IB Union Calendar No. 168 111th CONGRESS 1st Session H. R. 3200 [Report No. 111–299, Parts I, II, and III] IN THE HOUSE OF REPRESENTATIVES July 14, 2009 Mr. Dingell (for himself, Mr. Rangel, Mr. Waxman, Mr. George Miller of California, Mr. Stark, Mr. Pallone, and Mr. Andrews) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Labor, Oversight and Government Reform, and the Budget, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned October 14, 2009 Additional sponsors: Mr. Kildee, Mrs. Maloney, and Mr. Baca October 14, 2009 Reported from the Committee on Energy and Commerce with an amendment Strike out all after the enacting clause (other than sections 321 and 322, title IV of division A, subtitle A of title I of division B, and title VIII of division B) and insert the part printed in italic For text of sections 321 and 322, title IV of division A, subtitle A of title I of division B, and title VIII of division B, see copy of bill as introduced on July 14, 2009 October 14, 2009 Reported from the Committee on Ways and Means with an amendment Strike out all after the enacting clause (other than title VII of division B and division C) and insert the part printed in boldface roman For text of title VII of division B and for division C (and the original sections of the bill that fall within the jurisdiction of the Committee on Ways and Means), see copy of bill as introduced on July 14, 2009 October 14, 2009 Reported from the Committee on Education and Labor with an amendment Strike out all after the enacting clause (other than sections 161 through 163, 322, and 323 and title IV of division A, division B, section 2002 and titles I through IV of division C, and subtitles A, B, C, and E of title V of division C) and insert the part printed in boldface italic For text of sections 161 through 163, 322, and 323 and title IV of division A, division B, section 2002 and titles I through IV of division C, and subtitles A, B, C, and E of title V of division C, see copy of bill as introduced on July 14, 2009 October 14, 2009 Committees on Oversight and Government Reform and the Budget discharged; committed to the Committee of the Whole House on the State of the Union and ordered to be printed A BILL To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

1.

Short title; table of divisions, titles, and subtitles

(a)

Short title

This Act may be cited as the America’s Affordable Health Choices Act of 2009. (b)

Table of divisions, titles, and subtitles

This Act is divided into divisions, titles, and subtitles as follows: Division A—Affordable Health Care Choices Title I—Protections and Standards for Qualified Health Benefits Plans Subtitle A—General Standards Subtitle B—Standards Guaranteeing Access to Affordable Coverage Subtitle C—Standards Guaranteeing Access to Essential Benefits Subtitle D—Additional Consumer Protections Subtitle E—Governance Subtitle F—Relation to Other Requirements; Miscellaneous Subtitle G—Early Investments Title II—Health Insurance Exchange and Related Provisions Subtitle A—Health Insurance Exchange Subtitle B—Public Health Insurance Option Subtitle C—Individual Affordability Credits Subtitle D—Health Insurance Cooperatives Title III—Shared Responsibility Subtitle A—Individual Responsibility Subtitle B—Employer Responsibility Title IV—Amendments to Internal Revenue Code of 1986 Subtitle A—Shared Responsibility Subtitle B—Credit for Small Business Employee Health Coverage Expenses Subtitle C—Disclosures To Carry Out Health Insurance Exchange Subsidies Subtitle D—Other Revenue Provisions Division B—Medicare and Medicaid Improvements Title I—Improving Health Care Value Subtitle A—Provisions Related to Medicare Part A Subtitle B—Provisions Related to Medicare Part B Subtitle C—Provisions Related to Medicare Parts A and B Subtitle D—Medicare Advantage Reforms Subtitle E—Improvements to Medicare Part D Subtitle F—Medicare Rural Access Protections Title II—Medicare Beneficiary Improvements Subtitle A—Improving and Simplifying Financial Assistance for Low Income Medicare Beneficiaries Subtitle B—Reducing Health Disparities Subtitle C—Miscellaneous Improvements Title III—Promoting Primary Care, Mental Health Services, and Coordinated Care Title IV—Quality Subtitle A—Comparative Effectiveness Research Subtitle B—Nursing Home Transparency Subtitle C—Quality Measurements Subtitle D—Physician Payments Sunshine Provision Subtitle E—Public Reporting on Health Care-Associated Infections Title V—Medicare Graduate Medical Education Title VI—Program Integrity Subtitle A—Increased Funding To Fight Waste, Fraud, and Abuse Subtitle B—Enhanced Penalties for Fraud and Abuse Subtitle C—Enhanced Program and Provider Protections Subtitle D—Access to Information Needed To Prevent Fraud, Waste, and Abuse Title VII—Medicaid and CHIP Subtitle A—Medicaid and Health Reform Subtitle B—Prevention Subtitle C—Access Subtitle D—Coverage Subtitle E—Financing Subtitle F—Waste, Fraud, and Abuse Subtitle G—Payments to the Territories Subtitle H—Miscellaneous Title VIII—Revenue-related provisions Title IX—Miscellaneous Provisions Division C—Public Health and Workforce Development Title I—Community Health Centers Title II—Workforce Subtitle A—Primary Care Workforce Subtitle B—Nursing Workforce Subtitle C—Public Health Workforce Subtitle D—Adapting Workforce to Evolving Health System Needs Title III—Prevention and Wellness Title IV—Quality and Surveillance Title V—Other Provisions Subtitle A—Drug Discount for Rural and Other Hospitals Subtitle B—Programs Subtitle C—Food and Drug Administration Subtitle D—Community Living Assistance Services and Supports Subtitle E—Miscellaneous

A

Affordable Health Care Choices

100.

Purpose; table of contents of division; general definitions

(a)

Purpose

(1)

In general

The purpose of this division is to provide affordable, quality health care for all Americans and reduce the growth in health care spending. (2)

Building on current system

This division achieves this purpose by building on what works in today’s health care system, while repairing the aspects that are broken. (3)

Insurance reforms

This division— (A)enacts strong insurance market reforms; (B)creates a new Health Insurance Exchange, with a public health insurance option alongside private plans and cooperatives under subtitle D of title II; (C)includes sliding scale affordability credits; and (D)initiates shared responsibility among workers, employers, and the government; so that all Americans have coverage of essential health benefits. (4)

Health delivery reform

This division institutes health delivery system reforms both to increase quality and to reduce growth in health spending so that health care becomes more affordable for businesses, families, and government. (b)

Table of contents of division

The table of contents of this division is as follows: Sec. 100. Purpose; table of contents of division; general definitions. Title I—Protections and Standards for Qualified Health Benefits Plans Subtitle A—General Standards Sec. 101. Requirements reforming health insurance marketplace. Sec. 102. Protecting the choice to keep current coverage. Subtitle B—Standards Guaranteeing Access to Affordable Coverage Sec. 111. Prohibiting preexisting condition exclusions. Sec. 112. Guaranteed issue and renewal for insured plans. Sec. 113. Insurance rating rules. Sec. 114. Nondiscrimination in benefits; parity in mental health and substance abuse disorder benefits. Sec. 115. Ensuring adequacy of provider networks. Sec. 116. Ensuring value and lower premiums. Subtitle C—Standards Guaranteeing Access to Essential Benefits Sec. 121. Coverage of essential benefits package. Sec. 122. Essential benefits package defined. Sec. 123. Health Benefits Advisory Committee. Sec. 124. Process for adoption of recommendations; adoption of benefit standards. Sec. 125. Prohibition of discrimination in health care services based on religious or spiritual content. Subtitle D—Additional Consumer Protections Sec. 131. Requiring fair marketing practices by health insurers. Sec. 132. Requiring fair grievance and appeals mechanisms. Sec. 133. Requiring information transparency and plan disclosure. Sec. 134. Application to qualified health benefits plans not offered through the Health Insurance Exchange. Sec. 135. Timely payment of claims. Sec. 136. Standardized rules for coordination and subrogation of benefits. Sec. 137. Application of administrative simplification. Sec. 138. Information on end-of-life planning. Sec. 139. Utilization review activities. Sec. 139A. Internal appeals procedures. Sec. 139B. External appeals procedures. Subtitle E—Governance Sec. 141. Health Choices Administration; Health Choices Commissioner. Sec. 142. Duties and authority of Commissioner. Sec. 143. Consultation and coordination. Sec. 144.  Health Insurance Ombudsman. Subtitle F—Relation to other requirements; Miscellaneous Sec. 151. Relation to other requirements. Sec. 152. Prohibiting discrimination in health care. Sec. 153. Whistleblower protection. Sec. 154. Construction regarding collective bargaining. Sec. 155. Severability. Sec. 156. Application of State and Federal laws regarding abortion. Sec. 157. Non-discrimination on abortion and respect for rights of conscience. Subtitle G—Early Investments Sec. 161. Ensuring value and lower premiums. Sec. 162. Ending health insurance rescission abuse. Sec. 163. Ending health insurance denials and delays of necessary treatment for children with deformities. Sec. 164. Administrative simplification. Sec. 165. Expansion of electronic transactions in medicare. Sec. 166. Reinsurance program for retirees. Sec. 167. Limitations on preexisting condition exclusions in group health plans and health insurance coverage in the group and individual markets in advance of applicability of new prohibition of preexisting condition exclusions. Title II—Health Insurance Exchange and Related Provisions Subtitle A—Health Insurance Exchange Sec. 201. Establishment of Health Insurance Exchange; outline of duties; definitions. Sec. 202. Exchange-eligible individuals and employers. Sec. 203. Benefits package levels. Sec. 204. Contracts for the offering of Exchange-participating health benefits plans. Sec. 205. Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plans. Sec. 206. Other functions. Sec. 207. Health Insurance Exchange Trust Fund. Sec. 208. Optional operation of State-based health insurance exchanges. Sec. 209. Limitation on premium increases under Exchange-participating health benefits plans. Subtitle B—Public health insurance option Sec. 221. Establishment and administration of a public health insurance option as an Exchange-qualified health benefits plan. Sec. 222. Premiums and financing. Sec. 223. Negotiated payment rates for items and services. Sec. 224. Modernized payment initiatives and delivery system reform. Sec. 225. Provider participation. Sec. 226. Application of fraud and abuse provisions. Sec. 227. Application of HIPAA insurance requirements. Sec. 228. Application of health information privacy, security, and electronic transaction requirements. Sec. 229. Enrollment in public health insurance option is voluntary. Subtitle C—Individual Affordability Credits Sec. 241. Availability through Health Insurance Exchange. Sec. 242. Affordable credit eligible individual. Sec. 243. Affordable premium credit. Sec. 244. Affordability cost-sharing credit. Sec. 245. Income determinations. Sec. 246. No Federal payment for undocumented aliens. Subtitle D—Health Insurance Cooperatives Sec. 251. Establishment. Sec. 252. Start-up and solvency grants and loans. Sec. 253. Definitions. Title III—Shared responsibility Subtitle A—Individual responsibility Sec. 301. Individual responsibility. Subtitle B—Employer Responsibility Part 1—Health coverage participation requirements Sec. 311. Health coverage participation requirements. Sec. 312. Employer responsibility to contribute towards employee and dependent coverage. Sec. 313. Employer contributions in lieu of coverage. Sec. 314. Authority related to improper steering. Part 2—Satisfaction of Health Coverage Participation Requirements Sec. 321. Satisfaction of health coverage participation requirements under the Employee Retirement Income Security Act of 1974. Sec. 322. Satisfaction of health coverage participation requirements under the Internal Revenue Code of 1986. Sec. 323. Satisfaction of health coverage participation requirements under the Public Health Service Act. Sec. 324. Additional rules relating to health coverage participation requirements. Title IV—Amendments to Internal Revenue Code of 1986 Subtitle A—Shared responsibility Part 1—Individual responsibility Sec. 401. Tax on individuals without acceptable health care coverage. Part 2—Employer Responsibility Sec. 411. Election to satisfy health coverage participation requirements. Sec. 412. Responsibilities of nonelecting employers. Subtitle B—Credit for small business employee health coverage expenses Sec. 421. Credit for small business employee health coverage expenses. Subtitle C—Disclosures To carry out health insurance exchange subsidies Sec. 431. Disclosures to carry out health insurance exchange subsidies. Subtitle D—Other revenue provisions Part 1—General provisions Sec. 441. Surcharge on high income individuals. Sec. 442. Delay in application of worldwide allocation of interest. Part 2—Prevention of tax avoidance Sec. 451. Limitation on treaty benefits for certain deductible payments. Sec. 452. Codification of economic substance doctrine. Sec. 453. Penalties for underpayments. (c)

General definitions

Except as otherwise provided, in this division: (1)

Acceptable coverage

The term acceptable coverage has the meaning given such term in section 202(d)(2). (2)

Basic plan

The term basic plan has the meaning given such term in section 203(c). (3)

Commissioner

The term Commissioner means the Health Choices Commissioner established under section 141. (4)

Cost-sharing

The term cost-sharing includes deductibles, coinsurance, copayments, and similar charges but does not include premiums or any network payment differential for covered services or spending for non-covered services. (5)

Dependent

The term dependent has the meaning given such term by the Commissioner and includes a spouse. (6)

Employment-based health plan

The term employment-based health plan— (A)means a group health plan (as defined in section 733(a)(1) of the Employee Retirement Income Security Act of 1974); and (B)includes such a plan that is the following: (i)

Federal, state, and tribal governmental plans

A governmental plan (as defined in section 3(32) of the Employee Retirement Income Security Act of 1974), including a health benefits plan offered under chapter 89 of title 5, United States Code. (ii)

Church plans

A church plan (as defined in section 3(33) of the Employee Retirement Income Security Act of 1974). (7)

Enhanced plan

The term enhanced plan has the meaning given such term in section 203(c). (8)

Essential benefits package

The term essential benefits package is defined in section 122(a). (9)

Family

The term family means an individual and includes the individual’s dependents. (10)

Federal poverty level; FPL

The terms Federal poverty level and FPL have the meaning given the term poverty line in section 673(2) of the Community Services Block Grant Act (42 U.S.C. 9902(2)), including any revision required by such section. (11)

Health benefits plan

The terms health benefits plan means health insurance coverage and an employment-based health plan and includes the public health insurance option and cooperatives under subtitle D of title II. (12)

Health insurance coverage; health insurance issuer

The terms health insurance coverage and health insurance issuer have the meanings given such terms in section 2791 of the Public Health Service Act. (13)

Health Insurance Exchange

The term Health Insurance Exchange means the Health Insurance Exchange established under section 201. (14)

Medicaid

The term Medicaid means a State plan under title XIX of the Social Security Act (whether or not the plan is operating under a waiver under section 1115 of such Act). (15)

Medicare

The term Medicare means the health insurance programs under title XVIII of the Social Security Act. (16)

Plan sponsor

The term plan sponsor has the meaning given such term in section 3(16)(B) of the Employee Retirement Income Security Act of 1974. (17)

Plan year

The term plan year means— (A)with respect to an employment-based health plan, a plan year as specified under such plan; or (B)with respect to a health benefits plan other than an employment-based health plan, a 12-month period as specified by the Commissioner. (18)

Premium plan; premium-plus plan

The terms premium plan and premium-plus plan have the meanings given such terms in section 203(c). (19)

QHBP offering entity

The terms QHBP offering entity means, with respect to a health benefits plan that is— (A)a group health plan (as defined, subject to subsection (d), in section 733(a)(1) of the Employee Retirement Income Security Act of 1974), the plan sponsor in relation to such group health plan, except that, in the case of a plan maintained jointly by 1 or more employers and 1 or more employee organizations and with respect to which an employer is the primary source of financing, such term means such employer; (B)health insurance coverage, the health insurance issuer offering the coverage, including a cooperative under subtitle D of title II; (C)the public health insurance option, the Secretary of Health and Human Services; (D)a non-Federal governmental plan (as defined in section 2791(d) of the Public Health Service Act), the State or political subdivision of a State (or agency or instrumentality of such State or subdivision) which establishes or maintains such plan; or (E)a Federal governmental plan (as defined in section 2791(d) of the Public Health Service Act), the appropriate Federal official. (20)

Qualified health benefits plan

The term qualified health benefits plan means a health benefits plan that meets the requirements for such a plan under title I and includes the public health insurance option and cooperatives under subtitle D of title II. (21)

Public health insurance option

The term public health insurance option means the public health insurance option as provided under subtitle B of title II. (22)

Service area; premium rating area

The terms service area and premium rating area mean with respect to health insurance coverage— (A)offered other than through the Health Insurance Exchange, such an area as established by the QHBP offering entity of such coverage in accordance with applicable State law; and (B)offered through the Health Insurance Exchange, such an area as established by such entity in accordance with applicable State law and applicable rules of the Commissioner for Exchange-participating health benefits plans. (23)

State

The term State means the 50 States and the District of Columbia. (24)

State Medicaid agency

The term State Medicaid agency means, with respect to a Medicaid plan, the single State agency responsible for administering such plan under title XIX of the Social Security Act. (25)

Y1, Y2, etc.

The terms Y1 , Y2, Y3, Y4, Y5, and similar subsequently numbered terms, mean 2013 and subsequent years, respectively.

B

Medicare and Medicaid Improvements

1001.

Table of contents of division

The table of contents for this division is as follows: Division B—Medicare and Medicaid Improvements Sec. 1001. Table of contents of division. Title I—Improving Health Care Value Subtitle A—Provisions related to Medicare part A Part 1—Market basket updates Sec. 1101. Skilled nursing facility payment update. Sec. 1102. Inpatient rehabilitation facility payment update. Sec. 1103. Incorporating productivity improvements into market basket updates that do not already incorporate such improvements. Part 2—Other Medicare part A provisions Sec. 1111. Payments to skilled nursing facilities. Sec. 1112. Medicare DSH report and payment adjustments in response to coverage expansion. Subtitle B—Provisions Related to Medicare Part B Part 1—Physicians’ Services Sec. 1121. Sustainable growth rate reform. Sec. 1122. Misvalued codes under the physician fee schedule. Sec. 1123. Payments for efficient areas. Sec. 1124. Modifications to the Physician Quality Reporting Initiative (PQRI). Sec. 1125. Adjustment to Medicare payment localities. Sec. 1126. Resource-based feedback program for physicians in Medicare. Part 2—Market basket updates Sec. 1131. Incorporating productivity improvements into market basket updates that do not already incorporate such improvements. Part 3—Other Provisions Sec. 1141. Rental and purchase of power-driven wheelchairs. Sec. 1141A. Election to take ownership, or to decline ownership, of a certain item of complex durable medical equipment after the 13-month capped rental period ends. Sec. 1142. Extension of payment rule for brachytherapy. Sec. 1143. Home infusion therapy report to congress. Sec. 1144. Require ambulatory surgical centers (ASCs) to submit cost data and other data. Sec. 1145. Treatment of certain cancer hospitals. Sec. 1146. Medicare Improvement Fund. Sec. 1147. Payment for imaging services. Sec. 1148. Durable medical equipment program improvements. Sec. 1149. MedPAC study and report on bone mass measurement. Sec. 1149A. Exclusion of customary prompt pay discounts extended to wholesalers from manufacturer’s average sales price for payments for drugs and biologicals under Medicare part B. Sec. 1149B. Timely access to postmastectomy items. Sec. 1149C. Moratorium on Medicare reductions in payment rates for certain interventional pain management procedures covered under the ASC fee schedule. Sec. 1149D. Medicare coverage of services of qualified respiratory therapists performed under the general supervision of a physician. Subtitle C—Provisions Related to Medicare Parts A and B Sec. 1151. Reducing potentially preventable hospital readmissions. Sec. 1152. Post acute care services payment reform plan and bundling pilot program. Sec. 1153. Home health payment update for 2010. Sec. 1154. Payment adjustments for home health care. Sec. 1155. Incorporating productivity improvements into market basket update for home health services. Sec. 1156. Limitation on Medicare exceptions to the prohibition on certain physician referrals made to hospitals. Sec. 1157. Institute of Medicine study of geographic adjustment factors under Medicare. Sec. 1158. Revision of Medicare payment systems to address geographic inequities. Subtitle D—Medicare Advantage Reforms Part 1—Payment and Administration Sec. 1161. Phase-in of payment based on fee-for-service costs. Sec. 1162. Quality bonus payments. Sec. 1163. Extension of Secretarial coding intensity adjustment authority. Sec. 1164. Simplification of annual beneficiary election periods. Sec. 1165. Extension of reasonable cost contracts. Sec. 1166. Limitation of waiver authority for employer group plans. Sec. 1167. Improving risk adjustment for payments. Sec. 1168. Elimination of MA Regional Plan Stabilization Fund. Sec. 1169. Study regarding the effects of calculating Medicare Advantage payment rates on a regional average of Medicare fee for service rates. Part 2—Beneficiary Protections and Anti-Fraud Sec. 1171. Limitation on cost-sharing for individual health services. Sec. 1172. Continuous open enrollment for enrollees in plans with enrollment suspension. Sec. 1173. Information for beneficiaries on MA plan administrative costs. Sec. 1174. Strengthening audit authority. Sec. 1175. Authority to deny plan bids. Part 3—Treatment of special needs plans Sec. 1176. Limitation on enrollment outside open enrollment period of individuals into chronic care specialized MA plans for special needs individuals. Sec. 1177. Extension of authority of special needs plans to restrict enrollment. Subtitle E—Improvements to Medicare Part D Sec. 1181. Elimination of coverage gap. Sec. 1182. Discounts for certain part D drugs in original coverage gap. Sec. 1183. Repeal of provision relating to submission of claims by pharmacies located in or contracting with long-term care facilities. Sec. 1184. Including costs incurred by AIDS drug assistance programs and Indian Health Service in providing prescription drugs toward the annual out-of-pocket threshold under part D. Sec. 1185. Permitting mid-year changes in enrollment for formulary changes that adversely impact an enrollee. Sec. 1186. Negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries. Sec. 1187. State certification prior to waiver of licensure requirements under Medicare prescription drug program. Subtitle F—Medicare Rural Access Protections Sec. 1191. Telehealth expansion and enhancements. Sec. 1192. Extension of outpatient hold harmless provision. Sec. 1193. Extension of section 508 hospital reclassifications. Sec. 1194. Extension of geographic floor for work. Sec. 1195. Extension of payment for technical component of certain physician pathology services. Sec. 1196. Extension of ambulance add-ons. Sec. 1197. Ensuring proportional representation of interests of rural areas on MedPAC. Title II—Medicare Beneficiary Improvements Subtitle A—Improving and Simplifying Financial Assistance for Low Income Medicare Beneficiaries Sec. 1201. Improving assets tests for Medicare Savings Program and low-income subsidy program. Sec. 1202. Elimination of part D cost-sharing for certain noninstitutionalized full-benefit dual eligible individuals. Sec. 1203. Eliminating barriers to enrollment. Sec. 1204. Enhanced oversight relating to reimbursements for retroactive low income subsidy enrollment. Sec. 1205. Intelligent assignment in enrollment. Sec. 1206. Special enrollment period and automatic enrollment process for certain subsidy eligible individuals. Sec. 1207. Application of MA premiums prior to rebate in calculation of low income subsidy benchmark. Subtitle B—Reducing Health Disparities Sec. 1221. Ensuring effective communication in Medicare. Sec. 1222. Demonstration to promote access for Medicare beneficiaries with limited-English proficiency by providing reimbursement for culturally and linguistically appropriate services. Sec. 1223. IOM report on impact of language access services. Sec. 1224. Definitions. Subtitle C—Miscellaneous Improvements Sec. 1231. Extension of therapy caps exceptions process. Sec. 1232. Extended months of coverage of immunosuppressive drugs for kidney transplant patients and other renal dialysis provisions. Sec. 1233. Advance care planning consultation. Sec. 1234. Part B special enrollment period and waiver of limited enrollment penalty for TRICARE beneficiaries. Sec. 1235. Exception for use of more recent tax year in case of gains from sale of primary residence in computing part B income-related premium. Sec. 1236. Demonstration program on use of patient decisions aids. Title III—Promoting Primary Care, Mental Health Services, and Coordinated Care Sec. 1301. Accountable Care Organization pilot program. Sec. 1302. Medical home pilot program. Sec. 1303. Independence at home pilot program. Sec. 1304. Payment incentive for selected primary care services. Sec. 1305. Increased reimbursement rate for certified nurse-midwives. Sec. 1306. Coverage and waiver of cost-sharing for preventive services. Sec. 1307. Waiver of deductible for colorectal cancer screening tests regardless of coding, subsequent diagnosis, or ancillary tissue removal. Sec. 1308. Excluding clinical social worker services from coverage under the Medicare skilled nursing facility prospective payment system and consolidated payment. Sec. 1309. Coverage of marriage and family therapist services and mental health counselor services. Sec. 1310. Extension of physician fee schedule mental health add-on. Sec. 1311. Expanding access to vaccines. Sec. 1312. Recognition of certified diabetes educators as certified providers for purposes of Medicare diabetes outpatient self-management training servicesdegett6-7. Title IV—Quality Subtitle A—Comparative Effectiveness Research Sec. 1401. Comparative effectiveness research. Subtitle B—Nursing Home Transparency Part 1—Improving transparency of information on skilled nursing facilities and nursing facilities Sec. 1411. Required disclosure of ownership and additional disclosable parties information. Sec. 1412. Accountability requirements. Sec. 1413. Nursing home compare Medicare website. Sec. 1414. Reporting of expenditures. Sec. 1415. Standardized complaint form. Sec. 1416. Ensuring staffing accountability. Part 2—Targeting Enforcement Sec. 1421. Civil money penalties. Sec. 1422. National independent monitor pilot program. Sec. 1423. Notification of facility closure. Part 3—Improving staff training Sec. 1431. Dementia and abuse prevention training. Sec. 1432. Study and report on training required for certified nurse aides and supervisory staff. Sec. 1433. Qualification of director of food services of a Medicaid nursing facility. Subtitle C—Quality Measurements Sec. 1441. Establishment of national priorities for quality improvement. Sec. 1442. Development of new quality measures; GAO evaluation of data collection process for quality measurement. Sec. 1443. Multistakeholder prerulemaking input into selection of quality measures. Sec. 1444. Application of quality measures. Sec. 1445. Consensus-based entity funding. Sec. 1446. Quality indicators for care of people with Alzheimer’s disease. Sec. 1447. Study on five star quality rating system. Subtitle D—Physician Payments Sunshine Provision Sec. 1451. Reports on financial relationships between manufacturers and distributors of covered drugs, devices, biologicals, or medical supplies under Medicare, Medicaid, or CHIP and physicians and other health care entities and between physicians and other health care entities. Subtitle E—Public Reporting on Health Care-Associated Infections Sec. 1461. Requirement for public reporting by hospitals and ambulatory surgical centers on health care-associated infections. Title V—Medicare Graduate Medical Education Sec. 1501. Distribution of unused residency positions. Sec. 1502. Increasing training in nonprovider settings. Sec. 1503. Rules for counting resident time for didactic and scholarly activities and other activities. Sec. 1504. Preservation of resident cap positions from closed hospitals. Sec. 1505. Improving accountability for approved medical residency training. Title VI—Program Integrity Subtitle A—Increased funding To fight waste, fraud, and abuse Sec. 1601. Increased funding and flexibility to fight fraud and abuse. Subtitle B—Enhanced penalties for fraud and abuse Sec. 1611. Enhanced penalties for false statements on provider or supplier enrollment applications. Sec. 1612. Enhanced penalties for submission of false statements material to a false claim. Sec. 1613. Enhanced penalties for delaying inspections. Sec. 1614. Enhanced hospice program safeguards. Sec. 1615. Enhanced penalties for individuals excluded from program participation. Sec. 1616. Enhanced penalties for provision of false information by Medicare Advantage and part D plans. Sec. 1617. Enhanced penalties for Medicare Advantage and part D marketing violations. Sec. 1618. Enhanced penalties for obstruction of program audits. Sec. 1619. Exclusion of certain individuals and entities from participation in Medicare and State health care programs. Subtitle C—Enhanced Program and Provider Protections Sec. 1631. Enhanced CMS program protection authority. Sec. 1632. Enhanced Medicare, Medicaid, and CHIP program disclosure requirements relating to previous affiliations. Sec. 1633. Required inclusion of payment modifier for certain evaluation and management services. Sec. 1634. Evaluations and reports required under Medicare Integrity Program. Sec. 1635. Require providers and suppliers to adopt programs to reduce waste, fraud, and abuse. Sec. 1636. Maximum period for submission of Medicare claims reduced to not more than 12 months. Sec. 1637. Physicians who order durable medical equipment or home health services required to be Medicare-enrolled physicians or eligible professionals. Sec. 1638. Requirement for physicians to provide documentation on referrals to programs at high risk of waste and abuse. Sec. 1639. Face-to-face encounter with patient required before physicians may certify eligibility for home health services or durable medical equipment under Medicare. Sec. 1640. Extension of testimonial subpoena authority to program exclusion investigations. Sec. 1641. Required repayments of Medicare and Medicaid overpayments. Sec. 1642. Expanded application of hardship waivers for OIG exclusions to beneficiaries of any Federal health care program. Sec. 1643. Access to certain information on renal dialysis facilities. Sec. 1644. Billing agents, clearinghouses, or other alternate payees required to register under Medicare. Sec. 1645. Conforming civil monetary penalties to False Claims Act amendments. Subtitle D—Access to Information Needed To Prevent Fraud, Waste, and Abuse Sec. 1651. Access to information necessary to identify fraud, waste, and abuse. Sec. 1652. Elimination of duplication between the Healthcare Integrity and Protection Data Bank and the National Practitioner Data Bank. Sec. 1653. Compliance with HIPAA privacy and security standards. Title VII—Medicaid and CHIP Subtitle A—Medicaid and Health Reform Sec. 1701. Eligibility for individuals with income below 1331/3 percent of the Federal poverty level. Sec. 1702.  Requirements and special rules for certain Medicaid eligible individuals. Sec. 1703. CHIP and Medicaid maintenance of eligibility. Sec. 1704. Reduction in Medicaid DSH. Sec. 1705. Expanded outstationing. Subtitle B—Prevention Sec. 1711. Required coverage of preventive services. Sec. 1712. Tobacco cessation. Sec. 1713. Optional coverage of nurse home visitation services. Sec. 1714. State eligibility option for family planning services. Subtitle C—Access Sec. 1721. Payments to primary care practitioners. Sec. 1722. Medical home pilot program. Sec. 1723. Translation or interpretation services. Sec. 1724. Optional coverage for freestanding birth center services. Sec. 1725. Inclusion of public health clinics under the vaccines for children program. Sec. 1726. Requiring coverage of services of podiatrists. Sec. 1726A. Requiring coverage of services of optometrists. Sec. 1727. Therapeutic foster care. Sec. 1728. Assuring adequate payment levels for services. Sec. 1729. Preserving Medicaid coverage for youths upon release from public institutions. Sec. 1730. Quality measures for maternity and adult health services under Medicaid and CHIP. Sec. 1730A. Accountable care organization pilot program. Subtitle D—Coverage Sec. 1731. Optional Medicaid coverage of low-income HIV-infected individuals. Sec. 1732. Extending transitional Medicaid Assistance (TMA). Sec. 1733. Requirement of 12-month continuous coverage under certain CHIP programs. Sec. 1734. Preventing the application under CHIP of coverage waiting periods for certain children. Sec. 1735. Adult day health care services. Sec. 1736. Medicaid coverage for citizens of Freely Associated States. Sec. 1737. Continuing requirement of Medicaid coverage of nonemergency transportation to medically necessary services. Sec. 1738. State option to disregard certain income in providing continued Medicaid coverage for certain individuals with extremely high prescription costs. Subtitle E—Financing Sec. 1741. Payments to pharmacists. Sec. 1742. Prescription drug rebates. Sec. 1743. Extension of prescription drug discounts to enrollees of Medicaid managed care organizations. Sec. 1744. Payments for graduate medical education. Sec. 1745. Report on Medicaid payments. Sec. 1746. Reviews of Medicaid. Sec. 1747. Extension of delay in managed care organization provider tax elimination. Subtitle F—Waste, Fraud, and Abuse Sec. 1751. Health care acquired conditions. Sec. 1752. Evaluations and reports required under Medicaid Integrity Program. Sec. 1753. Require providers and suppliers to adopt programs to reduce waste, fraud, and abuse. Sec. 1754. Overpayments. Sec. 1755. Managed care organizations. Sec. 1756. Termination of provider participation under Medicaid and CHIP if terminated under Medicare or other State plan or child health plan. Sec. 1757.  Medicaid and CHIP exclusion from participation relating to certain ownership, control, and management affiliations. Sec. 1758.  Requirement to report expanded set of data elements under MMIS to detect fraud and abuse. Sec. 1759. Billing agents, clearinghouses, or other alternate payees required to register under Medicaid. Sec. 1760. Denial of payments for litigation-related misconduct. Sec. 1761. Mandatory State use of national correct coding initiative. Subtitle G—Payments to the Territories Sec. 1771. Payment to territories. Subtitle H—Miscellaneous Sec. 1781. Technical corrections. Sec. 1782. Extension of QI program. Sec. 1783. Outreach and enrollment of Medicaid and CHIP eligible individuals. Sec. 1784. Prohibitions on Federal Medicaid and CHIP payment for undocumented aliens. Sec. 1785. Demonstration project for stabilization of emergency medical conditions by nonpublicly owned or operated institutions for mental diseases. Title VIII—Revenue-related provisions Sec. 1801. Disclosures to facilitate identification of individuals likely to be ineligible for the low-income assistance under the Medicare prescription drug program to assist Social Security Administration’s outreach to eligible individuals. Sec. 1802. Comparative Effectiveness Research Trust Fund; financing for Trust Fund. Title IX—Miscellaneous Provisions Sec. 1901. Repeal of trigger provision. Sec. 1902. Repeal of comparative cost adjustment (CCA) program. Sec. 1903. Extension of gainsharing demonstration. Sec. 1904. Grants to States for quality home visitation programs for families with young children and families expecting children. Sec. 1905. Improved coordination and protection for dual eligibles. Sec. 1906. Standardized marketing requirements under the Medicare Advantage and Medicare prescription drug programs. Sec. 1907. NAIC recommendations on the establishment of standardized benefit packages for Medicare Advantage plans and prescription drug plans. Sec. 1908. Application of emergency services laws. Sec. 1909. Nationwide program for national and State background checks on direct patient access employees of long-term care facilities and providers. Sec. 1910. Establishment of Center for Medicare and Medicaid Payment Innovation within CMS.

C

Public Health and Workforce Development

2001.

Table of contents; references

(a)

Table of contents

The table of contents of this division is as follows: Sec. 2001. Table of contents; references. Sec. 2002. Public Health Investment Fund. Title I—Community Health Centers Sec. 2101. Increased funding. Title II—Workforce Subtitle A—Primary care workforce Part 1—National Health Service Corps Sec. 2201. National Health Service Corps. Sec. 2202. Authorizations of appropriations. Part 2—Promotion of primary care and dentistry Sec. 2211. Frontline health providers. Sec. 2212. Primary care student loan funds. Sec. 2213. Training in family medicine, general internal medicine, general pediatrics, geriatrics, and physician assistants. Sec. 2214. Training of medical residents in community-based settings. Sec. 2215. Training for general, pediatric, and public health dentists and dental hygienists. Sec. 2216. Authorization of appropriations. Sec. 2217. Study on effectiveness of scholarships and loan repayments. Subtitle B—Nursing workforce Sec. 2221. Amendments to Public Health Service Act. Subtitle C—Public Health Workforce Sec. 2231. Public Health Workforce Corps. Sec. 2232. Enhancing the public health workforce. Sec. 2233. Public health training centers. Sec. 2234. Preventive medicine and public health training grant program. Sec. 2235. Authorization of appropriations. Subtitle D—Adapting workforce to evolving health system needs Part 1—Health professions training for diversity Sec. 2241. Scholarships for disadvantaged students, loan repayments and fellowships regarding faculty positions, and educational assistance in the health professions regarding individuals from disadvantaged backgrounds. Sec. 2242. Nursing workforce diversity grants. Sec. 2243. Coordination of diversity and cultural competency programs. Part 2—Interdisciplinary training programs Sec. 2251. Cultural and linguistic competency training for health professionals. Sec. 2252. Innovations in interdisciplinary care training. Part 3—Advisory Committee on Health Workforce Evaluation and Assessment Sec. 2261. Health workforce evaluation and assessment. Part 4—Health workforce assessment Sec. 2271. Health workforce assessment. Part 5—Authorization of appropriations Sec. 2281. Authorization of appropriations. Title III—Prevention and Wellness Sec. 2301. Prevention and wellness. Title XXXI—Prevention and Wellness Subtitle A—Prevention and Wellness Trust Sec. 3111. Prevention and Wellness Trust. Subtitle B—National Prevention and Wellness Strategy Sec. 3121. National Prevention and Wellness Strategy. Subtitle C—Prevention Task Forces Sec. 3131. Task Force on Clinical Preventive Services. Sec. 3132. Task Force on Community Preventive Services. Subtitle D—Prevention and Wellness Research Sec. 3141. Prevention and wellness research activity coordination. Sec. 3142. Community prevention and wellness research grants. Subtitle E—Delivery of community prevention and wellness services Sec. 3151. Community prevention and wellness services grants. Subtitle F—Core Public Health Infrastructure Sec. 3161. Core public health infrastructure for State, local, and tribal health departments. Sec. 3162. Core public health infrastructure and activities for CDC. Subtitle G—General provisions Sec. 3171. Definitions. Title IV—Quality and Surveillance Sec. 2401. Implementation of best practices in the delivery of health care. Sec. 2402. Assistant Secretary for Health Information. Sec. 2403. Authorization of appropriations. Title V—Other provisions Subtitle A—Drug discount for rural and other hospitals Sec. 2501. Expanded participation in 340B program. Sec. 2502. Extension of discounts to inpatient drugs. Sec. 2503. Effective date. Subtitle B—Programs Part 1—Grants for clinics and centers Sec. 2511. School-based health clinics. Sec. 2512. Nurse-managed health centers. Sec. 2513. Federally qualified behavioral health centers. Part 2—Other grant programs Sec. 2521. Comprehensive programs to provide education to nurses and create a pipeline to nursing. Sec. 2522. Mental and behavioral health training. Sec. 2523. Programs to increase awareness of advance care planning issues. Sec. 2524. Reauthorization of telehealth and telemedicine grant programs. Sec. 2525. No child left unimmunized against influenza: demonstration program using elementary and secondary schools as influenza vaccination centers. Sec. 2526. Extension of Wisewoman Program. Sec. 2527. Healthy teen initiative to prevent teen pregnancy. Sec. 2528. National training initiative on autism supplemental grants and technical assistance. Sec. 2529. Implementation of medication management services in treatment of chronic diseases. Sec. 2530. Postpartum depression. Sec. 2531. Grants to promote positive health behaviors and outcomes. Part 3—Emergency care-related programs Sec. 2541. Trauma care centers. Sec. 2542. Emergency care coordination. Sec. 2543. Pilot programs to improve emergency medical care. Sec. 2544. Assisting veterans with military emergency medical training to become State-licensed or certified emergency medical technicians (EMTs). Sec. 2545. Dental emergency responders: public health and medical response. Sec. 2546. Dental emergency responders: homeland security. Part 4—Pain care and management programs Sec. 2551. Institute of Medicine Conference on Pain. Sec. 2552. Pain research at National Institutes of Health. Sec. 2553. Public awareness campaign on pain management. Subtitle C—Food and Drug Administration Part 1—In general Sec. 2561. National medical device registry. Sec. 2562. Nutrition labeling of standard menu items at chain restaurants and of articles of food sold from vending machines. Sec. 2563. Protecting consumer access to generic drugs. Part 2—Biosimilars Sec. 2565. Licensure pathway for biosimilar biological products. Sec. 2566. Fees relating to biosimilar biological products. Subtitle D—Community living assistance services and supports Sec. 2571. Establishment of national voluntary insurance program for purchasing community living assistance services and supports. Subtitle E—Miscellaneous Sec. 2581. States failing to adhere to certain employment obligations. Sec. 2582. Study, report, and termination of duplicative grant programs. Sec. 2583. Health centers under Public Health Service Act; liability protections for volunteer practitioners. Sec. 2584. Report to Congress on the current state of parasitic diseases that have been overlooked among the poorest Americans. Sec. 2585. Study of impact of optometrists on access to health care and on availability of support under Federal health programs for optometry. (b)

References

Except as otherwise specified, whenever in this division an amendment is expressed in terms of an amendment to a section or other provision, the reference shall be considered to be made to a section or other provision of the Public Health Service Act (42 U.S.C. 201 et seq.).

2002.

Public Health Investment Fund

(a)

Establishment of funds

(1)

In general

There is established a fund to be known as the Public Health Investment Fund (referred to in this section as the Fund). (2)

Funding

(A)There shall be deposited into the Fund— (i)for fiscal year 2010, $4,600,000,000; (ii)for fiscal year 2011, $5,600,000,000; (iii)for fiscal year 2012, $6,900,000,000; (iv)for fiscal year 2013, $7,800,000,000; and (v)for fiscal year 2014, $9,000,000,000. (B)Amounts deposited into the Fund shall be derived from general revenues of the Treasury. (b)

Authorization of appropriations from the Fund

(1)

New funding

(A)

In general

Amounts in the Fund are authorized to be appropriated by the Committees on Appropriations of the House of Representatives and the Senate for carrying out activities under designated public health provisions. (B)

Designated provisions

For purposes of this paragraph, the term designated public health provisions means the provisions for which amounts are authorized to be appropriated under section 330(s), 338(c), 338H–1, 799C, 872, or 3111 of the Public Health Service Act, as added by this division. (2)

Baseline funding

(A)

In general

Amounts in the Fund are authorized to be appropriated (as described in paragraph (1)) for a fiscal year only if (excluding any amounts in or appropriated from the Fund)— (i)the amounts specified in subparagraph (B) for the fiscal year involved are equal to or greater than the amounts specified in subparagraph (B) for fiscal year 2008; and (ii)the amounts appropriated, out of the general fund of the Treasury, to the Prevention and Wellness Trust under section 3111 of the Public Health Service Act, as added by this division, for the fiscal year involved are equal to or greater than the funds— (I)appropriated under the heading Prevention and Wellness Fund in title VIII of division A of the American Recovery and Reinvestment Act of 2009 (Public Law 111–5); and (II)allocated by the second proviso under such heading for evidence-based clinical and community-based prevention and wellness strategies. (B)

Amounts specified

The amounts specified in this subparagraph, with respect to a fiscal year, are the amounts appropriated for the following: (i)Community health centers (including funds appropriated under the authority of section 330 of the Public Health Service Act (42 U.S.C. 254b)). (ii)The National Health Service Corps Program (including funds appropriated under the authority of section 338 of such Act (42 U.S.C. 254k)). (iii)The National Health Service Corps Scholarship and Loan Repayment Programs (including funds appropriated under the authority of section 338H of such Act (42 U.S.C. 254q)). (iv)Primary care education programs (including funds appropriated under the authority of sections 736, 740, 741, and 747 of such Act (42 U.S.C. 293, 293d, and 293k)). (v)Sections 761 and 770 of such Act (42 U.S.C. 294n and 295e). (vi)Nursing workforce development (including funds appropriated under the authority of title VIII of such Act (42 U.S.C. 296 et seq.)). (vii)The National Center for Health Statistics (including funds appropriated under the authority of sections 304, 306, 307, and 308 of such Act (42 U.S.C. 242b, 242k, 242l, and 242m)). (viii)The Agency for Healthcare Research and Quality (including funds appropriated under the authority of title IX of such Act (42 U.S.C. 299 et seq.)). (3)

Budgetary implications

Amounts appropriated under this section, and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget resolutions for fiscal years during which appropriations are made from the Fund.

. (b)

Transition provisions applicable to Task Forces

(1)

Functions, personnel, assets, liabilities, and administrative actions

All functions, personnel, assets, and liabilities of, and administrative actions applicable to, the Preventive Services Task Force convened under section 915(a) of the Public Health Service Act and the Task Force on Community Preventive Services (as such section and Task Forces were in existence on the day before the date of the enactment of this Act) shall be transferred to the Task Force on Clinical Preventive Services and the Task Force on Community Preventive Services, respectively, established under sections 3121 and 3122 of the Public Health Service Act, as added by subsection (a). (2)

Recommendations

All recommendations of the Preventive Services Task Force and the Task Force on Community Preventive Services, as in existence on the day before the date of the enactment of this Act, shall be considered to be recommendations of the Task Force on Clinical Preventive Services and the Task Force on Community Preventive Services, respectively, established under sections 3121 and 3122 of the Public Health Service Act, as added by subsection (a). (3)

Members already serving

(A)

Initial members

The Secretary of Health and Human Services may select those individuals already serving on the Preventive Services Task Force and the Task Force on Community Preventive Services, as in existence on the day before the date of the enactment of this Act, to be among the first members appointed to the Task Force on Clinical Preventive Services and the Task Force on Community Preventive Services, respectively, under sections 3121 and 3122 of the Public Health Service Act, as added by subsection (a). (B)

Calculation of total service

In calculating the total years of service of a member of a task force for purposes of section 3131(d)(2)(A) or 3132(d)(2)(A) of the Public Health Service Act, as added by subsection (a), the Secretary of Health and Human Services shall not include any period of service by the member on the Preventive Services Task Force or the Task Force on Community Preventive Services, respectively, as in existence on the day before the date of the enactment of this Act. (c)

Period before completion of national strategy

Pending completion of the national strategy under section 3121 of the Public Health Service Act, as added by subsection (a), the Secretary of Health and Human Services, acting through the relevant agency head, may make a judgment about how the strategy will address an issue and rely on such judgment in carrying out any provision of subtitle C, D, E, or F of title XXXI of such Act, as added by subsection (a), that requires the Secretary— (1)to take into consideration such strategy; (2)to conduct or support research or provide services in priority areas identified in such strategy; or (3)to take any other action in reliance on such strategy. (d)

Conforming amendments

(1)Paragraph (61) of section 3(b) of the Indian Health Care Improvement Act (25 U.S.C. 1602) is amended by striking United States Preventive Services Task Force and inserting Task Force on Clinical Preventive Services. (2)Section 126 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (Appendix F of Public Law 106–554) is amended by striking United States Preventive Services Task Force each place it appears and inserting Task Force on Clinical Preventive Services. (3)Paragraph (7) of section 317D(a) of the Public Health Service Act (42 U.S.C. 247b–5(a)) is amended by striking United States Preventive Services Task Force and inserting Task Force on Clinical Preventive Services. (4)Section 915 of the Public Health Service Act (42 U.S.C. 299b–4) is amended by striking subsection (a). (5)Subsections (s)(2)(AA)(iii)(II), (xx)(1), and (ddd)(1)(B) of section 1861 of the Social Security Act (42 U.S.C. 1395x) are amended by striking United States Preventive Services Task Force each place it appears and inserting Task Force on Clinical Preventive Services. . (b)

Effective date

Title XXXII of the Public Health Service Act, as added by subsection (a), shall take effect on the effective date of a statute establishing a voluntary payroll deduction under the Internal Revenue Code of 1986 to support the program authorized by such title. E

Miscellaneous

2581.

States failing to adhere to certain employment obligations

A State is eligible for Federal funds under the provisions of the Public Health Service Act (42 U.S.C. 201 et seq.) only if the State— (1)agrees to be subject in its capacity as an employer to each obligation under division A of this Act and the amendments made by such division applicable to persons in their capacity as an employer; and (2)assures that all political subdivisions in the State will do the same.

2582.

Study, report, and termination of duplicative grant programs

(a)

Study

The Secretary of Health and Human Services (in this section referred to as the Secretary) shall conduct a study to determine if any grant program established by this division, or any amendment made by this division, is duplicative of one or more other Federal grant programs under the authority of the Secretary in existence as of the date of the enactment of this Act. (b)

Report

Not later than 1 year after the date of the enactment of this Act, the Secretary shall submit to Congress and make available to the public a report that contains the results of the study required under subsection (a). (c)

Termination of duplicative grant programs

If the Secretary determines under subsection (a) that any grant program established by this division, or any amendment made by this division, is duplicative of one or more other Federal grant programs under the authority of the Secretary, the Secretary shall, to maximum extent appropriate, terminate such other Federal grant programs not later than 180 days after the date of the submission of the report under subsection (b).

2583.

Health centers under Public Health Service Act; liability protections for volunteer practitioners

(a)

In general

Section 224 (42 U.S.C. 233) is amended— (1)in subsection (g)(1)(A)— (A)in the first sentence, by striking or employee and inserting employee, or (subject to subsection (k)(4)) volunteer practitioner; and (B)in the second sentence, by inserting and subsection (k)(4) after subject to paragraph (5); and (2)in each of subsections (g), (i), (j), (l), and (m), by striking the term employee, or contractor each place such term appears and inserting employee, volunteer practitioner, or contractor; (3)in subsection (g)(1)(H), by striking the term employee, and contractor each place such term appears and inserting employee, volunteer practitioner, and contractor; (4)in subsection (l), by striking the term employee, or any contractor and inserting employee, volunteer practitioner, or contractor; and (5)in subsections (h)(3) and (k), by striking the term employees, or contractors each place such term appears and inserting employees, volunteer practitioners, or contractors. (b)

Applicability; definition

Section 224(k) (42 U.S.C. 233(k)) is amended by adding at the end the following paragraph: (4) (A)Subsections (g) through (m) apply with respect to volunteer practitioners beginning with the first fiscal year for which an appropriations Act provides that amounts in the fund under paragraph (2) are available with respect to such practitioners. (B)For purposes of subsections (g) through (m), the term volunteer practitioner means a practitioner who, with respect to an entity described in subsection (g)(4), meets the following conditions: (i)The practitioner is a licensed physician, a licensed clinical psychologist, or other licensed or certified health care practitioner. (ii)At the request of such entity, the practitioner provides services to patients of the entity, at a site at which the entity operates or at a site designated by the entity. The weekly number of hours of services provided to the patients by the practitioner is not a factor with respect to meeting conditions under this subparagraph. (iii)The practitioner does not for the provision of such services receive any compensation from such patients, from the entity, or from third-party payors (including reimbursement under any insurance policy or health plan, or under any Federal or State health benefits program). .

2584.

Report to Congress on the current state of parasitic diseases that have been overlooked among the poorest Americans

Not later than 12 months after the date of the enactment of this Act, the Secretary of Health and Human Services shall report to Congress on the epidemiology of, impact of, and appropriate funding required to address neglected diseases of poverty, including neglected parasitic diseases identified as Chagas Disease, cysticercosis, toxocariasis, toxoplasmosis, trichomoniasis, the soil-transmitted helminths, and others. The report should provide the information necessary to enhance health policy to accurately evaluate and address the threat of these diseases.

2585.

Study of impact of optometrists on access to health care and on availability of support under Federal health programs for optometry

(a)

In general

The Secretary of Health and Human Services (in this section referred to as the Secretary) shall conduct a study with respect to optometrists and optometry to determine— (1)whether there is a current and projected role for, and the impact of, optometrists in increasing access to primary eye and vision care to underserved, rural, and senior populations; (2)the role and impact of optometrists in the early diagnosis and treatment of glaucoma, cataract, diabetes, and other conditions; (3)whether there is a need for optometrists to be recognized and supported as primary care providers; (4)whether there is an existence of, and the extent of, any barriers to recruitment and participation of underrepresented minorities in optometry, including the potential role played by the lack of eligibility of optometrists, optometry students, and facilities for certain Federal health programs; and (5)the scope of Federal support for clinical optometric education and options for enhancing that support— (A)to address barriers to underrepresented minority recruitment and participation in optometry; and (B)to improve access to primary eye and vision care, especially in underserved and rural areas. (b)

Comment on matters studied

In carrying out the study under subsection (a), the Secretary shall seek the comments of appropriate public and private entities. (c)

Report to Congress

Not later than 18 months after the date of the enactment of this Act, the Secretary shall submit to the Congress a report containing— (1)the results of the study under subsection (a); (2)a summary of comments received from public and private entities under subsection (b); and (3)recommendations for such legislation and administrative action as the Secretary determines to be appropriate regarding the issues studied under subsection (a).

1.

Short title; table of divisions, titles, and subtitles

(a)

Short title

This Act may be cited as the America’s Affordable Health Choices Act of 2009. (b)

Table of divisions, titles, and subtitles

This Act is divided into divisions, titles, and subtitles as follows: Division A—Affordable Health Care Choices Title I—Protections and Standards for Qualified Health Benefits Plans Subtitle A—General Standards Subtitle B—Standards Guaranteeing Access to Affordable Coverage Subtitle C—Standards Guaranteeing Access to Essential Benefits Subtitle D—Additional Consumer Protections Subtitle E—Governance Subtitle F—Relation to other requirements; Miscellaneous Subtitle G—Early Investments Title II—Health Insurance Exchange and Related Provisions Subtitle A—Health Insurance Exchange Subtitle B—Public health insurance option Subtitle C—Individual Affordability Credits Title III—Shared responsibility Subtitle A—Individual responsibility Subtitle B—Employer Responsibility Title IV—Amendments to Internal Revenue Code of 1986 Subtitle A—Shared responsibility Subtitle B—Credit for small business employee health coverage expenses Subtitle C—Disclosures to carry out health insurance exchange subsidies Subtitle D—Other revenue provisions Division B—Medicare and Medicaid Improvements Title I—Improving Health Care Value Subtitle A—Provisions related to Medicare part A Subtitle B—Provisions Related to Part B Subtitle C—Provisions Related to Medicare Parts A and B Subtitle D—Medicare Advantage Reforms Subtitle E—Improvements to Medicare Part D Subtitle F—Medicare Rural Access Protections Title II—Medicare Beneficiary Improvements Subtitle A—Improving and Simplifying Financial Assistance for Low Income Medicare Beneficiaries Subtitle B—Reducing Health Disparities Subtitle C—Miscellaneous Improvements Title III—Promoting Primary Care, Mental Health Services, and Coordinated Care Title IV—Quality Subtitle A—Comparative Effectiveness Research Subtitle B—Nursing Home Transparency Subtitle C—Quality Measurements Subtitle D—Physician Payments Sunshine Provision Subtitle E—Public Reporting on Health Care-Associated Infections Title V—Medicare Graduate Medical Education Title VI—Program Integrity Subtitle A—Increased funding to fight waste, fraud, and abuse Subtitle B—Enhanced penalties for fraud and abuse Subtitle C—Enhanced Program and Provider Protections Subtitle D—Access to Information Needed to Prevent Fraud, Waste, and Abuse Title VII—Medicaid and CHIP Subtitle A—Medicaid and Health Reform Subtitle B—Prevention Subtitle C—Access Subtitle D—Coverage Subtitle E—Financing Subtitle F—Waste, Fraud, and Abuse Subtitle G—Puerto Rico and the Territories Subtitle H—Miscellaneous Title VIII—Revenue-related provisions Title IX—Miscellaneous Provisions Division C—Public Health and Workforce Development Title I—Community Health Centers Title II—Workforce Subtitle A—Primary care workforce Subtitle B—Nursing workforce Subtitle C—Public Health Workforce Subtitle D—Adapting workforce to evolving health system needs Title III—Prevention and Wellness Title IV—Quality and Surveillance Title V—Other provisions Subtitle A—Drug discount for rural and other hospitals Subtitle B—School-Based health clinics Subtitle C—National medical device registry Subtitle D—Grants for comprehensive programs To provide education to nurses and create a pipeline to nursing Subtitle E—States failing To adhere to certain employment obligations

A

Affordable Health Care Choices

100.

Purpose; table of contents of division; general definitions

(a)

Purpose

(1)

In general

The purpose of this division is to provide affordable, quality health care for all Americans and reduce the growth in health care spending. (2)

Building on current system

This division achieves this purpose by building on what works in today’s health care system, while repairing the aspects that are broken. (3)

Insurance reforms

This division— (A)enacts strong insurance market reforms; (B)creates a new Health Insurance Exchange, with a public health insurance option alongside private plans; (C)includes sliding scale affordability credits; and (D)initiates shared responsibility among workers, employers, and the government; so that all Americans have coverage of essential health benefits. (4)

Health delivery reform

This division institutes health delivery system reforms both to increase quality and to reduce growth in health spending so that health care becomes more affordable for businesses, families, and government. (b)

Table of contents of division

The table of contents of this division is as follows: Sec. 100. Purpose; table of contents of division; general definitions. Title I—Protections and Standards for Qualified Health Benefits Plans Subtitle A—General Standards Sec. 101. Requirements reforming health insurance marketplace. Sec. 102. Protecting the choice to keep current coverage. Subtitle B—Standards Guaranteeing Access to Affordable Coverage Sec. 111. Prohibiting pre-existing condition exclusions. Sec. 112. Guaranteed issue and renewal for insured plans. Sec. 113. Insurance rating rules. Sec. 114. Nondiscrimination in benefits; parity in mental health and substance abuse disorder benefits. Sec. 115. Ensuring adequacy of provider networks. Sec. 116. Ensuring value and lower premiums. Subtitle C—Standards Guaranteeing Access to Essential Benefits Sec. 121. Coverage of essential benefits package. Sec. 122. Essential benefits package defined. Sec. 123. Health Benefits Advisory Committee. Sec. 124. Process for adoption of recommendations; adoption of benefit standards. Subtitle D—Additional Consumer Protections Sec. 131. Requiring fair marketing practices by health insurers. Sec. 132. Requiring fair grievance and appeals mechanisms. Sec. 133. Requiring information transparency and plan disclosure. Sec. 134. Application to qualified health benefits plans not offered through the Health Insurance Exchange. Sec. 135. Timely payment of claims. Sec. 136. Standardized rules for coordination and subrogation of benefits. Sec. 137. Application of administrative simplification. Subtitle E—Governance Sec. 141. Health Choices Administration; Health Choices Commissioner. Sec. 142. Duties and authority of Commissioner. Sec. 143. Consultation and coordination. Sec. 144.  Health Insurance Ombudsman. Subtitle F—Relation to other requirements; Miscellaneous Sec. 151. Relation to other requirements. Sec. 152. Prohibiting discrimination in health care. Sec. 153. Whistleblower protection. Sec. 154. Construction regarding collective bargaining. Sec. 155. Severability. Subtitle G—Early Investments Sec. 161. Ensuring value and lower premiums. Sec. 162. Ending health insurance rescission abuse. Sec. 163. Administrative simplification. Sec. 164. Reinsurance program for retirees. Title II—Health Insurance Exchange and Related Provisions Subtitle A—Health Insurance Exchange Sec. 201. Establishment of Health Insurance Exchange; outline of duties; definitions. Sec. 202. Exchange-eligible individuals and employers. Sec. 203. Benefits package levels. Sec. 204. Contracts for the offering of Exchange-participating health benefits plans. Sec. 205. Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plan. Sec. 206. Other functions. Sec. 207. Health Insurance Exchange Trust Fund. Sec. 208. Optional operation of State-based health insurance exchanges. Subtitle B—Public health insurance option Sec. 221. Establishment and administration of a public health insurance option as an Exchange-qualified health benefits plan. Sec. 222. Premiums and financing. Sec. 223. Payment rates for items and services. Sec. 224. Modernized payment initiatives and delivery system reform. Sec. 225. Provider participation. Sec. 226. Application of fraud and abuse provisions. Subtitle C—Individual Affordability Credits Sec. 241. Availability through Health Insurance Exchange. Sec. 242. Affordable credit eligible individual. Sec. 243. Affordable premium credit. Sec. 244. Affordability cost-sharing credit. Sec. 245. Income determinations. Sec. 246. No Federal payment for undocumented aliens. Title III—Shared responsibility Subtitle A—Individual responsibility Sec. 301. Individual responsibility. Subtitle B—Employer Responsibility Part 1—Health coverage participation requirements Sec. 311. Health coverage participation requirements. Sec. 312. Employer responsibility to contribute towards employee and dependent coverage. Sec. 313. Employer contributions in lieu of coverage. Sec. 314. Authority related to improper steering. Part 2—Satisfaction of Health Coverage Participation Requirements Sec. 321. Satisfaction of health coverage participation requirements under the Employee Retirement Income Security Act of 1974. Sec. 322. Satisfaction of health coverage participation requirements under the Internal Revenue Code of 1986. Sec. 323. Satisfaction of health coverage participation requirements under the Public Health Service Act. Sec. 324. Additional rules relating to health coverage participation requirements. Title IV—Amendments to Internal Revenue Code of 1986 Subtitle A—Shared responsibility Part 1—Individual responsibility Sec. 401. Tax on individuals without acceptable health care coverage. Part 2—Employer Responsibility Sec. 411. Election to satisfy health coverage participation requirements. Sec. 412. Responsibilities of nonelecting employers. Subtitle B—Credit for small business employee health coverage expenses Sec. 421. Credit for small business employee health coverage expenses. Subtitle C—Disclosures to carry out health insurance exchange subsidies Sec. 431. Disclosures to carry out health insurance exchange subsidies. Subtitle D—Other revenue provisions Part 1—General provisions Sec. 441. Surcharge on high income individuals. Sec. 442. Distributions for medicine qualified only if for prescribed drug or insulin. Sec. 443. Delay in application of worldwide allocation of interest. Part 2—Prevention of tax avoidance Sec. 451. Limitation on treaty benefits for certain deductible payments. Sec. 452. Codification of economic substance doctrine. Sec. 453. Penalties for underpayments. Part 3—Parity in health benefits Sec. 461. Certain health related benefits applicable to spouses and dependents extended to eligible beneficiaries. (c)

General definitions

Except as otherwise provided, in this division: (1)

Acceptable coverage

The term acceptable coverage has the meaning given such term in section 202(d)(2). (2)

Basic plan

The term basic plan has the meaning given such term in section 203(c). (3)

Commissioner

The term Commissioner means the Health Choices Commissioner established under section 141. (4)

Cost-sharing

The term cost-sharing includes deductibles, coinsurance, copayments, and similar charges but does not include premiums or any network payment differential for covered services or spending for non-covered services. (5)

Dependent

The term dependent has the meaning given such term by the Commissioner and includes a spouse. (6)

Employment-based health plan

The term employment-based health plan— (A)means a group health plan (as defined in section 733(a)(1) of the Employee Retirement Income Security Act of 1974); and (B)includes such a plan that is the following: (i)

Federal, state, and tribal governmental plans

A governmental plan (as defined in section 3(32) of the Employee Retirement Income Security Act of 1974), including a health benefits plan offered under chapter 89 of title 5, United States Code. (ii)

Church plans

A church plan (as defined in section 3(33) of the Employee Retirement Income Security Act of 1974). (7)

Enhanced plan

The term enhanced plan has the meaning given such term in section 203(c). (8)

Essential benefits package

The term essential benefits package is defined in section 122(a). (9)

Family

The term family means an individual and includes the individual’s dependents. (10)

Federal poverty level; FPL

The terms Federal poverty level and FPL have the meaning given the term poverty line in section 673(2) of the Community Services Block Grant Act (42 U.S.C. 9902(2)), including any revision required by such section. (11)

Health benefits plan

The terms health benefits plan means health insurance coverage and an employment-based health plan and includes the public health insurance option. (12)

Health insurance coverage; health insurance issuer

The terms health insurance coverage and health insurance issuer have the meanings given such terms in section 2791 of the Public Health Service Act. (13)

Health Insurance Exchange

The term Health Insurance Exchange means the Health Insurance Exchange established under section 201. (14)

Medicaid

The term Medicaid means a State plan under title XIX of the Social Security Act (whether or not the plan is operating under a waiver under section 1115 of such Act). (15)

Medicare

The term Medicare means the health insurance programs under title XVIII of the Social Security Act. (16)

Plan sponsor

The term plan sponsor has the meaning given such term in section 3(16)(B) of the Employee Retirement Income Security Act of 1974. (17)

Plan year

The term plan year means— (A)with respect to an employment-based health plan, a plan year as specified under such plan; or (B)with respect to a health benefits plan other than an employment-based health plan, a 12-month period as specified by the Commissioner. (18)

Premium plan; premium-plus plan

The terms premium plan and premium-plus plan have the meanings given such terms in section 203(c). (19)

QHBP offering entity

The terms QHBP offering entity means, with respect to a health benefits plan that is— (A)a group health plan (as defined, subject to subsection (d), in section 733(a)(1) of the Employee Retirement Income Security Act of 1974), the plan sponsor in relation to such group health plan, except that, in the case of a plan maintained jointly by 1 or more employers and 1 or more employee organizations and with respect to which an employer is the primary source of financing, such term means such employer; (B)health insurance coverage, the health insurance issuer offering the coverage; (C)the public health insurance option, the Secretary of Health and Human Services; (D)a non-Federal governmental plan (as defined in section 2791(d) of the Public Health Service Act), the State or political subdivision of a State (or agency or instrumentality of such State or subdivision) which establishes or maintains such plan; or (E)a Federal governmental plan (as defined in section 2791(d) of the Public Health Service Act), the appropriate Federal official. (20)

Qualified health benefits plan

The term qualified health benefits plan means a health benefits plan that meets the requirements for such a plan under title I and includes the public health insurance option. (21)

Public health insurance option

The term public health insurance option means the public health insurance option as provided under subtitle B of title II. (22)

Service area; premium rating area

The terms service area and premium rating area mean with respect to health insurance coverage— (A)offered other than through the Health Insurance Exchange, such an area as established by the QHBP offering entity of such coverage in accordance with applicable State law; and (B)offered through the Health Insurance Exchange, such an area as established by such entity in accordance with applicable State law and applicable rules of the Commissioner for Exchange-participating health benefits plans. (23)

State

The term State means the 50 States and the District of Columbia. (24)

State Medicaid agency

The term State Medicaid agency means, with respect to a Medicaid plan, the single State agency responsible for administering such plan under title XIX of the Social Security Act. (25)

Y1, Y2, etc.

The terms Y1 , Y2, Y3, Y4, Y5, and similar subsequently numbered terms, mean 2013 and subsequent years, respectively.

B

Medicare and Medicaid Improvements

1001.

Table of contents of division

The table of contents for this division is as follows: Division B—Medicare and Medicaid Improvements Sec. 1001. Table of contents of division. Title I—Improving Health Care Value Subtitle A—Provisions related to Medicare part A Part 1—Market basket updates Sec. 1101. Skilled nursing facility payment update. Sec. 1102. Inpatient rehabilitation facility payment update. Sec. 1103. Incorporating productivity improvements into market basket updates that do not already incorporate such improvements. Part 2—Other Medicare part A provisions Sec. 1111. Payments to skilled nursing facilities. Sec. 1112. Medicare DSH report and payment adjustments in response to coverage expansion. Sec. 1113. Extension of hospice regulation moratorium. Subtitle B—Provisions Related to Part B Part 1—Physicians’ Services Sec. 1121. Sustainable growth rate reform. Sec. 1122. Misvalued codes under the physician fee schedule. Sec. 1123. Payments for efficient areas. Sec. 1124. Modifications to the Physician Quality Reporting Initiative (PQRI). Sec. 1125. Adjustment to Medicare payment localities. Part 2—Market basket updates Sec. 1131. Incorporating productivity improvements into market basket updates that do not already incorporate such improvements. Part 3—Other Provisions Sec. 1141. Rental and purchase of power-driven wheelchairs. Sec. 1142. Extension of payment rule for brachytherapy. Sec. 1143. Home infusion therapy report to congress. Sec. 1144. Require ambulatory surgical centers (ASCs) to submit cost data and other data. Sec. 1145. Treatment of certain cancer hospitals. Sec. 1146. Medicare Improvement Fund. Sec. 1147. Payment for imaging services. Sec. 1148. Durable medical equipment program improvements. Sec. 1149. MedPAC study and report on bone mass measurement. Subtitle C—Provisions Related to Medicare Parts A and B Sec. 1151. Reducing potentially preventable hospital readmissions. Sec. 1152. Post acute care services payment reform plan and bundling pilot program. Sec. 1153. Home health payment update for 2010. Sec. 1154. Payment adjustments for home health care. Sec. 1155. Incorporating productivity improvements into market basket update for home health services. Sec. 1156. Limitation on Medicare exceptions to the prohibition on certain physician referrals made to hospitals. Sec. 1157. Institute of Medicine study of geographic adjustment factors under Medicare. Sec. 1158. Revision of medicare payment systems to address geographic inequities. Sec. 1159. Institute of Medicine study of geographic variation in health care spending and promoting high-value health care. Subtitle D—Medicare Advantage Reforms Part 1—Payment and Administration Sec. 1161. Phase-in of payment based on fee-for-service costs. Sec. 1162. Quality bonus payments. Sec. 1163. Extension of Secretarial coding intensity adjustment authority. Sec. 1164. Simplification of annual beneficiary election periods. Sec. 1165. Extension of reasonable cost contracts. Sec. 1166. Limitation of waiver authority for employer group plans. Sec. 1167. Improving risk adjustment for payments. Sec. 1168. Elimination of MA Regional Plan Stabilization Fund. Part 2—Beneficiary Protections and Anti-Fraud Sec. 1171. Limitation on cost-sharing for individual health services. Sec. 1172. Continuous open enrollment for enrollees in plans with enrollment suspension. Sec. 1173. Information for beneficiaries on MA plan administrative costs. Sec. 1174. Strengthening audit authority. Sec. 1175. Authority to deny plan bids. Part 3—Treatment of special needs plans Sec. 1176. Limitation on enrollment outside open enrollment period of individuals into chronic care specialized MA plans for special needs individuals. Sec. 1177. Extension of authority of special needs plans to restrict enrollment. Subtitle E—Improvements to Medicare Part D Sec. 1181. Elimination of coverage gap. Sec. 1182. Discounts for certain part D drugs in original coverage gap. Sec. 1183. Repeal of provision relating to submission of claims by pharmacies located in or contracting with long-term care facilities. Sec. 1184. Including costs incurred by AIDS drug assistance programs and Indian Health Service in providing prescription drugs toward the annual out-of-pocket threshold under part D. Sec. 1185. Permitting mid-year changes in enrollment for formulary changes that adversely impact an enrollee. Subtitle F—Medicare Rural Access Protections Sec. 1191. Telehealth expansion and enhancements. Sec. 1192. Extension of outpatient hold harmless provision. Sec. 1193. Extension of section 508 hospital reclassifications. Sec. 1194. Extension of geographic floor for work. Sec. 1195. Extension of payment for technical component of certain physician pathology services. Sec. 1196. Extension of ambulance add-ons. Title II—Medicare Beneficiary Improvements Subtitle A—Improving and Simplifying Financial Assistance for Low Income Medicare Beneficiaries Sec. 1201. Improving assets tests for Medicare Savings Program and low-income subsidy program. Sec. 1202. Elimination of part D cost-sharing for certain non-institutionalized full-benefit dual eligible individuals. Sec. 1203. Eliminating barriers to enrollment. Sec. 1204. Enhanced oversight relating to reimbursements for retroactive low income subsidy enrollment. Sec. 1205. Intelligent assignment in enrollment. Sec. 1206. Special enrollment period and automatic enrollment process for certain subsidy eligible individuals. Sec. 1207. Application of MA premiums prior to rebate in calculation of low income subsidy benchmark. Subtitle B—Reducing Health Disparities Sec. 1221. Ensuring effective communication in Medicare. Sec. 1222. Demonstration to promote access for Medicare beneficiaries with limited English proficiency by providing reimbursement for culturally and linguistically appropriate services. Sec. 1223. IOM report on impact of language access services. Sec. 1224. Definitions. Subtitle C—Miscellaneous Improvements Sec. 1231. Extension of therapy caps exceptions process. Sec. 1232. Extended months of coverage of immunosuppressive drugs for kidney transplant patients and other renal dialysis provisions. Sec. 1233. Advance care planning consultation. Sec. 1234. Part B special enrollment period and waiver of limited enrollment penalty for TRICARE beneficiaries. Sec. 1235. Exception for use of more recent tax year in case of gains from sale of primary residence in computing part B income-related premium. Sec. 1236. Demonstration program on use of patient decisions aids. Title III—Promoting Primary Care, Mental Health Services, and Coordinated Care Sec. 1301. Accountable Care Organization pilot program. Sec. 1302. Medical home pilot program. Sec. 1303. Payment incentive for selected primary care services. Sec. 1304. Increased reimbursement rate for certified nurse-midwives. Sec. 1305. Coverage and waiver of cost-sharing for preventive services. Sec. 1306. Waiver of deductible for colorectal cancer screening tests regardless of coding, subsequent diagnosis, or ancillary tissue removal. Sec. 1307. Excluding clinical social worker services from coverage under the medicare skilled nursing facility prospective payment system and consolidated payment. Sec. 1308. Coverage of marriage and family therapist services and mental health counselor services. Sec. 1309. Extension of physician fee schedule mental health add-on. Sec. 1310. Expanding access to vaccines. Sec. 1311. Expansion of Medicare-Covered Preventive Services at Federally Qualified Health Centers. Title IV—Quality Subtitle A—Comparative Effectiveness Research Sec. 1401. Comparative effectiveness research. Subtitle B—Nursing Home Transparency Part 1—Improving transparency of information on skilled nursing facilities and nursing facilities Sec. 1411. Required disclosure of ownership and additional disclosable parties information. Sec. 1412. Accountability requirements. Sec. 1413. Nursing home compare Medicare website. Sec. 1414. Reporting of expenditures. Sec. 1415. Standardized complaint form. Sec. 1416. Ensuring staffing accountability. Part 2—Targeting Enforcement Sec. 1421. Civil money penalties. Sec. 1422. National independent monitor pilot program. Sec. 1423. Notification of facility closure. Part 3—Improving staff training Sec. 1431. Dementia and abuse prevention training. Sec. 1432. Study and report on training required for certified nurse aides and supervisory staff. Subtitle C—Quality Measurements Sec. 1441. Establishment of national priorities for quality improvement. Sec. 1442. Development of new quality measures; GAO evaluation of data collection process for quality measurement. Sec. 1443. Multi-stakeholder pre-rulemaking input into selection of quality measures. Sec. 1444. Application of quality measures. Sec. 1445. Consensus-based entity funding. Subtitle D—Physician Payments Sunshine Provision Sec. 1451. Reports on financial relationships between manufacturers and distributors of covered drugs, devices, biologicals, or medical supplies under Medicare, Medicaid, or CHIP and physicians and other health care entities and between physicians and other health care entities. Subtitle E—Public Reporting on Health Care-Associated Infections Sec. 1461. Requirement for public reporting by hospitals and ambulatory surgical centers on health care-associated infections. Title V—Medicare Graduate Medical Education Sec. 1501. Distribution of unused residency positions. Sec. 1502. Increasing training in nonprovider settings. Sec. 1503. Rules for counting resident time for didactic and scholarly activities and other activities. Sec. 1504. Preservation of resident cap positions from closed hospitals. Sec. 1505. Improving accountability for approved medical residency training. Title VI—Program Integrity Subtitle A—Increased funding to fight waste, fraud, and abuse Sec. 1601. Increased funding and flexibility to fight fraud and abuse. Subtitle B—Enhanced penalties for fraud and abuse Sec. 1611. Enhanced penalties for false statements on provider or supplier enrollment applications. Sec. 1612. Enhanced penalties for submission of false statements material to a false claim. Sec. 1613. Enhanced penalties for delaying inspections. Sec. 1614. Enhanced hospice program safeguards. Sec. 1615. Enhanced penalties for individuals excluded from program participation. Sec. 1616. Enhanced penalties for provision of false information by Medicare Advantage and part D plans. Sec. 1617. Enhanced penalties for Medicare Advantage and part D marketing violations. Sec. 1618. Enhanced penalties for obstruction of program audits. Sec. 1619. Exclusion of certain individuals and entities from participation in Medicare and State health care programs. Subtitle C—Enhanced Program and Provider Protections Sec. 1631. Enhanced CMS program protection authority. Sec. 1632. Enhanced Medicare, Medicaid, and CHIP program disclosure requirements relating to previous affiliations. Sec. 1633. Required inclusion of payment modifier for certain evaluation and management services. Sec. 1634. Evaluations and reports required under Medicare Integrity Program. Sec. 1635. Require providers and suppliers to adopt programs to reduce waste, fraud, and abuse. Sec. 1636. Maximum period for submission of Medicare claims reduced to not more than 12 months. Sec. 1637. Physicians who order durable medical equipment or home health services required to be Medicare enrolled physicians or eligible professionals. Sec. 1638. Requirement for physicians to provide documentation on referrals to programs at high risk of waste and abuse. Sec. 1639. Face to face encounter with patient required before physicians may certify eligibility for home health services or durable medical equipment under Medicare. Sec. 1640. Extension of testimonial subpoena authority to program exclusion investigations. Sec. 1641. Required repayments of Medicare and Medicaid overpayments. Sec. 1642. Expanded application of hardship waivers for OIG exclusions to beneficiaries of any Federal health care program. Sec. 1643. Access to certain information on renal dialysis facilities. Sec. 1644. Billing agents, clearinghouses, or other alternate payees required to register under Medicare. Sec. 1645. Conforming civil monetary penalties to False Claims Act amendments. Subtitle D—Access to Information Needed to Prevent Fraud, Waste, and Abuse Sec. 1651. Access to Information Necessary to Identify Fraud, Waste, and Abuse. Sec. 1652. Elimination of duplication between the Healthcare Integrity and Protection Data Bank and the National Practitioner Data Bank. Sec. 1653. Compliance with HIPAA privacy and security standards. [For items relating to Title VII of division B, see copy of bill as introduced on July 14, 2009] Title VIII—Revenue-related provisions Sec. 1801. Disclosures to facilitate identification of individuals likely to be ineligible for the low-income assistance under the Medicare prescription drug program to assist Social Security Administration’s outreach to eligible individuals. Sec. 1802. Comparative Effectiveness Research Trust Fund; financing for Trust Fund. Title IX—Miscellaneous Provisions Sec. 1901. Repeal of trigger provision. Sec. 1902. Repeal of comparative cost adjustment (CCA) program. Sec. 1903. Extension of gainsharing demonstration. Sec. 1904. Grants to States for quality home visitation programs for families with young children and families expecting children. Sec. 1905. Improved coordination and protection for dual eligibles. Sec. 1906. Assessment of Medicare cost-intensive diseases and conditions.

C

Public Health and Workforce Development

For division C, see text of bill as introduced on July 14, 2009.

1.

Short title; table of divisions, titles, and subtitles

(a)

Table of divisions, titles, and subtitles

This Act is divided into divisions, titles, and subtitles as follows: Division A—Affordable Health Care Choices Title I—Protections and Standards for Qualified Health Benefits Plans Subtitle A—General Standards Subtitle B—Standards Guaranteeing Access to Affordable Coverage Subtitle C—Standards Guaranteeing Access to Essential Benefits Subtitle D—Additional Consumer Protections Subtitle E—Governance Subtitle F—Relation to other requirements; Miscellaneous Subtitle G—Early Investments Title II—Health Insurance Exchange and Related Provisions Subtitle A—Health Insurance Exchange Subtitle B—Public health insurance option Subtitle C—Individual Affordability Credits Subtitle D—State innovation Title III—Shared responsibility Subtitle A—Individual responsibility Subtitle B—Employer Responsibility [For division B—See text of introduced bill] Division C—Public health and workforce development [For titles I through IV of division C, see text of introduced bill.] Title V—Other provisions [For subtitles A , B, and C of title V, see text of introduced bill.] Subtitle D—Grants for comprehensive programs to provide education to nurses and create a pipeline to nursing [For subtitle E of title V, see text of introduced bill.] Subtitle F—Standards for accessibility to medical equipment for individuals with disabilities. Subtitle G—Other grant programs Subtitle H—Long-term care and family caregiver support Subtitle I—Online resources (b)

Short title

This Act may be cited as the America’s Affordable Health Choices Act of 2009.

A

Affordable Health Care Choices

100.

Purpose; table of contents of division; general definitions

(a)

Purpose

(1)

In general

The purpose of this division is to provide affordable, quality health care for all Americans and reduce the growth in health care spending. (2)

Building on current system

This division achieves this purpose by building on what works in today’s health care system, while repairing the aspects that are broken. (3)

Insurance reforms

This division— (A)enacts strong insurance market reforms; (B)creates a new Health Insurance Exchange, with a public health insurance option alongside private plans; (C)includes sliding scale affordability credits; and (D)initiates shared responsibility among workers, employers, and the government; so that all Americans have coverage of essential health benefits. (4)

Health delivery reform

This division institutes health delivery system reforms both to increase quality and to reduce growth in health spending so that health care becomes more affordable for businesses, families, and government. (b)

Table of contents of division

The table of contents of this division is as follows: Sec. 100. Purpose; table of contents of division; general definitions. Title I—Protections and Standards for Qualified Health Benefits Plans Subtitle A—General Standards Sec. 101. Requirements reforming health insurance marketplace. Sec. 102. Protecting the choice to keep current coverage. Subtitle B—Standards Guaranteeing Access to Affordable Coverage Sec. 111. Prohibiting pre-existing condition exclusions. Sec. 112. Guaranteed issue and renewal for insured plans. Sec. 113. Insurance rating rules. Sec. 114. Nondiscrimination in benefits; parity in mental health and substance abuse disorder benefits. Sec. 115. Ensuring adequacy of provider networks. Sec. 116. Ensuring value and lower premiums. Sec. 117. Consistency of costs and coverage under qualified health benefits plans during plan year. Subtitle C—Standards Guaranteeing Access to Essential Benefits Sec. 121. Coverage of essential benefits package. Sec. 122. Essential benefits package defined. Sec. 123. Health Benefits Advisory Committee. Sec. 124. Process for adoption of recommendations; adoption of benefit standards. Sec. 125. Prohibition of discrimination in health care services based on religious or spiritual content. Subtitle D—Additional Consumer Protections Sec. 131. Requiring fair marketing practices by health insurers. Sec. 132. Requiring fair grievance and appeals mechanisms. Sec. 133. Requiring information transparency and plan disclosure. Sec. 134. Application to qualified health benefits plans not offered through the Health Insurance Exchange. Sec. 135. Timely payment of claims. Sec. 136. Standardized rules for coordination and subrogation of benefits. Sec. 137. Application of administrative simplification. Sec. 138. Records relative to prescription information. Subtitle E—Governance Sec. 141. Health Choices Administration; Health Choices Commissioner. Sec. 142. Duties and authority of Commissioner. Sec. 143. Consultation and coordination. Sec. 144.  Health Insurance Ombudsman. Subtitle F—Relation to other requirements; Miscellaneous Sec. 151. Relation to other requirements. Sec. 152. Prohibiting discrimination in health care. Sec. 153. Whistleblower protection. Sec. 154. Construction regarding collective bargaining. Sec. 155. Severability. Sec. 156. Rule of construction regarding Hawaii Prepaid Health Care Act. Sec. 157. Increasing meaningful use of electronic health records. Sec. 158. Private right of contract with health care providers. Subtitle G—Early Investments [For sections 161-163. See text of introduced bill.] Sec. 164. Reinsurance program for retirees. Sec. 165. Prohibition against post-retirement reductions of retiree health benefits by group health plans. Sec. 166. Limitations on preexisting condition exclusions in group health plans in advance of applicability of new prohibition of preexisting condition exclusions. Sec. 167. Extension of COBRA continuation coverage. Title II—Health Insurance Exchange and Related Provisions Subtitle A—Health Insurance Exchange Sec. 201. Establishment of Health Insurance Exchange; outline of duties; definitions. Sec. 202. Exchange-eligible individuals and employers. Sec. 203. Benefits package levels. Sec. 204. Contracts for the offering of Exchange-participating health benefits plans. Sec. 205. Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plan. Sec. 206. Other functions. Sec. 207. Health Insurance Exchange Trust Fund. Sec. 208. Optional operation of State-based health insurance exchanges. Sec. 209. Participation of small employer benefit arrangements. Subtitle B—Public health insurance option Sec. 221. Establishment and administration of a public health insurance option as an Exchange-qualified health benefits plan. Sec. 222. Premiums and financing. Sec. 223. Payment rates for items and services. Sec. 224. Modernized payment initiatives and delivery system reform. Sec. 225. Provider participation. Sec. 226. Application of fraud and abuse provisions. Sec. 227. Sense of the House regarding enrollment of Members in the public option. Subtitle C—Individual Affordability Credits Sec. 241. Availability through Health Insurance Exchange. Sec. 242. Affordable credit eligible individual. Sec. 243. Affordable premium credit. Sec. 244. Affordability cost-sharing credit. Sec. 245. Income determinations. Sec. 246. No Federal payment for undocumented aliens. Subtitle D—State innovation Sec. 251. Waiver of ERISA limitation; application instead of state single payer system. Sec. 252. Requirements. Sec. 253. Definitions. Title III—Shared responsibility Subtitle A—Individual responsibility Sec. 301. Individual responsibility. Subtitle B—Employer Responsibility Part 1—Health coverage participation requirements Sec. 311. Health coverage participation requirements. Sec. 312. Employer responsibility to contribute towards employee and dependent coverage. Sec. 313. Employer contributions in lieu of coverage. Sec. 314. Authority related to improper steering. Part 2—Satisfaction of Health Coverage Participation Requirements Sec. 321. Satisfaction of health coverage participation requirements under the Employee Retirement Income Security Act of 1974. Sec. 324. Additional rules relating to health coverage participation requirements. [For title IV, see text of introduced bill.] (c)

General definitions

Except as otherwise provided, in this division: (1)

Acceptable coverage

The term acceptable coverage has the meaning given such term in section 202(d)(2). (2)

Basic plan

The term basic plan has the meaning given such term in section 203(c). (3)

Commissioner

The term Commissioner means the Health Choices Commissioner established under section 141. (4)

Cost-sharing

The term cost-sharing includes deductibles, coinsurance, copayments, and similar charges but does not include premiums or any network payment differential for covered services or spending for non-covered services. (5)

Dependent

The term dependent has the meaning given such term by the Commissioner and includes a spouse. (6)

Employment-based health plan

The term employment-based health plan— (A)means a group health plan (as defined in section 733(a)(1) of the Employee Retirement Income Security Act of 1974); (B)includes such a plan that is the following: (i)

Federal, state, and tribal governmental plans

A governmental plan (as defined in section 3(32) of the Employee Retirement Income Security Act of 1974), including a health benefits plan offered under chapter 89 of title 5, United States Code; or (ii)

Church plans

A church plan (as defined in section 3(33) of the Employee Retirement Income Security Act of 1974); and (C)excludes coverage described in section 202(d)(2)(E) (relating to TRICARE). (7)

Enhanced plan

The term enhanced plan has the meaning given such term in section 203(c). (8)

Essential benefits package

The term essential benefits package is defined in section 122(a). (9)

Family

The term family means an individual and includes the individual’s dependents. (10)

Federal poverty level; FPL

The terms Federal poverty level and FPL have the meaning given the term poverty line in section 673(2) of the Community Services Block Grant Act (42 U.S.C. 9902(2)), including any revision required by such section. (11)

Health benefits plan

The terms health benefits plan means health insurance coverage and an employment-based health plan and includes the public health insurance option. (12)

Health insurance coverage; health insurance issuer

The terms health insurance coverage and health insurance issuer have the meanings given such terms in section 2791 of the Public Health Service Act. (13)

Health Insurance Exchange

The term Health Insurance Exchange means the Health Insurance Exchange established under section 201. (14)

Medicaid

The term Medicaid means a State plan under title XIX of the Social Security Act (whether or not the plan is operating under a waiver under section 1115 of such Act). (15)

Medicare

The term Medicare means the health insurance programs under title XVIII of the Social Security Act. (16)

Plan sponsor

The term plan sponsor has the meaning given such term in section 3(16)(B) of the Employee Retirement Income Security Act of 1974. (17)

Plan year

The term plan year means— (A)with respect to an employment-based health plan, a plan year as specified under such plan; or (B)with respect to a health benefits plan other than an employment-based health plan, a 12-month period as specified by the Commissioner. (18)

Premium plan; premium-plus plan

The terms premium plan and premium-plus plan have the meanings given such terms in section 203(c). (19)

QHBP offering entity

The terms QHBP offering entity means, with respect to a health benefits plan that is— (A)a group health plan (as defined, subject to subsection (d), in section 733(a)(1) of the Employee Retirement Income Security Act of 1974), the plan sponsor in relation to such group health plan, except that, in the case of a plan maintained jointly by 1 or more employers and 1 or more employee organizations and with respect to which an employer is the primary source of financing, such term means such employer; (B)health insurance coverage, the health insurance issuer offering the coverage; (C)the public health insurance option, the Secretary of Health and Human Services; (D)a non-Federal governmental plan (as defined in section 2791(d) of the Public Health Service Act), the State or political subdivision of a State (or agency or instrumentality of such State or subdivision) which establishes or maintains such plan; or (E)a Federal governmental plan (as defined in section 2791(d) of the Public Health Service Act), the appropriate Federal official. (20)

Qualified health benefits plan

The term qualified health benefits plan means a health benefits plan that meets the requirements for such a plan under title I and includes the public health insurance option. (21)

Public health insurance option

The term public health insurance option means the public health insurance option as provided under subtitle B of title II. (22)

Service area; premium rating area

The terms service area and premium rating area mean with respect to health insurance coverage— (A)offered other than through the Health Insurance Exchange, such an area as established by the QHBP offering entity of such coverage in accordance with applicable State law; and (B)offered through the Health Insurance Exchange, such an area as established by such entity in accordance with applicable State law and applicable rules of the Commissioner for Exchange-participating health benefits plans. (23)

State

The term State means the 50 States and the District of Columbia. (24)

State Medicaid agency

The term State Medicaid agency means, with respect to a Medicaid plan, the single State agency responsible for administering such plan under title XIX of the Social Security Act. (25)

Y1, Y2, etc.

The terms Y1 , Y2, Y3, Y4, Y5, and similar subsequently numbered terms, mean 2013 and subsequent years, respectively. (26)

Employee premium

The term employee premium does not include a collectively bargained premium in the case of a group health plan (as defined in section 733(a)(1) of the Employee Retirement Income Security Act of 1974) that is a multiemployer plan (as defined in section 3(37) of such Act).

B

Medicare and Medicaid Improvements

For division B, see text of bill as introduced on July 14, 2009.

C

Public health and workforce development

2001.

Table of contents; references

(a)

Table of contents

The table of contents of this division is as follows: Sec. 2001. Table of contents; references. [For section 2002, see text of introduced bill.] [For text of titles I through IV, see text of introduced bill.] Title V—Other provisions [For subtitles A, B, and C, see text of introduced bill.] Subtitle D—Grants for comprehensive programs to provide education to nurses and create a pipeline to nursing [For subtitle E, see text of introduced bill.] Sec. 2531. Establishment of grant program. Subtitle F—Standards for accessibility to medical equipment for individuals with disabilities. Sec. 2541. Access for individuals with disabilities. Subtitle G—Other grant programs Sec. 2551. Reducing student-to-school nurse ratios. Sec. 2552. Wellness program grants. Sec. 2553. Health professions training for diversity programs. Subtitle H—Long-term care and family caregiver support Sec. 2561. Long-term care and family caregiver support. Subtitle I—Online resources Sec. 2571. Web site on health care labor market and related educational and training opportunities. Sec. 2572. Online health workforce training programs. (b)

References

Except as otherwise specified, whenever in this division an amendment is expressed in terms of an amendment to a section or other provision, the reference shall be considered to be made to a section or other provision of the Public Health Service Act (42 U.S.C. 201 et seq.)

For section 2002 and titles I through IV of division C, see text of bill as introduced on July 14, 2009.

October 14, 2009 Reported from the Committee on Energy and Commerce with an amendment; reported from the Committee on Ways and Means with an amendment; reported from the Committee on Education and Labor with an amendment October 14, 2009 Committees on Oversight and Government Reform and the Budget discharged; committed to the Committee of the Whole House on the State of the Union and ordered to be printed