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Health Security Act
Title VIII
TITLE VIII_HEALTH AND HEALTH-RELATED PROGRAMS OF THE FEDERAL
GOVERNMENT


table of contents of title


Subtitle A_Military Health Care Reform
Sec._8001._Uniformed services health plans.
Subtitle B_Department of Veterans Affairs
Sec._8101._Benefits and eligibility through Department of
Veterans Affairs Medical System.
Sec._8102._Organization of Department of Veterans Affairs
facilities as health plans.
Subtitle C_Federal Employees Health Benefits Program
Sec._8201._Definitions.
Sec._8202._FEHBP termination.
Sec._8203._Treatment of Federal employees, annuitants, and other
individuals (who would otherwise have been eligible for fehbp)
under health plans.
Sec._8204._Treatment of individuals residing abroad.
Sec._8205._Transition and savings provisions.
Sec._8206._Regulations.
Sec._8207._Technical and conforming amendments.
Subtitle D_Indian Health Service
Sec._8301._Definitions.
Sec._8302._Eligibility and health service coverage of Indians.
Sec._8303._Supplemental Indian health care benefits.
Sec._8304._Health plan and health alliance requirements.
Sec._8305._Exemption of tribal governments and tribal
organizations from employer payments.
Sec._8306._Provision of health services to non-enrollees and
non-Indians.
Sec._8307._Payment by other payors.
Sec._8308._Contracting authority.
Sec._8309._Consultation.
Sec._8310._Infrastructure.
Sec._8311._Financing.
Sec._8312._Rule of construction.
Sec._8313._Authorizations regarding Public Health Service
Initiatives fund.
Subtitle E_Amendments to the Employee Retirement Income Security
Act of 1974
Sec._8401._Group health plan defined.
Sec._8402._Limitation on coverage of group health plans under
title I of ERISA.
Sec._8403._Amendments relating to continuation coverage.
Sec._8404._Additional amendments relating to group health plans.
Sec._8405._Plan claims procedures.
Sec._8406._Effective dates.
Subtitle F_Special Fund for WIC Program
Sec._8501._Additional funding for special supplemental food
program for women, infants, and children (WIC).

Title VIII, Subtitle A
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:
``3a. 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 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 Secretary of Defense
and the Secretary of Health and Human Services shall enter into
an agreement specifying the payment responsibilities of Medicare
under this paragraph, except that the amount of the premium
payment may not exceed the expected per capita costs that
Medicare would bear for the person if the person remained in the
Medicare program. 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 plan
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
be required to pay a family share under section 1342 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:
``3a. 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 described.
``1823._Entitlement to chapter 17 benefits for certain veterans.
``1824._Supplemental benefits packages and policies.
``1825._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 described
__``The Secretary shall provide to each veteran described in
section 1823(a) of this title 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 care
under such chapter, notwithstanding that such care and services
are not included in the comprehensive benefit package.
``__1823. Entitlement to chapter 17 benefits for certain veterans
__``(a) The following veterans are eligible for additional care
and services as described in section 1822 of this title:
__``(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.
__``(b) In the case of a veteran who is eligible to receive care
or services under section 1710(a)(1)(G) of this title for a
disability which may be associated with exposure to a toxic
substance, radiation, or environmental hazard, the Secretary
shall furnish such care or services to that veteran.
__``(c) A veteran covered by subsection (a) or (b)_
__``(1) is eligible for care and services described in that
subsection whether or not such veteran is a VA enrollee; and
__``(2) shall not be subject to any charge or any other cost for
such care and services.
``__1824. Supplemental benefits packages and policies
__``(a)(1) In order to meet the special needs of veterans, the
Secretary may offer to veterans supplemental health benefits
packages for health care services not included in the
comprehensive benefit package. A veteran eligible under section
1823 of this title to receive the health care services described
in section 1822 of this title may not be offered a supplemental
health benefits package under this subsection. The supplemental
health benefits packages offered under this subsection may
consist of any or all of the benefits that the Secretary may
provide under chapter 17 of this title that are not included in
the comprehensive benefit package.
__``(2) The Secretary shall charge a premium for a supplemental
health benefits package under this subsection. The amount of such
premium shall be established so as to cover the actual and full
costs of such care.
__``(b) 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.
``_1825. 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 section 1823(a) of
this title 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) For other VA enrollees, 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.

``__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 VA health plan or Department facility shall be
deemed to be a Medicare provider.
__``(b)(1) The Secretary of Health and Human Services shall enter
into an agreement with a VA health plan or Department health-care
facility to treat such plan or facility as a Medicare HMO in any
case in which that health plan or facility seeks to enter into
such an agreement.
__``(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 1823(a) 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 on the same basis 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 Funds
__``(a) The Secretary shall establish for each VA health plan a
separate revolving 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 of that health plan.
__``(c) Notwithstanding subsection (b), a VA health plan 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) Each revolving fund for a health plan shall be managed by
that health plan.
__``(e) Amounts in a revolving fund for a health plan are hereby
made available for the expenses of the delivery of the items and
services in the comprehensive benefit package by the 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:

_I60``18. Benefits and Eligibility Under Health Security
Act_I521801.''.
__(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) to any veteran who is 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.
__``(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. 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._Funding provisions: grants and other sources of
assistance.
``Subchapter V_Research Corporations''.



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.
__(3) Employees health benefits fund._The term ``Employees Health
Benefits Fund'' means the fund under section 8909 of title 5,
United States Code.
__(4) FEHBP._The term ``FEHBP'' means the health insurance
program under chapter 89 of title 5, United States Code.
__(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.
__(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).
__(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 a
FEHBP plan.
__(b) Federal Employees._
__(1) Same treatment as non   federal 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, individual or 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) Optional offer of fehbp supplemental plans._The Federal
Government may, but is not required to_
__(A) offer to Federal employees one or more FEHBP supplemental
plans developed under subsection (f)(1); and
__(B) make a Government contribution with respect to the premium
for such a plan.
Any Government contribution under subparagraph (B) shall be
payable from the same appropriation or fund as would a Government
contribution under paragraph (2) on behalf of the Federal
employee involved.
__(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 ``non   Federal employee''
means an ``employee'' as defined by section 1901.
__(c) Annuitants._
__(1) Health plan._
__(A) Authority to make certain withholdings from annuities._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.
__(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 6115, 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 paragraph for a 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 may, but is not required_
__(i) to offer to such an annuitant one or more FEHBP
supplemental plans developed under subsection (f)(1); and
__(ii) to make a Government contribution with respect to the
premium for such a plan.
__(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 a FEHBP plan as an annuitant; or
__(II) covered under a FEHBP plan as a family member (but only if
such individual would otherwise have been eligible to enroll in a
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 a 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 of a medicare select plan (as defined in paragraph (3)).
__(B) Medicare contribution amount._The Office of Personnel
Management shall specify a level of Government contribution under
this paragraph for a 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
generally afforded under FEHBP (as last in effect).
__(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
generally afforded under FEHBP (as last in effect).
__(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 a 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 86-724; 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 generally afforded them
under FEHBP and RFEHBP, respectively, as last in effect).
__(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 subtitle C of title VIII of the Health Security Act (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 103-66; 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
a premium 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), 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 pay 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 8303(a)(1); 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 PAYORS.
__(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
payors).
__(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 payor 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
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 REGARDING PUBLIC HEALTH SERVICE
INITIATIVES FUND.
__(a) Authorization of Appropriations._For the purpose of
carrying out this subtitle, there are authorized to be
appropriated from the Public Health Service Initiatives Fund
(established in section 3701) $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 described in such subsection.





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 and 4 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 subparagraph (A)
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 and 4 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 provisions 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 and 4
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, by adding ``by pension
plans'' at the end;
__(B) by redesignating section 111 as section 112; and
__(C) by inserting after section 110 the following new section:
``special rules for group health plans
__``Sec. 111. 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.
1161(2)) 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(2)) 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''.

__(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 such Act (as redesignated by section
8403) is amended by adding at the end the following new
subsection:
__``(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._
__(1) Subsection (a)(2)(B)(ii) of section 601 of such Act (as
redesignated by section 8403) is amended by striking ``section
13822'' and inserting ``section 13623''.
__(2) Subsection (a)(4) of such section 601 is amended by
striking ``section 13822'' and inserting ``section 13623''.
__(3) Subsection (d) of such section 601 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 the Health Security 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) $4,126,000,000 for fiscal year 2000.