SECTION 1. SHORT TITLE.

    This Act may be cited as the ``527 Reform Act of 2004''.

SEC. 2. TREATMENT OF SECTION 527 ORGANIZATIONS.

    (a) Definition of Political Committee.--Section 301(4)(A) of the
Federal Election Campaign Act of 1971 (2 U.S.C. 431(4)(A)) is amended
to read as follows:
                    ``(A) any committee, club, association, or other
                group of persons that--
                            ``(i) during one calendar year, receives
                        contributions aggregating in excess of $1,000
                        or makes expenditures aggregating in excess of
                        $1,000; and
                            ``(ii) has as its major purpose the
                        nomination or election of one or more
                        candidates;''.
    (b) Definition of Major Purpose for Section 527 Organizations.--
Title III of the Federal Election Campaign Act of 1971 (2 U.S.C. 431 et
seq.) is amended by adding at the end the following new section:

``SEC. 325. DEFINITIONS AND RULES FOR DETERMINING ORGANIZATIONS AND
              DISBURSEMENTS INFLUENCING FEDERAL ELECTIONS.

    ``(a) Major Purpose of Section 527 Organizations.--For purposes of
section 301(4)(A)--
            ``(1) In general.--A committee, club, association, or group
        of persons that--
                    ``(A) is an organization described in section 527
                of the Internal Revenue Code of 1986, and
                    ``(B) is not described in paragraph (2),
        has as its major purpose the nomination or election of one or
        more candidates.
            ``(2) Excepted organizations.--Subject to paragraph (3), a
        committee, club, association, or other group of persons
        described in this paragraph is--
                    ``(A) an organization described in section
                527(i)(5) of the Internal Revenue Code of 1986, or
                    ``(B) any other organization which is one of the
                following:
                            ``(i) A committee, club, association, or
                        other group of persons whose election or
                        nomination activities relate exclusively to
                        elections where no candidate for Federal office
                        appears on the ballot.
                            ``(ii) A committee, club, association, or
                        other group of persons that is organized,
                        operated, and makes disbursements exclusively
                        for one or more of the following purposes:
                                    ``(I) Influencing the selection,
                                nomination, election, or appointment of
                                one or more candidates to non-Federal
                                offices.
                                    ``(II) Influencing one or more
                                State or local ballot initiatives,
                                State or local referenda, State or
                                local constitutional amendments, State
                                or local bond issues, or other State or
                                local ballot issues.
                                    ``(III) Influencing the selection,
                                appointment, nomination, or
                                confirmation of one or more individuals
                                to non-elected offices.
                                    ``(IV) Paying expenses described in
                                the last sentence of section 527(e)(2)
                                of the Internal Revenue Code of 1986 or
                                expenses of a newsletter fund described
                                in section 527(g) of such Code.
            ``(3) Section 527 organizations making certain
        disbursements.--A committee, club, association, or other group
        of persons described in paragraph (2)(B) shall not be
        considered to be described in such paragraph for purposes of
        paragraph (1)(B) if it makes disbursements for a public
        communication that promotes, supports, attacks, or opposes a
        clearly identified candidate for Federal office during the
        period beginning on the first day of the calendar year
        preceding the calendar year in which the general election for
        the office sought by the clearly identified candidate occurs
        and ending on the date of the general election.''.

SEC. 3. CERTAIN EXPENSES BY MAJOR PURPOSE ORGANIZATIONS TREATED AS
              EXPENDITURES.

    (a) In General.--Section 301(9)(A)(i) of the Federal Election
Campaign Act of 1971 (2 U.S.C. 431(9)(A)(i)) is amended by inserting
``, including any amount described in section 325(b)'' after
``office''.
    (b) Applicable Communications.--Section 325 of the Federal Election
Campaign Act of 1971 (as added by section 2(b)) is amended by adding at
the end the following new subsection:
    ``(b) Certain Expenditures for Major Purpose Organizations.--
            ``(1) In general.--Subject to paragraph (2), a purchase,
        payment, distribution, loan, advance, deposit, or gift of money
        or anything of value for--
                    ``(A) a public communication that refers to a
                clearly identified candidate for Federal office or to a
                political party (regardless of whether a candidate for
                State or local office is also mentioned or identified)
                and that promotes, supports, attacks, or opposes a
                candidate for that office or a political party
                (regardless of whether the communication expressly
                advocates a vote for or against a candidate), or
                    ``(B) voter registration activity, voter
                identification, get-out-the-vote activity, or generic
                campaign activity conducted in connection with an
                election in which a candidate for Federal office
                appears on the ballot (regardless of whether a
                candidate for State or local office also appears on the
                ballot),
        shall be an expenditure under section 301(9)(A)(i) if made by,
        or on behalf of, a political committee (as defined in section
        301(4)) or a committee, club, association, or other group of
        persons for which the nomination or election of one or more
        candidates is its major purpose.
            ``(2) Exception.--Any funds used for purposes described in
        paragraph (1) that, in accordance with allocation rules set
        forth in section 325(c), are disbursed from a non-Federal
        account shall not be treated as expenditures.''.

SEC. 4. RULES FOR ALLOCATION OF EXPENSES BETWEEN FEDERAL AND NON-
              FEDERAL ACTIVITIES.

    Section 325 of the Federal Election Campaign Act of 1971 (as added
by section 2(b) and amended by section 3) is amended by adding at the
end the following:
    ``(c) Allocation and Funding Rules for Expenses of Separate
Segregated Funds and Nonconnected Committees Relating to Federal and
Non-Federal Activities.--
            ``(1) In general.--In the case of any disbursements by any
        separate segregated fund or nonconnected committee for which
        allocation rules are provided under paragraph (2)--
                    ``(A) the disbursements shall be allocated between
                Federal and non-Federal accounts in accordance with
                this subsection and regulations prescribed by the
                Commission, and
                    ``(B) in the case of disbursements allocated to
                non-Federal accounts, may be paid only from a qualified
                non-Federal account.
            ``(2) Costs to be allocated and allocation rules.--
        Disbursements by any separate segregated fund or nonconnected
        committee in connection with Federal and non-Federal elections
        for any of the following categories of activity shall be
        allocated as follows:
                    ``(A) At least 50 percent of any administrative
                expenses, including rent, utilities, office supplies,
                and salaries not attributable to a clearly identified
                candidate shall be paid with funds from a Federal
                account, except that for a separate segregated fund
                such expenses may be paid instead by its connected
                organization.
                    ``(B) At least 50 percent of the direct costs of a
                fundraising program or event, including disbursements
                for solicitation of funds and for planning and
                administration of actual fundraising events, where
                Federal and non-Federal funds are collected through
                such program or event shall be paid with funds from a
                Federal account, except that for a separate segregated
                fund such costs may be paid instead by its connected
                organization.
                    ``(C) At least 50 percent of the expenses for
                public communications or voter drive activities that
                refer to a political party, but do not refer to any
                clearly identified Federal or non-Federal candidate,
                shall be paid with funds from a Federal account.
                    ``(D) 100 percent of the expenses for public
                communications or voter drive activities that refer to
                a political party, and refer to one or more clearly
                identified Federal candidates, but do not refer to any
                clearly identified non-Federal candidates, shall be
                paid with funds from a Federal account.
                    ``(E) At least 50 percent of the expenses for
                public communications or voter drive activities that
                refer to a political party, and refer to one or more
                clearly identified non-Federal candidates, but do not
                refer to any clearly identified Federal candidates,
                shall be paid with funds from a Federal account, except
                that this subparagraph shall not apply to
                communications or activities that relate exclusively to
                elections where no candidate for Federal office appears
                on the ballot.
                    ``(F) At least 50 percent of the expenses for
                public communications and voter drive activities that
                refer to one or more clearly identified candidates for
                Federal office and one or more clearly defined non-
                Federal candidates, without regard to whether the
                communication refers to a political party, shall be
                paid with funds from a Federal account.
            ``(3) Qualified non-federal account.--For purposes of this
        subsection--
                    ``(A) In general.--The term `qualified non-Federal
                account' means an account which consists solely of
                amounts--
                            ``(i) that, subject to the limitations of
                        subparagraphs (B) and (C), are raised by the
                        separate segregated fund or nonconnected
                        committee only from individuals, and
                            ``(ii) with respect to which all other
                        requirements of Federal, State, or local law
                        are met.
                    ``(B) Limitation on individual donations.--
                            ``(i) In general.--A separate segregated
                        fund or nonconnected committee may not accept
                        more than $25,000 in funds for its qualified
                        non-Federal account from any one individual in
                        any calendar year.
                            ``(ii) Affiliation.--For purposes of this
                        subparagraph, all qualified non-Federal
                        accounts of separate segregated funds or
                        nonconnected committees which are directly or
                        indirectly established, financed, maintained,
                        or controlled by the same person or persons
                        shall be treated as one account.
                    ``(C) Fundraising limitation.--No donation to a
                qualified non-Federal account may be solicited,
                received, directed, transferred, or spent by or in the
                name of any person described in subsection (a) or (e)
                of section 323.
            ``(4) Voter drive activity and federal account defined.--
        For purposes of this subsection--
                    ``(A) Voter drive activity.--The term `voter drive
                activity' means any of the following activities
                conducted in connection with an election in which a
                candidate for Federal office appears on the ballot
                (regardless of whether a candidate for State or local
                office also appears on the ballot):
                            ``(i) Voter registration activity.
                            ``(ii) Voter identification.
                            ``(iii) Get-out-the-vote activity.
                            ``(iv) Generic campaign activity.
                    ``(B) Federal account.--The term `Federal account'
                means an account which consists solely of contributions
                subject to the limitations, prohibitions, and reporting
                requirements of this Act. Nothing in this subsection or
                in section 323(b)(2)(B)(iii) shall be construed to
                infer that a limit other than the limit under section
                315(a)(1)(C) applies to contributions to the
                account.''.

SEC. 5. CONSTRUCTION.

    No provision of this Act, or amendment made by this Act, shall be
construed--
            (1) as approving, ratifying, or endorsing a regulation
        promulgated by the Federal Election Commission, or
            (2) as establishing, modifying, or otherwise affecting the
        definition of political organization for purposes of the
        Internal Revenue Code of 1986.

SEC. 6. EFFECTIVE DATE.

    The amendments made by this Act shall take effect on January 1,
2005.

Summary: Reform Act of 2004 - Amends the Federal Election Campaign Act of 1971 to revise the definition of political committee to include any committee, club, association, or other group of persons that has as its major purpose the nomination or election of one or more candidates . Treats certain expenses by major purpose organizations as expenditures subject to the limitations and reporting requirements of such Act. Provides that any disbursement by separate segregated fund or nonconnected committee shall be allocated between Federal and non-Federal accounts in accordance with this Act and regulations prescribed by the Federal Election Commission. States that disbursements allocated to non-Federal accounts may be paid only from a qualified non-Federal account. Prohibits a separate segregated fund or nonconnected committee from accepting more than $25,000 in funds for its qualified non-Federal account from any one individual in any calendar year.

A bill to amend the Federal Election Campaign Act of 1971 to define political committee and clarify when organizations described in section 527 of the Internal Revenue Code of 1968 must register as political committees, and for other purposes.


SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Cavernous Angioma Research Resource
Act of 2013''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Cavernous angioma, also termed ``cerebral cavernous
        malformations'' or ``CCM'', affects an estimated 1,500,000
        people in the United States.
            (2) Cavernous angioma is a devastating blood vessel disease
        that is characterized by the presence of vascular lesions that
        develop and grow within the brain and spinal cord.
            (3) Detection of cavernous angioma lesions is achieved
        through costly and specialized medical imaging techniques.
        These techniques are often not readily available where patients
        live, and require sedation for children and disabled adults.
            (4) Cavernous angioma is a common type of vascular anomaly,
        but individuals may not be aware that they have the disease
        until the onset of serious clinical symptoms. In the genetic
        forms, they may not be aware that it may be passed on to their
        children.
            (5) Individuals diagnosed with cavernous angioma may
        experience neurological deficits, seizure, stroke, or sudden
        death.
            (6) Due to limited research with respect to cavernous
        angioma, there is no treatment regimen for the disease other
        than brain and spinal surgery.
            (7) Some individuals with cavernous angioma are not
        candidates for brain surgery. No alternative treatment option
        is available for such individuals.
            (8) There is a shortage of physicians who are familiar with
        cavernous angioma and affected individuals may find it
        difficult to receive timely diagnosis and appropriate care.
            (9) Due to the presence of a specific disease-causing
        mutation, termed the ``common Hispanic mutation'' that has
        passed through as many as 17 generations of Americans descended
        from the original Spanish settlers of the Southwest in the
        1590s, New Mexico has the highest population density of
        cavernous angioma in the world. Cavernous angioma affects
        thousands of individuals in New Mexico and with ancestry in New
        Mexico.
            (10) Other States with high rates of cavernous angioma due
        to the common Hispanic Mutation include Texas, Arizona, and
        Colorado.
            (11) To address the public health threat posed by cavernous
        angioma in New Mexico and throughout the United States, there
        is a need to identify institutions capable of running clinical
        trial for this debilitating brain disorder.

SEC. 3. CAVERNOUS ANGIOMA RESEARCH ACTIVITIES.

    Part B of title IV of the Public Health Service Act (42 U.S.C. 284
et seq.) is amended by adding at the end the following:

``SEC. 409K. CAVERNOUS ANGIOMA RESEARCH ACTIVITIES.

    ``(a) Expansion, Intensification, and Coordination of Activities.--
The Director of NIH, acting through the director of the National
Institute of Neurological Disorders and Stroke, shall expand and
intensify programs of the National Institutes of Health or may award
grants and cooperative agreements to public or nonprofit private
entities (including State health departments, political subdivisions of
States, universities, and other educational entities) for research and
related activities concerning cavernous angioma.
    ``(b) Activities.--In expanding and intensifying programs under
subsection (a), the Director of NIH may carry out the following:
            ``(1) Basic, translational, and clinical research.--Conduct
        or financially support basic, clinical, and translational
        research on cavernous angioma, including research on the
        following:
                    ``(A) Proteomic, pharmacological, and cell
                biological analysis of the cerebral cavernous
                malformations (referred to in this section as the
                `CCM') molecules.
                    ``(B) Continued development and expansion of novel
                animal models for cavernous angioma preclinical
                research.
                    ``(C) Early detection, diagnosis, and treatment of
                cavernous angioma.
                    ``(D) Biological mechanisms for lesion genesis,
                development, and maturation.
                    ``(E) Biological mechanisms for lesion bleeding and
                symptomology.
                    ``(F) Novel biomedical and pharmacological
                interventions designed to prohibit new lesion
                development, lesion growth, and lesion bleeding.
                    ``(G) Contributions of genetic variation to
                clinical presentation as targets for therapy.
                    ``(H) Identification and development of biomarkers
                to measure phenotypic variation.
                    ``(I) Research related to improving the quality of
                life for individuals with cavernous angioma and their
                families.
                    ``(J) Clinical training programs aimed at
                increasing the number of scientists and clinicians who
                are trained to treat patients and carry out these
                research directions.
            ``(2) Facilitation of research resources; clinical trial
        preparedness.--
                    ``(A) Coordination.--Identify and support the
                development of a clinical and research coordinating
                center with the potential of coordinating a multi-site
                clinical drug trial for cavernous angioma. Such
                coordinating center shall provide a model for
                additional trial sites, facilitate medical research to
                develop a cure for cavernous angioma, and enhance the
                medical care of individuals with cavernous angioma
                nationwide. Such coordinating center shall--
                            ``(i) have an institutional infrastructure
                        that is capable of hosting a clinical trial
                        site and facilitating translational projects
                        and collaborations for clinical trials;
                            ``(ii) have the capacity to maintain
                        programs dedicated to patient education,
                        patient outreach, and awareness, including--
                                    ``(I) launching a national
                                multimedia public awareness campaign;
                                    ``(II) creating and distributing
                                patient education materials for
                                distribution by national physician and
                                surgeon offices;
                                    ``(III) establishing an education
                                program for elementary and secondary
                                school nurses to facilitate early
                                detection and diagnosis of cavernous
                                angioma in areas of high cavernous
                                angioma population density;
                                    ``(IV) coordinating regular patient
                                and family-oriented educational
                                conferences; and
                                    ``(V) developing nationally
                                relevant electronic health teaching and
                                communication tools and a network of
                                professional capacity and patient and
                                family support;
                            ``(iii) have the capacity to establish and
                        maintain communication with other major
                        cavernous angioma research and care
                        institutions internationally for information
                        sharing and coordination of research
                        activities;
                            ``(iv) have demonstrated clinical expertise
                        in cavernous angioma management;
                            ``(v) have a sufficient number of eligible
                        patients for participation with particular
                        focus on unique subpopulations including Common
                        Hispanic Mutation and CCM3 gene mutation
                        carriers; and
                            ``(vi) have a telehealth infrastructure to
                        support and to provide clinical consultation
                        for remote and underserved communities.
                    ``(B) Participation.--Identify and support the
                development of clinical and research participation
                centers with the potential to participate in a multi-
                site clinical drug trial for cavernous angioma. Such
                participation centers may facilitate medical research
                to develop a cure for cavernous angioma and enhance the
                medical care of individuals with cavernous angioma in
                partnership with the coordinating center under
                subparagraph (A) and other national and international
                centers. Such participation centers shall--
                            ``(i) have an institutional infrastructure
                        capable of hosting a clinical trial site and
                        facilitating translational projects and
                        collaborations for clinical trials;
                            ``(ii) have the capacity to maintain
                        communication with other major cavernous
                        angioma research and care institutions
                        internationally for information sharing and
                        coordination of research activities;
                            ``(iii) have demonstrated clinical
                        expertise in cavernous angioma management; and
                            ``(iv) have a sufficient numbers of
                        eligible patients for participation with
                        particular focus on unique subpopulations
                        including Common Hispanic Mutation and CCM3
                        gene mutation carriers as these unique
                        populations may provide insight to other
                        genetic and non-genetic forms of the illness.
    ``(c) Training Program for Clinicians and Scientists.--
            ``(1) In general.--Eligible coordinating and participation
        centers under this section shall establish or expand training
        programs for medical and allied health clinicians and
        scientists in clinical practice and research relevant to
        cavernous angioma.
            ``(2) Research resources.--In carrying out this subsection,
        the Director of NIH may--
                    ``(A) use information collected by the National
                Institutes of Health pursuant to other provisions of
                law or prior to the date of the enactment of this
                section;
                    ``(B) take into consideration the availability of
                other research resources;
                    ``(C) encourage the use of research resources for
                research on, and development of, therapies and
                treatments for individuals with cavernous angioma; and
                    ``(D) encourage the inclusion of individuals with
                cavernous angioma in clinical trials conducted or
                supported by the National Institutes of Health.
            ``(3) Cavernous angioma consortium.--The Director of NIH
        may provide for the participation of agencies of the National
        Institutes of Health in a consortium to facilitate the exchange
        of information and to make the research effort on cavernous
        angioma more efficient and effective by ensuring consistent
        communication, minimizing duplication of effort, and
        integrating the varied perspectives of partner agencies,
        organizations, and individuals. Such consortium shall include
        at least one national cavernous angioma patient advocacy
        organization and may be the same consortium receiving a grant
        or contract under subsection (b)(2)(A).''.

SEC. 4. CENTERS FOR DISEASE CONTROL AND PREVENTION CAVERNOUS ANGIOMA
              SURVEILLANCE AND RESEARCH PROGRAMS.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended by inserting after section 317T the following:

``SEC. 317U. CAVERNOUS ANGIOMA SURVEILLANCE AND RESEARCH PROGRAMS.

    ``(a) In General.--The Secretary, acting through the Director of
the Centers for Disease Control and Prevention, may award grants and
cooperative agreements to public or nonprofit private entities
(including State health departments, political subdivisions of States,
universities, and other educational entities) for the collection,
analysis, and reporting of data on cavernous angioma. In making such
awards, the Secretary may provide direct technical assistance,
including personnel support, in lieu of cash.
    ``(b) National Cavernous Angioma Epidemiology Program.--
            ``(1) Grants.--The Secretary, acting through the Director
        of the Centers for Disease Control and Prevention, may award
        grants to public or nonprofit private entities (including State
        health departments, political subdivisions of States,
        universities, and other educational entities) for the purpose
        of carrying out epidemiological activities regarding cavernous
        angioma, including collecting and analyzing information on the
        number, incidence, correlates, and symptoms of cases and the
        clinical utility (including costs and benefits) of specific
        practice patterns. In making such awards, the Secretary may
        provide direct technical assistance, including personnel
        support, in lieu of cash.
            ``(2) National surveillance program.--In carrying out
        subsection (a), the Secretary shall--
                    ``(A) provide for a national surveillance program;
                and
                    ``(B) where possible, ensure that the surveillance
                program is coordinated with the data and sample
                collection activities of the National Institutes of
                Health under section 409K.''.

SEC. 5. FOOD AND DRUG ADMINISTRATION CAVERNOUS ANGIOMA CLINICAL TRIAL
              PREPAREDNESS AND SUPPORT PROGRAM.

    (a) Investigational New Drug Application.--The Commissioner of Food
and Drugs shall work with clinical centers, investigators, and
advocates to support appropriate investigational new drug application
under section 505(i) of the Federal Food, Drug, and Cosmetic Act in an
effort to hasten the pace of clinical trials for cavernous angioma.
    (b) Orphan Product Development.--Where applicable in rare
subpopulations of cavernous angioma requiring unique pharmacological
intervention, including those with the Common Hispanic Mutation or CCM3
gene mutations, the Commissioner of Food and Drugs shall support
appropriate requests for designations of drugs as orphan drugs under
section 526 of the Federal Food, Drug, and Cosmetic Act.

SEC. 6. REPORT TO CONGRESS.

    Not later than January 1, 2015, and each January 1 thereafter, the
Secretary of Health and Human Services shall prepare and submit to the
appropriate committees of the Congress a report concerning the
implementation of this Act and the amendments made by this Act.

Summary: Cavernous Angioma Research Resource Act of 2013 - Amends the Public Health Service Act to require the Director of the National Institutes of Health (NIH), acting through the Director of the National Institute of Neurological Disorders and Stroke, to expand and intensify NIH programs regarding research and related activities concerning cavernous angioma. Authorizes grants and cooperative agreements to public or nonprofit private entities for such activities. Authorizes the Director of NIH to: (1) conduct basic, clinical, and translational research on cavernous angioma. (2) identify and support the development of a clinical and research coordinating center with the potential of coordinating a multi-site clinical drug trial for cavernous angioma. And (3) identify and support the development of clinical and research participation centers with the potential to participate in such a trial. Requires coordinating and participation centers to expand training programs for medical and allied health clinicians and scientists in clinical practice and research relevant to cavernous angioma. Authorizes the Director to provide for the participation of NIH agencies in a consortium to facilitate the exchange of information and increase the efficiency and effectiveness of the research effort. Authorizes the Secretary of Health and Human Services (HHS) to award grants and cooperative agreements, including technical assistance, to public or nonprofit private entities for: (1) the collection, analysis, and reporting of data on cavernous angioma. And (2) epidemiological activities, including collecting and analyzing information on the number, incidence, correlates, and symptoms of cases and the clinical utility of specific practice patterns. Requires establishment of a national surveillance program as part of such activities. Requires the Commissioner of Food and Drugs (FDA) to: (1) work with clinical centers, investigators, and advocates to support appropriate investigational new drug applications under the Federal Food, Drug, and Cosmetic Act in order to hasten the pace of clinical trials for cavernous angioma. And (2) where applicable in rare subpopulations of cavernous angioma requiring unique pharmacological intervention, including those with the Common Hispanic Mutation or CCM3 gene mutations, support appropriate requests for designations of orphan drugs.


SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Part D Drug Class
Protection Act of 2007''.

SEC. 2. SPECIAL TREATMENT UNDER MEDICARE PART D FOR DRUGS IN 6
              SPECIFIED THERAPEUTIC CATEGORIES.

    (a) Medicare Part D Formularies Required To Cover All Drugs in 6
Specified Therapeutic Categories.--
            (1) In general.--Section 1860D-4(b)(3) of the Social
        Security Act (42 U.S.C. 1395w-104(b)(3)) is amended--
                    (A) in subparagraph (C)(i), by inserting ``, except
                as provided in subparagraph (G),'' after ``although'';
                and
                    (B) by inserting after subparagraph (F) the
                following new subparagraph:
                    ``(G) Required inclusion of drugs in certain
                therapeutic categories and classes.--
                            ``(i) Requirement.--The formulary must
                        include, subject to clause (iii), all or
                        substantially all drugs in each of the
                        following therapeutic categories of covered
                        part D drugs:
                                    ``(I) Immunosuppresessants.
                                    ``(II) Antidepressants.
                                    ``(III) Antipsychotics.
                                    ``(IV) Anticonvulsants.
                                    ``(V) Antiretrovials.
                                    ``(VI) Antineoplastics.
                            ``(ii) Coverage of all unique dosage
                        forms.--To meet the requirement under clause
                        (i), the formulary must include all covered
                        part D drugs and unique dosages and forms of
                        such drugs in the categories specified in such
                        clause, except for--
                                    ``(I) multi-source brands of the
                                identical molecular structure;
                                    ``(II) extended release products in
                                the case that the immediate release
                                product involved is included on the
                                formulary;
                                    ``(III) products that have the same
                                active ingredient; and
                                    ``(IV) dosage forms that do not
                                provide a unique route of
                                administration, such as tablets and
                                capsules.
                            ``(iii) Application to new fda-approved
                        drugs.--In the case of a drug that becomes a
                        covered part D drug and that is included in a
                        category specified in clause (i), clause (i)
                        shall apply to such drug 30 days after the drug
                        has been placed on the market. Nothing in the
                        previous sentence shall be construed as
                        preventing a pharmacy and therapeutic committee
                        from advising a PDP sponsor of a prescription
                        drug plan on the clinical appropriateness of
                        formulary management practices and policies
                        related to new drugs in such categories.
                            ``(iv) Utilization management tools not
                        permitted.--A PDP sponsor of a prescription
                        drug plan may not apply a utilization
                        management tool, such as prior authorization or
                        step therapy, to a drug required under clause
                        (i) to be included on the formulary.
                            ``(v) Rules of construction.--
                                    ``(I) Issuance of guidance or
                                regulations to establish formulary or
                                utilization management requirements
                                permitted.--Nothing in this
                                subparagraph shall be construed as
                                prohibiting the Secretary from issuing
                                guidance or regulations to establish
                                formulary or utilization management
                                requirements under this section for any
                                category or class of covered part D
                                drugs if such guidance or regulations
                                are consistent with the requirements of
                                this subparagraph.
                                    ``(II) Additional therapeutic
                                categories permitted.--Nothing in this
                                subparagraph shall be construed as
                                prohibiting the Secretary from
                                including any additional therapeutic
                                category or class of covered part D
                                drugs under clause (i) for purposes of
                                this subparagraph.''.
            (2) Effective date.--The amendments made by paragraph (1)
        shall apply to plan years beginning on or after January 1,
        2008.
    (b) Special Requirements for Coverage Determinations,
Reconsiderations, and Appeals for Drugs Included in Specified
Therapeutic Categories.--
            (1) In general.--Section 1860D-4(g) of the Social Security
        Act (42 U.S.C. 1395w-104(g)) is amended by adding at the end
        the following new paragraph:
            ``(3) Reconsideration of determinations related to drugs
        included in specified therapeutic categories conducted by
        independent review entity.--With respect to a part D eligible
        individual enrolled in a prescription drug plan, in the case of
        a determination under this subsection that denies such
        individual coverage (in whole or in part) of a drug in a
        category specified in subsection (b)(3)(G)(i), the individual
        may request that the reconsideration of such determination
        authorized under section 1852(g)(2) (as applied by paragraph
        (1)) be conducted by the independent, outside entity described
        in paragraph (4) of section 1852(g) in accordance with the
        procedures for an expedited reconsideration under paragraph (3)
        of such section.
            ``(4) Required coverage of drugs included in specified
        therapeutic categories during determinations, reconsiderations,
        and appeals.--If a part D eligible individual enrolled in a
        prescription drug plan offered by a PDP sponsor requests a
        redetermination or reconsideration under this subsection (or an
        appeal under subsection (h)) with respect to an utilization
        management requirement or denial of coverage (in whole or in
        part) of a drug in a category specified in subsection
        (b)(3)(G)(i), such sponsor shall provide such individual with
        coverage of such drug as prescribed during the pendency of such
        redetermination, reconsideration, or appeal until 60 days after
        the date of receipt of a written notification of--
                    ``(A) in the case that the individual does not
                request a reconsideration or appeal, the determination
                on such redetermination;
                    ``(B) in the case that the individual requests a
                reconsideration but not an appeal, the determination on
                such reconsideration; or
                    ``(C) in the case that the individual requests an
                appeal, the determination on such appeal or the
                dismissal of the appeal;
        except that in no case shall such coverage end before the end
        of the period in which an individual may file an appeal with
        respect to the determination involved.''.
            (2) Effective date.--The amendment made by paragraph (1)
        shall apply to requests for redeterminations, reconsiderations,
        and appeal hearings made on or after the effective date
        described in subsection (a)(2).
    (c) Reporting Requirements for Drugs Included in Specified
Therapeutic Categories.--
            (1) In general.--Section 1860D-4(b) of the Social Security
        Act (42 U.S.C. 1395w-104(b)) is amended by adding at the end
        the following new paragraph:
            ``(4) Reporting requirements for drugs included in
        specified therapeutic categories.--
                    ``(A) Reports by pdp sponsors.--A PDP sponsor
                offering a prescription drug plan shall submit to the
                Secretary (in a form and manner specified by the
                Secretary), with respect to drugs in a category of
                covered part D drugs specified in subsection
                (b)(3)(G)(i), information on the number of favorable
                and unfavorable decisions under the plan relating to
                coverage determinations, redeterminations,
                reconsiderations, appeals, and enrollee requests for
                exceptions to formulary policies for such drugs.
                    ``(B) Report to congress.--The Secretary shall
                submit an annual report to Congress summarizing the
                information submitted under subparagraph (A) and shall
                publish each report in the Federal Register.''.
            (2) Effective date.--The amendment made by paragraph (1)
        shall apply to prescription drug plans and MA plans for plan
        years beginning on or after the effective date described in
        subsection (a)(2).

Summary: Medicare Part D Drug Class Protection Act of 2007 - Amends part D of title XVIII (Medicare) of the Social Security Act to require that Medicare prescription drug plans using formularies cover all drugs included in six specified therapeutic categories. Sets forth special requirements for reconsideration of coverage determinations, and appeals for drugs included in such categories. Establishes reporting requirements for drugs in these categories.

To amend title XVIII of the Social Security Act to require that Medicare prescription drug plans using formularies cover all drugs included in 6 specified therapeutic categories, to establish protective requirements for coverage determinations, reconsiderations, and appeals related to such drugs, and to require annual reports on such determinations, reconsiderations, and appeals.


That this Act may be cited as the ``Federal Forage Fee Act of
1993''.

SECTION 1. FINDINGS.

    (a) Findings.--Congress finds and declares that--
            (1) it is in the national interest that the public lands
        are producing and continue to produce water and soil
        conservation benefits, livestock forage, wildlife forage and
        recreation and other multiple use opportunities;
            (2) rangelands will continue to be stabilized and improved
        long term by providing for cooperative agreements, private,
        public partnerships and flexibility in management programs and
        agreements;
            (3) to assure sound management and stewardship of the
        renewable resources it is imperative to charge a fee that is
        reasonable and equitable and represents the fair value of the
        forage provided;
            (4) the intermingled private-public land ownership patterns
        prevailing in much of the west create a strong interdependence
        between public and private lands for forage, water, and habitat
        for both wildlife and livestock;
            (5) the social and economic infrastructure of many rural
        communities and stability of job opportunities in many areas of
        rural America are highly independent on the protection of the
        value of privately held production units on Federal lands.

SEC. 2. ENVIRONMENTAL AND LAND USE REQUIREMENTS.

    Unless contrary to this statute, all grazing operations conducted
on any Federal lands shall be subject to all applicable Federal, State,
and local laws, including but not limited to:
            (1) Animal Damage Control Act (7 U.S.C. 426-426b).
            (2) Bankhead-Jones Farm Tenant Act (50 Stat. 522) as
        amended.
            (3) Clean Air Act (42 U.S.C. 7401-7642) as amended.
            (4) Endangered Species Act of 1973 (16 U.S.C. 1531-1544) as
        amended.
            (5) Federal Advisory Committee Act (86 Stat. 770), as
        amended.
            (6) Federal Grant and Cooperative Agreement Act of 1977 (92
        Stat. 3).
            (7) Federal Insecticide, Fungicide, and Rodenticide Act (7
        U.S.C. 136-136y), as amended.
            (8) Federal Land Policy and Management Act of 1976 (43
        U.S.C. 1701 et seq.).
            (9) Federal Water Pollution Control Act (33 U.S.C. 1251
        1387), as amended.
            (10) Forest and Rangeland Renewable Resources Planning Act
        of 1974 (16 U.S.C. 1600-1614).
            (11) Granger-Thye Act (64 Stat. 82).
            (12) Independent Offices Appropriations Act of 1952 (31
        U.S.C. 9701), as amended, title V.
            (13) Multiple Use Sustained Yield Act of 1960 (16 U.S.C.
        528-531).
            (14) National Environmental Policy Act of 1969 (42 U.S.C.
        4321-4370a), as amended.
            (15 National Forest Management Act of 1976 (16 U.S.C. 1600,
        1611-1614).
            (16) Public Rangelands Improvement Act of 1978 (92 Stat.
        1803).
            (17) Taylor Grazing Act (48 Stat. 1269), as amended.
            (18) Wilderness Act (78 Stat. 890), as amended.

SEC. 3. FEE SCHEDULE.

    (a) For the purpose of this section the terms:
            (1) ``Sixteen Western States'' means WA, CA, ID, NV, NM,
        WY, CO, KS, SD, ND, NE, OR, OK, AZ, UT and MT.
            (2) ``AUM'' means an animal unit month as that term is used
        in the Public Rangeland Improvement Act (92 Stat. 1803);
            (3) ``Authorized Federal AUMs'' means all ``allotted AUMs''
        reported by BLM and ``permitted to graze AUMs'' reported by
        USFS.
            (4) ``WAPLLR'' means the weighted average private land
        lease rate determined by multiplying the private land lease
        rate reported by the Economic Research Service for the previous
        calendar year for each of the sixteen Western States by the
        total number of authorized Federal AUMs, as defined in section
        3(a)(3), in each State for the previous fiscal year, then that
        result divided by the total number of authorized Federal AUMs
        for the sixteen Western States. These individual State results
        are then added together and divided by 16 to yield a weighted
        average private land lease rate for that year.
            (5) ``Report'' means the report titled ``Grazing Fee Review
        and Evaluation Update of the 1986 Final Report'' dated April
        30, 1992 and prepared by the Departments of the Interior and
        Agriculture.
            (6) ``Nonfee cost differential'' means a value calculated
        annually by the Secretaries by multiplying the weighted
        difference in nonfee costs per AUM between public land and
        private land by the Input Cost Index (ICI) determined annually
        by the Department of Agriculture. The weighted difference in
        nonfee costs is a factor of 0.552 determined by deducting the
        private AUM nonfee costs (as outlined on page 58 of the report)
        from the public AUM nonfee costs for cattle times 4, added to
        the result of deducting private AUM nonfee costs from public
        AUM nonfee costs for sheep times 1, then that result divided by
        5.''
            (7) ``Net production differential'' is the percentage
        calculated annually by dividing the cash receipts per cow for
        Federal permittee livestock producers by the cash receipts per
        cow for western non-Federal livestock producers in the sixteen
        Western States as surveyed by the Economic Research Service in
        annual cost of production surveys (COPS).
            (8) ``PLFVR'' means the private lease forage value ratio
        determined by dividing the average of the 1964-1968 base years'
        private land lease rate into the forage value portion of the
        private land lease rate of $1.78 as determined in the 1966
        western livestock grazing survey.
    (b) The Secretaries of the Department of Agriculture and the
Department of the Interior shall calculate annually the Federal forage
fee by calculating the average of the WALLPR for the preceding three
years; multiplying it by the PLFVR; then deducting from that result the
nonfee cost differential; and multiplying that result by the net
production differential. For each year that this calculation is made,
all data used for calculating this fee shall come from the calendar
year previous to the year for which the fee is being calculated unless
specified otherwise in the above calculations.
    (c) The Federal forage fee shall apply to all authorized Federal
AUMs under the jurisdiction of the United States Department of
Agriculture and the United States Department of the Interior.
    (d) For the first year that the Secretaries calculate the Federal
forage fee, the fee shall not be greater than 125 percent, or less than
75 percent of the fee calculated for the previous year pursuant to
Executive Order 12548 dated February 14, 1986. For each year after the
first year that the Secretaries calculate the Federal forage fee, the
fee shall not be greater than 125 percent, or less than 75 percent of
the Federal forage fee calculated for the previous year.
    (e) The survey of nonfee costs used to calculate the nonfee cost
differential shall be updated periodically by the Secretaries so as to
reflect as accurately as possible the actual nonfee costs incurred by
the cattle and sheep industry that utilizes public lands in the sixteen
Western States. The results of the updated survey shall be incorporated
into the calculation of the Non Fee Cost Differential as they become
available.

Summary: Federal Forage Fee Act of 1993 - Subjects grazing operations on Federal land to applicable Federal, State, and local environmental and land use requirements. Sets forth a forage fee formula for lands under the jurisdiction of the Department of Agriculture and the Department of the Interior.

Federal Forage Fee Act of 1993


SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Nuclear Innovation Act''.

SEC. 2. DEFINITIONS.

    In this Act:
            (1) Advanced fission reactor.--The term ``advanced fission
        reactor'' means a nuclear fission reactor with significant
        improvements over the most recent generation of nuclear
        reactors, which may include inherent safety features, lower
        waste yields, greater fuel utilization, superior reliability,
        resistance to proliferation, and increased thermal efficiency.
            (2) Department.--The term ``Department'' means the
        Department of Energy.
            (3) National laboratories.--The term ``National
        Laboratories'' has the meaning given the term in section 2 of
        the Energy Policy Act of 2005 (42 U.S.C. 15801).
            (4) Secretary.--The term ``Secretary'' means the Secretary
        of Energy.

SEC. 3. HIGH-PERFORMANCE COMPUTATION AND SUPPORTIVE RESEARCH.

    (a) Modeling and Simulation.--The Secretary shall carry out a
program to enhance the Nation's capabilities to develop new reactor
technologies through high-performance computation modeling and
simulation techniques. This program shall coordinate with relevant
Federal agencies through the National Strategic Computing Initiative
created under Executive Order 13702 (July 29, 2015) while taking into
account the following objectives:
            (1) Utilizing expertise from the private sector,
        universities, and National Laboratories to develop
        computational software and capabilities that prospective users
        may access to accelerate research and development of advanced
        fission reactor systems, nuclear fusion systems, and reactor
        systems for space exploration.
            (2) Developing computational tools to simulate and predict
        nuclear phenomena that may be validated through physical
        experimentation.
            (3) Increasing the utility of the Department's research
        infrastructure by coordinating with the Advanced Scientific
        Computing Research program within the Office of Science.
            (4) Leveraging experience from the Energy Innovation Hub
        for Modeling and Simulation.
            (5) Ensuring that new experimental and computational tools
        are accessible to relevant research communities.
    (b) Supportive Research Activities.--The Secretary shall consider
support for additional research activities to maximize the utility of
its research facilities, including physical processes to simulate
degradation of materials and behavior of fuel forms and for validation
of computational tools.

SEC. 4. ENABLING NUCLEAR ENERGY INNOVATION.

    (a) National Reactor Innovation Center.--The Secretary shall carry
out a program to enable the testing and demonstration of reactor
concepts to be proposed and funded by the private sector. The Secretary
shall leverage the technical expertise of relevant Federal agencies and
National Laboratories in order to minimize the time required to enable
construction and operation of privately funded experimental reactors at
National Laboratories or other Department-owned sites while ensuring
reasonable safety for persons working within these sites. Such reactors
shall operate to meet the following objectives:
            (1) Enabling physical validation of novel reactor concepts.
            (2) Resolving technical uncertainty and increasing
        practical knowledge relevant to safety, resilience, security,
        and functionality of first-of-a-kind reactor concepts.
            (3) General research and development to improve nascent
        technologies.
    (b) Reporting Requirement.--Not later than 180 days after the date
of enactment of this Act, the Secretary, in consultation with the
National Laboratories, relevant Federal agencies, and other
stakeholders, shall transmit to the Committee on Science, Space, and
Technology of the House of Representatives and the Committee on Energy
and Natural Resources of the Senate a report assessing the Department's
capabilities to authorize, host, and oversee privately funded fusion
and advanced fission experimental reactors as described under
subsection (a). The report shall address the following:
            (1) The Department's safety review and oversight
        capabilities, including options to leverage expertise from the
        Nuclear Regulatory Commission and National Laboratories.
            (2) Potential sites capable of hosting activities described
        under subsection (a).
            (3) The efficacy of the Department's available contractual
        mechanisms to partner with the private sector and Federal
        agencies, including cooperative research and development
        agreements, strategic partnership projects, and agreements for
        commercializing technology.
            (4) Potential cost structures related to physical security,
        decommissioning, liability, and other long term project costs.
            (5) Other challenges or considerations identified by the
        Secretary.

Summary: Nuclear Innovation Act This bill directs the Department of Energy (DOE) to carry out a program for enhancing the US capability to develop new reactor technologies through high-performance computation modeling and simulation techniques. Such program shall coordinate with relevant federal agencies through the National Strategic Computing Initiative while taking into account specified objectives. DOE shall also carry out a program to: enable the testing and demonstration of reactor concepts proposed and funded by the private sector, and leverage the technical expertise of relevant federal agencies and national laboratories to minimize the time required to enable construction and operation of privately funded experimental reactors at national laboratories or other DOE-owned sites. These reactors shall operate to: enable physical validation of novel reactor concepts. Resolve technical uncertainty and increase practical knowledge relevant to safety, resilience, security, and functionality of first-of-a-kind reactor concepts, and generate research and development to improve nascent technologies.

Nuclear Innovation Act


SECTION 1. FLEXIBILITY FOR SCHOOLS.

    The Elementary and Secondary Education Act of 1965 (20 U.S.C. 2701
et seq.) is amended--
            (1) by redesignating sections 8001 through 8005 as 10001
        through 10005; and
            (2) by inserting after title VII the following:

      ``TITLE VIII--FLEXIBILITY TO IMPROVE EDUCATIONAL ACHIEVEMENT

``SEC. 8001. PURPOSE.

    ``It is the purpose of this title to allow States, local
educational agencies, and schools the flexibility to use and combine
Federal, State, and local funds as part of systemic educational reform
plans to improve the educational achievement of elementary and
secondary school students by waiving certain statutory and regulatory
requirements.

``SEC. 8002. PROGRAM AUTHORIZED.

    ``(a) Education Programs.--The Secretary of Education is authorized
to waive certain statutory and regulatory requirements (except as
provided in section 8004) for States that can demonstrate that such
waivers are part of a systemwide education reform plan and where such
States and local educational agencies have implemented similar waiver
plans.
    ``(b) Additional Programs.--Waivers may also be requested for
requirements regarding the following programs:
            ``(1) The Head Start Act.
            ``(2) The Runaway and Homeless Youth Act.
            ``(3) The Juvenile Justice and Delinquency Prevention Act.
            ``(4) The National School Lunch Act.
            ``(5) The School Breakfast Program.
            ``(6) The Child and Adult Care Food Program.
            ``(7) The Special School Milk Program.
            ``(8) The Summer Food Service Program.
            ``(9) The Community Services Block Grant Program.
``If such waivers are requested, the Secretary shall consult with the
heads of other appropriate Federal agencies, if any, in determining
whether to approve a project. The Secretary shall obtain the approval
of such agency head as part of final approval of such project.

``SEC. 8003. APPLICATIONS.

    ``(a) General Requirements.--A school, local educational agency, or
State that desires to receive a waiver under this title shall--
            ``(1) indicate which requirements are to be waived and how
        waiving such requirements is an integral part of the systemic
        reform plan and will improve educational achievement among
        students;
            ``(2) identify the Federal programs to be included in the
        project;
            ``(3) indicate which State and local requirements shall be
        waived;
            ``(4) describe specific, measurable educational improvement
        goals and expected outcomes;
            ``(5) describe methods to be used to measure progress
        toward meeting such goals;
            ``(6) describe the student population at proposed schools,
        including--
                    ``(A) current data regarding the achievement levels
                of students, particularly disadvantaged students;
                    ``(B) the number of students who--
                            ``(i) are of limited English proficiency,
                        as defined in section 7003(a)(1) of the
                        Bilingual Education Act;
                            ``(ii) are children with disabilities, as
                        defined in section 602(a)(1) of the Individuals
                        with Disabilities Act;
                            ``(iii) are currently or within the past 5
                        years were migratory;
                            ``(iv) are educationally deprived for the
                        purposes of chapter 1 of title I of this Act;
                        and
                            ``(v) are eligible for a free or reduced-
                        price lunch.
    ``(b) Additional Requirements.--The Secretary of Education may
include additional requirements as may reasonably be required.
    ``(c) Individual School Applications.--A local school that desires
to receive a waiver under this title shall submit an application to the
local education agency, which shall submit such application to the
State education agency.
    ``(d) Local Applications.--(1) A local educational agency that
desires to receive a waiver under this title shall submit an
application to the State educational agency.
    ``(2) A State educational agency that approves an application
submitted by a local education agency shall forward such application to
the Secretary of Education for consideration, unless such application
requires waivers for programs other than education programs.
    ``(3) An application that requests a waiver for a program other
than an education program shall be submitted to the chief executive of
the State and such executive shall forward such application to the
Secretary.
    ``(e) State Applications.--(1) A State educational agency that
desires to receive a waiver under this title shall submit an
application to the Secretary for consideration, unless such application
requires waivers for other than education programs.
    ``(2) Such application shall be submitted to the chief executive of
the State for review before forwarding such application to the
Secretary.

``SEC. 8004. WAIVER RESTRICTIONS.

    ``Requirements which shall not be waived include--
            ``(1) requirements governing fund allocations;
            ``(2) requirements governing privacy of pupil records;
            ``(3) requirements under title VI of the Civil Rights Act
        of 1964;
            ``(4) provisions of section 504 of the Rehabilitation Act
        of 1973;
            ``(5) provisions of title II of the Americans with
        Disabilities Education Act;
            ``(6) requirements of title IX of the Education Amendments
        of 1972;
            ``(7) requirements governing pupil rights under the
        Individuals with Disabilities Act; and
            ``(8) requirements governing--
                    ``(A) maintenance of effort;
                    ``(B) comparability; or
                    ``(C) the equitable participation of students
                attending private schools.

``SEC. 8005. EVALUATIONS AND TECHNICAL ASSISTANCE.

    ``(a) Local Evaluation.--Three years after a waiver is given to a
local educational agency, the Secretary of Education shall evaluate the
effectiveness of such waiver in achieving education reform and raising
student achievement.
    ``(b) Technical Assistance.--If the Secretary determines that
progress in achieving educational reform is not satisfactory, the
Secretary may provide technical assistance to a local educational
agency.
    ``(c) Termination.--If the Secretary determines that the technical
assistance does not improve educational reform efforts, the Secretary
may terminate any waivers previously granted.
    ``(d) National Evaluation.--Five years after the flexibility
program is implemented and at the end of every succeeding five-year
period, the Secretary shall evaluate the effectiveness of the
flexibility program nationwide. The findings of such evaluation shall
be submitted to the Congress not later than 120 days after such
evaluation is completed.

``SEC. 8006. REPORTS.

    ``(a) Local Reports.--A local educational agency or school that
participates in a flexibility project under this title shall submit an
annual report to the State educational agency that--
            ``(1) describes project activities;
            ``(2) evaluates the progress in achieving the goals stated
        in the application; and
            ``(3) evaluates the effectiveness of coordinating services
        for students and their families.
    ``(b) State Reports.--A State that participates in a flexibility
project under this title shall submit an annual report to the Secretary
of Education which evaluates the progress in achieving goals stated in
the application.
    ``(c) Secretary Reports.--The Secretary of Education shall submit
to the Congress a biennial report regarding the national progress of
flexibility programs and the effect of such programs on educational
reform.''.

Summary: Amends the Elementary and Secondary Education Act of 1965 to authorize the Secretary of Education to waive certain Federal statutory and regulatory requirements, with specified exceptions, for States, local educational agencies, and schools as part of systemic educational reform and efforts to meet the national education goals for all children. Allows additional waivers for specified related programs, with the approval of the appropriate Federal agency. Sets forth requirements for waiver applications, restrictions, evaluations, technical assistance, and reports.

To provide flexibility in education.


TITLE III--RURAL HEALTH CARE IMPROVEMENTS

SEC. 301. REFERENCE TO FULL MARKET BASKET INCREASE FOR SOLE COMMUNITY
              HOSPITALS.

    For provision eliminating any reduction from full market basket in
the update for inpatient hospital services for sole community
hospitals, see section 401.

SEC. 302. ENHANCED DISPROPORTIONATE SHARE HOSPITAL (DSH) TREATMENT FOR
              RURAL HOSPITALS AND URBAN HOSPITALS WITH FEWER THAN 100
              BEDS.

    (a) Blending of Payment Amounts.--
            (1) In general.--Section 1886(d)(5)(F) (42 U.S.C.
        1395ww(d)(5)(F)) is amended by adding at the end the following
        new clause:
    ``(xiv)(I) In the case of discharges in a fiscal year beginning on
or after October 1, 2002, subject to subclause (II), there shall be
substituted for the disproportionate share adjustment percentage
otherwise determined under clause (iv) (other than subclause (I)) or
under clause (viii), (x), (xi), (xii), or (xiii), the old blend
proportion (specified under subclause (III)) of the disproportionate
share adjustment percentage otherwise determined under the respective
clause and 100 percent minus such old blend proportion of the
disproportionate share adjustment percentage determined under clause
(vii) (relating to large, urban hospitals).
    ``(II) Under subclause (I), the disproportionate share adjustment
percentage shall not exceed 10 percent for a hospital that is not
classified as a rural referral center under subparagraph (C).
    ``(III) For purposes of subclause (I), the old blend proportion for
fiscal year 2003 is 80 percent, for each subsequent year (through 2006)
is the old blend proportion under this subclause for the previous year
minus 20 percentage points, and for each year beginning with 2007 is 0
percent.''.
            (2) Conforming amendments.--Section 1886(d)(5)(F) (42
        U.S.C. 1395ww(d)(5)(F)) is amended--
                    (A) in each of subclauses (II), (III), (IV), (V),
                and (VI) of clause (iv), by inserting ``subject to
                clause (xiv) and'' before ``for discharges occurring'';
                    (B) in clause (viii), by striking ``The formula''
                and inserting ``Subject to clause (xiv), the formula'';
                and
                    (C) in each of clauses (x), (xi), (xii), and
                (xiii), by striking ``For purposes'' and inserting
                ``Subject to clause (xiv), for purposes''.
    (b) Effective Date.--The amendments made by this section shall
apply with respect to discharges occurring on or after October 1, 2002.

SEC. 303. 2-YEAR PHASED-IN INCREASE IN THE STANDARDIZED AMOUNT IN RURAL
              AND SMALL URBAN AREAS TO ACHIEVE A SINGLE, UNIFORM
              STANDARDIZED AMOUNT.

    Section 1886(d)(3)(A)(iv) (42 U.S.C. 1395ww(d)(3)(A)(iv)) is
amended--
            (1) by striking ``(iv) For discharges'' and inserting
        ``(iv)(I) Subject to the succeeding provisions of this clause,
        for discharges''; and
            (2) by adding at the end the following new subclauses:
            ``(II) For discharges occurring during fiscal year 2003,
        the average standardized amount for hospitals located other
        than in a large urban area shall be increased by \1/2\ of the
        difference between the average standardized amount determined
        under subclause (I) for hospitals located in large urban areas
        for such fiscal year and such amount determined (without regard
        to this subclause) for other hospitals for such fiscal year.
            ``(III) For discharges occurring in a fiscal year beginning
        with fiscal year 2004, the Secretary shall compute an average
        standardized amount for hospitals located in any area within
        the United States and within each region equal to the average
        standardized amount computed for the previous fiscal year under
        this subparagraph for hospitals located in a large urban area
        (or, beginning with fiscal year 2005, for hospitals located in
        any area) increased by the applicable percentage increase under
        subsection (b)(3)(B)(i).''.

SEC. 304. MORE FREQUENT UPDATE IN WEIGHTS USED IN HOSPITAL MARKET
              BASKET.

    (a) More Frequent Updates in Weights.--After revising the weights
used in the hospital market basket under section 1886(b)(3)(B)(iii) of
the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)(iii)) to reflect the
most current data available, the Secretary shall establish a frequency
for revising such weights in such market basket to reflect the most
current data available more frequently than once every 5 years.
    (b) Report.--Not later than October 1, 2003, the Secretary shall
submit a report to Congress on the frequency established under
subsection (a), including an explanation of the reasons for, and
options considered, in determining such frequency.

SEC. 305. IMPROVEMENTS TO CRITICAL ACCESS HOSPITAL PROGRAM.

    (a) Reinstatement of Periodic Interim Payment (PIP).--Section
1815(e)(2) (42 U.S.C. 1395g(e)(2)) is amended--
            (1) by striking ``and'' at the end of subparagraph (C);
            (2) by adding ``and'' at the end of subparagraph (D); and
            (3) by inserting after subparagraph (D) the following new
        subparagraph:
            ``(E) inpatient critical access hospital services;''.
    (b) Condition for Application of Special Physician Payment
Adjustment.--Section 1834(g)(2) (42 U.S.C. 1395m(g)(2)) is amended by
adding after and below subparagraph (B) the following:
        ``The Secretary may not require, as a condition for applying
        subparagraph (B) with respect to a critical access hospital,
        that each physician providing professional services in the
        hospital must assign billing rights with respect to such
        services, except that such subparagraph shall not apply to
        those physicians who have not assigned such billing rights.''.
    (c) Flexibility in Bed Limitation for Hospitals With Strong
Seasonal Census Fluctuations.--Section 1820 (42 U.S.C. 1395i-4) is
amended--
            (1) in subsection (c)(2)(B)(iii), by inserting ``subject to
        paragraph (3)'' after ``(iii) provides'';
            (2) by adding at the end of subsection (c) the following
        new paragraph:
            ``(3) Increase in maximum number of beds for hospitals with
        strong seasonal census fluctuations.--
                    ``(A) In general.--In the case of a hospital that
                demonstrates that it meets the standards established
                under subparagraph (B), the bed limitations otherwise
                applicable under paragraph (2)(B)(iii) and subsection
                (f) shall be increased by 5 beds.
                    ``(B) Standards.--The Secretary shall specify
                standards for determining whether a critical access
                hospital has sufficiently strong seasonal variations in
                patient admissions to justify the increase in bed
                limitation provided under subparagraph (A).''; and
            (3) in subsection (f), by adding at the end the following
        new sentence: ``The limitations in numbers of beds under the
        first sentence are subject to adjustment under subsection
        (c)(3).''.
    (d) 5-Year Extension of the Authorization for Appropriations for
Grant Program.--Section 1820(j) (42 U.S.C. 1395i-4(j)) is amended by
striking ``through 2002'' and inserting ``through 2007''.
    (e) Effective Dates.--
            (1) Reinstatement of pip.--The amendments made by
        subsection (a) shall apply to payments made on or after January
        1, 2003.
            (2) Physician payment adjustment condition.--The amendment
        made by subsection (b) shall be effective as if included in the
        enactment of section 403(d) of the Medicare, Medicaid, and
        SCHIP Balanced Budget Refinement Act of 1999 (113 Stat. 1501A-
        371).
            (3) Flexibility in bed limitation.--The amendments made by
        subsection (c) shall apply to designations made on or after
        January 1, 2003, but shall not apply to critical access
        hospitals that were designated as of such date.

SEC. 306. EXTENSION OF TEMPORARY INCREASE FOR HOME HEALTH SERVICES
              FURNISHED IN A RURAL AREA.

    (a) In General.--Section 508(a) BIPA (114 Stat. 2763A-533) is
amended--
            (1) by striking ``24-Month Increase Beginning April 1,
        2001'' and inserting ``In General''; and
            (2) by striking ``April 1, 2003'' and inserting ``January
        1, 2005''.
    (b) Conforming Amendment.--Section 547(c)(2) of BIPA (114 Stat.
2763A-553) is amended by striking ``the period beginning on April 1,
2001, and ending on September 30, 2002,'' and inserting ``a period
under such section''.

SEC. 307. REFERENCE TO 10 PERCENT INCREASE IN PAYMENT FOR HOSPICE CARE
              FURNISHED IN A FRONTIER AREA AND RURAL HOSPICE
              DEMONSTRATION PROJECT.

    For--
            (1) provision of 10 percent increase in payment for hospice
        care furnished in a frontier area, see section 422; and
            (2) provision of a rural hospice demonstration project, see
        section 423.

SEC. 308. REFERENCE TO PRIORITY FOR HOSPITALS LOCATED IN RURAL OR SMALL
              URBAN AREAS IN REDISTRIBUTION OF UNUSED GRADUATE MEDICAL
              EDUCATION RESIDENCIES.

    For provision providing priority for hospitals located in rural or
small urban areas in redistribution of unused graduate medical
education residencies, see section 612.

SEC. 309. GAO STUDY OF GEOGRAPHIC DIFFERENCES IN PAYMENTS FOR
              PHYSICIANS' SERVICES.

    (a) Study.--The Comptroller General of the United States shall
conduct a study of differences in payment amounts under the physician
fee schedule under section 1848 of the Social Security Act (42 U.S.C.
1395w-4) for physicians' services in different geographic areas. Such
study shall include--
            (1) an assessment of the validity of the geographic
        adjustment factors used for each component of the fee schedule;
            (2) an evaluation of the measures used for such adjustment,
        including the frequency of revisions; and
            (3) an evaluation of the methods used to determine
        professional liability insurance costs used in computing the
        malpractice component, including a review of increases in
        professional liability insurance premiums and variation in such
        increases by State and physician specialty and methods used to
        update the geographic cost of practice index and relative
        weights for the malpractice component.
    (b) Report.--Not later than 1 year after the date of the enactment
of this Act, the Comptroller General shall submit to Congress a report
on the study conducted under subsection (a). The report shall include
recommendations regarding the use of more current data in computing
geographic cost of practice indices as well as the use of data directly
representative of physicians' costs (rather than proxy measures of such
costs).

SEC. 310. PROVIDING SAFE HARBOR FOR CERTAIN COLLABORATIVE EFFORTS THAT
              BENEFIT MEDICALLY UNDERSERVED POPULATIONS.

    (a) In General.--Section 1128B(b)(3) (42 U.S.C. 1320a-7(b)(3)) is
amended--
            (1) in subparagraph (E), by striking ``and'' after the
        semicolon at the end;
            (2) in subparagraph (F), by striking the period at the end
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(G) any remuneration between a public or
                nonprofit private health center entity described under
                clause (i) or (ii) of section 1905(l)(2)(B) and any
                individual or entity providing goods, items, services,
                donations or loans, or a combination thereof, to such
                health center entity pursuant to a contract, lease,
                grant, loan, or other agreement, if such agreement
                contributes to the ability of the health center entity
                to maintain or increase the availability, or enhance
                the quality, of services provided to a medically
                underserved population served by the health center
                entity.''.
    (b) Rulemaking for Exception for Health Center Entity
Arrangements.--
            (1) Establishment.--
                    (A) In general.--The Secretary of Health and Human
                Services (in this subsection referred to as the
                ``Secretary'') shall establish, on an expedited basis,
                standards relating to the exception described in
                section 1128B(b)(3)(G) of the Social Security Act, as
                added by subsection (a), for health center entity
                arrangements to the antikickback penalties.
                    (B) Factors to consider.--The Secretary shall
                consider the following factors, among others, in
                establishing standards relating to the exception for
                health center entity arrangements under subparagraph
                (A):
                            (i) Whether the arrangement between the
                        health center entity and the other party
                        results in savings of Federal grant funds or
                        increased revenues to the health center entity.
                            (ii) Whether the arrangement between the
                        health center entity and the other party
                        expands or enhances a patient's freedom of
                        choice.
                            (iii) Whether the arrangement between the
                        health center entity and the other party
                        protects a health care professional's
                        independent medical judgment regarding
                        medically appropriate treatment.
                The Secretary may also include other standards and
                criteria that are consistent with the intent of
                Congress in enacting the exception established under
                this section.
            (2) Interim final effect.--No later than 180 days after the
        date of enactment of this Act, the Secretary shall publish a
        rule in the Federal Register consistent with the factors under
        paragraph (1)(B). Such rule shall be effective and final
        immediately on an interim basis, subject to such change and
        revision, after public notice and opportunity (for a period of
        not more than 60 days) for public comment, as is consistent
        with this subsection.

Summary: Title III: Rural Health Care Improvements (sic) - Amends title XVIII (Medicare) of the Social Security Act to provide that, starting for discharges on or after October 1, 2002, hospitals will receive payments based on a blend of their current disproportionate share (DSH) adjustment and the current DSH adjustment for large urban hospitals. Limits such new DSH adjustment to ten percent for any hospital that is not classified as a rural referral center. Provides that for discharges occurring: (1) during FY 2003, the average standardized amount for hospitals located other than in a large urban area shall be increased by half the difference between the average standardized amount for hospitals located in large urban areas for such fiscal year, and such amount determined for other hospitals for such fiscal year. And (2) during FY 2004 and afterwards, the Secretary shall compute one standardized amount for all hospitals increased by the applicable percentage increase, and use this amount to pay all hospitals. Directs the Secretary of Health and Human Services, after revising the market basket cost weights to reflect the most current data available, to establish a frequency for revising such weights to reflect the most current data available more frequently than once every five years. Revises the critical access hospital (CAH) program to: (1) reinstate payments made on a periodic interim payment basis for inpatient services starting with payments made on or after January 1, 2003. (2) prohibit the Secretary from requiring as a condition for applying the special physician payment adjustment with respect to a CAH, that each physician providing professional services in the hospital must assign billing rights with respect to such services. (3) direct the Secretary to specify standards for determining whether a CAH has sufficiently strong seasonal variations in patient admissions to justify a five bed increase in the number of inpatient acute beds it can maintain and still retain its classification as a CAH. And (4) extend the authorization of appropriations for the Medicare rural hospital flexibility program through FY 2007. Prohibits the Secretary from recouping overpayments made for outpatient critical access hospital services under Medicare part B for services furnished in cost reporting periods that began before October 1, 2002, insofar as such overpayments are attributable to payment being based on 80 percent of reasonable costs . Amends the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) to extend through December 31, 2004, the ten percent additional payment for home health care furnished to beneficiaries residing in rural areas. Directs the Comptroller General to study and report to Congress on differences in payment amounts under the physician fee schedule for physicians' services in different geographic areas. Amends SSA title XI to provide that any remuneration in the form of a contract, lease, grant, loan, or other agreement between a public or non-profit private health center and any individual or entity providing goods or services to the health center is not a violation of the anti-kickback statute if such agreement contributes to the ability of the health center to maintain or increase the availability or quality of services provided to a medically underserved population served by the health center.

To amend title XVIII of the Social Security Act to make rural health care improvements under the Medicare Program.


SECTION 1. FINDINGS.

    The Congress makes the following findings:
            (1) Poland is one of the closest allies of the United
        States in Europe and worldwide; the diplomatic, political,
        military, and economic relationships between the two countries
        have never been better in history, but personal contacts among
        ordinary individuals are lagging behind. Over the medium and
        long terms, this will start to affect the overall quality of
        the strategic partnership between the United States and Poland.
            (2) Poland has actively participated in the global campaign
        against terrorism led by the United States. There is an
        indication that the threat of potential terrorist activities
        generated in Poland is actually smaller than that in most of
        the 27 countries currently participating in the visa waiver
        program established under section 217 of the Immigration and
        Nationality Act. Polish citizens have not been involved in any
        form of terrorist activities on the territory of the United
        States or against the interests of the United States overseas.
            (3) Since joining the North Atlantic Treaty Organization on
        March 12, 1999, Poland has proven to be a reliable partner and
        a capable guarantor of NATO security in Kosovo and Afghanistan.
            (4) From the first days of Operation Iraqi Freedom, Poland
        has been a staunch ally to the United States and has committed
        its soldiers to help with ongoing stabilization efforts in
        Iraq.
            (5) In recognition of the historic changes in our bilateral
        relations and motivated by the sincere need to enhance contacts
        between Polish and United States citizens, on April 15, 1991,
        Poland unilaterally repealed its visa obligation for United
        States citizens seeking to travel to Poland for a period of 90
        days or less.
            (6) The Polish-American community of 9.3 million people
        contributed significantly to the development of the United
        States.
            (7) Since the movement known as ``Solidarity'' and the
        turning point of 1989, Poland has undergone great political,
        social, and economic changes. It has become a nation committed
        to traditional values, rules of law, freedom, and democracy.
            (8) On May 1, 2004, Poland became a member state of the
        vibrant European Union. Poland is a free market economy, and
        Poland's integration within the European structures has had a
        stabilizing effect on its economy.
            (9) More than 150,000 Polish citizens visited the United
        States in 2003.
            (10) Poland's visa refusal rate has declined dramatically,
        and it continues to decline. Nevertheless, the visa refusal
        rate is an arbitrary standard that is not an objective
        measurement because it does not reflect the propensity of
        nationals from Poland to violate the terms of their admission
        into the United States.
            (11) Poland participates in the work and travel program
        that allows about 25,000 Polish students to visit the United
        States each year.
            (12) Warsaw International Airport Okecie participates in
        the pilot program of voluntary passenger screening for
        passengers leaving Warsaw to fly to the United States.
            (13) If Poland is allowed to conditionally participate in
        the visa waiver program, the Polish government will develop and
        implement a campaign to prevent Polish citizens from remaining
        in the United States beyond their authorized period of
        admission or otherwise violating the terms of their admission
        into the United States.
            (14) The Polish government is committed to becoming a
        successful part of the visa waiver program.
            (15) Poland is ready to demonstrate that adequate
        safeguards against fraudulent use of its passports are in
        place, including proper storage of blank passports and
        sufficient screening of passport applicants.
            (16) Poland is determined to fulfill its obligations and
        introduce extremely safe passports for its citizens, including
        two mandatory biometric identifiers. This is in addition to
        satisfaction of the machine-readable requirements for passports
        described in the Immigration and Nationality Act.
            (17) On February 23, 2004, and May 11, 2004, the assemblies
        of New Jersey and Massachusetts, respectively, enacted
        resolutions urging the President and the Congress to make
        Poland eligible for the visa waiver program.

SEC. 2. TEMPORARY AND CONDITIONAL DESIGNATIONS OF POLAND FOR VISA
              WAIVER PROGRAM.

    (a) Temporary Designation.--
            (1) In general.--Effective on the date of the enactment of
        this Act, and notwithstanding section 217(c) of the Immigration
        and Nationality Act (8 U.S.C. 1187(c)), Poland temporarily
        shall be designated a program country for purposes of the visa
        waiver program established under section 217 of such Act.
            (2) Expiration.--The temporary designation described in
        paragraph (1) shall expire on the date that is 18 months after
        the date of the enactment of this Act.
    (b) Review.--Not later than 1 year after the date of the enactment
of this Act, the Secretary of Homeland Security shall determine the
overstay rate for the portion of the period of temporary designation
described in subsection (a) that has elapsed when the determination is
made. Based on such calculation, the Secretary shall determine whether
Poland permanently, but conditionally, shall be designated a program
country for purposes of such visa waiver program.
    (c) Duration, Suspension, and Termination of Conditional
Designation.--
            (1) In general.--Notwithstanding any other provision of
        law, if the Secretary determines under subsection (b) that
        Poland permanently, but conditionally, shall be designated a
        program country, Poland shall continue to be a program country
        for purposes of the visa waiver program as long as the annual
        overstay rate for each fiscal year remains below 3 percent.
            (2) Suspension.--If the overstay rate for a fiscal year
        exceeds 3 percent, the Secretary of Homeland Security shall
        suspend the designation of Poland as a program country for
        purposes of the visa waiver program for a period of 1 year.
            (3) Termination.--If the annual overstay rate exceeds 3
        percent for any two fiscal years (regardless of whether such
        years are consecutive), the Secretary of Homeland Security
        shall terminate the designation of Poland as a program country
        for purposes of the visa waiver program.
            (4) Redesignation.--The Secretary of Homeland Security may
        redesignate Poland as a program country without regard to any
        other law when the Secretary determines that Poland has
        established satisfactory new safeguards to ensure that the
        overstay rate will remain acceptably low.
    (d) Definition.--For purposes of this section, the term ``overstay
rate'' means the percentage which--
            (1) the total number of nationals of Poland who were
        admitted as nonimmigrant visitors during the applicable
        measurement period and who violated the terms of such
        admission; bears to
            (2) the total number of nationals of such country who
        applied for admission as nonimmigrant visitors during such
        period.

Summary: Temporarily designates Poland as a program country for purposes of the Immigration and Nationality Act's visa waiver program (VWP), notwithstanding designation requirements of current law. Requires the Secretary of Homeland Security to determine the nonimmigrant visa overstay rate for Polish nationals for the elapsed period of temporary designation and, based on such calculation, to determine whether Poland shall be designated permanently but conditionally for VWP purposes. States that, if permanently but conditionally designated, Poland shall remain a VWP country as long as the annual overstay rate remains below three percent. Requires the Secretary to: (1) suspend VWP designation for one year if the overstay rate exceeds three percent. And (2) terminate VWP designation if the overstay rate exceeds three percent for any two fiscal years, with the possibility of redesignation.

To designate Poland as a program country under the visa waiver program established under section 217 of the Immigration and Nationality Act, subject to special conditions.