116 HR 8473 IH: Family First Medisave Empowerment Act
U.S. House of Representatives
2020-10-01
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I116th CONGRESS2d SessionH. R. 8473IN THE HOUSE OF REPRESENTATIVESOctober 1, 2020Mr. Gonzalez of Ohio (for himself and Mr. Westerman) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concernedA BILLTo amend the Internal Revenue Code of 1986 to consolidate health accounts into Medisave Accounts, and for other purposes.1.Short titleThis Act may be cited as the Family First Medisave Empowerment Act.2.Medisave Accounts(a)In generalPart VIII of subchapter F of chapter 1 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section:530A.Medisave Accounts(a)Medisave accountFor purposes of this section—(1)In generalThe term Medisave account means a trust created or organized in the United States as a Medisave account exclusively for the purpose of paying the qualified medical expenses of the account beneficiary, but only if the written governing instrument creating the trust meets the following requirements:(A)Except in the case of a rollover contribution described in subparagraph (A) or (B) of subsection (e)(5), no contribution will be accepted—(i)unless it is in cash,(ii)to the extent such contribution, when added to previous contributions to the trust for the calendar year, exceeds the limitation amount specified in subsection (b)(1), or(iii)to the extent such contribution, when added to the balance of the account, exceeds the limitation amount specified in subsection (b)(2).(B)The trustee is a bank (as defined in section 408(n)), an insurance company (as defined in section 816), or another person who demonstrates to the satisfaction of the Secretary that the manner in which such person will administer the trust will be consistent with the requirements of this section.(C)No part of the trust assets will be invested in life insurance contracts.(D)The assets of the trust will not be commingled with other property except in a common trust fund or common investment fund.(E)The interest of an individual in the balance in his account is nonforfeitable.(2)Qualified medical expenses(A)In generalThe term qualified medical expenses means, with respect to an account beneficiary, amounts paid by such beneficiary for medical care, but only to the extent such amounts are not compensated for by insurance or otherwise—(i)for—(I)such individual,(II)the spouse of such individual,(III)any dependent (as defined in section 152, determined without regard to subsections (b)(1), (b)(2), and (d)(1)(B) thereof) of such individual, and(IV)any individual who bears a relationship to the account beneficiary that is described in subparagraph (C) or (D) of section 152(d) if the account beneficiary is or was a dependent of such individual for any taxable year ending before or with the taxable year in which the individual attained 18 years of age, and(ii)if, on the date such medical care was provided, such individual, spouse or dependent to whom such care was provided was covered under the qualified health insurance of the account beneficiary.(B)Modified definition of medical careFor purposes of subparagraph (A), the term medical care has the meaning given such term by section 213(d), except that such term includes—(i)direct pay arrangements with primary physicians, and(ii)predetermined level of access to care from an integrated health plan.(3)Account beneficiaryThe term account beneficiary means the individual on whose behalf the Medisave account was established.(4)Certain rules to applyRules similar to the following rules shall apply for purposes of this section:(A)Section 219(d)(2) (relating to no deduction for rollovers).(B)Section 219(f)(3) (relating to time when contributions deemed made).(C)Except as provided in section 106(d), section 219(f)(5) (relating to employer payments).(D)Section 408(g) (relating to community property laws).(E)Section 408(h) (relating to custodial accounts).(b)Limitations(1)Annual limitation(A)In generalThe limitation amount specified in this paragraph is—(i)$10,000 in the case of a qualified health plan with an actuarial value of less than 55 percent,(ii)$8,600 in the case of a qualified health plan with an actuarial value that is 55 percent or more and less than 65 percent, and(iii)$7,200 in the case of a qualified health plan with an actuarial value that is 65 percent or more.(B)Actuarial value of qualified health planFor purposes of subparagraph (A), the actuarial value of a qualified health plan is the percentage of the total average costs of covered benefits under the health plan.(2)Account accumulation limitationThe limitation amount specified in this paragraph is $50,000.(3)Indexing(A)In generalIn the case of any taxable year beginning in a calendar year after 2020, each dollar amount contained in paragraph (1)(A) shall be increased by the medical care cost adjustment of such amount for such calendar year.(B)Medical care cost adjustmentFor purposes of subparagraph (A), the medical care cost adjustment for any calendar year is the percentage (if any) by which—(i)the medical care component of the C–CPI–U (as defined in section 1(f)(6)) for August of the preceding calendar year, exceeds(ii)such component of the C–CPI–U (as so defined) for August of 2019.(C)Rounding(i)Annual limitationIf any increase in a dollar amount contained in paragraph (1)(A) determined under subparagraph (A) is not a multiple of $100, such increase shall be rounded to the nearest multiple of $100.(ii)Account limitationIf any increase in the dollar amount contained in paragraph (2) determined under subparagraph (A) is not a multiple of $1,000, such increase shall be rounded to the nearest multiple of $1,000.(4)Coordination with other contributionsThe limitation which would (but for this paragraph) apply under paragraphs (1) and (2) to an individual for any taxable year shall be reduced (but not below zero) by the sum of—(A)the aggregate amount contributed to Medisave accounts of such individual which is excludable from the taxpayer’s gross income for such taxable year under section 106(d), and(B)the aggregate amount contributed to Medisave accounts of such individual for such taxable year under section 408(d)(9).(5)Deposit of advance premium tax creditAn account beneficiary who is eligible for an advance payment of the premium tax credit may elect to have the Secretary deposit the advance payment into the Medisave account of the account beneficiary.(c)Definitions and special rulesFor purposes of this section—(1)Eligible individual(A)In generalThe term eligible individual means, with respect to any month, any individual if such individual is covered under a qualified health plan as of the 1st day of such month.(B)Certain coverage disregardedSubparagraph (A) shall be applied without regard to—(i)coverage for any benefit provided by permitted insurance, and(ii)coverage (whether through insurance or otherwise) for accidents, disability, dental care, vision care, or long-term care.(C)Special rule for individuals eligible for certain veterans benefitsAn individual shall not fail to be treated as an eligible individual for any period merely because the individual receives hospital care or medical services under any law administered by the Secretary of Veterans Affairs for a service-connected disability (within the meaning of section 101(16) of title 38, United States Code).(2)Qualified health plan(A)In generalThe term qualified health plan means a health plan that offers health insurance coverage. Such term includes entitlement to benefits under title XVIII or title XIX of the Social Security Act.(B)Exclusion of certain plansSuch term does not include a health plan if substantially all of its coverage is disregarded under paragraph (1)(B).(C)Health insurance coverageThe term health insurance coverage means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care) under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuer.(D)Health insurance issuerThe term health insurance issuer means an insurance company, insurance service, or insurance organization (including a health maintenance organization) which is licensed to engage in the business of insurance in a State and which is subject to State law which regulates insurance (within the meaning of section 514(b)(2) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1144(b)(2)).(E)Health maintenance organizationThe term health maintenance organization means—(i)a Federally qualified health maintenance organization (as defined in section 1301(a) of the Public Health Service Act (42 U.S.C. 300e(a)),(ii)an organization recognized under State law as a health maintenance organization, or(iii)a similar organization regulated under State law for solvency in the same manner and to the same extent as such a health maintenance organization.(3)Permitted insuranceThe term permitted insurance means—(A)insurance if substantially all of the coverage provided under such insurance relates to—(i)liabilities incurred under workers’ compensation laws,(ii)tort liabilities,(iii)liabilities relating to ownership or use of property, or(iv)such other similar liabilities as the Secretary may specify by regulations,(B)insurance for a specified disease or illness, and(C)insurance paying a fixed amount per day (or other period) of hospitalization.(4)Family coverageThe term family coverage means any coverage other than self-only coverage.(d)Tax treatment of accounts(1)In generalA Medisave account is exempt from taxation under this subtitle unless such account has ceased to be a Medisave account. Notwithstanding the preceding sentence, any Medisave account is subject to the taxes imposed by section 511 (relating to imposition of tax on unrelated business income of charitable, etc. organizations).(2)Account terminationsRules similar to the rules of paragraphs (2) and (4) of section 408(e) shall apply to Medisave accounts, and any amount treated as distributed under such rules shall be treated as not used to pay qualified medical expenses.(e)Tax treatment of distributions(1)Amounts used for qualified medical expensesAny amount paid or distributed out of a Medisave account which is used exclusively to pay qualified medical expenses of any account beneficiary shall not be includible in gross income.(2)Inclusion of amounts not used for qualified medical expensesAny amount paid or distributed out of a Medisave account which is not used exclusively to pay the qualified medical expenses of the account beneficiary shall be included in the gross income of such beneficiary.(3)Excess contributions returned before due date of return(A)In generalIf any excess contribution is contributed for a taxable year to any Medisave account of an individual, paragraph (2) shall not apply to distributions from the Medisave accounts of such individual (to the extent such distributions do not exceed the aggregate excess contributions to all such accounts of such individual for such year) if—(i)such distribution is received by the individual on or before the last day prescribed by law (including extensions of time) for filing such individual’s return for such taxable year, and(ii)such distribution is accompanied by the amount of net income attributable to such excess contribution.Any net income described in clause (ii) shall be included in the gross income of the individual for the taxable year in which it is received. (B)Excess contributionFor purposes of subparagraph (A), the term excess contribution means any contribution (other than a rollover contribution described in paragraph (5)) which exceeds the limitations specified in subsection (b).(4)Additional tax on distributions not used for qualified medical expenses(A)In generalThe tax imposed by this chapter on the account beneficiary for any taxable year in which there is a payment or distribution from a Medisave account of such beneficiary which is includible in gross income under paragraph (2) shall be increased by 20 percent of the amount which is so includible.(B)Exception for disability or deathSubparagraph (A) shall not apply if the payment or distribution is made after the account beneficiary becomes disabled within the meaning of section 72(m)(7) or dies.(5)Rollover contribution(A)In generalAn amount is described in this subparagraph as a rollover contribution if it meets the requirements of clauses (i) and (ii).(i)In generalParagraph (2) shall not apply to any amount paid or distributed from a Medisave account to the account beneficiary to the extent the amount received is paid into a Medisave account for the benefit of such beneficiary not later than the 60th day after the day on which the beneficiary receives the payment or distribution.(ii)LimitationThis paragraph shall not apply to any amount described in clause (i) received by an individual from a Medisave account if, at any time during the 1-year period ending on the day of such receipt, such individual received any other amount described in clause (i) from a Medisave account which was not includible in the individual’s gross income because of the application of this paragraph.(B)Rollover from FSA, Archer MSA, and HSAAn amount is described in this subparagraph for a calendar year as a rollover contribution if the amount is the remaining balance in a flexible spending account, Archer MSA, or health savings account that is contributed to the Medisave account for a taxable year ending on or before one year after the date of the enactment of the Family First Medisave Empowerment Act.(6)Coordination with medical expense deductionFor purposes of determining the amount of the deduction under section 213, any payment or distribution out of a Medisave account for qualified medical expenses shall not be treated as an expense paid for medical care.(7)Transfer of account incident to divorceThe transfer of an individual’s interest in a Medisave account to an individual’s spouse or former spouse under a divorce or separation instrument described in clause (i) of section 121(d)(3)(C) shall not be considered a taxable transfer made by such individual notwithstanding any other provision of this subtitle, and such interest shall, after such transfer, be treated as a Medisave account with respect to which such spouse is the account beneficiary.(8)Treatment after death of account beneficiary(A)Treatment if designated beneficiary is spouseIf the account beneficiary’s surviving spouse acquires such beneficiary’s interest in a Medisave account by reason of being the designated beneficiary of such account at the death of the account beneficiary, such Medisave account shall be treated as if the spouse were the account beneficiary.(B)Other cases(i)In generalIf, by reason of the death of the account beneficiary, any person acquires the account beneficiary’s interest in a Medisave account in a case to which subparagraph (A) does not apply—(I)such account shall cease to be a Medisave account as of the date of death, and(II)an amount equal to the fair market value of the assets in such account on such date shall be includible if such person is not the estate of such beneficiary, in such person’s gross income for the taxable year which includes such date, or if such person is the estate of such beneficiary, in such beneficiary’s gross income for the last taxable year of such beneficiary.(ii)Special rules(I)Reduction of inclusion for predeath expensesThe amount includible in gross income under clause (i) by any person (other than the estate) shall be reduced by the amount of qualified medical expenses which were incurred by the decedent before the date of the decedent’s death and paid by such person within 1 year after such date.(II)Deduction for estate taxesAn appropriate deduction shall be allowed under section 691(c) to any person (other than the decedent or the decedent’s spouse) with respect to amounts included in gross income under clause (i) by such person.(f)ReportsThe Secretary may require—(1)the trustee of a Medisave account to make such reports regarding such account to the Secretary and to the account beneficiary with respect to contributions, distributions, the return of excess contributions, and such other matters as the Secretary determines appropriate, and(2)any person who provides an individual with a qualified health plan to make such reports to the Secretary and to the account beneficiary with respect to such plan as the Secretary determines appropriate.The reports required by this subsection shall be filed at such time and in such manner and furnished to such individuals at such time and in such manner as may be required by the Secretary. (g)Regulations and guidanceFor purposes of this section, the Secretary shall prescribe such regulations or other guidance as the Secretary determines necessary or appropriate to carry out this section, including regulations or guidance on the methods acceptable to the Secretary for determining qualified health plan actuarial value..(b)Treatment of employer payments(1)Exclusion limited to self-funded major medical plan of employersSection 105(b) of such Code is amended by striking paid, and inserting paid under a self-funded major medical plan of the employer.(2)Exclusion not applicable to health reimbursement arrangementsSubsection (h) of such Code is amended to read as follows:(h)Exclusion not applicable to health reimbursement arrangementsSubsection (b) shall not apply to health reimbursement arrangements..(3)Repeal of exclusions from income for Archer MSAs, FSAs, and HSAs(A)In generalSection 106 of such Code is amended—(i)by striking subsections (b), (d), and (e), and(ii)by redesignating subsections (f) and (g) as subsections (d) and (e), respectively.(B)Exclusion from income for Medisave accountsSection 106 of such Code, as amended by subparagraph (A), is amended by inserting after subsection (a) the following:(b)Contributions to Medisave accounts(1)In generalIn the case of an employee who is an eligible individual (as defined in section 530A(c)(1)), amounts contributed by such employee’s employer to any Medisave account (as defined in section 530A(a)) of such employee shall be treated as employer-provided coverage for medical expenses under an accident or health plan to the extent such amounts do not exceed the limitations specified in clauses (ii) and (iii) of section 530A(a)(1)(A) (determined without regard to this subsection) which is applicable to such employee for such taxable year.(2)No constructive receiptNo amount shall be included in the gross income of any employee solely because the employee may choose between the contributions referred to in paragraph (1) and employer contributions to another health plan of the employer.(3)Special rule for deduction of employer contributionsAny employer contribution to a Medisave account, if otherwise allowable as a deduction under this chapter, shall be allowed only for the taxable year in which paid.(4)Employer Medisave account contributions required to be shown on returnEvery individual required to file a return under section 6012 for the taxable year shall include on such return the aggregate amount contributed by employers to the Medisave accounts of such individual or such individual’s spouse for such taxable year.(5)Medisave account contributions not part of COBRA coverageParagraph (1) shall not apply for purposes of section 4980B.(6)Cross referenceFor penalty on failure by employer to make comparable contributions to the Medisave accounts of comparable employees, see section 4980G..(4)Distribution from certain retirement accounts for Medisave account fundingSection 408(d)(9) of such Code is amended to read as follows:(9)Distribution for Medisave account funding(A)In generalIn the case of an individual who is an eligible individual (as defined in section 530A(c)(1)) and who elects the application of this paragraph for a taxable year, gross income of the individual for the taxable year does not include a qualified Medisave account funding distribution to the extent such distribution is otherwise includible in gross income.(B)Qualified Medisave account funding distributionFor purposes of this paragraph, the term qualified Medisave account funding distribution means a distribution from an individual retirement plan (other than a plan described in subsection (k) or (p)) of the employee to the extent that—(i)such distribution is contributed to the Medisave account of the individual in a direct trustee-to-trustee transfer, and(ii)such distribution—(I)when added to previous contributions to the Medisave account for the calendar year does not exceed the limitation amount specified in section 530A(b)(1), and(II)when added to the balance of the Medisave account, exceeds the limitation amount specified in section 530A(b)(2).(C)One-time transferAn individual may make an election under subparagraph (A) only for one qualified Medisave account funding distribution during the lifetime of the individual. Such an election, once made, shall be irrevocable.(D)Application of section 72Notwithstanding section 72, in determining the extent to which an amount is treated as otherwise includible in gross income for purposes of subparagraph (A), the aggregate amount distributed from an individual retirement plan shall be treated as includible in gross income to the extent that such amount does not exceed the aggregate amount which would have been so includible if all amounts from all individual retirement plans were distributed. Proper adjustments shall be made in applying section 72 to other distributions in such taxable year and subsequent taxable years..(5)Failure of employer to make comparable contributions(A)Section 4980G(a) of such Code is amended by striking health savings account and inserting Medisave account.(B)Section 4980G(c) of such Code is amended by striking Archer MSAs and health savings accounts and inserting Medisave accounts.(6)W–2 statementsSection 6051(a) of such Code is amended—(A)by striking paragraph (11) and redesignating paragraphs (12) through (17) as paragraphs (11) through (16), respectively, and(B)by amending paragraph (11), as so redesignated, to read as follows:(11)the amount contributed to any Medisave account (as defined in section 530A) of such employee or such employee’s spouse,.(c)Other conforming amendments(1)Archer MSAsSection 220(a) of such Code is amended by adding at the end the following: No amount is allowed as a deduction under the preceding sentence for any taxable year beginning after one year after the date of the enactment of Family First Medisave Empowerment Act..(2)Health savings accountsSection 223(a) of such Code is amended by adding at the end the following: No amount is allowed as a deduction under the preceding sentence for any taxable year beginning after one year after the date of the enactment of the Family First Medisave Empowerment Act..(d)Rollover of FSA, Archer MSA, HSA to Medisave accountNotwithstanding any other provision of law, if the remaining balance in a health flexible spending arrangement, Archer MSA, or Health Savings Account is transferred to a Medisave account before the end of any taxable year ending on or before one year after the date of the enactment of the Family First Medisave Empowerment Act, such transfer shall be treated as a rollover to the Medisave account under section 530A(e)(5)(B) of the Internal Revenue Code of 1986 and the distribution from the health flexible spending arrangement, Archer MSA, or Health Savings Account shall not be includible in gross income.(e)Clerical amendmentsThe table of sections for part VIII of subchapter F of chapter 1 of such Code is amended by adding at the end the following new item:Sec. 530A. Medisave Accounts..(f)Effective dateThe amendments made by this section shall apply to taxable years beginning after one year after the date of the enactment of this Act.3.Tax credit for contributions to Medisave account during first year(a)In generalIn the case of an individual who makes a contribution to a Medisave account before the end of the 1-year period beginning on the date of the enactment of this Act, there shall be allowed as a credit against the tax imposed by subtitle A of the Internal Revenue Code of 1986 for the taxable year in which the contribution is made an amount equal to the aggregate of $1 for every $3 contributed to the account (other than a rollover contribution under section 530A(e)(5) of such Code) for such taxable year.(b)LimitationThe aggregate amount allowed to an individual as a credit under subsection (a) for all taxable years shall not exceed $1,000.(c)Portion of credit refundableFor purposes of this section—(1)In generalFor purposes of the Internal Revenue Code of 1986, in the case of an eligible individual—(A)Increase in credit rateSubsection (a) shall be applied by substituting $1 for every $1 contributed for $1 for every $3 contributed.(B)Credit refundableThe credit allowed under this section shall be treated in the same manner as a credit allowed under subpart C of part IV of subchapter A of chapter 1 of such Code.(2)Eligible individual(A)In generalThe term eligible individual means, with respect to any taxable year, a taxpayer whose household income for the taxable year does not exceeds 400 percent of an amount equal to the poverty line for a family of the size involved.(B)Married couples must file joint returnIf the taxpayer is married (within the meaning of section 7703 of such Code) at the close of the taxable year—(i)the taxpayer shall be treated as an eligible individual only if the taxpayer and the taxpayer’s spouse file a joint return for the taxable year, and(ii)paragraph (1) shall be applied separately to each spouse.(3)Family size, household income, modified adjusted gross income, poverty lineThe terms family size, household income, modified adjusted gross income, and poverty line have the meaning given such terms by section 36B(d) of such Code.(d)Denial of credit to dependentsNo credit shall be allowed under this section to any individual with respect to whom a deduction under section 151 is allowable to another taxpayer for a taxable year beginning in the calendar year in which such individual's taxable year begins.4.Alternative waiver for State innovation; cost-sharing reduction payments(a)Alternative waiver for State innovationSection 1332 of the Patient Protection and Affordable Care Act (42 U.S.C. 18052) is amended by adding at the end the following new subsection:(f)Alternative waiver for State innovation(1)In generalNotwithstanding any preceding provision of this section, a State may apply to the Secretary for the waiver of any requirement of subsection (a)(2) with respect to health insurance coverage within that State for plan years beginning on or after January 1, 2022, if instead of complying with section 1402 the State provides for the distribution of funding received under paragraph (2) to Medisave accounts of qualifying individuals with respect to such State. Such application shall be filed at such time and in such manner as the Secretary may require, and shall include such information as the Secretary may require (including a 10-year budget plan for such plan that is budget neutral for the Federal Government).(2)Pass-through fundingWith respect to a State waiver under paragraph (1), under which, due to the structure of such waiver, individuals in the State would not qualify for cost-sharing reductions under section 1402 for which they would otherwise be eligible, the Secretary shall provide for an alternative means by which an amount is transferred to the State equal to the aggregate amount of such reductions that would have been paid on behalf of the participants in the Exchanges established under this title—(A)had the State not received such waiver;(B)had references to eligible insureds under section 1402 referred to qualifying insureds (as defined in section 1332(f)); and(C)had, after application of clause (ii), in the case of a qualifying insured enrolled in the bronze level of coverage—(i)the percentages specified in subclauses (I), (II), and (III) of section 1402(c)(1)(B) were references to 84 percent, 77 percent, and 63 percent, respectively; and(ii)the references in subparagraphs (A), (B), and (C) of section 1402(c)(2) to 94 percent, 87 percent, and 73 percent, respectively, were references to 84 percent, 77 percent, and 63 percent, respectively.The amount transferred pursuant to the previous sentence shall be determined annually by the Secretary, taking into consideration the experience of other States with respect to participation in an Exchange and reductions provided under such provisions to residents of the other States, and shall be paid to the State for purposes of implementing such waiver. (3)Waiver consideration and transparencyThe provisions of paragraph (4) of subsection (a) shall apply to an application for a waiver under paragraph (1) in the same manner as such provisions apply with respect to an application for a waiver under subsection (a)(1), except that, for purposes of this paragraph, the provisions of subsection (a)(4)(B)(ii) shall not apply.(4)Determinations; term of waiverThe provisions of subsections (d) and (e) shall apply with respect to a determination with respect to an application under paragraph (1), and with respect to the term of a waiver under such paragraph, in the same manner as such provisions apply with respect to a determination with respect to an application under subsection (a)(1), and with respect to the term of a waiver under such subsection.(5)DefinitionsFor purposes of this subsection:(A)Medisave accountThe term Medisave account has the meaning given such term in section 530A(a) of the Internal Revenue Code of 1986.(B)Qualifying insuredThe term qualifying insured means, with respect to a State and a year, an individual—(i)who is enrolled in a Medisave account;(ii)who is enrolled for such year in a silver level or bronze level coverage offered through an Exchange; and(iii)whose household income is not less than 100 percent but not more than 250 percent of the Federal poverty line for a family of the size involved..(b)Conforming amendmentsSection 1332 of the Patient Protection and Affordable Care Act (42 U.S.C. 18052), as amended by subsection (a), is further amended in subsection (a)(4)—(1)in subparagraph (A) by striking the period and inserting , except in the case of a waiver described in subsection (f).; and(2)in subparagraph (B)(ii) by inserting after an application the following: (except in the case of a waiver described in subsection (f)).(c)Appropriation for cost-Sharing paymentsSection 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071) is amended by adding at the end the following new subsection:(g)Funding(1)AppropriationsOut of any funds in the Treasury not otherwise appropriated, there is appropriated such sums as may be necessary to, subject to paragraph (2), provide health benefits coverage through payment to issuers (under this section or through advance payment by the Secretary of the Treasury under section 1412(c)(3)) of the amounts computed under this section for each of plan years 2022 through 2026.(2)AdjustmentsNotwithstanding any other provision of law, payments and other actions for adjustments to obligations incurred prior to December 31, 2022, may be made through December 31, 2022.(3)LimitationAmounts appropriated under paragraph (1) for each of plan years 2022 through 2026 are subject to the requirements and limitations under sections 506 and 507 of division H of Public Law 115–31 in the same manner and to the same extent as if such amounts for each such year were appropriated under such division..5.Grants for Medisave assistance and outreach(a)In generalThe Administrator shall establish a grant program to provide assistance to eligible entities to carry out the activities described in subsection (c).(b)ApplicationAn eligible entity shall submit an application to the Administrator in such time and in such manner as the Administrator may require, providing that such application requires a demonstration of the existence of a relationship with, or the ability to establish a relationship with, an employer, employee, self-employed individual, or consumer eligible to enroll in a Medisave account.(c)Use of fundsAn eligible entity receiving a grant under this section shall use such funds to—(1)distribute fair and impartial information to consumers about Medisave accounts, including the availability of such accounts and how such accounts may be utilized;(2)conduct activities to raise public awareness of Medisave accounts;(3)facilitate enrollment in Medisave accounts; and(4)refer individuals enrolled in a Medisave account to the appropriate official, organization, or State agency for the purpose of addressing a complaint, grievance, or other question with respect to such Medisave account.(d)AmountThe Administrator may distribute up to $5,000,000 annually to be divided among grant recipients under this section.(e)ReportNot later than one year after the date on which the last of the grant periods awarded under this section ends, the Administrator shall submit a report to the Congress on the effectiveness of the grants provided under this section.(f)DefinitionsIn this section:(1)AdministratorThe term Administrator means the Administrator of the Centers for Medicare & Medicaid Services.(2)ConsumerThe term consumer means an individual enrolled in, or seeking to enroll in, a Medisave account.(3)Eligible entityThe term eligible entity includes the following:(A)A State.(B)Trade.(C)Industry.(D)Professional associations.(E)Commercial fishing industry organizations.(F)Ranching and farming organizations.(G)Community and consumer-focused nonprofit groups.(H)Chambers of commerce.(I)Unions.(J)Small business development centers (as defined in section 21 of the Small Business Act (15 U.S.C. 648)).(K)Other entities capable of carrying out the activities described under subsection (b).(4)Medisave accountThe term Medisave account has the meaning given such term in section 530A(a) of the Internal Revenue Code of 1986 (as added by section 2(a)).(5)StateThe term State means each of the several States, the District of Columbia, each territory and possession of the United States, and each federally recognized Indian Tribe.


		I
		112th CONGRESS
		1st Session
		H. R. 1606
		IN THE HOUSE OF REPRESENTATIVES

			April 15, 2011
			Mr. Engel (for
			 himself and Ms. Schakowsky) introduced
			 the following bill; which was referred to the
			 Committee on Energy and
			 Commerce

		A BILL
		To amend title XIX of the Social Security Act to require
		  States to provide oral health services to aged, blind, or disabled individuals
		  under the Medicaid Program, and for other purposes.

		1.Short title;
			 findings
			(a)Short
			 titleThis Act may be cited as the Special Care Dentistry Act of
			 2011.
			(b)FindingsCongress
			 finds the following:
				(1)According to the
			 United States Surgeon General’s Report on Oral Health in America:
					(A)No less than a
			 silent epidemic of oral diseases is affecting our most vulnerable citizens,
			 including low income elderly, individuals with disabilities, and many members
			 of racial and ethnic minority groups.
					(B)Oral diseases and
			 conditions affect health and well-being throughout life. The burden of oral
			 problems is extensive and may be particularly severe in vulnerable
			 populations.
					(C)Oral diseases and
			 conditions are associated with other health problems. Associations between
			 chronic oral infections and other health problems, including diabetes, heart
			 disease, and adverse pregnancy outcomes have been reported.
					(2)Providing
			 appropriate and necessary oral health benefits under Medicaid to individuals
			 classified as aged, blind, or disabled would prevent unnecessary emergency room
			 visits, hospitalizations, and downstream health care costs, reducing Medicaid
			 spending.
				(3)While 28 percent
			 of the people enrolled in Medicaid are aged, blind, or disabled, the high cost
			 of medical expenditures for these populations consumes 72 percent of the total
			 Medicaid budget. This is not the case with dental benefits.
				(4)For the aged,
			 blind, or disabled, oral health services are deemed optional by
			 the Federal Government and most States provide little to no Medicaid coverage
			 for these services. Many of these vulnerable citizen’s mouths are infected with
			 no hope of receiving access to even basic dental care.
				(5)In 2003, adult
			 aged, blind, and disabled Medicaid recipients received basic oral health
			 services in only 6 States (Connecticut, New Jersey, New York, North Dakota,
			 Pennsylvania, and Wisconsin).
				(6)Appropriate and
			 necessary oral health services for adult aged, blind, and disabled people will
			 help reduce not only Medicaid costs for these populations, but also downstream
			 Medicare expenditures, which together total almost $600,000,000,000
			 annually.
				(7)Dental office
			 overhead averages over 65 percent. Unfortunately, Medicaid reimbursement rates
			 fall far short of covering these expenses.
				(8)Additional Federal
			 investment for the delivery of oral health services is needed to ensure
			 vulnerable adults receive oral health benefits.
				(9)Investments are
			 needed for an oral health initiative to reduce the profound disparities in oral
			 health by improving the health status of vulnerable populations to the level of
			 health status that is enjoyed by the majority of Americans.
				2.Requirement to
			 provide aged, blind, or disabled individuals with oral health services under
			 the Medicaid program
			(a)In
			 generalTitle XIX of the Social Security Act (42 U.S.C. 1396 et
			 seq.) is amended by inserting after section 1943 the following new
			 section:

					1944.Oral health services for aged, blind, or disabled
		  individuals(a)Services under a State
				adult dental program for aged, blind, or disabled individualsA State shall provide oral health coverage
				for aged, blind, or disabled individuals described in subsection (b) through a
				separate State adult dental program. The State shall demonstrate that the
				services and fees provided and program requirements under this section are at
				least equivalent to the services, fees, and requirements that are provided to
				children under this title and include age-appropriate services for such
				individuals, and that the services are provided at intervals to determine the
				existence of a suspected illness or condition consistent with reasonable
				standards of dental practice (taking into account the increased needs and oral
				health complexities of the population) as determined by the Secretary after
				consultation with national professional dental organizations.
						(b)Aged, blind, or
				disabled individuals describedFor purposes of subsection (a), an
				aged, blind, or disabled individual described in this subsection is an
				individual—
							(1)who is eligible
				for medical assistance under subclause (I) or (II) of section 1902(a)(10)(A)(i)
				(but only, in the case of subclause (I), with respect to an individual who is
				so eligible on the basis of receiving aid or assistance under any plan of the
				State approved under title I, X, XIV, or XVI); and
							(2)who would be
				considered an aged, blind, or disabled individual under section 1614 (without
				regard to whether the individual satisfies the income and resource requirements
				for receiving supplemental security income benefits under title XVI) and is
				otherwise eligible for medical assistance under the State plan or under a
				waiver of such plan.
							(c)TransportationThe
				State shall provide transportation for aged, blind, or disabled individuals
				described in subsection (b) to dental offices, hospitals, clinics, or other
				treatment centers for the provision of oral health services to the same extent
				that transportation is provided under the State plan for children eligible for
				medical
				assistance.
						.
			(b)Definition of
			 oral health services
				(1)In
			 generalSection 1905 of the Social Security Act (42 U.S.C. 1396d)
			 is amended—
					(A)in subsection (a),
			 by amending paragraph (10) to read as follows:

							(10)oral health services (as defined in
				subsection (ee)); and
							;
				and
					(B)by adding at the
			 end the following:

							(ee)(1)For purposes of this
				title, the term oral health services means—
									(A)relief of pain and infections;
									(B)restoration or replacement of
				teeth;
									(C)periodontal treatment;
									(D)dental health preventive services,
				including adult fluoride application;
									(E)in-patient and out-patient dental
				surgical, evaluation, and examination services;
									(F)dentures or partial denture
				care;
									(G)per patient house call and long term
				care facility visits;
									(H)sedation and anesthesia; and
									(I)behavior management services.
									(2)For the purpose of this subsection:
									(A)The term long term care
				facility means—
										(i)a nursing facility;
										(ii)an assisted living facility or a
				resident care program facility (as such terms are defined by the
				Secretary);
										(iii)a board and care facility (as
				defined in section 1903(q)(4)(B), including a mental retardation group
				home);
										(iv)an intermediate care facility for
				the mentally retarded; and
										(v)any other facility that is licensed
				or certified by the State and is determined appropriate by the Secretary, such
				as a community mental health center that meets the requirements of section
				1913(c) of the Public Health Service Act, a psychiatric health facility, and a
				mental health rehabilitation center.
										(B)The term house call means
				the delivery of dental services in long term care facilities needed to overcome
				mobility impairments and transportation barriers.
									(C)The term behavior
				management means services needed to accommodate physical or behavioral
				impairment.
									.
					(c)Conforming
			 amendments
				(1)TerminologySection
			 1902(a)(43)(D)(iii) of the Social Security Act (42 U.S.C. 1396a(a)(43)(D)(iii))
			 is amended by striking dental and inserting oral
			 health each place it appears.
				(2)State
			 planSection 1902(a) of such Act (42 U.S.C. 1396a(a)) is
			 amended—
					(A)in paragraph (82),
			 by striking and at the end;
					(B)in paragraph (83),
			 by striking the period at the end and inserting ; and;
			 and
					(C)by inserting after
			 paragraph (83) the following:

							(84)provide for—
								(A)making oral health
				services available to aged, blind, or disabled individuals described in
				subsection (b) of section 1944 in accordance with the requirements of that
				section;
								(B)informing all
				persons in the State who are aged, blind, or disabled and have been determined
				to be eligible for medical assistance including oral health services (as
				defined in section 1905(ee)), of the availability of such services;
								(C)providing or
				arranging for the provision of such services in all cases where they are
				requested;
								(D)arranging for
				(directly or through referral to appropriate agencies, organizations, or
				individuals) corrective treatment the need for which is disclosed by such
				services; and
								(E)reporting to the
				Secretary (in a uniform form and manner established by the Secretary, by aged,
				blind, or disabled group and by basis of eligibility for medical assistance,
				and by not later than April 1 after the end of each fiscal year, beginning with
				fiscal year 2012) the information relating to oral health services provided
				under the plan during each fiscal year consisting of—
									(i)the number of
				aged, blind, or disabled individuals who reside in the State;
									(ii)the number of
				aged, blind, or disabled individuals provided oral health services;
									(iii)the number of
				such individuals referred for corrective treatment (the need for which is
				disclosed by such services);
									(iv)the amount of,
				and type of, preventive oral health services needed and provided;
									(v)the amount of, and
				type of, surgical restorative oral health services needed and provided;
				and
									(vi)the amount of,
				and type of, other oral health services needed and provided, disaggregated into
				whether the services were—
										(I)emergency;
										(II)preventive;
										(III)surgical;
										(IV)restorative;
										(V)periodontal;
										(VI)endodontic;
				or
										(VII)prosthodontic.
										.
					(3)Nursing
			 facilitiesSection 1919(b)(4)(A)(vi) of such Act (42 U.S.C.
			 1396r(b)(4)(A)(vi)) is amended by inserting, oral health services (as
			 defined in section 1905(ee)) for an aged, blind, or disabled individual
			 described in section 1944(b) who is a resident of the nursing facility,
			 after plan).
				(d)Federal funding
			 for cost of covering aged, blind, or disabledSection 1905 of the
			 Social Security Act (42 U.S.C. 1396d), as amended by subsection (b)(1), is
			 amended—
				(1)in subsection (b),
			 in the first sentence, by inserting “subsection (ee) and” before “section
			 1933(d)”; and
				(2)by adding at the
			 end the following new subsection:

						(ff)Increased FMAP
				for medical assistance for aged, blind, and disabled individualsThe Federal medical assistance percentage
				determined for a State that is one of the 50 States or the District of Columbia
				for each fiscal year with respect to amounts expended for medical assistance
				for aged, blind and disabled individuals described in section 1944(b) shall be
				equal to 100
				percent.
						.
				(e)Effective
			 date
				(1)In
			 generalExcept as provided in paragraph (2), the amendments made
			 by this section shall apply to calendar quarters beginning on or after October
			 1, 2011, without regard to whether or not final regulations to carry out such
			 amendments have been promulgated by such date.
				(2)Delay permitted
			 for State plan amendmentIn the case of a State plan for medical
			 assistance under title XIX of the Social Security Act which the Secretary of
			 Health and Human Services determines requires State legislation (other than
			 legislation appropriating funds) in order for the plan to meet the additional
			 requirements imposed by the amendments made by this section, the State plan
			 shall not be regarded as failing to comply with the requirements of such title
			 solely on the basis of its failure to meet these additional requirements before
			 the first day of the first calendar quarter beginning after the close of the
			 first regular session of the State legislature that begins after the date of
			 enactment of this Act. For purposes of the previous sentence, in the case of a
			 State that has a 2-year legislative session, each year of such session shall be
			 deemed to be a separate regular session of the State legislature.


109 HR 1103 IH: Fuel Efficiency Truth in Advertising Act of 2005
U.S. House of Representatives
2005-03-03
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I
109th CONGRESS
1st Session
H. R. 1103
IN THE HOUSE OF REPRESENTATIVES

March 3, 2005
Mrs. Johnson of Connecticut (for herself, Mr. Holt, Mr. Ehlers, Mr. McDermott, Mr. Olver, Mr. Gilchrest, Mr. Foley, Mr. Inslee, Mr. Engel, Mr. Boehlert, Mr. Pallone, Mr. Markey, Mr. Sanders, Mrs. Davis of California, Mr. Shays, Mr. Castle, Mr. English of Pennsylvania, Mr. Grijalva, Mr. Case, Ms. DeLauro, Mr. Udall of Colorado, Mr. Lantos, Ms. DeGette, Mr. Moran of Virginia, and Mr. Van Hollen) introduced the following bill; which was referred to the Committee on Energy and Commerce

A BILL
To require accurate fuel economy testing procedures.

1.Short titleThis Act may be cited as the Fuel Efficiency Truth in Advertising Act of 2005.
2.FindingsCongress finds the following:
(1)Current method inaccurateThe Environmental Protection Agency’s current method for estimating fuel economy is flawed and does not take into account the changes in driving conditions that have taken place over the past 30 years. As a result, the Environmental Protection Agency’s tests overestimate fuel economy by up to 30 percent, and Environmental Protection Agency window sticker information overestimates fuel economy by 10 percent or more.
(2)Underestimating highway speedsThe Environmental Protection Agency highway cycle assumes an average speed of 48 mph and a top speed of 60 mph. Many State highway speed limits are set at or above 65 mph. Government data indicates that fuel economy can drop by 17 percent for modern vehicles that drive at 70 mph instead of 55 mph. Even at 65 mph, fuel economy can drop by nearly 10 percent compared to driving at 55 mph.
(3)Assuming very gentle acceleration and brakingThe maximum acceleration rate in the Environmental Protection Agency test cycles is 3.3 mph per second, about the same as going from zero to 60 mph in about 18 seconds. The average new car or truck can accelerate nearly twice as fast. While most consumers don’t use all the power in their vehicle, the Environmental Protection Agency data shows that people accelerate as fast as 15 mph per second, nearly 5 times the Environmental Protection Agency tests. In 1996 the Environmental Protection Agency established a new driving cycle (US06) that includes tougher acceleration and deceleration and higher speeds, but this cycle is not used for fuel economy purposes.
(4)Neglecting the wide range of outdoor temperatures experienced in the real worldThe Environmental Protection Agency tests are performed between 68 and 86 degrees Fahrenheit. Most States frequently experience weather conditions outside this range and fuel economy can be significantly affected as a result.
(5)Failing to reflect the use of air conditioningFuel economy tests are run with the air conditioning off, while over 99 percent of all cars and trucks come with air conditioning. In 1996 the Environmental Protection Agency established a new driving cycle (SC03) that included air conditioning, but this cycle is not used for fuel economy purposes.
(6)Overestimating trip lengthsThe Environmental Protection Act city test cycle is 7.5 miles long. The Environmental Protection Agency’s own data indicate that average trip lengths may be only 5 miles long, with typical trips as short as 2.5 miles. Shorter trips often mean lower fuel economy because the engine does not have time to warm up and operate efficiently.
(7)Fuel consumptionFuels used for engine certification tests are artificial in that they are highly refined, and not equivalent to the fuel consumed during the life of a vehicle. Use of reference diesel and gasoline fuels while desirable from the standpoint of engineering design, optimization, and test repeatability, understate emissions and overstate fuel economy experienced by a vehicle in actual use. Current technology that improves commercially available fuel at or near the point of use is excluded from consideration by engine manufacturers as original or optional equipment due to lack of need to represent engine performance on anything other than reference fuels. While allowing use of reference fuels for certification purposes, the Environmental Protection Agency should consider requiring manufacturers to post fuel economy realized on commercially available fuel.
3.Update testing proceduresThe Administrator of the Environmental Protection Agency shall update or revise test procedures, Subpart B-Fuel Economy Regulations for 1978 and Later Model Year Automobiles-Test Procedures 600.209–85 & 600.209–95, of the Code of Federal Regulations, CFR Part 600 (1995) Fuel Economy Regulations for 1977 and Later Model Year Automobiles to take into consideration higher speed limits, faster acceleration rates, variations in temperature, use of air conditioning, shorter city test cycle lengths and the use of other fuel depleting features.


		II
		111th CONGRESS
		1st Session
		S. 1239
		IN THE SENATE OF THE UNITED STATES

			June 11, 2009
			Mr. Bingaman (for
			 himself, Mr. Thune, and
			 Mrs. Gillibrand) introduced the following
			 bill; which was read twice and referred to the
			 Committee on Health, Education, Labor,
			 and Pensions

		A BILL
		To amend section 340B of the Public Health Service Act to
		  revise and expand the drug discount program under that section to improve the
		  provision of discounts on drug purchases for certain safety net
		  providers.

		1.Short
			 titleThis Act may be cited as
			 the 340B Program Improvement and
			 Integrity Act of 2009.
		2.Expanded
			 participation in Section 340b program
			(a)Expansion of
			 Covered Entities Receiving Discounted PricesSection 340B(a)(4)
			 of the Public Health Service Act (42 U.S.C. 256b(a)(4)) is amended by adding at
			 the end the following:

					(M)A children's
				hospital excluded from the Medicare prospective payment system pursuant to
				section 1886(d)(1)(B)(iii) of the Social Security Act which would meet the
				requirements of subparagraph (L), including the disproportionate share
				adjustment percentage requirement under clause (ii) of such subparagraph, if
				the hospital were a subsection (d) hospital as defined by section 1886(d)(1)(B)
				of the Social Security Act.
					(N)An entity that is
				a critical access hospital (as determined under section 1820(c)(2) of the
				Social Security Act), and that meets the requirements of subparagraph
				(L)(i).
					(O)An entity that is
				a rural referral center, as defined by section 1886(d)(5)(C)(i) of the Social
				Security Act, or a sole community hospital, as defined by section
				1886(d)(5)(C)(iii) of such Act, and that both meets the requirements of
				subparagraph (L)(i) and has a disproportionate share adjustment percentage
				equal to or greater than 8
				percent.
					.
			(b)Extension of
			 discounts to inpatient drugsSection 340B of the Public Health
			 Service Act (42 U.S.C. 256b) is amended—
				(1)in subsection
			 (a), by striking outpatient each place that such appears in
			 paragraphs (2), (5), (7), and (9); and
				(2)in subsection
			 (b)—
					(A)by striking
			 In this section and inserting the following:

							(A)In
				generalIn this section
							;
				and
					(B)by adding at the
			 end the following:

							(B)Covered
				drugIn this section, the term covered drug—
								(i)means a covered
				outpatient drug (as defined in section 1927(k)(2) of the Social Security Act);
				and
								(ii)includes,
				notwithstanding paragraph (3)(A) of such section 1927(k), a drug used in
				connection with an inpatient or outpatient service provided by a hospital
				described in subparagraph (L), (M), (N), or (O) of subsection (a)(4) that is
				enrolled to participate in the drug discount program under this section.
								(C)Purchasing
				arrangements for inpatient drugsThe Secretary shall ensure that
				a hospital described in subparagraph (L), (M), (N), or (O) of subsection (a)(4)
				that is enrolled to participate in the drug discount program under this section
				shall have multiple options for purchasing covered drugs for inpatients
				including by utilizing a group purchasing organization or other group
				purchasing arrangement, establishing and utilizing its own group purchasing
				program, purchasing directly from a manufacturer, and any other purchasing
				arrangements that the Secretary may deem appropriate to ensure access to drug
				discount pricing under this section for inpatient drugs taking into account the
				particular needs of small and rural
				hospitals.
							.
					(c)Prohibition on
			 Group Purchasing ArrangementsSection 340B(a) of the Public
			 Health Service Act (42 U.S.C. 256b(a)) is amended—
				(1)in paragraph
			 (4)(L)—
					(A)in clause (i), by
			 adding and at the end;
					(B)in clause (ii),
			 by striking ; and and inserting a period; and
					(C)by striking
			 clause (iii); and
					(2)in paragraph
			 (5)—
					(A)by redesignating
			 subparagraphs (C) and (D) as subparagraphs (D) and (E); respectively;
			 and
					(B)by inserting
			 after subparagraph (B), the following:

							(C)Prohibiting the
				use of group purchasing arrangements
								(i)In
				generalA hospital described in subparagraphs (L), (M), (N), or
				(O) of paragraph (4) shall not obtain covered outpatient drugs through a group
				purchasing organization or other group purchasing arrangement, except as
				permitted or provided for pursuant to clauses (ii) or (iii).
								(ii)Inpatient
				drugsClause (i) shall not apply to drugs purchased for inpatient
				use.
								(iii)ExceptionsThe
				Secretary shall establish reasonable exceptions to clause (i)—
									(I)with respect to a
				covered outpatient drug that is unavailable to be purchased through the program
				under this section due to a drug shortage problem, manufacturer noncompliance,
				or any other circumstance beyond the hospital's control;
									(II)to facilitate
				generic substitution when a generic covered outpatient drug is available at a
				lower price; or
									(III)to reduce in
				other ways the administrative burdens of managing both inventories of drugs
				subject to this section and inventories of drugs that are not subject to this
				section, so long as the exceptions do not create a duplicate discount problem
				in violation of subparagraph (A) or a diversion problem in violation of
				subparagraph
				(B).
									.
					(d)Medicaid
			 Credits on Inpatient DrugsSection 340B(a)(5) of the Public
			 Health Service Act (42 U.S.C. 256b(a)(5)) is amended by adding at the end the
			 following:

					(E)Medicaid
				creditsNot later than 90 days after the date of filing of the
				hospital's most recently filed Medicare cost report, the hospital shall issue a
				credit as determined by the Secretary to the State Medicaid program for
				inpatient covered drugs provided to Medicaid
				recipients.
					.
			(e)Integrity
			 improvementsSubsection (c) of section 340B of the Public Health
			 Service Act (42 U.S.C. 256b(c)) is amended to read as follows:

					(c)Improvements in
				program integrity
						(1)Manufacturer
				compliance
							(A)In
				generalFrom amounts appropriated under paragraph (4), the
				Secretary shall provide for improvements in compliance by manufacturers with
				the requirements of this section in order to prevent overcharges and other
				violations of the discounted pricing requirements specified in this
				section.
							(B)ImprovementsThe
				improvements described in subparagraph (A) shall include the following:
								(i)The development
				of a system to enable the Secretary to verify the accuracy of ceiling prices
				calculated by manufacturers under subsection (a)(1) and charged to covered
				entities, which shall include the following:
									(I)Developing and
				publishing through an appropriate policy or regulatory issuance, precisely
				defined standards and methodology for the calculation of ceiling prices under
				such subsection.
									(II)Comparing
				regularly the ceiling prices calculated by the Secretary with the quarterly
				pricing data that is reported by manufacturers to the Secretary.
									(III)Performing spot
				checks of sales transactions by covered entities.
									(IV)Inquiring into
				the cause of any pricing discrepancies that may be identified and either
				taking, or requiring manufacturers to take, such corrective action as is
				appropriate in response to such price discrepancies.
									(ii)The
				establishment of procedures for manufacturers to issue refunds to covered
				entities in the event that there is an overcharge by the manufacturers,
				including the following:
									(I)Providing the
				Secretary with an explanation of why and how the overcharge occurred, how the
				refunds will be calculated, and to whom the refunds will be issued.
									(II)Oversight by the
				Secretary to ensure that the refunds are issued accurately and within a
				reasonable period of time, both in routine instances of retroactive adjustment
				to relevant pricing data and exceptional circumstances such as erroneous or
				intentional overcharging for covered drugs.
									(iii)The provision
				of access through the Internet website of the Department of Health and Human
				Services to the applicable ceiling prices for covered drugs as calculated and
				verified by the Secretary in accordance with this section, in a manner (such as
				through the use of password protection) that limits such access to covered
				entities and adequately assures security and protection of privileged pricing
				data from unauthorized re-disclosure.
								(iv)The development
				of a mechanism by which—
									(I)rebates and other
				discounts provided by manufacturers to other purchasers subsequent to the sale
				of covered drugs to covered entities are reported to the Secretary; and
									(II)appropriate
				credits and refunds are issued to covered entities if such discounts or rebates
				have the effect of lowering the applicable ceiling price for the relevant
				quarter for the drugs involved.
									(v)Selective
				auditing of manufacturers and wholesalers to ensure the integrity of the drug
				discount program under this section.
								(vi)The imposition
				of sanctions in the form of civil monetary penalties, which—
									(I)shall be assessed
				according to standards established in regulations to be promulgated by the
				Secretary within 180 days of the date of enactment of the
				340B Program Improvement and Integrity Act of
				2009;
									(II)shall not exceed
				$5,000 for each instance of overcharging a covered entity that may have
				occurred; and
									(III)shall apply to
				any manufacturer with an agreement under this section that knowingly and
				intentionally charges a covered entity a price for purchase of a drug that
				exceeds the maximum applicable price under subsection (a)(1).
									(2)Covered entity
				compliance
							(A)In
				generalFrom amounts appropriated under paragraph (4), the
				Secretary shall provide for improvements in compliance by covered entities with
				the requirements of this section in order to prevent diversion and violations
				of the duplicate discount provision and other requirements specified under
				subsection (a)(5).
							(B)ImprovementsThe
				improvements described in subparagraph (A) shall include the following:
								(i)The development
				of procedures to enable and require covered entities to regularly update (at
				least annually) the information on the Internet website of the Department of
				Health and Human Services relating to this section.
								(ii)The development
				of a system for the Secretary to verify the accuracy of information regarding
				covered entities that is listed on the website described in clause (i).
								(iii)The development
				of more detailed guidance describing methodologies and options available to
				covered entities for billing covered drugs to State Medicaid agencies in a
				manner that avoids duplicate discounts pursuant to subsection (a)(5)(A).
								(iv)The
				establishment of a single, universal, and standardized identification system by
				which each covered entity site can be identified by manufacturers,
				distributors, covered entities, and the Secretary for purposes of facilitating
				the ordering, purchasing, and delivery of covered drugs under this section,
				including the processing of chargebacks for such drugs.
								(v)The imposition of
				sanctions, in appropriate cases as determined by the Secretary, additional to
				those to which covered entities are subject under subparagraph (a)(5)(E),
				through one or more of the following actions:
									(I)Where a covered
				entity knowingly and intentionally violates subparagraph (a)(5)(B), the covered
				entity shall be required to pay a monetary penalty to a manufacturer or
				manufacturers in the form of interest on sums for which the covered entity is
				found liable under paragraph (a)(5)(E), such interest to be compounded monthly
				and equal to the current short term interest rate as determined by the Federal
				Reserve for the time period for which the covered entity is liable.
									(II)Where the
				Secretary determines a violation of subparagraph (a)(5)(B) was systematic and
				egregious as well as knowing and intentional, removing the covered entity from
				the drug discount program under this section and disqualifying the entity from
				re-entry into such program for a reasonable period of time to be determined by
				the Secretary.
									(III)Referring
				matters to appropriate Federal authorities within the Food and Drug
				Administration, the Office of Inspector General of Department of Health and
				Human Services, or other Federal agencies for consideration of appropriate
				action under other Federal statutes, such as the Prescription Drug Marketing
				Act.
									(3)Administrative
				dispute resolution process
							(A)In
				generalNot later than 180 days after the date of enactment of
				the 340B Program Improvement and Integrity
				Act of 2009, the Secretary shall promulgate regulations to
				establish and implement an administrative process for the resolution of claims
				by covered entities that they have been overcharged for drugs purchased under
				this section, and claims by manufacturers, after the conduct of audits as
				authorized by subsection (a)(5)(D), of violations of subsections (a)(5)(A) or
				(a)(5)(B), including appropriate procedures for the provision of remedies and
				enforcement of determinations made pursuant to such process through mechanisms
				and sanctions described in paragraphs (1)(B) and (2)(B).
							(B)Deadline and
				proceduresRegulations promulgated by the Secretary under
				subparagraph (A) shall—
								(i)designate or
				establish a decision-making official or decision-making body within the
				Department of Health and Human Services to be responsible for reviewing and
				finally resolving claims by covered entities that they have been charged prices
				for covered drugs in excess of the ceiling price described in subsection
				(a)(1), and claims by manufacturers that violations of subsection (a)(5)(A) or
				(a)(5)(B) have occurred;
								(ii)establish such
				deadlines and procedures as may be necessary to ensure that claims shall be
				resolved fairly, efficiently, and expeditiously;
								(iii)establish
				procedures by which a covered entity may discover and obtain such information
				and documents from manufacturers and third parties as may be relevant to
				demonstrate the merits of a claim that charges for a manufacturer's product
				have exceeded the applicable ceiling price under this section, and may submit
				such documents and information to the administrative official or body
				responsible for adjudicating such claim;
								(iv)require that a
				manufacturer conduct an audit of a covered entity pursuant to subsection
				(a)(5)(D) as a prerequisite to initiating administrative dispute resolution
				proceedings against a covered entity;
								(v)permit the
				official or body designated under clause (i), at the request of a manufacturer
				or manufacturers, to consolidate claims brought by more than one manufacturer
				against the same covered entity where, in the judgment of such official or
				body, consolidation is appropriate and consistent with the goals of fairness
				and economy of resources; and
								(vi)include
				provisions and procedures to permit multiple covered entities to jointly assert
				claims of overcharges by the same manufacturer for the same drug or drugs in
				one administrative proceeding, and permit such claims to be asserted on behalf
				of covered entities by associations or organizations representing the interests
				of such covered entities and of which the covered entities are members.
								(C)Finality of
				administrative resolutionThe administrative resolution of a
				claim or claims under the regulations promulgated under subparagraph (A) shall
				be a final agency decision and shall be binding upon the parties involved,
				unless invalidated by an order of a court of competent jurisdiction.
							(4)Authorization
				of appropriationsThere are authorized to be appropriated to
				carry out this subsection, such sums as may be necessary for fiscal year 2010,
				and each succeeding fiscal
				year.
						.
			(f)Conforming
			 amendments
				(1)Social Security
			 ActSection 1927 of the Social Security Act (42 U.S.C. 1396r–8),
			 is amended—
					(A)in subsection
			 (a)(5)—
						(i)in
			 subparagraph (A), by striking covered outpatient drugs and
			 inserting covered drugs (as defined in section 340B(b)(2) of the Public
			 Health Service Act);
						(ii)by
			 striking subparagraph (D); and
						(iii)by
			 redesignating subparagraph (E) as subparagraph (D);
						(B)in subsection
			 (c)(1)(C)(i), by redesignating subclauses (II) through (IV) as subclauses (III)
			 through (V), respectively and by inserting after subclause (I) the following
			 new subclause:

							(II)any prices
				charged for a covered drug (as defined in section 340B(b)(2) of the Public
				Health Service Act);
							;
				and
					(C)in subsection
			 (k)(1)—
						(i)in
			 subparagraph (A), by striking subparagraph (B) and inserting
			 subparagraphs (B) and (D); and
						(ii)by
			 adding at the end the following new subparagraph:

								(D)Calculation for
				covered drugsWith respect to a covered drug (as defined in
				section 340B(b)(2) of the Public Health Service Act), the average manufacturer
				price shall be determined in accordance with subparagraph (A) except that, in
				the event a covered drug is not distributed to the retail pharmacy class of
				trade, it shall mean the average price paid to the manufacturer for the drug in
				the United States by wholesalers for drugs distributed to the acute care class
				of trade, after deducting customary prompt pay discounts. The Secretary shall
				establish a mechanism for collecting the necessary data for the acute care
				class of trade from
				manufacturers.
								.
						(2)Public Health
			 Service ActSection 340B(a) of such Act (42 U.S.C. 256b(a)) is
			 amended—
					(A)in subsection
			 (a)(1), by adding at the end the following: Each such agreement shall
			 require that the manufacturer furnish the Secretary with reports, on a
			 quarterly basis, of the price for each covered drug subject to the agreement
			 that, according to the manufacturer, represents the maximum price that covered
			 entities may permissibly be required to pay for the drug (referred to in this
			 section as the ceiling price), and shall require that the
			 manufacturer offer each covered entity covered drugs for purchase at or below
			 the applicable ceiling price if such drug is made available to any other
			 purchaser at any price.; and
					(B)in the first
			 sentence of subsection (a)(5)(E), as so redesignated by subsection (c)(2), by
			 inserting after an audit as described in subparagraph (D), and
			 after finds,.
					3.Effective
			 dates
			(a)In
			 generalThe amendments made by this Act shall take effect on
			 January 1, 2010, and shall apply to drugs purchased on or after January 1,
			 2010.
			(b)EffectivenessThe
			 amendments made by this Act shall be effective, and shall be taken into account
			 in determining whether a manufacturer is deemed to meet the requirements of
			 section 340B(a) of the Public Health Service Act (42 U.S.C. 256b(a)) and of
			 section 1927(a)(5) of the Social Security Act (42 U.S.C. 1396r–8(a)(5)),
			 notwithstanding any other provision of law.


I
108th CONGRESS 2d Session
H. R. 5113
IN THE HOUSE OF REPRESENTATIVES

September 21, 2004
Mr. Kildee (for himself, Mr. Van Hollen, and Mr. George Miller of California) introduced the following bill; which was referred to the Committee on Education and the Workforce

A BILL
To prevent abuse of the special allowance subsidies under the Federal Family Education Loan Program.

1.Short titleThis Act may be cited as the Emergency Loan Abuse Prevention Act of 2004.
2.Termination of excessive allowancesSection 438(b)(2)(B) of the Higher Education Act of 1965 (20 U.S.C. 1087–1(b)(2)(B)) is amended by adding at the end the following new clause:

(v)This subparagraph shall not apply to—
(I)any loan made or purchased after the date of enactment of the Emergency Loan Abuse Prevention Act of 2004; or
(II)any loan made or purchased before such date of enactment with funds described in the first or second sentence of clause (i) if—
(aa)the obligation described in the first such sentence has, after such date of enactment, matured, or been retired or defeased; or
(bb)the maturity date, the date of defeasement, or the date of retirement of the obligation described in the first such sentence has, after such date of enactment, been extended. .
3.Expenditure of savings on increased Pell grantsFrom any amounts in the Treasury not otherwise appropriated, there is appropriated for each of the fiscal years beginning after the date of enactment of this Act an additional amount for the purposes of increasing the maximum Pell grant in each Act providing annual appropriations for the Pell grant program under subpart 1 of part A of title IV of the Higher Education Act of 1965 (20 U.S.C. 1070a) that is equal to the amount that is determined annually by the Congressional Budget Office to be the amount by which expenditures under section 438 of such Act (20 U.S.C. 1087–1) are reduced for such fiscal year by the enactment of section 2 of this Act.


		II
		110th CONGRESS
		2d Session
		S. 3510
		IN THE SENATE OF THE UNITED STATES

			September 17, 2008
			Mr. Bunning introduced
			 the following bill; which was read twice and referred to the
			 Committee on Banking, Housing, and Urban
			 Affairs

		A BILL
		To prohibit the Board of Governors of the Federal Reserve
		  System from making funds available at a discount rate to private individuals,
		  partnerships, and corporations.

		1.Repeal of discount authority
			 for private firmsSection 13
			 of the Federal Reserve Act (12 U.S.C. 343) is amended by striking the third
			 undesignated paragraph (relating to discounts for individuals, partnerships,
			 and corporations).


116 HR 3050 : Expanding Investment in Small Businesses Act
U.S. House of Representatives
2019-07-10
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

		IIB
		116th CONGRESS1st Session
		H. R. 3050
		IN THE SENATE OF THE UNITED STATES
		July 10, 2019 Received; read twice and referred to the Committee on Banking, Housing, and Urban AffairsAN ACT
		To require the Securities and Exchange Commission to carry out a study of the 10 per centum
			 threshold limitation applicable to the definition of a diversified company
			 under the Investment Company Act of 1940, and for other purposes.

 1.Short titleThis Act may be cited as the Expanding Investment in Small Businesses Act of 2019. 2.SEC study (a)In generalThe Securities and Exchange Commission shall carry out a study of the 10 per centum threshold limitation applicable to the definition of a diversified company under section 5(b)(1) of the Investment Company Act of 1940 (15 U.S.C. 80a–5(b)(1)) and determine the impacts of such threshold limits upon the protection of investors, efficiency, competition, and capital formation.
 (b)ConsiderationsIn carrying out the study required under subsection (a), the Commission shall consider the following:
 (1)The size and number of diversified companies that are currently restricted in their ability to own more than 10 percent of the voting shares in an individual company.
 (2)How the investing preferences of diversified companies have shifted over time with respect to companies with smaller market capitalizations and companies in industries where competition may be limited.
 (3)The expected impact to small and emerging growth companies regarding the availability of capital, related impacts on investor confidence and risk, and impacts on competition, if the threshold is increased or otherwise changed.
 (4)The ability of registered funds to manage liquidity risk. (5)Any other consideration that the Commission considers necessary and appropriate for the protection of investors.
 (c)Solicitation of public commentsIn carrying out the study required under subsection (a), the Commission may solicit public comments.
 (d)ReportNot later than the end of the 180-day period beginning on the date of enactment of this Act, the Commission shall issue a report to the Congress, and make such report publicly available on the website of the Commission, containing—
 (1)all findings and determinations made in carrying out the study required under subsection (a); and (2)any legislative recommendations of the Commission.

	Passed the House of Representatives July 9, 2019.Cheryl L. Johnson,Clerk


109 HR 4592 IH: Educational Immunity Act of 2005
U.S. House of Representatives
2005-12-16
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I
109th CONGRESS 1st Session
H. R. 4592
IN THE HOUSE OF REPRESENTATIVES

December 16, 2005
Mr. Gohmert introduced the following bill; which was referred to the Committee on the Judiciary

A BILL
To provide liability protection in Federal court for educators and school administrators, who are working within the scope of their employment, and for other purposes.

1.Short titleThis Act may be cited as the Educational Immunity Act of 2005.
2.Liability protection in Federal court for educators and school administrators
(a)In generalAn educator or school administrator in a pre-K–12 school is not liable, in Federal court, for damages of any nature or any other legal or equitable remedy, for any act or omission in the course and scope of that employment, except as provided in this section.
(b)ExceptionsThe liability protection in subsection (a) does not apply to—
(1)liability under a contract; or
(2)conduct punishable as a crime.
(c)Attorney fees and costsIf any teacher or school administrator is sued and the case is dismissed or no liability found against such teacher or administrator, the person immunized hereunder is entitled to be reimbursed for actual attorneys fees, all court related costs, fees and expenses, as well as out of pocket monies expended or lost arising out of or related to the litigation.
(d)DefinitionsIn this section:
(1)The term pre-K–12 school means a school, whether public or private, for one or more grades from pre-kindergarten through grade 12.
(2)The term educator includes a teacher, a teaching assistant, a guest lecturer, and a librarian.
(3)The term school administrator includes a principal, an assistant principal, a Superintendent, Assistant Superintendent, or their employees.
(4)The term employed includes work on an unpaid basis.


115 HR 5616 IH: Opioid Minority Health Report to Congress Act of 2018
U.S. House of Representatives
2018-04-25
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I
115th CONGRESS2d Session
H. R. 5616
IN THE HOUSE OF REPRESENTATIVES

April 25, 2018
Ms. Clarke of New York (for herself, Mr. Rush, Mr. Butterfield, and Ms. Kelly of Illinois) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

A BILL
To require the National Institute of Minority Health and Health Disparities to submit to Congress a report on the impact of the opioid epidemic on minority communities.

1.Short titleThis Act may be cited as the Opioid Minority Health Report to Congress Act of 2018.  2.National Institute of Minority Health and Health Disparities report on the impact of the opioid epidemic on minority communitiesNot later than one year after the date of the enactment of this Act, and annually thereafter, the National Institute of Minority Health and Health Disparities shall submit to the Committee on Finance of the Senate and the Committees on Ways and Means and Energy and Commerce of the House of Representatives, and make public on the Internet website of Department of Health and Human Services, a report on the impact of the opioid epidemic on racial and ethnic minority groups (as defined in section 1707(g) of the Public Health Service Act (42 U.S.C. 300u–6(g))), including the following:
(1)The scope of the epidemic within such racial and ethnic minority groups with respect to the use of prescription pain killers and illicit drug use, including synthetics. (2)The extent to which, and funding recommendations for how, the expansion of coverage under the Medicare program under title XVIII of the Social Security Act and the Medicaid program under title XIX of such Act of medication-assisted treatment and other treatment options could decrease the incidence of opioids use and of deaths caused by opioids overdoses.
(3)The role of participation of such racial and minority groups in clinical trials for pain management therapy and alternatives to opioids pain management and recommendations on how to increase such participation of such groups in such clinical trials.


116 HR 3765 IH: Citizens Count Census Act of 2019
U.S. House of Representatives
2019-07-16
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I116th CONGRESS1st SessionH. R. 3765IN THE HOUSE OF REPRESENTATIVESJuly 16, 2019Mr. Comer (for himself and Mr. Jordan) introduced the following bill; which was referred to the Committee on Oversight and ReformA BILLTo amend title 13, United States Code, to require that any questionnaire used for a decennial
			 census of population contains a question regarding citizenship, and for
			 other purposes.

 1.Short titleThis Act may be cited as the Citizens Count Census Act of 2019. 2.Citizenship status on census questionnairesSection 141 of title 13, United States Code, is amended—
 (1)by redesignating subsection (g) as subsection (h); and (2)by inserting after subsection (f) the following:

 (g)In conducting the 2020 decennial census and each decennial census thereafter, the Secretary shall include in any questionnaire distributed or otherwise used for the purpose of determining the total population by States a checkbox or other similar option for respondents to indicate whether the respondent is a citizen or national of the United States..


		I
		111th CONGRESS
		2d Session
		H. R. 4781
		IN THE HOUSE OF REPRESENTATIVES

			March 4, 2010
			Mr. Tiahrt introduced
			 the following bill; which was referred to the
			 Committee on Ways and
			 Means

		A BILL
		To amend the Internal Revenue Code of 1986 to reduce the
		  maximum corporate rate of tax to 22 percent.

		1.Short titleThis Act may be cited as the
			 Keeping American Businesses
			 Competitive Act of 2010.
		2.Reduction in
			 corporate marginal income tax rates
			(a)General
			 RuleParagraph (1) of section 11(b) of the Internal Revenue Code
			 of 1986 is amended—
				(1)by inserting
			 and at the end of subparagraph (A),
				(2)by striking
			 25 percent in subparagraph (B) and inserting 22
			 percent,
				(3)by striking
			 but does not exceed $75,000, in subparagraph (B) and inserting a
			 period,
				(4)by striking
			 subparagraphs (C) and (D), and
				(5)by striking the
			 last 2 sentences.
				(b)Personal Service
			 CorporationsParagraph (2) of section 11(b) of such Code is
			 amended by striking 35 percent and inserting 22
			 percent.
			(c)Conforming
			 AmendmentsParagraphs (1) and (2) of section 1445(e) of such Code
			 are each amended by striking 35 percent and inserting 22
			 percent.
			(d)Effective
			 DateThe amendments made by this section shall apply to taxable
			 years beginning after December 31, 2009, except that the amendments made by
			 subsection (c) shall take effect on the date of the enactment of this
			 Act.