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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
PART 2—OTHER PROVISIONS
Sec. 1251. Preservation of right to maintain existing coverage.
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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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—8
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 ø42 U.S.C. 300gg–12¿. 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 ø42 U.S.C. 300gg–13¿. 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
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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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States during the 5-year period beginning with fiscal year 2010
to assist such States in carrying out subsection (a), including—
‘‘(A) in reviewing and, if appropriate under State law,
approving premium increases for health insurance cov-
erage;
‘‘(B) in providing information and recommendations
to the Secretary under subsection (b)(1); and
‘‘(C) øAs added by section 10101(i)(1)(C)¿ in estab-
lishing centers (consistent with subsection (d)) at academic
or other nonprofit institutions to collect medical reimburse-
ment information from health insurance issuers, to analyze
and organize such information, and to make such informa-
tion available to such issuers, health care providers, health
researchers, health care policy makers, and the general
public.
‘‘(2) FUNDING.—
‘‘(A) IN GENERAL.—Out of all funds in the Treasury
not otherwise appropriated, there are appropriated to the
Secretary $250,000,000, to be available for expenditure for
grants under paragraph (1) and subparagraph (B).
‘‘(B) FURTHER AVAILABILITY FOR INSURANCE REFORM
AND CONSUMER PROTECTION.—If the amounts appropriated
under subparagraph (A) are not fully obligated under
grants under paragraph (1) by the end of fiscal year 2014,
any remaining funds shall remain available to the Sec-
retary for grants to States for planning and implementing
the insurance reforms and consumer protections under part
A.
‘‘(C) ALLOCATION.—The Secretary shall establish a for-
mula for determining the amount of any grant to a State
under this subsection. Under such formula—
‘‘(i) the Secretary shall consider the number of
plans of health insurance coverage offered in each State
and the population of the State; and
‘‘(ii) no State qualifying for a grant under para-
graph (1) shall receive less than $1,000,000, or more
than $5,000,000 for a grant year.
‘‘(d) MEDICAL REIMBURSEMENT DATA CENTERS.—øAs added by
section 10101(i)(2)¿
‘‘(1) FUNCTIONS.—A center established under subsection
(c)(1)(C) shall—
‘‘(A) develop fee schedules and other database tools
that fairly and accurately reflect market rates for medical
services and the geographic differences in those rates;
‘‘(B) use the best available statistical methods and
data processing technology to develop such fee schedules
and other database tools;
‘‘(C) regularly update such fee schedules and other
database tools to reflect changes in charges for medical
services;
‘‘(D) make health care cost information readily avail-
able to the public through an Internet website that allows
consumers to understand the amounts that health care
providers in their area charge for particular medical serv-
ices; and
‘‘(E) regularly publish information concerning the
statistical methodologies used by the center to analyze
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rules, rate and form filing rules, any applicable State premium
assessments and any other State law described in section
1324(b).
(6) COORDINATION WITH STATE INSURANCE REFORMS.—An
organization shall not be treated as a qualified nonprofit health
insurance issuer unless the organization does not offer a health
plan in a State until that State has in effect (or the Secretary
has implemented for the State) the market reforms required
by part A of title XXVII of the Public Health Service Act
(as amended by subtitles A and C of this Act).
(d) ESTABLISHMENT OF PRIVATE PURCHASING COUNCIL.—
(1) IN GENERAL.—Qualified nonprofit health insurance
issuers participating in the CO-OP program under this section
may establish a private purchasing council to enter into collec-
tive purchasing arrangements for items and services that
increase administrative and other cost efficiencies, including
claims administration, administrative services, health informa-
tion technology, and actuarial services.
(2) COUNCIL MAY NOT SET PAYMENT RATES.—The private
purchasing council established under paragraph (1) shall not
set payment rates for health care facilities or providers partici-
pating in health insurance coverage provided by qualified non-
profit health insurance issuers.
(3) CONTINUED APPLICATION OF ANTITRUST LAWS.—
(A) IN GENERAL.—Nothing in this section shall be con-
strued to limit the application of the antitrust laws to
any private purchasing council (whether or not established
under this subsection) or to any qualified nonprofit health
insurance issuer participating in such a council.
(B) ANTITRUST LAWS.—For purposes of this subpara-
graph, the term ‘‘antitrust laws’’ has the meaning given
the term in subsection (a) of the first section of the Clayton
Act (15 U.S.C. 12(a)). Such term also includes section 5
of the Federal Trade Commission Act (15 U.S.C. 45) to
the extent that such section 5 applies to unfair methods
of competition.
(e) LIMITATION ON PARTICIPATION.—No representative of any
Federal, State, or local government (or of any political subdivision
or instrumentality thereof), and no representative of a person
described in subsection (c)(2)(A), may serve on the board of directors
of a qualified nonprofit health insurance issuer or with a private
purchasing council established under subsection (d).
(f) LIMITATIONS ON SECRETARY.—
(1) IN GENERAL.—The Secretary shall not—
(A) participate in any negotiations between 1 or more
qualified nonprofit health insurance issuers (or a private
purchasing council established under subsection (d)) and
any health care facilities or providers, including any drug
manufacturer, pharmacy, or hospital; and
(B) establish or maintain a price structure for
reimbursement of any health benefits covered by such
issuers.
(2) COMPETITION.—Nothing in this section shall be con-
strued as authorizing the Secretary to interfere with the
competitive nature of providing health benefits through quali-
fied nonprofit health insurance issuers.
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reforms in such market under the provisions of, and the amend-
ments made by, this Act. Such study shall include an analysis
of new issuers of health insurance in such market.
(2) REPORT.—The Comptroller General shall, not later than
December 31 of each even-numbered year (beginning with
2014), report to the appropriate committees of the Congress
the results of the study conducted under paragraph (1),
including any recommendations for administrative or legislative
changes the Comptroller General determines necessary or
appropriate to increase competition in the health insurance
market.
SEC. 1323. COMMUNITY HEALTH INSURANCE OPTION øSTRICKEN¿.
øSection stricken by section 10104(m)¿
SEC. 1323 ø42 U.S.C. 18043¿. FUNDING FOR THE TERRITORIES.
øNew section 1323 inserted by section 1204(a) of HCERA¿
(a) IN GENERAL.—A territory that—
(1) elects consistent with subsection (b) to establish an
Exchange in accordance with part II of this subtitle and estab-
lishes such an Exchange in accordance with such part shall
be treated as a State for purposes of such part and shall
be entitled to payment from the amount allocated to the terri-
tory under subsection (c); or
(2) does not make such election shall be entitled to an
increase in the dollar limitation applicable to the territory
under subsections (f) and (g) of section 1108 of the Social
Security Act (42 U.S.C. 1308) for such period in such amount
for such territory and such increase shall not be taken into
account in computing any other amount under such subsections.
(b) TERMS AND CONDITIONS.—An election under subsection
(a)(1) shall—
(1) not be effective unless the election is consistent with
section 1321 and is received not later than October 1, 2013;
and
(2) be contingent upon entering into an agreement between
the territory and the Secretary that requires that—
(A) funds provided under the agreement shall be used
only to provide premium and cost-sharing assistance to
residents of the territory obtaining health insurance cov-
erage through the Exchange; and
(B) the premium and cost-sharing assistance provided
under such agreement shall be structured in such a manner
so as to prevent any gap in assistance for individuals
between the income level at which medical assistance is
available through the territory’s Medicaid plan under title
XIX of the Social Security Act and the income level at
which premium and cost-sharing assistance is available
under the agreement.
(c) APPROPRIATION AND ALLOCATION.—
(1) APPROPRIATION.—Out of any funds in the Treasury
not otherwise appropriated, there is appropriated for purposes
of payment pursuant to subsection (a) $1,000,000,000, to be
available during the period beginning with 2014 and ending
with 2019.
(2) ALLOCATION.—The Secretary shall allocate the amount
appropriated under paragraph (1) among the territories for
purposes of carrying out this section as follows:
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SEC. 1402 ø42 U.S.C. 18071¿. REDUCED COST-SHARING FOR INDIVIDUALS
ENROLLING IN QUALIFIED HEALTH PLANS.
(a) IN GENERAL.—In the case of an eligible insured enrolled
in a qualified health plan—
(1) the Secretary shall notify the issuer of the plan of
such eligibility; and
(2) the issuer shall reduce the cost-sharing under the plan
at the level and in the manner specified in subsection (c).
(b) ELIGIBLE INSURED.—In this section, the term ‘‘eligible
insured’’ means an individual—
(1) who enrolls in a qualified health plan in the silver
level of coverage in the individual market offered through an
Exchange; and
(2) whose household income exceeds 100 percent but does
not exceed 400 percent of the poverty line for a family of
the size involved.
In the case of an individual described in section 36B(c)(1)(B) of
the Internal Revenue Code of 1986, the individual shall be treated
as having household income equal to 100 percent for purposes
of applying this section.
(c) DETERMINATION OF REDUCTION IN COST-SHARING.—
(1) REDUCTION IN OUT-OF-POCKET LIMIT.—
(A) IN GENERAL.—The reduction in cost-sharing under
this subsection shall first be achieved by reducing the
applicable out-of pocket limit under section 1302(c)(1) in
the case of—
(i) an eligible insured whose household income is
more than 100 percent but not more than 200 percent
of the poverty line for a family of the size involved,
by two-thirds;
(ii) an eligible insured whose household income
is more than 200 percent but not more than 300 per-
cent of the poverty line for a family of the size involved,
by one-half; and
(iii) an eligible insured whose household income
is more than 300 percent but not more than 400 per-
cent of the poverty line for a family of the size involved,
by one-third.
(B) COORDINATION WITH ACTUARIAL VALUE LIMITS.—
(i) IN GENERAL.—The Secretary shall ensure the
reduction under this paragraph shall not result in an
increase in the plan’s share of the total allowed costs
of benefits provided under the plan above—
(I) 94 percent in the case of an eligible insured
described in paragraph (2)(A); øAs revised by sec-
tion 1001(b)(1)(A) of HCERA¿
(II) 87 percent in the case of an eligible insured
described in paragraph (2)(B);
øsection 1001(a)(1)(C) of HCERA struck subclause (III) and
inserted new subclauses (III) and (IV)¿
(III) 73 percent in the case of an eligible
insured whose household income is more than 200
percent but not more than 250 percent of the pov-
erty line for a family of the size involved; and
(IV) 70 percent in the case of an eligible
insured whose household income is more than 250
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SEC. 1415 ø42 U.S.C. 18084¿. PREMIUM TAX CREDIT AND COST-SHARING
REDUCTION PAYMENTS DISREGARDED FOR FEDERAL
AND FEDERALLY-ASSISTED PROGRAMS.
For purposes of determining the eligibility of any individual
for benefits or assistance, or the amount or extent of benefits
or assistance, under any Federal program or under any State or
local program financed in whole or in part with Federal funds—
(1) any credit or refund allowed or made to any individual
by reason of section 36B of the Internal Revenue Code of
1986 (as added by section 1401) shall not be taken into account
as income and shall not be taken into account as resources
for the month of receipt and the following 2 months; and
(2) any cost-sharing reduction payment or advance payment
of the credit allowed under such section 36B that is made
under section 1402 or 1412 shall be treated as made to the
qualified health plan in which an individual is enrolled and
not to that individual.
SEC. 1416. STUDY OF GEOGRAPHIC VARIATION IN APPLICATION OF
FPL.
øSection added by section 10105(f)¿
(a) IN GENERAL.—The Secretary shall conduct a study to
examine the feasibility and implication of adjusting the application
of the Federal poverty level under this subtitle (and the amend-
ments made by this subtitle) for different geographic areas so
as to reflect the variations in cost-of-living among different areas
within the United States. If the Secretary determines that an
adjustment is feasible, the study should include a methodology
to make such an adjustment. Not later than January 1, 2013,
the Secretary shall submit to Congress a report on such study
and shall include such recommendations as the Secretary deter-
mines appropriate.
(b) INCLUSION OF TERRITORIES.—
(1) IN GENERAL.—The Secretary shall ensure that the study
under subsection (a) covers the territories of the United States
and that special attention is paid to the disparity that exists
among poverty levels and the cost of living in such territories
and to the impact of such disparity on efforts to expand health
coverage and ensure health care.
(2) TERRITORIES DEFINED.—In this subsection, the term
‘‘territories of the United States’’ includes the Commonwealth
of Puerto Rico, the United States Virgin Islands, Guam, the
Northern Mariana Islands, and any other territory or possession
of the United States.
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‘‘SEC. 45R. EMPLOYEE HEALTH INSURANCE EXPENSES OF SMALL
EMPLOYERS.
‘‘(a) GENERAL RULE.—For purposes of section 38, in the case
of an eligible small employer, the small employer health insurance
credit determined under this section for any taxable year in the
credit period is the amount determined under subsection (b).
‘‘(b) HEALTH INSURANCE CREDIT AMOUNT.—Subject to sub-
section (c), the amount determined under this subsection with
respect to any eligible small employer is equal to 50 percent (35
percent in the case of a tax-exempt eligible small employer) of
the lesser of—
‘‘(1) the aggregate amount of nonelective contributions the
employer made on behalf of its employees during the taxable
year under the arrangement described in subsection (d)(4) for
premiums for qualified health plans offered by the employer
to its employees through an Exchange, or
‘‘(2) the aggregate amount of nonelective contributions
which the employer would have made during the taxable year
under the arrangement if each employee taken into account
under paragraph (1) had enrolled in a qualified health plan
which had a premium equal to the average premium (as deter-
mined by the Secretary of Health and Human Services) for
the small group market in the rating area in which the
employee enrolls for coverage.
‘‘(c) PHASEOUT OF CREDIT AMOUNT BASED ON NUMBER OF
EMPLOYEES AND AVERAGE WAGES.—The amount of the credit deter-
mined under subsection (b) without regard to this subsection shall
be reduced (but not below zero) by the sum of the following amounts:
‘‘(1) Such amount multiplied by a fraction the numerator
of which is the total number of full-time equivalent employees
of the employer in excess of 10 and the denominator of which
is 15.
‘‘(2) Such amount multiplied by a fraction the numerator
of which is the average annual wages of the employer in excess
of the dollar amount in effect under subsection (d)(3)(B) and
the denominator of which is such dollar amount.
‘‘(d) ELIGIBLE SMALL EMPLOYER.—For purposes of this section—
‘‘(1) IN GENERAL.—The term ‘eligible small employer’
means, with respect to any taxable year, an employer—
‘‘(A) which has no more than 25 full-time equivalent
employees for the taxable year,
‘‘(B) the average annual wages of which do not exceed
an amount equal to twice the dollar amount in effect under
paragraph (3)(B) for the taxable year, and
‘‘(C) which has in effect an arrangement described
in paragraph (4).
‘‘(2) FULL-TIME EQUIVALENT EMPLOYEES.—
‘‘(A) IN GENERAL.—The term ‘full-time equivalent
employees’ means a number of employees equal to the
number determined by dividing—
‘‘(i) the total number of hours of service for which
wages were paid by the employer to employees during
the taxable year, by
‘‘(ii) 2,080.
Such number shall be rounded to the next lowest whole
number if not otherwise a whole number.
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SEC. 1513. SHARED RESPONSIBILITY FOR EMPLOYERS.
(a) IN GENERAL.—Chapter 43 of the Internal Revenue Code
of 1986 is amended by adding at the end the following:
‘‘SEC. 4980H. SHARED RESPONSIBILITY FOR EMPLOYERS REGARDING
HEALTH COVERAGE.
‘‘(a) LARGE EMPLOYERS NOT OFFERING HEALTH COVERAGE.—
If—
‘‘(1) any applicable large employer fails to offer to its full-
time employees (and their dependents) the opportunity to enroll
in minimum essential coverage under an eligible employer-
sponsored plan (as defined in section 5000A(f)(2)) for any
month, and
‘‘(2) at least one full-time employee of the applicable large
employer has been certified to the employer under section 1411
of the Patient Protection and Affordable Care Act as having
enrolled for such month in a qualified health plan with respect
to which an applicable premium tax credit or cost-sharing
reduction is allowed or paid with respect to the employee,
then there is hereby imposed on the employer an assessable pay-
ment equal to the product of the applicable payment amount and
the number of individuals employed by the employer as full-time
employees during such month.
ø‘‘(b) LARGE EMPLOYERS WITH WAITING PERIODS EXCEEDING
60 DAYS.—øReplaced first by section 10106(e) and stricken by section
1003(d) of HCERA and succeeding subsections were redesignated
accordingly¿¿
‘‘(b) LARGE EMPLOYERS OFFERING COVERAGE WITH EMPLOYEES
WHO QUALIFY FOR PREMIUM TAX CREDITS OR COST-SHARING REDUC-
TIONS.—
‘‘(1) IN GENERAL.—If—
‘‘(A) an applicable large employer offers to its full-
time employees (and their dependents) the opportunity to
enroll in minimum essential coverage under an eligible
employer-sponsored plan (as defined in section 5000A(f)(2))
for any month, and
‘‘(B) 1 or more full-time employees of the applicable
large employer has been certified to the employer under
section 1411 of the Patient Protection and Affordable Care
Act as having enrolled for such month in a qualified health
plan with respect to which an applicable premium tax
credit or cost-sharing reduction is allowed or paid with
respect to the employee,
then there is hereby imposed on the employer an assessable
payment equal to the product of the number of full-time
employees of the applicable large employer described in
subparagraph (B) for such month and an amount equal to
1⁄12 of $3,000. øAs revised by section 1003(b)(1) of HCERA¿
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‘‘SEC. 139D. FREE CHOICE VOUCHERS.
‘‘Gross income shall not include the amount of any free choice
voucher provided by an employer under section 10108 of the Patient
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.
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SEC. 1560 ø42 U.S.C. 18118¿. 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.
(b) RULE OF CONSTRUCTION REGARDING HAWAII’S PREPAID
HEALTH CARE ACT.—Nothing in this title (or an amendment made
by this title) shall be construed to modify or limit the application
of the exemption for Hawaii’s Prepaid Health Care Act (Haw. Rev.
Stat. §§ 393–1 et seq.) as provided for under section 514(b)(5)
of the Employee Retirement Income Security Act of 1974 (29 U.S.C.
1144(b)(5)).
(c) STUDENT HEALTH INSURANCE PLANS.—Nothing in this title
(or an amendment made by this title) shall be construed to prohibit
an institution of higher education (as such term is defined for
purposes of the Higher Education Act of 1965) from offering a
student health insurance plan, to the extent that such requirement
is otherwise permitted under applicable Federal, State or local
law.
(d) NO EFFECT ON EXISTING REQUIREMENTS.—Nothing in this
title (or an amendment made by this title, unless specified by
direct statutory reference) shall be construed to modify any existing
Federal requirement concerning the State agency responsible for
determining eligibility for programs identified in section 1413.
SEC. 1561. HEALTH INFORMATION TECHNOLOGY ENROLLMENT STAND-
ARDS AND PROTOCOLS.
Title XXX of the Public Health Service Act (42 U.S.C. 300jj
et seq.) is amended by adding at the end the following:
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a State for a fiscal year (or for any portion of a fiscal year occurring
during such period) shall be increased by 23 percentage points,
but in no case shall exceed 100 percent. The increase in the
enhanced FMAP under the preceding sentence shall not apply with
respect to determining the payment to a State under subsection
(a)(1) for expenditures described in subparagraph (D)(iv), para-
graphs (8), (9), (11) of subsection (c), or clause (4) of the first
sentence of section 1905(b).’’.
(b) MAINTENANCE OF EFFORT.—
(1) IN GENERAL.—Section 2105(d) of the Social Security
Act (42 U.S.C. 1397ee(d)) is amended by adding at the end
the following:
‘‘(3) CONTINUATION OF ELIGIBILITY STANDARDS FOR CHIL-
DREN UNTIL OCTOBER 1, 2019.—
‘‘(A) IN GENERAL.—øAs revised by section
10203(c)(2)(A)(i)¿ During the period that begins on the
date of enactment of the Patient Protection and Affordable
Care Act and ends on September 30, 2019, as a condition
of receiving payments under section 1903(a), a State shall
not have in effect eligibility standards, methodologies, or
procedures under its State child health plan (including
any waiver under such plan) for children (including chil-
dren provided medical assistance for which payment is
made under section 2105(a)(1)(A)) that are more restrictive
than the eligibility standards, methodologies, or procedures,
respectively, under such plan (or waiver) as in effect on
the date of enactment of that Act. The preceding sentence
shall not be construed as preventing a State during such
period from—
‘‘(i) applying eligibility standards, methodologies,
or procedures for children under the State child health
plan or under any waiver of the plan that are less
restrictive than the eligibility standards, methodolo-
gies, or procedures, respectively, for children under
the plan or waiver that are in effect on the date of
enactment of such Act; øAs revised by section
10203(c)(2)(A)(ii)¿
‘‘(ii) after September 30, 2015, enrolling children
eligible to be targeted low-income children under the
State child health plan in a qualified health plan that
has been certified by the Secretary under subparagraph
(C); or øAs added by section 10203(c)(2)(A)(iv)¿
‘‘(iii) imposing a limitation described in section
2112(b)(7) for a fiscal year in order to limit expendi-
tures under the State child health plan to those for
which Federal financial participation is available under
this section for the fiscal year.
‘‘(B) ASSURANCE OF EXCHANGE COVERAGE FOR TAR-
GETED LOW-INCOME CHILDREN UNABLE TO BE PROVIDED
CHILD HEALTH ASSISTANCE AS A RESULT OF FUNDING SHORT-
FALLS.—In the event that allotments provided under section
2104 are insufficient to provide coverage to all children
who are eligible to be targeted low-income children under
the State child health plan under this title, a State shall
establish procedures to ensure that such children are
screened for eligibility for medical assistance under the
State plan under title XIX or a waiver of that plan and,
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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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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—274
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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under which the following steps occur with respect to the selection
of quality and efficiency measures described in section 1890(b)(7)(B):
‘‘(1) INPUT.—Pursuant to section 1890(b)(7), the entity with
a contract under section 1890 shall convene multi-stakeholder
groups to provide input to the Secretary on the selection of
quality and efficiency measures described in subparagraph (B)
of such paragraph.
‘‘(2) PUBLIC AVAILABILITY OF MEASURES CONSIDERED FOR
SELECTION.—Not later than December 1 of each year (beginning
with 2011), the Secretary shall make available to the public
a list of quality and efficiency measures described in section
1890(b)(7)(B) that the Secretary is considering under this title.
‘‘(3) TRANSMISSION OF MULTI-STAKEHOLDER INPUT.—Pursu-
ant to section 1890(b)(8), not later than February 1 of each
year (beginning with 2012), the entity shall transmit to the
Secretary the input of multi-stakeholder groups described in
paragraph (1).
‘‘(4) CONSIDERATION OF MULTI-STAKEHOLDER INPUT.—The
Secretary shall take into consideration the input from multi-
stakeholder groups described in paragraph (1) in selecting
quality and efficiency measures described in section
1890(b)(7)(B) that have been endorsed by the entity with a
contract under section 1890 and measures that have not been
endorsed by such entity.
‘‘(5) RATIONALE FOR USE OF QUALITY and efficiency meas-
ures.—The Secretary shall publish in the Federal Register
the rationale for the use of any quality and efficiency measure
described in section 1890(b)(7)(B) that has not been endorsed
by the entity with a contract under section 1890.
‘‘(6) ASSESSMENT OF IMPACT.—Not later than March 1,
2012, and at least once every three years thereafter, the Sec-
retary shall—
‘‘(A) conduct an assessment of the quality and efficiency
impact of the use of endorsed measures described in section
1890(b)(7)(B); and
‘‘(B) make such assessment available to the public.
‘‘(b) PROCESS FOR DISSEMINATION OF MEASURES USED BY THE
SECRETARY.—
‘‘(1) IN GENERAL.—The Secretary shall establish a process
for disseminating quality and efficiency measures used by the
Secretary. Such process shall include the following:
‘‘(A) The incorporation of such measures, where
applicable, in workforce programs, training curricula, and
any other means of dissemination determined appropriate
by the Secretary.
‘‘(B) The dissemination of such quality and efficiency
measures through the national strategy developed under
section 399HH of the Public Health Service Act.
‘‘(2) EXISTING METHODS.—To the extent practicable, the
Secretary shall utilize and expand existing dissemination
methods in disseminating quality and efficiency measures
under the process established under paragraph (1).
‘‘(c) REVIEW OF QUALITY AND EFFICIENCY MEASURES USED
BY THE SECRETARY.—
‘‘(1) IN GENERAL.—The Secretary shall—
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‘‘SEC. 399JJ ø42 U.S.C. 280j–2¿. PUBLIC REPORTING OF PERFORMANCE
INFORMATION.
‘‘(a) DEVELOPMENT OF PERFORMANCE WEBSITES.—The Secretary
shall make available to the public, through standardized Internet
websites, performance information summarizing data on quality
measures. Such information shall be tailored to respond to the
differing needs of hospitals and other institutional health care pro-
viders, physicians and other clinicians, patients, consumers,
researchers, policymakers, States, and other stakeholders, as the
Secretary may specify.
‘‘(b) INFORMATION ON CONDITIONS.—The performance informa-
tion made publicly available on an Internet website, as described
in subsection (a), shall include information regarding clinical condi-
tions to the extent such information is available, and the informa-
tion shall, where appropriate, be provider-specific and sufficiently
disaggregated and specific to meet the needs of patients with dif-
ferent clinical conditions.
‘‘(c) CONSULTATION.—
‘‘(1) IN GENERAL.—In carrying out this section, the Sec-
retary shall consult with the entity with a contract under
section 1890(a) of the Social Security Act, and other entities,
as appropriate, to determine the type of information that is
useful to stakeholders and the format that best facilitates use
of the reports and of performance reporting Internet websites.
‘‘(2) CONSULTATION WITH STAKEHOLDERS.—The entity with
a contract under section 1890(a) of the Social Security Act
shall convene multi-stakeholder groups, as described in such
section, to review the design and format of each Internet
website made available under subsection (a) and shall transmit
to the Secretary the views of such multi-stakeholder groups
with respect to each such design and format.
‘‘(d) COORDINATION.—Where appropriate, the Secretary shall
coordinate the manner in which data are presented through Internet
websites described in subsection (a) and for public reporting of
other quality measures by the Secretary, including such quality
measures under title XVIII of the Social Security Act.
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To carry out this sec-
tion, there are authorized to be appropriated such sums as may
be necessary for fiscal years 2010 through 2014.’’.
PART 3—ENCOURAGING DEVELOPMENT OF
NEW PATIENT CARE MODELS
SEC. 3021. ESTABLISHMENT OF CENTER FOR MEDICARE AND MED-
ICAID INNOVATION WITHIN CMS.
(a) IN GENERAL.—Title XI of the Social Security Act is amended
by inserting after section 1115 the following new section:
‘‘CENTER FOR MEDICARE AND MEDICAID INNOVATION
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SEC. 3025. HOSPITAL READMISSIONS REDUCTION PROGRAM.
(a) IN GENERAL.—Section 1886 of the Social Security Act (42
U.S.C. 1395ww), as amended by sections 3001 and 3008, is amended
by adding at the end the following new subsection:
‘‘(q) HOSPITAL READMISSIONS REDUCTION PROGRAM.—
‘‘(1) IN GENERAL.—With respect to payment for discharges
from an applicable hospital (as defined in paragraph (5)(C))
occurring during a fiscal year beginning on or after October
1, 2012, in order to account for excess readmissions in the
hospital, the Secretary shall make payments (in addition to
the payments described in paragraph (2)(A)(ii)) for such a dis-
charge to such hospital under subsection (d) (or section
1814(b)(3), as the case may be) in an amount equal to the
product of—øAs revised by section 10309¿
‘‘(A) the base operating DRG payment amount (as
defined in paragraph (2)) for the discharge; and
‘‘(B) the adjustment factor (described in paragraph
(3)(A)) for the hospital for the fiscal year.
‘‘(2) BASE OPERATING DRG PAYMENT AMOUNT DEFINED.—
‘‘(A) IN GENERAL.—Except as provided in subparagraph
(B), in this subsection, the term ‘base operating DRG pay-
ment amount’ means, with respect to a hospital for a fiscal
year—
‘‘(i) the payment amount that would otherwise be
made under subsection (d) (determined without regard
to subsection (o)) for a discharge if this subsection
did not apply; reduced by
‘‘(ii) any portion of such payment amount that
is attributable to payments under paragraphs (5)(A),
(5)(B), (5)(F), and (12) of subsection (d).
‘‘(B) SPECIAL RULES FOR CERTAIN HOSPITALS.—
‘‘(i) SOLE COMMUNITY HOSPITALS AND MEDICARE-
DEPENDENT, SMALL RURAL HOSPITALS.—In the case of
a medicare-dependent, small rural hospital (with
respect to discharges occurring during fiscal years 2012
and 2013) or a sole community hospital, in applying
subparagraph (A)(i), the payment amount that would
otherwise be made under subsection (d) shall be deter-
mined without regard to subparagraphs (I) and (L)
of subsection (b)(3) and subparagraphs (D) and (G)
of subsection (d)(5).
‘‘(ii) HOSPITALS PAID UNDER SECTION 1814.—In the
case of a hospital that is paid under section 1814(b)(3),
the Secretary may exempt such hospitals provided that
States paid under such section submit an annual report
to the Secretary describing how a similar program
in the State for a participating hospital or hospitals
achieves or surpasses the measured results in terms
of patient health outcomes and cost savings established
herein with respect to this section.
‘‘(3) ADJUSTMENT FACTOR.—
‘‘(A) IN GENERAL.—For purposes of paragraph (1), the
adjustment factor under this paragraph for an applicable
hospital for a fiscal year is equal to the greater of—
‘‘(i) the ratio described in subparagraph (B) for
the hospital for the applicable period (as defined in
paragraph (5)(D)) for such fiscal year; or
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SEC. 3103. EXTENSION OF EXCEPTIONS PROCESS FOR MEDICARE
THERAPY CAPS.
Section 1833(g)(5) of the Social Security Act (42 U.S.C.
1395l(g)(5)) is amended by striking ‘‘December 31, 2009’’ and
inserting ‘‘December 31, 2010’’.
SEC. 3104. EXTENSION OF PAYMENT FOR TECHNICAL COMPONENT OF
CERTAIN PHYSICIAN PATHOLOGY SERVICES.
Section 542(c) of the Medicare, Medicaid, and SCHIP Benefits
Improvement and Protection Act of 2000 (as enacted into law by
section 1(a)(6) of Public Law 106–554), as amended by section
732 of the Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003 (42 U.S.C. 1395w–4 note), section 104 of
division B of the Tax Relief and Health Care Act of 2006 (42
U.S.C. 1395w–4 note), section 104 of the Medicare, Medicaid, and
SCHIP Extension Act of 2007 (Public Law 110–173), and section
136 of the Medicare Improvements for Patients and Providers Act
of 2008 (Public Law 110–275), is amended by striking ‘‘and 2009’’
and inserting ‘‘2009, and 2010’’.
SEC. 3105. EXTENSION OF AMBULANCE ADD-ONS.
(a) GROUND AMBULANCE.—Section 1834(l)(13)(A) of the Social
Security Act (42 U.S.C. 1395m(l)(13)(A)) is amended—øAs would
be revised by section 10311(a)¿
(1) in the matter preceding clause (i), by striking ‘‘2010’’
and inserting ‘‘2011’’; and
(2) in each of clauses (i) and (ii), by striking ‘‘January
1, 2010’’ and inserting ‘‘January 1, 2011’’ each place it appears.
(b) AIR AMBULANCE.—Section 146(b)(1) of the Medicare
Improvements for Patients and Providers Act of 2008 (Public Law
110–275) is amended øAs would be revised by section 10311(b)¿
by striking ‘‘December 31, 2009’’ and inserting ‘‘December 31, 2010’’.
(c) SUPER RURAL AMBULANCE.—Section 1834(l)(12)(A) of the
Social Security Act (42 U.S.C. 1395m(l)(12)(A)) is amended øAs
would be revised by section 10311(c)¿ by striking ‘‘2010’’ and
inserting ‘‘2011’’.
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.
(a) EXTENSION OF CERTAIN PAYMENT RULES.—Section 114(c)
of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (42
U.S.C. 1395ww note), as amended by section 4302(a) of the Amer-
ican Recovery and Reinvestment Act (Public Law 111–5), is further
amended by striking ‘‘3-year period’’ each place it appears and
inserting ‘‘5-year period’’. øAs revised by section 10312(a)¿
(b) EXTENSION OF MORATORIUM.—Section 114(d)(1) of such Act
(42 U.S.C. 1395ww note), in the matter preceding subparagraph
(A), is amended by striking ‘‘3-year period’’ and inserting ‘‘5-year
period’’. øAs revised by section 10312(b)¿
SEC. 3107. EXTENSION OF PHYSICIAN FEE SCHEDULE MENTAL HEALTH
ADD-ON.
Section 138(a)(1) of the Medicare Improvements for Patients
and Providers Act of 2008 (Public Law 110–275) is amended by
striking ‘‘December 31, 2009’’ and inserting ‘‘December 31, 2010’’.
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SEC. 3108. PERMITTING PHYSICIAN ASSISTANTS TO ORDER POST-HOS-
PITAL EXTENDED CARE SERVICES.
(a) ORDERING POST-HOSPITAL EXTENDED CARE SERVICES.—
(1) IN GENERAL.—Section 1814(a)(2) of the Social Security
Act (42 U.S.C. 1395f(a)(2)), in the matter preceding subpara-
graph (A), is amended by striking ‘‘or clinical nurse specialist’’
and inserting ‘‘, a clinical nurse specialist, or a physician assist-
ant (as those terms are defined in section 1861(aa)(5))’’ after
‘‘nurse practitioner’’.
(2) CONFORMING AMENDMENT.—Section 1814(a) of the
Social Security Act (42 U.S.C. 1395f(a)) is amended, in the
second sentence, by striking ‘‘or clinical nurse specialist’’ and
inserting ‘‘clinical nurse specialist, or physician assistant’’ after
‘‘nurse practitioner,’’.
(b) EFFECTIVE DATE.—The amendments made by this section
shall apply to items and services furnished on or after January
1, 2011.
SEC. 3109. EXEMPTION OF CERTAIN PHARMACIES FROM ACCREDITA-
TION REQUIREMENTS.
(a) IN GENERAL.—Section 1834(a)(20) of the Social Security
Act (42 U.S.C. 1395m(a)(20)), as added by section 154(b)(1)(A) of
the Medicare Improvements for Patients and Providers Act of 2008
(Public Law 100–275), is amended—
(1) in subparagraph (F)(i)—
(A) by inserting ‘‘and subparagraph (G)’’ after ‘‘clause
(ii)’’; and
(B) by inserting ‘‘, except that the Secretary shall not
require a pharmacy to have submitted to the Secretary
such evidence of accreditation prior to January 1, 2011’’
before the semicolon at the end; and
(2) by adding at the end the following new subparagraph:
‘‘(G) APPLICATION OF ACCREDITATION REQUIREMENT TO
CERTAIN PHARMACIES.—
‘‘(i) IN GENERAL.—With respect to items and serv-
ices furnished on or after January 1, 2011, in imple-
menting quality standards under this paragraph—
‘‘(I) subject to subclause (II), in applying such
standards and the accreditation requirement of
subparagraph (F)(i) with respect to pharmacies
described in clause (ii) furnishing such items and
services, such standards and accreditation require-
ment shall not apply to such pharmacies; and
‘‘(II) the Secretary may apply to such phar-
macies an alternative accreditation requirement
established by the Secretary if the Secretary deter-
mines such alternative accreditation requirement
is more appropriate for such pharmacies.
‘‘(ii) PHARMACIES DESCRIBED.—A pharmacy
described in this clause is a pharmacy that meets
each of the following criteria:
‘‘(I) The total billings by the pharmacy for
such items and services under this title are less
than 5 percent of total pharmacy sales, as deter-
mined based on the average total pharmacy sales
for the previous 3 calendar years, 3 fiscal years,
or other yearly period specified by the Secretary.
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SEC. 3125. TEMPORARY IMPROVEMENTS TO THE MEDICARE
INPATIENT HOSPITAL PAYMENT ADJUSTMENT FOR LOW-
VOLUME HOSPITALS.
Section 1886(d)(12) of the Social Security Act (42 U.S.C.
1395ww(d)(12)) is amended—
(1) in subparagraph (A), by inserting ‘‘or (D)’’ after
‘‘subparagraph (B)’’;
(2) in subparagraph (B), in the matter preceding clause
(i), by striking ‘‘The Secretary’’ and inserting ‘‘For discharges
occurring in fiscal years 2005 through 2010 and for discharges
occurring in fiscal year 2013 and subsequent fiscal years, the
Secretary’’;
(3) in subparagraph (C)(i)—
(A) by inserting ‘‘(or, with respect to fiscal years 2011
and 2012, 15 road miles)’’ after ‘‘25 road miles’’; and
(B) by inserting ‘‘(or, with respect to fiscal years 2011
and 2012, 1,600 discharges of individuals entitled to, or
enrolled for, benefits under part A)’’ after ‘‘800 discharges’’;
and øAs revised by section 10314(1)¿
(4) by adding at the end the following new subparagraph:
‘‘(D) TEMPORARY APPLICABLE PERCENTAGE INCREASE.—
For discharges occurring in fiscal years 2011 and 2012,
the Secretary shall determine an applicable percentage
increase for purposes of subparagraph (A) using a contin-
uous linear sliding scale ranging from 25 percent for low-
volume hospitals with 200 or fewer discharges of individ-
uals entitled to, or enrolled for, benefits under part A
in the fiscal year to 0 percent for low-volume hospitals
with greater than 1,600 discharges of such individuals
in the fiscal year.øAs revised by section 10314(2)¿’’.
SEC. 3126. IMPROVEMENTS TO THE DEMONSTRATION PROJECT ON
COMMUNITY HEALTH INTEGRATION MODELS IN CERTAIN
RURAL COUNTIES.
(a) REMOVAL OF LIMITATION ON NUMBER OF ELIGIBLE COUNTIES
SELECTED.—Subsection (d)(3) of section 123 of the Medicare
Improvements for Patients and Providers Act of 2008 (42 U.S.C.
1395i–4 note) is amended by striking ‘‘not more than 6’’.
(b) REMOVAL OF REFERENCES TO RURAL HEALTH CLINIC SERV-
ICES AND INCLUSION OF PHYSICIANS’ SERVICES IN SCOPE OF DEM-
ONSTRATION PROJECT.—Such section 123 is amended—
(1) in subsection (d)(4)(B)(i)(3), by striking subclause (III);
and
(2) in subsection (j)—
(A) in paragraph (8), by striking subparagraph (B)
and inserting the following:
‘‘(B) Physicians’ services (as defined in section 1861(q)
of the Social Security Act (42 U.S.C. 1395x(q)).’’;
(B) by striking paragraph (9); and
(C) by redesignating paragraph (10) as paragraph (9).
SEC. 3127. MEDPAC STUDY ON ADEQUACY OF MEDICARE PAYMENTS
FOR HEALTH CARE PROVIDERS SERVING IN RURAL
AREAS.
(a) STUDY.—The Medicare Payment Advisory Commission shall
conduct a study on the adequacy of payments for items and services
furnished by providers of services and suppliers in rural areas
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under the Medicare program under title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.). Such study shall include an analysis
of—
(1) any adjustments in payments to providers of services
and suppliers that furnish items and services in rural areas;
(2) access by Medicare beneficiaries to items and services
in rural areas;
(3) the adequacy of payments to providers of services and
suppliers that furnish items and services in rural areas; and
(4) the quality of care furnished in rural areas.
(b) REPORT.—Not later than January 1, 2011, the Medicare
Payment Advisory Commission shall submit to Congress a report
containing the results of the study conducted under subsection
(a). Such report shall include recommendations on appropriate modi-
fications to any adjustments in payments to providers of services
and suppliers that furnish items and services in rural areas,
together with recommendations for such legislation and administra-
tive action as the Medicare Payment Advisory Commission deter-
mines appropriate.
SEC. 3128. TECHNICAL CORRECTION RELATED TO CRITICAL ACCESS
HOSPITAL SERVICES.
(a) IN GENERAL.—Subsections (g)(2)(A) and (l)(8) of section 1834
of the Social Security Act (42 U.S.C. 1395m) are each amended
by inserting ‘‘101 percent of’’ before ‘‘the reasonable costs’’.
(b) EFFECTIVE DATE.—The amendments made by subsection
(a) shall take effect as if included in the enactment of section
405(a) of the Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003 (Public Law 108–173; 117 Stat. 2266).
SEC. 3129. EXTENSION OF AND REVISIONS TO MEDICARE RURAL HOS-
PITAL FLEXIBILITY PROGRAM.
(a) AUTHORIZATION.—Section 1820(j) of the Social Security Act
(42 U.S.C. 1395i–4(j)) is amended—
(1) by striking ‘‘2010, and for’’ and inserting ‘‘2010, for’’;
and
(2) by inserting ‘‘and for making grants to all States under
subsection (g), such sums as may be necessary in each of
fiscal years 2011 and 2012, to remain available until expended’’
before the period at the end.
(b) USE OF FUNDS.—Section 1820(g)(3) of the Social Security
Act (42 U.S.C. 1395i–4(g)(3)) is amended—
(1) in subparagraph (A), by inserting ‘‘and to assist such
hospitals in participating in delivery system reforms under
the provisions of and amendments made by the Patient Protec-
tion and Affordable Care Act, such as value-based purchasing
programs, accountable care organizations under section 1899,
the National pilot program on payment bundling under section
1866D, and other delivery system reform programs determined
appropriate by the Secretary’’ before the period at the end;
and
(2) in subparagraph (E)—
(A) by striking ‘‘, and to offset’’ and inserting ‘‘, to
offset’’; and
(B) by inserting ‘‘and to participate in delivery system
reforms under the provisions of and amendments made
by the Patient Protection and Affordable Care Act, such
as value-based purchasing programs, accountable care
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SEC. 3141 ø42 U.S.C. 1395ww note¿. APPLICATION OF BUDGET NEU-
TRALITY ON A NATIONAL BASIS IN THE CALCULATION
OF THE MEDICARE HOSPITAL WAGE INDEX FLOOR.
In the case of discharges occurring on or after October 1,
2010, for purposes of applying section 4410 of the Balanced Budget
Act of 1997 (42 U.S.C. 1395ww note) and paragraph (h)(4) of section
412.64 of title 42, Code of Federal Regulations, the Secretary of
Health and Human Services shall administer subsection (b) of such
section 4410 and paragraph (e) of such section 412.64 in the same
manner as the Secretary administered such subsection (b) and
paragraph (e) for discharges occurring during fiscal year 2008
(through a uniform, national adjustment to the area wage index).
SEC. 3142. HHS STUDY ON URBAN MEDICARE-DEPENDENT HOSPITALS.
(a) STUDY.—
(1) IN GENERAL.—The Secretary of Health and Human
Services (in this section referred to as the ‘‘Secretary’’) shall
conduct a study on the need for an additional payment for
urban Medicare-dependent hospitals for inpatient hospital serv-
ices under section 1886 of the Social Security Act (42 U.S.C.
1395ww). Such study shall include an analysis of—
(A) the Medicare inpatient margins of urban Medicare-
dependent hospitals, as compared to other hospitals which
receive 1 or more additional payments or adjustments
under such section (including those payments or adjust-
ments described in paragraph (2)(A)); and
(B) whether payments to medicare-dependent, small
rural hospitals under subsection (d)(5)(G) of such section
should be applied to urban Medicare-dependent hospitals.
(2) URBAN MEDICARE-DEPENDENT HOSPITAL DEFINED.—For
purposes of this section, the term ‘‘urban Medicare-dependent
hospital’’ means a subsection (d) hospital (as defined in sub-
section (d)(1)(B) of such section) that—
(A) does not receive any additional payment or adjust-
ment under such section, such as payments for indirect
medical education costs under subsection (d)(5)(B) of such
section, disproportionate share payments under subsection
(d)(5)(A) of such section, payments to a rural referral center
under subsection (d)(5)(C) of such section, payments to
a critical access hospital under section 1814(l) of such Act
(42 U.S.C. 1395f(l)), payments to a sole community hospital
under subsection (d)(5)(D) of such section 1886, or pay-
ments to a medicare-dependent, small rural hospital under
subsection (d)(5)(G) of such section 1886; and
(B) for which more than 60 percent of its inpatient
days or discharges during 2 of the 3 most recently audited
cost reporting periods for which the Secretary has a settled
cost report were attributable to inpatients entitled to bene-
fits under part A of title XVIII of such Act.
(b) REPORT.—Not later than 9 months after the date of enact-
ment of this Act, the Secretary shall submit to Congress a report
containing the results of the study conducted under subsection
(a), together with recommendations for such legislation and
administrative action as the Secretary determines appropriate.
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SEC. 3143. PROTECTING HOME HEALTH BENEFITS.
Nothing in the provisions of, or amendments made by, this
Act shall result in the reduction of guaranteed home health benefits
under title XVIII of the Social Security Act.
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the area is at least $30 but less than $50, the blended
benchmark amount for the area is—
‘‘(i) for 2012 the sum of—
‘‘(I) 3⁄4 of the applicable amount for the area
and year; and
‘‘(II) 1⁄4 of the amount specified in paragraph
(2)(A) for the area and year;
‘‘(ii) for 2013 the sum of—
‘‘(I) 1⁄2 of the applicable amount for the area
and year; and
‘‘(II) 1⁄2 of the amount specified in paragraph
(2)(A) for the area and year;
‘‘(iii) for 2014 the sum of—
‘‘(I) 1⁄4 of the applicable amount for the area
and year; and
‘‘(II) 3⁄4 of the amount specified in paragraph
(2)(A) for the area and year; and
‘‘(iv) for a subsequent year the amount specified
in paragraph (2)(A) for the area and year.
‘‘(B) 6-YEAR PHASE-IN FOR CERTAIN AREAS.—If the dif-
ference between the applicable amount (as defined in sub-
section (k)) for an area for 2010 and the projected 2010
benchmark amount (as defined in subparagraph (C)) for
the area is at least $50, the blended benchmark amount
for the area is—
‘‘(i) for 2012 the sum of—
‘‘(I) 5⁄6 of the applicable amount for the area
and year; and
‘‘(II) 1⁄6 of the amount specified in paragraph
(2)(A) for the area and year;
‘‘(ii) for 2013 the sum of—
‘‘(I) 2⁄3 of the applicable amount for the area
and year; and
‘‘(II) 1⁄3 of the amount specified in paragraph
(2)(A) for the area and year;
‘‘(iii) for 2014 the sum of—
‘‘(I) 1⁄2 of the applicable amount for the area
and year; and
‘‘(II) 1⁄2 of the amount specified in paragraph
(2)(A) for the area and year;
‘‘(iv) for 2015 the sum of—
‘‘(I) 1⁄3 of the applicable amount for the area
and year; and
‘‘(II) 2⁄3 of the amount specified in paragraph
(2)(A) for the area and year; and
‘‘(v) for 2016 the sum of—
‘‘(I) 1⁄6 of the applicable amount for the area
and year; and
‘‘(II) 5⁄6 of the amount specified in paragraph
(2)(A) for the area and year; and
‘‘(vi) for a subsequent year the amount specified
in paragraph (2)(A) for the area and year.
‘‘(C) PROJECTED 2010 BENCHMARK AMOUNT.—The pro-
jected 2010 benchmark amount described in this subpara-
graph for an area is equal to the sum of—
‘‘(i) 1⁄2 of the applicable amount (as defined in
subsection (k)) for the area for 2010; and
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SEC. 3203. øAPPLICATION OF CODING INTENSITY ADJUSTMENT
DURING MA PAYMENT TRANSITION¿øREPEALED AND
REPLACED¿.
øSection 3203 (and the amendments made by such section)
was repealed by section 1102(a) of HCERA.¿
øSection 1102(e) of HCERA amended section 1853(a)(1)(C)(ii)
of the Social Security Act with respect to the coding intensity adjust-
ment, shown below¿
(e) øSec. 1102(e) of HCERA¿ Coding Intensity Adjustment.—
Section 1853(a)(1)(C)(ii) of such Act (42 U.S.C. 1395w–23(a)(1)(C)(ii))
is amended—
(1) in the heading, by striking ‘‘DURING PHASEOUT OF
BUDGET NEUTRALITY FACTOR’’ and inserting ‘‘OF CODING ADJUST-
MENT’’;
(2) in the matter before subclause (I), by striking ‘‘through
2010’’ and inserting ‘‘and each subsequent year’’; and
(3) in subclause (II)—
(A) in the first sentence, by inserting ‘‘annually’’ before
‘‘conduct an analysis’’;
(B) in the second sentence—
(i) by inserting ‘‘on a timely basis’’ after ‘‘are incor-
porated’’; and
(ii) by striking ‘‘only for 2008, 2009, and 2010’’
and inserting ‘‘for 2008 and subsequent years’’;
(C) in the third sentence, by inserting ‘‘and updated
as appropriate’’ before the period at the end; and
(D) by adding at the end the following new subclauses:
‘‘(III) In calculating each year’s adjustment,
the adjustment factor shall be for 2014, not less
than the adjustment factor applied for 2010, plus
1.3 percentage points; for each of years 2015
through 2018, not less than the adjustment factor
applied for the previous year, plus 0.25 percentage
point; and for 2019 and each subsequent year,
not less than 5.7 percent.
‘‘(IV) Such adjustment shall be applied to risk
scores until the Secretary implements risk adjust-
ment using Medicare Advantage diagnostic, cost,
and use data.’’.
SEC. 3204. SIMPLIFICATION OF ANNUAL BENEFICIARY ELECTION
PERIODS.
(a) ANNUAL 45-DAY PERIOD FOR DISENROLLMENT FROM MA
PLANS TO ELECT TO RECEIVE BENEFITS UNDER THE ORIGINAL MEDI-
CARE FEE-FOR-SERVICE PROGRAM.—
(1) IN GENERAL.—Section 1851(e)(2)(C) of the Social Secu-
rity Act (42 U.S.C. 1395w–1(e)(2)(C)) is amended to read as
follows:
‘‘(C) ANNUAL 45-DAY PERIOD FOR DISENROLLMENT FROM
MA PLANS TO ELECT TO RECEIVE BENEFITS UNDER THE
ORIGINAL MEDICARE FEE-FOR-SERVICE PROGRAM.—Subject to
subparagraph (D), at any time during the first 45 days
of a year (beginning with 2011), an individual who is
enrolled in a Medicare Advantage plan may change the
election under subsection (a)(1), but only with respect to
coverage under the original medicare fee-for-service pro-
gram under parts A and B, and may elect qualified
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SEC. 3309. ELIMINATION OF COST SHARING FOR CERTAIN DUAL
ELIGIBLE INDIVIDUALS.
Section 1860D–14(a)(1)(D)(i) of the Social Security Act (42
U.S.C. 1395w–114(a)(1)(D)(i)) is amended by inserting ‘‘or, effective
on a date specified by the Secretary (but in no case earlier than
January 1, 2012), who would be such an institutionalized individual
or couple, if the full-benefit dual eligible individual were not
receiving services under a home and community-based waiver
authorized for a State under section 1115 or subsection (c) or
(d) of section 1915 or under a State plan amendment under sub-
section (i) of such section or services provided through enrollment
in a medicaid managed care organization with a contract under
section 1903(m) or under section 1932’’ after ‘‘1902(q)(1)(B))’’.
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 ø42 U.S.C. 1395w–154¿. 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.
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SEC. 3506. PROGRAM TO FACILITATE SHARED DECISIONMAKING.
Part D of title IX of the Public Health Service Act, as amended
by section 3503, is further amended by adding at the end the
following:
‘‘SEC. 936 ø42 U.S.C. 299b–36¿. PROGRAM TO FACILITATE SHARED
DECISIONMAKING.
‘‘(a) PURPOSE.—The purpose of this section is to facilitate
collaborative processes between patients, caregivers or authorized
representatives, and clinicians that engages the patient, caregiver
or authorized representative in decisionmaking, provides patients,
caregivers or authorized representatives with information about
trade-offs among treatment options, and facilitates the incorporation
of patient preferences and values into the medical plan.
‘‘(b) DEFINITIONS.—In this section:
‘‘(1) PATIENT DECISION AID.—The term ‘patient decision aid’
means an educational tool that helps patients, caregivers or
authorized representatives understand and communicate their
beliefs and preferences related to their treatment options, and
to decide with their health care provider what treatments are
best for them based on their treatment options, scientific evi-
dence, circumstances, beliefs, and preferences.
‘‘(2) PREFERENCE SENSITIVE CARE.—The term ‘preference
sensitive care’ means medical care for which the clinical evi-
dence does not clearly support one treatment option such that
the appropriate course of treatment depends on the values
of the patient or the preferences of the patient, caregivers
or authorized representatives regarding the benefits, harms
and scientific evidence for each treatment option, the use of
such care should depend on the informed patient choice among
clinically appropriate treatment options.
‘‘(c) ESTABLISHMENT OF INDEPENDENT STANDARDS FOR PATIENT
DECISION AIDS FOR PREFERENCE SENSITIVE CARE.—
‘‘(1) CONTRACT WITH ENTITY TO ESTABLISH STANDARDS AND
CERTIFY PATIENT DECISION AIDS.—
‘‘(A) IN GENERAL.—For purposes of supporting con-
sensus-based standards for patient decision aids for pref-
erence sensitive care and a certification process for patient
decision aids for use in the Federal health programs and
by other interested parties, the Secretary shall have in
effect a contract with the entity with a contract under
section 1890 of the Social Security Act. Such contract shall
provide that the entity perform the duties described in
paragraph (2).
‘‘(B) TIMING FOR FIRST CONTRACT.—As soon as prac-
ticable after the date of the enactment of this section,
the Secretary shall enter into the first contract under
subparagraph (A).
‘‘(C) PERIOD OF CONTRACT.—A contract under subpara-
graph (A) shall be for a period of 18 months (except such
contract may be renewed after a subsequent bidding
process).
‘‘(2) DUTIES.—The following duties are described in this
paragraph:
‘‘(A) DEVELOP AND IDENTIFY STANDARDS FOR PATIENT
DECISION AIDS.—The entity shall synthesize evidence and
convene a broad range of experts and key stakeholders
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‘‘SEC. 399LL–1 ø42 U.S.C. 280k–1¿. RESEARCH-BASED DENTAL CARIES
DISEASE MANAGEMENT.
‘‘(a) IN GENERAL.—The Secretary, acting through the Director
of the Centers for Disease Control and Prevention, shall award
demonstration grants to eligible entities to demonstrate the
effectiveness of research-based dental caries disease management
activities.
‘‘(b) ELIGIBILITY.—To be eligible for a grant under this section,
an entity shall—
‘‘(1) be a community-based provider of dental services (as
defined by the Secretary), including a Federally-qualified health
center, a clinic of a hospital owned or operated by a State
(or by an instrumentality or a unit of government within a
State), a State or local department of health, a dental program
of the Indian Health Service, an Indian tribe or tribal organiza-
tion, or an urban Indian organization (as such terms are defined
in section 4 of the Indian Health Care Improvement Act),
a health system provider, a private provider of dental services,
medical, dental, public health, nursing, nutrition educational
institutions, or national organizations involved in improving
children’s oral health; 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.—A grantee shall use amounts received
under a grant under this section to demonstrate the effectiveness
of research-based dental caries disease management activities.
‘‘(d) USE OF INFORMATION.—The Secretary shall utilize informa-
tion generated from grantees under this section in planning and
implementing the public education campaign under section 399LL.
‘‘SEC. 399LL–2 ø42 U.S.C. 280k–2¿. AUTHORIZATION OF APPROPRIA-
TIONS.
‘‘There is authorized to be appropriated to carry out this part,
such sums as may be necessary.’’.
(b) SCHOOL-BASED SEALANT PROGRAMS.—Section 317M(c)(1) of
the Public Health Service Act (42 U.S.C. 247b–14(c)(1)) is amended
by striking ‘‘may award grants to States and Indian tribes’’ and
inserting ‘‘shall award a grant to each of the 50 States and terri-
tories and to Indians, Indian tribes, tribal organizations and urban
Indian organizations (as such terms are defined in section 4 of
the Indian Health Care Improvement Act)’’.
(c) ORAL HEALTH INFRASTRUCTURE.—Section 317M of the Public
Health Service Act (42 U.S.C. 247b–14) is amended—
(1) by redesignating subsections (d) and (e) as subsections
(e) and (f), respectively; and
(2) by inserting after subsection (c), the following:
‘‘(d) ORAL HEALTH INFRASTRUCTURE.—
‘‘(1) COOPERATIVE AGREEMENTS.—The Secretary, acting
through the Director of the Centers for Disease Control and
Prevention, shall enter into cooperative agreements with State,
territorial, and Indian tribes or tribal organizations (as those
terms are defined in section 4 of the Indian Health Care
Improvement Act) to establish oral health leadership and pro-
gram guidance, oral health data collection and interpretation,
(including determinants of poor oral health among vulnerable
populations), a multi-dimensional delivery system for oral
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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
Service in May 2008, or any subsequent modification of such
Guideline; and
‘‘(B) such other services that the Secretary recognizes to
be effective for cessation of tobacco use by pregnant women.
‘‘(3) Such term shall not include coverage for drugs or biologicals
that are not otherwise covered under this title.’’.
(b) EXCEPTION FROM OPTIONAL RESTRICTION UNDER MEDICAID
PRESCRIPTION DRUG COVERAGE.—Section 1927(d)(2)(F) of the Social
Security Act (42 U.S.C. 1396r–8(d)(2)(F)), as redesignated by section
2502(a), is amended by inserting before the period at the end
the following: ‘‘, except, in the case of pregnant women when rec-
ommended in accordance with the Guideline referred to in section
1905(bb)(2)(A), agents approved by the Food and Drug Administra-
tion under the over-the-counter monograph process for purposes
of promoting, and when used to promote, tobacco cessation’’.
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—475
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‘‘SEC. 1946 ø42 U.S.C. 1396w–5¿. ADDRESSING HEALTH CARE DISPARI-
TIES.
‘‘(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
under title XXI based on analyses of the data collected under
subsection (c).
‘‘(c) IMPLEMENTING EFFECTIVE APPROACHES.—Not later than
24 months after the date of the enactment of this section, the
Secretary shall implement the approaches identified in the report
submitted under subsection (b)(1) for the ongoing, accurate, and
timely collection and evaluation of data on health care disparities
on the basis of race, ethnicity, sex, primary language, and disability
status.’’.
SEC. 4303. CDC AND EMPLOYER-BASED WELLNESS PROGRAMS.
Title III of the Public Health Service Act (42 U.S.C. 241 et
seq.), by section 4102, is further amended by adding at the end
the following:
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‘‘SEC. 399MM–3 ø42 U.S.C. 280l–3¿. PROHIBITION OF FEDERAL WORK-
PLACE WELLNESS REQUIREMENTS.
‘‘Notwithstanding any other provision of this part, any rec-
ommendations, data, or assessments carried out under this part
shall not be used to mandate requirements for workplace wellness
programs.’’.
SEC. 4304. EPIDEMIOLOGY-LABORATORY CAPACITY GRANTS.
Title XXVIII of the Public Health Service Act (42 U.S.C. 300hh
et seq.) is amended by adding at the end the following:
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‘‘SEC. 759 ø42 U.S.C. 294i¿. PROGRAM FOR EDUCATION AND TRAINING
IN PAIN CARE.
‘‘(a) IN GENERAL.—The Secretary may make awards of grants,
cooperative agreements, and contracts to health professions schools,
hospices, and other public and private entities for the development
and implementation of programs to provide education and training
to health care professionals in pain care.
‘‘(b) CERTAIN TOPICS.—An award may be made under subsection
(a) only if the applicant for the award agrees that the program
carried out with the award will include information and education
on—
‘‘(1) recognized means for assessing, diagnosing, treating,
and managing pain and related signs and symptoms, including
the medically appropriate use of controlled substances;
‘‘(2) applicable laws, regulations, rules, and policies on con-
trolled substances, including the degree to which misconcep-
tions and concerns regarding such laws, regulations, rules,
and policies, or the enforcement thereof, may create barriers
to patient access to appropriate and effective pain care;
‘‘(3) interdisciplinary approaches to the delivery of pain
care, including delivery through specialized centers providing
comprehensive pain care treatment expertise;
‘‘(4) cultural, linguistic, literacy, geographic, and other bar-
riers to care in underserved populations; and
‘‘(5) recent findings, developments, and improvements in
the provision of pain care.
‘‘(c) EVALUATION OF PROGRAMS.—The Secretary shall (directly
or through grants or contracts) provide for the evaluation of pro-
grams implemented under subsection (a) in order to determine
the effect of such programs on knowledge and practice of pain
care.
‘‘(d) PAIN CARE DEFINED.—For purposes of this section the
term ‘pain care’ means the assessment, diagnosis, treatment, or
management of acute or chronic pain regardless of causation or
body location.
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section, such sums as may
be necessary for each of the fiscal years 2010 through 2012.
Amounts appropriated under this subsection shall remain available
until expended.’’.
SEC. 4306. FUNDING FOR CHILDHOOD OBESITY DEMONSTRATION
PROJECT.
Section 1139A(e)(8) of the Social Security Act (42 U.S.C. 1320b–
9a(e)(8)) is amended to read as follows:
‘‘(8) APPROPRIATION.—Out of any funds in the Treasury
not otherwise appropriated, there is appropriated to carry out
this subsection, $25,000,000 for the period of fiscal years 2010
through 2014.’’.
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—489
SEC. 4402. EFFECTIVENESS OF FEDERAL HEALTH AND WELLNESS INI-
TIATIVES.
To determine whether existing Federal health and wellness
initiatives are effective in achieving their stated goals, the Secretary
of Health and Human Services shall—
(1) conduct an evaluation of such programs as they relate
to changes in health status of the American public and specifi-
cally on the health status of the Federal workforce, including
absenteeism of employees, the productivity of employees, the
rate of workplace injury, and the medical costs incurred by
employees, and health conditions, including workplace fitness,
healthy food and beverages, and incentives in the Federal
Employee Health Benefits Program; and
(2) submit to Congress a report concerning such evaluation,
which shall include conclusions concerning the reasons that
such existing programs have proven successful or not successful
and what factors contributed to such conclusions.
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—490
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—492
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—494
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(g) POWERS.—
(1) DATA COLLECTION.—In order to carry out its functions
under this section, the Commission shall—
(A) utilize existing information, both published and
unpublished, where possible, collected and assessed either
by its own staff or under other arrangements made in
accordance with this section, including coordination with
the Bureau of Labor Statistics;
(B) carry out, or award grants or contracts for the
carrying out of, original research and development, where
existing information is inadequate, and
(C) adopt procedures allowing interested parties to
submit information for the Commission’s use in making
reports and recommendations.
(2) ACCESS OF THE GOVERNMENT ACCOUNTABILITY OFFICE
TO INFORMATION.—The Comptroller General of the United
States shall have unrestricted access to all deliberations,
records, and data of the Commission, immediately upon request.
(3) PERIODIC AUDIT.—The Commission shall be subject to
periodic audit by an independent public accountant under con-
tract to the Commission.
(h) AUTHORIZATION OF APPROPRIATIONS.—
(1) REQUEST FOR APPROPRIATIONS.—The Commission shall
submit requests for appropriations in the same manner as
the Comptroller General of the United States submits requests
for appropriations. Amounts so appropriated for the Commis-
sion shall be separate from amounts appropriated for the Comp-
troller General.
(2) AUTHORIZATION.—There are authorized to be appro-
priated such sums as may be necessary to carry out this section.
(3) GIFTS AND SERVICES.—The Commission may not accept
gifts, bequeaths, or donations of property, but may accept and
use donations of services for purposes of carrying out this
section.
(i) DEFINITIONS.—In this section:
(1) HEALTH CARE WORKFORCE.—The term ‘‘health care
workforce’’ includes all health care providers with direct patient
care and support responsibilities, such as physicians, nurses,
nurse practitioners, primary care providers, preventive medi-
cine physicians, optometrists, ophthalmologists, physician
assistants, pharmacists, dentists, dental hygienists, and other
oral healthcare professionals, allied health professionals, doc-
tors of chiropractic, community health workers, health care
paraprofessionals, direct care workers, psychologists and other
behavioral and mental health professionals (including sub-
stance abuse prevention and treatment providers), social
workers, physical and occupational therapists, certified nurse
midwives, podiatrists, the EMS workforce (including profes-
sional and volunteer ambulance personnel and firefighters who
perform emergency medical services), licensed complementary
and alternative medicine providers, integrative health practi-
tioners, public health professionals, and any other health
professional that the Comptroller General of the United States
determines appropriate.
(2) HEALTH PROFESSIONALS.—The term ‘‘health profes-
sionals’’ includes—
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(4) The Secretary of the Air Force shall appoint one rep-
resentative of the Air Force, from among officers at the Air
Force performing medical service functions.
(5) The Secretary of Veterans Affairs shall appoint one
representative of each of the following:
(A) The Department of Veterans Affairs.
(B) The Veterans Health Administration.
(6) The Secretary of Homeland Security shall appoint one
representative of the United States Coast Guard.
(d) CHAIRPERSON.—One chairperson of the Task Force shall
be appointed by the Secretary at the time of appointment of mem-
bers under subsection (c), selected from among the members
appointed under paragraph (1).
(e) MEETINGS.—The Task Force shall meet at the call of the
chairperson.
(f) REPORT.—Not later than 180 days after the date of enact-
ment of this Act, the Task Force shall submit to Congress a report
detailing the activities of the Task Force and containing the
findings, strategies, recommendations, policies, and initiatives
developed pursuant to the duty described in subsection (b)(2). In
preparing such report, the Task Force shall consider completed
and ongoing efforts by Federal agencies to improve access to health
care in the State of Alaska.
(g) TERMINATION.—The Task Force shall be terminated on the
date of submission of the report described in subsection (f).
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—509
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—513
SEC. 5205 ø20 U.S.C. 1078–11¿. ALLIED HEALTH WORKFORCE RECRUIT-
MENT AND RETENTION PROGRAMS.
(a) PURPOSE.—The purpose of this section is to assure an ade-
quate supply of allied health professionals to eliminate critical
allied health workforce shortages in Federal, State, local, and tribal
public health agencies or in settings where patients might require
health care services, including acute care facilities, ambulatory
care facilities, personal residences and other settings, as recognized
by the Secretary of Health and Human Services by authorizing
an Allied Health Loan Forgiveness Program.
(b) ALLIED HEALTH WORKFORCE RECRUITMENT AND RETENTION
PROGRAM.—Section 428K of the Higher Education Act of 1965 (20
U.S.C. 1078–11) is amended—
(1) in subsection (b), by adding at the end the following:
‘‘(18) ALLIED HEALTH PROFESSIONALS.—The individual is
employed full-time as an allied health professional—
‘‘(A) in a Federal, State, local, or tribal public health
agency; or
‘‘(B) in a setting where patients might require health
care services, including acute care facilities, ambulatory
care facilities, personal residences and other settings
located in health professional shortage areas, medically
underserved areas, or medically underserved populations,
as recognized by the Secretary of Health and Human Serv-
ices.’’; and
(2) in subsection (g)—
(A) by redesignating paragraphs (1) through (9) as
paragraphs (2) through (10), respectively; and
(B) by inserting before paragraph (2) (as redesignated
by subparagraph (A)) the following:
‘‘(1) ALLIED HEALTH PROFESSIONAL.—The term ‘allied health
professional’ means an allied health professional as defined
in section 799B(5) of the Public Heath Service Act (42 U.S.C.
295p(5)) who—
‘‘(A) has graduated and received an allied health profes-
sions degree or certificate from an institution of higher
education; and
‘‘(B) is employed with a Federal, State, local or tribal
public health agency, or in a setting where patients might
require health care services, including acute care facilities,
ambulatory care facilities, personal residences and other
settings located in health professional shortage areas, medi-
cally underserved areas, or medically underserved popu-
lations, as recognized by the Secretary of Health and
Human Services.’’.
SEC. 5206. GRANTS FOR STATE AND LOCAL PROGRAMS.
(a) IN GENERAL.—Section 765(d) of the Public Health Service
Act (42 U.S.C. 295(d)) is amended—
(1) in paragraph (7), by striking ‘‘; or’’ and inserting a
semicolon;
(2) by redesignating paragraph (8) as paragraph (9); and
(3) by inserting after paragraph (7) the following:
‘‘(8) public health workforce loan repayment programs; or’’.
(b) TRAINING FOR MID-CAREER PUBLIC HEALTH PROFES-
SIONALS.—Part E of title VII of the Public Health Service Act
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—514
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—515
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—516
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 ø42 U.S.C. 204¿. 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
‘‘(D) be available for service assignment in isolated,
hardship, and medically underserved communities (as
defined in section 799B) to improve access to health serv-
ices.
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—517
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—518
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—519
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—520
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—521
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—522
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—523
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—524
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—525
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—526
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—527
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—528
SEC. 5306. MENTAL AND BEHAVIORAL HEALTH EDUCATION AND
TRAINING GRANTS.
(a) IN GENERAL.—Part D of title VII (42 U.S.C. 294 et seq.)
is amended by—
(1) striking section 757;
(2) redesignating section 756 (as amended by section 5103)
as section 757; and
(3) inserting after section 755 the following:
‘‘SEC. 756 ø42 U.S.C. 294e–1¿. MENTAL AND BEHAVIORAL HEALTH EDU-
CATION AND TRAINING GRANTS.
‘‘(a) GRANTS AUTHORIZED.—The Secretary may award grants
to eligible institutions of higher education to support the recruit-
ment of students for, and education and clinical experience of the
students in—
‘‘(1) baccalaureate, master’s, and doctoral degree programs
of social work, as well as the development of faculty in social
work;
‘‘(2) accredited master’s, doctoral, internship, and post-doc-
toral residency programs of psychology for the development
and implementation of interdisciplinary training of psychology
graduate students for providing behavioral and mental health
services, including substance abuse prevention and treatment
services;
‘‘(3) accredited institutions of higher education or accredited
professional training programs that are establishing or
expanding internships or other field placement programs in
child and adolescent mental health in psychiatry, psychology,
school psychology, behavioral pediatrics, psychiatric nursing,
social work, school social work, substance abuse prevention
and treatment, marriage and family therapy, school counseling,
or professional counseling; and
‘‘(4) State-licensed mental health nonprofit and for-profit
organizations to enable such organizations to pay for programs
for preservice or in-service training of paraprofessional child
and adolescent mental health workers.
‘‘(b) ELIGIBILITY REQUIREMENTS.—To be eligible for a grant
under this section, an institution shall demonstrate—
‘‘(1) participation in the institutions’ programs of individ-
uals and groups from different racial, ethnic, cultural,
geographic, religious, linguistic, and class backgrounds, and
different genders and sexual orientations;
‘‘(2) knowledge and understanding of the concerns of the
individuals and groups described in subsection (a);
‘‘(3) any internship or other field placement program
assisted under the grant will prioritize cultural and linguistic
competency;
‘‘(4) the institution will provide to the Secretary such data,
assurances, and information as the Secretary may require;
and
‘‘(5) with respect to any violation of the agreement between
the Secretary and the institution, the institution will pay such
liquidated damages as prescribed by the Secretary by regula-
tion.
‘‘(c) INSTITUTIONAL REQUIREMENT.—For grants authorized
under subsection (a)(1), at least 4 of the grant recipients shall
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—529
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—530
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—531
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—532
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—533
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—534
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—535
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—536
‘‘SEC. 399V ø42 U.S.C. 280g–11¿. 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
1998. Nothing in this section shall be construed to require such
collaboration.
‘‘(f) EVIDENCE-BASED INTERVENTIONS.—The Secretary shall
encourage community health worker programs receiving funding
under this section to implement a process or an outcome-based
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—539
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—540
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—541
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—542
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—544
‘‘SEC. 274 ø42 U.S.C. 239l–3¿. FUNDING.
‘‘Beginning with fiscal year 2010, the Secretary shall transfer
from the Public Health and Social Services Emergency Fund such
sums as may be necessary to carry out this part.’’.
SEC. 5316 ø42 U.S.C. 296j–1¿. DEMONSTRATION GRANTS FOR FAMILY
NURSE PRACTITIONER TRAINING PROGRAMS.
øSection added by section 10501(e)¿
(a) ESTABLISHMENT OF PROGRAM.—The Secretary of Health and
Human Services (referred to in this section as the ‘‘Secretary’’)
shall establish a training demonstration program for family nurse
practitioners (referred to in this section as the ‘‘program’’) to employ
and provide 1-year training for nurse practitioners who have grad-
uated from a nurse practitioner program for careers as primary
care providers in Federally qualified health centers (referred to
in this section as ‘‘FQHCs’’) and nurse-managed health clinics
(referred to in this section as ‘‘NMHCs’’).
(b) PURPOSE.—The purpose of the program is to enable each
grant recipient to—
(1) provide new nurse practitioners with clinical training
to enable them to serve as primary care providers in FQHCs
and NMHCs;
(2) train new nurse practitioners to work under a model
of primary care that is consistent with the principles set forth
by the Institute of Medicine and the needs of vulnerable popu-
lations; and
(3) create a model of FQHC and NMHC training for nurse
practitioners that may be replicated nationwide.
(c) GRANTS.—The Secretary shall award 3-year grants to eligible
entities that meet the requirements established by the Secretary,
for the purpose of operating the nurse practitioner primary care
programs described in subsection (a) in such entities.
(d) ELIGIBLE ENTITIES.—To be eligible to receive a grant under
this section, an entity shall—
(1)(A) be a FQHC as defined in section 1861(aa) of the
Social Security Act (42 U.S.C. 1395x(aa)); or
(B) be a nurse-managed health clinic, as defined in section
330A–1 of the Public Health Service Act (as added by section
5208 of this Act); and
(2) submit to the Secretary an application at such time,
in such manner, and containing such information as the Sec-
retary may require.
(e) PRIORITY IN AWARDING GRANTS.—In awarding grants under
this section, the Secretary shall give priority to eligible entities
that—
(1) demonstrate sufficient infrastructure in size, scope, and
capacity to undertake the requisite training of a minimum
of 3 nurse practitioners per year, and to provide to each awardee
12 full months of full-time, paid employment and benefits con-
sistent with the benefits offered to other full-time employees
of such entity;
(2) will assign not less than 1 staff nurse practitioner
or physician to each of 4 precepted clinics;
(3) will provide to each awardee specialty rotations,
including specialty training in prenatal care and women’s
health, adult and child psychiatry, orthopedics, geriatrics, and
at least 3 other high-volume, high-burden specialty areas;
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—545
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—546
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—547
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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
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—558
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—559
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—560
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—561
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—562
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—563
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—564
SEC. 5506. PRESERVATION OF RESIDENT CAP POSITIONS FROM
CLOSED HOSPITALS.
(a) GME.—Section 1886(h)(4)(H) of the Social Security Act (42
U.S.C. Section 1395ww(h)(4)(H)) is amended by adding at the end
the following new clause:
‘‘(vi) REDISTRIBUTION OF RESIDENCY SLOTS AFTER
A HOSPITAL CLOSES.—
‘‘(I) IN GENERAL.—Subject to the succeeding
provisions of this clause, the Secretary shall, by
regulation, establish a process under which, in
the case where a hospital (other than a hospital
described in clause (v)) with an approved medical
residency program closes on or after a date that
is 2 years before the date of enactment of this
clause, the Secretary shall increase the otherwise
applicable resident limit under this paragraph for
other hospitals in accordance with this clause.
‘‘(II) PRIORITY FOR HOSPITALS IN CERTAIN
AREAS.—Subject to the succeeding provisions of
this clause, in determining for which hospitals the
increase in the otherwise applicable resident limit
is provided under such process, the Secretary shall
distribute the increase to hospitals in the following
priority order (with preference given within each
category to hospitals that are members of the same
affiliated group (as defined by the Secretary under
clause (ii)) as the closed hospital):
‘‘(aa) First, to hospitals located in the
same core-based statistical area as, or a core-
based statistical area contiguous to, the hos-
pital that closed.
‘‘(bb) Second, to hospitals located in the
same State as the hospital that closed.
‘‘(cc) Third, to hospitals located in the
same region of the country as the hospital
that closed.
‘‘(dd) Fourth, only if the Secretary is not
able to distribute the increase to hospitals
described in item (cc), to qualifying hospitals
in accordance with the provisions of paragraph
(8).
‘‘(III) REQUIREMENT HOSPITAL LIKELY TO FILL
POSITION WITHIN CERTAIN TIME PERIOD.—The Sec-
retary may only increase the otherwise applicable
resident limit of a hospital under such process
if the Secretary determines the hospital has dem-
onstrated a likelihood of filling the positions made
available under this clause within 3 years.
‘‘(IV) LIMITATION.—The aggregate number of
increases in the otherwise applicable resident
limits for hospitals under this clause shall be equal
to the number of resident positions in the approved
medical residency programs that closed on or after
the date described in subclause (I).
‘‘(V) ADMINISTRATION.—Chapter 35 of title 44,
United States Code, shall not apply to the
implementation of this clause.’’.
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—565
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—566
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—567
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
under this section to the same extent and in the same manner
as such section applies to payments to States under this title.’’.
(b) EXTENSION OF FAMILY-TO-FAMILY HEALTH INFORMATION
CENTERS.—Section 501(c)(1)(A)(iii) of the Social Security Act (42
U.S.C. 701(c)(1)(A)(iii)) is amended by striking ‘‘fiscal year 2009’’
and inserting ‘‘each of fiscal years 2009 through 2012’’.
SEC. 5508. INCREASING TEACHING CAPACITY.
(a) TEACHING HEALTH CENTERS TRAINING AND ENHANCE-
MENT.—Part C of title VII of the Public Health Service Act (42
U.S.C. 293k et. seq.), as amended by section 5303, is further
amended by inserting after section 749 the following:
‘‘SEC. 749A ø42 U.S.C. 293l–1¿. TEACHING HEALTH CENTERS DEVELOP-
MENT GRANTS.
‘‘(a) PROGRAM AUTHORIZED.—The Secretary may award grants
under this section to teaching health centers for the purpose of
establishing new accredited or expanded primary care residency
programs.
‘‘(b) AMOUNT AND DURATION.—Grants awarded under this sec-
tion shall be for a term of not more than 3 years and the maximum
award may not be more than $500,000.
‘‘(c) USE OF FUNDS.—Amounts provided under a grant under
this section shall be used to cover the costs of—
‘‘(1) establishing or expanding a primary care residency
training program described in subsection (a), including costs
associated with—
‘‘(A) curriculum development;
‘‘(B) recruitment, training and retention of residents
and faculty:
‘‘(C) accreditation by the Accreditation Council for
Graduate Medical Education (ACGME), the American
Dental Association (ADA), or the American Osteopathic
Association (AOA); and
‘‘(D) faculty salaries during the development phase;
and
‘‘(2) technical assistance provided by an eligible entity.
‘‘(d) APPLICATION.—A teaching health center seeking a grant
under this section shall submit an application to the Secretary
at such time, in such manner, and containing such information
as the Secretary may require.
‘‘(e) PREFERENCE FOR CERTAIN APPLICATIONS.—In selecting
recipients for grants under this section, the Secretary shall give
preference to any such application that documents an existing affili-
ation agreement with an area health education center program
as defined in sections 751 and 799B.
‘‘(f) DEFINITIONS.—In this section:
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible entity’ means an
organization capable of providing technical assistance including
an area health education center program as defined in sections
751 and 799B.
‘‘(2) PRIMARY CARE RESIDENCY PROGRAM.—The term ‘pri-
mary care residency program’ means an approved graduate
medical residency training program (as defined in section 340H)
in family medicine, internal medicine, pediatrics, internal medi-
cine-pediatrics, obstetrics and gynecology, psychiatry, general
dentistry, pediatric dentistry, and geriatrics.
‘‘(3) TEACHING HEALTH CENTER.—
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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
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—585
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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:
‘‘(1) As the Secretary determines to be necessary to carry
out this section or part D of title XVIII.
‘‘(2) To permit the Comptroller General to review the
information provided.
‘‘(3) To permit the Director of the Congressional Budget
Office to review the information provided.
‘‘(4) To States to carry out section 1311 of the Patient
Protection and Affordable Care Act.
‘‘(d) PENALTIES.—The provisions of subsection (b)(3)(C) of sec-
tion 1927 shall apply to a health benefits plan or PBM that fails
to provide information required under subsection (a) on a timely
basis or that knowingly provides false information in the same
manner as such provisions apply to a manufacturer with an agree-
ment under that section.’’.
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SEC. 6102. ACCOUNTABILITY REQUIREMENTS FOR SKILLED NURSING
FACILITIES AND NURSING FACILITIES.
Part A of title XI of the Social Security Act (42 U.S.C. 1301
et seq.), as amended by sections 6002 and 6004, is amended by
inserting after section 1128H the following new section:
‘‘SEC. 1128I ø42 U.S.C. 1320a–7j¿. ACCOUNTABILITY REQUIREMENTS FOR
FACILITIES.
‘‘(a) DEFINITION OF FACILITY.—In this section, the term ‘facility’
means—
‘‘(1) a skilled nursing facility (as defined in section 1819(a));
or
‘‘(2) a nursing facility (as defined in section 1919(a)).
‘‘(b) EFFECTIVE COMPLIANCE AND ETHICS PROGRAMS.—
‘‘(1) REQUIREMENT.—On or after the date that is 36 months
after the date of the enactment of this section, a facility shall,
with respect to the entity that operates the facility (in this
subparagraph referred to as the ‘operating organization’ or
‘organization’), have in operation a compliance and ethics pro-
gram that is effective in preventing and detecting criminal,
civil, and administrative violations under this Act and in pro-
moting quality of care consistent with regulations developed
under paragraph (2).
‘‘(2) DEVELOPMENT OF REGULATIONS.—
‘‘(A) IN GENERAL.—Not later than the date that is
2 years after such date of the enactment, the Secretary,
working jointly with the Inspector General of the Depart-
ment of Health and Human Services, shall promulgate
regulations for an effective compliance and ethics program
for operating organizations, which may include a model
compliance program.
‘‘(B) DESIGN OF REGULATIONS.—Such regulations with
respect to specific elements or formality of a program shall,
in the case of an organization that operates 5 or more
facilities, vary with the size of the organization, such that
larger organizations should have a more formal program
and include established written policies defining the stand-
ards and procedures to be followed by its employees. Such
requirements may specifically apply to the corporate level
management of multi unit nursing home chains.
‘‘(C) EVALUATION.—Not later than 3 years after the
date of the promulgation of regulations under this para-
graph, the Secretary shall complete an evaluation of the
compliance and ethics programs required to be established
under this subsection. Such evaluation shall determine if
such programs led to changes in deficiency citations,
changes in quality performance, or changes in other metrics
of patient quality of care. The Secretary shall submit to
Congress a report on such evaluation and shall include
in such report such recommendations regarding changes
in the requirements for such programs as the Secretary
determines appropriate.
‘‘(3) REQUIREMENTS FOR COMPLIANCE AND ETHICS PRO-
GRAMS.—In this subsection, the term ‘compliance and ethics
program’ means, with respect to a facility, a program of the
operating organization that—
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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—654
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—655
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—657
SEC. 6402. ENHANCED MEDICARE AND MEDICAID PROGRAM INTEG-
RITY PROVISIONS.
(a) IN GENERAL.—Part A of title XI of the Social Security
Act (42 U.S.C. 1301 et seq.), as amended by sections 6002, 6004,
and 6102, is amended by inserting after section 1128I the following
new section:
‘‘SEC. 1128J ø42 U.S.C. 1320a–7k¿. MEDICARE AND MEDICAID PROGRAM
INTEGRITY PROVISIONS.
‘‘(a) DATA MATCHING.—
‘‘(1) INTEGRATED DATA REPOSITORY.—
‘‘(A) INCLUSION OF CERTAIN DATA.—
‘‘(i) IN GENERAL.—The Integrated Data Repository
of the Centers for Medicare & Medicaid Services shall
include, at a minimum, claims and payment data from
the following:
‘‘(I) The programs under titles XVIII and XIX
(including parts A, B, C, and D of title XVIII).
‘‘(II) The program under title XXI.
‘‘(III) Health-related programs administered
by the Secretary of Veterans Affairs.
‘‘(IV) Health-related programs administered by
the Secretary of Defense.
‘‘(V) The program of old-age, survivors, and
disability insurance benefits established under
title II.
‘‘(VI) The Indian Health Service and the Con-
tract Health Service program.
‘‘(ii) PRIORITY FOR INCLUSION OF CERTAIN DATA.—
Inclusion of the data described in subclause (I) of such
clause in the Integrated Data Repository shall be a
priority. Data described in subclauses (II) through (VI)
of such clause shall be included in the Integrated Data
Repository as appropriate.
‘‘(B) DATA SHARING AND MATCHING.—
‘‘(i) IN GENERAL.—The Secretary shall enter into
agreements with the individuals described in clause
(ii) under which such individuals share and match
data in the system of records of the respective agencies
of such individuals with data in the system of records
of the Department of Health and Human Services for
the purpose of identifying potential fraud, waste, and
abuse under the programs under titles XVIII and XIX.
‘‘(ii) INDIVIDUALS DESCRIBED.—The following
individuals are described in this clause:
‘‘(I) The Commissioner of Social Security.
‘‘(II) The Secretary of Veterans Affairs.
‘‘(III) The Secretary of Defense.
‘‘(IV) The Director of the Indian Health
Service.
‘‘(iii) DEFINITION OF SYSTEM OF RECORDS.—For pur-
poses 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.
‘‘(2) ACCESS TO CLAIMS AND PAYMENT DATABASES.—For pur-
poses of conducting law enforcement and oversight activities
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—680
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—681
SEC. 6504. REQUIREMENT TO REPORT EXPANDED SET OF DATA ELE-
MENTS UNDER MMIS TO DETECT FRAUD AND ABUSE.
(a) IN GENERAL.—Section 1903(r)(1)(F) of the Social Security
Act (42 U.S.C. 1396b(r)(1)(F)) is amended by inserting after ‘‘nec-
essary’’ the following: ‘‘and including, for data submitted to the
Secretary on or after January 1, 2010, data elements from the
automated data system that the Secretary determines to be nec-
essary for program integrity, program oversight, and administra-
tion, at such frequency as the Secretary shall determine’’.
(b) MANAGED CARE ORGANIZATIONS.—
(1) IN GENERAL.—Section 1903(m)(2)(A)(xi) of the Social
Security Act (42 U.S.C. 1396b(m)(2)(A)(xi)) is amended by
inserting ‘‘and for the provision of such data to the State
at a frequency and level of detail to be specified by the Sec-
retary’’ after ‘‘patients’’.
(2) EFFECTIVE DATE.—The amendment made by paragraph
(1) shall apply with respect to contract years beginning on
or after January 1, 2010.
SEC. 6505. PROHIBITION ON PAYMENTS TO INSTITUTIONS OR ENTITIES
LOCATED OUTSIDE OF THE UNITED STATES.
Section 1902(a) of the Social Security Act (42 U.S.C. 1396b(a)),
as amended by section 6503, is amended by inserting after para-
graph (79) the following new paragraph:
‘‘(80) provide that the State shall not provide any payments
for items or services provided under the State plan or under
a waiver to any financial institution or entity located outside
of the United States;’’.
SEC. 6506. OVERPAYMENTS.
(a) EXTENSION OF PERIOD FOR COLLECTION OF OVERPAYMENTS
DUE TO FRAUD.—
(1) IN GENERAL.—Section 1903(d)(2) of the Social Security
Act (42 U.S.C. 1396b(d)(2)) is amended—
(A) in subparagraph (C)—
(i) in the first sentence, by striking ‘‘60 days’’ and
inserting ‘‘1 year’’; and
(ii) in the second sentence, by striking ‘‘60 days’’
and inserting ‘‘1-year period’’; and
(B) in subparagraph (D)—
(i) in inserting ‘‘(i)’’ after ‘‘(D)’’; and
(ii) by adding at the end the following:
‘‘(ii) In any case where the State is unable to recover a debt
which represents an overpayment (or any portion thereof) made
to a person or other entity due to fraud within 1 year of discovery
because there is not a final determination of the amount of the
overpayment under an administrative or judicial process (as
applicable), including as a result of a judgment being under appeal,
no adjustment shall be made in the Federal payment to such
State on account of such overpayment (or portion thereof) before
the date that is 30 days after the date on which a final judgment
(including, if applicable, a final determination on an appeal) is
made.’’.
(2) EFFECTIVE DATE.—The amendments made by this sub-
section take effect on the date of enactment of this Act and
apply to overpayments discovered on or after that date.
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‘‘(b) Any person that violates section 519 shall upon conviction
be imprisoned not more than 10 years or fined under title 18,
United States Code, or both.’’.
(c) CONFORMING AMENDMENT.—The table of sections for part
5 of subtitle B of title I of the Employee Retirement Income Security
Act of 1974 is amended by adding at the end the following:
‘‘Sec. 519. Prohibition on false statement and representations.’’.
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SEC. 6605. ENABLING THE DEPARTMENT OF LABOR TO ISSUE ADMINIS-
TRATIVE SUMMARY CEASE AND DESIST ORDERS AND
SUMMARY SEIZURES ORDERS AGAINST PLANS THAT ARE
IN FINANCIALLY HAZARDOUS CONDITION.
(a) IN GENERAL.—Part 5 of subtitle B of title I of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1131 et seq.),
as amended by section 6604, is further amended by adding at
the end the following:
‘‘SEC. 521 ø29 U.S.C. 1151¿. ADMINISTRATIVE SUMMARY CEASE AND
DESIST ORDERS AND SUMMARY SEIZURE ORDERS
AGAINST MULTIPLE EMPLOYER WELFARE ARRANGE-
MENTS IN FINANCIALLY HAZARDOUS CONDITION.
‘‘(a) IN GENERAL.—The Secretary may issue a cease and desist
(ex parte) order under this title if it appears to the Secretary
that the alleged conduct of a multiple employer welfare arrangement
described in section 3(40), other than a plan or arrangement
described in subsection (g), is fraudulent, or creates an immediate
danger to the public safety or welfare, or is causing or can be
reasonably expected to cause significant, imminent, and irreparable
public injury.
‘‘(b) HEARING.—A person that is adversely affected by the
issuance of a cease and desist order under subsection (a) may
request a hearing by the Secretary regarding such order. The Sec-
retary may require that a proceeding under this section, including
all related information and evidence, be conducted in a confidential
manner.
‘‘(c) BURDEN OF PROOF.—The burden of proof in any hearing
conducted under subsection (b) shall be on the party requesting
the hearing to show cause why the cease and desist order should
be set aside.
‘‘(d) DETERMINATION.—Based upon the evidence presented at
a hearing under subsection (b), the cease and desist order involved
may be affirmed, modified, or set aside by the Secretary in whole
or in part.
‘‘(e) SEIZURE.—The Secretary may issue a summary seizure
order under this title if it appears that a multiple employer welfare
arrangement is in a financially hazardous condition.
‘‘(f) REGULATIONS.—The Secretary may promulgate such regula-
tions or other guidance as may be necessary or appropriate to
carry out this section.
‘‘(g) EXCEPTION.—This section shall not apply to any plan or
arrangement that does not fall within the meaning of the term
‘multiple employer welfare arrangement’ under section 3(40)(A).’’.
(b) CONFORMING AMENDMENT.—The table of sections for part
5 of subtitle B of title I of the Employee Retirement Income Security
Act of 1974, as amended by section 6604, is further amended
by adding at the end the following:
‘‘Sec. 521. Administrative summary cease and desist orders and summary seizure
orders against health plans in financially hazardous condition.’’.
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‘‘(B) self-neglect.
‘‘(17) NURSING FACILITY.—
‘‘(A) IN GENERAL.—The term ‘nursing facility’ has the
meaning given such term under section 1919(a).
‘‘(B) INCLUSION OF SKILLED NURSING FACILITY.—The
term ‘nursing facility’ includes a skilled nursing facility
(as defined in section 1819(a)).
‘‘(18) SELF-NEGLECT.—The term ‘self-neglect’ means an
adult’s inability, due to physical or mental impairment or
diminished capacity, to perform essential self-care tasks
including—
‘‘(A) obtaining essential food, clothing, shelter, and
medical care;
‘‘(B) obtaining goods and services necessary to maintain
physical health, mental health, or general safety; or
‘‘(C) managing one’s own financial affairs.
‘‘(19) SERIOUS BODILY INJURY.—
‘‘(A) IN GENERAL.—The term ‘serious bodily injury’
means an injury—
‘‘(i) involving extreme physical pain;
‘‘(ii) involving substantial risk of death;
‘‘(iii) involving protracted loss or impairment of
the function of a bodily member, organ, or mental
faculty; or
‘‘(iv) requiring medical intervention such as sur-
gery, hospitalization, or physical rehabilitation.
‘‘(B) CRIMINAL SEXUAL ABUSE.—Serious bodily injury
shall be considered to have occurred if the conduct causing
the injury is conduct described in section 2241 (relating
to aggravated sexual abuse) or 2242 (relating to sexual
abuse) of title 18, United States Code, or any similar offense
under State law.
‘‘(20) SOCIAL.—The term ‘social’, when used with respect
to a service, includes adult protective services.
‘‘(21) STATE LEGAL ASSISTANCE DEVELOPER.—The term
‘State legal assistance developer’ means an individual described
in section 731 of the Older Americans Act of 1965.
‘‘(22) STATE LONG-TERM CARE OMBUDSMAN.—The term
‘State Long-Term Care Ombudsman’ means the State Long-
Term Care Ombudsman described in section 712(a)(2) of the
Older Americans Act of 1965.
‘‘SEC. 2012 42 U.S.C. 1397j–1. 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;
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‘‘SEC. 2023 42 U.S.C. 1397k–2. RESEARCH PROTECTIONS.
‘‘(a) GUIDELINES.—The Secretary shall promulgate guidelines
to assist researchers working in the area of elder abuse, neglect,
and exploitation, with issues relating to human subject protections.
‘‘(b) DEFINITION OF LEGALLY AUTHORIZED REPRESENTATIVE FOR
APPLICATION OF REGULATIONS.—For purposes of the application
of subpart A of part 46 of title 45, Code of Federal Regulations,
to research conducted under this subpart, the term ‘legally author-
ized representative’ means, unless otherwise provided by law, the
individual or judicial or other body authorized under the applicable
law to consent to medical treatment on behalf of another person.
‘‘SEC. 2024 42 U.S.C. 1397k–3. AUTHORIZATION OF APPROPRIATIONS.
‘‘There are authorized to be appropriated to carry out this
subpart—
‘‘(1) for fiscal year 2011, $6,500,000; and
‘‘(2) for each of fiscal years 2012 through 2014, $7,000,000.
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—695
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—696
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—697
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—698
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—699
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—700
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—701
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—702
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—703
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—704
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—705
‘‘(c) PENALTIES.—
‘‘(1) IN GENERAL.—If a covered individual violates sub-
section (b)—
‘‘(A) the covered individual shall be subject to a civil
money penalty of not more than $200,000; and
‘‘(B) the Secretary may make a determination in the
same proceeding to exclude the covered individual from
participation in any Federal health care program (as
defined in section 1128B(f)).
‘‘(2) INCREASED HARM.—If a covered individual violates sub-
section (b) and the violation exacerbates the harm to the victim
of the crime or results in harm to another individual—
‘‘(A) the covered individual shall be subject to a civil
money penalty of not more than $300,000; and
‘‘(B) the Secretary may make a determination in the
same proceeding to exclude the covered individual from
participation in any Federal health care program (as
defined in section 1128B(f)).
‘‘(3) EXCLUDED INDIVIDUAL.—During any period for which
a covered individual is classified as an excluded individual
under paragraph (1)(B) or (2)(B), a long-term care facility that
employs such individual shall be ineligible to receive Federal
funds under this Act.
‘‘(4) EXTENUATING CIRCUMSTANCES.—
‘‘(A) IN GENERAL.—The Secretary may take into account
the financial burden on providers with underserved popu-
lations in determining any penalty to be imposed under
this subsection.
‘‘(B) UNDERSERVED POPULATION DEFINED.—In this
paragraph, the term ‘underserved population’ means the
population of an area designated by the Secretary as an
area with a shortage of elder justice programs or a popu-
lation group designated by the Secretary as having a short-
age of such programs. Such areas or groups designated
by the Secretary may include—
‘‘(i) areas or groups that are geographically isolated
(such as isolated in a rural area);
‘‘(ii) racial and ethnic minority populations; and
‘‘(iii) populations underserved because of special
needs (such as language barriers, disabilities, alien
status, or age).
‘‘(d) ADDITIONAL PENALTIES FOR RETALIATION.—
‘‘(1) IN GENERAL.—A long-term care facility may not—
‘‘(A) discharge, demote, suspend, threaten, harass, or
deny a promotion or other employment-related benefit to
an employee, or in any other manner discriminate against
an employee in the terms and conditions of employment
because of lawful acts done by the employee; or
‘‘(B) file a complaint or a report against a nurse or
other employee with the appropriate State professional dis-
ciplinary agency because of lawful acts done by the nurse
or employee,
for making a report, causing a report to be made, or for taking
steps in furtherance of making a report pursuant to subsection
(b)(1).
‘‘(2) PENALTIES FOR RETALIATION.—If a long-term care
facility violates subparagraph (A) or (B) of paragraph (1) the
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—707
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—708
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—709
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—710
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—715
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—716
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—722
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—725
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—726
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‘‘SEC. 3203 ø42 U.S.C. 30011–2¿. CLASS INDEPENDENCE BENEFIT PLAN.
‘‘(a) PROCESS FOR DEVELOPMENT.—
‘‘(1) IN GENERAL.—The Secretary, in consultation with
appropriate actuaries and other experts, shall develop at least
3 actuarially sound benefit plans as alternatives for consider-
ation for designation by the Secretary as the CLASS Independ-
ence Benefit Plan under which eligible beneficiaries shall
receive benefits under this title. Each of the plan alternatives
developed shall be designed to provide eligible beneficiaries
with the benefits described in section 3205 consistent with
the following requirements:
‘‘(A) PREMIUMS.—
‘‘(i) IN GENERAL.—Beginning with the first year
of the CLASS program, and for each year thereafter,
subject to clauses (ii) and (iii), the Secretary shall
establish all premiums to be paid by enrollees for the
year based on an actuarial analysis of the 75-year
costs of the program that ensures solvency throughout
such 75-year period.
‘‘(ii) NOMINAL PREMIUM FOR POOREST INDIVIDUALS
AND FULL-TIME STUDENTS.—
‘‘(I) IN GENERAL.—The monthly premium for
enrollment in the CLASS program shall not exceed
the applicable dollar amount per month deter-
mined under subclause (II) for—
‘‘(aa) any individual whose income does
not exceed the poverty line; and
‘‘(bb) any individual who has not attained
age 22, and is actively employed during any
period in which the individual is a full-time
student (as determined by the Secretary).
‘‘(II) APPLICABLE DOLLAR AMOUNT.—The
applicable dollar amount described in this sub-
clause is the amount equal to $5, increased by
the percentage increase in the consumer price
index for all urban consumers (U.S. city average)
for each year occurring after 2009 and before such
year.
‘‘(iii) CLASS INDEPENDENCE FUND RESERVES.—At
such time as the CLASS program has been in operation
for 10 years, the Secretary shall establish all premiums
to be paid by enrollees for the year based on an actu-
arial analysis that accumulated reserves in the CLASS
Independence Fund would not decrease in that year.
At such time as the Secretary determines the CLASS
program demonstrates a sustained ability to finance
expected yearly expenses with expected yearly pre-
miums and interest credited to the CLASS Independ-
ence Fund, the Secretary may decrease the required
amount of CLASS Independence Fund reserves.
‘‘(B) VESTING PERIOD.—A 5-year vesting period for eligi-
bility for benefits.
‘‘(C) BENEFIT TRIGGERS.—A benefit trigger for provision
of benefits that requires a determination that an individual
has a functional limitation, as certified by a licensed health
care practitioner, described in any of the following clauses
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—739
‘‘SEC. 3204 ø42 U.S.C. 30011–3¿. ENROLLMENT AND DISENROLLMENT
REQUIREMENTS.
‘‘(a) AUTOMATIC ENROLLMENT.—
‘‘(1) IN GENERAL.—Subject to paragraph (2), the Secretary,
in coordination with the Secretary of the Treasury, shall estab-
lish procedures under which each individual described in sub-
section (c) may be automatically enrolled in the CLASS program
by an employer of such individual in the same manner as
an employer may elect to automatically enroll employees in
a plan under section 401(k), 403(b), or 457 of the Internal
Revenue Code of 1986.
‘‘(2) ALTERNATIVE ENROLLMENT PROCEDURES.—The proce-
dures established under paragraph (1) shall provide for an
alternative enrollment process for an individual described in
subsection (c) in the case of such an individual—
‘‘(A) who is self-employed;
‘‘(B) who has more than 1 employer; or
‘‘(C) whose employer does not elect to participate in
the automatic enrollment process established by the Sec-
retary.
‘‘(3) ADMINISTRATION.—
‘‘(A) IN GENERAL.—The Secretary and the Secretary
of the Treasury shall, by regulation, establish procedures
to ensure that an individual is not automatically enrolled
in the CLASS program by more than 1 employer.
‘‘(B) FORM.—Enrollment in the CLASS program shall
be made in such manner as the Secretary may prescribe
in order to ensure ease of administration.
‘‘(b) ELECTION TO OPT-OUT.—An individual described in sub-
section (c) may elect to waive enrollment in the CLASS program
at any time in such form and manner as the Secretary and the
Secretary of the Treasury shall prescribe.
‘‘(c) INDIVIDUAL DESCRIBED.—For purposes of enrolling in the
CLASS program, an individual described in this paragraph is an
individual—
‘‘(1) who has attained age 18;
‘‘(2) who—
‘‘(A) receives wages or income on which there is
imposed a tax under section 3101(a) or 3201(a) of the
Internal Revenue Code of 1986; or øReplaced by section
10802(a)(2)(A)¿
‘‘(B) derives self-employment income on which there
is imposed a tax under section 1401(a) of the Internal
Revenue Code of 1986;
‘‘(3) who is actively employed; and
‘‘(4) who is not—
‘‘(A) a patient in a hospital or nursing facility, an
intermediate care facility for the mentally retarded, or
an institution for mental diseases and receiving medical
assistance under Medicaid; or
‘‘(B) confined in a jail, prison, other penal institution
or correctional facility, or by court order pursuant to convic-
tion of a criminal offense or in connection with a verdict
or finding described in section 202(x)(1)(A)(ii) of the Social
Security Act (42 U.S.C. 402(x)(1)(A)(ii)).
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this title shall be
construed as requiring an active enrollee to continue to satisfy
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—740
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—744
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—746
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—748
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—756
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—758
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—759
SEC. 9002. INCLUSION OF COST OF EMPLOYER-SPONSORED HEALTH
COVERAGE ON W–2.
(a) IN GENERAL.—Section 6051(a) of the Internal Revenue Code
of 1986 (relating to receipts for employees) is amended by striking
‘‘and’’ at the end of paragraph (12), by striking the period at the
end of paragraph (13) and inserting ‘‘, and’’, and by adding after
paragraph (13) the following new paragraph:
‘‘(14) the aggregate cost (determined under rules similar
to the rules of section 4980B(f)(4)) of applicable employer-spon-
sored coverage (as defined in section 4980I(d)(1)), except that
this paragraph shall not apply to—
‘‘(A) coverage to which paragraphs (11) and (12) apply,
or
‘‘(B) the amount of any salary reduction contributions
to a flexible spending arrangement (within the meaning
of section 125).’’.
(b) EFFECTIVE DATE.—The amendments made by this section
shall apply to taxable years beginning after December 31, 2010.
SEC. 9003. DISTRIBUTIONS FOR MEDICINE QUALIFIED ONLY IF FOR
PRESCRIBED DRUG OR INSULIN.
(a) HSAS.—Subparagraph (A) of section 223(d)(2) of the Internal
Revenue Code of 1986 is amended by adding at the end the fol-
lowing: ‘‘Such term shall include an amount paid for medicine
or a drug only if such medicine or drug is a prescribed drug
(determined without regard to whether such drug is available with-
out a prescription) or is insulin.’’.
(b) ARCHER MSAS.—Subparagraph (A) of section 220(d)(2) of
the Internal Revenue Code of 1986 is amended by adding at the
end the following: ‘‘Such term shall include an amount paid for
medicine or a drug only if such medicine or drug is a prescribed
drug (determined without regard to whether such drug is available
without a prescription) or is insulin.’’.
(c) HEALTH FLEXIBLE SPENDING ARRANGEMENTS AND HEALTH
REIMBURSEMENT ARRANGEMENTS.—Section 106 of the Internal Rev-
enue Code of 1986 is amended by adding at the end the following
new subsection:
‘‘(f) REIMBURSEMENTS FOR MEDICINE RESTRICTED TO PRE-
SCRIBED DRUGS AND INSULIN.—For purposes of this section and
section 105, reimbursement for expenses incurred for a medicine
or a drug shall be treated as a reimbursement for medical expenses
only if such medicine or drug is a prescribed drug (determined
without regard to whether such drug is available without a prescrip-
tion) or is insulin.’’.
(d) EFFECTIVE DATES.—
(1) DISTRIBUTIONS FROM SAVINGS ACCOUNTS.—The amend-
ments made by subsections (a) and (b) shall apply to amounts
paid with respect to taxable years beginning after December
31, 2010.
(2) REIMBURSEMENTS.—The amendment made by sub-
section (c) shall apply to expenses incurred with respect to
taxable years beginning after December 31, 2010.
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SEC. 9004. INCREASE IN ADDITIONAL TAX ON DISTRIBUTIONS FROM
HSAS AND ARCHER MSAS NOT USED FOR QUALIFIED MED-
ICAL EXPENSES.
(a) HSAS.—Section 223(f)(4)(A) of the Internal Revenue Code
of 1986 is amended by striking ‘‘10 percent’’ and inserting ‘‘20
percent’’.
(b) ARCHER MSAS.—Section 220(f)(4)(A) of the Internal Revenue
Code of 1986 is amended by striking ‘‘15 percent’’ and inserting
‘‘20 percent’’.
(c) EFFECTIVE DATE.—The amendments made by this section
shall apply to distributions made after December 31, 2010.
SEC. 9005. LIMITATION ON HEALTH FLEXIBLE SPENDING ARRANGE-
MENTS UNDER CAFETERIA PLANS.
(a) IN GENERAL.—Section 125 of the Internal Revenue Code
of 1986 is amended—
(1) by redesignating subsections (i) and (j) as subsections
(j) and (k), respectively, and
(2) by inserting after subsection (h) the following new sub-
section:
‘‘(i) LIMITATION ON HEALTH FLEXIBLE SPENDING ARRANGE-
MENTS.—øReplaced by section 10902(a)¿
‘‘(1) IN GENERAL.—For purposes of this section, if a benefit
is provided under a cafeteria plan through employer contribu-
tions to a health flexible spending arrangement, such benefit
shall not be treated as a qualified benefit unless the cafeteria
plan provides that an employee may not elect for any taxable
year to have salary reduction contributions in excess of $2,500
made to such arrangement.
‘‘(2) ADJUSTMENT FOR INFLATION.—øAs revised by section
1403(b) of HCERA¿ In the case of any taxable year beginning
after December 31, 2013, the dollar amount in paragraph (1)
shall be increased by an amount equal to—
‘‘(A) such amount, multiplied by
‘‘(B) the cost-of-living adjustment determined under
section 1(f)(3) for the calendar year in which such taxable
year begins by substituting ‘calendar year 2012’ for ‘cal-
endar year 1992’ in subparagraph (B) thereof.
If any increase determined under this paragraph is not a mul-
tiple of $50, such increase shall be rounded to the next lowest
multiple of $50.’’.
(b) EFFECTIVE DATE.—The amendments made by this section
shall apply to taxable years beginning after December 31, 2010.
SEC. 9006. EXPANSION OF INFORMATION REPORTING REQUIREMENTS.
(a) IN GENERAL.—Section 6041 of the Internal Revenue Code
of 1986 is amended by adding at the end the following new sub-
sections:
‘‘(h) APPLICATION TO CORPORATIONS.—Notwithstanding any
regulation prescribed by the Secretary before the date of the enact-
ment of this subsection, for purposes of this section the term ‘person’
includes any corporation that is not an organization exempt from
tax under section 501(a).
‘‘(i) REGULATIONS.—The Secretary may prescribe such regula-
tions and other guidance as may be appropriate or necessary to
carry out the purposes of this section, including rules to prevent
duplicative reporting of transactions.’’.
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—764
(e) REPORTS.—
(1) REPORT ON LEVELS OF CHARITY CARE.—The Secretary
of the Treasury, in consultation with the Secretary of Health
and Human Services, shall submit to the Committees on Ways
and Means, Education and Labor, and Energy and Commerce
of the House of Representatives and to the Committees on
Finance and Health, Education, Labor, and Pensions of the
Senate an annual report on the following:
(A) Information with respect to private tax-exempt,
taxable, and government-owned hospitals regarding—
(i) levels of charity care provided,
(ii) bad debt expenses,
(iii) unreimbursed costs for services provided with
respect to means-tested government programs, and
(iv) unreimbursed costs for services provided with
respect to non-means tested government programs.
(B) Information with respect to private tax-exempt hos-
pitals regarding costs incurred for community benefit activi-
ties.
(2) REPORT ON TRENDS.—
(A) STUDY.—The Secretary of the Treasury, in consulta-
tion with the Secretary of Health and Human Services,
shall conduct a study on trends in the information required
to be reported under paragraph (1).
(B) REPORT.—Not later than 5 years after the date
of the enactment of this Act, the Secretary of the Treasury,
in consultation with the Secretary of Health and Human
Services, shall submit a report on the study conducted
under subparagraph (A) to the Committees on Ways and
Means, Education and Labor, and Energy and Commerce
of the House of Representatives and to the Committees
on Finance and Health, Education, Labor, and Pensions
of the Senate.
(f) EFFECTIVE DATES.—
(1) IN GENERAL.—Except as provided in paragraphs (2)
and (3), the amendments made by this section shall apply
to taxable years beginning after the date of the enactment
of this Act.
(2) COMMUNITY HEALTH NEEDS ASSESSMENT.—The require-
ments of section 501(r)(3) of the Internal Revenue Code of
1986, as added by subsection (a), shall apply to taxable years
beginning after the date which is 2 years after the date of
the enactment of this Act.
(3) EXCISE TAX.—The amendments made by subsection (b)
shall apply to failures occurring after the date of the enactment
of this Act.
SEC. 9008. IMPOSITION OF ANNUAL FEE ON BRANDED PRESCRIPTION
PHARMACEUTICAL MANUFACTURERS AND IMPORTERS.
(a) IMPOSITION OF FEE.—
(1) IN GENERAL.—Each covered entity engaged in the busi-
ness of manufacturing or importing branded prescription drugs
shall pay to the Secretary of the Treasury not later than the
annual payment date of each calendar year beginning after
2010 a fee in an amount determined under subsection (b).
øAs revised by section 1404(a)(1) of HCERA¿
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—766
2019 and thereafter ...................................................... $2,800,000,000.
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—767
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—768
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—769
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—770
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—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
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—778
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—779
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—780
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. 10310. REPEAL OF PHYSICIAN PAYMENT UPDATE øAMENDMENTS
FULLY INCORPORATED ABOVE¿.
øRepealed section 3101¿
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)¿
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—816
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¿
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
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—817
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—818
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—819
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—820
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—821
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—822
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—823
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—824
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—825
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—826
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—827
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—828
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—829
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—830
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—831
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
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
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—840
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—841
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—842
‘‘SEC. 402C ø42 U.S.C. 282d¿. CURES ACCELERATION NETWORK.
‘‘(a) DEFINITIONS.—In this section:
‘‘(1) BIOLOGICAL PRODUCT.—The term ‘biological product’
has the meaning given such term in section 351 of the Public
Health Service Act.
‘‘(2) DRUG; DEVICE.—The terms ‘drug’ and ‘device’ have
the meanings given such terms in section 201 of the Federal
Food, Drug, and Cosmetic Act.
‘‘(3) HIGH NEED CURE.—The term ‘high need cure’ means
a drug (as that term is defined by section 201(g)(1) of the
Federal Food, Drug, and Cosmetic Act, biological product (as
that term is defined by section 262(i)), or device (as that term
is defined by section 201(h) of the Federal Food, Drug, and
Cosmetic Act) that, in the determination of the Director of
NIH—
‘‘(A) is a priority to diagnose, mitigate, prevent, or
treat harm from any disease or condition; and
‘‘(B) for which the incentives of the commercial market
are unlikely to result in its adequate or timely development.
‘‘(4) MEDICAL PRODUCT.—The term ‘medical product’ means
a drug, device, biological product, or product that is a combina-
tion of drugs, devices, and biological products.
‘‘(b) ESTABLISHMENT OF THE CURES ACCELERATION NETWORK.—
Subject to the appropriation of funds as described in subsection
(g), there is established within the Office of the Director of NIH
a program to be known as the Cures Acceleration Network (referred
to in this section as ‘CAN’), which shall—
‘‘(1) be under the direction of the Director of NIH, taking
into account the recommendations of a CAN Review Board
(referred to in this section as the ‘Board’), described in sub-
section (d); and
‘‘(2) award grants and contracts to eligible entities, as
described in subsection (e), to accelerate the development of
high need cures, including through the development of medical
products and behavioral therapies.
‘‘(c) FUNCTIONS.—The functions of the CAN are to—
‘‘(1) conduct and support revolutionary advances in basic
research, translating scientific discoveries from bench to bed-
side;
‘‘(2) award grants and contracts to eligible entities to accel-
erate the development of high need cures;
‘‘(3) provide the resources necessary for government agen-
cies, independent investigators, research organizations, bio-
technology companies, academic research institutions, and other
entities to develop high need cures;
‘‘(4) reduce the barriers between laboratory discoveries and
clinical trials for new therapies; and
‘‘(5) facilitate review in the Food and Drug Administration
for the high need cures funded by the CAN, through activities
that may include—
‘‘(A) the facilitation of regular and ongoing communica-
tion with the Food and Drug Administration regarding
the status of activities conducted under this section;
‘‘(B) ensuring that such activities are coordinated with
the approval requirements of the Food and Drug Adminis-
tration, with the goal of expediting the development and
approval of countermeasures and products; and
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—843
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—844
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—845
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
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—853
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—854
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
(3) Section 337(b)(1) of the Public Health Service Act (42 U.S.C.
254j(b)(1)) is amended by striking ‘‘Members may not be reappointed
to the Council.’’.
(4) Section 338B(g)(2)(A) of the Public Health Service Act (42
U.S.C. 254l–1(g)(2)(A)) is amended by striking ‘‘$35,000’’ and
inserting ‘‘$50,000, plus, beginning with fiscal year 2012, an amount
determined by the Secretary on an annual basis to reflect inflation,’’.
(5) øAmended subsection (a) of section 338C of the Public Health
Service Act, as amended by section 5508¿
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 ø42 U.S.C. 254b–2¿. 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
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—864
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—865
SEC. 10602. CLARIFICATIONS TO PATIENT-CENTERED OUTCOMES
RESEARCH øAMENDMENTS FULLY INCORPORATED
ABOVE¿.
øAmended section 1181 of the Social Security Act (as added
by section 6301)¿
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
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Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—866
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—867
Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—868
‘‘SEC. 399V–4 ø42 U.S.C. 280g–15¿. STATE DEMONSTRATION PROGRAMS
TO EVALUATE ALTERNATIVES TO CURRENT MEDICAL
TORT LITIGATION.
‘‘(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—