S8516 CONGRESSIONAL RECORD — SENATE July 14, 1999 (1) congratulates the United States wom- AMENDMENTS SUBMITTED health plan shall provide notice to each par- en’s soccer team for winning the 1999 Wom- ticipant and beneficiary under such plan re- en’s World Cup; garding the coverage required by this section (2) recognizes the important contribution PATIENTS’ BILL OF RIGHTS ACT in accordance with regulations promulgated of each individual team member to the OF 1999 by the Secretary. Such notice shall be in United States and to the advancement of writing and prominently positioned in any women’s sports; and literature or correspondence made available (3) invites the members of the United or distributed by the plan or issuer and shall SNOWE (AND OTHERS) be transmitted— States women’s soccer team to the United AMENDMENT NO. 1241 States Capitol to be honored and recognized ‘‘(1) in the next mailing made by the plan by the Senate for their achievements. Ms. SNOWE (for herself, Mr. ABRA- or issuer to the participant or beneficiary; HAM, Mr. FITZGERALD, Mr. CRAPO, Ms. ‘‘(2) as part of any yearly informational SEC. 2. TRANSMISSION OF ENROLLED RESOLU- packet sent to the participant or beneficiary; COLLINS, Mr. JEFFORDS, Mr. MUR- TION. or KOWSKI, and Mr. DEWINE) proposed an The Secretary of the Senate shall transmit ‘‘(3) not later than January 1, 2000; amendment to amendment No. 1239 an enrolled copy of this resolution to the whichever is earlier. ‘‘(d) SECONDARY CONSULTATIONS.— United States women’s soccer team. proposed by Mr. DODD to the bill (S. 1344) to amend the Public Health Serv- ‘‘(1) IN GENERAL.—A group health plan, and Mr. CAMPBELL. Mr. President, ice Act, the Employee Retirement In- a health insurance issuer providing health today I submit a resolution in honor of come Security Act of 1974, and the In- insurance coverage in connection with a group health plan, that provides coverage the Women’s World Cup Soccer Cham- ternal Revenue Code of 1986 to protect with respect to medical and surgical services pions, the U.S. Women’s Soccer Team. consumers in managed care plans and provided in relation to the diagnosis and From the first game of the Women’s other health coverage; as follows: treatment of cancer shall ensure that full World Cup in New Jersey, which was Strike section 152 of the bill, and insert the coverage is provided for secondary consulta- tions by specialists in the appropriate med- played before a sold-out crowd, to the following: WOMEN’S HEALTH AND CANCER RIGHTS. ical fields (including pathology, radiology, final game at the filled with and oncology) to confirm or refute such diag- (a) SHORT TITLE.—This section may be 90,185 screaming fans, setting the wom- cited as the ‘‘Women’s Health and Cancer nosis. Such plan or issuer shall ensure that en’s sports record for attendance, this Rights Act of 1999’’. full coverage is provided for such secondary consultation whether such consultation is U.S. Women’s Soccer Team has in- (b) FINDINGS.—Congress finds that— spired us all. The U.S. Women’s Soccer (1) the offering and operation of health based on a positive or negative initial diag- nosis. In any case in which the attending Team had an outstanding run during plans affect commerce among the States; (2) health care providers located in a State physician certifies in writing that services the 1999 Women’s World Cup which cul- necessary for such a secondary consultation serve patients who reside in the State and minated in an amazing victory against are not sufficiently available from special- patients who reside in other States; and ists operating under the plan with respect to the Chinese in the final game. (3) in order to provide for uniform treat- whose services coverage is otherwise pro- ment of health care providers and patients After 120 minutes of exciting soccer, vided under such plan or by such issuer, such among the States, it is necessary to cover the game came down to a shoot-out plan or issuer shall ensure that coverage is health plans operating in 1 State as well as where the U.S. Women’s Team pre- provided with respect to the services nec- health plans operating among the several essary for the secondary consultation with vailed 5 to 4 to become the champions. States. any other specialist selected by the attend- From ’s game winning (c) AMENDMENTS TO ERISA.— ing physician for such purpose at no addi- save to the nail-biting seconds before (1) IN GENERAL.—Subpart B of part 7 of sub- made the winning title B of title I of the Employee Retirement tional cost to the individual beyond that Income Security Act of 1974, as amended by which the individual would have paid if the goal, they had us all sitting on the specialist was participating in the network edge of our chairs. section 301, is further amended by adding at the end the following: of the plan. As a former Olympic athlete, I know ‘‘(2) EXCEPTION.—Nothing in paragraph (1) ‘‘SEC. 715. REQUIRED COVERAGE FOR MINIMUM shall be construed as requiring the provision the dedication and determination that HOSPITAL STAY FOR of secondary consultations where the patient these women must have in order to MASTECTOMIES AND LYMPH NODE DISSECTIONS FOR THE TREATMENT determines not to seek such a consultation. achieve this tremendous accomplish- OF BREAST CANCER AND COVERAGE ‘‘(e) PROHIBITION ON PENALTIES OR INCEN- ment. I want to point out that every FOR SECONDARY CONSULTATIONS. TIVES.—A group health plan, and a health in- member of this team either has a col- ‘‘(a) INPATIENT CARE.— surance issuer providing health insurance lege degree or is pursuing one. I can’t ‘‘(1) IN GENERAL.—A group health plan, and coverage in connection with a group health a health insurance issuer providing health plan, may not— think of better role models for today’s ‘‘(1) penalize or otherwise reduce or limit youth than this World Cup Team. insurance coverage in connection with a group health plan, that provides medical and the reimbursement of a provider or specialist I want to congratulate and recognize surgical benefits shall ensure that inpatient because the provider or specialist provided each and every member of this team coverage with respect to the treatment of care to a participant or beneficiary in ac- breast cancer is provided for a period of time cordance with this section; and I ask unanimous consent that their ‘‘(2) provide financial or other incentives names and the resolution be printed in as is determined by the attending physician, in consultation with the patient, to be medi- to a physician or specialist to induce the the RECORD. I would also like to thank cally necessary and appropriate following— physician or specialist to keep the length of my good friend and former Olympian ‘‘(A) a mastectomy; inpatient stays of patients following a mas- Donna de Varona, the Chairwoman of ‘‘(B) a lumpectomy; or tectomy, lumpectomy, or a lymph node dis- the Women’s World Cup, for her hard ‘‘(C) a lymph node dissection for the treat- section for the treatment of breast cancer work and dedication to ensure that ment of breast cancer. below certain limits or to limit referrals for ‘‘(2) EXCEPTION.—Nothing in this section secondary consultations; or women’s soccer is finally given the rec- ‘‘(3) provide financial or other incentives ognition it deserves. I urge my col- shall be construed as requiring the provision of inpatient coverage if the attending physi- to a physician or specialist to induce the leagues to join in strong support of cian and patient determine that a shorter pe- physician or specialist to refrain from refer- passage of this resolution. riod of hospital stay is medically appro- ring a participant or beneficiary for a sec- There being no objection, the names priate. ondary consultation that would otherwise be covered by the plan or coverage involved were ordered to be printed in the ‘‘(b) PROHIBITION ON CERTAIN MODIFICA- TIONS.—In implementing the requirements of under subsection (d).’’. RECORD, as follows: this section, a group health plan, and a (2) CLERICAL AMENDMENT.—The table of contents in section 1 of the Employee Retire- U.S. WOMEN’S SOCCER TEAM health insurance issuer providing health in- surance coverage in connection with a group ment Income Security Act of 1974 is amended , Brandi Chastain, Tracy health plan, may not modify the terms and by inserting after the item relating to sec- Ducar, , , Danielle conditions of coverage based on the deter- tion 714 the following new item: Fotopoulos, , , Kris- mination by a participant or beneficiary to ‘‘Sec. 715. Required coverage for minimum tine Lilly, Shannon MacMillan, Tiffeny request less than the minimum coverage re- hospital stay for mastectomies Milbrett, , Cindy Parlow, quired under subsection (a). and lymph node dissections for , , Briana ‘‘(c) NOTICE.—A group health plan, and a the treatment of breast cancer Scurry, Kate Sobrero, , health insurance issuer providing health in- and coverage for secondary con- , . surance coverage in connection with a group sultations.’’.

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(d) AMENDMENTS TO PHSA RELATING TO THE any other specialist selected by the attend- ‘‘(2) EXCEPTION.—Nothing in this section GROUP MARKET.—Subpart 2 of part A of title ing physician for such purpose at no addi- shall be construed as requiring the provision XXVII of the Public Health Service Act, as tional cost to the individual beyond that of inpatient coverage if the attending physi- amended by section 201, is further amended which the individual would have paid if the cian and patient determine that a shorter pe- by adding at the end the following new sec- specialist was participating in the network riod of hospital stay is medically appro- tion: of the plan. priate. ‘‘SEC. 2708. REQUIRED COVERAGE FOR MINIMUM ‘‘(2) EXCEPTION.—Nothing in paragraph (1) ‘‘(b) PROHIBITION ON CERTAIN MODIFICA- HOSPITAL STAY FOR shall be construed as requiring the provision TIONS.—In implementing the requirements of MASTECTOMIES AND LYMPH NODE of secondary consultations where the patient this section, a group health plan may not DISSECTIONS FOR THE TREATMENT determines not to seek such a consultation. modify the terms and conditions of coverage OF BREAST CANCER AND COVERAGE ‘‘(e) PROHIBITION ON PENALTIES OR INCEN- based on the determination by a participant FOR SECONDARY CONSULTATIONS. TIVES.—A group health plan, and a health in- or beneficiary to request less than the min- ‘‘(a) INPATIENT CARE.— surance issuer providing health insurance imum coverage required under subsection ‘‘(1) IN GENERAL.—A group health plan, and coverage in connection with a group health (a). a health insurance issuer providing health plan, may not— ‘‘(c) NOTICE.—A group health plan shall insurance coverage in connection with a ‘‘(1) penalize or otherwise reduce or limit group health plan, that provides medical and provide notice to each participant and bene- the reimbursement of a provider or specialist ficiary under such plan regarding the cov- surgical benefits shall ensure that inpatient because the provider or specialist provided erage required by this section in accordance coverage with respect to the treatment of care to a participant or beneficiary in ac- with regulations promulgated by the Sec- breast cancer is provided for a period of time cordance with this section; retary. Such notice shall be in writing and as is determined by the attending physician, ‘‘(2) provide financial or other incentives prominently positioned in any literature or in consultation with the patient, to be medi- to a physician or specialist to induce the correspondence made available or distrib- cally necessary and appropriate following— physician or specialist to keep the length of uted by the plan and shall be transmitted— ‘‘(A) a mastectomy; inpatient stays of patients following a mas- ‘‘(1) in the next mailing made by the plan ‘‘(B) a lumpectomy; or tectomy, lumpectomy, or a lymph node dis- to the participant or beneficiary; ‘‘(C) a lymph node dissection for the treat- section for the treatment of breast cancer ‘‘(2) as part of any yearly informational ment of breast cancer. below certain limits or to limit referrals for packet sent to the participant or beneficiary; ‘‘(2) EXCEPTION.—Nothing in this section secondary consultations; or shall be construed as requiring the provision ‘‘(3) provide financial or other incentives or of inpatient coverage if the attending physi- to a physician or specialist to induce the ‘‘(3) not later than January 1, 2000; cian and patient determine that a shorter pe- physician or specialist to refrain from refer- whichever is earlier. riod of hospital stay is medically appro- ring a participant or beneficiary for a sec- ‘‘(d) SECONDARY CONSULTATIONS.— priate. ondary consultation that would otherwise be ‘‘(1) IN GENERAL.—A group health plan that ‘‘(b) PROHIBITION ON CERTAIN MODIFICA- covered by the plan or coverage involved provides coverage with respect to medical TIONS.—In implementing the requirements of under subsection (d).’’. and surgical services provided in relation to this section, a group health plan, and a (e) AMENDMENTS TO PHSA RELATING TO THE the diagnosis and treatment of cancer shall health insurance issuer providing health in- INDIVIDUAL MARKET.—Subpart 2 of part B of ensure that full coverage is provided for sec- surance coverage in connection with a group title XXVII of the Public Health Service Act, ondary consultations by specialists in the health plan, may not modify the terms and as amended by section 202, is further amend- appropriate medical fields (including pathol- conditions of coverage based on the deter- ed by adding at the end the following new ogy, radiology, and oncology) to confirm or mination by a participant or beneficiary to section: refute such diagnosis. Such plan or issuer request less than the minimum coverage re- ‘‘SEC. 2754. REQUIRED COVERAGE FOR MINIMUM shall ensure that full coverage is provided quired under subsection (a). HOSPITAL STAY FOR for such secondary consultation whether MASTECTOMIES AND LYMPH NODE ‘‘(c) NOTICE.—A group health plan, and a such consultation is based on a positive or DISSECTIONS FOR THE TREATMENT negative initial diagnosis. In any case in health insurance issuer providing health in- OF BREAST CANCER AND SEC- surance coverage in connection with a group ONDARY CONSULTATIONS. which the attending physician certifies in health plan shall provide notice to each par- ‘‘The provisions of section 2708 shall apply writing that services necessary for such a ticipant and beneficiary under such plan re- to health insurance coverage offered by a secondary consultation are not sufficiently garding the coverage required by this section health insurance issuer in the individual available from specialists operating under in accordance with regulations promulgated market in the same manner as they apply to the plan with respect to whose services cov- by the Secretary. Such notice shall be in health insurance coverage offered by a erage is otherwise provided under such plan writing and prominently positioned in any health insurance issuer in connection with a or by such issuer, such plan or issuer shall literature or correspondence made available group health plan in the small or large group ensure that coverage is provided with respect or distributed by the plan or issuer and shall market.’’. to the services necessary for the secondary be transmitted— (f) AMENDMENTS TO THE IRC.— consultation with any other specialist se- ‘‘(1) in the next mailing made by the plan (1) IN GENERAL.—Subchapter B of chapter lected by the attending physician for such or issuer to the participant or beneficiary; 100 of the Internal Revenue Code of 1986, as purpose at no additional cost to the indi- ‘‘(2) as part of any yearly informational amended by section 401, is further amended— vidual beyond that which the individual packet sent to the participant or beneficiary; (A) in the table of sections, by inserting would have paid if the specialist was partici- or after the item relating to section 9813 the pating in the network of the plan. ‘‘(3) not later than January 1, 2000; following new item: ‘‘(2) EXCEPTION.—Nothing in paragraph (1) shall be construed as requiring the provision whichever is earlier. ‘‘Sec. 9814. Required coverage for minimum ‘‘(d) SECONDARY CONSULTATIONS.— of secondary consultations where the patient hospital stay for mastectomies ‘‘(1) IN GENERAL.—A group health plan, and determines not to seek such a consultation. and lymph node dissections for a health insurance issuer providing health ‘‘(e) PROHIBITION ON PENALTIES.—A group the treatment of breast cancer insurance coverage in connection with a health plan may not— and coverage for secondary con- group health plan that provides coverage ‘‘(1) penalize or otherwise reduce or limit sultations.’’; and with respect to medical and surgical services the reimbursement of a provider or specialist provided in relation to the diagnosis and (B) by inserting after section 9813 the fol- because the provider or specialist provided treatment of cancer shall ensure that full lowing: care to a participant or beneficiary in ac- coverage is provided for secondary consulta- ‘‘SEC. 9814. REQUIRED COVERAGE FOR MINIMUM cordance with this section; HOSPITAL STAY FOR tions by specialists in the appropriate med- MASTECTOMIES AND LYMPH NODE ‘‘(2) provide financial or other incentives ical fields (including pathology, radiology, DISSECTIONS FOR THE TREATMENT to a physician or specialist to induce the and oncology) to confirm or refute such diag- OF BREAST CANCER AND COVERAGE physician or specialist to keep the length of nosis. Such plan or issuer shall ensure that FOR SECONDARY CONSULTATIONS. inpatient stays of patients following a mas- full coverage is provided for such secondary ‘‘(a) INPATIENT CARE.— tectomy, lumpectomy, or a lymph node dis- consultation whether such consultation is ‘‘(1) IN GENERAL.—A group health plan that section for the treatment of breast cancer based on a positive or negative initial diag- provides medical and surgical benefits shall below certain limits or to limit referrals for nosis. In any case in which the attending ensure that inpatient coverage with respect secondary consultations; or physician certifies in writing that services to the treatment of breast cancer is provided ‘‘(3) provide financial or other incentives necessary for such a secondary consultation for a period of time as is determined by the to a physician or specialist to induce the are not sufficiently available from special- attending physician, in consultation with physician or specialist to refrain from refer- ists operating under the plan with respect to the patient, to be medically necessary and ring a participant or beneficiary for a sec- whose services coverage is otherwise pro- appropriate following— ondary consultation that would otherwise be vided under such plan or by such issuer, such ‘‘(A) a mastectomy; covered by the plan involved under sub- plan or issuer shall ensure that coverage is ‘‘(B) a lumpectomy; or section (d).’’. provided with respect to the services nec- ‘‘(C) a lymph node dissection for the treat- (2) CLERICAL AMENDMENT.—The table of essary for the secondary consultation with ment of breast cancer. contents for chapter 100 of such Code is

VerDate Mar 15 2010 21:58 Nov 01, 2013 Jkt 081600 PO 00000 Frm 00095 Fmt 0624 Sfmt 0634 E:\1999SENATE\S14JY9.REC S14JY9 mmaher on DSKCGSP4G1 with SOCIALSECURITY S8518 CONGRESSIONAL RECORD — SENATE July 14, 1999 amended by inserting after the item relating is not liable for the issuer’s failure to pro- ‘‘SEC. 2754. PATIENT PROTECTION STANDARDS. to section 9813 the following new item: vide or make available the information), if ‘‘(a) IN GENERAL.—Each health insurance ‘‘Sec. 9814. Required coverage for minimum the issuer is obligated to provide and make issuer shall comply with the following pa- hospital stay for mastectomies available (or provides and makes available) tient protection requirements with respect and lymph node dissections for such information. to individual health insurance coverage it of- the treatment of breast cancer ‘‘(3) GRIEVANCE AND INTERNAL APPEALS.— fers, and such requirements shall be deemed and coverage for secondary con- With respect to the grievance system and in- to be incorporated into this subsection: sultations.’’. ternal appeals process required to be estab- ‘‘(1) The requirements of subpart C of part lished under section 503, in the case of a 7 of subtitle B of title I of the Employee Re- tirement Income Security Act of 1974. KENNEDY (AND OTHERS) group health plan that provides benefits in the form of health insurance coverage ‘‘(2) The requirements of section 714 of the AMENDMENT NO. 1242 through a health insurance issuer, the Sec- Employee Retirement Income Security Act Mr. DASCHLE (for Mr. KENNEDY (for retary shall determine the circumstances of 1974. himself, Mr. REID, Mr. DURBIN, Mr. under which the plan is not required to pro- ‘‘(3) The requirements of section 503 of the WELLSTONE, Mr. WYDEN, Mr. REED, vide for such system and process (and is not Employee Retirement Income Security Act liable for the issuer’s failure to provide for of 1974. Mrs. MURRAY, Mr. DASCHLE, Mr. such system and process), if the issuer is ob- ‘‘(b) NOTICE.—A health insurance issuer CHAFEE, and Mrs. FEINSTEIN)) proposed ligated to provide for (and provides for) such under this part shall comply with the notice an amendment to amendment No. 1239 system and process. requirement under section 104(b)(1) of the to the bill, S. 1344, supra; as follows: ‘‘(4) EXTERNAL APPEALS.—Pursuant to rules Employee Retirement Income Security Act At the appropriate place, insert the fol- of the Secretary, insofar as a group health of 1974 with respect to the requirements of lowing: plan enters into a contract with a qualified such subtitle as if such section applied to SEC. ll. APPLICATION TO ALL HEALTH PLANS. external appeal entity for the conduct of ex- such issuer and such issuer were a group (a) ERISA.—Subpart C of part 7 of subtitle ternal appeal activities in accordance with health plan. B of title I of the Employee Retirement In- section 503, the plan shall be treated as ‘‘(c) NONAPPLICATION OF CERTAIN PROVI- come Security Act of 1974, as added by sec- meeting the requirement of such section and SION.—Section 2763(a) shall not apply to the tion 101(a)(2) of this Act, is amended by add- is not liable for the entity’s failure to meet provisions of this section.’’. ing at the end the following: any requirements under such section. (d) APPLICATION TO GROUP HEALTH PLANS ‘‘(5) APPLICATION TO PROHIBITIONS.—Pursu- UNDER THE INTERNAL REVENUE CODE OF 1986.— ‘‘SEC. 730A. APPLICATION OF PROVISIONS. Subchapter B of chapter 100 of the Internal ‘‘(a) APPLICATION TO GROUP HEALTH ant to rules of the Secretary, if a health in- surance issuer offers health insurance cov- Revenue Code of 1986 is amended— PLANS.—The provisions of this subpart, and (1) in the table of sections, by inserting sections 714 and 503, shall apply to group erage in connection with a group health plan and takes an action in violation of section after the item relating to section 9812 the health plans and health insurance issuers of- following new item: fering health insurance coverage in connec- 727, the group health plan shall not be liable tion with a group health plan. for such violation unless the plan caused ‘‘Sec. 9813. Standard relating to patients’ ‘‘(b) TREATMENT OF MULTIPLE COVERAGE such violation. bill of rights.’’; and OPTIONS.—In the case of a group health plan ‘‘(6) CONSTRUCTION.—Nothing in this sub- (2) by inserting after section 9812 the fol- that provides benefits under 2 or more cov- section shall be construed to affect or modify lowing: the responsibilities of the fiduciaries of a erage options, the requirements of this sub- ‘‘SEC. 9813. STANDARD RELATING TO PATIENTS’ part, other than section 722, shall apply sepa- group health plan under part 4 of subtitle B. BILL OF RIGHTS. rately with respect to each coverage option. ‘‘(d) CONFORMING REGULATIONS.—The Sec- ‘‘A group health plan shall comply with ‘‘(c) PLAN SATISFACTION OF CERTAIN RE- retary may issue regulations to coordinate the following requirements (as in effect as of QUIREMENTS.— the requirements on group health plans the date of the enactment of such Act), and ‘‘(1) SATISFACTION OF CERTAIN REQUIRE- under this section with the requirements im- such requirements shall be deemed to be in- MENTS THROUGH INSURANCE.—For purposes of posed under the other provisions of this corporated into this section: subsection (a), insofar as a group health plan title.’’. ‘‘(1) The requirements of subpart C of part provides benefits in the form of health insur- (b) APPLICATION TO GROUP MARKET UNDER 7 of subtitle B of title I of the Employee Re- ance coverage through a health insurance PUBLIC HEALTH SERVICE ACT.—Subpart 2 of tirement Income Security Act of 1974. issuer, the plan shall be treated as meeting part A of title XXVII of the Public Health ‘‘(2) The requirements of section 714 of the the following requirements of this Act with Service Act (42 U.S.C. 300gg-4 et seq.), as Employee Retirement Income Security Act respect to such benefits and not be consid- amended by section 203(a)(1)(B), is further of 1974. ered as failing to meet such requirements be- amended by adding at the end the following ‘‘(3) The requirements of section 503 of the cause of a failure of the issuer to meet such new section: Employee Retirement Income Security Act requirements so long as the plan sponsor or ‘‘SEC. 2708. PATIENT PROTECTION STANDARDS. of 1974.’’. its representatives did not cause such failure ‘‘(a) IN GENERAL.—Each group health plan (e) CONFORMING AMENDMENT.—Section by the issuer: shall comply with the following patient pro- 2721(b)(2)(A) of the Public Health Service Act ‘‘(A) section 721 (relating to access to tection requirements, and each health insur- (42 U.S.C. 300gg–21(b)(2)(A)) is amended by in- emergency care). ance issuer shall comply with such patient serting ‘‘(other than section 2708)’’ after ‘‘re- ‘‘(B) Section 722 (relating to choice of cov- protection requirements with respect to quirements of such subparts’’. erage options), but only insofar as the plan is group health insurance coverage it offers, (f) NO IMPACT ON SOCIAL SECURITY TRUST meeting such requirement through an agree- and such requirements shall be deemed to be FUND.— ment with the issuer to offer the option to incorporated into this subsection: (1) IN GENERAL.—Nothing in the amend- purchase point-of-service coverage under ‘‘(1) The requirements of subpart C of part ments made by this section shall be con- such section. 7 of subtitle B of title I of the Employee Re- strued to alter or amend the Social Security ‘‘(C) Section 723, 724 and 725 (relating to ac- tirement Income Security Act of 1974. Act (or any regulation promulgated under cess to specialty care). ‘‘(2) The requirements of section 714 of the that Act). ‘‘(D) Section 726) (relating to continuity in Employee Retirement Income Security Act (2) TRANSFERS.— case of termination of provider (or, issuer in of 1974. (A) ESTIMATE OF SECRETARY.—The Sec- connection with health insurance coverage) ‘‘(3) The requirements of subsections (b) retary of the Treasury shall annually esti- contract) but only insofar as a replacement through (g) of section 503 of the Employee mate the impact that the enactment of this issuer assumes the obligation for continuity Retirement Income Security Act of 1974. section has on the income and balances of of care. ‘‘(b) NOTICE.—A group health plan shall the trust funds established under section 201 ‘‘(E) Section 727 (relating to patient-pro- comply with the notice requirement under of the Social Security Act (42 U.S.C. 401). vider communications). section 104(b)(1) of the Employee Retirement (B) TRANSFER OF FUNDS.—If, under subpara- ‘‘(F) Section 728 (relating to prescription Income Security Act of 1974 with respect to graph (A), the Secretary of the Treasury es- drugs). the requirements referred to in subsection timates that the enactment of this section ‘‘(G) Section 729 (relating to self-payment (a) and a health insurance issuer shall com- has a negative impact on the income and bal- for certain services). ply with such notice requirement as if such ances of the trust funds established under ‘‘(2) INFORMATION.—With respect to infor- section applied to such issuer and such issuer section 201 of the Social Security Act (42 mation required to be provided or made were a group health plan.’’. U.S.C. 401), the Secretary shall transfer, not available under section 714, in the case of a (c) APPLICATION TO INDIVIDUAL MARKET less frequently than quarterly, from the gen- group health plan that provides benefits in UNDER PUBLIC HEALTH SERVICE ACT.—Sub- eral revenues of the Federal Government an the form of health insurance coverage part 3 of part B of title XXVII of the Public amount sufficient so as to ensure that the through a health insurance issuer, the Sec- Health Service Act (42 U.S.C. 300gg-51 et income and balances of such trust funds are retary shall determine the circumstances seq.), as amended by section 203(b)(2), is fur- not reduced as a result of the enactment of under which the plan is not required to pro- ther amended by adding at the end the fol- such section. vide or make available the information (and lowing new section: (g) INFORMATION REQUIREMENTS.—

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(1) INFORMATION FROM GROUP HEALTH comply with a requirement imposed by the ment sale shall be taken into account for PLANS.—Section 1862(b) of the Social Secu- previous subparagraphs shall be subject to a purposes of this title under the installment rity Act (42 U.S.C. 1395y(b)) is amended by civil money penalty not to exceed $1,000 for method. adding at the end the following: each incident of such failure. The provisions ‘‘(2) ACCRUAL METHOD TAXPAYER.—The in- ‘‘(7) INFORMATION FROM GROUP HEALTH of section 1128A (other than subsections (a) stallment method shall not apply to income PLANS.— and (b)) shall apply to a civil money penalty from an installment sale if such income ‘‘(A) PROVISION OF INFORMATION BY GROUP under the previous sentence in the same would be reported under an accrual method HEALTH PLANS.—The administrator of a manner as those provisions apply to a pen- of accounting without regard to this section. group health plan subject to the require- alty or proceeding under section 1128A(a).’’ The preceding sentence shall not apply to a ments of paragraph (1) shall provide to the (2) EFFECTIVE DATE.—The amendment disposition described in subparagraph (A) or Secretary such of the information elements made by paragraph (1) shall take effect 180 (B) of subsection (l)(2).’’ described in subparagraph (C) as the Sec- days after the date of the enactment of this (B) CONFORMING AMENDMENTS.—Sections retary specifies, and in such manner and at Act. 453(d)(1), 453(i)(1), and 453(k) of such Act are such times as the Secretary may specify (but (h) MODIFICATION TO FOREIGN TAX CREDIT each amended by striking ‘‘(a)’’ each place it not more frequently than 4 times per year), CARRYBACK AND CARRYOVER PERIODS.— appears and inserting ‘‘(a)(1)’’. with respect to each individual covered (1) IN GENERAL.—Section 904(c) of the Inter- (2) MODIFICATION OF PLEDGE RULES.—Para- under the plan who is entitled to any bene- nal Revenue Code of 1986 (relating to limita- graph (4) of section 453A(d) of such Act (re- fits under this title. tion on credit) is amended— lating to pledges, etc., of installment obliga- ‘‘(B) PROVISION OF INFORMATION BY EMPLOY- (A) by striking ‘‘in the second preceding tions) is amended by adding at the end the ERS AND EMPLOYEE ORGANIZATIONS.—An em- taxable year,’’, and following: ‘‘A payment shall be treated as di- ployer (or employee organization) that main- (B) by striking ‘‘or fifth’’ and inserting rectly secured by an interest in an install- tains or participates in a group health plan ‘‘fifth, sixth, or seventh’’. ment obligation to the extent an arrange- subject to the requirements of paragraph (1) (2) EFFECTIVE DATE.—The amendment ment allows the taxpayer to satisfy all or a shall provide to the administrator of the made by paragraph (1) shall apply to credits portion of the indebtedness with the install- plan such of the information elements re- arising in taxable years beginning after De- ment obligation.’’ cember 31, 2001. quired to be provided under subparagraph (3) EFFECTIVE DATE.—The amendments (i) LIMITATIONS ON WELFARE BENEFIT (A), and in such manner and at such times as made by this subsection shall apply to sales FUNDS OF 10 OR MORE EMPLOYER PLANS.— the Secretary may specify, at a frequency or other dispositions occurring on or after (1) BENEFITS TO WHICH EXCEPTION APPLIES.— consistent with that required under subpara- the date of the enactment of this Act. graph (A) with respect to each individual de- Section 419A(f)(6)(A) of the Internal Revenue scribed in subparagraph (A) who is covered Code of 1986 (relating to exception for 10 or under the plan by reason of employment more employer plans) is amended to read as COLLINS (AND OTHERS) with that employer or membership in the or- follows: AMENDMENT NO. 1243 ganization. ‘‘(A) IN GENERAL.—This subpart shall not Ms. COLLINS (for herself, Mr. apply to a welfare benefit fund which is part ‘‘(C) INFORMATION ELEMENTS.—The infor- HUTCHINSON, Mr. JEFFORDS, Mr. FRIST, mation elements described in this subpara- of a 10 or more employer plan if the only graph are the following: benefits provided through the fund are 1 or Mr. GRAMS, Mr. GRASSLEY, and Mr. ‘‘(i) ELEMENTS CONCERNING THE INDI- more of the following: ABRAHAM) proposed an amendment to VIDUAL.— ‘‘(i) Medical benefits. amendment No. 1232 proposed by Mr. ‘‘(I) The individual’s name. ‘‘(ii) Disability benefits. DASCHLE to the bill, S. 1344, supra; as ‘‘(II) The individual’s date of birth. ‘‘(iii) Group term life insurance benefits follows: which do not provide for any cash surrender ‘‘(III) The individual’s sex. In the language proposed to be stricken, at value or other money that can be paid, as- ‘‘(IV) The individual’s social security in- the appropriate place, insert the following: surance number. signed, borrowed, or pledged for collateral for a loan. SEC. ll. INCLUSION OF QUALIFIED LONG-TERM ‘‘(V) The number assigned by the Secretary CARE INSURANCE CONTRACTS IN to the individual for claims under this title. The preceding sentence shall not apply to CAFETERIA PLANS, FLEXIBLE ‘‘(VI) The family relationship of the indi- any plan which maintains experience-rating SPENDING ARRANGEMENTS, AND vidual to the person who has or had current arrangements with respect to individual em- HEALTH FLEXIBLE SPENDING AC- or employment status with the employer. ployers.’’ COUNTS. ‘‘(ii) ELEMENTS CONCERNING THE FAMILY (2) LIMITATION ON USE OF AMOUNTS FOR (a) IN GENERAL.—Section 125(f) of the In- MEMBER WITH CURRENT OR FORMER EMPLOY- OTHER PURPOSES.—Section 4976(b) of such Act ternal Revenue Code of 1986 (defining quali- MENT STATUS.— (defining disqualified benefit) is amended by fied benefits) is amended by striking the last ‘‘(I) The name of the person in the individ- adding at the end the following new para- sentence and inserting the following: ‘‘Such ual’s family who has current or former em- graph: term includes any qualified long-term care ployment status with the employer. ‘‘(5) SPECIAL RULE FOR 10 OR MORE EM- insurance contract.’’ ‘‘(II) That person’s social security insur- PLOYER PLANS EXEMPTED FROM PREFUNDING (b) EFFECTIVE DATE.—The amendment ance number. LIMITS.—For purposes of paragraph (1)(C), made by this section shall apply to taxable ‘‘(III) The number or other identifier as- if— years beginning after December 31, 1999. signed by the plan to that person. ‘‘(A) subpart D of part I of subchapter D of SEC. ll. DEDUCTION FOR PREMIUMS FOR ‘‘(IV) The periods of coverage for that per- chapter 1 does not apply by reason of section LONG-TERM CARE INSURANCE. son under the plan. 419A(f)(6) to contributions to provide 1 or (a) IN GENERAL.—Part VII of subchapter B ‘‘(V) The employment status of that person more welfare benefits through a welfare ben- of chapter 1 of the Internal Revenue Code of (current or former) during those periods of efit fund under a 10 or more employer plan, 1986 (relating to additional itemized deduc- coverage. and tions) is amended by redesignating section ‘‘(VI) The classes (of that person’s family ‘‘(B) any portion of the welfare benefit 222 as section 223 and by inserting after sec- members) covered under the plan. fund attributable to such contributions is tion 221 the following: ‘‘(iii) PLAN ELEMENTS.— used for a purpose other than that for which ‘‘SEC. 222. PREMIUMS FOR LONG-TERM CARE IN- ‘‘(I) The items and services covered under the contributions were made, SURANCE. the plan. then such portion shall be treated as revert- ‘‘(a) IN GENERAL.—In the case of an eligible ‘‘(II) The name and address to which ing to the benefit of the employers maintain- individual, there shall be allowed as a deduc- claims under the plan are to be sent. ing the fund.’’ tion an amount equal to 100 percent of the ‘‘(iv) ELEMENTS CONCERNING THE EM- (3) EFFECTIVE DATE.—The amendments amount paid during the taxable year for any PLOYER.— made by this subsection shall apply to con- coverage for qualified long-term care serv- ‘‘(I) The employer’s name. tributions paid or accrued after the date of ices (as defined in section 7702B(c)) or any ‘‘(II) The employer’s address. the enactment of this Act, in taxable years qualified long-term care insurance contract ‘‘(III) The employer identification number ending after such date. (as defined in section 7702B(b)) which con- of the employer. (j) MODIFICATION OF INSTALLMENT METHOD stitutes medical care for the taxpayer, his ‘‘(D) USE OF IDENTIFIERS.—The adminis- AND REPEAL OF INSTALLMENT METHOD FOR spouse, and dependents. trator of a group health plan shall utilize a ACCRUAL METHOD TAXPAYERS.— ‘‘(b) LIMITATIONS.— unique identifier for the plan in providing in- (1) REPEAL OF INSTALLMENT METHOD FOR AC- ‘‘(1) DEDUCTION NOT AVAILABLE TO INDIVID- formation under subparagraph (A) and in CRUAL BASIS TAXPAYERS.— UALS ELIGIBLE FOR EMPLOYER-SUBSIDIZED COV- other transactions, as may be specified by (A) IN GENERAL.—Subsection (a) of section ERAGE.— the Secretary, related to the provisions of 453 of the Internal Revenue Code of 1986 (re- ‘‘(A) IN GENERAL.—Except as provided in this subsection. The Secretary may provide lating to installment method) is amended to subparagraph (B), subsection (a) shall not to the administrator the unique identifier read as follows: apply to any taxpayer for any calendar described in the preceding sentence. ‘‘(a) USE OF INSTALLMENT METHOD.— month for which the taxpayer is eligible to ‘‘(E) PENALTY FOR NONCOMPLIANCE.—Any ‘‘(1) IN GENERAL.—Except as otherwise pro- participate in any plan which includes cov- entity that knowingly and willfully fails to vided in this section, income from an install- erage for qualified long-term care services

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(as so defined) or is a qualified long-term (2) APPLICATION OF SECTION.—A group ‘‘(B) approved by the plan in a timely man- care insurance contract (as so defined) main- health plan described in this paragraph is a ner in accordance with the medical exigen- tained by any employer (or former employer) group health plan (other than a fully insured cies of the case; and of the taxpayer or of the spouse of the tax- group health plan), that— ‘‘(C) in accordance with the applicable payer. (A) provides coverage for obstetric care quality assurance and utilization review ‘‘(B) CONTINUATION COVERAGE.—Coverage (such as pregnancy-related services) or rou- standards of the plan. shall not be treated as subsidized for pur- tine gynecologic care (such as preventive ‘‘(2) NOTIFICATION.—Nothing in paragraph poses of this paragraph if— women’s health examinations); and (1) shall be construed as prohibiting a plan ‘‘(i) such coverage is continuation coverage (B) requires the designation by a partici- from requiring the specialist to provide the (within the meaning of section 4980B(f)) re- pant or beneficiary of a participating pri- case manager or primary care provider with quired to be provided by the employer, and mary care provider who is not a physician regular updates on the specialty care pro- ‘‘(ii) the taxpayer or the taxpayer’s spouse who specializes in obstetrics or gynecology. vided, as well as all other necessary medical is required to pay a premium for such cov- (3) RULES OF CONSTRUCTION.—Nothing in information. erage in an amount not less than 100 percent this subsection shall be construed— ‘‘(c) REFERRALS.—Nothing in this section of the applicable premium (within the mean- (A) as waiving any coverage requirement shall be construed to prohibit a plan from re- ing of section 4980B(f)(4)) for the period of relating to medical necessity or appropriate- quiring an authorization by the case man- such coverage. ness with respect to the coverage of obstetric ager or primary care provider of the partici- ‘‘(2) LIMITATION ON LONG-TERM CARE PRE- or gynecologic care described in paragraph pant or beneficiary in order to obtain cov- MIUMS.—In the case of a qualified long-term (1); erage for speciality services so long as such care insurance contract (as so defined), only (B) to preclude the plan from requiring authorization is for an adequate number of eligible long-term care premiums (as defined that the physician who specializes in obstet- referrals. ‘‘(d) SPECIALITY CARE DEFINED.—For pur- in section 213(d)(10)) shall be taken into ac- rics or gynecology notify the designated pri- poses of this subsection, the term ‘speciality count under subsection (a)(2). mary care provider or the plan of treatment care’ means, with respect to a condition, ‘‘(c) SPECIAL RULES.—For purposes of this decisions; care and treatment provided by a health care section— (C) to preclude a group health plan from al- practitioner, facility, or center (such as a ‘‘(1) COORDINATION WITH MEDICAL DEDUC- lowing health care professionals other than center of excellence) that has adequate ex- TION, ETC.—Any amount paid by a taxpayer physicians to provide routine obstetric or pertise (including age-appropriate expertise) for insurance to which subsection (a) applies routine gynecologic care; or through appropriate training and experience. shall not be taken into account in computing (D) to preclude a group health plan from SEC. . PATIENT ACCESS TO EMERGENCY MED- the amount allowable to the taxpayer as a permitting a physician who specializes in ob- ICAL CARE. deduction under section 213(a). stetrics and gynecology from being a pri- (a) COVERAGE OF EMERGENCY CARE.— ‘‘(2) DEDUCTION NOT ALLOWED FOR SELF-EM- mary care provider under the plan. (1) IN GENERAL.—To the extent that the PLOYMENT TAX PURPOSES.—The deduction al- (4) APPLICATION OF PROVISIONS.— group health plan (other than a fully insured lowable by reason of this section shall not be (A) IN GENERAL.—Notwithstanding any group health plan) provides coverage for ben- taken into account in determining an indi- other provision of this Act (or an amend- efits consisting of emergency medical care vidual’s net earnings from self-employment ment made by this Act), the provisions of (as defined in subsection (c)) or emergency (within the meaning of section 1402(a)) for this subsection shall only apply to group ambulance services, except for items or serv- purposes of chapter 2.’’ health plans (other than fully insured group ices specifically excluded— (b) CONFORMING AMENDMENTS.— health plans). (A) the plan shall provide coverage for ben- (1) Subsection (a) of section 62 of the Inter- (B) FULLY INSURED GROUP HEALTH PLAN.—In efits, without requiring preauthorization, for nal Revenue Code of 1986 is amended by in- this subsection, the term ‘‘fully insured emergency medical screening examinations serting after paragraph (17) the following: group health plan’’ means a group health or emergency ambulance services, to the ex- ‘‘(18) LONG-TERM CARE INSURANCE COSTS OF plan where benefits under the plan are pro- tent that a prudent layperson, who possesses CERTAIN INDIVIDUALS.—The deduction al- vided pursuant to the terms of an arrange- an average knowledge of health and medi- lowed by section 222.’’ ment between a group health plan and a cine, would determine such examinations or (2) The table of sections for part VII of sub- health insurance issuer and are guaranteed emergency ambulance services to be nec- chapter B of chapter 1 of such Code is amend- by the health insurance issuer under a con- essary to determine whether emergency ed by striking the last item and inserting tract or policy of insurance. medical care (as so defined) is necessary; and the following: ‘‘SEC. 725. TIMELY ACCESS TO SPECIALISTS. (B) the plan shall provide coverage for ben- efits, without requiring preauthorization, for ‘‘Sec. 222. Premiums for long-term care in- ‘‘(a) TIMELY ACCESS.— surance. additional emergency medical care to sta- ‘‘(1) IN GENERAL.—A group health plan bilize an emergency medical condition fol- ‘‘Sec. 223. Cross reference.’’ (other than a fully insured group health lowing an emergency medical screening ex- (c) EFFECTIVE DATE.—The amendments plan) shall ensure that participants and amination (if determined necessary under made by this section shall apply to taxable beneficiaries have timely, in accordance subparagraph (A)), pursuant to the definition years beginning after December 31, 1999. with the medical exigencies of the case, ac- of stabilize under section 1867(e)(3) of the So- SEC. ll. PATIENT RIGHT TO MEDICAL ADVICE cess to primary and speciality health care cial Security Act (42 U.S.C. 1395dd(e)(3)). AND CARE. professionals who are appropriate to the con- (2) REIMBURSEMENT FOR CARE TO MAINTAIN (a) IN GENERAL.—Part 7 of subtitle B of dition of the participant or beneficiary, when MEDICAL STABILITY.— title I of the Employee Retirement Income such care is covered under the plan. Such ac- (A) IN GENERAL.—In the case of services Security Act of 1974 (29 U.S.C. 1181 et seq.) is cess may be provided through contractual provided to a participant or beneficiary by a amended— arrangements with specialized providers out- nonparticipating provider in order to main- (1) by redesignating subpart C as subpart side of the network of the plan. tain the medical stability of the participant D; and ‘‘(2) RULE OF CONSTRUCTION.—Nothing in or beneficiary, the group health plan in- (2) by inserting after subpart B the fol- paragraph (1) shall be construed— volved shall provide for reimbursement with lowing: ‘‘(A) to require the coverage under a group respect to such services if— ‘‘SEC. 723. PATIENT ACCESS TO OBSTETRIC AND health plan of particular benefits or services (i) coverage for services of the type fur- GYNECOLOGICAL CARE or to prohibit a plan from including pro- nished is available under the group health (1) GENERAL RIGHTS.— viders only to the extent necessary to meet plan; (A) WAIVER OF PLAN REFERRAL REQUIRE- the needs of the plan’s participants or bene- (ii) the services were provided for care re- MENT.—If a group health plan described in ficiaries or from establishing any measure lated to an emergency medical condition and paragraph (2) requires a referral to obtain designed to maintain quality and control in an emergency department in order to coverage for speciality care, the plan shall costs consistent with the responsibilities of maintain the medical stability of the partic- waive the referral requirement in the case of the plan; or ipant or beneficiary; and a female participant or beneficiary who ‘‘(B) to override any State licensure or (iii) the nonparticipating provider con- seeks coverage for obstetrical care or rou- scope-of-practice law. tacted the plan regarding approval for such tine gynecological care (such as preventive ‘‘(b) TREATMENT PLANS.— services. gynecological care). ‘‘(1) IN GENERAL.—Nothing in this section (B) FAILURE TO RESPOND.—If a group health (B) RELATED ROUTINE CARE.—With respect shall be construed to prohibit a group health plan fails to respond within 1 hours of being to a participant or beneficiary described in plan (other than a fully insured group health contacted in accordance with subparagraph subparagraph (A), a group health plan de- plan) from requiring that speciality care be (A)(iii), then the plan shall be liable for the scribed in paragraph (2) may treat the order- provided pursuant to a treatment plan so cost of services provided by the nonpartici- ing of other care that is related to obstetric long as the treatment plan is— pating provider in order to maintain the sta- or routine gynecologic care, by a physician ‘‘(A) developed by the specialist, in con- bility of the participant or beneficiary. who specializes in obstetrics and gynecology sultation with the case manager or primary (C) LIMITATION.—The liability of a group as the authorization of the primary care pro- care provider, and the participant or bene- health plan to provide reimbursement under vider for such other care. ficiary; subparagraph (A) shall terminate when the

VerDate Mar 15 2010 21:58 Nov 01, 2013 Jkt 081600 PO 00000 Frm 00098 Fmt 0624 Sfmt 0634 E:\1999SENATE\S14JY9.REC S14JY9 mmaher on DSKCGSP4G1 with SOCIALSECURITY July 14, 1999 CONGRESSIONAL RECORD — SENATE S8521 plan has contacted the nonparticipating pro- tween a group health plan and a health in- duced by the producers under section 155 of vider to arrange for discharge or transfer. surance issuer and are guaranteed by the the Agricultural Market Transition Act (7 (D) LIABILITY OF PARTICIPANT.—A partici- health insurance issuer under a contract or U.S.C. 7271); by pant or beneficiary shall not be liable for the policy of insurance. (B) an amount equal to 5 percent of the costs of services to which subparagraph (A) f loan rate established for quota peanuts or in an amount that exceeds the amount of li- additional peanuts, respectively, under sec- ability that would be incurred if the services AGRICULTURE, RURAL DEVELOP- tion 155 of that Act. were provided by a participating health care MENT, FOOD AND DRUG ADMIN- SEC. ll03. CROP INSURANCE PREMIUM RE- provider with prior authorization by the ISTRATION AND RELATED AGEN- FUNDS. plan. CIES APPROPRIATIONS ACT, 2000 The Secretary, acting through the Federal (b) IN-NETWORK UNIFORM COSTS-SHARING Crop Insurance Corporation, shall use not AND OUT-OF-NETWORK CARE.— more than $400,000,000 of funds of the Com- (1) IN-NETWORK UNIFORM COST-SHARING.— CONRAD AMENDMENT NO. 1244 modity Credit Corporation to provide pre- Nothing in this section shall be construed as mium refunds or other assistance to pur- preventing a group health plan (other than a (Ordered to lie on the table.) chasers of crop insurance for their 2000 or fully insured group health plan) from impos- Mr. CONRAD submitted an amend- preceding insured crops. ing any form of cost-sharing applicable to ment intended to be proposed by him SEC. ll04. CROP LOSS ASSISTANCE. any participant or beneficiary (including co- to the bill (S. 1233) making appropria- (a) IN GENERAL.—In addition to amounts insurance, copayments, deductibles, and any tions for Agriculture, Rural Develop- that have been made available before the other charges) in relation to coverage for date of enactment of this Act to carry out benefits described in subsection (a), if such ment, Food and Drug Administration, section 1102 of the Agriculture, Rural Devel- form of cost-sharing is uniformly applied and Related Agencies programs for the opment, Food and Drug Administration, and under such plan, with respect to similarly fiscal year ending September 30, 2000, Related Agencies Appropriations Act, 1999 (7 situated participants and beneficiaries, to all and for other purposes; as follows: benefits consisting of emergency medical U.S.C. 1421 note; Public Law 105–277) under On page 76, between lines 6 and 7, insert other law, the Secretary shall use not more care (as defined in subsection (c)) provided to the following: such similarly situated participants and than $360,000,000 of funds of the Commodity TITLE ll—RURAL ECONOMY beneficiaries under the plan, and such cost- Credit Corporation to provide crop loss as- EMERGENCY STABILIZATION sharing is disclosed in accordance with sec- sistance in accordance with that section in a tion 714. SEC. ll01. SHORT TITLE. manner that, to the maximum extent prac- (2) OUT-OF-NETWORK CARE.—If a group This title may be cited as the ‘‘Rural Econ- ticable— health plan (other than a fully insured group omy Emergency Stabilization Act of 1999’’. (1) fully compensates agricultural pro- health plan) provides any benefits with re- SEC. ll02. MARKET LOSS ASSISTANCE. ducers for crop losses in accordance with spect to emergency medical care (as defined (a) IN GENERAL.—Except as provided in that section (including regulations promul- in subsection (c)), the plan shall cover emer- subsections (d) and (e), the Secretary of Ag- gated to carry out that section); and gency medical care under the plan in a man- riculture (referred to in this title as the (2) provides equitable treatment under that ner so that, if such care is provided to a par- ‘‘Secretary’’) shall use not more than section for agricultural producers described ticipant or beneficiary by a nonparticipating $5,600,000,000 of funds of the Commodity in subsections (b) and (c) of that section. health care provider, the participant or bene- Credit Corporation to provide assistance to (b) CITRUS CROP LOSSES.—Notwithstanding ficiary is not liable for amounts that exceed owners and producers on a farm that are eli- any other provision of law (including regula- the amounts of liability that would be in- gible for payments for fiscal year 1999 under tions), for the purposes of section 1102 of that curred if the services were provided by a par- a production flexibility contract for the farm Act, a loss of a citrus crop caused by a dis- ticipating provider. under the Agricultural Market Transition aster in 1998 shall be considered to be a loss (c) DEFINITION OF EMERGENCY MEDICAL Act (7 U.S.C. 7201 et seq.) to partially com- of the 1998 crop of the citrus crop, without CARE.—In this section: pensate the owners and producers for the regard to the time of harvest. (1) IN GENERAL.—The term ‘‘emergency loss of markets for the 1999 crop of a com- (c) COMPENSATION FOR DENIAL OF CROP medical care’’ means, with respect to a par- modity. LOSS ASSISTANCE BASED ON TAXPAYER IDEN- ticipant or beneficiary under a group health (b) AMOUNT.—Except as provided in sub- TIFICATION NUMBERS.—The Secretary shall plan (other than a fully insured group health sections (d) and (e), the amount of assistance use not more than $70,000,000 of funds of the plan), covered inpatient and outpatient serv- made available to owners and producers on a Commodity Credit Corporation to make pay- ices that— farm under this section shall be propor- ments to producers on a farm that were de- (A) are furnished by any provider, includ- tionate to the amount of the contract pay- nied crop loss assistance under section 1102 ing a nonparticipating provider, that is ment received by the owners and producers of the Agriculture, Rural Development, Food qualified to furnish such services; and for fiscal year 1999 under a production flexi- and Drug Administration, and Related Agen- (B) are needed to evaluate or stabilize (as bility contract for the farm under the Agri- cies Appropriations Act, 1999 (7 U.S.C. 1421 such term is defined in section 1867(e)(3) of cultural Market Transition Act. note; Public Law 105–277), as the result of a the Social Security Act (42 U.S.C. (c) TIME FOR PAYMENT.—The assistance change in the taxpayer identification num- 1395dd)(e)(3)) an emergency medical condi- made available under this section for an eli- bers of the producers if the Secretary deter- tion (as defined in paragraph (2)). gible owner or producer shall be provided as mines that the change was not made to cre- (2) EMERGENCY MEDICAL CONDITION.—The soon as practicable after the date of enact- ate an advantage for the producers in the term ‘‘emergency medical condition’’ means ment of this Act. crop insurance program through lower pre- a medical condition manifesting itself by (d) DAIRY PRODUCERS.— miums or higher actual production histories. acute symptoms of sufficient severity (in- (1) IN GENERAL.—Of the total amount made SEC. ll05. EMERGENCY LIVESTOCK FEED AS- cluding severe pain) such that a prudent available under subsection (a), $200,000,000 SISTANCE. layperson, who possesses an average knowl- shall be available to provide assistance to For an additional amount to provide emer- edge of health and medicine, could reason- dairy producers in a manner determined by gency livestock feed assistance in accord- ably expect the absence of immediate med- the Secretary. ance with section 1103 of the Agriculture, ical attention to result in— (2) FEDERAL MILK MARKETING ORDERS.— Rural Development, Food and Drug Adminis- (A) placing the health of the participant or Payments made under this subsection shall tration, and Related Agencies Appropria- beneficiary (or, with respect to a pregnant not affect any decision with respect to rule- tions Act, 1999 (7 U.S.C. 1421 note; Public woman, the health of the woman or her un- making activities under section 143 of the Law 105–277), there is appropriated, out of born child) in serious jeopardy, Agricultural Market Transition Act (7 U.S.C. any money in the Treasury not otherwise ap- (B) serious impairment to bodily functions, 7253). propriated, $295,000,000. or (e) PEANUTS.— SEC. ll06. FUNDS FOR STRENGTHENING MAR- (C) serious dysfunction of any bodily organ (1) IN GENERAL.—Of the total amount made KETS, INCOME, AND SUPPLY (SEC- or part. available under subsection (a), the Secretary TION 32). (d) APPLICATION OF PROVISIONS.— shall use not to exceed $45,000,000 to provide For an additional amount for the fund (1) IN GENERAL.—Notwithstanding any payments to producers of quota peanuts or maintained for funds made available under other provision of this Act (or an amend- additional peanuts to partially compensate section 32 of the Act of August 24, 1935 (7 ment made by this Act), the provisions of the producers for the loss of markets for the U.S.C. 612c), there is appropriated, out of any this section shall only apply to group health 1998 crop of peanuts. money in the Treasury not otherwise appro- plans (other than fully insured group health (2) AMOUNT.—The amount of a payment priated, $355,000,000. plans). made to producers on a farm of quota pea- SEC. ll07. DISASTER RESERVE. (2) FULLY INSURED GROUP HEALTH PLAN.—In nuts or additional peanuts under paragraph (a) IN GENERAL.—For the disaster reserve this section, the term ‘‘fully insured group (1) shall be equal to the product obtained by established under section 813 of the Agricul- health plan’’ means a group health plan multiplying— tural Act of 1970 (7 U.S.C. 1427a), there is ap- where benefits under the plan are provided (A) the quantity of quota peanuts or addi- propriated, out of any money in the Treas- pursuant to the terms of an arrangement be- tional peanuts produced or considered pro- ury not otherwise appropriated, $500,000,000.

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