110 HR 6212 IH: Medicare Efficiency and Development of
U.S. House of Representatives
2008-06-09
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 Efficiency and
Development of Improvement of Care and Services Act (MEDICS Act) of
2008
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Title I—Medicare
Subtitle A—Beneficiary improvements
Part
I—Prevention, mental health, and marketing
Sec. 101. Improvements to coverage of preventive
services.
Sec. 102. Elimination of discriminatory copayment rates for
Medicare outpatient psychiatric services.
Sec. 103. Prohibitions and limitations on certain sales and
marketing activities under Medicare Advantage plans and prescription drug
plans.
Sec. 104. Improvements to the Medigap program.
Part II—Low-income programs
Sec. 111. Extension of qualifying individual (QI)
program.
Sec. 112. Application of full LIS subsidy assets test under
Medicare Savings Program.
Sec. 113. Eliminating barriers to enrollment.
Sec. 114. Elimination of Medicare part D late enrollment
penalties paid by subsidy eligible individuals.
Sec. 115. Eliminating application of estate
recovery.
Sec. 116. Exemptions from income and resources for
determination of eligibility for low-income subsidy.
Sec. 117. Judicial review of decisions of the Commissioner of
Social Security under the Medicare part D low-income subsidy
program.
Sec. 118. Translation of model form.
Sec. 119. Medicare enrollment assistance.
Subtitle B—Provisions relating to part A
Sec. 121. Expansion and extension of the Medicare Rural
Hospital Flexibility Program.
Sec. 122. Rebasing for sole community hospitals.
Sec. 123. Demonstration project on community health integration
models in certain rural counties.
Sec. 124. Extension of the reclassification of certain
hospitals.
Sec. 125. Revocation of unique deeming authority of the Joint
Commission.
Subtitle C—Provisions relating to part B
Part I—Physicians' services
Sec. 131. Physician payment, efficiency, and quality
improvements.
Sec. 132. Incentives for electronic prescribing.
Sec. 133. Expanding access to primary care
services.
Sec. 134. Extension of floor on Medicare work geographic
adjustment under the Medicare physician fee schedule.
Sec. 135. Imaging provisions.
Sec. 136. Extension of treatment of certain physician pathology
services under Medicare.
Sec. 137. Accommodation of physicians ordered to active duty in
the Armed Services.
Sec. 138. Adjustment for Medicare mental health
services.
Sec. 139. Improvements for Medicare anesthesia teaching
programs.
Part II—Other payment and coverage improvements
Sec. 141. Extension of exceptions process for Medicare therapy
caps.
Sec. 142. Extension of payment rule for brachytherapy and
therapeutic radiopharmaceuticals.
Sec. 143. Speech-language pathology services.
Sec. 144. Payment and coverage improvements for patients with
chronic obstructive pulmonary disease and other conditions.
Sec. 145. Revision of payment for power-driven
wheelchairs.
Sec. 146. Clinical laboratory tests.
Sec. 147. Improved access to ambulance services.
Sec. 148. Extension and expansion of the Medicare hold harmless
provision under the prospective payment system for hospital outpatient
department (HOPD) services for certain hospitals.
Sec. 149. Clarification of payment for clinical laboratory
tests furnished by critical access hospitals.
Sec. 150. Adding certain entities as originating sites for
payment of telehealth services.
Sec. 151. MedPAC study and report on improving chronic care
demonstration programs.
Sec. 152. Increase of FQHC payment limits.
Sec. 153. Kidney disease education and awareness
provisions.
Sec. 154. Renal dialysis provisions.
Subtitle D—Provisions relating to part C
Sec. 161. Phase-out of indirect medical education
(IME).
Sec. 162. Revisions to requirements for Medicare Advantage
private fee-for-service plans.
Sec. 163. Revisions to quality improvement
programs.
Sec. 164. Revisions relating to specialized Medicare Advantage
plans for special needs individuals.
Sec. 165. Limitation on out-of-pocket costs for dual eligibles
and qualified medicare beneficiaries enrolled in a specialized Medicare
Advantage plan for special needs individuals.
Sec. 166. Adjustment to the Medicare Advantage stabilization
fund.
Sec. 167. Access to Medicare reasonable cost contract
plans.
Sec. 168. MedPAC study and report on quality
measures.
Sec. 169. MedPAC study and report on Medicare Advantage
payments.
Subtitle E—Provisions relating to part D
Part I—Improving pharmacy access
Sec. 171. Prompt payment by prescription drug plans and MA–PD
plans under part D.
Sec. 172. Submission of claims by pharmacies located in or
contracting with long-term care facilities.
Sec. 173. Regular update of prescription drug pricing
standard.
Part II—Other provisions
Sec. 175. Inclusion of barbiturates and benzodiazepines as
covered part D drugs.
Sec. 176. Formulary requirements with respect to certain
categories or classes of drugs.
Subtitle F—Other provisions
Sec. 181. Use of part D data.
Sec. 182. Revision of definition of medically accepted
indication for drugs.
Sec. 183. Contract with a consensus-based entity regarding
performance measurement.
Sec. 184. Cost-sharing for clinical trials.
Sec. 185. Addressing health care disparities.
Sec. 186. Demonstration to improve care to previously
uninsured.
Sec. 187. Office of the Inspector General report on compliance
with and enforcement of national standards on culturally and linguistically
appropriate services (CLAS) in Medicare.
Sec. 188. Medicare Improvement Funding.
Title II—Medicaid
Sec. 201. Extension of transitional medical assistance
(TMA).
Sec. 202. Medicaid DSH extension.
Sec. 203. Pharmacy reimbursement under Medicaid.
Sec. 204. Review of administrative claim
determinations.
Title III—Miscellaneous
Sec. 301. Extension of TANF supplemental grants.
Sec. 302. 70 percent federal matching for foster care and
adoption assistance for the District of Columbia.
Sec. 303. Extension of Special Diabetes Grant
Programs.
Sec. 304. IOM reports on best practices for conducting
systematic reviews of clinical effectiveness research and for developing
clinical protocols.
Sec. 305. Increasing number of primary care
physicians.
<enum>I</enum><header>Medicare</header>
<subtitle id="HEECA339782CC452290E540A3BA1BB140"><enum>A</enum><header>Beneficiary
improvements</header>
<part id="H5252E738B1884D5D8829CA456584F3E"><enum>I</enum><header>Prevention, mental
health, and marketing</header>
<section id="H03CD9BEA041E48A8B79F460011BF3566"><enum>101.</enum><header>Improvements to
coverage of preventive services</header>
<subsection id="HB1014BCFAF164B6BA963FFA3033E3013"><enum>(a)</enum><header>Coverage of
additional preventive services</header>
<paragraph id="H8EDCA52541BF447A9EA898DA00C00"><enum>(1)</enum><header>Coverage</header><text>Section
1861 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x</external-xref>), as amended by section 114 of
the Medicare, Medicaid, and SCHIP Extension Act of 2007 (<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>),
is amended—</text>
<subparagraph id="H1AD3975D964A453DB4C6F4CB44C65602"><enum>(A)</enum><text>in subsection
(s)(2)—</text>
<clause id="HC15EC862E0614FFF8070EA00C6E1153"><enum>(i)</enum><text>in
subparagraph (Z), by striking <quote>and</quote> after the semicolon at the
end;</text>
</clause><clause id="H85B8E6C72943494F00CD13830176206"><enum>(ii)</enum><text>in
subparagraph (AA), by adding <quote>and</quote> after the semicolon at the end;
and</text>
</clause><clause id="H3460F44F69CD417DA40378FFE6FE10C8"><enum>(iii)</enum><text>by
adding at the end the following new subparagraph:</text>
<quoted-block id="H52E9D612A1A54FF2AD7CFC04C108E2E8">
<subitem id="H6270687EB0A34BFFA400B61900EA619C" indent="up5"><enum>(BB)</enum><text>additional preventive services
(described in subsection (ddd)(1));</text>
</subitem><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="H836E256DA1CB4A0000C479AF44D8690"><enum>(B)</enum><text>by adding at the
end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H2EA4F65565DF4087A5501653E308A03B" other-style="archaic" style="other">
<subsection id="H6EC143DDDC6642F4BF83A5DED15E09FF"><enum>(ddd)</enum><header>Additional preventive services</header><paragraph commented="no" display-inline="yes-display-inline" id="H9E796458BB854E558E2F4127BB837F62"><enum>(1)</enum><text>The term
<quote>additional preventive services</quote> means services not otherwise
described in this title that identify medical conditions or risk factors and
that the Secretary determines are—</text>
<subparagraph id="H9CFE8E4FE2B24D128B9595E396A81C26" indent="up1"><enum>(A)</enum><text>reasonable and necessary for the
prevention or early detection of an illness or disability;</text>
</subparagraph><subparagraph id="H1C81297C9F5048E591F5FAE808F32763" indent="up1"><enum>(B)</enum><text>recommended with a grade of A or B by
the United States Preventive Services Task Force; and</text>
</subparagraph><subparagraph id="H8658CA7B0C7D48AA80BB905100E57607" indent="up1"><enum>(C)</enum><text>appropriate for individuals entitled
to benefits under part A or enrolled under part B.</text>
</subparagraph></paragraph><paragraph id="HF547268170664F34B88D99C9EF4F3924" indent="up1"><enum>(2)</enum><text>In making determinations under
paragraph (1) regarding the coverage of a new service, the Secretary shall use
the process for making national coverage determinations (as defined in section
1869(f)(1)(B)) under this title. As part of the use of such process, the
Secretary may conduct an assessment of the relation between predicted outcomes
and the expenditures for such service and may take into account the results of
such assessment in making such
determination.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H8862F72306EC4F878B6B4B246B19D142"><enum>(2)</enum><header>Payment and
coinsurance for additional preventive services</header><text>Section 1833(a)(1)
of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(a)(1)</external-xref>) is amended—</text>
<subparagraph id="H179ACCE3D0B24A0DBE837F1E6F4FF7FC"><enum>(A)</enum><text>by striking
<quote>and</quote> before <quote>(V)</quote>; and</text>
</subparagraph><subparagraph id="H812F8192997740F5A80029E997CF6586"><enum>(B)</enum><text>by inserting
before the semicolon at the end the following: <quote>, and (W) with respect to
additional preventive services (as defined in section 1861(ddd)(1)), the amount
paid shall be (i) in the case of such services which are clinical diagnostic
laboratory tests, the amount determined under subparagraph (D), and (ii) in the
case of all other such services, 80 percent of the lesser of the actual charge
for the service or the amount determined under a fee schedule established by
the Secretary for purposes of this subparagraph</quote>.</text>
</subparagraph></paragraph><paragraph id="H145FB1A54766402C9FB1D7721D5C58AE"><enum>(3)</enum><header>Conforming
amendment regarding coverage</header><text>Section 1862(a)(1)(A) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395y">42 U.S.C. 1395y(a)(1)(A)</external-xref>) is amended by inserting <quote>or
additional preventive services (as described in section 1861(ddd)(1))</quote>
after <quote>succeeding subparagraph</quote>.</text>
</paragraph><paragraph id="H01F4CB41B97B484CBD6F465413005E27"><enum>(4)</enum><header>Rule of
construction</header><text>Nothing in the provisions of, or amendments made by,
this subsection shall be construed to provide coverage under title XVIII of the
Social Security Act of items and services for the treatment of a medical
condition that is not otherwise covered under such title.</text>
</paragraph></subsection><subsection id="H07FFB03451334C4A8F2CBC07F2C8686"><enum>(b)</enum><header>Revisions to
initial preventive physical examination</header>
<paragraph id="HB4BA7C38177C4C0E9D52B33C36642884"><enum>(1)</enum><header>In
general</header><text>Section 1861(ww) of the Social Security Act (42 U.S.C.
1395x(ww)) is amended—</text>
<subparagraph id="H0AB117BF3D19461EBBF6F742FF3AC4"><enum>(A)</enum><text>in paragraph
(1)—</text>
<clause id="H99209CECC37146B88B39E270A84CC7B4"><enum>(i)</enum><text>by
inserting <quote>body mass index,</quote> after <quote>weight</quote>;</text>
</clause><clause id="H7936753096864BF7B83562A0CA68BDB7"><enum>(ii)</enum><text>by
striking <quote>, and an electrocardiogram</quote>; and</text>
</clause><clause id="HFEDA172004D84DF587001D236D698351"><enum>(iii)</enum><text>by
inserting <quote>and end-of-life planning (as defined in paragraph (3)) upon
the agreement with the individual</quote> after <quote>paragraph
(2)</quote>;</text>
</clause></subparagraph><subparagraph id="HC7AB71AF9E254BA0903FBD0117F7FBAB"><enum>(B)</enum><text>in paragraph (2),
by adding at the end the following new subparagraphs:</text>
<quoted-block id="HE2DEBE55FFF04ABDBAC016359583404E">
<subparagraph commented="no" id="HAC0E4F96F81B48AB9CD57FEDDF441D99" indent="up1"><enum>(M)</enum><text>An electrocardiogram.</text>
</subparagraph><subparagraph commented="no" id="H6B4EAFE4DC224522A8F7374BEDCFB142" indent="up1"><enum>(N)</enum><text>Additional preventive services (as
defined in subsection (ddd)(1)).</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="H8B66B344E692411A82D858C308F30171"><enum>(C)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H165F0038505E4D209CEA1E24E55CE7F5" style="OLC">
<paragraph id="H9DA5EE7C00E6466F8441358EAFED4B31" indent="up1"><enum>(3)</enum><text>For purposes of paragraph (1), the
term <term>end-of-life planning</term> means verbal or written information
regarding—</text>
<subparagraph id="H1C8A7DC68DAE4C2593422D6600FBEBB0"><enum>(A)</enum><text>an individual's ability to prepare an
advance directive in the case that an injury or illness causes the individual
to be unable to make health care decisions; and</text>
</subparagraph><subparagraph id="H967A43D7B69545E0B3329F9D25282582"><enum>(B)</enum><text>whether or not the physician is
willing to follow the individual’s wishes as expressed in an advance
directive.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H2FDBFE4CC2B54855ABC88760C100DD8E"><enum>(2)</enum><header>Waiver of
application of deductible</header><text>The first sentence of section 1833(b)
of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(b)</external-xref>) is amended—</text>
<subparagraph id="HA579AC72C04D4791AE247C20DAFCF020"><enum>(A)</enum><text>by striking
<quote>and</quote> before <quote>(8)</quote>; and</text>
</subparagraph><subparagraph id="H567430FB148F4EC0002DA22E814DC4A"><enum>(B)</enum><text>by inserting
<quote>, and (9) such deductible shall not apply with respect to an initial
preventive physical examination (as defined in section 1861(ww))</quote> before
the period at the end.</text>
</subparagraph></paragraph><paragraph id="H4B4C1F0C08FF479900C0D2D2067196BA"><enum>(3)</enum><header>Extension of
eligibility period from six months to one year</header><text display-inline="yes-display-inline">Section 1862(a)(1)(K) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395y">42 U.S.C. 1395y(a)(1)(K)</external-xref>) is amended by striking <quote>6
months</quote> and inserting <quote>1 year</quote>.</text>
</paragraph><paragraph id="H2F4D8CBC34FF47F3B7B47B02CF96DBFD"><enum>(4)</enum><header>Technical
correction</header><text>Section 1862(a)(1)(K) of the Social Security Act (42
U.S.C. 1395y(a)(1)(K)) is amended by striking <quote>not later</quote> and
inserting <quote>more</quote>.</text>
</paragraph></subsection><subsection id="H031F6F3CE63B4A43B5FE9499E4AC0043"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to services
furnished on or after January 1, 2009.</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="H18A7F6F9DC0647F6801B1C7CF56F673B" section-type="subsequent-section"><enum>102.</enum><header>Elimination of
discriminatory copayment rates for Medicare outpatient psychiatric
services</header><text display-inline="no-display-inline">Section 1833(c) of
the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395l(c)) is amended to read as follows:</text>
<quoted-block act-name="Social Security Act" display-inline="no-display-inline" id="HF3C2AB9024E94582AF9CBFFB882BDFC" style="OLC">
<subsection commented="no" display-inline="no-display-inline" id="HD7F4E6E076804C59B6C92348A0D560F6"><enum>(c)</enum><paragraph commented="no" display-inline="yes-display-inline" id="H89480655F4B04717B5DD5E4057A4BA7"><enum>(1)</enum><text display-inline="yes-display-inline">Notwithstanding any other provision of this
part, with respect to expenses incurred in a calendar year in connection with
the treatment of mental, psychoneurotic, and personality disorders of an
individual who is not an inpatient of a hospital at the time such expenses are
incurred, there shall be considered as incurred expenses for purposes of
subsections (a) and (b)—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H309B87BD0BD74F109F9846B03E988D40" indent="up1"><enum>(A)</enum><text display-inline="yes-display-inline">for expenses incurred in years prior to
2010, only 62<fraction>1/2</fraction> percent of such expenses;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H746CC1DEF0794424A6DE2679F9814433" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">for expenses incurred in 2010 or 2011, only
68<fraction>3/4</fraction> percent of such expenses;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H9206C58038C440FDA9B6B2DF2E002835" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">for expenses incurred in 2012, only 75
percent of such expenses;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H4F4D41A49C8E42EBB1EC9100E14FA138" indent="up1"><enum>(D)</enum><text display-inline="yes-display-inline">for expenses incurred in 2013, only
81<fraction>1/4</fraction> percent of such expenses; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H875FC3A136294018B9C6F27901DA6974" indent="up1"><enum>(E)</enum><text display-inline="yes-display-inline">for expenses incurred in 2014 or any
subsequent calendar year, 100 percent of such expenses.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HB679DED46D5F4BB78CA6D7C1BADE05DA" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">For purposes of subparagraphs (A) through
(D) of paragraph (1), the term <term>treatment</term> does not include brief
office visits (as defined by the Secretary) for the sole purpose of monitoring
or changing drug prescriptions used in the treatment of such disorders or
partial hospitalization services that are not directly provided by a
physician.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="HF650E5BAEA44416298BEA00E21E7DB8"><enum>103.</enum><header>Prohibitions and
limitations on certain sales and marketing activities under Medicare Advantage
plans and prescription drug plans</header>
<subsection id="HF4624F6D14AF4007A824013B45960023"><enum>(a)</enum><header>Prohibitions</header>
<paragraph id="HC4A29C6493B74508808D6CC111A38C88"><enum>(1)</enum><header>Medicare
advantage program</header>
<subparagraph id="HE2D7A5B971444D7B915D7BDFB0B07200"><enum>(A)</enum><header>In
general</header><text>Section 1851 of the Social Security Act (42 U.S.C.
1395w–21) is amended—</text>
<clause id="H08B19A0628E44ECC8077EAA42E468066"><enum>(i)</enum><text>in
subsection (h)(4)—</text>
<subclause id="H318DBE13FB47409E9FDAD9319C00C138"><enum>(I)</enum><text>in subparagraph
(A)—</text>
<item id="HC710BA712227413480CABE096802E2AA"><enum>(aa)</enum><text>by
striking <quote>cash or other monetary rebates</quote> and inserting <quote>,
subject to subsection (j)(2)(C), cash, gifts, prizes, or other monetary
rebates</quote>; and</text>
</item><item id="HBD5142B643D84C968F527665A484ACD0"><enum>(bb)</enum><text>by
striking <quote>, and</quote> at the end and inserting a semicolon;</text>
</item></subclause><subclause id="H16D664E940BD4430AEEC9F2118ED5160"><enum>(II)</enum><text>in subparagraph
(B), by striking the period at the end and inserting a semicolon; and</text>
</subclause><subclause id="H628CA996B39344D68081F00838DA526"><enum>(III)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H48655C031ED24931A2159695E83C75B" style="OLC">
<subparagraph id="HA6D2B2E7CCD34715B2C5E4CCFC68D55"><enum>(C)</enum><text>shall not permit a
Medicare Advantage organization (or the agents, brokers, and other third
parties representing such organization) to conduct the prohibited activities
described in subsection (j)(1); and</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subclause></clause><clause id="HC98AA449EBBC46AAAC118F41F72FC32C"><enum>(ii)</enum><text>by
adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H826E74E8212543C9877CC2A608482287" style="OLC">
<subsection id="H3280D9453DB04F54B6305223CAF78EBE"><enum>(j)</enum><header>Prohibited
activities described and limitations on the conduct of certain other
activities</header>
<paragraph id="HED6450691984479480F5419ED444B55D"><enum>(1)</enum><header>Prohibited
activities described</header><text>The following prohibited activities are
described in this paragraph:</text>
<subparagraph id="H81A5A11B172B43CDA28DA8E86F260070"><enum>(A)</enum><header>Unsolicited
means of direct contact</header><text>Any unsolicited means of direct contact
of prospective enrollees, including soliciting door-to-door or any outbound
telemarketing without the prospective enrollee initiating contact.</text>
</subparagraph><subparagraph id="H01AF23797BBA4E80B86327F31BDCE796"><enum>(B)</enum><header>Cross-selling</header><text>The
sale of other non-health related products (such as annuities and life
insurance) during any sales or marketing activity or presentation conducted
with respect to a Medicare Advantage plan.</text>
</subparagraph><subparagraph id="H0D0063462BD344E2A41B9395A87303A0"><enum>(C)</enum><header>Meals</header><text>The
provision of meals of any sort, regardless of value, to prospective enrollees
at promotional and sales activities.</text>
</subparagraph><subparagraph id="HC765FD976A8D4B96A5A8B300BB81D835"><enum>(D)</enum><header>Sales and
marketing in health care settings and at educational events</header><text>Sales
and marketing activities for the enrollment of individuals in Medicare
Advantage plans that are conducted—</text>
<clause id="H6A12294251D643B7B081C77063B5ADDA"><enum>(i)</enum><text>in
health care settings in areas where health care is delivered to individuals
(such as physician offices and pharmacies), except in the case where such
activities are conducted in common areas in health care settings; and</text>
</clause><clause id="H0842015BC1764713886B50EE027062C9"><enum>(ii)</enum><text>at educational
events.</text>
</clause></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph><paragraph id="HFD196B9F8AC643E5B2FCDD7EBD25C65E"><enum>(2)</enum><header>Medicare
prescription drug program</header><text>Section 1860D–4 of the Social Security
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-104">42 U.S.C. 1395w–104</external-xref>) is amended by adding at the end the following new
subsection:</text>
<quoted-block display-inline="no-display-inline" id="H1497CC0146BC429600D49B5365F79CD" style="OLC">
<subsection id="HC6CEB3E592344432994D945B6F5D4C19"><enum>(l)</enum><header>Requirements
with respect to sales and marketing activities</header><text>The following
provisions shall apply to a PDP sponsor (and the agents, brokers, and other
third parties representing such sponsor) in the same manner as such provisions
apply to a Medicare Advantage organization (and the agents, brokers, and other
third parties representing such organization):</text>
<paragraph id="HC4A607E0C84C40CDB2C08E5D5899E926"><enum>(1)</enum><text>The prohibition
under section 1851(h)(4)(C) on conducting activities described in section
1851(j)(1).</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H1FCB6C30D6D943B3ACDF2024DA418E2"><enum>(3)</enum><header>Effective
date</header><text>The amendments made by this subsection shall apply to plan
years beginning on or after January 1, 2009.</text>
</paragraph></subsection><subsection id="H80BE2D87AE5C4D789B9267AB767BB5D4"><enum>(b)</enum><header>Limitations</header>
<paragraph id="H465D941926B94CB8A8161D81F43D9864"><enum>(1)</enum><header>Medicare
advantage program</header><text>Section 1851 of the Social Security Act (42
U.S.C. 1395w–21), as amended by subsection (a)(1), is amended—</text>
<subparagraph id="HE08BAB7F3FB1406AB3B978635F217053"><enum>(A)</enum><text>in subsection
(h)(4), by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H72C9E2BDAE334756A52E007BBEEDFFE8" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="H575897040426479CB912EE82E85719C5"><enum>(D)</enum><text display-inline="yes-display-inline">shall only permit a Medicare Advantage
organization (and the agents, brokers, and other third parties representing
such organization) to conduct the activities described in subsection (j)(2) in
accordance with the limitations established under such
subsection.</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="H783F3B6EF34B4CEFA2A37CEF9F00CE58"><enum>(B)</enum><text>in subsection (j),
by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H92FB9FB47F16438CA992F3593EC597ED" style="OLC">
<paragraph id="H35E2BFF9BA6B44A3A96C7B9B9BDAE5D1"><enum>(2)</enum><header>Limitations</header><text>The
Secretary shall establish limitations with respect to at least the
following:</text>
<subparagraph id="HDAE8C86619BC4D4D8528DBAD3B860633"><enum>(A)</enum><header>Scope of
marketing appointments</header><text>The scope of any appointment with respect
to the marketing of a Medicare Advantage plan. Such limitation shall require
advance agreement with a prospective enrollee on the scope of the marketing
appointment and documentation of such agreement by the Medicare Advantage
organization. In the case where the marketing appointment is in person, such
documentation shall be in writing.</text>
</subparagraph><subparagraph id="HBC97398394804560BFAB711CF8D7B81C"><enum>(B)</enum><header>Co-branding</header><text>The
use of the name or logo of a co-branded network provider on Medicare Advantage
plan membership and marketing materials.</text>
</subparagraph><subparagraph id="H90920EEB84D04D0D815F144982E22EF2"><enum>(C)</enum><header>Limitation of
gifts to nominal dollar value</header><text>The offering of gifts and other
promotional items other than those that are of nominal value (as determined by
the Secretary) to prospective enrollees at promotional activities.</text>
</subparagraph><subparagraph id="H28B9AD5A47A84D86873CBE3976191150"><enum>(D)</enum><header>Compensation</header><text>The
use of compensation other than as provided under guidelines established by the
Secretary. Such guidelines shall ensure that the use of compensation creates
incentives for agents and brokers to enroll individuals in the Medicare
Advantage plan that is intended to best meet their health care needs.</text>
</subparagraph><subparagraph id="HBADCDE6791B1425896171439EDC2342E"><enum>(E)</enum><header>Required
training, annual retraining, and testing of agents, brokers, and other third
parties</header><text>The use by a Medicare Advantage organization of any
individual as an agent, broker, or other third party representing the
organization that has not completed an initial training and testing program and
does not complete an annual retraining and testing
program.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H155D5B08608F4928B1B4A6C0B79C0038"><enum>(2)</enum><header>Medicare
prescription drug program</header><text>Section 1860D–4(l) of the Social
Security Act, as added by subsection (a)(2), is amended by adding at the end
the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H7DB878DE20104FF7B8B072AD8E53218F" style="OLC">
<paragraph id="HEBBF534795CB4238A9EF64D04E1744F9"><enum>(2)</enum><text>The requirement
under section 1851(h)(4)(D) to conduct activities described in section
1851(j)(2) in accordance with the limitations established under such
subsection.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H3E87B7D184F946910002ED5087EED7C7"><enum>(3)</enum><header>Effective
date</header><text>The amendments made by this subsection shall take effect on
a date specified by the Secretary (but in no case later than November 15,
2008).</text>
</paragraph></subsection><subsection id="H4C080A5115824DC2BD90009B54EEB216"><enum>(c)</enum><header>Required
inclusion of plan type in plan name</header>
<paragraph id="HF3ED0BCC89944B82A4C2B67673A7006B"><enum>(1)</enum><header>Medicare
advantage program</header><text>Section 1851(h) of the Social Security Act (42
U.S.C. 1395w–21(h)) is amended by adding at the end following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H6650C2779A6C447D8E85B9FDF9926908" style="OLC">
<paragraph id="H2FF023FDDF4240668E9D174F00D7A939"><enum>(6)</enum><header>Required
inclusion of plan type in plan name</header><text>For plan years beginning on
or after January 1, 2010, a Medicare Advantage organization must ensure that
the name of each Medicare Advantage plan offered by the Medicare Advantage
organization includes the plan type of the plan (using standard terminology
developed by the
Secretary).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H869DF6B9AE7748D79B7B3786FA985FAA"><enum>(2)</enum><header>Prescription
drug plans</header><text>Section 1860D–4(l) of the Social Security Act, as
added by subsection (a)(2) and amended by subsection (b)(2), is amended by
adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H087B1422E80A4456A9D142963BBEAC59" style="OLC">
<paragraph id="H43633A2E913642FA9C6C8B00A348D390"><enum>(3)</enum><text>The inclusion of
the plan type in the plan name under section
1851(h)(6).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H70DFC876D61441C488B831E8FF1730FE"><enum>(d)</enum><header>Strengthening
the ability of States To act in collaboration with the Secretary To address
fraudulent or inappropriate marketing practices</header>
<paragraph id="HA270FE22B2CA469EA4CE0786C7A900"><enum>(1)</enum><header>Medicare advantage
program</header><text>Section 1851(h) of the Social Security Act (42 U.S.C.
1395w–21(h), as amended by subsection (c)(1), is amended by adding at the end
the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H01705C9ECEE749F6AD589632E5460646" style="OLC">
<paragraph id="H6D03A3E5469245B69125C40584D6EA33"><enum>(7)</enum><header>Strengthening
the ability of States to act in collaboration with the Secretary to address
fraudulent or inappropriate marketing practices</header>
<subparagraph id="H9DD554E4E0C542B49990A79591B8D765"><enum>(A)</enum><header>Appointment of
agents and brokers</header><text>Each Medicare Advantage organization
shall—</text>
<clause id="HB9A35068A4684F8BB58FFF7540C2A9F9"><enum>(i)</enum><text>only use agents
and brokers who have been licensed under State law to sell Medicare Advantage
plans offered by the Medicare Advantage organization;</text>
</clause><clause id="HEA7151E4141244268D47BAD1CCD3E43C"><enum>(ii)</enum><text>in the case where
a State has a State appointment law, abide by such law; and</text>
</clause><clause id="H7A5771B8A5DE45DEBCA32738C5F559CF"><enum>(iii)</enum><text>report to the
applicable State the termination of any such agent or broker, including the
reasons for such termination (as required under applicable State law).</text>
</clause></subparagraph><subparagraph id="H45644258576A44A4B48E49097822001D"><enum>(B)</enum><header>Compliance with
state information requests</header><text>Each Medicare Advantage organization
shall comply in a timely manner with any request by a State for information
regarding the performance of a licensed agent, broker, or other third party
representing the Medicare Advantage organization as part of an investigation by
the State into the conduct of the agent, broker, or other third
party.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H19B6B27E6C4E42D7A921AA713C001F20"><enum>(2)</enum><header>Prescription
drug plans</header><text>Section 1860D–4(l) of the Social Security Act, as
amended by subsection (c)(2), is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H246723351B2744E0902C8BA26C9694C1" style="OLC">
<paragraph id="H488D9A5AA1B74DF5BB2DF70F8F5ADE9"><enum>(4)</enum><text>The requirements
regarding the appointment of agents and brokers and compliance with State
information requests under subparagraphs (A) and (B), respectively, of section
1851(h)(7).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HEA698CAA7B7044D7BDBBA2E24DFBC27B"><enum>(3)</enum><header>Effective
date</header><text>The amendments made by this subsection shall apply to plan
years beginning on or after January 1, 2009.</text>
</paragraph></subsection></section><section id="H472AAC08CC1D4D868D5E5807B3F870F1"><enum>104.</enum><header>Improvements to
the Medigap program</header>
<subsection id="HFD02675D91D547B0A95F735B89DE72F"><enum>(a)</enum><header>Implementation of
NAIC recommendations</header>
<paragraph id="H0AFEC6BBDC794504864824DDAFDA1D44"><enum>(1)</enum><header>In
general</header><text>The Secretary of Health and Human Services (in this
section referred to as the <quote>Secretary</quote>) shall provide for
implementation of the changes in the NAIC model law and regulations approved by
the National Association of Insurance Commissioners in its Model #651
(<quote>Model Regulation to Implement the NAIC Medicare Supplement Insurance
Minimum Standards Model Act</quote>) on March 11, 2007, as modified to reflect
the changes made under this Act and the Genetic Information Nondiscrimination
Act of 2008 (<external-xref legal-doc="public-law" parsable-cite="pl/110/233">Public Law 110–233</external-xref>).</text>
</paragraph><paragraph id="HBC3B14F165BD4E4B9C5101A06EE3E0C2"><enum>(2)</enum><header>Implementation
dates</header>
<subparagraph id="HD76D53364116494086A54197B665775"><enum>(A)</enum><header>In
general</header><text>The modifications to Model #651 required under paragraph
(1) shall be completed by the National Association of Insurance Commissioners
not later than October 31, 2008. Except as provided in subparagraph (B), each
State shall have 1 year from the date the National Association of Insurance
Commissioners adopts the revised NAIC model law and regulations (as changed by
Model #651, as so modified) to conform the regulatory program established by
the State to such revised NAIC model law and regulations.</text>
</subparagraph><subparagraph id="H79E0932FDC6F40CEA7AF15C2DEAD369C"><enum>(B)</enum><header>Extension of
effective date for state law amendment</header><text>In the case of a State
which the Secretary determines requires State legislation in order to conform
the regulatory program established by the State to such revised NAIC model law
and regulations, the State shall not be regarded as failing to comply with the
requirements of this section solely on the basis of its failure to meet such
requirements before the first day of the first calendar quarter beginning after
the close of the first regular session of the State legislature that begins
after the date of the enactment of this Act. For purposes of the previous
sentence, in the case of a State that has a 2-year legislative session, each
year of the session is considered to be a separate regular session of the State
legislature.</text>
</subparagraph><subparagraph id="HEC2B4FA626EC4FA39EA45140F024FB00"><enum>(C)</enum><header>Transition
dates</header><text>No carrier may issue a new or revised medicare supplemental
policy or certificate under section 1882 of the Social Security Act (42 U.S.C.
1395ss) that meets the requirements of such revised NAIC model law and
regulations for coverage effective prior to June 1, 2010. A carrier may
continue to offer or issue a medicare supplemental policy under such section
that meets the requirements of the NAIC model law and regulations and State law
(as in effect prior to the adoption of such revised NAIC model law and
regulations) prior to June 1, 2010. Nothing shall preclude carriers from
marketing new or revised medicare supplemental policies or certificates that
meet the requirements of such revised NAIC model law and regulations on or
after the date on which the State conforms the regulatory program established
by the State to such revised NAIC model law and regulations.</text>
</subparagraph></paragraph></subsection><subsection id="H2248283AA81E4BF2A5F4F60595FFCB1"><enum>(b)</enum><header>Required offering
of a range of policies</header><text>Section 1882(o) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395s">42 U.S.C. 1395s(o)</external-xref>) is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HF986220996E34931B34B163C9D5D846D" style="OLC">
<paragraph id="HA5A9CC0F74024887AA01133D29D18488"><enum>(4)</enum><text>In addition to the
requirement under paragraph (2), the issuer of the policy must make available
to the individual at least Medicare supplemental policies with benefit packages
classified as <quote>C</quote> or
<quote>F</quote>.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section></part><part id="HA962D8B048F44877B77C912F84231F73"><enum>II</enum><header>Low-income
programs</header>
<section id="H20DF4CCB03E34322AE42929C7007B66"><enum>111.</enum><header>Extension of
qualifying individual (QI) program</header>
<subsection id="HC4DE8AB8910245FBA2F8E4217966D400"><enum>(a)</enum><header>Extension</header><text>Section
1902(a)(10)(E)(iv) of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)(10)(E)(iv)</external-xref>) is amended by striking
<quote>June 2008</quote> and inserting <quote>December 2009</quote>.</text>
</subsection><subsection id="HEAD803AE038045668435978BC17F68D2"><enum>(b)</enum><header>Extending Total
Amount Available for Allocation</header><text>Section 1933(g) of such Act (42
U.S.C. 1396u–3(g)) is amended—</text>
<paragraph id="H5F1DAA28A71B475F80C3BE3237002D05"><enum>(1)</enum><text>in paragraph
(2)—</text>
<subparagraph id="H7A0F8AA99AFE4F0DAC9E26D371D3EF50"><enum>(A)</enum><text>by striking
<quote>and</quote> at the end of subparagraph (H);</text>
</subparagraph><subparagraph id="H2EE5413D62B94A1885BEFDA854837899"><enum>(B)</enum><text>in subparagraph
(I)—</text>
<clause id="HB8746A96508F424BB350FE4116977B2B"><enum>(i)</enum><text>by
striking <quote>June 30</quote> and inserting <quote>September
30</quote>;</text>
</clause><clause id="H437D7B73998F480292D009C425464A0"><enum>(ii)</enum><text>by
striking <quote>$200,000,000</quote> and inserting <quote>$300,000,000</quote>;
and</text>
</clause><clause id="H292C3B6218CE4BD2A5B2C9BA5E032541"><enum>(iii)</enum><text>by
striking the period at the end and inserting a semicolon; and</text>
</clause></subparagraph><subparagraph id="H39E99CCC9CA149D18356FFE4087F8BD4"><enum>(C)</enum><text>by adding at the
end the following new subparagraphs:</text>
<quoted-block display-inline="no-display-inline" id="H9ADF4FA8B526415EB6435D23006F68E0" style="OLC">
<subparagraph id="HA2BB5E4A63124446A03E129CD1AC1B6"><enum>(J)</enum><text>for the period that
begins on October 1, 2008, and ends on December 31, 2008, the total allocation
amount is $100,000,000;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HD28880827DF4443793622E36633D336D"><enum>(K)</enum><text display-inline="yes-display-inline">for the period that begins on January 1,
2009, and ends on September 30, 2009, the total allocation amount is
$350,000,000; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HCCF1671146E64D0B9D75D7DF100F11E"><enum>(L)</enum><text display-inline="yes-display-inline">for the period that begins on October 1,
2009, and ends on December 31, 2009, the total allocation amount is
$150,000,000.</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H02D13D6653B14F76BF682365A0111536"><enum>(2)</enum><text>in paragraph (3),
in the matter preceding subparagraph (A), by striking <quote>or (H)</quote> and
inserting <quote>(H), (J), or (L)</quote>.</text>
</paragraph></subsection></section><section id="H2E0FFCC155A248ED8D5F9415A0CCD260"><enum>112.</enum><header>Application of
full LIS subsidy assets test under Medicare Savings Program</header><text display-inline="no-display-inline">Section 1905(p)(1)(C) of such Act (42 U.S.C.
1396d(p)(1)(C)) is amended by inserting before the period at the end the
following: <quote>or, effective beginning with January 1, 2010, whose resources
(as so determined) do not exceed the maximum resource level applied for the
year under subparagraph (D) of section 1860D–14(a)(3) (determined without
regard to the life insurance policy exclusion provided under subparagraph (G)
of such section) applicable to an individual or to the individual and the
individual’s spouse (as the case may be)</quote>.</text>
</section><section id="H9D87B132B84047019E1C8C18E97D646B"><enum>113.</enum><header>Eliminating
barriers to enrollment</header>
<subsection id="HB19C926825F14CAA8ED888B128D4EC2F"><enum>(a)</enum><header>SSA assistance
with medicare savings program and low-income subsidy program
applications</header><text>Section 1144 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1320b-14">42 U.S.C. 1320b–14</external-xref>) is
amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H96DBAF938032487FBAD35813B24E18CF" style="OLC">
<subsection id="H5A8E4B6CA4F0423A8162A0ACEE5BDAA9"><enum>(c)</enum><header>Assistance with
medicare savings program and low-income subsidy program applications</header>
<paragraph id="HFEE5C8AD65DB416380D45D46B9173DE8"><enum>(1)</enum><header>Distribution of
applications and information to individuals who are potentially eligible for
low-income subsidy program</header><text display-inline="yes-display-inline">For each individual who submits an
application for low-income subsidies under section 1860D–14, requests an
application for such subsidies, or is otherwise identified as an individual who
is potentially eligible for such subsidies, the Commissioner shall do the
following:</text>
<subparagraph id="HD1C7700783274297B9EAA9644E231F95"><enum>(A)</enum><text>Provide
information describing the low-income subsidy program under section 1860D–14
and the Medicare Savings Program (as defined in paragraph (7)).</text>
</subparagraph><subparagraph id="H17B76009A9C54B6EB0589F7374062063"><enum>(B)</enum><text>Provide an
application for enrollment under such low-income subsidy program (if not
already received by the Commissioner).</text>
</subparagraph><subparagraph id="H8D6A121735164BC6AB721D6363740028"><enum>(C)</enum><text>In accordance with
paragraph (3), transmit data from such an application for purposes of
initiating an application for benefits under the Medicare Savings
Program.</text>
</subparagraph><subparagraph id="HF26D310910C94D509C44F3B0671E32C6"><enum>(D)</enum><text>Provide
information on how the individual may obtain assistance in completing such
application and an application under the Medicare Savings Program, including
information on how the individual may contact the State health insurance
assistance program (SHIP).</text>
</subparagraph><subparagraph id="HF9FEC12882FB40189DB33BC37D40088D"><enum>(E)</enum><text>Make the
application described in subparagraph (B) and the information described in
subparagraphs (A) and (D) available at local offices of the Social Security
Administration.</text>
</subparagraph></paragraph><paragraph id="H5B0CAD22702144558E30DD665E3011B5"><enum>(2)</enum><header>Training
personnel in explaining benefit programs and assisting in completing LIS
application</header><text display-inline="yes-display-inline">The Commissioner
shall provide training to those employees of the Social Security Administration
who are involved in receiving applications for benefits described in paragraph
(1)(B) in order that they may promote beneficiary understanding of the
low-income subsidy program and the Medicare Savings Program in order to
increase participation in these programs. Such employees shall provide
assistance in completing an application described in paragraph (1)(B) upon
request.</text>
</paragraph><paragraph id="H6A75B6D3C2D94602B7C55D4546F0F94F"><enum>(3)</enum><header>Transmittal of
data to States</header><text>Beginning on January 1, 2010, with the consent of
an individual completing an application for benefits described in paragraph
(1)(B), the Commissioner shall electronically transmit to the appropriate State
Medicaid agency data from such application, as determined by the Commissioner,
which transmittal shall initiate an application of the individual for benefits
under the Medicare Savings Program. In order to ensure that such data
transmittal provides effective assistance for purposes of State adjudication of
applications for benefits under the Medicare Savings Program, the Commissioner
shall consult with the Secretary, after the Secretary has consulted with the
States, regarding the content, form, frequency, and manner in which data (on a
uniform basis for all States) shall be transmitted under this
subparagraph.</text>
</paragraph><paragraph id="HF80003C2FC1E4C6DB2AAFD7BF06F629D"><enum>(4)</enum><header>Coordination
with outreach</header><text display-inline="yes-display-inline">The
Commissioner shall coordinate outreach activities under this subsection with
outreach activities conducted by States in connection with the low-income
subsidy program and the Medicare Savings Program.</text>
</paragraph><paragraph id="HFEBACF69FFCB4DBAAC299BE9BD62DD00"><enum>(5)</enum><header>Reimbursement of
social security administration administrative costs</header>
<subparagraph id="H1403FB6D5C8C46E59017C8DD73963CB4"><enum>(A)</enum><header>Initial medicare
savings program costs; additional low-income subsidy costs</header>
<clause id="H37ACBA635CC44007B16B562018F63355"><enum>(i)</enum><header>Initial medicare
savings program costs</header><text display-inline="yes-display-inline">There
are hereby appropriated to the Commissioner to carry out this subsection, out
of any funds in the Treasury not otherwise appropriated, $21,100,000. The
amount appropriated under ths clause shall be available on October 1, 2008, and
shall remain available until expended.</text>
</clause><clause id="HA4BC1BCDA35149A5B37E03AFB59677B1"><enum>(ii)</enum><header>Additional
amount for low-income subsidy activities</header><text display-inline="yes-display-inline">There are hereby appropriated to the
Commissioner, out of any funds in the Treasury not otherwise appropriated,
$24,800,000 for fiscal year 2009 to carry out low-income subsidy activities
under this Act, to remain available until expended. Such funds shall be in
addition to the Social Security Administration’s Limitation on Administrative
Expenditure appropriations for such fiscal year.</text>
</clause></subparagraph><subparagraph id="H503D4B9E5A2948ABBA004483BE024502"><enum>(B)</enum><header>Subsequent
funding under agreements</header>
<clause id="H98E7323BFAFE4299B873A7907CA6DAB3"><enum>(i)</enum><header>In
general</header><text>Effective for fiscal years beginning on or after October
1, 2010, the Commissioner and the Secretary shall enter into an agreement which
shall provide funding to cover the administrative costs of the Commissioner's
activities under this subsection. Such agreement shall—</text>
<subclause id="HD0C7517686604306BC93F8F530008E24"><enum>(I)</enum><text>provide funds to
the Commissioner for the full cost of the Social Security Administration's work
related to the Medicare Savings Program required under this section;</text>
</subclause><subclause id="H39EE5E9FEE2F4D56863BC042006746E4"><enum>(II)</enum><text>provide such
funding quarterly in advance of the applicable quarter based on estimating
methodology agreed to by the Commissioner and the Secretary; and</text>
</subclause><subclause id="H6F0E845983E14ED4AA847E0549FE574B"><enum>(III)</enum><text>require an
annual accounting and reconciliation of the actual costs incurred and funds
provided under this subsection.</text>
</subclause></clause><clause id="HFDFC0B963ED9471D8DC8FA71A1F535D"><enum>(ii)</enum><header>Appropriation</header><text>There
are hereby appropriated to the Secretary solely for the purpose of providing
payments to the Commissioner pursuant to an agreement specified in clause (i)
that is in effect, out of any funds in the Treasury not otherwise appropriated,
not more than $3,000,000 for fiscal year 2011 and each fiscal year
thereafter.</text>
</clause></subparagraph><subparagraph id="HD1B66EBB37304CF780A6A528BA3887C"><enum>(C)</enum><header>Limitation</header><text display-inline="yes-display-inline">In no case shall funds from the Social
Security Administration’s Limitation on Administrative Expenses be used to
carry out activities under this subsection. For fiscal years beginning on or
after October 1, 2010, no such activities shall be undertaken by the Social
Security Administration unless the agreement specified in subparagraph (B) is
in effect and full funding has been provided to the Commissioner as specified
in such subparagraph.</text>
</subparagraph></paragraph><paragraph id="H6AFD7F28C2AC4244A33497DA90FACF96"><enum>(6)</enum><header>GAO analysis and
report</header>
<subparagraph id="HD091CD64F90E4648B43253386B47E1EB"><enum>(A)</enum><header>Analysis</header><text>The
Comptroller General of the United States shall prepare an analysis of the
impact of this subsection—</text>
<clause id="H6AF2ADF5EDB943469256D6D528BCE4E1"><enum>(i)</enum><text>in
increasing participation in the Medicare Savings Program, and</text>
</clause><clause id="HDF3B241672CB4CD5A18252536B8D368B"><enum>(ii)</enum><text>on States and the
Social Security Administration.</text>
</clause></subparagraph><subparagraph id="H73F13E638ADD4B4BB692E452B3798830"><enum>(B)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than January 1, 2012, the
Comptroller General shall submit to Congress, the Commissioner, and the
Secretary a report on the analysis conducted under subparagraph (A).</text>
</subparagraph></paragraph><paragraph id="H5B5631C85D1741F1A345D7F31F322707"><enum>(7)</enum><header>Medicare Savings
Program defined</header><text display-inline="yes-display-inline">For purposes
of this subsection, the term <quote>Medicare Savings Program</quote> means the
program of medical assistance for payment of the cost of medicare cost-sharing
under the Medicaid program pursuant to sections 1902(a)(10)(E) and
1933.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H504D32147A8D4A16B8E9F49C4196F16"><enum>(b)</enum><header>Medicaid agency
consideration of data transmittal</header><text>Section 1935(a) of such Act (42
U.S.C. 1396u–5(a)) is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HAE6366DC38C1497FA77FD70CB255D6B" style="OLC">
<paragraph id="H60DB0945496D4A07AB490859AFBB969F"><enum>(4)</enum><header>Consideration of
data transmitted by the Social Security Administration for purposes of Medicare
Savings Program</header><text>The State shall accept data transmitted under
section 1144(c)(3) and act on such data in the same manner and in accordance
with the same deadlines as if the data constituted an initiation of an
application for benefits under the Medicare Savings Program (as defined for
purposes of such section) that had been submitted directly by the applicant.
The date of the individual’s application for the low income subsidy program
from which the data have been derived shall constitute the date of filing of
such application for benefits under the Medicare Savings
Program.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H312347CFF7EB4D4E97DBE60168DEE079"><enum>(c)</enum><header>Effective
date</header><text display-inline="yes-display-inline">Except as otherwise
provided, the amendments made by this section shall take effect on January 1,
2010.</text>
</subsection></section><section display-inline="no-display-inline" id="HC767720F3FCD43EABB1173DD5F2F3419" section-type="subsequent-section"><enum>114.</enum><header>Elimination of
Medicare part D late enrollment penalties paid by subsidy eligible
individuals</header>
<subsection id="H1659744387ED459EAC6B6F68EF3DE37"><enum>(a)</enum><header>Waiver of late
enrollment penalty</header>
<paragraph id="HBE1D9949646D448599B1F3BFB11776"><enum>(1)</enum><header>In
general</header><text>Section 1860D–13(b) of the Social Security Act (42 U.S.C.
1395w–113(b)) is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H0F7E1B5B4FCE437DA3B307888B2593A0" style="OLC">
<paragraph id="H0BEA9C34857C410499CDAAF4FC994826"><enum>(8)</enum><header>Waiver of
penalty for subsidy-eligible individuals</header><text>In no case shall a part
D eligible individual who is determined to be a subsidy eligible individual (as
defined in section 1860D–14(a)(3)) be subject to an increase in the monthly
beneficiary premium established under subsection
(a).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H483CC97DC5164D3DA59919D45DD3F656"><enum>(2)</enum><header>Conforming
amendment</header><text>Section 1860D–14(a)(1)(A) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-114">42 U.S.C. 1395w–114(a)(1)(A)</external-xref>) is amended by striking <quote>equal to</quote>
and all that follows through the period and inserting <quote>equal to 100
percent of the amount described in subsection (b)(1), but not to exceed the
premium amount specified in subsection (b)(2)(B).</quote>.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H616502D20F0F4D3EA58307D9D800D9AF"><enum>(b)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to subsidies
for months beginning with January 2009.</text>
</subsection></section><section id="H9859FCE98B5544C9B5F0DCD4AD64DF29"><enum>115.</enum><header>Eliminating
application of estate recovery</header>
<subsection id="H31E15397E21A412E8026F01388689200"><enum>(a)</enum><header>In
general</header><text>Section 1917(b)(1)(B)(ii) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1396p(b)(1)(B)(ii)) is amended by inserting <quote>(but not including medical
assistance for medicare cost-sharing or for benefits described in section
1902(a)(10)(E))</quote> before the period at the end.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H4236318384924F8A87CDBA4959008C16"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall take effect as of
January 1, 2010.</text>
</subsection></section><section display-inline="no-display-inline" id="HA364CE3C5C924C1681E7CC5AD0068D9" section-type="subsequent-section"><enum>116.</enum><header>Exemptions from
income and resources for determination of eligibility for low-income
subsidy</header>
<subsection id="H473D3AECF6F944218DE6AEF7158BA642"><enum>(a)</enum><header>In
general</header><text>Section 1860D–14(a)(3) of the Social Security Act (42
U.S.C. 1395w–114(a)(3)) is amended—</text>
<paragraph id="HE4C7D5E0939447A6919F5C529914C477"><enum>(1)</enum><text>in subparagraph
(C)(i), by inserting <quote>and except that support and maintenance furnished
in kind shall not be counted as income</quote> after <quote>section
1902(r)(2)</quote>;</text>
</paragraph><paragraph display-inline="no-display-inline" id="HEA29BA59CB9E48CBB79B2DF01A9D205"><enum>(2)</enum><text>in subparagraph
(D), in the matter before clause (i), by inserting <quote>subject to the life
insurance policy exclusion provided under subparagraph (G)</quote> before
<quote>)</quote>;</text>
</paragraph><paragraph id="H88839846FB62485395BFB6F067A01DC2"><enum>(3)</enum><text>in subparagraph
(E)(i), in the matter before subclause (I), by inserting <quote>subject to the
life insurance policy exclusion provided under subparagraph (G)</quote> before
<quote>)</quote>; and</text>
</paragraph><paragraph id="HFB27F7F315364C43AB60372082ABDB40"><enum>(4)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H2B7A737B0C5741C18051D5B8BE00DC24" style="OLC">
<subparagraph id="H967585C3DF3D4181A7194E80415E2266"><enum>(G)</enum><header>Life insurance
policy exclusion</header><text>In determining the resources of an individual
(and the eligible spouse of the individual, if any) under section 1613 for
purposes of subparagraphs (D) and (E) no part of the value of any life
insurance policy shall be taken into
account.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H49583B7000CC43E5B5E2055D5BB942E0"><enum>(b)</enum><header>Effective
date</header><text>The amendments made by this section shall take effect on
January 1, 2010, and shall apply to determinations of eligibility for months
beginning with January 2010.</text>
</subsection></section><section id="H56AC5C3FAEDA4E6DACB10720F4777ED7"><enum>117.</enum><header>Judicial review
of decisions of the Commissioner of Social Security under the Medicare part D
low-income subsidy program</header>
<subsection id="HD80B2EC4988D43DDA062121441FB19D"><enum>(a)</enum><header>In
general</header><text>Section 1860D–14(a)(3)(B)(iv) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-114">42 U.S.C. 1395w–114(a)(3)(B)(iv)</external-xref>) is amended—</text>
<paragraph id="H8388F062963E4EFBA33E47198C99DB27"><enum>(1)</enum><text>in subclause (I),
by striking <quote>and</quote> at the end;</text>
</paragraph><paragraph id="H0FA2BFC6A04E460B9927D3F97E1C2B9E"><enum>(2)</enum><text>in subclause (II),
by striking the period at the end and inserting <quote>; and</quote>;
and</text>
</paragraph><paragraph id="H99612144C89144FA9339CB9C6949C2AB"><enum>(3)</enum><text>by adding at the
end the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="H04016D5CE583439F98C0A242F244C72" style="OLC">
<subclause id="H421ADA42A8B346BA9DB0F9A922EED388"><enum>(III)</enum><text>judicial review
of the final decision of the Commissioner made after a hearing shall be
available to the same extent, and with the same limitations, as provided in
subsections (g) and (h) of section
205.</text>
</subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H70E6871F83AB40C1AFE7F307367876F9"><enum>(b)</enum><header>Effective
date</header><text>The amendments made by subsection (a) shall take effect as
if included in the enactment of section 101 of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003.</text>
</subsection></section><section id="H409CC587C8E24E198B85B7E04DCAB0D1"><enum>118.</enum><header>Translation of
model form</header>
<subsection id="HB4B89507E19A4AB69F00446FAD008D2F"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1905(p)(5)(A)
of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(p)(5)(A)</external-xref>) is amended by adding at
the end the following: <quote>The Secretary shall provide for the translation
of such application form into at least the 10 languages (other than English)
that are most often used by individuals applying for hospital insurance
benefits under section 226 or 226A and shall make the translated forms
available to the States and to the Commissioner of Social
Security.</quote>.</text>
</subsection><subsection id="H68A1A7B0656840D2938624CE903E4839"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall take effect on
January 1, 2010.</text>
</subsection></section><section id="HF9F3C809AEA349F898E1ED01C29EE53"><enum>119.</enum><header>Medicare
enrollment assistance</header>
<subsection id="HAEA677314D6143B1B6FC76EDE29320AD"><enum>(a)</enum><header>Additional
Funding for State Health Insurance Assistance Programs</header>
<paragraph id="H06832503ED52439788782C30E842CF1"><enum>(1)</enum><header>Grants</header>
<subparagraph id="HB038C3F7B8CA438AA6D3C8E4E5B20310"><enum>(A)</enum><header>In
general</header><text>The Secretary of Health and Human Services (in this
section referred to as the <quote>Secretary</quote>) shall use amounts made
available under subparagraph (B) to make grants to States for State health
insurance assistance programs receiving assistance under section 4360 of the
Omnibus Budget Reconciliation Act of 1990.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H6AAE7F51FD7E4EC69185528E2882A22E"><enum>(B)</enum><header display-inline="yes-display-inline">Funding</header><text display-inline="yes-display-inline">For purposes of making grants under this
subsection, the Secretary shall provide for the transfer, from the Federal
Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42
U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under
section 1841 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395t">42 U.S.C. 1395t</external-xref>), in the same proportion as the
Secretary determines under section 1853(f) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-23">42 U.S.C. 1395w–23(f)</external-xref>),
of $7,500,000 to the Centers for Medicare & Medicaid Services Program
Management Account for fiscal year 2009, to remain available until
expended.</text>
</subparagraph></paragraph><paragraph id="H40C6E3E4C3B14E07907820156C99F837"><enum>(2)</enum><header>Amount of
grants</header><text>The amount of a grant to a State under this subsection
from the total amount made available under paragraph (1) shall be equal to the
sum of the amount allocated to the State under paragraph (3)(A) and the amount
allocated to the State under subparagraph (3)(B).</text>
</paragraph><paragraph id="HB4090ACA7FBD4FC79572B5B253D39464"><enum>(3)</enum><header>Allocation to
States</header>
<subparagraph id="H1677A17BDC694CC5955CCEAC97BC4BC"><enum>(A)</enum><header>Allocation based
on percentage of low-income beneficiaries</header><text>The amount allocated to
a State under this subparagraph from <fraction>2/3</fraction> of the total
amount made available under paragraph (1) shall be based on the number of
individuals who meet the requirement under subsection (a)(3)(A)(ii) of section
1860D–14 of the <act-name parsable-cite="SSA">Social Security Act</act-name>
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-114">42 U.S.C. 1395w–114</external-xref>) but who have not enrolled to receive a subsidy under such
section 1860D–14 relative to the total number of individuals who meet the
requirement under such subsection (a)(3)(A)(ii) in each State, as estimated by
the Secretary.</text>
</subparagraph><subparagraph id="HE60526DDF7AD4549B4DF00D7D94E7770"><enum>(B)</enum><header>Allocation based
on percentage of rural beneficiaries</header><text>The amount allocated to a
State under this subparagraph from <fraction>1/3</fraction> of the total amount
made available under paragraph (1) shall be based on the number of part D
eligible individuals (as defined in section 1860D–1(a)(3)(A) of such Act (42
U.S.C. 1395w–101(a)(3)(A))) residing in a rural area relative to the total
number of such individuals in each State, as estimated by the Secretary.</text>
</subparagraph></paragraph><paragraph id="H434FEF8D0FDA4F8C81D132315DE62329"><enum>(4)</enum><header>Portion of grant
based on percentage of low-income beneficiaries to be used to provide outreach
to individuals who may be subsidy eligible individuals or eligible for the
Medicare Savings Program</header><text>Each grant awarded under this subsection
with respect to amounts allocated under paragraph (3)(A) shall be used to
provide outreach to individuals who may be subsidy eligible individuals (as
defined in section 1860D–14(a)(3)(A) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395w–114(a)(3)(A)) or eligible for the Medicare Savings Program (as defined in
subsection (e)).</text>
</paragraph></subsection><subsection id="HB1C978F7E1544C088934E72253B37C29"><enum>(b)</enum><header>Additional
Funding for Area Agencies on Aging</header>
<paragraph id="H01DFB2501F724B9890E64C26C5FE0901"><enum>(1)</enum><header>Grants</header>
<subparagraph id="HA57EA39D861148F093D4D8D7ACE01347"><enum>(A)</enum><header>In
general</header><text>The Secretary, acting through the Assistant Secretary for
Aging, shall make grants to States for area agencies on aging (as defined in
section 102 of the Older Americans Act of 1965 (<external-xref legal-doc="usc" parsable-cite="usc/42/3002">42 U.S.C. 3002</external-xref>)).</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H7B67BABC0F984C8393043090E0231F49"><enum>(B)</enum><header display-inline="yes-display-inline">Funding</header><text display-inline="yes-display-inline">For purposes of making grants under this
subsection, the Secretary shall provide for the transfer, from the Federal
Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42
U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under
section 1841 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395t">42 U.S.C. 1395t</external-xref>), in the same proportion as the
Secretary determines under section 1853(f) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-23">42 U.S.C. 1395w–23(f)</external-xref>),
of $7,500,000 to the Administration on Aging for fiscal year 2009, to remain
available until expended.</text>
</subparagraph></paragraph><paragraph id="H5E62AC5B0EE54F00BDEF108C31A9934"><enum>(2)</enum><header>Amount of grant
and allocation to States based on percentage of low-income and rural
beneficiaries</header><text>The amount of a grant to a State under this
subsection from the total amount made available under paragraph (1) shall be
determined in the same manner as the amount of a grant to a State under
subsection (a), from the total amount made available under paragraph (1) of
such subsection, is determined under paragraph (2) and subparagraphs (A) and
(B) of paragraph (3) of such subsection.</text>
</paragraph><paragraph id="HFC752117FCDE4DC9A983CCBC28003540"><enum>(3)</enum><header>Required use of
funds</header>
<subparagraph id="HBEEBBD9F60F04A9ABC698200DBBCBF00"><enum>(A)</enum><header>All
funds</header><text>Subject to subparagraph (B), each grant awarded under this
subsection shall be used to provide outreach to eligible Medicare beneficiaries
regarding the benefits available under title XVIII of the
<act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</subparagraph><subparagraph id="H5B6EDCA7C68346FC96B687195E9B4B05"><enum>(B)</enum><header>Outreach to
individuals who may be subsidy eligible individuals or eligible for the
Medicare Savings Program</header><text>Subsection (a)(4) shall apply to each
grant awarded under this subsection in the same manner as it applies to a grant
under subsection (a).</text>
</subparagraph></paragraph></subsection><subsection id="H865A7D82B2314DA2A60066D0319F96B"><enum>(c)</enum><header>Additional
Funding for Aging and Disability Resource Centers</header>
<paragraph id="H365383312E254E8DBA75AAACE9F7321"><enum>(1)</enum><header>Grants</header>
<subparagraph id="H928CB8EDD3854A228406C4F5EE5F543"><enum>(A)</enum><header>In
general</header><text>The Secretary shall make grants to Aging and Disability
Resource Centers under the Aging and Disability Resource Center grant program
that are established centers under such program on the date of the enactment of
this Act.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HEF9E686CCA494C389BBC8874A6ECFF7"><enum>(B)</enum><header display-inline="yes-display-inline">Funding</header><text display-inline="yes-display-inline">For purposes of making grants under this
subsection, the Secretary shall provide for the transfer, from the Federal
Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42
U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under
section 1841 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395t">42 U.S.C. 1395t</external-xref>), in the same proportion as the
Secretary determines under section 1853(f) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-23">42 U.S.C. 1395w–23(f)</external-xref>),
of $5,000,000 to the Administration on Aging for fiscal year 2009, to remain
available until expended.</text>
</subparagraph></paragraph><paragraph id="H93F5484671D64C9285E33E0000564C41"><enum>(2)</enum><header>Required use of
funds</header><text>Each grant awarded under this subsection shall be used to
provide outreach to individuals regarding the benefits available under the
Medicare prescription drug benefit under part D of title XVIII of the
<act-name parsable-cite="SSA">Social Security Act</act-name> and under the
Medicare Savings Program.</text>
</paragraph></subsection><subsection id="H702222BF3795439C9640A314EB69ADB"><enum>(d)</enum><header>Coordination of
efforts To inform older americans about benefits available under Federal and
State programs</header>
<paragraph id="HC2E0562975A04B35AF288E70CD3FE5D4"><enum>(1)</enum><header>In
general</header><text>The Secretary, acting through the Assistant Secretary for
Aging, in cooperation with related Federal agency partners, shall make a grant
to, or enter into a contract with, a qualified, experienced entity under which
the entity shall—</text>
<subparagraph id="H3F319881C194462FAA79E9795E7B5624"><enum>(A)</enum><text>maintain and
update web-based decision support tools, and integrated, person-centered
systems, designed to inform older individuals (as defined in section 102 of the
<act-name parsable-cite="OAA65">Older Americans Act of 1965</act-name> (42
U.S.C. 3002)) about the full range of benefits for which the individuals may be
eligible under Federal and State programs;</text>
</subparagraph><subparagraph id="H0A395BB2EEAA41E8897065388BD11B10"><enum>(B)</enum><text>utilize
cost-effective strategies to find older individuals with the greatest economic
need (as defined in such section 102) and inform the individuals of the
programs;</text>
</subparagraph><subparagraph id="HB1C1F8C0E33842DD8909A89E99A3F9C7"><enum>(C)</enum><text>develop and
maintain an information clearinghouse on best practices and the most
cost-effective methods for finding older individuals with greatest economic
need and informing the individuals of the programs; and</text>
</subparagraph><subparagraph id="H93B01862CD234F5C942678FB71B311B9"><enum>(D)</enum><text>provide, in
collaboration with related Federal agency partners administering the Federal
programs, training and technical assistance on the most effective outreach,
screening, and follow-up strategies for the Federal and State programs.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H18D1FFBEAABB4389A82ECB24CE8506CD"><enum>(2)</enum><header display-inline="yes-display-inline">Funding</header><text display-inline="yes-display-inline">For purposes of making a grant or entering
into a contract under paragraph (1), the Secretary shall provide for the
transfer, from the Federal Hospital Insurance Trust Fund under section 1817 of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i">42 U.S.C. 1395i</external-xref>) and the Federal Supplementary Medical
Insurance Trust Fund under section 1841 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395t">42 U.S.C. 1395t</external-xref>), in the
same proportion as the Secretary determines under section 1853(f) of such Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-23">42 U.S.C. 1395w–23(f)</external-xref>), of $5,000,000 to the Administration on Aging for
fiscal year 2009, to remain available until expended.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H96E7395200DF40838889E2BEE636F735"><enum>(e)</enum><header display-inline="yes-display-inline">Medicare Savings Program
defined</header><text display-inline="yes-display-inline">For purposes of this
section, the term <term>Medicare Savings Program</term> means the program of
medical assistance for payment of the cost of medicare cost-sharing under the
Medicaid program pursuant to sections 1902(a)(10)(E) and 1933 of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)(10)(E)</external-xref>, 1396u–3).</text>
</subsection></section></part></subtitle><subtitle id="H2DA9278712B84AB2B541DD8B6694BC1E"><enum>B</enum><header>Provisions
relating to part A</header>
<section id="HB0F6D1A211994A6CAEB2DC8A4FD2E79"><enum>121.</enum><header>Expansion and
extension of the Medicare Rural Hospital Flexibility Program</header>
<subsection id="H5C854902649144B4B990B8BE185C0442"><enum>(a)</enum><header>In
general</header><text>Section 1820(g) of the Social Security Act (42 U.S.C.
1395i–4(g)) is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HA3EB49E81E164EBA948FE2B82B1F5719" style="OLC">
<paragraph id="H4DF4D6EA6EA4406D8FA8DE55E6D26FE"><enum>(6)</enum><header>Providing mental
health services and other health services to veterans and other residents of
rural areas</header>
<subparagraph id="HF96EAC52D64B485B9C9CE981CCD100E9"><enum>(A)</enum><header>Grants to
states</header><text>The Secretary may award grants to States that have
submitted applications in accordance with subparagraph (B) for increasing the
delivery of mental health services or other health care services deemed
necessary to meet the needs of veterans of Operation Iraqi Freedom and
Operation Enduring Freedom living in rural areas (as defined for purposes of
section 1886(d) and including areas that are rural census tracks, as defined by
the Administrator of the Health Resources and Services Administration),
including for the provision of crisis intervention services and the detection
of post-traumatic stress disorder, traumatic brain injury, and other signature
injuries of veterans of Operation Iraqi Freedom and Operation Enduring Freedom,
and for referral of such veterans to medical facilities operated by the
Department of Veterans Affairs, and for the delivery of such services to other
residents of such rural areas.</text>
</subparagraph><subparagraph id="H2951913BBF2F4B00BBF87B985200E512"><enum>(B)</enum><header>Application</header>
<clause id="H7D2F28F014074743A3BB9B4CE70256F8"><enum>(i)</enum><header>In
general</header><text>An application is in accordance with this subparagraph if
the State submits to the Secretary at such time and in such form as the
Secretary may require an application containing the assurances described in
subparagraphs (A)(ii) and (A)(iii) of subsection (b)(1).</text>
</clause><clause id="HBD447E9B76A141578DEE9F1D490017ED"><enum>(ii)</enum><header>Consideration
of regional approaches, networks, or technology</header><text>The Secretary
may, as appropriate in awarding grants to States under subparagraph (A),
consider whether the application submitted by a State under this subparagraph
includes 1 or more proposals that utilize regional approaches, networks, health
information technology, telehealth, or telemedicine to deliver services
described in subparagraph (A) to individuals described in that subparagraph.
For purposes of this clause, a network may, as the Secretary determines
appropriate, include federally qualified health centers, rural health clinics,
home health agencies, community mental health clinics and other providers of
mental health services, pharmacists, local government, and other providers
deemed necessary to meet the needs of veterans.</text>
</clause><clause id="HF73A2DC6B15E4C74AFF9E59C61E0EC4D"><enum>(iii)</enum><header>Coordination
at local level</header><text>The Secretary shall require, as appropriate, a
State to demonstrate consultation with the hospital association of such State,
rural hospitals located in such State, providers of mental health services, or
other appropriate stakeholders for the provision of services under a grant
awarded under this paragraph.</text>
</clause><clause commented="no" id="H365FF59353B74816842BFA92004DB1F3"><enum>(iv)</enum><header>Special
consideration of certain applications</header><text>In awarding grants to
States under subparagraph (A), the Secretary shall give special consideration
to applications submitted by States in which veterans make up a high percentage
(as determined by the Secretary) of the total population of the State. Such
consideration shall be given without regard to the number of veterans of
Operation Iraqi Freedom and Operation Enduring Freedom living in the areas in
which mental health services and other health care services would be delivered
under the application.</text>
</clause></subparagraph><subparagraph id="H0B8978BE989D4FA5A64150A99ED2451"><enum>(C)</enum><header>Coordination with
VA</header><text>The Secretary shall, as appropriate, consult with the Director
of the Office of Rural Health of the Department of Veterans Affairs in awarding
and administering grants to States under subparagraph (A).</text>
</subparagraph><subparagraph id="H9FA5D43F20E9435CB6028E76A86C89DA"><enum>(D)</enum><header>Use of
funds</header><text>A State awarded a grant under this paragraph may, as
appropriate, use the funds to reimburse providers of services described in
subparagraph (A) to individuals described in that subparagraph.</text>
</subparagraph><subparagraph id="H8A282F9341C342BBB1D52D10F1630925"><enum>(E)</enum><header>Limitation on
use of grant funds for administrative expenses</header><text>A State awarded a
grant under this paragraph may not expend more than 15 percent of the amount of
the grant for administrative expenses.</text>
</subparagraph><subparagraph id="HA84A81D5EC39424BA950D8DC854BF2E"><enum>(F)</enum><header>Independent
evaluation and final report</header><text>The Secretary shall provide for an
independent evaluation of the grants awarded under subparagraph (A). Not later
than 1 year after the date on which the last grant is awarded to a State under
such subparagraph, the Secretary shall submit a report to Congress on such
evaluation. Such report shall include an assessment of the impact of such
grants on increasing the delivery of mental health services and other health
services to veterans of the United States Armed Forces living in rural areas
(as so defined and including such areas that are rural census tracks), with
particular emphasis on the impact of such grants on the delivery of such
services to veterans of Operation Enduring Freedom and Operation Iraqi Freedom,
and to other individuals living in such rural
areas.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H969FA5DEC3C74C0BB4B9D168767100D1"><enum>(b)</enum><header>Use of funds for
federal administrative expenses</header><text>Section 1820(g)(5) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i-4">42 U.S.C. 1395i–4(g)(5)</external-xref>) is amended—</text>
<paragraph id="H78C47027620E4A66ABA7008839622F6C"><enum>(1)</enum><text>by striking
<quote>beginning with fiscal year 2005</quote> and inserting <quote>for each of
fiscal years 2005 through 2008</quote>; and</text>
</paragraph><paragraph id="H660EC3F4AF6B452E940069FE815312D6"><enum>(2)</enum><text>by inserting
<quote>and, of the total amount appropriated for grants under paragraphs (1),
(2), and (6) for a fiscal year (beginning with fiscal year 2009)</quote> after
<quote>2005)</quote>.</text>
</paragraph></subsection><subsection id="H2F05E67B5D6E4B5383FBC5E37D8D8CC0"><enum>(c)</enum><header>Extension of
authorization for FLEX grants</header><text>Section 1820(j) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i-4">42 U.S.C. 1395i–4(j)</external-xref>) is amended—</text>
<paragraph id="H582A3D2EE49C47229837FC84002E5711"><enum>(1)</enum><text>by striking
<quote>and for</quote> and inserting <quote>for</quote>; and</text>
</paragraph><paragraph id="H502C075B2211407E93CF2503BEC0CA86"><enum>(2)</enum><text>by inserting
<quote>, for making grants to all States under paragraphs (1) and (2) of
subsection (g), $55,000,000 in each of fiscal years 2009 and 2010, and for
making grants to all States under paragraph (6) of subsection (g), $50,000,000
in each of fiscal years 2009 and 2010, to remain available until
expended</quote> before the period at the end.</text>
</paragraph></subsection><subsection id="HDA5C15310FDC4E2B88D1FBAFAF57A5E8"><enum>(d)</enum><header>Medicare rural
hospital flexibility program</header><text>Section 1820(g)(1) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i-4">42 U.S.C. 1395i–4(g)(1)</external-xref>) is amended—</text>
<paragraph id="HC4CF7309811F47C99FBCEC3FB5D6E3D9"><enum>(1)</enum><text>in subparagraph
(B), by striking <quote>and</quote> at the end;</text>
</paragraph><paragraph id="H16B27D21A3F84B9696F022E555D004C"><enum>(2)</enum><text>in
subparagraph (C), by striking the period at the end and inserting <quote>;
and</quote>; and</text>
</paragraph><paragraph id="H01E1153ADD4345D888158C96EFCDDB04"><enum>(3)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H368163EC22014E36B1ACA2EFBF33EC1F" style="OLC">
<subparagraph id="H2BBAD75239F4414EB05BCBC3700881FB"><enum>(D)</enum><text>providing support
for critical access hospitals for quality improvement, quality reporting,
performance improvements, and
benchmarking.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HA317890E7F2D4B708771B6F3A827A9B8"><enum>(e)</enum><header>Assistance to
small critical access hospitals transitioning to skilled nursing facilities and
assisted living facilities</header><text display-inline="yes-display-inline">Section 1820(g) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395i-4">42 U.S.C. 1395i–4(g)</external-xref>), as amended by subsection (a), is amended by adding at
the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H23EE585B6B25459BB200F4D4CB493E1F" style="OLC">
<paragraph id="H8C017DD6E6A3483B96AD25F78F7C1F53"><enum>(7)</enum><header>Critical access
hospitals transitioning to skilled nursing facilities and assisted living
facilities</header>
<subparagraph id="H99C3598570EF481DA5336FF13B417F3E"><enum>(A)</enum><header>Grants</header><text>The
Secretary may award grants to eligible critical access hospitals that have
submitted applications in accordance with subparagraph (B) for assisting such
hospitals in the transition to skilled nursing facilities and assisted living
facilities.</text>
</subparagraph><subparagraph id="H7252F58F2D0049EE8479F003CB5C35D4"><enum>(B)</enum><header>Application</header><text>An
applicable critical access hospital seeking a grant under this paragraph shall
submit an application to the Secretary on or before such date and in such form
and manner as the Secretary specifies.</text>
</subparagraph><subparagraph id="H3903D001F7FF4870839BCA00B001D713"><enum>(C)</enum><header>Additional
requirements</header><text>The Secretary may not award a grant under this
paragraph to an eligible critical access hospital unless—</text>
<clause id="H21F7C245A7D04BC8B400FD00B800B200"><enum>(i)</enum><text>local
organizations or the State in which the hospital is located provides matching
funds; and</text>
</clause><clause id="H279041FA05AF431586535B383734372E"><enum>(ii)</enum><text>the hospital
provides assurances that it will surrender critical access hospital status
under this title within 180 days of receiving the grant.</text>
</clause></subparagraph><subparagraph id="HF17A1A6EF1844236B13B82D328F0C0A1"><enum>(D)</enum><header>Amount of
grant</header><text>A grant to an eligible critical access hospital under this
paragraph may not exceed $1,000,000.</text>
</subparagraph><subparagraph id="H37E9585876814B02AEB15D6744FA206E"><enum>(E)</enum><header>Funding</header><text>There
are appropriated from the Federal Hospital Insurance Trust Fund under section
1817 for making grants under this paragraph, $5,000,000 for fiscal year
2008.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H3D27BDC8B59A4E6B94D185F144161C73"><enum>(F)</enum><header>Eligible
critical access hospital defined</header><text>For purposes of this paragraph,
the term <quote>eligible critical access hospital</quote> means a critical
access hospital that has an average daily acute census of less than 0.5 and an
average daily swing bed census of greater than
10.0.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="H9163DADE0F8540D39320006D6381BA00"><enum>122.</enum><header>Rebasing for
sole community hospitals</header>
<subsection id="H2F3BFA1634224B9C830069557700D368"><enum>(a)</enum><header>Rebasing
permitted</header><text display-inline="yes-display-inline">Section 1886(b)(3)
of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(b)(3)</external-xref>) is amended by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H68CC8DFCE8EA4D939B32B5D21B01516" other-style="archaic" style="other">
<subparagraph id="HC2C60426EED34A49A6D887C4E5A69176" indent="up2"><enum>(L)</enum><clause commented="no" display-inline="yes-display-inline" id="H34E61C04D6C94CF9848332B453B9B96"><enum>(i)</enum><text display-inline="yes-display-inline">For cost reporting periods beginning on or
after January 1, 2009, in the case of a sole community hospital there shall be
substituted for the amount otherwise determined under subsection (d)(5)(D)(i)
of this section, if such substitution results in a greater amount of payment
under this section for the hospital, the subparagraph (L) rebased target
amount.</text>
</clause><clause id="H7E80C374B4FF4B3DB32710566F00E1E0" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">For purposes of this subparagraph, the term
<quote>subparagraph (L) rebased target amount</quote> has the meaning given the
term <term>target amount</term> in subparagraph (C), except that—</text>
<subclause id="H6EA061635FFE4266982B66F964A6B9DB"><enum>(I)</enum><text display-inline="yes-display-inline">there shall be substituted for the base
cost reporting period the 12-month cost reporting period beginning during
fiscal year 2006;</text>
</subclause><subclause id="H9072B52805D443CF96598080BA4C179D"><enum>(II)</enum><text display-inline="yes-display-inline">any reference in subparagraph (C)(i) to the
<quote>first cost reporting period</quote> described in such subparagraph is
deemed a reference to the first cost reporting period beginning on or after
January 1, 2009; and</text>
</subclause><subclause id="H005F0255976647238F1211D9269ED5F8"><enum>(III)</enum><text display-inline="yes-display-inline">the applicable percentage increase shall
only be applied under subparagraph (C)(iv) for discharges occurring on or after
January 1,
2009.</text>
</subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HE2FDABBFF84A4C278C266CA5A94CB721"><enum>(b)</enum><header>Conforming
amendments</header><text>Section 1886(b)(3) of the Social Security Act (42
U.S.C. 1395ww(b)(3)) is amended—</text>
<paragraph id="HE1FFC2AA1BB04E3B8EF595DDF4729DE"><enum>(1)</enum><text>in
subparagraph (C), in the matter preceding clause (i), by striking
<quote>subparagraph (I)</quote> and inserting <quote>subparagraphs (I) and
(L)</quote>; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H1E294E91FC4543C69E2D3514CDDA945C"><enum>(2)</enum><text>in subparagraph
(I)(i), in the matter preceding subclause (I), by striking <quote>For</quote>
and inserting <quote>Subject to subparagraph (L), for</quote>.</text>
</paragraph></subsection></section><section id="H6C7FA38FB47A4279BFBD00DBA010CBD3"><enum>123.</enum><header>Demonstration
project on community health integration models in certain rural
counties</header>
<subsection id="HB4C735AB7CF245A99C11C2648ECF6285"><enum>(a)</enum><header>In
general</header><text>The Secretary shall establish a demonstration project to
allow eligible entities to develop and test new models for the delivery of
health care services in eligible counties for the purpose of improving access
to, and better integrating the delivery of, acute care, extended care, and
other essential health care services to Medicare beneficiaries.</text>
</subsection><subsection id="H37317B4FBDCB4174A48F86B1ED40692B"><enum>(b)</enum><header>Purpose</header><text>The
purpose of the demonstration project under this section is to—</text>
<paragraph id="H8AAE237B74F24C3B86618FA700FEC01B"><enum>(1)</enum><text>explore ways to
increase access to, and improve the adequacy of, payments for acute care,
extended care, and other essential health care services provided under the
Medicare and Medicaid programs in eligible counties; and</text>
</paragraph><paragraph id="HD019C56D74D645ABBFCAC411FB2D429E"><enum>(2)</enum><text>evaluate
regulatory challenges facing such providers and the communities they
serve.</text>
</paragraph></subsection><subsection id="H9F5D7552998B42F9B22038A79D5454CA"><enum>(c)</enum><header>Requirements</header><text>The
following requirements shall apply under the demonstration project:</text>
<paragraph id="HF0136FC09015402A8EB446F87325012"><enum>(1)</enum><text>Health care
providers in eligible counties selected to participate in the demonstration
project under subsection (d)(3) shall (when determined appropriate by the
Secretary), instead of the payment rates otherwise applicable under the
Medicare program, be reimbursed at a rate that covers at least the reasonable
costs of the provider in furnishing acute care, extended care, and other
essential health care services to Medicare beneficiaries.</text>
</paragraph><paragraph id="H078669CA4DB646E88053CFD8189563BD"><enum>(2)</enum><text>Methods to
coordinate the survey and certification process under the Medicare program and
the Medicaid program across all health service categories included in the
demonstration project shall be tested with the goal of assuring quality and
safety while reducing administrative burdens, as appropriate, related to
completing such survey and certification process.</text>
</paragraph><paragraph id="H07042671BDB243F88817954FC1300F6"><enum>(3)</enum><text>Health care
providers in eligible counties selected to participate in the demonstration
project under subsection (d)(3) and the Secretary shall work with the State to
explore ways to revise reimbursement policies under the Medicaid program to
improve access to the range of health care services available in such eligible
counties.</text>
</paragraph><paragraph id="H786472E9C3A749E980445FCA00A4352B"><enum>(4)</enum><text>The Secretary
shall identify regulatory requirements that may be revised appropriately to
improve access to care in eligible counties.</text>
</paragraph><paragraph id="H11887C0AD4A34B5B859C30284F2C51E5"><enum>(5)</enum><text>Other essential
health care services necessary to ensure access to the range of health care
services in eligible counties selected to participate in the demonstration
project under subsection (d)(3) shall be identified. Ways to ensure adequate
funding for such services shall also be explored.</text>
</paragraph></subsection><subsection id="HAF6FF6C9AA99450D89827B2C8F75ABC0"><enum>(d)</enum><header>Application
process</header>
<paragraph id="HEBFB5EC0A5EB48BF00DA118079E91491"><enum>(1)</enum><header>Eligibility</header>
<subparagraph id="H17D95E1DBD344251B1E5CC3E5DD062E6"><enum>(A)</enum><header>In
general</header><text>Eligibility to participate in the demonstration project
under this section shall be limited to eligible entities.</text>
</subparagraph><subparagraph id="HB0A0E5E703574F8491EAECF22025339"><enum>(B)</enum><header>Eligible entity
defined</header><text>In this section, the term <quote>eligible entity</quote>
means an entity that—</text>
<clause id="H45C5AD9C1F794ECCBD009EF1B41ED08"><enum>(i)</enum><text>is a
Rural Hospital Flexibility Program grantee under section 1820(g) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i-4">42 U.S.C. 1395i–4(g)</external-xref>); and</text>
</clause><clause id="HD2E6D2C4CE11430FA6428D7F1F5F1DBC"><enum>(ii)</enum><text>is
located in a State in which at least 65 percent of the counties in the State
are counties that have 6 or less residents per square mile.</text>
</clause></subparagraph></paragraph><paragraph id="HFCB81752E8CD4CDBAC20B1187FF41777"><enum>(2)</enum><header>Application</header>
<subparagraph id="HB0755004D40D4066B4D8D823B67CD564"><enum>(A)</enum><header>In
general</header><text>An eligible entity seeking to participate in the
demonstration project under this section shall submit an application to the
Secretary at such time, in such manner, and containing such information as the
Secretary may require.</text>
</subparagraph><subparagraph id="H3A57C7A331AE48A4BA678EBDAB44415B"><enum>(B)</enum><header>Limitation</header><text>The
Secretary shall select eligible entities located in not more than 4 States to
participate in the demonstration project under this section.</text>
</subparagraph></paragraph><paragraph id="H915FF7BF225846EDB7A500F5124C937E"><enum>(3)</enum><header>Selection of
eligible counties</header><text>An eligible entity selected by the Secretary to
participate in the demonstration project under this section shall select not
more than 6 eligible counties in the State in which the entity is located in
which to conduct the demonstration project.</text>
</paragraph><paragraph id="H2F2794DC994644F6B41BFD71A1EA1B88"><enum>(4)</enum><header>Eligible county
defined</header><text>In this section, the term <term>eligible county</term>
means a county that meets the following requirements:</text>
<subparagraph id="H2DADEDE5F8344EBCB3B17C5133EDB12F"><enum>(A)</enum><text>The county has 6
or less residents per square mile.</text>
</subparagraph><subparagraph id="HC97CDF7EF363463FA9E8D4E3C9EA1E12"><enum>(B)</enum><text>As of the date of
the enactment of this Act, a facility designated as a critical access hospital
which meets the following requirements was located in the county:</text>
<clause id="H667E42D77E4E4AA188AE716D01697D11"><enum>(i)</enum><text>As
of the date of the enactment of this Act, the critical access hospital
furnished 1 or more of the following:</text>
<subclause id="HBC3094B658564C159925FAA1F09C47B"><enum>(I)</enum><text>Home health
services.</text>
</subclause><subclause id="H350B1571492C4A5298EF67EE2DADC028"><enum>(II)</enum><text>Hospice
care.</text>
</subclause><subclause id="H82DFB0375EF3463EB015C075E9268060"><enum>(III)</enum><text>Rural health
clinic services.</text>
</subclause></clause><clause id="H198C7B36511E4FC59FB6FD13AC4D19BF"><enum>(ii)</enum><text>As
of the date of the enactment of this Act, the critical access hospital has an
average daily inpatient census of 5 or less.</text>
</clause></subparagraph><subparagraph id="H79D84159326344A788E29EB9AD3C9693"><enum>(C)</enum><text>As of the date of
the enactment of this Act, skilled nursing facility services were available in
the county in—</text>
<clause id="H48F3456747354D508BE022767B22D5D0"><enum>(i)</enum><text>a
critical access hospital using swing beds; or</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HC977331F32604F0BB3097C01A20010F2"><enum>(ii)</enum><text>a local nursing
home.</text>
</clause></subparagraph></paragraph></subsection><subsection id="H4F0578ED060F4BF1A1C752BE66237853"><enum>(e)</enum><header>Administration</header>
<paragraph id="HAAB81377080A49CCBD7E918100983DC6"><enum>(1)</enum><header>In
general</header><text>The demonstration project under this section shall be
administered jointly by the Administrator of the Office of Rural Health Policy
of the Health Resources and Services Administration and the Administrator of
the Centers for Medicare & Medicaid Services, in accordance with paragraphs
(2) and (3).</text>
</paragraph><paragraph id="H1FE0F7D949DB4F8FAEFDFA052E9B241"><enum>(2)</enum><header>HRSA
duties</header><text>In administering the demonstration project under this
section, the Administrator of the Office of Rural Health Policy of the Health
Resources and Services Administration shall—</text>
<subparagraph id="H1795DFD8F7A1401D933D8CB4E0D9D74"><enum>(A)</enum><text>award grants to the
eligible entities selected to participate in the demonstration project;
and</text>
</subparagraph><subparagraph id="H46804294581344E0B17C83F71C15F563"><enum>(B)</enum><text>work with such
entities to provide technical assistance related to the requirements under the
project.</text>
</subparagraph></paragraph><paragraph id="H452AE361F7954F998F2114F379D8C2BC"><enum>(3)</enum><header>CMS
duties</header><text>In administering the demonstration project under this
section, the Administrator of the Centers for Medicare & Medicaid Services
shall determine which provisions of titles XVIII and XIX of the Social Security
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>; 1396 et seq.) the Secretary should waive under the
waiver authority under subsection (i) that are relevant to the development of
alternative reimbursement methodologies, which may include, as appropriate,
covering at least the reasonable costs of the provider in furnishing acute
care, extended care, and other essential health care services to Medicare
beneficiaries and coordinating the survey and certification process under the
Medicare and Medicaid programs, as appropriate, across all service categories
included in the demonstration project.</text>
</paragraph></subsection><subsection id="H8C42FBB5917D4A9D85853D82A42F6C66"><enum>(f)</enum><header>Duration</header>
<paragraph id="H304824C665CE4D1FA976CE2E5BE0B7AE"><enum>(1)</enum><header>In
general</header><text>The demonstration project under this section shall be
conducted for a 3-year period beginning on October 1, 2009.</text>
</paragraph><paragraph commented="no" id="HAD4D2278BEB942C48B00169B00562BA9"><enum>(2)</enum><header>Beginning date
of demonstration project</header><text>The demonstration project under this
section shall be considered to have begun in a State on the date on which the
eligible counties selected to participate in the demonstration project under
subsection (d)(3) begin operations in accordance with the requirements under
the demonstration project.</text>
</paragraph></subsection><subsection id="HE077B9DE82AD4DCAA03F40CBC2D63E0"><enum>(g)</enum><header>Funding</header>
<paragraph id="H9429753F22074D3BAE43628332A30658"><enum>(1)</enum><header>CMS</header>
<subparagraph id="H9950C61A1BCA478B9221B5E400F3B72C"><enum>(A)</enum><header>In
general</header><text>The Secretary shall provide for the transfer, in
appropriate part from the Federal Hospital Insurance Trust Fund established
under section 1817 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i">42 U.S.C. 1395i</external-xref>) and the Federal
Supplementary Medical Insurance Trust Fund established under section 1841 of
such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395t">42 U.S.C. 1395t</external-xref>), of such sums as are necessary for the costs to the
Centers for Medicare & Medicaid Services of carrying out its duties under
the demonstration project under this section.</text>
</subparagraph><subparagraph id="H7E4492ED92884BE085280659AAD461B2"><enum>(B)</enum><header>Budget
neutrality</header><text>In conducting the demonstration project under this
section, the Secretary shall ensure that the aggregate payments made by the
Secretary do not exceed the amount which the Secretary estimates would have
been paid if the demonstration project under this section was not
implemented.</text>
</subparagraph></paragraph><paragraph id="H7B0C3377E47D44DD998BD7EEDBCA9EF"><enum>(2)</enum><header>HRSA</header><text>There
are authorized to be appropriated to the Office of Rural Health Policy of the
Health Resources and Services Administration $800,000 for each of fiscal years
2010, 2011, and 2012 for the purpose of carrying out the duties of such Office
under the demonstration project under this section, to remain available for the
duration of the demonstration project.</text>
</paragraph></subsection><subsection id="H57815D37470C4CC5007992DFC0B1CF91"><enum>(h)</enum><header>Report</header>
<paragraph id="H6747E0AE2F35483EA1DCA0D876E11117"><enum>(1)</enum><header>Interim
report</header><text>Not later than the date that is 2 years after the date on
which the demonstration project under this section is implemented, the
Administrator of the Office of Rural Health Policy of the Health Resources and
Services Administration, in coordination with the Administrator of the Centers
for Medicare & Medicaid Services, shall submit a report to Congress on the
status of the demonstration project that includes initial recommendations on
ways to improve access to, and the availability of, health care services in
eligible counties based on the findings of the demonstration project.</text>
</paragraph><paragraph id="H0EFC2954578D45FDB1DFE67458FA39A"><enum>(2)</enum><header>Final
report</header><text>Not later than 1 year after the completion of the
demonstration project, the Administrator of the Office of Rural Health Policy
of the Health Resources and Services Administration, in coordination with the
Administrator of the Centers for Medicare & Medicaid Services, shall submit
a report to Congress on such project, together with recommendations for such
legislation and administrative action as the Secretary determines
appropriate.</text>
</paragraph></subsection><subsection id="H71FBE45545A0403385A941513292F0B0"><enum>(i)</enum><header>Waiver
authority</header><text>The Secretary may waive such requirements of titles
XVIII and XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>; 1396 et seq.)
as may be necessary and appropriate for the purpose of carrying out the
demonstration project under this section.</text>
</subsection><subsection id="H746C1666C1DA4348803400B125EB8FA4"><enum>(j)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="H916F56C78C194F68BCA004B86EA55136"><enum>(1)</enum><header>Extended care
services</header><text>The term <term>extended care services</term> means the
following:</text>
<subparagraph id="H05102ED696BE4FC88F113FD431506DAA"><enum>(A)</enum><text>Home health
services.</text>
</subparagraph><subparagraph id="H0EFCD945F3B84D058388889400BEB155"><enum>(B)</enum><text>Covered skilled
nursing facility services.</text>
</subparagraph><subparagraph id="H8A4E2ED9E95142F580097FB161D75636"><enum>(C)</enum><text>Hospice
care.</text>
</subparagraph></paragraph><paragraph commented="no" id="HF66D320CFBF24422B32389076152707F"><enum>(2)</enum><header>Covered skilled
nursing facility services</header><text>The term <term>covered skilled nursing
facility services</term> has the meaning given such term in section
1888(e)(2)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395yy">42 U.S.C. 1395yy(e)(2)(A)</external-xref>).</text>
</paragraph><paragraph id="H3166F8ACF83945A1A6AD00DA7EB1277F"><enum>(3)</enum><header>Critical access
hospital</header><text>The term <quote>critical access hospital</quote> means a
facility designated as a critical access hospital under section 1820(c) of such
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i-4">42 U.S.C. 1395i–4(c)</external-xref>).</text>
</paragraph><paragraph id="H97B4ED8C2E984BFFA0A337A6DBD3007F"><enum>(4)</enum><header>Home health
services</header><text>The term <term>home health services</term> has the
meaning given such term in section 1861(m) of such Act (42 U.S.C.
1395x(m)).</text>
</paragraph><paragraph id="HB4CCA0CCCB034569AF5E17D96CB47770"><enum>(5)</enum><header>Hospice
care</header><text>The term <term>hospice care</term> has the meaning given
such term in section 1861(dd) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(dd)</external-xref>).</text>
</paragraph><paragraph id="H483D9EAA8DB743109F794E22AA255600"><enum>(6)</enum><header>Medicaid
program</header><text>The term <term>Medicaid program</term> means the program
under title XIX of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>).</text>
</paragraph><paragraph id="HB677DA57C7084D6A827F99CC7CAD793E"><enum>(7)</enum><header>Medicare
program</header><text>The term <term>Medicare program</term> means the program
under title XVIII of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>).</text>
</paragraph><paragraph id="H02022DDA1AFC437BB2943639DBBF7775"><enum>(8)</enum><header>Other essential
health care services</header><text>The term <term>other essential health care
services</term> means the following:</text>
<subparagraph id="HF41F3823314742B58BE429D1CAF2C978"><enum>(A)</enum><text>Ambulance services
(as described in section 1861(s)(7) of the Social Security Act (42 U.S.C.
1395x(s)(7))).</text>
</subparagraph><subparagraph id="H971A8EB5F41445CC924903A40942E31"><enum>(B)</enum><text>Rural health clinic
services.</text>
</subparagraph><subparagraph id="H3237F3A7011F44A0BEA825ABB613113"><enum>(C)</enum><text>Public health
services (as defined by the Secretary).</text>
</subparagraph><subparagraph id="H34E80D8B2AC44733AD92A5C3203051C0"><enum>(D)</enum><text>Other health care
services determined appropriate by the Secretary.</text>
</subparagraph></paragraph><paragraph commented="no" id="HE5B1923B2125428D812CDB5DBC68363"><enum>(9)</enum><header>Rural health
clinic services</header><text>The term <term>rural health clinic
services</term> has the meaning given such term in section 1861(aa)(1) of such
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(aa)(1)</external-xref>).</text>
</paragraph><paragraph id="H261BA22382BD45A7003B88491EA89D07"><enum>(10)</enum><header>Secretary</header><text>The
term <quote>Secretary</quote> means the Secretary of Health and Human
Services.</text>
</paragraph></subsection></section><section id="H1F49B5713F304D82AC8CAC55DD8800D0"><enum>124.</enum><header>Extension of
the reclassification of certain hospitals</header>
<subsection id="HD57D25E88A974996ACE3265B28EE43"><enum>(a)</enum><header>In
general</header><text>Subsection (a) of section 106 of division B of the Tax
Relief and Health Care Act of 2006 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> note), as amended by section
117 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law
110–173), is amended by striking <quote>September 30, 2008</quote> and
inserting <quote>September 30, 2009</quote>.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H4DACD8573C5E48B3B684AD2610731B17"><enum>(b)</enum><header>Special
exception reclassifications</header><text>Section 117(a)(2) of the Medicare,
Medicaid, and SCHIP Extension Act of 2007 (<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>) is amended by
striking <quote>September 30, 2008</quote> and inserting <quote>September 30,
2009</quote>.</text>
</subsection></section><section id="H5EE7D68CB1694F23B228C5DE8EA54164"><enum>125.</enum><header>Revocation of
unique deeming authority of the Joint Commission</header>
<subsection id="H1B608025470647508EE6BC56FEE4B7B9"><enum>(a)</enum><header>Revocation</header><text>Section
1865 of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42
U.S.C. 1395bb) is amended—</text>
<paragraph id="H59294C01C44F429E902C6269E6B6E649"><enum>(1)</enum><text>by striking
subsection (a); and</text>
</paragraph><paragraph id="H30570931ACB44C0C950092C27FA079B5"><enum>(2)</enum><text>by redesignating
subsections (b), (c), (d), and (e) as subsections (a), (b), (c), and (d),
respectively.</text>
</paragraph></subsection><subsection id="HEDCB375B87C24136990051F5A1EEE3C"><enum>(b)</enum><header>Conforming
Amendments</header><paragraph commented="no" display-inline="yes-display-inline" id="H7504730C4E16490BAD810400219E3CF7"><enum>(1)</enum><text>Section 1865 of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395bb">42 U.S.C. 1395bb</external-xref>)
is amended—</text>
<subparagraph id="H9EF64C040DDD4F64B3CEAE1C15157D96" indent="up1"><enum>(A)</enum><text>in subsection (a)(1), as redesignated
by subsection (a)(2), by striking <quote>In addition, if</quote> and inserting
<quote>If</quote>;</text>
</subparagraph><subparagraph id="H895D191E7A724C0FA391E1854C134689" indent="up1"><enum>(B)</enum><text>in subsection (b), as so
redesignated—</text>
<clause id="HBFC298D6AB8B4E05A4CC00ED43584FD"><enum>(i)</enum><text>by striking <quote>released to him
by the Joint Commission on Accreditation of Hospitals,</quote> and inserting
<quote>released to the Secretary by</quote>; and</text>
</clause><clause id="H9A6448F71B8C47BC8EAB00B29B8D3028"><enum>(ii)</enum><text>by striking the comma after
<quote>Association</quote>;</text>
</clause></subparagraph><subparagraph id="HF259713895B94DDDB130826CE9A7A05" indent="up1"><enum>(C)</enum><text>in subsection (c), as so redesignated,
by striking <quote>pursuant to subsection (a) or (b)(1)</quote> and inserting
<quote>pursuant to subsection (a)(1)</quote>; and</text>
</subparagraph><subparagraph id="H4069E53E5F1F4ACD8506416D9DDD6073" indent="up1"><enum>(D)</enum><text>in subsection (d), as so redesignated,
by striking <quote>pursuant to subsection (a) or (b)(1)</quote> and inserting
<quote>pursuant to subsection (a)(1)</quote>.</text>
</subparagraph></paragraph><paragraph id="HC0338452778B425200E8138FEF39A82" indent="up1"><enum>(2)</enum><text>Section 1861(e) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(e)</external-xref>) is amended in the fourth sentence by striking
<quote>and (ii) is accredited by the Joint Commission on Accreditation of
Hospitals, or is accredited by or approved by a program of the country in which
such institution is located if the Secretary finds the accreditation or
comparable approval standards of such program to be essentially equivalent to
those of the Joint Commission on Accreditation of Hospitals</quote> and
inserting <quote>and (ii) is accredited by a national accreditation body
recognized by the Secretary under section 1865(a), or is accredited by or
approved by a program of the country in which such institution is located if
the Secretary finds the accreditation or comparable approval standards of such
program to be essentially equivalent to those of such a national accreditation
body.</quote>.</text>
</paragraph><paragraph id="H0F6CA103A13F42F9BE25B7090C83B67" indent="up1"><enum>(3)</enum><text>Section 1864(c) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395aa">42 U.S.C. 1395aa(c)</external-xref>) is amended by striking <quote>pursuant to
subsection (a) or (b)(1) of section 1865</quote> and inserting <quote>pursuant
to section 1865(a)(1)</quote>.</text>
</paragraph><paragraph id="H4E9667EB3D974B0C817E08242E4165B5" indent="up1"><enum>(4)</enum><text>Section 1875(b) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ll">42 U.S.C. 1395ll(b)</external-xref>) is amended by striking <quote>the Joint
Commission on Accreditation of Hospitals,</quote> and inserting <quote>national
accreditation bodies under section 1865(a)</quote>.</text>
</paragraph><paragraph id="HE981B5E05A4A4C90ACCC3C001868EC64" indent="up1"><enum>(5)</enum><text>Section 1834(a)(20)(B) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(a)(20)(B)</external-xref>) is amended by striking <quote>section
1865(b)</quote> and inserting <quote>section 1865(a)</quote>.</text>
</paragraph><paragraph id="H90125D176BBF4C148DB6246437BE9F88" indent="up1"><enum>(6)</enum><text>Section 1852(e)(4)(C) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-22">42 U.S.C. 1395w–22(e)(4)(C)</external-xref>) is amended by striking
<quote>section 1865(b)(2)</quote> and inserting <quote>section
1865(a)(2)</quote>.</text>
</paragraph></subsection><subsection id="H27B1591365FB4E3B9B6C696676B33F14"><enum>(c)</enum><header>Authority To
Recognize the Joint Commission as a National Accreditation
Body</header><text>The Secretary of Health and Human Services may recognize the
Joint Commission as a national accreditation body under section 1865 of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395bb), as amended by this section, upon such terms and conditions, and upon
submission of such information, as the Secretary may require.</text>
</subsection><subsection id="H4A8BC19A747D4C9987A535F8EF86064"><enum>(d)</enum><header>Effective Date;
Transition Rule</header><paragraph commented="no" display-inline="yes-display-inline" id="H800E063F72024725830084292B60549D"><enum>(1)</enum><text>Subject to paragraph
(2), the amendments made by this section shall apply with respect to
accreditations of hospitals granted on or after the date that is 24 months
after the date of the enactment of this Act.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H38206E5DFBB74FF29B6D31411C7F1192" indent="up1"><enum>(2)</enum><text>For purposes of title XVIII of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1395 et
seq.), the amendments made by this section shall not effect the accreditation
of a hospital by the Joint Commission, or under accreditation or comparable
approval standards found to be essentially equivalent to accreditation or
approval standards of the Joint Commission, for the period of time applicable
under such accreditation.</text>
</paragraph></subsection></section></subtitle><subtitle id="HB29396595A2545328D4E6E2D8B87BBF6"><enum>C</enum><header>Provisions
relating to part B</header>
<part id="H7BB3AEB674F74D6C87F4DA8375A1AA07"><enum>I</enum><header>Physicians'
services</header>
<section id="H370B24F86EB1496ABA45F013CE9FAE46"><enum>131.</enum><header>Physician
payment, efficiency, and quality improvements</header>
<subsection display-inline="no-display-inline" id="H1A1FD7DC1EE8432F923315812B029D66"><enum>(a)</enum><header>In
general</header>
<paragraph display-inline="no-display-inline" id="H82117CE114784FCD99EFBCA9CCF5C137"><enum>(1)</enum><header>Increase in
update for the second half of 2008 and for 2009</header>
<subparagraph display-inline="no-display-inline" id="H7DD0642CF77B4473B39811F54B258F19"><enum>(A)</enum><header>For the second
half of 2008</header><text>Section 1848(d)(8) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395w–4(d)(8)), as added by section 101 of the Medicare, Medicaid, and SCHIP
Extension Act of 2007 (<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>), is amended—</text>
<clause display-inline="no-display-inline" id="H8FFF519417454CF5BE96F1D08280C69C"><enum>(i)</enum><text>in the heading, by
striking <quote><header-in-text level="paragraph" style="OLC">a portion
of</header-in-text></quote>;</text>
</clause><clause display-inline="no-display-inline" id="HED54B0C82D94490A00BAD92DEBBE0031"><enum>(ii)</enum><text>in subparagraph
(A), by striking <quote>for the period beginning on January 1, 2008, and ending
on June 30, 2008,</quote>; and</text>
</clause><clause display-inline="no-display-inline" id="H003FFD798DC444D682C494C43E532635"><enum>(iii)</enum><text>in subparagraph
(B)—</text>
<subclause display-inline="no-display-inline" id="HDB064C5CF5214801B4AFE7B83D25212F"><enum>(I)</enum><text>in the heading, by
striking <quote><header-in-text level="subparagraph" style="OLC">the remaining
portion of 2008 and</header-in-text></quote>; and</text>
</subclause><subclause display-inline="no-display-inline" id="H4259592BE83241F79BFB11C52DFBD479"><enum>(II)</enum><text>by striking
<quote>for the period beginning on July 1, 2008, and ending on December 31,
2008, and</quote>.</text>
</subclause></clause></subparagraph><subparagraph display-inline="no-display-inline" id="H43A5D747C4B148148489B8E9F00020F8"><enum>(B)</enum><header>For
2009</header><text>Section 1848(d) of the <act-name parsable-cite="SSA">Social
Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(d)</external-xref>), as amended by section 101 of
the Medicare, Medicaid, and SCHIP Extension Act of 2007 (<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>),
is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H85873305C9AC48EC8E7CC00180ECB7E" style="OLC">
<paragraph id="HB04F48B8B30B452D8C5EA01DDF20AD9F"><enum>(9)</enum><header>Update for
2009</header>
<subparagraph id="H9C22A6944D054ECCAB5F736FF9A200D3"><enum>(A)</enum><header>In
general</header><text>Subject to paragraphs (7)(B) and (8)(B), in lieu of the
update to the single conversion factor established in paragraph (1)(C) that
would otherwise apply for 2009, the update to the single conversion factor
shall be 1.1 percent.</text>
</subparagraph><subparagraph id="HC86BDA0053074503B4C75BEA393D96CB"><enum>(B)</enum><header>No effect on
computation of conversion factor for 2010 and subsequent
years</header><text>The conversion factor under this subsection shall be
computed under paragraph (1)(A) for 2010 and subsequent years as if
subparagraph (A) had never
applied.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H218E23D4B4D34B11B914AEC2FB6E36E"><enum>(2)</enum><header>Beneficiary
premium protection</header><text display-inline="yes-display-inline">Section
1839(g) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395r">42 U.S.C. 1395r(g)</external-xref>) is amended—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HE5D67A243E034E9F89AEBD439BE91C40"><enum>(A)</enum><text>by redesignating
paragraphs (1) and (2) as subparagraphs (A) and (B), respectively, and moving
such subparagraphs 2 ems to the right;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H4DD5F99DF3094714BCF1B435ACE4C171"><enum>(B)</enum><text>in the matter
preceding paragraph (1), by striking <quote>shall exclude an estimate</quote>
and inserting “shall exclude—</text>
<quoted-block display-inline="no-display-inline" id="H9BE85E516B844BF68373F99B75F6D5E" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="HBCC8CABCA2794E40B31C7421C80056CF"><enum>(1)</enum><text>an
estimate</text>
</paragraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H66FCA4D3E0884B38AF5800D00DED5A1"><enum>(C)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HE1A608DD5A18416BA6D57D7CC9ADDD39" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="HAB8D248EE65C47A2B2C000951581E463"><enum>(2)</enum><text>with respect to
the monthly premium rate under subsection (a)(3) for 2009, $1,200,000,000 of
benefits and administrative
costs.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HD46BB3F4E5CD4F8A959C10C5E0CE2645"><enum>(3)</enum><header>Revision of the
Physician Assistance and Quality Initiative Fund</header><text>Section
1848(l)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(l)(2)</external-xref>), as amended by
section 101(a)(2) of the Medicare, Medicaid, and SCHIP Extension Act of 2007
(<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>), is amended—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H5847661DB5B34CF09B80174569838404"><enum>(A)</enum><text>in subparagraph
(A)—</text>
<clause commented="no" display-inline="no-display-inline" id="H2548404F62AE44CAB5427717AA8C00A6"><enum>(i)</enum><text>by striking clause
(i)(III); and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H91159743AB884EE199DD31FEA16317D"><enum>(ii)</enum><text>by striking clause
(ii)(III); and</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H5ADBB67726574757AA77CA45E1611834"><enum>(B)</enum><text>in subparagraph
(B)—</text>
<clause commented="no" display-inline="no-display-inline" id="HE538F52CE43E48B484B9129D005204B8"><enum>(i)</enum><text>in clause (i), by
adding <quote>and</quote> at the end;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H03866A7E59A24199ACE0518BC925BEB9"><enum>(ii)</enum><text>in clause (ii),
by striking <quote>; and</quote> and inserting a period; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HB158BF7A2B4E45E09FE9B68EAC483550"><enum>(iii)</enum><text>by striking
clause (iii).</text>
</clause></subparagraph></paragraph></subsection><subsection id="HF28FC5B2A1524B0BBF6E26853057239B"><enum>(b)</enum><header>Extension and
improvement of the quality reporting system</header>
<paragraph id="HDF4D1A5CD96C449883D4E6F92D273C2"><enum>(1)</enum><header>System</header><text>Section
1848(k)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(k)(2)</external-xref>), as amended by
section 101(b)(1) of the Medicare, Medicaid, and SCHIP Extension Act of 2007
(<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>), is amended by adding at the end the following new
subparagraphs:</text>
<quoted-block display-inline="no-display-inline" id="HE42799D642234E76A57D21C29CDE0899" style="OLC">
<subparagraph id="HCCC7365B7E3A4F8EBFFEA5812973AA62"><enum>(C)</enum><header>For 2010 and
subsequent years</header>
<clause id="H55BA6B37DED94053989C2B87BE686807"><enum>(i)</enum><header>In
general</header><text>Subject to clause (ii), for purposes of reporting data on
quality measures for covered professional services furnished during 2010 and
each subsequent year, subject to subsection (m)(3)(C), the quality measures
(including electronic prescribing quality measures) specified under this
paragraph shall be such measures selected by the Secretary from measures that
have been endorsed by the entity with a contract with the Secretary under
section 1890(a).</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H1BB5608546A84D29B5CC6414A8FC0002"><enum>(ii)</enum><header>Exception</header><text display-inline="yes-display-inline">In the case of a specified area or medical
topic determined appropriate by the Secretary for which a feasible and
practical measure has not been endorsed by the entity with a contract under
section 1890(a), the Secretary may specify a measure that is not so endorsed as
long as due consideration is given to measures that have been endorsed or
adopted by a consensus organization identified by the Secretary, such as the
AQA alliance.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H8D5CB459DFC3408BAA1639E77355C802"><enum>(D)</enum><header>Opportunity to
provide input on measures for 2009 and subsequent years</header><text display-inline="yes-display-inline">For each quality measure (including an
electronic prescribing quality measure) adopted by the Secretary under
subparagraph (B) (with respect to 2009) or subparagraph (C), the Secretary
shall ensure that eligible professionals have the opportunity to provide input
during the development, endorsement, or selection of measures applicable to
services they
furnish.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H08AD86912B2749CEB89541B0C9C0655"><enum>(2)</enum><header>Redesignation of
reporting system</header><text>Subsection (c) of section 101 of division B of
the Tax Relief and Health Care Act of 2006 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4</external-xref> note), as amended
by section 101(b)(2) of the Medicare, Medicaid, and SCHIP Extension Act of 2007
(<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>), is redesignated as subsection (m) of section 1848 of the
Social Security Act.</text>
</paragraph><paragraph id="HD30B5D6E9C104CCCBAEDA9BB005BF09F"><enum>(3)</enum><header>Incentive
payments under reporting system</header><text>Section 1848(m) of the Social
Security Act, as redesignated by paragraph (2), is amended—</text>
<subparagraph id="HDD0A1CC5AF334BB5827D7BBEE07162B3"><enum>(A)</enum><text>by amending the
heading to read as follows: <quote><header-in-text level="subsection" style="OLC">Incentive payments for quality
reporting</header-in-text></quote>;</text>
</subparagraph><subparagraph id="HBF970F227E5F435AAC29ABA472EF38A1"><enum>(B)</enum><text>by striking
paragraph (1) and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="H7F214198CDAE4281B383EB60A6577C1" style="OLC">
<paragraph id="H55C99B1C78944D320060CD10E762D47"><enum>(1)</enum><header>Incentive
payments</header>
<subparagraph id="H4F048F5EEDDE4BFEB46E216D56A698D0"><enum>(A)</enum><header>In
general</header><text>For 2007 through 2010, with respect to covered
professional services furnished during a reporting period by an eligible
professional, if—</text>
<clause id="H81948538FF174DB59FA496D49DB9CAE2"><enum>(i)</enum><text>there are any
quality measures that have been established under the physician reporting
system that are applicable to any such services furnished by such professional
for such reporting period; and</text>
</clause><clause id="HC74D02BD6B9B4A26A5EC2C4825CC8303"><enum>(ii)</enum><text>the eligible
professional satisfactorily submits (as determined under this subsection) to
the Secretary data on such quality measures in accordance with such reporting
system for such reporting period,</text>
</clause><continuation-text continuation-text-level="subparagraph">in
addition to the amount otherwise paid under this part, there also shall be paid
to the eligible professional (or to an employer or facility in the cases
described in clause (A) of section 1842(b)(6)) or, in the case of a group
practice under paragraph (3)(C), to the group practice, from the Federal
Supplementary Medical Insurance Trust Fund established under section 1841 an
amount equal to the applicable quality percent of the Secretary’s estimate
(based on claims submitted not later than 2 months after the end of the
reporting period) of the allowed charges under this part for all such covered
professional services furnished by the eligible professional (or, in the case
of a group practice under paragraph (3)(C), by the group practice) during the
reporting period.</continuation-text></subparagraph><subparagraph id="H961C520527AD4841892E14B01C00AE2D"><enum>(B)</enum><header>Applicable
quality percent</header><text>For purposes of subparagraph (A), the term
<quote>applicable quality percent</quote> means—</text>
<clause id="H381879094D53467383A42FEBD4AFFD4C"><enum>(i)</enum><text>for 2007 and 2008,
1.5 percent; and</text>
</clause><clause id="H6E77A031A49B468C8EE5DF64004308D"><enum>(ii)</enum><text>for 2009 and 2010,
2.0
percent.</text>
</clause></subparagraph></paragraph><after-quoted-block>;</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="H5C5CAB63903C414A9B31D64B077094"><enum>(C)</enum><text>by striking
paragraph (3) and redesignating paragraph (2) as paragraph (3);</text>
</subparagraph><subparagraph id="H2B6F5E33955547BBBACA44AF36585904"><enum>(D)</enum><text>in paragraph (3),
as so redesignated—</text>
<clause id="H302F50EB24C5426BAD71FDFF18438296"><enum>(i)</enum><text>in
the matter preceding subparagraph (A), by striking <quote>For purposes</quote>
and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="H9447E42F02B644E187F235A75C7287B7" style="OLC">
<subparagraph id="HAC58CEF7AE584BE49F411E86DD8DA390"><enum>(A)</enum><header>In
general</header><text>For
purposes</text>
</subparagraph><after-quoted-block>;</after-quoted-block></quoted-block>
</clause><clause id="H166554E8E0B246AD8FFEF673BDD66820"><enum>(ii)</enum><text>by
redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively,
and moving the indentation of such clauses 2 ems to the right;</text>
</clause><clause id="HB1D86A28405D411697AC40F312FC9961"><enum>(iii)</enum><text>in
subparagraph (A), as added by clause (i), by adding at the end the following
flush sentence:</text>
<quoted-block display-inline="no-display-inline" id="H0D900CB5C4874FC3BCCA002573F223C6" style="OLC">
<quoted-block-continuation-text quoted-block-continuation-text-level="subparagraph">For
years after 2008, quality measures for purposes of this subparagraph shall not
include electronic prescribing quality
measures.</quoted-block-continuation-text><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause><clause id="HDB3E1BFDCD4549BFA447D24395B19670"><enum>(iv)</enum><text>by
adding at the end the following new subparagraphs:</text>
<quoted-block display-inline="no-display-inline" id="HDED5A2CCA3494143B953CC484E507DB9" style="OLC">
<subparagraph id="H020E4F14A0F94EB1B0EFFB817F656EEB"><enum>(C)</enum><header>Satisfactory
reporting measures for group practices</header>
<clause id="H5C50C575E7B54C6D9DFAEE553985205D"><enum>(i)</enum><header>In
general</header><text>By January 1, 2010, the Secretary shall establish and
have in place a process under which eligible professionals in a group practice
(as defined by the Secretary) shall be treated as satisfactorily submitting
data on quality measures under subparagraph (A) and as meeting the requirement
described in subparagraph (B)(ii) for covered professional services for a
reporting period (or, for purposes of subsection (a)(5), for a reporting period
for a year) if, in lieu of reporting measures under subsection (k)(2)(C), the
group practice reports measures determined appropriate by the Secretary, such
as measures that target high-cost chronic conditions and preventive care, in a
form and manner, and at a time, specified by the Secretary.</text>
</clause><clause id="H53BAA932752D47C8BA8369F01965E22E"><enum>(ii)</enum><header>Statistical
sampling model</header><text>The process under clause (i) shall provide for the
use of a statistical sampling model to submit data on measures, such as the
model used under the Physician Group Practice demonstration project under
section 1866A.</text>
</clause><clause id="H3BAAD661D783483B88E228BFE421F9B9"><enum>(iii)</enum><header>No double
payments</header><text>Payments to a group practice under this subsection by
reason of the process under clause (i) shall be in lieu of the payments that
would otherwise be made under this subsection to eligible professionals in the
group practice for satisfactorily submitting data on quality measures.</text>
</clause></subparagraph><subparagraph id="HEADC33BA1B084F7B9EB57D295759035"><enum>(D)</enum><header>Authority to
revise satisfactorily reporting data</header><text>For years after 2009, the
Secretary, in consultation with stakeholders and experts, may revise the
criteria under this subsection for satisfactorily submitting data on quality
measures under subparagraph (A) and the criteria for submitting data on
electronic prescribing quality measures under subparagraph
(B)(ii).</text>
</subparagraph><after-quoted-block>;</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="HA427DF3E39924D60BA5000EB15CE8CAC"><enum>(E)</enum><text>in paragraph
(5)—</text>
<clause id="H67395496C55F4B4A90E68F4481813DAB"><enum>(i)</enum><text>in
subparagraph (C), by inserting <quote>for 2007, 2008, and 2009,</quote> after
<quote>provision of law,</quote>;</text>
</clause><clause id="HCB0BF380FBD34BAD8BC8A12362100091"><enum>(ii)</enum><text>in
subparagraph (D)—</text>
<subclause id="H562D9104038641408BB765918DD64C29"><enum>(I)</enum><text>in clause
(i)—</text>
<item id="H947998A595AC409AB6E149506C589490"><enum>(aa)</enum><text>by
inserting <quote>for 2007 and 2008</quote> after <quote>under this
subsection</quote>; and</text>
</item><item id="H2050EF29819943259EA4B6042C9F8B2E"><enum>(bb)</enum><text>by
striking <quote>paragraph (2)</quote> and inserting <quote>this
subsection</quote>;</text>
</item></subclause><subclause id="HCDFDD4BA8DDB46C088B3FCA2F09BDA9C"><enum>(II)</enum><text>in clause (ii),
by striking <quote>shall</quote> and inserting <quote>may establish procedures
to</quote>; and</text>
</subclause><subclause id="H6D29EB00F91A4139B912E34D3352A7F4"><enum>(III)</enum><text>in clause
(iii)—</text>
<item id="H75BF968C6BA14A9A952E39237D2C4C73"><enum>(aa)</enum><text>by
inserting <quote>(or, in the case of a group practice under paragraph (3)(C),
the group practice)</quote> after <quote>an eligible
professional</quote>;</text>
</item><item id="H7DA115C18D1E4083BF1110AAB5FC9EDA"><enum>(bb)</enum><text>by
striking <quote>bonus incentive payment</quote> and inserting <quote>incentive
payment under this subsection</quote>; and</text>
</item><item id="H5E1FDEA897E4402CA22DDE2E52471463"><enum>(cc)</enum><text>by
adding at the end the following new sentence: <quote>If such payments for such
period have already been made, the Secretary shall recoup such payments from
the eligible professional (or the group practice).</quote>;</text>
</item></subclause></clause><clause id="H40F4867AB16E423C9F321E351849A2CF"><enum>(iii)</enum><text>in
subparagraph (E)—</text>
<subclause id="HB43A43DF23264326AC942FD319D3104C"><enum>(I)</enum><text>by striking
<quote><header-in-text level="clause" style="OLC">(i) In
general</header-in-text>.—</quote>;</text>
</subclause><subclause id="H0101888BE4094FE8A700846064EC14A8"><enum>(II)</enum><text>by striking
clause (ii);</text>
</subclause><subclause id="HE865B8AA4DB04CC6B71F52096B00A87F"><enum>(III)</enum><text>by redesignating
subclauses (I) through (IV) as clauses (i) through (iv), respectively, and
moving the indentation of such clauses 2 ems to the left;</text>
</subclause><subclause id="HD83C8BFFA89B4EB99F471CABD3AC3533"><enum>(IV)</enum><text>in clause (ii),
as so redesignated, by striking <quote>paragraph (2)</quote> and inserting
<quote>this subsection</quote>; and</text>
</subclause><subclause id="H9CD3B2CC1AF84DF296A0C509EB442D46"><enum>(V)</enum><text>in clause (iv), as
so redesignated—</text>
<item id="H7BD8D3BF54D6442BADFA4987455F49C3"><enum>(aa)</enum><text>by
striking <quote>the bonus</quote> and inserting <quote>any</quote>; and</text>
</item><item id="H77572D754BD44B7FA6F0766944BD3BB3"><enum>(bb)</enum><text>by
inserting <quote>and the payment adjustment under subsection (a)(5)(A)</quote>
before the period at the end;</text>
</item></subclause></clause><clause id="HBF8E6AAE1DA34031AB8D21F75585BA4F"><enum>(iv)</enum><text>in
subparagraph (F)—</text>
<subclause id="H0CC83A589F3248BB8853D4A5D006D6B3"><enum>(I)</enum><text>by striking
<quote>2009, paragraph (3) shall not apply, and</quote> and inserting
<quote>subsequent years,</quote>; and</text>
</subclause><subclause id="HE9CBB04E522740D88F29E25D8C338574"><enum>(II)</enum><text>by striking
<quote>paragraph (2)</quote> and inserting <quote>this subsection</quote>;
and</text>
</subclause></clause><clause id="H02E9C10728ED4DC0969F653150885315"><enum>(v)</enum><text>by
adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H1EACF072518B41C483282F712595BA96" style="OLC">
<subparagraph commented="no" id="HBFB6D87B9E194013AF5700AB69A7523E"><enum>(G)</enum><header>Posting on
website</header><text>The Secretary shall post on the Internet website of the
Centers for Medicare & Medicaid Services, in an easily understandable
format, a list of the names of the following:</text>
<clause commented="no" id="H364877E410004677004057601241022E"><enum>(i)</enum><text>The eligible
professionals (or, in the case of reporting under paragraph (3)(C), the group
practices) who satisfactorily submitted data on quality measures under this
subsection.</text>
</clause><clause commented="no" id="H7A0D3D2A0AF1495792F1492147DEE473"><enum>(ii)</enum><text>The eligible
professionals (or, in the case of reporting under paragraph (3)(C), the group
practices) who are successful electronic
prescribers.</text>
</clause></subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="H5128C92FB16847ADA0B0B1C6134618FB"><enum>(F)</enum><text>in paragraph (6),
by striking subparagraph (C) and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="H5AA4239875E24B1581B078FF5C10F6" style="OLC">
<subparagraph id="H877473B4175C4E269D8CB245F64F3CFE"><enum>(C)</enum><header>Reporting
period</header>
<clause id="HACCC45957CD24A68A1CC41FEF9F87159"><enum>(i)</enum><header>In
general</header><text>Subject to clauses (ii) and (iii), the term
<quote>reporting period</quote> means—</text>
<subclause commented="no" display-inline="no-display-inline" id="HDEF4CF2DEE764E35AEDD07D4121D35F6"><enum>(I)</enum><text>for 2007, the
period beginning on July 1, 2007, and ending on December 31, 2007; and</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="H48326EBE1ABE4CAC8FF455CCCA3C542E"><enum>(II)</enum><text>for 2008, 2009,
2010, and 2011, the entire year.</text>
</subclause></clause><clause id="HAE8148CBD95D445D0062E1001B9E50B7"><enum>(ii)</enum><header>Authority to
revise reporting period</header><text>For years after 2009, the Secretary may
revise the reporting period under clause (i) if the Secretary determines such
revision is appropriate, produces valid results on measures reported, and is
consistent with the goals of maximizing scientific validity and reducing
administrative burden. If the Secretary revises such period pursuant to the
preceding sentence, the term <quote>reporting period</quote> shall mean such
revised period.</text>
</clause><clause id="H60104FE6FC2B4D6598CFFB3B8DE9BC37"><enum>(iii)</enum><header>Reference</header><text>Any
reference in this subsection to a reporting period with respect to the
application of subsection (a)(5) shall be deemed a reference to the reporting
period under subparagraph (D)(iii) of such
subsection.</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="HEE3D18B32AC044FD9512666C00B52021"><enum>(4)</enum><header>Inclusion of
qualified audiologists as eligible professionals</header>
<subparagraph id="HCF5AC3747A554D69AF0828931CF00A4"><enum>(A)</enum><header>In
general</header><text>Section 1848(k)(3)(B) of the Social Security Act (42
U.S.C. 1395w–4(k)(3)(B)), is amended by adding at the end the following new
clause:</text>
<quoted-block display-inline="no-display-inline" id="HA359037D25AA4DA2B2AF617FA1917746" style="OLC">
<clause id="H890A321E334840F1ACAE733BF63DAEFD"><enum>(iv)</enum><text>Beginning with
2009, a qualified audiologist (as defined in section
1861(ll)(3)(B)).</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="H7A007790D4954BD99CA3DAC3F66F1B43"><enum>(B)</enum><header>No change in
billing</header><text>Nothing in the amendment made by subparagraph (A) shall
be construed to change the way in which billing for audiology services (as
defined in section 1861(ll)(2) of the Social Security Act (42 U.S.C.
1395x(ll)(2))) occurs under title XVIII of such Act as of July 1, 2008.</text>
</subparagraph></paragraph><paragraph id="H7EFB5A62819A483D9F7628778B16A93E"><enum>(5)</enum><header>Conforming
amendments</header><text>Section 1848(m) of the Social Security Act, as added
and amended by paragraphs (2) and (3), is amended—</text>
<subparagraph id="H966AF485A4A4477EAC4C30DE47F927F"><enum>(A)</enum><text>in paragraph
(5)—</text>
<clause id="H37AF2863A4AF4CC39DBDF656C6B2D351"><enum>(i)</enum><text>in
subparagraph (A)—</text>
<subclause id="H8BE1312DB7AC45CBA4D7075CA31BCE4C"><enum>(I)</enum><text>by striking
<quote>section 1848(k) of the Social Security Act, as added by subsection
(b),</quote> and inserting <quote>subsection (k)</quote>; and</text>
</subclause><subclause id="H0F20C565918A421BB17C6DFABDFB9613"><enum>(II)</enum><text>by striking
<quote>such section</quote> and inserting <quote>such
subsection</quote>;</text>
</subclause></clause><clause id="H4B13C990DF234E4EAA1FB92B2D66073F"><enum>(ii)</enum><text>in
subparagraph (B), by striking <quote>of the Social Security Act (42 U.S.C.
1395l)</quote>;</text>
</clause><clause id="H53C721B797124390AEA93CB96BDE1E34"><enum>(iii)</enum><text>in
subparagraph (E), in the matter preceding clause (i), by striking <quote>1869
or 1878 of the Social Security Act or otherwise</quote> and inserting
<quote>1869, section 1878, or otherwise</quote>; and</text>
</clause><clause id="H137324A06EB64CC487953173093E007F"><enum>(iv)</enum><text>in
subparagraph (F)—</text>
<subclause id="HDA49322852C945D69F735FB98E5348AE"><enum>(I)</enum><text>by striking
<quote>paragraph (2)(B) of section 1848(k) of the Social Security Act (42
U.S.C. 1395w–4(k))</quote> and inserting <quote>subsection (k)(2)(B)</quote>;
and</text>
</subclause><subclause id="H1144E0CB75E44AC38EA0A1CA386324FA"><enum>(II)</enum><text>by striking
<quote>paragraph (4) of such section</quote> and inserting <quote>subsection
(k)(4)</quote>;</text>
</subclause></clause></subparagraph><subparagraph id="H5F4382054E0E4B5BBD10F34DA7E3EDD"><enum>(B)</enum><text>in paragraph
(6)—</text>
<clause id="H612CE42EFEF845D5BD00A5F2EE44FD3"><enum>(i)</enum><text>in
subparagraph (A), by striking <quote>section 1848(k)(3) of the Social Security
Act, as added by subsection (b)</quote> and inserting <quote>subsection
(k)(3)</quote>; and</text>
</clause><clause id="HAAF89C9ACD45480000AABA00D48917AD"><enum>(ii)</enum><text>in
subparagraph (B), by striking <quote>section 1848(k) of the Social Security
Act, as added by subsection (b)</quote> and inserting <quote>subsection
(k)</quote>; and</text>
</clause></subparagraph><subparagraph id="HA740D6F6830A4916AE81B9308B6131DB"><enum>(C)</enum><text>by striking
paragraph (6)(D).</text>
</subparagraph></paragraph><paragraph id="HAB39019BDBF64E4C9908C346B5F3456D"><enum>(6)</enum><header>No affect on
incentive payments for 2007 or 2008</header><text>Nothing in the amendments
made by this subsection or section 132 shall affect the operation of the
provisions of section 1848(m) of the Social Security Act, as redesignated and
amended by such subsection and section, with respect to 2007 or 2008.</text>
</paragraph></subsection><subsection id="HE7404F2854ED4F878B32483824DA8FF3"><enum>(c)</enum><header>Physician
Feedback Program To improve efficiency and control costs</header>
<paragraph id="H05BBDE5A110B4A13920051C07DE24F9B"><enum>(1)</enum><header>In
general</header><text>Section 1848 of the Social Security Act (42 U.S.C.
1395w–4), as amended by subsection (b), is amended by adding at the end the
following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HFCAF29298FD842EDA42766BAC0AE36B" style="OLC">
<subsection id="HA0D16972DACD487000C5900BC6B00D"><enum>(n)</enum><header>Physician Feedback
Program</header>
<paragraph id="H9BBDAA47CDCF4AAAABB500D8B28D99C0"><enum>(1)</enum><header>Establishment</header>
<subparagraph id="HF52C7BADEF33468786C3B057D6EF0099"><enum>(A)</enum><header>In
general</header><text>The Secretary shall establish a Physician Feedback
Program (in this subsection referred to as the <quote>Program</quote>) under
which the Secretary shall use claims data under this title (and may use other
data) to provide confidential reports to physicians (and, as determined
appropriate by the Secretary, to groups of physicians) that measure the
resources involved in furnishing care to individuals under this title. If
determined appropriate by the Secretary, the Secretary may include information
on the quality of care furnished to individuals under this title by the
physician (or group of physicians) in such reports.</text>
</subparagraph><subparagraph id="H646BA3D42F014D4CBCF5E9C46194CAD"><enum>(B)</enum><header>Resource
use</header><text>The resources described in subparagraph (A) may be
measured—</text>
<clause id="H8F0434147E11411FB079A9468A3904B"><enum>(i)</enum><text>on
an episode basis;</text>
</clause><clause id="H2E05C9E8A90240A7A944615D004FEBDE"><enum>(ii)</enum><text>on a per capita
basis; or</text>
</clause><clause id="H3CBBBD046CB74988A3D08F252863AAD8"><enum>(iii)</enum><text>on both an
episode and a per capita basis.</text>
</clause></subparagraph></paragraph><paragraph id="HE53DC3498611499C9602ADC3F1D69B62"><enum>(2)</enum><header>Implementation</header><text>The
Secretary shall implement the Program by not later than January 1, 2009.</text>
</paragraph><paragraph id="H5233BF6C4EC64AEAAED0486857DB00CF"><enum>(3)</enum><header>Data for
reports</header><text>To the extent practicable, reports under the Program
shall be based on the most recent data available.</text>
</paragraph><paragraph id="HF7618C73BA2640C29F68BCCE10E8B381"><enum>(4)</enum><header>Authority to
focus application</header><text>The Secretary may focus the application of the
Program as appropriate, such as focusing the Program on—</text>
<subparagraph id="HF0392463D8C743E7AC8C611FB6B5A200"><enum>(A)</enum><text>physician
specialties that account for a certain percentage of all spending for
physicians' services under this title;</text>
</subparagraph><subparagraph id="HEEFCAB8B4B1A495CB6CA96277E59607C"><enum>(B)</enum><text>physicians who
treat conditions that have a high cost or a high volume, or both, under this
title;</text>
</subparagraph><subparagraph id="H92D70DAD5BD84AE4AB74667FE0F24D05"><enum>(C)</enum><text>physicians who use
a high amount of resources compared to other physicians;</text>
</subparagraph><subparagraph id="H9A12B29D21944A1D8359A636459DFB67"><enum>(D)</enum><text>physicians
practicing in certain geographic areas; or</text>
</subparagraph><subparagraph id="HA30C86E4E17B4D3AAB36F773B6088F8"><enum>(E)</enum><text>physicians who
treat a minimum number of individuals under this title.</text>
</subparagraph></paragraph><paragraph id="HB1BDB7E3451E45B88CEBDBCB2E55A7"><enum>(5)</enum><header>Authority to
Exclude certain information if insufficient information</header><text>The
Secretary may exclude certain information regarding a service from a report
under the Program with respect to a physician (or group of physicians) if the
Secretary determines that there is insufficient information relating to that
service to provide a valid report on that service.</text>
</paragraph><paragraph id="HC1A3F517F6894611BA2982C197C4B448"><enum>(6)</enum><header>Adjustment of
data</header><text>To the extent practicable, the Secretary shall make
appropriate adjustments to the data used in preparing reports under the
Program, such as adjustments to take into account variations in health status
and other patient characteristics.</text>
</paragraph><paragraph id="H95A66E4113634A4F9494AC66E385A492"><enum>(7)</enum><header>Education and
outreach</header><text>The Secretary shall provide for education and outreach
activities to physicians on the operation of, and methodologies employed under,
the Program.</text>
</paragraph><paragraph id="HCD1160B084CD4171B96D60C0C75CF0EC"><enum>(8)</enum><header>Disclosure
exemption</header><text>Reports under the Program shall be exempt from
disclosure under <external-xref legal-doc="usc" parsable-cite="usc/5/552">section 552</external-xref> of title 5, United States
Code.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HB04B92A9165044DDA68F43F9F5DBEC87"><enum>(2)</enum><header>GAO study and
report on the Physician Feedback Program</header>
<subparagraph id="HC663F20BB7554D348D00EDBE162600DF"><enum>(A)</enum><header>Study</header><text>The
Comptroller General of the United States shall conduct a study of the Physician
Feedback Program conducted under section 1848(n) of the Social Security Act, as
added by paragraph (1), including the implementation of the Program.</text>
</subparagraph><subparagraph id="H37F5C33C544948A6ACAAA5D2F6B1CC17"><enum>(B)</enum><header>Report</header><text>Not
later than March 1, 2011, the Comptroller General of the United States shall
submit a report to Congress containing the results of the study conducted under
subparagraph (A), together with recommendations for such legislation and
administrative action as the Comptroller General determines appropriate.</text>
</subparagraph></paragraph></subsection><subsection id="HD9D29E76A4EE429FB8925930CC68A13B"><enum>(d)</enum><header>Plan for
transition to value-based purchasing program for physicians and other
practitioners</header>
<paragraph id="H7DF52171A97040BA9770B5E173F695B6"><enum>(1)</enum><header>In
general</header><text>The Secretary of Health and Human Services shall develop
a plan to transition to a value-based purchasing program for payment under the
Medicare program for covered professional services (as defined in section
1848(k)(3)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(k)(3)(A)</external-xref>)). The
Secretary shall consult with the Medicare Payment Advisory Commission in the
development of such plan.</text>
</paragraph><paragraph id="H00267743D7A34680B2DB34C34F065CE4"><enum>(2)</enum><header>Report</header><text>Not
later than May 1, 2010, the Secretary of Health and Human Services shall submit
a report to Congress containing the plan developed under paragraph (1),
together with recommendations for such legislation and administrative action as
the Secretary determines appropriate.</text>
</paragraph></subsection></section><section id="H2D2249F6F0144A538C7EC88C1F46B917"><enum>132.</enum><header>Incentives for
electronic prescribing</header>
<subsection id="H53529D6D84D449EDABADCDC5F8F18685"><enum>(a)</enum><header>Incentive
payments</header><text display-inline="yes-display-inline">Section 1848(m) of
the Social Security Act, as added and amended by section 131(b), is
amended—</text>
<paragraph id="HAAA315908A4F4A70A394A7C10041DDC7"><enum>(1)</enum><text>by inserting after
paragraph (1), the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HDEEAC16D97624875902B9593DF757F58" style="OLC">
<paragraph id="HFEB4AEF25942488397A8C563B954DEDC"><enum>(2)</enum><header>Incentive
payments for electronic prescribing</header>
<subparagraph id="HECB98774C00D49D9B5E204A704372F00"><enum>(A)</enum><header>In
general</header><text>For 2009 through 2013, with respect to covered
professional services furnished during a reporting period by an eligible
professional, if the eligible professional is a successful electronic
prescriber for such reporting period, in addition to the amount otherwise paid
under this part, there also shall be paid to the eligible professional (or to
an employer or facility in the cases described in clause (A) of section
1842(b)(6)) or, in the case of a group practice under paragraph (3)(C), to the
group practice, from the Federal Supplementary Medical Insurance Trust Fund
established under section 1841 an amount equal to the applicable electronic
prescribing percent of the Secretary’s estimate (based on claims submitted not
later than 2 months after the end of the reporting period) of the allowed
charges under this part for all such covered professional services furnished by
the eligible professional (or, in the case of a group practice under paragraph
(3)(C), by the group practice) during the reporting period.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H459918EEC4B942FF9E167FEFF8A9E54"><enum>(B)</enum><header display-inline="yes-display-inline">Limitation with respect to electronic
prescribing quality measures</header><text display-inline="yes-display-inline">The provisions of this paragraph and
subsection (a)(5) shall not apply to an eligible professional (or, in the case
of a group practice under paragraph (3)(C), to the group practice) if, for the
reporting period (or, for purposes of subsection (a)(5), for the reporting
period for a year)—</text>
<clause commented="no" display-inline="no-display-inline" id="H5F8E1239BD984407B8F1323528C88597"><enum>(i)</enum><text display-inline="yes-display-inline">the allowed charges under this part for all
covered professional services furnished by the eligible professional (or group,
as applicable) for the codes to which the electronic prescribing quality
measure applies (as identified by the Secretary and published on the Internet
website of the Centers for Medicare & Medicaid Services as of January 1,
2008, and as subsequently modified by the Secretary) are less than 10 percent
of the total of the allowed charges under this part for all such covered
professional services furnished by the eligible professional (or the group, as
applicable); or</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H98F15F32B759407B9184CAAD11F478D3"><enum>(ii)</enum><text>if determined
appropriate by the Secretary, the eligible professional does not submit
(including both electronically and nonelectronically) a sufficient number (as
determined by the Secretary) of prescriptions under part D.</text>
</clause><continuation-text continuation-text-level="subparagraph">If the
Secretary makes the determination to apply clause (ii) for a period, then
clause (i) shall not apply for such period.</continuation-text></subparagraph><subparagraph id="HC945B6ECA6C947F79988FE141BA30549"><enum>(C)</enum><header>Applicable
electronic prescribing percent</header><text>For purposes of subparagraph (A),
the term <quote>applicable electronic prescribing percent</quote> means—</text>
<clause id="HD8C1BCDEA57E435EA8F97FB2CA2C79A8"><enum>(i)</enum><text>for 2009 and 2010,
2.0 percent;</text>
</clause><clause id="H41EB353B270B47C4BBC5AF933205D9A3"><enum>(ii)</enum><text>for 2011 and
2012, 1.0 percent; and</text>
</clause><clause id="H5D15F6ABBAC04C45B529407EB4A282D9"><enum>(iii)</enum><text>for 2013, 0.5
percent.</text>
</clause></subparagraph></paragraph><after-quoted-block>;
</after-quoted-block></quoted-block>
</paragraph><paragraph commented="no" id="H48884076AD4C47609268E3CDD250DB26"><enum>(2)</enum><text>in paragraph (3),
as redesignated by section 131(b)—</text>
<subparagraph commented="no" id="H3629A278271E48D5B11C2625A69DB052"><enum>(A)</enum><text>in the heading, by
inserting <quote><header-in-text level="paragraph" style="OLC">and successful
electronic prescriber</header-in-text></quote> after <quote><header-in-text level="paragraph" style="OLC">reporting</header-in-text></quote>; and</text>
</subparagraph><subparagraph commented="no" id="H2E1CBB479A3C498A88BD95CF41205B68"><enum>(B)</enum><text>by inserting after
subparagraph (A) the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HC9B4A6634C3D4798B9D4970038F8E5A6" style="OLC">
<subparagraph id="H2B770D9E8343411788EAF3CEF23FAA1"><enum>(B)</enum><header>Successful
electronic prescriber</header>
<clause id="HA290222B95BB4A449613AB23F6A370AC"><enum>(i)</enum><header>In
general</header><text>For purposes of paragraph (2) and subsection (a)(5), an
eligible professional shall be treated as a successful electronic prescriber
for a reporting period (or, for purposes of subsection (a)(5), for the
reporting period for a year) if the eligible professional meets the requirement
described in clause (ii), or, if the Secretary determines appropriate, the
requirement described in clause (iii). If the Secretary makes the determination
under the preceding sentence to apply the requirement described in clause (iii)
for a period, then the requirement described in clause (ii) shall not apply for
such period.</text>
</clause><clause id="H1D91BF1501BE43A7987FD62235C9B657"><enum>(ii)</enum><header>Requirement for
submitting data on electronic prescribing quality measures</header><text>The
requirement described in this clause is that, with respect to covered
professional services furnished by an eligible professional during a reporting
period (or, for purposes of subsection (a)(5), for the reporting period for a
year), if there are any electronic prescribing quality measures that have been
established under the physician reporting system and are applicable to any such
services furnished by such professional for the period, such professional
reported each such measure under such system in at least 50 percent of the
cases in which such measure is reportable by such professional under such
system.</text>
</clause><clause id="HEC2AFE3298EF4E689748FA8191F9C824"><enum>(iii)</enum><header>Requirement
for electronically prescribing under part D</header><text>The requirement
described in this clause is that the eligible professional electronically
submitted a sufficient number (as determined by the Secretary) of prescriptions
under part D during the reporting period (or, for purposes of subsection
(a)(5), for the reporting period for a year).</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H83DEBE535D334AC390C5E653A8D40600"><enum>(iv)</enum><header>Use of part D
data</header><text>Notwithstanding sections 1860D–15(d)(2)(B) and
1860D–15(f)(2), the Secretary may use data regarding drug claims submitted for
purposes of section 1860D–15 that are necessary for purposes of clause (iii),
paragraph (2)(B)(ii), and paragraph (5)(G).</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H87A66E02492F413E81E20935748BA086"><enum>(v)</enum><header>Standards for
electronic prescribing</header><text>To the extent practicable, in determining
whether eligible professionals meet the requirements under clauses (ii) and
(iii) for purposes of clause (i), the Secretary shall ensure that eligible
professionals utilize electronic prescribing systems in compliance with
standards established for such systems pursuant to the Part D Electronic
Prescribing Program under section
1860D–4(e).</text>
</clause></subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" id="HBDE9906A42604621968421B3868528D0"><enum>(3)</enum><text>in paragraph
(5)(E), by striking clause (iii) and inserting the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="HA152B615FB284957988E7FD3F7538914" style="OLC">
<clause id="H65F131A4000F4431A8E4CBFF86738202"><enum>(iii)</enum><text>the
determination of a successful electronic prescriber under paragraph (3), the
limitation under paragraph (2)(B), and the exception under subsection
(a)(5)(B);
and</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" id="H69E6987051C94CEC94A2BFDEF603F7B0"><enum>(b)</enum><header>Incentive
payment adjustment</header><text>Section 1848(a) of the Social Security Act (42
U.S.C. 1395w–4(a)) is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H3659D082C03A470E8326752BD411A3D" style="OLC">
<paragraph id="H7EB52DF78ED24F5AA113EAB2C8BB4C"><enum>(5)</enum><header>Incentives for
electronic prescribing</header>
<subparagraph id="H0C4AE053329B4B648C362FEB9DECC895"><enum>(A)</enum><header>Adjustment</header>
<clause id="H6DEC75DE938F4AAF820004CE383B2B2E"><enum>(i)</enum><header>In
general</header><text>Subject to subparagraph (B) and subsection (m)(2)(B),
with respect to covered professional services furnished by an eligible
professional during 2012 or any subsequent year, if the eligible professional
is not a successful electronic prescriber for the reporting period for the year
(as determined under subsection (m)(3)(B)), the fee schedule amount for such
services furnished by such professional during the year (including the fee
schedule amount for purposes of determining a payment based on such amount)
shall be equal to the applicable percent of the fee schedule amount that would
otherwise apply to such services under this subsection (determined after
application of paragraph (3) but without regard to this paragraph).</text>
</clause><clause id="H012EC9E3E80C4C589B223EC782734C25"><enum>(ii)</enum><header>Applicable
percent</header><text>For purposes of clause (i), the term <quote>applicable
percent</quote> means—</text>
<subclause id="H01C13D148F6B4857B4EC8FB4FC7EA4"><enum>(I)</enum><text>for 2012, 99
percent;</text>
</subclause><subclause id="HB5C904E6BB7941298C8B0465D8309321"><enum>(II)</enum><text>for 2012, 98.5
percent; and</text>
</subclause><subclause id="HDB7214A2CF5946D694FC5F40775BB9A6"><enum>(III)</enum><text>for 2014 and
each subsequent year, 98 percent.</text>
</subclause></clause></subparagraph><subparagraph commented="no" id="H1B07C7BADD6145FF826EAB25578EBA5"><enum>(B)</enum><header>Significant
hardship exception</header><text>The Secretary may, on a case-by-case basis,
exempt an eligible professional from the application of the payment adjustment
under subparagraph (A) if the Secretary determines, subject to annual renewal,
that compliance with the requirement for being a successful electronic
prescriber would result in a significant hardship, such as in the case of an
eligible professional who practices in a rural area without sufficient Internet
access.</text>
</subparagraph><subparagraph id="H2AA246C503EC4A88B5512FD4C69D463"><enum>(C)</enum><header>Application</header>
<clause id="H7763C3A677284D43B6F15FA7FC93EE57"><enum>(i)</enum><header>Physician
reporting system rules</header><text>Paragraphs (5), (6), and (8) of subsection
(k) shall apply for purposes of this paragraph in the same manner as they apply
for purposes of such subsection.</text>
</clause><clause id="HF4D3F488BCA44647BC32AD2E60DCAE4D"><enum>(ii)</enum><header>Incentive
payment validation rules</header><text>Clauses (ii) and (iii) of subsection
(m)(5)(D) shall apply for purposes of this paragraph in a similar manner as
they apply for purposes of such subsection.</text>
</clause></subparagraph><subparagraph id="HA675B7564DEE4C92B70860751DC7DB28"><enum>(D)</enum><header>Definitions</header><text>For
purposes of this paragraph:</text>
<clause id="HACF4C67DFB904EE59595B36722C1CC39"><enum>(i)</enum><header>Eligible
professional; covered professional services</header><text>The terms
<term>eligible professional</term> and <term>covered professional
services</term> have the meanings given such terms in subsection (k)(3).</text>
</clause><clause id="HD2CD8AFCF268494BAF05DFCD1F479600"><enum>(ii)</enum><header>Physician
reporting system</header><text>The term <term>physician reporting system</term>
means the system established under subsection (k).</text>
</clause><clause id="H718F76E256CA4A97A3E00FBED70045"><enum>(iii)</enum><header>Reporting
period</header><text>The term <quote>reporting period</quote> means, with
respect to a year, a period specified by the
Secretary.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H91D9DA8859EB4D70002073ECA20E75E"><enum>(c)</enum><header>GAO report on
electronic prescribing</header><text>Not later than September 1, 2012, the
Comptroller General of the United States shall submit to Congress a report on
the implementation of the incentives for electronic prescribing established
under the provisions of, and amendments made by, this section. Such report
shall include information regarding the following:</text>
<paragraph id="H07C68710173A4A9C9C0966063002F78B"><enum>(1)</enum><text>The percentage of
eligible professionals (as defined in section 1848(k)(3) of the Social Security
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(k)(3)</external-xref>) that are using electronic prescribing systems,
including a determination of whether less than 50 percent of eligible
professionals are using electronic prescribing systems.</text>
</paragraph><paragraph id="H1324FA48433643AB8ED59E8E48F00EB"><enum>(2)</enum><text>If
less than 50 percent of eligible professionals are using electronic prescribing
systems, recommendations for increasing the use of electronic prescribing
systems by eligible professionals, such as changes to the incentive payment
adjustments established under section 1848(a)(5) of such Act, as added by
subsection (b).</text>
</paragraph><paragraph id="H03F4CCA906C94098BD8BA3AE41BC84A7"><enum>(3)</enum><text>The estimated
savings to the Medicare program under title XVIII of such Act resulting from
the use of electronic prescribing systems.</text>
</paragraph><paragraph id="HD0D78AE0644F4640001EB543BD84FEA5"><enum>(4)</enum><text>Reductions in
avoidable medical errors resulting from the use of electronic prescribing
systems.</text>
</paragraph><paragraph id="H7B4BDA1BDFEB4CF99DEEAED8B1A749BC"><enum>(5)</enum><text>The extent to
which the privacy and security of the personal health information of Medicare
beneficiaries is protected when such beneficiaries’ prescription drug data and
usage information is used for purposes other than their direct clinical care,
including—</text>
<subparagraph id="HBDF46EA063184F92A8A7611B9600B11D"><enum>(A)</enum><text>whether
information identifying the beneficiary is, and remains, removed from data
regarding the beneficiary's prescription drug utilization; and</text>
</subparagraph><subparagraph id="H9F3830744BC240AFA7F73D23FC00BACE"><enum>(B)</enum><text>the extent to
which current law requires sufficient and appropriate oversight and audit
capabilities to monitor the practice of prescription drug data mining.</text>
</subparagraph></paragraph><paragraph id="HDD4B11041A6C46F883558089658767F0"><enum>(6)</enum><text>Such other
recommendations and administrative action as the Comptroller General determines
to be appropriate.</text>
</paragraph></subsection></section><section commented="no" id="HA8A4A31E9C254FD5ABC7BF51DA4EF83B"><enum>133.</enum><header>Expanding
access to primary care services</header>
<subsection id="HD8AB479F81B243ADA6686D27C698444"><enum>(a)</enum><header>Incentive payment
program for primary care services furnished in physician scarcity
areas</header>
<paragraph id="HDA9D31DB1C5C4F77B59DAF416000EA36"><enum>(1)</enum><header>In
general</header><text>Section 1833 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l</external-xref>)
is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H167EC5DCC25F46ED96491B99D1D0E43D" style="OLC">
<subsection commented="no" display-inline="no-display-inline" id="H49F4CD078F9C4479A244F1F75226C1FE"><enum>(v)</enum><header display-inline="yes-display-inline">Incentive payments for primary care
services furnished in physician scarcity areas</header>
<paragraph commented="no" display-inline="no-display-inline" id="H803CD8A84D414C06A2AF837292CD5621"><enum>(1)</enum><header>In
general</header><text>In the case of primary care services furnished on or
after January 1, 2011, by a primary care physician in a primary care scarcity
county, in addition to the amount of payment that would otherwise be made for
such services under this part, there also shall be paid (on a monthly or
quarterly basis) an amount equal to 5 percent of the payment amount for the
service under this part.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HBDCCBC94E06146B2AF2514307843284F"><enum>(2)</enum><header>Definitions</header><text>In
this subsection:</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HCEB002DBDAF1435187C47C80F3DCAE00"><enum>(A)</enum><header>Primary care
physician</header><text>The term <quote>primary care physician</quote> means a
physician (as described in section 1861(r)(1)) for whom primary care services
accounted for at least a specified percent (as determined by the Secretary) of
the allowed charges under this part for such physician in a prior period as
determined appropriate by the Secretary.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HDCA22CBCCBEA4CA6B6CF260058E9F55D"><enum>(B)</enum><header>Primary care
scarcity county</header><text>The term <quote>primary care scarcity
county</quote> means the primary care scarcity counties that the Secretary was
using under subsection (u) with respect to physicians' services furnished on
December 31, 2007.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H4BB2B9D42637454781BF3913E81D118F"><enum>(C)</enum><header>Primary care
services</header><text>The term <quote>primary care services</quote> means
procedure codes for services in the category of the Healthcare Common Procedure
Coding System, as established by the Secretary under section 1848(c)(5) (as of
December 31, 2008 and as subsequently modified by the Secretary) consisting of
evaluation and management services, but limited to such procedure codes in the
category of office or other outpatient services, and consisting of
subcategories of such procedure codes for services for both new and established
patients.</text>
</subparagraph></paragraph><paragraph id="HC7B5E5A5630D4E33A2FF445414A5167B"><enum>(3)</enum><header>Judicial
review</header><text>There shall be no administrative or judicial review under
section 1869, 1878, or otherwise, respecting the identification of primary care
physicians, primary care specialty areas, or primary care services under this
subsection.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H9EF4F9B868664E6C8483310861E841ED"><enum>(2)</enum><header>Conforming
amendment</header><text>Section 1834(g)(2)(B) of the Social Security Act (42
U.S.C. 1395m(g)(2)(B)) is amended by adding at the end the following sentence:
<quote>Section 1833(v) shall not be taken into account in determining the
amounts that would otherwise be paid pursuant to the preceding
sentence.</quote>.</text>
</paragraph></subsection><subsection commented="no" id="HFBDA2E373CBB46D4B637422D08838508"><enum>(b)</enum><header>Revisions to the
Medicare medical home demonstration project</header>
<paragraph id="H65D87B43C0864772B6176E3EFA4790CE"><enum>(1)</enum><header>Authority to
expand</header><text>Section 204(b) of division B of the Tax Relief and Health
Care Act of 2006 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395b-1">42 U.S.C. 1395b–1</external-xref> note) is amended—</text>
<subparagraph id="HF216BFBBC02A4B619FE5750030189EF7"><enum>(A)</enum><text>in paragraph (1),
by striking <quote>The project</quote> and inserting <quote>Subject to
paragraph (3), the project</quote>; and</text>
</subparagraph><subparagraph id="HA3BADB2B79A849239E7E17D02D3F424F"><enum>(B)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H83291821619445AD989225B8DA177EB1" style="OLC">
<paragraph id="H4473248EEA0D4B7C82BA066B047E3B12"><enum>(3)</enum><header>Expansion</header><text>The
Secretary may expand the duration and the scope of the project under paragraph
(1), to an extent determined appropriate by the Secretary, if the Secretary
determines that such expansion will result in any of the following conditions
being met:</text>
<subparagraph id="H7762F1FDA61D47B0A86FF759DAE93DA9"><enum>(A)</enum><text>The expansion of
the project is expected to improve the quality of patient care without
increasing spending under the Medicare program (not taking into account amounts
available under subsection (g)).</text>
</subparagraph><subparagraph id="HEF3E7C72D0604AA28BABE9758900C412"><enum>(B)</enum><text>The expansion of
the project is expected to reduce spending under the Medicare program (not
taking into account amounts available under subsection (g)) without reducing
the quality of patient
care.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="HA4D7FA46E93D46CFB7D3EDE527383690"><enum>(2)</enum><header>Funding and
application</header><text>Section 204 of division B of the Tax Relief and
Health Care Act of 2006 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395b-1">42 U.S.C. 1395b–1</external-xref> note) is amended by adding at the
end the following new subsections:</text>
<quoted-block display-inline="no-display-inline" id="HBE2CCD2B08314A2AB5BB6BC4BE7DC4EA" style="OLC">
<subsection id="H91D920D7E6EC4D3880063EEFBDACE5FF"><enum>(g)</enum><header>Funding from SMI
trust fund</header><text>There shall be available, from the Federal
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>)), the amount of $100,000,000 to carry out the
project.</text>
</subsection><subsection id="HC53CD07CEC2F492B88157FD95BB00000"><enum>(h)</enum><header>Application</header><text>Chapter
35 of title 44, United States Code, shall not apply to the conduct of the
project.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HD52568F5E8954BC0A3A50014A600B35B"><enum>(c)</enum><header>Application of
budget-neutrality adjustor to conversion factor</header><text>Section
1848(c)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)(B)</external-xref>) is
amended by inserting at the end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="H00B0AEAD4D324FDF8CC99366167E166C" style="OLC">
<clause id="H544F282DDD3E414B864100D588CA5CA"><enum>(iv)</enum><header>Alternative
application of budget-neutrality adjustment</header><text>Notwithstanding
subsection (d)(9)(A), effective for fee schedules established beginning with
2009, with respect to the 5-year review of work relative value units used in
fee schedules for 2007 and 2008, in lieu of continuing to apply
budget-neutrality adjustments required under clause (ii) for 2007 and 2008 to
work relative value units, the Secretary shall apply such budget-neutrality
adjustments to the conversion factor otherwise determined for years beginning
with
2009.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="H99599C80C6514B4A9F7CAEED4CFEE097"><enum>134.</enum><header>Extension of
floor on Medicare work geographic adjustment under the Medicare physician fee
schedule</header>
<subsection id="H28ECD520E67B400FAD7BB9493018F328"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1848(e)(1)(E)
of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(e)(1)(E)</external-xref>), as amended by section
103 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law
110–173), is amended by striking <quote>before July 1, 2008</quote> and
inserting <quote>before January 1, 2010</quote>.</text>
</subsection><subsection id="H8E31756A48B04E77AAFD48FC96D3F915"><enum>(b)</enum><header>Treatment of
physicians' services furnished in certain areas</header><text>Section
1848(e)(1)(G) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(e)(1)(G)</external-xref>) is
amended by adding at the end the following new sentence: <quote>For purposes of
payment for services furnished in the State described in the preceding sentence
on or after January 1, 2009, after calculating the work geographic index in
subparagraph (A)(iii), the Secretary shall increase the work geographic index
to 1.5 if such index would otherwise be less than 1.5</quote>.</text>
</subsection><subsection commented="no" id="H8CF5F51F04D84889ADD2BE4F61B1C49C"><enum>(c)</enum><header>Technical
correction</header><text>Section 602(1) of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (<external-xref legal-doc="public-law" parsable-cite="pl/108/173">Public Law 108–173</external-xref>; 117 Stat. 2301)
is amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="H1F2A0286B2FB4EBF00266614604141F7" style="OLC">
<paragraph commented="no" id="H3120406CFC2142F08934546D97C37FB8"><enum>(1)</enum><text>in subparagraph
(A), by striking <quote>subparagraphs (B), (C), and (E)</quote> and inserting
<quote>subparagraphs (B), (C), (E), and (G)</quote>;
and</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section display-inline="no-display-inline" id="H515D97CA13654E28BDC85E48EFD5F493" section-type="subsequent-section"><enum>135.</enum><header>Imaging
provisions</header>
<subsection id="H1FEBAB367ABA4E589EFB99BA21008CFE"><enum>(a)</enum><header>Accreditation
requirement</header>
<paragraph id="H7B526B26D5CC44FC946807ECA695227F"><enum>(1)</enum><header>Accreditation
requirement</header><text>Section 1834 of the Social Security Act (42 U.S.C.
1395m) is amended by inserting after subsection (d) the following new
subsection:</text>
<quoted-block display-inline="no-display-inline" id="HAFA0044F39744FC18FA7F95403009FAB" style="OLC">
<subsection id="HEDF0A840F6FC42C58DD19E9B554029DB"><enum>(e)</enum><header>Accreditation
requirement for advanced diagnostic imaging services</header>
<paragraph id="H08E17D5CB0F54D06AEEBF2A1001F7B7E"><enum>(1)</enum><header>In
general</header>
<subparagraph id="H9463298334124D91A0BC3DADD2AC46FD"><enum>(A)</enum><header>In
general</header><text>Beginning with January 1, 2012, with respect to the
technical component of advanced diagnostic imaging services for which payment
is made under the fee schedule established under section 1848(b) and that are
furnished by a supplier, payment may only be made if such supplier is
accredited by an accreditation organization designated by the Secretary under
paragraph (2)(B)(i).</text>
</subparagraph><subparagraph id="H3B1B6219273B49F9A7F0A52B65ACD972"><enum>(B)</enum><header>Advanced
diagnostic imaging services defined</header><text>In this subsection, the term
<term>advanced diagnostic imaging services</term> includes—</text>
<clause id="HC8CCD3DA1D6F46598B0305C370C3B2F3"><enum>(i)</enum><text>diagnostic
magnetic resonance imaging, computed tomography, and nuclear medicine
(including positron emission tomography); and</text>
</clause><clause id="H7ACB6CE11522497B83C234004DBBBB3F"><enum>(ii)</enum><text>such other
diagnostic imaging services, including services described in section
1848(b)(4)(B) (excluding X-ray, ultrasound, and fluoroscopy), as specified by
the Secretary in consultation with physician specialty organizations and other
stakeholders.</text>
</clause></subparagraph><subparagraph id="H43CCD70E2C4B4D6596579B8CDAE4812D"><enum>(C)</enum><header>Supplier
defined</header><text>In this subsection, the term <term>supplier</term> has
the meaning given such term in section 1861(d).</text>
</subparagraph></paragraph><paragraph id="HB44230D0EF1F4D4C8ECDC2DDD0F4F43"><enum>(2)</enum><header>Accreditation
organizations</header>
<subparagraph id="H064C60E3D6724EFA9B00042FA72FEDBC"><enum>(A)</enum><header>Factors for
designation of accreditation organizations</header><text>The Secretary shall
consider the following factors in designating accreditation organizations under
subparagraph (B)(i) and in reviewing and modifying the list of accreditation
organizations designated pursuant to subparagraph (C):</text>
<clause id="HA2FCC8E85CED4170B5865783DB1D35D1"><enum>(i)</enum><text>The ability of the
organization to conduct timely reviews of accreditation applications.</text>
</clause><clause id="H0B514F575E06407BBAAB97DE8C62A7F9"><enum>(ii)</enum><text>Whether the
organization has established a process for the timely integration of new
advanced diagnostic imaging services into the organization’s accreditation
program.</text>
</clause><clause id="H901C25BB5ED14171B57320C84C6FBDE8"><enum>(iii)</enum><text>Whether the
organization uses random site visits, site audits, or other strategies for
ensuring accredited suppliers maintain adherence to the criteria described in
paragraph (3).</text>
</clause><clause id="H9BA01D604C174408B882B81434FFA00"><enum>(iv)</enum><text>The ability of the
organization to take into account the capacities of suppliers located in a
rural area (as defined in section 1886(d)(2)(D)).</text>
</clause><clause id="H308C384D62904362B23D1E3D674882B8"><enum>(v)</enum><text>Whether the
organization has established reasonable fees to be charged to suppliers
applying for accreditation.</text>
</clause><clause id="HDCE9C4CEF7744D8082923FE4A07E17C9"><enum>(vi)</enum><text>Such other
factors as the Secretary determines appropriate.</text>
</clause></subparagraph><subparagraph id="HFD6C9FF25E374DB48B37A0780700FE6C"><enum>(B)</enum><header>Designation</header><text display-inline="yes-display-inline">Not later than January 1, 2010, the
Secretary shall designate organizations to accredit suppliers furnishing the
technical component of advanced diagnostic imaging services. The list of
accreditation organizations so designated may be modified pursuant to
subparagraph (C).</text>
</subparagraph><subparagraph id="H6EB7D92C2DEF4812B63035F9B45BE00"><enum>(C)</enum><header>Review and
modification of list of accreditation organizations</header>
<clause id="HFD63EBDD52B9465E8ECBFE53BCE2B6E"><enum>(i)</enum><header>In
general</header><text>The Secretary shall review the list of accreditation
organizations designated under subparagraph (B) taking into account the factors
under subparagraph (A). Taking into account the results of such review, the
Secretary may, by regulation, modify the list of accreditation organizations
designated under subparagraph (B).</text>
</clause><clause id="H05DAEE3AB6AD4FE5B2526E1EB70724C1"><enum>(ii)</enum><header>Special rule
for accreditations done prior to removal from list of designated accreditation
organizations</header><text>In the case where the Secretary removes an
organization from the list of accreditation organizations designated under
subparagraph (B), any supplier that is accredited by the organization during
the period beginning on the date on which the organization is designated as an
accreditation organization under subparagraph (B) and ending on the date on
which the organization is removed from such list shall be considered to have
been accredited by an organization designated by the Secretary under
subparagraph (B) for the remaining period such accreditation is in
effect.</text>
</clause></subparagraph></paragraph><paragraph id="H5687BF07FBD4458AAECB33E8FE72DFA5"><enum>(3)</enum><header>Criteria for
accreditation</header><text>The Secretary shall establish procedures to ensure
that the criteria used by an accreditation organization designated under
paragraph (2)(B) to evaluate a supplier that furnishes the technical component
of advanced diagnostic imaging services for the purpose of accreditation of
such supplier is specific to each imaging modality. Such criteria shall
include—</text>
<subparagraph id="H567BAB77644C4B998D00540281ECCC8"><enum>(A)</enum><text>standards for
qualifications of medical personnel who are not physicians and who furnish the
technical component of advanced diagnostic imaging services;</text>
</subparagraph><subparagraph id="HC99BE086A6044A148FF1809D20466B18"><enum>(B)</enum><text>standards for
qualifications and responsibilities of medical directors and supervising
physicians, including standards that recognize the considerations described in
paragraph (4);</text>
</subparagraph><subparagraph id="H8BC5684CB4D24CA98455321473361D99"><enum>(C)</enum><text>procedures to
ensure that equipment used in furnishing the technical component of advanced
diagnostic imaging services meets performance specifications;</text>
</subparagraph><subparagraph id="H95B2A74845B8465785DC9C639BF6A6"><enum>(D)</enum><text>standards that
require the supplier have procedures in place to ensure the safety of persons
who furnish the technical component of advanced diagnostic imaging services and
individuals to whom such services are furnished;</text>
</subparagraph><subparagraph id="HEC7D3B8431664CC69F75A95559D6C791"><enum>(E)</enum><text>standards that
require the establishment and maintenance of a quality assurance and quality
control program by the supplier that is adequate and appropriate to ensure the
reliability, clarity, and accuracy of the technical quality of diagnostic
images produced by such supplier; and</text>
</subparagraph><subparagraph id="HB6E6428131214AFC92208FDCFDCB9CD6"><enum>(F)</enum><text>any other
standards or procedures the Secretary determines appropriate.</text>
</subparagraph></paragraph><paragraph commented="no" id="H17AE42F7764B4846BC30F7AB6771DF6E"><enum>(4)</enum><header>Recognition in
standards for the evaluation of medical directors and supervising
physicians</header><text>The standards described in paragraph (3)(B) shall
recognize whether a medical director or supervising physician—</text>
<subparagraph commented="no" id="H80F144F080FB4DF400BBEB8912B4179C"><enum>(A)</enum><text>in a particular
specialty receives training in advanced diagnostic imaging services in a
residency program;</text>
</subparagraph><subparagraph commented="no" id="H04F57642A3424AC300555191C710BE00"><enum>(B)</enum><text>has attained,
through experience, the necessary expertise to be a medical director or a
supervising physician;</text>
</subparagraph><subparagraph commented="no" id="HA523E3CB7B71455A83EAEF4C58157D06"><enum>(C)</enum><text>has completed any
continuing medical education courses relating to such services; or</text>
</subparagraph><subparagraph commented="no" id="HB0FDDC501B834E9B87CA165877F3CFF"><enum>(D)</enum><text>has met such other
standards as the Secretary determines appropriate.</text>
</subparagraph></paragraph><paragraph id="H4F0995CA7B00435396FBC83FD733CDCC"><enum>(5)</enum><header>Rule for
accreditations made prior to designation</header><text>In the case of a
supplier that is accredited before January 1, 2010, by an accreditation
organization designated by the Secretary under paragraph (2)(B) as of January
1, 2010, such supplier shall be considered to have been accredited by an
organization designated by the Secretary under such paragraph as of January 1,
2012, for the remaining period such accreditation is in
effect.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HDDDB0205CF9C4309ADE38217052746E5"><enum>(2)</enum><header>Conforming
amendments</header>
<subparagraph id="HF90A20E043FE44AC90FD29154CDA00E"><enum>(A)</enum><header>In
general</header><text>Section 1862(a) of the Social Security Act (42 U.S.C.
1395y(a)) is amended—</text>
<clause id="H2D9DDC00F12E40948E786CDB94022FB"><enum>(i)</enum><text>in
paragraph (21), by striking <quote>or</quote> at the end;</text>
</clause><clause id="H4D57A92FD94341CA8FEB18348BAC9B00"><enum>(ii)</enum><text>in
paragraph (22), by striking the period at the end and inserting <quote>;
or</quote>; and</text>
</clause><clause id="H3341DBC72A894928B9CA15A223518D4"><enum>(iii)</enum><text>by
inserting after paragraph (22) the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HC6CD5092D8F64BC1A09F3209FF7DE1D" style="OLC">
<paragraph id="H83C77ED04F89419CB96E8F9EA3EB69B3"><enum>(23)</enum><text>which are the
technical component of advanced diagnostic imaging services described in
section 1834(e)(1)(B) for which payment is made under the fee schedule
established under section 1848(b) and that are furnished by a supplier (as
defined in section 1861(d)), if such supplier is not accredited by an
accreditation organization designated by the Secretary under section
1834(e)(2)(B).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="H7443F1D9E45B4880960087EC76D0EA77"><enum>(B)</enum><header>Effective
date</header><text>The amendments made by this paragraph shall apply to
advanced diagnostic imaging services furnished on or after January 1,
2012.</text>
</subparagraph></paragraph></subsection><subsection id="H8A32A9E07CE34F9CA595F96F42946615"><enum>(b)</enum><header>Demonstration
project To assess the appropriate use of imaging services</header>
<paragraph id="H7668CB7FF44D4092B593C8DF08FAFF91"><enum>(1)</enum><header>Conduct of
demonstration project</header>
<subparagraph id="H3C2AB2D539FB4369A81F62D0ABAEA6A6"><enum>(A)</enum><header>In
general</header><text>The Secretary of Health and Human Services (in this
section referred to as the <quote>Secretary</quote>) shall conduct a
demonstration project using the models described in paragraph (2)(E) to collect
data regarding physician compliance with appropriateness criteria selected
under paragraph (2)(D) in order to determine the appropriateness of advanced
diagnostic imaging services furnished to Medicare beneficiaries.</text>
</subparagraph><subparagraph id="HD5614752A03F40A383B14DC5F8B7F58"><enum>(B)</enum><header>Advanced
diagnostic imaging services</header><text>In this subsection, the term
<term>advanced diagnostic imaging services</term> has the meaning given such
term in section 1834(e)(1)(B) of the Social Security Act, as added by
subsection (a).</text>
</subparagraph><subparagraph id="H9474081C8BD2491D97597C001F5531F3"><enum>(C)</enum><header>Authority to
focus demonstration project</header><text>The Secretary may focus the
demonstration project with respect to certain advanced diagnostic imaging
services, such as services that account for a large amount of expenditures
under the Medicare program, services that have recently experienced a high rate
of growth, or services for which appropriateness criteria exists.</text>
</subparagraph></paragraph><paragraph id="H93904A09FCC041F78264FD4DA5C66035"><enum>(2)</enum><header>Implementation
and design of demonstration project</header>
<subparagraph id="HD8B9CAD162EF4FB3B602E0C4FACCD4F9"><enum>(A)</enum><header>Implementation
and duration</header>
<clause id="HBD36DBF5764A49429C43B7CC20C11C39"><enum>(i)</enum><header>Implementation</header><text>The
Secretary shall implement the demonstration project under this subsection not
later than January 1, 2010.</text>
</clause><clause id="HC153BC0B11CD4FDD80FA382645652821"><enum>(ii)</enum><header>Duration</header><text>The
Secretary shall conduct the demonstration project under this subsection for a
2-year period.</text>
</clause></subparagraph><subparagraph id="HB979218B74954FC1A6D1DC8147172124"><enum>(B)</enum><header>Application and
selection of participating physicians</header>
<clause id="H07F37D4B543F4ABDA42104D3F8EE21A9"><enum>(i)</enum><header>Application</header><text>Each
physician that desires to participate in the demonstration project under this
subsection shall submit an application to the Secretary at such time, in such
manner, and containing such information as the Secretary may require.</text>
</clause><clause id="HBABA41EBC3FE435DA411E4A816C822D0"><enum>(ii)</enum><header>Selection</header><text>The
Secretary shall select physicians to participate in the demonstration project
under this subsection from among physicians submitting applications under
clause (i). The Secretary shall ensure that the physicians selected—</text>
<subclause id="HD3A0F1CD172C4F9B97676E958800F33C"><enum>(I)</enum><text>represent a wide
range of geographic areas, demographic characteristics (such as urban, rural,
and suburban), and practice settings (such as private and academic practices);
and</text>
</subclause><subclause id="H6C119C5A3EB541FA84F910004B8761EB"><enum>(II)</enum><text>have the
capability to submit data to the Secretary (or an entity under a subcontract
with the Secretary) in an electronic format in accordance with standards
established by the Secretary.</text>
</subclause></clause></subparagraph><subparagraph commented="no" id="H14F99661A922413AB4DBCFE007941678"><enum>(C)</enum><header>Administrative
costs and incentives</header><text>The Secretary shall—</text>
<clause commented="no" id="HE1EDBAD9FE694F5A815F81A2E8C86BAC"><enum>(i)</enum><text>reimburse
physicians for reasonable administrative costs incurred in participating in the
demonstration project under this subsection; and</text>
</clause><clause commented="no" id="H72CEADF8AAA44D24006F92B1C700F008"><enum>(ii)</enum><text>provide
reasonable incentives to physicians to encourage participation in the
demonstration project under this subsection.</text>
</clause></subparagraph><subparagraph id="H777F7D6CB473497688D9BB5D6039BB9F"><enum>(D)</enum><header>Use of
appropriateness criteria</header>
<clause id="HC4367DB4329440918315FF26D407DA7E"><enum>(i)</enum><header>In
general</header><text>The Secretary, in consultation with medical specialty
societies and other stakeholders, shall select criteria with respect to the
clinical appropriateness of advanced diagnostic imaging services for use in the
demonstration project under this subsection.</text>
</clause><clause id="HF5E089F133944074B2C388464BEDFAAB"><enum>(ii)</enum><header>Criteria
selected</header><text>Any criteria selected under clause (i) shall—</text>
<subclause id="H83AE4E692CDF42688083971CD138B34F"><enum>(I)</enum><text>be developed or
endorsed by a medical specialty society; and</text>
</subclause><subclause id="H07F876B87393433180BB469BCC1F4971"><enum>(II)</enum><text>be developed in
adherence to appropriateness principles developed by a consensus organization,
such as the AQA alliance.</text>
</subclause></clause></subparagraph><subparagraph id="H1C1DBAA1BE524694B0C7087581F0EB57"><enum>(E)</enum><header>Models for
collecting data regarding physician compliance with selected
criteria</header><text>Subject to subparagraph (H), in carrying out the
demonstration project under this subsection, the Secretary shall use each of
the following models for collecting data regarding physician compliance with
appropriateness criteria selected under subparagraph (D):</text>
<clause id="H53D35110EB4B417084AD853DD9A1D96B"><enum>(i)</enum><text>A
model described in subparagraph (F).</text>
</clause><clause id="HC9564A6D03C74955AB47432DEAFBC356"><enum>(ii)</enum><text>A
model described in subparagraph (G).</text>
</clause><clause id="HA69174AA989C4D9A91C58DAE4AA6364"><enum>(iii)</enum><text>Any
other model that the Secretary determines to be useful in evaluating the use of
appropriateness criteria for advanced diagnostic imaging services.</text>
</clause></subparagraph><subparagraph id="H4B453BD529904B72A223C6FE9A7CC6B"><enum>(F)</enum><header>Point of service
model described</header><text>A model described in this subparagraph is a model
that—</text>
<clause id="H2731FFF925F543259BFDA41B4B7CA002"><enum>(i)</enum><text>uses
an electronic or paper intake form that—</text>
<subclause id="HF9BBE11D763C46C1ABE4005B0906A2C7"><enum>(I)</enum><text>contains a
certification by the physician furnishing the imaging service that the data on
the intake form was confirmed with the Medicare beneficiary before the service
was furnished;</text>
</subclause><subclause id="H33347C3EA9A54CD184BE5789D3E5FA80"><enum>(II)</enum><text>contains
standardized data elements for diagnosis, service ordered, service furnished,
and such other information determined by the Secretary, in consultation with
medical specialty societies and other stakeholders, to be germane to evaluating
the effectiveness of the use of appropriateness criteria selected under
subparagraph (D); and</text>
</subclause><subclause id="HB73D5A3D98724144BAD798126DDF85B3"><enum>(III)</enum><text>is accessible to
physicians participating in the demonstration project under this subsection in
a format that allows for the electronic submission of such form; and</text>
</subclause></clause><clause id="H7CA594DA443B4A3ABFE8B5C14DC9168F"><enum>(ii)</enum><text>provides for
feedback reports in accordance with paragraph (3)(B).</text>
</clause></subparagraph><subparagraph id="H53C3A3054CB1496C9B81336820B41E9B"><enum>(G)</enum><header>Point of order
model described</header><text>A model described in this subparagraph is a model
that—</text>
<clause id="HC85942D6E39A45BBBAE679BA83650017"><enum>(i)</enum><text>uses
a computerized order-entry system that requires the transmittal of relevant
supporting information at the time of referral for advanced diagnostic imaging
services and provides automated decision-support feedback to the referring
physician regarding the appropriateness of furnishing such imaging services;
and</text>
</clause><clause id="H83A1FED41CA5404CB6BDABBEDA2F67BD"><enum>(ii)</enum><text>provides for
feedback reports in accordance with paragraph (3)(B).</text>
</clause></subparagraph><subparagraph id="HD627BF99CEBF44F59900E7943BCEFABF"><enum>(H)</enum><header>Limitation</header><text>In
no case may the Secretary use prior authorization—</text>
<clause id="HCD1FEFAC840D40CAB6F2ADB33CE47950"><enum>(i)</enum><text>as a
model for collecting data regarding physician compliance with appropriateness
criteria selected under subparagraph (D) under the demonstration project under
this subsection; or</text>
</clause><clause id="H44EB506F6706415990E46B25F2667C15"><enum>(ii)</enum><text>under any model
used for collecting such data under the demonstration project.</text>
</clause></subparagraph><subparagraph id="HDF112177A346490EB2522F1D46831868"><enum>(I)</enum><header>Required
contracts and performance standards for certain entities</header>
<clause id="H8B3924CE21864B668DB1973B7B281CD9"><enum>(i)</enum><header>In
general</header><text>The Secretary shall enter into contracts with entities to
carry out the model described in subparagraph (G).</text>
</clause><clause id="HE8DB918133CA474E963D3EF845EF63C5"><enum>(ii)</enum><header>Performance
standards</header><text>The Secretary shall establish and enforce performance
standards for such entities under the contracts entered into under clause (i),
including performance standards with respect to—</text>
<subclause id="H599C178BF0C14BF9AB1F30F8F660C980"><enum>(I)</enum><text>the satisfaction
of Medicare beneficiaries who are furnished advanced diagnostic imaging
services by a physician participating in the demonstration project;</text>
</subclause><subclause id="H588F63F24B5041C0A226E7526BE624BF"><enum>(II)</enum><text>the satisfaction
of physicians participating in the demonstration project;</text>
</subclause><subclause id="HADCD54E36EBE4223A5D8CE2928E98162"><enum>(III)</enum><text>if applicable,
timelines for the provision of feedback reports under paragraph (3)(B);
and</text>
</subclause><subclause id="H00A9E4B0545044B7B0004EB0A2DA81E0"><enum>(IV)</enum><text>any other areas
determined appropriate by the Secretary.</text>
</subclause></clause></subparagraph></paragraph><paragraph id="H09E77E96C9BF40E48C80E2E927CB358E"><enum>(3)</enum><header>Comparison of
utilization of advanced diagnostic imaging services and feedback
reports</header>
<subparagraph id="HD6567DAE9F4741CF9CA007B127FA355B"><enum>(A)</enum><header>Comparison of
utilization of advanced diagnostic imaging services</header><text>The Secretary
shall consult with medical specialty societies and other stakeholders to
develop mechanisms for comparing the utilization of advanced diagnostic imaging
services by physicians participating in the demonstration project under this
subsection against—</text>
<clause id="HDDCB7D1E769341E995725EEAD49DD28D"><enum>(i)</enum><text>the
appropriateness criteria selected under paragraph (2)(D); and</text>
</clause><clause id="H6DC440B58FC1422ABEFA7E0313510202"><enum>(ii)</enum><text>to
the extent feasible, the utilization of such services by physicians not
participating in the demonstration project.</text>
</clause></subparagraph><subparagraph id="HA18063A663144897A7D649F41E308369"><enum>(B)</enum><header>Feedback
reports</header><text>The Secretary shall, in consultation with medical
specialty societies and other stakeholders, develop mechanisms to provide
feedback reports to physicians participating in the demonstration project under
this subsection. Such feedback reports shall include—</text>
<clause id="H52540E51B21B4762B6F5DDCFD441CAAD"><enum>(i)</enum><text>a
profile of the rate of compliance by the physician with appropriateness
criteria selected under paragraph (2)(D), including a comparison of—</text>
<subclause id="H33AE76290BA74E7A82D0DA465CA1B5EE"><enum>(I)</enum><text>the rate of
compliance by the physician with such criteria; and</text>
</subclause><subclause id="HDA5B4563C183423891765EA97ABACF4"><enum>(II)</enum><text>the rate of
compliance by the physician’s peers (as defined by the Secretary) with such
criteria; and</text>
</subclause></clause><clause id="H750C2265A1194771BA9302AD4B008CB0"><enum>(ii)</enum><text>to
the extent feasible, a comparison of—</text>
<subclause id="H2AE31984EE39489CAB064063BBECBDC7"><enum>(I)</enum><text>the rate of
utilization of advanced diagnostic imaging services by the physician;
and</text>
</subclause><subclause id="H34D9185A86CA41568B008D4BD61BBEBB"><enum>(II)</enum><text>the rate of
utilization of such services by the physician’s peers (as defined by the
Secretary) who are not participating in the demonstration project.</text>
</subclause></clause></subparagraph></paragraph><paragraph id="HD7BAF7769B89408191EC5320C856B87F"><enum>(4)</enum><header>Conduct of
demonstration project and waiver</header>
<subparagraph id="H476922F16799455EA53F73C42496AF8D"><enum>(A)</enum><header>Conduct of
demonstration project</header><text><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/44/35">Chapter 35</external-xref> of title 44, United States Code,
shall not apply to the conduct of the demonstration project under this
subsection.</text>
</subparagraph><subparagraph id="HB96E8289430D4D60A8E5EA2FB4975579"><enum>(B)</enum><header>Waiver</header><text>The
Secretary may waive such provisions of titles XI and XVIII of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1301">42 U.S.C. 1301 et seq.</external-xref>; 1395 et seq.) as may be necessary to
carry out the demonstration project under this subsection.</text>
</subparagraph></paragraph><paragraph id="HAFFCB74875A545F9A7FDD4565FD9054"><enum>(5)</enum><header>Evaluation and
report</header>
<subparagraph id="HB2D895050D08464F8DDA49DF540095B0"><enum>(A)</enum><header>Evaluation</header><text>The
Secretary shall evaluate the demonstration project under this subsection
to—</text>
<clause id="HB77DF55BE68748D1930049BE80A44612"><enum>(i)</enum><text>assess the
timeliness and efficacy of the demonstration project;</text>
</clause><clause id="H5B860FEFD27448A9BCC27ECCE91C9DA5"><enum>(ii)</enum><text>assess the
performance of entities under a contract entered into under paragraph
(2)(I)(i);</text>
</clause><clause id="HD06AF28AA67D4321AF647D1861958B6F"><enum>(iii)</enum><text>analyze
data—</text>
<subclause id="HB0CEA827D42B422897D64067CD324CB4"><enum>(I)</enum><text>on the rates of
appropriate, uncertain, and inappropriate advanced diagnostic imaging services
furnished by physicians participating in the demonstration project;</text>
</subclause><subclause id="H1CE4363935AC472EB9FF13102BC2305B"><enum>(II)</enum><text>on patterns and
trends in the appropriateness and inappropriateness of such services furnished
by such physicians;</text>
</subclause><subclause id="H57CA0BC293A340B987E3CFDA1330EA5D"><enum>(III)</enum><text>on patterns and
trends in national and regional variations of care with respect to the
furnishing of such services; and</text>
</subclause><subclause id="H44035606EB914A26A6069606B1FBB8F"><enum>(IV)</enum><text>on the correlation
between the appropriateness of the services furnished and image results;
and</text>
</subclause></clause><clause id="H59A4266BB64C44E2B9FFE7EC881FB3A4"><enum>(iv)</enum><text>address—</text>
<subclause id="HF4DA850299EF427899F04F2E19D90052"><enum>(I)</enum><text>the thresholds
used under the demonstration project to identify acceptable and outlier levels
of performance with respect to the appropriateness of advanced diagnostic
imaging services furnished;</text>
</subclause><subclause id="H86C5F46BB6D245B3852E7D1E5B391BF1"><enum>(II)</enum><text>whether
prospective use of appropriateness criteria could have an effect on the volume
of such services furnished;</text>
</subclause><subclause id="H4909BA1CBED64177B569EF4EA3986DD5"><enum>(III)</enum><text>whether
expansion of the use of appropriateness criteria with respect to such services
to a broader population of Medicare beneficiaries would be advisable;</text>
</subclause><subclause id="HD9852A573F48459EB2F8241536E61C21"><enum>(IV)</enum><text>whether, under
such an expansion, physicians who demonstrate consistent compliance with such
appropriateness criteria should be exempted from certain requirements;</text>
</subclause><subclause id="H79EAD72E7C2F48728F96EBACED7643F"><enum>(V)</enum><text>the use of
incident-specific versus practice-specific outlier information in formulating
future recommendations with respect to the use of appropriateness criteria for
such services under the Medicare program; and</text>
</subclause><subclause id="HADBBCE363C3C42B9853C61565006961D"><enum>(VI)</enum><text>the potential for
using methods (including financial incentives), in addition to those used under
the models under the demonstration project, to ensure compliance with such
criteria.</text>
</subclause></clause></subparagraph><subparagraph id="H1D6AD866B8AE46A68E4E284037BA0043"><enum>(B)</enum><header>Report</header><text>Not
later than 1 year after the completion of the demonstration project under this
subsection, the Secretary shall submit to Congress a report containing the
results of the evaluation of the demonstration project conducted under
subparagraph (A), together with recommendations for such legislation and
administrative action as the Secretary determines appropriate.</text>
</subparagraph></paragraph><paragraph id="H828507A730C744928C5E83A43DB6953B"><enum>(6)</enum><header>Funding</header><text>The
Secretary shall provide for the transfer from the Federal Supplementary Medical
Insurance Trust Fund established 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>) of $10,000,000, for carrying out the demonstration project
under this subsection (including costs associated with administering the
demonstration project, reimbursing physicians for administrative costs and
providing incentives to encourage participation under paragraph (2)(C),
entering into contracts under paragraph (2)(I), and evaluating the
demonstration project under paragraph (5)).</text>
</paragraph></subsection><subsection id="H5E44EBA6C1E34062BFD6C77D804971F7"><enum>(c)</enum><header>GAO studies and
reports</header>
<paragraph id="H45FC7BA8BAC04AFFACF1947E3C79DEA4"><enum>(1)</enum><header>Study on
accreditation requirement for advanced diagnostic imaging services</header>
<subparagraph id="H2B98792155714CEFA03BC0C188519EF"><enum>(A)</enum><header>Study</header>
<clause id="H6727AC0F654D401F9F9FA2687870694B"><enum>(i)</enum><header>In
general</header><text>The Comptroller General of the United States (in this
subsection referred to as the <quote>Comptroller General</quote>) shall conduct
a study, by imaging modality, on—</text>
<subclause id="H9F4078B414554DBB983400DB6B6F103D"><enum>(I)</enum><text>the effect of the
accreditation requirement under section 1834(e) of the Social Security Act, as
added by subsection (a); and</text>
</subclause><subclause id="H3AD24D45BDB245509501046057D88B18"><enum>(II)</enum><text>any other
relevant questions involving access to, and the value of, advanced diagnostic
imaging services for Medicare beneficiaries.</text>
</subclause></clause><clause id="H4C510B293A7F434D803192DB898B96FF"><enum>(ii)</enum><header>Issues</header><text>The
study conducted under clause (i) shall examine the following:</text>
<subclause id="H2BF43DDC47254F039BF2D7FCABF8C730"><enum>(I)</enum><text>The impact of such
accreditation requirement on the number, type, and quality of imaging services
furnished to Medicare beneficiaries.</text>
</subclause><subclause id="HBE8858E69A0A4931ACC4BE429F5C4E6C"><enum>(II)</enum><text>The cost of such
accreditation requirement, including costs to facilities of compliance with
such requirement and costs to the Secretary of administering such
requirement.</text>
</subclause><subclause id="HA5A77D74F8054F1DA758959126A6E48F"><enum>(III)</enum><text>Access to
imaging services by Medicare beneficiaries, especially in rural areas, before
and after implementation of such accreditation requirement.</text>
</subclause><subclause id="H9A3993D3F13548569894E290769F81BE"><enum>(IV)</enum><text>Such other issues
as the Secretary determines appropriate.</text>
</subclause></clause></subparagraph><subparagraph id="H687840EA033D483DB33934A99B99E2DE"><enum>(B)</enum><header>Reports</header>
<clause id="H8CC2386A39D8463AAF2177B3579440A5"><enum>(i)</enum><header>Preliminary
report</header><text>Not later than March 1, 2013, the Comptroller General
shall submit a preliminary report to Congress on the study conducted under
subparagraph (A).</text>
</clause><clause id="H23B018C39ECF46EBA8C7804D6307307E"><enum>(ii)</enum><header>Final
report</header><text>Not later than March 1, 2014, the Comptroller General
shall submit a final report to Congress on the study conducted under
subparagraph (A), together with recommendations for such legislation and
administrative action as the Comptroller General determines appropriate.</text>
</clause></subparagraph></paragraph><paragraph id="H2505B3ECDD424B3F91DC9D4427F85072"><enum>(2)</enum><header>Study on
interest rate and equipment utilization assumptions used in determining
practice expense</header>
<subparagraph id="H3704F99603514954A45DA44BEA347EAF"><enum>(A)</enum><header>Study</header>
<clause id="H0FDD1E59926C4C4AA0F02DA258A7D7B5"><enum>(i)</enum><header>In
general</header><text>The Comptroller General shall conduct a study on the
assumptions used for interest rate and equipment utilization in the methodology
for determination of practice expense relative value units under section
1848(c)(2)(C)(ii) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)(C)(ii)</external-xref>)
with respect to imaging services.</text>
</clause><clause id="H4C521DA3C7F242258F3BD2AD3DD5416B"><enum>(ii)</enum><header>Collection of
data</header><text>In conducting the study under clause (i), the Comptroller
General shall collect data on imaging equipment utilization for different
modalities of imaging equipment used in—</text>
<subclause id="H2A0E53831E864B9EAB00270015640000"><enum>(I)</enum><text>different types of
practices; and</text>
</subclause><subclause id="H615C4BE14C1E43959C8450AED7306FD1"><enum>(II)</enum><text>different
geographic areas.</text>
</subclause></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H983E64ABEF094768B1FDC16198727D26"><enum>(B)</enum><header>Report</header><text>Not
later than June 1, 2010, the Comptroller General shall submit to Congress a
report containing the results of the study conducted under subparagraph (A),
including the data collected under clause (ii) of such subparagraph, together
with recommendations for such legislation and administrative action as the
Comptroller General determines appropriate.</text>
</subparagraph></paragraph></subsection></section><section id="HAEEE38F7499943D6A260A3B458F63294"><enum>136.</enum><header>Extension of
treatment of certain physician pathology services under Medicare</header><text display-inline="no-display-inline">Section 542(c) of the Medicare, Medicaid,
and SCHIP Benefits Improvement and Protection Act of 2000 (as enacted into law
by section 1(a)(6) of <external-xref legal-doc="public-law" parsable-cite="pl/106/554">Public Law 106–554</external-xref>), as amended by section 732 of the
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (42
U.S.C. 1395w–4 note), section 104 of division B of the Tax Relief and Health
Care Act of 2006 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4</external-xref> note), and section 104 of the Medicare,
Medicaid, and SCHIP Extension Act of 2007 (<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>), is amended by
striking <quote>2007, and the first 6 months of 2008</quote> and inserting
<quote>2007, 2008, and 2009</quote>.</text>
</section><section display-inline="no-display-inline" id="H4E7542536F85413695C9B5335E83C172" section-type="subsequent-section"><enum>137.</enum><header>Accommodation of
physicians ordered to active duty in the Armed Services</header><text display-inline="no-display-inline">Section 1842(b)(6)(D)(iii) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395u">42 U.S.C. 1395u(b)(6)(D)(iii)</external-xref>), as amended by section 116 of the
Medicare, Medicaid, and SCHIP Extension Act of 2007 (<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>), is
amended by striking <quote>(before July 1, 2008)</quote>.</text>
</section><section commented="no" id="HB6CDC850441C436298E954305878B8A9"><enum>138.</enum><header>Adjustment for
Medicare mental health services</header>
<subsection id="HF4F28B297DF94CA9979BB2F7982BDE9F"><enum>(a)</enum><header>Payment
adjustment</header>
<paragraph id="H62C21CCEADB048E9924126C6FC0805C2"><enum>(1)</enum><header>In
general</header><text>For purposes of payment for services furnished under the
physician fee schedule under section 1848 of the Social Security Act (42 U.S.C.
1395w–4) during the period beginning on July 1, 2008, and ending on December
31, 2009, the Secretary of Health and Human Services shall increase the fee
schedule otherwise applicable for specified services by 5 percent.</text>
</paragraph><paragraph id="H9F87301584C846B1B0CF1585E1C0EFF5"><enum>(2)</enum><header>Nonapplication
of budget-neutrality</header><text>The budget-neutrality provision of section
1848(c)(2)(B)(ii) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)(B)(ii)</external-xref>)
shall not apply to the adjustments described in paragraph (1).</text>
</paragraph></subsection><subsection id="H616D11F852D34102AD022DFA76A224BB"><enum>(b)</enum><header>Definition of
specified services</header><text>In this section, the term <term>specified
services</term> means procedure codes for services in the categories of the
Health Care Common Procedure Coding System, established by the Secretary of
Health and Human Services under section 1848(c)(5) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(5)</external-xref>), as of July 1, 2007, and as subsequently modified by
the Secretary, consisting of psychiatric therapeutic procedures furnished in
office or other outpatient facility settings or in inpatient hospital, partial
hospital, or residential care facility settings, but only with respect to such
services in such categories that are in the subcategories of services which
are—</text>
<paragraph id="H79E99FF47904445DBE809BA5FF072642"><enum>(1)</enum><text>insight oriented,
behavior modifying, or supportive psychotherapy; or</text>
</paragraph><paragraph id="H04A3BFD39C1F41E281396F6F8F301966"><enum>(2)</enum><text>interactive
psychotherapy.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H5CBF647069F545BFB963B04C87A3BEF7"><enum>(c)</enum><header>Implementation</header><text>Notwithstanding
any other provision of law, the Secretary may implement this section by program
instruction or otherwise.</text>
</subsection></section><section id="H085EE7D153C84C37BF00D525478302C0"><enum>139.</enum><header>Improvements
for Medicare anesthesia teaching programs</header>
<subsection id="H091CAA32A8D94A69A3AB63AA1FF75DF8"><enum>(a)</enum><header>Special payment
rule for teaching anesthesiologists</header><text display-inline="yes-display-inline">Section 1848(a) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(a)</external-xref>), as amended by section 132(b), is amended—</text>
<paragraph id="H2BF180D7F76A438D8250946BF4203CB"><enum>(1)</enum><text>in
paragraph (4)(A), by inserting <quote>except as provided in paragraph
(5),</quote> after <quote>anesthesia cases,</quote>; and</text>
</paragraph><paragraph id="HC2FF8CF2B68842399099CF3CA7D08194"><enum>(2)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HE5761736B3674880B662296F73F33D11" style="OLC">
<paragraph id="H678C0C5438AD48C8827EBCE6BB9158EC"><enum>(6)</enum><header>Special rule for
teaching anesthesiologists</header><text>With respect to physicians’ services
furnished on or after January 1, 2010, in the case of teaching
anesthesiologists involved in the training of physician residents in a single
anesthesia case or two concurrent anesthesia cases, the fee schedule amount to
be applied shall be 100 percent of the fee schedule amount otherwise applicable
under this section if the anesthesia services were personally performed by the
teaching anesthesiologist alone and paragraph (4) shall not apply if—</text>
<subparagraph id="H47D85762AF3E4D94ADB2A2CDA7322B47"><enum>(A)</enum><text>the teaching
anesthesiologist is present during all critical or key portions of the
anesthesia service or procedure involved; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H488D92FB3E69489BAD85F064B7D8A445"><enum>(B)</enum><text>the teaching
anesthesiologist (or another anesthesiologist with whom the teaching
anesthesiologist has entered into an arrangement) is immediately available to
furnish anesthesia services during the entire
procedure.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H42BD5F13D83B48819BFD379EAF93D5DC"><enum>(b)</enum><header>Treatment of
certified registered nurse anesthetists</header><text>With respect to items and
services furnished on or after January 1, 2010, the Secretary of Health and
Human Services shall make appropriate adjustments to payments under the
Medicare program under title XVIII of the Social Security Act for teaching
certified registered nurse anesthetists to implement a policy with respect to
teaching certified registered nurse anesthetists that—</text>
<paragraph id="HD6FCECAAA30746329BC681A376166915"><enum>(1)</enum><text>is consistent with
the adjustments made by the special rule for teaching anesthesiologists under
section 1848(a)(6) of the Social Security Act, as added by subsection (a);
and</text>
</paragraph><paragraph id="H54AB729C6DF1466400D357CE8BEA7F10"><enum>(2)</enum><text>maintains the
existing payment differences between teaching anesthesiologists and teaching
certified registered nurse anesthetists.</text>
</paragraph></subsection></section></part><part id="H230EF9E1D5B9485491C8DD51BDDDBA63"><enum>II</enum><header>Other
payment and coverage improvements</header>
<section display-inline="no-display-inline" id="HC1A18EBD60F8469FB440FC378BB245EF"><enum>141.</enum><header>Extension of
exceptions process for Medicare therapy caps</header><text display-inline="no-display-inline">Section 1833(g)(5) of the Social Security
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(g)(5)</external-xref>), as amended by section 105 of the Medicare,
Medicaid, and SCHIP Extension Act of 2007 (<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>), is amended by
striking <quote>June 30, 2008</quote> and inserting <quote>December 31,
2009</quote>.</text>
</section><section id="HAD5D656BF2DE410A9C26E74C7321EAA2"><enum>142.</enum><header>Extension of
payment rule for brachytherapy and therapeutic
radiopharmaceuticals</header><text display-inline="no-display-inline">Section
1833(t)(16)(C) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(t)(16)(C)</external-xref>), as
amended by section 106 of the Medicare, Medicaid, and SCHIP Extension Act of
2007 (<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>), is amended by striking <quote>July 1, 2008</quote>
each place it appears and inserting <quote>January 1, 2010</quote>.</text>
</section><section display-inline="no-display-inline" id="H6011621617824CE4A891217DBFB2B12D" section-type="subsequent-section"><enum>143.</enum><header>Speech-language
pathology services</header>
<subsection id="H66F0C6808F6148E50042132CC480CCCA"><enum>(a)</enum><header>In
general</header><text>Section 1861(ll) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(ll)</external-xref>) is
amended—</text>
<paragraph id="HF1722EE50AD74D50BE98952D8E543DA5"><enum>(1)</enum><text>by redesignating
paragraphs (2) and (3) as paragraphs (3) and (4), respectively; and</text>
</paragraph><paragraph id="H2A24D71EC6724B1BAD923B28184F5EBF"><enum>(2)</enum><text>by inserting after
paragraph (1) the following new paragraph:</text>
<quoted-block id="HD68F01E0D90644D79E2B5F2B7D31A704">
<paragraph id="HFB9CC1C52EAB4587A1AA95B5CD9328B8" indent="up1"><enum>(2)</enum><text>The term <term>outpatient
speech-language pathology services</term> has the meaning given the term
<term>outpatient physical therapy services</term> in subsection (p), except
that in applying such subsection—</text>
<subparagraph id="H4322F94298D64B5BA9B3E4EFC7AC3EFD"><enum>(A)</enum><text><quote>speech-language
pathology</quote> shall be substituted for <quote>physical therapy</quote> each
place it appears; and</text>
</subparagraph><subparagraph id="H17A351A5FEF949AAAABBB2C4F72961AB"><enum>(B)</enum><text><quote>speech-language
pathologist</quote> shall be substituted for <quote>physical therapist</quote>
each place it
appears.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HDCF6BE1CEBD0410BBBB7A95431F29953"><enum>(b)</enum><header>Conforming
amendments</header>
<paragraph id="HE63B70F0C5834EB5B1B2A0DF617302D8"><enum>(1)</enum><text>Section
1832(a)(2)(C) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395k">42 U.S.C. 1395k(a)(2)(C)</external-xref>) is
amended—</text>
<subparagraph id="HC37F8BBADB08432D9CC6CE8245DB0089"><enum>(A)</enum><text>by striking
<quote>and outpatient</quote> and inserting <quote>, outpatient</quote>;
and</text>
</subparagraph><subparagraph id="H65472224C41B4CC197F7136E4D51BA20"><enum>(B)</enum><text>by inserting
before the semicolon at the end the following: <quote>, and outpatient
speech-language pathology services (other than services to which the second
sentence of section 1861(p) applies through the application of section
1861(ll)(2))</quote>.</text>
</subparagraph></paragraph><paragraph id="H64BA815461C343699F4D230455FAA548"><enum>(2)</enum><text display-inline="yes-display-inline">Subparagraphs (A) and (B) of section
1833(a)(8) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(a)(8)</external-xref>) are each amended
by striking <quote>(which includes outpatient speech-language pathology
services)</quote> and inserting <quote>, outpatient speech-language pathology
services,</quote>.</text>
</paragraph><paragraph id="HEF335411F8B74619BE882D80BD009937"><enum>(3)</enum><text>Section 1833(g)(1)
of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(g)(1)</external-xref>) is amended—</text>
<subparagraph id="HEDA95387D0BF4C7BBEE95657D8949959"><enum>(A)</enum><text>by inserting
<quote>and speech-language pathology services of the type described in such
section through the application of section 1861(ll)(2)</quote> after
<quote>1861(p)</quote>; and</text>
</subparagraph><subparagraph id="H13330AA3DF6B4157B228AB1F46D00C2"><enum>(B)</enum><text>by inserting
<quote>and speech-language pathology services</quote> after <quote>and physical
therapy services</quote>.</text>
</subparagraph></paragraph><paragraph id="H1868C8D979614BA091FE60C5661CFD2C"><enum>(4)</enum><text>The second
sentence of section 1835(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395n">42 U.S.C. 1395n(a)</external-xref>) is
amended—</text>
<subparagraph id="HADE2778B06C84ED2A36E34CE0041B340"><enum>(A)</enum><text display-inline="yes-display-inline">by striking <quote>section 1861(g)</quote>
and inserting <quote>subsection (g) or (ll)(2) of section 1861</quote> each
place it appears; and</text>
</subparagraph><subparagraph id="H7014392273B34614A921ACFB88DFB7A2"><enum>(B)</enum><text>by inserting
<quote>or outpatient speech-language pathology services, respectively</quote>
after <quote>occupational therapy services</quote>.</text>
</subparagraph></paragraph><paragraph id="H2B8341C6D7444DE1A270A6946215F437"><enum>(5)</enum><text>Section 1861(p) of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(p)</external-xref>) is amended by striking the fourth
sentence.</text>
</paragraph><paragraph id="H6D643E418CC84264B2CE007900FE08F4"><enum>(6)</enum><text>Section
1861(s)(2)(D) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(s)(2)(D)</external-xref>) is amended
by inserting <quote>, outpatient speech-language pathology services,</quote>
after <quote>physical therapy services</quote>.</text>
</paragraph><paragraph id="H675710516789457FBB0042A911B2A553"><enum>(7)</enum><text>Section
1862(a)(20) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395y">42 U.S.C. 1395y(a)(20)</external-xref>) is
amended—</text>
<subparagraph id="H954E542F62854ED9B61D5CE1071BE804"><enum>(A)</enum><text>by striking
<quote>outpatient occupational therapy services or outpatient physical therapy
services</quote> and inserting <quote>outpatient physical therapy services,
outpatient speech-language pathology services, or outpatient occupational
therapy services</quote>; and</text>
</subparagraph><subparagraph id="H1B619C4F4CF04C0E007777A138847BA3"><enum>(B)</enum><text>by striking
<quote>section 1861(g)</quote> and inserting <quote>subsection (g) or (ll)(2)
of section 1861</quote>.</text>
</subparagraph></paragraph><paragraph id="HCB817CF90BE54200B79218E6C25712DD"><enum>(8)</enum><text>Section 1866(e)(1)
of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc(e)(1)</external-xref>) is amended—</text>
<subparagraph id="H49D967F5061C47D188CAE20044ADA209"><enum>(A)</enum><text display-inline="yes-display-inline">by striking <quote>section 1861(g)</quote>
and inserting <quote>subsection (g) or (ll)(2) of section 1861</quote> the
first two places it appears;</text>
</subparagraph><subparagraph id="HDEF87131DD054E3CABC2A4B400223BAD"><enum>(B)</enum><text>by striking
<quote>defined) or</quote> and inserting <quote>defined),</quote>; and</text>
</subparagraph><subparagraph id="HBDF5ADECC3EE42CCA13F177FB084418"><enum>(C)</enum><text>by inserting before
the semicolon at the end the following: <quote>, or (through the operation of
section 1861(ll)(2)) with respect to the furnishing of outpatient
speech-language pathology </quote>.</text>
</subparagraph></paragraph><paragraph id="HEA37E3096B5942308209A2F893CB044C"><enum>(9)</enum><text>Section 1877(h)(6)
of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395nn">42 U.S.C. 1395nn(h)(6)</external-xref>) is amended by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HCF8AAA037498452FB089F36334B9C915" style="OLC">
<subparagraph id="H5851556D2DCF4A72A6FF002E9F55111B"><enum>(L)</enum><text display-inline="yes-display-inline">Outpatient speech-language pathology
services.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H135CD22C73CC43D1A344B328F5B2ABC"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to services
furnished on or after July 1, 2009.</text>
</subsection><subsection id="HE757D8546C8E47FA88B8F409EBEB7C3B"><enum>(d)</enum><header>Construction</header><text display-inline="yes-display-inline">Nothing in this section shall be construed
to affect existing regulations and policies of the Centers for Medicare &
Medicaid Services that require physician oversight of care as a condition of
payment for speech-language pathology services under part B of the Medicare
program.</text>
</subsection></section><section id="H547F6B7625384032B940551CC4EF005D"><enum>144.</enum><header>Payment and
coverage improvements for patients with chronic obstructive pulmonary disease
and other conditions</header>
<subsection commented="no" display-inline="no-display-inline" id="H486C11C25C2743BFAF62489F8F6E033E"><enum>(a)</enum><header>Coverage of
pulmonary and cardiac rehabilitation</header>
<paragraph commented="no" display-inline="no-display-inline" id="HC8AEB0C80AB94A88B57FB66BD2452584"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1861 of the
Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x</external-xref>), as amended by section 101(a), is
amended—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HFC6D9262F86B47EDA6A843A43253D66"><enum>(A)</enum><text display-inline="yes-display-inline">in subsection (s)(2)—</text>
<clause id="H7ABE7FF9D002487F8981FFD9C4CB5CED"><enum>(i)</enum><text>in
subparagraph (AA), by striking <quote>and</quote> at the end;</text>
</clause><clause id="H43F63047489A4380AC7BDC54098D33EF"><enum>(ii)</enum><text>in
subparagraph (BB), by adding <quote>and</quote> after the semicolon at the end;
and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HFA1429E864EA43E58DD455DD488D1664"><enum>(iii)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H23782F9AD4FA490082613F00C820181" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="HE3EB5885141247B9828E977258636890"><enum>(CC)</enum><text display-inline="yes-display-inline">items and services furnished under a
cardiac rehabilitation program (as defined in subsection (eee)(1)) or under a
pulmonary rehabilitation program (as defined in subsection
(fff)(1));</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H491FF019F4DE42E78B89B867F21E67C3"><enum>(B)</enum><text display-inline="yes-display-inline">by adding at the end the following new
subsections:</text>
<quoted-block display-inline="no-display-inline" id="HDE65BF85CB384FD1ABFB4018F514C870" other-style="archaic" style="other">
<subsection commented="no" display-inline="no-display-inline" id="H761900F9D94A4EB400FCFC99F089394E"><enum>(eee)</enum><header>Cardiac rehabilitation program</header><paragraph commented="no" display-inline="yes-display-inline" id="H0523B9EA9C604F4CBDCE3E7EE4FC1AD"><enum>(1)</enum><text display-inline="yes-display-inline">The term <term>cardiac rehabilitation
program</term> means a physician-supervised program (as described in paragraph
(2)) that furnishes the items and services described in paragraph (3).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H62851531ED424BCE88996FEBA3AE9E2D" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">A
program described in this paragraph is a program under which—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H80DDC664AF25490C8F1D5400EE81B5C1"><enum>(A)</enum><text display-inline="yes-display-inline">items and services under the program are
delivered—</text>
<clause commented="no" display-inline="no-display-inline" id="H982CF321D4F2416FA3CF390374A728F3"><enum>(i)</enum><text display-inline="yes-display-inline">in a physician’s office;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H4357AE6B2AE64A7684D16AFF4AEF69"><enum>(ii)</enum><text display-inline="yes-display-inline">in a hospital on an outpatient basis;
or</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H9DADC8A4D7D5448DA0ADB24F436D682"><enum>(iii)</enum><text>in other settings determined
appropriate by the Secretary.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HB6FD1764164E4B519866B2DB6C5F14C6"><enum>(B)</enum><text display-inline="yes-display-inline">a physician is immediately available and
accessible for medical consultation and medical emergencies at all times items
and services are being furnished under the program, except that, in the case of
items and services furnished under such a program in a hospital, such
availability shall be presumed; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H1398D82FCE674A1797A700EBBBA7C531"><enum>(C)</enum><text display-inline="yes-display-inline">individualized treatment is furnished under
a written plan established, reviewed, and signed by a physician every 30 days
that describes—</text>
<clause commented="no" display-inline="no-display-inline" id="HF1277AA733934354814FB13749E5486"><enum>(i)</enum><text display-inline="yes-display-inline">the individual’s diagnosis;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HAE63084FDCA54B01AD9397F307F996AD"><enum>(ii)</enum><text display-inline="yes-display-inline">the type, amount, frequency, and duration
of the items and services furnished under the plan; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HF0F9F5ADD8BF4BE5A090B1883701006D"><enum>(iii)</enum><text display-inline="yes-display-inline">the goals set for the individual under the
plan.</text>
</clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H972F7AFA68D94C4A97AC1E00AB67EA8D" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">The items and services described in this
paragraph are—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H0B60930C2E6E4A6D863DC6C09B009EF6"><enum>(A)</enum><text display-inline="yes-display-inline">physician-prescribed exercise;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HC942CC724E424A2A98DDB46002F95FC"><enum>(B)</enum><text display-inline="yes-display-inline">cardiac risk factor modification, including
education, counseling, and behavioral intervention (to the extent such
education, counseling, and behavioral intervention is closely related to the
individual’s care and treatment and is tailored to the individual’s
needs);</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HC662C00222894B1AAE95876E3FC3CF2B"><enum>(C)</enum><text display-inline="yes-display-inline">psychosocial assessment;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HAD71E070EEC24CF0AABE17BDA126C2DA"><enum>(D)</enum><text display-inline="yes-display-inline">outcomes assessment; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H0F769EDAC88B42E8B4AFB0B800006200"><enum>(E)</enum><text display-inline="yes-display-inline">such other items and services as the
Secretary may determine, but only if such items and services are—</text>
<clause commented="no" display-inline="no-display-inline" id="H44532DD0EB8143CA826C98B63994D3F2"><enum>(i)</enum><text display-inline="yes-display-inline">reasonable and necessary for the diagnosis
or active treatment of the individual’s condition;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H9E77F2500266450AAAB99E7E6DDE35D0"><enum>(ii)</enum><text display-inline="yes-display-inline">reasonably expected to improve or maintain
the individual’s condition and functional level; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HA6334B79A39148948B4C663831E090EA"><enum>(iii)</enum><text display-inline="yes-display-inline">furnished under such guidelines relating to
the frequency and duration of such items and services as the Secretary shall
establish, taking into account accepted norms of medical practice and the
reasonable expectation of improvement of the individual.</text>
</clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H5578D5437B06499AB04E1480FA0C3A0" indent="up1"><enum>(4)</enum><text display-inline="yes-display-inline">The Secretary shall establish standards to
ensure that a physician with expertise in the management of individuals with
cardiac pathophysiology who is licensed to practice medicine in the State in
which a cardiac rehabilitation program (or the intensive cardiac rehabilitation
program, as the case may be) is offered—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H0CB7A8D63A5F4A8BB5573C49DBCFB450"><enum>(A)</enum><text display-inline="yes-display-inline">is responsible for such program; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H59D1C56F4DF642E8BD8573BDD06F3960"><enum>(B)</enum><text display-inline="yes-display-inline">in consultation with appropriate staff, is
involved substantially in directing the progress of individual in the
program.</text>
</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H80A6E84FD9BC456AB6B322C156E97423"><enum>(fff)</enum><header>Pulmonary rehabilitation
program</header><paragraph commented="no" display-inline="yes-display-inline" id="H0C1D91F327574F40B21E9FA1A34413C2"><enum>(1)</enum><text display-inline="yes-display-inline">The term <term>pulmonary rehabilitation
program</term> means a physician-supervised program (as described in subsection
(eee)(2) with respect to a program under this subsection) that furnishes the
items and services described in paragraph (2).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H1769164B16294209B9B22500AD812BD6" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">The items and services described in this
paragraph are—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H1D19EE32544646ABB815C6867F222406"><enum>(A)</enum><text display-inline="yes-display-inline">physician-prescribed exercise;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HCBAC7CAF35EC4D8287656769EB35DA74"><enum>(B)</enum><text display-inline="yes-display-inline">education or training (to the extent the
education or training is closely and clearly related to the individual’s care
and treatment and is tailored to such individual’s needs);</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H4EDDB878C1234FEDAB2497A8E916EAFC"><enum>(C)</enum><text display-inline="yes-display-inline">psychosocial assessment;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HBCBC9B2C00094DD8BEA7CDA7CF32B813"><enum>(D)</enum><text display-inline="yes-display-inline">outcomes assessment; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H5F3AB940B3784E408E29A2A6006F73FC"><enum>(E)</enum><text display-inline="yes-display-inline">such other items and services as the
Secretary may determine, but only if such items and services are—</text>
<clause commented="no" display-inline="no-display-inline" id="H49F53197ADDF4A84AAD2A2F9F253004C"><enum>(i)</enum><text display-inline="yes-display-inline">reasonable and necessary for the diagnosis
or active treatment of the individual’s condition;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H269E4763F01D472DBFAA4EB4A2EB365C"><enum>(ii)</enum><text display-inline="yes-display-inline">reasonably expected to improve or maintain
the individual’s condition and functional level; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H09BC0ADCC8384C57B4CBE2A0BAF376D3"><enum>(iii)</enum><text display-inline="yes-display-inline">furnished under such guidelines relating to
the frequency and duration of such items and services as the Secretary shall
establish, taking into account accepted norms of medical practice and the
reasonable expectation of improvement of the individual.</text>
</clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HAABB35045D7C40E1BE2E5D53A5377FAE" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">The Secretary shall establish standards to
ensure that a physician with expertise in the management of individuals with
respiratory pathophysiology who is licensed to practice medicine in the State
in which a pulmonary rehabilitation program is offered—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HBFCCDD0962CF42098EB1BFD5DE4AB09"><enum>(A)</enum><text display-inline="yes-display-inline">is responsible for such program; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HE913FCCA5EFD43978ED1B855FA645900"><enum>(B)</enum><text display-inline="yes-display-inline">in consultation with appropriate staff, is
involved substantially in directing the progress of individual in the
program.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HC9C477F0942043C2BFF9DCBE0DCD8BF"><enum>(2)</enum><header>Effective
date</header><text display-inline="yes-display-inline">The amendments made by
this subsection shall apply to items and services furnished on or after January
1, 2010.</text>
</paragraph></subsection><subsection id="H1A362D16D9344F5792667417007D80BC"><enum>(b)</enum><header>Repeal of
transfer of ownership of oxygen equipment</header>
<paragraph id="H961BE8ED5FAE4D25A5BF7793FE1FA90"><enum>(1)</enum><header>In
general</header><text>Section 1834(a)(5)(F) of the Social Security Act (42
U.S.C. 1395m(a)(5)(F)) is amended—</text>
<subparagraph id="H9A6EC390C7BA4EFFA248C7FD5FCC5117"><enum>(A)</enum><text>in the heading, by
striking <quote><header-in-text level="subparagraph" style="OLC">Ownership of
equipment</header-in-text></quote> and inserting <quote><header-in-text level="subparagraph" style="OLC">Rental cap</header-in-text></quote>;
and</text>
</subparagraph><subparagraph id="H14D445E7449B4E00A6EF0096E6E75558"><enum>(B)</enum><text>by striking clause
(ii) and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="HC5BC7E3EB73842418314AA71618741FC" style="OLC">
<clause id="H8563D569D49F4428B200D4DB6BD1F12D"><enum>(ii)</enum><header>Payments and
rules after rental cap</header><text>After the 36th continuous month during
which payment is made for the equipment under this paragraph—</text>
<subclause id="H1228B1E2A13C42D18CD6B1493718A674"><enum>(I)</enum><text>the supplier
furnishing such equipment under this subsection shall continue to furnish the
equipment during any period of medical need for the remainder of the reasonable
useful lifetime of the equipment, as determined by the Secretary;</text>
</subclause><subclause id="HDC54B76C7240495C9CBBE7A2E504753E"><enum>(II)</enum><text>payments for
oxygen shall continue to be made in the amount recognized for oxygen under
paragraph (9) for the period of medical need; and</text>
</subclause><subclause id="HE8BA345D7C634728B7FF395100B6557B"><enum>(III)</enum><text>maintenance and
servicing payments shall, if the Secretary determines such payments are
reasonable and necessary, be made (for parts and labor not covered by the
supplier’s or manufacturer’s warranty, as determined by the Secretary to be
appropriate for the equipment), and such payments shall be in an amount
determined to be appropriate by the
Secretary.</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HBD231695E8A244799B353203F48BF8D7"><enum>(2)</enum><header>Effective
date</header><text>The amendments made by paragraph (1) shall take effect on
January 1, 2009.</text>
</paragraph></subsection><subsection commented="no" id="HD46E82EABF62418A949B653BC34FCAAF"><enum>(c)</enum><header>Revision of
payment for oxygen and oxygen equipment, portable oxygen equipment, and oxygen
for stationary equipment</header>
<paragraph commented="no" id="H4E73011B182F4FD3B0D30655E0850000"><enum>(1)</enum><header>Separate payment
for oxygen equipment and oxygen for stationary equipment</header><text display-inline="yes-display-inline">Section 1834(a) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(a)</external-xref>) is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H9C646281532A45ABADC1552E53A92B52" style="OLC">
<paragraph commented="no" id="H5E658B61C3654E3FA5AE413B7062D720"><enum>(22)</enum><header>Additional
special payment rule beginning in 2009</header>
<subparagraph commented="no" id="H1BB1EC0099D34BC08EC2DBD2480000CA"><enum>(A)</enum><header>In
general</header><text>Notwithstanding the preceding provisions of this
subsection, for oxygen equipment (other than portable oxygen and oxygen
equipment) furnished during 2009, the payment amount otherwise determined under
this subsection for such equipment shall be equal to—</text>
<clause commented="no" id="HD294203944234A69B39849FFD94E622C"><enum>(i)</enum><text>the amount of the
monthly payment amount otherwise established by the Secretary under this
subsection for oxygen and oxygen equipment (other than portable oxygen
equipment) furnished in 2009; minus</text>
</clause><clause commented="no" id="H62C00A7584474FF7B87EF59FAC5C16B"><enum>(ii)</enum><text>71 percent of the
amount of the monthly payment amount established by the Secretary under this
subsection for oxygen for stationary equipment furnished in such year.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HC2F3345094944A58986241B8B057079"><enum>(B)</enum><header display-inline="yes-display-inline">Application of update to special payment
amount</header><text display-inline="yes-display-inline">The covered item
update under paragraph (14) for oxygen equipment for 2010 and each subsequent
year shall be applied to the payment amount under subparagraph (A) unless
payment is made for such items and supplies under section
1847.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph commented="no" id="H87B21B245D4843F58B5BEC7181E6DDCD"><enum>(2)</enum><header>Add-on payment
for oxygen for stationary oxygen equipment</header><text>Section 1834(a)(5) of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(a)(5)</external-xref>) is amended by adding at the end
the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H3FA044BF241346D2BA8BFEE1A557CF5F" style="OLC">
<subparagraph commented="no" id="H55C41524382342D49585A0DD1F57145"><enum>(G)</enum><header>Add-on for oxygen
for stationary oxygen equipment</header><text>In the case of oxygen furnished
on or after January 1, 2009, when oxygen is used with stationary oxygen
equipment, the payment amount recognized under subparagraph (A) shall be
increased by the amount established by the Secretary for such oxygen (or 71
percent of such amount during the rental period for such
equipment).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph commented="no" id="HC7FC63D167374CC09C2BFEACCB855913"><enum>(3)</enum><header>Equalizing
add-on payment for oxygen for portable oxygen and oxygen equipment during
monthly rental period and payment for such oxygen and oxygen equipment after
such rental period</header><text>Section 1834(a)(9) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(a)(9)</external-xref>) is amended by adding at the end the following new
subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H5E9B8EE7C01547B8B2F97118C92F2271" style="OLC">
<subparagraph commented="no" id="H24ADCA2C040D44849FB86FB11B2B520"><enum>(E)</enum><header>Special rule for
add-on payment for portable oxygen and oxygen equipment</header><text>In the
case of oxygen and oxygen equipment furnished on or after January 1, 2009, for
purposes of paragraph (5)(B), the monthly amount recognized under this
paragraph for portable oxygen and oxygen equipment in a year shall be equal to
the monthly payment amount for portable oxygen and oxygen equipment applicable
for the year under this subsection after the end of the 36-month period under
paragraph
(5)(F).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph commented="no" id="HA0B2F2D04BA245BA8125EEF9FA93B8F"><enum>(4)</enum><header>Special rule for
add-on payments for oxygen generating portable equipment</header><text>Section
1834(a)(9) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(a)(9)</external-xref>), as amended by
paragraph (3), is amended by adding at the end the following new
subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H39FD71163CA7498C9CA3F9F02396C9E9" style="OLC">
<subparagraph commented="no" id="H2F5B424F52F541D4B27F3CD4EC1D808F"><enum>(F)</enum><header>Special rule for
add-on payment for oxygen generating portable equipment</header><text>In the
case of oxygen generating portable equipment, as defined by the Secretary,
furnished on or after January 1, 2009, the Secretary shall make the following
monthly add-on payments during the 36-month rental period under paragraph
(5)(F):</text>
<clause id="H7994C5A3B2B84D03BC83AFF0AD4449F"><enum>(i)</enum><text>An
amount equal to the monthly payment amount specified in subparagraph (E) for
the month.</text>
</clause><clause id="HF62823857F504C5C9B762202B7E036AF"><enum>(ii)</enum><text>An amount equal
to the monthly payment amount otherwise established by the Secretary under this
subsection for such equipment for the month that recognizes that such equipment
substitutes for the delivery of portable oxygen and oxygen contents during the
remaining useful life of the equipment that occurs after the end of such
36-month rental
period.</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph commented="no" id="H857F5FD8994643D0A57B70B74683EF82"><enum>(5)</enum><header>Cap on total
monthly payment for liquid or gaseous stationary and portable
systems</header><text>Section 1834(a)(5) of the Social Security Act (42 U.S.C.
1395m(a)(5)), as amended by paragraph (2), is amended by adding at the end the
following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H8C6F2E7975264C56B303009FAE2CA240" style="OLC">
<subparagraph commented="no" id="H4B39F6DD3D3F4DF49F061CD51638B2E1"><enum>(H)</enum><header>Cap on total
payments for liquid or gaseous stationary and portable systems</header><text>In
the case of a liquid or gaseous stationary and portable system furnished on or
after January 1, 2009, the total monthly amount recognized under this part for
such system for a month (including any add-on payments under this subsection)
may not exceed the total monthly amount that would have otherwise been
recognized under this part for such system for the month (including any add-on
payments under this subsection) if the amendments made by section 144(c) of the
<short-title>Medicare Efficiency and Development of
Improvement of Care and Services Act (MEDICS Act) of 2008</short-title> had not
been
enacted.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph commented="no" id="H4726C438B35144EF9B89294685F8031C"><enum>(6)</enum><header>Conforming
amendments</header><subparagraph commented="no" display-inline="yes-display-inline" id="HB01CC8D6391545D8ACA2052636368600"><enum>(A)</enum><text>Section 1834(a)(5)(A) of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(a)(5)(A)</external-xref>) is amended—</text>
<clause commented="no" id="H97D1540A77A04BA58580C709AA003500" indent="up1"><enum>(i)</enum><text>by inserting <quote>and, in the
case of items and services furnished on or after January 1, 2009, other than
oxygen for stationary equipment</quote> after <quote>portable oxygen
equipment</quote>; and</text>
</clause><clause commented="no" id="H433856CC9AFA42699827EB8B93F5772E" indent="up1"><enum>(ii)</enum><text>by striking <quote>subparagraphs
(B), (C), (E), and (F)</quote> and inserting <quote>the succeeding provisions
of this paragraph</quote>.</text>
</clause></subparagraph><subparagraph commented="no" id="H67778F67F21043F0815BD83C24972285" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">Section 1834(a)(9) of the Social Security
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(a)(9)</external-xref>) is amended—</text>
<clause commented="no" id="H703857BCB1D7465EB6AC494D84780890"><enum>(i)</enum><text>in the first sentence of the matter
preceding subparagraph (A), by striking <quote>For purposes</quote> and
inserting <quote>Subject to paragraphs (21) and (22), for purposes</quote>;
and</text>
</clause><clause commented="no" id="H09AE620F11194CB6907BAB56CC3C75F3"><enum>(ii)</enum><text display-inline="yes-display-inline">in the second sentence of the matter
preceding subparagraph (A)—</text>
<subclause commented="no" id="H8C4D92438EEB4BB98D004FE5791BEB6F"><enum>(I)</enum><text display-inline="yes-display-inline">by
inserting <quote>and, in the case of items and services furnished on or after
January 1, 2009, other than oxygen for stationary equipment</quote> after
<quote>portable oxygen equipment</quote>;</text>
</subclause><subclause commented="no" id="H609BC8B962D24467B8ABFBD6564F7DC9"><enum>(II)</enum><text>by striking <quote>and</quote> before
<quote>(ii)</quote> and inserting a comma; and</text>
</subclause><subclause commented="no" id="H7181CAD1364D4163A99DB4A37F767999"><enum>(III)</enum><text>by inserting <quote>, and (iii) in the
case of items and services furnished on or after January 1, 2009, for oxygen
for stationary equipment</quote> before <quote>(each such group</quote>.</text>
</subclause></clause></subparagraph></paragraph></subsection><subsection commented="no" id="HBEE381BED712463EB6DBF4C6F8294C9B"><enum>(d)</enum><header>Application to
competitive bidding</header><text>The amendments made by subsections (b) and
(c) shall not apply to contracts entered into under section 1847 of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-3">42 U.S.C. 1395w–3</external-xref>) prior to September 1, 2008, pursuant to the
implementation of subsection (a)(1)(B)(i)(I) of such section 1847.</text>
</subsection><subsection commented="no" id="H166EBE3D1C30469EABEF5675AF8EEFA5"><enum>(e)</enum><header>Institute of
Medicine study and report on payments for different classes of oxygen
equipment</header>
<paragraph commented="no" id="H97C071C3A34E46C295EBF3F2544B086"><enum>(1)</enum><header>Study</header><text>Not
later than 3 months after the date of the enactment of this Act, the Secretary
of Health and Human Services shall enter into a contract with the Institute of
Medicine of the National Academies (in this section referred to as the
<quote>Institute</quote>) under which the Institute shall conduct a study on
the furnishing of, and payments for, oxygen and oxygen equipment under the
Medicare program. Such study shall include an analysis of the following:</text>
<subparagraph commented="no" id="HE3B180AC0C9841ABA727E79C7E1900D1"><enum>(A)</enum><text>The costs and
activities associated with furnishing different modalities of oxygen equipment
(covering gaseous and liquid portable equipment and oxygen generating portable
equipment), including—</text>
<clause commented="no" id="H27B0879878234B5FB2628119EAF22FBB"><enum>(i)</enum><text>the acquisition
cost of the oxygen equipment;</text>
</clause><clause commented="no" id="HA2E682F20B074B4A83E2E7868FB8C19"><enum>(ii)</enum><text>the delivery and
refilling of oxygen contents for stationary and portable systems, including the
frequency of delivery;</text>
</clause><clause commented="no" id="H64957BC4A58C48748CBE9D4898C785F"><enum>(iii)</enum><text>the delivery of
the equipment and the provision of supplies and accessories;</text>
</clause><clause commented="no" id="HA1B9E0A03DD041F7AB285754893455E8"><enum>(iv)</enum><text>training and
education, intake of patient information and related documentation, and
responding to beneficiary inquiries;</text>
</clause><clause commented="no" id="H1BD46284328649CCA302295300BE12E7"><enum>(v)</enum><text>servicing of
different types of oxygen and oxygen equipment, including—</text>
<subclause commented="no" id="HE7C0322419424C60B6391CB313D844B8"><enum>(I)</enum><text>the type and
frequency of routine and nonroutine servicing furnished, and variation across
suppliers in furnishing such servicing; and</text>
</subclause><subclause commented="no" id="H2EB64055961F433C859636B94748F6B9"><enum>(II)</enum><text>the extent to
which emergency or after hours servicing is needed and furnished; and</text>
</subclause></clause><clause commented="no" id="HF6E99F551F3A49FCAAA7BDAAAFC5D37"><enum>(vi)</enum><text>other items or
activities involved with furnishing oxygen and oxygen equipment not described
in clauses (i) though (v).</text>
</clause></subparagraph><subparagraph commented="no" id="H3DF40857C01B45B5A43BB616BC637194"><enum>(B)</enum><text>Whether the
various items and activities described in subparagraph (A) are medically
necessary and affect patient outcomes.</text>
</subparagraph><subparagraph commented="no" id="H0197F6C03EC040278F49E430EA5C9352"><enum>(C)</enum><clause commented="no" display-inline="yes-display-inline" id="H2C0292147D764D7AA0EE352F2B82C76F"><enum>(i)</enum><text>The adequacy of Medicare
payment rates for oxygen equipment and necessary servicing and items and
activities furnished in connection with the provision of oxygen and oxygen
equipment; and</text>
</clause><clause commented="no" id="H68E9EDC292C74DCA898275CC658FEC23" indent="up1"><enum>(ii)</enum><text>how such payment rates compare to
competitively bid rates.</text>
</clause></subparagraph><subparagraph commented="no" id="H4FC8E615977D449891C7137C8E1005F5"><enum>(D)</enum><text>Whether payment
rates for oxygen and oxygen equipment under the Medicare program should vary
depending on the modality of oxygen equipment used or should be the same for
all modalities.</text>
</subparagraph><subparagraph commented="no" id="H41CD4475A2EE474EBCFCE191E166D9C6"><enum>(E)</enum><text>The adequacy of
add-on payments under the Medicare program for—</text>
<clause commented="no" id="HB436061029DC494DA51C939CABB9DE94"><enum>(i)</enum><text>contents for
stationary equipment;</text>
</clause><clause commented="no" id="H1681F5B5F85B4009A95548A44ED9D618"><enum>(ii)</enum><text>contents for
portable equipment; and</text>
</clause><clause commented="no" id="H30B84DB93A6D42868C05748BBD367D81"><enum>(iii)</enum><text>oxygen-generating
portable equipment.</text>
</clause></subparagraph><subparagraph commented="no" id="H4679ACBB11AA4F90874FC78728E817AB"><enum>(F)</enum><clause commented="no" display-inline="yes-display-inline" id="H5803195A80814D82ABE74992B08CC272"><enum>(i)</enum><text>Whether, during the
rental period for oxygen equipment under the Medicare program, payment for such
equipment and servicing should be bundled together or whether separate payments
are appropriate; and</text>
</clause><clause commented="no" id="H39884E243AC5478AB9AA6E6E342F9BB" indent="up1"><enum>(ii)</enum><text>if separate payments are
appropriate, how the payment should be allocated between equipment and
servicing.</text>
</clause></subparagraph><subparagraph commented="no" id="HAA5A2294385347F8A3CC362072F9A9E3"><enum>(G)</enum><text>Options that could
be considered for suppliers to document or report under the Medicare program
detailed information on activities related to furnishing oxygen and oxygen
equipment to Medicare beneficiaries.</text>
</subparagraph></paragraph><paragraph commented="no" id="HD29745B7F2B74A76BCC354B2504D007F"><enum>(2)</enum><header>Survey</header><text>In
conducting the study under paragraph (1), the Institute shall conduct a survey
of suppliers of oxygen and oxygen equipment to obtain data on items described
in paragraph (1)(A).</text>
</paragraph><paragraph commented="no" id="HA26E78CC9D6D422193F478B2CC7F842"><enum>(3)</enum><header>Report</header><text>Not
later than 18 months after the date of the enactment of this Act, the Institute
shall submit to the Secretary of Health and Human Services a report containing
the results of the study conducted under paragraph (1), together with such
recommendations as the Institute determines appropriate.</text>
</paragraph><paragraph commented="no" id="H8CD51D2BA7924693B734916E6C4F6771"><enum>(4)</enum><header>Funding</header><text>For
the purpose of carrying out this section, the Secretary of Health and Human
Services shall provide for the transfer, from the Federal Supplementary Medical
Insurance Trust Fund established 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>), of $5,000,000 to the Centers for Medicare & Medicaid
Services Program Management Account.</text>
</paragraph></subsection></section><section display-inline="no-display-inline" id="H096B36C9C1A9440F945F4FD048159B56" section-type="subsequent-section"><enum>145.</enum><header>Revision of payment
for power-driven wheelchairs</header>
<subsection id="H3B5F1A75CF454EA2B44BFDFEC80A4FE"><enum>(a)</enum><header>In
general</header><text>Section 1834(a)(7)(A) of the Social Security Act (42
U.S.C. 1395m(a)(7)(A)) is amended—</text>
<paragraph id="H7DC3687D60CF4617A7C095BA78F721F9"><enum>(1)</enum><text>in clause
(i)—</text>
<subparagraph id="HD6553CADAE2E4E75A3652D1C586E81D4"><enum>(A)</enum><text>in subclause (II),
by inserting <quote>subclause (III) and</quote> after <quote>Subject
to</quote>; and</text>
</subparagraph><subparagraph id="H39EF66E67B7B41A38F00C8006D929CB0"><enum>(B)</enum><text>by adding at the
end the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="H1F649E78FD434CFCB03BB51600FA2CEB" style="OLC">
<subclause id="H51FF3307DEAD40A80012AA4F84E7B573"><enum>(III)</enum><header>Special rule
for power-driven wheelchairs</header><text>For purposes of payment for
power-driven wheelchairs, subclause (II) shall be applied by substituting
<quote>15 percent</quote> and <quote>6 percent</quote> for <quote>10
percent</quote> and <quote>7.5 percent</quote>,
respectively.</text>
</subclause><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="HD95210472D31494286D2A660158353B0"><enum>(2)</enum><text>in clause
(iii)—</text>
<subparagraph id="H88AD63E12A5F40FCA2020698AAA0205B"><enum>(A)</enum><text>in the heading, by
inserting <quote><header-in-text level="clause" style="OLC">complex,
rehabilitative</header-in-text></quote> before <quote><header-in-text level="clause" style="OLC">power-driven</header-in-text></quote>; and</text>
</subparagraph><subparagraph id="H8747FD85160D46DCA3D1CEBF65370013"><enum>(B)</enum><text>by inserting
<quote>complex, rehabilitative</quote> before
<quote>power-driven</quote>.</text>
</subparagraph></paragraph></subsection><subsection id="H15B9AFAC7439493EA0FBE166D26251A8"><enum>(b)</enum><header>Technical
amendment</header><text>Section 1834(a)(7)(C)(ii)(II) of the Social Security
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(a)(7)(C)(ii)(II)</external-xref>) is amended by striking <quote>(A)(ii)
or</quote>.</text>
</subsection><subsection id="H5E0C0A40BA324CC1A30085443F251546"><enum>(c)</enum><header>Effective
date</header>
<paragraph id="H21EC99A40E00442FA02FE81D76035749"><enum>(1)</enum><header>In
general</header><text>Subject to paragraph (2), the amendments made by
subsection (a) shall take effect on January 1, 2009, and shall apply to
power-driven wheelchairs furnished on or after such date.</text>
</paragraph><paragraph commented="no" id="HDAA72C79D85944B5B3D1BE112C00E8B8"><enum>(2)</enum><header>Application to
competitive bidding</header><text>The amendments made by subsection (a) shall
not apply to contracts entered into under section 1847 of the Social Security
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-3">42 U.S.C. 1395w–3</external-xref>) prior to January 1, 2009, pursuant to the
implementation of subsection (a)(1)(B)(i)(I) of such section 1847.</text>
</paragraph></subsection></section><section id="HE1DA6DB1651A4A7D8B886E2CD6ADA085" section-type="subsequent-section"><enum>146.</enum><header>Clinical laboratory
tests</header>
<subsection id="H615CDE3AD1FE49638FB6D81E9CCF058D"><enum>(a)</enum><header>Repeal of
Medicare competitive bidding demonstration project for clinical laboratory
services</header>
<paragraph id="HD1261ACDB8A94D7B96F253449FBB82FA"><enum>(1)</enum><header>In
general</header><text>Section 1847 of the Social Security Act (42 U.S.C.
1395w–3) is amended by striking subsection (e).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HA86417AAC3F24539902C8519A2D2BCD2"><enum>(2)</enum><header>Conforming
amendments</header><text>Section 1833(a)(1)(D) of the Social Security Act (42
U.S.C. 1395l(a)(1)(D)) is amended—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H738BC2E53F97496DB33B31F98D6CFCAD"><enum>(A)</enum><text>by inserting
<quote>or</quote> before <quote>(ii)</quote>; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HB930F5C904DE4ECEBF1C2363EC94E159"><enum>(B)</enum><text>by striking
<quote>or (iii) on the basis</quote> and all that follows before the comma at
the end.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H9EE0BF50160E490B9D67D84054302094"><enum>(3)</enum><header>Effective
date</header><text>The amendments made by this subsection shall take effect on
the date of the enactment of this Act.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HFCCB0F75C7E74EA1B7AA1100C0F71EC"><enum>(b)</enum><header>Clinical
laboratory test fee schedule update adjustment</header><text>Section
1833(h)(2)(A)(i) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(h)(2)(A)(ii)</external-xref>) is
amended by inserting <quote>minus, for each of the years 2009 through 2013, 0.5
percentage points</quote> after <quote>city average)</quote>.</text>
</subsection></section><section id="H6760EE792AA74DC59DE170BC2329AEEE"><enum>147.</enum><header>Improved access
to ambulance services</header>
<subsection id="H2E62FC9A6C64434B89B0D0BF5372B05D"><enum>(a)</enum><header>Extension of
increased Medicare payments for ground ambulance services</header><text display-inline="yes-display-inline">Section 1834(l)(13) of the Social Security
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(l)(13)</external-xref>) is amended—</text>
<paragraph id="H1D8ECD6EF9544C9687ECE1062B0315FE"><enum>(1)</enum><text>in subparagraph
(A)—</text>
<subparagraph id="HA1726BA3C8F144D6A3FDFE3DAE45738C"><enum>(A)</enum><text>in the matter
preceding clause (i), by inserting <quote>and for such services furnished on or
after July 1, 2008, and before January 1, 2010</quote> after
<quote>2007,</quote>;</text>
</subparagraph><subparagraph commented="no" id="H9489439644264BFB821B0025D6A689FD"><enum>(B)</enum><text>in clause (i), by
inserting <quote>(or 3 percent if such service is furnished on or after July 1,
2008, and before January 1, 2010)</quote> after <quote>2 percent</quote>;
and</text>
</subparagraph><subparagraph commented="no" id="H4030D6B6BF2A4BE2AE4BF3A84FD7DD63"><enum>(C)</enum><text>in clause (ii), by
inserting <quote>(or 2 percent if such service is furnished on or after July 1,
2008, and before January 1, 2010)</quote> after <quote>1 percent</quote>;
and</text>
</subparagraph></paragraph><paragraph id="H0D34FE43E8E048B88702E6B4B6C53B7E"><enum>(2)</enum><text>in subparagraph
(B)—</text>
<subparagraph id="HA8E6895C0AE44245A8073CDF64500017"><enum>(A)</enum><text>in the heading, by
striking <quote><header-in-text level="subparagraph" style="OLC">2006</header-in-text></quote> and inserting <quote><header-in-text level="subparagraph" style="OLC">applicable period</header-in-text></quote>;
and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H35B1D7E7CA334C18B87FE62269597112"><enum>(B)</enum><text>by inserting
<quote>applicable</quote> before <quote>period</quote>.</text>
</subparagraph></paragraph></subsection><subsection id="H1031B1734CA14070BF95BE004970C9A3"><enum>(b)</enum><header>Air ambulance
payment improvements</header>
<paragraph id="HA7A2F28C75924E9ABC7E9056A56FEA6B"><enum>(1)</enum><header>Treatment of
certain areas for payment for air ambulance services under the ambulance fee
schedule</header><text>Notwithstanding any other provision of law, for purposes
of making payments under section 1834(l) of the Social Security Act (42 U.S.C.
1395m(l)) for air ambulance services furnished during the period beginning on
July 1, 2008, and ending on December 31, 2009, any area that was designated as
a rural area for purposes of making payments under such section for air
ambulance services furnished on December 31, 2006, shall be treated as a rural
area for purposes of making payments under such section for air ambulance
services furnished during such period.</text>
</paragraph><paragraph id="H422F4048BCF1458C961E9D207899EB5F"><enum>(2)</enum><header>Clarification
regarding satisfaction of requirement of medically necessary</header>
<subparagraph id="H2F773CB211E5426191FF636B20FDE442"><enum>(A)</enum><header>In
general</header><text>Section 1834(l)(14)(B)(i) of the Social Security Act (42
U.S.C. 1395m(l)(14)(B)(i)) is amended by striking <quote>reasonably determines
or certifies</quote> and inserting <quote>certifies or reasonably
determines</quote>.</text>
</subparagraph><subparagraph id="H9C265767185B42BEA336FF00278B9E84"><enum>(B)</enum><header>Effective
date</header><text>The amendment made by subparagraph (A) shall apply to
services furnished on or after the date of the enactment of this Act.</text>
</subparagraph></paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="HFF0AF52B1FB2494E87C5B295D00D961"><enum>148.</enum><header>Extension and
expansion of the Medicare hold harmless provision under the prospective payment
system for hospital outpatient department (HOPD) services for certain
hospitals</header><text display-inline="no-display-inline">Section
1833(t)(7)(D)(i) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(t)(7)(D)(i)</external-xref>) is
amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="HB011685691FF4B3DADD31F9C4CFC1"><enum>(1)</enum><text display-inline="yes-display-inline">in subclause (II)—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HDB4986657E2143D59F324F892C9269A"><enum>(A)</enum><text>in the first
sentence, by striking <quote>2009</quote> and inserting <quote>2010</quote>;
and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HEF9193E8E83D4B3389FBB414769180FE"><enum>(B)</enum><text display-inline="yes-display-inline">by striking the second sentence and
inserting the following new sentence: <quote>For purposes of the preceding
sentence, the applicable percentage shall be 95 percent with respect to covered
OPD services furnished in 2006, 90 percent with respect to such services
furnished in 2007, and 85 percent with respect to such services furnished in
2008 or 2009.</quote>; and</text>
</subparagraph></paragraph><paragraph display-inline="no-display-inline" id="HE106DA170C3042DC807BADAB159E2F86"><enum>(2)</enum><text>by adding at the
end the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="HE06E98D1959B4D4DB928276585AAB8C2" style="OLC">
<subclause commented="no" display-inline="no-display-inline" id="HBB25A3B6D2F744D188736FBCC430C21F" indent="up1"><enum>(III)</enum><text display-inline="yes-display-inline">In the case of a sole community hospital
(as defined in section 1886(d)(5)(D)(iii)) that has not more than 100 beds, for
covered OPD services furnished on or after January 1, 2009, and before January
1, 2010, for which the PPS amount is less than the pre-BBA amount, the amount
of payment under this subsection shall be increased by 85 percent of the amount
of such
difference.</text>
</subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section id="H02E96881EDA840C791003BE59718EBDB"><enum>149.</enum><header>Clarification
of payment for clinical laboratory tests furnished by critical access
hospitals</header>
<subsection id="HD56C2ED4807342899300048B016ED7F0"><enum>(a)</enum><header>In
general</header><text>Section 1834(g)(4) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(g)(4)</external-xref>) is
amended—</text>
<paragraph id="HF5FE6FA5BFA84671BA009417B47021A8"><enum>(1)</enum><text>in the heading, by
striking <quote><header-in-text level="paragraph" style="OLC">no beneficiary
cost-sharing for</header-in-text></quote> and inserting <quote><header-in-text level="paragraph" style="OLC">treatment of</header-in-text></quote>; and</text>
</paragraph><paragraph id="H3172E382E9A84B448239EBFAEEBBF6A4"><enum>(2)</enum><text>by adding at the
end the following new sentence: <quote>For purposes of the preceding sentence
and section 1861(mm)(3), clinical diagnostic laboratory services furnished by a
critical access hospital shall be treated as being furnished as part of
outpatient critical access services without regard to whether the individual
with respect to whom such services are furnished is physically present in the
critical access hospital, or in a skilled nursing facility or a clinic
(including a rural health clinic) that is operated by a critical access
hospital, at the time the specimen is collected.</quote>.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H86621BC0A57442978E5219D64F10A336"><enum>(b)</enum><header>Effective
date</header><text>The amendments made by subsection (a) shall apply to
services furnished on or after July 1, 2009.</text>
</subsection></section><section id="HF5D2CAF1EDED41C0A61C74762DEB8CF4"><enum>150.</enum><header>Adding certain
entities as originating sites for payment of telehealth services</header>
<subsection id="HC6B4D2D2125D48C5A107298600275FDA"><enum>(a)</enum><header>In
general</header><text>Section 1834(m)(4)(C)(ii) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395m(m)(4)(C)(ii)) is amended by adding at the end the following new
subclauses:</text>
<quoted-block act-name="Social Security Act" id="H8BA9BADB95C34CC4BC1DCCCC15918B7">
<subclause id="HA569842D12994699B0D2E4F1ABBFC412"><enum>(VI)</enum><text>A hospital-based
or critical access hospital-based renal dialysis center (including
satellites).</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="H98DC333DB0E34CDD9CB86356E4703CF9"><enum>(VII)</enum><text display-inline="yes-display-inline">A skilled nursing facility (as defined in
section 1819(a)).</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="HA32424F7FC054C0F92ECEF4C01F1E1E1"><enum>(VIII)</enum><text display-inline="yes-display-inline">A community mental health center (as
defined in section
1861(ff)(3)(B)).</text>
</subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H07719915987C4EF28CBD33AAB47777D4"><enum>(b)</enum><header>Conforming
amendment</header><text>Section 1888(e)(2)(A)(ii) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395yy">42 U.S.C. 1395yy(e)(2)(A)(ii)</external-xref>) is amended by inserting <quote>telehealth
services furnished under section 1834(m)(4)(C)(ii)(VII),</quote> after
<quote>section 1861(s)(2),</quote>.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H7BB01CB6CDDA4AC483FE63AEEC867331"><enum>(c)</enum><header>Effective
Date</header><text display-inline="yes-display-inline">The amendments made by
this section shall apply to services furnished on or after January 1,
2009.</text>
</subsection></section><section id="HF7DEBD6DE81B4803B7B2AB3202A700E3"><enum>151.</enum><header>MedPAC study
and report on improving chronic care demonstration programs</header>
<subsection id="H28F8FD3AA8184220A400913CAACA7F2"><enum>(a)</enum><header>Study</header><text>The
Medicare Payment Advisory Commission shall conduct a study on the feasability
and advisability of establishing a Medicare Chronic Care Practice Research
Network that would serve as a standing network of providers testing new models
of care coordination and other care approaches for chronically ill
beneficiaries, including the initiation, operation, evaluation, and, if
appropriate, expansion of such models to the broader Medicare patient
population.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H7F290BA293FE40D4AD07EF3FD4AE6DB"><enum>(b)</enum><header>Report</header><text>Not
later than June 15, 2009, the Medicare Payment Advisory Commission shall submit
to Congress a report containing the results of the study conducted under
subsection (a).</text>
</subsection></section><section id="HD724AE0EBCB94DC190963FEC5B743E51"><enum>152.</enum><header>Increase of
FQHC payment limits</header>
<subsection id="H1FDFF7082AFC41C488EC24A200534338"><enum>(a)</enum><header>In
general</header><text>Section 1833 of the Social Security Act (42 U.S.C.
1395l), as amended by section 133(a), is amended by adding at the end the
following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HBEC70CBBAD914442B5B8E1D33069C148" style="OLC">
<subsection id="H9ADF0D706BB640B49E354F245573C063"><enum>(w)</enum><header>Increase of FQHC
payment limits</header><text>In the case of services furnished by federally
qualified health centers (as defined in section 1861(aa)(4)), the Secretary
shall establish payment limits with respect to such services under this part
for services furnished—</text>
<paragraph id="H6A7606415CCF48B30052E382F1A6C74"><enum>(1)</enum><text>in 2010, at the
limits otherwise established under this part for such year increased by $5;
and</text>
</paragraph><paragraph id="H76DA63186A9C4E5BBEB2B8D893AA8E4D"><enum>(2)</enum><text>in a subsequent
year, at the limits established under this subsection for the previous year
increased by the percentage increase in the MEI (as defined in section
1842(i)(3)) for such subsequent
year.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H956F8BD06C714F2CAB54733E21BED4C6"><enum>(b)</enum><header>Study and report
on the effects and adequacy of the Medicare Federally qualified health center
payment structure</header>
<paragraph id="HD0D0DBD3429A4F44AD488E053423A8AF"><enum>(1)</enum><header>Study</header><text>The
Comptroller General of the United States shall conduct a study to determine
whether the structure for payments for services furnished by federally
qualified health centers (as defined in section 1861(aa)(4) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(aa)(4)</external-xref>) under part B of title XVIII of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395j">42 U.S.C. 1395j et seq.</external-xref>) adequately reimburses federally
qualified health centers for the care furnished to Medicare beneficiaries. In
conducting such study, the Comptroller General shall—</text>
<subparagraph id="H4E37EA29633B43A19BF188238F9F30B6"><enum>(A)</enum><text>use the most
current cost report data available;</text>
</subparagraph><subparagraph id="H6B846532B0D041EBAE6300C56337DE1D"><enum>(B)</enum><text>examine the
effects of the payment limits established with respect to such services under
such part B on the ability of federally qualified health centers to furnish
care to Medicare beneficiaries; and</text>
</subparagraph><subparagraph id="HC655F8B7AB55440A8FDEA5581C4633A2"><enum>(C)</enum><text>examine the cost
of furnishing services covered under the Medicare program as of the date of the
enactment of this Act that were not covered under such program as of the date
on which the Secretary determined the payment rate for federally qualified
health centers in 1991.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H6FF880DEC6954C8B8FB6BAAA4891763F"><enum>(2)</enum><header>Report</header><text>Not
later than 15 months after the date of the enactment of this Act, the
Comptroller General of the United States shall submit to Congress a report on
the study conducted under paragraph (1), together with recommendations for such
legislation and administrative action the Comptroller General determines
appropriate, taking into consideration the structure and adequacy of the
prospective payment methodology used to make payments to federally qualified
health centers under the Medicaid program under title XIX of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>).</text>
</paragraph></subsection></section><section display-inline="no-display-inline" id="H0AFB2B0423FE43E2B85FEE61BED6F925"><enum>153.</enum><header>Kidney disease
education and awareness provisions</header>
<subsection display-inline="no-display-inline" id="H1502ED124CFF4ABFAF365108B2A4E277"><enum>(a)</enum><header>Chronic kidney
disease initiatives</header><text>Part P of title III of the Public Health
Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/280g">42 U.S.C. 280g et seq.</external-xref>) is amended by adding at the end the
following new section:</text>
<quoted-block display-inline="no-display-inline" id="H96D1096AEAB34C128002CCE0CC96BF3C" style="OLC">
<section id="H5D082455D08F494B981FDC955D25C84"><enum>399R.</enum><header>Chronic kidney
disease initiatives</header>
<subsection id="HB319065A06C64FAB8BFF017975FB1752"><enum>(a)</enum><header>In
general</header><text>The Secretary shall establish pilot projects to—</text>
<paragraph id="H72447554E03144FAAEABAB3453575ECA"><enum>(1)</enum><text>increase public
and medical community awareness (particularly of those who treat patients with
diabetes and hypertension) regarding chronic kidney disease, focusing on
prevention;</text>
</paragraph><paragraph id="HC8C5FFEB8EF74BF28EC09BC4FFA63D9"><enum>(2)</enum><text>increase screening
for chronic kidney disease, focusing on Medicare beneficiaries at risk of
chronic kidney disease; and</text>
</paragraph><paragraph id="HC0FF20B8A7EE456DB410B4A0800222F"><enum>(3)</enum><text>enhance
surveillance systems to better assess the prevalence and incidence of chronic
kidney disease.</text>
</paragraph></subsection><subsection id="H8600A1E5FE394C40A2C9E1AE629383D0"><enum>(b)</enum><header>Scope and
duration</header>
<paragraph id="H1BE0F0DA6F754493BED97BFA9F8D6F44"><enum>(1)</enum><header>Scope</header><text>The
Secretary shall select at least 3 States in which to conduct pilot projects
under this section.</text>
</paragraph><paragraph id="HA3AA72D24BD3416291623C8499B8AC2"><enum>(2)</enum><header>Duration</header><text>The
pilot projects under this section shall be conducted for a period that is not
longer than 5 years and shall begin on January 1, 2009.</text>
</paragraph></subsection><subsection id="HC68772CF2A0A452FB2F934A1DA336C43"><enum>(c)</enum><header>Evaluation and
report</header><text>The Comptroller General of the United States shall conduct
an evaluation of the pilot projects conducted under this section. Not later
than 12 months after the date on which the pilot projects are completed, the
Comptroller General shall submit to Congress a report on the evaluation.</text>
</subsection><subsection id="H6693429416D84BD50025D0285D64002E"><enum>(d)</enum><header>Authorization of
appropriations</header><text>There are authorized to be appropriated such sums
as may be necessary for the purpose of carrying out this
section.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection display-inline="no-display-inline" id="H930540108CED4AF388C4C455999512FB"><enum>(b)</enum><header>Medicare
coverage of kidney disease patient education services</header>
<paragraph id="H581F4B6DED064CE6AAA30047CB812DA4"><enum>(1)</enum><header>Coverage of
kidney disease education services</header>
<subparagraph id="H5E24132366E74623B5D45F7B8FDDB936"><enum>(A)</enum><header>Coverage</header><text>Section
1861(s)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(s)(2)</external-xref>), as amended by
section 144(a), is amended—</text>
<clause id="H74C2179FFB46417793345E7E6CDDBD79"><enum>(i)</enum><text>in
subparagraph (BB), by striking <quote>and</quote> after the semicolon at the
end;</text>
</clause><clause id="HB58EE6F997B84E22BEBEF01BDCF4953F"><enum>(ii)</enum><text>in
subparagraph (CC), by adding <quote>and</quote> after the semicolon at the end;
and</text>
</clause><clause id="H6D1D5231E86E4540B1B4B1DBBCB7FBEB"><enum>(iii)</enum><text>by
adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H663E345EC0D64EEBA102C33749F35EC4" style="OLC">
<subparagraph id="H455FA84C80AF4C8CA2656639CBE2763D" indent="up1"><enum>(DD)</enum><text>kidney disease education services (as
defined in subsection
(ggg));</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="HC1E2F9B1BC854646ACB5B11E0ABCF48"><enum>(B)</enum><header>Services
described</header><text>Section 1861 of the Social Security Act (42 U.S.C.
1395x), as amended by section 144(a), is amended by adding at the end the
following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H3976CF74371245B4A82EEBFD795E4003" other-style="archaic" style="other">
<subsection id="HA1A2D0EE057F4397A4AD18D5F4E244DF"><enum>(ggg)</enum><header>Kidney disease education services</header><paragraph commented="no" display-inline="yes-display-inline" id="H0836368E0D094A819118FBA64797EF16"><enum>(1)</enum><text>The term <term>kidney
disease education services</term> means educational services that are—</text>
<subparagraph id="H621438E416654FA185DC84380091F8F" indent="up1"><enum>(A)</enum><text>furnished to an individual with stage
IV chronic kidney disease who, according to accepted clinical guidelines
identified by the Secretary, will require dialysis or a kidney
transplant;</text>
</subparagraph><subparagraph id="H4DF229CD89694E92A1158329F8D5A77D" indent="up1"><enum>(B)</enum><text>furnished, upon the referral of the
physician managing the individual's kidney condition, by a qualified person (as
defined in paragraph (2)); and</text>
</subparagraph><subparagraph id="H0229E21E436E45EDA8001B00B2880080" indent="up1"><enum>(C)</enum><text>designed—</text>
<clause id="H330F1AE091884F25827B4BA11D9600C1"><enum>(i)</enum><text>to provide comprehensive
information (consistent with the standards set under paragraph (3))
regarding—</text>
<subclause id="H33A54EBC23E840D8B626FC5B785E79EB"><enum>(I)</enum><text>the management of comorbidities,
including for purposes of delaying the need for dialysis;</text>
</subclause><subclause id="H0C19F6A8DE0D4136AFDDCEC0C847CCB1"><enum>(II)</enum><text>the prevention of uremic complications;
and</text>
</subclause><subclause id="H65F9CE85F89042F48760D9DBB0070B0"><enum>(III)</enum><text>each option for renal replacement
therapy (including hemodialysis and peritoneal dialysis at home and in-center
as well as vascular access options and transplantation);</text>
</subclause></clause><clause id="H43F35233EDD04A35966264F47B8056E8"><enum>(ii)</enum><text>to ensure that the individual has
the opportunity to actively participate in the choice of therapy; and</text>
</clause><clause commented="no" id="HD68506AE78994EBDA3571FA8EFBE35A7"><enum>(iii)</enum><text>to be tailored to meet the needs
of the individual involved.</text>
</clause></subparagraph></paragraph><paragraph id="H87EB931BC6AC43E78BF8C000F1E578CD" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="HCDF8F2BA86D347EA9D74AECB9DE2E18"><enum>(A)</enum><text>The term <term>qualified
person</term> means—</text>
<clause id="H3DBF8EEC47374A89B610EC0314D4FC3B" indent="up1"><enum>(i)</enum><text>a physician (as defined in section
1861(r)(1)) or a physician assistant, nurse practitioner, or clinical nurse
specialist (as defined in section 1861(aa)(5)), who furnishes services for
which payment may be made under the fee schedule established under section
1848; and</text>
</clause><clause id="HFC28D48DB1304E9F9241E93F98D366B9" indent="up1"><enum>(ii)</enum><text>a provider of services located in a
rural area (as defined in section 1886(d)(2)(D)).</text>
</clause></subparagraph><subparagraph id="HC04F4D4841F94558A16E6355AE681600" indent="up1"><enum>(B)</enum><text>Such term does not include a provider
of services (other than a provider of services described in subparagraph
(A)(ii)) or a renal dialysis facility.</text>
</subparagraph></paragraph><paragraph id="H70C6B1D9859D41C195D3BF51F208CFB5" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">The Secretary shall set standards for the
content of such information to be provided under paragraph (1)(C)(i) after
consulting with physicians, other health professionals, health educators,
professional organizations, accrediting organizations, kidney patient
organizations, dialysis facilities, transplant centers, network organizations
described in section 1881(c)(2), and other knowledgeable persons. To the extent
possible the Secretary shall consult with persons or entities described in the
previous sentence, other than a dialysis facility, that has not received
industry funding from a drug or biological manufacturer or dialysis
facility.</text>
</paragraph><paragraph id="HE1B63609DCFA44B6B3E1A5482432E888" indent="up1"><enum>(4)</enum><text>No individual shall be furnished more
than 6 sessions of kidney disease education services under this
title.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="H0A7FDA2C7C5349809BEB69AB11934951"><enum>(C)</enum><header>Payment under
the physician fee schedule</header><text>Section 1848(j)(3) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(j)(3)</external-xref>), is amended by inserting
<quote>(2)(DD),</quote> after <quote>(2)(AA),</quote>.</text>
</subparagraph><subparagraph id="HB2F445C3BD814E53AEEF00F5F0692222"><enum>(D)</enum><header>Limitation on
number of sessions</header><text>Section 1862(a)(1) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395y">42 U.S.C. 1395y(a)(1)</external-xref>) is amended—</text>
<clause id="H258B3DFF604B48F69DE46C8EC92BC68D"><enum>(i)</enum><text>in
subparagraph (M), by striking <quote>and</quote> at the end;</text>
</clause><clause id="HE2842FB1E0F3457C90324843B6B83900"><enum>(ii)</enum><text>in
subparagraph (N), by striking the semicolon at the end and inserting <quote>,
and</quote>; and</text>
</clause><clause id="HCE5F508EF6A149C5B15CDDC976563DE"><enum>(iii)</enum><text>by
adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HEFB8222178004CBB983BDF8EA2DBC401" style="OLC">
<subparagraph id="H5B3D1CC8BBE04B5FBC9BB200760329E7" indent="up1"><enum>(O)</enum><text>in the case of kidney disease
education services (as defined in paragraph (1) of section 1861(ggg)), which
are furnished in excess of the number of sessions covered under paragraph (4)
of such
section;</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph><paragraph id="HBC32C4E272C84146802D91071D858597"><enum>(2)</enum><header>Effective
date</header><text>The amendments made by this subsection shall apply to
services furnished on or after January 1, 2010.</text>
</paragraph></subsection></section><section id="HF06B0CFD7AB24177AA1652C0D76EE4BB"><enum>154.</enum><header>Renal dialysis
provisions</header>
<subsection id="H0B54E416B74D4B609E009D6169FB4898"><enum>(a)</enum><header>Composite
rate</header>
<paragraph id="H86707622A2DF4300854185BC7D730782"><enum>(1)</enum><header>Update</header><text>Section
1881(b)(12)(G) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(b)(12)(G)</external-xref>) is
amended—</text>
<subparagraph commented="no" id="H3687CF9C680C4FE6BF4219C54FD00040"><enum>(A)</enum><text display-inline="yes-display-inline">in clause (i), by striking
<quote>and</quote> at the end;</text>
</subparagraph><subparagraph commented="no" id="HE982CA417F194D1B9F5C8785F0BD865F"><enum>(B)</enum><text>in clause
(ii)—</text>
<clause commented="no" id="HCD0BB77E06CE426E89B4B606F089ECD6"><enum>(i)</enum><text>by inserting
<quote>and before January 1, 2009,</quote> after <quote>April 1, 2007,</quote>;
and</text>
</clause><clause commented="no" id="H032B40B9944844C5928B3882DBAA03A4"><enum>(ii)</enum><text>by striking the
period at the end and inserting a semicolon; and</text>
</clause></subparagraph><subparagraph commented="no" id="H013FA571DCA0471600772DE2E381C71"><enum>(C)</enum><text>by adding at the
end the following new clauses:</text>
<quoted-block display-inline="no-display-inline" id="HB0294F94FD6C4461AD68E2E81FEAC79E" style="OLC">
<clause commented="no" id="H0A8F7BF7AA3F4B1EB59D07B2CC3EB700" indent="up2"><enum>(iii)</enum><text>furnished on or after January 1,
2009, and before January 1, 2010, by 1.0 percent above the amount of such
composite rate component for such services furnished on December 31, 2008;
and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H3D699516B7174298A1B51300515B5756" indent="up2"><enum>(iv)</enum><text display-inline="yes-display-inline">furnished on or after January 1, 2010, by
1.0 percent above the amount of such composite rate component for such services
furnished on December 31,
2009.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" id="HBED4D3FFE7D346578EFAE29EAFD1CC05"><enum>(2)</enum><header>Site neutral
composite rate</header><text>Section 1881(b)(12)(A) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(b)(12)(A)</external-xref>) is amended by adding at the end the following new
sentence: <quote>Under such system, the payment rate for dialysis services
furnished on or after January 1, 2009, by providers of services shall be the
same as the payment rate (computed without regard to this sentence) for such
services furnished by renal dialysis facilities, and in applying the geographic
index under subparagraph (D) to providers of services, the labor share shall be
based on the labor share otherwise applied for renal dialysis
facilities.</quote>.</text>
</paragraph></subsection><subsection id="H813985AF4A564872ABA25136A1FE0BE"><enum>(b)</enum><header>Development of
ESRD bundled payment system</header>
<paragraph id="H9A6C7EA0B08146B3B1C9490014C824D1"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1881(b) of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(b)</external-xref>) is amended by adding at the end
the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H407FE97249814AC981B3721294EE0435" style="traditional">
<paragraph id="H2B18AFDEC4BA471298108E3B74537D46" indent="up1"><enum>(14)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="H3BA55814162F404EB2A51D1EE848771E"><enum>(A)</enum><clause commented="no" display-inline="yes-display-inline" id="H77050BA8AA1B493900779355F80025F5"><enum>(i)</enum><text display-inline="yes-display-inline">Subject to subparagraph (E), for services
furnished on or after January 1, 2011, the Secretary shall implement a payment
system under which a single payment is made under this title to a provider of
services or a renal dialysis facility for renal dialysis services (as defined
in subparagraph (B)) in lieu of any other payment (including a payment
adjustment under paragraph (12)(B)(ii)) and for such services and items
furnished pursuant to paragraph (4).</text>
</clause><clause id="H410C35143EDC4E8FBB19A624A35375C" indent="up2"><enum>(ii)</enum><text display-inline="yes-display-inline">In implementing the system under this
paragraph the Secretary shall ensure that the estimated total amount of
payments under this title for 2011 for renal dialysis services shall equal 98
percent of the estimated total amount of payments for renal dialysis services,
including payments under paragraph (12)(B)(ii), that would have been made under
this title with respect to services furnished in 2011 if such system had not
been implemented. In making the estimation under subclause (I), the Secretary
shall use per patient utilization data from 2007, 2008, or 2009, whichever has
the lowest per patient utilization.</text>
</clause></subparagraph><subparagraph id="HB21B88DD30874C6FB799B448FE3C97E8" indent="up1"><enum>(B)</enum><text>For purposes of this paragraph, the
term <term>renal dialysis services</term> includes—</text>
<clause id="HF0EF865FEE1A497CB504696FDE5CDAE7"><enum>(i)</enum><text>items and services included in the
composite rate for renal dialysis services as of December 31, 2010;</text>
</clause><clause id="H32DC96B514604C87A13D637006581BD3"><enum>(ii)</enum><text display-inline="yes-display-inline">erythropoiesis stimulating agents and any
oral form of such agents that are furnished to individuals for the treatment of
end stage renal disease;</text>
</clause><clause id="HCC0969E10E99467FBACDD3072C8C1755"><enum>(iii)</enum><text>other drugs and biologicals that are
furnished to individuals for the treatment of end stage renal disease and for
which payment was (before the application of this paragraph) made separately
under this title, and any oral equivalent form of such drug or biological;
and</text>
</clause><clause commented="no" id="H41F2E9AF2F6A4E4CA0C5982615D04B6F"><enum>(iv)</enum><text display-inline="yes-display-inline">diagnostic laboratory tests and other items
and services not described in clause (i) that are furnished to individuals for
the treatment of end stage renal disease.</text>
</clause><continuation-text continuation-text-level="subparagraph" indent="subsection">Such term does not include vaccines.</continuation-text></subparagraph><subparagraph id="H10A30DC8EF23485E9BDDF4FADEF2C75D" indent="up1"><enum>(C)</enum><text>The system under this paragraph may
provide for payment on the basis of services furnished during a week or month
or such other appropriate unit of payment as the Secretary specifies.</text>
</subparagraph><subparagraph id="H918EC805BE304B21B4E2A246F554D98" indent="up1"><enum>(D)</enum><text display-inline="yes-display-inline">Such system—</text>
<clause id="HC64EEE600377443F875E4FD2CD87753C"><enum>(i)</enum><text>shall include a payment adjustment
based on case mix that may take into account patient weight, body mass index,
comorbidities, length of time on dialysis, age, race, ethnicity, and other
appropriate factors;</text>
</clause><clause id="H53DF2FBC11BB4691B1B9DDBA63C2A366"><enum>(ii)</enum><text display-inline="yes-display-inline">shall include a payment adjustment for high
cost outliers due to unusual variations in the type or amount of medically
necessary care, including variations in the amount of erythropoiesis
stimulating agents necessary for anemia management;</text>
</clause><clause id="HDEE057CB466647CF98BC2796D17C604F"><enum>(iii)</enum><text>shall include a payment adjustment
that reflects the extent to which costs incurred by low-volume facilities (as
defined by the Secretary) in furnishing renal dialysis services exceed the
costs incurred by other facilities in furnishing such services, and for payment
for renal dialysis services furnished on or after January 1, 2011, and before
January 1, 2014, such payment adjustment shall not be less than 10 percent;
and</text>
</clause><clause id="H4EAA5AD4CBC04401A8F695740074C6CB"><enum>(iv)</enum><text>may include such other payment
adjustments as the Secretary determines appropriate, such as a payment
adjustment—</text>
<subclause id="HA007A5DC7EDD4E36AD9EA4043702297D"><enum>(I)</enum><text>for pediatric providers of services
and renal dialysis facilities;</text>
</subclause><subclause id="H23C502DEADF44DA3A87B9C1C3000DD43"><enum>(II)</enum><text>by a geographic index, such as the
index referred to in paragraph (12)(D), as the Secretary determines to be
appropriate; and</text>
</subclause><subclause id="H791EFA53B3DC4794AAC0E403C6E306F0"><enum>(III)</enum><text>for providers of services or
renal dialysis facilities located in rural areas.</text>
</subclause></clause><continuation-text continuation-text-level="subparagraph">The
Secretary shall take into consideration the unique treatment needs of children
and young adults in establishing such system.</continuation-text></subparagraph><subparagraph commented="no" id="HEADB833FB8B54180A950430522DA30DD" indent="up1"><enum>(E)</enum><clause commented="no" display-inline="yes-display-inline" id="H4CAA54693AD047B886AAE19D7491F8AA"><enum>(i)</enum><text display-inline="yes-display-inline">The Secretary shall provide for a four-year
phase-in (in equal increments) of the payment amount under the payment system
under this paragraph, with such payment amount being fully implemented for
renal dialysis services furnished on or after January 1, 2014.</text>
</clause><clause commented="no" id="H90BB714B3D01490200047BA1DA70211D" indent="up1"><enum>(ii)</enum><text>A provider of services or renal
dialysis facility may make a one-time election to be excluded from the phase-in
under clause (i) and be paid entirely based on the payment amount under the
payment system under this paragraph. Such an election shall be made prior to
January 1, 2011, in a form and manner specified by the Secretary, and is final
and may not be rescinded.</text>
</clause><clause commented="no" id="H94E654E6BEEE43978C00C384ED02C7CF" indent="up1"><enum>(iii)</enum><text>The Secretary shall make an
adjustment to the payments under this paragraph for years during which the
phase-in under clause (i) is applicable so that the estimated total amount of
payments under this paragraph, including payments under this subparagraph,
shall equal the estimated total amount of payments that would otherwise occur
under this paragraph without such phase-in.</text>
</clause></subparagraph><subparagraph id="H87581574DA614E8AA64DADCFCEF6521C" indent="up1"><enum>(F)</enum><clause commented="no" display-inline="yes-display-inline" id="H0B61AB76C03E405FA5256057A853E33"><enum>(i)</enum><text>Subject to clause (ii),
beginning in 2012, the Secretary shall annually increase payment amounts
established under this paragraph by an ESRD market basket percentage increase
factor for a bundled payment system for renal dialysis services that reflects
changes over time in the prices of an appropriate mix of goods and services
included in renal dialysis services minus 1.0 percentage point.</text>
</clause><clause id="H17F80EDA41C9495BB9CE1D4346406B20" indent="up1"><enum>(ii)</enum><text>For years during which a phase-in of
the payment system pursuant to subparagraph (E) is applicable, the following
rules shall apply to the portion of the payment under the system that is based
on the payment of the composite rate that would otherwise apply if the system
under this paragraph had not been enacted:</text>
<subclause id="H643C0B8EEF3F40878C00B12800A2D8F7"><enum>(I)</enum><text>The update under clause (i) shall not
apply.</text>
</subclause><subclause id="H5289AB1C6C9645949B290584ECCB7891"><enum>(II)</enum><text>The Secretary shall annually increase
such composite rate by the ESRD market basket percentage increase factor
described in clause (i) minus 1.0 percentage point.</text>
</subclause></clause></subparagraph><subparagraph id="H9ACC56448BF94899B925DA14D2F58B22" indent="up1"><enum>(G)</enum><text>There shall be no administrative or
judicial review under section 1869, section 1878, or otherwise of the
determination of payment amounts under subparagraph (A), the establishment of
an appropriate unit of payment under subparagraph (C), the identification of
renal dialysis services included in the bundled payment, the adjustments under
subparagraph (D), the application of the phase-in under subparagraph (E), and
the establishment of the market basket percentage increase factors under
subparagraph (F).</text>
</subparagraph><subparagraph id="H6ACAE23A20D440B78006AB41EA032EFE" indent="up1"><enum>(H)</enum><text>Erythropoiesis stimulating agents and
other drugs and biologicals shall be treated as prescribed and dispensed or
administered and available only under part B if they are—</text>
<clause id="HF784ED43D718429BBC9E9DBA5E1EA446"><enum>(i)</enum><text>furnished to an individual for the
treatment of end stage renal disease; and</text>
</clause><clause id="H613063CD1D8D4C74B66026BD4FFCE34D"><enum>(ii)</enum><text>included in subparagraph (B) for
purposes of payment under this
paragraph.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HA8EEC3D728754EE0A5279002F8964E5F"><enum>(2)</enum><header>Prohibition of
unbundling</header><text display-inline="yes-display-inline">Section 1862(a) of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395y">42 U.S.C. 1395y(a)</external-xref>), as amended by section 135(a)(2),
is amended—</text>
<subparagraph id="H3A9D15F2254F4DC596F6F933AD20AF61"><enum>(A)</enum><text>in paragraph (22),
by striking <quote>or</quote> at the end;</text>
</subparagraph><subparagraph id="HCD2EAB626FF84369B03FF47D32A82FFC"><enum>(B)</enum><text>in paragraph (23),
by striking the period at the end and inserting <quote>; or</quote>; and</text>
</subparagraph><subparagraph id="H1F9D31F5FD214FD39C492017B563D223"><enum>(C)</enum><text>by inserting after
paragraph (23) the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H76AF3BCA04794518BDC59BFAA9C4B9" style="traditional">
<paragraph id="HE8F597B6F94340DE831D85395B684C9E"><enum>(24)</enum><text>where such
expenses are for renal dialysis services (as defined in subparagraph (B) of
section 1881(b)(14)) for which payment is made under such section unless such
payment is made under such section to a provider of services or a renal
dialysis facility for such
services.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H940854D5A1EB41FDBA67B2E97F3DE308"><enum>(3)</enum><header>Conforming
amendments</header><subparagraph commented="no" display-inline="yes-display-inline" id="HB8B41A0C4C6C47BFB1DB92D2BDA5DF82"><enum>(A)</enum><text>Section 1881(b) of the
Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(b)</external-xref>) is amended—</text>
<clause id="H515376066EAE435EB9FD864D14C30318" indent="up1"><enum>(i)</enum><text>in paragraph (12)(A), by striking
<quote>In lieu of payment</quote> and inserting <quote>Subject to paragraph
(14), in lieu of payment</quote>;</text>
</clause><clause id="HF969BEA2377245E9B126C87716758989" indent="up1"><enum>(ii)</enum><text>in the second sentence of
paragraph (12)(F)—</text>
<subclause id="HDB7C5FC155664ADD88C0BA006C1F5751"><enum>(I)</enum><text>by inserting <quote>or paragraph
(14)</quote> after <quote>this paragraph</quote>; and</text>
</subclause><subclause id="HD3F9FD0E134447CC9D8B1CD1B0186B99"><enum>(II)</enum><text>by inserting <quote>or under the system
under paragraph (14)</quote> after <quote>subparagraph (B)</quote>; and</text>
</subclause></clause><clause id="H2737D580042E454FB15D73124BCA35E" indent="up1"><enum>(iii)</enum><text>in paragraph (13)—</text>
<subclause id="H1BE8E553536C4864B82056E46EFE0038"><enum>(I)</enum><text>in subparagraph (A), in the matter
preceding clause (i), by striking <quote>The payment amounts</quote> and
inserting <quote>Subject to paragraph (14), the payment amounts</quote>;
and</text>
</subclause><subclause id="HB71C484D785441F3A8AF6016A0E379DD"><enum>(II)</enum><text>in subparagraph (B)—</text>
<item id="H1CF31B6285A84C75AFC1A91DE3745B29"><enum>(aa)</enum><text>in clause (i), by striking
<quote>(i)</quote> after <quote>(B)</quote> and by inserting <quote>, subject
to paragraph (14)</quote> before the period at the end; and</text>
</item><item id="HDF2D32E2B8A34A05B95099AC00D7FFA4"><enum>(bb)</enum><text>by striking clause (ii).</text>
</item></subclause></clause></subparagraph><subparagraph id="H8C70830C7CA04B87ADB074D561F892FB" indent="up1"><enum>(B)</enum><text>Section 1861(s)(2)(F) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(s)(2)(F)</external-xref>) is amended by inserting <quote>, and,
for items and services furnished on or after January 1, 2011, renal dialysis
services (as defined in section 1881(b)(14)(B))</quote> before the semicolon at
the end.</text>
</subparagraph><subparagraph id="H58C4928BDAC74C6F82B804FA36CACC6B" indent="up1"><enum>(C)</enum><text>Section 623(e) of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (42 U.S.C. 1395rr
note) is repealed.</text>
</subparagraph></paragraph><paragraph id="H921EB8F2E3D14D71A1DA00D5353F3E7B"><enum>(4)</enum><header>Rule of
construction</header><text display-inline="yes-display-inline">Nothing in this
subsection or the amendments made by this subsection shall be construed as
authorizing or requiring the Secretary of Health and Human Services to make
payments under the payment system implemented under paragraph (14)(A)(i) of
section 1881(b) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr(b)</external-xref>), as added by
paragraph (1), for any unrecovered amount for any bad debt attributable to
deductible and coinsurance on items and services not included in the basic
case-mix adjusted composite rate under paragraph (12) of such section as in
effect before the date of the enactment of this Act.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HA2CE3DEB89BC4AA9B44D9667A32C05B9"><enum>(c)</enum><header>Quality
incentives in the end-stage renal disease program</header><text>Section 1881 of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr</external-xref>) is amended by adding at the end the
following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HDB6320ECF8924B3C961B74C4A0BE006F" style="OLC">
<subsection id="H4B902F96687B4697B3FAB48DABF5191"><enum>(h)</enum><header>Quality
incentives in the end-stage renal disease program</header>
<paragraph id="HDBCBC1C874FD4CE88D2C68D69D43B74F"><enum>(1)</enum><header>Quality
incentives</header>
<subparagraph id="HCC98D3B3887E4361A31FFA60C12F4917"><enum>(A)</enum><header>In
general</header><text>With respect to renal dialysis services (as defined in
subsection (b)(14)(B)) furnished on or after January 1, 2012, in the case of a
provider of services or a renal dialysis facility that does not meet the
requirement described in subparagraph (B) with respect to the year, payments
otherwise made to such provider or facility under the system under subsection
(b)(14) for such services shall be reduced by up to 2.0 percent, as determined
appropriate by the Secretary.</text>
</subparagraph><subparagraph id="H5D7255FB05D04FB690BAC801D5E0563"><enum>(B)</enum><header>Requirement</header><text>The
requirement described in this subparagraph is that the provider or facility
meets (or exceeds) the total performance score under paragraph (3) with respect
to performance standards established by the Secretary with respect to measures
specified in paragraph (2).</text>
</subparagraph><subparagraph id="HC347748F0F8F4446B707C324F484B0B6"><enum>(C)</enum><header>No effect in
subsequent years</header><text>The reduction under subparagraph (A) shall apply
only with respect to the year involved, and the Secretary shall not take into
account such reduction in computing the single payment amount under the system
under paragraph (14) in a subsequent year.</text>
</subparagraph></paragraph><paragraph id="HC935DC9AA4CD424A91EF7D9F311803DE"><enum>(2)</enum><header>Measures</header>
<subparagraph id="H147813150446441E919F288092DF1687"><enum>(A)</enum><header>In
general</header><text>The measures specified under this paragraph with respect
to the year involved shall include—</text>
<clause id="HC998E9D6CBEA4313AB542558796E07D3"><enum>(i)</enum><text>measures on anemia
management that reflect the labeling approved by the Food and Drug
Administration for such management and measures on dialysis adequacy;</text>
</clause><clause id="H5018B6A2F4554BAF9FDA18E0C6588854"><enum>(ii)</enum><text display-inline="yes-display-inline">to the extent feasible, such measure (or
measures) of patient satisfaction as the Secretary shall specify; and</text>
</clause><clause id="H7E121C51CEB5450AA631D6A3491E64D"><enum>(iii)</enum><text>such other
measures as the Secretary specifies, including, to the extent feasible,
measures on—</text>
<subclause id="H5E11BD6166E24EDAB0AD7854445FD1B"><enum>(I)</enum><text>iron
management;</text>
</subclause><subclause id="H454AAADA7D274D5ABAF6CC76E2B032F"><enum>(II)</enum><text>bone mineral
metabolism; and</text>
</subclause><subclause id="HAC845E2B7E5749488F52948BFDAB3796"><enum>(III)</enum><text>vascular access,
including for maximizing the placement of arterial venous fistula.</text>
</subclause></clause></subparagraph><subparagraph id="H1C25B23624544D69A305EEBB00271FE0"><enum>(B)</enum><header>Use of endorsed
measures</header>
<clause id="HEEC248BC653A45C19434B8781405094D"><enum>(i)</enum><header>In
general</header><text>Subject to clause (ii), any measure specified by the
Secretary under subparagraph (A)(iii) must have been endorsed by the entity
with a contract under section 1890(a).</text>
</clause><clause id="H092CD312A0F34435A6C73C529D77F04"><enum>(ii)</enum><header>Exception</header><text>In
the case of a specified area or medical topic determined appropriate by the
Secretary for which a feasible and practical measure has not been endorsed by
the entity with a contract under section 1890(a), the Secretary may specify a
measure that is not so endorsed as long as due consideration is given to
measures that have been endorsed or adopted by a consensus organization
identified by the Secretary.</text>
</clause></subparagraph><subparagraph id="HCF11B7543E6C409BA1B355B6A4C8CFD7"><enum>(C)</enum><header>Updating
measures</header><text>The Secretary shall establish a process for updating the
measures specified under subparagraph (A) in consultation with interested
parties.</text>
</subparagraph><subparagraph id="H7C40ED99EE11437C8D00F1AD6220FA17"><enum>(D)</enum><header>Consideration</header><text display-inline="yes-display-inline">In specifying measures under subparagraph
(A), the Secretary shall consider the availability of measures that address the
unique treatment needs of children and young adults with kidney failure.</text>
</subparagraph></paragraph><paragraph id="HFF4500D78F4C402C807EC1DE644CF519"><enum>(3)</enum><header>Performance
scores</header>
<subparagraph id="HA2260CC08DAF4D3FAD4F5D2BAD5716FE"><enum>(A)</enum><header>Total
performance score</header>
<clause id="H6D1056A822CF4C62A72F696236D079A6"><enum>(i)</enum><header>In
general</header><text>Subject to clause (ii), the Secretary shall develop a
methodology for assessing the total performance of each provider of services
and renal dialysis facility based on performance standards with respect to the
measures selected under paragraph (2) for a performance period established
under paragraph (4)(D) (in this subsection referred to as the <quote>total
performance score</quote>).</text>
</clause><clause id="HE9A416C1112F46AEBEBD00A6A91B32CE"><enum>(ii)</enum><header>Application</header><text>For
providers of services and renal dialysis facilities that do not meet (or
exceed) the total performance score established by the Secretary, the Secretary
shall ensure that the application of the methodology developed under clause (i)
results in an appropriate distribution of reductions in payment under paragraph
(1) among providers and facilities achieving different levels of total
performance scores, with providers and facilities achieving the lowest total
performance scores receiving the largest reduction in payment under paragraph
(1)(A).</text>
</clause><clause id="H5C948ACD2B1F433A9C66F3C2A8FD69C8"><enum>(iii)</enum><header>Weighting of
measures</header><text>In calculating the total performance score, the
Secretary shall weight the scores with respect to individual measures
calculated under subparagraph (B) to reflect priorities for quality
improvement, such as weighting scores to ensure that providers of services and
renal dialysis facilities have strong incentives to meet or exceed anemia
management and dialysis adequacy performance standards, as determined
appropriate by the Secretary.</text>
</clause></subparagraph><subparagraph id="H7A98D3BCEDD649C68FADA75C86C8145B"><enum>(B)</enum><header>Performance
score with respect to individual measures</header><text>The Secretary shall
also calculate separate performance scores for each measure, including for
dialysis adequacy and anemia management.</text>
</subparagraph></paragraph><paragraph id="HCF3121A9F14A4818A72106706C801626"><enum>(4)</enum><header>Performance
standards</header>
<subparagraph id="H96BFD971051A4A18AE823D5B146BC008"><enum>(A)</enum><header>Establishment</header><text>Subject
to subparagraph (E), the Secretary shall establish performance standards with
respect to measures selected under paragraph (2) for a performance period with
respect to a year (as established under subparagraph (D)).</text>
</subparagraph><subparagraph id="H907904C2280B4DD38E687684DD642FF6"><enum>(B)</enum><header>Achievement and
improvement</header><text>The performance standards established under
subparagraph (A) shall include levels of achievement and improvement, as
determined appropriate by the Secretary.</text>
</subparagraph><subparagraph id="HB784D003C9D841E0A1A00907129101C7"><enum>(C)</enum><header>Timing</header><text>The
Secretary shall establish the performance standards under subparagraph (A)
prior to the beginning of the performance period for the year involved.</text>
</subparagraph><subparagraph id="H7D9462B4C24F41A5AFF17BBD29899E60"><enum>(D)</enum><header>Performance
period</header><text>The Secretary shall establish the performance period with
respect to a year. Such performance period shall occur prior to the beginning
of such year.</text>
</subparagraph><subparagraph id="HC2B33F4811BD471E9E7C96D37C55D151"><enum>(E)</enum><header>Special
rule</header><text>The Secretary shall initially use as the performance
standard for the measures specified under paragraph (2)(A)(i) for a provider of
services or a renal dialysis facility the lesser of—</text>
<clause id="H86425E09142F43ADA5F71C7F92B87D08"><enum>(i)</enum><text>the performance of
such provider or facility for such measures in the year selected by the
Secretary under the second sentence of subsection (b)(14)(A)(ii); or</text>
</clause><clause id="H2412FD09F44B486496007741D6F60154"><enum>(ii)</enum><text>a
performance standard based on the national performance rates for such measures
in a period determined by the Secretary.</text>
</clause></subparagraph></paragraph><paragraph id="H92956456489844C693701FA1E60CD23"><enum>(5)</enum><header>Limitation on
review</header><text display-inline="yes-display-inline">There shall be no
administrative or judicial review under section 1869, section 1878, or
otherwise of the following:</text>
<subparagraph id="HBEA3703609F741A2975EDDFA82D97CF9"><enum>(A)</enum><text>The determination
of the amount of the payment reduction under paragraph (1).</text>
</subparagraph><subparagraph id="HBB443A56D77B4F9B8800E61C7EF7061F"><enum>(B)</enum><text>The establishment
of the performance standards and the performance period under paragraph
(4).</text>
</subparagraph><subparagraph id="H77744D6751574AD0B7B456E1ADD29C86"><enum>(C)</enum><text>The specification
of measures under paragraph (2).</text>
</subparagraph><subparagraph id="HBE2E082F12644E34A6A50501BA0100EF"><enum>(D)</enum><text>The methodology
developed under paragraph (3) that is used to calculate total performance
scores and performance scores for individual measures.</text>
</subparagraph></paragraph><paragraph id="H3D87EC9C0F204E8FBB90DF619DC31579"><enum>(6)</enum><header>Public
reporting</header>
<subparagraph id="HAA346C2AB62B4EBFB830F78186848527"><enum>(A)</enum><header>In
general</header><text>The Secretary shall establish procedures for making
information regarding performance under this subsection available to the
public, including—</text>
<clause id="H96DAC7C99CA343598887F0ED7934CB2D"><enum>(i)</enum><text>the total
performance score achieved by the provider of services or renal dialysis
facility under paragraph (3) and appropriate comparisons of providers of
services and renal dialysis facilities to the national average with respect to
such scores; and</text>
</clause><clause id="H169B1DA7122C47F59B43785586D97E60"><enum>(ii)</enum><text>the performance
score achieved by the provider or facility with respect to individual
measures.</text>
</clause></subparagraph><subparagraph id="HBB72E358316E48299DD39119738FAA7E"><enum>(B)</enum><header>Opportunity to
review</header><text>The procedures established under subparagraph (A) shall
ensure that a provider of services and a renal dialysis facility has the
opportunity to review the information that is to be made public with respect to
the provider or facility prior to such data being made public.</text>
</subparagraph><subparagraph id="H673F497A7B904A11BA661DFE1539F58F"><enum>(C)</enum><header>Certificates</header>
<clause id="H8C66AB0EEA4B4E0BBECE7DF15C99118"><enum>(i)</enum><header>In
general</header><text>The Secretary shall provide certificates to providers of
services and renal dialysis facilities who furnish renal dialysis services
under this section to display in patient areas. The certificate shall indicate
the total performance score achieved by the provider or facility under
paragraph (3).</text>
</clause><clause id="H4A89B2A2F9E54C5700C858B21268124D"><enum>(ii)</enum><header>Display</header><text>Each
facility or provider receiving a certificate under clause (i) shall prominently
display the certificate at the provider or facility.</text>
</clause></subparagraph><subparagraph id="HDAA821C2F32845C1885BACC3A0079D3"><enum>(D)</enum><header>Web-based
list</header><text>The Secretary shall establish a list of providers of
services and renal dialysis facilities who furnish renal dialysis services
under this section that indicates the total performance score and the
performance score for individual measures achieved by the provider and facility
under paragraph (3). Such information shall be posted on the Internet website
of the Centers for Medicare & Medicaid Services in an easily understandable
format.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H4989E31A36444B78AB35F5E82ED3165"><enum>(d)</enum><header>GAO report on
ESRD bundling system and quality initiative</header><text>Not later than March
1, 2013, the Comptroller General of the United States shall submit to Congress
a report on the implementation of the payment system under subsection (b)(14)
of section 1881 of the Social Security Act (as added by subsection (b)) for
renal dialysis services and related services (defined in subparagraph (B) of
such subsection (b)(14)) and the quality initiative under subsection (h) of
such section 1881 (as added by subsection (b)). Such report shall include the
following information:</text>
<paragraph id="H21F6DA88A3C3424DBF2E3C7502EF3431"><enum>(1)</enum><text display-inline="yes-display-inline">The changes in utilization rates for
erythropoiesis stimulating agents.</text>
</paragraph><paragraph id="HF710D3B44E8647028822CD67C000083"><enum>(2)</enum><text>The mode of
administering such agents, including information on the proportion of
individuals receiving such agents intravenously as compared to
subcutaneously.</text>
</paragraph><paragraph id="H648E06A415684391A115EFC4219CF07F"><enum>(3)</enum><text>An analysis of the
payment adjustment under subparagraph (D)(iii) of such subsection (b)(14),
including an examination of the extent to which costs incurred by rural,
low-volume providers and facilities (as defined by the Secretary) in furnishing
renal dialysis services exceed the costs incurred by other providers and
facilities in furnishing such services, and a recommendation regarding the
appropriateness of such adjustment.</text>
</paragraph><paragraph id="H507541A8F21547A88263FF95C9C72DF0"><enum>(4)</enum><text>The changes, if
any, in utilization rates of drugs and biologicals that the Secretary
identifies under subparagraph (B)(iii) of such subsection (b)(14), and any oral
equivalent or oral substitutable forms of such drugs and biologicals or of
drugs and biologicals described in clause (ii), that have occurred after
implementation of the payment system under such subsection (b)(14).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HD04004F65C5042958FF562C1ED167EC8"><enum>(5)</enum><text>Any other
information or recommendations for legislative and administrative actions
determined appropriate by the Comptroller General.</text>
</paragraph></subsection></section></part></subtitle><subtitle id="H86930681C45D4BA88E001BDC093BF147"><enum>D</enum><header>Provisions
relating to part C</header>
<section id="HB5C01DE1684F41C5B108D262AE986DF4"><enum>161.</enum><header>Phase-out of
indirect medical education (IME)</header>
<subsection id="H8D3119B5FA83490FB28B75DAD9D52824"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1853(k) of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-23">42 U.S.C. 1395w–23(k)</external-xref>) is amended—</text>
<paragraph id="HEF480BDDD6E843EE9D5C16BB1399ADE5"><enum>(1)</enum><text display-inline="yes-display-inline">in paragraph (1), in the matter preceding
subparagraph (A), by striking <quote>paragraph (2)</quote> and inserting
<quote>paragraphs (2) and (4)</quote>; and</text>
</paragraph><paragraph id="H504A3A9911B241919EF1ACC5A245ABFC"><enum>(2)</enum><text display-inline="yes-display-inline">by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H7CEDB2A9D94E460090D77C1E8449DD41" style="OLC">
<paragraph id="HAAB46A23BC844EFC90E0612EB81F505F"><enum>(4)</enum><header>Phase-out of the
indirect costs of medical education from capitation rates</header>
<subparagraph id="HA6F52DCF82CB49EA8100689641D3E35"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">After determining the
applicable amount for an area for a year under paragraph (1) (beginning with
2010), the Secretary shall adjust such applicable amount to exclude from such
applicable amount the phase-in percentage (as defined in subparagraph (B)(i))
for the year of the Secretary's estimate of the standardized costs for payments
under section 1886(d)(5)(B) in the area for the year. Any adjustment under the
preceding sentence shall be made prior to the application of paragraph
(2).</text>
</subparagraph><subparagraph id="HEAF7467B62DC4920BF00BCADA016B9A7"><enum>(B)</enum><header>Percentages
defined</header><text display-inline="yes-display-inline">For purposes of this
paragraph:</text>
<clause id="H8F1646E3747F454DACDF3800B4D6FA96"><enum>(i)</enum><header>Phase-in
percentage</header><text display-inline="yes-display-inline">The term
<quote>phase-in percentage</quote> means, for an area for a year, the ratio
(expressed as a percentage, but in no case greater than 100 percent) of—</text>
<subclause id="H9FDC97CC209747D5A4926145307C9400"><enum>(I)</enum><text>the maximum
cumulative adjustment percentage for the year (as defined in clause (ii));
to</text>
</subclause><subclause id="H0463FD9FC8B042728C39637F5883F119"><enum>(II)</enum><text>the standardized
IME cost percentage (as defined in clause (iii)) for the area and year.</text>
</subclause></clause><clause id="H65405C9D99B144C7A9126237C0D27502"><enum>(ii)</enum><header>Maximum
cumulative adjustment percentage</header><text display-inline="yes-display-inline">The term <quote>maximum cumulative
adjustment percentage</quote> means, for—</text>
<subclause id="HF23A42ABA9AC42B0A9298D6EA397AE1B"><enum>(I)</enum><text>2010, 0.60
percent; and</text>
</subclause><subclause id="H363742650D6040A19EE991E7949DF3C"><enum>(II)</enum><text>a subsequent year,
the maximum cumulative adjustment percentage for the previous year increased by
0.60 percentage points.</text>
</subclause></clause><clause id="H62BC2D0604A943C500A162A373BBE9F9"><enum>(iii)</enum><header>Standardized
IME cost percentage</header><text display-inline="yes-display-inline">The term
<quote>standardized IME cost percentage</quote> means, for an area for a year,
the per capita costs for payments under section 1886(d)(5)(B) (expressed as a
percentage of the fee-for-service amount specified in subparagraph (C)) for the
area and the year.</text>
</clause></subparagraph><subparagraph id="HD69802D90D7641BD880008124900D9D0"><enum>(C)</enum><header>Fee-for-service
amount</header><text display-inline="yes-display-inline">The fee-for-service
amount specified in this subparagraph for an area for a year is the amount
specified under subsection (c)(1)(D) for the area and the
year.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H6F2826A737464D8DAD5CFE350669D00"><enum>(b)</enum><header>Excluding
adjustment from the update</header><text>Section 1853(k)(1)(B)(i) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-23">42 U.S.C. 1395w–23(k)(1)(B)(i)</external-xref>) is amended by striking
<quote>paragraph (2)</quote> and inserting <quote>paragraphs (2) and
(4)</quote>.</text>
</subsection><subsection id="HCD4E0BC6A8654902ADA280700777992"><enum>(c)</enum><header>Hold harmless for
PACE program payments</header><text>Section 1894(d) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395eee">42 U.S.C. 1395eee(d)</external-xref>) is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H333030BF532246988D61041D283F03AE" style="OLC">
<paragraph id="H1E59654669C14E68AEBDC32F89213F00"><enum>(3)</enum><header>Capitation rates
determined without regard to the phase-out of the indirect costs of medical
education from the annual Medicare Advantage capitation
rate</header><text>Capitation amounts under this subsection shall be determined
without regard to the application of section
1853(k)(4).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section commented="no" id="H532436D088F5477A8F1D3E8E2FC5FCA"><enum>162.</enum><header>Revisions to
requirements for Medicare Advantage private fee-for-service plans</header>
<subsection commented="no" id="H68DA3D4BD35143888851858F5E823F00"><enum>(a)</enum><header>Requirements To
assure access to network coverage</header>
<paragraph commented="no" id="HD886445B425843B5B3C707DB31776D24"><enum>(1)</enum><header>Individual
market</header><text>Section 1852(d) of the Social Security Act (42 U.S.C.
1395w–22(d)) is amended—</text>
<subparagraph commented="no" id="H1FB0419D06F84AEAB8493B95E0FD1013"><enum>(A)</enum><text>in paragraph (4),
in the second sentence, by striking <quote>The Secretary</quote> and inserting
<quote>Subject to paragraph (5), the Secretary</quote>; and</text>
</subparagraph><subparagraph commented="no" id="H31DF2AF8872946A0A097FF98B5CE47B1"><enum>(B)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HED805F3B5DDF4E8A84DA784C6EAAF54F" style="OLC">
<paragraph commented="no" id="H850880F95B6346BCABB5905E8F7CEA0"><enum>(5)</enum><header>Requirement of
certain nonemployer Medicare Advantage private fee-for-service plans to use
contracts with providers</header>
<subparagraph commented="no" id="H71629505899D41A4885000E63168826E"><enum>(A)</enum><header>In
general</header><text>For plan year 2011 and subsequent plan years, in the case
of a Medicare Advantage private fee-for-service plan not described in paragraph
(1) or (2) of section 1857(i) operating in a network area (as defined in
subparagraph (B)), the plan shall meet the access standards under paragraph (4)
in that area only through entering into written contracts as provided for under
subparagraph (B) of such paragraph and not, in whole or in part, through the
establishment of payment rates meeting the requirements under subparagraph (A)
of such paragraph.</text>
</subparagraph><subparagraph commented="no" id="H58DBB2DA8021459380CE46968DE02B00"><enum>(B)</enum><header>Network area
defined</header><text>For purposes of subparagraph (A), the term <quote>network
area</quote> means, for a plan year, an area which the Secretary identifies (in
the Secretary's announcement of the proposed payment rates for the previous
plan year under section 1853(b)(1)(B)) as having at least 2 network-based plans
(as defined in subparagraph (C)) with enrollment under this part as of the
first day of the year in which such announcement is made.</text>
</subparagraph><subparagraph commented="no" id="HF9B9936FE7254A4C873759E107C3F637"><enum>(C)</enum><header>Network-based
plan defined</header>
<clause commented="no" id="HF9C10C92431245EFB381A5AE88C4819E"><enum>(i)</enum><header>In
general</header><text>For purposes of subparagraph (B), the term
<quote>network-based plan</quote> means—</text>
<subclause commented="no" id="HA3AAD857306E406DBDE8A33B93C76FB8"><enum>(I)</enum><text>except as provided
in clause (ii), a Medicare Advantage plan that is a coordinated care plan
described in section 1851(a)(2)(A)(i);</text>
</subclause><subclause commented="no" id="HAD3C2A43691F4AC5AC302228AB7FE12F"><enum>(II)</enum><text>a network-based
MSA plan; and</text>
</subclause><subclause commented="no" id="H11EC0D26EC6E491893B8781BA0412DE8"><enum>(III)</enum><text>a reasonable
cost reimbursement plan under section 1876.</text>
</subclause></clause><clause commented="no" id="HEB11E3D86F574E9D9E3F7925268772C4"><enum>(ii)</enum><header>Exclusion of
non-network regional PPOs</header><text>The term <quote>network-based
plan</quote> shall not include an MA regional plan that, with respect to the
area, meets access adequacy standards under this part substantially through the
authority of <external-xref legal-doc="usc" parsable-cite="usc/42/422">section 422.112(a)(1)(ii)</external-xref> of title 42, Code of Federal
Regulations, rather than through written
contracts.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" id="H5381946EFFA14029855C3D5B9B546553"><enum>(2)</enum><header>Employer
plans</header><text>Section 1852(d) of the Social Security Act (42 U.S.C.
1395w–22(d)), as amended by paragraph (1), is amended—</text>
<subparagraph commented="no" id="H5D3EEB5BA77042A0A6F3E9B8BCEFD064"><enum>(A)</enum><text>in paragraph (4),
in the second sentence, by striking <quote>paragraph (5)</quote> and inserting
<quote>paragraphs (5) and (6)</quote>; and</text>
</subparagraph><subparagraph commented="no" id="H2791E4EC5A0443BFA8F60000F3F03DDA"><enum>(B)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H4E9A2C668EC049F19050163EF9E317A0" style="OLC">
<paragraph commented="no" id="HC4F7A2D3F3314387A95D95C558E10062"><enum>(6)</enum><header>Requirement of
all employer Medicare Advantage private fee-for-service plans to use contracts
with providers</header><text>For plan year 2011 and subsequent plan years, in
the case of a Medicare Advantage private fee-for-service plan that is described
in paragraph (1) or (2) of section 1857(i), the plan shall meet the access
standards under paragraph (4) only through entering into written contracts as
provided for under subparagraph (B) of such paragraph and not, in whole or in
part, through the establishment of payment rates meeting the requirements under
subparagraph (A) of such
paragraph.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" id="HCFF4CD73309A4EF7B85DE28597D215F7"><enum>(3)</enum><header>Access
requirements</header>
<subparagraph commented="no" id="H9C82206EE50B45DFA4F58054C66E00B6"><enum>(A)</enum><header>In
general</header><text>Section 1852(d)(4)(B) of the Social Security Act (42
U.S.C. 1395w–22(d)(4)(B)) is amended by striking <quote>a sufficient
number</quote> through <quote>terms of the plan</quote> and inserting <quote>a
sufficient number and range of providers within such category to meet the
access standards in subparagraphs (A) through (E) of paragraph
(1)</quote>.</text>
</subparagraph><subparagraph commented="no" id="HA6A6F8325CA04B5EBC00CD0074C7AA3"><enum>(B)</enum><header>Effective
date</header><text>The amendment made by subparagraph (A) shall apply to plan
year 2010 and subsequent plan years.</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="HF000F91F29D34719887E40BCBFA4B953"><enum>(b)</enum><header>Clarification
regarding utilization</header><text>Section 1859(b)(2) of the Social Security
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-28">42 U.S.C. 1395w–28(b)(2)</external-xref>) is amended by adding at the end the following
flush sentence:</text>
<quoted-block display-inline="no-display-inline" id="HCB0D4503D81B40CCBC10983C616DA7A7" style="OLC">
<quoted-block-continuation-text commented="no" quoted-block-continuation-text-level="paragraph">Nothing in subparagraph (B) shall be
construed to preclude a plan from varying rates for such a provider based on
the specialty of the provider, the location of the provider, or other factors
related to such provider that are not related to utilization, or to preclude a
plan from increasing rates for such a provider based on increased utilization
of specified preventive or screening
services.</quoted-block-continuation-text><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="HD3C15F81F9194951853024508EEED105"><enum>163.</enum><header>Revisions to
quality improvement programs</header>
<subsection id="H790A39C23815442491A1F6D33F00C00"><enum>(a)</enum><header>Requirement for
MA private fee-for-service and MSA plans To have a quality improvement
program</header>
<paragraph id="H6C8F69DE6B3F4E689BFEF02343FEAF7B"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1852(e)(1) of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-112">42 U.S.C. 1395w–112(e)(1)</external-xref>) is amended by striking
<quote>(other than an MA private fee-for-service plan or an MSA
plan)</quote>.</text>
</paragraph><paragraph id="H519BE9124E77428B9102C7485535C600"><enum>(2)</enum><header>Effective
date</header><text>The amendment made by paragraph (1) shall apply to plan
years beginning on or after January 1, 2010.</text>
</paragraph></subsection><subsection commented="no" id="HC7C134BB6AFE42E0BF00D7283F2C8EDA"><enum>(b)</enum><header>Data collection
requirements for MA regional plans, MA private fee-for-service plans, and MSA
plans</header>
<paragraph commented="no" id="H02963B4C83934672ADE3F875B9FD27A1"><enum>(1)</enum><header>In
general</header><text>Section 1852(e)(3)(A) of the Social Security Act (42
U.S.C. 1395w–22(e)(3)(A)) is amended—</text>
<subparagraph commented="no" id="H0CA8CE0B77034A06A845D163D5BF5673"><enum>(A)</enum><text>in clause (i), by
adding at the end the following new sentence: <quote>With respect to MA private
fee-for-service plans and MSA plans, such requirements may not exceed the
requirements under this subparagraph with respect to MA local plans that are
preferred provider organization plans, except that the limitation under clause
(iii) shall not apply and such requirements shall apply regardless of whether
or not the services are furnished by providers of services, physicians, or
other health care practitioners and suppliers that have contracts with the
organization offering the MA private fee-for-service plan or the MSA
plan.</quote></text>
</subparagraph><subparagraph commented="no" id="H5122A85169094B2D8E4F4250E8D2F9B9"><enum>(B)</enum><text>by striking clause
(ii)—</text>
</subparagraph><subparagraph commented="no" id="H60C9BC8C6EA0415A9EE1FFFB67D0F856"><enum>(C)</enum><text>in clause
(iii)—</text>
<clause commented="no" id="HD6B602F7275049F6B04829ED40A027DA"><enum>(i)</enum><text>in the
heading—</text>
<subclause commented="no" id="H2309F73258BC47A58FADF3BEFA59D5E3"><enum>(I)</enum><text>by inserting
<quote><header-in-text level="clause" style="OLC">local</header-in-text></quote> after <quote><header-in-text level="clause" style="OLC">to</header-in-text></quote>; and</text>
</subclause><subclause commented="no" id="H37459BC9455C4272826B482B2CCC3303"><enum>(II)</enum><text>by inserting
<quote><header-in-text level="clause" style="OLC">and MA regional
plans</header-in-text></quote> after <quote><header-in-text level="clause" style="OLC">organizations</header-in-text></quote>; and</text>
</subclause></clause><clause commented="no" id="HDB5A6A5FE7DD4BA4BD2BA7C485FDCFF5"><enum>(ii)</enum><text>by inserting
<quote>and to MA regional plans</quote> after <quote>organization
plans</quote>.</text>
</clause></subparagraph></paragraph><paragraph id="HC05421F555134CB4B974A0C8C14404EE"><enum>(2)</enum><header>Effective
date</header><text>The amendments made by paragraph (1) shall apply to plan
years beginning on or after January 1, 2010.</text>
</paragraph></subsection></section><section id="H2AC2090E670C4D8E99F3AE91A81DC1A7"><enum>164.</enum><header>Revisions
relating to specialized Medicare Advantage plans for special needs
individuals</header>
<subsection id="H7745CFA8D8EF4DA799E7FF5987C9F55"><enum>(a)</enum><header>Extension of
authority To restrict enrollment</header><text>Section 1859(f) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-28">42 U.S.C. 1395w–28(f)</external-xref>), as amended by section 108(a) of the
Medicare, Medicaid, and SCHIP Extension Act of 2007 (<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>) is
amended by striking <quote>2010</quote> and inserting
<quote>2011</quote>.</text>
</subsection><subsection id="HF2260920BB2F4C54862B5C60D000FABD"><enum>(b)</enum><header>Moratorium on
authority To designate other plans as specialized MA plans</header><text>During
the period beginning on January 1, 2010, and ending on December 31, 2010, the
Secretary of Health and Human Services may not exercise the authority provided
under section 231(d) of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-21">42 U.S.C. 1395w–21</external-xref> note) to designate other plans as
specialized MA plans for special needs individuals.</text>
</subsection><subsection id="HFC502DC84D38422CAB476FB3B1675318"><enum>(c)</enum><header>Requirements for
enrollment</header>
<paragraph id="H8071A1E16B0147539CBF35C542305C6F"><enum>(1)</enum><header>In
general</header><text>Section 1859 of the Social Security Act (42 U.S.C.
1395w–28) is amended—</text>
<subparagraph id="H4FF433DA24324823A1E8E1979EAFC34B"><enum>(A)</enum><text>in subsection
(b)(6)(A), by inserting <quote>and that, as of January 1, 2010, meets the
applicable requirements of paragraph (2), (3), or (4) of subsection (f), as the
case may be</quote> before the period at the end; and</text>
</subparagraph><subparagraph id="HEC389BF7BFD24153B12E555217E9896B"><enum>(B)</enum><text>in subsection
(f)—</text>
<clause id="H8BA8D4F60D07422C96EFE7FD6ABB1F1"><enum>(i)</enum><text>by
amending the heading to read as follows: <quote><header-in-text level="subsection" style="OLC">Requirements regarding enrollment in specialized
MA plans for special needs individuals</header-in-text></quote>;</text>
</clause><clause id="H719D650B0AE54914BCFA753E62008500"><enum>(ii)</enum><text>by
designating the sentence beginning <quote>In the case of</quote> as paragraph
(1) with the heading <quote><header-in-text level="paragraph" style="OLC">Requirements for enrollment.—</header-in-text></quote> and with
appropriate indentation; and</text>
</clause><clause id="HB72094FF7DD542C2B86E97F262EE3D5F"><enum>(iii)</enum><text>by
adding at the end the following new paragraphs:</text>
<quoted-block display-inline="no-display-inline" id="H916557C5970F48F4BBB34F37F7042DD5" style="OLC">
<paragraph id="HFC2492AFCD1E41BD8EAAA4B33C229147"><enum>(2)</enum><header>Additional
requirements for institutional SNPs</header><text>In the case of a specialized
MA plan for special needs individuals described in subsection (b)(6)(B)(i), the
applicable requirements described in this paragraph are as follows:</text>
<subparagraph id="H296490FD1C10426CB804EC38F512A201"><enum>(A)</enum><text>Each individual
that enrolls in the plan on or after January 1, 2010, is a special needs
individuals described in subsection (b)(6)(B)(i). In the case of an individual
who is living in the community but requires an institutional level of care,
such individual shall not be considered a special needs individual described in
subsection (b)(6)(B)(i) unless the determination that the individual requires
an institutional level of care was made—</text>
<clause id="H4875F98A5E1D476DAB391DCBFF124F37"><enum>(i)</enum><text>using a State
assessment tool of the State in which the individual resides; and</text>
</clause><clause id="H78CC98D58F3F461A8498F57EA49C66B"><enum>(ii)</enum><text>by
an entity other than the organization offering the plan.</text>
</clause></subparagraph><subparagraph id="HF65A0B8D80A94EC29500E7FF55807822"><enum>(B)</enum><text>The plan meets the
requirements described in paragraph (5).</text>
</subparagraph></paragraph><paragraph id="H9597BE1BE89B43CB909F1FAFD0D484E3"><enum>(3)</enum><header>Additional
requirements for dual SNPs</header><text display-inline="yes-display-inline">In
the case of a specialized MA plan for special needs individuals described in
subsection (b)(6)(B)(ii), the applicable requirements described in this
paragraph are as follows:</text>
<subparagraph id="HBF341269B42B41CA9B29234D41E7EBE"><enum>(A)</enum><text display-inline="yes-display-inline">Each individual that enrolls in the plan on
or after January 1, 2010, is a special needs individuals described in
subsection (b)(6)(B)(ii).</text>
</subparagraph><subparagraph id="H5DCB308D98A547B8A2F684D83932704"><enum>(B)</enum><text>The plan meets the
requirements described in paragraph (5).</text>
</subparagraph><subparagraph id="HF97E340F49CF47F5AD000343C3C4DA42"><enum>(C)</enum><text>The plan provides
each prospective enrollee, prior to enrollment, with a comprehensive written
statement (using standardized content and format established by the Secretary)
that describes—</text>
<clause id="H94A97331A806447B9C9522231D197995"><enum>(i)</enum><text>the benefits and
cost-sharing protections that the individual is entitled to under the State
Medicaid program under title XIX; and</text>
</clause><clause id="HE2FAF6928BD7431FBC1936277BA45BD"><enum>(ii)</enum><text>which of such
benefits and cost-sharing protections are covered under the plan.</text>
</clause><continuation-text continuation-text-level="subparagraph">Such
statement shall be included with any description of benefits offered by the
plan.</continuation-text></subparagraph><subparagraph commented="no" id="H58289AE0831C4C0E8956DF45EA770902"><enum>(D)</enum><text display-inline="yes-display-inline">The plan has a contract with the State
Medicaid agency to provide benefits, or arrange for benefits to be provided,
for which such individual is entitled to receive as medical assistance under
title XIX. Such benefits may include long-term care services consistent with
State policy.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H8F283895E7794E2790F4A196590038D8"><enum>(4)</enum><header>Additional
requirements for severe or disabling chronic condition SNPs</header><text display-inline="yes-display-inline">In the case of a specialized MA plan for
special needs individuals described in subsection (b)(6)(B)(iii), the
applicable requirements described in this paragraph are as follows:</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H8B47A9A3FEA34BFC9FB3219661A2FAE3"><enum>(A)</enum><text display-inline="yes-display-inline">Each individual that enrolls in the plan on
or after January 1, 2010, is a special needs individual described in subsection
(b)(6)(B)(iii).</text>
</subparagraph><subparagraph id="H8CCB58A24F824B269C4B9DC0337DA7D2"><enum>(B)</enum><text>The plan meets the
requirements described in paragraph
(5).</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H4392641369CB4E7B9B27E1BAA4310027"><enum>(2)</enum><header>Authority to
operate but no service area expansion for dual SNPs that do not meet certain
requirements</header><text>Notwithstanding subsection (f) of section 1859 of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-28">42 U.S.C. 1395w–28</external-xref>), during the period beginning on
January 1, 2010, and ending on December 31, 2010, in the case of a specialized
Medicare Advantage plan for special needs individuals described in subsection
(b)(6)(B)(ii) of such section, as amended by this section, that does not meet
the requirement described in subsection (f)(3)(D) of such section, the
Secretary of Health and Human Services—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H64EBA8AAE2594AB18F24CF664D0023D4"><enum>(A)</enum><text>shall permit such
plan to be offered under part C of title XVIII of such Act; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H668B914C847E440790DF4C0089007ED0"><enum>(B)</enum><text>shall not permit
an expansion of the service area of the plan under such part C.</text>
</subparagraph></paragraph><paragraph id="H96B06B939BEF4ED28EEB38F56EC3CED9"><enum>(3)</enum><header>Resources for
State Medicaid agencies</header><text>The Secretary of Health and Human
Services shall provide for the designation of appropriate staff and resources
that can address State inquiries with respect to the coordination of State and
Federal policies for specialized MA plans for special needs individuals
described in section 1859(b)(6)(B)(ii) of the Social Security Act (42 U.S.C.
1395w–28(b)(6)(B)(ii)), as amended by this section.</text>
</paragraph><paragraph commented="no" id="H9969901448964F1F9F1D1D72214D7D84"><enum>(4)</enum><header>No requirement
for contract</header><text>Nothing in the provisions of, or amendments made by,
this subsection shall require a State to enter into a contract with a Medicare
Advantage organization with respect to a specialized MA plan for special needs
individuals described in section 1859(b)(6)(B)(ii) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-28">42 U.S.C. 1395w–28(b)(6)(B)(ii)</external-xref>), as amended by this section.</text>
</paragraph></subsection><subsection id="H883E443152164850A865E642D1FE65B3"><enum>(d)</enum><header>Care management
requirements for all SNPs</header>
<paragraph id="H4D12087FF7EA40548DB4C2A89751644E"><enum>(1)</enum><header>Requirements</header><text>Section
1859(f) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-28">42 U.S.C. 1395w–28(f)</external-xref>), as amended by
subsection (c)(1), is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H9121F280F2B44545AE8045639D5359F" style="OLC">
<paragraph id="HFA387E482D4442569453D7D8F03F07DC"><enum>(5)</enum><header>Care management
requirements for all SNPs</header><text>The requirements described in this
paragraph are that the organization offering a specialized MA plan for special
needs individuals described in subsection (b)(6)(B)(i)—</text>
<subparagraph id="H0370CC885ABF4303907DD1DE5C9BE738"><enum>(A)</enum><text>have in place an
evidenced-based model of care with appropriate networks of providers and
specialists; and</text>
</subparagraph><subparagraph id="HFF01D2D22A57466594809F91DDE29752"><enum>(B)</enum><text>with respect to
each individual enrolled in the plan—</text>
<clause id="H8C3B2649064A4C0498D34597BE6E6687"><enum>(i)</enum><text>conduct an initial
assessment and an annual reassessment of the individual’s physical,
psychosocial, and functional needs;</text>
</clause><clause id="H6588F1E523C8427F877EDE9F04361629"><enum>(ii)</enum><text>develop a plan,
in consultation with the individual as feasible, that identifies goals and
objectives, including measurable outcomes as well as specific services and
benefits to be provided; and</text>
</clause><clause id="HFC6CD86505D44487A87B337310229D00"><enum>(iii)</enum><text>use an
interdisciplinary team in the management of
care.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H2500C46077D249D7BC0145D261ECC7DD"><enum>(2)</enum><header>Review to ensure
compliance with care management requirements</header><text>Section 1857(d) of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-27">42 U.S.C. 1395w–27(d)</external-xref>) is amended by adding at the end
the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HEBEA6F0280184E70876C5CF196AD3845" style="OLC">
<paragraph id="HD5E437A33B7C44179FB5334D5FA5A1BC"><enum>(6)</enum><header>Review to ensure
compliance with care management requirements for specialized Medicare Advantage
plans for special needs individuals</header><text>In conjunction with the
periodic audit of a specialized Medicare Advantage plan for special needs
individuals under paragraph (1), the Secretary shall conduct a review to ensure
that such organization offering the plan meets the requirements described in
section
1859(f)(5).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HA6BA592D7CD04087000559D2E6D4085D"><enum>(e)</enum><header>Clarification of
the definition of a severe or disabling chronic conditions specialized needs
individual</header>
<paragraph id="H08BDE5B627B04C27829B9DADD6EBFEA0"><enum>(1)</enum><header>In
general</header><text>Section 1859(b)(6)(B)(iii) of the Social Security Act (42
U.S.C. 1395w–28(b)(6)(B)(iii)) is amended by inserting <quote>who have one or
more comorbid and medically complex chronic conditions that are substantially
disabling or life threatening, have a high risk of hospitalization or other
significant adverse health outcomes, and require specialized delivery systems
across domains of care</quote> before the period at the end.</text>
</paragraph><paragraph id="H9ED52B4DF8584E83BB379432F796EE27"><enum>(2)</enum><header>Panel</header><text>The
Secretary of Health and Human Services shall convene a panel of clinical
advisors to determine the conditions that meet the definition of severe and
disabling chronic conditions under section 1859(b)(6)(B)(iii) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-28">42 U.S.C. 1395w–28(b)(6)(B)(iii)</external-xref>), as amended by paragraph (1).
The panel shall include the Director of the Agency for Healthcare Research and
Quality (or the Director’s designee).</text>
</paragraph></subsection><subsection commented="no" id="H07BDBD5F1B6A43ECB17DC7BE6002C900"><enum>(f)</enum><header>Special
requirements regarding quality reporting for specialized MA plans for special
needs individuals</header>
<paragraph commented="no" id="H7745929F3A734FAF910039982737DF3"><enum>(1)</enum><header>In
general</header><text>Section 1852(e)(3)(A) of the Social Security Act (42
U.S.C. 1395w–22(e)(3)(A)), as amended by section 163, is amended by inserting
after clause (i) the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="H0E200D5543AC4A3CB1430077E6E0A92F" style="OLC">
<clause commented="no" id="HE64E22B8C9DE4BCEB1B187E89746DF02"><enum>(ii)</enum><header>Special
requirements for specialized MA plans for special needs
individuals</header><text>In addition to the data required to be collected,
analyzed, and reported under clause (i) and notwithstanding the limitations
under subparagraph (B), as part of the quality improvement program under
paragraph (1), each MA organization offering a specialized Medicare Advantage
plan for special needs individuals shall provide for the collection, analysis,
and reporting of data that permits the measurement of health outcomes and other
indices of quality with respect to the requirements described in paragraphs (2)
through (5) of subsection (f). Such data may be based on claims data and shall
be at the plan
level.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph commented="no" id="H8E471ABF6BFE4C1090A65485DCDE12A"><enum>(2)</enum><header>Effective
date</header><text>The amendment made by paragraph (1) shall take effect on a
date specified by the Secretary of Health and Human Services (but in no case
later than January 1, 2010), and shall apply to all specialized Medicare
Advantage plans for special needs individuals regardless of when the plan first
entered the Medicare Advantage program under part C of title XVIII of the
Social Security Act.</text>
</paragraph></subsection><subsection id="H685B11B0308840119D255FA67CFD13B9"><enum>(g)</enum><header>Effective date
and application</header><text>The amendments made by subsections (c)(1), (d),
and (e)(1) shall apply to plan years beginning on or after January 1, 2010, and
shall apply to all specialized Medicare Advantage plans for special needs
individuals regardless of when the plan first entered the Medicare Advantage
program under part C of title XVIII of the Social Security Act.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H79EF50B6595E49BF9CB6FC2B0B35FF9"><enum>(h)</enum><header>No affect on
Medicaid benefits for duals</header><text>Nothing in the provisions of, or
amendments made by, this section shall affect the benefits available under the
Medicaid program under title XIX of the Social Security Act for special needs
individuals described in section 1859(b)(6)(B)(ii) of such Act (42 U.S.C.
1395w–28(b)(6)(B)(ii)).</text>
</subsection></section><section id="H7C5FF9C9843E4278B4002ED8A05FAFE3"><enum>165.</enum><header>Limitation on
out-of-pocket costs for dual eligibles and qualified medicare beneficiaries
enrolled in a specialized Medicare Advantage plan for special needs
individuals</header>
<subsection id="H095E95D9B6024B9591E666AE00873CDF"><enum>(a)</enum><header>In
general</header><text>Section 1852(a) of the Social Security Act (42 U.S.C.
1395w–22(a)) is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HB262199D358D4163B1A4996FCC03A67E" style="OLC">
<paragraph id="H569BB4A5842C4AA691E884C4440070D8"><enum>(7)</enum><header>Limitation on
cost-sharing for dual eligibles and qualified medicare
beneficiaries</header><text display-inline="yes-display-inline">In the case of
an individual who is a full-benefit dual eligible individual (as defined in
section 1935(c)(6)) or a qualified medicare beneficiary (as defined in section
1905(p)(1)) and who is enrolled in a specialized Medicare Advantage plan for
special needs individuals described in section 1859(b)(6)(B)(ii), the plan may
not impose cost-sharing that exceeds the amount of cost-sharing that would be
permitted with respect to the individual under title XIX if the individual were
not enrolled in such
plan.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HB2F8E9FEFAA74EBEBD39C933C849F1C0"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall apply to plan
years beginning on or after January 1, 2010.</text>
</subsection></section><section id="H08B09EC08AA24DC1A19D1D2ECEEA801B"><enum>166.</enum><header>Adjustment to
the Medicare Advantage stabilization fund</header><text display-inline="no-display-inline">Section 1858(e)(2)(A)(i) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395w–27a(e)(2)(A)(i)), as amended by section 110 of the Medicare, Medicaid,
and SCHIP Extension Act of 2007 (<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>), is amended—</text>
<paragraph id="H66F40ED18D594784AFABC7EDBBF2D950"><enum>(1)</enum><text display-inline="yes-display-inline">by striking <quote>2013</quote> and
inserting <quote>2014</quote>; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H1E68856E07EB48DCAB5C8EABD8DF6A3"><enum>(2)</enum><text display-inline="yes-display-inline">by striking <quote>$1,790,000,000</quote>
and inserting <quote>$1</quote>.</text>
</paragraph></section><section id="H4F62EE7E8F6645E1B1008FE3C1879515"><enum>167.</enum><header>Access to
Medicare reasonable cost contract plans</header>
<subsection id="H2C00AA1FCBF84D1AB815FC346EE2B3A8"><enum>(a)</enum><header>Extension of
reasonable cost contracts</header><text>Section 1876(h)(5)(C)(ii) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395mm">42 U.S.C. 1395mm(h)(5)(C)(ii)</external-xref>), as amended by section 109 of the
Medicare, Medicaid, and SCHIP Extension Act of 2007 (<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>), is
amended by striking <quote>January 1, 2009</quote> and inserting <quote>January
1, 2010</quote> in the matter preceding subclause (I).</text>
</subsection><subsection id="H23B77CE391CE41A8947D9083E55B6B50"><enum>(b)</enum><header>Requirement for
at least two Medicare Advantage organizations To be offering a plan in an area
for the prohibition To be applicable</header><text>Subclauses (I) and (II) of
section 1876(h)(5)(C)(ii) of the Social Security Act (42 U.S.C.
1395mm(h)(5)(C)(ii)) are each amended by inserting <quote>, provided that all
such plans are not offered by the same Medicare Advantage organization</quote>
after <quote>clause (iii)</quote>.</text>
</subsection><subsection id="H4C0EDB038A5749F88213B0C2DFB7AB34"><enum>(c)</enum><header>Revision of
requirements for a plan that are used To determine if prohibition is
applicable</header>
<paragraph id="H5B9BC91DBCA84105BC58B48D65D101A2"><enum>(1)</enum><header>In
general</header><text>Section 1876(h)(5)(C)(iii)(I) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395mm">42 U.S.C. 1395mm(h)(5)(C)(iii)(I)</external-xref>) is amended by inserting <quote>that are not
in another Metropolitan Statistical Area with a population of more than
250,000</quote> after <quote>such Metropolitan Statistical Area</quote>.</text>
</paragraph><paragraph id="HBD1B022474114E93B6428ED83EBBC2CD"><enum>(2)</enum><header>Clarification</header><text>Section
1876(h)(5)(C)(iii)(I) of the Social Security Act (42 U.S.C.
1395mm(h)(5)(C)(iii)(I)) is amended by adding at the end the following new
sentence: <quote>If the service area includes a portion in more than 1
Metropolitan Statistical Area with a population of more than 250,000, the
minimum enrollment determination under the preceding sentence shall be made
with respect to each such Metropolitan Statistical Area (and such applicable
contiguous counties to such Metropolitan Statistical Area).</quote>.</text>
</paragraph></subsection><subsection id="H26E60FADC26E4458819C753073E952A"><enum>(d)</enum><header>GAO study and
report</header>
<paragraph id="H2B77CB14C26B4EEA97D6AEBE72019985"><enum>(1)</enum><header>Study</header><text>The
Comptroller General of the United States shall conduct a study of the reasons
(if any) why reasonable cost contracts under section 1876(h) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395mm">42 U.S.C. 1395mm(h)</external-xref>) are unable to become Medicare Advantage
plans under part C of title XVIII of such Act.</text>
</paragraph><paragraph id="HECF947420D7A4814B2AEEA085BA93981"><enum>(2)</enum><header>Report</header><text>Not
later than December 31, 2009, the Comptroller General of the United States
shall submit to Congress a report containing the results of the study conducted
under paragraph (1), together with recommendations for such legislation and
administrative action as the Comptroller General determines appropriate.</text>
</paragraph></subsection></section><section id="H557528621EF743CCB6EB1C41AAF98C00"><enum>168.</enum><header>MedPAC study
and report on quality measures</header>
<subsection id="H2B3329C03C1E4006AEB6D19D64948272"><enum>(a)</enum><header>Study</header><text>The
Medicare Payment Advisory Commission shall conduct a study on how comparable
measures of performance and patient experience can be collected and reported by
2011 for the Medicare Advantage program under part C of title XVIII of the
Social Security Act and the original Medicare fee-for-service program under
parts A and B of such title. Such study shall address technical issues, such as
data requirements, in addition to issues relating to appropriate quality
benchmarks that—</text>
<paragraph id="HA246BC9B2F1A4A13AA896D1BA4F24D5"><enum>(1)</enum><text>compare the quality
of care Medicare beneficiaries receive across Medicare Advantage plans;
and</text>
</paragraph><paragraph id="H414F8D34D7CA46B99BAD1589AA97EB17"><enum>(2)</enum><text>compare the
quality of care Medicare beneficiaries receive under Medicare Advantage plans
and under the original Medicare fee-for-service program.</text>
</paragraph></subsection><subsection id="H5199DECFD648450ABD2EE26D50A1AB43"><enum>(b)</enum><header>Report</header><text>Not
later than March 31, 2010, the Medicare Payment Advisory Commission shall
submit to Congress a report containing the results of the study conducted under
subsection (a), together with recommendations for such legislation and
administrative action as the Medicare Payment Advisory Commission determines
appropriate.</text>
</subsection></section><section id="H6760A38EE72A42A5ABAC49E29204BEC"><enum>169.</enum><header>MedPAC study and
report on Medicare Advantage payments</header>
<subsection id="HFEE647EF5367446882F696591721634C"><enum>(a)</enum><header>Study</header><text>The
Medicare Payment Advisory Commission (in this section referred to as the
<quote>Commission</quote>) shall conduct a study of the following:</text>
<paragraph id="H82B2612D3C5C43CD902200C8F09B87B"><enum>(1)</enum><text>The correlation
between—</text>
<subparagraph id="H3AFDA1E6C9024E45A0214E44D1B7D472"><enum>(A)</enum><text>the costs that
Medicare Advantage organizations with respect to Medicare Advantage plans incur
in providing coverage under the plan for items and services covered under the
original Medicare fee-for-service program under parts A and B of title XVIII of
the Social Security Act, as reflected in plan bids; and</text>
</subparagraph><subparagraph id="H0A7A186310074554A287E623050AD24"><enum>(B)</enum><text>county-level
spending under such original Medicare fee-for-service program on a per capita
basis, as calculated by the Chief Actuary of the Centers for Medicare &
Medicaid Services.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">The study
with respect to the issue described in the preceding sentence shall include
differences in correlation statistics by plan type and geographic area.</continuation-text></paragraph><paragraph id="H9F933BE195A5411A87069B5BDD3FF22D"><enum>(2)</enum><text>Based on these
results of the study with respect to the issue described in paragraph (1), and
other data the Commission determines appropriate—</text>
<subparagraph id="H93BBD519F74B4989A482982100811740"><enum>(A)</enum><text>alternate
approaches to payment with respect to a Medicare beneficiary enrolled in a
Medicare Advantage plan other than through county-level payment area
equivalents.</text>
</subparagraph><subparagraph id="HB2BC47607B5848288462F05F507B79E2"><enum>(B)</enum><text>the accuracy and
completeness of county-level estimates of per capita spending under such
original Medicare fee-for-service program (including counties in Puerto Rico),
as used to determine the annual Medicare Advantage capitation rate under
section 1853 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-23">42 U.S.C. 1395w–23</external-xref>), and whether such
estimates include—</text>
<clause id="H8F60947AF09A409D933BDAAF15C40173"><enum>(i)</enum><text>expenditures with
respect to Medicare beneficiaries at facilities of the Department of Veterans
Affairs; and</text>
</clause><clause id="HD48960621BD24F43AABF3610A34CF52"><enum>(ii)</enum><text>all
appropriate administrative expenses, including claims processing.</text>
</clause></subparagraph></paragraph><paragraph id="HD8ADA287991E4A459BDAE2E5C8160EC"><enum>(3)</enum><text>Ways to improve the
accuracy and completeness of county-level estimates of per capita spending
described in paragraph (2)(B).</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H52FC6B034A4D4EC600CDD927E31DFC9B"><enum>(b)</enum><header>Report</header><text>Not
later than March 31, 2010, the Commission shall submit to Congress a report
containing the results of the study conducted under subsection (a), together
with recommendations for such legislation and administrative action as the
Commission determines appropriate.</text>
</subsection></section></subtitle><subtitle id="H807E8E831DBC46ABAF7E917C2CBE13C7"><enum>E</enum><header>Provisions
relating to part D</header>
<part id="HB156AFD8B60648FB9F1C01C50051B2AF"><enum>I</enum><header>Improving pharmacy
access</header>
<section commented="no" display-inline="no-display-inline" id="H62BC6634A40445F5A7EAECA893736B7" section-type="subsequent-section"><enum>171.</enum><header display-inline="yes-display-inline">Prompt payment by prescription drug plans
and MA–PD plans under part D</header>
<subsection commented="no" display-inline="no-display-inline" id="H113DA1AE9CCE4E36BBD3D149FD7875D"><enum>(a)</enum><header display-inline="yes-display-inline">Prompt payment by prescription drug
plans</header><text display-inline="yes-display-inline">Section 1860D–12(b) of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-112">42 U.S.C. 1395w–112(b)</external-xref>) is amended by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H6C7F7BD90A2B45A6881CFC20AE3CC742" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="H14CA7E935E024C1B00D40029DDB9E407"><enum>(4)</enum><header display-inline="yes-display-inline">Prompt payment of clean claims</header>
<subparagraph commented="no" display-inline="no-display-inline" id="H1CE84FA222334A4B9748519EA1E084AA"><enum>(A)</enum><header display-inline="yes-display-inline">Prompt payment</header>
<clause commented="no" display-inline="no-display-inline" id="H624AE6276E074FE7A7CD49E778E5008E"><enum>(i)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Each contract entered into with a PDP
sponsor under this part with respect to a prescription drug plan offered by
such sponsor shall provide that payment shall be issued, mailed, or otherwise
transmitted with respect to all clean claims submitted by pharmacies (other
than pharmacies that dispense drugs by mail order only or are located in, or
contract with, a long-term care facility) under this part within the applicable
number of calendar days after the date on which the claim is received.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HEC40DC32395444A8BCB5B1352A9434"><enum>(ii)</enum><header display-inline="yes-display-inline">Clean claim defined</header><text display-inline="yes-display-inline">In this paragraph, the term <term>clean
claim</term> means a claim that has no defect or impropriety (including any
lack of any required substantiating documentation) or particular circumstance
requiring special treatment that prevents timely payment from being made on the
claim under this part.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HBD17AFE347994E85004982F7F787A78F"><enum>(iii)</enum><header>Date of
receipt of claim</header><text>In this paragraph, a claim is considered to have
been received—</text>
<subclause commented="no" display-inline="no-display-inline" id="H28433A9CCB9741C39FBF5205542F71A0"><enum>(I)</enum><text display-inline="yes-display-inline">with respect to claims submitted
electronically, on the date on which the claim is transferred; and</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="H2F96C44817654D2CBC9364FE32E36206"><enum>(II)</enum><text display-inline="yes-display-inline">with respect to claims submitted otherwise,
on the 5th day after the postmark date of the claim or the date specified in
the time stamp of the transmission.</text>
</subclause></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H1A80C467C9E94DC5B3B9444C1DC59D60"><enum>(B)</enum><header display-inline="yes-display-inline">Applicable number of calendar days
defined</header><text display-inline="yes-display-inline">In this paragraph,
the term <term>applicable number of calendar days</term> means—</text>
<clause commented="no" display-inline="no-display-inline" id="HBA5877BCB142407CA4B53239EC31AB47"><enum>(i)</enum><text display-inline="yes-display-inline">with respect to claims submitted
electronically, 14 days; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HFD624D8F242346199427C14BE60643CD"><enum>(ii)</enum><text display-inline="yes-display-inline">with respect to claims submitted otherwise,
30 days.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H105E3E6CEB414EFFA11747CDA0CE8357"><enum>(C)</enum><header display-inline="yes-display-inline">Interest payment</header>
<clause commented="no" display-inline="no-display-inline" id="H58719D3B8CED4798ACA1196E4D356275"><enum>(i)</enum><header>In
general</header><text display-inline="yes-display-inline">Subject to clause
(ii), if payment is not issued, mailed, or otherwise transmitted within the
applicable number of calendar days (as defined in subparagraph (B)) after a
clean claim is received, the PDP sponsor shall pay interest to the pharmacy
that submitted the claim at a rate equal to the weighted average of interest on
3-month marketable Treasury securities determined for such period, increased by
0.1 percentage point for the period beginning on the day after the required
payment date and ending on the date on which payment is made (as determined
under subparagraph (D)(iv)). Interest amounts paid under this subparagraph
shall not be counted against the administrative costs of a prescription drug
plan or treated as allowable risk corridor costs under section
1860D–15(e).</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H0D4C644BCDE5464B9836DE95EEF784FF"><enum>(ii)</enum><header>Authority not
to charge interest</header><text>The Secretary may provide that a PDP sponsor
is not charged interest under clause (i) in the case where there are exigent
circumstances, including natural disasters and other unique and unexpected
events, that prevent the timely processing of claims.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HB6B7BC54D182478A87EA37AE3CF6D100"><enum>(D)</enum><header display-inline="yes-display-inline">Procedures involving claims</header>
<clause commented="no" display-inline="no-display-inline" id="H0A48AEBF5740473481EFB659DB8BB3E"><enum>(i)</enum><header display-inline="yes-display-inline">Claim deemed to be clean</header><text display-inline="yes-display-inline">A claim is deemed to be a clean claim if
the PDP sponsor involved does not provide notice to the claimant of any
deficiency in the claim—</text>
<subclause commented="no" display-inline="no-display-inline" id="H0F52459ECEC24D4FA0C09100DDCB243E"><enum>(I)</enum><text display-inline="yes-display-inline">with respect to claims submitted
electronically, within 10 days after the date on which the claim is received;
and</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="H26B374868404446893D224A68899DDCF"><enum>(II)</enum><text>with respect to
claims submitted otherwise, within 15 days after the date on which the claim is
received.</text>
</subclause></clause><clause commented="no" display-inline="no-display-inline" id="H051526872E364D88A8D74255BDCA3561"><enum>(ii)</enum><header display-inline="yes-display-inline">Claim determined to not be a clean
claim</header>
<subclause commented="no" display-inline="no-display-inline" id="H900C43DFC21A41FFB12404261B3D186D"><enum>(I)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">If a PDP sponsor determines that a
submitted claim is not a clean claim, the PDP sponsor shall, not later than the
end of the period described in clause (i), notify the claimant of such
determination. Such notification shall specify all defects or improprieties in
the claim and shall list all additional information or documents necessary for
the proper processing and payment of the claim.</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="H751864C124464D93B55761A5102E44CE"><enum>(II)</enum><header display-inline="yes-display-inline">Determination after submission of
additional information</header><text display-inline="yes-display-inline">A
claim is deemed to be a clean claim under this paragraph if the PDP sponsor
involved does not provide notice to the claimant of any defect or impropriety
in the claim within 10 days of the date on which additional information is
received under subclause (I).</text>
</subclause></clause><clause commented="no" display-inline="no-display-inline" id="HBDB1F6379E8A4111AE1300E17DF8A18"><enum>(iii)</enum><header display-inline="yes-display-inline">Obligation to pay</header><text display-inline="yes-display-inline">A claim submitted to a PDP sponsor that is
not paid or contested by the sponsor within the applicable number of days (as
defined in subparagraph (B)) after the date on which the claim is received
shall be deemed to be a clean claim and shall be paid by the PDP sponsor in
accordance with subparagraph (A).</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H9930938EFCC34747BDDD3860874BC6D"><enum>(iv)</enum><header display-inline="yes-display-inline">Date of Payment of Claim</header><text display-inline="yes-display-inline">Payment of a clean claim under such
subparagraph is considered to have been made on the date on which—</text>
<subclause commented="no" display-inline="no-display-inline" id="HE890DA79DF034A7D89065DEF4634A7DA"><enum>(I)</enum><text display-inline="yes-display-inline">with respect to claims paid electronically,
the payment is transferred; and</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="H8A5E6015652148079EFF6D3349A68F89"><enum>(II)</enum><text display-inline="yes-display-inline">with respect to claims paid otherwise, the
payment is submitted to the United States Postal Service or common carrier for
delivery.</text>
</subclause></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HC8F979604EDB42C88006CC69FF8E8F8D"><enum>(E)</enum><header display-inline="yes-display-inline">Electronic transfer of funds</header><text display-inline="yes-display-inline">A PDP sponsor shall pay all clean claims
submitted electronically by electronic transfer of funds if the pharmacy so
requests or has so requested previously. In the case where such payment is made
electronically, remittance may be made by the PDP sponsor electronically as
well.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H81A6927B503249729677A38DC53E51D0"><enum>(F)</enum><header display-inline="yes-display-inline">Protecting the rights of claimants</header>
<clause commented="no" display-inline="no-display-inline" id="H1A730082FE0E4AE0AFFC30006CA7EA6E"><enum>(i)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Nothing in this paragraph shall be
construed to prohibit or limit a claim or action not covered by the subject
matter of this section that any individual or organization has against a
provider or a PDP sponsor.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HB3AD0C39457345C38B7C72C1B5C4093"><enum>(ii)</enum><header display-inline="yes-display-inline">Anti-Retaliation</header><text display-inline="yes-display-inline">Consistent with applicable Federal or State
law, a PDP sponsor shall not retaliate against an individual or provider for
exercising a right of action under this subparagraph.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H4A3CAF77289C4CCEBC046DB06FF77922"><enum>(G)</enum><header display-inline="yes-display-inline">Rule of construction</header><text display-inline="yes-display-inline">A determination under this paragraph that a
claim submitted by a pharmacy is a clean claim shall not be construed as a
positive determination regarding eligibility for payment under this title, nor
is it an indication of government approval of, or acquiescence regarding, the
claim submitted. The determination shall not relieve any party of civil or
criminal liability with respect to the claim, nor does it offer a defense to
any administrative, civil, or criminal action with respect to the
claim.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="HB72E0852B9B24A24B416ECFB6DFAA9CD"><enum>(b)</enum><header display-inline="yes-display-inline">Prompt payment by MA–PD plans</header><text display-inline="yes-display-inline">Section 1857(f) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-27">42 U.S.C. 1395w–27</external-xref>) is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H2AAB6D0590484E0B002CE44DE6C41943" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="HEFDF526808394C7DB901CF23AE94B1FA"><enum>(3)</enum><header display-inline="yes-display-inline">Incorporation of certain prescription drug
plan contract requirements</header><text display-inline="yes-display-inline">The following provisions shall apply to
contracts with a Medicare Advantage organization offering an MA–PD plan in the
same manner as they apply to contracts with a PDP sponsor offering a
prescription drug plan under part D:</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HC9E3F99A55F042DE9D341D376B866500"><enum>(A)</enum><header display-inline="yes-display-inline">Prompt
payment</header><text display-inline="yes-display-inline">Section
1860D–12(b)(4).</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H8466D2E7F9F54ED98FD5B3200059CB9F"><enum>(c)</enum><header display-inline="yes-display-inline">Effective
date</header><text display-inline="yes-display-inline">The amendments made by
this section shall apply to plan years beginning on or after January 1,
2010.</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="HBC25D5A195AD495D97268036CBB600B3" section-type="subsequent-section"><enum>172.</enum><header display-inline="yes-display-inline">Submission of claims by pharmacies located
in or contracting with long-term care facilities</header>
<subsection commented="no" display-inline="no-display-inline" id="H1BC545839E8C42AB98AA00FF0038C474"><enum>(a)</enum><header display-inline="yes-display-inline">Submission of claims by pharmacies located
in or contracting with long-term care facilities</header>
<paragraph commented="no" display-inline="no-display-inline" id="HB12365D947314B4EB9EFE7C76C5E3B2"><enum>(1)</enum><header display-inline="yes-display-inline">Submission of claims to prescription drug
plans</header><text display-inline="yes-display-inline">Section 1860D–12(b) of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-112">42 U.S.C. 1395w–112(b)</external-xref>), as amended by section 171(a),
is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H1C4B82BBECF848840030CB1FEBFAE3E0" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="HBB0DE7FB9D404669BC8C4387728C96C9"><enum>(5)</enum><header display-inline="yes-display-inline">Submission of claims by pharmacies located
in or contracting with long-term care facilities</header><text display-inline="yes-display-inline">Each contract entered into with a PDP
sponsor under this part with respect to a prescription drug plan offered by
such sponsor shall provide that a pharmacy located in, or having a contract
with, a long-term care facility shall have not less than 30 days (but not more
than 90 days) to submit claims to the sponsor for reimbursement under the
plan.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H22CFF968C7F649E68FED4FA26988BDB5"><enum>(2)</enum><header display-inline="yes-display-inline">Submission of claims to MA–PD
plans</header><text display-inline="yes-display-inline">Section 1857(f)(3) of
the Social Security Act, as added by section 171(b), is amended by adding at
the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H568BE81658C54D54ADA48FE091F38D7E" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="H71DD2845DD774042A9E2FEF7FF5AAD7"><enum>(B)</enum><header display-inline="yes-display-inline">Submission of claims by pharmacies located
in or contracting with long-term care facilities</header><text display-inline="yes-display-inline">Section
1860D–12(b)(5).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HBCAAB83DD1164FD4BEBD87AD480508F"><enum>(b)</enum><header display-inline="yes-display-inline">Effective
date</header><text display-inline="yes-display-inline">The amendments made by
this section shall apply to plan years beginning on or after January 1,
2010.</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="HB2F348C9722C4A6BB6074360D1AB1DB2" section-type="subsequent-section"><enum>173.</enum><header display-inline="yes-display-inline">Regular update of prescription drug pricing
standard</header>
<subsection commented="no" display-inline="no-display-inline" id="H48A896FE11E4414D002E727FE697F554"><enum>(a)</enum><header display-inline="yes-display-inline">Requirement for prescription drug
plans</header><text display-inline="yes-display-inline">Section 1860D–12(b) of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-112">42 U.S.C. 1395w–112(b)</external-xref>), as amended by section
172(a)(1), is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H922126FF7D6B4DF8917677B099D08DCB" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="H21C6A039D1A548E0B9A145EABA49BEBB"><enum>(6)</enum><header display-inline="yes-display-inline">Regular update of prescription drug pricing
standard</header><text display-inline="yes-display-inline">If the PDP sponsor
of a prescription drug plan uses a standard for reimbursement of pharmacies
based on the cost of a drug, each contract entered into with such sponsor under
this part with respect to the plan shall provide that the sponsor shall update
such standard not less frequently than once every 7 days, beginning with an
initial update on January 1 of each year, to accurately reflect the market
price of acquiring the
drug.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="HDB4C5A7361634BF00066CA31E5FB1217"><enum>(b)</enum><header display-inline="yes-display-inline">Requirement for MA–PD plans</header><text display-inline="yes-display-inline">Section 1857(f)(3) of the Social Security
Act, as amended by section 172(a)(2), is amended by adding at the end the
following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HEDA60D8E09744266A9AB002D58240200" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="H604E8EE25416410BA476BB5421925B99"><enum>(C)</enum><header display-inline="yes-display-inline">Regular update of Prescription Drug Pricing
Standard</header><text display-inline="yes-display-inline">Section
1860D–12(b)(6).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H5D1809FC5F0F419BAE39149F1B97B750"><enum>(c)</enum><header display-inline="yes-display-inline">Effective
date</header><text display-inline="yes-display-inline">The amendments made by
this section shall apply to plan years beginning on or after January 1,
2009.</text>
</subsection></section></part><part id="H61A81D94C4204DB4B7216F77CD8E184F"><enum>II</enum><header>Other
provisions</header>
<section id="H565AAE20DB1844E4A9B9C77C471B3367"><enum>175.</enum><header>Inclusion of
barbiturates and benzodiazepines as covered part
<enum-in-header>D</enum-in-header> drugs</header>
<subsection id="HEDF874A6D7FB4934946CBDEC34832BA3"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section
1860D–2(e)(2)(A) of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-102">42 U.S.C. 1395w–102(e)(2)(A)</external-xref>) is amended by inserting after
<quote>agents),</quote> the following <quote>other than subparagraph (I) of
such section (relating to barbiturates) if the barbiturate is used in the
treatment of epilepsy, cancer, or a chronic mental health disorder, and other
than subparagraph (J) of such section (relating to
benzodiazepines),</quote>.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="HA0532B884680488FB927168794896C14"><enum>(b)</enum><header>Effective
date</header><text display-inline="yes-display-inline">The amendments made by
subsection (a) shall apply to prescriptions dispensed on or after January 1,
2012.</text>
</subsection></section><section id="HA7CE7658250943069CFAFF4DDACBF529"><enum>176.</enum><header>Formulary
requirements with respect to certain categories or classes of
drugs</header><text display-inline="no-display-inline">Section 1860D–4(b)(3) of
the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395w–104(b)(3)) is amended—</text>
<paragraph id="HD982D06F600C4DD5A6E8C7C77E4E71A5"><enum>(1)</enum><text>in subparagraph
(C)(i), by striking <quote>The formulary</quote> and inserting <quote>Subject
to subparagraph (G), the formulary</quote>; and</text>
</paragraph><paragraph id="H64DE5307E03C4314BD6747CDE9878D3C"><enum>(2)</enum><text>by inserting after
subparagraph (F) the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H3D384875C5FA470A8072473BF5098F96" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="H4E18B8C2CAAB45EBB2B2658055AFD9DD"><enum>(G)</enum><header>Required
inclusion of drugs in certain categories and classes</header>
<clause commented="no" display-inline="no-display-inline" id="H32AF22F1107F40238EB4316E921CAE1"><enum>(i)</enum><header>Identification of
drugs in certain categories and classes</header><text>Beginning with plan year
2010, the Secretary shall identify, as appropriate, categories and classes of
drugs for which both of the following criteria are met:</text>
<subclause id="HF93F453331E24B97999EFC78DA103E8C"><enum>(I)</enum><text>Restricted access
to drugs in the category or class would have major or life threatening clinical
consequences for individuals who have a disease or disorder treated by the
drugs in such category or class.</text>
</subclause><subclause id="HE94B0C084D6C4E84A5DE7C5E66ED8867"><enum>(II)</enum><text>There is
significant clinical need for such individuals to have access to multiple drugs
within a category or class due to unique chemical actions and pharmacological
effects of the drugs within the category or class, such as drugs used in the
treatment of cancer.</text>
</subclause></clause><clause id="H86828B5A66C34A21BFFD1B8BA06206DB"><enum>(ii)</enum><header>Formulary
requirements</header><text>Subject to clause (iii), PDP sponsors offering
prescription drug plans shall be required to include all covered part D drugs
in the categories and classes identified by the Secretary under clause
(i).</text>
</clause><clause id="HF837FE5ADBDE4C0687C300636092D68F"><enum>(iii)</enum><header>Exceptions</header><text>The
Secretary may establish exceptions that permits a PDP sponsor of a prescription
drug plan to exclude from its formulary a particular covered part D drug in a
category or class that is otherwise required to be included in the formulary
under clause (ii) (or to otherwise limit access to such a drug). Any exceptions
established under the preceding sentence shall be provided under a process
that—</text>
<subclause id="HBA61AFADCDA54C40BA55E066AD78AE69"><enum>(I)</enum><text>ensures that any
exception to such requirement is based upon scientific evidence and medical
standards of practice; and</text>
</subclause><subclause id="H3D1B42600D4E48FCBB5EC15B6080037"><enum>(II)</enum><text>includes a public
notice and comment
period.</text>
</subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section></part></subtitle><subtitle id="HFA63DE252C514617B9FB07A8A75100F0"><enum>F</enum><header>Other
provisions</header>
<section id="HC36D4D3D48424ADF852D3D9FF828EAD3"><enum>181.</enum><header>Use of part D
data</header><text display-inline="no-display-inline">Section 1860D–12(b)(3)(D)
of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-112">42 U.S.C. 1395w–112(b)(3)(D)</external-xref>) is amended by adding
at the end the following sentence: <quote>Notwithstanding any other provision
of law, information provided to the Secretary under the application of section
1857(e)(1) to contracts under this section under the preceding sentence may be
used for the purposes of carrying out this part, improving public health
through research on the utilization, safety, effectiveness, quality, and
efficiency of health care services (as the Secretary determines appropriate),
and conducting Congressional oversight, monitoring, and analysis of the program
under this title.</quote>.</text>
</section><section id="H483C2B3DCEFC47F6A6BE4B7C840074D8"><enum>182.</enum><header>Revision of
definition of medically accepted indication for drugs</header>
<subsection id="H0451E6F20E1C4EA8B97EA66DC36EC829"><enum>(a)</enum><header>Revision of
definition for part D drugs</header>
<paragraph id="H8BFB83B7E62346BFA9EF066C3879AEB6"><enum>(1)</enum><header>In
general</header><text>Section 1860D–2(e)(1) of the Social Security Act (42
U.S.C. 1395w–102(e)(1)) is amended, in the matter following subparagraph
(B)—</text>
<subparagraph id="H2050E5C211BC472FB8E2C0C7EB6FD0C0"><enum>(A)</enum><text>by striking
<quote>(as defined in section 1927(k)(6))</quote> and inserting <quote>(as
defined in paragraph (4))</quote>; and</text>
</subparagraph><subparagraph id="H83D69D1EC0774310B9AFEC61F591ACBB"><enum>(B)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H88B8B25E31F448B68521457391193124" style="OLC">
<paragraph id="HA854B53145644E4480BDF7B3F5AEA877"><enum>(4)</enum><header>Medically
accepted indication defined</header>
<subparagraph id="HAC9997268249429985ED3EB153AD345B"><enum>(A)</enum><header>In
general</header><text>For purposes of paragraph (1), the term <quote>medically
accepted indication</quote> has the meaning given that term—</text>
<clause id="HCA934763CB2B4FDF8718451330CA6FF9"><enum>(i)</enum><text>in
the case of a covered part D drug used in an anticancer chemotherapeutic
regimen, in section 1861(t)(2)(B), except that in applying such section—</text>
<subclause id="H2D95A348E3FD41039789549679C8A714"><enum>(I)</enum><text><quote>prescription
drug plan or MA–PD plan</quote> shall be substituted for <quote>carrier</quote>
each place it appears; and</text>
</subclause><subclause id="HF6608AAFB34A4D18B85DA096D6999883"><enum>(II)</enum><text>subject to
subparagraph (B), the compendia described in section 1927(g)(1)(B)(i)(III)
shall be included in the list of compendia described in clause (ii)(I) section
1861(t)(2)(B); and</text>
</subclause></clause><clause id="H8B512B845AA147488B818B943F39E14D"><enum>(ii)</enum><text>in the case of
any other covered part D drug, in section 1927(k)(6).</text>
</clause></subparagraph><subparagraph id="H9CDEF846F5E042FBB372E98D72CD1D22"><enum>(B)</enum><header>Conflict of
interest</header><text>On and after January 1, 2010, subparagraph (A)(i)(II)
shall not apply unless the compendia described in section 1927(g)(1)(B)(i)(III)
meets the requirement in the third sentence of section 1861(t)(2)(B).</text>
</subparagraph><subparagraph id="HD277A9BC2EAA43EF8481A4F751196C01"><enum>(C)</enum><header>Update</header><text>For
purposes of applying subparagraph (A)(ii), the Secretary shall revise the list
of compendia described in section 1927(g)(1)(B)(i) as is appropriate for
identifying medically accepted indications for drugs. Any such revision shall
be done in a manner consistent with the process for revising compendia under
section
1861(t)(2)(B).</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H71C19BE5757A4E4AAF6F3D51D5DF8BD"><enum>(2)</enum><header>Effective
date</header><text>The amendments made by this subsection shall apply to plan
years beginning on or after January 1, 2009.</text>
</paragraph></subsection><subsection id="HDF90A97BAE3E4A69A8861B4402D7DB8D"><enum>(b)</enum><header>Conflicts of
interest</header><text>Section 1861(t)(2)(B) of the Social Security Act (42
U.S.C. 1395x(t)(2)(B)) is amended by adding at the end the following new
sentence: <quote>On and after January 1, 2010, no compendia may be included on
the list of compendia under this subparagraph unless the compendia has a
publicly transparent process for evaluating therapies and for identifying
potential conflicts of interests.</quote>.</text>
</subsection></section><section display-inline="no-display-inline" id="H55B7E6031FAA457595577BF1189FD732"><enum>183.</enum><header>Contract with a
consensus-based entity regarding performance measurement</header>
<subsection id="H0C630C07C6B54B42A133CFD31E24A980"><enum>(a)</enum><header>Contract</header>
<paragraph id="H9F8A1CA708924E44B66B90544D700586"><enum>(1)</enum><header>In
general</header><text>Part E of title XVIII of the Social Security Act (42
U.S.C. 1395x et seq.) is amended by inserting after section 1889 the following
new section:</text>
<quoted-block display-inline="no-display-inline" id="HFABC140C1A4E45BA9B9F71D6E2A501AA" style="traditional">
<section id="HEF36874032BD436A8371333347A4E36"><enum>1890.</enum><header>Contract with a consensus-based entity regarding performance
measurement</header><subsection commented="no" display-inline="yes-display-inline" id="H2F19491A571C40E58124B2F0239942B1"><enum>(a)</enum><header>Contract</header>
<paragraph id="H2F19035FCCB949CE964270BA968538E4"><enum>(1)</enum><header>In
general</header><text>For purposes of activities conducted under this Act, the
Secretary shall identify and have in effect a contract with a consensus-based
entity, such as the National Quality Forum, that meets the requirements
described in subsection (c). Such contract shall provide that the entity will
perform the duties described in subsection (b).</text>
</paragraph><paragraph id="H71F114C64E164DA9880000B2F6B7A492"><enum>(2)</enum><header>Timing for first
contract</header><text>As soon as practicable after the date of the enactment
of this subsection, the Secretary shall enter into the first contract under
paragraph (1).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HA140220CABB94A33A54B57600800E204"><enum>(3)</enum><header display-inline="yes-display-inline">Period of contract</header><text>A contract
under paragraph (1) shall be for a period of 4 years (except as may be renewed
after a subsequent bidding process).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HA354B8F1371243F095207312ACEA6C6B"><enum>(4)</enum><header display-inline="yes-display-inline">Competitive procedures</header><text display-inline="yes-display-inline">Competitive procedures (as defined in
section 4(5) of the Office of Federal Procurement Policy Act (41 U.S.C.
403(5))) shall be used to enter into a contract under paragraph (1).</text>
</paragraph></subsection><subsection id="HEA89FAABB9084D4E8F9E7398D2F5FF64"><enum>(b)</enum><header>Duties</header><text>The
duties described in this subsection are the following:</text>
<paragraph id="H42CA23746EE94ED1BD4374421DEB0026"><enum>(1)</enum><header>Priority setting
process</header><text>The entity shall synthesize evidence and convene key
stakeholders to make recommendations, with respect to activities conducted
under this Act, on an integrated national strategy and priorities for health
care performance measurement in all applicable settings. In making such
recommendations, the entity shall—</text>
<subparagraph id="H2BF77594209B4243AB39D29641DA1E01"><enum>(A)</enum><text>ensure that
priority is given to measures—</text>
<clause id="H4EE6E0E47FC54D2CBE70FF4D53776D53"><enum>(i)</enum><text>that address the
health care provided to patients with prevalent, high-cost chronic
diseases;</text>
</clause><clause id="HC308A50B889545ED85695CCF5731CE03"><enum>(ii)</enum><text>with the greatest
potential for improving the quality, efficiency, and patient-centeredness of
health care; and</text>
</clause><clause id="HD11579BF3AE049E58009095C00BF6C00"><enum>(iii)</enum><text>that may be
implemented rapidly due to existing evidence, standards of care, or other
reasons; and</text>
</clause></subparagraph><subparagraph id="HF47848D79FA341E89B40CFA03F8B67"><enum>(B)</enum><text>take into account
measures that—</text>
<clause id="H9C37D281C1B143C1BCD48C7B88C48610"><enum>(i)</enum><text>may assist
consumers and patients in making informed health care decisions;</text>
</clause><clause id="HCA12E70DA9BC4B0D9223E2B9E59BD75"><enum>(ii)</enum><text>address health
disparities across groups and areas; and</text>
</clause><clause id="H63052953FAD247789252DC4EA79ECCBC"><enum>(iii)</enum><text>address the
continuum of care a patient receives, including services furnished by multiple
health care providers or practitioners and across multiple settings.</text>
</clause></subparagraph></paragraph><paragraph id="HDD0E49E5C5A944FE83581E34D5CB0477"><enum>(2)</enum><header>Endorsement of
measures</header><text>The entity shall provide for the endorsement of
standardized health care performance measures. The endorsement process under
the preceding sentence shall consider whether a measure—</text>
<subparagraph id="H35D4CF9F93764EAE8165256DDE5402E4"><enum>(A)</enum><text>is evidence-based,
reliable, valid, verifiable, relevant to enhanced health outcomes, actionable
at the caregiver level, feasible to collect and report, and responsive to
variations in patient characteristics, such as health status, language
capabilities, race or ethnicity, and income level; and</text>
</subparagraph><subparagraph id="H91DBA5DBEF534C95986721A114956369"><enum>(B)</enum><text>is consistent
across types of health care providers, including hospitals and
physicians.</text>
</subparagraph></paragraph><paragraph id="HB20A0B56204643BF9228C882866D4E8"><enum>(3)</enum><header>Maintenance of
measures</header><text>The entity shall establish and implement a process to
ensure that measures endorsed under paragraph (2) are updated (or retired if
obsolete) as new evidence is developed.</text>
</paragraph><paragraph id="HD558B7C720ED41A8A544B61C9415E43F"><enum>(4)</enum><header>Promotion of the
development of electronic health records</header><text>The entity shall promote
the development and use of electronic health records that contain the
functionality for automated collection, aggregation, and transmission of
performance measurement information.</text>
</paragraph><paragraph id="H7F1360B3B9994F1081E8ADFA24FBABF6"><enum>(5)</enum><header>Annual report to
Congress and the Secretary; Secretarial publication and comment</header>
<subparagraph id="HC302713867AD45729860BB735113ED19"><enum>(A)</enum><header>Annual
report</header><text>By not later than March 1 of each year (beginning with
2009), the entity shall submit to Congress and the Secretary a report
containing a description of—</text>
<clause id="H8D4A4F09307E48CFBB162494A8CF6CA9"><enum>(i)</enum><text>the implementation
of quality measurement initiatives under this Act and the coordination of such
initiatives with quality initiatives implemented by other payers;</text>
</clause><clause id="H3D5CD71351704EF4AFB75A6E86422FB"><enum>(ii)</enum><text>the
recommendations made under paragraph (1); and</text>
</clause><clause id="H49A3F7BC213847B4A95800CEF9137D4B"><enum>(iii)</enum><text>the performance
by the entity of the duties required under the contract entered into with the
Secretary under subsection (a).</text>
</clause></subparagraph><subparagraph id="HA51AB878401348CE9BC8CC3002CD4D70"><enum>(B)</enum><header>Secretarial
review and publication of annual report</header><text>Not later than 6 months
after receiving a report under subparagraph (A) for a year, the Secretary
shall—</text>
<clause id="H659675677B41423D9BAB2CBEAA512F80"><enum>(i)</enum><text>review such
report; and</text>
</clause><clause id="HEFB1862DC9534CB8A709102000857CC2"><enum>(ii)</enum><text>publish such
report in the Federal Register, together with any comments of the Secretary on
such report.</text>
</clause></subparagraph></paragraph></subsection><subsection id="H8BE7D7B27AC24779B702FF7296D7E31E"><enum>(c)</enum><header>Requirements
described</header><text>The requirements described in this subsection are the
following:</text>
<paragraph id="HE27F3C0B02A6420094BA096882C4067E"><enum>(1)</enum><header>Private
nonprofit</header><text>The entity is a private nonprofit entity governed by a
board.</text>
</paragraph><paragraph id="H2B4F0ED57DC744D09B8D3725867647FF"><enum>(2)</enum><header>Board
membership</header><text>The members of the board of the entity include—</text>
<subparagraph id="H744BF73C5B60480DA933FB25A76D1035"><enum>(A)</enum><text>representatives of
health plans and health care providers and practitioners or representatives of
groups representing such health plans and health care providers and
practitioners;</text>
</subparagraph><subparagraph id="H0DADA41D0A0F40F2AA5F7F001DB31206"><enum>(B)</enum><text>health care
consumers or representatives of groups representing health care consumers;
and</text>
</subparagraph><subparagraph id="H36625676C5024BBBAA92B992C40094A0"><enum>(C)</enum><text>representatives of
purchasers and employers or representatives of groups representing purchasers
or employers.</text>
</subparagraph></paragraph><paragraph id="H5108065B0D624AA585CA90001D3E6F03"><enum>(3)</enum><header>Entity
membership</header><text>The membership of the entity includes persons who have
experience with—</text>
<subparagraph id="H77FC7D02C3A74BB39B9C1C0745C24883"><enum>(A)</enum><text>urban health care
issues;</text>
</subparagraph><subparagraph id="H1961F43E1F7843A48608C0202CF40218"><enum>(B)</enum><text>safety net health
care issues;</text>
</subparagraph><subparagraph id="H0C701A7032584193B567391BAD8109C"><enum>(C)</enum><text>rural and frontier
health care issues; and</text>
</subparagraph><subparagraph id="HBF4D6CFB0A6C4B05A7776483A58C8D24"><enum>(D)</enum><text>health care
quality and safety issues.</text>
</subparagraph></paragraph><paragraph id="H4152DCACDD8C403182A200A39BC6D920"><enum>(4)</enum><header>Open and
transparent</header><text>With respect to matters related to the contract with
the Secretary under subsection (a), the entity conducts its business in an open
and transparent manner and provides the opportunity for public comment on its
activities.</text>
</paragraph><paragraph id="HB1E79FE2136048B78717C2F5D15286B1"><enum>(5)</enum><header>Voluntary
consensus standards setting organization</header><text>The entity operates as a
voluntary consensus standards setting organization as defined for purposes of
section 12(d) of the National Technology Transfer and Advancement Act of 1995
(<external-xref legal-doc="public-law" parsable-cite="pl/104/113">Public Law 104–113</external-xref>) and Office of Management and Budget Revised Circular A–119
(published in the Federal Register on February 10, 1998).</text>
</paragraph><paragraph id="H101E5E27F4FE4C5CA2433B20CDB14631"><enum>(6)</enum><header>Experience</header><text>The
entity has at least 4 years of experience in establishing national consensus
standards.</text>
</paragraph><paragraph id="HD4CB921748E6413A95A9B008A7F0E3CC"><enum>(7)</enum><header>Membership
fees</header><text>If the entity requires a membership fee for participation in
the functions of the entity, such fees shall be reasonable and adjusted based
on the capacity of the potential member to pay the fee. In no case shall
membership fees pose a barrier to the participation of individuals or groups
with low or nominal resources to participate in the functions of the
entity.</text>
</paragraph></subsection><subsection id="H9101E889BA7F4BF5A6005E2CC742977D"><enum>(d)</enum><header>Funding</header><text>For
purposes of carrying out this section, the Secretary shall provide for the
transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and
the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in
such proportion as the Secretary determines appropriate), of $10,000,000 to the
Centers for Medicare & Medicaid Services Program Management Account for
each of fiscal years 2009 through
2012.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph commented="no" id="H10B4736312B34280B7351703E0526F93"><enum>(2)</enum><header>Sense of the
Senate</header><text>It is the Sense of the Senate that the selection by the
Secretary of Health and Human Services of an entity to contract with under
section 1890(a) of the Social Security Act, as added by paragraph (1), should
not be construed as diminishing the significant contributions of the Boards of
Medicine, the quality alliances, and other clinical and technical experts to
efforts to measure and improve the quality of health care services.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HFDBB862A8033487DBFFE7034896D2B5F"><enum>(b)</enum><header>GAO study and
reports on the performance and costs of the consensus-based entity under the
contract</header>
<paragraph commented="no" display-inline="no-display-inline" id="HDE267B730F9E4DB19E5747116D041974"><enum>(1)</enum><header>In
general</header><text>The Comptroller General of the United States shall
conduct a study on—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H74A5D28FCB864C17961B99216BB3BCA5"><enum>(A)</enum><text>the performance of
the entity with a contract with the Secretary of Health and Human Services
under section 1890(a) of the Social Security Act, as added by subsection (a),
of its duties under such contract; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HB3C4EBBEA8A54AABA7B8182B5D8F402C"><enum>(B)</enum><text>the costs incurred
by such entity in performing such duties.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H91F73FF97AEC4B06A3A93C00F526008F"><enum>(2)</enum><header>Reports</header><text>Not
later than 18 months and 36 months after the effective date of the first
contract entered into under such section 1890(a), the Comptroller General of
the United States shall submit to Congress a report containing the results of
the study conducted under paragraph (1), together with recommendations for such
legislation and administrative action as the Comptroller General determines
appropriate.</text>
</paragraph></subsection></section><section id="HD077A151CE264C89B8BC211D38437F17"><enum>184.</enum><header>Cost-sharing
for clinical trials</header><text display-inline="no-display-inline">Section
1833 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l</external-xref>), as amended by section
152(a), is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HD557C61873DE42B19D1159E2CAFC896F" style="OLC">
<subsection id="HFD9CF426CFA5443481B1BEF5571BA3DA"><enum>(x)</enum><header>Methods of
payment</header><text>The Secretary may develop alternative methods of payment
for items and services provided under clinical trials and comparative
effectiveness studies sponsored or supported by an agency of the Department of
Health and Human Services, as determined by the Secretary, to those that would
otherwise apply under this section, to the extent such alternative methods are
necessary to preserve the scientific validity of such trials or studies, such
as in the case where masking the identity of interventions from patients and
investigators is necessary to comply with the particular trial or study
design.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="HE33C03C396BF4020ACA95DAEA8E9EAEE"><enum>185.</enum><header>Addressing
health care disparities</header><text display-inline="no-display-inline">Title
XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>) is amended by
inserting after section 1808 the following new section:</text>
<quoted-block display-inline="no-display-inline" id="HEA07960ED8564D4EB11880F3829EE7C4" style="traditional">
<section id="HC7789FFB75CD4914A0E8A445BFACB7DC"><enum>1809.</enum><header>Addressing health care disparities</header><subsection commented="no" display-inline="yes-display-inline" id="HA9B901E2E13740B3B0954871955DABAB"><enum>(a)</enum><header>Evaluating data
collection approaches</header><text>The Secretary shall evaluate approaches for
the collection of data under this title, to be performed in conjunction with
existing quality reporting requirements and programs under this title, that
allow for the ongoing, accurate, and timely collection and evaluation of data
on disparities in health care services and performance on the basis of race,
ethnicity, and gender. In conducting such evaluation, the Secretary shall
consider the following objectives:</text>
<paragraph id="HE2276721111343388733B1C66B74626F"><enum>(1)</enum><text>Protecting patient
privacy.</text>
</paragraph><paragraph id="H571B2E09FAF64C97AE3E7C493341DF58"><enum>(2)</enum><text>Minimizing the
administrative burdens of data collection and reporting on providers and health
plans participating under this title.</text>
</paragraph><paragraph id="H5BE7B3801D6C4D71A3E2AB445349A358"><enum>(3)</enum><text>Improving Medicare
program data on race, ethnicity, and gender.</text>
</paragraph></subsection><subsection id="HF8AF8B6A4C544127AC01F89E2D8DA445"><enum>(b)</enum><header>Reports to
congress</header>
<paragraph id="HE23ADAAFAB6F4E8AA3ADE8EEDA09A867"><enum>(1)</enum><header>Report on
evaluation</header><text>Not later than 18 months after the date of the
enactment of this section, the Secretary shall submit to Congress a report on
the evaluation conducted under subsection (a). Such report shall, taking into
consideration the results of such evaluation—</text>
<subparagraph id="HE16EF69A0584478A98E3E6730028EE14"><enum>(A)</enum><text>identify
approaches (including defining methodologies) for identifying and collecting
and evaluating data on health care disparities on the basis of race, ethnicity,
and gender for the original Medicare fee-for-service program under parts A and
B, the Medicare Advantage program under part C, and the Medicare prescription
drug program under part D; and</text>
</subparagraph><subparagraph id="HE8E1EBF8A64B42939DDA002294E37EDE"><enum>(B)</enum><text>include
recommendations on the most effective strategies and approaches to reporting
HEDIS quality measures as required under section 1852(e)(3) and other
nationally recognized quality performance measures, as appropriate, on the
basis of race, ethnicity, and gender.</text>
</subparagraph></paragraph><paragraph id="HA312EEC0CF734A16A69FE9D79C015505"><enum>(2)</enum><header>Reports on data
analyses</header><text>Not later than 4 years after the date of the enactment
of this section, and 4 years thereafter, the Secretary shall submit to Congress
a report that includes recommendations for improving the identification of
health care disparities for Medicare beneficiaries based on analyses of the
data collected under subsection (c).</text>
</paragraph></subsection><subsection id="H06AB23B9C5D94A26A063A15B215643E"><enum>(c)</enum><header>Implementing
effective approaches</header><text>Not later than 24 months after the date of
the enactment of this section, the Secretary shall implement the approaches
identified in the report submitted under subsection (b)(1) for the ongoing,
accurate, and timely collection and evaluation of data on health care
disparities on the basis of race, ethnicity, and
gender.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="H26D9DDA44C744B72B1F2DC0F629FFCD"><enum>186.</enum><header>Demonstration to
improve care to previously uninsured</header>
<subsection id="H891B172D2BF54D4EB00570824FE1B7F0"><enum>(a)</enum><header>Establishment</header><text>Within
one year after the date of the enactment of this Act, the Secretary (in this
section referred to as the <quote>Secretary</quote>) shall establish a
demonstration project to determine the greatest needs and most effective
methods of outreach to medicare beneficiaries who were previously
uninsured.</text>
</subsection><subsection id="HBC4CE213E7D14A0F8F8C09EC06D5254"><enum>(b)</enum><header>Scope</header><text display-inline="yes-display-inline">The demonstration shall be in no fewer than
10 sites, and shall include state health insurance assistance programs,
community health centers, community-based organizations, community health
workers, and other service providers under parts A, B, and C of title XVIII of
the Social Security Act. Grantees that are plans operating under part C shall
document that enrollees who were previously uninsured receive the
<quote>Welcome to Medicare</quote> physical exam.</text>
</subsection><subsection id="H23BF9FA5F27748919C46D76B3600F27"><enum>(c)</enum><header>Duration</header><text>The
Secretary shall conduct the demonstration project for a period of 2
years.</text>
</subsection><subsection id="H8C70AB5BD8B14321A85E00C5588B958C"><enum>(d)</enum><header>Report and
evaluation</header><text>The Secretary shall conduct an evaluation of the
demonstration and not later than 1 year after the completion of the project
shall submit to Congress a report including the following:</text>
<paragraph id="H91C12C782176496E968C1445D740DC07"><enum>(1)</enum><text>An analysis of the
effectiveness of outreach activities targeting beneficiaries who were
previously uninsured, such as revising outreach and enrollment materials
(including the potential for use of video information), providing one-on-one
counseling, working with community health workers, and amending the Medicare
and You handbook.</text>
</paragraph><paragraph id="H8D07224E52C5434EBA77E13F008D9D77"><enum>(2)</enum><text>The effect of such
outreach on beneficiary access to care, utilization of services, efficiency and
cost-effectiveness of health care delivery, patient satisfaction, and select
health outcomes.</text>
</paragraph></subsection></section><section id="H347CD4BC46AF49A0B2001169D0F1F133"><enum>187.</enum><header>Office of the
Inspector General report on compliance with and enforcement of national
standards on culturally and linguistically appropriate services (CLAS) in
Medicare</header>
<subsection id="HAC407376F5C341759B251FB220C557F7"><enum>(a)</enum><header>Report</header><text>Not
later than two years after the date of the enactment of this Act, the Inspector
General of the Department of Health and Human Services shall prepare and
publish a report on—</text>
<paragraph id="H7865C6A6F7094BA286C6E7CFEFE4D00"><enum>(1)</enum><text>the extent to which
Medicare providers and plans are complying with the Office for Civil Rights’
Guidance to Federal Financial Assistance Recipients Regarding Title VI
Prohibition Against National Origin Discrimination Affecting Limited English
Proficient Persons and the Office of Minority Health’s Culturally and
Linguistically Appropriate Services Standards in health care; and</text>
</paragraph><paragraph id="HBAD15573D5984A36BFA5998081B765BC"><enum>(2)</enum><text>a
description of the costs associated with or savings related to the provision of
language services.</text>
</paragraph><continuation-text continuation-text-level="subsection">Such report
shall include recommendations on improving compliance with CLAS Standards and
recommendations on improving enforcement of CLAS Standards.</continuation-text></subsection><subsection commented="no" display-inline="no-display-inline" id="H2C1593E9A668405E8121FC83D268A063"><enum>(b)</enum><header>Implementation</header><text>Not
later than one year after the date of publication of the report under
subsection (a), the Department of Health and Human Services shall implement
changes responsive to any deficiencies identified in the report.</text>
</subsection></section><section id="H2135945205E940B3BB137039DFC2AE89"><enum>188.</enum><header>Medicare
Improvement Funding</header>
<subsection id="H1EE6289C06EE45A6B9F0FB22FEC8A148"><enum>(a)</enum><header>Medicare
Improvement Fund</header><text display-inline="yes-display-inline">Title XVIII
of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>) is amended by adding at the
end the following new section:</text>
<quoted-block display-inline="no-display-inline" id="H2D87523F708847E79EA1BD04477C5757" style="traditional">
<section id="H2340C567979240638E03206400CEAD96"><enum>1898.</enum><header>Medicare improvement fund</header><subsection commented="no" display-inline="yes-display-inline" id="H1367FB5977A94D21AD9F57027C9DE5CF"><enum>(a)</enum><header>Establishment</header><text display-inline="no-display-inline">The Secretary shall establish under this
title a Medicare Improvement Fund (in this section referred to as the
<quote>Fund</quote>) which shall be available to the Secretary to make
improvements under the original fee-for-service program under parts A and B for
individuals entitled to, or enrolled for, benefits under part A or enrolled
under part B.</text>
</subsection><subsection id="HD08CB143A18E4D49985B003F977F622D"><enum>(b)</enum><header>Funding</header>
<paragraph id="H4452320EAF6B43A89608378200997700"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">There shall be
available to the Fund, for expenditures from the Fund for services furnished
during fiscal years 2013–2017, $22,450,000,000.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HFA9612963B8D4AF0A7CC7F6FA3F0AFF5"><enum>(2)</enum><header display-inline="yes-display-inline">Payment from trust funds</header><text display-inline="yes-display-inline">The amount specified under paragraph (1)
shall be available to the Fund, as expenditures are made from the Fund, from
the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical
Insurance Trust Fund in such proportion as the Secretary determines
appropriate.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H837E344FB88A4E19A25231425DA82BC1"><enum>(3)</enum><header display-inline="yes-display-inline">Funding limitation</header><text display-inline="yes-display-inline">Amounts in the Fund shall be available in
advance of appropriations but only if the total amount obligated from the Fund
does not exceed the amount available to the Fund under paragraph (1). The
Secretary may obligate funds from the Fund only if the Secretary determines
(and the Chief Actuary of the Centers for Medicare & Medicaid Services and
the appropriate budget officer certify) that there are available in the Fund
sufficient amounts to cover all such obligations incurred consistent with the
previous
sentence.</text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="HAC3B47C829EF4B99B1532908A0D930FC"><enum>(b)</enum><header display-inline="yes-display-inline">Implementation</header><text display-inline="yes-display-inline">For purposes of carrying out the provisions
of, and amendments made by, this Act, in addition to any other amounts provided
in such provisions and amendments, the Secretary of Health and Human Services
shall provide for the transfer, from the Federal Hospital Insurance Trust Fund
under section 1817 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i">42 U.S.C. 1395i</external-xref>) and the Federal
Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42
U.S.C. 1395t), in the same proportion as the Secretary determines under section
1853(f) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-23">42 U.S.C. 1395w–23(f)</external-xref>), of $140,000,000 to the Centers for
Medicare & Medicaid Services Program Management Account for the period of
fiscal years 2009 through 2013.</text>
</subsection></section></subtitle><enum>II</enum><header>Medicaid</header>
<section id="H55F42336A7DA4F7BB0680071B2FC01D9"><enum>201.</enum><header>Extension of
transitional medical assistance (TMA)</header><text display-inline="no-display-inline">Section 401 of division B of the Tax Relief
and Health Care Act of 2006 (<external-xref legal-doc="public-law" parsable-cite="pl/109/432">Public Law 109–432</external-xref>, 120 Stat. 2994), as amended by
section 1 of <external-xref legal-doc="public-law" parsable-cite="pl/110/48">Public Law 110–48</external-xref> (121 Stat. 244), section 2 of the TMA,
Abstinence, Education, and QI Programs Extension Act of 2007 (Public Law
110–90, 121 Stat. 984), and section 202 of the Medicare, Medicaid, and SCHIP
Extension Act of 2007 (<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>) is amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="H600B298ADB974EFA945435776DB869C5"><enum>(1)</enum><text display-inline="yes-display-inline">by inserting after <quote>June 30,
2008</quote> the following <quote>(or, in the case of section 1925, through
December 31, 2009)</quote>;</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H067697809AA1473000B9E88B0424C8F5"><enum>(2)</enum><text>by inserting after
<quote>the third quarter of fiscal year 2008</quote> the following: <quote>(or,
in the case of such section 1925, the first quarter of fiscal year
2010)</quote>; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HAE57BF2F65E845248E846DA2E075FE2"><enum>(3)</enum><text display-inline="yes-display-inline">by inserting after <quote>the third quarter
of fiscal year 2007</quote> the following: <quote>(or, in the case of such
section 1925, the first quarter of fiscal year 2008)</quote>.</text>
</paragraph></section><section commented="no" display-inline="no-display-inline" id="H0177B359EA204C28A8075D2B57BC5585" section-type="subsequent-section"><enum>202.</enum><header display-inline="yes-display-inline">Medicaid DSH extension</header><text display-inline="no-display-inline">Section 1923(f)(6) of the Social Security
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-4">42 U.S.C. 1396r–4(f)(6)</external-xref>) is amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="H3FC9369438E341319505CCCB77BCE53"><enum>(1)</enum><text display-inline="yes-display-inline">in the heading, by striking
<quote><header-in-text level="paragraph" style="OLC">fiscal year 2007 and
portions of fiscal year 2008</header-in-text></quote> and inserting
<quote><header-in-text level="paragraph" style="OLC">fiscal years 2007 through
2009 and the first calendar quarter of fiscal year
2010</header-in-text></quote>; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H7DD7EE23A706460F9CB0ACB751C96800"><enum>(2)</enum><text display-inline="yes-display-inline">in subparagraph (A)—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H722067D4F2D347CB9C00CC8BA0C270DC"><enum>(A)</enum><text display-inline="yes-display-inline">in clause (i)—</text>
<clause commented="no" display-inline="no-display-inline" id="HAD4308A545C647D696B973CA7318F196"><enum>(i)</enum><text display-inline="yes-display-inline">in the second sentence—</text>
<subclause commented="no" display-inline="no-display-inline" id="H9DA4E883281E4FAB872CE513CA09F9B3"><enum>(I)</enum><text display-inline="yes-display-inline">by striking <quote>fiscal year 2008 for the
period ending on June 30, 2008</quote> and inserting <quote>fiscal years 2008
and 2009</quote>; and</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="H6EC22C8C64A34E778DDCCB0088CF9613"><enum>(II)</enum><text>by striking
<quote>¾ of</quote>; and</text>
</subclause></clause><clause commented="no" display-inline="no-display-inline" id="H4A7E144552CD497AA021BE03CA8690A0"><enum>(ii)</enum><text>by adding at the
end the following new sentences: <quote>Only with respect to fiscal year 2010
for the period ending on December 31, 2009, the DSH allotment for Tennessee for
such portion of the fiscal year, notwithstanding such table or terms, shall be
¼ of the amount specified in the first sentence for fiscal year
2007.</quote>;</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HC31B673140834308A580B43099F0588"><enum>(B)</enum><text display-inline="yes-display-inline">in clause (ii), by striking <quote>or for a
period in fiscal year 2008</quote> and inserting <quote>, 2008, 2009, or for a
period in fiscal year 2010</quote>;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H9CB0BE6A639844C4A1526788C0757900"><enum>(C)</enum><text display-inline="yes-display-inline">in clause (iv)—</text>
<clause commented="no" display-inline="no-display-inline" id="HFE628B5945B9435B9C892398E0C3AD9"><enum>(i)</enum><text display-inline="yes-display-inline">in the heading, by striking
<quote><header-in-text level="clause" style="OLC">fiscal year 2007 and fiscal
year 2008</header-in-text></quote> and inserting <quote><header-in-text level="clause" style="OLC">fiscal years 2007 through 2009 and the first
calendar quarter of fiscal year 2010</header-in-text></quote>;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HE1F8B83BD2A7439CB61F295D3830CEB9"><enum>(ii)</enum><text display-inline="yes-display-inline">in subclause (I), by striking <quote>or for
a period in fiscal year 2008</quote> and inserting <quote>, 2008, 2009, or for
a period in fiscal year 2010</quote>; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HE1B23E21D6434C8DA8E79D802120F4CC"><enum>(iii)</enum><text display-inline="yes-display-inline">in subclause (II), by striking <quote>or
for a period in fiscal year 2008</quote> and inserting <quote>, 2008, 2009, or
for a period in fiscal year 2010</quote>; and</text>
</clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H937C18115B814F0394D104C18FB4F5B9"><enum>(3)</enum><text display-inline="yes-display-inline">in subparagraph (B)(i)—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H5D48943284594961AA61C1714EC79154"><enum>(A)</enum><text display-inline="yes-display-inline">in the first sentence, by striking
<quote>fiscal year 2007</quote> and inserting <quote>each of fiscal years 2007
through 2009</quote>; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HEBDCB1EE242C474788E9F300C6476855"><enum>(B)</enum><text>by striking the
second sentence and inserting the following: <quote>Only with respect to fiscal
year 2010 for the period ending on December 31, 2009, the DSH allotment for
Hawaii for such portion of the fiscal year, notwithstanding the table set forth
in paragraph (2), shall be $2,500,000.</quote>.</text>
</subparagraph></paragraph></section><section commented="no" display-inline="no-display-inline" id="H1975643DCD694A25A736CD8D47D8492" section-type="subsequent-section"><enum>203.</enum><header>Pharmacy
reimbursement under Medicaid</header>
<subsection commented="no" display-inline="no-display-inline" id="HAF8DAF73CB374F5DA9809E50FFBBE5C1"><enum>(a)</enum><header>Delay in new
payment limits for multiple source drugs under
Medicaid</header><text>Notwithstanding paragraphs (4) and (5) of subsection (e)
of section 1927 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-8">42 U.S.C. 1396r–8</external-xref>) or part 447 of
title 42, Code of Federal Regulations (as in effect on the date of the
enactment of this Act), the Secretary of Health and Human Services shall not
require a State to establish prior to September 30, 2009, payment limits for
multiple source drugs under a State Medicaid plan that do not exceed the
specific upper limit established under <external-xref legal-doc="usc" parsable-cite="usc/42/447">section 447.514(b)</external-xref> of title 42, Code of
Federal Regulations (as so in effect) and shall permit any State to continue to
receive Federal financial participation for payments for such drugs that do not
exceed the specific upper limit that would have applied to such payments under
<external-xref legal-doc="regulation" parsable-cite="cfr/42/447.332">section 447.332</external-xref> of title 42, Code of Federal Regulations (as in effect on
December 31, 2006).</text>
</subsection><subsection id="H90F5C075321D4997BAED366B6549D3B0"><enum>(b)</enum><header>Temporary
suspension of updated publicly available AMP data</header><text>Notwithstanding
clause (v) of section 1927(b)(3)(D) of the Social Security Act (42 U.S.C.
1396r–8(b)(3)(D)), the Secretary of Health and Human Services shall not, prior
to September 30, 2009, make publicly available any AMP disclosed to the
Secretary.</text>
</subsection><subsection id="H6895A4319C974DD4BE2C8EA03976249B"><enum>(c)</enum><header>Definitions</header><text>In
this subsection:</text>
<paragraph id="H71FEA1CAAF8A43259300C76885594EC"><enum>(1)</enum><text>The term
<term>multiple source drug</term> has the meaning given that term in section
1927(k)(7)(A)(i) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-8">42 U.S.C. 1396r–8(k)(7)(A)(i)</external-xref>);
and</text>
</paragraph><paragraph id="HD7CFC2DA715047E1BF8CDB177DB571EB"><enum>(2)</enum><text>The term
<term>AMP</term> has the meaning given <term>average manufacturer price</term>
in section 1927(k)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-8">42 U.S.C. 1396r–8(k)(1)</external-xref>) and
<term>AMP</term> in <external-xref legal-doc="regulation" parsable-cite="cfr/42/447.504">section 447.504(a)</external-xref> of title 42, Code of Federal Regulations
(as in effect on the date of the enactment of this Act).</text>
</paragraph></subsection></section><section id="HDF96616CB9934F859390A8205549DC43"><enum>204.</enum><header>Review of
administrative claim determinations</header>
<subsection id="HE4864DB72F8A409E0032E020AE641DAF"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1116 of the
Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1316">42 U.S.C. 1316</external-xref>) is amended by adding at the end the
following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HF3B2BF6F835E4C29B25661DF1E88E71" style="OLC">
<subsection id="HA9FA82EF1DE145D2B000D097533D0000"><enum>(e)</enum><paragraph commented="no" display-inline="yes-display-inline" id="H324E557EE2E9450DA5587D4C4627D165"><enum>(1)</enum><text>Whenever the Secretary
determines that any item or class of items on account of which Federal
financial participation is claimed under title XIX shall be disallowed for such
participation, the State shall be entitled to and upon request shall receive a
reconsideration of the disallowance, provided that such request is made during
the 60-day period that begins on the date the State receives notice of the
disallowance.</text>
</paragraph><paragraph id="H51312FA091A744FEBBD746BA7E01BFBF" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="HF586354026874E6D93CC9CCD2E5B5BF2"><enum>(A)</enum><text>A State may appeal a
disallowance of a claim for federal financial participation under title XIX by
the Secretary, or an unfavorable reconsideration of a disallowance, during the
60-day period that begins on the date the State receives notice of the
disallowance or of the unfavorable reconsideration, in whole or in part, to the
Departmental Appeals Board, established in the Department of Health and Human
Services (in this paragraph referred to as the <quote>Board</quote>), by filing
a notice of appeal with the Board.</text>
</subparagraph><subparagraph id="H7904E7BD8C3F42C6B7D99CE8CAB700E9" indent="up1"><enum>(B)</enum><text>The Board shall consider a State’s
appeal of a disallowance of such a claim (or of an unfavorable reconsideration
of a disallowance) on the basis of such documentation as the State may submit
and as the Board may require to support the final decision of the Board. In
deciding whether to uphold a disallowance of such a claim or any portion
thereof, the Board shall be bound by all applicable laws and regulations and
shall conduct a thorough review of the issues, taking into account all relevant
evidence. The Board’s decision of an appeal under subparagraph (A) shall be the
final decision of the Secretary and shall be subject to reconsideration by the
Board only upon motion of either party filed during the 60-day period that
begins on the date of the Board's decision or to judicial review in accordance
with subparagraph (C).</text>
</subparagraph><subparagraph id="H3E8B1BE934DC487B86E9C2660300AD16" indent="up1"><enum>(C)</enum><text>A State may obtain judicial review of
a decision of the Board by filing an action in any United States District Court
located within the appealing State (or, if several States jointly appeal the
disallowance of claims for Federal financial participation under section 1903,
in any United States District Court that is located within any State that is a
party to the appeal) or the United States District Court for the District of
Columbia. Such an action may only be filed—</text>
<clause id="H6C7323320CCF4F258D2FBC42AE402012"><enum>(i)</enum><text>if no motion for reconsideration was
filed within the 60-day period specified in subparagraph (B), during such
60-day period; or</text>
</clause><clause id="HF9572E15FCA047CFADEB8CE4C59B551E"><enum>(ii)</enum><text>if such a motion was filed within
such period, during the 60-day period that begins on the date of the Board's
decision on such
motion.</text>
</clause></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H15B3F878DA42454285EF1BF05CAA2FB9"><enum>(b)</enum><header>Conforming
amendment</header><text>Section 1116(d) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1316">42 U.S.C. 1316(d)</external-xref>) is
amended by striking <quote>or XIX,</quote>.</text>
</subsection><subsection id="H330DCE12441544EA9DE4FD3C80F6EC"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section take effect on the date
of the enactment of this Act and apply to any disallowance of a claim for
Federal financial participation under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) made on or after such date or during the 60-day period
prior to such date.</text>
</subsection></section><enum>III</enum><header>Miscellaneous</header>
<section id="HAA365DAF8A7642590088E42D1D2BEE96"><enum>301.</enum><header>Extension of
TANF supplemental grants</header>
<subsection id="H69957ADA29E74AFAB1026243807E0005"><enum>(a)</enum><header>Extension
through fiscal year 2009</header><text display-inline="yes-display-inline">Section 7101(a) of the Deficit Reduction
Act of 2005 (<external-xref legal-doc="public-law" parsable-cite="pl/109/171">Public Law 109–171</external-xref>; 120 Stat. 135) is amended by striking
<quote>fiscal year 2008</quote> and inserting <quote>fiscal year
2009</quote>.</text>
</subsection><subsection id="HD946F667755A433B8628CFFCC190651C"><enum>(b)</enum><header>Conforming
amendment</header><text>Section 403(a)(3)(H)(ii) of the Social Security Act (42
U.S.C. 603(a)(3)(H)(ii)) is amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="H0F20D17D4622403489D9D5583CCF9538" style="OLC">
<clause id="H2FFAF0674E49479D89AF34B0FE001D7D"><enum>(ii)</enum><text>subparagraph (G)
shall be applied as if <quote>fiscal year 2009</quote> were substituted for
<quote>fiscal year 2001</quote>;
and</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section commented="no" id="H3B8E3254B84C444BAB08A944CE5039DA"><enum>302.</enum><header>70 percent
federal matching for foster care and adoption assistance for the District of
Columbia</header>
<subsection commented="no" id="H54CCBB152B824F5299F6D6E0FD6B01F6"><enum>(a)</enum><header>In
general</header><text>Section 474(a) of the Social Security Act (42 U.S.C.
674(a)) is amended in each of paragraphs (1) and (2) by striking <quote>(as
defined in section 1905(b) of this Act)</quote> and inserting <quote>(which
shall be as defined in section 1905(b), in the case of a State other than the
District of Columbia, or 70 percent, in the case of the District of
Columbia)</quote>.</text>
</subsection><subsection commented="no" id="HB1C8B455D6AA44AA91073170A9F4F200"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall take effect on
October 1, 2008, and shall apply to calendar quarters beginning on or after
that date.</text>
</subsection></section><section id="HC6DAE5251820418FAB0538CBC1F317E4"><enum>303.</enum><header>Extension of
Special Diabetes Grant Programs</header>
<subsection id="HE9BDAB7639FF4DA997B94FC64C73152"><enum>(a)</enum><header>Special Diabetes
Programs for Type I Diabetes</header><text>Section 330B(b)(2)(C) of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> (42 U.S.C.
254c–2(b)(2)) is amended by striking <quote>2009</quote> and inserting
<quote>2011</quote>.</text>
</subsection><subsection id="H6B5FA290D13F48B7A820FED7E31B77D6"><enum>(b)</enum><header>Special Diabetes
Programs for Indians</header><text>Section 330C(c)(2)(C) of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> (42 U.S.C.
254c–3(c)(2)(C)) is amended by striking <quote>2009</quote> and inserting
<quote>2011</quote>.</text>
</subsection><subsection id="HBA07C93878A745009F8C576E6D9763DE"><enum>(c)</enum><header>Report on Grant
Programs</header><text>Section 4923(b) of the <act-name parsable-cite="BBA97">Balanced Budget Act of 1997</act-name> (42 U.S.C. 1254c–2
note), as amended by section 931(c) of the Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection Act of 2000, as enacted into law by section
1(a)(6) of <external-xref legal-doc="public-law" parsable-cite="pl/106/554">Public Law 106–554</external-xref>, and section 1(c) of <external-xref legal-doc="public-law" parsable-cite="pl/107/360">Public Law 107–360</external-xref>, is
amended—</text>
<paragraph id="HDE8C5D6916124FCD976855E37CE98114"><enum>(1)</enum><text>in paragraph (1),
by striking <quote>and</quote> at the end;</text>
</paragraph><paragraph id="HF29FA387CD084347B0DD22F3125C3947"><enum>(2)</enum><text>in paragraph
(2)—</text>
<subparagraph id="H36A674F0662E452C88A3DF414932A9D9"><enum>(A)</enum><text>by striking
<quote>a final report</quote> and inserting <quote>a second interim
report</quote>; and</text>
</subparagraph><subparagraph id="HA9AE5E0B80EE4021A9124B5BF2B6392C"><enum>(B)</enum><text>by striking the
period at the end and inserting <quote>; and</quote>; and</text>
</subparagraph></paragraph><paragraph id="H88B32273309C409CA8E5EB52EE2FE65"><enum>(3)</enum><text>by
adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HC7595B23FAC542AD94B12CCCEC4B17D1" style="OLC">
<paragraph id="HC59F7647557A40B583BAC639B3AE00F5"><enum>(3)</enum><text>a report on such
evaluation not later than January 1,
2011.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section><section id="HEE938D7143614D7FA66D491F24E746F3"><enum>304.</enum><header>IOM reports on
best practices for conducting systematic reviews of clinical effectiveness
research and for developing clinical protocols</header>
<subsection id="H233169CD4CBC44A6924B27C748825080"><enum>(a)</enum><header>Systematic
reviews of clinical effectiveness research</header>
<paragraph id="HED20754451DD426A8F408FE80860B9A"><enum>(1)</enum><header>Study</header><text>Not
later than 60 days after the date of the enactment of this Act, the Secretary
of Health and Human Services shall enter into a contract with the Institute of
Medicine of the National Academies (in this section referred to as the
<quote>Institute</quote>) under which the Institute shall conduct a study to
identify the methodological standards for conducting systematic reviews of
clinical effectiveness research on health and health care in order to ensure
that organizations conducting such reviews have information on methods that are
objective, scientifically valid, and consistent.</text>
</paragraph><paragraph id="HC2B07A5220194A4AA052AF2741A35837"><enum>(2)</enum><header>Report</header><text>Not
later than 18 months after the effective date of the contract under paragraph
(1), the Institute, as part of such contract, shall submit to the Secretary of
Health and Human Services and the appropriate committees of jurisdiction of
Congress a report containing the results of the study conducted under paragraph
(1), together with recommendations for such legislation and administrative
action as the Institute determines appropriate.</text>
</paragraph><paragraph id="HE4B55473040B4821828429D465093FD"><enum>(3)</enum><header>Participation</header><text>The
contract under paragraph (1) shall require that stakeholders with expertise in
conducting clinical effectiveness research participate on the panel responsible
for conducting the study under paragraph (1) and preparing the report under
paragraph (2).</text>
</paragraph></subsection><subsection id="H149619A3361C44E9A500655185E69B4"><enum>(b)</enum><header>Clinical
protocols</header>
<paragraph id="H9FDDFF5E9A174D6A93FDF0F1FDD8BFEE"><enum>(1)</enum><header>Study</header><text>Not
later than 60 days after the date of the enactment of this Act, the Secretary
of Health and Human Services shall enter into a contract with the Institute of
Medicine of the National Academies (in this section referred to as the
<quote>Institute</quote>) under which the Institute shall conduct a study on
the best methods used in developing clinical practice guidelines in order to
ensure that organizations developing such guidelines have information on
approaches that are objective, scientifically valid, and consistent.</text>
</paragraph><paragraph id="HBE226D6357274E51BA4C1967EDF00E"><enum>(2)</enum><header>Report</header><text>Not
later than 18 months after the effective date of the contract under paragraph
(1), the Institute, as part of such contract, shall submit to the Secretary of
Health and Human Services and the appropriate committees of jurisdiction of
Congress a report containing the results of the study conducted under paragraph
(1), together with recommendations for such legislation and administrative
action as the Institute determines appropriate.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H93494CEC9C224E41ACEC7357ABFF95C8"><enum>(3)</enum><header>Participation</header><text>The
contract under paragraph (1) shall require that stakeholders with expertise in
making clinical recommendations participate on the panel responsible for
conducting the study under paragraph (1) and preparing the report under
paragraph (2).</text>
</paragraph></subsection><subsection id="H4984F0D9B5CA499BB9A84CDFA618F0BC"><enum>(c)</enum><header>Funding</header><text>Out
of any funds in the Treasury not otherwise appropriated, there are appropriated
for the period of fiscal years 2009 and 2010, $3,000,000 to carry out this
section.</text>
</subsection></section><section id="H893CC8ADAB334E00A140473BA2BBA274"><enum>305.</enum><header>Increasing
number of primary care physicians</header><text display-inline="no-display-inline">Not later than one year after the date of
the enactment of this Act, the Secretary of Health and Human Services, in
coordination with the Association of American Medical Colleges, shall submit to
Congress an effective plan to increase the number of primary care physicians,
particularly those practicing in counties, cities, or towns classified as
underserved or with a disproportionate number of Medicare beneficiaries.</text>
</section>