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CHANGES IN TAX SCHEDULES

SEC. 16. (a) Section 1401 of the Internal Revenue Code of 1954 (relating to rate of tax on self-employment income) is amended to read as follows:

"SEC. 1401. RATE OF TAX.

"In addition to other taxes, there shall be imposed for each taxable year, on the self-employment income of every individual, a tax as follows:

"(1) in the case of any taxable year beginning after December 31, 1964, and before January 1, 1968. the tax shall be equal to 6 percent of the amount amount of the self-employment income for such taxable year;

"(2) in the case of any taxable year beginning after December 31, 1965, and before January 1, 1968, the tax shall be equal to 6 percent of the amount of the self-employment income for such taxable year; and

"(3) in the case of any taxable year beginning after December 31, 1967, and before January 1, 1971, the tax shall be equal to 6.8 percent of the amount of the self-employment income for such taxable year; and

"(4) in the case of any taxable year beginning after December 31, 1970, the tax shall be equal to 7.2 percent of the amount of the self-employment income for such taxable year."

(b) Section 3101 of such Code (relating to rate of tax on employees under the Federal Insurance Contributions Act) is amended to read as follows:

"SEC. 3101. RATE OF TAX.

"In addition to other taxes, there is hereby imposed on the income of every individual a tax equal to the following percentages of the wages (as defined in section 3121(a)) received by him with respect to employment (as defined in section 3121 (b)) —

"(1) with respect to wages received during the calendar year 1965, the rate shall be 3.8 percent;

"(2) with respect to wages received during the calendar years 1966 and 1967, the rate shall be 4 percent;

"(3) with respect to wages received during the calendar years 1968, 1969, and 1970, the rate shall be 4.5 percent; and

"(4) with respect to wages received after December 31, 1970, the rate shall be 4.8 percent."

(c) Section 3111 of such Code (relating to rate of tax on employers under the Federal Insurance Contributions Act) is amended to read as follows:

"SEC. 3111. RATE OF TAX.

"In addition to other taxes, there is hereby imposed on every employer an excise tax, with respect to having individuals in his employ, equal to the following percentages of the wages (as defined in section 3121 (a)) paid by him with respect to employment (as defined in section 3121 (b)) —

"(1) with respect to wages paid during the calendar year 1965, the rate shall be 3.8 percent;

"(2) with respect to wages paid during the calendar years 1966 and 1967, the rate shall be 4 percent;

"(3) with respect to wages paid during the calendar years 1968, 1969, and 1970, the rate shall be 4.5 percent; and

"(4) with respect to wages paid after December 31, 1970, the rate shall be 4.8 percent."

(d) (1) The proviso in section 3201 of such Code (relating to rate of tax on employees under Railroad Retirement Tax Act) is amended by inserting after "at such time" the following: "(determined under the provisions of section 3101 as in effect on June 1, 1964)".

(2) The proviso in section 3211 of such Code (relating to rate of tax on employee representatives under Railroad Retirement Tax Act) is amended by inserting after "at such time" the following: "(determined under the provisions of section 3101 as in effect on June 1, 1964)".

(3) Section 3221(b) of such Code (relating to rate of tax on employers under Railroad Retirement Tax Act) is amended by inserting after “at such time” the following: "(determined under the provisions of section 3111 as in effect on June 1, 1964)".

(e) The amendment made by subsection (a) shall apply only with respect to taxable years beginning after December 31, 1964. The amendments made by subsections (b) and (c) shall apply only with respect to remuneration paid after December 31, 1964.

Passed the House of Representatives July 29, 1964.
Attest:

RALPH R. ROBERTS, Clerk.

[H.R. 11865, 88th Cong., 2d sess.]

AMENDMENT No. 1163

AMENDMENTS Intended to be proposed by Mr. JAVITS (for himself, Mr. CASE, Mr. KEATING, Mr. KUCHEL, Mrs. SMITH, and Mr. COOPER) to H.R. 11865, an Act to increase benefits under the Federal Old-Age, Survivors, and Disability Insurance System, to provide child's insurance benefits beyond age 18 while in school, to provide widow's benefits at age 60 on a reduced basis, to provide benefits for certain individuals not otherwise eligible at age 72, to improve the actuarial status of the Trust Funds, to extend coverage, and for other purposes, viz:

On the first page of the bill, strike out lines 3 and 4, and insert in lieu thereof the following: "TITLE I-SOCIAL SECURITY AMENDMENTS

"SEC. 101. This title may be cited as the 'Social Security Amendments of 1964'." On page 3, line 3, strike out "SEC. 2." and insert in lieu thereof "SEC. 102.". On page 6, line 13, strike out "SEC. 3." and insert in lieu thereof "SEC. 103.". On page 15, line 11, strike out "SEC. 4." and insert in lieu thereof "SEC. 104.". On page 20, line 10, strike out "SEC. 5." and insert in lieu thereof "SEC. 105.". On page 22, line 11, strike out "SEC. 6." and insert in lieu thereof "SEC. 106.". On page 28, line 5, strike out "section 6" and insert in lieu thereof "section 106". On page 28, line 16, strike out "SEC. 7." and insert in lieu thereof "SEC. 107.". On page 29, line 2, strike out "SEC. 8." and insert in lieu thereof "SEC. 108.". On page 31, line 18, strike out "SEC. 9." and insert in lieu thereof "SEC. 109.". On page 36, line 6, strike out "section 16" and insert in lieu thereof "section 116".

On page 37, line 8, strike out "SEC. 10." and insert in lieu thereof "SEC. 110.". On page 38, line 3, strike out "SEC. 11." and insert in lieu thereof "SEC. 111.". On page 39, line 12, strike out "SEC. 12." and insert in lieu thereof "SEC. 112.".

On page 39, line 19, strike out "SEC. 13." and insert in lieu thereof "SEC. 113.".

On page 39, line 24, strike out "SEC. 14." and insert in lieu thereof "SEC. 114.".

On page 40, line 23, strike out "SEC. 15." and insert in lieu thereof "SEC. 115.".

On page 44, line 8, strike out "SEC. 16." and insert in lieu thereof "SEC. 116.".

On page 44, line 17, strike out "5.7 percent" and insert in lieu thereof "6.0075 percent".

On page 44, line 21, strike out "6 percent" and insert in lieu thereof "6.3075 percent".

On page 45, line 3, strike out "6.8 percent" and insert in lieu thereof "7.0575 percent".

On page 45, line 7, strike out "7.2 percent" and insert in lieu thereof "7.5075 percent".

On page 45, line 19, strike out "3.8 percent" and insert in lieu thereof "4.005 percent".

On page 45, line 21, strike out "4 percent" and insert in lieu thereof "4.205 percent".

On page 46, line 3, strike out "4.5 percent" and insert in lieu thereof "4.705 percent".

On page 46, line 5, strike out "4.8 percent" and insert in lieu thereof ❝5.005 percent".

On page 46, line 17, strike out "3.8 percent" and insert in lieu thereof "4.005 percent”.

On page 46, line 19, strike out "4 percent" and insert in lieu thereof "4.205 percent".

On page 46, line 21, strike out "4.5 percent" and insert in lieu thereof "4.705 percent".

On page 46, line 24, strike out "4.8 percent" and insert in lieu thereof ❝5.005 percent".

At the end of the bill, add the following:

"TITLE II-HEALTH CARE INSURANCE FOR THE AGED

SEC. 201. This title may be cited as the "Health Care Insurance Act of 1964". PART A-HOSPITAL INSURANCE BENEFITS FOR THE AGED

FINDINGS AND DECLARATIONS OF PURPOSE

SEC. 202. (a) The Congress finds that the rising costs of health care for the great majority of that portion of our population sixty-five years of age or over are a major threat to their independence and dignity; and that most of the older citizens cannot afford to pay for adequae private insurance health care coverage. Difficulty in meeting health care expenses which are more than twice as high as those of persons under sixty-five years of age has led to an increase in dependency and in the medically indigent with subsequent burdening of public relief programs. It is in the interest of the general welfare that a problem of such national proportions as this one be met by a dual public-private program of well-balanced basic health care in which the costs of hospital care and related services required by older citizens be met through contributory social insurance, and medical, surgical, and related services be met through a basic national private insurance plan which would be available to all persons in the aged group at the same basic premium cost.

"(b) The purposes of this title are (1) to provide all individuals sixty-five years of age or over with basic protection against the costs of hospital care and related services and to utilize social insurance for financing the protection so provided, and (2) to provide for the establishment of a national association composed of private carriers which shall make available to all individuals, sixty-five years of age or over, a nonprofit, tax-exempt standard health insurance policy at reasonable cost.

"(c) It is hereby declared to be the policy of the Congress that skilled nursing facility services for which payment may be made under this title shall be utilized in lieu of inpatient hospital services where skilled nursing facility services would suffice in meeting the medical needs of the patient and that home health services for which payment may be made under this title shall be utilized in lieu of inpatient hospital or skilled nursing facility services where home health services would suffice.

"(d) It is further declared to be the policy of the Congress that no individual who receives aid or assistance (including medical or any other type of remedial care) under a State plan approved under titles I, IV, X, XIV, or XVI of the Social Security Act shall receive less benefits or be otherwise disadvantaged by reason of the enactment of this title."

BENEFITS

SEC. 203. The Social Security Act is amended by adding after title XVII the following new title:

"TITLE XVIII-HOSPITAL INSURANCE BENEFITS FOR THE AGED

"PROHIBITION AGAINST ANY FEDERAL INTERFERENCE

"SEC. 1801. Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which services are provided, or over the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any hospital, skilled nursing facility, or home health agency; or to exercise any supervision or control over the administration or operation of any such hospital, facility, or agency.

"FREE CHOICE BY PATIENT GUARANTEED

"SEC. 1802. Any individual entitled to have payment made under this title for services furnished him may obtain inpatient hospital services, skilled nursing facility services, or home health services from any provider of services with which an agreement is in effect under this title and which undertakes to provide him such services.

"DESCRIPTION OF SERVICES

"SEC. 1803. For purposes of this title

"Inpatient Hospital Services

"(a) The term 'inpatient hospital services' means the following items and services furnished to an inpatient in a hospital and (except as provided in paragraph (3)) by the hospital

"(1) bed and board,

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'(2) such nursing services and other related services, such use of hospital facilities, and such medical social services as are customarily furnished by the hospital for the care and treatment of inpatients, and such drugs, biologicals, supplies, appliances, and equipment, for use in the hospital, as are customarily furnished by such hospital for the care and treatment of inpatients, and

"(3) such other diagnostic or therapeutic items or services, furnished by the hospital or by others under arrangements with them made by the hospital, as are customarily furnished to inpatients either by such hospital or by others under such arrangements; excluding, however—

"(4) medical or surgical services provided by a physician, resident, or intern, except services provided in the field of pathology, radiology, physiatry, or anesthesiology, and except services provided in the hospital by an intern or a resident-in-training under a teaching program approved by the Council on Medical Education and Hospitals of the American Medical Association (or, in the case of an osteopathic hospital, approved by the Bureau of Professional Education, Committee on Hospitals of the American Osteopathic Association), and

"(5) the services of a private-duty nurse.

"Skilled Nursing Facility Services

"(b) The term 'skilled nursing facility services' means the following items and services furnished to an inpatient in a skilled nursing facility (but only after transfer from a hospital in which he was an inpatient, in case of a skilled nursing facility which is not affiliated or under the common control with a hospital), and (except as provided in paragraph (3)) by such skilled nursing facility

"(1) nursing care provided by or under the supervision of a registered professional nurse,

"(2) bed and board in connection with the furnishing of such nursing

care,

“(3) physical, occupational, or speech therapy furnished by the skilled nursing facility or by others under arrangements with them made by the facility,

"(4) medical social services,

“(5) such drugs, biologicals, supplies, appliances, and equipment, furnished for use in the skilled nursing facility, as are customarily furnished by such facility for the care and treatment of inpatients,

"(6) medical services provided by an intern or resident-in-training of the hospital, with which the facility is affilicted or under common control, under a teaching program of such hospital approved as provided in subsection (a) (4), and

"(7) such other services necessary to the health of the patient as are generally provided by skilled nursing facilities;

excluding, however, any item or service if it would not be included under subsection (a) if furnished to an inpatient in a hospital.

"Home Health Services

"(c) The term 'home health services' means the following items and services furnished to an individual, who is under the care of a physician, by a home health agency or by others under arrangements with them made by such agency, under a plan (for furnishing such items and services to such individual) established and periodically reviewed by a physician, which items and services are provided in a place of residence used as such individual's home

"(1) part-time or intermittent nursing care provided by or under the supervision of a registered professional nurse,

“(2) physical, occupational, or speech therapy,

"(3) medical social services,

"(4) to the extent permitted in regulations, part-time or intermittent services of a home health aid,

"(5) medical supplies (other than drugs and biologicals), and the use of medical appliances, while under such a plan, and

"(6) medical services provided by an intern or resident-in-training of the hospital, with which the home health agency is affiliated or under common control, under a teaching program of such hospital approved as provided in subsection (a) (4) ;

excluding, however, any item or service if it would not be included under subsection (a) if furnished to an inpatient in a hospital.

"Drugs and Biologicals

"(d) The term 'drugs' and the term 'biologicals', except for purposes of subsection (c) (5) of this section, include only such drugs and biologicals, respectively, as are included in the 'United States Pharmacopoeia', 'National Formulary', 'New and Non-Official Drugs', or 'Accepted Dental Remedies', or are approved by the pharmacy and drug therapeutics committee, or equivalent committee) of the medical staff of the hospital furnishing such drugs or biologicals (or of the hospital with which the skilled nursing facility furnishing such drugs or biologicals is affiliated or is under common control).

"Arrangements for Certain Services

"(e) As used in this section, the term 'arrangements' is limited to arrange ments under which receipt of payment by the hospital, skilled nursing facility, or home health agency (whether in its own right or as agent), as the case may be, with respect to services for which an individual is entitled to have payment made under this title, discharges the liability of such individual or any other person to pay for the services.

"DURATION OF SERVICES AND BENEFIT PERIOD

"Duration of Services

"SEC. 1804. (a) Payment under this title for services furnished any individual during a benefit period may not be made for

"(1) inpatient hospital services furnished to him during such period after such services have been furnished to him for forty-five days during such period; or

"(2) skilled nursing facility services furnished to him during such period after such services have been furnished to him for one hundred and eighty days during such period.

For purposes of the preceding provisions of this subsection, inpatient hospital services or skilled nursing facility services shall be counted only if payment is or would, except for this subsection and except for the failure to comply with the procedural and other requirements of or under section 1809 (a) (1), be made with respect to such services under this title. Payment under this title for home health services furnished an individual during a calendar year may not be made for any such services after such services have been furnished him during two hundred and forty days in such year.

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