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Affordable Care Act
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H.R.3590 - Patient Protection and Affordable Care Act
=====================================================

An act entitled The Patient Protection and Affordable Care Act. view
all titles (45)

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Short: Young Women's Breast Health Education and Awareness
 Requires Learning Young Act of 2009 as enacted.

Short: Establishing a Network of Health-Advancing National Centers
 of Excellence for Depression Act of 2009 as enacted.

Short: ENHANCED Act of 2009 as enacted.

Short: Elder Justice Act of 2009 as enacted.

Short: EARLY Act as enacted.

Short: Cures Acceleration Network Act of 2009 as enacted.

Short: Congenital Heart Futures Act as enacted.

Short: Community Living Assistance Services and Supports Act as
 enacted.

Short: CLASS Act as enacted.

Short: Catalyst to Better Diabetes Care Act of 2009 as enacted.

Short: Biologics Price Competition and Innovation Act of 2009 as
 enacted.

Short: Patient Protection and Affordable Care Act as enacted.

Short: Young Women's Breast Health Education and Awareness
 Requires Learning Young Act of 2009 as passed house.

Short: Establishing a Network of Health-Advancing National Centers
 of Excellence for Depression Act of 2009 as passed house.

Short: ENHANCED Act of 2009 as passed house.

Short: Elder Justice Act of 2009 as passed house.

Short: EARLY Act as passed house.

Short: Cures Acceleration Network Act of 2009 as passed house.

Short: Congenital Heart Futures Act as passed house.

Short: Community Living Assistance Services and Supports Act as
 passed house.

Short: CLASS Act as passed house.

Short: Catalyst to Better Diabetes Care Act of 2009 as passed
 house.

Short: Biologics Price Competition and Innovation Act of 2009 as
 passed house.

Short: Patient Protection and Affordable Care Act as passed house.

Popular: Patient protection and affordable care bill.

Popular: Health care reform bill.

Official: An act entitled The Patient Protection and Affordable
 Care Act. as introduced.

Short: Young Women's Breast Health Education and Awareness
 Requires Learning Young Act of 2009 as passed senate.

Short: Establishing a Network of Health-Advancing National Centers
 of Excellence for Depression Act of 2009 as passed senate.

Short: ENHANCED Act of 2009 as passed senate.

Short: Elder Justice Act of 2009 as passed senate.

Short: EARLY Act as passed senate.

Short: Cures Acceleration Network Act of 2009 as passed senate.

Short: Congenital Heart Futures Act as passed senate.

Short: Community Living Assistance Services and Supports Act as
 passed senate.

Short: CLASS Act as passed senate.

Short: Catalyst to Better Diabetes Care Act of 2009 as passed
 senate.

Short: Biologics Price Competition and Innovation Act of 2009 as
 passed senate.

Official: An act entitled The Patient Protection and Affordable
 Care Act. as amended by senate.

Short: Patient Protection and Affordable Care Act as passed
 senate.

Popular: Patient Protection and Affordable Care Act (Legislative
 Vehicle) as introduced.

Short: Service Members Home Ownership Tax Act of 2009 as
 introduced.

Popular: Patient Protection and Affordable Care Act as introduced.

Short: Service Members Home Ownership Tax Act of 2009 as passed
 house.

Official: To amend the Internal Revenue Code of 1986 to modify the
 first-time homebuyers credit in the case of members of the Armed
 Forces and certain other Federal employees, and for other
 purposes. as introduced.

Overview

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Sponsor

 

Representative

Charles Rangel

D-NY

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Committees

House Ways and Means

Introduced

House
Passed

Senate
Passed

President
Signed

09/17/09

03/21/10

12/24/09

03/23/10

Latest Action Mar 23, 2010Became Public Law No: 111-148. Related Bills
(5) & Issues (89) Users Tracking H.R.3590 (1391)

OpenCongress Summary

This is the major health care reform bill, passed by the House on
March 21, 2010 by a party-line vote of 219-212. It would expand health
care coverage to 31 million currently uninsured Americans through a
combination of cost controls, subsidies and mandates. It is estimated
to cost $848 billion over a 10 year period, but would be fully offset
by new taxes and revenues and would actually reduce the deficit by
$131 billion over the same period. The Democratic Policy Committee has
posted a summary and more information about the bill. The Republicans
have posted their own summary here (.pdf).

Wiki Summary

Official Summary

This bill currently has no wiki summary. Create Summary

3/23/2010--Public Law. (This measure has not been amended since it was
passed by the Senate on December 24, 2009. The summary of that version
is repeated here.) Patient Protection and Affordable Care Act - Title
I: Quality, Affordable Health Care for All Americans - Subtitle A:
Immediate IClose

Official Summary

3/23/2010--Public Law. (This measure has not been amended since it was
passed by the Senate on December 24, 2009. The summary of that version
is repeated here.) Patient Protection and Affordable Care Act - Title
I: Quality, Affordable Health Care for All Americans - Subtitle A:
Immediate Improvements in Health Care Coverage for All Americans -
(Sec. 1001, as modified by Sec. 10101) Amends the Public Health
Service Act to prohibit a health plan ("health plan” under this
subtitle excludes any “grandfathered health plan” as defined in
section 1251) from establishing lifetime limits or annual limits on
the dollar value of benefits for any participant or beneficiary after
January 1, 2014. Permits a restricted annual limit for plan years
beginning prior to January 1, 2014. Declares that a health plan shall
not be prevented from placing annual or lifetime per-beneficiary
limits on covered benefits that are not essential health benefits to
the extent that such limits are otherwise permitted. Prohibits a
health plan from rescinding coverage of an enrollee except in the case
of fraud or intentional misrepresentation of material fact. Requires
health plans to provide coverage for, and to not impose any cost
sharing requirements for:
(1) specified preventive items or services;
(2) recommended immunizations; and
(3) recommended preventive care and screenings for women and children.
Requires a health plan that provides dependent coverage of children to
make such coverage available for an unmarried, adult child until the
child turns 26 years of age. Requires the Secretary of Health and
Human Services (HHS) to develop standards for health plans (including
grandfathered health plans) to provide an accurate summary of benefits
and coverage explanation. Directs each such health plan, prior to any
enrollment restriction, to provide such a summary of benefits and
coverage explanation to:
(1) the applicant at the time of application;
(2) an enrollee prior to the time of enrollment or re-enrollment; and
(3) a policy or certificate holder at the time of issuance of the
policy or delivery of the certificate. Requires group health plans to
comply with requirements relating to the prohibition against
discrimination in favor of highly compensated individuals. Requires
the Secretary to develop reporting requirements for health plans on
benefits or reimbursement structures that:
(1) improve health outcomes;
(2) prevent hospital readmissions;
(3) improve patient safety and reduce medical errors; and
(4) promote wellness and health. Requires a health plan (including a
grandfathered health plan) to:
(1) submit to the Secretary a report concerning the ratio of the
incurred loss (or incurred claims) plus the loss adjustment expense
(or change in contract reserves) to earned premiums; and
(2) provide an annual rebate to each enrollee if the ratio of the
amount of premium revenue expended by the issuer on reimbursement for
clinical services provided to enrollees and activities that improve
health care quality to the total amount of premium revenue for the
plan year is less than a 85% for large group markets or 80% for small
group or individual markets. Requires each U.S. hospital to establish
and make public a list of its standard charges for items and services.
Requires a health plan to implement an effective process for appeals
of coverage determinations and claims. Sets forth requirements for
health plans related to:
(1) designation of a primary care provider;
(2) coverage of emergency services; and
(3) elimination of referral requirements for obstetrical or
gynecological care.

(Sec. 1002)

Requires the Secretary to award grants to states for offices of health
insurance consumer assistance or health insurance ombudsman programs.
(Sec. 1003, as modified by Sec. 10101) Requires the Secretary to
establish a process for the annual review of unreasonable increases in
premiums for health insurance coverage.

(Sec. 1004)

Makes this subtitle effective for plan years beginning six months
after enactment of this Act, with certain exceptions. Subtitle B:
Immediate Actions to Preserve and Expand Coverage -

(Sec. 1101)

Requires the Secretary to establish a temporary high risk health
insurance pool program to provide health insurance coverage to
eligible individuals with a preexisting condition. Terminates such
coverage on January 1, 2014, and provides for a transition to an
American Health Benefit Exchange (Exchange). (Sec. 1102, as modified
by Sec. 10102) Requires the Secretary to establish a temporary
reinsurance program to provide reimbursement to participating
employment-based plans for a portion of the cost of providing health
insurance coverage to early retirees before January 1, 2014. (Sec.
1103, as modified by Sec. 10102) Requires the Secretary to establish a
mechanism, including an Internet website, through which a resident of,
or small business in, any state may identify affordable health
insurance coverage options in that state.

(Sec. 1104)

Sets forth provisions governing electronic health care transactions.
Establishes penalties for health plans failing to comply with
requirements.

(Sec. 1105)

Makes this subtitle effective on the date of enactment of this Act.
Subtitle C: Quality Health Insurance Coverage for All Americans - Part
I: Health Insurance Market Reforms - (Sec. 1201, as modified by Sec.
10103) Prohibits a health plan ("health plan” under this subtitle
excludes any “grandfathered health plan” as defined in section 1251)
from:
(1) imposing any preexisting condition exclusion; or
(2) discriminating on the basis of any health status-related factor.
Allows premium rates to vary only by individual or family coverage,
rating area, age, or tobacco use. Requires health plans in a state to:
(1) accept every employer and individual in the state that applies for
coverage; and
(2) renew or continue coverage at the option of the plan sponsor or
the individual, as applicable. Prohibits a health plan from
establishing individual eligibility rules based on health
status-related factors, including medical condition, claims
experience, receipt of health care, medical history, genetic
information, and evidence of insurability. Sets forth provisions
governing wellness programs under the health plan, including allowing
cost variances for coverage for participation in such a program.
Prohibits a health plan from discriminating with respect to
participation under the plan or coverage against any health care
provider who is acting within the scope of that provider's license or
certification under applicable state law. Requires health plans that
offer health insurance coverage in the individual or small group
market to ensure that such coverage includes the essential health
benefits package. Requires a group health plan to ensure that any
annual cost-sharing imposed under the plan does not exceed specified
limitations. Prohibits a health plan from:
(1) applying any waiting period for coverage that exceeds 90 days; or
(2) discriminating against individual participation in clinical trials
with respect to treatment of cancer or any other life-threatening
disease or condition. Part II: Other Provisions - (Sec. 1251, as
modified by Sec. 10103) Provides that nothing in this Act shall be
construed to require that an individual terminate coverage under a
group health plan or health insurance coverage in which such
individual was enrolled on the date of enactment of this Act. Allows
family members of individuals currently enrolled in a plan to enroll
in such plan or coverage if such enrollment was permitted under the
terms of the plan. Allows new employees and their families to enroll
in a group health plan that provides coverage on the date of enactment
of this Act. Defines a "grandfathered health plan" as a group health
plan or health insurance coverage in which an individual was enrolled
on the date of enactment of this Act. States that this subtitle and
subtitle A shall not apply to:
(1) a group health plan or health insurance coverage in which an
individual was enrolled on the date of enactment of this Act,
regardless of whether the individual renews such coverage after such
date of enactment;
(2) an existing group health plan that enrolls new employees under
this section; and
(3) health insurance coverage maintained pursuant to one or more
collective bargaining agreements between employee representatives and
one or more employers that was ratified before the date of enactment
of this Act until the date on which the last of the collective
bargaining agreements relating to the coverage terminates. Applies
provisions related to uniform coverage documents and medical loss
ratios to grandfathered health plans for plan years beginning after
enactment of this Act.

(Sec. 1252)

Requires uniform application of standards or requirements adopted by
states to all health plans in each applicable insurance market. (Sec.
1253, as added by Sec. 10103) Directs the Secretary of Labor to
prepare an annual report on self-insured group health plans and
self-insured employers. (Sec. 1254, as added by Sec. 10103) Requires
the HHS Secretary to conduct a study of the fully-insured and
self-insured group health plan markets related to financial solvency
and the effect of insurance market reforms. (Sec. 1255, as modified by
Sec. 10103) Sets forth effective dates for specified provisions of
this subtitle. Subtitle D: Available Coverage Choices for All
Americans - Part I: Establishment of Qualified Health Plans - (Sec.
1301, as modified by Sec. 10104) Defines "qualified health plan" to
require that such a plan provides essential health benefits and offers
at least one plan in the silver level at one plan in the gold level in
each Exchange through which such plan is offered. (Sec. 1302, as
modified by Sec. 10104) Requires the essential health benefits package
to provide essential health benefits and limit cost-sharing. Directs
the Secretary to:
(1) define essential health benefits and include emergency services,
hospitalization, maternity and newborn care, mental health and
substance use disorder services, prescription drugs, preventive and
wellness services and chronic disease management, and pediatric
services, including oral and vision care;
(2) ensure that the scope of the essential health benefits is equal to
the scope of benefits provided under a typical employer plan; and
(3) provide notice and an opportunity for public comment in defining
the essential health benefits. Establishes:
(1) an annual limit on cost-sharing beginning in 2014; and
(2) a limitation on the deductible under a small group market health
plan. Sets forth levels of coverage for health plans defined by a
certain percentage of the costs paid by the plan. Allows health plans
in the individual market to offer catastrophic coverage for
individuals under age 30, with certain limitations. (Sec. 1303, as
modified by Sec. 10104) Sets forth special rules for abortion
coverage, including:
(1) permitting states to elect to prohibit abortion coverage in
qualified health plans offered through an Exchange in the state;
(2) prohibiting federal funds from being used for abortion services;
and
(3) requiring separate accounts for payments for such services.
Prohibits any qualified health plan offered through an Exchange from
discriminating against any individual health care provider or health
care facility because of its unwillingness to provide, pay for,
provide coverage of, or refer for abortions. (Sec. 1304, as modified
by Sec. 10104) Sets forth definitions for terms used in this title.
Part II: Consumer Choices and Insurance Competition Through Health
Benefit Exchanges - (Sec. 1311, as modified by Sec. 10104) Requires
states to establish an American Health Benefit Exchange that:
(1) facilitates the purchase of qualified health plans; and
(2) provides for the establishment of a Small Business Health Options
Program (SHOP Exchange) that is designed to assist qualified small
employers in facilitating the enrollment of their employees in
qualified health plans offered in the small group market in the state.
Requires the Secretary to establish criteria for the certification of
health plans as qualified health plans, including requirements for:
(1) meeting market requirements; and
(2) ensuring a sufficient choice of providers. Sets forth the
requirements for an Exchange, including that an Exchange:
(1) must be a governmental agency or nonprofit entity that is
established by a state;
(2) may not make available any health plan that is not a qualified
health plan;
(3) must implement procedures for certification of health plans as
qualified health plans; and
(4) must require health plans seeking certification to submit a
justification of any premium increase prior to implementation of such
increase. Permits states to require qualified health plans to offer
additional benefits. Requires states to pay for the cost of such
additional benefits. Allows a state to establish one or more
subsidiary Exchanges for geographically distinct areas of a certain
size. Applies mental health parity provisions to qualified health
plans. (Sec. 1312, as modified by Sec. 10104) Allows an employer to
select a level of coverage to be made available to employees through
an Exchange. Allows employees to choose to enroll in any qualified
health plan that offers that level of coverage. Permits states to
allow large employers to join an Exchange after 2017. (Sec. 1313, as
modified by Sec. 10104) Requires an Exchange to keep an accurate
accounting of all activities, receipts, and expenditures and to submit
to the Secretary, annually, a report concerning such accountings.
Requires the Secretary to take certain action to reduce fraud and
abuse in the administration of this title. Requires the Comptroller
General to conduct an ongoing study of Exchange activities and the
enrollees in qualified health plans offered through Exchanges. Part
III: State Flexibility Relating to Exchanges -

(Sec. 1321)

Requires the Secretary to issue regulations setting standards related
to:
(1) the establishment and operation of Exchanges;
(2) the offering of qualified health plans through Exchanges; and
(3) the establishment of the reinsurance and risk adjustment programs
under part V. Requires the Secretary to:
(1) establish and operate an Exchange within a state if the state does
not have one operational by January 1, 2014; and
(2) presume that an Exchange operating in a state before January 1,
2010, that insures a specified percentage of its population meets the
standards under this section. (Sec. 1322, as modified by Sec. 10104)
Requires the Secretary to establish the Consumer Operated and Oriented
Plan (CO-OP) program to foster the creation of qualified nonprofit
health insurance issuers to offer qualified health plans in the
individual and small group markets. Requires the Secretary to provide
for loans and grants to persons applying to become qualified nonprofit
health insurance issuers. Sets forth provisions governing the
establishment and operation of CO-OP program plans. (Sec. 1323,
deleted by Sec. 10104) (Sec. 1324, as modified by Sec. 10104) Declares
that health insurance coverage offered by a private health insurance
issuer shall not be subject to federal or state laws if a qualified
health plan offered under the CO-OP program is not subject to such
law. Part IV: State Flexibility to Establish Alternative Programs -
(Sec. 1331, as modified by Sec. 10104) Requires the Secretary to
establish a basic health program under which a state may enter into
contracts to offer one or more standard health plans providing at
least the essential health benefits to eligible individuals in lieu of
offering such individuals coverage through an Exchange. Sets forth
requirements for such a plan. Transfers funds that would have gone to
the Exchange for such individuals to the state.

(Sec. 1332)

Authorizes a state to apply to the Secretary for the waiver of
specified requirements under this Act with respect to health insurance
coverage within that state for plan years beginning on or after
January 1, 2017. Directs the Secretary to provide for an alternative
means by which the aggregate amounts of credits or reductions that
would have been paid on behalf of participants in the Exchange will be
paid to the state for purposes of implementing the state plan. (Sec.
1333, as modified by Sec. 10104) Requires the Secretary to issue
regulations for the creation of health care choice compacts under
which two or more states may enter into an agreement that:
(1) qualified health plans could be offered in the individual markets
in all such states only subject to the laws and regulations of the
state in which the plan was written or issued; and
(2) the issuer of any qualified health plan to which the compact
applies would continue to be subject to certain laws of the state in
which the purchaser resides, would be required to be licensed in each
state, and must clearly notify consumers that the policy may not be
subject to all the laws and regulations of the state in which the
purchaser resides. Sets forth provisions regarding the Secretary's
approval of such compacts. (Sec. 1334, as added by Sec. 10104)
Requires the Director of the Office of Personnel Management (OPM) to:
(1) enter into contracts with health insurance issuers to offer at
least two multistate qualified health plans through each Exchange in
each state to provide individual or group coverage; and
(2) implement this subsection in a manner similar to the manner in
which the Director implements the Federal Employees Health Benefits
Program. Sets forth requirements for a multistate qualified health
plan. Part V: Reinsurance and Risk Adjustment - (Sec. 1341, as
modified by Sec. 10104) Directs each state, not later than January 1,
2014, to establish one or more reinsurance entities to carry out the
reinsurance program under this section. Requires the Secretary to
establish standards to enable states to establish and maintain a
reinsurance program under which:
(1) health insurance issuers and third party administrators on behalf
of group health plans are required to make payments to an applicable
reinsurance entity for specified plan years; and
(2) the applicable reinsurance entity uses amounts collected to make
reinsurance payments to health insurance issuers that cover high risk
individuals in the individual market. Directs the state to eliminate
or modify any state high-risk pool to the extent necessary to carry
out the reinsurance program established under this section.

(Sec. 1342)

Requires the Secretary to establish and administer a program of risk
corridors for calendar years 2014, 2015, and 2016 under which a
qualified health plan offered in the individual or small group market
shall participate in a payment adjusted system based on the ratio of
the allowable costs of the plan to the plan's aggregate premiums.
Directs the Secretary to make payments when a plan's allowable costs
exceed the target amount by a certain percentage and directs a plan to
make payments to the Secretary when its allowable costs are less than
target amount by a certain percentage.

(Sec. 1343)

Requires each state to assess a charge on health plans and health
insurance issuers if the actuarial risk of the enrollees of such plans
or coverage for a year is less than the average actuarial risk of all
enrollees in all plans or coverage in the state for the year. Requires
each state to provide a payment to health plans and health insurance
issuers if the actuarial risk of the enrollees of such plan or
coverage for a year is greater than the average actuarial risk of all
enrollees in all plans and coverage in the state for the year.
Excludes self-insured group health plans from this section.Subtitle E:
Affordable Coverage Choices for All Americans - Part I: Premium Tax
Credits and Cost-sharing Reductions - Subpart A: Premium Tax Credits
and Cost-sharing Reductions - (Sec. 1401, as modified by section
10105) Amends the Internal Revenue Code to allow individual taxpayers
whose household income equals or exceeds 100%, but does not exceed
400%, of the federal poverty line (as determined in the Social
Security Act SSA) a refundable tax credit for a percentage of the
cost of premiums for coverage under a qualified health plan. Sets
forth formulae and rules for the calculation of credit amounts based
upon taxpayer household income as a percentage of the poverty line.
Directs the Comptroller General, not later than five years after
enactment of this Act, to conduct a study and report to specified
congressional committees on the affordability of health insurance
coverage.

(Sec. 1402)

Requires reductions in the maximum limits for out-of-pocket expenses
for individuals enrolled in qualified health plans whose incomes are
between 100% and 400% of the poverty line. Subpart B: Eligibility
Determinations -

(Sec. 1411)

• Requires the Secretary to establish a program for verifying the eligibility of applicants for participation in a qualified health plan offered through an Exchange or for a tax credit for premium assistance based upon their income or their citizenship or immigration status. Requires an Exchange to submit information received from an applicant to the Secretary for verification of applicant eligibility. Provides for confidentiality of applicant information and for an appeals and redetermination process for denials of eligibility. Imposes civil penalties on applicants for providing false or fraudulent information relating to eligibility. Requires the Secretary to study and report to Congress by January 1, 2013, on procedures necessary to ensure the protection of privacy and due process rights in making eligibility and other determinations under this Act.

(Sec. 1412)

Requires the Secretary to establish a program for advance payments of
the tax credit for premium assistance and for reductions of
cost-sharing. Prohibits any federal payments, tax credit, or
cost-sharing reductions for individuals who are not lawfully present
in the United States.

(Sec. 1413)

Requires the Secretary to establish a system to enroll state residents
who apply to an Exchange in state health subsidy programs, including
Medicaid or the Children's Health Insurance Program (CHIP, formerly
known as SCHIP), if such residents are found to be eligible for such
programs after screening.

(Sec. 1414)

Requires the Secretary of the Treasury to disclose to HHS personnel
certain taxpayer information to determine eligibility for programs
under this Act or certain other social security programs.

(Sec. 1415)

Disregards the premium assistance tax credit and cost-sharing
reductions in determining eligibility for federal and
federally-assisted programs. (Sec. 1416, as added by section 10105)
Directs the HHS Secretary to study and report to Congress by January
1, 2013, on the feasibility and implication of adjusting the
application of the federal poverty level under this subtitle for
different geographic areas in the United States, including its
territories. Part II: Small Business Tax Credit - (Sec. 1421, as
modified by section 10105) Allows qualified small employers to elect,
beginning in 2010, a tax credit for 50% of their employee health care
coverage expenses. Defines "qualified small employer" as an employer
who has no more than 25 employees with average annual compensation
levels not exceeding $50,000. Requires a phase-out of such credit
based on employer size and employee compensation.Subtitle F: Shared
Responsibility for Health Care - Part I: Individual Responsibility -
(Sec. 1501, as modified by section 10106) Requires individuals to
maintain minimal essential health care coverage beginning in 2014.
Imposes a penalty for failure to maintain such coverage beginning in
2014, except for certain low-income individuals who cannot afford
coverage, members of Indian tribes, and individuals who suffer
hardship. Exempts from the coverage requirement individuals who object
to health care coverage on religious grounds, individuals not lawfully
present in the United States, and individuals who are incarcerated.

(Sec. 1502)

Requires providers of minimum essential coverage to file informational
returns providing identifying information of covered individuals and
the dates of coverage. Requires the IRS to send a notice to taxpayers
who are not enrolled in minimum essential coverage about services
available through the Exchange operating in their state. Part II:
Employer Responsibilities -

(Sec. 1511)

Amends the Fair Labor Standards Act of 1938 to:
(1) require employers with more than 200 full-time employees to
automatically enroll new employees in a health care coverage and
provide notice of the opportunity to opt-out of such coverage; and
(2) provide notice to employees about an Exchange, the availability of
a tax credit for premium assistance, and the loss of an employer's
contribution to an employer-provided health benefit plan if the
employee purchases a plan through an Exchange. (Sec. 1513, as modified
by section 10106) Imposes fines on large employers (employers with
more than 50 full-time employees) who fail to offer their full-time
employees the opportunity to enroll in minimum essential coverage or
who have a waiting period for enrollment of more than 60 days.
Requires the Secretary of Labor to study and report to Congress on
whether employees' wages are reduced due to fines imposed on
employers. (Sec. 1514, as modified by section 10106) Requires large
employers to file a report with the Secretary of the Treasury on
health insurance coverage provided to their full-time employees.
Requires such reports to contain:
(1) a certification as to whether such employers provide their
full-time employees (and their dependents) the opportunity to enroll
in minimum essential coverage under an eligible employer-sponsored
plan;
(2) the length of any waiting period for such coverage;
(3) the months during which such coverage was available;
(4) the monthly premium for the lowest cost option in each of the
enrollment categories under the plan;
(5) the employer's share of the total allowed costs of benefits
provided under the plan; and
(6) identifying information about the employer and full-time
employees. Imposes a penalty on employers who fail to provide such
report. Authorizes the Secretary of the Treasury to review the
accuracy of information provided by large employers.

(Sec. 1515)

Allows certain small employers to include as a benefit in a tax-exempt
cafeteria plan a qualified health plan offered through an Exchange.
Subtitle G: Miscellaneous Provisions -

(Sec. 1551)

Applies the definitions under the Public Health Service Act related to
health insurance coverage to this title.

(Sec. 1552)

Requires the HHS Secretary to publish on the HHS website a list of all
of the authorities provided to the Secretary under this Act.

(Sec. 1553)

Prohibits the federal government, any state or local government or
health care provider that receives federal financial assistance under
this Act, or any health plan created under this Act from
discriminating against an individual or institutional health care
entity on the basis that such individual or entity does not provide a
health care item or service furnished for the purpose of causing, or
assisting in causing, the death of any individual, such as by assisted
suicide, euthanasia, or mercy killing.

(Sec. 1554)

Prohibits the Secretary from promulgating any regulation that:
(1) creates an unreasonable barrier to the ability of individuals to
obtain appropriate medical care;
(2) impedes timely access to health care services;
(3) interferes with communications regarding a full range of treatment
options between the patient and the health care provider;
(4) restricts the ability of health care providers to provide full
disclosure of all relevant information to patients making health care
decisions;
(5) violates the principle of informed consent and the ethical
standards of health care professionals; or
(6) limits the availability of health care treatment for the full
duration of a patient's medical needs.

(Sec. 1555)

Declares that no individual, company, business, nonprofit entity, or
health insurance issuer offering group or individual health insurance
coverage shall be required to participate in any federal health
insurance program created by or expanded under this Act. Prohibits any
penalty from being imposed upon any such issuer for choosing not to
participate in any such program.

(Sec. 1556)

Amends the Black Lung Benefits Act, with respect to claims filed on or
after the effective date of the Black Lung Benefits Amendments of
1981, to eliminate exceptions to:
(1) the applicability of certain provisions regarding rebuttable
presumptions; and
(2) the prohibition against requiring eligible survivors of a miner
determined to be eligible for black lung benefits to file a new claim
or to refile or otherwise revalidate the miner's claim.

(Sec. 1557)

Prohibits discrimination by any federal health program or activity on
the grounds of race, color, national origin, sex, age, or disability.

(Sec. 1558)

Amends the Fair Labor Standards Act of 1938 to prohibit an employer
from discharging or discriminating against any employee because the
employee:
(1) has received a health insurance credit or subsidy;
(2) provides information relating to any violation of any provision of
such Act; or
(3) objects to, or refuses to participate in, any activity, policy,
practice, or assigned task that the employee reasonably believed to be
in violation of such Act.

(Sec. 1559)

Gives the HHS Inspector General oversight authority with respect to
the administration and implementation of this title.

(Sec. 1560)

Declares that nothing in this title shall be construed to modify,
impair, or supersede the operation of any antitrust laws.

(Sec. 1561)

Amends the Public Health Service Act to require the Secretary to:
(1) develop interoperable and secure standards and protocols that
facilitate enrollment of individuals in federal and state health and
human services programs; and
(2) award grants to develop and adapt technology systems to implement
such standards and protocols. (Sec. 1562, as added by Sec. 10107)
Directs the Comptroller General to study denials by health plans of
coverage for medical services and of applications to enroll in health
insurance. (Sec. 1563, as added by Sec. 10107) Disallows the waiver of
laws or regulations establishing procurement requirements relating to
small business concerns with respect to any contract awarded under any
program or other authority under this Act. (Sec. 1563 sic, as
modified by Sec. 10107) Makes technical and conforming amendments.
(Sec. 1563 sic) Expresses the sense of the Senate that:
(1) the additional surplus in the Social Security Trust Fund generated
by this Act should be reserved for Social Security; and
(2) the net savings generated by the CLASS program (established under
Title VIII of this Act) should be reserved for such program.Title II:
Role of Public Programs - Subtitle A: Improved Access to Medicaid -
(Sec. 2001, as modified by Sec. 10201) Amends title XIX (Medicaid) of
the SSA to extend Medicaid coverage, beginning in calendar 2014, to
individuals under age 65 who are not entitled to or enrolled in
Medicare and have incomes at or below 133% of the federal poverty
line. Grants a state the option to expand Medicaid eligibility to such
individuals as early as April 1, 2010. Provides that, for between 2014
and 2016, the federal government will pay 100% of the cost of covering
newly-eligible individuals. Increases the federal medical assistance
percentage (FMAP):
(1) with respect to newly eligible individuals; and
(2) between January 1, 2014, and December 31, 2016, for states meeting
certain eligibility requirements. Requires Medicaid benchmark benefits
to include coverage of prescription drugs and mental health services.
Grants states the option to extend Medicaid coverage to individuals
who have incomes that exceed 133% of the federal poverty line
beginning January 1, 2014.

(Sec. 2002)

Requires a state to use an individual's or household's modified gross
income to determine income eligibility for Medicaid for non-elderly
individuals, without applying any income or expense disregards or
assets or resources test. Exempts from this requirement:
(1) individuals eligible for Medicaid through another program;
(2) the elderly or Social Security Disability Insurance (SSDI) program
beneficiaries;
(3) the medically needy;
(4) enrollees in a Medicare Savings Program; and
(5) the disabled.

(Sec. 2003)

Revises state authority to offer a premium assistance subsidy for
qualified employer-sponsored coverage to children under age 19 to
extend such a subsidy to all individuals, regardless of age. Prohibits
a state from requiring, as a condition of Medicaid eligibility, that
an individual (or the individual's parent) apply for enrollment in
qualified employer-sponsored coverage. (Sec. 2004, as modified by Sec.
10201) Extends Medicaid coverage to former foster care children who
are under 26 years of age. (Sec. 2005, as modified by Sec. 10201)
Revises requirements for Medicaid payments to territories, including
an increase in the limits on payments for FY2011 and thereafter. (Sec.
2006, as modified by Sec. 10201) Prescribes an adjustment to the FMAP
determination for certain states recovering from a major disaster.

(Sec. 2007)

Rescinds any unobligated amounts available to the Medicaid Improvement
Fund for FY2014-FY2018. Subtitle B: Enhanced Support for the
Children's Health Insurance Program - (Sec. 2101, as modified by Sec.
10201) Amends SSA title XXI (State Children's Health Insurance
Program) (CHIP, formerly known as SCHIP) to increase the FY2016-FY2019
enhanced FMAP for states, subject to a 100% cap. Prohibits states from
applying, before the end of FY2019, CHIP eligibility standards that
are more restrictive than those under this Act. Deems ineligible for
CHIP any targeted low-income children who cannot enroll in CHIP
because allotments are capped, but who are therefore eligible for tax
credits in the Exchanges. Requires the Secretary to:
(1) review benefits offered for children, and related cost-sharing
imposed, by qualified health plans offered through an Exchange; and
(2) certify those plans whose benefits and cost-sharing are at least
comparable to those provided under the particular state's CHIP plan.
Prohibits enrollment bonus payments for children enrolled in CHIP
after FY2013. Requires a state CHIP plan, beginning January 1, 2014,
to use modified gross income and household income to determine CHIP
eligibility. Requires a state to treat as a targeted low-income child
eligible for CHIP any child determined ineligible for Medicaid as a
result of the elimination of an income disregard based on expense or
type of income.

(Sec. 2102)

Makes technical corrections to the Children's Health Insurance Program
Reauthorization Act of 2009 (CHIPRA). Subtitle C: Medicaid and CHIP
Enrollment Simplification -

(Sec. 2201)

Amends SSA title XIX (Medicaid) to require enrollment application
simplification and coordination with state health insurance Exchanges
and CHIP via state-run websites.

(Sec. 2202)

Permits hospitals to provide Medicaid services during a period of
presumptive eligibility to members of all Medicaid eligibility
categories. Subtitle D: Improvements to Medicaid Services -

(Sec. 2301)

Requires Medicaid coverage of:
(1) freestanding birth center services; and
(2) concurrent care for children receiving hospice care.

(Sec. 2303)

Gives states the option of extending Medicaid coverage to family
planning services and supplies under a presumptive eligibility period
for a categorically needy group of individuals. Subtitle E: New
Options for States to Provide Long-Term Services and Supports -

(Sec. 2401)

Authorizes states to offer home and community-based attendant services
and supports to Medicaid beneficiaries with disabilities who would
otherwise require care in a hospital, nursing facility, intermediate
care facility for the mentally retarded, or an institution for mental
diseases.

(Sec. 2402)

Gives states the option of:
(1) providing home and community-based services to individuals
eligible for services under a waiver; and
(2) offering home and community-based services to specific, targeted
populations Creates an optional eligibility category to provide full
Medicaid benefits to individuals receiving home and community-based
services under a state plan amendment.

(Sec. 2403)

Amends the Deficit Reduction Act of 2005 to:
(1) extend through FY2016 the Money Follows the Person Rebalancing
Demonstration; and
(2) reduce to 90 days the institutional residency period.

(Sec. 2404)

Applies Medicaid eligibility criteria to recipients of home and
community-based services, during calendar 2014 through 2019, in such a
way as to protect against spousal impoverishment.

(Sec. 2405)

Makes appropriations for FY2010-FY2014 to the Secretary, acting
through the Assistant Secretary for Aging, to expand state aging and
disability resource centers.

(Sec. 2406)

Expresses the sense of the Senate that:
(1) during the 111th session of Congress, Congress should address
long-term services and supports in a comprehensive way that guarantees
elderly and disabled individuals the care they need; and
(2) long-term services and supports should be made available in the
community in addition to institutions. Subtitle F: Medicaid
Prescription Drug Coverage -

(Sec. 2501)

Amends SSA title XIX (Medicaid) to:
(1) increase the minimum rebate percentage for single source drugs and
innovator multiple source drugs;
(2) increase the rebate for other drugs;
(3) require contracts with Medicaid managed care organizations to
extend prescription drug rebates (discounts) to their enrollees;
(4) provide an additional rebate for new formulations of existing
drugs; and
(5) set a maximum rebate amount.

(Sec. 2502)

Eliminates the exclusion from Medicaid coverage of, thereby extending
coverage to, certain drugs used to promote smoking cessation, as well
as barbiturates and benzodiazepines.

(Sec. 2503)

Revises requirements with respect to pharmacy reimbursements. Subtitle
G: Medicaid Disproportionate Share Hospital (DSH) Payments - (Sec.
2551, as modified by Sec. 10201) Reduces state disproportionate share
hospital (DSH) allotments, except for Hawaii, by 50% or 35% once a
state's uninsurance rate decreases by 45%, depending on whether they
have spent at least or more than 99.9% of their allotments on average
during FY2004-FY2008. Requires a reduction of only 25% or 17.5% for
low DSH states, depending on whether they have spent at least or more
than 99.9% of their allotments on average during FY2004-FY2008.
Prescribes allotment reduction requirements for subsequent fiscal
years. Revises DSH allotments for Hawaii for the last three quarters
of FY2012, and for FY2013 and succeeding fiscal years. Subtitle H:
Improved Coordination for Dual Eligible Beneficiaries -

(Sec. 2601)

Declares that any Medicaid waiver for individuals dually eligible for
both Medicaid and Medicare may be conducted for a period of five
years, with a five-year extension, upon state request, unless the
Secretary determines otherwise for specified reasons.

(Sec. 2602)

Directs the Secretary to establish a Federal Coordinated Health Care
Office to bring together officers and employees of the Medicare and
Medicaid programs at the Centers for Medicare and Medicaid Services
(CMMS) to:
(1) integrate Medicaid and Medicare benefits more effectively; and
(2) improve the coordination between the federal government and states
for dual eligible individuals to ensure that they get full access to
the items and services to which they are entitled. Subtitle I:
Improving the Quality of Medicaid for Patients and Providers -

(Sec. 2701)

Amends SSA title XI, as modified by CHIPRA, to direct the Secretary
to:
(1) identify and publish a recommended core set of adult health
quality measures for Medicaid eligible adults; and
(2) establish a Medicaid Quality Measurement Program.

(Sec. 2702)

Requires the Secretary to identify current state practices that
prohibit payment for health care-acquired conditions and to
incorporate them, or elements of them, which are appropriate for
application in regulations to the Medicaid program. Requires such
regulations to prohibit payments to states for any amounts expended
for providing medical assistance for specified health care-acquired
conditions.

(Sec. 2703)

Gives states the option to provide coordinated care through a health
home for individuals with chronic conditions. Authorizes the Secretary
to award planning grants to states to develop a state plan amendment
to that effect.

(Sec. 2704)

Directs the Secretary to establish a demonstration project to evaluate
the use of bundled payments for the provision of integrated care for a
Medicaid beneficiary:
(1) with respect to an episode of care that includes a
hospitalization; and
(2) for concurrent physicians services provided during a
hospitalization.

(Sec. 2705)

Requires the Secretary to establish a Medicaid Global Payment System
Demonstration Project under which a participating state shall adjust
payments made to an eligible safety net hospital or network from a
fee-for-service payment structure to a global capitated payment model.
Authorizes appropriations.

(Sec. 2706)

Directs the Secretary to establish the Pediatric Accountable Care
Organization Demonstration Project to authorize a participating state
to allow pediatric medical providers meeting specified requirements to
be recognized as an accountable care organization for the purpose of
receiving specified incentive payments. Authorizes appropriations.

(Sec. 2707)

Requires the Secretary to establish a three-year Medicaid emergency
psychiatric demonstration project. Makes appropriations for FY2011.
Subtitle J: Improvements to the Medicaid and CHIP Payment and Access
Commission (MACPAC) -

(Sec. 2801)

Revises requirements with respect to the Medicaid and CHIP Payment and
Access Commission (MACPAC) and the Medicare Payment Advisory
Commission (MEDPAC), including those for MACPAC membership, topics to
be reviewed, and MEDPAC review of Medicaid trends in spending,
utilization, and financial performance. Requires MACPAC and MEDPAC to
consult with one another on related issues. Makes appropriations to
MACPAC for FY2010. Subtitle K: Protections for American Indians and
Alaska Natives -

(Sec. 2901)

Sets forth special rules relating to Indians.Declares that health
programs operated by the Indian Health Service (IHS), Indian tribes,
tribal organizations, and Urban Indian organizations shall be the
payer of last resort for services they provide to eligible
individuals. Makes such organizations Express Lane agencies for
determining Medicaid and CHIP eligibility.

(Sec. 2902)

Makes permanent the requirement that the Secretary reimburse certain
Indian hospitals and clinics for all Medicare part B services.
Subtitle L: Maternal and Child Health Services -

(Sec. 2951)

Amends SSA title V (Maternal and Child Health Services) to direct the
Secretary to make grants to eligible entities for early childhood home
visitation programs. Makes appropriations for FY2010-FY2014.

(Sec. 2952)

Encourages the Secretary to continue activities on postpartum
depression or postpartum psychosis, including research to expand the
understanding of their causes and treatment. Authorizes the Secretary
to make grants to eligible entities for projects to establish,
operate, and coordinate effective and cost-efficient systems for the
delivery of essential services to individuals with or at risk for
postpartum conditions and their families. Authorizes appropriations
for FY2010-FY2012. (Sec. 2953, as modified by Sec. 10201) Directs the
Secretary to allot funds to states to award grants to local
organizations and other specified entities to carry out personal
responsibility education programs to educate adolescents on both
abstinence and contraception for the prevention of pregnancy and
sexually transmitted infections, as well as on certain adulthood
preparation subjects. Makes appropriations for FY2010-FY2014.

(Sec. 2954)

Makes appropriations for FY2010-FY2014 for abstinence education.

(Sec. 2955)

Requires the case review system for children aging out of foster care
and independent living programs to include information about the
importance of having a health care power of attorney in transition
planning. Title III: Improving the Quality and Efficiency of Health
Care - Subtitle A: Transforming the Health Care Delivery System - Part
I: Linking Payment to Quality Outcomes under the Medicare Program -

(Sec. 3001)

Amends SSA title XVIII (Medicare) to direct the Secretary to establish
a hospital value-based purchasing program under which value-based
incentive payments are made in a fiscal year to hospitals that meet
specified performance standards for a certain performance period.
Directs the Secretary to establish value-based purchasing
demonstration programs for:
(1) inpatient critical access hospital services; and
(2) hospitals excluded from the program because of insufficient
numbers of measures and cases.

(Sec. 3002)

Extends through 2013 the authority for incentive payments under the
physician quality reporting system. Prescribes an incentive (penalty)
for providers who do not report quality measures satisfactorily,
beginning in 2015. Requires the Secretary to integrate reporting on
quality measures with reporting requirements for the meaningful use of
electronic health records.

(Sec. 3003)

Requires specified new types of reports and data analysis under the
physician feedback program.

(Sec. 3004)

Requires long-term care hospitals, inpatient rehabilitation hospitals,
and hospices, starting in rate year 2014, to submit data on specified
quality measures. Requires reduction of the annual update of entities
which do not comply.

(Sec. 3005)

Directs the Secretary, starting FY2014, to establish quality reporting
programs for inpatient cancer hospitals exempt from the prospective
payment system. (Sec. 3006, as modified by Sec. 10301) Directs the
Secretary to develop a plan to implement value-based purchasing
programs for Medicare payments for skilled nursing facilities (SNFs),
home health agencies, and ambulatory surgical centers.

(Sec. 3007)

Directs the Secretary to establish a value-based payment modifier,
under the physician fee schedule, based upon the quality of care
furnished compared to cost.

(Sec. 3008)

Subjects hospitals to a penalty adjustment to hospital payments for
high rates of hospital acquired conditions. Part II: National Strategy
to Improve Health Care Quality - (Sec. 3011, as modified by Sec.
10302) Amends the Public Health Service Act to direct the Secretary,
through a transparent collaborative process, to establish a National
Strategy for Quality Improvement in health care services, patient
health outcomes, and population health, taking into consideration
certain limitations on the use of comparative effectiveness data.

(Sec. 3012)

Directs the President to convene an Interagency Working Group on
Health Care Quality. (Sec. 3013, as modified by Sec. 10303) Directs
the Secretary, at least triennially, to identify gaps where no quality
measures exist as well as existing quality measures that need
improvement, updating, or expansion, consistent with the national
strategy for use in federal health programs. Directs the Secretary to
award grants, contracts, or intergovernmental agreements to eligible
entities for purposes of developing, improving, updating, or expanding
such quality measures. Requires the Secretary to develop and update
periodically provider-level outcome measures for hospitals and
physicians, as well as other appropriate providers. (Sec. 3014, as
modified by Sec. 10304) Requires the convening of multi-stakeholder
groups to provide input into the selection of quality and efficiency
measures. (Sec. 3015, as modified by Sec. 10305) Directs the Secretary
to:
(1) establish an overall strategic framework to carry out the public
reporting of performance information; and
(2) collect and aggregate consistent data on quality and resource use
measures from information systems used to support health care
delivery. Authorizes the Secretary to award grants for such purpose.
Directs the Secretary to make available to the public, through
standardized Internet websites, performance information summarizing
data on quality measures. Part III: Encouraging Development of New
Patient Care Models - (Sec. 3021, as modified by Sec. 10306) Creates
within CMMS a Center for Medicare and Medicaid Innovation to test
innovative payment and service delivery models to reduce program
expenditures while preserving or enhancing the quality of care
furnished to individuals. Makes appropriations for FY2010-FY2019.
(Sec. 3022, as modified by Sec. 10307) Directs the Secretary to
establish a shared savings program that:
(1) promotes accountability for a patient population;
(2) coordinates items and services under Medicare parts A and B; and
(3) encourages investment in infrastructure and redesigned care
processes for high quality and efficient service delivery. (Sec. 3023,
as modified by Sec. 10308) Directs the Secretary to establish a pilot
program for integrated care (involving payment bundling) during an
episode of care provided to an applicable beneficiary around a
hospitalization in order to improve the coordination, quality, and
efficiency of health care services.

(Sec. 3024)

Directs the Secretary to conduct a demonstration program to test a
payment incentive and service delivery model that utilizes physician
and nurse practitioner directed home-based primary care teams designed
to reduce expenditures and improve health outcomes in the provision of
items and services to applicable beneficiaries. (Sec. 3025, as
modified by Sec. 10309) Requires the Secretary to establish a hospital
readmissions reduction program involving certain payment adjustments,
effective for discharges on or after October 1, 2012, for certain
potentially preventable Medicare inpatient hospital readmissions.
Directs the Secretary to make available a program for hospitals with a
high severity adjusted readmission rate to improve their readmission
rates through the use of patient safety organizations.

(Sec. 3026)

Directs the Secretary to establish a Community-Based Care Transitions
Program which provides funding to eligible entities that furnish
improved care transitions services to high-risk Medicare
beneficiaries.

(Sec. 3027)

Amends the Deficit Reduction Act of 2005 to extend certain Gainsharing
Demonstration Projects through FY2011. Subtitle B: Improving Medicare
for Patients and Providers - Part 1: Ensuring Beneficiary Access to
Physician Care and Other Services - (Sec. 3101, deleted by section
10310)

(Sec. 3102)

Extends through calendar 2010 the floor on geographic indexing
adjustments to the work portion of the physician fee schedule. Revises
requirements for calculation of the practice expense portion of the
geographic adjustment factor applied in a fee schedule area for
services furnished in 2010 or 2011. Directs the Secretary to analyze
current methods of establishing practice expense geographic
adjustments and make appropriate further adjustments (a new
methodology) to such adjustments for 2010 and subsequent years.

(Sec. 3103)

Extends the process allowing exceptions to limitations on medically
necessary therapy caps through December 31, 2010.

(Sec. 3104)

Amends the Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000 to extend until January 1, 2010, an exception
to a payment rule that permits laboratories to receive direct Medicare
reimbursement when providing the technical component of certain
physician pathology services that had been outsourced by certain
(rural) hospitals. (Sec. 3105, as modified by Sec. 10311) Amends SSA
title XVIII (Medicare)to extend the bonus and increased payments for
ground ambulance services until January 1, 2011. Amends the Medicare
Improvements for Patients and Providers Act of 2008 (MIPPA) to extend
the payment of certain urban air ambulance services until January 1,
2011. (Sec. 3106, as modified by Sec. 10312) Amends the Medicare,
Medicaid, and SCHIP Extension Act of 2007, as modified by the American
Recovery and Reinvestment Act, to extend for two years:
(1) certain payment rules for long-term care hospital services; and
(2) a certain moratorium on the establishment of certain hospitals and
facilities.

(Sec. 3107)

Amends MIPPA to extend the physician fee schedule mental health add-on
payment provision through December 31, 2010.

(Sec. 3108)

Allows a physician assistant who does not have a direct or indirect
employment relationship with a SNF, but who is working in
collaboration with a physician, to certify the need for post-hospital
extended care services for Medicare payment purposes.

(Sec. 3109)

Amends SSA title XVIII (Medicare), as modified by MIPPA, to exempt
certain pharmacies from accreditation requirements until the Secretary
develops pharmacy-specific standards.

(Sec. 3110)

Creates a special part B enrollment period for military retirees,
their spouses (including widows/ widowers), and dependent children,
who are otherwise eligible for TRICARE (the health care plan under the
Department of Defense DOD) and entitled to Medicare part A (Hospital
Insurance) based on disability or end stage renal disease, but who
have declined Medicare part B (Supplementary Medical Insurance).

(Sec. 3111)

Sets payments for dual-energy x-ray absorptiometry services in 2010
and 2011 at 70% of the 2006 reimbursement rates. Directs the Secretary
to arrange with the Institute of Medicine of the National Academies to
study and report to the Secretary and Congress on the ramifications of
Medicare reimbursement reductions for such services on beneficiary
access to bone mass measurement benefits.

(Sec. 3112)

Eliminates funding in the Medicare Improvement Fund FY2014.

(Sec. 3113)

Directs the Secretary to conduct a demonstration project under
Medicare part B of separate payments for complex diagnostic laboratory
tests provided to individuals.

(Sec. 3114)

Increases from 65% to 100% of the fee schedule amount provided for the
same service performed by a physician the fee schedule for
certified-midwife services provided on or after January 1, 2011. Part
II: Rural Protections -

(Sec. 3121)

Extends through 2010 hold harmless provisions under the prospective
payment system for hospital outpatient department services.Removes the
100-bed limitation for sole community hospitals so all such hospitals
receive an 85% increase in the payment difference in 2010.

(Sec. 3122)

Amends the Medicare Prescription Drug, Improvement, and Modernization
Act of 2003, as modified by other federal law, to extend from July 1,
2010, until July 1, 2011, the reasonable cost reimbursement for
clinical diagnostic laboratory service for qualifying rural hospitals
with under 50 beds. (Sec. 3123, as modified by Sec. 10313) Extends the
Rural Community Hospital Demonstration Program for five additional
years. Expands the maximum number of participating hospitals to 30,
and to 20 the number of demonstration states with low population
densities.

(Sec. 3124)

Extends the Medicare-dependent Hospital Program through FY2012. (Sec.
3125, as modified by Sec. 10314) Modifies the Medicare inpatient
hospital payment adjustment for low-volume hospitals for
FY2011-FY2012.

(Sec. 3126)

Revises requirements for the Demonstration Project on Community Health
Integration Models in Certain Rural Counties to allow additional
counties as well as physicians to participate.

(Sec. 3127)

Directs MEDPAC to study and report to Congress on the adequacy of
payments for items and services furnished by service providers and
suppliers in rural areas under the Medicare program.

(Sec. 3128)

Allows a critical access hospital to continue to be eligible to
receive 101% of reasonable costs for providing:
(1) outpatient care regardless of the eligible billing method such
hospital uses; and
(2) qualifying ambulance services.

(Sec. 3129)

Extends through FY2012 FLEX grants under the Medicare Rural Hospital
Flexibility Program. Allows the use of grant funding to assist small
rural hospitals to participate in delivery system reforms. Part III:
Improving Payment Accuracy - (Sec. 3131, as modified by Sec. 10315)
Requires the Secretary, starting in 2014, to rebase home health
payments by an appropriate percentage, among other things, to reflect
the number, mix, and level of intensity of home health services in an
episode, and the average cost of providing care. Directs the Secretary
to study and report to Congress on home health agency costs involved
with providing ongoing access to care to low-income Medicare
beneficiaries or beneficiaries in medically underserved areas, and in
treating beneficiaries with varying levels of severity of illness.
Authorizes a Medicare demonstration project based on the study
results.

(Sec. 3132)

Requires the Secretary, by January 1, 2011, to begin collecting
additional data and information needed to revise payments for hospice
care. Directs the Secretary, not earlier than October 1, 2013, to
implement, by regulation, budget neutral revisions to the methodology
for determining hospice payments for routine home care and other
services, which may include per diem payments reflecting changes in
resource intensity in providing such care and services during the
course of an entire episode of hospice care. Requires the Secretary to
impose new requirements on hospice providers participating in
Medicare, including requirements for:
(1) a hospice physician or nurse practitioner to have a face-to-face
encounter with the individual regarding eligibility and
recertification; and
(2) a medical review of any stays exceeding 180 days, where the number
of such cases exceeds a specified percentage of them for all hospice
programs. (Sec. 3133, as modified by Sec. 10316) Specifies reductions
to Medicare DSH payments for FY2015 and ensuing fiscal years,
especially to subsection (d) hospitals, to reflect lower uncompensated
care costs relative to increases in the number of insured.(Generally,
a subsection d hospital is an acute care hospital, particularly one
that receives payments under Medicare's inpatient prospective payment
system when providing covered inpatient services to eligible
beneficiaries.)

(Sec. 3134)

Directs the Secretary periodically to identify physician services as
being potentially misvalued, and make appropriate adjustments to the
relative values of such services under the Medicare physician fee
schedule.

(Sec. 3135)

Increases the presumed utilization rate for calculating the payment
for advanced imaging equipment other than low-tech imaging such as
ultrasound, x-rays and EKGs. Increases the technical component payment
"discount" for sequential imaging services on contiguous body parts
during the same visit.

(Sec. 3136)

Restricts the lump-sum payment option for new or replacement chairs to
the complex, rehabilitative power-driven wheelchairs only. Eliminates
the lump-sum payment option for all other power-driven wheelchairs.
Makes the rental payment for power-driven wheelchairs 15% of the
purchase price for each of the first three months (instead of 10%),
and 6% of the purchase price for each of the remaining 10 months of
the rental period (instead of 7.5%). (Sec. 3137, as modified by Sec.
10317) Amends the Tax Relief and Health Care Act of 2006, as modified
by other federal law, to extend "Section 508" hospital
reclassifications until September 30, 2010, with a special rule for
FY2010. ("Section 508" refers to Section 508 of the Medicare
Modernization Act of 2003, which allows the temporary reclassification
of a hospital with a low Medicare area wage index, for reimbursement
purposes, to a nearby location with a higher Medicare area wage index,
so that the "Section 508 hospital" will receive the higher Medicare
reimbursement rate.) Directs the Secretary to report to Congress a
plan to reform the hospital wage index system.

(Sec. 3138)

Requires the Secretary to determine if the outpatient costs incurred
by inpatient prospective payment system-exempt cancer hospitals,
including those for drugs and biologicals, with respect to Medicare
ambulatory payment classification groups, exceed those costs incurred
by other hospitals reimbursed under the outpatient prospective payment
system (OPPS). Requires the Secretary, if this is so, to provide for
an appropriate OPPS adjustment to reflect such higher costs for
services furnished on or after January 1, 2011.

(Sec. 3139)

Allows a biosimilar biological product to be reimbursed at 6% of the
average sales price of the brand biological product.

(Sec. 3140)

Directs the Secretary to establish a Medicare Hospice Concurrent Care
demonstration program under which Medicare beneficiaries are
furnished, during the same period, hospice care and any other Medicare
items or services from Medicare funds otherwise paid to such hospice
programs.

(Sec. 3141)

Requires application of the budget neutrality requirement associated
with the effect of the imputed rural floor on the area wage index
under the Balanced Budget Act of 1997 through a uniform national,
instead of state-by-state, adjustment to the area hospital wage index
floor.

(Sec. 3142)

Directs the Secretary to study and report to Congress on the need for
an additional payment for urban Medicare-dependent hospitals for
inpatient hospital services under Medicare.

(Sec. 3143)

Declares that nothing in this Act shall result in the reduction of
guaranteed home health benefits under the Medicare program. Subtitle
C: Provisions Relating to Part C - (Sec. 3201, as modified by Sec.
10318) Bases the MedicareAdvantage (MA) benchmark on the average of
the bids from MA plans in each market. Revises the formula for
calculating the annual Medicare+Choice capitation rate to reduce the
national MA per capita Medicare+Choice growth percentage used to
increase benchmarks in 2011. Increases the monthly MA plan rebates
from 75% to 100% of the average per capita savings. Requires that bid
information which MA plans are required to submit to the Secretary be
certified by a member of the American Academy of Actuaries and meet
actuarial guidelines and rules established by the Secretary. Directs
the Secretary, acting through the CMMS Chief Actuary, to establish
actuarial guidelines for the submission of bid information and bidding
rules that are appropriate to ensure accurate bids and fair
competition among MA plans. Directs the Secretary to:
(1) establish new MA payment areas for urban areas based on the Core
Based Statistical Area; and
(2) make monthly care coordination and management performance bonus
payments, quality performance bonus payments, and quality bonuses for
new and low enrollment MA plans, to MA plans that meet certain
criteria. Directs the Secretary to provide transitional rebates for
the provision of extra benefits to enrollees.

(Sec. 3202)

Prohibits MA plans from charging beneficiaries cost sharing for
chemotherapy administration services, renal dialysis services, or
skilled nursing care that is greater than what is charged under the
traditional fee-for-service program. Requires MA plans to apply the
full amount of rebates, bonuses, and supplemental premiums according
to the following order:
(1) reduction of cost sharing,
(2) coverage of preventive care and wellness benefits, and
(3) other benefits not covered under the original Medicare
fee-for-service program.

(Sec. 3203)

Requires the Secretary to analyze the differences in coding patterns
between MA and the original Medicare fee-for-service programs.
Authorizes the Secretary to incorporate the results of the analysis
into risk scores for 2014 and subsequent years.

(Sec. 3204)

Allows beneficiaries to disenroll from an MA plan and return to the
traditional Medicare fee-for-service program from January 1 to March
15 of each year. Revises requirements for annual beneficiary election
periods.

(Sec. 3205)

Amends SSA title XVIII (Medicare), as modified by MIPPA, to extend
special needs plan (SNP) authority through December 31, 2013.
Authorizes the Secretary to establish a frailty payment adjustment
under PACE payment rules for fully-integrated, dual-eligible SNPs.
Extends authority through calendar 2012 for SNPs that do not have
contracts with state Medicaid programs to continue to operate, but not
to expand their service areas. Directs the Secretary to require an MA
organization offering a specialized MA plan for special needs
individuals to be approved by the National Committee for Quality
Assurance. Requires the Secretary to use a risk score reflecting the
known underlying risk profile and chronic health status of similar
individuals, instead of the default risk score, for new enrollees in
MA plans that are not specialized MA SNPs.

(Sec. 3206)

Extends through calendar 2012 the length of time reasonable cost plans
may continue operating regardless of any other MA plans serving the
area.

(Sec. 3208)

Creates a new type of MA plan called an MA Senior Housing Facility
Plan, which would be allowed to limit its service area to a senior
housing facility (continuing care retirement community) within a
geographic area.

(Sec. 3209)

Declares that the Secretary is not required to accept any or every bid
submitted by an MA plan or Medicare part D prescription drug plan that
proposes to increase significantly any beneficiary cost sharing or
decrease benefits offered.

(Sec. 3210)

Directs the Secretary to request the National Association of Insurance
Commissioners (NAIC) to develop new standards for certain Medigap
plans. Subtitle D: Medicare Part D Improvements for Prescription Drug
Plans and MA-PD Plans -

(Sec. 3301)

Amends Medicare part D (Voluntary Prescription Drug Benefit Program)
to establish conditions for the availability of coverage for part D
drugs. Requires the manufacturer to participate in the Medicare
coverage gap discount program. Directs the Secretary to establish such
a program.

(Sec. 3302)

Excludes the MA rebate amounts and quality bonus payments from
calculation of the regional low-income subsidy benchmark premium for
MA monthly prescription drug beneficiaries.

(Sec. 3303)

Directs the Secretary to permit a prescription drug plan or an MA-PD
plan to waive the monthly beneficiary premium for a subsidy eligible
individual if the amount of such premium is de minimis. Provides that,
if such premium is waived, the Secretary shall not reassign subsidy
eligible individuals enrolled in the plan to other plans based on the
fact that the monthly beneficiary premium under the plan was greater
than the low-income benchmark premium amount. Authorizes the Secretary
to auto-enroll subsidy eligible individuals in plans that waive de
minimis premiums.

(Sec. 3304)

Sets forth a special rule for widows and widowers regarding
eligibility for low-income assistance. Allows the surviving spouse of
an eligible couple to delay redetermination of eligibility for one
year after the death of a spouse.

(Sec. 3305)

Directs the Secretary, in the case of a subsidy eligible individual
enrolled in one prescription drug plan but subsequently reassigned by
the Secretary to a new prescription drug plan, to provide the
individual with:
(1) information on formulary differences between the individual's
former plan and the new plan with respect to the individual's drug
regimens; and
(2) a description of the individual's right to request a coverage
determination, exception, or reconsideration, bring an appeal, or
resolve a grievance.

(Sec. 3306)

Amends MIPPA to provide additional funding for FY2010-FY2012 for
outreach and education activities related to specified Medicare
low-income assistance programs.

(Sec. 3307)

Authorizes the Secretary to identify classes of clinical concern
through rulemaking, including anticonvulsants, antidepressants,
antineoplastics, antipsychotics, antiretrovirals, and
immunosuppressants for the treatment of transplant rejection. Requires
prescription drug plan sponsors to include all drugs in these classes
in their formularies.

(Sec. 3308)

Requires part D enrollees who exceed certain income thresholds to pay
higher premiums. Revises the current authority of the IRS to disclose
income information to the Social Security Administration for purposes
of adjusting the part B subsidy.

(Sec. 3309)

Eliminates cost sharing for certain dual eligible individuals
receiving care under a home and community-based waiver program who
would otherwise require institutional care.

(Sec. 3310)

Directs the Secretary to require sponsors of prescription drug plans
to utilize specific, uniform techniques for dispensing covered part D
drugs to enrollees who reside in an long-term care facility in order
to reduce waste associated with 30-day refills.

(Sec. 3311)

Directs the Secretary to develop and maintain an easy to use complaint
system to collect and maintain information on MA-PD plan and
prescription drug complaints received by the Secretary until the
complaint is resolved.

(Sec. 3312)

Requires a prescription drug plan sponsor to:
(1) use a single, uniform exceptions and appeals process for
determination of a plan enrollee's prescription drug coverage; and
(2) provide instant access to this process through a toll-free
telephone number and an Internet website.

(Sec. 3313)

Requires the HHS Inspector General to study and report to Congress on
the inclusion in formularies of:
(1) drugs commonly used by dual eligibles; and
(2) prescription drug prices under Medicare part D and Medicaid.

(Sec. 3314)

Allows the costs incurred by AIDS drug assistance programs and by IHS
in providing prescription drugs to count toward the annual
out-of-pocket threshold.

(Sec. 3315)

Increases by $500 the 2010 standard initial coverage limit (thus
decreasing the time that a part D enrollee would be in the coverage
gap). Subtitle E: Ensuring Medicare Sustainability - (Sec. 3401, as
modified by Sec. 10319 and Sec. 10322) Revises certain market basket
updates and incorporates a full productivity adjustment into any
updates that do not already incorporate such adjustments, including
inpatient hospitals, home health providers, nursing homes, hospice
providers, inpatient psychiatric facilities, long-term care hospitals,
inpatient rehabilitation facilities, and Part B providers. Establishes
a quality measure reporting program for psychiatric hospitals
beginning in FY2014.

(Sec. 3402)

Revises requirements for reduction of the Medicare part B premium
subsidy based on income. Maintains the current 2010 income thresholds
for the period of 2011 through 2019. (Sec. 3403, as modified by Sec.
10320) Establishes an Independent Medicare Advisory Board to develop
and submit detailed proposals to reduce the per capita rate of growth
in Medicare spending to the President for the Congress to consider.
Establishes a consumer advisory council to advise the Board on the
impact of payment policies under this title on consumers. Subtitle F:
Health Care Quality Improvements -

(Sec. 3501)

Amends the Public Health Service Act to direct the Center for Quality
Improvement and Patient Safety of the Agency for Healthcare Research
and Quality (AHRQ) to conduct or support activities for best practices
in the delivery of health care services and support research on the
development of tools to facilitate adoption of best practices that
improve the quality, safety, and efficiency of health care delivery
services. Authorizes appropriations for FY2010-FY2014. Requires the
AHRQ Director, through the AHRQ Center for Quality Improvement and
Patient Safety, to award grants or contracts to eligible entities to
provide technical support or to implement models and practices
identified in the research conducted by the Center. (Sec. 3502, as
modified by Sec. 10321) Directs the Secretary to establish a program
to provide grants to or enter into contracts with eligible entities to
establish community-based interdisciplinary, interprofessional teams
to support primary care practices, including obstetrics and gynecology
practices, within the hospital service areas served by the eligible
entities.

(Sec. 3503)

Directs the Secretary, acting through the Patient Safety Research
Center, to establish a program to provide grants or contracts to
eligible entities to implement medication management services provided
by licensed pharmacists, as a collaborative multidisciplinary,
inter-professional approach to the treatment of chronic diseases for
targeted individuals, to improve the quality of care and reduce
overall cost in the treatment of such disease.

(Sec. 3504)

Directs the Secretary, acting through the Assistant Secretary for
Preparedness and Response, to award at least four multiyear contracts
or competitive grants to eligible entities to support pilot projects
that design, implement, and evaluate innovative models of
regionalized, comprehensive, and accountable emergency care and trauma
systems. Requires the Secretary to support federal programs
administered by the National Institutes of Health, the AHRQ, the
Health Resources and Services Administration (HRSA), the CMMS, and
other agencies involved in improving the emergency care system to
expand and accelerate research in emergency medical care systems and
emergency medicine. Directs the Secretary to support federal programs
administered by the such agencies to coordinate and expand research in
pediatric emergency medical care systems and pediatric emergency
medicine. Authorizes appropriations for FY2010-FY2014.

(Sec. 3505)

Requires the Secretary to establish three programs to award grants to
qualified public, nonprofit IHS, Indian tribal, and urban Indian
trauma centers to:
(1) assist in defraying substantial uncompensated care costs;
(2) further the core missions of such trauma centers, including by
addressing costs associated with patient stabilization and transfer;
and
(3) provide emergency relief to ensure the continued and future
availability of trauma services. Authorizes appropriations for
FY2010-FY2015. Directs the Secretary to provide funding to states to
enable them to award grants to eligible entities for trauma services.
Authorizes appropriations for FY2010-FY2015.

(Sec. 3506)

Directs the Secretary to:
(1) establish a program to award grants or contracts to develop,
update, and produce patient decision aids to assist health care
providers and patients;
(2) establish a program to provide for the phased-in development,
implementation, and evaluation of shared decision making using patient
decision aids to meet the objective of improving the understanding of
patients of their medical treatment options; and
(3) award grants for establishment and support of Shared
Decisionmaking Resource Centers. Authorizes appropriations for FY2010
and subsequent fiscal years.

(Sec. 3507)

Requires the Secretary, acting through the Commissioner of Food and
Drugs, to determine whether the addition of quantitative summaries of
the benefits and risks of prescription drugs in a standardized format
to the promotional labeling or print advertising of such drugs would
improve heath care decisionmaking by clinicians and patients and
consumers.

(Sec. 3508)

Authorizes the Secretary to award grants to eligible entities or
consortia to carry out demonstration projects to develop and implement
academic curricula that integrate quality improvement and patient
safety in the clinical education of health professionals.

(Sec. 3509)

Establishes an Office on Women's Health within the Office of the
Secretary, the Office of the Director of the Centers for Disease
Control and Prevention (CDC), the Office of the AHRQ Director, the
Office of the Administrator of HRSA, and the Office of the
Commissioner of Food and Drugs. Authorizes appropriations for
FY2010-FY2014 for all such Offices on Women's Health.

(Sec. 3510)

Extends from three years to four years the duration of a patient
navigator grant. Prohibits the Secretary from awarding such a grant
unless the recipient entity provides assurances that patient
navigators recruited, assigned, trained, or employed using grant funds
meet minimum core proficiencies tailored for the main focus or
intervention of the navigator involved. Authorizes appropriations for
FY2010-FY2015.

(Sec. 3511)

Authorizes appropriations to carry out this title, except where
otherwise provided in the title. (Sec. 3512, as added by Sec. 10201)
Directs the Comptroller General to study and report to Congress on
whether the development, recognition, or implementation of any
guideline or other standards under specified provisions of this Act
would result in the establishment of a new cause of action or claim.
Subtitle G: Protecting and Improving Guaranteed Medicare Benefits -

(Sec. 3601)

Provides that nothing in this Act shall result in a reduction of
guaranteed benefits under the Medicare program. States that savings
generated for the Medicare program under this Act shall extend the
solvency of the Medicare trust funds, reduce Medicare premiums and
other cost-sharing for beneficiaries, and improve or expand guaranteed
Medicare benefits and protect access to Medicare providers.

(Sec. 3602)

Declares that nothing in this Act shall result in the reduction or
elimination of any benefits guaranteed by law to participants in MA
plans. Title IV: Prevention of Chronic Disease and Improving Public
Health - Subtitle A: Modernizing Disease Prevention and Public Health
Systems - (Sec. 4001, as modified by Sec. 10401) Requires the
President to:
(1) establish the National Prevention, Health Promotion and Public
Health Council;
(2) establish the Advisory Group on Prevention, Health Promotion, and
Integrative and Public Health; and
(3) appoint the Surgeon General as Chairperson of the Council in order
to develop a national prevention, health promotion, and public health
strategy. Requires the Secretary and the Comptroller General to
conduct periodic reviews and evaluations of every federal disease
prevention and health promotion initiative, program, and agency. (Sec.
4002, as modified by Sec. 10401) Establishes a Prevention and Public
Health Fund to provide for expanded and sustained national investment
in prevention and public health programs to improve health and help
restrain the rate of growth in private and public sector health care
costs. Authorizes appropriations and appropriates money to such Fund.
(Sec 4003) Requires (currently, allows) the Director of AHRQ to
convene the Preventive Services Task Force to review scientific
evidence related to the effectiveness, appropriateness, and
cost-effectiveness of clinical preventive services for the purpose of
developing recommendations for the health care community. Requires the
Director of CDC to convene an independent Community Preventive
Services Task Force to review scientific evidence related to the
effectiveness, appropriateness, and cost-effectiveness of community
preventive interventions for the purpose of developing recommendations
for individuals and organizations delivering populations-based
services and other policy makers (Sec. 4004, as modified by Sec.
10401) Requires the Secretary to provide for the planning and
implementation of a national public-private partnership for a
prevention and health promotion outreach and education campaign to
raise public awareness of health improvement across the life span.
Requires the Secretary, acting through the Director of CDC, to:
(1) establish and implement a national science-based media campaign on
health promotion and disease prevention; and
(2) enter into a contract for the development and operation of a
federal website personalized prevention plan tool. Subtitle B:
Increasing Access to Clinical Preventive Services - (Sec. 4101, as
modified by Sec. 10402) Requires the Secretary to establish a program
to award grants to eligible entities to support the operation of
school-based health centers.

(Sec. 4102)

Requires the Secretary, acting through the Director of CDC, to carry
out oral health activities, including:
(1) establishing a national public education campaign that is focused
on oral health care prevention and education;
(2) awarding demonstration grants for research-based dental caries
disease management activities;
(3) awarding grants for the development of school-based dental sealant
programs; and
(4) entering into cooperative agreements with state, territorial, and
Indian tribes or tribal organizations for oral health data collection
and interpretation, a delivery system for oral health, and
science-based programs to improve oral health. Requires the Secretary
to:
(1) update and improve the Pregnancy Risk Assessment Monitoring System
as it relates to oral health care;
(2) develop oral health care components for inclusion in the National
Health and Nutrition Examination Survey; and
(3) ensure that the Medical Expenditures Panel Survey by AHRQ includes
the verification of dental utilization, expenditure, and coverage
findings through conduct of a look-back analysis. (Sec. 4103, as
modified by Sec. 10402) Amends SSA title XVIII (Medicare) to provide
coverage of personalized prevention plan services, including a health
risk assessment, for individuals. Prohibits cost-sharing for such
services. (Sec. 4104, as modified by Sec. 10406) Eliminates
cost-sharing for certain preventive services recommended by the United
States Preventive Services Task Force.

(Sec. 4105)

Authorizes the Secretary to modify Medicare coverage of any preventive
service consistent with the recommendations of such Task Force.

(Sec. 4106)

Amends SSA title XIX (Medicaid) to provide Medicaid coverage of
preventive services and approved vaccines. Increases the FMAPfor such
services and vaccines.

(Sec. 4107)

Provides for Medicaid coverage of counseling and pharmacotherapy for
cessation of tobacco use by pregnant women.

(Sec. 4108)

Requires the Secretary to award grants to states to carry out
initiatives to provide incentives to Medicaid beneficiaries who
participate in programs to lower health risk and demonstrate changes
in health risk and outcomes. Subtitle C: Creating Healthier
Communities - (Sec. 4201, as modified by Sec. 10403) Requires the
Secretary, acting through the Director of CDC, to award grants to
state and local governmental agencies and community-based
organizations for the implementation, evaluation, and dissemination of
evidence-based community preventive health activities in order to
reduce chronic disease rates, prevent the development of secondary
conditions, address health disparities, and develop a stronger
evidence base of effective prevention programming.

(Sec. 4202)

Requires the Secretary, acting through the Director of CDC, to award
grants to state or local health departments and Indian tribes to carry
out pilot programs to provide public health community interventions,
screenings, and clinical referrals for individuals who are between 55
and 64 years of age. Requires the Secretary to:
(1) conduct an evaluation of community-based prevention and wellness
programs and develop a plan for promoting healthy lifestyles and
chronic disease self-management for Medicare beneficiaries; and
(2) evaluate community prevention and wellness programs that have
demonstrated potential to help Medicare beneficiaries reduce their
risk of disease, disability, and injury by making healthy lifestyle
choices.

(Sec. 4203)

Amends the Rehabilitation Act of 1973 to require the Architectural and
Transportation Barriers Compliance Board to promulgate standards
setting forth the minimum technical criteria for medical diagnostic
equipment used in medical settings to ensure that such equipment is
accessible to, and usable by, individuals with accessibility needs.

(Sec. 4204)

Authorizes the Secretary to negotiate and enter into contracts with
vaccine manufacturers for the purchase and delivery of vaccines for
adults. Allows a state to purchase additional quantities of adult
vaccines from manufacturers at the applicable price negotiated by the
Secretary. Requires the Secretary, acting through the Director of CDC,
to establish a demonstration program to award grants to states to
improve the provision of recommended immunizations for children and
adults through the use of evidence-based, population-based
interventions for high-risk populations. Reauthorizes appropriations
for preventive health service programs to immunize children and adults
against vaccine-preventable diseases without charge. Requires the
Comptroller General to study the ability of Medicare beneficiaries who
are 65 years or older to access routinely recommended vaccines covered
under the prescription drug program since its establishment.

(Sec. 4205)

Amends the Federal Food, Drug, and Cosmetic Act to require the
labeling of a food item offered for sale in a retail food
establishment that is part of a chain with 20 or more locations under
the same name to disclose on the menu and menu board:
(1) the number of calories contained in the standard menu item;
(2) the suggested daily caloric intake; and
(3) the availability on the premises and upon request of specified
additional nutrient information. Requires self-service facilities to
place adjacent to each food offered a sign that lists calories per
displayed food item or per serving. Requires vending machine operators
who operate 20 or more vending machines to provide a sign disclosing
the number of calories contained in each article of food.

(Sec. 4206)

Requires the Secretary to establish a pilot program to test the impact
of providing at-risk populations who utilize community health centers
an individualized wellness plan designed to reduce risk factors for
preventable conditions as identified by a comprehensive risk-factor
assessment.

(Sec. 4207)

Amends the Fair Labor Standards Act of 1938 to require employers to
provide a reasonable break time and a suitable place, other than a
bathroom, for an employee to express breast milk for her nursing
child. Excludes an employer with less than 50 employees if such
requirements would impose an undue hardship. Subtitle D: Support for
Prevention and Public Health Innovation -

(Sec. 4301)

Requires the Secretary, acting through the Director of CDC, to provide
funding for research in the area of public health services and
systems.

(Sec. 4302)

Requires the Secretary to ensure that any federally conduced or
supported health care or public health program, activity, or survey
collects and reports specified demographic data regarding health
disparities. Requires the Secretary, acting through the National
Coordinator for Health Information Technology, to develop:
(1) national standards for the management of data collected; and
(2) interoperability and security systems for data management. (Sec.
4303, as modified by Sec. 10404) Requires the Director of CDC to:
(1) provide employers with technical assistance, consultation, tools,
and other resources in evaluating employer-based wellness programs;
and
(2) build evaluation capacity among workplace staff by training
employers on how to evaluate such wellness programs and ensuring that
evaluation resources, technical assistance, and consultation are
available. Requires the Director of CDC to conduct a national worksite
health policies and programs survey to assess employer-based health
policies and programs.

(Sec. 4304)

Requires the Secretary, acting through the Director of CDC, to
establish an Epidemiology and Laboratory Capacity Grant Program to
award grants to assist public health agencies in improving
surveillance for, and response to, infectious diseases and other
conditions of public health importance.

(Sec. 4305)

Requires the Secretary to:
(1) enter into an agreement with the Institute of Medicine to convene
a Conference on Pain, the purposes of which shall include to increase
the recognition of pain as a significant public health problem in the
United States; and
(2) establish the Interagency Pain Research Coordinating Committee.

(Sec. 4306)

Appropriates funds to carry out childhood obesity demonstration
projects. Subtitle E: Miscellaneous Provisions -

(Sec. 4402)

Requires the Secretary to evaluate programs to determine whether
existing federal health and wellness initiatives are effective in
achieving their stated goals. Title V: Health Care Workforce -
Subtitle A: Purpose and Definitions -

(Sec. 5001)

Declares that the purpose of this title is to improve access to and
the delivery of health care services for all individuals, particularly
low income, underserved, uninsured, minority, health disparity, and
rural populations. Subtitle B: Innovations in the Health Care
Workforce - (Sec. 5101, as modified by Sec. 10501) Establishes a
National Health Care Workforce Commission to:
(1) review current and projected health care workforce supply and
demand; and
(2) make recommendations to Congress and the Administration concerning
national health care workforce priorities, goals, and policies.

(Sec. 5102)

Establishes a health care workforce development grant program.

(Sec. 5103)

Requires the Secretary to establish the National Center for Health
Care Workforce Analysis to provide for the development of information
describing and analyzing the health care workforce and workforce
related issues. Transfers the responsibilities and resources of the
National Center for Health Workforce Analysis to the Center created
under this section. (Sec. 5104, as added by Sec. 10501) Establishes
the Interagency Access to Health Care in Alaska Task Force to:
(1) assess access to health care for beneficiaries of federal health
care systems in Alaska; and
(2) develop a strategy to improve delivery to such beneficiaries.
Subtitle C: Increasing the Supply of the Health Care Workforce -

(Sec. 5201)

Revises student loan repayment provisions related to the length of
service requirement for the primary health care loan repayment
program.

(Sec. 5202)

Increases maximum amount of loans made by schools of nursing to
students.

(Sec. 5203)

Directs the Secretary to establish and carry out a pediatric specialty
loan repayment program.

(Sec. 5204)

Requires the Secretary to establish the Public Health Workforce Loan
Repayment Program to assure an adequate supply of public health
professionals to eliminate critical public health workforce shortages
in federal, state, local, and tribal public health agencies.

(Sec. 5205)

Amends the Higher Education Act of 1965 to expand student loan
forgiveness to include allied health professionals employed in public
health agencies.

(Sec. 5206)

Includes public health workforce loan repayment programs as permitted
activities under a grant program to increase the number of individuals
in the public health workforce. Authorizes the Secretary to provide
for scholarships for mid-career professionals in the public health and
allied health workforce to receive additional training in the field of
public health and allied health.

(Sec. 5207)

Authorizes appropriations for the National Health Service Corps
Scholarship Program and the National Health Service Corps Loan
Repayment Program.

(Sec. 5208)

Requires the Secretary to award grants for the cost of the operation
of nurse-managed health clinics.

(Sec. 5209)

Eliminates the cap on the number of commissioned officers in the
Public Health Service Regular Corps.

(Sec. 5210)

Revises the Regular Corps and the Reserve Corps (renamed the Ready
Reserve Corps) in the Public Health Service. Sets forth the uses of
the Ready Reserve Corps. Subtitle D: Enhancing Health Care Workforce
Education and Training -

(Sec. 5301)

Sets forth provisions providing for health care professional training
programs.

(Sec. 5302)

Requires the Secretary to award grants for new training opportunities
for direct care workers who are employed in long-term care settings.

(Sec. 5303)

Sets forth provisions providing for dentistry professional training
programs.

(Sec. 5304)

Authorizes the Secretary to award grants for demonstration programs to
establish training programs for alternative dental health care
providers in order to increase access to dental health services in
rural and other underserved communities.

(Sec. 5305)

Requires the Secretary to award grants or contracts to entities that
operate a geriatric education center to offer short-term, intensive
courses that focus on geriatrics, chronic care management, and
long-term care. Expands geriatric faculty fellowship programs to make
dentists eligible. Reauthorizes and revises the geriatric education
programs to allow grant funds to be used for the establishment of
traineeships for individuals who are preparing for advanced education
nursing degrees in areas that specialize in the care of elderly
populations.

(Sec. 5306)

Authorizes the Secretary to award grants to institutions of higher
education to support the recruitment of students for, and education
and clinical experience of the students in, social work programs,
psychology programs, child and adolescent mental health, and training
of paraprofessional child and adolescent mental health workers.

(Sec. 5307)

Authorizes the Secretary, acting through the Administrator of HRSA, to
award grants, contracts, or cooperative agreements for the
development, evaluation, and dissemination of research, demonstration
projects, and model curricula for health professions training in
cultural competency, prevention, public health proficiency, reducing
health disparities, and working with individuals with disabilities.

(Sec. 5308)

Requires nurse-midwifery programs, in order to be eligible for
advanced education nursing grants, to have as their objective the
education of midwives and to be accredited by the American College of
Nurse-Midwives Accreditation Commission for Midwifery Education.

(Sec. 5309)

Authorizes the Secretary to award grants or enter into contracts to
enhance the nursing workforce by initiating and maintaining nurse
retention programs.

(Sec. 5310)

Makes nurse faculty at an accredited school of nursing eligible for
the nursing education loan repayment program.

(Sec. 5311)

Revises the nurse faculty loan repayment program, including to
increase the amount of such loans. Authorizes the Secretary, acting
through the Administrator of HRSA, to enter into an agreement for the
repayment of education loans in exchange for service as a member of a
faculty at an accredited school of nursing.

(Sec. 5312)

Authorizes appropriations for carrying out nursing workforce programs.
(Sec. 5313, as modified by Sec. 10501) Requires the Director of CDC to
award grants to eligible entities to promote positive health behaviors
and outcomes for populations in medically underserved communities
through the use of community health workers.

(Sec. 5314)

Authorizes the Secretary to carry out activities to address documented
workforce shortages in state and local health departments in the
critical areas of applied public health epidemiology and public health
laboratory science and informatics.

(Sec. 5315)

Authorizes the establishment of the United States Public Health
Sciences Track, which is authorized to award advanced degrees in
public health, epidemiology, and emergency preparedness and response.
Directs the Surgeon General to develop:
(1) an integrated longitudinal plan for health professions continuing
education; and
(2) faculty development programs and curricula in decentralized venues
of health care to balance urban, tertiary, and inpatient venues. (Sec.
5316, as added by Sec. 10501) Requires the Secretary to establish a
training demonstration program for family nurse practitioners to
employ and provide one-year training for nurse practitioners serving
as primary care providers in federally qualified health centers or
nurse-managed health centers. Subtitle E: Supporting the Existing
Health Care Workforce -

(Sec. 5401)

Revises the allocation of funds to assist schools in supporting
programs of excellence in health professions education for
underrepresented minority individuals and schools designated as
centers of excellence. (Sec. 5402, as modified by Sec. 10501) Makes
schools offering physician assistant education programs eligible for
loan repayment for health profession faculty. Increases the amount of
loan repayment for such program. Authorizes appropriations for:
(1) scholarships for disadvantaged students attending health
professions or nursing schools;
(2) loan repayment for health professions faculty; and
(3) grants to health professions school to assist individuals from
disadvantaged backgrounds.

(Sec. 5403)

Requires the Secretary to:
(1) make awards for area health education center programs; and
(2) provide for timely dissemination of research findings using
relevant resources.

(Sec. 5404)

Makes revisions to the grant program to increase nursing education
opportunities for individuals from disadvantaged backgrounds to
include providing:
(1) stipends for diploma or associate degree nurses to enter a bridge
or degree completion program;
(2) student scholarships or stipends for accelerated nursing degree
programs; and
(3) advanced education preparation. (Sec. 5405, as modified by Sec.
10501) Requires the Secretary, acting through the Director of AHRQ, to
establish a Primary Care Extension Program to provide support and
assistance to educate primary care providers about preventive
medicine, health promotion, chronic disease management, mental and
behavioral health services, and evidence-based and evidence-informed
therapies and techniques. Requires the Secretary to award grants to
states for the establishment of Primary Care Extension Program State
Hubs to coordinate state health care functions with quality
improvement organizations and area health education centers. Subtitle
F: Strengthening Primary Care and Other Workforce Improvements - (Sec.
5501, as modified by Sec. 10501) Requires Medicare incentive payments
to:
(1) primary care practitioners providing primary care services on or
after January 1, 2011, and before January 1, 2016; and
(2) general surgeons performing major surgical procedures on or after
January 1, 2011, and before January 1, 2016, in a health professional
shortage area. (Sec. 5502, deleted by Sec. 10501)

(Sec. 5503)

Reallocates unused residency positions to qualifying hospitals for
primary care residents for purposes of payments to hospitals for
graduate medical education costs.

(Sec. 5504)

Revises provisions related to graduate medical education costs to
count the time residents spend in nonprovider settings toward the
full-time equivalency if the hospital incurs the costs of the stipends
and fringe benefits of such residents during such time. (Sec. 5505, as
modified by Sec. 10501) Includes toward the determination of full-time
equivalency for graduate medical education costs time spent by an
intern or resident in an approved medical residency training program
in a nonprovider setting that is primarily engaged in furnishing
patient care in nonpatient care activities.

(Sec. 5506)

Directs the Secretary, when a hospital with an approved medical
residency program closes, to increase the resident limit for other
hospitals based on proximity criteria.

(Sec. 5507)

Requires the Secretary to:
(1) award grants for demonstration projects that are designed to
provide certain low-income individuals with the opportunity to obtain
education and training for health care occupations that pay well and
that are expected to experience labor shortages or be in high demand;
and
(2) award grants to states to conduct demonstration projects for
purposes of developing core training competencies and certification
programs for personal or home care aides. Authorizes appropriations
for FY2009-FY2012 for family-to-family health information centers.

(Sec. 5508)

Authorizes the Secretary to award grants to teaching health centers
for the purpose of establishing new accredited or expanded primary
care residency programs. Allows up to 50% of time spent teaching by a
member of the National Health Service Corps to be considered clinical
practice for purposes of fulfilling the service obligation. Requires
the Secretary to make payments for direct and indirect expenses to
qualified teaching health centers for expansion or establishment of
approved graduate medical residency training programs.

(Sec. 5509)

Requires the Secretary to establish a graduate nurse education
demonstration under which a hospital may receive payment for the
hospital's reasonable costs for the provision of qualified clinical
training to advance practice nurses. Subtitle G: Improving Access to
Health Care Services -

(Sec. 5601)

Reauthorizes appropriations for health centers to serve medically
underserved populations

(Sec. 5602)

Requires the Secretary to establish through the negotiated rulemaking
process a comprehensive methodology and criteria for designation of
medically underserved populations and health professions shortage
areas.

(Sec. 5603)

Reauthorizes appropriations for FY2010-FY2014 for the expansion and
improvement of emergency medical services for children who need
treatment for trauma or critical care.

(Sec. 5604)

Authorizes the Secretary, acting through the Administrator of the
Substance Abuse and Mental Health Services Administration, to award
grants and cooperative agreements for demonstration projects for the
provision of coordinated and integrated services to special
populations through the co-location of primary and specialty care
services in community-based mental and behavioral health settings.

(Sec. 5605)

Establishes a Commission on Key National Indicators to:
(1) conduct comprehensive oversight of a newly established key
national indicators system; and
(2) make recommendations on how to improve such system. Directs the
National Academy of Sciences to enable the establishment of such
system by creating its own institutional capability or by partnering
with an independent private nonprofit organization to implement such
system. Directs the Comptroller General to study previous work
conducted by all public agencies, private organizations, or foreign
countries with respect to best practices for such systems. (Sec. 5606,
as added by Sec. 10501) Authorizes a state to award grants to health
care providers who treat a high percentage of medically underserved
populations or other special populations in the state. Subtitle H:
General Provisions -

(Sec. 5701)

Requires the Secretary to submit to the appropriate congressional
committees a report on activities carried out under this title and the
effectiveness of such activities.Title VI: Transparency and Program
Integrity - Subtitle A: Physician Ownership and Other Transparency -
(Sec. 6001, as modified by Sec. 10601) Amends SSA title XVIII
(Medicare) to prohibit physician-owned hospitals that do not have a
provider agreement by August 1, 2010, to participate in Medicare.
Allows their participation in Medicare under a rural provider and
hospital exception to the ownership or investment prohibition if they
meet certain requirements addressing conflict of interest, bona fide
investments, patient safety issues, and expansion limitations.

(Sec. 6002)

Amends SSA title XI to require drug, device, biological and medical
supply manufacturers to report to the Secretary transfers of value
made to a physician, physician medical practice, a physician group
practice, and/or teaching hospital, as well as information on any
physician ownership or investment interest in the manufacturer.
Provides penalties for noncompliance. Preempts duplicative state or
local laws.

(Sec. 6003)

Amends SSA title XVIII (Medicare), with respect to the Medicare
in-office ancillary exception to the prohibition against physician
self-referrals, to require a referring physician to inform the patient
in writing that the patient may obtain a specified imaging service
from a person other than the referring physician, a physician who is a
member of the same group practice as the referring physician, or an
individual directly supervised by the physician or by another
physician in the group practice. Requires the referring physician also
to provide the patient with a written list of suppliers who furnish
such services in the area in which the patient resides.

(Sec. 6004)

Amends SSA title XI to require prescription drug manufacturers and
authorized distributors of record to report to the Secretary specified
information pertaining to drug samples.

(Sec. 6005)

Amends SSA title XI to require a pharmacy benefit manager (PBM) or a
health benefits plan that manages prescription drug coverage under a
contract with a Medicare or Exchange health plan to report to the
Secretary information regarding the generic dispensing rate, the
rebates, discounts, or price concessions negotiated by the PBM, and
the payment difference between health plans and PBMs and the PBMs and
pharmacies. Subtitle B: Nursing Home Transparency and Improvement -
Part I: Improving Transparency of Information -

(Sec. 6101)

Amends SSA title XI to require SNFs under Medicare and nursing
facilities (NFs) under Medicaid to make available, upon request by the
Secretary, the HHS Inspector General, the states, or a state long-term
care ombudsman, information on ownership of the SNF or NF, including a
description of the facility's governing body and organizational
structure, as well as information regarding additional disclosable
parties.

(Sec. 6102)

Requires SNFs and NFs to operate a compliance and ethics program
effective in preventing and detecting criminal, civil, and
administrative violations. Directs the Secretary to establish and
implement a quality assurance and performance improvement program for
SNFs and NFs, including multi-unit chains of facilities

(Sec. 6103)

Amends SSA title XVIII (Medicare) to require the Secretary to publish
on the Nursing Home Compare Medicare website:
(1) standardized staffing data;
(2) links to state Internet websites regarding state survey and
certification programs;
(3) the model standardized complaint form;
(4) a summary of substantiated complaints; and
(5) the number of adjudicated instances of criminal violations by a
facility or its employee.

(Sec. 6104)

Requires SNFs to report separately expenditures on wages and benefits
for direct care staff, breaking out registered nurses, licensed
professional nurses, certified nurse assistants, and other medical and
therapy staff.

(Sec. 6105)

Requires the Secretary to develop a standardized complaint form for
use by residents (or a person acting on a resident’s behalf) in filing
complaints with a state survey and certification agency and a state
long-term care ombudsman program. Requires states to to establish
complaint resolution processes.

(Sec. 6106)

Amends SSA title XI to require the Secretary to develop a program for
facilities to report direct care staffing information on payroll and
other verifiable and auditable data in a uniform format based.

(Sec. 6107)

Requires the Comptroller General to study and report to Congress on
the Five-Star Quality Rating System for nursing homes of CMMS.Part II:
Targeting Enforcement -

(Sec. 6111)

Amends SSA title XVIII (Medicare) to authorize the Secretary to reduce
civil monetary penalties by 50% for certain SNFs and NFs that
self-report and promptly correct deficiencies within 10 calendar days
of imposition of the penalty. Directs the Secretary to issue
regulations providing for an informal dispute resolution process after
imposition of a penalty, as well as an escrow account for money
penalties pending resolution of any appeals.

(Sec. 6112)

Directs the Secretary to establish a demonstration project for
developing, testing, and implementing a national independent monitor
program to oversee interstate and large intrastate chains of SNFs and
NFs.

(Sec. 6113)

Requires the administrator of a SNF or a NF that is preparing to close
to notify in writing residents, legal representatives of residents or
other responsible parties, the Secretary, and the state long-term care
ombudsman program in advance of the closure by at least 60 days.
Requires the notice to include a plan for the transfer and adequate
relocation of residents to another facility or alternative setting.
Requires the state to ensure a successful relocation of residents.

(Sec. 6114)

Requires the Secretary to conduct two SNF- and NF-based demonstration
projects to develop best practice models in two areas:
(1) one for facilities involved in the “culture change” movement; and
(2) one for the use of information technology to improve resident
care.Part III: Improving Staff Training -

(Sec. 6121)

Requires SNFs and NFs to include dementia management and abuse
prevention training as part of pre-employment initial training and, if
appropriate, as part of ongoing in-service training for permanent and
contract or agency staff.Subtitle C: Nationwide Program for National
and State Background Checks on Direct Patient Access Employees of Long
Term Care Facilities and Providers -

(Sec. 6201)

Requires the Secretary to establish a nationwide program for national
and state background checks on prospective direct patient access
employees of long-term care facilities and providers.Subtitle D:
Patient-Centered Outcomes Research - (Sec. 6301, as modified by Sec.
10602) Amends SSA title XI to establish the Patient-Centered Outcomes
Research Institute to identify priorities for, and establish, update,
and carry out, a national comparative outcomes research project
agenda. Provides for a peer review process for primary research.
Prohibits the Institute from allowing the subsequent use of data from
original research in work-for-hire contracts with individuals,
entities, or instrumentalities that have a financial interest in the
results, unless approved by the Institute under a data use agreement.
Amends the Public Health Service Act to direct the Office of
Communication and Knowledge Transfer at AHRQ to disseminate broadly
the research findings published by the Institute and other
government-funded research relevant to comparative clinical effective
research. Prohibits the Secretary from using evidence and findings
from Institute research to make a determination regarding Medicare
coverage unless such use is through an iterative and transparent
process which includes public comment and considers the effect on
subpopulations. Amends the Internal Revenue Code to establish in the
Treasury the Patient-Centered Outcomes Research Trust Fund. Directs
the Secretary to make transfers to that Trust Fund from the Medicare
Trust Funds. Imposes annual fees of $2 times the number of insured
lives on each specified health insurance policy and on self-insured
health plans.

(Sec. 6302)

Terminates the Federal Coordinating Council for Comparative
Effectiveness Research upon enactment of this Act.Subtitle E:
Medicare, Medicaid, and CHIP Program Integrity Provisions - (Sec.
6401, as modified by Sec. 10603) Amends SSA title XVIII (Medicare) to
require the Secretary to:
(1) establish procedures for screening providers and suppliers
participating in Medicare, Medicaid, and CHIP; and
(2) determine the level of screening according to the risk of fraud,
waste, and abuse with respect to each category of provider or
supplier.Requires providers and suppliers applying for enrollment or
revalidation of enrollment in Medicare, Medicaid, or CHIP to disclose
current or previous affiliations with any provider or supplier that:
(1) has uncollected debt;
(2) has had its payments suspended;
(3) has been excluded from participating in a federal health care
program; or
(4) has had billing privileges revoked. Authorizes the Secretary to
deny enrollment in a program if these affiliations pose an undue risk
to it. Requires providers and suppliers to establish a compliance
program containing specified core elements. Directs the CMMS
Administrator to establish a process for making available to each
state agency with responsibility for administering a state Medicaid
plan or a child health plan under SSA title XXI the identity of any
provider or supplier under Medicare or CHIP who is terminated.

(Sec. 6402)

Requires CMMS to include in the integrated data repository claims and
payment data from Medicare, Medicaid, CHIP, and health-related
programs administered by the Departments of Veterans Affairs (VA) and
DOD, the Social Security Administration, and IHS. Directs the
Secretary to enter into data-sharing agreements with the Commissioner
of Social Security, the VA and DOD Secretaries, and the IHS Director
to help identity fraud, waste, and abuse. Requires that overpayments
be reported and returned within 60 days from the date the overpayment
was identified or by the date a corresponding cost report was due,
whichever is later. Directs the Secretary to issue a regulation
requiring all Medicare, Medicaid, and CHIP providers to include their
National Provider Identifier on enrollment applications. Authorizes
the Secretary to withhold the federal matching payment to states for
medical assistance expenditures whenever a state does not report
enrollee encounter data in a timely manner to the state’s Medicaid
Management Information System. Authorizes the Secretary to exclude
providers and suppliers participation in any federal health care
program for providing false information on any application to enroll
or participate.Subjects to civil monetary penalties excluded
individuals who:
(1) order or prescribe an item or service;
(2) make false statements on applications or contracts to participate
in a federal health care program; or
(3) know of an overpayment and do not return it. Subjects the latter
offense to civil monetary penalties of up to $50,000 or triple the
total amount of the claim involved.Authorizes the Secretary to issue
subpoenas and require the attendance and testimony of witnesses and
the production of any other evidence that relates to matters under
investigation or in question.Requires the Secretary take into account
the volume of billing for a durable medical equipment (DME) supplier
or home health agency when determining the size of the supplier's and
agency's surety bond. Authorizes the Secretary to require other
providers and suppliers to post a surety bond if the Secretary
considers them to be at risk.Authorizes the Secretary to suspend
payments to a provider or supplier pending a fraud
investigation.Appropriates an additional $10 million, adjusted for
inflation, to the Health Care Fraud and Abuse Control each of
FY2011-FY2020. Applies inflation adjustments as well to Medicare
Integrity Program funding.Requires the Medicaid Integrity Program and
Program contractors to provide the Secretary and the HHS Office of
Inspector General with performance statistics, including the number
and amount of overpayments recovered, the number of fraud referrals,
and the return on investment for such activities.

(Sec. 6403)

Requires the Secretary to furnish the National Practitioner Data Bank
(NPDB) with all information reported to the national health care fraud
and abuse data collection program on certain final adverse actions
taken against health care providers, suppliers, and practitioners.
Requires the Secretary to establish a process to terminate the
Healthcare Integrity and Protection Databank (HIPDB) and ensure that
the information formerly collected in it is transferred to the NPDB.

(Sec. 6404)

Reduces from three years to one year after the date of service the
maximum period for submission of Medicare claims.(Sec. 6405, as
modified by Sec. 10604) Requires DME or home health services to be
ordered by an enrolled Medicare eligible professional or physician.
Authorizes the Secretary to extend these requirements to other
Medicare items and services to reduce fraud, waste, and abuse.

(Sec. 6406)

Authorizes the Secretary to disenroll, for up to one year, a Medicare
enrolled physician or supplier that fails to maintain and provide
access to written orders or requests for payment for DME,
certification for home health services, or referrals for other items
and services. Authorizes the Secretary to exclude from participation
in any federal health care program any individual or entity ordering,
referring for furnishing, or certifying the need for an item or
service that fails to provide adequate documentation to verify
payment.(Sec. 6407, as modified by Sec. 10605) Requires a physician,
nurse practitioner, clinical nurse specialist, certified
nurse-midwife, or physician assistant to have a face-to-face encounter
with an individual before issuing a certification for home health
services or DME. Authorizes the Secretary to apply the same
face-to-face encounter requirement to other items and services based
upon a finding that doing so would reduce the risk of fraud, waste,
and abuse. Applies the same requirement, as well, to physicians making
certifications for home health services under Medicaid.

(Sec. 6408)

Revises civil monetary penalties for making false statements or
delaying inspections. Applies specified enhanced sanctions and civil
monetary penalties to MA or Part D plans that:
(1) enroll individuals in an MA or Part D plan without their consent;
(2) transfer an individual from one plan to another for the purpose of
earning a commission;
(3) fail to comply with marketing requirements and CMMS guidance; or
(4) employ or contract with an individual or entity that commits a
violation.

(Sec. 6409)

Requires the Secretary to establish a self-referral disclosure
protocol to enable health care providers and suppliers to disclose
actual or potential violations of the physician self-referral law.
Authorizes the Secretary to reduce the amount due and owing for all
violations of such law.

(Sec. 6410)

Requires the Secretary to:
(1) expand the number of areas to be included in round two of the
competitive bidding program from 79 to 100 of the largest metropolitan
statistical areas ; and
(2) use competitively bid prices in all areas by 2016.

(Sec. 6411)

Requires states to establish contracts with one or more Recovery Audit
Contractors (RACs), which shall identify underpayments and
overpayments and recoup overpayments made for services provided under
state Medicaid plans as well as state plan waivers. Requires the
Secretary to expand the RAC program to Medicare parts C
(Medicare+Choice) and D (Prescription Drug Program).Subtitle F:
Additional Medicaid Program Integrity Provisions -

(Sec. 6501)

Amends SSA title XIX (Medicaid) to require states to terminate
individuals or entities (providers) from their Medicaid programs if
they were terminated from Medicare or another state’s Medicaid
program.

(Sec. 6502)

Requires Medicaid agencies to exclude individuals or entities from
participating in Medicaid for a specified period of time if the entity
or individual owns, controls, or manages an entity that:
(1) has failed to repay overpayments during a specified period;
(2) is suspended, excluded, or terminated from participation in any
Medicaid program; or
(3) is affiliated with an individual or entity that has been
suspended, excluded, or terminated from Medicaid participation.

(Sec. 6503)

Requires state Medicaid plans to require any billing agents,
clearinghouses, or other alternate payees that submit claims on behalf
of health care providers to register with the state and the Secretary.

(Sec. 6504)

Requires states to submit data elements from the state mechanized
claims processing and information retrieval system (under the Medicaid
Statistical Information System) that the Secretary determines
necessary for program integrity, program oversight, and
administration. Requires a Medicaid managed care entity contract to
provide for maintenance of sufficient patient encounter data to
identify the physician who delivers services to patients (as under
current law) at a frequency and level of detail to be specified by the
Secretary.

(Sec. 6505)

Requires a state Medicaid plan to prohibit the state from making any
payments for items or services under a Medicaid state plan or a waiver
to any financial institution or entity located outside of the United
States.

(Sec. 6506)

Extends the period for states to recover overpayments from 60 days to
one year after discovery of the overpayment. Declares that, when
overpayments due to fraud are pending, state repayments of the federal
portion of such overpayments shall not be due until 30 days after the
date of the final administrative or judicial judgment on the matter.

(Sec. 6507)

Requires state mechanized Medicaid claims processing and information
retrieval systems to incorporate methodologies compatible with
Medicare’s National Correct Coding Initiative .Subtitle G: Additional
Program Integrity Provisions -

(Sec. 6601)

Amends the Employee Retirement Income Security Act of 1974 (ERISA) to
prohibit employees and agents of multiple employer welfare
arrangements (MEWAs), subject to criminal penalties, from making false
statements in marketing materials regarding an employee welfare
benefit plan’s financial solvency, benefits, or regulatory status.

(Sec. 6603)

Amends the Public Health Service Act to direct the Secretary to
request NAIC to develop a model uniform report form for a private
health insurance issuer seeking to refer suspected fraud and abuse to
state insurance departments or other responsible state agencies for
investigation.

(Sec. 6604)

Amends ERISA to direct the Secretary of Labor to adopt regulatory
standards and/or issue orders to subject MEWAs to state law relating
to fraud and abuse.

(Sec. 6605)

Authorizes the Secretary of Labor to:
(1) issue cease-and-desist orders to shut down temporarily the
operations of MEWAs conducting fraudulent activities or posing a
serious threat to the public, until hearings can be completed; and
(2) seize a plan's assets if it appears that the plan is in a
financially hazardous condition.

(Sec. 6606)

Directs the Secretary of Labor to require MEWAs which are not group
health plans to register with the Department of Labor before operating
in a state.

(Sec. 6607)

Authorizes the Secretary of Labor to promulgate a regulation providing
an evidentiary privilege that allows confidential communication among
specified federal and state officials relating to investigation of
fraud and abuse. Subtitle H: Elder Justice Act - Elder Justice Act of
2009 -

(Sec. 6702)

Amends SSA title XX (Block Grants to States for Social Services) with
respect to elder abuse, neglect, and exploitation and their
prevention. Requires the HHS Secretary to award grants and carry out
activities that provide:
(1) greater protection to those individuals seeking care in facilities
that provide long-term care services and supports; and
(2) greater incentives for individuals to train and seek employment at
such facilities.Requires facility owners, operators, and certain
employees to report suspected crimes committed at a facility. Requires
facility owners or operators also to:
(1) submit to the Secretary and to the state written notification of
an impending closure of a facility within 60 days before the closure;
and
(2) include a plan for transfer and adequate relocation of all
residents. Establishes an Elder Justice Coordinating Council. Subtitle
I: Sense of the Senate Regarding Medical Malpractice -

(Sec. 6801)

Expresses the sense of the Senate that:
(1) health reform presents an opportunity to address issues related to
medical malpractice and medical liability insurance;
(2) states should be encouraged to develop and test alternative models
to the existing civil litigation system; and
(3) Congress should consider state demonstration projects to evaluate
such alternatives. Title VII: Improving Access to Innovative Medical
Therapies - Subtitle A: Biologics Price Competition and Innovation -
Biologics Price Competition and Innovation Act of 2009 -

(Sec. 7002)

Amends the Public Health Service Act to allow a person to submit an
application for licensure of a biological product based on its
similarity to a licensed biological product (the reference product).
Requires the Secretary to license the biological product if it is
biosimilar to or interchangeable with the reference product. Prohibits
the Secretary from determining that a second or subsequent biological
product is interchangeable with a reference product for any condition
of use for specified periods based on the marketing of, and the
presence or status of litigation involving, the first biosimilar
biological product deemed interchangeable with the same reference
product. Prohibits the Secretary from making approval of an
application under this Act effective until 12 years after the date on
which the reference product was first licensed. Subtitle B: More
Affordable Medicine for Children and Underserved Communities -

(Sec. 7101)

Expands the 340B drug discount program (a program limiting the cost of
covered outpatient drugs to certain federal grantees) to allow
participation as a covered entity by certain:
(1) children's hospitals;
(2) freestanding cancer hospitals;
(3) critical access hospitals;
(4) rural referral centers; and
(5) sole community hospitals. Expands the program to include drugs
used in connection with an inpatient or outpatient service by enrolled
hospitals (currently, only outpatient drugs are covered under the
program). Requires the Secretary to establish reasonable exceptions to
the prohibition on enrolled hospitals obtaining covered outpatient
drugs through a group purchasing organization or other group
purchasing arrangement, including for drugs unavailable through the
program and to facilitate generic substitution when a generic covered
drug is available at a lower price. Allows such hospitals to purchase
covered drugs for inpatients through any such arrangement. Requires a
hospital enrolled in the 340B drug discount program to issue a credit
to a state Medicaid program for inpatient covered drugs provided to
Medicaid recipients.

(Sec. 7102)

Requires the Secretary to:
(1) provide for improvements in compliance by manufacturers and
covered entities with the requirements of the 340B drug discount
program; and
(2) establish and implement an administrative process for resolving
claims by covered entities and manufacturers of violations of such
requirements. Requires manufacturers to offer each covered entity
covered drugs for purchase at or below the applicable ceiling price if
such a drug is made available to any other purchaser at any price.

(Sec. 7103)

Requires the Comptroller General to report to Congress on whether
those individuals served by the covered entities under the 340B drug
discount program are receiving optimal health care services. Title
VIII: Class Act - Community Living Assistance Services and Supports
Act or the CLASS Act - (Sec. 8002, as modified by Sec. 10801)
Establishes a national, voluntary insurance program for purchasing
community living assistance services and supports (CLASS program)
under which:
(1) all employees are automatically enrolled, but are allowed to waive
enrollment;
(2) payroll deductions pay monthly premiums; and
(3) benefits under a CLASS Independence Benefit Plan provide
individuals with functional limitations with tools that will allow
them to maintain their personal and financial independence and live in
the community.Title IX: Revenue Provisions - Subtitle A: Revenue
Offset Provisions - (Sec. 9001, as modified by section 10901) Amends
the Internal Revenue Code to impose an excise tax of 40% of the excess
benefit from certain high cost employer-sponsored health coverage.
Deems any amount which exceeds payment of $8,500 for an employee
self-only coverage plan and $23,000 for employees with other than
self-only coverage (family plans) as an excess benefit. Increases such
amounts for certain retirees and employees who are engaged in
high-risk professions (e.g., law enforcement officers, emergency
medical first responders, or longshoremen). Imposes a penalty on
employers and coverage providers for failure to calculate the proper
amount of an excess benefit.

(Sec. 9002)

Requires employers to include in the W-2 form of each employee the
aggregate cost of applicable employer-sponsored group health coverage
that is excludable from the employee's gross income (excluding the
value of contributions to flexible spending arrangements).

(Sec. 9003)

Restricts payments from health savings accounts, medical savings
accounts, and heath flexible spending arrangements for medications to
prescription drugs or insulin.

(Sec. 9004)

Increases to 20% the penalty for distributions from a health savings
account or Archer medical savings account not used for qualified
medical expenses. (Sec. 9005, as modified by section 10902) Limits
annual salary reduction contributions by an employee to a health
flexible spending arrangement under a cafeteria plan to $2,500. Allows
an annual inflation adjustment to such amount after 2011.

(Sec. 9006)

Expands reporting requirements for payments of $600 or more to
corporations (other than tax-exempt corporations). (Sec. 9007, as
modified by section 10903) Requires tax-exempt charitable hospitals
to:
(1) conduct a community health needs assessment every two years;
(2) adopt a written financial assistance policy for patients who
require financial assistance for hospital care; and
(3) refrain from taking extraordinary collection actions against a
patient until the hospital has made reasonable efforts to determine
whether the patient is eligible for financial assistance. Imposes a
penalty tax on hospitals who fail to comply with the requirements of
this Act. Requires the Secretary of the Treasury to report to Congress
on information with respect to private tax-exempt, taxable, and
government-owned hospitals regarding levels of charity care provided,
bad debt expenses, unreimbursed costs, and costs for community benefit
activities.

(Sec. 9008)

Imposes an annual fee on the branded prescription drug sales exceeding
$5 million of manufacturers and importers of such drugs beginning in
2010. Requires the HHS, VA, and DOD Secretaries to report to the
Secretary of the Treasury on the total branded prescription drug sales
within government programs within their departments. (Sec. 9009, as
modified by section 10904) Imposes an annual fee on the gross sales
receipts exceeding $5 million of manufacturers and importers of
certain medical devices beginning in 2011. (Sec. 9010, as modified by
section 10905) Imposes on any entity that provides health insurance
for any United States health risk an annual fee beginning in 2011.
Exempts entities whose net premiums written are not more than $25
million. Requires all entities subject to such fee to report to the
Secretary of the Treasury on their net written premiums and imposes a
penalty for failure to report.

(Sec. 9011)

Requires the VA Secretary to study and report to Congress by December
31, 2012, on the effect of fees assessed by this Act on the cost of
medical care provided to veterans and on veterans' access to medical
devices and branded prescription drugs.

(Sec. 9012)

Eliminates the tax deduction for expenses for determining the subsidy
for employers who maintain prescription drug plans for Medicare Part D
eligible retirees.

(Sec. 9013)

Increases the adjusted gross income threshold for claiming the
itemized deduction for medical expenses from 7.5% to 10% beginning
after 2012. Retains the 7.5% threshold through 2016 for individual
taxpayers who have attained age 65 before the close of an applicable
taxable year.

(Sec. 9014)

Imposes a limitation after December 31, 2012, of $500,000 on the
deductibility of remuneration paid to officers, directors, employees,
and service providers of health insurance issuers who derive at least
25% of their gross premiums from providing health insurance coverage
that meets the minimum essential coverage requirements established by
this Act. (Sec. 9015, as modified by section 10906) Increases after
December 31, 2012, the hospital insurance tax rate by .9% for
individual taxpayers earning over $200,000 ($250,000 for married
couples filing joint tax returns).

(Sec. 9016)

Requires Blue Cross or Blue Shield organizations or other nonprofit
organizations that provide health insurance to reimburse at least 85%
of the cost of clinical services provided to their enrollees to be
eligible for special tax benefits currently provided to such
organizations. Subtitle B: Other Provisions -

(Sec. 9021)

Excludes from gross income the value of certain health benefits
provided to members of Indian tribes, including:
(1) health services or benefits provided or purchased by IHS;
(2) medical care provided by an Indian tribe or tribal organization to
a member of an Indian tribe;
(3) accident or health plan coverage provided by an Indian tribe or
tribal organization for medical care to a member of an Indian tribe
and dependents; and
(4) any other medical care provided by an Indian tribe that
supplements, replaces, or substitutes for federal programs.

(Sec. 9022)

Establishes a new employee benefit cafeteria plan to be known as a
Simple Cafeteria Plan, defined as a plan that:
(1) is established and maintained by an employer with an average of
100 or fewer employees during a two-year period;
(2) requires employers to make contributions or match employee
contributions to the plan; and
(3) requires participating employees to have at least 1,000 hours of
service for the preceding plan year; and
(4) allows such employees to elect any benefit available under the
plan.

(Sec. 9023)

Allows a 50% tax credit for investment in any qualifying therapeutic
discovery project, defined as a project that is designed to:
(1) treat or prevent diseases by conducting pre-clinical activities,
clinical trials, and clinical studies, or carrying out research
projects to approve new drugs or other biologic products;
(2) diagnose diseases or conditions to determine molecular factors
related to diseases or conditions; or
(3) develop a product, process, or technology to further the delivery
or administration of therapeutics. Directs the Secretary of the
Treasury to award grants for 50% of the investment in 2009 or 2010 in
such a project, in lieu of the tax credit. Title X: Strengthening
Quality, Affordable Health Care for All Americans - Subtitle A:
Provisions Relating to Title I -

(Sec. 10101)

Revises provisions of or related to Subtitles A, B, and C of Title I
of this Act (as reflected in the summary of those provisions).

(Sec. 10104)

Revises provisions of or related to Subtitle D of Title I of this Act
(as reflected in the summary of those provisions). Makes changes to
the False Claims Act related to the public disclosure bar on filing
civil claims.

(Sec. 10105)

Revises provisions of or related to Subtitles E, F, and G of Title I
of this Act (as reflected in the summary of those provisions).

(Sec. 10108)

Requires an offering employer to provide free choice vouchers to each
qualified employee. Defines "offering employer" to mean any employer
who offers minimum essential coverage to its employees consisting of
coverage through an eligible employer-sponsored plan and who pays any
portion of the costs of such plan. Defines "qualified employee" as an
employee whose required contribution for such coverage and household
income fall within a specified range. Requires:
(1) a Health Insurance Exchange to credit the amount of any free
choice voucher to the monthly premium of any qualified health plan in
which the employee is enrolled; and
(2) the offering employer to pay any amounts so credited to the
Exchange. Excludes the amount of any free choice voucher from the
gross income of the employee. Permits a deduction by employers for
such costs.

(Sec. 10109)

Amends the SSA to require the HHS Secretary to seek input to determine
if there could be greater uniformity in financial and administrative
health care activities and items. Requires the Secretary to:
(1) task the ICD-9-CM Coordination and Maintenance Committee to
convene a meeting to receive input regarding and recommend revisions
to the crosswalk between the Ninth and Tenth Revisions of the
International Classification of Diseases; and
(2) make appropriate revisions to such crosswalk.Subtitle B:
Provisions Relating to Title II - Part I: Medicaid and CHIP -

(Sec. 10201)

Revises provisions of Subtitles A through L of Title II of this Act
(as reflected in the summary of those provisions). Amends SSA title
XIX (Medicaid) to set the FMAP for the state of Nebraska, with respect
to all or any portion of a fiscal year that begins on or after January
1, 2017, at 100% (thus requiring the federal government to pay 100% of
the cost of covering newly-eligible individuals in Nebraska). Directs
the Comptroller General to study and report to Congress on whether the
development, recognition, or implementation of any specified health
care quality guideline or other standards would result in the
establishment of a new cause of action or claim.

(Sec. 10202)

Creates a State Balancing Incentive Payments Program to increase the
FMAP for states which offer home and community-based services as a
long-term care alternative to nursing homes.

(Sec. 10203)

Amends SSA title XXI (CHIP) to make appropriations for CHIP through
FY2015 and revise other CHIP-related requirements. Part II: Support
for Pregnant and Parenting Teens and Women -

(Sec. 10212)

Requires the Secretary to establish a Pregnancy Assistance Fund for
grants to states to assist pregnant and parenting teens and women.

(Sec. 10214)

Authorizes appropriations for FY2010-FY2019. Part III: Indian Health
Care Improvement -

(Sec. 10221)

Enacts into law the Indian Health Care Improvement Reauthorization and
Extension Act of 2009 (S. 1790), as reported by the Committee on
Indian Affairs of the Senate in December 2009. Amends the Indian
Health Care Improvement Act, as amended by the Indian Health Care
Improvement Reauthorization and Extension Act of 2009, to make an
exception to the requirement that a national Community Health Aide
Program exclude dental health aide therapist services. Declares that
the exclusion of dental health aide therapist services from services
covered under the national program shall not apply where an Indian
tribe or tribal organization, located in a state (other than Alaska)
in which state law authorizes the use of dental health aide therapist
services or midlevel dental health provider services, elects to supply
such services in accordance with state law. Subtitle C: Provisions
Relating to Title III -

(Sec. 10301)

Revises provisions of Subtitles A through G of Title III of this Act
(as reflected in the summary of those provisions).

(Sec. 10323)

Amends SSA title XVIII (Medicare) to deem eligible for Medicare
coverage certain individuals exposed to environmental health hazards.
Directs the Secretary to establish a pilot program for care of certain
individuals residing in emergency declaration areas. Amends SSA title
XX (Block Grants to States for Social Services) to direct the
Secretary to establish a program for early detection of certain
medical conditions related to environmental health hazards. Makes
appropriations for FY2012-FY2019.

(Sec. 10324)

Establishes floors:
(1) on the area wage index for hospitals in frontier states;
(2) on the area wage adjustment factor for hospital outpatient
department services in frontier states; and
(3) for practice expense index for services furnished in frontier
states.

(Sec. 10325)

Revises the SNF prospective payment system to delay specified changes
until FY2011.

(Sec. 10326)

Directs the Secretary to conduct separate pilot programs, for
specified kinds of hospitals and hospice programs, to test the
implementation of a value-based purchasing program for payments to the
provider.

(Sec. 10327)

Authorizes an additional incentive payment under the physician quality
reporting system in 2011 through 2014 to eligible professionals who
report quality measures to CMMS via a qualified Maintenance of
Certification program. Eliminates the MedicareAdvantage Regional Plan
Stabilization Fund.

(Sec. 10328)

Requires Medicare part D prescription drug plans to include a
comprehensive review of medications as part of their medication
therapy management programs. Requires automatic quarterly enrollment
of qualified beneficiaries, with an allowance for them to opt out.

(Sec. 10329)

Requires the Secretary to develop a methodology to measure health plan
value.

(Sec. 10330)

Directs the Secretary to develop a plan to modernize CMMS computer and
data systems.

(Sec. 10331)

Requires the Secretary to:
(1) develop a Physician Compare Internet website with information on
physicians enrolled in the Medicare program and other eligible
professionals who participate in the Physician Quality Reporting
Initiative; and
(2) implement a plan to make information on physician performance
public through Physician Compare, particularly quality and patient
experience measures. Authorizes the Secretary to provide financial
incentives to Medicare beneficiaries furnished services by high
quality physicians.

(Sec. 10332)

Directs the Secretary to make available to qualified entities
standardized extracts of Medicare claims data for the evaluation of
the performance of service providers and suppliers.

(Sec. 10333)

Amends the Public Health Service Act to authorize the Secretary to
award grants to eligible entities to support community-based
collaborative care networks for low-income populations.

(Sec. 10334)

Transfers the Office of Minority Health to the Office of the
Secretary. Authorizes appropriations for FY2011-FY2016. Establishes
individual offices of minority health within HHS. Redesignates the
National Center on Minority Health and Health Disparities in the
National Institutes of Health as the National Institute on Minority
Health and Health Disparities.

(Sec. 10336)

Directs the Comptroller General to study and report to Congress on the
impact on Medicare beneficiary access to high-quality dialysis
services of including specified oral drugs furnished to them for the
treatment of end state renal disease in the related bundled
prospective payment system. Subtitle D: Provisions Relating to Title
IV -

(Sec. 10401)

Revises provisions of or related to Subtitles A, B, C, D, and E of
Title IV of this Act (as reflected in the summary of those
provisions).

(Sec. 10407)

Catalyst to Better Diabetes Care Act of 2009 - Requires the Secretary
to prepare biennially a national diabetes report card and, to the
extent possible, one for each state. Requires the Secretary, acting
through the Director of CDC, to:
(1) promote the education and training of physicians on the importance
of birth and death certificate data and on how to properly complete
these documents;
(2) encourage state adoption of the latest standard revisions of birth
and death certificates; and
(3) work with states to reengineer their vital statistics systems in
order to provide cost-effective, timely, and accurate vital systems
data. Allows the Secretary to promote improvements to the collection
of diabetes mortality data. Directs the Secretary to conduct a study
of the impact of diabetes on the practice of medicine in the United
States and the level of diabetes medical education that should be
required prior to licensure, board certification, and board
recertification.

(Sec. 10408)

Requires the Secretary to award grants to eligible employers to
provide their employees with access to comprehensive workplace
wellness programs.

(Sec. 10409)

Cures Acceleration Network Act of 2009 - Amends the Public Health
Service Act to require the Secretary, acting through the Director of
the National Institutes of Health (NIH), to implement the Cures
Acceleration Network under which grants and contracts will be awarded
to accelerate the development of high need cures. Defines "high need
cure" as a drug, biological product, or device:
(1) that is a priority to diagnose, mitigate, prevent, or treat harm
from any disease or condition; and
(2) for which the incentives of the commercial market are unlikely to
result in its adequate or timely development. Establishes a Cures
Acceleration Network Review Board.

(Sec. 10410)

Establishing a Network of Health-Advancing National Centers of
Excellence for Depression Act of 2009 or the ENHANCED Act of 2009 -
Requires the Secretary, acting through the Administrator of the
Substance Abuse and Mental Health Services Administration, to:
(1) award grants to establish national centers of excellence for
depression; and
(2) designate one such center as a coordinating center. Requires the
coordinating center to establish and maintain a national, publicly
available database to improve prevention programs, evidence-based
interventions, and disease management programs for depressive
disorders using data collected from the national centers.

(Sec. 10411)

Congenital Heart Futures Act - Authorizes the Secretary, acting
through the Director of CDC, to:
(1) enhance and expand infrastructure to track the epidemiology of
congenital heart disease and to organize such information into the
National Congenital Heart Disease Surveillance System; or
(2) award a grant to an eligible entity to undertake such activities.
Authorizes the Director of the National Heart, Lung, and Blood
Institute to expand, intensify, and coordinate research and related
Institute activities on congenital heart disease.

(Sec. 10412)

Reauthorizes appropriations for grants for public access
defibrillation programs. Requires an information clearinghouse to
increase public access to defibrillation in schools established under
such program to be administered by an organization that has
substantial expertise in pediatric education, pediatric medicine, and
electrophysiology and sudden death.

(Sec. 10413)

Young Women's Breast Health Education and Awareness Requires Learning
Young Act of 2009 or the EARLY Act - Requires the Secretary, acting
through the Director of CDC, to conduct:
(1) a national education campaign to increase awareness of young
women's knowledge regarding breast health and breast cancer;
(2) an education campaign among physicians and other health care
professionals to increase awareness of breast health of young women;
and
(3) prevention research on breast cancer in younger women. Requires
the Secretary, acting through the Director of NIH, to conduct research
to develop and validate new screening tests and methods for prevention
and early detection of breast cancer in young women. Directs the
Secretary to award grants for the provision of health information to
young women diagnosed with breast cancer and pre-neoplastic breast
diseases. Subtitle E: Provisions Relating to Title V -

(Sec. 10501)

Revises provisions of or related to Title V of this Act (as reflected
in the summary of those provisions). Requires the Secretary, acting
through the Director of CDC, to establish a national diabetes
prevention program targeted at adults at high risk for diabetes.
Directs the Secretary to develop a Medicare prospective payment system
for payment for services furnished by federally qualified health
centers. Requires the Secretary, acting through the Administrator of
the HRSA, to establish a grant program to assist accredited schools of
allopathic or osteopathic medicine in:
(1) recruiting students most likely to practice medicine in
underserved rural communities;
(2) providing rural-focused training and experience; and
(3) increasing the number of recent allopathic and osteopathic medical
school graduates who practice in underserved rural communities.
Directs the Secretary, acting through the Administrator of HRSA, to
award grants or enter into contracts with eligible entities to provide
training to graduate medical residents in preventive medicine
specialties. Reauthorizes appropriations for public health workforce
activities. Revises provisions related to fulfillment of service
obligations under the National Health Service Corps related to
half-time clinical practice and teaching.

(Sec. 10502)

Authorizes appropriations to HHS for debt service on, or direct
construction or renovation of, a health care facility that provides
research, inpatient tertiary care, or outpatient clinical services and
that meets certain requirements, including that it is critical for the
provision of greater access to health care within the state.

(Sec. 10503)

Establishes a Community Health Center Fund to provide for expanded and
sustained national investment in community health centers. Authorizes
appropriations to such Fund.

(Sec. 10504)

Requires the Secretary, acting through the Administrator of HRSA, to
establish a demonstration project to provide access to comprehensive
health care services to the uninsured at reduced fees. Subtitle F:
Provisions Relating to Title VI -

(Sec. 10601)

Revises provisions of Subtitles A through E of Title IV of this Act
(as reflected in the summary of those provisions).

(Sec. 10606)

Directs the U.S. Sentencing Commission to amend the Federal Sentencing
Guidelines to provide two-level, three-level, and four-level increases
in the offense level for any defendant convicted of a federal health
care offense relating to a Government health care program of a loss
between $1 million and $7 million, between $7 million and $20 million,
and at least $20 million, respectively. Provides that a person need
not have actual knowledge of the prohibition against health care fraud
nor specific intent to violate it in order to commit health care
fraud. Expands the scope of violations constituting a federal health
care offense. Amends the Civil Rights of Institutionalized Persons Act
to authorize the Attorney General to require access to an institution
by subpoena to investigate conditions depriving residents of specified
constitutional or federal rights.

(Sec. 10607)

Authorizes the Secretary to award demonstration grants to states for
the development, implementation, and evaluation of alternatives to
current tort litigation for resolving disputes over injuries allegedly
caused by health care providers or health care organizations.

(Sec. 10608)

Amends the Public Health Service Act to extend medical malpractice
coverage to free clinics by deeming their officers, employees, board
members, and contractors to be employees of the Public Health Service.

(Sec. 10609)

Amends the Federal, Drug, and Cosmetic Act to set forth circumstances
under which a generic drug may be approved with a label different from
the listed drug. Subtitle G: Provisions Relating to Title VIII -

(Sec. 10801)

Revises provisions of or related to Title VIII of this Act (as
reflected in the summary of those provisions). Subtitle H: Provisions
Relating to Title IX:

(Sec. 10901)

Revises provisions of or related to Title IX of this Act (as reflected
in the summary of those provisions).

(Sec. 10907)

Amends the Internal Revenue Code to impose a 10% excise tax on any
amount paid for indoor tanning services on or after July 1, 2010.
Exempts phototherapy services performed by a licensed medical
professional from the definition of "indoor tanning services."

(Sec. 10908)

Excludes from gross income any payments under the National Health
Service Corps Loan Repayment Program and any other state loan
repayment or forgiveness programs intended to increase the
availability of health care services in underserved or health
professional shortage areas.

(Sec. 10909)

Increases from $10,000 to $13,170 the dollar limitation on:
(1) the tax credit for adoption expenses; and
(2) the tax exclusion for employer-provided adoption assistance.
Allows an inflation adjustment to such limitation after 2010. Makes
such credit refundable. Extends through 2011 the general terminating
date of the Economic Growth and Tax Relief Reconciliation Act of 2001
with respect to such credit and exclusion.

...Read the Rest
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04/17/10

Congress passes menu labeling in health care reform

Embedded deep in the mammoth health care reform legislation, HR 3590,
is the menu labeling legislation for chain ...

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Implications for multiemployer welfare benefit plans

... clients understand the complexities of the new health care reform
changes in the Patient Protection and Affordable Care Act (HR 3590)
(the Reform Act), ...

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Healthcare reform - some key business opportunities every hospital CEO
should know

The passage of the Patient Protection and Affordable Care Act (HR
3590) (the “Act”) on March 23, 2010, ...

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Tricks 9 – The Week In Health Reform

Under reconciliation rules, the House first would have to pass the
Senate version of the health care reform bill, H.R. 3590, which passed
on Christmas Eve last year. After that, the House would then be
required to pass a separate ...

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H.R.3590: what is it exactly?  The Mountaineer@Green Mountain College

After months of being thrown back and forth between the House and
Senate, H.R. 3590, also known as the Patient Protection and Affordable
Care Act, was enacted into law on March 23rd, 2010. While the battle
to make this law has finally ...

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MORE DETAILS ON HEALTH CARE REFORM « DMEC Legislative Updates

On March 23, President Obama signed H.R. 3590, the Patient Protection
and Affordable Care Act and on March 30, he signed H.R. 4872, the
Health Care and Education Affordability Reconciliation Act of 2010, a
companion package of “fixes” ...

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between because whom look themselves should about here about
same myself my the to themselves
munchies who other whom she theirs into