AMENDMENTS
(House of Representatives - March 26, 1996)

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[Pages H2867-H2874]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                               AMENDMENTS

  Under clause 6 of rule XXIII, proposed amendments were submitted as 
follows:

                               H.R. 3103

                       Offered by: Mr. Gunderson

       Amendment No. 1. At the end of the bill add the following 
     new title (and conform the table of contents accordingly):

TITLE V--PROMOTING ACCESS AND AVAILABILITY OF HEALTH COVERAGE IN RURAL 
                                 AREAS

                      Subtitle A--Medicare Program

     SECTION 501. MEDICARE RURAL HOSPITAL FLEXIBILITY PROGRAM.

       (a) Medicare Rural Hospital Flexibility Program.--Section 
     1820 of the Social Security Act (42 U.S.C. 1395i-4) is 
     amended to read as follows:


             ``medicare rural hospital flexibility program

       ``Sec. 1820. (a) Establishment.--Any State that submits an 
     application in accordance with subsection (b) may establish a 
     medicare rural hospital flexibility program described in 
     subsection (c).
       ``(b) Application.--A State may establish a medicare rural 
     hospital flexibility program described in subsection (c) if 
     the State submits to the Secretary at such time and in such 
     form as the Secretary may require an application containing--
       ``(1) assurances that the State--
       ``(A) has developed, or is in the process of developing, a 
     State rural health care plan that--
       ``(i) provides for the creation of one or more rural health 
     networks (as defined in subsection (d)) in the State,
       ``(ii) promotes regionalization of rural health services in 
     the State, and
       ``(iii) improves access to hospital and other health 
     services for rural residents of the State;
       ``(B) has developed the rural health care plan described in 
     subparagraph (A) in consultation with the hospital 
     association of the State, rural hospitals located in the 
     State, and the State Office of Rural Health (or, in the case 
     of a State in the process of developing such plan, that 
     assures the Secretary that the State will consult with its 
     State hospital association, rural hospitals located in the 
     State, and the State Office of Rural Health in developing 
     such plan);
       ``(2) assurances that the State has designated (consistent 
     with the rural health care plan described in paragraph 
     (1)(A)), or is in the process of so designating, rural 
     nonprofit or public hospitals or facilities located in the 
     State as critical access hospitals; and
       ``(3) such other information and assurances as the 
     Secretary may require.
       ``(c) Medicare Rural Hospital Flexibility Program 
     Described.--
       ``(1) In general.--A State that has submitted an 
     application in accordance with subsection (b), may establish 
     a medicare rural hospital flexibility program that provides 
     that--
       ``(A) the State shall develop at least one rural health 
     network (as defined in subsection (d)) in the State; and
       ``(B) at least one facility in the State shall be 
     designated as a critical access hospital in accordance with 
     paragraph (2).
       ``(2) State designation of facilities.--
       ``(A) In general.--A State may designate one or more 
     facilities as a critical access hospital in accordance with 
     subparagraph (B).
       ``(B) Criteria for designation as critical access 
     hospital.--A State may designate a facility as a critical 
     access hospital if the facility--
       ``(i) is located in a county (or equivalent unit of local 
     government) in a rural area (as defined in section 
     1886(d)(2)(D)) that--

       ``(I) is located more than a 35-mile drive from a hospital, 
     or another facility described in this subsection, or
       ``(II) is certified by the State as being a necessary 
     provider of health care services to residents in the area;

       ``(ii) makes available 24-hour emergency care services that 
     a State determines are necessary for ensuring access to 
     emergency care services in each area served by a critical 
     access hospital;
       ``(iii) provides not more than 6 acute care inpatient beds 
     (meeting such standards as the Secretary may establish) for 
     providing inpatient care for a period not to exceed 72 hours 
     (unless a longer period is required because transfer to a 
     hospital is precluded because of inclement weather or other 
     emergency conditions), except that a peer review organization 
     or equivalent entity may, on request, waive the 72-hour 
     restriction on a case-by-case basis;
       ``(iv) meets such staffing requirements as would apply 
     under section 1861(e) to a hospital located in a rural area, 
     except that--

       ``(I) the facility need not meet hospital standards 
     relating to the number of hours during a day, or days during 
     a week, in which the facility must be open and fully staffed, 
     except insofar as the facility is required to make available 
     emergency care services as determined under clause (ii) and 
     must have nursing services available on a 24-hour basis, but 
     need not otherwise staff the facility except when an 
     inpatient is present,
       ``(II) the facility may provide any services otherwise 
     required to be provided by a full-time, on-site dietitian, 
     pharmacist, laboratory technician, medical technologist, and 
     radiological technologist on a part-time, off-site basis 
     under arrangements as defined in section 1861(w)(1), and
       ``(III) the inpatient care described in clause (iii) may be 
     provided by a physician's assistant, nurse practitioner, or 
     clinical nurse specialist subject to the oversight of a 
     physician who need not be present in the facility; and

       ``(v) meets the requirements of subparagraph (I) of 
     paragraph (2) of section 1861(aa).
       ``(d) Rural Health Network Defined.--
       ``(1) In general.--For purposes of this section, the term 
     `rural health network' means, with respect to a State, an 
     organization consisting of--
       ``(A) at least 1 facility that the State has designated or 
     plans to designate as a critical access hospital, and
       ``(B) at least 1 hospital that furnishes acute care 
     services.
       ``(2) Agreements.--
       ``(A) In general.--Each critical access hospital that is a 
     member of a rural health network shall have an agreement with 
     respect to each item described in subparagraph (B) with at 
     least 1 hospital that is a member of the network.
       ``(B) Items described.--The items described in this 
     subparagraph are the following:
       ``(i) Patient referral and transfer.
       ``(ii) The development and use of communications systems 
     including (where feasible)--

       ``(I) telemetry systems, and
       ``(II) systems for electronic sharing of patient data.

       ``(iii) The provision of emergency and non-emergency 
     transportation among the facility and the hospital.
       ``(C) Credentialing and quality assurance.--Each critical 
     access hospital that is a

[[Page H2868]]

     member of a rural health network shall have an agreement with 
     respect to credentialing and quality assurance with at least 
     1--
       ``(i) hospital that is a member of the network;
       ``(ii) peer review organization or equivalent entity; or
       ``(iii) other appropriate and qualified entity identified 
     in the State rural health care plan.
       ``(e) Certification by the Secretary.--The Secretary shall 
     certify a facility as a critical access hospital if the 
     facility--
       ``(1) is located in a State that has established a medicare 
     rural hospital flexibility program in accordance with 
     subsection (c);
       ``(2) is designated as a critical access hospital by the 
     State in which it is located; and
       ``(3) meets such other criteria as the Secretary may 
     require.
       ``(f) Permitting Maintenance of Swing Beds.--Nothing in 
     this section shall be construed to prohibit a State from 
     designating or the Secretary from certifying a facility as a 
     critical access hospital solely because, at the time the 
     facility applies to the State for designation as a critical 
     access hospital, there is in effect an agreement between the 
     facility and the Secretary under section 1883 under which the 
     facility's inpatient hospital facilities are used for the 
     furnishing of extended care services, except that the number 
     of beds used for the furnishing of such services may not 
     exceed 12 beds (minus the number of inpatient beds used for 
     providing inpatient care in the facility pursuant to 
     subsection (c)(2)(B)(iii)). For purposes of the previous 
     sentence, the number of beds of the facility used for the 
     furnishing of extended care services shall not include any 
     beds of a unit of the facility that is licensed as a 
     distinct-part skilled nursing facility at the time the 
     facility applies to the State for designation as a critical 
     access hospital.
       ``(g) Waiver of Conflicting Part A Provisions.--The 
     Secretary is authorized to waive such provisions of this part 
     and part C as are necessary to conduct the program 
     established under this section.''.
       (b) Part A Amendments Relating to Rural Primary Care 
     Hospitals and Critical Access Hospitals.--
       (1) Definitions.--Section 1861(mm) of such Act (42 U.S.C. 
     1395x(mm)) is amended to read as follows:

     ``Critical Access Hospital; Critical Access Hospital Services

       ``(mm)(1) The term `critical access hospital' means a 
     facility certified by the Secretary as a critical access 
     hospital under section 1820(e).
       ``(2) The term `inpatient critical access hospital 
     services' means items and services, furnished to an inpatient 
     of a critical access hospital by such facility, that would be 
     inpatient hospital services if furnished to an inpatient of a 
     hospital by a hospital.''.
       (2) Coverage and payment.--(A) Section 1812(a)(1) of such 
     Act (42 U.S.C. 1395d(a)(1)) is amended by striking ``or 
     inpatient rural primary care hospital services'' and 
     inserting ``or inpatient critical access hospital services''.
       (B) Sections 1813(a) and section 1813(b)(3)(A) of such Act 
     (42 U.S.C. 1395e(a), 1395e(b)(3)(A)) are each amended by 
     striking ``inpatient rural primary care hospital services'' 
     each place it appears, and inserting ``inpatient critical 
     access hospital services''.
       (C) Section 1813(b)(3)(B) of such Act (42 U.S.C. 
     1395e(b)(3)(B)) is amended by striking ``inpatient rural 
     primary care hospital services'' and inserting ``inpatient 
     critical access hospital services''.
       (D) Section 1814 of such Act (42 U.S.C. 1395f) is amended--
       (i) in subsection (a)(8) by striking ``rural primary care 
     hospital'' each place it appears and inserting ``critical 
     access hospital''; and
       (ii) in subsection (b), by striking ``other than a rural 
     primary care hospital providing inpatient rural primary care 
     hospital services,'' and inserting ``other than a critical 
     access hospital providing inpatient critical access hospital 
     services,''; and
       (iii) by amending subsection (l) to read as follows:
       ``(l) Payment for Inpatient Critical Access Hospital 
     Services.--The amount of payment under this part for 
     inpatient critical access hospital services is the reasonable 
     costs of the critical access hospital in providing such 
     services.''.
       (3) Treatment of critical access hospitals as providers of 
     services.--(A) Section 1861(u) of such Act (42 U.S.C. 
     1395x(u)) is amended by striking ``rural primary care 
     hospital'' and inserting ``critical access hospital''.
       (B) The first sentence of section 1864(a) (42 U.S.C. 
     1395aa(a)) is amended by striking ``a rural primary care 
     hospital'' and inserting ``a critical access hospital''.
       (4) Conforming amendments.--(A) Section 1128A(b)(1) of such 
     Act (42 U.S.C. 1320a-7a(b)(1)) is amended by striking ``rural 
     primary care hospital'' each place it appears and inserting 
     ``critical access hospital''.
       (B) Section 1128B(c) of such Act (42 U.S.C. 1320a-7b(c)) is 
     amended by striking ``rural primary care hospital'' and 
     inserting ``critical access hospital''.
       (C) Section 1134 of such Act (42 U.S.C. 1320b-4) is amended 
     by striking ``rural primary care hospitals'' each place it 
     appears and inserting ``critical access hospitals''.
       (D) Section 1138(a)(1) of such Act (42 U.S.C. 1320b-
     8(a)(1)) is amended--
       (i) in the matter preceding subparagraph (A), by striking 
     ``rural primary care hospital'' and inserting ``critical 
     access hospital''; and
       (ii) in the matter preceding clause (i) of subparagraph 
     (A), by striking ``rural primary care hospital'' and 
     inserting ``critical access hospital''.
       (E) Section 1816(c)(2)(C) of such Act (42 U.S.C. 
     1395h(c)(2)(C)) is amended by striking ``rural primary care 
     hospital'' and inserting ``critical access hospital''.
       (F) Section 1833 of such Act (42 U.S.C. 1395l) is amended--
       (i) in subsection (h)(5)(A)(iii), by striking ``rural 
     primary care hospital'' and inserting ``critical access 
     hospital'';
       (ii) in subsection (i)(1)(A), by striking ``rural primary 
     care hospital'' and inserting ``critical access hospital'';
       (iii) in subsection (i)(3)(A), by striking ``rural primary 
     care hospital services'' and inserting ``critical access 
     hospital services'';
       (iv) in subsection (l)(5)(A), by striking ``rural primary 
     care hospital'' each place it appears and inserting 
     ``critical access hospital''; and
       (v) in subsection (l)(5)(B), by striking ``rural primary 
     care hospital'' each place it appears and inserting 
     ``critical access hospital''.
       (G) Section 1835(c) of such Act (42 U.S.C. 1395n(c)) is 
     amended by striking ``rural primary care hospital'' each 
     place it appears and inserting ``critical access hospital''.
       (H) Section 1842(b)(6)(A)(ii) of such Act (42 U.S.C. 
     1395u(b)(6)(A)(ii)) is amended by striking ``rural primary 
     care hospital'' and inserting ``critical access hospital''.
       (I) Section 1861 of such Act (42 U.S.C. 1395x) is amended--
       (i) in subsection (a)--
       (I) in paragraph (1), by striking ``inpatient rural primary 
     care hospital services'' and inserting ``inpatient critical 
     access hospital services''; and
       (II) in paragraph (2), by striking ``rural primary care 
     hospital'' and inserting ``critical access hospital'';
       (ii) in the last sentence of subsection (e), by striking 
     ``rural primary care hospital'' and inserting ``critical 
     access hospital'';
       (iii) in subsection (v)(1)(S)(ii)(III), by striking ``rural 
     primary care hospital'' and inserting ``critical access 
     hospital'';
       (iv) in subsection (w)(1), by striking ``rural primary care 
     hospital'' and inserting ``critical access hospital''; and
       (v) in subsection (w)(2), by striking ``rural primary care 
     hospital'' each place it appears and inserting ``critical 
     access hospital''.
       (J) Section 1862(a)(14) of such Act (42 U.S.C. 
     1395y(a)(14)) is amended by striking ``rural primary care 
     hospital'' each place it appears and inserting ``critical 
     access hospital''.
       (K) Section 1866(a)(1) of such Act (42 U.S.C 1395cc(a)(1)) 
     is amended--
       (i) in subparagraph (F)(ii), by striking ``rural primary 
     care hospitals'' and inserting ``critical access hospitals'';
       (ii) in subparagraph (H), in the matter preceding clause 
     (i), by striking ``rural primary care hospitals'' and ``rural 
     primary care hospital services'' and inserting ``critical 
     access hospitals'' and ``critical access hospital services'', 
     respectively;
       (iii) in subparagraph (I), in the matter preceding clause 
     (i), by striking ``rural primary care hospital'' and 
     inserting ``critical access hospital''; and
       (iv) in subparagraph (N)--
       (I) in the matter preceding clause (i), by striking ``rural 
     primary care hospitals'' and inserting ``critical access 
     hospitals'', and
       (II) in clause (i), by striking ``rural primary care 
     hospital'' and inserting ``critical access hospital''.
       (L) Section 1866(a)(3) of such Act (42 U.S.C. 1395cc(a)(3)) 
     is amended--
       (i) by striking ``rural primary care hospital'' each place 
     it appears in subparagraphs (A) and (B) and inserting 
     ``critical access hospital''; and
       (ii) in subparagraph (C)(ii)(II), by striking ``rural 
     primary care hospitals'' each place it appears and inserting 
     ``critical access hospitals''.
       (M) Section 1867(e)(5) of such Act (42 U.S.C. 1395dd(e)(5)) 
     is amended by striking ``rural primary care hospital'' and 
     inserting ``critical access hospital''.
       (c) Payment Continued to Designated EACHs.--Section 
     1886(d)(5)(D) of such Act (42 U.S.C. 1395ww(d)(5)(D)) is 
     amended--
       (1) in clause (iii)(III), by inserting ``as in effect on 
     September 30, 1995'' before the period at the end; and
       (2) in clause (v)--
       (A) by inserting ``as in effect on September 30, 1995'' 
     after ``1820 (i)(1)''; and
       (B) by striking ``1820(g)'' and inserting ``1820(e)''.
       (d) Part B Amendments Relating to Critical Access 
     Hospitals.--
       (1) Coverage.--(A) Section 1861(mm) of such Act (42 U.S.C. 
     1395x(mm)) as amended by subsection (d)(1), is amended by 
     adding at the end the following new paragraph:
       ``(3) The term `outpatient critical access hospital 
     services' means medical and other health services furnished 
     by a critical access hospital on an outpatient basis.''.
       (B) Section 1832(a)(2)(H) of such Act (42 U.S.C. 
     1395k(a)(2)(H)) is amended by striking ``rural primary care 
     hospital services'' and inserting ``critical access hospital 
     services''.
       (2) Payment.--(A) Section 1833(a) of such Act (42 U.S.C. 
     1395l(a)) is amended in paragraph (6), by striking 
     ``outpatient rural primary care hospital services'' and 
     inserting ``outpatient critical access hospital services''.
       (B) Section 1834(g) of such Act (42 U.S.C. 1395m(g)) is 
     amended to read as follows:

[[Page H2869]]

       ``(g) Payment for Outpatient Critical Access Hospital 
     Services.--The amount of payment under this part for 
     outpatient critical access hospital services is the 
     reasonable costs of the critical access hospital in providing 
     such services.''.
       (e) Effective Date.--The amendments made by this section 
     shall apply to services furnished on or after October 1, 
     1996.

     SEC. 502. ESTABLISHMENT OF RURAL EMERGENCY ACCESS CARE 
                   HOSPITALS.

       (a) In General.--Section 1861 of the Social Security Act 
     (42 U.S.C. 1395x) is amended by adding at the end the 
     following new subsection:

  ``Rural Emergency Access Care Hospital; Rural Emergency Access Care 
                           Hospital Services

       ``(oo)(1) The term `rural emergency access care hospital' 
     means, for a fiscal year, a facility with respect to which 
     the Secretary finds the following:
       ``(A) The facility is located in a rural area (as defined 
     in section 1886(d)(2)(D)).
       ``(B) The facility was a hospital under this title at any 
     time during the 5-year period that ends on the date of the 
     enactment of this subsection.
       ``(C) The facility is in danger of closing due to low 
     inpatient utilization rates and operating losses, and the 
     closure of the facility would limit the access to emergency 
     services of individuals residing in the facility's service 
     area.
       ``(D) The facility has entered into (or plans to enter 
     into) an agreement with a hospital with a participation 
     agreement in effect under section 1866(a), and under such 
     agreement the hospital shall accept patients transferred to 
     the hospital from the facility and receive data from and 
     transmit data to the facility.
       ``(E) There is a practitioner who is qualified to provide 
     advanced cardiac life support services (as determined by the 
     State in which the facility is located) on-site at the 
     facility on a 24-hour basis.
       ``(F) A physician is available on-call to provide emergency 
     medical services on a 24-hour basis.
       ``(G) The facility meets such staffing requirements as 
     would apply under section 1861(e) to a hospital located in a 
     rural area, except that--
       ``(i) the facility need not meet hospital standards 
     relating to the number of hours during a day, or days during 
     a week, in which the facility must be open, except insofar as 
     the facility is required to provide emergency care on a 24-
     hour basis under subparagraphs (E) and (F); and
       ``(ii) the facility may provide any services otherwise 
     required to be provided by a full-time, on-site dietitian, 
     pharmacist, laboratory technician, medical technologist, or 
     radiological technologist on a part-time, off-site basis.
       ``(H) The facility meets the requirements applicable to 
     clinics and facilities under subparagraphs (C) through (J) of 
     paragraph (2) of section 1861(aa) and of clauses (ii) and 
     (iv) of the second sentence of such paragraph (or, in the 
     case of the requirements of subparagraph (E), (F), or (J) of 
     such paragraph, would meet the requirements if any reference 
     in such subparagraph to a `nurse practitioner' or to `nurse 
     practitioners' were deemed to be a reference to a `nurse 
     practitioner or nurse' or to `nurse practitioners or 
     nurses'); except that in determining whether a facility meets 
     the requirements of this subparagraph, subparagraphs (E) and 
     (F) of that paragraph shall be applied as if any reference to 
     a `physician' is a reference to a physician as defined in 
     section 1861(r)(1).
       ``(2) The term `rural emergency access care hospital 
     services' means the following services provided by a rural 
     emergency access care hospital and furnished to an individual 
     over a continuous period not to exceed 24 hours (except that 
     such services may be furnished over a longer period in the 
     case of an individual who is unable to leave the hospital 
     because of inclement weather):
       ``(A) An appropriate medical screening examination (as 
     described in section 1867(a)).
       ``(B) Necessary stabilizing examination and treatment 
     services for an emergency medical condition and labor (as 
     described in section 1867(b)).''.
       (b) Requiring Rural Emergency Access Care Hospitals To Meet 
     Hospital Anti-Dumping Requirements.--Section 1867(e)(5) of 
     such Act (42 U.S.C. 1395dd(e)(5)) is amended by striking 
     ``1861(mm)(1))'' and inserting ``1861(mm)(1)) and a rural 
     emergency access care hospital (as defined in section 
     1861(oo)(1))''.
       (c) Coverage and Payment for Services.--
       (1) Coverage.--Section 1832(a)(2) of such Act (42 U.S.C. 
     1395k(a)(2)) is amended--
       (A) by striking ``and'' at the end of subparagraph (I);
       (B) by striking the period at the end of subparagraph (J) 
     and inserting ``; and''; and
       (C) by adding at the end the following new subparagraph:
       ``(K) rural emergency access care hospital services (as 
     defined in section 1861(oo)(2)).''.
       (2) Payment based on payment for outpatient critical access 
     hospital services.--
       (A) In general.--Section 1833(a)(6) of such Act (42 U.S.C. 
     1395l(a)(6)), as amended by section 501(f)(2), is amended by 
     striking ``services,'' and inserting ``services and rural 
     emergency access care hospital services,''.
       (B) Payment methodology described.--Section 1834(g) of such 
     Act (42 U.S.C. 1395m(g)), as amended by section 501(f)(2)(B), 
     is amended--
       (i) in the heading, by striking ``Services'' and inserting 
     ``Services and Rural Emergency Access Care Hospital 
     Services''; and
       (ii) by adding at the end the following new sentence: ``The 
     amount of payment for rural emergency access care hospital 
     services provided during a year shall be determined using the 
     applicable method provided under this subsection for 
     determining payment for outpatient rural primary care 
     hospital services during the year.''.
       (d) Effective Date.--The amendments made by this section 
     shall apply to fiscal years beginning on or after October 1, 
     1996.

     SEC. 503. CLASSIFICATION OF RURAL REFERRAL CENTERS.

       (a) Prohibiting Denial of Request for Reclassification on 
     Basis of Comparability of Wages.--
       (1) In general.--Section 1886(d)(10)(D) of the Social 
     Security Act (42 U.S.C. 1395ww(d)(10)(D)) is amended--
       (A) by redesignating clause (iii) as clause (iv); and
       (B) by inserting after clause (ii) the following new 
     clause:
       ``(iii) Under the guidelines published by the Secretary 
     under clause (i), in the case of a hospital which is 
     classified by the Secretary as a rural referral center under 
     paragraph (5)(C), the Board may not reject the application of 
     the hospital under this paragraph on the basis of any 
     comparison between the average hourly wage of the hospital 
     and the average hourly wage of hospitals in the area in which 
     it is located.''.
       (2) Effective date.--Notwithstanding section 
     1886(d)(10)(C)(ii) of the Social Security Act, a hospital may 
     submit an application to the Medicare Geographic 
     Classification Review Board during the 30-day period 
     beginning on the date of the enactment of this Act requesting 
     a change in its classification for purposes of determining 
     the area wage index applicable to the hospital under section 
     1886(d)(3)(D) of such Act for fiscal year 1997, if the 
     hospital would be eligible for such a change in its 
     classification under the standards described in section 
     1886(d)(10)(D) of such Act (as amended by paragraph (1)) but 
     for its failure to meet the deadline for applications under 
     section 1886(d)(10)(C)(ii) of such Act.
       (b) Continuing Treatment of Previously Designated 
     Centers.--Any hospital classified as a rural referral center 
     by the Secretary of Health and Human Services under section 
     1886(d)(5)(C) of the Social Security Act for fiscal year 1994 
     shall be classified as such a rural referral center for 
     fiscal year 1997 and each subsequent fiscal year.
          Subtitle B--Small Rural Hospital Antitrust Fairness

     SEC. 511. ANTITRUST EXEMPTION.

       The antitrust laws shall not apply with respect to--
       (1) the merger of, or the attempt to merge, 2 or more 
     hospitals,
       (2) a contract entered into solely by 2 or more hospitals 
     to allocate hospital services, or
       (3) the attempt by only 2 or more hospitals to enter into a 
     contract to allocate hospital services,

     if each of such hospitals satisfies all of the requirements 
     of section 512 at the time such hospitals engage in the 
     conduct described in paragraph (1), (2), or (3), as the case 
     may be.

     SEC. 512. REQUIREMENTS.

       The requirements referred to in section 511 are as follows:
       (1) The hospital is located outside of a city, or in a city 
     that has less than 150,000 inhabitants, as determined in 
     accordance with the most recent data available from the 
     Bureau of the Census.
       (2) In the most recently concluded calendar year, the 
     hospital received more than 40 percent of its gross revenue 
     from payments made under Federal programs.
       (3) There is in effect with respect to the hospital a 
     certificate issued by the Health Care Financing 
     Administration specifying that such Administration has 
     determined that Federal expenditures would be reduced, 
     consumer costs would not increase, and access to health care 
     services would not be reduced, if the hospital and the other 
     hospitals that requested such certificate merge, or allocate 
     the hospital services specified in such request, as the case 
     may be.

     SEC. 513. DEFINITION.

       For purposes of this title, the term ``antitrust laws'' has 
     the meaning given such term in subsection (a) of the first 
     section of the Clayton Act (15 U.S.C. 12), except that such 
     term includes section 5 of the Federal Trade Commission Act 
     (15 U.S.C. 45) to the extent that such section 5 applies with 
     respect to unfair methods of competition.
                  Subtitle C--Miscellaneous Provisions

     SEC. 521. NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENTS 
                   EXCLUDED FROM GROSS INCOME.

       (a) In General.--Part III of subchapter B of chapter 1 of 
     the Internal Revenue Code of 1986 (relating to items 
     specifically excluded from gross income) is amended by 
     redesignating section 137 as section 138 and by inserting 
     after section 136 the following new section:

     ``SEC. 137. NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENTS.

       ``(a) General Rule.--Gross income shall not include any 
     qualified loan repayment.
       ``(b) Qualified Loan Repayment.--For purposes of this 
     section, the term `qualified loan repayment' means any 
     payment made on behalf of the taxpayer by the National

[[Page H2870]]

     Health Service Corps Loan Repayment Program under section 
     338B(g) of the Public Health Service Act.''.
       (b) Conforming Amendment.--Paragraph (3) of section 338B(g) 
     of the Public Health Service Act is amended by striking 
     ``Federal, State, or local'' and inserting ``State or 
     local''.
       (c) Clerical Amendment.--The table of sections for part III 
     of subchapter B of chapter 1 of the Internal Revenue Code of 
     1986 is amended by striking the item relating to section 137 
     and inserting the following:
``Sec. 137. National Health Service Corps loan repayments.
``Sec. 138. Cross references to other Acts.''.

       (d) Effective Date.--The amendments made by this section 
     shall apply to payments made under section 338B(g) of the 
     Public Health Service Act after the date of the enactment of 
     this Act.

     SEC. 522. TELEMEDICINE SERVICES.

       The Secretary of Health and Human Services shall establish 
     a methodology for making payments under part B of the 
     medicare program for telemedicine services furnished on an 
     emergency basis to individuals residing in an area designated 
     as a health professional shortage area (under section 332(a) 
     of the Public Health Service Act).

                               H.R. 3136

                          Offered by: Mr. Hyde

       Amendment No. 2. Strike title III and insert the following:

             TITLE III--SMALL BUSINESS REGULATORY FAIRNESS

     SEC. 301. SHORT TITLE.

       This title may be cited as the ``Small Business Regulatory 
     Enforcement Fairness Act of 1996''.

     SEC. 302. FINDINGS.

       Congress finds that--
       (1) a vibrant and growing small business sector is critical 
     to creating jobs in a dynamic economy;
       (2) small businesses bear a disproportionate share of 
     regulatory costs and burdens;
       (3) fundamental changes that are needed in the regulatory 
     and enforcement culture of Federal agencies to make agencies 
     more responsive to small business can be made without 
     compromising the statutory missions of the agencies;
       (4) three of the top recommendations of the 1995 White 
     House Conference on Small Business involve reforms to the way 
     government regulations are developed and enforced, and 
     reductions in government paperwork requirements;
       (5) the requirements of chapter 6 of title 5, United States 
     Code, have too often been ignored by government agencies, 
     resulting in greater regulatory burdens on small entities 
     than necessitated by statute; and
       (6) small entities should be given the opportunity to seek 
     judicial review of agency actions required by chapter 6 of 
     title 5, United States Code.

      SEC. 303. PURPOSES.

       The purposes of this title are--
       (1) to implement certain recommendations of the 1995 White 
     House Conference on Small Business regarding the development 
     and enforcement of Federal regulations;
       (2) to provide for judicial review of chapter 6 of title 5, 
     United States Code;
       (3) to encourage the effective participation of small 
     businesses in the Federal regulatory process;
       (4) to simplify the language of Federal regulations 
     affecting small businesses;
       (5) to develop more accessible sources of information on 
     regulatory and reporting requirements for small businesses;
       (6) to create a more cooperative regulatory environment 
     among agencies and small businesses that is less punitive and 
     more solution-oriented; and
       (7) to make Federal regulators more accountable for their 
     enforcement actions by providing small entities with a 
     meaningful opportunity for redress of excessive enforcement 
     activities.
            Subtitle A--Regulatory Compliance Simplification

      SECTION 311. DEFINITIONS.

       For purposes of this subtitle--
       (1) the terms ``rule'' and ``small entity'' have the same 
     meanings as in section 601 of title 5, United States Code;
       (2) the term ``agency'' has the same meaning as in section 
     551 of title 5, United States Code; and
       (3) the term ``small entity compliance guide'' means a 
     document designated as such by an agency.

      SEC. 312. COMPLIANCE GUIDES.

       (a) Compliance Guide.--For each rule or group of related 
     rules for which an agency is required to prepare a final 
     regulatory flexibility analysis under section 604 of title 5, 
     United States Code, the agency shall publish one or more 
     guides to assist small entities in complying with the rule, 
     and shall designate such publications as ``small entity 
     compliance guides''. The guides shall explain the actions a 
     small entity is required to take to comply with a rule or 
     group of rules. The agency shall, in its sole discretion, 
     taking into account the subject matter of the rule and the 
     language of relevant statutes, ensure that the guide is 
     written using sufficiently plain language likely to be 
     understood by affected small entities. Agencies may prepare 
     separate guides covering groups or classes of similarly 
     affected small entities, and may cooperate with associations 
     of small entities to develop and distribute such guides.
       (b) Comprehensive Source of Information.--Agencies shall 
     cooperate to make available to small entities through 
     comprehensive sources of information, the small entity 
     compliance guides and all other available information on 
     statutory and regulatory requirements affecting small 
     entities.
       (c) Limitation on Judicial Review.--An agency's small 
     entity compliance guide shall not be subject to judicial 
     review, except that in any civil or administrative action 
     against a small entity for a violation occurring after the 
     effective date of this section, the content of the small 
     entity compliance guide may be considered as evidence of the 
     reasonableness or appropriateness of any proposed fines, 
     penalties or damages.

      SEC. 313. INFORMAL SMALL ENTITY GUIDANCE.

       (a) General.--Whenever appropriate in the interest of 
     administering statutes and regulations within the 
     jurisdiction of an agency which regulates small entities, it 
     shall be the practice of the agency to answer inquiries by 
     small entities concerning information on, and advice about, 
     compliance with such statutes and regulations, interpreting 
     and applying the law to specific sets of facts supplied by 
     the small entity. In any civil or administrative action 
     against a small entity, guidance given by an agency applying 
     the law to facts provided by the small entity may be 
     considered as evidence of the reasonableness or 
     appropriateness of any proposed fines, penalties or damages 
     sought against such small entity.
       (b) Program.--Each agency regulating the activities of 
     small entities shall establish a program for responding to 
     such inquiries no later than 1 year after enactment of this 
     section, utilizing existing functions and personnel of the 
     agency to the extent practicable.
       (c) Reporting.--Each agency regulating the activities of 
     small business shall report to the Committee on Small 
     Business and Committee on Governmental Affairs of the Senate 
     and the Committee on Small Business and Committee on the 
     Judiciary of the House of Representatives no later than 2 
     years after the date of the enactment of this section on the 
     scope of the agency's program, the number of small entities 
     using the program, and the achievements of the program to 
     assist small entity compliance with agency regulations.

      SEC. 314. SERVICES OF SMALL BUSINESS DEVELOPMENT CENTERS.

       (a) Section 21(c)(3) of the Small Business Act (15 U.S.C. 
     648(c)(3)) is amended--
       (1) in subparagraph (O), by striking ``and'' at the end;
       (2) in subparagraph (P), by striking the period at the end 
     and inserting a semicolon; and
       (3) by inserting after subparagraph (P) the following new 
     subparagraphs:
       ``(Q) providing information to small business concerns 
     regarding compliance with regulatory requirements; and
       ``(R) developing informational publications, establishing 
     resource centers of reference materials, and distributing 
     compliance guides published under section 312(a) of the Small 
     Business Regulatory Enforcement Fairness Act of 1996.''.
       (b) Nothing in this Act in any way affects or limits the 
     ability of other technical assistance or extension programs 
     to perform or continue to perform services related to 
     compliance assistance.

     SEC. 315. COOPERATION ON GUIDANCE.

       Agencies may, to the extent resources are available and 
     where appropriate, in cooperation with the states, develop 
     guides that fully integrate requirements of both Federal and 
     state regulations where regulations within an agency's area 
     of interest at the Federal and state levels impact small 
     entities. Where regulations vary among the states, separate 
     guides may be created for separate states in cooperation with 
     State agencies.

     SEC. 316. EFFECTIVE DATE.

       This subtitle and the amendments made by this subtitle 
     shall take effect on the expiration of 90 days after the date 
     of enactment of this subtitle.
               Subtitle B--Regulatory Enforcement Reforms

      SECTION 321. DEFINITIONS.

       For purposes of this subtitle--
       (1) the terms ``rule'' and ``small entity'' have the same 
     meanings as in section 601 of title 5, United States Code;
       (2) the term ``agency'' has the same meaning as in section 
     551 of title 5, United States Code; and
       (3) the term ``small entity compliance guide'' means a 
     document designated as such by an agency.

      SEC. 322. SMALL BUSINESS AND AGRICULTURE ENFORCEMENT 
                   OMBUDSMAN.

       The Small Business Act (15 U.S.C. 631 et seq.) is amended--
       (1) by redesignating section 30 as section 31; and
       (2) by inserting after section 29 the following new 
     section:

     ``SEC. 30. OVERSIGHT OF REGULATORY ENFORCEMENT.

       ``(a) Definitions.--For purposes of this section, the 
     term--
       ``(1) ``Board'' means a Regional Small Business Regulatory 
     Fairness Board established under subsection (c); and
       ``(2) ``Ombudsman'' means the Small Business and 
     Agriculture Regulatory Enforcement Ombudsman designated under 
     subsection (b).
       ``(b) SBA Enforcement Ombudsman.--
       ``(1) Not later than 180 days after the date of enactment 
     of this section, the Administrator shall designate a Small 
     Business and

[[Page H2871]]

     Agriculture Regulatory Enforcement Ombudsman, who shall 
     report directly to the Administrator, utilizing personnel of 
     the Small Business Administration to the extent practicable. 
     Other agencies shall assist the Ombudsman and take actions as 
     necessary to ensure compliance with the requirements of this 
     section. Nothing in this section is intended to replace or 
     diminish the activities of any Ombudsman or similar office in 
     any other agency.
       ``(2) The Ombudsman shall--
       ``(A) work with each agency with regulatory authority over 
     small businesses to ensure that small business concerns that 
     receive or are subject to an audit, on-site inspection, 
     compliance assistance effort, or other enforcement related 
     communication or contact by agency personnel are provided 
     with a means to comment on the enforcement activity conducted 
     by such personnel;
       ``(B) establish means to receive comments from small 
     business concerns regarding actions by agency employees 
     conducting compliance or enforcement activities with respect 
     to the small business concern, means to refer comments to the 
     Inspector General of the affected agency in the appropriate 
     circumstances, and otherwise seek to maintain the identity of 
     the person and small business concern making such comments on 
     a confidential basis to the same extent as employee 
     identities are protected under section 7 of the Inspector 
     General Act of 1978 (5 U.S.C.App.);
       ``(C) based on substantiated comments received from small 
     business concerns and the Boards, annually report to Congress 
     and affected agencies evaluating the enforcement activities 
     of agency personnel including a rating of the responsiveness 
     to small business of the various regional and program offices 
     of each agency;
       ``(D) coordinate and report annually on the activities, 
     findings and recommendations of the Boards to the 
     Administrator and to the heads of affected agencies; and
       ``(E) provide the affected agency with an opportunity to 
     comment on draft reports prepared under subparagraph (C), and 
     include a section of the final report in which the affected 
     agency may make such comments as are not addressed by the 
     Ombudsman in revisions to the draft.
       ``(c) Regional Small Business Regulatory Fairness Boards.--
       ``(1) Not later than 180 days after the date of enactment 
     of this section, the Administrator shall establish a Small 
     Business Regulatory Fairness Board in each regional office of 
     the Small Business Administration.
       ``(2) Each Board established under paragraph (1) shall--
       ``(A) meet at least annually to advise the Ombudsman on 
     matters of concern to small businesses relating to the 
     enforcement activities of agencies;
       ``(B) report to the Ombudsman on substantiated instances of 
     excessive enforcement actions of agencies against small 
     business concerns including any findings or recommendations 
     of the Board as to agency enforcement policy or practice; and
       ``(C) prior to publication, provide comment on the annual 
     report of the Ombudsman prepared under subsection (b).
       ``(3) Each Board shall consist of five members, who are 
     owners, operators, or officers of small business concerns, 
     appointed by the Administrator, after receiving the 
     recommendations of the chair and ranking minority member of 
     the Committees on Small Business of the House of 
     Representatives and the Senate. Not more than three of the 
     Board members shall be of the same political party. No member 
     shall be an officer or employee of the Federal Government, in 
     either the executive branch or the Congress.
       ``(4) Members of the Board shall serve at the pleasure of 
     the Administrator for terms of three years or less.
       ``(5) The Administrator shall select a chair from among the 
     members of the Board who shall serve at the pleasure of the 
     Administrator for not more than 1 year as chair.
       ``(6) A majority of the members of the Board shall 
     constitute a quorum for the conduct of business, but a lesser 
     number may hold hearings.
       ``(d) Powers of the Boards.
       ``(1) The Board may hold such hearings and collect such 
     information as appropriate for carrying out this section.
       ``(2) The Board may use the United States mails in the same 
     manner and under the same conditions as other departments and 
     agencies of the Federal Government.
       ``(3) The Board may accept donations of services necessary 
     to conduct its business, provided that the donations and 
     their sources are disclosed by the Board.
       ``(4) Members of the Board shall serve without 
     compensation, provided that, members of the Board shall be 
     allowed travel expenses, including per diem in lieu of 
     subsistence, at rates authorized for employees of agencies 
     under subchapter I of chapter 57 of title 5, United States 
     Code, while away from their homes or regular places of 
     business in the performance of services for the Board.''.

      SEC. 323. RIGHTS OF SMALL ENTITIES IN ENFORCEMENT ACTIONS.

       (a) In General.--Each agency regulating the activities of 
     small entities shall establish a policy or program within 1 
     year of enactment of this section to provide for the 
     reduction, and under appropriate circumstances for the 
     waiver, of civil penalties for violations of a statutory or 
     regulatory requirement by a small entity. Under appropriate 
     circumstances, an agency may consider ability to pay in 
     determining penalty assessments on small entities.
       (b) Conditions and Exclusions.--Subject to the requirements 
     or limitations of other statutes, policies or programs 
     established under this section shall contain conditions or 
     exclusions which may include, but shall not be limited to--
       (1) requiring the small entity to correct the violation 
     within a reasonable correction period;
       (2) limiting the applicability to violations discovered 
     through participation by the small entity in a compliance 
     assistance or audit program operated or supported by the 
     agency or a state;
       (3) excluding small entities that have been subject to 
     multiple enforcement actions by the agency;
       (4) excluding violations involving willful or criminal 
     conduct;
       (5) excluding violations that pose serious health, safety 
     or environmental threats; and
       (6) requiring a good faith effort to comply with the law.
       (c) Reporting.--Agencies shall report to the Committee on 
     Small Business and Committee on Governmental Affairs of the 
     Senate and the Committee on Small Business and Committee on 
     Judiciary of the House of Representatives no later than 2 
     years after the date of enactment of this section on the 
     scope of their program or policy, the number of enforcement 
     actions against small entities that qualified or failed to 
     qualify for the program or policy, and the total amount of 
     penalty reductions and waivers.

     SEC. 324. EFFECTIVE DATE.

       This subtitle and the amendments made by this subtitle 
     shall take effect on the expiration of 90 days after the date 
     of enactment of this subtitle.
           Subtitle C--Equal Access to Justice Act Amendments

     SECTION 331. ADMINISTRATIVE PROCEEDINGS.

       (a) Section 504(a) of title 5, United States Code, is 
     amended by adding at the end the following new paragraph:
       ``(4) If, in an adversary adjudication brought by an 
     agency, the demand by the agency is substantially in excess 
     of the decision of the adjudicative officer and is 
     unreasonable when compared with such decision, under the 
     facts and circumstances of the case, the adjudicative officer 
     shall award to the party the fees and other expenses related 
     to defending against the excessive demand, unless the party 
     has committed a willful violation of law or otherwise acted 
     in bad faith, or special circumstances make an award 
     unjust.''.
       (b) Section 504(b) of title 5, United States Code, is 
     amended--
       (1) in paragraph (1)(A), by striking ``$75'' and inserting 
     '`$125'';
       (2) at the end of paragraph (1)(B), by inserting before the 
     semicolon ``or for purposes of subsection (a)(4), a small 
     entity as defined in section 601'';
       (3) at the end of paragraph (1)(D), by striking ``and'';
       (4) at the end of paragraph (1)(E), by striking the period 
     and inserting ``; and''; and
       (5) at the end of paragraph (1), by adding the following 
     new subparagraph:
       ``(F) `demand' means the express demand of the agency which 
     led to the adversary adjudication, but does not include a 
     recitation by the agency of the maximum statutory penalty (i) 
     in the administrative complaint, or (ii) elsewhere when 
     accompanied by an express demand for a lesser amount.''.

     SEC. 332. JUDICIAL PROCEEDINGS.

       (a) Section 2412(d)(1) of title 28, United States Code, is 
     amended by adding at the end the following new subparagraph:
       ``(D) If, in a civil action brought by the United States, 
     the demand by the United States is substantially in excess of 
     the judgment finally obtained by the United States and is 
     unreasonable when compared with such judgment, under the 
     facts and circumstances of the case, the court shall award to 
     the party the fees and other expenses related to defending 
     against the excessive demand, unless the party has committed 
     a willful violation of law or otherwise acted in bad faith, 
     or special circumstances make an award unjust.''.
       (b) Section 2412(d) of title 28, United States Code, is 
     amended--
       (1) in paragraph (2)(A), by striking ``$75'' and inserting 
     ``$125'';
       (2) at the end of paragraph (2)(B), by inserting before the 
     semicolon ``or for purposes of subsection (d)(1)(D), a small 
     entity as defined in section 601 of title 5'';
       (3) at the end of paragraph (2)(G), by striking ``and'';
       (4) at the end of paragraph (2)(H), by striking the period 
     and inserting ``; and''; and
       (5) at the end of paragraph (2), by adding the following 
     new subparagraph:
       ``(I) `demand' means the express demand of the United 
     States which led to the adversary adjudication, but shall not 
     include a recitation of the maximum statutory penalty (i) in 
     the complaint, or (ii) elsewhere when accompanied by an 
     express demand for a lesser amount.''.

     SEC. 333. EFFECTIVE DATE.

       The amendments made by sections 331 and 332 shall apply to 
     civil actions and adversary adjudications commenced on or 
     after the date of the enactment of this subtitle.
           Subtitle D--Regulatory Flexibility Act Amendments

      SEC. 341. REGULATORY FLEXIBILITY ANALYSES.

       (a) Initial Regulatory Flexibility Analysis.--

[[Page H2872]]

       (1) Section 603.--Section 603(a) of title 5, United States 
     Code, is amended--
       (A) by inserting after ``proposed rule'', the phrase ``, or 
     publishes a notice of proposed rulemaking for an 
     interpretative rule of general applicability involving the 
     internal revenue laws of the United States''; and
       (B) by inserting at the end of the subsection, the 
     following new sentence: ``In the case of an interpretative 
     rule involving the internal revenue laws of the United 
     States, this chapter applies to interpretative rules 
     published in the Federal Register for codification in the 
     Code of Federal Regulations, but only to the extent that such 
     interpretative rules impose on small entities a collection of 
     information requirement.''.
       (2) Section 601.--Section 601 of title 5, United States 
     Code, is amended by striking ``and'' at the end of paragraph 
     (5), by striking the period at the end of paragraph (6) and 
     inserting ``; and'', and by adding at the end the following:
       ``(7) the term `collection of information'--
       ``(A) means the obtaining, causing to be obtained, 
     soliciting, or requiring the disclosure to third parties or 
     the public, of facts or opinions by or for an agency, 
     regardless of form or format, calling for either--
       ``(i) answers to identical questions posed to, or identical 
     reporting or recordkeeping requirements imposed on, 10 or 
     more persons, other than agencies, instrumentalities, or 
     employees of the United States; or
       ``(ii) answers to questions posed to agencies, 
     instrumentalities, or employees of the United States which 
     are to be used for general statistical purposes; and
       ``(B) shall not include a collection of information 
     described under section 3518(c)(1) of title 44, United States 
     Code.
       ``(8) Recordkeeping requirement.--The term `recordkeeping 
     requirement' means a requirement imposed by an agency on 
     persons to maintain specified records.
       (b) Final Regulatory Flexibility Analysis.--Section 604 of 
     title 5, United States Code, is amended--
       (1) in subsection (a) to read as follows:
       ``(a) When an agency promulgates a final rule under section 
     553 of this title, after being required by that section or 
     any other law to publish a general notice of proposed 
     rulemaking, or promulgates a final interpretative rule 
     involving the internal revenue laws of the United States as 
     described in section 603(a), the agency shall prepare a final 
     regulatory flexibility analysis. Each final regulatory 
     flexibility analysis shall contain--
       ``(1) a succinct statement of the need for, and objectives 
     of, the rule;
       ``(2) a summary of the significant issues raised by the 
     public comments in response to the initial regulatory 
     flexibility analysis, a summary of the assessment of the 
     agency of such issues, and a statement of any changes made in 
     the proposed rule as a result of such comments;
       ``(3) a description of and an estimate of the number of 
     small entities to which the rule will apply or an explanation 
     of why no such estimate is available;
       ``(4) a description of the projected reporting, record 
     keeping and other compliance requirements of the rule, 
     including an estimate of the classes of small entities which 
     will be subject to the requirement and the type of 
     professional skills necessary for preparation of the report 
     or record; and
       ``(5) a description of the steps the agency has taken to 
     minimize the significant economic impact on small entities 
     consistent with the stated objectives of applicable statutes, 
     including a statement of the factual, policy, and legal 
     reasons for selecting the alternative adopted in the final 
     rule and why each one of the other significant alternatives 
     to the rule considered by the agency which affect the impact 
     on small entities was rejected.''; and
       (2) in subsection (b), by striking ``at the time'' and all 
     that follows and inserting ``such analysis or a summary 
     thereof.''.

      SEC. 342. JUDICIAL REVIEW.

       Section 611 of title 5, United States Code, is amended to 
     read as follows:

     ``Sec. 611. Judicial review

       ``(a)(1) For any rule subject to this chapter, a small 
     entity that is adversely affected or aggrieved by final 
     agency action is entitled to judicial review of agency 
     compliance with the requirements of sections 601, 604, 
     605(b), 608(b), and 610 in accordance with chapter 7. Agency 
     compliance with sections 607 and 609(a) shall be judicially 
     reviewable in connection with judicial review of section 604.
       ``(2) Each court having jurisdiction to review such rule 
     for compliance with section 553, or under any other provision 
     of law, shall have jurisdiction to review any claims of 
     noncompliance with sections 601, 604, 605(b), 608(b), and 610 
     in accordance with chapter 7. Agency compliance with sections 
     607 and 609(a) shall be judicially reviewable in connection 
     with judicial review of section 604.
       ``(3)(A) A small entity may seek such review during the 
     period beginning on the date of final agency action and 
     ending one year later, except that where a provision of law 
     requires that an action challenging a final agency action be 
     commenced before the expiration of one year, such lesser 
     period shall apply to an action for judicial review under 
     this section.
       ``(B) In the case where an agency delays the issuance of a 
     final regulatory flexibility analysis pursuant to section 
     608(b) of this chapter, an action for judicial review under 
     this section shall be filed not later than--
       ``(i) one year after the date the analysis is made 
     available to the public, or
       ``(ii) where a provision of law requires that an action 
     challenging a final agency regulation be commenced before the 
     expiration of the 1-year period, the number of days specified 
     in such provision of law that is after the date the analysis 
     is made available to the public.
       ``(4) In granting any relief in an action under this 
     section, the court shall order the agency to take corrective 
     action consistent with this chapter and chapter 7, including, 
     but not limited to--
       ``(A) remanding the rule to the agency, and
       ``(B) deferring the enforcement of the rule against small 
     entities unless the court finds that continued enforcement of 
     the rule is in the public interest.
       ``(5) Nothing in this subsection shall be construed to 
     limit the authority of any court to stay the effective date 
     of any rule or provision thereof under any other provision of 
     law or to grant any other relief in addition to the 
     requirements of this section.
       ``(b) In an action for the judicial review of a rule, the 
     regulatory flexibility analysis for such rule, including an 
     analysis prepared or corrected pursuant to paragraph (a)(4), 
     shall constitute part of the entire record of agency action 
     in connection with such review.
       ``(c) Compliance or noncompliance by an agency with the 
     provisions of this chapter shall be subject to judicial 
     review only in accordance with this section.
       ``(d) Nothing in this section bars judicial review of any 
     other impact statement or similar analysis required by any 
     other law if judicial review of such statement or analysis is 
     otherwise permitted by law.''.

      SEC. 343. TECHNICAL AND CONFORMING AMENDMENTS.

       (a) Section 605(b) of title 5, United States Code, is 
     amended to read as follows:
       ``(b) Sections 603 and 604 of this title shall not apply to 
     any proposed or final rule if the head of the agency 
     certifies that the rule will not, if promulgated, have a 
     significant economic impact on a substantial number of small 
     entities. If the head of the agency makes a certification 
     under the preceding sentence, the agency shall publish such 
     certification in the Federal Register at the time of 
     publication of general notice of proposed rulemaking for the 
     rule or at the time of publication of the final rule, along 
     with a statement providing the factual basis for such 
     certification. The agency shall provide such certification 
     and statement to the Chief Counsel for Advocacy of the Small 
     Business Administration.''.
       (b) Section 612 of title 5, United States Code is amended--
       (1) in subsection (a), by striking ``the committees on the 
     Judiciary of the Senate and the House of Representatives, the 
     Select Committee on Small Business of the Senate, and the 
     Committee on Small Business of the House of Representatives'' 
     and inserting ``the Committees on the Judiciary and Small 
     Business of the Senate and House of Representatives''.
       (2) in subsection (b), by striking ``his views with respect 
     to the'' and inserting in lieu thereof, ``his or her views 
     with respect to compliance with this chapter, the adequacy of 
     the rulemaking record with respect to small entities and 
     the''.

      SEC. 344. SMALL BUSINESS ADVOCACY REVIEW PANELS.

       (a) Small Business Outreach and Interagency Coordination.-- 
     Section 609 of title 5, United States Code is amended--
       (1) before ``techniques,'' by inserting ``the reasonable 
     use of'';
       (2) in paragraph (4), after ``entities'' by inserting 
     ``including soliciting and receiving comments over computer 
     networks'';
       (3) by designating the current text as subsection (a); and
       (4) by adding the following:
       ``(b) Prior to publication of an initial regulatory 
     flexibility analysis which a covered agency is required to 
     conduct by this chapter--
       ``(1) a covered agency shall notify the Chief Counsel for 
     Advocacy of the Small Business Administration and provide the 
     Chief Counsel with information on the potential impacts of 
     the proposed rule on small entities and the type of small 
     entities that might be affected;
       ``(2) not later than 15 days after the date of receipt of 
     the materials described in paragraph (1), the Chief Counsel 
     shall identify individuals representative of affected small 
     entities for the purpose of obtaining advice and 
     recommendations from those individuals about the potential 
     impacts of the proposed rule;
       ``(3) the agency shall convene a review panel for such rule 
     consisting wholly of full time Federal employees of the 
     office within the agency responsible for carrying out the 
     proposed rule, the Office of Information and Regulatory 
     Affairs within the Office of Management and Budget, and the 
     Chief Counsel;
       ``(4) the panel shall review any material the agency has 
     prepared in connection with this chapter, including any draft 
     proposed rule, collect advice and recommendations of each 
     individual small entity representative identified by the 
     agency after consultation with the Chief Counsel, on issues 
     related to subsections 603(b), paragraphs (3), (4) and (5) 
     and 603(c);
       ``(5) not later than 60 days after the date a covered 
     agency convenes a review panel pursuant to paragraph (3), the 
     review panel shall report on the comments of the small entity 
     representatives and its findings as to issues related to 
     subsections 603(b), paragraphs (3),

[[Page H2873]]

     (4) and (5) and 603(c), provided that such report shall be 
     made public as part of the rulemaking record; and
       ``(6) where appropriate, the agency shall modify the 
     proposed rule, the initial regulatory flexibility analysis or 
     the decision on whether an initial regulatory flexibility 
     analysis is required.
       ``(c) An agency may in its discretion apply subsection (b) 
     to rules that the agency intends to certify under subsection 
     605(b), but the agency believes may have a greater than de 
     minimis impact on a substantial number of small entities.
       ``(d) For purposed of this section, the term covered agency 
     means the Environmental Protection Agency and the 
     Occupational Safety and Health Administration of the 
     Department of Labor.
       ``(e) The Chief Counsel for Advocacy, in consultation with 
     the individuals identified in subsection (b)(2), and with the 
     Administrator of the Office of Information and Regulatory 
     Affairs within the Office of Management and Budget, may waive 
     the requirements of subsections (b)(3), (b)(4), and (b)(5) by 
     including in the rulemaking record a written finding, with 
     reasons therefor, that those requirements would not advance 
     the effective participation of small entities in the 
     rulemaking process. For purposes of this subsection, the 
     factors to be considered in making such a finding are as 
     follows:
       ``(1) In developing a proposed rule, the extent to which 
     the covered agency consulted with individuals representative 
     of affected small entities with respect to the potential 
     impacts of the rule and took such concerns into 
     consideration; or in developing a final rule, the extent to 
     which the covered agency took into consideration the comments 
     filed by the individuals identified in subsection (b)(2).
       ``(2) Special circumstances requiring prompt issuance of 
     the rule.
       ``(3) Whether the requirements of subsection (b) would 
     provide the individuals identified in subsection (b)(2) with 
     a competitive advantage relative to other small entities.''.
       (b) Small Business Advocacy Chairpersons.--Not later than 
     30 days after the date of enactment of this Act, the head of 
     each covered agency that has conducted a final regulatory 
     flexibility analysis shall designate a small business 
     advocacy chairperson using existing personnel to the extent 
     possible, to be responsible for implementing this section and 
     to act as permanent chair of the agency's review panels 
     established pursuant to this section.

     SEC. 345. EFFECTIVE DATE.

       This subtitle shall become effective on the expiration of 
     90 days after the date of enactment of this subtitle, except 
     that such amendments shall not apply to interpretative rules 
     for which a notice of proposed rulemaking was published prior 
     to the date of enactment.

                    Subtitle E--Congressional Review

     SEC. 351. CONGRESSIONAL REVIEW OF AGENCY RULEMAKING.

       Title 5, United States Code, is amended by inserting 
     immediately after chapter 7 the following new chapter:

         ``CHAPTER 8--CONGRESSIONAL REVIEW OF AGENCY RULEMAKING

``Sec.
``801. Congressional review.
``802. Congressional disapproval procedure.
``803. Special rule on statutory, regulatory, and judicial deadlines.
``804. Definitions.
``805. Judicial review.
``806. Applicability; severability.
``807. Exemption for monetary policy.
``808. Effective date of certain rules.

     ``Sec. 801. Congressional review

       ``(a)(1)(A) Before a rule can take effect, the Federal 
     agency promulgating such rule shall submit to each House of 
     the Congress and to the Comptroller General a report 
     containing--
       ``(i) a copy of the rule;
       ``(ii) a concise general statement relating to the rule, 
     including whether it is a major rule; and
       ``(iii) the proposed effective date of the rule.
       ``(B) On the date of the submission of the report under 
     subparagraph (A), the Federal agency promulgating the rule 
     shall submit to the Comptroller General and make available to 
     each House of Congress--
       ``(i) a complete copy of the cost-benefit analysis of the 
     rule, if any;
       ``(ii) the agency's actions relevant to sections 603, 604, 
     605, 607, and 609;
       ``(iii) the agency's actions relevant to sections 202, 203, 
     204, and 205 of the Unfunded Mandates Reform Act of 1995; and
       ``(iv) any other relevant information or requirements under 
     any other Act and any relevant Executive Orders.
       ``(C) Upon receipt of a report submitted under subparagraph 
     (A), each House shall provide copies of the report to the 
     Chairman and Ranking Member of each standing committee with 
     jurisdiction under the rules of the House of Representatives 
     or the Senate to report a bill to amend the provision of law 
     under which the rule is issued.
       ``(2)(A) The Comptroller General shall provide a report on 
     each major rule to the committees of jurisdiction in each 
     House of the Congress by the end of 15 calendar days after 
     the submission or publication date as provided in section 
     802(b)(2). The report of the Comptroller General shall 
     include an assessment of the agency's compliance with 
     procedural steps required by paragraph (1)(B).
       ``(B) Federal agencies shall cooperate with the Comptroller 
     General by providing information relevant to the Comptroller 
     General's report under subparagraph (A).
       ``(3) A major rule relating to a report submitted under 
     paragraph (1) shall take effect on the latest of--
       ``(A) the later of the date occurring 60 days after the 
     date on which--
       ``(i) the Congress receives the report submitted under 
     paragraph (1); or
       ``(ii) the rule is published in the Federal Register, if so 
     published;
       ``(B) if the Congress passes a joint resolution of 
     disapproval described in section 802 relating to the rule, 
     and the President signs a veto of such resolution, the 
     earlier date--
       ``(i) on which either House of Congress votes and fails to 
     override the veto of the President; or
       ``(ii) occurring 30 session days after the date on which 
     the Congress received the veto and objections of the 
     President; or
       ``(C) the date the rule would have otherwise taken effect, 
     if not for this section (unless a joint resolution of 
     disapproval under section 802 is enacted).
       ``(4) Except for a major rule, a rule shall take effect as 
     otherwise provided by law after submission to Congress under 
     paragraph (1).
       ``(5) Notwithstanding paragraph (3), the effective date of 
     a rule shall not be delayed by operation of this chapter 
     beyond the date on which either House of Congress votes to 
     reject a joint resolution of disapproval under section 802.
       ``(b)(1) A rule shall not take effect (or continue), if the 
     Congress enacts a joint resolution of disapproval, described 
     under section 802, of the rule.
       ``(2) A rule that does not take effect (or does not 
     continue) under paragraph (1) may not be reissued in 
     substantially the same form, and a new rule that is 
     substantially the same as such a rule may not be issued, 
     unless the reissued or new rule is specifically authorized by 
     a law enacted after the date of the joint resolution 
     disapproving the original rule.
       ``(c)(1) Notwithstanding any other provision of this 
     section (except subject to paragraph (3)), a rule that would 
     not take effect by reason of subsection (a)(3) may take 
     effect, if the President makes a determination under 
     paragraph (2) and submits written notice of such 
     determination to the Congress.
       ``(2) Paragraph (1) applies to a determination made by the 
     President by Executive Order that the rule should take effect 
     because such rule is--
       ``(A) necessary because of an imminent threat to health or 
     safety or other emergency;
       ``(B) necessary for the enforcement of criminal laws;
       ``(C) necessary for national security; or
       ``(D) issued pursuant to any statute implementing an 
     international trade agreement.
       ``(3) An exercise by the President of the authority under 
     this subsection shall have no effect on the procedures under 
     section 802 or the effect of a joint resolution of 
     disapproval under this section.
       ``(d)(1) In addition to the opportunity for review 
     otherwise provided under this chapter, in the case of any 
     rule for which a report was submitted in accordance with 
     subsection (a)(1)(A) during the period beginning on the date 
     occurring--
       ``(A) in the case of the Senate, 60 session days, or
       ``(B) in the case of the House of Representatives, 60 
     legislative days,

     before the date the Congress adjourns a session of Congress 
     through the date on which the same or succeeding Congress 
     first convenes its next session, section 802 shall apply to 
     such rule in the succeeding session of Congress.
       ``(2)(A) In applying section 802 for purposes of such 
     additional review, a rule described under paragraph (1) shall 
     be treated as though--
       ``(i) such rule were published in the Federal Register (as 
     a rule that shall take effect) on--
       ``(I) in the case of the Senate, the 15th session day, or
       ``(II) in the case of the House of Representatives, the 
     15th legislative day,

     after the succeeding session of Congress first convenes; and
       ``(ii) a report on such rule were submitted to Congress 
     under subsection (a)(1) on such date.
       ``(B) Nothing in this paragraph shall be construed to 
     affect the requirement under subsection (a)(1) that a report 
     shall be submitted to Congress before a rule can take effect.
       ``(3) A rule described under paragraph (1) shall take 
     effect as otherwise provided by law (including other 
     subsections of this section).
       ``(e)(1) For purposes of this subsection, section 802 shall 
     also apply to any major rule promulgated between March 1, 
     1996, and the date of the enactment of this chapter.
       ``(2) In applying section 802 for purposes of Congressional 
     review, a rule described under paragraph (1) shall be treated 
     as though--
       ``(A) such rule were published in the Federal Register on 
     the date of enactment of this chapter; and
       ``(B) a report on such rule were submitted to Congress 
     under subsection (a)(1) on such date.
       ``(3) The effectiveness of a rule described under paragraph 
     (1) shall be as otherwise

[[Page H2874]]

     provided by law, unless the rule is made of no force or 
     effect under section 802.
       ``(f) Any rule that takes effect and later is made of no 
     force or effect by enactment of a joint resolution under 
     section 802 shall be treated as though such rule had never 
     taken effect.
       ``(g) If the Congress does not enact a joint resolution of 
     disapproval under section 802 respecting a rule, no court or 
     agency may infer any intent of the Congress from any action 
     or inaction of the Congress with regard to such rule, related 
     statute, or joint resolution of disapproval.

     ``Sec. 802. Congressional disapproval procedure

       ``(a) For purposes of this section, the term `joint 
     resolution' means only a joint resolution introduced in the 
     period beginning on the date on which the report referred to 
     in section 801(a)(1)(A) is received by Congress and ending 60 
     days thereafter (excluding days either House of Congress is 
     adjourned for more than 3 days during a session of Congress), 
     the matter after the resolving clause of which is as follows: 
     `That Congress disapproves the rule submitted by the ____ 
     relating to ____, and such rule shall have no force or 
     effect.' (The blank spaces being appropriately filled in).
       ``(b)(1) A joint resolution described in subsection (a) 
     shall be referred to the committees in each House of Congress 
     with jurisdiction.
       ``(2) For purposes of this section, the term `submission or 
     publication date' means the later of the date on which--
       ``(A) the Congress receives the report submitted under 
     section 801(a)(1); or
       ``(B) the rule is published in the Federal Register, if so 
     published.
       ``(c) In the Senate, if the committee to which is referred 
     a joint resolution described in subsection (a) has not 
     reported such joint resolution (or an identical joint 
     resolution) at the end of 20 calendar days after the 
     submission or publication date defined under subsection 
     (b)(2), such committee may be discharged from further 
     consideration of such joint resolution upon a petition 
     supported in writing by 30 Members of the Senate, and such 
     joint resolution shall be placed on the calendar.
       ``(d)(1) In the Senate, when the committee to which a joint 
     resolution is referred has reported, or when a committee is 
     discharged (under subsection (c)) from further consideration 
     of a joint resolution described in subsection (a), it is at 
     any time thereafter in order (even though a previous motion 
     to the same effect has been disagreed to) for a motion to 
     proceed to the consideration of the joint resolution, and all 
     points of order against the joint resolution (and against 
     consideration of the joint resolution) are waived. The motion 
     is not subject to amendment, or to a motion to postpone, or 
     to a motion to proceed to the consideration of other 
     business. A motion to reconsider the vote by which the motion 
     is agreed to or disagreed to shall not be in order. If a 
     motion to proceed to the consideration of the joint 
     resolution is agreed to, the joint resolution shall remain 
     the unfinished business of the Senate until disposed of.
       ``(2) In the Senate, debate on the joint resolution, and on 
     all debatable motions and appeals in connection therewith, 
     shall be limited to not more than 10 hours, which shall be 
     divided equally between those favoring and those opposing the 
     joint resolution. A motion further to limit debate is in 
     order and not debatable. An amendment to, or a motion to 
     postpone, or a motion to proceed to the consideration of 
     other business, or a motion to recommit the joint resolution 
     is not in order.
       ``(3) In the Senate, immediately following the conclusion 
     of the debate on a joint resolution described in subsection 
     (a), and a single quorum call at the conclusion of the debate 
     if requested in accordance with the rules of the Senate, the 
     vote on final passage of the joint resolution shall occur.
       ``(4) Appeals from the decisions of the Chair relating to 
     the application of the rules of the Senate to the procedure 
     relating to a joint resolution described in subsection (a) 
     shall be decided without debate.
       ``(e) In the Senate the procedure specified in subsection 
     (c) or (d) shall not apply to the consideration of a joint 
     resolution respecting a rule--
       ``(1) after the expiration of the 60 session days beginning 
     with the applicable submission or publication date, or
       ``(2) if the report under section 801(a)(1)(A) was 
     submitted during the period referred to in section 801(d)(1), 
     after the expiration of the 60 session days beginning on the 
     15th session day after the succeeding session of Congress 
     first convenes.
       ``(f) If, before the passage by one House of a joint 
     resolution of that House described in subsection (a), that 
     House receives from the other House a joint resolution 
     described in subsection (a), then the following procedures 
     shall apply:
       ``(1) The joint resolution of the other House shall not be 
     referred to a committee.
       ``(2) With respect to a joint resolution described in 
     subsection (a) of the House receiving the joint resolution--
       ``(A) the procedure in that House shall be the same as if 
     no joint resolution had been received from the other House; 
     but
       ``(B) the vote on final passage shall be on the joint 
     resolution of the other House.
       ``(g) This section is enacted by Congress--
       ``(1) as an exercise of the rulemaking power of the Senate 
     and House of Representatives, respectively, and as such it is 
     deemed a part of the rules of each House, respectively, but 
     applicable only with respect to the procedure to be followed 
     in that House in the case of a joint resolution described in 
     subsection (a), and it supersedes other rules only to the 
     extent that it is inconsistent with such rules; and
       ``(2) with full recognition of the constitutional right of 
     either House to change the rules (so far as relating to the 
     procedure of that House) at any time, in the same manner, and 
     to the same extent as in the case of any other rule of that 
     House.

     ``Sec. 803. Special rule on statutory, regulatory, and 
       judicial deadlines

       ``(a) In the case of any deadline for, relating to, or 
     involving any rule which does not take effect (or the 
     effectiveness of which is terminated) because of enactment of 
     a joint resolution under section 802, that deadline is 
     extended until the date 1 year after the date of enactment of 
     the joint resolution. Nothing in this subsection shall be 
     construed to affect a deadline merely by reason of the 
     postponement of a rule's effective date under section 801(a).
       ``(b) The term `deadline' means any date certain for 
     fulfilling any obligation or exercising any authority 
     established by or under any Federal statute or regulation, or 
     by or under any court order implementing any Federal statute 
     or regulation.

     ``Sec. 804. Definitions

       ``For purposes of this chapter--
       ``(1) The term `Federal agency' means any agency as that 
     term is defined in section 551(1).
       ``(2) The term ``major rule'' means any rule that the 
     Administrator of the Office of Information and Regulatory 
     Affairs of the Office of Management and Budget finds has 
     resulted in or is likely to result in--
       ``(A) an annual effect on the economy of $100,000,000 or 
     more;
       ``(B) a major increase in costs or prices for consumers, 
     individual industries, Federal, State, or local government 
     agencies, or geographic regions; or
       ``(C) significant adverse effects on competition, 
     employment, investment, productivity, innovation, or on the 
     ability of United States-based enterprises to compete with 
     foreign-based enterprises in domestic and export markets.

     The term does not include any rule promulgated under the 
     Telecommunications Act of 1996 and the amendments made by 
     that Act.
       ``(3) The term `rule' has the meaning given such term in 
     section 551, except that such term does not include--
       ``(A) any rule of particular applicability, including a 
     rule that approves or prescribes for the future rates, wages, 
     prices, services, or allowances therefor, corporate or 
     financial structures, reorganizations, mergers, or 
     acquisitions thereof, or accounting practices or disclosures 
     bearing on any of the foregoing;
       ``(B) any rule relating to agency management or personnel; 
     or
       ``(C) any rule of agency organization, procedure, or 
     practice that does not substantially affect the rights or 
     obligations of non-agency parties.

     ``Sec. 805. Judicial review

       ``No determination, finding, action, or omission under this 
     chapter shall be subject to judicial review.

     ``Sec. 806. Applicability; severability

       ``(a) This chapter shall apply notwithstanding any other 
     provision of law.
       ``(b) If any provision of this chapter or the application 
     of any provision of this chapter to any person or 
     circumstance, is held invalid, the application of such 
     provision to other persons or circumstances, and the 
     remainder of this chapter, shall not be affected thereby.

     ``Sec. 807. Exemption for monetary policy

       ``Nothing in this chapter shall apply to rules that concern 
     monetary policy proposed or implemented by the Board of 
     Governors of the Federal Reserve System or the Federal Open 
     Market Committee.

     ``Sec. 808. Effective date of certain rules

       ``Notwithstanding section 801--
       ``(1) any rule that establishes, modifies, opens, closes, 
     or conducts a regulatory program for a commercial, 
     recreational, or subsistence activity related to hunting, 
     fishing, or camping, or
       ``(2) any rule which an agency for good cause finds (and 
     incorporates the finding and a brief statement of reasons 
     therefor in the rule issued) that notice and public procedure 
     thereon are impracticable, unnecessary, or contrary to the 
     public interest,

     shall take effect at such time as the Federal agency 
     promulgating the rule determines.''.

     SEC. 352. EFFECTIVE DATE.

       The amendment made by section 351 shall take effect on the 
     date of enactment of this Act.

     SEC. 353. TECHNICAL AMENDMENT.

       The table of chapters for part I of title 5, United States 
     Code, is amended by inserting immediately after the item 
     relating to chapter 7 the following:

``8. Congressional Review of Agency Rulemaking...................801''.