109 HR 5866 IH: To amend titles XI and XVIII of the Social Security Act
U.S. House of Representatives
2006-07-24
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of
contents
(a)This Act may be cited
as the Medicare Physician Payment Reform and Quality Improvement Act of
2006
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Title I—Medicare Physician Payment Reform
Sec. 101. Medicare physician payment update reform.
Sec. 102. Voluntary reporting of quality measures for
physicians’ services.
Sec. 103. Removing limitations on balance billing with
beneficiary notice for highest income beneficiaries.
Title II—Quality Improvement Organization (QIO)
Modernization
Sec. 201. Quality improvement activities.
Sec. 202. Improved program administration.
Sec. 203. Data disclosure.
Sec. 204. Use of evaluation and competition.
Sec. 205. Quality improvement funding.
Sec. 206. Qualifications for QIOs.
Sec. 207. Coordination with medicaid.
Title III—Medicare Savings and Other Provisions
Sec. 301. Elimination of stabilization fund for regional
PPOs.
Sec. 302. Ongoing examination of medicare funding.
Sec. 303. One-year delay in medicare adjustments in payments
for imaging services; IOM study on utilization and appropriateness of imaging
services.
Sec. 304. Eliminating phase-in for implementation of reduction
in part B premium subsidy for higher income beneficiaries.
Sec. 305. Exclusion of indirect graduate medical education
payment in computation of payments to medicare advantage
organizations.
<enum>I</enum><header>Medicare Physician
Payment Reform</header>
<section id="H777814E3DA5D4AECB219B23038F7AFF1"><enum>101.</enum><header>Medicare
physician payment update reform</header>
<subsection id="H57DBF37A7E644DDE002C64FA31765F65"><enum>(a)</enum><header>Substitution of
MEI Increase for SGR Adjustments</header><text>Section 1848(d) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(d)</external-xref>) is amended—</text>
<paragraph id="HE3DE535CEB474F509375AFD9895FA2F2"><enum>(1)</enum><text>in paragraph
(1)(A), by inserting <quote>and before 2007</quote> after <quote>beginning with
2001</quote>;</text>
</paragraph><paragraph id="H904E286CD07647339CA7739FD7FD96B1"><enum>(2)</enum><text>in paragraph
(1)(A), by inserting before the period at the end the following: <quote>, and
for years beginning with 2007, multiplied by the update established under
paragraph (7) applicable to the year involved</quote>; and</text>
</paragraph><paragraph id="HA0B6E0E8EE6245F4B801BA30180D701"><enum>(3)</enum><text>in
paragraph (4)—</text>
<subparagraph id="H078A3F12FC394358B5B63BEF285F78FE"><enum>(A)</enum><text>in the heading by
striking <quote><header-in-text level="paragraph" style="OLC">years beginning
with 2001</header-in-text></quote> and inserting <quote><header-in-text level="paragraph" style="OLC">2001, 2002, and 2003</header-in-text></quote>;
and</text>
</subparagraph><subparagraph id="H1749A3C46F764243955253534967CF4B"><enum>(B)</enum><text>in subparagraph
(A), by inserting <quote>and ending with 2003</quote> after <quote>beginning
with 2001</quote>; and</text>
</subparagraph></paragraph><paragraph id="H8100667FF7C74B79A3ECA4BFFC023AC"><enum>(4)</enum><text>by
adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HB825E25F3091491C97804895E442AAA" style="OLC">
<paragraph id="H4289BE1CD9A84F5C0000BC461516F5A"><enum>(7)</enum><header>Update beginning
with 2007</header><text>The update to the single conversion factor established
in paragraph (1)(C) for 2007 and each succeeding year shall be the percentage
increase in the MEI (as defined in section 1842(i)(3)) for the year involved
minus 1 percentage
point.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H2B489F05EEC44B80807716674D997222"><enum>(b)</enum><header>Ending
application of sustainable growth rate (SGR)</header><text>Section
1848(f)(1)(B) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(f)(1)(B)</external-xref>) is amended by inserting
<quote>(and before 2006)</quote> after <quote>each succeeding
year</quote>.</text>
</subsection><subsection id="H4CA3BAB4E7F54C3BAAC5C37C7F0456C"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to payment
for services furnished on or after January 1, 2007.</text>
</subsection></section><section id="H56B3181B04534055B9E9CA14CBE06324"><enum>102.</enum><header>Voluntary
reporting of quality measures for physicians’ services</header>
<subsection id="HE6076F8A4F544C01ABCE5F98F93727B"><enum>(a)</enum><header>Reporting
program</header><text>Section 1848 of the Social Security Act (42 U.S.C.
1395w–4) is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HDB6B67DCBCB948348FEE462ECF1DEB5F" style="OLC">
<subsection id="HFDA39B2D45AB479B88EB8CCB5253B46B"><enum>(k)</enum><header>Quality
improvement</header>
<paragraph id="HC145B657743F4CDCB823372C73D358F3"><enum>(1)</enum><header>Selection of
quality measures (Q measures)</header>
<subparagraph id="H41E6DC6D57F9412C9645E4DFCE50D1F7"><enum>(A)</enum><header>In
general</header><text>Not later than January 1, 2009, the Secretary shall
provide for the selection of quality measures (in this subsection referred to
as <quote>Q-measures</quote>) consistent with and in accordance with this
paragraph and paragraph (2).</text>
</subparagraph><subparagraph id="H4F900FFFD6F64C9F9B9F50E1E7253EE"><enum>(B)</enum><header>Level of
measurement</header><text>Q-measures shall be measures that provide for
assessment of quality in the provision of services to individuals enrolled
under this part at the level of a billing unit under this part.</text>
</subparagraph><subparagraph id="H2158B95C009E454EB3BE2B32A8798D6B"><enum>(C)</enum><header>Characteristics
of measures</header><text display-inline="yes-display-inline">To the extent
feasible and practicable, Q measures shall—</text>
<clause id="H97B6186EDCCD41F300437C012CD3CA6B"><enum>(i)</enum><text display-inline="yes-display-inline">include a mixture of outcome measures,
process measures (such as furnishing a service), and structural measures (such
as the use of physician extenders, disease management, and health information
technology for submission of measures);</text>
</clause><clause id="H93E42A5809224E93B45156BACD46BB7E"><enum>(ii)</enum><text display-inline="yes-display-inline">include measures of care furnished to frail
individuals over the age of 75 and to individuals with multiple complex chronic
conditions;</text>
</clause><clause id="H001C6CFABFA641309419699899C68660"><enum>(iii)</enum><text>be
evidence-based, if pertaining to clinical care;</text>
</clause><clause id="H391A1CEF830044CF9F000029ECB4CEB"><enum>(iv)</enum><text>be
consistent, valid, practicable, and not overly burdensome to collect;</text>
</clause><clause id="HAA5EF623FFE34513B2316991D2062C88"><enum>(v)</enum><text>be
relevant to physicians and other practitioners and individuals enrolled under
this part;</text>
</clause><clause id="H6B05C7FF822C4FE4BDA0C2B344AF1F42"><enum>(vi)</enum><text>include measures
that, taken as a whole, provide a balanced measure of performance of a billing
unit under this part; and</text>
</clause><clause id="H8245D9604D5C4844A1CAD55C20356BC2"><enum>(vii)</enum><text>include measures
that capture individuals’ assessment of clinical care provided.</text>
</clause></subparagraph><subparagraph id="HE09DAC14F3374B7C84858FCDF9ECC6B0"><enum>(D)</enum><header>Fairness</header><text>To
the extent feasible and practicable, this subsection shall be implemented in a
manner that—</text>
<clause id="HBD836899F5D74303ADC13C4DA13B3002"><enum>(i)</enum><text>takes into account
differences in individual health status;</text>
</clause><clause id="H51080D2BFA71476A95E2AF8E8D175E2F"><enum>(ii)</enum><text>takes into
account individual’s compliance with orders;</text>
</clause><clause id="H9F444EC7331B4F0BBFFC012068DBE1D"><enum>(iii)</enum><text>does not directly
or indirectly encourage patient selection or de-selection by billing units
under this part;</text>
</clause><clause id="H8A3DD168DC5542878F69C13655736D32"><enum>(iv)</enum><text>reduces health
disparities across groups and areas; and</text>
</clause><clause id="HFE9258184E7D4A47B58ED92E7B948BE4"><enum>(v)</enum><text>uses appropriate
statistical techniques to ensure valid results.</text>
</clause></subparagraph><subparagraph id="HCC786257133B4D4EA9216C6C1129DCCB"><enum>(E)</enum><header>Application to
non-physician practitioners and other suppliers for which payment is made under
or in relation to physician fee schedule</header><text>Insofar as physicians’
services under this section are furnished by non-physician practitioner or a
supplier other than a physician—</text>
<clause id="H9C61506E01A24A0FAD007DD6722F4C2E"><enum>(i)</enum><text>any reference in
this subsection to a physician shall be a reference to such practitioner or
supplier; and</text>
</clause><clause id="HE551FB2D5E6941B9B4A2C7806C7F6B00"><enum>(ii)</enum><text>any reference to
a physician specialty organization is deemed a reference to a specialty
organization representing the speciality of such practitioners or
suppliers.</text>
</clause></subparagraph><subparagraph id="H4ED18537067E41CA83CA7B9C8B41993C"><enum>(F)</enum><header>Development</header><text>In
developing Q measures, the Secretary shall provide for—</text>
<clause id="HAF7412BC09874976B72B04B2A02990F2"><enum>(i)</enum><text display-inline="yes-display-inline">measurement of quality by stratified groups
and the review of the absolute level of quality provided by a physician or
medical group; and</text>
</clause><clause id="H8603C99CA96944CDB8D6E8A18FCB4E7"><enum>(ii)</enum><text>including
practicing physicians with expertise in eliminating racial and ethnic health
disparities in the design, implementation and evaluation of the program.</text>
</clause></subparagraph></paragraph><paragraph id="H8D00F09612794BB2A58CF9E8B88477CC"><enum>(2)</enum><header>Selection
process for measures</header>
<subparagraph id="HE0920050CE8D49A9BD7B70636CABC969"><enum>(A)</enum><header>Submission of
proposed measures to consensus-building organization</header>
<clause id="HC94F01025A9E480DABB040FEFD50076"><enum>(i)</enum><header>By physician
specialty organizations</header><text display-inline="yes-display-inline">The
Secretary shall request each physician specialty organization to submit to the
consensus-building organization by January 1, 2008, proposed Q measures
described in clauses (i) through (vi) of paragraph (1)(C) that would be
applicable to core clinical services that billing units under this part
practicing in the specialty provide to individuals enrolled under this
part.</text>
</clause><clause id="H33509F238D414572ACCBDE00DECB8DF8"><enum>(ii)</enum><header>By
Secretary</header><text display-inline="yes-display-inline">If the physician
specialty organization for a physician specialty has not submitted proposed Q
measures under clause (i) by January 1, 2008, the Secretary shall submit, as
soon as possible but not later than February 1, 2008, proposed Q measures
described in clauses (i) through (vi) of paragraph (1)(C) for such specialty to
the consensus-building organization.</text>
</clause><clause id="HAE31BC40D4B34D3A9C5340781718F981"><enum>(iii)</enum><header>Consensus-building
organization defined</header><text display-inline="yes-display-inline">For
purposes of this paragraph, the term <term>consensus-building
organization</term> means an organization, such as the National Quality Forum,
that the Secretary identifies as—</text>
<subclause id="H30337435E95649E097F0E400CDEA7C0"><enum>(I)</enum><text display-inline="yes-display-inline">having experience in using a process (such
as the process described in OMB circular A–119 published in the Federal
Register on February 10, 1998) for reaching a group consensus with respect to
measures, such as Q measures, relating to performance of those providing health
care services; and</text>
</subclause><subclause id="H8A80016042F64BA7008B524E86A044A4"><enum>(II)</enum><text display-inline="yes-display-inline">including in such process representatives
of the Secretary, practicing physicians (and, as provided under paragraph
(1)(E), practicing non-physician practitioners and other suppliers),
practitioners with experience in the care of the frail elderly and individuals
with multiple complex chronic conditions, organizations and individuals
representative of the specialty involved, individuals enrolled under this part,
experts in health care quality, and individuals with experience in the delivery
of health care in urban, rural, and frontier areas and to underserved
populations and those who serve a disproportionate number of minority
patients.</text>
</subclause></clause></subparagraph><subparagraph id="H8B837A07F79B42FFA5F49BA5D2661638"><enum>(B)</enum><header>Recommendations
by consensus-building organization</header><text>The consensus-building
organization that receives proposed measures under subparagraph (A) is
requested to submit to the Secretary by May 1, 2008, recommendations respecting
the Q measures described in clauses (i) through (vi) of paragraph (1)(C) to be
implemented under this subsection.</text>
</subparagraph><subparagraph id="HEED54F413D7D407CBA9D214F8F54B81F"><enum>(C)</enum><header>Secretarial
selection</header><text display-inline="yes-display-inline">The Secretary shall
select Q measures described in paragraph (1)(C) for purposes of this subsection
consistent with the following:</text>
<clause id="HEB00CB54A5F54BB5BE406E78A69BCF25"><enum>(i)</enum><header>Use of
recommendations for clinical care measures submitted by certain
organizations</header><text>Except as provided in clause (ii), the Secretary
shall not select a Q measure described in clauses (i) through (vi) of paragraph
(1)(C) and relating to clinical care unless that measure has been submitted by
a physician specialty organization (or through a physician-consensus building
process, such as the Physician Consortium for Performance Improvement) and
recommended by the consensus-building organization under subparagraph
(B).</text>
</clause><clause id="H029AE11485E6424BABD3CAD3DA06F24D"><enum>(ii)</enum><header>Provision by
regulation</header><text>The Secretary may by regulation select—</text>
<subclause id="H8D61DE5B160543229B7FF547DF4DA0CA"><enum>(I)</enum><text>Q measures
described in clauses (i) through (vi) of paragraph (1)(C) and relating to
clinical care that do not meet the requirements of clause (i) only if the
Secretary determines that there were no, or insufficient, recommendations
regarding such Q measures under such clause and only if the Secretary takes
into account research-based peer-reviewed medical publications in selecting
such measures; and</text>
</subclause><subclause id="HD5EBE5F5E38940AA8DE074000613F78E"><enum>(II)</enum><text>Q measures
described in clause (vii) or (viii) of paragraph (1)(C) and Q measures
described in clause (i) through (vi) of such paragraph that do not relate to
clinical care.</text>
</subclause></clause></subparagraph><subparagraph id="H1497C3A7AAA34DB191A98ED309924D00"><enum>(D)</enum><header>Periodic
revision of selection</header><text>The Secretary shall provide for the
periodic revision and selection of Q measures consistent with the provisions of
this paragraph and paragraph (1) and the application of such revised Q measures
on a prospective basis for a following year.</text>
</subparagraph></paragraph><paragraph id="HAC991B28A1614617A09CA766E4001424"><enum>(3)</enum><header>Ratings of
physicians based on measures</header>
<subparagraph id="H03337CE1AEE242EDBA32CCE3139962F3"><enum>(A)</enum><header>Ratings and
identification of quality performance</header>
<clause id="HBC835D9D35FA4708AFE758741BB91E67"><enum>(i)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary shall
determine a single rating of each billing unit under this part based on Q
measures selected under paragraph (2) and information reported under paragraph
(4). Such a rating shall be determined for a billing unit based on its
performance on Q measures relative to the performance of its peers taking into
account the voluntary nature of the reporting system under this
subsection.</text>
</clause><clause id="H66D5C13C15D94C98962537E6127047E"><enum>(ii)</enum><header>No direct
disclosure of rating</header><text>Subject to subparagraph (B), the Secretary
shall not make such ratings of identifiable billing units under this part
available other than to the respective unit.</text>
</clause><clause id="H408B1836870D48D998D729E41578382C"><enum>(iii)</enum><header>Improvement
and performance thresholds</header><text>For specification of improvement and
performance thresholds, see paragraph (5)(C).</text>
</clause></subparagraph><subparagraph id="H7F54FE2109794DFAA39B1B70EC006DE"><enum>(B)</enum><header>Disclosure of
performance in relation to performance thresholds</header>
<clause id="H1E7AE946F6E44E12B53ED56AB7D6E44"><enum>(i)</enum><header>In
general</header><text>Subject to the succeeding provisions of this
subparagraph, each year the Secretary shall make widely available to the public
the following information regarding a billing unit’s performance on the Q
measures:</text>
<subclause id="H346D5B0D85AB4B7BB68FBA2665B80869"><enum>(I)</enum><text>Whether the unit
was a new billing unit or otherwise had insufficient data to provide for a
measurement of whether it met the performance objectives under paragraph
(5)(C).</text>
</subclause><subclause id="H003DE25BB0054A4FB057832DDE4C762B"><enum>(II)</enum><text>For any other
unit, whether the unit met the performance objectives under such
paragraph.</text>
</subclause></clause><clause id="HCDA98C82E84040A9A126C65CE198649E"><enum>(ii)</enum><header>Limitation
during first 2 years</header><text display-inline="yes-display-inline">During
2009 and 2010, the Secretary shall not make the information under clause (i)
with respect to an identifiable billing unit available other than to the
respective unit.</text>
</clause><clause id="HE9B50556BA694A999EDB9B40EC50B4B"><enum>(iii)</enum><header>Physician
notification and opportunity for comment or appeal</header><text>Before making
information under clause (i) available with respect to a billing unit under
this part for years beginning with 2010, the Secretary shall notify the unit of
the performance on Q measures (including information on the unit’s performance
in relation to performance objectives and aggregate information regarding the
performance of peers) and provide the opportunity for the unit to provide
written comments regarding the unit’s performance. The Secretary shall respond
in writing to the comments and seek to reach agreement on the unit’s
performance and shall establish a formal appeals process in the event of
continued disagreement concerning such performance. Upon conclusion of the
appeals process, if the unit provides comments relating directly to the final
determination under clause (i) respecting such performance, the Secretary shall
disclose such comments with the disclosure of the information under such
clause.</text>
</clause><clause id="HDC19DE125B384AEE987B195EF8A4EDE"><enum>(iv)</enum><header>Application of
HIPAA privacy rules</header><text>Nothing in this subparagraph shall be
construed as changing or affecting the application of rules promulgated under
section 264(c) of the Health Insurance Portability and Accountability Act of
1996.</text>
</clause></subparagraph><subparagraph id="HBDB532AA3C3C45148588585DD502EFC6"><enum>(C)</enum><header>Peers
defined</header><text>For purposes of this subsection, the term
<term>peers</term> means, with respect to a billing unit under this part that
practices in a specialty in an MA region (as established under section
1858(a)(2)), other billing units under this part that practice in the same
specialty in the same region, or, beginning with the update for 2013, or in the
United States.</text>
</subparagraph></paragraph><paragraph id="H43C76779FE194E28B077850908E8CE90"><enum>(4)</enum><header>Reporting on
performance beginning with 2008</header><text display-inline="yes-display-inline">Beginning with 2008, each billing unit
under this part may submit information on performance on the Q measures
selected under this subsection with respect to individuals enrolled under this
part. Such information shall be submitted in a form and manner and time
specified by the Secretary, which may include submission as part of claims data
under this part. The Secretary shall provide a process for auditing the
accuracy of the information submitted under this paragraph.</text>
</paragraph><paragraph id="HEA4C89A863C24838B3FD1844AFC000E5"><enum>(5)</enum><header>Informational
performance standards and thresholds</header>
<subparagraph id="H06CC502DAE78404DB0D61DEA71A8241"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">For purposes of
disclosure under paragraph (3)(B), the Secretary shall establish quality
performance objectives for billing units under this part.</text>
</subparagraph><subparagraph id="HDADBE2F0BA0E46DC8E755328E9F291C"><enum>(B)</enum><header>Disclosure</header><text>For
purposes of paragraph (3)(B), such a billing unit is considered to meet
performance objectives for a year if, based on the unit’s rating under
paragraph (3)(A), the unit’s performance meets or exceeds the performance
thresholds specified by the Secretary under subparagraph (C).</text>
</subparagraph><subparagraph id="HDB2C9D9427CB4E6A9D3969CEB8176DE0"><enum>(C)</enum><header>Improvement
standards and performance thresholds</header><text>The Secretary shall specify
the performance thresholds under subparagraphs (B) before the beginning of the
year involved.</text>
</subparagraph><subparagraph id="H317298A121C941B8A899862772D3A7F4"><enum>(D)</enum><header>Treatment of
cases of insufficient information</header><text>A billing unit is deemed to
meet performance objectives under subparagraphs (B) and (C) if the unit
complied with the reporting requirement under paragraph (4) but there was
insufficient information, as determined by the Secretary, to provide a valid
measure of performance.</text>
</subparagraph></paragraph><paragraph id="H0F203799F3CB40D1B4040642612CCA76"><enum>(6)</enum><header>Review of
additional expenses</header><text display-inline="yes-display-inline">Not later
than January 1, 2010, and after consultation with the medical community, the
Secretary shall review, and report to Congress on, the extent to which billing
unit compliance with the reporting provisions of paragraph (4) results in
increased work and practice expenses to billing units and whether participating
billing units showed a demonstrable improvement in the delivery of quality
health care.</text>
</paragraph><paragraph id="H652C4754589E4C83B596EB5900C2F993"><enum>(7)</enum><header>Physician and
beneficiary education</header><text display-inline="yes-display-inline">During
2008, the Secretary shall establish a program to educate billing units under
this part and individuals enrolled under this part about the voluntary quality
disclosure system under this subsection and recommendations on training
opportunities to improve ratings and performance on Q measures .</text>
</paragraph><paragraph id="H22BA3E7D66124224968EE4A99B08CCC8"><enum>(8)</enum><header>Annual report on
growth in volume of physicians’ services</header>
<subparagraph id="H78FE78A97C1E4F06BB2585007C80B6B2"><enum>(A)</enum><header>In
general</header><text>The Secretary shall report to the Medicare Payment
Advisory Commission and Congress by April 1 of each year (beginning with 2008)
information on the growth in volume of services per enrollee and growth in
expenditures per enrollee, based upon services and expenditures for which
payment is based, or related to, the fee schedule established under this
section.</text>
</subparagraph><subparagraph id="H2A70E07A03424018005BBB31189713AC"><enum>(B)</enum><header>Details</header><text>The
information under subparagraph (A) shall—</text>
<clause id="HD54CDE50E2C14F27B4885C9100E7FBF"><enum>(i)</enum><text display-inline="yes-display-inline">be disaggregated by type of service, by
geographic area, and by specialty of physicians (or, if applicable, of
non-physician practitioners or suppliers);</text>
</clause><clause id="H73550EBBE1A6480788BC1568EDBF09F4"><enum>(ii)</enum><text display-inline="yes-display-inline">distinguish between growth in expenditures
due to price change versus volume change and intensity change, including growth
due to the development and improvement of procedures; and</text>
</clause><clause id="H7DAFDFE136A94B09943568DAEFF94DED"><enum>(iii)</enum><text>identify types
of service or geographic areas where changes in volume or expenditures are
inappropriate or unjustified, taking into account clinical outcomes.</text>
</clause></subparagraph><subparagraph id="H8F625FD35670480980E01485FC9F3CA6"><enum>(C)</enum><header>Recommendations</header><text>Each
such report shall include recommendations to respond to inappropriate growth in
service volume. Such recommendations may include regulatory or legislative
changes, or both.</text>
</subparagraph><subparagraph id="HA97CC9CD28924A18970060DD54AA01ED"><enum>(D)</enum><header>MedPAC
response</header><text>The Medicare Payment Advisory Committee shall review
each report submitted under this paragraph, including recommendations included
under subparagraph (C). The Commission shall include in its report to Congress
in June following each such report an analysis of the Secretary’s findings and
recommendations.</text>
</subparagraph></paragraph><paragraph id="H731931B0CDCA480FA9B2B1FC79009E9B"><enum>(9)</enum><header>Evaluation;
report</header>
<subparagraph id="HBE8930FA8A3B4768B1C5BBB4D7AA915C"><enum>(A)</enum><header>Evaluation</header><text>The
Secretary shall provide for an evaluation of the operation of this subsection
during the 5-year period in which this subsection is first applied. Such
evaluation shall review the impact of this subsection on improving the quality
of services and on access to such services and on the fairness of its
implementation. Such evaluation shall include a study of the extent to
which—</text>
<clause id="H06103B70CC9342A48CEE35C351171DA0"><enum>(i)</enum><text>payment policies
under this section exacerbate or diminish racial and ethnic health disparities;
and</text>
</clause><clause id="H32D4F1EDA2A24DEEBCE0E3979969D42"><enum>(ii)</enum><text>there has been
improvement in meeting performance measures for racial and ethnic minorities
through the operation of this section.</text>
</clause><continuation-text continuation-text-level="subparagraph">The
Secretary is authorized to enter into a contract with the Institute of Medicine
of the National Academy of Sciences for the conduct of the evaluation under
this subparagraph.</continuation-text></subparagraph><subparagraph id="H65D7B57A847D4AE48439387927B672EC"><enum>(B)</enum><header>Report</header><text>The
Secretary shall submit to Congress a report on such evaluation by not later
than September 30, 2012.</text>
</subparagraph></paragraph><paragraph id="H8F5D593BD40648E6948C8682D165309B"><enum>(10)</enum><header>Waiver of
administrative and judicial review</header><text>There shall be no
administrative or judicial review under section 1869 or otherwise of—</text>
<subparagraph id="HA5B4E42CBF2D4565A732B615B2DF06D9"><enum>(A)</enum><text>the selection of Q
measures under paragraphs (1) and (2);</text>
</subparagraph><subparagraph id="H6EBD723CAA674C80AAF0068F3B3A0FB"><enum>(B)</enum><text>the development and
computation of ratings under paragraph (3)(A), standards and thresholds under
paragraph (5)(C), and the application of such standards and thresholds under
paragraphs (3)(B) and (5)(B); and</text>
</subparagraph><subparagraph id="H8044701EE7754411A6B28895F089A793"><enum>(C)</enum><text>the definition of
peers and new billing units under this
subsection.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HC30E1CDBD5884B6AADA7B8942CF43900"><enum>(b)</enum><header>Conforming
MedPAC duties</header><text>Section 1805(b)(2) of such Act (42 U.S.C.
1395b–6(b)(2)) is amended by adding at the end the following new
subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H904C2C5E8E37420ABCAB47EBF916CD42" style="OLC">
<subparagraph id="H0AF78D2487374E8787F8198258C050BE"><enum>(D)</enum><header>Review of report
on growth in physician services</header><text>Specifically, under section
1848(k)(8)(D), the Commission shall review and make recommendations concerning
the Secretary’s report on the growth of physicians’ services under section
1848.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="H464E844EC0B4417900C7C84283C48919"><enum>103.</enum><header>Removing
limitations on balance billing with beneficiary notice for highest income
beneficiaries</header>
<subsection id="HE1836477A72244E495F711AC5E860403"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1848(g) of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(g)</external-xref>) is amended—</text>
<paragraph id="HF1D54E84A7C3482189023D2F7BD863EE"><enum>(1)</enum><text>in paragraph
(1)(A), in the matter before clause (i), by inserting <quote>, subject to
subparagraph (D),</quote> after <quote>enrolled under this part</quote>;</text>
</paragraph><paragraph id="H2DA7749C28E6443E9DD2D61968ACB324"><enum>(2)</enum><text>in paragraph (1),
by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HF2936CDC68D141AB008E54F290299425" style="OLC">
<subparagraph id="HE99743023861449DBEBE449F5F4C03FD"><enum>(D)</enum><header>Exception for
highest income beneficiaries</header><text display-inline="yes-display-inline">Subparagraph (A) shall not apply with
respect to physicians’ services furnished in a month to an individual with
respect to whom and for such month a reduction in premium subsidy is in effect
under section 1839(i) if the individual furnishing such services provides the
advance notice of such non-participation and non-acceptance of assignment under
paragraph (8) and (for services furnished on or after January 1, 2008) submits
information in accordance with subsection
(k)(4).</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</paragraph><paragraph id="H767579EB77A8415C966B77F016180947"><enum>(3)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H45476D1B5D734AA3BD024BDA6E80D500" style="OLC">
<paragraph id="H26194C9BCDB7422AB648BEE5CEECCB9"><enum>(8)</enum><header>Notice of
non-participation and non-acceptance of assignment</header><text>For purposes
of paragraph (1)(D), the advance notice of non-participation and non-acceptance
of assignment shall be, with respect to an item or service furnished under this
part by (or under the supervision of) a physician, a notice (that may be in the
form of a posting in a conspicuous place in a physician’s office or on patient
information forms) that is posted or otherwise furnished in a manner so as to
inform the individual receiving the item or service that—</text>
<subparagraph id="H6646F7A03F0C4A4AB12BA12A7F553E8"><enum>(A)</enum><text>the physician
furnishing (or supervising the furnishing of) the items or service is not a
participating physician and does not accept assignment with respect to the
service; and</text>
</subparagraph><subparagraph id="H27834F51EA644AAB00DAD65FE39C50AA"><enum>(B)</enum><text display-inline="yes-display-inline">because of such non-acceptance, in the case
of physicians’ services furnished in a month to an individual with respect to
whom and for such month a reduction in premium subsidy is in effect under
section 1839(i), the charge imposed is not limited and may exceed the limiting
charge described in paragraph
(2).</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HB057C3BA64AD42A7AAD81200EDB8002B"><enum>(b)</enum><header>Conforming
amendment to private contract provisions</header><text>Section 1802 of such Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395a">42 U.S.C. 1395a</external-xref>) is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H25555DA306874B1DBB45FFB46E34832" style="OLC">
<paragraph id="H3046030F80B64DB19F9E42C439ABDC1"><enum>(6)</enum><header>Exception for
highest income beneficiaries</header><text display-inline="yes-display-inline">The previous provisions of this subsection
shall not apply to physicians’ services furnished in a month to an individual
with respect to whom and for such month a reduction in premium subsidy is in
effect under section 1839(i) if the advance notice described in section
1848(g)(8) has been provided and (for services furnished on or after January 1,
2008) the physician furnishing the services submits information in accordance
with section
1848(k)(4).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H4911716BBA1C4B86A3E97B854E002222"><enum>(c)</enum><header>Conforming
amendment to participation provisions</header><text>Section 1842(h) of such Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395u">42 U.S.C. 1395u</external-xref>) is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HD75B0AE0785D4F29998850D8F7B2746C" style="traditional">
<paragraph id="HA352EAB578AB41E8BB7E8DA4213856BF" indent="up1"><enum>(8)</enum><text>The previous provisions of this
subsection, insofar as they limit the charges that a participating physician
may impose, shall not apply to physicians’ services furnished in a month to an
individual with respect to whom and for such month a reduction in premium
subsidy is in effect under section 1839(i) if the advance notice described in
section 1848(g)(8) has been provided and (for services furnished on or after
January 1, 2008) the physician furnishing the services submits information in
accordance with section
1848(k)(4).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HA0F72823BA8C4485BD1F412482959714"><enum>(d)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to services
furnished on or after January 1, 2008.</text>
</subsection><subsection id="HBF29A7B82C0A49938F5E6BD7497ECD17"><enum>(e)</enum><header>Review and
report on impact</header>
<paragraph id="HE2074E0472964184B31BF72BF193A0D9"><enum>(1)</enum><header>Review</header><text>The
Secretary of Health and Human Services shall monitor and review the impact of
the amendments made by this section on the access of medicare beneficiaries to
physicians’ services.</text>
</paragraph><paragraph id="HA897668ABB774C9CBDD71B2E28F400B6"><enum>(2)</enum><header>Report</header><text>Not
later than January 1, 2009, the Secretary shall submit to Congress a report on
such review and shall include such recommendations regarding changes in the
amendments made by this section (such as reducing the income threshold applied
for purposes of determining applicability of such amendments and thereby
expanding the application of such amendments) as the Secretary deems
appropriate.</text>
</paragraph></subsection></section><enum>II</enum><header>Quality
Improvement Organization (QIO) Modernization</header>
<section id="H28854F667D884F5783BAD8FE1C474FE7"><enum>201.</enum><header>Quality
improvement activities</header>
<subsection id="HEDCDFE6450F94F159000D0F5CACD48A"><enum>(a)</enum><header>Inclusion of
quality improvement functions</header><text display-inline="yes-display-inline">Section 1154(a) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1320c-3">42 U.S.C. 1320c–3(a)</external-xref>) is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="yes-display-inline" id="H1897B5EF9F124347A000A423CCFD556" style="OLC">
<paragraph id="HDCC69341C4214345AE2C3E46B45CE500"><enum>(18)</enum><text>The organization
shall offer quality improvement assistance to providers, practitioners,
Medicare Advantage organizations offering Medicare Advantage plans under part C
of title XVIII, and prescription drug sponsors offering prescription drug plans
under part D of such title, including the following:</text>
<subparagraph id="HAE3B13338FCB4B9FAD33F1C48EED7700"><enum>(A)</enum><text>Education on
quality improvement initiatives, strategies and techniques.</text>
</subparagraph><subparagraph id="HA73888E3384B4E2A8B10321FF4FB00AF"><enum>(B)</enum><text>Instruction on how
to collect, submit, aggregate and interpret data on measures that may be used
for quality improvement, public reporting and payment.</text>
</subparagraph><subparagraph id="HAC69A6379A5C4A3B9308C9FEFDC1B6EC"><enum>(C)</enum><text>Instruction on how
to conduct root-cause analyses.</text>
</subparagraph><subparagraph id="H74032A08403A44579696BAC4D5784000"><enum>(D)</enum><text>Technical
assistance for providers and practitioners in beneficiary education to
facilitate patient self-management.</text>
</subparagraph><subparagraph id="H6E793F16CCB44C44B1A30376F1960038"><enum>(E)</enum><text>Facilitating
cooperation among various local stakeholders in quality improvement.</text>
</subparagraph><subparagraph id="H1ECB444EA7B840D99F1B227C00ABEA31"><enum>(F)</enum><text>Facilitating
adoption of procedures that encourage timely candid feedback from patients and
their families concerning perceived problems.</text>
</subparagraph><subparagraph id="H33610DACF68342E4B2BB27C63D3CA827"><enum>(G)</enum><text>Guidance on
redesigning clinical processes, including the adoption and effective use of
health information technology, to improve the coordination, effectiveness, and
safety of care.</text>
</subparagraph><subparagraph id="H231AF86DDAB743B49CB98491F68CA07"><enum>(H)</enum><text display-inline="yes-display-inline">Assistance in improving the quality of care
delivered in rural and frontier areas and reducing health care disparities
among racial and ethnic minorities, as well as gender
disparities.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HBBEC27F98EB64E47A49DB80000D279D5"><enum>(b)</enum><header>Medicare quality
accountability program</header><text>Paragraph (14) of section 1154(a) of such
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1320c-3">42 U.S.C. 1320c–3(a)</external-xref>) is amended to read as follows:</text>
<quoted-block display-inline="yes-display-inline" id="H48E005181B6346AD96E92B1C4F3E446D" style="OLC">
<paragraph id="H3125977E65384B4D005086E9DF5B05AE"><enum>(14)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="H7C540427C9CE42BAB77B67864780C21"><enum>(A)</enum><text>The organization shall
conduct an appropriate review of all written complaints about the quality of
services (for which payment may otherwise be made under title XVIII) not
meeting professionally recognized standards of health care, if the complaint is
filed with the organization by an individual entitled to benefits for such
services under such title (or a person acting on the individual’s behalf).
Before the organization concludes that the quality of services does not meet
professionally recognized standards of health care, the organization must
provide the practitioner or person concerned with reasonable notice and
opportunity for discussion.</text>
</subparagraph><subparagraph id="HE33E0809AB074F2B917F6EB851243F50" indent="up1"><enum>(B)</enum><text>The organization shall establish and
operate a Medicare quality accountability program consistent with the
following:</text>
<clause id="HED248F2559864B608EE2EFE1F43FDC51"><enum>(i)</enum><text>The organization shall actively
educate Medicare beneficiaries of their right to bring quality concerns to
Quality Improvement Organizations.</text>
</clause><clause id="H334B5CE6EA854BDAA9969EFD9100A092"><enum>(ii)</enum><text>The organization shall report
findings of its investigations to complainants, the beneficiary involved, or
their representative, whether the complaint findings involve physicians or
institutional providers, practitioners, or Medicare Advantage plans, but such
complaint findings may not be used in any form in a medical malpractice
action.</text>
</clause><clause id="H66A15E6E85114D9A9E09497E2C8C66EE"><enum>(iii)</enum><text>The organization shall assist
providers, practitioners, and plans in adopting best practices for soliciting
and welcoming feedback about patient concerns, and assist providers,
practitioners, and plans in remedying patient-reported problems that are
confirmed by the organization and shall report findings of patient reported
problems to the provider, practitioner, or plan involved before disclosing
investigation results to the patient or patient’s representative.</text>
</clause><clause id="H043855C9B3F84D68B740DA3BC38ED311"><enum>(iv)</enum><text>The organization shall determine
whether the complaint allegations about clinical quality of care are confirmed
and assist provider, practitioners, and plans in remedying confirmed
complaints.</text>
</clause><clause id="HE573A72FDD3A40CB8320A2EA9329D1CF"><enum>(v)</enum><text>The organization shall respond
supportively to quality problems caused by unsafe systems, and refer for
enforcement providers who are unwilling or unable to improve.</text>
</clause><clause id="H854258FBD8DA439084C3A1C4A812DC9C"><enum>(vi)</enum><text>The organization shall publish
annual quality reports in each State in which the organization operates,
including aggregate complaint data and provider performance on standardized
quality measures.</text>
</clause><clause id="H563F9D164F5348EBAA6947B68DB52BBC"><enum>(vii)</enum><text display-inline="yes-display-inline">The organization shall promote beneficiary
awareness of standardized quality measures that may be used for evaluating care
and for choosing providers, practitioners and plans</text>
</clause></subparagraph><subparagraph id="HABE41D0D142F4A808545ADC9B92922D0" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">The Secretary shall monitor and report to
Congress, regarding—</text>
<clause id="H87392120845C4A4697281BAF7F63CC9E"><enum>(i)</enum><text>the reliability of complaint
determinations by Quality Improvement Organizations;</text>
</clause><clause id="HB6708F12429544D783C74F4BB1AD0454"><enum>(ii)</enum><text>the effect of disclosure of
complaint findings on the availability of primary- and specialty-care physician
reviewers;</text>
</clause><clause id="H80F6AA4A08AB47F7006D3F00B2FD7394"><enum>(iii)</enum><text>changes resulting from the
systems change process described in subparagraph (B)(v); and</text>
</clause><clause id="H538C9508638F4097B58EADC700063975"><enum>(iv)</enum><text>trends in civil litigation filed
by
complainants.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="HFB59DF9C6B404888B3CC3814C0BE295B"><enum>202.</enum><header>Improved
program administration</header><text display-inline="no-display-inline">Part B
of title XI of the Social Security Act is amended by adding at the end the
following new section:</text>
<quoted-block display-inline="no-display-inline" id="H03DF029A47894D398272ABA64706311B" style="traditional">
<section id="H0B5EA4EBCB3449549B15FD57AF388BF4"><enum>1164.</enum><header>Program administration</header><subsection commented="no" display-inline="yes-display-inline" id="H4D04FB1D8791461A8C706E4BE68B0952"><enum>(a)</enum><header>Improved program
management</header>
<paragraph id="H226DBC9D72654E59B4F312C216742755"><enum>(1)</enum><header>Report on
management of the QIO program</header><text>The Comptroller General of the
United States shall submit to Congress, no later than March 31, 2010, a report
on the implementation by the Secretary and the Director of the Office of
Management and Budget of this part and their overall management of the program
under this part.</text>
</paragraph><paragraph id="HCCB57E7E93EA4F7991DB6030B43DB72E"><enum>(2)</enum><header>Program
management</header><text>The report under paragraph (1) shall include a review
of all of the following:</text>
<subparagraph id="HE32518481B8A44F1BB509D756B1100C5"><enum>(A)</enum><text display-inline="yes-display-inline">Implementation of the priorities,
recommendations, and strategies of the strategic advisory committee under
subsection (c)(1).</text>
</subparagraph><subparagraph id="H964D9A76490D44F9902E77CFE2AA9F04"><enum>(B)</enum><text>Implementation of
appropriate program and contractor evaluation.</text>
</subparagraph><subparagraph id="H0930EBF166014844A900E9008E53F847"><enum>(C)</enum><text>Ensuring timely
issuance of statements of work.</text>
</subparagraph><subparagraph id="H8F0D9566D8374961897FFF0240215D40"><enum>(D)</enum><text>Ensuring timely
and priority QIO access to Medicare data for quality improvement
purposes.</text>
</subparagraph><subparagraph id="HF55DAF9DFCDF4EC6A79478A3498730D0"><enum>(E)</enum><text>Ensuring timely
apportionment of funding.</text>
</subparagraph><subparagraph id="H86A0D879C45F4C729D4D24AE871FEF01"><enum>(F)</enum><text>Ensuring funding
levels for new work are added to the QIO contract, as described in the second
sentence of section 1159(b)(1).</text>
</subparagraph><subparagraph id="H71F3F888285D4E4BB97144086DA6F400"><enum>(G)</enum><text>The process of
developing the apportionment request and determining the funding allocation to
QIOs.</text>
</subparagraph><subparagraph id="HEF0ABE4D8D174660B84BF099F7BA5EE6"><enum>(H)</enum><text>The identification
of and progress towards measures of effective management by the Secretary of
the QIO program.</text>
</subparagraph><subparagraph id="HE009EB54629D4395B96F57F712E700DE"><enum>(I)</enum><text>A review of the
experience and qualifications of staff of the Centers for Medicare &
Medicaid Services in overseeing the program.</text>
</subparagraph></paragraph><paragraph id="H80F69CC7870B494EB4A56345EB00AB11"><enum>(3)</enum><header>Innovation</header><text display-inline="yes-display-inline">The Secretary shall ensure that such staff
Quality Improvement Organizations are provided maximum freedom in designing and
applying intervention strategies for local quality improvement.</text>
</paragraph></subsection><subsection id="H4A8379CE97B14141A91E4BD8DA82DAE6"><enum>(b)</enum><header>Assuring data
access</header><text>The Secretary shall ensure that Quality Improvement
Organizations have timely, top priority access to Medicare data for all parts
of Medicare pertinent to the contract activities, in a form allowing the data
to be integrated and analyzed by such organizations according to the needs of
partners and beneficiaries in each jurisdiction.</text>
</subsection><subsection id="HFEA0B833BCC54A19A88401005C15A7D7"><enum>(c)</enum><header>Setting
strategic priorities</header>
<paragraph id="H7A0206CEBFA1412A83A8ADBF91D7DDD9"><enum>(1)</enum><header>Appointment of
strategic advisory committee</header><text display-inline="yes-display-inline">The Secretary shall appoint an independent
strategic advisory committee, composed of national quality measurement and
improvement experts, representatives of beneficiaries, health care providers,
and practitioners, and organizations holding contracts under this part.</text>
</paragraph><paragraph id="H1A5DCF5B8D6B4BD0A5B78DA492F1D480"><enum>(2)</enum><header>Duties of
committee</header><text display-inline="yes-display-inline">Such committee
shall set national strategic priorities for improvement in the quality of care,
consistent with the Institute of Medicine's six aims for health care
improvement, including safety, effectiveness, patient centeredness, timeliness,
efficiency and equity, and update these in time to permit preparation of a
draft statement of work and funding request for each program cycle under this
part.</text>
</paragraph><paragraph id="H25E0AA6061864463AA8390D4C9A28660"><enum>(3)</enum><header>Independent
evaluation</header><text display-inline="yes-display-inline">The committee
should ensure that the Quality Improvement Organization program is evaluated by
an independent entity using a study design, such as to a crossover design, to
allow for a reliable assessment of program performance in a way that does not
have an adverse impact on providers, practitioners, and plans that may work
with the Organization.</text>
</paragraph><paragraph id="H8D7C54FE31E74ABD888E555C96CBFDB"><enum>(4)</enum><header>Funding</header><text display-inline="yes-display-inline">The Secretary shall allocate funds for the
strategic advisory committee from the portion of the additional funding
provided under the second sentence of section 1159(b)(1).</text>
</paragraph></subsection><subsection id="HC1F35CA7238F48C38363729866E7B302"><enum>(d)</enum><header>Taking into
account recommendations from stakeholders in statements of
work</header><text>Each statement of work under this part for a contract period
beginning on or after August 1, 2008, shall include a task for the contracting
Quality Improvement Organization to convene stakeholders to identify high
priority quality problems for work in the contract period that are relevant to
Medicare beneficiaries in the State. Each such organization shall propose, as
part of such statement, one or more projects to the Secretary taking into
consideration the recommendations of such stakeholders recommendations, along
with suggested performance measures to evaluate progress on such item.</text>
</subsection><subsection id="H78E7410AB94741AE00CF46F3E2AFBAB7"><enum>(e)</enum><header>Allocation of
resources to priority areas</header><text>The Secretary shall allocate at least
20 percent of the additional funding that is provided under the second sentence
of section 1159(b)(1) to promote improvement in one or more locally defined
priority areas identified under subsection
(d).</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="H3574A343A8804E2E8BD5E3481D3E2925"><enum>203.</enum><header>Data
disclosure</header><text display-inline="no-display-inline">Section 1160 of the
Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1320c-9">42 U.S.C. 1320c–9</external-xref>) is amended—</text>
<paragraph id="HDA9E11AE439549EC935CEE571E2791A6"><enum>(1)</enum><text>in subsection
(a)(3), by striking <quote>subsection (b)</quote> and inserting
<quote>subsections (b) and (f)</quote>; and</text>
</paragraph><paragraph id="H3C96B769837648EFBEFAC6005FCA3186"><enum>(2)</enum><text>by adding at the
end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H3B5B823898F74F11A866F27F3B7074D3" style="traditional">
<subsection id="HAEDEB42B0B314112B0F0E33841DA0022"><enum>(f)</enum><paragraph commented="no" display-inline="yes-display-inline" id="HAA1224A836A34344B3257C5569DB00AA"><enum>(1)</enum><text display-inline="yes-display-inline">An organization with a contract with the
Secretary under this part may share individual-specific data with a physician
treating the individual, for quality improvement and patient safety
purposes.</text>
</paragraph><paragraph id="H56BAED747A064190861FCE4B35E35447" indent="up1"><enum>(2)</enum><text>The Secretary shall promulgate, not
later than 30 days after the date of the enactment of this subsection, a
regulation that permits the sharing of data under paragraph (1).</text>
</paragraph><paragraph id="HEE36877B2EBA4F8291123BE1586C546D" indent="up1"><enum>(3)</enum><text>Nothing in this subsection shall be
construed to limit, alter, or affect the requirements imposed the regulations
promulgated under section 264(c) of the Health Insurance Portability and
Accountability Act of
1996.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section id="H12E833DAA85545E2B5F74802A9332824"><enum>204.</enum><header>Use of
evaluation and competition</header><text display-inline="no-display-inline">Section 1153 of the Social Security Act (42
U.S.C. 1320c–2) is amended—</text>
<paragraph id="H1C8060BF21824054BEFEF978307C0027"><enum>(1)</enum><text>by amending
paragraph (3) of subsection (c) to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="HA5208BF5017E4A1FB0B094B6873450D8" style="traditional">
<paragraph id="H19A0A2D1906A4BF48040C2ACC870E92B"><enum>(3)</enum><text>subject to
subsection (k), the contract shall be for an initial term of five years and
shall be renewable for each 5 years
thereafter;</text>
</paragraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</paragraph><paragraph id="HAE9FBEECA3254FCDAE1197A0D8F140AE"><enum>(2)</enum><text>by adding at the
end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HC915FFAB1CC442D486C2552B9E47B04E" style="OLC">
<subsection id="HFB9CEF55DB104645BC85B6175807704E"><enum>(k)</enum><paragraph commented="no" display-inline="yes-display-inline" id="HB588BECFAF4043658C6C56114B0023F9"><enum>(1)</enum><text>Subject to the
succeeding provisions of this subsection, at the end of each contract period
under subsection (c)(3), the contract shall be subject to open
competition.</text>
</paragraph><paragraph id="HEB091950E47F4A52817768463FF30459" indent="up1"><enum>(2)</enum><text>Before publishing a request for
proposal for a contract period, the Secretary shall, in consultation with the
strategic advisory committee appointed under section 1164(c)(1), establish
measurable goals for each task to be included in such proposal. The contract
shall include a performance threshold by which an organization holding a
contract under this section may demonstrate excellent performance. The
Secretary may not establish such performance thresholds in such a way as to
predetermine or limit either the number or percentage of organizations which
may demonstrate excellent performance.</text>
</paragraph><paragraph id="H9DC38250484149599B5C1B7B7D61F029" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">The Secretary shall publish the request for
proposals no later than four months prior to the beginning of such contract
period.</text>
</paragraph><paragraph id="HAC49D124AB26440EABFC9EC807E6CA16" indent="up1"><enum>(4)</enum><text>The Secretary shall utilize the
strategic advisory committee appointed under section 1164(c)(1) to qualify the
validity, reliability, and feasibility of measures to be used in evaluating the
performance of organizations holding a contract under this section. Before any
performance measure may be used for such purpose, it must have been designated
by such committee to be valid, reliable, and feasible for use under similar
circumstances, as demonstrated in at least one reliable and valid study.</text>
</paragraph><paragraph id="H4101720AA74841EABC68B0061779F16" indent="up1"><enum>(5)</enum><text>In the case of an open competition
for a contract under this section, if an organization bidding for the contract
demonstrates excellent performance in fulfilling the terms of such a contract
during the previous contract period, the Secretary shall award the bidder a
bonus equivalent to ten percent of the total possible score for the
proposal.</text>
</paragraph><paragraph id="H386279979A6C458994FE1C4F0009C8AA" indent="up1"><enum>(6)</enum><text>The Secretary may not reduce the
amount of a contract award below the amount proposed by the bidder prevailing
in a competitive bidding process.</text>
</paragraph><paragraph id="H759B85E49CA84888878D0403AA86B2DA" indent="up1"><enum>(7)</enum><text>The Secretary shall design the
process for performance evaluation of contracts under this section—</text>
<subparagraph id="H42075A048BF24C9A001E810043BED480"><enum>(A)</enum><text>to avoid interfering with the work of
contractors with plans, providers, and practitioners;</text>
</subparagraph><subparagraph id="H3A97B0698469493A9E19EE2D8495BCCF"><enum>(B)</enum><text>to hold harmless and not penalize
contractors when performance is impaired or delayed by failures of the
Secretary, personnel of the Department of Health and Human Services, or
contractors of the Secretary to provide timely deliverables by other
entities;</text>
</subparagraph><subparagraph id="H15D46760F30C4C77909FAF981FA6CE3"><enum>(C)</enum><text>to use a continuous measurement
strategy with provision for frequent performance updates for evaluating interim
progress; and</text>
</subparagraph><subparagraph id="H265E433D07A44E50A2656522E6B05137"><enum>(D)</enum><text>to require that evaluation metrics be
monitored and adjusted based on experience or evolving science over the course
of a contract cycle.</text>
</subparagraph></paragraph><paragraph id="H6EEE7EB8AB6E4E8A9515DDDF47A7D1FE" indent="up1"><enum>(8)</enum><text display-inline="yes-display-inline">At the end of each 5-year contract term,
the Secretary may, without full and open competition, extend the term for an
additional period of 5 years if the Secretary determines that the organization
holding the contract has achieved excellent performance during the previous
5-year term. But in no case shall an organization be allowed to maintain such a
contract for a period of longer than 10 years without being subject to full and
open
competition.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section id="H042D2E6361A2435EB5A4B593F470039"><enum>205.</enum><header>Quality
improvement funding</header><text display-inline="no-display-inline">Section
1159 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1320c-8">42 U.S.C. 1320c–8</external-xref>) is amended—</text>
<paragraph id="HB901DC7EE72E4251A88F8645A944C412"><enum>(1)</enum><text>by inserting
<quote>(a)</quote> before <quote>Expenses incurred</quote>; and</text>
</paragraph><paragraph id="H19B94D5574E2487983D577808F75C5C6"><enum>(2)</enum><text>by adding at the
end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HEA30788C8F6049FF866320CFBE6ED4" style="traditional">
<subsection id="HDB8EEA2AA1F04FC39CBD515794316EEE"><enum>(b)</enum><paragraph commented="no" display-inline="yes-display-inline" id="HAEB4D3281D3F471185DC11CEA8B9CC00"><enum>(1)</enum><text display-inline="yes-display-inline">The aggregate annual funding under
contracts under this part for fiscal year 2007 and each subsequent fiscal year
shall not be less than $421,666,000. In addition, there are authorized to be
appropriated for contract periods in subsequent fiscal years such additional
amounts funds as may be necessary to adequately fund any resource needs over
the amount provided under the previous sentence.</text>
</paragraph><paragraph id="H742437607FBB498B8B934642DDF414D6" indent="up1"><enum>(2)</enum><text>At least 80 percent of the funding
under this part in a contract period shall be expended in support of core
contracts held by organizations under this part.</text>
</paragraph><paragraph id="H2854EFDBAEB34CF6B493FF7D91E68100" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">The Secretary shall determine the resource
needs for a contract period in consultation with representatives from existing
contractors. The determination shall take into account factors including any
new work added via contract modification during the course of the contract
period or added from one contract cycle to the next cycle. New work
includes—</text>
<subparagraph id="H652E105FADC340D981235989A3FD0060"><enum>(A)</enum><text>additional core contract tasks,
requirements, deliverables, and performance thresholds;</text>
</subparagraph><subparagraph id="H0E681DC279FE489280B073C21FE91012"><enum>(B)</enum><text>technical assistance for additional
providers, practitioners, and health plans and additional provider
settings;</text>
</subparagraph><subparagraph id="H225E30AC2E874AEDBBE25F18C285B4F"><enum>(C)</enum><text>increased outreach and communications
to Medicare beneficiaries, providers, practitioners, and plans; and</text>
</subparagraph><subparagraph id="HE039128500A7468E9D33D6454D274790"><enum>(D)</enum><text>increased volume of medical
reviews.</text>
</subparagraph></paragraph><paragraph id="HB39CE6226F9642359C532F2892A24953" indent="up1"><enum>(4)</enum><text>With respect to the apportionment of
funds under this part for a contract period—</text>
<subparagraph id="H9452D67F998D4BB490A937E38FC014E"><enum>(A)</enum><text>the Secretary shall submit a proposed
apportionment to the Director of the Office of Management and Budget no later
than 1 year before the first date of the contract period;</text>
</subparagraph><subparagraph id="HAC42631B4ABE466292C1B9781CE4E606"><enum>(B)</enum><text>such Director shall approve or deny
the proposed apportionment no later than 9 months before the first date of such
contract period;</text>
</subparagraph><subparagraph id="H241C87B32D3B4A54B116C5233AF4412"><enum>(C)</enum><text>for tasks the Secretary proposes to
continue from the previous contract period, if the apportionment is not
authorized by the deadline specified in subparagraph (B), funding shall
continue for the next contract period at a level no less than the level for the
previous contract period, increased by the percentage increase in the consumer
price index for all urban consumers during the preceding 12-month
period.</text>
</subparagraph></paragraph><paragraph id="HBF30701B4D9D400D9FB973FE00F83F49" indent="up1"><enum>(5)</enum><text>Organizations with a contract under
this part may enter into contracts with public or private entities including
providers, practitioners, and payers other than Secretary, to provide quality
improvement or other forms of technical assistance if there were arrangements
made to avoid potential conflicts of interest.</text>
</paragraph><paragraph id="HF76969E25983459E952DB98C762FF8C8" indent="up1"><enum>(6)</enum><text display-inline="yes-display-inline">Such organizations shall have the ability
to meet the terms of a contract by allocating funds to functions established by
the Secretary at its discretion. The Secretary shall review the allocation of
these funds and whether the organization met the functions and goals set out
for the organization, regardless of allocation of funds at the initial
acceptance of the
contract.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section id="HE148F5059A60492EA6A38EC7AB084D57"><enum>206.</enum><header>Qualifications
for QIOs</header>
<subsection id="H93AC4DED6F6646CABD704FAE9BE83B80"><enum>(a)</enum><header>In
general</header><text>Section 1153(b) of the Social Security Act (42 U.S.C.
1320c–2(b)) is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HFEDED93DF6014964BEB586BAD08D008D" style="traditional">
<paragraph id="HA82BC636792645DF8127ED10515300DE" indent="up1"><enum>(4)</enum><text>The Secretary shall not enter into or
renew a contract under this section with an entity unless the following
requirements are met:</text>
<subparagraph id="HAB86895CDF1B49B3B633C88F90970075"><enum>(A)</enum><text>The entity’s governing body must
reflect representation of consumers and other stakeholders.</text>
</subparagraph><subparagraph id="H6836212940324FC59F34AB98E1FF70B1"><enum>(B)</enum><text>The entity must have demonstrated
success in facilitating clinical and administrative system redesign to improve
the coordination, effectiveness, and safety of health care, and in facilitating
cooperation among stakeholders in quality
improvement.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H1007B4B9F2D14B98A457E4F900790075"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall apply to contract
periods beginning after the date of the enactment of this Act.</text>
</subsection></section><section id="H02A4984F572E431C8E5FA337F5B6246"><enum>207.</enum><header>Coordination
with medicaid</header>
<subsection display-inline="no-display-inline" id="HD19B7413342B4F9BA33B6B826C9558CB"><enum>(a)</enum><header>Permitting
alternative quality improvement program</header><text display-inline="yes-display-inline">Section 1902(a)(30) of the Social Security
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)(30)</external-xref>) is amended by striking <quote>and</quote> at the
end of subparagraph (A), by adding <quote>and</quote> and the end of
subparagraph (B), and by adding at the end the following new
subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H9914765B9F3C44B4A0005F0060182CFB" style="OLC">
<subparagraph id="HDB84A0A3EA3E48BEBD7458B84E92ABF2"><enum>(C)
</enum><text display-inline="yes-display-inline">provide, at the discretion of
the State plan, for a quality improvement program in place of the program
described in subparagraph (A), in whole or in part, that—</text>
<clause id="H33A182B0FEC042DAA83573EBBC2F173E"><enum>(i)</enum><text>establishes
priorities for achieving significant measurable improvement in the quality of
health care services provided to individuals eligible under this title, and
reviews such priorities at least every five years for the purpose of making
appropriate revisions;</text>
</clause><clause id="H7F65CDC8336542E8B07D87D22504BAE5"><enum>(ii)</enum><text>provides quality
improvement assistance to providers and practitioners consistent with such
priorities; and</text>
</clause><clause id="H7C268E1C39D44CEF87EDD5C604168FA"><enum>(iii)</enum><text>provides for an
annual report to the Secretary on quality performance under such plan of
providers and practitioners using nationally standardized quality
measures;</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HE929A1576AAD46ACB1A252A5E1B9D2E3"><enum>(b)</enum><header>Role of
QIOs</header><text>Section 1902(d) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(d)</external-xref>) is
amended—</text>
<paragraph id="H5C58D38365964A828CB23666CEF1A085"><enum>(1)</enum><text>by inserting
<quote>(1)</quote> after <quote>(d)</quote>; and</text>
</paragraph><paragraph id="H408B0D96E25E4173ABA4EB22DF5E98AC"><enum>(2)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H52496FB0F5F047499E7F0423165C8E5D" style="traditional">
<paragraph id="HB63E41F518994696A5B3CEFA95DE7C67" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">If a State contracts with a Quality
Improvement Organization having a contract with the Secretary under part B of
title XI for the performance of quality improvement program activities required
by subsection (a)(30)(C), such requirements shall be deemed to be met for those
activities by delegation to such an Organization if the contract provides for
the performance of activities not inconsistent with part B of title XI and
provides for such assurances of satisfactory performance by such an entity or
organization as the Secretary may
prescribe.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H0AE63A02D6C44035BD203E8FC2B29D05"><enum>(c)</enum><header>Funding</header><text display-inline="yes-display-inline">Section 1903(a)(3)(C) of such Act (42
U.S.C. 1396b(a)(3)(C)) is amended—</text>
<paragraph id="H63C2E10F9C2440B69B99D87759686DDD"><enum>(1)</enum><text>in clause (i), by
striking <quote>1902(d)</quote> and inserting <quote>1902(d)(1)</quote>;
and</text>
</paragraph><paragraph id="H0248E82776D14C2F8EB8CCCE7584F598"><enum>(2)</enum><text>by adding at the
end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="H27B05D1A260C46D4AA29A800349732C4" style="traditional">
<clause id="H821E1FC8B3F8478C9679A320B650C9E1"><enum>(iii)</enum><text display-inline="yes-display-inline">75 percent of the sums expended with
respect to costs incurred during such quarter (as found necessary by the
Secretary for the proper and efficient administration of the State plan) as are
attributable to the performance of quality improvement program activities by a
Quality Improvement Organization under a contract entered into under section
1902(d)(2);
and</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H2A5C3013E3E5411DABFFA936A53BE599"><enum>(d)</enum><header>Effective
date</header><text display-inline="yes-display-inline">The amendments made by
this section shall apply to contract periods beginning after the date of the
enactment of this Act</text>
</subsection></section><enum>III</enum><header>Medicare Savings
and Other Provisions</header>
<section id="H033F77CC8B874D4BBC579B917FB8029F"><enum>301.</enum><header>Elimination of
stabilization fund for regional PPOs</header>
<subsection id="HA30DBD62DB4144BD9B833DC2C2B74F68"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Except as provided in
subsection (b), no funds shall be available for obligation, on or after the
date of the enactment of this Act, from the MA Regional Plan Stabilization Fund
(under section 1858(e) of the Social Security Act).</text>
</subsection><subsection id="HBFDD4BD6704146CCA343DD2F98C528C2"><enum>(b)</enum><header>Availability of
freed up funds</header><text>Amounts in such MA Regional Plan Stabilization
Fund that are not otherwise obligated shall be transferred and deposited into
the Medicare Supplementary Medical Insurance Trust Fund under section 1841 of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395t">42 U.S.C. 1395t</external-xref>) without additional appropriation to
cover additional expenditures resulting from the amendments made by section
title I of this Act.</text>
</subsection></section><section display-inline="no-display-inline" id="HFACC948CF08D4DC9B54EED060786D44" section-type="subsequent-section"><enum>302.</enum><header>Ongoing examination
of medicare funding</header>
<subsection id="H2840346A08AD49DFBE3DAA18DABB162C"><enum>(a)</enum><header>Examination by
Board of Trustees</header><text display-inline="yes-display-inline">The Board
of Trustees of the Federal Hospital Insurance Trust Fund and of the Federal
Supplementary Medical Insurance Trust Fund shall monitor and examine the extent
to which the different funding mechanisms under parts A, B, and D of title
XVIII of the Social Security Act provide an appropriate alignment with the
program goals of the respective parts. Such examination shall include an
examination of each of the following:</text>
<paragraph id="H218CE3E17C864ABCBBA0B292A4B6B02C"><enum>(1)</enum><text>The extent to
which, as volume of services increases in physician settings under such part B,
there is a corresponding reduction in similar services provided in a hospital
setting under such part A.</text>
</paragraph><paragraph id="HAA1C0B6514E74DA100B4AB5518B6E380"><enum>(2)</enum><text>The extent to
which, as a result of increased coordination between physicians and the
delivery of prescription drugs under such part D, particularly with respect to
individuals with chronic conditions, there will there be a decrease in
hospitalizations under such part A.</text>
</paragraph><paragraph id="HA0050ECEA16C48BDACC5651F57D8F8CB"><enum>(3)</enum><text>The extent to
which other changes in physician or other health care practice results in a
shifting of expenditures among the various parts.</text>
</paragraph></subsection><subsection id="H7F337EFA08C34E31A25559D1898FE46F"><enum>(b)</enum><header>Inclusion in
annual reports</header><text>In each annual report submitted to the Congress
after the date of the enactment of this Act under section 1817(b)(2) or section
1841(b)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i">42 U.S.C. 1395i(b)(2)</external-xref>, 1395t(b)(2)),
such Board of Trustees shall include information on the matters described in
subsection (a).</text>
</subsection></section><section id="H6391E3C375F3496CA79C8CB187507769"><enum>303.</enum><header>One-year delay
in medicare adjustments in payments for imaging services; IOM study on
utilization and appropriateness of imaging services</header>
<subsection id="H8F0DCD7075D54891BFF5AC45FD94141F"><enum>(a)</enum><header>Delay</header><text display-inline="yes-display-inline">Subsections (b)(4)(A), (c)(2)(B)(v)(I), and
(c)(2)(B)(v)(II) of section 1848 of the Social Security Act (42 U.S.C.
1395w–4), as amended by section 5102 of the Deficit Reduction Act of 2005
(<external-xref legal-doc="public-law" parsable-cite="pl/109/171">Public Law 109–171</external-xref>) are each amended by striking <quote>2007</quote> and
inserting <quote>2008</quote>.</text>
</subsection><subsection id="HCF399A747EC9491D96114C07929FEE0"><enum>(b)</enum><header>Study and report
on utilization and appropriateness of imaging services</header>
<paragraph id="H11738D17FBB84C8C9270237B22F2F7DC"><enum>(1)</enum><header>In
general</header><text>The Secretary of Health and Human Services shall request
(and shall enter into a contract with) the Institute of Medicine to conduct a
study of the utilization and appropriateness of imaging services described in
section 1848(b)(4)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(b)(4)(B)</external-xref>)
under the Medicare program and to submit to the Secretary, not later than April
1, 2007, a report on such study, including recommendations regarding changes in
medicare payment for such services. Such study shall include an examination
of—</text>
<subparagraph id="H1AD67A897F6C495C8CA5395956CF79C"><enum>(A)</enum><text>the role of medical
malpractice in the utilization of such services;</text>
</subparagraph><subparagraph id="H29B8BDCEE67C4D6AA78E599300A76305"><enum>(B)</enum><text>the impact of
utilization of such services in reducing or increasing the subsequent delivery
of services;</text>
</subparagraph><subparagraph id="H9BD5B923031649CF8969EF53B3F088D2"><enum>(C)</enum><text display-inline="yes-display-inline">the impact of increased disease as a
factor in utilization of such services; and</text>
</subparagraph><subparagraph id="HB88B40C356FB4D009D8B039F6430D915"><enum>(D)</enum><text>a delineation of
factors in utilization and appropriateness by site of service, by modality, and
by specialty.</text>
</subparagraph></paragraph><paragraph id="HD1E598734459401B956877F800F85253"><enum>(2)</enum><header>Report</header><text display-inline="yes-display-inline">The Secretary shall submit to Congress the
report submitted under paragraph (1).</text>
</paragraph></subsection></section><section id="H5878048FC7E34545A9E4B54D183FCA7D"><enum>304.</enum><header>Eliminating
phase-in for implementation of reduction in part B premium subsidy for higher
income beneficiaries</header><text display-inline="no-display-inline">Section
1839(i)(3) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395r">42 U.S.C. 1395r(i)(3)</external-xref>) is
amended—</text>
<paragraph id="HE184396BC7C148D19763734D1D85A6D6"><enum>(1)</enum><text>in subparagraph
(A), by striking <quote>Subject to subparagraph (B), the</quote> and inserting
<quote>The</quote>;</text>
</paragraph><paragraph id="HC948E7102CAA446083F5C6F0221B2F82"><enum>(2)</enum><text>in subparagraph
(A)(i), by striking <quote>subparagraph (C)</quote> and inserting
<quote>subparagraph (B)</quote>;</text>
</paragraph><paragraph id="H1D0C828D72AC4B19000054E7623698E8"><enum>(3)</enum><text>by striking
subparagraph (B); and</text>
</paragraph><paragraph id="HBD64963CF4354807B76355B7DF3B7D00"><enum>(4)</enum><text>by redesignating
subparagraph (C) as subparagraph (B).</text>
</paragraph></section><section id="H7989F27BA7FF49569D91D110D483551F"><enum>305.</enum><header>Exclusion of
indirect graduate medical education payment in computation of payments to
medicare advantage organizations</header>
<subsection id="H4BFF9051C8D5402FA3691F9331662315"><enum>(a)</enum><header>In
general</header><text>Section 1853(c)(1)(D)(i) of the Social Security Act (42
U.S.C. 1395w–23(c)(1)(D)(i)) is amended by inserting <quote>or under section
1886(d)(5)(B)</quote> after <quote>1886(h)</quote>.</text>
</subsection><subsection id="H9FC72A56A32E4FED83A5FE225F838C99"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall apply to payment
for years beginning with 2007 and the Secretary of Health and Human Services
shall provide for the application of clause (i) of section 1853(c)(1)(D) of the
Social Security Act, as so amended, for 2007.</text>
</subsection></section>