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Wynn

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So the motion to lay the appeal of the ruling of the Chair on the table was agreed to.

A motion to reconsider the vote whereby said motion was agreed to was, by unanimous consent, laid on the table.

The SPEAKER pro tempore, Mr. HASTINGS of Washington, recognized the gentleman from Texas [Mr. DELAY] to proceed in order.

After further debate,

The question being put, viva voce, Will the House now consider the motion to recommit with instructions?

The SPEAKER pro tempore, Mr. HASTINGS of Washington, announced that the nays appeared to have it.

Mr. BONIOR demanded a recorded vote on the question as to whether the House should consider the motion to recommit with instructions, which demand was supported by one-fifth of a quorum, so a recorded vote was dered.

The vote was taken by electronic device.

It was decided in the Yeas negative

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192

Nays

228

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Visclosky
Volkmer
Ward
Waters
Watt (NC)
Waxman

Woolsey

Latham
LaTourette
Laughlin
Lazio
Lewis (CA)
Lewis (KY)
Lightfoot
Linder
Livingston
LoBiondo
Longley
Lucas

Allard

Archer

Armey

Bachus

Baesler

Baker (CA)

Baker (LA)
Ballenger
Barr

Barrett (NE)

Forbes

Bartlett

Fox

Barton

Franks (CT)
Franks (NJ)

Bateman

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Funderburk

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So, the question of consideration of said motion was resolved in the negative.

Mr. ORTON moved to recommit the bill to the Committee on Ways and Means with instructions to report the bill back to the House forthwith with the following amendment:

On page 60, strike lines 5 through 15 and insert the following:

SEC. 205. EFFECTIVE DATES.

This title and the amendments made by it shall take effect and apply to measures enacted after the date of its enactment and shall have no force or effect on or after January 1, 2005.

After debate,

By unanimous consent, the previous question was ordered on the motion to recommit with instructions.

The question being put, viva voce, Will the House recommit said bill with instructions?

The SPEAKER pro tempore, Mr. HASTINGS of Washington, announced that the nays had it.

Mr. ORTON demanded that the vote be taken by the yeas and nays, which demand was supported by one-fifth of the Members present, so the yeas and nays were ordered.

The vote was taken by electronic device.

It was decided in the negative

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Ney

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Myers
Myrick,
Nethercutt
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Norwood

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Dingell

Jacobs

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Packard

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Parker

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Petri
Pombo

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Porter

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Johnson (SD)

Johnson, E. B.

Johnston
Kanjorski

Kaptur

Kennedy (MA) Kennedy (RI)

Portman

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Hostettler
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Pryce

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137.18 MESSAGE FROM THE PRESIDENT

NATIONAL ENDOWMENT FOR THE ARTS The SPEAKER pro tempore, Mr. KOLBE, laid before the House a message from the President, which was read as follows:

To the Congress of the United States:

It is my special pleasure to transmit herewith the Annual Report of the National Endowment for the Arts for the fiscal year 1994.

Over the course of its history, the National Endowment for the Arts has awarded grants for arts projects that reach into every community in the Nation. The agency's mission is public service through the arts, and it fulfills this mandate through support of artistic excellence, our cultural heritage and traditions, individual creativity, education, and public and private partnerships for the arts. Perhaps most importantly, the Arts Endowment encourages arts organizations to reach out to the American people, to bring in new audiences for the performing, literary, and visual arts.

The results over the past 30 years can be measured by the increased presence of the arts in the lives of our fellow citizens. More children have contact with working artists in the classroom, at children's museums and festivals, and in the curricula. More older Americans now have access to museums, concert halls, and other venues. The arts reach into the smallest and most isolated communities, and in our inner cities, arts programs are often a haven for the most disadvantaged, a place where our youth can rediscover the power of imagination, creativity, and hope.

We can measure this progress as well in our re-designed communities, in the buildings and sculpture that grace our cities and towns, and in the vitality of the local economy whenever the arts arrive. The National Endowment for the Arts works the way a Government agency should work-in partnership with the private sector, in cooperation with State and local government, and in service to all Americans. We enjoy a rich and diverse culture in the United States, open to every citizen, and supported by the Federal Government for our common good and benefit.

WILLIAM J. CLINTON.

THE WHITE HOUSE, March 28, 1996. By unanimous consent, the message, together with the accompanying papers, was referred to the Committee on Economic and Educational Opportunity.

137.19 PROVIDING FOR THE

CONSIDERATION OF H.R. 3103

Mr. GOSS, by direction of the Committee on Rules, called up the following resolution (H. Res. 392):

Resolved, That upon the adoption of this resolution it shall be in order to consider in the House the bill (H.R. 3103) to amend the Internal Revenue Code of 1986 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery,

to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance, and for other purposes. An amendment in the nature of a substitute consisting of the text of H.R. 3160, modified by the amendment specified in part 1 of the report of the Committee on Rules accompanying this resolution, shall be considered as adopted. All points of order against the bill, as amended, and against its consideration are waived (except those arising under section 425(a) of the Congressional Budget Act of 1974). The previous question shall be considered as ordered on the bill, as amended, and on any further amendment thereto to final passage without intervening motion except: (1) two hours of debate on the bill, as amended, with 45 minutes equally divided and controlled by the chairman and ranking minority member of the Committee on Ways and Means, 45 minutes equally divided and controlled by the chairman and ranking minority member of the Committee on Commerce, and 30 minutes equally divided and controlled by the chairman and ranking minority member of the Committee on Economic and Educational Opportunities; (2) the further amendment specified in part 2 of the Committee on Rules, if offered by the minority leader or his designee, which shall be in order without intervention of any point of order (except those arising under section 425(a) of the Congressional Budget Act of 1974) or demand for division of the question, shall be considered as read, and shall be separately debatable for one hour equally divided and controlled by the proponent and an opponent; and (3) one motion to recommit, which may include instructions only if offered by the minority leader or his designee. The yeas and nays shall be considered as ordered on the question of passage of the bill and on any conference report thereon. Clause 5(c) of rule XXI shall not apply to the bill, amendments thereto, or conference reports thereon.

When said resolution was considered. After debate,

Mr. GOSS moved the previous question on the resolution to its adoption or rejection.

The question being put, viva voce, Will the House now order the previous question?

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The roll was called under clause 4. rule XV, and the call was taken by electronic device.

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The SPEAKER pro tempore, Mr. KOLBE, announced that the nays had it.

Mr. GOSS objected to the vote on the ground that a quorum was not present and not voting.

A quorum not being present,

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Archer

Armey

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Baker (CA)

Baker (LA) Ballenger

Barr

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Bartlett
Barton
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A message from the Senate by Mr. Lundregan, one of its clerks, announced that the Senate has passed without amendment a bill and joint resolution of the House of the following titles:

H.R. 3136. An Act to provide for enactment of the Senior Citizens' Right to Work Act of 1996, the Line-Item Veto Act, and the Small Business Growth and Fairness Act of 1996, and to provide for a permanent increase in the public debt limit; and

H.J. Res. 168. Joint resolution waiving certain enrollment requirements with respect to two bills of the One Hundred Fourth Congress.

The message also announced that the Senate agrees, to the report of the committee of conference on the disagreeing votes of the two House on the amendment of the Senate to the bill (H.R. 2854) "An Act to modify the operation of certain agricultural grams".

137.22 HEALTH CARE COVERAGE

pro

Mr. ARCHER, pursuant to House Resolution 392, called up the bill (H.R. 3103) to amend the Internal Revenue Code of 1986 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage,

to simplify the administration of health insurance, and for other purposes.

When said bill was considered and read twice.

Pursuant to House Resolution 392, the following amendment in the nature of a substitute consisting of the text of H.R. 3160, modified by the amendment specified in Part 1 of House Report 104501, was considered as adopted:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. (a) SHORT TITLE.-This Act may be cited as the "Health Coverage Availability and Affordability Act of 1996".

(b) TABLE OF CONTENTS.-The table of contents of this Act is as follows:

Sec. 1. Short title; table of contents.
TITLE I-IMPROVED AVAILABILITY AND

PORTABILITY OF HEALTH INSURANCE
COVERAGE

Subtitle A-Coverage Under Group Health

Plans

Sec. 101. Portability of coverage for previously covered individuals.

Sec. 102. Limitation on preexisting condi-
tion exclusions; no application
to certain newborns, adopted
children, and pregnancy.
exclusions
Sec. 103. Prohibiting
based on
health status and providing for
enrollment periods.

Sec. 104. Enforcement.
Subtitle B-Certain Requirements for Insur-
ers and HMOs in the Group and Individual
Markets

PART 1-AVAILABILITY OF GROUP HEALTH
INSURANCE COVERAGE

Sec. 131. Guaranteed availability of general coverage in the small group market.

Sec. 132. Guaranteed renewability of group coverage.

PART 2-AVAILABILITY OF INDIVIDUAL HEALTH INSURANCE COVERAGE

Sec. 141. Guaranteed availability of indi

vidual health insurance coverage to certain individuals with prior group coverage.

Sec. 142. Guaranteed renewability of individual health insurance COVerage.

PART 3-ENFORCEMENT Sec. 151. Incorporation of provisions for State enforcement with Federal fallback authority.

Subtitle C-Affordable and Available Health Coverage Through Multiple Employer Pooling Arrangements

Sec. 161. Clarification of duty of the Sec

retary of Labor to implement provisions of current law providing for exemptions and solvency standards for multiple employer health plans.

"PART 7-RULES GOVERNING REGULATION OF MULTIPLE EMPLOYER HEALTH PLANS "Sec. 701. Definitions. "Sec. 702. Clarification of duty of the

Secretary to implement provisions of current law providing for exemptions and solvency standards for multiple ployer health plans.

em

"Sec. 703. Requirements relating to sponsors, boards of trustees, and plan operations.

"Sec. 704. Other requirements for exemption.

"Sec. 705. Maintenance of reserves. "Sec. 706. Notice requirements for voluntary termination. "Sec. 707. Corrective actions and mandatory termination.

"Sec. 708. Additional rules regarding State authority.".

Sec. 162. Affordable and available fully insured health coverage through voluntary health insurance associations.

Sec. 163. State authority fully applicable to self-insured multiple employer welfare arrangements providing medical care which are not exempted under new part 7. Sec. 164. Clarification of treatment of single employer arrangements. Sec. 165. Clarification of treatment of certain collectively bargained arrangements.

Sec. 166. Treatment of church plans. Sec. 167. Enforcement provisions relating to multiple employer welfare arrangements.

Sec. 168. Cooperation between Federal and State authorities.

Sec. 169. Filing and disclosure requirements for multiple employer welfare arrangements offering health benefits.

Sec. 170. Single annual filing for all participating employers.

Sec. 171. Effective date; transitional rule.
Subtitle D-Definitions; General Provisions
Sec. 191. Definitions; scope of coverage.
Sec. 192. State flexibility to provide greater
protection.

Sec. 193. Effective date.
Sec. 194. Rule of construction.

Sec. 195. Findings relating to exercise of
commerce clause authority.
TITLE II-PREVENTING HEALTH CARE
FRAUD AND ABUSE; ADMINISTRATIVE
SIMPLIFICATION; MEDICAL LIABILITY

REFORM

Sec. 200. References in title.

Subtitle A-Fraud and Abuse Control
Program

Sec. 201. Fraud and abuse control program.
Sec. 202. Medicare integrity program.
Sec. 203. Beneficiary incentive programs.
Sec. 204. Application of certain health anti-
fraud and abuse sanctions to
fraud and abuse against Federal
health care programs.
Sec. 205. Guidance regarding application of

health care fraud and abuse sanctions.

Subtitle B-Revisions to Current Sanctions for Fraud and Abuse Sec. 211. Mandatory exclusion from participation in medicare and State health care programs.

Sec. 212. Establishment of minimum period of exclusion for certain individuals and entities subject to permissive exclusion from medicare and State health care programs.

Sec. 213. Permissive exclusion of individuals with ownership or control interest in sanctioned entities. Sec. 214. Sanctions against practitioners and persons for failure to comply with statutory obligations.

Sec. 215. Intermediate sanctions for medicare health maintenance organizations.

Sec. 216. Additional exception to anti-kickback penalties for discounting and managed arrangements.

care

Sec. 217. Criminal penalty for fraudulent disposition of assets in order to obtain medicaid benefits.

Sec. 218. Effective date.

Subtitle C-Data Collection

Sec. 221. Establishment of the health care fraud and abuse data collection program.

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"Sec. 1173. Standards for information
transactions and data elements.
"Sec. 1174. Timetables for adoption of
standards.

"Sec. 1175. Requirements.
"Sec. 1176. General penalty for failure to
comply with requirements and
standards.

"Sec. 1177. Wrongful disclosure of indi-
vidually identifiable health in-
formation.

"Sec. 1178. Effect on State law. Sec. 253. Changes in membership and duties. of National Committee on Vital and Health Statistics.

Subtitle G-Duplication and Coordination of Medicare-Related Plans

Sec. 261. Duplication and coordination of medicare-related plans.

Subtitle H-Medical Liability Reform
PART 1-GENERAL PROVISIONS

Sec. 271. Federal reform of health care liability actions.

Sec. 272. Definitions.
Sec. 273. Effective date.

PART 2-UNIFORM STANDARDS FOR HEALTH
CARE LIABILITY ACTIONS

Sec. 281. Statute of limitations.

Sec. 282. Calculation and payment of damages.

Sec. 283. Alternative dispute resolution.

TITLE III-TAX-RELATED HEALTH
PROVISIONS

Sec. 300. Amendment of 1986 code.

Subtitle A-Medical Savings Accounts Sec. 301. Medical savings accounts. Subtitle B-Increase in Deduction for Health Insurance Costs of Self-Employed Individuals

Sec. 311. Increase in deduction for health insurance costs of self-employed individuals.

Subtitle C-Long-Term Care Services and

Contracts

PART I-GENERAL PROVISIONS

Sec. 321. Treatment of long-term care insur

ance.

Sec. 322. Qualified long-term care services treated as medical care.

Sec. 323. Reporting requirements.

PART II-CONSUMER PROTECTION PROVISIONS Sec. 325. Policy requirements.

Sec. 326. Requirements for issuers of long-
term care insurance policies.
Sec. 327. Coordination with State require-
ments.

Sec. 328. Effective dates.
Subtitle D-Treatment of Accelerated Death
Benefits

Sec. 331. Treatment of accelerated death
benefits by recipient.
Sec. 332. Tax treatment of companies
issuing qualified accelerated
death benefit riders.
Subtitle E-High-Risk Pools
Sec. 341. Exemption from income tax for
State-sponsored organizations
providing health coverage for
high-risk individuals.

Subtitle F-Organizations Subject to
Section 833

Sec. 351. Organizations subject to section 833.

TITLE IV-REVENUE OFFSETS Sec. 400. Amendment of 1986 Code.

Subtitle A-Repeal of Bad Debt Reserve Method for Thrift Savings Associations Sec. 401. Repeal of bad debt reserve method for thrift savings associations. Subtitle B-Reform of the Earned Income Credit

Sec. 411. Earned income credit denied to individuals not authorized to be employed in the United States. Subtitle C-Treatment of Individuals Who Lose United States Citizenship Sec. 421. Revision of income, estate, and gift taxes on individuals who lose United States citizenship. Sec. 422. Information on individuals losing United States citizenship. compliance by United States citizens and residents living abroad.

Sec. 423. Report on tax

TITLE I-IMPROVED AVAILABILITY AND

PORTABILITY OF HEALTH INSURANCE COVERAGE

Subtitle A-Coverage Under Group Health Plans

SEC. 101. PORTABILITY OF COVERAGE FOR PREVIOUSLY COVERED INDIVIDUALS.

(a) CREDITING PERIODS OF PREVIOUS COVERAGE TOWARD PREEXISTING CONDITION RESTRICTIONS.-Subject to the succeeding provisions of this section, a group health plan, and an insurer or health maintenance organization offering health insurance coverage in connection with a group health plan, shall provide that any preexisting condition limitation period (as defined in subsection (b)(2)) is reduced by the length of the aggregate period of qualified prior coverage (if any, as defined in subsection (b)(3)) applicable to the participant or beneficiary as of the date of commencement of coverage under the plan. (b) DEFINITIONS AND OTHER PROVISIONS RELATING TO PREEXISTING CONDITIONS.

(1) PREEXISTING CONDITION.—

(A) IN GENERAL.-For purposes of this subtitle, subject to subparagraph (B), the term "preexisting condition" means a condition, regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on the day before

(i) the effective date of the coverage of such participant or beneficiary, or

(ii) the earliest date upon which such coverage could have been effective if there were no waiting period applicable, whichever is earlier.

(B) TREATMENT OF GENETIC INFORMATION.— For purposes of this section, genetic information shall not be considered to be a preexisting condition, so long as treatment of

the condition to which the information is applicable has not been sought during the 6month period described in subparagraph (A). (2) PREEXISTING CONDITION LIMITATION PERIOD. For purposes of this subtitle, the term "preexisting condition limitation period" means, with respect to coverage of an individual under a group health plan or under health insurance coverage, the period during which benefits with respect to treatment of a condition of such individual are not provided based on the fact that the condition is a preexisting condition.

(3) AGGREGATE PERIOD OF QUALIFIED PRIOR COVERAGE.

(A) IN GENERAL.-For purposes of this section, the term "aggregate period of qualified prior coverage" means, with respect to commencement of coverage of an individual under a group health plan or health insurance coverage offered in connection with a group health plan, the aggregate of the qualified coverage periods (as defined in subparagraph (B)) of such individual occurring before the date of such commencement. Such period shall be treated as zero if there is more than a 60-day break in coverage under a group health plan (or health insurance coverage offered in connection with such a plan) between the date the most recent qualified coverage period ends and the date of such commencement.

(B) QUALIFIED COVERAGE PERIOD.—

(i) IN GENERAL.-For purposes of this paragraph, subject to subsection (c), the term "qualified coverage period" means, with respect to an individual, any period of coverage of the individual under a group health plan, health insurance coverage, under title XVIII or XIX of the Social Security Act, coverage under the TRICARE program under chapter 55 of title 10, United States Code, a program of the Indian Health Service, and State health insurance coverage or risk pool, and includes coverage under a health plan offered under chapter 89 of title 5, United States Code.

(ii) DISREGARDING PERIODS BEFORE BREAKS IN COVERAGE.-Such term does not include any period occurring before any 60-day break in coverage described in subparagraph (A).

(C) WAITING PERIOD NOT TREATED AS A BREAK IN COVERAGE.-For purposes of subparagraphs (A) and (B), any period that is in a waiting period for any coverage under a group health plan (or for health insurance coverage offered in connection with a group health plan) shall not be considered to be a break in coverage described in subparagraph (B)(ii).

(D) ESTABLISHMENT OF PERIOD.-A qualified coverage period with respect to an individual shall be established through presentation of certifications described in subsection (c) or in such other manner as may be specified in regulations to carry out this title.

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(1) IN GENERAL.-The plan administrator of a group health plan, or the insurer or HMO offering health insurance coverage in connection with a group health plan, shall, on request made on behalf of an individual covered (or previously covered within the previous 18 months) under the plan or coverage, provide for a certification of the period of coverage of the individual under such plan or coverage and of the waiting period (if any) imposed with respect to the individual for any coverage under the plan.

(2) STANDARD METHOD.-Subject to paragraph (3), a group health plan, or insurer or HMO offering health insurance coverage in connection with a group health plan, shall determine qualified coverage periods under subsection (b)(3)(B) by including all periods described in such subsection, without regard to the specific benefits offered during such a period.

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