SENATE HEALTHCARE BILL -- H.R. 3590
“Patient Protection and Affordable Care Act”
November 18, 2009
http://democrats.senate.gov/reform/patient-protection-affordable-care-act.pdf
(The version of the Senate Bill on Senator Reid’s website does not include page numbers on the Table of Contents. A private citizen has laboriously entered the page numbers on the attached Table of Contents.)
Table of Contents
Pages
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 4 (a) SHORT TITLE.—This Act may be cited as the 5 ‘‘Patient Protection and Affordable Care Act’’. 6 (b) TABLE OF CONTENTS.—The table of contents of 7 this Act is as follows: Sec. 1. Short title; table of contents. TITLE I—QUALITY, AFFORDABLE HEALTH CARE FOR ALL 15 AMERICANS Subtitle A—Immediate Improvements in Health Care Coverage for All 15 Americans Sec. 1001. Amendments to the Public Health Service Act. 15 ‘‘PART A—INDIVIDUAL AND GROUP MARKET REFORMS 15 ‘‘SUBPART II—IMPROVING COVERAGE 16 ‘‘Sec. 2711. No lifetime or annual limits 16 ‘‘Sec. 2712. Prohibition on rescissions. 16 ‘‘Sec. 2713. Coverage of preventive health services. 17 ‘‘Sec. 2714. Extension of dependent coverage. 18 ‘‘Sec. 2715. Development and utilization of uniform explanation of coverage 19 documents and standardized definitions. ‘‘Sec. 2716. Prohibition of discrimination based on salary. 26 ‘‘Sec. 2717. Ensuring the quality of care. 26 ‘‘Sec. 2718. Bringing down the cost of health care coverage. 30 ‘‘Sec. 2719. Appeals process. 33 Sec. 1002. Health insurance consumer information. 34 Sec. 1003. Ensuring that consumers get value for their dollars. 37 Sec. 1004. Effective dates. 40 Subtitle B—Immediate Actions to Preserve and Expand Coverage 41 Sec. 1101. Immediate access to insurance for uninsured individuals with a preexisting 41 condition. Sec. 1102. Reinsurance for early retirees. 48 Sec. 1103. Immediate information that allows consumers to identify affordable 54 coverage options. Sec. 1104. Administrative simplification. 57 Sec. 1105. Effective Date 77 Subtitle C—Quality Health Insurance Coverage for All Americans 78 PART I—HEALTH INSURANCE MARKET REFORMS 78 Sec. 1201. Amendment to the Public Health Service Act. 78 ‘‘SUBPART I—GENERAL REFORM 78 ‘‘Sec. 2701. Fair health insurance premiums. 80 ‘‘Sec. 2702. Guaranteed availability of coverage. 82 ‘‘Sec. 2703. Guaranteed renewability of coverage. 83 ‘‘Sec. 2704. Prohibition of preexisting condition exclusions or other discrimination 78 based on health status. ‘‘Sec. 2705. Prohibiting discrimination against individual participants and 83 beneficiaries based on health status. ‘‘Sec. 2706. Non-discrimination in health care. 95 ‘‘Sec. 2707. Comprehensive health insurance coverage. 96 ‘‘Sec. 2708. Prohibition on excessive waiting periods. 97 PART II—OTHER PROVISIONS 97 Sec. 1251. Preservation of right to maintain existing coverage. 97 Sec. 1252. Rating reforms must apply uniformly to all health insurance issuers 99 and group health plans. Sec. 1253. Effective dates. 99 Subtitle D—Available Coverage Choices for All Americans 100 PART I—ESTABLISHMENT OF QUALIFIED HEALTH PLANS 100 Sec. 1301. Qualified health plan defined. 100 Sec. 1302. Essential health benefits requirements. 102 Sec. 1303. Special rules. 116 Sec. 1304. Related definitions. 124 PART II—CONSUMER CHOICES AND INSURANCE COMPETITION THROUGH 128 HEALTH BENEFIT EXCHANGES Sec. 1311. Affordable choices of health benefit plans. 128 Sec. 1312. Consumer choice. 153 Sec. 1313. Financial integrity. 160 PART III—STATE FLEXIBILITY RELATING TO EXCHANGES 164 Sec. 1321. State flexibility in operation and enforcement of Exchanges and related 164 requirements. Sec. 1322. Federal program to assist establishment and operation of nonprofit, 168 member-run health insurance issuers. Sec. 1323. Community health insurance option. 182 Sec. 1324. Level playing field. 200 PART IV—STATE FLEXIBILITY TO ESTABLISH ALTERNATIVE PROGRAMS 201 Sec. 1331. State flexibility to establish basic health programs for low-income individuals 201 not eligible for Medicaid. Sec. 1332. Waiver for State innovation. 212 Sec. 1333. Provisions relating to offering of plans in more than one State. 219 PART V—REINSURANCE AND RISK ADJUSTMENT 226 Sec. 1341. Transitional reinsurance program for individual and small group 226 markets in each State. Sec. 1342. Establishment of risk corridors for plans in individual and small 233 group markets. Sec. 1343. Risk adjustment. 236 Subtitle E—Affordable Coverage Choices for All Americans 238 PART I—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS 238 SUBPART A—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS 238Sec. 1401. Refundable tax credit providing premium assistance for coverage 238 under a qualified health plan. Sec. 1402. Reduced cost-sharing for individuals enrolling in qualified health 259 plans. SUBPART B—ELIGIBILITY DETERMINATIONS 269 Sec. 1411. Procedures for determining eligibility for Exchange participation, 269 premium tax credits and reduced cost-sharing , and individual responsibility exemptions. Sec. 1412. Advance determination and payment of premium tax credits and 290 cost-sharing reductions. Sec. 1413. Streamlining of procedures for enrollment through an exchange and 295 State Medicaid, CHIP, and health subsidy programs. Sec. 1414. Disclosures to carry out eligibility requirements for certain programs. 302 Sec. 1415. Premium tax credit and cost-sharing reduction payments disregarded 306 for Federal and Federally-assisted programs. PART II—SMALL BUSINESS TAX CREDIT 307 Sec. 1421. Credit for employee health insurance expenses of small businesses. 307 Subtitle F—Shared Responsibility for Health Care 320 PART I—INDIVIDUAL RESPONSIBILITY 320 Sec. 1501. Requirement to maintain minimum essential coverage. 320 Sec. 1502. Reporting of health insurance coverage. 340 PART II—EMPLOYER RESPONSIBILITIES 346 Sec. 1511. Automatic enrollment for employees of large employers. 346 Sec. 1512. Employer requirement to inform employees of coverage options. 347 Sec. 1513. Shared responsibility for employers. 348 Sec. 1514. Reporting of employer health insurance coverage. 357 Sec. 1515. Offering of Exchange-participating qualified health plans through 362 cafeteria plans. Subtitle G—Miscellaneous Provisions 364 Sec. 1551. Definitions. 364 Sec. 1552. Transparency in government. 364 Sec. 1553. Prohibition against discrimination on assisted suicide. 364 Sec. 1554. Access to therapies. 366 Sec. 1555. Freedom not to participate in Federal health insurance programs. 367 Sec. 1556. Equity for certain eligible survivors. 367 Sec. 1557. Nondiscrimination. 368 Sec. 1558. Protections for employees. 369 Sec. 1559. Oversight. 371 Sec. 1560. Rules of construction. 371 Sec. 1561. Health information technology enrollment standards and protocols. 373 Sec. 1562. Conforming amendments. 377 TITLE II—ROLE OF PUBLIC PROGRAMS 396 Subtitle A—Improved Access to Medicaid 396 Sec. 2001. Medicaid coverage for the lowest income populations. 396 Sec. 2002. Income eligibility for nonelderly determined using modified gross income. 418 Sec. 2003. Requirement to offer premium assistance for employer-sponsored insurance. 427 Sec. 2004. Medicaid coverage for former foster care children. 428 Sec. 2005. Payments to territories. 430 Sec. 2006. Special adjustment to FMAP determination for certain States recovering 432 from a major disaster. Sec. 2007. Medicaid Improvement Fund rescission. 436 Subtitle B—Enhanced Support for the Children’s Health Insurance Program 436 Sec. 2101. Additional federal financial participation for CHIP. 436 Sec. 2102. Technical corrections. 442 Subtitle C—Medicaid and CHIP Enrollment Simplification 445 Sec. 2201. Enrollment Simplification and coordination with State Health Insurance 445 Exchanges. Sec. 2202. Permitting hospitals to make presumptive eligibility determinations 451 for all Medicaid eligible populations. Subtitle D—Improvements to Medicaid Services 453 Sec. 2301. Coverage for freestanding birth center services. 453 Sec. 2302. Concurrent care for children. 456 Sec. 2303. State eligibility option for family planning services. 457 Sec. 2304. Clarification of definition of medical assistance. 466 Subtitle E—New Options for States to Provide Long-Term Services and 466 Supports Sec. 2401. Community First Choice Option. 466 Sec. 2402. Removal of barriers to providing home and community-based services. 479 Sec. 2403. Money Follows the Person Rebalancing Demonstration. 488 Sec. 2404. Protection for recipients of home and community-based services 489 against spousal impoverishment. Sec. 2405. Funding to expand State Aging and Disability Resource Centers. 490 Sec. 2406. Sense of the Senate regarding long-term care. 490 Subtitle F—Medicaid Prescription Drug Coverage 492 Sec. 2501. Prescription drug rebates. 492 Sec. 2502. Elimination of exclusion of coverage of certain drugs. 502 Sec. 2503. Providing adequate pharmacy reimbursement. 503 Subtitle G—Medicaid Disproportionate Share Hospital (DSH) Payments 510 Sec. 2551. Disproportionate share hospital payments. 510 Subtitle H—Improved Coordination for Dual Eligible Beneficiaries 515 Sec. 2601. 5-year period for demonstration projects. 515 Sec. 2602. Providing Federal coverage and payment coordination for dual eligible 517 beneficiaries. Subtitle I—Improving the Quality of Medicaid for Patients and Providers 522 Sec. 2701. Adult health quality measures. 522 Sec. 2702. Payment Adjustment for Health Care-Acquired Conditions. 526 Sec. 2703. State option to provide health homes for enrollees with chronic conditions. 528 Sec. 2704. Demonstration project to evaluate integrated care around a hospitalization. 538 Sec. 2705. Medicaid Global Payment System Demonstration Project. 542 Sec. 2706. Pediatric Accountable Care Organization Demonstration Project. 544 Sec. 2707. Medicaid emergency psychiatric demonstration project. 547 Subtitle J—Improvements to the Medicaid and CHIP Payment and Access 553 Commission (MACPAC) Sec. 2801. MACPAC assessment of policies affecting all Medicaid beneficiaries. 553 Subtitle K—Protections for American Indians and Alaska Natives 565 Sec. 2901. Special rules relating to Indians. 565 Sec. 2902. Elimination of sunset for reimbursement for all medicare part B 567 services furnished by certain indian hospitals and clinics. Subtitle L—Maternal and Child Health Services 568 Sec. 2951. Maternal, infant, and early childhood home visiting programs. 568 Sec. 2952. Support, education, and research for postpartum depression. 595 Sec. 2953. Personal responsibility education. 604 Sec. 2954. Restoration of funding for abstinence education. 618 Sec. 2955. Inclusion of information about the importance of having a health 619 care power of attorney in transition planning for children aging out of foster care and independent living programs. TITLE III—IMPROVING THE QUALITY AND EFFICIENCY OF 621 HEALTH CARE Subtitle A—Transforming the Health Care Delivery System 621 PART I—LINKING PAYMENT TO QUALITY OUTCOMES UNDER THE 621 MEDICARE PROGRAM Sec. 3001. Hospital Value-Based purchasing program. 622 Sec. 3002. Improvements to the physician quality reporting system. 652 Sec. 3003. Improvements to the physician feedback program. 658 Sec. 3004. Quality reporting for long-term care hospitals, inpatient rehabilitation 663 hospitals, and hospice programs. Sec. 3005. Quality reporting for PPS-exempt cancer hospitals. 673 Sec. 3006. Plans for a Value-Based purchasing program for skilled nursing facilities 676 and home health agencies. Sec. 3007. Value-based payment modifier under the physician fee schedule. 680 Sec. 3008. Payment adjustment for conditions acquired in hospitals. 687 PART II—NATIONAL STRATEGY TO IMPROVE HEALTH CARE QUALITY 692 Sec. 3011. National strategy. 692 Sec. 3012. Interagency Working Group on Health Care Quality. 699 Sec. 3013. Quality measure development. 702 Sec. 3014. Quality measurement. 709 Sec. 3015. Data collection; public reporting. 717 PART III—ENCOURAGING DEVELOPMENT OF NEW PATIENT CARE MODELS 723 Sec. 3021. Establishment of Center for Medicare and Medicaid Innovation 723 within CMS. Sec. 3022. Medicare shared savings program. 739 Sec. 3023. National pilot program on payment bundling. 751 Sec. 3024. Independence at home demonstration program. 764 Sec. 3025. Hospital readmissions reduction program. 775 Sec. 3026. Community-Based Care Transitions Program. 789 Sec. 3027. Extension of gainsharing demonstration. 795 Subtitle B—Improving Medicare for Patients and Providers 796 PART I—ENSURING BENEFICIARY ACCESS TO PHYSICIAN CARE AND OTHER 796 SERVICES Sec. 3101. Increase in the physician payment update. 796 Sec. 3102. Extension of the work geographic index floor and revisions to the 797 practice expense geographic adjustment under the Medicare physician fee schedule. Sec. 3103. Extension of exceptions process for Medicare therapy caps. 801 Sec. 3104. Extension of payment for technical component of certain physician 801 pathology services. Sec. 3105. Extension of ambulance add-ons. 802 Sec. 3106. Extension of certain payment rules for long-term care hospital services 803 and of moratorium on the establishment of certain hospitals and facilities. Sec. 3107. Extension of physician fee schedule mental health add-on. 803 Sec. 3108. Permitting physician assistants to order post-Hospital extended care 803 services. Sec. 3109. Exemption of certain pharmacies from accreditation requirements. 804 Sec. 3110. Part B special enrollment period for disabled TRICARE beneficiaries. 808 Sec. 3111. Payment for bone density tests. 810 Sec. 3112. Revision to the Medicare Improvement Fund. 813 Sec. 3113. Treatment of certain complex diagnostic laboratory tests. 813 Sec. 3114. Improved access for certified nurse-midwife services. 816 PART II—RURAL PROTECTIONS 817 Sec. 3121. Extension of outpatient hold harmless provision. 817 Sec. 3122. Extension of Medicare reasonable costs payments for certain clinical 818 diagnostic laboratory tests furnished to hospital patients in certain rural areas. Sec. 3123. Extension of the Rural Community Hospital Demonstration Program. 818 Sec. 3124. Extension of the Medicare-dependent hospital (MDH) program. 821 Sec. 3125. Temporary improvements to the Medicare inpatient hospital payment 822 adjustment for low-volume hospitals. Sec. 3126. Improvements to the demonstration project on community health integration 824 models in certain rural counties. Sec. 3127. MedPAC study on adequacy of Medicare payments for health care 825 providers serving in rural areas. Sec. 3128. Technical correction related to critical access hospital services. 826 Sec. 3129. Extension of and revisions to Medicare rural hospital flexibility program. 826 PART III—IMPROVING PAYMENT ACCURACY 828 Sec. 3131. Payment adjustments for home health care. 828 Sec. 3132. Hospice reform. 836 Sec. 3133. Improvement to medicare disproportionate share hospital (DSH) 842 payments. Sec. 3134. Misvalued codes under the physician fee schedule. 846 Sec. 3135. Modification of equipment utilization factor for advanced imaging 852 services. Sec. 3136. Revision of payment for power-driven wheelchairs. 857 Sec. 3137. Hospital wage index improvement. 858 Sec. 3138. Treatment of certain cancer hospitals. 861 Sec. 3139. Payment for biosimilar biological products. 863 Sec. 3140. Medicare hospice concurrent care demonstration program. 865 Sec. 3141. Application of budget neutrality on a national basis in the calculation 867 of the Medicare hospital wage index floor. Sec. 3142. HHS study on urban Medicare-dependent hospitals. 867 Subtitle C—Provisions Relating to Part C 869 Sec. 3201. Medicare Advantage payment. 869 Sec. 3202. Benefit protection and simplification. 903 Sec. 3203. Application of coding intensity adjustment during MA payment 908 transition. Sec. 3204. Simplification of annual beneficiary election periods. 909 Sec. 3205. Extension for specialized MA plans for special needs individuals. 911 Sec. 3206. Extension of reasonable cost contracts. 918 Sec. 3207. Technical correction to MA private fee-for-service plans. 918 Sec. 3208. Making senior housing facility demonstration permanent. 919 Sec. 3209. Authority to deny plan bids. 920 Sec. 3210. Development of new standards for certain Medigap plans. 921 Subtitle D—Medicare Part D Improvements for Prescription Drug Plans and 923 MA–PD Plans Sec. 3301. Medicare coverage gap discount program. 923 Sec. 3302. Improvement in determination of Medicare part D low-income 943 benchmark premium. Sec. 3303. Voluntary de minimis policy for subsidy eligible individuals under 943 prescription drug plans and MA–PD plans. Sec. 3304. Special rule for widows and widowers regarding eligibility for low income 945 assistance. Sec. 3305. Improved information for subsidy eligible individuals reassigned to 946 prescription drug plans and MA–PD plans. Sec. 3306. Funding outreach and assistance for low-income programs. 947 Sec. 3307. Improving formulary requirements for prescription drug plans and 950 MA–PD plans with respect to certain categories or classes of drugs. Sec. 3308. Reducing part D premium subsidy for high-income beneficiaries. 952 Sec. 3309. Elimination of cost sharing for certain dual eligible individuals. 961 Sec. 3310. Reducing wasteful dispensing of outpatient prescription drugs in 962 long-term care facilities under prescription drug plans and MA–PD plans. Sec. 3311. Improved Medicare prescription drug plan and MA–PD plan complaint 963 system. Sec. 3312. Uniform exceptions and appeals process for prescription drug plans 964 and MA–PD plans. Sec. 3313. Office of the Inspector General studies and reports. 965 Sec. 3314. Including costs incurred by AIDS drug assistance programs and Indian 970 Health Service in providing prescription drugs toward the annual out-of-pocket threshold under part D. Sec. 3315. Immediate reduction in coverage gap in 2010. 972 Subtitle E—Ensuring Medicare Sustainability 974 Sec. 3401. Revision of certain market basket updates and incorporation of productivity 974 improvements into market basket updates that do not already incorporate such improvements. Sec. 3402. Temporary adjustment to the calculation of part B premiums. 999 Sec. 3403. Independent Medicare Advisory Board. 1000 Subtitle F—Health Care Quality Improvements 1053 Sec. 3501. Health care delivery system research; Quality improvement technical 1053 assistance. Sec. 3502. Establishing community health teams to support the patient-centered 1067 medical home. Sec. 3503. Medication management services in treatment of chronic disease. 1075 Sec. 3504. Design and implementation of regionalized systems for emergency 1081 care. Sec. 3505. Trauma care centers and service availability. 1091 Sec. 3506. Program to facilitate shared decision making. 1105 Sec. 3507. Presentation of prescription drug benefit and risk information. 1113 Sec. 3508. Demonstration program to integrate quality improvement and patient 1115 safety training into clinical education of health professionals. Sec. 3509. Improving women’s health. 1118 Sec. 3510. Patient navigator program. 1132 Sec. 3511. Authorization of appropriations. 1133 TITLE IV—PREVENTION OF CHRONIC DISEASE AND IMPROVING 1134 PUBLIC HEALTH Subtitle A—Modernizing Disease Prevention and Public Health Systems 1134 Sec. 4001. National Prevention, Health Promotion and Public Health Council. 1134 Sec. 4002. Prevention and Public Health Fund. 1141 Sec. 4003. Clinical and community preventive services. 1142 Sec. 4004. Education and outreach campaign regarding preventive benefits. 1150 Subtitle B—Increasing Access to Clinical Preventive Services 1156 Sec. 4101. School-based health centers. 1156 Sec. 4102. Oral healthcare prevention activities. 1167 Sec. 4103. Medicare coverage of annual wellness visit providing a personalized 1174 prevention plan. Sec. 4104. Removal of barriers to preventive services in Medicare. 1184 Sec. 4105. Evidence-based coverage of preventive services in Medicare. 1189 Sec. 4106. Improving access to preventive services for eligible adults in Medicaid. 1190 Sec. 4107. Coverage of comprehensive tobacco cessation services for pregnant 1192 women in Medicaid. Sec. 4108. Incentives for prevention of chronic diseases in Medicaid. 1195 Subtitle C—Creating Healthier Communities 1203 Sec. 4201. Community transformation grants. 1203 Sec. 4202. Healthy aging, living well; evaluation of community-based prevention 1209 and wellness programs for Medicare beneficiaries. Sec. 4203. Removing barriers and improving access to wellness for individuals 1220 with disabilities. Sec. 4204. Immunizations. 1221 Sec. 4205. Nutrition labeling of standard menu items at chain restaurants. 1228 Sec. 4206. Demonstration project concerning individualized wellness plan. 1237 Sec. 4207. Reasonable break time for nursing mothers. 1239 Subtitle D—Support for Prevention and Public Health Innovation 1240 Sec. 4301. Research on optimizing the delivery of public health services. 1240 Sec. 4302. Understanding health disparities: data collection and analysis. 1241 Sec. 4303. CDC and employer-based wellness programs. 1252 Sec. 4304. Epidemiology-Laboratory Capacity Grants. 1255 Sec. 4305. Advancing research and treatment for pain care management. 1257 Sec. 4306. Funding for Childhood Obesity Demonstration Project. 1265 Subtitle E—Miscellaneous Provisions 1265 Sec. 4401. Sense of the Senate concerning CBO scoring. 1265 Sec. 4402. Effectiveness of Federal health and wellness initiatives. 1265 TITLE V—HEALTH CARE WORKFORCE 1266 Subtitle A—Purpose and Definitions 1266 Sec. 5001. Purpose. 1266 Sec. 5002. Definitions. 1267 Subtitle B—Innovations in the Health Care Workforce 1278 Sec. 5101. National health care workforce commission. 1278 Sec. 5102. State health care workforce development grants. 1297 Sec. 5103. Health care workforce assessment. 1309 Subtitle C—Increasing the Supply of the Health Care Workforce 1316 Sec. 5201. Federally supported student loan funds. 1316 Sec. 5202. Nursing student loan program. 1318 Sec. 5203. Health care workforce loan repayment programs. 1319 Sec. 5204. Public health workforce recruitment and retention programs. 1324 Sec. 5205. Allied health workforce recruitment and retention programs. 1329 Sec. 5206. Grants for State and local programs. 1331 Sec. 5207. Funding for National Health Service Corps. 1333 Sec. 5208. Nurse-managed health clinics. 1334 Sec. 5209. Elimination of cap on commissioned Corps. 1336 Sec. 5210. Establishing a Ready Reserve Corps. 1336 Subtitle D—Enhancing Health Care Workforce Education and Training 1339 Sec. 5301. Training in family medicine, general internal medicine, general pediatrics, 1339 and physician assistantship. Sec. 5302. Training opportunities for direct care workers. 1346 Sec. 5303. Training in general, pediatric, and public health dentistry. 1349 Sec. 5304. Alternative dental health care providers demonstration project. 1355 Sec. 5305. Geriatric education and training; career awards; comprehensive geriatric 1359 education. Sec. 5306. Mental and behavioral health education and training grants. 1368 Sec. 5307. Cultural competency, prevention, and public health and individuals 1374 with disabilities training. Sec. 5308. Advanced nursing education grants. 1377 Sec. 5309. Nurse education, practice, and retention grants. 1378 Sec. 5310. Loan repayment and scholarship program. 1382 Sec. 5311. Nurse faculty loan program. 1384 Sec. 5312. Authorization of appropriations for parts B through D of Title VIII. 1389 Sec. 5313. Grants to promote the community health workforce. 1389 Sec. 5314. Fellowship training in public health. 1395 Sec. 5315. United States Public Health Sciences Track. 1397 Subtitle E—Supporting the Existing Health Care Workforce 1411 Sec. 5401. Centers of excellence. 1411 Sec. 5402. Health care professionals training for diversity. 1416 Sec. 5403. Interdisciplinary, community-based linkages. 1417 Sec. 5404. Workforce diversity grants. 1430 Sec. 5405. Primary care extension program. 1431 Subtitle F—Strengthening Primary Care and Other Workforce Improvements 1440 Sec. 5501. Expanding access to primary care services and general surgery services. 1440 Sec. 5502. Medicare Federally qualified health center improvements. 1446 Sec. 5503. Distribution of additional residency positions. 1449 Sec. 5504. Counting resident time in outpatient settings and allowing flexibility 1458 for jointly operated residency training programs. Sec. 5505. Rules for counting resident time for didactic and scholarly activities 1461 and other activities. Sec. 5506. Preservation of resident cap positions from closed hospitals. 1465 Sec. 5507. Demonstration projects To address health professions workforce 1469 needs; extension of family-to-family health information centers. Sec. 5508. Increasing teaching capacity. 1485 Sec. 5509. Graduate nurse education demonstration. 1500 Subtitle G—Improving Access to Health Care Services 1508 Sec. 5601. Spending for Federally Qualified Health Centers (FQHCs). 1508 Sec. 5602. Negotiated rulemaking for development of methodology and criteria 1510 for designating medically underserved populations and health professions shortage areas. Sec. 5603. Reauthorization of the Wakefield Emergency Medical Services for 1514 Children Program. Sec. 5604. Co-locating primary and specialty care in community-based mental 1515 health settings. Sec. 5605. Key National indicators. 1518 Subtitle H—General Provisions 1528 Sec. 5701. Reports. 1528 TITLE VI—TRANSPARENCY AND PROGRAM INTEGRITY 1529 Subtitle A—Physician Ownership and Other Transparency 1529 Sec. 6001. Limitation on Medicare exception to the prohibition on certain physician 1529 referrals for hospitals. Sec. 6002. Transparency reports and reporting of physician ownership or investment 1542 interests. Sec. 6003. Disclosure requirements for in-office ancillary services exception to 1564 the prohibition on physician self-referral for certain imaging services. Sec. 6004. Prescription drug sample transparency. 1564 Sec. 6005. Pharmacy benefit managers transparency requirements. 1567 Subtitle B—Nursing Home Transparency and Improvement 1571 PART I—IMPROVING TRANSPARENCY OF INFORMATION 1571 Sec. 6101. Required disclosure of ownership and additional disclosable parties 1571 information. Sec. 6102. Accountability requirements for skilled nursing facilities and nursing 1579 facilities. Sec. 6103. Nursing home compare Medicare website. 1585 Sec. 6104. Reporting of expenditures. 1603 Sec. 6105. Standardized complaint form. 1605 Sec. 6106. Ensuring staffing accountability. 1607 Sec. 6107. GAO study and report on Five-Star Quality Rating System. 1609 PART II—TARGETING ENFORCEMENT 1610 Sec. 6111. Civil money penalties. 1610 Sec. 6112. National independent monitor demonstration project. 1619 Sec. 6113. Notification of facility closure. 1625 Sec. 6114. National demonstration projects on culture change and use of information 1628 technology in nursing homes. PART III—IMPROVING STAFF TRAINING 1630 Sec. 6121. Dementia and abuse prevention training. 1630 Subtitle C—Nationwide Program for National and State Background Checks 1632 on Direct Patient Access Employees of Long-term Care Facilities and Providers Sec. 6201. Nationwide program for National and State background checks on 1632 direct patient access employees of long-term care facilities and providers. Subtitle D—Patient-Centered Outcomes Research 1648 Sec. 6301. Patient-Centered Outcomes Research. 1648 Sec. 6302. Federal coordinating council for comparative effectiveness research. 1702 Subtitle E—Medicare, Medicaid, and CHIP Program Integrity Provisions 1703 Sec. 6401. Provider screening and other enrollment requirements under Medicare, 1703 Medicaid, and CHIP. Sec. 6402. Enhanced Medicare and Medicaid program integrity provisions. 1720 Sec. 6403. Elimination of duplication between the Healthcare Integrity and 1747 Protection Data Bank and the National Practitioner Data Bank. Sec. 6404. Maximum period for submission of Medicare claims reduced to not 1760 more than 12 months. Sec. 6405. Physicians who order items or services required to be Medicare enrolled 1762 physicians or eligible professionals. Sec. 6406. Requirement for physicians to provide documentation on referrals to 1764 programs at high risk of waste and abuse. Sec. 6407. Face to face encounter with patient required before physicians may 1765 certify eligibility for home health services or durable medical equipment under Medicare. Sec. 6408. Enhanced penalties. 1768 Sec. 6409. Medicare self-referral disclosure protocol. 1773 Sec. 6410. Adjustments to the Medicare durable medical equipment, prosthetics, 1775 orthotics, and supplies competitive acquisition program. Sec. 6411. Expansion of the Recovery Audit Contractor (RAC) program. 1777 Subtitle F—Additional Medicaid Program Integrity Provisions 1778 Sec. 6501. Termination of provider participation under Medicaid if terminated 1783 under Medicare or other State plan. Sec. 6502. Medicaid exclusion from participation relating to certain ownership, 1783 control, and management affiliations. Sec. 6503. Billing agents, clearinghouses, or other alternate payees required to 1784 register under Medicaid. Sec. 6504. Requirement to report expanded set of data elements under MMIS 1785 to detect fraud and abuse. Sec. 6505. Prohibition on payments to institutions or entities located outside of 1786 the United States. Sec. 6506. Overpayments. 1786 Sec. 6507. Mandatory State use of national correct coding initiative. 1788 Sec. 6508. General effective date. 1790 Subtitle G—Additional Program Integrity Provisions 1791 Sec. 6601. Prohibition on false statements and representations. 1791 Sec. 6602. Clarifying definition. 1793 Sec. 6603. Development of model uniform report form. 1793 Sec. 6604. Applicability of State law to combat fraud and abuse. 1794 Sec. 6605. Enabling the Department of Labor to issue administrative summary 1795 cease and desist orders and summary seizures orders against plans that are in financially hazardous condition. Sec. 6606. MEWA plan registration with Department of Labor. 1797 Sec. 6607. Permitting evidentiary privilege and confidential communications. 1797 Subtitle H—Elder Justice Act 1798 Sec. 6701. Short title of subtitle. 1798 Sec. 6702. Definitions. 1799 Sec. 6703. Elder Justice. 1799 Subtitle I—Sense of the Senate Regarding Medical Malpractice 1858 Sec. 6801. Sense of the Senate regarding medical malpractice. 1858 TITLE VII—IMPROVING ACCESS TO INNOVATIVE MEDICAL 1859 THERAPIES Subtitle A—Biologics Price Competition and Innovation 1859 Sec. 7001. Short title. 1859 Sec. 7002. Approval pathway for biosimilar biological products. 1859 Sec. 7003. Savings. 1906 Subtitle B—More Affordable Medicines for Children and Underserved 1906 Communities Sec. 7101. Expanded participation in 340B program. 1906 Sec. 7102. Improvements to 340B program integrity. 1913 Sec. 7103. GAO study to make recommendations on improving the 340B program. 1924 TITLE VIII—CLASS ACT 1925 Sec. 8001. Short title of title. 1925 Sec. 8002. Establishment of national voluntary insurance program for purchasing 1925 community living assistance services and support. TITLE IX—REVENUE PROVISIONS 1979 Subtitle A—Revenue Offset Provisions 1979 Sec. 9001. Excise tax on high cost employer-sponsored health coverage. 1979 Sec. 9002. Inclusion of cost of employer-sponsored health coverage on W–2. 1996 Sec. 9003. Distributions for medicine qualified only if for prescribed drug or insulin. 1997 Sec. 9004. Increase in additional tax on distributions from HSAs and Archer 1998 MSAs not used for qualified medical expenses. Sec. 9005. Limitation on health flexible spending arrangements under cafeteria 1999 plans. Sec. 9006. Expansion of information reporting requirements. 1999 Sec. 9007. Additional requirements for charitable hospitals. 2001 Sec. 9008. Imposition of annual fee on branded prescription pharmaceutical 2010 manufacturers and importers. Sec. 9009. Imposition of annual fee on medical device manufacturers and importers. 2020 Sec. 9010. Imposition of annual fee on health insurance providers. 2026 Sec. 9011. Study and report of effect on veterans health care. 2033 Sec. 9012. Elimination of deduction for expenses allocable to Medicare Part D 2034 subsidy. Sec. 9013. Modification of itemized deduction for medical expenses. 2034 Sec. 9014. Limitation on excessive remuneration paid by certain health insurance 2035 providers. Sec. 9015. Additional hospital insurance tax on high-income taxpayers. 2040 Sec. 9016. Modification of section 833 treatment of certain health organizations. 2044 Sec. 9017. Excise tax on elective cosmetic medical procedures. 2045 Subtitle B—Other Provisions 2047 Sec. 9021. Exclusion of health benefits provided by Indian tribal governments. 2047 Sec. 9022. Establishment of simple cafeteria plans for small businesses. 2050
Sec. 9023. Qualifying therapeutic discovery project credit 2057
(Note – Page 2074 is the last page of the document.)
(11/19/09)