SENATE HEALTHCARE BILL — H.R. 3590
Patient Protection and Affordable Care Act
November 18,
2009
http://democrats.senate.gov/reform/patient-protection-affordable-care-act.pdf
(The version of
the Senate Bill on Senator Reids website does not include page numbers
on the Table of Contents. A private citizen has laboriously entered the page
numbers on the attached Table of Contents.)
Table of Contents
Pages
SECTION 1.
SHORT TITLE; TABLE OF CONTENTS.
4
(a) SHORT TITLE.This Act may
be cited as the
5
Patient Protection and
Affordable Care Act.
6
(b) TABLE OF CONTENTS.The
table of contents of
7
this Act is as follows:
Sec. 1. Short title; table
of contents.
TITLE IQUALITY,
AFFORDABLE HEALTH CARE FOR ALL
15
AMERICANS
Subtitle AImmediate
Improvements in Health Care Coverage for All
15
Americans
Sec. 1001. Amendments to
the Public Health Service Act.
15
PART AINDIVIDUAL
AND GROUP
MARKET
REFORMS
15
SUBPART
IIIMPROVING
COVERAGE
16
Sec. 2711. No lifetime
or annual
limits
16
Sec. 2712. Prohibition
on
rescissions.
16
Sec. 2713. Coverage of
preventive health
services.
17
Sec. 2714. Extension of
dependent
coverage.
18
Sec. 2715. Development
and utilization of uniform explanation of coverage
19
documents and standardized
definitions.
Sec. 2716. Prohibition
of discrimination based on salary.
26
Sec. 2717. Ensuring the
quality of
care.
26
Sec. 2718. Bringing down
the cost of health care coverage.
30
Sec. 2719. Appeals
process.
33
Sec. 1002. Health
insurance consumer
information.
34
Sec. 1003. Ensuring that
consumers get value for their
dollars. 37
Sec. 1004. Effective
dates.
40
Subtitle BImmediate
Actions to Preserve and Expand Coverage
41
Sec. 1101. Immediate
access to insurance for uninsured individuals with a
preexisting 41
condition.
Sec. 1102. Reinsurance for
early
retirees.
48
Sec. 1103. Immediate
information that allows consumers to identify
affordable 54
coverage options.
Sec. 1104. Administrative
simplification. 57
Sec. 1105. Effective
Date 77
Subtitle CQuality Health
Insurance Coverage for All
Americans 78
PART IHEALTH
INSURANCE
MARKET
REFORMS
78
Sec. 1201. Amendment to
the Public Health Service
Act. 78
SUBPART
IGENERAL
REFORM
78
Sec. 2701. Fair health
insurance
premiums.
80
Sec. 2702. Guaranteed
availability of
coverage.
82
Sec. 2703. Guaranteed
renewability of
coverage. 83
Sec. 2704. Prohibition
of preexisting condition exclusions or other
discrimination 78
based on health status.
Sec. 2705. Prohibiting
discrimination against individual participants
and 83
beneficiaries based on
health status.
Sec. 2706.
Non-discrimination in health
care.
95
Sec. 2707. Comprehensive
health insurance
coverage. 96
Sec. 2708. Prohibition
on excessive waiting
periods. 97
PART IIOTHER
PROVISIONS
97
Sec. 1251. Preservation of
right to maintain existing
coverage. 97
Sec. 1252. Rating reforms
must apply uniformly to all health insurance
issuers 99
and group health plans.
Sec. 1253. Effective
dates.
99
Subtitle DAvailable
Coverage Choices for All
Americans
100
PART IESTABLISHMENT
OF QUALIFIED
HEALTH
PLANS 100
Sec. 1301. Qualified
health plan defined.
100
Sec. 1302. Essential
health benefits
requirements.
102
Sec. 1303. Special
rules.
116
Sec. 1304. Related
definitions.
124
PART IICONSUMER
CHOICES
AND INSURANCE
COMPETITION
THROUGH
128
HEALTH
BENEFIT
EXCHANGES
Sec. 1311. Affordable
choices of health benefit
plans. 128
Sec. 1312. Consumer
choice.
153
Sec. 1313. Financial
integrity.
160
PART IIISTATE
FLEXIBILITY
RELATING
TO EXCHANGES
164
Sec. 1321. State
flexibility in operation and enforcement of Exchanges and related
164
requirements.
Sec. 1322. Federal program
to assist establishment and operation of
nonprofit, 168
member-run health
insurance issuers.
Sec. 1323. Community
health insurance
option.
182
Sec. 1324. Level playing
field.
200
PART IVSTATE
FLEXIBILITY
TO ESTABLISH
ALTERNATIVE
PROGRAMS
201
Sec. 1331. State
flexibility to establish basic health programs for low-income
individuals 201
not eligible for Medicaid.
Sec. 1332. Waiver for
State
innovation.
212
Sec. 1333. Provisions
relating to offering of plans in more than one State.
219
PART VREINSURANCE
AND RISK
ADJUSTMENT
226
Sec. 1341. Transitional
reinsurance program for individual and small group
226
markets in each State.
Sec. 1342. Establishment
of risk corridors for plans in individual and small
233
group markets.
Sec. 1343. Risk
adjustment.
236
Subtitle EAffordable
Coverage Choices for All
Americans 238
PART IPREMIUM
TAX
CREDITS
AND COST–SHARING
REDUCTIONS
238
SUBPART APREMIUM
TAX CREDITS AND COST–SHARING
REDUCTIONS
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
plans.
SUBPART BELIGIBILITY
DETERMINATIONS
269
Sec. 1411. Procedures for
determining eligibility for Exchange
participation, 269
premium tax credits and
reduced cost-sharing , and individual
responsibility exemptions.
Sec. 1412. Advance
determination and payment of premium tax credits
and 290
cost-sharing reductions.
Sec. 1413. Streamlining of
procedures for enrollment through an exchange and
295
State Medicaid, CHIP, and
health subsidy programs.
Sec. 1414. Disclosures to
carry out eligibility requirements for certain
programs. 302
Sec. 1415. Premium tax
credit and cost-sharing reduction payments
disregarded 306
for Federal and
Federally-assisted programs.
PART IISMALL
BUSINESS
TAX
CREDIT
307
Sec. 1421. Credit for
employee health insurance expenses of small
businesses. 307
Subtitle FShared
Responsibility for Health
Care
320
PART IINDIVIDUAL
RESPONSIBILITY
320
Sec. 1501. Requirement to
maintain minimum essential coverage.
320
Sec. 1502. Reporting of
health insurance coverage.
340
PART IIEMPLOYER
RESPONSIBILITIES
346
Sec. 1511. Automatic
enrollment for employees of large
employers. 346
Sec. 1512. Employer
requirement to inform employees of coverage
options. 347
Sec. 1513. Shared
responsibility for employers.
348
Sec. 1514. Reporting of
employer health insurance
coverage. 357
Sec. 1515. Offering of
Exchange-participating qualified health plans
through 362
cafeteria plans.
Subtitle GMiscellaneous
Provisions
364
Sec. 1551.
Definitions.
364
Sec. 1552. Transparency in
government.
364
Sec. 1553. Prohibition
against discrimination on assisted
suicide. 364
Sec. 1554. Access to
therapies.
366
Sec. 1555. Freedom not to
participate in Federal health insurance
programs. 367
Sec. 1556. Equity for
certain eligible
survivors.
367
Sec. 1557.
Nondiscrimination.
368
Sec. 1558. Protections for
employees.
369
Sec. 1559.
Oversight.
371
Sec. 1560. Rules of
construction.
371
Sec. 1561. Health
information technology enrollment standards and
protocols. 373
Sec. 1562. Conforming
amendments.
377
TITLE IIROLE OF PUBLIC
PROGRAMS
396
Subtitle AImproved 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 BEnhanced
Support for the Childrens Health Insurance
Program 436
Sec. 2101. Additional
federal financial participation for
CHIP. 436
Sec. 2102. Technical
corrections.
442
Subtitle CMedicaid and
CHIP Enrollment
Simplification 445
Sec. 2201. Enrollment
Simplification and coordination with State Health Insurance 445
Exchanges.
Sec. 2202. Permitting
hospitals to make presumptive eligibility
determinations 451
for all Medicaid eligible
populations.
Subtitle DImprovements 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 ENew Options for
States to Provide Long-Term Services
and 466
Supports
Sec. 2401. Community First
Choice
Option.
466
Sec. 2402. Removal of
barriers to providing home and community-based services. 479
Sec. 2403. Money Follows
the Person Rebalancing
Demonstration. 488
Sec. 2404. Protection for
recipients of home and community-based
services 489
against spousal
impoverishment.
Sec. 2405. Funding to
expand State Aging and Disability Resource
Centers. 490
Sec. 2406. Sense of the
Senate regarding long-term care.
490
Subtitle FMedicaid
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 GMedicaid
Disproportionate Share Hospital (DSH)
Payments 510
Sec. 2551.
Disproportionate share hospital
payments. 510
Subtitle HImproved
Coordination for Dual Eligible
Beneficiaries 515
Sec. 2601. 5-year period
for demonstration
projects.
515
Sec. 2602. Providing
Federal coverage and payment coordination for dual eligible 517
beneficiaries.
Subtitle IImproving 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 JImprovements to
the Medicaid and CHIP Payment and Access 553
Commission (MACPAC)
Sec. 2801. MACPAC
assessment of policies affecting all Medicaid
beneficiaries. 553
Subtitle KProtections 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 LMaternal and
Child Health
Services
568
Sec. 2951. Maternal,
infant, and early childhood home visiting
programs. 568
Sec. 2952. Support,
education, and research for postpartum
depression. 595
Sec. 2953. Personal
responsibility
education.
604
Sec. 2954. Restoration of
funding for abstinence
education. 618
Sec. 2955. Inclusion of
information about the importance of having a health 619
care power of attorney in
transition planning for children
aging
out of foster care and
independent living programs.
TITLE IIIIMPROVING THE
QUALITY AND EFFICIENCY OF
621
HEALTH CARE
Subtitle ATransforming
the Health Care Delivery
System 621
PART ILINKING
PAYMENT
TO QUALITY
OUTCOMES
UNDER
THE
621
MEDICARE
PROGRAM
Sec. 3001. Hospital
Value-Based purchasing
program. 622
Sec. 3002. Improvements to
the physician quality reporting
system. 652
Sec. 3003. Improvements to
the physician feedback
program. 658
Sec. 3004. Quality
reporting for long-term care hospitals, inpatient
rehabilitation 663
hospitals, and hospice
programs.
Sec. 3005. Quality
reporting for PPS-exempt cancer
hospitals. 673
Sec. 3006. Plans for a
Value-Based purchasing program for skilled nursing
facilities 676
and home health agencies.
Sec. 3007. Value-based
payment modifier under the physician fee
schedule. 680
Sec. 3008. Payment
adjustment for conditions acquired in
hospitals. 687
PART IINATIONAL
STRATEGY
TO IMPROVE
HEALTH
CARE
QUALITY
692
Sec. 3011. National
strategy.
692
Sec. 3012. Interagency
Working Group on Health Care
Quality. 699
Sec. 3013. Quality measure
development.
702
Sec. 3014. Quality
measurement.
709
Sec. 3015. Data
collection; public
reporting.
717
PART IIIENCOURAGING
DEVELOPMENT
OF NEW
PATIENT
CARE
MODELS
723
Sec. 3021. Establishment
of Center for Medicare and Medicaid Innovation 723
within CMS.
Sec. 3022. Medicare shared
savings
program.
739
Sec. 3023. National pilot
program on payment
bundling. 751
Sec. 3024. Independence at
home demonstration
program. 764
Sec. 3025. Hospital
readmissions reduction
program. 775
Sec. 3026. Community-Based
Care Transitions Program. 789
Sec. 3027. Extension of
gainsharing
demonstration.
795
Subtitle BImproving
Medicare for Patients and
Providers 796
PART IENSURING
BENEFICIARY
ACCESS
TO PHYSICIAN
CARE
AND OTHER
796
SERVICES
Sec. 3101. Increase in the
physician payment
update. 796
Sec. 3102. Extension of
the work geographic index floor and revisions to
the 797
practice expense
geographic adjustment under the Medicare
physician fee schedule.
Sec. 3103. Extension of
exceptions process for Medicare therapy
caps. 801
Sec. 3104. Extension of
payment for technical component of certain
physician 801
pathology services.
Sec. 3105. Extension of
ambulance
add-ons.
802
Sec. 3106. Extension of
certain payment rules for long-term care hospital services 803
and of moratorium on the
establishment of certain hospitals
and facilities.
Sec. 3107. Extension of
physician fee schedule mental health
add-on. 803
Sec. 3108. Permitting
physician assistants to order post-Hospital extended
care 803
services.
Sec. 3109. Exemption of
certain pharmacies from accreditation
requirements. 804
Sec. 3110. Part B special
enrollment period for disabled TRICARE
beneficiaries. 808
Sec. 3111. Payment for
bone density
tests.
810
Sec. 3112. Revision to the
Medicare Improvement
Fund. 813
Sec. 3113. Treatment of
certain complex diagnostic laboratory
tests. 813
Sec. 3114. Improved access
for certified nurse-midwife
services. 816
PART IIRURAL
PROTECTIONS
817
Sec. 3121. Extension of
outpatient hold harmless
provision. 817
Sec. 3122. Extension of
Medicare reasonable costs payments for certain
clinical 818
diagnostic laboratory
tests furnished to hospital patients in certain
rural areas.
Sec. 3123. Extension of
the Rural Community Hospital Demonstration Program.
818
Sec. 3124. Extension of
the Medicare-dependent hospital (MDH) program. 821
Sec. 3125. Temporary
improvements to the Medicare inpatient hospital
payment 822
adjustment for low-volume
hospitals.
Sec. 3126. Improvements to
the demonstration project on community health integration 824
models in certain rural
counties.
Sec. 3127. MedPAC study on
adequacy of Medicare payments for health care 825
providers serving in rural
areas.
Sec. 3128. Technical
correction related to critical access hospital
services. 826
Sec. 3129. Extension of
and revisions to Medicare rural hospital flexibility program. 826
PART IIIIMPROVING
PAYMENT
ACCURACY
828
Sec. 3131. Payment
adjustments for home health
care. 828
Sec. 3132. Hospice
reform.
836
Sec. 3133. Improvement to
medicare disproportionate share hospital (DSH)
842
payments.
Sec. 3134. Misvalued codes
under the physician fee
schedule. 846
Sec. 3135. Modification of
equipment utilization factor for advanced
imaging 852
services.
Sec. 3136. Revision of
payment for power-driven
wheelchairs. 857
Sec. 3137. Hospital wage
index
improvement.
858
Sec. 3138. Treatment of
certain cancer
hospitals. 861
Sec. 3139. Payment for
biosimilar biological
products. 863
Sec. 3140. Medicare
hospice concurrent care demonstration
program. 865
Sec. 3141. Application of
budget neutrality on a national basis in the
calculation 867
of the Medicare hospital
wage index floor.
Sec. 3142. HHS study on
urban Medicare-dependent
hospitals. 867
Subtitle CProvisions
Relating to Part
C 869
Sec. 3201. Medicare
Advantage
payment.
869
Sec. 3202. Benefit
protection and
simplification.
903
Sec. 3203. Application of
coding intensity adjustment during MA
payment 908
transition.
Sec. 3204. Simplification
of annual beneficiary election
periods. 909
Sec. 3205. Extension for
specialized MA plans for special needs
individuals. 911
Sec. 3206. Extension of
reasonable cost
contracts.
918
Sec. 3207. Technical
correction to MA private fee-for-service
plans. 918
Sec. 3208. Making senior
housing facility demonstration
permanent. 919
Sec. 3209. Authority to
deny plan
bids.
920
Sec. 3210. Development of
new standards for certain Medigap
plans. 921
Subtitle DMedicare Part D
Improvements for Prescription Drug Plans and
923
MAPD 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 MAPD
plans.
Sec. 3304. Special rule
for widows and widowers regarding eligibility for low
income 945
assistance.
Sec. 3305. Improved
information for subsidy eligible individuals reassigned
to 946
prescription drug plans
and MAPD plans.
Sec. 3306. Funding
outreach and assistance for low-income
programs. 947
Sec. 3307. Improving
formulary requirements for prescription drug plans
and 950
MAPD plans with respect
to certain categories or classes of
drugs.
Sec. 3308. Reducing part D
premium subsidy for high-income beneficiaries.
952
Sec. 3309. Elimination of
cost sharing for certain dual eligible
individuals. 961
Sec. 3310. Reducing
wasteful dispensing of outpatient prescription drugs
in 962
long-term care facilities
under prescription drug plans and
MAPD plans.
Sec. 3311. Improved
Medicare prescription drug plan and MAPD plan
complaint 963
system.
Sec. 3312. Uniform
exceptions and appeals process for prescription drug
plans 964
and MAPD 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 EEnsuring
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 FHealth Care
Quality
Improvements
1053
Sec. 3501. Health care
delivery system research; Quality improvement
technical 1053
assistance.
Sec. 3502. Establishing
community health teams to support the
patient-centered 1067
medical home.
Sec. 3503. Medication
management services in treatment of chronic
disease. 1075
Sec. 3504. Design and
implementation of regionalized systems for
emergency 1081
care.
Sec. 3505. Trauma care
centers and service
availability.
1091
Sec. 3506. Program to
facilitate shared decision
making. 1105
Sec. 3507. Presentation of
prescription drug benefit and risk
information. 1113
Sec. 3508. Demonstration
program to integrate quality improvement and
patient 1115
safety training into
clinical education of health professionals.
Sec. 3509. Improving
womens
health.
1118
Sec. 3510. Patient
navigator
program.
1132
Sec. 3511. Authorization
of
appropriations.
1133
TITLE IVPREVENTION OF
CHRONIC DISEASE AND IMPROVING 1134
PUBLIC HEALTH
Subtitle AModernizing
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 BIncreasing
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 CCreating
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 DSupport 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 EMiscellaneous
Provisions
1265
Sec. 4401. Sense of the
Senate concerning CBO scoring.
1265
Sec. 4402. Effectiveness
of Federal health and wellness
initiatives. 1265
TITLE VHEALTH CARE
WORKFORCE
1266
Subtitle APurpose and
Definitions
1266
Sec. 5001.
Purpose.
1266
Sec. 5002.
Definitions.
1267
Subtitle BInnovations 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 CIncreasing 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 DEnhancing
Health Care Workforce Education and
Training 1339
Sec. 5301. Training in
family medicine, general internal medicine, general
pediatrics, 1339
and physician
assistantship.
Sec. 5302. Training
opportunities for direct care
workers. 1346
Sec. 5303. Training in
general, pediatric, and public health
dentistry. 1349
Sec. 5304. Alternative
dental health care providers demonstration project.
1355
Sec. 5305. Geriatric
education and training; career awards; comprehensive
geriatric 1359
education.
Sec. 5306. Mental and
behavioral health education and training
grants. 1368
Sec. 5307. Cultural
competency, prevention, and public health and
individuals 1374
with disabilities
training.
Sec. 5308. Advanced
nursing education
grants.
1377
Sec. 5309. Nurse
education, practice, and retention
grants. 1378
Sec. 5310. Loan repayment
and scholarship
program. 1382
Sec. 5311. Nurse faculty
loan
program.
1384
Sec. 5312. Authorization
of appropriations for parts B through D of Title
VIII. 1389
Sec. 5313. Grants to
promote the community health
workforce. 1389
Sec. 5314. Fellowship
training in public
health.
1395
Sec. 5315. United States
Public Health Sciences
Track. 1397
Subtitle ESupporting 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 FStrengthening
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 GImproving
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 HGeneral
Provisions
1528
Sec. 5701.
Reports.
1528
TITLE VITRANSPARENCY AND
PROGRAM INTEGRITY 1529
Subtitle APhysician
Ownership and Other
Transparency 1529
Sec. 6001. Limitation on
Medicare exception to the prohibition on certain physician 1529
referrals for hospitals.
Sec. 6002. Transparency
reports and reporting of physician ownership or investment
1542
interests.
Sec. 6003. Disclosure
requirements for in-office ancillary services exception
to 1564
the prohibition on
physician self-referral for certain imaging
services.
Sec. 6004. Prescription
drug sample
transparency.
1564
Sec. 6005. Pharmacy
benefit managers transparency
requirements. 1567
Subtitle BNursing Home
Transparency and
Improvement 1571
PART IIMPROVING
TRANSPARENCY
OF INFORMATION
1571
Sec. 6101. Required
disclosure of ownership and additional disclosable
parties 1571
information.
Sec. 6102. Accountability
requirements for skilled nursing facilities and
nursing 1579
facilities.
Sec. 6103. Nursing home
compare Medicare
website. 1585
Sec. 6104. Reporting of
expenditures.
1603
Sec. 6105. Standardized
complaint
form.
1605
Sec. 6106. Ensuring
staffing
accountability.
1607
Sec. 6107. GAO study and
report on Five-Star Quality Rating
System. 1609
PART IITARGETING
ENFORCEMENT
1610
Sec. 6111. Civil money
penalties.
1610
Sec. 6112. National
independent monitor demonstration
project. 1619
Sec. 6113. Notification of
facility
closure.
1625
Sec. 6114. National
demonstration projects on culture change and use of
information 1628
technology in nursing
homes.
PART IIIIMPROVING
STAFF
TRAINING
1630
Sec. 6121. Dementia and
abuse prevention
training.
1630
Subtitle CNationwide
Program for National and State Background
Checks 1632
on Direct Patient Access
Employees of Long-term Care Facilities and Providers
Sec. 6201. Nationwide
program for National and State background checks
on 1632
direct patient access
employees of long-term care facilities and
providers.
Subtitle
DPatient-Centered Outcomes
Research
1648
Sec. 6301.
Patient-Centered Outcomes
Research.
1648
Sec. 6302. Federal
coordinating council for comparative effectiveness
research. 1702
Subtitle EMedicare,
Medicaid, and CHIP Program Integrity
Provisions 1703
Sec. 6401. Provider
screening and other enrollment requirements under Medicare, 1703
Medicaid, and CHIP.
Sec. 6402. Enhanced
Medicare and Medicaid program integrity provisions. 1720
Sec. 6403. Elimination of
duplication between the Healthcare Integrity and 1747
Protection Data Bank and
the National Practitioner Data
Bank.
Sec. 6404. Maximum period
for submission of Medicare claims reduced to not
1760
more than 12 months.
Sec. 6405. Physicians who
order items or services required to be Medicare enrolled
1762
physicians or eligible
professionals.
Sec. 6406. Requirement for
physicians to provide documentation on referrals to
1764
programs at high risk of
waste and abuse.
Sec. 6407. Face to face
encounter with patient required before physicians
may 1765
certify eligibility for
home health services or durable medical
equipment under Medicare.
Sec. 6408. Enhanced
penalties.
1768
Sec. 6409. Medicare
self-referral disclosure
protocol.
1773
Sec. 6410. Adjustments to
the Medicare durable medical equipment, prosthetics,
1775
orthotics, and supplies
competitive acquisition program.
Sec. 6411. Expansion of
the Recovery Audit Contractor (RAC)
program. 1777
Subtitle FAdditional
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 GAdditional
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 HElder Justice
Act
1798
Sec. 6701. Short title of
subtitle.
1798
Sec. 6702.
Definitions.
1799
Sec. 6703. Elder
Justice.
1799
Subtitle ISense of the
Senate Regarding Medical
Malpractice 1858
Sec. 6801. Sense of the
Senate regarding medical
malpractice. 1858
TITLE VIIIMPROVING ACCESS
TO INNOVATIVE MEDICAL 1859
THERAPIES
Subtitle ABiologics Price
Competition and
Innovation 1859
Sec. 7001. Short
title.
1859
Sec. 7002. Approval
pathway for biosimilar biological
products. 1859
Sec. 7003.
Savings.
1906
Subtitle BMore Affordable
Medicines for Children and
Underserved 1906
Communities
Sec. 7101. Expanded
participation in 340B
program.
1906
Sec. 7102. Improvements to
340B program
integrity.
1913
Sec. 7103. GAO study to
make recommendations on improving the 340B program. 1924
TITLE VIIICLASS
ACT
1925
Sec. 8001. Short title of
title.
1925
Sec. 8002. Establishment
of national voluntary insurance program for
purchasing 1925
community living
assistance services and support.
TITLE IXREVENUE
PROVISIONS
1979
Subtitle ARevenue 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
W2. 1996
Sec. 9003. Distributions
for medicine qualified only if for prescribed drug or insulin. 1997
Sec. 9004. Increase in
additional tax on distributions from HSAs and
Archer 1998
MSAs not used for
qualified medical expenses.
Sec. 9005. Limitation on
health flexible spending arrangements under
cafeteria 1999
plans.
Sec. 9006. Expansion of
information reporting
requirements. 1999
Sec. 9007. Additional
requirements for charitable
hospitals. 2001
Sec. 9008. Imposition of
annual fee on branded prescription
pharmaceutical 2010
manufacturers and
importers.
Sec. 9009. Imposition of
annual fee on medical device manufacturers and importers.
2020
Sec. 9010. Imposition of
annual fee on health insurance providers.
2026
Sec. 9011. Study and
report of effect on veterans health
care. 2033
Sec. 9012. Elimination of
deduction for expenses allocable to Medicare Part
D 2034
subsidy.
Sec. 9013. Modification of
itemized deduction for medical
expenses. 2034
Sec. 9014. Limitation on
excessive remuneration paid by certain health
insurance 2035
providers.
Sec. 9015. Additional
hospital insurance tax on high-income
taxpayers. 2040
Sec. 9016. Modification of
section 833 treatment of certain health
organizations. 2044
Sec. 9017. Excise tax on
elective cosmetic medical
procedures. 2045
Subtitle BOther
Provisions
2047
Sec. 9021. Exclusion of
health benefits provided by Indian tribal
governments. 2047
Sec. 9022. Establishment
of simple cafeteria plans for small
businesses. 2050
Sec. 9023. Qualifying
therapeutic discovery project
credit 2057
(Note Page 2074 is the
last page of the document.)
(11/19/09)