. ELIMINATION OF CONTINGENT 15 PERCENT REDUCTION IN PAYMENT 
              LIMITS UNDER THE INTERIM PAYMENT SYSTEM.

    Section 4603 of the Balanced Budget Act of 1997 (Public Law 105-
33), as amended by section 5101(c)(3) of the Tax and Trade Relief 
Extension Act of 1998 (Public Law 105-277) (111 Stat. 471), is amended 
by striking subsection (e).

SEC. 5. INFORMATIONAL MATERIALS FOR MEDICARE BENEFICIARIES WITH RESPECT 
              TO HOME HEALTH SERVICES.

    (a) In General.--The Secretary shall prepare a notice of the rights 
of individuals entitled to benefits under the medicare program (under 
title XVIII of the Social Security Act) to appeal a coverage 
determination with respect to items and services furnished to such 
individual under the program. In the case of such items and services 
consisting of home health services furnished by a home health agency, 
the home health agency shall furnish such notice to such an individual 
upon discharge by the agency of such individual from such services.
    (b) Information for Physicians.--The Secretary shall provide 
guidance for physicians contacted by affected individuals to assist 
such individuals, including specific guidance in the case of such 
individuals for whom home health services are discontinued before the 
recommended treatment is complete, but on behalf of whom payment under 
the limits established under section 1861(v)(1)(L) of the Social 
Security Act (42 U.S.C. 1395x(v)(1)(L)) has been made in full by the 
Secretary to the home health agency. The materials shall include 
telephone numbers and such other information to enable the physician to 
seek further assistance or clarification from individuals within the 
Health Care Financing Administration with appropriate expertise.
    (c) Requests for Additional Resources.--The Secretary may submit to 
Congress an estimate of additional resources required by the Health 
Care Financing Administration to comply with the provisions of the 
section. Any such estimate shall be included in the report required 
under paragraph (1) of section 2(d).
    (d) Effective Date.--By not later than six months after the date of 
the enactment of this Act, the Secretary shall begin distributing to 
home health agencies furnishing home health services under the medicare 
program (under title XVIII of the Social Security Act), and to 
physicians furnishing services under such program, the information 
prepared under this section.

SEC. 6. COMPTROLLER GENERAL STUDY ON MEDICARE HOME HEALTH BENEFIT.

    (a) Study.--
            (1) Cost of services.--The Comptroller General of the 
        United States shall conduct a study on the relationship between 
        the costs to the medicare program (under title XVIII of the 
        Social Security Act) for home health services furnished by home 
        health agencies under the program, and the costs to State and 
        Federal government programs (including the medicare program and 
        the medicaid program (under title XIX of such Act)) for 
        services furnished by rehabilitation agencies, public health 
        agencies, clinics, comprehensive outpatient rehabilitation 
        facilities, skilled nursing facilities under the medicare 
        program, and for long-term care services furnished under the 
        medicaid program (under title XIX of such Act).
            (2) Determination of saving overall to medicare program.--
        The Comptroller General shall also determine whether providing 
        home health services as a benefit under the medicare program 
        has resulted in lower costs overall to the Federal government.
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General shall submit to Congress 
a report describing the results of the study conducted under subsection 
(a).
[EX A]:
Amends the Balanced Budget Act of 1997 to eliminate the 15 percent contingent reduction in payment amounts under the interim prospective payment system (PPS) for home health services.
Directs: (1) the Secretary to prepare specified informational materials for assisting Medicare beneficiaries with regard to home health services; and (2) the Comptroller General to study and report to Congress on certain aspects of the Medicare home health benefit, including whether it has resulted in overall lower costs to the Federal Government.