1.Short title; references;
purpose of legislation
(a)This Act may be cited
as the Medicare Funding Warning
Response Act of 2008
.
(b)In this Act:
(1)Except where
otherwise specifically provided, references in this Act shall be considered to
be made to the Social Security Act, or to a section or other provision
thereof.
(2)The term
Secretary
shall be deemed a reference to the Secretary of Health
and Human Services.
(3)The terms
Medicare
and Medicare program
mean the program
under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
(4)The Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law
108–173) shall be referred to as the MMA
.
(5)The term
excess general revenue medicare funding
has the meaning given
such term by section 801(c) of the MMA.
(6)The term
Trustees Report
means the annual report submitted under
subsection (b)(2) of sections 1817 and 1841 of the Social Security Act (42
U.S.C. 1395i(b)(2) and 1395t(b)(2), respectively).
(c)It is the purpose of this Act to respond to
the medicare funding warning currently in effect under section 801(a)(2) of the
MMA.
<enum>I</enum><header>INTRODUCING
PRINCIPLES OF VALUE-BASED HEALTH CARE INTO THE MEDICARE PROGRAM</header>
<section id="H5D154671C93F4B90B499D4ED80BFA9C6"><enum>101.</enum><header>Introducing
principles of value-based health care into the medicare program</header>
<subsection id="H585E6695AFD9429594009EA2BEBA3D30"><enum>(a)</enum><header>Electronic
health records</header><text>The Secretary shall develop and implement a system
for encouraging nationwide adoption and use of interoperable electronic health
records and to make available personal health records for Medicare
beneficiaries.</text>
</subsection><subsection id="H39C8B026526440CB996EB92D35B669C7"><enum>(b)</enum><header>Pricing
transparency</header><text>The Secretary shall make publicly available
information on prices and payments under the Medicare program for treatments
(including episodes of care), items, and services to assist Medicare
beneficiaries in making choices among providers, plans, and treatment
options.</text>
</subsection><subsection id="HD80592257B3E41F500B400F361B11B66"><enum>(c)</enum><header>Quality
transparency</header><text>The Secretary shall make publicly available
information on the quality of care provided to Medicare beneficiaries to assist
them in making choices among providers, plans, and treatments. To ensure the
continued development and evolution of quality measures, the Secretary shall
develop and implement a plan for ensuring that, by the year 2013, quality
measures are available and reported with respect to at least 50 percent of the
care provided under the Medicare program (determined according to the amount of
payment made under such program for items and services with respect to which
such measures are available). The Secretary shall report to the Committees on
Ways and Means and Energy and Commerce in the House of Representatives and the
Committee on Finance in the Senate annually on the progress of the goal
specified in the preceding sentence.</text>
</subsection><subsection id="H3163E2A793E04429AF7EC424ABDB37AB"><enum>(d)</enum><header>Incentives for
value</header>
<paragraph id="H6C17488342314410B2BC398EA0C2A6C2"><enum>(1)</enum><header>Incentives for
providers and suppliers</header>
<subparagraph id="H967BDC2854A047E199E9706849FBB9D9"><enum>(A)</enum><header>In
General</header><text>The Secretary shall design and implement a system for use
in the Medicare program under which a portion of the payments that would
otherwise be made under such program to some or all classes of individuals and
entities furnishing items or services to beneficiaries of such program would be
based on the quality and efficiency of their performance.</text>
</subparagraph><subparagraph id="HE192682ABBFE410BBB38FC025C4E158D"><enum>(B)</enum><header>Implementation</header><text>The
Secretary shall first implement such system in settings where measures are
well-accepted and already collected, including hospitals, physicians’ offices,
home health agencies, skilled nursing facilities, and renal dialysis
facilities. The initial focus of such efforts shall be on quality, but the
Secretary shall add measures of efficiency as they are identified. The system
shall also include incentives for reducing unwarranted geographic variations in
quality and efficiency.</text>
</subparagraph><subparagraph id="H50979B471B224F1AB1F06241E42F3600"><enum>(C)</enum><header>Secretary’s
Authority</header><text>The Secretary may implement the system described in
this paragraph without regard to any provision of title XVIII of the Social
Security Act that would, in the absence of subparagraphs (A) and (B), apply
with respect to payment to an individual or entity furnishing items or services
for which payment may be made under the Medicare program.</text>
</subparagraph></paragraph><paragraph id="H3E4D7351BA6B40B79F50D374D89C9601"><enum>(2)</enum><header>Beneficiary
incentives</header>
<subparagraph id="H9BB4A28C7F5D425980601E7013CB7E44"><enum>(A)</enum><header>In
general</header><text>The Secretary shall implement incentives for Medicare
beneficiaries to use more efficient providers and preventive services known to
reduce costs.</text>
</subparagraph><subparagraph id="H55B64D3F9A994528A30061CA60C513CA"><enum>(B)</enum><header>Access to health
savings accounts</header><text>The Secretary shall assure a transition into the
Medicare program for individuals who are not yet enrolled in such program who
own health savings accounts, and shall provide for the availability of high
deductible health plan options in the Medicare program.</text>
</subparagraph></paragraph></subsection><subsection id="H308E5930363A4E94BEB7E1573C53AC43"><enum>(e)</enum><header>Broadly
transforming the private health care marketplace</header><text>The Secretary
shall use and release Medicare data for quality improvement, performance
measurement, public reporting, and treatment-related purposes. In implementing
the preceding sentence, the Secretary shall apply risk adjustment techniques
where appropriate and shall determine the circumstances under which it is
appropriate to release such data.</text>
</subsection><subsection id="H431D2592ECA84FAE8DB1AC7D1F3942C"><enum>(f)</enum><header>Protecting
individually identifiable health information</header><text>In implementing this
title, the Secretary shall ensure that individually identifiable beneficiary
health information is protected (in accordance with the regulations adopted
under section 264(c) of the Health Insurance Portability and Accountability Act
of 1996 and such other laws and regulations as may apply).</text>
</subsection><subsection id="H5B2E05FDEECF4DCABD82BBB39E2DC622"><enum>(g)</enum><header>Regulations</header><text>The
Secretary may implement a system described in this section by regulation, but
only if such regulation is issued after public notice and an opportunity for
public comment.</text>
</subsection><subsection id="HAB8B9450DF3D41AB9F1301515E4583F2"><enum>(h)</enum><header>Definitions</header><text>As
used in this section:</text>
<paragraph id="H5815C8C326CC44B2B29E54179C006F00"><enum>(1)</enum><text>The term
<quote>efficiency</quote> means the delivery of health care in a manner that
reduces the costs of providing care for Medicare beneficiaries while
maintaining or improving the quality of such care.</text>
</paragraph><paragraph id="H0A69A2F3861D4E45872BC87200244398"><enum>(2)</enum><text>The term
<quote>information on quality of care</quote> means such measures of—</text>
<subparagraph id="H9E354EC47CBA4313B1C22B8CA26346"><enum>(A)</enum><text>the use of clinical
processes and structures known to improve care;</text>
</subparagraph><subparagraph id="HEC26FA55895A41A59720116E7F78BC20"><enum>(B)</enum><text>health outcomes;
and</text>
</subparagraph><subparagraph id="HD3EEFAAF637B41B89F8999A741BB4C23"><enum>(C)</enum><text>patient
perceptions of their care,</text>
</subparagraph><continuation-text continuation-text-level="paragraph" indent="paragraph">as the Secretary may select with preference given to
those measures that have been recognized through a consensus-based
process.</continuation-text></paragraph></subsection><subsection id="HAF3FA05684D446558DDF132D85F5004F"><enum>(i)</enum><header>Savings
requirement</header>
<paragraph id="H00C092C53DEB4B089CE2EE34815FF68"><enum>(1)</enum><header>In
general</header><text>The Secretary may implement the provisions of subsections
(a) through (e) of section 101 and section 102 for a year only to the extent
that the Secretary determines (and the Chief Actuary of the Centers for
Medicare & Medicaid Services certifies) that—</text>
<subparagraph id="HBEC2772F77564DA59F4B65922D40EDCE"><enum>(A)</enum><text>the total amount
of payment made under title XVIII of the Social Security Act over the five and
ten year periods that begin with January 1 of such year as a result of the
implementation of such subsections (a) through (e) and section 102 is less than
the amount that would have been made over such periods if such implementation
had not occurred; and</text>
</subparagraph><subparagraph id="H2F92A06433F9409B0015A3639523AF99"><enum>(B)</enum><text>the total amount
of payment made under each of titles XIX and XXI of such Act over such periods
as a result of such implementation is no greater than the amount that would
have been made under each such title over such periods if such implementation
had not occurred.</text>
</subparagraph></paragraph><paragraph id="H3F775BD0D22D471BA08F2260560043E8"><enum>(2)</enum><header>Availability of
appropriations</header><text>The Secretary shall carry out the provisions of
this section subject to the availability of appropriations and to the extent
permitted consistent with paragraph (1).</text>
</paragraph></subsection></section><section id="H36F87DBDBCD3423E9015554D7EEE471D"><enum>102.</enum><header>Release of
physician performance measurements</header><text display-inline="no-display-inline">Section 1848(k) (42 U.S.C. 1395w–4(k)) is
amended by adding at the end the following new paragraph:</text>
<quoted-block id="H3323273D8DC840CF83FD6F204C129FD" style="OLC">
<paragraph id="H697620E35A3944AD852FEB1E959688E5"><enum>(9)</enum><header>Release of
quality measurements</header>
<subparagraph id="H7CAA7BF628AD49EDB4722E3E9C28B900"><enum>(A)</enum><header>In
general</header><text>Notwithstanding section 552a of title 5, United States
Code, the Secretary may—</text>
<clause id="H28D9056C314D49CB89F4581D02C504A6"><enum>(i)</enum><text>release to the
public physician-specific measurements of the quality or efficiency of
physician performance against a standard (reflecting measurements that have
been recognized through a consensus-based process) that has been endorsed by
the Secretary; and</text>
</clause><clause id="H7F50A030F360428FA4AC875CA5C81AB"><enum>(ii)</enum><text>release, to an
entity that will generate or calculate such measurements, data that the entity
may use to perform such task.</text>
</clause></subparagraph><subparagraph id="H07D32BC9AAD244069EFA83F91F6EE2E4"><enum>(B)</enum><header>Endorsement of
standards</header><text>The Secretary may make an endorsement under
subparagraph (A) by publication of a notice in the Federal
Register.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</section><enum>II</enum><header>REDUCING THE
EXCESSIVE BURDEN THE LIABILITY SYSTEM PLACES ON THE HEALTH CARE DELIVERY
SYSTEM</header>
<section id="H65FB8BB0A86B4E098216D6DA1792B6C4"><enum>201.</enum><header>Short
title</header><text display-inline="no-display-inline">This title may be cited
as the <quote>Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH)
Act of 2008</quote>.</text>
</section><section id="HDB7B0BA4802440D796703CFB4FF6E35"><enum>202.</enum><header>Findings and
purpose</header>
<subsection id="H330318E48BA14978902E40C1F9A1CD25"><enum>(a)</enum><header>Findings</header>
<paragraph id="H9BAB57EE6CD2429798D3DC431B1345"><enum>(1)</enum><header>Effect on health
care access and costs</header><text>Congress finds that our current civil
justice system is adversely affecting patient access to health care services,
better patient care, and cost-efficient health care, in that the health care
liability system is a costly and ineffective mechanism for resolving claims of
health care liability and compensating injured patients, and is a deterrent to
the sharing of information among health care professionals which impedes
efforts to improve patient safety and quality of care.</text>
</paragraph><paragraph id="H87B7BC1759B948A684158D333CFC1968"><enum>(2)</enum><header>Effect on
interstate commerce</header><text>Congress finds that the health care and
insurance industries are industries affecting interstate commerce and the
health care liability litigation systems existing throughout the United States
are activities that affect interstate commerce by contributing to the high
costs of health care and premiums for health care liability insurance purchased
by health care system providers.</text>
</paragraph><paragraph id="HE59D1A3E28A342549F004C78B3C24000"><enum>(3)</enum><header>Effect on
federal spending</header><text>Congress finds that the health care liability
litigation systems existing throughout the United States have a significant
effect on the amount, distribution, and use of Federal funds because of—</text>
<subparagraph id="H135839E2CD51443097A72C004D682340"><enum>(A)</enum><text>the large number
of individuals who receive health care benefits under programs operated or
financed by the Federal Government;</text>
</subparagraph><subparagraph id="H05F3ABDD90C14F03AC6BD65494A800BE"><enum>(B)</enum><text>the large number
of individuals who benefit because of the exclusion from Federal taxes of the
amounts spent to provide them with health insurance benefits; and</text>
</subparagraph><subparagraph id="H1B680C80006046CC8881D1691E58BF88"><enum>(C)</enum><text>the large number
of health care providers who provide items or services for which the Federal
Government makes payments.</text>
</subparagraph></paragraph></subsection><subsection id="HED53199E475A4CA5BB8BAFF2B8C3BBFB"><enum>(b)</enum><header>Purpose</header><text>It
is the purpose of this title to implement reasonable, comprehensive, and
effective health care liability reforms designed to—</text>
<paragraph id="H8451B7AF24074720B38C83B148E1CAB8"><enum>(1)</enum><text>improve the
availability of health care services in cases in which health care liability
actions have been shown to be a factor in the decreased availability of
services;</text>
</paragraph><paragraph id="H5CCA3761E2944A7DB061B520007BAA03"><enum>(2)</enum><text>reduce the
incidence of <quote>defensive medicine</quote> and lower the cost of health
care liability insurance, all of which contribute to the escalation of health
care costs;</text>
</paragraph><paragraph id="H1FAE1A8513D74991914004C3F005D35"><enum>(3)</enum><text>ensure that persons
with meritorious health care injury claims receive fair and adequate
compensation, including reasonable noneconomic damages;</text>
</paragraph><paragraph id="H34C619C558C64ED5834DE8B239FBE031"><enum>(4)</enum><text>improve the
fairness and cost-effectiveness of our current health care liability system to
resolve disputes over, and provide compensation for, health care liability by
reducing uncertainty in the amount of compensation provided to injured
individuals; and</text>
</paragraph><paragraph id="H6B252F8B415F4C1CBB4C9044F8F850C3"><enum>(5)</enum><text>provide an
increased sharing of information in the health care system which will reduce
unintended injury and improve patient care.</text>
</paragraph></subsection></section><section id="HBE2B8743190148E7A37EA1F6EEBAB3D6"><enum>203.</enum><header>Encouraging
speedy resolution of claims</header><text display-inline="no-display-inline">The time for the commencement of a health
care lawsuit shall be 3 years after the date of manifestation of injury or 1
year after the claimant discovers, or through the use of reasonable diligence
should have discovered, the injury, whichever occurs first. In no event shall
the time for commencement of a health care lawsuit exceed 3 years after the
date of manifestation of injury unless tolled for any of the following—</text>
<paragraph id="HDBF412F2E10E4CB1B700901CE7808FE5"><enum>(1)</enum><text>upon proof of
fraud;</text>
</paragraph><paragraph id="H7C7FF903DC844EE7836D1F3E7DDC9DF3"><enum>(2)</enum><text>intentional
concealment; or</text>
</paragraph><paragraph id="H390144799FA846AD8000A5DD26D4892F"><enum>(3)</enum><text>the presence of a
foreign body, which has no therapeutic or diagnostic purpose or effect, in the
person of the injured person.</text>
</paragraph><continuation-text continuation-text-level="section">Actions by a
minor shall be commenced within 3 years from the date of the alleged
manifestation of injury except that actions by a minor under the full age of 6
years shall be commenced within 3 years of manifestation of injury or prior to
the minor’s 8th birthday, whichever provides a longer period. Such time
limitation shall be tolled for minors for any period during which a parent or
guardian and a health care provider or health care organization have committed
fraud or collusion in the failure to bring an action on behalf of the injured
minor.</continuation-text></section><section id="H70784CE55AD94C8888D53CFAD761B7E5"><enum>204.</enum><header>Compensating
patient injury</header>
<subsection id="HC96620628F364C63ACBA6B1C751FFF14"><enum>(a)</enum><header>Unlimited amount
of damages for actual economic losses in health care lawsuits</header><text>In
any health care lawsuit, nothing in this title shall limit a claimant’s
recovery of the full amount of the available economic damages, notwithstanding
the limitation in subsection (b).</text>
</subsection><subsection id="H40D1B55E6150446B88B757B57FA87C66"><enum>(b)</enum><header>Additional
noneconomic damages</header><text>In any health care lawsuit, the amount of
noneconomic damages, if available, may be as much as $250,000, regardless of
the number of parties against whom the action is brought or the number of
separate claims or actions brought with respect to the same injury.</text>
</subsection><subsection id="HA736E797A7BF4446B47CE766AF3FBAF"><enum>(c)</enum><header>No discount of
award for noneconomic damages</header><text>For purposes of applying the
limitation in subsection (b), future noneconomic damages shall not be
discounted to present value. The jury shall not be informed about the maximum
award for noneconomic damages. An award for noneconomic damages in excess of
$250,000 shall be reduced either before the entry of judgment, or by amendment
of the judgment after entry of judgment, and such reduction shall be made
before accounting for any other reduction in damages required by law. If
separate awards are rendered for past and future noneconomic damages and the
combined awards exceed $250,000, the future noneconomic damages shall be
reduced first.</text>
</subsection><subsection id="H700FD07CC10A412183BAE927DE153194"><enum>(d)</enum><header>Fair share
rule</header><text>In any health care lawsuit, each party shall be liable for
that party’s several share of any damages only and not for the share of any
other person. Each party shall be liable only for the amount of damages
allocated to such party in direct proportion to such party’s percentage of
responsibility. Whenever a judgment of liability is rendered as to any party, a
separate judgment shall be rendered against each such party for the amount
allocated to such party. For purposes of this section, the trier of fact shall
determine the proportion of responsibility of each party for the claimant’s
harm.</text>
</subsection></section><section id="H2A83F65D41504EC5BAFDEF37B485A242"><enum>205.</enum><header>Maximizing
patient recovery</header>
<subsection id="H3FEE4D8F889A4071B949A9BE0A2DBF7"><enum>(a)</enum><header>Court supervision
of share of damages actually paid to claimants</header><text>In any health care
lawsuit, the court shall supervise the arrangements for payment of damages to
protect against conflicts of interest that may have the effect of reducing the
amount of damages awarded that are actually paid to claimants. In particular,
in any health care lawsuit in which the attorney for a party claims a financial
stake in the outcome by virtue of a contingent fee, the court shall have the
power to restrict the payment of a claimant’s damage recovery to such attorney,
and to redirect such damages to the claimant based upon the interests of
justice and principles of equity. In no event shall the total of all contingent
fees for representing all claimants in a health care lawsuit exceed the
following limits:</text>
<paragraph id="H1A8D9D26A99C464A807264A5ABCC8600"><enum>(1)</enum><text>40 percent of the
first $50,000 recovered by the claimant(s).</text>
</paragraph><paragraph id="H8A52CDF1AE43474AA09C215E581B7BEF"><enum>(2)</enum><text>33<fraction>1/3</fraction>
percent of the next $50,000 recovered by the claimant(s).</text>
</paragraph><paragraph id="H73CC30A47E0A4F0183875636BAF2BFCC"><enum>(3)</enum><text>25 percent of the
next $500,000 recovered by the claimant(s).</text>
</paragraph><paragraph id="H244E4B33797A4E65972EF4AD2117DF3E"><enum>(4)</enum><text>15 percent of any
amount by which the recovery by the claimant(s) is in excess of
$600,000.</text>
</paragraph></subsection><subsection id="HDDD70FFF2929431BA1E26C8013EABE30"><enum>(b)</enum><header>Applicability</header><text>The
limitations in this section shall apply whether the recovery is by judgment,
settlement, mediation, arbitration, or any other form of alternative dispute
resolution. In a health care lawsuit involving a minor or incompetent person, a
court retains the authority to authorize or approve a fee that is less than the
maximum permitted under this section. The requirement for court supervision in
the first two sentences of subsection (a) applies only in civil actions.</text>
</subsection></section><section id="H89AECB10E91C42429E60F97582E43622"><enum>206.</enum><header>Additional
health benefits</header><text display-inline="no-display-inline">In any health
care lawsuit involving injury or wrongful death, any party may introduce
evidence of collateral source benefits. If a party elects to introduce such
evidence, any opposing party may introduce evidence of any amount paid or
contributed or reasonably likely to be paid or contributed in the future by or
on behalf of the opposing party to secure the right to such collateral source
benefits. No provider of collateral source benefits shall recover any amount
against the claimant or receive any lien or credit against the claimant’s
recovery or be equitably or legally subrogated to the right of the claimant in
a health care lawsuit involving injury or wrongful death. This section shall
apply to any health care lawsuit that is settled as well as a health care
lawsuit that is resolved by a fact finder. This section shall not apply to
section 1862(b) (42 U.S.C. 1395y(b)) or section 1902(a)(25) (42 U.S.C.
1396a(a)(25)) of the Social Security Act, or to section 8131 or section 8132 of
title 5, United States Code. This section shall not apply to section 1862(b)
(42 U.S.C. 1395y(b)) or section 1902(a)(25) (42 U.S.C. 1396a(a)(25)) of the
Social Security Act, or to section 8131 or section 8132 of title 5, United
States Code, or to a collateral source provider that is an employee benefit
plan under section 3(3) of the Employee Retirement Income Security Act of 1974
(29 U.S.C. 1002(3)).</text>
</section><section id="HFB335A432BE9423182A242178D4FF0AF"><enum>207.</enum><header>Punitive
damages</header>
<subsection id="HF0A911BB29664A668EB281D04D576640"><enum>(a)</enum><header>In
general</header><text>Punitive damages may, if otherwise permitted by
applicable State or Federal law, be awarded against any person in a health care
lawsuit only if it is proven by clear and convincing evidence that such person
acted with malicious intent to injure the claimant, or that such person
deliberately failed to avoid unnecessary injury that such person knew the
claimant was substantially certain to suffer. In any health care lawsuit where
no judgment for compensatory damages is rendered against such person, no
punitive damages may be awarded with respect to the claim in such lawsuit. No
demand for punitive damages shall be included in a health care lawsuit as
initially filed. A court may allow a claimant to file an amended pleading for
punitive damages only upon a motion by the claimant and after a finding by the
court, upon review of supporting and opposing affidavits or after a hearing,
after weighing the evidence, that the claimant has established by a substantial
probability that the claimant will prevail on the claim for punitive damages.
At the request of any party in a health care lawsuit, the trier of fact shall
consider in a separate proceeding—</text>
<paragraph id="HD2B82F79EBC9478D8D9E8E8F99F392EB"><enum>(1)</enum><text>whether punitive
damages are to be awarded and the amount of such award; and</text>
</paragraph><paragraph id="H0E5846B327AD49FFBCF59CFF4BB942EE"><enum>(2)</enum><text>the amount of
punitive damages following a determination of punitive liability.</text>
</paragraph><continuation-text continuation-text-level="subsection">If a
separate proceeding is requested, evidence relevant only to the claim for
punitive damages, as determined by applicable State law, shall be inadmissible
in any proceeding to determine whether compensatory damages are to be
awarded.</continuation-text></subsection><subsection id="H4C6EF5E2ABA746C500346DA418B3515"><enum>(b)</enum><header>Determining
amount of punitive damages</header>
<paragraph id="HE27369B769904C859F81F9947E7D78A3"><enum>(1)</enum><header>Factors
considered</header><text>In determining the amount of punitive damages, if
awarded, in a health care lawsuit, the trier of fact shall consider only the
following—</text>
<subparagraph id="HC1E05C14A7574224A0AAF3FB8D0BBE8"><enum>(A)</enum><text>the severity of the
harm caused by the conduct of such party;</text>
</subparagraph><subparagraph id="H2C184C2D4B5A4C90A7E99F1B7100F121"><enum>(B)</enum><text>the duration of
the conduct or any concealment of it by such party;</text>
</subparagraph><subparagraph id="H9F9A182F649F438FAA4175F345D49D00"><enum>(C)</enum><text>the profitability
of the conduct to such party;</text>
</subparagraph><subparagraph id="HDC0151D92CB349F79ED8EEDCF852D01"><enum>(D)</enum><text>the number of
products sold or medical procedures rendered for compensation, as the case may
be, by such party, of the kind causing the harm complained of by the
claimant;</text>
</subparagraph><subparagraph id="H124A3EA33FF34A8700B707E9DC2D1CAE"><enum>(E)</enum><text>any criminal
penalties imposed on such party, as a result of the conduct complained of by
the claimant; and</text>
</subparagraph><subparagraph id="HD8B3AA135B804017BCEAFDD098A8C761"><enum>(F)</enum><text>the amount of any
civil fines assessed against such party as a result of the conduct complained
of by the claimant.</text>
</subparagraph></paragraph><paragraph id="H3BBE4F804BF8465A84327C69E2941455"><enum>(2)</enum><header>Maximum
award</header><text>The amount of punitive damages, if awarded, in a health
care lawsuit may be as much as $250,000 or as much as two times the amount of
economic damages awarded, whichever is greater. The jury shall not be informed
of this limitation.</text>
</paragraph></subsection><subsection id="HF47E0B5D668F474982D89185E698F52E"><enum>(c)</enum><header>No punitive
damages for products that comply with FDA standards</header>
<paragraph id="H0BDE9A160C924B8492F62DA00A04BDA"><enum>(1)</enum><header>In
general</header>
<subparagraph id="H508FB84E7B014F63B0D42300432EC2F6"><enum>(A)</enum><text>No punitive
damages may be awarded against the manufacturer or distributor of a medical
product, or a supplier of any component or raw material of such medical
product, based on a claim that such product caused the claimant’s harm
where—</text>
<clause id="H85218E1DD9524E43B3231E244DAE4844"><enum>(i)</enum><subclause commented="no" display-inline="yes-display-inline" id="H10711BED97D343EEB42BFAB43FFF9100"><enum>(I)</enum><text>such medical product was
subject to premarket approval, clearance, or licensure by the Food and Drug
Administration with respect to the safety of the formulation or performance of
the aspect of such medical product which caused the claimant’s harm or the
adequacy of the packaging or labeling of such medical product; and</text>
</subclause><subclause id="H15D7446CF4E1406D81FD9E92DAC02F61" indent="up1"><enum>(II)</enum><text>such medical product was so approved,
cleared, or licensed; or</text>
</subclause></clause><clause id="H520BDB30AC084D4A97A829906FC4E6"><enum>(ii)</enum><text>such
medical product is generally recognized among qualified experts as safe and
effective pursuant to conditions established by the Food and Drug
Administration and applicable Food and Drug Administration regulations,
including without limitation those related to packaging and labeling, unless
the Food and Drug Administration has determined that such medical product was
not manufactured or distributed in substantial compliance with applicable Food
and Drug Administration statutes and regulations.</text>
</clause></subparagraph><subparagraph id="HAD75705DCFD14B438450CBEFCC36929E"><enum>(B)</enum><header>Rule of
construction</header><text>Subparagraph (A) may not be construed as
establishing the obligation of the Food and Drug Administration to demonstrate
affirmatively that a manufacturer, distributor, or supplier referred to in such
subparagraph meets any of the conditions described in such subparagraph.</text>
</subparagraph></paragraph><paragraph id="H9217406240A04D65AC005CC6AB754C20"><enum>(2)</enum><header>Liability of
health care providers</header><text>A health care provider who prescribes, or
who dispenses pursuant to a prescription, a medical product approved, licensed,
or cleared by the Food and Drug Administration shall not be named as a party to
a product liability lawsuit involving such product and shall not be liable to a
claimant in a class action lawsuit against the manufacturer, distributor, or
seller of such product. Nothing in this paragraph prevents a court from
consolidating cases involving health care providers and cases involving
products liability claims against the manufacturer, distributor, or product
seller of such medical product.</text>
</paragraph><paragraph id="HFE93801EFD1048978EB4113CFBEA85E4"><enum>(3)</enum><header>Packaging</header><text>In
a health care lawsuit for harm which is alleged to relate to the adequacy of
the packaging or labeling of a drug which is required to have tamper-resistant
packaging under regulations of the Secretary of Health and Human Services
(including labeling regulations related to such packaging), the manufacturer or
product seller of the drug shall not be held liable for punitive damages unless
such packaging or labeling is found by the trier of fact by clear and
convincing evidence to be substantially out of compliance with such
regulations.</text>
</paragraph><paragraph id="H3335BB65B56B4F94B7ABD52853C535A9"><enum>(4)</enum><header>Exception</header><text>Paragraph
(1) shall not apply in any health care lawsuit in which—</text>
<subparagraph id="HB327F39F75DF441BA792AEA8BD538C8"><enum>(A)</enum><text>a person, before or
after premarket approval, clearance, or licensure of such medical product,
knowingly misrepresented to or withheld from the Food and Drug Administration
information that is required to be submitted under the Federal Food, Drug, and
Cosmetic Act (21 U.S.C. 301 et seq.) or section 351 of the Public Health
Service Act (42 U.S.C. 262) that is material and is causally related to the
harm which the claimant allegedly suffered; or</text>
</subparagraph><subparagraph id="H7FDF46253FCB4B7D89ECBDDA22DB77B"><enum>(B)</enum><text>a person made an
illegal payment to an official of the Food and Drug Administration for the
purpose of either securing or maintaining approval, clearance, or licensure of
such medical product.</text>
</subparagraph></paragraph></subsection></section><section id="H873ABE97D4684AFF9B906EE19D9FFF6"><enum>208.</enum><header>Authorization of
payment of future damages to claimants in health care lawsuits</header>
<subsection id="HA3E08DCF79C048F98D492B009793267D"><enum>(a)</enum><header>In
general</header><text>In any health care lawsuit, if an award of future
damages, without reduction to present value, equaling or exceeding $50,000 is
made against a party with sufficient insurance or other assets to fund a
periodic payment of such a judgment, the court shall, at the request of any
party, enter a judgment ordering that the future damages be paid by periodic
payments. In any health care lawsuit, the court may be guided by the Uniform
Periodic Payment of Judgments Act promulgated by the National Conference of
Commissioners on Uniform State Laws.</text>
</subsection><subsection id="HACF1FC6259294B13B323EC1BF8C484B"><enum>(b)</enum><header>Applicability</header><text>This
section applies to all actions which have not been first set for trial or
retrial before the effective date of this Act.</text>
</subsection></section><section id="H9A47D14D221E464CA8000165AEABC767"><enum>209.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text>
<paragraph id="H4E49B6904D67450E96F923F9B1CCEEA"><enum>(1)</enum><header>Alternative
dispute resolution system; ADR</header><text>The term <quote>alternative
dispute resolution system</quote> or <quote>ADR</quote> means a system that
provides for the resolution of health care lawsuits in a manner other than
through a civil action brought in a State or Federal court.</text>
</paragraph><paragraph id="HA31B30EA4AC645B4A814537ECB8915E"><enum>(2)</enum><header>Claimant</header><text>The
term <quote>claimant</quote> means any person who brings a health care lawsuit,
including a person who asserts or claims a right to legal or equitable
contribution, indemnity or subrogation, arising out of a health care liability
claim or action, and any person on whose behalf such a claim is asserted or
such an action is brought, whether deceased, incompetent, or a minor.</text>
</paragraph><paragraph id="H5E66E4489CA04E22958430DDD1BC57FC"><enum>(3)</enum><header>Collateral
source benefits</header><text>The term <quote>collateral source
benefits</quote> means any amount paid or reasonably likely to be paid in the
future to or on behalf of the claimant, or any service, product or other
benefit provided or reasonably likely to be provided in the future to or on
behalf of the claimant, as a result of the injury or wrongful death, pursuant
to—</text>
<subparagraph id="H718E2F21132245D1945DCB465431FE11"><enum>(A)</enum><text>any State or
Federal health, sickness, income-disability, accident, or workers’ compensation
law (except the Federal Employees’ Compensation Act (5 U.S.C. 8101 et
seq.));</text>
</subparagraph><subparagraph id="H80D6C71F7D24485C00001B2DBF479DE7"><enum>(B)</enum><text>any health,
sickness, income-disability, or accident insurance that provides health
benefits or income-disability coverage;</text>
</subparagraph><subparagraph id="HB1F13883791C45559E828B08F2E2D365"><enum>(C)</enum><text>any contract or
agreement of any group, organization, partnership, or corporation to provide,
pay for, or reimburse the cost of medical, hospital, dental, or income
disability benefits; and</text>
</subparagraph><subparagraph id="H5D3D2099930348FDAA4B96B38DD24F6E"><enum>(D)</enum><text>any other publicly
or privately funded program.</text>
</subparagraph></paragraph><paragraph id="H65009A99E19D4820885BBEC5DA1994C"><enum>(4)</enum><header>Compensatory
damages</header><text>The term <quote>compensatory damages</quote> means
objectively verifiable monetary losses incurred as a result of the provision
of, use of, or payment for (or failure to provide, use, or pay for) health care
services or medical products, such as past and future medical expenses, loss of
past and future earnings, cost of obtaining domestic services, loss of
employment, and loss of business or employment opportunities, damages for
physical and emotional pain, suffering, inconvenience, physical impairment,
mental anguish, disfigurement, loss of enjoyment of life, loss of society and
companionship, loss of consortium (other than loss of domestic service),
hedonic damages, injury to reputation, and all other nonpecuniary losses of any
kind or nature. The term <quote>compensatory damages</quote> includes economic
damages and noneconomic damages, as such terms are defined in this
section.</text>
</paragraph><paragraph id="H13CE79FFF4A14A8DBDC73DA67C0014F"><enum>(5)</enum><header>Contingent
fee</header><text>The term <quote>contingent fee</quote> includes all
compensation to any person or persons which is payable only if a recovery is
effected on behalf of one or more claimants.</text>
</paragraph><paragraph id="H0D20CC72F8C54BE78FCB1499B36E4570"><enum>(6)</enum><header>Economic
damages</header><text>The term <quote>economic damages</quote> means
objectively verifiable monetary losses incurred as a result of the provision
of, use of, or payment for (or failure to provide, use, or pay for) health care
services or medical products, such as past and future medical expenses, loss of
past and future earnings, cost of obtaining domestic services, loss of
employment, and loss of business or employment opportunities.</text>
</paragraph><paragraph id="H8DB9F28B00BB4298B39BEB979155278"><enum>(7)</enum><header>Health care
lawsuit</header><text>The term <quote>health care lawsuit</quote> means any
health care liability claim concerning the provision of health care goods or
services or any medical product affecting interstate commerce, or any health
care liability action concerning the provision of health care goods or services
or any medical product affecting interstate commerce, brought in a State or
Federal court or pursuant to an alternative dispute resolution system, against
a health care provider, a health care organization, or the manufacturer,
distributor, supplier, marketer, promoter, or seller of a medical product,
regardless of the theory of liability on which the claim is based, or the
number of claimants, plaintiffs, defendants, or other parties, or the number of
claims or causes of action, in which the claimant alleges a health care
liability claim. Such term does not include a claim brought by the United
States Government or a relator under the False Claims Act (31 U.S.C. 3729 et
seq.) or a claim or action which is based on criminal liability; which seeks
civil fines or penalties paid to Federal, State, or local government; or which
is grounded in antitrust.</text>
</paragraph><paragraph id="HA2B92079EA1D45E8909201F05F55E731"><enum>(8)</enum><header>Health care
liability action</header><text>The term <quote>health care liability
action</quote> means a civil action brought in a State or Federal Court or
pursuant to an alternative dispute resolution system, against a health care
provider, a health care organization, or the manufacturer, distributor,
supplier, marketer, promoter, or seller of a medical product, regardless of the
theory of liability on which the claim is based, or the number of plaintiffs,
defendants, or other parties, or the number of causes of action, in which the
claimant alleges a health care liability claim.</text>
</paragraph><paragraph id="HA55B89E932CC4B26AE416797B16B236B"><enum>(9)</enum><header>Health care
liability claim</header><text>The term <quote>health care liability
claim</quote> means a demand by any person, whether or not pursuant to ADR,
against a health care provider, health care organization, or the manufacturer,
distributor, supplier, marketer, promoter, or seller of a medical product,
including, but not limited to, third-party claims, cross-claims,
counter-claims, or contribution claims, which are based upon the provision of,
use of, or payment for (or the failure to provide, use, or pay for) health care
services or medical products, regardless of the theory of liability on which
the claim is based, or the number of plaintiffs, defendants, or other parties,
or the number of causes of action.</text>
</paragraph><paragraph id="H29F1113718F64010892DF8EC679146B"><enum>(10)</enum><header>Health care
organization</header><text>The term <quote>health care organization</quote>
means any person or entity which is obligated to provide or pay for health
benefits under any health plan, including any person or entity acting under a
contract or arrangement with a health care organization to provide or
administer any health benefit.</text>
</paragraph><paragraph id="H9972869079954D31A46816C2E3603086"><enum>(11)</enum><header>Health care
provider</header><text>The term <quote>health care provider</quote> means any
person or entity required by State or Federal laws or regulations to be
licensed, registered, or certified to provide health care services, and being
either so licensed, registered, or certified, or exempted from such requirement
by other statute or regulation.</text>
</paragraph><paragraph id="HA5B6B4B351F44CF19D6D74A0A4578D04"><enum>(12)</enum><header>Health care
goods or services</header><text>The term <quote>health care goods or
services</quote> means any goods or services provided by a health care
organization, provider, or by any individual working under the supervision of a
health care provider, that relates to the diagnosis, prevention, or treatment
of any human disease or impairment, or the assessment or care of the health of
human beings.</text>
</paragraph><paragraph id="H92BF8F9CA9664DCD891C172BB912D6C"><enum>(13)</enum><header>Malicious intent
to injure</header><text>The term <quote>malicious intent to injure</quote>
means intentionally causing or attempting to cause physical injury other than
providing health care goods or services.</text>
</paragraph><paragraph id="H629F3C7E1FA645328CB9E8BA5E006198"><enum>(14)</enum><header>Medical
product</header><text>The term <quote>medical product</quote> means a drug,
device, or biological product intended for humans, and the terms
<quote>drug</quote>, <quote>device</quote>, and <quote>biological
product</quote> have the meanings given such terms in sections 201(g)(1) and
201(h) of the Federal Food, Drug and Cosmetic Act (21 U.S.C. 321) and section
351(a) of the Public Health Service Act (42 U.S.C. 262(a)), respectively,
including any component or raw material used therein, but excluding health care
services.</text>
</paragraph><paragraph id="H063D459D105E4AB1B158DAC1AA5E83F0"><enum>(15)</enum><header>Noneconomic
damages</header><text>The term <quote>noneconomic damages</quote> means damages
for physical and emotional pain, suffering, inconvenience, physical impairment,
mental anguish, disfigurement, loss of enjoyment of life, loss of society and
companionship, loss of consortium (other than loss of domestic service),
hedonic damages, injury to reputation, and all other nonpecuniary losses of any
kind or nature.</text>
</paragraph><paragraph id="HFD32FC94E63F4D3000F16C7601FDF200"><enum>(16)</enum><header>Punitive
damages</header><text>The term <quote>punitive damages</quote> means damages
awarded, for the purpose of punishment or deterrence, and not solely for
compensatory purposes, against a health care provider, health care
organization, or a manufacturer, distributor, or supplier of a medical product.
Punitive damages are neither economic nor noneconomic damages.</text>
</paragraph><paragraph id="HAC665A02A77B4B5CA6D53408E3338F29"><enum>(17)</enum><header>Recovery</header><text>The
term <quote>recovery</quote> means the net sum recovered after deducting any
disbursements or costs incurred in connection with prosecution or settlement of
the claim, including all costs paid or advanced by any person. Costs of health
care incurred by the plaintiff and the attorneys’ office overhead costs or
charges for legal services are not deductible disbursements or costs for such
purpose.</text>
</paragraph><paragraph id="H14210F1128054933B431AC9595221544"><enum>(18)</enum><header>State</header><text>The
term <quote>State</quote> means each of the several States, the District of
Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American
Samoa, the Northern Mariana Islands, the Trust Territory of the Pacific
Islands, and any other territory or possession of the United States, or any
political subdivision thereof.</text>
</paragraph></section><section id="H3C703D051E08488D8FFEF15C49FA40"><enum>210.</enum><header>Effect on other
laws</header>
<subsection id="HB735259AFCFF4BEEA605B334B0FB00FD"><enum>(a)</enum><header>Vaccine
injury</header>
<paragraph id="HB967B2EC69E34A6700638D60BE6363"><enum>(1)</enum><text>To
the extent that title XXI of the Public Health Service Act establishes a
Federal rule of law applicable to a civil action brought for a vaccine-related
injury or death—</text>
<subparagraph id="H783FE67770B94DC69C8B31A394E4776F"><enum>(A)</enum><text>this title does
not affect the application of the rule of law to such an action; and</text>
</subparagraph><subparagraph id="H8C9111EDDF8C487B0025DCCF3F89DEFF"><enum>(B)</enum><text>any rule of law
prescribed by this title in conflict with a rule of law of such title XXI shall
not apply to such action.</text>
</subparagraph></paragraph><paragraph id="H58A74BB8DE5A431C8CA4500994E5FCD0"><enum>(2)</enum><text>If there is an
aspect of a civil action brought for a vaccine-related injury or death to which
a Federal rule of law under title XXI of the Public Health Service Act does not
apply, then this title or otherwise applicable law (as determined under this
title) will apply to such aspect of such action.</text>
</paragraph></subsection><subsection id="H1D98458823C247B0B8463F646F6174E1"><enum>(b)</enum><header>Other federal
law</header><text>Except as provided in this section, nothing in this title
shall be deemed to affect any defense available to a defendant in a health care
lawsuit or action under any other provision of Federal law.</text>
</subsection></section><section id="H7A85A29FBFEC4251A3EA4C61FDB627C5"><enum>211.</enum><header>State
flexibility and protection of states’ rights</header>
<subsection id="HAAC6BB066D5A485FBB8861BCED1810E4"><enum>(a)</enum><header>Health care
lawsuits</header><text>The provisions governing health care lawsuits set forth
in this title preempt, subject to subsections (b) and (c), State law to the
extent that State law prevents the application of any provisions of law
established by or under this title. The provisions governing health care
lawsuits set forth in this title supersede chapter 171 of title 28, United
States Code, to the extent that such chapter—</text>
<paragraph id="H93FBDE10EC5D48F68484C5F750009893"><enum>(1)</enum><text>provides or allows
for a greater amount of damages or contingent fees, or a longer period in which
a health care lawsuit may be commenced, than provided in this title;</text>
</paragraph><paragraph id="HC024297C5EEE4D1300DFDC5410AF2F00"><enum>(2)</enum><text>precludes or
reduces the applicability or scope of periodic payment of future damages as
provided in this title; or</text>
</paragraph><paragraph id="H5FE258E2F48B49029C18D62243339B1B"><enum>(3)</enum><text>through
application of State law, conflicts with provisions of this title concerning
joint liability, collateral source benefits, subrogation, or liens.</text>
</paragraph></subsection><subsection id="H5EE00F4AC8B44D9AA300008200F2C27"><enum>(b)</enum><header>Protection of
states’ rights and other laws</header>
<paragraph id="H523FA70C258F4073AC09037BC2478EA6"><enum>(1)</enum><text>Any issue that is
not governed by any provision of law established by or under this title
(including State standards of negligence) shall be governed by otherwise
applicable State or Federal law.</text>
</paragraph><paragraph id="H5DDB2780C9A84D97A3BF1351D33FC446"><enum>(2)</enum><text>This title shall
not preempt or supersede any State or Federal law that imposes greater
procedural or substantive protections for health care providers and health care
organizations from liability, loss, or damages than those provided by this
title or create a cause of action.</text>
</paragraph></subsection><subsection id="HCEAC1BE66F204F77A0CA98A87EEA6EDF"><enum>(c)</enum><header>State
flexibility</header><text>No provision of this title shall be construed to
preempt—</text>
<paragraph id="H6DD096D57A894D7A84F25C23B7959289"><enum>(1)</enum><text>any State law
(whether effective before, on, or after the date of the enactment of this
title) that specifies a particular monetary amount of compensatory or punitive
damages (or the total amount of damages) that may be awarded in a health care
lawsuit, regardless of whether such monetary amount is greater or lesser than
is provided for under this title, notwithstanding section 204(a); or</text>
</paragraph><paragraph id="H725F57E88EEA48838516A451F98900B4"><enum>(2)</enum><text>any defense
available to a party in a health care lawsuit under any other provision of
State or Federal law.</text>
</paragraph></subsection></section><section id="H4FA7C82A78B24266998FB00CD1443E8"><enum>212.</enum><header>Applicability;
effective date</header><text display-inline="no-display-inline">This title
shall apply to any health care lawsuit brought in a Federal or State court, or
subject to an alternative dispute resolution system, that is initiated on or
after the date of the enactment of this title, except that any health care
lawsuit arising from an injury occurring prior to the date of the enactment of
this title shall be governed by the applicable statute of limitations
provisions in effect at the time the injury occurred.</text>
</section><enum>III</enum><header>INCREASING
HIGH-INCOME BENEFICIARY AWARENESS AND RESPONSIBILITY FOR HEALTH CARE
COSTS</header>
<section id="HE84BB1AEFA3349B28720D968348C4663"><enum>301.</enum><header>INCOME-RELATED
REDUCTION IN PART D PREMIUM SUBSIDY</header>
<subsection id="H63EAA0BC3CEA46B38E00D45BCEA8B9FB"><enum>(a)</enum><header>Income-related
reduction in part d premium subsidy</header>
<paragraph id="HB3EFE0BC41D24A3D83DCBBDF8CE434D"><enum>(1)</enum><header>In
general</header><text>Section 1860D–13(a) (42 U.S.C. 1395w–113(a)) is amended
by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H2A46E608141946E193ADFF1CDDCFC4D7" style="OLC">
<paragraph id="H6C22D6B01D8E4932BEEB0029C17E546B"><enum>(7)</enum><header>Reduction in
premium subsidy based on income</header>
<subparagraph id="H45902763F1424C2E8BB5AE438852A991"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">In the case of an
individual whose modified adjusted gross income exceeds the threshold amount
applicable under subparagraph (B) for the calendar year, the monthly amount of
the premium subsidy applicable to the premium under this section for a month
after December 2008 shall be reduced (and the monthly beneficiary premium shall
be increased) by the monthly adjustment amount specified in subparagraph
(C).</text>
</subparagraph><subparagraph id="H7B06B6F56F534415AA2CB411248CC4BB"><enum>(B)</enum><header>Threshold
amount</header><text display-inline="yes-display-inline">For purposes of this
paragraph, the threshold amount is—</text>
<clause id="HC562658B7F1A4A08A10000006E70D1D"><enum>(i)</enum><text display-inline="yes-display-inline">except as provided in clause (ii), $82,000;
and</text>
</clause><clause id="HFA6FB94F14194F86AD7754B57B82C3CC"><enum>(ii)</enum><text display-inline="yes-display-inline">in the case of a joint return, twice the
amount applicable under clause (i) for the calendar year.</text>
</clause></subparagraph><subparagraph id="H1BC4A4E583FB4410BDE9A454F7B4ED8F"><enum>(C)</enum><header>Monthly
adjustment amount</header>
<clause id="H1108EAE48EA64A70ADC003FCF337ABE9"><enum>(i)</enum><header>In
general</header><text display-inline="yes-display-inline">The monthly
adjustment amount specified in this subparagraph for an individual for a month
in a year is equal to the product of—</text>
<subclause id="H0E4A98F097924E33A9099512D8C774B5"><enum>(I)</enum><text display-inline="yes-display-inline">the quotient obtained by dividing—</text>
<item id="HC6C172E285334CF785838FD2B4FB4641"><enum>(aa)</enum><text display-inline="yes-display-inline">the applicable percentage specified in the
table in clause (ii) for the individual for the calendar year reduced by 25.5
percent; by</text>
</item><item id="H8A60793F5E5E49BD91002837FA3D05EA"><enum>(bb)</enum><text display-inline="yes-display-inline">25.5 percent; and</text>
</item></subclause><subclause id="HEDC2494D846E4B4093097FC20090ADBB"><enum>(II)</enum><text display-inline="yes-display-inline">the base beneficiary premium (as computed
under paragraph (2)).</text>
</subclause></clause><clause id="HFF1729BD16F84525996594004D71CCDE"><enum>(ii)</enum><header>Applicable
percentage</header>
<subclause id="HE2F3B41928EC41DE93B0976DBFAB0019"><enum>(I)</enum><header>In
general</header>
<table align-to-level="section" blank-lines-before="1" colsep="0" frame="none" line-rules="no-gen" rowsep="0" rule-weights="0.0.0.0.0.0" subformat="S6211" table-template-name="Flush/hang, 1 text, 1 num, bold hds" table-type="subformat">
<tgroup cols="2" rowsep="0"><colspec coldef="txt" colname="column1" colwidth="260pts" min-data-value="100"></colspec><colspec char="." charoff="1" coldef="fig" colname="column2" colwidth="99.00pt" min-data-value="15"></colspec>
<thead>
<row><entry align="left" colname="column1" morerows="0" namest="column1" rowsep="0"><bold><?xm-replace_text {Table Head Entry}?></bold></entry><entry align="right" colname="column2" morerows="0" namest="column2" rowsep="0"><bold>The applicable</bold></entry>
</row>
<row><entry align="left" colname="column1" morerows="0" namest="column1" rowsep="0"><bold>If the modified adjusted gross income
is:</bold></entry><entry align="right" colname="column2" morerows="0" namest="column2" rowsep="0"><bold>percentage is:</bold></entry>
</row>
</thead>
<tbody>
<row><entry colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr">More than $82,000 but not more than
$102,000</entry><entry colname="column2" rowsep="0">35 percent</entry>
</row>
<row><entry colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr">More than $102,000 but not more than
$153,000</entry><entry colname="column2" rowsep="0">50 percent</entry>
</row>
<row><entry colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr">More than $153,000 but not more than
$205,000</entry><entry colname="column2" rowsep="0">65 percent</entry>
</row>
<row><entry colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr">More than $205,000</entry><entry colname="column2" rowsep="0">80 percent.</entry>
</row>
</tbody>
</tgroup>
</table>
</subclause><subclause id="H77A7053401CB4C91B954D5BFA3D0DD00"><enum>(II)</enum><header>Joint
returns</header><text display-inline="yes-display-inline">In the case of a
joint return, subclause (I) shall be applied by substituting dollar amounts
which are twice the dollar amounts otherwise applicable under subclause (I) for
the calendar year.</text>
</subclause><subclause id="H748A1AB5A36743C9A11B22E334CB1B3F"><enum>(III)</enum><header>Married
individuals filing separate returns</header><text display-inline="yes-display-inline">In the case of an individual who—</text>
<item id="H6968FA250A3C48149C31934DC4A578B"><enum>(aa)</enum><text display-inline="yes-display-inline">is married as of the close of the taxable
year (within the meaning of section 7703 of the Internal Revenue Code of 1986)
but does not file a joint return for such year, and</text>
</item><item id="H566A892A47674FD684256390D593E44B"><enum>(bb)</enum><text display-inline="yes-display-inline">does not live apart from such individual's
spouse at all times during the taxable year,</text>
</item><continuation-text continuation-text-level="subclause">subclause
(I) shall be applied by reducing each of the dollar amounts otherwise
applicable under such subclause for the calendar year by the threshold amount
for such year applicable to an unmarried individual.</continuation-text></subclause></clause></subparagraph><subparagraph id="H03FFCED3927F450D82B734172E96CEE"><enum>(D)</enum><header>Determination by
commissioner of social security</header><text display-inline="yes-display-inline">The Commissioner of Social Security shall
have the authority to make initial and reconsideration determinations necessary
to carry out the income-related reduction in premium subsidy under this
paragraph.</text>
</subparagraph><subparagraph id="HED9EDE4C362549399BA9F067F861EE2"><enum>(E)</enum><header>Modified adjusted
gross income</header><text display-inline="yes-display-inline">For purposes of
this paragraph, the term ‘modified adjusted gross income’ has the meaning given
such term in subparagraph (A) of section 1839(i)(4), determined for the taxable
year applicable under subparagraphs (B) and (C) of such section.</text>
</subparagraph><subparagraph id="H81BD45B640EE401F8D39FB60F76F1189"><enum>(F)</enum><header>Joint return
defined</header><text display-inline="yes-display-inline">For purposes of this
paragraph, the term ‘joint return’ has the meaning given to such term by
section 7701(a)(38) of the Internal Revenue Code of 1986.</text>
</subparagraph><subparagraph id="H710E58C6194446D9AD92E3DF60A18CCB"><enum>(G)</enum><header>Procedures to
assure correct income-related reduction in premium subsidy</header>
<clause id="H48FCDCF8738644D29B9F38F7A77964C0"><enum>(i)</enum><header>Disclosure of
base beneficiary premium</header><text display-inline="yes-display-inline">Not
later than September 15 of each year beginning with 2008, the Secretary shall
disclose to the Commissioner of Social Security the amount of the base
beneficiary premium (as computed under paragraph (2)) for the purpose of
carrying out the income-related reduction in premium subsidy under this
paragraph with respect to the following year.</text>
</clause><clause id="H7A06E639841144A985A468B46339CD8D"><enum>(ii)</enum><header>Additional
disclosure</header><text display-inline="yes-display-inline">Not later than
October 15 of each year beginning with 2008, the Secretary shall disclose to
the Commissioner of Social Security the following information for the purpose
of carrying out the income-related reduction in premium subsidy under this
paragraph with respect to the following year:</text>
<subclause id="H13AFEAB92CD44DF3BB6294F234329FEA"><enum>(I)</enum><text display-inline="yes-display-inline">The monthly adjustment amount specified in
subparagraph (C).</text>
</subclause><subclause id="HBD1E5DDF56594400B651BC8CCD8200CA"><enum>(II)</enum><text display-inline="yes-display-inline">Any other information the Commissioner of
Social Security determines necessary to carry out the income-related reduction
in premium subsidy under this paragraph.</text>
</subclause></clause></subparagraph><subparagraph id="H6D19F6D8E1B34F7196F0F9B01CEE00B8"><enum>(H)</enum><header>Rule of
construction</header><text display-inline="yes-display-inline">The formula used
to determine the monthly adjustment amount specified under subparagraph (C)
shall only be used for the purpose of determining such monthly adjustment
amount under such
subparagraph.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H1C7CBD0B23E3408183C5ED0035484BDE"><enum>(2)</enum><header>Collection of
monthly adjustment amount</header><text display-inline="yes-display-inline">Section 1860D–13(c) (42 U.S.C.
1395w–113(c)) is amended—</text>
<subparagraph id="H2F064EAECF04428D877993BB10DB33CF"><enum>(A)</enum><text display-inline="yes-display-inline">in paragraph (1), by striking <quote>(2)
and (3)</quote> and inserting <quote>(2), (3), and (4)</quote>; and</text>
</subparagraph><subparagraph id="H28D936499E1A4F4CA342C8C7DBAD3EE3"><enum>(B)</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="HADE2A597734E455F90F8E51629A336C0" style="OLC">
<paragraph id="HC6B13B4474A44B139854EBD20CFF8BC"><enum>(4)</enum><header>Collection of
monthly adjustment amount</header>
<subparagraph id="H9F92D935ADA046AE817F21444111BB09"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">Notwithstanding any
provision of this subsection or section 1854(d)(2), subject to subparagraph
(B), the amount of the income-related reduction in premium subsidy for an
individual for a month (as determined under subsection (a)(7)) shall be paid
through withholding from benefit payments in the manner provided under section
1840.</text>
</subparagraph><subparagraph id="H381F596DC0EE472D97FD90D0F2209F78"><enum>(B)</enum><header>Agreements</header><text display-inline="yes-display-inline">In the case where the monthly benefit
payments of an individual that are withheld under subparagraph (A) are
insufficient to pay the amount described in such subparagraph, the Commissioner
of Social Security shall enter into agreements with the Secretary, the Director
of the Office of Personnel Management, and the Railroad Retirement Board as
necessary in order to allow other agencies to collect the amount described in
subparagraph (A) that was not withheld under such
subparagraph.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></subsection><subsection id="H99ED413C101C42CA8EC0F88ED9C31F16"><enum>(b)</enum><header>Conforming
amendments</header>
<paragraph id="H0686E030802642EC9301209BFC3D1419"><enum>(1)</enum><header>Medicare</header><text display-inline="yes-display-inline">Part D of title XVIII (42 U.S.C. 1395w–101
et seq.) is amended—</text>
<subparagraph id="H90BEF44F2A5F43899F7E99CA0E82109"><enum>(A)</enum><text display-inline="yes-display-inline">in section 1860D–13(a)(1)—</text>
<clause id="HE93399393AA94572B75C00800764EE94"><enum>(i)</enum><text display-inline="yes-display-inline">by redesignating subparagraph (F) as
subparagraph (G);</text>
</clause><clause id="H4BAEC60A45384FD8A9AB6CF91FCB39FC"><enum>(ii)</enum><text display-inline="yes-display-inline">in subparagraph (G), as redesignated by
subparagraph (A), by striking <quote>(D) and (E)</quote> and inserting
<quote>(D), (E), and (F)</quote>; and</text>
</clause><clause id="H71D434B549414CF19C4DA54564A1612E"><enum>(iii)</enum><text display-inline="yes-display-inline">by inserting after subparagraph (E) the
following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HD761302D546C4C3FB88B38DE97747BA3" style="OLC">
<subparagraph id="idA6851C94865B4328A72BE3713A640BC4"><enum>(F)</enum><header>Increase based
on income</header><text display-inline="yes-display-inline">The monthly
beneficiary premium shall be increased pursuant to paragraph
(7).</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="H22AA0727588048B29CE515FB79276E7F"><enum>(B)</enum><text display-inline="yes-display-inline">in section 1860D–15(a)(1)(B), by striking
<quote>paragraph (1)(B)</quote> and inserting <quote>paragraphs (1)(B) and
(1)(F)</quote>.</text>
</subparagraph></paragraph><paragraph id="H040708EF4F8D4BC2A18002A1F3645B60"><enum>(2)</enum><header>Internal revenue
code</header><text display-inline="yes-display-inline">Section 6103(l)(20) of
the Internal Revenue Code of 1986 (relating to disclosure of return information
to carry out Medicare part B premium subsidy adjustment) is amended—</text>
<subparagraph id="H1718253890044E4BA1EB5758B7FFBA0"><enum>(A)</enum><text display-inline="yes-display-inline">in the heading, by striking
<quote><header-in-text level="paragraph">part B premium subsidy
adjustment</header-in-text></quote> and inserting <quote><header-in-text level="paragraph">parts B and D premium subsidy
adjustments</header-in-text></quote>;</text>
</subparagraph><subparagraph id="H91665472637B4D6B9BA0C2075D2E0184"><enum>(B)</enum><text display-inline="yes-display-inline">in subparagraph (A)—</text>
<clause id="H67478F67233B4B90A7820016CEB5262C"><enum>(i)</enum><text display-inline="yes-display-inline">in the matter preceding clause (i), by
inserting <quote>or 1860D–13(a)(7)</quote> after <quote>1839(i)</quote>;
and</text>
</clause><clause id="HC3D178E6A4184EF9902C6F3167EB39F4"><enum>(ii)</enum><text display-inline="yes-display-inline">in clause (vii), by inserting after
<quote>subsection (i) of such section</quote> the following: <quote>or under
section 1860D–13(a)(7) of such Act</quote>; and</text>
</clause></subparagraph><subparagraph id="HFEC26BBF72C9434FB1D1D7DA1EC96E18"><enum>(C)</enum><text display-inline="yes-display-inline">in subparagraph (B)—</text>
<clause id="H29DD3A8834B6464A86322F48C71B2DB4"><enum>(i)</enum><text display-inline="yes-display-inline">by inserting <quote>or such section
1860D–13(a)(7)</quote> before the period at the end;</text>
</clause><clause id="HF201D7AB6CAF40B9A340C81EDE75963B"><enum>(ii)</enum><text display-inline="yes-display-inline">as amended by clause (i), by adding at the
end the following new sentence: <quote>Such return information may be disclosed
to officers and employees of the Departments of Health and Human Services and
Justice, to the extent necessary, and solely for their use, in any
administrative or judicial proceeding ensuing from an adjustment to any such
premium.</quote>; and</text>
</clause></subparagraph><subparagraph id="H1267771AF57F44DB9710496914E82ED4"><enum>(D)</enum><text display-inline="yes-display-inline">by adding at the end the following new
subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H3085774499E14EDEAF48343097CE817" style="OLC">
<subparagraph id="HCF0A08EE2DB44F16A0B54712F003F59"><enum>(C)</enum><header>Timing of
disclosure</header><text display-inline="yes-display-inline">Return information
shall be disclosed to officers, employees, and contractors of the Social
Security Administration under subparagraph (A):</text>
<clause id="HC53027596E984666B5547BE904C68D95"><enum>(i)</enum><text display-inline="yes-display-inline">for taxpayers currently entitled to
benefits under title II of the Social Security Act, or as qualified railroad
retirement beneficiaries within the meaning of section 7(d) of the Railroad
Retirement Act of 1974, within 4 months preceding the month in which the
taxpayer first becomes entitled to benefits under part A or is eligible to
enroll in part B or part D of title XVIII of the Social Security Act;
and</text>
</clause><clause id="H0AA0D1DDC1E24F4D833C48B452C5BFF1"><enum>(ii)</enum><text display-inline="yes-display-inline">for taxpayers not currently receiving
benefits under title II of the Social Security Act, or as qualified railroad
retirement beneficiaries within the meaning of section 7(d) of the Railroad
Retirement Act of 1974, or who have participated in Medicare qualified
government employment as defined in section 210(p) of the Social Security Act,
after the taxpayer applies for a benefit under part A or part B and is eligible
to enroll in part D of title XVIII of the Social Security
Act.</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></subsection><subsection id="HA8B9039425D747AF8E4600AB119EFFE0"><enum>(c)</enum><header>Implementation</header><text display-inline="yes-display-inline">Notwithstanding any other provision of law,
the Secretary, in consultation with the Commissioner of Social Security may
implement this section, and the amendments made by this section, by program
instruction or otherwise.</text>
</subsection></section>