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A Constitution Day Comparison

The Founders’ handiwork versus Obama’s.

11:21 AM, Sep 17, 2011 • By JEFFREY H. ANDERSON
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PART II—SMALL BUSINESS TAX CREDIT

Sec. 1421. Credit for employee health insurance expenses of small businesses

............................................................................................................. 138

Subtitle F—Shared Responsibility for Health Care

PART I—INDIVIDUAL RESPONSIBILITY

Sec. 1501. Requirement to maintain minimum essential coverage ............ 143

Sec. 1502. Reporting of health insurance coverage ...................................... 151

PART II—EMPLOYER RESPONSIBILITIES

Sec. 1511. Automatic enrollment for employees of large employers ........... 154

Sec. 1512. Employer requirement to inform employees of coverage options

................................................................................................................ 154

Sec. 1513. Shared responsibility for employers ............................................ 155

Sec. 1514. Reporting of employer health insurance coverage ..................... 159

Sec. 1515. Offering of Exchange-participating qualified health plans

through cafeteria plans ................................................................................ 161

Subtitle G—Miscellaneous Provisions

Sec. 1551. Definitions ..................................................................................... 164

Sec. 1552. Transparency in government ....................................................... 164

Sec. 1553. Prohibition against discrimination on assisted suicide ............. 164

Sec. 1554. Access to therapies ........................................................................ 165

Sec. 1555. Freedom not to participate in Federal health insurance programs

............................................................................................................. 165

Sec. 1556. Equity for certain eligible survivors ............................................ 165

Sec. 1557. Nondiscrimination ........................................................................ 166

Sec. 1558. Protections for employees ............................................................. 166

Sec. 1559. Oversight ....................................................................................... 167

Sec. 1560. Rules of construction .................................................................... 167

Sec. 1561. Health information technology enrollment standards and protocols

.............................................................................................................. 168

Sec. 1562. GAO study regarding the rate of denial of coverage and enrollment

by health insurance issuers and group health plans .................. 170

Sec. 1563. Small business procurement ........................................................ 170

Sec. 1563 [sic]. Conforming amendments ..................................................... 171

Sec. 1563 [sic]. Sense of the Senate promoting fiscal responsibility ........... 178

TITLE II—ROLE OF PUBLIC PROGRAMS

Subtitle A—Improved Access to Medicaid

Sec. 2001. Medicaid coverage for the lowest income populations ............... 179

Sec. 2002. Income eligibility for nonelderly determined using modified

gross income .................................................................................................. 186

Sec. 2003. Requirement to offer premium assistance for employer-sponsored

insurance ............................................................................................. 190

Sec. 2004. Medicaid coverage for former foster care children ..................... 191

Sec. 2005. Payments to territories ................................................................. 191

Sec. 2006. Special adjustment to FMAP determination for certain States

recovering from a major disaster ................................................................. 192

Sec. 2007. Medicaid Improvement Fund rescission ..................................... 193

Subtitle B—Enhanced Support for the Children’s Health Insurance Program

Sec. 2101. Additional federal financial participation for CHIP .................. 194

Sec. 2102. Technical corrections .................................................................... 197

Subtitle C—Medicaid and CHIP Enrollment Simplification

Sec. 2201. Enrollment Simplification and coordination with State Health

Insurance Exchanges .................................................................................... 198

Sec. 2202. Permitting hospitals to make presumptive eligibility determinations

for all Medicaid eligible populations .......................................... 200

Subtitle D—Improvements to Medicaid Services

Sec. 2301. Coverage for freestanding birth center services ......................... 201

Sec. 2302. Concurrent care for children ........................................................ 202

Sec. 2303. State eligibility option for family planning services .................. 203

Sec. 2304. Clarification of definition of medical assistance ......................... 206

Subtitle E—New Options for States to Provide Long-Term Services and Supports

Sec. 2401. Community First Choice Option .................................................. 206

Sec. 2402. Removal of barriers to providing home and community-based

services ........................................................................................................... 211

Sec. 2403. Money Follows the Person Rebalancing Demonstration ........... 214

Sec. 2404. Protection for recipients of home and community-based services

against spousal impoverishment .......................................................... 215

Sec. 2405. Funding to expand State Aging and Disability Resource Centers

................................................................................................................. 215

Sec. 2406. Sense of the Senate regarding long-term care ........................... 215

Subtitle F—Medicaid Prescription Drug Coverage

Sec. 2501. Prescription drug rebates ............................................................. 216

Sec. 2502. Elimination of exclusion of coverage of certain drugs ............... 219

Sec. 2503. Providing adequate pharmacy reimbursement .......................... 220

Subtitle G—Medicaid Disproportionate Share Hospital (DSH) Payments

Sec. 2551. Disproportionate share hospital payments ................................. 223

Subtitle H—Improved Coordination for Dual Eligible Beneficiaries

Sec. 2601. 5-year period for demonstration projects .................................... 224

Sec. 2602. Providing Federal coverage and payment coordination for dual

eligible beneficiaries ..................................................................................... 225

Subtitle I—Improving the Quality of Medicaid for Patients and Providers

Sec. 2701. Adult health quality measures .................................................... 227

Sec. 2702. Payment Adjustment for Health Care-Acquired Conditions ..... 229

Sec. 2703. State option to provide health homes for enrollees with chronic

conditions ................................................................................................... 229

Sec. 2704. Demonstration project to evaluate integrated care around a

hospitalization ............................................................................................... 233

Sec. 2705. Medicaid Global Payment System Demonstration Project ........ 235

Sec. 2706. Pediatric Accountable Care Organization Demonstration

Project ............................................................................................................ 236

Sec. 2707. Medicaid emergency psychiatric demonstration project ............ 237

Subtitle J—Improvements to the Medicaid and CHIP Payment and Access

Commission (MACPAC)

Sec. 2801. MACPAC assessment of policies affecting all Medicaid beneficiaries

.......................................................................................................... 239

Subtitle K—Protections for American Indians and Alaska Natives

Sec. 2901. Special rules relating to Indians ................................................ 244

Sec. 2902. Elimination of sunset for reimbursement for all medicare part

B services furnished by certain indian hospitals and clinics .................... 244

Subtitle L—Maternal and Child Health Services

Sec. 2951. Maternal, infant, and early childhood home visiting programs 245

Sec. 2952. Support, education, and research for postpartum depression ... 255

Sec. 2953. Personal responsibility education ................................................ 258

Sec. 2954. Restoration of funding for abstinence education ........................ 263

Sec. 2955. Inclusion of information about the importance of having a

health care power of attorney in transition planning for children aging

out of foster care and independent living programs .................................. 264

TITLE III—IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE

Subtitle A—Transforming the Health Care Delivery System

PART 1—LINKING PAYMENT TO QUALITY OUTCOMES UNDER THE MEDICARE

PROGRAM

Sec. 3001. Hospital Value-Based purchasing program ................................ 266

Sec. 3002. Improvements to the physician quality reporting system ......... 277

Sec. 3003. Improvements to the physician feedback program .................... 279

Sec. 3004. Quality reporting for long-term care hospitals, inpatient rehabilitation

hospitals, and hospice programs ................................................. 282

Sec. 3005. Quality reporting for PPS-exempt cancer hospitals ................... 285

Sec. 3006. Plans for a Value-Based purchasing program for skilled nursing

facilities and home health agencies ...................................................... 286

Sec. 3007. Value-based payment modifier under the physician fee schedule

................................................................................................................... 288

Sec. 3008. Payment adjustment for conditions acquired in hospitals ........ 291

PART 2—NATIONAL STRATEGY TO IMPROVE HEALTH CARE QUALITY

Sec. 3011. National strategy .......................................................................... 293

Sec. 3012. Interagency Working Group on Health Care Quality ................ 295

Sec. 3013. Quality measure development ..................................................... 296

Sec. 3014. Quality measurement ................................................................... 300

Sec. 3015. Data collection; public reporting .................................................. 304

PART 3—ENCOURAGING DEVELOPMENT OF NEW PATIENT CARE MODELS

Sec. 3021. Establishment of Center for Medicare and Medicaid Innovation

within CMS ............................................................................................ 306

Sec. 3022. Medicare shared savings program ............................................... 313

Sec. 3023. National pilot program on payment bundling ............................ 318

Sec. 3024. Independence at home demonstration program ......................... 324

Sec. 3025. Hospital readmissions reduction program .................................. 328

Sec. 3026. Community-Based Care Transitions Program ........................... 333

Sec. 3027. Extension of gainsharing demonstration .................................... 335

Subtitle B—Improving Medicare for Patients and Providers

PART I—ENSURING BENEFICIARY ACCESS TO PHYSICIAN CARE AND OTHER SERVICES

Sec. 3101. Increase in the physician payment update [repealed] ........... 336

Sec. 3102. Extension of the work geographic index floor and revisions

to the practice expense geographic adjustment under the Medicare

physician fee schedule .................................................................................. 336

Sec. 3103. Extension of exceptions process for Medicare therapy caps ...... 338

Sec. 3104. Extension of payment for technical component of certain physician

pathology services .............................................................................. 338

Sec. 3105. Extension of ambulance add-ons ................................................. 338

Sec. 3106. Extension of certain payment rules for long-term care hospital

services and of moratorium on the establishment of certain hospitals

and facilities .................................................................................................. 338

Sec. 3107. Extension of physician fee schedule mental health add-on ....... 338

Sec. 3108. Permitting physician assistants to order post-Hospital extended

care services ...................................................................................... 339

Sec. 3109. Exemption of certain pharmacies from accreditation requirements

............................................................................................................. 339

Sec. 3110. Part B special enrollment period for disabled TRICARE beneficiaries

.......................................................................................................... 340

Sec. 3111. Payment for bone density tests ................................................... 341

Sec. 3112. Revision to the Medicare Improvement Fund ............................ 342

Sec. 3113. Treatment of certain complex diagnostic laboratory tests ........ 342

Sec. 3114. Improved access for certified nurse-midwife services ................ 343

PART II—RURAL PROTECTIONS

Sec. 3121. Extension of outpatient hold harmless provision ....................... 344

Sec. 3122. Extension of Medicare reasonable costs payments for certain

clinical diagnostic laboratory tests furnished to hospital patients in

certain rural areas ........................................................................................ 344

Sec. 3123. Extension of the Rural Community Hospital Demonstration

Program ......................................................................................................... 344

Sec. 3124. Extension of the Medicare-dependent hospital (MDH) program

............................................................................................................... 345

Sec. 3125. Temporary improvements to the Medicare inpatient hospital

payment adjustment for low-volume hospitals ........................................... 346

Sec. 3126. Improvements to the demonstration project on community

health integration models in certain rural counties .................................. 346

Sec. 3127. MedPAC study on adequacy of Medicare payments for health

care providers serving in rural areas .......................................................... 347

Sec. 3128. Technical correction related to critical access hospital services

.................................................................................................................. 347

Sec. 3129. Extension of and revisions to Medicare rural hospital flexibility

program ................................................................................................ 347

PART III—IMPROVING PAYMENT ACCURACY

Sec. 3131. Payment adjustments for home health care ............................... 348

Sec. 3132. Hospice reform .............................................................................. 352

Sec. 3133. Improvement to medicare disproportionate share hospital

(DSH) payments ............................................................................................ 354

Sec. 3134. Mis-valued codes under the physician fee schedule .................... 356

Sec. 3135. Modification of equipment utilization factor for advanced imaging

services ................................................................................................ 358

Sec. 3136. Revision of payment for power-driven wheelchairs ................... 359

Sec. 3137. Hospital wage index improvement .............................................. 360

Sec. 3138. Treatment of certain cancer hospitals ......................................... 362

Sec. 3139. Payment for bio-similar biological products ................................. 362

Sec. 3140. Medicare hospice concurrent care demonstration program ....... 363

Sec. 3141. Application of budget neutrality on a national basis in the

calculation of the Medicare hospital wage index floor ............................... 364

Sec. 3142. HHS study on urban Medicare-dependent hospitals ................. 364

Sec. 3143. Protecting home health benefits .................................................. 365

Subtitle C—Provisions Relating to Part C

Sec. 3201. Medicare Advantage payment [repealed & replaced] ............. 365

Sec. 3202. Benefit protection and simplification .......................................... 370

Sec. 3203. Application of coding intensity adjustment during MA payment

Transition [repealed and replaced] ................................................... 372

Sec. 3204. Simplification of annual beneficiary election periods ................ 373

Sec. 3205. Extension for specialized MA plans for special needs individuals

................................................................................................................. 373

Sec. 3206. Extension of reasonable cost contracts ....................................... 376

Sec. 3207. Technical correction to MA private fee-for-service plans ........... 376

Sec. 3208. Making senior housing facility demonstration permanent ........ 376

Sec. 3209. Authority to deny plan bids ......................................................... 377

Sec. 3210. Development of new standards for certain Medigap plans ....... 377

Subtitle D—Medicare Part D Improvements for Prescription Drug Plans and MA–

PD Plans

Sec. 3301. Medicare coverage gap discount program ................................... 378

Sec. 3302. Improvement in determination of Medicare part D low-income

benchmark premium ..................................................................................... 386

Sec. 3303. Voluntary de minimis policy for subsidy eligible individuals

under prescription drug plans and MA–PD plans ..................................... 386

Sec. 3304. Special rule for widows and widowers regarding eligibility

for low-income assistance ............................................................................. 387

Sec. 3305. Improved information for subsidy eligible individuals reassigned

to prescription drug plans and MA–PD plans ................................ 387

Sec. 3306. Funding outreach and assistance for low-income programs ..... 388

Sec. 3307. Improving formulary requirements for prescription drug plans

and MA–PD plans with respect to certain categories or classes of drugs 389

Sec. 3308. Reducing part D premium subsidy for high-income beneficiaries

.......................................................................................................... 390

Sec. 3309. Elimination of cost sharing for certain dual eligible individuals

................................................................................................................. 393

Sec. 3310. Reducing wasteful dispensing of outpatient prescription drugs

in long-term care facilities under prescription drug plans and MA–

PD plans ........................................................................................................ 393

Sec. 3311. Improved Medicare prescription drug plan and MA–PD plan

complaint system .......................................................................................... 394

Sec. 3312. Uniform exceptions and appeals process for prescription drug

plans and MA–PD plans ............................................................................... 394

Sec. 3313. Office of the Inspector General studies and reports .................. 395

Sec. 3314. Including costs incurred by AIDS drug assistance programs

and Indian Health Service in providing prescription drugs toward the

annual out-of-pocket threshold under part D ............................................. 396

Sec. 3315. Immediate reduction in coverage gap in 2010 [repealed and

Replaced] ........................................................................................................ 397

Subtitle E—Ensuring Medicare Sustainability

Sec. 3401. Revision of certain market basket updates and incorporation

of productivity improvements into market basket updates that do not

already incorporate such improvements ..................................................... 398

Sec. 3402. Temporary adjustment to the calculation of part B premiums . 407

Sec. 3403. Independent Medicare Payment Advisory Board .................... 407

Subtitle F—Health Care Quality Improvements

Sec. 3501. Health care delivery system research; Quality improvement

technical assistance ...................................................................................... 429

Sec. 3502. Establishing community health teams to support the patient-centered

medical home ................................................................................. 435

Sec. 3503. Medication management services in treatment of chronic disease

................................................................................................................ 438

Sec. 3504. Design and implementation of regionalized systems for emergency

care ...................................................................................................... 440

Sec. 3505. Trauma care centers and service availability ............................. 444

Sec. 3506. Program to facilitate shared decision-making ............................. 450

Sec. 3507. Presentation of prescription drug benefit and risk information

................................................................................................................. 453

Sec. 3508. Demonstration program to integrate quality improvement and

patient safety training into clinical education of health professionals ..... 453

Sec. 3509. Improving women’s health ........................................................... 454

Sec. 3510. Patient navigator program ........................................................... 460

Sec. 3511. Authorization of appropriations ................................................... 461

Sec. 3512. GAO study and report on causes of action ................................. 461

Subtitle G—Protecting and Improving Guaranteed Medicare Benefits

Sec. 3601. Protecting and improving guaranteed Medicare benefits .......... 462

Sec. 3602. No cuts in guaranteed benefits .................................................... 462

TITLE IV—PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC

HEALTH

Subtitle A—Modernizing Disease Prevention and Public Health Systems

Sec. 4001. National Prevention, Health Promotion and Public Health

Council ........................................................................................................... 463

Sec. 4002. Prevention and Public Health Fund ............................................ 466

Sec. 4003. Clinical and community Preventive Services ............................. 466

Sec. 4004. Education and outreach campaign regarding preventive benefits

.................................................................................................................. 469

Subtitle B—Increasing Access to Clinical Preventive Services

Sec. 4101. School-based health centers ......................................................... 471

Sec. 4102. Oral healthcare prevention activities .......................................... 476

Sec. 4103. Medicare coverage of annual wellness visit providing a personalized

prevention plan ............................................................................. 478

Sec. 4104. Removal of barriers to preventive services in Medicare ............ 482

Sec. 4105. Evidence-based coverage of preventive services in Medicare .... 483

Sec. 4106. Improving access to preventive services for eligible adults

in Medicaid .................................................................................................... 484

Sec. 4107. Coverage of comprehensive tobacco cessation services for pregnant

women in Medicaid .............................................................................. 485

Sec. 4108. Incentives for prevention of chronic diseases in medicaid ........ 486

Subtitle C—Creating Healthier Communities

Sec. 4201. Community transformation grants .............................................. 489

Sec. 4202. Healthy aging, living well; evaluation of community-based

prevention and wellness programs for Medicare beneficiaries ................. 492

Sec. 4203. Removing barriers and improving access to wellness for individuals

with disabilities ............................................................................... 496

Sec. 4204. Immunizations .............................................................................. 496

Sec. 4205. Nutrition labeling of standard menu items at Chain Restaurants

......................................................................................................... 499

Sec. 4206. Demonstration project concerning individualized wellness

plan ................................................................................................................ 502

Sec. 4207. Reasonable break time for nursing mothers ............................... 503

Subtitle D—Support for Prevention and Public Health Innovation

Sec. 4301. Research on optimizing the delivery of public health services . 504

Sec. 4302. Understanding health disparities: data collection and analysis

................................................................................................................. 504

Sec. 4303. CDC and employer-based wellness programs ............................. 509

Sec. 4304. Epidemiology-Laboratory Capacity Grants ................................. 510

Sec. 4305. Advancing research and treatment for pain care management 511

Sec. 4306. Funding for Childhood Obesity Demonstration Project ............. 513

Subtitle E—Miscellaneous Provisions

Sec. 4401. Sense of the Senate concerning CBO scoring ............................. 514

Sec. 4402. Effectiveness of Federal health and wellness initiatives ........... 514

TITLE V—HEALTH CARE WORKFORCE

Subtitle A—Purpose and Definitions

Sec. 5001. Purpose .......................................................................................... 515

Sec. 5002. Definitions ..................................................................................... 515

Subtitle B—Innovations in the Health Care Workforce

Sec. 5101. National health care workforce commission ............................... 519

Sec. 5102. State health care workforce development grants ....................... 526

Sec. 5103. Health care workforce assessment .............................................. 531

Sec. 5104. Interagency task force to assess and improve access to health

care in the State of Alaska ........................................................................... 534

Subtitle C—Increasing the Supply of the Health Care Workforce

Sec. 5201. Federally supported student loan funds ..................................... 535

Sec. 5202. Nursing student loan program .................................................... 535

Sec. 5203. Health care workforce loan repayment programs ...................... 536

Sec. 5204. Public health workforce recruitment and retention programs .. 538

Sec. 5205. Allied health workforce recruitment and retention programs .. 540

Sec. 5206. Grants for State and local programs ........................................... 540

Sec. 5207. Funding for National Health Service Corps ............................... 541

Sec. 5208. Nurse-managed health clinics ...................................................... 542

Sec. 5209. Elimination of cap on commissioned corps ................................. 534

Sec. 5210. Establishing a Ready Reserve Corps ........................................... 543

Subtitle D—Enhancing Health Care Workforce Education and Training

Sec. 5301. Training in family medicine, general internal medicine, general

pediatrics, and physician assistantship ............................................... 544

Sec. 5302. Training opportunities for direct care workers .......................... 547

Sec. 5303. Training in general, pediatric, and public health dentistry ...... 548

Sec. 5304. Alternative dental health care providers demonstration

project ............................................................................................................ 550

Sec. 5305. Geriatric education and training; career awards; comprehensive

geriatric education ................................................................................ 552

Sec. 5306. Mental and behavioral health education and training grants .. 555

Sec. 5307. Cultural competency, prevention, and public health and individuals

with disabilities training ................................................................. 558

Sec. 5308. Advanced nursing education grants ............................................ 559

Sec. 5309. Nurse education, practice, and retention grants ........................ 559

Sec. 5310. Loan repayment and scholarship program ................................. 561

Sec. 5311. Nurse faculty loan program ......................................................... 561

Sec. 5312. Authorization of appropriations for parts B through D of title

VIII ................................................................................................................. 563

Sec. 5313. Grants to promote the community health workforce ................. 564

Sec. 5314. Fellowship training in public health ........................................... 566

Sec. 5315. United States Public Health Sciences Track .............................. 567

Sec. 5316. Demonstration grants for family nurse practitioner training

programs ........................................................................................................ 572

Subtitle E—Supporting the Existing Health Care Workforce

Sec. 5401. Centers of excellence .................................................................... 574

Sec. 5402. Health care professionals training for diversity ......................... 576

Sec. 5403. Interdisciplinary, community-based linkages ............................. 576

Sec. 5404. Workforce diversity grants ........................................................... 581

Sec. 5405. Primary care extension program ................................................. 582

Subtitle F—Strengthening Primary Care and Other Workforce Improvements

Sec. 5501. Expanding access to primary care services and general surgery

services .................................................................................................. 585

Sec. 5502. Medicare Federally qualified health center improvements

[repealed] .......................................................................................... 587

Sec. 5503. Distribution of additional residency positions ............................ 587

Sec. 5504. Counting resident time in non-provider settings ........................ 590

Sec. 5505. Rules for counting resident time for didactic and scholarly

activities and other activities ....................................................................... 591

Sec. 5506. Preservation of resident cap positions from closed hospitals .... 593

Sec. 5507. Demonstration projects To address health professions workforce

needs; extension of family-to-family health information centers ..... 595

Sec. 5508. Increasing teaching capacity ........................................................ 601

Sec. 5509. Graduate nurse education demonstration .................................. 606

Subtitle G—Improving Access to Health Care Services

Sec. 5601. Spending for Federally Qualified Health Centers (FQHCs) ...... 609

Sec. 5602. Negotiated rulemaking for development of methodology and

criteria for designating medically underserved populations and health

professions shortage areas ........................................................................... 610

Sec. 5603. Reauthorization of the Wakefield Emergency Medical Services

for Children Program .................................................................................... 612

Sec. 5604. Co-locating primary and specialty care in community-based

mental health settings .................................................................................. 612

Sec. 5605. Key National indicators ................................................................ 613

Sec. 5606. State grants to health care providers who provide services

to a high percentage of medically underserved populations or other

special populations ........................................................................................ 617

Subtitle H—General Provisions

Sec. 5701. Reports ........................................................................................... 618

TITLE VI—TRANSPARENCY AND PROGRAM INTEGRITY

Subtitle A—Physician Ownership and Other Transparency

Sec. 6001. Limitation on Medicare exception to the prohibition on certain

physician referrals for hospitals .................................................................. 619

Sec. 6002. Transparency reports and reporting of physician ownership

or investment interests ................................................................................. 624

Sec. 6003. Disclosure requirements for in-office ancillary services exception

to the prohibition on physician self-referral for certain imaging

services ........................................................................................................... 632

Sec. 6004. Prescription drug sample transparency ...................................... 632

Sec. 6005. Pharmacy benefit managers transparency requirements .......... 633

Subtitle B—Nursing Home Transparency and Improvement

PART 1—IMPROVING TRANSPARENCY OF INFORMATION

Sec. 6101. Required disclosure of ownership and additional disclosable

parties information ....................................................................................... 635

Sec. 6102. Accountability requirements for skilled nursing facilities and

nursing facilities ........................................................................................... 638

Sec. 6103. Nursing home compare Medicare website .................................. 640

Sec. 6104. Reporting of expenditures ............................................................ 647

Sec. 6105. Standardized complaint form ....................................................... 648

Sec. 6106. Ensuring staffing accountability .................................................. 648

Sec. 6107. GAO study and report on Five-Star Quality Rating System .... 649

PART 2—TARGETING ENFORCEMENT

Sec. 6111. Civil money penalties ................................................................... 649

Sec. 6112. National independent monitor demonstration project ............... 653

Sec. 6113. Notification of facility closure ...................................................... 655

Sec. 6114. National demonstration projects on culture change and use

of information technology in nursing homes .............................................. 656

PART 3—IMPROVING STAFF TRAINING

Sec. 6121. Dementia and abuse prevention training ................................... 657

Subtitle C—Nationwide Program for National and State Background Checks on

Direct Patient Access Employees of Long-term Care Facilities and Providers

Sec. 6201. Nationwide program for National and State background

checks on direct patient access employees of long-term care facilities

and providers ................................................................................................. 658

Subtitle D—Patient-Centered Outcomes Research

Sec. 6301. Patient-Centered Outcomes Research ......................................... 664

Sec. 6302. Federal coordinating council for comparative effectiveness research

............................................................................................................. 685

Subtitle E—Medicare, Medicaid, and CHIP Program Integrity Provisions

Sec. 6401. Provider screening and other enrollment requirements under

Medicare, Medicaid, and CHIP .................................................................... 685

Sec. 6402. Enhanced Medicare and Medicaid program integrity provisions

............................................................................................................... 691

Sec. 6403. Elimination of duplication between the Healthcare Integrity

and Protection Data Bank and the National Practitioner Data Bank ..... 702

Sec. 6404. Maximum period for submission of Medicare claims reduced

to not more than 12 months ......................................................................... 707

Sec. 6405. Physicians who order items or services required to be Medicare

enrolled physicians or eligible professionals ....................................... 708

Sec. 6406. Requirement for physicians to provide documentation on referrals

to programs at high risk of waste and abuse ................................. 708

Sec. 6407. Face to face encounter with patient required before physicians

may certify eligibility for home health services or durable medical

equipment under Medicare .......................................................................... 709

Sec. 6408. Enhanced penalties ....................................................................... 710

Sec. 6409. Medicare self-referral disclosure protocol ................................... 712

Sec. 6410. Adjustments to the Medicare durable medical equipment,

prosthetics, orthotics, and supplies competitive acquisition program ...... 713

Sec. 6411. Expansion of the Recovery Audit Contractor (RAC) program ... 714

Subtitle F—Additional Medicaid Program Integrity Provisions

Sec. 6501. Termination of provider participation under Medicaid if terminated

under Medicare or other State plan ................................................. 716

Sec. 6502. Medicaid exclusion from participation relating to certain

ownership, control, and management affiliations ...................................... 716

Sec. 6503. Billing agents, clearinghouses, or other alternate payees required

to register under Medicaid ............................................................... 716

Sec. 6504. Requirement to report expanded set of data elements under

MMIS to detect fraud and abuse ................................................................. 717

Sec. 6505. Prohibition on payments to institutions or entities located

outside of the United States ........................................................................ 717

Sec. 6506. Overpayments ............................................................................... 717

Sec. 6507. Mandatory State use of national correct coding initiative ........ 718

Sec. 6508. General effective date ................................................................... 719

Subtitle G—Additional Program Integrity Provisions

Sec. 6601. Prohibition on false statements and representations ................ 719

Sec. 6602. Clarifying definition ...................................................................... 720

Sec. 6603. Development of model uniform report form ............................... 720

Sec. 6604. Applicability of State law to combat fraud and abuse ............... 720

Sec. 6605. Enabling the Department of Labor to issue administrative

summary cease and desist orders and summary seizures orders against

plans that are in financially hazardous condition ...................................... 721

Sec. 6606. MEWA plan registration with Department of Labor ................. 722

Sec. 6607. Permitting evidentiary privilege and confidential communications

................................................................................................................ 722

Subtitle H—Elder Justice Act

Sec. 6701. Short title of subtitle .................................................................... 722

Sec. 6702. Definitions ..................................................................................... 722

Sec. 6703. Elder Justice ................................................................................. 722

Subtitle I—Sense of the Senate Regarding Medical Malpractice

Sec. 6801. Sense of the Senate regarding medical malpractice .................. 745

TITLE VII—IMPROVING ACCESS TO INNOVATIVE MEDICAL THERAPIES

Subtitle A—Biologics Price Competition and Innovation

Sec. 7001. Short title ...................................................................................... 747

Sec. 7002. Approval pathway for bio-similar biological products ................. 747

Sec. 7003. Savings ........................................................................................... 764

Subtitle B—More Affordable Medicines for Children and Underserved

Communities

Sec. 7101. Expanded participation in 340B program ................................... 764

Sec. 7102. Improvements to 340B program integrity .................................. 767

Sec. 7103. GAO study to make recommendations on improving the 340B

program .......................................................................................................... 771

TITLE VIII—CLASS ACT

Sec. 8001. Short title of title .......................................................................... 772

Sec. 8002. Establishment of national voluntary insurance program for

purchasing community living assistance services and support ................. 772

TITLE IX—REVENUE PROVISIONS

Subtitle A—Revenue Offset Provisions

Sec. 9001. Excise tax on high cost employer-sponsored health coverage ... 793

Sec. 9002. Inclusion of cost of employer-sponsored health coverage on

W–2 ................................................................................................................ 800

Sec. 9003. Distributions for medicine qualified only if for prescribed drug

or insulin ....................................................................................................... 800

Sec. 9004. Increase in additional tax on distributions from HSAs and

Archer MSAs not used for qualified medical expenses .............................. 801

Sec. 9005. Limitation on health flexible spending arrangements under

cafeteria plans ............................................................................................... 801

Sec. 9006. Expansion of information reporting requirements ..................... 801

Sec. 9007. Additional requirements for charitable hospitals ....................... 802

Sec. 9008. Imposition of annual fee on branded prescription pharmaceutical

manufacturers and importers ........................................................ 806

Sec. 9009. Imposition of annual fee on medical device manufacturers

and importers [repealed and replaced] ..................................................... 810

Sec. 9010. Imposition of annual fee on health insurance providers ........... 811

Sec. 9011. Study and report of effect on veterans health care .................... 815

Sec. 9012. Elimination of deduction for expenses allocable to Medicare

Part D subsidy .............................................................................................. 816

Sec. 9013. Modification of itemized deduction for medical expenses .......... 816

Sec. 9014. Limitation on excessive remuneration paid by certain health

insurance providers ...................................................................................... 816

Sec. 9015. Additional hospital insurance tax on high-income taxpayers ... 818

Sec. 9016. Modification of section 833 treatment of certain health organizations

............................................................................................................ 820

Sec. 9017. Excise tax on elective cosmetic medical procedures

[nullified] .......................................................................................... 820

Subtitle B—Other Provisions

Sec. 9021. Exclusion of health benefits provided by Indian tribal governments

............................................................................................................. 821

Sec. 9022. Establishment of simple cafeteria plans for small businesses .. 822

Sec. 9023. Qualifying therapeutic discovery project credit .......................... 825

TITLE X—STRENGTHENING QUALITY, AFFORDABLE HEALTH CARE FOR

ALL AMERICANS

Subtitle A—Provisions Relating to Title I

Sec. 10101. Amendments to subtitle A [amendments fully incorporated] 833

Sec. 10102. Amendments to subtitle B [amendments fully incorporated] 833

Sec. 10103. Amendments to subtitle C [amendments fully incorporated] 833

Sec. 10104. Amendments to subtitle D ......................................................... 834

Sec. 10105. Amendments to subtitle E [amendments fully incorporated] 834

Sec. 10106. Amendments to subtitle F [amendments fully incorporated] 835

Sec. 10107. Amendments to subtitle G [amendments fully incorporated] 835

Sec. 10108. Free choice vouchers ................................................................... 835

Sec. 10109. Development of standards for financial and administrative

transactions ................................................................................................... 838

Subtitle B—Provisions Relating to Title II

PART 1—MEDICAID AND CHIP

Sec. 10201. Amendments to the Social Security Act and title II of this

Act .................................................................................................................. 839

Sec. 10202. Incentives for States to offer home and community-based

services as a long-term care alternative to nursing homes ....................... 845

Sec. 10203. Extension of funding for CHIP through fiscal year 2015 and

other CHIP-related provisions ..................................................................... 848

PART 2—SUPPORT FOR PREGNANT AND PARENTING TEENS AND WOMEN

Sec. 10211. Definitions ................................................................................... 852

Sec. 10212. Establishment of pregnancy assistance fund ........................... 853

Sec. 10213. Permissible uses of Fund ........................................................... 853

Sec. 10214. Appropriations ............................................................................. 856

PART 3—INDIAN HEALTH CARE IMPROVEMENT

Sec. 10221. Indian health care improvement ............................................... 857

Subtitle C—Provisions Relating to Title III

Sec. 10301. Plans for a Value-Based purchasing program for ambulatory

surgical centers [amendments fully incorporated] .................................... 858

Sec. 10302. Revision to national strategy for quality improvement in

health care [amendments fully incorporated] ............................................ 858

Sec. 10303. Development of outcome measures ........................................... 858

Sec. 10304. Selection of efficiency measures [amendments fully incorporated] ......................................................................................................... 858

Sec. 10305. Data collection; public reporting [amendments fully incorporated] ......................................................................................................... 858

Sec. 10306. Improvements under the Center for Medicare and Medicaid

Innovation [amendments fully incorporated] ............................................ 859

Sec. 10307. Improvements to the Medicare shared savings program

[amendments fully incorporated] ............................................................... 859

Sec. 10308. Revisions to national pilot program on payment bundling

[amendments fully incorporated] ................................................................ 859

Sec. 10309. Revisions to hospital readmissions reduction program

[amendments fully incorporated] ............................................................... 859

Sec. 10310. Repeal of physician payment update [amendments fully incorporated] .................................................................................................... 859

Sec. 10311. Revisions to extension of ambulance add-ons [amendments

fully incorporated] ........................................................................................ 859

Sec. 10312. Certain payment rules for long-term care hospital services

and moratorium on the establishment of certain hospitals and facilities

[amendments fully incorporated] ................................................................ 859

Sec. 10313. Revisions to the extension for the rural community hospital

demonstration program [amendments fully incorporated] ....................... 860

Sec. 10314. Adjustment to low-volume hospital provision [amendments

fully incorporated] ........................................................................................ 860

Sec. 10315. Revisions to home health care provisions [amendments fully

Incorporated] ................................................................................................. 860

Sec. 10316. Medicare DSH [amendments fully incorporated] .................... 860

Sec. 10317. Revisions to extension of section 508 hospital provisions

[amendments fully incorporated] ............................................................... 860

Sec. 10318. Revisions to transitional extra benefits under Medicare Advantage

[amendments fully incorporated] ................................................. 860

Sec. 10319. Revisions to market basket adjustments [amendments fully

Incorporated] ................................................................................................. 860

Sec. 10320. Expansion of the scope of, and additional improvements to,

the Independent Medicare Advisory Board ................................................ 861

Sec. 10321. Revision to community health teams [amendments fully incorporated] .................................................................................................... 861

Sec. 10322. Quality reporting for psychiatric hospitals ............................... 861

Sec. 10323. Medicare coverage for individuals exposed to environmental

health hazards ............................................................................................... 863

Sec. 10324. Protections for frontier States ................................................... 868

Sec. 10325. Revision to skilled nursing facility prospective ?payment system

................................................................................................................. 870

Sec. 10326. Pilot testing pay-for-performance programs for certain Medicare

providers ................................................................................................ 870

Sec. 10327. Improvements to the physician quality reporting system ....... 871

Sec. 10328. Improvement in part D medication therapy management

(MTM) programs ........................................................................................... 873

Sec. 10329. Developing methodology to assess health plan value .............. 874

Sec. 10330. Modernizing computer and data systems of the Centers for

Medicare & Medicaid services to support improvements in care delivery

.................................................................................................................. 875

Sec. 10331. Public reporting of performance information ........................... 875

Sec. 10332. Availability of medicare data for performance measurement . 877

Sec. 10333. Community-based collaborative care networks ........................ 879

Sec. 10334. Minority health ........................................................................... 880

Sec. 10335. Technical correction to the hospital value-based purchasing

program [amendments fully incorporated] ................................................ 883

Sec. 10336. GAO study and report on Medicare beneficiary access to

high-quality dialysis services ....................................................................... 884

Subtitle D—Provisions Relating to Title IV

Sec. 10401. Amendments to subtitle A [amendments fully incorporated] 884

Sec. 10402. Amendments to subtitle B [amendments fully incorporated] 884

Sec. 10403. Amendments to subtitle C [amendments fully incorporated] 884

Sec. 10404. Amendments to subtitle D [amendments fully incorporated] 885

Sec. 10405. Amendments to subtitle E [amendments fully incorporated] 885

Sec. 10406. Amendment relating to waiving coinsurance for preventive

services [amendments fully incorporated] ................................................. 885

Sec. 10407. Better diabetes care .................................................................... 885

Sec. 10408. Grants for small businesses to provide comprehensive workplace

wellness programs ............................................................................... 886

Sec. 10409. Cures Acceleration Network ...................................................... 887

Sec. 10410. Centers of Excellence for Depression ........................................ 894

Sec. 10411. Programs relating to congenital heart disease ......................... 898

Sec. 10412. Automated Defibrillation in Adam’s Memory Act .................... 899

Sec. 10413. Young women’s breast health awareness and support of

young women diagnosed with breast cancer ............................................... 900

Subtitle E—Provisions Relating to Title V

Sec. 10501. Amendments to the Public Health Service Act, the Social

Security Act, and title V of this Act ............................................................ 903

Sec. 10502. Infrastructure to Expand Access to Care .................................. 910

Sec. 10503. Community Health Centers and the National Health Service

Corps Fund .................................................................................................... 910

Sec. 10504. Demonstration project to provide access to affordable care .... 911

Subtitle F—Provisions Relating to Title VI

Sec. 10601. Revisions to limitation on medicare exception to the prohibition

on certain physician referrals for hospitals [amendments fully

incorporated] ................................................................................................. 911

Sec. 10602. Clarifications to patient-centered outcomes research [amendments

fully incorporated] ............................................................................. 912

Sec. 10603. Striking provisions relating to individual provider application

fees [amendments fully incorporated] ................................................ 912

Sec. 10604. Technical correction to section 6405 [amendments fully incorporated] .................................................................................................... 912

Sec. 10605. Certain other providers permitted to conduct face to face

encounter for home health services [amendments fully incorporated] .... 912

Sec. 10606. Health care fraud enforcement .................................................. 912

Sec. 10607. State demonstration programs to evaluate alternatives to

current medical tort litigation ..................................................................... 915

Sec. 10608. Extension of medical malpractice coverage to free clinics ....... 920

Sec. 10609. Labeling changes ........................................................................ 920

Subtitle G—Provisions Relating to Title VIII

Sec. 10801. Provisions relating to title VIII [amendments fully incorporated] ......................................................................................................... 921

Subtitle H—Provisions Relating to Title IX

Sec. 10901. Modifications to excise tax on high cost employer-sponsored

health coverage [amendments fully incorporated] .................................... 921

Sec. 10902. Inflation adjustment of limitation on health flexible spending

arrangements under cafeteria plans [amendments fully incorporated] .. 921

Sec. 10903. Modification of limitation on charges by charitable hospitals

[amendments fully incorporated] ................................................................ 922

Sec. 10904. Modification of annual fee on medical device manufacturers

and importers [amendments fully incorporated] ....................................... 922

Sec. 10905. Modification of annual fee on health insurance providers

[amendments fully incorporated] ................................................................ 922

Sec. 10906. Modifications to additional hospital insurance tax on high-income

taxpayers [amendments fully incorporated] ................................. 922

Sec. 10907. Excise tax on indoor tanning services in lieu of elective

cosmetic medical procedures [substitutes for section 9017 of PPACA] .... 922

Sec. 10908. Exclusion for assistance provided to participants in State

student loan repayment programs for certain health professionals ......... 923

Sec. 10909. Expansion of adoption credit and adoption assistance programs

............................................................................................................. 924

Health Care and Education Reconciliation Act of 2010 (Public Law 111–

152) ........................................................................................................................ 927

Sec. 1001. Tax credits [amendments fully incorporated into PPACA]. ..... 928

Sec. 1002. Individual responsibility [amendments fully incorporated into

PPACA]. ........................................................................................................ 929

Sec. 1003. Employer responsibility [amendments fully incorporated into

PPACA]. ........................................................................................................ 929

Sec. 1004. Income definitions. ........................................................................ 929

Sec. 1005. Implementation funding. .............................................................. 931

Subtitle B—Medicare

Sec. 1101. Closing the medicare prescription drug ‘‘donut

hole’’ [substitutes for section 3315 of PPACA]. ........................................... 931

Sec. 1102. Medicare Advantage payments [substitutes for sections 3201

& 3203 of PPACA]. ....................................................................................... 934

Sec. 1103. Savings from limits on MA plan administrative costs. .............. 939

Sec. 1104. Disproportionate share hospital (DSH) payments [amendment

fully incorporated into PPACA]. .................................................................. 940

Sec. 1105. Market basket updates [amendments fully incorporated into

PPACA]. ........................................................................................................ 940

Sec. 1106. Physician ownership-referral [amendments fully incorporated

into PPACA]. ................................................................................................. 940

Sec. 1107. Payment for imaging services [amendments fully incorporated

into PPACA]. ................................................................................................. 941

Sec. 1108. PE GPCI adjustment for 2010 [amendment fully incorporated

into PPACA]. ................................................................................................. 941

Sec. 1109. Payment for qualifying hospitals. ................................................ 941

Subtitle C—Medicaid

Sec. 1201. Federal funding for States [amendments fully incorporated

into PPACA]. ................................................................................................. 931

Sec. 1202. Payments to primary care physicians. ........................................ 942

Sec. 1203. Disproportionate share hospital payments. ................................ 943

Sec. 1204. Funding for the territories. .......................................................... 943

Sec. 1205. Delay in Community First Choice option [amendment fully

incorporated into PPACA]. .......................................................................... 944

Sec. 1206. Drug rebates for new formulations of existing drugs [amendment

fully incorporated into PPACA]. ........................................................ 944

Subtitle D—Reducing Fraud, Waste, and Abuse

Sec. 1301. Community mental health centers. ............................................. 944

Sec. 1302. Medicare prepayment medical review limitations. .................... 944

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