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The BlogA Constitution Day ComparisonThe Founders’ handiwork versus Obama’s.11:21 AM, Sep 17, 2011
• By JEFFREY H. ANDERSON
 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 The Weekly Standard ArchivesBrowse 15 Years of the Weekly Standard 
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