Sponsor:

Sen. Domenici, Pete V. [R-NM] (Introduced 06/20/1997)

Summary:

Summary: S.947 — 105th Congress (1997-1998)

There are 2 summaries for this bill. Passed Senate amended (06/25/1997)Introduced in Senate (06/20/1997)     Bill summaries are authored by CRS. $("#summarySelector").congress_dropDownNavigation({ stubUrl: '/bill/105th-congress/senate-bill/947/summary', suffix: '' }); Shown Here:
Passed Senate amended (06/25/1997) TABLE OF CONTENTS: Title I: Committee on Agriculture, Nutrition, and Forestry Title II: Committee on Banking, Housing, and Urban Affairs Subtitle A: Mortgage Assignment and Annual Adjustment Factors Subtitle B: Multifamily Housing Reform Title III: Committee on Commerce Science and Transportation Subtitle A: Spectrum Auctions and License Fees Subtitle B: Merchant Marine Provisions Title IV: Committee on Energy and Natural Resources Title V: Committee on Finance Division 1: Medicare 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: Prospective Payment Systems Subtitle F: Provisions Relating to Part A Subtitle G: Provisions Relating to Part B Only Subtitle H: Provisions Relating to Parts A and B Division 2: Medicaid and Childrens' Health Insurance Initiatives Subtitle I: Medicaid Subtitle J: Children's Health Insurance Initiatives Division 3: Income Security and Other Provisions Subtitle K: Income Security, Welfare-to-Work Grant Program, and Other Provisions Division 4: Earned Income Credit and Other Provisions Subtitle L: Earned Income Credit and Other Provisions Subtitle M: Welfare Reform Technical Corrections Title VI: Committee on Governmental Affairs Subtitle A: Civil Service and Postal Provisions Subtitle B: GSA Property Sales Title VII: Committee on Labor and Human Resources Title VIII: Committee on Veterans' Affairs Subtitle A: Extension of Temporary Authorities Subtitle B: Copayments and Medical Care Cost Recovery Subtitle C: Other Matters Balanced Budget Act of 1997 - Title I: Committee on Agriculture, Nutrition, and Forestry - Amends the Food Stamp Act to define "caseload" and "covered individual." Authorizes State agencies to provide an additional 15 percent hardship 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: Committee on Banking, Housing, and Urban Affairs - Subtitle A: Mortgage Assignment and Annual Adjustment Factors - Amends the Balanced Budget Downpayment Act, I to extend permanently certain foreclosure avoidance and borrower assistance provisions under the single family housing mortgage insurance program. (Sec. 2003) Amends the United States Housing Act of 1937 with respect to the section 8 rental assistance program to make certain maximum monthly rent adjustment provisions for certain new and rehabilitated and nonturnover units applicable to FY 1999 and thereafter. Subtitle B: Multifamily Housing Reform - Multifamily Assisted Housing Reform and Affordability Act of 1997 - Part 1: FHA-Insured Multifamily Housing Mortgage and Housing Assistance Restructuring - Directs the Secretary (Secretary) of Housing and Urban Development to enter into agreements with participating administrative entities (with preference given to State housing finance agencies) to develop and implement mortgage restructuring and rental assistance plans for FHA-insured multifamily housing mortgages in order to: (1) reduce expiring section 8 contracts costs; (2) address troubled projects; and (3) correct management and ownership deficiencies. Includes two-tiered mortgage restructuring among plan incentives. Terminates program authority as of October 1, 2001. Part 2: Miscellaneous Provisions - Amends the National Housing Act to authorize the Secretary to make rehabilitation grants for certain insured projects. (Sec. 2203) Repeals specified Federal housing preference provisions under the United States Housing Act of 1937, the Cranston- Gonzalez National Affordable Housing Act, the Housing and Urban Development Act of 1965, the Low-Income Housing Preservation and Resident Homeownership Act of 1990, and the Housing and Community Development Act of 1992. Part 3: Enforcement Provisions - Directs the Secretary to issue implementing regulations. Subpart A: FHA Single Family and Multifamily Housing - Amends the National Housing Act to expand HUD authorities with respect to: (1) lender sanctions; (2) equity skimming; and (3) civil money penalties. Subpart B: FHA Multifamily Provisions - Amends the National Housing Act and the Housing Act of 1937 to expand multifamily housing-related civil money penalties. (Sec. 2322) Amends the Housing and Community Development Act of 1987 to extend the double damages remedy. Title III: Committee on Commerce Science and Transportation - Subtitle A: Spectrum Auctions and License Fees - Amends the Communications Act of 1934 (the Act) to revise provisions regarding competitive bidding for use of the electromagnetic spectrum to authorize the Federal Communications Commission (FCC) to use auctions as a means to assign spectrum. Makes competitive bidding authority inapplicable to licenses or construction permits issued for: (1) public safety services; (2) public telecommunications services when the license application is for channels reserved for noncommercial use; (3) spectrum and associated orbits used within global satellite systems; (4) new digital television (TV) service given to existing terrestrial broadcast licensees to replace current licenses; (5) terrestrial radio and TV broadcasting when the FCC determines that an alternative method of resolving mutually exclusive applications serves the public interest better than competitive bidding; or (6) spectrum allocated for specified unlicensed use if competitive bidding would interfere with operation of end-user products. Extends competitive bidding authority through FY 2007. Requires the FCC, by the end of 2001, to assign by competitive bidding 45 megahertz (mhz.) located at 1,710-1,755 mhz. for commercial use. Provides that Federal Government stations assigned to use such band shall retain use until the end of 2003 unless exempted from relocation. Directs the FCC, by the end of FY 2002, to permit the assignment by competitive bidding of licenses for the use of currently allocated bands of frequencies that: (1) in the aggregate span not less than 55 mhz.; (2) are located below three gigahertz (ghz.); and (3) have not been designated for assignment, identified by the Secretary of Commerce as reallocable frequencies pursuant to the National Telecommunications and Information Administration Organization Act, or allocated for Federal Government use. Requires the FCC to attempt to accommodate displaced licensees by relocating them to other frequencies and notify the Secretary whenever unable to provide for effective relocation. Amends the National Telecommunications and Information Administration Organization Act to require the Secretary of Commerce to make specified recommendations, upon receiving a report from the FCC on inability to accommodate displaced licensees, for purposes of reassigning such licensees to frequencies allocated for Government use. Sets forth requirements regarding: (1) the reimbursement of Federal spectrum users for relocation costs; (2) petitions by persons seeking to relocate Federal stations; and (3) Federal rights to reclaim reallocated spectrum. Directs the Secretary to make available for reallocation from Federal frequencies 20 mhz. located below three ghz. (Sec. 3002) Amends the Act to prohibit, under competitive bidding provisions, the renewal of a license authorizing analog TV services beyond the end of 2006. Extends or waives this deadline for a station in any TV market unless 95 percent of the TV households have access to digital local TV signals. Provides that commercial digital TV licenses shall expire at the end of FY 2003. Directs the FCC to report biennially to the Congress on the status of digital TV conversion in each TV market. Sets forth requirements with respect to the resale of, and competitive bidding for, spectrum previously used for the broadcast of analog TV. Directs the FCC to report the total revenues from such bidding by January 1, 2002. (Sec. 3003) Directs the FCC, no later than January 1, 1998, to allocate from the electromagnetic spectrum between 746 and 806 mhz.: (1) 24 mhz. for public safety services; and (2) 36 mhz. for commercial purposes to be assigned by competitive bidding. (Sec. 3005) Requires the FCC, in any auction for any license, permit, or right which has value, to set a reasonable reserve price for each unit in the auction unless it is not in the public interest to do so. Provides that the reserve price shall establish a minimum bid for the unit to be auctioned. Retains units for which no bid above the reserve price is received. Directs the FCC to reassess reserve prices for such units and place them in the next appropriate auction. Subtitle B: Merchant Marine Provisions - Extends through FY 2002 the current tonnage duties imposed upon foreign vessels entering into U.S. ports. Title IV: Committee on Energy and Natural Resources - Amends the Energy Policy and Conservation Act to authorize the Secretary of Energy to store foreign-owned petroleum products in underutilized Strategic Petroleum Reserve (SPR) facilities, subject to the following conditions: (1) funds resulting from the leasing or other use of an SPR facility after October 1, 2007, shall be available to the Secretary, without further appropriation, for SPR petroleum product purchases; (2) such stored petroleum product is neither part of the SPR, nor subject to the contracting requirements governing petroleum product not owned by the United States; and (3) such product may be exported. Title V: Committee on Finance - 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 under title XIX of the Social Security Act (SSA). Division 1: Medicare - 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 traditional Medicare fee-for- service program or through a Medicare Choice plan. (Sec. 5001) Outlines the types of Medicare Choice plans that may be available, including: (1) fee-for-service plans; (2) plans offered by preferred provider organizations; (3) point of service plans; (4) plans offered by provider-sponsored organizations; (5) plans offered by health maintenance organizations; and (6) a combination of MSA (Medicare Choice savings account) plan and contributions to Medicare Choice MSA. 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 provide for broad dissemination of coverage option and comparison information to Medicare beneficiaries and prospective Medicare beneficiaries. Directs the Secretary to 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 any Medicare Choice organization to accept without restrictions individuals eligible to make an election at any time during which such elections are accepted. Requires the approval of Medicare Choice marketing material and application forms before they are distributed. 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 and specified additional benefits, as well, at its option, as certain supplemental benefits, subject to the Secretary's approval. 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. Requires each Medicare Choice organization, at an enrollee's request, to disclose annually the proportion of the premiums and other revenues received by the organization that are expended for non-health care items and services. Outlines a mechanism for grievances and appeals. Sets forth certain payment rules for providers not participating in the MedicarePlus (sic) 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. Directs the Secretary and the Medicare Payment Advisory Commission to each study and report to the Congress on appropriate measures for adjusting the annual Medicare Choice capitation rates to reflect local price indicators. 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. Details rules for the submission and charging of premiums by each Medicare Choice organization. Sets limitations on enrollee cost- sharing for basic, additional, and supplemental benefits, except for MSA plans and unrestricted fee-for-service plans. Requires the Secretary to audit each year the financial records of at least one- third of the Medicare Choice organizations offering Medicare Choice plans. Prohibits a State from imposing a premium tax or similar tax with respect to payments on Medicare Choice plans or the offering of such plans. 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. 5002) 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. 5006) 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: Integrated Long-Term Care Programs - Amends SSA title XVIII to provide for 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. 5013) 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. (Sec. 5015) 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. 5018) 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 and make appropriate recommendations to restore such integrity through the year 2030; and (3) analyze potential solutions to the problems identified that will ensure both the financial integrity of Medicare and the provision of appropriate benefits under such program, including the extent to which current Medicare update indexes do not accurately reflect inflation. 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 through the year 2030; 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. 5022) 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. 5031) 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. Provides for extending the six-month initial enrollment period under the Medicare supplemental policy program to non-elderly Medicare beneficiaries. (Sec. 5032) 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 before the policy begins payment of benefits. Chapter 5: Demonstrations - Directs the Secretary to conduct demonstration projects in ten urban areas where less than 25 percent of the Medicare beneficiaries are enrolled with an eligible HMO, as well as three rural areas, which are to be treated as Medicare Choice payment areas. Requires such projects to: (1) apply a pricing methodology for payments to Medicare Choice organizations using a specified competitive market approach; (2) apply a benefit structure and beneficiary premium structure specified in this chapter; (3) apply specified information and quality programs; and (4) evaluate the effects of the methodology and structures on Medicare fee-for-service spending under Medicare parts A and B in the project area. Requires the Secretary to report on the project to the President, and the President to report to the Congress any legislative recommendations for extending the project to the entire Medicare population. (Sec. 5042) Provides that, in the case of a Medicare Choice payment area in which such a project is being conducted, the annual Medicare Choice capitation rate shall be the standardized payment amount determined according to prescribed guidelines rather than the amount determined under the Medicare Choice program. Establishes within HHS the Office of Competition to administer Medicare Choice competitive pricing demonstrations. (Sec. 5043) Outlines benefits and beneficiary premiums under Medicare Choice competitive pricing demonstrations, which include, respectively, those items and services traditionally covered under Medicare plus prescription drugs as well as any optional supplemental benefits the demonstration plan offers, and certain cost-sharing obligations. (Sec. 5044) Details information and comparative reports the Secretary shall require to be used in a Medicare Choice demonstration plan under this chapter in lieu of those required under chapter 1. (Sec. 5044B) Establishes the Quality Advisory Institute to make recommendations to the Director of the Office of Competition concerning licensing and certification criteria and comparative measurement methods with regard to demonstration plans. Requires the Director to: (1) advise the President and the Congress on health insurance and health care provided under demonstration plans, recommending measures to protect the health of all enrollees in demonstration plans; (2) ensure that a demonstration plan may not be offered unless it has been certified in accordance with specified requirements; (3) establish a program to reward demonstration plans for meeting or exceeding quality targets; (4) develop procedures for licensing entities to certify demonstration plans; (5) establish minimum criteria for such licensed entities to use in certifying such plans; and (5) develop grievance and appeals procedures for plans denied certification. (Sec. 5045) 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. 5046) 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 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. 5047) Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a demonstration 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 veterans. Directs the Secretaries to try to include in the demonstration at least one medical center that is in the same catchment area as a closed military medical facility. Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a similar 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. Directs the Secretary of Defense to waive the enrollment fee for any Medicare-eligible military retiree or dependent enrolled in the managed care option of the TRICARE program for any period for which reimbursement is made under such a demonstration project with respect to such retiree or dependent. Chapter 6: 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 for 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) annual screening mammography for women over age 39, while providing for the waiver of coinsurance for screening mammography; (2) colorectal cancer screening tests, subject to prescribed frequency and payment limits; (3) 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 (4) bone mass measurements for qualified individuals. (Sec. 5103) 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. 5105) 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. Subtitle C: Rural Initiatives - Revises the formula for payments to sole community hospitals, in order to increase a hospital's target amount, by replacing the base cost reporting period with: (1) a hospital's cost reporting period for FY 1997; and (2) allowable operating costs of inpatient hospital services for subsequent fiscal years. Extends the target amount for Medicare- dependent, small rural hospitals. (Sec. 5153) 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 that shall be designated as a critical access hospital in accordance with prescribed guidelines. Authorizes the Secretary to award grants to States: (1) for the planning and implementation of the program; and (2) for establishment or expansion of rural emergency medical services. Authorizes appropriations. Directs the Administrator of the Health Care Financing Administration 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. 5154) 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. 5155) 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. 5156) 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 health care provider 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 health care provider providing the professional consultation is not at the same location as the health care provider 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. 5157) Directs the Secretary to conduct a demonstration project to study the use of eligible health care provider telemedicine networks to implement high-capacity computing and advanced networks to improve primary care and prevent health care complications, improve access to specialty care, and provide educational and training support to rural practitioners. Provides limited funding. Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity - Chapter 1: Revisions to Sanctions for Fraud and Abuse - 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. 5202) 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. 5203) 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; (2) any person that presents or causes to be presented to any State or Federal agency a claim for a medical or other item or service ordered or prescribed by an excluded person and the person furnishing such item or service knows or should have known of such exclusion; and (3) kickbacks. Chapter 2: Improvements in Protecting Program Integrity - Outlines various specified requirements regarding disclosure of information, surety bonds, and accreditation with regard to DME suppliers. Includes surety bond requirements for home health agencies, and provides for the application of disclosure and surety bond requirements to ambulance services and certain clinics. Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORFs) and to rehabilitation agencies. (Sec. 5212) 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. 5213) Amends SSA title XI part A (General Provisions) to provide that: (1) Medicare- and Medicaid-related actions against debtors are generally not stayed by bankruptcy proceedings; (2) certain Medicare- and Medicaid-related debts are not dischargeable in bankruptcy; and (3) the repayment of certain debts is considered final. (Sec. 5214) 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. 5219) Requires the Secretary to provide beneficiaries with an explanation of benefits that urges beneficiaries to check the 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 and review them. Requires the Secretary to take measures to recover amounts unnecessarily paid out. (Sec. 5220) 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) costs for fines and penalties resulting from violations of Federal, State, or local laws; and (3) education expenses for spouses or other dependents of service providers, their employees or contractors. (Sec. 5221) Changes from discretionary to mandatory the Secretary's authority to make lists of unnecessarily utilized items and of suppliers of items for whom the Secretary has identified a pattern of overutilization resulting from certain supplier business practices. (Sec. 5225) Authorizes the Secretary to apply to surgical dressings certain factors for determining grossly excessive payment amounts, and repeals the exemption from specified payment requirements for dressings furnished by a home health agency. Chapter 3: Clarifications and Technical Changes - Makes technical amendments with respect to fraud and abuse. Subtitle E: Prospective Payment Systems - Chapter 1: Provisions Relating to Part A - Provides for a prospective payment system (PPS) under Medicare for inpatient rehabilitation hospital services. (Sec. 5302) Directs the Secretary to submit to the Congress a legislative proposal for establishing a case-mix adjusted PPS for long-term care hospitals. Chapter 2: Provisions Relating to Part B - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 5312) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 5313) Directs the Secretary to establish a PPS for hospital outpatient department services. (Sec. 5321) 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 to carry out certain provisions with respect to the coverage of ambulance service, the Secretary may include coverage of advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. Chapter 3: Provisions Relating to Parts A and B - 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. 5332) 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 chapter and their effect on the quality of covered SNF services furnished to Medicare beneficiaries. (Sec. 5341) 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. 5342) 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. 5343) Directs the Secretary to establish a PPS for home health services for cost reporting periods beginning in FY 2000. (Sec. 5344) Bases the payment for home health services on the location where the service is furnished. (Sec. 5361) 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. 5362) Imposes a $5 co-payment for Medicare part B home health services. (Sec. 5364) 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. 5365) 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. 5366) Requires each explanation of Medicare part B benefits provided in conjunction with the payment of claims to include the total cost of home health services for which the agency or provider billed. Subtitle F: Provisions Relating to Part A - Chapter 1: Payment of PPS Hospitals - Revises requirements for PPS hospital payment updates and capital payments for PPS hospitals. Chapter 2: Payment of PPS Exempt Hospitals - Revises requirements for the payment of PPS exempt hospitals, including those for: (1) payment updates; (2) capital payments; (3) bonus and relief payments; (4) target amounts for rehabilitation hospitals, long-term care hospitals, and psychiatric hospitals; (5) treatment of certain long-term care hospitals located within other hospitals; (6) rebasing; and (7) certain cancer hospitals. Chapter 3: Graduate Medical Education Payments - 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 managed care enrollees. Makes a special reimbursement rule for primary care combined residency programs, setting the period of board eligibility. (Sec. 5452) Directs the Secretary to establish a demonstration project for making direct GME payments to qualifying consortia instead of teaching hospitals. Chapter 4: Other Hospital Payments - Directs the Secretary to make additional payments (including disproportionate share payments (DSH)) to hospitals for managed care and Medicare Choice enrollees. Revises requirements for DSH payments to hospitals serving vulnerable populations. Eliminates indirect GME and DSH payments attributable to outlier payments. Requires reductions in payments for enrollee bad debt. Increases the base payment rate to Puerto Rico hospitals. Repeals the termination date to make a permanent extension of the hemophilia passthrough. 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). Chapter 5: 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. Subtitle G: Provisions Relating to Part B Only - Chapter 1: Payments for Physicians and Other Health Care Providers - 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; (5) providing for adjustments in relative value units for 1998, and the application of resource-based methodology to malpractice relative value units; and (6) increasing Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. (Sec. 5505) Directs the Comptroller General to review and evaluate the proposed rule on resource-based methodology for practice expenses issued by the Health Care Financing Administration. Chapter 2: Other Payment Provisions - Requires a specified reduction in updates to payment amounts for clinical diagnostic laboratory tests, while lowering the cap on payment amounts. Directs the Secretary to request the Institute of Medicine of the National Academy of Sciences to study Medicare part B payments for clinical laboratory services for a report to the appropriate congressional committees. (Sec. 5522) 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. 5523) Provides for a reduction in payment amounts for items of DME. Revises requirements for payment for oxygen and oxygen equipment, ambulatory surgical services, and drugs and biologicals. Provides for a reduction in the increase for parenteral and enteral nutrients, supplies, and equipment. Directs the Secretary to establish service standards and accreditation requirements for persons seeking Medicare part B payment for the providing of oxygen and oxygen equipment to beneficiaries within their homes. Details certain studies, demonstration projects, and congressional reporting relating to access to home oxygen equipment. Directs the Secretary to conduct studies or surveys to determine the average wholesale price of any drug or biological for purposes related to their reimbursement. Requires a report to the appropriate congressional committees. Chapter 3: 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. 5542) Specifies a formula for income-related increases in the monthly Medicare part B premium. Amends the Internal Revenue Code to authorize the Secretary of the Treasury, upon the HHS Secretary's request, to disclose to Health Care Financing Administration officers and employees certain income tax return information about a taxpayer required to pay a monthly Medicare part B premium. (Sec. 5543) Directs the Secretary to conduct a demonstration project in which individuals otherwise responsible for an income- related premium under this chapter would instead be responsible for an income-related deductible using the same income limits and administrative procedures provided for. Prohibits Medigap beneficiaries from participating in such project. (Sec. 5544) Directs the Secretary to establish a program to award block grants to States for the payment of certain Medicare cost- sharing on behalf of eligible low-income Medicare beneficiaries. Authorizes the Secretary to transfer certain amounts from the Federal Supplementary Medical Insurance Trust Fund for such new program. Subtitle H: Provisions Relating to Parts A and B - Chapter 1: Secondary Payor Provisions - Revises requirements for Medicare as secondary payor. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Chapter 2: Other Provisions - Amends SSA title II (Old Age, Survivors and Disability Insurance) (OASDI) to conform the age for eligibility under Medicare to the retirement age for OASDI benefits. (Sec. 5612) Provides for an increased certification period for certain organ procurement organizations. (Sec. 5613) Amends SSA title XVIII to allow physicians or other health care professionals who do not provide items or services under the Medicare program from entering private contracts with Medicare beneficiaries for health services for which no claim for Medicare payment is to be submitted. Requires the Administrator of the Health Care Financing Administration to report to the Congress on the effect on Medicare of private contracts. Subtitle I: Miscellaneous Provisions - Provides that, with respect to inpatient hospital services on the basis of prospective rates, the large urban area of Charlotte-Gastonia-Rock Hill-North Carolina-South Carolina may be deemed to include Stanly County, North Carolina. (Sec. 5652) Declares that, with respect to certain criminal penalties for selling or issuing a health insurance policy with knowledge it duplicates Medicare or Medigap health benefits, a health insurance policy is not considered to duplicate such benefits if it: (1) provides comprehensive health care benefits that replace the benefits provided by another health insurance policy; (2) is being provided to an individual entitled to benefits under Medicare part A or enrolled under Medicare part B; and (3) coordinates against items and services available or paid for under Medicare or Medicaid, provided that Medicare or Medicaid payments shall not be treated as payments under such policy in determining annual or lifetime benefit limits. Division 2: Medicaid and Children's Health Insurance Initiatives - Subtitle I: Medicaid - Chapter 1: Medicaid Savings - Amends SSA title XIX to establish a new part B (Managed Care) giving States the option to require Medicaid-eligible, non-special needs individuals to enroll in managed care arrangements of the individual's choice as a condition of receiving Medicaid. Prescribes requirements for: (1) referral to specialty care; (2) treatment of children with special health care needs; (3) access to emergency care; (4) annual external independent review of managed care entity activities and other specified quality care assurance measures; (5) fraud and abuse prohibitions and protections; and (6) enforcement sanctions. (Sec. 5701) Requires States to permit individuals access to religiously-affiliated long-term care facilities (including out-of-network facilities) that are not pervasively sectarian and that provide nonsectarian medical care comparable to a managed care entity meeting State Medicare requirements. Requires each Medicaid managed care organization to disclose annually to enrollees the proportion of the premiums and other revenues received by the organization that are expended for non-health care items and services. Directs the Secretary and the Comptroller General to report annually to specified congressional committees on rates paid for hospital services under managed care entities. Directs the Institute of Medicine of the National Academy of Sciences to analyze 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. (Sec. 5702) Amends SSA title XIX to grant States the option of providing Medicaid coverage of primary care case management services without the need for a waiver. (Sec. 5703) Repeals the (75-25) requirement that Medicare and Medicaid beneficiaries under SSA titles XVIII and XIX, respectively, constitute less than 75 percent of the membership of a participating HMO. Repeals the prohibition on co-payments for services furnished by HMOs. (Sec. 5711) 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. 5712) Revises requirements for Medicaid payment rates for qualified Medicare beneficiaries, placing a limitation on nonparticipating providers. (Sec. 5721) 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. Chapter 2: Expansion of Medicaid Eligibility - Grants States the option to: (1) permit workers with disabilities to buy into Medicaid; and (2) provide for 12-month continuous Medicaid eligibility for children. Chapter 3: Programs of All-Inclusive Care for the Elderly (PACE) - Authorizes a State to establish a 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. Requires the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under the Medicare and Medicaid programs, specifically comparing costs, quality, and access to services by private, for-profit entities operating under demonstration project waivers with those of other PACE providers. Chapter 4: Medicaid Management and Program Reforms - Repeals: (1) the requirement that a State pay for private insurance; (2) obstetrical and pediatric payment rate and various other specified requirements; and (3) certain physician qualification requirements. Authorizes a State to impose cost-sharing for any Medicaid provided to certain individuals. (Sec. 5755) Revises a specified penalty for fraudulent eligibility. (Sec. 5756) Prohibits the expenditure of Medicaid funds for roads, bridges, stadiums, and other items and services not covered by a State plan. 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. 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. Directs the Administrator of the Health Care Financing Administration to: (1) develop mechanisms to better monitor and prevent inappropriate Medicaid payments in the case of individuals who are dually eligible for Medicaid and Medicare benefits; (2) study the use of case management or care coordination in order to improve the appropriateness, quality, and cost effectiveness of care for dually- eligible individuals; and (3) work with the States to ensure better care coordination for dual eligibles. (Sec. 5757) Requires the Secretary to study and report to the Congress on: (1) early and periodic screening, diagnostic, and treatment benefits; and (2) individuals with special health care needs and chronic conditions in capitated managed care or primary care case management plans. Chapter 5: Miscellaneous - Provides for: (1) increased Federal medical assistance percentages (FMAPs) for the District of Columbia and Alaska and increased payment caps for the territories; (2) coverage of community-based mental health services and optional coverage of certain Centers for Disease Control screened breast cancer patients; and (3) treatment of veterans pensions. (Sec. 5765) 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. 5767) Directs the Secretary to study and report to the Congress on: (1) the use of nurse aide registries by States; (2) the extent to which institutional environmental factors contribute to cases of abuse and neglect at nursing facilities; and (3) whether alternatives to current sanctions for abuse and neglect at nursing facilities might be more effective in minimizing future cases of abuse and neglect. (Sec. 5768) Deems 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. (Thus exempts 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). (Sec. 5769) Applies certain requirements to the extension of statewide comprehensive research and demonstration projects for which waivers of Medicaid compliance have been granted. Subtitle J: Children's Health Insurance Initiatives - Amends SSA to add a new title XXI (Child Health Insurance Initiatives) in order to provide funds to States to expand the provision of health insurance coverage to low-income children. Mandates coverage that is actuarially equivalent to the benefits required to be offered for a child under the Federal Employees' Health Benefits Program (FEHBP). Requires the use of funds to achieve such purpose through specified outreach activities and, at the State's option, through: (1) a grant program to provide FEHBP-equivalent children's health insurance coverage for low-income children in the State; or (2) expansion of coverage of such children under the State Medicaid program who are not otherwise required to be provided medical assistance under Medicaid. Makes appropriations to carry out this title. Directs the Secretary to establish a basic allotment pool for distribution of funds to eligible States, with provision for bonus payments, including incentive bonuses. Prohibits their use to provide health insurance coverage for families of State public employees or children in penal institutions. Allows their use for abortion only if necessary to save the life of the mother or if the pregnancy results from rape or incest. Exempts such a State program from the five-year limit on means-tested public benefits under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Division 3: Income Security and Other Provisions - Subtitle K: Income Security, Welfare-to-Work Grant Program, and Other Provisions - Chapter 1: Income Security - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 to make aliens eligible for Supplemental Security Income (SSI) who, as of the date of enactment of such Act, were: (1) receiving such benefits; or (2) disabled and lawfully residing in the United States. Includes Cuban and Haitian entrants within the definition of "qualified alien" for purposes of welfare and public benefits. (Sec. 5812) Extends from five years 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. (Sec. 5813) Exempts from: (1) SSI and Medicaid eligibility limitations certain Canadian-born American Indians who are members of an Indian tribe; and (2) SSI eligibility limitations certain SSI recipients with pre-January 1, 1979 applications. (Sec. 5816) 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. 5817) Exempts legal aliens under the age of 19 from the five-year Medicaid limitation. (Sec. 5818) Treats certain Amerasian immigrants as refugees for purposes of specified public benefits eligibility. (Sec. 5819) Makes certain severely disabled legal aliens who were denied naturalization eligible for SSI benefits. Chapter 2: Welfare-to-Work Grant Program - 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. 5821) Sets forth requirements relating to State entitlement to non-competitive grants under such program and State distribution of such funds among local governments. Provides for competitive grants, based on program effectiveness and other factors, for State-approved projects proposed by local governments. 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 and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to: (1) develop a plan to evaluate the use of such grants; and (2) submit interim and final reports to the Congress. (Sec. 5822) Revises PRWORA provisions relating to a State's ability to sanction an individual receiving assistance under the TANF program for noncompliance. Chapter 3: Unemployment Compensation - Amends SSA title IX (Employment Security) with respect to unemployment compensation to increase the Federal Unemployment Account ceiling. (Sec. 5832) Provides for a special distribution to States from the Unemployment Trust Fund. (Sec. 5833) Revises the Internal Revenue Code exclude from the definition of employment, for specified unemployment compensation purposes, any service performed by a prison inmate. Division 4: Earned Income Credit and Other Provisions - Subtitle L: Earned Income Credit and Other Provisions - Chapter 1: Earned Income Credit - Prohibits allowing the earned income credit for: (1) ten years, if the credit was found to have been fraudulently claimed; and (2) two years, if the credit was claimed with intentional or reckless disregard of the earned income credit rules. Chapter 2: Increase in Public Debt Limit - Increases the public debt limit. Chapter 3: Miscellaneous - Expresses the sense of the Senate that all cost-of-living adjustments required by statute should accurately reflect the best available estimate of changes in the cost of living. Subtitle M: Welfare Reform Technical Corrections - Welfare Reform Technical Corrections Act of 1997 - Chapter 1: Block Grants for Temporary Assistance to Needy Families - Amends part A (Temporary Assistance for Needy Families) (TANF) of title IV of the Social Security Act (SSA) to make various specified technical as well as substantive amendments with regard to sundry (welfare reform) provisions added by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRAWORA). (Sec. 5902) Provides for a later deadline for submission of State TANF plans. (Sec. 5903) Revises the computation of bonus grants to States for a decrease in illegitimacy, requiring: (1) use of calendar year instead of fiscal year data; (2) use of the ratio of out-of-wedlock births to all births instead of the number of out-of-wedlock births; and (3) that certain territories be taken into account. Revises the formula for annual reconciliation of payments to States with specified maximums. Limits to non-needy States the requirement for annual State remission of excess funds to HHS. (Sec. 5905) Revises specified mandatory work requirements. States that a family with a disabled parent shall not treated as a two-parent family. Allows the minimum work req

Major Actions:

Summary: S.947 — 105th Congress (1997-1998)

There are 2 summaries for this bill. Passed Senate amended (06/25/1997)Introduced in Senate (06/20/1997)     Bill summaries are authored by CRS. $("#summarySelector").congress_dropDownNavigation({ stubUrl: '/bill/105th-congress/senate-bill/947/summary', suffix: '' }); Shown Here:
Passed Senate amended (06/25/1997) TABLE OF CONTENTS: Title I: Committee on Agriculture, Nutrition, and Forestry Title II: Committee on Banking, Housing, and Urban Affairs Subtitle A: Mortgage Assignment and Annual Adjustment Factors Subtitle B: Multifamily Housing Reform Title III: Committee on Commerce Science and Transportation Subtitle A: Spectrum Auctions and License Fees Subtitle B: Merchant Marine Provisions Title IV: Committee on Energy and Natural Resources Title V: Committee on Finance Division 1: Medicare 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: Prospective Payment Systems Subtitle F: Provisions Relating to Part A Subtitle G: Provisions Relating to Part B Only Subtitle H: Provisions Relating to Parts A and B Division 2: Medicaid and Childrens' Health Insurance Initiatives Subtitle I: Medicaid Subtitle J: Children's Health Insurance Initiatives Division 3: Income Security and Other Provisions Subtitle K: Income Security, Welfare-to-Work Grant Program, and Other Provisions Division 4: Earned Income Credit and Other Provisions Subtitle L: Earned Income Credit and Other Provisions Subtitle M: Welfare Reform Technical Corrections Title VI: Committee on Governmental Affairs Subtitle A: Civil Service and Postal Provisions Subtitle B: GSA Property Sales Title VII: Committee on Labor and Human Resources Title VIII: Committee on Veterans' Affairs Subtitle A: Extension of Temporary Authorities Subtitle B: Copayments and Medical Care Cost Recovery Subtitle C: Other Matters Balanced Budget Act of 1997 - Title I: Committee on Agriculture, Nutrition, and Forestry - Amends the Food Stamp Act to define "caseload" and "covered individual." Authorizes State agencies to provide an additional 15 percent hardship 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: Committee on Banking, Housing, and Urban Affairs - Subtitle A: Mortgage Assignment and Annual Adjustment Factors - Amends the Balanced Budget Downpayment Act, I to extend permanently certain foreclosure avoidance and borrower assistance provisions under the single family housing mortgage insurance program. (Sec. 2003) Amends the United States Housing Act of 1937 with respect to the section 8 rental assistance program to make certain maximum monthly rent adjustment provisions for certain new and rehabilitated and nonturnover units applicable to FY 1999 and thereafter. Subtitle B: Multifamily Housing Reform - Multifamily Assisted Housing Reform and Affordability Act of 1997 - Part 1: FHA-Insured Multifamily Housing Mortgage and Housing Assistance Restructuring - Directs the Secretary (Secretary) of Housing and Urban Development to enter into agreements with participating administrative entities (with preference given to State housing finance agencies) to develop and implement mortgage restructuring and rental assistance plans for FHA-insured multifamily housing mortgages in order to: (1) reduce expiring section 8 contracts costs; (2) address troubled projects; and (3) correct management and ownership deficiencies. Includes two-tiered mortgage restructuring among plan incentives. Terminates program authority as of October 1, 2001. Part 2: Miscellaneous Provisions - Amends the National Housing Act to authorize the Secretary to make rehabilitation grants for certain insured projects. (Sec. 2203) Repeals specified Federal housing preference provisions under the United States Housing Act of 1937, the Cranston- Gonzalez National Affordable Housing Act, the Housing and Urban Development Act of 1965, the Low-Income Housing Preservation and Resident Homeownership Act of 1990, and the Housing and Community Development Act of 1992. Part 3: Enforcement Provisions - Directs the Secretary to issue implementing regulations. Subpart A: FHA Single Family and Multifamily Housing - Amends the National Housing Act to expand HUD authorities with respect to: (1) lender sanctions; (2) equity skimming; and (3) civil money penalties. Subpart B: FHA Multifamily Provisions - Amends the National Housing Act and the Housing Act of 1937 to expand multifamily housing-related civil money penalties. (Sec. 2322) Amends the Housing and Community Development Act of 1987 to extend the double damages remedy. Title III: Committee on Commerce Science and Transportation - Subtitle A: Spectrum Auctions and License Fees - Amends the Communications Act of 1934 (the Act) to revise provisions regarding competitive bidding for use of the electromagnetic spectrum to authorize the Federal Communications Commission (FCC) to use auctions as a means to assign spectrum. Makes competitive bidding authority inapplicable to licenses or construction permits issued for: (1) public safety services; (2) public telecommunications services when the license application is for channels reserved for noncommercial use; (3) spectrum and associated orbits used within global satellite systems; (4) new digital television (TV) service given to existing terrestrial broadcast licensees to replace current licenses; (5) terrestrial radio and TV broadcasting when the FCC determines that an alternative method of resolving mutually exclusive applications serves the public interest better than competitive bidding; or (6) spectrum allocated for specified unlicensed use if competitive bidding would interfere with operation of end-user products. Extends competitive bidding authority through FY 2007. Requires the FCC, by the end of 2001, to assign by competitive bidding 45 megahertz (mhz.) located at 1,710-1,755 mhz. for commercial use. Provides that Federal Government stations assigned to use such band shall retain use until the end of 2003 unless exempted from relocation. Directs the FCC, by the end of FY 2002, to permit the assignment by competitive bidding of licenses for the use of currently allocated bands of frequencies that: (1) in the aggregate span not less than 55 mhz.; (2) are located below three gigahertz (ghz.); and (3) have not been designated for assignment, identified by the Secretary of Commerce as reallocable frequencies pursuant to the National Telecommunications and Information Administration Organization Act, or allocated for Federal Government use. Requires the FCC to attempt to accommodate displaced licensees by relocating them to other frequencies and notify the Secretary whenever unable to provide for effective relocation. Amends the National Telecommunications and Information Administration Organization Act to require the Secretary of Commerce to make specified recommendations, upon receiving a report from the FCC on inability to accommodate displaced licensees, for purposes of reassigning such licensees to frequencies allocated for Government use. Sets forth requirements regarding: (1) the reimbursement of Federal spectrum users for relocation costs; (2) petitions by persons seeking to relocate Federal stations; and (3) Federal rights to reclaim reallocated spectrum. Directs the Secretary to make available for reallocation from Federal frequencies 20 mhz. located below three ghz. (Sec. 3002) Amends the Act to prohibit, under competitive bidding provisions, the renewal of a license authorizing analog TV services beyond the end of 2006. Extends or waives this deadline for a station in any TV market unless 95 percent of the TV households have access to digital local TV signals. Provides that commercial digital TV licenses shall expire at the end of FY 2003. Directs the FCC to report biennially to the Congress on the status of digital TV conversion in each TV market. Sets forth requirements with respect to the resale of, and competitive bidding for, spectrum previously used for the broadcast of analog TV. Directs the FCC to report the total revenues from such bidding by January 1, 2002. (Sec. 3003) Directs the FCC, no later than January 1, 1998, to allocate from the electromagnetic spectrum between 746 and 806 mhz.: (1) 24 mhz. for public safety services; and (2) 36 mhz. for commercial purposes to be assigned by competitive bidding. (Sec. 3005) Requires the FCC, in any auction for any license, permit, or right which has value, to set a reasonable reserve price for each unit in the auction unless it is not in the public interest to do so. Provides that the reserve price shall establish a minimum bid for the unit to be auctioned. Retains units for which no bid above the reserve price is received. Directs the FCC to reassess reserve prices for such units and place them in the next appropriate auction. Subtitle B: Merchant Marine Provisions - Extends through FY 2002 the current tonnage duties imposed upon foreign vessels entering into U.S. ports. Title IV: Committee on Energy and Natural Resources - Amends the Energy Policy and Conservation Act to authorize the Secretary of Energy to store foreign-owned petroleum products in underutilized Strategic Petroleum Reserve (SPR) facilities, subject to the following conditions: (1) funds resulting from the leasing or other use of an SPR facility after October 1, 2007, shall be available to the Secretary, without further appropriation, for SPR petroleum product purchases; (2) such stored petroleum product is neither part of the SPR, nor subject to the contracting requirements governing petroleum product not owned by the United States; and (3) such product may be exported. Title V: Committee on Finance - 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 under title XIX of the Social Security Act (SSA). Division 1: Medicare - 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 traditional Medicare fee-for- service program or through a Medicare Choice plan. (Sec. 5001) Outlines the types of Medicare Choice plans that may be available, including: (1) fee-for-service plans; (2) plans offered by preferred provider organizations; (3) point of service plans; (4) plans offered by provider-sponsored organizations; (5) plans offered by health maintenance organizations; and (6) a combination of MSA (Medicare Choice savings account) plan and contributions to Medicare Choice MSA. 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 provide for broad dissemination of coverage option and comparison information to Medicare beneficiaries and prospective Medicare beneficiaries. Directs the Secretary to 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 any Medicare Choice organization to accept without restrictions individuals eligible to make an election at any time during which such elections are accepted. Requires the approval of Medicare Choice marketing material and application forms before they are distributed. 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 and specified additional benefits, as well, at its option, as certain supplemental benefits, subject to the Secretary's approval. 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. Requires each Medicare Choice organization, at an enrollee's request, to disclose annually the proportion of the premiums and other revenues received by the organization that are expended for non-health care items and services. Outlines a mechanism for grievances and appeals. Sets forth certain payment rules for providers not participating in the MedicarePlus (sic) 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. Directs the Secretary and the Medicare Payment Advisory Commission to each study and report to the Congress on appropriate measures for adjusting the annual Medicare Choice capitation rates to reflect local price indicators. 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. Details rules for the submission and charging of premiums by each Medicare Choice organization. Sets limitations on enrollee cost- sharing for basic, additional, and supplemental benefits, except for MSA plans and unrestricted fee-for-service plans. Requires the Secretary to audit each year the financial records of at least one- third of the Medicare Choice organizations offering Medicare Choice plans. Prohibits a State from imposing a premium tax or similar tax with respect to payments on Medicare Choice plans or the offering of such plans. 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. 5002) 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. 5006) 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: Integrated Long-Term Care Programs - Amends SSA title XVIII to provide for 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. 5013) 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. (Sec. 5015) 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. 5018) 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 and make appropriate recommendations to restore such integrity through the year 2030; and (3) analyze potential solutions to the problems identified that will ensure both the financial integrity of Medicare and the provision of appropriate benefits under such program, including the extent to which current Medicare update indexes do not accurately reflect inflation. 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 through the year 2030; 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. 5022) 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. 5031) 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. Provides for extending the six-month initial enrollment period under the Medicare supplemental policy program to non-elderly Medicare beneficiaries. (Sec. 5032) 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 before the policy begins payment of benefits. Chapter 5: Demonstrations - Directs the Secretary to conduct demonstration projects in ten urban areas where less than 25 percent of the Medicare beneficiaries are enrolled with an eligible HMO, as well as three rural areas, which are to be treated as Medicare Choice payment areas. Requires such projects to: (1) apply a pricing methodology for payments to Medicare Choice organizations using a specified competitive market approach; (2) apply a benefit structure and beneficiary premium structure specified in this chapter; (3) apply specified information and quality programs; and (4) evaluate the effects of the methodology and structures on Medicare fee-for-service spending under Medicare parts A and B in the project area. Requires the Secretary to report on the project to the President, and the President to report to the Congress any legislative recommendations for extending the project to the entire Medicare population. (Sec. 5042) Provides that, in the case of a Medicare Choice payment area in which such a project is being conducted, the annual Medicare Choice capitation rate shall be the standardized payment amount determined according to prescribed guidelines rather than the amount determined under the Medicare Choice program. Establishes within HHS the Office of Competition to administer Medicare Choice competitive pricing demonstrations. (Sec. 5043) Outlines benefits and beneficiary premiums under Medicare Choice competitive pricing demonstrations, which include, respectively, those items and services traditionally covered under Medicare plus prescription drugs as well as any optional supplemental benefits the demonstration plan offers, and certain cost-sharing obligations. (Sec. 5044) Details information and comparative reports the Secretary shall require to be used in a Medicare Choice demonstration plan under this chapter in lieu of those required under chapter 1. (Sec. 5044B) Establishes the Quality Advisory Institute to make recommendations to the Director of the Office of Competition concerning licensing and certification criteria and comparative measurement methods with regard to demonstration plans. Requires the Director to: (1) advise the President and the Congress on health insurance and health care provided under demonstration plans, recommending measures to protect the health of all enrollees in demonstration plans; (2) ensure that a demonstration plan may not be offered unless it has been certified in accordance with specified requirements; (3) establish a program to reward demonstration plans for meeting or exceeding quality targets; (4) develop procedures for licensing entities to certify demonstration plans; (5) establish minimum criteria for such licensed entities to use in certifying such plans; and (5) develop grievance and appeals procedures for plans denied certification. (Sec. 5045) 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. 5046) 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 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. 5047) Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a demonstration 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 veterans. Directs the Secretaries to try to include in the demonstration at least one medical center that is in the same catchment area as a closed military medical facility. Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a similar 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. Directs the Secretary of Defense to waive the enrollment fee for any Medicare-eligible military retiree or dependent enrolled in the managed care option of the TRICARE program for any period for which reimbursement is made under such a demonstration project with respect to such retiree or dependent. Chapter 6: 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 for 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) annual screening mammography for women over age 39, while providing for the waiver of coinsurance for screening mammography; (2) colorectal cancer screening tests, subject to prescribed frequency and payment limits; (3) 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 (4) bone mass measurements for qualified individuals. (Sec. 5103) 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. 5105) 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. Subtitle C: Rural Initiatives - Revises the formula for payments to sole community hospitals, in order to increase a hospital's target amount, by replacing the base cost reporting period with: (1) a hospital's cost reporting period for FY 1997; and (2) allowable operating costs of inpatient hospital services for subsequent fiscal years. Extends the target amount for Medicare- dependent, small rural hospitals. (Sec. 5153) 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 that shall be designated as a critical access hospital in accordance with prescribed guidelines. Authorizes the Secretary to award grants to States: (1) for the planning and implementation of the program; and (2) for establishment or expansion of rural emergency medical services. Authorizes appropriations. Directs the Administrator of the Health Care Financing Administration 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. 5154) 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. 5155) 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. 5156) 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 health care provider 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 health care provider providing the professional consultation is not at the same location as the health care provider 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. 5157) Directs the Secretary to conduct a demonstration project to study the use of eligible health care provider telemedicine networks to implement high-capacity computing and advanced networks to improve primary care and prevent health care complications, improve access to specialty care, and provide educational and training support to rural practitioners. Provides limited funding. Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity - Chapter 1: Revisions to Sanctions for Fraud and Abuse - 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. 5202) 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. 5203) 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; (2) any person that presents or causes to be presented to any State or Federal agency a claim for a medical or other item or service ordered or prescribed by an excluded person and the person furnishing such item or service knows or should have known of such exclusion; and (3) kickbacks. Chapter 2: Improvements in Protecting Program Integrity - Outlines various specified requirements regarding disclosure of information, surety bonds, and accreditation with regard to DME suppliers. Includes surety bond requirements for home health agencies, and provides for the application of disclosure and surety bond requirements to ambulance services and certain clinics. Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORFs) and to rehabilitation agencies. (Sec. 5212) 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. 5213) Amends SSA title XI part A (General Provisions) to provide that: (1) Medicare- and Medicaid-related actions against debtors are generally not stayed by bankruptcy proceedings; (2) certain Medicare- and Medicaid-related debts are not dischargeable in bankruptcy; and (3) the repayment of certain debts is considered final. (Sec. 5214) 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. 5219) Requires the Secretary to provide beneficiaries with an explanation of benefits that urges beneficiaries to check the 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 and review them. Requires the Secretary to take measures to recover amounts unnecessarily paid out. (Sec. 5220) 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) costs for fines and penalties resulting from violations of Federal, State, or local laws; and (3) education expenses for spouses or other dependents of service providers, their employees or contractors. (Sec. 5221) Changes from discretionary to mandatory the Secretary's authority to make lists of unnecessarily utilized items and of suppliers of items for whom the Secretary has identified a pattern of overutilization resulting from certain supplier business practices. (Sec. 5225) Authorizes the Secretary to apply to surgical dressings certain factors for determining grossly excessive payment amounts, and repeals the exemption from specified payment requirements for dressings furnished by a home health agency. Chapter 3: Clarifications and Technical Changes - Makes technical amendments with respect to fraud and abuse. Subtitle E: Prospective Payment Systems - Chapter 1: Provisions Relating to Part A - Provides for a prospective payment system (PPS) under Medicare for inpatient rehabilitation hospital services. (Sec. 5302) Directs the Secretary to submit to the Congress a legislative proposal for establishing a case-mix adjusted PPS for long-term care hospitals. Chapter 2: Provisions Relating to Part B - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 5312) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 5313) Directs the Secretary to establish a PPS for hospital outpatient department services. (Sec. 5321) 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 to carry out certain provisions with respect to the coverage of ambulance service, the Secretary may include coverage of advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. Chapter 3: Provisions Relating to Parts A and B - 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. 5332) 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 chapter and their effect on the quality of covered SNF services furnished to Medicare beneficiaries. (Sec. 5341) 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. 5342) 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. 5343) Directs the Secretary to establish a PPS for home health services for cost reporting periods beginning in FY 2000. (Sec. 5344) Bases the payment for home health services on the location where the service is furnished. (Sec. 5361) 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. 5362) Imposes a $5 co-payment for Medicare part B home health services. (Sec. 5364) 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. 5365) 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. 5366) Requires each explanation of Medicare part B benefits provided in conjunction with the payment of claims to include the total cost of home health services for which the agency or provider billed. Subtitle F: Provisions Relating to Part A - Chapter 1: Payment of PPS Hospitals - Revises requirements for PPS hospital payment updates and capital payments for PPS hospitals. Chapter 2: Payment of PPS Exempt Hospitals - Revises requirements for the payment of PPS exempt hospitals, including those for: (1) payment updates; (2) capital payments; (3) bonus and relief payments; (4) target amounts for rehabilitation hospitals, long-term care hospitals, and psychiatric hospitals; (5) treatment of certain long-term care hospitals located within other hospitals; (6) rebasing; and (7) certain cancer hospitals. Chapter 3: Graduate Medical Education Payments - 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 managed care enrollees. Makes a special reimbursement rule for primary care combined residency programs, setting the period of board eligibility. (Sec. 5452) Directs the Secretary to establish a demonstration project for making direct GME payments to qualifying consortia instead of teaching hospitals. Chapter 4: Other Hospital Payments - Directs the Secretary to make additional payments (including disproportionate share payments (DSH)) to hospitals for managed care and Medicare Choice enrollees. Revises requirements for DSH payments to hospitals serving vulnerable populations. Eliminates indirect GME and DSH payments attributable to outlier payments. Requires reductions in payments for enrollee bad debt. Increases the base payment rate to Puerto Rico hospitals. Repeals the termination date to make a permanent extension of the hemophilia passthrough. 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). Chapter 5: 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. Subtitle G: Provisions Relating to Part B Only - Chapter 1: Payments for Physicians and Other Health Care Providers - 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; (5) providing for adjustments in relative value units for 1998, and the application of resource-based methodology to malpractice relative value units; and (6) increasing Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. (Sec. 5505) Directs the Comptroller General to review and evaluate the proposed rule on resource-based methodology for practice expenses issued by the Health Care Financing Administration. Chapter 2: Other Payment Provisions - Requires a specified reduction in updates to payment amounts for clinical diagnostic laboratory tests, while lowering the cap on payment amounts. Directs the Secretary to request the Institute of Medicine of the National Academy of Sciences to study Medicare part B payments for clinical laboratory services for a report to the appropriate congressional committees. (Sec. 5522) 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. 5523) Provides for a reduction in payment amounts for items of DME. Revises requirements for payment for oxygen and oxygen equipment, ambulatory surgical services, and drugs and biologicals. Provides for a reduction in the increase for parenteral and enteral nutrients, supplies, and equipment. Directs the Secretary to establish service standards and accreditation requirements for persons seeking Medicare part B payment for the providing of oxygen and oxygen equipment to beneficiaries within their homes. Details certain studies, demonstration projects, and congressional reporting relating to access to home oxygen equipment. Directs the Secretary to conduct studies or surveys to determine the average wholesale price of any drug or biological for purposes related to their reimbursement. Requires a report to the appropriate congressional committees. Chapter 3: 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. 5542) Specifies a formula for income-related increases in the monthly Medicare part B premium. Amends the Internal Revenue Code to authorize the Secretary of the Treasury, upon the HHS Secretary's request, to disclose to Health Care Financing Administration officers and employees certain income tax return information about a taxpayer required to pay a monthly Medicare part B premium. (Sec. 5543) Directs the Secretary to conduct a demonstration project in which individuals otherwise responsible for an income- related premium under this chapter would instead be responsible for an income-related deductible using the same income limits and administrative procedures provided for. Prohibits Medigap beneficiaries from participating in such project. (Sec. 5544) Directs the Secretary to establish a program to award block grants to States for the payment of certain Medicare cost- sharing on behalf of eligible low-income Medicare beneficiaries. Authorizes the Secretary to transfer certain amounts from the Federal Supplementary Medical Insurance Trust Fund for such new program. Subtitle H: Provisions Relating to Parts A and B - Chapter 1: Secondary Payor Provisions - Revises requirements for Medicare as secondary payor. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Chapter 2: Other Provisions - Amends SSA title II (Old Age, Survivors and Disability Insurance) (OASDI) to conform the age for eligibility under Medicare to the retirement age for OASDI benefits. (Sec. 5612) Provides for an increased certification period for certain organ procurement organizations. (Sec. 5613) Amends SSA title XVIII to allow physicians or other health care professionals who do not provide items or services under the Medicare program from entering private contracts with Medicare beneficiaries for health services for which no claim for Medicare payment is to be submitted. Requires the Administrator of the Health Care Financing Administration to report to the Congress on the effect on Medicare of private contracts. Subtitle I: Miscellaneous Provisions - Provides that, with respect to inpatient hospital services on the basis of prospective rates, the large urban area of Charlotte-Gastonia-Rock Hill-North Carolina-South Carolina may be deemed to include Stanly County, North Carolina. (Sec. 5652) Declares that, with respect to certain criminal penalties for selling or issuing a health insurance policy with knowledge it duplicates Medicare or Medigap health benefits, a health insurance policy is not considered to duplicate such benefits if it: (1) provides comprehensive health care benefits that replace the benefits provided by another health insurance policy; (2) is being provided to an individual entitled to benefits under Medicare part A or enrolled under Medicare part B; and (3) coordinates against items and services available or paid for under Medicare or Medicaid, provided that Medicare or Medicaid payments shall not be treated as payments under such policy in determining annual or lifetime benefit limits. Division 2: Medicaid and Children's Health Insurance Initiatives - Subtitle I: Medicaid - Chapter 1: Medicaid Savings - Amends SSA title XIX to establish a new part B (Managed Care) giving States the option to require Medicaid-eligible, non-special needs individuals to enroll in managed care arrangements of the individual's choice as a condition of receiving Medicaid. Prescribes requirements for: (1) referral to specialty care; (2) treatment of children with special health care needs; (3) access to emergency care; (4) annual external independent review of managed care entity activities and other specified quality care assurance measures; (5) fraud and abuse prohibitions and protections; and (6) enforcement sanctions. (Sec. 5701) Requires States to permit individuals access to religiously-affiliated long-term care facilities (including out-of-network facilities) that are not pervasively sectarian and that provide nonsectarian medical care comparable to a managed care entity meeting State Medicare requirements. Requires each Medicaid managed care organization to disclose annually to enrollees the proportion of the premiums and other revenues received by the organization that are expended for non-health care items and services. Directs the Secretary and the Comptroller General to report annually to specified congressional committees on rates paid for hospital services under managed care entities. Directs the Institute of Medicine of the National Academy of Sciences to analyze 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. (Sec. 5702) Amends SSA title XIX to grant States the option of providing Medicaid coverage of primary care case management services without the need for a waiver. (Sec. 5703) Repeals the (75-25) requirement that Medicare and Medicaid beneficiaries under SSA titles XVIII and XIX, respectively, constitute less than 75 percent of the membership of a participating HMO. Repeals the prohibition on co-payments for services furnished by HMOs. (Sec. 5711) 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. 5712) Revises requirements for Medicaid payment rates for qualified Medicare beneficiaries, placing a limitation on nonparticipating providers. (Sec. 5721) 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. Chapter 2: Expansion of Medicaid Eligibility - Grants States the option to: (1) permit workers with disabilities to buy into Medicaid; and (2) provide for 12-month continuous Medicaid eligibility for children. Chapter 3: Programs of All-Inclusive Care for the Elderly (PACE) - Authorizes a State to establish a 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. Requires the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under the Medicare and Medicaid programs, specifically comparing costs, quality, and access to services by private, for-profit entities operating under demonstration project waivers with those of other PACE providers. Chapter 4: Medicaid Management and Program Reforms - Repeals: (1) the requirement that a State pay for private insurance; (2) obstetrical and pediatric payment rate and various other specified requirements; and (3) certain physician qualification requirements. Authorizes a State to impose cost-sharing for any Medicaid provided to certain individuals. (Sec. 5755) Revises a specified penalty for fraudulent eligibility. (Sec. 5756) Prohibits the expenditure of Medicaid funds for roads, bridges, stadiums, and other items and services not covered by a State plan. 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. 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. Directs the Administrator of the Health Care Financing Administration to: (1) develop mechanisms to better monitor and prevent inappropriate Medicaid payments in the case of individuals who are dually eligible for Medicaid and Medicare benefits; (2) study the use of case management or care coordination in order to improve the appropriateness, quality, and cost effectiveness of care for dually- eligible individuals; and (3) work with the States to ensure better care coordination for dual eligibles. (Sec. 5757) Requires the Secretary to study and report to the Congress on: (1) early and periodic screening, diagnostic, and treatment benefits; and (2) individuals with special health care needs and chronic conditions in capitated managed care or primary care case management plans. Chapter 5: Miscellaneous - Provides for: (1) increased Federal medical assistance percentages (FMAPs) for the District of Columbia and Alaska and increased payment caps for the territories; (2) coverage of community-based mental health services and optional coverage of certain Centers for Disease Control screened breast cancer patients; and (3) treatment of veterans pensions. (Sec. 5765) 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. 5767) Directs the Secretary to study and report to the Congress on: (1) the use of nurse aide registries by States; (2) the extent to which institutional environmental factors contribute to cases of abuse and neglect at nursing facilities; and (3) whether alternatives to current sanctions for abuse and neglect at nursing facilities might be more effective in minimizing future cases of abuse and neglect. (Sec. 5768) Deems 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. (Thus exempts 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). (Sec. 5769) Applies certain requirements to the extension of statewide comprehensive research and demonstration projects for which waivers of Medicaid compliance have been granted. Subtitle J: Children's Health Insurance Initiatives - Amends SSA to add a new title XXI (Child Health Insurance Initiatives) in order to provide funds to States to expand the provision of health insurance coverage to low-income children. Mandates coverage that is actuarially equivalent to the benefits required to be offered for a child under the Federal Employees' Health Benefits Program (FEHBP). Requires the use of funds to achieve such purpose through specified outreach activities and, at the State's option, through: (1) a grant program to provide FEHBP-equivalent children's health insurance coverage for low-income children in the State; or (2) expansion of coverage of such children under the State Medicaid program who are not otherwise required to be provided medical assistance under Medicaid. Makes appropriations to carry out this title. Directs the Secretary to establish a basic allotment pool for distribution of funds to eligible States, with provision for bonus payments, including incentive bonuses. Prohibits their use to provide health insurance coverage for families of State public employees or children in penal institutions. Allows their use for abortion only if necessary to save the life of the mother or if the pregnancy results from rape or incest. Exempts such a State program from the five-year limit on means-tested public benefits under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Division 3: Income Security and Other Provisions - Subtitle K: Income Security, Welfare-to-Work Grant Program, and Other Provisions - Chapter 1: Income Security - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 to make aliens eligible for Supplemental Security Income (SSI) who, as of the date of enactment of such Act, were: (1) receiving such benefits; or (2) disabled and lawfully residing in the United States. Includes Cuban and Haitian entrants within the definition of "qualified alien" for purposes of welfare and public benefits. (Sec. 5812) Extends from five years 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. (Sec. 5813) Exempts from: (1) SSI and Medicaid eligibility limitations certain Canadian-born American Indians who are members of an Indian tribe; and (2) SSI eligibility limitations certain SSI recipients with pre-January 1, 1979 applications. (Sec. 5816) 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. 5817) Exempts legal aliens under the age of 19 from the five-year Medicaid limitation. (Sec. 5818) Treats certain Amerasian immigrants as refugees for purposes of specified public benefits eligibility. (Sec. 5819) Makes certain severely disabled legal aliens who were denied naturalization eligible for SSI benefits. Chapter 2: Welfare-to-Work Grant Program - 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. 5821) Sets forth requirements relating to State entitlement to non-competitive grants under such program and State distribution of such funds among local governments. Provides for competitive grants, based on program effectiveness and other factors, for State-approved projects proposed by local governments. 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 and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to: (1) develop a plan to evaluate the use of such grants; and (2) submit interim and final reports to the Congress. (Sec. 5822) Revises PRWORA provisions relating to a State's ability to sanction an individual receiving assistance under the TANF program for noncompliance. Chapter 3: Unemployment Compensation - Amends SSA title IX (Employment Security) with respect to unemployment compensation to increase the Federal Unemployment Account ceiling. (Sec. 5832) Provides for a special distribution to States from the Unemployment Trust Fund. (Sec. 5833) Revises the Internal Revenue Code exclude from the definition of employment, for specified unemployment compensation purposes, any service performed by a prison inmate. Division 4: Earned Income Credit and Other Provisions - Subtitle L: Earned Income Credit and Other Provisions - Chapter 1: Earned Income Credit - Prohibits allowing the earned income credit for: (1) ten years, if the credit was found to have been fraudulently claimed; and (2) two years, if the credit was claimed with intentional or reckless disregard of the earned income credit rules. Chapter 2: Increase in Public Debt Limit - Increases the public debt limit. Chapter 3: Miscellaneous - Expresses the sense of the Senate that all cost-of-living adjustments required by statute should accurately reflect the best available estimate of changes in the cost of living. Subtitle M: Welfare Reform Technical Corrections - Welfare Reform Technical Corrections Act of 1997 - Chapter 1: Block Grants for Temporary Assistance to Needy Families - Amends part A (Temporary Assistance for Needy Families) (TANF) of title IV of the Social Security Act (SSA) to make various specified technical as well as substantive amendments with regard to sundry (welfare reform) provisions added by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRAWORA). (Sec. 5902) Provides for a later deadline for submission of State TANF plans. (Sec. 5903) Revises the computation of bonus grants to States for a decrease in illegitimacy, requiring: (1) use of calendar year instead of fiscal year data; (2) use of the ratio of out-of-wedlock births to all births instead of the number of out-of-wedlock births; and (3) that certain territories be taken into account. Revises the formula for annual reconciliation of payments to States with specified maximums. Limits to non-needy States the requirement for annual State remission of excess funds to HHS. (Sec. 5905) Revises specified mandatory work requirements. States that a family with a disabled parent shall not treated as a two-parent family. Allows the minimum work requirement for a two-parent family to be shared between both parents, if it amounts

Amendments:

Summary: S.947 — 105th Congress (1997-1998)

There are 2 summaries for this bill. Passed Senate amended (06/25/1997)Introduced in Senate (06/20/1997)     Bill summaries are authored by CRS. $("#summarySelector").congress_dropDownNavigation({ stubUrl: '/bill/105th-congress/senate-bill/947/summary', suffix: '' }); Shown Here:
Passed Senate amended (06/25/1997) TABLE OF CONTENTS: Title I: Committee on Agriculture, Nutrition, and Forestry Title II: Committee on Banking, Housing, and Urban Affairs Subtitle A: Mortgage Assignment and Annual Adjustment Factors Subtitle B: Multifamily Housing Reform Title III: Committee on Commerce Science and Transportation Subtitle A: Spectrum Auctions and License Fees Subtitle B: Merchant Marine Provisions Title IV: Committee on Energy and Natural Resources Title V: Committee on Finance Division 1: Medicare 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: Prospective Payment Systems Subtitle F: Provisions Relating to Part A Subtitle G: Provisions Relating to Part B Only Subtitle H: Provisions Relating to Parts A and B Division 2: Medicaid and Childrens' Health Insurance Initiatives Subtitle I: Medicaid Subtitle J: Children's Health Insurance Initiatives Division 3: Income Security and Other Provisions Subtitle K: Income Security, Welfare-to-Work Grant Program, and Other Provisions Division 4: Earned Income Credit and Other Provisions Subtitle L: Earned Income Credit and Other Provisions Subtitle M: Welfare Reform Technical Corrections Title VI: Committee on Governmental Affairs Subtitle A: Civil Service and Postal Provisions Subtitle B: GSA Property Sales Title VII: Committee on Labor and Human Resources Title VIII: Committee on Veterans' Affairs Subtitle A: Extension of Temporary Authorities Subtitle B: Copayments and Medical Care Cost Recovery Subtitle C: Other Matters Balanced Budget Act of 1997 - Title I: Committee on Agriculture, Nutrition, and Forestry - Amends the Food Stamp Act to define "caseload" and "covered individual." Authorizes State agencies to provide an additional 15 percent hardship 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: Committee on Banking, Housing, and Urban Affairs - Subtitle A: Mortgage Assignment and Annual Adjustment Factors - Amends the Balanced Budget Downpayment Act, I to extend permanently certain foreclosure avoidance and borrower assistance provisions under the single family housing mortgage insurance program. (Sec. 2003) Amends the United States Housing Act of 1937 with respect to the section 8 rental assistance program to make certain maximum monthly rent adjustment provisions for certain new and rehabilitated and nonturnover units applicable to FY 1999 and thereafter. Subtitle B: Multifamily Housing Reform - Multifamily Assisted Housing Reform and Affordability Act of 1997 - Part 1: FHA-Insured Multifamily Housing Mortgage and Housing Assistance Restructuring - Directs the Secretary (Secretary) of Housing and Urban Development to enter into agreements with participating administrative entities (with preference given to State housing finance agencies) to develop and implement mortgage restructuring and rental assistance plans for FHA-insured multifamily housing mortgages in order to: (1) reduce expiring section 8 contracts costs; (2) address troubled projects; and (3) correct management and ownership deficiencies. Includes two-tiered mortgage restructuring among plan incentives. Terminates program authority as of October 1, 2001. Part 2: Miscellaneous Provisions - Amends the National Housing Act to authorize the Secretary to make rehabilitation grants for certain insured projects. (Sec. 2203) Repeals specified Federal housing preference provisions under the United States Housing Act of 1937, the Cranston- Gonzalez National Affordable Housing Act, the Housing and Urban Development Act of 1965, the Low-Income Housing Preservation and Resident Homeownership Act of 1990, and the Housing and Community Development Act of 1992. Part 3: Enforcement Provisions - Directs the Secretary to issue implementing regulations. Subpart A: FHA Single Family and Multifamily Housing - Amends the National Housing Act to expand HUD authorities with respect to: (1) lender sanctions; (2) equity skimming; and (3) civil money penalties. Subpart B: FHA Multifamily Provisions - Amends the National Housing Act and the Housing Act of 1937 to expand multifamily housing-related civil money penalties. (Sec. 2322) Amends the Housing and Community Development Act of 1987 to extend the double damages remedy. Title III: Committee on Commerce Science and Transportation - Subtitle A: Spectrum Auctions and License Fees - Amends the Communications Act of 1934 (the Act) to revise provisions regarding competitive bidding for use of the electromagnetic spectrum to authorize the Federal Communications Commission (FCC) to use auctions as a means to assign spectrum. Makes competitive bidding authority inapplicable to licenses or construction permits issued for: (1) public safety services; (2) public telecommunications services when the license application is for channels reserved for noncommercial use; (3) spectrum and associated orbits used within global satellite systems; (4) new digital television (TV) service given to existing terrestrial broadcast licensees to replace current licenses; (5) terrestrial radio and TV broadcasting when the FCC determines that an alternative method of resolving mutually exclusive applications serves the public interest better than competitive bidding; or (6) spectrum allocated for specified unlicensed use if competitive bidding would interfere with operation of end-user products. Extends competitive bidding authority through FY 2007. Requires the FCC, by the end of 2001, to assign by competitive bidding 45 megahertz (mhz.) located at 1,710-1,755 mhz. for commercial use. Provides that Federal Government stations assigned to use such band shall retain use until the end of 2003 unless exempted from relocation. Directs the FCC, by the end of FY 2002, to permit the assignment by competitive bidding of licenses for the use of currently allocated bands of frequencies that: (1) in the aggregate span not less than 55 mhz.; (2) are located below three gigahertz (ghz.); and (3) have not been designated for assignment, identified by the Secretary of Commerce as reallocable frequencies pursuant to the National Telecommunications and Information Administration Organization Act, or allocated for Federal Government use. Requires the FCC to attempt to accommodate displaced licensees by relocating them to other frequencies and notify the Secretary whenever unable to provide for effective relocation. Amends the National Telecommunications and Information Administration Organization Act to require the Secretary of Commerce to make specified recommendations, upon receiving a report from the FCC on inability to accommodate displaced licensees, for purposes of reassigning such licensees to frequencies allocated for Government use. Sets forth requirements regarding: (1) the reimbursement of Federal spectrum users for relocation costs; (2) petitions by persons seeking to relocate Federal stations; and (3) Federal rights to reclaim reallocated spectrum. Directs the Secretary to make available for reallocation from Federal frequencies 20 mhz. located below three ghz. (Sec. 3002) Amends the Act to prohibit, under competitive bidding provisions, the renewal of a license authorizing analog TV services beyond the end of 2006. Extends or waives this deadline for a station in any TV market unless 95 percent of the TV households have access to digital local TV signals. Provides that commercial digital TV licenses shall expire at the end of FY 2003. Directs the FCC to report biennially to the Congress on the status of digital TV conversion in each TV market. Sets forth requirements with respect to the resale of, and competitive bidding for, spectrum previously used for the broadcast of analog TV. Directs the FCC to report the total revenues from such bidding by January 1, 2002. (Sec. 3003) Directs the FCC, no later than January 1, 1998, to allocate from the electromagnetic spectrum between 746 and 806 mhz.: (1) 24 mhz. for public safety services; and (2) 36 mhz. for commercial purposes to be assigned by competitive bidding. (Sec. 3005) Requires the FCC, in any auction for any license, permit, or right which has value, to set a reasonable reserve price for each unit in the auction unless it is not in the public interest to do so. Provides that the reserve price shall establish a minimum bid for the unit to be auctioned. Retains units for which no bid above the reserve price is received. Directs the FCC to reassess reserve prices for such units and place them in the next appropriate auction. Subtitle B: Merchant Marine Provisions - Extends through FY 2002 the current tonnage duties imposed upon foreign vessels entering into U.S. ports. Title IV: Committee on Energy and Natural Resources - Amends the Energy Policy and Conservation Act to authorize the Secretary of Energy to store foreign-owned petroleum products in underutilized Strategic Petroleum Reserve (SPR) facilities, subject to the following conditions: (1) funds resulting from the leasing or other use of an SPR facility after October 1, 2007, shall be available to the Secretary, without further appropriation, for SPR petroleum product purchases; (2) such stored petroleum product is neither part of the SPR, nor subject to the contracting requirements governing petroleum product not owned by the United States; and (3) such product may be exported. Title V: Committee on Finance - 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 under title XIX of the Social Security Act (SSA). Division 1: Medicare - 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 traditional Medicare fee-for- service program or through a Medicare Choice plan. (Sec. 5001) Outlines the types of Medicare Choice plans that may be available, including: (1) fee-for-service plans; (2) plans offered by preferred provider organizations; (3) point of service plans; (4) plans offered by provider-sponsored organizations; (5) plans offered by health maintenance organizations; and (6) a combination of MSA (Medicare Choice savings account) plan and contributions to Medicare Choice MSA. 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 provide for broad dissemination of coverage option and comparison information to Medicare beneficiaries and prospective Medicare beneficiaries. Directs the Secretary to 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 any Medicare Choice organization to accept without restrictions individuals eligible to make an election at any time during which such elections are accepted. Requires the approval of Medicare Choice marketing material and application forms before they are distributed. 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 and specified additional benefits, as well, at its option, as certain supplemental benefits, subject to the Secretary's approval. 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. Requires each Medicare Choice organization, at an enrollee's request, to disclose annually the proportion of the premiums and other revenues received by the organization that are expended for non-health care items and services. Outlines a mechanism for grievances and appeals. Sets forth certain payment rules for providers not participating in the MedicarePlus (sic) 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. Directs the Secretary and the Medicare Payment Advisory Commission to each study and report to the Congress on appropriate measures for adjusting the annual Medicare Choice capitation rates to reflect local price indicators. 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. Details rules for the submission and charging of premiums by each Medicare Choice organization. Sets limitations on enrollee cost- sharing for basic, additional, and supplemental benefits, except for MSA plans and unrestricted fee-for-service plans. Requires the Secretary to audit each year the financial records of at least one- third of the Medicare Choice organizations offering Medicare Choice plans. Prohibits a State from imposing a premium tax or similar tax with respect to payments on Medicare Choice plans or the offering of such plans. 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. 5002) 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. 5006) 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: Integrated Long-Term Care Programs - Amends SSA title XVIII to provide for 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. 5013) 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. (Sec. 5015) 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. 5018) 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 and make appropriate recommendations to restore such integrity through the year 2030; and (3) analyze potential solutions to the problems identified that will ensure both the financial integrity of Medicare and the provision of appropriate benefits under such program, including the extent to which current Medicare update indexes do not accurately reflect inflation. 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 through the year 2030; 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. 5022) 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. 5031) 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. Provides for extending the six-month initial enrollment period under the Medicare supplemental policy program to non-elderly Medicare beneficiaries. (Sec. 5032) 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 before the policy begins payment of benefits. Chapter 5: Demonstrations - Directs the Secretary to conduct demonstration projects in ten urban areas where less than 25 percent of the Medicare beneficiaries are enrolled with an eligible HMO, as well as three rural areas, which are to be treated as Medicare Choice payment areas. Requires such projects to: (1) apply a pricing methodology for payments to Medicare Choice organizations using a specified competitive market approach; (2) apply a benefit structure and beneficiary premium structure specified in this chapter; (3) apply specified information and quality programs; and (4) evaluate the effects of the methodology and structures on Medicare fee-for-service spending under Medicare parts A and B in the project area. Requires the Secretary to report on the project to the President, and the President to report to the Congress any legislative recommendations for extending the project to the entire Medicare population. (Sec. 5042) Provides that, in the case of a Medicare Choice payment area in which such a project is being conducted, the annual Medicare Choice capitation rate shall be the standardized payment amount determined according to prescribed guidelines rather than the amount determined under the Medicare Choice program. Establishes within HHS the Office of Competition to administer Medicare Choice competitive pricing demonstrations. (Sec. 5043) Outlines benefits and beneficiary premiums under Medicare Choice competitive pricing demonstrations, which include, respectively, those items and services traditionally covered under Medicare plus prescription drugs as well as any optional supplemental benefits the demonstration plan offers, and certain cost-sharing obligations. (Sec. 5044) Details information and comparative reports the Secretary shall require to be used in a Medicare Choice demonstration plan under this chapter in lieu of those required under chapter 1. (Sec. 5044B) Establishes the Quality Advisory Institute to make recommendations to the Director of the Office of Competition concerning licensing and certification criteria and comparative measurement methods with regard to demonstration plans. Requires the Director to: (1) advise the President and the Congress on health insurance and health care provided under demonstration plans, recommending measures to protect the health of all enrollees in demonstration plans; (2) ensure that a demonstration plan may not be offered unless it has been certified in accordance with specified requirements; (3) establish a program to reward demonstration plans for meeting or exceeding quality targets; (4) develop procedures for licensing entities to certify demonstration plans; (5) establish minimum criteria for such licensed entities to use in certifying such plans; and (5) develop grievance and appeals procedures for plans denied certification. (Sec. 5045) 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. 5046) 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 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. 5047) Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a demonstration 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 veterans. Directs the Secretaries to try to include in the demonstration at least one medical center that is in the same catchment area as a closed military medical facility. Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a similar 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. Directs the Secretary of Defense to waive the enrollment fee for any Medicare-eligible military retiree or dependent enrolled in the managed care option of the TRICARE program for any period for which reimbursement is made under such a demonstration project with respect to such retiree or dependent. Chapter 6: 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 for 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) annual screening mammography for women over age 39, while providing for the waiver of coinsurance for screening mammography; (2) colorectal cancer screening tests, subject to prescribed frequency and payment limits; (3) 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 (4) bone mass measurements for qualified individuals. (Sec. 5103) 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. 5105) 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. Subtitle C: Rural Initiatives - Revises the formula for payments to sole community hospitals, in order to increase a hospital's target amount, by replacing the base cost reporting period with: (1) a hospital's cost reporting period for FY 1997; and (2) allowable operating costs of inpatient hospital services for subsequent fiscal years. Extends the target amount for Medicare- dependent, small rural hospitals. (Sec. 5153) 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 that shall be designated as a critical access hospital in accordance with prescribed guidelines. Authorizes the Secretary to award grants to States: (1) for the planning and implementation of the program; and (2) for establishment or expansion of rural emergency medical services. Authorizes appropriations. Directs the Administrator of the Health Care Financing Administration 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. 5154) 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. 5155) 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. 5156) 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 health care provider 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 health care provider providing the professional consultation is not at the same location as the health care provider 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. 5157) Directs the Secretary to conduct a demonstration project to study the use of eligible health care provider telemedicine networks to implement high-capacity computing and advanced networks to improve primary care and prevent health care complications, improve access to specialty care, and provide educational and training support to rural practitioners. Provides limited funding. Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity - Chapter 1: Revisions to Sanctions for Fraud and Abuse - 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. 5202) 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. 5203) 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; (2) any person that presents or causes to be presented to any State or Federal agency a claim for a medical or other item or service ordered or prescribed by an excluded person and the person furnishing such item or service knows or should have known of such exclusion; and (3) kickbacks. Chapter 2: Improvements in Protecting Program Integrity - Outlines various specified requirements regarding disclosure of information, surety bonds, and accreditation with regard to DME suppliers. Includes surety bond requirements for home health agencies, and provides for the application of disclosure and surety bond requirements to ambulance services and certain clinics. Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORFs) and to rehabilitation agencies. (Sec. 5212) 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. 5213) Amends SSA title XI part A (General Provisions) to provide that: (1) Medicare- and Medicaid-related actions against debtors are generally not stayed by bankruptcy proceedings; (2) certain Medicare- and Medicaid-related debts are not dischargeable in bankruptcy; and (3) the repayment of certain debts is considered final. (Sec. 5214) 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. 5219) Requires the Secretary to provide beneficiaries with an explanation of benefits that urges beneficiaries to check the 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 and review them. Requires the Secretary to take measures to recover amounts unnecessarily paid out. (Sec. 5220) 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) costs for fines and penalties resulting from violations of Federal, State, or local laws; and (3) education expenses for spouses or other dependents of service providers, their employees or contractors. (Sec. 5221) Changes from discretionary to mandatory the Secretary's authority to make lists of unnecessarily utilized items and of suppliers of items for whom the Secretary has identified a pattern of overutilization resulting from certain supplier business practices. (Sec. 5225) Authorizes the Secretary to apply to surgical dressings certain factors for determining grossly excessive payment amounts, and repeals the exemption from specified payment requirements for dressings furnished by a home health agency. Chapter 3: Clarifications and Technical Changes - Makes technical amendments with respect to fraud and abuse. Subtitle E: Prospective Payment Systems - Chapter 1: Provisions Relating to Part A - Provides for a prospective payment system (PPS) under Medicare for inpatient rehabilitation hospital services. (Sec. 5302) Directs the Secretary to submit to the Congress a legislative proposal for establishing a case-mix adjusted PPS for long-term care hospitals. Chapter 2: Provisions Relating to Part B - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 5312) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 5313) Directs the Secretary to establish a PPS for hospital outpatient department services. (Sec. 5321) 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 to carry out certain provisions with respect to the coverage of ambulance service, the Secretary may include coverage of advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. Chapter 3: Provisions Relating to Parts A and B - 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. 5332) 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 chapter and their effect on the quality of covered SNF services furnished to Medicare beneficiaries. (Sec. 5341) 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. 5342) 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. 5343) Directs the Secretary to establish a PPS for home health services for cost reporting periods beginning in FY 2000. (Sec. 5344) Bases the payment for home health services on the location where the service is furnished. (Sec. 5361) 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. 5362) Imposes a $5 co-payment for Medicare part B home health services. (Sec. 5364) 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. 5365) 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. 5366) Requires each explanation of Medicare part B benefits provided in conjunction with the payment of claims to include the total cost of home health services for which the agency or provider billed. Subtitle F: Provisions Relating to Part A - Chapter 1: Payment of PPS Hospitals - Revises requirements for PPS hospital payment updates and capital payments for PPS hospitals. Chapter 2: Payment of PPS Exempt Hospitals - Revises requirements for the payment of PPS exempt hospitals, including those for: (1) payment updates; (2) capital payments; (3) bonus and relief payments; (4) target amounts for rehabilitation hospitals, long-term care hospitals, and psychiatric hospitals; (5) treatment of certain long-term care hospitals located within other hospitals; (6) rebasing; and (7) certain cancer hospitals. Chapter 3: Graduate Medical Education Payments - 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 managed care enrollees. Makes a special reimbursement rule for primary care combined residency programs, setting the period of board eligibility. (Sec. 5452) Directs the Secretary to establish a demonstration project for making direct GME payments to qualifying consortia instead of teaching hospitals. Chapter 4: Other Hospital Payments - Directs the Secretary to make additional payments (including disproportionate share payments (DSH)) to hospitals for managed care and Medicare Choice enrollees. Revises requirements for DSH payments to hospitals serving vulnerable populations. Eliminates indirect GME and DSH payments attributable to outlier payments. Requires reductions in payments for enrollee bad debt. Increases the base payment rate to Puerto Rico hospitals. Repeals the termination date to make a permanent extension of the hemophilia passthrough. 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). Chapter 5: 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. Subtitle G: Provisions Relating to Part B Only - Chapter 1: Payments for Physicians and Other Health Care Providers - 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; (5) providing for adjustments in relative value units for 1998, and the application of resource-based methodology to malpractice relative value units; and (6) increasing Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. (Sec. 5505) Directs the Comptroller General to review and evaluate the proposed rule on resource-based methodology for practice expenses issued by the Health Care Financing Administration. Chapter 2: Other Payment Provisions - Requires a specified reduction in updates to payment amounts for clinical diagnostic laboratory tests, while lowering the cap on payment amounts. Directs the Secretary to request the Institute of Medicine of the National Academy of Sciences to study Medicare part B payments for clinical laboratory services for a report to the appropriate congressional committees. (Sec. 5522) 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. 5523) Provides for a reduction in payment amounts for items of DME. Revises requirements for payment for oxygen and oxygen equipment, ambulatory surgical services, and drugs and biologicals. Provides for a reduction in the increase for parenteral and enteral nutrients, supplies, and equipment. Directs the Secretary to establish service standards and accreditation requirements for persons seeking Medicare part B payment for the providing of oxygen and oxygen equipment to beneficiaries within their homes. Details certain studies, demonstration projects, and congressional reporting relating to access to home oxygen equipment. Directs the Secretary to conduct studies or surveys to determine the average wholesale price of any drug or biological for purposes related to their reimbursement. Requires a report to the appropriate congressional committees. Chapter 3: 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. 5542) Specifies a formula for income-related increases in the monthly Medicare part B premium. Amends the Internal Revenue Code to authorize the Secretary of the Treasury, upon the HHS Secretary's request, to disclose to Health Care Financing Administration officers and employees certain income tax return information about a taxpayer required to pay a monthly Medicare part B premium. (Sec. 5543) Directs the Secretary to conduct a demonstration project in which individuals otherwise responsible for an income- related premium under this chapter would instead be responsible for an income-related deductible using the same income limits and administrative procedures provided for. Prohibits Medigap beneficiaries from participating in such project. (Sec. 5544) Directs the Secretary to establish a program to award block grants to States for the payment of certain Medicare cost- sharing on behalf of eligible low-income Medicare beneficiaries. Authorizes the Secretary to transfer certain amounts from the Federal Supplementary Medical Insurance Trust Fund for such new program. Subtitle H: Provisions Relating to Parts A and B - Chapter 1: Secondary Payor Provisions - Revises requirements for Medicare as secondary payor. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Chapter 2: Other Provisions - Amends SSA title II (Old Age, Survivors and Disability Insurance) (OASDI) to conform the age for eligibility under Medicare to the retirement age for OASDI benefits. (Sec. 5612) Provides for an increased certification period for certain organ procurement organizations. (Sec. 5613) Amends SSA title XVIII to allow physicians or other health care professionals who do not provide items or services under the Medicare program from entering private contracts with Medicare beneficiaries for health services for which no claim for Medicare payment is to be submitted. Requires the Administrator of the Health Care Financing Administration to report to the Congress on the effect on Medicare of private contracts. Subtitle I: Miscellaneous Provisions - Provides that, with respect to inpatient hospital services on the basis of prospective rates, the large urban area of Charlotte-Gastonia-Rock Hill-North Carolina-South Carolina may be deemed to include Stanly County, North Carolina. (Sec. 5652) Declares that, with respect to certain criminal penalties for selling or issuing a health insurance policy with knowledge it duplicates Medicare or Medigap health benefits, a health insurance policy is not considered to duplicate such benefits if it: (1) provides comprehensive health care benefits that replace the benefits provided by another health insurance policy; (2) is being provided to an individual entitled to benefits under Medicare part A or enrolled under Medicare part B; and (3) coordinates against items and services available or paid for under Medicare or Medicaid, provided that Medicare or Medicaid payments shall not be treated as payments under such policy in determining annual or lifetime benefit limits. Division 2: Medicaid and Children's Health Insurance Initiatives - Subtitle I: Medicaid - Chapter 1: Medicaid Savings - Amends SSA title XIX to establish a new part B (Managed Care) giving States the option to require Medicaid-eligible, non-special needs individuals to enroll in managed care arrangements of the individual's choice as a condition of receiving Medicaid. Prescribes requirements for: (1) referral to specialty care; (2) treatment of children with special health care needs; (3) access to emergency care; (4) annual external independent review of managed care entity activities and other specified quality care assurance measures; (5) fraud and abuse prohibitions and protections; and (6) enforcement sanctions. (Sec. 5701) Requires States to permit individuals access to religiously-affiliated long-term care facilities (including out-of-network facilities) that are not pervasively sectarian and that provide nonsectarian medical care comparable to a managed care entity meeting State Medicare requirements. Requires each Medicaid managed care organization to disclose annually to enrollees the proportion of the premiums and other revenues received by the organization that are expended for non-health care items and services. Directs the Secretary and the Comptroller General to report annually to specified congressional committees on rates paid for hospital services under managed care entities. Directs the Institute of Medicine of the National Academy of Sciences to analyze 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. (Sec. 5702) Amends SSA title XIX to grant States the option of providing Medicaid coverage of primary care case management services without the need for a waiver. (Sec. 5703) Repeals the (75-25) requirement that Medicare and Medicaid beneficiaries under SSA titles XVIII and XIX, respectively, constitute less than 75 percent of the membership of a participating HMO. Repeals the prohibition on co-payments for services furnished by HMOs. (Sec. 5711) 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. 5712) Revises requirements for Medicaid payment rates for qualified Medicare beneficiaries, placing a limitation on nonparticipating providers. (Sec. 5721) 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. Chapter 2: Expansion of Medicaid Eligibility - Grants States the option to: (1) permit workers with disabilities to buy into Medicaid; and (2) provide for 12-month continuous Medicaid eligibility for children. Chapter 3: Programs of All-Inclusive Care for the Elderly (PACE) - Authorizes a State to establish a 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. Requires the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under the Medicare and Medicaid programs, specifically comparing costs, quality, and access to services by private, for-profit entities operating under demonstration project waivers with those of other PACE providers. Chapter 4: Medicaid Management and Program Reforms - Repeals: (1) the requirement that a State pay for private insurance; (2) obstetrical and pediatric payment rate and various other specified requirements; and (3) certain physician qualification requirements. Authorizes a State to impose cost-sharing for any Medicaid provided to certain individuals. (Sec. 5755) Revises a specified penalty for fraudulent eligibility. (Sec. 5756) Prohibits the expenditure of Medicaid funds for roads, bridges, stadiums, and other items and services not covered by a State plan. 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. 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. Directs the Administrator of the Health Care Financing Administration to: (1) develop mechanisms to better monitor and prevent inappropriate Medicaid payments in the case of individuals who are dually eligible for Medicaid and Medicare benefits; (2) study the use of case management or care coordination in order to improve the appropriateness, quality, and cost effectiveness of care for dually- eligible individuals; and (3) work with the States to ensure better care coordination for dual eligibles. (Sec. 5757) Requires the Secretary to study and report to the Congress on: (1) early and periodic screening, diagnostic, and treatment benefits; and (2) individuals with special health care needs and chronic conditions in capitated managed care or primary care case management plans. Chapter 5: Miscellaneous - Provides for: (1) increased Federal medical assistance percentages (FMAPs) for the District of Columbia and Alaska and increased payment caps for the territories; (2) coverage of community-based mental health services and optional coverage of certain Centers for Disease Control screened breast cancer patients; and (3) treatment of veterans pensions. (Sec. 5765) 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. 5767) Directs the Secretary to study and report to the Congress on: (1) the use of nurse aide registries by States; (2) the extent to which institutional environmental factors contribute to cases of abuse and neglect at nursing facilities; and (3) whether alternatives to current sanctions for abuse and neglect at nursing facilities might be more effective in minimizing future cases of abuse and neglect. (Sec. 5768) Deems 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. (Thus exempts 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). (Sec. 5769) Applies certain requirements to the extension of statewide comprehensive research and demonstration projects for which waivers of Medicaid compliance have been granted. Subtitle J: Children's Health Insurance Initiatives - Amends SSA to add a new title XXI (Child Health Insurance Initiatives) in order to provide funds to States to expand the provision of health insurance coverage to low-income children. Mandates coverage that is actuarially equivalent to the benefits required to be offered for a child under the Federal Employees' Health Benefits Program (FEHBP). Requires the use of funds to achieve such purpose through specified outreach activities and, at the State's option, through: (1) a grant program to provide FEHBP-equivalent children's health insurance coverage for low-income children in the State; or (2) expansion of coverage of such children under the State Medicaid program who are not otherwise required to be provided medical assistance under Medicaid. Makes appropriations to carry out this title. Directs the Secretary to establish a basic allotment pool for distribution of funds to eligible States, with provision for bonus payments, including incentive bonuses. Prohibits their use to provide health insurance coverage for families of State public employees or children in penal institutions. Allows their use for abortion only if necessary to save the life of the mother or if the pregnancy results from rape or incest. Exempts such a State program from the five-year limit on means-tested public benefits under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Division 3: Income Security and Other Provisions - Subtitle K: Income Security, Welfare-to-Work Grant Program, and Other Provisions - Chapter 1: Income Security - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 to make aliens eligible for Supplemental Security Income (SSI) who, as of the date of enactment of such Act, were: (1) receiving such benefits; or (2) disabled and lawfully residing in the United States. Includes Cuban and Haitian entrants within the definition of "qualified alien" for purposes of welfare and public benefits. (Sec. 5812) Extends from five years 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. (Sec. 5813) Exempts from: (1) SSI and Medicaid eligibility limitations certain Canadian-born American Indians who are members of an Indian tribe; and (2) SSI eligibility limitations certain SSI recipients with pre-January 1, 1979 applications. (Sec. 5816) 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. 5817) Exempts legal aliens under the age of 19 from the five-year Medicaid limitation. (Sec. 5818) Treats certain Amerasian immigrants as refugees for purposes of specified public benefits eligibility. (Sec. 5819) Makes certain severely disabled legal aliens who were denied naturalization eligible for SSI benefits. Chapter 2: Welfare-to-Work Grant Program - 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. 5821) Sets forth requirements relating to State entitlement to non-competitive grants under such program and State distribution of such funds among local governments. Provides for competitive grants, based on program effectiveness and other factors, for State-approved projects proposed by local governments. 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 and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to: (1) develop a plan to evaluate the use of such grants; and (2) submit interim and final reports to the Congress. (Sec. 5822) Revises PRWORA provisions relating to a State's ability to sanction an individual receiving assistance under the TANF program for noncompliance. Chapter 3: Unemployment Compensation - Amends SSA title IX (Employment Security) with respect to unemployment compensation to increase the Federal Unemployment Account ceiling. (Sec. 5832) Provides for a special distribution to States from the Unemployment Trust Fund. (Sec. 5833) Revises the Internal Revenue Code exclude from the definition of employment, for specified unemployment compensation purposes, any service performed by a prison inmate. Division 4: Earned Income Credit and Other Provisions - Subtitle L: Earned Income Credit and Other Provisions - Chapter 1: Earned Income Credit - Prohibits allowing the earned income credit for: (1) ten years, if the credit was found to have been fraudulently claimed; and (2) two years, if the credit was claimed with intentional or reckless disregard of the earned income credit rules. Chapter 2: Increase in Public Debt Limit - Increases the public debt limit. Chapter 3: Miscellaneous - Expresses the sense of the Senate that all cost-of-living adjustments required by statute should accurately reflect the best available estimate of changes in the cost of living. Subtitle M: Welfare Reform Technical Corrections - Welfare Reform Technical Corrections Act of 1997 - Chapter 1: Block Grants for Temporary Assistance to Needy Families - Amends part A (Temporary Assistance for Needy Families) (TANF) of title IV of the Social Security Act (SSA) to make various specified technical as well as substantive amendments with regard to sundry (welfare reform) provisions added by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRAWORA). (Sec. 5902) Provides for a later deadline for submission of State TANF plans. (Sec. 5903) Revises the computation of bonus grants to States for a decrease in illegitimacy, requiring: (1) use of calendar year instead of fiscal year data; (2) use of the ratio of out-of-wedlock births to all births instead of the number of out-of-wedlock births; and (3) that certain territories be taken into account. Revises the formula for annual reconciliation of payments to States with specified maximums. Limits to non-needy States the requirement for annual State remission of excess funds to HHS. (Sec. 5905) Revises specified mandatory work requirements. States that a family with a disabled parent shall not treated as a two-parent family. Allows the minimum work requirement for a two-parent family to be shared between both parents, if it amounts

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Summary: S.947 — 105th Congress (1997-1998)

There are 2 summaries for this bill. Passed Senate amended (06/25/1997)Introduced in Senate (06/20/1997)     Bill summaries are authored by CRS. $("#summarySelector").congress_dropDownNavigation({ stubUrl: '/bill/105th-congress/senate-bill/947/summary', suffix: '' }); Shown Here:
Passed Senate amended (06/25/1997) TABLE OF CONTENTS: Title I: Committee on Agriculture, Nutrition, and Forestry Title II: Committee on Banking, Housing, and Urban Affairs Subtitle A: Mortgage Assignment and Annual Adjustment Factors Subtitle B: Multifamily Housing Reform Title III: Committee on Commerce Science and Transportation Subtitle A: Spectrum Auctions and License Fees Subtitle B: Merchant Marine Provisions Title IV: Committee on Energy and Natural Resources Title V: Committee on Finance Division 1: Medicare 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: Prospective Payment Systems Subtitle F: Provisions Relating to Part A Subtitle G: Provisions Relating to Part B Only Subtitle H: Provisions Relating to Parts A and B Division 2: Medicaid and Childrens' Health Insurance Initiatives Subtitle I: Medicaid Subtitle J: Children's Health Insurance Initiatives Division 3: Income Security and Other Provisions Subtitle K: Income Security, Welfare-to-Work Grant Program, and Other Provisions Division 4: Earned Income Credit and Other Provisions Subtitle L: Earned Income Credit and Other Provisions Subtitle M: Welfare Reform Technical Corrections Title VI: Committee on Governmental Affairs Subtitle A: Civil Service and Postal Provisions Subtitle B: GSA Property Sales Title VII: Committee on Labor and Human Resources Title VIII: Committee on Veterans' Affairs Subtitle A: Extension of Temporary Authorities Subtitle B: Copayments and Medical Care Cost Recovery Subtitle C: Other Matters Balanced Budget Act of 1997 - Title I: Committee on Agriculture, Nutrition, and Forestry - Amends the Food Stamp Act to define "caseload" and "covered individual." Authorizes State agencies to provide an additional 15 percent hardship 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: Committee on Banking, Housing, and Urban Affairs - Subtitle A: Mortgage Assignment and Annual Adjustment Factors - Amends the Balanced Budget Downpayment Act, I to extend permanently certain foreclosure avoidance and borrower assistance provisions under the single family housing mortgage insurance program. (Sec. 2003) Amends the United States Housing Act of 1937 with respect to the section 8 rental assistance program to make certain maximum monthly rent adjustment provisions for certain new and rehabilitated and nonturnover units applicable to FY 1999 and thereafter. Subtitle B: Multifamily Housing Reform - Multifamily Assisted Housing Reform and Affordability Act of 1997 - Part 1: FHA-Insured Multifamily Housing Mortgage and Housing Assistance Restructuring - Directs the Secretary (Secretary) of Housing and Urban Development to enter into agreements with participating administrative entities (with preference given to State housing finance agencies) to develop and implement mortgage restructuring and rental assistance plans for FHA-insured multifamily housing mortgages in order to: (1) reduce expiring section 8 contracts costs; (2) address troubled projects; and (3) correct management and ownership deficiencies. Includes two-tiered mortgage restructuring among plan incentives. Terminates program authority as of October 1, 2001. Part 2: Miscellaneous Provisions - Amends the National Housing Act to authorize the Secretary to make rehabilitation grants for certain insured projects. (Sec. 2203) Repeals specified Federal housing preference provisions under the United States Housing Act of 1937, the Cranston- Gonzalez National Affordable Housing Act, the Housing and Urban Development Act of 1965, the Low-Income Housing Preservation and Resident Homeownership Act of 1990, and the Housing and Community Development Act of 1992. Part 3: Enforcement Provisions - Directs the Secretary to issue implementing regulations. Subpart A: FHA Single Family and Multifamily Housing - Amends the National Housing Act to expand HUD authorities with respect to: (1) lender sanctions; (2) equity skimming; and (3) civil money penalties. Subpart B: FHA Multifamily Provisions - Amends the National Housing Act and the Housing Act of 1937 to expand multifamily housing-related civil money penalties. (Sec. 2322) Amends the Housing and Community Development Act of 1987 to extend the double damages remedy. Title III: Committee on Commerce Science and Transportation - Subtitle A: Spectrum Auctions and License Fees - Amends the Communications Act of 1934 (the Act) to revise provisions regarding competitive bidding for use of the electromagnetic spectrum to authorize the Federal Communications Commission (FCC) to use auctions as a means to assign spectrum. Makes competitive bidding authority inapplicable to licenses or construction permits issued for: (1) public safety services; (2) public telecommunications services when the license application is for channels reserved for noncommercial use; (3) spectrum and associated orbits used within global satellite systems; (4) new digital television (TV) service given to existing terrestrial broadcast licensees to replace current licenses; (5) terrestrial radio and TV broadcasting when the FCC determines that an alternative method of resolving mutually exclusive applications serves the public interest better than competitive bidding; or (6) spectrum allocated for specified unlicensed use if competitive bidding would interfere with operation of end-user products. Extends competitive bidding authority through FY 2007. Requires the FCC, by the end of 2001, to assign by competitive bidding 45 megahertz (mhz.) located at 1,710-1,755 mhz. for commercial use. Provides that Federal Government stations assigned to use such band shall retain use until the end of 2003 unless exempted from relocation. Directs the FCC, by the end of FY 2002, to permit the assignment by competitive bidding of licenses for the use of currently allocated bands of frequencies that: (1) in the aggregate span not less than 55 mhz.; (2) are located below three gigahertz (ghz.); and (3) have not been designated for assignment, identified by the Secretary of Commerce as reallocable frequencies pursuant to the National Telecommunications and Information Administration Organization Act, or allocated for Federal Government use. Requires the FCC to attempt to accommodate displaced licensees by relocating them to other frequencies and notify the Secretary whenever unable to provide for effective relocation. Amends the National Telecommunications and Information Administration Organization Act to require the Secretary of Commerce to make specified recommendations, upon receiving a report from the FCC on inability to accommodate displaced licensees, for purposes of reassigning such licensees to frequencies allocated for Government use. Sets forth requirements regarding: (1) the reimbursement of Federal spectrum users for relocation costs; (2) petitions by persons seeking to relocate Federal stations; and (3) Federal rights to reclaim reallocated spectrum. Directs the Secretary to make available for reallocation from Federal frequencies 20 mhz. located below three ghz. (Sec. 3002) Amends the Act to prohibit, under competitive bidding provisions, the renewal of a license authorizing analog TV services beyond the end of 2006. Extends or waives this deadline for a station in any TV market unless 95 percent of the TV households have access to digital local TV signals. Provides that commercial digital TV licenses shall expire at the end of FY 2003. Directs the FCC to report biennially to the Congress on the status of digital TV conversion in each TV market. Sets forth requirements with respect to the resale of, and competitive bidding for, spectrum previously used for the broadcast of analog TV. Directs the FCC to report the total revenues from such bidding by January 1, 2002. (Sec. 3003) Directs the FCC, no later than January 1, 1998, to allocate from the electromagnetic spectrum between 746 and 806 mhz.: (1) 24 mhz. for public safety services; and (2) 36 mhz. for commercial purposes to be assigned by competitive bidding. (Sec. 3005) Requires the FCC, in any auction for any license, permit, or right which has value, to set a reasonable reserve price for each unit in the auction unless it is not in the public interest to do so. Provides that the reserve price shall establish a minimum bid for the unit to be auctioned. Retains units for which no bid above the reserve price is received. Directs the FCC to reassess reserve prices for such units and place them in the next appropriate auction. Subtitle B: Merchant Marine Provisions - Extends through FY 2002 the current tonnage duties imposed upon foreign vessels entering into U.S. ports. Title IV: Committee on Energy and Natural Resources - Amends the Energy Policy and Conservation Act to authorize the Secretary of Energy to store foreign-owned petroleum products in underutilized Strategic Petroleum Reserve (SPR) facilities, subject to the following conditions: (1) funds resulting from the leasing or other use of an SPR facility after October 1, 2007, shall be available to the Secretary, without further appropriation, for SPR petroleum product purchases; (2) such stored petroleum product is neither part of the SPR, nor subject to the contracting requirements governing petroleum product not owned by the United States; and (3) such product may be exported. Title V: Committee on Finance - 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 under title XIX of the Social Security Act (SSA). Division 1: Medicare - 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 traditional Medicare fee-for- service program or through a Medicare Choice plan. (Sec. 5001) Outlines the types of Medicare Choice plans that may be available, including: (1) fee-for-service plans; (2) plans offered by preferred provider organizations; (3) point of service plans; (4) plans offered by provider-sponsored organizations; (5) plans offered by health maintenance organizations; and (6) a combination of MSA (Medicare Choice savings account) plan and contributions to Medicare Choice MSA. 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 provide for broad dissemination of coverage option and comparison information to Medicare beneficiaries and prospective Medicare beneficiaries. Directs the Secretary to 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 any Medicare Choice organization to accept without restrictions individuals eligible to make an election at any time during which such elections are accepted. Requires the approval of Medicare Choice marketing material and application forms before they are distributed. 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 and specified additional benefits, as well, at its option, as certain supplemental benefits, subject to the Secretary's approval. 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. Requires each Medicare Choice organization, at an enrollee's request, to disclose annually the proportion of the premiums and other revenues received by the organization that are expended for non-health care items and services. Outlines a mechanism for grievances and appeals. Sets forth certain payment rules for providers not participating in the MedicarePlus (sic) 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. Directs the Secretary and the Medicare Payment Advisory Commission to each study and report to the Congress on appropriate measures for adjusting the annual Medicare Choice capitation rates to reflect local price indicators. 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. Details rules for the submission and charging of premiums by each Medicare Choice organization. Sets limitations on enrollee cost- sharing for basic, additional, and supplemental benefits, except for MSA plans and unrestricted fee-for-service plans. Requires the Secretary to audit each year the financial records of at least one- third of the Medicare Choice organizations offering Medicare Choice plans. Prohibits a State from imposing a premium tax or similar tax with respect to payments on Medicare Choice plans or the offering of such plans. 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. 5002) 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. 5006) 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: Integrated Long-Term Care Programs - Amends SSA title XVIII to provide for 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. 5013) 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. (Sec. 5015) 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. 5018) 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 and make appropriate recommendations to restore such integrity through the year 2030; and (3) analyze potential solutions to the problems identified that will ensure both the financial integrity of Medicare and the provision of appropriate benefits under such program, including the extent to which current Medicare update indexes do not accurately reflect inflation. 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 through the year 2030; 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. 5022) 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. 5031) 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. Provides for extending the six-month initial enrollment period under the Medicare supplemental policy program to non-elderly Medicare beneficiaries. (Sec. 5032) 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 before the policy begins payment of benefits. Chapter 5: Demonstrations - Directs the Secretary to conduct demonstration projects in ten urban areas where less than 25 percent of the Medicare beneficiaries are enrolled with an eligible HMO, as well as three rural areas, which are to be treated as Medicare Choice payment areas. Requires such projects to: (1) apply a pricing methodology for payments to Medicare Choice organizations using a specified competitive market approach; (2) apply a benefit structure and beneficiary premium structure specified in this chapter; (3) apply specified information and quality programs; and (4) evaluate the effects of the methodology and structures on Medicare fee-for-service spending under Medicare parts A and B in the project area. Requires the Secretary to report on the project to the President, and the President to report to the Congress any legislative recommendations for extending the project to the entire Medicare population. (Sec. 5042) Provides that, in the case of a Medicare Choice payment area in which such a project is being conducted, the annual Medicare Choice capitation rate shall be the standardized payment amount determined according to prescribed guidelines rather than the amount determined under the Medicare Choice program. Establishes within HHS the Office of Competition to administer Medicare Choice competitive pricing demonstrations. (Sec. 5043) Outlines benefits and beneficiary premiums under Medicare Choice competitive pricing demonstrations, which include, respectively, those items and services traditionally covered under Medicare plus prescription drugs as well as any optional supplemental benefits the demonstration plan offers, and certain cost-sharing obligations. (Sec. 5044) Details information and comparative reports the Secretary shall require to be used in a Medicare Choice demonstration plan under this chapter in lieu of those required under chapter 1. (Sec. 5044B) Establishes the Quality Advisory Institute to make recommendations to the Director of the Office of Competition concerning licensing and certification criteria and comparative measurement methods with regard to demonstration plans. Requires the Director to: (1) advise the President and the Congress on health insurance and health care provided under demonstration plans, recommending measures to protect the health of all enrollees in demonstration plans; (2) ensure that a demonstration plan may not be offered unless it has been certified in accordance with specified requirements; (3) establish a program to reward demonstration plans for meeting or exceeding quality targets; (4) develop procedures for licensing entities to certify demonstration plans; (5) establish minimum criteria for such licensed entities to use in certifying such plans; and (5) develop grievance and appeals procedures for plans denied certification. (Sec. 5045) 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. 5046) 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 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. 5047) Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a demonstration 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 veterans. Directs the Secretaries to try to include in the demonstration at least one medical center that is in the same catchment area as a closed military medical facility. Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a similar 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. Directs the Secretary of Defense to waive the enrollment fee for any Medicare-eligible military retiree or dependent enrolled in the managed care option of the TRICARE program for any period for which reimbursement is made under such a demonstration project with respect to such retiree or dependent. Chapter 6: 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 for 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) annual screening mammography for women over age 39, while providing for the waiver of coinsurance for screening mammography; (2) colorectal cancer screening tests, subject to prescribed frequency and payment limits; (3) 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 (4) bone mass measurements for qualified individuals. (Sec. 5103) 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. 5105) 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. Subtitle C: Rural Initiatives - Revises the formula for payments to sole community hospitals, in order to increase a hospital's target amount, by replacing the base cost reporting period with: (1) a hospital's cost reporting period for FY 1997; and (2) allowable operating costs of inpatient hospital services for subsequent fiscal years. Extends the target amount for Medicare- dependent, small rural hospitals. (Sec. 5153) 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 that shall be designated as a critical access hospital in accordance with prescribed guidelines. Authorizes the Secretary to award grants to States: (1) for the planning and implementation of the program; and (2) for establishment or expansion of rural emergency medical services. Authorizes appropriations. Directs the Administrator of the Health Care Financing Administration 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. 5154) 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. 5155) 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. 5156) 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 health care provider 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 health care provider providing the professional consultation is not at the same location as the health care provider 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. 5157) Directs the Secretary to conduct a demonstration project to study the use of eligible health care provider telemedicine networks to implement high-capacity computing and advanced networks to improve primary care and prevent health care complications, improve access to specialty care, and provide educational and training support to rural practitioners. Provides limited funding. Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity - Chapter 1: Revisions to Sanctions for Fraud and Abuse - 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. 5202) 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. 5203) 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; (2) any person that presents or causes to be presented to any State or Federal agency a claim for a medical or other item or service ordered or prescribed by an excluded person and the person furnishing such item or service knows or should have known of such exclusion; and (3) kickbacks. Chapter 2: Improvements in Protecting Program Integrity - Outlines various specified requirements regarding disclosure of information, surety bonds, and accreditation with regard to DME suppliers. Includes surety bond requirements for home health agencies, and provides for the application of disclosure and surety bond requirements to ambulance services and certain clinics. Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORFs) and to rehabilitation agencies. (Sec. 5212) 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. 5213) Amends SSA title XI part A (General Provisions) to provide that: (1) Medicare- and Medicaid-related actions against debtors are generally not stayed by bankruptcy proceedings; (2) certain Medicare- and Medicaid-related debts are not dischargeable in bankruptcy; and (3) the repayment of certain debts is considered final. (Sec. 5214) 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. 5219) Requires the Secretary to provide beneficiaries with an explanation of benefits that urges beneficiaries to check the 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 and review them. Requires the Secretary to take measures to recover amounts unnecessarily paid out. (Sec. 5220) 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) costs for fines and penalties resulting from violations of Federal, State, or local laws; and (3) education expenses for spouses or other dependents of service providers, their employees or contractors. (Sec. 5221) Changes from discretionary to mandatory the Secretary's authority to make lists of unnecessarily utilized items and of suppliers of items for whom the Secretary has identified a pattern of overutilization resulting from certain supplier business practices. (Sec. 5225) Authorizes the Secretary to apply to surgical dressings certain factors for determining grossly excessive payment amounts, and repeals the exemption from specified payment requirements for dressings furnished by a home health agency. Chapter 3: Clarifications and Technical Changes - Makes technical amendments with respect to fraud and abuse. Subtitle E: Prospective Payment Systems - Chapter 1: Provisions Relating to Part A - Provides for a prospective payment system (PPS) under Medicare for inpatient rehabilitation hospital services. (Sec. 5302) Directs the Secretary to submit to the Congress a legislative proposal for establishing a case-mix adjusted PPS for long-term care hospitals. Chapter 2: Provisions Relating to Part B - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 5312) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 5313) Directs the Secretary to establish a PPS for hospital outpatient department services. (Sec. 5321) 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 to carry out certain provisions with respect to the coverage of ambulance service, the Secretary may include coverage of advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. Chapter 3: Provisions Relating to Parts A and B - 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. 5332) 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 chapter and their effect on the quality of covered SNF services furnished to Medicare beneficiaries. (Sec. 5341) 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. 5342) 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. 5343) Directs the Secretary to establish a PPS for home health services for cost reporting periods beginning in FY 2000. (Sec. 5344) Bases the payment for home health services on the location where the service is furnished. (Sec. 5361) 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. 5362) Imposes a $5 co-payment for Medicare part B home health services. (Sec. 5364) 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. 5365) 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. 5366) Requires each explanation of Medicare part B benefits provided in conjunction with the payment of claims to include the total cost of home health services for which the agency or provider billed. Subtitle F: Provisions Relating to Part A - Chapter 1: Payment of PPS Hospitals - Revises requirements for PPS hospital payment updates and capital payments for PPS hospitals. Chapter 2: Payment of PPS Exempt Hospitals - Revises requirements for the payment of PPS exempt hospitals, including those for: (1) payment updates; (2) capital payments; (3) bonus and relief payments; (4) target amounts for rehabilitation hospitals, long-term care hospitals, and psychiatric hospitals; (5) treatment of certain long-term care hospitals located within other hospitals; (6) rebasing; and (7) certain cancer hospitals. Chapter 3: Graduate Medical Education Payments - 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 managed care enrollees. Makes a special reimbursement rule for primary care combined residency programs, setting the period of board eligibility. (Sec. 5452) Directs the Secretary to establish a demonstration project for making direct GME payments to qualifying consortia instead of teaching hospitals. Chapter 4: Other Hospital Payments - Directs the Secretary to make additional payments (including disproportionate share payments (DSH)) to hospitals for managed care and Medicare Choice enrollees. Revises requirements for DSH payments to hospitals serving vulnerable populations. Eliminates indirect GME and DSH payments attributable to outlier payments. Requires reductions in payments for enrollee bad debt. Increases the base payment rate to Puerto Rico hospitals. Repeals the termination date to make a permanent extension of the hemophilia passthrough. 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). Chapter 5: 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. Subtitle G: Provisions Relating to Part B Only - Chapter 1: Payments for Physicians and Other Health Care Providers - 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; (5) providing for adjustments in relative value units for 1998, and the application of resource-based methodology to malpractice relative value units; and (6) increasing Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. (Sec. 5505) Directs the Comptroller General to review and evaluate the proposed rule on resource-based methodology for practice expenses issued by the Health Care Financing Administration. Chapter 2: Other Payment Provisions - Requires a specified reduction in updates to payment amounts for clinical diagnostic laboratory tests, while lowering the cap on payment amounts. Directs the Secretary to request the Institute of Medicine of the National Academy of Sciences to study Medicare part B payments for clinical laboratory services for a report to the appropriate congressional committees. (Sec. 5522) 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. 5523) Provides for a reduction in payment amounts for items of DME. Revises requirements for payment for oxygen and oxygen equipment, ambulatory surgical services, and drugs and biologicals. Provides for a reduction in the increase for parenteral and enteral nutrients, supplies, and equipment. Directs the Secretary to establish service standards and accreditation requirements for persons seeking Medicare part B payment for the providing of oxygen and oxygen equipment to beneficiaries within their homes. Details certain studies, demonstration projects, and congressional reporting relating to access to home oxygen equipment. Directs the Secretary to conduct studies or surveys to determine the average wholesale price of any drug or biological for purposes related to their reimbursement. Requires a report to the appropriate congressional committees. Chapter 3: 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. 5542) Specifies a formula for income-related increases in the monthly Medicare part B premium. Amends the Internal Revenue Code to authorize the Secretary of the Treasury, upon the HHS Secretary's request, to disclose to Health Care Financing Administration officers and employees certain income tax return information about a taxpayer required to pay a monthly Medicare part B premium. (Sec. 5543) Directs the Secretary to conduct a demonstration project in which individuals otherwise responsible for an income- related premium under this chapter would instead be responsible for an income-related deductible using the same income limits and administrative procedures provided for. Prohibits Medigap beneficiaries from participating in such project. (Sec. 5544) Directs the Secretary to establish a program to award block grants to States for the payment of certain Medicare cost- sharing on behalf of eligible low-income Medicare beneficiaries. Authorizes the Secretary to transfer certain amounts from the Federal Supplementary Medical Insurance Trust Fund for such new program. Subtitle H: Provisions Relating to Parts A and B - Chapter 1: Secondary Payor Provisions - Revises requirements for Medicare as secondary payor. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Chapter 2: Other Provisions - Amends SSA title II (Old Age, Survivors and Disability Insurance) (OASDI) to conform the age for eligibility under Medicare to the retirement age for OASDI benefits. (Sec. 5612) Provides for an increased certification period for certain organ procurement organizations. (Sec. 5613) Amends SSA title XVIII to allow physicians or other health care professionals who do not provide items or services under the Medicare program from entering private contracts with Medicare beneficiaries for health services for which no claim for Medicare payment is to be submitted. Requires the Administrator of the Health Care Financing Administration to report to the Congress on the effect on Medicare of private contracts. Subtitle I: Miscellaneous Provisions - Provides that, with respect to inpatient hospital services on the basis of prospective rates, the large urban area of Charlotte-Gastonia-Rock Hill-North Carolina-South Carolina may be deemed to include Stanly County, North Carolina. (Sec. 5652) Declares that, with respect to certain criminal penalties for selling or issuing a health insurance policy with knowledge it duplicates Medicare or Medigap health benefits, a health insurance policy is not considered to duplicate such benefits if it: (1) provides comprehensive health care benefits that replace the benefits provided by another health insurance policy; (2) is being provided to an individual entitled to benefits under Medicare part A or enrolled under Medicare part B; and (3) coordinates against items and services available or paid for under Medicare or Medicaid, provided that Medicare or Medicaid payments shall not be treated as payments under such policy in determining annual or lifetime benefit limits. Division 2: Medicaid and Children's Health Insurance Initiatives - Subtitle I: Medicaid - Chapter 1: Medicaid Savings - Amends SSA title XIX to establish a new part B (Managed Care) giving States the option to require Medicaid-eligible, non-special needs individuals to enroll in managed care arrangements of the individual's choice as a condition of receiving Medicaid. Prescribes requirements for: (1) referral to specialty care; (2) treatment of children with special health care needs; (3) access to emergency care; (4) annual external independent review of managed care entity activities and other specified quality care assurance measures; (5) fraud and abuse prohibitions and protections; and (6) enforcement sanctions. (Sec. 5701) Requires States to permit individuals access to religiously-affiliated long-term care facilities (including out-of-network facilities) that are not pervasively sectarian and that provide nonsectarian medical care comparable to a managed care entity meeting State Medicare requirements. Requires each Medicaid managed care organization to disclose annually to enrollees the proportion of the premiums and other revenues received by the organization that are expended for non-health care items and services. Directs the Secretary and the Comptroller General to report annually to specified congressional committees on rates paid for hospital services under managed care entities. Directs the Institute of Medicine of the National Academy of Sciences to analyze 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. (Sec. 5702) Amends SSA title XIX to grant States the option of providing Medicaid coverage of primary care case management services without the need for a waiver. (Sec. 5703) Repeals the (75-25) requirement that Medicare and Medicaid beneficiaries under SSA titles XVIII and XIX, respectively, constitute less than 75 percent of the membership of a participating HMO. Repeals the prohibition on co-payments for services furnished by HMOs. (Sec. 5711) 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. 5712) Revises requirements for Medicaid payment rates for qualified Medicare beneficiaries, placing a limitation on nonparticipating providers. (Sec. 5721) 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. Chapter 2: Expansion of Medicaid Eligibility - Grants States the option to: (1) permit workers with disabilities to buy into Medicaid; and (2) provide for 12-month continuous Medicaid eligibility for children. Chapter 3: Programs of All-Inclusive Care for the Elderly (PACE) - Authorizes a State to establish a 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. Requires the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under the Medicare and Medicaid programs, specifically comparing costs, quality, and access to services by private, for-profit entities operating under demonstration project waivers with those of other PACE providers. Chapter 4: Medicaid Management and Program Reforms - Repeals: (1) the requirement that a State pay for private insurance; (2) obstetrical and pediatric payment rate and various other specified requirements; and (3) certain physician qualification requirements. Authorizes a State to impose cost-sharing for any Medicaid provided to certain individuals. (Sec. 5755) Revises a specified penalty for fraudulent eligibility. (Sec. 5756) Prohibits the expenditure of Medicaid funds for roads, bridges, stadiums, and other items and services not covered by a State plan. 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. 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. Directs the Administrator of the Health Care Financing Administration to: (1) develop mechanisms to better monitor and prevent inappropriate Medicaid payments in the case of individuals who are dually eligible for Medicaid and Medicare benefits; (2) study the use of case management or care coordination in order to improve the appropriateness, quality, and cost effectiveness of care for dually- eligible individuals; and (3) work with the States to ensure better care coordination for dual eligibles. (Sec. 5757) Requires the Secretary to study and report to the Congress on: (1) early and periodic screening, diagnostic, and treatment benefits; and (2) individuals with special health care needs and chronic conditions in capitated managed care or primary care case management plans. Chapter 5: Miscellaneous - Provides for: (1) increased Federal medical assistance percentages (FMAPs) for the District of Columbia and Alaska and increased payment caps for the territories; (2) coverage of community-based mental health services and optional coverage of certain Centers for Disease Control screened breast cancer patients; and (3) treatment of veterans pensions. (Sec. 5765) 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. 5767) Directs the Secretary to study and report to the Congress on: (1) the use of nurse aide registries by States; (2) the extent to which institutional environmental factors contribute to cases of abuse and neglect at nursing facilities; and (3) whether alternatives to current sanctions for abuse and neglect at nursing facilities might be more effective in minimizing future cases of abuse and neglect. (Sec. 5768) Deems 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. (Thus exempts 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). (Sec. 5769) Applies certain requirements to the extension of statewide comprehensive research and demonstration projects for which waivers of Medicaid compliance have been granted. Subtitle J: Children's Health Insurance Initiatives - Amends SSA to add a new title XXI (Child Health Insurance Initiatives) in order to provide funds to States to expand the provision of health insurance coverage to low-income children. Mandates coverage that is actuarially equivalent to the benefits required to be offered for a child under the Federal Employees' Health Benefits Program (FEHBP). Requires the use of funds to achieve such purpose through specified outreach activities and, at the State's option, through: (1) a grant program to provide FEHBP-equivalent children's health insurance coverage for low-income children in the State; or (2) expansion of coverage of such children under the State Medicaid program who are not otherwise required to be provided medical assistance under Medicaid. Makes appropriations to carry out this title. Directs the Secretary to establish a basic allotment pool for distribution of funds to eligible States, with provision for bonus payments, including incentive bonuses. Prohibits their use to provide health insurance coverage for families of State public employees or children in penal institutions. Allows their use for abortion only if necessary to save the life of the mother or if the pregnancy results from rape or incest. Exempts such a State program from the five-year limit on means-tested public benefits under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Division 3: Income Security and Other Provisions - Subtitle K: Income Security, Welfare-to-Work Grant Program, and Other Provisions - Chapter 1: Income Security - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 to make aliens eligible for Supplemental Security Income (SSI) who, as of the date of enactment of such Act, were: (1) receiving such benefits; or (2) disabled and lawfully residing in the United States. Includes Cuban and Haitian entrants within the definition of "qualified alien" for purposes of welfare and public benefits. (Sec. 5812) Extends from five years 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. (Sec. 5813) Exempts from: (1) SSI and Medicaid eligibility limitations certain Canadian-born American Indians who are members of an Indian tribe; and (2) SSI eligibility limitations certain SSI recipients with pre-January 1, 1979 applications. (Sec. 5816) 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. 5817) Exempts legal aliens under the age of 19 from the five-year Medicaid limitation. (Sec. 5818) Treats certain Amerasian immigrants as refugees for purposes of specified public benefits eligibility. (Sec. 5819) Makes certain severely disabled legal aliens who were denied naturalization eligible for SSI benefits. Chapter 2: Welfare-to-Work Grant Program - 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. 5821) Sets forth requirements relating to State entitlement to non-competitive grants under such program and State distribution of such funds among local governments. Provides for competitive grants, based on program effectiveness and other factors, for State-approved projects proposed by local governments. 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 and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to: (1) develop a plan to evaluate the use of such grants; and (2) submit interim and final reports to the Congress. (Sec. 5822) Revises PRWORA provisions relating to a State's ability to sanction an individual receiving assistance under the TANF program for noncompliance. Chapter 3: Unemployment Compensation - Amends SSA title IX (Employment Security) with respect to unemployment compensation to increase the Federal Unemployment Account ceiling. (Sec. 5832) Provides for a special distribution to States from the Unemployment Trust Fund. (Sec. 5833) Revises the Internal Revenue Code exclude from the definition of employment, for specified unemployment compensation purposes, any service performed by a prison inmate. Division 4: Earned Income Credit and Other Provisions - Subtitle L: Earned Income Credit and Other Provisions - Chapter 1: Earned Income Credit - Prohibits allowing the earned income credit for: (1) ten years, if the credit was found to have been fraudulently claimed; and (2) two years, if the credit was claimed with intentional or reckless disregard of the earned income credit rules. Chapter 2: Increase in Public Debt Limit - Increases the public debt limit. Chapter 3: Miscellaneous - Expresses the sense of the Senate that all cost-of-living adjustments required by statute should accurately reflect the best available estimate of changes in the cost of living. Subtitle M: Welfare Reform Technical Corrections - Welfare Reform Technical Corrections Act of 1997 - Chapter 1: Block Grants for Temporary Assistance to Needy Families - Amends part A (Temporary Assistance for Needy Families) (TANF) of title IV of the Social Security Act (SSA) to make various specified technical as well as substantive amendments with regard to sundry (welfare reform) provisions added by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRAWORA). (Sec. 5902) Provides for a later deadline for submission of State TANF plans. (Sec. 5903) Revises the computation of bonus grants to States for a decrease in illegitimacy, requiring: (1) use of calendar year instead of fiscal year data; (2) use of the ratio of out-of-wedlock births to all births instead of the number of out-of-wedlock births; and (3) that certain territories be taken into account. Revises the formula for annual reconciliation of payments to States with specified maximums. Limits to non-needy States the requirement for annual State remission of excess funds to HHS. (Sec. 5905) Revises specified mandatory work requirements. States that a family with a disabled parent shall not treated as a two-parent family. Allows the minimum work requirement for a two-parent family to be shared between both parents, if it amounts

Sponsor:

Sen. Domenici, Pete V. [R-NM] (Introduced 06/20/1997)

Summary:

Summary: S.947 — 105th Congress (1997-1998)

There are 2 summaries for this bill. Passed Senate amended (06/25/1997)Introduced in Senate (06/20/1997)     Bill summaries are authored by CRS. $("#summarySelector").congress_dropDownNavigation({ stubUrl: '/bill/105th-congress/senate-bill/947/summary', suffix: '' }); Shown Here:
Passed Senate amended (06/25/1997) TABLE OF CONTENTS: Title I: Committee on Agriculture, Nutrition, and Forestry Title II: Committee on Banking, Housing, and Urban Affairs Subtitle A: Mortgage Assignment and Annual Adjustment Factors Subtitle B: Multifamily Housing Reform Title III: Committee on Commerce Science and Transportation Subtitle A: Spectrum Auctions and License Fees Subtitle B: Merchant Marine Provisions Title IV: Committee on Energy and Natural Resources Title V: Committee on Finance Division 1: Medicare 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: Prospective Payment Systems Subtitle F: Provisions Relating to Part A Subtitle G: Provisions Relating to Part B Only Subtitle H: Provisions Relating to Parts A and B Division 2: Medicaid and Childrens' Health Insurance Initiatives Subtitle I: Medicaid Subtitle J: Children's Health Insurance Initiatives Division 3: Income Security and Other Provisions Subtitle K: Income Security, Welfare-to-Work Grant Program, and Other Provisions Division 4: Earned Income Credit and Other Provisions Subtitle L: Earned Income Credit and Other Provisions Subtitle M: Welfare Reform Technical Corrections Title VI: Committee on Governmental Affairs Subtitle A: Civil Service and Postal Provisions Subtitle B: GSA Property Sales Title VII: Committee on Labor and Human Resources Title VIII: Committee on Veterans' Affairs Subtitle A: Extension of Temporary Authorities Subtitle B: Copayments and Medical Care Cost Recovery Subtitle C: Other Matters Balanced Budget Act of 1997 - Title I: Committee on Agriculture, Nutrition, and Forestry - Amends the Food Stamp Act to define "caseload" and "covered individual." Authorizes State agencies to provide an additional 15 percent hardship 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: Committee on Banking, Housing, and Urban Affairs - Subtitle A: Mortgage Assignment and Annual Adjustment Factors - Amends the Balanced Budget Downpayment Act, I to extend permanently certain foreclosure avoidance and borrower assistance provisions under the single family housing mortgage insurance program. (Sec. 2003) Amends the United States Housing Act of 1937 with respect to the section 8 rental assistance program to make certain maximum monthly rent adjustment provisions for certain new and rehabilitated and nonturnover units applicable to FY 1999 and thereafter. Subtitle B: Multifamily Housing Reform - Multifamily Assisted Housing Reform and Affordability Act of 1997 - Part 1: FHA-Insured Multifamily Housing Mortgage and Housing Assistance Restructuring - Directs the Secretary (Secretary) of Housing and Urban Development to enter into agreements with participating administrative entities (with preference given to State housing finance agencies) to develop and implement mortgage restructuring and rental assistance plans for FHA-insured multifamily housing mortgages in order to: (1) reduce expiring section 8 contracts costs; (2) address troubled projects; and (3) correct management and ownership deficiencies. Includes two-tiered mortgage restructuring among plan incentives. Terminates program authority as of October 1, 2001. Part 2: Miscellaneous Provisions - Amends the National Housing Act to authorize the Secretary to make rehabilitation grants for certain insured projects. (Sec. 2203) Repeals specified Federal housing preference provisions under the United States Housing Act of 1937, the Cranston- Gonzalez National Affordable Housing Act, the Housing and Urban Development Act of 1965, the Low-Income Housing Preservation and Resident Homeownership Act of 1990, and the Housing and Community Development Act of 1992. Part 3: Enforcement Provisions - Directs the Secretary to issue implementing regulations. Subpart A: FHA Single Family and Multifamily Housing - Amends the National Housing Act to expand HUD authorities with respect to: (1) lender sanctions; (2) equity skimming; and (3) civil money penalties. Subpart B: FHA Multifamily Provisions - Amends the National Housing Act and the Housing Act of 1937 to expand multifamily housing-related civil money penalties. (Sec. 2322) Amends the Housing and Community Development Act of 1987 to extend the double damages remedy. Title III: Committee on Commerce Science and Transportation - Subtitle A: Spectrum Auctions and License Fees - Amends the Communications Act of 1934 (the Act) to revise provisions regarding competitive bidding for use of the electromagnetic spectrum to authorize the Federal Communications Commission (FCC) to use auctions as a means to assign spectrum. Makes competitive bidding authority inapplicable to licenses or construction permits issued for: (1) public safety services; (2) public telecommunications services when the license application is for channels reserved for noncommercial use; (3) spectrum and associated orbits used within global satellite systems; (4) new digital television (TV) service given to existing terrestrial broadcast licensees to replace current licenses; (5) terrestrial radio and TV broadcasting when the FCC determines that an alternative method of resolving mutually exclusive applications serves the public interest better than competitive bidding; or (6) spectrum allocated for specified unlicensed use if competitive bidding would interfere with operation of end-user products. Extends competitive bidding authority through FY 2007. Requires the FCC, by the end of 2001, to assign by competitive bidding 45 megahertz (mhz.) located at 1,710-1,755 mhz. for commercial use. Provides that Federal Government stations assigned to use such band shall retain use until the end of 2003 unless exempted from relocation. Directs the FCC, by the end of FY 2002, to permit the assignment by competitive bidding of licenses for the use of currently allocated bands of frequencies that: (1) in the aggregate span not less than 55 mhz.; (2) are located below three gigahertz (ghz.); and (3) have not been designated for assignment, identified by the Secretary of Commerce as reallocable frequencies pursuant to the National Telecommunications and Information Administration Organization Act, or allocated for Federal Government use. Requires the FCC to attempt to accommodate displaced licensees by relocating them to other frequencies and notify the Secretary whenever unable to provide for effective relocation. Amends the National Telecommunications and Information Administration Organization Act to require the Secretary of Commerce to make specified recommendations, upon receiving a report from the FCC on inability to accommodate displaced licensees, for purposes of reassigning such licensees to frequencies allocated for Government use. Sets forth requirements regarding: (1) the reimbursement of Federal spectrum users for relocation costs; (2) petitions by persons seeking to relocate Federal stations; and (3) Federal rights to reclaim reallocated spectrum. Directs the Secretary to make available for reallocation from Federal frequencies 20 mhz. located below three ghz. (Sec. 3002) Amends the Act to prohibit, under competitive bidding provisions, the renewal of a license authorizing analog TV services beyond the end of 2006. Extends or waives this deadline for a station in any TV market unless 95 percent of the TV households have access to digital local TV signals. Provides that commercial digital TV licenses shall expire at the end of FY 2003. Directs the FCC to report biennially to the Congress on the status of digital TV conversion in each TV market. Sets forth requirements with respect to the resale of, and competitive bidding for, spectrum previously used for the broadcast of analog TV. Directs the FCC to report the total revenues from such bidding by January 1, 2002. (Sec. 3003) Directs the FCC, no later than January 1, 1998, to allocate from the electromagnetic spectrum between 746 and 806 mhz.: (1) 24 mhz. for public safety services; and (2) 36 mhz. for commercial purposes to be assigned by competitive bidding. (Sec. 3005) Requires the FCC, in any auction for any license, permit, or right which has value, to set a reasonable reserve price for each unit in the auction unless it is not in the public interest to do so. Provides that the reserve price shall establish a minimum bid for the unit to be auctioned. Retains units for which no bid above the reserve price is received. Directs the FCC to reassess reserve prices for such units and place them in the next appropriate auction. Subtitle B: Merchant Marine Provisions - Extends through FY 2002 the current tonnage duties imposed upon foreign vessels entering into U.S. ports. Title IV: Committee on Energy and Natural Resources - Amends the Energy Policy and Conservation Act to authorize the Secretary of Energy to store foreign-owned petroleum products in underutilized Strategic Petroleum Reserve (SPR) facilities, subject to the following conditions: (1) funds resulting from the leasing or other use of an SPR facility after October 1, 2007, shall be available to the Secretary, without further appropriation, for SPR petroleum product purchases; (2) such stored petroleum product is neither part of the SPR, nor subject to the contracting requirements governing petroleum product not owned by the United States; and (3) such product may be exported. Title V: Committee on Finance - 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 under title XIX of the Social Security Act (SSA). Division 1: Medicare - 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 traditional Medicare fee-for- service program or through a Medicare Choice plan. (Sec. 5001) Outlines the types of Medicare Choice plans that may be available, including: (1) fee-for-service plans; (2) plans offered by preferred provider organizations; (3) point of service plans; (4) plans offered by provider-sponsored organizations; (5) plans offered by health maintenance organizations; and (6) a combination of MSA (Medicare Choice savings account) plan and contributions to Medicare Choice MSA. 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 provide for broad dissemination of coverage option and comparison information to Medicare beneficiaries and prospective Medicare beneficiaries. Directs the Secretary to 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 any Medicare Choice organization to accept without restrictions individuals eligible to make an election at any time during which such elections are accepted. Requires the approval of Medicare Choice marketing material and application forms before they are distributed. 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 and specified additional benefits, as well, at its option, as certain supplemental benefits, subject to the Secretary's approval. 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. Requires each Medicare Choice organization, at an enrollee's request, to disclose annually the proportion of the premiums and other revenues received by the organization that are expended for non-health care items and services. Outlines a mechanism for grievances and appeals. Sets forth certain payment rules for providers not participating in the MedicarePlus (sic) 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. Directs the Secretary and the Medicare Payment Advisory Commission to each study and report to the Congress on appropriate measures for adjusting the annual Medicare Choice capitation rates to reflect local price indicators. 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. Details rules for the submission and charging of premiums by each Medicare Choice organization. Sets limitations on enrollee cost- sharing for basic, additional, and supplemental benefits, except for MSA plans and unrestricted fee-for-service plans. Requires the Secretary to audit each year the financial records of at least one- third of the Medicare Choice organizations offering Medicare Choice plans. Prohibits a State from imposing a premium tax or similar tax with respect to payments on Medicare Choice plans or the offering of such plans. 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. 5002) 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. 5006) 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: Integrated Long-Term Care Programs - Amends SSA title XVIII to provide for 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. 5013) 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. (Sec. 5015) 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. 5018) 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 and make appropriate recommendations to restore such integrity through the year 2030; and (3) analyze potential solutions to the problems identified that will ensure both the financial integrity of Medicare and the provision of appropriate benefits under such program, including the extent to which current Medicare update indexes do not accurately reflect inflation. 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 through the year 2030; 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. 5022) 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. 5031) 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. Provides for extending the six-month initial enrollment period under the Medicare supplemental policy program to non-elderly Medicare beneficiaries. (Sec. 5032) 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 before the policy begins payment of benefits. Chapter 5: Demonstrations - Directs the Secretary to conduct demonstration projects in ten urban areas where less than 25 percent of the Medicare beneficiaries are enrolled with an eligible HMO, as well as three rural areas, which are to be treated as Medicare Choice payment areas. Requires such projects to: (1) apply a pricing methodology for payments to Medicare Choice organizations using a specified competitive market approach; (2) apply a benefit structure and beneficiary premium structure specified in this chapter; (3) apply specified information and quality programs; and (4) evaluate the effects of the methodology and structures on Medicare fee-for-service spending under Medicare parts A and B in the project area. Requires the Secretary to report on the project to the President, and the President to report to the Congress any legislative recommendations for extending the project to the entire Medicare population. (Sec. 5042) Provides that, in the case of a Medicare Choice payment area in which such a project is being conducted, the annual Medicare Choice capitation rate shall be the standardized payment amount determined according to prescribed guidelines rather than the amount determined under the Medicare Choice program. Establishes within HHS the Office of Competition to administer Medicare Choice competitive pricing demonstrations. (Sec. 5043) Outlines benefits and beneficiary premiums under Medicare Choice competitive pricing demonstrations, which include, respectively, those items and services traditionally covered under Medicare plus prescription drugs as well as any optional supplemental benefits the demonstration plan offers, and certain cost-sharing obligations. (Sec. 5044) Details information and comparative reports the Secretary shall require to be used in a Medicare Choice demonstration plan under this chapter in lieu of those required under chapter 1. (Sec. 5044B) Establishes the Quality Advisory Institute to make recommendations to the Director of the Office of Competition concerning licensing and certification criteria and comparative measurement methods with regard to demonstration plans. Requires the Director to: (1) advise the President and the Congress on health insurance and health care provided under demonstration plans, recommending measures to protect the health of all enrollees in demonstration plans; (2) ensure that a demonstration plan may not be offered unless it has been certified in accordance with specified requirements; (3) establish a program to reward demonstration plans for meeting or exceeding quality targets; (4) develop procedures for licensing entities to certify demonstration plans; (5) establish minimum criteria for such licensed entities to use in certifying such plans; and (5) develop grievance and appeals procedures for plans denied certification. (Sec. 5045) 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. 5046) 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 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. 5047) Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a demonstration 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 veterans. Directs the Secretaries to try to include in the demonstration at least one medical center that is in the same catchment area as a closed military medical facility. Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a similar 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. Directs the Secretary of Defense to waive the enrollment fee for any Medicare-eligible military retiree or dependent enrolled in the managed care option of the TRICARE program for any period for which reimbursement is made under such a demonstration project with respect to such retiree or dependent. Chapter 6: 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 for 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) annual screening mammography for women over age 39, while providing for the waiver of coinsurance for screening mammography; (2) colorectal cancer screening tests, subject to prescribed frequency and payment limits; (3) 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 (4) bone mass measurements for qualified individuals. (Sec. 5103) 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. 5105) 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. Subtitle C: Rural Initiatives - Revises the formula for payments to sole community hospitals, in order to increase a hospital's target amount, by replacing the base cost reporting period with: (1) a hospital's cost reporting period for FY 1997; and (2) allowable operating costs of inpatient hospital services for subsequent fiscal years. Extends the target amount for Medicare- dependent, small rural hospitals. (Sec. 5153) 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 that shall be designated as a critical access hospital in accordance with prescribed guidelines. Authorizes the Secretary to award grants to States: (1) for the planning and implementation of the program; and (2) for establishment or expansion of rural emergency medical services. Authorizes appropriations. Directs the Administrator of the Health Care Financing Administration 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. 5154) 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. 5155) 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. 5156) 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 health care provider 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 health care provider providing the professional consultation is not at the same location as the health care provider 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. 5157) Directs the Secretary to conduct a demonstration project to study the use of eligible health care provider telemedicine networks to implement high-capacity computing and advanced networks to improve primary care and prevent health care complications, improve access to specialty care, and provide educational and training support to rural practitioners. Provides limited funding. Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity - Chapter 1: Revisions to Sanctions for Fraud and Abuse - 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. 5202) 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. 5203) 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; (2) any person that presents or causes to be presented to any State or Federal agency a claim for a medical or other item or service ordered or prescribed by an excluded person and the person furnishing such item or service knows or should have known of such exclusion; and (3) kickbacks. Chapter 2: Improvements in Protecting Program Integrity - Outlines various specified requirements regarding disclosure of information, surety bonds, and accreditation with regard to DME suppliers. Includes surety bond requirements for home health agencies, and provides for the application of disclosure and surety bond requirements to ambulance services and certain clinics. Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORFs) and to rehabilitation agencies. (Sec. 5212) 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. 5213) Amends SSA title XI part A (General Provisions) to provide that: (1) Medicare- and Medicaid-related actions against debtors are generally not stayed by bankruptcy proceedings; (2) certain Medicare- and Medicaid-related debts are not dischargeable in bankruptcy; and (3) the repayment of certain debts is considered final. (Sec. 5214) 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. 5219) Requires the Secretary to provide beneficiaries with an explanation of benefits that urges beneficiaries to check the 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 and review them. Requires the Secretary to take measures to recover amounts unnecessarily paid out. (Sec. 5220) 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) costs for fines and penalties resulting from violations of Federal, State, or local laws; and (3) education expenses for spouses or other dependents of service providers, their employees or contractors. (Sec. 5221) Changes from discretionary to mandatory the Secretary's authority to make lists of unnecessarily utilized items and of suppliers of items for whom the Secretary has identified a pattern of overutilization resulting from certain supplier business practices. (Sec. 5225) Authorizes the Secretary to apply to surgical dressings certain factors for determining grossly excessive payment amounts, and repeals the exemption from specified payment requirements for dressings furnished by a home health agency. Chapter 3: Clarifications and Technical Changes - Makes technical amendments with respect to fraud and abuse. Subtitle E: Prospective Payment Systems - Chapter 1: Provisions Relating to Part A - Provides for a prospective payment system (PPS) under Medicare for inpatient rehabilitation hospital services. (Sec. 5302) Directs the Secretary to submit to the Congress a legislative proposal for establishing a case-mix adjusted PPS for long-term care hospitals. Chapter 2: Provisions Relating to Part B - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 5312) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 5313) Directs the Secretary to establish a PPS for hospital outpatient department services. (Sec. 5321) 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 to carry out certain provisions with respect to the coverage of ambulance service, the Secretary may include coverage of advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. Chapter 3: Provisions Relating to Parts A and B - 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. 5332) 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 chapter and their effect on the quality of covered SNF services furnished to Medicare beneficiaries. (Sec. 5341) 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. 5342) 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. 5343) Directs the Secretary to establish a PPS for home health services for cost reporting periods beginning in FY 2000. (Sec. 5344) Bases the payment for home health services on the location where the service is furnished. (Sec. 5361) 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. 5362) Imposes a $5 co-payment for Medicare part B home health services. (Sec. 5364) 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. 5365) 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. 5366) Requires each explanation of Medicare part B benefits provided in conjunction with the payment of claims to include the total cost of home health services for which the agency or provider billed. Subtitle F: Provisions Relating to Part A - Chapter 1: Payment of PPS Hospitals - Revises requirements for PPS hospital payment updates and capital payments for PPS hospitals. Chapter 2: Payment of PPS Exempt Hospitals - Revises requirements for the payment of PPS exempt hospitals, including those for: (1) payment updates; (2) capital payments; (3) bonus and relief payments; (4) target amounts for rehabilitation hospitals, long-term care hospitals, and psychiatric hospitals; (5) treatment of certain long-term care hospitals located within other hospitals; (6) rebasing; and (7) certain cancer hospitals. Chapter 3: Graduate Medical Education Payments - 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 managed care enrollees. Makes a special reimbursement rule for primary care combined residency programs, setting the period of board eligibility. (Sec. 5452) Directs the Secretary to establish a demonstration project for making direct GME payments to qualifying consortia instead of teaching hospitals. Chapter 4: Other Hospital Payments - Directs the Secretary to make additional payments (including disproportionate share payments (DSH)) to hospitals for managed care and Medicare Choice enrollees. Revises requirements for DSH payments to hospitals serving vulnerable populations. Eliminates indirect GME and DSH payments attributable to outlier payments. Requires reductions in payments for enrollee bad debt. Increases the base payment rate to Puerto Rico hospitals. Repeals the termination date to make a permanent extension of the hemophilia passthrough. 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). Chapter 5: 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. Subtitle G: Provisions Relating to Part B Only - Chapter 1: Payments for Physicians and Other Health Care Providers - 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; (5) providing for adjustments in relative value units for 1998, and the application of resource-based methodology to malpractice relative value units; and (6) increasing Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. (Sec. 5505) Directs the Comptroller General to review and evaluate the proposed rule on resource-based methodology for practice expenses issued by the Health Care Financing Administration. Chapter 2: Other Payment Provisions - Requires a specified reduction in updates to payment amounts for clinical diagnostic laboratory tests, while lowering the cap on payment amounts. Directs the Secretary to request the Institute of Medicine of the National Academy of Sciences to study Medicare part B payments for clinical laboratory services for a report to the appropriate congressional committees. (Sec. 5522) 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. 5523) Provides for a reduction in payment amounts for items of DME. Revises requirements for payment for oxygen and oxygen equipment, ambulatory surgical services, and drugs and biologicals. Provides for a reduction in the increase for parenteral and enteral nutrients, supplies, and equipment. Directs the Secretary to establish service standards and accreditation requirements for persons seeking Medicare part B payment for the providing of oxygen and oxygen equipment to beneficiaries within their homes. Details certain studies, demonstration projects, and congressional reporting relating to access to home oxygen equipment. Directs the Secretary to conduct studies or surveys to determine the average wholesale price of any drug or biological for purposes related to their reimbursement. Requires a report to the appropriate congressional committees. Chapter 3: 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. 5542) Specifies a formula for income-related increases in the monthly Medicare part B premium. Amends the Internal Revenue Code to authorize the Secretary of the Treasury, upon the HHS Secretary's request, to disclose to Health Care Financing Administration officers and employees certain income tax return information about a taxpayer required to pay a monthly Medicare part B premium. (Sec. 5543) Directs the Secretary to conduct a demonstration project in which individuals otherwise responsible for an income- related premium under this chapter would instead be responsible for an income-related deductible using the same income limits and administrative procedures provided for. Prohibits Medigap beneficiaries from participating in such project. (Sec. 5544) Directs the Secretary to establish a program to award block grants to States for the payment of certain Medicare cost- sharing on behalf of eligible low-income Medicare beneficiaries. Authorizes the Secretary to transfer certain amounts from the Federal Supplementary Medical Insurance Trust Fund for such new program. Subtitle H: Provisions Relating to Parts A and B - Chapter 1: Secondary Payor Provisions - Revises requirements for Medicare as secondary payor. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Chapter 2: Other Provisions - Amends SSA title II (Old Age, Survivors and Disability Insurance) (OASDI) to conform the age for eligibility under Medicare to the retirement age for OASDI benefits. (Sec. 5612) Provides for an increased certification period for certain organ procurement organizations. (Sec. 5613) Amends SSA title XVIII to allow physicians or other health care professionals who do not provide items or services under the Medicare program from entering private contracts with Medicare beneficiaries for health services for which no claim for Medicare payment is to be submitted. Requires the Administrator of the Health Care Financing Administration to report to the Congress on the effect on Medicare of private contracts. Subtitle I: Miscellaneous Provisions - Provides that, with respect to inpatient hospital services on the basis of prospective rates, the large urban area of Charlotte-Gastonia-Rock Hill-North Carolina-South Carolina may be deemed to include Stanly County, North Carolina. (Sec. 5652) Declares that, with respect to certain criminal penalties for selling or issuing a health insurance policy with knowledge it duplicates Medicare or Medigap health benefits, a health insurance policy is not considered to duplicate such benefits if it: (1) provides comprehensive health care benefits that replace the benefits provided by another health insurance policy; (2) is being provided to an individual entitled to benefits under Medicare part A or enrolled under Medicare part B; and (3) coordinates against items and services available or paid for under Medicare or Medicaid, provided that Medicare or Medicaid payments shall not be treated as payments under such policy in determining annual or lifetime benefit limits. Division 2: Medicaid and Children's Health Insurance Initiatives - Subtitle I: Medicaid - Chapter 1: Medicaid Savings - Amends SSA title XIX to establish a new part B (Managed Care) giving States the option to require Medicaid-eligible, non-special needs individuals to enroll in managed care arrangements of the individual's choice as a condition of receiving Medicaid. Prescribes requirements for: (1) referral to specialty care; (2) treatment of children with special health care needs; (3) access to emergency care; (4) annual external independent review of managed care entity activities and other specified quality care assurance measures; (5) fraud and abuse prohibitions and protections; and (6) enforcement sanctions. (Sec. 5701) Requires States to permit individuals access to religiously-affiliated long-term care facilities (including out-of-network facilities) that are not pervasively sectarian and that provide nonsectarian medical care comparable to a managed care entity meeting State Medicare requirements. Requires each Medicaid managed care organization to disclose annually to enrollees the proportion of the premiums and other revenues received by the organization that are expended for non-health care items and services. Directs the Secretary and the Comptroller General to report annually to specified congressional committees on rates paid for hospital services under managed care entities. Directs the Institute of Medicine of the National Academy of Sciences to analyze 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. (Sec. 5702) Amends SSA title XIX to grant States the option of providing Medicaid coverage of primary care case management services without the need for a waiver. (Sec. 5703) Repeals the (75-25) requirement that Medicare and Medicaid beneficiaries under SSA titles XVIII and XIX, respectively, constitute less than 75 percent of the membership of a participating HMO. Repeals the prohibition on co-payments for services furnished by HMOs. (Sec. 5711) 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. 5712) Revises requirements for Medicaid payment rates for qualified Medicare beneficiaries, placing a limitation on nonparticipating providers. (Sec. 5721) 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. Chapter 2: Expansion of Medicaid Eligibility - Grants States the option to: (1) permit workers with disabilities to buy into Medicaid; and (2) provide for 12-month continuous Medicaid eligibility for children. Chapter 3: Programs of All-Inclusive Care for the Elderly (PACE) - Authorizes a State to establish a 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. Requires the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under the Medicare and Medicaid programs, specifically comparing costs, quality, and access to services by private, for-profit entities operating under demonstration project waivers with those of other PACE providers. Chapter 4: Medicaid Management and Program Reforms - Repeals: (1) the requirement that a State pay for private insurance; (2) obstetrical and pediatric payment rate and various other specified requirements; and (3) certain physician qualification requirements. Authorizes a State to impose cost-sharing for any Medicaid provided to certain individuals. (Sec. 5755) Revises a specified penalty for fraudulent eligibility. (Sec. 5756) Prohibits the expenditure of Medicaid funds for roads, bridges, stadiums, and other items and services not covered by a State plan. 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. 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. Directs the Administrator of the Health Care Financing Administration to: (1) develop mechanisms to better monitor and prevent inappropriate Medicaid payments in the case of individuals who are dually eligible for Medicaid and Medicare benefits; (2) study the use of case management or care coordination in order to improve the appropriateness, quality, and cost effectiveness of care for dually- eligible individuals; and (3) work with the States to ensure better care coordination for dual eligibles. (Sec. 5757) Requires the Secretary to study and report to the Congress on: (1) early and periodic screening, diagnostic, and treatment benefits; and (2) individuals with special health care needs and chronic conditions in capitated managed care or primary care case management plans. Chapter 5: Miscellaneous - Provides for: (1) increased Federal medical assistance percentages (FMAPs) for the District of Columbia and Alaska and increased payment caps for the territories; (2) coverage of community-based mental health services and optional coverage of certain Centers for Disease Control screened breast cancer patients; and (3) treatment of veterans pensions. (Sec. 5765) 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. 5767) Directs the Secretary to study and report to the Congress on: (1) the use of nurse aide registries by States; (2) the extent to which institutional environmental factors contribute to cases of abuse and neglect at nursing facilities; and (3) whether alternatives to current sanctions for abuse and neglect at nursing facilities might be more effective in minimizing future cases of abuse and neglect. (Sec. 5768) Deems 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. (Thus exempts 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). (Sec. 5769) Applies certain requirements to the extension of statewide comprehensive research and demonstration projects for which waivers of Medicaid compliance have been granted. Subtitle J: Children's Health Insurance Initiatives - Amends SSA to add a new title XXI (Child Health Insurance Initiatives) in order to provide funds to States to expand the provision of health insurance coverage to low-income children. Mandates coverage that is actuarially equivalent to the benefits required to be offered for a child under the Federal Employees' Health Benefits Program (FEHBP). Requires the use of funds to achieve such purpose through specified outreach activities and, at the State's option, through: (1) a grant program to provide FEHBP-equivalent children's health insurance coverage for low-income children in the State; or (2) expansion of coverage of such children under the State Medicaid program who are not otherwise required to be provided medical assistance under Medicaid. Makes appropriations to carry out this title. Directs the Secretary to establish a basic allotment pool for distribution of funds to eligible States, with provision for bonus payments, including incentive bonuses. Prohibits their use to provide health insurance coverage for families of State public employees or children in penal institutions. Allows their use for abortion only if necessary to save the life of the mother or if the pregnancy results from rape or incest. Exempts such a State program from the five-year limit on means-tested public benefits under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Division 3: Income Security and Other Provisions - Subtitle K: Income Security, Welfare-to-Work Grant Program, and Other Provisions - Chapter 1: Income Security - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 to make aliens eligible for Supplemental Security Income (SSI) who, as of the date of enactment of such Act, were: (1) receiving such benefits; or (2) disabled and lawfully residing in the United States. Includes Cuban and Haitian entrants within the definition of "qualified alien" for purposes of welfare and public benefits. (Sec. 5812) Extends from five years 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. (Sec. 5813) Exempts from: (1) SSI and Medicaid eligibility limitations certain Canadian-born American Indians who are members of an Indian tribe; and (2) SSI eligibility limitations certain SSI recipients with pre-January 1, 1979 applications. (Sec. 5816) 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. 5817) Exempts legal aliens under the age of 19 from the five-year Medicaid limitation. (Sec. 5818) Treats certain Amerasian immigrants as refugees for purposes of specified public benefits eligibility. (Sec. 5819) Makes certain severely disabled legal aliens who were denied naturalization eligible for SSI benefits. Chapter 2: Welfare-to-Work Grant Program - 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. 5821) Sets forth requirements relating to State entitlement to non-competitive grants under such program and State distribution of such funds among local governments. Provides for competitive grants, based on program effectiveness and other factors, for State-approved projects proposed by local governments. 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 and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to: (1) develop a plan to evaluate the use of such grants; and (2) submit interim and final reports to the Congress. (Sec. 5822) Revises PRWORA provisions relating to a State's ability to sanction an individual receiving assistance under the TANF program for noncompliance. Chapter 3: Unemployment Compensation - Amends SSA title IX (Employment Security) with respect to unemployment compensation to increase the Federal Unemployment Account ceiling. (Sec. 5832) Provides for a special distribution to States from the Unemployment Trust Fund. (Sec. 5833) Revises the Internal Revenue Code exclude from the definition of employment, for specified unemployment compensation purposes, any service performed by a prison inmate. Division 4: Earned Income Credit and Other Provisions - Subtitle L: Earned Income Credit and Other Provisions - Chapter 1: Earned Income Credit - Prohibits allowing the earned income credit for: (1) ten years, if the credit was found to have been fraudulently claimed; and (2) two years, if the credit was claimed with intentional or reckless disregard of the earned income credit rules. Chapter 2: Increase in Public Debt Limit - Increases the public debt limit. Chapter 3: Miscellaneous - Expresses the sense of the Senate that all cost-of-living adjustments required by statute should accurately reflect the best available estimate of changes in the cost of living. Subtitle M: Welfare Reform Technical Corrections - Welfare Reform Technical Corrections Act of 1997 - Chapter 1: Block Grants for Temporary Assistance to Needy Families - Amends part A (Temporary Assistance for Needy Families) (TANF) of title IV of the Social Security Act (SSA) to make various specified technical as well as substantive amendments with regard to sundry (welfare reform) provisions added by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRAWORA). (Sec. 5902) Provides for a later deadline for submission of State TANF plans. (Sec. 5903) Revises the computation of bonus grants to States for a decrease in illegitimacy, requiring: (1) use of calendar year instead of fiscal year data; (2) use of the ratio of out-of-wedlock births to all births instead of the number of out-of-wedlock births; and (3) that certain territories be taken into account. Revises the formula for annual reconciliation of payments to States with specified maximums. Limits to non-needy States the requirement for annual State remission of excess funds to HHS. (Sec. 5905) Revises specified mandatory work requirements. States that a family with a disabled parent shall not treated as a two-parent family. Allows the minimum work req

Major Actions:

Summary: S.947 — 105th Congress (1997-1998)

There are 2 summaries for this bill. Passed Senate amended (06/25/1997)Introduced in Senate (06/20/1997)     Bill summaries are authored by CRS. $("#summarySelector").congress_dropDownNavigation({ stubUrl: '/bill/105th-congress/senate-bill/947/summary', suffix: '' }); Shown Here:
Passed Senate amended (06/25/1997) TABLE OF CONTENTS: Title I: Committee on Agriculture, Nutrition, and Forestry Title II: Committee on Banking, Housing, and Urban Affairs Subtitle A: Mortgage Assignment and Annual Adjustment Factors Subtitle B: Multifamily Housing Reform Title III: Committee on Commerce Science and Transportation Subtitle A: Spectrum Auctions and License Fees Subtitle B: Merchant Marine Provisions Title IV: Committee on Energy and Natural Resources Title V: Committee on Finance Division 1: Medicare 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: Prospective Payment Systems Subtitle F: Provisions Relating to Part A Subtitle G: Provisions Relating to Part B Only Subtitle H: Provisions Relating to Parts A and B Division 2: Medicaid and Childrens' Health Insurance Initiatives Subtitle I: Medicaid Subtitle J: Children's Health Insurance Initiatives Division 3: Income Security and Other Provisions Subtitle K: Income Security, Welfare-to-Work Grant Program, and Other Provisions Division 4: Earned Income Credit and Other Provisions Subtitle L: Earned Income Credit and Other Provisions Subtitle M: Welfare Reform Technical Corrections Title VI: Committee on Governmental Affairs Subtitle A: Civil Service and Postal Provisions Subtitle B: GSA Property Sales Title VII: Committee on Labor and Human Resources Title VIII: Committee on Veterans' Affairs Subtitle A: Extension of Temporary Authorities Subtitle B: Copayments and Medical Care Cost Recovery Subtitle C: Other Matters Balanced Budget Act of 1997 - Title I: Committee on Agriculture, Nutrition, and Forestry - Amends the Food Stamp Act to define "caseload" and "covered individual." Authorizes State agencies to provide an additional 15 percent hardship 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: Committee on Banking, Housing, and Urban Affairs - Subtitle A: Mortgage Assignment and Annual Adjustment Factors - Amends the Balanced Budget Downpayment Act, I to extend permanently certain foreclosure avoidance and borrower assistance provisions under the single family housing mortgage insurance program. (Sec. 2003) Amends the United States Housing Act of 1937 with respect to the section 8 rental assistance program to make certain maximum monthly rent adjustment provisions for certain new and rehabilitated and nonturnover units applicable to FY 1999 and thereafter. Subtitle B: Multifamily Housing Reform - Multifamily Assisted Housing Reform and Affordability Act of 1997 - Part 1: FHA-Insured Multifamily Housing Mortgage and Housing Assistance Restructuring - Directs the Secretary (Secretary) of Housing and Urban Development to enter into agreements with participating administrative entities (with preference given to State housing finance agencies) to develop and implement mortgage restructuring and rental assistance plans for FHA-insured multifamily housing mortgages in order to: (1) reduce expiring section 8 contracts costs; (2) address troubled projects; and (3) correct management and ownership deficiencies. Includes two-tiered mortgage restructuring among plan incentives. Terminates program authority as of October 1, 2001. Part 2: Miscellaneous Provisions - Amends the National Housing Act to authorize the Secretary to make rehabilitation grants for certain insured projects. (Sec. 2203) Repeals specified Federal housing preference provisions under the United States Housing Act of 1937, the Cranston- Gonzalez National Affordable Housing Act, the Housing and Urban Development Act of 1965, the Low-Income Housing Preservation and Resident Homeownership Act of 1990, and the Housing and Community Development Act of 1992. Part 3: Enforcement Provisions - Directs the Secretary to issue implementing regulations. Subpart A: FHA Single Family and Multifamily Housing - Amends the National Housing Act to expand HUD authorities with respect to: (1) lender sanctions; (2) equity skimming; and (3) civil money penalties. Subpart B: FHA Multifamily Provisions - Amends the National Housing Act and the Housing Act of 1937 to expand multifamily housing-related civil money penalties. (Sec. 2322) Amends the Housing and Community Development Act of 1987 to extend the double damages remedy. Title III: Committee on Commerce Science and Transportation - Subtitle A: Spectrum Auctions and License Fees - Amends the Communications Act of 1934 (the Act) to revise provisions regarding competitive bidding for use of the electromagnetic spectrum to authorize the Federal Communications Commission (FCC) to use auctions as a means to assign spectrum. Makes competitive bidding authority inapplicable to licenses or construction permits issued for: (1) public safety services; (2) public telecommunications services when the license application is for channels reserved for noncommercial use; (3) spectrum and associated orbits used within global satellite systems; (4) new digital television (TV) service given to existing terrestrial broadcast licensees to replace current licenses; (5) terrestrial radio and TV broadcasting when the FCC determines that an alternative method of resolving mutually exclusive applications serves the public interest better than competitive bidding; or (6) spectrum allocated for specified unlicensed use if competitive bidding would interfere with operation of end-user products. Extends competitive bidding authority through FY 2007. Requires the FCC, by the end of 2001, to assign by competitive bidding 45 megahertz (mhz.) located at 1,710-1,755 mhz. for commercial use. Provides that Federal Government stations assigned to use such band shall retain use until the end of 2003 unless exempted from relocation. Directs the FCC, by the end of FY 2002, to permit the assignment by competitive bidding of licenses for the use of currently allocated bands of frequencies that: (1) in the aggregate span not less than 55 mhz.; (2) are located below three gigahertz (ghz.); and (3) have not been designated for assignment, identified by the Secretary of Commerce as reallocable frequencies pursuant to the National Telecommunications and Information Administration Organization Act, or allocated for Federal Government use. Requires the FCC to attempt to accommodate displaced licensees by relocating them to other frequencies and notify the Secretary whenever unable to provide for effective relocation. Amends the National Telecommunications and Information Administration Organization Act to require the Secretary of Commerce to make specified recommendations, upon receiving a report from the FCC on inability to accommodate displaced licensees, for purposes of reassigning such licensees to frequencies allocated for Government use. Sets forth requirements regarding: (1) the reimbursement of Federal spectrum users for relocation costs; (2) petitions by persons seeking to relocate Federal stations; and (3) Federal rights to reclaim reallocated spectrum. Directs the Secretary to make available for reallocation from Federal frequencies 20 mhz. located below three ghz. (Sec. 3002) Amends the Act to prohibit, under competitive bidding provisions, the renewal of a license authorizing analog TV services beyond the end of 2006. Extends or waives this deadline for a station in any TV market unless 95 percent of the TV households have access to digital local TV signals. Provides that commercial digital TV licenses shall expire at the end of FY 2003. Directs the FCC to report biennially to the Congress on the status of digital TV conversion in each TV market. Sets forth requirements with respect to the resale of, and competitive bidding for, spectrum previously used for the broadcast of analog TV. Directs the FCC to report the total revenues from such bidding by January 1, 2002. (Sec. 3003) Directs the FCC, no later than January 1, 1998, to allocate from the electromagnetic spectrum between 746 and 806 mhz.: (1) 24 mhz. for public safety services; and (2) 36 mhz. for commercial purposes to be assigned by competitive bidding. (Sec. 3005) Requires the FCC, in any auction for any license, permit, or right which has value, to set a reasonable reserve price for each unit in the auction unless it is not in the public interest to do so. Provides that the reserve price shall establish a minimum bid for the unit to be auctioned. Retains units for which no bid above the reserve price is received. Directs the FCC to reassess reserve prices for such units and place them in the next appropriate auction. Subtitle B: Merchant Marine Provisions - Extends through FY 2002 the current tonnage duties imposed upon foreign vessels entering into U.S. ports. Title IV: Committee on Energy and Natural Resources - Amends the Energy Policy and Conservation Act to authorize the Secretary of Energy to store foreign-owned petroleum products in underutilized Strategic Petroleum Reserve (SPR) facilities, subject to the following conditions: (1) funds resulting from the leasing or other use of an SPR facility after October 1, 2007, shall be available to the Secretary, without further appropriation, for SPR petroleum product purchases; (2) such stored petroleum product is neither part of the SPR, nor subject to the contracting requirements governing petroleum product not owned by the United States; and (3) such product may be exported. Title V: Committee on Finance - 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 under title XIX of the Social Security Act (SSA). Division 1: Medicare - 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 traditional Medicare fee-for- service program or through a Medicare Choice plan. (Sec. 5001) Outlines the types of Medicare Choice plans that may be available, including: (1) fee-for-service plans; (2) plans offered by preferred provider organizations; (3) point of service plans; (4) plans offered by provider-sponsored organizations; (5) plans offered by health maintenance organizations; and (6) a combination of MSA (Medicare Choice savings account) plan and contributions to Medicare Choice MSA. 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 provide for broad dissemination of coverage option and comparison information to Medicare beneficiaries and prospective Medicare beneficiaries. Directs the Secretary to 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 any Medicare Choice organization to accept without restrictions individuals eligible to make an election at any time during which such elections are accepted. Requires the approval of Medicare Choice marketing material and application forms before they are distributed. 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 and specified additional benefits, as well, at its option, as certain supplemental benefits, subject to the Secretary's approval. 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. Requires each Medicare Choice organization, at an enrollee's request, to disclose annually the proportion of the premiums and other revenues received by the organization that are expended for non-health care items and services. Outlines a mechanism for grievances and appeals. Sets forth certain payment rules for providers not participating in the MedicarePlus (sic) 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. Directs the Secretary and the Medicare Payment Advisory Commission to each study and report to the Congress on appropriate measures for adjusting the annual Medicare Choice capitation rates to reflect local price indicators. 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. Details rules for the submission and charging of premiums by each Medicare Choice organization. Sets limitations on enrollee cost- sharing for basic, additional, and supplemental benefits, except for MSA plans and unrestricted fee-for-service plans. Requires the Secretary to audit each year the financial records of at least one- third of the Medicare Choice organizations offering Medicare Choice plans. Prohibits a State from imposing a premium tax or similar tax with respect to payments on Medicare Choice plans or the offering of such plans. 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. 5002) 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. 5006) 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: Integrated Long-Term Care Programs - Amends SSA title XVIII to provide for 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. 5013) 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. (Sec. 5015) 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. 5018) 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 and make appropriate recommendations to restore such integrity through the year 2030; and (3) analyze potential solutions to the problems identified that will ensure both the financial integrity of Medicare and the provision of appropriate benefits under such program, including the extent to which current Medicare update indexes do not accurately reflect inflation. 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 through the year 2030; 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. 5022) 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. 5031) 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. Provides for extending the six-month initial enrollment period under the Medicare supplemental policy program to non-elderly Medicare beneficiaries. (Sec. 5032) 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 before the policy begins payment of benefits. Chapter 5: Demonstrations - Directs the Secretary to conduct demonstration projects in ten urban areas where less than 25 percent of the Medicare beneficiaries are enrolled with an eligible HMO, as well as three rural areas, which are to be treated as Medicare Choice payment areas. Requires such projects to: (1) apply a pricing methodology for payments to Medicare Choice organizations using a specified competitive market approach; (2) apply a benefit structure and beneficiary premium structure specified in this chapter; (3) apply specified information and quality programs; and (4) evaluate the effects of the methodology and structures on Medicare fee-for-service spending under Medicare parts A and B in the project area. Requires the Secretary to report on the project to the President, and the President to report to the Congress any legislative recommendations for extending the project to the entire Medicare population. (Sec. 5042) Provides that, in the case of a Medicare Choice payment area in which such a project is being conducted, the annual Medicare Choice capitation rate shall be the standardized payment amount determined according to prescribed guidelines rather than the amount determined under the Medicare Choice program. Establishes within HHS the Office of Competition to administer Medicare Choice competitive pricing demonstrations. (Sec. 5043) Outlines benefits and beneficiary premiums under Medicare Choice competitive pricing demonstrations, which include, respectively, those items and services traditionally covered under Medicare plus prescription drugs as well as any optional supplemental benefits the demonstration plan offers, and certain cost-sharing obligations. (Sec. 5044) Details information and comparative reports the Secretary shall require to be used in a Medicare Choice demonstration plan under this chapter in lieu of those required under chapter 1. (Sec. 5044B) Establishes the Quality Advisory Institute to make recommendations to the Director of the Office of Competition concerning licensing and certification criteria and comparative measurement methods with regard to demonstration plans. Requires the Director to: (1) advise the President and the Congress on health insurance and health care provided under demonstration plans, recommending measures to protect the health of all enrollees in demonstration plans; (2) ensure that a demonstration plan may not be offered unless it has been certified in accordance with specified requirements; (3) establish a program to reward demonstration plans for meeting or exceeding quality targets; (4) develop procedures for licensing entities to certify demonstration plans; (5) establish minimum criteria for such licensed entities to use in certifying such plans; and (5) develop grievance and appeals procedures for plans denied certification. (Sec. 5045) 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. 5046) 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 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. 5047) Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a demonstration 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 veterans. Directs the Secretaries to try to include in the demonstration at least one medical center that is in the same catchment area as a closed military medical facility. Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a similar 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. Directs the Secretary of Defense to waive the enrollment fee for any Medicare-eligible military retiree or dependent enrolled in the managed care option of the TRICARE program for any period for which reimbursement is made under such a demonstration project with respect to such retiree or dependent. Chapter 6: 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 for 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) annual screening mammography for women over age 39, while providing for the waiver of coinsurance for screening mammography; (2) colorectal cancer screening tests, subject to prescribed frequency and payment limits; (3) 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 (4) bone mass measurements for qualified individuals. (Sec. 5103) 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. 5105) 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. Subtitle C: Rural Initiatives - Revises the formula for payments to sole community hospitals, in order to increase a hospital's target amount, by replacing the base cost reporting period with: (1) a hospital's cost reporting period for FY 1997; and (2) allowable operating costs of inpatient hospital services for subsequent fiscal years. Extends the target amount for Medicare- dependent, small rural hospitals. (Sec. 5153) 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 that shall be designated as a critical access hospital in accordance with prescribed guidelines. Authorizes the Secretary to award grants to States: (1) for the planning and implementation of the program; and (2) for establishment or expansion of rural emergency medical services. Authorizes appropriations. Directs the Administrator of the Health Care Financing Administration 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. 5154) 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. 5155) 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. 5156) 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 health care provider 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 health care provider providing the professional consultation is not at the same location as the health care provider 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. 5157) Directs the Secretary to conduct a demonstration project to study the use of eligible health care provider telemedicine networks to implement high-capacity computing and advanced networks to improve primary care and prevent health care complications, improve access to specialty care, and provide educational and training support to rural practitioners. Provides limited funding. Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity - Chapter 1: Revisions to Sanctions for Fraud and Abuse - 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. 5202) 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. 5203) 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; (2) any person that presents or causes to be presented to any State or Federal agency a claim for a medical or other item or service ordered or prescribed by an excluded person and the person furnishing such item or service knows or should have known of such exclusion; and (3) kickbacks. Chapter 2: Improvements in Protecting Program Integrity - Outlines various specified requirements regarding disclosure of information, surety bonds, and accreditation with regard to DME suppliers. Includes surety bond requirements for home health agencies, and provides for the application of disclosure and surety bond requirements to ambulance services and certain clinics. Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORFs) and to rehabilitation agencies. (Sec. 5212) 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. 5213) Amends SSA title XI part A (General Provisions) to provide that: (1) Medicare- and Medicaid-related actions against debtors are generally not stayed by bankruptcy proceedings; (2) certain Medicare- and Medicaid-related debts are not dischargeable in bankruptcy; and (3) the repayment of certain debts is considered final. (Sec. 5214) 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. 5219) Requires the Secretary to provide beneficiaries with an explanation of benefits that urges beneficiaries to check the 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 and review them. Requires the Secretary to take measures to recover amounts unnecessarily paid out. (Sec. 5220) 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) costs for fines and penalties resulting from violations of Federal, State, or local laws; and (3) education expenses for spouses or other dependents of service providers, their employees or contractors. (Sec. 5221) Changes from discretionary to mandatory the Secretary's authority to make lists of unnecessarily utilized items and of suppliers of items for whom the Secretary has identified a pattern of overutilization resulting from certain supplier business practices. (Sec. 5225) Authorizes the Secretary to apply to surgical dressings certain factors for determining grossly excessive payment amounts, and repeals the exemption from specified payment requirements for dressings furnished by a home health agency. Chapter 3: Clarifications and Technical Changes - Makes technical amendments with respect to fraud and abuse. Subtitle E: Prospective Payment Systems - Chapter 1: Provisions Relating to Part A - Provides for a prospective payment system (PPS) under Medicare for inpatient rehabilitation hospital services. (Sec. 5302) Directs the Secretary to submit to the Congress a legislative proposal for establishing a case-mix adjusted PPS for long-term care hospitals. Chapter 2: Provisions Relating to Part B - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 5312) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 5313) Directs the Secretary to establish a PPS for hospital outpatient department services. (Sec. 5321) 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 to carry out certain provisions with respect to the coverage of ambulance service, the Secretary may include coverage of advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. Chapter 3: Provisions Relating to Parts A and B - 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. 5332) 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 chapter and their effect on the quality of covered SNF services furnished to Medicare beneficiaries. (Sec. 5341) 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. 5342) 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. 5343) Directs the Secretary to establish a PPS for home health services for cost reporting periods beginning in FY 2000. (Sec. 5344) Bases the payment for home health services on the location where the service is furnished. (Sec. 5361) 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. 5362) Imposes a $5 co-payment for Medicare part B home health services. (Sec. 5364) 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. 5365) 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. 5366) Requires each explanation of Medicare part B benefits provided in conjunction with the payment of claims to include the total cost of home health services for which the agency or provider billed. Subtitle F: Provisions Relating to Part A - Chapter 1: Payment of PPS Hospitals - Revises requirements for PPS hospital payment updates and capital payments for PPS hospitals. Chapter 2: Payment of PPS Exempt Hospitals - Revises requirements for the payment of PPS exempt hospitals, including those for: (1) payment updates; (2) capital payments; (3) bonus and relief payments; (4) target amounts for rehabilitation hospitals, long-term care hospitals, and psychiatric hospitals; (5) treatment of certain long-term care hospitals located within other hospitals; (6) rebasing; and (7) certain cancer hospitals. Chapter 3: Graduate Medical Education Payments - 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 managed care enrollees. Makes a special reimbursement rule for primary care combined residency programs, setting the period of board eligibility. (Sec. 5452) Directs the Secretary to establish a demonstration project for making direct GME payments to qualifying consortia instead of teaching hospitals. Chapter 4: Other Hospital Payments - Directs the Secretary to make additional payments (including disproportionate share payments (DSH)) to hospitals for managed care and Medicare Choice enrollees. Revises requirements for DSH payments to hospitals serving vulnerable populations. Eliminates indirect GME and DSH payments attributable to outlier payments. Requires reductions in payments for enrollee bad debt. Increases the base payment rate to Puerto Rico hospitals. Repeals the termination date to make a permanent extension of the hemophilia passthrough. 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). Chapter 5: 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. Subtitle G: Provisions Relating to Part B Only - Chapter 1: Payments for Physicians and Other Health Care Providers - 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; (5) providing for adjustments in relative value units for 1998, and the application of resource-based methodology to malpractice relative value units; and (6) increasing Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. (Sec. 5505) Directs the Comptroller General to review and evaluate the proposed rule on resource-based methodology for practice expenses issued by the Health Care Financing Administration. Chapter 2: Other Payment Provisions - Requires a specified reduction in updates to payment amounts for clinical diagnostic laboratory tests, while lowering the cap on payment amounts. Directs the Secretary to request the Institute of Medicine of the National Academy of Sciences to study Medicare part B payments for clinical laboratory services for a report to the appropriate congressional committees. (Sec. 5522) 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. 5523) Provides for a reduction in payment amounts for items of DME. Revises requirements for payment for oxygen and oxygen equipment, ambulatory surgical services, and drugs and biologicals. Provides for a reduction in the increase for parenteral and enteral nutrients, supplies, and equipment. Directs the Secretary to establish service standards and accreditation requirements for persons seeking Medicare part B payment for the providing of oxygen and oxygen equipment to beneficiaries within their homes. Details certain studies, demonstration projects, and congressional reporting relating to access to home oxygen equipment. Directs the Secretary to conduct studies or surveys to determine the average wholesale price of any drug or biological for purposes related to their reimbursement. Requires a report to the appropriate congressional committees. Chapter 3: 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. 5542) Specifies a formula for income-related increases in the monthly Medicare part B premium. Amends the Internal Revenue Code to authorize the Secretary of the Treasury, upon the HHS Secretary's request, to disclose to Health Care Financing Administration officers and employees certain income tax return information about a taxpayer required to pay a monthly Medicare part B premium. (Sec. 5543) Directs the Secretary to conduct a demonstration project in which individuals otherwise responsible for an income- related premium under this chapter would instead be responsible for an income-related deductible using the same income limits and administrative procedures provided for. Prohibits Medigap beneficiaries from participating in such project. (Sec. 5544) Directs the Secretary to establish a program to award block grants to States for the payment of certain Medicare cost- sharing on behalf of eligible low-income Medicare beneficiaries. Authorizes the Secretary to transfer certain amounts from the Federal Supplementary Medical Insurance Trust Fund for such new program. Subtitle H: Provisions Relating to Parts A and B - Chapter 1: Secondary Payor Provisions - Revises requirements for Medicare as secondary payor. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Chapter 2: Other Provisions - Amends SSA title II (Old Age, Survivors and Disability Insurance) (OASDI) to conform the age for eligibility under Medicare to the retirement age for OASDI benefits. (Sec. 5612) Provides for an increased certification period for certain organ procurement organizations. (Sec. 5613) Amends SSA title XVIII to allow physicians or other health care professionals who do not provide items or services under the Medicare program from entering private contracts with Medicare beneficiaries for health services for which no claim for Medicare payment is to be submitted. Requires the Administrator of the Health Care Financing Administration to report to the Congress on the effect on Medicare of private contracts. Subtitle I: Miscellaneous Provisions - Provides that, with respect to inpatient hospital services on the basis of prospective rates, the large urban area of Charlotte-Gastonia-Rock Hill-North Carolina-South Carolina may be deemed to include Stanly County, North Carolina. (Sec. 5652) Declares that, with respect to certain criminal penalties for selling or issuing a health insurance policy with knowledge it duplicates Medicare or Medigap health benefits, a health insurance policy is not considered to duplicate such benefits if it: (1) provides comprehensive health care benefits that replace the benefits provided by another health insurance policy; (2) is being provided to an individual entitled to benefits under Medicare part A or enrolled under Medicare part B; and (3) coordinates against items and services available or paid for under Medicare or Medicaid, provided that Medicare or Medicaid payments shall not be treated as payments under such policy in determining annual or lifetime benefit limits. Division 2: Medicaid and Children's Health Insurance Initiatives - Subtitle I: Medicaid - Chapter 1: Medicaid Savings - Amends SSA title XIX to establish a new part B (Managed Care) giving States the option to require Medicaid-eligible, non-special needs individuals to enroll in managed care arrangements of the individual's choice as a condition of receiving Medicaid. Prescribes requirements for: (1) referral to specialty care; (2) treatment of children with special health care needs; (3) access to emergency care; (4) annual external independent review of managed care entity activities and other specified quality care assurance measures; (5) fraud and abuse prohibitions and protections; and (6) enforcement sanctions. (Sec. 5701) Requires States to permit individuals access to religiously-affiliated long-term care facilities (including out-of-network facilities) that are not pervasively sectarian and that provide nonsectarian medical care comparable to a managed care entity meeting State Medicare requirements. Requires each Medicaid managed care organization to disclose annually to enrollees the proportion of the premiums and other revenues received by the organization that are expended for non-health care items and services. Directs the Secretary and the Comptroller General to report annually to specified congressional committees on rates paid for hospital services under managed care entities. Directs the Institute of Medicine of the National Academy of Sciences to analyze 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. (Sec. 5702) Amends SSA title XIX to grant States the option of providing Medicaid coverage of primary care case management services without the need for a waiver. (Sec. 5703) Repeals the (75-25) requirement that Medicare and Medicaid beneficiaries under SSA titles XVIII and XIX, respectively, constitute less than 75 percent of the membership of a participating HMO. Repeals the prohibition on co-payments for services furnished by HMOs. (Sec. 5711) 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. 5712) Revises requirements for Medicaid payment rates for qualified Medicare beneficiaries, placing a limitation on nonparticipating providers. (Sec. 5721) 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. Chapter 2: Expansion of Medicaid Eligibility - Grants States the option to: (1) permit workers with disabilities to buy into Medicaid; and (2) provide for 12-month continuous Medicaid eligibility for children. Chapter 3: Programs of All-Inclusive Care for the Elderly (PACE) - Authorizes a State to establish a 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. Requires the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under the Medicare and Medicaid programs, specifically comparing costs, quality, and access to services by private, for-profit entities operating under demonstration project waivers with those of other PACE providers. Chapter 4: Medicaid Management and Program Reforms - Repeals: (1) the requirement that a State pay for private insurance; (2) obstetrical and pediatric payment rate and various other specified requirements; and (3) certain physician qualification requirements. Authorizes a State to impose cost-sharing for any Medicaid provided to certain individuals. (Sec. 5755) Revises a specified penalty for fraudulent eligibility. (Sec. 5756) Prohibits the expenditure of Medicaid funds for roads, bridges, stadiums, and other items and services not covered by a State plan. 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. 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. Directs the Administrator of the Health Care Financing Administration to: (1) develop mechanisms to better monitor and prevent inappropriate Medicaid payments in the case of individuals who are dually eligible for Medicaid and Medicare benefits; (2) study the use of case management or care coordination in order to improve the appropriateness, quality, and cost effectiveness of care for dually- eligible individuals; and (3) work with the States to ensure better care coordination for dual eligibles. (Sec. 5757) Requires the Secretary to study and report to the Congress on: (1) early and periodic screening, diagnostic, and treatment benefits; and (2) individuals with special health care needs and chronic conditions in capitated managed care or primary care case management plans. Chapter 5: Miscellaneous - Provides for: (1) increased Federal medical assistance percentages (FMAPs) for the District of Columbia and Alaska and increased payment caps for the territories; (2) coverage of community-based mental health services and optional coverage of certain Centers for Disease Control screened breast cancer patients; and (3) treatment of veterans pensions. (Sec. 5765) 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. 5767) Directs the Secretary to study and report to the Congress on: (1) the use of nurse aide registries by States; (2) the extent to which institutional environmental factors contribute to cases of abuse and neglect at nursing facilities; and (3) whether alternatives to current sanctions for abuse and neglect at nursing facilities might be more effective in minimizing future cases of abuse and neglect. (Sec. 5768) Deems 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. (Thus exempts 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). (Sec. 5769) Applies certain requirements to the extension of statewide comprehensive research and demonstration projects for which waivers of Medicaid compliance have been granted. Subtitle J: Children's Health Insurance Initiatives - Amends SSA to add a new title XXI (Child Health Insurance Initiatives) in order to provide funds to States to expand the provision of health insurance coverage to low-income children. Mandates coverage that is actuarially equivalent to the benefits required to be offered for a child under the Federal Employees' Health Benefits Program (FEHBP). Requires the use of funds to achieve such purpose through specified outreach activities and, at the State's option, through: (1) a grant program to provide FEHBP-equivalent children's health insurance coverage for low-income children in the State; or (2) expansion of coverage of such children under the State Medicaid program who are not otherwise required to be provided medical assistance under Medicaid. Makes appropriations to carry out this title. Directs the Secretary to establish a basic allotment pool for distribution of funds to eligible States, with provision for bonus payments, including incentive bonuses. Prohibits their use to provide health insurance coverage for families of State public employees or children in penal institutions. Allows their use for abortion only if necessary to save the life of the mother or if the pregnancy results from rape or incest. Exempts such a State program from the five-year limit on means-tested public benefits under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Division 3: Income Security and Other Provisions - Subtitle K: Income Security, Welfare-to-Work Grant Program, and Other Provisions - Chapter 1: Income Security - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 to make aliens eligible for Supplemental Security Income (SSI) who, as of the date of enactment of such Act, were: (1) receiving such benefits; or (2) disabled and lawfully residing in the United States. Includes Cuban and Haitian entrants within the definition of "qualified alien" for purposes of welfare and public benefits. (Sec. 5812) Extends from five years 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. (Sec. 5813) Exempts from: (1) SSI and Medicaid eligibility limitations certain Canadian-born American Indians who are members of an Indian tribe; and (2) SSI eligibility limitations certain SSI recipients with pre-January 1, 1979 applications. (Sec. 5816) 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. 5817) Exempts legal aliens under the age of 19 from the five-year Medicaid limitation. (Sec. 5818) Treats certain Amerasian immigrants as refugees for purposes of specified public benefits eligibility. (Sec. 5819) Makes certain severely disabled legal aliens who were denied naturalization eligible for SSI benefits. Chapter 2: Welfare-to-Work Grant Program - 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. 5821) Sets forth requirements relating to State entitlement to non-competitive grants under such program and State distribution of such funds among local governments. Provides for competitive grants, based on program effectiveness and other factors, for State-approved projects proposed by local governments. 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 and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to: (1) develop a plan to evaluate the use of such grants; and (2) submit interim and final reports to the Congress. (Sec. 5822) Revises PRWORA provisions relating to a State's ability to sanction an individual receiving assistance under the TANF program for noncompliance. Chapter 3: Unemployment Compensation - Amends SSA title IX (Employment Security) with respect to unemployment compensation to increase the Federal Unemployment Account ceiling. (Sec. 5832) Provides for a special distribution to States from the Unemployment Trust Fund. (Sec. 5833) Revises the Internal Revenue Code exclude from the definition of employment, for specified unemployment compensation purposes, any service performed by a prison inmate. Division 4: Earned Income Credit and Other Provisions - Subtitle L: Earned Income Credit and Other Provisions - Chapter 1: Earned Income Credit - Prohibits allowing the earned income credit for: (1) ten years, if the credit was found to have been fraudulently claimed; and (2) two years, if the credit was claimed with intentional or reckless disregard of the earned income credit rules. Chapter 2: Increase in Public Debt Limit - Increases the public debt limit. Chapter 3: Miscellaneous - Expresses the sense of the Senate that all cost-of-living adjustments required by statute should accurately reflect the best available estimate of changes in the cost of living. Subtitle M: Welfare Reform Technical Corrections - Welfare Reform Technical Corrections Act of 1997 - Chapter 1: Block Grants for Temporary Assistance to Needy Families - Amends part A (Temporary Assistance for Needy Families) (TANF) of title IV of the Social Security Act (SSA) to make various specified technical as well as substantive amendments with regard to sundry (welfare reform) provisions added by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRAWORA). (Sec. 5902) Provides for a later deadline for submission of State TANF plans. (Sec. 5903) Revises the computation of bonus grants to States for a decrease in illegitimacy, requiring: (1) use of calendar year instead of fiscal year data; (2) use of the ratio of out-of-wedlock births to all births instead of the number of out-of-wedlock births; and (3) that certain territories be taken into account. Revises the formula for annual reconciliation of payments to States with specified maximums. Limits to non-needy States the requirement for annual State remission of excess funds to HHS. (Sec. 5905) Revises specified mandatory work requirements. States that a family with a disabled parent shall not treated as a two-parent family. Allows the minimum work requirement for a two-parent family to be shared between both parents, if it amounts

Amendments:

Summary: S.947 — 105th Congress (1997-1998)

There are 2 summaries for this bill. Passed Senate amended (06/25/1997)Introduced in Senate (06/20/1997)     Bill summaries are authored by CRS. $("#summarySelector").congress_dropDownNavigation({ stubUrl: '/bill/105th-congress/senate-bill/947/summary', suffix: '' }); Shown Here:
Passed Senate amended (06/25/1997) TABLE OF CONTENTS: Title I: Committee on Agriculture, Nutrition, and Forestry Title II: Committee on Banking, Housing, and Urban Affairs Subtitle A: Mortgage Assignment and Annual Adjustment Factors Subtitle B: Multifamily Housing Reform Title III: Committee on Commerce Science and Transportation Subtitle A: Spectrum Auctions and License Fees Subtitle B: Merchant Marine Provisions Title IV: Committee on Energy and Natural Resources Title V: Committee on Finance Division 1: Medicare 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: Prospective Payment Systems Subtitle F: Provisions Relating to Part A Subtitle G: Provisions Relating to Part B Only Subtitle H: Provisions Relating to Parts A and B Division 2: Medicaid and Childrens' Health Insurance Initiatives Subtitle I: Medicaid Subtitle J: Children's Health Insurance Initiatives Division 3: Income Security and Other Provisions Subtitle K: Income Security, Welfare-to-Work Grant Program, and Other Provisions Division 4: Earned Income Credit and Other Provisions Subtitle L: Earned Income Credit and Other Provisions Subtitle M: Welfare Reform Technical Corrections Title VI: Committee on Governmental Affairs Subtitle A: Civil Service and Postal Provisions Subtitle B: GSA Property Sales Title VII: Committee on Labor and Human Resources Title VIII: Committee on Veterans' Affairs Subtitle A: Extension of Temporary Authorities Subtitle B: Copayments and Medical Care Cost Recovery Subtitle C: Other Matters Balanced Budget Act of 1997 - Title I: Committee on Agriculture, Nutrition, and Forestry - Amends the Food Stamp Act to define "caseload" and "covered individual." Authorizes State agencies to provide an additional 15 percent hardship 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: Committee on Banking, Housing, and Urban Affairs - Subtitle A: Mortgage Assignment and Annual Adjustment Factors - Amends the Balanced Budget Downpayment Act, I to extend permanently certain foreclosure avoidance and borrower assistance provisions under the single family housing mortgage insurance program. (Sec. 2003) Amends the United States Housing Act of 1937 with respect to the section 8 rental assistance program to make certain maximum monthly rent adjustment provisions for certain new and rehabilitated and nonturnover units applicable to FY 1999 and thereafter. Subtitle B: Multifamily Housing Reform - Multifamily Assisted Housing Reform and Affordability Act of 1997 - Part 1: FHA-Insured Multifamily Housing Mortgage and Housing Assistance Restructuring - Directs the Secretary (Secretary) of Housing and Urban Development to enter into agreements with participating administrative entities (with preference given to State housing finance agencies) to develop and implement mortgage restructuring and rental assistance plans for FHA-insured multifamily housing mortgages in order to: (1) reduce expiring section 8 contracts costs; (2) address troubled projects; and (3) correct management and ownership deficiencies. Includes two-tiered mortgage restructuring among plan incentives. Terminates program authority as of October 1, 2001. Part 2: Miscellaneous Provisions - Amends the National Housing Act to authorize the Secretary to make rehabilitation grants for certain insured projects. (Sec. 2203) Repeals specified Federal housing preference provisions under the United States Housing Act of 1937, the Cranston- Gonzalez National Affordable Housing Act, the Housing and Urban Development Act of 1965, the Low-Income Housing Preservation and Resident Homeownership Act of 1990, and the Housing and Community Development Act of 1992. Part 3: Enforcement Provisions - Directs the Secretary to issue implementing regulations. Subpart A: FHA Single Family and Multifamily Housing - Amends the National Housing Act to expand HUD authorities with respect to: (1) lender sanctions; (2) equity skimming; and (3) civil money penalties. Subpart B: FHA Multifamily Provisions - Amends the National Housing Act and the Housing Act of 1937 to expand multifamily housing-related civil money penalties. (Sec. 2322) Amends the Housing and Community Development Act of 1987 to extend the double damages remedy. Title III: Committee on Commerce Science and Transportation - Subtitle A: Spectrum Auctions and License Fees - Amends the Communications Act of 1934 (the Act) to revise provisions regarding competitive bidding for use of the electromagnetic spectrum to authorize the Federal Communications Commission (FCC) to use auctions as a means to assign spectrum. Makes competitive bidding authority inapplicable to licenses or construction permits issued for: (1) public safety services; (2) public telecommunications services when the license application is for channels reserved for noncommercial use; (3) spectrum and associated orbits used within global satellite systems; (4) new digital television (TV) service given to existing terrestrial broadcast licensees to replace current licenses; (5) terrestrial radio and TV broadcasting when the FCC determines that an alternative method of resolving mutually exclusive applications serves the public interest better than competitive bidding; or (6) spectrum allocated for specified unlicensed use if competitive bidding would interfere with operation of end-user products. Extends competitive bidding authority through FY 2007. Requires the FCC, by the end of 2001, to assign by competitive bidding 45 megahertz (mhz.) located at 1,710-1,755 mhz. for commercial use. Provides that Federal Government stations assigned to use such band shall retain use until the end of 2003 unless exempted from relocation. Directs the FCC, by the end of FY 2002, to permit the assignment by competitive bidding of licenses for the use of currently allocated bands of frequencies that: (1) in the aggregate span not less than 55 mhz.; (2) are located below three gigahertz (ghz.); and (3) have not been designated for assignment, identified by the Secretary of Commerce as reallocable frequencies pursuant to the National Telecommunications and Information Administration Organization Act, or allocated for Federal Government use. Requires the FCC to attempt to accommodate displaced licensees by relocating them to other frequencies and notify the Secretary whenever unable to provide for effective relocation. Amends the National Telecommunications and Information Administration Organization Act to require the Secretary of Commerce to make specified recommendations, upon receiving a report from the FCC on inability to accommodate displaced licensees, for purposes of reassigning such licensees to frequencies allocated for Government use. Sets forth requirements regarding: (1) the reimbursement of Federal spectrum users for relocation costs; (2) petitions by persons seeking to relocate Federal stations; and (3) Federal rights to reclaim reallocated spectrum. Directs the Secretary to make available for reallocation from Federal frequencies 20 mhz. located below three ghz. (Sec. 3002) Amends the Act to prohibit, under competitive bidding provisions, the renewal of a license authorizing analog TV services beyond the end of 2006. Extends or waives this deadline for a station in any TV market unless 95 percent of the TV households have access to digital local TV signals. Provides that commercial digital TV licenses shall expire at the end of FY 2003. Directs the FCC to report biennially to the Congress on the status of digital TV conversion in each TV market. Sets forth requirements with respect to the resale of, and competitive bidding for, spectrum previously used for the broadcast of analog TV. Directs the FCC to report the total revenues from such bidding by January 1, 2002. (Sec. 3003) Directs the FCC, no later than January 1, 1998, to allocate from the electromagnetic spectrum between 746 and 806 mhz.: (1) 24 mhz. for public safety services; and (2) 36 mhz. for commercial purposes to be assigned by competitive bidding. (Sec. 3005) Requires the FCC, in any auction for any license, permit, or right which has value, to set a reasonable reserve price for each unit in the auction unless it is not in the public interest to do so. Provides that the reserve price shall establish a minimum bid for the unit to be auctioned. Retains units for which no bid above the reserve price is received. Directs the FCC to reassess reserve prices for such units and place them in the next appropriate auction. Subtitle B: Merchant Marine Provisions - Extends through FY 2002 the current tonnage duties imposed upon foreign vessels entering into U.S. ports. Title IV: Committee on Energy and Natural Resources - Amends the Energy Policy and Conservation Act to authorize the Secretary of Energy to store foreign-owned petroleum products in underutilized Strategic Petroleum Reserve (SPR) facilities, subject to the following conditions: (1) funds resulting from the leasing or other use of an SPR facility after October 1, 2007, shall be available to the Secretary, without further appropriation, for SPR petroleum product purchases; (2) such stored petroleum product is neither part of the SPR, nor subject to the contracting requirements governing petroleum product not owned by the United States; and (3) such product may be exported. Title V: Committee on Finance - 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 under title XIX of the Social Security Act (SSA). Division 1: Medicare - 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 traditional Medicare fee-for- service program or through a Medicare Choice plan. (Sec. 5001) Outlines the types of Medicare Choice plans that may be available, including: (1) fee-for-service plans; (2) plans offered by preferred provider organizations; (3) point of service plans; (4) plans offered by provider-sponsored organizations; (5) plans offered by health maintenance organizations; and (6) a combination of MSA (Medicare Choice savings account) plan and contributions to Medicare Choice MSA. 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 provide for broad dissemination of coverage option and comparison information to Medicare beneficiaries and prospective Medicare beneficiaries. Directs the Secretary to 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 any Medicare Choice organization to accept without restrictions individuals eligible to make an election at any time during which such elections are accepted. Requires the approval of Medicare Choice marketing material and application forms before they are distributed. 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 and specified additional benefits, as well, at its option, as certain supplemental benefits, subject to the Secretary's approval. 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. Requires each Medicare Choice organization, at an enrollee's request, to disclose annually the proportion of the premiums and other revenues received by the organization that are expended for non-health care items and services. Outlines a mechanism for grievances and appeals. Sets forth certain payment rules for providers not participating in the MedicarePlus (sic) 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. Directs the Secretary and the Medicare Payment Advisory Commission to each study and report to the Congress on appropriate measures for adjusting the annual Medicare Choice capitation rates to reflect local price indicators. 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. Details rules for the submission and charging of premiums by each Medicare Choice organization. Sets limitations on enrollee cost- sharing for basic, additional, and supplemental benefits, except for MSA plans and unrestricted fee-for-service plans. Requires the Secretary to audit each year the financial records of at least one- third of the Medicare Choice organizations offering Medicare Choice plans. Prohibits a State from imposing a premium tax or similar tax with respect to payments on Medicare Choice plans or the offering of such plans. 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. 5002) 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. 5006) 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: Integrated Long-Term Care Programs - Amends SSA title XVIII to provide for 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. 5013) 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. (Sec. 5015) 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. 5018) 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 and make appropriate recommendations to restore such integrity through the year 2030; and (3) analyze potential solutions to the problems identified that will ensure both the financial integrity of Medicare and the provision of appropriate benefits under such program, including the extent to which current Medicare update indexes do not accurately reflect inflation. 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 through the year 2030; 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. 5022) 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. 5031) 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. Provides for extending the six-month initial enrollment period under the Medicare supplemental policy program to non-elderly Medicare beneficiaries. (Sec. 5032) 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 before the policy begins payment of benefits. Chapter 5: Demonstrations - Directs the Secretary to conduct demonstration projects in ten urban areas where less than 25 percent of the Medicare beneficiaries are enrolled with an eligible HMO, as well as three rural areas, which are to be treated as Medicare Choice payment areas. Requires such projects to: (1) apply a pricing methodology for payments to Medicare Choice organizations using a specified competitive market approach; (2) apply a benefit structure and beneficiary premium structure specified in this chapter; (3) apply specified information and quality programs; and (4) evaluate the effects of the methodology and structures on Medicare fee-for-service spending under Medicare parts A and B in the project area. Requires the Secretary to report on the project to the President, and the President to report to the Congress any legislative recommendations for extending the project to the entire Medicare population. (Sec. 5042) Provides that, in the case of a Medicare Choice payment area in which such a project is being conducted, the annual Medicare Choice capitation rate shall be the standardized payment amount determined according to prescribed guidelines rather than the amount determined under the Medicare Choice program. Establishes within HHS the Office of Competition to administer Medicare Choice competitive pricing demonstrations. (Sec. 5043) Outlines benefits and beneficiary premiums under Medicare Choice competitive pricing demonstrations, which include, respectively, those items and services traditionally covered under Medicare plus prescription drugs as well as any optional supplemental benefits the demonstration plan offers, and certain cost-sharing obligations. (Sec. 5044) Details information and comparative reports the Secretary shall require to be used in a Medicare Choice demonstration plan under this chapter in lieu of those required under chapter 1. (Sec. 5044B) Establishes the Quality Advisory Institute to make recommendations to the Director of the Office of Competition concerning licensing and certification criteria and comparative measurement methods with regard to demonstration plans. Requires the Director to: (1) advise the President and the Congress on health insurance and health care provided under demonstration plans, recommending measures to protect the health of all enrollees in demonstration plans; (2) ensure that a demonstration plan may not be offered unless it has been certified in accordance with specified requirements; (3) establish a program to reward demonstration plans for meeting or exceeding quality targets; (4) develop procedures for licensing entities to certify demonstration plans; (5) establish minimum criteria for such licensed entities to use in certifying such plans; and (5) develop grievance and appeals procedures for plans denied certification. (Sec. 5045) 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. 5046) 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 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. 5047) Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a demonstration 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 veterans. Directs the Secretaries to try to include in the demonstration at least one medical center that is in the same catchment area as a closed military medical facility. Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a similar 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. Directs the Secretary of Defense to waive the enrollment fee for any Medicare-eligible military retiree or dependent enrolled in the managed care option of the TRICARE program for any period for which reimbursement is made under such a demonstration project with respect to such retiree or dependent. Chapter 6: 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 for 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) annual screening mammography for women over age 39, while providing for the waiver of coinsurance for screening mammography; (2) colorectal cancer screening tests, subject to prescribed frequency and payment limits; (3) 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 (4) bone mass measurements for qualified individuals. (Sec. 5103) 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. 5105) 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. Subtitle C: Rural Initiatives - Revises the formula for payments to sole community hospitals, in order to increase a hospital's target amount, by replacing the base cost reporting period with: (1) a hospital's cost reporting period for FY 1997; and (2) allowable operating costs of inpatient hospital services for subsequent fiscal years. Extends the target amount for Medicare- dependent, small rural hospitals. (Sec. 5153) 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 that shall be designated as a critical access hospital in accordance with prescribed guidelines. Authorizes the Secretary to award grants to States: (1) for the planning and implementation of the program; and (2) for establishment or expansion of rural emergency medical services. Authorizes appropriations. Directs the Administrator of the Health Care Financing Administration 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. 5154) 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. 5155) 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. 5156) 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 health care provider 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 health care provider providing the professional consultation is not at the same location as the health care provider 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. 5157) Directs the Secretary to conduct a demonstration project to study the use of eligible health care provider telemedicine networks to implement high-capacity computing and advanced networks to improve primary care and prevent health care complications, improve access to specialty care, and provide educational and training support to rural practitioners. Provides limited funding. Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity - Chapter 1: Revisions to Sanctions for Fraud and Abuse - 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. 5202) 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. 5203) 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; (2) any person that presents or causes to be presented to any State or Federal agency a claim for a medical or other item or service ordered or prescribed by an excluded person and the person furnishing such item or service knows or should have known of such exclusion; and (3) kickbacks. Chapter 2: Improvements in Protecting Program Integrity - Outlines various specified requirements regarding disclosure of information, surety bonds, and accreditation with regard to DME suppliers. Includes surety bond requirements for home health agencies, and provides for the application of disclosure and surety bond requirements to ambulance services and certain clinics. Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORFs) and to rehabilitation agencies. (Sec. 5212) 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. 5213) Amends SSA title XI part A (General Provisions) to provide that: (1) Medicare- and Medicaid-related actions against debtors are generally not stayed by bankruptcy proceedings; (2) certain Medicare- and Medicaid-related debts are not dischargeable in bankruptcy; and (3) the repayment of certain debts is considered final. (Sec. 5214) 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. 5219) Requires the Secretary to provide beneficiaries with an explanation of benefits that urges beneficiaries to check the 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 and review them. Requires the Secretary to take measures to recover amounts unnecessarily paid out. (Sec. 5220) 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) costs for fines and penalties resulting from violations of Federal, State, or local laws; and (3) education expenses for spouses or other dependents of service providers, their employees or contractors. (Sec. 5221) Changes from discretionary to mandatory the Secretary's authority to make lists of unnecessarily utilized items and of suppliers of items for whom the Secretary has identified a pattern of overutilization resulting from certain supplier business practices. (Sec. 5225) Authorizes the Secretary to apply to surgical dressings certain factors for determining grossly excessive payment amounts, and repeals the exemption from specified payment requirements for dressings furnished by a home health agency. Chapter 3: Clarifications and Technical Changes - Makes technical amendments with respect to fraud and abuse. Subtitle E: Prospective Payment Systems - Chapter 1: Provisions Relating to Part A - Provides for a prospective payment system (PPS) under Medicare for inpatient rehabilitation hospital services. (Sec. 5302) Directs the Secretary to submit to the Congress a legislative proposal for establishing a case-mix adjusted PPS for long-term care hospitals. Chapter 2: Provisions Relating to Part B - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 5312) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 5313) Directs the Secretary to establish a PPS for hospital outpatient department services. (Sec. 5321) 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 to carry out certain provisions with respect to the coverage of ambulance service, the Secretary may include coverage of advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. Chapter 3: Provisions Relating to Parts A and B - 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. 5332) 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 chapter and their effect on the quality of covered SNF services furnished to Medicare beneficiaries. (Sec. 5341) 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. 5342) 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. 5343) Directs the Secretary to establish a PPS for home health services for cost reporting periods beginning in FY 2000. (Sec. 5344) Bases the payment for home health services on the location where the service is furnished. (Sec. 5361) 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. 5362) Imposes a $5 co-payment for Medicare part B home health services. (Sec. 5364) 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. 5365) 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. 5366) Requires each explanation of Medicare part B benefits provided in conjunction with the payment of claims to include the total cost of home health services for which the agency or provider billed. Subtitle F: Provisions Relating to Part A - Chapter 1: Payment of PPS Hospitals - Revises requirements for PPS hospital payment updates and capital payments for PPS hospitals. Chapter 2: Payment of PPS Exempt Hospitals - Revises requirements for the payment of PPS exempt hospitals, including those for: (1) payment updates; (2) capital payments; (3) bonus and relief payments; (4) target amounts for rehabilitation hospitals, long-term care hospitals, and psychiatric hospitals; (5) treatment of certain long-term care hospitals located within other hospitals; (6) rebasing; and (7) certain cancer hospitals. Chapter 3: Graduate Medical Education Payments - 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 managed care enrollees. Makes a special reimbursement rule for primary care combined residency programs, setting the period of board eligibility. (Sec. 5452) Directs the Secretary to establish a demonstration project for making direct GME payments to qualifying consortia instead of teaching hospitals. Chapter 4: Other Hospital Payments - Directs the Secretary to make additional payments (including disproportionate share payments (DSH)) to hospitals for managed care and Medicare Choice enrollees. Revises requirements for DSH payments to hospitals serving vulnerable populations. Eliminates indirect GME and DSH payments attributable to outlier payments. Requires reductions in payments for enrollee bad debt. Increases the base payment rate to Puerto Rico hospitals. Repeals the termination date to make a permanent extension of the hemophilia passthrough. 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). Chapter 5: 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. Subtitle G: Provisions Relating to Part B Only - Chapter 1: Payments for Physicians and Other Health Care Providers - 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; (5) providing for adjustments in relative value units for 1998, and the application of resource-based methodology to malpractice relative value units; and (6) increasing Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. (Sec. 5505) Directs the Comptroller General to review and evaluate the proposed rule on resource-based methodology for practice expenses issued by the Health Care Financing Administration. Chapter 2: Other Payment Provisions - Requires a specified reduction in updates to payment amounts for clinical diagnostic laboratory tests, while lowering the cap on payment amounts. Directs the Secretary to request the Institute of Medicine of the National Academy of Sciences to study Medicare part B payments for clinical laboratory services for a report to the appropriate congressional committees. (Sec. 5522) 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. 5523) Provides for a reduction in payment amounts for items of DME. Revises requirements for payment for oxygen and oxygen equipment, ambulatory surgical services, and drugs and biologicals. Provides for a reduction in the increase for parenteral and enteral nutrients, supplies, and equipment. Directs the Secretary to establish service standards and accreditation requirements for persons seeking Medicare part B payment for the providing of oxygen and oxygen equipment to beneficiaries within their homes. Details certain studies, demonstration projects, and congressional reporting relating to access to home oxygen equipment. Directs the Secretary to conduct studies or surveys to determine the average wholesale price of any drug or biological for purposes related to their reimbursement. Requires a report to the appropriate congressional committees. Chapter 3: 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. 5542) Specifies a formula for income-related increases in the monthly Medicare part B premium. Amends the Internal Revenue Code to authorize the Secretary of the Treasury, upon the HHS Secretary's request, to disclose to Health Care Financing Administration officers and employees certain income tax return information about a taxpayer required to pay a monthly Medicare part B premium. (Sec. 5543) Directs the Secretary to conduct a demonstration project in which individuals otherwise responsible for an income- related premium under this chapter would instead be responsible for an income-related deductible using the same income limits and administrative procedures provided for. Prohibits Medigap beneficiaries from participating in such project. (Sec. 5544) Directs the Secretary to establish a program to award block grants to States for the payment of certain Medicare cost- sharing on behalf of eligible low-income Medicare beneficiaries. Authorizes the Secretary to transfer certain amounts from the Federal Supplementary Medical Insurance Trust Fund for such new program. Subtitle H: Provisions Relating to Parts A and B - Chapter 1: Secondary Payor Provisions - Revises requirements for Medicare as secondary payor. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Chapter 2: Other Provisions - Amends SSA title II (Old Age, Survivors and Disability Insurance) (OASDI) to conform the age for eligibility under Medicare to the retirement age for OASDI benefits. (Sec. 5612) Provides for an increased certification period for certain organ procurement organizations. (Sec. 5613) Amends SSA title XVIII to allow physicians or other health care professionals who do not provide items or services under the Medicare program from entering private contracts with Medicare beneficiaries for health services for which no claim for Medicare payment is to be submitted. Requires the Administrator of the Health Care Financing Administration to report to the Congress on the effect on Medicare of private contracts. Subtitle I: Miscellaneous Provisions - Provides that, with respect to inpatient hospital services on the basis of prospective rates, the large urban area of Charlotte-Gastonia-Rock Hill-North Carolina-South Carolina may be deemed to include Stanly County, North Carolina. (Sec. 5652) Declares that, with respect to certain criminal penalties for selling or issuing a health insurance policy with knowledge it duplicates Medicare or Medigap health benefits, a health insurance policy is not considered to duplicate such benefits if it: (1) provides comprehensive health care benefits that replace the benefits provided by another health insurance policy; (2) is being provided to an individual entitled to benefits under Medicare part A or enrolled under Medicare part B; and (3) coordinates against items and services available or paid for under Medicare or Medicaid, provided that Medicare or Medicaid payments shall not be treated as payments under such policy in determining annual or lifetime benefit limits. Division 2: Medicaid and Children's Health Insurance Initiatives - Subtitle I: Medicaid - Chapter 1: Medicaid Savings - Amends SSA title XIX to establish a new part B (Managed Care) giving States the option to require Medicaid-eligible, non-special needs individuals to enroll in managed care arrangements of the individual's choice as a condition of receiving Medicaid. Prescribes requirements for: (1) referral to specialty care; (2) treatment of children with special health care needs; (3) access to emergency care; (4) annual external independent review of managed care entity activities and other specified quality care assurance measures; (5) fraud and abuse prohibitions and protections; and (6) enforcement sanctions. (Sec. 5701) Requires States to permit individuals access to religiously-affiliated long-term care facilities (including out-of-network facilities) that are not pervasively sectarian and that provide nonsectarian medical care comparable to a managed care entity meeting State Medicare requirements. Requires each Medicaid managed care organization to disclose annually to enrollees the proportion of the premiums and other revenues received by the organization that are expended for non-health care items and services. Directs the Secretary and the Comptroller General to report annually to specified congressional committees on rates paid for hospital services under managed care entities. Directs the Institute of Medicine of the National Academy of Sciences to analyze 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. (Sec. 5702) Amends SSA title XIX to grant States the option of providing Medicaid coverage of primary care case management services without the need for a waiver. (Sec. 5703) Repeals the (75-25) requirement that Medicare and Medicaid beneficiaries under SSA titles XVIII and XIX, respectively, constitute less than 75 percent of the membership of a participating HMO. Repeals the prohibition on co-payments for services furnished by HMOs. (Sec. 5711) 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. 5712) Revises requirements for Medicaid payment rates for qualified Medicare beneficiaries, placing a limitation on nonparticipating providers. (Sec. 5721) 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. Chapter 2: Expansion of Medicaid Eligibility - Grants States the option to: (1) permit workers with disabilities to buy into Medicaid; and (2) provide for 12-month continuous Medicaid eligibility for children. Chapter 3: Programs of All-Inclusive Care for the Elderly (PACE) - Authorizes a State to establish a 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. Requires the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under the Medicare and Medicaid programs, specifically comparing costs, quality, and access to services by private, for-profit entities operating under demonstration project waivers with those of other PACE providers. Chapter 4: Medicaid Management and Program Reforms - Repeals: (1) the requirement that a State pay for private insurance; (2) obstetrical and pediatric payment rate and various other specified requirements; and (3) certain physician qualification requirements. Authorizes a State to impose cost-sharing for any Medicaid provided to certain individuals. (Sec. 5755) Revises a specified penalty for fraudulent eligibility. (Sec. 5756) Prohibits the expenditure of Medicaid funds for roads, bridges, stadiums, and other items and services not covered by a State plan. 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. 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. Directs the Administrator of the Health Care Financing Administration to: (1) develop mechanisms to better monitor and prevent inappropriate Medicaid payments in the case of individuals who are dually eligible for Medicaid and Medicare benefits; (2) study the use of case management or care coordination in order to improve the appropriateness, quality, and cost effectiveness of care for dually- eligible individuals; and (3) work with the States to ensure better care coordination for dual eligibles. (Sec. 5757) Requires the Secretary to study and report to the Congress on: (1) early and periodic screening, diagnostic, and treatment benefits; and (2) individuals with special health care needs and chronic conditions in capitated managed care or primary care case management plans. Chapter 5: Miscellaneous - Provides for: (1) increased Federal medical assistance percentages (FMAPs) for the District of Columbia and Alaska and increased payment caps for the territories; (2) coverage of community-based mental health services and optional coverage of certain Centers for Disease Control screened breast cancer patients; and (3) treatment of veterans pensions. (Sec. 5765) 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. 5767) Directs the Secretary to study and report to the Congress on: (1) the use of nurse aide registries by States; (2) the extent to which institutional environmental factors contribute to cases of abuse and neglect at nursing facilities; and (3) whether alternatives to current sanctions for abuse and neglect at nursing facilities might be more effective in minimizing future cases of abuse and neglect. (Sec. 5768) Deems 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. (Thus exempts 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). (Sec. 5769) Applies certain requirements to the extension of statewide comprehensive research and demonstration projects for which waivers of Medicaid compliance have been granted. Subtitle J: Children's Health Insurance Initiatives - Amends SSA to add a new title XXI (Child Health Insurance Initiatives) in order to provide funds to States to expand the provision of health insurance coverage to low-income children. Mandates coverage that is actuarially equivalent to the benefits required to be offered for a child under the Federal Employees' Health Benefits Program (FEHBP). Requires the use of funds to achieve such purpose through specified outreach activities and, at the State's option, through: (1) a grant program to provide FEHBP-equivalent children's health insurance coverage for low-income children in the State; or (2) expansion of coverage of such children under the State Medicaid program who are not otherwise required to be provided medical assistance under Medicaid. Makes appropriations to carry out this title. Directs the Secretary to establish a basic allotment pool for distribution of funds to eligible States, with provision for bonus payments, including incentive bonuses. Prohibits their use to provide health insurance coverage for families of State public employees or children in penal institutions. Allows their use for abortion only if necessary to save the life of the mother or if the pregnancy results from rape or incest. Exempts such a State program from the five-year limit on means-tested public benefits under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Division 3: Income Security and Other Provisions - Subtitle K: Income Security, Welfare-to-Work Grant Program, and Other Provisions - Chapter 1: Income Security - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 to make aliens eligible for Supplemental Security Income (SSI) who, as of the date of enactment of such Act, were: (1) receiving such benefits; or (2) disabled and lawfully residing in the United States. Includes Cuban and Haitian entrants within the definition of "qualified alien" for purposes of welfare and public benefits. (Sec. 5812) Extends from five years 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. (Sec. 5813) Exempts from: (1) SSI and Medicaid eligibility limitations certain Canadian-born American Indians who are members of an Indian tribe; and (2) SSI eligibility limitations certain SSI recipients with pre-January 1, 1979 applications. (Sec. 5816) 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. 5817) Exempts legal aliens under the age of 19 from the five-year Medicaid limitation. (Sec. 5818) Treats certain Amerasian immigrants as refugees for purposes of specified public benefits eligibility. (Sec. 5819) Makes certain severely disabled legal aliens who were denied naturalization eligible for SSI benefits. Chapter 2: Welfare-to-Work Grant Program - 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. 5821) Sets forth requirements relating to State entitlement to non-competitive grants under such program and State distribution of such funds among local governments. Provides for competitive grants, based on program effectiveness and other factors, for State-approved projects proposed by local governments. 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 and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to: (1) develop a plan to evaluate the use of such grants; and (2) submit interim and final reports to the Congress. (Sec. 5822) Revises PRWORA provisions relating to a State's ability to sanction an individual receiving assistance under the TANF program for noncompliance. Chapter 3: Unemployment Compensation - Amends SSA title IX (Employment Security) with respect to unemployment compensation to increase the Federal Unemployment Account ceiling. (Sec. 5832) Provides for a special distribution to States from the Unemployment Trust Fund. (Sec. 5833) Revises the Internal Revenue Code exclude from the definition of employment, for specified unemployment compensation purposes, any service performed by a prison inmate. Division 4: Earned Income Credit and Other Provisions - Subtitle L: Earned Income Credit and Other Provisions - Chapter 1: Earned Income Credit - Prohibits allowing the earned income credit for: (1) ten years, if the credit was found to have been fraudulently claimed; and (2) two years, if the credit was claimed with intentional or reckless disregard of the earned income credit rules. Chapter 2: Increase in Public Debt Limit - Increases the public debt limit. Chapter 3: Miscellaneous - Expresses the sense of the Senate that all cost-of-living adjustments required by statute should accurately reflect the best available estimate of changes in the cost of living. Subtitle M: Welfare Reform Technical Corrections - Welfare Reform Technical Corrections Act of 1997 - Chapter 1: Block Grants for Temporary Assistance to Needy Families - Amends part A (Temporary Assistance for Needy Families) (TANF) of title IV of the Social Security Act (SSA) to make various specified technical as well as substantive amendments with regard to sundry (welfare reform) provisions added by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRAWORA). (Sec. 5902) Provides for a later deadline for submission of State TANF plans. (Sec. 5903) Revises the computation of bonus grants to States for a decrease in illegitimacy, requiring: (1) use of calendar year instead of fiscal year data; (2) use of the ratio of out-of-wedlock births to all births instead of the number of out-of-wedlock births; and (3) that certain territories be taken into account. Revises the formula for annual reconciliation of payments to States with specified maximums. Limits to non-needy States the requirement for annual State remission of excess funds to HHS. (Sec. 5905) Revises specified mandatory work requirements. States that a family with a disabled parent shall not treated as a two-parent family. Allows the minimum work requirement for a two-parent family to be shared between both parents, if it amounts

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Summary: S.947 — 105th Congress (1997-1998)

There are 2 summaries for this bill. Passed Senate amended (06/25/1997)Introduced in Senate (06/20/1997)     Bill summaries are authored by CRS. $("#summarySelector").congress_dropDownNavigation({ stubUrl: '/bill/105th-congress/senate-bill/947/summary', suffix: '' }); Shown Here:
Passed Senate amended (06/25/1997) TABLE OF CONTENTS: Title I: Committee on Agriculture, Nutrition, and Forestry Title II: Committee on Banking, Housing, and Urban Affairs Subtitle A: Mortgage Assignment and Annual Adjustment Factors Subtitle B: Multifamily Housing Reform Title III: Committee on Commerce Science and Transportation Subtitle A: Spectrum Auctions and License Fees Subtitle B: Merchant Marine Provisions Title IV: Committee on Energy and Natural Resources Title V: Committee on Finance Division 1: Medicare 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: Prospective Payment Systems Subtitle F: Provisions Relating to Part A Subtitle G: Provisions Relating to Part B Only Subtitle H: Provisions Relating to Parts A and B Division 2: Medicaid and Childrens' Health Insurance Initiatives Subtitle I: Medicaid Subtitle J: Children's Health Insurance Initiatives Division 3: Income Security and Other Provisions Subtitle K: Income Security, Welfare-to-Work Grant Program, and Other Provisions Division 4: Earned Income Credit and Other Provisions Subtitle L: Earned Income Credit and Other Provisions Subtitle M: Welfare Reform Technical Corrections Title VI: Committee on Governmental Affairs Subtitle A: Civil Service and Postal Provisions Subtitle B: GSA Property Sales Title VII: Committee on Labor and Human Resources Title VIII: Committee on Veterans' Affairs Subtitle A: Extension of Temporary Authorities Subtitle B: Copayments and Medical Care Cost Recovery Subtitle C: Other Matters Balanced Budget Act of 1997 - Title I: Committee on Agriculture, Nutrition, and Forestry - Amends the Food Stamp Act to define "caseload" and "covered individual." Authorizes State agencies to provide an additional 15 percent hardship 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: Committee on Banking, Housing, and Urban Affairs - Subtitle A: Mortgage Assignment and Annual Adjustment Factors - Amends the Balanced Budget Downpayment Act, I to extend permanently certain foreclosure avoidance and borrower assistance provisions under the single family housing mortgage insurance program. (Sec. 2003) Amends the United States Housing Act of 1937 with respect to the section 8 rental assistance program to make certain maximum monthly rent adjustment provisions for certain new and rehabilitated and nonturnover units applicable to FY 1999 and thereafter. Subtitle B: Multifamily Housing Reform - Multifamily Assisted Housing Reform and Affordability Act of 1997 - Part 1: FHA-Insured Multifamily Housing Mortgage and Housing Assistance Restructuring - Directs the Secretary (Secretary) of Housing and Urban Development to enter into agreements with participating administrative entities (with preference given to State housing finance agencies) to develop and implement mortgage restructuring and rental assistance plans for FHA-insured multifamily housing mortgages in order to: (1) reduce expiring section 8 contracts costs; (2) address troubled projects; and (3) correct management and ownership deficiencies. Includes two-tiered mortgage restructuring among plan incentives. Terminates program authority as of October 1, 2001. Part 2: Miscellaneous Provisions - Amends the National Housing Act to authorize the Secretary to make rehabilitation grants for certain insured projects. (Sec. 2203) Repeals specified Federal housing preference provisions under the United States Housing Act of 1937, the Cranston- Gonzalez National Affordable Housing Act, the Housing and Urban Development Act of 1965, the Low-Income Housing Preservation and Resident Homeownership Act of 1990, and the Housing and Community Development Act of 1992. Part 3: Enforcement Provisions - Directs the Secretary to issue implementing regulations. Subpart A: FHA Single Family and Multifamily Housing - Amends the National Housing Act to expand HUD authorities with respect to: (1) lender sanctions; (2) equity skimming; and (3) civil money penalties. Subpart B: FHA Multifamily Provisions - Amends the National Housing Act and the Housing Act of 1937 to expand multifamily housing-related civil money penalties. (Sec. 2322) Amends the Housing and Community Development Act of 1987 to extend the double damages remedy. Title III: Committee on Commerce Science and Transportation - Subtitle A: Spectrum Auctions and License Fees - Amends the Communications Act of 1934 (the Act) to revise provisions regarding competitive bidding for use of the electromagnetic spectrum to authorize the Federal Communications Commission (FCC) to use auctions as a means to assign spectrum. Makes competitive bidding authority inapplicable to licenses or construction permits issued for: (1) public safety services; (2) public telecommunications services when the license application is for channels reserved for noncommercial use; (3) spectrum and associated orbits used within global satellite systems; (4) new digital television (TV) service given to existing terrestrial broadcast licensees to replace current licenses; (5) terrestrial radio and TV broadcasting when the FCC determines that an alternative method of resolving mutually exclusive applications serves the public interest better than competitive bidding; or (6) spectrum allocated for specified unlicensed use if competitive bidding would interfere with operation of end-user products. Extends competitive bidding authority through FY 2007. Requires the FCC, by the end of 2001, to assign by competitive bidding 45 megahertz (mhz.) located at 1,710-1,755 mhz. for commercial use. Provides that Federal Government stations assigned to use such band shall retain use until the end of 2003 unless exempted from relocation. Directs the FCC, by the end of FY 2002, to permit the assignment by competitive bidding of licenses for the use of currently allocated bands of frequencies that: (1) in the aggregate span not less than 55 mhz.; (2) are located below three gigahertz (ghz.); and (3) have not been designated for assignment, identified by the Secretary of Commerce as reallocable frequencies pursuant to the National Telecommunications and Information Administration Organization Act, or allocated for Federal Government use. Requires the FCC to attempt to accommodate displaced licensees by relocating them to other frequencies and notify the Secretary whenever unable to provide for effective relocation. Amends the National Telecommunications and Information Administration Organization Act to require the Secretary of Commerce to make specified recommendations, upon receiving a report from the FCC on inability to accommodate displaced licensees, for purposes of reassigning such licensees to frequencies allocated for Government use. Sets forth requirements regarding: (1) the reimbursement of Federal spectrum users for relocation costs; (2) petitions by persons seeking to relocate Federal stations; and (3) Federal rights to reclaim reallocated spectrum. Directs the Secretary to make available for reallocation from Federal frequencies 20 mhz. located below three ghz. (Sec. 3002) Amends the Act to prohibit, under competitive bidding provisions, the renewal of a license authorizing analog TV services beyond the end of 2006. Extends or waives this deadline for a station in any TV market unless 95 percent of the TV households have access to digital local TV signals. Provides that commercial digital TV licenses shall expire at the end of FY 2003. Directs the FCC to report biennially to the Congress on the status of digital TV conversion in each TV market. Sets forth requirements with respect to the resale of, and competitive bidding for, spectrum previously used for the broadcast of analog TV. Directs the FCC to report the total revenues from such bidding by January 1, 2002. (Sec. 3003) Directs the FCC, no later than January 1, 1998, to allocate from the electromagnetic spectrum between 746 and 806 mhz.: (1) 24 mhz. for public safety services; and (2) 36 mhz. for commercial purposes to be assigned by competitive bidding. (Sec. 3005) Requires the FCC, in any auction for any license, permit, or right which has value, to set a reasonable reserve price for each unit in the auction unless it is not in the public interest to do so. Provides that the reserve price shall establish a minimum bid for the unit to be auctioned. Retains units for which no bid above the reserve price is received. Directs the FCC to reassess reserve prices for such units and place them in the next appropriate auction. Subtitle B: Merchant Marine Provisions - Extends through FY 2002 the current tonnage duties imposed upon foreign vessels entering into U.S. ports. Title IV: Committee on Energy and Natural Resources - Amends the Energy Policy and Conservation Act to authorize the Secretary of Energy to store foreign-owned petroleum products in underutilized Strategic Petroleum Reserve (SPR) facilities, subject to the following conditions: (1) funds resulting from the leasing or other use of an SPR facility after October 1, 2007, shall be available to the Secretary, without further appropriation, for SPR petroleum product purchases; (2) such stored petroleum product is neither part of the SPR, nor subject to the contracting requirements governing petroleum product not owned by the United States; and (3) such product may be exported. Title V: Committee on Finance - 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 under title XIX of the Social Security Act (SSA). Division 1: Medicare - 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 traditional Medicare fee-for- service program or through a Medicare Choice plan. (Sec. 5001) Outlines the types of Medicare Choice plans that may be available, including: (1) fee-for-service plans; (2) plans offered by preferred provider organizations; (3) point of service plans; (4) plans offered by provider-sponsored organizations; (5) plans offered by health maintenance organizations; and (6) a combination of MSA (Medicare Choice savings account) plan and contributions to Medicare Choice MSA. 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 provide for broad dissemination of coverage option and comparison information to Medicare beneficiaries and prospective Medicare beneficiaries. Directs the Secretary to 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 any Medicare Choice organization to accept without restrictions individuals eligible to make an election at any time during which such elections are accepted. Requires the approval of Medicare Choice marketing material and application forms before they are distributed. 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 and specified additional benefits, as well, at its option, as certain supplemental benefits, subject to the Secretary's approval. 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. Requires each Medicare Choice organization, at an enrollee's request, to disclose annually the proportion of the premiums and other revenues received by the organization that are expended for non-health care items and services. Outlines a mechanism for grievances and appeals. Sets forth certain payment rules for providers not participating in the MedicarePlus (sic) 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. Directs the Secretary and the Medicare Payment Advisory Commission to each study and report to the Congress on appropriate measures for adjusting the annual Medicare Choice capitation rates to reflect local price indicators. 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. Details rules for the submission and charging of premiums by each Medicare Choice organization. Sets limitations on enrollee cost- sharing for basic, additional, and supplemental benefits, except for MSA plans and unrestricted fee-for-service plans. Requires the Secretary to audit each year the financial records of at least one- third of the Medicare Choice organizations offering Medicare Choice plans. Prohibits a State from imposing a premium tax or similar tax with respect to payments on Medicare Choice plans or the offering of such plans. 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. 5002) 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. 5006) 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: Integrated Long-Term Care Programs - Amends SSA title XVIII to provide for 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. 5013) 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. (Sec. 5015) 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. 5018) 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 and make appropriate recommendations to restore such integrity through the year 2030; and (3) analyze potential solutions to the problems identified that will ensure both the financial integrity of Medicare and the provision of appropriate benefits under such program, including the extent to which current Medicare update indexes do not accurately reflect inflation. 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 through the year 2030; 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. 5022) 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. 5031) 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. Provides for extending the six-month initial enrollment period under the Medicare supplemental policy program to non-elderly Medicare beneficiaries. (Sec. 5032) 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 before the policy begins payment of benefits. Chapter 5: Demonstrations - Directs the Secretary to conduct demonstration projects in ten urban areas where less than 25 percent of the Medicare beneficiaries are enrolled with an eligible HMO, as well as three rural areas, which are to be treated as Medicare Choice payment areas. Requires such projects to: (1) apply a pricing methodology for payments to Medicare Choice organizations using a specified competitive market approach; (2) apply a benefit structure and beneficiary premium structure specified in this chapter; (3) apply specified information and quality programs; and (4) evaluate the effects of the methodology and structures on Medicare fee-for-service spending under Medicare parts A and B in the project area. Requires the Secretary to report on the project to the President, and the President to report to the Congress any legislative recommendations for extending the project to the entire Medicare population. (Sec. 5042) Provides that, in the case of a Medicare Choice payment area in which such a project is being conducted, the annual Medicare Choice capitation rate shall be the standardized payment amount determined according to prescribed guidelines rather than the amount determined under the Medicare Choice program. Establishes within HHS the Office of Competition to administer Medicare Choice competitive pricing demonstrations. (Sec. 5043) Outlines benefits and beneficiary premiums under Medicare Choice competitive pricing demonstrations, which include, respectively, those items and services traditionally covered under Medicare plus prescription drugs as well as any optional supplemental benefits the demonstration plan offers, and certain cost-sharing obligations. (Sec. 5044) Details information and comparative reports the Secretary shall require to be used in a Medicare Choice demonstration plan under this chapter in lieu of those required under chapter 1. (Sec. 5044B) Establishes the Quality Advisory Institute to make recommendations to the Director of the Office of Competition concerning licensing and certification criteria and comparative measurement methods with regard to demonstration plans. Requires the Director to: (1) advise the President and the Congress on health insurance and health care provided under demonstration plans, recommending measures to protect the health of all enrollees in demonstration plans; (2) ensure that a demonstration plan may not be offered unless it has been certified in accordance with specified requirements; (3) establish a program to reward demonstration plans for meeting or exceeding quality targets; (4) develop procedures for licensing entities to certify demonstration plans; (5) establish minimum criteria for such licensed entities to use in certifying such plans; and (5) develop grievance and appeals procedures for plans denied certification. (Sec. 5045) 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. 5046) 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 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. 5047) Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a demonstration 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 veterans. Directs the Secretaries to try to include in the demonstration at least one medical center that is in the same catchment area as a closed military medical facility. Authorizes the HHS Secretary and the Secretary of Veterans Affairs to establish a similar 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. Directs the Secretary of Defense to waive the enrollment fee for any Medicare-eligible military retiree or dependent enrolled in the managed care option of the TRICARE program for any period for which reimbursement is made under such a demonstration project with respect to such retiree or dependent. Chapter 6: 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 for 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) annual screening mammography for women over age 39, while providing for the waiver of coinsurance for screening mammography; (2) colorectal cancer screening tests, subject to prescribed frequency and payment limits; (3) 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 (4) bone mass measurements for qualified individuals. (Sec. 5103) 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. 5105) 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. Subtitle C: Rural Initiatives - Revises the formula for payments to sole community hospitals, in order to increase a hospital's target amount, by replacing the base cost reporting period with: (1) a hospital's cost reporting period for FY 1997; and (2) allowable operating costs of inpatient hospital services for subsequent fiscal years. Extends the target amount for Medicare- dependent, small rural hospitals. (Sec. 5153) 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 that shall be designated as a critical access hospital in accordance with prescribed guidelines. Authorizes the Secretary to award grants to States: (1) for the planning and implementation of the program; and (2) for establishment or expansion of rural emergency medical services. Authorizes appropriations. Directs the Administrator of the Health Care Financing Administration 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. 5154) 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. 5155) 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. 5156) 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 health care provider 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 health care provider providing the professional consultation is not at the same location as the health care provider 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. 5157) Directs the Secretary to conduct a demonstration project to study the use of eligible health care provider telemedicine networks to implement high-capacity computing and advanced networks to improve primary care and prevent health care complications, improve access to specialty care, and provide educational and training support to rural practitioners. Provides limited funding. Subtitle D: Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity - Chapter 1: Revisions to Sanctions for Fraud and Abuse - 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. 5202) 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. 5203) 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; (2) any person that presents or causes to be presented to any State or Federal agency a claim for a medical or other item or service ordered or prescribed by an excluded person and the person furnishing such item or service knows or should have known of such exclusion; and (3) kickbacks. Chapter 2: Improvements in Protecting Program Integrity - Outlines various specified requirements regarding disclosure of information, surety bonds, and accreditation with regard to DME suppliers. Includes surety bond requirements for home health agencies, and provides for the application of disclosure and surety bond requirements to ambulance services and certain clinics. Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORFs) and to rehabilitation agencies. (Sec. 5212) 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. 5213) Amends SSA title XI part A (General Provisions) to provide that: (1) Medicare- and Medicaid-related actions against debtors are generally not stayed by bankruptcy proceedings; (2) certain Medicare- and Medicaid-related debts are not dischargeable in bankruptcy; and (3) the repayment of certain debts is considered final. (Sec. 5214) 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. 5219) Requires the Secretary to provide beneficiaries with an explanation of benefits that urges beneficiaries to check the 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 and review them. Requires the Secretary to take measures to recover amounts unnecessarily paid out. (Sec. 5220) 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) costs for fines and penalties resulting from violations of Federal, State, or local laws; and (3) education expenses for spouses or other dependents of service providers, their employees or contractors. (Sec. 5221) Changes from discretionary to mandatory the Secretary's authority to make lists of unnecessarily utilized items and of suppliers of items for whom the Secretary has identified a pattern of overutilization resulting from certain supplier business practices. (Sec. 5225) Authorizes the Secretary to apply to surgical dressings certain factors for determining grossly excessive payment amounts, and repeals the exemption from specified payment requirements for dressings furnished by a home health agency. Chapter 3: Clarifications and Technical Changes - Makes technical amendments with respect to fraud and abuse. Subtitle E: Prospective Payment Systems - Chapter 1: Provisions Relating to Part A - Provides for a prospective payment system (PPS) under Medicare for inpatient rehabilitation hospital services. (Sec. 5302) Directs the Secretary to submit to the Congress a legislative proposal for establishing a case-mix adjusted PPS for long-term care hospitals. Chapter 2: Provisions Relating to Part B - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 5312) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 5313) Directs the Secretary to establish a PPS for hospital outpatient department services. (Sec. 5321) 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 to carry out certain provisions with respect to the coverage of ambulance service, the Secretary may include coverage of advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. Chapter 3: Provisions Relating to Parts A and B - 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. 5332) 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 chapter and their effect on the quality of covered SNF services furnished to Medicare beneficiaries. (Sec. 5341) 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. 5342) 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. 5343) Directs the Secretary to establish a PPS for home health services for cost reporting periods beginning in FY 2000. (Sec. 5344) Bases the payment for home health services on the location where the service is furnished. (Sec. 5361) 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. 5362) Imposes a $5 co-payment for Medicare part B home health services. (Sec. 5364) 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. 5365) 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. 5366) Requires each explanation of Medicare part B benefits provided in conjunction with the payment of claims to include the total cost of home health services for which the agency or provider billed. Subtitle F: Provisions Relating to Part A - Chapter 1: Payment of PPS Hospitals - Revises requirements for PPS hospital payment updates and capital payments for PPS hospitals. Chapter 2: Payment of PPS Exempt Hospitals - Revises requirements for the payment of PPS exempt hospitals, including those for: (1) payment updates; (2) capital payments; (3) bonus and relief payments; (4) target amounts for rehabilitation hospitals, long-term care hospitals, and psychiatric hospitals; (5) treatment of certain long-term care hospitals located within other hospitals; (6) rebasing; and (7) certain cancer hospitals. Chapter 3: Graduate Medical Education Payments - 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 managed care enrollees. Makes a special reimbursement rule for primary care combined residency programs, setting the period of board eligibility. (Sec. 5452) Directs the Secretary to establish a demonstration project for making direct GME payments to qualifying consortia instead of teaching hospitals. Chapter 4: Other Hospital Payments - Directs the Secretary to make additional payments (including disproportionate share payments (DSH)) to hospitals for managed care and Medicare Choice enrollees. Revises requirements for DSH payments to hospitals serving vulnerable populations. Eliminates indirect GME and DSH payments attributable to outlier payments. Requires reductions in payments for enrollee bad debt. Increases the base payment rate to Puerto Rico hospitals. Repeals the termination date to make a permanent extension of the hemophilia passthrough. 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). Chapter 5: 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. Subtitle G: Provisions Relating to Part B Only - Chapter 1: Payments for Physicians and Other Health Care Providers - 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; (5) providing for adjustments in relative value units for 1998, and the application of resource-based methodology to malpractice relative value units; and (6) increasing Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. (Sec. 5505) Directs the Comptroller General to review and evaluate the proposed rule on resource-based methodology for practice expenses issued by the Health Care Financing Administration. Chapter 2: Other Payment Provisions - Requires a specified reduction in updates to payment amounts for clinical diagnostic laboratory tests, while lowering the cap on payment amounts. Directs the Secretary to request the Institute of Medicine of the National Academy of Sciences to study Medicare part B payments for clinical laboratory services for a report to the appropriate congressional committees. (Sec. 5522) 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. 5523) Provides for a reduction in payment amounts for items of DME. Revises requirements for payment for oxygen and oxygen equipment, ambulatory surgical services, and drugs and biologicals. Provides for a reduction in the increase for parenteral and enteral nutrients, supplies, and equipment. Directs the Secretary to establish service standards and accreditation requirements for persons seeking Medicare part B payment for the providing of oxygen and oxygen equipment to beneficiaries within their homes. Details certain studies, demonstration projects, and congressional reporting relating to access to home oxygen equipment. Directs the Secretary to conduct studies or surveys to determine the average wholesale price of any drug or biological for purposes related to their reimbursement. Requires a report to the appropriate congressional committees. Chapter 3: 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. 5542) Specifies a formula for income-related increases in the monthly Medicare part B premium. Amends the Internal Revenue Code to authorize the Secretary of the Treasury, upon the HHS Secretary's request, to disclose to Health Care Financing Administration officers and employees certain income tax return information about a taxpayer required to pay a monthly Medicare part B premium. (Sec. 5543) Directs the Secretary to conduct a demonstration project in which individuals otherwise responsible for an income- related premium under this chapter would instead be responsible for an income-related deductible using the same income limits and administrative procedures provided for. Prohibits Medigap beneficiaries from participating in such project. (Sec. 5544) Directs the Secretary to establish a program to award block grants to States for the payment of certain Medicare cost- sharing on behalf of eligible low-income Medicare beneficiaries. Authorizes the Secretary to transfer certain amounts from the Federal Supplementary Medical Insurance Trust Fund for such new program. Subtitle H: Provisions Relating to Parts A and B - Chapter 1: Secondary Payor Provisions - Revises requirements for Medicare as secondary payor. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Chapter 2: Other Provisions - Amends SSA title II (Old Age, Survivors and Disability Insurance) (OASDI) to conform the age for eligibility under Medicare to the retirement age for OASDI benefits. (Sec. 5612) Provides for an increased certification period for certain organ procurement organizations. (Sec. 5613) Amends SSA title XVIII to allow physicians or other health care professionals who do not provide items or services under the Medicare program from entering private contracts with Medicare beneficiaries for health services for which no claim for Medicare payment is to be submitted. Requires the Administrator of the Health Care Financing Administration to report to the Congress on the effect on Medicare of private contracts. Subtitle I: Miscellaneous Provisions - Provides that, with respect to inpatient hospital services on the basis of prospective rates, the large urban area of Charlotte-Gastonia-Rock Hill-North Carolina-South Carolina may be deemed to include Stanly County, North Carolina. (Sec. 5652) Declares that, with respect to certain criminal penalties for selling or issuing a health insurance policy with knowledge it duplicates Medicare or Medigap health benefits, a health insurance policy is not considered to duplicate such benefits if it: (1) provides comprehensive health care benefits that replace the benefits provided by another health insurance policy; (2) is being provided to an individual entitled to benefits under Medicare part A or enrolled under Medicare part B; and (3) coordinates against items and services available or paid for under Medicare or Medicaid, provided that Medicare or Medicaid payments shall not be treated as payments under such policy in determining annual or lifetime benefit limits. Division 2: Medicaid and Children's Health Insurance Initiatives - Subtitle I: Medicaid - Chapter 1: Medicaid Savings - Amends SSA title XIX to establish a new part B (Managed Care) giving States the option to require Medicaid-eligible, non-special needs individuals to enroll in managed care arrangements of the individual's choice as a condition of receiving Medicaid. Prescribes requirements for: (1) referral to specialty care; (2) treatment of children with special health care needs; (3) access to emergency care; (4) annual external independent review of managed care entity activities and other specified quality care assurance measures; (5) fraud and abuse prohibitions and protections; and (6) enforcement sanctions. (Sec. 5701) Requires States to permit individuals access to religiously-affiliated long-term care facilities (including out-of-network facilities) that are not pervasively sectarian and that provide nonsectarian medical care comparable to a managed care entity meeting State Medicare requirements. Requires each Medicaid managed care organization to disclose annually to enrollees the proportion of the premiums and other revenues received by the organization that are expended for non-health care items and services. Directs the Secretary and the Comptroller General to report annually to specified congressional committees on rates paid for hospital services under managed care entities. Directs the Institute of Medicine of the National Academy of Sciences to analyze 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. (Sec. 5702) Amends SSA title XIX to grant States the option of providing Medicaid coverage of primary care case management services without the need for a waiver. (Sec. 5703) Repeals the (75-25) requirement that Medicare and Medicaid beneficiaries under SSA titles XVIII and XIX, respectively, constitute less than 75 percent of the membership of a participating HMO. Repeals the prohibition on co-payments for services furnished by HMOs. (Sec. 5711) 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. 5712) Revises requirements for Medicaid payment rates for qualified Medicare beneficiaries, placing a limitation on nonparticipating providers. (Sec. 5721) 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. Chapter 2: Expansion of Medicaid Eligibility - Grants States the option to: (1) permit workers with disabilities to buy into Medicaid; and (2) provide for 12-month continuous Medicaid eligibility for children. Chapter 3: Programs of All-Inclusive Care for the Elderly (PACE) - Authorizes a State to establish a 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. Requires the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under the Medicare and Medicaid programs, specifically comparing costs, quality, and access to services by private, for-profit entities operating under demonstration project waivers with those of other PACE providers. Chapter 4: Medicaid Management and Program Reforms - Repeals: (1) the requirement that a State pay for private insurance; (2) obstetrical and pediatric payment rate and various other specified requirements; and (3) certain physician qualification requirements. Authorizes a State to impose cost-sharing for any Medicaid provided to certain individuals. (Sec. 5755) Revises a specified penalty for fraudulent eligibility. (Sec. 5756) Prohibits the expenditure of Medicaid funds for roads, bridges, stadiums, and other items and services not covered by a State plan. 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. 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. Directs the Administrator of the Health Care Financing Administration to: (1) develop mechanisms to better monitor and prevent inappropriate Medicaid payments in the case of individuals who are dually eligible for Medicaid and Medicare benefits; (2) study the use of case management or care coordination in order to improve the appropriateness, quality, and cost effectiveness of care for dually- eligible individuals; and (3) work with the States to ensure better care coordination for dual eligibles. (Sec. 5757) Requires the Secretary to study and report to the Congress on: (1) early and periodic screening, diagnostic, and treatment benefits; and (2) individuals with special health care needs and chronic conditions in capitated managed care or primary care case management plans. Chapter 5: Miscellaneous - Provides for: (1) increased Federal medical assistance percentages (FMAPs) for the District of Columbia and Alaska and increased payment caps for the territories; (2) coverage of community-based mental health services and optional coverage of certain Centers for Disease Control screened breast cancer patients; and (3) treatment of veterans pensions. (Sec. 5765) 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. 5767) Directs the Secretary to study and report to the Congress on: (1) the use of nurse aide registries by States; (2) the extent to which institutional environmental factors contribute to cases of abuse and neglect at nursing facilities; and (3) whether alternatives to current sanctions for abuse and neglect at nursing facilities might be more effective in minimizing future cases of abuse and neglect. (Sec. 5768) Deems 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. (Thus exempts 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). (Sec. 5769) Applies certain requirements to the extension of statewide comprehensive research and demonstration projects for which waivers of Medicaid compliance have been granted. Subtitle J: Children's Health Insurance Initiatives - Amends SSA to add a new title XXI (Child Health Insurance Initiatives) in order to provide funds to States to expand the provision of health insurance coverage to low-income children. Mandates coverage that is actuarially equivalent to the benefits required to be offered for a child under the Federal Employees' Health Benefits Program (FEHBP). Requires the use of funds to achieve such purpose through specified outreach activities and, at the State's option, through: (1) a grant program to provide FEHBP-equivalent children's health insurance coverage for low-income children in the State; or (2) expansion of coverage of such children under the State Medicaid program who are not otherwise required to be provided medical assistance under Medicaid. Makes appropriations to carry out this title. Directs the Secretary to establish a basic allotment pool for distribution of funds to eligible States, with provision for bonus payments, including incentive bonuses. Prohibits their use to provide health insurance coverage for families of State public employees or children in penal institutions. Allows their use for abortion only if necessary to save the life of the mother or if the pregnancy results from rape or incest. Exempts such a State program from the five-year limit on means-tested public benefits under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Division 3: Income Security and Other Provisions - Subtitle K: Income Security, Welfare-to-Work Grant Program, and Other Provisions - Chapter 1: Income Security - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 to make aliens eligible for Supplemental Security Income (SSI) who, as of the date of enactment of such Act, were: (1) receiving such benefits; or (2) disabled and lawfully residing in the United States. Includes Cuban and Haitian entrants within the definition of "qualified alien" for purposes of welfare and public benefits. (Sec. 5812) Extends from five years 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. (Sec. 5813) Exempts from: (1) SSI and Medicaid eligibility limitations certain Canadian-born American Indians who are members of an Indian tribe; and (2) SSI eligibility limitations certain SSI recipients with pre-January 1, 1979 applications. (Sec. 5816) 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. 5817) Exempts legal aliens under the age of 19 from the five-year Medicaid limitation. (Sec. 5818) Treats certain Amerasian immigrants as refugees for purposes of specified public benefits eligibility. (Sec. 5819) Makes certain severely disabled legal aliens who were denied naturalization eligible for SSI benefits. Chapter 2: Welfare-to-Work Grant Program - 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. 5821) Sets forth requirements relating to State entitlement to non-competitive grants under such program and State distribution of such funds among local governments. Provides for competitive grants, based on program effectiveness and other factors, for State-approved projects proposed by local governments. 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 and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to: (1) develop a plan to evaluate the use of such grants; and (2) submit interim and final reports to the Congress. (Sec. 5822) Revises PRWORA provisions relating to a State's ability to sanction an individual receiving assistance under the TANF program for noncompliance. Chapter 3: Unemployment Compensation - Amends SSA title IX (Employment Security) with respect to unemployment compensation to increase the Federal Unemployment Account ceiling. (Sec. 5832) Provides for a special distribution to States from the Unemployment Trust Fund. (Sec. 5833) Revises the Internal Revenue Code exclude from the definition of employment, for specified unemployment compensation purposes, any service performed by a prison inmate. Division 4: Earned Income Credit and Other Provisions - Subtitle L: Earned Income Credit and Other Provisions - Chapter 1: Earned Income Credit - Prohibits allowing the earned income credit for: (1) ten years, if the credit was found to have been fraudulently claimed; and (2) two years, if the credit was claimed with intentional or reckless disregard of the earned income credit rules. Chapter 2: Increase in Public Debt Limit - Increases the public debt limit. Chapter 3: Miscellaneous - Expresses the sense of the Senate that all cost-of-living adjustments required by statute should accurately reflect the best available estimate of changes in the cost of living. Subtitle M: Welfare Reform Technical Corrections - Welfare Reform Technical Corrections Act of 1997 - Chapter 1: Block Grants for Temporary Assistance to Needy Families - Amends part A (Temporary Assistance for Needy Families) (TANF) of title IV of the Social Security Act (SSA) to make various specified technical as well as substantive amendments with regard to sundry (welfare reform) provisions added by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRAWORA). (Sec. 5902) Provides for a later deadline for submission of State TANF plans. (Sec. 5903) Revises the computation of bonus grants to States for a decrease in illegitimacy, requiring: (1) use of calendar year instead of fiscal year data; (2) use of the ratio of out-of-wedlock births to all births instead of the number of out-of-wedlock births; and (3) that certain territories be taken into account. Revises the formula for annual reconciliation of payments to States with specified maximums. Limits to non-needy States the requirement for annual State remission of excess funds to HHS. (Sec. 5905) Revises specified mandatory work requirements. States that a family with a disabled parent shall not treated as a two-parent family. Allows the minimum work requirement for a two-parent family to be shared between both parents, if it amounts