TITLE VIII HEALTH AND HEALTH-RELATED PROGRAMS OF THE FEDERAL GOVERNMENT

table of contents of title                                                Page

Subtitle A Military Health Care Reform

Sec. 8001. Uniformed services health plans                                1207

Subtitle B Department of Veterans Affairs

Sec. 8101. Benefits and eligibility through Department of Veterans Affairs
Medical System                                                            1218

Sec. 8102. Organization of Department of Veterans Affairs facilities as health
plans                                                                     1227

Subtitle C Federal Employees Health Benefits Program

Sec. 8201. Definitions                                                    1233

Sec. 8202. FEHBP termination                                              1234

Sec. 8203. Treatment of Federal employees, annuitants, and other individuals
(who would otherwise have been eligible for FEHBP) under health plans     1235

Sec. 8204. Treatment of individuals residing abroad                       1245

Sec. 8205. Transition and savings provisions                              1246

Sec. 8206. Regulations                                                    1248

Sec. 8207. Technical and conforming amendments                            1248

Subtitle D Indian Health Service

Sec. 8301. Definitions                                                    1249

Sec. 8302. Eligibility and health service coverage of Indians             1250

Sec. 8303. Supplemental Indian health care benefits                       1252

Sec. 8304. Health plan and health alliance requirements                   1252

Sec. 8305. Exemption of tribal governments and tribal organizations from
employer payments                                                         1253

Sec. 8306. Provision of health services to non-enrollees and non-Indians  1253

Sec. 8307. Payment by other payers                                        1258

Sec. 8308. Contracting authority                                          1258

Sec. 8309. Consultation                                                   1258

Sec. 8310. Infrastructure                                                 1259

Sec. 8311. Financing                                                      1259

Sec. 8312. Rule of construction                                           1261

Sec. 8313. Authorizations of appropriations                               1261

Sec. 8314. Payment of premium discount equivalent amounts for unemployed
Indians                                                                   1261

Subtitle E Amendments to the Employee Retirement Income Security Act of   1974

Sec. 8401. Group health plan defined                                      1262

Sec. 8402. Limitation on coverage of group health plans under title I of
ERISA                                                                     1263

Sec. 8403. Amendments relating to continuation coverage                   1269

Sec. 8404. Additional amendments relating to group health plans           1271

Sec. 8405. Plan claims procedures                                         1272

Sec. 8406. Effective dates                                                1273

Subtitle F Special Fund for WIC Program

Sec. 8501. Additional funding for special supplemental food program for women,
infants, and children (WIC)                                               1274


Subtitle A Military Health Care Reform

SEC. 8001. UNIFORMED SERVICES HEALTH PLANS.

  (a) Establishment of Plans. (1) Chapter 55 of title 10, United States Code,
is amended by inserting after section 1073 the following new section:

" 1073a. Uniformed Services Health Plans: establishment and coordination with
national health care reform

  "(a) Establishment Authorized. (1) The Secretary of Defense, in consultation
with the other administering Secretaries, may establish one or more Uniformed
Services Health Plans pursuant to this section in order to provide health care
services to members of the uniformed services on active duty for a period of
more than 30 days and persons described in subsection (e)(2).

  "(2) The establishment and operation of a Uniformed Services Health Plan
shall be carried out in accordance with regulations prescribed by the
Secretary of Defense, in consultation with the other administering
Secretaries. The Secretary shall assure that such regulations conform, to the
maximum extent practicable, to the requirements for health plans set forth in
the Health Security Act.

  "(b) Use of Uniformed Services Facilities and Other Health Care Providers.
(1) A Uniformed Services Health Plan may rely upon the use of facilities of
the uniformed services for the provision of health care services to persons
enrolled in the plan, supplemented by the use of civilian health care
providers or health plans under agreements entered into by the Secretary of
Defense.

  "(2) An agreement with a civilian health care provider or a health plan
under paragraph (1) may be entered into without regard to provisions of law
requiring the use of competitive procedures. An agreement with a health plan
may provide for the sharing of resources with the health plan that is a party
to the agreement.

  "(c) Health Care Services Under a Plan. (1) Subject to paragraph (2), a
Uniformed Services Health Plan shall provide to persons enrolled in the plan
at least the items and services in the comprehensive benefit package under the
Health Security Act.

  "(2)(A) In addition, a Uniformed Services Health Plan shall guarantee to
each person described in subparagraph (B) who is enrolled in the plan those
health care services that the person would be entitled to receive under this
chapter in the absence of this section. In the case of a person described in
subparagraph (B) who is a covered beneficiary, such health care services shall
consist of the types of health care services described in section 1079(a) of
this title.

  "(B) A person referred to in subparagraph (A) is a member of the uniformed
services on active duty for a period of more than 30 days as of December 31,
1994, or any person who is a covered beneficiary as of that date, who is (or
afterwards becomes) enrolled in a Uniformed Services Health Plan.

  "(d) Preemption of Conflicting State Requirements. In carrying out
responsibilities under the Health Security Act, a State (or State-established
entity)

  "(1) may not impose any standard or requirement on a Uniformed Services
Health Plan that is inconsistent with this section or any regulation
prescribed under this section or other Federal law regarding the operation of
this section; and

  "(2) may not deny certification of a Uniformed Services Health Plan as a
health plan under the Health Security Act on the basis of a conflict between a
rule of a State or health alliance and this section or any regulation
prescribed under this section or other Federal law regarding the operation of
this section.

  "(e) Enrollment. (1) Except as authorized by the administering Secretary
concerned, each member of a uniformed service on active duty for a period of
more than 30 days shall be required to enroll in a Uniformed Services Health
Plan available to the member.

  "(2) After enrolling members described in paragraph (1), opportunities for
further enrollment in a Uniformed Services Health Plan shall be offered by the
administering Secretaries to covered beneficiaries in the following order of
priority:

  "(A) Spouses and children of members of the uniformed services who are on
active duty for a period of more than 30 days.

  "(B) Persons described in subsection (c) of section 1086 of this title. The
administering Secretary concerned may disregard the exclusion set forth in
subsection (d)(1) of such section in the case of a person described in
subsection (c) of such section who is enrolled in the supplementary medical
insurance program under part B of title XVIII of the Social Security Act (42
U.S.C. 1395j et seq.).

  "(3) With respect to a member described in paragraph (1) or a covered
beneficiary described in paragraph (2) who enrolls in a Uniformed Services
Health Plan, participation in such a plan shall be the exclusive source of
health care services available to the member or person under this chapter.

  "(f) Effect of Failure to Enroll. (1) Except as provided in paragraph (2),
if a person described in subsection (e)(2) declines the opportunity offered by
the administering Secretaries to enroll in a Uniformed Services Health Plan,
the person shall not be entitled or eligible for health care services in
facilities of the uniformed services or pursuant to a contract entered into
under this chapter. However, nothing in this paragraph shall be construed to
effect the right of a person to a premium payment by the Secretary of Defense
if the person is enrolled in another health plan under the Health Security Act
and is otherwise entitled to such a payment under subsection (h).

  "(2) A person described in subsection (e)(2) who is enrolled with a health
plan that is not a Uniformed Services Health Plan may receive the items and
services in the comprehensive benefit package in a facility of the uniformed
services only if

  "(A) the Secretary of Defense authorizes the provision of a particular item
or service in the package to the person;

  "(B) the Secretary determines that the provision of the item or service
involved will not interfere with the provision of health care services to
members of the uniformed services or persons enrolled in a Uniformed Services
Health Plan; and

  "(C) the health plan in which the person is enrolled agrees to pay the
actual and full cost of the items and services in the package actually
provided to the person.

  "(3) The administering Secretaries shall assure that all rights and
entitlements under this chapter of any person described in subsection (e)(2)
are fully preserved if the person

  "(A) is not offered the opportunity to enroll in a Uniformed Services Health
Plan; and

  "(B) is not otherwise enrolled in a health plan provided through a health
alliance under the Health Security Act.

  "(g) Special Rule for Other Payers. (1)(A) In the case of a person who is
enrolled in the supplementary medical insurance program under part B of title
XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) and who is also
enrolled in a Uniformed Services Health Plan, Medicare shall be responsible
for making a premium payment on behalf of the person. The payment
responsibilities of Medicare under this paragraph shall be in the same amounts
and under the same terms and conditions under which the Secretary of Health
and Human Services makes payments to eligible organizations with a
risk-sharing contract under section 1876 of the Social Security Act. A premium
payment by Medicare under this paragraph shall be the person's exclusive
benefit under Medicare.

  "(B) In this paragraph, the term `Medicare' means any program administered
under title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.).

  "(2) Nothing in this section shall affect the payment of the retiree
discount under the Health Security Act on behalf of a person who is enrolled
in a Uniformed Services Health Plan if the person is otherwise eligible for
the retiree discount.

  "(h) Payment Responsibilities of the Secretary. (1) In the case of a person
described in subsection (e)(2) who is not enrolled in a Uniformed Services
Health Plan, the Secretary may make a premium payment for the person's
enrollment through a health alliance in another health plan. In determining
the amount of the payment, the Secretary shall consider the amount of any
retiree discount payable under the Health Security Act on behalf of the person
and the amount of any premium credits attributable to employer payments with
respect to employment of the person.

  "(2) The Secretary shall not make a payment pursuant to this subsection in
connection with any person enrolled in a health plan of the Department of
Veterans Affairs or a health program of the Indian Health Service.

  "(i) Payment Responsibilities of Persons Enrolled in a Uniformed Services
Health Plan. (1) In the case of an active duty member who is enrolled in a
Uniformed Services Health Plan, the administering Secretaries may not impose
or collect from the member a cost-share charge of any kind (whether a premium,
copayment, deductible, coinsurance charge, or other charge) other than
subsistence charges authorized under section 1075 of this title.

  "(2) Subject to paragraph (3), persons described in subsection (e)(2) who
are enrolled in a Uniformed Services Health Plan shall have such payment
responsibilities as the Secretary establishes, but not to exceed payment of a
family share under section 1343 of a premium and cost sharing. Payment
obligations established under this paragraph may not exceed those obligations
otherwise required under the national standards for health plans established
pursuant to the Health Security Act.

  "(3)(A) Persons described in subsection (e)(2) who enroll in a Uniformed
Services Health Plan and who (in the absence of this section) would be covered
beneficiaries under section 1079 or 1086 of this title continuously since
December 31, 1994, shall have, as a group, out-of-pocket costs in 1995 no
greater than the lesser of

  "(i) the out-of-pocket costs in effect for such beneficiaries under section
1075, 1078, 1079(b), or 1086(b) of this title (whichever applies) on December
31, 1994; and

  "(ii) those obligations otherwise required under the national standards for
health plans established pursuant to the Health Security Act.

  "(B) Members of the uniformed services on active duty as of December 31,
1994, who afterward become covered beneficiaries under section 1079 or 1086 of
this title (or would become covered beneficiaries in the absence of this
section) without a break in eligibility for health care services under this
chapter shall have, as a group, out-of-pocket costs as covered beneficiaries
no higher than the out-of-pocket costs in effect for similarly situated
covered beneficiaries described in subparagraph (A).

  "(C) The limitation on out-of-pocket costs established pursuant to
subparagraph (A) may be adjusted for years after 1995 by an appropriate
economic index, as determined by the Secretary of Defense.

  "(4) The Secretary of Defense shall establish the payment requirements under
paragraph (2), and enforce the limitations on such requirements specified in
paragraph (3), in regulations prescribed pursuant to subsection (a).

  "(j) Financial Account. There is hereby established in the Department of
Defense a financial account to which shall be credited all premium payments
and other receipts from other payers and beneficiaries made in connection with
any person enrolled in a Uniformed Services Health Plan. The account shall be
administered by the Secretary of Defense, and funds in the account may be used
by the Secretary for any purpose directly related to the delivery and
financing of health care services under this chapter, including operations,
maintenance, personnel, procurement, contributions toward construction
projects, and related costs. Funds in the account shall remain available until
expended.''.

  (2) The table of sections at the beginning of such chapter is amended by
inserting after the item relating to section 1073 the following new item:

"1073a. Uniformed Services Health Plans: establishment and coordination with
national health care reform.''.

  (b) Definition. Section 1072 of such title is amended by adding at the end
the following new paragraph:

  "(6) The term `Uniformed Services Health Plan' means a plan established by
the Secretary of Defense under section 1073a(a) of this title in order to
provide health care services to members of the uniformed services on active
duty and other covered beneficiaries under this chapter.''.

  (c) Report on Establishment. If the Secretary of Defense determines to
establish any Uniformed Services Health Plan under section 1073a of title 10,
United States Code, as added by subsection (a), the Secretary shall submit to
Congress a report describing the Plans proposed to be initially offered under
such section. The report required by this subsection shall be submitted not
later than 30 days before the date on which the Secretary first issues
proposed rules under subsection (a) of such section to establish any such
Plan.

Subtitle B Department of Veterans Affairs

Title VIII, Subtitle B

SEC. 8101. BENEFITS AND ELIGIBILITY THROUGH DEPARTMENT OF VETERANS AFFAIRS
MEDICAL SYSTEM.

  (a) DVA As a Participant in Health Care Reform.

  (1) In general. Title 38, United States Code, is amended by inserting after
chapter 17 the following new chapter:

"CHAPTER 18 ELIGIBILITY AND BENEFITS UNDER HEALTH SECURITY ACT

"SUBCHAPTER I GENERAL

"1801. Definitions.

"SUBCHAPTER II ENROLLMENT

"1811. Enrollment: veterans.

"1812. Enrollment: CHAMPVA eligibles.

"1813. Enrollment: family members.

"SUBCHAPTER III BENEFITS

"1821. Benefits for VA enrollees.

"1822. Chapter 17 benefits.

"1823. Supplemental benefits packages and policies.

"1824. Limitation regarding veterans enrolled with health plans outside
Department.

"SUBCHAPTER IV FINANCIAL MATTERS

"1831. Premiums, copayments, etc.

"1832. Medicare coverage and reimbursement.

"1833. Recovery of cost of certain care and services.

"1834. Health Plan Funds.

"SUBCHAPTER I GENERAL

" 1801. Definitions

  "For purposes of this chapter:

  "(1) The term `health plan' means an entity that has been certified under
the Health Security Act as a health plan.

  "(2) The term `VA health plan' means a health plan that is operated by the
Secretary under section 7341 of this title.

  "(3) The term `VA enrollee' means an individual enrolled under the Health
Security Act in a VA health plan.

"SUBCHAPTER II ENROLLMENT

" 1811. Enrollment: veterans

  "Each veteran who is an eligible individual within the meaning of section
1001 of the Health Security Act may enroll with a VA health plan. A veteran
who wants to receive the comprehensive benefit package through the Department
shall enroll with a VA health plan.

" 1812. Enrollment: CHAMPVA eligibles

  "An individual who is eligible for benefits under section 1713 of this title
and who is eligible to enroll in a health plan pursuant to section 1001 of the
Health Security Act may enroll under that Act with a VA health plan in the
same manner as a veteran.

" 1813. Enrollment: family members

  "(a) The Secretary may authorize a VA health plan to enroll members of the
family of an enrollee under section 1811 or 1812 of this title, subject to
payment of premiums, deductibles, copayments, and coinsurance as required
under the Health Security Act.

  "(b) For purposes of subsection (a), an enrollee's family is those
individuals (other than the enrollee) included within the term `family' as
defined in section 1011(b) of the Health Security Act.

"SUBCHAPTER III BENEFITS

" 1821. Benefits for VA enrollees

  "The Secretary shall ensure that each VA health plan provides to each
individual enrolled with it the items and services in the comprehensive
benefit package under the Health Security Act.

" 1822. Chapter 17 benefits

  "The Secretary shall provide to veterans the care and services that are
authorized to be provided under chapter 17 of this title in accordance with
the terms and conditions applicable to that veteran and that care under such
chapter, notwithstanding that such care and services are not included in the
comprehensive benefit package.

" 1823. Supplemental benefits packages and policies

  "A VA health plan may offer supplemental health benefits policies for health
care services not provided under chapter 17 of this title and cost sharing
policies consistent with the requirements of part 2 of subtitle E of title I
of the Health Security Act.

" 1824. Limitation regarding veterans enrolled with health plans outside
Department

  "A veteran who is residing in a regional alliance area in which the
Department operates a health plan and who is enrolled in a health plan that is
not operated by the Department may be provided the items and services in the
comprehensive benefit package by a VA health plan only if the plan is
reimbursed for the actual and full cost of the care provided.

"SUBCHAPTER IV FINANCIAL MATTERS

" 1831. Premiums, copayments, etc.

  "(a) In the case of a veteran described in subsection (b) who is a VA
enrollee, the Secretary may not impose or collect from the veteran a
cost-share charge of any kind (whether a premium, copayment, deductible,
coinsurance charge, or other charge). The Secretary shall make such
arrangements as necessary with health alliances in order to carry out this
subsection.

  "(b) The veterans referred to in subsection (a) are the following:

  "(1) Any veteran with a service-connected disability.

  "(2) Any veteran whose discharge or release from the active military, naval
or air service was for a disability incurred or aggravated in the line of
duty.

  "(3) Any veteran who is in receipt of, or who, but for a suspension pursuant
to section 1151 of this title (or both such a suspension and the receipt of
retired pay), would be entitled to disability compensation, but only to the
extent that such a veteran's continuing eligibility for such care is provided
for in the judgment or settlement provided for in such section.

  "(4) Any veteran who is a former prisoner of war.

  "(5) Any veteran of the Mexican border period or World War I.

  "(6) Any veteran who is unable to defray the expenses of necessary care as
determined under section 1722(a) of this title.

  "(c) In the case of a VA enrollee who is not described in subsection (b),
the Secretary shall charge premiums and establish copayments, deductibles, and
coinsurance amounts. The premium rate, and the rates for deductibles and
copayments, for each VA health plan shall be established by that health plan
based on rules established by the health alliance under which it is operating.

  "(d) In the case of a veteran with a service-connected disability who is
enrolled in a VA health plan and who has net earnings from self-employment,
the Secretary shall, under regulations prescribed by the Secretary, provide
for a reduction in any premium payment (or alliance credit repayment) owed by
the veteran under section 6126 or 6111 of the Health Security Act by virtue of
the veteran's net earnings from self-employment.

" 1832. Medicare coverage and reimbursement

  "(a) For purposes of any program administered by the Secretary of  Health
and Human Services under title XVIII of the Social Security Act, a Department
facility shall be deemed to be a Medicare provider.

  "(b)(1) A VA health plan shall be considered to be a Medicare HMO.

  "(2) For purposes of this section, the term `Medicare HMO' means an eligible
organization under section 1876 of the Social Security Act.

  "(c) In the case of care provided to a veteran other than a veteran
described in section 1831(b) of this title who is eligible for benefits under
the Medicare program under title XVIII of the Social Security Act, the
Secretary of Health and Human Services shall reimburse a VA health plan or
Department health-care facility providing services as a Medicare provider or
Medicare HMO in the same amounts and under the same terms and conditions as
that Secretary reimburses other Medicare providers or Medicare HMOs,
respectively. The Secretary of Health and Human Services shall include with
each such reimbursement a Medicare explanation of benefits.

  "(d) When the Secretary provides care to a veteran for which the Secretary
receives reimbursement under this section, the Secretary shall require the
veteran to pay to the Department any applicable deductible or copayment that
is not covered by Medicare.

" 1833. Recovery of cost of certain care and services

  "(a) In the case of an individual provided care or services through a VA
health plan who has coverage under a supplemental health insurance policy
pursuant to part 2 of subtitle E of title I of the Health Security Act or
under any other provision of law, or who has coverage under a Medicare
supplemental health insurance plan (as defined in the Health Security Act) or
under any other provision of law, the Secretary has the right to recover or
collect charges for care or services (as determined by the Secretary, but not
including care or services for a service-connected disability) from the party
providing that coverage to the extent that the individual (or the provider of
the care or services) would be eligible to receive payment for such care or
services from such party if the care or services had not been furnished by a
department or agency of the United States.

  "(b) The provisions of subsections (b) through (f) of section 1729 of this
title shall apply with respect to claims by the United States under subsection
(a) in the same manner as they apply to claims under subsection (a) of that
section.

" 1834. Health Plan Fund

  "(a) There is hereby established in the Treasury a revolving fund to be
known as the `Department of Veterans Affairs Health Plan Fund'.

  "(b) Any amount received by the Department by reason of the furnishing of
health care by a VA health plan or the enrollment of an individual with a VA
health plan (including amounts received as premiums, premium discount
payments, copayments or coinsurance, and deductibles, amounts received as
third-party reimbursements, and amounts received as reimbursements from
another health plan for care furnished to one of its enrollees) shall be
credited to the revolving fund.

  "(c) Notwithstanding subsection (b), the Department may not retain amounts
received for care furnished to a VA enrollee in a case in which the costs of
such care have been covered by appropriations. Such amounts shall be deposited
in the General Fund of the Treasury.

  "(d) Amounts in the revolving fund are hereby made available for the
expenses of the delivery by a VA health plan of the items and services in the
comprehensive benefit package and any supplemental benefits package or policy
offered by that health plan.''.

  (2) The table of chapters at the beginning of part II of title 38, United
States Code, is amended by inserting after the item relating to chapter 17 the
following new item:

"18. Benefits and Eligibility Under Health Security Act 1801.''.

  (b) Preservation of Existing Benefits for Facilities Not Operating as Health
Plans. (1) Chapter 17 of title 38, United States Code, is amended by inserting
after section 1704 the following new section:

" 1705. Facilities not operating within health plans; veterans not eligible
to enroll in health plans

  "The provisions of this chapter shall apply with respect to the furnishing
of care and services

  "(1) by any facility of the Department that is not operating as or within a
health plan certified as a health plan under the Health Security Act; and

  "(2) by any facility of the Department (whether or not operating as or
within a health plan certified as a health plan under the Health Security Act)
in the case of a veteran who is not an eligible individual with the meaning of
section 1001 of the Health Security Act.''.

  (2) The table of sections at the beginning of such chapter is amended by
inserting after the item relating to section 1704 the following new item:

"1705. Facilities not operating within health plans; veterans not eligible to
enroll in health plans.''.

SEC. 8102. ORGANIZATION OF DEPARTMENT OF VETERANS AFFAIRS FACILITIES AS HEALTH
PLANS.

  (a) In General. Chapter 73 of title 38, United States Code, is amended

  (1) by redesignating subchapter IV as subchapter V; and

  (2) by inserting after subchapter III the following new subchapter:

"SUBCHAPTER IV PARTICIPATION AS PART OF NATIONAL HEALTH CARE REFORM

" 7341. Organization of health care facilities as health plans

  "(a) The Secretary shall organize health plans and operate Department
facilities as or within health plans under the Health Security Act. The
Secretary shall prescribe regulations establishing standards for the operation
of Department health care facilities as or within health plans under that Act.
In prescribing those standards, the Secretary shall assure that they conform,
to the maximum extent practicable, to the requirements for health plans
generally set forth in part 1 of subtitle E of title I of the Health Security
Act.

  "(b) Within a geographic area or region, health care facilities of the
Department located within that area or region may be organized to operate as a
single health plan encompassing all Department facilities within that area or
region or may be organized to operate as several health plans.

  "(c) In carrying out responsibilities under the Health Security Act, a State
(or a State-established entity)

  "(1) may not impose any standard or requirement on a VA health plan that is
inconsistent with this section or any regulation prescribed under this section
or other Federal laws regarding the operation of this section; and

  "(2) may not deny certification of a VA health plan under the Health
Security Act on the basis of a conflict between a rule of a State or health
alliance and this section or regulations prescribed under this section or
other Federal laws regarding the operation of this section.

" 7342. Contract authority for facilities operating as or within health plans

  "The Secretary may enter into a contract (without regard to provisions of
law requiring the use of competitive procedures) for the provision of services
by a VA health plan in any case in which the Secretary determines that such
contracting is more cost-effective than providing such services directly
through Department facilities or when such contracting is necessary because of
geographic inaccessibility.

" 7343. Resource sharing authority: facilities operating as or within health
plans

  "The Secretary may enter into agreements under section 8153 of this title
with other health care plans, with health care providers, and with other
health industry organizations, and with individuals, for the sharing of
resources of the Department through facilities of the Department operating as
or within health plans.

" 7344. Administrative and personnel flexibility

  "(a) In order to carry out this subchapter, the Secretary may

  "(1) carry out administrative reorganizations of the Department without
regard to those provisions of section 510 of this title following subsection
(a) of that section; and

  "(2) enter into contracts for the performance of services previously
performed by employees of the Department without regard to section 8110(c) of
this title.

  "(b) The Secretary may establish alternative personnel systems or procedures
for personnel at facilities operating as or with health plans under the Health
Security Act whenever the Secretary considers such action necessary in order
to carry out the terms of that Act, except that the Secretary shall provide
for preference eligibles (as defined in section 2108 of title 5, United States
Code) in a manner comparable to the preference for such eligibles under
subchapter I of chapter 33, and subchapter I of chapter 35, of such title.

  "(c) Subject to the provisions of section 1404 of the Health Security Act,
the Secretary may carry out appropriate promotional, advertising, and
marketing activities to inform individuals of the availability of facilities
of the Department operating as or within health plans. Such activities may
only be carried out using nonappropriated funds.

" 7345. Veterans Health Care Investment Fund

  "(a) There is hereby authorized to be appropriated to the Department, in
addition to amounts otherwise authorized to be appropriated to the Department
for VA health plans, such amounts as are necessary for the Secretary of the
Treasury to fulfill the requirement of subsection (b).

  "(b) For each of fiscal years 1995, 1996, and 1997, the Secretary of the
Treasury shall, subject to subsection (a), credit to a special fund (in this
section referred to as the `Fund') of the Treasury an amount equal to

  "(1) $1,000,000,000 for fiscal year 1995;

  "(2) $600,000,000 for fiscal year 1996; and

  "(3) $1,700,000,000 for fiscal year 1997.

  "(c)(1) Subject to paragraph (2), amounts in the Fund shall be available to
the Secretary only for the VA health plans authorized under this chapter.

  "(2) For fiscal year 1995, 1996, or 1997, the amount credited to the Fund
for the fiscal year shall be available for use by the Secretary under
paragraph (1) only if appropriations Acts for that fiscal year, without
addition of amounts provided under subsection (a) for the Fund, provide new
budget authority for the Department of Veterans Affairs Medical Care account,
for that fiscal year, of no less than the amount for that account proposed in
the budget of the President for that fiscal year under section 1105 of title
31.

  "(d) The Secretary shall submit to Congress, no later than March 1, 1997, a
report concerning the operation of the Department of Veterans Affairs health
care system in preparing for, and operating under, national health care reform
under the Health Security Act during fiscal years 1995 and 1996. The report
shall include a discussion of

  "(1) the adequacy of amounts in the Fund for the operation of VA health
plans;

  "(2) the quality of care provided by such plans;

  "(3) the ability of such plans to attract patients; and

  "(4) the need (if any) for additional funds for the Fund in fiscal years
after fiscal year 1997.

" 7346. Funding provisions: grants and other sources of assistance

  "The Secretary may apply for and accept, if awarded, any grant or other
source of funding that is intended to meet the needs of special populations
and that but for this section is unavailable to facilities of the Department
or to health plans operated by the Government if funds obtained through the
grant or other source of funding will be used through a facility of the
Department operating as or within a health plan.''.

  (b) Clerical Amendment. The table of sections at the beginning of chapter 73
is amended by striking out the item relating to the heading for subchapter IV
and inserting in lieu thereof the following:

"Subchapter IV Participation as Part of National Health Care Reform

"7341. Organization of health care facilities as health plans.

"7342. Contract authority for facilities operating as or within health plans.

"7343. Resource sharing authority: facilities operating as or within health
plans.

"7344. Administrative and personnel flexibility.

"7345. Veterans Health Care Investment Fund.

"7346. Funding provisions: grants and other sources of assistance.

"Subchapter V Research Corporations''.

  (c) Transition Provision. The limitation in the second sentence of section
7344(c) of title 38, United States Code, as added by subsection (a), shall not
apply during fiscal year 1994.

Title VIII, Subtitle C

Subtitle C Federal Employees Health Benefits Program

SEC. 8201. DEFINITIONS.

  Except as otherwise specifically provided, in this subtitle:

  (1) Abroad. The term "abroad'' means outside the United States.

  (2) Annuitant, etc. The terms "annuitant'', "employee'', and "Government'',
have the same respective meanings as are given such terms by section 8901 of
title 5, United States Code (as last in effect).

  (3) Employees health benefits fund. The term "Employees Health Benefits
Fund'' means the fund under section 8909 of title 5, United States Code (as
last in effect).

  (4) FEHBP. The term "FEHBP'' means the health insurance program under
chapter 89 of title 5, United States Code (as last in effect).

  (5) FEHBP plan. The term "FEHBP plan'' has the same meaning as is given the
term "health benefits plan'' by section 8901(6) of title 5, United States Code
(as last in effect).

  (6) FEHBP termination date. The term "FEHBP termination date'' means the
date (specified in section 8202) after which FEHBP ceases to be in effect.

  (7) Retired employees health benefits fund. The term "Retired Employees
Health Benefits Fund'' means the fund under section 8 of the Retired Federal
Employees Health Benefits Act (Public Law 86-724; 74 Stat. 851), as last in
effect.

  (8) RFEHBP. The term "RFEHBP'' means the health insurance program under the
Retired Federal Employees Health Benefits Act.

SEC. 8202. FEHBP TERMINATION.

  Chapter 89 of title 5, United States Code, is repealed effective as of
December 31, 1997, and all contracts under such chapter shall terminate not
later than such date.

SEC. 8203. TREATMENT OF FEDERAL EMPLOYEES, ANNUITANTS, AND OTHER INDIVIDUALS
(WHO WOULD OTHERWISE HAVE BEEN ELIGIBLE FOR FEHBP) UNDER HEALTH PLANS.

  (a) Applicability. This section sets forth rules applicable, after the FEHBP
termination date, with respect to individuals who

  (1) are eligible individuals under section 1001; and

  (2) but for this subtitle, would be eligible to enroll in an FEHBP plan.

  (b) Federal Employees.

  (1) Same treatment as nonfederal employees. A Federal employee shall be
treated in the same way, for purposes of provisions of this Act outside of
this subtitle, as if that individual were a non-Federal employee, including
for purposes of any requirements relating to enrollment, family premium
payments, and employer premium payments.

  (2) Employer premium payments. Any employer premium payment required with
respect to the employment of a Federal employee shall be payable from the
appropriation or fund from which any Government contribution on behalf of such
employee would have been payable under FEHBP.

  (3) Offer of fehbp supplemental plans. The Federal Government shall offer to
Federal employees one or more FEHBP supplemental plans developed under
subsection (f)(1).

  (4) Definitions. In this subsection:

  (A) Federal employee. The term "Federal employee'' means an "employee'' as
defined by section 8201.

  (B) Non-federal employee. The term "nonFederal employee'' means an
"employee'' as defined by section 1901.

  (c) Annuitants.

  (1) Health plan.

  (A) Authority to make certain withholdings from annuities.

  (i) In general. The Office of Personnel Management may, on the request of an
annuitant enrolled in a health plan, withhold from the annuity of such
annuitant any premiums required for such enrollment. The Office shall forward
any amounts so withheld to the appropriate fund or as otherwise indicated in
the request. A request under this subparagraph shall contain such information,
and otherwise be made in such form and manner, as the Office shall by
regulation prescribe.

  (ii) References. Any reference in clause (i) to the Office of Personnel
Management shall, for purposes of any annuity (including monthly compensation
under subchapter I of chapter 81 of title 5, United States Code) payable under
provisions of law which are administered by a Government entity other than the
Office, be considered to be a reference to such other Government entity.

  (B) Payment of alliance credit liability for annuitants below age 55. In the
case of an annuitant who does not satisfy the eligibility requirements under
section 6114, a Government contribution shall be made equal to such amount as
is necessary to reduce the employee's liability under section 6111 to zero.

  (2) FEHBP supplemental plan.

  (A) Current annuitants.

  (i) In general. Each current annuitant

  (I) shall be eligible to enroll in FEHBP supplemental plans developed under
subsection (f)(1); and

  (II) shall be eligible for the Government contribution amount described in
clause (ii) toward the premium for such a plan.

  (ii) Government contribution amount. The Office of Personnel Management
shall specify a level of Government contribution under this subparagraph for
an FEHBP supplemental plan. Such level

  (I) shall reasonably reflect the portion of the Government contributions
(last provided under FEHBP) attributable to the portion of FEHBP benefits
which the plan is designed to replace; and

  (II) shall be applied toward premiums for such a plan.

  (B) Future annuitants. In the case of a future annuitant, the Federal
Government shall offer to such an annuitant one or more FEHBP supplemental
plans developed under subsection (f)(1).

  (C) Definitions. In this paragraph:

  (i) Current annuitant. The term "current annuitant'' means an individual who
is residing in a State on January 1, 1998, and, on the day before such date,
was

  (I) enrolled in an FEHBP plan as an annuitant; or

  (II) covered under an FEHBP plan as a family member (but only if such
individual would otherwise have been eligible to enroll in an FEHBP plan as an
annuitant).

  (ii) Future annuitant. The term "future annuitant'' means an annuitant who
is not a current annuitant.

  (d) Individuals Who Would Not Be Eligible for a Government Contribution
Under FEHBP.

  (1) In general. In the case of an individual described in paragraph (2)

  (A) the Federal Government may, but is not required to, offer one or more
FEHBP supplemental plans developed under subsection (f)(1); and

  (B) no Government contribution shall be payable with respect to the premium
for such a plan.

  (2) Applicability. This subsection shall apply with respect to any
individual who (but for this subtitle) would be eligible to enroll in an FEHBP
plan, but would not be eligible for a Government contribution toward any such
plan.

  (e) Medicare-Eligible Individuals.

  (1) Current medicare-eligible individuals.

  (A) In general. Each current medicare-eligible individual

  (i) shall be eligible to enroll in medicare supplemental plans developed
under subsection (f)(2); and

  (ii) if such individual would (but for this subtitle) have been eligible for
a Government contribution under FEHBP (assuming such individual were then
enrolled thereunder), shall be eligible for the Government medicare
contribution amount described in subparagraph (B) toward the premium for such
a plan or toward the premium for enrollment with an eligible organization
under a risk-sharing contract under section 1876 of the Social Security Act).

  (B) Medicare contribution amount. The Office of Personnel Management shall
specify a level of Government contribution under this paragraph for an FEHBP
medicare supplemental plan. Such level

  (i) shall reasonably reflect the portion of the Government contributions
(last provided under FEHBP) attributable to the portion of FEHBP benefits
which the plan is designed to replace; and

  (ii) except as otherwise provided in paragraph (3), shall be applied toward
premiums for such a plan.

  (2) Future medicare-eligible individuals. In the case of a future
medicare-eligible individual, the Federal Government may, but is not required
to

  (A) offer to such a medicare-eligible individual one or more FEHBP medicare
supplemental plans developed under subsection (f)(2); and

  (B) make a Government contribution with respect to the premium for such a
plan.

  (3) Application of contribution toward medicare hmo option.

  (A) Election. A medicare-eligible individual may elect to have the amount of
the Government contribution described in paragraph (1)(B) or referred to in
paragraph (2)(B) applied toward premiums for enrollment with an eligible
organization under a risk-sharing contract under section 1876 of the Social
Security Act.

  (B) Level contribution rule. The level of such Government contribution on
behalf of an individual shall be determined without taking into account any
election under subparagraph (A).

  (4) Definitions. In this subsection:

  (A) Current medicare-eligible individual. The term "current
medicare-eligible individual'' means an individual who is residing in a State
on January 1, 1998, and, on the day before such date, was a medicare-eligible
individual.

  (B) Future medicare-eligible individual. The term "future medicare-eligible
individual'' means a medicare-eligible individual who is not a current
medicare-eligible individual.

  (5) Inapplicability. Subsections (b) through (d) shall not apply with
respect to a medicare-eligible individual.

  (f) Development of Supplemental Plans.

  (1) FEHBP supplemental plans. The Office of Personnel Management shall
develop one or more FEHBP supplemental plans which are supplemental health
benefit policies or cost sharing policies (as defined in section 1421(b)).
Each such plan shall

  (A) be consistent with the applicable requirements of part 2 of subtitle E
of title I (including the requirements under section 1423(f)); and

  (B) reflect (taking into consideration the benefits in the comprehensive
benefit package) the overall level of benefits last generally afforded under
FEHBP.

  (2) FEHBP medicare supplemental plans. The Office of Personnel Management
shall develop one or more medicare supplemental plans. Each such plan shall

  (A) offer benefits which shall include the core group of basic benefits
identified under section 1882(p)(2) of the Social Security Act; and

  (B) reflect (taking into consideration the benefits provided under the
medicare program) the overall level of benefits last generally afforded under
FEHBP.

  (g) Authorization of appropriations. The Government contributions authorized
by this section on behalf of an annuitant (including an annuitant who is a
medicare-eligible individual) shall be paid from annual appropriations which
are authorized to be made for that purpose and which may be made available
until expended.

  (h) Fund.

  (1) Establishment. There shall be established in the Treasury of the United
States a fund into which shall be paid all contributions relating to any

  (A) FEHBP supplemental plan developed under subsection (f)(1);

  (B) FEHBP medicare supplemental plan developed under subsection (f)(2); or

  (C) health insurance program established under section 8204.

  (2) Administration and use. The fund shall be administered by the Office of
Personnel Management, and any monies in the fund shall be available for
purposes of the plan or program (referred to in paragraph (1)) to which they
are attributable.

SEC. 8204. TREATMENT OF INDIVIDUALS RESIDING ABROAD.

  (a) In General. After the FEHBP termination date, individuals residing
abroad who (but for this subtitle) would be eligible to enroll in an FEHBP
plan shall be eligible for health insurance under a program which the Office
of Personnel Management shall by regulation establish.

  (b) Requirement. To the extent practicable, coverage and benefits provided
to individuals under such program shall be equal to the coverage and benefits
which would be available to them if they were residing in the United States.

  (c) Government Contributions. Any Government contribution payable under such
program shall be made from the appropriation or fund from which any Government
contribution would have been payable under FEHBP (if any) on behalf of the
individual involved, except that, in the case of an annuitant, any such
contribution shall be payable from amounts appropriated pursuant to section
8203(g).

SEC. 8205. TRANSITION AND SAVINGS PROVISIONS.

  (a) Employees Health Benefits Fund.

  (1) Temporary continued availability. Notwithstanding section 8202, the
Employees Health Benefits Fund shall be maintained, and amounts in such Fund
shall remain available, after the FEHBP termination date, for such period of
time as the Office of Personnel Management considers necessary in order to
satisfy any outstanding claims.

  (2) Final disbursement. After the end of the period referred to in paragraph
(1), any amounts remaining in the Fund shall be disbursed (between the
Government and former participants in FEHBP) in accordance with a plan which
the Office shall prepare, consistent with the cost-sharing ratio between the
Government and plan enrollees during the final contract term. The details of
any such plan shall be submitted to the President and the Congress at least 1
year before the date of its proposed implementation.

  (b) Proceedings. After the FEHBP termination date, chapter 89 of title 5,
United States Code (as last in effect) shall be considered to have remained in
effect for purposes of any suit, action, or other proceeding with respect to
any liability incurred or violation which occurred on or before such date.

  (c) RFEHBA.

  (1) Repeal. The Retired Federal Employees Health Benefits Act (Public Law
86724; 74 Stat. 849) is repealed effective as of the FEHBP termination date.

  (2) Related provisions. After the FEHBP termination date

  (A) the Retired Employees Health Benefits Fund shall temporarily remain
available, and amounts in that fund shall subsequently be disbursed, in a
manner comparable to that provided for under subsection (a); and

  (B) retired employees who (but for this subtitle) would be eligible for
coverage under the Retired Federal Employees Health Benefits Act shall be
treated, for purposes of this subtitle, as if they were annuitants (subject to
any differences in the overall level of coverage or benefits last generally
afforded to annuitants under FEHBP and to retired employees under RFEHBP,
respectively).

  (3) Regulations. Regulations prescribed under section 8206 to carry out this
subsection shall include any necessary provisions relating to individuals
residing abroad.

SEC. 8206. REGULATIONS.

  The Office of Personnel Management shall prescribe any regulations which may
be necessary to carry out this subtitle.

SEC. 8207. TECHNICAL AND CONFORMING AMENDMENTS.

  (a) OPM's Annual Report on FEHBP. Subsection (c) of section 1308 of title 5,
United States Code, is repealed.

  (b) Other References to FEHBP. Any reference in any provision of law to the
health insurance program under chapter 89 of title 5, United States Code (or
any aspect of such program) shall be considered to be a reference to the
health insurance program under this subtitle (or corresponding aspect),
subject to such clarification as may be provided, or except as may otherwise
be provided, in regulations prescribed by the agency or other authority
responsible for the administration of such provision.

  (c) Omnibus Budget Reconciliation Act of 1993. Effective as of the date of
the enactment of this Act, section 11101(b)(3) of the Omnibus Budget
Reconciliation Act of 1993 (Public Law 10366; 107 Stat. 413) is amended by
striking "September 30, 1998'' and inserting "December 31, 1997''.

  (d) Effective Date. Except as provided in subsection (c), this section and
the amendments made by this section shall take effect on the day after the
FEHBP termination date.

Title VIII, Subtitle D

Subtitle D Indian Health Service

SEC. 8301. DEFINITIONS.

  For the purposes of this subtitle

  (1) the term "health program of the Indian Health Service'' means a program
which provides health services under this Act through a facility of the Indian
Health Service, a tribal organization under the authority of the Indian
Self-Determination Act or a self-governance compact, or an urban Indian
program;

  (2) the term "reservation'' means the reservation of any federally
recognized Indian tribe, former Indian reservations in Oklahoma, and lands
held by incorporated Native groups, regional corporations, and village
corporations under the provisions of the Alaska Native Claims Settlement Act
(43 U.S.C. 1601 et seq.);

  (3) the term "urban Indian program'' means any program operated pursuant to
title V of the Indian Health Care Improvement Act; and

  (4) the terms "Indian'', "Indian tribe'', "tribal organization'', "urban
Indian'', "urban Indian organization'', and "service unit'' have the same
meaning as when used in the Indian Health Care Improvement Act (25 U.S.C. 1601
et seq.).

SEC. 8302. ELIGIBILITY AND HEALTH SERVICE COVERAGE OF INDIANS.

  (a) Eligibility. An eligible individual, as defined in section 1001(c), is
eligible to enroll in a health program of the Indian Health Service if the
individual is

  (1) an Indian, or a descendent of a member of an Indian tribe who belongs to
and is regarded as an Indian by the Indian community in which the individual
lives, who resides on or near an Indian reservation or in a geographical area
designated by statute as meeting the requirements of being on or near an
Indian reservation notwithstanding the lack of an Indian reservation;

  (2) an urban Indian; or

  (3) an Indian described in section 809(b) of the Indian Health Care
Improvement Act (25 U.S.C. 1679(b)).

  (b) Election. An individual described in subsection (a) may elect a health
program of the Indian Health Service instead of a health plan.

  (c) Enrollment for Benefits. An individual who elects a health program of
the Indian Health Service under subsection (b) shall enroll in such program
through a service unit, tribal organization, or urban Indian program. An
individual who enrolls in such program is not subject to any charge for health
insurance premiums, deductibles, copayments, coinsurance, or any other cost
for health services provided under such program.

  (d) Payments by Individuals Who Do not Enroll. If an individual described in
subsection (a) does not enroll in a health program of the Indian Health
Service, no payment shall be made by the Indian Health Service to the
individual (or on behalf of the individual) with respect to premiums charged
for enrollment in an applicable health plan or any other cost of health
services under the applicable health plan which the individual is required to
pay.

SEC. 8303. SUPPLEMENTAL INDIAN HEALTH CARE BENEFITS.

  (a) In General. All individuals described in sections 8302(a) remain
eligible for such benefits under the laws administered by the Indian Health
Service as supplement the comprehensive benefit package. The individual shall
not be subject to any charge or any other cost for such benefits.

  (b) Authorization of Appropriations. In addition to amounts otherwise
authorized to be appropriated, there is authorized to be appropriated to carry
out this section $180,000,000 for fiscal year 1995, $200,000,000 for each of
the fiscal years 1996 through 1999, and such sums as may be necessary for
fiscal year 2000 and each fiscal year thereafter.

SEC. 8304. HEALTH PLAN AND HEALTH ALLIANCE REQUIREMENTS.

  (a) Comprehensive Benefit Package. The Secretary shall ensure that the
comprehensive benefit package is provided by all health programs of the Indian
Health Service effective January 1, 1999, notwithstanding section 1001(a).

  (b) Applicable Requirements of Health Plans. In addition to subsection (a),
the Secretary shall determine which other requirements relating to health
plans apply to health programs of the Indian Health Service.

  (c) Certification. Effective January 1, 1999, all health programs of the
Indian Health Service must meet the certification requirements for health
plans, as required by the Secretary under this section, as certified from time
to time by the Secretary. Before January 1, 1999, all such health programs
shall, to the extent practicable, meet such certification requirements.

  (d) Health Alliance Requirements. The Secretary shall determine which
requirements relating to health alliances apply to the Indian Health Service.

SEC. 8305. EXEMPTION OF TRIBAL GOVERNMENTS AND TRIBAL ORGANIZATIONS FROM
EMPLOYER PAYMENTS.

  A tribal government and a tribal organization under the Indian
Self-Determination and Educational Assistance Act or a self-governance compact
shall be exempt from making employer premium payments as an employer under
section 6121.

SEC. 8306. PROVISION OF HEALTH SERVICES TO NON-ENROLLEES AND NON-INDIANS.

  (a) Contracts With Health Plans.

  (1) In general. A health program of the Indian Health Service, a service
unit, a tribal organization, or an urban Indian organization operating within
a health program may enter into a contract with a health plan for the
provision of health care services to individuals enrolled in such health plan
if the program, unit, or organization determines that the provision of such
health services will not result in a denial or diminution of health services
to any individual described in section 8302(a) who is enrolled for health
services provided by such program, unit, or organization.

  (2) Reimbursement. Any contract entered into pursuant to paragraph (1) shall
provide for reimbursement to such program, unit, or organization in accordance
with the essential community provider provisions of section 1431(c), as
determined by the Secretary.

  (b) Family Treatment.

  (1) Determination to open enrollment. A health program of the Indian Health
Service may open enrollment to family members of individuals described in
section 8302(a).

  (2) Election. If a health program of the Indian Health Service opens
enrollment to family members of individuals described in section 8302(a), an
individual described in that section may elect family enrollment in the health
program instead of in a health plan.

  (3) Enrollment.

  (A) In general. An individual who elects family enrollment under paragraph
(2) in a health program of the Indian Health Service shall enroll in such
program.

  (B) Applicable individual charges. The individual who enrolls in such
program under subparagraph (A) is not subject to any charge for health
insurance premiums, deductibles, copayments, coinsurance, or any other cost
for health services provided under such program attributable to the
individual, but the family members who are not eligible for a health program
of the Indian Health Service under section 8302(a) are subject to all such
charges.

  (C) Applicable employer charges. Employers, other than tribal governments
and tribal organizations exempt under section 8305, are liable for making
employer premium payments as an employer under section 6121 in the case of any
family member enrolled under this subsection who is not eligible for a health
program of the Indian Health Service under section 8302(a).

  (4) Premium.

  (A) Establishment and collection. The Secretary shall establish premiums for
all family members enrolled in a health program of the Indian Health Service
under this paragraph who are not eligible for a health program of the Indian
Health Service under section 8302(a). The Secretary shall collect each premium
payment owed under this paragraph.

  (B) Reduction. The Secretary shall provide for a process for premium
reduction which is the same as the process, and uses the same standards, used
by regional alliances for the areas in which individuals described in
subparagraph (A) reside, except that in computing the family share of the
premiums the Secretary shall use the lower of the premium quoted or the
reduced weighted average accepted bid for the reference regional alliance.

  (C) Payment by secretary. The Secretary shall provide for payment to each
health program of the Indian Health Service, in the same manner as payments
under section 6201, amounts equivalent to the amount of payments that would
have been made to a regional alliance if the individuals described in
subparagraph (A) were enrolled in a regional alliance health plan (with a
final accepted bid equal to the reduced weighted average accepted bid premium
for the regional alliance).

  (c) Essential Community Provider.

  (1) Health services. If a health program of the Indian Health Service, a
service unit, a tribal organization, or an urban Indian organization operating
within a health program elects to be an essential community provider under
section 1431, an individual described in paragraph (2) enrolled in a health
plan other than a health program of the Indian Health Service may receive
health services from that essential community provider.

  (2) Individual covered. An individual referred to in paragraph (1) is an
individual who

  (A) is described in section 8302(a); or

  (B) is a family member described in subsection (b) who does not enroll in a
health program of the Indian Health Service.

SEC. 8307. PAYMENT BY OTHER PAYERS.

  (a) Payment for Services Provided by Indian Health Service Programs. Nothing
in this subtitle shall be construed as amending section 206, 401, or 402 of
the Indian Health Care Improvement Act (relating to payments on behalf of
Indians for health services from other Federal programs or from other third
party payers).

  (b) Payment for Services Provided by Contractors. Nothing in this subtitle
shall be construed as affecting any other provision of law, regulation, or
judicial or administrative interpretation of law or policy concerning the
status of the Indian Health Service as the payer of last resort for Indians
eligible for contract health services under a health program of the Indian
Health Service.

SEC. 8308. CONTRACTING AUTHORITY.

  Section 601(d)(1)(B) of the Indian Health Care Improvement Act (25 U.S.C.
1661(d)(1)(B)) is amended by inserting "(including personal services for the
provision of direct health care services)'' after "goods and services''.

SEC. 8309. CONSULTATION.

  The Secretary shall consult with representatives of Indian tribes, tribal
organizations, and urban Indian organizations annually concerning health care
reform initiatives that affect Indian communities.

SEC. 8310. INFRASTRUCTURE.

  (a) Facilities. The Secretary, acting through the Indian Health Service, may
expend amounts appropriated pursuant to section 8313 for the construction and
renovation of hospitals, health centers, health stations, and other facilities
for the purpose of improving and expanding such facilities to enable the
delivery of the full array of items and services guaranteed in the
comprehensive benefit package.

  (b) Capital Financing. There is established in the Indian Health Service a
revolving loan program. Under the program, the Secretary, acting through the
Indian Health Service, shall provide guaranteed loans under such terms and
conditions as the Secretary may prescribe to providers within the Indian
Health Service system to improve and expand health care facilities to enable
the delivery of the full array of items and services guaranteed in the
comprehensive benefit package.

SEC. 8311. FINANCING.

  (a) Establishment of Fund. Each health program of the Indian Health Service
shall establish a comprehensive benefit package fund (hereafter in this
section referred to as the "fund'').

  (b) Deposits. There shall be deposited into the fund the following:

  (1) All amounts received as employer premium payments pursuant to section
1351(e)(3).

  (2) All amounts received as family premium payments and premium discount
payments pursuant to section 8306(b)(4).

  (3) All amounts appropriated for the fund for the purpose of providing the
comprehensive benefit package to individuals enrolled in a health program of
the Indian Health Service.

  (4) Any other amount received with respect to health services for the
comprehensive benefit package.

  (c) Administration and Expenditures.

  (1) Management. The fund shall be managed by the health program of the
Indian Health Service.

  (2) Expenditures. Expenditures may be made from the fund to provide for the
delivery of the items and services of the comprehensive benefit package under
the health program of the Indian Health Service.

  (3) Availability of funds. Amounts in the fund established by a service unit
of the Indian Health Service under this section shall be available without
further appropriation and shall remain available until expended for payments
for the delivery of the items and services in the comprehensive benefit
package.

SEC. 8312. RULE OF CONSTRUCTION.

  Unless otherwise provided by this Act, no part of this Act shall be
construed to rescind or otherwise modify any obligations, findings, or
purposes contained in the Indian Health Care Improvement Act (25 U.S.C. 1601
et seq.) and in the Indian Self-Determination and Education Assistance Act.

SEC. 8313. AUTHORIZATIONS OF APPROPRIATIONS.

  (a) Authorization of Appropriations. For the purpose of carrying out this
subtitle, there are authorized to be appropriated $40,000,000 for fiscal year
1995, $180,000,000 for fiscal year 1996, and $200,000,000 for each of the
fiscal years 1997 through 2000.

  (b) Relation to Other Funds. The authorizations of appropriations
established in subsection (a) are in addition to any other authorizations of
appropriations that are available for the purposes of carrying out this
subtitle.

SEC. 8314. PAYMENT OF PREMIUM DISCOUNT EQUIVALENT AMOUNTS FOR UNEMPLOYED
INDIANS.

  (a) Determination. The Secretary shall determine (and certify to the
Secretary of the Treasury) for each fiscal year (beginning with fiscal year
1998) an amount equivalent to the aggregate amount of the premium discounts
(established in section 6104) that would have been paid to individuals
described in subsection (c) if such individuals had been enrolled in regional
alliance health plans.

  (b) Payment. For each fiscal year for which an amount is certified to the
Secretary of the Treasury under subsection (a), from the funds available under
section 9102, such Secretary shall pay the amount so certified to the Indian
Health Service for the purpose of providing the comprehensive benefit package.

  (c) Individual Described. For purposes of this section, an individual
described in this subsection is an individual described in section 8302(a) who
is not a qualifying employee or a family member of such an employee.

Title VIII, Subtitle E

Subtitle E Amendments to the Employee Retirement Income Security Act of 1974

SEC. 8401. GROUP HEALTH PLAN DEFINED.

  Section 3 of the Employee Retirement Income Security Act of 1974 (29 U.S.C.
1002) is amended by adding at the end the following new paragraph:

  "(42) The term `group health plan' means an employee welfare benefit plan
which provides medical care (as defined in section 213(d) of the Internal
Revenue Code of 1986) to participants or beneficiaries directly or through
insurance, reimbursement, or otherwise.''.

SEC. 8402. LIMITATION ON COVERAGE OF GROUP HEALTH PLANS UNDER TITLE I OF
ERISA.

  (a) In General. Section 4 of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1003) is amended

  (1) in subsection (a), by striking "subsection (b)'' and inserting
"subsections (b) and (c)'';

  (2) in subsection (b), by striking "The provisions'' and inserting "Except
as provided in subsection (c), the provisions''; and

  (3) by adding at the end the following new subsection:

  "(c) Coverage of Group Health Plans.

  "(1) Limited inclusion. This title shall apply to a group health plan only
to the extent provided in this subsection.

  "(2) Coverage under certain provisions with respect to certain plans.

  "(A) In general. Except as provided in subparagraph (B), parts 1, 4, and 6
of subtitle B shall apply to

  "(i) a group health plan which is maintained by

  "(I) a corporate alliance (as defined in section 1311(a) of the Health
Security Act), or

  "(II) a member of a corporate alliance (as so defined) whose eligible
sponsor is described in section 1311(b)(1)(C) (relating to rural electric
cooperatives and rural telephone cooperative associations), and

  "(ii) a group health plan not described in clause (i) which provides
benefits which are permitted under paragraph (4) of section 1003 of the Health
Security Act.

  "(B) Inapplicability with respect to state-certified health plans.
Subparagraph (A) shall not apply with respect to any plan or portion thereof
which consists of a State-certified health plan (as defined in section 1400(c)
of the Health Security Act). The Secretary shall provide by regulation for
treatment as a separate group health plan of any arrangement which would
otherwise be treated under this title as part of a group health plan to the
extent necessary to carry out the purposes of this title.

  "(3) Civil actions by corporate alliance participants, beneficiaries, and
fiduciaries and by the secretary.

  "(A) In general. Except as provided in subparagraph (B), in the case of a
group health plan to which parts 1, 4, and 6 of subtitle B apply under
paragraph (2), section 502 shall apply with respect to a civil action
described in such section brought

  "(i) by a participant, beneficiary, or fiduciary under such plan, or

  "(ii) by the Secretary.

  "(B) Exception where review is otherwise available under health security
act. Subparagraph (A) shall not apply with respect to any cause of action for
which, under section 5202(d) of the Health Security Act, proceedings under
sections 5203 and 5204 of such Act pursuant to complaints filed under section
5202(b) of such Act, and review under section 5205 of such Act of
determinations made under such section 5204, are the exclusive means of
review.

  "(4) Definitions and enforcement provisions. Sections 3, 501, 502, 503, 504,
505, 506, 507, 508, 509, 510, and 511 and the preceding subsections of this
section shall apply to a group health plan to the extent necessary to
effectively carry out, and enforce the requirements under, the provisions of
this title as they apply pursuant to this subsection.

  "(5) Applicability of preemption rules. Section 514 shall apply in the case
of any group health plan to which parts 1, 4, and 6 of subtitle B apply under
paragraph (2).''.

  (b) Reporting and Disclosure Requirements Applicable to Group Health Plans.

  (1) In general. Part 1 of subtitle B of title I of such Act is amended

  (A) in the heading for section 110 (29 U.S.C. 1030), by adding "by pension
plans'' at the end;

  (B) by redesignating section 111 (29 U.S.C. 1031) as section 112; and

  (C) by inserting after section 110 the following new section: "special rules
for group health plans

  "Sec. 111. (a) In General. The Secretary may by regulation provide special
rules for the application of this part to group health plans which are
consistent with the purposes of this title and the Health Security Act and
which take into account the special needs of participants, beneficiaries, and
health care providers under such plans.

  "(b) Expeditious Reporting and Disclosure. Such special rules may include
rules providing for

  "(1) reductions in the periods of time referred to in this part,

  "(2) increases in the frequency of reports and disclosures required under
this part, and

  "(3) such other changes in the provisions of this part as may result in more
expeditious reporting and disclosure of plan terms and changes in such terms
to the Secretary and to plan participants and beneficiaries,

to the extent that the Secretary determines that the rules described in this
subsection are necessary to ensure timely reporting and disclosure of
information consistent with the purposes of this part and the Health Security
Act as they relate to group health plans.

  "(c) Additional Requirements. Such special rules may include rules providing
for reporting and disclosure to the Secretary and to participants and
beneficiaries of additional information or at additional times with respect to
group health plans to which this part applies under section 4(c)(2), if such
reporting and disclosure would be comparable to and consistent with similar
requirements applicable under the Health Security Act with respect to plans
maintained by regional alliances (as defined in such section 1301 of such Act)
and applicable regulations of the Secretary of Health and Human Services
prescribed thereunder.''.

  (2) Clerical amendment. The table of contents in section 1 of such Act is
amended by striking the items relating to sections 110 and 111 and inserting
the following new items:

"Sec. 110. Alternative methods of compliance by pension plans.

"Sec. 111. Special rules for group health plans.

"Sec. 112. Repeal and effective date.''.

  (d) Exclusion of Plans Maintained by Regional Alliances from Treatment as
Multiple Employer Welfare Arrangements. Section 3(40)(A) of such Act (29
U.S.C. 1002(40)(A)) is amended

  (1) in clause (ii), by striking "or'';

  (2) in clause (iii), by striking the period and inserting ", or''; and

  (3) by adding after clause (iii) the following new clause:

  "(iv) by a regional alliance (as defined in section 1301 of the Health
Security Act).''.

SEC. 8403. AMENDMENTS RELATING TO CONTINUATION COVERAGE.

  (a) Period of Coverage. Subparagraph (D) of section 602(2) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1162(1)) is amended

  (1) by striking "or'' at the end of clause (i), by striking the period at
the end of clause (ii) and inserting ", or'', and by adding at the end the
following new clause:

  "(iii) eligible for coverage under a comprehensive benefit package described
in section 1101 of the Health Security Act.'', and

  (2) by striking "or medicare entitlement'' in the heading and inserting ",
medicare entitlement, or health security act eligibility''.

  (b) Qualified Beneficiary. Section 607(3) of such Act (29 U.S.C. 1167(3)) is
amended by adding at the end the following new subparagraph:

  "(D) Special rule for individuals covered by health security act. The term
`qualified beneficiary' shall not include any individual who, upon termination
of coverage under a group health plan, is eligible for coverage under a
comprehensive benefit package described in section 1101 of the Health Security
Act.''

  (c) Repeal Upon Implementation of Health Security Act.

  (1) In general. Part 6 of subtitle B of title I of such Act (29 U.S.C. 601
et seq.) is amended by striking sections 601 through 608 and by redesignating
section 609 as section 601.

  (2) Conforming amendments.

  (A) Section 502(a)(7) of such Act (29 U.S.C. 1132(a)(7)) is amended by
striking "609(a)(2)(A)'' and inserting "601(a)(2)(A)''.

  (B) Section 502(c)(1) is amended by striking "paragraph (1) or (4) of
section 606 or''.

  (C) Section 514 of such Act (29 U.S.C. 1144) is amended by striking "609''
each place it appears in subsections (b)(7) and (b)(8) and inserting "601''.

  (D) The table of contents in section 1 of such Act is amended by striking
the items relating to sections 601 through 609 and inserting the following new
item:

"Sec. 601. Additional standards for group health plans.''

  (d) Effective Date.

  (1) Subsections (a) and (b). The amendments made by subsections (a) and (b)
shall take effect on the date of the enactment of this Act.

  (2) Subsection (c). The amendments made by subsection (c) shall take effect
on the earlier of

  (A) January 1, 1998, or

  (B) the first day of the first calendar year following the calendar year in
which all States have in effect plans under which individuals are eligible for
coverage under a comprehensive benefit package described in section 1101 of
this Act.

SEC. 8404. ADDITIONAL AMENDMENTS RELATING TO GROUP HEALTH PLANS.

  (a) Regulations of the National Health Board Regarding Cases of Adoption.
Section 601(c) of the Employee Retirement Income Security Act of 1974 (as
redesignated by section 8403) is amended by adding at the end the following
new paragraph:

  "(4) Regulations by national health board. The preceding provisions of this
subsection shall apply except  to the extent otherwise provided in regulations
of the National Health Board under the Health Security Act.''.

  (b) Coverage of Pediatric Vaccines. Section 601(d) of such Act (as
redesignated by section 8403) is amended by adding at the end the following
new sentence: "The preceding sentence shall cease to apply to a group health
plan upon becoming a corporate alliance health plan pursuant to an effective
election of the plan sponsor to be a corporate alliance under section 1311 of
the Health Security Act.''.

  (c) Technical Corrections. Effective as if included in the enactment of the
Omnibus Budget Reconciliation Act of 1993

  (1) Subsection (a)(2)(B)(ii) of section 609 of the Employee Retirement
Income Security Act of 1974 is amended by striking "section 13822'' and
inserting "section 13623''.

  (2) Subsection (a)(4) of such section 609 is amended by striking "section
13822'' and inserting "section 13623''.

  (3) Subsection (d) of such section 609 is amended by striking "section
13830'' and inserting "section 13631''.

SEC. 8405. PLAN CLAIMS PROCEDURES.

  Section 503 of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1133) is amended

  (1) by inserting "(a) In General. '' after "Sec. 503.''; and

  (2) by adding at the end the following new subsection:

  "(b) Group Health Plans. In addition to the requirements of subsection (a),
a group health plan to which parts 1 and 4 apply under section 4(c)(2) shall
comply with the requirements of section 5201 of the Health Security Act
(relating to health plan claims procedure).''.

SEC. 8406. EFFECTIVE DATES.

  Except as otherwise provided in this subtitle, the amendments made by this
subtitle shall take effect on the earlier of

  (1) January 1, 1998, or

  (2) such date or dates as may be prescribed in regulations of the National
Health Board in connection with plans whose participants or beneficiaries
reside in any State which becomes a participating State under section 1200 of
this Act before January 1, 1998.

Title VIII, Subtitle F

Subtitle F Special Fund for WIC Program

SEC. 8501. ADDITIONAL FUNDING FOR SPECIAL SUPPLEMENTAL FOOD PROGRAM FOR WOMEN,
INFANTS, AND CHILDREN (WIC).

  (a) Authorization of Additional Appropriations. There is hereby authorized
to be appropriated for the special supplemental food program for women,
infants, and children (WIC) under section 17 of the Child Nutrition Act of
1966, in addition to amounts otherwise authorized to be appropriated for such
program, such amounts as are necessary for the Secretary of the Treasury to
fulfill the requirements of subsection (b).

  (b) WIC Fund.

  (1) Credit. For each of fiscal years 1996 through 2000, the Secretary of the
Treasury shall credit to a special fund of the Treasury an amount equal to

  (A) $254,000,000 for fiscal year 1996,

  (B) $407,000,000 for fiscal year 1997,

  (C) $384,000,000 for fiscal year 1998,

  (D) $398,000,000 for fiscal year 1999, and

  (E) $411,000,000 for fiscal year 2000.

  (2) Availability. Subject to paragraph (3), amounts in such fund

  (A) shall be available only for the program authorized under section 17 of
the Child Nutrition Act of 1966, exclusive of activities authorized under
section 17(m) of such Act, and

  (B) shall be paid to the Secretary of Agriculture for such purposes.

  (3) Limitation. For a fiscal year specified in paragraph (1), the amount
credited to such fund for the fiscal year shall be available for use in such
program only if appropriations Acts for the fiscal year, without the addition
of amounts provided under subsection (a) for the fund, provide new budget
authority for the program of no less than

  (A) $3,660,000,000 for fiscal year 1996,

  (B) $3,759,000,000 for fiscal year 1997,

  (C) $3,861,000,000 for fiscal year 1998,

  (D) $3,996,000,000 for fiscal year 1999, and

  (E) $4,136,000,000 for fiscal year 2000.


