Sponsor:

Rep. Kasich, John R. [R-OH-12] (Introduced 06/24/1997)

Summary:

Summary: H.R.2015 — 105th Congress (1997-1998)

There are 3 summaries for this bill. Line item veto by President (08/11/1997)Conference report filed in House (07/30/1997)Introduced in House (06/24/1997)     Bill summaries are authored by CRS. $("#summarySelector").congress_dropDownNavigation({ stubUrl: '/bill/105th-congress/house-bill/2015/summary', suffix: '' }); Shown Here:
Line item veto by President (08/11/1997) (On June 25, 1998, the Supreme Court ruled that the Line Item Veto Act (Public Law 104-130) is unconstitutional, thus restoring provisions that had been cancelled as summarized below.) (On August 11, 1997, the President line-item-vetoed Sec. 4722(c), which deemed to be permissible broad-based health care related taxes certain taxes, fees, or assessments collected by New York State from a health care provider before June 1, 1997, for which a specified waiver has been applied, or would be but for this provision. The provision would thus exempt such taxes, fees, or assessments from the requirement that provider-specific taxes be subtracted from the State share of Medicaid expenditures for purposes of Federal share calculation. The following revised digest of H.R. 2015 reflects the Act as signed into law, minus the line-item-vetoed provision. For more information on the specific items vetoed, see the text of the conference report for H.R. 2015, H.Rept. 105-217, and Presidential Cancellation Number 97-3.) TABLE OF CONTENTS: Title I: Food Stamp Provisions Title II: Housing and Related Provisions Title III: Communications and Spectrum Allocation Provisions Title IV: Medicare, Medicaid, and Children's Health Provisions Subtitle A: Medicare+Choice Program Subtitle B: Prevention Initiatives Subtitle C: Rural Initiatives Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity Subtitle E: Provisions Relating to Part A Only Subtitle F: Provisions Relating to Part B Only Subtitle G: Provisions Relating to Parts A and B Subtitle H: Medicaid Subtitle I: Programs of All-Inclusive Care for the Elderly (PACE) Subtitle J: State Children's Health Insurance Program Title V: Welfare and Related Provisions Subtitle A: TANF Block Grant Subtitle B: Supplemental Security Income Subtitle C: Child Support Enforcement Subtitle D: Restricting Welfare and Public Benefits for Aliens Subtitle E: Unemployment Compensation Subtitle F: Welfare Reform Technical Corrections Subtitle G: Miscellaneous Title VI: Education and Related Provisions Subtitle A: Higher Education Subtitle B: Repeal of Smith-Hughes Vocational Education Act Title VII: Civil Service Retirement and Related Provisions Title VIII: Veterans and Related Matters Subtitle A: Extension of Temporary Authorities Subtitle B: Copayments and Medical Care Cost Recovery Subtitle C: Other Matters Title IX: Asset Sales, User Fees, and Miscellaneous Provisions Subtitle A: Asset Sales Subtitle B: User Fees Subtitle C: Miscellaneous Provisions Title X: Budget Enforcement and Process Provisions Subtitle A: Amendments to the Congressional Budget and Impoundment Control Act of 1974 Subtitle B: Amendments to the Balanced Budget and Emergency Deficit Control Act of 1985 Title XI: District of Columbia Revitalization Subtitle A: District of Columbia Retirement Funds Subtitle B: Management Reform Plans Subtitle C: Criminal Justice Subtitle D: Privatization of Tax Collection and Administration Subtitle E: Financing of District of Columbia Accumulated Deficit Subtitle F: District of Columbia Bond Financing Improvements Subtitle G: District of Columbia Government Budget Subtitle H: Miscellaneous Provisions Balanced Budget Act of 1997 - Title I: Food Stamp Provisions - Amends the Food Stamp Act to define "caseload" and "covered individual." Authorizes State agencies to provide an additional 15 percent exemption from the food stamp program (program) work requirement for specified covered individuals. Provides for related caseload and exemption adjustments. (Sec. 1002) Obligates additional FY 1996 through 2002 funds for program employment and training programs. Sets forth State allocation provisions. (Sec. 1003) Requires State agencies, with assistance provided by the Secretary of Agriculture, to deny program benefits to prisoners incarcerated for more than 30 days. (Sec. 1004) Directs the Secretary to make specified funds available for FY 1998 through 2001 to eligible private nonprofit organizations and State agencies for nutrition education. Title II: Housing and Related Provisions - Amends the Balanced Budget Downpayment Act, I to extend permanently certain foreclosure avoidance provisions under the single family housing mortgage insurance program. (Sec. 203) Amends the United States Housing Act of 1937 with respect to the section 8 rental assistance program to make specified maximum monthly rent adjustment provisions for certain new and rehabilitated and nonturnover units applicable to FY 1999 and thereafter. Title III: Communications and Spectrum Allocation Provisions - Amends the Communications Act of 1934 (the Act) to make competitive bidding authority with respect to licenses or construction permits involving uses of the electromagnetic spectrum (spectrum) inapplicable to such licenses and permits issued by the Federal Communications Commission (FCC) that are for: (1) certain public safety radio services; (2) initial licenses or permits assigned to existing terrestrial broadcast licensees for digital television (TV) service; or (3) noncommercial educational or public broadcast stations. Requires the FCC to provide for the design and conduct of spectrum competitive bidding using a contingent combinatorial bidding system that permits prospective bidders to bid on combinations of licenses in a single bid and to enter multiple alternative bids within a single bidding round. Directs the FCC to prescribe methods by which a reasonable reserve price will be required, or a minimum bid will be established, to obtain any license or permit assigned under competitive bidding, unless determined not to be in the public interest. Repeals a requirement that any funds appropriated to the FCC for FY 1994 through 1998 for assigning licenses using random selection procedures be retained in the FCC's salaries and expenses account. Requires competitive bidding information to be included in annual FCC reports in order for any funds collected after FY 1998 to be retained in such account. Extends competitive bidding authority through FY 2008. Prohibits the FCC, after July 1, 1997, from issuing a license or construction permit for spectrum through a random selection system. Excepts from such prohibition licenses or permits for noncommercial educational or public broadcast stations. Provides for the applicability of competitive bidding requirements to pending comparative licensing cases. Makes available for assignment for commercial use the 1710 to 1755 megahertz (mhz) frequency band. Directs the FCC to assign licenses for such use by competitive bidding commenced after January 1, 2001. Directs the FCC to assign certain additional spectrum by competitive bidding no later than September 30, 2002. Directs the FCC to reallocate: (1) spectrum located at 2110 to 2150 mhz; and (2) 15 mhz located in the 1990 to 2110 range, with an exception in both cases when not in the public interest. Requires the FCC to notify the Secretary of Commerce if it is unable to provide for effective relocation of incumbent licensees to available bands of frequencies and has identified bands suitable for such relocation that are allocated for Federal use but could be reallocated pursuant to the National Telecommunications and Information Administration Organization Act (NTIA). Amends NTIA to direct the Secretary to report to the President, the FCC, and the Congress on recommendations for reallocating frequencies allocated for Federal use other than by Government licensees under the Communications Act of 1934. Authorizes any entity which operates a Government station to accept payment for frequency relocation expenses. Provides a relocation process triggered by a petition under NTIA. Allows a Federal entity to reclaim a former frequency if it demonstrates that relocated facilities or spectrum are not comparable to its former facilities or spectrum. Requires the Secretary to recommend for reallocation for use other than by Government stations a band of frequencies that: (1) in the aggregate span at least 20 mhz; (2) are located below three gigahertz; and (3) meet other relocation criteria. Directs the FCC to prepare and submit to the President and the Congress a plan for the immediate allocation and assignment of frequencies identified under this title. (Sec. 3003) Amends the Act to prohibit the renewal of a license authorizing analog TV services beyond the end of 2006, with an extension in specified circumstances. Prohibits the FCC, in prescribing regulations relating to qualifications of spectrum bidders, from: (1) precluding any party from being a qualified bidder for spectrum allocated for any use that includes digital TV service on the basis of the FCC's duopoly rule or newspaper cross-ownership rule; or (2) applying either rule to preclude a successful bidder from using such spectrum for digital TV service. (Sec. 3004) Directs the FCC, no later than January 1, 1998, to allocate from radio spectrum between 746 and 806 mhz: (1) 24 mhz for public safety services; and (2) the remainder for commercial purposes to be assigned by competitive bidding. Sets deadlines for the assignment of such licenses and the commencement of competitive bidding. Provides for the licensing of unused frequencies for public safety services. (Sec. 3005) Authorizes the FCC to allocate spectrum to provide flexibility of use, as long as such use is consistent with international agreements and upon a finding that such use is in the public interest and would not deter investment or result in harmful interference among users. (Sec. 3006) Authorizes appropriations to the FCC for FY 2001 for universal service support programs. (Sec. 3007) Directs the FCC to conduct all competitive bidding required under this title so that proceeds from such bidding are deposited no later than the end of FY 2002. (Sec. 3008) Requires seven days' public notice before the granting by the FCC of an application for spectrum frequency assignment under the Act. Title IV: Medicare, Medicaid, and Children's Health Provisions - Subtitle A: Medicare+Choice Program - Chapter 1: Medicare+Choice Program - Amends title XVIII (Medicare) of the Social Security Act (SSA) to establish a Medicare+Choice program under which each Medicare+Choice eligible individual (one entitled to benefits under Medicare part A (Hospital Insurance) and enrolled under Medicare part B (Supplementary Medical Insurance)) is entitled to elect, in accordance with certain procedures, to receive Medicare benefits either through the original Medicare fee-for-service program or through a Medicare+Choice plan. (Sec. 4001) Outlines the types of Medicare+Choice plans that may be available, namely: (1) coordinated care plans; (2) combination of a medical savings account (MSA) plan and contributions into a Medicare+Choice MSA; and (3) private fee-for-service plans. Sets forth various special rules regarding, among other things, residence, individuals with end-stage renal disease, and individuals covered under the Federal Employees Health Benefits Program or eligible for veterans' or military health benefits. Directs the Secretary of Health and Human Services (HHS) to: (1) provide for broad dissemination of coverage option and comparison information to Medicare beneficiaries and prospective Medicare beneficiaries; and (2) maintain a toll-free number for inquiries about Medicare+Choice options and program operation, as well as an Internet site through which individuals may obtain such information electronically. Requires: (1) any Medicare+Choice organization to accept without restrictions individuals eligible to make an election at any time during which such elections are accepted; and (2) approval of Medicare+Choice marketing material and application forms before they are distributed. Provides for continuous open enrollment and disenrollment through 2001, the first six months of 2002, and the first three months of every subsequent year, limiting an individual's change of enrollment during such initial period to one. Provides for an annual, coordinated election period during November for all participants as well as special election periods in certain circumstances. Outlines benefits and beneficiary protections. Requires each Medicare+Choice plan (except MSA plans) to provide those items and services for which benefits are available under Medicare parts A and B (other than hospice care) and specified additional benefits, as well, at its option, as certain supplemental benefits, subject to the Secretary's approval. Excludes individuals enrolled under a MSA plan from participating in such supplemental package. Prohibits a Medicare+Choice organization from denying, limiting, or conditioning coverage or benefits based on any described health status-related factor. Prescribes plan disclosure requirements and an ongoing quality assurance program. Outlines a mechanism for grievances and appeals. Sets forth certain payment rules for providers not participating in the Medicare+Choice program. Directs the Secretary to make monthly advance payments with respect to an individual's coverage to Medicare+Choice organizations according to a specified formula. Requires the Secretary to establish separate payment rates for individuals with end-stage renal disease. Sets forth special rules for individuals electing MSA plans. Requires such an individual to establish a Medicare+Choice MSA into which the Secretary shall make monthly deposits out of the Medicare trust funds in accordance with prescribed guidelines. Prescribes special rules for hospice care. Details rules for the submission and charging of premiums by each Medicare+Choice organization. Sets limitations on enrollee liability for basic, additional, and supplemental benefits. Prescribes a special rule for private fee-for-service plans. Prohibits a State from imposing a premium tax or similar tax with respect to payments to Medicare+Choice organizations. Sets out organizational and financial requirements for Medicare+Choice organizations and provider-sponsored organizations. Directs the Secretary to establish solvency and capital adequacy standards for provider-sponsored organizations, and other standards for Medicare+Choice organizations. Prescribes requirements, including minimum enrollment requirements, for contracts between the Secretary and Medicare+Choice organizations. Provides for: (1) intermediate sanctions and civil monetary penalties to enforce contract provisions; and (2) procedures for termination of contracts. (Sec. 4002) Details transitional rules for the current Medicare health maintenance organization (HMO) program, as well as specified conforming changes in the Medicare supplemental health insurance policy (Medigap) program. (Sec. 4006) Amends the Internal Revenue Code to outline special rules for Medicare+Choice MSAs. Excludes from gross income any payment by the Secretary to an individual's Medicare+Choice MSA. Excludes from qualified deductible medical expenses any amounts paid for the medical care of any individual but the account holder. Prescribes a penalty for distributions from the Medicare+Choice MSA not used for qualified medical expenses if the minimum balance is not maintained, with certain exceptions if the account holder becomes disabled or dies. Chapter 2: Demonstrations - Directs the Secretary to establish a Medicare prepaid competitive pricing demonstration project in up to four (eventually seven) designated Medicare payment areas, of which initially three shall be in urban areas and one in a rural area. (Sec. 4012) Directs the Secretary to appoint a Competitive Pricing Advisory Committee to recommend areas for the demonstration and research design for project implementation. (Sec. 4014) Amends the Omnibus Budget Reconciliation Act of 1987 to extend the authorities for the social health maintenance organization (SHMO) demonstration project. Amends the Omnibus Budget Reconciliation Act of 1993 to increase the cap on the number of individuals who may participate in a SHMO demonstration. Directs the Secretary to submit to the Congress a plan for the integration of SHMO health plans and similar plans as an option under the Medicare+Choice program. (Sec. 4015) Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a demonstration (subvention) project under which the HHS Secretary shall reimburse the Secretary of Veterans Affairs from the Medicare trust funds for Medicare health care services furnished to certain targeted Medicare-eligible military retirees or dependents. Authorizes the Secretary of Defense to modify existing TRICARE contracts in order to provide Medicare health care services to project participants. (Sec. 4016) Directs the Secretary to conduct demonstration projects in a certain number of rural and urban areas for the purpose of evaluating methods, such as case management and other models of coordinated care, that improve the quality of items and services provided to target individuals, and reduce Medicare expenditures for such items and services. Defines a target individual as an individual with a chronic illness who is enrolled under the Medicare parts A and B fee-for-service program. Provides for project funding. (Sec. 4017) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to direct the Secretary to work with each municipal health service demonstration project to develop a plan for the orderly transition of such projects and project participants to a non-demonstration project health care delivery system, such as through integration with a private or public health care plan, including a Medicaid managed care or Medicare+Choice plan. (Sec. 4018) Directs the Secretary to implement a time-limited demonstration project for the purpose of evaluating the use of a third-party contractor to conduct the Medicare+Choice plan enrollment and disenrollment functions in an area. (Sec. 4019) Extends for an additional two years certain Medicare community nursing organization demonstration projects under the Omnibus Budget Reconciliation Act of 1987. Chapter 3: Commissions - Establishes the National Bipartisan Commission on the Future of Medicare to: (1) review and analyze the long-term financial condition of the Medicare program; (2) identify problems that threaten the financial integrity of the Medicare trust funds, including the extent to which current Medicare update indexes do not accurately reflect inflation; and (3) analyze potential solutions to the problems identified that will ensure both the financial integrity of Medicare and the provision of appropriate benefits. Requires the Commission to make recommendations: (1) to restore the solvency of the Federal Hospital Insurance Trust Fund and the financial integrity of the Federal Supplementary Medical Insurance Trust Fund; and (2) to establish the appropriate financial structure of the Medicare program as a whole and the appropriate balance of benefits covered and beneficiary contributions. Requires recommendations on: (1) the financing of graduate medical education; (2) the feasibility of allowing individuals between age 62 and the Medicare eligibility age to buy into the Medicare program; and (3) the impact of chronic disease and disability trends on future costs and quality of services under the current benefit, financing, and delivery system structure of the Medicare program. Requires a report to the President and the Congress. Authorizes appropriations. (Sec. 4022) Establishes the Medicare Payment Advisory Commission to replace the Prospective Payment Assessment Commission and the Physician Payment Review Commission, hereby abolished. Requires the new Commission to review and make recommendations to the Congress about payment policies under Medicare (including certain specific payment-related topics). Authorizes appropriations. Chapter 4: Medigap Protections - Amends SSA title XVIII with respect to the issuer of a Medicare supplemental (Medigap) policy in the case of certain individuals terminated by an employee welfare benefit plan providing supplementary health benefits who seek to enroll under a Medigap policy not later than 63 days after termination or disenrollment. Prohibits the Medigap issuer from: (1) denying or conditioning the issuance or effectiveness of such a policy; (2) discriminating in the pricing of such policy because of health status, claims experience, receipt of health care, or medical condition; or (3) imposing an exclusion of benefits based on a pre-existing condition. (Sec. 4031) Specifies limitations on the imposition of preexisting condition exclusions during the initial open enrollment period in the case of a Medicare supplemental policy issued to an individual who is age 65 or older with a certain minimum period of creditable coverage. (Sec. 4032) Creates under the Medicare supplemental policy program a high deductible feature which requires the policy beneficiary to pay annual out-of-pocket expenses (other than premiums) of $1,500 (indexed for inflation) before the policy begins payment of benefits. Chapter 5: Tax Treatment of Hospitals Participating in Provider- Sponsored Organizations - Amends the Internal Revenue Code to provide that an organization shall not fail to be treated as a tax-exempt charitable organization solely because a hospital which it owns and operates also participates in a provider-sponsored organization, whether or not the provider-sponsored organization is exempt from tax. Provides that any person with a material financial interest in such a provider-sponsored organization shall be treated as a private shareholder or individual with respect to the hospital. Subtitle B: Prevention Initiatives - Outlines various specified new preventive health measures covered under Medicare, namely coverage for: (1) an annual screening mammography for women over age 39 and triennial screening pap smear and screening pelvic exam for any woman (annually for a woman with cervical or vaginal cancer or other abnormality, or who is at high risk of developing such a cancer), while providing for a waiver of deductible; (2) annual prostate cancer screening tests; (3) colorectal cancer screening tests, subject to prescribed frequency and payment limits; (4) diabetes outpatient self-management training services, including blood-testing strips (with a ten percent payment reduction after 1997) and glucose monitors as durable medical equipment (DME) for individuals with diabetes; and (5) bone mass measurements for qualified individuals. (Sec. 4105) Directs the Secretary to establish outcome measures, including glysolated hemoglobin (past 90-day average blood sugar levels), for the purpose of evaluating the improvement of health status of Medicare beneficiaries with diabetes mellitus, with a view to recommending coverage modifications. (Sec. 4107) Extends through FY 2002 the Influenza and Pneumococcal Vaccination Campaign of the Health Care Financing Administration (HCFA). Authorizes appropriations. (Sec. 4108) Directs the Secretary to request the National Academy of Sciences to analyze (for a report to specified congressional committees) the expansion or modification of Medicare preventive benefits to include medical nutrition therapy services by a registered dietitian, skin cancer screening, medically necessary dental care, and other specified items. Subtitle C: Rural Initiatives - Replaces the Essential Access Community Hospital Program with an optional Medicare Rural Hospital Flexibility Program under which participating States shall develop at least one rural health network in the State and at least one facility designated as a critical access hospital in accordance with prescribed guidelines. Authorizes the Secretary to award grants to States for: (1) planning and implementation of the program; and (2) establishment or expansion of rural emergency medical services. Authorizes appropriations. Directs the HCFA Administrator to report to the Congress on the feasibility of, and administrative requirements necessary to establish, an alternative for certain medical diagnoses to the current 96-hour limitation for inpatient care in critical access hospitals. (Sec. 4202) Amends SSA title XVIII to prohibit denial, on the basis of wage comparisons, of a rural referral center's request for reclassification. Provides that any hospital classified as a rural referral center for FY 1991 shall be classified as such for FY 1998 and each subsequent fiscal year. (Sec. 4204) Extends through FY 2001 the special treatment of payment methodology and target amount for Medicare-dependent, small rural hospitals. (Sec. 4205) Amends requirements for rural health clinic services with respect to: (1) per-visit payment limits for provider-based clinics; (2) mandatory quality assessment and performance improvement programs; (3) limitation of waivers of certain staffing requirements to clinics participating in the rural health clinic program; (4) the insufficiency of needed health care practitioners in shortage areas; and (5) regulations providing for payment for certain physician assistant services. (Sec. 4206) Directs the Secretary to make payments from the Federal Supplementary Medical Insurance Trust Fund under Medicare part B in accordance with a specified payment methodology for professional consultation via telecommunications systems with a physician or practitioner furnishing a service for which payment may be made to a Medicare beneficiary residing in a rural health professional shortage area, notwithstanding that the individual physician or practitioner providing the professional consultation is not at the same location as the physician or practitioner furnishing the service to that beneficiary. Directs the Secretary to report to the Congress: (1) a detailed analysis of telemedicine and telehealth (T&T) services; and (2) an examination of the possibility of making similar payments for professional consultation via telecommunications systems to Medicare beneficiaries who do not reside in a rural health professional shortage area, are homebound or nursing homebound, and for whom being transferred for health care services imposes a serious hardship. (Sec. 4207) Directs the Secretary to conduct a demonstration project to use eligible health care provider telemedicine networks to apply high-capacity computing and advanced networks to improve primary care and prevent health care complications to Medicare beneficiaries with diabetes mellitus who reside in medically underserved rural or inner-city areas. Provides funding. Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity - Chapter 1: Revisions to Sanctions for Fraud and Abuse - Amends SSA title XI, with respect to health care related crimes, to exclude from the Medicare and State health care programs any person: (1) for ten years for one previous conviction for one or more offenses; and (2) permanently for two or more previous convictions of one or more offenses. (Sec. 4302) Authorizes the Secretary to refuse to enter into Medicare agreements with individuals or entities convicted of felonies for offenses determined inconsistent with the best interests of program beneficiaries. (Sec. 4303) Authorizes the Secretary to exclude from the Medicare program any entity with respect to which a sanctioned person with an ownership or control interest in it transfers such interest in anticipation of (or following) a conviction, assessment, or exclusion against the person, to an immediate family member or member of the household who continues to maintain such an interest. (Sec. 4304) Provides for the imposition of civil monetary penalties for: (1) any person who arranges or contracts with an individual or entity that the person knows or should know is excluded from participation in a Federal health care program; and (2) kickbacks. Chapter 2: Improvements in Protecting Program Integrity - Amends SSA title XVIII to require the Secretary, in the annual notice of Medicare benefits, to urge beneficiaries to check the notice and any itemized statement for accuracy and report any errors or questionable charges by calling a certain toll-free number. Authorizes Medicare beneficiaries to submit written requests for itemized bills of medical or other items or services provided, and review them. Requires the Secretary to take measures to recover amounts unnecessarily paid out. (Sec. 4312) Outlines various specified requirements regarding disclosure of information and surety bonds with regard to DME suppliers. Includes surety bond requirements for home health agencies. Authorizes the Secretary to apply disclosure and surety bond requirements to other health care providers or item and service suppliers (except physicians or practitioners). Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORFs) and to rehabilitation agencies. (Sec. 4313) Requires any participating entity to disclose to the Secretary its own employer identification numbers and social security account numbers, as well as those of persons with ownership or control interests and subcontractors in which the entity has a five percent or greater interest. Directs the Secretary to report to Congress on the steps taken to assure the confidentiality of such social security account numbers. (Sec. 4314) Requires the Secretary, upon a party's request, to issue binding advisory opinions on whether a referral relating to designated health services (other than clinical laboratory services) is a prohibited physician self-referral. (Sec. 4315) Amends SSA title XVIII to: (1) replace the reasonable charge payment methodology with fee schedules developed by the Secretary for particular services; (2) provide for application of inherent reasonableness to charges for all Medicare part B services other than physicians' services; (3) require bills and requests for payment for services by non-physician practitioners to include diagnostic codes; (4) outline requirements to provide diagnostic information when ordering certain items or services furnished by another entity; (5) mandate establishment of competitive acquisition areas for contract award purposes for the furnishing under Medicare part B after 1997 of described items and services; and (6) prohibit payment under Medicare part A or part B for any expenses for an item or service furnished in a competitive acquisition area by an entity other than an entity with which the Secretary has contracted, except for urgent need, or in other circumstances specified by the Secretary. (Sec. 4320) Excludes from reasonable costs and declares unreimbursable under Medicare any payments for certain items unrelated to patient care, including: (1) entertainment, gifts, or donations; (2) personal use of motor vehicles; (3) costs for fines and penalties resulting from violations of Federal, State, or local laws; and (4) education expenses for spouses or other dependents of service providers, their employees, or contractors. (Sec. 4321) Requires a Medicare hospital's discharge planning process to include information on the availability of home health services through certain individuals or entities. Requires a discharge plan: (1) not to specify or otherwise limit the qualified provider which may provide home health services; and (2) identify any entity to whom the individual is referred in which the hospital has a disclosable financial interest. Requires the service provider agreement to require disclosure of any financial interest a hospital has in any entity to which individuals are referred, or any entity has in the hospital, and related information. Chapter 3: Clarifications and Technical Changes - Makes technical amendments with respect to fraud and abuse. Subtitle E: Provisions Relating to Part A Only - Chapter 1: Payment of PPS Hospitals - Revises requirements for: (1) prospective payment system (PPS) hospital payment updates; (2) maintenance of savings from the temporary reduction in capital payments for prospective payment system (PPS) hospitals; (3) additional payments to any hospital with a disproportionate share of low-income patients (disproportionate share hospital (DSH)); (4) the sales price of a Medicare capital asset (book value); (5) elimination of indirect medical education (IME) and DSH payments attributable to outlier payments; (6) the base rate of payments to Puerto Rico hospitals; (7) payments to hospitals for certain discharges to post-acute care; (8) inclusion of Stanly County, North Carolina, in the large urban area of Charlotte-Gastonia-Rock Hill-North Carolina-South Carolina; and (9) the floor on wage area indexes. (Sec. 4409) Requires the Secretary to publish and use alternative guidelines under which certain disproportionately large hospitals qualify for geographic reclassification. Chapter 2: Payment of PPS-Exempt Hospitals - Revises requirements for the payment of PPS-exempt hospitals, including those for: (1) payment updates; (2) reductions to capital payments; (3) bonus and relief payments; (4) payment and the target amount for new providers; (5) treatment of certain long-term care hospitals located within other hospitals; (6) rebasing; (7) certain cancer hospitals; and (8) elimination of exemptions for certain hospitals. (Sec. 4421) Provides for a Medicare PPS for inpatient rehabilitation hospital services. (Sec. 4422) Directs the Secretary to submit to the Congress a legislative proposal for establishing a case-mix adjusted PPS for long-term care hospitals. Chapter 3: Payment for Skilled Nursing Facilities - Declares that updates to per diem limits, with respect to payments to skilled nursing facilities (SNFs), effective for FY 1998, shall be based on cost limits effective for FY 1997. (Sec. 4432) Mandates a PPS for SNF services along with consolidated billing for them. Directs the Secretary, in order to ensure that Medicare beneficiaries are furnished appropriate SNF services, to establish a thorough medical review process to examine the provisions of this section and their effect on the quality of covered SNF services furnished to Medicare beneficiaries. Chapter 4: Provisions Related to Hospice Services - Provides for update of payments for hospice services. Bases payment for home hospice care on the location where care is furnished. Revises the home hospice care benefit period. Provides for home hospice care coverage of any other items and services specified in a plan. Allows waiver of certain staffing requirements for hospice care programs in non-urbanized areas. Chapter 5: Other Payment Provisions - Requires reductions in payments for enrollee bad debt. Repeals the termination date to make a permanent extension of the hemophilia passthrough. Requires a certain reduction in the part A Medicare premium for specified public retirees. Authorizes Medicare and Medicaid coverage of inpatient hospital and post-hospital extended care services in religious nonmedical health care institutions (currently limited to Christian Science sanatoria). Subtitle F: Provisions Relating to Part B Only - Chapter 1: Services of Health Professionals - Revises requirements for the payment of physicians' services, with changes: (1) establishing a single conversion factor for 1998; (2) adding new update provisions; (3) replacing the volume performance standard with sustainable growth rate; (4) adding payment rules for anesthesia services; and (5) providing for adjustments in relative value units for 1998, and the application of resource-based methodology to malpractice relative value units. (Sec. 4505) Directs the Comptroller General to review and evaluate the proposed rule on resource-based methodology for practice expenses issued by the HCFA. (Sec. 4506) Directs the Secretary to determine for each hospital: (1) its hospital-specific per discharge relative value for physicians' services; and (2) whether such value is projected to be excessive. Requires the Secretary to notify the medical executive committee of a subset of the hospitals identified as having an excessive hospital-specific relative value, and evaluate their responses with the responses of other hospitals so identified that were not notified. (Sec. 4507) Amends SSA title XVIII to declare that nothing shall prohibit a physician or practitioner from privately contracting with a Medicare beneficiary for any item or service for which no Medicare claim will be submitted, and for which the physician or practitioner shall receive no Medicare reimbursement. (Sec. 4511) Increases Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. (Sec. 4513) Repeals the requirement of an X-ray for reimbursement for chiropractic services. Directs the Secretary to develop utilization guidelines for the coverage of chiropractic services where a subluxation has not been demonstrated by an X-ray. Chapter 2: Payment for Hospital Outpatient Department Services - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 4522) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 4523) Directs the Secretary to establish a PPS for hospital outpatient department services. Chapter 3: Ambulance Services - Provides for certain interim reductions in payments for ambulance services. Directs the Secretary to establish a prospective fee schedule for payment of such services. Provides that, in promulgating regulations for coverage of ambulance services, the Secretary may cover advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. (Sec. 4532) Directs the Secretary to establish up to three demonstration projects contracting with local governments for ambulance services paid for under Medicare. Chapter 4: Prospective Payment for Outpatient Rehabilitative Services - Provides for a PPS for outpatient physical (including speech-language pathology) and occupational therapy services. Chapter 5: Other Payment Provisions - Provides for a reduction in payment amounts for items of DME and for clinical diagnostic laboratory tests. Provides for a payment freeze for parenteral and enteral nutrients, supplies, and equipment. Revises update requirements for payment for orthotics and prosthetics, and other payment requirements for oxygen and oxygen equipment, ambulatory surgical services, and drugs and biologicals. (Sec. 4552) Requires the Comptroller General to study and report to specified congressional committees on access to home oxygen equipment. Requires the Secretary to arrange for peer review organizations to evaluate such access. (Sec. 4553) Directs the Secretary to request the National Academy of Sciences to study (for a report to specified congressional committees) Medicare payments for clinical laboratory tests. (Sec. 4554) Directs the Secretary to divide the United States into up to five regions, and designate a single carrier for each region, for the payment of Medicare part B claims for clinical diagnostic laboratory services. Requires the Secretary to adopt uniform policies for clinical diagnostic laboratory tests. (Sec. 4557) Provides for coverage of oral anti-nausea drugs under a chemotherapeutic regimen. (Sec. 4558) Requires the Secretary to: (1) audit cost reports of each renal dialysis provider at least once every three years; and (2) develop a method to measure and report on the quality of Medicare renal dialysis services. (Sec. 4559) Directs the Secretary, for electrocardiogram tests furnished during 1998, to restore separate part B payment for electrocardiogram transportation based upon methods in effect on December 31, 1996. Requires the Secretary, by a certain deadline, to recommend to specified congressional committees whether portable electrocardiogram transportation should be covered under Medicare part B. Chapter 6: Part B Premium and Related Provisions - Revises the formula for the monthly Medicare part B premium rate the Secretary promulgates each September for the following calendar year. Requires such rate to equal 50 percent of the monthly actuarial rate for enrollees age 65 and over for that succeeding calendar year. (Sec. 4581) Provides for a special Medicare enrollment period, with no premium penalty for late enrollment, for certain disabled workers whose continuous enrollment under an employer's group health plan is involuntarily terminated in certain circumstances. (Sec. 4582) Allows appropriate State or local governmental entities to elect to pay part B premiums for certain eligible individuals. Subtitle G: Provisions Relating to Parts A and B - Chapter 1: Home Health Services and Benefits - Provides that, in establishing payment limits for cost reporting periods beginning after September 30, 1997, the Secretary shall not take into account any changes in the home health market basket with respect to cost reporting periods which began on or after July 1, 1994, and before July 1, 1996. (Sec. 4602) Revises requirements for interim payments for home health services. Directs the Secretary to expand research on a PPS for home health agencies under the Medicare program that ties prospective payments to a unit of service. (Sec. 4603) Directs the Secretary to establish a PPS for home health services for cost reporting periods beginning in FY 2000. (Sec. 4604) Bases the payment for home health services on the location where the service is furnished. (Sec. 4611) Provides for a modification of the Medicare part A home health benefit for individuals enrolled under Medicare part B. Provides for specified post-institutional home health services. (Sec. 4613) Directs the Secretary to study and report to the Congress on the criteria that should be applied in determining whether an individual is homebound for purposes of qualifying for Medicare home health services. (Sec. 4614) Provides for the denial of home health claims based on home health services the frequency and duration of which are in excess of normative guidelines established by the Secretary. (Sec. 4615) Denies payment for home health benefits based solely on venipuncture to obtain a blood sample. (Sec. 4616) Directs the Secretary to estimate part A and part B outlays for FY 1998 through 2002 for specified congressional committees, and report annually a comparison of actual outlays with such estimates. Chapter 2: Graduate Medical Education - Revises requirements for direct and indirect Medicare payments for graduate medical education (GME). Limits the number of residents in allopathic and osteopathic medicine. Permits payment to qualified nonhospital providers for direct GME costs. Prohibits restandardization of certain indirect GME payment amounts. Requires the Secretary to provide for direct and indirect GME payments to hospitals for Medicare+Choice enrollees. Makes a special reimbursement rule for primary care combined residency programs, setting the period of board eligibility. (Sec. 4626) Provides for incentive payments to hospitals under plans for voluntary reduction in the number of full-time equivalent residents in an approved medical training program. (Sec. 4628) Directs the Secretary to establish a demonstration project under which GME payments shall be made to consortia of teaching hospitals and other medical entities. (Sec. 4629) Directs the Medicare Payment Advisory Commission to develop recommendations to the Congress on whether and to what extent Medicare payment policies and other Federal policies regarding teaching hospitals and GME should be changed. (Sec. 4630) Directs the Secretary to study and report to the appropriate congressional committees on variations among hospitals in the overhead and supervisory physician components of their direct medical education costs. Chapter 3: Provisions Relating to Medicare Secondary Payer - Revises requirements for Medicare as secondary payer. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Chapter 4: Other Provisions - Amends SSA title XVIII to require placement of an advance directive in a prominent part of the individual's current medical record. (Sec. 4642) Provides for an increased certification period for certain organ procurement organizations. (Sec. 4643) Establishes in the HCFA the position of Chief Actuary. Subtitle H: Medicaid - Chapter 1: Managed Care - Amends SSA title XIX (Medicaid) to establish a new part B (Managed Care) giving States the option to require Medicaid-eligible individuals (except Medicare beneficiaries, Medicare-eligible individuals, and certain children with special needs) to enroll in managed care arrangements of the individual's choice as a condition of receiving Medicaid. (Sec. 4702) Grants States the option of providing Medicaid coverage of primary care case management services without the need for a waiver. (Sec. 4703) Repeals the (75-25) requirement that Medicare and Medicaid beneficiaries constitute less than 75 percent of the membership of a participating HMO. Repeals the prohibition on co-payments for services furnished by HMOs. (Sec. 4704) Prescribes requirements for: (1) access to emergency care; (2) annual external independent review of managed care entity activities and other specified quality care assurance measures; and (3) fraud and abuse prohibitions and protections. (Sec. 4705) Amends SSA title XIX (Medicaid) to require any State contracting with Medicaid managed care organizations to develop and implement a quality assessment and improvement strategy incorporating certain access standards, monitoring procedures, and other measures. Directs the Comptroller General to analyze and report to specified congressional committees on the quality assurance programs and accreditation standards applicable to managed care entities operating in the private sector or under Medicare contracts to determine if such programs and standards consider the accessibility and quality of the health care items and services delivered under such contracts to low-income individuals. Directs the Secretary to study and report to such committees on safeguards that may be needed to ensure that the health care needs of individuals with special health care needs and chronic conditions who are enrolled with Medicaid managed care organizations are adequately met. (Sec. 4706) Requires an HMO to meet solvency standards established by the State for private HMOs, or be State-licensed or -certified as a risk-bearing entity. (Sec. 4708) Increases from $100,000 to $1 million, indexed annually, the threshold amount for HMO contracts requiring the Secretary's prior approval. Permits the same copayments in HMOs as in fee-for-service. Chapter 2: Flexibility in Payment of Providers - Repeals "Boren Amendment" provider reimbursement requirements. Requires the Secretary to study and report to the appropriate congressional committees on the effect on access to services, service quality, and service safety of the rate-setting methods used by States as a result of such repeal. (Sec. 4712) Specifies reductions from 100 percent to 70 percent between FY 1999 through 2003 in the percentage of reasonable costs that shall be paid under a State plan for federally-qualified health center and rural health clinic services (with a special supplemental payment for services furnished under certain managed care contracts). (Sec. 4713) Repeals payment rate requirements for obstetrical and pediatric services. (Sec. 4714) Revises requirements for Medicaid payment rates for qualified Medicare beneficiaries, placing a limitation on nonparticipating providers. (Sec. 4715) Declares that, in the case of a Medicaid-eligible veteran residing in a State veterans' home, any veterans' pension over $90 per month shall be counted as income only for the purpose of applying such excess payment to the State veterans' home's cost of providing nursing care to the veteran. Chapter 3: Federal Payments to States - Revises specified limitations of Federal payments for inpatient hospital services furnished by disproportionate share hospitals (DSH), including limitations on certain State DSH expenditures to institutions for mental diseases or other mental health facilities. Requires direct State Medicaid payment to hospitals for managed care enrollees. (Sec. 4722) Revises the treatment as broad-based health care related taxes of certain State hospital taxes which currently are not subtracted as revenues from the State share of Medicaid expenditures for purposes of calculating the Federal share of such expenditures. Declares that an exemption from such State hospital tax for certain Federal-tax-exempt hospitals that do not accept Medicaid or Medicare payments (provide free care) shall not disqualify the hospital tax as a broad-based health care related tax (thus allowing continued exclusion of such State hospital tax from the requirement that provider-specific taxes be subtracted from the State share of Medicaid expenditures for purposes of Federal share calculation). (Sec. 4723) Specifies additional funding for State emergency health services furnished to undocumented aliens. (Sec. 4724) Prohibits the expenditure of Medicaid funds for roads, bridges, stadiums, and other items and services not covered by a State plan. Requires home health agencies to provide a surety bond. Revises conflict-of-interest safeguards. Declares that States are not required to provide medical assistance for items or services furnished by a person or entity convicted of a felony for an offense inconsistent with the best interests of beneficiaries under the State plan. Requires State action for program and beneficiary protection against waste, fraud, and abuse. Conditions issuance or renewal of a DME supplier provider number on the supplier's provision of a surety bond and disclosure of all persons with ownership or control interests in the supplier, and of all subcontractors in which the supplier has a five percent or greater interest. (Sec. 4725) Provides for increased Federal medical assistance percentages (FMAPs) for the District of Columbia and Alaska and increased payment caps for the territories. Chapter 4: Eligibility - Grants States the option to provide for 12-month continuous Medicaid eligibility for children. (Sec. 4732) Requires State Medicaid plan coverage of the Medicare cost-sharing for certain additional low-income Medicare beneficiaries whose income otherwise disqualifies them for specified Medicare benefits. (Sec. 4733) Grants States the option to permit workers with disabilities to buy into Medicaid. (Sec. 4734) Prescribes criminal penalties for knowingly and willfully, for a fee, counseling or assisting an individual to dispose of assets (including transfer in trust) in order for that individual to become Medicaid-eligible (fraudulent eligibility). (Sec. 4735) Declares that certain payments in a class settlement of the case of Susan Walker v. Bayer Corporation shall not be considered income or resources in determining Medicaid eligibility. Chapter 5: Benefits - Changes from mandatory to discretionary a State's authority to enroll individuals under private group health plans and pay their premiums. (Sec. 4742) Repeals: (1) certain physician qualification requirements with respect to services to pregnant women and to children under age 21; and (2) the requirement of prior institutionalization with respect to habilitation services furnished under a waiver for home or community-based services. (Sec. 4744) Requires the Secretary to study and report to the Congress on early and periodic screening, diagnostic, and treatment benefits. Chapter 6: Administration and Miscellaneous - Repeals requirements for inspections of the care being provided at mental hospitals and intermediate care facilities for the mentally retarded (ICFS-MR). (Sec. 4752) Authorizes a State, in lieu of terminating a noncompliant ICFS-MR, to establish alternative remedies if the State demonstrates to the Secretary's satisfaction that such alternative remedies are effective in deterring noncompliance and correcting deficiencies. (Sec. 4753) Revises requirements for mechanized claims processing and information retrieval systems. (Sec. 4754) Repeals the requirement for State refund to the Federal Government of any payments received during remediation of a noncompliant nursing facility. (Sec. 4755) Requires States to establish procedures to permit a nurse aide, in the case of a finding of neglect, to petition the State for name removal from the nurse aide registry upon a State determination that: (1) the employment and personal history of the nurse aide does not reflect a pattern of abusive behavior or neglect; and (2) the neglect involved in the original finding was a singular occurrence. (Sec. 4756) Includes the DRUGDEX Information System among the compendia to be used in drug use review for Medicaid payment. (Sec. 4757) Applies certain requirements to the extension of statewide comprehensive research and demonstration projects for which waivers of Medicaid compliance have been granted. (Sec. 4758) Amends the Omnibus Budget Reconciliation Act of 1989 to extend the moratorium on the treatment of the Kent Community Hospital Complex and Saginaw Community Hospital in Michigan as institutions for mental diseases for purposes of Medicaid reimbursement. Subtitle I: Programs of All-Inclusive Care for the Elderly (PACE) - Amends SSA title XVIII to provide for Medicare programs of all-inclusive care for the elderly (PACE programs) for individuals age 55 or older who require the level of care required under the State Medicaid plan for coverage of nursing facility services. Specifies benefit and payment requirements. Limits PACE provider eligibility to public and private non-profit entities; but requires the Secretary to waive such limitations to demonstrate the operation of a PACE program by a private, for-profit entity. (Sec. 4802) Amends SSA title XIX to authorize a State to establish a Medicaid program of all-inclusive care for the elderly (PACE) for individuals who need not be eligible for Medicare part A benefits, or enrolled under Medicare part B. (Sec. 4804) Directs the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under Medicare and Medicaid, specifically comparing the costs, quality, and access to services by private, for-profit entities under the demonstration projects with the costs, quality, and access to services of other PACE providers. Subtitle J: State Children's Health Insurance Program - Chapter 1: State Children's Health Insurance Program - Amends SSA to add a new title XXI (State Children's Health Insurance Program) in order to provide funds to States to expand the provision of child health assistance to uninsured, low-income children. Requires a State to submit for the Secretary's approval a child health plan for the use of funds, containing strategic objectives, performance goals, and performance measures. Mandates coverage equivalent to benefits coverage in a benchmark benefit package, consisting of benefits offered by either: (1) the Federal Employees' Health Benefits Program (FEHBP); (2) a State employee health benefit plan; or (3) an HMO. Makes appropriations to carry out this title. Allows their use for abortion only if necessary to save the life of the mother or if the pregnancy results from rape or incest. Chapter 2: Expanded Coverage of Children Under Medicaid - Amends SSA title XIX to provide for an increased Medicaid FMAP for expanded coverage of targeted low-income children. (Sec. 4912) Authorizes an approved State plan to make Medicaid available to a low-income child during a specified presumptive eligibility period after determination that family income does not exceed a certain level. (Sec. 4913) Provides for continuation of Medicaid eligibility for disabled children who lose benefits under SSA title XVI (Supplemental Security Income) (SSI). Chapter 3: Diabetes Grant Programs - Amends the Public Health Service Act to direct the Secretary to make grants for services for the prevention and treatment of type I diabetes in children, and for research in innovative approaches to such services. Provides for funding. (Sec. 4922) Directs the Secretary to make grants for services for the prevention and treatment of type I diabetes in Indians through the Indian Health Service and tribal and urban Indian health programs. (Sec. 4923) Requires the Secretary to evaluate such programs and report to the Congress. Title V: Welfare and Related Provisions - Subtitle A: TANF Block Grant - Amends part A (Temporary Assistance for Needy Families) (TANF) of SSA title IV to establish a program of welfare-to-work grants to States. (Sec. 5001) Sets forth requirements relating to State entitlement to non-competitive formula grants under such program and State distribution of such funds among local governments. Authorizes State Governors to distribute up to 15 percent of such grant funds for projects to help long-term welfare recipients enter unsubsidized employment. Provides for competitive grants, based on program effectiveness and other factors, including the history of the applicant's success in moving individuals with multiple barriers into work, for State-approved projects proposed by private industry councils or local governments. Sets forth rules relating to required beneficiaries and targeting of individuals with characteristics associated with long-term welfare dependency. Authorizes use of grant funds to provide work-related services to individuals who have reached the five-year limit on assistance. Directs the Secretary of Labor to use certain set-aside funds to make grants to each successful performance State in FY 2000. Makes appropriations for FY 1998 and 1999 for grants. Sets forth requirements for: (1) nondisplacement of other workers by participants in work activities under this program; (2) applicable health and safety standards; and (3) grievance procedures with respect to alleged violations of such nondisplacement and health and safety requirements. Provides for such grants to outlying areas territories and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to develop a plan to evaluate the use of such grants. Sets forth penalties for: (1) failure of a State to maintain its historic effort during a year in which a welfare-to-work grant is received; and (2) misuse of competitive welfare-to-work grant funds. Declares that State sanctions against recipients for TANF program violations are not wage reductions. (Sec. 5002) Limits to not more than ten percent the portion of such welfare-to-work grant funds which a State may use to carry out State programs under SSA title XX block grants to States for social services. (Sec. 5003) Increases from 20 percent to 30 percent of individuals in all families and in two-parent families the limitation on the number of persons who may be treated as engaged in work by reason of participation in a vocational education program or, in the case of teen heads of household, maintenance of satisfactory school attendance. (Sec. 5004) Requires reduction of a State's welfare-to-work grant if a State fails to reduce assistance for recipients refusing work without good cause. Subtitle B: Supplemental Security Income - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRAWORA) to extend by six months the deadline for certain childhood disability redeterminations under SSA title XVI (Supplemental Security Income) (SSI). (Sec. 5102) Prescribes the schedule of administrative fees the Commissioner of Social Security shall assess each State from FY 1997 through 2003 and after for making optional and mandatory State SSI payments to individuals. Revises requirements for deposit of such fees, directing that a portion be credited to a special fund for FY 1998 and subsequent fiscal years for use in defraying expenses. Provides that the amounts so credited shall not be scored as receipts under the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act), but credited as a discretionary offset to discretionary spending. Authorizes appropriations. Subtitle C: Child Support Enforcement - Amends SSA title III (Unemployment Insurance) with respect to the authority to permit certain redisclosures of wage and claim information for purposes related to the child support enforcement program under SSA title IV part D (Child Support and Establishment of Paternity). Subtitle D: Restricting Welfare and Public Benefits for Aliens - Amends PRAWORA to make aliens eligible for SSI who, as of the date of enactment of such Act, were receiving such benefits, or were legally residing in the United States and are blind or disabled. Extends the SSI grandfather provision through September 30, 1998. (Sec. 5302) Extends from five to seven years the refugee and asylee eligibility period for SSI and Medicaid, and includes Cuban and Haitian entrants within such category. Provides a five-year food stamp eligibility period for such aliens. Includes Cuban and Haitian entrants within the definition of "qualified alien" for purposes of welfare and public benefits. Exempts such aliens from specified periods of ineligibility for State and Federal means-tested benefits. (Sec. 5303) Exempts: (1) certain American Indians (including persons born in Canada) from SSI and Medicaid eligibility limitations; and (2) certain SSI recipients with pre-January 1, 1979 applications from SSI eligibility limitations. (Sec. 5305) States that an alien who is ineligible for food stamps shall not be eligible for such program based upon SSI eligibility. Authorizes Medicaid eligibility based upon SSI eligibility. (Sec. 5306) Treats certain Amerasian immigrants as refugees for purposes of specified

Major Actions:

Summary: H.R.2015 — 105th Congress (1997-1998)

There are 3 summaries for this bill. Line item veto by President (08/11/1997)Conference report filed in House (07/30/1997)Introduced in House (06/24/1997)     Bill summaries are authored by CRS. $("#summarySelector").congress_dropDownNavigation({ stubUrl: '/bill/105th-congress/house-bill/2015/summary', suffix: '' }); Shown Here:
Line item veto by President (08/11/1997) (On June 25, 1998, the Supreme Court ruled that the Line Item Veto Act (Public Law 104-130) is unconstitutional, thus restoring provisions that had been cancelled as summarized below.) (On August 11, 1997, the President line-item-vetoed Sec. 4722(c), which deemed to be permissible broad-based health care related taxes certain taxes, fees, or assessments collected by New York State from a health care provider before June 1, 1997, for which a specified waiver has been applied, or would be but for this provision. The provision would thus exempt such taxes, fees, or assessments from the requirement that provider-specific taxes be subtracted from the State share of Medicaid expenditures for purposes of Federal share calculation. The following revised digest of H.R. 2015 reflects the Act as signed into law, minus the line-item-vetoed provision. For more information on the specific items vetoed, see the text of the conference report for H.R. 2015, H.Rept. 105-217, and Presidential Cancellation Number 97-3.) TABLE OF CONTENTS: Title I: Food Stamp Provisions Title II: Housing and Related Provisions Title III: Communications and Spectrum Allocation Provisions Title IV: Medicare, Medicaid, and Children's Health Provisions Subtitle A: Medicare+Choice Program Subtitle B: Prevention Initiatives Subtitle C: Rural Initiatives Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity Subtitle E: Provisions Relating to Part A Only Subtitle F: Provisions Relating to Part B Only Subtitle G: Provisions Relating to Parts A and B Subtitle H: Medicaid Subtitle I: Programs of All-Inclusive Care for the Elderly (PACE) Subtitle J: State Children's Health Insurance Program Title V: Welfare and Related Provisions Subtitle A: TANF Block Grant Subtitle B: Supplemental Security Income Subtitle C: Child Support Enforcement Subtitle D: Restricting Welfare and Public Benefits for Aliens Subtitle E: Unemployment Compensation Subtitle F: Welfare Reform Technical Corrections Subtitle G: Miscellaneous Title VI: Education and Related Provisions Subtitle A: Higher Education Subtitle B: Repeal of Smith-Hughes Vocational Education Act Title VII: Civil Service Retirement and Related Provisions Title VIII: Veterans and Related Matters Subtitle A: Extension of Temporary Authorities Subtitle B: Copayments and Medical Care Cost Recovery Subtitle C: Other Matters Title IX: Asset Sales, User Fees, and Miscellaneous Provisions Subtitle A: Asset Sales Subtitle B: User Fees Subtitle C: Miscellaneous Provisions Title X: Budget Enforcement and Process Provisions Subtitle A: Amendments to the Congressional Budget and Impoundment Control Act of 1974 Subtitle B: Amendments to the Balanced Budget and Emergency Deficit Control Act of 1985 Title XI: District of Columbia Revitalization Subtitle A: District of Columbia Retirement Funds Subtitle B: Management Reform Plans Subtitle C: Criminal Justice Subtitle D: Privatization of Tax Collection and Administration Subtitle E: Financing of District of Columbia Accumulated Deficit Subtitle F: District of Columbia Bond Financing Improvements Subtitle G: District of Columbia Government Budget Subtitle H: Miscellaneous Provisions Balanced Budget Act of 1997 - Title I: Food Stamp Provisions - Amends the Food Stamp Act to define "caseload" and "covered individual." Authorizes State agencies to provide an additional 15 percent exemption from the food stamp program (program) work requirement for specified covered individuals. Provides for related caseload and exemption adjustments. (Sec. 1002) Obligates additional FY 1996 through 2002 funds for program employment and training programs. Sets forth State allocation provisions. (Sec. 1003) Requires State agencies, with assistance provided by the Secretary of Agriculture, to deny program benefits to prisoners incarcerated for more than 30 days. (Sec. 1004) Directs the Secretary to make specified funds available for FY 1998 through 2001 to eligible private nonprofit organizations and State agencies for nutrition education. Title II: Housing and Related Provisions - Amends the Balanced Budget Downpayment Act, I to extend permanently certain foreclosure avoidance provisions under the single family housing mortgage insurance program. (Sec. 203) Amends the United States Housing Act of 1937 with respect to the section 8 rental assistance program to make specified maximum monthly rent adjustment provisions for certain new and rehabilitated and nonturnover units applicable to FY 1999 and thereafter. Title III: Communications and Spectrum Allocation Provisions - Amends the Communications Act of 1934 (the Act) to make competitive bidding authority with respect to licenses or construction permits involving uses of the electromagnetic spectrum (spectrum) inapplicable to such licenses and permits issued by the Federal Communications Commission (FCC) that are for: (1) certain public safety radio services; (2) initial licenses or permits assigned to existing terrestrial broadcast licensees for digital television (TV) service; or (3) noncommercial educational or public broadcast stations. Requires the FCC to provide for the design and conduct of spectrum competitive bidding using a contingent combinatorial bidding system that permits prospective bidders to bid on combinations of licenses in a single bid and to enter multiple alternative bids within a single bidding round. Directs the FCC to prescribe methods by which a reasonable reserve price will be required, or a minimum bid will be established, to obtain any license or permit assigned under competitive bidding, unless determined not to be in the public interest. Repeals a requirement that any funds appropriated to the FCC for FY 1994 through 1998 for assigning licenses using random selection procedures be retained in the FCC's salaries and expenses account. Requires competitive bidding information to be included in annual FCC reports in order for any funds collected after FY 1998 to be retained in such account. Extends competitive bidding authority through FY 2008. Prohibits the FCC, after July 1, 1997, from issuing a license or construction permit for spectrum through a random selection system. Excepts from such prohibition licenses or permits for noncommercial educational or public broadcast stations. Provides for the applicability of competitive bidding requirements to pending comparative licensing cases. Makes available for assignment for commercial use the 1710 to 1755 megahertz (mhz) frequency band. Directs the FCC to assign licenses for such use by competitive bidding commenced after January 1, 2001. Directs the FCC to assign certain additional spectrum by competitive bidding no later than September 30, 2002. Directs the FCC to reallocate: (1) spectrum located at 2110 to 2150 mhz; and (2) 15 mhz located in the 1990 to 2110 range, with an exception in both cases when not in the public interest. Requires the FCC to notify the Secretary of Commerce if it is unable to provide for effective relocation of incumbent licensees to available bands of frequencies and has identified bands suitable for such relocation that are allocated for Federal use but could be reallocated pursuant to the National Telecommunications and Information Administration Organization Act (NTIA). Amends NTIA to direct the Secretary to report to the President, the FCC, and the Congress on recommendations for reallocating frequencies allocated for Federal use other than by Government licensees under the Communications Act of 1934. Authorizes any entity which operates a Government station to accept payment for frequency relocation expenses. Provides a relocation process triggered by a petition under NTIA. Allows a Federal entity to reclaim a former frequency if it demonstrates that relocated facilities or spectrum are not comparable to its former facilities or spectrum. Requires the Secretary to recommend for reallocation for use other than by Government stations a band of frequencies that: (1) in the aggregate span at least 20 mhz; (2) are located below three gigahertz; and (3) meet other relocation criteria. Directs the FCC to prepare and submit to the President and the Congress a plan for the immediate allocation and assignment of frequencies identified under this title. (Sec. 3003) Amends the Act to prohibit the renewal of a license authorizing analog TV services beyond the end of 2006, with an extension in specified circumstances. Prohibits the FCC, in prescribing regulations relating to qualifications of spectrum bidders, from: (1) precluding any party from being a qualified bidder for spectrum allocated for any use that includes digital TV service on the basis of the FCC's duopoly rule or newspaper cross-ownership rule; or (2) applying either rule to preclude a successful bidder from using such spectrum for digital TV service. (Sec. 3004) Directs the FCC, no later than January 1, 1998, to allocate from radio spectrum between 746 and 806 mhz: (1) 24 mhz for public safety services; and (2) the remainder for commercial purposes to be assigned by competitive bidding. Sets deadlines for the assignment of such licenses and the commencement of competitive bidding. Provides for the licensing of unused frequencies for public safety services. (Sec. 3005) Authorizes the FCC to allocate spectrum to provide flexibility of use, as long as such use is consistent with international agreements and upon a finding that such use is in the public interest and would not deter investment or result in harmful interference among users. (Sec. 3006) Authorizes appropriations to the FCC for FY 2001 for universal service support programs. (Sec. 3007) Directs the FCC to conduct all competitive bidding required under this title so that proceeds from such bidding are deposited no later than the end of FY 2002. (Sec. 3008) Requires seven days' public notice before the granting by the FCC of an application for spectrum frequency assignment under the Act. Title IV: Medicare, Medicaid, and Children's Health Provisions - Subtitle A: Medicare+Choice Program - Chapter 1: Medicare+Choice Program - Amends title XVIII (Medicare) of the Social Security Act (SSA) to establish a Medicare+Choice program under which each Medicare+Choice eligible individual (one entitled to benefits under Medicare part A (Hospital Insurance) and enrolled under Medicare part B (Supplementary Medical Insurance)) is entitled to elect, in accordance with certain procedures, to receive Medicare benefits either through the original Medicare fee-for-service program or through a Medicare+Choice plan. (Sec. 4001) Outlines the types of Medicare+Choice plans that may be available, namely: (1) coordinated care plans; (2) combination of a medical savings account (MSA) plan and contributions into a Medicare+Choice MSA; and (3) private fee-for-service plans. Sets forth various special rules regarding, among other things, residence, individuals with end-stage renal disease, and individuals covered under the Federal Employees Health Benefits Program or eligible for veterans' or military health benefits. Directs the Secretary of Health and Human Services (HHS) to: (1) provide for broad dissemination of coverage option and comparison information to Medicare beneficiaries and prospective Medicare beneficiaries; and (2) maintain a toll-free number for inquiries about Medicare+Choice options and program operation, as well as an Internet site through which individuals may obtain such information electronically. Requires: (1) any Medicare+Choice organization to accept without restrictions individuals eligible to make an election at any time during which such elections are accepted; and (2) approval of Medicare+Choice marketing material and application forms before they are distributed. Provides for continuous open enrollment and disenrollment through 2001, the first six months of 2002, and the first three months of every subsequent year, limiting an individual's change of enrollment during such initial period to one. Provides for an annual, coordinated election period during November for all participants as well as special election periods in certain circumstances. Outlines benefits and beneficiary protections. Requires each Medicare+Choice plan (except MSA plans) to provide those items and services for which benefits are available under Medicare parts A and B (other than hospice care) and specified additional benefits, as well, at its option, as certain supplemental benefits, subject to the Secretary's approval. Excludes individuals enrolled under a MSA plan from participating in such supplemental package. Prohibits a Medicare+Choice organization from denying, limiting, or conditioning coverage or benefits based on any described health status-related factor. Prescribes plan disclosure requirements and an ongoing quality assurance program. Outlines a mechanism for grievances and appeals. Sets forth certain payment rules for providers not participating in the Medicare+Choice program. Directs the Secretary to make monthly advance payments with respect to an individual's coverage to Medicare+Choice organizations according to a specified formula. Requires the Secretary to establish separate payment rates for individuals with end-stage renal disease. Sets forth special rules for individuals electing MSA plans. Requires such an individual to establish a Medicare+Choice MSA into which the Secretary shall make monthly deposits out of the Medicare trust funds in accordance with prescribed guidelines. Prescribes special rules for hospice care. Details rules for the submission and charging of premiums by each Medicare+Choice organization. Sets limitations on enrollee liability for basic, additional, and supplemental benefits. Prescribes a special rule for private fee-for-service plans. Prohibits a State from imposing a premium tax or similar tax with respect to payments to Medicare+Choice organizations. Sets out organizational and financial requirements for Medicare+Choice organizations and provider-sponsored organizations. Directs the Secretary to establish solvency and capital adequacy standards for provider-sponsored organizations, and other standards for Medicare+Choice organizations. Prescribes requirements, including minimum enrollment requirements, for contracts between the Secretary and Medicare+Choice organizations. Provides for: (1) intermediate sanctions and civil monetary penalties to enforce contract provisions; and (2) procedures for termination of contracts. (Sec. 4002) Details transitional rules for the current Medicare health maintenance organization (HMO) program, as well as specified conforming changes in the Medicare supplemental health insurance policy (Medigap) program. (Sec. 4006) Amends the Internal Revenue Code to outline special rules for Medicare+Choice MSAs. Excludes from gross income any payment by the Secretary to an individual's Medicare+Choice MSA. Excludes from qualified deductible medical expenses any amounts paid for the medical care of any individual but the account holder. Prescribes a penalty for distributions from the Medicare+Choice MSA not used for qualified medical expenses if the minimum balance is not maintained, with certain exceptions if the account holder becomes disabled or dies. Chapter 2: Demonstrations - Directs the Secretary to establish a Medicare prepaid competitive pricing demonstration project in up to four (eventually seven) designated Medicare payment areas, of which initially three shall be in urban areas and one in a rural area. (Sec. 4012) Directs the Secretary to appoint a Competitive Pricing Advisory Committee to recommend areas for the demonstration and research design for project implementation. (Sec. 4014) Amends the Omnibus Budget Reconciliation Act of 1987 to extend the authorities for the social health maintenance organization (SHMO) demonstration project. Amends the Omnibus Budget Reconciliation Act of 1993 to increase the cap on the number of individuals who may participate in a SHMO demonstration. Directs the Secretary to submit to the Congress a plan for the integration of SHMO health plans and similar plans as an option under the Medicare+Choice program. (Sec. 4015) Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a demonstration (subvention) project under which the HHS Secretary shall reimburse the Secretary of Veterans Affairs from the Medicare trust funds for Medicare health care services furnished to certain targeted Medicare-eligible military retirees or dependents. Authorizes the Secretary of Defense to modify existing TRICARE contracts in order to provide Medicare health care services to project participants. (Sec. 4016) Directs the Secretary to conduct demonstration projects in a certain number of rural and urban areas for the purpose of evaluating methods, such as case management and other models of coordinated care, that improve the quality of items and services provided to target individuals, and reduce Medicare expenditures for such items and services. Defines a target individual as an individual with a chronic illness who is enrolled under the Medicare parts A and B fee-for-service program. Provides for project funding. (Sec. 4017) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to direct the Secretary to work with each municipal health service demonstration project to develop a plan for the orderly transition of such projects and project participants to a non-demonstration project health care delivery system, such as through integration with a private or public health care plan, including a Medicaid managed care or Medicare+Choice plan. (Sec. 4018) Directs the Secretary to implement a time-limited demonstration project for the purpose of evaluating the use of a third-party contractor to conduct the Medicare+Choice plan enrollment and disenrollment functions in an area. (Sec. 4019) Extends for an additional two years certain Medicare community nursing organization demonstration projects under the Omnibus Budget Reconciliation Act of 1987. Chapter 3: Commissions - Establishes the National Bipartisan Commission on the Future of Medicare to: (1) review and analyze the long-term financial condition of the Medicare program; (2) identify problems that threaten the financial integrity of the Medicare trust funds, including the extent to which current Medicare update indexes do not accurately reflect inflation; and (3) analyze potential solutions to the problems identified that will ensure both the financial integrity of Medicare and the provision of appropriate benefits. Requires the Commission to make recommendations: (1) to restore the solvency of the Federal Hospital Insurance Trust Fund and the financial integrity of the Federal Supplementary Medical Insurance Trust Fund; and (2) to establish the appropriate financial structure of the Medicare program as a whole and the appropriate balance of benefits covered and beneficiary contributions. Requires recommendations on: (1) the financing of graduate medical education; (2) the feasibility of allowing individuals between age 62 and the Medicare eligibility age to buy into the Medicare program; and (3) the impact of chronic disease and disability trends on future costs and quality of services under the current benefit, financing, and delivery system structure of the Medicare program. Requires a report to the President and the Congress. Authorizes appropriations. (Sec. 4022) Establishes the Medicare Payment Advisory Commission to replace the Prospective Payment Assessment Commission and the Physician Payment Review Commission, hereby abolished. Requires the new Commission to review and make recommendations to the Congress about payment policies under Medicare (including certain specific payment-related topics). Authorizes appropriations. Chapter 4: Medigap Protections - Amends SSA title XVIII with respect to the issuer of a Medicare supplemental (Medigap) policy in the case of certain individuals terminated by an employee welfare benefit plan providing supplementary health benefits who seek to enroll under a Medigap policy not later than 63 days after termination or disenrollment. Prohibits the Medigap issuer from: (1) denying or conditioning the issuance or effectiveness of such a policy; (2) discriminating in the pricing of such policy because of health status, claims experience, receipt of health care, or medical condition; or (3) imposing an exclusion of benefits based on a pre-existing condition. (Sec. 4031) Specifies limitations on the imposition of preexisting condition exclusions during the initial open enrollment period in the case of a Medicare supplemental policy issued to an individual who is age 65 or older with a certain minimum period of creditable coverage. (Sec. 4032) Creates under the Medicare supplemental policy program a high deductible feature which requires the policy beneficiary to pay annual out-of-pocket expenses (other than premiums) of $1,500 (indexed for inflation) before the policy begins payment of benefits. Chapter 5: Tax Treatment of Hospitals Participating in Provider- Sponsored Organizations - Amends the Internal Revenue Code to provide that an organization shall not fail to be treated as a tax-exempt charitable organization solely because a hospital which it owns and operates also participates in a provider-sponsored organization, whether or not the provider-sponsored organization is exempt from tax. Provides that any person with a material financial interest in such a provider-sponsored organization shall be treated as a private shareholder or individual with respect to the hospital. Subtitle B: Prevention Initiatives - Outlines various specified new preventive health measures covered under Medicare, namely coverage for: (1) an annual screening mammography for women over age 39 and triennial screening pap smear and screening pelvic exam for any woman (annually for a woman with cervical or vaginal cancer or other abnormality, or who is at high risk of developing such a cancer), while providing for a waiver of deductible; (2) annual prostate cancer screening tests; (3) colorectal cancer screening tests, subject to prescribed frequency and payment limits; (4) diabetes outpatient self-management training services, including blood-testing strips (with a ten percent payment reduction after 1997) and glucose monitors as durable medical equipment (DME) for individuals with diabetes; and (5) bone mass measurements for qualified individuals. (Sec. 4105) Directs the Secretary to establish outcome measures, including glysolated hemoglobin (past 90-day average blood sugar levels), for the purpose of evaluating the improvement of health status of Medicare beneficiaries with diabetes mellitus, with a view to recommending coverage modifications. (Sec. 4107) Extends through FY 2002 the Influenza and Pneumococcal Vaccination Campaign of the Health Care Financing Administration (HCFA). Authorizes appropriations. (Sec. 4108) Directs the Secretary to request the National Academy of Sciences to analyze (for a report to specified congressional committees) the expansion or modification of Medicare preventive benefits to include medical nutrition therapy services by a registered dietitian, skin cancer screening, medically necessary dental care, and other specified items. Subtitle C: Rural Initiatives - Replaces the Essential Access Community Hospital Program with an optional Medicare Rural Hospital Flexibility Program under which participating States shall develop at least one rural health network in the State and at least one facility designated as a critical access hospital in accordance with prescribed guidelines. Authorizes the Secretary to award grants to States for: (1) planning and implementation of the program; and (2) establishment or expansion of rural emergency medical services. Authorizes appropriations. Directs the HCFA Administrator to report to the Congress on the feasibility of, and administrative requirements necessary to establish, an alternative for certain medical diagnoses to the current 96-hour limitation for inpatient care in critical access hospitals. (Sec. 4202) Amends SSA title XVIII to prohibit denial, on the basis of wage comparisons, of a rural referral center's request for reclassification. Provides that any hospital classified as a rural referral center for FY 1991 shall be classified as such for FY 1998 and each subsequent fiscal year. (Sec. 4204) Extends through FY 2001 the special treatment of payment methodology and target amount for Medicare-dependent, small rural hospitals. (Sec. 4205) Amends requirements for rural health clinic services with respect to: (1) per-visit payment limits for provider-based clinics; (2) mandatory quality assessment and performance improvement programs; (3) limitation of waivers of certain staffing requirements to clinics participating in the rural health clinic program; (4) the insufficiency of needed health care practitioners in shortage areas; and (5) regulations providing for payment for certain physician assistant services. (Sec. 4206) Directs the Secretary to make payments from the Federal Supplementary Medical Insurance Trust Fund under Medicare part B in accordance with a specified payment methodology for professional consultation via telecommunications systems with a physician or practitioner furnishing a service for which payment may be made to a Medicare beneficiary residing in a rural health professional shortage area, notwithstanding that the individual physician or practitioner providing the professional consultation is not at the same location as the physician or practitioner furnishing the service to that beneficiary. Directs the Secretary to report to the Congress: (1) a detailed analysis of telemedicine and telehealth (T&T) services; and (2) an examination of the possibility of making similar payments for professional consultation via telecommunications systems to Medicare beneficiaries who do not reside in a rural health professional shortage area, are homebound or nursing homebound, and for whom being transferred for health care services imposes a serious hardship. (Sec. 4207) Directs the Secretary to conduct a demonstration project to use eligible health care provider telemedicine networks to apply high-capacity computing and advanced networks to improve primary care and prevent health care complications to Medicare beneficiaries with diabetes mellitus who reside in medically underserved rural or inner-city areas. Provides funding. Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity - Chapter 1: Revisions to Sanctions for Fraud and Abuse - Amends SSA title XI, with respect to health care related crimes, to exclude from the Medicare and State health care programs any person: (1) for ten years for one previous conviction for one or more offenses; and (2) permanently for two or more previous convictions of one or more offenses. (Sec. 4302) Authorizes the Secretary to refuse to enter into Medicare agreements with individuals or entities convicted of felonies for offenses determined inconsistent with the best interests of program beneficiaries. (Sec. 4303) Authorizes the Secretary to exclude from the Medicare program any entity with respect to which a sanctioned person with an ownership or control interest in it transfers such interest in anticipation of (or following) a conviction, assessment, or exclusion against the person, to an immediate family member or member of the household who continues to maintain such an interest. (Sec. 4304) Provides for the imposition of civil monetary penalties for: (1) any person who arranges or contracts with an individual or entity that the person knows or should know is excluded from participation in a Federal health care program; and (2) kickbacks. Chapter 2: Improvements in Protecting Program Integrity - Amends SSA title XVIII to require the Secretary, in the annual notice of Medicare benefits, to urge beneficiaries to check the notice and any itemized statement for accuracy and report any errors or questionable charges by calling a certain toll-free number. Authorizes Medicare beneficiaries to submit written requests for itemized bills of medical or other items or services provided, and review them. Requires the Secretary to take measures to recover amounts unnecessarily paid out. (Sec. 4312) Outlines various specified requirements regarding disclosure of information and surety bonds with regard to DME suppliers. Includes surety bond requirements for home health agencies. Authorizes the Secretary to apply disclosure and surety bond requirements to other health care providers or item and service suppliers (except physicians or practitioners). Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORFs) and to rehabilitation agencies. (Sec. 4313) Requires any participating entity to disclose to the Secretary its own employer identification numbers and social security account numbers, as well as those of persons with ownership or control interests and subcontractors in which the entity has a five percent or greater interest. Directs the Secretary to report to Congress on the steps taken to assure the confidentiality of such social security account numbers. (Sec. 4314) Requires the Secretary, upon a party's request, to issue binding advisory opinions on whether a referral relating to designated health services (other than clinical laboratory services) is a prohibited physician self-referral. (Sec. 4315) Amends SSA title XVIII to: (1) replace the reasonable charge payment methodology with fee schedules developed by the Secretary for particular services; (2) provide for application of inherent reasonableness to charges for all Medicare part B services other than physicians' services; (3) require bills and requests for payment for services by non-physician practitioners to include diagnostic codes; (4) outline requirements to provide diagnostic information when ordering certain items or services furnished by another entity; (5) mandate establishment of competitive acquisition areas for contract award purposes for the furnishing under Medicare part B after 1997 of described items and services; and (6) prohibit payment under Medicare part A or part B for any expenses for an item or service furnished in a competitive acquisition area by an entity other than an entity with which the Secretary has contracted, except for urgent need, or in other circumstances specified by the Secretary. (Sec. 4320) Excludes from reasonable costs and declares unreimbursable under Medicare any payments for certain items unrelated to patient care, including: (1) entertainment, gifts, or donations; (2) personal use of motor vehicles; (3) costs for fines and penalties resulting from violations of Federal, State, or local laws; and (4) education expenses for spouses or other dependents of service providers, their employees, or contractors. (Sec. 4321) Requires a Medicare hospital's discharge planning process to include information on the availability of home health services through certain individuals or entities. Requires a discharge plan: (1) not to specify or otherwise limit the qualified provider which may provide home health services; and (2) identify any entity to whom the individual is referred in which the hospital has a disclosable financial interest. Requires the service provider agreement to require disclosure of any financial interest a hospital has in any entity to which individuals are referred, or any entity has in the hospital, and related information. Chapter 3: Clarifications and Technical Changes - Makes technical amendments with respect to fraud and abuse. Subtitle E: Provisions Relating to Part A Only - Chapter 1: Payment of PPS Hospitals - Revises requirements for: (1) prospective payment system (PPS) hospital payment updates; (2) maintenance of savings from the temporary reduction in capital payments for prospective payment system (PPS) hospitals; (3) additional payments to any hospital with a disproportionate share of low-income patients (disproportionate share hospital (DSH)); (4) the sales price of a Medicare capital asset (book value); (5) elimination of indirect medical education (IME) and DSH payments attributable to outlier payments; (6) the base rate of payments to Puerto Rico hospitals; (7) payments to hospitals for certain discharges to post-acute care; (8) inclusion of Stanly County, North Carolina, in the large urban area of Charlotte-Gastonia-Rock Hill-North Carolina-South Carolina; and (9) the floor on wage area indexes. (Sec. 4409) Requires the Secretary to publish and use alternative guidelines under which certain disproportionately large hospitals qualify for geographic reclassification. Chapter 2: Payment of PPS-Exempt Hospitals - Revises requirements for the payment of PPS-exempt hospitals, including those for: (1) payment updates; (2) reductions to capital payments; (3) bonus and relief payments; (4) payment and the target amount for new providers; (5) treatment of certain long-term care hospitals located within other hospitals; (6) rebasing; (7) certain cancer hospitals; and (8) elimination of exemptions for certain hospitals. (Sec. 4421) Provides for a Medicare PPS for inpatient rehabilitation hospital services. (Sec. 4422) Directs the Secretary to submit to the Congress a legislative proposal for establishing a case-mix adjusted PPS for long-term care hospitals. Chapter 3: Payment for Skilled Nursing Facilities - Declares that updates to per diem limits, with respect to payments to skilled nursing facilities (SNFs), effective for FY 1998, shall be based on cost limits effective for FY 1997. (Sec. 4432) Mandates a PPS for SNF services along with consolidated billing for them. Directs the Secretary, in order to ensure that Medicare beneficiaries are furnished appropriate SNF services, to establish a thorough medical review process to examine the provisions of this section and their effect on the quality of covered SNF services furnished to Medicare beneficiaries. Chapter 4: Provisions Related to Hospice Services - Provides for update of payments for hospice services. Bases payment for home hospice care on the location where care is furnished. Revises the home hospice care benefit period. Provides for home hospice care coverage of any other items and services specified in a plan. Allows waiver of certain staffing requirements for hospice care programs in non-urbanized areas. Chapter 5: Other Payment Provisions - Requires reductions in payments for enrollee bad debt. Repeals the termination date to make a permanent extension of the hemophilia passthrough. Requires a certain reduction in the part A Medicare premium for specified public retirees. Authorizes Medicare and Medicaid coverage of inpatient hospital and post-hospital extended care services in religious nonmedical health care institutions (currently limited to Christian Science sanatoria). Subtitle F: Provisions Relating to Part B Only - Chapter 1: Services of Health Professionals - Revises requirements for the payment of physicians' services, with changes: (1) establishing a single conversion factor for 1998; (2) adding new update provisions; (3) replacing the volume performance standard with sustainable growth rate; (4) adding payment rules for anesthesia services; and (5) providing for adjustments in relative value units for 1998, and the application of resource-based methodology to malpractice relative value units. (Sec. 4505) Directs the Comptroller General to review and evaluate the proposed rule on resource-based methodology for practice expenses issued by the HCFA. (Sec. 4506) Directs the Secretary to determine for each hospital: (1) its hospital-specific per discharge relative value for physicians' services; and (2) whether such value is projected to be excessive. Requires the Secretary to notify the medical executive committee of a subset of the hospitals identified as having an excessive hospital-specific relative value, and evaluate their responses with the responses of other hospitals so identified that were not notified. (Sec. 4507) Amends SSA title XVIII to declare that nothing shall prohibit a physician or practitioner from privately contracting with a Medicare beneficiary for any item or service for which no Medicare claim will be submitted, and for which the physician or practitioner shall receive no Medicare reimbursement. (Sec. 4511) Increases Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. (Sec. 4513) Repeals the requirement of an X-ray for reimbursement for chiropractic services. Directs the Secretary to develop utilization guidelines for the coverage of chiropractic services where a subluxation has not been demonstrated by an X-ray. Chapter 2: Payment for Hospital Outpatient Department Services - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 4522) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 4523) Directs the Secretary to establish a PPS for hospital outpatient department services. Chapter 3: Ambulance Services - Provides for certain interim reductions in payments for ambulance services. Directs the Secretary to establish a prospective fee schedule for payment of such services. Provides that, in promulgating regulations for coverage of ambulance services, the Secretary may cover advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. (Sec. 4532) Directs the Secretary to establish up to three demonstration projects contracting with local governments for ambulance services paid for under Medicare. Chapter 4: Prospective Payment for Outpatient Rehabilitative Services - Provides for a PPS for outpatient physical (including speech-language pathology) and occupational therapy services. Chapter 5: Other Payment Provisions - Provides for a reduction in payment amounts for items of DME and for clinical diagnostic laboratory tests. Provides for a payment freeze for parenteral and enteral nutrients, supplies, and equipment. Revises update requirements for payment for orthotics and prosthetics, and other payment requirements for oxygen and oxygen equipment, ambulatory surgical services, and drugs and biologicals. (Sec. 4552) Requires the Comptroller General to study and report to specified congressional committees on access to home oxygen equipment. Requires the Secretary to arrange for peer review organizations to evaluate such access. (Sec. 4553) Directs the Secretary to request the National Academy of Sciences to study (for a report to specified congressional committees) Medicare payments for clinical laboratory tests. (Sec. 4554) Directs the Secretary to divide the United States into up to five regions, and designate a single carrier for each region, for the payment of Medicare part B claims for clinical diagnostic laboratory services. Requires the Secretary to adopt uniform policies for clinical diagnostic laboratory tests. (Sec. 4557) Provides for coverage of oral anti-nausea drugs under a chemotherapeutic regimen. (Sec. 4558) Requires the Secretary to: (1) audit cost reports of each renal dialysis provider at least once every three years; and (2) develop a method to measure and report on the quality of Medicare renal dialysis services. (Sec. 4559) Directs the Secretary, for electrocardiogram tests furnished during 1998, to restore separate part B payment for electrocardiogram transportation based upon methods in effect on December 31, 1996. Requires the Secretary, by a certain deadline, to recommend to specified congressional committees whether portable electrocardiogram transportation should be covered under Medicare part B. Chapter 6: Part B Premium and Related Provisions - Revises the formula for the monthly Medicare part B premium rate the Secretary promulgates each September for the following calendar year. Requires such rate to equal 50 percent of the monthly actuarial rate for enrollees age 65 and over for that succeeding calendar year. (Sec. 4581) Provides for a special Medicare enrollment period, with no premium penalty for late enrollment, for certain disabled workers whose continuous enrollment under an employer's group health plan is involuntarily terminated in certain circumstances. (Sec. 4582) Allows appropriate State or local governmental entities to elect to pay part B premiums for certain eligible individuals. Subtitle G: Provisions Relating to Parts A and B - Chapter 1: Home Health Services and Benefits - Provides that, in establishing payment limits for cost reporting periods beginning after September 30, 1997, the Secretary shall not take into account any changes in the home health market basket with respect to cost reporting periods which began on or after July 1, 1994, and before July 1, 1996. (Sec. 4602) Revises requirements for interim payments for home health services. Directs the Secretary to expand research on a PPS for home health agencies under the Medicare program that ties prospective payments to a unit of service. (Sec. 4603) Directs the Secretary to establish a PPS for home health services for cost reporting periods beginning in FY 2000. (Sec. 4604) Bases the payment for home health services on the location where the service is furnished. (Sec. 4611) Provides for a modification of the Medicare part A home health benefit for individuals enrolled under Medicare part B. Provides for specified post-institutional home health services. (Sec. 4613) Directs the Secretary to study and report to the Congress on the criteria that should be applied in determining whether an individual is homebound for purposes of qualifying for Medicare home health services. (Sec. 4614) Provides for the denial of home health claims based on home health services the frequency and duration of which are in excess of normative guidelines established by the Secretary. (Sec. 4615) Denies payment for home health benefits based solely on venipuncture to obtain a blood sample. (Sec. 4616) Directs the Secretary to estimate part A and part B outlays for FY 1998 through 2002 for specified congressional committees, and report annually a comparison of actual outlays with such estimates. Chapter 2: Graduate Medical Education - Revises requirements for direct and indirect Medicare payments for graduate medical education (GME). Limits the number of residents in allopathic and osteopathic medicine. Permits payment to qualified nonhospital providers for direct GME costs. Prohibits restandardization of certain indirect GME payment amounts. Requires the Secretary to provide for direct and indirect GME payments to hospitals for Medicare+Choice enrollees. Makes a special reimbursement rule for primary care combined residency programs, setting the period of board eligibility. (Sec. 4626) Provides for incentive payments to hospitals under plans for voluntary reduction in the number of full-time equivalent residents in an approved medical training program. (Sec. 4628) Directs the Secretary to establish a demonstration project under which GME payments shall be made to consortia of teaching hospitals and other medical entities. (Sec. 4629) Directs the Medicare Payment Advisory Commission to develop recommendations to the Congress on whether and to what extent Medicare payment policies and other Federal policies regarding teaching hospitals and GME should be changed. (Sec. 4630) Directs the Secretary to study and report to the appropriate congressional committees on variations among hospitals in the overhead and supervisory physician components of their direct medical education costs. Chapter 3: Provisions Relating to Medicare Secondary Payer - Revises requirements for Medicare as secondary payer. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Chapter 4: Other Provisions - Amends SSA title XVIII to require placement of an advance directive in a prominent part of the individual's current medical record. (Sec. 4642) Provides for an increased certification period for certain organ procurement organizations. (Sec. 4643) Establishes in the HCFA the position of Chief Actuary. Subtitle H: Medicaid - Chapter 1: Managed Care - Amends SSA title XIX (Medicaid) to establish a new part B (Managed Care) giving States the option to require Medicaid-eligible individuals (except Medicare beneficiaries, Medicare-eligible individuals, and certain children with special needs) to enroll in managed care arrangements of the individual's choice as a condition of receiving Medicaid. (Sec. 4702) Grants States the option of providing Medicaid coverage of primary care case management services without the need for a waiver. (Sec. 4703) Repeals the (75-25) requirement that Medicare and Medicaid beneficiaries constitute less than 75 percent of the membership of a participating HMO. Repeals the prohibition on co-payments for services furnished by HMOs. (Sec. 4704) Prescribes requirements for: (1) access to emergency care; (2) annual external independent review of managed care entity activities and other specified quality care assurance measures; and (3) fraud and abuse prohibitions and protections. (Sec. 4705) Amends SSA title XIX (Medicaid) to require any State contracting with Medicaid managed care organizations to develop and implement a quality assessment and improvement strategy incorporating certain access standards, monitoring procedures, and other measures. Directs the Comptroller General to analyze and report to specified congressional committees on the quality assurance programs and accreditation standards applicable to managed care entities operating in the private sector or under Medicare contracts to determine if such programs and standards consider the accessibility and quality of the health care items and services delivered under such contracts to low-income individuals. Directs the Secretary to study and report to such committees on safeguards that may be needed to ensure that the health care needs of individuals with special health care needs and chronic conditions who are enrolled with Medicaid managed care organizations are adequately met. (Sec. 4706) Requires an HMO to meet solvency standards established by the State for private HMOs, or be State-licensed or -certified as a risk-bearing entity. (Sec. 4708) Increases from $100,000 to $1 million, indexed annually, the threshold amount for HMO contracts requiring the Secretary's prior approval. Permits the same copayments in HMOs as in fee-for-service. Chapter 2: Flexibility in Payment of Providers - Repeals "Boren Amendment" provider reimbursement requirements. Requires the Secretary to study and report to the appropriate congressional committees on the effect on access to services, service quality, and service safety of the rate-setting methods used by States as a result of such repeal. (Sec. 4712) Specifies reductions from 100 percent to 70 percent between FY 1999 through 2003 in the percentage of reasonable costs that shall be paid under a State plan for federally-qualified health center and rural health clinic services (with a special supplemental payment for services furnished under certain managed care contracts). (Sec. 4713) Repeals payment rate requirements for obstetrical and pediatric services. (Sec. 4714) Revises requirements for Medicaid payment rates for qualified Medicare beneficiaries, placing a limitation on nonparticipating providers. (Sec. 4715) Declares that, in the case of a Medicaid-eligible veteran residing in a State veterans' home, any veterans' pension over $90 per month shall be counted as income only for the purpose of applying such excess payment to the State veterans' home's cost of providing nursing care to the veteran. Chapter 3: Federal Payments to States - Revises specified limitations of Federal payments for inpatient hospital services furnished by disproportionate share hospitals (DSH), including limitations on certain State DSH expenditures to institutions for mental diseases or other mental health facilities. Requires direct State Medicaid payment to hospitals for managed care enrollees. (Sec. 4722) Revises the treatment as broad-based health care related taxes of certain State hospital taxes which currently are not subtracted as revenues from the State share of Medicaid expenditures for purposes of calculating the Federal share of such expenditures. Declares that an exemption from such State hospital tax for certain Federal-tax-exempt hospitals that do not accept Medicaid or Medicare payments (provide free care) shall not disqualify the hospital tax as a broad-based health care related tax (thus allowing continued exclusion of such State hospital tax from the requirement that provider-specific taxes be subtracted from the State share of Medicaid expenditures for purposes of Federal share calculation). (Sec. 4723) Specifies additional funding for State emergency health services furnished to undocumented aliens. (Sec. 4724) Prohibits the expenditure of Medicaid funds for roads, bridges, stadiums, and other items and services not covered by a State plan. Requires home health agencies to provide a surety bond. Revises conflict-of-interest safeguards. Declares that States are not required to provide medical assistance for items or services furnished by a person or entity convicted of a felony for an offense inconsistent with the best interests of beneficiaries under the State plan. Requires State action for program and beneficiary protection against waste, fraud, and abuse. Conditions issuance or renewal of a DME supplier provider number on the supplier's provision of a surety bond and disclosure of all persons with ownership or control interests in the supplier, and of all subcontractors in which the supplier has a five percent or greater interest. (Sec. 4725) Provides for increased Federal medical assistance percentages (FMAPs) for the District of Columbia and Alaska and increased payment caps for the territories. Chapter 4: Eligibility - Grants States the option to provide for 12-month continuous Medicaid eligibility for children. (Sec. 4732) Requires State Medicaid plan coverage of the Medicare cost-sharing for certain additional low-income Medicare beneficiaries whose income otherwise disqualifies them for specified Medicare benefits. (Sec. 4733) Grants States the option to permit workers with disabilities to buy into Medicaid. (Sec. 4734) Prescribes criminal penalties for knowingly and willfully, for a fee, counseling or assisting an individual to dispose of assets (including transfer in trust) in order for that individual to become Medicaid-eligible (fraudulent eligibility). (Sec. 4735) Declares that certain payments in a class settlement of the case of Susan Walker v. Bayer Corporation shall not be considered income or resources in determining Medicaid eligibility. Chapter 5: Benefits - Changes from mandatory to discretionary a State's authority to enroll individuals under private group health plans and pay their premiums. (Sec. 4742) Repeals: (1) certain physician qualification requirements with respect to services to pregnant women and to children under age 21; and (2) the requirement of prior institutionalization with respect to habilitation services furnished under a waiver for home or community-based services. (Sec. 4744) Requires the Secretary to study and report to the Congress on early and periodic screening, diagnostic, and treatment benefits. Chapter 6: Administration and Miscellaneous - Repeals requirements for inspections of the care being provided at mental hospitals and intermediate care facilities for the mentally retarded (ICFS-MR). (Sec. 4752) Authorizes a State, in lieu of terminating a noncompliant ICFS-MR, to establish alternative remedies if the State demonstrates to the Secretary's satisfaction that such alternative remedies are effective in deterring noncompliance and correcting deficiencies. (Sec. 4753) Revises requirements for mechanized claims processing and information retrieval systems. (Sec. 4754) Repeals the requirement for State refund to the Federal Government of any payments received during remediation of a noncompliant nursing facility. (Sec. 4755) Requires States to establish procedures to permit a nurse aide, in the case of a finding of neglect, to petition the State for name removal from the nurse aide registry upon a State determination that: (1) the employment and personal history of the nurse aide does not reflect a pattern of abusive behavior or neglect; and (2) the neglect involved in the original finding was a singular occurrence. (Sec. 4756) Includes the DRUGDEX Information System among the compendia to be used in drug use review for Medicaid payment. (Sec. 4757) Applies certain requirements to the extension of statewide comprehensive research and demonstration projects for which waivers of Medicaid compliance have been granted. (Sec. 4758) Amends the Omnibus Budget Reconciliation Act of 1989 to extend the moratorium on the treatment of the Kent Community Hospital Complex and Saginaw Community Hospital in Michigan as institutions for mental diseases for purposes of Medicaid reimbursement. Subtitle I: Programs of All-Inclusive Care for the Elderly (PACE) - Amends SSA title XVIII to provide for Medicare programs of all-inclusive care for the elderly (PACE programs) for individuals age 55 or older who require the level of care required under the State Medicaid plan for coverage of nursing facility services. Specifies benefit and payment requirements. Limits PACE provider eligibility to public and private non-profit entities; but requires the Secretary to waive such limitations to demonstrate the operation of a PACE program by a private, for-profit entity. (Sec. 4802) Amends SSA title XIX to authorize a State to establish a Medicaid program of all-inclusive care for the elderly (PACE) for individuals who need not be eligible for Medicare part A benefits, or enrolled under Medicare part B. (Sec. 4804) Directs the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under Medicare and Medicaid, specifically comparing the costs, quality, and access to services by private, for-profit entities under the demonstration projects with the costs, quality, and access to services of other PACE providers. Subtitle J: State Children's Health Insurance Program - Chapter 1: State Children's Health Insurance Program - Amends SSA to add a new title XXI (State Children's Health Insurance Program) in order to provide funds to States to expand the provision of child health assistance to uninsured, low-income children. Requires a State to submit for the Secretary's approval a child health plan for the use of funds, containing strategic objectives, performance goals, and performance measures. Mandates coverage equivalent to benefits coverage in a benchmark benefit package, consisting of benefits offered by either: (1) the Federal Employees' Health Benefits Program (FEHBP); (2) a State employee health benefit plan; or (3) an HMO. Makes appropriations to carry out this title. Allows their use for abortion only if necessary to save the life of the mother or if the pregnancy results from rape or incest. Chapter 2: Expanded Coverage of Children Under Medicaid - Amends SSA title XIX to provide for an increased Medicaid FMAP for expanded coverage of targeted low-income children. (Sec. 4912) Authorizes an approved State plan to make Medicaid available to a low-income child during a specified presumptive eligibility period after determination that family income does not exceed a certain level. (Sec. 4913) Provides for continuation of Medicaid eligibility for disabled children who lose benefits under SSA title XVI (Supplemental Security Income) (SSI). Chapter 3: Diabetes Grant Programs - Amends the Public Health Service Act to direct the Secretary to make grants for services for the prevention and treatment of type I diabetes in children, and for research in innovative approaches to such services. Provides for funding. (Sec. 4922) Directs the Secretary to make grants for services for the prevention and treatment of type I diabetes in Indians through the Indian Health Service and tribal and urban Indian health programs. (Sec. 4923) Requires the Secretary to evaluate such programs and report to the Congress. Title V: Welfare and Related Provisions - Subtitle A: TANF Block Grant - Amends part A (Temporary Assistance for Needy Families) (TANF) of SSA title IV to establish a program of welfare-to-work grants to States. (Sec. 5001) Sets forth requirements relating to State entitlement to non-competitive formula grants under such program and State distribution of such funds among local governments. Authorizes State Governors to distribute up to 15 percent of such grant funds for projects to help long-term welfare recipients enter unsubsidized employment. Provides for competitive grants, based on program effectiveness and other factors, including the history of the applicant's success in moving individuals with multiple barriers into work, for State-approved projects proposed by private industry councils or local governments. Sets forth rules relating to required beneficiaries and targeting of individuals with characteristics associated with long-term welfare dependency. Authorizes use of grant funds to provide work-related services to individuals who have reached the five-year limit on assistance. Directs the Secretary of Labor to use certain set-aside funds to make grants to each successful performance State in FY 2000. Makes appropriations for FY 1998 and 1999 for grants. Sets forth requirements for: (1) nondisplacement of other workers by participants in work activities under this program; (2) applicable health and safety standards; and (3) grievance procedures with respect to alleged violations of such nondisplacement and health and safety requirements. Provides for such grants to outlying areas territories and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to develop a plan to evaluate the use of such grants. Sets forth penalties for: (1) failure of a State to maintain its historic effort during a year in which a welfare-to-work grant is received; and (2) misuse of competitive welfare-to-work grant funds. Declares that State sanctions against recipients for TANF program violations are not wage reductions. (Sec. 5002) Limits to not more than ten percent the portion of such welfare-to-work grant funds which a State may use to carry out State programs under SSA title XX block grants to States for social services. (Sec. 5003) Increases from 20 percent to 30 percent of individuals in all families and in two-parent families the limitation on the number of persons who may be treated as engaged in work by reason of participation in a vocational education program or, in the case of teen heads of household, maintenance of satisfactory school attendance. (Sec. 5004) Requires reduction of a State's welfare-to-work grant if a State fails to reduce assistance for recipients refusing work without good cause. Subtitle B: Supplemental Security Income - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRAWORA) to extend by six months the deadline for certain childhood disability redeterminations under SSA title XVI (Supplemental Security Income) (SSI). (Sec. 5102) Prescribes the schedule of administrative fees the Commissioner of Social Security shall assess each State from FY 1997 through 2003 and after for making optional and mandatory State SSI payments to individuals. Revises requirements for deposit of such fees, directing that a portion be credited to a special fund for FY 1998 and subsequent fiscal years for use in defraying expenses. Provides that the amounts so credited shall not be scored as receipts under the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act), but credited as a discretionary offset to discretionary spending. Authorizes appropriations. Subtitle C: Child Support Enforcement - Amends SSA title III (Unemployment Insurance) with respect to the authority to permit certain redisclosures of wage and claim information for purposes related to the child support enforcement program under SSA title IV part D (Child Support and Establishment of Paternity). Subtitle D: Restricting Welfare and Public Benefits for Aliens - Amends PRAWORA to make aliens eligible for SSI who, as of the date of enactment of such Act, were receiving such benefits, or were legally residing in the United States and are blind or disabled. Extends the SSI grandfather provision through September 30, 1998. (Sec. 5302) Extends from five to seven years the refugee and asylee eligibility period for SSI and Medicaid, and includes Cuban and Haitian entrants within such category. Provides a five-year food stamp eligibility period for such aliens. Includes Cuban and Haitian entrants within the definition of "qualified alien" for purposes of welfare and public benefits. Exempts such aliens from specified periods of ineligibility for State and Federal means-tested benefits. (Sec. 5303) Exempts: (1) certain American Indians (including persons born in Canada) from SSI and Medicaid eligibility limitations; and (2) certain SSI recipients with pre-January 1, 1979 applications from SSI eligibility limitations. (Sec. 5305) States that an alien who is ineligible for food stamps shall not be eligible for such program based upon SSI eligibility. Authorizes Medicaid eligibility based upon SSI eligibility. (Sec. 5306) Treats certain Amerasian immigrants as refugees for purposes of specified public benefits eligibility. (Sec. 5307) Authorizes States to require State and local assistance applicants to provide v

Amendments:

Summary: H.R.2015 — 105th Congress (1997-1998)

There are 3 summaries for this bill. Line item veto by President (08/11/1997)Conference report filed in House (07/30/1997)Introduced in House (06/24/1997)     Bill summaries are authored by CRS. $("#summarySelector").congress_dropDownNavigation({ stubUrl: '/bill/105th-congress/house-bill/2015/summary', suffix: '' }); Shown Here:
Line item veto by President (08/11/1997) (On June 25, 1998, the Supreme Court ruled that the Line Item Veto Act (Public Law 104-130) is unconstitutional, thus restoring provisions that had been cancelled as summarized below.) (On August 11, 1997, the President line-item-vetoed Sec. 4722(c), which deemed to be permissible broad-based health care related taxes certain taxes, fees, or assessments collected by New York State from a health care provider before June 1, 1997, for which a specified waiver has been applied, or would be but for this provision. The provision would thus exempt such taxes, fees, or assessments from the requirement that provider-specific taxes be subtracted from the State share of Medicaid expenditures for purposes of Federal share calculation. The following revised digest of H.R. 2015 reflects the Act as signed into law, minus the line-item-vetoed provision. For more information on the specific items vetoed, see the text of the conference report for H.R. 2015, H.Rept. 105-217, and Presidential Cancellation Number 97-3.) TABLE OF CONTENTS: Title I: Food Stamp Provisions Title II: Housing and Related Provisions Title III: Communications and Spectrum Allocation Provisions Title IV: Medicare, Medicaid, and Children's Health Provisions Subtitle A: Medicare+Choice Program Subtitle B: Prevention Initiatives Subtitle C: Rural Initiatives Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity Subtitle E: Provisions Relating to Part A Only Subtitle F: Provisions Relating to Part B Only Subtitle G: Provisions Relating to Parts A and B Subtitle H: Medicaid Subtitle I: Programs of All-Inclusive Care for the Elderly (PACE) Subtitle J: State Children's Health Insurance Program Title V: Welfare and Related Provisions Subtitle A: TANF Block Grant Subtitle B: Supplemental Security Income Subtitle C: Child Support Enforcement Subtitle D: Restricting Welfare and Public Benefits for Aliens Subtitle E: Unemployment Compensation Subtitle F: Welfare Reform Technical Corrections Subtitle G: Miscellaneous Title VI: Education and Related Provisions Subtitle A: Higher Education Subtitle B: Repeal of Smith-Hughes Vocational Education Act Title VII: Civil Service Retirement and Related Provisions Title VIII: Veterans and Related Matters Subtitle A: Extension of Temporary Authorities Subtitle B: Copayments and Medical Care Cost Recovery Subtitle C: Other Matters Title IX: Asset Sales, User Fees, and Miscellaneous Provisions Subtitle A: Asset Sales Subtitle B: User Fees Subtitle C: Miscellaneous Provisions Title X: Budget Enforcement and Process Provisions Subtitle A: Amendments to the Congressional Budget and Impoundment Control Act of 1974 Subtitle B: Amendments to the Balanced Budget and Emergency Deficit Control Act of 1985 Title XI: District of Columbia Revitalization Subtitle A: District of Columbia Retirement Funds Subtitle B: Management Reform Plans Subtitle C: Criminal Justice Subtitle D: Privatization of Tax Collection and Administration Subtitle E: Financing of District of Columbia Accumulated Deficit Subtitle F: District of Columbia Bond Financing Improvements Subtitle G: District of Columbia Government Budget Subtitle H: Miscellaneous Provisions Balanced Budget Act of 1997 - Title I: Food Stamp Provisions - Amends the Food Stamp Act to define "caseload" and "covered individual." Authorizes State agencies to provide an additional 15 percent exemption from the food stamp program (program) work requirement for specified covered individuals. Provides for related caseload and exemption adjustments. (Sec. 1002) Obligates additional FY 1996 through 2002 funds for program employment and training programs. Sets forth State allocation provisions. (Sec. 1003) Requires State agencies, with assistance provided by the Secretary of Agriculture, to deny program benefits to prisoners incarcerated for more than 30 days. (Sec. 1004) Directs the Secretary to make specified funds available for FY 1998 through 2001 to eligible private nonprofit organizations and State agencies for nutrition education. Title II: Housing and Related Provisions - Amends the Balanced Budget Downpayment Act, I to extend permanently certain foreclosure avoidance provisions under the single family housing mortgage insurance program. (Sec. 203) Amends the United States Housing Act of 1937 with respect to the section 8 rental assistance program to make specified maximum monthly rent adjustment provisions for certain new and rehabilitated and nonturnover units applicable to FY 1999 and thereafter. Title III: Communications and Spectrum Allocation Provisions - Amends the Communications Act of 1934 (the Act) to make competitive bidding authority with respect to licenses or construction permits involving uses of the electromagnetic spectrum (spectrum) inapplicable to such licenses and permits issued by the Federal Communications Commission (FCC) that are for: (1) certain public safety radio services; (2) initial licenses or permits assigned to existing terrestrial broadcast licensees for digital television (TV) service; or (3) noncommercial educational or public broadcast stations. Requires the FCC to provide for the design and conduct of spectrum competitive bidding using a contingent combinatorial bidding system that permits prospective bidders to bid on combinations of licenses in a single bid and to enter multiple alternative bids within a single bidding round. Directs the FCC to prescribe methods by which a reasonable reserve price will be required, or a minimum bid will be established, to obtain any license or permit assigned under competitive bidding, unless determined not to be in the public interest. Repeals a requirement that any funds appropriated to the FCC for FY 1994 through 1998 for assigning licenses using random selection procedures be retained in the FCC's salaries and expenses account. Requires competitive bidding information to be included in annual FCC reports in order for any funds collected after FY 1998 to be retained in such account. Extends competitive bidding authority through FY 2008. Prohibits the FCC, after July 1, 1997, from issuing a license or construction permit for spectrum through a random selection system. Excepts from such prohibition licenses or permits for noncommercial educational or public broadcast stations. Provides for the applicability of competitive bidding requirements to pending comparative licensing cases. Makes available for assignment for commercial use the 1710 to 1755 megahertz (mhz) frequency band. Directs the FCC to assign licenses for such use by competitive bidding commenced after January 1, 2001. Directs the FCC to assign certain additional spectrum by competitive bidding no later than September 30, 2002. Directs the FCC to reallocate: (1) spectrum located at 2110 to 2150 mhz; and (2) 15 mhz located in the 1990 to 2110 range, with an exception in both cases when not in the public interest. Requires the FCC to notify the Secretary of Commerce if it is unable to provide for effective relocation of incumbent licensees to available bands of frequencies and has identified bands suitable for such relocation that are allocated for Federal use but could be reallocated pursuant to the National Telecommunications and Information Administration Organization Act (NTIA). Amends NTIA to direct the Secretary to report to the President, the FCC, and the Congress on recommendations for reallocating frequencies allocated for Federal use other than by Government licensees under the Communications Act of 1934. Authorizes any entity which operates a Government station to accept payment for frequency relocation expenses. Provides a relocation process triggered by a petition under NTIA. Allows a Federal entity to reclaim a former frequency if it demonstrates that relocated facilities or spectrum are not comparable to its former facilities or spectrum. Requires the Secretary to recommend for reallocation for use other than by Government stations a band of frequencies that: (1) in the aggregate span at least 20 mhz; (2) are located below three gigahertz; and (3) meet other relocation criteria. Directs the FCC to prepare and submit to the President and the Congress a plan for the immediate allocation and assignment of frequencies identified under this title. (Sec. 3003) Amends the Act to prohibit the renewal of a license authorizing analog TV services beyond the end of 2006, with an extension in specified circumstances. Prohibits the FCC, in prescribing regulations relating to qualifications of spectrum bidders, from: (1) precluding any party from being a qualified bidder for spectrum allocated for any use that includes digital TV service on the basis of the FCC's duopoly rule or newspaper cross-ownership rule; or (2) applying either rule to preclude a successful bidder from using such spectrum for digital TV service. (Sec. 3004) Directs the FCC, no later than January 1, 1998, to allocate from radio spectrum between 746 and 806 mhz: (1) 24 mhz for public safety services; and (2) the remainder for commercial purposes to be assigned by competitive bidding. Sets deadlines for the assignment of such licenses and the commencement of competitive bidding. Provides for the licensing of unused frequencies for public safety services. (Sec. 3005) Authorizes the FCC to allocate spectrum to provide flexibility of use, as long as such use is consistent with international agreements and upon a finding that such use is in the public interest and would not deter investment or result in harmful interference among users. (Sec. 3006) Authorizes appropriations to the FCC for FY 2001 for universal service support programs. (Sec. 3007) Directs the FCC to conduct all competitive bidding required under this title so that proceeds from such bidding are deposited no later than the end of FY 2002. (Sec. 3008) Requires seven days' public notice before the granting by the FCC of an application for spectrum frequency assignment under the Act. Title IV: Medicare, Medicaid, and Children's Health Provisions - Subtitle A: Medicare+Choice Program - Chapter 1: Medicare+Choice Program - Amends title XVIII (Medicare) of the Social Security Act (SSA) to establish a Medicare+Choice program under which each Medicare+Choice eligible individual (one entitled to benefits under Medicare part A (Hospital Insurance) and enrolled under Medicare part B (Supplementary Medical Insurance)) is entitled to elect, in accordance with certain procedures, to receive Medicare benefits either through the original Medicare fee-for-service program or through a Medicare+Choice plan. (Sec. 4001) Outlines the types of Medicare+Choice plans that may be available, namely: (1) coordinated care plans; (2) combination of a medical savings account (MSA) plan and contributions into a Medicare+Choice MSA; and (3) private fee-for-service plans. Sets forth various special rules regarding, among other things, residence, individuals with end-stage renal disease, and individuals covered under the Federal Employees Health Benefits Program or eligible for veterans' or military health benefits. Directs the Secretary of Health and Human Services (HHS) to: (1) provide for broad dissemination of coverage option and comparison information to Medicare beneficiaries and prospective Medicare beneficiaries; and (2) maintain a toll-free number for inquiries about Medicare+Choice options and program operation, as well as an Internet site through which individuals may obtain such information electronically. Requires: (1) any Medicare+Choice organization to accept without restrictions individuals eligible to make an election at any time during which such elections are accepted; and (2) approval of Medicare+Choice marketing material and application forms before they are distributed. Provides for continuous open enrollment and disenrollment through 2001, the first six months of 2002, and the first three months of every subsequent year, limiting an individual's change of enrollment during such initial period to one. Provides for an annual, coordinated election period during November for all participants as well as special election periods in certain circumstances. Outlines benefits and beneficiary protections. Requires each Medicare+Choice plan (except MSA plans) to provide those items and services for which benefits are available under Medicare parts A and B (other than hospice care) and specified additional benefits, as well, at its option, as certain supplemental benefits, subject to the Secretary's approval. Excludes individuals enrolled under a MSA plan from participating in such supplemental package. Prohibits a Medicare+Choice organization from denying, limiting, or conditioning coverage or benefits based on any described health status-related factor. Prescribes plan disclosure requirements and an ongoing quality assurance program. Outlines a mechanism for grievances and appeals. Sets forth certain payment rules for providers not participating in the Medicare+Choice program. Directs the Secretary to make monthly advance payments with respect to an individual's coverage to Medicare+Choice organizations according to a specified formula. Requires the Secretary to establish separate payment rates for individuals with end-stage renal disease. Sets forth special rules for individuals electing MSA plans. Requires such an individual to establish a Medicare+Choice MSA into which the Secretary shall make monthly deposits out of the Medicare trust funds in accordance with prescribed guidelines. Prescribes special rules for hospice care. Details rules for the submission and charging of premiums by each Medicare+Choice organization. Sets limitations on enrollee liability for basic, additional, and supplemental benefits. Prescribes a special rule for private fee-for-service plans. Prohibits a State from imposing a premium tax or similar tax with respect to payments to Medicare+Choice organizations. Sets out organizational and financial requirements for Medicare+Choice organizations and provider-sponsored organizations. Directs the Secretary to establish solvency and capital adequacy standards for provider-sponsored organizations, and other standards for Medicare+Choice organizations. Prescribes requirements, including minimum enrollment requirements, for contracts between the Secretary and Medicare+Choice organizations. Provides for: (1) intermediate sanctions and civil monetary penalties to enforce contract provisions; and (2) procedures for termination of contracts. (Sec. 4002) Details transitional rules for the current Medicare health maintenance organization (HMO) program, as well as specified conforming changes in the Medicare supplemental health insurance policy (Medigap) program. (Sec. 4006) Amends the Internal Revenue Code to outline special rules for Medicare+Choice MSAs. Excludes from gross income any payment by the Secretary to an individual's Medicare+Choice MSA. Excludes from qualified deductible medical expenses any amounts paid for the medical care of any individual but the account holder. Prescribes a penalty for distributions from the Medicare+Choice MSA not used for qualified medical expenses if the minimum balance is not maintained, with certain exceptions if the account holder becomes disabled or dies. Chapter 2: Demonstrations - Directs the Secretary to establish a Medicare prepaid competitive pricing demonstration project in up to four (eventually seven) designated Medicare payment areas, of which initially three shall be in urban areas and one in a rural area. (Sec. 4012) Directs the Secretary to appoint a Competitive Pricing Advisory Committee to recommend areas for the demonstration and research design for project implementation. (Sec. 4014) Amends the Omnibus Budget Reconciliation Act of 1987 to extend the authorities for the social health maintenance organization (SHMO) demonstration project. Amends the Omnibus Budget Reconciliation Act of 1993 to increase the cap on the number of individuals who may participate in a SHMO demonstration. Directs the Secretary to submit to the Congress a plan for the integration of SHMO health plans and similar plans as an option under the Medicare+Choice program. (Sec. 4015) Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a demonstration (subvention) project under which the HHS Secretary shall reimburse the Secretary of Veterans Affairs from the Medicare trust funds for Medicare health care services furnished to certain targeted Medicare-eligible military retirees or dependents. Authorizes the Secretary of Defense to modify existing TRICARE contracts in order to provide Medicare health care services to project participants. (Sec. 4016) Directs the Secretary to conduct demonstration projects in a certain number of rural and urban areas for the purpose of evaluating methods, such as case management and other models of coordinated care, that improve the quality of items and services provided to target individuals, and reduce Medicare expenditures for such items and services. Defines a target individual as an individual with a chronic illness who is enrolled under the Medicare parts A and B fee-for-service program. Provides for project funding. (Sec. 4017) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to direct the Secretary to work with each municipal health service demonstration project to develop a plan for the orderly transition of such projects and project participants to a non-demonstration project health care delivery system, such as through integration with a private or public health care plan, including a Medicaid managed care or Medicare+Choice plan. (Sec. 4018) Directs the Secretary to implement a time-limited demonstration project for the purpose of evaluating the use of a third-party contractor to conduct the Medicare+Choice plan enrollment and disenrollment functions in an area. (Sec. 4019) Extends for an additional two years certain Medicare community nursing organization demonstration projects under the Omnibus Budget Reconciliation Act of 1987. Chapter 3: Commissions - Establishes the National Bipartisan Commission on the Future of Medicare to: (1) review and analyze the long-term financial condition of the Medicare program; (2) identify problems that threaten the financial integrity of the Medicare trust funds, including the extent to which current Medicare update indexes do not accurately reflect inflation; and (3) analyze potential solutions to the problems identified that will ensure both the financial integrity of Medicare and the provision of appropriate benefits. Requires the Commission to make recommendations: (1) to restore the solvency of the Federal Hospital Insurance Trust Fund and the financial integrity of the Federal Supplementary Medical Insurance Trust Fund; and (2) to establish the appropriate financial structure of the Medicare program as a whole and the appropriate balance of benefits covered and beneficiary contributions. Requires recommendations on: (1) the financing of graduate medical education; (2) the feasibility of allowing individuals between age 62 and the Medicare eligibility age to buy into the Medicare program; and (3) the impact of chronic disease and disability trends on future costs and quality of services under the current benefit, financing, and delivery system structure of the Medicare program. Requires a report to the President and the Congress. Authorizes appropriations. (Sec. 4022) Establishes the Medicare Payment Advisory Commission to replace the Prospective Payment Assessment Commission and the Physician Payment Review Commission, hereby abolished. Requires the new Commission to review and make recommendations to the Congress about payment policies under Medicare (including certain specific payment-related topics). Authorizes appropriations. Chapter 4: Medigap Protections - Amends SSA title XVIII with respect to the issuer of a Medicare supplemental (Medigap) policy in the case of certain individuals terminated by an employee welfare benefit plan providing supplementary health benefits who seek to enroll under a Medigap policy not later than 63 days after termination or disenrollment. Prohibits the Medigap issuer from: (1) denying or conditioning the issuance or effectiveness of such a policy; (2) discriminating in the pricing of such policy because of health status, claims experience, receipt of health care, or medical condition; or (3) imposing an exclusion of benefits based on a pre-existing condition. (Sec. 4031) Specifies limitations on the imposition of preexisting condition exclusions during the initial open enrollment period in the case of a Medicare supplemental policy issued to an individual who is age 65 or older with a certain minimum period of creditable coverage. (Sec. 4032) Creates under the Medicare supplemental policy program a high deductible feature which requires the policy beneficiary to pay annual out-of-pocket expenses (other than premiums) of $1,500 (indexed for inflation) before the policy begins payment of benefits. Chapter 5: Tax Treatment of Hospitals Participating in Provider- Sponsored Organizations - Amends the Internal Revenue Code to provide that an organization shall not fail to be treated as a tax-exempt charitable organization solely because a hospital which it owns and operates also participates in a provider-sponsored organization, whether or not the provider-sponsored organization is exempt from tax. Provides that any person with a material financial interest in such a provider-sponsored organization shall be treated as a private shareholder or individual with respect to the hospital. Subtitle B: Prevention Initiatives - Outlines various specified new preventive health measures covered under Medicare, namely coverage for: (1) an annual screening mammography for women over age 39 and triennial screening pap smear and screening pelvic exam for any woman (annually for a woman with cervical or vaginal cancer or other abnormality, or who is at high risk of developing such a cancer), while providing for a waiver of deductible; (2) annual prostate cancer screening tests; (3) colorectal cancer screening tests, subject to prescribed frequency and payment limits; (4) diabetes outpatient self-management training services, including blood-testing strips (with a ten percent payment reduction after 1997) and glucose monitors as durable medical equipment (DME) for individuals with diabetes; and (5) bone mass measurements for qualified individuals. (Sec. 4105) Directs the Secretary to establish outcome measures, including glysolated hemoglobin (past 90-day average blood sugar levels), for the purpose of evaluating the improvement of health status of Medicare beneficiaries with diabetes mellitus, with a view to recommending coverage modifications. (Sec. 4107) Extends through FY 2002 the Influenza and Pneumococcal Vaccination Campaign of the Health Care Financing Administration (HCFA). Authorizes appropriations. (Sec. 4108) Directs the Secretary to request the National Academy of Sciences to analyze (for a report to specified congressional committees) the expansion or modification of Medicare preventive benefits to include medical nutrition therapy services by a registered dietitian, skin cancer screening, medically necessary dental care, and other specified items. Subtitle C: Rural Initiatives - Replaces the Essential Access Community Hospital Program with an optional Medicare Rural Hospital Flexibility Program under which participating States shall develop at least one rural health network in the State and at least one facility designated as a critical access hospital in accordance with prescribed guidelines. Authorizes the Secretary to award grants to States for: (1) planning and implementation of the program; and (2) establishment or expansion of rural emergency medical services. Authorizes appropriations. Directs the HCFA Administrator to report to the Congress on the feasibility of, and administrative requirements necessary to establish, an alternative for certain medical diagnoses to the current 96-hour limitation for inpatient care in critical access hospitals. (Sec. 4202) Amends SSA title XVIII to prohibit denial, on the basis of wage comparisons, of a rural referral center's request for reclassification. Provides that any hospital classified as a rural referral center for FY 1991 shall be classified as such for FY 1998 and each subsequent fiscal year. (Sec. 4204) Extends through FY 2001 the special treatment of payment methodology and target amount for Medicare-dependent, small rural hospitals. (Sec. 4205) Amends requirements for rural health clinic services with respect to: (1) per-visit payment limits for provider-based clinics; (2) mandatory quality assessment and performance improvement programs; (3) limitation of waivers of certain staffing requirements to clinics participating in the rural health clinic program; (4) the insufficiency of needed health care practitioners in shortage areas; and (5) regulations providing for payment for certain physician assistant services. (Sec. 4206) Directs the Secretary to make payments from the Federal Supplementary Medical Insurance Trust Fund under Medicare part B in accordance with a specified payment methodology for professional consultation via telecommunications systems with a physician or practitioner furnishing a service for which payment may be made to a Medicare beneficiary residing in a rural health professional shortage area, notwithstanding that the individual physician or practitioner providing the professional consultation is not at the same location as the physician or practitioner furnishing the service to that beneficiary. Directs the Secretary to report to the Congress: (1) a detailed analysis of telemedicine and telehealth (T&T) services; and (2) an examination of the possibility of making similar payments for professional consultation via telecommunications systems to Medicare beneficiaries who do not reside in a rural health professional shortage area, are homebound or nursing homebound, and for whom being transferred for health care services imposes a serious hardship. (Sec. 4207) Directs the Secretary to conduct a demonstration project to use eligible health care provider telemedicine networks to apply high-capacity computing and advanced networks to improve primary care and prevent health care complications to Medicare beneficiaries with diabetes mellitus who reside in medically underserved rural or inner-city areas. Provides funding. Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity - Chapter 1: Revisions to Sanctions for Fraud and Abuse - Amends SSA title XI, with respect to health care related crimes, to exclude from the Medicare and State health care programs any person: (1) for ten years for one previous conviction for one or more offenses; and (2) permanently for two or more previous convictions of one or more offenses. (Sec. 4302) Authorizes the Secretary to refuse to enter into Medicare agreements with individuals or entities convicted of felonies for offenses determined inconsistent with the best interests of program beneficiaries. (Sec. 4303) Authorizes the Secretary to exclude from the Medicare program any entity with respect to which a sanctioned person with an ownership or control interest in it transfers such interest in anticipation of (or following) a conviction, assessment, or exclusion against the person, to an immediate family member or member of the household who continues to maintain such an interest. (Sec. 4304) Provides for the imposition of civil monetary penalties for: (1) any person who arranges or contracts with an individual or entity that the person knows or should know is excluded from participation in a Federal health care program; and (2) kickbacks. Chapter 2: Improvements in Protecting Program Integrity - Amends SSA title XVIII to require the Secretary, in the annual notice of Medicare benefits, to urge beneficiaries to check the notice and any itemized statement for accuracy and report any errors or questionable charges by calling a certain toll-free number. Authorizes Medicare beneficiaries to submit written requests for itemized bills of medical or other items or services provided, and review them. Requires the Secretary to take measures to recover amounts unnecessarily paid out. (Sec. 4312) Outlines various specified requirements regarding disclosure of information and surety bonds with regard to DME suppliers. Includes surety bond requirements for home health agencies. Authorizes the Secretary to apply disclosure and surety bond requirements to other health care providers or item and service suppliers (except physicians or practitioners). Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORFs) and to rehabilitation agencies. (Sec. 4313) Requires any participating entity to disclose to the Secretary its own employer identification numbers and social security account numbers, as well as those of persons with ownership or control interests and subcontractors in which the entity has a five percent or greater interest. Directs the Secretary to report to Congress on the steps taken to assure the confidentiality of such social security account numbers. (Sec. 4314) Requires the Secretary, upon a party's request, to issue binding advisory opinions on whether a referral relating to designated health services (other than clinical laboratory services) is a prohibited physician self-referral. (Sec. 4315) Amends SSA title XVIII to: (1) replace the reasonable charge payment methodology with fee schedules developed by the Secretary for particular services; (2) provide for application of inherent reasonableness to charges for all Medicare part B services other than physicians' services; (3) require bills and requests for payment for services by non-physician practitioners to include diagnostic codes; (4) outline requirements to provide diagnostic information when ordering certain items or services furnished by another entity; (5) mandate establishment of competitive acquisition areas for contract award purposes for the furnishing under Medicare part B after 1997 of described items and services; and (6) prohibit payment under Medicare part A or part B for any expenses for an item or service furnished in a competitive acquisition area by an entity other than an entity with which the Secretary has contracted, except for urgent need, or in other circumstances specified by the Secretary. (Sec. 4320) Excludes from reasonable costs and declares unreimbursable under Medicare any payments for certain items unrelated to patient care, including: (1) entertainment, gifts, or donations; (2) personal use of motor vehicles; (3) costs for fines and penalties resulting from violations of Federal, State, or local laws; and (4) education expenses for spouses or other dependents of service providers, their employees, or contractors. (Sec. 4321) Requires a Medicare hospital's discharge planning process to include information on the availability of home health services through certain individuals or entities. Requires a discharge plan: (1) not to specify or otherwise limit the qualified provider which may provide home health services; and (2) identify any entity to whom the individual is referred in which the hospital has a disclosable financial interest. Requires the service provider agreement to require disclosure of any financial interest a hospital has in any entity to which individuals are referred, or any entity has in the hospital, and related information. Chapter 3: Clarifications and Technical Changes - Makes technical amendments with respect to fraud and abuse. Subtitle E: Provisions Relating to Part A Only - Chapter 1: Payment of PPS Hospitals - Revises requirements for: (1) prospective payment system (PPS) hospital payment updates; (2) maintenance of savings from the temporary reduction in capital payments for prospective payment system (PPS) hospitals; (3) additional payments to any hospital with a disproportionate share of low-income patients (disproportionate share hospital (DSH)); (4) the sales price of a Medicare capital asset (book value); (5) elimination of indirect medical education (IME) and DSH payments attributable to outlier payments; (6) the base rate of payments to Puerto Rico hospitals; (7) payments to hospitals for certain discharges to post-acute care; (8) inclusion of Stanly County, North Carolina, in the large urban area of Charlotte-Gastonia-Rock Hill-North Carolina-South Carolina; and (9) the floor on wage area indexes. (Sec. 4409) Requires the Secretary to publish and use alternative guidelines under which certain disproportionately large hospitals qualify for geographic reclassification. Chapter 2: Payment of PPS-Exempt Hospitals - Revises requirements for the payment of PPS-exempt hospitals, including those for: (1) payment updates; (2) reductions to capital payments; (3) bonus and relief payments; (4) payment and the target amount for new providers; (5) treatment of certain long-term care hospitals located within other hospitals; (6) rebasing; (7) certain cancer hospitals; and (8) elimination of exemptions for certain hospitals. (Sec. 4421) Provides for a Medicare PPS for inpatient rehabilitation hospital services. (Sec. 4422) Directs the Secretary to submit to the Congress a legislative proposal for establishing a case-mix adjusted PPS for long-term care hospitals. Chapter 3: Payment for Skilled Nursing Facilities - Declares that updates to per diem limits, with respect to payments to skilled nursing facilities (SNFs), effective for FY 1998, shall be based on cost limits effective for FY 1997. (Sec. 4432) Mandates a PPS for SNF services along with consolidated billing for them. Directs the Secretary, in order to ensure that Medicare beneficiaries are furnished appropriate SNF services, to establish a thorough medical review process to examine the provisions of this section and their effect on the quality of covered SNF services furnished to Medicare beneficiaries. Chapter 4: Provisions Related to Hospice Services - Provides for update of payments for hospice services. Bases payment for home hospice care on the location where care is furnished. Revises the home hospice care benefit period. Provides for home hospice care coverage of any other items and services specified in a plan. Allows waiver of certain staffing requirements for hospice care programs in non-urbanized areas. Chapter 5: Other Payment Provisions - Requires reductions in payments for enrollee bad debt. Repeals the termination date to make a permanent extension of the hemophilia passthrough. Requires a certain reduction in the part A Medicare premium for specified public retirees. Authorizes Medicare and Medicaid coverage of inpatient hospital and post-hospital extended care services in religious nonmedical health care institutions (currently limited to Christian Science sanatoria). Subtitle F: Provisions Relating to Part B Only - Chapter 1: Services of Health Professionals - Revises requirements for the payment of physicians' services, with changes: (1) establishing a single conversion factor for 1998; (2) adding new update provisions; (3) replacing the volume performance standard with sustainable growth rate; (4) adding payment rules for anesthesia services; and (5) providing for adjustments in relative value units for 1998, and the application of resource-based methodology to malpractice relative value units. (Sec. 4505) Directs the Comptroller General to review and evaluate the proposed rule on resource-based methodology for practice expenses issued by the HCFA. (Sec. 4506) Directs the Secretary to determine for each hospital: (1) its hospital-specific per discharge relative value for physicians' services; and (2) whether such value is projected to be excessive. Requires the Secretary to notify the medical executive committee of a subset of the hospitals identified as having an excessive hospital-specific relative value, and evaluate their responses with the responses of other hospitals so identified that were not notified. (Sec. 4507) Amends SSA title XVIII to declare that nothing shall prohibit a physician or practitioner from privately contracting with a Medicare beneficiary for any item or service for which no Medicare claim will be submitted, and for which the physician or practitioner shall receive no Medicare reimbursement. (Sec. 4511) Increases Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. (Sec. 4513) Repeals the requirement of an X-ray for reimbursement for chiropractic services. Directs the Secretary to develop utilization guidelines for the coverage of chiropractic services where a subluxation has not been demonstrated by an X-ray. Chapter 2: Payment for Hospital Outpatient Department Services - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 4522) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 4523) Directs the Secretary to establish a PPS for hospital outpatient department services. Chapter 3: Ambulance Services - Provides for certain interim reductions in payments for ambulance services. Directs the Secretary to establish a prospective fee schedule for payment of such services. Provides that, in promulgating regulations for coverage of ambulance services, the Secretary may cover advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. (Sec. 4532) Directs the Secretary to establish up to three demonstration projects contracting with local governments for ambulance services paid for under Medicare. Chapter 4: Prospective Payment for Outpatient Rehabilitative Services - Provides for a PPS for outpatient physical (including speech-language pathology) and occupational therapy services. Chapter 5: Other Payment Provisions - Provides for a reduction in payment amounts for items of DME and for clinical diagnostic laboratory tests. Provides for a payment freeze for parenteral and enteral nutrients, supplies, and equipment. Revises update requirements for payment for orthotics and prosthetics, and other payment requirements for oxygen and oxygen equipment, ambulatory surgical services, and drugs and biologicals. (Sec. 4552) Requires the Comptroller General to study and report to specified congressional committees on access to home oxygen equipment. Requires the Secretary to arrange for peer review organizations to evaluate such access. (Sec. 4553) Directs the Secretary to request the National Academy of Sciences to study (for a report to specified congressional committees) Medicare payments for clinical laboratory tests. (Sec. 4554) Directs the Secretary to divide the United States into up to five regions, and designate a single carrier for each region, for the payment of Medicare part B claims for clinical diagnostic laboratory services. Requires the Secretary to adopt uniform policies for clinical diagnostic laboratory tests. (Sec. 4557) Provides for coverage of oral anti-nausea drugs under a chemotherapeutic regimen. (Sec. 4558) Requires the Secretary to: (1) audit cost reports of each renal dialysis provider at least once every three years; and (2) develop a method to measure and report on the quality of Medicare renal dialysis services. (Sec. 4559) Directs the Secretary, for electrocardiogram tests furnished during 1998, to restore separate part B payment for electrocardiogram transportation based upon methods in effect on December 31, 1996. Requires the Secretary, by a certain deadline, to recommend to specified congressional committees whether portable electrocardiogram transportation should be covered under Medicare part B. Chapter 6: Part B Premium and Related Provisions - Revises the formula for the monthly Medicare part B premium rate the Secretary promulgates each September for the following calendar year. Requires such rate to equal 50 percent of the monthly actuarial rate for enrollees age 65 and over for that succeeding calendar year. (Sec. 4581) Provides for a special Medicare enrollment period, with no premium penalty for late enrollment, for certain disabled workers whose continuous enrollment under an employer's group health plan is involuntarily terminated in certain circumstances. (Sec. 4582) Allows appropriate State or local governmental entities to elect to pay part B premiums for certain eligible individuals. Subtitle G: Provisions Relating to Parts A and B - Chapter 1: Home Health Services and Benefits - Provides that, in establishing payment limits for cost reporting periods beginning after September 30, 1997, the Secretary shall not take into account any changes in the home health market basket with respect to cost reporting periods which began on or after July 1, 1994, and before July 1, 1996. (Sec. 4602) Revises requirements for interim payments for home health services. Directs the Secretary to expand research on a PPS for home health agencies under the Medicare program that ties prospective payments to a unit of service. (Sec. 4603) Directs the Secretary to establish a PPS for home health services for cost reporting periods beginning in FY 2000. (Sec. 4604) Bases the payment for home health services on the location where the service is furnished. (Sec. 4611) Provides for a modification of the Medicare part A home health benefit for individuals enrolled under Medicare part B. Provides for specified post-institutional home health services. (Sec. 4613) Directs the Secretary to study and report to the Congress on the criteria that should be applied in determining whether an individual is homebound for purposes of qualifying for Medicare home health services. (Sec. 4614) Provides for the denial of home health claims based on home health services the frequency and duration of which are in excess of normative guidelines established by the Secretary. (Sec. 4615) Denies payment for home health benefits based solely on venipuncture to obtain a blood sample. (Sec. 4616) Directs the Secretary to estimate part A and part B outlays for FY 1998 through 2002 for specified congressional committees, and report annually a comparison of actual outlays with such estimates. Chapter 2: Graduate Medical Education - Revises requirements for direct and indirect Medicare payments for graduate medical education (GME). Limits the number of residents in allopathic and osteopathic medicine. Permits payment to qualified nonhospital providers for direct GME costs. Prohibits restandardization of certain indirect GME payment amounts. Requires the Secretary to provide for direct and indirect GME payments to hospitals for Medicare+Choice enrollees. Makes a special reimbursement rule for primary care combined residency programs, setting the period of board eligibility. (Sec. 4626) Provides for incentive payments to hospitals under plans for voluntary reduction in the number of full-time equivalent residents in an approved medical training program. (Sec. 4628) Directs the Secretary to establish a demonstration project under which GME payments shall be made to consortia of teaching hospitals and other medical entities. (Sec. 4629) Directs the Medicare Payment Advisory Commission to develop recommendations to the Congress on whether and to what extent Medicare payment policies and other Federal policies regarding teaching hospitals and GME should be changed. (Sec. 4630) Directs the Secretary to study and report to the appropriate congressional committees on variations among hospitals in the overhead and supervisory physician components of their direct medical education costs. Chapter 3: Provisions Relating to Medicare Secondary Payer - Revises requirements for Medicare as secondary payer. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Chapter 4: Other Provisions - Amends SSA title XVIII to require placement of an advance directive in a prominent part of the individual's current medical record. (Sec. 4642) Provides for an increased certification period for certain organ procurement organizations. (Sec. 4643) Establishes in the HCFA the position of Chief Actuary. Subtitle H: Medicaid - Chapter 1: Managed Care - Amends SSA title XIX (Medicaid) to establish a new part B (Managed Care) giving States the option to require Medicaid-eligible individuals (except Medicare beneficiaries, Medicare-eligible individuals, and certain children with special needs) to enroll in managed care arrangements of the individual's choice as a condition of receiving Medicaid. (Sec. 4702) Grants States the option of providing Medicaid coverage of primary care case management services without the need for a waiver. (Sec. 4703) Repeals the (75-25) requirement that Medicare and Medicaid beneficiaries constitute less than 75 percent of the membership of a participating HMO. Repeals the prohibition on co-payments for services furnished by HMOs. (Sec. 4704) Prescribes requirements for: (1) access to emergency care; (2) annual external independent review of managed care entity activities and other specified quality care assurance measures; and (3) fraud and abuse prohibitions and protections. (Sec. 4705) Amends SSA title XIX (Medicaid) to require any State contracting with Medicaid managed care organizations to develop and implement a quality assessment and improvement strategy incorporating certain access standards, monitoring procedures, and other measures. Directs the Comptroller General to analyze and report to specified congressional committees on the quality assurance programs and accreditation standards applicable to managed care entities operating in the private sector or under Medicare contracts to determine if such programs and standards consider the accessibility and quality of the health care items and services delivered under such contracts to low-income individuals. Directs the Secretary to study and report to such committees on safeguards that may be needed to ensure that the health care needs of individuals with special health care needs and chronic conditions who are enrolled with Medicaid managed care organizations are adequately met. (Sec. 4706) Requires an HMO to meet solvency standards established by the State for private HMOs, or be State-licensed or -certified as a risk-bearing entity. (Sec. 4708) Increases from $100,000 to $1 million, indexed annually, the threshold amount for HMO contracts requiring the Secretary's prior approval. Permits the same copayments in HMOs as in fee-for-service. Chapter 2: Flexibility in Payment of Providers - Repeals "Boren Amendment" provider reimbursement requirements. Requires the Secretary to study and report to the appropriate congressional committees on the effect on access to services, service quality, and service safety of the rate-setting methods used by States as a result of such repeal. (Sec. 4712) Specifies reductions from 100 percent to 70 percent between FY 1999 through 2003 in the percentage of reasonable costs that shall be paid under a State plan for federally-qualified health center and rural health clinic services (with a special supplemental payment for services furnished under certain managed care contracts). (Sec. 4713) Repeals payment rate requirements for obstetrical and pediatric services. (Sec. 4714) Revises requirements for Medicaid payment rates for qualified Medicare beneficiaries, placing a limitation on nonparticipating providers. (Sec. 4715) Declares that, in the case of a Medicaid-eligible veteran residing in a State veterans' home, any veterans' pension over $90 per month shall be counted as income only for the purpose of applying such excess payment to the State veterans' home's cost of providing nursing care to the veteran. Chapter 3: Federal Payments to States - Revises specified limitations of Federal payments for inpatient hospital services furnished by disproportionate share hospitals (DSH), including limitations on certain State DSH expenditures to institutions for mental diseases or other mental health facilities. Requires direct State Medicaid payment to hospitals for managed care enrollees. (Sec. 4722) Revises the treatment as broad-based health care related taxes of certain State hospital taxes which currently are not subtracted as revenues from the State share of Medicaid expenditures for purposes of calculating the Federal share of such expenditures. Declares that an exemption from such State hospital tax for certain Federal-tax-exempt hospitals that do not accept Medicaid or Medicare payments (provide free care) shall not disqualify the hospital tax as a broad-based health care related tax (thus allowing continued exclusion of such State hospital tax from the requirement that provider-specific taxes be subtracted from the State share of Medicaid expenditures for purposes of Federal share calculation). (Sec. 4723) Specifies additional funding for State emergency health services furnished to undocumented aliens. (Sec. 4724) Prohibits the expenditure of Medicaid funds for roads, bridges, stadiums, and other items and services not covered by a State plan. Requires home health agencies to provide a surety bond. Revises conflict-of-interest safeguards. Declares that States are not required to provide medical assistance for items or services furnished by a person or entity convicted of a felony for an offense inconsistent with the best interests of beneficiaries under the State plan. Requires State action for program and beneficiary protection against waste, fraud, and abuse. Conditions issuance or renewal of a DME supplier provider number on the supplier's provision of a surety bond and disclosure of all persons with ownership or control interests in the supplier, and of all subcontractors in which the supplier has a five percent or greater interest. (Sec. 4725) Provides for increased Federal medical assistance percentages (FMAPs) for the District of Columbia and Alaska and increased payment caps for the territories. Chapter 4: Eligibility - Grants States the option to provide for 12-month continuous Medicaid eligibility for children. (Sec. 4732) Requires State Medicaid plan coverage of the Medicare cost-sharing for certain additional low-income Medicare beneficiaries whose income otherwise disqualifies them for specified Medicare benefits. (Sec. 4733) Grants States the option to permit workers with disabilities to buy into Medicaid. (Sec. 4734) Prescribes criminal penalties for knowingly and willfully, for a fee, counseling or assisting an individual to dispose of assets (including transfer in trust) in order for that individual to become Medicaid-eligible (fraudulent eligibility). (Sec. 4735) Declares that certain payments in a class settlement of the case of Susan Walker v. Bayer Corporation shall not be considered income or resources in determining Medicaid eligibility. Chapter 5: Benefits - Changes from mandatory to discretionary a State's authority to enroll individuals under private group health plans and pay their premiums. (Sec. 4742) Repeals: (1) certain physician qualification requirements with respect to services to pregnant women and to children under age 21; and (2) the requirement of prior institutionalization with respect to habilitation services furnished under a waiver for home or community-based services. (Sec. 4744) Requires the Secretary to study and report to the Congress on early and periodic screening, diagnostic, and treatment benefits. Chapter 6: Administration and Miscellaneous - Repeals requirements for inspections of the care being provided at mental hospitals and intermediate care facilities for the mentally retarded (ICFS-MR). (Sec. 4752) Authorizes a State, in lieu of terminating a noncompliant ICFS-MR, to establish alternative remedies if the State demonstrates to the Secretary's satisfaction that such alternative remedies are effective in deterring noncompliance and correcting deficiencies. (Sec. 4753) Revises requirements for mechanized claims processing and information retrieval systems. (Sec. 4754) Repeals the requirement for State refund to the Federal Government of any payments received during remediation of a noncompliant nursing facility. (Sec. 4755) Requires States to establish procedures to permit a nurse aide, in the case of a finding of neglect, to petition the State for name removal from the nurse aide registry upon a State determination that: (1) the employment and personal history of the nurse aide does not reflect a pattern of abusive behavior or neglect; and (2) the neglect involved in the original finding was a singular occurrence. (Sec. 4756) Includes the DRUGDEX Information System among the compendia to be used in drug use review for Medicaid payment. (Sec. 4757) Applies certain requirements to the extension of statewide comprehensive research and demonstration projects for which waivers of Medicaid compliance have been granted. (Sec. 4758) Amends the Omnibus Budget Reconciliation Act of 1989 to extend the moratorium on the treatment of the Kent Community Hospital Complex and Saginaw Community Hospital in Michigan as institutions for mental diseases for purposes of Medicaid reimbursement. Subtitle I: Programs of All-Inclusive Care for the Elderly (PACE) - Amends SSA title XVIII to provide for Medicare programs of all-inclusive care for the elderly (PACE programs) for individuals age 55 or older who require the level of care required under the State Medicaid plan for coverage of nursing facility services. Specifies benefit and payment requirements. Limits PACE provider eligibility to public and private non-profit entities; but requires the Secretary to waive such limitations to demonstrate the operation of a PACE program by a private, for-profit entity. (Sec. 4802) Amends SSA title XIX to authorize a State to establish a Medicaid program of all-inclusive care for the elderly (PACE) for individuals who need not be eligible for Medicare part A benefits, or enrolled under Medicare part B. (Sec. 4804) Directs the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under Medicare and Medicaid, specifically comparing the costs, quality, and access to services by private, for-profit entities under the demonstration projects with the costs, quality, and access to services of other PACE providers. Subtitle J: State Children's Health Insurance Program - Chapter 1: State Children's Health Insurance Program - Amends SSA to add a new title XXI (State Children's Health Insurance Program) in order to provide funds to States to expand the provision of child health assistance to uninsured, low-income children. Requires a State to submit for the Secretary's approval a child health plan for the use of funds, containing strategic objectives, performance goals, and performance measures. Mandates coverage equivalent to benefits coverage in a benchmark benefit package, consisting of benefits offered by either: (1) the Federal Employees' Health Benefits Program (FEHBP); (2) a State employee health benefit plan; or (3) an HMO. Makes appropriations to carry out this title. Allows their use for abortion only if necessary to save the life of the mother or if the pregnancy results from rape or incest. Chapter 2: Expanded Coverage of Children Under Medicaid - Amends SSA title XIX to provide for an increased Medicaid FMAP for expanded coverage of targeted low-income children. (Sec. 4912) Authorizes an approved State plan to make Medicaid available to a low-income child during a specified presumptive eligibility period after determination that family income does not exceed a certain level. (Sec. 4913) Provides for continuation of Medicaid eligibility for disabled children who lose benefits under SSA title XVI (Supplemental Security Income) (SSI). Chapter 3: Diabetes Grant Programs - Amends the Public Health Service Act to direct the Secretary to make grants for services for the prevention and treatment of type I diabetes in children, and for research in innovative approaches to such services. Provides for funding. (Sec. 4922) Directs the Secretary to make grants for services for the prevention and treatment of type I diabetes in Indians through the Indian Health Service and tribal and urban Indian health programs. (Sec. 4923) Requires the Secretary to evaluate such programs and report to the Congress. Title V: Welfare and Related Provisions - Subtitle A: TANF Block Grant - Amends part A (Temporary Assistance for Needy Families) (TANF) of SSA title IV to establish a program of welfare-to-work grants to States. (Sec. 5001) Sets forth requirements relating to State entitlement to non-competitive formula grants under such program and State distribution of such funds among local governments. Authorizes State Governors to distribute up to 15 percent of such grant funds for projects to help long-term welfare recipients enter unsubsidized employment. Provides for competitive grants, based on program effectiveness and other factors, including the history of the applicant's success in moving individuals with multiple barriers into work, for State-approved projects proposed by private industry councils or local governments. Sets forth rules relating to required beneficiaries and targeting of individuals with characteristics associated with long-term welfare dependency. Authorizes use of grant funds to provide work-related services to individuals who have reached the five-year limit on assistance. Directs the Secretary of Labor to use certain set-aside funds to make grants to each successful performance State in FY 2000. Makes appropriations for FY 1998 and 1999 for grants. Sets forth requirements for: (1) nondisplacement of other workers by participants in work activities under this program; (2) applicable health and safety standards; and (3) grievance procedures with respect to alleged violations of such nondisplacement and health and safety requirements. Provides for such grants to outlying areas territories and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to develop a plan to evaluate the use of such grants. Sets forth penalties for: (1) failure of a State to maintain its historic effort during a year in which a welfare-to-work grant is received; and (2) misuse of competitive welfare-to-work grant funds. Declares that State sanctions against recipients for TANF program violations are not wage reductions. (Sec. 5002) Limits to not more than ten percent the portion of such welfare-to-work grant funds which a State may use to carry out State programs under SSA title XX block grants to States for social services. (Sec. 5003) Increases from 20 percent to 30 percent of individuals in all families and in two-parent families the limitation on the number of persons who may be treated as engaged in work by reason of participation in a vocational education program or, in the case of teen heads of household, maintenance of satisfactory school attendance. (Sec. 5004) Requires reduction of a State's welfare-to-work grant if a State fails to reduce assistance for recipients refusing work without good cause. Subtitle B: Supplemental Security Income - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRAWORA) to extend by six months the deadline for certain childhood disability redeterminations under SSA title XVI (Supplemental Security Income) (SSI). (Sec. 5102) Prescribes the schedule of administrative fees the Commissioner of Social Security shall assess each State from FY 1997 through 2003 and after for making optional and mandatory State SSI payments to individuals. Revises requirements for deposit of such fees, directing that a portion be credited to a special fund for FY 1998 and subsequent fiscal years for use in defraying expenses. Provides that the amounts so credited shall not be scored as receipts under the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act), but credited as a discretionary offset to discretionary spending. Authorizes appropriations. Subtitle C: Child Support Enforcement - Amends SSA title III (Unemployment Insurance) with respect to the authority to permit certain redisclosures of wage and claim information for purposes related to the child support enforcement program under SSA title IV part D (Child Support and Establishment of Paternity). Subtitle D: Restricting Welfare and Public Benefits for Aliens - Amends PRAWORA to make aliens eligible for SSI who, as of the date of enactment of such Act, were receiving such benefits, or were legally residing in the United States and are blind or disabled. Extends the SSI grandfather provision through September 30, 1998. (Sec. 5302) Extends from five to seven years the refugee and asylee eligibility period for SSI and Medicaid, and includes Cuban and Haitian entrants within such category. Provides a five-year food stamp eligibility period for such aliens. Includes Cuban and Haitian entrants within the definition of "qualified alien" for purposes of welfare and public benefits. Exempts such aliens from specified periods of ineligibility for State and Federal means-tested benefits. (Sec. 5303) Exempts: (1) certain American Indians (including persons born in Canada) from SSI and Medicaid eligibility limitations; and (2) certain SSI recipients with pre-January 1, 1979 applications from SSI eligibility limitations. (Sec. 5305) States that an alien who is ineligible for food stamps shall not be eligible for such program based upon SSI eligibility. Authorizes Medicaid eligibility based upon SSI eligibility. (Sec. 5306) Treats certain Amerasian immigrants as refugees for purposes of specified public benefits eligibility. (Sec. 5307) Authorizes States to require State and local assistance applicants to provide v

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Summary: H.R.2015 — 105th Congress (1997-1998)

There are 3 summaries for this bill. Line item veto by President (08/11/1997)Conference report filed in House (07/30/1997)Introduced in House (06/24/1997)     Bill summaries are authored by CRS. $("#summarySelector").congress_dropDownNavigation({ stubUrl: '/bill/105th-congress/house-bill/2015/summary', suffix: '' }); Shown Here:
Line item veto by President (08/11/1997) (On June 25, 1998, the Supreme Court ruled that the Line Item Veto Act (Public Law 104-130) is unconstitutional, thus restoring provisions that had been cancelled as summarized below.) (On August 11, 1997, the President line-item-vetoed Sec. 4722(c), which deemed to be permissible broad-based health care related taxes certain taxes, fees, or assessments collected by New York State from a health care provider before June 1, 1997, for which a specified waiver has been applied, or would be but for this provision. The provision would thus exempt such taxes, fees, or assessments from the requirement that provider-specific taxes be subtracted from the State share of Medicaid expenditures for purposes of Federal share calculation. The following revised digest of H.R. 2015 reflects the Act as signed into law, minus the line-item-vetoed provision. For more information on the specific items vetoed, see the text of the conference report for H.R. 2015, H.Rept. 105-217, and Presidential Cancellation Number 97-3.) TABLE OF CONTENTS: Title I: Food Stamp Provisions Title II: Housing and Related Provisions Title III: Communications and Spectrum Allocation Provisions Title IV: Medicare, Medicaid, and Children's Health Provisions Subtitle A: Medicare+Choice Program Subtitle B: Prevention Initiatives Subtitle C: Rural Initiatives Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity Subtitle E: Provisions Relating to Part A Only Subtitle F: Provisions Relating to Part B Only Subtitle G: Provisions Relating to Parts A and B Subtitle H: Medicaid Subtitle I: Programs of All-Inclusive Care for the Elderly (PACE) Subtitle J: State Children's Health Insurance Program Title V: Welfare and Related Provisions Subtitle A: TANF Block Grant Subtitle B: Supplemental Security Income Subtitle C: Child Support Enforcement Subtitle D: Restricting Welfare and Public Benefits for Aliens Subtitle E: Unemployment Compensation Subtitle F: Welfare Reform Technical Corrections Subtitle G: Miscellaneous Title VI: Education and Related Provisions Subtitle A: Higher Education Subtitle B: Repeal of Smith-Hughes Vocational Education Act Title VII: Civil Service Retirement and Related Provisions Title VIII: Veterans and Related Matters Subtitle A: Extension of Temporary Authorities Subtitle B: Copayments and Medical Care Cost Recovery Subtitle C: Other Matters Title IX: Asset Sales, User Fees, and Miscellaneous Provisions Subtitle A: Asset Sales Subtitle B: User Fees Subtitle C: Miscellaneous Provisions Title X: Budget Enforcement and Process Provisions Subtitle A: Amendments to the Congressional Budget and Impoundment Control Act of 1974 Subtitle B: Amendments to the Balanced Budget and Emergency Deficit Control Act of 1985 Title XI: District of Columbia Revitalization Subtitle A: District of Columbia Retirement Funds Subtitle B: Management Reform Plans Subtitle C: Criminal Justice Subtitle D: Privatization of Tax Collection and Administration Subtitle E: Financing of District of Columbia Accumulated Deficit Subtitle F: District of Columbia Bond Financing Improvements Subtitle G: District of Columbia Government Budget Subtitle H: Miscellaneous Provisions Balanced Budget Act of 1997 - Title I: Food Stamp Provisions - Amends the Food Stamp Act to define "caseload" and "covered individual." Authorizes State agencies to provide an additional 15 percent exemption from the food stamp program (program) work requirement for specified covered individuals. Provides for related caseload and exemption adjustments. (Sec. 1002) Obligates additional FY 1996 through 2002 funds for program employment and training programs. Sets forth State allocation provisions. (Sec. 1003) Requires State agencies, with assistance provided by the Secretary of Agriculture, to deny program benefits to prisoners incarcerated for more than 30 days. (Sec. 1004) Directs the Secretary to make specified funds available for FY 1998 through 2001 to eligible private nonprofit organizations and State agencies for nutrition education. Title II: Housing and Related Provisions - Amends the Balanced Budget Downpayment Act, I to extend permanently certain foreclosure avoidance provisions under the single family housing mortgage insurance program. (Sec. 203) Amends the United States Housing Act of 1937 with respect to the section 8 rental assistance program to make specified maximum monthly rent adjustment provisions for certain new and rehabilitated and nonturnover units applicable to FY 1999 and thereafter. Title III: Communications and Spectrum Allocation Provisions - Amends the Communications Act of 1934 (the Act) to make competitive bidding authority with respect to licenses or construction permits involving uses of the electromagnetic spectrum (spectrum) inapplicable to such licenses and permits issued by the Federal Communications Commission (FCC) that are for: (1) certain public safety radio services; (2) initial licenses or permits assigned to existing terrestrial broadcast licensees for digital television (TV) service; or (3) noncommercial educational or public broadcast stations. Requires the FCC to provide for the design and conduct of spectrum competitive bidding using a contingent combinatorial bidding system that permits prospective bidders to bid on combinations of licenses in a single bid and to enter multiple alternative bids within a single bidding round. Directs the FCC to prescribe methods by which a reasonable reserve price will be required, or a minimum bid will be established, to obtain any license or permit assigned under competitive bidding, unless determined not to be in the public interest. Repeals a requirement that any funds appropriated to the FCC for FY 1994 through 1998 for assigning licenses using random selection procedures be retained in the FCC's salaries and expenses account. Requires competitive bidding information to be included in annual FCC reports in order for any funds collected after FY 1998 to be retained in such account. Extends competitive bidding authority through FY 2008. Prohibits the FCC, after July 1, 1997, from issuing a license or construction permit for spectrum through a random selection system. Excepts from such prohibition licenses or permits for noncommercial educational or public broadcast stations. Provides for the applicability of competitive bidding requirements to pending comparative licensing cases. Makes available for assignment for commercial use the 1710 to 1755 megahertz (mhz) frequency band. Directs the FCC to assign licenses for such use by competitive bidding commenced after January 1, 2001. Directs the FCC to assign certain additional spectrum by competitive bidding no later than September 30, 2002. Directs the FCC to reallocate: (1) spectrum located at 2110 to 2150 mhz; and (2) 15 mhz located in the 1990 to 2110 range, with an exception in both cases when not in the public interest. Requires the FCC to notify the Secretary of Commerce if it is unable to provide for effective relocation of incumbent licensees to available bands of frequencies and has identified bands suitable for such relocation that are allocated for Federal use but could be reallocated pursuant to the National Telecommunications and Information Administration Organization Act (NTIA). Amends NTIA to direct the Secretary to report to the President, the FCC, and the Congress on recommendations for reallocating frequencies allocated for Federal use other than by Government licensees under the Communications Act of 1934. Authorizes any entity which operates a Government station to accept payment for frequency relocation expenses. Provides a relocation process triggered by a petition under NTIA. Allows a Federal entity to reclaim a former frequency if it demonstrates that relocated facilities or spectrum are not comparable to its former facilities or spectrum. Requires the Secretary to recommend for reallocation for use other than by Government stations a band of frequencies that: (1) in the aggregate span at least 20 mhz; (2) are located below three gigahertz; and (3) meet other relocation criteria. Directs the FCC to prepare and submit to the President and the Congress a plan for the immediate allocation and assignment of frequencies identified under this title. (Sec. 3003) Amends the Act to prohibit the renewal of a license authorizing analog TV services beyond the end of 2006, with an extension in specified circumstances. Prohibits the FCC, in prescribing regulations relating to qualifications of spectrum bidders, from: (1) precluding any party from being a qualified bidder for spectrum allocated for any use that includes digital TV service on the basis of the FCC's duopoly rule or newspaper cross-ownership rule; or (2) applying either rule to preclude a successful bidder from using such spectrum for digital TV service. (Sec. 3004) Directs the FCC, no later than January 1, 1998, to allocate from radio spectrum between 746 and 806 mhz: (1) 24 mhz for public safety services; and (2) the remainder for commercial purposes to be assigned by competitive bidding. Sets deadlines for the assignment of such licenses and the commencement of competitive bidding. Provides for the licensing of unused frequencies for public safety services. (Sec. 3005) Authorizes the FCC to allocate spectrum to provide flexibility of use, as long as such use is consistent with international agreements and upon a finding that such use is in the public interest and would not deter investment or result in harmful interference among users. (Sec. 3006) Authorizes appropriations to the FCC for FY 2001 for universal service support programs. (Sec. 3007) Directs the FCC to conduct all competitive bidding required under this title so that proceeds from such bidding are deposited no later than the end of FY 2002. (Sec. 3008) Requires seven days' public notice before the granting by the FCC of an application for spectrum frequency assignment under the Act. Title IV: Medicare, Medicaid, and Children's Health Provisions - Subtitle A: Medicare+Choice Program - Chapter 1: Medicare+Choice Program - Amends title XVIII (Medicare) of the Social Security Act (SSA) to establish a Medicare+Choice program under which each Medicare+Choice eligible individual (one entitled to benefits under Medicare part A (Hospital Insurance) and enrolled under Medicare part B (Supplementary Medical Insurance)) is entitled to elect, in accordance with certain procedures, to receive Medicare benefits either through the original Medicare fee-for-service program or through a Medicare+Choice plan. (Sec. 4001) Outlines the types of Medicare+Choice plans that may be available, namely: (1) coordinated care plans; (2) combination of a medical savings account (MSA) plan and contributions into a Medicare+Choice MSA; and (3) private fee-for-service plans. Sets forth various special rules regarding, among other things, residence, individuals with end-stage renal disease, and individuals covered under the Federal Employees Health Benefits Program or eligible for veterans' or military health benefits. Directs the Secretary of Health and Human Services (HHS) to: (1) provide for broad dissemination of coverage option and comparison information to Medicare beneficiaries and prospective Medicare beneficiaries; and (2) maintain a toll-free number for inquiries about Medicare+Choice options and program operation, as well as an Internet site through which individuals may obtain such information electronically. Requires: (1) any Medicare+Choice organization to accept without restrictions individuals eligible to make an election at any time during which such elections are accepted; and (2) approval of Medicare+Choice marketing material and application forms before they are distributed. Provides for continuous open enrollment and disenrollment through 2001, the first six months of 2002, and the first three months of every subsequent year, limiting an individual's change of enrollment during such initial period to one. Provides for an annual, coordinated election period during November for all participants as well as special election periods in certain circumstances. Outlines benefits and beneficiary protections. Requires each Medicare+Choice plan (except MSA plans) to provide those items and services for which benefits are available under Medicare parts A and B (other than hospice care) and specified additional benefits, as well, at its option, as certain supplemental benefits, subject to the Secretary's approval. Excludes individuals enrolled under a MSA plan from participating in such supplemental package. Prohibits a Medicare+Choice organization from denying, limiting, or conditioning coverage or benefits based on any described health status-related factor. Prescribes plan disclosure requirements and an ongoing quality assurance program. Outlines a mechanism for grievances and appeals. Sets forth certain payment rules for providers not participating in the Medicare+Choice program. Directs the Secretary to make monthly advance payments with respect to an individual's coverage to Medicare+Choice organizations according to a specified formula. Requires the Secretary to establish separate payment rates for individuals with end-stage renal disease. Sets forth special rules for individuals electing MSA plans. Requires such an individual to establish a Medicare+Choice MSA into which the Secretary shall make monthly deposits out of the Medicare trust funds in accordance with prescribed guidelines. Prescribes special rules for hospice care. Details rules for the submission and charging of premiums by each Medicare+Choice organization. Sets limitations on enrollee liability for basic, additional, and supplemental benefits. Prescribes a special rule for private fee-for-service plans. Prohibits a State from imposing a premium tax or similar tax with respect to payments to Medicare+Choice organizations. Sets out organizational and financial requirements for Medicare+Choice organizations and provider-sponsored organizations. Directs the Secretary to establish solvency and capital adequacy standards for provider-sponsored organizations, and other standards for Medicare+Choice organizations. Prescribes requirements, including minimum enrollment requirements, for contracts between the Secretary and Medicare+Choice organizations. Provides for: (1) intermediate sanctions and civil monetary penalties to enforce contract provisions; and (2) procedures for termination of contracts. (Sec. 4002) Details transitional rules for the current Medicare health maintenance organization (HMO) program, as well as specified conforming changes in the Medicare supplemental health insurance policy (Medigap) program. (Sec. 4006) Amends the Internal Revenue Code to outline special rules for Medicare+Choice MSAs. Excludes from gross income any payment by the Secretary to an individual's Medicare+Choice MSA. Excludes from qualified deductible medical expenses any amounts paid for the medical care of any individual but the account holder. Prescribes a penalty for distributions from the Medicare+Choice MSA not used for qualified medical expenses if the minimum balance is not maintained, with certain exceptions if the account holder becomes disabled or dies. Chapter 2: Demonstrations - Directs the Secretary to establish a Medicare prepaid competitive pricing demonstration project in up to four (eventually seven) designated Medicare payment areas, of which initially three shall be in urban areas and one in a rural area. (Sec. 4012) Directs the Secretary to appoint a Competitive Pricing Advisory Committee to recommend areas for the demonstration and research design for project implementation. (Sec. 4014) Amends the Omnibus Budget Reconciliation Act of 1987 to extend the authorities for the social health maintenance organization (SHMO) demonstration project. Amends the Omnibus Budget Reconciliation Act of 1993 to increase the cap on the number of individuals who may participate in a SHMO demonstration. Directs the Secretary to submit to the Congress a plan for the integration of SHMO health plans and similar plans as an option under the Medicare+Choice program. (Sec. 4015) Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a demonstration (subvention) project under which the HHS Secretary shall reimburse the Secretary of Veterans Affairs from the Medicare trust funds for Medicare health care services furnished to certain targeted Medicare-eligible military retirees or dependents. Authorizes the Secretary of Defense to modify existing TRICARE contracts in order to provide Medicare health care services to project participants. (Sec. 4016) Directs the Secretary to conduct demonstration projects in a certain number of rural and urban areas for the purpose of evaluating methods, such as case management and other models of coordinated care, that improve the quality of items and services provided to target individuals, and reduce Medicare expenditures for such items and services. Defines a target individual as an individual with a chronic illness who is enrolled under the Medicare parts A and B fee-for-service program. Provides for project funding. (Sec. 4017) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to direct the Secretary to work with each municipal health service demonstration project to develop a plan for the orderly transition of such projects and project participants to a non-demonstration project health care delivery system, such as through integration with a private or public health care plan, including a Medicaid managed care or Medicare+Choice plan. (Sec. 4018) Directs the Secretary to implement a time-limited demonstration project for the purpose of evaluating the use of a third-party contractor to conduct the Medicare+Choice plan enrollment and disenrollment functions in an area. (Sec. 4019) Extends for an additional two years certain Medicare community nursing organization demonstration projects under the Omnibus Budget Reconciliation Act of 1987. Chapter 3: Commissions - Establishes the National Bipartisan Commission on the Future of Medicare to: (1) review and analyze the long-term financial condition of the Medicare program; (2) identify problems that threaten the financial integrity of the Medicare trust funds, including the extent to which current Medicare update indexes do not accurately reflect inflation; and (3) analyze potential solutions to the problems identified that will ensure both the financial integrity of Medicare and the provision of appropriate benefits. Requires the Commission to make recommendations: (1) to restore the solvency of the Federal Hospital Insurance Trust Fund and the financial integrity of the Federal Supplementary Medical Insurance Trust Fund; and (2) to establish the appropriate financial structure of the Medicare program as a whole and the appropriate balance of benefits covered and beneficiary contributions. Requires recommendations on: (1) the financing of graduate medical education; (2) the feasibility of allowing individuals between age 62 and the Medicare eligibility age to buy into the Medicare program; and (3) the impact of chronic disease and disability trends on future costs and quality of services under the current benefit, financing, and delivery system structure of the Medicare program. Requires a report to the President and the Congress. Authorizes appropriations. (Sec. 4022) Establishes the Medicare Payment Advisory Commission to replace the Prospective Payment Assessment Commission and the Physician Payment Review Commission, hereby abolished. Requires the new Commission to review and make recommendations to the Congress about payment policies under Medicare (including certain specific payment-related topics). Authorizes appropriations. Chapter 4: Medigap Protections - Amends SSA title XVIII with respect to the issuer of a Medicare supplemental (Medigap) policy in the case of certain individuals terminated by an employee welfare benefit plan providing supplementary health benefits who seek to enroll under a Medigap policy not later than 63 days after termination or disenrollment. Prohibits the Medigap issuer from: (1) denying or conditioning the issuance or effectiveness of such a policy; (2) discriminating in the pricing of such policy because of health status, claims experience, receipt of health care, or medical condition; or (3) imposing an exclusion of benefits based on a pre-existing condition. (Sec. 4031) Specifies limitations on the imposition of preexisting condition exclusions during the initial open enrollment period in the case of a Medicare supplemental policy issued to an individual who is age 65 or older with a certain minimum period of creditable coverage. (Sec. 4032) Creates under the Medicare supplemental policy program a high deductible feature which requires the policy beneficiary to pay annual out-of-pocket expenses (other than premiums) of $1,500 (indexed for inflation) before the policy begins payment of benefits. Chapter 5: Tax Treatment of Hospitals Participating in Provider- Sponsored Organizations - Amends the Internal Revenue Code to provide that an organization shall not fail to be treated as a tax-exempt charitable organization solely because a hospital which it owns and operates also participates in a provider-sponsored organization, whether or not the provider-sponsored organization is exempt from tax. Provides that any person with a material financial interest in such a provider-sponsored organization shall be treated as a private shareholder or individual with respect to the hospital. Subtitle B: Prevention Initiatives - Outlines various specified new preventive health measures covered under Medicare, namely coverage for: (1) an annual screening mammography for women over age 39 and triennial screening pap smear and screening pelvic exam for any woman (annually for a woman with cervical or vaginal cancer or other abnormality, or who is at high risk of developing such a cancer), while providing for a waiver of deductible; (2) annual prostate cancer screening tests; (3) colorectal cancer screening tests, subject to prescribed frequency and payment limits; (4) diabetes outpatient self-management training services, including blood-testing strips (with a ten percent payment reduction after 1997) and glucose monitors as durable medical equipment (DME) for individuals with diabetes; and (5) bone mass measurements for qualified individuals. (Sec. 4105) Directs the Secretary to establish outcome measures, including glysolated hemoglobin (past 90-day average blood sugar levels), for the purpose of evaluating the improvement of health status of Medicare beneficiaries with diabetes mellitus, with a view to recommending coverage modifications. (Sec. 4107) Extends through FY 2002 the Influenza and Pneumococcal Vaccination Campaign of the Health Care Financing Administration (HCFA). Authorizes appropriations. (Sec. 4108) Directs the Secretary to request the National Academy of Sciences to analyze (for a report to specified congressional committees) the expansion or modification of Medicare preventive benefits to include medical nutrition therapy services by a registered dietitian, skin cancer screening, medically necessary dental care, and other specified items. Subtitle C: Rural Initiatives - Replaces the Essential Access Community Hospital Program with an optional Medicare Rural Hospital Flexibility Program under which participating States shall develop at least one rural health network in the State and at least one facility designated as a critical access hospital in accordance with prescribed guidelines. Authorizes the Secretary to award grants to States for: (1) planning and implementation of the program; and (2) establishment or expansion of rural emergency medical services. Authorizes appropriations. Directs the HCFA Administrator to report to the Congress on the feasibility of, and administrative requirements necessary to establish, an alternative for certain medical diagnoses to the current 96-hour limitation for inpatient care in critical access hospitals. (Sec. 4202) Amends SSA title XVIII to prohibit denial, on the basis of wage comparisons, of a rural referral center's request for reclassification. Provides that any hospital classified as a rural referral center for FY 1991 shall be classified as such for FY 1998 and each subsequent fiscal year. (Sec. 4204) Extends through FY 2001 the special treatment of payment methodology and target amount for Medicare-dependent, small rural hospitals. (Sec. 4205) Amends requirements for rural health clinic services with respect to: (1) per-visit payment limits for provider-based clinics; (2) mandatory quality assessment and performance improvement programs; (3) limitation of waivers of certain staffing requirements to clinics participating in the rural health clinic program; (4) the insufficiency of needed health care practitioners in shortage areas; and (5) regulations providing for payment for certain physician assistant services. (Sec. 4206) Directs the Secretary to make payments from the Federal Supplementary Medical Insurance Trust Fund under Medicare part B in accordance with a specified payment methodology for professional consultation via telecommunications systems with a physician or practitioner furnishing a service for which payment may be made to a Medicare beneficiary residing in a rural health professional shortage area, notwithstanding that the individual physician or practitioner providing the professional consultation is not at the same location as the physician or practitioner furnishing the service to that beneficiary. Directs the Secretary to report to the Congress: (1) a detailed analysis of telemedicine and telehealth (T&T) services; and (2) an examination of the possibility of making similar payments for professional consultation via telecommunications systems to Medicare beneficiaries who do not reside in a rural health professional shortage area, are homebound or nursing homebound, and for whom being transferred for health care services imposes a serious hardship. (Sec. 4207) Directs the Secretary to conduct a demonstration project to use eligible health care provider telemedicine networks to apply high-capacity computing and advanced networks to improve primary care and prevent health care complications to Medicare beneficiaries with diabetes mellitus who reside in medically underserved rural or inner-city areas. Provides funding. Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity - Chapter 1: Revisions to Sanctions for Fraud and Abuse - Amends SSA title XI, with respect to health care related crimes, to exclude from the Medicare and State health care programs any person: (1) for ten years for one previous conviction for one or more offenses; and (2) permanently for two or more previous convictions of one or more offenses. (Sec. 4302) Authorizes the Secretary to refuse to enter into Medicare agreements with individuals or entities convicted of felonies for offenses determined inconsistent with the best interests of program beneficiaries. (Sec. 4303) Authorizes the Secretary to exclude from the Medicare program any entity with respect to which a sanctioned person with an ownership or control interest in it transfers such interest in anticipation of (or following) a conviction, assessment, or exclusion against the person, to an immediate family member or member of the household who continues to maintain such an interest. (Sec. 4304) Provides for the imposition of civil monetary penalties for: (1) any person who arranges or contracts with an individual or entity that the person knows or should know is excluded from participation in a Federal health care program; and (2) kickbacks. Chapter 2: Improvements in Protecting Program Integrity - Amends SSA title XVIII to require the Secretary, in the annual notice of Medicare benefits, to urge beneficiaries to check the notice and any itemized statement for accuracy and report any errors or questionable charges by calling a certain toll-free number. Authorizes Medicare beneficiaries to submit written requests for itemized bills of medical or other items or services provided, and review them. Requires the Secretary to take measures to recover amounts unnecessarily paid out. (Sec. 4312) Outlines various specified requirements regarding disclosure of information and surety bonds with regard to DME suppliers. Includes surety bond requirements for home health agencies. Authorizes the Secretary to apply disclosure and surety bond requirements to other health care providers or item and service suppliers (except physicians or practitioners). Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORFs) and to rehabilitation agencies. (Sec. 4313) Requires any participating entity to disclose to the Secretary its own employer identification numbers and social security account numbers, as well as those of persons with ownership or control interests and subcontractors in which the entity has a five percent or greater interest. Directs the Secretary to report to Congress on the steps taken to assure the confidentiality of such social security account numbers. (Sec. 4314) Requires the Secretary, upon a party's request, to issue binding advisory opinions on whether a referral relating to designated health services (other than clinical laboratory services) is a prohibited physician self-referral. (Sec. 4315) Amends SSA title XVIII to: (1) replace the reasonable charge payment methodology with fee schedules developed by the Secretary for particular services; (2) provide for application of inherent reasonableness to charges for all Medicare part B services other than physicians' services; (3) require bills and requests for payment for services by non-physician practitioners to include diagnostic codes; (4) outline requirements to provide diagnostic information when ordering certain items or services furnished by another entity; (5) mandate establishment of competitive acquisition areas for contract award purposes for the furnishing under Medicare part B after 1997 of described items and services; and (6) prohibit payment under Medicare part A or part B for any expenses for an item or service furnished in a competitive acquisition area by an entity other than an entity with which the Secretary has contracted, except for urgent need, or in other circumstances specified by the Secretary. (Sec. 4320) Excludes from reasonable costs and declares unreimbursable under Medicare any payments for certain items unrelated to patient care, including: (1) entertainment, gifts, or donations; (2) personal use of motor vehicles; (3) costs for fines and penalties resulting from violations of Federal, State, or local laws; and (4) education expenses for spouses or other dependents of service providers, their employees, or contractors. (Sec. 4321) Requires a Medicare hospital's discharge planning process to include information on the availability of home health services through certain individuals or entities. Requires a discharge plan: (1) not to specify or otherwise limit the qualified provider which may provide home health services; and (2) identify any entity to whom the individual is referred in which the hospital has a disclosable financial interest. Requires the service provider agreement to require disclosure of any financial interest a hospital has in any entity to which individuals are referred, or any entity has in the hospital, and related information. Chapter 3: Clarifications and Technical Changes - Makes technical amendments with respect to fraud and abuse. Subtitle E: Provisions Relating to Part A Only - Chapter 1: Payment of PPS Hospitals - Revises requirements for: (1) prospective payment system (PPS) hospital payment updates; (2) maintenance of savings from the temporary reduction in capital payments for prospective payment system (PPS) hospitals; (3) additional payments to any hospital with a disproportionate share of low-income patients (disproportionate share hospital (DSH)); (4) the sales price of a Medicare capital asset (book value); (5) elimination of indirect medical education (IME) and DSH payments attributable to outlier payments; (6) the base rate of payments to Puerto Rico hospitals; (7) payments to hospitals for certain discharges to post-acute care; (8) inclusion of Stanly County, North Carolina, in the large urban area of Charlotte-Gastonia-Rock Hill-North Carolina-South Carolina; and (9) the floor on wage area indexes. (Sec. 4409) Requires the Secretary to publish and use alternative guidelines under which certain disproportionately large hospitals qualify for geographic reclassification. Chapter 2: Payment of PPS-Exempt Hospitals - Revises requirements for the payment of PPS-exempt hospitals, including those for: (1) payment updates; (2) reductions to capital payments; (3) bonus and relief payments; (4) payment and the target amount for new providers; (5) treatment of certain long-term care hospitals located within other hospitals; (6) rebasing; (7) certain cancer hospitals; and (8) elimination of exemptions for certain hospitals. (Sec. 4421) Provides for a Medicare PPS for inpatient rehabilitation hospital services. (Sec. 4422) Directs the Secretary to submit to the Congress a legislative proposal for establishing a case-mix adjusted PPS for long-term care hospitals. Chapter 3: Payment for Skilled Nursing Facilities - Declares that updates to per diem limits, with respect to payments to skilled nursing facilities (SNFs), effective for FY 1998, shall be based on cost limits effective for FY 1997. (Sec. 4432) Mandates a PPS for SNF services along with consolidated billing for them. Directs the Secretary, in order to ensure that Medicare beneficiaries are furnished appropriate SNF services, to establish a thorough medical review process to examine the provisions of this section and their effect on the quality of covered SNF services furnished to Medicare beneficiaries. Chapter 4: Provisions Related to Hospice Services - Provides for update of payments for hospice services. Bases payment for home hospice care on the location where care is furnished. Revises the home hospice care benefit period. Provides for home hospice care coverage of any other items and services specified in a plan. Allows waiver of certain staffing requirements for hospice care programs in non-urbanized areas. Chapter 5: Other Payment Provisions - Requires reductions in payments for enrollee bad debt. Repeals the termination date to make a permanent extension of the hemophilia passthrough. Requires a certain reduction in the part A Medicare premium for specified public retirees. Authorizes Medicare and Medicaid coverage of inpatient hospital and post-hospital extended care services in religious nonmedical health care institutions (currently limited to Christian Science sanatoria). Subtitle F: Provisions Relating to Part B Only - Chapter 1: Services of Health Professionals - Revises requirements for the payment of physicians' services, with changes: (1) establishing a single conversion factor for 1998; (2) adding new update provisions; (3) replacing the volume performance standard with sustainable growth rate; (4) adding payment rules for anesthesia services; and (5) providing for adjustments in relative value units for 1998, and the application of resource-based methodology to malpractice relative value units. (Sec. 4505) Directs the Comptroller General to review and evaluate the proposed rule on resource-based methodology for practice expenses issued by the HCFA. (Sec. 4506) Directs the Secretary to determine for each hospital: (1) its hospital-specific per discharge relative value for physicians' services; and (2) whether such value is projected to be excessive. Requires the Secretary to notify the medical executive committee of a subset of the hospitals identified as having an excessive hospital-specific relative value, and evaluate their responses with the responses of other hospitals so identified that were not notified. (Sec. 4507) Amends SSA title XVIII to declare that nothing shall prohibit a physician or practitioner from privately contracting with a Medicare beneficiary for any item or service for which no Medicare claim will be submitted, and for which the physician or practitioner shall receive no Medicare reimbursement. (Sec. 4511) Increases Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. (Sec. 4513) Repeals the requirement of an X-ray for reimbursement for chiropractic services. Directs the Secretary to develop utilization guidelines for the coverage of chiropractic services where a subluxation has not been demonstrated by an X-ray. Chapter 2: Payment for Hospital Outpatient Department Services - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 4522) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 4523) Directs the Secretary to establish a PPS for hospital outpatient department services. Chapter 3: Ambulance Services - Provides for certain interim reductions in payments for ambulance services. Directs the Secretary to establish a prospective fee schedule for payment of such services. Provides that, in promulgating regulations for coverage of ambulance services, the Secretary may cover advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. (Sec. 4532) Directs the Secretary to establish up to three demonstration projects contracting with local governments for ambulance services paid for under Medicare. Chapter 4: Prospective Payment for Outpatient Rehabilitative Services - Provides for a PPS for outpatient physical (including speech-language pathology) and occupational therapy services. Chapter 5: Other Payment Provisions - Provides for a reduction in payment amounts for items of DME and for clinical diagnostic laboratory tests. Provides for a payment freeze for parenteral and enteral nutrients, supplies, and equipment. Revises update requirements for payment for orthotics and prosthetics, and other payment requirements for oxygen and oxygen equipment, ambulatory surgical services, and drugs and biologicals. (Sec. 4552) Requires the Comptroller General to study and report to specified congressional committees on access to home oxygen equipment. Requires the Secretary to arrange for peer review organizations to evaluate such access. (Sec. 4553) Directs the Secretary to request the National Academy of Sciences to study (for a report to specified congressional committees) Medicare payments for clinical laboratory tests. (Sec. 4554) Directs the Secretary to divide the United States into up to five regions, and designate a single carrier for each region, for the payment of Medicare part B claims for clinical diagnostic laboratory services. Requires the Secretary to adopt uniform policies for clinical diagnostic laboratory tests. (Sec. 4557) Provides for coverage of oral anti-nausea drugs under a chemotherapeutic regimen. (Sec. 4558) Requires the Secretary to: (1) audit cost reports of each renal dialysis provider at least once every three years; and (2) develop a method to measure and report on the quality of Medicare renal dialysis services. (Sec. 4559) Directs the Secretary, for electrocardiogram tests furnished during 1998, to restore separate part B payment for electrocardiogram transportation based upon methods in effect on December 31, 1996. Requires the Secretary, by a certain deadline, to recommend to specified congressional committees whether portable electrocardiogram transportation should be covered under Medicare part B. Chapter 6: Part B Premium and Related Provisions - Revises the formula for the monthly Medicare part B premium rate the Secretary promulgates each September for the following calendar year. Requires such rate to equal 50 percent of the monthly actuarial rate for enrollees age 65 and over for that succeeding calendar year. (Sec. 4581) Provides for a special Medicare enrollment period, with no premium penalty for late enrollment, for certain disabled workers whose continuous enrollment under an employer's group health plan is involuntarily terminated in certain circumstances. (Sec. 4582) Allows appropriate State or local governmental entities to elect to pay part B premiums for certain eligible individuals. Subtitle G: Provisions Relating to Parts A and B - Chapter 1: Home Health Services and Benefits - Provides that, in establishing payment limits for cost reporting periods beginning after September 30, 1997, the Secretary shall not take into account any changes in the home health market basket with respect to cost reporting periods which began on or after July 1, 1994, and before July 1, 1996. (Sec. 4602) Revises requirements for interim payments for home health services. Directs the Secretary to expand research on a PPS for home health agencies under the Medicare program that ties prospective payments to a unit of service. (Sec. 4603) Directs the Secretary to establish a PPS for home health services for cost reporting periods beginning in FY 2000. (Sec. 4604) Bases the payment for home health services on the location where the service is furnished. (Sec. 4611) Provides for a modification of the Medicare part A home health benefit for individuals enrolled under Medicare part B. Provides for specified post-institutional home health services. (Sec. 4613) Directs the Secretary to study and report to the Congress on the criteria that should be applied in determining whether an individual is homebound for purposes of qualifying for Medicare home health services. (Sec. 4614) Provides for the denial of home health claims based on home health services the frequency and duration of which are in excess of normative guidelines established by the Secretary. (Sec. 4615) Denies payment for home health benefits based solely on venipuncture to obtain a blood sample. (Sec. 4616) Directs the Secretary to estimate part A and part B outlays for FY 1998 through 2002 for specified congressional committees, and report annually a comparison of actual outlays with such estimates. Chapter 2: Graduate Medical Education - Revises requirements for direct and indirect Medicare payments for graduate medical education (GME). Limits the number of residents in allopathic and osteopathic medicine. Permits payment to qualified nonhospital providers for direct GME costs. Prohibits restandardization of certain indirect GME payment amounts. Requires the Secretary to provide for direct and indirect GME payments to hospitals for Medicare+Choice enrollees. Makes a special reimbursement rule for primary care combined residency programs, setting the period of board eligibility. (Sec. 4626) Provides for incentive payments to hospitals under plans for voluntary reduction in the number of full-time equivalent residents in an approved medical training program. (Sec. 4628) Directs the Secretary to establish a demonstration project under which GME payments shall be made to consortia of teaching hospitals and other medical entities. (Sec. 4629) Directs the Medicare Payment Advisory Commission to develop recommendations to the Congress on whether and to what extent Medicare payment policies and other Federal policies regarding teaching hospitals and GME should be changed. (Sec. 4630) Directs the Secretary to study and report to the appropriate congressional committees on variations among hospitals in the overhead and supervisory physician components of their direct medical education costs. Chapter 3: Provisions Relating to Medicare Secondary Payer - Revises requirements for Medicare as secondary payer. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Chapter 4: Other Provisions - Amends SSA title XVIII to require placement of an advance directive in a prominent part of the individual's current medical record. (Sec. 4642) Provides for an increased certification period for certain organ procurement organizations. (Sec. 4643) Establishes in the HCFA the position of Chief Actuary. Subtitle H: Medicaid - Chapter 1: Managed Care - Amends SSA title XIX (Medicaid) to establish a new part B (Managed Care) giving States the option to require Medicaid-eligible individuals (except Medicare beneficiaries, Medicare-eligible individuals, and certain children with special needs) to enroll in managed care arrangements of the individual's choice as a condition of receiving Medicaid. (Sec. 4702) Grants States the option of providing Medicaid coverage of primary care case management services without the need for a waiver. (Sec. 4703) Repeals the (75-25) requirement that Medicare and Medicaid beneficiaries constitute less than 75 percent of the membership of a participating HMO. Repeals the prohibition on co-payments for services furnished by HMOs. (Sec. 4704) Prescribes requirements for: (1) access to emergency care; (2) annual external independent review of managed care entity activities and other specified quality care assurance measures; and (3) fraud and abuse prohibitions and protections. (Sec. 4705) Amends SSA title XIX (Medicaid) to require any State contracting with Medicaid managed care organizations to develop and implement a quality assessment and improvement strategy incorporating certain access standards, monitoring procedures, and other measures. Directs the Comptroller General to analyze and report to specified congressional committees on the quality assurance programs and accreditation standards applicable to managed care entities operating in the private sector or under Medicare contracts to determine if such programs and standards consider the accessibility and quality of the health care items and services delivered under such contracts to low-income individuals. Directs the Secretary to study and report to such committees on safeguards that may be needed to ensure that the health care needs of individuals with special health care needs and chronic conditions who are enrolled with Medicaid managed care organizations are adequately met. (Sec. 4706) Requires an HMO to meet solvency standards established by the State for private HMOs, or be State-licensed or -certified as a risk-bearing entity. (Sec. 4708) Increases from $100,000 to $1 million, indexed annually, the threshold amount for HMO contracts requiring the Secretary's prior approval. Permits the same copayments in HMOs as in fee-for-service. Chapter 2: Flexibility in Payment of Providers - Repeals "Boren Amendment" provider reimbursement requirements. Requires the Secretary to study and report to the appropriate congressional committees on the effect on access to services, service quality, and service safety of the rate-setting methods used by States as a result of such repeal. (Sec. 4712) Specifies reductions from 100 percent to 70 percent between FY 1999 through 2003 in the percentage of reasonable costs that shall be paid under a State plan for federally-qualified health center and rural health clinic services (with a special supplemental payment for services furnished under certain managed care contracts). (Sec. 4713) Repeals payment rate requirements for obstetrical and pediatric services. (Sec. 4714) Revises requirements for Medicaid payment rates for qualified Medicare beneficiaries, placing a limitation on nonparticipating providers. (Sec. 4715) Declares that, in the case of a Medicaid-eligible veteran residing in a State veterans' home, any veterans' pension over $90 per month shall be counted as income only for the purpose of applying such excess payment to the State veterans' home's cost of providing nursing care to the veteran. Chapter 3: Federal Payments to States - Revises specified limitations of Federal payments for inpatient hospital services furnished by disproportionate share hospitals (DSH), including limitations on certain State DSH expenditures to institutions for mental diseases or other mental health facilities. Requires direct State Medicaid payment to hospitals for managed care enrollees. (Sec. 4722) Revises the treatment as broad-based health care related taxes of certain State hospital taxes which currently are not subtracted as revenues from the State share of Medicaid expenditures for purposes of calculating the Federal share of such expenditures. Declares that an exemption from such State hospital tax for certain Federal-tax-exempt hospitals that do not accept Medicaid or Medicare payments (provide free care) shall not disqualify the hospital tax as a broad-based health care related tax (thus allowing continued exclusion of such State hospital tax from the requirement that provider-specific taxes be subtracted from the State share of Medicaid expenditures for purposes of Federal share calculation). (Sec. 4723) Specifies additional funding for State emergency health services furnished to undocumented aliens. (Sec. 4724) Prohibits the expenditure of Medicaid funds for roads, bridges, stadiums, and other items and services not covered by a State plan. Requires home health agencies to provide a surety bond. Revises conflict-of-interest safeguards. Declares that States are not required to provide medical assistance for items or services furnished by a person or entity convicted of a felony for an offense inconsistent with the best interests of beneficiaries under the State plan. Requires State action for program and beneficiary protection against waste, fraud, and abuse. Conditions issuance or renewal of a DME supplier provider number on the supplier's provision of a surety bond and disclosure of all persons with ownership or control interests in the supplier, and of all subcontractors in which the supplier has a five percent or greater interest. (Sec. 4725) Provides for increased Federal medical assistance percentages (FMAPs) for the District of Columbia and Alaska and increased payment caps for the territories. Chapter 4: Eligibility - Grants States the option to provide for 12-month continuous Medicaid eligibility for children. (Sec. 4732) Requires State Medicaid plan coverage of the Medicare cost-sharing for certain additional low-income Medicare beneficiaries whose income otherwise disqualifies them for specified Medicare benefits. (Sec. 4733) Grants States the option to permit workers with disabilities to buy into Medicaid. (Sec. 4734) Prescribes criminal penalties for knowingly and willfully, for a fee, counseling or assisting an individual to dispose of assets (including transfer in trust) in order for that individual to become Medicaid-eligible (fraudulent eligibility). (Sec. 4735) Declares that certain payments in a class settlement of the case of Susan Walker v. Bayer Corporation shall not be considered income or resources in determining Medicaid eligibility. Chapter 5: Benefits - Changes from mandatory to discretionary a State's authority to enroll individuals under private group health plans and pay their premiums. (Sec. 4742) Repeals: (1) certain physician qualification requirements with respect to services to pregnant women and to children under age 21; and (2) the requirement of prior institutionalization with respect to habilitation services furnished under a waiver for home or community-based services. (Sec. 4744) Requires the Secretary to study and report to the Congress on early and periodic screening, diagnostic, and treatment benefits. Chapter 6: Administration and Miscellaneous - Repeals requirements for inspections of the care being provided at mental hospitals and intermediate care facilities for the mentally retarded (ICFS-MR). (Sec. 4752) Authorizes a State, in lieu of terminating a noncompliant ICFS-MR, to establish alternative remedies if the State demonstrates to the Secretary's satisfaction that such alternative remedies are effective in deterring noncompliance and correcting deficiencies. (Sec. 4753) Revises requirements for mechanized claims processing and information retrieval systems. (Sec. 4754) Repeals the requirement for State refund to the Federal Government of any payments received during remediation of a noncompliant nursing facility. (Sec. 4755) Requires States to establish procedures to permit a nurse aide, in the case of a finding of neglect, to petition the State for name removal from the nurse aide registry upon a State determination that: (1) the employment and personal history of the nurse aide does not reflect a pattern of abusive behavior or neglect; and (2) the neglect involved in the original finding was a singular occurrence. (Sec. 4756) Includes the DRUGDEX Information System among the compendia to be used in drug use review for Medicaid payment. (Sec. 4757) Applies certain requirements to the extension of statewide comprehensive research and demonstration projects for which waivers of Medicaid compliance have been granted. (Sec. 4758) Amends the Omnibus Budget Reconciliation Act of 1989 to extend the moratorium on the treatment of the Kent Community Hospital Complex and Saginaw Community Hospital in Michigan as institutions for mental diseases for purposes of Medicaid reimbursement. Subtitle I: Programs of All-Inclusive Care for the Elderly (PACE) - Amends SSA title XVIII to provide for Medicare programs of all-inclusive care for the elderly (PACE programs) for individuals age 55 or older who require the level of care required under the State Medicaid plan for coverage of nursing facility services. Specifies benefit and payment requirements. Limits PACE provider eligibility to public and private non-profit entities; but requires the Secretary to waive such limitations to demonstrate the operation of a PACE program by a private, for-profit entity. (Sec. 4802) Amends SSA title XIX to authorize a State to establish a Medicaid program of all-inclusive care for the elderly (PACE) for individuals who need not be eligible for Medicare part A benefits, or enrolled under Medicare part B. (Sec. 4804) Directs the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under Medicare and Medicaid, specifically comparing the costs, quality, and access to services by private, for-profit entities under the demonstration projects with the costs, quality, and access to services of other PACE providers. Subtitle J: State Children's Health Insurance Program - Chapter 1: State Children's Health Insurance Program - Amends SSA to add a new title XXI (State Children's Health Insurance Program) in order to provide funds to States to expand the provision of child health assistance to uninsured, low-income children. Requires a State to submit for the Secretary's approval a child health plan for the use of funds, containing strategic objectives, performance goals, and performance measures. Mandates coverage equivalent to benefits coverage in a benchmark benefit package, consisting of benefits offered by either: (1) the Federal Employees' Health Benefits Program (FEHBP); (2) a State employee health benefit plan; or (3) an HMO. Makes appropriations to carry out this title. Allows their use for abortion only if necessary to save the life of the mother or if the pregnancy results from rape or incest. Chapter 2: Expanded Coverage of Children Under Medicaid - Amends SSA title XIX to provide for an increased Medicaid FMAP for expanded coverage of targeted low-income children. (Sec. 4912) Authorizes an approved State plan to make Medicaid available to a low-income child during a specified presumptive eligibility period after determination that family income does not exceed a certain level. (Sec. 4913) Provides for continuation of Medicaid eligibility for disabled children who lose benefits under SSA title XVI (Supplemental Security Income) (SSI). Chapter 3: Diabetes Grant Programs - Amends the Public Health Service Act to direct the Secretary to make grants for services for the prevention and treatment of type I diabetes in children, and for research in innovative approaches to such services. Provides for funding. (Sec. 4922) Directs the Secretary to make grants for services for the prevention and treatment of type I diabetes in Indians through the Indian Health Service and tribal and urban Indian health programs. (Sec. 4923) Requires the Secretary to evaluate such programs and report to the Congress. Title V: Welfare and Related Provisions - Subtitle A: TANF Block Grant - Amends part A (Temporary Assistance for Needy Families) (TANF) of SSA title IV to establish a program of welfare-to-work grants to States. (Sec. 5001) Sets forth requirements relating to State entitlement to non-competitive formula grants under such program and State distribution of such funds among local governments. Authorizes State Governors to distribute up to 15 percent of such grant funds for projects to help long-term welfare recipients enter unsubsidized employment. Provides for competitive grants, based on program effectiveness and other factors, including the history of the applicant's success in moving individuals with multiple barriers into work, for State-approved projects proposed by private industry councils or local governments. Sets forth rules relating to required beneficiaries and targeting of individuals with characteristics associated with long-term welfare dependency. Authorizes use of grant funds to provide work-related services to individuals who have reached the five-year limit on assistance. Directs the Secretary of Labor to use certain set-aside funds to make grants to each successful performance State in FY 2000. Makes appropriations for FY 1998 and 1999 for grants. Sets forth requirements for: (1) nondisplacement of other workers by participants in work activities under this program; (2) applicable health and safety standards; and (3) grievance procedures with respect to alleged violations of such nondisplacement and health and safety requirements. Provides for such grants to outlying areas territories and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to develop a plan to evaluate the use of such grants. Sets forth penalties for: (1) failure of a State to maintain its historic effort during a year in which a welfare-to-work grant is received; and (2) misuse of competitive welfare-to-work grant funds. Declares that State sanctions against recipients for TANF program violations are not wage reductions. (Sec. 5002) Limits to not more than ten percent the portion of such welfare-to-work grant funds which a State may use to carry out State programs under SSA title XX block grants to States for social services. (Sec. 5003) Increases from 20 percent to 30 percent of individuals in all families and in two-parent families the limitation on the number of persons who may be treated as engaged in work by reason of participation in a vocational education program or, in the case of teen heads of household, maintenance of satisfactory school attendance. (Sec. 5004) Requires reduction of a State's welfare-to-work grant if a State fails to reduce assistance for recipients refusing work without good cause. Subtitle B: Supplemental Security Income - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRAWORA) to extend by six months the deadline for certain childhood disability redeterminations under SSA title XVI (Supplemental Security Income) (SSI). (Sec. 5102) Prescribes the schedule of administrative fees the Commissioner of Social Security shall assess each State from FY 1997 through 2003 and after for making optional and mandatory State SSI payments to individuals. Revises requirements for deposit of such fees, directing that a portion be credited to a special fund for FY 1998 and subsequent fiscal years for use in defraying expenses. Provides that the amounts so credited shall not be scored as receipts under the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act), but credited as a discretionary offset to discretionary spending. Authorizes appropriations. Subtitle C: Child Support Enforcement - Amends SSA title III (Unemployment Insurance) with respect to the authority to permit certain redisclosures of wage and claim information for purposes related to the child support enforcement program under SSA title IV part D (Child Support and Establishment of Paternity). Subtitle D: Restricting Welfare and Public Benefits for Aliens - Amends PRAWORA to make aliens eligible for SSI who, as of the date of enactment of such Act, were receiving such benefits, or were legally residing in the United States and are blind or disabled. Extends the SSI grandfather provision through September 30, 1998. (Sec. 5302) Extends from five to seven years the refugee and asylee eligibility period for SSI and Medicaid, and includes Cuban and Haitian entrants within such category. Provides a five-year food stamp eligibility period for such aliens. Includes Cuban and Haitian entrants within the definition of "qualified alien" for purposes of welfare and public benefits. Exempts such aliens from specified periods of ineligibility for State and Federal means-tested benefits. (Sec. 5303) Exempts: (1) certain American Indians (including persons born in Canada) from SSI and Medicaid eligibility limitations; and (2) certain SSI recipients with pre-January 1, 1979 applications from SSI eligibility limitations. (Sec. 5305) States that an alien who is ineligible for food stamps shall not be eligible for such program based upon SSI eligibility. Authorizes Medicaid eligibility based upon SSI eligibility. (Sec. 5306) Treats certain Amerasian immigrants as refugees for purposes of specified public benefits eligibility. (Sec. 5307) Authorizes States to require State and local assistance applicants to provide v

Sponsor:

Rep. Kasich, John R. [R-OH-12] (Introduced 06/24/1997)

Summary:

Summary: H.R.2015 — 105th Congress (1997-1998)

There are 3 summaries for this bill. Line item veto by President (08/11/1997)Conference report filed in House (07/30/1997)Introduced in House (06/24/1997)     Bill summaries are authored by CRS. $("#summarySelector").congress_dropDownNavigation({ stubUrl: '/bill/105th-congress/house-bill/2015/summary', suffix: '' }); Shown Here:
Line item veto by President (08/11/1997) (On June 25, 1998, the Supreme Court ruled that the Line Item Veto Act (Public Law 104-130) is unconstitutional, thus restoring provisions that had been cancelled as summarized below.) (On August 11, 1997, the President line-item-vetoed Sec. 4722(c), which deemed to be permissible broad-based health care related taxes certain taxes, fees, or assessments collected by New York State from a health care provider before June 1, 1997, for which a specified waiver has been applied, or would be but for this provision. The provision would thus exempt such taxes, fees, or assessments from the requirement that provider-specific taxes be subtracted from the State share of Medicaid expenditures for purposes of Federal share calculation. The following revised digest of H.R. 2015 reflects the Act as signed into law, minus the line-item-vetoed provision. For more information on the specific items vetoed, see the text of the conference report for H.R. 2015, H.Rept. 105-217, and Presidential Cancellation Number 97-3.) TABLE OF CONTENTS: Title I: Food Stamp Provisions Title II: Housing and Related Provisions Title III: Communications and Spectrum Allocation Provisions Title IV: Medicare, Medicaid, and Children's Health Provisions Subtitle A: Medicare+Choice Program Subtitle B: Prevention Initiatives Subtitle C: Rural Initiatives Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity Subtitle E: Provisions Relating to Part A Only Subtitle F: Provisions Relating to Part B Only Subtitle G: Provisions Relating to Parts A and B Subtitle H: Medicaid Subtitle I: Programs of All-Inclusive Care for the Elderly (PACE) Subtitle J: State Children's Health Insurance Program Title V: Welfare and Related Provisions Subtitle A: TANF Block Grant Subtitle B: Supplemental Security Income Subtitle C: Child Support Enforcement Subtitle D: Restricting Welfare and Public Benefits for Aliens Subtitle E: Unemployment Compensation Subtitle F: Welfare Reform Technical Corrections Subtitle G: Miscellaneous Title VI: Education and Related Provisions Subtitle A: Higher Education Subtitle B: Repeal of Smith-Hughes Vocational Education Act Title VII: Civil Service Retirement and Related Provisions Title VIII: Veterans and Related Matters Subtitle A: Extension of Temporary Authorities Subtitle B: Copayments and Medical Care Cost Recovery Subtitle C: Other Matters Title IX: Asset Sales, User Fees, and Miscellaneous Provisions Subtitle A: Asset Sales Subtitle B: User Fees Subtitle C: Miscellaneous Provisions Title X: Budget Enforcement and Process Provisions Subtitle A: Amendments to the Congressional Budget and Impoundment Control Act of 1974 Subtitle B: Amendments to the Balanced Budget and Emergency Deficit Control Act of 1985 Title XI: District of Columbia Revitalization Subtitle A: District of Columbia Retirement Funds Subtitle B: Management Reform Plans Subtitle C: Criminal Justice Subtitle D: Privatization of Tax Collection and Administration Subtitle E: Financing of District of Columbia Accumulated Deficit Subtitle F: District of Columbia Bond Financing Improvements Subtitle G: District of Columbia Government Budget Subtitle H: Miscellaneous Provisions Balanced Budget Act of 1997 - Title I: Food Stamp Provisions - Amends the Food Stamp Act to define "caseload" and "covered individual." Authorizes State agencies to provide an additional 15 percent exemption from the food stamp program (program) work requirement for specified covered individuals. Provides for related caseload and exemption adjustments. (Sec. 1002) Obligates additional FY 1996 through 2002 funds for program employment and training programs. Sets forth State allocation provisions. (Sec. 1003) Requires State agencies, with assistance provided by the Secretary of Agriculture, to deny program benefits to prisoners incarcerated for more than 30 days. (Sec. 1004) Directs the Secretary to make specified funds available for FY 1998 through 2001 to eligible private nonprofit organizations and State agencies for nutrition education. Title II: Housing and Related Provisions - Amends the Balanced Budget Downpayment Act, I to extend permanently certain foreclosure avoidance provisions under the single family housing mortgage insurance program. (Sec. 203) Amends the United States Housing Act of 1937 with respect to the section 8 rental assistance program to make specified maximum monthly rent adjustment provisions for certain new and rehabilitated and nonturnover units applicable to FY 1999 and thereafter. Title III: Communications and Spectrum Allocation Provisions - Amends the Communications Act of 1934 (the Act) to make competitive bidding authority with respect to licenses or construction permits involving uses of the electromagnetic spectrum (spectrum) inapplicable to such licenses and permits issued by the Federal Communications Commission (FCC) that are for: (1) certain public safety radio services; (2) initial licenses or permits assigned to existing terrestrial broadcast licensees for digital television (TV) service; or (3) noncommercial educational or public broadcast stations. Requires the FCC to provide for the design and conduct of spectrum competitive bidding using a contingent combinatorial bidding system that permits prospective bidders to bid on combinations of licenses in a single bid and to enter multiple alternative bids within a single bidding round. Directs the FCC to prescribe methods by which a reasonable reserve price will be required, or a minimum bid will be established, to obtain any license or permit assigned under competitive bidding, unless determined not to be in the public interest. Repeals a requirement that any funds appropriated to the FCC for FY 1994 through 1998 for assigning licenses using random selection procedures be retained in the FCC's salaries and expenses account. Requires competitive bidding information to be included in annual FCC reports in order for any funds collected after FY 1998 to be retained in such account. Extends competitive bidding authority through FY 2008. Prohibits the FCC, after July 1, 1997, from issuing a license or construction permit for spectrum through a random selection system. Excepts from such prohibition licenses or permits for noncommercial educational or public broadcast stations. Provides for the applicability of competitive bidding requirements to pending comparative licensing cases. Makes available for assignment for commercial use the 1710 to 1755 megahertz (mhz) frequency band. Directs the FCC to assign licenses for such use by competitive bidding commenced after January 1, 2001. Directs the FCC to assign certain additional spectrum by competitive bidding no later than September 30, 2002. Directs the FCC to reallocate: (1) spectrum located at 2110 to 2150 mhz; and (2) 15 mhz located in the 1990 to 2110 range, with an exception in both cases when not in the public interest. Requires the FCC to notify the Secretary of Commerce if it is unable to provide for effective relocation of incumbent licensees to available bands of frequencies and has identified bands suitable for such relocation that are allocated for Federal use but could be reallocated pursuant to the National Telecommunications and Information Administration Organization Act (NTIA). Amends NTIA to direct the Secretary to report to the President, the FCC, and the Congress on recommendations for reallocating frequencies allocated for Federal use other than by Government licensees under the Communications Act of 1934. Authorizes any entity which operates a Government station to accept payment for frequency relocation expenses. Provides a relocation process triggered by a petition under NTIA. Allows a Federal entity to reclaim a former frequency if it demonstrates that relocated facilities or spectrum are not comparable to its former facilities or spectrum. Requires the Secretary to recommend for reallocation for use other than by Government stations a band of frequencies that: (1) in the aggregate span at least 20 mhz; (2) are located below three gigahertz; and (3) meet other relocation criteria. Directs the FCC to prepare and submit to the President and the Congress a plan for the immediate allocation and assignment of frequencies identified under this title. (Sec. 3003) Amends the Act to prohibit the renewal of a license authorizing analog TV services beyond the end of 2006, with an extension in specified circumstances. Prohibits the FCC, in prescribing regulations relating to qualifications of spectrum bidders, from: (1) precluding any party from being a qualified bidder for spectrum allocated for any use that includes digital TV service on the basis of the FCC's duopoly rule or newspaper cross-ownership rule; or (2) applying either rule to preclude a successful bidder from using such spectrum for digital TV service. (Sec. 3004) Directs the FCC, no later than January 1, 1998, to allocate from radio spectrum between 746 and 806 mhz: (1) 24 mhz for public safety services; and (2) the remainder for commercial purposes to be assigned by competitive bidding. Sets deadlines for the assignment of such licenses and the commencement of competitive bidding. Provides for the licensing of unused frequencies for public safety services. (Sec. 3005) Authorizes the FCC to allocate spectrum to provide flexibility of use, as long as such use is consistent with international agreements and upon a finding that such use is in the public interest and would not deter investment or result in harmful interference among users. (Sec. 3006) Authorizes appropriations to the FCC for FY 2001 for universal service support programs. (Sec. 3007) Directs the FCC to conduct all competitive bidding required under this title so that proceeds from such bidding are deposited no later than the end of FY 2002. (Sec. 3008) Requires seven days' public notice before the granting by the FCC of an application for spectrum frequency assignment under the Act. Title IV: Medicare, Medicaid, and Children's Health Provisions - Subtitle A: Medicare+Choice Program - Chapter 1: Medicare+Choice Program - Amends title XVIII (Medicare) of the Social Security Act (SSA) to establish a Medicare+Choice program under which each Medicare+Choice eligible individual (one entitled to benefits under Medicare part A (Hospital Insurance) and enrolled under Medicare part B (Supplementary Medical Insurance)) is entitled to elect, in accordance with certain procedures, to receive Medicare benefits either through the original Medicare fee-for-service program or through a Medicare+Choice plan. (Sec. 4001) Outlines the types of Medicare+Choice plans that may be available, namely: (1) coordinated care plans; (2) combination of a medical savings account (MSA) plan and contributions into a Medicare+Choice MSA; and (3) private fee-for-service plans. Sets forth various special rules regarding, among other things, residence, individuals with end-stage renal disease, and individuals covered under the Federal Employees Health Benefits Program or eligible for veterans' or military health benefits. Directs the Secretary of Health and Human Services (HHS) to: (1) provide for broad dissemination of coverage option and comparison information to Medicare beneficiaries and prospective Medicare beneficiaries; and (2) maintain a toll-free number for inquiries about Medicare+Choice options and program operation, as well as an Internet site through which individuals may obtain such information electronically. Requires: (1) any Medicare+Choice organization to accept without restrictions individuals eligible to make an election at any time during which such elections are accepted; and (2) approval of Medicare+Choice marketing material and application forms before they are distributed. Provides for continuous open enrollment and disenrollment through 2001, the first six months of 2002, and the first three months of every subsequent year, limiting an individual's change of enrollment during such initial period to one. Provides for an annual, coordinated election period during November for all participants as well as special election periods in certain circumstances. Outlines benefits and beneficiary protections. Requires each Medicare+Choice plan (except MSA plans) to provide those items and services for which benefits are available under Medicare parts A and B (other than hospice care) and specified additional benefits, as well, at its option, as certain supplemental benefits, subject to the Secretary's approval. Excludes individuals enrolled under a MSA plan from participating in such supplemental package. Prohibits a Medicare+Choice organization from denying, limiting, or conditioning coverage or benefits based on any described health status-related factor. Prescribes plan disclosure requirements and an ongoing quality assurance program. Outlines a mechanism for grievances and appeals. Sets forth certain payment rules for providers not participating in the Medicare+Choice program. Directs the Secretary to make monthly advance payments with respect to an individual's coverage to Medicare+Choice organizations according to a specified formula. Requires the Secretary to establish separate payment rates for individuals with end-stage renal disease. Sets forth special rules for individuals electing MSA plans. Requires such an individual to establish a Medicare+Choice MSA into which the Secretary shall make monthly deposits out of the Medicare trust funds in accordance with prescribed guidelines. Prescribes special rules for hospice care. Details rules for the submission and charging of premiums by each Medicare+Choice organization. Sets limitations on enrollee liability for basic, additional, and supplemental benefits. Prescribes a special rule for private fee-for-service plans. Prohibits a State from imposing a premium tax or similar tax with respect to payments to Medicare+Choice organizations. Sets out organizational and financial requirements for Medicare+Choice organizations and provider-sponsored organizations. Directs the Secretary to establish solvency and capital adequacy standards for provider-sponsored organizations, and other standards for Medicare+Choice organizations. Prescribes requirements, including minimum enrollment requirements, for contracts between the Secretary and Medicare+Choice organizations. Provides for: (1) intermediate sanctions and civil monetary penalties to enforce contract provisions; and (2) procedures for termination of contracts. (Sec. 4002) Details transitional rules for the current Medicare health maintenance organization (HMO) program, as well as specified conforming changes in the Medicare supplemental health insurance policy (Medigap) program. (Sec. 4006) Amends the Internal Revenue Code to outline special rules for Medicare+Choice MSAs. Excludes from gross income any payment by the Secretary to an individual's Medicare+Choice MSA. Excludes from qualified deductible medical expenses any amounts paid for the medical care of any individual but the account holder. Prescribes a penalty for distributions from the Medicare+Choice MSA not used for qualified medical expenses if the minimum balance is not maintained, with certain exceptions if the account holder becomes disabled or dies. Chapter 2: Demonstrations - Directs the Secretary to establish a Medicare prepaid competitive pricing demonstration project in up to four (eventually seven) designated Medicare payment areas, of which initially three shall be in urban areas and one in a rural area. (Sec. 4012) Directs the Secretary to appoint a Competitive Pricing Advisory Committee to recommend areas for the demonstration and research design for project implementation. (Sec. 4014) Amends the Omnibus Budget Reconciliation Act of 1987 to extend the authorities for the social health maintenance organization (SHMO) demonstration project. Amends the Omnibus Budget Reconciliation Act of 1993 to increase the cap on the number of individuals who may participate in a SHMO demonstration. Directs the Secretary to submit to the Congress a plan for the integration of SHMO health plans and similar plans as an option under the Medicare+Choice program. (Sec. 4015) Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a demonstration (subvention) project under which the HHS Secretary shall reimburse the Secretary of Veterans Affairs from the Medicare trust funds for Medicare health care services furnished to certain targeted Medicare-eligible military retirees or dependents. Authorizes the Secretary of Defense to modify existing TRICARE contracts in order to provide Medicare health care services to project participants. (Sec. 4016) Directs the Secretary to conduct demonstration projects in a certain number of rural and urban areas for the purpose of evaluating methods, such as case management and other models of coordinated care, that improve the quality of items and services provided to target individuals, and reduce Medicare expenditures for such items and services. Defines a target individual as an individual with a chronic illness who is enrolled under the Medicare parts A and B fee-for-service program. Provides for project funding. (Sec. 4017) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to direct the Secretary to work with each municipal health service demonstration project to develop a plan for the orderly transition of such projects and project participants to a non-demonstration project health care delivery system, such as through integration with a private or public health care plan, including a Medicaid managed care or Medicare+Choice plan. (Sec. 4018) Directs the Secretary to implement a time-limited demonstration project for the purpose of evaluating the use of a third-party contractor to conduct the Medicare+Choice plan enrollment and disenrollment functions in an area. (Sec. 4019) Extends for an additional two years certain Medicare community nursing organization demonstration projects under the Omnibus Budget Reconciliation Act of 1987. Chapter 3: Commissions - Establishes the National Bipartisan Commission on the Future of Medicare to: (1) review and analyze the long-term financial condition of the Medicare program; (2) identify problems that threaten the financial integrity of the Medicare trust funds, including the extent to which current Medicare update indexes do not accurately reflect inflation; and (3) analyze potential solutions to the problems identified that will ensure both the financial integrity of Medicare and the provision of appropriate benefits. Requires the Commission to make recommendations: (1) to restore the solvency of the Federal Hospital Insurance Trust Fund and the financial integrity of the Federal Supplementary Medical Insurance Trust Fund; and (2) to establish the appropriate financial structure of the Medicare program as a whole and the appropriate balance of benefits covered and beneficiary contributions. Requires recommendations on: (1) the financing of graduate medical education; (2) the feasibility of allowing individuals between age 62 and the Medicare eligibility age to buy into the Medicare program; and (3) the impact of chronic disease and disability trends on future costs and quality of services under the current benefit, financing, and delivery system structure of the Medicare program. Requires a report to the President and the Congress. Authorizes appropriations. (Sec. 4022) Establishes the Medicare Payment Advisory Commission to replace the Prospective Payment Assessment Commission and the Physician Payment Review Commission, hereby abolished. Requires the new Commission to review and make recommendations to the Congress about payment policies under Medicare (including certain specific payment-related topics). Authorizes appropriations. Chapter 4: Medigap Protections - Amends SSA title XVIII with respect to the issuer of a Medicare supplemental (Medigap) policy in the case of certain individuals terminated by an employee welfare benefit plan providing supplementary health benefits who seek to enroll under a Medigap policy not later than 63 days after termination or disenrollment. Prohibits the Medigap issuer from: (1) denying or conditioning the issuance or effectiveness of such a policy; (2) discriminating in the pricing of such policy because of health status, claims experience, receipt of health care, or medical condition; or (3) imposing an exclusion of benefits based on a pre-existing condition. (Sec. 4031) Specifies limitations on the imposition of preexisting condition exclusions during the initial open enrollment period in the case of a Medicare supplemental policy issued to an individual who is age 65 or older with a certain minimum period of creditable coverage. (Sec. 4032) Creates under the Medicare supplemental policy program a high deductible feature which requires the policy beneficiary to pay annual out-of-pocket expenses (other than premiums) of $1,500 (indexed for inflation) before the policy begins payment of benefits. Chapter 5: Tax Treatment of Hospitals Participating in Provider- Sponsored Organizations - Amends the Internal Revenue Code to provide that an organization shall not fail to be treated as a tax-exempt charitable organization solely because a hospital which it owns and operates also participates in a provider-sponsored organization, whether or not the provider-sponsored organization is exempt from tax. Provides that any person with a material financial interest in such a provider-sponsored organization shall be treated as a private shareholder or individual with respect to the hospital. Subtitle B: Prevention Initiatives - Outlines various specified new preventive health measures covered under Medicare, namely coverage for: (1) an annual screening mammography for women over age 39 and triennial screening pap smear and screening pelvic exam for any woman (annually for a woman with cervical or vaginal cancer or other abnormality, or who is at high risk of developing such a cancer), while providing for a waiver of deductible; (2) annual prostate cancer screening tests; (3) colorectal cancer screening tests, subject to prescribed frequency and payment limits; (4) diabetes outpatient self-management training services, including blood-testing strips (with a ten percent payment reduction after 1997) and glucose monitors as durable medical equipment (DME) for individuals with diabetes; and (5) bone mass measurements for qualified individuals. (Sec. 4105) Directs the Secretary to establish outcome measures, including glysolated hemoglobin (past 90-day average blood sugar levels), for the purpose of evaluating the improvement of health status of Medicare beneficiaries with diabetes mellitus, with a view to recommending coverage modifications. (Sec. 4107) Extends through FY 2002 the Influenza and Pneumococcal Vaccination Campaign of the Health Care Financing Administration (HCFA). Authorizes appropriations. (Sec. 4108) Directs the Secretary to request the National Academy of Sciences to analyze (for a report to specified congressional committees) the expansion or modification of Medicare preventive benefits to include medical nutrition therapy services by a registered dietitian, skin cancer screening, medically necessary dental care, and other specified items. Subtitle C: Rural Initiatives - Replaces the Essential Access Community Hospital Program with an optional Medicare Rural Hospital Flexibility Program under which participating States shall develop at least one rural health network in the State and at least one facility designated as a critical access hospital in accordance with prescribed guidelines. Authorizes the Secretary to award grants to States for: (1) planning and implementation of the program; and (2) establishment or expansion of rural emergency medical services. Authorizes appropriations. Directs the HCFA Administrator to report to the Congress on the feasibility of, and administrative requirements necessary to establish, an alternative for certain medical diagnoses to the current 96-hour limitation for inpatient care in critical access hospitals. (Sec. 4202) Amends SSA title XVIII to prohibit denial, on the basis of wage comparisons, of a rural referral center's request for reclassification. Provides that any hospital classified as a rural referral center for FY 1991 shall be classified as such for FY 1998 and each subsequent fiscal year. (Sec. 4204) Extends through FY 2001 the special treatment of payment methodology and target amount for Medicare-dependent, small rural hospitals. (Sec. 4205) Amends requirements for rural health clinic services with respect to: (1) per-visit payment limits for provider-based clinics; (2) mandatory quality assessment and performance improvement programs; (3) limitation of waivers of certain staffing requirements to clinics participating in the rural health clinic program; (4) the insufficiency of needed health care practitioners in shortage areas; and (5) regulations providing for payment for certain physician assistant services. (Sec. 4206) Directs the Secretary to make payments from the Federal Supplementary Medical Insurance Trust Fund under Medicare part B in accordance with a specified payment methodology for professional consultation via telecommunications systems with a physician or practitioner furnishing a service for which payment may be made to a Medicare beneficiary residing in a rural health professional shortage area, notwithstanding that the individual physician or practitioner providing the professional consultation is not at the same location as the physician or practitioner furnishing the service to that beneficiary. Directs the Secretary to report to the Congress: (1) a detailed analysis of telemedicine and telehealth (T&T) services; and (2) an examination of the possibility of making similar payments for professional consultation via telecommunications systems to Medicare beneficiaries who do not reside in a rural health professional shortage area, are homebound or nursing homebound, and for whom being transferred for health care services imposes a serious hardship. (Sec. 4207) Directs the Secretary to conduct a demonstration project to use eligible health care provider telemedicine networks to apply high-capacity computing and advanced networks to improve primary care and prevent health care complications to Medicare beneficiaries with diabetes mellitus who reside in medically underserved rural or inner-city areas. Provides funding. Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity - Chapter 1: Revisions to Sanctions for Fraud and Abuse - Amends SSA title XI, with respect to health care related crimes, to exclude from the Medicare and State health care programs any person: (1) for ten years for one previous conviction for one or more offenses; and (2) permanently for two or more previous convictions of one or more offenses. (Sec. 4302) Authorizes the Secretary to refuse to enter into Medicare agreements with individuals or entities convicted of felonies for offenses determined inconsistent with the best interests of program beneficiaries. (Sec. 4303) Authorizes the Secretary to exclude from the Medicare program any entity with respect to which a sanctioned person with an ownership or control interest in it transfers such interest in anticipation of (or following) a conviction, assessment, or exclusion against the person, to an immediate family member or member of the household who continues to maintain such an interest. (Sec. 4304) Provides for the imposition of civil monetary penalties for: (1) any person who arranges or contracts with an individual or entity that the person knows or should know is excluded from participation in a Federal health care program; and (2) kickbacks. Chapter 2: Improvements in Protecting Program Integrity - Amends SSA title XVIII to require the Secretary, in the annual notice of Medicare benefits, to urge beneficiaries to check the notice and any itemized statement for accuracy and report any errors or questionable charges by calling a certain toll-free number. Authorizes Medicare beneficiaries to submit written requests for itemized bills of medical or other items or services provided, and review them. Requires the Secretary to take measures to recover amounts unnecessarily paid out. (Sec. 4312) Outlines various specified requirements regarding disclosure of information and surety bonds with regard to DME suppliers. Includes surety bond requirements for home health agencies. Authorizes the Secretary to apply disclosure and surety bond requirements to other health care providers or item and service suppliers (except physicians or practitioners). Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORFs) and to rehabilitation agencies. (Sec. 4313) Requires any participating entity to disclose to the Secretary its own employer identification numbers and social security account numbers, as well as those of persons with ownership or control interests and subcontractors in which the entity has a five percent or greater interest. Directs the Secretary to report to Congress on the steps taken to assure the confidentiality of such social security account numbers. (Sec. 4314) Requires the Secretary, upon a party's request, to issue binding advisory opinions on whether a referral relating to designated health services (other than clinical laboratory services) is a prohibited physician self-referral. (Sec. 4315) Amends SSA title XVIII to: (1) replace the reasonable charge payment methodology with fee schedules developed by the Secretary for particular services; (2) provide for application of inherent reasonableness to charges for all Medicare part B services other than physicians' services; (3) require bills and requests for payment for services by non-physician practitioners to include diagnostic codes; (4) outline requirements to provide diagnostic information when ordering certain items or services furnished by another entity; (5) mandate establishment of competitive acquisition areas for contract award purposes for the furnishing under Medicare part B after 1997 of described items and services; and (6) prohibit payment under Medicare part A or part B for any expenses for an item or service furnished in a competitive acquisition area by an entity other than an entity with which the Secretary has contracted, except for urgent need, or in other circumstances specified by the Secretary. (Sec. 4320) Excludes from reasonable costs and declares unreimbursable under Medicare any payments for certain items unrelated to patient care, including: (1) entertainment, gifts, or donations; (2) personal use of motor vehicles; (3) costs for fines and penalties resulting from violations of Federal, State, or local laws; and (4) education expenses for spouses or other dependents of service providers, their employees, or contractors. (Sec. 4321) Requires a Medicare hospital's discharge planning process to include information on the availability of home health services through certain individuals or entities. Requires a discharge plan: (1) not to specify or otherwise limit the qualified provider which may provide home health services; and (2) identify any entity to whom the individual is referred in which the hospital has a disclosable financial interest. Requires the service provider agreement to require disclosure of any financial interest a hospital has in any entity to which individuals are referred, or any entity has in the hospital, and related information. Chapter 3: Clarifications and Technical Changes - Makes technical amendments with respect to fraud and abuse. Subtitle E: Provisions Relating to Part A Only - Chapter 1: Payment of PPS Hospitals - Revises requirements for: (1) prospective payment system (PPS) hospital payment updates; (2) maintenance of savings from the temporary reduction in capital payments for prospective payment system (PPS) hospitals; (3) additional payments to any hospital with a disproportionate share of low-income patients (disproportionate share hospital (DSH)); (4) the sales price of a Medicare capital asset (book value); (5) elimination of indirect medical education (IME) and DSH payments attributable to outlier payments; (6) the base rate of payments to Puerto Rico hospitals; (7) payments to hospitals for certain discharges to post-acute care; (8) inclusion of Stanly County, North Carolina, in the large urban area of Charlotte-Gastonia-Rock Hill-North Carolina-South Carolina; and (9) the floor on wage area indexes. (Sec. 4409) Requires the Secretary to publish and use alternative guidelines under which certain disproportionately large hospitals qualify for geographic reclassification. Chapter 2: Payment of PPS-Exempt Hospitals - Revises requirements for the payment of PPS-exempt hospitals, including those for: (1) payment updates; (2) reductions to capital payments; (3) bonus and relief payments; (4) payment and the target amount for new providers; (5) treatment of certain long-term care hospitals located within other hospitals; (6) rebasing; (7) certain cancer hospitals; and (8) elimination of exemptions for certain hospitals. (Sec. 4421) Provides for a Medicare PPS for inpatient rehabilitation hospital services. (Sec. 4422) Directs the Secretary to submit to the Congress a legislative proposal for establishing a case-mix adjusted PPS for long-term care hospitals. Chapter 3: Payment for Skilled Nursing Facilities - Declares that updates to per diem limits, with respect to payments to skilled nursing facilities (SNFs), effective for FY 1998, shall be based on cost limits effective for FY 1997. (Sec. 4432) Mandates a PPS for SNF services along with consolidated billing for them. Directs the Secretary, in order to ensure that Medicare beneficiaries are furnished appropriate SNF services, to establish a thorough medical review process to examine the provisions of this section and their effect on the quality of covered SNF services furnished to Medicare beneficiaries. Chapter 4: Provisions Related to Hospice Services - Provides for update of payments for hospice services. Bases payment for home hospice care on the location where care is furnished. Revises the home hospice care benefit period. Provides for home hospice care coverage of any other items and services specified in a plan. Allows waiver of certain staffing requirements for hospice care programs in non-urbanized areas. Chapter 5: Other Payment Provisions - Requires reductions in payments for enrollee bad debt. Repeals the termination date to make a permanent extension of the hemophilia passthrough. Requires a certain reduction in the part A Medicare premium for specified public retirees. Authorizes Medicare and Medicaid coverage of inpatient hospital and post-hospital extended care services in religious nonmedical health care institutions (currently limited to Christian Science sanatoria). Subtitle F: Provisions Relating to Part B Only - Chapter 1: Services of Health Professionals - Revises requirements for the payment of physicians' services, with changes: (1) establishing a single conversion factor for 1998; (2) adding new update provisions; (3) replacing the volume performance standard with sustainable growth rate; (4) adding payment rules for anesthesia services; and (5) providing for adjustments in relative value units for 1998, and the application of resource-based methodology to malpractice relative value units. (Sec. 4505) Directs the Comptroller General to review and evaluate the proposed rule on resource-based methodology for practice expenses issued by the HCFA. (Sec. 4506) Directs the Secretary to determine for each hospital: (1) its hospital-specific per discharge relative value for physicians' services; and (2) whether such value is projected to be excessive. Requires the Secretary to notify the medical executive committee of a subset of the hospitals identified as having an excessive hospital-specific relative value, and evaluate their responses with the responses of other hospitals so identified that were not notified. (Sec. 4507) Amends SSA title XVIII to declare that nothing shall prohibit a physician or practitioner from privately contracting with a Medicare beneficiary for any item or service for which no Medicare claim will be submitted, and for which the physician or practitioner shall receive no Medicare reimbursement. (Sec. 4511) Increases Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. (Sec. 4513) Repeals the requirement of an X-ray for reimbursement for chiropractic services. Directs the Secretary to develop utilization guidelines for the coverage of chiropractic services where a subluxation has not been demonstrated by an X-ray. Chapter 2: Payment for Hospital Outpatient Department Services - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 4522) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 4523) Directs the Secretary to establish a PPS for hospital outpatient department services. Chapter 3: Ambulance Services - Provides for certain interim reductions in payments for ambulance services. Directs the Secretary to establish a prospective fee schedule for payment of such services. Provides that, in promulgating regulations for coverage of ambulance services, the Secretary may cover advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. (Sec. 4532) Directs the Secretary to establish up to three demonstration projects contracting with local governments for ambulance services paid for under Medicare. Chapter 4: Prospective Payment for Outpatient Rehabilitative Services - Provides for a PPS for outpatient physical (including speech-language pathology) and occupational therapy services. Chapter 5: Other Payment Provisions - Provides for a reduction in payment amounts for items of DME and for clinical diagnostic laboratory tests. Provides for a payment freeze for parenteral and enteral nutrients, supplies, and equipment. Revises update requirements for payment for orthotics and prosthetics, and other payment requirements for oxygen and oxygen equipment, ambulatory surgical services, and drugs and biologicals. (Sec. 4552) Requires the Comptroller General to study and report to specified congressional committees on access to home oxygen equipment. Requires the Secretary to arrange for peer review organizations to evaluate such access. (Sec. 4553) Directs the Secretary to request the National Academy of Sciences to study (for a report to specified congressional committees) Medicare payments for clinical laboratory tests. (Sec. 4554) Directs the Secretary to divide the United States into up to five regions, and designate a single carrier for each region, for the payment of Medicare part B claims for clinical diagnostic laboratory services. Requires the Secretary to adopt uniform policies for clinical diagnostic laboratory tests. (Sec. 4557) Provides for coverage of oral anti-nausea drugs under a chemotherapeutic regimen. (Sec. 4558) Requires the Secretary to: (1) audit cost reports of each renal dialysis provider at least once every three years; and (2) develop a method to measure and report on the quality of Medicare renal dialysis services. (Sec. 4559) Directs the Secretary, for electrocardiogram tests furnished during 1998, to restore separate part B payment for electrocardiogram transportation based upon methods in effect on December 31, 1996. Requires the Secretary, by a certain deadline, to recommend to specified congressional committees whether portable electrocardiogram transportation should be covered under Medicare part B. Chapter 6: Part B Premium and Related Provisions - Revises the formula for the monthly Medicare part B premium rate the Secretary promulgates each September for the following calendar year. Requires such rate to equal 50 percent of the monthly actuarial rate for enrollees age 65 and over for that succeeding calendar year. (Sec. 4581) Provides for a special Medicare enrollment period, with no premium penalty for late enrollment, for certain disabled workers whose continuous enrollment under an employer's group health plan is involuntarily terminated in certain circumstances. (Sec. 4582) Allows appropriate State or local governmental entities to elect to pay part B premiums for certain eligible individuals. Subtitle G: Provisions Relating to Parts A and B - Chapter 1: Home Health Services and Benefits - Provides that, in establishing payment limits for cost reporting periods beginning after September 30, 1997, the Secretary shall not take into account any changes in the home health market basket with respect to cost reporting periods which began on or after July 1, 1994, and before July 1, 1996. (Sec. 4602) Revises requirements for interim payments for home health services. Directs the Secretary to expand research on a PPS for home health agencies under the Medicare program that ties prospective payments to a unit of service. (Sec. 4603) Directs the Secretary to establish a PPS for home health services for cost reporting periods beginning in FY 2000. (Sec. 4604) Bases the payment for home health services on the location where the service is furnished. (Sec. 4611) Provides for a modification of the Medicare part A home health benefit for individuals enrolled under Medicare part B. Provides for specified post-institutional home health services. (Sec. 4613) Directs the Secretary to study and report to the Congress on the criteria that should be applied in determining whether an individual is homebound for purposes of qualifying for Medicare home health services. (Sec. 4614) Provides for the denial of home health claims based on home health services the frequency and duration of which are in excess of normative guidelines established by the Secretary. (Sec. 4615) Denies payment for home health benefits based solely on venipuncture to obtain a blood sample. (Sec. 4616) Directs the Secretary to estimate part A and part B outlays for FY 1998 through 2002 for specified congressional committees, and report annually a comparison of actual outlays with such estimates. Chapter 2: Graduate Medical Education - Revises requirements for direct and indirect Medicare payments for graduate medical education (GME). Limits the number of residents in allopathic and osteopathic medicine. Permits payment to qualified nonhospital providers for direct GME costs. Prohibits restandardization of certain indirect GME payment amounts. Requires the Secretary to provide for direct and indirect GME payments to hospitals for Medicare+Choice enrollees. Makes a special reimbursement rule for primary care combined residency programs, setting the period of board eligibility. (Sec. 4626) Provides for incentive payments to hospitals under plans for voluntary reduction in the number of full-time equivalent residents in an approved medical training program. (Sec. 4628) Directs the Secretary to establish a demonstration project under which GME payments shall be made to consortia of teaching hospitals and other medical entities. (Sec. 4629) Directs the Medicare Payment Advisory Commission to develop recommendations to the Congress on whether and to what extent Medicare payment policies and other Federal policies regarding teaching hospitals and GME should be changed. (Sec. 4630) Directs the Secretary to study and report to the appropriate congressional committees on variations among hospitals in the overhead and supervisory physician components of their direct medical education costs. Chapter 3: Provisions Relating to Medicare Secondary Payer - Revises requirements for Medicare as secondary payer. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Chapter 4: Other Provisions - Amends SSA title XVIII to require placement of an advance directive in a prominent part of the individual's current medical record. (Sec. 4642) Provides for an increased certification period for certain organ procurement organizations. (Sec. 4643) Establishes in the HCFA the position of Chief Actuary. Subtitle H: Medicaid - Chapter 1: Managed Care - Amends SSA title XIX (Medicaid) to establish a new part B (Managed Care) giving States the option to require Medicaid-eligible individuals (except Medicare beneficiaries, Medicare-eligible individuals, and certain children with special needs) to enroll in managed care arrangements of the individual's choice as a condition of receiving Medicaid. (Sec. 4702) Grants States the option of providing Medicaid coverage of primary care case management services without the need for a waiver. (Sec. 4703) Repeals the (75-25) requirement that Medicare and Medicaid beneficiaries constitute less than 75 percent of the membership of a participating HMO. Repeals the prohibition on co-payments for services furnished by HMOs. (Sec. 4704) Prescribes requirements for: (1) access to emergency care; (2) annual external independent review of managed care entity activities and other specified quality care assurance measures; and (3) fraud and abuse prohibitions and protections. (Sec. 4705) Amends SSA title XIX (Medicaid) to require any State contracting with Medicaid managed care organizations to develop and implement a quality assessment and improvement strategy incorporating certain access standards, monitoring procedures, and other measures. Directs the Comptroller General to analyze and report to specified congressional committees on the quality assurance programs and accreditation standards applicable to managed care entities operating in the private sector or under Medicare contracts to determine if such programs and standards consider the accessibility and quality of the health care items and services delivered under such contracts to low-income individuals. Directs the Secretary to study and report to such committees on safeguards that may be needed to ensure that the health care needs of individuals with special health care needs and chronic conditions who are enrolled with Medicaid managed care organizations are adequately met. (Sec. 4706) Requires an HMO to meet solvency standards established by the State for private HMOs, or be State-licensed or -certified as a risk-bearing entity. (Sec. 4708) Increases from $100,000 to $1 million, indexed annually, the threshold amount for HMO contracts requiring the Secretary's prior approval. Permits the same copayments in HMOs as in fee-for-service. Chapter 2: Flexibility in Payment of Providers - Repeals "Boren Amendment" provider reimbursement requirements. Requires the Secretary to study and report to the appropriate congressional committees on the effect on access to services, service quality, and service safety of the rate-setting methods used by States as a result of such repeal. (Sec. 4712) Specifies reductions from 100 percent to 70 percent between FY 1999 through 2003 in the percentage of reasonable costs that shall be paid under a State plan for federally-qualified health center and rural health clinic services (with a special supplemental payment for services furnished under certain managed care contracts). (Sec. 4713) Repeals payment rate requirements for obstetrical and pediatric services. (Sec. 4714) Revises requirements for Medicaid payment rates for qualified Medicare beneficiaries, placing a limitation on nonparticipating providers. (Sec. 4715) Declares that, in the case of a Medicaid-eligible veteran residing in a State veterans' home, any veterans' pension over $90 per month shall be counted as income only for the purpose of applying such excess payment to the State veterans' home's cost of providing nursing care to the veteran. Chapter 3: Federal Payments to States - Revises specified limitations of Federal payments for inpatient hospital services furnished by disproportionate share hospitals (DSH), including limitations on certain State DSH expenditures to institutions for mental diseases or other mental health facilities. Requires direct State Medicaid payment to hospitals for managed care enrollees. (Sec. 4722) Revises the treatment as broad-based health care related taxes of certain State hospital taxes which currently are not subtracted as revenues from the State share of Medicaid expenditures for purposes of calculating the Federal share of such expenditures. Declares that an exemption from such State hospital tax for certain Federal-tax-exempt hospitals that do not accept Medicaid or Medicare payments (provide free care) shall not disqualify the hospital tax as a broad-based health care related tax (thus allowing continued exclusion of such State hospital tax from the requirement that provider-specific taxes be subtracted from the State share of Medicaid expenditures for purposes of Federal share calculation). (Sec. 4723) Specifies additional funding for State emergency health services furnished to undocumented aliens. (Sec. 4724) Prohibits the expenditure of Medicaid funds for roads, bridges, stadiums, and other items and services not covered by a State plan. Requires home health agencies to provide a surety bond. Revises conflict-of-interest safeguards. Declares that States are not required to provide medical assistance for items or services furnished by a person or entity convicted of a felony for an offense inconsistent with the best interests of beneficiaries under the State plan. Requires State action for program and beneficiary protection against waste, fraud, and abuse. Conditions issuance or renewal of a DME supplier provider number on the supplier's provision of a surety bond and disclosure of all persons with ownership or control interests in the supplier, and of all subcontractors in which the supplier has a five percent or greater interest. (Sec. 4725) Provides for increased Federal medical assistance percentages (FMAPs) for the District of Columbia and Alaska and increased payment caps for the territories. Chapter 4: Eligibility - Grants States the option to provide for 12-month continuous Medicaid eligibility for children. (Sec. 4732) Requires State Medicaid plan coverage of the Medicare cost-sharing for certain additional low-income Medicare beneficiaries whose income otherwise disqualifies them for specified Medicare benefits. (Sec. 4733) Grants States the option to permit workers with disabilities to buy into Medicaid. (Sec. 4734) Prescribes criminal penalties for knowingly and willfully, for a fee, counseling or assisting an individual to dispose of assets (including transfer in trust) in order for that individual to become Medicaid-eligible (fraudulent eligibility). (Sec. 4735) Declares that certain payments in a class settlement of the case of Susan Walker v. Bayer Corporation shall not be considered income or resources in determining Medicaid eligibility. Chapter 5: Benefits - Changes from mandatory to discretionary a State's authority to enroll individuals under private group health plans and pay their premiums. (Sec. 4742) Repeals: (1) certain physician qualification requirements with respect to services to pregnant women and to children under age 21; and (2) the requirement of prior institutionalization with respect to habilitation services furnished under a waiver for home or community-based services. (Sec. 4744) Requires the Secretary to study and report to the Congress on early and periodic screening, diagnostic, and treatment benefits. Chapter 6: Administration and Miscellaneous - Repeals requirements for inspections of the care being provided at mental hospitals and intermediate care facilities for the mentally retarded (ICFS-MR). (Sec. 4752) Authorizes a State, in lieu of terminating a noncompliant ICFS-MR, to establish alternative remedies if the State demonstrates to the Secretary's satisfaction that such alternative remedies are effective in deterring noncompliance and correcting deficiencies. (Sec. 4753) Revises requirements for mechanized claims processing and information retrieval systems. (Sec. 4754) Repeals the requirement for State refund to the Federal Government of any payments received during remediation of a noncompliant nursing facility. (Sec. 4755) Requires States to establish procedures to permit a nurse aide, in the case of a finding of neglect, to petition the State for name removal from the nurse aide registry upon a State determination that: (1) the employment and personal history of the nurse aide does not reflect a pattern of abusive behavior or neglect; and (2) the neglect involved in the original finding was a singular occurrence. (Sec. 4756) Includes the DRUGDEX Information System among the compendia to be used in drug use review for Medicaid payment. (Sec. 4757) Applies certain requirements to the extension of statewide comprehensive research and demonstration projects for which waivers of Medicaid compliance have been granted. (Sec. 4758) Amends the Omnibus Budget Reconciliation Act of 1989 to extend the moratorium on the treatment of the Kent Community Hospital Complex and Saginaw Community Hospital in Michigan as institutions for mental diseases for purposes of Medicaid reimbursement. Subtitle I: Programs of All-Inclusive Care for the Elderly (PACE) - Amends SSA title XVIII to provide for Medicare programs of all-inclusive care for the elderly (PACE programs) for individuals age 55 or older who require the level of care required under the State Medicaid plan for coverage of nursing facility services. Specifies benefit and payment requirements. Limits PACE provider eligibility to public and private non-profit entities; but requires the Secretary to waive such limitations to demonstrate the operation of a PACE program by a private, for-profit entity. (Sec. 4802) Amends SSA title XIX to authorize a State to establish a Medicaid program of all-inclusive care for the elderly (PACE) for individuals who need not be eligible for Medicare part A benefits, or enrolled under Medicare part B. (Sec. 4804) Directs the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under Medicare and Medicaid, specifically comparing the costs, quality, and access to services by private, for-profit entities under the demonstration projects with the costs, quality, and access to services of other PACE providers. Subtitle J: State Children's Health Insurance Program - Chapter 1: State Children's Health Insurance Program - Amends SSA to add a new title XXI (State Children's Health Insurance Program) in order to provide funds to States to expand the provision of child health assistance to uninsured, low-income children. Requires a State to submit for the Secretary's approval a child health plan for the use of funds, containing strategic objectives, performance goals, and performance measures. Mandates coverage equivalent to benefits coverage in a benchmark benefit package, consisting of benefits offered by either: (1) the Federal Employees' Health Benefits Program (FEHBP); (2) a State employee health benefit plan; or (3) an HMO. Makes appropriations to carry out this title. Allows their use for abortion only if necessary to save the life of the mother or if the pregnancy results from rape or incest. Chapter 2: Expanded Coverage of Children Under Medicaid - Amends SSA title XIX to provide for an increased Medicaid FMAP for expanded coverage of targeted low-income children. (Sec. 4912) Authorizes an approved State plan to make Medicaid available to a low-income child during a specified presumptive eligibility period after determination that family income does not exceed a certain level. (Sec. 4913) Provides for continuation of Medicaid eligibility for disabled children who lose benefits under SSA title XVI (Supplemental Security Income) (SSI). Chapter 3: Diabetes Grant Programs - Amends the Public Health Service Act to direct the Secretary to make grants for services for the prevention and treatment of type I diabetes in children, and for research in innovative approaches to such services. Provides for funding. (Sec. 4922) Directs the Secretary to make grants for services for the prevention and treatment of type I diabetes in Indians through the Indian Health Service and tribal and urban Indian health programs. (Sec. 4923) Requires the Secretary to evaluate such programs and report to the Congress. Title V: Welfare and Related Provisions - Subtitle A: TANF Block Grant - Amends part A (Temporary Assistance for Needy Families) (TANF) of SSA title IV to establish a program of welfare-to-work grants to States. (Sec. 5001) Sets forth requirements relating to State entitlement to non-competitive formula grants under such program and State distribution of such funds among local governments. Authorizes State Governors to distribute up to 15 percent of such grant funds for projects to help long-term welfare recipients enter unsubsidized employment. Provides for competitive grants, based on program effectiveness and other factors, including the history of the applicant's success in moving individuals with multiple barriers into work, for State-approved projects proposed by private industry councils or local governments. Sets forth rules relating to required beneficiaries and targeting of individuals with characteristics associated with long-term welfare dependency. Authorizes use of grant funds to provide work-related services to individuals who have reached the five-year limit on assistance. Directs the Secretary of Labor to use certain set-aside funds to make grants to each successful performance State in FY 2000. Makes appropriations for FY 1998 and 1999 for grants. Sets forth requirements for: (1) nondisplacement of other workers by participants in work activities under this program; (2) applicable health and safety standards; and (3) grievance procedures with respect to alleged violations of such nondisplacement and health and safety requirements. Provides for such grants to outlying areas territories and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to develop a plan to evaluate the use of such grants. Sets forth penalties for: (1) failure of a State to maintain its historic effort during a year in which a welfare-to-work grant is received; and (2) misuse of competitive welfare-to-work grant funds. Declares that State sanctions against recipients for TANF program violations are not wage reductions. (Sec. 5002) Limits to not more than ten percent the portion of such welfare-to-work grant funds which a State may use to carry out State programs under SSA title XX block grants to States for social services. (Sec. 5003) Increases from 20 percent to 30 percent of individuals in all families and in two-parent families the limitation on the number of persons who may be treated as engaged in work by reason of participation in a vocational education program or, in the case of teen heads of household, maintenance of satisfactory school attendance. (Sec. 5004) Requires reduction of a State's welfare-to-work grant if a State fails to reduce assistance for recipients refusing work without good cause. Subtitle B: Supplemental Security Income - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRAWORA) to extend by six months the deadline for certain childhood disability redeterminations under SSA title XVI (Supplemental Security Income) (SSI). (Sec. 5102) Prescribes the schedule of administrative fees the Commissioner of Social Security shall assess each State from FY 1997 through 2003 and after for making optional and mandatory State SSI payments to individuals. Revises requirements for deposit of such fees, directing that a portion be credited to a special fund for FY 1998 and subsequent fiscal years for use in defraying expenses. Provides that the amounts so credited shall not be scored as receipts under the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act), but credited as a discretionary offset to discretionary spending. Authorizes appropriations. Subtitle C: Child Support Enforcement - Amends SSA title III (Unemployment Insurance) with respect to the authority to permit certain redisclosures of wage and claim information for purposes related to the child support enforcement program under SSA title IV part D (Child Support and Establishment of Paternity). Subtitle D: Restricting Welfare and Public Benefits for Aliens - Amends PRAWORA to make aliens eligible for SSI who, as of the date of enactment of such Act, were receiving such benefits, or were legally residing in the United States and are blind or disabled. Extends the SSI grandfather provision through September 30, 1998. (Sec. 5302) Extends from five to seven years the refugee and asylee eligibility period for SSI and Medicaid, and includes Cuban and Haitian entrants within such category. Provides a five-year food stamp eligibility period for such aliens. Includes Cuban and Haitian entrants within the definition of "qualified alien" for purposes of welfare and public benefits. Exempts such aliens from specified periods of ineligibility for State and Federal means-tested benefits. (Sec. 5303) Exempts: (1) certain American Indians (including persons born in Canada) from SSI and Medicaid eligibility limitations; and (2) certain SSI recipients with pre-January 1, 1979 applications from SSI eligibility limitations. (Sec. 5305) States that an alien who is ineligible for food stamps shall not be eligible for such program based upon SSI eligibility. Authorizes Medicaid eligibility based upon SSI eligibility. (Sec. 5306) Treats certain Amerasian immigrants as refugees for purposes of specified

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Summary: H.R.2015 — 105th Congress (1997-1998)

There are 3 summaries for this bill. Line item veto by President (08/11/1997)Conference report filed in House (07/30/1997)Introduced in House (06/24/1997)     Bill summaries are authored by CRS. $("#summarySelector").congress_dropDownNavigation({ stubUrl: '/bill/105th-congress/house-bill/2015/summary', suffix: '' }); Shown Here:
Line item veto by President (08/11/1997) (On June 25, 1998, the Supreme Court ruled that the Line Item Veto Act (Public Law 104-130) is unconstitutional, thus restoring provisions that had been cancelled as summarized below.) (On August 11, 1997, the President line-item-vetoed Sec. 4722(c), which deemed to be permissible broad-based health care related taxes certain taxes, fees, or assessments collected by New York State from a health care provider before June 1, 1997, for which a specified waiver has been applied, or would be but for this provision. The provision would thus exempt such taxes, fees, or assessments from the requirement that provider-specific taxes be subtracted from the State share of Medicaid expenditures for purposes of Federal share calculation. The following revised digest of H.R. 2015 reflects the Act as signed into law, minus the line-item-vetoed provision. For more information on the specific items vetoed, see the text of the conference report for H.R. 2015, H.Rept. 105-217, and Presidential Cancellation Number 97-3.) TABLE OF CONTENTS: Title I: Food Stamp Provisions Title II: Housing and Related Provisions Title III: Communications and Spectrum Allocation Provisions Title IV: Medicare, Medicaid, and Children's Health Provisions Subtitle A: Medicare+Choice Program Subtitle B: Prevention Initiatives Subtitle C: Rural Initiatives Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity Subtitle E: Provisions Relating to Part A Only Subtitle F: Provisions Relating to Part B Only Subtitle G: Provisions Relating to Parts A and B Subtitle H: Medicaid Subtitle I: Programs of All-Inclusive Care for the Elderly (PACE) Subtitle J: State Children's Health Insurance Program Title V: Welfare and Related Provisions Subtitle A: TANF Block Grant Subtitle B: Supplemental Security Income Subtitle C: Child Support Enforcement Subtitle D: Restricting Welfare and Public Benefits for Aliens Subtitle E: Unemployment Compensation Subtitle F: Welfare Reform Technical Corrections Subtitle G: Miscellaneous Title VI: Education and Related Provisions Subtitle A: Higher Education Subtitle B: Repeal of Smith-Hughes Vocational Education Act Title VII: Civil Service Retirement and Related Provisions Title VIII: Veterans and Related Matters Subtitle A: Extension of Temporary Authorities Subtitle B: Copayments and Medical Care Cost Recovery Subtitle C: Other Matters Title IX: Asset Sales, User Fees, and Miscellaneous Provisions Subtitle A: Asset Sales Subtitle B: User Fees Subtitle C: Miscellaneous Provisions Title X: Budget Enforcement and Process Provisions Subtitle A: Amendments to the Congressional Budget and Impoundment Control Act of 1974 Subtitle B: Amendments to the Balanced Budget and Emergency Deficit Control Act of 1985 Title XI: District of Columbia Revitalization Subtitle A: District of Columbia Retirement Funds Subtitle B: Management Reform Plans Subtitle C: Criminal Justice Subtitle D: Privatization of Tax Collection and Administration Subtitle E: Financing of District of Columbia Accumulated Deficit Subtitle F: District of Columbia Bond Financing Improvements Subtitle G: District of Columbia Government Budget Subtitle H: Miscellaneous Provisions Balanced Budget Act of 1997 - Title I: Food Stamp Provisions - Amends the Food Stamp Act to define "caseload" and "covered individual." Authorizes State agencies to provide an additional 15 percent exemption from the food stamp program (program) work requirement for specified covered individuals. Provides for related caseload and exemption adjustments. (Sec. 1002) Obligates additional FY 1996 through 2002 funds for program employment and training programs. Sets forth State allocation provisions. (Sec. 1003) Requires State agencies, with assistance provided by the Secretary of Agriculture, to deny program benefits to prisoners incarcerated for more than 30 days. (Sec. 1004) Directs the Secretary to make specified funds available for FY 1998 through 2001 to eligible private nonprofit organizations and State agencies for nutrition education. Title II: Housing and Related Provisions - Amends the Balanced Budget Downpayment Act, I to extend permanently certain foreclosure avoidance provisions under the single family housing mortgage insurance program. (Sec. 203) Amends the United States Housing Act of 1937 with respect to the section 8 rental assistance program to make specified maximum monthly rent adjustment provisions for certain new and rehabilitated and nonturnover units applicable to FY 1999 and thereafter. Title III: Communications and Spectrum Allocation Provisions - Amends the Communications Act of 1934 (the Act) to make competitive bidding authority with respect to licenses or construction permits involving uses of the electromagnetic spectrum (spectrum) inapplicable to such licenses and permits issued by the Federal Communications Commission (FCC) that are for: (1) certain public safety radio services; (2) initial licenses or permits assigned to existing terrestrial broadcast licensees for digital television (TV) service; or (3) noncommercial educational or public broadcast stations. Requires the FCC to provide for the design and conduct of spectrum competitive bidding using a contingent combinatorial bidding system that permits prospective bidders to bid on combinations of licenses in a single bid and to enter multiple alternative bids within a single bidding round. Directs the FCC to prescribe methods by which a reasonable reserve price will be required, or a minimum bid will be established, to obtain any license or permit assigned under competitive bidding, unless determined not to be in the public interest. Repeals a requirement that any funds appropriated to the FCC for FY 1994 through 1998 for assigning licenses using random selection procedures be retained in the FCC's salaries and expenses account. Requires competitive bidding information to be included in annual FCC reports in order for any funds collected after FY 1998 to be retained in such account. Extends competitive bidding authority through FY 2008. Prohibits the FCC, after July 1, 1997, from issuing a license or construction permit for spectrum through a random selection system. Excepts from such prohibition licenses or permits for noncommercial educational or public broadcast stations. Provides for the applicability of competitive bidding requirements to pending comparative licensing cases. Makes available for assignment for commercial use the 1710 to 1755 megahertz (mhz) frequency band. Directs the FCC to assign licenses for such use by competitive bidding commenced after January 1, 2001. Directs the FCC to assign certain additional spectrum by competitive bidding no later than September 30, 2002. Directs the FCC to reallocate: (1) spectrum located at 2110 to 2150 mhz; and (2) 15 mhz located in the 1990 to 2110 range, with an exception in both cases when not in the public interest. Requires the FCC to notify the Secretary of Commerce if it is unable to provide for effective relocation of incumbent licensees to available bands of frequencies and has identified bands suitable for such relocation that are allocated for Federal use but could be reallocated pursuant to the National Telecommunications and Information Administration Organization Act (NTIA). Amends NTIA to direct the Secretary to report to the President, the FCC, and the Congress on recommendations for reallocating frequencies allocated for Federal use other than by Government licensees under the Communications Act of 1934. Authorizes any entity which operates a Government station to accept payment for frequency relocation expenses. Provides a relocation process triggered by a petition under NTIA. Allows a Federal entity to reclaim a former frequency if it demonstrates that relocated facilities or spectrum are not comparable to its former facilities or spectrum. Requires the Secretary to recommend for reallocation for use other than by Government stations a band of frequencies that: (1) in the aggregate span at least 20 mhz; (2) are located below three gigahertz; and (3) meet other relocation criteria. Directs the FCC to prepare and submit to the President and the Congress a plan for the immediate allocation and assignment of frequencies identified under this title. (Sec. 3003) Amends the Act to prohibit the renewal of a license authorizing analog TV services beyond the end of 2006, with an extension in specified circumstances. Prohibits the FCC, in prescribing regulations relating to qualifications of spectrum bidders, from: (1) precluding any party from being a qualified bidder for spectrum allocated for any use that includes digital TV service on the basis of the FCC's duopoly rule or newspaper cross-ownership rule; or (2) applying either rule to preclude a successful bidder from using such spectrum for digital TV service. (Sec. 3004) Directs the FCC, no later than January 1, 1998, to allocate from radio spectrum between 746 and 806 mhz: (1) 24 mhz for public safety services; and (2) the remainder for commercial purposes to be assigned by competitive bidding. Sets deadlines for the assignment of such licenses and the commencement of competitive bidding. Provides for the licensing of unused frequencies for public safety services. (Sec. 3005) Authorizes the FCC to allocate spectrum to provide flexibility of use, as long as such use is consistent with international agreements and upon a finding that such use is in the public interest and would not deter investment or result in harmful interference among users. (Sec. 3006) Authorizes appropriations to the FCC for FY 2001 for universal service support programs. (Sec. 3007) Directs the FCC to conduct all competitive bidding required under this title so that proceeds from such bidding are deposited no later than the end of FY 2002. (Sec. 3008) Requires seven days' public notice before the granting by the FCC of an application for spectrum frequency assignment under the Act. Title IV: Medicare, Medicaid, and Children's Health Provisions - Subtitle A: Medicare+Choice Program - Chapter 1: Medicare+Choice Program - Amends title XVIII (Medicare) of the Social Security Act (SSA) to establish a Medicare+Choice program under which each Medicare+Choice eligible individual (one entitled to benefits under Medicare part A (Hospital Insurance) and enrolled under Medicare part B (Supplementary Medical Insurance)) is entitled to elect, in accordance with certain procedures, to receive Medicare benefits either through the original Medicare fee-for-service program or through a Medicare+Choice plan. (Sec. 4001) Outlines the types of Medicare+Choice plans that may be available, namely: (1) coordinated care plans; (2) combination of a medical savings account (MSA) plan and contributions into a Medicare+Choice MSA; and (3) private fee-for-service plans. Sets forth various special rules regarding, among other things, residence, individuals with end-stage renal disease, and individuals covered under the Federal Employees Health Benefits Program or eligible for veterans' or military health benefits. Directs the Secretary of Health and Human Services (HHS) to: (1) provide for broad dissemination of coverage option and comparison information to Medicare beneficiaries and prospective Medicare beneficiaries; and (2) maintain a toll-free number for inquiries about Medicare+Choice options and program operation, as well as an Internet site through which individuals may obtain such information electronically. Requires: (1) any Medicare+Choice organization to accept without restrictions individuals eligible to make an election at any time during which such elections are accepted; and (2) approval of Medicare+Choice marketing material and application forms before they are distributed. Provides for continuous open enrollment and disenrollment through 2001, the first six months of 2002, and the first three months of every subsequent year, limiting an individual's change of enrollment during such initial period to one. Provides for an annual, coordinated election period during November for all participants as well as special election periods in certain circumstances. Outlines benefits and beneficiary protections. Requires each Medicare+Choice plan (except MSA plans) to provide those items and services for which benefits are available under Medicare parts A and B (other than hospice care) and specified additional benefits, as well, at its option, as certain supplemental benefits, subject to the Secretary's approval. Excludes individuals enrolled under a MSA plan from participating in such supplemental package. Prohibits a Medicare+Choice organization from denying, limiting, or conditioning coverage or benefits based on any described health status-related factor. Prescribes plan disclosure requirements and an ongoing quality assurance program. Outlines a mechanism for grievances and appeals. Sets forth certain payment rules for providers not participating in the Medicare+Choice program. Directs the Secretary to make monthly advance payments with respect to an individual's coverage to Medicare+Choice organizations according to a specified formula. Requires the Secretary to establish separate payment rates for individuals with end-stage renal disease. Sets forth special rules for individuals electing MSA plans. Requires such an individual to establish a Medicare+Choice MSA into which the Secretary shall make monthly deposits out of the Medicare trust funds in accordance with prescribed guidelines. Prescribes special rules for hospice care. Details rules for the submission and charging of premiums by each Medicare+Choice organization. Sets limitations on enrollee liability for basic, additional, and supplemental benefits. Prescribes a special rule for private fee-for-service plans. Prohibits a State from imposing a premium tax or similar tax with respect to payments to Medicare+Choice organizations. Sets out organizational and financial requirements for Medicare+Choice organizations and provider-sponsored organizations. Directs the Secretary to establish solvency and capital adequacy standards for provider-sponsored organizations, and other standards for Medicare+Choice organizations. Prescribes requirements, including minimum enrollment requirements, for contracts between the Secretary and Medicare+Choice organizations. Provides for: (1) intermediate sanctions and civil monetary penalties to enforce contract provisions; and (2) procedures for termination of contracts. (Sec. 4002) Details transitional rules for the current Medicare health maintenance organization (HMO) program, as well as specified conforming changes in the Medicare supplemental health insurance policy (Medigap) program. (Sec. 4006) Amends the Internal Revenue Code to outline special rules for Medicare+Choice MSAs. Excludes from gross income any payment by the Secretary to an individual's Medicare+Choice MSA. Excludes from qualified deductible medical expenses any amounts paid for the medical care of any individual but the account holder. Prescribes a penalty for distributions from the Medicare+Choice MSA not used for qualified medical expenses if the minimum balance is not maintained, with certain exceptions if the account holder becomes disabled or dies. Chapter 2: Demonstrations - Directs the Secretary to establish a Medicare prepaid competitive pricing demonstration project in up to four (eventually seven) designated Medicare payment areas, of which initially three shall be in urban areas and one in a rural area. (Sec. 4012) Directs the Secretary to appoint a Competitive Pricing Advisory Committee to recommend areas for the demonstration and research design for project implementation. (Sec. 4014) Amends the Omnibus Budget Reconciliation Act of 1987 to extend the authorities for the social health maintenance organization (SHMO) demonstration project. Amends the Omnibus Budget Reconciliation Act of 1993 to increase the cap on the number of individuals who may participate in a SHMO demonstration. Directs the Secretary to submit to the Congress a plan for the integration of SHMO health plans and similar plans as an option under the Medicare+Choice program. (Sec. 4015) Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a demonstration (subvention) project under which the HHS Secretary shall reimburse the Secretary of Veterans Affairs from the Medicare trust funds for Medicare health care services furnished to certain targeted Medicare-eligible military retirees or dependents. Authorizes the Secretary of Defense to modify existing TRICARE contracts in order to provide Medicare health care services to project participants. (Sec. 4016) Directs the Secretary to conduct demonstration projects in a certain number of rural and urban areas for the purpose of evaluating methods, such as case management and other models of coordinated care, that improve the quality of items and services provided to target individuals, and reduce Medicare expenditures for such items and services. Defines a target individual as an individual with a chronic illness who is enrolled under the Medicare parts A and B fee-for-service program. Provides for project funding. (Sec. 4017) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to direct the Secretary to work with each municipal health service demonstration project to develop a plan for the orderly transition of such projects and project participants to a non-demonstration project health care delivery system, such as through integration with a private or public health care plan, including a Medicaid managed care or Medicare+Choice plan. (Sec. 4018) Directs the Secretary to implement a time-limited demonstration project for the purpose of evaluating the use of a third-party contractor to conduct the Medicare+Choice plan enrollment and disenrollment functions in an area. (Sec. 4019) Extends for an additional two years certain Medicare community nursing organization demonstration projects under the Omnibus Budget Reconciliation Act of 1987. Chapter 3: Commissions - Establishes the National Bipartisan Commission on the Future of Medicare to: (1) review and analyze the long-term financial condition of the Medicare program; (2) identify problems that threaten the financial integrity of the Medicare trust funds, including the extent to which current Medicare update indexes do not accurately reflect inflation; and (3) analyze potential solutions to the problems identified that will ensure both the financial integrity of Medicare and the provision of appropriate benefits. Requires the Commission to make recommendations: (1) to restore the solvency of the Federal Hospital Insurance Trust Fund and the financial integrity of the Federal Supplementary Medical Insurance Trust Fund; and (2) to establish the appropriate financial structure of the Medicare program as a whole and the appropriate balance of benefits covered and beneficiary contributions. Requires recommendations on: (1) the financing of graduate medical education; (2) the feasibility of allowing individuals between age 62 and the Medicare eligibility age to buy into the Medicare program; and (3) the impact of chronic disease and disability trends on future costs and quality of services under the current benefit, financing, and delivery system structure of the Medicare program. Requires a report to the President and the Congress. Authorizes appropriations. (Sec. 4022) Establishes the Medicare Payment Advisory Commission to replace the Prospective Payment Assessment Commission and the Physician Payment Review Commission, hereby abolished. Requires the new Commission to review and make recommendations to the Congress about payment policies under Medicare (including certain specific payment-related topics). Authorizes appropriations. Chapter 4: Medigap Protections - Amends SSA title XVIII with respect to the issuer of a Medicare supplemental (Medigap) policy in the case of certain individuals terminated by an employee welfare benefit plan providing supplementary health benefits who seek to enroll under a Medigap policy not later than 63 days after termination or disenrollment. Prohibits the Medigap issuer from: (1) denying or conditioning the issuance or effectiveness of such a policy; (2) discriminating in the pricing of such policy because of health status, claims experience, receipt of health care, or medical condition; or (3) imposing an exclusion of benefits based on a pre-existing condition. (Sec. 4031) Specifies limitations on the imposition of preexisting condition exclusions during the initial open enrollment period in the case of a Medicare supplemental policy issued to an individual who is age 65 or older with a certain minimum period of creditable coverage. (Sec. 4032) Creates under the Medicare supplemental policy program a high deductible feature which requires the policy beneficiary to pay annual out-of-pocket expenses (other than premiums) of $1,500 (indexed for inflation) before the policy begins payment of benefits. Chapter 5: Tax Treatment of Hospitals Participating in Provider- Sponsored Organizations - Amends the Internal Revenue Code to provide that an organization shall not fail to be treated as a tax-exempt charitable organization solely because a hospital which it owns and operates also participates in a provider-sponsored organization, whether or not the provider-sponsored organization is exempt from tax. Provides that any person with a material financial interest in such a provider-sponsored organization shall be treated as a private shareholder or individual with respect to the hospital. Subtitle B: Prevention Initiatives - Outlines various specified new preventive health measures covered under Medicare, namely coverage for: (1) an annual screening mammography for women over age 39 and triennial screening pap smear and screening pelvic exam for any woman (annually for a woman with cervical or vaginal cancer or other abnormality, or who is at high risk of developing such a cancer), while providing for a waiver of deductible; (2) annual prostate cancer screening tests; (3) colorectal cancer screening tests, subject to prescribed frequency and payment limits; (4) diabetes outpatient self-management training services, including blood-testing strips (with a ten percent payment reduction after 1997) and glucose monitors as durable medical equipment (DME) for individuals with diabetes; and (5) bone mass measurements for qualified individuals. (Sec. 4105) Directs the Secretary to establish outcome measures, including glysolated hemoglobin (past 90-day average blood sugar levels), for the purpose of evaluating the improvement of health status of Medicare beneficiaries with diabetes mellitus, with a view to recommending coverage modifications. (Sec. 4107) Extends through FY 2002 the Influenza and Pneumococcal Vaccination Campaign of the Health Care Financing Administration (HCFA). Authorizes appropriations. (Sec. 4108) Directs the Secretary to request the National Academy of Sciences to analyze (for a report to specified congressional committees) the expansion or modification of Medicare preventive benefits to include medical nutrition therapy services by a registered dietitian, skin cancer screening, medically necessary dental care, and other specified items. Subtitle C: Rural Initiatives - Replaces the Essential Access Community Hospital Program with an optional Medicare Rural Hospital Flexibility Program under which participating States shall develop at least one rural health network in the State and at least one facility designated as a critical access hospital in accordance with prescribed guidelines. Authorizes the Secretary to award grants to States for: (1) planning and implementation of the program; and (2) establishment or expansion of rural emergency medical services. Authorizes appropriations. Directs the HCFA Administrator to report to the Congress on the feasibility of, and administrative requirements necessary to establish, an alternative for certain medical diagnoses to the current 96-hour limitation for inpatient care in critical access hospitals. (Sec. 4202) Amends SSA title XVIII to prohibit denial, on the basis of wage comparisons, of a rural referral center's request for reclassification. Provides that any hospital classified as a rural referral center for FY 1991 shall be classified as such for FY 1998 and each subsequent fiscal year. (Sec. 4204) Extends through FY 2001 the special treatment of payment methodology and target amount for Medicare-dependent, small rural hospitals. (Sec. 4205) Amends requirements for rural health clinic services with respect to: (1) per-visit payment limits for provider-based clinics; (2) mandatory quality assessment and performance improvement programs; (3) limitation of waivers of certain staffing requirements to clinics participating in the rural health clinic program; (4) the insufficiency of needed health care practitioners in shortage areas; and (5) regulations providing for payment for certain physician assistant services. (Sec. 4206) Directs the Secretary to make payments from the Federal Supplementary Medical Insurance Trust Fund under Medicare part B in accordance with a specified payment methodology for professional consultation via telecommunications systems with a physician or practitioner furnishing a service for which payment may be made to a Medicare beneficiary residing in a rural health professional shortage area, notwithstanding that the individual physician or practitioner providing the professional consultation is not at the same location as the physician or practitioner furnishing the service to that beneficiary. Directs the Secretary to report to the Congress: (1) a detailed analysis of telemedicine and telehealth (T&T) services; and (2) an examination of the possibility of making similar payments for professional consultation via telecommunications systems to Medicare beneficiaries who do not reside in a rural health professional shortage area, are homebound or nursing homebound, and for whom being transferred for health care services imposes a serious hardship. (Sec. 4207) Directs the Secretary to conduct a demonstration project to use eligible health care provider telemedicine networks to apply high-capacity computing and advanced networks to improve primary care and prevent health care complications to Medicare beneficiaries with diabetes mellitus who reside in medically underserved rural or inner-city areas. Provides funding. Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity - Chapter 1: Revisions to Sanctions for Fraud and Abuse - Amends SSA title XI, with respect to health care related crimes, to exclude from the Medicare and State health care programs any person: (1) for ten years for one previous conviction for one or more offenses; and (2) permanently for two or more previous convictions of one or more offenses. (Sec. 4302) Authorizes the Secretary to refuse to enter into Medicare agreements with individuals or entities convicted of felonies for offenses determined inconsistent with the best interests of program beneficiaries. (Sec. 4303) Authorizes the Secretary to exclude from the Medicare program any entity with respect to which a sanctioned person with an ownership or control interest in it transfers such interest in anticipation of (or following) a conviction, assessment, or exclusion against the person, to an immediate family member or member of the household who continues to maintain such an interest. (Sec. 4304) Provides for the imposition of civil monetary penalties for: (1) any person who arranges or contracts with an individual or entity that the person knows or should know is excluded from participation in a Federal health care program; and (2) kickbacks. Chapter 2: Improvements in Protecting Program Integrity - Amends SSA title XVIII to require the Secretary, in the annual notice of Medicare benefits, to urge beneficiaries to check the notice and any itemized statement for accuracy and report any errors or questionable charges by calling a certain toll-free number. Authorizes Medicare beneficiaries to submit written requests for itemized bills of medical or other items or services provided, and review them. Requires the Secretary to take measures to recover amounts unnecessarily paid out. (Sec. 4312) Outlines various specified requirements regarding disclosure of information and surety bonds with regard to DME suppliers. Includes surety bond requirements for home health agencies. Authorizes the Secretary to apply disclosure and surety bond requirements to other health care providers or item and service suppliers (except physicians or practitioners). Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORFs) and to rehabilitation agencies. (Sec. 4313) Requires any participating entity to disclose to the Secretary its own employer identification numbers and social security account numbers, as well as those of persons with ownership or control interests and subcontractors in which the entity has a five percent or greater interest. Directs the Secretary to report to Congress on the steps taken to assure the confidentiality of such social security account numbers. (Sec. 4314) Requires the Secretary, upon a party's request, to issue binding advisory opinions on whether a referral relating to designated health services (other than clinical laboratory services) is a prohibited physician self-referral. (Sec. 4315) Amends SSA title XVIII to: (1) replace the reasonable charge payment methodology with fee schedules developed by the Secretary for particular services; (2) provide for application of inherent reasonableness to charges for all Medicare part B services other than physicians' services; (3) require bills and requests for payment for services by non-physician practitioners to include diagnostic codes; (4) outline requirements to provide diagnostic information when ordering certain items or services furnished by another entity; (5) mandate establishment of competitive acquisition areas for contract award purposes for the furnishing under Medicare part B after 1997 of described items and services; and (6) prohibit payment under Medicare part A or part B for any expenses for an item or service furnished in a competitive acquisition area by an entity other than an entity with which the Secretary has contracted, except for urgent need, or in other circumstances specified by the Secretary. (Sec. 4320) Excludes from reasonable costs and declares unreimbursable under Medicare any payments for certain items unrelated to patient care, including: (1) entertainment, gifts, or donations; (2) personal use of motor vehicles; (3) costs for fines and penalties resulting from violations of Federal, State, or local laws; and (4) education expenses for spouses or other dependents of service providers, their employees, or contractors. (Sec. 4321) Requires a Medicare hospital's discharge planning process to include information on the availability of home health services through certain individuals or entities. Requires a discharge plan: (1) not to specify or otherwise limit the qualified provider which may provide home health services; and (2) identify any entity to whom the individual is referred in which the hospital has a disclosable financial interest. Requires the service provider agreement to require disclosure of any financial interest a hospital has in any entity to which individuals are referred, or any entity has in the hospital, and related information. Chapter 3: Clarifications and Technical Changes - Makes technical amendments with respect to fraud and abuse. Subtitle E: Provisions Relating to Part A Only - Chapter 1: Payment of PPS Hospitals - Revises requirements for: (1) prospective payment system (PPS) hospital payment updates; (2) maintenance of savings from the temporary reduction in capital payments for prospective payment system (PPS) hospitals; (3) additional payments to any hospital with a disproportionate share of low-income patients (disproportionate share hospital (DSH)); (4) the sales price of a Medicare capital asset (book value); (5) elimination of indirect medical education (IME) and DSH payments attributable to outlier payments; (6) the base rate of payments to Puerto Rico hospitals; (7) payments to hospitals for certain discharges to post-acute care; (8) inclusion of Stanly County, North Carolina, in the large urban area of Charlotte-Gastonia-Rock Hill-North Carolina-South Carolina; and (9) the floor on wage area indexes. (Sec. 4409) Requires the Secretary to publish and use alternative guidelines under which certain disproportionately large hospitals qualify for geographic reclassification. Chapter 2: Payment of PPS-Exempt Hospitals - Revises requirements for the payment of PPS-exempt hospitals, including those for: (1) payment updates; (2) reductions to capital payments; (3) bonus and relief payments; (4) payment and the target amount for new providers; (5) treatment of certain long-term care hospitals located within other hospitals; (6) rebasing; (7) certain cancer hospitals; and (8) elimination of exemptions for certain hospitals. (Sec. 4421) Provides for a Medicare PPS for inpatient rehabilitation hospital services. (Sec. 4422) Directs the Secretary to submit to the Congress a legislative proposal for establishing a case-mix adjusted PPS for long-term care hospitals. Chapter 3: Payment for Skilled Nursing Facilities - Declares that updates to per diem limits, with respect to payments to skilled nursing facilities (SNFs), effective for FY 1998, shall be based on cost limits effective for FY 1997. (Sec. 4432) Mandates a PPS for SNF services along with consolidated billing for them. Directs the Secretary, in order to ensure that Medicare beneficiaries are furnished appropriate SNF services, to establish a thorough medical review process to examine the provisions of this section and their effect on the quality of covered SNF services furnished to Medicare beneficiaries. Chapter 4: Provisions Related to Hospice Services - Provides for update of payments for hospice services. Bases payment for home hospice care on the location where care is furnished. Revises the home hospice care benefit period. Provides for home hospice care coverage of any other items and services specified in a plan. Allows waiver of certain staffing requirements for hospice care programs in non-urbanized areas. Chapter 5: Other Payment Provisions - Requires reductions in payments for enrollee bad debt. Repeals the termination date to make a permanent extension of the hemophilia passthrough. Requires a certain reduction in the part A Medicare premium for specified public retirees. Authorizes Medicare and Medicaid coverage of inpatient hospital and post-hospital extended care services in religious nonmedical health care institutions (currently limited to Christian Science sanatoria). Subtitle F: Provisions Relating to Part B Only - Chapter 1: Services of Health Professionals - Revises requirements for the payment of physicians' services, with changes: (1) establishing a single conversion factor for 1998; (2) adding new update provisions; (3) replacing the volume performance standard with sustainable growth rate; (4) adding payment rules for anesthesia services; and (5) providing for adjustments in relative value units for 1998, and the application of resource-based methodology to malpractice relative value units. (Sec. 4505) Directs the Comptroller General to review and evaluate the proposed rule on resource-based methodology for practice expenses issued by the HCFA. (Sec. 4506) Directs the Secretary to determine for each hospital: (1) its hospital-specific per discharge relative value for physicians' services; and (2) whether such value is projected to be excessive. Requires the Secretary to notify the medical executive committee of a subset of the hospitals identified as having an excessive hospital-specific relative value, and evaluate their responses with the responses of other hospitals so identified that were not notified. (Sec. 4507) Amends SSA title XVIII to declare that nothing shall prohibit a physician or practitioner from privately contracting with a Medicare beneficiary for any item or service for which no Medicare claim will be submitted, and for which the physician or practitioner shall receive no Medicare reimbursement. (Sec. 4511) Increases Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. (Sec. 4513) Repeals the requirement of an X-ray for reimbursement for chiropractic services. Directs the Secretary to develop utilization guidelines for the coverage of chiropractic services where a subluxation has not been demonstrated by an X-ray. Chapter 2: Payment for Hospital Outpatient Department Services - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 4522) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 4523) Directs the Secretary to establish a PPS for hospital outpatient department services. Chapter 3: Ambulance Services - Provides for certain interim reductions in payments for ambulance services. Directs the Secretary to establish a prospective fee schedule for payment of such services. Provides that, in promulgating regulations for coverage of ambulance services, the Secretary may cover advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. (Sec. 4532) Directs the Secretary to establish up to three demonstration projects contracting with local governments for ambulance services paid for under Medicare. Chapter 4: Prospective Payment for Outpatient Rehabilitative Services - Provides for a PPS for outpatient physical (including speech-language pathology) and occupational therapy services. Chapter 5: Other Payment Provisions - Provides for a reduction in payment amounts for items of DME and for clinical diagnostic laboratory tests. Provides for a payment freeze for parenteral and enteral nutrients, supplies, and equipment. Revises update requirements for payment for orthotics and prosthetics, and other payment requirements for oxygen and oxygen equipment, ambulatory surgical services, and drugs and biologicals. (Sec. 4552) Requires the Comptroller General to study and report to specified congressional committees on access to home oxygen equipment. Requires the Secretary to arrange for peer review organizations to evaluate such access. (Sec. 4553) Directs the Secretary to request the National Academy of Sciences to study (for a report to specified congressional committees) Medicare payments for clinical laboratory tests. (Sec. 4554) Directs the Secretary to divide the United States into up to five regions, and designate a single carrier for each region, for the payment of Medicare part B claims for clinical diagnostic laboratory services. Requires the Secretary to adopt uniform policies for clinical diagnostic laboratory tests. (Sec. 4557) Provides for coverage of oral anti-nausea drugs under a chemotherapeutic regimen. (Sec. 4558) Requires the Secretary to: (1) audit cost reports of each renal dialysis provider at least once every three years; and (2) develop a method to measure and report on the quality of Medicare renal dialysis services. (Sec. 4559) Directs the Secretary, for electrocardiogram tests furnished during 1998, to restore separate part B payment for electrocardiogram transportation based upon methods in effect on December 31, 1996. Requires the Secretary, by a certain deadline, to recommend to specified congressional committees whether portable electrocardiogram transportation should be covered under Medicare part B. Chapter 6: Part B Premium and Related Provisions - Revises the formula for the monthly Medicare part B premium rate the Secretary promulgates each September for the following calendar year. Requires such rate to equal 50 percent of the monthly actuarial rate for enrollees age 65 and over for that succeeding calendar year. (Sec. 4581) Provides for a special Medicare enrollment period, with no premium penalty for late enrollment, for certain disabled workers whose continuous enrollment under an employer's group health plan is involuntarily terminated in certain circumstances. (Sec. 4582) Allows appropriate State or local governmental entities to elect to pay part B premiums for certain eligible individuals. Subtitle G: Provisions Relating to Parts A and B - Chapter 1: Home Health Services and Benefits - Provides that, in establishing payment limits for cost reporting periods beginning after September 30, 1997, the Secretary shall not take into account any changes in the home health market basket with respect to cost reporting periods which began on or after July 1, 1994, and before July 1, 1996. (Sec. 4602) Revises requirements for interim payments for home health services. Directs the Secretary to expand research on a PPS for home health agencies under the Medicare program that ties prospective payments to a unit of service. (Sec. 4603) Directs the Secretary to establish a PPS for home health services for cost reporting periods beginning in FY 2000. (Sec. 4604) Bases the payment for home health services on the location where the service is furnished. (Sec. 4611) Provides for a modification of the Medicare part A home health benefit for individuals enrolled under Medicare part B. Provides for specified post-institutional home health services. (Sec. 4613) Directs the Secretary to study and report to the Congress on the criteria that should be applied in determining whether an individual is homebound for purposes of qualifying for Medicare home health services. (Sec. 4614) Provides for the denial of home health claims based on home health services the frequency and duration of which are in excess of normative guidelines established by the Secretary. (Sec. 4615) Denies payment for home health benefits based solely on venipuncture to obtain a blood sample. (Sec. 4616) Directs the Secretary to estimate part A and part B outlays for FY 1998 through 2002 for specified congressional committees, and report annually a comparison of actual outlays with such estimates. Chapter 2: Graduate Medical Education - Revises requirements for direct and indirect Medicare payments for graduate medical education (GME). Limits the number of residents in allopathic and osteopathic medicine. Permits payment to qualified nonhospital providers for direct GME costs. Prohibits restandardization of certain indirect GME payment amounts. Requires the Secretary to provide for direct and indirect GME payments to hospitals for Medicare+Choice enrollees. Makes a special reimbursement rule for primary care combined residency programs, setting the period of board eligibility. (Sec. 4626) Provides for incentive payments to hospitals under plans for voluntary reduction in the number of full-time equivalent residents in an approved medical training program. (Sec. 4628) Directs the Secretary to establish a demonstration project under which GME payments shall be made to consortia of teaching hospitals and other medical entities. (Sec. 4629) Directs the Medicare Payment Advisory Commission to develop recommendations to the Congress on whether and to what extent Medicare payment policies and other Federal policies regarding teaching hospitals and GME should be changed. (Sec. 4630) Directs the Secretary to study and report to the appropriate congressional committees on variations among hospitals in the overhead and supervisory physician components of their direct medical education costs. Chapter 3: Provisions Relating to Medicare Secondary Payer - Revises requirements for Medicare as secondary payer. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Chapter 4: Other Provisions - Amends SSA title XVIII to require placement of an advance directive in a prominent part of the individual's current medical record. (Sec. 4642) Provides for an increased certification period for certain organ procurement organizations. (Sec. 4643) Establishes in the HCFA the position of Chief Actuary. Subtitle H: Medicaid - Chapter 1: Managed Care - Amends SSA title XIX (Medicaid) to establish a new part B (Managed Care) giving States the option to require Medicaid-eligible individuals (except Medicare beneficiaries, Medicare-eligible individuals, and certain children with special needs) to enroll in managed care arrangements of the individual's choice as a condition of receiving Medicaid. (Sec. 4702) Grants States the option of providing Medicaid coverage of primary care case management services without the need for a waiver. (Sec. 4703) Repeals the (75-25) requirement that Medicare and Medicaid beneficiaries constitute less than 75 percent of the membership of a participating HMO. Repeals the prohibition on co-payments for services furnished by HMOs. (Sec. 4704) Prescribes requirements for: (1) access to emergency care; (2) annual external independent review of managed care entity activities and other specified quality care assurance measures; and (3) fraud and abuse prohibitions and protections. (Sec. 4705) Amends SSA title XIX (Medicaid) to require any State contracting with Medicaid managed care organizations to develop and implement a quality assessment and improvement strategy incorporating certain access standards, monitoring procedures, and other measures. Directs the Comptroller General to analyze and report to specified congressional committees on the quality assurance programs and accreditation standards applicable to managed care entities operating in the private sector or under Medicare contracts to determine if such programs and standards consider the accessibility and quality of the health care items and services delivered under such contracts to low-income individuals. Directs the Secretary to study and report to such committees on safeguards that may be needed to ensure that the health care needs of individuals with special health care needs and chronic conditions who are enrolled with Medicaid managed care organizations are adequately met. (Sec. 4706) Requires an HMO to meet solvency standards established by the State for private HMOs, or be State-licensed or -certified as a risk-bearing entity. (Sec. 4708) Increases from $100,000 to $1 million, indexed annually, the threshold amount for HMO contracts requiring the Secretary's prior approval. Permits the same copayments in HMOs as in fee-for-service. Chapter 2: Flexibility in Payment of Providers - Repeals "Boren Amendment" provider reimbursement requirements. Requires the Secretary to study and report to the appropriate congressional committees on the effect on access to services, service quality, and service safety of the rate-setting methods used by States as a result of such repeal. (Sec. 4712) Specifies reductions from 100 percent to 70 percent between FY 1999 through 2003 in the percentage of reasonable costs that shall be paid under a State plan for federally-qualified health center and rural health clinic services (with a special supplemental payment for services furnished under certain managed care contracts). (Sec. 4713) Repeals payment rate requirements for obstetrical and pediatric services. (Sec. 4714) Revises requirements for Medicaid payment rates for qualified Medicare beneficiaries, placing a limitation on nonparticipating providers. (Sec. 4715) Declares that, in the case of a Medicaid-eligible veteran residing in a State veterans' home, any veterans' pension over $90 per month shall be counted as income only for the purpose of applying such excess payment to the State veterans' home's cost of providing nursing care to the veteran. Chapter 3: Federal Payments to States - Revises specified limitations of Federal payments for inpatient hospital services furnished by disproportionate share hospitals (DSH), including limitations on certain State DSH expenditures to institutions for mental diseases or other mental health facilities. Requires direct State Medicaid payment to hospitals for managed care enrollees. (Sec. 4722) Revises the treatment as broad-based health care related taxes of certain State hospital taxes which currently are not subtracted as revenues from the State share of Medicaid expenditures for purposes of calculating the Federal share of such expenditures. Declares that an exemption from such State hospital tax for certain Federal-tax-exempt hospitals that do not accept Medicaid or Medicare payments (provide free care) shall not disqualify the hospital tax as a broad-based health care related tax (thus allowing continued exclusion of such State hospital tax from the requirement that provider-specific taxes be subtracted from the State share of Medicaid expenditures for purposes of Federal share calculation). (Sec. 4723) Specifies additional funding for State emergency health services furnished to undocumented aliens. (Sec. 4724) Prohibits the expenditure of Medicaid funds for roads, bridges, stadiums, and other items and services not covered by a State plan. Requires home health agencies to provide a surety bond. Revises conflict-of-interest safeguards. Declares that States are not required to provide medical assistance for items or services furnished by a person or entity convicted of a felony for an offense inconsistent with the best interests of beneficiaries under the State plan. Requires State action for program and beneficiary protection against waste, fraud, and abuse. Conditions issuance or renewal of a DME supplier provider number on the supplier's provision of a surety bond and disclosure of all persons with ownership or control interests in the supplier, and of all subcontractors in which the supplier has a five percent or greater interest. (Sec. 4725) Provides for increased Federal medical assistance percentages (FMAPs) for the District of Columbia and Alaska and increased payment caps for the territories. Chapter 4: Eligibility - Grants States the option to provide for 12-month continuous Medicaid eligibility for children. (Sec. 4732) Requires State Medicaid plan coverage of the Medicare cost-sharing for certain additional low-income Medicare beneficiaries whose income otherwise disqualifies them for specified Medicare benefits. (Sec. 4733) Grants States the option to permit workers with disabilities to buy into Medicaid. (Sec. 4734) Prescribes criminal penalties for knowingly and willfully, for a fee, counseling or assisting an individual to dispose of assets (including transfer in trust) in order for that individual to become Medicaid-eligible (fraudulent eligibility). (Sec. 4735) Declares that certain payments in a class settlement of the case of Susan Walker v. Bayer Corporation shall not be considered income or resources in determining Medicaid eligibility. Chapter 5: Benefits - Changes from mandatory to discretionary a State's authority to enroll individuals under private group health plans and pay their premiums. (Sec. 4742) Repeals: (1) certain physician qualification requirements with respect to services to pregnant women and to children under age 21; and (2) the requirement of prior institutionalization with respect to habilitation services furnished under a waiver for home or community-based services. (Sec. 4744) Requires the Secretary to study and report to the Congress on early and periodic screening, diagnostic, and treatment benefits. Chapter 6: Administration and Miscellaneous - Repeals requirements for inspections of the care being provided at mental hospitals and intermediate care facilities for the mentally retarded (ICFS-MR). (Sec. 4752) Authorizes a State, in lieu of terminating a noncompliant ICFS-MR, to establish alternative remedies if the State demonstrates to the Secretary's satisfaction that such alternative remedies are effective in deterring noncompliance and correcting deficiencies. (Sec. 4753) Revises requirements for mechanized claims processing and information retrieval systems. (Sec. 4754) Repeals the requirement for State refund to the Federal Government of any payments received during remediation of a noncompliant nursing facility. (Sec. 4755) Requires States to establish procedures to permit a nurse aide, in the case of a finding of neglect, to petition the State for name removal from the nurse aide registry upon a State determination that: (1) the employment and personal history of the nurse aide does not reflect a pattern of abusive behavior or neglect; and (2) the neglect involved in the original finding was a singular occurrence. (Sec. 4756) Includes the DRUGDEX Information System among the compendia to be used in drug use review for Medicaid payment. (Sec. 4757) Applies certain requirements to the extension of statewide comprehensive research and demonstration projects for which waivers of Medicaid compliance have been granted. (Sec. 4758) Amends the Omnibus Budget Reconciliation Act of 1989 to extend the moratorium on the treatment of the Kent Community Hospital Complex and Saginaw Community Hospital in Michigan as institutions for mental diseases for purposes of Medicaid reimbursement. Subtitle I: Programs of All-Inclusive Care for the Elderly (PACE) - Amends SSA title XVIII to provide for Medicare programs of all-inclusive care for the elderly (PACE programs) for individuals age 55 or older who require the level of care required under the State Medicaid plan for coverage of nursing facility services. Specifies benefit and payment requirements. Limits PACE provider eligibility to public and private non-profit entities; but requires the Secretary to waive such limitations to demonstrate the operation of a PACE program by a private, for-profit entity. (Sec. 4802) Amends SSA title XIX to authorize a State to establish a Medicaid program of all-inclusive care for the elderly (PACE) for individuals who need not be eligible for Medicare part A benefits, or enrolled under Medicare part B. (Sec. 4804) Directs the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under Medicare and Medicaid, specifically comparing the costs, quality, and access to services by private, for-profit entities under the demonstration projects with the costs, quality, and access to services of other PACE providers. Subtitle J: State Children's Health Insurance Program - Chapter 1: State Children's Health Insurance Program - Amends SSA to add a new title XXI (State Children's Health Insurance Program) in order to provide funds to States to expand the provision of child health assistance to uninsured, low-income children. Requires a State to submit for the Secretary's approval a child health plan for the use of funds, containing strategic objectives, performance goals, and performance measures. Mandates coverage equivalent to benefits coverage in a benchmark benefit package, consisting of benefits offered by either: (1) the Federal Employees' Health Benefits Program (FEHBP); (2) a State employee health benefit plan; or (3) an HMO. Makes appropriations to carry out this title. Allows their use for abortion only if necessary to save the life of the mother or if the pregnancy results from rape or incest. Chapter 2: Expanded Coverage of Children Under Medicaid - Amends SSA title XIX to provide for an increased Medicaid FMAP for expanded coverage of targeted low-income children. (Sec. 4912) Authorizes an approved State plan to make Medicaid available to a low-income child during a specified presumptive eligibility period after determination that family income does not exceed a certain level. (Sec. 4913) Provides for continuation of Medicaid eligibility for disabled children who lose benefits under SSA title XVI (Supplemental Security Income) (SSI). Chapter 3: Diabetes Grant Programs - Amends the Public Health Service Act to direct the Secretary to make grants for services for the prevention and treatment of type I diabetes in children, and for research in innovative approaches to such services. Provides for funding. (Sec. 4922) Directs the Secretary to make grants for services for the prevention and treatment of type I diabetes in Indians through the Indian Health Service and tribal and urban Indian health programs. (Sec. 4923) Requires the Secretary to evaluate such programs and report to the Congress. Title V: Welfare and Related Provisions - Subtitle A: TANF Block Grant - Amends part A (Temporary Assistance for Needy Families) (TANF) of SSA title IV to establish a program of welfare-to-work grants to States. (Sec. 5001) Sets forth requirements relating to State entitlement to non-competitive formula grants under such program and State distribution of such funds among local governments. Authorizes State Governors to distribute up to 15 percent of such grant funds for projects to help long-term welfare recipients enter unsubsidized employment. Provides for competitive grants, based on program effectiveness and other factors, including the history of the applicant's success in moving individuals with multiple barriers into work, for State-approved projects proposed by private industry councils or local governments. Sets forth rules relating to required beneficiaries and targeting of individuals with characteristics associated with long-term welfare dependency. Authorizes use of grant funds to provide work-related services to individuals who have reached the five-year limit on assistance. Directs the Secretary of Labor to use certain set-aside funds to make grants to each successful performance State in FY 2000. Makes appropriations for FY 1998 and 1999 for grants. Sets forth requirements for: (1) nondisplacement of other workers by participants in work activities under this program; (2) applicable health and safety standards; and (3) grievance procedures with respect to alleged violations of such nondisplacement and health and safety requirements. Provides for such grants to outlying areas territories and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to develop a plan to evaluate the use of such grants. Sets forth penalties for: (1) failure of a State to maintain its historic effort during a year in which a welfare-to-work grant is received; and (2) misuse of competitive welfare-to-work grant funds. Declares that State sanctions against recipients for TANF program violations are not wage reductions. (Sec. 5002) Limits to not more than ten percent the portion of such welfare-to-work grant funds which a State may use to carry out State programs under SSA title XX block grants to States for social services. (Sec. 5003) Increases from 20 percent to 30 percent of individuals in all families and in two-parent families the limitation on the number of persons who may be treated as engaged in work by reason of participation in a vocational education program or, in the case of teen heads of household, maintenance of satisfactory school attendance. (Sec. 5004) Requires reduction of a State's welfare-to-work grant if a State fails to reduce assistance for recipients refusing work without good cause. Subtitle B: Supplemental Security Income - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRAWORA) to extend by six months the deadline for certain childhood disability redeterminations under SSA title XVI (Supplemental Security Income) (SSI). (Sec. 5102) Prescribes the schedule of administrative fees the Commissioner of Social Security shall assess each State from FY 1997 through 2003 and after for making optional and mandatory State SSI payments to individuals. Revises requirements for deposit of such fees, directing that a portion be credited to a special fund for FY 1998 and subsequent fiscal years for use in defraying expenses. Provides that the amounts so credited shall not be scored as receipts under the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act), but credited as a discretionary offset to discretionary spending. Authorizes appropriations. Subtitle C: Child Support Enforcement - Amends SSA title III (Unemployment Insurance) with respect to the authority to permit certain redisclosures of wage and claim information for purposes related to the child support enforcement program under SSA title IV part D (Child Support and Establishment of Paternity). Subtitle D: Restricting Welfare and Public Benefits for Aliens - Amends PRAWORA to make aliens eligible for SSI who, as of the date of enactment of such Act, were receiving such benefits, or were legally residing in the United States and are blind or disabled. Extends the SSI grandfather provision through September 30, 1998. (Sec. 5302) Extends from five to seven years the refugee and asylee eligibility period for SSI and Medicaid, and includes Cuban and Haitian entrants within such category. Provides a five-year food stamp eligibility period for such aliens. Includes Cuban and Haitian entrants within the definition of "qualified alien" for purposes of welfare and public benefits. Exempts such aliens from specified periods of ineligibility for State and Federal means-tested benefits. (Sec. 5303) Exempts: (1) certain American Indians (including persons born in Canada) from SSI and Medicaid eligibility limitations; and (2) certain SSI recipients with pre-January 1, 1979 applications from SSI eligibility limitations. (Sec. 5305) States that an alien who is ineligible for food stamps shall not be eligible for such program based upon SSI eligibility. Authorizes Medicaid eligibility based upon SSI eligibility. (Sec. 5306) Treats certain Amerasian immigrants as refugees for purposes of specified public benefits eligibility. (Sec. 5307) Authorizes States to require State and local assistance applicants to provide v

Amendments:

Summary: H.R.2015 — 105th Congress (1997-1998)

There are 3 summaries for this bill. Line item veto by President (08/11/1997)Conference report filed in House (07/30/1997)Introduced in House (06/24/1997)     Bill summaries are authored by CRS. $("#summarySelector").congress_dropDownNavigation({ stubUrl: '/bill/105th-congress/house-bill/2015/summary', suffix: '' }); Shown Here:
Line item veto by President (08/11/1997) (On June 25, 1998, the Supreme Court ruled that the Line Item Veto Act (Public Law 104-130) is unconstitutional, thus restoring provisions that had been cancelled as summarized below.) (On August 11, 1997, the President line-item-vetoed Sec. 4722(c), which deemed to be permissible broad-based health care related taxes certain taxes, fees, or assessments collected by New York State from a health care provider before June 1, 1997, for which a specified waiver has been applied, or would be but for this provision. The provision would thus exempt such taxes, fees, or assessments from the requirement that provider-specific taxes be subtracted from the State share of Medicaid expenditures for purposes of Federal share calculation. The following revised digest of H.R. 2015 reflects the Act as signed into law, minus the line-item-vetoed provision. For more information on the specific items vetoed, see the text of the conference report for H.R. 2015, H.Rept. 105-217, and Presidential Cancellation Number 97-3.) TABLE OF CONTENTS: Title I: Food Stamp Provisions Title II: Housing and Related Provisions Title III: Communications and Spectrum Allocation Provisions Title IV: Medicare, Medicaid, and Children's Health Provisions Subtitle A: Medicare+Choice Program Subtitle B: Prevention Initiatives Subtitle C: Rural Initiatives Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity Subtitle E: Provisions Relating to Part A Only Subtitle F: Provisions Relating to Part B Only Subtitle G: Provisions Relating to Parts A and B Subtitle H: Medicaid Subtitle I: Programs of All-Inclusive Care for the Elderly (PACE) Subtitle J: State Children's Health Insurance Program Title V: Welfare and Related Provisions Subtitle A: TANF Block Grant Subtitle B: Supplemental Security Income Subtitle C: Child Support Enforcement Subtitle D: Restricting Welfare and Public Benefits for Aliens Subtitle E: Unemployment Compensation Subtitle F: Welfare Reform Technical Corrections Subtitle G: Miscellaneous Title VI: Education and Related Provisions Subtitle A: Higher Education Subtitle B: Repeal of Smith-Hughes Vocational Education Act Title VII: Civil Service Retirement and Related Provisions Title VIII: Veterans and Related Matters Subtitle A: Extension of Temporary Authorities Subtitle B: Copayments and Medical Care Cost Recovery Subtitle C: Other Matters Title IX: Asset Sales, User Fees, and Miscellaneous Provisions Subtitle A: Asset Sales Subtitle B: User Fees Subtitle C: Miscellaneous Provisions Title X: Budget Enforcement and Process Provisions Subtitle A: Amendments to the Congressional Budget and Impoundment Control Act of 1974 Subtitle B: Amendments to the Balanced Budget and Emergency Deficit Control Act of 1985 Title XI: District of Columbia Revitalization Subtitle A: District of Columbia Retirement Funds Subtitle B: Management Reform Plans Subtitle C: Criminal Justice Subtitle D: Privatization of Tax Collection and Administration Subtitle E: Financing of District of Columbia Accumulated Deficit Subtitle F: District of Columbia Bond Financing Improvements Subtitle G: District of Columbia Government Budget Subtitle H: Miscellaneous Provisions Balanced Budget Act of 1997 - Title I: Food Stamp Provisions - Amends the Food Stamp Act to define "caseload" and "covered individual." Authorizes State agencies to provide an additional 15 percent exemption from the food stamp program (program) work requirement for specified covered individuals. Provides for related caseload and exemption adjustments. (Sec. 1002) Obligates additional FY 1996 through 2002 funds for program employment and training programs. Sets forth State allocation provisions. (Sec. 1003) Requires State agencies, with assistance provided by the Secretary of Agriculture, to deny program benefits to prisoners incarcerated for more than 30 days. (Sec. 1004) Directs the Secretary to make specified funds available for FY 1998 through 2001 to eligible private nonprofit organizations and State agencies for nutrition education. Title II: Housing and Related Provisions - Amends the Balanced Budget Downpayment Act, I to extend permanently certain foreclosure avoidance provisions under the single family housing mortgage insurance program. (Sec. 203) Amends the United States Housing Act of 1937 with respect to the section 8 rental assistance program to make specified maximum monthly rent adjustment provisions for certain new and rehabilitated and nonturnover units applicable to FY 1999 and thereafter. Title III: Communications and Spectrum Allocation Provisions - Amends the Communications Act of 1934 (the Act) to make competitive bidding authority with respect to licenses or construction permits involving uses of the electromagnetic spectrum (spectrum) inapplicable to such licenses and permits issued by the Federal Communications Commission (FCC) that are for: (1) certain public safety radio services; (2) initial licenses or permits assigned to existing terrestrial broadcast licensees for digital television (TV) service; or (3) noncommercial educational or public broadcast stations. Requires the FCC to provide for the design and conduct of spectrum competitive bidding using a contingent combinatorial bidding system that permits prospective bidders to bid on combinations of licenses in a single bid and to enter multiple alternative bids within a single bidding round. Directs the FCC to prescribe methods by which a reasonable reserve price will be required, or a minimum bid will be established, to obtain any license or permit assigned under competitive bidding, unless determined not to be in the public interest. Repeals a requirement that any funds appropriated to the FCC for FY 1994 through 1998 for assigning licenses using random selection procedures be retained in the FCC's salaries and expenses account. Requires competitive bidding information to be included in annual FCC reports in order for any funds collected after FY 1998 to be retained in such account. Extends competitive bidding authority through FY 2008. Prohibits the FCC, after July 1, 1997, from issuing a license or construction permit for spectrum through a random selection system. Excepts from such prohibition licenses or permits for noncommercial educational or public broadcast stations. Provides for the applicability of competitive bidding requirements to pending comparative licensing cases. Makes available for assignment for commercial use the 1710 to 1755 megahertz (mhz) frequency band. Directs the FCC to assign licenses for such use by competitive bidding commenced after January 1, 2001. Directs the FCC to assign certain additional spectrum by competitive bidding no later than September 30, 2002. Directs the FCC to reallocate: (1) spectrum located at 2110 to 2150 mhz; and (2) 15 mhz located in the 1990 to 2110 range, with an exception in both cases when not in the public interest. Requires the FCC to notify the Secretary of Commerce if it is unable to provide for effective relocation of incumbent licensees to available bands of frequencies and has identified bands suitable for such relocation that are allocated for Federal use but could be reallocated pursuant to the National Telecommunications and Information Administration Organization Act (NTIA). Amends NTIA to direct the Secretary to report to the President, the FCC, and the Congress on recommendations for reallocating frequencies allocated for Federal use other than by Government licensees under the Communications Act of 1934. Authorizes any entity which operates a Government station to accept payment for frequency relocation expenses. Provides a relocation process triggered by a petition under NTIA. Allows a Federal entity to reclaim a former frequency if it demonstrates that relocated facilities or spectrum are not comparable to its former facilities or spectrum. Requires the Secretary to recommend for reallocation for use other than by Government stations a band of frequencies that: (1) in the aggregate span at least 20 mhz; (2) are located below three gigahertz; and (3) meet other relocation criteria. Directs the FCC to prepare and submit to the President and the Congress a plan for the immediate allocation and assignment of frequencies identified under this title. (Sec. 3003) Amends the Act to prohibit the renewal of a license authorizing analog TV services beyond the end of 2006, with an extension in specified circumstances. Prohibits the FCC, in prescribing regulations relating to qualifications of spectrum bidders, from: (1) precluding any party from being a qualified bidder for spectrum allocated for any use that includes digital TV service on the basis of the FCC's duopoly rule or newspaper cross-ownership rule; or (2) applying either rule to preclude a successful bidder from using such spectrum for digital TV service. (Sec. 3004) Directs the FCC, no later than January 1, 1998, to allocate from radio spectrum between 746 and 806 mhz: (1) 24 mhz for public safety services; and (2) the remainder for commercial purposes to be assigned by competitive bidding. Sets deadlines for the assignment of such licenses and the commencement of competitive bidding. Provides for the licensing of unused frequencies for public safety services. (Sec. 3005) Authorizes the FCC to allocate spectrum to provide flexibility of use, as long as such use is consistent with international agreements and upon a finding that such use is in the public interest and would not deter investment or result in harmful interference among users. (Sec. 3006) Authorizes appropriations to the FCC for FY 2001 for universal service support programs. (Sec. 3007) Directs the FCC to conduct all competitive bidding required under this title so that proceeds from such bidding are deposited no later than the end of FY 2002. (Sec. 3008) Requires seven days' public notice before the granting by the FCC of an application for spectrum frequency assignment under the Act. Title IV: Medicare, Medicaid, and Children's Health Provisions - Subtitle A: Medicare+Choice Program - Chapter 1: Medicare+Choice Program - Amends title XVIII (Medicare) of the Social Security Act (SSA) to establish a Medicare+Choice program under which each Medicare+Choice eligible individual (one entitled to benefits under Medicare part A (Hospital Insurance) and enrolled under Medicare part B (Supplementary Medical Insurance)) is entitled to elect, in accordance with certain procedures, to receive Medicare benefits either through the original Medicare fee-for-service program or through a Medicare+Choice plan. (Sec. 4001) Outlines the types of Medicare+Choice plans that may be available, namely: (1) coordinated care plans; (2) combination of a medical savings account (MSA) plan and contributions into a Medicare+Choice MSA; and (3) private fee-for-service plans. Sets forth various special rules regarding, among other things, residence, individuals with end-stage renal disease, and individuals covered under the Federal Employees Health Benefits Program or eligible for veterans' or military health benefits. Directs the Secretary of Health and Human Services (HHS) to: (1) provide for broad dissemination of coverage option and comparison information to Medicare beneficiaries and prospective Medicare beneficiaries; and (2) maintain a toll-free number for inquiries about Medicare+Choice options and program operation, as well as an Internet site through which individuals may obtain such information electronically. Requires: (1) any Medicare+Choice organization to accept without restrictions individuals eligible to make an election at any time during which such elections are accepted; and (2) approval of Medicare+Choice marketing material and application forms before they are distributed. Provides for continuous open enrollment and disenrollment through 2001, the first six months of 2002, and the first three months of every subsequent year, limiting an individual's change of enrollment during such initial period to one. Provides for an annual, coordinated election period during November for all participants as well as special election periods in certain circumstances. Outlines benefits and beneficiary protections. Requires each Medicare+Choice plan (except MSA plans) to provide those items and services for which benefits are available under Medicare parts A and B (other than hospice care) and specified additional benefits, as well, at its option, as certain supplemental benefits, subject to the Secretary's approval. Excludes individuals enrolled under a MSA plan from participating in such supplemental package. Prohibits a Medicare+Choice organization from denying, limiting, or conditioning coverage or benefits based on any described health status-related factor. Prescribes plan disclosure requirements and an ongoing quality assurance program. Outlines a mechanism for grievances and appeals. Sets forth certain payment rules for providers not participating in the Medicare+Choice program. Directs the Secretary to make monthly advance payments with respect to an individual's coverage to Medicare+Choice organizations according to a specified formula. Requires the Secretary to establish separate payment rates for individuals with end-stage renal disease. Sets forth special rules for individuals electing MSA plans. Requires such an individual to establish a Medicare+Choice MSA into which the Secretary shall make monthly deposits out of the Medicare trust funds in accordance with prescribed guidelines. Prescribes special rules for hospice care. Details rules for the submission and charging of premiums by each Medicare+Choice organization. Sets limitations on enrollee liability for basic, additional, and supplemental benefits. Prescribes a special rule for private fee-for-service plans. Prohibits a State from imposing a premium tax or similar tax with respect to payments to Medicare+Choice organizations. Sets out organizational and financial requirements for Medicare+Choice organizations and provider-sponsored organizations. Directs the Secretary to establish solvency and capital adequacy standards for provider-sponsored organizations, and other standards for Medicare+Choice organizations. Prescribes requirements, including minimum enrollment requirements, for contracts between the Secretary and Medicare+Choice organizations. Provides for: (1) intermediate sanctions and civil monetary penalties to enforce contract provisions; and (2) procedures for termination of contracts. (Sec. 4002) Details transitional rules for the current Medicare health maintenance organization (HMO) program, as well as specified conforming changes in the Medicare supplemental health insurance policy (Medigap) program. (Sec. 4006) Amends the Internal Revenue Code to outline special rules for Medicare+Choice MSAs. Excludes from gross income any payment by the Secretary to an individual's Medicare+Choice MSA. Excludes from qualified deductible medical expenses any amounts paid for the medical care of any individual but the account holder. Prescribes a penalty for distributions from the Medicare+Choice MSA not used for qualified medical expenses if the minimum balance is not maintained, with certain exceptions if the account holder becomes disabled or dies. Chapter 2: Demonstrations - Directs the Secretary to establish a Medicare prepaid competitive pricing demonstration project in up to four (eventually seven) designated Medicare payment areas, of which initially three shall be in urban areas and one in a rural area. (Sec. 4012) Directs the Secretary to appoint a Competitive Pricing Advisory Committee to recommend areas for the demonstration and research design for project implementation. (Sec. 4014) Amends the Omnibus Budget Reconciliation Act of 1987 to extend the authorities for the social health maintenance organization (SHMO) demonstration project. Amends the Omnibus Budget Reconciliation Act of 1993 to increase the cap on the number of individuals who may participate in a SHMO demonstration. Directs the Secretary to submit to the Congress a plan for the integration of SHMO health plans and similar plans as an option under the Medicare+Choice program. (Sec. 4015) Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a demonstration (subvention) project under which the HHS Secretary shall reimburse the Secretary of Veterans Affairs from the Medicare trust funds for Medicare health care services furnished to certain targeted Medicare-eligible military retirees or dependents. Authorizes the Secretary of Defense to modify existing TRICARE contracts in order to provide Medicare health care services to project participants. (Sec. 4016) Directs the Secretary to conduct demonstration projects in a certain number of rural and urban areas for the purpose of evaluating methods, such as case management and other models of coordinated care, that improve the quality of items and services provided to target individuals, and reduce Medicare expenditures for such items and services. Defines a target individual as an individual with a chronic illness who is enrolled under the Medicare parts A and B fee-for-service program. Provides for project funding. (Sec. 4017) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to direct the Secretary to work with each municipal health service demonstration project to develop a plan for the orderly transition of such projects and project participants to a non-demonstration project health care delivery system, such as through integration with a private or public health care plan, including a Medicaid managed care or Medicare+Choice plan. (Sec. 4018) Directs the Secretary to implement a time-limited demonstration project for the purpose of evaluating the use of a third-party contractor to conduct the Medicare+Choice plan enrollment and disenrollment functions in an area. (Sec. 4019) Extends for an additional two years certain Medicare community nursing organization demonstration projects under the Omnibus Budget Reconciliation Act of 1987. Chapter 3: Commissions - Establishes the National Bipartisan Commission on the Future of Medicare to: (1) review and analyze the long-term financial condition of the Medicare program; (2) identify problems that threaten the financial integrity of the Medicare trust funds, including the extent to which current Medicare update indexes do not accurately reflect inflation; and (3) analyze potential solutions to the problems identified that will ensure both the financial integrity of Medicare and the provision of appropriate benefits. Requires the Commission to make recommendations: (1) to restore the solvency of the Federal Hospital Insurance Trust Fund and the financial integrity of the Federal Supplementary Medical Insurance Trust Fund; and (2) to establish the appropriate financial structure of the Medicare program as a whole and the appropriate balance of benefits covered and beneficiary contributions. Requires recommendations on: (1) the financing of graduate medical education; (2) the feasibility of allowing individuals between age 62 and the Medicare eligibility age to buy into the Medicare program; and (3) the impact of chronic disease and disability trends on future costs and quality of services under the current benefit, financing, and delivery system structure of the Medicare program. Requires a report to the President and the Congress. Authorizes appropriations. (Sec. 4022) Establishes the Medicare Payment Advisory Commission to replace the Prospective Payment Assessment Commission and the Physician Payment Review Commission, hereby abolished. Requires the new Commission to review and make recommendations to the Congress about payment policies under Medicare (including certain specific payment-related topics). Authorizes appropriations. Chapter 4: Medigap Protections - Amends SSA title XVIII with respect to the issuer of a Medicare supplemental (Medigap) policy in the case of certain individuals terminated by an employee welfare benefit plan providing supplementary health benefits who seek to enroll under a Medigap policy not later than 63 days after termination or disenrollment. Prohibits the Medigap issuer from: (1) denying or conditioning the issuance or effectiveness of such a policy; (2) discriminating in the pricing of such policy because of health status, claims experience, receipt of health care, or medical condition; or (3) imposing an exclusion of benefits based on a pre-existing condition. (Sec. 4031) Specifies limitations on the imposition of preexisting condition exclusions during the initial open enrollment period in the case of a Medicare supplemental policy issued to an individual who is age 65 or older with a certain minimum period of creditable coverage. (Sec. 4032) Creates under the Medicare supplemental policy program a high deductible feature which requires the policy beneficiary to pay annual out-of-pocket expenses (other than premiums) of $1,500 (indexed for inflation) before the policy begins payment of benefits. Chapter 5: Tax Treatment of Hospitals Participating in Provider- Sponsored Organizations - Amends the Internal Revenue Code to provide that an organization shall not fail to be treated as a tax-exempt charitable organization solely because a hospital which it owns and operates also participates in a provider-sponsored organization, whether or not the provider-sponsored organization is exempt from tax. Provides that any person with a material financial interest in such a provider-sponsored organization shall be treated as a private shareholder or individual with respect to the hospital. Subtitle B: Prevention Initiatives - Outlines various specified new preventive health measures covered under Medicare, namely coverage for: (1) an annual screening mammography for women over age 39 and triennial screening pap smear and screening pelvic exam for any woman (annually for a woman with cervical or vaginal cancer or other abnormality, or who is at high risk of developing such a cancer), while providing for a waiver of deductible; (2) annual prostate cancer screening tests; (3) colorectal cancer screening tests, subject to prescribed frequency and payment limits; (4) diabetes outpatient self-management training services, including blood-testing strips (with a ten percent payment reduction after 1997) and glucose monitors as durable medical equipment (DME) for individuals with diabetes; and (5) bone mass measurements for qualified individuals. (Sec. 4105) Directs the Secretary to establish outcome measures, including glysolated hemoglobin (past 90-day average blood sugar levels), for the purpose of evaluating the improvement of health status of Medicare beneficiaries with diabetes mellitus, with a view to recommending coverage modifications. (Sec. 4107) Extends through FY 2002 the Influenza and Pneumococcal Vaccination Campaign of the Health Care Financing Administration (HCFA). Authorizes appropriations. (Sec. 4108) Directs the Secretary to request the National Academy of Sciences to analyze (for a report to specified congressional committees) the expansion or modification of Medicare preventive benefits to include medical nutrition therapy services by a registered dietitian, skin cancer screening, medically necessary dental care, and other specified items. Subtitle C: Rural Initiatives - Replaces the Essential Access Community Hospital Program with an optional Medicare Rural Hospital Flexibility Program under which participating States shall develop at least one rural health network in the State and at least one facility designated as a critical access hospital in accordance with prescribed guidelines. Authorizes the Secretary to award grants to States for: (1) planning and implementation of the program; and (2) establishment or expansion of rural emergency medical services. Authorizes appropriations. Directs the HCFA Administrator to report to the Congress on the feasibility of, and administrative requirements necessary to establish, an alternative for certain medical diagnoses to the current 96-hour limitation for inpatient care in critical access hospitals. (Sec. 4202) Amends SSA title XVIII to prohibit denial, on the basis of wage comparisons, of a rural referral center's request for reclassification. Provides that any hospital classified as a rural referral center for FY 1991 shall be classified as such for FY 1998 and each subsequent fiscal year. (Sec. 4204) Extends through FY 2001 the special treatment of payment methodology and target amount for Medicare-dependent, small rural hospitals. (Sec. 4205) Amends requirements for rural health clinic services with respect to: (1) per-visit payment limits for provider-based clinics; (2) mandatory quality assessment and performance improvement programs; (3) limitation of waivers of certain staffing requirements to clinics participating in the rural health clinic program; (4) the insufficiency of needed health care practitioners in shortage areas; and (5) regulations providing for payment for certain physician assistant services. (Sec. 4206) Directs the Secretary to make payments from the Federal Supplementary Medical Insurance Trust Fund under Medicare part B in accordance with a specified payment methodology for professional consultation via telecommunications systems with a physician or practitioner furnishing a service for which payment may be made to a Medicare beneficiary residing in a rural health professional shortage area, notwithstanding that the individual physician or practitioner providing the professional consultation is not at the same location as the physician or practitioner furnishing the service to that beneficiary. Directs the Secretary to report to the Congress: (1) a detailed analysis of telemedicine and telehealth (T&T) services; and (2) an examination of the possibility of making similar payments for professional consultation via telecommunications systems to Medicare beneficiaries who do not reside in a rural health professional shortage area, are homebound or nursing homebound, and for whom being transferred for health care services imposes a serious hardship. (Sec. 4207) Directs the Secretary to conduct a demonstration project to use eligible health care provider telemedicine networks to apply high-capacity computing and advanced networks to improve primary care and prevent health care complications to Medicare beneficiaries with diabetes mellitus who reside in medically underserved rural or inner-city areas. Provides funding. Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity - Chapter 1: Revisions to Sanctions for Fraud and Abuse - Amends SSA title XI, with respect to health care related crimes, to exclude from the Medicare and State health care programs any person: (1) for ten years for one previous conviction for one or more offenses; and (2) permanently for two or more previous convictions of one or more offenses. (Sec. 4302) Authorizes the Secretary to refuse to enter into Medicare agreements with individuals or entities convicted of felonies for offenses determined inconsistent with the best interests of program beneficiaries. (Sec. 4303) Authorizes the Secretary to exclude from the Medicare program any entity with respect to which a sanctioned person with an ownership or control interest in it transfers such interest in anticipation of (or following) a conviction, assessment, or exclusion against the person, to an immediate family member or member of the household who continues to maintain such an interest. (Sec. 4304) Provides for the imposition of civil monetary penalties for: (1) any person who arranges or contracts with an individual or entity that the person knows or should know is excluded from participation in a Federal health care program; and (2) kickbacks. Chapter 2: Improvements in Protecting Program Integrity - Amends SSA title XVIII to require the Secretary, in the annual notice of Medicare benefits, to urge beneficiaries to check the notice and any itemized statement for accuracy and report any errors or questionable charges by calling a certain toll-free number. Authorizes Medicare beneficiaries to submit written requests for itemized bills of medical or other items or services provided, and review them. Requires the Secretary to take measures to recover amounts unnecessarily paid out. (Sec. 4312) Outlines various specified requirements regarding disclosure of information and surety bonds with regard to DME suppliers. Includes surety bond requirements for home health agencies. Authorizes the Secretary to apply disclosure and surety bond requirements to other health care providers or item and service suppliers (except physicians or practitioners). Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORFs) and to rehabilitation agencies. (Sec. 4313) Requires any participating entity to disclose to the Secretary its own employer identification numbers and social security account numbers, as well as those of persons with ownership or control interests and subcontractors in which the entity has a five percent or greater interest. Directs the Secretary to report to Congress on the steps taken to assure the confidentiality of such social security account numbers. (Sec. 4314) Requires the Secretary, upon a party's request, to issue binding advisory opinions on whether a referral relating to designated health services (other than clinical laboratory services) is a prohibited physician self-referral. (Sec. 4315) Amends SSA title XVIII to: (1) replace the reasonable charge payment methodology with fee schedules developed by the Secretary for particular services; (2) provide for application of inherent reasonableness to charges for all Medicare part B services other than physicians' services; (3) require bills and requests for payment for services by non-physician practitioners to include diagnostic codes; (4) outline requirements to provide diagnostic information when ordering certain items or services furnished by another entity; (5) mandate establishment of competitive acquisition areas for contract award purposes for the furnishing under Medicare part B after 1997 of described items and services; and (6) prohibit payment under Medicare part A or part B for any expenses for an item or service furnished in a competitive acquisition area by an entity other than an entity with which the Secretary has contracted, except for urgent need, or in other circumstances specified by the Secretary. (Sec. 4320) Excludes from reasonable costs and declares unreimbursable under Medicare any payments for certain items unrelated to patient care, including: (1) entertainment, gifts, or donations; (2) personal use of motor vehicles; (3) costs for fines and penalties resulting from violations of Federal, State, or local laws; and (4) education expenses for spouses or other dependents of service providers, their employees, or contractors. (Sec. 4321) Requires a Medicare hospital's discharge planning process to include information on the availability of home health services through certain individuals or entities. Requires a discharge plan: (1) not to specify or otherwise limit the qualified provider which may provide home health services; and (2) identify any entity to whom the individual is referred in which the hospital has a disclosable financial interest. Requires the service provider agreement to require disclosure of any financial interest a hospital has in any entity to which individuals are referred, or any entity has in the hospital, and related information. Chapter 3: Clarifications and Technical Changes - Makes technical amendments with respect to fraud and abuse. Subtitle E: Provisions Relating to Part A Only - Chapter 1: Payment of PPS Hospitals - Revises requirements for: (1) prospective payment system (PPS) hospital payment updates; (2) maintenance of savings from the temporary reduction in capital payments for prospective payment system (PPS) hospitals; (3) additional payments to any hospital with a disproportionate share of low-income patients (disproportionate share hospital (DSH)); (4) the sales price of a Medicare capital asset (book value); (5) elimination of indirect medical education (IME) and DSH payments attributable to outlier payments; (6) the base rate of payments to Puerto Rico hospitals; (7) payments to hospitals for certain discharges to post-acute care; (8) inclusion of Stanly County, North Carolina, in the large urban area of Charlotte-Gastonia-Rock Hill-North Carolina-South Carolina; and (9) the floor on wage area indexes. (Sec. 4409) Requires the Secretary to publish and use alternative guidelines under which certain disproportionately large hospitals qualify for geographic reclassification. Chapter 2: Payment of PPS-Exempt Hospitals - Revises requirements for the payment of PPS-exempt hospitals, including those for: (1) payment updates; (2) reductions to capital payments; (3) bonus and relief payments; (4) payment and the target amount for new providers; (5) treatment of certain long-term care hospitals located within other hospitals; (6) rebasing; (7) certain cancer hospitals; and (8) elimination of exemptions for certain hospitals. (Sec. 4421) Provides for a Medicare PPS for inpatient rehabilitation hospital services. (Sec. 4422) Directs the Secretary to submit to the Congress a legislative proposal for establishing a case-mix adjusted PPS for long-term care hospitals. Chapter 3: Payment for Skilled Nursing Facilities - Declares that updates to per diem limits, with respect to payments to skilled nursing facilities (SNFs), effective for FY 1998, shall be based on cost limits effective for FY 1997. (Sec. 4432) Mandates a PPS for SNF services along with consolidated billing for them. Directs the Secretary, in order to ensure that Medicare beneficiaries are furnished appropriate SNF services, to establish a thorough medical review process to examine the provisions of this section and their effect on the quality of covered SNF services furnished to Medicare beneficiaries. Chapter 4: Provisions Related to Hospice Services - Provides for update of payments for hospice services. Bases payment for home hospice care on the location where care is furnished. Revises the home hospice care benefit period. Provides for home hospice care coverage of any other items and services specified in a plan. Allows waiver of certain staffing requirements for hospice care programs in non-urbanized areas. Chapter 5: Other Payment Provisions - Requires reductions in payments for enrollee bad debt. Repeals the termination date to make a permanent extension of the hemophilia passthrough. Requires a certain reduction in the part A Medicare premium for specified public retirees. Authorizes Medicare and Medicaid coverage of inpatient hospital and post-hospital extended care services in religious nonmedical health care institutions (currently limited to Christian Science sanatoria). Subtitle F: Provisions Relating to Part B Only - Chapter 1: Services of Health Professionals - Revises requirements for the payment of physicians' services, with changes: (1) establishing a single conversion factor for 1998; (2) adding new update provisions; (3) replacing the volume performance standard with sustainable growth rate; (4) adding payment rules for anesthesia services; and (5) providing for adjustments in relative value units for 1998, and the application of resource-based methodology to malpractice relative value units. (Sec. 4505) Directs the Comptroller General to review and evaluate the proposed rule on resource-based methodology for practice expenses issued by the HCFA. (Sec. 4506) Directs the Secretary to determine for each hospital: (1) its hospital-specific per discharge relative value for physicians' services; and (2) whether such value is projected to be excessive. Requires the Secretary to notify the medical executive committee of a subset of the hospitals identified as having an excessive hospital-specific relative value, and evaluate their responses with the responses of other hospitals so identified that were not notified. (Sec. 4507) Amends SSA title XVIII to declare that nothing shall prohibit a physician or practitioner from privately contracting with a Medicare beneficiary for any item or service for which no Medicare claim will be submitted, and for which the physician or practitioner shall receive no Medicare reimbursement. (Sec. 4511) Increases Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. (Sec. 4513) Repeals the requirement of an X-ray for reimbursement for chiropractic services. Directs the Secretary to develop utilization guidelines for the coverage of chiropractic services where a subluxation has not been demonstrated by an X-ray. Chapter 2: Payment for Hospital Outpatient Department Services - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 4522) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 4523) Directs the Secretary to establish a PPS for hospital outpatient department services. Chapter 3: Ambulance Services - Provides for certain interim reductions in payments for ambulance services. Directs the Secretary to establish a prospective fee schedule for payment of such services. Provides that, in promulgating regulations for coverage of ambulance services, the Secretary may cover advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. (Sec. 4532) Directs the Secretary to establish up to three demonstration projects contracting with local governments for ambulance services paid for under Medicare. Chapter 4: Prospective Payment for Outpatient Rehabilitative Services - Provides for a PPS for outpatient physical (including speech-language pathology) and occupational therapy services. Chapter 5: Other Payment Provisions - Provides for a reduction in payment amounts for items of DME and for clinical diagnostic laboratory tests. Provides for a payment freeze for parenteral and enteral nutrients, supplies, and equipment. Revises update requirements for payment for orthotics and prosthetics, and other payment requirements for oxygen and oxygen equipment, ambulatory surgical services, and drugs and biologicals. (Sec. 4552) Requires the Comptroller General to study and report to specified congressional committees on access to home oxygen equipment. Requires the Secretary to arrange for peer review organizations to evaluate such access. (Sec. 4553) Directs the Secretary to request the National Academy of Sciences to study (for a report to specified congressional committees) Medicare payments for clinical laboratory tests. (Sec. 4554) Directs the Secretary to divide the United States into up to five regions, and designate a single carrier for each region, for the payment of Medicare part B claims for clinical diagnostic laboratory services. Requires the Secretary to adopt uniform policies for clinical diagnostic laboratory tests. (Sec. 4557) Provides for coverage of oral anti-nausea drugs under a chemotherapeutic regimen. (Sec. 4558) Requires the Secretary to: (1) audit cost reports of each renal dialysis provider at least once every three years; and (2) develop a method to measure and report on the quality of Medicare renal dialysis services. (Sec. 4559) Directs the Secretary, for electrocardiogram tests furnished during 1998, to restore separate part B payment for electrocardiogram transportation based upon methods in effect on December 31, 1996. Requires the Secretary, by a certain deadline, to recommend to specified congressional committees whether portable electrocardiogram transportation should be covered under Medicare part B. Chapter 6: Part B Premium and Related Provisions - Revises the formula for the monthly Medicare part B premium rate the Secretary promulgates each September for the following calendar year. Requires such rate to equal 50 percent of the monthly actuarial rate for enrollees age 65 and over for that succeeding calendar year. (Sec. 4581) Provides for a special Medicare enrollment period, with no premium penalty for late enrollment, for certain disabled workers whose continuous enrollment under an employer's group health plan is involuntarily terminated in certain circumstances. (Sec. 4582) Allows appropriate State or local governmental entities to elect to pay part B premiums for certain eligible individuals. Subtitle G: Provisions Relating to Parts A and B - Chapter 1: Home Health Services and Benefits - Provides that, in establishing payment limits for cost reporting periods beginning after September 30, 1997, the Secretary shall not take into account any changes in the home health market basket with respect to cost reporting periods which began on or after July 1, 1994, and before July 1, 1996. (Sec. 4602) Revises requirements for interim payments for home health services. Directs the Secretary to expand research on a PPS for home health agencies under the Medicare program that ties prospective payments to a unit of service. (Sec. 4603) Directs the Secretary to establish a PPS for home health services for cost reporting periods beginning in FY 2000. (Sec. 4604) Bases the payment for home health services on the location where the service is furnished. (Sec. 4611) Provides for a modification of the Medicare part A home health benefit for individuals enrolled under Medicare part B. Provides for specified post-institutional home health services. (Sec. 4613) Directs the Secretary to study and report to the Congress on the criteria that should be applied in determining whether an individual is homebound for purposes of qualifying for Medicare home health services. (Sec. 4614) Provides for the denial of home health claims based on home health services the frequency and duration of which are in excess of normative guidelines established by the Secretary. (Sec. 4615) Denies payment for home health benefits based solely on venipuncture to obtain a blood sample. (Sec. 4616) Directs the Secretary to estimate part A and part B outlays for FY 1998 through 2002 for specified congressional committees, and report annually a comparison of actual outlays with such estimates. Chapter 2: Graduate Medical Education - Revises requirements for direct and indirect Medicare payments for graduate medical education (GME). Limits the number of residents in allopathic and osteopathic medicine. Permits payment to qualified nonhospital providers for direct GME costs. Prohibits restandardization of certain indirect GME payment amounts. Requires the Secretary to provide for direct and indirect GME payments to hospitals for Medicare+Choice enrollees. Makes a special reimbursement rule for primary care combined residency programs, setting the period of board eligibility. (Sec. 4626) Provides for incentive payments to hospitals under plans for voluntary reduction in the number of full-time equivalent residents in an approved medical training program. (Sec. 4628) Directs the Secretary to establish a demonstration project under which GME payments shall be made to consortia of teaching hospitals and other medical entities. (Sec. 4629) Directs the Medicare Payment Advisory Commission to develop recommendations to the Congress on whether and to what extent Medicare payment policies and other Federal policies regarding teaching hospitals and GME should be changed. (Sec. 4630) Directs the Secretary to study and report to the appropriate congressional committees on variations among hospitals in the overhead and supervisory physician components of their direct medical education costs. Chapter 3: Provisions Relating to Medicare Secondary Payer - Revises requirements for Medicare as secondary payer. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Chapter 4: Other Provisions - Amends SSA title XVIII to require placement of an advance directive in a prominent part of the individual's current medical record. (Sec. 4642) Provides for an increased certification period for certain organ procurement organizations. (Sec. 4643) Establishes in the HCFA the position of Chief Actuary. Subtitle H: Medicaid - Chapter 1: Managed Care - Amends SSA title XIX (Medicaid) to establish a new part B (Managed Care) giving States the option to require Medicaid-eligible individuals (except Medicare beneficiaries, Medicare-eligible individuals, and certain children with special needs) to enroll in managed care arrangements of the individual's choice as a condition of receiving Medicaid. (Sec. 4702) Grants States the option of providing Medicaid coverage of primary care case management services without the need for a waiver. (Sec. 4703) Repeals the (75-25) requirement that Medicare and Medicaid beneficiaries constitute less than 75 percent of the membership of a participating HMO. Repeals the prohibition on co-payments for services furnished by HMOs. (Sec. 4704) Prescribes requirements for: (1) access to emergency care; (2) annual external independent review of managed care entity activities and other specified quality care assurance measures; and (3) fraud and abuse prohibitions and protections. (Sec. 4705) Amends SSA title XIX (Medicaid) to require any State contracting with Medicaid managed care organizations to develop and implement a quality assessment and improvement strategy incorporating certain access standards, monitoring procedures, and other measures. Directs the Comptroller General to analyze and report to specified congressional committees on the quality assurance programs and accreditation standards applicable to managed care entities operating in the private sector or under Medicare contracts to determine if such programs and standards consider the accessibility and quality of the health care items and services delivered under such contracts to low-income individuals. Directs the Secretary to study and report to such committees on safeguards that may be needed to ensure that the health care needs of individuals with special health care needs and chronic conditions who are enrolled with Medicaid managed care organizations are adequately met. (Sec. 4706) Requires an HMO to meet solvency standards established by the State for private HMOs, or be State-licensed or -certified as a risk-bearing entity. (Sec. 4708) Increases from $100,000 to $1 million, indexed annually, the threshold amount for HMO contracts requiring the Secretary's prior approval. Permits the same copayments in HMOs as in fee-for-service. Chapter 2: Flexibility in Payment of Providers - Repeals "Boren Amendment" provider reimbursement requirements. Requires the Secretary to study and report to the appropriate congressional committees on the effect on access to services, service quality, and service safety of the rate-setting methods used by States as a result of such repeal. (Sec. 4712) Specifies reductions from 100 percent to 70 percent between FY 1999 through 2003 in the percentage of reasonable costs that shall be paid under a State plan for federally-qualified health center and rural health clinic services (with a special supplemental payment for services furnished under certain managed care contracts). (Sec. 4713) Repeals payment rate requirements for obstetrical and pediatric services. (Sec. 4714) Revises requirements for Medicaid payment rates for qualified Medicare beneficiaries, placing a limitation on nonparticipating providers. (Sec. 4715) Declares that, in the case of a Medicaid-eligible veteran residing in a State veterans' home, any veterans' pension over $90 per month shall be counted as income only for the purpose of applying such excess payment to the State veterans' home's cost of providing nursing care to the veteran. Chapter 3: Federal Payments to States - Revises specified limitations of Federal payments for inpatient hospital services furnished by disproportionate share hospitals (DSH), including limitations on certain State DSH expenditures to institutions for mental diseases or other mental health facilities. Requires direct State Medicaid payment to hospitals for managed care enrollees. (Sec. 4722) Revises the treatment as broad-based health care related taxes of certain State hospital taxes which currently are not subtracted as revenues from the State share of Medicaid expenditures for purposes of calculating the Federal share of such expenditures. Declares that an exemption from such State hospital tax for certain Federal-tax-exempt hospitals that do not accept Medicaid or Medicare payments (provide free care) shall not disqualify the hospital tax as a broad-based health care related tax (thus allowing continued exclusion of such State hospital tax from the requirement that provider-specific taxes be subtracted from the State share of Medicaid expenditures for purposes of Federal share calculation). (Sec. 4723) Specifies additional funding for State emergency health services furnished to undocumented aliens. (Sec. 4724) Prohibits the expenditure of Medicaid funds for roads, bridges, stadiums, and other items and services not covered by a State plan. Requires home health agencies to provide a surety bond. Revises conflict-of-interest safeguards. Declares that States are not required to provide medical assistance for items or services furnished by a person or entity convicted of a felony for an offense inconsistent with the best interests of beneficiaries under the State plan. Requires State action for program and beneficiary protection against waste, fraud, and abuse. Conditions issuance or renewal of a DME supplier provider number on the supplier's provision of a surety bond and disclosure of all persons with ownership or control interests in the supplier, and of all subcontractors in which the supplier has a five percent or greater interest. (Sec. 4725) Provides for increased Federal medical assistance percentages (FMAPs) for the District of Columbia and Alaska and increased payment caps for the territories. Chapter 4: Eligibility - Grants States the option to provide for 12-month continuous Medicaid eligibility for children. (Sec. 4732) Requires State Medicaid plan coverage of the Medicare cost-sharing for certain additional low-income Medicare beneficiaries whose income otherwise disqualifies them for specified Medicare benefits. (Sec. 4733) Grants States the option to permit workers with disabilities to buy into Medicaid. (Sec. 4734) Prescribes criminal penalties for knowingly and willfully, for a fee, counseling or assisting an individual to dispose of assets (including transfer in trust) in order for that individual to become Medicaid-eligible (fraudulent eligibility). (Sec. 4735) Declares that certain payments in a class settlement of the case of Susan Walker v. Bayer Corporation shall not be considered income or resources in determining Medicaid eligibility. Chapter 5: Benefits - Changes from mandatory to discretionary a State's authority to enroll individuals under private group health plans and pay their premiums. (Sec. 4742) Repeals: (1) certain physician qualification requirements with respect to services to pregnant women and to children under age 21; and (2) the requirement of prior institutionalization with respect to habilitation services furnished under a waiver for home or community-based services. (Sec. 4744) Requires the Secretary to study and report to the Congress on early and periodic screening, diagnostic, and treatment benefits. Chapter 6: Administration and Miscellaneous - Repeals requirements for inspections of the care being provided at mental hospitals and intermediate care facilities for the mentally retarded (ICFS-MR). (Sec. 4752) Authorizes a State, in lieu of terminating a noncompliant ICFS-MR, to establish alternative remedies if the State demonstrates to the Secretary's satisfaction that such alternative remedies are effective in deterring noncompliance and correcting deficiencies. (Sec. 4753) Revises requirements for mechanized claims processing and information retrieval systems. (Sec. 4754) Repeals the requirement for State refund to the Federal Government of any payments received during remediation of a noncompliant nursing facility. (Sec. 4755) Requires States to establish procedures to permit a nurse aide, in the case of a finding of neglect, to petition the State for name removal from the nurse aide registry upon a State determination that: (1) the employment and personal history of the nurse aide does not reflect a pattern of abusive behavior or neglect; and (2) the neglect involved in the original finding was a singular occurrence. (Sec. 4756) Includes the DRUGDEX Information System among the compendia to be used in drug use review for Medicaid payment. (Sec. 4757) Applies certain requirements to the extension of statewide comprehensive research and demonstration projects for which waivers of Medicaid compliance have been granted. (Sec. 4758) Amends the Omnibus Budget Reconciliation Act of 1989 to extend the moratorium on the treatment of the Kent Community Hospital Complex and Saginaw Community Hospital in Michigan as institutions for mental diseases for purposes of Medicaid reimbursement. Subtitle I: Programs of All-Inclusive Care for the Elderly (PACE) - Amends SSA title XVIII to provide for Medicare programs of all-inclusive care for the elderly (PACE programs) for individuals age 55 or older who require the level of care required under the State Medicaid plan for coverage of nursing facility services. Specifies benefit and payment requirements. Limits PACE provider eligibility to public and private non-profit entities; but requires the Secretary to waive such limitations to demonstrate the operation of a PACE program by a private, for-profit entity. (Sec. 4802) Amends SSA title XIX to authorize a State to establish a Medicaid program of all-inclusive care for the elderly (PACE) for individuals who need not be eligible for Medicare part A benefits, or enrolled under Medicare part B. (Sec. 4804) Directs the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under Medicare and Medicaid, specifically comparing the costs, quality, and access to services by private, for-profit entities under the demonstration projects with the costs, quality, and access to services of other PACE providers. Subtitle J: State Children's Health Insurance Program - Chapter 1: State Children's Health Insurance Program - Amends SSA to add a new title XXI (State Children's Health Insurance Program) in order to provide funds to States to expand the provision of child health assistance to uninsured, low-income children. Requires a State to submit for the Secretary's approval a child health plan for the use of funds, containing strategic objectives, performance goals, and performance measures. Mandates coverage equivalent to benefits coverage in a benchmark benefit package, consisting of benefits offered by either: (1) the Federal Employees' Health Benefits Program (FEHBP); (2) a State employee health benefit plan; or (3) an HMO. Makes appropriations to carry out this title. Allows their use for abortion only if necessary to save the life of the mother or if the pregnancy results from rape or incest. Chapter 2: Expanded Coverage of Children Under Medicaid - Amends SSA title XIX to provide for an increased Medicaid FMAP for expanded coverage of targeted low-income children. (Sec. 4912) Authorizes an approved State plan to make Medicaid available to a low-income child during a specified presumptive eligibility period after determination that family income does not exceed a certain level. (Sec. 4913) Provides for continuation of Medicaid eligibility for disabled children who lose benefits under SSA title XVI (Supplemental Security Income) (SSI). Chapter 3: Diabetes Grant Programs - Amends the Public Health Service Act to direct the Secretary to make grants for services for the prevention and treatment of type I diabetes in children, and for research in innovative approaches to such services. Provides for funding. (Sec. 4922) Directs the Secretary to make grants for services for the prevention and treatment of type I diabetes in Indians through the Indian Health Service and tribal and urban Indian health programs. (Sec. 4923) Requires the Secretary to evaluate such programs and report to the Congress. Title V: Welfare and Related Provisions - Subtitle A: TANF Block Grant - Amends part A (Temporary Assistance for Needy Families) (TANF) of SSA title IV to establish a program of welfare-to-work grants to States. (Sec. 5001) Sets forth requirements relating to State entitlement to non-competitive formula grants under such program and State distribution of such funds among local governments. Authorizes State Governors to distribute up to 15 percent of such grant funds for projects to help long-term welfare recipients enter unsubsidized employment. Provides for competitive grants, based on program effectiveness and other factors, including the history of the applicant's success in moving individuals with multiple barriers into work, for State-approved projects proposed by private industry councils or local governments. Sets forth rules relating to required beneficiaries and targeting of individuals with characteristics associated with long-term welfare dependency. Authorizes use of grant funds to provide work-related services to individuals who have reached the five-year limit on assistance. Directs the Secretary of Labor to use certain set-aside funds to make grants to each successful performance State in FY 2000. Makes appropriations for FY 1998 and 1999 for grants. Sets forth requirements for: (1) nondisplacement of other workers by participants in work activities under this program; (2) applicable health and safety standards; and (3) grievance procedures with respect to alleged violations of such nondisplacement and health and safety requirements. Provides for such grants to outlying areas territories and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to develop a plan to evaluate the use of such grants. Sets forth penalties for: (1) failure of a State to maintain its historic effort during a year in which a welfare-to-work grant is received; and (2) misuse of competitive welfare-to-work grant funds. Declares that State sanctions against recipients for TANF program violations are not wage reductions. (Sec. 5002) Limits to not more than ten percent the portion of such welfare-to-work grant funds which a State may use to carry out State programs under SSA title XX block grants to States for social services. (Sec. 5003) Increases from 20 percent to 30 percent of individuals in all families and in two-parent families the limitation on the number of persons who may be treated as engaged in work by reason of participation in a vocational education program or, in the case of teen heads of household, maintenance of satisfactory school attendance. (Sec. 5004) Requires reduction of a State's welfare-to-work grant if a State fails to reduce assistance for recipients refusing work without good cause. Subtitle B: Supplemental Security Income - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRAWORA) to extend by six months the deadline for certain childhood disability redeterminations under SSA title XVI (Supplemental Security Income) (SSI). (Sec. 5102) Prescribes the schedule of administrative fees the Commissioner of Social Security shall assess each State from FY 1997 through 2003 and after for making optional and mandatory State SSI payments to individuals. Revises requirements for deposit of such fees, directing that a portion be credited to a special fund for FY 1998 and subsequent fiscal years for use in defraying expenses. Provides that the amounts so credited shall not be scored as receipts under the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act), but credited as a discretionary offset to discretionary spending. Authorizes appropriations. Subtitle C: Child Support Enforcement - Amends SSA title III (Unemployment Insurance) with respect to the authority to permit certain redisclosures of wage and claim information for purposes related to the child support enforcement program under SSA title IV part D (Child Support and Establishment of Paternity). Subtitle D: Restricting Welfare and Public Benefits for Aliens - Amends PRAWORA to make aliens eligible for SSI who, as of the date of enactment of such Act, were receiving such benefits, or were legally residing in the United States and are blind or disabled. Extends the SSI grandfather provision through September 30, 1998. (Sec. 5302) Extends from five to seven years the refugee and asylee eligibility period for SSI and Medicaid, and includes Cuban and Haitian entrants within such category. Provides a five-year food stamp eligibility period for such aliens. Includes Cuban and Haitian entrants within the definition of "qualified alien" for purposes of welfare and public benefits. Exempts such aliens from specified periods of ineligibility for State and Federal means-tested benefits. (Sec. 5303) Exempts: (1) certain American Indians (including persons born in Canada) from SSI and Medicaid eligibility limitations; and (2) certain SSI recipients with pre-January 1, 1979 applications from SSI eligibility limitations. (Sec. 5305) States that an alien who is ineligible for food stamps shall not be eligible for such program based upon SSI eligibility. Authorizes Medicaid eligibility based upon SSI eligibility. (Sec. 5306) Treats certain Amerasian immigrants as refugees for purposes of specified public benefits eligibility. (Sec. 5307) Authorizes States to require State and local assistance applicants to provide v

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Summary: H.R.2015 — 105th Congress (1997-1998)

There are 3 summaries for this bill. Line item veto by President (08/11/1997)Conference report filed in House (07/30/1997)Introduced in House (06/24/1997)     Bill summaries are authored by CRS. $("#summarySelector").congress_dropDownNavigation({ stubUrl: '/bill/105th-congress/house-bill/2015/summary', suffix: '' }); Shown Here:
Line item veto by President (08/11/1997) (On June 25, 1998, the Supreme Court ruled that the Line Item Veto Act (Public Law 104-130) is unconstitutional, thus restoring provisions that had been cancelled as summarized below.) (On August 11, 1997, the President line-item-vetoed Sec. 4722(c), which deemed to be permissible broad-based health care related taxes certain taxes, fees, or assessments collected by New York State from a health care provider before June 1, 1997, for which a specified waiver has been applied, or would be but for this provision. The provision would thus exempt such taxes, fees, or assessments from the requirement that provider-specific taxes be subtracted from the State share of Medicaid expenditures for purposes of Federal share calculation. The following revised digest of H.R. 2015 reflects the Act as signed into law, minus the line-item-vetoed provision. For more information on the specific items vetoed, see the text of the conference report for H.R. 2015, H.Rept. 105-217, and Presidential Cancellation Number 97-3.) TABLE OF CONTENTS: Title I: Food Stamp Provisions Title II: Housing and Related Provisions Title III: Communications and Spectrum Allocation Provisions Title IV: Medicare, Medicaid, and Children's Health Provisions Subtitle A: Medicare+Choice Program Subtitle B: Prevention Initiatives Subtitle C: Rural Initiatives Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity Subtitle E: Provisions Relating to Part A Only Subtitle F: Provisions Relating to Part B Only Subtitle G: Provisions Relating to Parts A and B Subtitle H: Medicaid Subtitle I: Programs of All-Inclusive Care for the Elderly (PACE) Subtitle J: State Children's Health Insurance Program Title V: Welfare and Related Provisions Subtitle A: TANF Block Grant Subtitle B: Supplemental Security Income Subtitle C: Child Support Enforcement Subtitle D: Restricting Welfare and Public Benefits for Aliens Subtitle E: Unemployment Compensation Subtitle F: Welfare Reform Technical Corrections Subtitle G: Miscellaneous Title VI: Education and Related Provisions Subtitle A: Higher Education Subtitle B: Repeal of Smith-Hughes Vocational Education Act Title VII: Civil Service Retirement and Related Provisions Title VIII: Veterans and Related Matters Subtitle A: Extension of Temporary Authorities Subtitle B: Copayments and Medical Care Cost Recovery Subtitle C: Other Matters Title IX: Asset Sales, User Fees, and Miscellaneous Provisions Subtitle A: Asset Sales Subtitle B: User Fees Subtitle C: Miscellaneous Provisions Title X: Budget Enforcement and Process Provisions Subtitle A: Amendments to the Congressional Budget and Impoundment Control Act of 1974 Subtitle B: Amendments to the Balanced Budget and Emergency Deficit Control Act of 1985 Title XI: District of Columbia Revitalization Subtitle A: District of Columbia Retirement Funds Subtitle B: Management Reform Plans Subtitle C: Criminal Justice Subtitle D: Privatization of Tax Collection and Administration Subtitle E: Financing of District of Columbia Accumulated Deficit Subtitle F: District of Columbia Bond Financing Improvements Subtitle G: District of Columbia Government Budget Subtitle H: Miscellaneous Provisions Balanced Budget Act of 1997 - Title I: Food Stamp Provisions - Amends the Food Stamp Act to define "caseload" and "covered individual." Authorizes State agencies to provide an additional 15 percent exemption from the food stamp program (program) work requirement for specified covered individuals. Provides for related caseload and exemption adjustments. (Sec. 1002) Obligates additional FY 1996 through 2002 funds for program employment and training programs. Sets forth State allocation provisions. (Sec. 1003) Requires State agencies, with assistance provided by the Secretary of Agriculture, to deny program benefits to prisoners incarcerated for more than 30 days. (Sec. 1004) Directs the Secretary to make specified funds available for FY 1998 through 2001 to eligible private nonprofit organizations and State agencies for nutrition education. Title II: Housing and Related Provisions - Amends the Balanced Budget Downpayment Act, I to extend permanently certain foreclosure avoidance provisions under the single family housing mortgage insurance program. (Sec. 203) Amends the United States Housing Act of 1937 with respect to the section 8 rental assistance program to make specified maximum monthly rent adjustment provisions for certain new and rehabilitated and nonturnover units applicable to FY 1999 and thereafter. Title III: Communications and Spectrum Allocation Provisions - Amends the Communications Act of 1934 (the Act) to make competitive bidding authority with respect to licenses or construction permits involving uses of the electromagnetic spectrum (spectrum) inapplicable to such licenses and permits issued by the Federal Communications Commission (FCC) that are for: (1) certain public safety radio services; (2) initial licenses or permits assigned to existing terrestrial broadcast licensees for digital television (TV) service; or (3) noncommercial educational or public broadcast stations. Requires the FCC to provide for the design and conduct of spectrum competitive bidding using a contingent combinatorial bidding system that permits prospective bidders to bid on combinations of licenses in a single bid and to enter multiple alternative bids within a single bidding round. Directs the FCC to prescribe methods by which a reasonable reserve price will be required, or a minimum bid will be established, to obtain any license or permit assigned under competitive bidding, unless determined not to be in the public interest. Repeals a requirement that any funds appropriated to the FCC for FY 1994 through 1998 for assigning licenses using random selection procedures be retained in the FCC's salaries and expenses account. Requires competitive bidding information to be included in annual FCC reports in order for any funds collected after FY 1998 to be retained in such account. Extends competitive bidding authority through FY 2008. Prohibits the FCC, after July 1, 1997, from issuing a license or construction permit for spectrum through a random selection system. Excepts from such prohibition licenses or permits for noncommercial educational or public broadcast stations. Provides for the applicability of competitive bidding requirements to pending comparative licensing cases. Makes available for assignment for commercial use the 1710 to 1755 megahertz (mhz) frequency band. Directs the FCC to assign licenses for such use by competitive bidding commenced after January 1, 2001. Directs the FCC to assign certain additional spectrum by competitive bidding no later than September 30, 2002. Directs the FCC to reallocate: (1) spectrum located at 2110 to 2150 mhz; and (2) 15 mhz located in the 1990 to 2110 range, with an exception in both cases when not in the public interest. Requires the FCC to notify the Secretary of Commerce if it is unable to provide for effective relocation of incumbent licensees to available bands of frequencies and has identified bands suitable for such relocation that are allocated for Federal use but could be reallocated pursuant to the National Telecommunications and Information Administration Organization Act (NTIA). Amends NTIA to direct the Secretary to report to the President, the FCC, and the Congress on recommendations for reallocating frequencies allocated for Federal use other than by Government licensees under the Communications Act of 1934. Authorizes any entity which operates a Government station to accept payment for frequency relocation expenses. Provides a relocation process triggered by a petition under NTIA. Allows a Federal entity to reclaim a former frequency if it demonstrates that relocated facilities or spectrum are not comparable to its former facilities or spectrum. Requires the Secretary to recommend for reallocation for use other than by Government stations a band of frequencies that: (1) in the aggregate span at least 20 mhz; (2) are located below three gigahertz; and (3) meet other relocation criteria. Directs the FCC to prepare and submit to the President and the Congress a plan for the immediate allocation and assignment of frequencies identified under this title. (Sec. 3003) Amends the Act to prohibit the renewal of a license authorizing analog TV services beyond the end of 2006, with an extension in specified circumstances. Prohibits the FCC, in prescribing regulations relating to qualifications of spectrum bidders, from: (1) precluding any party from being a qualified bidder for spectrum allocated for any use that includes digital TV service on the basis of the FCC's duopoly rule or newspaper cross-ownership rule; or (2) applying either rule to preclude a successful bidder from using such spectrum for digital TV service. (Sec. 3004) Directs the FCC, no later than January 1, 1998, to allocate from radio spectrum between 746 and 806 mhz: (1) 24 mhz for public safety services; and (2) the remainder for commercial purposes to be assigned by competitive bidding. Sets deadlines for the assignment of such licenses and the commencement of competitive bidding. Provides for the licensing of unused frequencies for public safety services. (Sec. 3005) Authorizes the FCC to allocate spectrum to provide flexibility of use, as long as such use is consistent with international agreements and upon a finding that such use is in the public interest and would not deter investment or result in harmful interference among users. (Sec. 3006) Authorizes appropriations to the FCC for FY 2001 for universal service support programs. (Sec. 3007) Directs the FCC to conduct all competitive bidding required under this title so that proceeds from such bidding are deposited no later than the end of FY 2002. (Sec. 3008) Requires seven days' public notice before the granting by the FCC of an application for spectrum frequency assignment under the Act. Title IV: Medicare, Medicaid, and Children's Health Provisions - Subtitle A: Medicare+Choice Program - Chapter 1: Medicare+Choice Program - Amends title XVIII (Medicare) of the Social Security Act (SSA) to establish a Medicare+Choice program under which each Medicare+Choice eligible individual (one entitled to benefits under Medicare part A (Hospital Insurance) and enrolled under Medicare part B (Supplementary Medical Insurance)) is entitled to elect, in accordance with certain procedures, to receive Medicare benefits either through the original Medicare fee-for-service program or through a Medicare+Choice plan. (Sec. 4001) Outlines the types of Medicare+Choice plans that may be available, namely: (1) coordinated care plans; (2) combination of a medical savings account (MSA) plan and contributions into a Medicare+Choice MSA; and (3) private fee-for-service plans. Sets forth various special rules regarding, among other things, residence, individuals with end-stage renal disease, and individuals covered under the Federal Employees Health Benefits Program or eligible for veterans' or military health benefits. Directs the Secretary of Health and Human Services (HHS) to: (1) provide for broad dissemination of coverage option and comparison information to Medicare beneficiaries and prospective Medicare beneficiaries; and (2) maintain a toll-free number for inquiries about Medicare+Choice options and program operation, as well as an Internet site through which individuals may obtain such information electronically. Requires: (1) any Medicare+Choice organization to accept without restrictions individuals eligible to make an election at any time during which such elections are accepted; and (2) approval of Medicare+Choice marketing material and application forms before they are distributed. Provides for continuous open enrollment and disenrollment through 2001, the first six months of 2002, and the first three months of every subsequent year, limiting an individual's change of enrollment during such initial period to one. Provides for an annual, coordinated election period during November for all participants as well as special election periods in certain circumstances. Outlines benefits and beneficiary protections. Requires each Medicare+Choice plan (except MSA plans) to provide those items and services for which benefits are available under Medicare parts A and B (other than hospice care) and specified additional benefits, as well, at its option, as certain supplemental benefits, subject to the Secretary's approval. Excludes individuals enrolled under a MSA plan from participating in such supplemental package. Prohibits a Medicare+Choice organization from denying, limiting, or conditioning coverage or benefits based on any described health status-related factor. Prescribes plan disclosure requirements and an ongoing quality assurance program. Outlines a mechanism for grievances and appeals. Sets forth certain payment rules for providers not participating in the Medicare+Choice program. Directs the Secretary to make monthly advance payments with respect to an individual's coverage to Medicare+Choice organizations according to a specified formula. Requires the Secretary to establish separate payment rates for individuals with end-stage renal disease. Sets forth special rules for individuals electing MSA plans. Requires such an individual to establish a Medicare+Choice MSA into which the Secretary shall make monthly deposits out of the Medicare trust funds in accordance with prescribed guidelines. Prescribes special rules for hospice care. Details rules for the submission and charging of premiums by each Medicare+Choice organization. Sets limitations on enrollee liability for basic, additional, and supplemental benefits. Prescribes a special rule for private fee-for-service plans. Prohibits a State from imposing a premium tax or similar tax with respect to payments to Medicare+Choice organizations. Sets out organizational and financial requirements for Medicare+Choice organizations and provider-sponsored organizations. Directs the Secretary to establish solvency and capital adequacy standards for provider-sponsored organizations, and other standards for Medicare+Choice organizations. Prescribes requirements, including minimum enrollment requirements, for contracts between the Secretary and Medicare+Choice organizations. Provides for: (1) intermediate sanctions and civil monetary penalties to enforce contract provisions; and (2) procedures for termination of contracts. (Sec. 4002) Details transitional rules for the current Medicare health maintenance organization (HMO) program, as well as specified conforming changes in the Medicare supplemental health insurance policy (Medigap) program. (Sec. 4006) Amends the Internal Revenue Code to outline special rules for Medicare+Choice MSAs. Excludes from gross income any payment by the Secretary to an individual's Medicare+Choice MSA. Excludes from qualified deductible medical expenses any amounts paid for the medical care of any individual but the account holder. Prescribes a penalty for distributions from the Medicare+Choice MSA not used for qualified medical expenses if the minimum balance is not maintained, with certain exceptions if the account holder becomes disabled or dies. Chapter 2: Demonstrations - Directs the Secretary to establish a Medicare prepaid competitive pricing demonstration project in up to four (eventually seven) designated Medicare payment areas, of which initially three shall be in urban areas and one in a rural area. (Sec. 4012) Directs the Secretary to appoint a Competitive Pricing Advisory Committee to recommend areas for the demonstration and research design for project implementation. (Sec. 4014) Amends the Omnibus Budget Reconciliation Act of 1987 to extend the authorities for the social health maintenance organization (SHMO) demonstration project. Amends the Omnibus Budget Reconciliation Act of 1993 to increase the cap on the number of individuals who may participate in a SHMO demonstration. Directs the Secretary to submit to the Congress a plan for the integration of SHMO health plans and similar plans as an option under the Medicare+Choice program. (Sec. 4015) Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a demonstration (subvention) project under which the HHS Secretary shall reimburse the Secretary of Veterans Affairs from the Medicare trust funds for Medicare health care services furnished to certain targeted Medicare-eligible military retirees or dependents. Authorizes the Secretary of Defense to modify existing TRICARE contracts in order to provide Medicare health care services to project participants. (Sec. 4016) Directs the Secretary to conduct demonstration projects in a certain number of rural and urban areas for the purpose of evaluating methods, such as case management and other models of coordinated care, that improve the quality of items and services provided to target individuals, and reduce Medicare expenditures for such items and services. Defines a target individual as an individual with a chronic illness who is enrolled under the Medicare parts A and B fee-for-service program. Provides for project funding. (Sec. 4017) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to direct the Secretary to work with each municipal health service demonstration project to develop a plan for the orderly transition of such projects and project participants to a non-demonstration project health care delivery system, such as through integration with a private or public health care plan, including a Medicaid managed care or Medicare+Choice plan. (Sec. 4018) Directs the Secretary to implement a time-limited demonstration project for the purpose of evaluating the use of a third-party contractor to conduct the Medicare+Choice plan enrollment and disenrollment functions in an area. (Sec. 4019) Extends for an additional two years certain Medicare community nursing organization demonstration projects under the Omnibus Budget Reconciliation Act of 1987. Chapter 3: Commissions - Establishes the National Bipartisan Commission on the Future of Medicare to: (1) review and analyze the long-term financial condition of the Medicare program; (2) identify problems that threaten the financial integrity of the Medicare trust funds, including the extent to which current Medicare update indexes do not accurately reflect inflation; and (3) analyze potential solutions to the problems identified that will ensure both the financial integrity of Medicare and the provision of appropriate benefits. Requires the Commission to make recommendations: (1) to restore the solvency of the Federal Hospital Insurance Trust Fund and the financial integrity of the Federal Supplementary Medical Insurance Trust Fund; and (2) to establish the appropriate financial structure of the Medicare program as a whole and the appropriate balance of benefits covered and beneficiary contributions. Requires recommendations on: (1) the financing of graduate medical education; (2) the feasibility of allowing individuals between age 62 and the Medicare eligibility age to buy into the Medicare program; and (3) the impact of chronic disease and disability trends on future costs and quality of services under the current benefit, financing, and delivery system structure of the Medicare program. Requires a report to the President and the Congress. Authorizes appropriations. (Sec. 4022) Establishes the Medicare Payment Advisory Commission to replace the Prospective Payment Assessment Commission and the Physician Payment Review Commission, hereby abolished. Requires the new Commission to review and make recommendations to the Congress about payment policies under Medicare (including certain specific payment-related topics). Authorizes appropriations. Chapter 4: Medigap Protections - Amends SSA title XVIII with respect to the issuer of a Medicare supplemental (Medigap) policy in the case of certain individuals terminated by an employee welfare benefit plan providing supplementary health benefits who seek to enroll under a Medigap policy not later than 63 days after termination or disenrollment. Prohibits the Medigap issuer from: (1) denying or conditioning the issuance or effectiveness of such a policy; (2) discriminating in the pricing of such policy because of health status, claims experience, receipt of health care, or medical condition; or (3) imposing an exclusion of benefits based on a pre-existing condition. (Sec. 4031) Specifies limitations on the imposition of preexisting condition exclusions during the initial open enrollment period in the case of a Medicare supplemental policy issued to an individual who is age 65 or older with a certain minimum period of creditable coverage. (Sec. 4032) Creates under the Medicare supplemental policy program a high deductible feature which requires the policy beneficiary to pay annual out-of-pocket expenses (other than premiums) of $1,500 (indexed for inflation) before the policy begins payment of benefits. Chapter 5: Tax Treatment of Hospitals Participating in Provider- Sponsored Organizations - Amends the Internal Revenue Code to provide that an organization shall not fail to be treated as a tax-exempt charitable organization solely because a hospital which it owns and operates also participates in a provider-sponsored organization, whether or not the provider-sponsored organization is exempt from tax. Provides that any person with a material financial interest in such a provider-sponsored organization shall be treated as a private shareholder or individual with respect to the hospital. Subtitle B: Prevention Initiatives - Outlines various specified new preventive health measures covered under Medicare, namely coverage for: (1) an annual screening mammography for women over age 39 and triennial screening pap smear and screening pelvic exam for any woman (annually for a woman with cervical or vaginal cancer or other abnormality, or who is at high risk of developing such a cancer), while providing for a waiver of deductible; (2) annual prostate cancer screening tests; (3) colorectal cancer screening tests, subject to prescribed frequency and payment limits; (4) diabetes outpatient self-management training services, including blood-testing strips (with a ten percent payment reduction after 1997) and glucose monitors as durable medical equipment (DME) for individuals with diabetes; and (5) bone mass measurements for qualified individuals. (Sec. 4105) Directs the Secretary to establish outcome measures, including glysolated hemoglobin (past 90-day average blood sugar levels), for the purpose of evaluating the improvement of health status of Medicare beneficiaries with diabetes mellitus, with a view to recommending coverage modifications. (Sec. 4107) Extends through FY 2002 the Influenza and Pneumococcal Vaccination Campaign of the Health Care Financing Administration (HCFA). Authorizes appropriations. (Sec. 4108) Directs the Secretary to request the National Academy of Sciences to analyze (for a report to specified congressional committees) the expansion or modification of Medicare preventive benefits to include medical nutrition therapy services by a registered dietitian, skin cancer screening, medically necessary dental care, and other specified items. Subtitle C: Rural Initiatives - Replaces the Essential Access Community Hospital Program with an optional Medicare Rural Hospital Flexibility Program under which participating States shall develop at least one rural health network in the State and at least one facility designated as a critical access hospital in accordance with prescribed guidelines. Authorizes the Secretary to award grants to States for: (1) planning and implementation of the program; and (2) establishment or expansion of rural emergency medical services. Authorizes appropriations. Directs the HCFA Administrator to report to the Congress on the feasibility of, and administrative requirements necessary to establish, an alternative for certain medical diagnoses to the current 96-hour limitation for inpatient care in critical access hospitals. (Sec. 4202) Amends SSA title XVIII to prohibit denial, on the basis of wage comparisons, of a rural referral center's request for reclassification. Provides that any hospital classified as a rural referral center for FY 1991 shall be classified as such for FY 1998 and each subsequent fiscal year. (Sec. 4204) Extends through FY 2001 the special treatment of payment methodology and target amount for Medicare-dependent, small rural hospitals. (Sec. 4205) Amends requirements for rural health clinic services with respect to: (1) per-visit payment limits for provider-based clinics; (2) mandatory quality assessment and performance improvement programs; (3) limitation of waivers of certain staffing requirements to clinics participating in the rural health clinic program; (4) the insufficiency of needed health care practitioners in shortage areas; and (5) regulations providing for payment for certain physician assistant services. (Sec. 4206) Directs the Secretary to make payments from the Federal Supplementary Medical Insurance Trust Fund under Medicare part B in accordance with a specified payment methodology for professional consultation via telecommunications systems with a physician or practitioner furnishing a service for which payment may be made to a Medicare beneficiary residing in a rural health professional shortage area, notwithstanding that the individual physician or practitioner providing the professional consultation is not at the same location as the physician or practitioner furnishing the service to that beneficiary. Directs the Secretary to report to the Congress: (1) a detailed analysis of telemedicine and telehealth (T&T) services; and (2) an examination of the possibility of making similar payments for professional consultation via telecommunications systems to Medicare beneficiaries who do not reside in a rural health professional shortage area, are homebound or nursing homebound, and for whom being transferred for health care services imposes a serious hardship. (Sec. 4207) Directs the Secretary to conduct a demonstration project to use eligible health care provider telemedicine networks to apply high-capacity computing and advanced networks to improve primary care and prevent health care complications to Medicare beneficiaries with diabetes mellitus who reside in medically underserved rural or inner-city areas. Provides funding. Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity - Chapter 1: Revisions to Sanctions for Fraud and Abuse - Amends SSA title XI, with respect to health care related crimes, to exclude from the Medicare and State health care programs any person: (1) for ten years for one previous conviction for one or more offenses; and (2) permanently for two or more previous convictions of one or more offenses. (Sec. 4302) Authorizes the Secretary to refuse to enter into Medicare agreements with individuals or entities convicted of felonies for offenses determined inconsistent with the best interests of program beneficiaries. (Sec. 4303) Authorizes the Secretary to exclude from the Medicare program any entity with respect to which a sanctioned person with an ownership or control interest in it transfers such interest in anticipation of (or following) a conviction, assessment, or exclusion against the person, to an immediate family member or member of the household who continues to maintain such an interest. (Sec. 4304) Provides for the imposition of civil monetary penalties for: (1) any person who arranges or contracts with an individual or entity that the person knows or should know is excluded from participation in a Federal health care program; and (2) kickbacks. Chapter 2: Improvements in Protecting Program Integrity - Amends SSA title XVIII to require the Secretary, in the annual notice of Medicare benefits, to urge beneficiaries to check the notice and any itemized statement for accuracy and report any errors or questionable charges by calling a certain toll-free number. Authorizes Medicare beneficiaries to submit written requests for itemized bills of medical or other items or services provided, and review them. Requires the Secretary to take measures to recover amounts unnecessarily paid out. (Sec. 4312) Outlines various specified requirements regarding disclosure of information and surety bonds with regard to DME suppliers. Includes surety bond requirements for home health agencies. Authorizes the Secretary to apply disclosure and surety bond requirements to other health care providers or item and service suppliers (except physicians or practitioners). Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORFs) and to rehabilitation agencies. (Sec. 4313) Requires any participating entity to disclose to the Secretary its own employer identification numbers and social security account numbers, as well as those of persons with ownership or control interests and subcontractors in which the entity has a five percent or greater interest. Directs the Secretary to report to Congress on the steps taken to assure the confidentiality of such social security account numbers. (Sec. 4314) Requires the Secretary, upon a party's request, to issue binding advisory opinions on whether a referral relating to designated health services (other than clinical laboratory services) is a prohibited physician self-referral. (Sec. 4315) Amends SSA title XVIII to: (1) replace the reasonable charge payment methodology with fee schedules developed by the Secretary for particular services; (2) provide for application of inherent reasonableness to charges for all Medicare part B services other than physicians' services; (3) require bills and requests for payment for services by non-physician practitioners to include diagnostic codes; (4) outline requirements to provide diagnostic information when ordering certain items or services furnished by another entity; (5) mandate establishment of competitive acquisition areas for contract award purposes for the furnishing under Medicare part B after 1997 of described items and services; and (6) prohibit payment under Medicare part A or part B for any expenses for an item or service furnished in a competitive acquisition area by an entity other than an entity with which the Secretary has contracted, except for urgent need, or in other circumstances specified by the Secretary. (Sec. 4320) Excludes from reasonable costs and declares unreimbursable under Medicare any payments for certain items unrelated to patient care, including: (1) entertainment, gifts, or donations; (2) personal use of motor vehicles; (3) costs for fines and penalties resulting from violations of Federal, State, or local laws; and (4) education expenses for spouses or other dependents of service providers, their employees, or contractors. (Sec. 4321) Requires a Medicare hospital's discharge planning process to include information on the availability of home health services through certain individuals or entities. Requires a discharge plan: (1) not to specify or otherwise limit the qualified provider which may provide home health services; and (2) identify any entity to whom the individual is referred in which the hospital has a disclosable financial interest. Requires the service provider agreement to require disclosure of any financial interest a hospital has in any entity to which individuals are referred, or any entity has in the hospital, and related information. Chapter 3: Clarifications and Technical Changes - Makes technical amendments with respect to fraud and abuse. Subtitle E: Provisions Relating to Part A Only - Chapter 1: Payment of PPS Hospitals - Revises requirements for: (1) prospective payment system (PPS) hospital payment updates; (2) maintenance of savings from the temporary reduction in capital payments for prospective payment system (PPS) hospitals; (3) additional payments to any hospital with a disproportionate share of low-income patients (disproportionate share hospital (DSH)); (4) the sales price of a Medicare capital asset (book value); (5) elimination of indirect medical education (IME) and DSH payments attributable to outlier payments; (6) the base rate of payments to Puerto Rico hospitals; (7) payments to hospitals for certain discharges to post-acute care; (8) inclusion of Stanly County, North Carolina, in the large urban area of Charlotte-Gastonia-Rock Hill-North Carolina-South Carolina; and (9) the floor on wage area indexes. (Sec. 4409) Requires the Secretary to publish and use alternative guidelines under which certain disproportionately large hospitals qualify for geographic reclassification. Chapter 2: Payment of PPS-Exempt Hospitals - Revises requirements for the payment of PPS-exempt hospitals, including those for: (1) payment updates; (2) reductions to capital payments; (3) bonus and relief payments; (4) payment and the target amount for new providers; (5) treatment of certain long-term care hospitals located within other hospitals; (6) rebasing; (7) certain cancer hospitals; and (8) elimination of exemptions for certain hospitals. (Sec. 4421) Provides for a Medicare PPS for inpatient rehabilitation hospital services. (Sec. 4422) Directs the Secretary to submit to the Congress a legislative proposal for establishing a case-mix adjusted PPS for long-term care hospitals. Chapter 3: Payment for Skilled Nursing Facilities - Declares that updates to per diem limits, with respect to payments to skilled nursing facilities (SNFs), effective for FY 1998, shall be based on cost limits effective for FY 1997. (Sec. 4432) Mandates a PPS for SNF services along with consolidated billing for them. Directs the Secretary, in order to ensure that Medicare beneficiaries are furnished appropriate SNF services, to establish a thorough medical review process to examine the provisions of this section and their effect on the quality of covered SNF services furnished to Medicare beneficiaries. Chapter 4: Provisions Related to Hospice Services - Provides for update of payments for hospice services. Bases payment for home hospice care on the location where care is furnished. Revises the home hospice care benefit period. Provides for home hospice care coverage of any other items and services specified in a plan. Allows waiver of certain staffing requirements for hospice care programs in non-urbanized areas. Chapter 5: Other Payment Provisions - Requires reductions in payments for enrollee bad debt. Repeals the termination date to make a permanent extension of the hemophilia passthrough. Requires a certain reduction in the part A Medicare premium for specified public retirees. Authorizes Medicare and Medicaid coverage of inpatient hospital and post-hospital extended care services in religious nonmedical health care institutions (currently limited to Christian Science sanatoria). Subtitle F: Provisions Relating to Part B Only - Chapter 1: Services of Health Professionals - Revises requirements for the payment of physicians' services, with changes: (1) establishing a single conversion factor for 1998; (2) adding new update provisions; (3) replacing the volume performance standard with sustainable growth rate; (4) adding payment rules for anesthesia services; and (5) providing for adjustments in relative value units for 1998, and the application of resource-based methodology to malpractice relative value units. (Sec. 4505) Directs the Comptroller General to review and evaluate the proposed rule on resource-based methodology for practice expenses issued by the HCFA. (Sec. 4506) Directs the Secretary to determine for each hospital: (1) its hospital-specific per discharge relative value for physicians' services; and (2) whether such value is projected to be excessive. Requires the Secretary to notify the medical executive committee of a subset of the hospitals identified as having an excessive hospital-specific relative value, and evaluate their responses with the responses of other hospitals so identified that were not notified. (Sec. 4507) Amends SSA title XVIII to declare that nothing shall prohibit a physician or practitioner from privately contracting with a Medicare beneficiary for any item or service for which no Medicare claim will be submitted, and for which the physician or practitioner shall receive no Medicare reimbursement. (Sec. 4511) Increases Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. (Sec. 4513) Repeals the requirement of an X-ray for reimbursement for chiropractic services. Directs the Secretary to develop utilization guidelines for the coverage of chiropractic services where a subluxation has not been demonstrated by an X-ray. Chapter 2: Payment for Hospital Outpatient Department Services - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 4522) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 4523) Directs the Secretary to establish a PPS for hospital outpatient department services. Chapter 3: Ambulance Services - Provides for certain interim reductions in payments for ambulance services. Directs the Secretary to establish a prospective fee schedule for payment of such services. Provides that, in promulgating regulations for coverage of ambulance services, the Secretary may cover advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. (Sec. 4532) Directs the Secretary to establish up to three demonstration projects contracting with local governments for ambulance services paid for under Medicare. Chapter 4: Prospective Payment for Outpatient Rehabilitative Services - Provides for a PPS for outpatient physical (including speech-language pathology) and occupational therapy services. Chapter 5: Other Payment Provisions - Provides for a reduction in payment amounts for items of DME and for clinical diagnostic laboratory tests. Provides for a payment freeze for parenteral and enteral nutrients, supplies, and equipment. Revises update requirements for payment for orthotics and prosthetics, and other payment requirements for oxygen and oxygen equipment, ambulatory surgical services, and drugs and biologicals. (Sec. 4552) Requires the Comptroller General to study and report to specified congressional committees on access to home oxygen equipment. Requires the Secretary to arrange for peer review organizations to evaluate such access. (Sec. 4553) Directs the Secretary to request the National Academy of Sciences to study (for a report to specified congressional committees) Medicare payments for clinical laboratory tests. (Sec. 4554) Directs the Secretary to divide the United States into up to five regions, and designate a single carrier for each region, for the payment of Medicare part B claims for clinical diagnostic laboratory services. Requires the Secretary to adopt uniform policies for clinical diagnostic laboratory tests. (Sec. 4557) Provides for coverage of oral anti-nausea drugs under a chemotherapeutic regimen. (Sec. 4558) Requires the Secretary to: (1) audit cost reports of each renal dialysis provider at least once every three years; and (2) develop a method to measure and report on the quality of Medicare renal dialysis services. (Sec. 4559) Directs the Secretary, for electrocardiogram tests furnished during 1998, to restore separate part B payment for electrocardiogram transportation based upon methods in effect on December 31, 1996. Requires the Secretary, by a certain deadline, to recommend to specified congressional committees whether portable electrocardiogram transportation should be covered under Medicare part B. Chapter 6: Part B Premium and Related Provisions - Revises the formula for the monthly Medicare part B premium rate the Secretary promulgates each September for the following calendar year. Requires such rate to equal 50 percent of the monthly actuarial rate for enrollees age 65 and over for that succeeding calendar year. (Sec. 4581) Provides for a special Medicare enrollment period, with no premium penalty for late enrollment, for certain disabled workers whose continuous enrollment under an employer's group health plan is involuntarily terminated in certain circumstances. (Sec. 4582) Allows appropriate State or local governmental entities to elect to pay part B premiums for certain eligible individuals. Subtitle G: Provisions Relating to Parts A and B - Chapter 1: Home Health Services and Benefits - Provides that, in establishing payment limits for cost reporting periods beginning after September 30, 1997, the Secretary shall not take into account any changes in the home health market basket with respect to cost reporting periods which began on or after July 1, 1994, and before July 1, 1996. (Sec. 4602) Revises requirements for interim payments for home health services. Directs the Secretary to expand research on a PPS for home health agencies under the Medicare program that ties prospective payments to a unit of service. (Sec. 4603) Directs the Secretary to establish a PPS for home health services for cost reporting periods beginning in FY 2000. (Sec. 4604) Bases the payment for home health services on the location where the service is furnished. (Sec. 4611) Provides for a modification of the Medicare part A home health benefit for individuals enrolled under Medicare part B. Provides for specified post-institutional home health services. (Sec. 4613) Directs the Secretary to study and report to the Congress on the criteria that should be applied in determining whether an individual is homebound for purposes of qualifying for Medicare home health services. (Sec. 4614) Provides for the denial of home health claims based on home health services the frequency and duration of which are in excess of normative guidelines established by the Secretary. (Sec. 4615) Denies payment for home health benefits based solely on venipuncture to obtain a blood sample. (Sec. 4616) Directs the Secretary to estimate part A and part B outlays for FY 1998 through 2002 for specified congressional committees, and report annually a comparison of actual outlays with such estimates. Chapter 2: Graduate Medical Education - Revises requirements for direct and indirect Medicare payments for graduate medical education (GME). Limits the number of residents in allopathic and osteopathic medicine. Permits payment to qualified nonhospital providers for direct GME costs. Prohibits restandardization of certain indirect GME payment amounts. Requires the Secretary to provide for direct and indirect GME payments to hospitals for Medicare+Choice enrollees. Makes a special reimbursement rule for primary care combined residency programs, setting the period of board eligibility. (Sec. 4626) Provides for incentive payments to hospitals under plans for voluntary reduction in the number of full-time equivalent residents in an approved medical training program. (Sec. 4628) Directs the Secretary to establish a demonstration project under which GME payments shall be made to consortia of teaching hospitals and other medical entities. (Sec. 4629) Directs the Medicare Payment Advisory Commission to develop recommendations to the Congress on whether and to what extent Medicare payment policies and other Federal policies regarding teaching hospitals and GME should be changed. (Sec. 4630) Directs the Secretary to study and report to the appropriate congressional committees on variations among hospitals in the overhead and supervisory physician components of their direct medical education costs. Chapter 3: Provisions Relating to Medicare Secondary Payer - Revises requirements for Medicare as secondary payer. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Chapter 4: Other Provisions - Amends SSA title XVIII to require placement of an advance directive in a prominent part of the individual's current medical record. (Sec. 4642) Provides for an increased certification period for certain organ procurement organizations. (Sec. 4643) Establishes in the HCFA the position of Chief Actuary. Subtitle H: Medicaid - Chapter 1: Managed Care - Amends SSA title XIX (Medicaid) to establish a new part B (Managed Care) giving States the option to require Medicaid-eligible individuals (except Medicare beneficiaries, Medicare-eligible individuals, and certain children with special needs) to enroll in managed care arrangements of the individual's choice as a condition of receiving Medicaid. (Sec. 4702) Grants States the option of providing Medicaid coverage of primary care case management services without the need for a waiver. (Sec. 4703) Repeals the (75-25) requirement that Medicare and Medicaid beneficiaries constitute less than 75 percent of the membership of a participating HMO. Repeals the prohibition on co-payments for services furnished by HMOs. (Sec. 4704) Prescribes requirements for: (1) access to emergency care; (2) annual external independent review of managed care entity activities and other specified quality care assurance measures; and (3) fraud and abuse prohibitions and protections. (Sec. 4705) Amends SSA title XIX (Medicaid) to require any State contracting with Medicaid managed care organizations to develop and implement a quality assessment and improvement strategy incorporating certain access standards, monitoring procedures, and other measures. Directs the Comptroller General to analyze and report to specified congressional committees on the quality assurance programs and accreditation standards applicable to managed care entities operating in the private sector or under Medicare contracts to determine if such programs and standards consider the accessibility and quality of the health care items and services delivered under such contracts to low-income individuals. Directs the Secretary to study and report to such committees on safeguards that may be needed to ensure that the health care needs of individuals with special health care needs and chronic conditions who are enrolled with Medicaid managed care organizations are adequately met. (Sec. 4706) Requires an HMO to meet solvency standards established by the State for private HMOs, or be State-licensed or -certified as a risk-bearing entity. (Sec. 4708) Increases from $100,000 to $1 million, indexed annually, the threshold amount for HMO contracts requiring the Secretary's prior approval. Permits the same copayments in HMOs as in fee-for-service. Chapter 2: Flexibility in Payment of Providers - Repeals "Boren Amendment" provider reimbursement requirements. Requires the Secretary to study and report to the appropriate congressional committees on the effect on access to services, service quality, and service safety of the rate-setting methods used by States as a result of such repeal. (Sec. 4712) Specifies reductions from 100 percent to 70 percent between FY 1999 through 2003 in the percentage of reasonable costs that shall be paid under a State plan for federally-qualified health center and rural health clinic services (with a special supplemental payment for services furnished under certain managed care contracts). (Sec. 4713) Repeals payment rate requirements for obstetrical and pediatric services. (Sec. 4714) Revises requirements for Medicaid payment rates for qualified Medicare beneficiaries, placing a limitation on nonparticipating providers. (Sec. 4715) Declares that, in the case of a Medicaid-eligible veteran residing in a State veterans' home, any veterans' pension over $90 per month shall be counted as income only for the purpose of applying such excess payment to the State veterans' home's cost of providing nursing care to the veteran. Chapter 3: Federal Payments to States - Revises specified limitations of Federal payments for inpatient hospital services furnished by disproportionate share hospitals (DSH), including limitations on certain State DSH expenditures to institutions for mental diseases or other mental health facilities. Requires direct State Medicaid payment to hospitals for managed care enrollees. (Sec. 4722) Revises the treatment as broad-based health care related taxes of certain State hospital taxes which currently are not subtracted as revenues from the State share of Medicaid expenditures for purposes of calculating the Federal share of such expenditures. Declares that an exemption from such State hospital tax for certain Federal-tax-exempt hospitals that do not accept Medicaid or Medicare payments (provide free care) shall not disqualify the hospital tax as a broad-based health care related tax (thus allowing continued exclusion of such State hospital tax from the requirement that provider-specific taxes be subtracted from the State share of Medicaid expenditures for purposes of Federal share calculation). (Sec. 4723) Specifies additional funding for State emergency health services furnished to undocumented aliens. (Sec. 4724) Prohibits the expenditure of Medicaid funds for roads, bridges, stadiums, and other items and services not covered by a State plan. Requires home health agencies to provide a surety bond. Revises conflict-of-interest safeguards. Declares that States are not required to provide medical assistance for items or services furnished by a person or entity convicted of a felony for an offense inconsistent with the best interests of beneficiaries under the State plan. Requires State action for program and beneficiary protection against waste, fraud, and abuse. Conditions issuance or renewal of a DME supplier provider number on the supplier's provision of a surety bond and disclosure of all persons with ownership or control interests in the supplier, and of all subcontractors in which the supplier has a five percent or greater interest. (Sec. 4725) Provides for increased Federal medical assistance percentages (FMAPs) for the District of Columbia and Alaska and increased payment caps for the territories. Chapter 4: Eligibility - Grants States the option to provide for 12-month continuous Medicaid eligibility for children. (Sec. 4732) Requires State Medicaid plan coverage of the Medicare cost-sharing for certain additional low-income Medicare beneficiaries whose income otherwise disqualifies them for specified Medicare benefits. (Sec. 4733) Grants States the option to permit workers with disabilities to buy into Medicaid. (Sec. 4734) Prescribes criminal penalties for knowingly and willfully, for a fee, counseling or assisting an individual to dispose of assets (including transfer in trust) in order for that individual to become Medicaid-eligible (fraudulent eligibility). (Sec. 4735) Declares that certain payments in a class settlement of the case of Susan Walker v. Bayer Corporation shall not be considered income or resources in determining Medicaid eligibility. Chapter 5: Benefits - Changes from mandatory to discretionary a State's authority to enroll individuals under private group health plans and pay their premiums. (Sec. 4742) Repeals: (1) certain physician qualification requirements with respect to services to pregnant women and to children under age 21; and (2) the requirement of prior institutionalization with respect to habilitation services furnished under a waiver for home or community-based services. (Sec. 4744) Requires the Secretary to study and report to the Congress on early and periodic screening, diagnostic, and treatment benefits. Chapter 6: Administration and Miscellaneous - Repeals requirements for inspections of the care being provided at mental hospitals and intermediate care facilities for the mentally retarded (ICFS-MR). (Sec. 4752) Authorizes a State, in lieu of terminating a noncompliant ICFS-MR, to establish alternative remedies if the State demonstrates to the Secretary's satisfaction that such alternative remedies are effective in deterring noncompliance and correcting deficiencies. (Sec. 4753) Revises requirements for mechanized claims processing and information retrieval systems. (Sec. 4754) Repeals the requirement for State refund to the Federal Government of any payments received during remediation of a noncompliant nursing facility. (Sec. 4755) Requires States to establish procedures to permit a nurse aide, in the case of a finding of neglect, to petition the State for name removal from the nurse aide registry upon a State determination that: (1) the employment and personal history of the nurse aide does not reflect a pattern of abusive behavior or neglect; and (2) the neglect involved in the original finding was a singular occurrence. (Sec. 4756) Includes the DRUGDEX Information System among the compendia to be used in drug use review for Medicaid payment. (Sec. 4757) Applies certain requirements to the extension of statewide comprehensive research and demonstration projects for which waivers of Medicaid compliance have been granted. (Sec. 4758) Amends the Omnibus Budget Reconciliation Act of 1989 to extend the moratorium on the treatment of the Kent Community Hospital Complex and Saginaw Community Hospital in Michigan as institutions for mental diseases for purposes of Medicaid reimbursement. Subtitle I: Programs of All-Inclusive Care for the Elderly (PACE) - Amends SSA title XVIII to provide for Medicare programs of all-inclusive care for the elderly (PACE programs) for individuals age 55 or older who require the level of care required under the State Medicaid plan for coverage of nursing facility services. Specifies benefit and payment requirements. Limits PACE provider eligibility to public and private non-profit entities; but requires the Secretary to waive such limitations to demonstrate the operation of a PACE program by a private, for-profit entity. (Sec. 4802) Amends SSA title XIX to authorize a State to establish a Medicaid program of all-inclusive care for the elderly (PACE) for individuals who need not be eligible for Medicare part A benefits, or enrolled under Medicare part B. (Sec. 4804) Directs the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under Medicare and Medicaid, specifically comparing the costs, quality, and access to services by private, for-profit entities under the demonstration projects with the costs, quality, and access to services of other PACE providers. Subtitle J: State Children's Health Insurance Program - Chapter 1: State Children's Health Insurance Program - Amends SSA to add a new title XXI (State Children's Health Insurance Program) in order to provide funds to States to expand the provision of child health assistance to uninsured, low-income children. Requires a State to submit for the Secretary's approval a child health plan for the use of funds, containing strategic objectives, performance goals, and performance measures. Mandates coverage equivalent to benefits coverage in a benchmark benefit package, consisting of benefits offered by either: (1) the Federal Employees' Health Benefits Program (FEHBP); (2) a State employee health benefit plan; or (3) an HMO. Makes appropriations to carry out this title. Allows their use for abortion only if necessary to save the life of the mother or if the pregnancy results from rape or incest. Chapter 2: Expanded Coverage of Children Under Medicaid - Amends SSA title XIX to provide for an increased Medicaid FMAP for expanded coverage of targeted low-income children. (Sec. 4912) Authorizes an approved State plan to make Medicaid available to a low-income child during a specified presumptive eligibility period after determination that family income does not exceed a certain level. (Sec. 4913) Provides for continuation of Medicaid eligibility for disabled children who lose benefits under SSA title XVI (Supplemental Security Income) (SSI). Chapter 3: Diabetes Grant Programs - Amends the Public Health Service Act to direct the Secretary to make grants for services for the prevention and treatment of type I diabetes in children, and for research in innovative approaches to such services. Provides for funding. (Sec. 4922) Directs the Secretary to make grants for services for the prevention and treatment of type I diabetes in Indians through the Indian Health Service and tribal and urban Indian health programs. (Sec. 4923) Requires the Secretary to evaluate such programs and report to the Congress. Title V: Welfare and Related Provisions - Subtitle A: TANF Block Grant - Amends part A (Temporary Assistance for Needy Families) (TANF) of SSA title IV to establish a program of welfare-to-work grants to States. (Sec. 5001) Sets forth requirements relating to State entitlement to non-competitive formula grants under such program and State distribution of such funds among local governments. Authorizes State Governors to distribute up to 15 percent of such grant funds for projects to help long-term welfare recipients enter unsubsidized employment. Provides for competitive grants, based on program effectiveness and other factors, including the history of the applicant's success in moving individuals with multiple barriers into work, for State-approved projects proposed by private industry councils or local governments. Sets forth rules relating to required beneficiaries and targeting of individuals with characteristics associated with long-term welfare dependency. Authorizes use of grant funds to provide work-related services to individuals who have reached the five-year limit on assistance. Directs the Secretary of Labor to use certain set-aside funds to make grants to each successful performance State in FY 2000. Makes appropriations for FY 1998 and 1999 for grants. Sets forth requirements for: (1) nondisplacement of other workers by participants in work activities under this program; (2) applicable health and safety standards; and (3) grievance procedures with respect to alleged violations of such nondisplacement and health and safety requirements. Provides for such grants to outlying areas territories and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to develop a plan to evaluate the use of such grants. Sets forth penalties for: (1) failure of a State to maintain its historic effort during a year in which a welfare-to-work grant is received; and (2) misuse of competitive welfare-to-work grant funds. Declares that State sanctions against recipients for TANF program violations are not wage reductions. (Sec. 5002) Limits to not more than ten percent the portion of such welfare-to-work grant funds which a State may use to carry out State programs under SSA title XX block grants to States for social services. (Sec. 5003) Increases from 20 percent to 30 percent of individuals in all families and in two-parent families the limitation on the number of persons who may be treated as engaged in work by reason of participation in a vocational education program or, in the case of teen heads of household, maintenance of satisfactory school attendance. (Sec. 5004) Requires reduction of a State's welfare-to-work grant if a State fails to reduce assistance for recipients refusing work without good cause. Subtitle B: Supplemental Security Income - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRAWORA) to extend by six months the deadline for certain childhood disability redeterminations under SSA title XVI (Supplemental Security Income) (SSI). (Sec. 5102) Prescribes the schedule of administrative fees the Commissioner of Social Security shall assess each State from FY 1997 through 2003 and after for making optional and mandatory State SSI payments to individuals. Revises requirements for deposit of such fees, directing that a portion be credited to a special fund for FY 1998 and subsequent fiscal years for use in defraying expenses. Provides that the amounts so credited shall not be scored as receipts under the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act), but credited as a discretionary offset to discretionary spending. Authorizes appropriations. Subtitle C: Child Support Enforcement - Amends SSA title III (Unemployment Insurance) with respect to the authority to permit certain redisclosures of wage and claim information for purposes related to the child support enforcement program under SSA title IV part D (Child Support and Establishment of Paternity). Subtitle D: Restricting Welfare and Public Benefits for Aliens - Amends PRAWORA to make aliens eligible for SSI who, as of the date of enactment of such Act, were receiving such benefits, or were legally residing in the United States and are blind or disabled. Extends the SSI grandfather provision through September 30, 1998. (Sec. 5302) Extends from five to seven years the refugee and asylee eligibility period for SSI and Medicaid, and includes Cuban and Haitian entrants within such category. Provides a five-year food stamp eligibility period for such aliens. Includes Cuban and Haitian entrants within the definition of "qualified alien" for purposes of welfare and public benefits. Exempts such aliens from specified periods of ineligibility for State and Federal means-tested benefits. (Sec. 5303) Exempts: (1) certain American Indians (including persons born in Canada) from SSI and Medicaid eligibility limitations; and (2) certain SSI recipients with pre-January 1, 1979 applications from SSI eligibility limitations. (Sec. 5305) States that an alien who is ineligible for food stamps shall not be eligible for such program based upon SSI eligibility. Authorizes Medicaid eligibility based upon SSI eligibility. (Sec. 5306) Treats certain Amerasian immigrants as refugees for purposes of specified public benefits eligibility. (Sec. 5307) Authorizes States to require State and local assistance applicants to provide v