[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 192 Introduced in House (IH)]
103d CONGRESS
1st Session
H. R. 192
To provide for improvements to the health of farm families, and for
other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 5, 1993
Mr. Gunderson introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To provide for improvements to the health of farm families, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Farm and Rural Medical Equity Reform
Act of 1993''.
TABLE OF CONTENTS
Sec. 1. Short title.
TITLE I--DEDUCTIBILITY OF HEALTH INSURANCE EXPENSES FOR THE SELF-
EMPLOYED
Sec. 101. Increase in amount of deduction for health insurance costs of
self-employed individuals.
TITLE II--MEDICAL SAVINGS ACCOUNTS
Sec. 202. Unused amounts in flexible spending accounts transferable to
medical savings accounts.
Sec. 203. Deduction for amounts paid for qualified catastrophic
coverage health plan.
TITLE III--UNIFORM CLAIMS; ELECTRONIC CARDS; ELECTRONIC BILLS
Sec. 301. Advisory council on health claim processing standardization.
Sec. 302. Specification and use of uniform health claim reimbursement
forms.
TITLE IV--HEALTH INSURANCE PORTABILITY PROVISIONS
Sec. 401. Limitation on exclusion for pre-existing conditions;
assurance of continuity of coverage.
Sec. 402. Limits on premium increases.
Sec. 403. Definitions.
Sec. 404. Excise tax for violations.
TITLE V--IMPROVED ACCESS TO RURAL HEALTH SERVICES
Subtitle A--Rural Emergency Medical Services Amendments
Sec. 501. Establishment of office of emergency medical services.
Sec. 502. State offices of emergency medical services.
Sec. 503. Programs for rural areas.
Sec. 504. Funding.
Sec. 505. Conforming Amendments.
Subtitle B--Extension of Special Treatment Rules for Medicare
Dependent, Small Rural Hospitals
Sec. 511. Extension of special treatment rules for Medicare dependent,
small rural hospitals.
Subtitle C--Outreach Grant Program
Sec. 521. Establishment of program of grants for rural health outreach.
TITLE I--DEDUCTIBILITY OF HEALTH INSURANCE EXPENSES FOR THE SELF-
EMPLOYED
SEC. 101. INCREASE IN AMOUNT OF DEDUCTION FOR HEALTH INSURANCE COSTS OF
SELF-EMPLOYED INDIVIDUALS.
(a) Increase in Deduction.--Paragraph (1) of section 162(l) of the
Internal Revenue Code of 1986 (relating to special rules for health
insurance costs of self-employed individuals) is amended by striking
``25 percent'' and inserting ``100 percent''.
(b) Deduction Made Permanent.--Subsection (l) of section 162 of
such Code is amended by striking paragraph (6).
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after June 30, 1992.
TITLE II--MEDICAL SAVINGS ACCOUNTS
SEC. 201. MEDICAL SAVINGS ACCOUNTS.
(a) In General.--Part VII of subchapter B of chapter 1 of the
Internal Revenue Code of 1986 (relating to additional itemized
deductions for individuals) is amended by redesignating section 220 as
section 221 and by inserting after section 219 the following new
section:
``SEC. 220. MEDICAL SAVINGS ACCOUNTS.
``(a) Deduction Allowed.--In the case of an eligible individual,
there shall be allowed as a deduction amounts paid in cash during the
taxable year by or on behalf of such individual to a medical savings
account.
``(b) Limitation.--
``(1) In general.--The amount allowable as a deduction
under subsection (a) to an individual for the taxable year
shall not exceed the excess (if any) of--
``(A) the lesser of--
``(i) the applicable limit, or
``(ii) the compensation (as defined in
section 219(f)) includible in the individual's
gross income for the taxable year, over
``(B) the sum of--
``(i) the value of employer-provided
coverage for the medical expenses of such
individual,
``(ii) the amount paid by the individual
(other than from amounts distributed from a
medical savings account) for coverage under
qualified catastrophic coverage health plan for
coverage for such individual, the spouse of
such individual, and dependents (as defined in
section 152) of such individual, plus
``(iii) the aggregate amount contributed to
such account during the taxable year pursuant
to section 125(d)(3).
``(2) Applicable limit.--For purposes of paragraph (1), the
applicable limit is the sum of--
``(A) $4,800, plus
``(B) $600 for each individual who is a dependent
(as defined in section 152) of the individual for whose
benefit the account is established.
``(c) Definitions and Special Rules.--For purposes of this
section--
``(1) Medical savings account.--The term `medical savings
account' means a trust created or organized in the United
States exclusively for the purpose of paying the qualified
medical expenses of the individual for whose benefit the trust
is established, but only if the written governing instrument
creating the trust meets the following requirements:
``(A) A contribution will be accepted unless it is
in cash and contributions will not be accepted for any
taxable year in excess of the applicable limit )as
defined in subsection (b)(2)).
``(B) The trustee is a bank (as defined in section
408(n)) or another person who demonstrates to the
satisfaction of the Secretary that the manner in which
such person will administer the trust will be
consistent with the requirements of this section.
``(C) No part of the trust assets will be invested
in life insurance contracts.
``(D) The assets of the trust will not be
commingled with other property except in a common trust
fund or common investment fund.
``(2) Eligible individual.--The term `eligible individual'
means any individual if--
``(A) Such individual is not covered by any
employer-provided group health plan, or
``(B) such individual is covered by an employer-
provided group health plan which is a qualified
catastrophic coverage health plan and is not covered by
any other health plan.
``(3) Qualified medical expenses.--
``(A) In general.--The term `qualified medical
expenses' means--
``(i) medical expenses, and
``(ii) amounts paid for qualified long-term
care insurance (as defined in section 818(g)).
``(B) Medical expenses.--The term `medical
expenses' means amount paid by the individual for whose
benefit the account was established for medical care
(as defined in section 213) of such individual, the
spouse of such individual, and any dependent (as
defined in section 152) of such individual, but only to
the extent such amounts are not compensated for by
insurance of otherwise.
``(4) Qualified catastrophic coverage health plan.--The
term `qualified catastrophic coverage health plan' means any
health plan which is certified by the Secretary of Health and
Human Services as a plan--
``(A) which provides no compensation for medical
expenses not exceeding $3,000 during any year,
``(B) which requires the individual to pay 15
percent of such individual's medical expenses to the
extent they exceed $3,000 but not $9,000 during any
year, and
``(C) which provides full reimbursement for medical
expenses exceeding $9,000.
``(5) Time when contributions deemed made.--A taxpayer
shall be deemed to have made a contribution on the last day of
the preceding taxable year if the contribution is made on
account of such taxable year and is made not later than the
time prescribed by law for filing the return for such taxable
year (not including extensions thereof).
``(d) Tax Treatment of Distributions.--
``(1) In general.--Except as otherwise provided in this
subsection, any amount paid or distributed out of a medical
savings account shall be included in the gross income of the
individual for whose benefit such account was established
unless such amount is used exclusively to pay the qualified
medical expenses of such individual.
``(2) Excess contributions returned before due date of
return.--Paragraph (1) shall not apply to the distribution of
any contribution paid during a taxable year to a medical
savings account to the extent that such contribution exceeds
the amount allowable as a deduction under subsection (a) if--
``(A) such distribution is received on or before
the day prescribed by law (including extensions of
time) for filing such individual's return for such
taxable year,
``(B) no deduction is allowed under subsection (a)
with respect to such excess contribution, and
``(C) such distribution is accompanied by the
amount of net income attributable to such excess
contribution.
Any net income described in subparagraph (C) shall be included
in the gross income of the individual for the taxable year in
which it is received.
``(e) Tax Treatment of Accounts.--
``(1) Exemption from tax.--A medical savings account is
exempt from taxation under this subtitle unless such account
has ceased to be an investment savings account by reason of
paragraph (2). Notwithstanding the preceding sentence, any such
account is subject to the taxes imposed by section 511
(relating to imposition of tax on unrelated business income of
charitable, etc. organizations).
``(2) Loss of exemption of account where individual engages
in prohibited transaction.--
``(A) In general.--If, during any taxable year of
the individual for whose benefit the medical savings
account was established, such individual engages in any
transaction prohibited by section 4975 with respect to
the account, the account ceases to be a medical savings
account as of the first day of that taxable year.
``(B) Account treated as distributing all its
assets.--In any case in which any account ceases to be
a medical savings account by reason of subparagraph (A)
on the first day of any taxable year, paragraph (1) of
subsection (d) applies as if there were a distribution
on such first day in an amount equal to the fair market
value (on such first day) of all assets in the account
(on such first day).
``(3) Effect of pledging account as security.--If, during
any taxable year, the individual for whose benefit a medical
savings account was established uses the account or any portion
thereof as security for a loan, the portion so used is treated
as distributed to that individual.
``(f) Additional Tax on Certain Amounts Included in Gross Income.--
``(1) Distribution not used for qualified medical
expenses.--If a distribution from a medical savings account is
made, and not used to pay the qualified medical expenses of the
individual for whose benefit the account was established, the
tax liability of such individual for the taxable year in which
such distribution is received shall be increased by an amount
equal to 10 percent of the amount of the distribution which is
includible in gross income for such taxable year.
``(2) Disqualification cases.--If an amount is includible
in the gross income of an individual for a taxable year under
subsection (e), his tax under this chapter for such taxable
year shall be increased by an amount equal to 10 percent of
such amount includible in his gross income.
``(3) Disability or death cases.--Paragraphs (1) and (2) do
not apply if the payment or distribution is made after the
individual for whose benefit the medical savings account was
established becomes disabled within the meaning of section
72(m)(7) or dies.
``(g) Special Rules.--
``(1) Community property laws.--This section shall be
applied without regard to any community property laws.
``(2) Custodial accounts.--For purposes of this section, a
custodial account shall be treated as a trust if--
``(A) the assets of such account are held by a bank
(as defined in section 408(n)) or another person who
demonstrates to the satisfaction of the Secretary that
the manner in which he will administer the account will
be consistent with the requirements of this section,
and
``(B) the custodial account would, except for the
fact that it is not a trust, constitute a medical
savings account described in subsection (c).
For purposes of this title, in the case of a custodial account
treated as a trust by reason of the preceding sentence, the
custodian of such account shall be treated as the trustee
thereof.
``(3) Denial of deductions.--No amount paid or distributed
from a medical savings account shall be taken into account in
determining the deduction provided by section 213.
``(h) Inflation Adjustment.--
``(1) In general.--In the case of any taxable year
beginning in a calendar year after 1994, each applicable dollar
amount shall be increased by an amount equal to--
``(A) such dollar amount, multiplied by
``(B) the cost-of-living adjustment for the
calendar year in which the taxable year begins.
``(2) Cost-of-living adjustment.--For purposes of paragraph
(1), the cost-of-living adjustment for any calendar year is the
percentage (if any) by which--
``(A) the deemed average total wages (as defined in
section 209(k) of the Social Security Act) for the
preceding calendar year, exceeds
``(B) the deemed average total wages (as so
defined) for calendar year 1993.
``(3) Applicable dollar amount.--For purposes of paragraph
(1), the term `applicable dollar amount' means--
``(A) the $4,800 and $600 amounts in subsection
(b), and
``(B) the $3,000 and $9,000 amounts in subsection
(c)(4).
``(4) Rounding.--If any amount as adjusted under paragraph
(1) is not a multiple of $10, such amount shall be rounded to
the nearest multiple of $10 (or, if such amount is a multiple
of $5 and not of $10, such amount shall be rounded to the next
highest multiple of $10).
``(i) Reports.--The trustee of a medical savings account shall make
such reports regarding such account to the Secretary and to the
individual for whose benefit the account is maintained with respect to
contributions, distributions, and such other matters as the Secretary
may require under regulations. The reports required by this subsection
shall be filed at such time and in such manner and furnished to such
individuals at such time and in such manner as may be required by those
regulations.''.
(b) Deduction Allowed in Arriving at Adjusted Gross Income.--
Paragraph (7) of section 62(a) of such Code (relating to retirement
savings) is amended--
(1) by inserting ``or medical expense'' after
``Retirement'' in the heading of such paragraph, and
(2) by inserting before the period at the end thereof the
following: ``and the deduction allowed by section 220 (relating
to deduction of certain payments to medical savings
accounts)''.
(c) Tax on Excess Contributions.--Section 4973 of such Code
(relating to tax on excess contributions to individual retirement
accounts, certain section 403(b) contracts, and certain individual
retirement annuities) is amended--
(1) by inserting ``medical savings accounts,'' after
``accounts,'' in the heading of such section,
(2) by redesignating paragraph (2) of subsection (a) as
paragraph (3) and by inserting after paragraph (1) the
following:
``(2) a medical savings account (within the meaning of
section 220(c)),'',
(3) by striking ``or'' at the end of paragraph (1) of
subsection (a), and
(4) by adding at the end thereof the following new
subsection:
``(d) Excess Contributions to Medical Savings Accounts.--For
purposes of this section, in the case of a medical savings account, the
term `excess contributions' means the amount by which the amount
contributed for the taxable year to the account exceeds the amount
allowable as a deduction under section 220 for such taxable year. For
purposes of this subsection, any contribution which is distributed out
of the medical savings account and a distribution to which section
220(d)(2) applies shall be treated as an amount not contributed.''.
(d) Tax on Prohibited Transactions.--Section 4975 of such Code
(relating to prohibited transactions) is amended--
(1) by adding at the end of subsection (c) the following
new paragraph:
``(4) Special rule for medical savings accounts.--An
individual for whose benefit a medical savings account is
established shall be exempt from the tax imposed by this
section with respect to any transaction concerning such account
(which would otherwise be taxable under this section) if, with
respect to such transaction, the account ceases to be a medical
savings account by reason of the application of section
220(e)(2)(A) to such account.'', and
(2) by inserting ``or a medical savings account described
in section 220(c)'' in subsection (e)(1) after ``described in
section 408(a)''.
(e) Failure To Provide Reports on Medical Savings Accounts.--
Section 6693 of such Code (relating to failure to provide reports on
individual retirement account or annuities) is amended--
(1) by inserting ``or on medical savings accounts'' after
``annuities'' in the heading of such section, and
(2) by adding at the end of subsection (a) the following:
``The person required by section 220(i) to file a report
regarding a medical savings account at the time and in the
manner required by such section shall pay a penalty of $50 for
each failure unless it is shown that such failure is due to
reasonable cause.''
(f) Clerical Amendments.--
(1) The table of sections for part VII of subchapter B of
chapter 1 of such Code is amended by striking the item relating
to section 220 and inserting the following:
``Sec. 220. Medical savings accounts.
``Sec. 221. Cross reference.''.
(2) The table of sections for chapter 43 of such Code is
amended by striking the item relating to section 4973 and
inserting the following:
``Sec. 4973. Tax on excess contributions to individual retirement
accounts, medical savings accounts, certain
403(b) contracts, and certain individual
retirement annuities.''.
(3) The table of sections for subchapter B of chapter 68 of
such Code is amended by inserting ``or on medical savings
accounts'' after ``annuities'' in the item relating to section
6693.
(g) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 1993.
SEC. 202. UNUSED AMOUNTS IN FLEXIBLE SPENDING ACCOUNTS TRANSFERABLE TO
MEDICAL SAVINGS ACCOUNTS.
(a) In General.--Subsection (d) of section 125 of the Internal
Revenue Code of 1986 (relating to cafeteria plans) is amended by adding
at the end thereof the following new paragraph:
``(3) Unused amounts transferable to medical savings
accounts.--
``(A) In general.--Subsection (a) shall not fail to
apply to a participant in a plan, and a plan shall not
fail to be treated as a cafeteria plan, solely because
under the plan amounts not paid out as reimbursements
under a flexible spending arrangement for health and
disability for the benefit of an individual are
contributed to a medical savings account (as defined in
section 220(c)) for the benefit of such individual.
``(B) Special rules.--
``(i) Timing of contributions.--
Contributions made under this paragraph shall
be made on the last day of the plan year of the
cafeteria plan.
``(ii) Availability requirement.--
Subparagraph (A) shall apply only if the plan
is available to at least 80 percent of the
employees of the employer. For purposes of the
preceding sentence, there shall be excluded
employees who are excluded under section
414(q)(8) or who would be so excluded if `30'
were substituted for `17\1/2\' in subparagraph
(B) thereof.''.
(b) Treatment of Amounts Received by Qualified Cash or Deferred
Arrangement.--
(1) Paragraph (2) of section 401(k) of such Code is amended
by striking ``and'' at the end of subparagraph (C), by striking
the period at the end of subparagraph (D) and inserting ``,
and'', and by adding at the end thereof the following new
subparagraph:
``(E) which provides that, with respect to amounts
held by the trust which are attributable to
contributions made to the trust pursuant to section
125(d)(3)--
``(i) an employee's right to such amounts
is nonforfeitable, and
``(ii) such amounts may be used only to pay
expenses (not compensated for by insurance or
otherwise) for the medical care (as defined in
section 213) of the employee, the spouse of the
employee, or any dependent (as defined in
section 152) of the employee.''.
(2) Subsection (k) of section 401 of such Code is amended
by adding at the end thereof the following new paragraph:
``(11) Treatment of amounts received from medical savings
arrangements.--Contributions made to a trust by reason of
section 125(d)(3) shall not be taken into account under
paragraph (3)(A)(ii), and subsection (1) shall not apply to
such contributions.''.
(c) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after December 31, 1993.
SEC. 203. DEDUCTION FOR AMOUNTS PAID FOR QUALIFIED CATASTROPHIC
COVERAGE HEALTH PLAN.
(a) In General.--Section 213 of the Internal Revenue Code of 1986
(relating to medical, dental, etc., expenses) is amended adding at the
end thereof the following new subsection:
``(g) Full Deduction for Amounts Paid for Qualified Catastrophic
Coverage Health Plans.--In the case of amounts paid for coverage under
a qualified catastrophic coverage health plan (as defined in section
220(c))--
``(1) subsection (a) shall be applied without regard to the
limitation based on adjusted gross income, and
``(2) such amounts shall not be taken into account in
determining whether any other amounts are allowable as a
deduction under this section.''.
(b) Technical Amendment.--Paragraph (2) of section 162(l) of such
Code is amended by adding at the end thereof the following new
subparagraph:
``(C) Qualified catastrophic coverage.--Paragraph
(1) shall not apply to any amount allowed as a
deduction under section 213 for amounts paid for
coverage under a qualified catastrophic coverage health
plan (as defined in section 220(c)).''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 1993.
TITLE III--UNIFORM CLAIMS; ELECTRONIC CARDS; ELECTRONIC BILLING
SEC. 301. ADVISORY COUNCIL ON HEALTH CLAIM PROCESSING STANDARDIZATION.
(a) Establishment.--The Secretary of Health and Human Services (in
this title referred to as the ``Secretary'') shall establish an
Advisory Council on Health Claim Processing Standardization (in this
title referred to as the ``Council'').
(b) Composition.--The Council shall consist of 15 members appointed
by the Secretary and shall include individuals representative of the
health care community.
(c) Recommendations.--Not later than 2 years after a majority of
its members are appointed, the Council shall submit to the Secretary
recommendations concerning--
(1) standards for uniform health claim reimbursement forms
for hospitals and physicians and the information to be
contained on such forms;
(2) standards for electronic cards that could be used to
store a patient's insurance information and medical records;
and
(3) the computerization of health claim billing and the use
of electronic means to transmit billing information from
hospitals and physicians to insurers and the Secretary.
SEC. 302. SPECIFICATION AND USE OF UNIFORM HEALTH CLAIM REIMBURSEMENT
FORMS.
(a) Establishment.--Taking into account the recommendations of the
Council under section 301(c)(1), the Secretary shall specify a uniform
health claim reimbursement form for use by hospitals and such a form
for use by physicians.
(b) Use.--(1) Each insurer or other entity responsible for
administration of a health benefit plan shall require the use of the
appropriate form specified under subsection (a) for claims for hospital
services or physician services in the United States under the plan.
(2) The requirement of paragraph (1) shall apply with respect to
claims for reimbursement submitted under a health benefit plan more
than 6 months after the date of the Secretary specifies the forms under
subsection (a).
(c) Health Benefit Plan Defined.--The term ``health benefit plan''
means any hospital or medical expense incurred policy or certificate,
hospital or medical service plan contract, health maintenance
subscriber contract, multiple employer welfare arrangement, employee
benefit plan (as defined under the Employee Retirement Income Security
Act of 1974) that provides benefits with respect to health care
services, or the medicare or medicaid programs, but does not include--
(1) coverage only for accident, dental, vision, disability
income, or long-term care insurance, or any combination
thereof,
(2) coverage issued as a supplement to liability insurance,
(3) worker's compensation or similar insurance, or
(4) automobile medical-payment insurance, or any
combination thereof.
TITLE IV--HEALTH INSURANCE PORTABILITY PROVISIONS
SEC. 401. LIMITATION ON EXCLUSION FOR PRE-EXISTING CONDITIONS;
ASSURANCE OF CONTINUITY OF COVERAGE.
(a) Limitations on Treatment of Pre-Existing Conditions.--Subject
to subsection (c), a carrier may not impose (or require an employer to
impose through a waiting period for coverage under a group health plan
or similar requirement) a limitation or exclusion of benefits under a
group health plan relating to treatment of a condition based on the
fact that the condition pre-existed the effectiveness of the coverage
if--
(1) the condition relates to a condition that was not
diagnosed or treated within 3 months before the date of
coverage under the plan;
(2) the limitation or exclusion extends over more than 6
months after the date of coverage under the plan;
(3) the limitation or exclusion applies to an individual
who, as of the date of birth, was covered under the plan or
whose mother, as of such date, was covered under the plan; or
(4) the limitation or exclusion relates to pregnancy.
In the case of an individual who is eligible for coverage under an
employer health benefit plan but for a waiting period imposed by the
employer, in applying paragraphs (1) and (2), the individual shall be
treated as having been covered under the plan as of the earliest date
of the beginning of the waiting period.
(b) Assurance of Continuity of Coverage Through Previous
Satisfaction of Pre-Existing Condition Requirement.--
(1) In general.--Each carrier shall waive any period
applicable to a preexisting condition for similar benefits with
respect to an individual to the extent that the individual was
covered for the condition under any health benefit plan that
was in effect before the date of the enrollment under the
carrier's plan.
(2) Continuous coverage required.--
(A) In general.--Paragraph (1) shall no longer
apply if there is a continuous period of more than 60
days on which the individual was not covered under a
health benefit plan.
(B) Treatment of waiting periods.--In applying
subparagraph (A), any waiting period imposed by an
employer before an employee is eligible to be covered
under a policy shall be treated as a period in which
the employee was covered under a health benefit plan.
(3) Exclusion of cash-only and dread disease policies.--In
this subsection, the term ``health benefit plan'' does not
include any insurance which is offered primarily to provide--
(A) coverage for a specified disease or illness, or
(B) hospital or fixed indemnity policy, unless the
Secretary (or in the case of a plan in a State, the
State) determines that such a policy provides
sufficiently comprehensive coverage of a benefit so
that it should be treated as a health benefit plan
under this subsection.
(c) Regulatory Authority.--The Secretary is authorized directly, or
through the states, to issue such regulations as may be required to
carry out this section.
(d) Effective Date.--
(1) In general.--The amendments made by this section shall
apply to coverage provided under a group health plan on or
after the first day of the first month beginning more than 1
year after the date of the enactment of this Act.
(2) Application.--In applying paragraph (1), coverage
provided before the effective date shall be taken into account
in applying this section.
SEC. 402. LIMITS ON PREMIUM INCREASES.
(a) In General.--A carrier may not provide for an increase in the
premium charged a small employer for a small employer health benefit
plan in a percentage that exceeds the percentage change in the premium
charged under the plan for a newly covered employer within the same
class of business plus 15 percentage points.
(b) A carrier will only be allowed to set the maximum percent
increase in renewal premiums at 5 percent plus the percent change in
the base premium rate.
(c) Effective Date.--Subsection (a) shall apply to premiums for
plans renewed more than 1 year after the date of the enactment of this
Act.
SEC. 403. DEFINITIONS.
In this title:
(1) The term ``carrier'' means any entity which provides
health insurance or health benefits in a State, and includes a
licensed insurance company, a prepaid hospital or medical
service plan, a health maintenance organization, the plan
sponsor of a multiple employer welfare arrangement or an
employee benefit plan (as defined under the Employee Retirement
Income Security Act of 1974), or any other entity providing a
plan of health insurance subject to State insurance regulation.
(2) The term ``employer health benefit plan'' means a
health benefit plan (including an employee welfare benefit
plan, as defined in section 3(1) of the Employee Retirement
Income Security Act of 1974) which is offered to employees
through an employer and for which the employer provides for any
contribution to such plan or any premium for such plan are
deducted by the employer from compensation to the employee.
(3) The term ``full-time employee'' means, with respect to
an employer, an individual who normally is employed for at
least thirty hours per week by the employer.
(4) The term ``small employer'' means an entity actively
engaged in business which, on at least 50 percent of its
working days during the preceding year, employed at least two,
but no more than one hundred, full-time employees. For purposes
of determining if an employer is a small employer, rules
similar to the rules of subsection (b) and (c) of section 414
of the Internal Revenue Code of 1986 shall apply.
(5) The term ``small employer carrier'' means a carrier
with respect to the issuance of a small employer health benefit
plan.
(6) The term ``small employer health benefit plan'' means
an employer health benefit plan which provides coverage to one
or more full-time employees of a small employer.
(7) The term ``base premium rate'' means the lowest premium
that the insurer may charge for a group with similar
demographic characteristics, excluding factors related to
health status, claims history, or duration of coverage.
(8) The term ``State'' means the 50 States, the District of
Columbia, Puerto Rico, the Virgin Islands, Guam, and American
Samoa.
SEC. 404. EXCISE TAX FOR VIOLATIONS.
(a) In General.--Chapter 47 of the Internal Revenue Code of 1986
(relating to taxes on group health plans) is amended by adding at the
end thereof the following new section:
``SEC. 5000A. FAILURE TO SATISFY CERTAIN STANDARDS FOR HEALTH
INSURANCE.
``(a) General Rule.--
``(1) Tax for portability violations.--There is hereby
imposed a tax on a carrier for violating a requirement of
section 401 of the Farm and Rural Equity Reform Act of 1993,
and
``(2) Tax for excessive premium increase.--There is hereby
imposed a tax on a carrier providing for a premium increase in
violation of section 402 of the Farm and Rural Medical Equity
Reform Act of 1993.
``(3) Determination of violations.--The Secretary of Health
and Human Services shall determine whether any carrier meets
the requirements of such sections.
``(b) Amount of Tax.--
``(1) In general.--The amount of tax imposed by subsection
(a) by reason of 1 or more violations during a taxable year
shall be equal to 25 percent of the gross premiums received
during such taxable year with respect to the employer health
benefit plan with respect to which the violation occurred.
``(2) Gross premiums.--For purposes of paragraph (1), gross
premiums shall include any consideration received with respect
to any health benefit plan.
``(3) Controlled groups.--For purposes of paragraph (1)--
``(A) Controlled group of corporations.--All
corporations which are members of the same controlled
group of corporations shall be treated as 1 person. For
purposes of the preceding sentence, the term
`controlled group of corporations' has the meaning
given to such term by section 1563(a), except that--
``(i) `more than 50 percent' shall be
substituted for `at least 80 percent' each
place it appears in section 1563(a)(1), and
``(ii) the determination shall be made
without regard to subsections (a)(4) and
(e)(3)(C) of section 1563.
``(B) Partnerships, proprietorships, etc., which
are under common control.--Under regulations prescribed
by the Secretary, all trades or business (whether or
not incorporated) which are under common control shall
be treated as 1 person. The regulations prescribed
under this subparagraph shall be based on principles
similar to the principles which apply in the case of
subparagraph (A).
``(c) Limitation on Tax.--
``(1) Tax not to apply where failure not discovered
exercising reasonable diligence.--No tax shall be imposed by
subsection (a) with respect to any failure for which it is
established to the satisfaction of the Secretary that the
person on whom the tax is imposed did not know, and exercising
reasonable diligence would not have known, that such failure
existed.
``(2) Tax not to apply where failures corrected within 30
days.--No tax shall be imposed by subsection (a) with respect
to any failure if--
``(A) such failure was due to reasonable cause and
not to willful neglect, and
``(B) such failure is corrected during the 30-day
period beginning on the 1st date any of the persons on
whom the tax is imposed knew, or exercising reasonable
diligence would have known, that such failure existed.
``(3) Waiver by secretary.--In the case of a failure which
is due to reasonable cause and not to willful neglect, the
Secretary may waive part or all of the tax imposed by
subsection (a) to the extent that the payment of such tax would
be excessive relative to the failure involved.
``(d) Carrier; Employer Health Benefit Plan Defined.--For purposes
of this section, the terms `carrier' and `employer health benefit plan'
have the meanings given such terms in section 403 of the Farm and Rural
Medical Equity Reform Act of 1993.''.
(b) Nondeductibility of Tax.--Paragraph (6) of section 275(a) of
such Code (relating to nondeductibility of certain taxes) is amended by
inserting ``47,'' after ``46,''.
(c) Clerical Amendments.--The table of sections for such chapter 47
is amended by adding at the end thereof the following new item:
``Sec. 5000A. Failure to satisfy certain standards for health
insurance.''.
(d) Effective Dates.--
(1) In general.--The amendments made by subsections (a) and
(c) shall take effect on the date of the enactment of this Act.
(2) Nondeductibility of tax.--The amendment made by section
503(b) shall apply to taxable years beginning after December
31, 1993.
TITLE V--IMPROVED ACCESS TO RURAL HEALTH SERVICES
Subtitle A--Rural Emergency Medical Services Amendments
SEC. 501. ESTABLISHMENT OF OFFICE OF EMERGENCY MEDICAL SERVICES.
Title XII of the Public Health Service Act (42 U.S.C. 300d et seq.)
is amended--
(1) in the heading for the title, by striking ``TRAUMA
CARE'' and inserting ``EMERGENCY MEDICAL SERVICES'';
(2) in the heading for part A, by striking ``General'' and
all that follows and inserting ``General Authorities and
Duties''; and
(3) by amending section 1201 to read as follows:
``SEC. 1201. ESTABLISHMENT OF OFFICE OF EMERGENCY MEDICAL SERVICES.
``(a) In General.--The Secretary shall establish an office to be
known as the Office of Emergency Medical Services, which shall be
headed by a director appointed by the Secretary. The Secretary shall
carry out this title acting through the Director of such Office.
``(b) General Authorities and Duties.--With respect to emergency
medical services (including trauma care), the Secretary shall--
``(1) conduct and support research, training, evaluations,
and demonstration projects;
``(2) foster the development of appropriate, modern systems
of such services through the sharing of information among
agencies and individuals involved in the study and provision of
such services;
``(3) sponsor workshops and conferences;
``(4) as appropriate, disseminate to public and private
entities information obtained in carrying out paragraphs (1)
through (4);
``(5) provide technical assistance to State and local
agencies;
``(6) coordinate activities of the Department of Health and
Human Services; and
``(7) as appropriate, coordinate activities of such
Department with activities of other Federal agencies.
``(c) Certain Requirements.--With respect to emergency medical
services (including trauma care), the Secretary shall ensure that
activities under subsection (b) are carried out regarding--
``(1) maintaining an adequate number of health
professionals with expertise in the provision of the services,
including hospital-based professional and prehospital-based
professionals;
``(2) developing, periodically reviewing, and revising as
appropriate, in collaboration with appropriate public and
private entities, guidelines for the provision of such services
(including, for various typical circumstances, guidelines on
the number and variety of professionals, on equipment, and on
training);
``(3) the appropriate use of available technologies,
including communications technologies; and
``(4) the unique needs of underserved inner-city areas and
underserved rural areas.
``(d) Grants, Cooperative Agreements, and Contracts.--In carrying
out subsections (b) and (c), the Secretary may make grants and enter
into cooperative agreements and contracts.
``(e) Definitions.--For purposes of this part:
``(1) The term `hospital-based professional' means a health
professional (including an allied health professional) who has
expertise in providing one or more emergency medical services
and who normally provides the services at a medical facility.
``(2) The term `prehospital-based professional' means a
health professional (including an allied health professional)
who has expertise in providing one or more emergency medical
services and who normally provides the services at the site of
the medical emergency or during transport to a medical
facility.''.
SEC. 502. STATE OFFICES OF EMERGENCY MEDICAL SERVICES.
(a) Technical Amendments to Facilitate Establishment of Program.--
(1) In general.--Title XII of the Public Health Service Act
(42 U.S.C. 300d et seq.) is amended--
(A) by redesignating section 1232 as section 1235;
(B) by redesignating sections 1231 and 1233 as
sections 1241 and 1242, respectively; and
(C) by redesignating sections 1211 through 1222 as
sections 1221 through 1232, respectively.
(2) Modifications in format of title xii.--Title XII of the
Public Health Service Act, as amended by paragraph (1) of this
subsection, is amended--
(A) by striking ``Part B'' and all that follow
through ``State Plans'' and inserting the following:
``Subpart II--Formula Grants With Respect to Modifications of State
Plans'';
(B) by striking ``Part C--General Provisions'' and
inserting the following:
``Subpart III--General Provisions'';
(C) be redesignating sections 1202 and 1203 as
sections 1211 and 1212, respectively; and
(D) by inserting before section 1211 (as so
redesignated) the following:
``Part B--Trauma Care
``Subpart I--Advisory Council; Clearinghouse''.
(b) State Offices.--Title XII of the Public Health Service Act, as
amended by subsection (a) of this section, is amended by inserting
after section 1201 the following new section:
``SEC. 1202. STATE OFFICES OF EMERGENCY MEDICAL SERVICES.
``(a) Program of Grants.--The Secretary may make grants to States
for the purpose of improving the availability and quality of emergency
medical services through the operation of State offices of emergency
medical services.
``(b) Requirement of Matching Funds.--
``(1) In general.--The Secretary may not make a grant under
subsection (a) unless the State involved agrees, with respect
to the costs to be incurred by the State in carrying out the
purpose described in such subsection, to provide non-Federal
contributions toward such costs in an amount that--
``(A) for the first fiscal year of payments under
the grant, is not less than $1 for each $3 of Federal
funds provided in the grant;
``(B) for any second fiscal year of such payments,
is not less than $1 for each $1 of Federal funds
provided in the grant; and
``(C) for any third fiscal year of such payments,
is not less than $3 for each $1 of Federal funds
provided in the grant.
``(2) Determination of amount of non-federal
contribution.--
``(A) Subject to subparagraph (B), non-Federal
contributions required in paragraph (1) may be in cash
or in kind, fairly evaluated, including plant,
equipment, or services. Amounts provided by the Federal
Government, or services assisted or subsidized to any
significant extent by the Federal Government, may not
be included in determining the amount of such non-
Federal contributions.
``(B) The Secretary may not make a grant under
subsection (a) unless the State involved agrees that--
``(i) for the first fiscal year of payments
under the grant, 100 percent or less of the
non-Federal contributions required in paragraph
(1) will be provided in the form of in-kind
contributions;
``(ii) for any second fiscal year of such
payments, not more than 50 percent of such non-
Federal contributions will be provided in the
form of in-kind contributions; and
``(iii) for any third fiscal year of such
payments, such non-Federal contributions will
be provided solely in the form of cash.
``(c) Certain Required Activities.--The Secretary may not make a
grant under subsection (a) unless the State involved agrees that
activities carried out by an office operated pursuant to such
subsection will include--
``(1) coordinating the activities carried out in the State
that relate to emergency medical services;
``(2) activities regarding the matters described in
paragraphs (1) through (4) section 1201(b);
``(3) identifying Federal and State programs regarding
emergency medical services and providing technical assistance
to public and nonprofit private entities regarding
participation in such programs.
``(d) Requirement Regarding Annual Budget for Office.--The
Secretary may not make a grant under subsection (a) unless the State
involved agrees that, for any fiscal year for which the State receives
such a grant, the office operated pursuant to subsection (a) will be
provided with an annual budget of not less than $50,000.
``(e) Certain Uses of Funds.--
``(1) Restrictions.--The Secretary may not make a grant
under subsection (a) unless the State involved agrees that--
``(A) if research with respect to emergency medical
services is conducted pursuant to the grant, not more
than 10 percent of the grant will be expended for such
research; and
``(B) the grant will not be expended to provide
emergency medical services (including providing cash
payments regarding such services).
``(2) Establishment of office.--Activities for which a
State may expend a grant under subsection (a) include paying
the costs of establishing an office of emergency medical
services for purposes of such subsection.
``(f) Reports.--The Secretary may not make a grant under subsection
(a) unless the State involved agrees to submit to the Secretary reports
containing such information as the Secretary may require regarding
activities carried out under this section by the State.
``(g) Requirement of Application.--The Secretary may not make a
grant under subsection (a) unless an application for the grant is
submitted to the Secretary and the application is in such form, is made
in such manner, and contains such agreements, assurances, and
information as the Secretary determines to be necessary to carry out
this section.''.
SEC. 503. PROGRAMS FOR RURAL AREAS.
(a) In General.--Title XII of the Public Health Service Act, as
amended by section 502 of this Act, is amended--
(1) by transferring section 1204 to part A;
(2) by redesignating such section as section 1203;
(3) by inserting such section after section 1202; and
(4) in section 1203 (as so redesignated)--
(A) by redesignating subsection (c) as subsection
(d); and
(B) by inserting after subsection (b) the following
new subsection:
``(c) Demonstration Program Regarding Telecommunications.--
``(1) Linkages for rural facilities.--Projects under
subsection (a)(1) shall include demonstration projects to
establish telecommunications between rural medical facilities
and medical facilities that have expertise or equipment that
can be utilized by the rural facilities through the
telecommunications.
``(2) Modes of communication.--The Secretary shall ensure
that the telecommunications technologies demonstrated under
paragraph (1) include (interactive) video telecommunications
(static video imaging transmitted through the telephone
system), and facsimiles transmitted through such system.''.
(b) Conforming Amendment.--Section 1203 of the Public Health
Service Act, as redesignated by subsection (a)(2) of this section, is
amended in the heading for the section by striking ``establishment''
and all that follows and inserting ``programs for rural areas.''.
SEC. 504. FUNDING.
Title XII of the Public Health Service Act, as amended by the
preceding provisions of this subtitle, is amended--
(1) by inserting after subpart III of part B the following:
``Part C--Funding'';
(2) by transferring section 1235 to part C (as so added);
and
(3) in such section, by striking subsections (a) and (b)
and inserting the following:
``(a) Emergency Medical Services Generally.--
``(1) In general.--For the purpose of carrying out section
1201 other than with respect to trauma care, there are
authorized to be appropriated $2,000,000 for fiscal year 1994,
and such sums as may be necessary for each of the fiscal years
1995 and 1996.
``(2) State offices.--For the purpose of carrying out
section 1202, there are authorized to be appropriated
$3,000,000 for fiscal year 1994, and such sums as may be
necessary for each of the fiscal years 1995 and 1996.
``(3) Certain telecommunications demonstrations.--For the
purpose of carrying out section 1203(c), there are authorized
to be appropriated $10,000,000 for fiscal year 1994, and such
sums as may be necessary for each of the fiscal years 1995 and
1996.
``(b) Trauma Care and Certain Other Activities.--
``(1) In general.--For the purpose of carrying out part B,
section 1201 with respect to trauma care, and section 1203
(other than subsection (c) of such section), there are
authorized to be appropriated $60,000,000 for fiscal year 1994,
and such sums as may be necessary for each of the fiscal years
1995 and 1996.
``(2) Allocation of funds by secretary.--
``(A) For the purpose of carrying out subpart I of
part B, section 1201 with respect to trauma care, and
section 1203 (other than subsection (c) of such
section), the Secretary shall make available 10 percent
of the amounts appropriated for a fiscal year under
paragraph (1).
``(B) For the purpose of carrying out section 1203
(other than subsection (c) of such section), the
Secretary shall make available 10 percent of the
amounts appropriated for a fiscal year under paragraph
(1).
``(C)(i) For the purpose of making allotments under
section 1221(a), the Secretary shall, subject to
subsection (c), make available 80 percent of the
amounts appropriated for a fiscal year under paragraph
(1).
``(ii) Amounts paid to a State under section
1221(a) for a fiscal year shall, for the purposes for
which the amounts were paid, remain available for
obligation until the end of the fiscal year immediately
following the fiscal year for which the amounts were
paid.''.
SEC. 505. CONFORMING AMENDMENTS.
Title XII of the Public Health Service Act, as amended by the
preceding provisions of this subtitle, is amended--
(1) in section 1203(b), by striking ``1214(c)(1)'' and
inserting ``1224(c)(1)'';
(2) in section 1211(b)(3), by striking ``1213(c)'' and
inserting ``1223(c)'';
(3) in section 1221--
(A) in subsection (a)--
(i) by striking ``1218'' and inserting
``1228''; and
(ii) by striking ``1217'' and inserting
``1227''; and
(B) in subsection (b)--
(i) by striking ``1233'' and inserting
``1242''; and
(ii) by striking ``1213'' and inserting
``1223'';
(4) in section 1222--
(A) in subsection (a)--
(i) in paragraph (1), by striking
``1211(a)'' and inserting ``1221(a)''; and
(ii) in paragraph (2)(A), by striking
``1211(c)'' and inserting ``1221(c)''; and
(B) in subsection (b), by striking ``1211(a)'' and
inserting ``1221(a)'';
(5) in section 1223--
(A) in subsection (a), by striking ``1211(b)'' and
inserting ``1221(b)'';
(B) in subsection (b)--
(i) in paragraph (1), by striking
``1211(a)'' and inserting ``1221(a)''; and
(ii) in paragraph (3), by striking
``1211(a)'' and inserting ``1221(a)''; and
(C) in subsection (d), by striking ``1211(a)'' and
inserting ``1221(a)'';
(6) in section 1224--
(A) in each of subsections (a) through (c), by
striking ``1211(a)'' and inserting ``1221(a)''; and
(B) in subsection (b), by striking ``1213(a)(7)''
and inserting ``1223(a)(7)'';
(7) in section 1225--
(A) in subsection (a)--
(i) by striking ``1211(a)'' and inserting
``1221(a)''; and
(ii) by striking ``1233'' and inserting
``1242''; and
(B) in subsection (b), by striking ``1211(b)'' and
inserting ``1221(b)'';
(8) in section 1226, in each of subsections (a) through
(c), by striking ``1211(a)'' and inserting ``1221(a)'';
(9) in section 1227--
(A) by striking ``1211(a)'' and inserting
``1221(a)''; and
(B) by striking ``1214'' and inserting ``1224'';
(10) in section 1228--
(A) in each of subsections (a) through (c), by
striking ``1211(a)'' each place such term appears and
inserting ``1221(a)'';
(B) in subsection (b), in each of paragraphs (2)(A)
and (3)(A), by striking ``1232(a)'' and inserting
``1235(a)''; and
(C) in subsection (c)(2)--
(i) by striking ``1232(b)(3)'' and
inserting ``1235(b)(3)''; and
(ii) by striking ``1217'' and inserting
``1227'';
(11) in section 1229(a), by striking ``1211(a)'' each place
such term appears and inserting ``1221(a)'';
(12) in section 1230(a), by striking ``1211(a)'' each place
such term appears and inserting ``1221(a)'';
(13) in section 1231--
(A) in each of subsections (a) and (b), by striking
``1211(a)'' each place such term appears and inserting
``1221(a)''; and
(B) in each of subsections (a) and (b), by striking
``1211(b)'' and inserting ``1221(b)'';
(14) in section 1232, by striking ``1211'' and inserting
``1221'';
(15) in section 1241--
(A) in the matter preceding paragraph (1), by
striking ``this title'' and inserting ``this part'';
and
(B) in paragraph (1), by striking ``1213'' and
inserting ``1223'';
(16) in section 1242--
(A) in each of subsections (a) and (b), by striking
``1211'' each place such term appears and inserting
``1221'';
(B) in subsection (b)--
(i) by striking ``part B'' and inserting
``subpart II''; and
(ii) by striking ``1214(c)(1)'' and
inserting ``1224(c)(1)''; and
(C) in subsection (c), by striking ``1213'' and
inserting ``1223''; and
(17) in section 1251(c)(1)--
(A) by striking ``1211(a)'' and inserting
``1221(a)'';
(B) by striking ``1218(a)(2)'' and inserting
``1228(a)(2)''; and
(C) by striking ``part B'' and inserting ``subpart
II''.
Subtitle B--Extension of Special Treatment Rules for Medicare-
Dependent, Small Rural Hospitals
SEC. 511. EXTENSION OF SPECIAL TREATMENT RULES FOR MEDICARE-DEPENDENT,
SMALL RURAL HOSPITALS.
(a) In General.--
(1) Determination of payment amount.--Section 1886(b)(3)(D)
of the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is
amended by striking ``March 31, 1993,'' and inserting ``March
31, 1994,''.
(2) Eligibility for designation.--Section 1886(d)(5)(G)(i)
of such Act (42 U.S.C. 1395ww(d)(5)(G)(i)) is amended by
striking ``March 31, 1993,'' and inserting ``March 31, 1994,''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect as if included in the enactment of section 6003(f) of the
Omnibus Budget Reconciliation Act of 1989.
Subtitle C--Outreach Grants Program
SEC. 521. ESTABLISHMENT OF PROGRAM OF GRANTS FOR RURAL HEALTH OUTREACH.
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.)
is amended by adding at the end the following part:
``Part O--Rural Health Outreach Program.
``SEC. 399J. RURAL HEALTH OUTREACH GRANT PROGRAM.
``(a) In General.--The Secretary may make grants to demonstrate new
and innovative models of outreach and health care services delivery in
rural areas that lack basic health services. Grants will be awarded for
one of the following: direct provision of health services to rural
populations (especially for those who are not currently receiving those
services), or to enhance access to and utilization of existing
available services.
``(b) Missions of the Outreach Projects.--Projects under subsection
(a) should be designed to address the needs of a wide range of
populations living in rural communities including, but not limited to,
the poor, farmers, farm workers, senior citizens, individuals with
disabilities, pregnant women, infants, adolescents, and rural
populations with special health care needs. The program could include
projects to:
``(1) Provide, enhance, or revitalize emergency medical
services in rural communities.
``(2) Provide ambulatory health and/or mental health
services in health professional shortage areas and in frontier
areas.
``(3) Enhance the health and safety of farmers through
direct health services for farm families, and migrant and
seasonal farm workers.
``(4) Provide direct health services to enhance health care
services to senior citizens.
``(5) Provide direct health services that will reduce
infant mortality in rural communities.
``(c) Composition of Program.--
``(1) Consortium arrangements.--Participation in the
program established in subsection (a) requires the formation of
consortium arrangements among three or more separate and
distinct entities to carry out an outreach project.
``(2) Certain requirements.--
``(A) A consortium under paragraph (1) must be
composed of three or more existing health care
providers or a combination of three or more health care
and social service providers. Consortium members may
include such entities as hospitals, public health
agencies, home health providers, mental health centers,
rural health clinics, social service agencies, health
professional schools, educational institutions,
emergency medical centers/providers, and community and
migrant health centers.
``(B) All public and private entities, both
nonprofit and for-profit may participate as members of
a consortium arrangement under paragraph (1).
``(C) A grant under subsection (a) will be made to
only one entity in a consortium under paragraph (1).
The grant recipient must be a nonprofit or public
entity which meets one of the following requirements:
``(i) The applicant must be located outside
of a Metropolitan Statistical Area as defined
by the Federal Government.
``(ii) The applicant must be located in a
rural census tract.
``(d) Review Criteria.--An outreach application under this section
shall be evaluated based on the following criteria:
``(1) The extent to which the applicant has proposed a new
and innovative approach to health care in the rural area.
Services shall be directed to population groups that are
unserved or underserved.
``(2) The extent to which the applicant has justified and
documented the needs for the project and developed measurable
goals for meeting the needs.
``(3) The extent to which the applicant has clearly defined
the roles and responsibilities for each member of the
consortium and developed a workable plan for managing the
consortium's activities.
``(4) The level of local commitment and involvement with
the project, including the extent of cost participation by the
applicant and/or other organizations.
``(5) The feasibility of the project to continue after
Federal grant support is completed.
``(6) The extent of the evaluation component.
``(e) How Project Funds Are to be Expended.--
``(1) Grantees under subsection (a) will be required to use
at least 85 percent of the total amount awarded for outreach
and care services.
``(2) 60 percent of funds must be spent in rural areas.
``(3) Grant funds may not be used for purchase,
construction, or renovation of real property or to support the
delivery of inpatient services.
``(4) Grant funds may be used for equipment and vehicles
when such equipment is essential to carrying out the outreach
project.
``(5) Individual grant awards will be limited to a total
amount of $300,000 per year for not to exceed 3 years.
``(6) Applicants must demonstrate that existing levels of
institutional and other support are not reduced or supplanted
by the availability of these grant funds.
``(f) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $25,000,000
for fiscal year 1994, and such sums as may be necessary for each fiscal
year thereafter.''.
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