Input:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Iraq Transition Act of 2006''.

SEC. 2. FINDINGS; DECLARATIONS OF POLICY.

    (a) Findings.--Congress makes the following findings:
            (1) The people of Iraq have made significant progress in
        establishing the framework for a democratic government.
            (2) In an October 2005 referendum, the Iraqi people voted
        to approve Iraq's Constitution, setting up an Islamic federal
        democracy while strengthening the rights of women and
        minorities in that country.
            (3) On December 15, 2005, Iraqis voted in the first multi-
        party elections in that country in 50 years.
            (4) The Iraqi parliament that emerged from the December
        2005 elections includes representation across a broad cross
        section of the population and has established affirmative
        measures to include women and ethnic minorities in positions of
        authority.
            (5) The Iraqi constitutional framework has allowed the
        election of President Jalal Talabani and Prime Minister Nouri
        Kamal al-Maliki to form Iraq's first democratically-elected
        government in its history.
            (6) The Government of the United States has expended,
        through the Iraq Relief and Reconstruction Fund (IRRF),
        approximately 67 percent of the $20,912,000,000 in various
        reconstruction efforts in Iraq.
            (7) In an effort to allow Iraqis to take over security
        operations, approximately 265,000 Iraqi Security Forces (ISF)
        have been trained, nearing the total force goal of 325,000 by
        August 2007.
            (8) However, despite the emergence of a democratically-
        elected Iraqi Government, most civilian functions of that
        government remain the responsibility of United States military
        and Coalition military forces.
    (b) Declarations of Policy.--Congress makes the following
declarations of policy:
            (1) While the military excellence with which Operation
        Iraqi Freedom has been executed is to be congratulated, it is
        in the best interests of the United States and the nation of
        Iraq that the proper functions of government be transferred to
        Iraqi control as soon as is practicable.
            (2) In order to have an orderly, deliberate, and
        expeditious transition to Iraqi civilian control, the task of
        doing so must be vested in a national commission which is
        specifically empowered and authorized to monitor and assess
        that transition and oversee that such transition is carried
        out.
            (3) Congress acknowledges that there is successful
        precedent for such a commission in comparable circumstances. At
        the close of World War II, a national commission, composed of
        three United States Senators, three Members of the House of
        Representatives, and three Presidential appointees were
        appointed and directed to oversee the transition of the
        Philippines from United States military to local, civilian
        control.
            (4) It is again the desire of Congress, as set forth in
        this Act, to establish a national commission to undertake the
        responsibility of overseeing the development of a plan and its
        implementation to transition Iraq from United States military
        control to Iraqi civilian control in an orderly, deliberate,
        and expeditious manner.
            (5) Congress anticipates and expects that the United States
        military will work in concert with and be an integral part of
        the national commission.

SEC. 3. PURPOSE.

    It is the purpose of this Act to establish a national commission to
develop plans for the orderly and expeditious transfer of power for
Iraqi Government operations from United States military forces to the
newly-elected Government of Iraq. The national commission shall seek
the goals of empowering the newly-elected Government of Iraq and
reducing reliance on United States military forces, while enabling the
safe, prompt, and orderly return of such military forces to the United
States, and further--
            (1) to facilitate a dialogue between members of the
        commission, Iraqi leaders, and coalition and international
        partners in furtherance of the purpose of this Act;
            (2) to report such findings, conclusions, and
        recommendations as are consistent with the purpose of this Act;
        and
            (3) to provide guidance and support for the expeditious
        assumption of governmental responsibility by the newly-elected
        and appointed Iraqi government officials as is consistent with
        congressional oversight responsibilities regarding the proper
        use of United States reconstruction assistance for Iraq.

SEC. 4. ESTABLISHMENT.

    There is established a commission to be known as the ``Commission
on Iraqi Transition'' (in this Act referred to as the ``Commission'').

SEC. 5. MEMBERSHIP.

    (a) Number and Appointment.--
            (1) In general.--The Commission shall be composed of 21
        members, as follows:
                    (A) Seven members appointed by the President, of
                whom one shall be the Secretary of State (or the
                Secretary's designee), one shall be the Secretary of
                Defense (or the Secretary's designee), and one shall be
                the Secretary of Commerce.
                    (B) Seven members appointed by the Speaker of the
                House of Representatives and the minority leader of the
                House of Representatives, of whom four shall be Members
                of the House of Representatives from the majority party
                and three shall be Members of the House of
                Representatives from the minority party.
                    (C) Seven members appointed by the majority leader
                of the Senate and the minority leader of the Senate, of
                whom four shall be Members of the Senate from the
                majority party and three shall be Members of the Senate
                from the minority party.
            (2) Deadline.--Members of the Commission shall be appointed
        not later than 60 days after the date of the enactment of this
        Act.
    (b) Qualifications.--It is the sense of Congress that individuals
appointed to the Commission shall be United States citizens, with
significant depth of experience relevant to the goals of the
Commission, including in the fields of public administration, finance,
and management.
    (c) Meetings; Quorum; Majority; Vacancies.--
            (1) Meetings.--Not later than 30 days after the date on
        which all members of the Commission have been appointed
        pursuant to subsection (a), the Commission shall hold its first
        meeting. After its initial meeting, the Commission shall meet
        upon the call of the Chairperson or a majority of its members.
            (2) Quorum.--At least 11 members shall constitute a quorum
        for the transaction of business provided a bipartisan
        representation is present.
            (3) Majority.--At least 11 Members shall constitute a
        majority of the Commission.
            (4) Vacancies.--Any vacancy in the Commission shall not
        affect its powers, but shall be filled in the same manner in
        which the original appointment was made.
    (d) Chairperson.--The Chairperson of the Commission shall be
elected by the members of the Commission

SEC. 6. DUTIES OF COMMISSION.

    (a) Study and Report.--The Commission shall study and report upon
all issues relating to the orderly and expeditious transfer of power
for Iraqi Government operations from United States military forces to
the newly-elected Government of Iraq, particularly to the Prime
Minister of Iraq, the President of Iraq, and the Iraqi Council of
Representatives, including day-to-day operations of Iraqi ministries
and departments, as have been established by the Iraqi Constitution and
laws, including the Ministries of Agriculture, Capital Markets
Institutions, Communications, Commission on Public Integrity, Culture,
Defense, Displacement and Migration, Education, Electricity,
Environment, Finance, Foreign Affairs, Health, Higher Educations,
Housing and Construction, Humane Rights, Industry and Minerals,
Interior, Property Claims Commission, Justice, Labor and Social
Affairs, Municipalities and Public Works, Oil, Planning and
Development, Private Sector Development, Science and Technology, Trade,
Transportation, Water Resources, and Youth and Sports.
    (b) Promotion of Accountability and Other Goals.--In carrying out
subsection (a), the Commission shall seek to promote the government-
wide management goals of accountability, effective management,
efficiency and economy of operations, ethical conduct, and the merit-
based recruitment and compensation of a professional civil service for
the Iraqi Government.

SEC. 7. POWERS OF COMMISSION.

    (a) Hearings; Subpoena Power.--
            (1) In general.--The Commission or, on the authority of the
        Commission, any subcommittee or member thereof, may, for the
        purpose of carrying out this Act--
                    (A) hold such hearings and sit and act at such
                times and places, take such testimony, receive such
                evidence, and administer such oaths as the Commission
                considers appropriate; and
                    (B) require, by subpoena or otherwise, the
                attendance and testimony of such witnesses and the
                production of such books, records, correspondence,
                memoranda, papers, and other documents, as the
                Commission, or such designated subcommittee or
                designated member thereof, is empowered to investigate
                under this Act.
            (2) Service of subpoenas.--A subpoena issued pursuant to
        paragraph (1)(B) may be issued under the signature of the
        Chairperson of the Commission, the chairperson of any
        designated subcommittee thereof, or any designated member
        thereof, and may be served by any person designated by such
        Chairperson, subcommittee chairperson, or member. The
        provisions of sections 102 through 104 of the Revised Statutes
        of the United States (2 U.S.C. 192-194) shall apply in the case
        of any failure of any witness to comply with any subpoena or to
        testify when summoned under authority of this section.
    (b) Contracting.--The Commission may, to such extent and in such
amounts as are provided in appropriation Acts, enter into contracts to
enable the Commission to discharge its duties under this Act.
    (c) Information From Federal Agencies.--The Commission is
authorized to secure directly from any executive department, bureau,
agency, board, commission, office, independent establishment, or
instrumentality of the Government information, suggestions, estimates,
and statistics for the purposes of this Act. Each such department,
bureau, agency, board, commission, office, independent establishment,
or instrumentality shall, to the extent authorized by law, furnish such
information, suggestions, estimates, and statistics directly to the
Commission, upon request made by the Chairperson of the Commission.
    (d) Assistance From Federal Agencies.--
            (1) Department of state.--The Secretary of State is
        authorized on a reimbursable or nonreimbursable basis to
        provide the Commission with administrative services, funds,
        facilities, staff, and other support services for the
        performance of the Commission's duties under this Act.
            (2) General services administration.--The Administrator of
        General Services shall provide to the Commission on a
        reimbursable basis such administrative support services as the
        Commission may request.
            (3) Other departments and agencies.--In addition to the
        assistance set forth in paragraphs (1) and (2), departments and
        agencies of the United States are authorized to provide to the
        Commission such services, funds, facilities, staff, and other
        support services as such departments and agencies may deem
        advisable and as may be authorized by law.
    (e) Gifts.--The Commission may accept, use, and dispose of gifts or
donations of services or property.
    (f) Postal Services.--The Commission may use the United States
mails in the same manner and under the same conditions as department
and agencies of the United States.

SEC. 8. STAFF OF COMMISSION.

    (a) In General.--The Chairperson of the Commission, in accordance
with rules agreed upon by the Commission, may appoint and fix the
compensation of a staff director and such other personnel as may be
necessary to enable the Commission to carry out its duties under this
Act, without regard to the provisions of title 5, United States Code,
governing appointments in the competitive service, and without regard
to the provisions of chapter 51 and subchapter III of chapter 53 of
such title relating to classification and General Schedule pay rates,
except that no rate of pay fixed under this subsection may exceed the
equivalent of that payable for a position at level V of the Executive
Schedule under section 5316 of title 5, United States Code.
    (b) Detailees.--Any Federal Government employee may be detailed to
the Commission without reimbursement for the Commission, and such
detailee shall retain the rights, status, and privileges of his or her
regular employment without interruption.
    (c) Consultant Services.--The Commission is authorized to procure
the services of experts and consultants in accordance with section 3109
of title 5, United States Code, but at rates not to exceed the daily
rate paid a person occupying a position at level IV of the Executive
Schedule under section 5315 of title 5, United States Code.

SEC. 9. COMPENSATION AND TRAVEL EXPENSES.

    (a) Compensation.--
            (1) Rates of pay.--Each member of the Commission may be
        compensated at not to exceed the daily equivalent of the annual
        rate of basic pay in effect for a position at level IV of the
        Executive Schedule under section 5315 of title 5, United States
        Code, for each day during which that member is engaged in the
        actual performance of the duties of the Commission.
            (2) Prohibition on compensation of federal employees.--
        Members of the Commission who are officers or employees of the
        United States or Members of Congress may not receive additional
        pay on account of their service on the Commission.
    (b) Travel Expenses.--While away from their homes or regular places
of business in the performance of services for the Commission, members
of the Commission shall be allowed travel expenses, including per diem
in lieu of subsistence, in the same manner as persons employed
intermittently in the Government service are allowed expenses under
section 5703(b) of title 5, United States Code.

SEC. 10. SECURITY CLEARANCES FOR COMMISSION MEMBERS AND STAFF.

    The appropriate Federal agencies or departments shall cooperate
with the Commission in expeditiously providing to the Commission
members and staff appropriate security clearances to the extent
possible pursuant to existing procedures and requirements, except that
no person shall be provided with access to classified information under
this Act without the appropriate security clearances.

SEC. 11. REPORTS OF COMMISSION; CONGRESSIONAL RESPONSE; TERMINATION.

    (a) Initial Report.--Not later than 90 days after the date of its
initial meeting, the Commission shall submit to the President and
Congress a report that contains--
            (1) an assessment of any and all progress in the transfer
        of governmental authority to the newly elected Iraqi
        Government; and
            (2) such findings, conclusions, and recommendations,
        approved by a majority of its members, as the Commission shall
        determine to be consistent with the purpose of this Act.
    (b) Interim Reports.--The Commission may submit to the President
and Congress interim reports containing such findings, conclusions, and
recommendations as have been agreed to by a majority of Commission
members.
    (c) Final Report.--By vote of a majority of its members, the
Commission shall submit to the President and Congress a determination
in its final report that all or substantially all of the governing
authority has been transferred to the Iraqi Government.
    (d) Congressional Response.--
            (1) Hearings.--At any time following the receipt of the
        initial report, interim reports, or final report of the
        Commission under this section, the Committee on International
        Relations of the House of Representatives and the Committee on
        Foreign Relations of the Senate may initiate hearings to
        consider the findings and recommendations of the report.
            (2) Legislation.--At any time following the receipt of the
        initial report, interim reports, or final report of the
        Commission under this section, Congress may give such findings,
        conclusions, or recommendations legislative effect as it deems
        appropriate.
    (e) Termination.--
            (1) In general.--The Commission, and all the authorities of
        this Act, shall terminate no later than 90 days after the date
        on which the final report is submitted under subsection (c).
            (2) Administrative activities before termination.--The
        Commission may use the 90-day period referred to in paragraph
        (1) for the purpose of concluding its activities, including
        providing testimony to committees of Congress concerning its
        reports and disseminating the final report.

SEC. 12. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There are authorized to be appropriated such sums
as may be necessary to carry out this Act.
    (b) Availability.--Amounts appropriated pursuant to the
authorization of appropriations under subsection (a) are authorized to
remain available, without fiscal year limitation, until expended.

Output: Iraq Transition Act of 2006 - Establishes the Commission on Iraqi Transition, which shall report upon all issues relating to the transfer of power for Iraqi government operations from U.S. military forces to the newly-elected government of Iraq, particularly to the Prime Minister of Iraq, the President of Iraq, and the Iraqi Council of Representatives, including day-to-day operations of Iraqi ministries and departments.


Input:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Value Based Insurance Design for
Better Care Act of 2014'' or the ``VBID for Better Care Act of 2014''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) A growing body of evidence demonstrates that increases
        in patient-level financial barriers (including deductibles,
        copayments, and coinsurance) for high-value medical services
        (such as prescription medications, clinician visits, diagnostic
        tests, and procedures) systematically reduce their use. Savings
        attributable to cost-related decreased utilization of specific
        services may lead to an increase in total medical expenditures
        due to increased use of other related clinical services, such
        as hospitalizations and emergency room visits.
            (2) Empirical research studies demonstrate that reductions
        in beneficiary out-of-pocket expenses for high-value
        prescription medications and clinical services can mitigate the
        adverse health and financial consequences attributable to cost-
        related decreased utilization of high-value services.
            (3) Financial barriers to prescription medications and
        clinical services that are deemed to be high value should be
        reduced or eliminated to increase their use.
            (4) Value-Based Insurance Design is a methodology that
        adjusts patient out-of-pocket costs for prescription
        medications and clinical services according to the clinical
        value--not exclusively the cost. Value-Based Insurance Design
        is based on the concept of clinical nuance that recognizes--
                    (A) prescription medications and clinical services
                differ in the clinical benefit provided; and
                    (B) the clinical benefit derived from a specific
                prescription medication or clinical service depends on
                the clinical situation, the provider, and where the
                care is delivered.
            (5) The current ``one-size-fits-all'' copayment or
        coinsurance design for prescription medications and clinical
        services provided under the Medicare program does not recognize
        the well-established value differences in health outcomes
        produced by various medical interventions.
            (6) The establishment by Medicare of copayment and
        coinsurance requirements using Value-Based Insurance Design
        methodologies will improve patient-centered health outcomes,
        enhance personal responsibility, and afford a more efficient
        use of taxpayer dollars.

SEC. 3. DEMONSTRATION PROGRAM.

    (a) In General.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall establish a 3-year
demonstration program to test the use of value-based insurance design
methodologies (as defined in subsection (c)(1)) under eligible Medicare
Advantage plans offered by Medicare Advantage organizations under part
C of title XVIII of the Social Security Act (42 U.S.C. 1395w-21 et
seq.).
    (b) Demonstration Program Design.--
            (1) Selection of ma region and eligible medicare advantage
        plans.--The Secretary shall--
                    (A) select at least two MA regions (as defined in
                section 1858(a)(2) of the Social Security Act (42
                U.S.C. 1395w-27a(a)(2))) with respect to which to
                conduct the demonstration program under this section;
                and
                    (B) approve eligible Medicare Advantage plans to
                participate in such demonstration program.
            (2) Start of demonstration.--The demonstration program
        shall begin with respect to the first plan year beginning after
        the date on which at least two eligible Medicare Advantage
        plans have been approved by the Secretary in at least one MA
        region selected under paragraph (1).
            (3) Eligible medicare advantage plans.--For purposes of
        this section, the term ``eligible Medicare Advantage plan''
        means a Medicare Advantage plan under part C of title XVIII of
        the Social Security Act (42 U.S.C. 1395w-21 et seq.) that meets
        the following requirements:
                    (A) The plan is an MA regional plan (as defined in
                paragraph (4) of section 1859(b) of such Act (42 U.S.C.
                1395w-28(b))) or MA local plan (as defined in paragraph
                (5) of such section) offered in the MA region selected
                under paragraph (1)(A).
                    (B) The plan has--
                            (i) a quality rating under section
                        1853(n)(4) of such Act (42 U.S.C. 1395w-
                        23(n)(4)) of 4 stars or higher based on the
                        most recent data available for such year;
                            (ii) in the case of a specialized MA plan
                        for special needs individuals, as defined in
                        subsection (b)(6)(A) of section 1859(b)(6)(A)
                        of such Act (42 U.S.C. 1395w-28(b)(6)(A)),
                        received a multi-year approval by the National
                        Committee for Quality Assurance under
                        subsection (f)(7) of such section; or
                            (iii) at least 20 percent of the population
                        to whom the plan is offered consists of subsidy
                        eligible individuals (as defined in section
                        1860D-14(a)(3)(A) of the Social Security Act
                        (42 U.S.C. 1395w-114(a)(3)(A))).
    (c) Value-Based Insurance Design Methodologies.--
            (1) Definition.--For purposes of this section, the term
        ``value-based insurance design methodology'' means a
        methodology for identifying specific prescription medications,
        and clinical services that are reimbursable under title XVIII
        of the Social Security Act, for which copayments, coinsurance,
        or both should be reduced or eliminated because of the high
        value and effectiveness of such medications and services for
        specific chronic clinical conditions (as approved by the
        Secretary).
            (2) Use of methodologies to reduce copayments and
        coinsurance.--A Medicare Advantage organization offering an
        eligible Medicare Advantage plan selected to participate under
        the demonstration program, for each plan year for which the
        plan is so selected and using value-based insurance design
        methodologies--
                    (A) shall identify each prescription medication and
                clinical service covered under such plan for which the
                amount of the copayment or coinsurance should be
                reduced or eliminated, with respect to the management
                of specific chronic clinical conditions (as specified
                by the Secretary) of MA eligible individuals (as
                defined in section 1851(a)(3) of the Social Security
                Act (42 U.S.C. 1395w-21(a)(3))) enrolled under such
                plans, for such plan year; and
                    (B) may, for such plan year, reduce or eliminate
                copayments, coinsurance, or both for such prescription
                medication and clinical services so identified with
                respect to the management of such conditions of such
                individuals--
                            (i) if such reduction or elimination is
                        evidence-based, for the purpose of encouraging
                        such individuals in such plan to use such
                        prescription medications and clinical services
                        (such as preventive care, primary care,
                        specialty visits, diagnostic tests, procedures,
                        and durable medical equipment) with respect to
                        such conditions; and
                            (ii) for the purpose of encouraging such
                        individuals in such plan to use health care
                        providers that such organization has identified
                        with respect to such plan year.
            (3) Prohibition of increases of copayments and
        coinsurance.--In no case may any Medicare Advantage plan
        participating in the demonstration program increase, for any
        plan year for which the plan is so participating, the amount of
        copayments or coinsurance for any item or service covered under
        such plan for purposes of discouraging the use of such item or
        service.
    (d) Report on Implementation.--
            (1) In general.--Not later than 1 year after the date on
        which the demonstration program under this section begins under
        subsection (b)(2), the Secretary shall submit to Congress a
        report on the status of the implementation of the demonstration
        program.
            (2) Elements.--The report required by paragraph (1) shall,
        with respect to eligible Medicare Advantage plans participating
        in the demonstration program for the first plan year of such
        program, include the following:
                    (A) A list of each medication and service
                identified pursuant to subsection (c)(2)(A) for such
                plan with respect to such plan year.
                    (B) For each such medication or service so
                identified, the amount of the copayment or coinsurance
                required under such plan with respect to such plan year
                for such medication or service and the amount of the
                reduction of such copayment or coinsurance from the
                previous plan year.
                    (C) For each provider identified pursuant to
                subsection (c)(2)(B)(ii) for such plan with respect to
                such plan year, a statement of the amount of the
                copayment or coinsurance required under such plan with
                respect to such plan year and the amount of the
                reduction of such copayment or coinsurance from the
                previous plan year.
    (e) Review and Assessment of Utilization of Value-Based Insurance
Design Methodologies.--
            (1) In general.--The Secretary shall enter into a contract
        or agreement with an independent, non-biased entity having
        expertise in value-based insurance design methodologies to
        review and assess the implementation of the demonstration
        program under this section. The review and assessment shall
        include the following:
                    (A) An assessment of the utilization of value-based
                insurance design methodologies by Medicare Advantage
                plans participating under such program.
                    (B) An analysis of whether reducing or eliminating
                the copayment or coinsurance for each medication and
                clinical service identified pursuant to subsection
                (c)(2)(A) resulted in increased adherence to medication
                regimens, increased service utilization, improvement in
                quality metrics, better health outcomes, and enhanced
                beneficiary experience.
                    (C) An analysis of the extent to which costs to
                Medicare Advantage plans under part C of title XVIII of
                the Social Security Act participating in the
                demonstration program is less than costs to Medicare
                Advantage plans under such part that are not
                participating in the demonstration program.
                    (D) An analysis of whether reducing or eliminating
                the copayment or coinsurance for providers identified
                pursuant to subsection (c)(2)(B)(ii) resulted in
                improvement in quality metrics, better health outcomes,
                and enhanced beneficiary experience.
                    (E) An analysis, for each provider so identified,
                the extent to which costs to Medicare Advantage plans
                under part C of title XVIII of the Social Security Act
                participating in the demonstration program is less than
                costs to Medicare Advantage plans under such part that
                are not participating in the demonstration program.
                    (F) Such other matters, as the Secretary considers
                appropriate.
            (2) Report.--The contract or agreement entered into under
        paragraph (1) shall require such entity to submit to the
        Secretary a report on the review and assessment conducted by
        the entity under such paragraph in time for the inclusion of
        the results of such report in the report required by paragraph
        (3).
            (3) Report to congress.--Not later than 3 years after the
        date on which the demonstration program begins under subsection
        (b)(2), the Secretary shall submit to Congress a report on the
        review and assessment of the demonstration program conducted
        under this subsection. The report shall include the following:
                    (A) A description of the results of the review and
                assessment included in the report submitted pursuant to
                paragraph (2).
                    (B) Such recommendations as the Secretary considers
                appropriate for enhancing the utilization of the
                methodologies applied under the demonstration program
                to all Medicare Advantage plans under part C of title
                XVIII of the Social Security Act so as to reduce
                copayments and coinsurance under such plans paid by
                Medicare beneficiaries for high-value prescription
                medications and clinical services for which coverage is
                provided under such plans and to otherwise improve the
                quality of health care provided under such plans.
    (f) Expansion of Demonstration Program.--The Secretary shall expand
the demonstration program, pursuant to notice and comment rulemaking,
to implement, on a permanent basis, the components of the demonstration
program that are beneficial to Medicare beneficiaries and the Medicare
program, unless the report under subsection (d) or (e)(3) contains an
evaluation that the demonstration program--
            (1) increases expenditures under title XVIII with respect
        to Medicare beneficiaries participating in the demonstration
        program; or
            (2) decreases the quality of health care services furnished
        to such Medicare beneficiaries participating in the
        demonstration program.
    (g) Waiver Authority.--The Secretary may waive such provisions of
titles XI and XVIII of the Social Security Act as may be necessary to
carry out the demonstration program under this section.
    (h) Implementation Funding.--For purposes of carrying out the
demonstration program under this section, the Secretary shall provide
for the transfer from the Federal Hospital Insurance Trust Fund under
section 1817 of the Social Security Act (42 U.S.C. 1395i) and the
Federal Supplementary Insurance Trust Fund under section 1841 of the
Social Security Act (42 U.S.C. 1395t), including the Medicare
Prescription Drug Account in such Trust Fund, in such proportion as
determined appropriate by the Secretary, of such sums as may be
necessary.

Output: Value Based Insurance Design for Better Care Act of 2014 or the VBID for Better Care Act of 2014 - Directs the Secretary of Health and Human Services (HHS) to establish a three-year demonstration program to test the use of value-based insurance design methodologies under the eligible Medicare plans offered by Medicare Advantage organizations under part C (Medicare+Choice) of title XVIII (Medicare) of the Social Security Act. Defines "value-based insurance design methodology" as one for identifying specific prescription medications, and clinical services reimbursable under Medicare, for which copayments, coinsurance, or both should be reduced or eliminated because of the high-value and effectiveness of these medications and services for specific chronic clinical conditions (as approved by the Secretary). Directs the Secretary to expand the demonstration program to implement, on a permanent basis, those components beneficial to Medicare beneficiaries and the Medicare program, unless a required evaluation of the program states that it: (1) increases expenditures under Medicare with respect to participating beneficiaries, or (2) decreases the quality of health care services furnished to such beneficiaries.


Input:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Protection Against Wasteful Spending
Act of 2014''.

SEC. 2. REPORT RECOMMENDATIONS OF WASTEFUL AND EXCESSIVE SPENDING
              REQUIRED.

    (a) Implementation of Report Recommendations Required.--With
respect to each of fiscal years 2014 through 2020 and except as
provided in subsection (b), not later than 4 years after the submission
of a report regarding wasteful and excessive spending, or duplicative
programs causing wasteful and excessive spending, by an inspector
general of an agency (in this Act, referred to as the ``IG report''),
the head of the agency shall implement all of the recommendations in
such report.
    (b) Exception.--The implementation requirement in subsection (a)
shall not apply to a recommendation by an inspector general that would
violate an existing law. With regard to any such recommendation, the
head of the relevant agency shall submit to Congress a description of
the necessary change to the law to legally implement the
recommendation.
    (c) Report Required.--
            (1) Initial report.--Not later than 6 months after the
        submission of an IG report, or 6 months after the date of the
        enactment of this Act, whichever is later, the head of the
        relevant agency shall submit to Congress a report on--
                    (A) the progress of the implementation of each
                recommendation in the IG report;
                    (B) the time period required to complete each such
                implementation;
                    (C) the wasteful and excessive spending, and
                duplicative programs causing wasteful and excessive
                spending within each agency described in the IG report;
                    (D) the savings created from the completion of
                implementing each recommendation; and
                    (E) the reason each recommendation was not
                implemented before the submission of the IG report.
            (2) Subsequent reports.--Not later than 13 months, and
        yearly thereafter until an updated report is submitted for
        fiscal year 2020, after the submission of an IG report, the
        head of the relevant agency shall submit to Congress an updated
        report on the information described in subparagraphs (A)
        through (E) of paragraph (1).

SEC. 3. FAILURE TO IMPLEMENT RECOMMENDATIONS.

    (a) In General.--Any agency that fails to implement a
recommendation from an IG report, that is not an exception under
section 2(b), in a timely manner, may not obligate any funds available
to such agency for--
            (1) convention or seminar attendance and international or
        domestic travel by any politically-appointed official; or
            (2) any bonus or salary increase, performance or otherwise,
        with respect to such an official.
    (b) Funds Subject to Obligation Limitation.--On the date that is 60
days after the submission of a report pursuant to section 2(c) that
shows that an agency has failed to implement a recommendation of an IG
report in a timely manner, of the funds prohibited from being obligated
pursuant to subsection (a) (if any)--
            (1) 50 percent shall be credited to the Highway Trust Fund
        established under section 9503(a) of the Internal Revenue Code
        of 1986, to be made available without further appropriation;
        and
            (2) 50 percent shall be transferred to the Administrator of
        the Environmental Protection Agency for making capitalization
        grants for State water pollution control revolving funds under
        section 603 of the Federal Water Pollution Control Act (33
        U.S.C. 1382), to be made available without further
        appropriation.
    (c) Timely Manner Defined.--In this section, the term ``timely
manner'' means, as determined by the Director of the Office of
Management and Budget, in consultation with the Comptroller General and
the inspector general of the relevant agency, with regard to the
implementation of a recommendation from an IG report, that is not an
exception under section 2(b)--
            (1) 30 percent completion of such recommendation within the
        first year following the submission of the IG report; and
            (2) 70 percent completion of such recommendation within the
        second year following the submission of the IG report.

SEC. 4. USE OF SAVINGS.

    Of the savings (if any) from the implementation of a recommendation
from an IG report pursuant to this Act--
            (1) 50 percent shall be credited to the Highway Trust Fund
        established under section 9503(a) of the Internal Revenue Code
        of 1986, to be made available without further appropriation;
        and
            (2) 50 percent shall be transferred to the Administrator of
        the Environmental Protection Agency for making capitalization
        grants for State water pollution control revolving funds under
        section 603 of the Federal Water Pollution Control Act (33
        U.S.C. 1382), to be made available without further
        appropriation.

SEC. 5. DEFINITIONS.

    In this Act--
            (1) the term ``agency'' has the meaning given that term in
        section 551 of title 5, United States Code; and
            (2) the term ``politically-appointed official'' means any
        employee of the Federal Government who is--
                    (A) not paid under the General Schedule (chapter 53
                of title 5, United States Code); and
                    (B) appointed by the President by and with the
                advice and consent of the Senate.

Output: Protection Against Wasteful Spending Act of 2014 - Requires the head of a federal agency to: (1) implement in each of fiscal years 2014-2020 all of the recommendations of the agency's inspector general (IG) regarding wasteful and excessive spending, or duplicative programs causing wasteful and excessive spending, except for any recommendation that would violate an existing law; and (2) report to Congress on such implementation.  Prohibits an agency that fails to implement an IG recommendation in a timely manner from obligating funds for: (1) convention or seminar attendance and international or domestic travel by any politically-appointed official, or (2) any bonus or salary increase for such official.  Directs that such funds that are prohibited from being obligated and amounts saved by the implementation of IG recommendations be credited or transferred equally to: (1) the Highway Trust Fund, and (2) the Administrator of the Environmental Protection Agency (EPA) for capitalization grants for state water pollution control revolving funds under the Clean Water Act.


Input:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Rural Health Care Facility
Improvement Act of 2002''.

SEC. 2. GUARANTEED LOANS FOR RURAL HEALTH FACILITIES.

    Title VI of the Public Health Service Act (42 U.S.C. 291 et seq.)
is amended by adding at the end the following:

                   ``PART E--RURAL HEALTH FACILITIES

``SEC. 651. GUARANTEED LOANS FOR RURAL HEALTH FACILITIES.

    ``(a) Authorization of Loan Guarantees.--
            ``(1) Establishment.--The Secretary is authorized to
        establish a program under which the Secretary may guarantee 100
        percent of the principal and interest on loans made by non-
        Federal lenders to rural health facilities to pay for the costs
        of--
                    ``(A) buying new or repairing existing
                infrastructure; and
                    ``(B) buying new or repairing existing technology.
            ``(2) Total loan amount available.--The Secretary is
        authorized to guarantee not more than--
                    ``(A) $250,000,000 in the aggregate of the
                principal and interest on loans for rural health
                facilities under paragraph (1); and
                    ``(B) $5,000,000 of the principal and interest on
                loans under paragraph (1) for each rural health
                facility.
    ``(b) Protection of Financial Interests.--The Secretary may not
approve a loan guarantee under this section unless the Secretary
determines that--
            ``(1) the terms, conditions, security (if any), and
        schedule and amount of repayments with respect to the loan are
        sufficient to protect the financial interests of the United
        States and are otherwise reasonable, including a determination
        that the rate of interest does not exceed such percent per
        annum on the principal obligation outstanding as the Secretary
        determines to be reasonable, taking into account the range of
        interest rates prevailing in the private market for similar
        loans and the risks assumed by the United States, except that
        the Secretary may not require as security any rural health
        facility asset that is, or may be, needed by the rural health
        facility involved to provide health services;
            ``(2) the loan would not be available on reasonable terms
        and conditions without the guarantee under this section; and
            ``(3) amounts appropriated for the program under this
        section are sufficient to provide loan guarantees under this
        section.
    ``(c) Recovery of Payments.--
            ``(1) In general.--The United States shall be entitled to
        recover from the applicant for a loan guarantee under this
        section the amount of any payment made pursuant to such
        guarantee, unless the Secretary for good cause waives such
        right of recovery (subject to appropriations remaining
        available to permit such a waiver) and, upon making any such
        payment, the United States shall be subrogated to all of the
        rights of the recipient of the payments with respect to which
        the guarantee was made. Amounts recovered under this section
        shall be credited as reimbursements to the financing account of
        the program established under this section.
            ``(2) Modification of terms and conditions.--To the extent
        permitted by paragraph (3) and subject to the requirements of
        section 504(e) of the Federal Credit Reform Act of 1990 (2
        U.S.C. 661c(e)), any terms and conditions applicable to a loan
        guarantee under this section (including terms and conditions
        imposed under paragraph (4)) may be modified or waived by the
        Secretary to the extent the Secretary determines it to be
        consistent with the financial interest of the United States.
            ``(3) Incontestability.--Any loan guarantee made by the
        Secretary under this section shall be incontestable--
                    ``(A) in the hands of an applicant on whose behalf
                such guarantee is made unless the applicant engaged in
                fraud or misrepresentation in securing such guarantee;
                and
                    ``(B) as to any person (or successor in interest)
                who makes or contracts to make a loan to such applicant
                in reliance thereon unless such person (or successor in
                interest) engaged in fraud or misrepresentation in
                making or contracting to make such loan.
            ``(4) Further terms and conditions.--Guarantees of loans
        under this section shall be subject to such further terms and
        conditions as the Secretary determines to be necessary to
        assure that the purposes of this section will be achieved.
    ``(d) Defaults.--
            ``(1) In general.--Subject to the requirements of the
        Federal Credit Reform Act of 1990 (2 U.S.C. 661 et seq.), the
        Secretary may take such action as may be necessary to prevent a
        default on a loan guaranteed under this section, including the
        waiver of regulatory conditions, deferral of loan payments,
        renegotiation of loans, and the expenditure of funds for
        technical and consultative assistance, for the temporary
        payment of the interest and principal on such a loan, and for
        other purposes. Any such expenditure made under the preceding
        sentence on behalf of a rural health facility shall be made
        under such terms and conditions as the Secretary shall
        prescribe, including the implementation of such organizational,
        operational, and financial reforms as the Secretary determines
        are appropriate and the disclosure of such financial or other
        information as the Secretary may require to determine the
        extent of the implementation of such reforms.
            ``(2) Foreclosure.--The Secretary may take such action,
        consistent with State law respecting foreclosure procedures
        and, with respect to reserves required for furnishing services
        on a prepaid basis, subject to the consent of the affected
        States, as the Secretary determines appropriate to protect the
        interest of the United States in the event of a default on a
        loan guaranteed under this section, except that the Secretary
        may only foreclose on assets offered as security (if any) in
        accordance with subsection (b).
    ``(e) Nonapplication of Part D.--The provisions of part D shall not
apply to this part.
    ``(f) Definitions.--In this part:
            ``(1) Non-federal lender.--The term `non-Federal lender'
        means any entity other than an agency or instrumentality of the
        Federal Government authorized by law to make such loan,
        including a federally insured bank, a lending institution
        authorized or licensed by the State in which it resides to make
        such loans, and a State or municipal bonding authority or such
        authority's designee.
            ``(2) Rural area.--The term `rural area' has the meaning
        given the term in section 1886(d)(2)(D) of the Social Security
        Act (42 U.S.C. 1395ww(d)(2)(D)).
            ``(3) Rural health facility.--The term `rural health
        facility' includes--
                    ``(A) rural health clinics (as defined in section
                1861(aa)(2) of the Social Security Act (42 U.S.C.
                1395x(aa)(2)));
                    ``(B) critical access hospitals (as defined in
                section 1861(mm)(1) of the Social Security Act (42
                U.S.C. 1395x(mm)(1))) that are located in rural areas;
                    ``(C) hospitals (as defined in section 1861(e) of
                the Social Security Act (42 U.S.C. 1395x(e))) that are
                located in rural areas;
                    ``(D) skilled nursing facilities (as defined in
                section 1819(a) of the Social Security Act (42 U.S.C.
                1395i-3(a))) that are located in rural areas;
                    ``(E) health centers (as defined in section 330)
                that are located in rural areas;
                    ``(F) federally qualified health centers (as
                defined in section 1861(aa)(3) of the Social Security
                Act (42 U.S.C. 1395x(aa)(3))); and
                    ``(G) nursing homes (as defined in section 1908(e)
                of the Social Security Act (42 U.S.C. 1396g(e))) that
                are located in rural areas.''.

Output: Rural Health Care Facility Improvement Act of 2002 - Amends the Public Health Service Act to authorizes the Secretary of Health and Human Services to establish a loan guarantee program for rural health facilities. Defines rural health facility to include the following facilities found in rural areas: health clinics, critical access hospitals, hospitals, skilled nursing facilities, health centers, federally qualified health centers, and nursing homes. Covers the purchase of new and the repair of existing infrastructure and technology. Sets forth loan limits.Entitles the United States to subrogation and makes such loan guarantees incontestable. Authorizes the Secretary to take such action as may be necessary to prevent a default, subject to the requirements of the Federal Credit Reform Act of 1990. Permits the Secretary to foreclose, as specified.


Input:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Down Payment to Protect National
Security Act of 2012''.

SEC. 2. REDUCTION IN THE NUMBER OF FEDERAL EMPLOYEES.

    (a) Definition.--In this section, the term ``agency'' has the
meaning given the term ``Executive agency'' under section 105 of title
5, United States Code.
    (b) Determination of Number of Employees.--Not later than 60 days
after the date of enactment of this Act, the Director of the Office of
Management and Budget shall determine the number of full-time employees
employed in each agency. The head of each agency shall cooperate with
the Director of the Office of Management and Budget in making the
determinations.
    (c) Replacement Hire Rate.--
            (1) In general.--During the period described under
        paragraph (2), the head of each agency may hire no more than 2
        employees in that agency for every 3 employees who leave
        employment in that agency.
            (2) Period of replacement hire rate.--Paragraph (1) shall
        apply to each agency during the period beginning 60 days after
        the date of enactment of this Act through the date on which the
        Director of the Office of Management and Budget makes a
        determination that the number of full-time employees employed
        in that agency is 5 percent less than the number of full-time
        employees employed in that agency determined under subsection
        (a).
    (d) Waivers.--This section may be waived upon a determination by
the President that--
            (1) the existence of a state of war or other national
        security concern so requires; or
            (2) the existence of an extraordinary emergency threatening
        life, health, public safety, property, or the environment so
        requires.

SEC. 3. EXTENSION OF PAY FREEZE FOR FEDERAL EMPLOYEES.

    (a) In General.--Section 147 of the Continuing Appropriations Act,
2011 (Public Law 111-242; 5 U.S.C. 5303 note) is amended--
            (1) in subsection (b)(1), by striking ``December 31, 2012''
        and inserting ``June 30, 2014''; and
            (2) in subsection (c), by striking ``December 31, 2012''
        and inserting ``June 30, 2014''.
    (b) Clarification That Freeze Applies to Members of Congress.--
Notwithstanding any other provision of law, no adjustment shall be made
under section 601(a) of the Legislative Reorganization Act of 1946 (2
U.S.C. 31) (relating to cost of living adjustments for Members of
Congress) during the period beginning on the first day of the first pay
period beginning on or after February 1, 2013 and ending on June 30,
2014.

SEC. 4. REDUCTION OF REVISED DISCRETIONARY SPENDING LIMITS TO ACHIEVE
              SAVINGS FROM FEDERAL EMPLOYEE PROVISIONS.

    Paragraph (2) of section 251A of the Balanced Budget and Emergency
Deficit Control Act of 1985 (2 U.S.C. 901a) is amended to read as
follows:
            ``(2) Revised discretionary spending limits.--The
        discretionary spending limits for fiscal years 2013 through
        2021 under section 251(c) shall be replaced with the following:
                    ``(A) For fiscal year 2013--
                            ``(i) for the revised security category,
                        $546,000,000,000 in budget authority; and
                            ``(ii) for the revised nonsecurity
                        category, $501,000,000,000 in budget authority.
                    ``(B) For fiscal year 2014--
                            ``(i) for the revised security category,
                        $551,000,000,000 in budget authority; and
                            ``(ii) for the revised nonsecurity
                        category, $500,000,000,000 in budget authority.
                    ``(C) For fiscal year 2015--
                            ``(i) for the revised security category,
                        $560,000,000,000 in budget authority; and
                            ``(ii) for the revised nonsecurity
                        category, $510,000,000,000 in budget authority.
                    ``(D) For fiscal year 2016--
                            ``(i) for the revised security category,
                        $571,000,000,000 in budget authority; and
                            ``(ii) for the revised nonsecurity
                        category, $520,000,000,000 in budget authority.
                    ``(E) For fiscal year 2017--
                            ``(i) for the revised security category,
                        $584,000,000,000 in budget authority; and
                            ``(ii) for the revised nonsecurity
                        category, $531,000,000,000 in budget authority.
                    ``(F) For fiscal year 2018--
                            ``(i) for the revised security category,
                        $598,000,000,000 in budget authority; and
                            ``(ii) for the revised nonsecurity
                        category, $543,000,000,000 in budget authority.
                    ``(G) For fiscal year 2019--
                            ``(i) for the revised security category,
                        $610,000,000,000 in budget authority; and
                            ``(ii) for the revised nonsecurity
                        category, $556,000,000,000 in budget authority.
                    ``(H) For fiscal year 2020--
                            ``(i) for the revised security category,
                        $624,000,000,000 in budget authority; and
                            ``(ii) for the revised nonsecurity
                        category, $568,000,000,000 in budget authority.
                    ``(I) For fiscal year 2021--
                            ``(i) for the revised security category,
                        $638,000,000,000 in budget authority; and
                            ``(ii) for the revised nonsecurity
                        category, $579,000,000,000 in budget
                        authority.''.

SEC. 5. CALCULATION OF TOTAL DEFICIT REDUCTION.

    Section 251A of the Balanced Budget and Emergency Deficit Control
Act of 1985 (2 U.S.C. 901a) is amended--
            (1) in paragraph (3)--
                    (A) in subparagraph (A), by striking
                ``$1,200,000,000,000'' and inserting
                ``$1,073,000,000,000''; and
                    (B) in subparagraph (D), by striking ``by 9'' and
                inserting ``by 8'';
            (2) in paragraph (4), by striking ``On January 2, 2013, for
        fiscal year 2013, and in'' and inserting ``In'';
            (3) in paragraphs (5) and (6), by striking ``2013'' each
        place it appears and inserting ``2014''; and
            (4) in paragraph (7)--
                    (A) by striking ``reductions.--'' and all that
                follows through ``Fiscal years 2014-2021.--On the
                date'' and inserting ``reductions.--On the date''; and
                    (B) by redesignating clauses (i) and (ii) as
                subparagraphs (A) and (B), respectively, and adjusting
                the margin accordingly.

Output:
Down Payment to Protect National Security Act of 2012 - Requires the Director of the Office of Management and Budget (OMB) to determine the number of full-time employees employed in each federal agency. Prohibits a federal agency head from hiring more than 2 employee for every 3 full-time employees who leave employment in such agency until the OMB Director makes a determination that the number of full-time federal employees is 5% less than the initial level as determined by OMB. Allows a waiver of such workforce limitation by the President for national security reasons or in the case of an extraordinary emergency.

Amends the Continuing Appropriations Act, 2011 to extend the freeze on the pay of federal employees, including Members of Congress, until June 30, 2014.

Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act), as amended by the Budget Control Act of 2011, to offset mandatory sequestration in security and nonsecurity categories in FY2013-FY2021 with revenues resulting from the reduction in the federal workforce and the pay freeze under this Act.


Input:
SECTION 1. MAXIMUM SPENDING AMOUNTS.

    Section 601(a)(1) of the Congressional Budget Act of 1974 is
amended to read as follows:
            ``(1) Maximum spending amount.--The term `maximum spending
        amount' means--
                    ``(A) with respect to fiscal year 1996,
                $1,562,000,000,000 in outlays;
                    ``(B) with respect to fiscal year 1997,
                $1,593,000,000,000 in outlays;
                    ``(C) with respect to fiscal year 1998,
                $1,625,000,000,000 in outlays;
                    ``(D) with respect to fiscal year 1999,
                $1,658,000,000,000 in outlays;
                    ``(E) with respect to fiscal year 2000,
                $1,691,000,000,000 in outlays;
                    ``(F) with respect to fiscal year 2001,
                $1,725,000,000,000 in outlays; and
                    ``(G) with respect to fiscal year 2002,
                $1,760,000,000,000 in outlays.''.

SEC. 2. ENFORCING MAXIMUM SPENDING SEQUESTRATION.

    (a) Sequestration.--Section 253(a) of the Balanced Budget and
Emergency Deficit Control Act of 1985 is amended to read as follows:
    ``(a) Sequestration.--Within 15 days after Congress adjourns to end
a session (other than the One Hundred Fourth Congress), and on the same
day as sequestration (if any) under sections 251 and 252, but after any
sequestration required by those sections, there shall be a
sequestration (if necessary) to reduce total Federal spending to the
maximum permissible level as set forth in section 601(a)(1) of the
Congressional Budget Act of 1974.''.
    (b) Conforming Amendment to Heading.--The section heading of
section 253 of the Balanced Budget and Emergency Deficit Control Act of
1985 is amended to read as follows:

``SEC. 253. ENFORCING MAXIMUM SPENDING LIMITS.''.

    (c) Additional Conforming Amendments.--Section 253 of the Balanced
Budget and Emergency Deficit Control Act of 1985 is amended--
            (1) by repealing subsections (b), (g), and (h), and by
        redesignating subsections (c), (d), (e), and (f), as
        subsections (b), (c), (d), and (e), respectively;
            (2) in subsection (b) (as redesignated), by amending the
        first sentence to read as follows: ``To reduce total Federal
        spending to the maximum permissible level for a budget year, 20
        percent of the required outlay reductions shall be obtained
        from non-exempt defense accounts (accounts designated as
        function 050 in the President's fiscal year 1995 budget
        submission) and 80 percent from non-exempt, non-defense
        accounts (all other non-exempt accounts).'';
            (3) in subsection (c) (as redesignated), by striking
        ``subsection (c)'' and inserting ``subsection (b)''; and
            (4) in subsection (e) (as redesignated), by striking ``(b),
        (c), (d), and (e)'' and inserting ``(b), (c), and (d)'' and by
        striking ``(d) or (e)'' and inserting ``(c) or (d)''.
    (d) Look-Back Sequester.--Section 253 of the Balanced Budget and
Emergency Deficit Control Act of 1985 is amended by adding at the end
the following new subsection:
    ``(f) Look-Back Sequester.--
            ``(1) In general.--On July 1 of each fiscal year, the
        Director of OMB shall determine if laws effective during the
        current fiscal year will cause the spending to exceed the
        maximum spending amount for such fiscal year. If the limit is
        exceeded, there shall be a preliminary sequester on July 1 to
        eliminate the excess.
            ``(2) Permanent sequester.--Budget authority sequestered on
        July 1 pursuant to paragraph (1) shall be permanently canceled
        on July 15.
            ``(3) No margin.--The margin for determining a sequester
        under this subsection shall be zero.
            ``(4) Sequestration procedures.--The provision of
        subsections (b), (c), and (d) of this section shall apply to a
        sequester under this subsection.''.
    (e) Reports.--Section 254 of the Balanced Budget and Emergency
Deficit Control Act of 1985 is amended--
            (1) by striking subsection (c);
            (2) in subsection (d)(1), by striking ``deficit
        sequestration'' and inserting ``total spending sequestration'';
            (3) in subsection (d) by repealing paragraph (4) and
        inserting the following new paragraph:
            ``(4) Total Spending Sequestration Reports.--The preview
        reports shall set forth for the budget year estimates for each
        of the following:
                    ``(A) The amount of reductions required from
                defense accounts and the reductions required from non-
                defense accounts.
                    ``(B) The sequestration percentage necessary to
                achieve the required reduction in defense accounts
                under section 253(c).
                    ``(C) The reductions required under sections
                253(d)(1) and 253(d)(2).
                    ``(D) The sequestration percentage necessary to
                achieve the required reduction in non-defense accounts
                under section 253(d)(3).''; and
            (4) in subsection (g)(3), by striking ``Deficit'' and
        inserting ``Total Spending'' in the side heading and in the
        first sentence by striking ``deficit'' and inserting ``total
        spending''.
    (f) Conforming Amendment to Table of Contents.--The item relating
to section 253 is amended by striking ``Enforcing deficit targets'' and
inserting ``Enforcing maximum spending limits''.

SEC. 3. TOTAL SPENDING POINT OF ORDER.

    (a) Total Spending Point of Order.--Section 605(b) of the
Congressional Budget Act of 1974 is amended to read as follows:
    ``(b) Total Spending Point of Order.--
            ``(1) In general.--It shall not be in order in the House of
        Representatives or the Senate to consider any bill, joint
        resolution, amendment, or conference report that includes any
        provision that would result in total spending for a fiscal year
        that exceeds the maximum permissible total spending amount for
        such fiscal year as set forth in section 601(a)(1).
            ``(2) Waiver or suspension.--This subsection may be waived
        or suspended in the House of Representatives or the Senate only
        by the affirmative vote of three-fifths of its Members, duly
        chosen and sworn.''.

Output:
Amends the Congressional Budget Act of 1974 to establish maximum spending amounts for FY 1996 through 2002.
Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) to revise sequestration procedures for enforcement.
Requires look-back sequestration in the last quarter of each fiscal year.
Revises preview sequestration reports to include total spending (instead of deficit spending).
Makes it out of order in the House of Representatives or the Senate to consider legislation that would result in total spending exceeding maximum permissible total spending, unless waived or suspended by a three-fifths vote of Members of each House.


Input:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Resuming Education After Defense
Service Act of 2005''.

SEC. 2. EDUCATIONAL ASSISTANCE UNDER MONTGOMERY GI BILL FOR MEMBERS OF
              THE SELECTED RESERVE WHO AGGREGATE MORE THAN 2 YEARS OF
              ACTIVE DUTY SERVICE DURING ANY 5-YEAR PERIOD.

    (a) Entitlement.--Section 3012(a)(1) of title 38, United States
Code, is amended--
            (1) in subparagraph (B), by striking ``or'' at the end;
            (2) in subparagraph (C), by adding ``or'' at the end; and
            (3) by inserting after subparagraph (C) the following new
        subparagraph (D):
                    ``(D) while in the Selected Reserve--
                            ``(i) is first ordered to serve on active
                        duty in the Armed Forces under section
                        12301(a), 12301(d), 12301(g), 12302, or 12304
                        of title 10, during the period beginning on
                        September 11, 2001, and ending December 31,
                        2006; and
                            ``(ii) serves on active duty in the Armed
                        Forces for one or more periods (whether
                        continuous or otherwise) aggregating not less
                        than two years of service on active duty during
                        a five-year period beginning on the date the
                        individual is first ordered to serve on active
                        duty during the period referred to in clause
                        (i);''.
    (b) Duration of Assistance.--Section 3013(b) of such title is
amended by striking ``is entitled to'' and all that follows and
inserting the following:
 ``is entitled to--
            ``(1) one month of educational assistance benefits under
        this chapter--
                    ``(A) in the case of an individual described in
                section 3012(a)(1)(A) of this title, for each month of
                continuous active duty served by such individual after
                June 30, 1985, as part of the obligated period of
                active duty on which such entitlement is based;
                    ``(B) in the case of an individual described in
                section 3012(a)(1)(B) of this title, for each month of
                continuous active duty served by such individual after
                June 30, 1985; or
                    ``(C) in the case of an individual described in
                section 3012(a)(1)(D) of this title, for each month of
                active duty served by such individual after September
                11, 2001, as part of the aggregate period of active
                duty on which such entitlement is based; and
            ``(2) one month of educational assistance benefits under
        this chapter for each four months served by such individual in
        the Selected Reserve after the applicable date specified in
        paragraph (1) (other than any month in which the individual
        served on active duty).''.
    (c) Amount of Assistance.--Section 3015 of such title is amended--
            (1) in subsections (a)(1)(D) and (b)(1)(D), by striking
        ``subsection (h)'' and inserting ``subsection (i)'';
            (2) by redesignating subsection (h) as subsection (i); and
            (3) by inserting after subsection (g) the following new
        subsection (h):
    ``(h) In the case of an individual entitled to an educational
assistance allowance under section 3012(a)(1)(D) of this title, the
amount of the basic educational assistance allowance payable under this
chapter is the amount determined under subsection (b) of this
section.''.
    (d) Contribution.--Subsection (c) of section 3012 of such title is
amended--
            (1) in paragraph (1), by striking ``Except as provided in
        paragraph (2)'' and inserting `Except as provided in paragraphs
        (2) and (3)'';
            (2) by redesignating paragraphs (2) and (3) as paragraphs
        (3) and (4), respectively; and
            (3) by inserting after paragraph (1) the following new
        paragraph:
    ``(2) The basic pay of any individual described in subsection
(a)(1)(D) who does not make an election under subsection (d)(1) shall
be reduced by $100 for each of the first 12 months of active duty
service (whether continuous or otherwise) that such individual is
entitled to such pay.''.
    (e) Election to Opt Out.--Subsection (d)(1) of section 3012 of such
title is amended by striking ``in subsection (a)(1)(A) of this
section'' and inserting ``in subsection (a)(1)(A) or (a)(1)(D)''.
    (f) Outreach.--(1) The Secretaries concerned shall take actions to
inform members of the Selected Reserve who are or may become entitled
to basic educational assistance benefits under chapter 30 of title 38,
United States Code, as a result of section 3012(a)(1)(D) of such title
(as amended by subsection (a) of this section) of the minimum service
requirements for entitlement to such benefits under that chapter and of
the scope and nature of such benefits.
    (2) In this subsection:
            (A) The term ``Secretary concerned'' has the meaning given
        such term in section 101(25) of title 38, United States Code.
            (B) The term ``Selected Reserve'' has the meaning given
        such term in section 3002(4) of title 38, United States Code.

Output:
Resuming Education After Defense Service Act of 2005 - Makes eligible for basic educational assistance under the Montgomery GI Bill a member of the Selected Reserve who (among other qualifications), during the period beginning on September 11, 2001, and ending on December 31, 2006, serves on active duty in the Armed Forces for one or more periods aggregating not less than two years. Entitles such individuals to one month of educational assistance for each month served on active duty. Makes the amount of such assistance equivalent to that provided for active-duty personnel who have served a minimum of two years of active duty. Requires the basic pay of qualifying members to be reduced by $100 for each of first 12 months of such active duty service.

Requires the Secretaries of the military departments concerned to inform eligible Selected Reserve personnel of such entitlement.


Input:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Women's Health Research and
Prevention Amendments of 1998''.

  TITLE I--PROVISIONS RELATING TO WOMEN'S HEALTH RESEARCH AT NATIONAL
                          INSTITUTES OF HEALTH

    SEC. 101. RESEARCH ON DRUG DES; NATIONAL PROGRAM OF EDUCATION.
    (a) Research.--Section 403A(e) of the Public Health Service Act (42
U.S.C. 283a(e)) is amended by striking ``1996'' and inserting ``2003''.
    (b) National Program for Education of Health Professionals and
Public.--Title XVII of the Public Health Service Act (42 U.S.C. 300u et
seq.) is amended by adding at the end the following:

                        ``education regarding des

    ``Sec. 1710. (a) In General.--The Secretary, acting through the
heads of the appropriate agencies of the Public Health Service, shall
carry out a national program for the education of health professionals
and the public with respect to the drug diethylstilbestrol (commonly
known as DES). To the extent appropriate, such national program shall
use methodologies developed through the education demonstration program
carried out under section 403A. In developing and carrying out the
national program, the Secretary shall consult closely with
representatives of nonprofit private entities that represent
individuals who have been exposed to DES and that have expertise in
community-based information campaigns for the public and for health
care providers. The implementation of the national program shall begin
during fiscal year 1999.
    ``(b) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 1999 through 2003. The
authorization of appropriations established in the preceding sentence
is in addition to any other authorization of appropriation that is
available for such purpose.''.
    SEC. 102. RESEARCH ON OSTEOPOROSIS, PAGET'S DISEASE, AND RELATED
      BONE DISORDERS.
    Section 409A(d) of the Public Health Service Act (42 U.S.C.
284e(d)) is amended by striking ``and 1996'' and inserting ``through
2003''.

SEC. 103. RESEARCH ON CANCER.

    (a) Research on Breast Cancer.--Section 417B(b)(1) of the Public
Health Service Act (42 U.S.C. 286a-8(b)(1)) is amended--
        (1) in subparagraph (A), by striking ``and 1996'' and inserting
    ``through 2003''; and
        (2) in subparagraph (B), by striking ``and 1996'' and inserting
    ``through 2003''.
    (b) Research on Ovarian and Related Cancer Research.--Section
417B(b)(2) of the Public Health Service Act (42 U.S.C. 286a-8(b)(2)) is
amended by striking ``and 1996'' and inserting ``through 2003''.
    SEC. 104. RESEARCH ON HEART ATTACK, STROKE, AND OTHER
      CARDIOVASCULAR DISEASES IN WOMEN.
    Subpart 2 of part C of title IV of the Public Health Service Act
(42 U.S.C. 285b et seq.) is amended by inserting after section 424 the
following:

    ``heart attack, stroke, and other cardiovascular diseases in women

    ``Sec. 424A. (a) In General.--The Director of the Institute shall
expand, intensify, and coordinate research and related activities of
the Institute with respect to heart attack, stroke, and other
cardiovascular diseases in women.
    ``(b) Coordination With Other Institutes.--The Director of the
Institute shall coordinate activities under subsection (a) with similar
activities conducted by the other national research institutes and
agencies of the National Institutes of Health to the extent that such
Institutes and agencies have responsibilities that are related to heart
attack, stroke, and other cardiovascular diseases in women.
    ``(c) Certain Programs.--In carrying out subsection (a), the
Director of the Institute shall conduct or support research to expand
the understanding of the causes of, and to develop methods for
preventing, cardiovascular diseases in women. Activities under such
subsection shall include conducting and supporting the following:
        ``(1) Research to determine the reasons underlying the
    prevalence of heart attack, stroke, and other cardiovascular
    diseases in women, including African-American women and other women
    who are members of racial or ethnic minority groups.
        ``(2) Basic research concerning the etiology and causes of
    cardiovascular diseases in women.
        ``(3) Epidemiological studies to address the frequency and
    natural history of such diseases and the differences among men and
    women, and among racial and ethnic groups, with respect to such
    diseases.
        ``(4) The development of safe, efficient, and cost-effective
    diagnostic approaches to evaluating women with suspected ischemic
    heart disease.
        ``(5) Clinical research for the development and evaluation of
    new treatments for women, including rehabilitation.
        ``(6) Studies to gain a better understanding of methods of
    preventing cardiovascular diseases in women, including applications
    of effective methods for the control of blood pressure, lipids, and
    obesity.
        ``(7) Information and education programs for patients and
    health care providers on risk factors associated with heart attack,
    stroke, and other cardiovascular diseases in women, and on the
    importance of the prevention or control of such risk factors and
    timely referral with appropriate diagnosis and treatment. Such
    programs shall include information and education on health-related
    behaviors that can improve such important risk factors as smoking,
    obesity, high blood cholesterol, and lack of exercise.
    ``(d) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 1999 through 2003. The
authorization of appropriations established in the preceding sentence
is in addition to any other authorization of appropriation that is
available for such purpose.''.

SEC. 105. AGING PROCESSES REGARDING WOMEN.

    Section 445H of the Public Health Service Act (42 U.S.C. 285e-10)
is amended--
        (1) by striking ``The Director'' and inserting ``(a) The
    Director''; and
        (2) by adding at the end the following subsection:
    ``(b) For the purpose of carrying out this section, there are
authorized to be appropriated such sums as may be necessary for each of
the fiscal years 1999 through 2003. The authorization of appropriations
established in the preceding sentence is in addition to any other
authorization of appropriation that is available for such purpose.''.

SEC. 106. OFFICE OF RESEARCH ON WOMEN'S HEALTH.

    Section 486(d)(2) of the Public Health Service Act (42 U.S.C.
287d(d)(2)) is amended by striking ``Director of the Office'' and
inserting ``Director of NIH''.

TITLE II--PROVISIONS RELATING TO WOMEN'S HEALTH AT CENTERS FOR DISEASE
                         CONTROL AND PREVENTION

SEC. 201. NATIONAL CENTER FOR HEALTH STATISTICS.

    Section 306(n) of the Public Health Service Act (42 U.S.C. 242k(n))
is amended--
        (1) in paragraph (1), by striking ``through 1998'' and
    inserting ``through 2003''; and
        (2) in paragraph (2), by striking ``through 1998'' and
    inserting ``through 2003''.

SEC. 202. NATIONAL PROGRAM OF CANCER REGISTRIES.

    Section 399L(a) of the Public Health Service Act (42 U.S.C. 280e-
4(a)) is amended by striking ``through 1998'' and inserting ``through
2003''.
    SEC. 203. NATIONAL BREAST AND CERVICAL CANCER EARLY DETECTION
      PROGRAM.
    (a) Services.--Section 1501(a)(2) of the Public Health Service Act
(42 U.S.C. 300k(a)(2)) is amended by inserting before the semicolon the
following: ``and support services such as case management''.
    (b) Providers of Services.--Section 1501(b) of the Public Health
Service Act (42 U.S.C. 300k(b)) is amended--
        (1) in paragraph (1), by striking ``through grants'' and all
    that follows and inserting the following: ``through grants to
    public and nonprofit private entities and through contracts with
    public and private entities.''; and
        (2) by striking paragraph (2) and inserting the following:
        ``(2) Certain applications.--If a nonprofit private entity and
    a private entity that is not a nonprofit entity both submit
    applications to a State to receive an award of a grant or contract
    pursuant to paragraph (1), the State may give priority to the
    application submitted by the nonprofit private entity in any case
    in which the State determines that the quality of such application
    is equivalent to the quality of the application submitted by the
    other private entity.''.
    (c) Authorizations of Appropriations.--
        (1) Supplemental grants for additional preventive health
    services.--Section 1509(d)(1) of the Public Health Service Act (42
    U.S.C. 300n-4a(d)(1)) is amended by striking ``through 1998'' and
    inserting ``through 2003''.
        (2) General program.--Section 1510(a) of the Public Health
    Service Act (42 U.S.C. 300n-5(a)) is amended by striking ``through
    1998'' and inserting ``through 2003''.
    SEC. 204. CENTERS FOR RESEARCH AND DEMONSTRATION OF HEALTH
      PROMOTION.
    Section 1706(e) of the Public Health Service Act (42 U.S.C. 300u-
5(e)) is amended by striking ``through 1998'' and inserting ``through
2003''.

                               Speaker of the House of Representatives.

                            Vice President of the United States and
                                               President of the Senate.

Output:
TABLE OF CONTENTS:
     Title I:  Provisions Relating to Women's Health Research at
          National Institutes of Health
     Title II:  Provisions Relating to Women's Health at Centers
          for Disease Control and Prevention
Women's Health Research and Prevention Amendments of 1998 -
Title I:  Provisions Relating to Women's Health Research at National Institutes of Health
 - Amends the Public Health Service Act to extend the authorization of appropriations for programs regarding diethylstilbestrol (DES).
Mandates a program of education of health professionals and the public concerning DES.  Authorizes appropriations.
(Sec. 102) Extends the authorizations of appropriations for:  (1) research on osteoporosis, Paget's disease, and related bone disorders; (2) breast cancer programs; and (3) programs on ovarian and other cancers of the reproductive system of women.
(Sec. 104) Mandates expansion, intensification, and coordination of research and related activities of the National Heart, Lung, and Blood Institute regarding heart attack, stroke, and other cardiovascular diseases in women.  Authorizes appropriations.
(Sec. 105) Extends the authorization of appropriations for research on the aging processes of women.
(Sec. 106) Requires that the Director of the National Institutes of Health (currently, the Director of the Office of Research on Women's Health) appoint members of the Advisory Committee on Women's Health.
Title II:  Provisions Relating to Women's Health at Centers for Disease Control and Prevention
 - Extends the authorization of appropriations for the National Center for Health Statistics and the National Program of Cancer Registries.
(Sec. 203) Authorizes grants to States to ensure the provision to women screened for breast or cervical cancer of support services such as case management.  Allows certain breast and cervical cancer programs to be carried out through grants to public and nonprofit private entities and contracts with public or private entities (currently, through grants and contracts with public or nonprofit private entities).  Allows a State to give priority to a nonprofit entity over an entity that is not a nonprofit if the quality of the entities' applications are equivalent.  Extends authorizations of appropriations for:  (1) annual evaluations of programs relating to preventive health measures regarding breast and cervical cancers; and (2) various breast and cervical cancer preventive health measures.
(Sec. 204) Extends the authorization of appropriations for centers for research and demonstration regarding health promotion and disease prevention.


Input:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Municipal Biological Monitoring Use
Act''.

SEC. 2. BIOLOGICAL MONITORING AT PUBLICLY OWNED TREATMENT WORKS,
              MUNICIPAL SEPARATE STORM SEWER SYSTEMS, AND MUNICIPAL
              COMBINED SEWER OVERFLOWS, INCLUDING CONTROL FACILITIES,
              AND OTHER WET WEATHER CONTROL FACILITIES.

    (a) Biological Monitoring Criteria.--Section 303(c)(2) of the
Federal Water Pollution Control Act (33 U.S.C. 1313(c)(2)) is amended--
            (1) in subparagraph (B)--
                    (A) by striking the period at the end and inserting
                the following: ``: Provided, That for publicly owned
                treatment works, municipal separate storm sewer
                systems, and municipal combined sewer overflows,
                including control facilities, and other wet weather
                control facilities, nothing in this Act shall be
                construed to authorize the use of water quality
                standards or permit effluent limitations which result
                in the finding of a violation upon failure of whole
                effluent toxicity tests or biological monitoring
                tests.''; and
                    (B) by inserting after the third sentence the
                following: ``Criteria for biological monitoring or
                whole effluent toxicity shall employ an aquatic species
                that is indigenous to the type of waters, a species
                that is representative of such species, or such other
                appropriate species as will indicate the toxicity of
                the effluent in the specific receiving waters. Such
                criteria shall take into account the natural biological
                variability of the species, and shall ensure that the
                accompanying test method accurately represents actual
                in-stream conditions, including conditions associated
                with dry and wet weather.''; and
            (2) by adding at the end the following:
    ``(C) Where the permitting authority determines that the discharge
from a publicly owned treatment works, a municipal separate storm sewer
system, or municipal combined sewer overflows, including control
facilities, or other wet weather control facilities causes, has the
reasonable potential to cause, or contributes to an in-stream excursion
above a narrative or numeric criterion for whole effluent toxicity, the
permit may contain terms, conditions, or limitations requiring further
analysis, identification evaluation, or reduction evaluation of such
effluent toxicity. Such terms, conditions, or limitations meeting the
requirements of this section may be utilized in conjunction with a
municipal separate storm sewer system, or municipal combined sewer
overflows, including control facilities, or other wet weather control
facilities only upon a demonstration that such terms, conditions, or
limitations are technically feasible, accurately represent toxicity
associated with wet weather conditions, and can materially assist in an
identification evaluation or reduction evaluation of such toxicity.''.
    (b) Information on Water Quality Criteria.--Section 304(a)(8) of
the Federal Water Pollution Control Act (33 U.S.C. 1314(a)(8)) is
amended by inserting ``, consistent with subparagraphs (B) and (C) of
section 303(c)(2),'' after ``publish''.
    (c) Use of Biological Monitoring or Whole Effluent Toxicity Testing
at Publicly Owned Treatment Works, Municipal Separate Storm Sewer
Systems, or Municipal Combined Sewer Overflows, Including Control
Facilities, or Other Wet Weather Control Facilities.--Section 402 of
the Federal Water Pollution Control Act (33 U.S.C. 1342) is amended by
adding at the end the following:
    ``(q) Use of Biological Monitoring or Whole Effluent Toxicity
Testing at Publicly Owned Treatment Works, Municipal Separate Storm
Sewer Systems, or Municipal Combined Sewer Overflows, Including Control
Facilities, or Other Wet Weather Control Facilities.--
            ``(1) In general.--Where the Administrator determines that
        it is necessary in accordance with subparagraphs (B) and (C) of
        section 303(c)(2) to include biological monitoring, whole
        effluent toxicity testing, or assessment methods as a term,
        condition, or limitation in a permit issued to a publicly owned
        treatment works, a municipal separate storm sewer system, or a
        municipal combined sewer overflow, including a control
        facility, or other wet weather control facility pursuant to
        this section, such permit term, condition, or limitation shall
        be in accordance with such subparagraphs.
            ``(2) Responding to test failures.--If a permit issued
        under this section contains terms, conditions, or limitations
        requiring biological monitoring or whole effluent toxicity
        testing designed to meet criteria for biological monitoring or
        whole effluent toxicity, the permit may establish procedures
        for further analysis, identification evaluation, or reduction
        evaluation of such toxicity. The permit shall allow the
        permittee to discontinue such procedures, subject to future
        reinitiation of such procedures upon a showing by the
        permitting authority of changed conditions, if the source of
        such toxicity cannot, after thorough investigation, be
        identified.
            ``(3) Test failure not a violation.--The failure of a
        biological monitoring test or a whole effluent toxicity test at
        a publicly owned treatment works, a municipal separate storm
        sewer system, or a municipal combined sewer overflow, including
        a control facility, or other wet weather control facility shall
        not result in a finding of a violation under this Act.''.

Output:
Municipal Biological Monitoring Use Act - Amends the Federal Water Pollution Control Act relating to a State's adoption of water quality standards to provide that, with respect to publicly owned treatment works, municipal separate storm sewer systems, and municipal combined sewer overflows (public sewer facilities), nothing in such Act shall be construed to authorize the use of water quality standards or permit effluent limitations which result in a finding of a violation upon failure of whole effluent toxicity or biological monitoring tests. Requires criteria for such testing to employ an aquatic species that is indigenous to the type of waters, a species that is representative of such species, or other appropriate species to indicate the toxicity of the effluent in the specific receiving waters, taking into account the natural biological variability of the species.
States that where the permitting authority determines that the discharge from a public sewer facility has reasonable potential to cause or contribute to an in-stream excursion above the criterion for whole effluent toxicity, the permit may contain terms, conditions and limitations requiring further toxicity analysis and evaluation.  Directs the Administrator of the Environmental Protection Agency to follow the above criteria when the Administrator determines that it is necessary to include biological monitoring, whole effluent toxicity testing, or assessment methods as a permit term, condition or limitation issued to a public sewer facility.  States that the failure of a biological monitoring or whole effluent toxicity test at a public sewer facility shall not result in a finding of a violation under the Federal Water Pollution Control Act.