110 HR 3162 PCS: Children’s Health and Medicare Protection Act of 2007 U.S. House of Representatives 2007-09-04 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.

II Calendar No. 338 110th CONGRESS 1st Session H. R. 3162 IN THE SENATE OF THE UNITED STATES September 4, 2007 Received; read twice and placed on the calendar AN ACT To amend titles XVIII, XIX, and XXI of the Social Security Act to extend and improve the children’s health insurance program, to improve beneficiary protections under the Medicare, Medicaid, and the CHIP program, and for other purposes.

1.

Short title; table of contents

(a)

Short title

This Act may be cited as the Children’s Health and Medicare Protection Act of 2007. (b)

Table of contents

The table of contents of this Act is as follows: Sec. 1. Short title; table of contents. Title I—Children’s Health Insurance Program Sec. 100.  Purpose. Subtitle A—Funding Sec. 101. Establishment of new base CHIP allotments. Sec. 102. 2-year initial availability of CHIP allotments. Sec. 103. Redistribution of unused allotments to address State funding shortfalls. Sec. 104. Extension of option for qualifying States. Subtitle B—Improving Enrollment and Retention of Eligible Children Sec. 111. CHIP performance bonus payment to offset additional enrollment costs resulting from enrollment and retention efforts. Sec. 112. State option to rely on findings from an express lane agency to conduct simplified eligibility determinations. Sec. 113. Application of medicaid outreach procedures to all children and pregnant women. Sec. 114. Encouraging culturally appropriate enrollment and retention practices. Sec. 115. Continuous coverage under CHIP. Subtitle C—Coverage Sec. 121. Ensuring child-centered coverage. Sec. 122. Improving benchmark coverage options. Sec. 123. Premium grace period. Subtitle D—Populations Sec. 131. Optional coverage of children up to age 21 under CHIP. Sec. 132. Optional coverage of legal immigrants under the Medicaid program and CHIP. Sec. 133. State option to expand or add coverage of certain pregnant women under CHIP. Sec. 134. Limitation on waiver authority to cover adults. Sec. 135. No Federal funding for illegal aliens. Sec. 136. Auditing requirement to enforce citizenship restrictions on eligibility for Medicaid and CHIP benefits. Subtitle E—Access Sec. 141. Children’s Access, Payment, and Equality Commission. Sec. 142. Model of Interstate coordinated enrollment and coverage process. Sec. 143. Medicaid citizenship documentation requirements. Sec. 144. Access to dental care for children. Sec. 145. Prohibiting initiation of new health opportunity account demonstration programs. Subtitle F—Quality and Program Integrity Sec. 151. Pediatric health quality measurement program. Sec. 152. Application of certain managed care quality safeguards to CHIP. Sec. 153. Updated Federal evaluation of CHIP. Sec. 154. Access to records for IG and GAO audits and evaluations. Sec. 155. References to title XXI. Sec. 156. Reliance on law; exception for State legislation. Title II—Medicare Beneficiary Improvements Subtitle A—Improvements in Benefits Sec. 201. Coverage and waiver of cost-sharing for preventive services. Sec. 202. Waiver of deductible for colorectal cancer screening tests regardless of coding, subsequent diagnosis, or ancillary tissue removal. Sec. 203. Parity for mental health coinsurance. Subtitle B—Improving, Clarifying, and Simplifying Financial Assistance for Low Income Medicare Beneficiaries Sec. 211. Improving assets tests for Medicare Savings Program and low-income subsidy program. Sec. 212. Making QI program permanent and expanding eligibility. Sec. 213. Eliminating barriers to enrollment. Sec. 214. Eliminating application of estate recovery. Sec. 215. Elimination of part D cost-sharing for certain non-institutionalized full-benefit dual eligible individuals. Sec. 216. Exemptions from income and resources for determination of eligibility for low-income subsidy. Sec. 217. Cost-sharing protections for low-income subsidy-eligible individuals. Sec. 218. Intelligent assignment in enrollment. Subtitle C—Part D Beneficiary Improvements Sec. 221. Including costs incurred by AIDS drug assistance programs and Indian Health Service in providing prescription drugs toward the annual out of pocket threshold under Part D. Sec. 222. Permitting mid-year changes in enrollment for formulary changes adversely impact an enrollee. Sec. 223. Removal of exclusion of benzodiazepines from required coverage under the Medicare prescription drug program. Sec. 224. Permitting updating drug compendia under part D using part B update process. Sec. 225. Codification of special protections for six protected drug classifications. Sec. 226. Elimination of Medicare part D late enrollment penalties paid by low-income subsidy-eligible individuals. Sec. 227. Special enrollment period for subsidy eligible individuals. Subtitle D—Reducing Health Disparities Sec. 231. Medicare data on race, ethnicity, and primary language. Sec. 232. Ensuring effective communication in Medicare. Sec. 233. Demonstration to promote access for Medicare beneficiaries with limited English proficiency by providing reimbursement for culturally and linguistically appropriate services. Sec. 234. Demonstration to improve care to previously uninsured. Sec. 235. Office of the Inspector General report on compliance with and enforcement of national standards on culturally and linguistically appropriate services (CLAS) in medicare. Sec. 236. IOM report on impact of language access services. Sec. 237. Definitions. Title III—Physicians’ Service Payment Reform Sec. 301. Establishment of separate target growth rates for service categories. Sec. 302. Improving accuracy of relative values under the Medicare physician fee schedule. Sec. 303. Feedback mechanism on practice patterns. Sec. 304. Payments for efficient areas. Sec. 305. Recommendations on refining the physician fee schedule. Sec. 306. Improved and expanded medical home demonstration project. Sec. 307. Repeal of Physician Assistance and Quality Initiative Fund. Sec. 308. Adjustment to Medicare payment localities. Sec. 309. Payment for imaging services. Sec. 310. Reducing frequency of meetings of the Practicing Physicians Advisory Council. Title IV—Medicare Advantage Reforms Subtitle A—Payment Reform Sec. 401. Equalizing payments between Medicare Advantage plans and fee-for-service Medicare. Subtitle B—Beneficiary Protections Sec. 411. NAIC development of marketing, advertising, and related protections. Sec. 412. Limitation on out-of-pocket costs for individual health services. Sec. 413. MA plan enrollment modifications. Sec. 414. Information for beneficiaries on MA plan administrative costs. Subtitle C—Quality and Other Provisions Sec. 421. Requiring all MA plans to meet equal standards. Sec. 422. Development of new quality reporting measures on racial disparities. Sec. 423. Strengthening audit authority. Sec. 424. Improving risk adjustment for MA payments. Sec. 425. Eliminating special treatment of private fee-for-service plans. Sec. 426. Renaming of Medicare Advantage program. Subtitle D—Extension of Authorities Sec. 431. Extension and revision of authority for special needs plans (SNPs). Sec. 432. Extension and revision of authority for Medicare reasonable cost contracts. Title V—Provisions Relating to Medicare Part A Sec. 501. Inpatient hospital payment updates. Sec. 502. Payment for inpatient rehabilitation facility (IRF) services. Sec. 503. Long-term care hospitals. Sec. 504. Increasing the DSH adjustment cap. Sec. 505. PPS-exempt cancer hospitals. Sec. 506. Skilled nursing facility payment update. Sec. 507. Revocation of unique deeming authority of the Joint Commission for the Accreditation of Healthcare Organizations. Sec. 508. Treatment of Medicare hospital reclassifications. Sec. 509. Medicare critical access hospital designations. Title VI—Other Provisions Relating to Medicare Part B Subtitle A—Payment and Coverage Improvements Sec. 601. Payment for therapy services. Sec. 602. Medicare separate definition of outpatient speech-language pathology services. Sec. 603. Increased reimbursement rate for certified nurse-midwives. Sec. 604. Adjustment in outpatient hospital fee schedule increase factor. Sec. 605. Exception to 60-day limit on Medicare substitute billing arrangements in case of physicians ordered to active duty in the Armed Forces. Sec. 606. Excluding clinical social worker services from coverage under the medicare skilled nursing facility prospective payment system and consolidated payment. Sec. 607. Coverage of marriage and family therapist services and mental health counselor services. Sec. 608. Rental and purchase of power-driven wheelchairs. Sec. 609. Rental and purchase of oxygen equipment. Sec. 610. Adjustment for Medicare mental health services. Sec. 611. Extension of brachytherapy special rule. Sec. 612. Payment for part B drugs. Subtitle B—Extension of Medicare Rural Access Protections Sec. 621. 2-year extension of floor on medicare work geographic adjustment. Sec. 622. 2-year extension of special treatment of certain physician pathology services under Medicare. Sec. 623. 2-year extension of medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas. Sec. 624. 2-year extension of Medicare incentive payment program for physician scarcity areas. Sec. 625. 2-year extension of medicare increase payments for ground ambulance services in rural areas. Sec. 626. Extending hold harmless for small rural hospitals under the HOPD prospective payment system. Subtitle C—End Stage Renal Disease Program Sec. 631. Chronic kidney disease demonstration projects. Sec. 632. Medicare coverage of kidney disease patient education services. Sec. 633. Required training for patient care dialysis technicians. Sec. 634. MedPAC report on treatment modalities for patients with kidney failure. Sec. 635. Adjustment for erythropoietin stimulating agents (ESAs). Sec. 636. Site neutral composite rate. Sec. 637. Development of ESRD bundling system and quality incentive payments. Sec. 638. MedPAC report on ESRD bundling system. Sec. 639. OIG study and report on erythropoietin. Subtitle D—Miscellaneous Sec. 651. Limitation on exception to the prohibition on certain physician referrals for hospitals. Title VII—Provisions Relating to Medicare Parts A and B Sec. 701. Home health payment update for 2008. Sec. 702. 2-year extension of temporary Medicare payment increase for home health services furnished in a rural area. Sec. 703. Extension of Medicare secondary payer for beneficiaries with end stage renal disease for large group plans. Sec. 704. Plan for Medicare payment adjustments for never events. Sec. 705. Reinstatement of residency slots. Sec. 706. Studies relating to home health. Sec. 707. Rural home health quality demonstration projects. Title VIII—Medicaid Subtitle A—Protecting Existing Coverage Sec. 801. Modernizing transitional Medicaid. Sec. 802. Family planning services. Sec. 803. Authority to continue providing adult day health services approved under a State Medicaid plan. Sec. 804. State option to protect community spouses of individuals with disabilities. Sec. 805. County medicaid health insuring organizatios. Subtitle B—Payments Sec. 811. Payments for Puerto Rico and territories. Sec. 812. Medicaid drug rebate. Sec. 813. Adjustment in computation of Medicaid FMAP to disregard an extraordinary employer pension contribution. Sec. 814. Moratorium on certain payment restrictions. Sec. 815. Tennessee DSH. Sec. 816. Clarification treatment of regional medical center. Sec. 817. Extension of SSI web-based asset demonstration project to the Medicaid program. Subtitle C—Miscellaneous Sec. 821. Demonstration project for employer buy-in. Sec. 822. Diabetes grants. Sec. 823. Technical correction. Title IX—Miscellaneous Sec. 901.  Medicare Payment Advisory Commission status. Sec. 902. Repeal of trigger provision. Sec. 903. Repeal of comparative cost adjustment (CCA) program. Sec. 904. Comparative effectiveness research. Sec. 905. Implementation of Health information technology (IT) under Medicare. Sec. 906. Development, reporting, and use of health care measures. Sec. 907. Improvements to the Medigap program. Sec. 908. Implementation funding. Sec. 909. Access to data on prescription drug plans and medicare advantage plans. Sec. 910. Abstinence education. Title X—Revenues Sec. 1001. Increase in rate of excise taxes on tobacco products and cigarette papers and tubes. Sec. 1002. Exemption for emergency medical services transportation.

Passed the House of Representatives August 1, 2007. Lorraine C. Miller, Clerk. Jorge E. Sorensen,Deputy Clerk. September 4, 2007 Received; read twice and placed on the calendar