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AAHCA BillText 071409
AAHCA BillText 071409
XML
H.L.C.
.....................................................................
(Original Signature of Member)
H. R. ll
111TH CONGRESS
1ST SESSION
To provide affordable, quality health care for all Americans and reduce
the growth in health care spending, and for other purposes.
A BILL
To provide affordable, quality health care for all Americans
and reduce the growth in health care spending, and
for other purposes.
1
4
5
AND SUBTITLES.
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2
1
2
(b) TABLE
TITLES.This
OF
DIVISIONS, TITLES,
AND
SUB-
3 subtitles as follows:
DIVISION AAFFORDABLE HEALTH CARE CHOICES
TITLE IPROTECTIONS AND STANDARDS FOR QUALIFIED
HEALTH BENEFITS PLANS
Subtitle AGeneral Standards
Subtitle BStandards Guaranteeing Access to Affordable Coverage
Subtitle CStandards Guaranteeing Access to Essential Benefits
Subtitle DAdditional Consumer Protections
Subtitle EGovernance
Subtitle FRelation to Other Requirements; Miscellaneous
Subtitle GEarly Investments
TITLE IIHEALTH INSURANCE EXCHANGE AND RELATED
PROVISIONS
Subtitle AHealth Insurance Exchange
Subtitle BPublic Health Insurance Option
Subtitle CIndividual Affordability Credits
TITLE IIISHARED RESPONSIBILITY
Subtitle AIndividual Responsibility
Subtitle BEmployer Responsibility
TITLE IVAMENDMENTS TO INTERNAL REVENUE CODE OF 1986
Subtitle AShared Responsibility
Subtitle BCredit for Small Business Employee Health Coverage Expenses
Subtitle CDisclosures to Carry Out Health Insurance Exchange Subsidies
Subtitle DOther Revenue Provisions
DIVISION BMEDICARE AND MEDICAID IMPROVEMENTS
TITLE IIMPROVING HEALTH CARE VALUE
Subtitle AProvisions Related to Medicare Part A
Subtitle BProvisions Related to Part B
Subtitle CProvisions Related to Medicare Parts A and B
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3
Subtitle DMedicare Advantage Reforms
Subtitle EImprovements to Medicare Part D
Subtitle FMedicare Rural Access Protections
TITLE IIMEDICARE BENEFICIARY IMPROVEMENTS
Subtitle AImproving and Simplifying Financial Assistance for Low Income
Medicare Beneficiaries
Subtitle BReducing Health Disparities
Subtitle CMiscellaneous Improvements
TITLE IIIPROMOTING PRIMARY CARE, MENTAL HEALTH
SERVICES, AND COORDINATED CARE
TITLE IVQUALITY
Subtitle AComparative Effectiveness Research
Subtitle BNursing Home Transparency
Subtitle CQuality Measurements
Subtitle DPhysician Payments Sunshine Provision
Subtitle EPublic Reporting on Health Care-Associated Infections
TITLE VMEDICARE GRADUATE MEDICAL EDUCATION
TITLE VIPROGRAM INTEGRITY
Subtitle AIncreased Funding to Fight Waste, Fraud, and Abuse
Subtitle BEnhanced Penalties for Fraud and Abuse
Subtitle CEnhanced Program and Provider Protections
Subtitle DAccess to Information Needed to Prevent Fraud, Waste, and
Abuse
TITLE VIIMEDICAID AND CHIP
Subtitle AMedicaid and Health Reform
Subtitle BPrevention
Subtitle CAccess
Subtitle DCoverage
Subtitle EFinancing
Subtitle FWaste, Fraud, and Abuse
Subtitle GPuerto Rico and the Territories
Subtitle HMiscellaneous
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4
TITLE VIIIREVENUE-RELATED PROVISIONS
TITLE IXMISCELLANEOUS PROVISIONS
DIVISION CPUBLIC HEALTH AND WORKFORCE DEVELOPMENT
TITLE ICOMMUNITY HEALTH CENTERS
TITLE IIWORKFORCE
Subtitle APrimary Care Workforce
Subtitle BNursing Workforce
Subtitle CPublic Health Workforce
Subtitle DAdapting Workforce to Evolving Health System Needs
TITLE IIIPREVENTION AND WELLNESS
TITLE IVQUALITY AND SURVEILLANCE
TITLE VOTHER PROVISIONS
Subtitle ADrug Discount for Rural and Other Hospitals
Subtitle BSchool-Based Health Clinics
Subtitle CNational Medical Device Registry
Subtitle DGrants for Comprehensive Programs to Provide Education to
Nurses and Create a Pipeline to Nursing
Subtitle EStates Failing to Adhere to Certain Employment Obligations
DIVISION AAFFORDABLE
HEALTH CARE CHOICES
GENERAL DEFINITIONS.
(a) PURPOSE.
(1) IN
spending.
10
11
(2) BUILDING
ON CURRENT SYSTEM.This
di-
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GENERAL.The
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5
1
(3) INSURANCE
REFORMS.This
division
forms;
10
credits; and
11
12
13
14
health benefits.
15
(4) HEALTH
DELIVERY REFORM.This
division
16
17
18
19
20
(b) TABLE
OF
CONTENTS
OF
DIVISION.The table
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6
Subtitle BStandards Guaranteeing Access to Affordable Coverage
Sec.
Sec.
Sec.
Sec.
111.
112.
113.
114.
121.
122.
123.
124.
Sec.
Sec.
Sec.
Sec.
131.
132.
133.
134.
141.
142.
143.
144.
Sec.
Sec.
Sec.
Sec.
Sec.
151.
152.
153.
154.
155.
Sec.
Sec.
Sec.
Sec.
161.
162.
163.
164.
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Sec. 202. Exchange-eligible individuals and employers.
Sec. 203. Benefits package levels.
Sec. 204. Contracts for the offering of Exchange-participating health benefits
plans.
Sec. 205. Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plan.
Sec. 206. Other functions.
Sec. 207. Health Insurance Exchange Trust Fund.
Sec. 208. Optional operation of State-based health insurance exchanges.
Subtitle BPublic Health Insurance Option
Sec. 221. Establishment and administration of a public health insurance option
as an Exchange-qualified health benefits plan.
Sec. 222. Premiums and financing.
Sec. 223. Payment rates for items and services.
Sec. 224. Modernized payment initiatives and delivery system reform.
Sec. 225. Provider participation.
Sec. 226. Application of fraud and abuse provisions.
Subtitle CIndividual Affordability Credits
Sec.
Sec.
Sec.
Sec.
Sec.
Sec.
241.
242.
243.
244.
245.
246.
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Subtitle AShared Responsibility
PART 1INDIVIDUAL RESPONSIBILITY
Sec. 401. Tax on individuals without acceptable health care coverage.
PART 2EMPLOYER RESPONSIBILITY
Sec. 411. Election to satisfy health coverage participation requirements.
Sec. 412. Responsibilities of nonelecting employers.
Subtitle BCredit for Small Business Employee Health Coverage Expenses
Sec. 421. Credit for small business employee health coverage expenses.
Subtitle CDisclosures to Carry Out Health Insurance Exchange Subsidies
Sec. 431. Disclosures to carry out health insurance exchange subsidies.
Subtitle DOther Revenue Provisions
PART 1GENERAL PROVISIONS
Sec. 441. Surcharge on high income individuals.
Sec. 442. Delay in application of worldwide allocation of interest.
PART 2PREVENTION
OF
TAX AVOIDANCE
(1) ACCEPTABLE
term ac-
in section 202(d)(2).
(2) BASIC
9
10
PLAN.The
(3)
COMMISSIONER.The
term
Commis-
sioner means the Health Choices Commissioner established under section 141.
11
12
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COVERAGE.The
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9
1
7
8
(6) EMPLOYMENT-BASED
10
11
12
13
lowing:
14
(i) FEDERAL,
STATE,
AND
TRIBAL
15
GOVERNMENTAL PLANS.A
16
17
18
19
20
States Code.
21
(ii) CHURCH
PLANS.A
governmental
church plan
22
23
24
1974).
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HEALTH PLAN.The
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10
1
(7) ENHANCED
term enhanced
203(c).
(8) ESSENTIAL
BENEFITS PACKAGE.The
term
122(a).
7
8
(9) FAMILY.The term family means an individual and includes the individuals dependents.
(10) FEDERAL
POVERTY
LEVEL;
FPL.The
10
11
12
13
14
by such section.
15
(11) HEALTH
BENEFITS
PLAN.The
terms
16
17
18
19
(12) HEALTH
20
INSURANCE ISSUER.The
21
22
23
24
25
(13) HEALTH
INSURANCE
EXCHANGE.The
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PLAN.The
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1
tion 201.
10
(16) PLAN
11
12
13
14
(17) PLAN
15
YEAR.The
means
16
17
18
plan; or
19
20
21
22
sioner.
23
(18) PREMIUM
24
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SPONSOR.The
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1
203(c).
(19) QHBP
terms
10
11
12
13
14
15
ployer;
16
17
18
19
20
21
22
23
24
25
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OFFERING ENTITY.The
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1
(20) QUALIFIED
(21) PUBLIC
10
11
12
13
(22) SERVICE
14
15
16
erage
17
18
19
20
21
and
22
23
24
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14
1
(24) STATE
MEDICAID
AGENCY.The
term
10
(25) Y1,
Y2, ETC..The
terms Y1 , Y2,
11
12
13
spectively.
17
TITLE
IPROTECTIONS
AND
STANDARDS FOR QUALIFIED
HEALTH BENEFITS PLANS
Subtitle AGeneral Standards
18
14
15
16
19
20
ANCE MARKETPLACE.
21 lish standards to ensure that new health insurance cov22 erage and employment-based health plans that are offered
23 meet standards guaranteeing access to affordable cov24 erage, essential benefits, and other consumer protections.
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15
1
2
(b) REQUIREMENTS
FOR
FITS
10
tion).
11
12
(1)
IN
EMPLOYMENT-BASED
13
HEALTH PLANS.An
14
15
16
17
18
19
(2) INDIVIDUAL
20
ANCE COVERAGE.The
21
22
23
24
25
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ENROLLMENT
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1
2
3
4
COVERAGE.
5 this section, for purposes of establishing acceptable cov6 erage under this division, the term grandfathered health
7 insurance coverage means individual health insurance
8 coverage that is offered and in force and effect before the
9 first day of Y1 if the following conditions are met:
10
(1) LIMITATION
11
(A) IN
GENERAL.Except
as provided in
12
13
14
15
16
day of Y1.
17
(B)
DEPENDENT
COVERAGE
PER-
18
MITTED.Subparagraph
19
20
21
(2) LIMITATION
ON CHANGES IN TERMS OR
22
CONDITIONS.Subject
23
24
25
26
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ON NEW ENROLLMENT.
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1
(3) RESTRICTIONS
ON PREMIUM INCREASES.
Commissioner.
FOR
CURRENT EMPLOYMENT-
(1) GRACE
11
(A)
IN
GENERAL.The
Commissioner
12
13
14
15
16
17
18
19
20
(B) EXCEPTION
21
PLANS.Subparagraph
22
23
24
lowing:
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PERIOD.
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1
10
of such section.
11
12
13
14
15
16
17
18
(2) TRANSITIONAL
TREATMENT
AS
ACCEPT-
19
ABLE COVERAGE.During
20
21
22
23
24 COVERAGE.
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19
1
(1) IN
GENERAL.Individual
health insurance
(2) SEPARATE,
EXCEPTED
COVERAGE
PER-
MITTED.Excepted
10
11
12
13
14
coverage.
17
Subtitle
BStandards
Guaranteeing Access to Affordable Coverage
18
15
16
19
20
SIONS.
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20
1 2791(d)(9) of the Public Health Service Act) in relation
2 to the individual or dependent.
3
4
5
SURED PLANS.
6 sections (c) and (e)) and 2712 (other than paragraphs (3),
7 and (6) of subsection (b) and subsection (e)) of the Public
8 Health Service Act, relating to guaranteed availability and
9 renewability of health insurance coverage, shall apply to
10 individuals and employers in all individual and group
11 health insurance coverage, whether offered to individuals
12 or employers through the Health Insurance Exchange,
13 through any employment-based health plan, or otherwise,
14 in the same manner as such sections apply to employers
15 and health insurance coverage offered in the small group
16 market, except that such section 2712(b)(1) shall apply
17 only if, before nonrenewal or discontinuation of coverage,
18 the issuer has provided the enrollee with notice of non19 payment of premiums and there is a grace period during
20 which the enrollees has an opportunity to correct such
21 nonpayment. Rescissions of such coverage shall be prohib22 ited except in cases of fraud as defined in sections
23 2712(b)(2) of such Act.
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1
2
(1) LIMITED
10
(2) BY
AREA.By
11
12
13
14
15
(3) BY
FAMILY ENROLLMENT.By
family en-
16
17
18
19
20
21
of the Commissioner.
22
23
24
25
26
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1
plans.
10
11
ployer size.
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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1
10
11
DISORDER BENEFITS.
(a) NONDISCRIMINATION
IN
BENEFITS.A qualified
12 health benefits plan shall comply with standards estab13 lished by the Commissioner to prohibit discrimination in
14 health benefits or benefit structures for qualifying health
15 benefits plans, building from sections 702 of Employee
16 Retirement Income Security Act of 1974, 2702 of the
17 Public Health Service Act, and section 9802 of the Inter18 nal Revenue Code of 1986.
19
(b) PARITY
IN
MENTAL HEALTH
AND
SUBSTANCE
20 ABUSE DISORDER BENEFITS.To the extent such provi21 sions are not superceded by or inconsistent with subtitle
22 C, the provisions of section 2705 (other than subsections
23 (a)(1), (a)(2), and (c)) of section 2705 of the Public
24 Health Service Act shall apply to a qualified health bene25 fits plan, regardless of whether it is offered in the indi-
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24
1 vidual or group market, in the same manner as such provi2 sions apply to health insurance coverage offered in the
3 large group market.
4
19 shall meet a medical loss ratio as defined by the Commis20 sioner. For any plan year in which the qualified health
21 benefits plan does not meet such medical loss ratio, QHBP
22 offering entity shall provide in a manner specified by the
23 Commissioner for rebates to enrollees of payment suffi24 cient to meet such loss ratio.
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1
(b) BUILDING
ON
14
Subtitle
CStandards
Guaranteeing Access to Essential Benefits
15
12
13
16
22
(1)
HEALTH
23
BENEFITS PLANS.In
24
25
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1
(2) EXCHANGE-PARTICIPATING
HEALTH BENE-
FITS PLANS.In
(3) CONTINUATION
OF OFFERING OF SEPARATE
10
11
12
13
14
15
certificate of insurance.
16
(c) NO RESTRICTIONS
17
TO
ON
in this
COVERAGE UNRELATED
18 efits plan may not impose any restriction (other than cost19 sharing) unrelated to clinical appropriateness on the cov20 erage of the health care items and services.
21
22
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1 ensure the provision of quality health care and financial
2 security, that
3
10
11
12
services;
13
14
15
16
17
18
sored coverage.
19
TO
BE COVERED.The
20 items and services described in this subsection are the fol21 lowing:
22
(1) Hospitalization.
23
24
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1
health professionals.
10
11
services.
12
13
14
15
16
17
18
19
20
21
22
AND
COST-SHARING
23
(1) NO
24
ICES.There
25
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29
1
(2) ANNUAL
(A) ANNUAL
LIMITATION.The
cost-shar-
(B) APPLICABLE
LEVEL.The
applicable
10
11
12
13
14
15
16
17
(C) USE
OF COPAYMENTS.In
establishing
18
19
20
21
22
(3) MINIMUM
23
(A) IN
ACTUARIAL VALUE.
GENERAL.The
cost-sharing under
24
25
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LIMITATION.
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30
1
paragraph (B).
(B) REFERENCE
SCRIBED.The
10
11
12
imposed.
SEC. 123. HEALTH BENEFITS ADVISORY COMMITTEE.
(a) ESTABLISHMENT.
13
(1) IN
GENERAL.There
is established a pri-
14
15
16
17
18
19
20
21
sory Committee.
22
23
24
f:\VHLC\071409\071409.140.xml
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31
1
the President.
10
11
12
13
14
15
16
Act.
17
18
19
20
21
22
bers.
23
24
25
f:\VHLC\071409\071409.140.xml
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32
1
10
such Committee.
11
(b) DUTIES.
12
(1) RECOMMENDATIONS
13
ARDS.The
14
15
16
17
18
19
20
21
parities.
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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ON BENEFIT STAND-
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33
1
(3) PUBLIC
section.
(4) BENEFIT
STANDARDS DEFINED.In
this
ards respecting
10
11
12
13
14
15
(5) LEVELS
16
17
(A) ENHANCED
PLAN.The
level of cost-
18
19
20
21
22
23
in section 122(c)(3)(B).
24
(B) PREMIUM
25
PLAN.The
level of cost-
f:\VHLC\071409\071409.140.xml
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INPUT.The
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34
1
in section 122(c)(3)(B).
(c) OPERATIONS.
(1) PER
PAY.Each
DIEM
member of the
10
11
12
13
(2) MEMBERS
14
PLOYEES.Members
15
16
17
18
(3) APPLICATION
OF FACA.The
Federal Advi-
19
20
21
Committee.
22
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35
1 Services of all recommendations made by the Health Ben2 efits Advisory Committee under this section.
3
4
5
6
(a) PROCESS
ADOPTION
OF
RECOMMENDA-
TIONS.
(1) REVIEW
OF RECOMMENDED STANDARDS.
10
11
12
13
14
(2) DETERMINATION
15
TO ADOPT STANDARDS.
16
17
18
19
20
such standards; or
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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FOR
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36
1
10
11
12
deadline.
13
14
15
16
section.
17
18
(1) INITIAL
later than 18
19
20
21
22
benefit standards.
23
24
(2) PERIODIC
UPDATING STANDARDS.Under
f:\VHLC\071409\071409.140.xml
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37
1
8
9
10
11
12
HEALTH INSURERS.
16
17
MECHANISMS.
AND
APPEALS PROCESS.
f:\VHLC\071409\071409.140.xml
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38
1 published on November 21, 2000 (65 Fed. Reg. 70246)
2 and shall update such process in accordance with any
3 standards that the Commissioner may establish.
4
(1) IN
GENERAL.The
10
(2) REQUIRING
11
MECHANISMS.A
12
13
14
15
16
21
22
PLAN DISCLOSURE.
23
(1) IN
24
25
f:\VHLC\071409\071409.140.xml
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GENERAL.A
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39
1
10
plain language.
11
(2) PLAIN
LANGUAGE.In
12
13
14
15
16
17
guage writing.
18
19
20
language writing.
21
22 health benefits plan shall comply with standards estab23 lished by the Commissioner to ensure transparency to each
24 health care provider relating to reimbursement arrange25 ments between such plan and such provider.
f:\VHLC\071409\071409.140.xml
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40
1
OF
PLAN CHANGES.A
PLANS
NOT
OFFERED
THROUGH
THE
21
22
SUBROGATION OF BENEFITS.
23 coordination and subrogation of benefits and reimburse24 ment of payments in cases involving individuals and mul25 tiple plan coverage.
f:\VHLC\071409\071409.140.xml
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41
1
2
3
TION.
Subtitle EGovernance
9
10
CHOICES COMMISSIONER.
11 independent agency in the executive branch of the Govern12 ment, a Health Choices Administration (in this division
13 referred to as the Administration).
14
(b) COMMISSIONER.
15
(1) IN
Administration shall be
16
17
18
19
20
(2) COMPENSATION;
ETC.The
provisions of
21
22
23
24
25
26
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GENERAL.The
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42
1
ministration.
3
4
(1) QUALIFIED
estab-
10
11
ury.
12
(2) HEALTH
INSURANCE EXCHANGE.The
es-
13
14
15
(3) INDIVIDUAL
AFFORDABILITY
CREDITS.
16
17
18
19
(4) ADDITIONAL
FUNCTIONS.Such
additional
20
21
22
(1) IN
GENERAL.The
23
24
25
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PLAN STANDARDS.The
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
43
1
of such Exchange.
(2) COMPLIANCE
(A)
IN
GENERAL.The
commissioner
10
11
12
pected non-compliance.
13
(B) RECOUPMENT
OF COSTS IN CONNEC-
14
15
16
17
18
19
20 collect data for purposes of carrying out the Commis21 sioners duties, including for purposes of promoting qual22 ity and value, protecting consumers, and addressing dis23 parities in health and health care and may share such data
24 with the Secretary of Health and Human Services.
25
f:\VHLC\071409\071409.140.xml
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44
1
(1) IN
10
11
12
13
14
15
Act;
16
17
18
19
20
21
22
recur;
23
24
25
f:\VHLC\071409\071409.140.xml
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45
1
10
11
this title.
(e) STANDARD DEFINITIONS
OF
INSURANCE
AND
(f) EFFICIENCY
IN
ADMINISTRATION.The Commis-
f:\VHLC\071409\071409.140.xml
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46
1 the Office of Personnel Management pursuant to section
2 208 of the Intergovernmental Personnel Act of 1970 (42
3 U.S.C. 4728).
4
5
10
insurance
11
12
13
14
15
16
17
18
title.
including
concerning
the
19
20
21
22
23
24
subtitles B and D.
25
(b) COORDINATION.
f:\VHLC\071409\071409.140.xml
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47
1
(1) IN
GENERAL.In
(2) UNIFORM
STANDARDS.The
Commissioner,
10
11
12
13
14
15
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48
1
a decision or determination;
a plan;
10
11
12
enroll; and
13
14
15
16
17
18
19
20
21
22
23
24
erage policies.
f:\VHLC\071409\071409.140.xml
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49
1
2
3
4
5
(1) IN
10
11
12
13
14
15
16
17
18
Commissioner.
19
20
21
22
23
f:\VHLC\071409\071409.140.xml
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50
1
(1) IN
GENERAL.In
Exchange
10
11
12
Commissioner; and
13
14
15
16
17
18
19
20
(1)(A).
21
22
23 mitted by this Act and by subsequent regulations con24 sistent with this Act, all health care and related services
25 (including insurance coverage and public health activities)
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51
1 covered by this Act shall be provided without regard to
2 personal characteristics extraneous to the provision of
3 high quality health care or related services.
4
23
24
25
f:\VHLC\071409\071409.140.xml
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52
1
Act;
5
6
7
8
10
11
12
13
14
Act.
15
f:\VHLC\071409\071409.140.xml
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53
1 corporated organizations, nongovernmental organizations,
2 or trustees) engaged in profit or nonprofit business or in3 dustry whose activities are governed by this Act, and any
4 agent, contractor, subcontractor, grantee, or consultant of
5 such person.
6
(d) RULE
OF
10
11
GAINING.
17 provision to any person or circumstance, is held to be un18 constitutional, the remainder of the provisions of this Act
19 and the application of the provision to any other person
20 or circumstance shall not be affected.
21
22
23
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54
1
2
f:\VHLC\071409\071409.140.xml
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55
1 same manner as such provisions apply to health insurance
2 coverage offered in the small or large group market..
3
9 GUARANTEED RENEWABILITY
OF
OF
INDIVIDUAL HEALTH
CON-
13
14
TION OF RESCISSION,
15
NEWABILITY;
16
after GUARANTEED
RE-
and
17
18
19
SIONS.Section
22 scind health insurance coverage only upon clear and con23 vincing evidence of fraud described in subsection (b)(2).
24 The Secretary, no later than July 1, 2010, shall issue
f:\VHLC\071409\071409.140.xml
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56
1 guidance implementing this requirement, including proce2 dures for independent, external third party review..
3
(c) OPPORTUNITY
FOR
IN
INDEPENDENT, EXTERNAL
CERTAIN CASES.Subpart 1
SION.
10
(a) NOTICE
AND
11 surance issuer determines to rescind health insurance cov12 erage for an individual in the individual market, before
13 such rescission may take effect the issuer shall provide the
14 individual with notice of such proposed rescission and an
15 opportunity for a review of such determination by an inde16 pendent, external third party under procedures specified
17 by the Secretary under section 2742(f).
18
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57
1 respect to health insurance coverage issued before, on, or
2 after such date.
3
5 TRANSACTIONS.
6
(1) IN
10
11
TRANSACTIONS.
12
13
(a) STANDARDS
FOR
FINANCIAL
AND
ADMINISTRA-
TRANSACTIONS.
TIVE
14
(1) IN
GENERAL.The
15
16
17
(2) GOALS
18
TIVE
19
20
21
TRANSACTIONS.The
dundant standards;
22
23
24
f:\VHLC\071409\071409.140.xml
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GENERAL.Part
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58
1
nications;
10
11
12
13
fication card;
14
15
adjudication of claims;
16
17
18
19
the Secretary;
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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59
1
standards.
(3) TIME
later than 2
(4) REQUIREMENTS
FOR
SPECIFIC
10
ARDS.The
11
STAND-
12
13
14
1173;
15
16
17
18
19
20
version;
21
22
23
24
vice;
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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60
1
10
11
12
holders.
13
(5) BUILDING
14
15
16
ards.
17
(6) IMPLEMENTATION
AND ENFORCEMENT.
18
19
20
21
22
23
24
clude
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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ON EXISTING STANDARDS.In
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61
1
ards;
10
11
12
13
14
15
16
17
HITECH Act;
18
19
20
21
22
23
24
plan; and
f:\VHLC\071409\071409.140.xml
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62
1
(b) LIMITATIONS
ON
USE
OF
DATA.Nothing in
9 this section shall be construed to permit the use of infor10 mation collected under this section in a manner that would
11 adversely affect any individual.
12
13 sure (through the promulgation of regulations or other14 wise) that all data collected pursuant to subsection (a)
15 are
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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63
1
Secretary..
3
4
10
11
12
13
14
15
paragraph:
16
(9) OPERATING
term operating
17
18
19
lowing:
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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RULES.The
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64
1
(3)
CONFORMING
AMENDMENT.Section
10
11
FOR
CLAIMS ATTACHMENTS
AND
12 COORDINATION OF BENEFITS .
13
(1) STANDARD
14
MENTS.Not
15
16
17
18
19
20
21
22
(2) REVISION
23
(A) IN
GENERAL.Section
24
25
f:\VHLC\071409\071409.140.xml
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65
1
(B) EFFECTIVE
amendments
10
11
12
13
(a) ESTABLISHMENT.
14
(1) IN
GENERAL.Not
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
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DATE.The
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1
that
plan, and
10
11
ees.
12
13
14
15
16
17
erwise.
18
19
20
21
ance program.
22
23
24
25
f:\VHLC\071409\071409.140.xml
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67
1
8
9
(c) PAYMENT.
16
(1) SUBMISSION
17
(A) IN
GENERAL.Under
the reinsurance
18
19
20
21
22
23
(B) BASIS
FOR CLAIMS.Each
claim sub-
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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OF CLAIMS.
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1
10
11
12
13
14
15
pendent
16
17
18
19
(2) PROGRAM
the
retiree
in
the
form
of
the
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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of
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1
(3) USE
paid to a
10
11
12
13
14
15
16
17
(4) APPEALS
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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OF PAYMENTS.Amounts
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70
1
(1) ESTABLISHMENT.
(A) IN
is established in
10
11
12
13
14
15
until expended.
16
17
18
19
20
21
22
$10,000,000,000.
23
(C) APPROPRIATIONS
24
FUND.
f:\VHLC\071409\071409.140.xml
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GENERAL.There
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71
1
in the
program.
(ii)
BUDGETARY
IMPLICATIONS.
10
11
12
13
14
15
16
Trust Fund.
17
(iii)
18
FUNDS.The
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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GENERAL.Amounts
(i) IN
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72
1
2
3
4
9 the Health Choices Administration and under the direc10 tion of the Commissioner a Health Insurance Exchange
11 in order to facilitate access of individuals and employers,
12 through a transparent process, to a variety of choices of
13 affordable, quality health insurance coverage, including a
14 public health insurance option.
15
(b) OUTLINE
OF
DUTIES
OF
COMMISSIONER.In ac-
16 cordance with this subtitle and in coordination with appro17 priate Federal and State officials as provided under sec18 tion 143(b), the Commissioner shall
19
20
21
22
23
24
25
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73
1
9 PLAN DEFINED.In this division, the term Exchange10 participating health benefits plan means a qualified
11 health benefits plan that is offered through the Health In12 surance Exchange.
13
14
15
ERS.
(a) ACCESS
TO
22
(1)
INDIVIDUAL.The
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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EXCHANGE-ELIGIBLE
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74
1
of such individual.
(2)
EXCHANGE-ELIGIBLE
EMPLOYER.The
10
(3)
EMPLOYMENT-RELATED
DEFINITIONS.
11
12
13
14
15
16 only be eligible to enroll or participate in the Health Insur17 ance Exchange in accordance with the following transition
18 schedule:
19
20
(1) FIRST
100(c))
21
22
23
24
25
section (e)(1).
f:\VHLC\071409\071409.140.xml
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YEAR.In
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75
1
(2) SECOND
section (e)(2).
(3) THIRD
Y3
10
11
12
Y2
13
(1) INDIVIDUAL
DESCRIBED.Subject
to the
14
15
16
who
17
18
19
(2); and
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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YEAR.In
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76
1
(2) ACCEPTABLE
purposes of
(A) QUALIFIED
10
COVERAGE.Coverage
11
benefits plan.
12
(B) GRANDFATHERED
HEALTH INSURANCE
13
14
HEALTH
15
16
17
18
19
PLAN.Coverage
under a grand-
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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COVERAGE.For
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77
1
(E) MEMBERS
AND
Code.
DEPENDENTS
(INCLUDING
TRICARE).
10
11
12
13
14
15
16
17
18
(G) OTHER
COVERAGE.Such
other health
19
20
21
22
23
24
25
the Treasury.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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78
1
(3)
OF
CERTAIN
NON-TRADI-
10
11
12
13
14
under Medicaid.
15
(4) CONTINUING
16
(A) IN
indi-
ELIGIBILITY PERMITTED.
GENERAL.Except
as provided in
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
TREATMENT
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79
1
plan.
(B) EXCEPTIONS.
(i) IN
(A)
program;
10
11
12
13
14
15
(ii) TRANSITION
PERIOD.In
the case
16
17
18
19
20
21
22
23
(e) EMPLOYERS.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.Subparagraph
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80
1
to para-
(2) SMALLER
EMPLOYERS.Subject
to para-
ployees.
(3) LARGER
10
(A) IN
EMPLOYERS.
GENERAL.Beginning
11
12
13
eligible employers.
14
15
16
17
18
19
deems appropriate.
20
(4) CONTINUING
ELIGIBILITY.Once
an em-
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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EMPLOYER.Subject
(1) SMALLEST
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81
1
6
7
(5) EMPLOYER
TIONS.
(A) SATISFACTION
SIBILITY.For
OF EMPLOYER RESPON-
10
11
12
13
14
15
16
17
III.
18
(B) EMPLOYEE
CHOICE.Any
employee
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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82
1
(6) AFFILIATED
GROUPS.Any
employer which
as a single employer.
(7) OTHER
COUNTING RULES.The
Commis-
10
section.
11
(g) SURVEYS
OF
INDIVIDUALS
AND
EMPLOYERS.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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83
1
(1) IN
10
11
Exchange.
12
(2) ITEMS
13
INCLUDED IN STUDY.Such
study
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.The
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84
1
ers.
4
5
6 the benefits to be made available under Exchange-partici7 pating health benefits plans during each plan year, con8 sistent with subtitle C of title I and this section.
9
10
(b) LIMITATION
FERED BY
ON
(1) REQUIRED
16
17
area.
18
(2)
OPTIONAL
OFFERING
OF
ENHANCED
19
PLAN.If
20
for such service area, the entity may offer one en-
21
22
(3) OPTIONAL
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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85
1
(4) OPTIONAL
OFFERING OF PREMIUM-PLUS
PLANS.If
plan for such service area, the entity may offer one
(c) SPECIFICATION
BENEFIT LEVELS
OF
FOR
8 PLANS.
9
(1) IN
10
11
12
(A) BASIC,
ENHANCED,
AND
PREMIUM
13
PLANS.Standards
14
15
16
17
18
(B) PREMIUM-PLUS
PLAN
BENEFITS.
19
20
21
22
23
24
(2) BASIC
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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GENERAL.The
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86
1
(A) IN
(B) TIERED
10
11
12
244(c).
13
(3) ENHANCED
PLAN.A
the
14
15
16
17
(4) PREMIUM
PLAN.A
18
19
20
21
(5) PREMIUM-PLUS
PLAN.A
premium-plus
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.A
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87
1
(6) RANGE
COST-SHARING.The
10
11
12
13
(d) TREATMENT
OF
OF
PERMISSIBLE
VARIATION
IN
14 Insofar as a State requires a health insurance issuer offer15 ing health insurance coverage to include benefits beyond
16 the essential benefits package, such requirement shall con17 tinue to apply to an Exchange-participating health bene18 fits plan, if the State has entered into an arrangement
19 satisfactory to the Commissioner to reimburse the Com20 missioner for the amount of any net increase in afford21 ability premium credits under subtitle C as a result of an
22 increase in premium in basic plans as a result of applica23 tion of such requirement.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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88
1
2
3
(1) OFFERING
ARDS.The
AND
PLAN
STAND-
Commissioner shall
for
10
11
12
13
14
15
16
17
18
19
(2) SOLICITING
20
TRACTS.The
Commissioner shall
21
22
23
24
25
26
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
ENTITY
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89
1
(3) FAR
NOT APPLICABLE.The
provisions of
10
11
(b) STANDARDS
FOR
TO
18
19
20
(2) DATA
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
REPORTING.The
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90
1
(3)
AFFORDABILITY
CRED-
ITS.The
10
11
12
13
in a limitation in enrollment.
14
(5) RISK
POOLING PARTICIPATION.The
entity
15
16
17
(6) ESSENTIAL
COMMUNITY PROVIDERS.With
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
IMPLEMENTING
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91
1
(7) CULTURALLY
(8) ADDITIONAL
REQUIREMENTS.The
en-
entity
10
11
12
13
14
15
16
17
(c) CONTRACTS.
18
(1) BID
APPLICATION.To
be eligible to enter
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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1
(3) ENFORCEMENT
that if
10
11
12
13
14
15
16
17
18
19
(4) OVERSIGHT
20
SIBILITIES.The
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF NETWORK ADEQUACY.
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93
1
the following:
(A) GRIEVANCE
NISMS.The
10
11
12
13
14
(C) TERMINATION.
15
(i) IN
GENERAL.The
Commissioner
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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94
1
10
11
12
(ii) EXCEPTION
13
SERIOUS
14
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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RISK
TO
HEALTH.Clause
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(i)
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
95
1
of such a requirement.
PLAN.
(a) IN GENERAL.
10
11
12
13
14
15
16
17
18
19
(2)
Commissioner
shall
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
ELIGIBILITY.The
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96
1
section (b).
(1) IN
10
(2) ENROLLMENT
11
(A) OPEN
PERIODS.
ENROLLMENT
PERIOD.The
12
13
14
15
16
17
18
19
20
21
22
23
days.
24
(B) SPECIAL
25
ENROLLMENT.The
Com-
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.The
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1
as an individual who
10
11
in income.
12
(C)
INFORMATION.The
13
14
15
16
17
18
19
20
(3) AUTOMATIC
21
22
(A)
IN
GENERAL.The
Commissioner
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
ENROLLMENT
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98
1
(B)
SUBSIDIZED
SCRIBED.An
DE-
10
11
12
(i) AFFORDABILITY
13
INDIVIDUALS.The
14
CREDIT ELIGIBLE
individual
15
termined
16
17
eligible
for,
affordability
18
19
20
21
benefits plan.
22
(ii) INDIVIDUALS
ENROLLED
IN
23
TERMINATED PLAN.The
24
25
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INDIVIDUALS
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1
(4)
PAYMENT
OF
PREMIUMS
TO
PLANS.Under
change.
10
11
(1) COVERAGE
INFORMATION.The
Commis-
12
13
14
15
16
17
18
satisfaction.
19
(2) CONSUMER
20
21
22
23
24
25
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DIRECT
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100
1
responsibilities;
plans; and
10
11
12
13
14
133(a)(2)).
15
(3) USE
OF OTHER ENTITIES.In
carrying out
16
17
18
19
20
TO
MEDICAID
AND
21 CHIP.
22
(1) COVERAGE
23
(A) IN
GENERAL.In
24
25
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101
1
10
Medicaid; and
11
12
13
(3).
14
(B) EXTENDED
AS
TRADI-
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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TREATMENT
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1
such Act.
(2) CHIP
10
11
day.
12
(3) AUTOMATIC
13
14
15
16
17
18
under Medicaid.
Com-
19
20
21
22
23
24
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TRANSITION.A
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1
FOR
MEDICAID ELIGIBLE
2 INDIVIDUALS.
3
(1) IN
(A) CHOICE
GIBLE INDIVIDUALS.As
10
11
12
13
14
(B)
MEDICAID
ENROLLMENT
OBLIGA-
15
TION.An
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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GENERAL.
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1
(2) NON-TRADITIONAL
DIVIDUALS.In
icaid
individual
10
11
12
13
14
(4).
15
eligible
(3) COORDINATED
described
in
section
16
THROUGH
17
18
19
20
21
22
23
24
25
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MEMORANDUM
OF
UNDERSTANDING.
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1
plan.
(4) MEDICAID
10
11
(A) MEDICAID
INDIVIDUALS.For
ELIGIBLE
INDIVIDUAL.
12
13
14
15
(B) TRADITIONAL
16
DIVIDUAL.The
17
18
19
20
21
22
23
24
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ELIGIBLE
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106
1
(C) NON-TRADITIONAL
MEDICAID ELIGI-
BLE INDIVIDUAL.The
term non-traditional
AND
LINGUISTICALLY
14
(a) COORDINATION
OF
AFFORDABILITY CREDITS.
15 The Commissioner shall coordinate the distribution of af16 fordability premium and cost-sharing credits under sub17 title C to QHBP offering entities offering Exchange-par18 ticipating health benefits plans.
19
(b) COORDINATION
OF
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107
1 dividuals and employers enrolled under the different Ex2 change-participating health benefits plans offered by such
3 entities so as to minimize the impact of adverse selection
4 of enrollees among the plans offered by such entities.
5
6 INSURANCE EXCHANGE.
7
(1) ESTABLISHMENT;
is
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
the Exchange;
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APPOINTMENT.There
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108
1
rect them;
and
10
11
12
13
(3) APPLICATION
14
15
16
17
18
19
20
21
22
23
24
25
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109
1
8
9
(a) ESTABLISHMENT
CHANGE
OF
17 sioner shall pay from time to time from the Trust Fund
18 such amounts as the Commissioner determines are nec19 essary to make payments to operate the Health Insurance
20 Exchange, including payments under subtitle C (relating
21 to affordability credits).
22
23
(1) DEDICATED
is hereby
24
25
to the following:
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PAYMENTS.There
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110
1
(A) TAXES
viduals).
(B) EMPLOYMENT
amounts re-
TAXES ON EMPLOYERS
10
11
12
health benefits).
13
(C) EXCISE
14
CERTAIN
15
MENTS.The
16
17
18
participation requirements).
19
(2) APPROPRIATIONS
HEALTH
COVERAGE
REQUIRE-
TO COVER GOVERNMENT
20
CONTRIBUTIONS.There
21
22
23
24
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111
1
paragraph (1).
(d) APPLICATION
OF
4 lar to the rules of subchapter B of chapter 98 of the Inter5 nal Revenue Code of 1986 shall apply with respect to the
6 Trust Fund.
7
8
9
INSURANCE EXCHANGES.
(a) IN GENERAL.If
10
11
12
13
14
of States); and
15
16
(b) REQUIREMENTS
FOR
APPROVAL.The Commis-
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112
1 Exchange under this section unless the following require2 ments are met:
3
including
10
(A)
and
contracting
with
11
12
13
14
15
16
17
18
19
20
(D)
administering
affordability
credits
21
22
23
24
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1
federal requirements.
State.
10
11
12
13
14
15
16
quirements.
17
18
19
20
(1) IN
21
22
23
24
25
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GENERAL.A
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114
1
(2) TERMINATION;
INSURANCE
EX-
10
11
12
13
14
15
the
16
17
18
19
Commissioner
determines
the
Com-
State-based
20
21
22
23
24
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HEALTH
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115
1
(1) AUTHORITY
RETAINED.Enforcement
au-
the Commissioner.
(2) DISCRETION
THORITY.The
section; or
10
11
12
ance Exchange.
13
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116
EXCHANGE-QUALIFIED
PLAN.
HEALTH
BENEFITS
8 the Secretary of Health and Human Services (in this sub9 title referred to as the Secretary) shall provide for the
10 offering of an Exchange-participating health benefits plan
11 (in this division referred to as the public health insurance
12 option) that ensures choice, competition, and stability of
13 affordable, high quality coverage throughout the United
14 States in accordance with this subtitle. In designing the
15 option, the Secretarys primary responsibility is to create
16 a low-cost plan without comprimising quality or access to
17 care.
18
(b) OFFERING
AS AN
EXCHANGE-PARTICIPATING
(1) EXCLUSIVE
pub-
21
22
23
(2) ENSURING
24
25
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117
1
5
6
(3) PROVISION
OF BENEFIT LEVELS.The
pub-
10
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118
1 health insurance option similar to the duties of the Medi2 care Beneficiary Ombudsman under section 1808(c)(2) of
3 the Social Security Act.
4
(g) ACCESS
TO
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119
1
(1) IN
GENERAL.The
plans; and
costs of
10
11
12
13
14
(2) CONTINGENCY
MARGIN.In
establishing
15
16
17
gency margin.
18
(b) ACCOUNT.
19
20
21
22
23
24
25
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120
1
(2) START-UP
(A) IN
GENERAL.In
10
11
12
13
14
15
ment.
16
(B) AMORTIZATION
OF START-UP FUND-
17
ING.The
18
19
20
21
with Y1.
22
(C) LIMITATION
ON FUNDING.Nothing
in
23
24
25
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FUNDING.
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121
1
3
4
(1) IN
10
(2) INITIAL
PAYMENT RULES.
11
(A) IN
GENERAL.Except
as provided in
12
13
14
15
16
17
18
(B) EXCEPTIONS.
19
(i) PRACTITIONERS
SERVICES.Pay-
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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GENERAL.The
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122
1
than 1 percent.
(3) FOR
Secretary shall
10
11
12
13
under Medicare.
14
(4) PRESCRIPTION
DRUGS.Payment
rates
15
16
17
18
(b) INCENTIVES
19
(1) INITIAL
20
FOR
PARTICIPATING PROVIDERS.
INCENTIVE PERIOD.
(A) IN
GENERAL.The
Secretary shall
21
22
23
24
25
(a).
f:\VHLC\071409\071409.140.xml
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NEW SERVICES.The
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123
1
(B) SERVICES
services
(C) SPECIAL
RULES.A
pediatrician and
10
11
12
13
(2) SUBSEQUENT
PERIODS.
Beginning with
14
15
16
17
18
19
20
21
22
23
24
continued.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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DESCRIBED.The
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124
1
(3) ESTABLISHMENT
OF
PROVIDER
NET-
WORK.Health
(c)
ADMINISTRATIVE
PROCESS
FOR
SETTING
13 be construed as limiting the Secretarys authority to cor14 rect for payments that are excessive or deficient, taking
15 into account the provisions of section 221(a) and the
16 amounts paid for similar health care providers and serv17 ices under other Exchange-participating health benefits
18 plans.
19
(f) LIMITATIONS
ON
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125
1 odology established under this section or under section
2 224.
3
4
5
(b) REQUIREMENTS
FOR
INNOVATIVE PAYMENTS.
(1) seeks to
20
21
22
23
24
25
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126
1
(c) ENCOURAGING
ICES.To
THE
USE
OF
(b) LICENSURE
OR
CERTIFICATION.The Secretary
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127
1
in one of 2 classes:
(A) PREFERRED
phy-
10
(B)
PARTICIPATING,
NON-PREFERRED
11
PHYSICIANS.Those
12
13
14
15
16
Act.
17
(2) OTHER
PROVIDERS.The
Secretary shall
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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128
1
(d) EXCLUSION
OF
8
9
SIONS.
17
Subtitle CIndividual
Affordability Credits
18
16
19
20
CHANGE.
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129
1
sisting of
10
11
plan; and
12
13
14
15
16
17
(b) APPLICATION.
18
(1) IN
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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GENERAL.An
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130
1
10
(2) USE
11
12
13
14
15
16
17
18
19
20
determination; and
21
22
23
24
(3) MEDICAID
25
TION.In
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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131
1
10
11
12
13
14
(1) IN
Y1 and Y2 an affordable
15
16
17
(2) FLEXIBILITY
18
THORIZED.Beginning
19
20
21
22
23
24
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July 14, 2009 (12:51 p.m.)
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132
1
(d) ACCESS
TO
(a) DEFINITION.
13
(1) IN
14
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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GENERAL.For
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133
1
10
(2) TREATMENT
OF FAMILY.Except
as the
11
12
13
14
15
16
(b) LIMITATIONS
ON
EMPLOYEE
AND
DEPENDENT
17 DISQUALIFICATION.
18
(1) IN
to paragraph (2),
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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GENERAL.Subject
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134
1
(2) EXCEPTIONS.
(A)
CERTAIN
FAMILY
CIR-
CUMSTANCES.The
gible individual.
10
(B) FOR
11
ERAGE.Beginning
12
13
14
15
16
17
18
19
20
(1) IN
GENERAL.In
21
22
23
of 1986).
24
25
(2) STUDY
OF
INCOME
DISREGARDS.The
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FOR
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135
1
this subtitle. Not later than the first day of Y2, the
(d) CLARIFICATION
ABILITY
OF
TREATMENT
OF
AFFORD-
14 under this section for an affordable credit eligible indi15 vidual enrolled in an Exchange-participating health bene16 fits plan is in an amount equal to the amount (if any)
17 by which the premium for the plan (or, if less, the ref18 erence premium amount specified in subsection (c)), ex19 ceeds the affordable premium amount specified in sub20 section (b) for the individual.
21
22
(1) IN
affordable premium
23
24
25
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GENERAL.The
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136
1
and
plan year.
(2) PREMIUM
TABLE.The
10
11
12
13
14
15
tier.
16
(d) TABLE
OF
ON
INCOME
25 TIER.
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AND
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137
1
(1) IN
GENERAL.For
lows:
In the case of family income (expressed as a
percent of FPL) within
the following income
tier:
133%
150%
200%
250%
300%
350%
through
through
through
through
through
through
4
5
The actuarial
value percentage is
1.5%
3%
5%
7%
9%
10%
3%
5%
7%
9%
10%
11%
97%
93%
85%
78%
72%
70%
150%
200%
250%
300%
350%
400%
(2) SPECIAL
RULES.For
purposes of applying
(A) FOR
10
of FPL.
11
(B) APPLICATION
OF HIGHER ACTUARIAL
12
VALUE
13
POINTS.If
14
15
16
17
18
PERCENTAGE
AT
TIER
TRANSITION
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138
1 benefits plan is in the form of the cost-sharing reduction
2 described in subsection (b) provided under this section for
3 the income tier in which the individual is classified based
4 on the individuals family income.
5
(c) DETERMINATION
ING
AND
PAYMENT
OF
COST-SHAR-
19 able credit eligible individual in a tier enrolled in an Ex20 change-participating health benefits plan offered by a
21 QHBP offering entity, the Commissioner shall provide for
22 payment to the offering entity of an amount equivalent
23 to the increased actuarial value of the benefits under the
24 plan provided under section 203(c)(2)(B) resulting from
25 the reduction in cost-sharing described in subsection (b).
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139
1
2
10 PROCEDURES.
11
(1) PROGRAM
Commissioner
12
13
14
15
(2) INCOME
VERIFICATION.
16
(A) IN
GENERAL.Upon
an initial applica-
17
18
19
20
21
22
graph (A)
23
24
25
26
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INTEGRITY.The
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140
1
and
mation.
(B)
PROCEDURES.The
10
11
12
(1) CHANGES
IN INCOME AS A PERCENT OF
13
FPL.In
14
15
16
17
18
19
20
21
22
23
24
25
otherwise applicable.
f:\VHLC\071409\071409.140.xml
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ALTERNATIVE
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141
1
(2) REPORTING
INCOME.The
10
11
12
13
14
15
16
17
18
eligible individual.
19
(3) TRANSITION
FOR CHIP.In
the case of a
20
21
22
23
24
25
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142
1
(4) STUDY
PLICATION OF FPL.The
10
11
12
13
14
(d) PENALTIES
FOR
MISREPRESENTATION.In the
15 case of an individual intentionally misrepresents family in16 come or the individual fails (without regard to intent) to
17 disclose to the Commissioner a significant change in fam18 ily income under subsection (c) in a manner that results
19 in the individual becoming an affordable credit eligible in20 dividual when the individual is not or in the amount of
21 the affordability credit exceeding the correct amount
22
23
24
25
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143
1
an additional penalty.
4
5
ALIENS.
TITLE IIISHARED
RESPONSIBILITY
Subtitle AIndividual
Responsibility
8
9
10
11
12
13
17
Subtitle BEmployer
Responsibility
18
19
REQUIREMENTS
20
16
21
22
MENTS.
(1) OFFER
employer of-
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144
1
tion 312.
(2) CONTRIBUTION
TOWARDS COVERAGE.If
(3) CONTRIBUTION
IN LIEU OF COVERAGE.
10
11
12
13
14
15
16
17
18
19
20
ERAGE.
21
(1) OFFERING
employer
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OF COVERAGE.The
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
145
1
(2) EMPLOYER
REQUIRED
CONTRIBUTION.
erage.
(3) PROVISION
OF
INFORMATION.The
em-
10
11
12
13
14
15
(4) AUTOENROLLMENT
OF EMPLOYEES.The
16
17
18
(b) REDUCTION
OF
(1) FULL-TIME
minimum
21
22
23
24
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EMPLOYEES.The
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
146
1
10
11
12
13
14
(2) APPLICABLE
15
ERAGE.In
16
17
18
19
20
21
22
(3) MINIMUM
23
EMPLOYEES
24
EES.In
25
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OTHER
THAN
FULL-TIME
EMPLOY-
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147
1
10
11
12
13
full-time employee.
14
(4) SALARY
15
PLOYER CONTRIBUTIONS.For
16
17
18
19
20
21
SORED
22
HEALTH BENEFITS.
(1) IN
GENERAL.The
23
24
25
f:\VHLC\071409\071409.140.xml
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148
1
10
11
12
(3) NOTICE
13
(A) IN
GENERAL.Each
employer de-
14
15
16
17
18
19
20
21
22
23
24
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REQUIREMENTS.
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149
1
(B) INCLUSION
OF
SPECIFIC
INFORMA-
TION.The
10
11
12
13
ployee.
14
15
16
ERAGE.
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150
1
rolled.
(1) IN
GENERAL.In
10
11
12
13
14
(2) SMALL
purposes of this
15
16
17
18
19
(3) ANNUAL
PAYROLL.For
purposes of this
20
21
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EMPLOYER.For
The applicable
percentage is:
0 percent
2 percent
4 percent
6 percent
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151
1
calendar year.
(4) AGGREGATION
RULES.Related
employers
6
7
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152
1
PARTICIPATION REQUIREMENTS
PLOYEE
ACT OF 1974.
RETIREMENT
INCOME
SECURITY
8 ployee Retirement Income Security Act of 1974 is amend9 ed by adding at the end the following new part:
10
11
PARTICIPATION REQUIREMENTS
12
13
14
REQUIREMENTS.
15
(b) TIME
AND
22
23
ELECTION.
26
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153
1
COMPLIANCE.The
TO
DISCOVER NON-
20
21
MENTS.
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154
1
2
3 ployer which is part of a group of employers who are treat4 ed as a single employer under subsection (b), (c), (m), or
5 (o) of section 414 of the Internal Revenue Code of 1986,
6 the election under section 801 shall be made by such em7 ployer as the Secretary may provide. Any such election,
8 once made, shall apply to all members of such group.
9
13
14
15
16
17
STANTIAL NONCOMPLIANCE.
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155
1 sions of this part, in accordance with section 324(a) of
2 the Americas Affordable Health Choices Act of 2009. The
3 Secretary may promulgate any interim final rules as the
4 Secretary determines are appropriate to carry out this
5 part..
6
7
(b) ENFORCEMENT
PATION
OF
10
11
12
13
14
15
16
new paragraph:
17
18
(11) HEALTH
QUIREMENTS.
19
(A) CIVIL
PENALTIES.In
the case of
20
21
22
23
24
25
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156
1
failure is corrected.
(B) HEALTH
REQUIREMENTS.For
tion 803.
(C) LIMITATIONS
10
ON AMOUNT OF PEN-
ALTY.
11
(i) PENALTY
12
FAILURE
13
REASONABLE
14
15
16
17
18
19
20
failure existed.
21
NOT
DISCOVERED
EXERCISING
DILIGENCE.No
(ii) PENALTY
NOT
TO
penalty
APPLY
TO
22
23
24
25
if
f:\VHLC\071409\071409.140.xml
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COVERAGE PARTICIPATION
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157
1
glect, and
or
existed.
10
(iii) OVERALL
reasonable
diligence
11
INTENTIONAL FAILURES.In
12
13
14
15
16
the case of
17
18
19
20
21
22
(II) $500,000.
23
(D) ADVANCE
NOTIFICATION OF FAILURE
24
PRIOR TO ASSESSMENT.Before
25
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158
1
(E) COORDINATION
10
11
12
13
14
15
16
17
18
19
(F) DEPOSIT
OF PENALTY COLLECTED.
20
21
22
23
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159
Sec. 801. Election of employer to be subject to national health coverage participation requirements.
Sec. 802. Treatment of coverage resulting from election.
Sec. 803. Health coverage participation requirements.
Sec. 804. Rules for applying requirements.
Sec. 805. Termination of election in cases of substantial noncompliance.
Sec. 806. Regulations..
2 this section shall apply to periods beginning after Decem3 ber 31, 2012.
4
(a) FAILURE
TO
PLY
QUIREMENTS.For
ELECT,
OR
SUBSTANTIALLY COM-
15 ures of electing employers to comply with such require16 ments, see section 4980H of the Internal Revenue Code
17 of 1986 (as added by section 411 of this Act).
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160
1
8
9
REQUIREMENTS.
(a) ELECTION
OF
EMPLOYER
TO
BE SUBJECT
TO
MENTS.
12
(1) IN
GENERAL.An
13
14
15
(2) TIME
AND MANNER.An
election under
16
17
18
scribe.
19
(b) TREATMENT
OF
20 ELECTION.
21
22
(1) IN
an employer makes an
23
24
25
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GENERAL.If
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161
1
(2) PERIODIC
INVESTIGATIONS TO DETERMINE
TION REQUIREMENTS.The
10
11
12
13
14
15
16
17
18
19
20
21
ance.
22
23
MENTS.For
24 coverage participation requirements means the require25 ments of part 1 of subtitle B of title III of division A
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162
1 of the Americas Affordable Health Choices Act of 2009
2 (as in effect on the date of the enactment of this section).
3
(e) TERMINATION
STANTIAL
OF
ELECTION
IN
CASES
OF
SUB-
(f) ENFORCEMENT
TICIPATION
17
REQUIREMENTS.
(1) CIVIL
PENALTIES.In
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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OF
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163
1
(2) LIMITATIONS
(A) PENALTY
NOT
TO
APPLY
WHERE
SONABLE DILIGENCE.No
10
11
(B) PENALTY
12
13
14
pen-
15
16
17
18
19
20
21
22
(C) OVERALL
23
TIONAL
24
25
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ON AMOUNT OF PENALTY.
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164
1
of
or
(ii) $500,000.
10
(3) ADVANCE
OF
FAILURE
11
PRIOR TO ASSESSMENT.Before
12
13
14
15
16
17
18
such failure.
19
(4) ACTIONS
a reasonable time
TO ENFORCE ASSESSMENTS.
20
21
22
23
(5) COORDINATION
WITH
EXCISE
TAX.
24
25
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July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
NOTIFICATION
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165
1
(6) DEPOSIT
OF PENALTY COLLECTED.Any
10
11
12
13
21 subsection (a) shall apply to periods beginning after De22 cember 31, 2012.
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1
2
3
10
11
12
13
14
15
16
17
18
19
20
21
22
23
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167
1 with subsection (a) by the officers referred to in subsection
2 (a) shall provide for the application of the health coverage
3 participation requirements to the plan sponsor and con4 tributing sponsors of such plan.
5
6
7
10
11
12
16
17
18
19
20
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168
1
2
(1) the taxpayers modified adjusted gross income for the taxable year, over
(b) LIMITATIONS.
(1) TAX
(A) IN
GENERAL.The
tax imposed
10
11
taxable year.
12
(B) APPLICABLE
13
NATIONAL
AVERAGE
PREMIUM.
14
(i) IN
GENERAL.For
purposes of
15
16
17
18
19
20
21
22
23
24
(ii) FAILURE
25
TO PROVIDE COVERAGE
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169
1
coverage.
(2) PRORATION
10
11
12
13
graph (1)) as
14
15
16
17
to
18
19
20
21
22
23
24
25
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170
1
(2) NONRESIDENT
(a)
resident alien.
(3) INDIVIDUALS
STATES.Any
10
11
(4) INDIVIDUALS
RESIDING IN POSSESSIONS
12
13
14
15
16
17
18
19
(5) RELIGIOUS
20
(A) IN
individual who is a
CONSCIENCE EXEMPTION.
GENERAL.Subsection
(a) shall
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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ALIENS.Subsection
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171
1
tion.
10
11
12
13
(1) IN
requirements of this
14
15
16
17
18
(2) ACCEPTABLE
COVERAGE.For
purposes
19
20
21
(A) QUALIFIED
22
COVERAGE.Coverage
23
24
25
2009).
f:\VHLC\071409\071409.140.xml
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GENERAL.The
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172
1
(B) GRANDFATHERED
FATHERED
PLAN.Coverage
10
EMPLOYMENT-BASED
HEALTH
11
12
13
14
Act.
15
(E) MEMBERS
16
AND
17
18
19
20
Code.
DEPENDENTS
(INCLUDING
TRICARE).
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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INSUR-
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173
1
such title.
(G)
COVERAGE.Such
other
10
11
12
section.
13
14
(1) QUALIFYING
CHILD.For
purposes of this
15
16
17
(2) BASIC
PLAN.For
18
19
20
21
(3) HEALTH
INSURANCE
EXCHANGE.For
22
23
24
25
f:\VHLC\071409\071409.140.xml
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OTHER
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174
1
(4) FAMILY
COVERAGE.For
purposes of this
(5) MODIFIED
10
911, and
11
12
13
14
(6) NOT
15
16
17
18
19
20
tax im-
f:\VHLC\071409\071409.140.xml
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175
1
(1) IN
GENERAL.Subpart
B of part III of
10
11
section:
SEC. 6050X. RETURNS RELATING TO HEALTH INSURANCE
12
COVERAGE.
13
(a) REQUIREMENT
OF
REPORTING.Every person
(b) FORM
AND
MANNER
OF
RETURNS.A return
23
(2) contains
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176
1
8
9
10
UALS
11
QUIRED.Every
WITH RESPECT
TO
TO
BE FURNISHED
TO
INDIVID-
16
17
18
19
20 The written statement required under the preceding sen21 tence shall be furnished on or before January 31 of the
22 year following the calendar year for which the return
23 under subsection (a) is required to be made.
24
BY
GOVERNMENTAL
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177
1 mental unit or any agency or instrumentality thereof, the
2 officer or employee who enters into the agreement to pro3 vide such coverage (or the person appropriately designated
4 for purposes of this section) shall make the returns and
5 statements required by this section..
6
(2) PENALTY
10
11
12
13
14
15
erage), and.
16
17
18
19
20
21
22
paragraph:
23
24
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178
1
such individual..
10
11
12
13
item:
PART VIII. HEALTH CARE RELATED TAXES..
14
15
16
17
TO
APPLY.The amendment
22
(1) IN
amendments made by
23
24
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GENERAL.The
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179
1
6
7
TICIPATION REQUIREMENTS.
11
12
(a) ELECTION
OF
EMPLOYER RESPONSIBILITY
TO
(1) IN
15
16
17
(2) TIME
AND MANNER.An
employer may
18
19
20
prescribe.
21
(3) AFFILIATED
GROUPS.In
22
23
24
25
f:\VHLC\071409\071409.140.xml
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GENERAL.Subsection
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180
1
group.
(4) SEPARATE
ELECTIONS.Under
regula-
10
(5) TERMINATION
OF ELECTION IN CASES OF
11
SUBSTANTIAL
12
13
14
15
16
17
NONCOMPLIANCE.The
TO
Secretary
FAILURE
TO
MENTS.
20
(1) IN
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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GENERAL.In
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181
1
ure is corrected.
(2) LIMITATIONS
(A) TAX
NOT
DILIGENCE.No
10
11
12
13
14
DISCOVERED
(B) TAX
EXERCISING
REASONABLE
15
16
tax shall be
17
18
19
20
21
22
23
24
(C) OVERALL
25
TIONAL
f:\VHLC\071409\071409.140.xml
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ON AMOUNT OF TAX.
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182
1
the lesser of
10
health plans, or
11
(ii) $500,000.
12
(D) COORDINATION
WITH
OTHER
EN-
13
FORCEMENT
14
15
16
17
18
19
20
such failure.
21
22
PROVISIONS.The
tax imposed
23 coverage participation requirements means the require24 ments of part I of subtitle B of title III of the Americas
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183
1 Affordable Health Choices Act of 2009 (as in effect on
2 the date of the enactment of this section)..
3
7 this section shall apply to periods beginning after Decem8 ber 31, 2012.
9
10
11
ERS.
TO
NOT PROVIDE
16 HEALTH BENEFITS.
17
(1) IN
18
19
20
21
22
23
24
(2) SPECIAL
RULES
FOR
SMALL
EMPLOY-
ERS.
f:\VHLC\071409\071409.140.xml
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184
1
(A) IN
GENERAL.In
percent:
If the annual payroll of such employer for
the preceding calendar year:
Does not exceed $250,000 .....................................
Exceeds $250,000, but does not exceed $300,000
Exceeds $300,000, but does not exceed $350,000
Exceeds $350,000, but does not exceed $400,000
(B) SMALL
EMPLOYER.For
purposes of
10
11
12
(C) ANNUAL
PAYROLL.For
purposes of
13
14
15
16
17
18
19
(3) NONELECTING
EMPLOYER.For
purposes
20
21
f:\VHLC\071409\071409.140.xml
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The applicable
percentage is:
0 percent
2 percent
4 percent
6 percent
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185
1
(4) SPECIAL
RULE
FOR
SEPARATE
ELEC-
TIONS.In
tion.
10
11
(5) AGGREGATION;
PREDECESSORS.For
pur-
12
13
14
15
16
17
18
22 ELECTING NOT
TO
FOR
TAX
ON
EMPLOYERS
(1) Paragraphs (1), (5), and (19) of subsection (b) shall not apply.
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186
1
(F) thereof.
12
(1) IN
GENERAL.Section
13
14
15
16
TO
NOT PROVIDE
17 HEALTH BENEFITS.
18
(1) IN
19
20
21
22
23
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GENERAL.In
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187
1
(2) EXCEPTION
(3) NONELECTING
EMPLOYER.For
purposes
(4) SPECIAL
RULE
FOR
SEPARATE
ELEC-
10
TIONS.In
11
12
13
14
15
tion..
16
17
18
19
(13) SPECIAL
20
21
22
23
24
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188
1
(3) CONFORMING
AMENDMENT.Subsection
(d)
3231(e).
8 this section shall apply to periods beginning after Decem9 ber 31, 2012.
12
13
SEC.
10
11
421.
CREDIT
14
15
FOR
SMALL
BUSINESS
EMPLOYEE
20
21
ERAGE CREDIT.
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189
1 ble percentage of the qualified employee health coverage
2 expenses of such employer for such taxable year.
3
4
5
(1) IN
(2) PHASEOUT
BASED
ON
AVERAGE
COM-
PENSATION OF EMPLOYEES.In
10
11
12
13
(c) LIMITATIONS.
14
(1) PHASEOUT
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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GENERAL.For
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190
1
(B) 15.
(2) CREDIT
10
11
12
PENSES.For
13
(1) IN
GENERAL.The
14
15
16
17
18
19
20
health coverage.
21
(2) QUALIFIED
HEALTH
COVERAGE.The
22
23
24
25
f:\VHLC\071409\071409.140.xml
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191
1
2
3
in section 4980H(c).
(e) OTHER DEFINITIONS.For purposes of this
4 section
5
(1) QUALIFIED
pur-
if
10
11
12
13
14
15
16
(2) QUALIFIED
EMPLOYEE.The
term quali-
17
18
19
20
21
(3) AVERAGE
22
TION.The
23
24
f:\VHLC\071409\071409.140.xml
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SMALL EMPLOYER.For
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
192
1
408(p)(6)(A).
(5) FAMILY
COVERAGE.The
term family
coverage.
10 tion
11
(1) SPECIAL
12
SELF-EMPLOYED.In
13
14
15
16
17
18
19
treated as an employee.
20
(2) AGGREGATION
RULE.All
persons treated
21
22
23
(3) DENIAL
OF DOUBLE BENEFIT.Any
de-
24
25
f:\VHLC\071409\071409.140.xml
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193
1
(4) INFLATION
ADJUSTMENT.In
the case of
10
11
12
13
thereof.
14
15
16
17
(b) CREDIT
TO
BE PART
OF
GENERAL BUSINESS
18 CREDIT.Subsection (b) of section 38 of such Code (re19 lating to general business credit) is amended by striking
20 plus at the end of paragraph (34), by striking the period
21 at the end of paragraph (35) and inserting , plus , and
22 by adding at the end the following new paragraph:
23
24
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194
1
section 45R(a)..
12
13
10
11
14
15
(21) DISCLOSURE
19
20
SIDIES.
21
(A) IN
GENERAL.The
Secretary, upon
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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OF RETURN INFORMATION
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195
1
10
(i)
11
identity
information
12
13
payer,
14
15
16
tion 59B(e)(5)),
17
18
taxpayer,
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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taxpayer
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196
1
(B) RESTRICTION
ON USE OF DISCLOSED
INFORMATION.Return
information disclosed
10
11
12
13
14
15
16
17
(b) PROCEDURES
TO
AND
RECORDKEEPING RELATED
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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197
1
OR
INSPECTION.
10
11
16
17
18 other than a corporation, there is hereby imposed (in addi19 tion to any other tax imposed by this subtitle) a tax equal
20 to
21
22
23
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198
1
$1,000,000.
JOINT RETURN.
15
16
17
18
19
ON
FEDERAL HEALTH
GENERAL.Except
as provided in para-
20 REFORM SAVINGS.
21
(1) IN
22
23
24
plied
f:\VHLC\071409\071409.140.xml
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199
1
cent, and
percent.
(2) ADJUSTMENTS
(A) EXCEPTION
AMOUNT.If
10
11
12
13
(B) FURTHER
14
15
16
17
18
19
20
(C) EXCESS
21
SAVINGS.For
22
23
24
ings, over
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
12:51 Jul 14, 2009
25
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200
1
(ii) $525,000,000,000.
(D) FEDERAL
REFORM
SAV-
INGS.The
(3) DETERMINATION
OF FEDERAL HEALTH
REFORM SAVINGS.Not
Budget shall
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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HEALTH
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201
1
(4) STUDY
SAVINGS.The
10
11
12
(5) REDUCTIONS
IN FEDERAL EXPENDITURES
13
14
VESTMENTS.For
15
16
17
18
19
thereof.
20
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1 gross income shall be determined as provided in section
2 67(e).
3
(1) IN
to
10
11
12
13
14
15
16
17
multiple of $5,000.
18
19
(1) NONRESIDENT
ALIEN.In
the case of a
20
21
22
23
24
(2)
25
ABROAD.The
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1
paragraph (A).
(3) CHARITABLE
TRUSTS.Subsection
(a)
10
11
12
13
(4) NOT
14
15
16
17
18
19
tax im-
23
TO
APPLY.The amendment
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1 in a rate of tax for purposes of section 15 of the Internal
2 Revenue Code of 1986.
3
TION OF INTEREST.
15
16
DEDUCTIBLE PAYMENTS.
17
(d) LIMITATION
TREATY BENEFITS
FOR
CER-
DEDUCTIBLE PAYMENTS.
TAIN
23
(1) IN
GENERAL.In
24
25
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1
ent corporation.
(2)
RELATED-PARTY
PAY-
MENT.For
10
11
12
13
14
tities.
15
16
(3) FOREIGN
TIES.For
17
(A) IN
GENERAL.The
term foreign
18
19
20
is a foreign corporation.
21
(B) CONTROLLED
GROUP OF ENTITIES.
22
23
24
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1
10
trolled
11
12
13
14
(4) FOREIGN
the
meaning
PARENT
of
section
CORPORATION.For
15
16
17
18
19
paragraph (3)(A).
20
21
22
23
24
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1
and
10
11
15
16
TRINE.
(o) CLARIFICATION
OF
ECONOMIC SUBSTANCE
21 DOCTRINE.
22
(1) APPLICATION
the case
23
24
25
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1
(2) SPECIAL
ON PROFIT POTENTIAL.
(A) IN
GENERAL.The
potential for
10
11
12
13
14
15
16
17
18
19
(B) TREATMENT
20
TAXES.Fees
21
22
23
subparagraph (A).
24
(3) STATE
25
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1
(4) FINANCIAL
10
(5) DEFINITIONS
11
12
(A) ECONOMIC
SUBSTANCE DOCTRINE.
13
14
15
16
17
18
purpose.
19
(B) EXCEPTION
20
ACTIONS OF INDIVIDUALS.In
21
22
23
24
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1
(C) OTHER
COMMON
LAW
DOCTRINES
NOT AFFECTED.Except
law.
(D) DETERMINATION
as specifically pro-
OF APPLICATION OF
10
11
12
13
14
15
16
17
18
section..
19
determination
23
24
(a) PENALTY
TO
UNDERPAYMENTS ATTRIBUTABLE
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1
(b) of section
of law..
10
(2) INCREASED
11
TRANSACTIONS.Section
12
13
subsection:
14
(i) INCREASE
15
CLOSED
16
IN
PENALTY
IN
CASE
OF
NONDIS-
GENERAL.In
17
18
19
20
21
percent.
22
(2)
NONDISCLOSED
NONECONOMIC
SUB-
23
STANCE TRANSACTIONS.For
24
25
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1
(3)
RULE
FOR
AMENDED
RE-
TURNS.Except
10
11
12
13
by the Secretary..
14
as provided in regulations, in no
(3) CONFORMING
AMENDMENT.Subparagraph
15
16
ed
17
18
19
and
20
(B)
by
striking
GROSS
21
MISSTATEMENT PENALTY
22
inserting
23
PAYMENT PENALTIES.
24
25
CERTAIN
VALUATION
INCREASED
UNDER-
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1 SHELTERS,
AND
CERTAIN LARGE
OR
PUBLICLY TRADED
(3), and
9
10
11
12
13
14
15
16
17
18
specified
19
6662(d)(2)(D)(ii))..
20
(c) APPLICATION
21 CLAIM
22
person
FOR
STANCE
REFUND
OR
OF
(as
defined
PENALTY
CREDIT
TO
FOR
in
section
ERRONEOUS
NONECONOMIC SUB-
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1
2 TREATED
AS
3 poses of this section, any excessive amount which is attrib4 utable to any transaction described in section 6662(b)(6)
5 shall not be treated as having a reasonable basis..
6
7
CERTAIN LARGE
8
9
10
(1) IN
GENERAL.Paragraph
(2) of section
11
(D) SPECIAL
12
13
(i) IN
14
GENERAL.In
specified person
15
16
apply, and
17
18
19
20
21
22
23
24
25
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1
(ii) SPECIFIED
PERSON.For
pur-
1934, and
10
11
12
13
14
(2) CONFORMING
AMENDMENT.Subparagraph
15
16
17
18
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TITLE IIMPROVING HEALTH CARE VALUE
Subtitle AProvisions Related to Medicare Part A
PART 1MARKET BASKET UPDATES
Sec. 1101. Skilled nursing facility payment update.
Sec. 1102. Inpatient rehabilitation facility payment update.
Sec. 1103. Incorporating productivity improvements into market basket updates
that do not already incorporate such improvements.
PART 2OTHER MEDICARE PART A PROVISIONS
Sec. 1111. Payments to skilled nursing facilities.
Sec. 1112. Medicare DSH report and payment adjustments in response to coverage expansion.
Subtitle BProvisions Related to Part B
PART 1PHYSICIANS SERVICES
Sec.
Sec.
Sec.
Sec.
Sec.
1121.
1122.
1123.
1124.
1125.
1141.
1142.
1143.
1144.
Sec.
Sec.
Sec.
Sec.
Sec.
1145.
1146.
1147.
1148.
1149.
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217
Sec. 1158. Revision of Medicare payment systems to address geographic inequities.
Subtitle DMedicare Advantage Reforms
PART 1PAYMENT
Sec.
Sec.
Sec.
Sec.
Sec.
Sec.
Sec.
Sec.
1161.
1162.
1163.
1164.
1165.
1166.
1167.
1168.
AND
ADMINISTRATION
AND
ANTI-FRAUD
OF
Sec. 1176. Limitation on enrollment outside open enrollment period of individuals into chronic care specialized MA plans for special needs
individuals.
Sec. 1177. Extension of authority of special needs plans to restrict enrollment.
Subtitle EImprovements to Medicare Part D
Sec. 1181. Elimination of coverage gap.
Sec. 1182. Discounts for certain part D drugs in original coverage gap.
Sec. 1183. Repeal of provision relating to submission of claims by pharmacies
located in or contracting with long-term care facilities.
Sec. 1184. 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. 1185. Permitting mid-year changes in enrollment for formulary changes
that adversely impact an enrollee.
Subtitle FMedicare Rural Access Protections
Sec.
Sec.
Sec.
Sec.
Sec.
1191.
1192.
1193.
1194.
1195.
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218
Sec. 1201. Improving assets tests for Medicare Savings Program and low-income subsidy program.
Sec. 1202. Elimination of part D cost-sharing for certain non-institutionalized
full-benefit dual eligible individuals.
Sec. 1203. Eliminating barriers to enrollment.
Sec. 1204. Enhanced oversight relating to reimbursements for retroactive low
income subsidy enrollment.
Sec. 1205. Intelligent assignment in enrollment.
Sec. 1206. Special enrollment period and automatic enrollment process for certain subsidy eligible individuals.
Sec. 1207. Application of MA premiums prior to rebate in calculation of low
income subsidy benchmark.
Subtitle BReducing Health Disparities
Sec. 1221. Ensuring effective communication in Medicare.
Sec. 1222. Demonstration to promote access for Medicare beneficiaries with
limited English proficiency by providing reimbursement for culturally and linguistically appropriate services.
Sec. 1223. IOM report on impact of language access services.
Sec. 1224. Definitions.
Subtitle CMiscellaneous Improvements
Sec. 1231. Extension of therapy caps exceptions process.
Sec. 1232. Extended months of coverage of immunosuppressive drugs for kidney transplant patients and other renal dialysis provisions.
Sec. 1233. Advance care planning consultation.
Sec. 1234. Part B special enrollment period and waiver of limited enrollment
penalty for TRICARE beneficiaries.
Sec. 1235. Exception for use of more recent tax year in case of gains from sale
of primary residence in computing part B income-related premium.
Sec. 1236. Demonstration program on use of patient decisions aids.
TITLE IIIPROMOTING PRIMARY CARE, MENTAL HEALTH
SERVICES, AND COORDINATED CARE
Sec.
Sec.
Sec.
Sec.
Sec.
Sec.
1301.
1302.
1303.
1304.
1305.
1306.
Sec. 1307.
Sec. 1308.
Sec. 1309.
Sec. 1310.
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219
Sec. 1401. Comparative effectiveness research.
Subtitle BNursing Home Transparency
PART 1IMPROVING TRANSPARENCY OF INFORMATION ON SKILLED
NURSING FACILITIES AND NURSING FACILITIES
Sec. 1411. Required disclosure of ownership and additional disclosable parties
information.
Sec. 1412. Accountability requirements.
Sec. 1413. Nursing home compare Medicare website.
Sec. 1414. Reporting of expenditures.
Sec. 1415. Standardized complaint form.
Sec. 1416. Ensuring staffing accountability.
PART 2TARGETING ENFORCEMENT
Sec. 1421. Civil money penalties.
Sec. 1422. National independent monitor pilot program.
Sec. 1423. Notification of facility closure.
PART 3IMPROVING STAFF TRAINING
Sec. 1431. Dementia and abuse prevention training.
Sec. 1432. Study and report on training required for certified nurse aides and
supervisory staff.
Subtitle CQuality Measurements
Sec. 1441. Establishment of national priorities for quality improvement.
Sec. 1442. Development of new quality measures; GAO evaluation of data collection process for quality measurement.
Sec. 1443. Multi-stakeholder pre-rulemaking input into selection of quality
measures.
Sec. 1444. Application of quality measures.
Sec. 1445. Consensus-based entity funding.
Subtitle DPhysician Payments Sunshine Provision
Sec. 1451. Reports on financial relationships between manufacturers and distributors of covered drugs, devices, biologicals, or medical supplies under Medicare, Medicaid, or CHIP and physicians and
other health care entities and between physicians and other
health care entities.
Subtitle EPublic Reporting on Health Care-Associated Infections
Sec. 1461. Requirement for public reporting by hospitals and ambulatory surgical centers on health care-associated infections.
TITLE VMEDICARE GRADUATE MEDICAL EDUCATION
Sec. 1501. Distribution of unused residency positions.
Sec. 1502. Increasing training in nonprovider settings.
Sec. 1503. Rules for counting resident time for didactic and scholarly activities
and other activities.
Sec. 1504. Preservation of resident cap positions from closed hospitals.
Sec. 1505. Improving accountability for approved medical residency training.
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TITLE VIPROGRAM INTEGRITY
Subtitle AIncreased Funding to Fight Waste, Fraud, and Abuse
Sec. 1601. Increased funding and flexibility to fight fraud and abuse.
Subtitle BEnhanced Penalties for Fraud and Abuse
Sec. 1611. Enhanced penalties for false statements on provider or supplier enrollment applications.
Sec. 1612. Enhanced penalties for submission of false statements material to
a false claim.
Sec. 1613. Enhanced penalties for delaying inspections.
Sec. 1614. Enhanced hospice program safeguards.
Sec. 1615. Enhanced penalties for individuals excluded from program participation.
Sec. 1616. Enhanced penalties for provision of false information by Medicare
Advantage and part D plans.
Sec. 1617. Enhanced penalties for Medicare Advantage and part D marketing
violations.
Sec. 1618. Enhanced penalties for obstruction of program audits.
Sec. 1619. Exclusion of certain individuals and entities from participation in
Medicare and State health care programs.
Subtitle CEnhanced Program and Provider Protections
Sec. 1631. Enhanced CMS program protection authority.
Sec. 1632. Enhanced Medicare, Medicaid, and CHIP program disclosure requirements relating to previous affiliations.
Sec. 1633. Required inclusion of payment modifier for certain evaluation and
management services.
Sec. 1634. Evaluations and reports required under Medicare Integrity Program.
Sec. 1635. Require providers and suppliers to adopt programs to reduce waste,
fraud, and abuse.
Sec. 1636. Maximum period for submission of Medicare claims reduced to not
more than 12 months.
Sec. 1637. Physicians who order durable medical equipment or home health
services required to be Medicare enrolled physicians or eligible
professionals.
Sec. 1638. Requirement for physicians to provide documentation on referrals to
programs at high risk of waste and abuse.
Sec. 1639. Face to face encounter with patient required before physicians may
certify eligibility for home health services or durable medical
equipment under Medicare.
Sec. 1640. Extension of testimonial subpoena authority to program exclusion
investigations.
Sec. 1641. Required repayments of Medicare and Medicaid overpayments.
Sec. 1642. Expanded application of hardship waivers for OIG exclusions to
beneficiaries of any Federal health care program.
Sec. 1643. Access to certain information on renal dialysis facilities.
Sec. 1644. Billing agents, clearinghouses, or other alternate payees required to
register under Medicare.
Sec. 1645. Conforming civil monetary penalties to False Claims Act amendments.
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221
Subtitle DAccess to Information Needed to Prevent Fraud, Waste, and
Abuse
Sec. 1651. Access to Information Necessary to Identify Fraud, Waste, and
Abuse.
Sec. 1652. Elimination of duplication between the Healthcare Integrity and
Protection Data Bank and the National Practitioner Data
Bank.
Sec. 1653. Compliance with HIPAA privacy and security standards.
TITLE VIIMEDICAID AND CHIP
Subtitle AMedicaid and Health Reform
Sec. 1701. Eligibility for individuals with income below 133-13 percent of the
Federal poverty level.
Sec. 1702. Requirements and special rules for certain Medicaid eligible individuals.
Sec. 1703. CHIP and Medicaid maintenance of effort.
Sec. 1704. Reduction in Medicaid DSH.
Sec. 1705. Expanded outstationing.
Subtitle BPrevention
Sec.
Sec.
Sec.
Sec.
1711.
1712.
1713.
1714.
Sec.
Sec.
Sec.
Sec.
Sec.
1721.
1722.
1723.
1724.
1725.
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222
Sec. 1753. Require providers and suppliers to adopt programs to reduce waste,
fraud, and abuse.
Sec. 1754. Overpayments.
Sec. 1755. Managed Care Organizations.
Sec. 1756. Termination of provider participation under Medicaid and CHIP if
terminated under Medicare or other State plan or child health
plan.
Sec. 1757. Medicaid and CHIP exclusion from participation relating to certain
ownership, control, and management affiliations.
Sec. 1758. Requirement to report expanded set of data elements under MMIS
to detect fraud and abuse.
Sec. 1759. Billing agents, clearinghouses, or other alternate payees required to
register under Medicaid.
Sec. 1760. Denial of payments for litigation-related misconduct.
Subtitle GPuerto Rico and the Territories
Sec. 1771. Puerto Rico and territories.
Subtitle HMiscellaneous
Sec. 1781. Technical corrections.
Sec. 1782. Extension of QI program.
TITLE VIIIREVENUE-RELATED PROVISIONS
Sec. 1801. Disclosures to facilitate identification of individuals likely to be ineligible for the low-income assistance under the Medicare prescription drug program to assist Social Security Administrations outreach to eligible individuals.
Sec. 1802. Comparative Effectiveness Research Trust Fund; financing for
Trust Fund.
TITLE IXMISCELLANEOUS PROVISIONS
Sec.
Sec.
Sec.
Sec.
1901.
1902.
1903.
1904.
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1
2
3
12
13
14
15
16
17
18
19
20
21
22
23
24
year; and.
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1
(b)
EFFECTIVE
DELAYED
DATE.Section
2 1888(e)(4)(E)(ii)(V) of the Social Security Act, as in3 serted by subsection (a)(3), shall not apply to payment
4 for days before January 1, 2010.
5
MENT UPDATE.
SEC.
1103.
INCORPORATING
PRODUCTIVITY
IMPROVE-
14
MENTS
15
16
IMPROVEMENTS.
17
(a)
INTO
INPATIENT
MARKET
ACUTE
BASKET
UPDATES
HOSPITALS.Section
21
22
23
24
25
(II),; and
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1
2
3
subclause:
(II) The productivity adjustment described in this
4 subclause, with respect to an increase or change for a fis5 cal year or year or cost reporting period, or other annual
6 period, is a productivity offset equal to the percentage
7 change in the 10-year moving average of annual economy8 wide private nonfarm business multi-factor productivity
9 (as recently published before the promulgation of such in10 crease for the year or period involved). Except as other11 wise provided, any reference to the increase described in
12 this clause shall be a reference to the percentage increase
13 described in subclause (I) minus the percentage change
14 under this subclause.;
15
16
17
duced; and
18
19
20
21
22
23
24
after reduced.
(b)
SKILLED
NURSING
FACILITIES.Section
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226
1 is amended by inserting subject to the productivity ad2 justment described in section 1886(b)(3)(B)(iii)(II) after
3 as calculated by the Secretary.
4
(c)
LONG
TERM
CARE
HOSPITALS.Section
(3) PRODUCTIVITY
ADJUSTMENT.In
imple-
10
11
12
13
14
15
tivity
16
1886(b)(3)(B)(iii)(II)..
17
adjustment
described
in
section
18 second sentence of section 1886(j)(3)(C) of the Social Se19 curity Act (42 U.S.C. 1395ww(j)(3)(C)) is amended by in20 serting (subject to the productivity adjustment described
21 in section 1886(b)(3)(B)(iii)(II)) after appropriate per22 centage increase.
23
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1
FOR
PSYCHIATRIC
2 HOSPITALS.
3
(1) REFERENCE
PLEMENTATION OF SYSTEM.For
10
11
12
13
1999.
14
(2) PRODUCTIVITY
provisions related
ADJUSTMENT.In
imple-
15
16
17
18
19
20
21
22
23
tion 1886(b)(3)(B)(iii)(II)..
24
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228
1 1395f(i)(1)(C)(ii)) is amended by inserting after the
2 market basket percentage increase the following: (which
3 is subject to the productivity adjustment described in sec4 tion 1886(b)(3)(B)(iii)(II)).
5
6 subsections (a), (b), (d), and (f) shall apply to annual in7 creases effected for fiscal years beginning with fiscal year
8 2010.
9
10
11
12
13
14
15
16
17
18
tems.
19
(2) ADJUSTMENT
RECALIBRATION
FAC-
20
TOR.Based
21
22
23
24
25
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229
1
(b) CHANGE
LARY
(1) CHANGES
FOR
NONTHERAPY ANCIL-
FICATION SYSTEM.
(A) IN
GENERAL.Subject
to subpara-
10
11
12
13
14
15
16
17
18
(B) EFFECTIVE
DATE.The
changes in
19
20
21
22
23
24
25
U.S.C. 1395yy(e)).
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PAYMENT
5
6
IN
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230
1
2
(2) CHANGES
CLASSIFICATION SYSTEM.
(A) ANALYSIS.
(i) IN
GENERAL.The
Secretary of
10
11
12
13
14
15
16
17
18
19
20
(ii)
APPLICATION.Such
analysis
21
22
23
24
25
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IMPLEMENTATION.Notwithstanding
(C)
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1
costs.
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
graph (A).
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232
1
(E) BUDGET
NEUTRALITY.The
Secretary
10
11
12
changes.
13
(13) OUTLIERS
18
(A)
GENERAL.With
respect
to
19
20
21
22
23
24
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233
1
such outliers.
(B) OUTLIERS
COSTS.Outlier
ON
AGGREGATE
10
11
12
13
14
(C) BUDGET
NEUTRALITY.
The Sec-
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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234
1
(d)
CONFORMING
AMENDMENTS.Section
10
11
12
13
paragraph (13)..
14
15
16
SION.
17
18
(1) IN
19
20
21
22
23
24
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235
1
DSH.
10
11
12
13
14
(2) COORDINATION
15
PORT.The
16
17
18
19
ERAGE
20
IN
RESPONSE
TO
COV-
EXPANSION.
(1) IN
GENERAL.If
21
22
23
24
25
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1
10
11
12
13
(2) SIGNIFICANT
14
15
16
(A) IN
GENERAL.There
is a significant
17
18
19
20
21
22
(B) NATIONAL
RATE
OF
UNINSURANCE
23
DEFINED.The
24
25
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237
1
(3) UNCOMPENSATED
CARE INCREASE.
(A) COMPUTATION
OF DSH SAVINGS.For
10
(B)
STRUCTURE
OF
PAYMENT
IN-
11
CREASE.The
12
13
14
15
vides that
16
17
18
19
20
21
22
23
crease.
24
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238
1 section 1886(d)(5)(F) of the Social Security Act (42
2 U.S.C. 1395ww(d)(5)(F)) for inpatient hospital services
3 furnished by disproportionate share hospitals.
FOR
2010.Section
(10) UPDATE
FOR 2010.The
update to the
13
14
15
16
year..
17
ON
21
22
(G); and
23
24
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1
(G) REBASING
UPDATE
ADJUSTMENTS.In
determining the
2009; and
10
11
12
13
14
15
(c) LIMITATION
CLUDED IN
ON
TO
ULE.Effective
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240
1 such services when furnished in the facility of a provider
2 of services).
3
(d)
ESTABLISHMENT
OF
SEPARATE
TARGET
(1)
OF
SERVICE
CAT-
EGORIES.Subsection
(5) SERVICE
CATEGORIES.For
services fur-
10
11
12
13
service category:
14
15
16
17
18
19
20
21
22
23
retary); and
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ESTABLISHMENT
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241
1
subparagraph (A).
(2) ESTABLISHMENT
10
11
12
13
14
15
16
17
18
appropriate indentation;
OF SIN-
and with
19
20
21
22
23
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1
(ii) APPLICATION
VERSION
2011.
(I) IN
BEGINNING
GENERAL.In
WITH
applying
2011,
10
11
12
13
14
egories.
15
separate
(II) INITIAL
conversion
factors
CONVERSION FAC-
16
TORS.Such
17
18
19
20
21
2011.
22
(III) UPDATING
OF
CONVER-
23
SION
24
25
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243
1
volved.; and
10
(3) ESTABLISHING
11
FACTORS
12
13
14
amended
FOR
SERVICE
CATEGORIES.Section
15
16
17
18
19
paragraph:
20
(11) UPDATES
21
22
(A) IN
GENERAL.In
applying paragraph
23
24
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1
(i) APPLICATION
CATEGORY.Pursuant
10
11
ice category.
12
to
(ii) COMPUTATION
paragraph
OF ALLOWED AND
13
14
ICE CATEGORIES.In
15
16
17
18
19
(I) APPLICATION
BASED
ON
20
SERVICE
21
22
23
24
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1
(II) APPLICATION
(B) DETERMINATION
OF ALLOWED EX-
PENDITURES.In
10
11
12
13
as follows:
14
(i) FOR
15
2010.For
(I) TOTAL
2010:
2009
ACTUAL
EX-
16
17
18
19
20
21
22
service category.
23
(II)
INCREASE
BY
GROWTH
24
25
PENDITURES
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246
1
EGORY.Compute
(ii) FOR
SUBSEQUENT YEARS.For
10
11
12
13
14
15
16
(4)
APPLICATION
OF
SEPARATE
TARGET
17
(A) IN
GENERAL.Section
1848(f) of the
18
19
20
new paragraph:
21
(5)
APPLICATION
OF
SEPARATE
TARGET
22
23
24
25
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247
1
(B) USE
10
11
12
13
14
able; and
15
16
17
tainable; and
18
19
by
20
RATE
21
RATE;
22
inserting
TARGET
GROWTH
SUSTAINABLE
GROWTH
24
of subparagraph (A);
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after
AND
23
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1
and; and
10
11
12
13
14
15
16
(e) APPLICATION
ZATION
TO
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249
1
and
10
11
tion.
18
19
SCHEDULE.
(K) POTENTIALLY
23
(i) IN
24
GENERAL.The
Secretary
shall
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MISVALUED CODES.
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1
(ii)
OF
POTEN-
10
purposes
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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IDENTIFICATION
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1
by the Secretary.
(iii) REVIEW
10
isting
11
12
13
14
(i)(II).
processes
to
receive
rec-
15
16
17
18
19
20
propriate
21
clause (i)(II).
adjustment
described
in
22
23
24
analyze
25
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AND ADJUSTMENTS.
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1
(i)(II).
subparagraph (B).
10
11
12
13
14
15
priate
16
17
18
19
20
21
subsection (b).
revisions
(including
22
23
24
25
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253
1
(B)(ii)(II).
(L)
UNITS.
(i) IN
RELATIVE
GENERAL.The
VALUE
Secretary
subsection (b).
10
(ii) COMPONENTS
AND
ELEMENTS
11
OF
12
13
14
15
16
17
18
19
WORK.The
(iii) SCOPE
process
described
OF CODES.The
in
valida-
20
21
22
23
paragraph (K)(ii)
24
25
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1
appropriate.
10
11
12
13
adjustments
14
(B)(ii)(II)..
15
subparagraph
(b) IMPLEMENTATION.
16
17
18
19
20
21
22
23
24
25
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1
(2) ADMINISTRATION.
section.
10
11
12
13
14
15
16
17
18
19
20
section.
21
(3) FOCUSING
RESOURCES
ON
POTEN-
22
23
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1
2
(x)
INCENTIVE
PAYMENTS
FOR
EFFICIENT
6 AREAS.
7
(1) IN
10
11
12
13
14
15
16
17
18
(2) IDENTIFICATION
19
(A) IN
OF EFFICIENT AREAS.
GENERAL.Based
upon available
20
21
22
23
24
25
26
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July 14, 2009 (12:51 p.m.)
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GENERAL.In
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1
in payment rates.
(B)
OF
COUNTIES
WHERE
10
11
12
13
SERVICE
(C)
IS
FURNISHED..For
LIMITATION
ON
pur-
REVIEW.There
14
15
16
ing
17
18
19
20
21
paragraph (B).
22
(D) PUBLICATION
23
POSTING ON WEBSITE.With
24
25
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IDENTIFICATION
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1
Medicaid Services..
9
10
14
15
16
17
18
19
20
21
22
23
24
(I) INFORMAL
25
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1
7
8
(c) INTEGRATION
ING AND
OF
(7) INTEGRATION
12
13
14
15
16
17
18
19
later than
20
21
22
23
(o); and
24
25
to an individual.
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1
this part.
6
7
the Secretary..
(d) EXTENSION
OF
INCENTIVE PAYMENTS.Section
12
13
14
through 2012.
15
16
17
ITIES.
(6) TRANSITION
22
(A) IN
GENERAL.
23
24
25
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1
methodology as follows:
10
using
11
12
13
14
15
16
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18
19
20
21
22
23
24
25
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1
10
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12
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ond-highest
14
15
16
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separate
18
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20
21
22
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24
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12
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14
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16
(B) SUBSEQUENT
17
(i) PERIODIC
18
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24
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1
(ii) LINK
DATA REVISION.The
10
11
12
13
14
(C) REFERENCES
revision described in
TO
FEE
SCHEDULE
15
AREAS.Effective
16
17
18
19
20
TO
DEFINITION
OF
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1
2
1131.
INCORPORATING
PRODUCTIVITY
IMPROVE-
MENTS
IMPROVEMENTS.
INTO
MARKET
BASKET
UPDATES
(1) IN
GENERAL.The
10
11
12
(II)
13
1886(b)(3)(B)(iii); and
14
of
such
section)
after
15
reduced.
16
(2) EFFECTIVE
DATE.The
amendments made
17
18
19
adjustment
described
in
section
24 1886(b)(3)(B)(iii)(II).
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1
2 Section
1833(i)(2)(D)
of
such
Act
(42
U.S.C.
3 1395l(i)(2)(D)) is amended
4
5
new clause:
(d)
LABORATORY
SERVICES.Section
17
18
19
20
clause (III);
21
22
23
24
subclause:
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1
10
11
1886(b)(3)(B)(iii)(II);
12
13
14
tivity
15
1886(b)(3)(B)(iii)(II),;
described
in
section
16
17
18
tivity
19
1886(b)(3)(B)(iii)(II); and
adjustment
described
in
section
20
21
22
productivity
23
1886(b)(3)(B)(iii)(II).
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1
WHEELCHAIRS.
PLEX REHABILITATIVE
after OPTION
FOR;
COM-
and
10
11
12
group 3 or higher.
13
SEC.
1142.
22
23
EXTENSION
OF
PAYMENT
RULE
FOR
BRACHYTHERAPY.
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1 first place it appears, January 1, 2010 and inserting
2 January 1, 2012.
3
4
5
GRESS.
10
11
12
13
14
15
16
17
18
19
20
21
22
sion therapy.
23
24
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1
program.
10
11
12
DATA.
13
14
(1) IN
GENERAL.Section
15
16
17
(2) DEVELOPMENT
COST
REPORT.Not
23
24
25
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1
(3) AUDIT
REQUIREMENT.The
Secretary shall
(4) EFFECTIVE
DATE.The
amendment made
10
11
12
13
14
(1) IN
GENERAL.Section
1833(i)(7) of such
15
16
17
18
19
20
subparagraph:
(C) Under subparagraph (B) the Secretary shall re-
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1
(2) EFFECTIVE
DATE.The
amendment made
4
5
(18) AUTHORIZATION
CANCER HOSPITALS.
10
11
12
13
14
15
16
17
18
(B) AUTHORIZATION
OF ADJUSTMENT.
19
20
21
22
23
24
25
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1
$8,000,000,000; and.
10
11
(a) ADJUSTMENT
FLECT
IN
PRACTICE EXPENSE
TO
RE -
15
16
17
and
18
19
subparagraph:
20
(C) ADJUSTMENT
21
TO
22
TION.In
23
24
25
imaging
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section
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1
AND
CAP.
(b) ADJUSTMENT
OTHER PROVISIONS
COUNT ON
IN
after OPD
PAYMENT
SINGLE-SESSION IMAGING
TO
CONSECUTIVE
(D) ADJUSTMENT
IN TECHNICAL COMPO-
14
15
16
17
18
19
20
21
22
23
percent to 50 percent..
24
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1 tion, shall apply to services furnished on or after January
2 1, 2011.
3
4
5
PROVEMENTS.
19
(1) IN
OXYGEN EQUIPMENT .
GENERAL.Section
1834(a)(5)(F) of the
20
21
amended
22
23
24
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1
clause:
(iii) CONTINUATION
10
11
12
13
14
15
16
17
18
19
20
of such period..
21
(2) EFFECTIVE
DATE.The
amendments made
22
23
24
25
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1
(c) TREATMENT
PLICATIONS.Section
OF
10
11
12
13
14
15
16
17
18
19
20
plies.
21
22
23
24
25
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1
suppliers application..
3
4
CASE
OF
SUPPLIER BANKRUPTCY
FOR
CERTAIN
(iii)
EXCEPTION
RUPTCY.If
FOR
BANK-
10
11
12
13
14
15
16
17
18
19
MEASUREMENT.
25
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1
10
to such recommendations.
11
12
13
14
15
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4
5
PITAL READMISSIONS.
(a) HOSPITALS.
(1) IN
GENERAL.Section
10
(p) ADJUSTMENT
TO
HOSPITAL PAYMENTS
FOR
11 EXCESS READMISSIONS.
12
(1) IN
respect to payment
13
14
15
16
17
18
19
20
21
of
22
23
24
discharge; and
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1
year.
(2)
OPERATING
DRG
PAYMENT
AMOUNT.
(A) IN
GENERAL.Except
as provided in
10
11
12
13
14
15
16
17
18
19
20
21
(3) ADJUSTMENT
22
(A) IN
FACTOR.
GENERAL.For
purposes of para-
23
24
25
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1
10
11
12
13
14
15
discharges
16
17
18
(C) FLOOR
defined
in
paragraph
ADJUSTMENT FACTOR.For
19
20
21
for
22
23
24
25
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1
(4) AGGREGATE
section:
(A) AGGREGATE
READMISSIONS.The
10
11
12
13
14
15
16
17
18
19
20
(B) AGGREGATE
21
CHARGES.The
22
23
24
25
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1
(C) EXCESS
(i) IN
GENERAL.Subject
to clauses
of
10
11
12
been
13
14
15
applicable period; to
16
endorsed
under
paragraph
17
readmissions
18
19
20
21
(ii) EXCLUSION
(as
determined
OF
CERTAIN
con-
RE-
22
ADMISSIONS.For
23
24
25
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10
11
12
13
14
15
16
17
section:
18
(A) APPLICABLE
term
19
20
21
22
23
24
25
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1
1890(a); and
10
11
12
plicable hospital).
13
(B) EXPANSION
14
TIONS.Beginning
15
16
17
18
19
20
21
22
23
24
25
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1
(C) APPLICABLE
term
1814(b)(3).
(D) APPLICABLE
PERIOD.The
term ap-
10
11
12
13
sions.
14
15
16
17
18
19
20
21
22
23
24
25
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1
(6) LIMITATIONS
shall be
10
11
12
13
14
15
16
17
18
19
20
21
22
23
(7) MONITORING
INAPPROPRIATE CHANGES IN
24
ADMISSIONS PRACTICES.The
25
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1
priate sanction.
(8) ASSISTANCE
10
(A) IN
GENERAL.For
purposes of pro-
11
12
13
14
15
16
17
18
19
20
21
(B) TARGETED
HOSPITALS.Subpara-
22
23
that
24
25
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1
(E).
10
(C) CAPS.
11
(i) AGGREGATE
aggregate
12
13
14
15
16
17
18
19
paragraph (1).
20
(ii) HOSPITAL-SPECIFIC
LIMIT.The
21
22
23
24
25
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CAP.The
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1
(D) FORM
Secretary
(E) USE
OF ADDITIONAL PAYMENT.
10
11
12
13
14
lowing:
15
16
17
18
19
preters.
20
21
discharge planners.
22
23
24
upon discharge.
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1
to a medical home.
(F) GAO
10
11
12
13
14
(G)
DISPROPORTIONATE
SHARE
HOS-
15
PITAL PAYMENT.In
16
disproportionate
17
18
subsection (d)(5)(F)..
19
20
(b) APPLICATION
PITALS.Section
share
TO
hospital
payment
23
24
paragraph (C);
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new subparagraph:
10
11
12
13
14
15 1886(p)(3) shall apply to payments with respect to a crit16 ical access hospital with respect to a cost reporting period
17 beginning in fiscal year 2012 and each subsequent fiscal
18 year (after application of paragraph (4) of this subsection)
19 in a manner similar to the manner in which such section
20 applies with respect to a fiscal year to an applicable hos21 pital as described in section 1886(p)(2)..
22
23
(1) INTERIM
24
(A) IN
25
GENERAL.With
respect to a read-
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1
10
11
12
13
14
15
16
17
18
19
20
(B) APPLICABLE
21
22
percent is
23
24
0.996;
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1
0.993; and
0.99.
(C) EFFECTIVE
(1)
10
11
12
(2) DEVELOPMENT
13
FORMANCE MEASURES.
14
(A)
IN
GENERAL.The
Secretary
of
15
16
17
18
19
20
21
22
23
24
25
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1
subsection (a).
(B)
Secretary
10
11
12
13
14
15
(C) MONITORING
AND PENALTIES.The
16
17
18
19
20
21
section:
22
(A) POST
23
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1
rity Act);
Act);
10
11
(B) OTHER
12
13
14
15
16
(d) PHYSICIANS.
17
18
19
20
21
(2)
CONSIDERATIONS.In
conducting
the
22
23
as
24
25
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TERMS
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1
pital;
10
11
12
13
14
cian or physicians.
15
16
lic report on such study not later than the date that
17
18
Act.
19
20 visions of this section, in addition to funds otherwise avail21 able, out of any funds in the Treasury not otherwise ap22 propriated, there are appropriated to the Secretary of
23 Health and Human Services for the Center for Medicare
24 & Medicaid Services Program Management Account
25 $25,000,000 for each fiscal year beginning with 2010.
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299
1 Amounts appropriated under this subsection for a fiscal
2 year shall be available until expended.
3
4
5
(a) PLAN.
(1) IN
10
11
12
13
reform are to
14
15
16
17
18
19
(2) BUNDLING
20
21
22
23
24
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1
(3) POST
ACUTE SERVICES.For
purposes of
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18
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20
21
22
23
24
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1
DRGs.
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13
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17
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such rates.
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20
21
22
23
24
25
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1
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25
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1
program.
appropriate.
(1) CONSULTATION
10
11
appropriate.
12
13
(2) ANALYSIS
de-
14
15
16
determines appropriate;
17
18
19
20
21
22
23
24
25
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1
(d) ADMINISTRATION.
10
11
12
icaid
13
14
15
16
expended.
17
Program
(2) EXPEDITED
Management
Account
DATA COLLECTION.Chapter
18
19
this section.
20
21
(1) INTERIM
REPORTS.The
Secretary shall
22
23
24
25
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305
1
REPORT.Not
(2) FINAL
(f) CONVERSION
ONSTRATION TO
CLUDE
OF
PILOT PROGRAM
AND
EXPANSION
TO IN-
GENERAL.Part
10
11
12
13
14
15
ICES.
16
21
22
23
24
25
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1
ices.
15
16
17
18
19
20
21
22
23
24
25 (c), the Chief Actuary of the Centers for Medicare & Med-
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307
1 icaid Services shall certify whether expansion of the pilot
2 program under this section would result in estimated
3 spending that would be less than what spending would
4 otherwise be in the absence of this section.
5
6 paragraph shall be construed as requiring the participa7 tion of an entity in the pilot program under this section..
8
(2)
CONFORMING
AMENDMENT.Section
10
11
12
Secretary.
13
14
17
18
(VII); and
19
20
21
22
23
24
25
0 percent; and.
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308
1
2
3
CARE.
(a) ACCELERATION
OF
ADJUSTMENT
FOR
CASE MIX
8
9
10
(vi) SPECIAL
11
12
(I) IN
GENERAL.With
respect
13
14
15
16
17
18
19
20
21
(II) CONSTRUCTION.Nothing
22
23
24
25
26
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1
3
4
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22
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25
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1
amount
(B).; and
5
6
amounts)
determined
(iii) SPECIAL
(I)
APPLICATION
OF
PROXY
10
11
12
13
14
15
retary
16
17
18
19
20
(II) ADJUSTMENT
shall
the Secretary
substitute
for
such
FOR SUBSE-
21
22
23
24
shall
25
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311
1
10
11
12
spectively,
13
14
15
SEC.
1155.
INCORPORATING
than
the
amount
PRODUCTIVITY
(or
IMPROVE-
16
17
18
22
23
24
manner; and
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12
13
14
15
16
17
subparagraph:
18
19
20
paragraph (3)(D).;
21
22
23
24
25
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1
subparagraph:
lows:
(f)
REPORTING
DISCLOSURE
REQUIRE-
MENTS.
(1) IN
GENERAL.Each
10
11
12
13
14
including
15
16
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21
22
23
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25
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1
8
9
(2) REQUIREMENTS
HOSPITALS
WITH
the
10
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18
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20
21
22
23
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25
hospital; and
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1
pital; and
hospital.
10
11
12
13
14
15
16
(3) PUBLICATION
INFORMATION.The
17
18
19
20
21
22
23
24
(5) FAILURE
MATION.
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10
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23
section:
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1
2
(i) REQUIREMENTS
VIDER
AND
TO
QUALIFY
FOR
RURAL PRO-
TO
3 SELF-REFERRAL PROHIBITION.
4
(1) REQUIREMENTS
pur-
(A) PROVIDER
AGREEMENT.The
hos-
pital had
10
11
12
13
(B) PROHIBITION
14
SHIP OR INVESTMENT.The
15
16
17
18
19
20
21
(C) PROHIBITION
ON PHYSICIAN OWNER-
percentage of the
ON EXPANSION OF FA-
22
CILITY CAPACITY.Except
23
24
25
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1
(D) ENSURING
AND INVESTMENT.
10
11
12
pital.
13
14
15
16
17
18
19
20
21
22
23
24
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1
the hospital.
10
11
12
13
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16
17
18
19
20
21
22
23
24
25
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1
owner or investor.
(E) PATIENT
the case of a
10
11
12
13
14
15
16
17
18
19
(F) LIMITATION
ON
APPLICATION
TO
20
CERTAIN
21
22
23
24
(2) EXCEPTION
25
CONVERTED
FACILITIES.The
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1
(A) PROCESS.
paragraph (1)(C).
(ii) OPPORTUNITY
INPUT.The
10
11
12
13
tion.
14
(iii)
TIMING
FOR
IMPLEMENTA-
15
TION.The
16
17
18
19
20
21
22
23
24
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1
tions.
(C) PERMITTED
(i) IN
GENERAL.Subject
to clause
10
11
12
13
14
15
16
17
18
19
20
21
exception).
22
(ii) 100
23
TION.The
24
25
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INCREASE.
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1
(iii) BASELINE
ATING
BEDS.In
PROCEDURE
ROOMS,
OR
10
11
12
13
14
subsection.
15
(D) INCREASE
LIMITED TO FACILITIES
16
17
18
19
20
21
(E) CONDITIONS
FOR APPROVAL OF AN
22
23
24
25
hospital
f:\VHLC\071409\071409.140.xml
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ROOMS,
NUMBER OF OPER-
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1
10
11
12
13
14
15
16
17
(iii)
does
not
discriminate
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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1
(F) PROCEDURE
this sub-
10
11
12
13
14
15
(G)
PUBLICATION
OF
FINAL
DECI-
16
SIONS.Not
17
18
19
20
21
such application.
22
(H) LIMITATION
ON
REVIEW.There
23
24
25
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July 14, 2009 (12:51 p.m.)
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326
1
ess.
(3) PHYSICIAN
OR
INVESTOR
DE-
FINED.For
10
(4) PATIENT
SAFETY REQUIREMENT.In
the
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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1
(c) IMPLEMENTATION.
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
subsection (b).
f:\VHLC\071409\071409.140.xml
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1
GRAPHIC
MEDICARE.
ADJUSTMENT
FACTORS
UNDER
5 Human Services shall enter into a contract with the Insti6 tute of Medicine of the National Academy of Science to
7 conduct a comprehensive empirical study, and provide rec8 ommendations as appropriate, on the accuracy of the geo9 graphic adjustment factors established under sections
10 1848(e) and 1886(d)(3)(E) of the Social Security Act (42
11 U.S.C. 1395w4(e), 11395ww(d)(3)).
12
16
17
ment factors.
18
19
20
21
22
23
24
25
ticipate in Medicare.
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1
2 text of the United States health care marketplace, evalu3 ate and consider the following:
4
10
11
12
and
13
14
medical technologies.
15
16
17
18
19
care.
20
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330
1
2 priated to carry out this section such sums as may be nec3 essary.
4
7 Human Services, taking into account the recommenda8 tions made in the report under section 1157(d), shall in9 clude in the proposed rules published to implement
10 changes to payment systems for physicians and hospitals
11 under sections 1848(e) and 1886(d)(3)(E), respectively, of
12 the Social Security Act, proposals to revise geographic ad13 justment factors for such payment systems for services
14 furnished under the Medicare program. Such proposed
15 rules shall be published in the rulemaking period imme16 diately following submission of the report under section
17 1157(d).
18
19
(1) FUNDING
making
20
21
22
23
subsection (c).
24
25
(2) ENSURING
FAIRNESS.In
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331
1
16
17
18
15
19
20
SERVICE COSTS.
21 1395w23) is amended
22
23
24
25
and
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1
section:
(n) DETERMINATION
OF
BLENDED BENCHMARK
8 AMOUNT.
9
(1) IN
purposes of subsection
10
11
12
13
14
15
year; and
16
(ii)
13
17
18
19
20
21
(ii)
23
22
23
24
25
year.
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333
1
(2) SPECIFIED
AMOUNT.The
amount speci-
(3) FEE-FOR-SERVICE
PAYMENT FLOOR.In
10
11
paragraph (2).
12
(4) EXCEPTION
sub-
13
14
15
16
20
21
and
22
23
section:
24
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334
1
(1) HIGH
10
(2) IMPROVED
11
12
13
14
15
16
17
18
19
(3) DETERMINATIONS
20
(A) QUALITY
OF QUALITY.
PERFORMANCE.The
Sec-
21
22
23
24
25
(B) COMPUTATION
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1
(i) FOR
formance on
quality measures;
10
and
11
12
13
specify.
14
15
16
(ii) ESTABLISHMENT
OF OUTCOME-
17
BASED MEASURES.By
18
19
20
21
22
23
24
25
may include
f:\VHLC\071409\071409.140.xml
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336
1
(II)
of
prevention
10
11
12
13
14
15
and
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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measures
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337
1
(iii) RULES
SELECTION
OF
MEASURES.The
10
11
12
13
14
15
16
17
18
19
20
21
measure.
22
(iv)
23
BLEND.For
24
25
f:\VHLC\071409\071409.140.xml
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FOR
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338
1
(v) USE
QUALITY
OUTCOMES
MEASURES.For
10
11
(C) DATA
12
13
14
15
2009; and
16
17
18
19
preceding year.
20
(D) REPORTING
OF DATA.Each
Medi-
21
22
23
24
f:\VHLC\071409\071409.140.xml
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339
1
(E) RANKING
(i) INITIAL
RANKING.Based
on the
formance
10
11
12
13
14
vious year.
15
16
17
18
19
20
ment.
21
(ii) IDENTIFICATION
OF HIGH QUAL-
22
23
PROJECTED ENROLLMENT.The
24
25
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OF PLANS.
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340
1
10
plan.
11
(iii) IDENTIFICATION
12
13
ON PROJECTED ENROLLMENT.The
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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341
1
(iv)
AUTHORITY
TO
DISQUALIFY
CERTAIN PLANS.In
10
11
12
13
14
15
16
17
18
19
20
21
22
23
f:\VHLC\071409\071409.140.xml
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342
1
duct an analysis;
10
11
years.
12
13
14
15
ELECTION PERIODS.
FOR
ANNUAL EN-
19
20
21
22
23
24
25
clause:
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343
1
(b) ELIMINATION
OF
10
14
15
16
17
18
tract.
19
20
21
f:\VHLC\071409\071409.140.xml
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344
1 under such plan reside in a county in which the MA orga2 nization offers an MA local plan.
3
(a) REPORT
TO
(b) IMPROVEMENTS
TO
RISK ADJUSTMENT.Not
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345
1
2
3
BILIZATION FUND.
FRAUD
12
13
14
HEALTH SERVICES.
17
18
19
20
program option;
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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346
1
(ii) PERMITTING
10
11
12
13
14
(b) LIMITATION
FIED
FOR
DUAL ELIGIBLES
AND
in
QUALI-
(7) LIMITATION
18
ELIGIBLES
19
FICIARIES.In
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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QUALIFIED
MEDICARE
BENE-
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347
1
ary 1, 2011.
ary 1, 2011.
10
11
12
SION.
13
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
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348
1
7
8
ADMINISTRATIVE COSTS.
(a) DISCLOSURE
OF
AND
9 OTHER EXPENSE DATA.Section 1851 of the Social Se10 curity Act (42 U.S.C. 1395w21), as previously amended
11 by this subtitle, is amended by adding at the end the fol12 lowing new subsection:
13
(p) PUBLICATION
OF
AND
(1) IN
16
17
18
19
(2) SUBMISSION
20
(A) IN
OF DATA.
GENERAL.Each
MA organization
21
22
23
24
f:\VHLC\071409\071409.140.xml
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GENERAL.The
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349
1
(B) DATA
data
(C) USE
OF STANDARDIZED ELEMENTS
AND DEFINITIONS.The
10
11
12
(3) DEVELOPMENT
13
data to be submitted
OF
DATA
REPORTING
STANDARDS.
14
(A) IN
GENERAL.The
Secretary shall
15
16
17
18
19
20
21
22
definitions so developed.
23
(B)
CONSULTATION.The
Secretary
24
25
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350
1
(4) MEDICAL
10
11
12
(4) REQUIREMENT
17
LOSS RATIO.If
18
19
20
21
22
23
24
25
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351
1
10
11
(b)
17
CIENCIES.
18
ENFORCEMENT
(1) IN
AUDITS
GENERAL.Section
AND
DEFI-
19
20
21
22
(5) ENFORCEMENT
CIENCIES.
23
(A) INFORMATION
IN CONTRACT.The
24
25
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352
1
(B)
ENFORCEMENT
AUTHORITY.The
activities..
10
(2) APPLICATION
provi-
11
12
13
14
(C) REJECTION
24
in
f:\VHLC\071409\071409.140.xml
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353
1
(3) REJECTION
OF BIDS.Paragraph
(5)(C)
10
11 this section shall apply to bids for contract years begin12 ning on or after January 1, 2011.
13 PART 3TREATMENT OF SPECIAL NEEDS PLANS
14
15
16
17
18
22
23
24
25
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354
1
an
(b)(6)(B)(iii)..
described
in
subsection
4
5
individual
12
(1) PLANS
purposes of sec-
13
14
15
16
17
18
19
of January 1, 2004.
20
(2) ANALYSIS;
REPORT.The
Secretary of
21
22
23
24
25
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DESCRIBED.For
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355
1
Subtitle EImprovements to
Medicare Part D
8
9
10
14
15
16
and
17
18
19
20
(7) PHASED-IN
GAP.
21
(A) IN
GENERAL.For
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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ELIMINATION OF COVERAGE
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1
paragraph (4).
(B) INCREASE
INITIAL
COVERAGE
LIMIT.For
10
11
12
13
14
15
(C) DECREASE
IN ANNUAL OUT-OF-POCK-
16
ET THRESHOLD.For
17
18
19
shall be decreased by
20
21
22
12
of the cumulative
paragraph:
f:\VHLC\071409\071409.140.xml
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12:51 Jul 14, 2009
23
IN
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357
1
(i) ANNUAL
AGE.The
age means
PERCENT-
2015, 5 percent;
10
11
(ii) CUMULATIVE
PHASE-IN
PER-
12
CENTAGE.The
13
14
15
16
17
18
cent.
19
(E) OUT-OF-POCKET
GAP AMOUNT.For
20
21
22
amount by which
23
24
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PHASE-IN
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358
1
10
11
(1) IN
GENERAL.Section
14
15
16
17
18
19
20
subsection:
(f) PRESCRIPTION DRUG REBATE AGREEMENT
FOR
(1) IN
23
24
f:\VHLC\071409\071409.140.xml
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VerDate Nov 24 2008
GENERAL.In
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359
1
(2) REBATE
rebate agree-
10
11
12
13
14
15
16
17
18
section 1857(f)(3).
19
(3) REBATE
20
21
(A) IN
GENERAL.The
22
23
24
25
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AGREEMENT.A
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360
1
10
11
12
13
14
15
ceeds
16
17
18
19
20
and period.
21
(B) MEDICAID
AMOUNT.For
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
REBATE
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361
1
period
the
specified
in
paragraph
10
11
12
13
14
(C) AVERAGE
15
FULL-BENEFIT
16
AMOUNT.For
17
18
19
20
21
22
23
24
of
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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amount
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DUAL
ELIGIBLE
REBATE
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362
1
sor or organization, of
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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363
1
(4) LENGTH
provisions
10
11
12
13
14
(5) OTHER
15
16
17
18
19
20
21
(A) FULL-BENEFIT
22
VIDUAL.The
23
24
section 1935(c)(6).
f:\VHLC\071409\071409.140.xml
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364
1
(B) REBATE
term rebate
tion 1927(k)(8)..
(2) REPORTING
EES.
(A)
REQUIREMENTS
FOR
PDP
SPON-
10
SORS.Section
11
12
13
graph:
14
(7) REPORTING
15
16
17
18
ROLLEES.
19
(A) IN
GENERAL.For
purposes of the
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
PERIOD.The
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365
1
(B) REPORT
manufacturer
10
11
12
13
14
15
16
17
18
19
period;
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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1
10
11
12
13
14
Secretary.
15
(C) SUBMISSION
16
17
18
19
20
(D)
CONFIDENTIALITY
OF
INFORMA-
21
TION.The
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
TO SECRETARY.Each
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1
section;
10
11
12
13
14
15
16
17
18
19
uations.
20
(F) PENALTIES
21
22
FALSE INFORMATION.In
23
sponsor
24
25
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1
10
11
12
13
14
15
16
17
18
(B)
TO
MA
ORGANIZA-
19
TIONS.Section
20
21
22
(D) REPORTING
REQUIREMENT RELATED
23
24
25
1860D12(b)(7)..
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1
(3) DEPOSIT
(6) REBATE
1860D16(c)
10
11
1860D2(b)(7)..
12
13
14
19
20
21
22
section; and
23
24
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1
(g) REQUIREMENT
FOR
MANUFACTURER DISCOUNT
(1) IN
has not entered into and have in effect for all quali-
(2) DISCOUNT
10
AGREEMENT.
(A) PERIODIC
DISCOUNTS.A
discount
11
12
13
14
15
16
17
18
19
20
21
paragraph (5)(E)).
22
(B) DISCOUNT
AGREEMENT.Insofar
as
23
24
25
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1
cept that
10
11
12
13
and
14
15
16
17
18
(C) COUNTING
19
OUT-OF-POCKET
20
21
22
23
24
25
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1
(3) DISCOUNT
amount of the
(4) ADDITIONAL
TERMS.In
10
11
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13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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AMOUNT.The
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1
(A)
DRUG.The
term
10
11
12
drug application;
13
14
15
16
Administration; or
17
18
19
20
21
22
23
24
(B) QUALIFYING
25
ENROLLEE.The
term
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QUALIFYING
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1
1860D14(a)(3)).
(C)
NEGOTIATED
PRICE.The
10
11
12
(D) ACTUAL
GAP IN COVERAGE.The
13
14
15
16
17
18
19
(E) ORIGINAL
GAP IN COVERAGE.The
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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DRUG-COMPONENT
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375
1
FACILITIES.
(b)
SUBMISSION
TO
MAPD
PLANS.Section
13 1857(f)(3) of the Social Security Act (42 U.S.C. 1395w14 27(f)(3)), as added by section 171(b) of Public Law 110
15 275 and amended by section 172(a)(2) of such Public
16 Law, is amended by striking subparagraph (B) and redes17 ignating subparagraph (C) as subparagraph (B).
18
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376
1
SERVICE
IN
PROVIDING
PRESCRIPTION
10
11
12
13
14
15
16
17
Program; and
18
19
20
21
new clause:
22
23
24
25
26
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1
10
11
ice Act..
12
16
17
18
19 cial Security Act (42 U.S.C. 1395w101(b)(3)) is amend20 ed by adding at the end the following new subparagraph:
21
(F) CHANGE
22
IN INCREASE IN COST-SHARING.
23
(i) IN
GENERAL.Except
as pro-
24
25
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1
10
11
12
13
14
15
16
applied to
17
18
19
20
21
22
successor regulation); or
23
24
25
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1
section..
11
12
13
(1) IN
GENERAL.Paragraph
14
15
16
17
18
(2) EFFECTIVE
DATE.The
amendment made
19
20
21
22
23
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380
1
MITTEE;
and
5
6
subsection:
(c) TELEHEALTH ADVISORY COMMITTEE.
(1) IN
GENERAL.The
10
11
12
13
14
15
16
17
18
(2) MEMBERSHIP;
19
TERMS.
(A) MEMBERSHIP.
20
(i)
IN
GENERAL.The
Advisory
21
22
23
whom
24
25
cians;
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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ADVISORY COM-
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381
1
and
of telehealth programs.
(ii) REQUIREMENTS
ING MEMBERS.In
shall
appointing members of
10
11
12
of telemedicine or telehealth;
13
14
15
16
17
health programs;
18
19
20
21
22
23
ommendations of stakeholders.
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382
1
(C) CONFLICTS
advi-
10
11
12
13
14
15
(4) PERMANENT
COMMITTEE.Section
14 of
16
17
18
(2) FOLLOWING
RECOMMENDATIONS.Section
19
1834(m)(4)(F)
20
21
22
of
such
Act
(42
(iii) RECOMMENDATIONS
U.S.C.
OF
THE
23
24
25
f:\VHLC\071409\071409.140.xml
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OF INTEREST.An
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383
1
10
11
12
13
(3)
14
TION.The
15
16
17
18
19
20
21
OF
ADMINISTRATIVE
LIMITA-
22
23
WAIVER
PROVISION.
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1
2
3
and
7
8
9
10
SIFICATIONS.
19
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1
OGY SERVICES.
21
22
23
24
25
26
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386
1
(b)
AMBULANCE
AIR
IMPROVEMENTS.Section
11
TITLE IIMEDICARE
BENEFICIARY IMPROVEMENTS
Subtitle AImproving and Simplifying Financial Assistance for
Low Income Medicare Beneficiaries
12
13
14
PROGRAM.
6
7
8
9
10
15
(a) APPLICATION
16 UNDER LIS
17
(1) IN
1860D14(a)(1) of
18
the
19
20
21
22
Social
Security
(2) ANNUAL
Act
(42
INCREASE
IN
U.S.C.
LIS
1395w
RESOURCE
23
TEST.Section
24
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TO
OF
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clause (I);
10
11
12
13
14
15
16
17
18
19
20
21
year.; and
22
23
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1
(3) APPLICATION
1905(p)(1)(C) of
10
11
12
13
14
15
16
17
18
19
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1
CERTAIN
NON-INSTITUTIONALIZED
FULL-
5 the
Social
Security
Act
(42
U.S.C.
1395w
6 114(a)(1)(D)(i)) is amended
7
UALS.In
10
(I) INSTITUTIONALIZED
12
VIDUALS.In;
13
14
OF COST-
BLE INDIVIDUALS.
11
INDI-
and
15
(II) CERTAIN
OTHER INDIVID-
16
UALS.In
17
18
19
20
21
22
23
24
25
26
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1
14 RESOURCES UNDER
15
GRAM.
16
(1) IN
GENERAL.Clause
(iii) of section
17
18
19
follows:
20
(iii) CERTIFICATION
21
RESOURCES.For
22
this section
OF INCOME AND
purposes of applying
23
24
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OF INCOME AND
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391
1
and
by the Commissioner..
10
(2) EFFECTIVE
DATE.The
amendment made
11
12
2010.
13
(b) DISCLOSURES
14
OF
FACILITATE IDENTIFICATION
TO
INDIVIDUALS LIKELY
TO
BE INELIGIBLE
SCRIPTION
DRUG PROGRAM
TO
17 ADMINISTRATIONS OUTREACH
18
UALS.For
THE
FOR THE
MEDICARE PRE-
ELIGIBLE INDIVID-
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1
TO
19 REIMBURSEMENTS.
20
(1) LINE-ITEM
reimburse-
21
22
23
24
is made.
25
26
(2) TIMING
OF REIMBURSEMENTS.A
prescrip-
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1
such subsection; or
10
11
12
(3)
REQUIREMENT.For
each
13
14
15
16
17
18
19
20
21
22
23
24
25
readjudicated.
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REPORTING
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1
ices.
10
11
(1) COVERED
term cov-
12
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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DRUG COSTS.The
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1
(2) ELIGIBLE
term eligi-
such beneficiary.
10
11
(3) RETROACTIVE
COVERAGE
PERIOD.The
12
13
14
15
16
17
18
19
20
eligible; and
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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THIRD PARTY.The
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1
9
10
(4) RETROACTIVE
ENROLLMENT
BENE-
FICIARY.
11
(A) IN
GENERAL.The
term retroactive
12
13
vidual who
14
15
16
17
18
19
20
21
22
23
24
Savings
25
f:\VHLC\071409\071409.140.xml
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LIS
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
397
1
10
such Act.
11
(B) EXCEPTION
12
13
(i) IN
GENERAL.In
no case shall an
14
individual
15
16
17
18
19
20
described
(ii) RFP
in
CONTRACT
subparagraph
DESCRIBED.
21
22
23
24
25
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1
5
6
24 subsection (a) shall take effect for contract years begin25 ning with 2012.
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1
(a)
SPECIAL
ENROLLMENT
PERIOD.Section
(D) SUBSIDY
ELIGIBLE INDIVIDUALS.
10
11
12
(D) SPECIAL
17
BLE
18
19
20
21
22
23
24
25
26
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INDIVIDUALS.The
process established
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1
12
13
SIDY BENCHMARK.
14
15 of
the
Social
Security
Act
(42
U.S.C.
1395w
16 114(b)(2)(B)(iii)) is amended by inserting before the pe17 riod the following: before the application of the monthly
18 rebate computed under section 1854(b)(1)(C)(i) for that
19 plan and year involved.
20
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4
5
MEDICARE.
BY THE
(1) STUDY
GUAGE SERVICES.The
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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1
tient.
10
11
12
13
14
15
16
17
18
19
sharing.
20
21
22
23
24
25
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July 14, 2009 (12:51 p.m.)
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1
(3) VARIATION
SCRIBED.The
PAYMENT
SYSTEM
DE-
10
11
12
13
factors as
14
15
16
17
18
preter);
19
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tion);
22
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24
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404
1
and
10
11
Act.
12
(5) EXEMPTION
13
ACT.Chapter
14
15
16
this subsection.
17
(6) AUTHORIZATION
OF
APPROPRIATIONS.
18
19
20
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2
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4
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14
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406
1 the Secretary shall take into consideration the results of
2 the study conducted under section 1221(a) and adjust, as
3 appropriate, the distribution of grants so as to better tar4 get Medicare beneficiaries who are in the greatest need
5 of language services. The Secretary shall not authorize a
6 grant larger than $500,000 over three years for any grant7 ee.
8
9
10
11
(A) be
12
13
14
15
such title;
16
17
18
title; or
19
20
21
22
23
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25
(2) PRIORITY.
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1
10
11
12
(B) FOR
13
14
15
16
17
(C) VARIATION
IN GRANTEES.The
Sec-
18
19
20
variations in
21
22
23
24
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1
quency of use;
7
8
(1) IN
10
11
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15
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18
19
20
21
22
23
24
section (e).
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1
(3) DETERMINATION
GUAGE SERVICES.Payments
to grantees shall be
10
11
12
13
14
English
15
16
17
18
19
20
by the grantee; or
proficient
individuals
who
speak
21
22
23
24
25
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410
1
ed in subparagraph (A).
(4) LIMITATIONS.
10
11
12
13
14
onstration program.
15
(B) TYPE
16
(i) IN
GENERAL.Subject
to clause
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
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OF SERVICES.
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1
10
11
12
13
14
15
16
17
18
19
20
and
21
22
23
24
interpreter
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1
tient.
10
11 shall
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18
19
20
21
22
23
guage;
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10
11
12
13
14
15
22
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25
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1
of an interpreter).
3
4
contractors or agencies).
8
9
10
11
12
the Secretary).
13
(g) EVALUATION
AND
24
25
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1
participating.
10
11
gram.
12
(i) AUTHORIZATION
OF
APPROPRIATIONS.There
22
23
SERVICES.
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416
1 pare and publish, not later than 3 years after the date
2 of the enactment of this Act, a report on the impact of
3 language access services on the health and health care of
4 limited English proficient populations.
5
10
11
12
13
14
15
ices.
16
17
In this subtitle:
18
19
20
21
22
languages.
23
(2) COMPETENT
24
25
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1
10
(3) COMPETENT
11
12
13
14
15
16
17
18
19
20
21
22
(4) EFFECTIVE
COMMUNICATION.The
term
23
24
25
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1
related services.
(5)
(6)
HEALTH
CARE
SERVICES.The
term
10
11
12
care settings.
13
(7) HEALTH
CARE-RELATED SERVICES.The
14
15
16
17
(8) LANGUAGE
ACCESS.The
term language
18
19
20
21
22
(9) LANGUAGE
SERVICES.The
term lan-
23
24
25
f:\VHLC\071409\071409.140.xml
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INTERPRETING/INTERPRETATION.The
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1
(10)
ENGLISH
PROFICIENT.The
10
(11)
MEDICARE
BENEFICIARY.The
term
11
12
13
14
(12) MEDICARE
PROGRAM.The
term Medi-
15
16
17
(13) SERVICE
PROVIDER.The
term service
18
19
20
21
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420
Subtitle CMiscellaneous
Improvements
4
5
PROCESS.
11
12
13
SIS PROVISIONS.
14
(a) PROVISION
15
MUNOSUPPRESSIVE
16
GRAM FOR
17
18
APPROPRIATE COVERAGE
DRUGS UNDER
THE
OF
IM-
MEDICARE PRO-
(1) CONTINUED
ENTITLEMENT
TO
IMMUNO-
SUPPRESSIVE DRUGS.
19
(A) KIDNEY
TRANSPLANT RECIPIENTS.
20
21
22
23
24
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1
new subsection:
TO
INDIVIDUALS
(1) IN
12
13
14
15
16
17
18
19
20
21
22
23
24
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1
1833(b); and
this part).
10
11
this part.
12
(2) ESTABLISHMENT
PROCEDURES
13
14
IN
Secretary
15
16
17
18
19
20
21
part..
22
(C) TECHNICAL
AMENDMENT TO CORRECT
23
24
25
U.S.C.
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423
1
(2) EXTENSION
OF
SECONDARY
PAYER
RE-
1862(b)(1)(C)
10
11
12
13
14
of
such
FOR
Act
(42
U.S.C.
ESRD PATIENTS.
17
18
19
20
biologicals;
21
22
23
24
25
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1
in); and
10
11
12
13
14
15
16
(a) MEDICARE.
17
(1) IN
18
19
20
21
subparagraph (DD);
22
23
24
25
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425
1
2
subsection:
7 term advance care planning consultation means a con8 sultation between the individual and a practitioner de9 scribed in paragraph (2) regarding advance care planning,
10 if, subject to paragraph (3), the individual involved has
11 not had such a consultation within the last 5 years. Such
12 consultation shall include the following:
13
14
15
16
17
18
19
20
21
22
23
24
25
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1
service
(including
those
funded
10
11
12
13
14
15
16
17
18
19
20
order; and
21
22
23
24
25
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1
care proxy).
furnished in a State
10
11
12
13
14
clause (iii).
15
16
17
program that
18
19
20
21
22
23
24
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1
10
11
12
13
14
15
16
(r)(1)); and
17
18
19
20
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1
18
19
20
21
22
23
24
25
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1
10
dividual.
11
12 graph (A)(ii) may range from an indication for full treat13 ment to an indication to limit some or all or specified
14 interventions. Such indicated levels of treatment may in15 clude indications respecting, among other items
16
17
18
or pulmonary problems;
19
20
21
ting;
22
23
24
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1
4
5
(3) FREQUENCY
LIMITATION.Section
1862(a)
10
11
and; and
12
13
14
15
consultations
16
17
18
and
19
(as
defined
in
section
20
21
(4) EFFECTIVE
DATE.The
amendments made
22
23
24
(b) EXPANSION
OF
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1
(1) PHYSICIANS
TIVE.Section
5
6
(3) PHYSICIANS
TIVE.
(A) IN
GENERAL.For
purposes of re-
10
11
12
13
14
15
16
17
sustaining treatment.
18
(B) PROPOSED
SET OF MEASURES.
The
19
20
21
22
23
24
25
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1
(c) INCLUSION
INFORMATION
OF
IN
MEDICARE &
4 YOU HANDBOOK.
5
(1) MEDICARE
(A) IN
GENERAL.Not
10
11
12
13
ing
14
15
16
(III)
17
treatment; and
18
orders
of
life-sustaining
19
20
21
22
23
24
organizations
25
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1
seq.);
and
10
(B) UPDATE
11
VERSIONS.The
12
13
14
15
16
17
18
19
20
21
(1) IN
GENERAL.Section
22
23
24
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435
1 United States Code) at the time the individual is entitled
2 to hospital insurance benefits under part A under section
3 226(b) or section 226A and who is eligible to enroll but
4 who has elected not to enroll (or to be deemed enrolled)
5 during the individuals initial enrollment period, there
6 shall be a special enrollment period described in paragraph
7 (2).
8
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1
amendment made
(1) IN
GENERAL.Section
(2) EFFECTIVE
10
(A) IN
DATE.
GENERAL.The
amendment made
11
12
13
14
(B) REBATES
15
FOR
CERTAIN
DISABLED
16
(i) IN
GENERAL.With
respect to
17
18
19
20
21
22
23
24
25
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1
10
(ii) CONSULTATION
DEPART-
11
MENT
12
13
14
15
graph.
16
DEFENSE.The
OF
(iii)
REBATES.The
Secretary of
Secretary
of
17
18
19
20
21
22
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1
COME-RELATED PREMIUM.
13
14
(b) SITES.
24
25
26
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1
10
11
12
13
sion making;
14
15
16
17
poses; and
18
19
20
21
(1) IN
22
23
24
25
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1
care.
(2) PAYMENT
VISIT.The
10
11
services; and
12
13
14
15
16
17
18
19
(d) COSTS
OF
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441
1 ance Trust Fund established under section 1841 of the
2 Social Security Act (42 U.S.C. 1395t) of such funds as
3 are necessary for the costs of carrying out the program.
4
10 date of completion of the program, the Secretary shall sub11 mit to Congress a report on such program, together with
12 recommendations for such legislation and administrative
13 action as the Secretary determines to be appropriate. The
14 final report shall include an evaluation of the impact of
15 the use of the program on health quality, utilization of
16 health care services, and on improving the quality of life
17 of such beneficiaries.
18
19
20
(1) ELIGIBLE
term eligible
21
22
23
24
(D) A hospital.
25
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PROVIDER.The
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442
1
10
(2) PATIENT
term pa-
11
12
13
14
15
16
17
18
19
20
(3) SHARED
DECISION
MAKING.The
term
21
22
23
24
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VerDate Nov 24 2008
DECISION AID.The
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443
1
TITLE
IIIPROMOTING
PRIMARY
CARE,
MENTAL
HEALTH SERVICES, AND COORDINATED CARE
3
4
5
8
9
PROGRAM.
ACCOUNTABLE
23
24
A and B;
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444
1
TIONS
(ACOS).
9
10
(1) QUALIFYING
this sec-
tion:
11
(A) IN
GENERAL.The
terms qualifying
12
13
14
15
16
17
18
ices; and
19
20
21
22
23
(B) INCLUSION
OF OTHER PROVIDERS.
24
25
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ACO DEFINED.In
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445
1
gram.
10
11
12
13
services.
14
(D) OTHER
15
MODEL.The
16
17
18
19
20
21
22
23
(E) OTHER
SERVICES.Nothing
in this
24
25
f:\VHLC\071409\071409.140.xml
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PHYSICIAN ORGANIZATIONAL
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446
1
(2) QUALIFYING
following are
10
11
12
13
14
15
16
17
18
pliers, or both).
19
20
21
22
23
f:\VHLC\071409\071409.140.xml
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CRITERIA.The
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447
1
10
11
12
13
14
ment plan.
15
16
17
18 specific payment incentive models described in this sub19 section are the following:
20
(1) PERFORMANCE
21
22
23
target model):
24
(A) IN
25
GENERAL.A
qualifying ACO
f:\VHLC\071409\071409.140.xml
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TARGET MODEL.Under
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448
1
(B) COMPUTATION
PERFORMANCE
TARGET.
(i) IN
GENERAL.The
Secretary
10
11
12
13
14
15
16
17
appropriate.
18
(ii) BASE
AMOUNT.For
purposes of
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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OF
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449
1
(iii)
FACTOR.For
10
11
12
13
14
15
16
17
18
19
by the Secretary.
20
21
22
23
clause (ii).
24
(C) MEETING
f:\VHLC\071409\071409.140.xml
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ADJUSTMENT
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450
1
(i) IN
to clause
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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GENERAL.Subject
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451
1
(D) REPORTING
MENTS.In
appropriate)
10
11
12
13
14
15
16
paragraph.
17
(2) PARTIAL
18
(A) IN
incorporate
reporting
require-
CAPITATION MODEL.
GENERAL.Subject
to subpara-
19
20
21
22
23
risk for some, but not all, of the items and serv-
24
25
f:\VHLC\071409\071409.140.xml
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452
1
(B) NO
TURES.Payments
10
11
12
13
14
15
retary.
16
(3) OTHER
17
PAYMENT MODELS.
(A) IN
GENERAL.Subject
to subpara-
18
19
20
21
(B) NO
22
TURES.Subparagraph
23
24
f:\VHLC\071409\071409.140.xml
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453
1
paragraph (2).
(1) IN
10
11
12
13
14
15
16
(2)
FOLLOWING
APPLICABLE
BENE-
17
FICIARIES.The
18
19
20
21
(e) IMPLEMENTATION.
22
(1) STARTING
DATE.The
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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GENERAL.In
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454
1
(3) PERFORMANCE
ally.
(4) LIMITATIONS
ON REVIEW.There
shall be
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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RESULTS REPORTS.The
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455
1
(1) IN
10
11
12
13
14
15
16
17
18
(g) EXTENSION
19
CESSFUL
20
OF
ORGANIZATIONS.
(1) REPORTS
TO CONGRESS.Not
later than
21
22
23
24
25
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GENERAL.The
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456
1
title.
10
11
12
quality standards or
13
14
15
16
17
18
19
20
21
gram.
22
23
(1) TESTING
24
INCENTIVE MODELS.Subject
25
f:\VHLC\071409\071409.140.xml
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457
1
ACOs.
5
6
(2) EXPANDING
TO PROGRAM IMPLEMENTATION.
(A) IN
GENERAL.Subject
to subpara-
10
11
12
13
14
15
16
17
18
19
20
(i) TREATMENT
OF
21 DEMONSTRATION.
22
23
24
25
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458
1
section is operational.
10
11
12
13
(1) AUTHORITY
14
ARRANGEMENTS.The
15
16
17
18
19
20
21
22
deems appropriate.
23
(2) ENCOURAGEMENT
24
SMALLER ORGANIZATIONS.In
25
f:\VHLC\071409\071409.140.xml
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OF PARTICIPATION OF
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1
(3) INVOLVEMENT
PRIVATE
PAYER
AR-
RANGEMENTS.Nothing
(4) ANTIDISCRIMINATION
LIMITATION.The
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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IN
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460
1
10
11
12 Act is amended by inserting after section 1866D, as in13 serted by section 1301, the following new section:
14
15
MEDICAL
AND
MEDICAL
16 HOME MODELS.
17
(1) ESTABLISHMENT
18
19
20
21
22
23
24
need
25
26
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OF PILOT PROGRAM.
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(as
defined
in
subsection
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1
served areas.
(3) MODELS
PILOT PROGRAM.The
(A) INDEPENDENT
PATIENT-CENTERED
10
patient-
(c).
11
(B) COMMUNITY-BASED
12
MODEL.Community-based
13
14
(4) PARTICIPATION
15
MEDICAL HOME
medical
home
OF NURSE PRACTITIONERS
16
17
18
19
as
20
21
22
23
24
25
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1
home so long as
6
7
8
9
10
(1)
SERVICES.The
term
MEDICAL
patient-centered
HOME
medical
11
12
13
14
15
16
eficiary;
17
18
19
20
21
22
appropriate;
23
24
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PATIENT-CENTERED
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1
community resources;
10
11
12
13
14
15
16
17
18
(2) PRIMARY
19
20
21
22
23
(3) PRINCIPAL
CARE.The
term principal
24
25
f:\VHLC\071409\071409.140.xml
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CARE.The
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1
6 HOME MODEL.
7
(1) IN
(A) PAYMENT
independent
AUTHORITY.Under
patient-centered
medical
the
home
10
11
12
13
14
15
16
graph (C)).
17
(B) INDEPENDENT
18
19
term
20
21
22
independent
23
patient-centered
medical
f:\VHLC\071409\071409.140.xml
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12:51 Jul 14, 2009
PATIENT-CENTERED
24
GENERAL.
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1
(C) TARGETED
DEFINED.For
ficiaries.
10
(D) BENEFICIARY
ELECTION TO PARTICI-
11
PATE.The
12
13
14
15
16
17
of this section.
18
(2)
19
PROCESS
20
HOMES.The
21
22
PATIENT-CENTERED
MEDICAL
23
24
25
f:\VHLC\071409\071409.140.xml
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1
such standards.
(3) PAYMENT.
(A)
OLOGY.The
10
11
12
13
risk beneficiaries.
14
OF
METHOD-
(B) PER
15
MENTS.Under
16
17
18
19
20
ical home.
21
(C) PROSPECTIVE
PAYMENT.The
fee
22
23
spective basis.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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ESTABLISHMENT
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1
(D) AMOUNT
deter-
10
11
12
13
14
15
16
17
18
19
20
21
22
beneficiaries.
23
(4) ENCOURAGING
PARTICIPATION OF VARI-
24
ETY OF PRACTICES.The
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF PAYMENT.In
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1
(5) NO
TION.A
10
11
12
13
subsection (e)(3).
14
15
(1) IN
16
GENERAL.
(A) AUTHORITY
FOR PAYMENTS.Under
17
18
19
20
21
22
23
24
ficiaries.
f:\VHLC\071409\071409.140.xml
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1
(B) COMMUNITY-BASED
DEFINED.In
10
11
12
13
14
15
home provider.
16
17
18
other
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
MEDICAL HOME
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non-physician
practitioners,
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
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1
specify.
(C) HIGH
this
10
11
12
13
(2) QUALIFICATION
PROCESS
14
15
establish a process
FOR
COMMU-
Secretary shall
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
NEED BENEFICIARY.In
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to
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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1
(5) PAYMENTS.
(A)
OLOGY.The
OF
METHOD-
(B) PER
MENTS.Under
10
11
12
13
14
(i) PAYMENT
TO COMMUNITY-BASED
15
ORGANIZATION.One
16
17
zation.
18
(ii) PAYMENT
monthly payment to
TO PRIMARY OR PRIN-
19
20
21
22
(C) PROSPECTIVE
monthly pay-
PAYMENT.The
pay-
23
24
a prospective basis.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
ESTABLISHMENT
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(D) AMOUNT
deter-
10
11
12
13
14
15
16
17
paragraph.
18
(6) INITIAL
IMPLEMENTATION
FUNDING.
19
20
21
22
23
24
25
be used.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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1
(1) EVALUATION
determine
sult in
10
patients;
11
12
disparities;
13
14
pitalizations;
15
16
17
visits;
18
19
20
applicable;
21
22
tion;
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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475
1
penditures; and
10
11
(3) EXPANSION
12
(A) IN
GENERAL.Subject
to the results
13
14
15
16
17
18
19
20
21
(B) CERTIFICATION
REQUIREMENT.The
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23
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sion.
(1) NO
10
11
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an individual.
14
(2) NO
15
TION
16
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AND
MANAGEMENT
SERVICES.Payments
19
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(g) FUNDING.
22
(1) OPERATIONAL
COSTS.For
purposes of
23
24
25
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(2)
MEDICAL
HOME
10
SERVICES.In
11
12
13
14
15
16
17
18
19
20
section (d)(5).
21
22
23
(3) INITIAL
IMPLEMENTATION.In
addition
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25
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(h) TREATMENT
OF
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subsection (c)..
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1
10
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CARE SERVICES.
15
(1) IN
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25
f:\VHLC\071409\071409.140.xml
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shortage area.
6
7
(2) PRIMARY
10
1848(j)(5)(A); and
11
12
13
14
cian.
15
(3)
PRIMARY
16
FINED.In
17
practitioner
CARE
PRACTITIONER
DE-
18
19
20
tioner) who
21
22
23
24
cology; and
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available; and
10
11
(4) LIMITATION
shall be
12
13
14
15
16
17
18
19
20
section.
21
(5)
22
COORDINATION
WITH
OTHER
PAY-
MENTS.
23
(A) WITH
24
TIVES.The
25
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(B) WITH
QUALITY INCENTIVES.Pay-
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shortage area.
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1
2
3
TIFIED NURSE-MIDWIVES.
11
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13
PREVENTIVE SERVICES.
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1
2
(C)
tain
(s)(2)(V)).
described
in
subsection
14
15
16
17
18
19
20
21
section (s)(10)(B)).
22
23
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25
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individuals
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self-management
outpatient
3
4
Diabetes
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1
2
3
4
in subsection (ddd)).
(b) PAYMENT
AND
ELIMINATION
OF
COST-SHAR-
ING.
13
(1) IN
14
GENERAL.
(A) IN
GENERAL.Section
1833(a) of the
15
16
17
(B) APPLICATION
SIGMOIDOSCOPIES
24
AND COLONOSCOPIES.Section
25
f:\VHLC\071409\071409.140.xml
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1
(ii) NO
the case
(ii) NO
COINSURANCE.In
the case
10
11
12
surance applied..
13
14
(2) ELIMINATION
OF COINSURANCE IN OUT-
15
(A) EXCLUSION
16
ULE.Section
17
18
19
20
mammography
21
22
23
and
(B) CONFORMING
inserting
diagnostic
AMENDMENTS.Section
24
25
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10
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(1)(W);.
12
(3) WAIVER
13
14
15
first sen-
16
17
18
19
20
21
22
(4) APPLICATION
TO
PROVIDERS
OF
SERV-
23
ICES.Section
24
f:\VHLC\071409\071409.140.xml
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1
PAYMENT.
(b)
CONFORMING
AMENDMENT.Section
20
21
SELOR SERVICES.
22
23
(a) COVERAGE
(1)
AND
FAMILY THERA-
COVERAGE
OF
SERVICES.Section
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SERVICES.
PIST
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amended
subparagraph:
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12
13
14
15
16
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1 or is paid any amounts with respect to the furnishing of
2 such services.
3
4 an individual who
5
law;
10
11
12
13
14
15
(3) PROVISION
16
B.Section
17
18
19
20
services;.
21
(4) AMOUNT
22
(A) IN
OF PAYMENT.
GENERAL.Section
1833(a)(1) of
23
24
is amended
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and
10
11
(L).
12
(B) DEVELOPMENT
13
SPECT
14
CARE PROFESSIONAL.The
15
16
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25
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HEALTH
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(5) EXCLUSION
MARRIAGE
AND
FAMILY
CILITY
PROSPECTIVE
(6) COVERAGE
PAYMENT
OF
SYSTEM.Section
MARRIAGE
AND
FAMILY
10
11
12
TERS.Section
13
14
15
16
17
18
subsection (jjj)(2)),.
19
(7) INCLUSION
OF
MARRIAGE
AND
FAMILY
20
21
OF CLAIMS.Section
22
23
24
25
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(b) COVERAGE
OF
2 SERVICES.
3
(1)
COVERAGE
OF
SERVICES.Section
amended
10
11
12
subparagraph:
13
14
15
16
17
18
19
20
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1 the State in which such services are performed, as would
2 otherwise be covered if furnished by a physician or as inci3 dent to a physicians professional service, but only if no
4 facility or other provider charges or is paid any amounts
5 with respect to the furnishing of such services.
6
7 individual who
8
10
11
12
13
14
15
16
17
18
(3) PROVISION
19
B.Section
20
21
22
(iv);
24
25
(v); and
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1
clause:
ices;.
(4) AMOUNT
(A) IN
GENERAL.Section
1833(a)(1) of
the
further amended
Social
10
Security
Act
(42
U.S.C.
11
and
12
13
14
15
under
16
17
18
19
20
(L).
21
(B) DEVELOPMENT
section
1861(s)(2)(HH),
the
22
23
24
25
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(5) EXCLUSION
10
11
PROSPECTIVE
12
13
14
15
16
17
therapist
18
(jjj)(1)),.
19
SYSTEM.Section
PAYMENT
services
(6) COVERAGE
(as
defined
OF
MENTAL
in
subsection
HEALTH
COUN-
20
SELOR
21
22
TERS.Section
23
24
25
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section (kkk)(2)),.
(7) INCLUSION
CLAIMS.Section
10
11
12
section 1861(kkk)(2))..
13
17
18
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istration;.
FINED.Section
15
16
17
18
19
20
place it appears.
21
22
23
24
of; and
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1
2011.
(G) IMPLEMENTATION.Chapter 35 of
10
11
12
13
14
15
16
17
18
19
20
21
22
spective administration.
23
24
25
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1
istration..
matter
paragraph.
10
following
subclause
(III),
by
inserting
11 by
12
13
14
15
16
17
TITLE IVQUALITY
Subtitle AComparative
Effectiveness Research
18
19
20
21
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1
2
3
4
COMPARATIVE
FOR
COMPARATIVE EFFEC-
RESEARCH ESTABLISHED.
(1) IN
GENERAL.The
10
11
12
13
14
15
16
17
18
managed clinically.
19
20
21
22
23
24
25
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EFFECTIVENESS RESEARCH
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1
odologies appropriately;
10
11
12
13
14
15
16
17
18
19
data.
20
(3) POWERS.
21
(A) OBTAINING
DATA.The
22
23
24
25
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1
schedule.
(B) DATA
order to
10
11
12
13
14
inadequate, and
15
16
17
18
19
and recommendations.
20
(C) ACCESS
OF GAO TO INFORMATION.
21
22
23
24
f:\VHLC\071409\071409.140.xml
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COLLECTION.In
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1
(D) PERIODIC
AUDIT.The
Center and
eral.
(b) OVERSIGHT
BY
COMPARATIVE EFFECTIVENESS
6 RESEARCH COMMISSION.
7
(1) IN
10
11
12
13
14
15
16
17
18
19
20
21
ers;
22
23
24
f:\VHLC\071409\071409.140.xml
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10
11
12
13
14
15
16
17
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credible research;
19
20
21
22
23
24
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10
11
point of care;
12
13
14
15
16
17
18
19
20
21
22
23
holders; and
24
25
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1
value.
(3) COMPOSITION
(A) IN
GENERAL.The
members of the
10
11
12
13
and
14
15
16
17
18
19
20
physicians,
21
sumers, or patients.
health
care
practitioners,
22
(B) QUALIFICATIONS.
23
(i) DIVERSE
REPRESENTATION
con-
OF
24
PERSPECTIVES.The
25
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OF COMMISSION.
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
509
1
(I) Epidemiology.
(III) Bioethics.
(VI) Economics.
(ii) DIVERSE
10
11
12
13
(I) Patients.
14
15
16
least one
cluding surgeons.
17
18
19
(V) Employers.
20
21
22
23
24
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1
searchers
(B)(ii)(VIII).
(4) APPOINTMENT.
(A) IN
under
subparagraph
GENERAL.The
Secretary shall
10
11
12
13
14
15
(5) CHAIRMAN;
VICE CHAIRMAN.The
Sec-
16
17
18
19
20
21
22
23
24
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1
(6) TERMS.
(A) IN
as provided in
years.
(B) TERMS
OF INITIAL APPOINTEES.Of
10
11
4 years; and
12
13
of 3 years.
14
15
16
17
18
19
Quality.
20
(8) CONFLICTS
21
(A) IN
OF INTEREST.
GENERAL.In
appointing the
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.Except
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512
1
flicts.
(B) EVALUATION
10
11
12
13
14
15
16
17
18
19
20
21
22
(C)
23
(i) DISCLOSURE
25
TEREST.Prior
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
12:51 Jul 14, 2009
DISCLOSURES;
PROHIBITIONS
ON
PARTICIPATION; WAIVERS.
24
AND CRITERIA.When
Jkt 000000
OF FINANCIAL IN-
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PO 00000
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
513
1
10
11
12
(ii) PROHIBITIONS
PARTICIPA-
13
TION.Except
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
ON
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
514
1
10
11
12
paragraph to
13
14
15
16
17
meeting; or
18
19
20
21
22
meeting.
23
(iv) LIMITATION
24
OTHER EXCEPTIONS.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
Jkt 000000
ON WAIVERS AND
(444390|2)
PO 00000
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
515
1
2
SION.The
sion.
(II) PROHIBITION
STATUS
ON
CLINICAL
ON VOTING
PERSPECTIVE
10
ADVISORY PANELS.No
11
12
13
14
15
16
(D) FINANCIAL
INTEREST
voting mem-
DEFINED.
17
18
19
20
Code.
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF ALLOW-
(I) DETERMINATION
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
516
1
of the Commission.
(10) AVAILABILITY
Com-
10
(11) DIRECTOR
11
CONSULTANTS.Subject
12
13
14
may
15
16
17
18
19
20
21
22
competitive service);
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF REPORTS.The
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517
1
agencies;
10
mission;
11
12
13
and
14
15
16
17
sion.
18
(1) ENSURING
AND ACCESS.
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
TRANSPARENCY, CREDIBILITY,
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
518
1
10
11
12
13
14
15
(2) USE
16
PANELS.The
17
search
18
19
20
21
determined
(3) STAKEHOLDER
22
(A) IN
under
subsection
INPUT.
GENERAL.The
Commission shall
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
priority
Jkt 000000
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PO 00000
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
519
1
(B) SPECIFIC
OF
shall
include
TION.Consultation
where
and questions;
odologies; and
10
11
12
13
14
man shall
15
16
17
18
19
20
21
22
Commission.
23
(4) TAKING
24
FERENCES.Research
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
CONSULTA-
AREAS
Jkt 000000
shall
(444390|2)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
520
1
comorbidities; and
10
11
12
13
COMPARATIVE EFFECTIVE-
NESS INFORMATION.
14
(1) IN
GENERAL.Not
15
16
17
18
19
20
21
22
(2) RELEVANT
REPORTS
DESCRIBED.For
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
TO
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
521
1
5
6
(e) DISSEMINATION
PARATIVE
INCORPORATION
OF
COM-
EFFECTIVENESS INFORMATION.
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
AND
Jkt 000000
(444390|2)
PO 00000
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C:\TEMP\AAHCA0~1.XML
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
522
1
10
11
(2) DISSEMINATION
12
GIES.The
13
14
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
Jkt 000000
(444390|2)
PO 00000
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Sfmt 6201
C:\TEMP\AAHCA0~1.XML
HOLCPC
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
523
1
ficiency.
(1) ANNUAL
not later
10
11
12
13
14
(2) RECOMMENDATION
15
16
17
18
19
20
21
22
(3) ANALYSIS
AND REVIEW.Not
later than
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
REPORTS.Beginning
Jkt 000000
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PO 00000
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C:\TEMP\AAHCA0~1.XML
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
524
1
not funded.
(g) FUNDING
OF
COMPARATIVE EFFECTIVENESS
(b)
COMPARATIVE
EFFECTIVENESS
FOR THE
RESEARCH
TRUST FUND.For
20 provision establishing a Comparative Effectiveness Re21 search Trust Fund and financing such Trust Fund, see
22 section 1802.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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PO 00000
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
525
1
2
MATION.
OF
OWNERSHIP
AND
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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PO 00000
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
526
1
mation; and
10
11
12
13
paragraph (4)(A).
14
(2) PUBLIC
15
16
facility shall
17
18
19
20
21
tion; and
22
23
24
a prominent manner.
25
(3) INFORMATION
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
AVAILABILITY OF INFORMATION.
Jkt 000000
DESCRIBED.
(444390|2)
PO 00000
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C:\TEMP\AAHCA0~1.XML
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
527
1
(A) IN
following infor-
graph (C).
on
10
11
12
13
14
15
16
17
18
19
20
the facility.
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.The
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PO 00000
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
528
1
another.
(B) SPECIAL
10
11
12
13
14
15
16
the Secretary.
17
(C) SPECIAL
18
paragraph (A)(i)
RULE.In
applying sub-
19
20
21
22
23
ties; and
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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(444390|2)
PO 00000
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
529
1
(4) REPORTING.
(A) IN
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.Not
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PO 00000
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C:\TEMP\AAHCA0~1.XML
HOLCPC
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
530
1
subparagraph (A).
(5) NO
QUIREMENTS.Nothing
(A) ADDITIONAL
DISCLOSABLE PARTY.
10
11
12
who
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
Jkt 000000
(444390|2)
PO 00000
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HOLCPC
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
531
1
the facility.
10
section 1919(a)).
11
(C) MANAGING
term
12
13
14
15
16
17
18
(D) ORGANIZATIONAL
STRUCTURE.The
19
20
case of
21
22
23
24
25
percent;
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
EMPLOYEE.The
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PO 00000
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HOLCPC
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
532
1
10
11
12
13
14
15
16
17
18
19
appropriate..
20
21
(1) IN
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.Not
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PO 00000
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HOLCPC
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
533
1
(A) NURSING
term nurs-
10
11
Services.
12
(C) SKILLED
NURSING
FACILITY.The
13
14
15
16
17
(1) SKILLED
NURSING
FACILITIES.Section
18
19
20
21
graph (B).
22
(2) NURSING
FACILITIES.Section
1919(d)(1)
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
FACILITY.The
Jkt 000000
(444390|2)
PO 00000
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HOLCPC
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
534
1
2
3
ETHICS PRO-
GRAMS.
(1) SKILLED
NURSING
FACILITIES.Section
subparagraph:
(C)
10
GRAMS.
COMPLIANCE
AND
ETHICS
PRO-
11
12
13
14
15
16
17
18
19
20
21
22
23
24
(ii)
25
TIONS.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
AND
Jkt 000000
DEVELOPMENT
OF
REGULA-
(444390|2)
PO 00000
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
535
1
later
10
11
gram.
12
(II)
13
TIONS.Such
14
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.Not
(I) IN
Jkt 000000
DESIGN
OF
REGULA-
(444390|2)
PO 00000
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
536
1
gation
10
11
12
13
14
15
16
17
18
determines appropriate.
19
(iii) REQUIREMENTS
regulations
under
FOR
this
COMPLI-
20
ANCE
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
of
Jkt 000000
AND
ETHICS
PROGRAMS.In
(444390|2)
PO 00000
Frm 00536
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C:\TEMP\AAHCA0~1.XML
HOLCPC
this
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
537
1
10
(iv).
11
(iv)
COMPONENTS
OF
12
PROGRAM.The
13
14
required components of a
15
16
17
18
19
20
21
22
Act.
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
REQUIRED
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PO 00000
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
538
1
10
11
12
13
this Act.
14
(IV)
organization
must
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
The
Jkt 000000
(444390|2)
PO 00000
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C:\TEMP\AAHCA0~1.XML
HOLCPC
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
539
1
fear of retribution.
10
11
12
13
14
15
to detect an offense.
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
Jkt 000000
(444390|2)
PO 00000
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HOLCPC
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
540
1
Act.
ties.
10
11
12
section 1874(d)..
13
(2) NURSING
1919(d)(1)
14
15
16
17
(C)
18
COMPLIANCE
AND
ETHICS
PRO-
GRAM.
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
FACILITIES.Section
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PO 00000
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HOLCPC
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
541
1
(ii)
TIONS.
(I) IN
OF
REGULA-
GENERAL.Not
later
10
11
12
13
14
15
16
17
18
19
(II)
20
TIONS.Such
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
DEVELOPMENT
Jkt 000000
DESIGN
OF
REGULA-
(444390|2)
PO 00000
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C:\TEMP\AAHCA0~1.XML
HOLCPC
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
542
1
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
determines appropriate.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
Jkt 000000
(444390|2)
PO 00000
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
543
1
(iii) REQUIREMENTS
COMPLI-
ANCE
AND
ETHICS
PROGRAMS.In
this
10
11
12
13
14
15
16
(iv).
17
(iv)
REQUIRED
COMPONENTS
OF
18
PROGRAM.The
19
20
required components of a
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
FOR
Jkt 000000
(444390|2)
PO 00000
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HOLCPC
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
544
1
10
11
12
13
14
15
16
17
18
this Act.
19
(IV)
organization
must
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
The
Jkt 000000
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PO 00000
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HOLCPC
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
545
1
10
11
12
13
14
15
fear of retribution.
16
17
18
19
20
21
to detect an offense.
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
Jkt 000000
(444390|2)
PO 00000
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
546
1
Act.
10
11
12
13
ties.
14
15
16
17
1902(a)(77)..
18
19
20
PERFORMANCE IM-
PROGRAM.
(1) SKILLED
NURSING
FACILITIES.Section
21
22
1396r(b)(1)(B)) is amended
23
24
ing ASSURANCE
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
AND
Jkt 000000
AND
QUALITY
ASSURANCE
(444390|2)
PO 00000
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
547
1
the heading IN
clause:
(ii) QUALITY
(I) IN
GENERAL.Not
later
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.
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(444390|2)
PO 00000
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548
1
10
11
(2)
NURSING
12
13
1396r(b)(1)(B)) is amended
14
15
ing ASSURANCE
16
17
18
19
the heading IN
20
21
QUALITY
GENERAL.
ASSURANCE
clause:
23
(ii) QUALITY
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
12:51 Jul 14, 2009
AND
22
FACILITIES.Section
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549
1
(I) IN
later
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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GENERAL.Not
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550
1
(3) PROPOSAL
AND
10
11
12
13
14
15
16
17
18
19
PERFORMANCE
(4) FACILITY
IMPROVEMENT
PLAN.Not
PROGRAMS.
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
551
1
10
(1) IN
GENERAL.The
Comptroller General of
the United States shall conduct a study that examines the following:
11
12
13
14
15
16
17
18
19
20
21
22
ization.
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
CAPITALIZATION.
8
9
ON
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
552
1
(3) NURSING
cility.
6
7
8
9
(1) IN
12
13
15
16
11
14
GENERAL.Section
10
(1) INCLUSION
OF
ADDITIONAL
INFORMA-
TION.
17
(A) IN
GENERAL.The
Secretary shall
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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FACILITY.In
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
553
1
10
11
12
13
14
15
16
program;
17
18
19
prove;
20
21
22
23
program; and
24
25
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
554
1
10
11
12
13
14
15
16
17
day);
18
19
20
21
22
23
care; and
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
555
1
10
11
12
such report.
13
14
15
16
17
18
19
20
21
22
substantiated complaints.
23
24
25
of a a nursing facility
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
556
1
the facility;
10
and
11
12
13
14
agents.
15
(B) DEADLINE
16
MATION.
17
(i) IN
GENERAL.Except
as pro-
18
19
20
21
22
23
subsection.
24
(ii)
25
EXCEPTION.The
Secretary
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
557
1
mented.
7
8
(2)
REVIEW
MODIFICATION
OF
WEBSITE.
(A) IN
10
GENERAL.The
Secretary shall
establish a process
11
12
13
14
15
16
17
18
19
20
clause (i).
21
22
23
24
25
programs;
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
AND
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
558
1
appropriate..
6
7
(2) TIMELINESS
(A) IN
GENERAL.Section
1819(g)(5) of
10
11
12
(E) SUBMISSION
13
TIFICATION
INFORMATION
14
RETARY.In
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF SUBMISSION OF SURVEY
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TO
THE
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
559
1
terly..
(B) EFFECTIVE
amendment
(3) SPECIAL
9
10
11
(8) SPECIAL
12
(A) IN
Secretary shall
13
14
15
16
17
18
(B) PERIODIC
SURVEYS.Under
such
19
20
21
every 6 months..
22
23
24
(1) IN
GENERAL.Section
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
DATE.The
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
560
1
4
5
6
7
(1) INCLUSION
ADDITIONAL
INFORMA-
TION.
(A) IN
GENERAL.The
Secretary shall
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
561
1
10
11
day);
12
13
14
15
16
17
care; and
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
562
1
such report.
(iii)
standardized
complaint
10
11
12
13
14
substantiated complaints.
15
16
17
of a nursing facility
18
19
20
21
22
23
24
25
an elder.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
The
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
563
1
(B) DEADLINE
MATION.
(i) IN
GENERAL.Except
as pro-
subsection.
10
(ii)
EXCEPTION.The
Secretary
11
12
13
14
15
16
17
mented.
18
19
(2)
REVIEW
AND
MODIFICATION
OF
WEBSITE.
20
(A) IN
21
GENERAL.The
Secretary shall
establish a process
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
564
1
clause (i).
10
11
12
programs;
13
14
15
16
17
18
19
appropriate..
20
21
(2) TIMELINESS
22
(A) IN
GENERAL.Section
1919(g)(5) of
23
24
25
new subparagraph:
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF SUBMISSION OF SURVEY
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565
1
(E) SUBMISSION
TIFICATION
INFORMATION
RETARY.In
10
11
12
13
14
15
16
17
18
terly..
19
(B) EFFECTIVE
TO
DATE.The
THE
SEC-
amendment
20
21
22
(3) SPECIAL
23
24
25
(10) SPECIAL
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
566
1
(A) IN
Secretary shall
of this Act.
(B) PERIODIC
SURVEYS.Under
such
10
11
12
13
OF
REPORTS
ON
SURVEYS, CER-
COMPLAINT INVESTIGATIONS.
(1) SKILLED
NURSING
FACILITIES.Section
14
15
16
17
new subparagraph:
18
(D) AVAILABILITY
OF SURVEY, CERTIFI-
19
20
PORTS.A
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.The
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567
1
plainants or residents..
(2) NURSING
1919(d)(1)
10
11
graph:
12
(D) AVAILABILITY
OF SURVEY, CERTIFI-
13
14
PORTS.A
15
16
17
18
19
20
21
22
23
24
25
plainants or residents..
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
FACILITIES.Section
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
568
1
amendments made
(d) GUIDANCE
SPECTION
PORTS.
REPORTS
TO
STATES
AND
ON
10
11
12
13
14
15
16
17
18
19
20
21
amended
22
23
paragraph (B);
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
DATE.The
(3) EFFECTIVE
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
569
1
subparagraph:
10
11
12
13
14
15
16
(A) NURSING
term nurs-
17
18
19
20
21
22
Services.
23
(C) SKILLED
24
NURSING
FACILITY.The
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
FACILITY.The
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
570
1
3
4
(f) REPORTING
TURES.
(1) IN
GENERAL.For
10
11
12
13
14
15
16
17
18
(2) MODIFICATION
OF FORM.The
Secretary,
19
20
21
22
23
24
25
(3) CATEGORIZATION
COUNTS.Not
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF
Jkt 000000
BY
FUNCTIONAL
(444390|2)
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AC-
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
571
1
10
11
12
basis:
13
14
15
16
17
18
land costs).
19
20
(4) AVAILABILITY
INFORMATION
SUB-
21
MITTED.The
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
572
1
(1) DEVELOPMENT
paragraph:
10
(9) STANDARDIZED
COMPLAINT FORM.The
11
12
13
14
15
16
17
(2) STATE
REQUIREMENTS.Section
1819(e)
18
19
20
paragraph:
21
22
(6) COMPLAINT
(A) COMPLAINT
24
FORMS.The
State must
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
12:51 Jul 14, 2009
BLOWER PROTECTION.
23
BY THE SECRETARY.Sec-
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573
1
quest to
cility;
10
(B) COMPLAINT
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
RESOLUTION PROCESS.
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574
1
10
11
clude
12
13
14
15
16
17
18
19
20
21
22
and
23
24
25
confidential.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
575
1
(C) WHISTLEBLOWER
(i) PROHIBITION
AGAINST RETALIA-
TION.No
10
11
12
13
14
15
16
17
18
(ii) RETALIATORY
REPORTING.A
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
PROTECTION.
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576
1
(iii) COMMENCEMENT
10
11
12
13
14
15
16
17
18
19
20
21
22
and proper.
23
(iv) RIGHTS
NOT WAIVABLE.The
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF ACTION.
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
577
1
ment.
(v) REQUIREMENT
OF
10
11
12
13
14
15
16
17
18
(D) RULE
EMPLOYEE
RIGHTS.Each
skilled
OF CONSTRUCTION.Nothing
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
TO POST NOTICE
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
578
1
pur-
sonably believes
10
formation..
11
12
(1) DEVELOPMENT
BY THE SECRETARY.Sec-
13
14
15
16
paragraph:
17
(11) STANDARDIZED
COMPLAINT FORM.The
18
19
20
21
22
23
nursing facility..
24
25
(2) STATE
REQUIREMENTS.Section
1919(e)
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
FAITH DEFINED.For
(E) GOOD
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
579
1
paragraph:
3
4
(8) COMPLAINT
BLOWER PROTECTION.
(A) COMPLAINT
FORMS.The
State must
quest to
10
11
12
13
14
worker.
15
(B) COMPLAINT
RESOLUTION PROCESS.
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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580
1
10
11
12
13
14
15
include
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
581
1
and
confidential.
(C) WHISTLEBLOWER
(i) PROHIBITION
AGAINST RETALIA-
TION.No
10
11
12
13
14
15
16
17
18
19
20
21
22
23
(ii) RETALIATORY
REPORTING.A
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
PROTECTION.
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582
1
(iii) COMMENCEMENT
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF ACTION.
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
583
1
and proper.
(iv) RIGHTS
10
ment.
11
(v) REQUIREMENT
TO POST NOTICE
12
OF EMPLOYEE RIGHTS.Each
13
14
15
16
17
18
19
20
21
22
plaint.
23
(D) RULE
nursing fa-
OF CONSTRUCTION.Nothing
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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1
(E) GOOD
FAITH DEFINED.For
pur-
10
sonably believes
11
12
13
14
15
formation..
16
17 this section shall take effect 1 year after the date of the
18 enactment of this Act.
19
20
(a)
SKILLED
NURSING
FACILITIES.Section
(C) SUBMISSION
25
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1
FORMAT.Beginning
10
11
12
13
14
15
16
17
18
tence
19
20
certified
21
22
23
24
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1
schedule; and
10
11
12
13
14
15
16
17
18
(C) SUBMISSION
22
23
FORMAT.Beginning
24
25
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10
11
12
13
14
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16
certified
17
18
19
20
21
(such
as
23
24
schedule; and
f:\VHLC\071409\071409.140.xml
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12:51 Jul 14, 2009
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22
employee
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588
1
10
11
12
13
14
15
16
17
(1) IN
GENERAL.Section
18
the
19
20
(ii) AUTHORITY
21
Social
Security
22
(I)
Act
(42
U.S.C.
1395i
WITH RESPECT TO
AMOUNT.The
Secretary
23
24
25
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1819(h)(2)(B)(ii) of
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589
1
retary).
(II) APPLICABLE
AMOUNT.In
applicable
means
per
instance
amount
10
11
12
resident
13
of
the
facility,
an
14
15
16
17
18
19
$25,000; and
20
21
22
23
$3050.
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1
(III)
PER
DAY
AMOUNT.In
$25,000 and
10
11
12
13
$3,050.
14
(IV)
REDUCTION
OF
CIVIL
15
16
CUMSTANCES.Subject
17
18
19
20
21
22
23
24
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1
(V) PROHIBITION
REDUC-
(aa)
REPEAT
DEFI-
CIENCIES.The
Secretary may
(bb) CERTAIN
FICIENCIES.The
OTHER DE-
Secretary may
10
11
12
13
ciency
14
15
16
immediately
17
18
19
20
ciency
21
(II)(bb).
22
(VI) LIMITATION
described
in
subclause
jeopardizes
described
in
the
subclause
ON
AGGRE-
23
GATE
24
25
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aggregate
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1
both.
(VII) COLLECTION
CIVIL
MONEY PENALTIES.In
10
the case of a
11
12
13
14
15
16
17
18
19
20
21
22
23
24
penalties;
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593
1
10
completed;
11
12
13
14
15
16
17
18
19
20
21
22
alty;
23
24
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10
11
12
13
14
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16
(voluntarily or involuntarily) or is
17
18
19
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21
22
23
24
25
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595
1
temporary
Secretary).
10
11
12
13
14
15
16
17
18
19
(2) CONFORMING
AMENDMENT.The
and
second
20
21
22
23
24
(1) PENALTIES
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596
1
(A) IN
1919(h)(2) of
is amended
new subparagraph:
10
(G) CIVIL
11
MONEY PENALTIES.
(i) IN
GENERAL.The
State may
12
13
14
15
16
17
18
(ii)
19
AMOUNT.In
20
APPLICABLE
PER
INSTANCE
21
22
23
24
25
$100,000.
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1
(iii)
PER
10
AMOUNT.In
11
DAY
12
13
14
15
16
17
18
19
20
(iv) REDUCTION
OF CIVIL MONEY
21
PENALTIES
22
CUMSTANCES.Subject
23
24
25
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July 14, 2009 (12:51 p.m.)
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1
percent.
(v) PROHIBITION
REDUCTION
(I) REPEAT
DEFICIENCIES.
10
11
12
13
14
a repeat deficiency.
15
(II)
CERTAIN
OTHER
DEFI-
16
CIENCIES.The
17
18
19
20
21
22
23
24
25
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599
1
(III) LIMITATION
AGGRE-
GATE
under
10
REDUCTIONS.The
regulations
(iv) COLLECTION
11
PENALTIES.In
12
penalty
13
aggregate
under
section
OF CIVIL MONEY
imposed
under
subparagraph
14
15
16
17
18
19
20
21
22
23
24
25
such penalties;
f:\VHLC\071409\071409.140.xml
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1
completed;
10
11
12
13
14
15
16
17
18
19
20
21
22
23
subsequent appeals;
24
25
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601
1
ond
(A)(ii)..
10
(B) CONFORMING
of
subparagraph
AMENDMENT.The
sec-
11
12
Social
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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sentence
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Security
Act
(42
U.S.C.
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602
1
(2)
PENALTIES
BY
THE
SEC-
RETARY.
(A)
IN
GENERAL.Section
10
11
follows:
12
(ii) AUTHORITY
13
WITH RESPECT TO
14
15
16
17
18
19
20
retary).
21
(II)
REDUCTION
OF
CIVIL
22
23
CUMSTANCES.Subject
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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603
1
(III) PROHIBITION
10
11
12
13
14
15
(IV)
COLLECTION
OF
CIVIL
16
MONEY PENALTIES.In
17
18
the case of a
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
ON REDUC-
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604
1
10
11
12
completed;
13
14
15
16
17
18
19
20
21
22
23
24
alty;
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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605
1
10
11
12
13
14
15
16
17
18
(voluntarily or involuntarily) or is
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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1
temporary
and
10
Secretary).
11
12
13
14
15
16
17
18
19
20
21
(B) CONFORMING
AMENDMENT.Section
22
23
24
25
(2)(A).
f:\VHLC\071409\071409.140.xml
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607
1
2 this section shall take effect 1 year after the date of the
3 enactment of this Act.
4
GRAM.
(a) ESTABLISHMENT.
(1) IN
Secretary, in consulta-
10
11
12
13
14
15
16
17
18
19
20
21
22
23
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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608
1
(c) RESPONSIBILITIES
ITOR.An
OF THE
INDEPENDENT MON-
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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609
1
10
11
12
13
14
15
(1) RECEIPT
later
16
17
18
19
20
21
22
such report; or
23
24
25
not do so.
f:\VHLC\071409\071409.140.xml
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610
1
(2) RECEIPT
OF REPORT BY INDEPENDENT
MONITOR.Not
(e) COST
OF
(g) AUTHORIZATION
OF
APPROPRIATIONS.There
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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611
1
(2) NURSING
term nursing
1396r(a)).
Evaluation.
(4) SKILLED
NURSING FACILITY.The
term
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
FACILITY.The
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
612
1
propriate.
9
10
11
(1) IN
12
13
14
(7) NOTIFICATION
15
(A) IN
OF FACILITY CLOSURE.
GENERAL.Any
individual who is
16
17
must
18
19
20
21
22
23
sure
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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GENERAL.Section
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613
1
10
11
12
submitted; and
13
14
15
16
17
18
19
20
21
22
23
(B) RELOCATION.
24
(i) IN
25
State shall
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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GENERAL.The
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614
1
ting.
(ii) CONTINUATION
PAYMENTS
10
11
12
13
14
15
(2)
CONFORMING
Sec-
AMENDMENTS.Section
16
17
1395i3(h)(4)) is amended
18
19
20
21
terminate; and
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
615
1
(1) IN
(9) NOTIFICATION
(A) IN
OF FACILITY CLOSURE.
GENERAL.Any
individual who is
10
11
12
sure
13
14
15
16
17
18
19
20
21
22
23
24
submitted; and
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.Section
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616
1
10
11
(B) RELOCATION.
12
(i) IN
State shall
13
14
15
16
17
ting.
18
(ii) CONTINUATION
OF
PAYMENTS
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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617
1
4 this section shall take effect 1 year after the date of the
5 enactment of this Act.
6
(a)
SKILLED
NURSING
FACILITIES.Section
(b)
NURSING
FACILITIES.Section
23 this section shall take effect 1 year after the date of the
24 enactment of this Act.
f:\VHLC\071409\071409.140.xml
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618
1
VISORY STAFF.
(a) STUDY.
(1) IN
10
11
12
sections
13
14
(42
15
16
17
18
19
20
1819(f)(2)(A)(i)(II)
U.S.C.
and
1395i3(f)(2)(A)(i)(II);
21
training
22
1819(f)(2)(A)(i)(II)
23
24
25
such training.
f:\VHLC\071409\071409.140.xml
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VerDate Nov 24 2008
GENERAL.The
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such
and
sections
1919(f)(2)(A)(i)(II)
(444390|2)
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619
1
(A) NURSING
FACILITY.The
term nurs-
10
11
12
13
14
15
(C) SKILLED
NURSING
FACILITY.The
16
17
18
19
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620
1
3
4
QUALITY IMPROVEMENT.
9
10
11
PERFORMANCE IMPROVEMENT
12 lish and periodically update, not less frequently than tri13 ennially, national priorities for performance improvement.
14
15
(b) RECOMMENDATIONS
ITIES.In
FOR
NATIONAL PRIOR-
16 under subsection (a), the Secretary shall solicit and con17 sider recommendations from multiple outside stake18 holders.
19
20
(c) CONSIDERATIONS
ORITIES.With
IN
24
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621
1
eases;
tients;
the
10
and
patient-
13
14
15
reasons.
16
17
(1) CONSENSUS-BASED
ENTITY.The
term
18
19
20
(2) QUALITY
MEASURE.The
term quality
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
affordability,
variations in care;
11
12
performance,
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622
1
(e) FUNDING.
(1) IN
GENERAL.The
10
(2) AUTHORIZATION
OF APPROPRIATIONS.
11
12
13
14
15
16
17
18
GAO
19
20
EVALUATION
OF
DATA
COLLECTION
21 by section 1441, is amended by adding at the end the fol22 lowing new sections:
23
24
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
623
1
(1) IN
GENERAL.The
(2) FORM
OF AGREEMENTS.The
Secretary
otherwise.
8
9
10
(3)
RECOMMENDATIONS
BASED ENTITY.In
OF
CONSENSUS-
Secretary shall
11
12
13
14
15
(b) DETERMINATION
OF
16 MEASURES ARE REQUIRED.Consistent with the na17 tional priorities established under this part and with the
18 programs administered by the Centers for Medicare &
19 Medicaid Services and in consultation with other relevant
20 Federal agencies, the Secretary shall determine areas in
21 which quality measures for assessing health care services
22 in the United States are needed.
23
24
25
(1) PATIENT-CENTERED
BASED
f:\VHLC\071409\071409.140.xml
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MEASURES.Quality
AND
POPULATION-
measures developed
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624
1
signed
status of patients;
10
tient engagement;
11
12
13
14
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
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625
1
(2) AVAILABILITY
OF MEASURES.The
Sec-
(3) TESTING
OF PROPOSED MEASURES.The
10
(4) UPDATING
OF ENDORSED MEASURES.
11
12
13
14
15
16
17
18 agreements with a qualified entity, the Secretary shall en19 sure that the entity is a public, nonprofit or academic in20 stitution with technical expertise in the area of health
21 quality measurement.
22
(e) APPLICATION
FOR
f:\VHLC\071409\071409.140.xml
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626
1 such agreements, assurances, and information as the Sec2 retary determines to be necessary to carry out this section.
3
(f) FUNDING.
(1) IN
GENERAL.The
10
11
12
(2) AUTHORIZATION
OF APPROPRIATIONS.
13
14
15
16
17
18
19
20
21
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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627
1
10
11
12
13
14
15
16
17
18
19
20
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
628
1
2
3
(d)
MULTI-STAKEHOLDER
PRE-RULEMAKING
(1) LIST
10
11
12
13
14
15
16
17
(2) CONSULTATION
ON SELECTION OF EN-
18
19
20
21
22
23
24
25
grams.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF MEASURES.Not
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
629
1
(3) MULTI-STAKEHOLDER
later
10
11
(4) REQUIREMENT
FOR
TRANSPARENCY
IN
PROCESS.
12
(A) IN
GENERAL.In
convening multi-
13
14
15
16
17
18
such convening.
19
(B) SELECTION
OF ORGANIZATIONS PAR-
20
TICIPATING
21
GROUPS.The
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
INPUT.Not
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IN
MULTI-STAKEHOLDER
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630
1
(5) USE
respective proposed
ommendations.
(6) MULTI-STAKEHOLDER
GROUPS.For
pur-
10
11
12
13
14
15
16
viders.
17
(B) Physicians.
18
19
20
tioners.
21
22
23
groups.
24
(G) Employers.
f:\VHLC\071409\071409.140.xml
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VerDate Nov 24 2008
OF INPUT.The
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
631
1
iting bodies.
10
(7) FUNDING.
11
(A) IN
Secretary shall
12
13
14
15
16
17
18
19
20
(B)
AUTHORIZATION
OF
APPROPRIA-
21
TIONS.For
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.The
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632
1
3
4
(a)
INPATIENT
HOSPITAL
SERVICES.Section
15 determined appropriate by the Secretary for which a fea16 sible and practical quality measure has not been endorsed
17 by the entity with a contract under section 1890(a), the
18 Secretary may specify a measure that is not so endorsed
19 as long as due consideration is given to measures that
20 have been endorsed or adopted by a consensus organiza21 tion identified by the Secretary. The Secretary shall sub22 mit such a non-endorsed measure to the entity for consid23 eration for endorsement. If the entity considers but does
24 not endorse such a measure and if the Secretary does not
25 phase-out use of such measure, the Secretary shall include
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
633
1 the rationale for continued use of such a measure in rule2 making..
3
(F) USE
URES.The
10
11
12
13
ices..
14
(c)
PHYSICIANS
SERVICES.Section
15 1848(k)(2)(C)(ii) of such Act (42 U.S.C. 1395w16 4(k)(2)(C)(ii)) is amended by adding at the end the fol17 lowing: The Secretary shall submit such a non-endorsed
18 measure to the entity for consideration for endorsement.
19 If the entity considers but does not endorse such a meas20 ure and if the Secretary does not phase-out use of such
21 measure, the Secretary shall include the rationale for con22 tinued use of such a measure in rulemaking...
23
(d)
RENAL
24 1881(h)(2)(B)(ii)
DIALYSIS
of
such
SERVICES.Section
Act
(42
U.S.C.
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634
1 following: The Secretary shall submit such a non-en2 dorsed measure to the entity for consideration for endorse3 ment. If the entity considers but does not endorse such
4 a measure and if the Secretary does not phase-out use
5 of such measure, the Secretary shall include the rationale
6 for continued use of such a measure in rulemaking..
7
(e)
ENDORSEMENT
OF
STANDARDS.Section
12
13
14
15
f:\VHLC\071409\071409.140.xml
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635
TWEEN
TORS
BIOLOGICALS,
10
11
MANUFACTURERS
OF
COVERED
OR
AND
DISTRIBU-
DRUGS,
DEVICES,
MEDICAL
SUPPLIES
12 Security Act (42 U.S.C. 1301 et seq.), as amended by sec13 tion 1631(a), is further amended by inserting after section
14 1128G the following new section:
15
16
17
ERS
18
19
20
21
22
23
(a) REPORTING
FERS OF
24
25
OF
DISTRIBUTORS
PAYMENTS
OR
OF
COVERED
OTHER TRANS-
VALUE.
(1) IN
GENERAL.Except
as provided in this
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
AND
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636
1
10
11
12
13
14
15
16
17
18
19
as
20
21
22
23
24
25
ment; or
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637
1
by the Secretary).
sample.
(2)
REPORTING.Information
10
11
12
13
14
15
16
disclosed.
17
(3) SPECIAL
18
19
20
21
22
23
24
25
cipient.
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AGGREGATE
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638
1
(4) DELAYED
FOR
PAYMENTS
MADE
AGREEMENTS.In
10
11
12
13
PURSUANT
TO
PRODUCT
DEVELOPMENT
14
15
16
17
tion.
18
19
20
made.
21
(5) DELAYED
REPORTING
FOR
PAYMENTS
22
23
24
25
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VerDate Nov 24 2008
REPORTING
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639
1
10
11
12
13
made.
14
(6)
CONFIDENTIALITY.Information
de-
15
16
17
18
19
20
21
(b) REPORTING
22
SICIANS IN
OF
HOSPITALS
OWNERSHIP INTEREST
AND
BY
PHY-
23 MEDICARE.Not later than March 31 of each year (be24 ginning with 2011), each hospital or other health care en25 tity (not including a Medicare Advantage organization)
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640
1 that bills the Secretary under part A or part B of title
2 XVIII for services shall report on the ownership shares
3 (other than ownership shares described in section 1877(c))
4 of each physician who, directly or indirectly, owns an in5 terest in the entity. In this subsection, the term physician
6 includes a physicians immediate family members (as de7 fined for purposes of section 1877(a)).
8
(1) IN
10
11
12
13
14
15
16
website that
17
18
19
20
21
22
23
24
25
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July 14, 2009 (12:51 p.m.)
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GENERAL.The
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641
1
as applicable;
10
11
12
13
14
15
16
17
industry-physician relationships;
18
19
20
21
22
23
24
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July 14, 2009 (12:51 p.m.)
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642
1
(2) ACCURACY
accuracy
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
(3) SPECIAL
f:\VHLC\071409\071409.140.xml
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643
1
(4) SPECIAL
IDENTIFIERS.Information
10
11
12
13
14
15
(1) FAILURE
16
(A) IN
TO REPORT.
GENERAL.Subject
to subpara-
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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644
1
10
11
12
13
14
15
16
(2) KNOWING
17
(A) IN
GENERAL.Subject
to subpara-
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
FAILURE TO REPORT.
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645
1
10
that section.
11
12
13
14
15
16
17
18
19
(3) USE
collected by the
20
21
22
23
(4) ENFORCEMENT
24
NEYS GENERAL.The
25
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
646
1
TO
CONGRESS.Not later
8 than April 1 of each year beginning with 2011, the Sec9 retary shall submit to Congress a report that includes the
10 following:
11
12
13
14
15
16
17
18
19
ceding year.
20
21
(1) APPLICABLE
APPLICA-
22
BLE DISTRIBUTOR.The
23
24
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July 14, 2009 (12:51 p.m.)
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MANUFACTURER;
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647
1
(2)
INVESTIGATION.The
term
(3) COVERED
MEDICAL SUPPLY.The
10
11
12
13
14
of such a plan).
15
16
(4) COVERED
RECIPIENT.The
term covered
17
(A) A physician.
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
CLINICAL
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648
1
(G) A hospital.
education program.
group.
10
sionals.
11
12
13
(5) DISTRIBUTOR
14
15
16
17
18
19
20
maceutical distributor.
21
22
term distributor
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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649
1
(8) MANUFACTURER
10
11
(9) PAYMENT
OR
OTHER
TRANSFER
OF
VALUE.
12
(A) IN
GENERAL.The
term payment or
13
14
15
16
17
(iii) Honoraria.
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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1
10
11
lowing:
12
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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1
ered device.
10
11
12
13
1877(c)).
14
15
16
17
18
19
or distributor.
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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1
TO
10
(1) IN
on January 1,
11
12
13
14
15
16
17
18
19
20
(2) NO
PREEMPTION
OF
ADDITIONAL
RE-
21
QUIREMENTS.Paragraph
22
23
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.Effective
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1
10
purposes.
11
12
13
14
15
(b) AVAILABILITY
CLOSURE
OF
OF INFORMATION
FINANCIAL
FROM
RELATIONSHIP
THE
DIS-
REPORT
f:\VHLC\071409\071409.140.xml
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654
HOSPITALS
FECTIONS.
AND
AMBULATORY
SURGICAL
11
HOSPITALS
12
13
FECTIONS.
14
AMBULATORY
SURGICAL
15
(1) IN
GENERAL.The
16
17
18
19
20
cable
21
22
23
24
f:\VHLC\071409\071409.140.xml
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including
sections
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655
1
(2) REPORTING
Such informa-
10
11
12
(3) COORDINATION
WITH
HIT.The
Sec-
13
14
15
16
17
18
where appropriate.
19
(4) PROCEDURES
20
OF INFORMATION.The
21
22
23
24
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PROTOCOLS.
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656
1
ing.
OF
INFORMATION.The Sec-
16
17
21
22
23
such year.
f:\VHLC\071409\071409.140.xml
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657
1
munization rates.
10
11
12
13
14
15
16
17
18
19
20
(d) NON-PREEMPTION
OF
STATE LAWS.Nothing
21 in this section shall be construed as preempting or other22 wise affecting any provision of State law relating to the
23 disclosure of information on health care-associated infec24 tions or patient safety procedures for a hospital or ambu25 latory surgical center.
f:\VHLC\071409\071409.140.xml
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658
1
(1) IN
GENERAL.The
(2) RELATED
10
11
12
was provided.
13
(f) APPLICATION
14
PITALS.For
TO
18 1138A of the Social Security Act (as inserted by sub19 section (a) of this section), the requirement under such
20 section that hospitals and ambulatory surgical centers
21 submit reports takes effect on such date (not later than
22 2 years after the date of the enactment of this Act) as
23 the Secretary of Health and Human Services shall specify.
24 In order to meet such deadline, the Secretary may imple25 ment such section through guidance or other instructions.
f:\VHLC\071409\071409.140.xml
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659
1
(d) REPORT
ON
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660
4
5
TIONS.
10
11
12
13
14
15
16
(8) ADDITIONAL
RESIDENCY POSITIONS.
17
(A) REDUCTIONS
18
USED POSITIONS.
19
(i) PROGRAMS
SUBJECT TO REDUC-
20
TION.If
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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REDISTRIBUTION OF UNUSED
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661
1
(ii) REFERENCE
(I) IN
GENERAL.Except
as
10
11
12
13
14
15
16
17
retary.
18
(II) USE
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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RESIDENT LEVEL.
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662
1
or establishment, as determined by
10
11
12
13
14
15
16
17
(III)
PROVIDER
18
AGREEMENT.In
19
pital
20
21
22
23
such paragraph.
24
(IV)
25
described
TION.The
f:\VHLC\071409\071409.140.xml
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SPECIAL
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PREVIOUS
paragraph
REDISTRIBU-
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1
subclause.
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
(B) REDISTRIBUTION.
f:\VHLC\071409\071409.140.xml
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664
1
(i) IN
Secretary
10
11
12
13
to subparagraph (A).
14
(ii)
REQUIREMENTS
FOR
QUALI-
15
FYING HOSPITALS.A
16
17
18
19
hospital is not a
(I) MAINTENANCE
OF PRIMARY
20
CARE
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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GENERAL.The
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LEVEL.The
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1
10
11
12
13
(A)(ii).
14
(II) DEDICATED
15
16
TO PRIMARY CARE.The
17
18
19
(III)
hospital as-
ACCREDITATION.The
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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ASSIGNMENT
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1
(iii)
IN
REDIS-
TRIBUTION.In
10
11
12
13
14
(iv) PRIORITY
15
PITALS.In
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
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CONSIDERATIONS
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1
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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1
10
population ratios).
11
12
13
14
15
any hospital.
16
(vi) APPLICATION
17
18
19
20
21
22
23
24
25
that hospital.
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OF PER RESIDENT
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669
1
July 1, 2011.
(C) RESIDENT
FINED.In
this paragraph:
10
(7)(C)(i).
11
12
13
14
15
16
17
18
graph (7)(A).
19
(D) MAINTENANCE
OF PRIMARY CARE
20
RESIDENT LEVEL.In
21
22
23
paragraph (B)
24
25
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1
of
10
11
12
and
13
14
tional positions..
15
(b) IME.
16
(1) IN
1886(d)(5)(B)(v) of
17
the
18
19
amended
Social
20
Security
U.S.C.
23
they apply.
24
(2)
CONFORMING
PROVISION.Section
f:\VHLC\071409\071409.140.xml
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12:51 Jul 14, 2009
(42
22
25
Act
21
GENERAL.Section
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1
17
18
TINGS.
21
22
indentation;
and appropriate
23
24
25
that
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; and; and
10
11
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13
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15
16
17
18
19
20
21
22
23
the
24
25
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Secretary
records
regarding
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673
1
fy..
10
and
11
12
13
14
15
16
17
18
19
20
21
ON
IMPACT
ON
TRAINING.The In-
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674
1 the Social Security Act, as amended by subsection (a), in
2 order to assess the extent to which there is an increase
3 in time spent by medical residents in training in nonpro4 vider settings as a result of the amendments made by this
5 section. Not later than 4 years after the date of the enact6 ment of this Act, the Inspector General shall submit a re7 port to Congress on such analysis and assessment.
8
FOR
APPROVED
(1) IN
11
12
13
14
15
16
17
18
19
20
21
22
23
program.
24
25
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1
program;
10
11
12
13
14
15
(3) APPROVED
16
FINED.In
17
18
19
20
21
22
23
hospital.
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1
OTHER ACTIVITIES.
10
rules; and
11
12
clause:
13
(ii) TREATMENT
14
PROVIDER
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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DIDACTIC
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1
of full-time equivalency.;
3
4
10
11
12
13
14
15
16
17
18
(K) NONPROVIDER
19
MARILY
20
CARE.The
21
22
23
24
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ENGAGED
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FURNISHING
PATIENT
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1
9 time equivalent residents for purposes of this subpara10 graph, all the time spent by an intern or resident in an
11 approved medical residency training program in non12 patient care activities, such as didactic conferences and
13 seminars, as such time and activities are defined by the
14 Secretary, that occurs in the hospital shall be counted to15 ward the determination of full-time equivalency if the hos16 pital
17
18
19
Rico hospital;
20
21
22
23
partment.
24
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679
1 graph, all the time spent by an intern or resident in an
2 approved medical residency training program in research
3 activities that are not associated with the treatment or di4 agnosis of a particular patient, as such time and activities
5 are defined by the Secretary, shall not be counted toward
6 the determination of full-time equivalency..
7
(1) IN
as otherwise pro-
10
11
12
13
(2) DIRECT
GME.Section
1886(h)(4)(E)(ii) of
14
15
16
17
18
19
20
21
22
23
24
25
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680
1
Act.
9
10
(vi) REDISTRIBUTION
14
15
(I) IN
GENERAL.The
Sec-
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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1
(II) PROCESS
IN CERTAIN AREAS.In
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
ment).
f:\VHLC\071409\071409.140.xml
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1
(III)
LIMITATION.The
esti-
10
11
(b) NO EFFECT
MENTS.The
ON
shall
not
affect
the
application
of
section
18
19
20
21
22
23
24
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1
5
6
(a) SPECIFICATION
RESIDENCY
ICAL
OF
GOALS
TRAINING
FOR
APPROVED MED-
PROGRAMS.Section
10
11
heading IN
12
dentation; and
13
14
15
(B) GOALS
16
17
GRAMS.The
18
19
20
to do the following:
21
22
23
settings.
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1
cialties.
ment options.
10
11
care.
12
13
14
15
16
17
18
19
sicians serve.
20
21
22
23
24
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685
1
2
EVALUATION
OF
TRAINING PRO-
GRAMS.
(1) IN
GENERAL.The
Comptroller General of
grams
10
11
12
13
14
goals.
15
16
17
18
19
20
21
22
23
ments; and
24
25
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graph (1)(A).
6
7
10
11
15
(7) ADDITIONAL
addition to the
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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1
7
8
appropriation.
(b)
FLEXIBILITY
IN
PURSUING
FRAUD
AND
13
14
15
16
APPLICATIONS.
12
17
20
21
22
23
24
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1
2
3
4
10
11
12
13
14
15
16
plans;;
17
18
19
20
21
22
23
24
25
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1
or misrepresentation).
12
13
CLAIM.
14
15 Security Act (42 U.S.C. 1320a7a(a)), as amended by sec16 tion 1611, is further amended
17
18
19
20
21
22
23
24
25
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1
program;; and
3
4
10
11
statement).
12
16
17
TIONS.
18 Security Act (42 U.S.C. 1320a7a(a)), as amended by sec19 tions 1611 and 1612, is further amended
20
21
22
23
24
25
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1
8
9
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13
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15
record or statement.
16
17 CONTRACTS
WITH
MA
TO
ORGANIZATIONS.Section
22
23
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1
9
10
CARE.
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24
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(1) DEVELOPMENT
24
25
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AND IMPLEMENTATION.
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694
1
such sanctions.
(2) SPECIFIED
(A)
GENERAL.The
intermediate
10
include
11
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15
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21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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IN
SANCTIONS.
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1
10
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13
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(B)
sanctions
18
19
20
21
22
23
(C) COMMENCEMENT
OF PAYMENT.A
24
25
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CLARIFICATION.The
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696
1
involved.
(3) SECRETARIAL
AUTHORITY.The
Secretary
10
11
12
13
14
15
16
17
18
19
rected deficiencies..
20
(b) APPLICATION
TO
MEDICAID.Section 1905(o) of
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697
1 in the same manner as such provisions apply to a hospice
2 program providing hospice care under title XVIII..
3
(c) APPLICATION
TO
4 Security Act is amended by adding at the end the fol5 lowing new section:
6
12
13
18
19
20
21
22
23
24
25
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1
10
11
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
699
1 sponsor based upon the misrepresentation or falsified in2 formation involved, after for each such determination,.
3
13
14
15
16
17
18
19
20
21
22
23
24
earning a commission;
f:\VHLC\071409\071409.140.xml
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700
1
tions or guidance; or
10
11
12
13
14
15
16
17
paragraph.
18
22
23
PROGRAM AUDITS.
f:\VHLC\071409\071409.140.xml
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701
1
2
AUDIT
10
program
11
1128B(f))..
12
(as
defined
in
section
16
17
18
23
24
EFFECT; and
f:\VHLC\071409\071409.140.xml
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AND
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22
23
24
25
f:\VHLC\071409\071409.140.xml
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1
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22
23
24
25
f:\VHLC\071409\071409.140.xml
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704
1
10
11
12
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14
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19
17
20
21
THORITY.
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
705
1
CHIP PROGRAMS.
5 OVERSIGHT PERIODS,
6
(1) IN
ENROLLMENT MORATORIA.
GENERAL.For
10
11
12
13
14
15
16
17
18
19
20
21
22
23
paragraph (3).
24
25
graph (4).
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
AND
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
706
1
10
11
12
13
14
15
16
17
18
19
20
site visits.
21
(3) ENHANCED
PERIOD.For
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OVERSIGHT
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
707
1
10
11
12
(4) MORATORIUM
13
14
15
16
17
18
19
20
21
22
23
24
such program.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
ON ENROLLMENT OF PRO-
Jkt 000000
purposes of para-
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
708
1
amended
10
11
12
13
14
15
16
end and;
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
709
1
12
13
14
15
16
17
18
19
20
21
22
(3) PROGRAM
provisions of
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
INTEGRITY.The
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
710
1
5 rity Act, as inserted by section 1631, is amended by add6 ing at the end the following new subsection:
7
8
10
11
12
13
14
15
16
17
18
19
20
(2) ENHANCED
the Sec-
21
22
23
24
25
26
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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SAFEGUARDS.If
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
711
1
a surety bond.
(3) AUTHORITY
10
11
12
13
14
vider or supplier..
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
TO DENY PARTICIPATION.If
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
712
1
1631(b)(2), is amended
end and;
10
11
paragraph:
12
13
14
15
16
17
18
19
20
MENT SERVICES.
21
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
713
1
2
FOR
CERTAIN EVALUA-
16
17
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
714
1
(b) REFERENCE
GRAM.For
TO
SEC.
1635.
REQUIRE
PROVIDERS
12
ADOPT
13
14
PROGRAMS
AND
TO
SUPPLIERS
REDUCE
TO
WASTE,
FOR
PROVIDERS
OF
(1)
GENERAL.The
Secretary
may
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
IN
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
715
1
(2) ESTABLISHMENT
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
(3) TIMELINE
25
FOR IMPLEMENTATION.The
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF CORE ELEMENTS.
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
716
1
subsection.
(4) CMS
AUTHORITY.The
10
11
12
13
14
15
16
(5) PILOT
PROGRAM.The
Secretary may
17
18
19
20
21
22
23
24
graph (3)..
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
ENFORCEMENT
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
717
1
2
(b) REFERENCE
SION.For
TO
12 MONTHS.
(1) PART A.Section 1814(a) of the Social Security Act (42 U.S.C. 1395f(a)) is amended
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
SUBMIS-
SION.
18
19
FOR
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
718
1
10
11
12
13
(3) PARTS
1857(d) of such
14
15
new paragraph:
16
(7) PERIOD
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
C AND D.Section
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
719
1
9 subsection (b) shall be effective for items and services fur10 nished on or after January 1, 2011.
11
12
13
14
15
21
(1) PART
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
A.Section
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
720
1
(2) PART
B.Section
a physician.
10
(c) DISCRETION
TO
EXPAND APPLICATION.The
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
721
1
(a) PHYSICIANS
OTHER SUPPLIERS.Section
AND
9 not more than one year for each act, a physician or sup10 plier under section 1866(j) if such physician or supplier
11 fails to maintain and, upon request of the Secretary, pro12 vide access to documentation relating to written orders or
13 requests for payment for durable medical equipment, cer14 tifications for home health services, or referrals for other
15 items or services written or ordered by such physician or
16 supplier under this title, as specified by the Secretary..
17
(b) PROVIDERS
OF
SERVICES.Section 1866(a)(1)
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
722
1
retary..
15 this section shall apply to orders, certifications, and refer16 rals made on or after January 1, 2010.
17
18
19
20
21
MEDICARE.
22
(a) CONDITION
OF
PAYMENT
FOR
HOME HEALTH
23 SERVICES.
24
25
(1) PART
1814(a)(2)(C) of such
Act is amended
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
A.Section
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
723
1
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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724
1
5
6
(b) CONDITION
OF
PAYMENT
FOR
DURABLE MED-
ICAL
(c) APPLICATION
CARE.The
TO
24 quirements pursuant to the amendments made by sub25 sections (a) and (b) shall apply in the case of physicians
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
725
1 making certifications for home health services under title
2 XIX or XXI of the Social Security Act, in the same man3 ner and to the same extent as such requirements apply
4 in the case of physicians making such certifications under
5 title XVIII of such Act.
6
TIGATIONS.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
726
1
2
3
MEDICAID OVERPAYMENTS.
(c) REPORTS
MENTS
REPAYMENT
ON AND
OF
OVERPAY-
AND
9 REVIEWS.
10
(1) REPORTING
11
MENTS.If
12
person must
13
14
15
16
17
18
19
20
21
22
23
later than the date that is 60 days after the date the
24
25
26
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
727
1
10
11
12
13
supplier.
14
15
16
17
18
19
20
21
22
23
24
title.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
728
1
sponsor
(as
defined
in
section
1860D
ERS
FOR
OIG
EXCLUSIONS
TO
BENE-
10
11
PROGRAM.
12
13 U.S.C. 1320a7(c)(3)(B)) is amended by striking indi14 viduals entitled to benefits under part A of title XVIII
15 or enrolled under part B of such title, or both and insert16 ing beneficiaries (as defined in section 1128A(i)(5)) of
17 that program.
18
19
20
DIALYSIS FACILITIES.
24 ments made to renal dialysis facilities for items and serv25 ices under this section under paragraph (1), each such
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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729
1 renal dialysis facility, upon the request of the Secretary,
2 shall provide to the Secretary access to information relat3 ing to any ownership or compensation arrangement be4 tween such facility and the medical director of such facility
5 or between such facility and any physician..
6
ALTERNATE
PAYEES
REQUIRED
TO
REG-
(D) BILLING
AGENTS
AND
CLEARING-
13
14
MEDICARE.Any
15
16
17
18
by the Secretary..
19
20 to the Medicaid program under title XIX of the Social Se21 curity Act, see section 1759.
22
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
730
1
2
3
10
11
(i)(1));
12
13
14
15
16
17
18
19
20
21
care
22
1128B(f));
23
24
defined
in
section
26
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
12:51 Jul 14, 2009
(as
graph (10);
25
program
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
731
1
2
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
732
1
avoided or decreased).
10
11
12
13
follows:
14
15
16
17
18
19
20
that
21
22
23
24
25
subsection (i)(1)); or
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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733
1
care program
demanded; or
10
11
12
13
quested or demanded.;
14
15
follows:
16
17
18
19
20
21
22
23
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
734
1
; or; and
follows:
10
information
11
12
tion;
13
14
15
16
17
18
and
19
20
paragraphs:
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
735
1
erty..
10
11
7
8
12
FRAUD, WASTE,
AND
18 enforcement activity, and to the extent consistent with ap19 plicable disclosure, privacy, and security laws, including
20 the Health Insurance Portability and Accountability Act
21 of 1996 and the Privacy Act of 1974, and subject to any
22 information systems security requirements enacted by law
23 or otherwise required by the Secretary, the Attorney Gen24 eral shall have access, facilitation by the Inspector General
25 of the Department of Health and Human Services, to
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
736
1 claims and payment data relating to titles XVIII and XIX,
2 in consultation with the Centers for Medicare & Medicaid
3 Services or the owner of such data..
4
16
17
later than;
18
19
20
21
22
section:
23
(h) SUNSET
OF THE
HEALTHCARE INTEGRITY
AND
24 PROTECTION DATA BANK; TRANSITION PROCESS.Ef25 fective upon the enactment of this subsection, the Sec-
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
737
1 retary shall implement a process to eliminate duplication
2 between the Healthcare Integrity and Protection Data
3 Bank (in this subsection referred to as the HIPDB es4 tablished pursuant to subsection (a) and the National
5 Practitioner Data Bank (in this subsection referred to as
6 the NPDB) as implemented under the Health Care Qual7 ity Improvement Act of 1986 and section 1921 of this Act,
8 including systems testing necessary to ensure that infor9 mation formerly collected in the HIPDB will be accessible
10 through the NPDB, and other activities necessary to
11 eliminate duplication between the two data banks. Upon
12 the completion of such process, notwithstanding any other
13 provision of law, the Secretary shall cease the operation
14 of the HIPDB and shall collect information required to
15 be reported under the preceding provisions of this section
16 in the NPDB. Except as otherwise provided in this sub17 section, the provisions of subsections (a) through (g) shall
18 continue to apply with respect to the reporting of (or fail19 ure to report), access to, and other treatment of the infor20 mation specified in this section...
21
(b) ELIMINATION
22 HHS OFFICE
OF THE
OF THE
RESPONSIBILITY
OF THE
INSPECTOR GENERAL.Section
23 1128C(a)(1) of the Social Security Act (42 U.S.C. 1320a24 7c(a)(1)) is amended
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
738
1
2
3
4
5
6
TIONAL
MENT OF
FOR
ACCESS
TO THE
BY THE
NA -
DEPART-
VETERANS AFFAIRS.
(1) IN
GENERAL.Notwithstanding
any other
10
11
12
13
14
15
16
without charge.
17
(2) INFORMATION
DESCRIBED.For
purposes
18
19
20
21
22
23
24 this Act, sections 1128E(d)(2) and 1817(k)(3) of the So25 cial Security Act, or any other provision of law, there shall
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
739
1 be available for carrying out the transition process under
2 section 1128E(h) of the Social Security Act over the pe3 riod required to complete such process, and for operation
4 of the National Practitioner Data Bank until such process
5 is completed, without fiscal year limitation
6
7
10
11
12
13
14
15
Act.
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
740
1
2
3
RITY STANDARDS.
11
12
13
14
POVERTY LEVEL.
9
10
15
(a) ELIGIBILITY
NON-TRADITIONAL INDIVID-
16
UALS
17
ERAL
POVERTY LEVEL.
18
(1) IN
GENERAL.Section
the
20
1396b(a)(10)(A)(i) is amended
Social
FED-
Act
(42
U.S.C.
22
clause (VI);
23
24
(VII); and
25
26
subclause:
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
12:51 Jul 14, 2009
Security
OF THE
1902(a)(10)(A)(i) of
19
21
FOR
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
741
1
in
with
the
Health
10
11
12
13
14
15
16
volved;.
17
(2) 100%
18
ICAID
19
ELIGIBLE
INDIVIDUALS.Section
1905 of
20
21
22
23
24
25
subsection:
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
consultation
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
742
1
TO
tion 1902(a)(10)(A)(i)..
erage
subclause
(VIII)
of
section
10
11
12
13
14
15
16
17
(4)
CONFORMING
AMENDMENT.Section
18
19
1396b(f)(4))
20
1902(a)(10)(A)(i)(VIII),
21
1902(a)(10)(A)(i)(VII),.
22
(b) ELIGIBILITY
23
GIBLE INDIVIDUALS
24
13
is
FOR
amended
by
inserting
after
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
under
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
743
1
(1) IN
1902(a)(10)(A)(i) of
the
is amended
Social
Security
Act
(42
U.S.C.
clause (VII);
(VIII); and
10
subclause:
11
12
13
14
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.Section
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
744
1
size involved;.
(2) 100%
after (VIII).
1905(y)
10
erage
11
12
13
14
15
16
17
18
under
(4)
subclause
CONFORMING
(IX)
of
section
AMENDMENT.Section
19
20
21
22
1902(a)(10)(A)(i)(VIII),.
23
24
ERAGE OF
FOR
TEMPORARY COV-
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
745
1
10
11
(D) ENROLLMENT
16
MEDICAID ELIGIBLES.A
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF NON-TRADITIONAL
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
746
1
2 this section shall take effect on the first day of Y1, and
3 shall apply with respect to items and services furnished
4 on or after such date.
5
11
12
13
CHANGE
14
STANDING.
15
(1) IN
MEMORANDUM
GENERAL.The
OF
UNDER-
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
THROUGH
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
747
1
title.
3
4
(2) ENROLLMENT
INDIVIDUALS.
(A) NON-TRADITIONAL
INDIVIDUALS.
10
11
12
13
14
15
16
17
18
19
(B) TRADITIONAL
20
(i)
INDIVIDUALS.
REGULAR
ENROLLMENT
OP-
21
TION.Pursuant
22
23
the
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF EXCHANGE-REFERRED
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option
to such memorandum,
described
in
section
(444390|2)
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748
1
(ii) PRESUMPTIVE
TION.Pursuant
to such memorandum,
10
11
the
12
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
ELIGIBILITY OP-
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option
described
in
section
(444390|2)
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749
1
(3) DETERMINATIONS
AFFORDABILITY CREDITS.If
10
11
12
13
tion;
14
15
16
17
18
19
20
21
22
23
24
25
(1) IN
GENERAL.In
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF ELIGIBILITY FOR
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750
1
8
9
(2) EXTENDED
MEDICAID
INDIVIDUAL.In
accordance
10
11
12
13
14
15
16
17
18
19
20
21
22
23
(1) MEDICAID
ELIGIBLE
INDIVIDUALS.In
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
ELIGIBLE
TREATMENT AS TRADITIONAL
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751
1
2009.
10
11
12
TO
ERROR RATE.
13
14
15
16
17 payments, there shall not be included any erroneous pay18 ments made that are attributable to an error in an eligi19 bility determination under subtitle C of title II of division
20 A of the Americas Affordable Health Choices Act of
21 2009..
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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752
1
XIX..
3
4
OF
EFFORT.Section
10
graph (72);
11
12
13
14
15
16
17
18
19
section:
20
21
EFFORT REQUIRE-
MENT.
22
(1) IN
GENERAL.Subject
to paragraph (2),
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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OF
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
753
1
10
11
12
13
14
15
16
17
18
19
(3) CHIP
para-
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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754
1
2009),
10
11
12
13
14
such Act).
15
16
17
18
19
20
21
22
23
24
FYING
AND
25
TWEEN
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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OF
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
755
1
(1) IN
FYING
TWEEN
ICAID.
AND
(1) MAINTENANCE
AND
OF EFFORT.A
MED-
State is
10
11
12
13
14
15
16
17
18
19
20
21
22
23
(2) REMOVAL
24
ELIGIBILITY CATEGORIES.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.Section
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756
1
(A) IN
of the following:
10
11
of section 1902(a)(10)(A)(i).
12
13
14
15
(B) OVERRIDING
CONTRARY PROVISIONS;
16
REFERENCES.The
17
18
19
waived.
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.A
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
757
1
(2) CONFORMING
AMENDMENTS.(A)
Section
1902(a)(10)(A)
clause
(i),
of
by
such
inserting
Act
(42
subject
to
U.S.C.
section
(c) STANDARDS
FOR
BENCHMARK PACKAGES.Sec-
14
15
16
(5) MINIMUM
January
17
18
19
20
21
Insurance Exchange..
22
23
(a) REPORT.
24
25
(1) IN
GENERAL.Not
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
STANDARDS.Effective
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
758
1
ficiaries.
10
11
(2) MATTERS
report
12
(A)
13
RECOMMENDATIONS.Recommenda-
tions regarding
14
15
16
17
18
(B) SPECIFICATION
19
FORM METHODOLOGY.The
20
21
22
23
(3) COORDINATION
24
PORT.The
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
TO BE INCLUDED.The
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759
1
(4) MEDICAID
(1) IN
GENERAL.The
10
11
ments
12
13
14
year 2019.
15
to
all
(2) DSH
States
for
such
purpose
by
16
17
18
19
20
21
22
23
24
or
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
DSH.In
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
760
1
on
(3) DSH
10
(A) IN
GENERAL.Not
11
12
13
14
15
16
17
18
19
(B) PUBLICATAION
DEADLINE.The
pub-
20
21
is
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
ALLOTMENT PUBLICATIONS.
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761
1
8
9
10
11
12
13
14
(7) SPECIAL
15
16
(A) FISCAL
YEAR 2017.Notwithstanding
17
18
States for
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
762
1
such
$2,500,000,000; and
year
decreased
by
such
$6,000,000,000..
fiscal
year
decreased
by
10
11
12
13
14
15
AND
16
CRIMINATION.
17
(1) IN
GENERAL.Section
18
19
20
21
22
access
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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fiscal
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
763
1
pital; and
10
11
12
(2) EFFECTIVE
DATE.The
amendment made
13
14
15
16
under
subsection
19 (a)(10)(A)(i)(VI),
(a)(10)(A)(i)(IV),
(a)(10)(A)(i)(VII),
or
f:\VHLC\071409\071409.140.xml
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764
1
date.
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
legislature.
f:\VHLC\071409\071409.140.xml
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765
1
Subtitle BPrevention
3
4
ICES.
10
11
12
13
section:
14
19
20
or
21
22
23
24
25
(2) appropriate for individuals entitled to medical assistance under this title..
f:\VHLC\071409\071409.140.xml
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766
1
10
vention.; and
11
12
13
14
15
16
17
18
such date.
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
767
1
10
11
legislature.
12
13
14 FROM
COVERED
OUTPATIENT
DRUGS.Section
18
19
20
21
22
23
(3)
redesignating
subparagraphs
(F)
24
25
spectively.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
by
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
768
1
5
6
TION SERVICES.
10
11
at the end;
12
13
14
15
16
17
18
19
section:
20
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
769
1 upon evidence, that such services are effective in one or
2 more of the following:
3
tween pregnancies.
10
11
12
13
14
public assistance..
15
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
770
1 1903(a) or 2105(a) of such Act, respectively, on or after
2 the date of the enactment of this Act.
3
4
5
NING SERVICES.
(a)
COVERAGE
AS
OPTIONAL
CATEGORICALLY
6 NEEDY GROUP.
7
(1) IN
GENERAL.Section
1902(a)(10)(A)(ii)
of
1396a(a)(10)(A)(ii)) is amended
the
10
Social
Security
Act
(42
U.S.C.
11
at the end;
12
13
14
15
subclause:
16
17
18
ards);.
19
(2) GROUP
DESCRIBED.Section
1902 of such
20
21
22
subsection:
23
24 individuals
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
771
1
10
11
12
13
14
15
16
1115.
17
18
19
20
21
(3)
ON
BENEFITS.Section
22
23
24
(G)
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
LIMITATION
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
772
1
(XIV); and
10
11
cer.
12
(4)
CONFORMING
13
14
15
16
17
end;
18
19
end; and
20
21
lowing:
22
23
24
1902(hh),.
(b) PRESUMPTIVE ELIGIBILITY.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
AMENDMENTS.Section
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
773
1
(1) IN
GENERAL.Title
PRESUMPTIVE
5
6
SERVICES
7 proved under section 1902 may provide for making med8 ical assistance available to an individual described in sec9 tion 1902(hh) (relating to individuals who meet certain
10 income eligibility standard) during a presumptive eligi11 bility period. In the case of an individual described in sec12 tion 1902(hh), such medical assistance shall be limited to
13 family planning services and supplies described in
14 1905(a)(4)(C) and, at the States option, medical diag15 nosis and treatment services that are provided in conjunc16 tion with a family planning service in a family planning
17 setting.
18
19
(1) PRESUMPTIVE
20
21
22
23
24
25
26
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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ELIGIBILITY PERIOD.The
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
774
1
of
plan; or
10
11
12
last day.
13
(2) QUALIFIED
14
(A) IN
GENERAL.Subject
to subpara-
15
16
17
18
19
20
21
22
(B) RULE
OF CONSTRUCTION.Nothing
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
ENTITY.
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775
1
(c) ADMINISTRATION.
4
5
(1) IN
10
11
12
(2) NOTIFICATION
REQUIREMENTS.A
quali-
13
fied
14
15
16
entity
that
determines
under
subsection
17
18
19
20
21
22
23
24
25
tion is made.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.The
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
776
1
(3)
APPLICATION
FOR
MEDICAL
ASSIST-
ANCE.In
termination is made.
13
14
riod;
15
16
17
18
(2) CONFORMING
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
AMENDMENTS.
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
777
1
such section.
for; and
10
11
12
13
14
15
tion.
16
17
(c) CLARIFICATION
NING
SERVICES
AND
OF
COVERAGE
OF
FAMILY PLAN-
(5) COVERAGE
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
778
1
section..
Subtitle CAccess
9
10
11
(a) IN GENERAL.
12
(1)
PAYMENTS.Section
13
14
1396b(a)(13)) is amended
15
16
paragraph (A);
17
18
19
20
subparagraph:
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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FEE-FOR-SERVICE
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
779
1
10
11
year;.
12
(2)
MEDICAID
13
PLANS.Section
14
1396u2(f)) is amended
15
MANAGED
CARE
16
17
OF
PAYMENT
FOR
18
19
20
care
21
22
23
24
25
partial capitation).
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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UNDER
Jkt 000000
services
described
in
section
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
780
1
(b) INCREASE
IN
10
11
12
13
14
15
16
17
18
23 Human Services shall establish under this section a med24 ical home pilot program under which a State may apply
25 to the Secretary for approval of a medical home pilot
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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781
1 project described in subsection (b) (in this section referred
2 to as a pilot project) for the application of the medical
3 home concept under title XIX of the Social Security Act.
4 The pilot program shall operate for a period of up to 5
5 years.
6
(1) IN
GENERAL.A
10
11
12
13
14
15
16
17
18
19
20
21
(1)
the
requirements
of
section
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
waive
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
782
1
care workers).
18
19
20
21
22
this section.
23
24
25
f:\VHLC\071409\071409.140.xml
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783
1
20
21
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
784
1
paragraph (30);
10
11
12
13
14
20 health facility
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
785
1 volved to provide health care at childbirth and who pro2 vides such care within the scope of practice under which
3 the individual is legally authorized to perform such care
4 under State law (or the State regulatory mechanism pro5 vided by State law), regardless of whether the individual
6 is under the supervision of, or associated with, a physician
7 or other health care provider. Nothing in this subpara8 graph shall be construed as changing State law require9 ments applicable to a licensed birth attendant..
10
14
15
(1) by striking or a rural health clinic and inserting , a rural health clinic; and
19
20
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
786
1
Subtitle DCoverage
3
4
clause (XIX);
10
11
(XX); and
12
13
14
15
16
17
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
787
1
subclause
(XVIII)
or
(XX)
of
section
11 1902(a)(10)(A)(ii).
12
16
17
and
18
19
20
21
1902(ii),.
(d) EXEMPTION FROM FUNDING LIMITATION
FOR
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
788
1
(5) DISREGARDING
OPTIONAL
LOW-INCOME
UALS.The
1902(a)(10)(A)(ii)(XX)..
HIV-INFECTED
INDIVID-
10 made by this section shall apply to expenditures for cal11 endar quarters beginning on or after the date of the enact12 ment of this Act, and before January 1, 2013, without
13 regard to whether or not final regulations to carry out
14 such amendments have been promulgated by such date.
15
16
17
ANCE (TMA).
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
789
1
2
3
(6) REQUIREMENT
UOUS ELIGIBILITY.In
10
11
12
13
14
15
line..
16
17 subsection (a) shall apply to determinations (and redeter18 minations) of eligibility made on or after January 1, 2010.
Subtitle EFinancing
19
20
21
22
(1) IN
23
24
ed
25
26
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.Section
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
790
1
(5) USE
ITS.The
(2)
DEFINITION
OF
AMP.Section
8(k)(1)(B)) is amended
10
11
TENDED
12
AND
TO
WHOLESALERS
OTHER PAYMENTS;
and inserting
and
13
14
15
lowing: regard to
16
17
extended to wholesalers;
18
19
manufacturers;
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
791
1
10
11
12
retail pharmacies;
13
14
15
16
17
18
19
20
21
22
23
24
view; or
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
792
1
(3)
REPORTING
MENTS.Section
1396r8(b)(3)) is amended
REQUIRE-
10
11
12
13
14
15
16
drug.
17
(4) AUTHORITY
TO
PROMULGATE
REGULA-
18
TION.The
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
MANUFACTURER
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
793
1
(5) PHARMACY
such payments.
10
(b) DISCLOSURE
OF
REIMBURSEMENTS
THROUGH
PRICE INFORMATION
TO THE
14
15
16
each; and
17
18
19
and
20
21
22
23
24
NEW FORMULATIONS
EXISTING DRUGS.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
FOR
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
794
1
(1) IN
1927(c)(2) of the
subparagraph:
(C) TREATMENT
OF
NEW
FORMULA-
TIONS.In
10
11
12
13
14
15
16
17
18
19
20
21
22
and
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.Section
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
795
1
the State).
(2) EFFECTIVE
DATE.The
amendment made
FOR
15
16
17
18
19
20
21
clause:
22
23
is 22.1 percent..
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
796
1
SEC.
1743.
EXTENSION
OF
PRESCRIPTION
DRUG
DIS-
10
11
12
13
14
15
16
17
18
19
20
21
24
25
26
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
797
1
of such drugs;
3
4
(C) REPORTING
ON MMCO DRUGS.On
10
11
12
13
14
TION
15
16
22
23
CATION.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
798
1 1701(a)(2), 1711(a), and 1713(a), is amended by adding
2 at the end the following new subsection:
3
4
(bb) PAYMENT
CATION.
(1) IN
GENERAL.The
(2) SUBMISSION
OF INFORMATION.For
pur-
10
poses
11
12
of
paragraph
(1)
and
section
13
14
15
16
17
18
19
20
21
22
23
24
being supported;
f:\VHLC\071409\071409.140.xml
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799
1
goals; and
10
11
(3) REVIEW
Secretary
12
13
14
15
16
17
18
19
20
(4) SPECIFICATION
21
MENTS.The
22
23
2011
24
25
f:\VHLC\071409\071409.140.xml
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OF INFORMATION.The
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800
1
1886(h)(1)(B); and
ment..
10
(b)
CONFORMING
AMENDMENT.Section
14
15
and
16
17
18
19
20
21
22
education; and.
23
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801
1 affecting payments made before such date under a State
2 plan under title XIX of the Social Security Act for grad3 uate medical education.
4
5
6
7
12
13
(2) by striking the period at the end of paragraph (24) and inserting ; or; and
14
15
16
17
18
19
20
21
22
(b) APPLICATION
TO
CHIP.Section 2107(e)(1)(G)
f:\VHLC\071409\071409.140.xml
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802
1
(c) PERMISSION
TO
10
11
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
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803
1
SEC.
1753.
REQUIRE
PROVIDERS
ADOPT
PROGRAMS
AND
TO
SUPPLIERS
REDUCE
TO
WASTE,
and;
10
11
12
13
14
15
16
17
18
19
20
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804
1
2
(xii);
10
11
clause:
12
13
14
15
16
17
18
19
20
and
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
805
1
(3) EFFECTIVE
DATE.The
amendments made
(1) IN
GENERAL.Section
1903(m)(2)(A)(xi)
of
the
Social
Security
10
11
(2) EFFECTIVE
Act
DATE.The
(42
U.S.C.
amendment made
12
13
14
15
16
17
18
(a)
STATE
PLAN
REQUIREMENT.Section
f:\VHLC\071409\071409.140.xml
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806
1 XVIII, any other State plan under this title, or any child
2 health plan under title XXI,.
3
(b) APPLICATION
TO
CHIP.Section 2107(e)(1)(A)
10
11
12
13
14
by such date.
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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807
1
10
11
12
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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808
1
10
11
12
13
14
period..
15
1902(a)(39)
and
inserting
sections
21
22
23
24
f:\VHLC\071409\071409.140.xml
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809
1
by such date.
10
11
12
13
14
15
16
17
18
19
20
21
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
810
1
12
ALTERNATE
13
14
PAYEES
REQUIRED
TO
REG-
20
21
22
23
24
25
26
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
811
1
(b) DENIAL
OF
8
9
(2) by striking the period at the end of paragraph (25) and inserting ; or; and
10
11
12
13
14
15
16
17
18
19
20
21
22
by such date.
23
24
25
f:\VHLC\071409\071409.140.xml
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812
1
10
11
12
13
14
15
16
17
18
LATED MISCONDUCT.
23
24
(2) by striking the period at the end of paragraph (26) and inserting a semicolon; and
f:\VHLC\071409\071409.140.xml
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813
1
2
10
11
12
conduct..
13
20
(1) IN
21
22
23
f:\VHLC\071409\071409.140.xml
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GENERAL.Section
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814
1
paragraph:
(6) FISCAL
10
11
12
13
14
to this paragraph).
15
(7) FISCAL
16
CAL
17
18
19
20
21
22
23
24
(1)(B),
25
f:\VHLC\071409\071409.140.xml
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YEARS.The
rounded
to
the
nearest
$10,000
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(or
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
815
1
(2)
COORDINATION
ARRA.Section
WITH
(1) IN
GENERAL.Section
1905(b)(2) of the
10
11
12
13
14
15
year 2019.
16
(2) EFFECTIVE
DATE.The
amendment made
17
18
19
(c) SPECIFICATION
OF
PERCENTAGES.The Sec-
f:\VHLC\071409\071409.140.xml
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816
1 the total estimated additional Federal expenditures result2 ing from the application of such percentages will be equal
3 to $10,350,000,000.
Subtitle HMiscellaneous
4
5
6
7
TO
SECTION 1144
OF
THE
11
12
13
14
TO
SECTION 1935
OF
THE
19
20
21
22
23
24
(B) FURNISHING
25
WITH
f:\VHLC\071409\071409.140.xml
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GENERAL;
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REASONABLE
MEDICAL ASSISTANCE
PROMPTNESS.For
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the
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
817
1
10
(C)
DETERMINING
AVAILABILITY
OF
11
MEDICAL ASSISTANCE.For
12
13
14
15
16
17
gram..
18
19 AGENCY CONSIDERATION
20
PLICATION AND
OF
TO
MEDICAID
TO
SECTION 605
OF
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818
1 ance Program Reauthorization Act of 2009 (Public Law
2 1113) is amended by striking legal residents and in3 serting lawfully residing in the United States.
4
5
TO
SECTION 1905
OF
THE
6 cial Security Act (42 U.S.C. 1396d(a)) is amended by in7 serting or the care and services themselves, or both be8 fore (if provided in or after.
9
10
TO
SECTION 1115
OF
THE
11 cial Security Act (42 U.S.C. 1315(a)) is amended by add12 ing at the end the following: If an experimental, pilot,
13 or demonstration project that relates to title XIX is ap14 proved pursuant to any part of this subsection, such
15 project shall be treated as part of the State plan, all med16 ical assistance provided on behalf of any individuals af17 fected by such project shall be medical assistance provided
18 under the State plan, and all provisions of this Act not
19 explicitly waived in approving such project shall remain
20 fully applicable to all individuals receiving benefits under
21 the State plan..
22
23
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819
1
2
December 2012.
6
7
(1) IN
10
section (b);
11
12
and (g);
13
14
15
16
17
18
19
(2)
CONFORMING
AMENDMENT.Section
20
21
22
(3) EFFECTIVE
DATE.The
amendments made
23
24
2011.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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GENERAL.Section
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820
TITLE VIIIREVENUE-RELATED
PROVISIONS
UALS.
10
(19) DISCLOSURES
14
15
16
17
18
ELIGIBLE INDIVIDUALS.
19
(A) IN
GENERAL.Upon
written request
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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821
1
Social Security
subsection),
10
11
12
13
year,
14
15
16
17
18
19
20
21
22
23
return,
24
25
f:\VHLC\071409\071409.140.xml
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822
1
10
11
12
13
14
(B) APPLICABLE
the pur-
15
16
17
18
19
(C) RESTRICTION
ON INDIVIDUALS FOR
20
21
22
23
spect to
24
25
f:\VHLC\071409\071409.140.xml
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YEAR.For
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
823
1
scription
(D) RESTRICTION
ON USE OF DISCLOSED
10
INFORMATION.Return
information disclosed
11
12
13
14
15
16
17
18
19
drug
subsidy
under
section
23
24
f:\VHLC\071409\071409.140.xml
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824
1
SEC.
1802.
COMPARATIVE
9
10
EFFECTIVENESS
RESEARCH
11
(1) IN
GENERAL.Subchapter
A of chapter 98
12
13
14
15
16
17
(a) CREATION
OF
(b) TRANSFERS
TO
f:\VHLC\071409\071409.140.xml
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825
1
year 2013
10
11
12
13
14
15
16
17
18
19
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
826
1 proportion (as estimated by the Secretary) to the total ex2 penditures during such fiscal year that are made under
3 title XVIII of such Act from the respective trust fund or
4 account.
5
(1) COMPUTATION.
(A) IN
to subpara-
10
11
12
13
14
15
result
16
17
in
revenues
to
(B) ALTERNATIVE
18
(i) IN
the
CERTF
of
COMPUTATION.
GENERAL.If
the Secretary is
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.Subject
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
827
1
(ii) DEFAULT
default
$2; or
10
11
12
13
14
15
16
(2) LIMITATION
ON MEDICARE FUNDING.In
17
18
section
19
$90,000,000.
20
21
(b)(4)(B)
(1) IN
for
any
fiscal
GENERAL.Subject
year
exceed
to paragraph (2),
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
AMOUNT.The
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828
1
(2) ALLOCATION
FOR COMMISSION.Not
less
10
11
12
2012, $10,000,000.
13
14
15
16
17
22
23
24
chapter..
f:\VHLC\071409\071409.140.xml
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829
1
AMENDMENT.The
(2) CLERICAL
table of sec-
4
5
(b) FINANCING
AND
FOR
ON INSURED
(1) GENERAL
RULE.Chapter
34 of the Inter-
10
Health Plans
Sec. 4375. Health insurance.
Sec. 4376. Self-insured health plans.
Sec. 4377. Definitions and special rules.
11
12
(a) IMPOSITION
OF
(b) LIABILITY
FOR
(1) IN
as otherwise pro-
22
23
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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GENERAL.Except
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
830
1
(2) EXEMPTION
9832(c).
8
9
(3) TREATMENT
ERAGE ARRANGEMENTS.
10
(A) IN
11
GENERAL.In
12
13
14
15
16
issuer.
17
(B) DESCRIPTION
OF ARRANGEMENTS.
18
19
20
21
22
23
24
25
ranged to be provided.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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831
1
2
(a) IMPOSITION
OF
8
9
(1) IN
(2) PLAN
SPONSOR.For
purposes of para-
12
13
14
15
16
ployee organization,
17
18
19
20
21
organizations,
22
23
rangement, or
24
25
26
501(c)(9),
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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10
11
GENERAL.The
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
832
1
or
erative or association.
10 For purposes of this section, the term applicable self-in11 sured health plan means any plan for providing accident
12 or health coverage if
13
14
15
16
17
18
19
20
members,
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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833
1
tion 501(c)(6), or
10
11
12
13 chapter
14
(1) ACCIDENT
15
16
17
18
19
(2) INSURANCE
POLICY.The
term insurance
20
21
22
tended.
23
(3) UNITED
STATES.The
term United
24
25
(b) TREATMENT
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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GOVERNMENTAL ENTITIES.
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834
1
2
(1) IN
chapter
(2) TREATMENT
OF EXEMPT GOVERNMENTAL
10
PROGRAMS.In
11
12
13
gram.
14
(3) EXEMPT
15
FINED.For
16
17
18
19
20
21
curity Act,
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.For
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835
1
10
11
AS
TO
POSSESSIONS.Notwith-
(2) CLERICAL
19
20
21
the following:
22
23
INSURANCE POLICIES
SUBCHAPTER A.
SUBCHAPTER
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July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
AMENDMENTS.
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836
1
Insurers.
new item:
CHAPTER 34TAXES
ON
(3) EFFECTIVE
DATE.The
amendments made
10
11
TITLE IXMISCELLANEOUS
PROVISIONS
12
13
14
15 Drug, Improvement, and Modernization Act of 2003 (Pub16 lic Law 108173) is repealed and the provisions of law
17 amended by such subtitle are restored as if such subtitle
18 had never been enacted.
19
20
21
(CCA) PROGRAM.
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837
1
(b) FUNDING.
(1) IN
9
10
(f)(1) of such
11
12
13
14
(c) REPORTS.
15
(1) QUALITY
16
17
18
31, 2011.
19
(2) FINAL
REPORT.Subsection
(e)(4) of such
20
21
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GENERAL.Subsection
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838
1
DREN.
Programs
10
11
12
PECTING CHILDREN.
13
19 receive a grant under this section shall submit to the Sec20 retary for approval, at such time and in such manner as
21 the Secretary may require, an application for the grant
22 that includes the following:
23
(1) DESCRIPTION
24
GRAMS.A
25
26
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839
1
(2) RESULTS
scribes
10
11
in the State;
12
13
14
15
16
17
18
19
20
21
of the programs.
22
23
that
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF NEEDS ASSESSMENT.The
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840
1
of child maltreatment;
such funds;
10
11
12
13
14
15
16
17
sistance;
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
841
1
(4) OTHER
(c) ALLOTMENTS.
(1) INDIAN
TRIBES.From
other infor-
the fiscal year the amount that bears the same ratio
10
11
12
13
14
15
(2) STATES
AND
TERRITORIES.From
the
16
17
18
19
20
21
ble, for the fiscal year the amount that bears the
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
INFORMATION.Such
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842
1
10
11
this subsection.
12
(d) MAINTENANCE
OF
EFFORT.Beginning with
22
(1) IN
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.The
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843
1
for the fiscal year, but not more than the amount
cal year.
(2) REIMBURSABLE
10
2010;
11
12
2011; or
13
14
15
16
17
(1) IN
GENERAL.In
eligible expenditures
18
19
20
21
22
23
24
that
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
PERCENTAGE DEFINED.
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
844
1
ment;
10
11
12
13
a program;
14
15
16
and supports;
17
18
19
20
and
21
22
(I)
of
age-appro-
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
knowledge
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845
1
haviors;
ents;
10
11
12
13
velopment;
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
846
1
eral law.
(2) PRIORITY
STRONGEST EVIDENCE.
(A) IN
GENERAL.The
expenditures, de-
10
11
12
13
14
15
year.
16
(B)
APPLICABLE
PERCENTAGE
DE-
17
FINED.In
18
19
year
20
21
22
23
24
or
25
f:\VHLC\071409\071409.140.xml
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847
1
(g) NO USE
OF
FOR
(1) IN
GENERAL.The
10
11
12
(2) SPECIAL
RULE.An
Indian tribe is
13
14
15
16
or
17
18
19
requirement.
20
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
848
1
2
tics;
10
11
12
13
14
15
16
program;
17
18
19
20
21
22
23
24
25
designed; and
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
849
1
by the Secretary.
(j) EVALUATION.
(1) IN
Secretary shall, by
10
11
12
13
services.
14
15
16
17
18
populations.
19
(2) REPORTS
20
TO THE CONGRESS.
(A) INTERIM
REPORT.Within
3 years
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.The
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
850
1
(B) FINAL
REPORT.Within
5 years
TO THE
CONGRESS.The
12
13
14
15
tion.
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
851
1
to the programs.
the programs.
10
11
12
plemented as designed.
13
(l) RESERVATIONS
OF
17
18
19
20
21
visitation; and
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
852
1
10
AS
STATES.In this
14
15
18
19
ELIGIBLES
f:\VHLC\071409\071409.140.xml
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853
1
costs; and
10
11
12
(1) to simplify access of dual eligibles to benefits and services under Medicare and Medicaid;
16
17
18
19
20
gibles; and
21
22
23
f:\VHLC\071409\071409.140.xml
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854
1
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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855
1
Medicaid.
10
16
(1) DUAL
17
18
19
20
21
22
(2) MEDICARE;
MEDICAID.The
terms Medi-
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
ELIGIBLE.The
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
856
1
2
(a) TABLE
OF
OF
PRIMARY CARE
AND
DENTISTRY
Sec.
Sec.
Sec.
Sec.
Sec.
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857
Sec.
Sec.
Sec.
Sec.
FOR
DIVERSITY
Sec. 2241. Scholarships for disadvantaged students, loan repayments and fellowships regarding faculty positions, and educational assistance
in the health professions regarding individuals from disadvantaged backgrounds.
Sec. 2242. Nursing workforce diversity grants.
Sec. 2243. Coordination of diversity and cultural competency programs.
PART 2INTERDISCIPLINARY TRAINING PROGRAMS
Sec. 2251. Cultural and linguistic competency training for health care professionals.
Sec. 2252. Innovations in interdisciplinary care training.
PART 3ADVISORY COMMITTEE
OF
APPROPRIATIONS
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AND
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
858
Subtitle EDelivery of Community Prevention and Wellness Services
Sec. 3151. Community prevention and wellness services grants.
Subtitle FCore Public Health Infrastructure
Sec. 3161. Core public health infrastructure for State, local, and tribal
health departments.
Sec. 3162. Core public health infrastructure and activities for CDC.
Subtitle GGeneral Provisions
Sec. 3171. Definitions.
TITLE IVQUALITY AND SURVEILLANCE
Sec. 2401. Implementation of best practices in the delivery of health care.
Sec. 2402. Assistant Secretary for Health Information.
Sec. 2403. Authorization of appropriations.
TITLE VOTHER PROVISIONS
Subtitle ADrug Discount for Rural and Other Hospitals
Sec. 2501. Expanded participation in 340B program.
Sec. 2502. Extension of discounts to inpatient drugs.
Sec. 2503. Effective date.
Subtitle BSchool-Based Health Clinics
Sec. 2511. School-based health clinics.
Subtitle CNational Medical Device Registry
Sec. 2521. National medical device registry.
Subtitle DGrants for Comprehensive Programs to Provide Education to
Nurses and Create a Pipeline to Nursing
Sec. 2531. Establishment of grant program.
Subtitle EStates Failing to Adhere to Certain Employment Obligations
Sec. 2541. Limitation on Federal funds.
f:\VHLC\071409\071409.140.xml
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859
1
2
(1) IN
is established a fund
(2) FUNDING.
Fund
(i)
10
(ii)
12
fiscal
year
2010,
for
fiscal
year
2011,
fiscal
year
2012,
fiscal
year
2013,
fiscal
year
2014,
fiscal
year
2015,
fiscal
year
2016,
fiscal
year
2017,
fiscal
year
2018,
$5,600,000,000;
13
(iii)
14
for
$6,900,000,000;
15
(iv)
16
for
$7,800,000,000;
17
(v)
18
for
$9,000,000,000;
19
(vi)
20
for
$9,400,000,000;
21
(vii)
22
for
$10,100,000,000;
23
(viii)
24
for
$10,800,000,000;
25
(ix)
26
for
$11,800,000,000; and
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
12:51 Jul 14, 2009
for
$4,600,000,000;
11
GENERAL.There
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
860
1
(x)
for
fiscal
year
2019,
$12,700,000,000.
ury.
(b) AUTHORIZATION
OF
APPROPRIATIONS FROM
THE
7 FUND.
8
(1) NEW
(A) IN
GENERAL.Amounts
in the Fund
10
11
12
13
14
sions.
15
(B) DESIGNATED
PROVISIONS.For
pur-
16
17
18
19
20
21
22
(2) BASELINE
23
(A) IN
FUNDING.
GENERAL.Amounts
in the Fund
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
FUNDING.
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861
1
the Fund)
2008; and
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
(B) AMOUNTS
25
amounts
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
SPECIFIED.The
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862
1
the following:
10
11
12
13
14
15
16
17
18
19
20
U.S.C. 292y(f))).
21
22
23
24
25
and 293k)).
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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863
1
10
11
12
13
14
15
16
(3) BUDGETARY
ap-
17
18
19
20
21
22
23
24
Fund.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
IMPLICATIONS.Amounts
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864
1
2
3
4
10
11
12
13
14
15
lowing:
16
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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865
1
TITLE IIWORKFORCE
Subtitle APrimary Care
Workforce
6
7
10
11
12
(a) FULFILLMENT
QUIREMENT
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF
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866
1
service; and
10
11
12
13
14
15
16
17
ther
18
19
or
20
21
22
23
24
25
and
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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867
1
10
11
12
13
14
15
16
CIL
(c)
LOAN
REPAYMENT
AMOUNT.Section
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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868
1 is amended by adding at the end the following: The Sec2 retary may treat teaching as clinical practice for up to
3 20 percent of such period of obligated service..
4
5
6
7
8
9
10
11 in addition to any other amounts authorized to be appro12 priated for such purpose, there are authorized to be appro13 priated, out of any monies in the Public Health Invest14 ment Fund, the following:
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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869
1
2
(b) SCHOLARSHIP
GRAMS.Subpart
AND
the end;
10
11
12
13
14
15
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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870
1
DENTISTRY
7
8
13 Administrator of the Health Resources and Services Ad14 ministration, shall establish a program, to be known as
15 the Frontline Health Providers Loan Repayment Pro16 gram, to address unmet health care needs in health profes17 sional needs areas through loan repayments under section
18 340I.
19
(b) DESIGNATION
OF
HEALTH PROFESSIONAL
20 NEEDS AREAS.
21
(1) IN
22
23
24
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1
this subpart:
services.
10
11
12
professionals; or
13
14
15
16
17
18
19
20
21
22
signed.
23
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1
public health);
retary;
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18
19
20
21
22
23
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1
nology.
13
14
15
16
17
18
19
20
21
22
23
24
25
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874
1
10
11
12
13
14
15
(c) APPLICATION
OF
CERTAIN PROVISIONS.The
23 provisions of subpart III of part D shall, except as incon24 sistent with this section, apply to the loan repayment pro25 gram under this subpart in the same manner and to the
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875
1 same extent as such provisions apply to the National
2 Health Service Corps Loan Repayment Program estab3 lished under section 338B.
4
OF
APPLICANTS.If
5 there are an insufficient number of applicants for loan re6 payments under this section to obligate all appropriated
7 funds, the Secretary shall transfer the unobligated funds
8 to the National Health Service Corps for the purpose of
9
10
11
year; or
12
13
14
15
tion.
16
17
23
24
services; and
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876
1
2
3
4
(e) RATE
OF
AND
PRIMARY HEALTH
18
19
20
21
22
23
following:
24
25
(3) NONCOMPLIANCE
an in-
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877
1
10
11
12
(1) IN
292y) is amended
13
14
15
16
17
GENERAL.Section
following:
(f) DETERMINATION
OF
FINANCIAL NEED.The
18 Secretary
19
20
21
22
23
part; and
24
25
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878
1
family members..
(2) REVISED
Secretary of
tions; and
10
11
12
13
paragraph (1).
14
15
16
GERIATRICS,
17
ASSISTANTSHIP.
18
follows: PRIMARY
21
HANCEMENT;
22
f:\VHLC\071409\071409.140.xml
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12:51 Jul 14, 2009
24
25
PHYSICIAN
20
23
AND
19
GUIDELINES.The
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879
1
2 mary care training and capacity building program con3 sisting of awarding grants and contracts under sub4 sections (b) and (c).
5
(b) SUPPORT
AND
DEVELOPMENT
OF
PRIMARY
(1) IN
ties
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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880
1
in community-based settings;
10
11
12
13
14
15
16
17
18
be
19
20
21
22
gram;
23
24
or
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1
(1) IN
GENERAL.The
10
11
rics, or geriatrics; or
12
13
14
15
16
17
icine.
18
22
23
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1
grounds.
10
11
needs).
12
13
14
lations.
15
22
23
NITY-BASED SETTINGS.
24
25
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1
2
3
NITY-BASED SETTINGS.
4 gram for the training of medical residents in community5 based settings consisting of awarding grants or contracts
6 under this section.
7
8
(b) DEVELOPMENT
NITY-BASED
AND
OPERATION
OF
COMMU-
11
12
13
14
faculty; and
15
16
17
18
19
include
20
21
22
and
23
24
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884
1
10
11
12
13
14
15
19
20
21
22
23
24
FOR
ESTABLISHED
f:\VHLC\071409\071409.140.xml
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885
1 subsection (b)(2), the Secretary shall give preference to
2 entities that have a demonstrated record of training
3
care;
6
7
10
11
12
13
14
15
16
17
(1) IN
19
20
21
22
(2) SPECIAL
23
RULES.
24
f:\VHLC\071409\071409.140.xml
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12:51 Jul 14, 2009
period of a grant or
18
GENERAL.The
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886
1
subsection (b)(1).
10
(1) PRIMARY
11
GRAM.The
12
13
14
15
16
17
18
19
20
21
(2) HEALTH
DISPARITIES.The
term health
22
23
tion 3171..
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887
1
ISTS.
5
6
7
8
10
11
ISTS.
12
(b) SUPPORT
AND
DEVELOPMENT
OF
DENTAL
19
20
health professionals;
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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888
1
10
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13
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21
22
23
tistry; and
24
25
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889
1
private hospital;
10
11
12
13
(4) a consortium of
14
15
16
17
21
22
23
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890
1
grounds.
10
11
needs).
12
13
(4) Supporting teaching programs that address the dental needs of vulnerable populations.
14
15
16
17
18
22
23
24
25
f:\VHLC\071409\071409.140.xml
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891
1
giene; or
5
6
7
11
12
13
MENT FUND.
(a) PROMOTION
TISTRY.For
OF
PRIMARY CARE
AND
DEN-
14 part D of title III and sections 723, 747, 748, and 749,
15 in addition to any other amounts authorized to be appro16 priated for such purpose, there is authorized to be appro17 priated, out of any monies in the Public Health Invest18 ment Fund, the following:
19
20
21
22
23
24
25
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892
1
4
5
OF
APPROPRIA-
TIONS.
(1) SECTION
735.Paragraph
(1) of section
10
the end.
11
(2) SECTION
747.Subsection
(f), as so redes-
12
13
14
15
16
17 seq.) is amended
18
19
(1) in paragraph (1), by inserting nurse-managed health centers after nursing centers,; and
20
21
(16) NURSE-MANAGED
CENTER.
22
23
24
25
f:\VHLC\071409\071409.140.xml
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HEALTH
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893
1
(a) GRANTS
CATION.Title
FOR
10
11
12
13
14
15
award
16
17
18
19
20
21
education nurses..
(c) NURSE EDUCATION, PRACTICE,
AND
RETENTION
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894
1
2
(1)
(2)
$2,500
and
inserting
by
striking
$4,000
and
inserting
by
striking
$13,000
and
inserting
$5,200;
12
13
striking
$3,300;
10
11
by
(3)
$17,000; and
14
15
16
17
18
19
20 297n) is amended
21
22
23
24
25
years
f:\VHLC\071409\071409.140.xml
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895
1
member.
(h) TECHNICAL
AND
CONFORMING AMENDMENTS.
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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896
1
2
3
4
10
11
12
(8) in part G
13
14
851; and
15
16
(9) in part I
17
18
861; and
19
20
(i) FUNDING.
21
(1) IN
H, as redesignated, of
22
23
lowing:
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897
1
2
3
MENT FUND.
10
11
12
13
14
15
16
17
18
(2) EXISTING
19
TIONS.
20
(A) SECTIONS
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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AUTHORIZATIONS OF APPROPRIA-
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898
1
(B) SECTION
2
3
4
871.Section
871, as so re-
5 (subject to section 845(g)), there are authorized to be ap6 propriated such sums as may be necessary for each fiscal
7 year through fiscal year 2019..
8
9
10
11
22
23
and
24
25
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899
1
2 section (c), the Secretary shall carry out this subpart act3 ing through the Administrator of the Health Resources
4 and Services Administration.
5
(d) APPLICATION
OF
CERTAIN PROVISIONS.The
f:\VHLC\071409\071409.140.xml
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900
1
2
3
PROGRAM.
10
11
12
13
health; or
14
15
16
17
18
at
19
20
21
22
23
medicine; or
24
25
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901
1
10
section (c)(2)(E).
11
16
17
18
19
20
21
22
23
24
Corps;
f:\VHLC\071409\071409.140.xml
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902
1
2
to the individual;
gram;
10
11
12
13
14
of study or program);
15
16
internship; and
17
18
19
er of
20
21
22
23
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903
1
may include
10
11
12
13
14
15
time or part-time.
16
(d) APPLICATION
OF
CERTAIN PROVISIONS.The
f:\VHLC\071409\071409.140.xml
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904
1
2
3
MENT PROGRAM.
4 lish the Public Health Workforce Loan Repayment Pro5 gram (referred to in this section as the Program) for the
6 purpose described in section 340L(a).
7
(1)(A) have a graduate degree from an accredited school or program of public health;
11
12
13
14
from
15
16
17
18
19
20
21
22
23
24
25
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905
1
5
6
10
11
15
16
17
18
19
20
21
22
23
24
25
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906
1
(d) PAYMENTS.
(1) IN
10
11
12
13
14
15
16
17
18
19
20
(2) PAYMENTS
21
(A) IN
GENERAL.For
22
23
24
25
f:\VHLC\071409\071409.140.xml
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907
1
in paragraph (1).
(B) REPAYMENT
SCHEDULE.Any
ar-
10
11
OF
CERTAIN PROVISIONS.The
19
20 follows:
21
22
23 Administrator of the Health Resources and Services Ad24 ministration and in consultation with the Director of the
25 Centers for Disease Control and Prevention, shall estab-
f:\VHLC\071409\071409.140.xml
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908
1 lish a public health workforce training and enhancement
2 program consisting of awarding grants and contracts
3 under subsection (b).
4
(b) GRANTS
AND
10
11
12
13
professionals;
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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909
1
dental medicine.
10
11
12
13
14
15
16
20
21
22
23
24
grounds.
f:\VHLC\071409\071409.140.xml
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910
1
retary).
14
15
16
17
18
19
3121; and
20
21
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
911
1
2
3
4 follows:
5
6
7
8 Administrator of the Health Resources and Services Ad9 ministration and in consultation with the Director of the
10 Centers for Disease Control and Prevention, shall award
11 grants to, or enter into contracts with, eligible entities to
12 provide training to graduate medical residents in preven13 tive medicine specialties.
14
18
19
20
or
21
22
23
(c) USE
OF
26
f:\VHLC\071409\071409.140.xml
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912
1
3
4
health; or
10
11
12
f:\VHLC\071409\071409.140.xml
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913
1
10
11
OF
APPROPRIA-
14
15
16
DIVERSITY
17
18
19
20
21
PROFESSIONS
22
13
23
REGARDING
INDIVIDUALS
f:\VHLC\071409\071409.140.xml
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914
1 ing: not more than $35,000 (plus, beginning with fiscal
2 year 2012, an amount determined by the Secretary on an
3 annual basis to reflect inflation) of the principal and inter4 est of the educational loans of such individuals..
5
6
7 amended
8
9
10
11
12
13
14
15
16
COMPETENCY PROGRAMS.
19
20
COMPETENCY PROGRAMS.
21 ordinate the activities carried out under this part and sec22 tion 821 in order to enhance the effectiveness of such ac23 tivities and avoid duplication of effort..
f:\VHLC\071409\071409.140.xml
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915
1
PROGRAMS
CULTURAL
AND
TRAINING
FOR
SIONALS.
SEC.
2251.
CARE
PROFES-
FOR
serting CULTURAL
TRAINING
11
12
HEALTH
COMPETENCY
10
LINGUISTIC
FOR
AND
LINGUISTIC COMPETENCY
13
14
following:
15
(b) CULTURAL
AND
LINGUISTIC COMPETENCY
21 TRAINING.The Secretary shall award grants and con22 tracts to eligible entities
23
24
25
26
and
f:\VHLC\071409\071409.140.xml
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916
1
10
11
12
13 tracts under this section, the Secretary shall give pref14 erence to entities that have a demonstrated record of the
15 following:
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
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917
1
16
TRAINING.
17
20
TRAINING.
21
22 novations in interdisciplinary care training program con23 sisting of awarding grants and contracts under subsection
24 (b).
f:\VHLC\071409\071409.140.xml
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918
1
2 award grants to, or enter into contracts with, eligible enti3 ties
4
10
11
12
13
14
15
16
17
18
19
23
f:\VHLC\071409\071409.140.xml
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919
1
education center); or
7 tracts under this section, the Secretary shall give pref8 erence to entities that have a demonstrated record of the
9 following:
10
11
12
13
14
15
16
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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920
1
4
5
MENT.
8
9
MENT.
16 shall
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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921
1
force; and
10
11
(B); and
12
13
14
15
16
(c) ROLE
OF
(d) MEMBERSHIP.
22
(1) NUMBER;
Secretary
23
24
Committee.
25
(2) TERMS.
f:\VHLC\071409\071409.140.xml
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APPOINTMENT.The
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922
1
(A) IN
Secretary shall
years.
(B)
STAGGERED
TERMS.Notwith-
10
11
12
1 year;
13
14
of 2 years; and
15
16
of 3 years.
17
18
19
20
following areas:
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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GENERAL.The
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923
1
care services.
shall
tive of each of
10
11
health workforce;
12
13
sumers;
14
(iii) employers;
15
16
17
18
19
20
21
22
23
with
f:\VHLC\071409\071409.140.xml
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924
1
groups; and
10
11
12
(5) DISCLOSURE
13
EST.Members
14
15
16
17
18
19
20
21
22
23
(6) NO
24
PENSES.Members
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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PAY;
RECEIPT
OF
TRAVEL
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925
1
Code.
6 the Secretary shall consult with the Secretary of Edu7 cation and the Secretary of Labor.
8
f:\VHLC\071409\071409.140.xml
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926
1
15 amended
16
17
18
19
20
f:\VHLC\071409\071409.140.xml
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927
1
such professionals;
10
11
professionals; and
12
13
14
15
16
2009.
17
(b) GRANTS
18
FORCE
CONTRACTS
FOR
HEALTH WORK-
ANALYSIS.
19
(1) IN
GENERAL.The
20
21
subsection (a).
22
23
24
be
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
928
1
school or program;
7
8
AND
DATA SHARING.The
OF
NATIONAL
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
929
1 may make a judgment about the classifications, meth2 odologies, and procedures to be used for collection of data
3 under section 761(a) of the Public Health Service Act, as
4 amended by this section.
5
6
7
FOR
DIVER-
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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930
1
VISORY
TION AND
SESSMENT.For
COMMITTEE
ON
ASSESSMENT,
AND
10
11
12
13
14
15
16
17
18
19
20
APPROPRIA-
TIONS.
21
(1) SECTION
736.Paragraph
(1) of section
22
23
24
25
(2) SECTIONS
f:\VHLC\071409\071409.140.xml
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VerDate Nov 24 2008
OF
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
931
1
2019.
3
4
(3) SECTION
741.Subsection
(h), as so redes-
2003,; and
be
necessary
for
10
11
(4) SECTION
subsequent
761.Subsection
fiscal
years
(e)(1), as so re-
12
13
14
15
16
17
f:\VHLC\071409\071409.140.xml
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
932
1
2
3
4
5
6
(1)
described
in
section
10
11
12
13
(2) in addition, out of any monies in the Public Health Investment Fund
14
15
16
17
18
19
20
21
22
23
and
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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amounts
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933
1
10
11
12
13
14
15
16
17
18
19
20
21
22
and
23
24
25
f:\VHLC\071409\071409.140.xml
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934
1
10
and
11
12
13
14
15
16
17
18
19
20
21
22
23
24
and
f:\VHLC\071409\071409.140.xml
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935
1
and
2019.
10
11
EGY.
12 the Congress within one year after the date of the enact13 ment of this section, and at least every 2 years thereafter,
14 a national strategy that is designed to improve the Na15 tions health through evidence-based clinical and commu16 nity prevention and wellness activities (in this section re17 ferred to as prevention and wellness activities), including
18 core public health infrastructure improvement activities.
19
22
23
24
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936
1
and wellness.
10
11
12
13
14
18
19
20
21
Womens Health.
22
23
24
25
Secretary).
f:\VHLC\071409\071409.140.xml
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937
1
2
6
7
9
10
ICES.
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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938
1
subsection (f);
10
11
12
13
14
3121.
15
(c) ROLE
OF
(d) MEMBERSHIP.
21
(1)
APPOINTMENT.The
Task
22
23
by the Secretary.
24
(2) TERMS.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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NUMBER;
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
939
1
(A) IN
Secretary shall
(B)
STAGGERED
TERMS.Notwith-
10
11
of 2 years;
12
13
of 4 years; and
14
15
of 6 years.
16
17
18
19
areas:
20
21
tion.
22
23
f:\VHLC\071409\071409.140.xml
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GENERAL.The
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940
1
icy.
olescent health.
10
11
12
13
that
14
15
16
17
18
19
20
21 ciency, the Task Force may delegate authority for con22 ducting reviews and making recommendations to sub23 groups consisting of Task Force members, subject to final
24 approval by the Task Force.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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941
1
(f)
CLINICAL
PREVENTION
STAKEHOLDERS
2 BOARD.
3
(1) IN
10
services.
11
12
13
14
15
groups.
16
17
18
19
including
20
21
22
23
24
Health,
25
Health; and
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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GENERAL.The
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942
1
10
11
12
13
14
15
16
17
18
19
ity.
20
(g) DISCLOSURE
AND
CONFLICTS
OF
INTEREST.
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943
1 ing of section 107 of the Ethics in Government Act of
2 1978 (5 U.S.C. App.) and section 208 of title 18, United
3 States Code, for the purposes of disclosure and manage4 ment of conflicts of interest under those sections.
5
OF
TRAVEL EXPENSES.
(i) APPLICATION
OF
22
23
SERVICES.
24 the Director of the Centers for Disease Control and Pre25 vention, shall establish a permanent task force to be
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944
1 known as the Task Force on Community Preventive Serv2 ices (in this section referred to as the Task Force).
3
4
5
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
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945
1
3121.
(c) ROLE
OF
(d) MEMBERSHIP.
10
(1)
NUMBER;
Task
11
12
by the Secretary.
13
(2) TERMS.
14
(A) IN
GENERAL.The
Secretary shall
15
16
17
18
19
(B)
STAGGERED
TERMS.Notwith-
20
21
22
23
24
of 2 years;
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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APPOINTMENT.The
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946
1
of 4 years; and
of 6 years.
areas:
10
11
12
13
14
15
16
17
tics.
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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947
1
7 ciency, the Task Force may delegate authority for con8 ducting reviews and making recommendations to sub9 groups consisting of Task Force members, subject to final
10 approval by the Task Force.
11
(f)
COMMUNITY
PREVENTION
STAKEHOLDERS
12 BOARD.
13
(1) IN
14
15
16
17
18
19
20
21
22
23
24
25
groups.
f:\VHLC\071409\071409.140.xml
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GENERAL.The
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948
1
including
Health,
10
the
Office
on
Womens
Health; and
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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and
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949
1
(g) DISCLOSURE
AND
CONFLICTS
OF
INTEREST.
OF
TRAVEL EXPENSES.
(i) APPLICATION
OF
f:\VHLC\071409\071409.140.xml
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950
1
8
9
ITY COORDINATION.
10 and wellness, the Director of the Centers for Disease Con11 trol and Prevention, the Director of the National Insti12 tutes of Health, and the heads of other agencies within
13 the Department of Health and Human Services con14 ducting or supporting such research, shall take into con15 sideration the national strategy under section 3121 and
16 the recommendations of the Task Force on Clinical Pre17 ventive Services under section 3131 and the Task Force
18 on Community Preventive Services under section 3132.
19
20
21
SEARCH GRANTS.
22 the Director of the Centers for Disease Control and Pre23 vention, shall conduct, or award grants to eligible entities
24 to conduct, research in priority areas identified by the Sec25 retary in the national strategy under section 3121 or by
f:\VHLC\071409\071409.140.xml
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951
1 the Task Force on Community Preventive Services as re2 quired by section 3132.
3
9
10
15
16
13
14
17
18
SERVICES GRANTS.
19 the Director of the Centers for Disease Control and Pre20 vention, shall establish a program for the delivery of com21 munity preventive and wellness services consisting of
22 awarding grants to eligible entities
23
24
f:\VHLC\071409\071409.140.xml
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952
1
section 3121; or
3
4
5
6
health;
10
(C) a consortium of
11
12
13
14
15
(2) HEALTH
this
16
17
means an area
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
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EMPOWERMENT ZONE.In
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953
1
holders;
13
14
15
16
17
18
19
20
21
22
munity;
23
24
f:\VHLC\071409\071409.140.xml
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954
1
2
(6) demonstrate that the community preventive services to be funded will be sustainable; and
(e) EMPHASIS
ON
RECOMMENDED SERVICES.For
OF
22 receives a grant under this section may not use funds pro23 vided through the grant
24
25
f:\VHLC\071409\071409.140.xml
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955
1
pected to be made
9
10
19
20
21
22
MENTS.
18
23
f:\VHLC\071409\071409.140.xml
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956
1 tion shall establish a core public health infrastructure pro2 gram consisting of awarding grants under subsection (b).
3
(b) GRANTS.
retary
10
11
ments.
12
13
14
fiscal year
15
16
17
18
19
20
21
(c) USE
OF
22 grant to an entity under subsection (b)(1) only if the enti23 ty agrees to use the grant to address core public health
24 infrastructure needs, including those identified in the ac25 creditation process under subsection (g).
f:\VHLC\071409\071409.140.xml
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957
1
2
3 the Secretary shall award funds to each State health de4 partment in accordance with
5
and
10
11
12
13
14
will
15
16
17
18
19
TO
STATE, LOCAL,
AND
f:\VHLC\071409\071409.140.xml
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958
1
(f) MAINTENANCE
OF
EFFORT.The Secretary
10
11
12
13
14
15
16
the grant.
17
(g) ESTABLISHMENT
18
CREDITATION
19
PROGRAM.
(1) IN
GENERAL.The
Secretary, acting
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
OF A
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F:\P11\NHI\TRICOMM\AAHCA09_001.XML
959
1
(2) COOPERATIVE
AGREEMENT.The
Sec-
(1).
10
11 Congress an annual report on progress being made to ac12 credit entities under subsection (g), including
13
14
15
16
and
17
18
19
20
21
22
23 the Director of the Centers for Disease Control and Pre24 vention, shall expand and improve the core public health
25 infrastructure and activities of the Centers for Disease
f:\VHLC\071409\071409.140.xml
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960
1 Control and Prevention to address unmet and emerging
2 public health needs.
3
In this title:
10
11
12
13
14
15
activities.
16
17
18
Human Services.
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
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961
1
TO
TASK
8 FORCES.
9
(1) FUNCTIONS,
10
11
12
13
14
15
16
17
18
19
20
21
22
func-
23
24
25
f:\VHLC\071409\071409.140.xml
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962
1
(3) MEMBERS
(A) INITIAL
MEMBERS.The
Secretary of
10
11
12
13
14
15
16
17
18
19
20
21
(B) CALCULATION
OF TOTAL SERVICE.In
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
ALREADY SERVING.
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963
1
OF
NATIONAL
18
19
20
or
21
22
strategy.
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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964
1
10
ices.
11
12
13
14
15
16
17
18
section (a).
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
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965
4
5
10
11
12
13
14
15
16
(b) PRIORITIZATION.
20
(1)
GENERAL.The
Director
shall
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
IN
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966
1
best practices).
10
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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967
1
12
13
14
15
16
17
18
19
organization.
20
23
24
f:\VHLC\071409\071409.140.xml
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968
1
settings.
10
11
12
providers; and
13
14
15
settings.
16
(g) EVALUATION
OF
21
22
23
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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969
1
settings;
10
11
12
13
(1) IN
14
15
16
17
18
19
20
21
22
23
24
25
practices.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.The
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970
1
10
11
12
13
OF
INFORMATION.
(j) REPORT.
21
(1) IN
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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GENERAL.The
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971
1
practices; and
9 INITIATIVES
TO
(1) HEALTH
16
17
18
19
20
21
22
(3) EMERGENCY
ROOM.Improving
care in
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
CARE-ASSOCIATED INFECTIONS.
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972
1
ery care.
8
9
TION.
10 et seq.) is amended
11
12
13
14
15
16
17
TION.
18 Department an Assistant Secretary for Health Informa19 tion (in this section referred to as the Assistant Sec20 retary), to be appointed by the Secretary.
21
22 shall
23
24
25
f:\VHLC\071409\071409.140.xml
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973
1
10
11
12
13
14
15
16
17
18
19
20
21
22
by the Secretary;
23
24
25
f:\VHLC\071409\071409.140.xml
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974
1
standards); and
primary language;
10
11
12
13
14
15
16
17
18
19
20
21
22
retary);
23
24
25
f:\VHLC\071409\071409.140.xml
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975
1
ties;
10
11
12
13
14
15
16
17
18
19
20
(1) IN
21
22
23
such subsection;
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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976
1
ever warranted by
health indicator; or
care; and
10
11
12
13
14
15
(2) RELEASE
16
17
18
19
20
21
22
23
24
Labor Statistics.
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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977
1
(e) REQUEST
10
PARTMENTS AND
FOR INFORMATION
(f) REPORT.
15
16
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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978
1
10
11
in subparagraph (B).
12
13
14
15
16
913(b)(2).
17
(g) PROPRIETARY
AND
PRIVACY PROTECTIONS.
18 Nothing in this section shall be construed to affect appli19 cable proprietary or privacy protections.
20
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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979
1
Secretary).
10
11
12
(2) The term Department means the Department of Health and Human Services.
13
14
15
18
19
20
21
22
23
24
retary.
f:\VHLC\071409\071409.140.xml
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980
1
2
(e) QUALITY
AND
14
15
12
13
16
(a) EXPANSION
OF
21
22
23
24
25
26
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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981
1
curity Act.
10
services.
11
12
13
14
15
16
17
18
19
20
abuse.
21
22
23
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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982
1
hospital
(as
defined
in
section
7
8
9 ed
10
11
12
(i);
13
14
15
16
17
18
19
20
(C) PROHIBITING
21
CHASING ARRANGEMENTS.
22
23
24
25
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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983
1
clause (i)
10
11
12
13
14
15
16
17
price; and
18
19
20
21
22
23
24
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
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984
1
of subparagraph (B)..
4
5
DRUGS.
6 is amended
7
10
(1) IN
11
terms; and
12
paragraph:
13
(2) COVERED
14
DRUG.The
term covered
drug
15
16
17
18
19
20
21
22
23
24
25
and
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.The
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985
1
appears.
ON
INPATIENT DRUGS.
(1) IN
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
(2) AMOUNT
f:\VHLC\071409\071409.140.xml
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008
GENERAL.For
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986
1
(A) SINGLE
AND
INNOVATOR
purposes of
paragraph (1)(A)
10
11
12
13
14
15
16
centage
17
18
Act;
19
20
21
22
23
24
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1
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equal to
12
13
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port, divided by
16
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18
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20
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22
(B) NONINNOVATOR
23
DRUGS.For
24
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25
MULTIPLE SOURCE
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1
turer price;
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11
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sum of
19
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period, multiplied by
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24
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1
equal to
port, divided by
10
11
12
13
14
15
Security Act.
16
(3) CALCULATION
17
(A) IN
GENERAL.Each
State calculates
18
19
20
21
(B) HOSPITAL
PROVISION OF INFORMA-
22
TION.Not
23
24
25
f:\VHLC\071409\071409.140.xml
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OF CREDITS.
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1
(4) PAYMENT
DEADLINE.The
credits pro-
10
(5) OPT
OUT.A
11
12
13
14
15
16
17
18
(6) OFFSET
19
20
21
22
23
24
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1
Service Act);
5
6
(2) in subsection (a)(5), by striking subparagraph (D) and inserting the following:
(D) STATE
10
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16
17
18
19
State shall
20
21
22
23
24
(D)
25
DRUGS.With
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COVERED
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1
10
11
counts..
12
13
17 this subtitle shall be effective, and shall be taken into ac18 count in determining whether a manufacturer is deemed
19 to meet the requirements of section 340B(a) of the Public
20 Health Service Act (42 U.S.C. 256b(a)) and of section
21 1927(a)(5) of the Social Security Act (42 U.S.C. 1396r
22 8(a)(5)), notwithstanding any other provision of law.
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1
2
3
4
17
18
19
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imum
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SBHC;
24
25
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994
1
laws governing
10
11
12
sions Act;
13
14
15
other
16
care
providers
in
the
17
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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health
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1
and
8
9
OF
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16
17
18
(d) CONSIDERATION
OF
22
23
24
25
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1
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14
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997
1 operation of the SBHC (including each activity described
2 in paragraph (1) or (2) of subsection (c)).
3
(h) PAYOR
OF
10
11
12
Security Act); or
13
14
on a prepaid basis.
15
16
FOR
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998
1 meet the requirements of this section. Such assistance
2 may include fiscal and program management assistance,
3 training in fiscal and program management, operational
4 and administrative support, and the provision of informa5 tion to the SBHCs of the variety of resources available
6 under this title and how those resources can be best used
7 to meet the health needs of the communities served by
8 the SBHCs.
9
10
11
12
13
14
15
16
(1) COMPREHENSIVE
17
ICES.The
18
19
20
(A)
PHYSICAL.Comprehensive
health
21
22
23
24
(B) MENTAL
25
HEALTH.Mental
health
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999
1
outpatient programs.
(C)
SERVICES.Additional
(2) MEDICALLY
UNDERSERVED
CHILDREN
10
AND ADOLESCENTS.The
11
12
13
14
15
16
(3) SCHOOL-BASED
HEALTH
CLINIC.The
17
18
ic that
19
20
21
22
23
24
ity; and
f:\VHLC\071409\071409.140.xml
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1000
1
community practice.
(4) SPONSORING
FACILITY.The
term spon-
soring facility is
(A) a hospital;
10
11
12
13
14
15
16
17
18
19
20
21
Improvement Act.
22
(m) AUTHORIZATION
OF
APPROPRIATIONS.For
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1001
1 such sums as may be necessary for each of the fiscal years
2 2011 through 2014..
3
9
10
11
12
(a) REGISTRY.
13
(1) IN
GENERAL.Section
14
15
amended
16
17
18
19
following:
20
21
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1
(B) is
4
5
life-supporting, or life-sustaining.
(2) In developing the registry, the Secretary shall,
13
14
15
16
tifier;
17
18
19
20
21
22
23
24
25
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2
identification);
10
11
chapter; and
12
13
14
15
16
17
and scientists.
18
23
24
25
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1004
1
(II)
private
sector
health-related
data); and
10
11
and
12
13
14
22 enactment of this subsection, the Secretary shall promul23 gate regulations for establishment and operation of the
24 registry under paragraph (1). Such regulations
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1006
1
and
10
11
entists.
12
(2)
DATE.The
Secretary
of
16
17
18
19
20
21
22
23
24
25
(3)
CONFORMING
AMENDMENT.Section
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EFFECTIVE
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1007
1
AND
OF
USE
IN
CERTIFIED
UNIQUE DEVICE
5 IDENTIFIERS.
6
(1)
HIT
Policy
10
11
12
13
14
15
16
17
(2) STANDARDS,
IMPLEMENTATION CRITERIA,
18
19
20
21
22
23
24
25
f:\VHLC\071409\071409.140.xml
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RECOMMENDATIONS.The
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1008
1
Subtitle DGrants for Comprehensive Programs to Provide Education to Nurses and Create a
Pipeline to Nursing
4
5
6
10 authorize grants to
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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1009
1
5 of the enactment of this Act, the Secretary of Labor (re6 ferred to in this section as the Secretary) shall establish
7 a partnership grant program to award grants to eligible
8 entities to carry out comprehensive programs to provide
9 education to nurses and create a pipeline to nursing for
10 incumbent ancillary health care workers who wish to ad11 vance their careers, and to otherwise carry out the pur12 poses of this section.
13
16
17
18
19
20
21
22
23
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1010
1
providers; and
zation;
10
11
12
13
14
15
16
17
18
19
20
21
296)).
22
23 EMPLOYER DESCRIBED
IN
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1011
1
10
11
12
13
licensed
14
nurses.
nurses,
and
registered
15
16
17
gram involved.
18
19
20
21
22
23
24
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vocational
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1
cation program.
gram.
(1) MATCHING
(A) IN
GENERAL.The
10
11
12
13
14
15
16
17
18
19
20
21
22
students.
23
(B) DETERMINATION
OF AMOUNT OF NON-
24
FEDERAL
25
f:\VHLC\071409\071409.140.xml
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REQUIREMENT.
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1013
1
(2) REQUIRED
COLLABORATION.Entities
car-
10
11
12
13
14
15
16
17
(f) USE
OF
18 under a grant under this section shall be used for the fol19 lowing:
20
21
22
23
24
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prerequisite to nursing.
10
11
12
13
14
15
16
quirements.
17
(D)
out
orientation
and
18
19
20
bedside
21
22
to
ensure
their
retention
23
24
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programs.
10
11
12
13
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17
18
19
20
21
22
23
24
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1016
1
10
11
12
13
14
15
16
17
18
(h) EVALUATION.
19
(1) PROGRAM
entity that
20
21
22
23
24
clude
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EVALUATIONS.An
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1017
1
censure rates;
10
11
12
13
faculty;
14
15
16
17
ures); and
18
19
20
lation.
21
(2) GENERAL
22
23
24
25
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July 14, 2009 (12:51 p.m.)
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REPORT.Not
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(i) AUTHORIZATION
OF
APPROPRIATIONS.There
6
7
10
14
15
16
17
and
18
19
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