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HR 105 · United States
Empowering Patients First Act
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HR 105 — Empowering Patients First Act
Last action — Referred to the Subcommittee on Health, Employment, Labor, and Pensions.
No card. One bill, free forever — alerts when it moves.
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✓Introduced
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✓In Committee
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Died in session
This bill died with 112th Congress. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.
Summary
Empowering Patients First Act - Repeals the Patient Protection and Affordable Care Act and the health care provisions of the Health Care and Education and Reconciliation Act of 2010, effective as of their enactment. Restores or revives provisions amended or repealed by such Act or such health care provisions. Amends the Internal Revenue Code to allow a tax credit for qualified health insurance costs to residents of a state that implements a high-risk pool, a reinsurance pool, or other risk-adjustment mechanism. Amends the Public Health Service Act to provide for the establishment and governance of individual membership associations (IMAs) to make available health benefits coverage to IMA members and their dependents. Small Business Health Fairness Act of 2011 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to provide for establishment and governance of association health plans, which are group health plans whose sponsors are trade, industry, professional, chamber of commerce, or similar business associations and which meet certain ERISA certification requirements. Directs that the laws of the state designated by a health insurance issuer (primary state) shall apply to individual health insurance coverage offered by that issuer in the primary state and in any other state (secondary state), but only if the coverage and issuer comply with conditions of this Act. Amends title XXI (Children's Health Insurance) (CHIP, formerly known as SCHIP) of the Social Security Act (SSA) to: (1) require a state CHIP plan to specify how it will achieve coverage for 90% of targeted low-income children; and (2) prohibit CHIP payments for children with family income above 300% of the applicable poverty line. Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 - Sets conditions for lawsuits arising from health care liability claims regarding health care goods or services or any medical product affecting interstate commerce. Establishes a statute of limitations and limits noneconomic and punitive damages. Permits a group health plan to vary premiums and cost-sharing by up to 50% of the benefits based on participation (or lack of participation) in a wellness program. Requires a health insurance issuer to provide claims information, on request, to a plan, plan sponsor, or plan administrator. Prohibits the Secretary of Health and Human Services (HHS) from using comparative effectiveness research to deny coverage of an item or service under a federal health care program. Authorizes a state to establish a Health Plan and Provider Portal website to standardize information on health insurance plans available in the state. Revises the formula for determining rates in the fee schedule for Medicare physician payments. Sets forth provisions regarding students loans and loan repayment for health care professionals. Establishes discretionary spending limits for FY2011-FY2020 for new budget authority in the nondefense category. Amends the Balanced Budget and Emergency Deficit Control Act of 1985 to reinstate budget provisions related to deficit reductions during a recession. Rescinds unobligated balances of certain discretionary appropriations made available under the American Recovery and Reinvestment Act of 2009. Repeals other provisions of such Act, including provisions providing fiscal assistance to states and setting limits on executive compensation.
Bill Text
- Introduced Introduced in House Current html January 05, 2011
Sections of law this bill changes
36 sections in 12 lawsFrom the bill's own amending language, matched to the official United States Code (current through Public Law 119-124).
Health insurance · 5 U.S.C. ch. 89 1 section
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§ 8906 Contributions Amends
5 U.S.C. § 8906
The law today
(a) (1) Not later than October 1 of each year, the Office of Personnel Management shall determine the weighted average of the subscription charges that will be in effect during the following contract year with respect to— (A) enrollments under this chapter for self alone; (B) enrollments under this chapter for self plus one; and (C) enrollments under this chapter for self and family. (2) In determining each weighted average under paragraph (1), the weight to be given to a particular subscription charge shall, with respect to each plan (and option) to which it is to apply, be commensurate with the number of enrollees enrolled in such plan (and option) as of March 31 of the year in which the determination is being made. (3) For purposes of paragraph (2), the term “enrollee” means any individual who, during the contract year for which the weighted average is to be used under this section, will be eligible for a Government contribution for health benefits. (b) (1) Except as provided in paragraphs (2), (3), and (4), the biweekly Government contribution for health benefits for an employee or annuitant enrolled in a health benefits plan under this chapter is adjusted to an amount equal to 72 percent of the weighted average under subsection (a)(1)(A) or (B), as applicable. For an employee, the adjustment begins on the first day of the employee’s first pay period of each year. For an annuitant, the adjustment begins on the first day of the first period of each year for which an annuity payment is made. (2) The biweekly Government contribution for an employee or annuitant enrolled in a plan under this chapter shall not exceed 75 percent of the subscription charge. (3) In the case of an employee who is occupying a position on a part-time career employment basis (as defined in section 3401(2) of this title), the biweekly Government contribution shall be equal to the percentage which bears the same ratio to the percentage determined under this subsection (without regard to this paragraph) as the average number of hours of such employee’s regularly scheduled workweek bears to the average number of hours in the regularly scheduled workweek of an employee serving in a comparable position on a full-time career basis (as determined under regulations prescribed by the Office). (4) In the case of persons who are enrolled in a health benefits plan as part of the demonstration project under section 1108 of title 10, the Government contribution shall be subject to the limitation set forth in subsection (i) of that section. (c) There shall be withheld from the pay of each enrolled employee and (except as provided in subsection (i) of this section) the annuity of each enrolled annuitant and there shall be contributed by the Government, amounts, in the same ratio as the contributions of the employee or annuitant and the Government under subsection (b) of this section, which are necessary for the administrative costs and the reserves provided for by section 8909(b) of this title. (d) The amount necessary to pay the total charge for enrollment, after the Government contribution is deducted, shall be withheld from the pay of each enrolled employee and (except as provided in subsection (i) of this section) from the annuity of each enrolled annuitant. The withholding for an annuitant shall be the same as that for an employee enrolled in the same health benefits plan and level of benefits. (e) (1) (A) An employee enrolled in a health benefits plan under this chapter who is placed in a leave without pay status may have his coverage and the coverage of members of his family continued under the plan for not to exceed 1 year under regulations prescribed by the Office. (B) During each pay period in which an enrollment continues under subparagraph (A)— (i) employee and Government contributions required by this section shall be paid on a current basis; and (ii) if necessary, the head of the employing agency shall approve advance payment, recoverable in the same ...2 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
Normal taxes and surtaxes · 26 U.S.C. ch. 1 4 sections
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§ 38 General business credit Amends
26 U.S.C. § 38
The law today
(a) Allowance of credit There shall be allowed as a credit against the tax imposed by this chapter for the taxable year an amount equal to the sum of— (1) the business credit carryforwards carried to such taxable year, (2) the amount of the current year business credit, plus (3) the business credit carrybacks carried to such taxable year. (b) Current year business credit For purposes of this subpart, the amount of the current year business credit is the sum of the following credits determined for the taxable year: (1) the investment credit determined under section 46, (2) the work opportunity credit determined under section 51(a), (3) the alcohol fuels credit determined under section 40(a), (4) the research credit determined under section 41(a), (5) the low-income housing credit determined under section 42(a), (6) the enhanced oil recovery credit under section 43(a), (7) in the case of an eligible small business (as defined in section 44(b)), the disabled access credit determined under section 44(a), (8) the renewable electricity production credit under section 45(a), (9) the empowerment zone employment credit determined under section 1396(a), (10) the Indian employment credit as determined under section 45A(a), (11) the employer social security credit determined under section 45B(a), (12) the orphan drug credit determined under section 45C(a), (13) the new markets tax credit determined under section 45D(a), (14) in the case of an eligible employer (as defined in section 45E(c)), the small employer pension plan startup cost credit determined under section 45E(a), (15) the employer-provided child care credit determined under section 45F(a), (16) the railroad track maintenance credit determined under section 45G(a), (17) the biodiesel fuels credit determined under section 40A(a), (18) the low sulfur diesel fuel production credit determined under section 45H(a), (19) the marginal oil and gas well production credit determined under section 45I(a), (20) the distilled spirits credit determined under section 5011(a), (21) the advanced nuclear power facility production credit determined under section 45J(a), (22) the nonconventional source production credit determined under section 45K(a), (23) the new energy efficient home credit determined under section 45L(a), (24) the portion of the alternative motor vehicle credit to which section 30B(g)(1) applies, (25) the portion of the alternative fuel vehicle refueling property credit to which section 30C(d)(1) applies, (26) the mine rescue team training credit determined under section 45N(a), (27) in the case of an eligible agricultural business (as defined in section 45O(e)), the agricultural chemicals security credit determined under section 45O(a), (28) the differential wage payment credit determined under section 45P(a), (29) the carbon dioxide sequestration credit determined under section 45Q(a), (30) the portion of the new clean vehicle credit to which section 30D(c)(1) applies, (31) the small employer health insurance credit determined under section 45R, (32) in the case of an eligible employer (as defined in section 45S(c)), the paid family and medical leave credit determined under section 45S(a), (33) in the case of an eligible employer (as defined in section 45T(c)), the retirement auto-enrollment credit determined under section 45T(a), plus (34) the zero-emission nuclear power production credit determined under section 45U(a). (35) the sustainable aviation fuel credit determined under section 40B, (36) the clean hydrogen production credit determined under section 45V(a), (37) the qualified commercial clean vehicle credit determined under section 45W, (38) the advanced manufacturing production credit determined under section 45X(a), (39) the clean electricity production credit determined under section 45Y(a), (40) the clean fuel production credit determined under section 45Z(a), plus (41) in the case of an eligible small employer (as defined in section 45AA(c)), the military sp...464 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 62 Adjusted gross income defined Amends
26 U.S.C. § 62
The law today
(a) General rule For purposes of this subtitle, the term “adjusted gross income” means, in the case of an individual, gross income minus the following deductions: (1) Trade and business deductions The deductions allowed by this chapter (other than by part VII of this subchapter) which are attributable to a trade or business carried on by the taxpayer, if such trade or business does not consist of the performance of services by the taxpayer as an employee. (2) Certain trade and business deductions of employees (A) Reimbursed expenses of employees The deductions allowed by part VI (section 161 and following) which consist of expenses paid or incurred by the taxpayer, in connection with the performance by him of services as an employee, under a reimbursement or other expense allowance arrangement with his employer. The fact that the reimbursement may be provided by a third party shall not be determinative of whether or not the preceding sentence applies. (B) Certain expenses of performing artists The deductions allowed by section 162 which consist of expenses paid or incurred by a qualified performing artist in connection with the performances by him of services in the performing arts as an employee. (C) Certain expenses of officials The deductions allowed by section 162 which consist of expenses paid or incurred with respect to services performed by an official as an employee of a State or a political subdivision thereof in a position compensated in whole or in part on a fee basis. (D) Certain expenses of early childhood, elementary, and secondary school teachers The deductions allowed by section 162 which consist of expenses, not in excess of $250, paid or incurred by an eligible educator— (i) by reason of the participation of the educator in professional development courses related to the curriculum in which the educator provides instruction or to the students for which the educator provides instruction, and (ii) in connection with books, supplies (other than nonathletic supplies for courses of instruction in health or physical education), computer equipment (including related software and services) and other equipment, and supplementary materials used by the eligible educator in the classroom. (E) Certain expenses of members of reserve components of the Armed Forces of the United States The deductions allowed by section 162 which consist of expenses, determined at a rate not in excess of the rates for travel expenses (including per diem in lieu of subsistence) authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, paid or incurred by the taxpayer in connection with the performance of services by such taxpayer as a member of a reserve component of the Armed Forces of the United States for any period during which such individual is more than 100 miles away from home in connection with such services. (3) Losses from sale or exchange of property The deductions allowed by part VI (sec. 161 and following) as losses from the sale or exchange of property. (4) Deductions attributable to rents and royalties The deductions allowed by part VI (sec. 161 and following), by section 212 (relating to expenses for production of income), and by section 611 (relating to depletion) which are attributable to property held for the production of rents or royalties. (5) Certain deductions of life tenants and income beneficiaries of property In the case of a life tenant of property, or an income beneficiary of property held in trust, or an heir, legatee, or devisee of an estate, the deduction for depreciation allowed by section 167 and the deduction allowed by section 611. (6) Pension, profit-sharing, and annuity plans of self-employed individuals In the case of an individual who is an employee within the meaning of section 401(c)(1), the deduction allowed by section 404. (7) Retirement savings The deduction allowed by section 219 (relating to deduction of certain retirement savings). [(8) Repealed. Pu...164 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 166 Bad debts Amends
26 U.S.C. § 166
The law today
(a) General rule (1) Wholly worthless debts There shall be allowed as a deduction any debt which becomes worthless within the taxable year. (2) Partially worthless debts When satisfied that a debt is recoverable only in part, the Secretary may allow such debt, in an amount not in excess of the part charged off within the taxable year, as a deduction. (b) Amount of deduction For purposes of subsection (a), the basis for determining the amount of the deduction for any bad debt shall be the adjusted basis provided in section 1011 for determining the loss from the sale or other disposition of property. [(c) Repealed. Pub. L. 99–514, title VIII, § 805(a), Oct. 22, 1986, 100 Stat. 2361] (d) Nonbusiness debts (1) General rule In the case of a taxpayer other than a corporation— (A) subsection (a) shall not apply to any nonbusiness debt; and (B) where any nonbusiness debt becomes worthless within the taxable year, the loss resulting therefrom shall be considered a loss from the sale or exchange, during the taxable year, of a capital asset held for not more than 1 year. (2) Nonbusiness debt defined For purposes of paragraph (1), the term “nonbusiness debt” means a debt other than— (A) a debt created or acquired (as the case may be) in connection with a trade or business of the taxpayer; or (B) a debt the loss from the worthlessness of which is incurred in the taxpayer’s trade or business. (e) Worthless securities This section shall not apply to a debt which is evidenced by a security as defined in section 165(g)(2)(C). (f) Cross references (1) For disallowance of deduction for worthlessness of debts owed by political parties and similar organizations, see section 271. (2) For special rule for banks with respect to worthless securities, see section 582. -
§ 213 Medical, dental, etc., expenses Amends
26 U.S.C. § 213 — at 213(d)
The law today
(a) Allowance of deduction There shall be allowed as a deduction the expenses paid during the taxable year, not compensated for by insurance or otherwise, for medical care of the taxpayer, his spouse, or a dependent (as defined in section 152, determined without regard to subsections (b)(1), (b)(2), and (d)(1)(B) thereof), to the extent that such expenses exceed 7.5 percent of adjusted gross income. (b) Limitation with respect to medicine and drugs An amount paid during the taxable year for medicine or a drug shall be taken into account under subsection (a) only if such medicine or drug is a prescribed drug or is insulin. (c) Special rule for decedents (1) Treatment of expenses paid after death For purposes of subsection (a), expenses for the medical care of the taxpayer which are paid out of his estate during the 1-year period beginning with the day after the date of his death shall be treated as paid by the taxpayer at the time incurred. (2) Limitation Paragraph (1) shall not apply if the amount paid is allowable under section 2053 as a deduction in computing the taxable estate of the decedent, but this paragraph shall not apply if (within the time and in the manner and form prescribed by the Secretary) there is filed— (A) a statement that such amount has not been allowed as a deduction under section 2053, and (B) a waiver of the right to have such amount allowed at any time as a deduction under section 2053. (d) Definitions For purposes of this section— (1) The term “medical care” means amounts paid— (A) for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body, (B) for transportation primarily for and essential to medical care referred to in subparagraph (A), (C) for qualified long-term care services (as defined in section 7702B(c)), or (D) for insurance (including amounts paid as premiums under part B of title XVIII of the Social Security Act, relating to supplementary medical insurance for the aged) covering medical care referred to in subparagraphs (A) and (B) or for any qualified long-term care insurance contract (as defined in section 7702B(b)). In the case of a qualified long-term care insurance contract (as defined in section 7702B(b)), only eligible long-term care premiums (as defined in paragraph (10)) shall be taken into account under subparagraph (D). (2) Amounts paid for certain lodging away from home treated as paid for medical care.— Amounts paid for lodging (not lavish or extravagant under the circumstances) while away from home primarily for and essential to medical care referred to in paragraph (1)(A) shall be treated as amounts paid for medical care if— (A) the medical care referred to in paragraph (1)(A) is provided by a physician in a licensed hospital (or in a medical care facility which is related to, or the equivalent of, a licensed hospital), and (B) there is no significant element of personal pleasure, recreation, or vacation in the travel away from home. The amount taken into account under the preceding sentence shall not exceed $50 for each night for each individual. (3) Prescribed drug.— The term “prescribed drug” means a drug or biological which requires a prescription of a physician for its use by an individual. (4) Physician.— The term “physician” has the meaning given to such term by section 1861(r) of the Social Security Act (42 U.S.C. 1395x(r)). (5) Special rule in the case of child of divorced parents, etc.— Any child to whom section 152(e) applies shall be treated as a dependent of both parents for purposes of this section. (6) In the case of an insurance contract under which amounts are payable for other than medical care referred to in subparagraphs (A), (B), and (C) of paragraph (1)— (A) no amount shall be treated as paid for insurance to which paragraph (1)(D) applies unless the charge for such insurance is either separately stated in the contract, or furnished to the policyholder by the insuranc...117 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
Certain group health plans · 26 U.S.C. ch. 47 1 section
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§ 5000 Certain group health plans Amends
26 U.S.C. § 5000
The law today
(a) Imposition of tax There is hereby imposed on any employer (including a self-employed person) or employee organization that contributes to a nonconforming group health plan a tax equal to 25 percent of the employer’s or employee organization’s expenses incurred during the calendar year for each group health plan to which the employer or employee organization contributes. (b) Group health plan and large group health plan For purposes of this section— (1) Group health plan The term “group health plan” means a plan (including a self-insured plan) of, or contributed to by, an employer (including a self-employed person) or employee organization to provide health care (directly or otherwise) to the employees, former employees, the employer, others associated or formerly associated with the employer in a business relationship, or their families. (2) Large group health plan The term “large group health plan” means a plan of, or contributed to by, an employer or employee organization (including a self-insured plan) to provide health care (directly or otherwise) to the employees, former employees, the employer, others associated or formerly associated with the employer in a business relationship, or their families, that covers employees of at least one employer that normally employed at least 100 employees on a typical business day during the previous calendar year. For purposes of the preceding sentence— (A) all employers treated as a single employer under subsection (a) or (b) of section 52 shall be treated as a single employer, (B) all employees of the members of an affiliated service group (as defined in section 414(m)) shall be treated as employed by a single employer, and (C) leased employees (as defined in section 414(n)(2)) shall be treated as employees of the person for whom they perform services to the extent they are so treated under section 414(n). (c) Nonconforming group health plan For purposes of this section, the term “nonconforming group health plan” means a group health plan or large group health plan that at any time during a calendar year does not comply with the requirements of subparagraphs (A) and (C) or subparagraph (B), respectively, of paragraph (1), or with the requirements of paragraph (2), of section 1862(b) of the Social Security Act. (d) Government entities For purposes of this section, the term “employer” does not include a Federal or other governmental entity.
Information and returns · 26 U.S.C. ch. 61 1 section
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§ 6103 Confidentiality and disclosure of returns and return information Amends
26 U.S.C. § 6103 — at 6103(a)
The law today
(a) General rule Returns and return information shall be confidential, and except as authorized by this title— (1) no officer or employee of the United States, (2) no officer or employee of any State, any local law enforcement agency receiving information under subsection (i)(1)(C) or (7)(A), any tribal or local child support enforcement agency, or any local agency administering a program listed in subsection (l)(7)(D) who has or had access to returns or return information under this section or section 6104(c), and (3) no other person (or officer or employee thereof) who has or had access to returns or return information under subsection (c), subsection (e)(1)(D)(iii), paragraph (10), (13), (14), or (15) of subsection (k), paragraph (6), (8), (10), (12), (13) (other than subparagraphs (D)(v) and (D)(vi) thereof), (16), (19), (20), or (21) of subsection (l), paragraph (2) or (4)(B) of subsection (m), or subsection (n), shall disclose any return or return information obtained by him in any manner in connection with his service as such an officer or an employee or otherwise or under the provisions of this section. For purposes of this subsection, the term “officer or employee” includes a former officer or employee. (b) Definitions For purposes of this section— (1) Return The term “return” means any tax or information return, declaration of estimated tax, or claim for refund required by, or provided for or permitted under, the provisions of this title which is filed with the Secretary by, on behalf of, or with respect to any person, and any amendment or supplement thereto, including supporting schedules, attachments, or lists which are supplemental to, or part of, the return so filed. (2) Return information The term “return information” means— (A) a taxpayer’s identity, the nature, source, or amount of his income, payments, receipts, deductions, exemptions, credits, assets, liabilities, net worth, tax liability, tax withheld, deficiencies, overassessments, or tax payments, whether the taxpayer’s return was, is being, or will be examined or subject to other investigation or processing, or any other data, received by, recorded by, prepared by, furnished to, or collected by the Secretary with respect to a return or with respect to the determination of the existence, or possible existence, of liability (or the amount thereof) of any person under this title for any tax, penalty, interest, fine, forfeiture, or other imposition, or offense, (B) any part of any written determination or any background file document relating to such written determination (as such terms are defined in section 6110(b)) which is not open to public inspection under section 6110, (C) any advance pricing agreement entered into by a taxpayer and the Secretary and any background information related to such agreement or any application for an advance pricing agreement, and (D) any agreement under section 7121, and any similar agreement, and any background information related to such an agreement or request for such an agreement, but such term does not include data in a form which cannot be associated with, or otherwise identify, directly or indirectly, a particular taxpayer. Nothing in the preceding sentence, or in any other provision of law, shall be construed to require the disclosure of standards used or to be used for the selection of returns for examination, or data used or to be used for determining such standards, if the Secretary determines that such disclosure will seriously impair assessment, collection, or enforcement under the internal revenue laws. (3) Taxpayer return information The term “taxpayer return information” means return information as defined in paragraph (2) which is filed with, or furnished to, the Secretary by or on behalf of the taxpayer to whom such return information relates. (4) Tax administration The term “tax administration”— (A) means— (i) the administration, management, conduct, direction, and supervision of the execution and ap...208 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
Additions to the tax, additional amounts, and assessable penalties · 26 U.S.C. ch. 68 1 section
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§ 6724 Waiver; definitions and special rules Amends
26 U.S.C. § 6724 — at 6724(d)(1) and 6724(d)
The law today
(a) Reasonable cause waiver No penalty shall be imposed under this part with respect to any failure if it is shown that such failure is due to reasonable cause and not to willful neglect. (b) Payment of penalty Any penalty imposed by this part shall be paid on notice and demand by the Secretary and in the same manner as tax. (c) Special rule for failure to meet magnetic media requirements No penalty shall be imposed under section 6721 solely by reason of any failure to comply with the requirements of the regulations prescribed under section 6011(e)(2), except to the extent that such a failure occurs with respect to more than the applicable number (determined under section 6011(e)(5) with respect to the calendar year to which such returns relate) of information returns or with respect to a return described in section 6011(e)(4). (d) Definitions For purposes of this part— (1) Information return The term “information return” means— (A) any statement of the amount of payments to another person required by— (i) section 6041(a) or (b) (relating to certain information at source), (ii) section 6042(a)(1) (relating to payments of dividends), (iii) section 6044(a)(1) (relating to payments of patronage dividends), (iv) section 6049(a) (relating to payments of interest), (v) section 6050A(a) (relating to reporting requirements of certain fishing boat operators), (vi) section 6050N(a) (relating to payments of royalties), (vii) section 6051(d) (relating to information returns with respect to income tax withheld), (viii) section 6050R (relating to returns relating to certain purchases of fish), or (ix) section 110(d) (relating to qualified lessee construction allowances for short-term leases), (B) any return required by— (i) section 6041A(a) or (b) (relating to returns of direct sellers), (ii) section 6043A(a) (relating to returns relating to taxable mergers and acquisitions), (iii) section 6045(a) or (d) (relating to returns of brokers), (iv) section 6045B(a) (relating to returns relating to actions affecting basis of specified securities), (v) section 6050H(a) or (h)(1) (relating to mortgage interest received in trade or business from individuals), (vi) section 6050I(a) or (g)(1) (relating to cash received in trade or business, etc.), (vii) section 6050J(a) (relating to foreclosures and abandonments of security), (viii) section 6050K(a) (relating to exchanges of certain partnership interests), (ix) section 6050L(a) (relating to returns relating to certain dispositions of donated property), (x) section 6050P (relating to returns relating to the cancellation of indebtedness by certain financial entities), (xi) section 6050Q (relating to certain long-term care benefits), (xii) section 6050S (relating to returns relating to payments for qualified tuition and related expenses), (xiii) section 6050T (relating to returns relating to credit for health insurance costs of eligible individuals), (xiv) section 6052(a) (relating to reporting payment of wages in the form of group-life insurance), (xv) section 6050V (relating to returns relating to applicable insurance contracts in which certain exempt organizations hold interests), (xvi) section 6053(c)(1) (relating to reporting with respect to certain tips), (xvii) subsection (b) or (e) of section 1060 (relating to reporting requirements of transferors and transferees in certain asset acquisitions), (xviii) section 4101(d) (relating to information reporting with respect to fuels taxes), (xix) subparagraph (C) of section 338(h)(10) (relating to information required to be furnished to the Secretary in case of elective recognition of gain or loss), (xx) section 264(f)(5)(A)(iv) (relating to reporting with respect to certain life insurance and annuity contracts), (xxi) section 6050U (relating to charges or payments for qualified long-term care insurance contracts under combined arrangements), (xxii) section 6039(a) (relating to returns required with respect to certain options), (xxiii) section 6050W (re...55 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
Crimes, other offenses, and forfeitures · 26 U.S.C. ch. 75 1 section
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§ 7213 Unauthorized disclosure of information Amends
26 U.S.C. § 7213 — at 7213(a)
The law today
(a) Returns and return information (1) Federal employees and other persons It shall be unlawful for any officer or employee of the United States or any person described in section 6103(n) (or an officer or employee of any such person), or any former officer or employee, willfully to disclose to any person, except as authorized in this title, any return or return information (as defined in section 6103(b)). Any violation of this paragraph shall be a felony punishable upon conviction by a fine in any amount not exceeding $5,000, or imprisonment of not more than 5 years, or both, together with the costs of prosecution, and if such offense is committed by any officer or employee of the United States, he shall, in addition to any other punishment, be dismissed from office or discharged from employment upon conviction for such offense. (2) State and other employees It shall be unlawful for any person (not described in paragraph (1)) willfully to disclose to any person, except as authorized in this title, any return or return information (as defined in section 6103(b)) acquired by him or another person under subsection (d), (i)(1)(C), (3)(B)(i), or (7)(A)(ii), (k)(10), (13), (14), or (15), (l)(6), (7), (8), (9), (10), (12), (15), (16), (19), (20), or (21) or (m)(2), (4), (5), (6), or (7) of section 6103 or under section 6104(c). Any violation of this paragraph shall be a felony punishable by a fine in any amount not exceeding $5,000, or imprisonment of not more than 5 years, or both, together with the costs of prosecution. (3) Other persons It shall be unlawful for any person to whom any return or return information (as defined in section 6103(b)) is disclosed in a manner unauthorized by this title thereafter willfully to print or publish in any manner not provided by law any such return or return information. Any violation of this paragraph shall be a felony punishable by a fine in any amount not exceeding $5,000, or imprisonment of not more than 5 years, or both, together with the costs of prosecution. (4) Solicitation It shall be unlawful for any person willfully to offer any item of material value in exchange for any return or return information (as defined in section 6103(b)) and to receive as a result of such solicitation any such return or return information. Any violation of this paragraph shall be a felony punishable by a fine in any amount not exceeding $5,000, or imprisonment of not more than 5 years, or both, together with the costs of prosecution. (5) Shareholders It shall be unlawful for any person to whom a return or return information (as defined in section 6103(b)) is disclosed pursuant to the provisions of section 6103(e)(1)(D)(iii) willfully to disclose such return or return information in any manner not provided by law. Any violation of this paragraph shall be a felony punishable by a fine in any amount not to exceed $5,000, or imprisonment of not more than 5 years, or both, together with the costs of prosecution. (b) Disclosure of operations of manufacturer or producer Any officer or employee of the United States who divulges or makes known in any manner whatever not provided by law to any person the operations, style of work, or apparatus of any manufacturer or producer visited by him in the discharge of his official duties shall be guilty of a misdemeanor and, upon conviction thereof, shall be fined not more than $1,000, or imprisoned not more than 1 year, or both, together with the costs of prosecution; and the offender shall be dismissed from office or discharged from employment. (c) Disclosures by certain delegates of Secretary All provisions of law relating to the disclosure of information, and all provisions of law relating to penalties for unauthorized disclosure of information, which are applicable in respect of any function under this title when performed by an officer or employee of the Treasury Department are likewise applicable in respect of such function when performed by any person who is a “del...21 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
Group health plan requirements · 26 U.S.C. ch. 100 1 section
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§ 9831 General exceptions Amends
26 U.S.C. § 9831
The law today
(a) Exception for certain plans The requirements of this chapter shall not apply to— (1) any governmental plan, and (2) other than with respect to section 9826, any group health plan for any plan year if, on the first day of such plan year, such plan has less than 2 participants who are current employees. (b) Exception for certain benefits The requirements of this chapter shall not apply to any group health plan in relation to its provision of excepted benefits described in section 9832(c)(1). (c) Exception for certain benefits if certain conditions met (1) Limited, excepted benefits The requirements of this chapter shall not apply to any group health plan in relation to its provision of excepted benefits described in section 9832(c)(2) if the benefits— (A) are provided under a separate policy, certificate, or contract of insurance; or (B) are otherwise not an integral part of the plan. (2) Noncoordinated, excepted benefits The requirements of this chapter shall not apply to any group health plan in relation to its provision of excepted benefits described in section 9832(c)(3) if all of the following conditions are met: (A) The benefits are provided under a separate policy, certificate, or contract of insurance. (B) There is no coordination between the provision of such benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor. (C) Such benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor. (3) Supplemental excepted benefits The requirements of this chapter shall not apply to any group health plan in relation to its provision of excepted benefits described in section 9832(c)(4) if the benefits are provided under a separate policy, certificate, or contract of insurance. (d) Exception for qualified small employer health reimbursement arrangements (1) In general For purposes of this title (and notwithstanding any other provision of this title), the term “group health plan” shall not include any qualified small employer health reimbursement arrangement. (2) Qualified small employer health reimbursement arrangement For purposes of this subsection— (A) In general The term “qualified small employer health reimbursement arrangement” means an arrangement which— (i) is described in subparagraph (B), and (ii) is provided on the same terms to all eligible employees of the eligible employer. (B) Arrangement described An arrangement is described in this subparagraph if— (i) such arrangement is funded solely by an eligible employer and no salary reduction contributions may be made under such arrangement, (ii) such arrangement provides, after the employee provides proof of coverage, for the payment of, or reimbursement of, an eligible employee for expenses for medical care (as defined in section 213(d)) incurred by the eligible employee or the eligible employee’s family members (as determined under the terms of the arrangement), and (iii) the amount of payments and reimbursements described in clause (ii) for any year do not exceed $4,950 ($10,000 in the case of an arrangement that also provides for payments or reimbursements for family members of the employee). (C) Certain variation permitted For purposes of subparagraph (A)(ii), an arrangement shall not fail to be treated as provided on the same terms to each eligible employee merely because the employee’s permitted benefit under such arrangement varies in accordance with the variation in the price of an insurance policy in the relevant individual health insurance market based on— (i) the age of the eligible employee (and, in the case of an arrangement which covers medical expenses of the eligible employee’s family members, the age of such family members), or (ii) the number of family members of the eligible employee the medical expenses of which are covered under such arrangement. The variation permitted under the ...16 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
Jurisdiction of courts in matters affecting employer and employee · 29 U.S.C. ch. 6 1 section
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§ 102 Public policy in labor matters declared Amends
29 U.S.C. § 102 — at 102(16)(B) and 102(b)
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In the interpretation of this chapter and in determining the jurisdiction and authority of the courts of the United States, as such jurisdiction and authority are defined and limited in this chapter, the public policy of the United States is declared as follows: Whereas under prevailing economic conditions, developed with the aid of governmental authority for owners of property to organize in the corporate and other forms of ownership association, the individual unorganized worker is commonly helpless to exercise actual liberty of contract and to protect his freedom of labor, and thereby to obtain acceptable terms and conditions of employment, wherefore, though he should be free to decline to associate with his fellows, it is necessary that he have full freedom of association, self-organization, and designation of representatives of his own choosing, to negotiate the terms and conditions of his employment, and that he shall be free from the interference, restraint, or coercion of employers of labor, or their agents, in the designation of such representatives or in self-organization or in other concerted activities for the purpose of collective bargaining or other mutual aid or protection; therefore, the following definitions of, and limitations upon, the jurisdiction and authority of the courts of the United States are enacted.7 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
Employee retirement income security program · 29 U.S.C. ch. 18 9 sections
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§ 1002 Definitions Amends
29 U.S.C. § 1002 — at 1002(40)(B)
The law today
For purposes of this subchapter: (1) The terms “employee welfare benefit plan” and “welfare plan” mean any plan, fund, or program which was heretofore or is hereafter established or maintained by an employer or by an employee organization, or by both, to the extent that such plan, fund, or program was established or is maintained for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise, (A) medical, surgical, or hospital care or benefits, or benefits in the event of sickness, accident, disability, death or unemployment, or vacation benefits, apprenticeship or other training programs, or day care centers, scholarship funds, or prepaid legal services, or (B) any benefit described in section 186(c) of this title (other than pensions on retirement or death, and insurance to provide such pensions). (2) (A) Except as provided in subparagraph (B), the terms “employee pension benefit plan” and “pension plan” mean any plan, fund, or program which was heretofore or is hereafter established or maintained by an employer or by an employee organization, or by both, to the extent that by its express terms or as a result of surrounding circumstances such plan, fund, or program— (i) provides retirement income to employees, or (ii) results in a deferral of income by employees for periods extending to the termination of covered employment or beyond, regardless of the method of calculating the contributions made to the plan, the method of calculating the benefits under the plan or the method of distributing benefits from the plan. A distribution from a plan, fund, or program shall not be treated as made in a form other than retirement income or as a distribution prior to termination of covered employment solely because such distribution is made to an employee who has attained age 62 and who is not separated from employment at the time of such distribution. (B) The Secretary may by regulation prescribe rules consistent with the standards and purposes of this chapter providing one or more exempt categories under which— (i) severance pay arrangements, and (ii) supplemental retirement income payments, under which the pension benefits of retirees or their beneficiaries are supplemented to take into account some portion or all of the increases in the cost of living (as determined by the Secretary of Labor) since retirement, shall, for purposes of this subchapter, be treated as welfare plans rather than pension plans. In the case of any arrangement or payment a principal effect of which is the evasion of the standards or purposes of this chapter applicable to pension plans, such arrangement or payment shall be treated as a pension plan. An applicable voluntary early retirement incentive plan (as defined in section 457(e)(11)(D)(ii) of title 26) making payments or supplements described in section 457(e)(11)(D)(i) of title 26, and an applicable employment retention plan (as defined in section 457(f)(4)(C) of title 26) making payments of benefits described in section 457(f)(4)(A) of title 26, shall, for purposes of this subchapter, be treated as a welfare plan (and not a pension plan) with respect to such payments and supplements. (C) A pooled employer plan shall be treated as— (i) a single employee pension benefit plan or single pension plan; and (ii) a plan to which section 1060(a) of this title applies. (3) The term “employee benefit plan” or “plan” means an employee welfare benefit plan or an employee pension benefit plan or a plan which is both an employee welfare benefit plan and an employee pension benefit plan. (4) The term “employee organization” means any labor union or any organization of any kind, or any agency or employee representation committee, association, group, or plan, in which employees participate and which exists for the purpose, in whole or in part, of dealing with employers concerning an employee benefit plan, or other matters incidental to employment relationships;...98 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 1104 Fiduciary duties Amends
29 U.S.C. § 1104
The law today
(a) Prudent man standard of care (1) Subject to sections 1103(c) and (d), 1342, and 1344 of this title, a fiduciary shall discharge his duties with respect to a plan solely in the interest of the participants and beneficiaries and— (A) for the exclusive purpose of: (i) providing benefits to participants and their beneficiaries; and (ii) defraying reasonable expenses of administering the plan; (B) with the care, skill, prudence, and diligence under the circumstances then prevailing that a prudent man acting in a like capacity and familiar with such matters would use in the conduct of an enterprise of a like character and with like aims; (C) by diversifying the investments of the plan so as to minimize the risk of large losses, unless under the circumstances it is clearly prudent not to do so; and (D) in accordance with the documents and instruments governing the plan insofar as such documents and instruments are consistent with the provisions of this subchapter and subchapter III. (2) In the case of an eligible individual account plan (as defined in section 1107(d)(3) of this title), the diversification requirement of paragraph (1)(C) and the prudence requirement (only to the extent that it requires diversification) of paragraph (1)(B) is not violated by acquisition or holding of qualifying employer real property or qualifying employer securities (as defined in section 1107(d)(4) and (5) of this title). (b) Indicia of ownership of assets outside jurisdiction of district courts Except as authorized by the Secretary by regulations, no fiduciary may maintain the indicia of ownership of any assets of a plan outside the jurisdiction of the district courts of the United States. (c) Control over assets by participant or beneficiary (1) (A) In the case of a pension plan which provides for individual accounts and permits a participant or beneficiary to exercise control over the assets in his account, if a participant or beneficiary exercises control over the assets in his account (as determined under regulations of the Secretary)— (i) such participant or beneficiary shall not be deemed to be a fiduciary by reason of such exercise, and (ii) no person who is otherwise a fiduciary shall be liable under this part for any loss, or by reason of any breach, which results from such participant’s or beneficiary’s exercise of control, except that this clause shall not apply in connection with such participant or beneficiary for any blackout period during which the ability of such participant or beneficiary to direct the investment of the assets in his or her account is suspended by a plan sponsor or fiduciary. (B) If a person referred to in subparagraph (A)(ii) meets the requirements of this subchapter in connection with authorizing and implementing the blackout period, any person who is otherwise a fiduciary shall not be liable under this subchapter for any loss occurring during such period. (C) For purposes of this paragraph, the term “blackout period” has the meaning given such term by section 1021(i)(7) of this title. (2) In the case of a simple retirement account established pursuant to a qualified salary reduction arrangement under section 408(p) of title 26, a participant or beneficiary shall, for purposes of paragraph (1), be treated as exercising control over the assets in the account upon the earliest of— (A) an affirmative election among investment options with respect to the initial investment of any contribution, (B) a rollover to any other simple retirement account or individual retirement plan, or (C) one year after the simple retirement account is established. No reports, other than those required under section 1021(g) of this title, shall be required with respect to a simple retirement account established pursuant to such a qualified salary reduction arrangement. (3) In the case of a pension plan which makes a transfer to an individual retirement account or annuity of a designated trustee or issuer under section 401(a)(31)(B) ...65 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 1131 Criminal penalties Amends
29 U.S.C. § 1131
The law today
(a) Any person who willfully violates any provision of part 1 of this subtitle, or any regulation or order issued under any such provision, shall upon conviction be fined not more than $100,000 or imprisoned not more than 10 years, or both; except that in the case of such violation by a person not an individual, the fine imposed upon such person shall be a fine not exceeding $500,000. (b) Any person that violates section 1149 of this title shall upon conviction be imprisoned not more than 10 years or fined under title 18, or both.22 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 1132 Civil enforcement Amends
29 U.S.C. § 1132
The law today
(a) Persons empowered to bring a civil action A civil action may be brought— (1) by a participant or beneficiary— (A) for the relief provided for in subsection (c) of this section, or (B) to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan; (2) by the Secretary, or by a participant, beneficiary or fiduciary for appropriate relief under section 1109 of this title; (3) by a participant, beneficiary, or fiduciary (A) to enjoin any act or practice which violates any provision of this subchapter or the terms of the plan, or (B) to obtain other appropriate equitable relief (i) to redress such violations or (ii) to enforce any provisions of this subchapter or the terms of the plan; (4) by the Secretary, or by a participant, or beneficiary for appropriate relief in the case of a violation of section 1025(c) or 1032(a) of this title; (5) except as otherwise provided in subsection (b), by the Secretary (A) to enjoin any act or practice which violates any provision of this subchapter, or (B) to obtain other appropriate equitable relief (i) to redress such violation or (ii) to enforce any provision of this subchapter; (6) by the Secretary to collect any civil penalty under paragraph (2), (4), (5), (6), (7), (8), (9), or (13) of subsection (c) or under subsection (i) or (l); (7) by a State to enforce compliance with a qualified medical child support order (as defined in section 1169(a)(2)(A) of this title); (8) by the Secretary, or by an employer or other person referred to in section 1021(f)(1) of this title, (A) to enjoin any act or practice which violates subsection (f) of section 1021 of this title, or (B) to obtain appropriate equitable relief (i) to redress such violation or (ii) to enforce such subsection; (9) in the event that the purchase of an insurance contract or insurance annuity in connection with termination of an individual’s status as a participant covered under a pension plan with respect to all or any portion of the participant’s pension benefit under such plan constitutes a violation of part 4 of this title 1 or the terms of the plan, by the Secretary, by any individual who was a participant or beneficiary at the time of the alleged violation, or by a fiduciary, to obtain appropriate relief, including the posting of security if necessary, to assure receipt by the participant or beneficiary of the amounts provided or to be provided by such insurance contract or annuity, plus reasonable prejudgment interest on such amounts; (10) in the case of a multiemployer plan that has been certified by the actuary to be in endangered or critical status under section 1085 of this title, if the plan sponsor— (A) has not adopted a funding improvement or rehabilitation plan under that section by the deadline established in such section, or (B) fails to update or comply with the terms of the funding improvement or rehabilitation plan in accordance with the requirements of such section, by an employer that has an obligation to contribute with respect to the multiemployer plan or an employee organization that represents active participants in the multiemployer plan, for an order compelling the plan sponsor to adopt a funding improvement or rehabilitation plan or to update or comply with the terms of the funding improvement or rehabilitation plan in accordance with the requirements of such section and the funding improvement or rehabilitation plan; or (11) in the case of a multiemployer plan, by an employee representative, or any employer that has an obligation to contribute to the plan, (A) to enjoin any act or practice which violates subsection (k) of section 1021 of this title (or, in the case of an employer, subsection (l) of such section), or (B) to obtain appropriate equitable relief (i) to redress such violation or (ii) to enforce such subsection. (b) Plans qualified under Internal Revenue Code; mainten...61 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 1133 Claims procedure Amends
29 U.S.C. § 1133
The law today
In accordance with regulations of the Secretary, every employee benefit plan shall— (1) provide adequate notice in writing to any participant or beneficiary whose claim for benefits under the plan has been denied, setting forth the specific reasons for such denial, written in a manner calculated to be understood by the participant, and (2) afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim.6 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 1136 Coordination and responsibility of agencies enforcing this subchapter and related Federal laws Amends
29 U.S.C. § 1136
The law today
(a) Coordination with other agencies and departments In order to avoid unnecessary expense and duplication of functions among Government agencies, the Secretary may make such arrangements or agreements for cooperation or mutual assistance in the performance of his functions under this subchapter and the functions of any such agency as he may find to be practicable and consistent with law. The Secretary may utilize, on a reimbursable or other basis, the facilities or services of any department, agency, or establishment of the United States or of any State or political subdivision of a State, including the services of any of its employees, with the lawful consent of such department, agency, or establishment; and each department, agency, or establishment of the United States is authorized and directed to cooperate with the Secretary and, to the extent permitted by law, to provide such information and facilities as he may request for his assistance in the performance of his functions under this subchapter. The Attorney General or his representative shall receive from the Secretary for appropriate action such evidence developed in the performance of his functions under this subchapter as may be found to warrant consideration for criminal prosecution under the provisions of this subchapter or other Federal law. (b) Responsibility for detecting and investigating civil and criminal violations of this subchapter and related Federal laws The Secretary shall have the responsibility and authority to detect and investigate and refer, where appropriate, civil and criminal violations related to the provisions of this subchapter and other related Federal laws, including the detection, investigation, and appropriate referrals of related violations of title 18. Nothing in this subsection shall be construed to preclude other appropriate Federal agencies from detecting and investigating civil and criminal violations of this subchapter and other related Federal laws. (c) Coordination of enforcement with States with respect to certain arrangements A State may enter into an agreement with the Secretary for delegation to the State of some or all of the Secretary’s authority under sections 1132 and 1134 of this title to enforce the requirements under part 7 in connection with multiple employer welfare arrangements, providing medical care (within the meaning of section 1191b(a)(2) of this title), which are not group health plans.8 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 1144 Other laws Amends
29 U.S.C. § 1144 — at 1144(b)(6) and 1144(b)(6)(A)
The law today
(a) Supersedure; effective date Except as provided in subsection (b) of this section, the provisions of this subchapter and subchapter III shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan described in section 1003(a) of this title and not exempt under section 1003(b) of this title. This section shall take effect on January 1, 1975. (b) Construction and application (1) This section shall not apply with respect to any cause of action which arose, or any act or omission which occurred, before January 1, 1975. (2) (A) Except as provided in subparagraph (B), nothing in this subchapter shall be construed to exempt or relieve any person from any law of any State which regulates insurance, banking, or securities. (B) Neither an employee benefit plan described in section 1003(a) of this title, which is not exempt under section 1003(b) of this title (other than a plan established primarily for the purpose of providing death benefits), nor any trust established under such a plan, shall be deemed to be an insurance company or other insurer, bank, trust company, or investment company or to be engaged in the business of insurance or banking for purposes of any law of any State purporting to regulate insurance companies, insurance contracts, banks, trust companies, or investment companies. (3) Nothing in this section shall be construed to prohibit use by the Secretary of services or facilities of a State agency as permitted under section 1136 of this title. (4) Subsection (a) shall not apply to any generally applicable criminal law of a State. (5) (A) Except as provided in subparagraph (B), subsection (a) shall not apply to the Hawaii Prepaid Health Care Act (Haw. Rev. Stat. §§ 393–1 through 393–51). (B) Nothing in subparagraph (A) shall be construed to exempt from subsection (a)— (i) any State tax law relating to employee benefit plans, or (ii) any amendment of the Hawaii Prepaid Health Care Act enacted after September 2, 1974, to the extent it provides for more than the effective administration of such Act as in effect on such date. (C) Notwithstanding subparagraph (A), parts 1 and 4 of this subtitle, and the preceding sections of this part to the extent they govern matters which are governed by the provisions of such parts 1 and 4, shall supersede the Hawaii Prepaid Health Care Act (as in effect on or after January 14, 1983), but the Secretary may enter into cooperative arrangements under this paragraph and section 1136 of this title with officials of the State of Hawaii to assist them in effectuating the policies of provisions of such Act which are superseded by such parts 1 and 4 and the preceding sections of this part. (6) (A) Notwithstanding any other provision of this section— (i) in the case of an employee welfare benefit plan which is a multiple employer welfare arrangement and is fully insured (or which is a multiple employer welfare arrangement subject to an exemption under subparagraph (B)), any law of any State which regulates insurance may apply to such arrangement to the extent that such law provides— (I) standards, requiring the maintenance of specified levels of reserves and specified levels of contributions, which any such plan, or any trust established under such a plan, must meet in order to be considered under such law able to pay benefits in full when due, and (II) provisions to enforce such standards, and (ii) in the case of any other employee welfare benefit plan which is a multiple employer welfare arrangement, in addition to this subchapter, any law of any State which regulates insurance may apply to the extent not inconsistent with the preceding sections of this subchapter. (B) The Secretary may, under regulations which may be prescribed by the Secretary, exempt from subparagraph (A)(ii), individually or by class, multiple employer welfare arrangements which are not fully insured. Any such exemption may be granted with respect to any arrangement or ...31 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 1182 Prohibiting discrimination against individual participants and beneficiaries based on health status Amends
29 U.S.C. § 1182 — at 1182(b)(2)
The law today
(a) In eligibility to enroll (1) In general Subject to paragraph (2), a group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any of the following health status-related factors in relation to the individual or a dependent of the individual: (A) Health status. (B) Medical condition (including both physical and mental illnesses). (C) Claims experience. (D) Receipt of health care. (E) Medical history. (F) Genetic information. (G) Evidence of insurability (including conditions arising out of acts of domestic violence). (H) Disability. (2) No application to benefits or exclusions To the extent consistent with section 1181 of this title, paragraph (1) shall not be construed— (A) to require a group health plan, or group health insurance coverage, to provide particular benefits other than those provided under the terms of such plan or coverage, or (B) to prevent such a plan or coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage. (3) Construction For purposes of paragraph (1), rules for eligibility to enroll under a plan include rules defining any applicable waiting periods for such enrollment. (b) In premium contributions (1) In general A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, may not require any individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution which is greater than such premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status-related factor in relation to the individual or to an individual enrolled under the plan as a dependent of the individual. (2) Construction Nothing in paragraph (1) shall be construed— (A) to restrict the amount that an employer may be charged for coverage under a group health plan except as provided in paragraph (3); or (B) to prevent a group health plan, and a health insurance issuer offering group health insurance coverage, from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention. (3) No group-based discrimination on basis of genetic information (A) In general For purposes of this section, a group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not adjust premium or contribution amounts for the group covered under such plan on the basis of genetic information. (B) Rule of construction Nothing in subparagraph (A) or in paragraphs (1) and (2) of subsection (d) shall be construed to limit the ability of a health insurance issuer offering health insurance coverage in connection with a group health plan to increase the premium for an employer based on the manifestation of a disease or disorder of an individual who is enrolled in the plan. In such case, the manifestation of a disease or disorder in one individual cannot also be used as genetic information about other group members and to further increase the premium for the employer. (c) Genetic testing (1) Limitation on requesting or requiring genetic testing A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, shall not request or require an individual or a family member of such individual to undergo a genetic test. (2) Rule of construction Paragraph (1) shall not be construed to limit the authority of a health care professional who is providing health care services to an individual to request that such individual undergo a genetic ...2 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 1191a Special rules relating to group health plans Amends
29 U.S.C. § 1191a
The law today
(a) General exception for certain small group health plans The requirements of this part (other than sections 1185 and 1185o of this title) shall not apply to any group health plan (and group health insurance coverage offered in connection with a group health plan) for any plan year if, on the first day of such plan year, such plan has less than 2 participants who are current employees. (b) Exception for certain benefits The requirements of this part shall not apply to any group health plan (and group health insurance coverage) in relation to its provision of excepted benefits described in section 1191b(c)(1) of this title. (c) Exception for certain benefits if certain conditions met (1) Limited, excepted benefits The requirements of this part shall not apply to any group health plan (and group health insurance coverage offered in connection with a group health plan) in relation to its provision of excepted benefits described in section 1191b(c)(2) of this title if the benefits— (A) are provided under a separate policy, certificate, or contract of insurance; or (B) are otherwise not an integral part of the plan. (2) Noncoordinated, excepted benefits The requirements of this part shall not apply to any group health plan (and group health insurance coverage offered in connection with a group health plan) in relation to its provision of excepted benefits described in section 1191b(c)(3) of this title if all of the following conditions are met: (A) The benefits are provided under a separate policy, certificate, or contract of insurance. (B) There is no coordination between the provision of such benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor. (C) Such benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor. (3) Supplemental excepted benefits The requirements of this part shall not apply to any group health plan (and group health insurance coverage) in relation to its provision of excepted benefits described in section 1191b(c)(4) of this title if the benefits are provided under a separate policy, certificate, or contract of insurance. (d) Treatment of partnerships For purposes of this part— (1) Treatment as a group health plan Any plan, fund, or program which would not be (but for this subsection) an employee welfare benefit plan and which is established or maintained by a partnership, to the extent that such plan, fund, or program provides medical care (including items and services paid for as medical care) to present or former partners in the partnership or to their dependents (as defined under the terms of the plan, fund, or program), directly or through insurance, reimbursement, or otherwise, shall be treated (subject to paragraph (2)) as an employee welfare benefit plan which is a group health plan. (2) Employer In the case of a group health plan, the term “employer” also includes the partnership in relation to any partner. (3) Participants of group health plans In the case of a group health plan, the term “participant” also includes— (A) in connection with a group health plan maintained by a partnership, an individual who is a partner in relation to the partnership, or (B) in connection with a group health plan maintained by a self-employed individual (under which one or more employees are participants), the self-employed individual, if such individual is, or may become, eligible to receive a benefit under the plan or such individual’s beneficiaries may be eligible to receive any such benefit.18 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
Appropriations · 31 U.S.C. ch. 13 1 section
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§ 1324 Refund of internal revenue collections Amends
31 U.S.C. § 1324 — at 1324(b)
The law today
(a) Necessary amounts are appropriated to the Secretary of the Treasury for refunding internal revenue collections as provided by law, including payment of— (1) claims for prior fiscal years; and (2) accounts arising under— (A) “Allowance or drawback (Internal Revenue)”; (B) “Redemption of stamps (Internal Revenue)”; (C) “Refunding legacy taxes, Act of March 30, 1928”; (D) “Repayment of taxes on distilled spirits destroyed by casualty”; and (E) “Refunds and payments of processing and related taxes”. (b) Disbursements may be made from the appropriation made by this section only for— (1) refunds to the limit of liability of an individual tax account; and (2) refunds due from credit provisions of the Internal Revenue Code of 1986 (26 U.S.C. 1 et seq.) enacted before January 1, 1978, or enacted by the Taxpayer Relief Act of 1997, or from section 21, 24, 25A, 35, 36, 36A,1 36B, 168(k)(4)(F), 53(e),1 54B(h),1 3131, 3132, 3134, 6428, 6428A, 6428B, 6431,1 or 7527A of such Code, or due under section 3081(b)(2) of the Housing Assistance Tax Act of 2008.275 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
Public health service · 42 U.S.C. ch. 6A 3 sections Amends the act as a whole
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§ 233 Civil actions or proceedings against commissioned officers or employees Amends
42 U.S.C. § 233 — at 233(k) and 233(g)
The law today
(a) Exclusiveness of remedy The remedy against the United States provided by sections 1346(b) and 2672 of title 28, or by alternative benefits provided by the United States where the availability of such benefits precludes a remedy under section 1346(b) of title 28, for damage for personal injury, including death, resulting from the performance of medical, surgical, dental, or related functions, including the conduct of clinical studies or investigation, by any commissioned officer or employee of the Public Health Service while acting within the scope of his office or employment, shall be exclusive of any other civil action or proceeding by reason of the same subject-matter against the officer or employee (or his estate) whose act or omission gave rise to the claim. (b) Attorney General to defend action or proceeding; delivery of process to designated official; furnishing of copies of pleading and process to United States attorney, Attorney General, and Secretary The Attorney General shall defend any civil action or proceeding brought in any court against any person referred to in subsection (a) of this section (or his estate) for any such damage or injury. Any such person against whom such civil action or proceeding is brought shall deliver within such time after date of service or knowledge of service as determined by the Attorney General, all process served upon him or an attested true copy thereof to his immediate superior or to whomever was designated by the Secretary to receive such papers and such person shall promptly furnish copies of the pleading and process therein to the United States attorney for the district embracing the place wherein the proceeding is brought, to the Attorney General, and to the Secretary. (c) Removal to United States district court; procedure; proceeding upon removal deemed a tort action against United States; hearing on motion to remand to determine availability of remedy against United States; remand to State court or dismissal Upon a certification by the Attorney General that the defendant was acting in the scope of his employment at the time of the incident out of which the suit arose, any such civil action or proceeding commenced in a State court shall be removed without bond at any time before trial by the Attorney General to the district court of the United States of the district and division embracing the place wherein it is pending and the proceeding deemed a tort action brought against the United States under the provisions of title 28 and all references thereto. Should a United States district court determine on a hearing on a motion to remand held before a trial on the merit that the case so removed is one in which a remedy by suit within the meaning of subsection (a) of this section is not available against the United States, the case shall be remanded to the State Court: Provided, That where such a remedy is precluded because of the availability of a remedy through proceedings for compensation or other benefits from the United States as provided by any other law, the case shall be dismissed, but in the event the running of any limitation of time for commencing, or filing an application or claim in, such proceedings for compensation or other benefits shall be deemed to have been suspended during the pendency of the civil action or proceeding under this section. (d) Compromise or settlement of claim by Attorney General The Attorney General may compromise or settle any claim asserted in such civil action or proceeding in the manner provided in section 2677 of title 28 and with the same effect. (e) Assault or battery For purposes of this section, the provisions of section 2680(h) of title 28 shall not apply to assault or battery arising out of negligence in the performance of medical, surgical, dental, or related functions, including the conduct of clinical studies or investigations. (f) Authority of Secretary or designee to hold harmless or provide liability insurance for assigne...21 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 300gg-21 Exclusion of certain plans Amends
42 U.S.C. § 300gg-21
The law today
(a) Limitation on application of provisions relating to group health plans (1) In general The requirements of subparts 1 and 2 1 and part D shall apply with respect to group health plans only— (A) subject to paragraph (2), in the case of a plan that is a nonfederal governmental plan, and (B) with respect to health insurance coverage offered in connection with a group health plan (including such a plan that is a church plan or a governmental plan). (2) Treatment of non-Federal governmental plans (A) Election to be excluded Except as provided in subparagraph (D) or (E), if the plan sponsor of a nonfederal governmental plan which is a group health plan to which the provisions of subparts 1 and 2 1 otherwise apply makes an election under this subparagraph (in such form and manner as the Secretary may by regulations prescribe), then the requirements of such subparts insofar as they apply directly to group health plans (and not merely to group health insurance coverage) shall not apply to such governmental plans for such period except as provided in this paragraph. (B) Period of election An election under subparagraph (A) shall apply— (i) for a single specified plan year, or (ii) in the case of a plan provided pursuant to a collective bargaining agreement, for the term of such agreement. An election under clause (i) may be extended through subsequent elections under this paragraph. (C) Notice to enrollees Under such an election, the plan shall provide for— (i) notice to enrollees (on an annual basis and at the time of enrollment under the plan) of the fact and consequences of such election, and (ii) certification and disclosure of creditable coverage under the plan with respect to enrollees in accordance with section 2701(e).1 (D) Election not applicable to requirements concerning genetic information The election described in subparagraph (A) shall not be available with respect to the provisions of subsections (a)(1)(F), (b)(3), (c), and (d) of section 2702 1 and the provisions of sections 2701 1 and 2702(b) 1 to the extent that such provisions apply to genetic information. (E) Election not applicable The election described in subparagraph (A) shall not be available with respect to the provisions of subparts I and II. (F) Sunset of election option (i) In general Notwithstanding the preceding provisions of this paragraph— (I) no election described in subparagraph (A) with respect to section 300gg–26 of this title may be made on or after December 29, 2022; and (II) except as provided in clause (ii), no such election with respect to section 300gg–26 of this title expiring on or after the date that is 180 days after December 29, 2022, may be renewed. (ii) Exception for certain collectively bargained plans Notwithstanding clause (i)(II), a plan described in subparagraph (B)(ii) that is subject to multiple agreements described in such subparagraph of varying lengths and that has an election described in subparagraph (A) with respect to section 300gg–26 of this title in effect as of December 29, 2022, that expires on or after the date that is 180 days after December 29, 2022, may extend such election until the date on which the term of the last such agreement expires. (b) Exception for certain benefits The requirements of subparts 1 and 2 1 and part D shall not apply to any individual coverage or any group health plan (or group health insurance coverage) in relation to its provision of excepted benefits described in section 300gg–91(c)(1) of this title. (c) Exception for certain benefits if certain conditions met (1) Limited, excepted benefits The requirements of subparts 1 and 2 1 and part D shall not apply to any individual coverage or any group health plan (and group health insurance coverage offered in connection with a group health plan) in relation to its provision of excepted benefits described in section 300gg–91(c)(2) of this title if the benefits— (A) are provided under a separate policy, certificate, or contract of insurance;...20 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 300gg-45 Relief for high risk pools Amends
42 U.S.C. § 300gg-45 — at 300gg-45(d)(2)
The law today
(a) Seed grants to States The Secretary shall provide from the funds appropriated under subsection (d)(1)(A) a grant of up to $1,000,000 to each State that has not created a qualified high risk pool as of February 10, 2006, for the State’s costs of creation and initial operation of such a pool. (b) Grants for operational losses (1) In general In the case of a State that has established a qualified high risk pool that— (A) restricts premiums charged under the pool to no more than 200 percent of the premium for applicable standard risk rates; (B) offers a choice of two or more coverage options through the pool; and (C) has in effect a mechanism reasonably designed to ensure continued funding of losses incurred by the State in connection with operation of the pool after the end of the last fiscal year for which a grant is provided under this paragraph; the Secretary shall provide, from the funds appropriated under paragraphs (1)(B)(i) and (2)(A) of subsection (d) and allotted to the State under paragraph (2), a grant for the losses incurred by the State in connection with the operation of the pool. (2) Allotment Subject to paragraph (4), the amounts appropriated under paragraphs (1)(B)(i) and (2)(A) of subsection (d) for a fiscal year shall be allotted and made available to the States (or the entities that operate the high risk pool under applicable State law) that qualify for a grant under paragraph (1) as follows: (A) An amount equal to 40 percent of such appropriated amount for the fiscal year shall be allotted in equal amounts to each qualifying State that is one of the 50 States or the District of Columbia and that applies for a grant under this subsection. (B) An amount equal to 30 percent of such appropriated amount for the fiscal year shall be allotted among qualifying States that apply for such a grant so that the amount allotted to such a State bears the same ratio to such appropriated amount as the number of uninsured individuals in the State bears to the total number of uninsured individuals (as determined by the Secretary) in all qualifying States that so apply. (C) An amount equal to 30 percent of such appropriated amount for the fiscal year shall be allotted among qualifying States that apply for such a grant so that the amount allotted to a State bears the same ratio to such appropriated amount as the number of individuals enrolled in health care coverage through the qualified high risk pool of the State bears to the total number of individuals so enrolled through qualified high risk pools (as determined by the Secretary) in all qualifying States that so apply. (3) Special rule for pools charging higher premiums In the case of a qualified high risk pool of a State which charges premiums that exceed 150 percent of the premium for applicable standard risks, the State shall use at least 50 percent of the amount of the grant provided to the State to carry out this subsection to reduce premiums for enrollees. (4) Limitation for territories In no case shall the aggregate amount allotted and made available under paragraph (2) for a fiscal year to States that are not the 50 States or the District of Columbia exceed $1,000,000. (c) Bonus grants for supplemental consumer benefits (1) In general In the case of a State that is one of the 50 States or the District of Columbia, that has established a qualified high risk pool, and that is receiving a grant under subsection (b)(1), the Secretary shall provide, from the funds appropriated under paragraphs (1)(B)(ii) and (2)(B) of subsection (d) and allotted to the State under paragraph (3), a grant to be used to provide supplemental consumer benefits to enrollees or potential enrollees (or defined subsets of such enrollees or potential enrollees) in qualified high risk pools. (2) Benefits A State shall use amounts received under a grant under this subsection to provide one or more of the following benefits: (A) Low-income premium subsidies. (B) A reduction in premium trends, ac...2 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
Social security · 42 U.S.C. ch. 7 8 sections
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§ 1395i Federal Hospital Insurance Trust Fund Amends
42 U.S.C. § 1395i — at 1395i(k)(3)(A)
The law today
(a) Creation; deposits; transfers from Treasury There is hereby created on the books of the Treasury of the United States a trust fund to be known as the “Federal Hospital Insurance Trust Fund” (hereinafter in this section referred to as the “Trust Fund”). The Trust Fund shall consist of such gifts and bequests as may be made as provided in section 401(i)(1) of this title, and such amounts as may be deposited in, or appropriated to, such fund as provided in this part. There are hereby appropriated to the Trust Fund for the fiscal year ending June 30, 1966, and for each fiscal year thereafter, out of any moneys in the Treasury not otherwise appropriated, amounts equivalent to 100 per centum of— (1) the taxes imposed by sections 3101(b) and 3111(b) of the Internal Revenue Code of 1986 with respect to wages reported to the Secretary of the Treasury or his delegate pursuant to subtitle F of such Code after December 31, 1965, as determined by the Secretary of the Treasury by applying the applicable rates of tax under such sections to such wages, which wages shall be certified by the Commissioner of Social Security on the basis of records of wages established and maintained by the Commissioner of Social Security in accordance with such reports; and (2) the taxes imposed by section 1401(b) of the Internal Revenue Code of 1986 with respect to self-employment income reported to the Secretary of the Treasury or his delegate on tax returns under subtitle F of such Code, as determined by the Secretary of the Treasury by applying the applicable rate of tax under such section to such self-employment income, which self-employment income shall be certified by the Commissioner of Social Security on the basis of records of self-employment established and maintained by the Commissioner of Social Security in accordance with such returns. The amounts appropriated by the preceding sentence shall be transferred from time to time from the general fund in the Treasury to the Trust Fund, such amounts to be determined on the basis of estimates by the Secretary of the Treasury of the taxes, specified in the preceding sentence, paid to or deposited into the Treasury; and proper adjustments shall be made in amounts subsequently transferred to the extent prior estimates were in excess of or were less than the taxes specified in such sentence. (b) Board of Trustees; composition; meetings; duties With respect to the Trust Fund, there is hereby created a body to be known as the Board of Trustees of the Trust Fund (hereinafter in this section referred to as the “Board of Trustees”) composed of the Commissioner of Social Security, the Secretary of the Treasury, the Secretary of Labor, and the Secretary of Health and Human Services, all ex officio, and of two members of the public (both of whom may not be from the same political party), who shall be nominated by the President for a term of four years and subject to confirmation by the Senate. A member of the Board of Trustees serving as a member of the public and nominated and confirmed to fill a vacancy occurring during a term shall be nominated and confirmed only for the remainder of such term. An individual nominated and confirmed as a member of the public may serve in such position after the expiration of such member’s term until the earlier of the time at which the member’s successor takes office or the time at which a report of the Board is first issued under paragraph (2) after the expiration of the member’s term. The Secretary of the Treasury shall be the Managing Trustee of the Board of Trustees (hereinafter in this section referred to as the “Managing Trustee”). The Administrator of the Centers for Medicare & Medicaid Services shall serve as the Secretary of the Board of Trustees. The Board of Trustees shall meet not less frequently than once each calendar year. It shall be the duty of the Board of Trustees to— (1) Hold the Trust Fund; (2) Report to the Congress not later than the first day of April ...14 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 1395w-4 Payment for physicians’ services Amends
42 U.S.C. § 1395w-4 — at 1395w-4(d), 1395w-4(d)(4), and 1395w-4(f)
The law today
(a) Payment based on fee schedule (1) In general Effective for all physicians’ services (as defined in subsection (j)(3)) furnished under this part during a year (beginning with 1992) for which payment is otherwise made on the basis of a reasonable charge or on the basis of a fee schedule under section 1395m(b) of this title, payment under this part shall instead be based on the lesser of— (A) the actual charge for the service, or (B) subject to the succeeding provisions of this subsection, the amount determined under the fee schedule established under subsection (b) for services furnished during that year (in this subsection referred to as the “fee schedule amount”). (2) Transition to full fee schedule (A) Limiting reductions and increases to 15 percent in 1992 (i) Limit on increase In the case of a service in a fee schedule area (as defined in subsection (j)(2)) for which the adjusted historical payment basis (as defined in subparagraph (D)) is less than 85 percent of the fee schedule amount for services furnished in 1992, there shall be substituted for the fee schedule amount an amount equal to the adjusted historical payment basis plus 15 percent of the fee schedule amount otherwise established (without regard to this paragraph). (ii) Limit in reduction In the case of a service in a fee schedule area for which the adjusted historical payment basis exceeds 115 percent of the fee schedule amount for services furnished in 1992, there shall be substituted for the fee schedule amount an amount equal to the adjusted historical payment basis minus 15 percent of the fee schedule amount otherwise established (without regard to this paragraph). (B) Special rule for 1993, 1994, and 1995 If a physicians’ service in a fee schedule area is subject to the provisions of subparagraph (A) in 1992, for physicians’ services furnished in the area— (i) during 1993, there shall be substituted for the fee schedule amount an amount equal to the sum of— (I) 75 percent of the fee schedule amount determined under subparagraph (A), adjusted by the update established under subsection (d)(3) for 1993, and (II) 25 percent of the fee schedule amount determined under paragraph (1) for 1993 without regard to this paragraph; (ii) during 1994, there shall be substituted for the fee schedule amount an amount equal to the sum of— (I) 67 percent of the fee schedule amount determined under clause (i), adjusted by the update established under subsection (d)(3) for 1994 and as adjusted under subsection (c)(2)(F)(ii) and under section 13515(b) of the Omnibus Budget Reconciliation Act of 1993, and (II) 33 percent of the fee schedule amount determined under paragraph (1) for 1994 without regard to this paragraph; and (iii) during 1995, there shall be substituted for the fee schedule amount an amount equal to the sum of— (I) 50 percent of the fee schedule amount determined under clause (ii) adjusted by the update established under subsection (d)(3) for 1995, and (II) 50 percent of the fee schedule amount determined under paragraph (1) for 1995 without regard to this paragraph. (C) Special rule for anesthesia and radiology services With respect to physicians’ services which are anesthesia services, the Secretary shall provide for a transition in the same manner as a transition is provided for other services under subparagraph (B). With respect to radiology services, “109 percent” and “9 percent” shall be substituted for “115 percent” and “15 percent”, respectively, in subparagraph (A)(ii). (D) “Adjusted historical payment basis” defined (i) In general In this paragraph, the term “adjusted historical payment basis” means, with respect to a physicians’ service furnished in a fee schedule area, the weighted average prevailing charge applied in the area for the service in 1991 (as determined by the Secretary without regard to physician specialty and as adjusted to reflect payments for services with customary charges below the prevailing charge or other payment limitation...167 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 1396r-4 Adjustment in payment for inpatient hospital services furnished by disproportionate share hospitals Amends
42 U.S.C. § 1396r-4 — at 1396r-4(f)
The law today
(a) Implementation of requirement (1) A State plan under this subchapter shall not be considered to meet the requirement of section 1396a(a)(13)(A)(iv) of this title (insofar as it requires payments to hospitals to take into account the situation of hospitals which serve a disproportionate number of low income patients with special needs), as of July 1, 1988, unless the State has submitted to the Secretary, by not later than such date, an amendment to such plan that— (A) specifically defines the hospitals so described (and includes in such definition any disproportionate share hospital described in subsection (b)(1) which meets the requirements of subsection (d)), and (B) provides, effective for inpatient hospital services provided not later than July 1, 1988, for an appropriate increase in the rate or amount of payment for such services provided by such hospitals, consistent with subsection (c). (2) (A) In order to be considered to have met such requirement of section 1396a(a)(13)(A) of this title as of July 1, 1989, the State must submit to the Secretary by not later than April 1, 1989, the State plan amendment described in paragraph (1), consistent with subsection (c), effective for inpatient hospital services provided on or after July 1, 1989. (B) In order to be considered to have met such requirement of section 1396a(a)(13)(A) of this title as of July 1, 1990, the State must submit to the Secretary by not later than April 1, 1990, the State plan amendment described in paragraph (1), consistent with subsections (c) and (f), effective for inpatient hospital services provided on or after July 1, 1990. (C) If a State plan under this subchapter provides for payments for inpatient hospital services on a prospective basis (whether per diem, per case, or otherwise), in order for the plan to be considered to have met such requirement of section 1396a(a)(13)(A) of this title as of July 1, 1989, the State must submit to the Secretary by not later than April 1, 1989, a State plan amendment that provides, in the case of hospitals defined by the State as disproportionate share hospitals under paragraph (1)(A), for an outlier adjustment in payment amounts for medically necessary inpatient hospital services provided on or after July 1, 1989, involving exceptionally high costs or exceptionally long lengths of stay for individuals under one year of age. (D) A State plan under this subchapter shall not be considered to meet the requirements of section 1396a(a)(13)(A)(iv) of this title (insofar as it requires payments to hospitals to take into account the situation of hospitals that serve a disproportionate number of low-income patients with special needs), as of October 1, 1998, unless the State has submitted to the Secretary by such date a description of the methodology used by the State to identify and to make payments to disproportionate share hospitals, including children’s hospitals, on the basis of the proportion of low-income and medicaid patients (including such patients who receive benefits through a managed care entity) served by such hospitals. The State shall provide an annual report to the Secretary describing the disproportionate share payments to each such disproportionate share hospital. (3) The Secretary shall, not later than 90 days after the date a State submits an amendment under this subsection, review each such amendment for compliance with such requirement and by such date shall approve or disapprove each such amendment. If the Secretary disapproves such an amendment, the State shall immediately submit a revised amendment which meets such requirement. (4) The requirement of this subsection may not be waived under section 1396n(b)(4) of this title. (b) Hospitals deemed disproportionate share (1) For purposes of subsection (a)(1), a hospital which meets the requirements of subsection (d) is deemed to be a disproportionate share hospital if— (A) the hospital’s medicaid inpatient utilization rate (as defined in paragra...37 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 1397b Allotments Amends
42 U.S.C. § 1397b — at 1397b(a)
The law today
(a) Computation of amounts for jurisdictions of Puerto Rico, Guam, etc. The allotment for any fiscal year to each of the jurisdictions of Puerto Rico, Guam, the Virgin Islands, and the Northern Mariana Islands shall be an amount which bears the same ratio to the amount specified in subsection (c) as the amount which was specified for allocation to the particular jurisdiction involved for the fiscal year 1981 under section 1397a(a)(2)(C) of this title (as in effect prior to Aug. 13, 1981) bore to $2,900,000,000. The allotment for fiscal year 1989 and each succeeding fiscal year to American Samoa shall be an amount which bears the same ratio to the amount allotted to the Northern Mariana Islands for that fiscal year as the population of American Samoa bears to the population of the Northern Mariana Islands determined on the basis of the most recent data available at the time such allotment is determined. (b) Computation of amounts for each State other than jurisdictions of Puerto Rico, Guam, etc. The allotment for any fiscal year for each State other than the jurisdictions of Puerto Rico, Guam, the Virgin Islands, American Samoa, and the Northern Mariana Islands shall be an amount which bears the same ratio to— (1) the amount specified in subsection (c), reduced by (2) the total amount allotted to those jurisdictions for that fiscal year under subsection (a), as the population of that State bears to the population of all the States (other than Puerto Rico, Guam, the Virgin Islands, American Samoa, and the Northern Mariana Islands) as determined by the Secretary (on the basis of the most recent data available from the Department of Commerce) and promulgated prior to the first day of the third month of the preceding fiscal year. (c) Appropriations The amount specified for purposes of subsections (a) and (b) shall be— (1) $2,400,000,000 for the fiscal year 1982; (2) $2,450,000,000 for the fiscal year 1983; (3) $2,700,000,000 for the fiscal years 1984, 1985, 1986, 1987, and 1989; (4) $2,750,000,000 for the fiscal year 1988; (5) $2,800,000,000 for each of the fiscal years 1990 through 1995; (6) $2,381,000,000 for the fiscal year 1996; (7) $2,380,000,000 for the fiscal year 1997; (8) $2,299,000,000 for the fiscal year 1998; (9) $2,380,000,000 for the fiscal year 1999; (10) $2,380,000,000 for the fiscal year 2000; and (11) $1,700,000,000 for the fiscal year 2001 and each fiscal year thereafter.3 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 1397bb General contents of State child health plan; eligibility; outreach Amends
42 U.S.C. § 1397bb — at 1397bb(a)
The law today
(a) General background and description A State child health plan shall include a description, consistent with the requirements of this subchapter, of— (1) the extent to which, and manner in which, children in the State, including targeted low-income children and other classes of children classified by income and other relevant factors, currently have creditable health coverage (as defined in section 1397jj(c)(2) of this title); (2) current State efforts to provide or obtain creditable health coverage for uncovered children, including the steps the State is taking to identify and enroll all uncovered children who are eligible to participate in public health insurance programs and health insurance programs that involve public-private partnerships; (3) how the plan is designed to be coordinated with such efforts to increase coverage of children under creditable health coverage; (4) the child health assistance provided under the plan for targeted low-income children, including the proposed methods of delivery, and utilization control systems; (5) eligibility standards consistent with subsection (b); (6) outreach activities consistent with subsection (c); and (7) methods (including monitoring) used— (A) to assure the quality and appropriateness of care, particularly with respect to well-baby care, well-child care, and immunizations provided under the plan; (B) to assure access to covered services, including emergency services and services described in paragraphs (5) and (6) of section 1397cc(c) of this title; and (C) to ensure that the State agency involved is in compliance with subparagraphs (A), (B), and (C) of section 1320a–7n(b)(2) of this title. (b) General description of eligibility standards and methodology (1) Eligibility standards (A) In general The plan shall include a description of the standards used to determine the eligibility of targeted low-income children for child health assistance under the plan. Such standards may include (to the extent consistent with this subchapter) those relating to the geographic areas to be served by the plan, age, income and resources (including any standards relating to spenddowns and disposition of resources), residency, disability status (so long as any standard relating to such status does not restrict eligibility), access to or coverage under other health coverage, and duration of eligibility. Such standards may not discriminate on the basis of diagnosis. (B) Limitations on eligibility standards Such eligibility standards— (i) shall, within any defined group of covered targeted low-income children, not cover such children with higher family income without covering children with a lower family income; (ii) may not deny eligibility based on a child having a preexisting medical condition; (iii) may not apply a waiting period (including a waiting period to carry out paragraph (3)(C)) in the case of a targeted low-income pregnant woman provided pregnancy-related assistance under section 1397ll of this title; (iv) at State option, may not apply a waiting period in the case of a child provided dental-only supplemental coverage under section 1397jj(b)(5) of this title; and (v) shall, beginning January 1, 2014, use modified adjusted gross income and household income (as defined in section 36B(d)(2) of the Internal Revenue Code of 1986) to determine eligibility for child health assistance under the State child health plan or under any waiver of such plan and for any other purpose applicable under the plan or waiver for which a determination of income is required, including with respect to the imposition of premiums and cost-sharing, consistent with section 1396a(e)(14) of this title. (2) Methodology The plan shall include a description of methods of establishing and continuing eligibility and enrollment. (3) Eligibility screening; coordination with other health coverage programs The plan shall include a description of procedures to be used to ensure— (A) through both intake and followup scr...36 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 1397d Limitation on use of grants; waiver Amends
42 U.S.C. § 1397d
The law today
(a) Except as provided in subsection (b), grants made under this division may not be used by the State, or by any other person with which the State makes arrangements to carry out the purposes of this division— (1) for the purchase or improvement of land, or the purchase, construction, or permanent improvement (other than minor remodeling) of any building or other facility; (2) for the provision of cash payments for costs of subsistence or for the provision of room and board (other than costs of subsistence during rehabilitation, room and board provided for a short term as an integral but subordinate part of a social service, or temporary emergency shelter provided as a protective service); (3) for payment of the wages of any individual as a social service (other than payment of the wages of welfare recipients employed in the provision of child day care services); (4) for the provision of medical care (other than family planning services, rehabilitation services, or initial detoxification of an alcoholic or drug dependent individual) unless it is an integral but subordinate part of a social service for which grants may be used under this division; (5) for social services (except services to an alcoholic or drug dependent individual or rehabilitation services) provided in and by employees of any hospital, skilled nursing facility, intermediate care facility, or prison, to any individual living in such institution; (6) for the provision of any educational service which the State makes generally available to its residents without cost and without regard to their income; (7) for any child day care services unless such services meet applicable standards of State and local law; (8) for the provision of cash payments as a service (except as otherwise provided in this section); (9) for payment for any item or service (other than an emergency item or service) furnished— (A) by an individual or entity during the period when such individual or entity is excluded under this division or subchapter V, XVIII, or XIX pursuant to section 1320a–7, 1320a–7a, 1320c–5, or 1395u(j)(2) of this title, or (B) at the medical direction or on the prescription of a physician during the period when the physician is excluded under this division or subchapter V, XVIII, or XIX pursuant to section 1320a–7, 1320a–7a, 1320c–5, or 1395u(j)(2) of this title and when the person furnishing such item or service knew or had reason to know of the exclusion (after a reasonable time period after reasonable notice has been furnished to the person); or (10) in a manner inconsistent with the Assisted Suicide Funding Restriction Act of 1997 [42 U.S.C. 14401 et seq.]. (b) The Secretary may waive the limitation contained in subsection (a)(1) and (4) upon the State’s request for such a waiver if he finds that the request describes extraordinary circumstances to justify the waiver and that permitting the waiver will contribute to the State’s ability to carry out the purposes of this division.2 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 1397dd Allotments Amends
42 U.S.C. § 1397dd — at 1397dd(c)
The law today
(a) Appropriation; total allotment For the purpose of providing allotments to States under this section, subject to subsection (d), there is appropriated, out of any money in the Treasury not otherwise appropriated— (1) for fiscal year 1998, $4,295,000,000; (2) for fiscal year 1999, $4,275,000,000; (3) for fiscal year 2000, $4,275,000,000; (4) for fiscal year 2001, $4,275,000,000; (5) for fiscal year 2002, $3,150,000,000; (6) for fiscal year 2003, $3,150,000,000; (7) for fiscal year 2004, $3,150,000,000; (8) for fiscal year 2005, $4,050,000,000; (9) for fiscal year 2006, $4,050,000,000; (10) for fiscal year 2007, $5,000,000,000; (11) for fiscal year 2008, $5,000,000,000.1 (12) for fiscal year 2009, $10,562,000,000; (13) for fiscal year 2010, $12,520,000,000; (14) for fiscal year 2011, $13,459,000,000; (15) for fiscal year 2012, $14,982,000,000; (16) for fiscal year 2013, $17,406,000,000; (17) for fiscal year 2014, $19,147,000,000; (18) for fiscal year 2015, for purposes of making 2 semi-annual allotments— (A) $2,850,000,000 for the period beginning on October 1, 2014, and ending on March 31, 2015, and (B) $2,850,000,000 for the period beginning on April 1, 2015, and ending on September 30, 2015; (19) for fiscal year 2016, $19,300,000,000; (20) for fiscal year 2017, for purposes of making 2 semi-annual allotments— (A) $2,850,000,000 for the period beginning on October 1, 2016, and ending on March 31, 2017; and (B) $2,850,000,000 for the period beginning on April 1, 2017, and ending on September 30, 2017; (21) for fiscal year 2018, $21,500,000,000; (22) for fiscal year 2019, $22,600,000,000; (23) for fiscal year 2020, $23,700,000,000; (24) for fiscal year 2021, $24,800,000,000; (25) for fiscal year 2022, $25,900,000,000; (26) for fiscal year 2023, for purposes of making two semi-annual allotments— (A) $2,850,000,000 for the period beginning on October 1, 2022, and ending on March 31, 2023; and (B) $2,850,000,000 for the period beginning on April 1, 2023, and ending on September 30, 2023; (27) for each of fiscal years 2024 through 2028, such sums as are necessary to fund allotments to States under subsections (c) and (m); and (28) for fiscal year 2029, for purposes of making two semi-annual allotments— (A) $7,650,000,000 for the period beginning on October 1, 2028, and ending on March 31, 2029; and (B) $7,650,000,000 for the period beginning on April 1, 2029, and ending on September 30, 2029. (b) Allotments to 50 States and District of Columbia (1) In general Subject to paragraph (4) and subsections (d) and (m), of the amount available for allotment under subsection (a) for a fiscal year, reduced by the amount of allotments made under subsection (c) (determined without regard to paragraph (4) thereof) for the fiscal year, the Secretary shall allot to each State (other than a State described in such subsection) with a State child health plan approved under this subchapter the same proportion as the ratio of— (A) the product of (i) the number of children described in paragraph (2) for the State for the fiscal year and (ii) the State cost factor for that State (established under paragraph (3)); to (B) the sum of the products computed under subparagraph (A). (2) Number of children (A) In general The number of children described in this paragraph for a State for— (i) each of fiscal years 1998 and 1999 is equal to the number of low-income children in the State with no health insurance coverage for the fiscal year; (ii) fiscal year 2000 is equal to— (I) 75 percent of the number of low-income children in the State for the fiscal year with no health insurance coverage, plus (II) 25 percent of the number of low-income children in the State for the fiscal year; and (iii) each succeeding fiscal year is equal to— (I) 50 percent of the number of low-income children in the State for the fiscal year with no health insurance coverage, plus (II) 50 percent of the number of low-income children in the State for the fiscal year. (B) Determination ...41 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
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§ 1397jj Definitions Amends
42 U.S.C. § 1397jj
The law today
(a) Child health assistance For purposes of this subchapter, the term “child health assistance” means payment for part or all of the cost of health benefits coverage for targeted low-income children that includes any of the following (and includes, in the case described in section 1397ee(a)(1)(D)(i) of this title, payment for part or all of the cost of providing any of the following), as specified under the State plan: (1) Inpatient hospital services. (2) Outpatient hospital services. (3) Physician services. (4) Surgical services. (5) Clinic services (including health center services) and other ambulatory health care services. (6) Prescription drugs and biologicals and the administration of such drugs and biologicals, only if such drugs and biologicals are not furnished for the purpose of causing, or assisting in causing, the death, suicide, euthanasia, or mercy killing of a person. (7) Over-the-counter medications. (8) Laboratory and radiological services. (9) Prenatal care and prepregnancy family planning services and supplies. (10) Inpatient mental health services, other than services described in paragraph (18) but including services furnished in a State-operated mental hospital and including residential or other 24-hour therapeutically planned structured services. (11) Outpatient mental health services, other than services described in paragraph (19) but including services furnished in a State-operated mental hospital and including community-based services. (12) Durable medical equipment and other medically-related or remedial devices (such as prosthetic devices, implants, eyeglasses, hearing aids, dental devices, and adaptive devices). (13) Disposable medical supplies. (14) Home and community-based health care services and related supportive services (such as home health nursing services, home health aide services, personal care, assistance with activities of daily living, chore services, day care services, respite care services, training for family members, and minor modifications to the home). (15) Nursing care services (such as nurse practitioner services, nurse midwife services, advanced practice nurse services, private duty nursing care, pediatric nurse services, and respiratory care services) in a home, school, or other setting. (16) Abortion only if necessary to save the life of the mother or if the pregnancy is the result of an act of rape or incest. (17) Dental services. (18) Inpatient substance use treatment services and residential substance use treatment services. (19) Outpatient substance use treatment services. (20) Case management services. (21) Care coordination services. (22) Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders. (23) Hospice care (concurrent, in the case of an individual who is a child, with care related to the treatment of the child’s condition with respect to which a diagnosis of terminal illness has been made.1 (24) Any other medical, diagnostic, screening, preventive, restorative, remedial, therapeutic, or rehabilitative services (whether in a facility, home, school, or other setting) if recognized by State law and only if the service is— (A) prescribed by or furnished by a physician or other licensed or registered practitioner within the scope of practice as defined by State law, (B) performed under the general supervision or at the direction of a physician, or (C) furnished by a health care facility that is operated by a State or local government or is licensed under State law and operating within the scope of the license. (25) Premiums for private health care insurance coverage. (26) Medical transportation. (27) Enabling services (such as transportation, translation, and outreach services) only if designed to increase the accessibility of primary and preventive health care services for eligible low-income individuals. (28) Any other health care services or items specified by the Secretary and not excluded under this s...41 other bills also change this section · Follow it → Official text at uscode.house.gov ↗
Also cites: 11 U.S.C. § 704, 21 U.S.C. § 321, 26 U.S.C. § 35, 26 U.S.C. § 223, 26 U.S.C. § 1381, 26 U.S.C. § 9832, 29 U.S.C. § 158, 42 U.S.C. § 262, 42 U.S.C. § 295p, 42 U.S.C. § 300gg-91, 42 U.S.C. § 1320a-7b, 42 U.S.C. § 1395dd and 6 more
Action History
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Referred to the Subcommittee on Health, Employment, Labor, and Pensions.
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Referred to the Subcommittee on Government Organization, Efficiency, and Financial Management .
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Referred to the Subcommittee on Health.
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Referred to the Subcommittee Indian and Alaska Native Affairs.
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Referred to the Subcommittee on the Constitution.
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Referred to House Oversight and Government Reform
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Referred to House Appropriations
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Referred to House Rules
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Referred to House Judiciary
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Referred to House Ways and Means
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Referred to House Administration
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Referred to House Natural Resources
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Referred to House Education and the Workforce
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Referred to House Budget
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Referred to House Energy and Commerce
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Referred to the Committee on Energy and Commerce, and in addition to the Committees on the Budget, Education and the Workforce, Natural Resources, House Administration, Ways and Means, the Judiciary, Rules, Appropriations, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsors
- Dan Burton · Primary
Sponsorship breakdown
Export CSV (upgrade) →1 sponsors · 0 co-sponsors · 546 not signed on
Sponsors (1)
- Dan Burton
Co-sponsors (0)
None.
Not signed on (546)
546 members have not signed on to this bill.
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Frequently asked questions
- What does HR 105 do?
- Empowering Patients First Act - Repeals the Patient Protection and Affordable Care Act and the health care provisions of the Health Care and Education and Reconciliation Act of 2010, effective as of their enactment. Restores or revives provisions amended or repealed by such Act or such health care provisions. Amends the Internal Revenue Code to allow a tax credit for qualified health insurance costs to residents of a state that implements a high-risk pool, a reinsurance pool, or other risk-adjustment mechanism. Amends the Public Health Service Act to provide for the establishment and governance of individual membership associations (IMAs) to make available health benefits coverage to IMA members and their dependents. Small Business Health Fairness Act of 2011 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to provide for establishment and governance of association health plans, which are group health plans whose sponsors are trade, industry, professional, chamber of commerce, or similar business associations and which meet certain ERISA certification requirements. Directs that the laws of the state designated by a health insurance issuer (primary state) shall apply to individual health insurance coverage offered by that issuer in the primary state and in any other state (secondary state), but only if the coverage and issuer comply with conditions of this Act. Amends title XXI (Children's Health Insurance) (CHIP, formerly known as SCHIP) of the Social Security Act (SSA) to: (1) require a state CHIP plan to specify how it will achieve coverage for 90% of targeted low-income children; and (2) prohibit CHIP payments for children with family income above 300% of the applicable poverty line. Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 - Sets conditions for lawsuits arising from health care liability claims regarding health care goods or services or any medical product affecting interstate commerce. Establishes a statute of limitations and limits noneconomic and punitive damages. Permits a group health plan to vary premiums and cost-sharing by up to 50% of the benefits based on participation (or lack of participation) in a wellness program. Requires a health insurance issuer to provide claims information, on request, to a plan, plan sponsor, or plan administrator. Prohibits the Secretary of Health and Human Services (HHS) from using comparative effectiveness research to deny coverage of an item or service under a federal health care program. Authorizes a state to establish a Health Plan and Provider Portal website to standardize information on health insurance plans available in the state. Revises the formula for determining rates in the fee schedule for Medicare physician payments. Sets forth provisions regarding students loans and loan repayment for health care professionals. Establishes discretionary spending limits for FY2011-FY2020 for new budget authority in the nondefense category. Amends the Balanced Budget and Emergency Deficit Control Act of 1985 to reinstate budget provisions related to deficit reductions during a recession. Rescinds unobligated balances of certain discretionary appropriations made available under the American Recovery and Reinvestment Act of 2009. Repeals other provisions of such Act, including provisions providing fiscal assistance to states and setting limits on executive compensation.
- Who sponsors HR 105?
- HR 105 is sponsored by Dan Burton.
- What is the current status of HR 105?
- This bill died with 112th Congress. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
- Where can I track HR 105?
- Track HR 105 free on One Click Politics — get push/email alerts when it moves.
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