1.Short title; table of
contents
(a)This Act may be cited
as the Steps Toward Access and Reform Act of
2009
or the STAR Act of
2009
.
(b)The table of
contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Title I—MEDICAL LIABILITY REFORM
Sec. 101. Encouraging speedy resolution of claims.
Sec. 102. Compensating patient injury.
Sec. 103. Maximizing patient recovery.
Sec. 104. Additional collateral source benefits.
Sec. 105. Punitive damages.
Sec. 106. Authorization of payment of future damages to
claimants in health care lawsuits.
Sec. 107. Effect on other laws.
Sec. 108. State flexibility and protection of States’
rights.
Sec. 109. Applicability; effective date.
Sec. 110. Sense of Congress.
Sec. 111. Definitions.
Title II—IMPROVING ACCESS FOR RURAL AND INDIGENT
PATIENTS
Sec. 201. Improving access for rural and indigent
patients.
Title III—PROMOTING AFFORDABLE PRESCRIPTION DRUGS BY DEFINING
OBJECTIVES IN NEGOTIATION OF TRADE AGREEMENTS
Sec. 301. Promoting affordable prescription drugs by defining
objectives in negotiation of trade agreements.
Title IV—Encouraging Preventative Care
Sec. 401. Encouraging preventative care.
<enum>I</enum><header>MEDICAL LIABILITY
REFORM</header>
<section id="HA452ABB77FF44AC3BAF67967B4417EFB"><enum>101.</enum><header>Encouraging
speedy resolution of claims</header><text display-inline="no-display-inline">The time for the commencement of a health
care lawsuit shall be 3 years after the date of manifestation of injury or 1
year after the claimant discovers, or through the use of reasonable diligence
should have discovered, the injury, whichever occurs first. In no event shall
the time for commencement of a health care lawsuit exceed 3 years after the
date of manifestation of injury unless tolled for any of the following—</text>
<paragraph id="HEE8FD32D5B414CB68A3F00CA9D5D0DCA"><enum>(1)</enum><text>upon proof of
fraud;</text>
</paragraph><paragraph id="H63CF386129814E0C82221E6CD474935F"><enum>(2)</enum><text>intentional
concealment; or</text>
</paragraph><paragraph id="H5F14EDA1F2EA46DA9A7D3D9C98CF02A8"><enum>(3)</enum><text>the presence of a
foreign body, which has no therapeutic or diagnostic purpose or effect, in the
body of the injured person.</text>
</paragraph><continuation-text continuation-text-level="section">Actions by a
minor shall be commenced within 3 years from the date of the alleged
manifestation of injury except that actions by a minor under the full age of 6
years shall be commenced within 3 years of manifestation of injury or prior to
the minor’s 8th birthday, whichever provides a longer period. Such time
limitation shall be tolled for minors for any period during which a parent or
guardian and a health care provider or health care organization have committed
fraud or collusion in the failure to bring an action on behalf of the injured
minor.</continuation-text></section><section id="H880364C1782847F3835742EC3CCC2FE8"><enum>102.</enum><header>Compensating
patient injury</header>
<subsection id="H4E5C9C50A0B944C1A799645B94312A73"><enum>(a)</enum><header>Unlimited Amount
of Damages for Actual Economic Losses in Health Care Lawsuits</header><text>In
any health care lawsuit, nothing in this title shall limit a claimant’s
recovery of the full amount of the available economic damages, notwithstanding
the limitation in
<internal-xref idref="HBBA12A2765CF4C6D8E2394602C0A356E" legis-path="4.(b)">subsection (b)</internal-xref>.</text>
</subsection><subsection id="HBBA12A2765CF4C6D8E2394602C0A356E"><enum>(b)</enum><header>Additional
Noneconomic Damages</header><text>In any health care lawsuit, the amount of
noneconomic damages, if available, shall not exceed $250,000, regardless of the
number of parties against whom the action is brought or the number of separate
claims or actions brought with respect to the same injury.</text>
</subsection><subsection id="H06811012F89D4962AFA4192D8646CAEE"><enum>(c)</enum><header>No Discount of
Award for Noneconomic Damages</header><text>For purposes of applying the
limitation in
<internal-xref idref="HBBA12A2765CF4C6D8E2394602C0A356E" legis-path="4.(b)">subsection (b)</internal-xref>, future noneconomic damages
shall not be discounted to present value. The jury shall not be informed about
the maximum award for noneconomic damages. An award for noneconomic damages in
excess of $250,000 shall be reduced either before the entry of judgment, or by
amendment of the judgment after entry of judgment, and such reduction shall be
made before accounting for any other reduction in damages required by law. If
separate awards are rendered for past and future noneconomic damages and the
combined awards exceed $250,000, the future noneconomic damages shall be
reduced first.</text>
</subsection><subsection id="HB9C678CDD45E449CA99E203AEF4649AE"><enum>(d)</enum><header>Fair Share
Rule</header><text>In any health care lawsuit, each party shall be liable for
that party’s several share of any damages only and not for the share of any
other person. Each party shall be liable only for the amount of damages
allocated to such party in direct proportion to such party’s percentage of
responsibility. Whenever a judgment of liability is rendered as to any party, a
separate judgment shall be rendered against each such party for the amount
allocated to such party. For purposes of this section, the trier of fact shall
determine the proportion of responsibility of each party for the claimant’s
harm.</text>
</subsection></section><section id="HEFE46F088E1D4D2295AD1AAC31EEB785"><enum>103.</enum><header>Maximizing
patient recovery</header>
<subsection id="HEBC98CBAA9C34FF7976B12D2C3E66055"><enum>(a)</enum><header>Court
Supervision of Share of Damages Actually Paid to Claimants</header><text>In any
health care lawsuit, the court shall supervise the arrangements for payment of
damages to protect against conflicts of interest that may have the effect of
reducing the amount of damages awarded that are actually paid to claimants. In
particular, in any health care lawsuit in which the attorney for a party claims
a financial stake in the outcome by virtue of a contingent fee, the court shall
have the power to restrict the payment of a claimant’s damage recovery to such
attorney, and to redirect such damages to the claimant based upon the interests
of justice and principles of equity. In no event shall the total of all
contingent fees for representing all claimants in a health care lawsuit exceed
the following limits:</text>
<paragraph id="HD0CBA4A2F8D9466CA80C1A2BE1303435"><enum>(1)</enum><text>40 percent of the
first $50,000 recovered by the claimants.</text>
</paragraph><paragraph id="HB3D145F4ED094BD78462BB624E2B478F"><enum>(2)</enum><text>33<fraction>1/3</fraction>
percent of the next $50,000 recovered by the claimants.</text>
</paragraph><paragraph id="H93554BBD92C945D39726A4EB7EC6063E"><enum>(3)</enum><text>25 percent of the
next $500,000 recovered by the claimants.</text>
</paragraph><paragraph id="HA1B4405516944CAE98EAC40288A9BBE2"><enum>(4)</enum><text>15 percent of any
amount by which the recovery by the claimants is in excess of $600,000.</text>
</paragraph></subsection><subsection id="HDC5E155F1E3944D18429ED8E354FA02F"><enum>(b)</enum><header>Applicability</header><text>The
limitations in this section shall apply whether the recovery is by judgment,
settlement, mediation, arbitration, or any other form of alternative dispute
resolution. In a health care lawsuit involving a minor or incompetent person, a
court retains the authority to authorize or approve a fee that is less than the
maximum permitted under this section. The requirement for court supervision in
the first two sentences of
<internal-xref idref="HEBC98CBAA9C34FF7976B12D2C3E66055" legis-path="5.(a)">subsection (a)</internal-xref> applies only in civil
actions.</text>
</subsection></section><section id="H651E35EB53DD44CFB8E61F4F3E531F2A"><enum>104.</enum><header>Additional
collateral source benefits</header><text display-inline="no-display-inline">In
any health care lawsuit involving injury or wrongful death, any party may
introduce evidence of collateral source benefits. If a party elects to
introduce such evidence, any opposing party may introduce evidence of any
amount paid or contributed or reasonably likely to be paid or contributed in
the future by or on behalf of the opposing party to secure the right to such
collateral source benefits. No provider of collateral source benefits shall
recover any amount against the claimant or receive any lien or credit against
the claimant’s recovery or be equitably or legally subrogated to the right of
the claimant in a health care lawsuit involving injury or wrongful death. This
section shall apply to any health care lawsuit that is settled as well as a
health care lawsuit that is resolved by a fact finder. This section shall not
apply to section 1862(b) (42 U.S.C. 1395y(b)) or section 1902(a)(25) (42 U.S.C.
1396a(a)(25)) of the <act-name parsable-cite="SSA">Social Security
Act</act-name>.</text>
</section><section id="H8D70D532AAA24B12B4CC1B2944657936"><enum>105.</enum><header>Punitive
damages</header>
<subsection id="HB2F070CC724746C0B26CEFD006082394"><enum>(a)</enum><header>In
General</header><text>Punitive damages may, if otherwise permitted by
applicable State or Federal law, be awarded against any person in a health care
lawsuit only if it is proven by clear and convincing evidence that such person
acted with malicious intent to injure the claimant, or that such person
deliberately failed to avoid unnecessary injury that such person knew the
claimant was substantially certain to suffer. In any health care lawsuit where
no judgment for compensatory damages is rendered against such person, no
punitive damages may be awarded with respect to the claim in such lawsuit. No
demand for punitive damages shall be included in a health care lawsuit as
initially filed. A court may allow a claimant to file an amended pleading for
punitive damages only upon a motion by the claimant and after a finding by the
court, upon review of supporting and opposing affidavits or after a hearing,
after weighing the evidence, that the claimant has established by a substantial
probability that the claimant will prevail on the claim for punitive damages.
At the request of any party in a health care lawsuit, the trier of fact shall
consider in a separate proceeding—</text>
<paragraph id="HB23DA49CEA254B8D8CD7C1C7CBF69450"><enum>(1)</enum><text>whether punitive
damages are to be awarded and the amount of such award; and</text>
</paragraph><paragraph id="HD868B73E02F6430E8DF5D4FEE2E277DB"><enum>(2)</enum><text>the amount of
punitive damages following a determination of punitive liability.</text>
</paragraph><continuation-text continuation-text-level="subsection">If a
separate proceeding is requested, evidence relevant only to the claim for
punitive damages, as determined by applicable State law, shall be inadmissible
in any proceeding to determine whether compensatory damages are to be
awarded.</continuation-text></subsection><subsection id="H6CCDDC0CD3E74275801935EFAD2E6417"><enum>(b)</enum><header>Determining
Amount of Punitive Damages</header>
<paragraph commented="no" id="HA3EF7BE5AD0842F5B1CA31DC74EB8D95"><enum>(1)</enum><header>Factors
considered</header><text>In determining the amount of punitive damages, if
awarded, in a health care lawsuit, the trier of fact shall consider only the
following—</text>
<subparagraph commented="no" id="H79F85E046E214ACBB3996AC94C4324A3"><enum>(A)</enum><text>the severity of
the harm caused by the conduct of such party;</text>
</subparagraph><subparagraph commented="no" id="HF0A86E82EE7B43189A0CB34414BE5E2C"><enum>(B)</enum><text>the duration of
the conduct or any concealment of it by such party;</text>
</subparagraph><subparagraph commented="no" id="H88E21F60F0324C84B59353459196B4CE"><enum>(C)</enum><text>the profitability
of the conduct to such party;</text>
</subparagraph><subparagraph commented="no" id="HD591744FB716482C939086BA4D49B6AF"><enum>(D)</enum><text>the number of
products sold or medical procedures rendered for compensation, as the case may
be, by such party, of the kind causing the harm complained of by the
claimant;</text>
</subparagraph><subparagraph commented="no" id="HB6756002E4C74AE48A5830B03E559328"><enum>(E)</enum><text>any criminal
penalties imposed on such party, as a result of the conduct complained of by
the claimant; and</text>
</subparagraph><subparagraph commented="no" id="H3FF7A76CD52F4C45AFFAE58D8C7D3688"><enum>(F)</enum><text>the amount of any
civil fines assessed against such party as a result of the conduct complained
of by the claimant.</text>
</subparagraph></paragraph><paragraph id="HB38B94ED2A7A4C2B8E5FB5B4F5FB315E"><enum>(2)</enum><header>Maximum
award</header><text>The amount of punitive damages, if awarded, in a health
care lawsuit may not exceed $250,000 or two times the amount of economic
damages awarded, whichever is greater. The jury shall not be informed of this
limitation.</text>
</paragraph></subsection><subsection id="H9CFA3CBC6675415EAFB6874EBB30FE79"><enum>(c)</enum><header>No Punitive
Damages for Products That Comply With FDA Standards</header>
<paragraph id="H0D801B7BF25A4AC193B23CE9941B00DB"><enum>(1)</enum><header>In
general</header>
<subparagraph id="HE04F54461D6F4AE59B5DF840BA00507F"><enum>(A)</enum><text>No punitive
damages may be awarded against the manufacturer or distributor of a medical
product, or a supplier of any component or raw material of such medical
product, based on a claim that such product caused the claimant’s harm
where—</text>
<clause id="H1938C273B73C4371AF6D03D3763B9719"><enum>(i)</enum><subclause commented="no" display-inline="yes-display-inline" id="H414DE5DCB4124C12BDF20CAAE4D998DB"><enum>(I)</enum><text>such medical product was
subject to premarket approval, clearance, or licensure by the Food and Drug
Administration with respect to the safety of the formulation or performance of
the aspect of such medical product which caused the claimant’s harm or the
adequacy of the packaging or labeling of such medical product; and</text>
</subclause><subclause id="H6400939E5F30475EAD8A13018BF5020F" indent="up1"><enum>(II)</enum><text>such medical product was so approved,
cleared, or licensed; or</text>
</subclause></clause><clause id="HDCF6E1BEE5E1410BA138A2B44EE517A1"><enum>(ii)</enum><text>such medical
product is generally recognized among qualified experts as safe and effective
pursuant to conditions established by the Food and Drug Administration and
applicable Food and Drug Administration regulations, including without
limitation those related to packaging and labeling, unless the Food and Drug
Administration has determined that such medical product was not manufactured or
distributed in substantial compliance with applicable Food and Drug
Administration statutes and regulations.</text>
</clause></subparagraph><subparagraph id="H194F853AA8ED406B85F1518F53A87996"><enum>(B)</enum><header>Rule of
construction</header><text><internal-xref idref="HE04F54461D6F4AE59B5DF840BA00507F" legis-path="7.(c)(1)(A)">Subparagraph
(A)</internal-xref> may not be construed as establishing the obligation of the
Food and Drug Administration to demonstrate affirmatively that a manufacturer,
distributor, or supplier referred to in such subparagraph meets any of the
conditions described in such subparagraph.</text>
</subparagraph></paragraph><paragraph id="H241F4E33044148DA87A088F5635182D7"><enum>(2)</enum><header>Liability of
health care providers</header><text>A health care provider who prescribes, or
who dispenses pursuant to a prescription, a medical product approved, licensed,
or cleared by the Food and Drug Administration shall not be named as a party to
a product liability lawsuit involving such product and shall not be liable to a
claimant in a class action lawsuit against the manufacturer, distributor, or
seller of such product. Nothing in this paragraph prevents a court from
consolidating cases involving health care providers and cases involving
products liability claims against the manufacturer, distributor, or product
seller of such medical product.</text>
</paragraph><paragraph id="HB58E3300C9DD4419A03D494A12A6028B"><enum>(3)</enum><header>Packaging</header><text>In
a health care lawsuit for harm which is alleged to relate to the adequacy of
the packaging or labeling of a drug which is required to have tamper-resistant
packaging under regulations of the Secretary of Health and Human Services
(including labeling regulations related to such packaging), the manufacturer or
product seller of the drug shall not be held liable for punitive damages unless
such packaging or labeling is found by the trier of fact by clear and
convincing evidence to be substantially out of compliance with such
regulations.</text>
</paragraph><paragraph id="H0A191AB8FFD1465BB61D8659A45DDC92"><enum>(4)</enum><header>Exception</header><text><internal-xref idref="H0D801B7BF25A4AC193B23CE9941B00DB" legis-path="7.(c)(1)">Paragraph
(1)</internal-xref> shall not apply in any health care lawsuit in which—</text>
<subparagraph id="H33C7345B747B43A2B68443EF94748137"><enum>(A)</enum><text>a person, before
or after premarket approval, clearance, or licensure of such medical product,
knowingly misrepresented to or withheld from the Food and Drug Administration
information that is required to be submitted under the
<act-name parsable-cite="FFDCA">Federal Food, Drug, and Cosmetic Act</act-name>
(21 U.S.C. 301 et seq.) or section 351 of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (42 U.S.C. 262) that
is material and is causally related to the harm which the claimant allegedly
suffered; or</text>
</subparagraph><subparagraph id="HD9E704664BD74901BD6F6128BBF2ADC6"><enum>(B)</enum><text>a person made an
illegal payment to an official of the Food and Drug Administration for the
purpose of either securing or maintaining approval, clearance, or licensure of
such medical product.</text>
</subparagraph></paragraph></subsection></section><section commented="no" id="HB7074C011AF6419B87256C74B6B118D2"><enum>106.</enum><header>Authorization
of payment of future damages to claimants in health care lawsuits</header>
<subsection commented="no" id="H4A0CC120B73F4B3D8704EE6B80D33992"><enum>(a)</enum><header>In
General</header><text>In any health care lawsuit, if an award of future
damages, without reduction to present value, equaling or exceeding $50,000 is
made against a party with sufficient insurance or other assets to fund a
periodic payment of such a judgment, the court shall, at the request of any
party, enter a judgment ordering that the future damages be paid by periodic
payments. In any health care lawsuit, the court may be guided by the Uniform
Periodic Payment of Judgments Act promulgated by the National Conference of
Commissioners on Uniform State Laws.</text>
</subsection><subsection commented="no" id="H5557E08CF3B64F06BA6B67C2277E29FA"><enum>(b)</enum><header>Applicability</header><text>This
section applies to all actions which have not been first set for trial or
retrial before the effective date of this Act.</text>
</subsection></section><section id="H43BFCFB39E6F4B868F8079DEB6414B60"><enum>107.</enum><header>Effect on other
laws</header>
<subsection id="H3A195E8C035345F19B2326E4B9FC47C5"><enum>(a)</enum><header>Vaccine
Injury</header>
<paragraph id="H8F941BCEF90442E9911C2A6B0EB483A1"><enum>(1)</enum><text>To the extent that
title XXI of the <act-name parsable-cite="PHSA">Public Health Service
Act</act-name> establishes a Federal rule of law applicable to a civil action
brought for a vaccine-related injury or death—</text>
<subparagraph id="HA5C0731FE96D4DAC9F25D336B1D51DAE"><enum>(A)</enum><text>this title does
not affect the application of the rule of law to such an action; and</text>
</subparagraph><subparagraph id="HF2006F9C73E6486CA6E41235BED7122A"><enum>(B)</enum><text>any rule of law
prescribed by this title in conflict with a rule of law of such title XXI shall
not apply to such action.</text>
</subparagraph></paragraph><paragraph id="H77AF821DBED74AAA8E3909C76594C720"><enum>(2)</enum><text>If there is an
aspect of a civil action brought for a vaccine-related injury or death to which
a Federal rule of law under title XXI of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> does not apply, then
this title or otherwise applicable law (as determined under this title) will
apply to such aspect of such action.</text>
</paragraph></subsection><subsection id="H84E4D73579EA4EB0BFEDE7A6B313E3CD"><enum>(b)</enum><header>Other Federal
Law</header><text>Except as provided in this section, nothing in this title
shall be deemed to affect any defense available to a defendant in a health care
lawsuit or action under any other provision of Federal law.</text>
</subsection></section><section id="HAAA17EC53AE34AFA957882B5F88AD331"><enum>108.</enum><header>State
flexibility and protection of States’ rights</header>
<subsection id="H424768AC228D480C8156B403D9B6CADD"><enum>(a)</enum><header>Health Care
Lawsuits</header><text>The provisions governing health care lawsuits set forth
in this title preempt, subject to subsections (b) and (c), State law to the
extent that State law prevents the application of any provisions of law
established by or under this title. The provisions governing health care
lawsuits set forth in this title supersede chapter 171 of title 28, United
States Code, to the extent that such chapter—</text>
<paragraph id="H8B5CECB97C8C4FE8A1D288736D3B28C8"><enum>(1)</enum><text>provides for a
greater amount of damages or contingent fees, a longer period in which a health
care lawsuit may be commenced, or a reduced applicability or scope of periodic
payment of future damages, than provided in this title; or</text>
</paragraph><paragraph id="H07A85EF8405A4EFAA60BB0582CEF317B"><enum>(2)</enum><text>prohibits the
introduction of evidence regarding collateral source benefits, or mandates or
permits subrogation or a lien on collateral source benefits.</text>
</paragraph></subsection><subsection id="H98923608EE824050ACF9CE75570ABB52"><enum>(b)</enum><header>Protection of
States’ Rights and Other Laws</header><paragraph commented="no" display-inline="yes-display-inline" id="HC0293D3B917145F29A5D9DCE94B7F5ED"><enum>(1)</enum><text>Any issue that is not
governed by any provision of law established by or under this title (including
State standards of negligence) shall be governed by otherwise applicable State
or Federal law.</text>
</paragraph><paragraph id="HAEF0F94D22AD488AA6B488B3914DE7A8" indent="up1"><enum>(2)</enum><text>This title shall not preempt or
supersede any State or Federal law that imposes greater procedural or
substantive protections for health care providers and health care organizations
from liability, loss, or damages than those provided by this title or create a
cause of action.</text>
</paragraph></subsection><subsection id="HE9F28571DD8947758D759C7FB6C4B6B4"><enum>(c)</enum><header>State
Flexibility</header><text>No provision of this title shall be construed to
preempt—</text>
<paragraph id="H41B1888910AA44E4965478AEB59AE776"><enum>(1)</enum><text>any State law
(whether effective before, on, or after the date of the enactment of this Act)
that specifies a particular monetary amount of compensatory or punitive damages
(or the total amount of damages) that may be awarded in a health care lawsuit,
regardless of whether such monetary amount is greater or lesser than is
provided for under this title, notwithstanding
<internal-xref idref="H4E5C9C50A0B944C1A799645B94312A73" legis-path="4.(a)">section 104(a)</internal-xref>; or</text>
</paragraph><paragraph id="HFDEA82942B454802B00617A2DC749E64"><enum>(2)</enum><text>any defense
available to a party in a health care lawsuit under any other provision of
State or Federal law.</text>
</paragraph></subsection></section><section id="H40A6E2BD633640E497384BD57576A995"><enum>109.</enum><header>Applicability;
effective date</header><text display-inline="no-display-inline">This title
shall apply to any health care lawsuit brought in a Federal or State court, or
subject to an alternative dispute resolution system, that is initiated on or
after the date of the enactment of this Act, except that any health care
lawsuit arising from an injury occurring prior to the date of the enactment of
this Act shall be governed by the applicable statute of limitations provisions
in effect at the time the injury occurred.</text>
</section><section id="H02BE57F2D12547F681C1A40230485E27"><enum>110.</enum><header>Sense of
Congress</header><text display-inline="no-display-inline">It is the sense of
Congress that a health insurer should be liable for damages for harm caused
when it makes a decision as to what care is medically necessary and
appropriate.</text>
</section><section id="H7FA3CB7E2CAC4E31BB5B511DD76BBF25"><enum>111.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text>
<paragraph id="H142CB39893364C1480A135085F1748D9"><enum>(1)</enum><header>Alternative
dispute resolution system; ADR</header><text>The term <term>alternative dispute
resolution system</term> or <term>ADR</term> means a system that provides for
the resolution of health care lawsuits in a manner other than through a civil
action brought in a State or Federal court.</text>
</paragraph><paragraph id="H10529C70650E4B9EBA05690781299AE1"><enum>(2)</enum><header>Claimant</header><text>The
term <term>claimant</term> means any person who brings a title, including a
person who asserts or claims a right to legal or equitable contribution,
indemnity, or subrogation, arising out of a health care liability claim or
action, and any person on whose behalf such a claim is asserted or such an
action is brought, whether deceased, incompetent, or a minor.</text>
</paragraph><paragraph id="H59D0BEF7BBEC4512AD2CE3108D5E479A"><enum>(3)</enum><header>Collateral
source benefits</header><text>The term <term>collateral source benefits</term>
means any amount paid or reasonably likely to be paid in the future to or on
behalf of the claimant, or any service, product, or other benefit provided or
reasonably likely to be provided in the future to or on behalf of the claimant,
as a result of the injury or wrongful death, pursuant to—</text>
<subparagraph id="HF31075136127472EB03B1499BE23C5A3"><enum>(A)</enum><text>any State or
Federal health, sickness, income-disability, accident, or workers’ compensation
law;</text>
</subparagraph><subparagraph id="H1FBA6A2A0AC848A09A229B86CDF5D044"><enum>(B)</enum><text>any health,
sickness, income-disability, or accident insurance that provides health
benefits or income-disability coverage;</text>
</subparagraph><subparagraph id="H6BAFFE2713DA4AD7A1DCF1C14194570B"><enum>(C)</enum><text>any contract or
agreement of any group, organization, partnership, or corporation to provide,
pay for, or reimburse the cost of medical, hospital, dental, or
income-disability benefits; and</text>
</subparagraph><subparagraph id="H4A0B51893D66400383A240AE5F5659EF"><enum>(D)</enum><text>any other publicly
or privately funded program.</text>
</subparagraph></paragraph><paragraph id="H5236FB395A914BB4ADDD16829695A344"><enum>(4)</enum><header>Compensatory
damages</header><text>The term <term>compensatory damages</term> means
objectively verifiable monetary losses incurred as a result of the provision
of, use of, or payment for (or failure to provide, use, or pay for) health care
services or medical products, such as past and future medical expenses, loss of
past and future earnings, cost of obtaining domestic services, loss of
employment, and loss of business or employment opportunities, damages for
physical and emotional pain, suffering, inconvenience, physical impairment,
mental anguish, disfigurement, loss of enjoyment of life, loss of society and
companionship, loss of consortium (other than loss of domestic service),
hedonic damages, injury to reputation, and all other nonpecuniary losses of any
kind or nature. The term <term>compensatory damages</term> includes economic
damages and noneconomic damages, as such terms are defined in this
section.</text>
</paragraph><paragraph id="HA76293EFD36E4CA8B09443FA21AF6C2D"><enum>(5)</enum><header>Contingent
fee</header><text>The term <term>contingent fee</term> includes all
compensation to any person or persons which is payable only if a recovery is
effected on behalf of one or more claimants.</text>
</paragraph><paragraph id="HE9EA9F40AFFA4C09A6AEA3A994342A20"><enum>(6)</enum><header>Economic
damages</header><text>The term <term>economic damages</term> means objectively
verifiable monetary losses incurred as a result of the provision of, use of, or
payment for (or failure to provide, use, or pay for) health care services or
medical products, such as past and future medical expenses, loss of past and
future earnings, cost of obtaining domestic services, loss of employment, and
loss of business or employment opportunities.</text>
</paragraph><paragraph id="HBE005447E0714DE29EAAA9C6AA9F254C"><enum>(7)</enum><header>Health care
lawsuit</header><text>The term <term>health care lawsuit</term> means any
health care liability claim concerning the provision of health care goods or
services or any medical product affecting interstate commerce, or any health
care liability action concerning the provision of health care goods or services
or any medical product affecting interstate commerce, brought in a State or
Federal court or pursuant to an alternative dispute resolution system, against
a health care provider, a health care organization, or the manufacturer,
distributor, supplier, marketer, promoter, or seller of a medical product,
regardless of the theory of liability on which the claim is based, or the
number of claimants, plaintiffs, defendants, or other parties, or the number of
claims or causes of action, in which the claimant alleges a health care
liability claim. Such term does not include a claim or action which is based on
criminal liability; which seeks civil fines or penalties paid to Federal,
State, or local government; or which is grounded in antitrust.</text>
</paragraph><paragraph id="HD9B6B04E54234D1099C1D4E0A8D4D410"><enum>(8)</enum><header>Health care
liability action</header><text>The term <term>health care liability
action</term> means a civil action brought in a State or Federal court or
pursuant to an alternative dispute resolution system, against a health care
provider, a health care organization, or the manufacturer, distributor,
supplier, marketer, promoter, or seller of a medical product, regardless of the
theory of liability on which the claim is based, or the number of plaintiffs,
defendants, or other parties, or the number of causes of action, in which the
claimant alleges a health care liability claim.</text>
</paragraph><paragraph id="HD2BD46BAC86748638C8C04B897AFE9CF"><enum>(9)</enum><header>Health care
liability claim</header><text>The term <term>health care liability claim</term>
means a demand by any person, whether or not pursuant to ADR, against a health
care provider, health care organization, or the manufacturer, distributor,
supplier, marketer, promoter, or seller of a medical product, including, but
not limited to, third-party claims, cross-claims, counter-claims, or
contribution claims, which are based upon the provision of, use of, or payment
for (or the failure to provide, use, or pay for) health care services or
medical products, regardless of the theory of liability on which the claim is
based, or the number of plaintiffs, defendants, or other parties, or the number
of causes of action.</text>
</paragraph><paragraph id="HFB9C790DEB9246549BE2373A7273E5AA"><enum>(10)</enum><header>Health care
organization</header><text>The term <term>health care organization</term> means
any person or entity which is obligated to provide or pay for health benefits
under any health plan, including any person or entity acting under a contract
or arrangement with a health care organization to provide or administer any
health benefit.</text>
</paragraph><paragraph id="H7AE69958C8D94D41A0F807A0417BF688"><enum>(11)</enum><header>Health care
provider</header><text>The term <term>health care provider</term> means any
person or entity required by State or Federal laws or regulations to be
licensed, registered, or certified to provide health care services, and being
either so licensed, registered, or certified, or exempted from such requirement
by other statute or regulation.</text>
</paragraph><paragraph id="H5F048D172CAD49D9BBA417BCF88282FA"><enum>(12)</enum><header>Health care
goods or services</header><text>The term <term>health care goods or
services</term> means any goods or services provided by a health care
organization, provider, or by any individual working under the supervision of a
health care provider, that relates to the diagnosis, prevention, or treatment
of any human disease or impairment, or the assessment or care of the health of
human beings.</text>
</paragraph><paragraph id="H7FA010D8A5A94342A211CA35E4B14F49"><enum>(13)</enum><header>Malicious
intent to injure</header><text>The term <term>malicious intent to injure</term>
means intentionally causing or attempting to cause physical injury other than
providing health care goods or services.</text>
</paragraph><paragraph id="H58FEC326D4F0428399067106542AE83D"><enum>(14)</enum><header>Medical
product</header><text>The term <term>medical product</term> means a drug,
device, or biological product intended for humans, and the terms
<term>drug</term>, <term>device</term>, and <term>biological product</term>
have the meanings given such terms in sections 201(g)(1) and 201(h) of the
Federal Food, Drug and Cosmetic Act (21 U.S.C. 321(g)(1) and (h)) and section
351(a) of the <act-name parsable-cite="PHSA">Public Health Service
Act</act-name> (42 U.S.C. 262(a)), respectively, including any component or raw
material used therein, but excluding health care services.</text>
</paragraph><paragraph id="HE19B7AC339F14B4AA275FE6B388D3E5B"><enum>(15)</enum><header>Noneconomic
damages</header><text>The term <term>noneconomic damages</term> means damages
for physical and emotional pain, suffering, inconvenience, physical impairment,
mental anguish, disfigurement, loss of enjoyment of life, loss of society and
companionship, loss of consortium (other than loss of domestic service),
hedonic damages, injury to reputation, and all other nonpecuniary losses of any
kind or nature.</text>
</paragraph><paragraph id="H665D40CD172E41F8B0D4A4CA50EB9960"><enum>(16)</enum><header>Punitive
damages</header><text>The term <term>punitive damages</term> means damages
awarded, for the purpose of punishment or deterrence, and not solely for
compensatory purposes, against a health care provider, health care
organization, or a manufacturer, distributor, or supplier of a medical product.
Punitive damages are neither economic nor noneconomic damages.</text>
</paragraph><paragraph id="H467D52287BC545D0BA4204B91030C0BC"><enum>(17)</enum><header>Recovery</header><text>The
term <term>recovery</term> means the net sum recovered after deducting any
disbursements or costs incurred in connection with prosecution or settlement of
the claim, including all costs paid or advanced by any person. Costs of health
care incurred by the plaintiff and the attorneys’ office overhead costs or
charges for legal services are not deductible disbursements or costs for such
purpose.</text>
</paragraph><paragraph id="HF4BE1B9F483740F98925796261715F62"><enum>(18)</enum><header>State</header><text>The
term <term>State</term> means each of the several States, the District of
Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American
Samoa, the Northern Mariana Islands, the Trust Territory of the Pacific
Islands, and any other territory or possession of the United States, or any
political subdivision thereof.</text>
</paragraph></section><enum>II</enum><header>IMPROVING ACCESS
FOR RURAL AND INDIGENT PATIENTS</header>
<section id="H319DD4ED086940D4B3D5FBD730E6A135"><enum>201.</enum><header>Improving
access for rural and indigent patients</header>
<subsection id="H57F7DF757AA446409F3B13EA5751A8DB"><enum>(a)</enum><header>Loan forgiveness
for primary care providers</header>
<paragraph id="HF85D719C88D14A349E77D6C8227EB581"><enum>(1)</enum><header>In
general</header><text>The Secretary of Health and Human Services shall carry
out a program of entering into contracts with eligible individuals under
which—</text>
<subparagraph id="H0A72D2AD3E4C47338C218DFDB5C2417A"><enum>(A)</enum><text display-inline="yes-display-inline">the individual agrees to serve for a period
of not less than 4 years as a primary care provider in a medically underserved
community (as defined in section 799B of the Public Health Service Act (42
U.S.C. 295p)); and</text>
</subparagraph><subparagraph id="H3394AE219A304B30B05434008389B9DA"><enum>(B)</enum><text>in consideration
of such service, the Secretary agrees to pay not more than $100,000 on the
principal and interest on the individual’s graduate educational loans.</text>
</subparagraph></paragraph><paragraph id="H4A87CB89EB95426CAF0A517A59817EBC"><enum>(2)</enum><header>Eligibility</header><text>To
be eligible to enter into a contract under subsection (1), an individual
must—</text>
<subparagraph id="HCDD0304811BB4774882999DFE5EED407"><enum>(A)</enum><text display-inline="yes-display-inline">have a graduate degree in medicine,
osteopathic medicine, or another health profession from an accredited (as
determined by the Secretary of Health and Human Services) institution of higher
education; and</text>
</subparagraph><subparagraph id="HB40C5DBC40AF4C1C91E84A1FC977870D"><enum>(B)</enum><text>have practiced as
a primary care provider for a period (excluding any residency or fellowship
training period) of not less than 3 years in a medically underserved community
(as defined in section 799B of the Public Health Service Act (42 U.S.C.
295p)).</text>
</subparagraph></paragraph><paragraph id="HFF77BC644C454239901BE722B0BCDB26"><enum>(3)</enum><header>Installments</header><text>Payments
under this section may be made in installments of not more than $25,000 for
each year of service described in paragraph (1) (A).</text>
</paragraph><paragraph id="H0889FE5AD81842BF8AF3FCFAE5CFF845"><enum>(4)</enum><header>Applicability of
certain provisions</header><text>The provisions of subpart III of part D of
title III of the Public Health Service Act shall, except as inconsistent with
this section, apply to the program established under this section in the same
manner and to the same extent as such provisions apply to the National Health
Service Corps Loan Repayment Program established in such subpart.</text>
</paragraph></subsection><subsection commented="no" id="H6C6393BB617B4E7A9A5839503FA54D43"><enum>(b)</enum><header>Permitting State
designation of critical access hospitals</header><text>Section
1820(c)(2)(B)(i)(II) of the Social Security Act (42 U.S.C.
1395i–4(c)(2)(B)(i)(II)) is amended by inserting <quote>or on or after the date
of enactment of the Steps Toward Access and Reform Act of 2009</quote> after
<quote>January 1, 2006,</quote>.</text>
</subsection><subsection id="H45A4BE482CA2475E8D2245DCC50B9965"><enum>(c)</enum><header>Patient fairness
and indigent care promotion</header>
<paragraph id="HF0FD883DED45484D946844ABB7721FE3"><enum>(1)</enum><header>In
General</header><text>Section 166 of the Internal Revenue Code of 1986
(relating to bad debts) is amended by redesignating subsection (f) as
subsection (g) and by inserting after subsection (e) the following new
subsection:</text>
<quoted-block id="H5C734A51F0DE48F896865AAAD4C3FF38" style="OLC">
<subsection id="H3A30706F86834DC9A9F0DB64CE768E34"><enum>(f)</enum><header>Unpaid Medical
Care Provided to Low-Income Individuals</header>
<paragraph id="HC11F9DF1880441D89CBFB69A4A9123ED"><enum>(1)</enum><header>In
general</header><text>In the case of a taxpayer to whom this subsection
applies, the deduction under subsection (a) for worthless qualified medical
care debt shall not be less than 75 percent of the taxpayer’s charge for such
care.</text>
</paragraph><paragraph id="H690F32C720084149950D3F4765F30ED9"><enum>(2)</enum><header>Taxpayer to whom
subsection applies</header><text>This subsection shall apply to any taxpayer
who is engaged in the trade or business of providing medical care other than as
an employee and who used the cash receipts and disbursements method of
accounting.</text>
</paragraph><paragraph id="H0177E4C2CFEB4D23A842CC381C962023"><enum>(3)</enum><header>Qualified
medical care debt</header><text display-inline="yes-display-inline">For
purposes of this subsection, the term <term>qualified medical care debt</term>
means any debt for medical care provided by the taxpayer to a low-income
individual who is a citizen or legal resident of the United States.</text>
</paragraph><paragraph id="HF9B590B0CE84456C8CEFEF02A692B908"><enum>(4)</enum><header>Determination of
charge</header><text>The amount of the taxpayer’s charge which may be taken
into account—</text>
<subparagraph id="HA22B003DA0EE4C869545840C0257F2F5"><enum>(A)</enum><text>shall not exceed
the amount of the charge that would be recognized for purposes of title XVIII
of the Social Security Act, and</text>
</subparagraph><subparagraph id="HF894C8E5C73B429C97D0C38C73BCE3E5"><enum>(B)</enum><text>shall not include
any amount for which the taxpayer is not entitled to reimbursement from the
low-income individual.</text>
</subparagraph></paragraph><paragraph id="H863DF3390F2547F1B24E4723517FDB6D"><enum>(5)</enum><header>Low-income
individual</header><text display-inline="yes-display-inline">For purposes of
this subsection, the term <term>low-income individual</term> means an
individual who, at the time the medical care attributable to the debt is
provided, has an annual household income below 135 percent of the poverty line
(as defined in section 673 of the Community Services Block Grant Act (42 U.S.C.
9902)) applicable to the size of the family involved, and is a citizen or legal
resident of the United States.</text>
</paragraph><paragraph id="HE149A6F32FEE43FF9CD69FBC318672C7"><enum>(6)</enum><header>Medical
care</header><text>For purposes of this subsection, the term <term>medical
care</term> has the meaning given to such term by section 213(d).</text>
</paragraph><paragraph id="H94ABEE01FD4F4D5D95924229CBC041EE"><enum>(7)</enum><header>Regulations</header><text>The
Secretary shall prescribe such regulations as may be necessary or appropriate
to carry out this section, including regulations providing for methods of
establishing that an individual is a low-income individual for purposes of this
section.</text>
</paragraph></subsection><after-quoted-block></after-quoted-block></quoted-block>
</paragraph><paragraph id="H4C2782BC3D074F6B9EBB52E09FEFB317"><enum>(2)</enum><header>Effective
Date</header><text>The amendment made by this section shall apply to taxable
years beginning after the date of the enactment of this Act.</text>
</paragraph></subsection></section><enum>III</enum><header>PROMOTING
AFFORDABLE PRESCRIPTION DRUGS BY DEFINING OBJECTIVES IN NEGOTIATION OF TRADE
AGREEMENTS </header>
<section id="HF3F0668774F44DF98632B0C8A015D48F"><enum>301.</enum><header>Promoting
affordable prescription drugs by defining objectives in negotiation of trade
agreements</header>
<subsection id="H5FA6CDCFE9634D9F9C2595EC95FF98AF"><enum>(a)</enum><header>In
General</header><text>Section 2102(a) of the Bipartisan Trade Promotion
Authority Act of 2002 (19 U.S.C. 3802(a)) is amended—</text>
<paragraph id="H02AB8EE59F65471F800B4D1D57D08E0A"><enum>(1)</enum><text>by striking
<quote>and</quote> at the end of paragraph (8);</text>
</paragraph><paragraph id="H661EA920EAE6409890080684F177389C"><enum>(2)</enum><text>by striking the
period at the end of paragraph (9) and inserting <quote>; and</quote>;
and</text>
</paragraph><paragraph id="H7879C1F60E93429F90968EE859A6BDCD"><enum>(3)</enum><text>by adding at the
end the following:</text>
<quoted-block id="HCB4DDC5AE92C499D8839199613CC2197" style="OLC">
<paragraph id="H1FD1DEBEF0894C9F8B82B175EED8FAEB"><enum>(10)</enum><text>to avoid
negotiating trade agreements that could restrict, or be interpreted to
restrict, the access of consumers in the United States to pharmaceutical
imports from countries with a pharmaceutical infrastructure that is equivalent,
or superior, to that of the United States—</text>
<subparagraph id="HF4B1731BDCC840339E2D5C83A21C09BB"><enum>(A)</enum><text>by or through the
use and development of the doctrine of international patent exhaustion, as
interpreted or applied by United States courts on the date of enactment of this
Act; or</text>
</subparagraph><subparagraph id="H0CAD51B3D3E748CCB350EDD2FBEDFC36"><enum>(B)</enum><text>by making it a
violation for the United States to enact legislation permitting pharmaceutical
imports without the consent of patent owners when the products involved have
been sold outside the United
States.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H7C10F63300914269B5E7F010D17E5544"><enum>(b)</enum><header>Certain
Prohibitions</header><text>Notwithstanding any other provision of law, the
United States Trade Representative—</text>
<paragraph id="H47A2E9343C514F80B94B9FA8DC26815E"><enum>(1)</enum><text>may not enter into
a bilateral or multilateral trade agreement that, with respect to the
importation of pharmaceutical products without the consent of the patent
owners, includes provisions that are the same or similar to the provisions
of—</text>
<subparagraph id="H88D077F6813E49B1B53D7161C3C3AD3F"><enum>(A)</enum><text>paragraph 2 of
Article 16.7 of the United States-Singapore Free Trade Agreement;</text>
</subparagraph><subparagraph id="H605EC689680445E8A0BCDDD83CBA00D9"><enum>(B)</enum><text>paragraph 4 of
Article 17.9 of the United States-Australia Free Trade Agreement; or</text>
</subparagraph><subparagraph id="H300A235879774D53AEE34937B488E210"><enum>(C)</enum><text>paragraph 4 of
Article 15.9 of the United States-Morocco Free Trade Agreement; and</text>
</subparagraph></paragraph><paragraph id="H0D8A97BC62B04BB08ED9C7DFAAA7BCFA"><enum>(2)</enum><text>may not, with
respect to the importation of pharmaceutical products without the consent of
the patent owners, negotiate an agreement or understanding with respect to any
of the provisions referred to in paragraph (1).</text>
</paragraph></subsection></section><enum>IV</enum><header>Encouraging
Preventative Care</header>
<section id="HEEEA6722E1034688A701249CA7D79B44"><enum>401.</enum><header>Encouraging
preventative care</header>
<subsection id="HDC6A0D9C93834483ADEA219586491170"><enum>(a)</enum><header>Mobile
mammography promotion</header>
<paragraph id="H61DA4D5263B74171BE9D49DB5D35313C"><enum>(1)</enum><header>Refunds</header><text>Section
6427 of the Internal Revenue Code of 1986 (relating to fuels not used for
taxable purposes) is amended by inserting after subsection (f) the following
new subsection:</text>
<quoted-block id="HD9A3B4183ADE463FB5275F2187F092F0" style="OLC">
<subsection id="H56F82695EF304511837171005E92B7DD"><enum>(g)</enum><header>Fuels Used in
Mobile Mammography Vehicles</header><text>Except as provided in subsection (k),
if any fuel on which tax was imposed by section 4041 or 4081 is used in any
highway vehicle designed exclusively to provide mobile mammography services to
patients within such vehicle, the Secretary shall pay (without interest) to the
ultimate purchaser of such fuel an amount equal to the aggregate amount of the
tax imposed on such
fuel.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H721E65F655E54CC2801E5B382B16636E"><enum>(2)</enum><header>Exemption From
Retail Tax</header><text>Section 4041 of such Code is amended by adding at the
end the following new subsection:</text>
<quoted-block id="H1D8D0C2BB8E5455D8170B1433062244B" style="OLC">
<subsection id="H588238C07CDE4BABB9A931A720901157"><enum>(n)</enum><header>Fuels Used in
Mobile Mammography Vehicles</header><text>No tax shall be imposed under this
section on any liquid sold for use in, or used in, any highway vehicle designed
exclusively to provide mobile mammography services to patients within such
vehicle.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HDB7121EE3CAA4F0FB84E388DCB9B5CF5"><enum>(3)</enum><header>Effective
Date</header><text>The amendments made by this section shall take effect on the
date of the enactment of this Act.</text>
</paragraph></subsection><subsection commented="no" id="HFF42B441393744C489593E90CF9CF921"><enum>(b)</enum><header>Medicare lung
cancer early detection</header><text>Section 1834 of the Social Security Act
(42 U.S.C. 1395m) is amended—</text>
<paragraph commented="no" id="HFC1C9D2A3A3B4F06A3F5187CFBB13363"><enum>(1)</enum><text>in subsection
(b)(1)(B), by striking <quote>subsection (c)(1)(A)</quote> and inserting
<quote>subsections (c)(1)(A) and (n)</quote>; and</text>
</paragraph><paragraph commented="no" id="H387820414E694ABA8E82D3CEC534D58F"><enum>(2)</enum><text>by adding at the
end the following new subsection:</text>
<quoted-block id="H72ACCBDD04A74AAD971D08A026A778AB" style="OLC">
<subsection commented="no" id="H9AA3D923848347FB802DFEE1C0E83340"><enum>(n)</enum><header>Payment for
chest radiography services that use Computer Aided Detection technology for the
early detection of lung cancer</header>
<paragraph commented="no" id="H0D8B0875D174488685AE82F9921B9062"><enum>(1)</enum><header>In
general</header><text>Notwithstanding any other provision of this part, with
respect to chest radiography services (identified as of September 1, 2006, by
HCPCS codes 71010, 71020, 71021, 71022, and 71030, and as subsequently modified
by the Secretary) furnished on or after January 1, 2010, that use Computer
Aided Detection technology for the early detection of lung cancer (as defined
in paragraph (4)), the amount of payment shall be equal to—</text>
<subparagraph commented="no" id="H5533CCA08A7B4145ABD9A40C60F1199C"><enum>(A)</enum><text>with respect to
the technical component of such services—</text>
<clause commented="no" id="H9ED33CA5A19D48B0A831A7CBFD6D5A2F"><enum>(i)</enum><text>the amount of
payment under the fee schedule established under section 1848 for such
component for the year that would otherwise apply; plus</text>
</clause><clause commented="no" id="H8A5A2BBC53BB45AB9879DEB79075CA04"><enum>(ii)</enum><text>the amount
described in paragraph (2); and</text>
</clause></subparagraph><subparagraph commented="no" id="H8DC73271C47E4BDE98F862329F2DEC8D"><enum>(B)</enum><text>with respect to
the professional component of such services—</text>
<clause commented="no" id="H7B0B2ABD22D9439E91355340F8308F03"><enum>(i)</enum><text>the amount of
payment under the fee schedule established under section 1848 for such
component for the year that would otherwise apply; plus</text>
</clause><clause commented="no" id="H333172CED0E74149B6B1D5D3F43E715C"><enum>(ii)</enum><text>the amount
described in paragraph (3).</text>
</clause></subparagraph></paragraph><paragraph commented="no" id="HCB1E2A04D3E84CDE8F670DFCCEFF130A"><enum>(2)</enum><header>Amount described
for technical component</header><text>The amount described in this paragraph
for services furnished—</text>
<subparagraph commented="no" id="HB1C576838F174FA38E6F7B2815E69481"><enum>(A)</enum><text>during 2010 is
$12; or</text>
</subparagraph><subparagraph commented="no" id="H5889A2891ADA4176BC957B43856BA846"><enum>(B)</enum><text>during a
subsequent year is the amount established under this paragraph for the
preceding year, increased by the update determined under section 1848(d) for
the year.</text>
</subparagraph></paragraph><paragraph commented="no" id="H33149E0E454343E195329AF716822B06"><enum>(3)</enum><header>Amount described
for professional component</header><text>The amount described in this paragraph
for services furnished—</text>
<subparagraph commented="no" id="H62225EBFE1F94E17BF99DD6986BCEABA"><enum>(A)</enum><text>during 2010 is $4;
and</text>
</subparagraph><subparagraph commented="no" id="H61CF8B7957684B0E894417C97DB5FDA0"><enum>(B)</enum><text>during a
subsequent year is the amount established under this paragraph for the
preceding year increased by the update determined under section 1848(d) for the
year.</text>
</subparagraph></paragraph><paragraph commented="no" id="H29CC631F0B3C4BD5AB363D846EA811B4"><enum>(4)</enum><header>Computer Aided
Detection technology for the early detection of lung cancer
defined</header><text display-inline="yes-display-inline">In this subsection,
the term <term>Computer Aided Detection technology for the early detection of
lung cancer</term> means a computer software technology which allows for the
production of a digital chest x-ray image or the conversion of a chest x-ray
into a digital image to be subsequently analyzed for early lung cancer nodules
and which the Food and Drug Administration has granted approval or
clearance.</text>
</paragraph><paragraph commented="no" id="H99575AB477934F12BFDE958A7805834C"><enum>(5)</enum><header>New
codes</header><text>The Secretary shall establish new codes for chest
radiography services described in paragraph (1) in order to implement this
subsection.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H733F246513DF4EB9A48B3BFF71722A61"><enum>(c)</enum><header>Veterans travel
tax relief</header>
<paragraph display-inline="no-display-inline" id="H33A1093F7AD44EDC98560D07A22F5783"><enum>(1)</enum><header>In
general</header><text>Part VII of subchapter B of chapter I of the Internal
Revenue Code of 1986 (relating to additional itemized deductions for
individuals) is amended by redesignating section 224 as section 225, and by
inserting after section 223 the following new section:</text>
<quoted-block display-inline="no-display-inline" id="H21F02FF16F574227B5DF52D82192713F" style="OLC">
<section id="H7715215A3A034D7FAEA5F5F00B2963A4"><enum>224.</enum><header>Travel expenses
of veterans for health care at medical centers of the Department of Veterans
Affairs</header>
<subsection id="H198C7BCFDE104282B3681170FB98C45F"><enum>(a)</enum><header>Allowance of
Deduction</header><text>In the case of an individual, there shall be allowed as
a deduction the qualified travel expenses for the taxable year.</text>
</subsection><subsection id="HB44DCE3B76E543928A9004A5533F5B3E"><enum>(b)</enum><header>Limitations</header>
<paragraph id="H2AF1B1915ECC418BB514DFC58A46FCB4"><enum>(1)</enum><header>Dollar
limitation</header><text>The amount allowed as a deduction under subsection (a)
for a taxable year shall not exceed $400.</text>
</paragraph><paragraph id="HB5432006B63E47CF843C4F436A86C8AA"><enum>(2)</enum><header>Limitation based
on adjusted gross income</header><text display-inline="yes-display-inline">The
amount allowable as a deduction under subsection (a) shall be reduced (but not
below zero) by an amount which bears the same ratio to the amount so allowable
(determined without regard to this paragraph but with regard to paragraph (1))
as—</text>
<subparagraph id="H6168E5FB6BB44F38AF2F565C0DE04067"><enum>(A)</enum><text>the amount (if
any) by which the taxpayer’s adjusted gross income exceeds $75,000 ($150,000 in
the case of a joint return), bears to</text>
</subparagraph><subparagraph id="H0B33648A00D64699A85FAB135A89901E"><enum>(B)</enum><text>$10,000 ($20,000
in the case of a joint return).</text>
</subparagraph></paragraph><paragraph id="HC65772F3114442CCAAA73E5A519DD3EB"><enum>(3)</enum><header>Adjustments for
inflation</header><text display-inline="yes-display-inline">In the case of a
taxable year beginning after 2009, each of the dollar amounts in paragraph (2)
shall be increased by an amount equal to—</text>
<subparagraph id="H1AE0B174FC4045E29A03CBFD7D8128C1"><enum>(A)</enum><text>such dollar
amount, multiplied by</text>
</subparagraph><subparagraph id="HBAC49D65DE604163A111C7F411E8DFD9"><enum>(B)</enum><text>the cost-of-living
adjustment determined under section 1(f)(3) for the calendar year in which the
taxable year begins, determined by substituting <quote>calendar year
2008</quote> for <quote>calendar year 1992</quote> in subparagraph (B)
thereof.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">If any
amount as increased under the preceding sentence is not a multiple of $100,
such amount shall be rounded to the nearest multiple of $100.</continuation-text></paragraph></subsection><subsection id="HB0855DB9BA7B434B9926A29BBEC722A7"><enum>(c)</enum><header>Qualified travel
expenses</header><text display-inline="yes-display-inline">For purposes of this
section—</text>
<paragraph id="HC64435AA5CAC4284A89D50903F97FADB"><enum>(1)</enum><header>In
general</header><text>The term <term>qualified travel expenses</term> means
amounts paid for travel expenses of a veteran and a family member of the
veteran to a medical center of the Department of Veterans Affairs for—</text>
<subparagraph id="H67612E3C6402410DAFFC0909A3B4F378"><enum>(A)</enum><text>treatment relating
to a service-connected disability, or</text>
</subparagraph><subparagraph id="H8D8080E55B944CE3A4A6DF7261B9C6A2"><enum>(B)</enum><text>examination
conducted by the Secretary of Veterans Affairs relating to a claim for
disability compensation or pension under the laws administered by the Secretary
of Veterans Affairs.</text>
</subparagraph></paragraph><paragraph id="HC15398115E0B4B989C5556B6EECAB17D"><enum>(2)</enum><header>Reimbursements
by Department of Veterans Affairs</header><text>The term <term>qualified travel
expenses</term> does not include any travel expense which is reimbursed by the
Department of Veterans Affairs or any other insurance plan.</text>
</paragraph><paragraph id="H26055491328B492C83EADCD1E04FB558"><enum>(3)</enum><header>Limitation</header><text>Travel
expenses incurred by a veteran shall not be taken into account under paragraph
(1) unless—</text>
<subparagraph id="H5485542927C14562984BF2C04538327F"><enum>(A)</enum><text display-inline="yes-display-inline">the principal place of abode of the veteran
is more than 25 miles from the medical center in which the treatment is
provided or examination conducted, and</text>
</subparagraph><subparagraph id="H137817020DCF4532A2E0C4388362FF4B"><enum>(B)</enum><text>such medical
center is the nearest medical center of the Department of Veterans Affairs to
such place of abode.</text>
</subparagraph></paragraph><paragraph display-inline="no-display-inline" id="HC9DF1728FD7D436C8C87613F7995056E"><enum>(4)</enum><header>Travel
expenses</header><text>The term <term>travel expenses</term> includes
transportation, food, and lodging.</text>
</paragraph></subsection><subsection id="H71A0A4F9813C4450B683A71117A9BD0C"><enum>(d)</enum><header>Other
definitions</header><text>For purposes of this section—</text>
<paragraph id="HA9FA9BC1ADD4495BA16DEF7204D97C8D"><enum>(1)</enum><header>Veteran</header><text display-inline="yes-display-inline">The term <term>veteran</term> has the
meaning given such term by section 101(2) of title 38, United States
Code.</text>
</paragraph><paragraph id="H6EBFDB9A05CC4E27A78CB4960C69FB5F"><enum>(2)</enum><header>Service-connected
disability</header><text display-inline="yes-display-inline">The term
<term>service-connected disability</term> has the meaning given such term under
section 101(13) of such Code.</text>
</paragraph><paragraph id="HE22F918B057B4F149D78C8957256E603"><enum>(3)</enum><header>Family
member</header><text display-inline="yes-display-inline">The members of an
individual’s family shall be determined under section 4946(d); except that such
members also shall include the brothers and sisters (whether by the whole or
half blood) of the individual and their
spouses.</text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph display-inline="no-display-inline" id="HC77A39FB0D4E4761A13D42A796A3109D"><enum>(2)</enum><header>Deduction
allowed whether or not taxpayer itemizes other deductions</header><text display-inline="yes-display-inline">Subsection (a) of section 62 of such Code
(defining adjusted gross income) is amended by inserting before the last
sentence the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H6D51950A45EC4AC28EAA5180328F0C82" style="OLC">
<paragraph id="HD4C8B999018E41E6964C991212D9DFB8"><enum>(22)</enum><header>Travel expenses
of veterans for health care at medical centers of the Department of Veterans
Affairs</header><text display-inline="yes-display-inline">The deduction allowed
by section
224.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph display-inline="no-display-inline" id="H4A35A3054E5E41508DD7659A903D5C5A"><enum>(3)</enum><header>Clerical
Amendments</header><text>The table of sections for part VII of subchapter B of
chapter 1 of such Code is amended by striking the item relating to section 224
and inserting the following:</text>
<quoted-block id="H09219AE336C2437FB28AA2A439693CF4" style="OLC">
<toc regeneration="no-regeneration">
<toc-entry level="section">Sec. 224. Travel expenses of veterans for
health care at medical centers of the Department of Veterans
Affairs.</toc-entry>
<toc-entry level="section">Sec. 225. Cross
reference.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H8A522816BA2542F9A475F63C56CD11C1"><enum>(4)</enum><header>Effective
Date</header><text>The amendments made by this section shall apply to taxable
years beginning after December 31, 2008.</text>
</paragraph></subsection></section>