Health Insurance Portability and Accountability Act of 1996

TABLE OF CONTENTS: Title I: Health Care Access, Portability, and Renewability Subtitle A: Group Market Rules Subtitle B: Individual Market Rules Subtitle C: General and Miscellaneous Provisions Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Subtitle A: Fraud and Abuse Control Program Subtitle B: Revisions to Current Sanctions for Fraud and Abuse Subtitle C: Data Collection Subtitle D: Civil Monetary Penalties Subtitle E: Revisions to Criminal Law Subtitle F: Administrative Simplification Subtitle G: Duplication and Coordination of Medicare-Related Plans Subtitle H: Patent Extension Title III: Tax-Related Health Provisions Subtitle A: Medical Savings Accounts Subtitle B: Increase in Deduction for Health Insurance Costs of Self-Employed Individuals Subtitle C: Long-Term Care Services and Contracts Subtitle D: Treatment of Accelerated Death Benefits Subtitle E: State Insurance Pools Subtitle F: Organizations Subject to Section 833 Subtitle G: IRA Distributions to the Unemployed Subtitle H: Organ and Tissue Donation Information Included with Income Tax Refund Payments Title IV: Application and Enforcement of Group Health Plan Requirements Subtitle A: Application and Enforcement of Group Health Plan Requirements Subtitle B: Clarification of Certain Continuation Coverage Requirements Title V: Revenue Offsets Subtitle A: Company-Owned Life Insurance Subtitle B: Treatment of Individuals Who Lose United States Citizenship Subtitle C: Repeal of Financial Institution Transition Rule to Interest Allocation Rules Health Insurance Portability and Accountability Act of 1996 - Title I: Health Care Access, Portability, and Renewability - Subtitle A: Group Market Rules - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to add group health plan portability, access, and renewability requirements. (Sec. 101) Provides for increased portability through limitation on preexisting condition exclusions. Limits the preexisting condition exclusion period. Sets forth rules relating to crediting for periods of previous coverage. Makes preexisting condition exclusions inapplicable to certain newborns, adopted children, and pregnancy. Requires special enrollment periods for certain individuals losing other coverage and for dependent beneficiaries. Allows group health plans that offer health maintenance organization (HMO) coverage to provide for an affiliation period with respect to such coverage only if there is no previous condition exclusion and if such affiliation is applied uniformly and for a specified limited period. Prohibits discrimination against individual participants and beneficiaries based on health status, both in eligibility to enroll and in premium contributions. Provides for guaranteed renewability in group health plans which are multiemployer plans or multiple employer welfare arrangements (MEWAs). Sets forth provisions relating to preemption, State flexibility, and rules of construction. Provides for continued applicability of State law with respect to health insurance issuers (and continued preemption with respect to group health plans under other specified ERISA provisions). Sets forth special rules in case of portability requirements. Sets forth special rules relating to group health plans, including: (1) a general exception for certain small group health plans which have less than two participants who are current employees; (2) an exception for certain benefits; (3) an exception for certain other benefits if certain conditions are met; and (4) treatment of certain partnerships as group health plans. Sets forth definitions and provisions relating to regulations and enforcement of this Act and other ERISA provisions. (Sec. 102) Amends the Public Health Service Act to create a new title on assuring portability, availability, and renewability of health insurance coverage. Limits preexisting condition exclusion periods and mandates crediting periods of previous coverage. Prohibits a group health plan and an insurance issuer offering coverage in connection with a group plan from discriminating based on health status, genetic information, and other specified factors. Requires: (1) each issuer offering coverage in the small group market to accept every applying small employer and individual; (2) reports on large employer health insurance access; (3) issuers in the small or large group market to renew or continue the coverage at the option of the plan sponsor, except for premium nonpayment, fraud, and other factors; and (4) certain disclosures to small employers. Excludes certain plans from the above requirements of this Act. Provides for State and Federal enforcement. Subtitle B: Individual Market Rules - Prohibits each issuer offering individual market health coverage from declining to offer or denying enrollment to any eligible individual or imposing a preexisting condition exclusion. Requires an issuer providing coverage to an individual to renew or continue coverage at the option of the individual, except for premium nonpayment, fraud, or other factors. Applies to issuers in the individual market the provisions of this Act regarding crediting periods of previous coverage. Declares that provisions of this subtitle prohibiting declining to offer or denying enrollment to eligible individuals do not apply in a State with an alternative mechanism meeting specified requirements. Provides for State enforcement and fall back Federal enforcement. Subtitle C: General and Miscellaneous Provisions - Mandates studies and reports to appropriate congressional committees on: (1) the effectiveness of the provisions of this title and State laws in ensuring the availability of group and individual health coverage; and (2) patient access to and choice of providers inside and outside of networks, the cost and cost-effectiveness to issuers of out-of-network access, and the impact on cost and quality of providing that access. Requires the Health Care Financing Administration to complete its study of Medicare (title XVIII of the Social Security Act) reimbursement of all telemedicine services and report to the Congress. Allows a health maintenance organization (HMO) to offer a high- deductible health plan. Deems a free clinic health professional to be a Public Health Service employee for purposes of provisions relating to proceedings against commissioned officers or employees for damages resulting from the provision of health services. Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification (sic) - Subtitle A: Fraud and Abuse Control Program - Amends title XI of the Social Security Act (SSA) to require the Secretary of Health and Human Services (HHS), acting through HHS' Office of Inspector General (IG), and the Attorney General to establish a program to: (1) coordinate Federal, State, and local law enforcement programs to control health care fraud and abuse; (2) conduct investigations, audits, and inspections relating to the delivery of and payment for health care; (3) facilitate enforcement of certain provisions of title XI and other Acts applicable to health care fraud and abuse; (4) provide for the modification and establishment of safe harbors and to issue advisory opinions and special fraud alerts; and (5) provide for the reporting and disclosure of certain final adverse actions against health care providers, suppliers, or practitioners pursuant to the data collection system established below. (Sec. 201) Establishes the Health Care Fraud and Abuse Control Account (Account) in Medicare's Federal Hospital Insurance Trust Fund (Trust Fund) to hold the criminal fines and civil monetary penalties and assessments obtained from Federal health care cases, as well as property forfeiture proceeds resulting from such cases, and other specified amounts for financing the program above and the Medicare Integrity Program established by this title. Makes certain appropriations to the Trust Fund and Account, earmarking certain amounts for activities of HHS' IG with respect to the Medicare and Medicaid programs under SSA titles XVIII and XIX. Requires the HHS Secretary and the Attorney General to jointly submit a report to the Congress with regard to Trust Fund appropriations. Directs the Comptroller General to submit a similar report to the Congress analyzing Trust Fund operations. (Sec. 202) Establishes the Medicare Integrity Program under which the HHS Secretary shall promote the integrity of the Medicare program by entering into contracts with certain eligible private entities to: (1) review the activities of Medicare service providers and audit cost reports to determine whether payment should not have been made; (2) educate service providers, beneficiaries, and other persons with respect to payment and benefit issues; and (3) develop and periodically update a list of items of durable medical equipment subject to prior authorization. Details the process for entering into contracts. Sets certain limitations on contractor liability. Prohibits fiscal intermediaries under Medicare part A (Hospital Insurance) and carriers under Medicare part B (Supplementary Medical Insurance) from carrying out certain activities under Medicare to the extent the activity is carried out pursuant to a contract under the Medicare Integrity Program. (Sec. 203) Directs the HHS Secretary to provide an explanation of Medicare benefits with respect to each furnished item or service for which payment may be made to an individual without regard to whether or not a deductible or coinsurance may be imposed. Directs the HHS Secretary to establish a program for encouraging individuals to: (1) report information on fraud and abuse under Medicare or other Federal or State health care programs; and (2) submit suggestions on methods to improve the efficiency of the Medicare program. Provides for the payment to such individuals of a portion of: (1) any amounts collected due to any such reports; or (2) any savings resulting from any such suggestions which are adopted. (Sec. 204) Amends SSA title XI to require application of criminal penalties for acts involving the Medicare program to similar violations of any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or in part, by the Federal Government, except the Federal Employees' Health Benefits Program (Federal care health programs). (Sec. 205) Directs the HHS Secretary to periodically publish a notice in the Federal Register soliciting proposals for: (1) modifications to existing safe harbors issued under the Medicare and Medicaid Patient and Program Protection Act of 1987; (2) additional safe harbors specifying payment practices that shall not be treated as a criminal offense or serve as the basis for an exclusion; (3) advisory opinions by the HHS IG with regard to, among other matters, prohibited remuneration constituting grounds for the imposition of a sanction; and (4) special fraud alerts by the HHS IG, upon request, with regard to suspect practices under the Medicare program or a State health care program. Requires the Secretary to issue appropriate implementing regulations. Subtitle B: Revisions to Current Sanctions for Fraud and Abuse - Excludes from participation in Medicare and State health care programs any individual or entity convicted after the enactment of this Act of a felony related to: (1) fraud in connection with the delivery of a health care item or service; or (2) a controlled substance. (Sec. 212) Revises specified current sanctions involving exclusion for fraud and abuse under Medicare and State health care programs, among other changes establishing minimum periods of exclusion for: (1) certain individuals and entities subject to permissive exclusion from Medicare and State health care programs; and (2) practitioners and persons failing to meet certain statutory obligations with regard to services or items. (Sec. 213) Authorizes the permissive exclusion of individuals with a direct or indirect ownership or control interest in certain sanctioned entities. (Sec. 214) Repeals the prerequisite that a health care practitioner or person be determined "unwilling or unable" to comply substantially with a corrective action plan before sanctions may be imposed (thus permitting the Secretary to exclude such practitioner or person from eligibility to provide services for failure to comply with a corrective action plan, regardless of circumstances). (Sec. 215) Permits the imposition of intermediate sanctions on Medicare health maintenance organizations in addition to the current option of termination. Provides additional intermediate sanctions for miscellaneous program violations. (Sec. 216) Provides an additional specified exception to anti-kickback penalties for risk-sharing arrangements. (Sec. 217) Creates a criminal penalty under SSA title XI for fraudulent disposition of assets in order to obtain Medicaid benefits. Subtitle C: Data Collection - Directs the HHS Secretary to establish a national health care fraud and abuse data collection program for reporting final adverse actions against health care providers, suppliers, or practitioners and maintain a database of such information. Requires each Government agency and health plan to report to the Secretary any final adverse action taken against such provider, supplier, or practitioner. (Sec. 221) Allows the HHS Secretary to establish reasonable fees for disclosure of information in the database. Subtitle D: Civil Monetary Penalties - Revises civil monetary penalties, providing among other changes for: (1) the exclusion from participation in Federal and State health care programs of persons subject to penalties and assessments for applicable program violations; (2) modifications in the amounts of various specified penalties and assessments, including the sanctions against health care practitioners who violate their statutory obligations with regard to the services or items ordered or provided by them to a covered beneficiary or recipient; (3) a prohibition against offering inducements to individuals enrolled under Medicare or a State health care program; (4) subjecting to civil money penalties certain excluded individuals retaining an ownership or controlling interest in a participating entity if they knew or should have known of the action constituting the basis for the exclusion of such entity at the time of violation; (5) a specific definition, for such penalty purposes, of remuneration which includes the waiver of coinsurance and deductible amounts and transfers of items or services for free or for other than fair market value; and (6) a penalty for false certification for home health services. Subtitle E: Revisions to Criminal Law - Amends the Federal criminal code to set penalties for the commission of health care fraud, theft or embezzlement in connection with health care, false statements relating to health care matters, obstruction of criminal investigations of Federal health care offenses, and laundering of monetary instruments in connection with a Federal health care offense. (Sec. 247) Provides for injunctive relief relating to covered Federal health care offenses, as well as for property forfeitures. (Sec. 248) Establishes investigative demand procedures, including limits on the disclosure of health information about an individual in any administrative, civil, or criminal action or investigation. Subtitle F: Administrative Simplification - Amends SSA title XI to add a new part C (Administrative Simplification) for development of an electronic system for: (1) processing health care information consistent with the goal of improving the operation of the overall health care system; and (2) reducing related administrative costs through the HHS Secretary's adoption of certain standards for information transactions (including enrollment, disenrollment, claims attachments, and referral certification and authorization) and data elements for such transactions, as well as standards relating to security and performance of specified tasks. Requires the Secretary, in adopting such standards, to rely on recommendations of the National Committee on Vital and Health Statistics. (Sec. 261) Provides penalties for violations of this subtitle, including wrongful disclosure of individually identifiable health information. (Sec. 263) Amends the Public Health Service Act to provide for a change in the membership and duties of the National Committee on Vital and Health Statistics, including responsibility for advising the HHS Secretary and the Congress on the implementation of the administrative simplification requirements of this subtitle. (Sec. 264) Directs the HHS Secretary to submit to specified congressional committees detailed recommendations on standards with respect to the privacy of individually identifiable health information. Subtitle G: Duplication and Coordination of Medicare-Related Plans - Declares that certain health insurance policies (other than Medicare supplemental policies) are not considered to duplicate benefits under Medicare, Medicaid, or other health insurance policies, if they: (1) provide health care benefits only for long-term care, nursing home care, home health care, or community-based care, or any combination thereof; (2) coordinate against or exclude items and services available or paid for under Medicare or another health insurance policy; and (3) disclose such coordination or exclusion, in policies sold or issued on or after a specified date, in the policy's outline of coverage. Subtitle H: Patent Extension - Extends for two years beginning February 28, 1997, the active agent patent (and prohibition of infringement) for any owner of the right to market a nonsteroidal anti-inflammatory drug that: (1) contains a patented active agent; (2) has been reviewed by the Food and Drug Administration (FDA) for more than 96 months as a new drug application; and (3) was approved as safe and effective by the FDA on January 31, 1991. (Sec. 281) Requires such an owner, as a condition of eligibility for such entitlement, to: (1) pay $10 million per year to the HHS Secretary in FY 1997 and 1998; and (2) enter into a legally binding agreement with the HHS Secretary to provide a means for ensuring that such entitlement shall not create any net costs to the States under Medicaid. Title III: Tax-Related Health Provisions - Subtitle A: Medical Savings Accounts - Amends the Internal Revenue Code to allow a deduction for limited amounts paid to a medical savings account (MSA). Defines "medical savings account" as a trust for paying the account holder's medical expenses. Exempts an MSA from taxation unless it has ceased being an MSA. Provides for the treatment of distributions. Allows the MSA deduction to be taken whether or not the individual itemizes deductions. Excludes limited employer MSA contributions from employee gross income. Excludes employer MSA contributions from provisions relating to social security, railroad retirement, unemployment, and withholding taxes. Makes MSA contributions unavailable under cafeteria plans. Excludes MSAs from the value of taxable estates. Imposes a tax on excess MSA contributions. Exempts an MSA holder from prohibited transaction taxes if the MSA ceases to be an MSA. Imposes a penalty on MSA reporting failures. Exempts MSAs from the definition of "specified insurance contract" for provisions relating to capitalization of certain policy acquisition expenses. Mandates a study of the effects of MSAs in the small group market. Subtitle B: Increase in Deduction for Health Insurance Costs of Self-Employed Individuals - Increases the deduction for medical insurance expenditures by self-employed individuals. Subtitle C: Long-Term Care Services and Contracts - Part I: General Provisions - Requires treating: (1) a long-term care insurance contract as accident and health insurance and associated amounts received as amounts received for personal injuries and sickness and as reimbursement for medical care expenses actually incurred; (2) an employer's plan providing long-term care as an accident and health plan; (3) limited amounts paid for such insurance as payments for medical care; and (4) such insurance as guaranteed renewable under specified provisions. Provides for the treatment of: (1) excess aggregate long-term care payments; and (2) long-term care coverage provided in conjunction with life insurance. Excludes long-term care from cafeteria plans. Includes in an employee's gross income employer-provided long-term care coverage provided through a flexible spending arrangement. Declares, under Internal Revenue Code (IRC), Employee Retirement Income Security Act of 1974, and Public Health Service Act provisions, that the term group health plan does not include any plan substantially all of the coverage under which is for qualified long-term care services. Mandates a study on the marketing and other effects of per diem limits on certain types of long-term care policies. (Sec. 322) Amends the definition of "medical care" (for provisions allowing a deduction for medical care expenses) to include qualified long-term care services. (Sec. 323) Imposes reporting requirements on long-term care benefit payors. Part II: Consumer Protection Provisions - Sets forth provisions regarding: (1) the model regulation and model Act promulgated by the National Association of Insurance Commissioners; and (2) certain disclosure and nonforfeitability requirements. (Sec. 326) Imposes a tax the failure to meet requirements regarding: (1) the model regulation and model Act; (2) contract or certificate delivery; and (3) claims denials information. Subtitle D: Treatment of Accelerated Death Benefits - Treats life insurance amounts paid as amounts paid because of death if the insured is terminally or chronically ill. Treats the amount paid by a viatical settlement provider for a life insurance contract as an amount paid by reason of the death of the insured. (Sec. 332) Treats, for life insurance company provisions, references to life insurance contracts as including references to accelerated death benefit riders (unless a rider is treated as a long-term care contract). Subtitle E: State Insurance Pools - Exempts from taxation certain State-established membership organizations established exclusively to provide: (1) nonprofit medical care coverage to high risk individuals; or (2) to reimburse members for losses arising under workmen's compensation acts. Subtitle F: Organizations Subject to Section 833 - Allows (for provisions affording a special deduction) an organization that is not a blue cross or blue shield (BCBS) organization to be treated as if it were a BCBS organization if it is not for profit and meets other requirements. Subtitle G: IRA Distributions to the Unemployed - Permits penalty-free distributions from IRA accounts to pay health insurance premiums for certain unemployed individuals. Subtitle H: Organ and Tissue Donation Information Included With Income Tax Refund Payments - Directs the Secretary of the Treasury, to the extent practicable, to include certain organ and tissue donation information with income tax refund payments. Title IV: Application and Enforcement of Group Health Plan Requirements - Subtitle A: Application and Enforcement of Group Health Plan Requirements - Adds to the end of the IRC a new subtitle, Subtitle K - Group Health Plan Portability, Access, and Renewability Requirements. Permits a group health plan to impose a preexisting condition exclusion only if: (1) the exclusion relates to a condition for which medical advice, diagnosis, care, or treatment was recommended or received within the six-month period ending on the date of enrollment; (2) the exclusion extends for no more than twelve months (18 months for a late enrollee); and (3) such exclusion period is reduced by the length of the aggregate of the periods of creditable coverage applicable to the enrollee as of the enrollment date. Prohibits a group health plan from refusing to enroll, subject to exceptions, an individual because of the individual's: (1) health status; (2) medical condition; (3) claims experience; (4) receipt of health care; (5) medical history; (6) genetic information; (7) evidence of insurability; or (8) disability. Provides for guaranteed renewability in multiemployer plans and certain multiple employer welfare arrangements, subject to certain exceptions, including: (1) nonpayment of premiums; (2) fraud; or (3) the plan ceases to cover a geographic area. Sets forth provisions concerning: (1) exceptions for certain plans (includes government plans within the exceptions) and benefits; (2) definitions; (3) promulgation of regulations; and (4) penalties for failure to meet certain group health plan requirements. Subtitle B: Clarification of Certain Continuation Coverage Requirements - Amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the IRC to modify continuation coverage requirements. Title V: Revenue Offsets - Subtitle A: Company-Owned Life Insurance - Revises provisions prohibiting a deduction for interest on loans with respect to company-owned life insurance, including a revision which prohibits a deduction for interest on loans with respect to company-owned endowment or annuity contracts. Subtitle B: Treatment of Individuals Who Lose United States Citizenship - Revises provisions concerning expatriation to avoid taxes, including the following changes: (1) applies the provisions to certain long-term residents; (2) permits the Secretary to expand the ten-year taxation period to fifteen years; (3) increases the categories of income treated as U.S. source income; (4) giving credit for foreign taxes imposed on U.S. source income; and (5) requiring the filing of certain information by expatriates. Revises the comparable estate and gift tax provisions. Subtitle C: Repeal of Financial Institution Transition Rule to Interest Allocation Rules - Amends the Tax Reform Act of 1986 to repeal a provision concerning the allocation and apportionment of interest expense, by financial institutions that are members of an affiliated group, between U.S. and foreign source income.

TABLE OF CONTENTS: Title I: Health Care Access, Portability, and Renewability Subtitle A: Group Market Rules Subtitle B: Individual Market Rules Subtitle C: COBRA Clarifications Subtitle D: Private Health Plan Purchasing Cooperatives Title II: Application and Enforcement of Standards Title III: Miscellaneous Provisions Title IV: Tax-Related Health Provisions Subtitle A: Increase in Deduction for Health Insurance Costs of Self-Employed Individuals Subtitle B: Long-Term Care Provisions Subtitle C: High-Risk Pools Subtitle D: Penalty-Free IRA Distributions Subtitle E: Revenue Offsets Title V: Health Care Fraud and Abuse Prevention Subtitle A: Fraud and Abuse Control Program Subtitle B: Revisions to Current Sanctions for Fraud and Abuse Subtitle C: Data Collection and Miscellaneous Provisions Subtitle D: Civil Monetary Penalties Subtitle E: Amendments to Criminal Law Title VI: Internal Revenue Code and Other Provisions Subtitle A: Foreign Trust Tax Compliance Subtitle B: Repeal of Bad Debt Reserve Method for Thrift Savings Associations Subtitle C: Other Provisions Health Insurance Reform Act of 1996 - Title I: Health Care Access, Portability, and Renewability - Subtitle A: Group Market Rules - Prohibits insurers from declining to offer whole group coverage to a group purchaser. Allows plans to establish eligibility, continuation, enrollment, or premium requirements, provided the requirements are not based on health status, medical condition, genetic information, or other factors. (Sec. 102) Mandates plan renewability, except for premium nonpayment, material misrepresentation, plan termination, or other specified reasons. (Sec. 103) Regulates the circumstances in which a plan may impose a benefit limitation or exclusion because of a preexisting condition. Mandates crediting of previous qualifying coverage. Allows State laws (unless preempted by specified provisions of the Employee Retirement Income Security Act of 1974 (ERISA)) that: (1) limit preexisting conditions to shorter periods than the provisions of this paragraph; (2) recognize previous qualifying coverage with a lapse period longer than provided for by the provisions of this paragraph; or (3) require issuers to have a lookback period shorter than under this Act. (Sec. 104) Mandates special enrollment periods for individuals who have certain types of changes in family composition or employment status. (Sec. 105) Regulates disclosures an insurer must make to a small employer (as defined in State law or, if not defined in State law, employers with not more than 50 employees). Amends ERISA to modify requirements regarding disclosures to plan participants and beneficiaries. Subtitle B: Individual Market Rules - Prohibits an insurer from declining to offer individual coverage or denying individual enrollment based on health status, medical condition, or other factors if the individual meets specified requirements, including having had previous group coverage and not being currently eligible for group coverage. (Sec. 111) Mandates renewability of coverage for individuals, except for nonpayment of premiums, material misrepresentation, or plan termination. (Sec. 112) Allows a State to adopt alternative public or private mechanisms designed to provide access to affordable health benefits for individuals unless the Secretary of Health and Human Services finds that the State alternative mechanism fails to meet specified requirements of this Act. Deems a State to have met those requirements if it adopts a National Association of Insurance Commissioners (NAIC) model found by the Secretary to meet the requirements. Sets forth the circumstances in which a State high risk pool will be deemed in compliance. Subtitle C: COBRA Clarifications - Amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code to modify continuation coverage requirements. Subtitle D: Private Health Plan Purchasing Cooperatives - Requires a State to certify health plan purchasing cooperatives (HPPCs) meeting the requirements of this section. Provides for Federal certification if a State fails to do so, but prohibits Federal certification in a State where the Secretary finds that, under State law, all small employers have a means readily available that ensures that: (1) individuals and employees have a choice of multiple, unaffiliated health plan issuers; and (2) other requirements of this Act are met. Regulates HPPC organization, duties, and activities. Preempts, for a HPPC meeting these requirements, State fictitious group laws. Specifies the circumstances in which HPPCs are required to comply with State premium rating and mandated benefit laws. Applies to HPPCs, for enforcement purposes only, the requirements of ERISA provisions relating to fiduciary responsibility and administration and enforcement. Title II: Application and Enforcement of Standards - Deems a requirement or standard under this Act imposed on a plan to be imposed on the issuer. (Sec. 202) Requires each State to enforce the standards under this Act pursuant to an enforcement plan filed by the State with the Secretary of Labor. Mandates enforcement of employee health benefit plans by the Secretary in the same manner as under specified ERISA provisions. Provides for Federal enforcement if a State fails to do so. Title III: Miscellaneous Provisions - Amends the Public Health Service Act to allow a health maintenance organization, if notified by a member that a medical savings account has been established for the member and if the member requests, to reduce the basic health services payment by requiring the payment of a deductible for basic health services. Declares that it is the sense of the: (1) Senate Labor and Human Resources Committee that the establishment of medical savings accounts should be encouraged as part of any health insurance reform legislation passed; and (2) Senate that the Congress should take steps to further the purposes of this Act. (Sec. 302) Mandates studies and reports to appropriate congressional committees on: (1) mechanisms to ensure the availability of reasonably priced health coverage to employers purchasing group and individuals purchasing non-group coverage; (2) whether standards limiting premium variation will further the purposes of this Act; (3) the effectiveness of this Act; and (4) patient access to and choice of providers inside and outside of networks, the cost to insurers and the feasibility of out-of-network access, and the percent of premium dollar used for medical care and administration of the types of coverage offered. (Sec. 303) Requires the Health Care Financing Administration to complete their ongoing study of reimbursement of all telemedicine services and report to the Congress with a proposal for reimbursement for fee-for-service medicine. (Sec. 304) Declares that the Senate Labor and Human Resources Committee finds that the Public Trustees of Medicare concluded in a specified report that: (1) the current Medicare program (title XVIII of the Social Security Act) is unsustainable; (2) the Hospital Insurance Trust Fund will be able to pay benefits for only about seven years and is severely out of long-range balance; and (3) the Trustees recommended that the Fund problems be comprehensively addressed. (Sec. 305) Prohibits an employee health benefit plan and a health plan issuer offering a group plan or an individual health plan from imposing treatment limits or financial requirements on the coverage of mental health services if similar limits or requirements are not imposed regarding other conditions. (Sec. 306) Amends the Immigration and Nationality Technical Corrections Act of 1994 to extend the termination date of and modify requirements regarding provisions relating to waivers of a requirement that aliens who came to the United States to receive graduate medical education or training return to their country of nationality for two years before applying for an immigrant visa, permanent residence, or a nonimmigrant visa. (Sec. 307) Mandates inclusion with any income tax refund of a document encouraging organ and tissue donation. (Sec. 308) Declares that it is the sense of the Senate that: (1) the issue of adequate health care for mothers and children is important to the future of the United States and the Senate should pass legislation ensuring coverage for all U.S. pregnant women and children; and (2) patients deserve to know the full range of available treatments and the Congress should examine these issues to ensure that all patients get the care they deserve. (Sec. 310) Medical Volunteer Act - Requires that a health care professional who provides a health care service to a medically underserved person without receiving compensation be regarded, for purposes of any medical malpractice claim arising in connection with the service, as a Federal employee for purposes of the Federal tort claims provisions of Federal law relating to the judiciary and judicial procedure. Deems the professional to have provided the service without compensation only if, prior to furnishing the care, the professional: (1) agrees to furnish the service without charge to any person, including any insurance or program covering the recipient; and (2) provides the recipient with notice of the limited liability. Preempts inconsistent State laws, but not State laws providing greater incentives or protections to the professional. Title IV: Tax-Related Health Provisions - Health Insurance and Long-term Care Affordability Act of 1996 - Subtitle A: Increase in Deduction for Insurance Costs of Self-Employed Individuals - Amends the Internal Revenue Code to increase annually, from 30 percent to 80 percent by the year 2006, the amount of health insurance costs for the self-employed which are deductible. Subtitle B: Long-Term Care Provisions - Chapter 1: Long-Term Care Services and Contracts - Subchapter A: General Provisions - Sets forth definitions and rules concerning the treatment of qualified long-term care insurance plans, including that: (1) a qualified long- term care insurance contract (including an employer provided plan) shall be treated as an accident and health insurance contract; (2) amounts received under such a contract shall be treated as amounts received for personal injuries and sickness; (3) subject to exception, per diem payments made under such a contract shall be treated as payments made for insurance covering medical care; and (4) such a contract shall be treated as a guaranteed renewable contract. Defines such a contract and the services it must provide. Provides for the treatment of such contract as part of a life insurance contract. Provides for the exclusion of such insurance under cafeteria plans and the inclusion of long-term care benefits provided through flexible spending arrangements. Defines a flexible spending arrangement as a benefit program which provides employees with coverage under which: (1) specified incurred expenses may be reimbursed, subject to exceptions; and (2) the maximum amount of reimbursement to a participant for such coverage is less than 500 percent of the value of such coverage. Makes the provision of continuation coverage optional. (Sec. 412) Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 413) Recognizes no gain or loss on the exchange of a life insurance contract or an endowment or annuity contract for a qualified long-term care insurance contract. (Sec. 414) Exempts from the early withdrawal penalty amounts withdrawn from a qualified retirement plan for qualified long-term care insurance. (Sec. 415) Sets forth reporting requirements for any person paying long-term care benefits. Subchapter B: Consumer Protection Provisions - Sets forth consumer protection provisions, including provisions pertaining to model regulations and penalties for any issuer of a long-term care insurance policy violating such regulations. Chapter 2: Treatment of Accelerated Death Benefits - Treats accelerated death benefits under a life insurance contract as being paid by reason of the death of the insured. (Sec. 432) Treats qualified accelerated death benefit riders as life insurance, but excepts long-term care insurance riders. Subtitle C: High-Risk Pools - Exempts from taxation a State- sponsored non-profit organization formed exclusively to provide medical coverage to high-risk individuals. Subtitle D: Penalty-Free IRA Distributions - Permits penalty-free withdrawals from qualified retirement plans to pay health insurance premiums for certain unemployed individuals. Subtitle E: Revenue Offsets - Chapter 1: Treatment of Individuals Who Expatriate - Sets forth the tax responsibilities of an expatriate: (1) who has had an average annual net income tax of more than $100,000 for the five year period ending before expatriation; (2) or whose net worth is $500,000 or more. Provides as a general rule that all property of a covered expatriate shall be treated as sold on the expatriation date for its fair market value. Allows an exclusion from gain of up to $600,000. Permits an expatriate to elect to continue to be taxed as a United States citizen, in which case the provisions applicable to other expatriates will not apply. Sets forth specified reporting requirements for all expatriates. Chapter 2: Company-Owned Insurance - Prohibits a deduction for any interest paid or accrued on any indebtedness with respect to life insurance policies owned by a taxpayer covering the life of any individual, or any endowment or annuity contracts owned by the taxpayer covering any individual, who is an officer or employee of, or is financially interested in, any business of the taxpayer to the extent that such indebtedness with respect to policies covering such individual exceeds $50,000. Permits an exception for contracts relating to key persons. Title V: Health Care Fraud and Abuse Prevention - Subtitle A: Fraud and Abuse Control Program - Amends title XI of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS), acting through the HHS Office of Inspector General (IG), and the Attorney General to establish a program to: (1) coordinate Federal, State, and local law enforcement programs to control health care fraud and abuse; (2) conduct investigations, audits, and inspections relating to the delivery of and payment for health care; (3) facilitate enforcement of certain provisions of that title and other Acts applicable to health care fraud and abuse; (4) provide for the modification and establishment of safe harbors and to issue interpretative rulings and special fraud alerts; and (5) provide for the reporting and disclosure of certain final adverse actions against health care providers, suppliers, or practitioners pursuant to the data collection system established by this title. (Sec. 501) Establishes the Health Care Fraud and Abuse Control Account (Account) in Medicare's Federal Hospital Insurance Trust Fund (Trust Fund) to hold the criminal fines and civil monetary penalties and assessments obtained from Federal health care cases, as well as property forfeiture proceeds resulting from such cases, and other specified amounts for financing the program above and the Medicare Integrity Program established below. Makes certain appropriations to the Trust Fund and Account, earmarking specified amounts for activities of the Department of Health and Human Services' (HHS) Office of the Inspector General (IG) with respect to the Medicare and Medicaid programs under SSA titles XVIII and XIX. (Sec. 502) Establishes under Medicare the Medicare Integrity Program under which the HHS Secretary shall promote the integrity of the Medicare program by entering into contracts with certain eligible private entities to: (1) review the activities of service providers under Medicare and audit cost reports to determine whether payment should not have been made; (2) educate service providers, beneficiaries, and other persons with respect to payment and benefit issues; and (3) develop and periodically update a list of items of durable medical equipment which are subject to prior authorization. Prohibits payment to fiscal intermediaries under Medicare part A (Hospital Insurance) and carriers under Medicare part B (Supplementary Medical Insurance) for carrying out certain activities to the extent such an activity is carried out pursuant to a contract under the Medicare Integrity Program. (Sec. 503) Directs the HHS Secretary to provide an explanation of benefits under the Medicare program with respect to each furnished item or service for which payment may be made, without regard to whether or not a deductible or coinsurance may be imposed against the individual with respect to such item or service. Directs the HHS Secretary to establish a program to encourage individuals to: (1) report information on fraud and abuse under Medicare; and (2) submit suggestions on methods to improve the efficiency of the Medicare program. Provides for the payment to such individuals of a portion of: (1) any amounts collected due to any reports of fraud or abuse; or (2) any savings resulting from any suggestions that are adopted. (Sec. 504) Amends SSA title XI to extend the application of criminal penalties for acts involving the Medicare program to similar violations of any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or in part, by the Federal Government, except the Federal Employees' Health Benefits Program (Federal care health programs). (Sec. 505) Directs the HHS Secretary periodically to publish a notice in the Federal Register soliciting proposals for: (1) modifications to existing safe harbors issued under the Medicare and Medicaid Patient and Program Protection Act of 1987; (2) additional safe harbors specifying payment practices that shall not be treated as a criminal offense or exclusion; (3) interpretive rulings, upon request, by the HHS IG with regard to SSA title XI civil monetary and criminal penalty provisions; and (4) special fraud alerts by the HHS IG, upon request, with regard to suspect practices under the Medicare program or a State health care program. Requires subsequent issuance of any appropriate implementing regulations. Subtitle B: Revisions to Current Sanctions for Fraud and Abuse - Excludes from participation in Medicare and State health care programs any individual or entity convicted after the enactment of this Act of a felony related to: (1) fraud in connection with the delivery of a health care item or service; or (2) a controlled substance. (Sec. 512) Revises specified current sanctions involving exclusion for fraud and abuse under Medicare and State health care programs, among other changes specifying minimum periods of exclusion for: (1) certain individuals and entities subject to permissive exclusion from Medicare and State health care programs; and (2) practitioners and persons failing to meet certain statutory obligations with regard to services or items ordered or provided to the covered beneficiary or recipient. Repeals the prerequisite that a health care practitioner or person be determined "unwilling or unable" to comply substantially with a corrective action plan before sanctions may be imposed (thus permitting the Secretary to exclude such practitioner or person from eligibility to provide services for failure to comply with a corrective action plan, regardless of circumstances). (Sec. 515) Permits the imposition of intermediate sanctions on Medicare health maintenance organizations, in addition to the current option of termination. Provides additional intermediate sanctions, including civil money penalties and enrollment suspension, for miscellaneous program violations. (Sec. 516) Excepts from anti-kickback penalties for risk-sharing arrangements any remuneration between an organization and an item or service provider pursuant to a written agreement between them if: (1) the organization is a Medicare-eligible health maintenance organization or competitive medical plan; or (2) the written agreement places the item or service provider at substantial financial risk for the cost or utilization of such items or services which it is obligated to provide, whether through a withhold, capitation, or other similar risk arrangement which places such provider at substantial financial risk. Subtitle C: Data Collection and Miscellaneous Provisions - Directs the HHS Secretary to establish a national health care fraud and abuse data collection program for reporting final adverse actions taken against health care providers, suppliers, or practitioners. Requires each Government agency and health plan to report to the Secretary any such final adverse actions. Provides for the coordination of such program with the National Practitioner Data Bank. (Sec. 521) Allows the HHS Secretary, under the system for unique identifiers for Medicare physicians, to impose appropriate fees on such physicians to cover the costs of investigation and recertification activities with respect to the issuance of the identifiers. Subtitle D: Civil Monetary Penalties - Revises civil monetary penalty and other related SSA title XI provisions, among other things: (1) subjecting to civil penalties certain program-excluded individuals who retain an ownership or control interest in a participating entity if they know or should know of the action constituting the basis for the exclusion at the time they violated such provisions; (2) increasing the amounts of various specified penalties and assessments, including those against health care practitioners who fail to comply with their statutory obligations; and (3) prohibiting the offering of inducements to individuals enrolled under Medicare or a State health care program, including waiver of coinsurance and deductible amounts and transfers of items or services for free or for other than fair market value. Subtitle E: Amendments to Criminal Law - Amends the Federal criminal code to cover the commission of health care fraud, theft or embezzlement in connection with health care, obstruction of criminal investigations of Federal health care offenses, and other specified matters related to health care, such as the laundering of monetary instruments. (Sec. 543) Provides for injunctive relief relating to covered Federal health care offenses, as well as for property forfeitures. Title VI: Internal Revenue Code and Other Provisions - Subtitle A: Foreign Trust Tax Compliance - Revises the requirements regarding information that must be reported regarding certain foreign trusts. Modifies the circumstances (with regard to foreign trusts having one or more U.S. beneficiaries) in which a transferor is treated as the owner. Replaces provisions setting forth a special rule applicable to foreign grantors with provisions declaring that provisions relating to treating grantors and others as substantial owners shall apply only when that application results in an amount being currently taken into account in computing the income of a U.S. citizen or resident or a domestic corporation. Requires a United States person to report information regarding foreign gifts or bequests when the gifts' aggregate value during a taxable year exceeds $10,000. Modifies requirements regarding the interest charge on accumulation distributions from foreign trusts. Changes the circumstances in which an estate or trust is included in the definition of "United States person." Modifies the definition of "foreign estate or trust." Requires (for provisions relating to the imposition of a tax on transfers to avoid income tax) treating a trust which is not a foreign trust and which becomes a foreign trust as having transferred, immediately before becoming a foreign trust, all of its assets to a foreign trust. Subtitle B: Repeal of Bad Debt Reserve Method for Thrift Savings Associations - Repeals the bad debt reserve method, concerning reserves for losses on loans, for thrift savings associations. Subtitle C: Other Provisions - Amends title XVIII (Medicare) of the Social Security Act to extend the secondary payor provisions. Amends the United States Housing Act of 1937 to direct the Secretary of Housing and Urban Development, in specified circumstances, to modify rent adjustments using an operating costs factor that increases the rent to reflect increases in operating costs in the market area. Amends the National Housing Act to remove the provision which limits foreclosure avoidance and borrower assistance to those mortgages insured under such Act which originated before October 1, 1995.

TABLE OF CONTENTS: Title I: Improved Availability and Portability of Health Insurance Coverage Subtitle A: Coverage Under Group Health Plans Subtitle B: Certain Requirements for Insurers and HMOs in the Group and Individual Markets Subtitle C: Affordable and Available Health Coverage Through Multiple Employer Pooling Arrangements Subtitle D: Definitions; General Provisions Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Subtitle A: Fraud and Abuse Control Program Subtitle B: Revisions to Current Sanctions for Fraud and Abuse Subtitle C: Data Collection Subtitle D: Civil Monetary Penalties Subtitle E: Revisions to Criminal Law Subtitle F: Administrative Simplification Subtitle G: Duplication and Coordination of Medicare-Related Plans Subtitle H: Medical Liability Reform Title III: Tax-Related Health Provisions Subtitle A: Medical Savings Accounts Subtitle B: Increase in Deduction for Health Insurance Costs of Self-Employed Individuals Subtitle C: Long-Term Care Services and Contracts Subtitle D: Treatment of Accelerated Death Benefits Subtitle E: High-Risk Pools Subtitle F: Organizations Subject to Section 833 Title IV: Revenue Offsets Subtitle A: Repeal of Bad Debt Reserve Method for Thrift Savings Associations Subtitle B: Reform of the Earned Income Credit Subtitle C: Treatment of Individuals Who Lose United States Citizenship Health Coverage Availability and Affordability Act of 1996 - Title I: Improved Availability and Portability of Health Insurance Coverage - Subtitle A: Coverage Under Group Health Plans - Requires a group health plan and an insurer or health maintenance organization (HMO) offering health insurance in connection with a group health plan to: (1) reduce any preexisting condition period by the aggregate period of prior coverage; and (2) limit any preexisting condition period to not more than 12 months. Prohibits: (1) preexisting condition periods for newborns and regarding certain adoptions; and (2) treating pregnancy as a preexisting condition. Allows an HMO that does not use preexisting condition limitations to: (1) impose an eligibility period; and (2) use alternative methods to address adverse selection as approved by a State authority. (Sec. 103) Prohibits coverage exclusion and premium or contribution discrimination on the basis of health status. Requires a plan to allow an otherwise-eligible employee to enroll if the employee previously declined enrollment because of other coverage and subsequently lost the other coverage. Prohibits, if a plan offers family coverage, a waiting period for a newborn, certain adopted children, or a spouse. Prohibits a group health plan that is a multi-employer plan, a multiple employer health plan, or a multiple employer welfare arrangement (MEWA) from denying an employer continued access to the same or different coverage under the terms of the plan or arrangement, except for nonpayment of premiums, fraud, or similar matters. (Sec. 104) Amends the Internal Revenue Code to impose a tax on any failure of a group health plan to meet certain requirements of this Act. Deems sections 101 through 103 of this subtitle and subtitle D as it is applicable to those sections to be provisions of the Employee Retirement Income Security Act of 1974 (ERISA). Provides for civil money penalties for failure to meet a requirement of this subtitle. Subtitle B: Certain Requirements for Insurers and HMOs in the Group and Individual Markets - Requires each insurer or HMO that offers health insurance coverage in the small group market in a State to accept every applying small employer and every applying eligible individual. Allows minimum participation or contribution rules. (Sec. 132) Requires an insurer or HMO that offers coverage in the small or large group market to renew or continue the coverage at the option of the employer, except for nonpayment of premiums, fraud, and similar reasons. Allows uniform termination or modification of coverage. (Sec. 141) Requires each insurer or HMO that issues individual health insurance to offer coverage to each individual who previously had group coverage. Prohibits declining issuance based on health status. Allows superseding State mechanisms reasonably designed to meet the goals of guaranteeing coverage to qualifying individuals and assuring that the individuals receive credit for prior coverage toward the new coverage's preexisting condition exclusion period. (Sec. 142) Mandates renewal or continuation of individual coverage, except for nonpayment of premiums, fraud, or similar matters. (Sec. 151) Applies the civil money penalty provisions of subtitle A to subtitle B. Subtitle C: Affordable and Available Health Coverage Through Multiple Employer Pooling Arrangements - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to set forth rules regarding multiple employer health plans. Treats a multiple employer welfare arrangement (MEWA) under which the benefits consist solely of medical care, and under which some or all benefits are not fully insured, as an employee welfare benefit plan that is a health plan. Provides for the treatment of such arrangements under preemption rules. Regulates reserves, notice regarding voluntary termination, and corrective actions and mandatory termination. (Sec. 166) Provides for the treatment of church plans. (Sec. 167) Provides for enforcement through civil monetary penalties, injunctions, and criminal penalties, as well as Federal-State cooperation in enforcement. (Sec. 169) Requires each MEWA to register before beginning operations and annually thereafter. (Sec. 170) Provides for a single annual report regarding all employers participating in a MEWA. Subtitle D: Definitions; General Provisions - Excludes church plans from the requirements of this title as they apply to group health plans. Allows governmental plans to elect not to be subject to such requirements. Requires treatment as group health plans of State Medicaid (unless a State elects otherwise) and Medicare plans and Indian Health Service programs for individual coverage certification purposes. Provides for the treatment of partnerships. Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform - Subtitle A: Fraud and Abuse Control Program - Amends title XI of the Social Security Act (SSA) to require the Secretary of Health and Human Services (HHS), acting through the Department of HHS Office of Inspector General (IG), and the Attorney General to establish a program to: (1) coordinate Federal, State, and local law enforcement programs to control health care fraud and abuse; (2) conduct investigations, audits, and inspections relating to the delivery of and payment for health care; (3) facilitate enforcement of certain provisions of title XI and other Acts applicable to health care fraud and abuse; (4) provide for the modification and establishment of safe harbors and to issue advisory opinions and special fraud alerts; and (5) provide for the reporting and disclosure of certain final adverse actions against health care providers, suppliers, or practitioners pursuant to the data collection system established below. (Sec. 201) Establishes the Health Care Fraud and Abuse Control Account (Account) in Medicare's Federal Hospital Insurance Trust Fund (Trust Fund) to hold the criminal fines and civil monetary penalties and assessments obtained from Federal health care cases, as well as property forfeiture proceeds resulting from such cases, and other specified amounts for financing the program above and the Medicare Integrity Program established by this title. Makes certain appropriations to the Trust Fund and Account, earmarking certain amounts for activities of the Department of HHS Office of the IG with respect to the Medicare and Medicaid programs under SSA titles XVIII and XIX. (Sec. 202) Establishes under Medicare the Medicare Integrity Program under which the HHS Secretary shall promote the integrity of the Medicare program by entering into contracts with certain eligible private entities to: (1) review the activities of service providers under Medicare and audit cost reports to determine whether payment should not have been made; (2) educate service providers, beneficiaries, and other persons with respect to payment and benefit issues; and (3) develop and periodically update a list of items of durable medical equipment which are subject to prior authorization. Prohibits fiscal intermediaries under Medicare part A (Hospital Insurance) and carriers under Medicare part B (Supplementary Medical Insurance) from carrying out certain activities to the extent the activity is carried out pursuant to a contract under the Medicare Integrity Program. (Sec. 203) Directs the HHS Secretary to provide an explanation of Medicare benefits with respect to each furnished item or service for which payment may be made to an individual without regard to whether or not a deductible or coinsurance may be imposed. Directs the HHS Secretary to establish a program for encouraging individuals to: (1) report information on fraud and abuse under Medicare; and (2) submit suggestions on methods to improve the efficiency of the Medicare program. Provides for the payment to such individuals of a portion of: (1) any amounts collected due to any such reports; or (2) any savings resulting from any such suggestions which are adopted. (Sec. 204) Amends SSA title XI to require application of criminal penalties for acts involving the Medicare program to similar violations of any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or in part, by the Federal Government, except the Federal Employees' Health Benefits Program (Federal care health programs). (Sec. 205) Directs the HHS Secretary to periodically publish a notice in the Federal Register soliciting proposals for: (1) modifications to existing safe harbors issued under the Medicare and Medicaid Patient and Program Protection Act of 1987; (2) additional safe harbors specifying payment practices that shall not be treated as a criminal offense or serve as the basis for an exclusion; (3) advisory opinions by the HHS IG with regard to prohibited remuneration constituting grounds for the imposition of a sanction; and (4) special fraud alerts by the HHS IG, upon request, with regard to suspect practices under the Medicare program or a State health care program. Requires the Secretary to issue appropriate implementing regulations. Subtitle B: Revisions to Current Sanctions for Fraud and Abuse - Excludes from participation in Medicare and State health care programs any individual or entity convicted after the enactment of this Act of a felony related to: (1) fraud in connection with the delivery of a health care item or service; or (2) a controlled substance. (Sec. 212) Revises specified current sanctions involving exclusion for fraud and abuse under Medicare and State health care programs, among other changes establishing minimum periods of exclusion for: (1) certain individuals and entities subject to permissive exclusion from Medicare and State health care programs; and (2) practitioners and persons failing to meet certain statutory obligations with regard to services or items. Repeals the prerequisite that a health care practitioner or person be determined "unwilling or unable" to comply substantially with a corrective action plan before sanctions may be imposed (thus permitting the Secretary to exclude such practitioner or person from eligibility to provide services for failure to comply with a corrective action plan, regardless of circumstances). (Sec. 215) Permits the imposition of intermediate sanctions on Medicare health maintenance organizations in addition to the current option of termination. Provides additional intermediate sanctions for miscellaneous program violations. (Sec. 216) Provides an additional specified exception to anti-kickback penalties for discounting and managed care arrangements. (Sec. 217) Creates a criminal penalty under SSA title XI for fraudulent disposition of assets in order to obtain Medicaid benefits. Subtitle C: Data Collection - Directs the HHS Secretary to establish a national health care fraud and abuse data collection program for reporting final adverse actions against health care providers, suppliers, or practitioners. Requires each Government agency and health plan to report to the Secretary any final adverse action taken against such provider, supplier, or practitioner. (Sec. 221) Allows the HHS Secretary, under the system for unique identifiers for Medicare physicians, to impose appropriate fees on such physicians to cover the costs of investigation and recertification activities with respect to the issuance of the identifiers. Subtitle D: Civil Monetary Penalties - Revises civil monetary penalties, providing among other changes for: (1) the exclusion from participation in Federal and State health care programs of persons subject to penalties and assessments for applicable program violations; (2) modifications in the amounts of various specified penalties and assessments, including the sanctions against health care practitioners who violate their statutory obligations with regard to the services or items ordered or provided by them to a covered beneficiary or recipient; (3) a prohibition against offering inducements to individuals enrolled under Medicare or a State health care program; (4) subjecting to civil money penalties certain excluded individuals retaining an ownership or control interest in a participating entity if they knew or should have known of the action constituting the basis for the exclusion of such entity at the time of violation; (5) a specific definition, for such penalty purposes, for remuneration which includes the waiver of coinsurance and deductible amounts and transfers of items or services for free or for other than fair market value; and (6) a penalty for false certification for home health services. Subtitle E: Revisions to Criminal Law - Amends the Federal criminal code to define a Federal health care offense and cover within its general purview, and provide sanctions for, the commission of health care fraud, theft or embezzlement in connection with health care, obstruction of criminal investigations of Federal health care offenses, and other specified matters related to health care, such as the laundering of monetary instruments in connection with a Federal health care offense. (Sec. 247) Provides for injunctive relief relating to covered Federal health care offenses, as well as for property forfeitures. Subtitle F: Administrative Simplification - Amends SSA title XI to add a new part C (Administrative Simplification) for development of an electronic system for: (1) processing health care information consistent with the goal of improving the operation of the overall health care system; and (2) reducing related administrative costs through the HHS Secretary's adoption of certain standards for information transactions (including enrollment, disenrollment, claims attachments, and coordination of benefits) and data elements as well as standards relating to security and privacy, and performance of tasks pursuant to specified requirements, assisted by the National Committee on Vital and Health Statistics. (Sec. 251) Provides penalties for violations of provisions of this subtitle, including for the wrongful disclosure of individually identifiable health information. (Sec. 253) Amends the Public Health Service Act to provide for a change in the membership and duties of the National Committee on Vital and Health Statistics, including responsibility for advising the HHS Secretary and the Congress on the implementation of the administrative simplification requirements of this subtitle. Subtitle G: Duplication and Coordination of Medicare-Related Plans - Provides for the treatment of certain health insurance policies as nonduplicative under Medicare or Medicaid, such as policies providing for benefits payable to or on behalf of an individual without regard to other health benefit coverage of the individual. Subtitle H: Medical Liability Reform - Outlines various specified measures designed for addressing health care liability issues, including changes establishing: (1) limitations for health care liability actions brought in a State or Federal court against a health care provider; (2) a limitation on the total amount of noneconomic damages which may be awarded to a claimant for losses resulting from an injury; (3) certain restrictions on punitive damage awards; and (4) standards for alternative dispute resolution used to resolve a health care liability action or claim. Title III: Tax-Related Health Provisions - Subtitle A: Medical Savings Accounts - Amends the Internal Revenue Code to allow a deduction for limited amounts paid to a medical savings account (MSA). Defines "medical savings account" as a trust for paying the account holder's medical expenses. Exempts an MSA from taxation unless it has ceased being an MSA. Provides for the treatment of distributions. Allows the MSA deduction to be taken whether or not the individual itemizes deductions. Excludes limited employer MSA contributions from employee gross income. Excludes employer MSA contributions from provisions relating to social security, railroad retirement, unemployment, and withholding taxes. Makes MSA contributions unavailable under cafeteria plans. Excludes MSAs from the value of taxable estates. Imposes a tax on excess MSA contributions. Exempts an MSA holder from prohibited transactions taxes if the MSA ceases to be an MSA. Imposes a penalty on MSA reporting failure. Exempts MSAs from the definition of "specified insurance contract" for provisions relating to capitalization of certain policy acquisition expenses. Subtitle B: Increase in Deduction for Health Insurance Costs of Self-Employed Individuals - Allows self-employed individuals to deduct a portion of their expenditures for medical insurance for the individual, spouse, and dependents. Subtitle C: Long-Term Care Services and Contracts - Part I: General Provisions - Requires treating: (1) a long-term care insurance as accident and health insurance and associated amounts received as received for personal injuries and sickness and as reimbursement for medical care expenses actually incurred; (2) an employer's plan providing long-term care as an accident and health plan; (3) limited amounts paid for such insurance as payments for medical care; and (4) such insurance as guaranteed renewable under specified provisions. Provides for the treatment of: (1) excess aggregate long-term care payments; and (2) long-term care coverage provided in conjunction with life insurance. Excludes long-term care from cafeteria plans. Includes in an employee's gross income employer-provided long-term care overage provided through a flexible spending arrangement. Declares that a group health plan does not fail to meet continuation requirements solely because it fails to provide long-term coverage. (Sec. 322) Amends the definition of "medical care" (for provisions allowing a deduction for medical care expenses) to include qualified long-term care services. (Sec. 323) Imposes reporting requirements on long-term care benefit payors. Part II: Consumer Protection Provisions - Sets forth provisions regarding: (1) the model regulation and model Act promulgated by the National Association of Insurance Commissioners; and (2) certain disclosure and nonforfeitability requirements. (Sec. 326) Imposes a tax the failure to meet requirements regarding: (1) the model regulation and model Act; (2) policy or certificate delivery; and (3) claims denials information. Subtitle D: Treatment of Accelerated Death Benefits - Treats life insurance amounts paid as an amount paid because of death if the insured is terminally or chronically ill and the amount is received under a provision that is treated as long-term care insurance. Treats the amount paid by a viatical settlement provider for a life insurance contract as an amount paid by reason of the death of the insured. (Sec. 332) Treats, for life insurance company provisions, references to life insurance contracts as including references to accelerated death benefit riders (unless a rider is treated as a long-term care contract). Subtitle E: High-Risk Pools - Exempts from taxation a State-established membership organization providing nonprofit medical care coverage to high risk individuals. Subtitle F: Organizations Subject to Section 833 - Allows (for provisions affording a special deduction) an organization that is not a blue cross or blue shield (BCBS) organization to be treated as if it were a BCBS organization if it is not for profit and meets other requirements. Title IV: Revenue Offsets - Subtitle A: Repeal of Bad Debt Reserve Method for Thrift Savings Associations - Declares that bad debt reserve banking provisions shall not apply after a specified date. Provides for the resulting accounting method change. Subtitle B: Reform of the Earned Income Credit - Requires, in order to be eligible for the earned income credit (EIC), that a taxpayer include on the return the taxpayer's (and, if married, the spouse's) social security number (SSN). Adds to the definition of "mathematical or clerical error" references to omission of a SSN required by EIC provisions. Subtitle C: Treatment of Individuals Who Lose United States Citizenship - Requires that individuals who lose U.S. citizenship and who meet specified criteria be treated (for income, estate, and gift tax provisions) as having a principal purpose to avoid taxes. Requires, for these purposes, treating long-term U.S. residents who cease being permanent U.S. residents or begin being the resident of a foreign country as if they were U.S. citizens who lost U.S. citizenship. (Sec. 422) Requires a person who loses U.S. citizenship or ceases to be a long-term U.S. resident to provide a statement with specified contents. (Sec. 423) Mandates a report to specified congressional committees on income tax compliance by citizens and lawful permanent U.S. residents residing outside the United States.

TABLE OF CONTENTS: Title I: Improved Availability and Portability of Health Insurance Coverage Subtitle A: Coverage Under Group Health Plans Subtitle B: Definitions; General Provisions Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification Subtitle A: Fraud and Abuse Control Program Subtitle B: Revisions to Current Sanctions for Fraud and Abuse Subtitle C: Data Collection Subtitle D: Civil Monetary Penalties Subtitle E: Revisions to Criminal Law Subtitle F: Administrative Simplification Title III: Tax-Related Health Provisions Subtitle A: Medical Savings Accounts Subtitle B: Increase in Deduction for Health Insurance Costs of Self-Employed Individuals Subtitle C: Long-Term Care Services and Contracts Subtitle D: Treatment of Accelerated Death Benefits Subtitle E: High-Risk Pools Title IV: Revenue Offsets Subtitle A: Repeal of Bad Debt Reserve Method for Thrift Savings Associations Subtitle B: Reform of the Earned Income Credit Health Coverage Availability and Affordability Act of 1996 - Title I: Improved Availability and Portability of Health Insurance Coverage - Subtitle A: Coverage Under Group Health Plans - Requires a group health plan and an insurer or health maintenance organization (HMO) offering health insurance in connection with a group health plan to: (1) reduce any preexisting condition period by the aggregate period of prior coverage; and (2) limit any preexisting condition period to not more than 12 months. Prohibits: (1) preexisting condition periods for newborns and regarding certain adoptions; and (2) treating pregnancy as a preexisting condition. Allows an HMO that does not use preexisting condition limitations to impose an eligibility period. (Sec. 103) Prohibits coverage exclusion on the basis of health status. Requires a plan to allow an otherwise-eligible employee to enroll if the employee previously declined enrollment because of other coverage and subsequently lost the other coverage. Prohibits, if a plan offers family coverage, a waiting period for a newborn, certain adopted children, or a spouse. (Sec. 104) Amends the Internal Revenue Code to impose a tax on any failure of a group health plan to meet certain requirements of this Act. Deems sections 101 through 103 of this Act to be provisions of the Employee Retirement Income Security Act of 1974 (ERISA). Provides for civil money penalties for failure to meet a requirement of this subtitle. Subtitle B: Definitions; General Provisions - Sets forth definitions and general provisions, including: (1) excluding church plans from the requirements of this title; and (2) requiring treatment of State Medicaid (unless a State elects otherwise) and Medicare plans as a group health plan for individual coverage certification purposes. Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification - Subtitle A: Fraud and Abuse Control Program - Amends title XI of the Social Security Act (SSA) to require the Secretary of Health and Human Services (HHS), acting through the Department of HHS Office of Inspector General (IG), and the Attorney General to establish a program to: (1) coordinate Federal, State, and local law enforcement programs to control health care fraud and abuse; (2) conduct investigations, audits, and inspections relating to the delivery of and payment for health care; (3) facilitate enforcement of certain provisions of title XI and other Acts applicable to health care fraud and abuse; (4) provide for the modification and establishment of safe harbors and to issue advisory opinions and special fraud alerts; and (5) provide for the reporting and disclosure of certain final adverse actions against health care providers, suppliers, or practitioners pursuant to the data collection system established below. (Sec. 201) Establishes the Health Care Fraud and Abuse Control Account (Account) in Medicare's Federal Hospital Insurance Trust Fund (Trust Fund) to hold the criminal fines and civil monetary penalties and assessments obtained from Federal health care cases, as well as property forfeiture proceeds resulting from such cases, and other specified amounts for financing the program above and the Medicare Integrity Program established by this title. Makes certain appropriations to the Trust Fund and Account, earmarking certain amounts for activities of the Department of HHS Office of the IG with respect to the Medicare and Medicaid programs under SSA titles XVIII and XIX. (Sec. 202) Establishes the Medicare Integrity Program under which the HHS Secretary shall promote the integrity of the Medicare program by entering into contracts with certain eligible private entities to: (1) review the activities of Medicare service providers and audit cost reports to determine whether payment should not have been made; (2) educate service providers, beneficiaries, and other persons with respect to payment and benefit issues; and (3) develop and periodically update a list of items of durable medical equipment subject to prior authorization. Prohibits fiscal intermediaries under Medicare part A (Hospital Insurance) and carriers under Medicare part B (Supplementary Medical Insurance) from carrying out certain activities under Medicare to the extent the activity is carried out pursuant to a contract under the Medicare Integrity Program. (Sec. 203) Directs the HHS Secretary to provide an explanation of Medicare benefits with respect to each furnished item or service for which payment may be made to an individual without regard to whether or not a deductible or coinsurance may be imposed. Directs the HHS Secretary to establish a program for encouraging individuals to: (1) report information on fraud and abuse under Medicare or other Federal or State health care programs; and (2) submit suggestions on methods to improve the efficiency of the Medicare program. Provides for the payment to such individuals of a portion of: (1) any amounts collected due to any such reports; or (2) any savings resulting from any such suggestions which are adopted. (Sec. 204) Amends SSA title XI to require application of criminal penalties for acts involving the Medicare program to similar violations of any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or in part, by the Federal Government, except the Federal Employees' Health Benefits Program (Federal care health programs). (Sec. 205) Directs the HHS Secretary to periodically publish a notice in the Federal Register soliciting proposals for: (1) modifications to existing safe harbors issued under the Medicare and Medicaid Patient and Program Protection Act of 1987; (2) additional safe harbors specifying payment practices that shall not be treated as a criminal offense or serve as the basis for an exclusion; (3) advisory opinions by the HHS IG with regard to prohibited remuneration constituting grounds for the imposition of a sanction; and (4) special fraud alerts by the HHS IG, upon request, with regard to suspect practices under the Medicare program or a State health care program. Requires the Secretary to issue appropriate implementing regulations. Subtitle B: Revisions to Current Sanctions for Fraud and Abuse - Excludes from participation in Medicare and State health care programs any individual or entity convicted after the enactment of this Act of a felony related to: (1) fraud in connection with the delivery of a health care item or service; or (2) a controlled substance. (Sec. 212) Revises specified current sanctions involving exclusion for fraud and abuse under Medicare and State health care programs, among other changes establishing minimum periods of exclusion for: (1) certain individuals and entities subject to permissive exclusion from Medicare and State health care programs; and (2) practitioners and persons failing to meet certain statutory obligations with regard to services or items. Repeals the prerequisite that a health care practitioner or person be determined "unwilling or unable" to comply substantially with a corrective action plan before sanctions may be imposed (thus permitting the Secretary to exclude such practitioner or person from eligibility to provide services for failure to comply with a corrective action plan, regardless of circumstances). (Sec. 215) Permits the imposition of intermediate sanctions on Medicare health maintenance organizations in addition to the current option of termination. Provides additional intermediate sanctions for miscellaneous program violations. (Sec. 216) Provides an additional specified exception to anti- kickback penalties for discounting and managed care arrangements. (Sec. 217) Creates a criminal penalty under SSA title XI for fraudulent disposition of assets in order to obtain Medicaid benefits. Subtitle C: Data Collection - Directs the HHS Secretary to establish a national health care fraud and abuse data collection program for reporting final adverse actions against health care providers, suppliers, or practitioners. Requires each Government agency and health plan to report to the Secretary any final adverse action taken against such provider, supplier, or practitioner. (Sec. 221) Allows the HHS Secretary, under the system for unique identifiers for Medicare physicians, to impose appropriate fees on such physicians to cover the costs of investigation and recertification activities with respect to the issuance of the identifiers. Subtitle D: Civil Monetary Penalties - Revises civil monetary penalties, providing among other changes for: (1) the exclusion from participation in Federal and State health care programs of persons subject to penalties and assessments for applicable program violations; (2) modifications in the amounts of various specified penalties and assessments, including the sanctions against health care practitioners who violate their statutory obligations with regard to the services or items ordered or provided by them to a covered beneficiary or recipient; (3) a prohibition against offering inducements to individuals enrolled under Medicare or a State health care program; (4) subjecting to civil money penalties certain excluded individuals retaining an ownership or control interest in a participating entity if they knew or should have known of the action constituting the basis for the exclusion of such entity at the time of violation; (5) a specific definition, for such penalty purposes, for remuneration which includes the waiver of coinsurance and deductible amounts and transfers of items or services for free or for other than fair market value; and (6) a penalty for false certification for home health services. Subtitle E: Revisions to Criminal Law - Amends the Federal criminal code to define a Federal health care offense and cover within its general purview, and provide sanctions for, the commission of health care fraud, theft or embezzlement in connection with health care, obstruction of criminal investigations of Federal health care offenses, and other specified matters related to health care, such as the laundering of monetary instruments in connection with a Federal health care offense. (Sec. 247) Provides for injunctive relief relating to covered Federal health care offenses, as well as for property forfeitures. Subtitle F: Administrative Simplification - Amends SSA title XI to add a new part C (Administrative Simplification) for development of an electronic system for: (1) processing health care information consistent with the goal of improving the operation of the health care system; and (2) reducing related administrative costs through the HHS Secretary's adoption of certain standards for information transactions (including enrollment, disenrollment, claims attachments, and coordination of benefits) and data elements as well as standards relating to security and privacy, and performance of tasks pursuant to specified requirements, assisted by the newly established Health Information Advisory Committee. (Sec. 251) Provides penalties for violations of provisions of this subtitle, including for the wrongful disclosure of individually identifiable health information. (Sec. 261) Directs the HHS Secretary to adopt uniform coverage, administration, and payment policies for clinical diagnostic laboratory tests under Medicare part B (Supplementary Medical Insurance) in accordance with a specified process. Provides that, effective for claims submitted after the expiration of a specified 90-day period, an independent laboratory may select a single carrier for the processing of all of its claims for payment under Medicare part B without regard to the location where the laboratory or the patient or provider involved resides or conducts business. Requires such election of a single carrier to be made by the clinical laboratory, and an agreement between the carrier and laboratory to be forwarded to the HHS Secretary. Title III: Tax-Related Health Provisions - Subtitle A: Medical Savings Accounts - Amends the Internal Revenue Code to allow a deduction for limited amounts paid to a medical savings account (MSA). Defines "medical savings account" as a trust for paying the account holder's medical expenses. Exempts an MSA from taxation unless it has ceased being an MSA. Provides for the treatment of distributions. Allows the MSA deduction to be taken whether or not the individual itemizes deductions. Excludes limited employer MSA contributions from employee gross income. Excludes employer MSA contributions from provisions relating to social security, railroad retirement, unemployment, and withholding taxes. Makes MSA contributions unavailable under cafeteria plans. Excludes MSAs from the value of taxable estates. Imposes a tax on excess MSA contributions. Exempts an MSA holder from prohibited transactions taxes if the MSA ceases to be an MSA. Imposes a penalty on MSA reporting failure. Exempts MSAs from the definition of "specified insurance contract" for provisions relating to capitalization of certain policy acquisition expenses. Subtitle B: Increase in Deduction for Health Insurance Costs of Self-Employed Individuals - Allows self-employed individuals to deduct a portion of their expenditures for medical insurance for the individual, spouse, and dependents. Subtitle C: Long-Term Care Services and Contracts - Requires treating: (1) a long-term care insurance as accident and health insurance and associated amounts received as received for personal injuries and sickness and as reimbursement for medical care expenses actually incurred; (2) an employer's plan providing long-term care as an accident and health plan; (3) limited amounts paid for such insurance as payments for medical care; and (4) such insurance as guaranteed renewable under specified provisions. Provides for the treatment of: (1) excess aggregate long-term care payments; and (2) long-term care coverage provided in conjunction with life insurance. Excludes long-term care from cafeteria plans. Includes in an employee's gross income employer-provided long-term care overage provided through a flexible spending arrangement. Declares that a group health plan does not fail to meet continuation requirements solely because it fails to provide long-term coverage. (Sec. 323) Imposes reporting requirements on long-term care benefit payors. (Sec. 325) Sets forth provisions regarding: (1) the model regulation and model Act promulgated by the National Association of Insurance Commissioners; and (2) certain disclosure and nonforfeitability requirements. (Sec. 326) Imposes a tax the failure to meet requirements regarding: (1) the model regulation and model Act; (2) policy or certificate delivery; and (3) claims denials information. Subtitle D: Treatment of Accelerated Death Benefits - Treats life insurance amounts paid as an amount paid because of death if the insured is terminally or chronically ill and the amount is received under a provision that is treated as long-term care insurance. Treats the amount paid by a viatical settlement provider for a life insurance contract as an amount paid by reason of the death of the insured. (Sec. 332) Treats, for life insurance company provisions, references to life insurance contracts as including references to accelerated death benefit riders (unless a rider is treated as a long- term care contract). Subtitle E: High-Risk Pools - Exempts from taxation a State- established membership organization providing nonprofit medical care coverage to high risk individuals. Title IV: Revenue Offsets - Subtitle A: Repeal of Bad Debt Reserve Method for Thrift Savings Associations - Declares that bad debt reserve banking provisions shall not apply after a specified date. Provides for the resulting accounting method change. Subtitle B: Reform of the Earned Income Credit - Requires, in order to be eligible for the earned income credit (EIC), that a taxpayer include on the return the taxpayer's (and, if married, the spouse's) social security number (SSN). Adds to the definition of "mathematical or clerical error" references to omission of a SSN required by EIC provisions. (Sec. 412) Increases preparer penalties for certain failures or actions.