I 111th CONGRESS 1st Session H. R. 3962 IN THE HOUSE OF REPRESENTATIVES October 29, 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 Education and Labor, Ways and Means, Oversight and Government Reform, the Budget, Rules, Natural Resources, and the Judiciary, 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 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 Affordable Health Care for America Act. (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—Immediate Reforms Title II—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 Title III—Health Insurance Exchange and Related Provisions Subtitle A—Health Insurance Exchange Subtitle B—Public Health Insurance Option Subtitle C—Individual Affordability Credits Title IV—Shared responsibility Subtitle A—Individual Responsibility Subtitle B—Employer Responsibility Title V—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; 340B Program Integrity Subtitle B—Programs Subtitle C—Food and Drug Administration Subtitle D—Community Living Assistance Services and Supports Subtitle E—Miscellaneous Division D—Indian Health Care Improvement Title I—Amendments to Indian Laws Title II—Improvement of Indian Health Care Provided Under the Social Security Act

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—Immediate Reforms Sec. 101. National high-risk pool program. Sec. 102. Ensuring value and lower premiums. Sec. 103. Ending health insurance rescission abuse. Sec. 104. Sunshine on price gouging by health insurance issuers. Sec. 105. Requiring the option of extension of dependent coverage for uninsured young adults. Sec. 106. Limitations on preexisting condition exclusions in group health plans in advance of applicability of new prohibition of preexisting condition exclusions. Sec. 107. Prohibiting acts of domestic violence from being treated as preexisting conditions. Sec. 108. Ending health insurance denials and delays of necessary treatment for children with deformities. Sec. 109. Elimination of lifetime limits. Sec. 110. Prohibition against postretirement reductions of retiree health benefits by group health plans. Sec. 111. Reinsurance program for retirees. Sec. 112. Wellness program grants. Sec. 113. Extension of COBRA continuation coverage. Sec. 114. State Health Access Program grants. Sec. 115. Administrative simplification. Title II—Protections and Standards for Qualified Health Benefits Plans Subtitle A—General Standards Sec. 201. Requirements reforming health insurance marketplace. Sec. 202. Protecting the choice to keep current coverage. Subtitle B—Standards Guaranteeing Access to Affordable Coverage Sec. 211. Prohibiting preexisting condition exclusions. Sec. 212. Guaranteed issue and renewal for insured plans and prohibiting rescissions. Sec. 213. Insurance rating rules. Sec. 214. Nondiscrimination in benefits; parity in mental health and substance abuse disorder benefits. Sec. 215. Ensuring adequacy of provider networks. Sec. 216. Requiring the option of extension of dependent coverage for uninsured young adults. Sec. 217. Consistency of costs and coverage under qualified health benefits plans during plan year. Subtitle C—Standards Guaranteeing Access to Essential Benefits Sec. 221. Coverage of essential benefits package. Sec. 222. Essential benefits package defined. Sec. 223. Health Benefits Advisory Committee. Sec. 224. Process for adoption of recommendations; adoption of benefit standards. Subtitle D—Additional Consumer Protections Sec. 231. Requiring fair marketing practices by health insurers. Sec. 232. Requiring fair grievance and appeals mechanisms. Sec. 233. Requiring information transparency and plan disclosure. Sec. 234. Application to qualified health benefits plans not offered through the Health Insurance Exchange. Sec. 235. Timely payment of claims. Sec. 236. Standardized rules for coordination and subrogation of benefits. Sec. 237. Application of administrative simplification. Sec. 238. State prohibitions on discrimination against health care providers. Sec. 239. Protection of physician prescriber information. Sec. 240. Dissemination of advance care planning information. Subtitle E—Governance Sec. 241. Health Choices Administration; Health Choices Commissioner. Sec. 242. Duties and authority of Commissioner. Sec. 243. Consultation and coordination. Sec. 244. Health Insurance Ombudsman. Subtitle F—Relation to other requirements; Miscellaneous Sec. 251. Relation to other requirements. Sec. 252. Prohibiting discrimination in health care. Sec. 253. Whistleblower protection. Sec. 254. Construction regarding collective bargaining. Sec. 255. Severability. Sec. 256. Treatment of Hawaii Prepaid Health Care Act. Sec. 257. Actions by State attorneys general. Sec. 258. Application of State and Federal laws regarding abortion. Sec. 259. Nondiscrimination on abortion and respect for rights of conscience. Sec. 260. Authority of Federal Trade Commission. Sec. 261. Construction regarding standard of care. Sec. 262. Restoring application of antitrust laws to health sector insurers. Sec. 263. Study and report on methods to increase EHR use by small health care providers. Title III—Health Insurance Exchange and Related Provisions Subtitle A—Health Insurance Exchange Sec. 301. Establishment of Health Insurance Exchange; outline of duties; definitions. Sec. 302. Exchange-eligible individuals and employers. Sec. 303. Benefits package levels. Sec. 304. Contracts for the offering of Exchange-participating health benefits plans. Sec. 305. Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plan. Sec. 306. Other functions. Sec. 307. Health Insurance Exchange Trust Fund. Sec. 308. Optional operation of State-based health insurance exchanges. Sec. 309. Interstate health insurance compacts. Sec. 310. Health insurance cooperatives. Sec. 311. Retention of DOD and VA authority. Subtitle B—Public Health Insurance Option Sec. 321. Establishment and administration of a public health insurance option as an Exchange-qualified health benefits plan. Sec. 322. Premiums and financing. Sec. 323. Payment rates for items and services. Sec. 324. Modernized payment initiatives and delivery system reform. Sec. 325. Provider participation. Sec. 326. Application of fraud and abuse provisions. Sec. 327. Application of HIPAA insurance requirements. Sec. 328. Application of health information privacy, security, and electronic transaction requirements. Sec. 329. Enrollment in public health insurance option is voluntary. Sec. 330. Enrollment in public health insurance option by Members of Congress. Sec. 331. Reimbursement of Secretary of Veterans Affairs. Subtitle C—Individual Affordability Credits Sec. 341. Availability through Health Insurance Exchange. Sec. 342. Affordable credit eligible individual. Sec. 343. Affordability premium credit. Sec. 344. Affordability cost-sharing credit. Sec. 345. Income determinations. Sec. 346. Special rules for application to territories. Sec. 347. No Federal payment for undocumented aliens. Title IV—Shared responsibility Subtitle A—Individual responsibility Sec. 401. Individual responsibility. Subtitle B—Employer Responsibility Part 1—Health coverage participation requirements Sec. 411. Health coverage participation requirements. Sec. 412. Employer responsibility to contribute toward employee and dependent coverage. Sec. 413. Employer contributions in lieu of coverage. Sec. 414. Authority related to improper steering. Sec. 415. Impact study on employer responsibility requirements. Sec. 416. Study on employer hardship exemption. Part 2—Satisfaction of Health Coverage Participation Requirements Sec. 421. Satisfaction of health coverage participation requirements under the Employee Retirement Income Security Act of 1974. Sec. 422. Satisfaction of health coverage participation requirements under the Internal Revenue Code of 1986. Sec. 423. Satisfaction of health coverage participation requirements under the Public Health Service Act. Sec. 424. Additional rules relating to health coverage participation requirements. Title V—Amendments to Internal Revenue Code of 1986 Subtitle A—Provisions relating to health care reform Part 1—Shared responsibility Subpart A—Individual responsibility Sec. 501. Tax on individuals without acceptable health care coverage. Subpart B—Employer Responsibility Sec. 511. Election to satisfy health coverage participation requirements. Sec. 512. Health care contributions of nonelecting employers. Part 2—Credit for small business employee health coverage expenses Sec. 521. Credit for small business employee health coverage expenses. Part 3—Limitations on health care related expenditures Sec. 531. Distributions for medicine qualified only if for prescribed drug or insulin. Sec. 532. Limitation on health flexible spending arrangements under cafeteria plans. Sec. 533. Increase in penalty for nonqualified distributions from health savings accounts. Sec. 534. Denial of deduction for federal subsidies for prescription drug plans which have been excluded from gross income. Part 4—Other provisions to carry out health insurance reform Sec. 541. Disclosures to carry out health insurance exchange subsidies. Sec. 542. Offering of exchange-participating health benefits plans through cafeteria plans. Sec. 543. Exclusion from gross income of payments made under reinsurance program for retirees. Sec. 544. CLASS program treated in same manner as long-term care insurance. Sec. 545. Exclusion from gross income for medical care provided for Indians. Subtitle B—Other revenue provisions Part 1—General provisions Sec. 551. Surcharge on high income individuals. Sec. 552. Excise tax on medical devices. Sec. 553. Expansion of information reporting requirements. Sec. 554. Delay in application of worldwide allocation of interest. Part 2—Prevention of tax avoidance Sec. 561. Limitation on treaty benefits for certain deductible payments. Sec. 562. Codification of economic substance doctrine; penalties. Sec. 563. Certain large or publicly traded persons made subject to a more likely than not standard for avoiding penalties on underpayments. Part 3—Parity in health benefits Sec. 571. 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 302(d)(2). (2)

Basic plan

The term basic plan has the meaning given such term in section 303(c). (3)

Commissioner

The term Commissioner means the Health Choices Commissioner established under section 241. (4)

Cost-sharing

The term cost-sharing includes deductibles, coinsurance, copayments, and similar charges, but does not include premiums, balance billing amounts for non-network providers, 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. (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 302(d)(2)(E) (relating to TRICARE). (7)

Enhanced plan

The term enhanced plan has the meaning given such term in section 303(c). (8)

Essential benefits package

The term essential benefits package is defined in section 222(a). (9)

Exchange-participating health benefits plan

The term Exchange-participating health benefits plan means a qualified health benefits plan that is offered through the Health Insurance Exchange and may be purchased directly from the entity offering the plan or through enrollment agents and brokers. (10)

Family

The term family means an individual and includes the individual’s dependents. (11)

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. (12)

Health benefits plan

The term health benefits plan means health insurance coverage and an employment-based health plan and includes the public health insurance option. (13)

Health insurance coverage

The term health insurance coverage has the meaning given such term in section 2791 of the Public Health Service Act, but does not include coverage in relation to its provision of excepted benefits— (A)described in paragraph (1) of subsection (c) of such section; or (B)described in paragraph (2), (3), or (4) of such subsection if the benefits are provided under a separate policy, certificate, or contract of insurance. (14)

Health insurance issuer

The term health insurance issuer has the meaning given such term in section 2791(b)(2) of the Public Health Service Act. (15)

Health Insurance Exchange

The term Health Insurance Exchange means the Health Insurance Exchange established under section 301. (16)

Indian

The term Indian has the meaning given such term in section 4 of the Indian Health Care Improvement Act (24 U.S.C. 1603). (17)

Indian health care provider

The term Indian health care provider means a health care program operated by the Indian Health Service, an Indian tribe, tribal organization, or urban Indian organization as such terms are defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603). (18)

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). (19)

Medicaid eligible individual

The term Medicaid eligible individual means an individual who is eligible for medical assistance under Medicaid. (20)

Medicare

The term Medicare means the health insurance programs under title XVIII of the Social Security Act. (21)

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. (22)

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. (23)

Premium plan; premium-plus plan

The terms premium plan and premium-plus plan have the meanings given such terms in section 303(c). (24)

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. (25)

Qualified health benefits plan

The term qualified health benefits plan means a health benefits plan that— (A)meets the requirements for such a plan under title II and includes the public health insurance option; and (B)is offered by a QHBP offering entity that meets the applicable requirements of such title with respect to such plan. (26)

Public health insurance option

The term public health insurance option means the public health insurance option as provided under subtitle B of title III. (27)

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. (28)

State

The term State means the 50 States and the District of Columbia and includes— (A)for purposes of title I, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands; and (B)for purposes of titles II and III, as elected under and subject to section 346, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. (29)

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. (30)

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 of this division is as follows: 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. Sec. 1114. Permitting physician assistants to order post-hospital extended care services and to provide for recognition of attending physician assistants as attending physicians to serve hospice patients. Subtitle B—Provisions Related to Part B Part 1—Physicians’ Services Sec. 1121. Resource-based feedback program for physicians in Medicare. 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. 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. Payment for imaging services. Sec. 1147. Durable medical equipment program improvements. Sec. 1148. MedPAC study and report on bone mass measurement. Sec. 1149. Timely access to post-mastectomy items. Sec. 1149A. Payment for biosimilar biological products. Sec. 1149B. Study and report on DME competitive bidding process. 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. 1155A. MedPAC study on variation in home health margins. Sec. 1155B. Permitting home health agencies to assign the most appropriate skilled service to make the initial assessment visit under a Medicare home health plan of care for rehabilitation cases. 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. Sec. 1160. Implementation, and Congressional review, of proposal to revise Medicare payments to promote 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; quality bonus payments. Sec. 1162. Authority for Secretarial coding intensity adjustment authority. Sec. 1163. Simplification of annual beneficiary election periods. Sec. 1164. Extension of reasonable cost contracts. Sec. 1165. Limitation of waiver authority for employer group plans. Sec. 1166. Improving risk adjustment for payments. Sec. 1167. Elimination of MA Regional Plan Stabilization Fund. Sec. 1168. 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. Sec. 1175A. State authority to enforce standardized marketing requirements. 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; service area moratorium for certain SNPs. Sec. 1178. Extension of Medicare senior housing plans. 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. No mid-year formulary changes permitted. Sec. 1186. Negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries. Sec. 1187. Accurate dispensing in long-term care facilities. Sec. 1188. Free generic fill. Sec. 1189. 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. 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 and quality bonus payments 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. Voluntary 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. Sec. 1312. Independence at home demonstration program. Sec. 1313. Recognition of certified diabetes educators as certified providers for purposes of Medicare diabetes outpatient self-management training services. 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, nursing facilities, and other long-term care 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. Sec. 1417. Nationwide program for national and State background checks on direct patient access employees of long-term care facilities and providers. 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 skilled nursing facility or 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. 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. Sec. 1620.  OIG authority to exclude from Federal health care programs officers and owners of entities convicted of fraud. Sec. 1621. Self-referral disclosure protocol. 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 eligibility certifications for home health services or durable medical equipment. 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. Sec. 1646. Requiring provider and supplier payments under Medicare to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions. Sec. 1647. Inspector General for the Health Choices Administration. 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 Sec. 1. Table of contents Temporary. Subtitle A—Medicaid and Health Reform Sec. 1701. Eligibility for individuals with income below 150 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. Sec. 1730B. FQHC coverage. 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. Sec. 1739. Provisions relating to community living assistance services and supports (CLASS). 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. Nursing Facility Supplemental Payment Program. Sec. 1746. Report on Medicaid payments. Sec. 1747. Reviews of Medicaid. Sec. 1748. Extension of delay in managed care organization provider tax elimination. Sec. 1749. Extension of ARRA increase in FMAP. 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. Assuring transparency of information. Sec. 1784. Medicaid and CHIP Payment and Access Commission. Sec. 1785. Outreach and enrollment of Medicaid and CHIP eligible individuals. Sec. 1786. Prohibitions on Federal Medicaid and CHIP payment for undocumented aliens. Sec. 1787. Demonstration project for stabilization of emergency medical conditions by institutions for mental diseases. Sec. 1788. Application of Medicaid Improvement Fund. Sec. 1789. Treatment of certain Medicaid brokers. Sec. 1790. Rule for changes requiring State legislation. 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. Sec. 1907. Establishment of Center for Medicare and Medicaid Innovation within CMS. Sec. 1908. Application of emergency services laws. Sec. 1909. Disregard under the Supplemental Security Income program of compensation for participation in clinical trials for rare diseases or conditions.

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. Sec. 2003. Deficit neutrality. 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. Subpart XI—Health professional needs areas Sec. 340H. In general. Sec. 340I. Loan repayments. Sec. 340J. Report. Sec. 340K. Allocation. 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. Subpart XII—Public health workforce Sec. 340L. Public Health Workforce Corps. Sec. 340M. Public Health Workforce Scholarship Program. Sec. 340N. Public Health Workforce Loan Repayment Program. 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. Sec. 3143. Research on subsidies and rewards to encourage wellness and healthy behaviors. 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; 340B program integrity Sec. 2501. Expanded participation in 340B program. Sec. 2502. Improvements to 340B program integrity. 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. Reauthorization of telehealth and telemedicine grant programs. Sec. 2524. No child left unimmunized against influenza: demonstration program using elementary and secondary schools as influenza vaccination centers. Sec. 2525. Extension of Wisewoman Program. Sec. 2526. Healthy teen initiative to prevent teen pregnancy. Sec. 2527. National training initiatives on autism spectrum disorders. Sec. 2528. Implementation of medication management services in treatment of chronic diseases. Sec. 2529. Postpartum depression. Sec. 2530. Grants to promote positive health behaviors and outcomes. Sec. 2531. Medical liability alternatives. Sec. 2532. Infant mortality pilot programs. Sec. 2533. Secondary school health sciences training program. Sec. 2534. Community-based collaborative care networks. Sec. 2535. Community-based overweight and obesity prevention program. Sec. 2536. Reducing student-to-school nurse ratios. Sec. 2537. Medical-legal partnerships. Part 3—Emergency Care-Related Programs Sec. 2551. Trauma care centers. Sec. 2552. Emergency care coordination. Sec. 2553. Pilot programs to improve emergency medical care. Sec. 2554. Assisting veterans with military emergency medical training to become State-licensed or certified emergency medical technicians (EMTs). Sec. 2555. Dental emergency responders: public health and medical response. Sec. 2556. Dental emergency responders: homeland security. Part 4—Pain care and management programs Sec. 2561. Institute of Medicine Conference on Pain. Sec. 2562. Pain research at National Institutes of Health. Sec. 2563. Public awareness campaign on pain management. Subtitle C—Food and Drug Administration Part 1—In general Sec. 2571. National medical device registry. Sec. 2572. Nutrition labeling of standard menu items at chain restaurants and of articles of food sold from vending machines. Sec. 2573. Protecting consumer access to generic drugs. Part 2—Biosimilars Sec. 2575. Licensure pathway for biosimilar biological products. Sec. 2576. Fees relating to biosimilar biological products. Sec. 2577. Amendments to certain patent provisions. Subtitle D—Community living assistance services and supports Sec. 2581. Establishment of national voluntary insurance program for purchasing community living assistance services and support (CLASS program). Title XXXII—Community Living Assistance Services and Supports Sec. 3201. Purpose. Sec. 3202. Definitions. Sec. 3203. CLASS Independence Benefit Plan. Sec. 3204. Enrollment and disenrollment requirements. Sec. 3205. Benefits. Sec. 3206. CLASS Independence Fund. Sec. 3207. CLASS Independence Advisory Council. Sec. 3208. Regulations; annual report. Sec. 3209. Inspector General's report. Subtitle E—Miscellaneous Sec. 2585. States failing to adhere to certain employment obligations. Sec. 2586. Health centers under Public Health Service Act; liability protections for volunteer practitioners. Sec. 2587. Report to Congress on the current state of parasitic diseases that have been overlooked among the poorest Americans. Sec. 2588. Office of Women’s Health. Sec. 2589. Long-Term Care and Family Caregiver Support. Sec. 2590. Web site on health care labor market and related educational and training opportunities. Sec. 2591. Online health workforce training programs. Sec. 2592. Access for individuals with disabilities. (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

Subject to section 2003, there is hereby established in the Treasury a separate account to be known as the Public Health Investment Fund (referred to in this section and section 2003 as the Fund). (2)

Funding

(A)There shall be deposited into the Fund— (i)for fiscal year 2011, $4,600,000,000; (ii)for fiscal year 2012, $5,600,000,000; (iii)for fiscal year 2013, $6,900,000,000; (iv)for fiscal year 2014, $7,800,000,000; and (v)for fiscal year 2015, $9,000,000,000. (B)Amounts deposited into the Fund shall be derived from general revenues of the Treasury only for the fiscal years set forth in this section, and amounts appropriated from the Fund shall remain available until expended. (b)

Authorization of appropriations from the Fund

(1)

New funding

(A)

In general

Subject to section 2003, amounts in the Fund are authorized to be appropriated 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(a)(1) 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.)).

2003.

Deficit neutrality

(a)

Availability

Funds appropriated or made available pursuant to sections 330(s), 338(c), 338H–1, 799C, 872, or 3111 of the Public Health Service Act, as added by this division, are only available for the purposes set forth in this Act. Appropriations shall not be available and are precluded from obligation for any other purpose. (b)

Estimation of budgetary impact

For the purposes of estimating the spending effects of this Act, the authorization of appropriations from the Fund, to the extent amounts in the Fund are derived from the general revenues of the Treasury, shall be treated as new direct spending and attributed to this Act. (c)

Budgetary treatment

For the purposes of section 257 of the Balanced Budget and Emergency Deficit Control Act of 1985, the Fund, to the extent amounts in the Fund are derived from the general revenues of the Treasury, and not in excess of amounts subsequently appropriated from the Fund, shall be deemed to be included on the list of appropriations referenced under section 250(c)(17) of that Act.

. (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 3131 and 3132 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 3131 and 3132 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 3131 and 3132 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)

Conforming amendments to Medicaid

For conforming provisions amending the Medicaid program, see section 1739. E

Miscellaneous

2585.

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.

2586.

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)..

2587.

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.

2588.

Office of Women’s Health

(a)

Health and Human Services office on women's health

(1)

Establishment

Part A of title II (42 U.S.C. 202 et seq.) is amended by adding at the end the following:

229.

Health and Human Services Office on Women’s Health

(a)

Establishment of office

There is established within the Office of the Secretary, an Office on Women’s Health (referred to in this section as the Office). The Office shall be headed by a Deputy Assistant Secretary for Women’s Health who may report to the Secretary. (b)

Duties

The Secretary, acting through the Office, with respect to the health concerns of women, shall— (1)establish short-range and long-range goals and objectives within the Department of Health and Human Services and, as relevant and appropriate, coordinate with other appropriate offices on activities within the Department that relate to disease prevention, health promotion, service delivery, research, and public and health care professional education, for issues of particular concern to women throughout their lifespan; (2)provide expert advice and consultation to the Secretary concerning scientific, legal, ethical, and policy issues relating to women’s health; (3)monitor the Department of Health and Human Services’ offices, agencies, and regional activities regarding women’s health and identify needs regarding the coordination of activities, including intramural and extramural multidisciplinary activities; (4)establish a Department of Health and Human Services Coordinating Committee on Women’s Health, which shall be chaired by the Deputy Assistant Secretary for Women’s Health and composed of senior level representatives from each of the agencies and offices of the Department of Health and Human Services; (5)establish a National Women’s Health Information Center to— (A)facilitate the exchange of information regarding matters relating to health information, health promotion, preventive health services, research advances, and education in the appropriate use of health care; (B)facilitate access to such information; (C)assist in the analysis of issues and problems relating to the matters described in this paragraph; and (D)provide technical assistance with respect to the exchange of information (including facilitating the development of materials for such technical assistance); (6)coordinate efforts to promote women’s health programs and policies with the private sector; and (7)through publications and any other means appropriate, provide for the exchange of information between the Office and recipients of grants, contracts, and agreements under subsection (c), and between the Office and health professionals and the general public. (c)

Grants and contracts regarding duties

(1)

Authority

In carrying out subsection (b), the Secretary may make grants to, and enter into cooperative agreements, contracts, and interagency agreements with, public and private entities, agencies, and organizations. (2)

Evaluation and dissemination

The Secretary shall directly or through contracts with public and private entities, agencies, and organizations, provide for evaluations of projects carried out with financial assistance provided under paragraph (1) and for the dissemination of information developed as a result of such projects. (d)

Reports

Not later than 1 year after the date of enactment of this section, and every second year thereafter, the Secretary shall prepare and submit to the appropriate committees of Congress a report describing the activities carried out under this section during the period for which the report is being prepared.

. (2)

Transfer of functions

There are transferred to the Office on Women’s Health (established under section 229 of the Public Health Service Act, as added by this section), all functions exercised by the Office on Women’s Health of the Public Health Service prior to the date of enactment of this section, including all personnel and compensation authority, all delegation and assignment authority, and all remaining appropriations. All orders, determinations, rules, regulations, permits, agreements, grants, contracts, certificates, licenses, registrations, privileges, and other administrative actions that— (A)have been issued, made, granted, or allowed to become effective by the President, any Federal agency or official thereof, or by a court of competent jurisdiction, in the performance of functions transferred under this paragraph; and (B)are in effect at the time this section takes effect, or were final before the date of enactment of this section and are to become effective on or after such date;shall continue in effect according to their terms until modified, terminated, superseded, set aside, or revoked in accordance with law by the President, the Secretary, or other authorized official, a court of competent jurisdiction, or by operation of law. (b)

Centers for disease control and prevention office of women’s health

Part A of title III (42 U.S.C. 241 et seq.) is amended by adding at the end the following:

310A.

Centers for disease control and prevention office of women’s health

(a)

Establishment

There is established within the Office of the Director of the Centers for Disease Control and Prevention, an office to be known as the Office of Women’s Health (referred to in this section as the Office). The Office shall be headed by a director who shall be appointed by the Director of such Centers. (b)

Purpose

The Director of the Office shall— (1)report to the Director of the Centers for Disease Control and Prevention on the current level of the Centers’ activity regarding women’s health conditions across, where appropriate, age, biological, and sociocultural contexts, in all aspects of the Centers’ work, including prevention programs, public and professional education, services, and treatment; (2)establish short-range and long-range goals and objectives within the Centers for women’s health and, as relevant and appropriate, coordinate with other appropriate offices on activities within the Centers that relate to prevention, research, education and training, service delivery, and policy development, for issues of particular concern to women; (3)identify projects in women’s health that should be conducted or supported by the Centers; (4)consult with health professionals, nongovernmental organizations, consumer organizations, women’s health professionals, and other individuals and groups, as appropriate, on the policy of the Centers with regard to women; and (5)serve as a member of the Department of Health and Human Services Coordinating Committee on Women’s Health (established under section 229(b)(4)). (c)

Definition

As used in this section, the term women's health conditions, with respect to women of all age, ethnic, and racial groups, means diseases, disorders, and conditions— (1)unique to, significantly more serious for, or significantly more prevalent in women; and (2)for which the factors of medical risk or type of medical intervention are different for women, or for which there is reasonable evidence that indicates that such factors or types may be different for women.

. (c)

Office of women’s health research

Section 486(a) (42 U.S.C. 287d(a)) is amended by inserting and who shall report directly to the Director before the period at the end thereof. (d)

Substance abuse and mental health services administration

Section 501(f) (42 U.S.C. 290aa(f)) is amended— (1)in paragraph (1), by inserting who shall report directly to the Administrator before the period; (2)by redesignating paragraph (4) as paragraph (5); and (3)by inserting after paragraph (3), the following: (4)

Office

Nothing in this subsection shall be construed to preclude the Secretary from establishing within the Substance Abuse and Mental Health Administration an Office of Women’s Health.. (e)

Agency for Healthcare Research and Quality activities regarding women’s health

Part C of title IX (42 U.S.C. 299c et seq.) is amended— (1)by redesignating sections 927 and 928 as sections 928 and 929, respectively; (2)by inserting after section 926 the following:

927.

Activities regarding women’s health

(a)

Establishment

There is established within the Office of the Director, an Office of Women’s Health and Gender-Based Research (referred to in this section as the Office). The Office shall be headed by a director who shall be appointed by the Director of Healthcare and Research Quality. (b)

Purpose

The official designated under subsection (a) shall— (1)report to the Director on the current Agency level of activity regarding women’s health, across, where appropriate, age, biological, and sociocultural contexts, in all aspects of Agency work, including the development of evidence reports and clinical practice protocols and the conduct of research into patient outcomes, delivery of health care services, quality of care, and access to health care; (2)establish short-range and long-range goals and objectives within the Agency for research important to women’s health and, as relevant and appropriate, coordinate with other appropriate offices on activities within the Agency that relate to health services and medical effectiveness research, for issues of particular concern to women; (3)identify projects in women’s health that should be conducted or supported by the Agency; (4)consult with health professionals, nongovernmental organizations, consumer organizations, women’s health professionals, and other individuals and groups, as appropriate, on Agency policy with regard to women; and (5)serve as a member of the Department of Health and Human Services Coordinating Committee on Women’s Health (established under section 229(b)(4)).

; and (3)by adding at the end of section 928 (as redesignated by paragraph (1)) the following: (e)

Women’s health

For the purpose of carrying out section 927 regarding women’s health, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2011 through 2015.. (f)

Health resources and services administration office of women’s health

Title VII of the Social Security Act (42 U.S.C. 901 et seq.) is amended by adding at the end the following:

713.

Office of Women’s Health

(a)

Establishment

The Secretary shall establish within the Office of the Administrator of the Health Resources and Services Administration, an office to be known as the Office of Women’s Health. The Office shall be headed by a director who shall be appointed by the Administrator. (b)

Purpose

The Director of the Office shall— (1)report to the Administrator on the current Administration level of activity regarding women’s health across, where appropriate, age, biological, and sociocultural contexts; (2)establish short-range and long-range goals and objectives within the Health Resources and Services Administration for women’s health and, as relevant and appropriate, coordinate with other appropriate offices on activities within the Administration that relate to health care provider training, health service delivery, research, and demonstration projects, for issues of particular concern to women; (3)identify projects in women’s health that should be conducted or supported by the bureaus of the Administration; (4)consult with health professionals, nongovernmental organizations, consumer organizations, women’s health professionals, and other individuals and groups, as appropriate, on Administration policy with regard to women; and (5)serve as a member of the Department of Health and Human Services Coordinating Committee on Women’s Health (established under section 229(b)(4) of the Public Health Service Act). (c)

Continued administration of existing programs

The Director of the Office shall assume the authority for the development, implementation, administration, and evaluation of any projects carried out through the Health Resources and Services Administration relating to women’s health on the date of enactment of this section. (d)

Definitions

For purposes of this section: (1)

Administration

The term Administration means the Health Resources and Services Administration. (2)

Administrator

The term Administrator means the Administrator of the Health Resources and Services Administration. (3)

Office

The term Office means the Office of Women’s Health established under this section in the Administration.

. (g)

Food and drug administration office of women’s health

Chapter IX of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 391 et seq.) is amended by adding at the end the following:

911.

Office of Women’s Health

(a)

Establishment

There is established within the Office of the Commissioner, an office to be known as the Office of Women’s Health (referred to in this section as the Office). The Office shall be headed by a director who shall be appointed by the Commissioner of Food and Drugs. (b)

Purpose

The Director of the Office shall— (1)report to the Commissioner of Food and Drugs on current Food and Drug Administration (referred to in this section as the Administration) levels of activity regarding women’s participation in clinical trials and the analysis of data by sex in the testing of drugs, medical devices, and biological products across, where appropriate, age, biological, and sociocultural contexts; (2)establish short-range and long-range goals and objectives within the Administration for issues of particular concern to women’s health within the jurisdiction of the Administration, including, where relevant and appropriate, adequate inclusion of women and analysis of data by sex in Administration protocols and policies; (3)provide information to women and health care providers on those areas in which differences between men and women exist; (4)consult with pharmaceutical, biologics, and device manufacturers, health professionals with expertise in women’s issues, consumer organizations, and women’s health professionals on Administration policy with regard to women; (5)make annual estimates of funds needed to monitor clinical trials and analysis of data by sex in accordance with needs that are identified; and (6)serve as a member of the Department of Health and Human Services Coordinating Committee on Women’s Health (established under section 229(b)(4) of the Public Health Service Act).

. (h)

No new regulatory authority

Nothing in this section and the amendments made by this section may be construed as establishing regulatory authority or modifying any existing regulatory authority. (i)

Limitation on termination

Notwithstanding any other provision of law, a Federal office of women’s health (including the Office of Research on Women’s Health of the National Institutes of Health) or Federal appointive position with primary responsibility over women’s health issues (including the Associate Administrator for Women’s Services under the Substance Abuse and Mental Health Services Administration) that is in existence on the date of enactment of this section shall not be terminated, reorganized, or have any of its powers or duties transferred unless such termination, reorganization, or transfer is approved by an Act of Congress. (j)

Rule of construction

Nothing in this section (or the amendments made by this section) shall be construed to limit the authority of the Secretary of Health and Human Services with respect to women’s health, or with respect to activities carried out through the Department of Health and Human Services on the date of enactment of this section.

2589.

Long-Term Care and Family Caregiver Support

(a)

Amendments to the Older Americans Act of 1965

(1)

Promotion of direct care workforce

Section 202(b)(1) of the Older Americans Act of 1965 (42 U.S.C. 3012(b)(1)) is amended by inserting before the semicolon the following: , and, in carrying out the purposes of this paragraph, shall make recommendations to other Federal entities regarding appropriate and effective means of identifying, promoting, and implementing investments in the direct care workforce necessary to meet the growing demand for long-term health services and supports and of assisting States in developing a comprehensive State workforce development plan with respect to such workforce, including assisting efforts to systematically assess, track, and report on workforce adequacy and capacity. (2)

Personal care attendant workforce advisory panel

Section 202 of such Act (42 U.S.C. 3012) is amended by adding at the end the following: (g) (1)Not later than 90 days after the date of the enactment of this subsection, the Assistant Secretary shall establish a Personal Care Attendant Workforce Advisory Panel to examine and formulate recommendations on— (A)working conditions and training for workers providing long-term services and supports, including home health aides, certified nurse aides, and personal care attendants; and (B)other workforce issues related to such workers, including with respect to the adequacy of the number of such workers; the salaries, wages, and benefits of such workers; and access to the services provided by such workers. (2)The Panel shall include representatives of— (A)relevant home- and community-based service providers, health care agencies, and facilities (including personal or home care agencies, home health care agencies, nursing homes, assisted living facilities, and residential care facilities); (B)the disability community, including individuals with disabilities and family caregivers; (C)the nursing community; (D)direct care workers (which may include unions and national organizations); (E)older individuals, including senior individuals and family caregivers; (F)State and Federal health care entities; and (G)experts in workforce development and adult learning. (3)Within one year after the establishment of the Panel, the Panel shall submit a report to the Assistant Secretary and the Congress on workforce issues related to providing long-term services and supports, including information on core competencies for eligible personal or home care aides necessary to successfully provide long-term services and supports to eligible consumers, as well as recommended training curricula and resources. (4)Within 180 days after receipt by the Assistant Secretary of the report under paragraph (3), the Assistant Secretary shall establish a 3-year demonstration program in 4 States to pilot and evaluate the effectiveness of the competencies articulated by the Panel and the training curricula and training methods recommended by the Panel. (5)Not later than 1 year after the completion of the demonstration program under paragraph (4), the Assistant Secretary shall submit to the Congress a report containing the results of the evaluations by the Assistant Secretary pursuant to paragraph (4), together with such recommendations for legislation or administrative action as the Assistant Secretary determines appropriate.. (b)

Authorization of Additional Appropriations for the Family Caregiver Support Program Under the Older Americans Act of 1965

Section 303(e)(2) of the Older Americans Act of 1965 (42 U.S.C. 3023(e)(2)) is amended by striking , $173,000,000 and all that follows through 2011, and inserting and $250,000,000 for each of fiscal years 2011, 2012, and 2013.

2590.

Web site on health care labor market and related educational and training opportunities

(a)

In General

The Secretary of Labor, in consultation with the National Center for Health Workforce Analysis, shall establish and maintain a Web site to serve as a comprehensive source of information, searchable by workforce region, on the health care labor market and related educational and training opportunities. (b)

Contents

The Web site maintained under this section shall include the following: (1)Information on the types of jobs that are currently or are projected to be in high demand in the health care field, including— (A)salary information; and (B)training requirements, such as requirements for educational credentials, licensure, or certification. (2)Information on training and educational opportunities within each region for the type of jobs described in paragraph (1), including by— (A)type of provider or program (such as public, private nonprofit, or private for-profit); (B)duration; (C)cost (such as tuition, fees, books, laboratory expenses, and other mandatory costs); (D)performance outcomes (such as graduation rates, job placement, average salary, job retention, and wage progression); (E)Federal financial aid participation; (F)average graduate loan debt; (G)student loan default rates; (H)average institutional grant aid provided; (I)Federal and State accreditation information; and (J)other information determined by the Secretary. (3)A mechanism for searching and comparing training and educational options for specific health care occupations to facilitate informed career and education choices. (4)Financial aid information, including with respect to loan forgiveness, loan cancellation, loan repayment, stipends, scholarships, and grants or other assistance authorized by this Act or other Federal or State programs. (c)

Public Accessibility

The Web site maintained under this section shall— (1)be publicly accessible; (2)be user friendly and convey information in a manner that is easily understandable; and (3)be in English and the second most prevalent language spoken based on the latest Census information.

2591.

Online health workforce training programs

Section 171 of the Workforce Investment Act of 1998 (29 U.S.C. 2916) is amended by adding at the end the following: (f)

Online Health Workforce Training Program

(1)

Grant program

(A)

In general

The Secretary in consultation with the Secretary of Health and Human Services, shall award National Health Workforce Online Training Grants on a competitive basis to eligible entities to enable such entities to carry out training for individuals to attain or advance in health care occupations. An entity may leverage such grant with other Federal, State, local, and private resources, in order to expand the participation of businesses, employees, and individuals in such training programs. (B)

Eligibility

In order to receive a grant under the program established under this paragraph— (i)an entity shall be an educational institution, community-based organization, nonprofit organization, workforce investment board, or local or county government; and (ii)an entity shall provide online workforce training for individuals seeking to attain or advance in health care occupations, including nursing, nursing assistants, dentistry, pharmacy, health care management and administration, public health, health information systems analysis, medical assistants, and other health care practitioner and support occupations. (C)

Priority

Priority in awarding grants under this paragraph shall be given to entities that— (i)have demonstrated experience in implementing and operating online worker skills training and education programs; (ii)have demonstrated experience coordinating activities, where appropriate, with the workforce investment system; and (iii)conduct training for occupations with national or local shortages. (D)

Data collection

Grantees under this paragraph shall collect and report information on— (i)the number of participants; (ii)the services received by the participants; (iii)program completion rates; (iv)factors determined as significantly interfering with program participation or completion; (v)the rate of job placement; and (vi)other information as determined as needed by the Secretary. (E)

Outreach

Grantees under this paragraph shall conduct outreach activities to disseminate information about their program and results to workforce investment boards, local governments, educational institutions, and other workforce training organizations. (F)

Performance levels

The Secretary shall establish indicators of performance that will be used to evaluate the performance of grantees under this paragraph in carrying out the activities described in this paragraph. The Secretary shall negotiate and reach agreement with each grantee regarding the levels of performance expected to be achieved by the grantee on the indicators of performance. (G)

Authorization of appropriations

There are authorized to be appropriated to the Secretary to carry out this subsection $50,000,000 for fiscal years 2011 through 2020. (2)

Online health professions training program clearinghouse

(A)

Description of grant

The Secretary may award one or more grants to eligible postsecondary educational institutions to provide the services described in this paragraph. (B)

Eligibility

To be eligible to receive a grant under this paragraph, a postsecondary educational institution shall— (i)have demonstrated the ability to disseminate research on best practices for implementing workforce investment programs; and (ii)be a national leader in producing cutting-edge research on technology related to workforce investment systems under subtitle B. (C)

Services

The postsecondary educational institution that receives a grant under this paragraph shall use such grant— (i)to provide technical assistance to entities that receive grants under paragraph (1); (ii)to collect and nationally disseminate the data gathered by entities that receive grants under paragraph (1); and (iii)to disseminate the best practices identified by the National Health Workforce Online Training Grant Program to other workforce training organizations. (D)

Authorization of appropriations

There are authorized to be appropriated to the Secretary to carry out this subsection $1,000,000 for fiscal years 2011 through 2020..

2592.

Access for individuals with disabilities

Title V of the Rehabilitation Act of 1973 (29 U.S.C. 791 et seq.) is amended by adding at the end of the following:

510.

Standards for accessibility of medical diagnostic equipment

(a)

Standards

Not later than 9 months after the date of enactment of the Affordable Health Care for America Act, the Architectural and Transportation Barriers Compliance Board (Access Board) shall issue guidelines setting forth the minimum technical criteria for new medical diagnostic equipment to be purchased for use in (or in conjunction with) physician’s offices, clinics, emergency rooms, hospitals, and other medical settings. The guidelines shall ensure that such equipment is accessible to, and usable by, individuals with disabilities, including provisions to ensure independent entry to, use of, and exit from the equipment by such individuals to the maximum extent possible. (b)

Medical diagnostic equipment covered

The guidelines issued under subsection (a) for medical diagnostic equipment shall apply to new purchases of equipment that includes examination tables, examination chairs (including chairs used for eye examinations or procedures, and dental examinations or procedures), weight scales, mammography equipment, x-ray machines, and other equipment commonly used for diagnostic or examination purposes by health professionals. (c)

Regulations

Not later than 6 months after the date of the issuance of the guidelines under subsection (a), each appropriate Federal agency authorized to promulgate regulations under this Act or under the Americans with Disabilities Act shall— (1)prescribe regulations in an accessible format as necessary to carry out the provisions of such Act and section 504 of this Act that include accessibility standards that are consistent with the guidelines issued under subsection (a); and (2)ensure that health care providers and health care plans covered by the Affordable Health Care for America Act meet the requirements of the Americans with Disabilities Act and section 504, including provisions ensuring that individuals with disabilities receive equal access to all aspects of the health care delivery system. (d)

Review and amend

The Architectural and Transportation Barriers Compliance Board (Access Board) shall periodically review and, as appropriate, amend the guidelines as prescribed under subsection (a). Not later than 6 months after the date of the issuance of such revised guidelines, revised regulations consistent with such guidelines shall be promulgated in an accessible format by the appropriate Federal agencies described in subsection (c).

.

D

Indian Health Care Improvement

3001.

Short title; table of contents

(a)

Short title

This division may be cited as the Indian Health Care Improvement Act Amendments of 2009. (b)

Table of contents

The table of contents of this division is as follows: Division D—Indian Health Care Improvement Sec. 3001. Short title; table of contents. Title I—Amendments to Indian Laws Sec. 3101. Indian Health Care Improvement At amended. Sec. 3102. Soboba sanitation facilities. Sec. 3103. Native American Health and Wellness Foundation. Sec. 3104. GAO study and report on payments for contract health services. Title II—Improvement of Indian Health Care Provided Under the Social Security Act Sec. 3201. Expansion of payments under Medicare, Medicaid, and SCHIP for all covered services furnished by Indian Health Programs. Sec. 3202. Additional provisions to increase outreach to, and enrollment of, Indians in SCHIP and Medicaid. Sec. 3203. Solicitation of proposals for safe harbors under the Social Security Act for facilities of Indian Health Programs and urban Indian organizations. Sec. 3204. Annual report on Indians served by Social Security Act health benefit programs. Sec. 3205. Development of recommendations to improve interstate coordination of Medicaid and SCHIP coverage of Indian children and other children who are outside of their State of residency because of educational or other needs.

. (b)

Rate of pay

(1)

Positions at level IV

Section 5315 of title 5, United States Code, is amended by striking Assistant Secretaries of Health and Human Services (6). and inserting Assistant Secretaries of Health and Human Services (7). (2)

Positions at level V

Section 5316 of title 5, United States Code, is amended by striking Director, Indian Health Service, Department of Health and Human Services. (c)

Amendments to other provisions of law

(1)Section 3307(b)(1)(C) of the Children’s Health Act of 2000 (25 U.S.C. 1671 note; Public Law 106–310) is amended by striking Director of the Indian Health Service and inserting Assistant Secretary for Indian Health. (2)The Indian Lands Open Dump Cleanup Act of 1994 is amended— (A)in section 3 (25 U.S.C. 3902)— (i)by striking paragraph (2); (ii)by redesignating paragraphs (1), (3), (4), (5), and (6) as paragraphs (4), (5), (2), (6), and (1), respectively, and moving those paragraphs so as to appear in numerical order; and (iii)by inserting before paragraph (4) (as redesignated by subclause (II)) the following: (3)

Assistant Secretary

The term Assistant Secretary means the Assistant Secretary for Indian Health.; (B)in section 5 (25 U.S.C. 3904), by striking the section designation and heading and inserting the following:

5.

Authority of Assistant Secretary for Indian Health

; (C)in section 6(a) (25 U.S.C. 3905(a)), in the subsection heading, by striking Director and inserting Assistant Secretary; (D)in section 9(a) (25 U.S.C. 3908(a)), in the subsection heading, by striking Director and inserting Assistant Secretary; and (E)by striking Director each place it appears and inserting Assistant Secretary. (3)Section 5504(d)(2) of the Augustus F. Hawkins-Robert T. Stafford Elementary and Secondary School Improvement Amendments of 1988 (25 U.S.C. 2001 note; Public Law 100–297) is amended by striking Director of the Indian Health Service and inserting Assistant Secretary for Indian Health. (4)Section 203(a)(1) of the Rehabilitation Act of 1973 (29 U.S.C. 763(a)(1)) is amended by striking Director of the Indian Health Service and inserting Assistant Secretary for Indian Health. (5)Subsections (b) and (e) of section 518 of the Federal Water Pollution Control Act (33 U.S.C. 1377) are amended by striking Director of the Indian Health Service each place it appears and inserting Assistant Secretary for Indian Health. (6)Section 317M(b) of the Public Health Service Act (42 U.S.C. 247b–14(b)) is amended— (A)by striking Director of the Indian Health Service each place it appears and inserting Assistant Secretary for Indian Health; and (B)in paragraph (2)(A), by striking the Directors referred to in such paragraph and inserting the Director of the Centers for Disease Control and Prevention and the Assistant Secretary for Indian Health. (7)Section 417C(b) of the Public Health Service Act (42 U.S.C. 285–9(b)) is amended by striking Director of the Indian Health Service and inserting Assistant Secretary for Indian Health. (8)Section 1452(i) of the Safe Drinking Water Act (42 U.S.C. 300j–12(i)) is amended by striking Director of the Indian Health Service each place it appears and inserting Assistant Secretary for Indian Health. (9)Section 803B(d)(1) of the Native American Programs Act of 1974 (42 U.S.C. 2991b–2(d)(1)) is amended in the last sentence by striking Director of the Indian Health Service and inserting Assistant Secretary for Indian Health. (10)Section 203(b) of the Michigan Indian Land Claims Settlement Act (Public Law 105–143; 111 Stat. 2666) is amended by striking Director of the Indian Health Service and inserting Assistant Secretary for Indian Health.

3102.

Soboba sanitation facilities

The Act of December 17, 1970 (84 Stat. 1465), is amended by adding at the end the following:

9.Nothing in this Act shall preclude the Soboba Band of Mission Indians and the Soboba Indian Reservation from being provided with sanitation facilities and services under the authority of section 7 of the Act of August 5, 1954 (68 Stat. 674), as amended by the Act of July 31, 1959 (73 Stat. 267).

.

3103.

Native American Health and Wellness Foundation

(a)

In general

The Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) is amended by adding at the end the following: . (b)

Technical amendments

The Indian Self-Determination and Education Assistance Act is amended— (1)by redesignating title V (25 U.S.C. 458bbb et seq.) as title VII; (2)by redesignating sections 501, 502, and 503 (25 U.S.C. 458bbb, 458bbb–1, 458bbb–2) as sections 701, 702, and 703, respectively; and (3)in subsection (a)(2) of section 702 and paragraph (2) of section 703 (as redesignated by paragraph (2)), by striking section 501 and inserting section 701.

3104.

GAO study and report on payments for contract health services

(a)

Study

(1)

In general

The Comptroller General of the United States (in this section referred to as the Comptroller General) shall conduct a study on the utilization of health care furnished by health care providers under the contract health services program funded by the Indian Health Service and operated by the Indian Health Service, an Indian Tribe, or a Tribal Organization (as those terms are defined in section 4 of the Indian Health Care Improvement Act). (2)

Analysis

The study conducted under paragraph (1) shall include an analysis of— (A)the amounts reimbursed under the contract health services program described in paragraph (1) for health care furnished by entities, individual providers, and suppliers, including a comparison of reimbursement for such health care through other public programs and in the private sector; (B)barriers to accessing care under such contract health services program, including, but not limited to, barriers relating to travel distances, cultural differences, and public and private sector reluctance to furnish care to patients under such program; (C)the adequacy of existing Federal funding for health care under such contract health services program; and (D)any other items determined appropriate by the Comptroller General. (b)

Report

Not later than 18 months after the date of enactment of this Act, the Comptroller General shall submit to Congress a report on the study conducted under subsection (a), together with recommendations regarding— (1)the appropriate level of Federal funding that should be established for health care under the contract health services program described in subsection (a)(1); and (2)how to most efficiently utilize such funding. (c)

Consultation

In conducting the study under subsection (a) and preparing the report under subsection (b), the Comptroller General shall consult with the Indian Health Service, Indian Tribes, and Tribal Organizations.