“Patient Protection and Affordable Care Act”

November 18, 2009


(The version of the Senate Bill on Senator Reid’s website does not include page numbers on the Table of Contents.  A private citizen has laboriously entered the page numbers on the attached Table of Contents.)


Table  of  Contents                         



SECTION 1. SHORT TITLE; TABLE OF CONTENTS.                            

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Patient Protection and Affordable Care Act’’.

6 (b) TABLE OF CONTENTS.—The table of contents of

7 this Act is as follows:

Sec. 1. Short title; table of contents.


TITLE I—QUALITY, AFFORDABLE HEALTH CARE FOR ALL                                  15


Subtitle A—Immediate Improvements in Health Care Coverage for All                        15


Sec. 1001. Amendments to the Public Health Service Act.                15

‘‘PART A—INDIVIDUAL AND GROUP MARKET REFORMS                            15


‘‘Sec. 2711. No lifetime or annual limits                      16

‘‘Sec. 2712. Prohibition on rescissions.                      16

‘‘Sec. 2713. Coverage of preventive health services.                           17

‘‘Sec. 2714. Extension of dependent coverage.                                 18

‘‘Sec. 2715. Development and utilization of uniform explanation of coverage               19

documents and standardized definitions.

‘‘Sec. 2716. Prohibition of discrimination based on salary.                  26

‘‘Sec. 2717. Ensuring the quality of care.                    26

‘‘Sec. 2718. Bringing down the cost of health care coverage.              30

‘‘Sec. 2719. Appeals process.             33

Sec. 1002. Health insurance consumer information.    34

Sec. 1003. Ensuring that consumers get value for their dollars.          37

Sec. 1004. Effective dates.                 40

Subtitle B—Immediate Actions to Preserve and Expand Coverage      41

Sec. 1101. Immediate access to insurance for uninsured individuals with a preexisting                     41


Sec. 1102. Reinsurance for early retirees.                  48

Sec. 1103. Immediate information that allows consumers to identify affordable          54

coverage options.



Sec. 1104. Administrative simplification.                     57

Sec. 1105. Effective Date                    77

Subtitle C—Quality Health Insurance Coverage for All Americans        78

PART I—HEALTH INSURANCE MARKET REFORMS                                       78

Sec. 1201. Amendment to the Public Health Service Act.                  78


‘‘Sec. 2701. Fair health insurance premiums.             80

‘‘Sec. 2702. Guaranteed availability of coverage.         82

‘‘Sec. 2703. Guaranteed renewability of coverage.                 83

‘‘Sec. 2704. Prohibition of preexisting condition exclusions or other discrimination     78

based on health status.

‘‘Sec. 2705. Prohibiting discrimination against individual participants and                  83

beneficiaries based on health status.

‘‘Sec. 2706. Non-discrimination in health care.            95

‘‘Sec. 2707. Comprehensive health insurance coverage.                    96

‘‘Sec. 2708. Prohibition on excessive waiting periods. 97


Sec. 1251. Preservation of right to maintain existing coverage.           97


Sec. 1252. Rating reforms must apply uniformly to all health insurance issuers         99

and group health plans.

Sec. 1253. Effective dates.                 99

Subtitle D—Available Coverage Choices for All Americans                100


Sec. 1301. Qualified health plan defined.                   100

Sec. 1302. Essential health benefits requirements.     102

Sec. 1303. Special rules.                    116

Sec. 1304. Related definitions.            124



Sec. 1311. Affordable choices of health benefit plans. 128

Sec. 1312. Consumer choice.             153

Sec. 1313. Financial integrity.             160


Sec. 1321. State flexibility in operation and enforcement of Exchanges and related    164


Sec. 1322. Federal program to assist establishment and operation of nonprofit,         168

member-run health insurance issuers.

Sec. 1323. Community health insurance option.         182

Sec. 1324. Level playing field.             200


Sec. 1331. State flexibility to establish basic health programs for low-income individuals                  201

not eligible for Medicaid.

Sec. 1332. Waiver for State innovation.                      212

Sec. 1333. Provisions relating to offering of plans in more than one State.                 219


Sec. 1341. Transitional reinsurance program for individual and small group                226

markets in each State.

Sec. 1342. Establishment of risk corridors for plans in individual and small                233

group markets.

Sec. 1343. Risk adjustment.               236

Subtitle E—Affordable Coverage Choices for All Americans                238





Sec. 1401. Refundable tax credit providing premium assistance for coverage             238

under a qualified health plan.

Sec. 1402. Reduced cost-sharing for individuals enrolling in qualified health               259



Sec. 1411. Procedures for determining eligibility for Exchange participation,              269

premium tax credits and reduced cost-sharing , and individual

responsibility exemptions.

Sec. 1412. Advance determination and payment of premium tax credits and             290

cost-sharing reductions.

Sec. 1413. Streamlining of procedures for enrollment through an exchange and         295

State Medicaid, CHIP, and health subsidy programs.

Sec. 1414. Disclosures to carry out eligibility requirements for certain programs.       302

Sec. 1415. Premium tax credit and cost-sharing reduction payments disregarded      306

for Federal and Federally-assisted programs.


Sec. 1421. Credit for employee health insurance expenses of small businesses.       307

Subtitle F—Shared Responsibility for Health Care       320


Sec. 1501. Requirement to maintain minimum essential coverage.     320

Sec. 1502. Reporting of health insurance coverage.                           340


Sec. 1511. Automatic enrollment for employees of large employers.   346

Sec. 1512. Employer requirement to inform employees of coverage options.              347

Sec. 1513. Shared responsibility for employers.          348

Sec. 1514. Reporting of employer health insurance coverage.            357

Sec. 1515. Offering of Exchange-participating qualified health plans through              362

cafeteria plans.

Subtitle G—Miscellaneous Provisions  364

Sec. 1551. Definitions. 364

Sec. 1552. Transparency in government.                    364

Sec. 1553. Prohibition against discrimination on assisted suicide.      364

Sec. 1554. Access to therapies.         366

Sec. 1555. Freedom not to participate in Federal health insurance programs.            367

Sec. 1556. Equity for certain eligible survivors.            367

Sec. 1557. Nondiscrimination.             368

Sec. 1558. Protections for employees. 369

Sec. 1559. Oversight.   371

Sec. 1560. Rules of construction.        371

Sec. 1561. Health information technology enrollment standards and protocols.          373

Sec. 1562. Conforming amendments.  377


Subtitle A—Improved Access to Medicaid                  396

Sec. 2001. Medicaid coverage for the lowest income populations.                396

Sec. 2002. Income eligibility for nonelderly determined using modified gross income. 418

Sec. 2003. Requirement to offer premium assistance for employer-sponsored insurance.                 427

Sec. 2004. Medicaid coverage for former foster care children.             428

Sec. 2005. Payments to territories.     430


Sec. 2006. Special adjustment to FMAP determination for certain States recovering  432

from a major disaster.

Sec. 2007. Medicaid Improvement Fund rescission.    436

Subtitle B—Enhanced Support for the Children’s Health Insurance Program              436

Sec. 2101. Additional federal financial participation for CHIP.             436

Sec. 2102. Technical corrections.        442

Subtitle C—Medicaid and CHIP Enrollment Simplification                  445

Sec. 2201. Enrollment Simplification and coordination with State Health Insurance              445


Sec. 2202. Permitting hospitals to make presumptive eligibility determinations          451

for all Medicaid eligible populations.

Subtitle D—Improvements to Medicaid Services          453

Sec. 2301. Coverage for freestanding birth center services.                453

Sec. 2302. Concurrent care for children.                     456

Sec. 2303. State eligibility option for family planning services.            457

Sec. 2304. Clarification of definition of medical assistance.                466

Subtitle E—New Options for States to Provide Long-Term Services and                    466


Sec. 2401. Community First Choice Option.               466

Sec. 2402. Removal of barriers to providing home and community-based services.               479

Sec. 2403. Money Follows the Person Rebalancing Demonstration.   488

Sec. 2404. Protection for recipients of home and community-based services             489

against spousal impoverishment.

Sec. 2405. Funding to expand State Aging and Disability Resource Centers.            490

Sec. 2406. Sense of the Senate regarding long-term care.     490

Subtitle F—Medicaid Prescription Drug Coverage                  492

Sec. 2501. Prescription drug rebates.  492

Sec. 2502. Elimination of exclusion of coverage of certain drugs.        502

Sec. 2503. Providing adequate pharmacy reimbursement.     503

Subtitle G—Medicaid Disproportionate Share Hospital (DSH) Payments                   510

Sec. 2551. Disproportionate share hospital payments.                      510

Subtitle H—Improved Coordination for Dual Eligible Beneficiaries        515

Sec. 2601. 5-year period for demonstration projects.   515

Sec. 2602. Providing Federal coverage and payment coordination for dual eligible                517


Subtitle I—Improving the Quality of Medicaid for Patients and Providers                    522

Sec. 2701. Adult health quality measures.                 522

Sec. 2702. Payment Adjustment for Health Care-Acquired Conditions.                     526

Sec. 2703. State option to provide health homes for enrollees with chronic conditions.                     528

Sec. 2704. Demonstration project to evaluate integrated care around a hospitalization.                    538


Sec. 2705. Medicaid Global Payment System Demonstration Project.                      542

Sec. 2706. Pediatric Accountable Care Organization Demonstration Project.            544

Sec. 2707. Medicaid emergency psychiatric demonstration project.   547

Subtitle J—Improvements to the Medicaid and CHIP Payment and Access   553

Commission (MACPAC)

Sec. 2801. MACPAC assessment of policies affecting all Medicaid beneficiaries.      553

Subtitle K—Protections for American Indians and Alaska Natives       565

Sec. 2901. Special rules relating to Indians.               565

Sec. 2902. Elimination of sunset for reimbursement for all medicare part B   567

services furnished by certain indian hospitals and clinics.

Subtitle L—Maternal and Child Health Services           568

Sec. 2951. Maternal, infant, and early childhood home visiting programs.                  568

Sec. 2952. Support, education, and research for postpartum depression.                  595

Sec. 2953. Personal responsibility education.             604

Sec. 2954. Restoration of funding for abstinence education.               618

Sec. 2955. Inclusion of information about the importance of having a health   619

care power of attorney in transition planning for children aging           

out of foster care and independent living programs.



Subtitle A—Transforming the Health Care Delivery System                621



Sec. 3001. Hospital Value-Based purchasing program.                      622

Sec. 3002. Improvements to the physician quality reporting system.   652

Sec. 3003. Improvements to the physician feedback program.            658

Sec. 3004. Quality reporting for long-term care hospitals, inpatient rehabilitation        663

hospitals, and hospice programs.

Sec. 3005. Quality reporting for PPS-exempt cancer hospitals.          673

Sec. 3006. Plans for a Value-Based purchasing program for skilled nursing facilities  676

and home health agencies.

Sec. 3007. Value-based payment modifier under the physician fee schedule.            680

Sec. 3008. Payment adjustment for conditions acquired in hospitals. 687


Sec. 3011. National strategy.              692

Sec. 3012. Interagency Working Group on Health Care Quality.         699

Sec. 3013. Quality measure development.                  702

Sec. 3014. Quality measurement.       709

Sec. 3015. Data collection; public reporting.               717


Sec. 3021. Establishment of Center for Medicare and Medicaid Innovation    723

within CMS.

Sec. 3022. Medicare shared savings program.            739

Sec. 3023. National pilot program on payment bundling.                    751


Sec. 3024. Independence at home demonstration program.               764

Sec. 3025. Hospital readmissions reduction program. 775

Sec. 3026. Community-Based Care Transitions Program.      789

Sec. 3027. Extension of gainsharing demonstration.   795

Subtitle B—Improving Medicare for Patients and Providers     796



Sec. 3101. Increase in the physician payment update.                      796

Sec. 3102. Extension of the work geographic index floor and revisions to the             797

practice expense geographic adjustment under the Medicare

physician fee schedule.

Sec. 3103. Extension of exceptions process for Medicare therapy caps.                   801

Sec. 3104. Extension of payment for technical component of certain physician         801

pathology services.

Sec. 3105. Extension of ambulance add-ons.             802

Sec. 3106. Extension of certain payment rules for long-term care hospital services              803

and of moratorium on the establishment of certain hospitals

and facilities.

Sec. 3107. Extension of physician fee schedule mental health add-on.                     803

Sec. 3108. Permitting physician assistants to order post-Hospital extended care      803


Sec. 3109. Exemption of certain pharmacies from accreditation requirements.          804

Sec. 3110. Part B special enrollment period for disabled TRICARE beneficiaries.       808

Sec. 3111. Payment for bone density tests.               810

Sec. 3112. Revision to the Medicare Improvement Fund.                   813

Sec. 3113. Treatment of certain complex diagnostic laboratory tests. 813

Sec. 3114. Improved access for certified nurse-midwife services.        816

PART II—RURAL PROTECTIONS                        817

Sec. 3121. Extension of outpatient hold harmless provision.              817

Sec. 3122. Extension of Medicare reasonable costs payments for certain clinical      818

diagnostic laboratory tests furnished to hospital patients in certain

rural areas.

Sec. 3123. Extension of the Rural Community Hospital Demonstration Program.       818

Sec. 3124. Extension of the Medicare-dependent hospital (MDH) program.   821

Sec. 3125. Temporary improvements to the Medicare inpatient hospital payment       822

adjustment for low-volume hospitals.

Sec. 3126. Improvements to the demonstration project on community health integration                   824

models in certain rural counties.

Sec. 3127. MedPAC study on adequacy of Medicare payments for health care         825

providers serving in rural areas.

Sec. 3128. Technical correction related to critical access hospital services.              826

Sec. 3129. Extension of and revisions to Medicare rural hospital flexibility program.             826


Sec. 3131. Payment adjustments for home health care.                    828

Sec. 3132. Hospice reform.                 836

Sec. 3133. Improvement to medicare disproportionate share hospital (DSH)              842



Sec. 3134. Misvalued codes under the physician fee schedule.          846

Sec. 3135. Modification of equipment utilization factor for advanced imaging              852


Sec. 3136. Revision of payment for power-driven wheelchairs.            857

Sec. 3137. Hospital wage index improvement.            858

Sec. 3138. Treatment of certain cancer hospitals.                 861

Sec. 3139. Payment for biosimilar biological products.                      863

Sec. 3140. Medicare hospice concurrent care demonstration program.                     865

Sec. 3141. Application of budget neutrality on a national basis in the calculation       867

of the Medicare hospital wage index floor.

Sec. 3142. HHS study on urban Medicare-dependent hospitals.         867

Subtitle C—Provisions Relating to Part C       869

Sec. 3201. Medicare Advantage payment.                  869

Sec. 3202. Benefit protection and simplification.         903

Sec. 3203. Application of coding intensity adjustment during MA payment                908


Sec. 3204. Simplification of annual beneficiary election periods.         909

Sec. 3205. Extension for specialized MA plans for special needs individuals.            911

Sec. 3206. Extension of reasonable cost contracts.    918

Sec. 3207. Technical correction to MA private fee-for-service plans.    918

Sec. 3208. Making senior housing facility demonstration permanent.  919

Sec. 3209. Authority to deny plan bids.                      920

Sec. 3210. Development of new standards for certain Medigap plans. 921

Subtitle D—Medicare Part D Improvements for Prescription Drug Plans and              923

MA–PD Plans

Sec. 3301. Medicare coverage gap discount program. 923

Sec. 3302. Improvement in determination of Medicare part D low-income                  943

benchmark premium.

Sec. 3303. Voluntary de minimis policy for subsidy eligible individuals under             943

prescription drug plans and MA–PD plans.                

Sec. 3304. Special rule for widows and widowers regarding eligibility for low income  945


Sec. 3305. Improved information for subsidy eligible individuals reassigned to            946

prescription drug plans and MA–PD plans.

Sec. 3306. Funding outreach and assistance for low-income programs.                    947

Sec. 3307. Improving formulary requirements for prescription drug plans and             950

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


Sec. 3308. Reducing part D premium subsidy for high-income beneficiaries.             952

Sec. 3309. Elimination of cost sharing for certain dual eligible individuals.                 961

Sec. 3310. Reducing wasteful dispensing of outpatient prescription drugs in              962

long-term care facilities under prescription drug plans and

MA–PD plans.

Sec. 3311. Improved Medicare prescription drug plan and MA–PD plan complaint      963


Sec. 3312. Uniform exceptions and appeals process for prescription drug plans        964

and MA–PD plans.

Sec. 3313. Office of the Inspector General studies and reports.          965

Sec. 3314. Including costs incurred by AIDS drug assistance programs and Indian              970

Health Service in providing prescription drugs toward the

annual out-of-pocket threshold under part D.

Sec. 3315. Immediate reduction in coverage gap in 2010.      972

Subtitle E—Ensuring Medicare Sustainability             974

Sec. 3401. Revision of certain market basket updates and incorporation of productivity                    974

improvements into market basket updates that do not

already incorporate such improvements.

Sec. 3402. Temporary adjustment to the calculation of part B premiums.                  999

Sec. 3403. Independent Medicare Advisory Board.      1000

Subtitle F—Health Care Quality Improvements            1053

Sec. 3501. Health care delivery system research; Quality improvement technical      1053


Sec. 3502. Establishing community health teams to support the patient-centered      1067

medical home.

Sec. 3503. Medication management services in treatment of chronic disease.           1075

Sec. 3504. Design and implementation of regionalized systems for emergency         1081


Sec. 3505. Trauma care centers and service availability.                    1091

Sec. 3506. Program to facilitate shared decision making.                  1105

Sec. 3507. Presentation of prescription drug benefit and risk information.                  1113

Sec. 3508. Demonstration program to integrate quality improvement and patient        1115

safety training into clinical education of health professionals.

Sec. 3509. Improving women’s health. 1118

Sec. 3510. Patient navigator program.  1132

Sec. 3511. Authorization of appropriations.                 1133



Subtitle A—Modernizing Disease Prevention and Public Health Systems                  1134

Sec. 4001. National Prevention, Health Promotion and Public Health Council.           1134

Sec. 4002. Prevention and Public Health Fund.           1141

Sec. 4003. Clinical and community preventive services.                     1142

Sec. 4004. Education and outreach campaign regarding preventive benefits.              1150

Subtitle B—Increasing Access to Clinical Preventive Services            1156

Sec. 4101. School-based health centers.       1156

Sec. 4102. Oral healthcare prevention activities.         1167

Sec. 4103. Medicare coverage of annual wellness visit providing a personalized         1174

prevention plan.

Sec. 4104. Removal of barriers to preventive services in Medicare.                1184

Sec. 4105. Evidence-based coverage of preventive services in Medicare.                   1189

Sec. 4106. Improving access to preventive services for eligible adults in Medicaid.               1190

Sec. 4107. Coverage of comprehensive tobacco cessation services for pregnant        1192

women in Medicaid.

Sec. 4108. Incentives for prevention of chronic diseases in Medicaid.  1195

Subtitle C—Creating Healthier Communities               1203

Sec. 4201. Community transformation grants.            1203

Sec. 4202. Healthy aging, living well; evaluation of community-based prevention        1209

and wellness programs for Medicare beneficiaries.


Sec. 4203. Removing barriers and improving access to wellness for individuals          1220

with disabilities.

Sec. 4204. Immunizations.                 1221

Sec. 4205. Nutrition labeling of standard menu items at chain restaurants.    1228

Sec. 4206. Demonstration project concerning individualized wellness plan.   1237

Sec. 4207. Reasonable break time for nursing mothers.                    1239

Subtitle D—Support for Prevention and Public Health Innovation         1240

Sec. 4301. Research on optimizing the delivery of public health services.                  1240

Sec. 4302. Understanding health disparities: data collection and analysis.    1241

Sec. 4303. CDC and employer-based wellness programs.     1252

Sec. 4304. Epidemiology-Laboratory Capacity Grants.                      1255

Sec. 4305. Advancing research and treatment for pain care management.     1257

Sec. 4306. Funding for Childhood Obesity Demonstration Project.                1265

Subtitle E—Miscellaneous Provisions  1265

Sec. 4401. Sense of the Senate concerning CBO scoring.     1265

Sec. 4402. Effectiveness of Federal health and wellness initiatives.    1265

TITLE V—HEALTH CARE WORKFORCE                  1266

Subtitle A—Purpose and Definitions    1266

Sec. 5001. Purpose.    1266

Sec. 5002. Definitions. 1267

Subtitle B—Innovations in the Health Care Workforce  1278

Sec. 5101. National health care workforce commission.                    1278

Sec. 5102. State health care workforce development grants.              1297

Sec. 5103. Health care workforce assessment.                                1309

Subtitle C—Increasing the Supply of the Health Care Workforce         1316

Sec. 5201. Federally supported student loan funds.    1316

Sec. 5202. Nursing student loan program.                  1318

Sec. 5203. Health care workforce loan repayment programs.             1319

Sec. 5204. Public health workforce recruitment and retention programs.                   1324

Sec. 5205. Allied health workforce recruitment and retention programs.                    1329

Sec. 5206. Grants for State and local programs.         1331

Sec. 5207. Funding for National Health Service Corps.                      1333

Sec. 5208. Nurse-managed health clinics.                  1334

Sec. 5209. Elimination of cap on commissioned Corps.                     1336

Sec. 5210. Establishing a Ready Reserve Corps.                  1336

Subtitle D—Enhancing Health Care Workforce Education and Training                      1339

Sec. 5301. Training in family medicine, general internal medicine, general pediatrics, 1339

and physician assistantship.

Sec. 5302. Training opportunities for direct care workers.                   1346

Sec. 5303. Training in general, pediatric, and public health dentistry.  1349

Sec. 5304. Alternative dental health care providers demonstration project.     1355

Sec. 5305. Geriatric education and training; career awards; comprehensive geriatric  1359


Sec. 5306. Mental and behavioral health education and training grants.                     1368


Sec. 5307. Cultural competency, prevention, and public health and individuals           1374

with disabilities training.

Sec. 5308. Advanced nursing education grants.          1377

Sec. 5309. Nurse education, practice, and retention grants.               1378

Sec. 5310. Loan repayment and scholarship program. 1382

Sec. 5311. Nurse faculty loan program.                      1384

Sec. 5312. Authorization of appropriations for parts B through D of Title VIII.              1389

Sec. 5313. Grants to promote the community health workforce.         1389

Sec. 5314. Fellowship training in public health.           1395

Sec. 5315. United States Public Health Sciences Track.                   1397

Subtitle E—Supporting the Existing Health Care Workforce               1411

Sec. 5401. Centers of excellence.       1411

Sec. 5402. Health care professionals training for diversity.     1416

Sec. 5403. Interdisciplinary, community-based linkages.                   1417

Sec. 5404. Workforce diversity grants. 1430

Sec. 5405. Primary care extension program.              1431

Subtitle F—Strengthening Primary Care and Other Workforce Improvements             1440

Sec. 5501. Expanding access to primary care services and general surgery services.                      1440

Sec. 5502. Medicare Federally qualified health center improvements. 1446

Sec. 5503. Distribution of additional residency positions.                   1449

Sec. 5504. Counting resident time in outpatient settings and allowing flexibility         1458

for jointly operated residency training programs.

Sec. 5505. Rules for counting resident time for didactic and scholarly activities         1461

and other activities.

Sec. 5506. Preservation of resident cap positions from closed hospitals.                   1465

Sec. 5507. Demonstration projects To address health professions workforce             1469

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

Sec. 5508. Increasing teaching capacity.                   1485

Sec. 5509. Graduate nurse education demonstration.  1500

Subtitle G—Improving Access to Health Care Services                      1508

Sec. 5601. Spending for Federally Qualified Health Centers (FQHCs).                      1508

Sec. 5602. Negotiated rulemaking for development of methodology and criteria          1510

for designating medically underserved populations and health

professions shortage areas.

Sec. 5603. Reauthorization of the Wakefield Emergency Medical Services for           1514

Children Program.

Sec. 5604. Co-locating primary and specialty care in community-based mental         1515

health settings.

Sec. 5605. Key National indicators.     1518

Subtitle H—General Provisions            1528

Sec. 5701. Reports.     1528


Subtitle A—Physician Ownership and Other Transparency                1529

Sec. 6001. Limitation on Medicare exception to the prohibition on certain physician             1529

referrals for hospitals.


Sec. 6002. Transparency reports and reporting of physician ownership or investment 1542


Sec. 6003. Disclosure requirements for in-office ancillary services exception to         1564

the prohibition on physician self-referral for certain imaging


Sec. 6004. Prescription drug sample transparency.     1564

Sec. 6005. Pharmacy benefit managers transparency requirements.  1567

Subtitle B—Nursing Home Transparency and Improvement                1571


Sec. 6101. Required disclosure of ownership and additional disclosable parties         1571


Sec. 6102. Accountability requirements for skilled nursing facilities and nursing        1579


Sec. 6103. Nursing home compare Medicare website. 1585

Sec. 6104. Reporting of expenditures.  1603

Sec. 6105. Standardized complaint form.       1605

Sec. 6106. Ensuring staffing accountability.               1607

Sec. 6107. GAO study and report on Five-Star Quality Rating System.                     1609


Sec. 6111. Civil money penalties.        1610

Sec. 6112. National independent monitor demonstration project.        1619

Sec. 6113. Notification of facility closure.                   1625

Sec. 6114. National demonstration projects on culture change and use of information                      1628

technology in nursing homes.


Sec. 6121. Dementia and abuse prevention training.    1630

Subtitle C—Nationwide Program for National and State Background Checks             1632

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

Sec. 6201. Nationwide program for National and State background checks on           1632

direct patient access employees of long-term care facilities and


Subtitle D—Patient-Centered Outcomes Research      1648

Sec. 6301. Patient-Centered Outcomes Research.     1648

Sec. 6302. Federal coordinating council for comparative effectiveness research.        1702

Subtitle E—Medicare, Medicaid, and CHIP Program Integrity Provisions                   1703

Sec. 6401. Provider screening and other enrollment requirements under Medicare,              1703

Medicaid, and CHIP.

Sec. 6402. Enhanced Medicare and Medicaid program integrity provisions.   1720

Sec. 6403. Elimination of duplication between the Healthcare Integrity and    1747

Protection Data Bank and the National Practitioner Data


Sec. 6404. Maximum period for submission of Medicare claims reduced to not         1760

more than 12 months.


Sec. 6405. Physicians who order items or services required to be Medicare enrolled  1762

physicians or eligible professionals.

Sec. 6406. Requirement for physicians to provide documentation on referrals to        1764

programs at high risk of waste and abuse.

Sec. 6407. Face to face encounter with patient required before physicians may         1765

certify eligibility for home health services or durable medical

equipment under Medicare.

Sec. 6408. Enhanced penalties.          1768

Sec. 6409. Medicare self-referral disclosure protocol.  1773

Sec. 6410. Adjustments to the Medicare durable medical equipment, prosthetics,     1775

orthotics, and supplies competitive acquisition program.

Sec. 6411. Expansion of the Recovery Audit Contractor (RAC) program.                   1777

Subtitle F—Additional Medicaid Program Integrity Provisions             1778

Sec. 6501. Termination of provider participation under Medicaid if terminated             1783

under Medicare or other State plan.

Sec. 6502. Medicaid exclusion from participation relating to certain ownership,         1783

control, and management affiliations.

Sec. 6503. Billing agents, clearinghouses, or other alternate payees required to        1784

register under Medicaid.

Sec. 6504. Requirement to report expanded set of data elements under MMIS          1785

to detect fraud and abuse.               

Sec. 6505. Prohibition on payments to institutions or entities located outside of        1786

the United States.

Sec. 6506. Overpayments.                  1786

Sec. 6507. Mandatory State use of national correct coding initiative.  1788

Sec. 6508. General effective date.       1790

Subtitle G—Additional Program Integrity Provisions     1791

Sec. 6601. Prohibition on false statements and representations.        1791

Sec. 6602. Clarifying definition.           1793

Sec. 6603. Development of model uniform report form. 1793

Sec. 6604. Applicability of State law to combat fraud and abuse.       1794

Sec. 6605. Enabling the Department of Labor to issue administrative summary         1795

cease and desist orders and summary seizures orders against     

plans that are in financially hazardous condition.

Sec. 6606. MEWA plan registration with Department of Labor.                                 1797

Sec. 6607. Permitting evidentiary privilege and confidential communications.             1797

Subtitle H—Elder Justice Act              1798

Sec. 6701. Short title of subtitle.         1798

Sec. 6702. Definitions. 1799

Sec. 6703. Elder Justice.                    1799

Subtitle I—Sense of the Senate Regarding Medical Malpractice         1858

Sec. 6801. Sense of the Senate regarding medical malpractice.         1858



Subtitle A—Biologics Price Competition and Innovation                     1859

Sec. 7001. Short title.  1859

Sec. 7002. Approval pathway for biosimilar biological products.          1859


Sec. 7003. Savings.     1906

Subtitle B—More Affordable Medicines for Children and Underserved  1906


Sec. 7101. Expanded participation in 340B program.   1906

Sec. 7102. Improvements to 340B program integrity.   1913

Sec. 7103. GAO study to make recommendations on improving the 340B program.             1924


Sec. 8001. Short title of title.               1925

Sec. 8002. Establishment of national voluntary insurance program for purchasing      1925

community living assistance services and support.


Subtitle A—Revenue Offset Provisions 1979

Sec. 9001. Excise tax on high cost employer-sponsored health coverage.                1979

Sec. 9002. Inclusion of cost of employer-sponsored health coverage on W–2.           1996

Sec. 9003. Distributions for medicine qualified only if for prescribed drug or insulin.              1997

Sec. 9004. Increase in additional tax on distributions from HSAs and Archer             1998

MSAs not used for qualified medical expenses.

Sec. 9005. Limitation on health flexible spending arrangements under cafeteria         1999


Sec. 9006. Expansion of information reporting requirements.              1999

Sec. 9007. Additional requirements for charitable hospitals.               2001

Sec. 9008. Imposition of annual fee on branded prescription pharmaceutical              2010

manufacturers and importers.

Sec. 9009. Imposition of annual fee on medical device manufacturers and importers. 2020

Sec. 9010. Imposition of annual fee on health insurance providers.               2026

Sec. 9011. Study and report of effect on veterans health care.            2033

Sec. 9012. Elimination of deduction for expenses allocable to Medicare Part D         2034


Sec. 9013. Modification of itemized deduction for medical expenses.  2034

Sec. 9014. Limitation on excessive remuneration paid by certain health insurance     2035


Sec. 9015. Additional hospital insurance tax on high-income taxpayers.                   2040

Sec. 9016. Modification of section 833 treatment of certain health organizations.       2044

Sec. 9017. Excise tax on elective cosmetic medical procedures.       2045

Subtitle B—Other Provisions               2047

Sec. 9021. Exclusion of health benefits provided by Indian tribal governments.           2047

Sec. 9022. Establishment of simple cafeteria plans for small businesses.                 2050

Sec. 9023. Qualifying therapeutic discovery project credit      2057


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