Site
Web

You are here: >

Okay... so here's the "data":

America's Affordable Health Choices Act of 2009

As summarized by computer (specifically, Copernic Summarizer). To be clear, Copernic Summarizer only reproduces text that's in the document. It doesn't synthesize or group text. Sentences that, statistically, represent phrases and themes in the whole document, make it in to the summary.

Don't bother complaining that the word counts aren't exact. The summarizing software doesn't truncate text... so you can find the full word count at the bottom of each section.

Really want to get the text? Try the 5% version, 23,579 words.

100 Word Version

To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plan.

QUALIFIED HEALTH BENEFITS PLAN .---The term ''qualified health benefits plan'' means a health benefits plan that meets the requirements for such a plan under title I and includes the public health insurance option.

PURPOSE.---The purpose of this title is to establish standards to ensure that new health insurance coverage and employment-based health plans that are offered meet standards guaranteeing access to affordable coverage, essential benefits, and other consumer protections. (105 words)

250 Word Version

To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plan.

For any plan year in which the qualified health benefits plan does not meet such medical loss ratio, QHBP offering entity shall provide in a manner specified by the Commissioner for rebates to enrollees of payment sufficient to meet such loss ratio.

IN GENERAL.---A qualified health benefits plan shall provide coverage that at least meets the benefit standards adopted under section 124 for the essential benefits package described in section 122 for the plan year involved.

REQUIRING FAIR MARKETING PRACTICES BY HEALTH INSURERS.

IN GENERAL.---A QHBP offering entity shall provide for timely grievance and appeals mechanisms that the Commissioner shall establish.

CONSTRUCTION.---Nothing in paragraph (1) shall be construed as affecting the application of section 514 of the Employee Retirement Income Security Act of 1974.

''(a) IN GENERAL.---Each health insurance issuer that offers health insurance coverage in the small or large group market shall provide that for any plan year in which the coverage has a medical loss ratio below a level specified by the Secretary, the issuer shall provide in a manner specified by the Secretary for rebates to enrollees of payment sufficient to meet such loss ratio. (297 words)

1000 Word Version

To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plan.

REQUIRING FAIR MARKETING PRACTICES BY HEALTH INSURERS.

IN GENERAL.---A QHBP offering entity shall provide for timely grievance and appeals mechanisms that the Commissioner shall establish.

CONSTRUCTION.---Nothing in paragraph (1) shall be construed as affecting the application of section 514 of the Employee Retirement Income Security Act of 1974.

PAYMENT.---(1) SUBMISSION OF CLAIMS .---(A) IN GENERAL.---Under the reinsurance program, a participating employment-based plan shall submit claims for reimbursement to the Secretary which shall contain documentation of the actual costs of the items and services for which each claim is being submitted.

RETIREE RESERVE TRUST FUND.---(1) ESTABLISHMENT.---(A) IN GENERAL.---There is established in the Treasury of the United States a trust fund to be known as the ''Retiree Reserve Trust Fund'' (referred to in this section as the ''Trust Fund''), that shall consist of such amounts as may be appropriated or credited to the Trust Fund as provided for in this subsection to enable the Secretary to carry out the reinsurance program.

PLAN DEFINED.---In this division, the term ''Exchangeparticipating health benefits plan'' means a qualified health benefits plan that is offered through the Health Insurance Exchange.

ACCESS TO COVERAGE.---In accordance with this section, all individuals are eligible to obtain coverage through enrollment in an Exchange-participating health benefits plan offered through the Health Insurance Exchange unless such individuals are enrolled in another qualified health benefits plan or other acceptable coverage.

PREMIUM-PLUS PLAN BENEFITS .---Standards for additional benefits that may be offered, consistent with this subsection and subtitle C of title I, under a premium plan (such a plan with additional benefits referred to in this division as a ''premium-plus plan'').

IN GENERAL.---A basic plan shall offer the essential benefits package required under title I for a qualified health benefits plan.

ENROLLMENT INFORMATION.---The Commissioner shall provide for the broad dissemination of information to prospective enrollees on the enrollment process, including before each open enrollment period.

enrolled in an Exchange-partcipating health benefits plan shall pay such plans directly, and not through the Commissioner or the Health Insurance Exchange.

TRUST HEALTH INSURANCE EX-FUND.---There is created within the Treasury of the United States a trust fund to be known as the ''Health Insurance Exchange Trust Fund'' (in this section referred to as the ''Trust Fund''), consisting of such amounts as may be appropriated or credited to the Trust Fund under this section or any other provision of law.

PAYMENTS FROM TRUST FUND.---The Commissioner shall pay from time to time from the Trust Fund such amounts as the Commissioner determines are necessary to make payments to operate the Health Insurance Exchange, including payments under subtitle C (relating to affordability credits).

the Commissioner shall pay the QHBP offering entity that offers such plan from the Health Insurance Exchange Trust Fund the aggregate amount of affordability credits for all affordable credit eligible individuals enrolled in such plan.

USE OF STATE MEDICAID AGENCIES .---If the Commissioner determines that a State Medicaid agency has the capacity to make a determination of eligibility for affordability credits under this subtitle and under the same standards as used by the Commissioner, under the Medicaid memorandum of understanding (as defined in section 205(c)(4))---(A) the State Medicaid agency is authorized to conduct such determinations for any Ex-change-eligible individual who requests such a determination; and (B) the Commissioner shall reimburse the State Medicaid agency for the costs of conducting such determinations.

TREATMENT OF FAMILY .---Except as the Commissioner may otherwise provide, members of the same family who are affordable credit eligible individuals shall be treated as a single affordable credit individual eligible for the applicable credit for such a family under this subtitle.

FOR UNAFFORDABLE EMPLOYER COV -ERAGE.---Beginning in Y2, in the case of fulltime employees for which the cost of the employee premium for coverage under a group health plan would exceed 11 percent of current family income (determined by the Commissioner on the basis of verifiable documentation and without regard to section 245), paragraph (1) shall not apply.

For an individual's responsibility to obtain acceptable coverage, see section 59B of the Internal Revenue Code of 1986 (as added by section 401 of this Act).

CONTRIBUTION IN LIEU OF COVERAGE .---Beginning with Y2, if an employee declines such offer but otherwise obtains coverage in an Exchangeparticipating health benefits plan (other than by reason of being covered by family coverage as a spouse or dependent of the primary insured), the employer shall make a timely contribution to the Health Insurance Exchange with respect to each such employee in accordance with section 313.

day in the period beginning on the date such failure first occurs and ending on the date such failure is corrected. (1037 words)

5% of Document Version

To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

SHORT TITLE; TABLE OF DIVISIONS, TITLES, AND SUBTITLES.

SHORT TITLE.---This Act may be cited as the ''America's Affordable Health Choices Act of 2009''.

Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plan.

Establishment and administration of a public health insurance option as an Exchange-qualified health benefits plan.

Employer responsibility to contribute towards employee and dependent coverage.

Satisfaction of health coverage participation requirements under the Employee Retirement Income Security Act of 1974.

STATE MEDICAID AGENCY .---The term ''State Medicaid agency'' means, with respect to a Medicaid plan, the single State agency responsible for administering such plan under title XIX of the Social Security Act.

INDIVIDUAL AND GROUP HEALTH INSUR -ANCE COVERAGE.---The terms ''individual health insurance coverage'' and ''group health insurance coverage'' mean health insurance coverage offered in the individual market or large or small group market, respectively, as defined in section 2791 of the Public Health Service Act.

RESTRICTIONS ON PREMIUM INCREASES .---The issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner.

LIMITED AGE VARIATION PERMITTED .---By age (within such age categories as the Commissioner shall specify) so long as the ratio of the highest such premium to the lowest such premium does not exceed the ratio of 2 to 1.

Such study shall examine the following: (A) The types of employers by key characteristics, including size, that purchase insured products versus those that self-insure.

IN GENERAL.---A qualified health benefits plan that uses a provider network for items and services shall meet such standards respecting provider networks as the Commissioner may establish to assure the adequacy of such networks in ensuring enrollee access to such items and services and transparency in the cost-sharing differentials between in-network coverage and out-of-network coverage.

RULES.---In implementing subsection (a), the Commissioner shall build on the definition and methodology developed by the Secretary of Health and Human Services under the amendments made by section 161 for determining how to calculate the medical loss ratio.

erage in addition to the essential benefits package as the QHBP offering entity may specify.

TO CLINICAL APPROPRIATENESS.---A qualified health benefits plan may not impose any restriction (other than costsharing) unrelated to clinical appropriateness on the coverage of the health care items and services.

Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.

REFERENCE BENEFITS PACKAGE DE -SCRIBED.---The reference benefits package described in this subparagraph is the essential benefits package if there were no cost-sharing imposed.

PROCESS FOR ADOPTION OF RECOMMENDA-TIONS; ADOPTION OF BENEFIT STANDARDS.

REQUIRING FAIR MARKETING PRACTICES BY HEALTH INSURERS.

The Commissioner shall establish uniform marketing standards that all insured QHBP offering entities shall meet.

IN GENERAL.---A QHBP offering entity shall provide for timely grievance and appeals mechanisms that the Commissioner shall establish.

The requirements of the previous provisions of this subtitle shall apply to qualified health benefits plans that are not being offered through the Health Insurance Exchange only to the extent specified by the Commissioner.

The Commissioner shall establish standards for the coordination and subrogation of benefits and reimbursement of payments in cases involving individuals and multiple plan coverage.

IN GENERAL.---There is hereby established, as an independent agency in the executive branch of the Government, a Health Choices Administration (in this division referred to as the ''Administration'').

DUTIES.---The Commissioner is responsible for carrying out the following functions under this division: (1) QUALIFIED PLAN STANDARDS .---The establishment of qualified health benefits plan standards under this title, including the enforcement of such standards in coordination with State insurance regulators and the Secretaries of Labor and the Treasury.

HEALTH INSURANCE EXCHANGE .---The establishment and operation of a Health Insurance Exchange under subtitle A of title II. (3) INDIVIDUAL AFFORDABILITY CREDITS .---The administration of individual affordability credits under subtitle C of title II, including determination of eligibility for such credits.

CONSTRUCTION.---Nothing in paragraph (1) shall be construed as affecting the application of section 514 of the Employee Retirement Income Security Act of 1974.

covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.

IMPLEMENTATION.---To implement the requirement set forth in subsection (a), the Secretary of Health and Human Services shall, not later than 18 months after the date of the enactment of this Act, promulgate such regulations as are necessary or appropriate to insure that all health care and related services (including insurance coverage and public health activities) covered by this Act are provided (whether directly or through contractual, licensing, or other arrangements) without regard to personal characteristics extraneous to the provision of high quality health care or related services.

objected to, or refused to participate in, any activity, policy, practice, or assigned task that the employee (or other such person) reasonably believed to be in violation of any provision of this Act or any order, rule, or regulation promulgated under this Act.

ENFORCEMENT ACTION.---An employee covered by this section who alleges discrimination by an employer in violation of subsection (a) may bring an action governed by the rules, procedures, legal burdens of proof, and remedies set forth in section 40(b) of the Consumer Product Safety Act (15 U.S.C. 2087(b)).

OPPORTUNITY FOR INDEPENDENT, EXTERNAL THIRD PARTY REVIEW IN CASES OF RESCIS-SION.

''(D) require timely and transparent claim and denial management processes, including tracking, adjudication, and appeal processing; ''(E) require the use of a standard electronic transaction with which health care providers may quickly and efficiently enroll with a health plan to conduct the other electronic transactions provided for in this part; and ''(F) provide for other requirements relating to administrative simplification as identified by the Secretary, in consultation with stakeholders.

''(F) an enforcement process that includes timely investigation of complaints, random audits to ensure compliance, civil monetary and programmatic penalties for non-compliance consistent with existing laws and regulations, and a fair and reasonable appeals process building off of enforcement provisions under this part.

DATA.---Nothing in this section shall be construed to permit the use of information collected under this section in a manner that would adversely affect any individual.

pating employment-based plan involved within the plan year for the appropriate employment based health benefits provided to a retiree or to the spouse, surviving spouse, or dependent of a retiree.

In determining the amount of any claim for purposes of this subsection, the participating employment-based plan shall take into account any negotiated price concessions (such as discounts, direct or indirect subsidies, rebates, and direct or indirect remunerations) obtained by such plan with respect to such health benefits.

For purposes of calculating the amount of any claim, the costs paid by the retiree or by the spouse, surviving spouse, or dependent of the retiree in the form of deductibles, co-payments, and co-insurance shall be included along with the amounts paid by the participating employment-based plan.

PROGRAM PAYMENTS AND LIMIT .---If the Secretary determines that a participating employ-ment-based plan has submitted a valid claim under paragraph (1), the Secretary shall reimburse such plan for 80 percent of that portion of the costs attributable to such claim that exceeds $15,000, but is less than $90,000.

PLAN DEFINED.---In this division, the term ''Exchangeparticipating health benefits plan'' means a qualified health benefits plan that is offered through the Health Insurance Exchange.

EXCHANGE-ELIGIBLE EMPLOYER.---The term ''Exchange-eligible employer'' means an employer that is eligible under this section to enroll through the Health Insurance Exchange employees of the employer (and their dependents) in Exchangeeligible health benefits plans.

EMPLOYMENT-RELATED DEFINITIONS.---The terms ''employer'', ''employee'', ''full-time employee'', and ''part-time employee'' have the meanings given such terms by the Commissioner for purposes of this division.

FIRST YEAR.---In Y1 (as defined in section 100(c))---(A) individuals described in subsection (d)(1), including individuals described in paragraphs (3) and (4) of subsection (d); and (B) smallest employers described in subsection (e)(1).

INDIVIDUALS.---(1) INDIVIDUAL DESCRIBED.---Subject to the succeeding provisions of this subsection, an individual described in this paragraph is an individual who---(A) is not enrolled in coverage described in subparagraphs (C) through (F) of paragraph (2); and (B) is not enrolled in coverage as a fulltime employee (or as a dependent of such an employee) under a group health plan if the coverage and an employer contribution under the plan meet the requirements of section 312.

For purposes of subparagraph (B), in the case of an individual who is self-employed, who has at least 1 employee, and who meets the requirements of section 312, such individual shall be deemed a full-time employee described in such subparagraph.

TRANSITION PERIOD.---In the case described in clause (i)(II), the Commissioner shall permit the individual to continue treatment under subparagraph (A) until such limited time as the Commissioner determines it is administratively feasible, consistent with minimizing disruption in the individual's access to health care.

PLANS.---Standards for 3 levels of Exchangeparticipating health benefits plans: basic, enhanced, and premium (in this division referred to as a ''basic plan'', ''enhanced plan'', and ''premium plan'', respectively).

IN GENERAL.---A basic plan shall offer the essential benefits package required under title I for a qualified health benefits plan.

TIERED COST-SHARING FOR AFFORD -ABLE CREDIT ELIGIBLE INDIVIDUALS .---In the

TREATMENT OF STATE BENEFIT MANDATES.---Insofar as a State requires a health insurance issuer offering health insurance coverage to include benefits beyond the essential benefits package, such requirement shall continue to apply to an Exchange-participating health benefits plan, if the State has entered into an arrangement satisfactory to the Commissioner to reimburse the Commissioner for the amount of any net increase in affordability premium credits under subtitle C as a result of an increase in premium in basic plans as a result of application of such requirement.

OFFERING ENTITY AND PLAN STAND -ARDS.---The Commissioner shall---(A) establish standards necessary to implement the requirements of this title and title I for---(i) QHBP offering entities for the offering of an Exchange-participating health benefits plan; and (ii) for Exchange-participating health benefits plans; and (B) certify QHBP offering entities and qualified health benefits plans as meeting such standards and requirements of this title and title I for purposes of this subtitle.

The entity shall notify the Commissioner if the entity projects or anticipates reaching such a capacity limitation that would result in a limitation in enrollment.

OUTREACH AND ENROLLMENT OF EXCHANGE-EL-IGIBLE INDIVIDUALS AND EMPLOYERS IN EX-CHANGE-PARTICIPATING HEALTH BENEFITS PLAN.

ENROLLMENT INFORMATION.---The Commissioner shall provide for the broad dissemination of information to prospective enrollees on the enrollment process, including before each open enrollment period.

enrolled under an appropriate Exchange-partici-pating health benefits plan.

Such process may involve a random assignment or some other form of assignment that takes into account the health care providers used by the individual involved or such other relevant factors as the Commissioner may specify.

enrolled in an Exchange-partcipating health benefits plan shall pay such plans directly, and not through the Commissioner or the Health Insurance Exchange.

USE OF OTHER ENTITIES .---In carrying out this subsection, the Commissioner may work with other appropriate entities to facilitate the dissemination of information under this subsection and to provide assistance as described in paragraph (2).

If the individual is determined to be so eligible, the Commissioner, through the Medicaid memorandum of understanding, shall provide for the enrollment of the individual under the State Medicaid plan in accordance with the Medicaid memorandum of understanding under paragraph (4).

the State shall provide for the same periodic redetermination of eligibility under Medicaid as would otherwise apply if the individual had directly applied for medical assistance to the State Medicaid agency.

tion of the provisions of this division with respect to the Medicaid program.

OPTIONAL OPERATION OF STATE-BASED HEALTH INSURANCE EXCHANGES.

The Commissioner shall approve a State-based Health Insurance Exchange if it meets the requirements for approval under subsection (b).

ESTABLISHMENT AND ADMINISTRATION OF A PUBLIC HEALTH INSURANCE OPTION AS AN EXCHANGE-QUALIFIED HEALTH BENEFITS PLAN.

EXCLUSIVE TO THE EXCHANGE .---The public health insurance option shall only be made available through the Health Insurance Exchange.

The Secretary has the same authority with respect to the public health insurance option as the Secretary has under subsections (a)(1) and (b) of section 1874A of the Social Security Act with respect to title XVIII of such Act.

ACCESS TO FEDERAL COURTS.---The provisions of Medicare (and related provisions of title II of the Social Security Act) relating to access of Medicare beneficiaries to Federal courts for the enforcement of rights under Medicare, including with respect to amounts in controversy, shall apply to the public health insurance option and individuals enrolled under such option under this title in the same manner as such provisions apply to Medicare and Medicare beneficiaries.

ADJUSTMENTS.---The Secretary may determine the extent to which Medicare adjustments applicable to base payment rates under parts A and B of Medicare shall apply under this subtitle.

IN GENERAL.---For plan years beginning with Y1, the Secretary may utilize innovative payment mechanisms and policies to determine payments for items and services under the public health insurance option.

IN GENERAL.---The Secretary shall establish conditions of participation for health care providers under the public health insurance option.

PHYSICIANS.---The Secretary shall provide for the annual participation of physicians under the public health insurance option, for which payment may be made for services furnished during the year, in one of 2 classes: (A) PREFERRED PHYSICIANS.---Those physicians who agree to accept the payment rate established under section 223 (without regard to cost-sharing) as the payment in full.

sioner shall make a determination as to eligibility of an individual for affordability credits under this subtitle.

qualified health benefits plan that meets the requirements of section 312; (B) with family income below 400 percent of the Federal poverty level for a family of the size involved; and (C) who is not a Medicaid eligible individual, other than an individual described in section 202(d)(3) or an individual during a transition period under section 202(d)(4)(B)(ii).

IN GENERAL.---The affordability premium credit under this section for an affordable credit eligible individual enrolled in an Exchange-participating health benefits plan is in an amount equal to the amount (if any) by which the premium for the plan (or, if less, the reference premium amount specified in subsection (c)), exceeds the affordable premium amount specified in subsection (b) for the individual.

percentage limits so that for individuals whose family income is within an income tier specified in the table in subsection (d) such percentage limits shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage specified in such table for such income tier.

The Federal poverty level applied shall be such level in effect as of the date of the application.

FPL.---In the case that an individual's income (expressed as a percentage of the Federal poverty level for a family of the size involved) for a plan year is expected (in a manner specified by the Commissioner) to be significantly different from the income (as so expressed) used under subsection (a), the Commissioner shall establish rules requiring an individual to report, consistent with the mechanism established under paragraph (2), significant changes in such income (including a significant change in family composition) to the Commissioner and requiring the substitution of such income for the income otherwise applicable.

Such mechanism shall provide for guidelines that specify the circumstances that qualify as a significant change, the verifiable information required to document such a change, and the process for submission of such information.

For an individual's responsibility to obtain acceptable coverage, see section 59B of the Internal Revenue Code of 1986 (as added by section 401 of this Act).

CONTRIBUTION TOWARDS COVERAGE .---If an employee accepts such offer of coverage, the employer makes timely contributions towards such coverage in accordance with section 312.

EMPLOYER RESPONSIBILITY TO CONTRIBUTE TO-WARDS EMPLOYEE AND DEPENDENT COV-ERAGE.

through an Exchange-participating health benefits plan or other than through such a plan.

EMPLOYER REQUIRED CONTRIBUTION .---The employer timely pays to the issuer of such coverage an amount not less than the employer required contribution specified in subsection (b) for such coverage.

SALARY REDUCTIONS NOT TREATED AS EM -PLOYER CONTRIBUTIONS.---For purposes of this section, any contribution on behalf of an employee with respect to which there is a corresponding reduction in the compensation of the employee shall not be treated as an amount paid by the employer.

OPT-OUT.---In no case may an employer automatically enroll an employee in a plan under paragraph (1) if such employee makes an affirmative election to opt out of such plan or to elect coverage under an employment-based health benefits plan offered by such employer.

Secretary determines are appropriate to carry out this part.''.

day in the period beginning on the date such failure first occurs and ending on the date such failure is corrected.

REQUIREMENTS.---For purposes of this paragraph, the term 'health coverage participation requirements' has the meaning provided in section 803.

shall be assessed under subparagraph (A) with respect to any failure during any period for which it is established to the satisfaction of the Secretary that the employer did not know, or exercising reasonable diligence would not have known, that such failure existed.

''(I) such failure was due to reasonable cause and not to willful neglect, and ''(II) such failure is corrected during the 30-day period beginning on the 1st date that the employer knew, or exercising reasonable diligence would have known, that such failure existed.

Election of employer to be subject to national health coverage participation requirements.

PATION REQUIREMENTS UNDER THE INTER-NAL REVENUE CODE OF 1986.

The Secretary shall take such timely enforcement action as appropriate to achieve compliance.

with subsection (a) by the officers referred to in subsection (a) shall provide for the application of the health coverage participation requirements to the plan sponsor and contributing sponsors of such plan.

TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE.

Tax on individuals without acceptable health care coverage.

TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE.

''(b) LIMITATIONS.---''(1) TAX LIMITED TO AVERAGE PREMIUM .---''(A) IN GENERAL.---The tax imposed under subsection (a) with respect to any taxpayer for any taxable year shall not exceed the applicable national average premium for such taxable year.

FOR MORE THAN ONE INDIVIDUAL .---In the

case of any taxpayer who fails to meet the requirements of subsection (e) with respect to more than one individual during the taxable year, clause (i) shall be applied by substituting 'family coverage' for 'self-only coverage'.

insurance coverage (as defined in subsection (a) of section 102 of the America's Affordable Health Choices Act of 2009) or under a current employment-based health plan (within the meaning of subsection (b) of such section).

SECTION 15 NOT TO APPLY.---The amendment made by subsection (a) shall not be treated as a change in a rate of tax for purposes of section 15 of the Internal Revenue Code of 1986.

RETURNS.---The amendments made by subsection (b) shall apply to calendar years beginning after December 31, 2012.

ELECTION TO SATISFY HEALTH COVERAGE PAR-TICIPATION REQUIREMENTS.

ELECTION WITH RESPECT TO HEALTH COV-ERAGE PARTICIPATION REQUIREMENTS.

''(2) TIME AND MANNER .---An employer may make an election under this paragraph at such time and in such form and manner as the Secretary may prescribe.

Any such election, once made, shall apply to all members of such group.

may terminate the election of any employer under paragraph (2) if the Secretary (in coordination with the Health Choices Commissioner) determines that such employer is in substantial noncompliance with the health coverage participation requirements.

CREDIT FOR SMALL BUSINESS EMPLOYEE HEALTH COVERAGE EXPENSES.

''(2) QUALIFIED EMPLOYEE.---The term 'qualified employee' means any employee of an employer for any taxable year of the employer if such employee received at least $5,000 of compensation from such employer during such taxable year.

tion paid by such employer to qualified employees of such employer during such taxable year.

''(5) FAMILY COVERAGE.---The term 'family coverage' means any coverage other than self-only coverage.

a trade or business carried on by an individual) which has one or more qualified employees (determined without regard to this paragraph) with respect to whom the election under 4980H(a) applies, each partner (or, in the case of a trade or business carried on by an individual, such individual) shall be treated as an employee.

which subsection (a) applies shall be reduced by the amount of the credit determined under this section.

''(4) INFLATION ADJUSTMENT.---In the case of any taxable year beginning after 2013, each of the dollar amounts in subsections (b)(2), (c)(2), and (e)(2) shall be increased by an amount equal to---''(A) such dollar amount, multiplied by ''(B) the cost of living adjustment determined under section 1(f)(3) for the calendar year in which the taxable year begins determined by substituting 'calendar year 2012' for 'calendar year 1992' in subparagraph (B) thereof.

If any increase determined under this paragraph is not a multiple of $50, such increase shall be rounded to the next lowest multiple of $50.''.

Health Choices Act of 2009, shall disclose to officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, return information of any taxpayer whose income is relevant in determining any affordability credit described in subtitle C of title II of the America's Affordable Health Choices Act of 2009.

''(f) SPECIAL RULES.---''(1) NONRESIDENT ALIEN.---In the case of a nonresident alien individual, only amounts taken into account in connection with the tax imposed under section 871(b) shall be taken into account under this section.

section (a) (after the application of subsections (b) and (e)) shall be decreased by the excess of---''(A) the amounts excluded from the taxpayer's gross income under section 911, over ''(B) the amounts of any deductions or exclusions disallowed under section 911(d)(6) with respect to the amounts described in subparagraph (A).

CHAPTER FOR CERTAIN PURPOSES .---The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55.''.

TRANSITION.---Subsection (f) of section 864 of such Code is amended by striking paragraph (7).

'deductible related-party payment' means any payment made, directly or indirectly, by any person to any other person if the payment is allowable as a deduction under this chapter and both persons are members of the same foreign controlled group of entities.

''(A) the treatment of two or more persons as members of a foreign controlled group of entities if such persons would be the common parent of such group if treated as one corporation, and ''(B) the treatment of any member of a foreign controlled group of entities as the common parent of such group if such treatment is appropriate taking into account the economic relationships among such entities.''.

EFFECTIVE DATE.---The amendment made by this section shall apply to payments made after the date of the enactment of this Act.

''(A) the transaction changes in a meaningful way (apart from Federal income tax effects) the taxpayer's economic position, and ''(B) the taxpayer has a substantial purpose (apart from Federal income tax effects) for entering into such transaction.

Medicare DSH report and payment adjustments in response to coverage expansion.

Post acute care services payment reform plan and bundling pilot program.

Extension of Secretarial coding intensity adjustment authority.

Continuous open enrollment for enrollees in plans with enrollment suspension.

Repeal of provision relating to submission of claims by pharmacies located in or contracting with long-term care facilities.

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 A---Increased Funding To Fight Waste, Fraud, and Abuse Sec. 1601.

Enhanced penalties for false statements on provider or supplier enrollment applications.

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 Administration's outreach to eligible individuals.

Repeal of comparative cost adjustment (CCA) program.

2004 through 2009, the rate computed for the previous fiscal year increased by the skilled nursing facility market basket percentage change for the fiscal year involved; ''(V) for fiscal year 2010, the rate computed for the previous fiscal year; and''.

IN GENERAL.---Section 1886(j)(3)(C) of the Social Security Act (42 U.S.C. 1395ww(j)(3)(C)) is amended by striking ''and 2009'' and inserting ''through 2010''.

DELAYED EFFECTIVE DATE.---The amendment made by subsection (a) shall not apply to payment units occurring before January 1, 2010.

INCORPORATING PRODUCTIVITY IMPROVE-MENTS INTO MARKET BASKET UPDATES THAT DO NOT ALREADY INCORPORATE SUCH IMPROVEMENTS.

by adding at the end the following new subclause: ''(II) The productivity adjustment described in this subclause, with respect to an increase or change for a fiscal year or year or cost reporting period, or other annual period, is a productivity offset equal to the percentage change in the 10-year moving average of annual economywide private nonfarm business multi-factor productivity (as recently published before the promulgation of such increase for the year or period involved).

CLASSIFICATION SYSTEM.---(A) ANALYSIS.---(i) IN GENERAL.---The Secretary of Health and Human Services shall analyze payments for non-therapy ancillary services under a future skilled nursing facility classification system to ensure the accuracy of payment for non-therapy ancillary services.

by adding at the end the following new subparagraph: ''(D) the establishment of outliers under paragraph (13).''.

MEDICARE DSH REPORT AND PAYMENT ADJUST-MENTS IN RESPONSE TO COVERAGE EXPAN-SION.

2016, the Secretary of Health and Human Services shall submit to Congress a report on Medicare DSH taking into account the impact of the health care reforms carried out under division A in reducing the number of uninsured individuals.

The appropriate amount, targeting, and distribution of Medicare DSH to hospitals given their continued uncompensated care costs, to the extent such costs remain.

The amount of Medicare DSH shall be adjusted based on the recommendations of the report under subsection (a)(1)(A) and shall take into account variations in the empirical justification for Medicare DSH attributable to hospital characteristics, including bed size.

Subject to paragraph (3), increase Medicare DSH for a hospital by an additional amount that is based on the amount of uncompensated care provided by the hospital based on criteria for uncompensated care as determined by the Secretary, which shall exclude bad debt.

section 1886(d)(5)(F) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)) for inpatient hospital services furnished by disproportionate share hospitals.

SPECIFIC TARGET GROWTH RATE .---The growth rate applied under clause (ii)(II) of such paragraph shall be the target growth rate for the service category involved under subsection (f)(5).

provides that the target growth rate applicable to other physicians shall not apply to such physicians to the extent that the physicians' services are furnished through the accountable care organization.

In applying paragraph (1), the Secretary of Health and Human Services may apply the difference in the update under such paragraph on a claim-by-claim or lump sum basis and such a payment shall be taken into account under the pilot program.

MISVALUED CODES UNDER THE PHYSICIAN FEE SCHEDULE.

''(I) periodically identify services as being potentially misvalued using criteria specified in clause (ii); and ''(II) review and make appropriate adjustments to the relative values established under this paragraph for services identified as being potentially misvalued under subclause (I).

larly those that are often billed multiple times for a single treatment; codes which have not been subject to review since the implementation of the RBRVS (the socalled 'Harvard-valued codes'); and such other codes determined to be appropriate by the Secretary.

same manner as such provisions apply to adjustments under subparagraph (B)(ii)(II).

clause (i) may include validation of work elements (such as time, mental effort and professional judgment, technical skill and physical effort, and stress due to risk) involved with furnishing a service and may include validation of the pre, post, and intra-service components of work.

''(1) IN GENERAL.---In the case of services furnished under the physician fee schedule under section 1848 on or after January 1, 2011, and before January 1, 2013, by a supplier that is paid under such fee schedule in an efficient area (as identified under paragraph (2)), in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid (on a monthly or quarterly basis) an amount equal to 5 percent of the payment amount for the services under this part.

January 1, 2012, the Secretary shall develop a plan to integrate clinical reporting on quality measures under this subsection with reporting requirements under subsection (o) relating to the meaningful use of electronic health records.

in subparagraph (B)(ii), by striking ''2009 and 2010'' and inserting ''for each of the years 2009 through 2012''.

to the weighted-average GAF of the group of remaining MSAs in the State.

If the ratio of the GAF of the highest cost MSA to the weighted-av-erage GAF of the rest of State is 1.05 or greater then the highest cost MSA becomes a separate fee schedule area.

clause (i) shall be made effective concurrently with the application of the periodic review of the adjustment factors required under paragraph (1)(C) for California for 2012 and subsequent periods.

U.S.C. 1395l(t)(3)(C)(iv)) is amended---(A) by inserting ''(which is subject to the productivity adjustment described in subclause (II) of such section)'' after ''1886(b)(3)(B)(iii)''; and (B) by inserting ''(but not below 0)'' after ''reduced''.

EFFECTIVE DATE.---The amendments made by subsection (a) shall take effect on January 1, 2011, and shall apply to power-driven wheelchairs furnished on or after such date.

The benefits and costs of providing such coverage under the Medicare program, including a calculation of the potential savings achieved through avoided or shortened hospital and nursing home stays as a result of Medicare coverage of home infusion therapy.

EFFECTIVE DATE.---The amendment made by paragraph (1) shall to reporting for years beginning with 2012.

CANCER HOSPITALS.---''(A) STUDY.---The Secretary shall conduct a study to determine if, under the system under this subsection, costs incurred by hospitals described in section 1886(d)(1)(B)(v) with respect to ambulatory payment classification groups exceed those costs incurred by other hospitals furnishing services under this subsection (as determined appropriate by the Secretary).

higher costs effective for services furnished on or after January 1, 2011.''.

1834(e)(1)(B)), the Secretary shall adjust such number of units so it reflects a 75 percent (rather than 50 percent) presumed rate of utilization of imaging equipment.''; and

Secretary shall increase the reduction in expenditures attributable to the multiple procedure payment reduction applicable to the technical component for imaging under the final rule published by the Secretary in the Federal Register on November 21, 2005 (part 405 of title 42, Code of Federal Regulations) from 25 percent to 50 percent.''.

by adding at the end the following new clause: ''(iii) CONTINUATION OF SUPPLY .---In the case of a supplier furnishing such equipment to an individual under this subsection as of the 27th month of the 36 months described in clause (i), the supplier furnishing such equipment as of such month shall continue to furnish such equipment to such individual (either directly or though arrangements with other suppliers of such equipment) during any subsequent period of medical need for the remainder of the reasonable useful lifetime of the equipment, as determined by the Secretary, regardless of the location of the individual, unless another supplier has accepted responsibility for continuing to furnish such equipment during the remainder of such period.''.

IN GENERAL.---The Medicare Payment Advisory Commission shall conduct a study regarding bone mass measurement, including computed tomography, duel-en-ergy x-ray absorptriometry, and vertebral fracture assessment.

A review of the clinically appropriate and recommended use among Medicare beneficiaries and how usage rates among such beneficiaries compares to such recommendations.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 284 ''(C) EXCESS READMISSION RATIO .---''(i) IN GENERAL.---Subject to clauses (ii) and (iii), the term 'excess readmissions ratio' means, with respect to an applicable condition for a hospital for an applicable period, the ratio (but not less than 1.0) of---''(I) the risk adjusted readmissions based on actual readmissions, as determined consistent with a readmission measure methodology that has been endorsed under paragraph (5)(A)(ii)(I), for an applicable hospital for such condition with respect to the applicable period; to ''(II) the risk adjusted expected readmissions (as determined consistent with such a methodology) for such hospital for such condition with respect to such applicable period.

''(iii) ADJUSTMENT.---In order to promote a reduction over time in the overall rate of readmissions for applicable conditions, the Secretary may provide, beginning with discharges for fiscal year 2014, for the determination of the excess readmissions ratio under subparagraph (C) to be based on a ranking of hospitals by readmission ratios (from lower to higher readmission ratios) normalized to a benchmark that is lower than the 50th percentile.

Secretary shall expand the applicable conditions beyond the 3 conditions for which measures have been endorsed as described in subparagraph (A)(ii)(I) as of the date of the enactment of this subsection to the additional 4 conditions that have been so identified by the Medicare Payment Advisory Commission in its report to Congress in June 2007 and to other conditions and procedures which may include an all-condi-tion measure of readmissions, as determined appropriate by the Secretary.

such applicable conditions, the Secretary shall seek the endorsement described in subparagraph (A)(ii)(I) but may apply such measures without such an endorsement.

''(D) APPLICABLE PERIOD.---The term 'applicable period' means, with respect to a fiscal year, such period as the Secretary shall specify for purposes of determining excess readmissions.

''(E) READMISSION.---The term 'readmission' means, in the case of an individual who is discharged from an applicable hospital, the admission of the individual to the same or another applicable hospital within a time period specified by the Secretary from the date of such discharge.

''(E) USE OF ADDITIONAL PAYMENT .---Funding under this paragraph shall be used by targeted hospitals for transitional care activities designed to address the patient noncompliance issues that result in higher than normal readmission rates, such as one or more of the following: ''(i) Providing care coordination services to assist in transitions from the targeted hospital to other settings.

by inserting after paragraph (4) the following new paragraph: ''(5) The adjustment factor described in section 1886(p)(3) shall apply to payments with respect to a critical access hospital with respect to a cost reporting period beginning in fiscal year 2012 and each subsequent fiscal year (after application of paragraph (4) of this subsection) in a manner similar to the manner in which such section applies with respect to a fiscal year to an applicable hospital as described in section 1886(p)(2).''.

IMPLEMENTATION.---The Secretary shall apply, on or after October 1, 2014, with respect to post acute care providers, policies similar to the policies applied with respect to applicable hospitals and critical access hospitals under the amendments made by subsection (a).

The provisions of paragraph (1) shall apply with respect to any period on or after October 1, 2014, and before such application date described in the previous sentence in the same manner as such provisions apply with respect to fiscal or rate year 2014.

Amounts appropriated under this subsection for a fiscal year shall be available until expended.

POST ACUTE CARE SERVICES PAYMENT REFORM PLAN AND BUNDLING PILOT PROGRAM.

POST ACUTE SERVICES .---For purposes of this section, the term ''post acute services'' means services for which payment may be made under the Medicare program that are furnished by skilled nursing facilities, inpatient rehabilitation facilities, long term care hospitals, hospital based outpatient rehabilitation facilities and home health agencies to an individual after discharge of such individual from a hospital, and such other services determined appropriate by the Secretary.

DETAILS.---The plan described in subsection (a)(1) shall include consideration of the following issues: (1) The nature of payments under a post acute care bundle, including the type of provider or entity to whom payment should be made, the scope of activities and services included in the bundle, whether payment for physicians' services should be included in the bundle, and the period covered by the bundle.

Quality measures that would be appropriate for reporting by hospitals and post acute providers (such as measures that assess changes in functional status and quality measures appropriate for each type of post acute services provider including how the reporting of such quality measures could be coordinated with other reporting of such quality measures by such providers otherwise required).

CHANGES FOR 2011 .---''(I) IN GENERAL.---With respect to the case mix adjustments established in section 484.220(a) of title 42, Code of Federal Regulations, the Secretary shall apply, in 2010, the adjustment established in paragraph (3) of such section for 2011, in addition to applying the adjustment established in paragraph (2) for 2010.

amount established in the section described in subclause (I).''.

EFFECTIVE DATE.---The amendment made by subsection (a) shall apply to home health market basket percentage increases for years beginning with 2010.

LIMITATION ON MEDICARE EXCEPTIONS TO THE PROHIBITION ON CERTAIN PHYSICIAN RE-FERRALS MADE TO HOSPITALS.

MENTS.---DISCLOSURE REQUIRE-''(1) IN GENERAL.---Each entity providing covered items or services for which payment may be made under this title shall provide the Secretary with the information concerning the entity's ownership, investment, and compensation arrangements, including---''(A) the covered items and services provided by the entity, and ''(B) the names and unique physician identification numbers of all physicians with an ownership or investment interest (as described in subsection (a)(2)(A)), or with a compensation arrangement (as described in subsection (a)(2)(B)), in the entity, or whose immediate relatives have such an ownership or investment interest or who have such a compensation relationship with the entity.

''(A) REPORTING.---Any person who is required, but fails, to meet a reporting requirement of paragraphs (1) and (2)(A) of subsection (f) is subject to a civil money penalty of not more than $10,000 for each day for which reporting is required to have been made.

''(B) DISCLOSURE.---Any physician who is required, but fails, to meet a disclosure requirement of subsection (f)(2)(B) or a hospital that is required, but fails, to meet a disclosure requirement of subsection (f)(2)(C) is subject to a civil money penalty of not more than $10,000 for each case in which disclosure is required to have been made.

''(viii) The hospital does not condition any physician ownership or investment interests either directly or indirectly on the physician owner or investor making or influencing referrals to the hospital or otherwise generating business for the hospital.

CERTAIN CONVERTED FACILITIES .---The hospital was not converted from an ambulatory surgical center to a hospital on or after the date of enactment of this subsection.

process under clause (i) on the date that is one month after the promulgation of regulations described in clause (iv).

a complete application under this paragraph, the Secretary shall publish on the public Internet website of the Centers for Medicare & Medicaid Services the final decision with respect to such application.

COMPLIANCE.---The Secretary of Health and Human Services shall establish policies and procedures to verify compliance with the requirements described in subsections (i)(1) and (i)(4) of section 1877 of the Social Security Act, as added by subsection (a)(5).

The Secretary may use unannounced site reviews of hospitals and audits to verify compliance with such requirements.

The effect of the adjustment factors on the ability of providers to furnish efficient, high value care.

''(2) SPECIFIED AMOUNT.---The amount specified in this paragraph for an area and year is the amount specified in subsection (c)(1)(D)(i) for the area and year adjusted (in a manner specified by the Secretary) to take into account the phase-out in the indirect costs of medical education from capitation rates described in subsection (k)(4).

''(4) EXCEPTION FOR PACE PLANS .---This subsection shall not apply to payments to a PACE program under section 1894.''.

2013 the Secretary shall implement reporting requirements for quality under this section on measures selected under clause (iii) that reflect the outcomes of care experienced by individuals enrolled in Medicare Advantage plans (in addition to measures described in clause (i)).

''(I) measures of rates of admission and readmission to a hospital; ''(II) measures of prevention quality, such as those established by the Agency for Healthcare Research and Quality (that include hospital admission rates for specified conditions); ''(III) measures of patient mortality and morbidity following surgery; ''(IV) measures of health functioning (such as limitations on activities of daily living) and survival for patients with chronic diseases; and ''(V) measures of patient safety; ''(VI) other measure of outcomes and patient quality of life as determined by the Secretary.

jected enrollment for each plan and subject to clause (iv), identify those Medicare Advantage plans with the highest score that, based upon projected enrollment, are projected to include in the aggregate 20 percent of the total projected enrollment for the year.

For purposes of this subsection, a plan so identified shall be referred to in this subsection as a 'high quality MA plan'.

in subclause (II)---(A) by inserting ''periodically'' before ''conduct an analysis''; (B) by inserting ''on a timely basis'' after ''are incorporated''; and (C) by striking ''only for 2008, 2009, and 2010'' and inserting ''for 2008 and subsequent years''.

REPORT TO CONGRESS.---Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report that evaluates the adequacy of the risk adjustment system under section 1853(a)(1)(C) of the Social Security Act (42 U.S.C. 1395--23(a)(1)(C)) in predicting costs for beneficiaries with chronic or co-morbid conditions, beneficiaries dually-eligible for Medicare and Medicaid, and non-Medicaid eligible low-income beneficiaries; and the need and feasibility of including further gradations of diseases or conditions and multiple years of beneficiary data.

ADJUSTMENT.---Not later than January 1, 2012, the Secretary shall implement necessary improvements to the risk adjustment system under section 1853(a)(1)(C) of the Social Security Act (42 U.S.C. 1395--23(a)(1)(C)), taking into account the evaluation under subsection (a).

IN GENERAL.---Section 1858 of the Social Security Act (42 U.S.C. 1395w--27a) is amended by striking subsection (e).

TRANSITION.---Any amount contained in the MA Regional Plan Stabilization Fund as of the date of the enactment of this Act shall be transferred to the Federal Supplementary Medical Insurance Trust Fund.

LIMITATION ON COST-SHARING FOR INDIVIDUAL HEALTH SERVICES.

clause (i) shall be construed as prohibiting a Medicare Advantage plan from using a flat copayment or per diem rate, in lieu of the cost-sharing that would be imposed under part A or B, so long as the amount of the cost-sharing imposed does not exceed the amount of the cost-sharing that would be imposed under the respective part if the individual were not enrolled in a plan under this part.''.

CONTINUOUS OPEN ENROLLMENT FOR ENROLL-EES IN PLANS WITH ENROLLMENT SUSPEN-SION.

threshold from the amounts otherwise computed until there is a continuation of coverage from the initial coverage limit for expenditures incurred through the total amount of expenditures at which benefits are available under paragraph (4).

initial coverage limit otherwise computed without regard to this paragraph shall be increased by 1D2 of the cumulative phase-in percentage (as defined in subparagraph (D)(ii) for the year) times the out-of-pocket gap amount (as defined in subparagraph (E)) for the year.

2011, the annual out-of-pocket threshold otherwise computed without regard to this paragraph shall be decreased by 1D2 of the cumulative phase-in percentage of the out-of-pocket gap amount for the year multiplied by 1.75.

percentage' means for a year the sum of the annual phase-in percentage for the year and the annual phase-in percentages for each previous year beginning with 2011, but in no case more than 100 percent.

has not entered into and have in effect a rebate agreement described in paragraph (2).

''(2) REBATE AGREEMENT.---A rebate agreement under this subsection shall require the manufacturer to provide to the Secretary a rebate for each rebate period (as defined in paragraph (6)(B)) ending after December 31, 2010, in the amount specified in paragraph (3) for any covered part D drug of the manufacturer dispensed after December 31, 2010, to any full-benefit dual eligible individual (as defined in paragraph (6)(A)) for which payment was made by a PDP sponsor under part D or a MA organization under part C for such period.

Such rebate shall be paid by the manufacturer to the Secretary not later than 30 days after the date of receipt of the information described in section 1860D--12(b)(7), including as such section is applied under section 1857(f)(3).

''(6) REBATE FOR FULL -BENEFIT DUAL ELIGI -BLE MEDICARE DRUG PLAN ENROLLEES .---Amounts

paid under a rebate agreement under section 1860D--2(f) shall be deposited into the Account and shall be used to pay for all or part of the gradual elimination of the coverage gap under section 1860D--2(b)(7).''.

DISCOUNTS FOR CERTAIN PART D DRUGS IN ORIGINAL COVERAGE GAP.

relating to compliance, similar to the terms and conditions for rebate agreements under paragraphs (2), (3), and (4) of section 1927(b), except that---''(i) discounts shall be applied under this subsection to prescription drug plans and MA--PD plans instead of State plans under title XIX; ''(ii) PDP sponsors and MA organizations shall be responsible, instead of States, for provision of necessary utilization information to drug manufacturers; and ''(iii) sponsors and MA organizations shall be responsible for reporting information on drug-component negotiated price, instead of other manufacturer prices.

''(3) DISCOUNT AMOUNT.---The amount of the discount specified in this paragraph for a discount period for a plan is equal to 50 percent of the amount of the drug-component negotiated price (as defined in paragraph (5)(C)) for qualifying drugs for the period involved.

PART D SUBMISSION.---Section 1860D--12(b) of the Social Security Act (42 U.S.C. 1395w--112(b)), as amended by section 172(a)(1) of Public Law 110--275, is amended by striking paragraph (5) and redesignating paragraph (6) and paragraph (7), as added by section 1181(b)(2), as paragraph (5) and paragraph (6), respectively.

1857(f)(3) of the Social Security Act (42 U.S.C. 1395w--27(f)(3)), as added by section 171(b) of Public Law 110--275 and amended by section 172(a)(2) of such Public Law, is amended by striking subparagraph (B) and redesignating subparagraph (C) as subparagraph (B).

Medicare & Medicaid Services regarding the delivery of telehealth services.

IMPROVING ASSETS TESTS FOR MEDICARE SAV-INGS PROGRAM AND LOW-INCOME SUBSIDY PROGRAM.

by inserting after subclause (II) the following new subclauses: ''(III) for 2012, $17,000 (or $34,000 in the case of the combined value of the individual's assets or resources and the assets or resources of the individual's spouse); and ''(IV) for a subsequent year, the dollar amounts specified in this subclause (or subclause (III)) for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.''; and (E) in the last sentence, by inserting ''or (IV)'' after ''subclause (II)''.

EFFECTIVE DATE.---The amendments made by subsection (a) shall apply to eligibility determinations for income-related subsidies and medicare cost-sharing furnished for periods beginning on or after January 1, 2012.

who is a full-benefit dual eligible individual and with respect to whom there has been a determination that but for the provision of home and community based care (whether under section 1915, 1932, or under a waiver under section 1115) the individual would require the level of care provided in a hospital or a nursing facility or intermediate care facility for the mentally retarded the cost of which could be reimbursed under the State plan under title XIX, the elimination of any beneficiary coinsurance described in section 1860D--2(b)(2) (for all amounts through the total amount of expenditures at which benefits are available under section 1860D--2(b)(4)).''.

ADMINISTRATION'S OUTREACH TO ELIGIBLE INDIVID-UALS.---For provision authorizing disclosure of return information to facilitate identification of individuals likely to be ineligible for low-income subsidies under Medicare prescription drug program, see section 1801.

The Medicare Health Insurance Claims Number of beneficiaries for whom claims were readjudicated.

ELIGIBLE THIRD PARTY .---The term ''eligible third party'' means, with respect to a retroactive LIS enrollment beneficiary, an organization or other third party that is owed payment on behalf of such beneficiary for covered drug costs incurred by such beneficiary during the retroactive coverage period of such beneficiary.

RETROACTIVE COVERAGE PERIOD .---The term ''retroactive coverage period'' means---(A) with respect to a retroactive LIS enrollment beneficiary described in paragraph (4)(A)(i), the period---(i) beginning on the effective date of the assistance described in such paragraph for which the individual is eligible; and (ii) ending on the date the plan effectuates the status of such individual as so eligible; and (B) with respect to a retroactive LIS enrollment beneficiary described in paragraph (4)(A)(ii), the period---(i) beginning on the date the individual is both entitled to benefits under part A, or enrolled under part B, of title XVIII of the Social Security Act and eligible for medical assistance under a State plan under title XIX of such Act; and (ii) ending on the date the plan effectuates the status of such individual as a full-benefit dual eligible individual (as defined in section 1935(c)(6) of such Act).

RFP CONTRACT DESCRIBED.---The RFP contract described in this section is a contract entered into between the Secretary and a sponsor of a prescription drug plan pursuant to the Centers for Medicare & Medicaid Services' request for proposals issued on February 17, 2009, relating to Medicare part D retroactive coverage for certain low income beneficiaries, or a similar subsequent request for proposals.

In the case the Secretary enrolls such individuals through use of an intelligent assignment process, such process shall take into account the extent to which prescription drugs necessary for the individual are covered in the case of a PDP sponsor of a prescription drug plan that uses a formulary, the use of prior authorization or other restrictions on access to coverage of such prescription drugs by such a sponsor, and the overall quality of a prescription drug plan as measured by quality ratings established by the Secretary.'' (b) EFFECTIVE DATE.---The amendment made by subsection (a) shall take effect for contract years beginning with 2012.

lize, offer, or make available language services for beneficiaries who are limited English proficient and ways that Medicare should develop payment systems for language services.

ANALYSES.---The study shall include an analysis of each of the following: (A) How to develop and structure appropriate payment systems for language services for all Medicare service providers.

The feasibility of adopting a payment methodology for on-site interpreters, including interpreters who work as independent contractors and interpreters who work for agencies that provide on-site interpretation, pursuant to which such interpreters could directly bill Medicare for services provided in support of physician office services for an LEP Medicare patient.

FOR COMMUNITY ORGANIZATIONS .---The Secretary shall give priority to applicants that have developed partnerships with community organizations or with agencies with experience in language access.

IN GENERAL.---A grantee shall use grant funds received under this section to pay for the provision of competent language services to Medicare beneficiaries who are limited English proficient.

Competent interpreter services may be provided through on-site interpretation, telephonic interpretation, or video interpretation or direct provision of health care or health care related services by a bilingual health care provider.

A grantee may use grant funds to pay for competent translation services.

A grantee may use up to 10 percent of the grant funds to pay for administrative costs associated with the provision of competent language services and for reporting required under subsection (e).

in the case of a Medicare beneficiary who is limited English proficient (who has been informed in the beneficiary's primary language of the availability of free interpreter and translation services) and who requests the use of family, friends, or other persons untrained in interpretation or translation and the grantee documents the request in the beneficiary's record; and (II) in the case of a medical emergency where the delay directly associated with obtaining a competent interpreter or translation services would jeopardize the health of the patient.

NO COST SHARING.---Limited English proficient Medicare beneficiaries shall not have to pay cost-sharing or co-pays for language services provided through this demonstration program.

HEALTH CARE SERVICES .---The term ''health care services'' means services that address physical as well as mental health conditions in all care settings.

LANGUAGE ACCESS.---The term ''language access'' means the provision of language services to an LEP individual designed to enhance that individual's access to, understanding of or benefit from health care or health care-related services.

MEDICARE BENEFICIARY.---The term ''Medicare beneficiary'' means an individual entitled to benefits under part A of title XVIII of the Social Security Act or enrolled under part B of such title.

SERVICE PROVIDER.---The term ''service provider'' includes all suppliers, providers of services, or entities under contract to provide coverage, items or services under any part of title XVIII of the Social Security Act.

EXTENDED MONTHS OF COVERAGE OF IMMUNO-SUPPRESSIVE DRUGS FOR KIDNEY TRANS-PLANT PATIENTS AND OTHER RENAL DIALY-SIS PROVISIONS.

Such consultation shall include the following: ''(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

''(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and ''(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).

''(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions.

professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate.

VERSIONS.---The Secretary shall include the information described in subparagraph (A) in all paper and electronic versions of the Medicare & You Handbook that are published on or after the date that is 1 year after the date of the enactment of this Act.

PART B SPECIAL ENROLLMENT PERIOD AND WAIVER OF LIMITED ENROLLMENT PENALTY FOR TRICARE BENEFICIARIES.

''(4) The Secretary of Defense shall establish a method for identifying individuals described in paragraph (1) and providing notice to them of their eligibility for enrollment during the special enrollment period described in paragraph (2).''.

GENERAL.---The Secretary of Health and Human Services shall establish a shared decision making demonstration program (in this subsection referred to as the ''program'') under the Medicare program using patient decision aids to meet the objective of improving the understanding by Medicare beneficiaries of their medical treatment options, as compared to comparable Medicare beneficiaries who do not participate in a shared decision making process using patient decision aids.

APPLICATION.---An eligible provider seeking to participate in the program shall submit to the Secretary an application at such time and containing such information as the Secretary may require.

other health care provider which is set up for the purpose of testing shared decision making and patient decision aids.

MODEL.---The term 'other physician organization model' means, with respect to a qualifying ACO any model of organization under which physicians enter into agreements with other providers for the purposes of participation in the pilot program in order to provide high quality and efficient health care services and share in any incentive payments under such program.

''(E) OTHER SERVICES.---Nothing in this paragraph shall be construed as preventing a qualifying ACO from furnishing items or services, for which payment may not be made under this title, for purposes of achieving performance goals under the pilot program.

''(B) The group includes a sufficient number of primary care physicians for the applicable beneficiaries for whose care the group is accountable (as determined by the Secretary).

''(C) The group reports on quality measures in such form, manner, and frequency as specified by the Secretary (which may be for the group, for providers of services and suppliers, or both).

''(c) SPECIFIC PAYMENT INCENTIVE MODELS.---The specific payment incentive models described in this subsection are the following: ''(1) PERFORMANCE TARGET MODEL .---Under the performance target model under this paragraph (in this paragraph referred to as the 'performance target model'): ''(A) IN GENERAL.---A qualifying ACO qualifies to receive an incentive payment if expenditures for applicable beneficiaries are less than a target spending level or a target rate of growth.

''(ii) BASE AMOUNT.---For purposes of clause (i), the base amount in this subparagraph is equal to the average total payments (or allowed charges) under parts A and B (and may include part D, if the Secretary determines appropriate) for applicable beneficiaries for whom the qualifying ACO furnishes items and services in a base period determined by the Secretary.

fying ACOs under the pilot program at least annually.

ACO under the pilot program to assess impacts on beneficiaries, providers of services, suppliers and the program under this title.

''(2) MONITORING.---The Inspector General of the Department of Health and Human Services shall provide for monitoring of the operation of ACOs under the pilot program with regard to violations of section 1877 (popularly known as the 'Stark law').

the participation of smaller accountable care organizations under the pilot program, the Secretary may limit a qualifying ACO's exposure to high cost patients under the program.

''(5) CONSTRUCTION.---Nothing in this section shall be construed to compel or require an organization to use an organization-specific target growth rate for an accountable care organization under this section for purposes of section 1848.

HOME MODELS.---MEDICAL ''(1) ESTABLISHMENT OF PILOT PROGRAM .---The Secretary shall establish a medical home pilot program (in this section referred to as the 'pilot program') for the purpose of evaluating the feasibility and advisability of reimbursing qualified patient-cen-tered medical homes for furnishing medical home services (as defined under subsection (b)(1)) to high need beneficiaries (as defined in subsection (d)(1)(C)) and to targeted high need beneficiaries (as defined in subsection (c)(1)(C)).

AND PHYSICIAN ASSISTANTS .---''(A) Nothing in this section shall be construed as preventing a nurse practitioner from leading a patient centered medical home so long as---''(i) all the requirements of this section are met; and ''(ii) the nurse practitioner is acting consistently with State law.

Secretary shall pay independent patient-cen-tered medical homes a monthly fee for each targeted high need beneficiary who consents to receive medical home services through such medical home.

''(iii) Use appropriate risk-adjustment in determining the amount of the per beneficiary per month payment under this paragraph in a manner that ensures that higher payments are made for higher risk beneficiaries.

subsection shall be designed to include the participation of physicians in practices with fewer than 10 full-time equivalent physicians, as well as physicians in larger practices, particularly in underserved and rural areas, as well as federally qualified community health centers, and rural health centers.

and in close collaboration with the primary care or principal care physician or nurse practitioner designated by the beneficiary as his or her community-based medical home provider.

''(iii) The organization employs community health workers, including nurses or other non-physician practitioners, lay health workers, or other persons as determined appropriate by the Secretary, that assist the primary or principal care physician or nurse practitioner in chronic care management activities such as teaching self-care skills for managing chronic illnesses, transitional care services, care plan setting, medication therapy management services for patients with multiple chronic diseases, or help beneficiaries access the health care and community-based resources in their local geographic area.

Such organization shall provide the Secretary with a detailed implementation plan that includes how such funds will be used.

''(2) REPORT.---Not later than 60 days after the date of completion of the evaluation under paragraph (1), the Secretary shall submit to Congress and make available to the public a report on the findings of the evaluation under paragraph (1).

PAYMENT INCENTIVE FOR SELECTED PRIMARY CARE SERVICES.

IN GENERAL.---Section 1833 of the Social Security Act is amended by inserting after subsection (o) the following new subsection: ''(p) PRIMARY CARE PAYMENT INCENTIVES.---''(1) IN GENERAL.---In the case of primary care services (as defined in paragraph (2)) furnished on or after January 1, 2011, by a primary care practitioner (as defined in paragraph (3)) for which amounts are payable under section 1848, in addition to the amount otherwise paid under this part there shall also be paid to the practitioner (or to an employer or facility in the cases described in clause (A) of section 1842(b)(6)) (on a monthly or quarterly basis) from the Federal Supplementary Medical Insurance Trust Fund an amount equal 5 percent (or 10 percent if the practitioner predominately furnishes such services in an area that is designated (under section 332(a)(1)(A) of the Public Health Service Act) as a primary care health professional shortage area.

''(B) includes a physician assistant who is under the supervision of a practitioner described in subparagraph (A).

IN GENERAL.---Section 1833(a)(1)(K) of the Social Security Act (42 U.S.C.1395l(a)(1)(K)) is amended by striking ''(but in no event'' and all that follows through ''performed by a physician)''.

COVERAGE AND WAIVER OF COST-SHARING FOR PREVENTIVE SERVICES.

''(B) Colorectal cancer screening tests (as defined in subsection (pp) and when applicable as described in section 1305).

''(B) after obtaining such degree has performed at least 2 years of clinical supervised experience in marriage and family therapy; and ''(C) is licensed or certified as a marriage and family therapist in the State in which marriage and family therapist services are performed.''.

and Human Services shall, taking into consideration concerns for patient confidentiality, develop criteria with respect to payment for marriage and family therapist services for which payment may be made directly to the marriage and family therapist under part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) under which such a therapist must agree to consult with a patient's attending or primary care physician or nurse practitioner in accordance with such criteria.

THERAPIST SERVICES FROM SKILLED NURSING FA -CILITY PROSPECTIVE PAYMENT SYSTEM .---Section

THERAPIST SERVICES PROVIDED IN RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CEN -TERS.---Section 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 1395x(aa)(1)(B)) is amended by striking ''or by a clinical social worker (as defined in subsection (hh)(1)),'' and inserting '', by a clinical social worker (as defined in subsection (hh)(1)), or by a marriage and family therapist (as defined in subsection (jjj)(2)),''.

Security Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following new clause: ''(vii) A marriage and family therapist (as defined in section 1861(jjj)(2)).''.

in subparagraph (GG), by inserting ''and'' at the end; and (C) by adding at the end the following new subparagraph: ''(HH) mental health counselor services (as defined in subsection (kkk)(1));''.

DEFINITION.---Section 1861 of the Social Security Act (42 U.S.C. 1395x), as previously amended, is amended by adding at the end the following new subsection: ''Mental Health Counselor Services ''(kkk)(1) The term 'mental health counselor services' means services performed by a mental health counselor (as defined in paragraph (2)) for the diagnosis and treatment of mental illnesses which the mental health counselor is legally authorized to perform under State law (or the State regulatory mechanism provided by the State law) of the State in which such services are performed, as would otherwise be covered if furnished by a physician or as incident to a physician's professional service, but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services.

''Federally Recommended Vaccines ''(lll) The term 'federally recommended vaccine' means an approved vaccine recommended by the Advisory Committee on Immunization Practices (an advisory committee established by the Secretary, acting through the Director of the Centers for Disease Control and Prevention).''.

''(ii) carry out, or award grants or contracts for, original research and experimentation, where existing information is inadequate, and ''(iii) adopt procedures allowing any interested party to submit information for the use by the Center and Commission under subsection (b) in making reports and recommendations.

ject to the authority of the Secretary, to ensure such activities result in highly credible research and information resulting from such research.

''(I) make recommendations for the priority for periodic reviews of previous comparative effectiveness research and studies conducted by the Center under subsection (a); ''(J) routinely review processes of the Center with respect to such research to confirm that the information produced by such research is objective, credible, consistent with standards of evidence established under this section, and developed through a transparent process that includes consultations with appropriate stakeholders; and ''(K) make recommendations to the center for the broad dissemination of the findings of research conducted and supported under this section that enables clinicians, patients, consumers, and payers to make more informed health care decisions that improve quality and value.

member shall represent each of the following health care communities: ''(I) Patients.

Secretary may consult with the Government Accountability Office and the Institute of Medicine of the National Academy of Sciences.

''(5) CHAIRMAN; VICE CHAIRMAN.---The Secretary shall designate a member of the Commission, at the time of appointment of the member, as Chairman and a member as Vice Chairman for that term of appointment, except that in the case of vacancy of the Chairmanship or Vice Chairmanship, the Secretary may designate another member for the remainder of that member's term.

ernment Act of 1978 for each individual under consideration for the appointment, so as to reduce the likelihood that an appointed individual will later require a written determination as referred to in section 208(b)(1) of title 18, United States Code, a written certification as referred to in section 208(b)(3) of title 18, United States Code, or a waiver as referred to in subparagraph (D)(iii) for service on the Commission at a meeting of the Commission.

''(E) provide transportation and subsistence for persons serving without compensation; and ''(F) prescribe such rules and regulations as it deems necessary with respect to the internal organization and operation of the Commission.

''(C) All aspects of the prioritization of research, conduct of the research, and development of conclusions based on the research shall be transparent to all stakeholders.

''(D) The process and methods for conducting such research shall be publicly documented and available to all stakeholders.

''(E) Throughout the process of such research, the Center shall provide opportunities for all stakeholders involved to review and provide public comment on the methods and findings of such research.

PANELS.---The research shall meet a national research priority determined under subsection (b)(2)(A) and shall consider advice given to the Center by the clinical perspective advisory panel for the national research priority.

produced by research supported, conducted, or synthesized under this section to health care providers, patients, vendors of health information technology focused on clinical decision support, appropriate professional associations, and Federal and private health plans, and other relevant stakeholders.

REQUIRED DISCLOSURE OF OWNERSHIP AND ADDITIONAL DISCLOSABLE PARTIES INFOR-MATION.

QUIREMENTS.---Nothing in this subsection shall reduce, diminish, or alter any reporting requirement for a facility that is in effect as of the date of the enactment of this subsection.

''(i) exercises operational, financial, or managerial control over the facility or a part thereof, or provides policies or procedures for any of the operations of the facility, or provides financial or cash management services to the facility; ''(ii) leases or subleases real property to the facility, or owns a whole or part interest equal to or exceeding 5 percent of the total value of such real property; ''(iii) lends funds or provides a financial guarantee to the facility in an amount which is equal to or exceeds $50,000; or ''(iv) provides management or administrative services, clinical consulting services, or accounting or financial services to the facility.

PUBLIC AVAILABILITY OF INFORMATION.---(1) IN GENERAL.---Not later than the date that is 1 year after the date on which the final regulations promulgated under section 1124(c)(4)(A) of the Social Security Act, as added by subsection (a), are published in the Federal Register, the information reported in accordance with such final regulations shall be made available to the public in accordance with procedures established by the Secretary.

1819(d)(1) of the Social Security Act (42 U.S.C. 1395i--3(d)(1)) is amended by striking subparagraph (B) and redesignating subparagraph (C) as subparagraph (B).

''(i) REQUIREMENT.---On or after the date that is 36 months after the date of the enactment of this subparagraph, a skilled nursing facility shall, with respect to the entity that operates the facility (in this subparagraph referred to as the 'operating organization' or 'organization'), have in operation a compliance and ethics program that is effective in preventing and detecting criminal, civil, and administrative violations under this Act and in promoting quality of care consistent with regulations developed under clause (ii).

such report such recommendations regarding changes in the requirements for such programs as the Secretary determines appropriate.

''(iii) REQUIREMENTS FOR COMPLI -ANCE AND ETHICS PROGRAMS .---In this

compliance and ethics program of an organization are the following: ''(I) The organization must have established compliance standards and procedures to be followed by its employees and other agents that are reasonably capable of reducing the prospect of criminal, civil, and administrative violations under this Act.

quality assurance and performance improvement program (in this clause referred to as the 'QAPI program') for skilled nursing facilities, including multi-unit chains of such facilities.

Under the QAPI program, the Secretary shall establish standards relating to such facilities and provide technical assistance to such facilities on the development of best practices in order to meet such standards.

Not later than 1 year after the date on which the regulations are promulgated under subclause (II), a skilled nursing facility must submit to the Secretary a plan for the facility to meet such standards and implement such best practices, including how to coordinate the implementation of such plan with quality assessment and assurance activities conducted under clause (i).

The effects of such undercapitalization on quality of care, including staffing and food costs, at such facilities.

REPORT.---Not later than 18 months after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report on the study conducted under paragraph (1).

NURSING FACILITY.---In this subsection, the term ''nursing facility'' includes a skilled nursing facility.

website as of the day before the date of the enactment of this subsection; and ''(ii) not later than 1 year after the date of the enactment of this subsection, to modify or revamp such website in accordance with the review conducted under clause (i).

information made available to the public under subparagraph (A) and provided on the Nursing Home Compare Medicare website under subsection (i), each State shall submit information respecting any survey or certification made respecting a skilled nursing facility (including any enforcement actions taken by the State) to the Secretary not later than the date on which the State sends such information to the facility.

The Secretary shall use the information submitted under the preceding sentence to update the information provided on the Nursing Home Compare Medicare website as expeditiously as practicable but not less frequently than quarterly.''.

EFFECTIVE DATE.---The amendment made by this paragraph shall take effect 1 year after the date of the enactment of this Act.

forcement of requirements for skilled nursing facilities that the Secretary has identified as having substantially failed to meet applicable requirement of this Act.

''(ii) Links to State Internet websites with information regarding State survey and certification programs, links to Form 2567 State inspection reports (or a successor form) on such websites, information to guide consumers in how to interpret and understand such reports, and the facility plan of correction or other response to such report.

''(iii) The standardized complaint form developed under subsection (f)(10), including explanatory material on what complaint forms are, how they are used, and how to file a complaint with the State survey and certification program and the State long-term care ombudsman program.

''(2) MODIFICATION OF FORM .---The Secretary, in consultation with private sector accountants experienced with skilled nursing facility cost reports, shall redesign such reports to meet the requirement of paragraph (1) not later than 1 year after the date of the enactment of this subsection.

of the enactment of this subsection, the Secretary, working in consultation with the Medicare Payment Advisory Commission, the Inspector General of the Department of Health and Human Services, and other expert parties the Secretary determines appropriate, shall take the expenditures listed on cost reports, as modified under paragraph (1), submitted by skilled nursing facilities and categorize such expenditures, regardless of any source of payment for such expenditures, for each skilled nursing facility into the following functional accounts on an annual basis: ''(A) Spending on direct care services (including nursing, therapy, and medical services).

''(B) Spending on indirect care (including housekeeping and dietary services).

to make information on expenditures submitted under this subsection readily available to interested parties upon request, subject to such requirements as the Secretary may specify under the procedures established under this paragraph.''.

term care ombudsman program with respect to a skilled nursing facility.''.

''(6) COMPLAINT PROCESSES AND WHISTLE -BLOWER PROTECTION.---''(A) COMPLAINT FORMS.---The State must make the standardized complaint form developed under subsection (f)(9) available upon request to---''(i) a resident of a skilled nursing facility; ''(ii) any person acting on the resident's behalf; and ''(iii) any person who works at a skilled nursing facility or is a representative of such a worker.

resentative, or responsible party has complained, in good faith, about the quality of care or other issues relating to the skilled nursing facility, that the legal representative of a resident of a skilled nursing facility or other responsible party is not denied access to such resident or otherwise retaliated against if such representative party has complained, in good faith, about the quality of care provided by the facility or other issues relating to the facility, and that a person who works at a skilled nursing facility is not retaliated against if the worker has complained, in good faith, about quality of care or services or an issue relating to the quality of care or services provided at the facility, whether the resident, legal representative, other responsible party, or worker used the form developed under subsection (f)(9) or some other method for submitting the complaint.

''(iv) RIGHTS NOT WAIVABLE .---The rights protected by this paragraph may not be diminished by contract or other agreement, and nothing in this paragraph shall be construed to diminish any greater or additional protection provided by Federal or State law or by contract or other agreement.

''(D) RULE OF CONSTRUCTION .---Nothing in this paragraph shall be construed as preventing a resident of a nursing facility (or a person acting on the resident's behalf) from submitting a complaint in a manner or format other than by using the standardized complaint form developed under subsection (f)(11) (including submitting a complaint orally).

''(ii) the violation of this title has occurred or may occur in relation to such information.''.

data in a uniform format (according to specifications established by the Secretary in consultation with such programs, groups, and parties).

Such specifications shall require that the information submitted under the preceding sen-tence--- ''(i) specify the category of work a certified employee performs (such as whether the employee is a registered nurse, licensed practical nurse, licensed vocational nurse, certified nursing assistant, therapist, or other medical personnel); ''(ii) include resident census data and information on resident case mix; ''(iii) include a regular reporting schedule; and ''(iv) include information on employee turnover and tenure and on the hours of care provided by each category of certified employees referenced in clause (i) per resident per day.

and (VI), in the case where a facility self-reports and promptly corrects a deficiency for which a penalty was imposed under this clause not later than 10 calendar days after the date of such imposition, the Secretary may reduce the amount of the penalty imposed by not more than 50 percent.

not reduce under subclause (IV) the amount of a penalty if the deficiency is a repeat deficiency.

CONFORMING AMENDMENT.---The second sentence of section 1819(h)(5) of the Social Security Act (42 U.S.C. 1395i--3(h)(5)) is amended by inserting ''(ii),'' after ''(i),''.

''(II) in each case of a deficiency where the facility is cited for actual harm or immediate jeopardy, an amount not less than $3,050 and not more than $25,000; and ''(III) in each case of any other deficiency, an amount not less than $250 and not to exceed $3,050.

''(II) in each case of any other deficiency, an amount not less than $250 and not to exceed $3,050.

not later than 10 calendar days after the date of such imposition, the State may reduce the amount of the penalty imposed by not more than 50 percent.

under clause (iv) the amount of a penalty if the penalty is imposed for a deficiency described in clause (ii)(II) or (iii)(I) and the actual harm or widespread harm that immediately jeopardizes the health or safety of a resident or residents of the facility, or if the penalty is imposed for a deficiency described in clause (ii)(I).

clause (I) is completed or the date that is 90 days after the date of the imposition of the penalty; ''(IV) may provide that such amounts collected are kept in such account pending the resolution of any subsequent appeals; ''(V) in the case where the facility successfully appeals the penalty, may provide for the return of such amounts collected (plus interest) to the facility; and ''(VI) in the case where all such appeals are unsuccessful, may provide that such funds collected shall be used for the purposes described in the second sentence of subparagraph (A)(ii).''.

assistance to support and protect residents of a facility that closes (voluntarily or involuntarily) or is decertified (including offsetting costs of relocating residents to home and communitybased settings or another facility), projects that support resident and family councils and other consumer involvement in assuring quality care in facilities, and facility improvement initiatives approved by the Secretary (including joint training of facility staff and surveyors, providing technical assistance to facilities under quality assurance programs, the appointment of temporary management, and other activities approved by the Secretary)''.

outlining corrective actions the chain will take to implement the recommendations in such report; or (B) indicating that the chain will not implement such recommendations and why it will not do so.

COST OF APPOINTMENT.---A chain shall be responsible for a portion of the costs associated with the appointment of independent monitors under the pilot program.

FACILITY.---The term ''facility'' means a skilled nursing facility or a nursing facility.

NURSING FACILITY.---The term ''nursing facility'' has the meaning given such term in section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a)).

SKILLED NURSING FACILITY .---The term ''skilled nursing facility'' has the meaning given such term in section 1819(a) of the Social Security Act (42 U.S.C. 1395(a)).

REPORT.---Not later than 180 days after the completion of the pilot program, the Inspector General shall submit to Congress and the Secretary a report containing the results of the evaluation conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Inspector General determines appropriate.

''(ii) ensure that the facility does not admit any new residents on or after the date on which such written notification is submitted; and ''(iii) include in the notice a plan for the transfer and adequate relocation of the residents of the facility by a specified date prior to closure that has been approved by the State, including assurances that the residents will be transferred to the most appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs and best interests of each resident.

''(1) contribute to a large burden of disease, including those that address the health care provided to patients with prevalent, high-cost chronic diseases; ''(2) have the greatest potential to decrease morbidity and mortality in this country, including those that are designed to eliminate harm to patients; ''(3) have the greatest potential for improving the performance, affordability, and patientcenteredness of health care, including those due to variations in care; ''(4) address health disparities across groups and areas; and ''(5) have the potential for rapid improvement due to existing evidence, standards of care or other reasons.

''(d) DEFINITIONS.---In this part: ''(1) CONSENSUS-BASED ENTITY.---The term 'consensus-based entity' means an entity with a contract with the Secretary under section 1890.

''(2) AUTHORIZATION OF APPROPRIATIONS .---For purposes of carrying out the provisions of this section, in addition to funds otherwise available, out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services $2,000,000 for each of the fiscal years 2010 through 2014.''.

REQUIRED.---Consistent with the national priorities established under this part and with the programs administered by the Centers for Medicare & Medicaid Services and in consultation with other relevant Federal agencies, the Secretary shall determine areas in which quality measures for assessing health care services in the United States are needed.

''(3) TESTING OF PROPOSED MEASURES .---The Secretary may use amounts made available under subsection (f) to fund the testing of proposed quality measures by qualified entities.

MULTI-STAKEHOLDER PRE-RULEMAKING INPUT INTO SELECTION OF QUALITY MEASURES.

The Secretary shall submit such a non-endorsed measure to the entity for consideration for endorsement.

PHYSICIANS' SERVICES.---Section 1848(k)(2)(C)(ii) of such Act (42 U.S.C. 1395w--4(k)(2)(C)(ii)) is amended by adding at the end the following: ''The Secretary shall submit such a non-endorsed measure to the entity for consideration for endorsement.

following: ''The Secretary shall submit such a non-en-dorsed measure to the entity for consideration for endorsement.

EFFECTIVE DATE.---Except as otherwise provided, the amendments made by this section shall apply to quality measures applied for payment years beginning with 2012 or fiscal year 2012, as the case may be.

REPORTS ON FINANCIAL RELATIONSHIPS BE-TWEEN MANUFACTURERS AND DISTRIBU-TORS OF COVERED DRUGS, DEVICES, BIOLOGICALS, OR MEDICAL SUPPLIES UNDER MEDICARE, MEDICAID, OR CHIP AND PHYSICIANS AND OTHER HEALTH CARE ENTI-TIES AND BETWEEN PHYSICIANS AND OTHER HEALTH CARE ENTITIES.

nually thereafter, each applicable manufacturer or distributor that provides a payment or other transfer of value to a covered recipient, or to an entity or individual at the request of or designated on behalf of a covered recipient, shall submit to the Secretary, in such electronic form as the Secretary shall require, the following information with respect to the preceding calendar year: ''(A) With respect to the covered recipient, the recipient's name, business address, physician specialty, and national provider identifier.

''(2) AGGREGATE REPORTING.---Information submitted by an applicable manufacturer or distributor under paragraph (1) shall include the aggregate amount of all payments or other transfers of value provided by the manufacturer or distributor to covered recipients (and to entities or individuals at the request of or designated on behalf of a covered recipient) during the year involved, including all payments and transfers of value regardless of whether such payments or transfer of value were individually disclosed.

transfer of value made to a covered recipient by an applicable manufacturer or distributor pursuant to a product development agreement for services furnished in connection with the development of a new drug, device, biological, or medical supply, the applicable manufacturer or distributor may report the value and recipient of such payment or other transfer of value in the first reporting period under this subsection in the next reporting deadline after the earlier of the following: ''(A) The date of the approval or clearance of the covered drug, device, biological, or medical supply by the Food and Drug Administration.

subsection shall be subject to a civil money penalty of not less than $1,000, but not more than $10,000, for each payment or other transfer of value or ownership or investment interest not reported as required under such subsection.

Such penalty shall be imposed and collected in the same manner as civil money penalties under subsection (a) of section 1128A are imposed and collected under that section.

''(B) LIMITATION.---The total amount of civil money penalties imposed under subparagraph (A) with respect to each annual submission of information under subsection (a) by an applicable manufacturer or distributor or other entity shall not exceed $150,000.

CONGRESS.---Not later than April 1 of each year beginning with 2011, the Secretary shall submit to Congress a report that includes the following: ''(1) The information submitted under this section during the preceding year, aggregated for each applicable manufacturer or distributor of a covered drug, device, biological, or medical supply that submitted such information during such year.

''(E) A health insurance issuer, group health plan, or other entity offering a health benefits plan, including any employee of such an issuer, plan, or entity.

''(A) The disclosure or reporting of information not of the type required to be disclosed or reported under this section.

REQUIREMENT FOR PUBLIC REPORTING BY HOSPITALS AND AMBULATORY SURGICAL CENTERS ON HEALTH CARE-ASSOCIATED IN-FECTIONS.

Such information shall be set forth in a manner that allows for the comparison of information on health care-associated infec-tions--- ''(1) among hospitals and ambulatory surgical centers; and ''(2) by demographic information.

''(c) ANNUAL REPORT TO CONGRESS.---On an annual basis the Secretary shall submit to the Congress a report that summarizes each of the following: ''(1) The number and types of health care-asso-ciated infections reported under subsection (a) in hospitals and ambulatory surgical centers during such year.

''(3) Based on the most recent information available to the Secretary on the composition of the professional staff of hospitals and ambulatory surgical centers, the number of certified infection control professionals on the staff of hospitals and ambulatory surgical centers.

''(4) The total increases or decreases in health care costs that resulted from increases or decreases in the rates of occurrence of each such type of infection during such year.

EFFECTIVE DATE.---With respect to section 1138A of the Social Security Act (as inserted by subsection (a) of this section), the requirement under such section that hospitals and ambulatory surgical centers submit reports takes effect on such date (not later than 2 years after the date of the enactment of this Act) as the Secretary of Health and Human Services shall specify.

erwise applicable resident limit shall be reduced by 90 percent of the difference between such otherwise applicable resident limit and such reference resident level.

''(i) IN GENERAL.---The Secretary shall increase the otherwise applicable resident limit for each qualifying hospital that submits an application under this subparagraph by such number as the Secretary may approve for portions of cost reporting periods occurring on or after July 1, 2011.

spect to additional residency positions in a hospital attributable to the increase provided under this subparagraph, the approved FTE resident amounts are deemed to be equal to the hospital per resident amounts for primary care and nonprimary care computed under paragraph (2)(D) for that hospital.

''(vi) DISTRIBUTION.---The Secretary shall distribute the increase in resident training positions to qualifying hospitals under this subparagraph not later than July 1, 2011.

ber of primary care residents in its residency training programs; and ''(ii) as a condition of payment for a cost reporting period under this subsection for such positions, to maintain the level of such positions at not less than the sum of---(b) IME.---''(I) the base level of primary care resident positions (as determined under subparagraph (B)(ii)(I)) before receiving such additional positions; and ''(II) the number of such additional positions.''.

1395ww(d)(5)(B)) is amended by adding at the end the following clause: ''(x) For discharges occurring on or after July 1, 2011, insofar as an additional payment amount under this subparagraph is attributable to resident positions distributed to a hospital under subsection (h)(8)(B), the indirect teaching adjustment factor shall be computed in the same manner as provided under clause (ii) with respect to such resident positions.''.

CONFORMING AMENDMENT.---Section 422(b)(2) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108--173) is amended by striking ''section 1886(h)(7)'' and all that follows and inserting ''paragraphs (7) and (8) of subsection (h) of section 1886 of the Social Security Act''.

by inserting after subclause (I), as inserted by paragraph (1), the following new subclause: ''(II) Effective for discharges occurring on or after July 1, 2009, all the time spent by an intern or resident in patient care activities at an entity in a nonprovider setting shall be counted towards the determination of full-time equivalency if the hospital incurs the costs of the stipends and fringe benefits of the intern or resident during the time the intern or resident spends in that setting.''.

an approved teaching health center shall contract with an accredited teaching hospital to carry out the inpatient responsibilities of the primary care residency program of the hospital involved and is responsible for payment to the hospital for the hospital's costs of the salary and fringe benefits for residents in the program; (B) the number of primary care residents of the center shall not count against the contracting hospital's resident limit; and (C) the contracting hospital shall agree not to diminish the number of residents in its primary care residency training program.

plicable resident limit under this paragraph for other hospitals in the State in accordance with this clause.

''(III) LIMITATION.---The estimated aggregate number of increases in the otherwise applicable resident limits for hospitals under this clause shall be equal to the estimated number of resident positions in the approved medical residency programs that closed on or after the date described in subclause (I).''.

by inserting ''or under paragraph (4)(H)(vi)'' after ''under this paragraph''.

APPROVED MEDICAL RESIDENCY TRAINING PRO -GRAMS.---The goals of medical residency training programs are to foster a physician workforce so that physicians are trained to be able to do the following: ''(i) Work effectively in various health care delivery settings, such as nonprovider settings.

2010, and shall be available without further appropriation until expended.''.

ENHANCED PENALTIES FOR FALSE STATEMENTS ON PROVIDER OR SUPPLIER ENROLLMENT APPLICATIONS.

EFFECTIVE DATE.---The amendments made by subsection (a) shall apply to acts committed on or after January 1, 2010.

If the Secretary determines that a hospice program that is certified for participation under this title is in compliance with such requirements but, as of a previous period, was not in compliance with such requirements, the Secretary may provide for a civil money penalty under subsection (b)(2)(A)(i) for the days in which it finds that the program was not in compliance with such requirements.

the hospice program and to protect and assure the health and safety of the individuals under the care of the program while improvements are made, ''(iv) corrective action plans, and ''(v) in-service training for staff.

''(B) CLARIFICATION.---The sanctions specified in subparagraph (A) are in addition to sanctions otherwise available under State or Federal law and shall not be construed as limiting other remedies, including any remedy available to an individual at common law.

''(3) SECRETARIAL AUTHORITY.---The Secretary shall develop and implement, by not later than July 1, 2011, specific procedures with respect to the conditions under which each of the intermediate sanctions developed under paragraph (1) is to be applied, including the amount of any fines and the severity of each of these sanctions.

ENHANCED PENALTIES FOR INDIVIDUALS EX-CLUDED FROM PROGRAM PARTICIPATION.

EXCLUSION OF CERTAIN INDIVIDUALS AND EN-TITIES FROM PARTICIPATION IN MEDICARE AND STATE HEALTH CARE PROGRAMS.

In such case the Secretary shall notify such individual eligible for such benefits of the exclusion of the individual or entity furnishing the items or services.

title XVIII or XIX or the excluded individual or entity, and the Secretary determines that the individual or entity that submitted the claim took reasonable steps to learn of the exclusion and reasonably relied upon inaccurate or misleading information from the relevant Federal health care program or its contractor, the Secretary may waive repayment of the amount paid in violation of the exclusion to the individual or entity that submitted the claim for the items or services furnished by the excluded individual or entity.

ENHANCED PROGRAM AND PROVIDER PRO-TECTIONS IN THE MEDICARE, MEDICAID, AND CHIP PROGRAMS.

In applying this subsection for purposes of title XIX and XXI the Secretary may require a State to carry out the provisions of this subsection as a requirement of the State plan under title XIX or the child health plan under title XXI.

''(4) MORATORIUM ON ENROLLMENT OF PRO -VIDERS AND SUPPLIERS .---For purposes of paragraph (1), the Secretary, based upon a finding of a risk of serious ongoing fraud within a program under title XVIII, XIX, or XXI, may impose a moratorium on the enrollment of providers of services and suppliers within a category of providers of services and suppliers (including a category within a specific geographic area) under such title.

Such a moratorium may only be imposed if the Secretary makes a determination that the moratorium would not adversely impact access of individuals to care under such program.

ENHANCED MEDICARE, MEDICAID, AND CHIP PROGRAM DISCLOSURE REQUIREMENTS RE-LATING TO PREVIOUS AFFILIATIONS.

EVALUATIONS AND REPORTS REQUIRED UNDER MEDICARE INTEGRITY PROGRAM.

''(2) ESTABLISHMENT OF CORE ELEMENTS .---The Secretary, in consultation with the Inspector General of the Department of Health and Human Services, shall establish core elements for a compliance program under paragraph (1).

Such elements may include written policies, procedures, and standards of conduct, a designated compliance officer and a compliance committee; effective training and education pertaining to fraud, waste, and abuse for the organization's employees and contractors; a confidential or anonymous mechanism, such as a hotline, to receive compliance questions and reports of fraud, waste, or abuse; disciplinary guidelines for enforcement of standards; internal monitoring and auditing procedures, including monitoring and auditing of contractors; procedures for ensuring prompt responses to detected offenses and development of corrective action initiatives, including responses to potential offenses; and procedures to return all identified overpayments to the programs under this title, title XIX, and title XXI.

Administrator for the Centers of Medicare & Medicaid Services shall have the authority to determine whether a provider of services or supplier described in subparagraph (3) has met the requirement of this subsection and to impose a civil monetary penalty not to exceed $50,000 for each violation.

SIMILAR MEDICAID PROVI-SION.---For a similar provision with respect to the Medicaid program under title XIX of the Social Security Act, see section 1753.

PHYSICIANS WHO ORDER DURABLE MEDICAL EQUIPMENT OR HOME HEALTH SERVICES RE-QUIRED TO BE MEDICARE ENROLLED PHYSI-CIANS OR ELIGIBLE PROFESSIONALS.

EFFECTIVE DATE.---The amendments made by this section shall apply to written orders and certifications made on or after July 1, 2010.

FACE TO FACE ENCOUNTER WITH PATIENT RE-QUIRED BEFORE PHYSICIANS MAY CERTIFY ELIGIBILITY FOR HOME HEALTH SERVICES OR DURABLE MEDICAL EQUIPMENT UNDER MEDICARE.

REQUIRED REPAYMENTS OF MEDICARE AND MEDICAID OVERPAYMENTS.

''(2) TIMING.---An overpayment must be reported and returned under paragraph (1)(A) by not later than the date that is 60 days after the date the person knows of the overpayment.

''(3) CLARIFICATION.---Repayment of any overpayments (or refunding by withholding of future payments) by a provider of services or supplier does not otherwise limit the provider or supplier's potential liability for administrative obligations such as applicable interests, fines, and specialties or civil or criminal sanctions involving the same claim if it is determined later that the reason for the overpayment was related to fraud by the provider or supplier or the employees or agents of such provider or supplier.

EXPANDED APPLICATION OF HARDSHIP WAIV-ERS FOR OIG EXCLUSIONS TO BENE-FICIARIES OF ANY FEDERAL HEALTH CARE PROGRAM.

renal dialysis facility, upon the request of the Secretary, shall provide to the Secretary access to information relating to any ownership or compensation arrangement between such facility and the medical director of such facility or between such facility and any physician.''.

Upon the completion of such process, notwithstanding any other provision of law, the Secretary shall cease the operation of the HIPDB and shall collect information required to be reported under the preceding provisions of this section in the NPDB.

Except as otherwise provided in this subsection, the provisions of subsections (a) through (g) shall continue to apply with respect to the reporting of (or failure to report), access to, and other treatment of the information specified in this section.''.

INFORMATION DESCRIBED.---For purposes of paragraph (1), the information described in this paragraph is the information that would, but for the amendments made by this section, have been available to the Secretary of Veterans Affairs from the Healthcare Integrity and Protection Data Bank.

EFFECTIVE DATE.---The amendments made---(1) by subsection (a)(2) shall take effect on the first day after the Secretary of Health and Human Services certifies that the process implemented pursuant to section 1128E(h) of the Social Security Act (as added by subsection (a)(3)) is complete; and (2) by subsection (b) shall take effect on the earlier of the date specified in paragraph (1) or the first day of the second succeeding fiscal year after the fiscal year during which this Act is enacted.

COMPLIANCE WITH HIPAA PRIVACY AND SECU-RITY STANDARDS.

ELIGIBILITY FOR INDIVIDUALS WITH INCOME BELOW 1331D3 PERCENT OF THE FEDERAL POVERTY LEVEL.

100% FMAP FOR NON -TRADITIONAL MED-ICAID ELIGIBLE INDIVIDUALS .---Section 1905 of

Commissioner, acting in consultation with the Secretary, with respect to coordinating the implementation of the provisions of division A of such Act with the State plan under this title in order to ensure the enrollment of Medicaid eligible individuals in acceptable coverage.

The State shall not do any redeterminations of eligibility for such individuals unless the periodicity of such redeterminations is consistent with the periodicity for redeterminations by the Commissioner of eligibility for affordability credits under subtitle C of title II of division A of the America's Affordable Health Choices Act of 2009, as specified under such memorandum.

Affordable Health Choices Act of 2009 to be a nontraditional Medicaid eligible individual and enrolled under this title pursuant to such section, the State shall provide for a determination, by not later than the end of the period referred to in subparagraph (A) of such section, of the child's eligibility for medical assistance under this title.

with subparagraph (B) of section 205(d)(1) of the America's Affordable Health Choices Act of 2009, in the case of a child described in subparagraph (A) of such section who at the end of the period referred to in such subparagraph is not otherwise covered under acceptable coverage, the child shall be deemed (until such time as the child obtains such coverage or the State otherwise makes a determination of the child's eligibility for medical assistance under its plan under this title pursuant to paragraph (1)) to be a traditional Medicaid eligible individual described in section 1902(l)(1)(B).

1902 of the Social Security Act (42 U.S.C. 1396a) is amended---(1) in subsection (a), as amended by section 1631(b)(1)(D)---(A) by striking ''and'' at the end of paragraph (72); (B) by striking the period at the end of paragraph (73) and inserting ''; and''; and (C) by inserting after paragraph (74) the following new paragraph: ''(75) provide for maintenance of effort under the State child health plan under title XXI in accordance with subsection (gg).''; and

quarters beginning after the date of the enactment of this subsection and before CHIP MOE termination date specified in paragraph (3), a State shall not have in effect eligibility standards, methodologies, or procedures under its State child health plan under title XXI (including any waiver under such title or under section 1115 that is permitted to continue effect) that are more restrictive than the eligibility standards, methodologies, or procedures, respectively, under such plan (or waiver) as in effect on June 16, 2009.

''(B) The Secretary has determined that such Exchange, the State, and employers have procedures in effect to ensure the timely transition without interruption of coverage of CHIP enrollees from assistance under title XXI to acceptable coverage (as defined for purposes of such Act).

In this paragraph, the term 'CHIP enrollee' means a targeted low-income child or (if the State has elected the option under section 2112, a targeted low-income pregnant woman) who is or otherwise would be (but for acceptable coverage) eligible for child health assistance or pregnancy-related assistance, respectively, under the State child health plan referred to in paragraph (1).''.

In preparing the report, the Secretary shall consult with community-based health care networks serving low-income beneficiaries.

''(A) provides services to beneficiaries under this title without discrimination on the ground of race, color, national origin, creed, source of payment, status as a beneficiary under this title, or any other ground unrelated to such beneficiary's need for the services or the availability of the needed services in the hospital; and ''(B) makes arrangements for, and accepts, reimbursement under this title for services provided to eligible beneficiaries under this title.''.

EFFECTIVE DATE.---The amendment made by subsection (a) shall be apply to expenditures made on or after July 1, 2010.

In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendment made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act.

For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.

upon evidence, that such services are effective in one or more of the following: ''(1) Improving maternal or child health and pregnancy outcomes or increasing birth intervals between pregnancies.

STATE ELIGIBILITY OPTION FOR FAMILY PLAN-NING SERVICES.

''(A) whose income does not exceed an income eligibility level established by the State that does not exceed the highest income eligibility level established under the State plan under this title (or under its State child health plan under title XXI) for pregnant women; and ''(B) who are not pregnant.

''(2) QUALIFIED ENTITY.---''(A) IN GENERAL.---Subject to subparagraph (B), the term 'qualified entity' means any entity that---''(i) is eligible for payments under a State plan approved under this title; and ''(ii) is determined by the State agency to be capable of making determinations of the type described in paragraph (1)(A).

tities that may become qualified entities in order to prevent fraud and abuse.

''(c) ADMINISTRATION.---''(1) IN GENERAL.---The State agency shall provide qualified entities with---''(A) such forms as are necessary for an application to be made by an individual described in subsection (a) for medical assistance under the State plan; and ''(B) information on how to assist such individuals in completing and filing such forms.

subsection (a) who is determined by a qualified entity to be presumptively eligible for medical assistance under a State plan, the individual shall apply for medical assistance by not later than the last day of the month following the month during which the determination is made.

the following: ''and provide for making medical assistance available to individuals described in subsection (a) of section 1920C during a presumptive eligibility period in accordance with such section''.

EVALUATION; REPORT.---(1) EVALUATION.---The Secretary, using the criteria described in section 1866E(g)(1) of the Social Security Act (as inserted by section 1123), shall conduct an evaluation of the pilot program under this section.

OPTIONAL COVERAGE FOR FREESTANDING BIRTH CENTER SERVICES.

Act (42 U.S.C. 1396s(b)(2)(A)(iii)(I)) is amended---(1) by striking ''or a rural health clinic'' and inserting '', a rural health clinic''; and (2) by inserting ''or a public health clinic,'' after '''1905(l)(1)),''.

OPTIONAL MEDICAID COVERAGE OF LOW-IN-COME HIV-INFECTED INDIVIDUALS.

''(3) whose resources (as determined under the State plan under this title with respect to disabled individuals) do not exceed the maximum amount of resources a disabled individual described in subsection (a)(10)(A)(i) may have and obtain medical assistance under the plan.''.

upper reimbursement limit established under paragraph (4) as 130 percent of the weighted average (determined on the basis of manufacturer utilization) of monthly average manufacturer prices.''.

with return goods handling and processing, reverse logistics, and drug destruction; ''(iv) sales directly to, or rebates, discounts, or other price concessions provided to, pharmacy benefit managers, managed care organizations, health maintenance organizations, insurers, mail order pharmacies that are not open to all members of the public, or long term care providers, provided that these rebates, discounts, or price concessions are not passed through to retail pharmacies; ''(v) sales directly to, or rebates, discounts, or other price concessions provided to, hospitals, clinics, and physicians, unless the drug is an inhalation, infusion, or injectable drug, or unless the Secretary determines, as allowed for in Agency administrative procedures, that it is necessary to include such sales, rebates, discounts, and price concessions in order to obtain an accurate AMP for the drug.

1396r--8(b)(3)) is amended---(A) in subparagraph (A), by adding at the end the following new clause: ''(iv) not later than 30 days after the last day of each month of a rebate period under the agreement, on the manufacturer's total number of units that are used to calculate the monthly average manufacturer price for each covered outpatient drug.''.

AUTHORITY TO PROMULGATE REGULA -TION.---The Secretary of Health and Human Services may promulgate regulations to clarify the requirements for upper payment limits and for the determination of the average manufacturer price in an expedited manner.

''(iv) the workforce or other goals to which the funding is being applied; ''(v) State progress in meeting such goals; and ''(vi) such other information as the Secretary determines will assist in carrying out paragraphs (3) and (4); and ''(B) such expenditures are made consistent with such goals and requirements as are established under paragraph (4).

''(3) REVIEW OF INFORMATION .---The Secretary shall make the information submitted under paragraph (2) available to the Advisory Committee on Health Workforce Evaluation and Assessment (established under section 2261 of the Public Health Service Act).

affecting payments made before such date under a State plan under title XIX of the Social Security Act for graduate medical education.

PERMISSION TO INCLUDE ADDITIONAL HEALTH CARE-ACQUIRED CONDITIONS.---Nothing in this section shall prevent a State from including additional health care-acquired conditions for non-payment in its Medicaid program under title XIX of the Social Security Act.

EFFECTIVE DATE.---The amendments made by this section shall apply to discharges occurring on or after January 1, 2010.

XVIII, any other State plan under this title, or any child health plan under title XXI,''.

REQUIREMENT TO REPORT EXPANDED SET OF DATA ELEMENTS UNDER MMIS TO DETECT FRAUD AND ABUSE.

Section 1903(r)(1)(F) of the Social Security Act (42 U.S.C. 1396b(r)(1)(F)) is amended by inserting after ''necessary'' the following: ''and including, for data submitted to the Secretary on or after July 1, 2010, data elements from the automated data system that the Secretary determines to be necessary for detection of waste, fraud, and abuse''.

BILLING AGENTS, CLEARINGHOUSES, OR OTHER ALTERNATE PAYEES REQUIRED TO REG-ISTER UNDER MEDICAID.

determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendments made by this section, the State plan or child health plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act.

EFFECTIVE DATE.---The amendments made by subsection (a) shall apply to amounts expended on or after January 1, 2010.

MEDICAL ASSISTANCE.---For the purpose of determining when medical assistance will be made available, the State shall consider the date of the individual's application for the low income subsidy program to constitute the date of filing for benefits under the Medicare Savings Program.''.

''(B) APPLICABLE YEAR.---For the purposes of this paragraph, the term 'applicable year' means the most recent taxable year for which information is available in the Internal Revenue Service's taxpayer information records.

other reasonably available information, as likely to be eligible for a low-income prescription drug subsidy under section 1860D--14 of the Social Security Act and who have not applied for such subsidy, and ''(ii) any individual the Social Security Administration has identified as a spouse of an individual described in clause (i).

under this paragraph may be used only by officers and employees of the Social Security Administration solely for purposes of identifying individuals likely to be ineligible for a low-in-come prescription drug subsidy under section 1860D--14 of the Social Security Act for use in outreach efforts under section 1144 of the Social Security Act.''.

EFFECTIVE DATE.---The amendments made by this section shall apply to disclosures made after the date which is 12 months after the date of the enactment of this Act.

COMPARATIVE EFFECTIVENESS RESEARCH TRUST FUND; FINANCING FOR TRUST FUND.

HEALTH CARE COMPARATIVE EFFECTIVENESS RESEARCH TRUST FUND.

proportion (as estimated by the Secretary) to the total expenditures during such fiscal year that are made under title XVIII of such Act from the respective trust fund or account.

''(1) IN GENERAL.---For purposes of this sub-chapter--- ''(A) the term 'person' includes any governmental entity, and ''(B) notwithstanding any other law or rule of law, governmental entities shall not be exempt from the fees imposed by this subchapter except as provided in paragraph (2).

''(d) NO COVER OVER TO POSSESSIONS.---Notwith-standing any other provision of law, no amount collected under this subchapter shall be covered over to any possession of the United States.''.

EFFECTIVE DATE.---The amendments made by this subsection shall apply with respect to policies and plans for portions of policy or plan years beginning on or after October 1, 2012.

GRANTS TO STATES FOR QUALITY HOME VISITA-TION PROGRAMS FOR FAMILIES WITH YOUNG CHILDREN AND FAMILIES EXPECTING CHIL-DREN.

HOME VISITATION PROGRAMS FOR FAMILIES WITH YOUNG CHILDREN AND FAMILIES EX-PECTING CHILDREN.

the State shall identify and prioritize serving communities that are in high need of such services, especially communities with a high proportion of low-income families or a high incidence of child maltreatment; ''(B) the State will reserve 5 percent of the grant funds for training and technical assistance to the home visitation programs using such funds; ''(C) in supporting home visitation programs using funds provided under this section, the State will promote coordination and collaboration with other home visitation programs (including programs funded under title XIX) and with other child and family services, health services, income supports, and other related assistance; ''(D) home visitation programs supported using such funds will, when appropriate, provide referrals to other programs serving children and families; and ''(E) the State will comply with subsection (i), and cooperate with any evaluation conducted under subsection (j).

''(d) MAINTENANCE OF EFFORT.---Beginning with fiscal year 2011, a State meets the requirement of this subsection for a fiscal year if the Secretary finds that the aggregate expenditures by the State from State and local sources for programs of home visitation for families with young children and families expecting children for the then preceding fiscal year was not less than 100 percent of such aggregate expenditures for the then 2nd preceding fiscal year.

''(A) IN GENERAL.---The expenditures, described in paragraph (1), of a State for a fiscal year that are attributable to the cost of programs that do not adhere to a model of home visitation with the strongest evidence of effectiveness shall not be considered eligible expenditures for the fiscal year to the extent that the total of the expenditures exceeds the applicable percentage for the fiscal year of the allotment of the State under subsection (c) for the fiscal year.

''(B) APPLICABLE PERCENTAGE DE -FINED.---In subparagraph (A), the term 'applicable percentage' means, with respect to a fiscal year---or ''(i) 60 percent for fiscal year 2010; ''(ii) 55 percent for fiscal year 2011; ''(iii) 50 percent for fiscal year 2012; ''(iv) 45 percent for fiscal year 2013; ''(v) 40 percent for fiscal year 2014.

STATE MATCH.---A State to which a grant is made under this section may not expend any Federal funds to meet the State share of the cost of an eligible expenditure for which the State receives a payment under this section.

IMPROVED COORDINATION AND PROTECTION FOR DUAL ELIGIBLES.

IN GENERAL.---The Secretary shall provide, through an identifiable office or program within the Centers for Medicare & Medicaid Services, for a focused effort to provide for improved coordination between Medicare and Medicaid and protection in the case of dual eligibles (as defined in subsection (e)).

''(1) review Medicare and Medicaid policies related to enrollment, benefits, service delivery, payment, and grievance and appeals processes under parts A and B of title XVIII, under the Medicare Advantage program under part C of such title, and under title XIX; ''(2) identify areas of such policies where better coordination and protection could improve care and costs; and ''(3) issue guidance to States regarding improving such coordination and protection.

''(4) An assessment of communication strategies for dual eligibles to determine whether additional informational materials or outreach is needed, including an assessment of the Medicare website, 1--800--MEDICARE, and the Medicare handbook.

Core public health infrastructure for State, local, and tribal health departments.

Subtitle E---States Failing To Adhere to Certain Employment Obligations Sec. 2541.

REFERENCES.---Except as otherwise specified, whenever in this division an amendment is expressed in terms of an amendment to a section or other provision, the reference shall be considered to be made to a section or other provision of the Public Health Service Act (42 U.S.C. 201 et seq.).

Amounts deposited into the Fund shall be derived from general revenues of the Treasury.

DESIGNATED PROVISIONS.---For purposes of this paragraph, the term ''designated public health provisions'' means the provisions for which amounts are authorized to be appropriated under section 330(s), 338(c), 338H--1, 799C, 872, or 3111 of the Public Health Service Act, as added by this division.

cluding any amounts in or appropriated from the Fund)---(i) the amounts specified in subparagraph (B) for the fiscal year involved are equal to or greater than the amounts specified in subparagraph (B) for fiscal year 2008; and (ii) the amounts appropriated, out of the general fund of the Treasury, to the Prevention and Wellness Trust under section 3111 of the Public Health Service Act, as added by this division, for the fiscal year involved are equal to or greater than the funds---(I) appropriated under the heading ''Prevention and Wellness Fund'' in title VIII of division A of the American Recovery and Reinvestment Act of 2009 (Public Law 111--5); and (II) allocated by the second proviso under such heading for evidencebased clinical and community-based prevention and wellness strategies.

The National Health Service Corps Program (including funds appropriated under the authority of section 338 of such Act (42 U.S.C. 254k)).

''(1) IN GENERAL.---In this subpart, the term 'health professional needs area' means an area, population, or facility that is designated by the Secretary in accordance with paragraph (2).

''(2) DESIGNATION.---To be designated by the Secretary as a health professional needs area under this subpart: ''(A) In the case of an area, the area must be a rational area for the delivery of health services.

''(C) With respect to the delivery of primary health services, the area, population, or facility must not include a health professional shortage area (as designated under section 332), except that the area, population, or facility may include such a health professional shortage area to which no member of the National Health Service Corps is currently assigned.

ment as primary health services provider or provider of other health services in accordance with subparagraphs (A) and (B), to complete the education or training and maintain an acceptable level of academic standing (as determined by the educational institution offering the course of study or training); and ''(2) the Secretary agrees to pay, for each year of such service, an amount on the principal and interest of the undergraduate or graduate educational loans (or both) of the individual that is not more than 50 percent of the average award made under the National Health Service Corps Loan Repayment Program under subpart III in that year.

''(b) PRACTICE SETTING.---A contract entered into under this section shall allow the individual receiving the loan repayment to satisfy the service requirement described in subsection (a)(1) through employment in a solo or group practice, a clinic, an accredited public or private nonprofit hospital, or any other health care entity, as deemed appropriate by the Secretary.

TRAINING IN FAMILY MEDICINE, GENERAL IN-TERNAL MEDICINE, GENERAL PEDIATRICS, GERIATRICS, AND PHYSICIAN ASSISTANTSHIP.

''(a) PROGRAM.---The Secretary shall establish a primary care training and capacity building program consisting of awarding grants and contracts under subsections (b) and (c).

TRAINING OF MEDICAL RESIDENTS IN COMMU-NITY-BASED SETTINGS.

''(a) PROGRAM.---The Secretary shall establish a program for the training of medical residents in communitybased settings consisting of awarding grants or contracts under this section.

OPERATION OF COMMU-PROGRAMS.---The Secretary shall make grants to, or enter into contracts with, eligible entities---''(1) to plan and develop a new primary care residency training program, which may include---''(A) planning and developing curricula; ''(B) recruiting and training residents and faculty; and ''(C) other activities designated to result in accreditation of such a program; or ''(2) to operate or participate in an established primary care residency training program, which may include---and ''(A) planning and developing curricula; ''(B) recruitment and training of residents; ''(C) retention of faculty.

''(1) be designated as a recipient of payment for the direct costs of medical education under section 1886(k) of the Social Security Act; ''(2) be designated as an approved teaching health center under section 1502(d) of the America's Affordable Health Choices Act of 2009 and continuing to participate in the demonstration project under such section; or ''(3) be an applicant for designation described in paragraph (1) or (2) and have demonstrated to the Secretary appropriate involvement of an accredited teaching hospital to carry out the inpatient responsibilities associated with a primary care residency training program.

''(f) PERIOD OF AWARDS.---''(1) IN GENERAL.---The period of a grant or contract under this section---''(A) shall not exceed 2 years for awards under subsection (b)(1); and ''(B) shall not exceed 5 years for awards under subsection (b)(2).

program' means an approved medical residency training program described in section 1886(h)(5)(A) of the Social Security Act that is---''(A) in the case of entities seeking awards under subsection (b)(1), actively applying to be accredited by the Accreditation Council for Graduate Medical Education; or ''(B) in the case of entities seeking awards under subsection (b)(2), so accredited.

in subsection (g)(1), by striking ''to provide health services'' each place it appears and inserting ''to provide health services or serve as a faculty member''.

NURSE FACULTY LOAN PROGRAM.---Paragraph (2) of section 846A(c) (42 U.S.C. 297n--1(c)) is amended by striking ''$30,000'' and all that follows through the semicolon and inserting ''$35,000, plus, beginning with fiscal year 2012, an amount determined by the Secretary on an annual basis to reflect inflation;''.

in section 839, by striking ''839'' and all that follows through ''(a)'' and inserting ''839.

''For the purpose of carrying out this title, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following: ''(1) $115,000,000 for fiscal year 2010.

''(a) ESTABLISHMENT.---There is established, within the Service, the Public Health Workforce Corps (in this subpart referred to as the 'Corps'), for the purpose of ensuring an adequate supply of public health professionals throughout the Nation.

''(d) APPLICATION OF CERTAIN PROVISIONS.---The provisions of subpart II shall, except as inconsistent with this subpart, apply to the Public Health Workforce Corps in the same manner and to the same extent as such provisions apply to the National Health Service Corps established under section 331.

''(2) be eligible for, or hold, an appointment as a commissioned officer in the Regular or Reserve Corps of the Service or be eligible for selection for civilian service in the Corps; and ''(3) sign and submit to the Secretary a written contract (described in subsection (c)) to serve fulltime as a public health professional, upon the completion of the course of study or program involved, for the period of obligated service described in subsection (c)(2)(E).

''(B) REPAYMENT SCHEDULE.---Any arrangement made by the Secretary for the making of loan repayments in accordance with this subsection shall provide that any repayments for a year of obligated service shall be made no later than the end of the fiscal year in which the individual completes such year of service.

lish a public health workforce training and enhancement program consisting of awarding grants and contracts under subsection (b).

the field of public health, including nursing; health administration, management, or policy; preventive medicine; laboratory science; veterinary medicine; or dental medicine.

''(d) PREFERENCE.---In awarding grants or contracts under this section, the Secretary shall give preference to entities that have a demonstrated record of the following: ''(1) Training the greatest percentage, or significantly improving the percentage, of public health professionals who serve in underserved communities.

SCHOLARSHIPS FOR DISADVANTAGED STU-DENTS, LOAN REPAYMENTS AND FELLOW-SHIPS REGARDING FACULTY POSITIONS, AND EDUCATIONAL ASSISTANCE IN THE HEALTH PROFESSIONS REGARDING INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.

COORDINATION OF DIVERSITY AND CULTURAL COMPETENCY PROGRAMS.

CULTURAL AND LINGUISTIC COMPETENCY TRAINING FOR HEALTH CARE PROFES-SIONALS.

''(3) a public or private nonprofit entity (including an area health education center or a geriatric education center); or ''(4) a consortium of 2 or more entities described in paragraphs (1) through (3).

''(d) PREFERENCES.---In awarding grants and contracts under this section, the Secretary shall give preference to entities that have a demonstrated record of the following: ''(1) Training the greatest percentage, or significantly increasing the percentage, of health professionals who serve in underserved communities.

''(2) The term 'interdisciplinary' means collaboration across health professions and specialties, which may include public health, nursing, allied health, and appropriate medical specialties.''.

''(a) ADVISORY COMMITTEE.---The Secretary, acting through the Assistant Secretary for Health, shall establish a permanent advisory committee to be known as the Advisory Committee on Health Workforce Evaluation and Assessment (referred to in this section as the 'Advisory Committee').

''(A) IN GENERAL.---The Secretary shall appoint members of the Advisory Committee for a term of 3 years and may reappoint such members, but the Secretary may not appoint any member to serve more than a total of 6 years.

''(g) FACA.---The Federal Advisory Committee Act (5 U.S.C. App.) except for section 14 of such Act shall apply to the Advisory Committee under this section only to the extent that the provisions of such Act do not conflict with the requirements of this section.

SHARING.---The Secretary shall collaborate with Federal departments and agencies, health professions organizations (including health professions education organizations), and professional medical societies for the purpose of carrying out subsection (a).

''(a) DEPOSITS INTO TRUST.---There is established a Prevention and Wellness Trust.

''(b) AVAILABILITY OF FUNDS.---Amounts in the Prevention and Wellness Trust shall be available, as provided in advance in appropriation Acts, for carrying out this title.

''(a) IN GENERAL.---The Secretary shall submit to the Congress within one year after the date of the enactment of this section, and at least every 2 years thereafter, a national strategy that is designed to improve the Nation's health through evidence-based clinical and community prevention and wellness activities (in this section referred to as 'prevention and wellness activities'), including core public health infrastructure improvement activities.

Force shall be composed of 30 members, appointed by the Secretary.

''(A) IN GENERAL.---The Secretary shall appoint members of the Task Force for a term of 6 years and may reappoint such members, but the Secretary may not appoint any member to serve more than a total of 12 years.

''(B) Evaluation of research and systematic evidence reviews.

''(1) IN GENERAL.---The Task Force shall convene a clinical prevention stakeholders board composed of representatives of appropriate public and private entities with an interest in clinical preventive services to advise the Task Force on developing, updating, publishing, and disseminating evidence-based recommendations on the use of clinical preventive services.

3121. ''(c) ROLE OF AGENCY.---The Secretary shall provide ongoing administrative, research, and technical support for the operations of the Task Force, including coordinating and supporting the dissemination of the recommendations of the Task Force.

Force shall be composed of 30 members, appointed by the Secretary.

''(3) QUALIFICATIONS.---Members of the Task Force shall be appointed from among individuals who possess expertise in at least one of the following areas: ''(A) Public health.

''(1) IN GENERAL.---The Task Force shall convene a community prevention stakeholders board composed of representatives of appropriate public and private entities with an interest in community preventive services to advise the Task Force on developing, updating, publishing, and disseminating evidence-based recommendations on the use of community preventive services.

''(j) REPORT.---The Secretary shall submit to the Congress an annual report on the Task Force, including with respect to gaps identified and recommendations made under subsection (b)(4).

''In conducting or supporting research on prevention and wellness, the Director of the Centers for Disease Control and Prevention, the Director of the National Institutes of Health, and the heads of other agencies within the Department of Health and Human Services conducting or supporting such research, shall take into consideration the national strategy under section 3121 and the recommendations of the Task Force on Clinical Preventive Services under section 3131 and the Task Force on Community Preventive Services under section 3132.

''(d) HEALTH DISPARITIES.---Of the funds awarded under this section for a fiscal year, the Secretary shall award not less than 50 percent for planning or implementing community preventive and wellness services whose primary purpose is to achieve a measurable reduction in one or more health disparities, including those identified by the Secretary in the national strategy under section 3121.

the Secretary shall award funds to each State health department in accordance with---''(1) a formula based on population size; burden of preventable disease and disability; and core public health infrastructure gaps, including those identified in the accreditation process under subsection (g); and ''(2) application requirements established by the Secretary, including a requirement that the State submit a plan that demonstrates to the satisfaction of the Secretary that the State's health department will---''(A) address its highest priority core public health infrastructure needs; and ''(B) as appropriate, allocate funds to local health departments within the State.

DEPARTMENTS.---In making grants under subsection (b)(1)(B), the Secretary shall give priority to applicants demonstrating core public health infrastructure needs identified in the accreditation process under subsection (g).

vancing the quality and performance of such departments and laboratories; and ''(B) implement a program to accredit such health departments and laboratories in accordance with such standards.

''In this title: ''(1) The term 'core public health infrastructure' includes workforce capacity and competency; laboratory systems; health information, health information systems, and health information analysis; communications; financing; other relevant components of organizational capacity; and other related activities.

''(3) The term 'health disparities' includes health and health care disparities and means popu-lation-specific differences in the presence of disease, health outcomes, or access to health care.

Services and the Task Force on Community Preventive Services, respectively, established under sections 3121 and 3122 of the Public Health Service Act, as added by subsection (a).

Section 126 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (Appendix F of Public Law 106--554) is amended by striking ''United States Preventive Services Task Force'' each place it appears and inserting ''Task Force on Clinical Preventive Services''.

DISSEMINATION OF INFORMATION.---The Director shall provide for the public dissemination of information with respect to best practices and activities under this section.

Such information shall be made available in appropriate formats and languages to reflect the varying needs of consumers and diverse levels of health literacy.

''(A) information on activities conducted pursuant to grants and contracts awarded; ''(B) summary data on patient outcomes before, during, and after implementation of best practices; and ''(C) recommendations on the adaptability of best practices for use by health providers.''.

HEALTH CARE-ASSOCIATED INFECTIONS.---Reducing health care-associated infections, including infections in nursing homes and outpatient settings.

OBSTETRICS.---Improving the provision of obstetrical and neonatal care, including the identification of interventions that are effective in reducing the risk of preterm and premature labor and the implementation of best practices for labor and delivery care.

''(8) facilitate and coordinate identification and monitoring by the agencies of the Department of health disparities to inform program and policy efforts to reduce such disparities, including facilitating and funding analyses conducted in cooperation with the Social Security Administration, the Bureau of the Census, and other appropriate agencies and entities; ''(9) consistent with privacy, proprietary, and other appropriate safeguards, facilitate public accessibility of datasets (such as de-identified Medicare datasets or publicly available data on key health indicators) by means of the Internet; and ''(10) award grants or contracts for the collection and collation of information described in paragraphs (1) and (2) (including through statewide surveys that provide standardized information).

''(C) recommendations for addressing such gaps and identification of the appropriate agency within the Department or other entity to address such gaps; ''(D) a description of analyses of health disparities, including the results of completed analyses, the status of ongoing longitudinal studies, and proposed or planned research; and ''(E) a plan for actions to be taken by the Assistant Secretary to address gaps described in subparagraph (B).

organization or other group purchasing arrangement, except as permitted or provided pursuant to clause (ii).

or a diversion problem in violation of subparagraph (B).''.

IN GENERAL.---Section 340B (42 U.S.C. 256b) is amended---(1) in subsection (b)---(A) by striking ''In this section, the terms'' and inserting the following: ''In this section: ''(1) IN GENERAL.---The terms''; and (B) by adding at the end the following new paragraph: ''(2) COVERED DRUG.---The term 'covered drug'---''(A) means a covered outpatient drug (as defined in section 1927(k)(2) of the Social Security Act); and ''(B) includes, notwithstanding the section 1927(k)(3)(A) of such Act, a drug used in connection with an inpatient or outpatient service provided by a hospital described in subparagraph (L), (M), (N), (R), (S), or (T) of subsection (a)(4) that is enrolled to participate in the drug discount program under this section.''; and

''(iii) the reference in clause (i)(II) to the estimated percentage of the hospital's drug purchases attributable to Medicaid beneficiaries for inpatient use shall be equal to---''(I) the Medicaid inpatient drug charges as reported on the hospital's most recently filed Medicare cost report, divided by ''(II) total drug charges reported on the cost report; and ''(iv) the term 'noninnovator multiple source drug' has the meaning given such term in section 1927(k)(7) of the Social Security Act.

''(3) CALCULATION OF CREDITS .---''(A) IN GENERAL.---Each State calculates credits under paragraph (1) and informs hospitals of amount under section 1927(a)(5)(D) of the Social Security Act.

With respect to each drug purchased during the cost reporting period, the hospital shall provide the dosage form, strength, package size, date of purchase and the number of units purchased.

''(4) PAYMENT DEADLINE.---The credits provided by a hospital under paragraph (1) shall be paid within 60 days after receiving the information specified in paragraph (3)(A).

''(e) PREFERENCES.---In awarding grants under this section, the Secretary shall give preference to SBHCs that have a demonstrated record of service to the following: ''(1) A high percentage of medically underserved children and adolescents.

''(2) Communities or populations in which children and adolescents have difficulty accessing health and mental health services.

''(3) Communities with high percentages of children and adolescents who are uninsured, underinsured, or eligible for medical assistance under Federal or State health benefits programs (including titles XIX and XXI of the Social Security Act).

''(f) MATCHING REQUIREMENT.---The Secretary may award a grant to an SBHC only if the SBHC agrees to provide, from non-Federal sources, an amount equal to 20 percent of the amount of the grant (which may be provided in cash or in kind) to carry out the activities supported by the grant.

operation of the SBHC (including each activity described in paragraph (1) or (2) of subsection (c)).

FOR HEALTH SERVICES.---The Secretary shall issue regulations regarding the reimbursement for health services provided by SBHCs to individuals eligible to receive such services through the program under this section, including reimbursement under any insurance policy or any Federal or State health benefits program (including titles XIX and XXI of the Social Security Act).

treatment, and referral to a continuum of services including emergency psychiatric care, community support programs, inpatient care, and outpatient programs.

staff nurses and frontline health care workers, working in collaboration with accredited schools of nursing and academic institutions.

GRANTS.---Not later than 6 months after the date of the enactment of this Act, the Secretary of Labor (referred to in this section as the ''Secretary'') shall establish a partnership grant program to award grants to eligible entities to carry out comprehensive programs to provide education to nurses and create a pipeline to nursing for incumbent ancillary health care workers who wish to advance their careers, and to otherwise carry out the purposes of this section.

Contributions to a joint labor-manage-ment training fund which administers the program involved.

OTHER REQUIREMENTS.---(1) MATCHING REQUIREMENT.---(A) IN GENERAL.---The Secretary may not make a grant under this section unless the applicant involved agrees, with respect to the costs to be incurred by the applicant in carrying out the program under the grant, to make available non-Federal contributions (in cash or in kind under subparagraph (B)) toward such costs in an amount equal to not less than $1 for each $1 of Federal funds provided in the grant.

REQUIRED COLLABORATION.---Entities carrying out or overseeing programs carried out with assistance provided under this section shall demonstrate collaboration with accredited schools of nursing which may include community colleges and other academic institutions providing associate, bachelor's, or advanced nursing degree programs or specialty training or certification programs.

Providing assistance in preparing for and meeting all nursing licensure tests and requirements.

To carry out programs that assist nurses in obtaining advanced degrees and completing specialty training or certification programs and to establish incentives for nurses to assume nurse faculty positions on a part-time or full-time basis.

Wow

You read the whole thing - or are quick with a scroll bar? The full version is 1017 pages and can be found here.

Home | Blog