Ways and Means Budget Reconciliation Act of 1993

TABLE OF CONTENTS:

Title I: Short Title; References to Omnibus Budget

Reconciliation Act of 1993

Titles II-XII: (Reserved)

Title XIII: Committee on Ways and Means-Savings

Subtitle A: Old-Age, Survivors, and Disability

Insurance Program

Subtitle D (sic): Customs and Trade Provisions

Subtitle E: Customs Officer Pay Reform

Subtitle B (sic): Human Resources Amendments

Subtitle C: Medicare Program

Title XIV: Revenue Provisions

Subtitle A: Training and Investment Incentives

Subtitle B: Revenue Increases

Subtitle C: Empowerment Zones and Enterprise

Communities, Etc.

Subtitle D: Other Provisions

Title I: Short Title; References to Omnibus Budget Reconciliation Act of 1993 - Ways and Means Budget Reconciliation Act of 1993 - Deems any reference in this Act to the Omnibus Budget Reconciliation Act of 1993 to be a reference to the Ways and Means Budget Reconciliation Act of 1993.

Titles II-XII: (Reserved)

Title XIII: Committee on Ways and Means: Savings - Subtitle A: Old-Age, Survivors and Disability Insurance Program - Amends the Omnibus Budget Reconciliation Act of 1990 (OMBRA '90) to require the Secretary of Health and Human Services (Secretary) to reestablish and maintain in service the same number of telephone lines to each local social security office that were in place on September 30, 1989.

(Sec. 13002) Amends the Internal Revenue Code (IRC) and title II (Old Age, Survivors and Disability Insurance) of the Social Security Act (SSA) to raise the threshold at which election services become subject to social security employment taxes.

(Sec. 13003) Amends SSA title II to: (1) permit States which already collect social security numbers under current law to use them to eliminate duplicate names and names of convicted felons from jury source lists; (2) extend to all States the option to provide police officers and firefighters participating in a public retirement system with social security coverage under voluntary agreements with the Secretary; (3) disregard the windfall elimination provision in computing any U.S. totalization benefit and the amount of a regular U.S. benefit of an individual who receives a foreign totalization benefit based in part on U.S. employment, and who does not receive any other pension which is based on noncovered employment; (4) provide that military pensions based wholly on service in the military reserves before 1988 shall not trigger application of the Government pension offset or windfall elimination provision to the individual's social security benefits; (5) repeal the facility-of-payment provision; (6) make the guaranteed primary insurance amount the basis for calculating the guaranteed maximum family benefit; (7) make unauthorized disclosure of information and fraudulent attempts to obtain personal information under SSA a felony, and increase penalties for such offenses; (8) increase the time for which an extension may be granted for filing an annual earnings report; (9) permit the Department of Agriculture to share its list of names, social security numbers, and employer identification numbers of the owners and officers of retail grocery stores which redeem food stamps with other Federal agencies for the purpose of investigating food stamp fraud and violations of other Federal laws; (10) prohibit the misuse of Department of the Treasury names, symbols, etc.; (11) prohibit a State from using an individual's social security number in the administration of any driver's license or motor vehicle registration law where the State has not entered into a contract to provide death certificate and related information to the Secretary, or where such a contract restricts the Secretary's use of death information; and (12) require the Secretary to study improvements in gathering and reporting of death information.

(Sec. 13005) Exempts from payment liability and penalties any ministers who were American citizens and residents of Canada prior to the 1984 totalization agreement between the United States and Canada and failed to file a tax return or pay self-employment taxes.

(Sec. 13010) Amends IRC to: (1) authorize the Secretary of the Treasury to disclose information from tax returns on individuals' mortality status to the Secretary for epidemiological research purposes; (2) provide for the coordination of the collection of domestic service employment taxes with the collection of income taxes; and (3) change threshold requirements with respect to social security employment taxes on domestic services.

(Sec. 13015) Requires the Secretary to study the rising costs of disability benefits for a report to the Congress with recommendations for legislative changes.

(Sec. 13016) Amends the Social Security Disability Amendments of 1980 to extend the Secretary's authority to conduct disability work incentive demonstration projects.

Subtitle D (sic): Customs and Trade Provisions - Amends the Tariff Act of 1930 to authorize appropriations for the United States International Trade Commission (ITC). Prohibits use of such funds for any special study, investigation, or report requested by an agency of the executive branch unless such agency reimburses the ITC for its costs.

(Sec. 13601) Amends the Customs Procedural Reform and Simplification Act of 1978 to authorize appropriations for the United States Customs Service for: (1) noncommercial and commercial operations; and (2) the air and marine interdiction programs.

Amends the Trade Act of 1974 to authorize appropriations for the Office of the United States Trade Representative.

(Sec. 13602) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) to extend the authority of the Secretary of the Treasury to collect customs user fees.

(Sec. 13603) Amends the Trade Act of 1974 to remove the Union of Soviet Socialist Republics from the list of countries ineligible for designation as a beneficiary developing country under the Generalized System of Preferences (GSP). Extends duty-free treatment provided under the GSP.

(Sec. 13604) Extends the worker trade adjustment assistance program (trade adjustment assistance benefits for workers adversely affected by import competition or the relocation of U.S. production facilities abroad) as well as authorization of appropriations for it.

(Sec. 13605) Amends the Omnibus Trade and Competitiveness Act of 1988 to extend the authority of the President, for a specified period of time, to enter into trade agreements with foreign countries for the reduction or elimination of tariff or nontariff barriers if the Uruguay Round of multilateral trade negotiations under the General Agreement on Tariffs and Trade (GATT) has not resulted in such trade agreements by May 31, 1993.

Provides that implementing bills involving tariff and nontariff trade agreements shall be effective only if, among other things, the President, at least 120 calendar days (currently, 90 days) before he enters into such agreement, notifies the Congress of his intention to enter into it, and publishes such intention in the Federal Register.

Extends congressional "fast track procedures" to such implementing bills through April 16, 1994.

(Sec. 13606) Amends the Trade Act of 1974 to eliminate the East-West Trade Statistics Monitoring System.

Subtitle E: Customs Officer Pay Reform - Amends Federal law to revise the pay system for United States Customs Service Inspectors (customs inspectors).

(Sec. 13702) Authorizes cash awards to customs officers for foreign language proficiency.

(Sec. 13703) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) to provide for reimbursement of appropriations from the Customs User Fee Account (Account) for agency retirement contributions.

(Sec. 13704) Amends Federal law with regard to the treatment of certain pay of customs officers for retirement purposes.

(Sec. 13705) Revises COBRA congressional reporting requirements respecting Account reimbursements. Requires additional General Accounting Office reports to the Congress concerning the financing of overtime inspectional services through user fees.

Subtitle B: (sic) Human Resources Amendments - Chapter 1: Child Welfare Services, Foster Care, and Adoption Assistance - Amends SSA title IV part B (Child-Welfare Services) to: (1) create a capped entitlement program to provide child welfare services designed to strengthen and preserve families; (2) repeal provisions linking the payment of certain SSA title IV part B funds to the implementation of certain protections for children in foster care; (3) require that the State part B plan provide for the foster care protections currently outlined in such provisions as well as for State review of its procedures in effect for children abandoned at or shortly after birth, as well as enactment of any procedures necessary to enable permanent child placement decisions to be made expeditiously; (4) provide that the funds withheld or recovered from a State owing to its failure to comply with such protections may not be reallotted among other States; (5) require State part B plans to contain a description of the specific measures taken by the State to comply with the Indian Child Welfare Act; and (6) provide for child welfare traineeships.

(Sec. 13212) Directs the Secretary to provide grants for State courts to assess and improve proceedings relating to foster care placement and adoption.

(Sec. 13216) Amends SSA title IV part E (Foster Care and Adoption Assistance) (FCAA) to: (1) change the reimbursement policy with respect to foster care maintenance payments made on behalf of certain children whose adoption has been set aside by a court or whose voluntary placement in foster care has been judicially determined to be in the best interests of the child; (2) provide for 90 (and later 50) percent matching of State expenditures for planning, design, development, or installation of statewide mechanized data collection and information retrieval systems, and 50 percent matching of State expenditures for operation of the systems; (3) require States to review periodically their foster care maintenance payment and adoption assistance levels to ensure their continuing appropriateness; (4) revise the case review system to provide that hearings after the initial dispositional hearing take place at least every 12 months, rather than periodically; (5) require the health and education records in each child's case plan to include a record that the foster care provider was advised (where appropriate) of the child's eligibility for early and periodic Medicaid screening, diagnostic, and treatment services; (6) provide for the treatment of assets of youths participating in the independent living program; (7) make permanent the authorization for the independent living program; (8) repeal authority to transfer unused foster care funds to the child welfare services program; (9) require the Secretary to promulgate regulations for on-site reviews and audits of State expenditures for foster care maintenance and adoption assistance payments; (10) set forth case plan requirements for children placed in foster care a substantial distance from their homes or in a different State; (11) require the dispositional hearing for a child placed in foster care in a different State to determine whether the out-of-State placement continues to be appropriate and in the child's best interests; (12) require the adoption and foster care data collection system to provide information on the number and characteristics of children placed in foster care outside the State; and (13) codify Federal regulations providing a timetable for the treatment of State claims for foster care and adoption assistance.

(Sec. 13218) Directs the Secretary to study and report to the Congress on the ways in which States implement the reasonable efforts requirements for State SSA title IV part E plans.

(Sec. 13225) Amends the Omnibus Budget Reconciliation Act of 1989 (OMBRA '89) to extend permanently (and retroactively to October 1, 1992) the level of Federal reimbursement under SSA title IV part E for the training of personnel employed or preparing for employment by the State or local child welfare agency, and for the training of foster and adoptive parents.

(Sec. 13227) Amends SSA title XI part A to: (1) bar the Secretary from imposing financial penalties on States for the failure of State programs under SSA title IV parts B and E to comply with State plan requirements, except pursuant to final regulations meeting specified requirements; (2) provide for certain demonstration projects to promote the objectives of such parts; and (3) overturn certain limitations in Suter v. Artist M. on private enforceability of State plan requirements.

(Sec. 13232) Prohibits the Secretary: (1) until October 1, 1994, from reducing any payment to, withholding any payments from, or seeking any repayments from any State under SSA title IV parts B or E by reason of a determination in connection with a review of State compliance with SSA title IV part B foster care protections; and (2) from reducing any payments to, withholding any payments from, or seeking any repayments from any State under SSA title IV part E by reason of a determination in connection with any on-site Federal financial review, or any audit conducted by the Inspector General using similar methodologies.

(Sec. 13233) Requires the Secretary to make grants to eligible institutions to train individuals to deliver culturally sensitive and bilingual child welfare services in border areas with Mexico. Authorizes appropriations.

Chapter 2: Child Support Enforcement - Amends SSA title IV part D (Child Support and Establishment of Paternity) to: (1) set up new paternity establishment performance standards and procedures for State child support enforcement programs; (2) outline State SSA title IV part D plan requirements applicable to health insurers, employers, and State Medicaid agencies with regard to health insurance coverage for children of parents subject to a support order; and (3) require State child support enforcement agencies to periodically report, at no charge, the names of obligors at least two months delinquent in child support payments to bona fide consumer reporting agencies capable of making accurate use of such information.

Chapter 3: Supplemental Security Income - Amends SSA title XVI (Supplemental Security Income) (SSI) and other Federal law to: (1) require the Social Security Administration to charge States fees for the Federal cost of administering State supplemental SSI payments; and (2) require the Secretary to charge fees for additional services requested by the State that are beyond the level customarily provided in administering such payments.

(Sec. 13252) Amends OMBRA '90 to make permanent the exclusion of State and local relocation assistance from countable income under SSI.

(Sec. 13253) Amends SSA title XVI to: (1) deem to be living in a household a spouse or parent of family members on SSI who is absent from the household solely because of active duty military assignment; (2) exclude hazardous duty pay received while on active military duty from countable income; (3) continue SSI benefits to children who are U.S. citizens if they received SSI in the United States and then accompany their parents on military assignment to any U.S. territory or possession; and (4) extend the SSI definition of disability for children under 18 to any person under 18.

(Sec. 13257) Amends Federal law to exempt income of up to $2,000 per year received by individual Indians that is derived from leases on individually-owned trust or restricted Indian lands in determining eligibility and benefit levels under AFDC (SSA title IV part A) and SSI.

Chapter 4: Aid to Families with Dependent Children - (Sec. 13261) Amends SSA title IV part A to: (1) reduce to 50 percent the enhanced Federal matching available for certain categories of State administrative expenses; (2) make optional a State's verification of an individual's immigration status with the Immigration and Naturalization Service through an immigration status verification system; (3) delay Federal requirements regarding AFDC-UP participation rates; and (4) increase the amount of stepparent earnings disregarded in determining the eligibility and benefit amounts of AFDC recipients and applicants.

(Sec. 13263) Amends SSA title IV part F (Job Opportunities and Basic Skills Training Program) (JOBS) to require the Secretary to develop criteria for performance standards in the JOBS program, rather than performance standards themselves, by a certain date.

(Sec. 13264) States that the Congress hereby declares that: (1) it is the policy and responsibility of the Federal Government to reduce the rate and degree to which families depend on income from welfare programs, to assist them toward self-sufficiency, and to increase the living standards of low-income families; and (2) the Federal Government should help welfare recipients as well as individuals at risk of welfare participation to improve their education and job skills, to obtain access to high quality child care and other necessary support services, and to take such other steps as may assist them to meet their responsibilities to become financially independent.

Directs the Secretary to develop welfare participation measures and predictors, and report annually on welfare participation to specified congressional committees.

Establishes the Advisory Board on Welfare Participation to assist the Secretary in the development of such measures and predictors.

(Sec. 13265) Directs the Secretary to provide for a demonstration project offering low-income residents of Milwaukee, Wisconsin, employment, wage supplements, health and child care, and counseling and training for job retention or advancement.

(Sec. 13266) Amends the Family Support Act of 1988 to: (1) delay the requirement for implementation of the Unemployed Parent program in Puerto Rico, Guam, the Virgin Islands, and American Soma until the limitations on Federal matching payments to these jurisdictions with respect to AFDC and FCAA maintenance payments are repealed; and (2) extend the authorization for early childhood development projects.

(Sec. 13269) Amends the Omnibus Budget Reconciliation Act of 1987 (OMBRA '87) to extend New York State's Child Assistance Program demonstration.

(Sec. 13267) Amends SSA title XI to provide that, with respect to AFDC, one adult member of a family or household may sign, under penalty of perjury, a declaration attesting to the citizenship or satisfactory immigration status of other family or household members. Permits an adult to sign a declaration on behalf of a newly born child no later than the next eligibility redetermination date.

Chapter 5: Unemployment Insurance - Amends IRC and SSA title III (Unemployment Compensation) to provide for the treatment of short-time compensation programs under which individuals whose workweeks have been reduced by at least ten percent (especially as an alternative to a temporary layoff) are eligible for unemployment compensation, under certain conditions.

(Sec. 13275) Amends the Federal-State Extended Unemployment Compensation Act of 1970 to increase the reimbursement rate and repeal special eligibility requirements under the extended unemployment program.

(Sec. 13276) Amends IRC to: (1) extend the current Federal unemployment tax rate; and (2) require disclosure of information about certain taxes to the Railroad Retirement Board for purposes of its administration of the Railroad Retirement and Railroad Unemployment Insurance Acts.

Chapter 6: Technical Provisions - Makes technical corrections related to the income security and human resources provisions of OMBRAs '89 and '90.

(Sec. 13283) Amends SSA title XVI to repeal certain obsolete provisions relating to treatment of the earned income tax credit.

Subtitle C: Medicare Program - Chapter 1: Provisions Relating to Part A - Subchapter A: Elimination of Inflation Update for Services Provided under Part A: - Amends SSA title XVIII (Medicare) to eliminate updates for inpatient hospital services and hospice care under Medicare part A in FY 1994 and 1995.

(Sec. 13402) Prohibits the Secretary from applying an update factor to the cost limits for skilled nursing facility cost reporting periods beginning in FY 1994 and 1995.

Subchapter B: Other Provisions Relating to Part A - Amends SSA title XVIII to: (1) provide that a change in classification of hospitals from one area to another cannot result in a reduction in the wage index for an urban area if the area has a wage index below the rural wage index for the State or if the area is the only urban area in a State with no rural areas; (2) change certain requirements with respect to the standards for designating metropolitan statistical areas that are used in determining treatment of certain hospitals in rural counties adjacent to one or more urban areas; (3) require the Secretary to phase out payments for day outlier cases starting in FY 1995; (4) revise and authorize appropriations for the Essential Access Community Hospital (EACH) demonstration program; (5) provide for a prospective payment system for determining payments for outpatient rural primary care hospital services; (6) continue special payments for Medicare-dependent, small rural hospitals for discharges occurring through FY 1994, with reduced payments for certain discharges; (7) extend the regional floor provision with respect to certain hospital discharges the payment for which is set at 85 percent of the national amount and 15 percent of the regional amount; (8) allow to participate in Medicare hospitals where the care of patients receiving qualified psychologist services is under a clinical psychologist; (9) provide for additional medical education payments for interns and residents providing services at a community heath center under a hospital's ownership or control; (10) require skilled nursing facilities to inform beneficiaries of the hospice benefit under Medicare, except under certain conditions; (11) reduce the part A premium, on a phase-in basis, for individuals with 30 or more quarters of social security coverage (and their spouses); (12) require the Secretary to update periodically the salary equivalency guidelines for physical therapy and respiratory therapy services using the most recent available data; and (13) provide that diagnosis-related group (DRG) window provisions will not apply to hospitals that are not paid on a DRG basis.

(Sec. 13414) Amends OMBRA '87 to: (1) reauthorize and extend the rural health transition grant program; and (2) provide that all hospitals classified as regional referral centers on September 30, 1992, shall retain such status through FY 1994.

(Sec. 13415) Requires the Secretary to: (1) make a lump sum retroactive payment to any such hospital for payments lost as a result of the loss of its regional referral center status; and (2) provide any hospital which fails to qualify as a rural referral center as a result of its urban reclassification with the opportunity to decline such reclassification and retain rural referral center status.

(Sec. 13418) Amends OMBRA '90 to require the Secretary to continue limited-service rural hospital demonstration projects through calendar 1995.

(Sec. 13419) Amends OMBRA' 89 to extend the hemophilia pass-through program.

(Sec. 13420) Declares that, in the case of a State with a Medicare-approved payment system, no other provision of law shall be construed as preventing the system from providing that payment for covered services be made on the basis of rates provided for under such system.

(Sec. 13423) Prohibits the Secretary from taking action to recover certain amounts paid by Medicare to uniformed services treatment facilities in Boston, Baltimore, and Seattle for services that were provided between October 1, 1986, and December 31, 1989, except to the extent that funds are made available for that purpose under the Department of Defense Appropriations Act, 1993.

Requires a study and report to the Congress by the Secretary on establishment of joint medical facilities among the Department of Defense, the Department of Veterans Affairs, and other public and private entities.

(Sec. 13424) Requires the Secretary to: (1) review ]the DRGs assigned to discharges of patients with intractable epilepsy; (2) revise, for discharges occurring on or after October 1, 1994, the assignment of discharges to such groups as the Secretary considers appropriate to account for the resource requirements of such patients; and (3) begin collecting the data necessary to compute a skilled nursing facility wage index adjustment to the routine service cost limits required under Medicare.

Requires the Prospective Payment Assessment Commission to study and report to the Congress on the impact of applying routine per diem cost limits for skilled nursing facilities on a regional basis.

(Sec. 13429) Allows hospitals that have been reclassified from urban to rural as a result of revisions to metropolitan statistical area definitions issued by the Office of Management and Budget on December 28, 1992, to apply to the Medicare Geographic Classification Review Board for reclassification in FY 1994.

Chapter 2: Provisions Relating to Part B: Subchapter A: Elimination of Inflation Update - Amends SSA title XVIII part B to eliminate the inflation update for physician and related professional services and other specified items and services.

(Sec. 13432) Freezes payments for enteral and parenteral nutrients, supplies and equipment, rural health clinic, federally-qualified health center, and comprehensive outpatient rehabilitation facility services, dialysis services, and other part B items and services.

Subchapter B: Physicians' Services - Amends SSA title XVIII part B to: (1) repeal the OMBRA '90 prohibition on separate payments for EKG interpretations; (2) repeal the reductions in payments to new physicians and practitioners; (3) prohibit the Secretary from changing the methodology in effect as of January 1, 1992, for calculating anesthesia time in the fee schedules for anesthesia services; (4) revise requirements with respect to geographic adjustment factors and beneficiary liability for amounts billed above the limiting charge; (5) require pre-payment screening by carriers of unassigned claims submitted by nonparticipating physicians; (6) require the Explanation of Benefits form to contain information on amounts billed in excess of the applicable limiting charge; (7) specify the practitioners who may only bill for services on an assignment-related basis; (8) include antigens prepared by a physician on the physician fee schedule; (9) prohibit the imposition of user fees in specified circumstances in the administration of claims relating to physicians' services; and (10) specify the conditions under which the Secretary can recognize substitute billing arrangements between two physicians.

(Sec. 13444) Requires the Secretary to: (1) study and report to specified congressional committees on the data necessary to review and revise geographic indices; and (2) review and revise such indices and the geographic index values applied for all fee schedule areas by a certain date.

Requires the Physician Payment Review Commission to conduct a study to develop criteria for use in redefining the localities used within States for adjusting physicians' fees.

(Sec. 13446) Requires the Secretary to: (1) fully develop, by not later than July 1, 1994, relative values for the full range of pediatric physicians' services; and (2) study and report to the Congress on the relative values for pediatric and other services.

Subchapter C: Ambulatory Surgical Center Services - Amends SSA title XVIII to extend special payment rates for certain eye or eye and ear hospitals to any hospital that otherwise meets current law criteria but, on October 1, 1987, operated as a physically separate or distinct eye or ear unit of a general acute care hospital which has since disposed of a substantial portion of its other acute care operations.

(Sec. 13452) Amends OMBRA '90 to extend the cap on payments for intraocular lenses through 1994.

Requires the Secretary to study and report to the Congress on the costs to providers of intraocular lenses provided to individuals enrolled under Medicare part B.

Subchapter D: Durable Medical Equipment - Amends SSA title XVIII to: (1) remove aspirators and nebulizers from the category of durable medical equipment (DME) items requiring frequent and substantial servicing; (2) specifically provide for payment of accessories relating to aspirators and nebulizers; (3) set forth requirements which suppliers of medical equipment and supplies must satisfy in order to qualify for Medicare reimbursement; (4) require the Secretary to develop standardized certificates of medical necessity forms for use in documenting the medical necessity of DME items and supplies; (5) require DME suppliers to submit claims to the carrier having jurisdiction over the geographic area that includes the permanent residence of the patient to whom the item is furnished; (6) place restrictions on certain marketing and sales practices by DME suppliers; (7) specify the circumstances under which Medicare beneficiaries are not financially liable for covered items and services furnished by a supplier on an unassigned basis; (8) address adjustments made to final DME payment amounts for inherent reasonableness generally and require adjustments for certain items where the final payment amounts are found reasonable; and (9) subject ostomy supplies, tracheostomy supplies, and urologicals to national payment limits.

Subchapter E: Other Provisions - Amends SSA title XVIII to: (1) freeze at the 1992 level the conversion factor used to determine payments to medically directed certified registered nurse anesthetists; (2) provide that in subsequent years such factor shall be the previous year's conversion factor increased by the update for physician anesthesia services for that year; (3) provide for Medicare coverage of oral cancer drugs, under certain conditions; (4) provide for uniform coverage of "off-label" anti-cancer drugs; (5) cap the part B premium penalty for late enrollment for Federal employees who meet certain conditions; (6) authorize the Secretary to enter into agreements with States to allow them to pay the late enrollment premium increases of eligible individuals; (7) establish statutory definitions for speech-language pathologists and audiologists consistent with current coverage guidelines; and (8) provide for the treatment of certain Indian health programs and facilities as federally-qualified health centers.

(Sec. 13473) Requires a study and report to specified congressional committees by the Secretary on Medicare coverage of patient care costs associated with clinical trials of new cancer therapies.

(Sec. 13476) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to extend municipal health service demonstration projects.

Subchapter F: Part B Premium - Amends SSA title XVIII to extend current law provisions for establishing the monthly Medicare part B premium for beneficiaries enrolled in Medicare.

Chapter 3: Provisions Relating to Parts A and B - Subchapter A: Elimination of Updates - Amends SSA title XVIII to eliminate updates in payments to hospitals for the direct costs of graduate medical education for cost reporting periods beginning during FY 1994 and 1995.

(Sec. 13502) Prohibits the Secretary from providing any update in the cost limits for home health services for cost reporting periods beginning during FY 1994 and 1995.

Subchapter B: Medicare Secondary Payer Provisions - Specifies numerous changes with regard to Medicare as secondary payor.

Subchapter C: Physician Ownership and Referral - Amends SSA title XVIII to: (1) apply the ban on certain referrals by physicians to all payers, extending it to cover additional specified health services as well as new exceptions; (2) expand current standards used to define a group practice; and (3) provide that Federal law shall not preempt State laws that relate to referrals not covered under the ban, or that relate to referrals covered under the ban but are even more restrictive.

Subchapter D: Other Provisions - Requires the Secretary to: (1) redetermine the full-time-equivalent (FTE) resident amount to reflect the amount that would be allowed if the hospital had been liable to pay FICA taxes or make other specified retirement contributions for residents during the base year, but did not make such payments, yet now must do so as a result of OMBRA '90; and (2) establish outreach to Medicare beneficiaries who may qualify for Medicaid payment of their out-of-pocket Medicare expenses.

(Sec. 13551) Amends SSA title XVIII to: (1) reduce payments for erythropoientin; (2) require home health agencies to inform Medicare beneficiaries of their entitlement to hospice care under Medicare; (3) provide for interest payments to be made on clean claims if payment is not made within 30 days of receipt; (4) provide for adjustment in Medicare capitation payments to account for regional variations in application of Medicare secondary payer provisions; (5) provide for adjustments for certain publicly- funded family practice residency programs; (6) extend on a graduated basis to three years (after 1997) the current one-year period following a transplant procedure during which Medicare covers immunosuppressive drug therapy for beneficiaries who have received organ transplants; and (7) provide that user fees imposed under the Clinical Laboratories Improvement Act of 1967 are not subject to the general ban on user fees for determining compliance with any requirement of Medicare.

(Sec. 13555) Amends OMBRA '87 and the Deficit Reduction Act of 1984 to: (1) extend social health maintenance organization demonstration projects for an additional two years; and (2) permit one of the projects to enroll Medicare end-stage renal disease beneficiaries. Increases the limit on the number of individuals who pay participate in such projects.

(Sec. 13558) Amends SSA title XI to repeal the requirement that peer review organizations precertify selected surgical procedures.

(Sec. 13560) Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) to provide that to the extent that appropriations are enacted providing budget authority for Medicare administrative costs above a base level of spending in FY 1992 of $1.526 billion, the appropriate discretionary spending limits shall be adjusted to accommodate additional budget authority in FY 1994 and 1995.

Chapter 4: Medicare Supplemental Insurance Policies - Amends OMBRA '90 and Medicare to make specified changes to Federal standards respecting the sale and regulation of Medicare supplemental insurance policies.

Chapter 5: Treatment of Certain State Health Care Programs - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to provide that: (1) the Hawaii Prepaid Health Care Act will not be preempted by ERISA unless the Secretary of Labor notifies the Governor of Hawaii that, as a result of any amendment to such Act, the proportion of the population covered would be less than the current proportion or the level of coverage would be less than the actuarial equivalent of the current level of coverage; and (2) State tax laws relating to employee benefit plans will continue to be preempted.

Title XIV: Revenue Provisions - Revenue Reconciliation Act of 1993 - Subtitle A: Training and Investment Incentives - Part I: Provisions Relating to Education and Training - Makes permanent after June 30, 1992: (1) the tax exclusion of employer-provided educational assistance; and (2) the targeted jobs credit. Allows the use of the targeted jobs credit, with limitations, for the hiring of a qualified participant in an approved school-to-work program.

Part II: Investment Incentives - Subpart A: Research Credit - Makes permanent the credit for increasing research activities. Modifies the fixed base percentage of such credit for startup companies for taxable years after 1993.

Subpart B: Capital Gain Provisions - Allows a taxpayer other than a corporation to exclude from gross income 50 percent of gain from the sale or exchange of qualified small business stock held for more than five years. Set forth rules and limitations for such exclusion. Treats one-half of such exclusion as an item of tax preference for minimum tax purposes.

(Sec. 14114) Allows the rollover of gain from the sale of publicly traded securities into specialized small business investment companies.

Subpart C: Modifications to Minimum Tax Depreciation Rules - Modifies the method of determining the depreciation deduction for certain personal property placed in service after 1993. Eliminates the depreciation adjustment for computing adjusted current earnings for such property.

Subpart D: Increase in Expense Treatment for Small Business - Increases the dollar limitation on the election to expense certain depreciable small business assets.

Part III: Tax-Exempt Bond Provisions - Provides a complete tax exemption (currently a 75 percent tax exemption) for bonds used to finance high-speed intercity rail facilities.

(Sec. 14122) Permanently extends the authority to issue qualified small issue bonds to finance manufacturing facilities and farm property.

Part IV: Expansion and Simplification of Earned Income Tax Credit - Repeals certain interaction rules with respect to the medical expense deduction, the deduction for health insurance, and the dependent care credit. Revises credit and phaseout percentages for 1994.

Part V: Incentives for Investment in Real Estate - Subpart A: Extension of Qualified Mortgage Bonds and Low-Income Housing Credit - Makes permanent: (1) the authority to issue qualified mortgage bonds and qualified mortgage credit certificates; and (2) the low-income housing credit.

(Sec. 14142) Provides that assistance under the HOME Investment Partnerships Act should not result in certain buildings being federally subsidized.

Subpart B: Modification of Passive Loss Rules - Provides for the treatment of rental real estate activities under the limitations on losses from passive activities.

Subpart C: Provisions Relating to Real Estate Investments by Pension Funds - Modifies exceptions to the exclusion of real property acquired by a qualified organization from the meaning of acquisition indebtedness. Makes certain exceptions inapplicable to sales out of foreclosure by a financial institution.

(Sec. 14145) Repeals the special rule for publicly traded partnerships with respect to the treatment of unrelated business taxable income.

(Sec. 14146) Permits a tax-exempt title-holding company to receive unrelated business taxable income if the unrelated income is incidentally derived from the holding of real property.

(Sec. 14147) Excludes from unrelated business taxable income: (1) gains from the sale, exchange or other disposition of real property acquired from financial institutions that are in conservatorship or receivership; and (2) loan commitment fees and certain option premiums. Provides for the tax treatment of pension fund investments in real estate investment trusts.

Subpart D: Discharge of Indebtedness - Excludes from gross income the income from the discharge of qualified real property business indebtedness.

Subpart E: Increase in Recovery Period for Nonresidential Real Property - Increases the depreciation recovery period for nonresidential real property.

Part VI: Luxury Tax - Repeals the luxury excise tax on boats, aircraft, jewelry, and furs.

(Sec. 14162) Modifies the luxury excise tax on automobiles to index the threshold for inflation occurring after 1990 and make such tax applicable to the first retail sale.

Exempts from the luxury excise tax parts for accessories installed for use of passenger vehicles by disabled individuals.

(Sec. 14163) Extends the current diesel fuel excise tax to diesel fuel used by noncommercial motorboats. Retains such taxes in the General Fund of the Treasury.

Part VII: Other Changes - Repeals the tax preference for the appreciated property charitable deduction. Disallows an adjustment related to the earnings and profits effects of any charitable contribution from being made in computing adjusted current earnings.

Requires the Secretary of the Treasury to report to specified congressional committees on the development of a procedure for taxpayers to seek an agreement with the Secretary on the value of tangible personal property prior to the donation of such property to a qualifying charitable organization.

(Sec. 14172) Amends the Railroad Retirement Solvency Act of 1983 to make permanent the treatment of certain railroad retirement benefits as received under employer plans.

(Sec. 14173) Provides for the temporary extension of the deduction of health insurance costs of self-employed individuals.

Subtitle B: Revenue Increases - Part I: Provisions Affecting Individuals- Subpart A: Rate Increases - Lowers the tax rates for certain taxpayers and increases the tax rate for certain higher incomes. Imposes a surtax on certain higher incomes.

(Sec. 14203) Increases the tentative minimum tax for taxpayers other than corporations.

(Sec. 14204) Makes permanent the overall limitation on itemized deductions and the phaseout of personal exemptions for high-income taxpayers.

(Sec. 14206) Sets forth provisions to prevent the conversion of ordinary income to capital gain in certain financial transactions.

Repeals certain exceptions to market discount rules.

Provides for the treatment of purchases of stripped preferred stock after April 30, 1993.

Revises the methods of: (1) computing the limitation on the deductibility of investment interest; and (2) determining substantial appreciation of partnership inventory items.

Subpart B: Other Provisions - Repeals the limitation on the amount of wages subject to the health insurance employment tax.

(Sec. 14208) Increases and makes permanent the highest estate and gift tax rate.

(Sec. 14209) Reduces the deduction for business meals and entertainment expenses.

(Sec. 14210) Disallows a tax deduction for social club membership dues, except for employee recreational expenses.

(Sec. 14211) Disallows a deduction as a trade or business expense remuneration to certain employees in excess of $1 million.

(Sec. 14212) Reduces the compensation taken into account in determining contributions and benefits under qualified retirement plans.

(Sec. 14213) Removes qualified residence sales, purchases, or leases and meals from the deduction for moving expenses.

(Sec. 14214) Revises the limitation on using the preceding year's tax to calculate an individual's estimated tax payments.

(Sec. 14215) Increases the amount of social security and tier 1 railroad retirement benefits to be included in the gross income of certain taxpayers.

Part II: Provisions Affecting Business - Increases the tax rate for corporate income in excess of $10 million and the tax rate on personal service corporations.

(Sec. 14222) Denies a tax deduction for lobbying expenses. Subjects lobbying organizations to special reporting requirements.

(Sec. 14223) Requires any security which is inventory in the hands of the dealer to be included in inventory at its fair market value. Requires any dealer in securities that holds any security which is not in inventory at the close of any taxable year to:

(1) recognize gain or loss as if the security were sold on the last business day of the taxable year; and (2) take into account any such gain or loss for such year (the mark-to-market requirement).

(Sec. 14224) Requires taking into account: (1) certain Federal Savings and Loan Insurance Corporation (FSLIC) assistance as compensation for loss; and (2) any FSLIC assistance for any debt for determining whether such debt is worthless and in determining the amount of any addition to a reserve for bad debts arising from such worthlessness or partial worthlessness.

(Sec. 14225) Increases the required annual payment for corporations that fail to pay estimated income tax. Modifies the periods for applying such annualization.

(Sec. 14226) Limits the Puerto Rico and possession tax credit to 60 percent of the possession corporation's qualified possession wages.

(Sec. 14227) Modifies the limitation on corporate deductions for interest paid to related persons to take into account disqualified guarantees of indebtedness and the imposition of a gross basis tax.

Part III: Foreign Tax Provisions - Subpart A: Current Taxation of Certain Earnings of Controlled Foreign Corporations - Requires U.S. shareholders of controlled foreign corporations to include in gross income a pro rata share of the corporations excess passive assets. Sets forth rules for determining such amounts. Modifies the rule on taxation of investment in United States property and takes into account excessive passive assets. Requires a report to specified congressional committees on a study of investments by controlled foreign corporations in U.S property.

(Sec. 14233) Excepts from foreign personal holding income any dividends attributable to earnings and profits of the distributing corporation accumulated during any period during which the person receiving such dividend did not hold such stock.

Requires the establishment of an excess limitation account by taxpayers who receive foreign tax credits in a year they receive previously taxed earnings and profits.

Subpart B: Allocation of Research and Experimental Expenditures - Reduces the amount allowed as allocation and apportionment of research and experimental expenditures from sources within the United States.

Subpart C: Other Provisions - Excludes passive dividends or interest income from foreign oil and gas income.

(Sec. 14236) Modifies accuracy-related penalties for tax underpayments.

(Sec. 14237) Denies the inclusion of certain contingent interest in the exemption for portfolio interest for nonresident aliens.

(Sec. 14238) Authorizes the Secretary of the Treasury to prescribe regulations recharacterizing any multiple-party financing transaction as a transaction directly among any two or more of such parties where appropriate to prevent any tax avoidance.

Part IV: Energy Tax Provisions - Subpart A: Energy Tax Based on Btu Content - Imposes an excise tax on the following energy products: (1) taxable refined petroleum products removed from a U.S. refinery or terminal entered into the United States for consumption, use, or warehousing, and sold to a nonregistered person; (2) natural gas removed from any pipeline in the United States, entered into the United States for consumption, use, or warehousing, and entered into any nonregistered pipeline; (3) coal received at any facility for use as a fuel at such facility; and (4) the sale of electricity to ultimate users in the United States and the use of electricity which was not subject to such tax. Bases the rate of tax on such products on the applicable Btu factor and content.

Provides for refunding certain amounts to ultimate vendors of petroleum used for heating oil and international commercial transportation. Repays certain sums to persons who use petroleum to produce calcined coke.

Provides exemptions from such excise tax for certain uses. Refunds the tax paid by certain users of methane recovered from biomass or coal mining.

Imposes a tax on the use of any fossil fuel: (1) in the manufacture or production of a fuel other than at a U.S. refinery; or (2) as a fuel. Specifies the application of such tax and exceptions.

Imposes a tax on floor stock of taxable fuels held on the date of the tax increase. Allows a credit against such tax.

Provides for such tax increases to begin July 1, 1994.

Imposes an imported Btu tax on certain imported products that contain significant levels of direct energy inputs that would be taxable if the products were manufactured in the United States.

Imposes a penalty on persons who sell dyed fuel for taxable uses.

Subpart B: Modifications to Tax on Diesel Fuel - Imposes an excise tax on diesel fuel (separate from the gasoline tax and the tax on aviation). Exempts from such tax diesel fuel: (1) used by trains and intercity, local, or school buses; and (2) which is dyed or marked in accordance in regulations prescribed by the Secretary of the Treasury.

Provides that the Airport and Airway Trust Fund financing rate does not apply to aviation fuel sold by a producer or importer for use by the purchaser in a nontaxable use.

Imposes a civil penalty on persons who use reduced-rate fuel for a taxable use.

(Sec. 14243) Imposes a floor stocks tax on any person holding diesel fuel April 1, 1994.

Subpart C: Extension of Motor Fuel Tax Rates; Increased Deposits Into Highway Trust Fund - Increases the tax on gasoline and diesel fuels for purposes of the Highway Trust Fund financing rate. Increases the amount to be transferred to the Mass Transit Account from such Fund.

Part V: Compliance Provisions - Requires information reporting on payments to corporations for services.

(Sec. 14252) Modifies provisions concerning substantial understatement and return-preparer penalties to allow reasonable cause exceptions.

(Sec. 14253) Requires certain financial entities (including the Federal Deposit Insurance Corporation, the Resolution Trust Corporation, and the National Credit Union Administration, and their successors or subunits) to file information returns regarding discharges of indebtedness of $600 or more.

Part VI: Treatment of Intangibles - Allows an amortization deduction with respect to certain intangible property, including goodwill, that is acquired and held by a taxpayer in connection with the conduct of a trade or business or an activity engaged in for the production of income.

Part VII: Miscellaneous Provisions - Establishes substantiation requirements for charitable contributions of $750 or more.

(Sec. 14272) Sets forth disclosure requirements for an organization that receives a quid pro quo contribution (payment made partly as a contribution and partly in consideration for goods or services provided to the payor by the donee organization). Imposes a penalty for failure to make such disclosure.

(Sec. 14273) Expands the 45-day interest-free period for refunding tax overpayments to all returns, as well as to amended returns and claims for refunds. Provides that if interest is not refunded within 45 days after the taxpayer files an amended return or claim for refund, interest will be paid only for periods after the date on which the return or claim is filed.

(Sec. 14274) Denies the business travel expense deduction for spouses, dependents, or others.

(Sec. 14275) Increases the withholding rate for supplemental wage payments.

Subtitle C: Empowerment Zones and Enterprise Communities- Part I:

Empowerment Zones and Enterprise Communities, Etc. - Provides for the designation of 100 tax enterprise communities and ten empowerment zones during calendar years after 1993 and before 1996: (1) by the Secretary of Housing and Urban Development, in the case of an urban area; (2) by the Secretary of Agriculture in the case of a rural area; and (3) the Secretary of the Interior for an Indian reservation.

Sets forth eligibility criteria for such designations.

Makes certain buildings in such communities or zones eligible for the low-income housing credit applicable to buildings in high-cost areas.

Provides for the issuance of enterprise zone facility bonds in enterprise communities and empowerment zones in a manner similar to exempt facility bonds. Excludes enterprise zone facility bonds from the interest deduction limitations on financial institutions.

Provides States an additional housing credit ceiling for each zone and community through 1996.

Allows an empowerment zone employment credit to employers for a percentage of qualified zone wages paid during calendar years 1994 through 2004. Limits the amount of such credit.

Allows businesses a zone resident empowerment savings credit of 50 percent of the qualified savings contributions made by an employer to a defined contribution plan on behalf of a zone employee. Limits the amount of such credit based on the employee's compensation.

Increases the limitation on expensing certain depreciable business assets.

Increases the volume cap applicable to enterprise zone facility bonds if the business owners meet specified ownership requirements with regard to abiding in such zones.

(Sec. 14302) Allows the use of the targeted jobs credit for hiring empowerment zone residents.

Part II: Credit for Contributions to Certain Community Development Corporations - Allows a general business tax credit for contributions to selected community development corporations to provide employment of, and business opportunities for low-income individuals who are residents of the operational area of the community.

Subtitle D: Other Provisions - Part I: Disclosure Provisions - Extends the authority to disclose tax return information to the Department of Veterans Affairs through September 30, 1998.

(Sec. 14402) Authorizes the disclosure of certain tax return information to: (1) the Department of Education to implement the direct student loan program; and (2) to the Department of Housing for income verification under certain housing programs.

Part II: User Fee Provisions - Requires the establishment of a program requiring the payment of user fees for the processing of applications for certificates of alcohol label approval and exemption, formula reviews, and statements of process (including laboratory tests and analyses).

(Sec. 14412) Removes authority to use the Harbor Maintenance Trust Fund for administrative expenses of certain customs fee collections.

(Sec. 14413) Increases the tax on fuel used on commercial transportation on inland waterways.

Part III: Public Debt Limit - Increases the public debt limit and repeals the temporary limit on such increase.

Part IV: Vaccine Provisions - Makes permanent: (1) the excise tax on certain vaccines; and (2) the authority to pay compensation from the Vaccine Trust Fund under the National Vaccine Injury Compensation Program for certain damages resulting from vaccines administered after September 30, 1988. Directs the Secretary of the Treasury to report to specified congressional committees on various uses of such Fund.

Imposes a floor stocks tax on taxable vaccines.

(Sec. 14432) Requires continuation coverage under group health plans of the costs of pediatric vaccines.

(Sec. 14433) Establishes the Childhood Immunization Trust Fund for the childhood immunization entitlement program under the Public Health Service Act.