Summary: H.R.3299 — 101st Congress (1989-1990)All Information (Except Text)

Bill summaries are authored by CRS.

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Conference report filed in House (11/21/1989)

Omnibus Budget Reconciliation Act of 1989 - Title I: Agriculture and Related Programs - Agricultural Reconciliation Act of 1989 - Amends the Agricultural Act of 1949 to direct the Secretary of Agriculture to permit producers to plant soybeans, sunflowers, or safflowers on up to 25 percent of the permitted acreage for 1990 crops of wheat, feed grains, cotton, and rice. Requires the Secretary to reduce such percentage (or even prohibit such plantings) if it is estimated, based on the anticipated additional soybean, sunflower, and safflower plantings, that the average market price for the 1990 soybean crop will be below 110 percent of the loan rate for the 1989 crop. Requires a report to the appropriate congressional committees. Counts any acreage planted to soybeans, sunflowers, or safflowers as acreage planted to the program crop for which they are substituted.

Sets forth a sliding-scale of acreage limitations and reductions for the 1990 crop of feed grains.

Makes across-the-board reductions in deficiency payments for the 1990 crops of: (1) wheat and corn, by 2.33 cents per bushel; (2) cotton, by .515 cents per pound; and (3) rice, by .515 cents per hundred-weight.

Amends the Disaster Assistance Act of 1988 to declare that refunds of advance deficiency payments may not be required: (1) before December 31, 1989, (currently July 31) for producers of 1988 crops of wheat, feed grains, rice, and cotton if they suffered losses of 1988 or 1989 crops due to a natural disaster; or (2) before July 31, 1990, for any such 1988 deficiency payments.

Prohibits the Commodity Credit Corporation during FY 1990 from making more than $566,000,000 in commodities available to exporters, processors, or foreign importers in order to enhance the export of U.S. commodities by making their prices competitive in the world market.

Amends the Food Security Act of 1985 to reduce the amount of targeted export assistance available for FY 1990 from $325,000,000 to $200,000,000.

Delays until October 1, 1992, the effective date of certain Farm Credit System Financial Assistance Corporation (FAC) stock purchase requirements of the Farm Credit Act of 1971, as amended by the Rural Development, Agriculture, and Related Agencies Appropriations Act, 1989. Requires that FAC make, out of its Trust Fund, four annual payments (calculated according to specified formulae) to each institution of the Farm Credit System that purchased FAC stock. Makes such installments payable as soon as practicable after October 1 of each of the calendar years 1989 through 1992.

Directs the Secretary, during calendar year 1990, to offer to buy butter at no more than $1.10 per pound. Permits the Secretary to allocate the rate of price support between the purchase prices for nonfat dry milk and butter in any other manner determined to result in the lowest level of expenditures by the Commodity Credit Corporation. Requires notification of the appropriate congressional committees of such a determination.

Makes the mandatory 50 percent cut in the price support for milk discretionary.

Title II: Student Loan and Pension Fiduciary Amendments - Subtitle A: Student Loan Reconciliation Amendments - Student Loan Reconciliation Amendments of 1989 - Amends the Higher Education Act of 1965 (HEA) to revise provisions relating to repayment of student loans by medical residents.

Provides that no borrower shall be eligible for certain student loans or be classified as a student for a deferment of student loan repayments while serving in a medical internship or residency program.

Requires lenders to grant borrowers, upon written request, forbearance from student loan repayments, renewable at 12-month intervals, for the time remaining in the borrower's medical or dental internship, residency, or fellowship program. Prohibits lenders from: (1) charging an administrative or other fee in connection with granting such a forbearance; or (2) reporting adverse information regarding a borrower solely because of granting such a forbearance.

Revises HEA provisions relating to the Supplemental Loans for Students (SLS) program. Prohibits borrowing of funds under the SLS program at an institution of higher education by any undergraduate student if that institution had a cohort default rate of 30 percent or more with respect to repayment of student loans under the SLS or the Guaranteed Student Loan (GSL) programs.

Revises maximum annual limits on individual student loan amounts under the SLS program.

Makes ability-to-benefit students ineligible for the SLS program until they have obtained a high school diploma or equivalency certificate. Requires institutions which admit ability-to-benefit students to make available to them a program proven successful in assisting students in obtaining a high school equivalency certificate.

Sets forth additional requirements with respect to the disbursement of GSL and SLS loans. Requires multiple disbursement of such student loans, with minimum intervals between first and second installments.

Prohibits endorsements of the first installment of an SLS loan to a new student borrower entering the first undergraduate year until 30 days after the borrower begins a course of study, but allows such installment to be delivered to the eligible institution prior to the end of the 30-day period. Prohibits disbursement of loans to any other student more than 30 days before the beginning of the enrollment period under GSL and SLS programs.

Sets forth requirements for methods of multiple disbursement.

Requires the lender or escrow agent to withhold a second or succeeding installment if the borrower has ceased to be enrolled on at least a half-time basis.

Requires withholding of all or part of the second installment if a student has received an overpayment in the first installment.

Excludes from such additional disbursement requirements parent (PLUS) loans, consolidation loans, and loans to cover study at an institution outside the United States.

Directs the Secretary of Education (the Secretary) to establish a student loan default reduction program. Establishes such program as an amnesty program for defaulters on loans under the Robert T. Stafford Student Loan Program. Allows borrowers with defaulted loans to fully repay the debt: (1) without penalties; (2) with any information on the defaulted loans removed from credit bureaus; and (3) with their student aid eligibility restored. Directs the Secretary to make a specified share of repayments. Sets forth other repayment incentives, including sale of loans, use of proceeds of sales, and borrower eligibility for additional loans under general loan conditions. Directs the Secretary to widely publicize the availability of such default reduction program.

Authorizes the Secretary to take certain emergency actions to impose sanctions against lenders and institutions and their agents if they violate HEA student aid program provisions.

Prohibits an institution from being certified or recertified as eligible for the Stafford Student Loan Program or other HEA title IV student assistance programs if it has lost its institutional accreditation during the preceding 24 months, unless such accreditation has been restored or the institution has demonstrated its academic integrity to the Secretary's satisfaction.

Directs the Secretary to consult with a representative group of guaranty agencies, eligible lenders, and eligible institutions to develop a mutually agreeable proposal for the establishment of a National Student Loan Data System. (Such a system is currently authorized but not mandated.) Authorizes the Secretary to require lenders, guaranty agencies, and institutions to verify information or eligibility through such system before making, guaranteeing, or certifying student loans. Directs the Secretary to report annually to the appropriate congressional committees on the results obtained through such system.

Provides that nothing in title IV limits the authority of student financial aid administrators to: (1) make necessary adjustments to the cost of attendance and expected student and/or parent contribution under special circumstances; or (2) use supplementary information about the financial status or personal circumstance of eligible applicants in selecting recipients and determining award amounts under specified student assistance programs.

Subtitle B: Fiduciary Responsibilities - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to provide for mandatory civil penalties for certain violations by fiduciaries.

Directs the Secretary of Labor to assess a civil penalty equal to 20 percent of the applicable recovery amount under a settlement or court order against a fiduciary or other person in the case of: (1) any breach of fiduciary responsibility or other violation of specified ERISA provisions; or (2) any knowing participation in such breach or violation by any other person. Authorizes the Secretary to have sole discretion to waive or reduce such penalty upon determination that the fiduciary or other person: (1) acted reasonably and in good faith; or (2) cannot restore all losses to the plan without severe financial hardship unless such waiver or reduction is granted. Reduces such penalty by the amount of any penalty or tax imposed on such fiduciary or other person with respect to such transaction under specified provisions of the Internal Revenue Code.

Title III: Regulatory Agency Fees - Subtitle A: Federal Communications Commission Fees and Penalties - Amends the Communications Act of 1934 to adjust the Schedule of Charges assessed by the Federal Communications Commission (FCC) for the provision of the following services: (1) private radio services; (2) equipment approval services/experimental radio; (3) mass media services; (4) common carrier services; and (5) miscellaneous charges. Changes to every two years after October 1, 1991, the date upon which such Schedule shall be reviewed by the FCC and adjusted to reflect changes in the Consumer Price Index.

Increases fines and penalties for various failures and noncompliance under the Communications Act of 1934 (the Act).

Increases the fines assessed against those who receive from a common carrier a rebate or offset against the regular charges for the transmission of messages or signals. Makes such fines higher for broadcast station licensees or permittees, cable television operators, or applicants for cable television operation. States penalty amounts if the violator is a common carrier subject to the provisions of the Act or an applicant for a common carrier license. Requires the FCC to assess such forfeiture penalty amount via written notice.

Subtitle B: Nuclear Regulatory Commission User Fees - Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to provide that for FY 1990 the maximum amount of aggregate user charges which the Nuclear Regulatory Commission may assess from its licensees shall, when added to other amounts collected, not exceed 45 percent of the costs incurred by the Commission for such fiscal year.

Title IV: Civil Service and Postal Service Programs - Declares that the receipts and disbursements of the Postal Service Fund: (1) shall not be included in the totals of the Federal budget or the congressional budget; (2) shall be exempt from Federal budget limitations on expenditures and net lending; and (3) shall be exempt from sequestration and shall not be counted for purposes of calculating the Federal deficit.

Makes the United Postal Service liable for unfunded increases in the benefits to be paid from the Civil Service Retirement and Disability Fund to: (1) Postal Service annuitants who separated from service after September 30, 1986; (2) their survivors; or (3) the survivors of Postal Service employees who died after such date, when such increases result from cost-of-living adjustments.

Directs the Office of Personnel Management (OPM) to determine such increases. Requires the Postal Service to pay such increases to OPM in annual installments plus interest with the first payment due at the end of the fiscal year in which the cost-of-living adjustment becomes effective. Requires the first payment to include the total of amounts which would have been due if this Act had been enacted before October 1, 1986, plus interest. Specifies the amount of such annual installments to fund cost-of-living adjustments for FY 1987 through 1989.

Provides for the funding of health benefit premiums for survivors of Postal Service annuitants or employees of the Postal Service who died after October 1, 1986.

Mandates that required Postal Service payments to the Employees' Compensation Fund to cover costs paid from the Fund for Postal Service employee injury or death benefits must be deposited within 30 days after the Secretary of Labor furnishes a statement of the amount of such costs due from the Postal Service. Requires such deposits to remain available without fiscal year limitation.

Provides for partial deferred payments of lump-sum credit according to a specified payment schedule for certain individuals electing alternative forms of annuities if the commencement date of the annuity to be paid falls between December 2, 1989 and October 1, 1990. Directs OPM to prescribe regulations to provide that, unless the individual involved indicates otherwise by written notice to OPM, provisions for such payment of lump-sum credit shall not apply in the case of any individual: (1) who is separated from Government service involuntarily, other than for cause on charges of misconduct or delinquency; and (2) if application of such provisions would be against equity and good conscience due to a critical medical condition affecting such individual.

Title V: Veterans Programs - Extends through FY 1990 the authority of the Secretary of Veterans Affairs to collect a loan fee from veterans receiving home loans guaranteed by the Department of Veterans Affairs.

Title VI: Medicare, Medicaid, Maternal and Child Health, and Other Health Provisions - Subtitle A: Medicare - Part 1: Provisions Relating to Part A - Subpart A: General Provisions - Continues payment reductions under part A (Hospital Insurance) of title XVIII (Medicare) of the Social Security Act made pursuant to the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) through 1989. Increases such payments for the remainder of FY 1990.

Amends the Medicare Program to reduce payments for the capital-related costs of inpatient hospital services for the final three quarter of FY 1990 by 15 percent.

Increases Medicare payments for the operating costs of inpatient hospital services in FY 1990 by the market basket percentage increase in such costs: (1) plus 4.22 percent for rural hospitals; (2) plus .12 percent for hospitals in large urban areas; and (3) minus .53 percent for hospitals located in other urban areas. Requires the reduction of diagnosis-related group weighting factors by 1.22 percent for FY 1990 and their annual recalibration in a budget-neutral manner. Increases payments to hospitals serving a disproportionate share of low-income patients. Continues the classification of certain hospitals as rural referral centers through FY 1992.

Alters the formula for determining the amount of payments to be made to sole community hospitals. Provides a payment adjustment to sole community hospitals and Medicare dependent, small rural hospitals which experience a decrease of more than five percent of their inpatient cases due to circumstances beyond their control so as to cover fixed costs. Redefines a sole community hospital as a hospital located more than 35 road miles from another hospital or serving as the sole source of inpatient hospital services reasonably available to part A Medicare beneficiaries in a geographical area. Maintains the sole community hospital designation of current sole community hospitals which do not satisfy the new definition of such hospitals.

Establishes a demonstration program under which the Secretary of Health and Human Services makes grants to no more than seven States for use in: (1) planning and implementing a rural health care plan and rural health networks; (2) designating hospitals or facilities as essential access community hospitals or rural primary care hospitals; and (3) developing and supporting communication and emergency transportation systems. Authorizes hospitals and facilities in grant States to apply, subject to the State's approval, to the Secretary for a grant to finance the costs it incurs in converting itself to a primary care hospital or in becoming part of a rural health network in the State in which it is located. Requires that hospitals designated as essential access community hospitals be isolated rural hospitals that have at least 75 inpatient beds and provide emergency and medical backup services to rural primary care hospitals in their rural health network and throughout their service area. Requires that rural primary care hospitals provide 24-hour emergency care and no more than 72 hours of inpatient care for no more than six inpatients. Requires States, in designating facilities as rural primary care hospitals, to give preference to facilities participating in the rural health network. Defines a "rural health network" as an organization consisting of at least one essential access community hospital, rural referral center, or urban regional referral center and at least one rural primary care hospital which cooperate in the deliverance of health care. Authorizes appropriations for FY 1990 through 1992 for such demonstration program.

Amends the Omnibus Budget Reconciliation Act of 1987 to extend the Rural Health Care Transition Grant Program through FY 1992, and permit hospitals to use grants received under such Program to provide instruction and consultation via telecommunications to physicians in rural health manpower shortage areas, to develop a plan for converting to rural primary care hospitals or to develop a rural health network, if located in a State participating in the preceding demonstration program.

Amends the Medicare program to treat essential access community hospitals as sole community hospitals.

Covers inpatient rural primary care hospital services.

Establishes the Medicare Geographical Classification Review Board which shall consider hospital requests for changes in their geographical classification pursuant to guidelines to be issued by the Secretary. Directs the Secretary to fashion a legislative proposal eliminating the system of determining separate average standardized payment amounts for hospitals located in large urban, other urban, or rural areas. Requires the Prospective Payment Assessment Commission to conduct a study regarding Medicare reimbursement of small rural hospitals and rural sole community hospitals.

Exempts hospitals involved extensively in cancer treatment or cancer research from the prospective payment system (PPS). Sets forth a formula for establishing the target amount to be used in determining the amount of payments to be made to such hospitals.

Increases medicare payment rates for hospice care. Requires a hospice care beneficiary to be certified as terminally ill no later than two days or eight days, if verbal certification is obtained within two days, after the initiation of such care.

Subpart B: Technical and Miscellaneous Provisions - Requires that Medicare payments for blood clotting factors administered to inpatient hemophiliacs be made on the basis of a predetermined price per unit consumed.

Allows individuals under age 65 whose entitlement to OASDI disability benefits ended due to their employment earnings to enroll in part A (Hospital Insurance) of the Medicare program. Requires the Secretary, at the request of a State, to permit qualified Medicare beneficiaries in the State (enrolled under part B of the Medicare program) to enroll in the Hospital Insurance program.

Requires studies into the appropriateness of an adjustment to the methodology of determining payment amounts for hospitals serving a disproportionate share of Medicare beneficiaries and on methods of compensating hospices for high-cost care.

Authorizes the Secretary to assign a new base period to a hospital in determining Medicare hospital payment amounts when such hospital's costs are skewed by events beyond the hospital's control or by extraordinary circumstances.

Imposes obligations on hospitals regarding the treatment of emergency medical conditions and indigent care.

Provides for the release of hospital accreditation surveys to the Secretary and the Secretary's release of survey information which relates to an enforcement action. Permits the Secretary to withdraw a hospital's Medicare-approved status on the basis of information other than accreditation surveys.

Establishes intermediate sanctions for psychiatric hospitals.

Permits certain merged or consolidated hospitals to receive Medicare periodic interim payments.

Alters the basis for judging the effectiveness of a waiver of Medicare hospital reimbursement mechanisms in favor of a State hospital reimbursement control system.

Prohibits the Secretary from requiring a hospital to change its bad debt recognition policy approved as of August 1, 1987.

Requires the Secretary to determine a nursing facility's routine service costs using data collected no earlier than October 1985.

Permits dentists to serve as hospital medical directors.

Directs the Comptroller General to conduct a study of the differences in costs and case-mix between hospital-based and freestanding skilled nursing facilities.

Prohibits the Secretary from collecting overpayments from hospitals in Massachusetts prior to May 1990 occurring during a specified statewide hospital reimbursement demonstration project.

Permits nurse practitioners and clinical nurse specialists to certify an individual's need for Medicare extended care and hospice services.

Part 2: Provisions Relating to Part B - Subpart A: General Provisions - Continues payment reductions under part B (Supplementary Medical Insurance) of the Medicare program made pursuant to the Balanced Budget and Emergency Deficit Control Act of 1985 through the first half of FY 1990.

Provides for the gradual transition, from 1992 through 1995, to the determination of Medicare payments for physician services pursuant to a fee schedule which takes into account the relative value of the work, practice expenses, and malpractice risks associated with each physician services. Allows for geographic variations in resource values and fee schedule adjustments which take into account inflation, changes in demand for and the technology of a physician service, and inadequate access to such service. Sets Medicare payments for nonparticipating physicians' services at 95 percent of the fee schedule amount. Prohibits payments for the same physician service from varying on the basis of whether or not the physician is a specialist. Sets forth sumptuary provisions. Limits nonparticipating physicians' actual charges for unassigned claims. Requires that payments for physician services to Medicaid-eligible Medicare beneficiaries be made on an assignment-related basis. Increases the incentive payment for physicians' services furnished in manpower shortage areas from five to ten percent of the payment for such services. Sets forth miscellaneous study and reporting requirements.

Amends the Public Health Service Act to create a new title to establish, within the Public Health Service, the Agency for Health Care Research and Policy (Agency) to enhance the quality, appropriateness, and effectiveness of health care services, and access to such services, through the establishment of a broad base of scientific research, and improvements in clinical practice and in the organization, financing, and delivery of health care services. Requires that the agency be headed by an Administrator for Health Care Research and Policy, to be appointed by the President. Directs the Secretary of Health and Human Services, through the Administrator, to carry out the new title.

Sets forth the general authorities and duties of the Administrator, including conducting and supporting research, demonstration projects, evaluations, training, and the dissemination of information. Prohibits the Administrator from restricting the publication of data or results from projects conducted or supported under the new title, but prohibits disclosure of identifying data without consent.

Directs the Administrator and the Director of the National Library of Medicine (the Library) to enter into an agreement for indexing, abstracting, translating, publishing, and other services leading to a more effective and timely dissemination of information on research, demonstration projects, and evaluations.

Directs the Administrator to promote the development and application of appropriate health care technology assessments. Establishes at the Library an information center on health care technologies and health care technology assessment. Directs the Administrator and the Director of the Library to enter into an agreement providing for the information center the Administrator to make recommendations to the Secretary with respect to whether specific health care technologies should be reimbursable under federally financed health programs.

Establishes within the Agency the Office of the Forum for Quality and Effectiveness in Health Care, to be headed by a director to be appointed by the Administrator. Directs the Administrator, through the Director, to establish the Forum for Quality and Effectiveness in Health Care to develop, review, and update: (1) clinically relevant diagnosis and treatment guidelines for physicians and health care practitioners; and (2) standards of quality, performance measures, and medical review criteria. Requires the Director to contract with public or private nonprofit entities and convene panels of qualified experts, practicing physicians, and health care consumers for the development of such guidelines and standards.

Amends part A (General Provisions) of title XI of the Social Security Act to direct the Secretary, through the Administrator for Health Care Research and Policy, to: (1) conduct and support research with respect to the outcomes of health care services and procedures to identify how diseases and disorders can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically; and (2) assure that Medicare needs and priorities are reflected in treatment-specific or condition-specific practice guidelines. Directs the Secretary to establish priorities with respect to the diseases and disorders for which outcome evaluations are to be conducted. Imposes additional duties on the Secretary concerning the administration of outcomes research and information dissemination. Authorizes appropriations for outcomes research for FY 1990 through 1994.

Amends the Public Health Service Act to establish the National Advisory Council for Health Care Policy, Research, and Evaluation to advise the Secretary and the Administrator with respect to activities of the Agency for Health Care Research and Policy.

Requires that technical and scientific peer review be conducted on each application for a grant, cooperative agreement, or contract under the new title of the Public Health Service Act added by this Act. Prohibits application approval by the administrator unless the application has been recommended for approval by a peer review group.

Directs the Administrator to: (1) establish guidelines for uniform methods of developing and collecting data under the title added by this Act; (2) assure that statistics developed under that title are of high quality, timely, comprehensive, specific, standardized, and adequately analyzed and indexed; and (3) disseminate the statistics and widely as possible.

Authorizes appropriations for FY 1990 through 1992 to carry out the title added by this Act. Requires, in addition, that a portion of amounts available under specified existing provisions of the Public Health Service Act relating to evaluations of programs be made available for evaluations under the title added by this Act.

Removes from the Public Health Service Act provisions establishing the National Center for Health Services Research and provisions providing for grants for a council on health care technology.

Directs the Secretary to request the Institute of Medicine of the National Academy of Sciences to enter into a contract to: (1) recommend priorities for the assessment of specific health care technologies; and (2) assist in the establishment of the information center. Authorizes appropriations for FY 1990 for carrying out such contract.

Provides for the transfer of information and materials developed by the council on health care technology to the Secretary in establishing the information center on health care technologies and health care technology assessment.

Amends part B (Supplementary Medical Insurance) of the Medicare program to reduce Medicare payments for a specified list of physicians' services furnished during the last three quarters of 1990.

Reduces payments for radiology services (other than portable X-ray services). Requires the Secretary to establish a relative value guide for use in all carrier localities in making payment for physician anesthesia services. Prohibits the rounding of fractional time units in calculating Medicare payments for anesthesia services.

Delays the Medicare economic index adjustment to payments for physicians' services from January 1, 1990, to April 1, 1990. Extends Medicare physician and supplier participation agreements for which a termination is not requested before December 31, 1989, through March 31, 1990. Limits increases in the Medicare economic index for the final three quarters of 1990 to: (1) zero percent for radiology services, anesthesia services and other physicians' services on a specified list; and (2) two percent for other physicians' services, excepting primary care services.

Requires the Secretary to set the customary charge for new physicians' services for the last three quarters of 1990 at 85 percent of the prevailing charge for such services. Limits payment for physician services furnished by more than one specialty.

Prohibits Medicare carriers from recovering certain part B overpayments made between July 1, 1985, and March 31, 1986.

Reduces payments for the capital-related costs of outpatient hospitals services for FY 1990 by 15 percent, except when the hospital is a sole community hospital.

Eliminates the requirement that a fee schedule for clinical diagnostic laboratory tests be established on a nationwide basis. Lowers the payment ceiling for a clinical laboratory test to 93 percent of the median of all fee schedules established for that test for that setting. Allows medicare payments for such tests to be made to the referring laboratory only if: (1) it is located in, or is part of, a rural hospital; (2) it submits payment requests for tests of which no more than 30 percent in any year are performed by another laboratory; or (3) it is involved in a common ownership relationship with the laboratory performing the test.

Delays current cost-of-living updates of payments for durable medical equipment until 1991. Establishes a 15-month cap on rental payments for an enteral or parenteral pump. Requires the payment of reasonable pump maintenance and servicing fees after the expiration of such period. Reduces payments for seat-lift chairs and transcutaneous electrical nerve stimulators furnished on or after April 1, 1990, by 15 percent. Treats power driven wheelchairs as routinely purchased durable medical equipment for Medicare payment purposes. Requires the Secretary to specify criteria to be used by carriers in deciding on a case-by-case basis whether to classify power-driven wheelchairs as customized items for payment purposes. Treats ostomy supplies as home health services which home health agencies must provide to beneficiaries who need them.

Eliminates the restriction of covered psychologist services to services furnished at community mental health centers. Covers clinical social worker services pertaining to the diagnosis and treatment of mental illnesses. Directs the Secretary to develop criteria requiring covered psychologists to consult with their patients' physicians within a reasonable time after initiating treatment so as to consider physical conditions that may be contributing to their patients' symptoms. Eliminates the dollar limitation on part B coverage of mental health services.

Covers the services of nurse practitioners working in collaboration with a physician in a nursing facility. Makes Medicare payments for such services to the nurse practitioner's employer. Requires Medicare carriers to permit routine part B payments for up to 1.5 monthly visits per resident of a nursing facility by a member of a team which includes a physician and physician assistant and/or nurse practitioner. Directs the Secretary to establish at least one demonstration project applying such limitation on visits on an average basis over the aggregate total of nursing facility residents served by team members.

Covers a screening pap smear for women who have not undergone such a test during the preceding three years or for a shorter period set by the Secretary for women at higher risk of developing cervical cancer.

Covers outpatient rural primary care hospital services. Directs the Secretary to develop and implement a prospective payment system for determining payments for such services by January 1, 1993.

Subpart B: Technical and Miscellaneous Provisions - Permits the coverage of additional inserts for therapeutic shoes for individuals with severe diabetic foot disease and the substitution of shoe modifications for inserts.

Extends indefinitely the coverage of certified registered nurse anesthetist services as inpatient hospital services when furnished at rural hospitals with 500 or fewer surgical procedures requiring anesthesia services per year.

Increases the payment limit for physical and occupational therapy services.

Requires studies into payments for portable X-ray services, ambulance services, hospital outpatient services, assistants at surgery, blood clotting factor for hemophilia patients, and standards for the use of and payment for durable medical equipment.

Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to terminate four specified municipal health service demonstration projects by January 1, 1994.

Amends the Medicare program to narrow the range of acceptable purchase prices for durable medical equipment.

Covers diagnostic tests performed in physician office labs which meet specified certification requirements.

Part 3: Provisions Relating to Parts A and B - Subpart A: General Provisions - Continues health maintenance organization (HMO) payment reductions made pursuant to the Balanced Budget and Emergency Deficit Control Act of 1985 through 1989. Increases such payments for the remainder of FY 1990.

Amends the Internal Revenue Code to provide for the disclosure of taxpayer identification information regarding a Medicare beneficiary for the determination of the extent to which such beneficiary is covered under a group health plan. Amends the Medicare program to require employers to disclose information concerning the status and nature of a beneficiary's coverage under a group health plan of the employer.

Prohibits group health plans of employers of 20 or more employees from discriminating in the provision of benefits against individuals who are entitled to Medicare benefits by reason of their eligibility for old-age insurance benefits under the OASDI program. Prohibits large group health plans from discriminating against individuals who are entitled to Medicare benefits by reason of their eligibility for disability or disability-based insurance benefits under the OASDI program. Prohibits group health plans, for 12 months, from discriminating in the provision of benefits against individuals who are entitled to Medicare benefits by reason of their affliction with end stage renal disease. Makes such group health plans primary payers against whom the Federal government may bring action to recover Medicare payments. Establishes a private cause of action against primary payers who fail to pay. Amends the Internal Revenue Code to impose a penalty excise tax against nonconforming group health plans. Repeals the denial of a tax deduction to nonconforming group health plans.

Amends the Omnibus Budget Reconciliation Act of 1986 to maintain the current base rate for routine dialysis treatment through FY 1990. Requires that subsequent changes in such rate be subject to Medicare notice and comment requirements. Amends the Medicare program to prohibit payments for dialysis services which are determined under any method other than a method based on a single composite weighted formula from exceeding payments that would have been made under such formula for hospital-based facilities. Requires suppliers of home dialysis supplies and equipment to a patient whose self-care home dialysis is not under the direct supervision of an approved provider to work under a written agreement under which it: (1) is the sole supplier to the patient; (2) agrees to receive payment only on an assignment-related basis; and (3) certifies that it has entered into a written agreement with an approved renal dialysis provider or facility under which such provider or facility agrees to furnish such patient with all self-care home dialysis support services and all other necessary dialysis services and supplies.

Prohibits a physician from referring a patient to an entity for the provision of Medicare clinical laboratory services or an entity from presenting a claim pursuant to such referral if the physician has a financial interest in, or receives compensation from, such entity. Makes exceptions to such prohibition. Sets forth entity investment and ownership disclosure requirements. Imposes sanctions against persons who present claims for services prohibited by this Act and against physicians or entities that enter into arrangements for the purpose of prohibited referrals or violate disclosure requirements. Directs the Comptroller General to conduct a study and report to the Congress by February 1, 1991, on the ownership of hospitals by referring physicians and joint ventures between hospitals and referring physicians. Requires the Secretary to submit quarterly reports to the Congress and the Comptroller General comparing Medicare beneficiaries' utilization of entities in which the referring physician has a financial interest and their utilization of entities in which the referring physician has no such interest.

Allows a hospital to be reimbursed on a reasonable cost basis for the costs of a hospital-based nursing school if it incurs at least 50 percent of the costs of training students at such school, the school and hospital share some board members, and all instruction is provided on the hospital grounds. Prohibits the Secretary from recovering, prior to October 1, 1990, alleged Medicare overpayments attributable to nursing and allied health education. Directs the Secretary to issue regulations before July 1, 1990, regarding Medicare payment of costs for such education.

Requires the Secretary to give health maintenance organizations (HMOs) annual notice of proposed changes in the methodology used or assumptions made in calculating payment rates for each class of HMO enrollee. Modifies the requirement that HMOs in an area have a coordinated annual open enrollment period to require such coordination only if the Medicare contract of one HMO in the area is not renewed or is terminated, or reduces its service area in a way which discontinues coverage for Medicare enrollees in part of the area.

Amends the Omnibus Budget Reconciliation Act of 1986 to delay, from April 1, 1990, to April 1, 1991, the effective date of the provision subjecting an HMO to civil penalties if it makes a payment to a physician to reduce or limit services provided to Medicare or Medicaid beneficiaries. Amends the Omnibus Budget Reconciliation Act of 1987 to extend the prohibition on the Secretary's issuing cost-saving policies before the beginning of a fiscal year through October 15, 1990.

Subpart B: Technical and Miscellaneous Provisions - Sets forth hospital responsibilities with respect to the treatment or transfer of individuals having emergency medical conditions. Imposes penalties against physicians who engage in specified acts related to the examination, treatment, or transfer of individuals with emergency medical conditions.

Amends the Omnibus Budget Reconciliation Act of 1986 to extend, through 1993, the application of a waiver of the Medicare requirement that HMOs must have an enrolled population of which not more than 50 percent are Medicare or Medicaid (title XIX of the Social Security Act) beneficiaries to HMOs which had a pre-existing waiver of such requirement and received specified grants in FY 1987. Amends the Medicare program to limit physician charges for emergency services or out-of-area coverage provided to an HMO enrollee by a person who is not under contract with such HMO. Amends the Deficit Reduction Act of 1984 to make the authority for HMO benefit stabilization funds permanent.

Amends the Medicare program to require rural health clinics to have a nurse practitioner, physician assistant, or certified nurse-midwife available to furnish patient care at least 50 percent of the time the clinic operates. Covers social worker services furnished to outpatients of rural health clinics. Expands the area within which rural health clinics may be located. Requires the dissemination of rural health clinic application information and materials. Prohibits the Secretary from denying the certification of a facility as a rural health clinic if such facility is located on an island and would meet certification requirements but for the requirement that physician assistant or nurse practitioner services be provided in the facility. Expands the functions of the Office of Rural Health Policy.

Alters the home health claims denial process.

Extends the Secretary's authority to contract with fiscal intermediaries and carriers on other than a cost basis.

Amends of the Omnibus Budget Reconciliation Act of 1987 to expand a rural health medical education demonstration project.

Establishes a triage demonstration project in a public hospital located in a large urban area.

Directs the Comptroller General to conduct a study of the administrative burden of Medicare regulations and program requirements on providers, fiscal intermediaries, and carriers.

Gives the Secretary guidelines to consider in distributing remaining payment amounts to end stage renal disease network organizations after covering their administrative costs. Makes liability limitations and information disclosure prohibitions established under part B (Peer Review) of title IX of the Social Security Act applicable to network organizations. Directs the Secretary to report to the Congress, by April 1, 1990, on the methodology and rationale used to establish a Medicare payment rate for the drug erythropoietin.

Amends the Medicare Catastrophic Coverage Act of 1988 and part A (General Provisions) of title XI of the Social Security Act to make miscellaneous amendments affecting the United States Bipartisan Commission on Comprehensive Health Care and the National Commission on Children.

Continues the use of the home health wage index in effect prior to July 1, 1989, until July 1, 1990.

Directs the Secretary to conduct a study regarding staffing at the Health Care Financing Administration.

Amends part B (Peer Review) of title XI of the Social Security Act to require Peer Review Organizations (PROs) which review of non-physician services to include practitioners of such services within their review body. Requires PROs to give providers whose services are denied Medicare coverage an opportunity for reconsideration of the determination before patients or organizations responsible for paying claims are notified of such determination.

Part 4: Part B Premium - Amends part B (Supplementary Medical Insurance) of the Medicare program to extend the basic part B premium through 1990.

Subtitle B: Medicaid - Part 1: General Provisions - Amends title XIX (Medicaid) of the Social Security Act to require States to provide Medicaid coverage of children between the ages of one and five, inclusive, whose family income does not exceed 133 percent of the Federal poverty level. Gives States the option of extending such coverage to children who are age seven or eight.

Requires that States submit to the Secretary, by April 1 of each year, proposed Medicaid payment rates for obstetrical and pediatric services and such other data as will assist the Secretary in determining whether such rates are sufficient to ensure that obstetrical and pediatric services will be at least as available to Medicaid beneficiaries as they are to the general population. Requires States to immediately revise rates determined to be insufficient.

Requires States to cover ambulatory services offered to pregnant women or children by certain federally-funded health centers.

Sets forth the required components of Medicaid early and periodic screening, diagnostic, and treatment services. Requires Medicaid coverage of the measures which need to be taken to correct or ameliorate defects or conditions discovered by the screening services. Requires States to report annually to the Secretary concerning the number of children receiving such services. Directs the Secretary to establish annual participation goals for each State to increase participation in Medicaid early and periodic screening and diagnostic services.

Requires States to provide Medicaid coverage of the services provided by health centers which provide the services rural health clinics are authorized to provide and meet the requirements for receiving a grant under the Public Health Service Act.

Requires States to provide Medicaid coverage of services furnished by certified pediatric or family nurse practitioners.

Requires States to: (1) coordinate Medicaid services with the special supplemental food program for women, infants, and children (WIC) under the Child Nutrition Act of 1966; and (2) notify Medicaid - eligible pregnant, breastfeeding, or postpartum women and children under age five of WIC program benefits.

Directs the Secretary to conduct three-year demonstration projects in several States to study the effect on access to health care, private insurance coverage, and health care costs of allowing States to extend Medicaid benefits to pregnant women and children under age 20 who are not eligible for Medicaid benefits but whose income does not exceed 185 percent of the Federal poverty level. Imposes premiums on project beneficiaries whose family income exceeds the Federal poverty level. Caps project expenditures. Sets forth reporting requirements.

Requires the Secretary to report to the Congress by October 1, 1990, on modifications in Medicaid coverage of mental health services that may be appropriate to accommodate to any changes which may have occurred in the delivery of inpatient mental health services since 1972 and on the continued Medicaid coverage of subacute psychiatric facility services. Places a moratorium on the consideration of two specified hospitals in Michigan as mental institutions for Medicaid purposes until 180 days after the submission of such report.

Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to extend from January 1, 1990, to July 1, 1990, waivers for the demonstration project, "Modification of the Texas System of Care for the Elderly: Alternatives to the Institutionalized Aged."

Sets a floor on Medicaid payments for hospice care.

Covers Medicare cost-sharing amounts for disabled individuals who are entitled to enroll for Medicare hospital insurance benefits and whose income and resources do not exceed 200 percent of the Federal poverty level and twice the SSI resource eligibility limit, respectively. Permits States to impose a Medicaid premium on such individuals pursuant to a sliding scale which increases from 1 to 100 percent of the cost-sharing amounts as incomes move from 150 to 200 percent of the Federal poverty level.

Part 2: Technical and Miscellaneous Provisions - Makes miscellaneous technical amendments to the Medicaid program.

Subtitle C: Maternal and Child Health Block Grant Program - Amends title V (Maternal and Child Health Services) of the Social Security Act to increase authorized appropriations under the title. Adds to the purposes to which title V funds shall be devoted: (1) the promotion and provision of family-centered, community-based, coordinated care for children with special health care needs; (2) screening of newborns for sickle cell anemia, and other genetic disorders and follow-up services; (3) projects to increase the participation of obstetricians and pediatricians under the title V program; and (4) outpatient and community-based services programs for children with special health care needs provided primarily through inpatient institutional care. Changes the formula for determining the amount to be set aside for specified title V purposes.

Authorizes States to use block grant funds to pay the salaries of National Health Service Corps personnel. Prohibits States from using more than ten percent of block grant funds for administering such funds. Requires that a State apply for an allocation of title V funds, and that the application include a needs assessment and a plan for meeting those needs. Requires States to use at least: (1) 30 percent of such funds for preventive and primary care for children; and (2) 30 percent of such funds on children with special health care needs. Permits a waiver of such requirement if a State demonstrates an extraordinary unmet need for one of the activities. Requires State agencies administering a State's title V program to: (1) provide for a toll-free telephone number for parents to access information about health care providers and practitioners who provide services under titles V and XIX; and (2) assist individuals who are eligible for assistance under title XIX (Medicaid) of the Social Security Act in applying for Medicaid benefits. Requires title V providers to provide Medicaid services.

Imposes maternal and child health reporting requirements on States and the Secretary of Health and Human Services.

Provides States with: (1) Federal technical assistance in developing consistent and accurate maternal and child health data collection mechanisms; (2) assistance in the development of care coordination services; and (3) national directory listing by State of the toll-free telephone numbers mandated by this Act.

Directs the Secretary to develop: (1) a model application form for use in applying, simultaneously, for assistance for a pregnant woman or a child under age six under specified maternal and child assistance programs; (2) a model application form for use by certain individuals in applying for benefits under title XIX (Medicaid) of the Social Security Act; and (3) a national system for linking an infant's birth record, such infant's death record, and information on Medicaid claims submitted with respect to such infant or his or her birth.

Authorizes the Secretary of Health and Human Services to conduct not more than four demonstration projects to provide health insurance to medically uninsurable children under the age of 19.

Sets forth various plan requirements, including: (1) that the plan be school based; (2) non-Federal funding in specified percentages; (3) that premiums, if any, be varied by the income of the individual; and (4) evaluation and reporting requirements.

Authorizes appropriations for FY 1991 through 1993.

Directs the Secretary to develop, publish, and make available a maternal and child health handbook. Authorizes appropriations for FY 1991 through 1993.

Subtitle D: Vaccine Compensation Technicals - Amends title XXI (Vaccines) of the Public Health Service Act to direct the Secretary to inform the public of the availability of the National Vaccine Injury Compensation Program. Makes miscellaneous changes affecting the procedures to be followed and compensation available under the Program. Grants the U.S. Claims Court and the U.S. Claims Court special masters (currently, the U.S. Claims Court) jurisdiction over proceedings to determine entitlement to compensation under the Program.

Establishes within the U.S. Claims Court an office of special masters. Provides for the appointment, removal, terms of office, compensation and functioning of the special masters, and for the responsibilities of the chief special master.

Requires the Claims Court to promulgate rules providing for: (1) a less-adversarial, expeditious, and informal proceeding; (2) flexible and informal admissibility standards; (3) summary judgment; (4) the opportunity to submit arguments and evidence on the record without routine use of oral presentations, cross examinations, or hearings; and (5) limitations on discovery and allowing the special masters to replace the usual rules of discovery in civil actions in the Claims Court.

Provides for the responsibility and authority of the special masters. Prohibits discovery other than that required by the special master.

Provides for the disclosure and protection from disclosure of certain types of information involved in a proceeding.

Allows payment of compensation under the Program to be used as ordered by the special master to purchase an annuity or otherwise used, with the consent of the petitioner, as determined by the special master to be in the best interests of the petitioner. Requires that payment of compensation for damages associated with the administration of a vaccine before the effective date of specified provisions be determined on the basis of the net present value of the elements of compensation and paid as ordered by the master or, with consent, as determined to be in the petitioner's best interests.

Prohibits payments from the Program for any item or service covered by a State health benefits program other than title XIX (Medicaid) of the Social Security Act (currently, by any State health benefits program).

Authorizes appropriations through FY 1993 for payment of compensation under the Program.

Extends from 365 to 420 days the time period after which, if the Claims Court has not entered a judgment, the petitioner may withdraw the petition and file a civil action.

Requires that the legal representatives of children receiving vaccines be provided with a summary of relevant Federal recommendations concerning a complete schedule of childhood immunizations and the availability of the Program.

Directs the Secretary to establish a task force on safer childhood vaccines to prepare recommendations to the Secretary on the implementation of provisions directing the Secretary to promote the development of safer childhood vaccines.

Authorizes appropriations for the administration of the National Vaccine Injury Compensation Program for FY 1990 and 1991. Directs the Secretary to conduct a study and report to the Congress by January 1, 1992, concerning such Program.

Requires the Comptroller General to conduct a study regarding the loss by retirees of health benefits due to the liquidation of their employer in bankruptcy.

Declares that, if any amendment made by this subtitle is held unconstitutional, title XXI (Vaccines) of the Public Health Service Act without that amendment shall continue in effect. (Current law invalidates all of title XXI if any part of it is held unconstitutional.)

Subtitle E: Provisions with respect to COBRA Continuation Coverage - Part 1: Extension of Coverage for Disabled Employees - Amends the Internal Revenue Code with respect to excise taxes on group health plans to require that continuation of coverage under a plan be offered to a disabled beneficiary of a qualified pension plan at the time of termination of employment.

Amends the Public Health Service Act to extend the maximum required period of continuation coverage of group health plans from 18 months to 29 months for an individual determined, under title II (Old Age, Survivors and Disability Insurance) or title XVI (Supplemental Security Income) of the Social Security Act, to have been disabled at the time of termination or reduction in hours. Makes the extension contingent on the beneficiary's notifying the plan administrator of the determination.

Terminates extended coverage in the month following a final determination that the beneficiary is no longer disabled.

Allows increased premiums, to a specified limit, during the period of extended coverage.

Requires a recipient who is determined to have been disabled at the time of termination or reduction in hours to notify the plan administrator: (1) within 60 days of that determination; and (2) within 30 days of any final determination that the beneficiary is no longer disabled.

Amends the Employee Retirement Income Security Act of 1974 to extend from 18 to 29 months the continuation of certain health insurance coverage to be offered to those with a disability at the time of termination of employment, if they notify the plan administrator of such disability determination before the end of the 18-month period. Allows increased premiums, to a specified limit, during the period of extended coverage.

Part 2: Miscellaneous Amendments - Amends the Public Health Service Act to remove provisions specifying which rules apply, with regard to continuation coverage, to State and local governmental group health plans.

Provides that continuation coverage for qualified beneficiaries other than the covered employee shall not terminate before 36 months after the covered employee becomes entitled to benefits under title XVIII (Medicare) of the Social Security Act.

Specifies that "continuation coverage" means coverage in which, in addition to other requirements, becoming covered under any other group health plan terminates coverage only if the new coverage does not contain any preexisting condition exclusion or limitation. (Current law makes no reference to preexisting conditions.)

Prohibits a plan from requiring premium payment before 45 days after the initial election for continuation coverage. (Current law requires a plan to permit payment within 45 days of the date of the election.)

Modifies the definition of "covered employee" to mean a person, including a self-employed individual, covered under a plan because of the performance of services for one or more persons maintaining the plan.

Subtitle F: Technical and Miscellaneous Provisions Relating to Nursing Home Reform - Makes miscellaneous amendments to Medicaid and Medicare requirements imposed on nursing facilities by the Omnibus Budget Reconciliation Act of 1987.

Subtitle G: Public Health Service Act - Sets forth a cross reference to a specified section of this Act which establishes the Agency for Health Care Policy and Research.

Title VII: Revenue Measures - Revenue Reconciliation Act of 1989 - Subtitle A: Extension of Expiring Tax Provisions - Amends the Internal Revenue Code to extend the tax exclusion for educational assistance programs for three years. Provides a tax exclusion for otherwise taxable employer-provided educational assistance that qualifies as a working condition fringe.

Provides extensions for the following: (1) targeted jobs credit; (2) mortgage revenue bonds exemption; (3) qualified small issue bond exemption; (4) energy investment credit for geothermal property; (5) deduction for health insurance costs of self-employed individuals; (6) employer-provided group legal services; and (7) exclusion for amounts received under qualified; group legal services plans.

Extends and modifies the low-income housing credit.

Exempts the low-income housing credit and rehabilitation credit from the income phaseout of the exemption from passive loss rules.

Makes permanent the credit for increasing research activities and makes changes in the computation of the incremental credit. Provides that the trade or business requirement is disregarded in the case of in-house research expenses of certain start-up ventures. Disallows a deduction for qualified research expenses which is equal to the credit for increasing research activities. Requires the deduction for research and experimental expenditures to be reasonable amounts.

Provides for the allocation of research and experimental expenditures with respect to sources of income within and without the United States.

Subtitle B: Corporate Provisions - Limits the use of group losses to offset the income of a subsidiary paying preferred dividends.

Provides for the treatment of: (1) certain original issue discount obligations as preferred stock; and (2) certain transfers to controlled corporations.

Increases the percentage of the required distribution of ordinary income of regulated investment companies in the computation of the excise tax on the undistributed income of such companies. Provides for the treatment of certain mutual fund sales charges and dividends with respect to taxation of such companies and their shareholders.

Provides a limitation on the threshold requirement for certain built-in gains and losses.

Requires distributions on disqualified preferred stock to be treated as extraordinary dividends.

Prohibits any reduction in gross income by reason of an excess loss account if such reduction is on account of a reduction in the basis of indebtedness.

Provides for the treatment of stock and debt concerning: (1) regulatory authority over the treatment of stock or indebtedness; and (2) reporting of certain acquisitions or recapitalizations.

Requires S corporations to make estimated tax payments for certain taxes.

Limits the deduction for certain interest paid by a corporation to a related person.

Places limitations on refunds due to net operating loss carrybacks or excess interest allocable to corporate equity reduction transactions.

Subtitle C: Employee Benefit Provisions - Part I: Employee Stock Ownership Plans - Provides limitations on partial exclusion of interest on loans used to acquire employer securities. Requires that employer security loans be held only by qualified lenders.

Requires employee stock ownership plans to file certain information reports.

Places limitations on deductions for dividends paid on employer securities.

Requires a three-year holding period before nonrecognition of gain is applicable on the sale of stock to employee stock ownership plans or certain cooperatives.

Repeals: (1) the estate tax deduction relating to the sale of employer securities to employee stock ownership plans or worker-owned corporations; and (2) the liability for payment of estate tax in the case of transfer of employer securities.

Revises limitations on employee stock ownership plans as they affect allocations to highly compensated employees.

Repeals special rules relating to net operating losses as they affect employee stock ownership plans.

Part II: Section 401 (H) Accounts - Limits contributions to retirement plans for medical benefits.

Subtitle D: Foreign Provisions - Provides for determining the taxable year of a controlled foreign corporation or a foreign personal holding company. Sets forth the deadline for paying dividends after the close of a taxable year in order to be considered as paid during such taxable year. Provides a limitation on the use of deconsolidation to avoid foreign tax credit limitations. Makes reporting requirements for foreign-owned corporations applicable to corporations that are 25-percent foreign-owned. Sets forth U.S. recordkeeping requirements for such corporations and establishes penalties for failure to furnish information or maintain records.

Amends the Tax Reform Act of 1986 regarding the foreign tax credit to repeal the transitional rule for the special treatment of high withholding tax interest on certain foreign loans.

Subtitle E: Excise Tax Provisions - Amends the Internal Revenue Code to provide a one-year suspension of certain automatic reductions in aviation-related taxes.

Specifies the schedule for the deposit of taxes on airline tickets.

Increases the international air passenger departure tax and establishes a ship passengers international departure tax.

Provides for the Oil Spill Liability Trust Fund tax to take effect on January 1, 1990.

Establishes an excise tax on the sale of chemicals which deplete the ozone layer and of products containing such chemicals.

Specifies the schedule for the deposit of gasoline excise taxes.

Provides for the taxation of bulk cigar imports.

Subtitle F: Miscellaneous Provisions - Part I: Limitation on Nonrecognition for Certain Exchanges - Sets forth limitations on the nonrecognition of gain or loss on the exchange of property with respect special rules for exchanges between related persons, where there is substantial diminution of risk, and for foreign real property.

Part II: Minimum Tax Provisions - Removes the book limitations applicable to depreciation of property placed in service after 1989 when determining alternative minimum taxable income.

Makes modifications to: (1) the corporate minimum tax credit; (2) the orphan drug credit; (3) certain home construction contracts; (4) certain research and experimental expenditures; and (5) the 90-percent limitation on foreign tax credit.

Directs the Secretary of the Treasury to study the proper class life for cars and light trucks.

Part III: Accounting Provisions - Requires that the percentage of completion method be used in determining the taxable income under any long-term contract.

Limits the deductibility of contingent payments in transfers of franchises, trademarks, and trade names.

Part IV: Employment Tax Provisions - Requires income tax withholding for certain agricultural employees.

Specifies the schedule and minimum amounts for the deposit of social security taxes and withheld income taxes.

Part V: Other Provisions - Limits the tax exclusion for compensation for personal injuries or sickness to cases involving physical injury or physical sickness.

Requires the recognition of gain or loss by any partner that contributes property to a partnership if the property is distributed by the partnership to other than the contributing partner.

Allows a depreciation deduction for the business use of cellular telephones or other similar telecommunications equipment.

Eliminates the retroactive certification of employees for the work incentive jobs credit.

Disallows a depreciation deduction for any term interest in property for any period during which the remainder interest in such property is held by a related person.

Requires a trade or business to report the amount of points received on mortgage loans and whether such points were paid by the borrower.

Modifies the computational rules with respect to life insurance contracts with more than one insured.

Part VI: Tax-Exempt Bond Provisions - Subjects to arbitrage rebate requirements certain tax-exempt bonds (hedge bonds) when certain percentages of the net proceeds are not spent by the end of each of five years from the date of issuance.

Provides exceptions from such requirements.

Subtitle G: Revision of Civil Penalties - Improved Penalty Administration and Compliance Tax Act - Part I: Document and Information Return Penalties - Revises penalty provisions in connection with tax return administration. Imposes a uniform penalty of $50 per offense to a maximum of $250,000 per year on any person who fails to: (1) file timely and correct information returns; (2) furnish correct payee statements; or (3) comply with other information reporting requirements. Reduces penalties if corrections are made within a specified time period. Allows exceptions for de minimus failures.

Lowers the limitations for persons with gross receipts of less than $5,000,000. Increases penalties and removes the annual penalty ceiling in cases of intentional disregard of filing requirements.

Revises requirements governing regulations prescribed by the Secretary of the Treasury in connection with returns that must be filed on magnetic media or in other machine-readable form.

Directs the Comptroller General to study and report to specified congressional committees concerning: (1) ways to resolve discrepancies between taxpayer identity information shown on information returns and that in Internal Revenue Service (IRS) records; and (2) whether persons in the business of transmitting information returns and other documents to the IRS on behalf of others should be subject to registration.

Part II: Revision of Accuracy-Related Penalties - Replaces current law governing additions to tax and other additional amounts with respect to tax administration violations with provisions that impose a 20 percent penalty in the form of additional tax in connection with underpayments attributable to at least one of the following: (1) negligence or disregard of relevant rules; (2) any substantial understatement of income tax; (3) any substantial valuation overstatement in connection with income tax; (4) any substantial overstatement of pension liabilities; or (5) any substantial estate or gift tax valuation understatement. Increases the penalty to 40 percent in cases of gross valuation misstatements.

Imposes: (1) a 75 percent penalty in the form of additional tax with respect to any underpayment attributable to fraud; and (2) a 50 percent penalty in connection with underpayments of or failure to pay any stamp tax.

Part III: Preparer, Promoter, and Protester Penalties - Revises provisions governing damages assessable for offenses related to Tax Court litigation to: (1) grant the Tax Court discretion in requiring a taxpayer to pay the United States a penalty (current law requires the penalty); (2) increase the amount of the permissible penalty from a $5,000 to a $25,000 maximum; (3) authorize the Tax Court to impose a penalty upon any attorney who unreasonably multiplies the proceedings in question. Authorizes similar sanctions in cases brought before other courts.

Modifies penalty provisions associated with understatements of taxpayer liability by income tax return preparers to: (1) increase penalty amounts; and (2) institute penalties for understatements due to unrealistic positions or reckless or intentional disregard of tax laws.

Increases from $25 to $50 (to an annual maximum of $25,000) the penalty imposed on income tax return preparers who fail to furnish copies to taxpayers, sign returns, or furnish identifying numbers.

Modifies penalties imposed on tax preparers who fail to file correct information returns.

Increases the possible penalty imposed on persons who promote abusive tax shelters.

Broadens the scope of persons subject to penalties for aiding and abetting understatements of tax liability.

Increases from $500 to $1,000 the penalty for filing a frivolous income tax return.

Repeals a provision prohibiting injunctions against any income tax return preparer who files a surety bond.

Requires that regulations governing disclosure or use of information by tax return preparers permit disclosures for quality or peer reviews.

Part IV: Failures to File or Pay - Increases penalties imposed on persons whose failure to file any return is fraudulent or intentional.

Revises penalty provisions in connection with failures to make deposits of taxes, varying the penalty rate as a function of the time involved in the deposit delay.

Declares that a taxpayer who belatedly pays a tax that should have been deducted and withheld is still liable for interest or applicable penalties or additions.

Subtitle H: Technical Corrections - Part I: Amendments Related to Technical and Miscellaneous Revenue Act of 1988 - Makes technical corrections with respect to: (1) corporate tax; (2) minimum tax; (3) accounting methods; (4) foreign tax; (5) estate and gift tax; (6) generation-skipping transfer tax; (7) estimated taxes of trusts and estates; (8) insurance; (9) pensions; (10) excise tax on undenatured distilled spirits; (11) tax-exempt bonds; (12) research tax credit; and (13) low-income housing tax credit.

Part II: Amendments Related to Revenue Act of 1987 - Revises: (1) accounting provisions concerning installment sales, the election of taxable years other than required taxable year, corporate earnings and profit adjustments, and treatment of foreign insurance; (2) provisions relating to excise taxes on diesel fuel and aviation fuel; and (3) enforcement authority in the case of flagrant political expenditures.

Part III: Amendments Related to Tax Reform Act of 1986 - Revises provisions with respect to: (1) modification of the accelerated cost recovery system; (2) low-income housing credit; (3) capitalization and inclusion in inventory costs of certain expenses; and (4) transitional rules on the application of future legislation to transitioned bonds.

Part IV: Miscellaneous Changes - Makes technical amendments to provisions related to transfers incident to divorce or separation and to the special rules for simplified employee pensions.

Part V: Amendments Related to Pension Provisions - Revises certain pension and employee benefit provisions of, or relating to, the Tax Reform Act of 1986 (Reform Act), the Employee Retirement Income Security Act of 1974 (ERISA), the Internal Revenue Code (IRC), the Technical and Miscellaneous Revenue Act of 1988, the Omnibus Budget Reconciliation Act of 1986, the Omnibus Budget Reconciliation Act of 1987, including the Pension Protection Act, the Single-Employer Pension Plan Amendments Act of 1986, and the Retirement Equity Act of 1984.

Subpart A: Amendments Related to Tax Reform Act of 1986 - Amends the Reform Act, ERISA, and the IRC (as amended by the Technical and Miscellaneous Revenue Act of 1988) to revise pension-related provisions.

Revises minimum vesting requirements to provide a special vesting rule by which the repeal of class-year vesting does not adversely affect the vesting status of certain plan participants. Applies such exemption rule to any employee for whom such a plan amendment eliminating class-year vesting would reduce a nonforfeitable right and who has an hour of service: (1) before the adoption of such plan amendment; and (2) on or after the first day of the first plan year for which the repeal of class-year vesting would be applicable. Limits such exemption rule to those employees who have not incurred a five-year break in service immediately before the hour of service after the plan amendment is applicable. Provides that compliance with this special vesting rule shall not be considered a violation of the minimum participation rule.

Allows the assets of a qualified pension plan in excess of its liabilities to be transferred to a welfare benefit plan upon the pension plan's termination if such assets are to be used to provide retiree benefits, and if: (1) both such plans are jointly administered pursuant to a collective bargaining agreement; (2) the welfare benefit plan provides retiree health benefits; and (3) the pension plan has assets in excess of liabilities (determined on a termination basis) and the welfare benefit plan has assets which are less than the value of the benefits to be provided under the plan (determined as of the time of termination of the pension plan). Treats any such transfer of assets, for IRC purposes, as a reversion of assets to the employer maintaining the plan, which is includible in gross income and subject to specified provisions.

Amends the Retirement Equity Act of 1984 (as well as the Reform Act and ERISA) to revise plan amendment deadlines.

Amends ERISA, the IRC, the Reform Act, and the Technical and Miscellaneous Revenue Act of 1988 to revise continuation coverage requirements for group health plans. Provides that if a covered employee has a qualifying event that results in 18 months of continuation coverage and such covered employee becomes entitled to Medicare before the 18 months expires, then a qualified beneficiary other than the covered employee is entitled to continuation coverage for a total of 36 months after the original qualifying event. Provides for termination of continuation coverage in the case of preexisting condition.

Subpart B: Amendments Related to the Omnibus Budget Reconciliation Act of 1986 - Amends IRC and ERISA, as if such amendments were included under the Omnibus Budget Reconciliation Act of 1986, to revise the definition of normal retirement age for purposes of minimum vesting standards for plans.

Makes technical amendments to the IRC and ERISA, including a repeal of the 133-1/3 percent rule relating to accrued benefit requirements applied to defined benefit pension plans.

Subpart C: Amendments Related to Pension Protection Act - Amends ERISA, IRC, and the Pension Protection Act (which is included under the Omnibus Budget Reconciliation Act of 1987) to revise provisions relating to: (1) the full limitation for multiemployer pension plans; (2) modification of the minimum funding standard for pension plans, including a special transition rule with respect to steel employees; (3) the time for making plan contributions; (4) funding waivers; (5) the interest rate to be used in connection with various plan funding rules; (6) plan terminations; and (7) reporting requirements. Provides that a specified change in the amortization period for experience gains and losses applies to gains and losses beginning after December 31, 1987. Sets forth a special transition rule for any experience gain or loss determined by a valuation occurring as of January 1, 1988.

Subpart D: Additional Pension Provisions - Makes various technical amendments to ERISA, the Reform Act, the IRC, and the Technical and Miscellaneous Revenue Act of 1988. Provides for alternative means of compliance with specified requirements for notification of multiemployer plans by employers. Provides for optional extensions of required periods of continuation coverage by group health plans.

Makes other technical amendments to ERISA as if they were included the Single-Employer Pension Plan Amendments Act of 1986 or the Multiemployer Pension Plan Amendments Act of 1980.

Title VIII: Human Resource and Income Security Provisions - Amends part E (Foster Care and Adoption Assistance) of title IV of the Social Security Act to extend through FY 1992 the authority of States to use foster care funds to cover expenditures under part B (Child Welfare Services) of title IV of the Social Security Act.

Extends, through FY 1992, Federal funding for State programs to assist children who have attained age 16 in making the transition from foster care to independent living (Independent Living Initiatives Program). Increases payments to States for such programs. Directs the Secretary of Health and Human Services to report to the Congress on the effectiveness of such programs.

Amends the Child Support Enforcement Amendments of 1984 to permanently extend the provision continuing a family's Medicaid (title XIX of the Social Security Act) eligibility if such family loses eligibility under part A (Aid to Families with Dependent Children) (AFDC) of title IV of the Social Security Act) due to the collection or increased collection of child support under part D (Child Support and Establishment of Paternity) of title IV of the Social Security Act.

Amends the AFDC program to establish a new AFDC quality control system which imposes penalties on States on the basis of a sliding scale which reflects the degree to which a State's AFDC error rate exceeds the national average. Takes into account erroneous payments and underpayments in determining such error rates. Establishes a Quality Control Review Panel for the resolution of quality control review cases that are in dispute between States and the Federal government. Directs the Secretary to conduct a study and report to the Congress on negative AFDC case actions.

Prohibits the Secretary from implementing specified proposed regulations concerning the use of AFDC emergency assistance. Permits the issuance of a revised proposed regulation on such subject incorporating certain recommendations submitted by the Secretary to the Congress on July 3, 1989. Prohibits the Secretary from establishing an effective date occurring before October 1, 1990, for any fiscal regulations changing current policy regarding the use of emergency assistance or special needs funds under the AFDC program. Requires States to report, on a quarterly basis, any AFDC emergency assistance and special needs funds spent by the State to house welfare recipients in temporary living arrangements.

Amends the Foster Care and Adoption Assistance program to cover, through FY 1992, 75 percent of the costs for the short-term training of current or prospective foster or adoptive parents and the staff of licensed child-care institutions.

Requires that the written case plan developed for each foster care child include specified health and education records which are to be reviewed and updated when the child is placed in foster care and to be supplied to the foster care parent or provider.

Amends title XVI (Supplemental Security Income) (SSI) of the Social Security Act to require the Secretary to conduct an ongoing outreach program for children who are potentially eligible for SSI benefits by reason of disability or blindness.

Makes the U.S. residency requirement for SSI eligibility inapplicable to a disabled child who resides with a parent who is serving overseas with the U.S. armed forces if such child was an SSI recipient prior to such parent's overseas assignment.

Excludes parental income and resources from the determination of a disabled child's SSI eligibility if such child was receiving SSI benefits and Medicaid home care plan benefits while in a hospital, extended care, nursing, or intermediate care facility. Specifies the SSI benefit rate to which such children are entitled.

Excludes the value of domestic commercial transportation tickets received as gifts and not converted to cash from income for SSI purposes.

Treats a married couple as separate individuals for SSI eligibility and benefit determination purposes beginning with the first month following their month of separation.

Excludes interest accrued on the value of the purchase of a burial space from the buyer's income and resources for SSI purposes.

Excludes all work-related equipment from resources in SSI eligibility and benefit determinations.

Authorizes Minnesota to conduct a demonstration project to determine whether the State family investment plan helps families to become self-supporting and enhances the ability of families to care for their children more effectively than does the AFDC program. Sets forth project requirements, including the requirement that family assistance under such project be no less than the family would have received under the AFDC and Food Stamp programs. Pays Minnesota the amount it would have been paid under the AFDC program in the absence of such project plus 50 percent of its expenses in evaluating the project.

Amends title XX (Block Grants to States for Social Services) of the Social Security Act to increase the amount authorized for such program in FY 1990 and thereafter.

Title IX: Offshore Oil Pollution Compensation Fund - Amends the Outer Continental Shelf Lands Act Amendments of 1978 to require a fee of three cents (currently, not to exceed such amount) on each barrel of oil from the Outer Continental Shelf.

Requires the Offshore Oil Pollution Compensation Fund to be maintained at a specified level.

Title X: Miscellaneous and Technical Social Security Act Amendments - Miscellaneous and Technical Social Security Act Amendments of 1989 - Subtitle A: Time-Sensitive Provisions - Amends title II (Old Age, Survivors and Disability Insurance) (OASDI) of the Social Security Act to extend the continued provision of disability benefits during appeal through June 1991.

Amends the Railroad Retirement Solvency Act of 1983 to transfer increases in FY 1990 railroad retirement tax liabilities to the Railroad Retirement Account.

Amends the Social Security Disability Amendments of 1980 to extend the authority for disability insurance demonstration projects through 1992.

Subtitle B: Technical Provisions - Amends the Internal Revenue Code to make agreements to provide OASDI coverage of U.S. citizens and residents employed abroad by a foreign affiliate of an American employer effective until the foreign entity ceases to be a foreign affiliate. Excludes refunds required to be paid to employees by employers who have duplicated Medicare (title XVIII of the Social Security Act) coverage in their employee benefit package from consideration as wages or compensation for OASDI or taxation purposes.

Amends the OASDI program to eliminate carryover reductions in retirement or disability benefits due to the receipt of widow's or widower's benefits before age 62.

Amends the Internal Revenue Code to exempt certain church employees from the self-employment tax if their services are exempt from the employment tax on wages. Clarifies the inclusion of partnerships among employers eligible for religious exemption from employment taxes.

Subjects to railroad retirement taxes: (1) payments for group-term life insurance which is includable in the employee's gross income as compensation; and (2) certain deferred compensation. Excludes the value of meals or lodging from railroad retirement taxes if at the time of such furnishing it was unreasonable to believe that the employee could exclude such items from income.

Includes deferred compensation in wages for OASDI purposes.

Subtitle C: Additional Amendments - Makes individuals who attained age 18 prior to being adopted by parents who were already entitled to old-age or disability insurance benefits eligible for child's insurance benefits if they lived with or were dependent upon such parents for the year preceding their adoption.

Deems an individual who failed to apply for OASDI or SSI (title XVI) (Supplemental Security Income) of the Social Security Act) benefits due to misinformation presented by an officer or employee of the Social Security Administration (SSA) to have applied for such benefits on the later of the date such information was provided to such individual or the date such individual met all eligibility requirements for such benefits.

Guarantees that individuals whose visit to an SSA Office is occasioned by their receipt of a notice requiring a timely response or their loss or nonreceipt of OASDI or SSI benefits will be seen for an interview that same day.

Restricts the Secretary of Health and Human Services' authority to amend wage records after the expiration of the time limit for such amendments.

Requires the Secretary to take into account an OASDI or SSI beneficiary's physical, mental, educational or linguistic limitations in specified situations when deciding whether his or her action or omission should result in the discontinuance of benefits or forfeiture of payments.

Provides that individuals who are applying for or receiving OASDI benefits on the basis of blindness may elect to receive notice of decisions made and actions taken with respect to their rights under the program: (1) by certified mail and by telephone five days after such mailing; or (2) by some alternative procedure established by the Secretary.

Requires the Secretary to: (1) maintain the names of representatives of OASDI and SSI claimants in the SSA's electronic information retrieval system; and (2) provide written notice to such claimants of the availability of attorneys to represent them in presenting their cases before the Secretary.

Amends part A (General Provisions) of title XI of the Social Security Act to require the Secretary to provide, upon request, beginning by October 1, 1990, a social security account statement to individuals who have a social security number, have wages or self-employment earnings, and have attained age 25 (hereinafter referred to as "eligible individuals"). Directs the Secretary to assure that eligible individuals are informed of the availability of the statement. Makes the provision of such statement to each eligible individual who attains age 60 and is not receiving benefits under title II (Old Age, Survivors and Disability Insurance) (OASDI) of the Act mandatory from FY 1995 through 1999, if his or her mailing address can be determined. Requires the provision of such statement biennially by FY 2000 to each eligible individual who is not receiving OASDI benefits and for whom a mailing address can be determined.

Subtitle D: Human Resource and Income Security Provisions - Amends part B (Child Welfare Services) of title IV of the Social Security Act to increase authorized appropriations under such part.

Amends part E (Foster Care and Adoption Assistance) of title IV of the Social Security Act to extend through FY 1992: (1) the ceiling on Federal payments to States for foster care expenditures; and (2) the authority for States to use such payments to cover expenditures under the Child Welfare Services program. Increases the appropriations level which triggers the foster care ceiling.

Makes miscellaneous technical corrections to the Family Support Act of 1988, the Tax Reform Act of 1986, and the Social Security Act.

Provides for the conduct of demonstration projects in up to ten communities to determine the extent to which the use of volunteer senior aides in the provision of basic medical assistance and support to families with disabled or chronically ill children reduces the cost of caring for such children.

Excludes Agent Orange settlement payments from income or resources in determining eligibility for benefits under certain Federal or federally assisted programs.

Prohibits the Secretary from penalizing States under part B or E of title IV of the Social Security Act before FY 1991 by reason of a determination made in connection with any triennial review of State compliance with foster care protections.

Title XI: Miscellaneous - Declares that any transfer of outlays, receipts, or revenues from one fiscal year to an adjacent fiscal year that occurs pursuant to this Act shall be considered a necessary (but secondary) result of a significant policy change as provided under the Balanced Budget and Emergency Deficit Control Reaffirmation Act of 1987 (thus allowing such transfer to be treated as altering the deficit or producing a net deficit reduction).

Rescinds the President's order for sequestration of October 16, 1989. Provides for the President to issue a new order with adjusted reductions. Requires a compliance report to the Congress by the Comptroller General with regard to a new final order of the President's. Prohibits any double reduction in Medicare.