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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print
An Act
Entitled The Patient Protection and Affordable Care Act.
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—2
Sec. 1252. Rating reforms must apply uniformly to all health insurance issuers and
group health plans.
Sec. 1253. Annual report on self-insured plans.
Sec. 1254. Study of large group market.
Sec. 1255. Effective dates.
Subtitle D—Available Coverage Choices for All Americans
PART 1—ESTABLISHMENT OF QUALIFIED HEALTH PLANS
Sec. 1301. Qualified health plan defined.
Sec. 1302. Essential health benefits requirements.
Sec. 1303. Special rules.
Sec. 1304. Related definitions.
PART 2—CONSUMER CHOICES AND INSURANCE COMPETITION THROUGH HEALTH
BENEFIT EXCHANGES
Sec. 1311. Affordable choices of health benefit plans.
Sec. 1312. Consumer choice.
Sec. 1313. Financial integrity.
PART 3—STATE FLEXIBILITY RELATING TO EXCHANGES
Sec. 1321. State flexibility in operation and enforcement of Exchanges and related
requirements.
Sec. 1322. Federal program to assist establishment and operation of nonprofit,
member-run health insurance issuers.
Sec. 1323. Community health insurance option østricken¿.
Sec. 1323. Funding for the territories.
Sec. 1324. Level playing field.
PART 4—STATE FLEXIBILITY TO ESTABLISH ALTERNATIVE PROGRAMS
Sec. 1331. State flexibility to establish basic health programs for low-income indi-
viduals not eligible for Medicaid.
Sec. 1332. Waiver for State innovation.
Sec. 1333. Provisions relating to offering of plans in more than one State.
Sec. 1334. Multi-State plans.
PART 5—REINSURANCE AND RISK ADJUSTMENT
Sec. 1341. Transitional reinsurance program for individual market in each State.
Sec. 1342. Establishment of risk corridors for plans in individual and small group
markets.
Sec. 1343. Risk adjustment.
Subtitle E—Affordable Coverage Choices for All Americans
PART I—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS
SUBPART A—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS
Sec. 1401. Refundable tax credit providing premium assistance for coverage under
a qualified health plan.
Sec. 1402. Reduced cost-sharing for individuals enrolling in qualified health plans.
SUBPART B—ELIGIBILITY DETERMINATIONS
Sec. 1411. Procedures for determining eligibility for Exchange participation, pre-
mium tax credits and reduced cost-sharing, and individual responsibility
exemptions.
Sec. 1412. Advance determination and payment of premium tax credits and cost-
sharing reductions.
Sec. 1413. Streamlining of procedures for enrollment through an exchange and
State Medicaid, CHIP, and health subsidy programs.
Sec. 1414. Disclosures to carry out eligibility requirements for certain programs.
Sec. 1415. Premium tax credit and cost-sharing reduction payments disregarded for
Federal and Federally-assisted programs.
Sec. 1416. Study of geographic variation in application of FPL.
PART II—SMALL BUSINESS TAX CREDIT
Sec. 1421. Credit for employee health insurance expenses of small businesses.
Subtitle F—Shared Responsibility for Health Care
PART I—INDIVIDUAL RESPONSIBILITY
Sec. 1501. Requirement to maintain minimum essential coverage.
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—3
Sec. 1502. Reporting of health insurance coverage.
PART II—EMPLOYER RESPONSIBILITIES
Sec. 1511. Automatic enrollment for employees of large employers.
Sec. 1512. Employer requirement to inform employees of coverage options.
Sec. 1513. Shared responsibility for employers.
Sec. 1514. Reporting of employer health insurance coverage.
Sec. 1515. Offering of Exchange-participating qualified health plans through cafe-
teria plans.
Subtitle G—Miscellaneous Provisions
Sec. 1551.
Definitions.
Sec. 1552.
Transparency in government.
Sec. 1553.
Prohibition against discrimination on assisted suicide.
Sec. 1554.
Access to therapies.
Sec. 1555.
Freedom not to participate in Federal health insurance programs.
Sec. 1556.
Equity for certain eligible survivors.
Sec. 1557.
Nondiscrimination.
Sec. 1558.
Protections for employees.
Sec. 1559.
Oversight.
Sec. 1560.
Rules of construction.
Sec. 1561.
Health information technology enrollment standards and protocols.
Sec. 1562.
GAO study regarding the rate of denial of coverage and enrollment by
health insurance issuers and group health plans.
Sec. 1563. Small business procurement.
Sec. 1563 [sic]. Conforming amendments.
Sec. 1563 [sic]. Sense of the Senate promoting fiscal responsibility.
TITLE II—ROLE OF PUBLIC PROGRAMS
Subtitle A—Improved Access to Medicaid
Sec. 2001. Medicaid coverage for the lowest income populations.
Sec. 2002. Income eligibility for nonelderly determined using modified gross in-
come.
Sec. 2003. Requirement to offer premium assistance for employer-sponsored insur-
ance.
Sec. 2004. Medicaid coverage for former foster care children.
Sec. 2005. Payments to territories.
Sec. 2006. Special adjustment to FMAP determination for certain States recovering
from a major disaster.
Sec. 2007. Medicaid Improvement Fund rescission.
Subtitle B—Enhanced Support for the Children’s Health Insurance Program
Sec. 2101. Additional federal financial participation for CHIP.
Sec. 2102. Technical corrections.
Subtitle C—Medicaid and CHIP Enrollment Simplification
Sec. 2201. Enrollment Simplification and coordination with State Health Insurance
Exchanges.
Sec. 2202. Permitting hospitals to make presumptive eligibility determinations for
all Medicaid eligible populations.
Subtitle D—Improvements to Medicaid Services
Sec. 2301. Coverage for freestanding birth center services.
Sec. 2302. Concurrent care for children.
Sec. 2303. State eligibility option for family planning services.
Sec. 2304. Clarification of definition of medical assistance.
Subtitle E—New Options for States to Provide Long-Term Services and Supports
Sec. 2401. Community First Choice Option.
Sec. 2402. Removal of barriers to providing home and community-based services.
Sec. 2403. Money Follows the Person Rebalancing Demonstration.
Sec. 2404. Protection for recipients of home and community-based services against
spousal impoverishment.
Sec. 2405. Funding to expand State Aging and Disability Resource Centers.
Sec. 2406. Sense of the Senate regarding long-term care.
Subtitle F—Medicaid Prescription Drug Coverage
Sec. 2501. Prescription drug rebates.
Sec. 2502. Elimination of exclusion of coverage of certain drugs.
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—4
Sec. 2503. Providing adequate pharmacy reimbursement.
Subtitle G—Medicaid Disproportionate Share Hospital (DSH) Payments
Sec. 2551. Disproportionate share hospital payments.
Subtitle H—Improved Coordination for Dual Eligible Beneficiaries
Sec. 2601. 5-year period for demonstration projects.
Sec. 2602. Providing Federal coverage and payment coordination for dual eligible
beneficiaries.
Subtitle I—Improving the Quality of Medicaid for Patients and Providers
Sec. 2701. Adult health quality measures.
Sec. 2702. Payment Adjustment for Health Care-Acquired Conditions.
Sec. 2703. State option to provide health homes for enrollees with chronic condi-
tions.
Sec. 2704. Demonstration project to evaluate integrated care around a hospitaliza-
tion.
Sec. 2705. Medicaid Global Payment System Demonstration Project.
Sec. 2706. Pediatric Accountable Care Organization Demonstration Project.
Sec. 2707. Medicaid emergency psychiatric demonstration project.
Subtitle II—Improvements to the Medicaid and CHIP Payment and Access
Commission (MACPAC)
Sec. 2801. MACPAC assessment of policies affecting all Medicaid beneficiaries.
Subtitle III—Protections for American Indians and Alaska Natives
Sec. 2901. Special rules relating to Indians.
Sec. 2902. Elimination of sunset for reimbursement for all medicare part B services
furnished by certain indian hospitals and clinics.
Subtitle IV—Maternal and Child Health Services
Sec. 2951. Maternal, infant, and early childhood home visiting programs.
Sec. 2952. Support, education, and research for postpartum depression.
Sec. 2953. Personal responsibility education.
Sec. 2954. Restoration of funding for abstinence education.
Sec. 2955. Inclusion of information about the importance of having a health care
power of attorney in transition planning for children aging out of foster
care and independent living programs.
TITLE III—IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE
Subtitle A—Transforming the Health Care Delivery System
PART 1—LINKING PAYMENT TO QUALITY OUTCOMES UNDER THE MEDICARE PROGRAM
Sec. 3001. Hospital Value-Based purchasing program.
Sec. 3002. Improvements to the physician quality reporting system.
Sec. 3003. Improvements to the physician feedback program.
Sec. 3004. Quality reporting for long-term care hospitals, inpatient rehabilitation
hospitals, and hospice programs.
Sec. 3005. Quality reporting for PPS-exempt cancer hospitals.
Sec. 3006. Plans for a Value-Based purchasing program for skilled nursing facilities
and home health agencies.
Sec. 3007. Value-based payment modifier under the physician fee schedule.
Sec. 3008. Payment adjustment for conditions acquired in hospitals.
PART 2—NATIONAL STRATEGY TO IMPROVE HEALTH CARE QUALITY
Sec. 3011. National strategy.
Sec. 3012. Interagency Working Group on Health Care Quality.
Sec. 3013. Quality measure development.
Sec. 3014. Quality measurement.
Sec. 3015. Data collection; public reporting.
PART 3—ENCOURAGING DEVELOPMENT OF NEW PATIENT CARE MODELS
Sec. 3021. Establishment of Center for Medicare and Medicaid Innovation within
CMS.
Sec. 3022. Medicare shared savings program.
Sec. 3023. National pilot program on payment bundling.
Sec. 3024. Independence at home demonstration program.
Sec. 3025. Hospital readmissions reduction program.
Sec. 3026. Community-Based Care Transitions Program.
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—5
Sec. 3027. Extension of gainsharing demonstration.
Subtitle B—Improving Medicare for Patients and Providers
PART I—ENSURING BENEFICIARY ACCESS TO PHYSICIAN CARE AND OTHER SERVICES
Sec. 3101. øIncrease in the physician payment update¿ørepealed¿.
Sec. 3102. Extension of the work geographic index floor and revisions to the prac-
tice expense geographic adjustment under the Medicare physician fee
schedule.
Sec. 3103. Extension of exceptions process for Medicare therapy caps.
Sec. 3104. Extension of payment for technical component of certain physician pa-
thology services.
Sec. 3105. Extension of ambulance add-ons.
Sec. 3106. Extension of certain payment rules for long-term care hospital services
and of moratorium on the establishment of certain hospitals and facili-
ties.
Sec. 3107. Extension of physician fee schedule mental health add-on.
Sec. 3108. Permitting physician assistants to order post-Hospital extended care
services.
Sec. 3109. Exemption of certain pharmacies from accreditation requirements.
Sec. 3110. Part B special enrollment period for disabled TRICARE beneficiaries.
Sec. 3111. Payment for bone density tests.
Sec. 3112. Revision to the Medicare Improvement Fund.
Sec. 3113. Treatment of certain complex diagnostic laboratory tests.
Sec. 3114. Improved access for certified nurse-midwife services.
PART II—RURAL PROTECTIONS
Sec. 3121. Extension of outpatient hold harmless provision.
Sec. 3122. Extension of Medicare reasonable costs payments for certain clinical di-
agnostic laboratory tests furnished to hospital patients in certain rural
areas.
Sec. 3123. Extension of the Rural Community Hospital Demonstration Program.
Sec. 3124. Extension of the Medicare-dependent hospital (MDH) program.
Sec. 3125. Temporary improvements to the Medicare inpatient hospital payment
adjustment for low-volume hospitals.
Sec. 3126. Improvements to the demonstration project on community health inte-
gration models in certain rural counties.
Sec. 3127. MedPAC study on adequacy of Medicare payments for health care pro-
viders serving in rural areas.
Sec. 3128. Technical correction related to critical access hospital services.
Sec. 3129. Extension of and revisions to Medicare rural hospital flexibility program.
PART III—IMPROVING PAYMENT ACCURACY
Sec. 3131. Payment adjustments for home health care.
Sec. 3132. Hospice reform.
Sec. 3133. Improvement to medicare disproportionate share hospital (DSH) pay-
ments.
Sec. 3134. Misvalued codes under the physician fee schedule.
Sec. 3135. Modification of equipment utilization factor for advanced imaging serv-
ices.
Sec. 3136. Revision of payment for power-driven wheelchairs.
Sec. 3137. Hospital wage index improvement.
Sec. 3138. Treatment of certain cancer hospitals.
Sec. 3139. Payment for biosimilar biological products.
Sec. 3140. Medicare hospice concurrent care demonstration program.
Sec. 3141. Application of budget neutrality on a national basis in the calculation of
the Medicare hospital wage index floor.
Sec. 3142. HHS study on urban Medicare-dependent hospitals.
Sec. 3143. Protecting home health benefits.
Subtitle C—Provisions Relating to Part C
Sec. 3201. øMedicare Advantage payment¿ørepealed & replaced¿.
Sec. 3202. Benefit protection and simplification.
Sec. 3203. øApplication of coding intensity adjustment during MA payment transi-
tion¿ørepealed and replaced¿.
Sec. 3204. Simplification of annual beneficiary election periods.
Sec. 3205. Extension for specialized MA plans for special needs individuals.
Sec. 3206. Extension of reasonable cost contracts.
Sec. 3207. Technical correction to MA private fee-for-service plans.
Sec. 3208. Making senior housing facility demonstration permanent.
Sec. 3209. Authority to deny plan bids.
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—6
Sec. 3210. Development of new standards for certain Medigap plans.
Subtitle D—Medicare Part D Improvements for Prescription Drug Plans and MA–
PD Plans
Sec. 3301. Medicare coverage gap discount program.
Sec. 3302. Improvement in determination of Medicare part D low-income bench-
mark premium.
Sec. 3303. Voluntary de minimis policy for subsidy eligible individuals under pre-
scription drug plans and MA–PD plans.
Sec. 3304. Special rule for widows and widowers regarding eligibility for low-in-
come assistance.
Sec. 3305. Improved information for subsidy eligible individuals reassigned to pre-
scription drug plans and MA–PD plans.
Sec. 3306. Funding outreach and assistance for low-income programs.
Sec. 3307. Improving formulary requirements for prescription drug plans and MA–
PD plans with respect to certain categories or classes of drugs.
Sec. 3308. Reducing part D premium subsidy for high-income beneficiaries.
Sec. 3309. Elimination of cost sharing for certain dual eligible individuals.
Sec. 3310. Reducing wasteful dispensing of outpatient prescription drugs in long-
term care facilities under prescription drug plans and MA–PD plans.
Sec. 3311. Improved Medicare prescription drug plan and MA–PD plan complaint
system.
Sec. 3312. Uniform exceptions and appeals process for prescription drug plans and
MA–PD plans.
Sec. 3313. Office of the Inspector General studies and reports.
Sec. 3314. Including costs incurred by AIDS drug assistance programs and Indian
Health Service in providing prescription drugs toward the annual out-
of-pocket threshold under part D.
Sec. 3315. øImmediate reduction in coverage gap in 2010¿ørepealed and replaced¿.
Subtitle E—Ensuring Medicare Sustainability
Sec. 3401. Revision of certain market basket updates and incorporation of produc-
tivity improvements into market basket updates that do not already in-
corporate such improvements.
Sec. 3402. Temporary adjustment to the calculation of part B premiums.
Sec. 3403. Independent øMedicare¿Payment Advisory Board.
Subtitle F—Health Care Quality Improvements
Sec. 3501. Health care delivery system research; Quality improvement technical as-
sistance.
Sec. 3502. Establishing community health teams to support the patient-centered
medical home.
Sec. 3503. Medication management services in treatment of chronic disease.
Sec. 3504. Design and implementation of regionalized systems for emergency care.
Sec. 3505. Trauma care centers and service availability.
Sec. 3506. Program to facilitate shared decisionmaking.
Sec. 3507. Presentation of prescription drug benefit and risk information.
Sec. 3508. Demonstration program to integrate quality improvement and patient
safety training into clinical education of health professionals.
Sec. 3509. Improving women’s health.
Sec. 3510. Patient navigator program.
Sec. 3511. Authorization of appropriations.
Sec. 3512. GAO study and report on causes of action.
Subtitle G—Protecting and Improving Guaranteed Medicare Benefits
Sec. 3601. Protecting and improving guaranteed Medicare benefits.
Sec. 3602. No cuts in guaranteed benefits.
TITLE IV—PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC
HEALTH
Subtitle A—Modernizing Disease Prevention and Public Health Systems
Sec. 4001. National Prevention, Health Promotion and Public Health Council.
Sec. 4002. Prevention and Public Health Fund.
Sec. 4003. Clinical and community Preventive Services.
Sec. 4004. Education and outreach campaign regarding preventive benefits.
Subtitle B—Increasing Access to Clinical Preventive Services
Sec. 4101. School-based health centers.
Sec. 4102. Oral healthcare prevention activities.
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Sec. 4103. Medicare coverage of annual wellness visit providing a personalized pre-
vention plan.
Sec. 4104. Removal of barriers to preventive services in Medicare.
Sec. 4105. Evidence-based coverage of preventive services in Medicare.
Sec. 4106. Improving access to preventive services for eligible adults in Medicaid.
Sec. 4107. Coverage of comprehensive tobacco cessation services for pregnant
women in Medicaid.
Sec. 4108. Incentives for prevention of chronic diseases in medicaid.
Subtitle C—Creating Healthier Communities
Sec. 4201. Community transformation grants.
Sec. 4202. Healthy aging, living well; evaluation of community-based prevention
and wellness programs for Medicare beneficiaries.
Sec. 4203. Removing barriers and improving access to wellness for individuals with
disabilities.
Sec. 4204. Immunizations.
Sec. 4205. Nutrition labeling of standard menu items at Chain Restaurants.
Sec. 4206. Demonstration project concerning individualized wellness plan.
Sec. 4207. Reasonable break time for nursing mothers.
Subtitle D—Support for Prevention and Public Health Innovation
Sec. 4301. Research on optimizing the delivery of public health services.
Sec. 4302. Understanding health disparities: data collection and analysis.
Sec. 4303. CDC and employer-based wellness programs.
Sec. 4304. Epidemiology-Laboratory Capacity Grants.
Sec. 4305. Advancing research and treatment for pain care management.
Sec. 4306. Funding for Childhood Obesity Demonstration Project.
Subtitle E—Miscellaneous Provisions
Sec. 4401. Sense of the Senate concerning CBO scoring.
Sec. 4402. Effectiveness of Federal health and wellness initiatives.
TITLE V—HEALTH CARE WORKFORCE
Subtitle A—Purpose and Definitions
Sec. 5001. Purpose.
Sec. 5002. Definitions.
Subtitle B—Innovations in the Health Care Workforce
Sec. 5101. National health care workforce commission.
Sec. 5102. State health care workforce development grants.
Sec. 5103. Health care workforce assessment.
Sec. 5104. Interagency task force to assess and improve access to health care in the
State of Alaska.
Subtitle C—Increasing the Supply of the Health Care Workforce
Sec. 5201. Federally supported student loan funds.
Sec. 5202. Nursing student loan program.
Sec. 5203. Health care workforce loan repayment programs.
Sec. 5204. Public health workforce recruitment and retention programs.
Sec. 5205. Allied health workforce recruitment and retention programs.
Sec. 5206. Grants for State and local programs.
Sec. 5207. Funding for National Health Service Corps.
Sec. 5208. Nurse-managed health clinics.
Sec. 5209. Elimination of cap on commissioned corps.
Sec. 5210. Establishing a Ready Reserve Corps.
Subtitle D—Enhancing Health Care Workforce Education and Training
Sec. 5301. Training in family medicine, general internal medicine, general pediat-
rics, and physician assistantship.
Sec. 5302. Training opportunities for direct care workers.
Sec. 5303. Training in general, pediatric, and public health dentistry.
Sec. 5304. Alternative dental health care providers demonstration project.
Sec. 5305. Geriatric education and training; career awards; comprehensive geriatric
education.
Sec. 5306. Mental and behavioral health education and training grants.
Sec. 5307. Cultural competency, prevention, and public health and individuals with
disabilities training.
Sec. 5308. Advanced nursing education grants.
Sec. 5309. Nurse education, practice, and retention grants.
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Sec. 5310. Loan repayment and scholarship program.
Sec. 5311. Nurse faculty loan program.
Sec. 5312. Authorization of appropriations for parts B through D of title VIII.
Sec. 5313. Grants to promote the community health workforce.
Sec. 5314. Fellowship training in public health.
Sec. 5315. United States Public Health Sciences Track.
Sec. 5316. Demonstration grants for family nurse practitioner training programs.
Subtitle E—Supporting the Existing Health Care Workforce
Sec. 5401. Centers of excellence.
Sec. 5402. Health care professionals training for diversity.
Sec. 5403. Interdisciplinary, community-based linkages.
Sec. 5404. Workforce diversity grants.
Sec. 5405. Primary care extension program.
Subtitle F—Strengthening Primary Care and Other Workforce Improvements
Sec. 5501. Expanding access to primary care services and general surgery services.
Sec. 5502. øMedicare Federally qualified health center improvements¿ørepealed¿.
Sec. 5503. Distribution of additional residency positions.
Sec. 5504. Counting resident time in nonprovider settings.
Sec. 5505. Rules for counting resident time for didactic and scholarly activities and
other activities.
Sec. 5506. Preservation of resident cap positions from closed hospitals.
Sec. 5507. Demonstration projects To address health professions workforce needs;
extension of family-to-family health information centers.
Sec. 5508. Increasing teaching capacity.
Sec. 5509. Graduate nurse education demonstration.
Subtitle G—Improving Access to Health Care Services
Sec. 5601. Spending for Federally Qualified Health Centers (FQHCs).
Sec. 5602. Negotiated rulemaking for development of methodology and criteria for
designating medically underserved populations and health professions
shortage areas.
Sec. 5603. Reauthorization of the Wakefield Emergency Medical Services for Chil-
dren Program.
Sec. 5604. Co-locating primary and specialty care in community-based mental
health settings.
Sec. 5605. Key National indicators.
Sec. 5606. State grants to health care providers who provide services to a high per-
centage of medically underserved populations or other special popu-
lations.
Subtitle H—General Provisions
Sec. 5701. Reports.
TITLE VI—TRANSPARENCY AND PROGRAM INTEGRITY
Subtitle A—Physician Ownership and Other Transparency
Sec. 6001. Limitation on Medicare exception to the prohibition on certain physician
referrals for hospitals.
Sec. 6002. Transparency reports and reporting of physician ownership or invest-
ment interests.
Sec. 6003. Disclosure requirements for in-office ancillary services exception to the
prohibition on physician self-referral for certain imaging services.
Sec. 6004. Prescription drug sample transparency.
Sec. 6005. Pharmacy benefit managers transparency requirements.
Subtitle B—Nursing Home Transparency and Improvement
PART 1—IMPROVING TRANSPARENCY OF INFORMATION
Sec. 6101. Required disclosure of ownership and additional disclosable parties in-
formation.
Sec. 6102. Accountability requirements for skilled nursing facilities and nursing fa-
cilities.
Sec. 6103. Nursing home compare Medicare website.
Sec. 6104. Reporting of expenditures.
Sec. 6105. Standardized complaint form.
Sec. 6106. Ensuring staffing accountability.
Sec. 6107. GAO study and report on Five-Star Quality Rating System.
PART 2—TARGETING ENFORCEMENT
Sec. 6111. Civil money penalties.
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Sec. 6112. National independent monitor demonstration project.
Sec. 6113. Notification of facility closure.
Sec. 6114. National demonstration projects on culture change and use of informa-
tion technology in nursing homes.
PART 3—IMPROVING STAFF TRAINING
Sec. 6121. Dementia and abuse prevention training.
Subtitle C—Nationwide Program for National and State Background Checks on
Direct Patient Access Employees of Long-term Care Facilities and Providers
Sec. 6201. Nationwide program for National and State background checks on direct
patient access employees of long-term care facilities and providers.
Subtitle D—Patient-Centered Outcomes Research
Sec. 6301. Patient-Centered Outcomes Research.
Sec. 6302. Federal coordinating council for comparative effectiveness research.
Subtitle E—Medicare, Medicaid, and CHIP Program Integrity Provisions
Sec. 6401. Provider screening and other enrollment requirements under Medicare,
Medicaid, and CHIP.
Sec. 6402. Enhanced Medicare and Medicaid program integrity provisions.
Sec. 6403. Elimination of duplication between the Healthcare Integrity and Protec-
tion Data Bank and the National Practitioner Data Bank.
Sec. 6404. Maximum period for submission of Medicare claims reduced to not more
than 12 months.
Sec. 6405. Physicians who order items or services required to be Medicare enrolled
physicians or eligible professionals.
Sec. 6406. Requirement for physicians to provide documentation on referrals to pro-
grams at high risk of waste and abuse.
Sec. 6407. Face to face encounter with patient required before physicians may cer-
tify eligibility for home health services or durable medical equipment
under Medicare.
Sec. 6408. Enhanced penalties.
Sec. 6409. Medicare self-referral disclosure protocol.
Sec. 6410. Adjustments to the Medicare durable medical equipment, prosthetics,
orthotics, and supplies competitive acquisition program.
Sec. 6411. Expansion of the Recovery Audit Contractor (RAC) program.
Subtitle F—Additional Medicaid Program Integrity Provisions
Sec. 6501. Termination of provider participation under Medicaid if terminated
under Medicare or other State plan.
Sec. 6502. Medicaid exclusion from participation relating to certain ownership,
control, and management affiliations.
Sec. 6503. Billing agents, clearinghouses, or other alternate payees required to reg-
ister under Medicaid.
Sec. 6504. Requirement to report expanded set of data elements under MMIS to
detect fraud and abuse.
Sec. 6505. Prohibition on payments to institutions or entities located outside of the
United States.
Sec. 6506. Overpayments.
Sec. 6507. Mandatory State use of national correct coding initiative.
Sec. 6508. General effective date.
Subtitle G—Additional Program Integrity Provisions
Sec. 6601.
Prohibition on false statements and representations.
Sec. 6602.
Clarifying definition.
Sec. 6603.
Development of model uniform report form.
Sec. 6604.
Applicability of State law to combat fraud and abuse.
Sec. 6605.
Enabling the Department of Labor to issue administrative summary
cease and desist orders and summary seizures orders against plans that
are in financially hazardous condition.
Sec. 6606. MEWA plan registration with Department of Labor.
Sec. 6607. Permitting evidentiary privilege and confidential communications.
Subtitle H—Elder Justice Act
Sec. 6701. Short title of subtitle.
Sec. 6702. Definitions.
Sec. 6703. Elder Justice.
Subtitle I—Sense of the Senate Regarding Medical Malpractice
Sec. 6801. Sense of the Senate regarding medical malpractice.
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TITLE VII—IMPROVING ACCESS TO INNOVATIVE MEDICAL THERAPIES
Subtitle A—Biologics Price Competition and Innovation
Sec. 7001. Short title.
Sec. 7002. Approval pathway for biosimilar biological products.
Sec. 7003. Savings.
Subtitle B—More Affordable Medicines for Children and Underserved Communities
Sec. 7101. Expanded participation in 340B program.
Sec. 7102. Improvements to 340B program integrity.
Sec. 7103. GAO study to make recommendations on improving the 340B program.
TITLE VIII—CLASS ACT
Sec. 8001. Short title of title.
Sec. 8002. Establishment of national voluntary insurance program for purchasing
community living assistance services and support.
TITLE IX—REVENUE PROVISIONS
Subtitle A—Revenue Offset Provisions
Sec. 9001. Excise tax on high cost employer-sponsored health coverage.
Sec. 9002. Inclusion of cost of employer-sponsored health coverage on W–2.
Sec. 9003. Distributions for medicine qualified only if for prescribed drug or insulin.
Sec. 9004. Increase in additional tax on distributions from HSAs and Archer MSAs
not used for qualified medical expenses.
Sec. 9005. Limitation on health flexible spending arrangements under cafeteria
plans.
Sec. 9006. Expansion of information reporting requirements.
Sec. 9007. Additional requirements for charitable hospitals.
Sec. 9008. Imposition of annual fee on branded prescription pharmaceutical manu-
facturers and importers.
Sec. 9009. øImposition of annual fee on medical device manufacturers and import-
ers¿ørepealed and replaced¿.
Sec. 9010. Imposition of annual fee on health insurance providers.
Sec. 9011. Study and report of effect on veterans health care.
Sec. 9012. Elimination of deduction for expenses allocable to Medicare Part D sub-
sidy.
Sec. 9013. Modification of itemized deduction for medical expenses.
Sec. 9014. Limitation on excessive remuneration paid by certain health insurance
providers.
Sec. 9015. Additional hospital insurance tax on high-income taxpayers.
Sec. 9016. Modification of section 833 treatment of certain health organizations.
Sec. 9017. øExcise tax on elective cosmetic medical procedures¿ønullified¿.
Subtitle B—Other Provisions
Sec. 9021. Exclusion of health benefits provided by Indian tribal governments.
Sec. 9022. Establishment of simple cafeteria plans for small businesses.
Sec. 9023. Qualifying therapeutic discovery project credit.
TITLE X—STRENGTHENING QUALITY, AFFORDABLE HEALTH CARE FOR
ALL AMERICANS
Subtitle A—Provisions Relating to Title I
Sec. 10101. Amendments to subtitle A øamendments fully incorporated above¿.
Sec. 10102. Amendments to subtitle B øamendments fully incorporated above¿.
Sec. 10103. Amendments to subtitle C øamendments fully incorporated above¿.
Sec. 10104. Amendments to subtitle D.
Sec. 10105. Amendments to subtitle E øamendments fully incorporated above¿.
Sec. 10106. Amendments to subtitle F øamendments fully incorporated above¿.
Sec. 10107. Amendments to subtitle G øamendments fully incorporated above¿.
Sec. 10108. Free choice vouchers.
Sec. 10109. Development of standards for financial and administrative trans-
actions.
Subtitle B—Provisions Relating to Title II
PART 1—MEDICAID AND CHIP
Sec. 10201. Amendments to the Social Security Act and title II of this Act.
Sec. 10202. Incentives for States to offer home and community-based services as a
long-term care alternative to nursing homes.
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Sec. 10203. Extension of funding for CHIP through fiscal year 2015 and other
CHIP-related provisions.
PART 2—SUPPORT FOR PREGNANT AND PARENTING TEENS AND WOMEN
Sec. 10211. Definitions.
Sec. 10212. Establishment of pregnancy assistance fund.
Sec. 10213. Permissible uses of Fund.
Sec. 10214. Appropriations.
PART 3—INDIAN HEALTH CARE IMPROVEMENT
Sec. 10221. Indian health care improvement.
Subtitle C—Provisions Relating to Title III
Sec. 10301. Plans for a Value-Based purchasing program for ambulatory surgical
centers øamendments fully incorporated above¿.
Sec. 10302. Revision to national strategy for quality improvement in health care
øamendments fully incorporated above¿.
Sec. 10303. Development of outcome measures.
Sec. 10304. Selection of efficiency measures øamendments fully incorporated
above¿.
Sec. 10305. Data collection; public reporting øamendments fully incorporated
above¿.
Sec. 10306. Improvements under the Center for Medicare and Medicaid Innovation
øamendments fully incorporated above¿.
Sec. 10307. Improvements to the Medicare shared savings program øamendments
fully incorporated above¿.
Sec. 10308. Revisions to national pilot program on payment bundling øamendments
fully incorporated above¿.
Sec. 10309. Revisions to hospital readmissions reduction program øamendments
fully incorporated above¿.
Sec. 10310. Repeal of physician payment update øamendments fully incorporated
above¿.
Sec. 10311. Revisions to extension of ambulance add-ons øamendments fully incor-
porated above¿.
Sec. 10312. Certain payment rules for long-term care hospital services and morato-
rium on the establishment of certain hospitals and facilities øamend-
ments fully incorporated above¿.
Sec. 10313. Revisions to the extension for the rural community hospital demonstra-
tion program øamendments fully incorporated above¿.
Sec. 10314. Adjustment to low-volume hospital provision øamendments fully incor-
porated above¿.
Sec. 10315. Revisions to home health care provisions øamendments fully incor-
porated above¿.
Sec. 10316. Medicare DSH øamendments fully incorporated above¿.
Sec. 10317. Revisions to extension of section 508 hospital provisions øamendments
fully incorporated above¿.
Sec. 10318. Revisions to transitional extra benefits under Medicare Advantage
øamendments fully incorporated above¿.
Sec. 10319. Revisions to market basket adjustments øamendments fully incor-
porated above¿.
Sec. 10320. Expansion of the scope of, and additional improvements to, the Inde-
pendent Medicare Advisory Board.
Sec. 10321. Revision to community health teams øamendments fully incorporated
above¿.
Sec. 10322. Quality reporting for psychiatric hospitals.
Sec. 10323. Medicare coverage for individuals exposed to environmental health haz-
ards.
Sec. 10324. Protections for frontier States.
Sec. 10325. Revision to skilled nursing facility prospective payment system.
Sec. 10326. Pilot testing pay-for-performance programs for certain Medicare pro-
viders.
Sec. 10327. Improvements to the physician quality reporting system.
Sec. 10328. Improvement in part D medication therapy management (MTM) pro-
grams.
Sec. 10329. Developing methodology to assess health plan value.
Sec. 10330. Modernizing computer and data systems of the Centers for Medicare &
Medicaid services to support improvements in care delivery.
Sec. 10331. Public reporting of performance information.
Sec. 10332. Availability of medicare data for performance measurement.
Sec. 10333. Community-based collaborative care networks.
Sec. 10334. Minority health.
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Sec. 10335. Technical correction to the hospital value-based purchasing program
øamendments fully incorporated above¿.
Sec. 10336. GAO study and report on Medicare beneficiary access to high-quality
dialysis services.
Subtitle D—Provisions Relating to Title IV
Sec. 10401. Amendments to subtitle A øamendments fully incorporated above¿.
Sec. 10402. Amendments to subtitle B øamendments fully incorporated above¿.
Sec. 10403. Amendments to subtitle C øamendments fully incorporated above¿.
Sec. 10404. Amendments to subtitle D øamendments fully incorporated above¿.
Sec. 10405. Amendments to subtitle E øamendments fully incorporated above¿.
Sec. 10406. Amendment relating to waiving coinsurance for preventive services
øamendments fully incorporated above¿.
Sec. 10407. Better diabetes care.
Sec. 10408. Grants for small businesses to provide comprehensive workplace
wellness programs.
Sec. 10409. Cures Acceleration Network.
Sec. 10410. Centers of Excellence for Depression.
Sec. 10411. Programs relating to congenital heart disease.
Sec. 10412. Automated Defibrillation in Adam’s Memory Act.
Sec. 10413. Young women’s breast health awareness and support of young women
diagnosed with breast cancer.
Subtitle E—Provisions Relating to Title V
Sec. 10501. Amendments to the Public Health Service Act, the Social Security Act,
and title V of this Act.
Sec. 10502. Infrastructure to Expand Access to Care.
Sec. 10503. Community Health Centers and the National Health Service Corps
Fund.
Sec. 10504. Demonstration project to provide access to affordable care.
Subtitle F—Provisions Relating to Title VI
Sec. 10601. Revisions to limitation on medicare exception to the prohibition on cer-
tain physician referrals for hospitals øamendments fully incorporated
above¿.
Sec. 10602. Clarifications to patient-centered outcomes research øamendments fully
incorporated above¿.
Sec. 10603. Striking provisions relating to individual provider application fees
øamendments fully incorporated above¿.
Sec. 10604. Technical correction to section 6405 øamendments fully incorporated
above¿.
Sec. 10605. Certain other providers permitted to conduct face to face encounter for
home health services øamendments fully incorporated above¿.
Sec. 10606. Health care fraud enforcement.
Sec. 10607. State demonstration programs to evaluate alternatives to current med-
ical tort litigation.
Sec. 10608. Extension of medical malpractice coverage to free clinics.
Sec. 10609. Labeling changes.
Subtitle G—Provisions Relating to Title VIII
Sec. 10801. Provisions relating to title VIII øamendments fully incorporated above¿.
Subtitle H—Provisions Relating to Title IX
Sec. 10901. Modifications to excise tax on high cost employer-sponsored health cov-
erage øamendments fully incorporated above¿.
Sec. 10902. Inflation adjustment of limitation on health flexible spending arrange-
ments under cafeteria plans øamendments fully incorporated above¿.
Sec. 10903. Modification of limitation on charges by charitable hospitals øamend-
ments fully incorporated above¿.
Sec. 10904. Modification of annual fee on medical device manufacturers and im-
porters øamendments fully incorporated above¿.
Sec. 10905. Modification of annual fee on health insurance providers øamendments
fully incorporated above¿.
Sec. 10906. Modifications to additional hospital insurance tax on high-income tax-
payers øamendments fully incorporated above¿.
Sec. 10907. Excise tax on indoor tanning services in lieu of elective cosmetic med-
ical procedures øsubstitutes for section 9017 of PPACA¿.
Sec. 10908. Exclusion for assistance provided to participants in State student loan
repayment programs for certain health professionals.
Sec. 10909. Expansion of adoption credit and adoption assistance programs.
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‘‘SEC. 2712. PROHIBITION ON RESCISSIONS.
‘‘A group health plan and a health insurance issuer offering
group or individual health insurance coverage shall not rescind
such plan or coverage with respect to an enrollee once the enrollee
is covered under such plan or coverage involved, except that this
section shall not apply to a covered individual who has performed
an act or practice that constitutes fraud or makes an intentional
misrepresentation of material fact as prohibited by the terms of
the plan or coverage. Such plan or coverage may not be cancelled
except with prior notice to the enrollee, and only as permitted
under section 2702(c) or 2742(b).
‘‘SEC. 2713. COVERAGE OF PREVENTIVE HEALTH SERVICES.
‘‘(a) IN GENERAL.—A group health plan and a health insurance
issuer offering group or individual health insurance coverage shall,
at a minimum provide coverage for and shall not impose any
cost sharing requirements for—
‘‘(1) evidence-based items or services that have in effect
a rating of ‘A’ or ‘B’ in the current recommendations of the
United States Preventive Services Task Force;
‘‘(2) immunizations that have in effect a recommendation
from the Advisory Committee on Immunization Practices of
the Centers for Disease Control and Prevention with respect
to the individual involved; and
‘‘(3) with respect to infants, children, and adolescents, evi-
dence-informed preventive care and screenings provided for
in the comprehensive guidelines supported by the Health
Resources and Services Administration.
‘‘(4) with respect to women, such additional preventive
care and screenings not described in paragraph (1) as provided
for in comprehensive guidelines supported by the Health
Resources and Services Administration for purposes of this
paragraph.
‘‘(5) for the purposes of this Act, and for the purposes
of any other provision of law, the current recommendations
of the United States Preventive Service Task Force regarding
breast cancer screening, mammography, and prevention shall
be considered the most current other than those issued in
or around November 2009.
Nothing in this subsection shall be construed to prohibit a plan
or issuer from providing coverage for services in addition to those
recommended by United States Preventive Services Task Force
or to deny coverage for services that are not recommended by
such Task Force.
‘‘(b) INTERVAL.—
‘‘(1) IN GENERAL.—The Secretary shall establish a minimum
interval between the date on which a recommendation described
in subsection (a)(1) or (a)(2) or a guideline under subsection
(a)(3) is issued and the plan year with respect to which the
requirement described in subsection (a) is effective with respect
to the service described in such recommendation or guideline.
‘‘(2) MINIMUM.—The interval described in paragraph (1)
shall not be less than 1 year.
‘‘(c) VALUE-BASED INSURANCE DESIGN.—The Secretary may
develop guidelines to permit a group health plan and a health
insurance issuer offering group or individual health insurance cov-
erage to utilize value-based insurance designs.
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‘‘SEC. 2714. EXTENSION OF DEPENDENT COVERAGE.
‘‘(a) IN GENERAL.—A group health plan and a health insurance
issuer offering group or individual health insurance coverage that
provides dependent coverage of children shall continue to make
such coverage available for an adult child until the child turns
26 years of age. Nothing in this section shall require a health
plan or a health insurance issuer described in the preceding sen-
tence to make coverage available for a child of a child receiving
dependent coverage. øAs revised by section 2301(b) of HCERA¿
‘‘(b) REGULATIONS.—The Secretary shall promulgate regulations
to define the dependents to which coverage shall be made available
under subsection (a).
‘‘(c) RULE OF CONSTRUCTION.—Nothing in this section shall
be construed to modify the definition of ‘dependent’ as used in
the Internal Revenue Code of 1986 with respect to the tax treatment
of the cost of coverage.
‘‘SEC. 2715. DEVELOPMENT AND UTILIZATION OF UNIFORM EXPLA-
NATION OF COVERAGE DOCUMENTS AND STANDARDIZED
DEFINITIONS.
‘‘(a) IN GENERAL.—Not later than 12 months after the date
of enactment of the Patient Protection and Affordable Care Act,
the Secretary shall develop standards for use by a group health
plan and a health insurance issuer offering group or individual
health insurance coverage, in compiling and providing to applicants,
enrollees, and policyholders or certificate holders a summary of
benefits and coverage explanation that accurately describes the
benefits and coverage under the applicable plan or coverage. In
developing such standards, the Secretary shall consult with the
National Association of Insurance Commissioners (referred to in
this section as the ‘NAIC’), a working group composed of representa-
tives of health insurance-related consumer advocacy organizations,
health insurance issuers, health care professionals, patient advo-
cates including those representing individuals with limited English
proficiency, and other qualified individuals. øAs revised by section
10101(b)¿
‘‘(b) REQUIREMENTS.—The standards for the summary of bene-
fits and coverage developed under subsection (a) shall provide for
the following:
‘‘(1) APPEARANCE.—The standards shall ensure that the
summary of benefits and coverage is presented in a uniform
format that does not exceed 4 pages in length and does not
include print smaller than 12-point font.
‘‘(2) LANGUAGE.—The standards shall ensure that the sum-
mary is presented in a culturally and linguistically appropriate
manner and utilizes terminology understandable by the average
plan enrollee.
‘‘(3) CONTENTS.—The standards shall ensure that the sum-
mary of benefits and coverage includes—
‘‘(A) uniform definitions of standard insurance terms
and medical terms (consistent with subsection (g)) so that
consumers may compare health insurance coverage and
understand the terms of coverage (or exception to such
coverage);
‘‘(B) a description of the coverage, including cost
sharing for—
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The Secretary shall make reports received under this section avail-
able to the public on the Internet website of the Department of
Health and Human Services.
‘‘(b) ENSURING THAT CONSUMERS RECEIVE VALUE FOR THEIR
PREMIUM PAYMENTS.—
‘‘(1) REQUIREMENT TO PROVIDE VALUE FOR PREMIUM PAY-
MENTS.—
‘‘(A) REQUIREMENT.—Beginning not later than January
1, 2011, a health insurance issuer offering group or indi-
vidual health insurance coverage (including a grand-
fathered health plan) shall, with respect to each plan year,
provide an annual rebate to each enrollee under such cov-
erage, on a pro rata basis, if the ratio of the amount
of premium revenue expended by the issuer on costs
described in paragraphs (1) and (2) of subsection (a) to
the total amount of premium revenue (excluding Federal
and State taxes and licensing or regulatory fees and after
accounting for payments or receipts for risk adjustment,
risk corridors, and reinsurance under sections 1341, 1342,
and 1343 of the Patient Protection and Affordable Care
Act) for the plan year (except as provided in subparagraph
(B)(ii)), is less than—
‘‘(i) with respect to a health insurance issuer
offering coverage in the large group market, 85 percent,
or such higher percentage as a State may by regulation
determine; or
‘‘(ii) with respect to a health insurance issuer
offering coverage in the small group market or in the
individual market, 80 percent, or such higher percent-
age as a State may by regulation determine, except
that the Secretary may adjust such percentage with
respect to a State if the Secretary determines that
the application of such 80 percent may destabilize the
individual market in such State.
‘‘(B) REBATE AMOUNT.—
‘‘(i) CALCULATION OF AMOUNT.—The total amount
of an annual rebate required under this paragraph
shall be in an amount equal to the product of—
‘‘(I) the amount by which the percentage
described in clause (i) or (ii) of subparagraph (A)
exceeds the ratio described in such subparagraph;
and
‘‘(II) the total amount of premium revenue
(excluding Federal and State taxes and licensing
or regulatory fees and after accounting for pay-
ments or receipts for risk adjustment, risk cor-
ridors, and reinsurance under sections 1341, 1342,
and 1343 of the Patient Protection and Affordable
Care Act) for such plan year.
‘‘(ii) CALCULATION BASED ON AVERAGE RATIO.—
Beginning on January 1, 2014, the determination made
under subparagraph (A) for the year involved shall
be based on the averages of the premiums expended
on the costs described in such subparagraph and total
premium revenue for each of the previous 3 years
for the plan.
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SEC. 1304. RELATED DEFINITIONS.
(a) DEFINITIONS RELATING TO MARKETS.—In this title:
(1) GROUP MARKET.—The term ‘‘group market’’ means the
health insurance market under which individuals obtain health
insurance coverage (directly or through any arrangement) on
behalf of themselves (and their dependents) through a group
health plan maintained by an employer.
(2) INDIVIDUAL MARKET.—The term ‘‘individual market’’
means the market for health insurance coverage offered to
individuals other than in connection with a group health plan.
(3) LARGE AND SMALL GROUP MARKETS.—The terms ‘‘large
group market’’ and ‘‘small group market’’ mean the health
insurance market under which individuals obtain health insur-
ance coverage (directly or through any arrangement) on behalf
of themselves (and their dependents) through a group health
plan maintained by a large employer (as defined in subsection
(b)(1)) or by a small employer (as defined in subsection (b)(2)),
respectively.
(b) EMPLOYERS.—In this title:
(1) LARGE EMPLOYER.—The term ‘‘large employer’’ means,
in connection with a group health plan with respect to a cal-
endar year and a plan year, an employer who employed an
average of at least 101 employees on business days during
the preceding calendar year and who employs at least 1
employee on the first day of the plan year.
(2) SMALL EMPLOYER.—The term ‘‘small employer’’ means,
in connection with a group health plan with respect to a cal-
endar year and a plan year, an employer who employed an
average of at least 1 but not more than 100 employees on
business days during the preceding calendar year and who
employs at least 1 employee on the first day of the plan year.
(3) STATE OPTION TO TREAT 50 EMPLOYEES AS SMALL.—
In the case of plan years beginning before January 1, 2016,
a State may elect to apply this subsection by substituting
‘‘51 employees’’ for ‘‘101 employees’’ in paragraph (1) and by
substituting ‘‘50 employees’’ for ‘‘100 employees’’ in paragraph
(2).
(4) RULES FOR DETERMINING EMPLOYER SIZE.—For purposes
of this subsection—
(A) APPLICATION OF AGGREGATION RULE FOR
EMPLOYERS.—All persons treated as a single employer
under subsection (b), (c), (m), or (o) of section 414 of the
Internal Revenue Code of 1986 shall be treated as 1
employer.
(B) EMPLOYERS NOT IN EXISTENCE IN PRECEDING
YEAR.—In the case of an employer which was not in exist-
ence throughout the preceding calendar year, the deter-
mination of whether such employer is a small or large
employer shall be based on the average number of
employees that it is reasonably expected such employer
will employ on business days in the current calendar year.
(C) PREDECESSORS.—Any reference in this subsection
to an employer shall include a reference to any predecessor
of such employer.
(D) CONTINUATION OF PARTICIPATION FOR GROWING
SMALL EMPLOYERS.—If—
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under this title had the State not received such waiver, shall
be paid to the State for purposes of implementing the State
plan under the waiver. Such amount shall be determined
annually by the Secretary, taking into consideration the experi-
ence of other States with respect to participation in an
Exchange and credits and reductions provided under such provi-
sions to residents of the other States.
(4) WAIVER CONSIDERATION AND TRANSPARENCY.—
(A) IN GENERAL.—An application for a waiver under
this section shall be considered by the Secretary in accord-
ance with the regulations described in subparagraph (B).
(B) REGULATIONS.—Not later than 180 days after the
date of enactment of this Act, the Secretary shall promul-
gate regulations relating to waivers under this section that
provide—
(i) a process for public notice and comment at
the State level, including public hearings, sufficient
to ensure a meaningful level of public input;
(ii) a process for the submission of an application
that ensures the disclosure of—
(I) the provisions of law that the State involved
seeks to waive; and
(II) the specific plans of the State to ensure
that the waiver will be in compliance with sub-
section (b);
(iii) a process for providing public notice and com-
ment after the application is received by the Secretary,
that is sufficient to ensure a meaningful level of public
input and that does not impose requirements that are
in addition to, or duplicative of, requirements imposed
under the Administrative Procedures Act, or require-
ments that are unreasonable or unnecessarily burden-
some with respect to State compliance;
(iv) a process for the submission to the Secretary
of periodic reports by the State concerning the
implementation of the program under the waiver; and
(v) a process for the periodic evaluation by the
Secretary of the program under the waiver.
(C) REPORT.—The Secretary shall annually report to
Congress concerning actions taken by the Secretary with
respect to applications for waivers under this section.
(5) COORDINATED WAIVER PROCESS.—The Secretary shall
develop a process for coordinating and consolidating the State
waiver processes applicable under the provisions of this section,
and the existing waiver processes applicable under titles XVIII,
XIX, and XXI of the Social Security Act, and any other Federal
law relating to the provision of health care items or services.
Such process shall permit a State to submit a single application
for a waiver under any or all of such provisions.
(6) DEFINITION.—In this section, the term ‘‘Secretary’’
means—
(A) the Secretary of Health and Human Services with
respect to waivers relating to the provisions described in
subparagraph (A) through (C) of paragraph (2); and
(B) the Secretary of the Treasury with respect to
waivers relating to the provisions described in paragraph
(2)(D).
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1986. The preceding sentence shall not apply to the tax imposed
by section 511 such Code (relating to tax on unrelated business
taxable income of an exempt organization).
(d) COORDINATION WITH STATE HIGH-RISK POOLS.—The State
shall eliminate or modify any State high-risk pool to the extent
necessary to carry out the reinsurance program established under
this section. The State may coordinate the State high-risk pool
with such program to the extent not inconsistent with the provisions
of this section.
SEC. 1342. ESTABLISHMENT OF RISK CORRIDORS FOR PLANS IN INDI-
VIDUAL AND SMALL GROUP MARKETS.
(a) IN GENERAL.—The Secretary shall establish and administer
a program of risk corridors for calendar years 2014, 2015, and
2016 under which a qualified health plan offered in the individual
or small group market shall participate in a payment adjustment
system based on the ratio of the allowable costs of the plan to
the plan’s aggregate premiums. Such program shall be based on
the program for regional participating provider organizations under
part D of title XVIII of the Social Security Act.
(b) PAYMENT METHODOLOGY.—
(1) PAYMENTS OUT.—The Secretary shall provide under the
program established under subsection (a) that if—
(A) a participating plan’s allowable costs for any plan
year are more than 103 percent but not more than 108
percent of the target amount, the Secretary shall pay to
the plan an amount equal to 50 percent of the target
amount in excess of 103 percent of the target amount;
and
(B) a participating plan’s allowable costs for any plan
year are more than 108 percent of the target amount,
the Secretary shall pay to the plan an amount equal to
the sum of 2.5 percent of the target amount plus 80 percent
of allowable costs in excess of 108 percent of the target
amount.
(2) PAYMENTS IN.—The Secretary shall provide under the
program established under subsection (a) that if—
(A) a participating plan’s allowable costs for any plan
year are less than 97 percent but not less than 92 percent
of the target amount, the plan shall pay to the Secretary
an amount equal to 50 percent of the excess of 97 percent
of the target amount over the allowable costs; and
(B) a participating plan’s allowable costs for any plan
year are less than 92 percent of the target amount, the
plan shall pay to the Secretary an amount equal to the
sum of 2.5 percent of the target amount plus 80 percent
of the excess of 92 percent of the target amount over
the allowable costs.
(c) DEFINITIONS.—In this section:
(1) ALLOWABLE COSTS.—
(A) IN GENERAL.—The amount of allowable costs of
a plan for any year is an amount equal to the total costs
(other than administrative costs) of the plan in providing
benefits covered by the plan.
(B) REDUCTION FOR RISK ADJUSTMENT AND REINSUR-
ANCE PAYMENTS.—Allowable costs shall reduced by any
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SEC. 1515. OFFERING OF EXCHANGE-PARTICIPATING QUALIFIED
HEALTH PLANS THROUGH CAFETERIA PLANS.
(a) IN GENERAL.—Subsection (f) of section 125 of the Internal
Revenue Code of 1986 is amended by adding at the end the following
new paragraph:
‘‘(3) CERTAIN EXCHANGE-PARTICIPATING QUALIFIED HEALTH
PLANS NOT QUALIFIED.—
‘‘(A) IN GENERAL.—The term ‘qualified benefit’ shall
not include any qualified health plan (as defined in section
1301(a) of the Patient Protection and Affordable Care Act)
offered through an Exchange established under section
1311 of such Act.
‘‘(B) EXCEPTION FOR EXCHANGE-ELIGIBLE EMPLOYERS.—
Subparagraph (A) shall not apply with respect to any
employee if such employee’s employer is a qualified
employer (as defined in section 1312(f)(2) of the Patient
Protection and Affordable Care Act) offering the employee
the opportunity to enroll through such an Exchange in
a qualified health plan in a group market.’’.
(b) CONFORMING AMENDMENTS.—Subsection (f) of section 125
of such Code is amended—
(1) by striking ‘‘For purposes of this section, the term’’
and inserting ‘‘For purposes of this section—
‘‘(1) IN GENERAL.—The term’’, and
(2) by striking ‘‘Such term shall not include’’ and inserting
the following:
‘‘(2) LONG-TERM CARE INSURANCE NOT QUALIFIED.—The
term ‘qualified benefit’ shall not include’’.
(c) EFFECTIVE DATE.—The amendments made by this section
shall apply to taxable years beginning after December 31, 2013.
øNote: Section 10108 provides for Free Choice Vouchers as fol-
lows:¿
SEC. 10108. FREE CHOICE VOUCHERSøCOPIED FROM TITLE X AND SHOWN
HERE FOR INFORMATION PURPOSES ONLY¿.
(a) IN GENERAL.—An offering employer shall provide free choice
vouchers to each qualified employee of such employer.
(b) OFFERING EMPLOYER.—For purposes of this section, the
term ‘‘offering employer’’ means any employer who—
(1) offers minimum essential coverage to its employees
consisting of coverage through an eligible employer-sponsored
plan; and
(2) pays any portion of the costs of such plan.
(c) QUALIFIED EMPLOYEE.—For purposes of this section—
(1) IN GENERAL.—The term ‘‘qualified employee’’ means,
with respect to any plan year of an offering employer, any
employee—
(A) whose required contribution (as determined under
section 5000A(e)(1)(B)) for minimum essential coverage
through an eligible employer-sponsored plan—
(i) exceeds 8 percent of such employee’s household
income for the taxable year described in section
1412(b)(1)(B) which ends with or within in the plan
year; and
(ii) does not exceed 9.8 percent of such employee’s
household income for such taxable year;
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SEC. 1552. TRANSPARENCY IN GOVERNMENT.
Not later than 30 days after the date of enactment of this
Act, the Secretary of Health and Human Services shall publish
on the Internet website of the Department of Health and Human
Services, a list of all of the authorities provided to the Secretary
under this Act (and the amendments made by this Act).
SEC. 1553. PROHIBITION AGAINST DISCRIMINATION ON ASSISTED SUI-
CIDE.
(a) IN GENERAL.—The Federal Government, and any State or
local government or health care provider that receives Federal
financial assistance under this Act (or under an amendment made
by this Act) or any health plan created under this Act (or under
an amendment made by this Act), may not subject an individual
or institutional health care entity to discrimination on the basis
that the entity does not provide any health care item or service
furnished for the purpose of causing, or for the purpose of assisting
in causing, the death of any individual, such as by assisted suicide,
euthanasia, or mercy killing.
(b) DEFINITION.—In this section, the term ‘‘health care entity’’
includes an individual physician or other health care professional,
a hospital, a provider-sponsored organization, a health maintenance
organization, a health insurance plan, or any other kind of health
care facility, organization, or plan.
(c) CONSTRUCTION AND TREATMENT OF CERTAIN SERVICES.—
Nothing in subsection (a) shall be construed to apply to, or to
affect, any limitation relating to—
(1) the withholding or withdrawing of medical treatment
or medical care;
(2) the withholding or withdrawing of nutrition or hydra-
tion;
(3) abortion; or
(4) the use of an item, good, benefit, or service furnished
for the purpose of alleviating pain or discomfort, even if such
use may increase the risk of death, so long as such item,
good, benefit, or service is not also furnished for the purpose
of causing, or the purpose of assisting in causing, death, for
any reason.
(d) ADMINISTRATION.—The Office for Civil Rights of the Depart-
ment of Health and Human Services is designated to receive com-
plaints of discrimination based on this section.
SEC. 1554. ACCESS TO THERAPIES.
Notwithstanding any other provision of this Act, the Secretary
of Health and Human Services shall not promulgate any regulation
that—
(1) creates any unreasonable barriers to the ability of
individuals to obtain appropriate medical care;
(2) impedes timely access to health care services;
(3) interferes with communications regarding a full range
of treatment options between the patient and the provider;
(4) restricts the ability of health care providers to provide
full disclosure of all relevant information to patients making
health care decisions;
(5) violates the principles of informed consent and the
ethical standards of health care professionals; or
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SEC. 1558. PROTECTIONS FOR EMPLOYEES.
The Fair Labor Standards Act of 1938 is amended by inserting
after section 18B (as added by section 1512) the following:
‘‘SEC. 18C. PROTECTIONS FOR EMPLOYEES.
‘‘(a) PROHIBITION.—No employer shall discharge or in any
manner discriminate against any employee with respect to his
or her compensation, terms, conditions, or other privileges of
employment because the employee (or an individual acting at the
request of the employee) has—
‘‘(1) received a credit under section 36B of the Internal
Revenue Code of 1986 or a subsidy under section 1402 of
this Act;
‘‘(2) provided, caused to be provided, or is about to provide
or cause to be provided to the employer, the Federal Govern-
ment, or the attorney general of a State information relating
to any violation of, or any act or omission the employee reason-
ably believes to be a violation of, any provision of this title
(or an amendment made by this title);
‘‘(3) testified or is about to testify in a proceeding concerning
such violation;
‘‘(4) assisted or participated, or is about to assist or partici-
pate, in such a proceeding; or
‘‘(5) objected to, or refused to participate in, any activity,
policy, practice, or assigned task that the employee (or other
such person) reasonably believed to be in violation of any provi-
sion of this title (or amendment), or any order, rule, regulation,
standard, or ban under this title (or amendment).
‘‘(b) COMPLAINT PROCEDURE.—
‘‘(1) IN GENERAL.—An employee who believes that he or
she has been discharged or otherwise discriminated against
by any employer in violation of this section may seek relief
in accordance with the procedures, notifications, burdens of
proof, remedies, and statutes of limitation set forth in section
2087(b) of title 15, United States Code.
‘‘(2) NO LIMITATION ON RIGHTS.—Nothing in this section
shall be deemed to diminish the rights, privileges, or remedies
of any employee under any Federal or State law or under
any collective bargaining agreement. The rights and remedies
in this section may not be waived by any agreement, policy,
form, or condition of employment.’’.
SEC. 1559. OVERSIGHT.
The Inspector General of the Department of Health and Human
Services shall have oversight authority with respect to the adminis-
tration and implementation of this title as it relates to such Depart-
ment.
SEC. 1560. RULES OF CONSTRUCTION.
(a) NO EFFECT ON ANTITRUST LAWS.—Nothing in this title
(or an amendment made by this title) shall be construed to modify,
impair, or supersede the operation of any of the antitrust laws.
For the purposes of this section, the term ‘‘antitrust laws’’ has
the meaning given such term in subsection (a) of the first section
of the Clayton Act, except that such term includes section 5 of
the Federal Trade Commission Act to the extent that such section
5 applies to unfair methods of competition.
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SEC. 2202. PERMITTING HOSPITALS TO MAKE PRESUMPTIVE ELIGI-
BILITY DETERMINATIONS FOR ALL MEDICAID ELIGIBLE
POPULATIONS.
(a) IN GENERAL.—Section 1902(a)(47) of the Social Security
Act (42 U.S.C. 1396a(a)(47)) is amended—
(1) by striking ‘‘at the option of the State, provide’’ and
inserting ‘‘provide—
‘‘(A) at the option of the State,’’;
(2) by inserting ‘‘and’’ after the semicolon; and
(3) by adding at the end the following:
‘‘(B) that any hospital that is a participating provider
under the State plan may elect to be a qualified entity
for purposes of determining, on the basis of preliminary
information, whether any individual is eligible for medical
assistance under the State plan or under a waiver of the
plan for purposes of providing the individual with medical
assistance during a presumptive eligibility period, in the
same manner, and subject to the same requirements, as
apply to the State options with respect to populations
described in section 1920, 1920A, or 1920B (but without
regard to whether the State has elected to provide for
a presumptive eligibility period under any such sections),
subject to such guidance as the Secretary shall establish;’’.
(b) CONFORMING AMENDMENT.—Section 1903(u)(1)(D)(v) of such
Act (42 U.S.C. 1396b(u)(1)(D)v)) is amended—
(1) by striking ‘‘or for’’ and inserting ‘‘for’’; and
(2) by inserting before the period at the end the following:
‘‘, or for medical assistance provided to an individual during
a presumptive eligibility period resulting from a determination
of presumptive eligibility made by a hospital that elects under
section 1902(a)(47)(B) to be a qualified entity for such purpose’’.
(c) EFFECTIVE DATE.—The amendments made by this section
take effect on January 1, 2014, and apply to services furnished
on or after that date.
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SEC. 2302. CONCURRENT CARE FOR CHILDREN.
(a) IN GENERAL.—Section 1905(o)(1) of the Social Security Act
(42 U.S.C. 1396d(o)(1)) is amended—
(1) in subparagraph (A), by striking ‘‘subparagraph (B)’’
and inserting ‘‘subparagraphs (B) and (C)’’; and
(2) by adding at the end the following new subparagraph:
‘‘(C) A voluntary election to have payment made for hospice
care for a child (as defined by the State) shall not constitute
a waiver of any rights of the child to be provided with, or to
have payment made under this title for, services that are related
to the treatment of the child’s condition for which a diagnosis
of terminal illness has been made.’’.
(b) APPLICATION TO CHIP.—Section 2110(a)(23) of the Social
Security Act (42 U.S.C. 1397jj(a)(23)) is amended by inserting
‘‘(concurrent, in the case of an individual who is a child, with
care related to the treatment of the child’s condition with respect
to which a diagnosis of terminal illness has been made’’ after
‘‘hospice care’’.
SEC. 2303. STATE ELIGIBILITY OPTION FOR FAMILY PLANNING SERV-
ICES.
(a) COVERAGE AS OPTIONAL CATEGORICALLY NEEDY GROUP.—
(1) IN GENERAL.—Section 1902(a)(10)(A)(ii) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)), as amended by
section 2001(e), is amended—
(A) in subclause (XIX), by striking ‘‘or’’ at the end;
(B) in subclause (XX), by adding ‘‘or’’ at the end; and
(C) by adding at the end the following new subclause:
‘‘(XXI) who are described in subsection (ii)
(relating to individuals who meet certain income
standards);’’.
(2) GROUP DESCRIBED.—Section 1902 of such Act (42 U.S.C.
1396a), as amended by section 2001(d), is amended by adding
at the end the following new subsection:
‘‘(ii)(1) Individuals described in this subsection are individuals—
‘‘(A) whose income does not exceed an income eligibility
level established by the State that does not exceed the
highest income eligibility level established under the State
plan under this title (or under its State child health plan
under title XXI) for pregnant women; and
‘‘(B) who are not pregnant.
‘‘(2) At the option of a State, individuals described in this
subsection may include individuals who, had individuals
applied on or before January 1, 2007, would have been made
eligible pursuant to the standards and processes imposed by
that State for benefits described in clause (XV) of the matter
following subparagraph (G) of section subsection (a)(10) pursu-
ant to a waiver granted under section 1115.
‘‘(3) At the option of a State, for purposes of subsection
(a)(17)(B), in determining eligibility for services under this sub-
section, the State may consider only the income of the applicant
or recipient.’’.
(3) LIMITATION ON BENEFITS.—Section 1902(a)(10) of the
Social Security Act (42 U.S.C. 1396a(a)(10)), as amended by
section 2001(a)(5)(A), is amended in the matter following
subparagraph (G)—
(A) by striking ‘‘and (XV)’’ and inserting ‘‘(XV)’’; and
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SEC. 3005. QUALITY REPORTING FOR PPS-EXEMPT CANCER HOS-
PITALS.
Section 1866 of the Social Security Act (42 U.S.C. 1395cc)
is amended—
(1) in subsection (a)(1)—
(A) in subparagraph (U), by striking ‘‘and’’ at the end;
(B) in subparagraph (V), by striking the period at
the end and inserting ‘‘, and’’; and
(C) by adding at the end the following new subpara-
graph:
‘‘(W) in the case of a hospital described in section
1886(d)(1)(B)(v), to report quality data to the Secretary
in accordance with subsection (k).’’; and
(2) by adding at the end the following new subsection:
‘‘(k) QUALITY REPORTING BY CANCER HOSPITALS.—
‘‘(1) IN GENERAL.—For purposes of fiscal year 2014 and
each subsequent fiscal year, a hospital described in section
1886(d)(1)(B)(v) shall submit data to the Secretary in accord-
ance with paragraph (2) with respect to such a fiscal year.
‘‘(2) SUBMISSION OF QUALITY DATA.—For fiscal year 2014
and each subsequent fiscal year, each hospital described in
such section shall submit to the Secretary data on quality
measures specified under paragraph (3). Such data shall be
submitted in a form and manner, and at a time, specified
by the Secretary for purposes of this subparagraph.
‘‘(3) QUALITY MEASURES.—
‘‘(A) IN GENERAL.—Subject to subparagraph (B), any
measure specified by the Secretary under this paragraph
must have been endorsed by the entity with a contract
under section 1890(a).
‘‘(B) EXCEPTION.—In the case of a specified area or
medical topic determined appropriate by the Secretary for
which a feasible and practical measure has not been
endorsed by the entity with a contract under section
1890(a), the Secretary may specify a measure that is not
so endorsed as long as due consideration is given to meas-
ures that have been endorsed or adopted by a consensus
organization identified by the Secretary.
‘‘(C) TIME FRAME.—Not later than October 1, 2012,
the Secretary shall publish the measures selected under
this paragraph that will be applicable with respect to fiscal
year 2014.
‘‘(4) PUBLIC AVAILABILITY OF DATA SUBMITTED.—The Sec-
retary shall establish procedures for making data submitted
under paragraph (4) available to the public. Such procedures
shall ensure that a hospital described in section 1886(d)(1)(B)(v)
has the opportunity to review the data that is to be made
public with respect to the hospital prior to such data being
made public. The Secretary shall report quality measures of
process, structure, outcome, patients’ perspective on care, effi-
ciency, and costs of care that relate to services furnished in
such hospitals on the Internet website of the Centers for Medi-
care & Medicaid Services.’’.
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SEC. 3006. PLANS FOR A VALUE-BASED PURCHASING PROGRAM FOR
SKILLED NURSING FACILITIES AND HOME HEALTH AGEN-
CIES.
(a) SKILLED NURSING FACILITIES.—
(1) IN GENERAL.—The Secretary of Health and Human
Services (in this section referred to as the ‘‘Secretary’’) shall
develop a plan to implement a value-based purchasing program
for payments under the Medicare program under title XVIII
of the Social Security Act for skilled nursing facilities (as
defined in section 1819(a) of such Act (42 U.S.C. 1395i–3(a))).
(2) DETAILS.—In developing the plan under paragraph (1),
the Secretary shall consider the following issues:
(A) The ongoing development, selection, and modifica-
tion process for measures (including under section 1890
of the Social Security Act (42 U.S.C. 1395aaa) and section
1890A such Act, as added by section 3014), to the extent
feasible and practicable, of all dimensions of quality and
efficiency in skilled nursing facilities. øAs revised by section
10301(b)¿
(B) The reporting, collection, and validation of quality
data.
(C) The structure of value-based payment adjustments,
including the determination of thresholds or improvements
in quality that would substantiate a payment adjustment,
the size of such payments, and the sources of funding
for the value-based bonus payments.
(D) Methods for the public disclosure of information
on the performance of skilled nursing facilities.
(E) Any other issues determined appropriate by the
Secretary.
(3) CONSULTATION.—In developing the plan under para-
graph (1), the Secretary shall—
(A) consult with relevant affected parties; and
(B) consider experience with such demonstrations that
the Secretary determines are relevant to the value-based
purchasing program described in paragraph (1).
(4) REPORT TO CONGRESS.—Not later than October 1, 2011,
the Secretary shall submit to Congress a report containing
the plan developed under paragraph (1).
(b) HOME HEALTH AGENCIES.—
(1) IN GENERAL.—The Secretary of Health and Human
Services (in this section referred to as the ‘‘Secretary’’) shall
develop a plan to implement a value-based purchasing program
for payments under the Medicare program under title XVIII
of the Social Security Act for home health agencies (as defined
in section 1861(o) of such Act (42 U.S.C. 1395x(o))).
(2) DETAILS.—In developing the plan under paragraph (1),
the Secretary shall consider the following issues:
(A) The ongoing development, selection, and modifica-
tion process for measures (including under section 1890
of the Social Security Act (42 U.S.C. 1395aaa) and section
1890A such Act, as added by section 3014), to the extent
feasible and practicable, of all dimensions of quality and
efficiency in home health agencies.
(B) The reporting, collection, and validation of quality
data.
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SEC. 3007. VALUE-BASED PAYMENT MODIFIER UNDER THE PHYSICIAN
FEE SCHEDULE.
Section 1848 of the Social Security Act (42 U.S.C. 1395w–
4) is amended—
(1) in subsection (b)(1), by inserting ‘‘subject to subsection
(p),’’ after ‘‘1998,’’; and
(2) by adding at the end the following new subsection:
‘‘(p) ESTABLISHMENT OF VALUE-BASED PAYMENT MODIFIER.—
‘‘(1) IN GENERAL.—The Secretary shall establish a payment
modifier that provides for differential payment to a physician
or a group of physicians under the fee schedule established
under subsection (b) based upon the quality of care furnished
compared to cost (as determined under paragraphs (2) and
(3), respectively) during a performance period. Such payment
modifier shall be separate from the geographic adjustment fac-
tors established under subsection (e).
‘‘(2) QUALITY.—
‘‘(A) IN GENERAL.—For purposes of paragraph (1),
quality of care shall be evaluated, to the extent practicable,
based on a composite of measures of the quality of care
furnished (as established by the Secretary under subpara-
graph (B)).
‘‘(B) MEASURES.—
‘‘(i) The Secretary shall establish appropriate
measures of the quality of care furnished by a physi-
cian or group of physicians to individuals enrolled
under this part, such as measures that reflect health
outcomes. Such measures shall be risk adjusted as
determined appropriate by the Secretary.
‘‘(ii) The Secretary shall seek endorsement of the
measures established under this subparagraph by the
entity with a contract under section 1890(a).
‘‘(3) COSTS.—For purposes of paragraph (1), costs shall
be evaluated, to the extent practicable, based on a composite
of appropriate measures of costs established by the Secretary
(such as the composite measure under the methodology estab-
lished under subsection (n)(9)(C)(iii)) that eliminate the effect
of geographic adjustments in payment rates (as described in
subsection (e)), and take into account risk factors (such as
socioeconomic and demographic characteristics, ethnicity, and
health status of individuals (such as to recognize that less
healthy individuals may require more intensive interventions)
and other factors determined appropriate by the Secretary.
‘‘(4) IMPLEMENTATION.—
‘‘(A) PUBLICATION OF MEASURES, DATES OF IMPLEMENTA-
TION, PERFORMANCE PERIOD.—Not later than January 1,
2012, the Secretary shall publish the following:
‘‘(i) The measures of quality of care and costs estab-
lished under paragraphs (2) and (3), respectively.
‘‘(ii) The dates for implementation of the payment
modifier (as determined under subparagraph (B)).
‘‘(iii) The initial performance period (as specified
under subparagraph (B)(ii)).
‘‘(B) DEADLINES FOR IMPLEMENTATION.—
‘‘(i) INITIAL IMPLEMENTATION.—Subject to the pre-
ceding provisions of this subparagraph, the Secretary
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‘‘(A) IN GENERAL.—
‘‘(i) ESTABLISHMENT OF PAYMENT METHODS.—The
Secretary shall develop payment methods for the pilot
program for entities participating in the pilot program.
Such payment methods may include bundled payments
and bids from entities for episodes of care. The Sec-
retary shall make payments to the entity for services
covered under this section.
‘‘(ii) NO ADDITIONAL PROGRAM EXPENDITURES.—
Payments under this section for applicable items and
services under this title (including payment for services
described in subparagraph (B)) for applicable bene-
ficiaries for a year shall be established in a manner
that does not result in spending more for such entity
for such beneficiaries than would otherwise be
expended for such entity for such beneficiaries for such
year if the pilot program were not implemented, as
estimated by the Secretary.
‘‘(B) INCLUSION OF CERTAIN SERVICES.—A payment
methodology tested under the pilot program shall include
payment for the furnishing of applicable services and other
appropriate services, such as care coordination, medication
reconciliation, discharge planning, transitional care serv-
ices, and other patient-centered activities as determined
appropriate by the Secretary.
‘‘(C) BUNDLED PAYMENTS.—
‘‘(i) IN GENERAL.—A bundled payment under the
pilot program shall—
‘‘(I) be comprehensive, covering the costs of
applicable services and other appropriate services
furnished to an individual during an episode of
care (as determined by the Secretary); and
‘‘(II) be made to the entity which is partici-
pating in the pilot program.
‘‘(ii) REQUIREMENT FOR PROVISION OF APPLICABLE
SERVICES AND OTHER APPROPRIATE SERVICES.—
Applicable services and other appropriate services for
which payment is made under this subparagraph shall
be furnished or directed by the entity which is partici-
pating in the pilot program.
‘‘(D) PAYMENT FOR POST-ACUTE CARE SERVICES AFTER
THE EPISODE OF CARE.—The Secretary shall establish proce-
dures, in the case where an applicable beneficiary requires
continued post-acute care services after the last day of
the episode of care, under which payment for such services
shall be made.
‘‘(4) QUALITY MEASURES.—
‘‘(A) IN GENERAL.—The Secretary shall establish
quality measures (including quality measures of process,
outcome, and structure) related to care provided by entities
participating in the pilot program. Quality measures estab-
lished under the preceding sentence shall include measures
of the following:
‘‘(i) Functional status improvement.
‘‘(ii) Reducing rates of avoidable hospital readmis-
sions.
‘‘(iii) Rates of discharge to the community.
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(B) Depression.
(C) A history of multiple readmissions.
(D) Any other chronic disease or risk factor as deter-
mined by the Secretary.
(3) MEDICARE BENEFICIARY.—The term ‘‘Medicare bene-
ficiary’’ means an individual who is entitled to benefits under
part A of title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.) and enrolled under part B of such title, but
not enrolled under part C of such title.
(4) PROGRAM.—The term ‘‘program’’ means the program
conducted under this section.
(5) READMISSION.—The term ‘‘readmission’’ has the
meaning given such term in section 1886(q)(5)(E) of the Social
Security Act, as added by section 3025.
(6) SECRETARY.—The term ‘‘Secretary’’ means the Secretary
of Health and Human Services.
(c) REQUIREMENTS.—
(1) DURATION.—
(A) IN GENERAL.—The program shall be conducted for
a 5-year period, beginning January 1, 2011.
(B) EXPANSION.—The Secretary may expand the dura-
tion and the scope of the program, to the extent determined
appropriate by the Secretary, if the Secretary determines
(and the Chief Actuary of the Centers for Medicare &
Medicaid Services, with respect to spending under this
title, certifies) that such expansion would reduce spending
under this title without reducing quality.
(2) APPLICATION; PARTICIPATION.—
(A) IN GENERAL.—
(i) APPLICATION.—An eligible entity seeking to
participate in the program shall submit an application
to the Secretary at such time, in such manner, and
containing such information as the Secretary may
require.
(ii) PARTNERSHIP.—If an eligible entity is a hos-
pital, such hospital shall enter into a partnership with
a community-based organization to participate in the
program.
(B) INTERVENTION PROPOSAL.—Subject to subparagraph
(C), an application submitted under subparagraph (A)(i)
shall include a detailed proposal for at least 1 care transi-
tion intervention, which may include the following:
(i) Initiating care transition services for a high-
risk Medicare beneficiary not later than 24 hours prior
to the discharge of the beneficiary from the eligible
entity.
(ii) Arranging timely post-discharge follow-up serv-
ices to the high-risk Medicare beneficiary to provide
the beneficiary (and, as appropriate, the primary care-
giver of the beneficiary) with information regarding
responding to symptoms that may indicate additional
health problems or a deteriorating condition.
(iii) Providing the high-risk Medicare beneficiary
(and, as appropriate, the primary caregiver of the bene-
ficiary) with assistance to ensure productive and timely
interactions between patients and post-acute and out-
patient providers.
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SEC. 3137. HOSPITAL WAGE INDEX IMPROVEMENT.
(a) EXTENSION.—øReplaced by section 10317¿
(1) IN GENERAL.—Subsection (a) of section 106 of division
B of the Tax Relief and Health Care Act of 2006 (42 U.S.C.
1395 note), as amended by section 117 of the Medicare, Med-
icaid, and SCHIP Extension Act of 2007 (Public Law 110–
173) and section 124 of the Medicare Improvements for Patients
and Providers Act of 2008 (Public Law 110–275), is amended
by striking ‘‘September 30, 2009’’ and inserting ‘‘September
30, 2010’’.
(2) SPECIAL RULE FOR FISCAL YEAR 2010.—
(A) IN GENERAL.—Subject to subparagraph (B), for pur-
poses of implementation of the amendment made by para-
graph (1), including (notwithstanding paragraph (3) of sec-
tion 117(a) of the Medicare, Medicaid and SCHIP Extension
Act of 2007 (Public Law 110–173), as amended by section
124(b) of the Medicare Improvements for Patients and Pro-
viders Act of 2008 (Public Law 110–275)) for purposes
of the implementation of paragraph (2) of such section
117(a), during fiscal year 2010, the Secretary of Health
and Human Services (in this subsection referred to as
the ‘‘Secretary’’) shall use the hospital wage index that
was promulgated by the Secretary in the Federal Register
on August 27, 2009 (74 Fed. Reg. 43754), and any subse-
quent corrections.
(B) EXCEPTION.—Beginning on April 1, 2010, in deter-
mining the wage index applicable to hospitals that qualify
for wage index reclassification, the Secretary shall include
the average hourly wage data of hospitals whose reclassi-
fication was extended pursuant to the amendment made
by paragraph (1) only if including such data results in
a higher applicable reclassified wage index.
(3) ADJUSTMENT FOR CERTAIN HOSPITALS IN FISCAL YEAR
2010.—
(A) IN GENERAL.—In the case of a subsection (d) hos-
pital (as defined in subsection (d)(1)(B) of section 1886
of the Social Security Act (42 U.S.C. 1395ww)) with respect
to which—
(i) a reclassification of its wage index for purposes
of such section was extended pursuant to the amend-
ment made by paragraph (1); and
(ii) the wage index applicable for such hospital
for the period beginning on October 1, 2009, and ending
on March 31, 2010, was lower than for the period
beginning on April 1, 2010, and ending on September
30, 2010, by reason of the application of paragraph
(2)(B);
the Secretary shall pay such hospital an additional pay-
ment that reflects the difference between the wage index
for such periods.
(B) TIMEFRAME FOR PAYMENTS.—The Secretary shall
make payments required under subparagraph by not later
than December 31, 2010.
(b) PLAN FOR REFORMING THE MEDICARE HOSPITAL WAGE INDEX
SYSTEM.—
(1) IN GENERAL.—Not later than December 31, 2011, the
Secretary of Health and Human Services (in this section
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SEC. 3310. REDUCING WASTEFUL DISPENSING OF OUTPATIENT
PRESCRIPTION DRUGS IN LONG-TERM CARE FACILITIES
UNDER PRESCRIPTION DRUG PLANS AND MA–PD PLANS.
(a) IN GENERAL.—Section 1860D–4(c) of the Social Security
Act (42 U.S.C. 1395w–104(c)) is amended by adding at the end
the following new paragraph:
‘‘(3) REDUCING WASTEFUL DISPENSING OF OUTPATIENT
PRESCRIPTION DRUGS IN LONG-TERM CARE FACILITIES.—The Sec-
retary shall require PDP sponsors of prescription drug plans
to utilize specific, uniform dispensing techniques, as determined
by the Secretary, in consultation with relevant stakeholders
(including representatives of nursing facilities, residents of
nursing facilities, pharmacists, the pharmacy industry
(including retail and long-term care pharmacy), prescription
drug plans, MA–PD plans, and any other stakeholders the
Secretary determines appropriate), such as weekly, daily, or
automated dose dispensing, when dispensing covered part D
drugs to enrollees who reside in a long-term care facility in
order to reduce waste associated with 30-day fills.’’.
(b) EFFECTIVE DATE.—The amendment made by subsection (a)
shall apply to plan years beginning on or after January 1, 2012.
SEC. 3311. IMPROVED MEDICARE PRESCRIPTION DRUG PLAN AND MA–
PD PLAN COMPLAINT SYSTEM.
(a) IN GENERAL.—The Secretary shall develop and maintain
a complaint system, that is widely known and easy to use, to
collect and maintain information on MA–PD plan and prescription
drug plan complaints that are received (including by telephone,
letter, e-mail, or any other means) by the Secretary (including
by a regional office of the Department of Health and Human Serv-
ices, the Medicare Beneficiary Ombudsman, a subcontractor, a car-
rier, a fiscal intermediary, and a Medicare administrative contractor
under section 1874A of the Social Security Act (42 U.S.C. 1395kk))
through the date on which the complaint is resolved. The system
shall be able to report and initiate appropriate interventions and
monitoring based on substantial complaints and to guide quality
improvement.
(b) MODEL ELECTRONIC COMPLAINT FORM.—The Secretary shall
develop a model electronic complaint form to be used for reporting
plan complaints under the system. Such form shall be prominently
displayed on the front page of the Medicare.gov Internet website
and on the Internet website of the Medicare Beneficiary Ombuds-
man.
(c) ANNUAL REPORTS BY THE SECRETARY.—The Secretary shall
submit to Congress annual reports on the system. Such reports
shall include an analysis of the number and types of complaints
reported in the system, geographic variations in such complaints,
the timeliness of agency or plan responses to such complaints,
and the resolution of such complaints.
(d) DEFINITIONS.—In this section:
(1) MA–PD PLAN.—The term ‘‘MA–PD plan’’ has the
meaning given such term in section 1860D–41(a)(9) of such
Act (42 U.S.C. 1395w–151(a)(9)).
(2) PRESCRIPTION DRUG PLAN.—The term ‘‘prescription drug
plan’’ has the meaning given such term in section 1860D–
41(a)(14) of such Act (42 U.S.C. 1395w–151(a)(14)).
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fiscal year being less than such payment rates for the preceding
fiscal year. øAs revised by section 1105(a)(2) of HCERA¿’’.
(b) SKILLED NURSING FACILITIES.—Section 1888(e)(5)(B) of the
Social Security Act (42 U.S.C. 1395yy(e)(5)(B)) is amended—
(1) by striking ‘‘PERCENTAGE.—The term’’ and inserting
‘‘PERCENTAGE.—
‘‘(i) IN GENERAL.—Subject to clause (ii), the term’’;
and
(2) by adding at the end the following new clause:
‘‘(ii) ADJUSTMENT.—For fiscal year 2012 and each
subsequent fiscal year, after determining the percent-
age described in clause (i), the Secretary shall reduce
such percentage by the productivity adjustment
described in section 1886(b)(3)(B)(xi)(II). The applica-
tion of the preceding sentence may result in such
percentage being less than 0.0 for a fiscal year, and
may result in payment rates under this subsection
for a fiscal year being less than such payment rates
for the preceding fiscal year.’’.
(c) LONG-TERM CARE HOSPITALS.—Section 1886(m) of the Social
Security Act (42 U.S.C. 1395ww(m)) is amended by adding at the
end the following new paragraphs:
‘‘(3) IMPLEMENTATION FOR RATE YEAR 2010 AND SUBSEQUENT
YEARS.—
‘‘(A) IN GENERAL.—In implementing the system
described in paragraph (1) for rate year 2010 and each
subsequent rate year, any annual update to a standard
Federal rate for discharges for the hospital during the
rate year, shall be reduced—
‘‘(i) for rate year 2012 and each subsequent rate
year, by the productivity adjustment described in sec-
tion 1886(b)(3)(B)(xi)(II); and
‘‘(ii) for each of rate years 2010 through 2019,
by the other adjustment described in paragraph (4).
‘‘(B) SPECIAL RULE.—The application of this paragraph
may result in such annual update being less than 0.0
for a rate year, and may result in payment rates under
the system described in paragraph (1) for a rate year
being less than such payment rates for the preceding rate
year.
‘‘(4) OTHER ADJUSTMENT.—øAs revised by section 10319(b)
and section 1105(b) of HCERA¿ For purposes of paragraph
(3)(A)(ii), the other adjustment described in this paragraph
is—
‘‘(A) for rate year 2010, 0.25 percentage point;
‘‘(B) for rate year 2011, 0.50 percentage point;
‘‘(C) for each of the rate years beginning in 2012 and
2013, 0.1 percentage point;
‘‘(D) for rate year 2014, 0.3 percentage point;
‘‘(E) for each of rate years 2015 and 2016, 0.2 percent-
age point; and
‘‘(F) for each of rate years 2017, 2018, and 2019, 0.75
percentage point.’’.
(d) INPATIENT REHABILITATION FACILITIES.—Section 1886(j)(3)
of the Social Security Act (42 U.S.C. 1395ww(j)(3)) is amended—
(1) in subparagraph (C)—
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‘‘(I) for 2013 and each subsequent fiscal year, by the produc-
tivity adjustment described in section 1886(b)(3)(B)(xi)(II); and
‘‘(II) subject to clause (v), for each of fiscal years 2013
through 2019, by 0.3 percentage point.
The application of this clause may result in the market basket
percentage increase under clause (ii)(VII) or (iii), as applicable,
being less than 0.0 for a fiscal year, and may result in payment
rates under this subsection for a fiscal year being less than such
payment rates for the preceding fiscal year.
‘‘(v) Clause (iv)(II) shall be applied with respect to any of
fiscal years 2014 through 2019 by substituting ‘0.0 percentage
points’ for ‘0.3 percentage point’, if for such fiscal year—
‘‘(I) the excess (if any) of—
‘‘(aa) the total percentage of the non-elderly insured
population for the preceding fiscal year (based on the most
recent estimates available from the Director of the Congres-
sional Budget Office before a vote in either House on the
Patient Protection and Affordable Care Act that, if deter-
mined in the affirmative, would clear such Act for enroll-
ment); over
‘‘(bb) the total percentage of the non-elderly insured
population for such preceding fiscal year (as estimated
by the Secretary); exceeds
‘‘(II) 5 percentage points.’’.
(h) DIALYSIS.—Section 1881(b)(14)(F) of the Social Security Act
(42 U.S.C. 1395rr(b)(14)(F)) is amended—
(1) in clause (i)—
(A) by inserting ‘‘(I)’’ after ‘‘(F)(i)’’
(B) in subclause (I), as inserted by subparagraph (A)—
(i) by striking ‘‘clause (ii)’’ and inserting ‘‘subclause
(II) and clause (ii)’’; and
(ii) by striking ‘‘minus 1.0 percentage point’’; and
(C) by adding at the end the following new subclause:
‘‘(II) For 2012 and each subsequent year, after determining
the increase factor described in subclause (I), the Secretary shall
reduce such increase factor by the productivity adjustment described
in section 1886(b)(3)(B)(xi)(II). The application of the preceding
sentence may result in such increase factor being less than 0.0
for a year, and may result in payment rates under the payment
system under this paragraph for a year being less than such pay-
ment rates for the preceding year.’’; and
(2) in clause (ii)(II)—
(A) by striking ‘‘The’’ and inserting ‘‘Subject to clause
(i)(II), the’’; and
(B) by striking ‘‘clause (i) minus 1.0 percentage point’’
and inserting ‘‘clause (i)(I)’’.
(i) OUTPATIENT HOSPITALS.—Section 1833(t)(3) of the Social
Security Act (42 U.S.C. 1395l(t)(3)) is amended—
(1) in subparagraph (C)(iv), by inserting ‘‘and subparagraph
(F) of this paragraph’’ after ‘‘(17)’’; and
(2) by adding at the end the following new subparagraphs:
‘‘(F) PRODUCTIVITY AND OTHER ADJUSTMENT.—After
determining the OPD fee schedule increase factor under
subparagraph (C)(iv), the Secretary shall reduce such
increase factor—
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SEC. 3402. TEMPORARY ADJUSTMENT TO THE CALCULATION OF PART
B PREMIUMS.
Section 1839(i) of the Social Security Act (42 U.S.C. 1395r(i))
is amended—
(1) in paragraph (2), in the matter preceding subparagraph
(A), by inserting ‘‘subject to paragraph (6),’’ after ‘‘subsection,’’;
(2) in paragraph (3)(A)(i), by striking ‘‘The applicable’’ and
inserting ‘‘Subject to paragraph (6), the applicable’’;
(3) by redesignating paragraph (6) as paragraph (7); and
(4) by inserting after paragraph (5) the following new para-
graph:
‘‘(6) TEMPORARY ADJUSTMENT TO INCOME THRESHOLDS.—
Notwithstanding any other provision of this subsection, during
the period beginning on January 1, 2011, and ending on
December 31, 2019—
‘‘(A) the threshold amount otherwise applicable under
paragraph (2) shall be equal to such amount for 2010;
and
‘‘(B) the dollar amounts otherwise applicable under
paragraph (3)(C)(i) shall be equal to such dollar amounts
for 2010.’’.
SEC. 3403. INDEPENDENT øMEDICARE¿PAYMENT ADVISORY BOARD.
øSection 1320(b) provides the following name change: ‘‘Any ref-
erence in the provisions of, or amendments made by, section 3403
to the ‘Independent Medicare Advisory Board’ shall be deemed to
be a reference to the ‘Independent Payment Advisory Board’ ’’¿
(a) BOARD.—
(1) IN GENERAL.—Title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.), as amended by section 3022, is
amended by adding at the end the following new section: øAs
revised by section 10320(a)¿
‘‘INDEPENDENT MEDICARE ADVISORY BOARD
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—391
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—392
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—394
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—395
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—396
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—397
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—398
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—399
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—400
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—401
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—402
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—403
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—404
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—405
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—406
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—407
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—408
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—457
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—458
SEC. 4104. REMOVAL OF BARRIERS TO PREVENTIVE SERVICES IN
MEDICARE.
(a) DEFINITION OF PREVENTIVE SERVICES.—Section 1861(ddd)
of the Social Security Act (42 U.S.C. 1395x(ddd)) is amended—
(1) in the heading, by inserting ‘‘; Preventive Services’’
after ‘‘Services’’;
(2) in paragraph (1), by striking ‘‘not otherwise described
in this title’’ and inserting ‘‘not described in subparagraph
(A) or (C) of paragraph (3)’’; and
(3) by adding at the end the following new paragraph:
‘‘(3) The term ‘preventive services’ means the following:
‘‘(A) The screening and preventive services described in
subsection (ww)(2) (other than the service described in subpara-
graph (M) of such subsection).
‘‘(B) An initial preventive physical examination (as defined
in subsection (ww)).
‘‘(C) Personalized prevention plan services (as defined in
subsection (hhh)(1)).’’.
(b) PAYMENT AND ELIMINATION OF COINSURANCE IN ALL SET-
TINGS.—øReplaced by section 10406¿ Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)), as amended by section
4103(c)(1), is amended—
(1) in subparagraph (T), by inserting ‘‘(or 100 percent if
such services are recommended with a grade of A or B by
the United States Preventive Services Task Force for any
indication or population and are appropriate for the individual)’’
after ‘‘80 percent’’;
(2) in subparagraph (W)—
(A) in clause (i), by inserting ‘‘(if such subparagraph
were applied, by substituting ‘100 percent’ for ‘80 percent’)’’
after ‘‘subparagraph (D)’’; and
(B) in clause (ii), by striking ‘‘80 percent’’ and inserting
‘‘100 percent’’;
(3) by striking ‘‘and’’ before ‘‘(X)’’; and
(4) by inserting before the semicolon at the end the fol-
lowing: ‘‘, and (Y) with respect to preventive services described
in subparagraphs (A) and (B) of section 1861(ddd)(3) that are
appropriate for the individual and, in the case of such services
described in subparagraph (A), are recommended with a grade
of A or B by the United States Preventive Services Task Force
for any indication or population, the amount paid shall be
100 percent of (i) except as provided in clause (ii), the lesser
of the actual charge for the services or the amount determined
under the fee schedule that applies to such services under
this part, and (ii) in the case of such services that are covered
OPD services (as defined in subsection (t)(1)(B)), the amount
determined under subsection (t)’’.
(c) WAIVER OF APPLICATION OF DEDUCTIBLE FOR PREVENTIVE
SERVICES AND COLORECTAL CANCER SCREENING TESTS.—Section
1833(b) of the Social Security Act (42 U.S.C. 1395l(b)), as amended
by section 4103(c)(4), is amended—
(1) in paragraph (1), by striking ‘‘items and services
described in section 1861(s)(10)(A)’’ and inserting ‘‘preventive
services described in subparagraph (A) of section 1861(ddd)(3)
that are recommended with a grade of A or B by the United
States Preventive Services Task Force for any indication or
population and are appropriate for the individual.’’; and
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the scope of their practice under State law, for the max-
imum reduction of physical or mental disability and res-
toration of an individual to the best possible functional
level;’’.
(b) INCREASED FMAP.—Section 1905(b) of the Social Security
Act (42 U.S.C. 1396d(b)), as amended by sections 2001(a)(3)(A)
and 2004(c)(1), is amended in the first sentence—
(1) by striking ‘‘, and (4)’’ and inserting ‘‘, (4)’’; and
(2) by inserting before the period the following: ‘‘, and
(5) in the case of a State that provides medical assistance
for services and vaccines described in subparagraphs (A) and
(B) of subsection (a)(13), and prohibits cost-sharing for such
services and vaccines, the Federal medical assistance percent-
age, as determined under this subsection and subsection (y)
(without regard to paragraph (1)(C) of such subsection), shall
be increased by 1 percentage point with respect to medical
assistance for such services and vaccines and for items and
services described in subsection (a)(4)(D)’’.
(c) EFFECTIVE DATE.—The amendments made under this section
shall take effect on January 1, 2013.
SEC. 4107. COVERAGE OF COMPREHENSIVE TOBACCO CESSATION
SERVICES FOR PREGNANT WOMEN IN MEDICAID.
(a) REQUIRING COVERAGE OF COUNSELING AND
PHARMACOTHERAPY FOR CESSATION OF TOBACCO USE BY PREGNANT
WOMEN.—Section 1905 of the Social Security Act (42 U.S.C. 1396d),
as amended by sections 2001(a)(3)(B) and 2303, is further
amended—
(1) in subsection (a)(4)—
(A) by striking ‘‘and’’ before ‘‘(C)’’; and
(B) by inserting before the semicolon at the end the
following new subparagraph: ‘‘; and (D) counseling and
pharmacotherapy for cessation of tobacco use by pregnant
women (as defined in subsection (bb))’’; and
(2) by adding at the end the following:
‘‘(bb)(1) For purposes of this title, the term ‘counseling and
pharmacotherapy for cessation of tobacco use by pregnant women’
means diagnostic, therapy, and counseling services and
pharmacotherapy (including the coverage of prescription and non-
prescription tobacco cessation agents approved by the Food and
Drug Administration) for cessation of tobacco use by pregnant
women who use tobacco products or who are being treated for
tobacco use that is furnished—
‘‘(A) by or under the supervision of a physician; or
‘‘(B) by any other health care professional who—
‘‘(i) is legally authorized to furnish such services under
State law (or the State regulatory mechanism provided
by State law) of the State in which the services are fur-
nished; and
‘‘(ii) is authorized to receive payment for other services
under this title or is designated by the Secretary for this
purpose.
‘‘(2) Subject to paragraph (3), such term is limited to—
‘‘(A) services recommended with respect to pregnant women
in ‘Treating Tobacco Use and Dependence: 2008 Update: A
Clinical Practice Guideline’, published by the Public Health
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be necessary for each of fiscal year 2010 through 2014. øAs revised
by section 10403(3)¿
SEC. 4202. HEALTHY AGING, LIVING WELL; EVALUATION OF COMMU-
NITY-BASED PREVENTION AND WELLNESS PROGRAMS
FOR MEDICARE BENEFICIARIES.
(a) HEALTHY AGING, LIVING WELL.—
(1) IN GENERAL.—The Secretary of Health and Human
Services (referred to in this section as the ‘‘Secretary’’), acting
through the Director of the Centers for Disease Control and
Prevention, shall award grants to State or local health depart-
ments and Indian tribes to carry out 5-year pilot programs
to provide public health community interventions, screenings,
and where necessary, clinical referrals for individuals who are
between 55 and 64 years of age.
(2) ELIGIBILITY.—To be eligible to receive a grant under
paragraph (1), an entity shall—
(A) be—
(i) a State health department;
(ii) a local health department; or
(iii) an Indian tribe;
(B) submit to the Secretary an application at such
time, in such manner, and containing such information
as the Secretary may require including a description of
the program to be carried out under the grant;
(C) design a strategy for improving the health of the
55-to-64 year-old population through community-based
public health interventions; and
(D) demonstrate the capacity, if funded, to develop
the relationships necessary with relevant health agencies,
health care providers, community-based organizations, and
insurers to carry out the activities described in paragraph
(3), such relationships to include the identification of a
community-based clinical partner, such as a community
health center or rural health clinic.
(3) USE OF FUNDS.—
(A) IN GENERAL.—A State or local health department
shall use amounts received under a grant under this sub-
section to carry out a program to provide the services
described in this paragraph to individuals who are between
55 and 64 years of age.
(B) PUBLIC HEALTH INTERVENTIONS.—
(i) IN GENERAL.—In developing and implementing
such activities, a grantee shall collaborate with the
Centers for Disease Control and Prevention and the
Administration on Aging, and relevant local agencies
and organizations.
(ii) TYPES OF INTERVENTION ACTIVITIES.—Interven-
tion activities conducted under this subparagraph may
include efforts to improve nutrition, increase physical
activity, reduce tobacco use and substance abuse,
improve mental health, and promote healthy lifestyles
among the target population.
(C) COMMUNITY PREVENTIVE SCREENINGS.—
(i) IN GENERAL.—In addition to community-wide
public health interventions, a State or local health
department shall use amounts received under a grant
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SEC. 4302. UNDERSTANDING HEALTH DISPARITIES: DATA COLLECTION
AND ANALYSIS.
(a) UNIFORM CATEGORIES AND COLLECTION REQUIREMENTS.—
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended
by adding at the end the following:
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‘‘(76) provide that any data collected under the State plan
meets the requirements of section 3101 of the Public Health
Service Act.’’.
(B) CHIP.—Section 2108(e) of the Social Security Act
(42 U.S.C. 1397hh(e)) is amended by adding at the end
the following new paragraph:
‘‘(7) Data collected and reported in accordance with section
3101 of the Public Health Service Act, with respect to individ-
uals enrolled in the State child health plan (and, in the case
of enrollees under 19 years of age, their parents or legal guard-
ians), including data regarding the primary language of such
individuals, parents, and legal guardians.’’.
(2) EXTENDING MEDICARE REQUIREMENT TO ADDRESS
HEALTH DISPARITIES DATA COLLECTION TO MEDICAID AND CHIP.—
Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.),
as amended by section 2703 is amended by adding at the
end the following new section:
‘‘SEC. 1946. ADDRESSING HEALTH CARE DISPARITIES.
‘‘(a) EVALUATING DATA COLLECTION APPROACHES.—The Sec-
retary shall evaluate approaches for the collection of data under
this title and title XXI, to be performed in conjunction with existing
quality reporting requirements and programs under this title and
title XXI, that allow for the ongoing, accurate, and timely collection
and evaluation of data on disparities in health care services and
performance on the basis of race, ethnicity, sex, primary language,
and disability status. In conducting such evaluation, the Secretary
shall consider the following objectives:
‘‘(1) Protecting patient privacy.
‘‘(2) Minimizing the administrative burdens of data collec-
tion and reporting on States, providers, and health plans
participating under this title or title XXI.
‘‘(3) Improving program data under this title and title
XXI on race, ethnicity, sex, primary language, and disability
status.
‘‘(b) REPORTS TO CONGRESS.—
‘‘(1) REPORT ON EVALUATION.—Not later than 18 months
after the date of the enactment of this section, the Secretary
shall submit to Congress a report on the evaluation conducted
under subsection (a). Such report shall, taking into consider-
ation the results of such evaluation—
‘‘(A) identify approaches (including defining methodolo-
gies) for identifying and collecting and evaluating data
on health care disparities on the basis of race, ethnicity,
sex, primary language, and disability status for the pro-
grams under this title and title XXI; and
‘‘(B) include recommendations on the most effective
strategies and approaches to reporting HEDIS quality
measures as required under section 1852(e)(3) and other
nationally recognized quality performance measures, as
appropriate, on such bases.
‘‘(2) REPORTS ON DATA ANALYSES.—Not later than 4 years
after the date of the enactment of this section, and 4 years
thereafter, the Secretary shall submit to Congress a report
that includes recommendations for improving the identification
of health care disparities for beneficiaries under this title and
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(3) TERMS.—
(A) IN GENERAL.—The terms of members of the
Commission shall be for 3 years except that the Comptroller
General shall designate staggered terms for the members
first appointed.
(B) VACANCIES.—Any member appointed to fill a
vacancy occurring before the expiration of the term for
which the member’s predecessor was appointed shall be
appointed only for the remainder of that term. A member
may serve after the expiration of that member’s term until
a successor has taken office. A vacancy in the Commission
shall be filled in the manner in which the original appoint-
ment was made.
(C) INITIAL APPOINTMENTS.—The Comptroller General
shall make initial appointments of members to the Commis-
sion not later than September 30, 2010.
(4) COMPENSATION.—While serving on the business of the
Commission (including travel time), a member of the Commis-
sion shall be entitled to compensation at the per diem equiva-
lent of the rate provided for level IV of the Executive Schedule
under section 5315 of tile 5, United States Code, and while
so serving away from home and the member’s regular place
of business, a member may be allowed travel expenses, as
authorized by the Chairman of the Commission. Physicians
serving as personnel of the Commission may be provided a
physician comparability allowance by the Commission in the
same manner as Government physicians may be provided such
an allowance by an agency under section 5948 of title 5, United
States Code, and for such purpose subsection (i) of such section
shall apply to the Commission in the same manner as it applies
to the Tennessee Valley Authority. For purposes of pay (other
than pay of members of the Commission) and employment
benefits, rights, and privileges, all personnel of the Commission
shall be treated as if they were employees of the United States
Senate. Personnel of the Commission shall not be treated as
employees of the Government Accountability Office for any
purpose.
(5) CHAIRMAN, VICE CHAIRMAN.—The Comptroller General
shall designate a member of the Commission, at the time of
appointment of the member, as Chairman and a member as
Vice Chairman for that term of appointment, except that in
the case of vacancy of the chairmanship or vice chairmanship,
the Comptroller General may designate another member for
the remainder of that member’s term.
(6) MEETINGS.—The Commission shall meet at the call
of the chairman, but no less frequently than on a quarterly
basis.
(d) DUTIES.—
(1) RECOGNITION, DISSEMINATION, AND COMMUNICATION.—
The Commission shall—
(A) recognize efforts of Federal, State, and local part-
nerships to develop and offer health care career pathways
of proven effectiveness;
(B) disseminate information on promising retention
practices for health care professionals; and
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SEC. 5103. HEALTH CARE WORKFORCE ASSESSMENT.
(a) IN GENERAL.—Section 761 of the Public Health Service
Act (42 U.S.C. 294m) is amended—
(1) by redesignating subsection (c) as subsection (e);
(2) by striking subsection (b) and inserting the following:
‘‘(b) NATIONAL CENTER FOR HEALTH CARE WORKFORCE ANAL-
YSIS.—
‘‘(1) ESTABLISHMENT.—The Secretary shall establish the
National Center for Health Workforce Analysis (referred to
in this section as the ‘National Center’).
‘‘(2) PURPOSES.—The National Center, in coordination to
the extent practicable with the National Health Care Workforce
Commission (established in section 5101 of the Patient Protec-
tion and Affordable Care Act), and relevant regional and State
centers and agencies, shall—
‘‘(A) provide for the development of information
describing and analyzing the health care workforce and
workforce related issues;
‘‘(B) carry out the activities under section 792(a);
‘‘(C) annually evaluate programs under this title;
‘‘(D) develop and publish performance measures and
benchmarks for programs under this title; and
‘‘(E) establish, maintain, and publicize a national Inter-
net registry of each grant awarded under this title and
a database to collect data from longitudinal evaluations
(as described in subsection (d)(2)) on performance measures
(as developed under sections 749(d)(3), 757(d)(3), and
762(a)(3)).
‘‘(3) COLLABORATION AND DATA SHARING.—
‘‘(A) IN GENERAL.—The National Center shall collabo-
rate with Federal agencies and relevant professional and
educational organizations or societies for the purpose of
linking data regarding grants awarded under this title.
‘‘(B) CONTRACTS FOR HEALTH WORKFORCE ANALYSIS.—
For the purpose of carrying out the activities described
in subparagraph (A), the National Center may enter into
contracts with relevant professional and educational
organizations or societies.
‘‘(c) STATE AND REGIONAL CENTERS FOR HEALTH WORKFORCE
ANALYSIS.—
‘‘(1) IN GENERAL.—The Secretary shall award grants to,
or enter into contracts with, eligible entities for purposes of—
‘‘(A) collecting, analyzing, and reporting data regarding
programs under this title to the National Center and to
the public; and
‘‘(B) providing technical assistance to local and regional
entities on the collection, analysis, and reporting of data.
‘‘(2) ELIGIBLE ENTITIES.—To be eligible for a grant or con-
tract under this subsection, an entity shall—
‘‘(A) be a State, a State workforce investment board,
a public health or health professions school, an academic
health center, or an appropriate public or private nonprofit
entity; and
‘‘(B) submit to the Secretary an application at such
time, in such manner, and containing such information
as the Secretary may require.
‘‘(d) INCREASE IN GRANTS FOR LONGITUDINAL EVALUATIONS.—
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SEC. 5208. NURSE-MANAGED HEALTH CLINICS.
(a) PURPOSE.—The purpose of this section is to fund the develop-
ment and operation of nurse-managed health clinics.
(b) GRANTS.—Subpart 1 of part D of title III of the Public
Health Service Act (42 U.S.C. 254b et seq.) is amended by inserting
after section 330A the following:
‘‘SEC. 330A–1. GRANTS TO NURSE–MANAGED HEALTH CLINICS.
‘‘(a) DEFINITIONS.—
‘‘(1) COMPREHENSIVE PRIMARY HEALTH CARE SERVICES.—
In this section, the term ‘comprehensive primary health care
services’ means the primary health services described in section
330(b)(1).
‘‘(2) NURSE-MANAGED HEALTH CLINIC.—The term ‘nurse-
managed health clinic’ means a nurse-practice arrangement,
managed by advanced practice nurses, that provides primary
care or wellness services to underserved or vulnerable popu-
lations and that is associated with a school, college, university
or department of nursing, federally qualified health center,
or independent nonprofit health or social services agency.
‘‘(b) AUTHORITY TO AWARD GRANTS.—The Secretary shall award
grants for the cost of the operation of nurse-managed health clinics
that meet the requirements of this section.
‘‘(c) APPLICATIONS.—To be eligible to receive a grant under
this section, an entity shall—
‘‘(1) be an NMHC; and
‘‘(2) submit to the Secretary an application at such time,
in such manner, and containing—
‘‘(A) assurances that nurses are the major providers
of services at the NMHC and that at least 1 advanced
practice nurse holds an executive management position
within the organizational structure of the NMHC;
‘‘(B) an assurance that the NMHC will continue pro-
viding comprehensive primary health care services or
wellness services without regard to income or insurance
status of the patient for the duration of the grant period;
and
‘‘(C) an assurance that, not later than 90 days of
receiving a grant under this section, the NMHC will estab-
lish a community advisory committee, for which a majority
of the members shall be individuals who are served by
the NMHC.
‘‘(d) GRANT AMOUNT.—The amount of any grant made under
this section for any fiscal year shall be determined by the Secretary,
taking into account—
‘‘(1) the financial need of the NMHC, considering State,
local, and other operational funding provided to the NMHC;
and
‘‘(2) other factors, as the Secretary determines appropriate.
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the purposes of
carrying out this section, there are authorized to be appropriated
$50,000,000 for the fiscal year 2010 and such sums as may be
necessary for each of the fiscal years 2011 through 2014.’’.
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SEC. 5209. ELIMINATION OF CAP ON COMMISSIONED CORPS.
Section 202 of the Department of Health and Human Services
Appropriations Act, 1993 (Public Law 102–394) is amended by
striking ‘‘not to exceed 2,800’’.
SEC. 5210. ESTABLISHING A READY RESERVE CORPS.
Section 203 of the Public Health Service Act (42 U.S.C. 204)
is amended to read as follows:
‘‘SEC. 203. COMMISSIONED CORPS AND READY RESERVE CORPS.
‘‘(a) ESTABLISHMENT.—
‘‘(1) IN GENERAL.—There shall be in the Service a commis-
sioned Regular Corps and a Ready Reserve Corps for service
in time of national emergency.
‘‘(2) REQUIREMENT.—All commissioned officers shall be citi-
zens of the United States and shall be appointed without regard
to the civil-service laws and compensated without regard to
the Classification Act of 1923, as amended.
‘‘(3) APPOINTMENT.—Commissioned officers of the Ready
Reserve Corps shall be appointed by the President and commis-
sioned officers of the Regular Corps shall be appointed by
the President with the advice and consent of the Senate.
‘‘(4) ACTIVE DUTY.—Commissioned officers of the Ready
Reserve Corps shall at all times be subject to call to active
duty by the Surgeon General, including active duty for the
purpose of training.
‘‘(5) WARRANT OFFICERS.—Warrant officers may be
appointed to the Service for the purpose of providing support
to the health and delivery systems maintained by the Service
and any warrant officer appointed to the Service shall be consid-
ered for purposes of this Act and title 37, United States Code,
to be a commissioned officer within the Commissioned Corps
of the Service.
‘‘(b) ASSIMILATING RESERVE CORP OFFICERS INTO THE REGULAR
CORPS.—Effective on the date of enactment of the Patient Protection
and Affordable Care Act, all individuals classified as officers in
the Reserve Corps under this section (as such section existed on
the day before the date of enactment of such Act) and serving
on active duty shall be deemed to be commissioned officers of
the Regular Corps.
‘‘(c) PURPOSE AND USE OF READY RESEARCH.—
‘‘(1) PURPOSE.—The purpose of the Ready Reserve Corps
is to fulfill the need to have additional Commissioned Corps
personnel available on short notice (similar to the uniformed
service’s reserve program) to assist regular Commissioned
Corps personnel to meet both routine public health and emer-
gency response missions.
‘‘(2) USES.—The Ready Reserve Corps shall—
‘‘(A) participate in routine training to meet the general
and specific needs of the Commissioned Corps;
‘‘(B) be available and ready for involuntary calls to
active duty during national emergencies and public health
crises, similar to the uniformed service reserve personnel;
‘‘(C) be available for backfilling critical positions left
vacant during deployment of active duty Commissioned
Corps members, as well as for deployment to respond to
public health emergencies, both foreign and domestic; and
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—519
‘‘SEC. 747A. TRAINING OPPORTUNITIES FOR DIRECT CARE WORKERS.
‘‘(a) IN GENERAL.—The Secretary shall award grants to eligible
entities to enable such entities to provide new training opportunities
for direct care workers who are employed in long-term care settings
such as nursing homes (as defined in section 1908(e)(1) of the
Social Security Act (42 U.S.C. 1396g(e)(1)), assisted living facilities
and skilled nursing facilities, intermediate care facilities for individ-
uals with mental retardation, home and community based settings,
and any other setting the Secretary determines to be appropriate.
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant under this
section, an entity shall—
‘‘(1) be an institution of higher education (as defined in
section 102 of the Higher Education Act of 1965 (20 U.S.C.
1002)) that—
‘‘(A) is accredited by a nationally recognized accrediting
agency or association listed under section 101(c) of the
Higher Education Act of 1965 (20 U.S.C. 1001(c)); and
‘‘(B) has established a public-private educational part-
nership with a nursing home or skilled nursing facility,
agency or entity providing home and community based
services to individuals with disabilities, or other long-term
care provider; and
‘‘(2) submit to the Secretary an application at such time,
in such manner, and containing such information as the Sec-
retary may require.
‘‘(c) USE OF FUNDS.—An eligible entity shall use amounts
awarded under a grant under this section to provide assistance
to eligible individuals to offset the cost of tuition and required
fees for enrollment in academic programs provided by such entity.
‘‘(d) ELIGIBLE INDIVIDUAL.—
‘‘(1) ELIGIBILITY.—To be eligible for assistance under this
section, an individual shall be enrolled in courses provided
by a grantee under this subsection and maintain satisfactory
academic progress in such courses.
‘‘(2) CONDITION OF ASSISTANCE.—As a condition of receiving
assistance under this section, an individual shall agree that,
following completion of the assistance period, the individual
will work in the field of geriatrics, disability services, long
term services and supports, or chronic care management for
a minimum of 2 years under guidelines set by the Secretary.
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section, $10,000,000 for the
period of fiscal years 2011 through 2013.’’.
SEC. 5303. TRAINING IN GENERAL, PEDIATRIC, AND PUBLIC HEALTH
DENTISTRY.
Part C of Title VII of the Public Health Service Act (42 U.S.C.
293k et seq.) is amended by—
(1) redesignating section 748, as amended by section 5103
of this Act, as section 749; and
(2) inserting after section 747A, as added by section 5302,
the following:
‘‘SEC. 748. TRAINING IN GENERAL, PEDIATRIC, AND PUBLIC HEALTH
DENTISTRY.
‘‘(a) SUPPORT AND DEVELOPMENT OF DENTAL TRAINING PRO-
GRAMS.—
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the contracts entered into under this section. Each such report
shall identify the overall number of such grants and contracts
and provide an explanation of why each such grant or contract
will meet the priority need of the nursing workforce.
‘‘(f) ELIGIBLE ENTITY.—For purposes of this section, the term
‘eligible entity’ includes an accredited school of nursing, as defined
by section 801(2), a health care facility, or a partnership of such
a school and facility.
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section such sums as may
be necessary for each of fiscal years 2010 through 2012.’’.
SEC. 5310. LOAN REPAYMENT AND SCHOLARSHIP PROGRAM.
(a) LOAN REPAYMENTS AND SCHOLARSHIPS.—Section 846(a)(3)
of the Public Health Service Act (42 U.S.C. 297n(a)(3)) is amended
by inserting before the semicolon the following: ‘‘, or in a accredited
school of nursing, as defined by section 801(2), as nurse faculty’’.
(b) TECHNICAL AND CONFORMING AMENDMENTS.—Title VIII (42
U.S.C. 296 et seq.) is amended—
(1) by redesignating section 810 (relating to prohibition
against discrimination by schools on the basis of sex) as section
809 and moving such section so that it follows section 808;
(2) in sections 835, 836, 838, 840, and 842, by striking
the term ‘‘this subpart’’ each place it appears and inserting
‘‘this part’’;
(3) in section 836(h), by striking the last sentence;
(4) in section 836, by redesignating subsection (l) as sub-
section (k);
(5) in section 839, by striking ‘‘839’’ and all that follows
through ‘‘(a)’’ and inserting ‘‘839. (a)’’;
(6) in section 835(b), by striking ‘‘841’’ each place it appears
and inserting ‘‘871’’;
(7) by redesignating section 841 as section 871, moving
part F to the end of the title, and redesignating such part
as part I;
(8) in part G—
(A) by redesignating section 845 as section 851; and
(B) by redesignating part G as part F;
(9) in part H—
(A) by redesignating sections 851 and 852 as sections
861 and 862, respectively; and
(B) by redesignating part H as part G; and
(10) in part I—
(A) by redesignating section 855, as amended by section
5305, as section 865; and
(B) by redesignating part I as part H.
SEC. 5311. NURSE FACULTY LOAN PROGRAM.
(a) IN GENERAL.—Section 846A of the Public Health Service
Act (42 U.S.C. 297n–1) is amended—
(1) in subsection (a)—
(A) in the subsection heading, by striking ‘‘ESTABLISH-
MENT’’ and inserting ‘‘SCHOOL OF NURSING STUDENT LOAN
FUND’’; and
(B) by inserting ‘‘accredited’’ after ‘‘agreement with
any’’;
(2) in subsection (c)—
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SEC. 5313. GRANTS TO PROMOTE THE COMMUNITY HEALTH
WORKFORCE.
(a) IN GENERAL.—Part P of title III of the Public Health Service
Act (42 U.S.C. 280g et seq.) is amended by adding at the end
the following:
‘‘SEC. 399V. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS AND
OUTCOMES.
‘‘(a) GRANTS AUTHORIZED.—The Director of the Centers for Dis-
ease Control and Prevention, in collaboration with the Secretary,
shall award grants to eligible entities to promote positive health
behaviors and outcomes for populations in medically underserved
communities through the use of community health workers.
‘‘(b) USE OF FUNDS.—Grants awarded under subsection (a) shall
be used to support community health workers—
‘‘(1) to educate, guide, and provide outreach in a community
setting regarding health problems prevalent in medically under-
served communities, particularly racial and ethnic minority
populations;
‘‘(2) to educate and provide guidance regarding effective
strategies to promote positive health behaviors and discourage
risky health behaviors;
‘‘(3) to educate and provide outreach regarding enrollment
in health insurance including the Children’s Health Insurance
Program under title XXI of the Social Security Act, Medicare
under title XVIII of such Act and Medicaid under title XIX
of such Act;
‘‘(4) to identify and refer underserved populations to appro-
priate healthcare agencies and community-based programs and
organizations in order to increase access to quality healthcare
services and to eliminate duplicative care; or øAs revised by
section 10501(c)(1)¿
‘‘(5) to educate, guide, and provide home visitation services
regarding maternal health and prenatal care.
‘‘(c) APPLICATION.—Each eligible entity that desires to receive
a grant under subsection (a) shall submit an application to the
Secretary, at such time, in such manner, and accompanied by
such information as the Secretary may require.
‘‘(d) PRIORITY.—In awarding grants under subsection (a), the
Secretary shall give priority to applicants that—
‘‘(1) propose to target geographic areas—
‘‘(A) with a high percentage of residents who are
eligible for health insurance but are uninsured or under-
insured;
‘‘(B) with a high percentage of residents who suffer
from chronic diseases; or
‘‘(C) with a high infant mortality rate;
‘‘(2) have experience in providing health or health-related
social services to individuals who are underserved with respect
to such services; and
‘‘(3) have documented community activity and experience
with community health workers.
‘‘(e) COLLABORATION WITH ACADEMIC INSTITUTIONS AND THE
ONE-STOP DELIVERY SYSTEM.—The Secretary shall encourage
community health worker programs receiving funds under this sec-
tion to collaborate with academic institutions and one-stop delivery
systems under section 134(c) of the Workforce Investment Act of
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SEC. 5315. UNITED STATES PUBLIC HEALTH SCIENCES TRACK.
Title II of the Public Health Service Act (42 U.S.C. 202 et
seq.) is amended by adding at the end the following:
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—543
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—546
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—547
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—548
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—549
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—550
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—551
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—552
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—553
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—554
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—555
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—556
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—557
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(b) IME.—
(1) IN GENERAL.—Section 1886(d)(5)(B)(v) of the Social
Security Act (42 U.S.C. 1395ww(d)(5)(B)(v)), in the second sen-
tence, is amended—
(A) by striking ‘‘subsection (h)(7)’’ and inserting ‘‘sub-
sections (h)(7) and (h)(8)’’; and
(B) by striking ‘‘it applies’’ and inserting ‘‘they apply’’.
(2) CONFORMING AMENDMENT.—Section 1886(d)(5)(B) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended
by adding at the end the following clause:
‘‘(x) For discharges occurring on or after July 1, 2011,
insofar as an additional payment amount under this subpara-
graph is attributable to resident positions distributed to a hos-
pital under subsection (h)(8)(B), the indirect teaching adjust-
ment factor shall be computed in the same manner as provided
under clause (ii) with respect to such resident positions.’’.
(c) CONFORMING AMENDMENT.—Section 422(b)(2) of the Medi-
care Prescription Drug, Improvement, and Modernization Act of
2003 (Public Law 108–173) is amended by striking ‘‘section
1886(h)(7)’’ and all that follows and inserting ‘‘paragraphs (7) and
(8) of subsection (h) of section 1886 of the Social Security Act’’.
SEC. 5504. COUNTING RESIDENT TIME IN NONPROVIDER SETTINGS.
(a) GME.—Section 1886(h)(4)(E) of the Social Security Act (42
U.S.C. 1395ww(h)(4)(E)) is amended—
(1) by striking ‘‘shall be counted and that all the time’’
and inserting ‘‘shall be counted and that—
‘‘(i) effective for cost reporting periods beginning
before July 1, 2010, all the time;’’;
(2) in clause (i), as inserted by paragraph (1), by striking
the period at the end and inserting ‘‘; and’’;
(3) by inserting after clause (i), as so inserted, the following
new clause:
‘‘(ii) effective for cost reporting periods beginning
on or after July 1, 2010, all the time so spent by
a resident shall be counted towards the determination
of full-time equivalency, without regard to the setting
in which the activities are performed, if a hospital
incurs the costs of the stipends and fringe benefits
of the resident during the time the resident spends
in that setting. If more than one hospital incurs these
costs, either directly or through a third party, such
hospitals shall count a proportional share of the time,
as determined by written agreement between the hos-
pitals, that a resident spends training in that setting.’’;
and
(4) by adding at the end the following flush sentence:
‘‘Any hospital claiming under this subparagraph for time
spent in a nonprovider setting shall maintain and make
available to the Secretary records regarding the amount
of such time and such amount in comparison with amounts
of such time in such base year as the Secretary shall
specify.’’.
(b) IME.—Section 1886(d)(5)(B)(iv) of the Social Security Act
(42 U.S.C. 1395ww(d)(5)) is amended—
(1) by striking ‘‘(iv) Effective for discharges occurring on
or after October 1, 1997’’ and inserting ‘‘(iv)(I) Effective for
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—564
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—565
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—566
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—568
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—569
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—570
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—571
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—572
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—573
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—574
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—575
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—576
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—577
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—578
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—579
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—580
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—581
SEC. 5603. REAUTHORIZATION OF THE WAKEFIELD EMERGENCY MED-
ICAL SERVICES FOR CHILDREN PROGRAM.
Section 1910 of the Public Health Service Act (42 U.S.C. 300w–
9) is amended—
(1) in subsection (a), by striking ‘‘3-year period (with an
optional 4th year’’ and inserting ‘‘4-year period (with an optional
5th year’’; and
(2) in subsection (d)—
(A) by striking ‘‘and such sums’’ and inserting ‘‘such
sums’’; and
(B) by inserting before the period the following: ‘‘,
$25,000,000 for fiscal year 2010, $26,250,000 for fiscal year
2011, $27,562,500 for fiscal year 2012, $28,940,625 for fiscal
year 2013, and $30,387,656 for fiscal year 2014’’.
SEC. 5604. CO-LOCATING PRIMARY AND SPECIALTY CARE IN COMMU-
NITY-BASED MENTAL HEALTH SETTINGS.
Subpart 3 of part B of title V of the Public Health Service
Act (42 U.S.C. 290bb–31 et seq.) is amended by adding at the
end the following:
‘‘SEC. 520K. AWARDS FOR CO-LOCATING PRIMARY AND SPECIALTY
CARE IN COMMUNITY-BASED MENTAL HEALTH SETTINGS.
‘‘(a) DEFINITIONS.—In this section:
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible entity’ means a
qualified community mental health program defined under sec-
tion 1913(b)(1).
‘‘(2) SPECIAL POPULATIONS.—The term ‘special populations’
means adults with mental illnesses who have co-occurring pri-
mary care conditions and chronic diseases.
‘‘(b) PROGRAM AUTHORIZED.—The Secretary, acting through the
Administrator shall award grants and cooperative agreements to
eligible entities to establish demonstration projects for the provision
of coordinated and integrated services to special populations
through the co-location of primary and specialty care services in
community-based mental and behavioral health settings.
‘‘(c) APPLICATION.—To be eligible to receive a grant or coopera-
tive agreement under this section, an eligible entity shall submit
an application to the Administrator at such time, in such manner,
and accompanied by such information as the Administrator may
require, including a description of partnerships, or other arrange-
ments with local primary care providers, including community
health centers, to provide services to special populations.
‘‘(d) USE OF FUNDS.—
‘‘(1) IN GENERAL.—For the benefit of special populations,
an eligible entity shall use funds awarded under this section
for—
‘‘(A) the provision, by qualified primary care profes-
sionals, of on site primary care services;
‘‘(B) reasonable costs associated with medically nec-
essary referrals to qualified specialty care professionals,
other coordinators of care or, if permitted by the terms
of the grant or cooperative agreement, by qualified specialty
care professionals on a reasonable cost basis on site at
the eligible entity;
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—582
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—583
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—584
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—585
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—586
year 2010, and $7,500,000 for each of fiscal year 2011 through
2018.
(2) AVAILABILITY.—Amounts appropriated under paragraph
(1) shall remain available until expended.
SEC. 5606. STATE GRANTS TO HEALTH CARE PROVIDERS WHO PROVIDE
SERVICES TO A HIGH PERCENTAGE OF MEDICALLY
UNDERSERVED POPULATIONS OR OTHER SPECIAL POPU-
LATIONS.
øSection added by section 10501(k)¿
(a) IN GENERAL.—A State may award grants to health care
providers who treat a high percentage, as determined by such
State, of medically underserved populations or other special popu-
lations in such State.
(b) SOURCE OF FUNDS.—A grant program established by a State
under subsection (a) may not be established within a department,
agency, or other entity of such State that administers the Medicaid
program under title XIX of the Social Security Act (42 U.S.C.
1396 et seq.), and no Federal or State funds allocated to such
Medicaid program, the Medicare program under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.), or the TRICARE
program under chapter 55 of title 10, United States Code, may
be used to award grants or to pay administrative costs associated
with a grant program established under subsection (a).
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—587
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—588
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—589
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—590
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—591
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—592
SEC. 6002. TRANSPARENCY REPORTS AND REPORTING OF PHYSICIAN
OWNERSHIP OR INVESTMENT INTERESTS.
Part A of title XI of the Social Security Act (42 U.S.C. 1301
et seq.) is amended by inserting after section 1128F the following
new section:
‘‘SEC. 1128G. TRANSPARENCY REPORTS AND REPORTING OF PHYSI-
CIAN OWNERSHIP OR INVESTMENT INTERESTS.
‘‘(a) TRANSPARENCY REPORTS.—
‘‘(1) PAYMENTS OR OTHER TRANSFERS OF VALUE.—
‘‘(A) IN GENERAL.—On March 31, 2013, and on the
90th day of each calendar year beginning thereafter, any
applicable manufacturer that provides a payment or other
transfer of value to a covered recipient (or to an entity
or individual at the request of or designated on behalf
of a covered recipient), shall submit to the Secretary, in
such electronic form as the Secretary shall require, the
following information with respect to the preceding cal-
endar year:
‘‘(i) The name of the covered recipient.
‘‘(ii) The business address of the covered recipient
and, in the case of a covered recipient who is a physi-
cian, the specialty and National Provider Identifier
of the covered recipient.
‘‘(iii) The amount of the payment or other transfer
of value.
‘‘(iv) The dates on which the payment or other
transfer of value was provided to the covered recipient.
‘‘(v) A description of the form of the payment or
other transfer of value, indicated (as appropriate for
all that apply) as—
‘‘(I) cash or a cash equivalent;
‘‘(II) in-kind items or services;
‘‘(III) stock, a stock option, or any other owner-
ship interest, dividend, profit, or other return on
investment; or
‘‘(IV) any other form of payment or other
transfer of value (as defined by the Secretary).
‘‘(vi) A description of the nature of the payment
or other transfer of value, indicated (as appropriate
for all that apply) as—
‘‘(I) consulting fees;
‘‘(II) compensation for services other than con-
sulting;
‘‘(III) honoraria;
‘‘(IV) gift;
‘‘(V) entertainment;
‘‘(VI) food;
‘‘(VII) travel (including the specified destina-
tions);
‘‘(VIII) education;
‘‘(IX) research;
‘‘(X) charitable contribution;
‘‘(XI) royalty or license;
‘‘(XII) current or prospective ownership or
investment interest;
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—593
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—594
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—595
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—596
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—597
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—598
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—599
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—600
SEC. 6004. PRESCRIPTION DRUG SAMPLE TRANSPARENCY.
Part A of title XI of the Social Security Act (42 U.S.C. 1301
et seq.), as amended by section 6002, is amended by inserting
after section 1128G the following new section:
‘‘SEC. 1128H. REPORTING OF INFORMATION RELATING TO DRUG SAM-
PLES.
‘‘(a) IN GENERAL.—Not later than April 1 of each year (begin-
ning with 2012), each manufacturer and authorized distributor
of record of an applicable drug shall submit to the Secretary (in
a form and manner specified by the Secretary) the following
information with respect to the preceding year:
‘‘(1) In the case of a manufacturer or authorized distributor
of record which makes distributions by mail or common carrier
under subsection (d)(2) of section 503 of the Federal Food,
Drug, and Cosmetic Act (21 U.S.C. 353), the identity and
quantity of drug samples requested and the identity and
quantity of drug samples distributed under such subsection
during that year, aggregated by—
‘‘(A) the name, address, professional designation, and
signature of the practitioner making the request under
subparagraph (A)(i) of such subsection, or of any individual
who makes or signs for the request on behalf of the practi-
tioner; and
‘‘(B) any other category of information determined
appropriate by the Secretary.
‘‘(2) In the case of a manufacturer or authorized distributor
of record which makes distributions by means other than mail
or common carrier under subsection (d)(3) of such section 503,
the identity and quantity of drug samples requested and the
identity and quantity of drug samples distributed under such
subsection during that year, aggregated by—
‘‘(A) the name, address, professional designation, and
signature of the practitioner making the request under
subparagraph (A)(i) of such subsection, or of any individual
who makes or signs for the request on behalf of the practi-
tioner; and
‘‘(B) any other category of information determined
appropriate by the Secretary.
‘‘(b) DEFINITIONS.—In this section:
‘‘(1) APPLICABLE DRUG.—The term ‘applicable drug’ means
a drug—
‘‘(A) which is subject to subsection (b) of such section
503; and
‘‘(B) for which payment is available under title XVIII
or a State plan under title XIX or XXI (or a waiver of
such a plan).
‘‘(2) AUTHORIZED DISTRIBUTOR OF RECORD.—The term
‘authorized distributor of record’ has the meaning given that
term in subsection (e)(3)(A) of such section.
‘‘(3) MANUFACTURER.—The term ‘manufacturer’ has the
meaning given that term for purposes of subsection (d) of such
section.’’.
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—601
SEC. 6005. PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIRE-
MENTS.
Part A of title XI of the Social Security Act (42 U.S.C. 1301
et seq.) is amended by inserting after section 1150 the following
new section:
‘‘SEC. 1150A. PHARMACY BENEFIT MANAGERS TRANSPARENCY
REQUIREMENTS.
‘‘(a) PROVISION OF INFORMATION.—A health benefits plan or
any entity that provides pharmacy benefits management services
on behalf of a health benefits plan (in this section referred to
as a ‘PBM’) that manages prescription drug coverage under a con-
tract with—
‘‘(1) a PDP sponsor of a prescription drug plan or an MA
organization offering an MA–PD plan under part D of title
XVIII; or
‘‘(2) a qualified health benefits plan offered through an
exchange established by a State under section 1311 of the
Patient Protection and Affordable Care Act,
shall provide the information described in subsection (b) to the
Secretary and, in the case of a PBM, to the plan with which
the PBM is under contract with, at such times, and in such form
and manner, as the Secretary shall specify.
‘‘(b) INFORMATION DESCRIBED.—The information described in
this subsection is the following with respect to services provided
by a health benefits plan or PBM for a contract year:
‘‘(1) The percentage of all prescriptions that were provided
through retail pharmacies compared to mail order pharmacies,
and the percentage of prescriptions for which a generic drug
was available and dispensed (generic dispensing rate), by phar-
macy type (which includes an independent pharmacy, chain
pharmacy, supermarket pharmacy, or mass merchandiser phar-
macy that is licensed as a pharmacy by the State and that
dispenses medication to the general public), that is paid by
the health benefits plan or PBM under the contract.
‘‘(2) The aggregate amount, and the type of rebates, dis-
counts, or price concessions (excluding bona fide service fees,
which include but are not limited to distribution service fees,
inventory management fees, product stocking allowances, and
fees associated with administrative services agreements and
patient care programs (such as medication compliance programs
and patient education programs)) that the PBM negotiates
that are attributable to patient utilization under the plan,
and the aggregate amount of the rebates, discounts, or price
concessions that are passed through to the plan sponsor, and
the total number of prescriptions that were dispensed.
‘‘(3) The aggregate amount of the difference between the
amount the health benefits plan pays the PBM and the amount
that the PBM pays retail pharmacies, and mail order phar-
macies, and the total number of prescriptions that were dis-
pensed.
‘‘(c) CONFIDENTIALITY.—Information disclosed by a health bene-
fits plan or PBM under this section is confidential and shall not
be disclosed by the Secretary or by a plan receiving the information,
except that the Secretary may disclose the information in a form
which does not disclose the identity of a specific PBM, plan, or
prices charged for drugs, for the following purposes:
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—602
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—603
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—604
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—605
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—606
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—607
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—608
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—609
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—610
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—611
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—612
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—613
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—614
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—615
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—616
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—617
‘‘(IV)
COLLECTION OF CIVIL MONEY PEN-
ALTIES.—In the case of a civil money penalty
imposed under this clause, the Secretary shall
issue regulations that—
‘‘(aa) subject to item (cc), not later than
30 days after the imposition of the penalty,
provide for the facility to have the opportunity
to participate in an independent informal dis-
pute resolution process which generates a
written record prior to the collection of such
penalty;
‘‘(bb) in the case where the penalty is
imposed for each day of noncompliance, pro-
vide that a penalty may not be imposed for
any day during the period beginning on the
initial day of the imposition of the penalty
and ending on the day on which the informal
dispute resolution process under item (aa) is
completed;
‘‘(cc) may provide for the collection of such
civil money penalty and the placement of such
amounts collected in an escrow account under
the direction of the Secretary on the earlier
of the date on which the informal dispute reso-
lution process under item (aa) is completed
or the date that is 90 days after the date
of the imposition of the penalty;
‘‘(dd) may provide that such amounts col-
lected are kept in such account pending the
resolution of any subsequent appeals;
‘‘(ee) in the case where the facility success-
fully appeals the penalty, may provide for the
return of such amounts collected (plus
interest) to the facility; and
‘‘(ff) in the case where all such appeals
are unsuccessful, may provide that some por-
tion of such amounts collected may be used
to support activities that benefit residents,
including assistance to support and protect
residents of a facility that closes (voluntarily
or involuntarily) or is decertified (including
offsetting costs of relocating residents to home
and community-based settings or another
facility), projects that support resident and
family councils and other consumer involve-
ment in assuring quality care in facilities, and
facility improvement initiatives approved by
the Secretary (including joint training of
facility staff and surveyors, technical assist-
ance for facilities implementing quality assur-
ance programs, the appointment of temporary
management firms, and other activities
approved by the Secretary).’’.
(2) CONFORMING AMENDMENT.—The second sentence of sec-
tion 1819(h)(5) of the Social Security Act (42 U.S.C. 1395i–
3(h)(5)) is amended by inserting ‘‘(ii)(IV),’’ after ‘‘(i),’’.
(b) NURSING FACILITIES.—
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—618
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—619
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—620
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—621
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—622
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—623
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—624
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—625
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—626
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—627
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—628
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—629
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—630
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—631
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—632
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—633
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—634
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—635
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—636
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—637
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—638
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—639
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—640
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—641
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—642
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—643
‘‘SEC. 1182. (a) The Secretary may only use evidence and
findings from research conducted under section 1181 to make a
determination regarding coverage under title XVIII if such use
is through an iterative and transparent process which includes
public comment and considers the effect on subpopulations.
‘‘(b) Nothing in section 1181 shall be construed as—
‘‘(1) superceding or modifying the coverage of items or
services under title XVIII that the Secretary determines are
reasonable and necessary under section 1862(l)(1); or
‘‘(2) authorizing the Secretary to deny coverage of items
or services under such title solely on the basis of comparative
clinical effectiveness research.
‘‘(c)(1) The Secretary shall not use evidence or findings from
comparative clinical effectiveness research conducted under section
1181 in determining coverage, reimbursement, or incentive pro-
grams under title XVIII in a manner that treats extending the
life of an elderly, disabled, or terminally ill individual as of lower
value than extending the life of an individual who is younger,
nondisabled, or not terminally ill.
‘‘(2) Paragraph (1) shall not be construed as preventing the
Secretary from using evidence or findings from such comparative
clinical effectiveness research in determining coverage, reimburse-
ment, or incentive programs under title XVIII based upon a
comparison of the difference in the effectiveness of alternative treat-
ments in extending an individual’s life due to the individual’s age,
disability, or terminal illness.
‘‘(d)(1) The Secretary shall not use evidence or findings from
comparative clinical effectiveness research conducted under section
1181 in determining coverage, reimbursement, or incentive pro-
grams under title XVIII in a manner that precludes, or with the
intent to discourage, an individual from choosing a health care
treatment based on how the individual values the tradeoff between
extending the length of their life and the risk of disability.
‘‘(2)(A) Paragraph (1) shall not be construed to—
‘‘(i) limit the application of differential copayments under
title XVIII based on factors such as cost or type of service;
or
‘‘(ii) prevent the Secretary from using evidence or findings
from such comparative clinical effectiveness research in deter-
mining coverage, reimbursement, or incentive programs under
such title based upon a comparison of the difference in the
effectiveness of alternative health care treatments in extending
an individual’s life due to that individual’s age, disability, or
terminal illness.
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—644
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—645
‘‘SEC. 9511. PATIENT-CENTERED OUTCOMES RESEARCH TRUST FUND.
‘‘(a) CREATION OF TRUST FUND.—There is established in the
Treasury of the United States a trust fund to be known as the
‘Patient-Centered Outcomes Research Trust Fund’ (hereafter in this
section referred to as the ‘PCORTF’), consisting of such amounts
as may be appropriated or credited to such Trust Fund as provided
in this section and section 9602(b).
‘‘(b) TRANSFERS TO FUND.—
‘‘(1) APPROPRIATION.—There are hereby appropriated to the
Trust Fund the following:
‘‘(A) For fiscal year 2010, $10,000,000.
‘‘(B) For fiscal year 2011, $50,000,000.
‘‘(C) For fiscal year 2012, $150,000,000.
‘‘(D) For fiscal year 2013—
‘‘(i) an amount equivalent to the net revenues
received in the Treasury from the fees imposed under
subchapter B of chapter 34 (relating to fees on health
insurance and self-insured plans) for such fiscal year;
and
‘‘(ii) $150,000,000.
‘‘(E) For each of fiscal years 2014, 2015, 2016, 2017,
2018, and 2019—
‘‘(i) an amount equivalent to the net revenues
received in the Treasury from the fees imposed under
subchapter B of chapter 34 (relating to fees on health
insurance and self-insured plans) for such fiscal year;
and
‘‘(ii) $150,000,000.
The amounts appropriated under subparagraphs (A), (B),
(C), (D)(ii), and (E)(ii) shall be transferred from the general
fund of the Treasury, from funds not otherwise appro-
priated.
‘‘(2) TRUST FUND TRANSFERS.—In addition to the amounts
appropriated under paragraph (1), there shall be credited to
the PCORTF the amounts transferred under section 1183 of
the Social Security Act.
‘‘(3) LIMITATION ON TRANSFERS TO PCORTF.—No amount
may be appropriated or transferred to the PCORTF on and
after the date of any expenditure from the PCORTF which
is not an expenditure permitted under this section. The deter-
mination of whether an expenditure is so permitted shall be
made without regard to—
‘‘(A) any provision of law which is not contained or
referenced in this chapter or in a revenue Act, and
‘‘(B) whether such provision of law is a subsequently
enacted provision or directly or indirectly seeks to waive
the application of this paragraph.
‘‘(c) TRUSTEE.—The Secretary of the Treasury shall be a trustee
of the PCORTF.
‘‘(d) EXPENDITURES FROM FUND.—
‘‘(1) AMOUNTS AVAILABLE TO THE PATIENT-CENTERED OUT-
COMES RESEARCH INSTITUTE.—Subject to paragraph (2),
amounts in the PCORTF are available, without further appro-
priation, to the Patient-Centered Outcomes Research Institute
established under section 1181(b) of the Social Security Act
for carrying out part D of title XI of the Social Security Act
(as in effect on the date of enactment of such Act).
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—648
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—650
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—659
‘‘may be used by’’ and all that follows through the period
at the end and inserting ‘‘may be used—
‘‘(A) by officers, employees, and contractors of the
Department of Health and Human Services for the pur-
poses of, and to the extent necessary in—
‘‘(i) carrying out this section; and
‘‘(ii) conducting oversight, evaluation, and enforce-
ment under this title; and
‘‘(B) by the Attorney General and the Comptroller Gen-
eral of the United States for the purposes of, and to the
extent necessary in, carrying out health oversight activi-
ties.’’.
(2) DATA MATCHING.—Section 552a(a)(8)(B) of title 5,
United States Code, is amended—
(A) in clause (vii), by striking ‘‘or’’ at the end;
(B) in clause (viii), by inserting ‘‘or’’ after the semicolon;
and
(C) by adding at the end the following new clause:
‘‘(ix) matches performed by the Secretary of Health
and Human Services or the Inspector General of the
Department of Health and Human Services with
respect to potential fraud, waste, and abuse, including
matches of a system of records with non-Federal
records;’’.
(3) MATCHING AGREEMENTS WITH THE COMMISSIONER OF
SOCIAL SECURITY.—Section 205(r) of the Social Security Act
(42 U.S.C. 405(r)) is amended by adding at the end the following
new paragraph:
‘‘(9)(A) The Commissioner of Social Security shall, upon
the request of the Secretary or the Inspector General of the
Department of Health and Human Services—
‘‘(i) enter into an agreement with the Secretary or
such Inspector General for the purpose of matching data
in the system of records of the Social Security Administra-
tion and the system of records of the Department of Health
and Human Services; and
‘‘(ii) include in such agreement safeguards to assure
the maintenance of the confidentiality of any information
disclosed.
‘‘(B) For purposes of this paragraph, the term ‘system of
records’ has the meaning given such term in section 552a(a)(5)
of title 5, United States Code.’’.
(c) WITHHOLDING OF FEDERAL MATCHING PAYMENTS FOR STATES
THAT FAIL TO REPORT ENROLLEE ENCOUNTER DATA IN THE MED-
ICAID STATISTICAL INFORMATION SYSTEM.—Section 1903(i) of the
Social Security Act (42 U.S.C. 1396b(i)) is amended—
(1) in paragraph (23), by striking ‘‘or’’ at the end;
(2) in paragraph (24), by striking the period at the end
and inserting ‘‘; or’’; and
(3) by adding at the end the following new paragraph:.
‘‘(25) with respect to any amounts expended for medical
assistance for individuals for whom the State does not report
enrollee encounter data (as defined by the Secretary) to the
Medicaid Statistical Information System (MSIS) in a timely
manner (as determined by the Secretary).’’.
(d) PERMISSIVE EXCLUSIONS AND CIVIL MONETARY PENALTIES.—
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—664
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—665
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—666
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—669
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—670
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—671
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—672
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SEC. 6407. FACE TO FACE ENCOUNTER WITH PATIENT REQUIRED
BEFORE PHYSICIANS MAY CERTIFY ELIGIBILITY FOR
HOME HEALTH SERVICES OR DURABLE MEDICAL EQUIP-
MENT UNDER MEDICARE.
(a) CONDITION OF PAYMENT FOR HOME HEALTH SERVICES.—
(1) PART A.—Section 1814(a)(2)(C) of such Act is amended—
(A) by striking ‘‘and such services’’ and inserting ‘‘such
services’’; and
(B) by inserting after ‘‘care of a physician’’ the fol-
lowing: ‘‘, and, in the case of a certification made by a
physician after January 1, 2010, prior to making such
certification the physician must document that the physi-
cian himself or herself, or a nurse practitioner or clinical
nurse specialist (as those terms are defined in section
1861(aa)(5)) who is working in collaboration with the physi-
cian in accordance with State law, or a certified nurse-
midwife (as defined in section 1861(gg)) as authorized by
State law, or a physician assistant (as defined in section
1861(aa)(5)) under the supervision of the physician, has
had a face-to-face encounter (including through use of tele-
health, subject to the requirements in section 1834(m),
and other than with respect to encounters that are incident
to services involved) with the individual within a reason-
able timeframe as determined by the Secretary’’. øAs
revised by section 10605(a)¿
(2) PART B.—Section 1835(a)(2)(A) of the Social Security
Act is amended—
(A) by striking ‘‘and’’ before ‘‘(iii)’’; and
(B) by inserting after ‘‘care of a physician’’ the fol-
lowing: ‘‘, and (iv) in the case of a certification after January
1, 2010, prior to making such certification the physician
must document that the physician, or a nurse practitioner
or clinical nurse specialist (as those terms are defined
in section 1861(aa)(5)) who is working in collaboration with
the physician in accordance with State law, or a certified
nurse-midwife (as defined in section 1861(gg)) as authorized
by State law, or a physician assistant (as defined in section
1861(aa)(5)) under the supervision of the physician, has
had a face-to-face encounter (including through use of tele-
health and other than with respect to encounters that
are incident to services involved) with the individual during
the 6-month period preceding such certification, or other
reasonable timeframe as determined by the Secretary’’.
øAs revised by section 10605(b)¿
(b) CONDITION OF PAYMENT FOR DURABLE MEDICAL EQUIP-
MENT.—Section 1834(a)(11)(B) of the Social Security Act (42 U.S.C.
1395m(a)(11)(B)) is amended—
(1) by striking ‘‘ORDER.—The Secretary’’ and inserting
‘‘ORDER.—
‘‘(i) IN GENERAL.—The Secretary’’; and
(2) by adding at the end the following new clause:
‘‘(ii) REQUIREMENT FOR FACE TO FACE
ENCOUNTER.—The Secretary shall require that such
an order be written pursuant to the physician docu-
menting that a physician, a physician assistant, a
nurse practitioner, or a clinical nurse specialist (as
those terms are defined in section 1861(aa)(5)) has
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—678
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—679
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—680
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—681
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—682
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—683
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—684
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—685
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—686
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—687
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—688
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‘‘SEC. 2012. GENERAL PROVISIONS.
‘‘(a) PROTECTION OF PRIVACY.—In pursuing activities under this
subtitle, the Secretary shall ensure the protection of individual
health privacy consistent with the regulations promulgated under
section 264(c) of the Health Insurance Portability and Accountability
Act of 1996 and applicable State and local privacy regulations.
‘‘(b) RULE OF CONSTRUCTION.—Nothing in this subtitle shall
be construed to interfere with or abridge an elder’s right to practice
his or her religion through reliance on prayer alone for healing
when this choice—
‘‘(1) is contemporaneously expressed, either orally or in
writing, with respect to a specific illness or injury which the
elder has at the time of the decision by an elder who is com-
petent at the time of the decision;
‘‘(2) is previously set forth in a living will, health care
proxy, or other advance directive document that is validly
executed and applied under State law; or
‘‘(3) may be unambiguously deduced from the elder’s life
history.
‘‘PART I—NATIONAL COORDINATION OF
ELDER JUSTICE ACTIVITIES AND RESEARCH
‘‘Subpart A—Elder Justice Coordinating Council
and Advisory Board on Elder Abuse, Neglect,
and Exploitation
‘‘SEC. 2021. ELDER JUSTICE COORDINATING COUNCIL.
‘‘(a) ESTABLISHMENT.—There is established within the Office
of the Secretary an Elder Justice Coordinating Council (in this
section referred to as the ‘Council’).
‘‘(b) MEMBERSHIP.—
‘‘(1) IN GENERAL.—The Council shall be composed of the
following members:
‘‘(A) The Secretary (or the Secretary’s designee).
‘‘(B) The Attorney General (or the Attorney General’s
designee).
‘‘(C) The head of each Federal department or agency
or other governmental entity identified by the Chair
referred to in subsection (d) as having responsibilities, or
administering programs, relating to elder abuse, neglect,
and exploitation.
‘‘(2) REQUIREMENT.—Each member of the Council shall be
an officer or employee of the Federal Government.
‘‘(c) VACANCIES.—Any vacancy in the Council shall not affect
its powers, but shall be filled in the same manner as the original
appointment was made.
‘‘(d) CHAIR.—The member described in subsection (b)(1)(A) shall
be Chair of the Council.
‘‘(e) MEETINGS.—The Council shall meet at least 2 times per
year, as determined by the Chair.
‘‘(f) DUTIES.—
‘‘(1) IN GENERAL.—The Council shall make recommenda-
tions to the Secretary for the coordination of activities of the
Department of Health and Human Services, the Department
of Justice, and other relevant Federal, State, local, and private
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—710
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—711
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—712
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—713
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—717
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—718
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—720
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SEC. 8002. ESTABLISHMENT OF NATIONAL VOLUNTARY INSURANCE
PROGRAM FOR PURCHASING COMMUNITY LIVING ASSIST-
ANCE SERVICES AND SUPPORT.
(a) ESTABLISHMENT OF CLASS PROGRAM.—
(1) IN GENERAL.—The Public Health Service Act (42 U.S.C.
201 et seq.), as amended by section 4302(a), is amended by
adding at the end the following:
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—744
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‘‘SEC. 3207. CLASS INDEPENDENCE ADVISORY COUNCIL.
‘‘(a) ESTABLISHMENT.—There is hereby created an Advisory
Committee to be known as the ‘CLASS Independence Advisory
Council’.
‘‘(b) MEMBERSHIP.—
‘‘(1) IN GENERAL.—The CLASS Independence Advisory
Council shall be composed of not more than 15 individuals,
not otherwise in the employ of the United States—
‘‘(A) who shall be appointed by the President without
regard to the civil service laws and regulations; and
‘‘(B) a majority of whom shall be representatives of
individuals who participate or are likely to participate in
the CLASS program, and shall include representatives of
older and younger workers, individuals with disabilities,
family caregivers of individuals who require services and
supports to maintain their independence at home or in
another residential setting of their choice in the community,
individuals with expertise in long-term care or disability
insurance, actuarial science, economics, and other relevant
disciplines, as determined by the Secretary.
‘‘(2) TERMS.—
‘‘(A) IN GENERAL.—The members of the CLASS
Independence Advisory Council shall serve overlapping
terms of 3 years (unless appointed to fill a vacancy occur-
ring prior to the expiration of a term, in which case the
individual shall serve for the remainder of the term).
‘‘(B) LIMITATION.—A member shall not be eligible to
serve for more than 2 consecutive terms.
‘‘(3) CHAIR.—The President shall, from time to time, appoint
one of the members of the CLASS Independence Advisory
Council to serve as the Chair.
‘‘(c) DUTIES.—The CLASS Independence Advisory Council shall
advise the Secretary on matters of general policy in the administra-
tion of the CLASS program established under this title and in
the formulation of regulations under this title including with respect
to—
‘‘(1) the development of the CLASS Independence Benefit
Plan under section 3203;
‘‘(2) the determination of monthly premiums under such
plan; and
‘‘(3) the financial solvency of the program.
‘‘(d) APPLICATION OF FACA.—The Federal Advisory Committee
Act (5 U.S.C. App.), other than section 14 of that Act, shall apply
to the CLASS Independence Advisory Council.
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) IN GENERAL.—There are authorized to be appropriated
to the CLASS Independence Advisory Council to carry out
its duties under this section, such sums as may be necessary
for fiscal year 2011 and for each fiscal year thereafter.
‘‘(2) AVAILABILITY.—Any sums appropriated under the
authorization contained in this section shall remain available,
without fiscal year limitation, until expended.
‘‘SEC. 3208. SOLVENCY AND FISCAL INDEPENDENCE; REGULATIONS;
ANNUAL REPORT.
‘‘(a) SOLVENCY.—The Secretary shall regularly consult with the
Board of Trustees of the CLASS Independence Fund and the CLASS
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—758
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—759
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—760
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—761
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—762
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—763
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—764
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2013 ............................................................................... $2,800,000,000
2014 ............................................................................... $3,000,000,000
2015 ............................................................................... $3,000,000,000
2016 ............................................................................... $3,000,000,000
2017 ............................................................................... $4,000,000,000
2018 ............................................................................... $4,100,000,000
2019 and thereafter ...................................................... $2,800,000,000.
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—766
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—767
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—768
SEC. 9009. øIMPOSITION OF ANNUAL FEE ON MEDICAL DEVICE MANU-
FACTURERS AND IMPORTERS¿øREPEALED AND
REPLACED¿.
øRepealed by section 1405(d) of HCERA, without redesignation
of succeeding sections; previously amended by section 10904(a) of
PPACA. Note section 1405(a)-(c) of HCERA amended the IRC to
provide an excise tax on medical device manufacturers, as follows:¿
(a) øSec. 1405(a) of HCERA¿ In General.— Chapter 32 of
the Internal Revenue Code of 1986 is amended—
(1) by inserting after subchapter D the following new sub-
chapter:
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—769
The percentage of
With respect to a covered entity’s net pre- net premiums writ-
miums written during the calendar year that ten that are taken
are: into account is:
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—770
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—771
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—772
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—773
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—774
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—775
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—776
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—777
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—778
ø‘‘SEC. 5000B. IMPOSITION OF TAX ON ELECTIVE COSMETIC MEDICAL
PROCEDURES.¿
ø‘‘(a) IN GENERAL.—There is hereby imposed on any cosmetic
surgery and medical procedure a tax equal to 5 percent of the
amount paid for such procedure (determined without regard to
this section), whether paid by insurance or otherwise.¿
ø‘‘(b) COSMETIC SURGERY AND MEDICAL PROCEDURE.—For pur-
poses of this section, the term ‘cosmetic surgery and medical proce-
dure’ means any cosmetic surgery (as defined in section 213(d)(9)(B))
or other similar procedure which—¿
ø‘‘(1) is performed by a licensed medical professional, and¿
ø‘‘(2) is not necessary to ameliorate a deformity arising
from, or directly related to, a congenital abnormality, a personal
injury resulting from an accident or trauma, or disfiguring
disease.¿
ø‘‘(c) PAYMENT OF TAX.—¿
ø‘‘(1) IN GENERAL.—The tax imposed by this section shall
be paid by the individual on whom the procedure is performed.¿
ø‘‘(2) COLLECTION.—Every person receiving a payment for
procedures on which a tax is imposed under subsection (a)
shall collect the amount of the tax from the individual on
whom the procedure is performed and remit such tax quarterly
to the Secretary at such time and in such manner as provided
by the Secretary.¿
ø‘‘(3) SECONDARY LIABILITY.—Where any tax imposed by
subsection (a) is not paid at the time payments for cosmetic
surgery and medical procedures are made, then to the extent
that such tax is not collected, such tax shall be paid by the
person who performs the procedure.’’.¿
ø(b) CLERICAL AMENDMENT.—The table of chapters for subtitle
D of the Internal Revenue Code of 1986, as amended by this
Act, is amended by inserting after the item relating to chapter
48 the following new item:¿
‘‘CHAPTER 49—ELECTIVE COSMETIC MEDICAL PROCEDURES’’.
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—779
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—780
SEC. 9022. ESTABLISHMENT OF SIMPLE CAFETERIA PLANS FOR SMALL
BUSINESSES.
(a) IN GENERAL.—Section 125 of the Internal Revenue Code
of 1986 (relating to cafeteria plans), as amended by this Act, is
amended by redesignating subsections (j) and (k) as subsections
(k) and (l), respectively, and by inserting after subsection (i) the
following new subsection:
‘‘(j) SIMPLE CAFETERIA PLANS FOR SMALL BUSINESSES.—
‘‘(1) IN GENERAL.—An eligible employer maintaining a
simple cafeteria plan with respect to which the requirements
of this subsection are met for any year shall be treated as
meeting any applicable nondiscrimination requirement during
such year.
‘‘(2) SIMPLE CAFETERIA PLAN.—For purposes of this sub-
section, the term ‘simple cafeteria plan’ means a cafeteria
plan—
‘‘(A) which is established and maintained by an eligible
employer, and
‘‘(B) with respect to which the contribution require-
ments of paragraph (3), and the eligibility and participation
requirements of paragraph (4), are met.
‘‘(3) CONTRIBUTION REQUIREMENTS.—
‘‘(A) IN GENERAL.—The requirements of this paragraph
are met if, under the plan the employer is required, without
regard to whether a qualified employee makes any salary
reduction contribution, to make a contribution to provide
qualified benefits under the plan on behalf of each qualified
employee in an amount equal to—
‘‘(i) a uniform percentage (not less than 2 percent)
of the employee’s compensation for the plan year, or
‘‘(ii) an amount which is not less than the lesser
of—
‘‘(I) 6 percent of the employee’s compensation
for the plan year, or
‘‘(II) twice the amount of the salary reduction
contributions of each qualified employee.
‘‘(B) MATCHING CONTRIBUTIONS ON BEHALF OF HIGHLY
COMPENSATED AND KEY EMPLOYEES.—The requirements of
subparagraph (A)(ii) shall not be treated as met if, under
the plan, the rate of contributions with respect to any
salary reduction contribution of a highly compensated or
key employee at any rate of contribution is greater than
that with respect to an employee who is not a highly
compensated or key employee.
‘‘(C) ADDITIONAL CONTRIBUTIONS.—Subject to subpara-
graph (B), nothing in this paragraph shall be treated as
prohibiting an employer from making contributions to pro-
vide qualified benefits under the plan in addition to con-
tributions required under subparagraph (A).
‘‘(D) DEFINITIONS.—For purposes of this paragraph—
‘‘(i) SALARY REDUCTION CONTRIBUTION.—The term
‘salary reduction contribution’ means, with respect to
a cafeteria plan, any amount which is contributed to
the plan at the election of the employee and which
is not includible in gross income by reason of this
section.
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—781
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—782
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—783
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—784
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—785
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—786
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—787
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—788
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—789
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—790
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—791
SEC. 10104. AMENDMENTS TO SUBTITLE D.
(a) øReplaced section 1301(a)(2)¿
(b) øAmended section 1302 in subsection (d)(2)(B) and adding
a new subsection (g)¿
(c) øReplaced section 1303¿
(d) øAmended section 1304 by adding a new subsection (e)¿
(e) øAmended section 1311(d) by replacing paragraph (3)(B)(ii)
and by inserting language in paragraph (6)(A)¿
(f) øAmended section 1311(e) in paragraph (2) and by adding
a new paragraph (3)¿
(g) øAmended section 1311(g)(1) by adding a new subparagraph
(E)¿
(h) øAmended language in section 1311(i)(2)(B)¿
(i) øAmended subsections (a)(1), (e), and (f)(1)(A)(ii) of section
1312¿
(j)(1) Subparagraph (B) of section 1313(a)(6) of this Act is
hereby deemed null, void, and of no effect.
(2) Section 3730(e) of title 31, United States Code, is amended
by striking paragraph (4) and inserting the following:
‘‘(4)(A) The court shall dismiss an action or claim under
this section, unless opposed by the Government, if substantially
the same allegations or transactions as alleged in the action
or claim were publicly disclosed—
‘‘(i) in a Federal criminal, civil, or administrative
hearing in which the Government or its agent is a party;
‘‘(ii) in a congressional, Government Accountability
Office, or other Federal report, hearing, audit, or investiga-
tion; or
‘‘(iii) from the news media,
unless the action is brought by the Attorney General or the
person bringing the action is an original source of the informa-
tion.
‘‘(B) For purposes of this paragraph, ‘‘original source’’
means an individual who either (i) prior to a public disclosure
under subsection (e)(4)(a), has voluntarily disclosed to the
Government the information on which allegations or trans-
actions in a claim are based, or (2) who has knowledge that
is independent of and materially adds to the publicly disclosed
allegations or transactions, and who has voluntarily provided
the information to the Government before filing an action under
this section.’’.
(k) øInserted new paragraph (4) in section 1313(b)¿
(l) øInserted new paragraph (2) in section 1322(b)¿
(m) øStruck section 1323¿
(n) øAmended section 1324(a)¿
(o) øAmended subsections (d)(3)(A)(i) and (e)(1)(B) of section
1331¿
(p) øStruck subsection (b) of section 1333¿
(q) øAdded section 1334 to part IV of subtitle D of title I¿
SEC. 10105. AMENDMENTS TO SUBTITLE E øAMENDMENTS FULLY INCOR-
PORATED ABOVE¿.
(a) øAmended section 36B(b)(3)(A)(ii) of the IRC, as added by
section 1401(a)¿
(b) øAmended section 36B(c)(1)(A) of the IRC, as added by
section 1401(a)¿
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—792
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—793
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—794
Protection and Affordable Care Act to the extent that the amount
of such voucher does not exceed the amount paid for a qualified
health plan (as defined in section 1301 of such Act) by the tax-
payer.’’.
(2) CLERICAL AMENDMENT.—The table of sections for part
III of subchapter B of chapter 1 of such Code is amended
by inserting after the item relating to section 139C the following
new item:
‘‘Sec. 139D. Free choice vouchers.’’.
(3) EFFECTIVE DATE.—The amendments made by this sub-
section shall apply to vouchers provided after December 31,
2013.
(g) DEDUCTION ALLOWED TO EMPLOYER.—
(1) IN GENERAL.—Section 162(a) of the Internal Revenue
Code of 1986 is amended by adding at the end the following
new sentence: ‘‘For purposes of paragraph (1), the amount
of a free choice voucher provided under section 10108 of the
Patient Protection and Affordable Care Act shall be treated
as an amount for compensation for personal services actually
rendered.’’.
(2) EFFECTIVE DATE.—The amendments made by this sub-
section shall apply to vouchers provided after December 31,
2013.
(h) VOUCHER TAKEN INTO ACCOUNT IN DETERMINING PREMIUM
CREDIT.—
(1) øAdded a subparagraph (D) to section 36(c)(2) of the
IRC, added by section 1401¿
(2) EFFECTIVE DATE.—The amendment made by this sub-
section shall apply to taxable years beginning after December
31, 2013.
(i) COORDINATION WITH EMPLOYER RESPONSIBILITIES.—
(1) SHARED RESPONSIBILITY PENALTY.—
(A) øAdded a paragraph (3) to section 4980H(c) of
the IRC, added by section 1513¿
(B) EFFECTIVE DATE.—The amendment made by this
paragraph shall apply to months beginning after December
31, 2013.
(2) øAmended section 18B(a)(3) of FLSA, added by section
1512¿
(j) EMPLOYER REPORTING.—
(1) øAmended section 6056(a) of the IRC, added by section
1514¿
(2) øReplaced subsection (f) of section 6056 of the IRC,
added by section 1514¿
(3) øMade miscellaneous conforming amendments to sec-
tions 6056 and 6724(d) of the IRC, added by section 1514,
as well as a table of sections amendment¿
(4) EFFECTIVE DATE.—The amendments made by this sub-
section shall apply to periods beginning after December 31,
2013.
SEC. 10109. DEVELOPMENT OF STANDARDS FOR FINANCIAL AND
ADMINISTRATIVE TRANSACTIONS.
(a) ADDITIONAL TRANSACTION STANDARDS AND OPERATING
RULES.—
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—795
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—796
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—797
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—798
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—799
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—800
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—801
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—802
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—803
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—804
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—805
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—806
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—807
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—808
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—809
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—810
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—811
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—812
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—813
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—814
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—815
SEC. 10311. REVISIONS TO EXTENSION OF AMBULANCE ADD-ONS
øAMENDMENTS FULLY INCORPORATED ABOVE¿.
(a) øAmended section 1834(l)(13)(A) of the Social Security Act,
as amended by section 3105(a)¿
(b) øAmended section 146(b)(1) of the Medicare Improvements
for Patients and Providers Act of 2008, as amended by section
3105(b)¿
(c) øAmended section 1834(l)(12)(A) of the Social Security Act,
as amended by section 3105(c)¿
SEC. 10312. CERTAIN PAYMENT RULES FOR LONG-TERM CARE HOS-
PITAL SERVICES AND MORATORIUM ON THE ESTABLISH-
MENT OF CERTAIN HOSPITALS AND FACILITIES øAMEND-
MENTS FULLY INCORPORATED ABOVE¿.
(a) øAmended section 114(c) of the Medicare, Medicaid, and
SCHIP Extension Act of 2007, as amended by section 4302(a) of
the American Recovery and Reinvestment Act and section 3106(a)¿
(b) øAmended section 114(d) of such Act, as amended by section
3106(b)¿
SEC. 10313. REVISIONS TO THE EXTENSION FOR THE RURAL COMMU-
NITY HOSPITAL DEMONSTRATION PROGRAM øAMEND-
MENTS FULLY INCORPORATED ABOVE¿.
(a) øReplaced subsection (g) of section 410A of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003,
as added by section 3123(a)¿
(b) øAmended subsection (a)(5) of section 410A of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003,
as amended by section 3123(b)¿
SEC. 10314. ADJUSTMENT TO LOW-VOLUME HOSPITAL PROVISION
øAMENDMENTS FULLY INCORPORATED ABOVE¿.
øAmended subparagraphs (C)(i) and (D) of section 1886(d)(12)
of the Social Security Act, as amended by section 3125¿
SEC. 10315. REVISIONS TO HOME HEALTH CARE PROVISIONS øAMEND-
MENTS FULLY INCORPORATED ABOVE¿.
(a) øAmended section 1895(b)(3)(A)(iii) of the Social Security
Act, as added by section 3131¿
(b) øReplaced section 3131(d)¿
SEC. 10316. MEDICARE DSH øAMENDMENTS FULLY INCORPORATED
ABOVE¿.
øAmended section 1886(r)(2)(B) of the Social Security Act, as
added by section 3133¿
SEC. 10317. REVISIONS TO EXTENSION OF SECTION 508 HOSPITAL
PROVISIONS øAMENDMENTS FULLY INCORPORATED
ABOVE¿.
øReplaced section 3137(a)¿
SEC. 10318. REVISIONS TO TRANSITIONAL EXTRA BENEFITS UNDER
MEDICARE ADVANTAGE øAMENDMENTS FULLY INCOR-
PORATED ABOVE¿.
øAmended section 1853(p)(3)(A) of the Social Security Act, as
added by section 3201(h); section 3201 and its amendments was
subsequently repealed by section 1102(a) of HCERA¿
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—816
SEC. 10319. REVISIONS TO MARKET BASKET ADJUSTMENTS øAMEND-
MENTS FULLY INCORPORATED ABOVE¿.
(a) INPATIENT ACUTE HOSPITALS.—øAmended section
1886(b)(3)(B)(xii) of the Social Security Act, as added by section
3401(a); subsequently amended by section 1105(a) of HCERA¿
(b) LONG-TERM CARE HOSPITALS.—øAmended section 1886(m)(4)
of the Social Security Act, as added by section 3401(c); subsequently
amended by section 1105(b) of HCERA¿
(c) INPATIENT REHABILITATION FACILITIES.—øAmended section
1886(j)(3)(D)(i) of SSA, as added by section 3401(d); subsequently
amended by section 1105(c) of HCERA¿
(d) HOME HEALTH AGENCIES.—øAmended section
1895(b)(3)(B)(vi)(II) of SSA, as added by section 3401(e)¿
(e) PSYCHIATRIC HOSPITALS.—øAmended section 1886(s)(3)(A)
of SSA, as added by section 3401(f); subsequently amended by section
1105(d) of HCERA¿
(f) HOSPICE CARE.—øAmended section 1814(i)(1)(C) of the Social
Security Act, as amended by section 3401(g)¿
(g) OUTPATIENT HOSPITALS.—øAmended section 1833(t)(3)(G)(i)
of SSA, as added by section 3401(i); subsequently amended by section
1105(e) of HCERA¿
SEC. 10320. EXPANSION OF THE SCOPE OF, AND ADDITIONAL IMPROVE-
MENTS TO, THE INDEPENDENT MEDICARE ADVISORY
BOARD.
(a) IN GENERAL.—Section 1899A of the Social Security Act,
as added by section 3403, is amended—
(1) in subsection (c)—
(A) øAdded sentence at end of paragraph (1)(B)¿;
(B) øAmended paragraph (2)(A) in clause (iv) and by
adding new clause (vii)¿
(C) øAdded clause (vii) to paragraph (2)(B)¿
(D) øAmended paragraph (3), including striking
subparagraph (A)(ii)(III)¿
(E) øAmended paragraph (4)¿
(F) øAmended paragraph (5)¿
(G) øAmended paragraph (6)(B)(i)¿
(2) øAmended subsection (d)¿
(3) in subsection (e)—
(A) øAmended paragraph (1)¿
(B) øAmended paragraph (3), including adding a new
subparagraph (B)¿
(4) øAmended subsection (f)(3)(B)¿
(5) øAdded subsections (n) and (o)¿
(b) NAME CHANGE.—Any reference in the provisions of, or
amendments made by, section 3403 to the ‘‘Independent Medicare
Advisory Board’’ shall be deemed to be a reference to the ‘‘Inde-
pendent Payment Advisory Board’’.
(c) RULE OF CONSTRUCTION.—Nothing in the amendments made
by this section shall preclude the Independent Medicare Advisory
Board, as established under section 1899A of the Social Security
Act (as added by section 3403), from solely using data from public
or private sources to carry out the amendments made by subsection
(a)(4).
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—817
SEC. 10321. REVISION TO COMMUNITY HEALTH TEAMS øAMENDMENTS
FULLY INCORPORATED ABOVE¿.
øAmended section 3502(c)(2)(A)¿
SEC. 10322. QUALITY REPORTING FOR PSYCHIATRIC HOSPITALS.
(a) IN GENERAL.—Section 1886(s) of the Social Security Act,
as added by section 3401(f), is amended by adding at the end
the following new paragraph:
‘‘(4) QUALITY REPORTING.—
‘‘(A) REDUCTION IN UPDATE FOR FAILURE TO REPORT.—
‘‘(i) IN GENERAL.—Under the system described in
paragraph (1), for rate year 2014 and each subsequent
rate year, in the case of a psychiatric hospital or psy-
chiatric unit that does not submit data to the Secretary
in accordance with subparagraph (C) with respect to
such a rate year, any annual update to a standard
Federal rate for discharges for the hospital during
the rate year, and after application of paragraph (2),
shall be reduced by 2 percentage points.
‘‘(ii) SPECIAL RULE.—The application of this
subparagraph may result in such annual update being
less than 0.0 for a rate year, and may result in payment
rates under the system described in paragraph (1)
for a rate year being less than such payment rates
for the preceding rate year.
‘‘(B) NONCUMULATIVE APPLICATION.—Any reduction
under subparagraph (A) shall apply only with respect to
the rate year involved and the Secretary shall not take
into account such reduction in computing the payment
amount under the system described in paragraph (1) for
a subsequent rate year.
‘‘(C) SUBMISSION OF QUALITY DATA.—For rate year 2014
and each subsequent rate year, each psychiatric hospital
and psychiatric unit shall submit to the Secretary data
on quality measures specified under subparagraph (D).
Such data shall be submitted in a form and manner, and
at a time, specified by the Secretary for purposes of this
subparagraph.
‘‘(D) QUALITY MEASURES.—
‘‘(i) IN GENERAL.—Subject to clause (ii), any
measure specified by the Secretary under this subpara-
graph must have been endorsed by the entity with
a contract under section 1890(a).
‘‘(ii) EXCEPTION.—In the case of a specified area
or medical topic determined appropriate by the Sec-
retary for which a feasible and practical measure has
not been endorsed by the entity with a contract under
section 1890(a), the Secretary may specify a measure
that is not so endorsed as long as due consideration
is given to measures that have been endorsed or
adopted by a consensus organization identified by the
Secretary.
‘‘(iii) TIME FRAME.—Not later than October 1, 2012,
the Secretary shall publish the measures selected
under this subparagraph that will be applicable with
respect to rate year 2014.
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SEC. 10325. REVISION TO SKILLED NURSING FACILITY PROSPECTIVE
PAYMENT SYSTEM.
(a) TEMPORARY DELAY OF RUG–IV.—Notwithstanding any other
provision of law, the Secretary of Health and Human Services
shall not, prior to October 1, 2011, implement Version 4 of the
Resource Utilization Groups (in this subsection refereed to as
‘‘RUG–IV’’) published in the Federal Register on August 11, 2009,
entitled ‘‘Prospective Payment System and Consolidated Billing for
Skilled Nursing Facilities for FY 2010; Minimum Data Set, Version
3.0 for Skilled Nursing Facilities and Medicaid Nursing Facilities’’
(74 Fed. Reg. 40288). Beginning on October 1, 2010, the Secretary
of Health and Human Services shall implement the change specific
to therapy furnished on a concurrent basis that is a component
of RUG–IV and changes to the lookback period to ensure that
only those services furnished after admission to a skilled nursing
facility are used as factors in determining a case mix classification
under the skilled nursing facility prospective payment system under
section 1888(e) of the Social Security Act (42 U.S.C. 1395yy(e)).
(b) CONSTRUCTION.—Nothing in this section shall be interpreted
as delaying the implementation of Version 3.0 of the Minimum
Data Sets (MDS 3.0) beyond the planned implementation date
of October 1, 2010.
SEC. 10326. PILOT TESTING PAY-FOR-PERFORMANCE PROGRAMS FOR
CERTAIN MEDICARE PROVIDERS.
(a) IN GENERAL.—Not later than January 1, 2016, the Secretary
of Health and Human Services (in this section referred to as the
‘‘Secretary’’) shall, for each provider described in subsection (b),
conduct a separate pilot program under title XVIII of the Social
Security Act to test the implementation of a value-based purchasing
program for payments under such title for the provider.
(b) PROVIDERS DESCRIBED.—The providers described in this
paragraph are the following:
(1) Psychiatric hospitals (as described in clause (i) of section
1886(d)(1)(B) of such Act (42 U.S.C. 1395ww(d)(1)(B))) and psy-
chiatric units (as described in the matter following clause (v)
of such section).
(2) Long-term care hospitals (as described in clause (iv)
of such section).
(3) Rehabilitation hospitals (as described in clause (ii) of
such section).
(4) PPS-exempt cancer hospitals (as described in clause
(v) of such section).
(5) Hospice programs (as defined in section 1861(dd)(2)
of such Act (42 U.S.C. 1395x(dd)(2))).
(c) WAIVER AUTHORITY.—The Secretary may waive such
requirements of titles XI and XVIII of the Social Security Act
as may be necessary solely for purposes of carrying out the pilot
programs under this section.
(d) NO ADDITIONAL PROGRAM EXPENDITURES.—Payments under
this section under the separate pilot program for value based pur-
chasing (as described in subsection (a)) for each provider type
described in paragraphs (1) through (5) of subsection (b) for
applicable items and services under title XVIII of the Social Security
Act for a year shall be established in a manner that does not
result in spending more under each such value based purchasing
program for such year than would otherwise be expended for such
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—826
provider type for such year if the pilot program were not imple-
mented, as estimated by the Secretary.
(e) EXPANSION OF PILOT PROGRAM.—The Secretary may, at
any point after January 1, 2018, expand the duration and scope
of a pilot program conducted under this subsection, to the extent
determined appropriate by the Secretary, if—
(1) the Secretary determines that such expansion is
expected to—
(A) reduce spending under title XVIII of the Social
Security Act without reducing the quality of care; or
(B) improve the quality of care and reduce spending;
(2) the Chief Actuary of the Centers for Medicare & Med-
icaid Services certifies that such expansion would reduce pro-
gram spending under such title XVIII; and
(3) the Secretary determines that such expansion would
not deny or limit the coverage or provision of benefits under
such title XIII for Medicare beneficiaries.
SEC. 10327. IMPROVEMENTS TO THE PHYSICIAN QUALITY REPORTING
SYSTEM.
(a) IN GENERAL.—Section 1848(m) of the Social Security Act
(42 U.S.C. 1395w–4(m)) is amended by adding at the end the
following new paragraph:
‘‘(7) ADDITIONAL INCENTIVE PAYMENT.—
‘‘(A) IN GENERAL.—For 2011 through 2014, if an eligible
professional meets the requirements described in subpara-
graph (B), the applicable quality percent for such year,
as described in clauses (iii) and (iv) of paragraph (1)(B),
shall be increased by 0.5 percentage points.
‘‘(B) REQUIREMENTS DESCRIBED.—In order to qualify
for the additional incentive payment described in subpara-
graph (A), an eligible professional shall meet the following
requirements:
‘‘(i) The eligible professional shall—
‘‘(I) satisfactorily submit data on quality meas-
ures for purposes of paragraph (1) for a year; and
‘‘(II) have such data submitted on their behalf
through a Maintenance of Certification Program
(as defined in subparagraph (C)(i)) that meets—
‘‘(aa) the criteria for a registry (as
described in subsection (k)(4)); or
‘‘(bb) an alternative form and manner
determined appropriate by the Secretary.
‘‘(ii) The eligible professional, more frequently than
is required to qualify for or maintain board certification
status—
‘‘(I) participates in such a Maintenance of Cer-
tification program for a year; and
‘‘(II) successfully completes a qualified Mainte-
nance of Certification Program practice assessment
(as defined in subparagraph (C)(ii)) for such year.
‘‘(iii) A Maintenance of Certification program sub-
mits to the Secretary, on behalf of the eligible profes-
sional, information—
‘‘(I) in a form and manner specified by the
Secretary, that the eligible professional has
successfully met the requirements of clause (ii)
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—828
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the website of the Centers for Medicare & Medicaid Services the
plan described in subsection (a).
SEC. 10331. PUBLIC REPORTING OF PERFORMANCE INFORMATION.
(a) IN GENERAL.—
(1) DEVELOPMENT.—Not later than January 1, 2011, the
Secretary shall develop a Physician Compare Internet website
with information on physicians enrolled in the Medicare pro-
gram under section 1866(j) of the Social Security Act (42 U.S.C.
1395cc(j)) and other eligible professionals who participate in
the Physician Quality Reporting Initiative under section 1848
of such Act (42 U.S.C. 1395w–4).
(2) PLAN.—Not later than January 1, 2013, and with
respect to reporting periods that begin no earlier than January
1, 2012, the Secretary shall also implement a plan for making
publicly available through Physician Compare, consistent with
subsection (c), information on physician performance that pro-
vides comparable information for the public on quality and
patient experience measures with respect to physicians enrolled
in the Medicare program under such section 1866(j). To the
extent scientifically sound measures that are developed con-
sistent with the requirements of this section are available,
such information, to the extent practicable, shall include—
(A) measures collected under the Physician Quality
Reporting Initiative;
(B) an assessment of patient health outcomes and the
functional status of patients;
(C) an assessment of the continuity and coordination
of care and care transitions, including episodes of care
and risk-adjusted resource use;
(D) an assessment of efficiency;
(E) an assessment of patient experience and patient,
caregiver, and family engagement;
(F) an assessment of the safety, effectiveness, and time-
liness of care; and
(G) other information as determined appropriate by
the Secretary.
(b) OTHER REQUIRED CONSIDERATIONS.—In developing and
implementing the plan described in subsection (a)(2), the Secretary
shall, to the extent practicable, include—
(1) processes to assure that data made public, either by
the Centers for Medicare & Medicaid Services or by other
entities, is statistically valid and reliable, including risk adjust-
ment mechanisms used by the Secretary;
(2) processes by which a physician or other eligible profes-
sional whose performance on measures is being publicly
reported has a reasonable opportunity, as determined by the
Secretary, to review his or her individual results before they
are made public;
(3) processes by the Secretary to assure that the
implementation of the plan and the data made available on
Physician Compare provide a robust and accurate portrayal
of a physician’s performance;
(4) data that reflects the care provided to all patients
seen by physicians, under both the Medicare program and,
to the extent practicable, other payers, to the extent such
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—832
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—833
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—834
SEC. 10333. COMMUNITY-BASED COLLABORATIVE CARE NETWORKS.
Part D of title III of the Public Health Service Act (42 U.S.C.
254b et seq.) is amended by adding at the end the following new
subpart:
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—835
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—836
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—837
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—838
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—839
SEC. 10402. AMENDMENTS TO SUBTITLE B øAMENDMENTS FULLY INCOR-
PORATED ABOVE¿.
(a) øAmended section 399Z–1(a)(1)(A) of the Public Health
Service Act, as added by section 4101(b)¿
(b) øReplaced section 1861(hhh)(4)(G) of the Social Security
Act, as added by section 4103(b)¿
SEC. 10403. AMENDMENTS TO SUBTITLE C øAMENDMENTS FULLY INCOR-
PORATED ABOVE¿.
øAmended section 4201¿
SEC. 10404. AMENDMENTS TO SUBTITLE D øAMENDMENTS FULLY INCOR-
PORATED ABOVE¿.
øAmended section 399MM(2) of the Public Health Service Act,
as added by section 4303¿
SEC. 10405. AMENDMENTS TO SUBTITLE E øAMENDMENTS FULLY INCOR-
PORATED ABOVE¿.
øStruck section 4401¿
SEC. 10406. AMENDMENT RELATING TO WAIVING COINSURANCE FOR
PREVENTIVE SERVICES øAMENDMENTS FULLY INCOR-
PORATED ABOVE¿.
øReplaced section 4104(b)¿
SEC. 10407. BETTER DIABETES CARE.
(a) SHORT TITLE.—This section may be cited as the ‘‘Catalyst
to Better Diabetes Care Act of 2009’’.
(b) NATIONAL DIABETES REPORT CARD.—
(1) IN GENERAL.—The Secretary, in collaboration with the
Director of the Centers for Disease Control and Prevention
(referred to in this section as the ‘‘Director’’), shall prepare
on a biennial basis a national diabetes report card (referred
to in this section as a ‘‘Report Card’’) and, to the extent possible,
for each State.
(2) CONTENTS.—
(A) IN GENERAL.—Each Report Card shall include
aggregate health outcomes related to individuals diagnosed
with diabetes and prediabetes including—
(i) preventative care practices and quality of care;
(ii) risk factors; and
(iii) outcomes.
(B) UPDATED REPORTS.—Each Report Card that is pre-
pared after the initial Report Card shall include trend
analysis for the Nation and, to the extent possible, for
each State, for the purpose of—
(i) tracking progress in meeting established
national goals and objectives for improving diabetes
care, costs, and prevalence (including Healthy People
2010); and
(ii) informing policy and program development.
(3) AVAILABILITY.—The Secretary, in collaboration with the
Director, shall make each Report Card publicly available,
including by posting the Report Card on the Internet.
(c) IMPROVEMENT OF VITAL STATISTICS COLLECTION.—
(1) IN GENERAL.—The Secretary, acting through the
Director of the Centers for Disease Control and Prevention
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—841
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—843
‘‘(2) MEMBERSHIP.—
‘‘(A) IN GENERAL.—
‘‘(i) APPOINTMENT.—The Board shall be comprised
of 24 members who are appointed by the Secretary
and who serve at the pleasure of the Secretary.
‘‘(ii) CHAIRPERSON AND VICE CHAIRPERSON.—The
Secretary shall designate, from among the 24 members
appointed under clause (i), one Chairperson of the
Board (referred to in this section as the ‘Chairperson’)
and one Vice Chairperson.
‘‘(B) TERMS.—
‘‘(i) IN GENERAL.—Each member shall be appointed
to serve a 4-year term, except that any member
appointed to fill a vacancy occurring prior to the expira-
tion of the term for which the member’s predecessor
was appointed shall be appointed for the remainder
of such term.
‘‘(ii) CONSECUTIVE APPOINTMENTS; MAXIMUM
TERMS.—A member may be appointed to serve not
more than 3 terms on the Board, and may not serve
more than 2 such terms consecutively.
‘‘(C) QUALIFICATIONS.—
‘‘(i) IN GENERAL.—The Secretary shall appoint
individuals to the Board based solely upon the individ-
ual’s established record of distinguished service in one
of the areas of expertise described in clause (ii). Each
individual appointed to the Board shall be of distin-
guished achievement and have a broad range of dis-
ciplinary interests.
‘‘(ii) EXPERTISE.—The Secretary shall select
individuals based upon the following requirements:
‘‘(I) For each of the fields of—
‘‘(aa) basic research;
‘‘(bb) medicine;
‘‘(cc) biopharmaceuticals;
‘‘(dd) discovery and delivery of medical
products;
‘‘(ee) bioinformatics and gene therapy;
‘‘(ff) medical instrumentation; and
‘‘(gg) regulatory review and approval of
medical products,
the Secretary shall select at least 1 individual
who is eminent in such fields.
‘‘(II) At least 4 individuals shall be recognized
leaders in professional venture capital or private
equity organizations and have demonstrated
experience in private equity investing.
‘‘(III) At least 8 individuals shall represent
disease advocacy organizations.
‘‘(3) EX-OFFICIO MEMBERS.—
‘‘(A) APPOINTMENT.—In addition to the 24 Board mem-
bers described in paragraph (2), the Secretary shall appoint
as ex-officio members of the Board—
‘‘(i) a representative of the National Institutes of
Health, recommended by the Secretary of the Depart-
ment of Health and Human Services;
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—846
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—847
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—848
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—849
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—850
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—851
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—852
‘‘SEC. 399V–2. NATIONAL CONGENITAL HEART DISEASE SURVEILLANCE
SYSTEM.
‘‘(a) IN GENERAL.—The Secretary, acting through the Director
of the Centers for Disease Control and Prevention, may—
‘‘(1) enhance and expand infrastructure to track the epide-
miology of congenital heart disease and to organize such
information into a nationally-representative, population-based
surveillance system that compiles data concerning actual occur-
rences of congenital heart disease, to be known as the ‘National
Congenital Heart Disease Surveillance System’; or
‘‘(2) award a grant to one eligible entity to undertake
the activities described in paragraph (1).
‘‘(b) PURPOSE.—The purpose of the Congenital Heart Disease
Surveillance System shall be to facilitate further research into
the types of health services patients use and to identify possible
areas for educational outreach and prevention in accordance with
standard practices of the Centers for Disease Control and Preven-
tion.
‘‘(c) CONTENT.—The Congenital Heart Disease Surveillance
System—
‘‘(1) may include information concerning the incidence and
prevalence of congenital heart disease in the United States;
‘‘(2) may be used to collect and store data on congenital
heart disease, including data concerning—
‘‘(A) demographic factors associated with congenital
heart disease, such as age, race, ethnicity, sex, and family
history of individuals who are diagnosed with the disease;
‘‘(B) risk factors associated with the disease;
‘‘(C) causation of the disease;
‘‘(D) treatment approaches; and
‘‘(E) outcome measures, such that analysis of the out-
come measures will allow derivation of evidence-based best
practices and guidelines for congenital heart disease
patients; and
‘‘(3) may ensure the collection and analysis of longitudinal
data related to individuals of all ages with congenital heart
disease, including infants, young children, adolescents, and
adults of all ages.
‘‘(d) PUBLIC ACCESS.—The Congenital Heart Disease Surveil-
lance System shall be made available to the public, as appropriate,
including congenital heart disease researchers.
‘‘(e) PATIENT PRIVACY.—The Secretary shall ensure that the
Congenital Heart Disease Surveillance System is maintained in
a manner that complies with the regulations promulgated under
section 264 of the Health Insurance Portability and Accountability
Act of 1996.
‘‘(f) ELIGIBILITY FOR GRANT.—To be eligible to receive a grant
under subsection (a)(2), an entity shall—
‘‘(1) be a public or private nonprofit entity with specialized
experience in congenital heart disease; and
‘‘(2) submit to the Secretary an application at such time,
in such manner, and containing such information as the Sec-
retary may require.’’.
(2) CONGENITAL HEART DISEASE RESEARCH.—Subpart 2 of
part C of title IV of the Public Health Service Act (42 U.S.C.
285b et seq.) is amended by adding at the end the following:
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‘‘SEC. 425. CONGENITAL HEART DISEASE.
‘‘(a) IN GENERAL.—The Director of the Institute may expand,
intensify, and coordinate research and related activities of the
Institute with respect to congenital heart disease, which may
include congenital heart disease research with respect to—
‘‘(1) causation of congenital heart disease, including genetic
causes;
‘‘(2) long-term outcomes in individuals with congenital
heart disease, including infants, children, teenagers, adults,
and elderly individuals;
‘‘(3) diagnosis, treatment, and prevention;
‘‘(4) studies using longitudinal data and retrospective anal-
ysis to identify effective treatments and outcomes for individ-
uals with congenital heart disease; and
‘‘(5) identifying barriers to life-long care for individuals
with congenital heart disease.
‘‘(b) COORDINATION OF RESEARCH ACTIVITIES.—The Director of
the Institute may coordinate research efforts related to congenital
heart disease among multiple research institutions and may develop
research networks.
‘‘(c) MINORITY AND MEDICALLY UNDERSERVED COMMUNITIES.—
In carrying out the activities described in this section, the Director
of the Institute shall consider the application of such research
and other activities to minority and medically underserved commu-
nities.’’.
(c) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out the amendments made by this
section such sums as may be necessary for each of fiscal years
2011 through 2015.
SEC. 10412. AUTOMATED DEFIBRILLATION IN ADAM’S MEMORY ACT.
Section 312 of the Public Health Service Act (42 U.S.C. 244)
is amended—
(1) in subsection (c)(6), after ‘‘clearinghouse’’ insert ‘‘, that
shall be administered by an organization that has substantial
expertise in pediatric education, pediatric medicine, and
electrophysiology and sudden death,’’; and
(2) in the first sentence of subsection (e), by striking ‘‘fiscal
year 2003’’ and all that follows through ‘‘2006’’ and inserting
‘‘for each of fiscal years 2003 through 2014’’.
SEC. 10413. YOUNG WOMEN’S BREAST HEALTH AWARENESS AND SUP-
PORT OF YOUNG WOMEN DIAGNOSED WITH BREAST
CANCER.
(a) SHORT TITLE.—This section may be cited as the ‘‘Young
Women’s Breast Health Education and Awareness Requires
Learning Young Act of 2009’’ or the ‘‘EARLY Act’’.
(b) AMENDMENT.—Title III of the Public Health Service Act
(42 U.S.C. 241 et seq.), as amended by this Act, is further amended
by adding at the end the following:
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—855
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—856
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—857
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—858
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—859
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—860
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—861
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—862
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—863
SEC. 10502. INFRASTRUCTURE TO EXPAND ACCESS TO CARE.
(a) APPROPRIATION.—There are authorized to be appropriated,
and there are appropriated to the Department of Health and Human
Services, $100,000,000 for fiscal year 2010, to remain available
for obligation until September 30, 2011, to be used for debt service
on, or direct construction or renovation of, a health care facility
that provides research, inpatient tertiary care, or outpatient clinical
services. Such facility shall be affiliated with an academic health
center at a public research university in the United States that
contains a State’s sole public academic medical and dental school.
(b) REQUIREMENT.—Amount appropriated under subsection (a)
may only be made available by the Secretary of Health and Human
Services upon the receipt of an application from the Governor
of a State that certifies that—
(1) the new health care facility is critical for the provision
of greater access to health care within the State;
(2) such facility is essential for the continued financial
viability of the State’s sole public medical and dental school
and its academic health center;
(3) the request for Federal support represents not more
than 40 percent of the total cost of the proposed new facility;
and
(4) the State has established a dedicated funding mecha-
nism to provide all remaining funds necessary to complete
the construction or renovation of the proposed facility.
SEC. 10503. COMMUNITY HEALTH CENTERS AND THE NATIONAL
HEALTH SERVICE CORPS FUND.
(a) PURPOSE.—It is the purpose of this section to establish
a Community Health Center Fund (referred to in this section as
the ‘‘CHC Fund’’), to be administered through the Office of the
Secretary of the Department of Health and Human Services to
provide for expanded and sustained national investment in commu-
nity health centers under section 330 of the Public Health Service
Act and the National Health Service Corps.
(b) FUNDING.—There is authorized to be appropriated, and there
is appropriated, out of any monies in the Treasury not otherwise
appropriated, to the CHC Fund—
(1) to be transferred to the Secretary of Health and Human
Services to provide enhanced funding for the community health
center program under section 330 of the Public Health Service
Act—øAs revised by section 2303 of HCERA¿
(A) $1,000,000,000 for fiscal year 2011;
(B) $1,200,000,000 for fiscal year 2012;
(C) $1,500,000,000 for fiscal year 2013;
(D) $2,200,000,000 for fiscal year 2014; and
(E) $3,600,000,000 for fiscal year 2015; and
(2) to be transferred to the Secretary of Health and Human
Services to provide enhanced funding for the National Health
Service Corps—
(A) $290,000,000 for fiscal year 2011;
(B) $295,000,000 for fiscal year 2012;
(C) $300,000,000 for fiscal year 2013;
(D) $305,000,000 for fiscal year 2014; and
(E) $310,000,000 for fiscal year 2015.
(c) CONSTRUCTION.—There is authorized to be appropriated,
and there is appropriated, out of any monies in the Treasury
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—864
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—865
SEC. 10603. STRIKING PROVISIONS RELATING TO INDIVIDUAL PRO-
VIDER APPLICATION FEES øAMENDMENTS FULLY INCOR-
PORATED ABOVE¿.
(a) øAmended section 1866(j)(2)(C) of the Social Security Act,
as added by section 6401(a)¿
(b) øReplaced section 6401(a)(2)¿
SEC. 10604. TECHNICAL CORRECTION TO SECTION 6405 øAMENDMENTS
FULLY INCORPORATED ABOVE¿.
øReplaced paragraphs (1) and (2) of section 6405(b)¿
SEC. 10605. CERTAIN OTHER PROVIDERS PERMITTED TO CONDUCT
FACE TO FACE ENCOUNTER FOR HOME HEALTH SERV-
ICES øAMENDMENTS FULLY INCORPORATED ABOVE¿.
(a) øAmended section 1814(a)(2)(C) of the Social Security Act,
as amended by section 6407(a)(1)¿
(b) øAmended section 1835(a)(2)(A)(iv) of the Social Security
Act, as amended by section 6407(a)(2)¿
SEC. 10606. HEALTH CARE FRAUD ENFORCEMENT.
(a) FRAUD SENTENCING GUIDELINES.—
(1) DEFINITION.—In this subsection, the term ‘‘Federal
health care offense’’ has the meaning given that term in section
24 of title 18, United States Code, as amended by this Act.
(2) REVIEW AND AMENDMENTS.—Pursuant to the authority
under section 994 of title 28, United States Code, and in accord-
ance with this subsection, the United States Sentencing
Commission shall—
(A) review the Federal Sentencing Guidelines and
policy statements applicable to persons convicted of Federal
health care offenses;
(B) amend the Federal Sentencing Guidelines and
policy statements applicable to persons convicted of Federal
health care offenses involving Government health care pro-
grams to provide that the aggregate dollar amount of
fraudulent bills submitted to the Government health care
program shall constitute prima facie evidence of the amount
of the intended loss by the defendant; and
(C) amend the Federal Sentencing Guidelines to pro-
vide—
(i) a 2-level increase in the offense level for any
defendant convicted of a Federal health care offense
relating to a Government health care program which
involves a loss of not less than $1,000,000 and less
than $7,000,000;
(ii) a 3-level increase in the offense level for any
defendant convicted of a Federal health care offense
relating to a Government health care program which
involves a loss of not less than $7,000,000 and less
than $20,000,000;
(iii) a 4-level increase in the offense level for any
defendant convicted of a Federal health care offense
relating to a Government health care program which
involves a loss of not less than $20,000,000; and
(iv) if appropriate, otherwise amend the Federal
Sentencing Guidelines and policy statements applicable
to persons convicted of Federal health care offenses
involving Government health care programs.
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—867
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—868
‘‘SEC. 399V–4. STATE DEMONSTRATION PROGRAMS TO EVALUATE
ALTERNATIVES TO CURRENT MEDICAL TORT LITIGA-
TION.
‘‘(a) IN GENERAL.—The Secretary is authorized to award dem-
onstration grants to States for the development, implementation,
and evaluation of alternatives to current tort litigation for resolving
disputes over injuries allegedly caused by health care providers
or health care organizations. In awarding such grants, the Secretary
shall ensure the diversity of the alternatives so funded.
‘‘(b) DURATION.—The Secretary may award grants under sub-
section (a) for a period not to exceed 5 years.
‘‘(c) CONDITIONS FOR DEMONSTRATION GRANTS.—
‘‘(1) REQUIREMENTS.—Each State desiring a grant under
subsection (a) shall develop an alternative to current tort litiga-
tion that—
‘‘(A) allows for the resolution of disputes over injuries
allegedly caused by health care providers or health care
organizations; and
‘‘(B) promotes a reduction of health care errors by
encouraging the collection and analysis of patient safety
data related to disputes resolved under subparagraph (A)
by organizations that engage in efforts to improve patient
safety and the quality of health care.
‘‘(2) ALTERNATIVE TO CURRENT TORT LITIGATION.—Each
State desiring a grant under subsection (a) shall demonstrate
how the proposed alternative described in paragraph (1)(A)—
‘‘(A) makes the medical liability system more reliable
by increasing the availability of prompt and fair resolution
of disputes;
‘‘(B) encourages the efficient resolution of disputes;
‘‘(C) encourages the disclosure of health care errors;
‘‘(D) enhances patient safety by detecting, analyzing,
and helping to reduce medical errors and adverse events;
‘‘(E) improves access to liability insurance;
‘‘(F) fully informs patients about the differences in
the alternative and current tort litigation;
‘‘(G) provides patients the ability to opt out of or volun-
tarily withdraw from participating in the alternative at
any time and to pursue other options, including litigation,
outside the alternative;
‘‘(H) would not conflict with State law at the time
of the application in a way that would prohibit the adoption
of an alternative to current tort litigation; and
‘‘(I) would not limit or curtail a patient’s existing legal
rights, ability to file a claim in or access a State’s legal
system, or otherwise abrogate a patient’s ability to file
a medical malpractice claim.
‘‘(3) SOURCES OF COMPENSATION.—Each State desiring a
grant under subsection (a) shall identify the sources from and
methods by which compensation would be paid for claims
resolved under the proposed alternative to current tort litiga-
tion, which may include public or private funding sources,
or a combination of such sources. Funding methods shall to
the extent practicable provide financial incentives for activities
that improve patient safety.
‘‘(4) SCOPE.—
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—869
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—870
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—871
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—872
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—873
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—874
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—875
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—876
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—877
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—878
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—879
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—880
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—881
Sec. 1407. Delay of elimination of deduction for expenses allocable to medicare part
D subsidy øamendment fully incorporated in PPACA¿.
Sec. 1408. Elimination of unintended application of cellulosic biofuel producer cred-
it.
Sec. 1409. Codification of economic substance doctrine and penalties.
Sec. 1410. Time for payment of corporate estimated taxes.
Subtitle F—Other Provisions
Sec. 1501. Community college and career training grant program.
TITLE II—EDUCATION AND HEALTH
Subtitle A—Education øOmitted From This Compilation¿
Subtitle B—Health
Sec. 2301. Insurance reforms øamendment fully incorporated into PPACA¿.
Sec. 2302. Drugs purchased by covered entities.
Sec. 2303. Community health centers øamendment fully incorporated into PPACA¿.
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—882
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—883
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—884
Subtitle B—Medicare
SEC. 1101. CLOSING THE MEDICARE PRESCRIPTION DRUG ‘‘DONUT
HOLE’’øSUBSTITUTES FOR SECTION 3315 OF PPACA¿.
(a) COVERAGE GAP REBATE FOR 2010.—
(1) IN GENERAL.—Section 1860D–42 of the Social Security
Act (42 U.S.C. 1395w–152) is amended by adding at the end
the following new subsection:
‘‘(c) COVERAGE GAP REBATE FOR 2010.—
‘‘(1) IN GENERAL.—In the case of an individual described
in subparagraphs (A) through (D) of section 1860D–14A(g)(1)
who as of the last day of a calendar quarter in 2010 has
incurred costs for covered part D drugs so that the individual
has exceeded the initial coverage limit under section 1860D–
2(b)(3) for 2010, the Secretary shall provide for payment from
the Medicare Prescription Drug Account of $250 to the indi-
vidual by not later than the 15th day of the third month
following the end of such quarter.
‘‘(2) LIMITATION.—The Secretary shall provide only 1 pay-
ment under this subsection with respect to any individual.’’.
(2) REPEAL OF PROVISION.—øRepealed section 3315 of
PPACA¿
(b) CLOSING THE DONUT HOLE.—Part D of title XVIII of the
Social Security Act (42 U.S.C. 1395w–101 et seq.), as amended
by section 3301 of the Patient Protection and Affordable Care Act,
is further amended—
(1) øAmended dates in section 1860D-43¿
(2) øAmended dates in section 1860D–14A¿
(3) in section 1860D–2(b)—
(A) in paragraph (2)(A), by striking ‘‘The coverage’’
and inserting ‘‘Subject to subparagraphs (C) and (D), the
coverage’’;
(B) in paragraph (2)(B), by striking ‘‘subparagraph
(A)(ii)’’ and inserting ‘‘subparagraphs (A)(ii), (C), and (D)’’;
(C) by adding at the end of paragraph (2) the following
new subparagraphs:
‘‘(C) COVERAGE FOR GENERIC DRUGS IN COVERAGE
GAP.—
‘‘(i) IN GENERAL.—Except as provided in paragraph
(4), the coverage for an applicable beneficiary (as
defined in section 1860D–14A(g)(1)) has coinsurance
(for costs above the initial coverage limit under para-
graph (3) and below the out-of-pocket threshold) for
covered part D drugs that are not applicable drugs
under section 1860D–14A(g)(2) that is—
‘‘(I) equal to the generic-gap coinsurance
percentage (specified in clause (ii)) for the year;
or
‘‘(II) actuarially equivalent (using processes
and methods established under section 1860D–
11(c)) to an average expected payment of such
percentage of such costs for covered part D drugs
that are not applicable drugs under section 1860D–
14A(g)(2).
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—885
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—886
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—887
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—888
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—889
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—890
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—891
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—892
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—893
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—894
for fiscal year 2009 bears to the sum of all such payments to
all qualifying hospitals for such fiscal year.
(d) QUALIFYING HOSPITAL DEFINED.—In this section, the term
‘‘qualifying hospital’’ means a subsection (d) hospital (as defined
for purposes of section 1886(d) of the Social Security Act) that
is located in a county that ranks, based upon its ranking in age,
sex, and race adjusted spending for benefits under parts A and
B under title XVIII of such Act per enrollee, within the lowest
quartile of such counties in the United States.
Subtitle C—Medicaid
SEC. 1201. FEDERAL FUNDING FOR STATES øAMENDMENTS FULLY
INCORPORATED INTO PPACA¿.
Section 1905 of the Social Security Act (42 U.S.C. 1396d),
as amended by sections 2001(a)(3) and 10201(c) of the Patient
Protection and Affordable Care Act, is amended—
(1) in subsection (y)—
(A) by redesignating subclause (II) of paragraph
(1)(B)(ii) as paragraph (5) of subsection (z) and realigning
the left margins accordingly øsee subsection (z) in section
10201(c), p. 796¿; and
(B) øReplaced paragraph (1)¿
(2) in subsection (z)—
(A) øAmended paragraph (1)¿
(B) øStruck paragraphs (2) through (4) and inserted
a new paragraph (2)¿
(C) by redesignating paragraph (5) (as added by para-
graph (1)(A) of this section) as paragraph (3), realigning
the left margins to align with paragraph (2), and striking
the heading and all that follows through ‘‘a State is’’ and
inserting ‘‘A State is’’.
SEC. 1202. PAYMENTS TO PRIMARY CARE PHYSICIANS.
(a) IN GENERAL.—
(1) FEE-FOR-SERVICE PAYMENTS.—Section 1902 of the Social
Security Act (42 U.S.C. 1396a), as amended by section
2303(a)(2) of the Patient Protection and Affordable Care Act,
is amended—
(A) in subsection (a)(13)—
(i) by striking ‘‘and’’ at the end of subparagraph
(A);
(ii) by adding ‘‘and’’ at the end of subparagraph
(B); and
(iii) by adding at the end the following new
subparagraph:
‘‘(C) payment for primary care services (as defined
in subsection (jj)) furnished in 2013 and 2014 by a physician
with a primary specialty designation of family medicine,
general internal medicine, or pediatric medicine at a rate
not less than 100 percent of the payment rate that applies
to such services and physician under part B of title XVIII
(or, if greater, the payment rate that would be applicable
under such part if the conversion factor under section
1848(d) for the year involved were the conversion factor
under such section for 2009);’’; and
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—895