1.This Act may be cited as the
Medical Rights and Reform Act of
2009
.
2.
Sec. 1. Short title.
Sec. 2. Table of contents.
Title I—Protecting the Doctor-Patient Relationship
Sec. 101. Prohibition on restrictions on the practice of
medicine and other health care professions.
Sec. 102. Right to contract for health care services and health
insurance.
Sec. 103. Prohibition on mandating State
restrictions.
Sec. 104. Clarification.
Sec. 105. Conforming amendment.
Sec. 106. Definitions.
Sec. 107. Effective date.
Title II—Improving quality and lowering the cost of health
care
Subtitle A—Equity for Our Nation’s Self-Employed
Sec. 201. SECA tax deduction for health insurance
costs.
Subtitle B—Help Efficient, Accessible, Low-cost, Timely
Healthcare
Sec. 211. Findings and purpose.
Sec. 212. Encouraging speedy resolution of claims.
Sec. 213. Compensating patient injury.
Sec. 214. Maximizing patient recovery.
Sec. 215. Additional HEALTH benefits.
Sec. 216. Punitive damages.
Sec. 217. Authorization of payment of future damages to
claimants in HEALTH care lawsuits.
Sec. 218. Definitions.
Sec. 219. Effect on other laws.
Sec. 220. State flexibility and protection Sf states’
rights.
Sec. 221. Applicability; effective date.
Sec. 222. Sense of Congress.
Subtitle C—Accelerating the Deployment of Health Information
Technology
Part 1—Enhanced coordination and adoption of health information
technology
Sec. 231. Strategic plan for coordinating implementation of
Medicare and Medicaid health information technology incentive
payments.
Sec. 232. Procedures to ensure timely updating of standards
that enable electronic exchanges.
Sec. 233. Study to improve preservation and protection of
security and confidentiality of health information.
Sec. 234. Assisting Doctors to Obtain Proficient and
Transmissible Health Information Technology.
Sec. 235. Expansion of Stark and anti-kickback exceptions for
electronic health records arrangements.
Sec. 236. Application of Medicare EHR incentives and
adjustments to additional providers.
Part 2—Telehealth Enhancement
Subpart A—Medicare Program
Sec. 241. Expansion and improvement of telehealth
services.
Sec. 242. Increase in number of types of originating sites;
clarification.
Sec. 243. Expansion of eligible telehealth providers and
credentialing of telemedicine practitioners.
Sec. 244. Access to telehealth services in the
home.
Sec. 245. Coverage of home health remote patient management
services for chronic health conditions.
Sec. 246. Sense of Congress on the use of remote patient
management services.
Sec. 247. Telehealth Advisory Committee.
Subpart B—HRSA Grant Program
Sec. 250. Grant program for the development of telehealth
networks.
Sec. 251. Reauthorization of telehealth network and telehealth
resource centers grant programs.
Subtitle D—Eliminating Waste, Fraud, and Abuse
Sec. 261. Site inspections; background checks; denial and
suspension of billing privileges.
Sec. 262. Registration and background checks of billing
agencies and individuals.
Sec. 263. Expanded access to the healthcare integrity and
protection data bank (HIPDB).
Sec. 264. Liability of Medicare administrative contractors for
claims submitted by excluded providers.
Sec. 265. Community mental health centers.
Sec. 266. Limiting the discharge of debts in bankruptcy
proceedings in cases where a health care provider or a supplier engages in
fraudulent activity.
Sec. 267. Illegal distribution of a Medicare or Medicaid
beneficiary identification or billing privileges.
Sec. 268. Treatment of certain Social Security Act crimes as Federal health
care offenses.
Sec. 269. Authority of Office of Inspector General of the
Department of Health and Human Services.
Sec. 270. Universal product numbers on claims forms for
reimbursement under the Medicare Program.
Subtitle E—Promoting Health and Preventing Chronic Disease
through Prevention and Wellness Programs
Sec. 281. Findings.
Sec. 282. Tax credit to employers for costs of implementing
prevention and wellness programs.
Sec. 283. Grants to increase physical activity and emotional
wellness, improve nutrition, and promote healthy eating behaviors.
Sec. 284. Prevention and wellness programs for individuals and
families.
Title III—Expanding Access to Health Care
Subtitle A—State Innovation Program
Sec. 301. Ensuring affordability and access through universal
access programs.
Sec. 302. Enhanced Federal funding and reduced red-tape for
State efforts to improve access to health insurance coverage.
Sec. 303. State innovation program described.
Sec. 304. State transparency program described.
Sec. 305. Health plan finder.
Sec. 306. Small business health plans.
Sec. 307. Interstate compacts on health insurance
regulation.
Sec. 308. Definitions.
Sec. 309. Authorization for appropriations.
Subtitle B—Interstate Market for Health Insurance
Sec. 311. Specification of constitutional authority for
enactment of law.
Sec. 312. Findings.
Sec. 313. Cooperative governing of individual health insurance
coverage.
Sec. 314. Severability.
Subtitle C—Young Adult Healthcare Coverage
Sec. 321. Requiring the option of extension of dependent
coverage for certain unmarried, uninsured young adults.
Title IV—Offsets
Sec. 401. Transfer of unobilgated stimulus funds.
<enum>I</enum><header>Protecting the
Doctor-Patient Relationship</header>
<section id="HF3F70FA8F98A4C1AB8CD8CD217EDACFB"><enum>101.</enum><header>Prohibition on
restrictions on the practice of medicine and other health care
professions</header>
<subsection id="HC6E18F61E24B4151978F8DB74FE84F59"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Subject to subsection
(b), no Federal funds shall be used to permit any Federal officer or employee
to exercise any supervision or control over—</text>
<paragraph id="H4A9F88EE1542409BBC605A74118F6A73"><enum>(1)</enum><text>the practice of
medicine, the practice of other health care professions, or the manner in which
health care services are provided;</text>
</paragraph><paragraph id="HCD4B51DFA48847729058B239D195D5D6"><enum>(2)</enum><text>the provision, by
a physician or a health care practitioner, of advice to a patient about the
patient’s health status or recommended treatment for a condition or
disease;</text>
</paragraph><paragraph id="H0926E90FF34947208164E7A23E310A6E"><enum>(3)</enum><text>the selection,
tenure, or compensation of any officer, employee, or contractor of any
institution, business, non-Federal agency, or individual providing health care
services; or</text>
</paragraph><paragraph id="H0CDF1475D769486B8BF6394E44860D84"><enum>(4)</enum><text>the administration
or operation of any such institution, business, non-Federal agency, or
individual, with respect to the provision of health care services to a
patient.</text>
</paragraph></subsection><subsection id="H0860B7F553E848DB818F0A377023D717"><enum>(b)</enum><header>Preserving
certain current programs</header><text display-inline="yes-display-inline">Subsection (a) shall not prohibit the
Federal Government from operating, managing, supervising employees of, or
defining the scope of services provided by Federal entities when directly
providing health care services and products, only with respect to the
following:</text>
<paragraph id="HB13452F181A2481F9BE33FE7093B0CDA"><enum>(1)</enum><text display-inline="yes-display-inline">The Veterans Health Administration—</text>
<subparagraph id="H64DD6026C8594841A774B1EB1DC538F4"><enum>(A)</enum><text display-inline="yes-display-inline">in the case of directly providing health
care services through its own facilities and by its own employees; or</text>
</subparagraph><subparagraph id="H1649C54552A341C0B9F9EAD6EB0D28F5"><enum>(B)</enum><text>in the case of
coordinating health care services not described in subparagraph (A) and paid
for with Federal funds under programs operated by the Veterans Health
Administration.</text>
</subparagraph></paragraph><paragraph id="HFE00DB99BA664618A9B1B500A9E8CC86"><enum>(2)</enum><text>The Department of
Defense—</text>
<subparagraph id="HF417CEC935414BD8A8CA00E12BE4B7AA"><enum>(A)</enum><text display-inline="yes-display-inline">in the case of directly providing health
care services through military treatment facilities;</text>
</subparagraph><subparagraph id="HC398F114EB004CC289E0508855960D2E"><enum>(B)</enum><text>in the case of
paying for health care services for active-duty members of the Armed Forces or
members of the Reserve component when called to active duty;</text>
</subparagraph><subparagraph id="HA5FD1FAA7B944F9C93986A39E561A7F4"><enum>(C)</enum><text>in the case of
directly providing health care services to the public in the event of emergency
or under other lawful circumstances; or</text>
</subparagraph><subparagraph id="HBF2BE9453D49460B9F294FEAC215A0BC"><enum>(D)</enum><text>when necessary to
determine whether health care services provided to those who are not
active-duty members of the Armed Forces are eligible for payment with Federal
funds or to coordinate health care services for patients who are served by both
non-Federal entities and military treatment facilities.</text>
</subparagraph></paragraph><paragraph id="HA9B31C9BDDDB493ABE9085400D1002C3"><enum>(3)</enum><text>The United States
Public Health Service—</text>
<subparagraph id="H65A51BED73D74CA0AC8A296DB6E25F82"><enum>(A)</enum><text display-inline="yes-display-inline">in the case of providing health care
services through its own facilities or by its officers or civilian Federal
employees;</text>
</subparagraph><subparagraph id="HE05267D70F6247859AFAECC345F777B6"><enum>(B)</enum><text>in the case of
providing or paying for health care services to active-duty members of
uniformed services or to Reserve members of such services when called to active
duty; or</text>
</subparagraph><subparagraph id="H185148D2486C4DC4A5540555BA18DD71"><enum>(C)</enum><text>when necessary to
determine whether health care services provided to those who are not
active-duty members of uniformed services are eligible for payment with Federal
funds or to coordinate health care services for patients who are served by both
non-Federal entities and Public Health Service treatment facilities.</text>
</subparagraph></paragraph><paragraph id="H2DCF574522B647F9AA020326B813685F"><enum>(4)</enum><text>The Indian Health
Service—</text>
<subparagraph id="H990B5BBE40BE45A390B8EE608792D580"><enum>(A)</enum><text display-inline="yes-display-inline">in the case of directly providing health
care services through its own facilities or Federal employees; or</text>
</subparagraph><subparagraph id="H83E1266384BC43AF8C5E2F9E59B9AAB2"><enum>(B)</enum><text>in the case of
providing care by non-Federal entities, to the extent necessary to administer
contracts and grants pursuant to the Indian Health Care Improvement Act.</text>
</subparagraph></paragraph><paragraph id="HBCC928624DB14C87BD8B5EAF7D21F722"><enum>(5)</enum><text>The National
Institutes of Health—</text>
<subparagraph id="HDDFCB8F9832F46338DBEFAA6533FAA66"><enum>(A)</enum><text display-inline="yes-display-inline">in the case of providing direct patient
care incident to medical research; or</text>
</subparagraph><subparagraph id="HEC69B728C0E84714A8841FB764BC0011"><enum>(B)</enum><text display-inline="yes-display-inline">in the case of administering grants for
medical research, but in no case shall a non-Federal entity be required or
requested to waive the protections of subsection (a) for health care services
not incident to medical research funded by the National Institutes of Health as
a condition of receiving research grant funding from the National Institutes of
Health.</text>
</subparagraph></paragraph><paragraph id="HBAD512A667BA4489962625E2A46A092E"><enum>(6)</enum><text display-inline="yes-display-inline">The Health Resources and Services
Administration—</text>
<subparagraph id="H2C50A1FC36394827A555A9E2F22D0293"><enum>(A)</enum><text display-inline="yes-display-inline">in the case of certifying federally
qualified health centers, as defined by section 1905(l)(2)(B) of the Social
Security Act (42 U.S.C. 1396d(l)(2)(B)), certifying FQHC look-alike status, as
defined in section 413.65(n) of title 45 of the Code of Federal Regulations, or
providing grants under section 330 of the Public Health Service Act (42 U.S.C.
254b), but only to the extent necessary to determine eligibility for such
certification and grant funding and the appropriate amounts of such funding;
or</text>
</subparagraph><subparagraph id="H31779B592CA24EEE8367B6FEAFDFC711"><enum>(B)</enum><text>in the case of
operating the nation’s human organ, bone marrow, and umbilical cord blood
donation and transplantation systems, as and to the extent authorized by law
and necessary for the operation of those programs.</text>
</subparagraph></paragraph></subsection></section><section id="HF527AF40DC104DEC8A2A57F06B9F6570"><enum>102.</enum><header>Right to
contract for health care services and health insurance</header>
<subsection id="H72B0D6B430A34F6AA21E3337868148E6"><enum>(a)</enum><header>Receipt of
health services</header><text>No Federal funds shall be used by any Federal
officer or employee to prohibit any individual from receiving health care
services from any provider of health care services—</text>
<paragraph id="HE044B40525AA4318BCE2B31CF5600495"><enum>(1)</enum><text>under terms and
conditions mutually acceptable to the patient and the provider; or</text>
</paragraph><paragraph id="H28305A8B49F94F77B3E19E61FEEC448A"><enum>(2)</enum><text>under terms and
conditions mutually acceptable to the patient, the provider, and any group
health plan or health insurance issuer that is obligated to provide health
insurance coverage to the patient or any other entity indemnifying the
patient’s consumption of health care services;</text>
</paragraph><continuation-text continuation-text-level="subsection">provided
that any such agreement shall be subject to the requirements of section 1802(b)
of the Social Security Act (42 U.S.C. 1395a(b)), as amended by section
105.</continuation-text></subsection><subsection id="H2092C73E1CF94D96B33AA0D7F7799DF5"><enum>(b)</enum><header>Health insurance
coverage</header><text display-inline="yes-display-inline">No Federal funds
shall be used by any Federal officer or employee to prohibit any person from
entering into a contract with any group health plan, health insurance issuer,
or other business, for the provision of, or payment to other parties for,
health care services to be determined and provided subsequent to the effective
date of the contract, according to terms, conditions, and procedures specified
in such contract.</text>
</subsection><subsection id="H62C1D716B9D04C2B97A581FE490370FB"><enum>(c)</enum><header>Eligibility for
Federal benefits</header><text display-inline="yes-display-inline">No person’s
eligibility for benefits under any program operated by or funded wholly or
partly by the Federal Government shall be adversely affected as a result of
having received services in a manner described by subsection (a) or having
entered into a contract described in subsection (b).</text>
</subsection><subsection id="H89CC102D027C4174A151F315B477F8E8"><enum>(d)</enum><header>Federal program
participation</header><text display-inline="yes-display-inline">No provider of
health care services—</text>
<paragraph id="H0AC909E6BD964C21A4AC71F674C4E9DF"><enum>(1)</enum><text>shall be denied
participation in a Federal program for which it would otherwise be eligible as
a result of having provided services in a manner described in subsection (a);
or</text>
</paragraph><paragraph id="H52BEB6452D77440187290387596EB827"><enum>(2)</enum><text>shall be denied
payment for services otherwise eligible for payment under a Federal program as
a result of having provided services in a manner described in subsection (a),
except to the extent required by subsection (a)(1).</text>
</paragraph></subsection></section><section id="H4CCA1E6FB2734F90809E28C2B235B369"><enum>103.</enum><header>Prohibition on
mandating State restrictions</header>
<subsection id="HBC5493C79632480A8895F49FD41F5E3E"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">No Federal funds
shall be used by any Federal officer or employee to induce or encourage any
State or other jurisdiction of the United States to enact any restriction or
prohibition prohibited to the Federal Government by this title.</text>
</subsection><subsection id="H4CCA38760F6B41B59EC0813E9941CE3A"><enum>(b)</enum><header>Protecting State
eligibility for Federal funds</header><text display-inline="yes-display-inline">No State’s eligibility for participation in
any program operated by or funded wholly or partly by the Federal Government,
or for receiving funds from the Federal Government shall be conditioned on that
State enacting any restriction or prohibition prohibited to the Federal
Government by this title, nor adversely affected by that State’s failure to
enact any restriction or prohibition prohibited to the Federal Government by
this title.</text>
</subsection></section><section id="H269C839831A14F1AA7FC006F73B10F88"><enum>104.</enum><header>Clarification</header><text display-inline="no-display-inline">Nothing in this subtitle shall be construed
to permit the expenditure of funds otherwise prohibited by law.</text>
</section><section id="H3BC38D2FBD9D45289AAAED3BD2D003E5"><enum>105.</enum><header>Conforming
amendment</header><text display-inline="no-display-inline">Section 1802(b)(3)
of the Social Security Act (42 U.S.C. 1395a(b)(3)) is hereby repealed.</text>
</section><section id="H63D0A31BC7914E70919F34B2C686BF2D"><enum>106.</enum><header>Definitions</header><text display-inline="no-display-inline">For purposes of this title:</text>
<paragraph display-inline="no-display-inline" id="H16A9AE4D826C403CA2E81AA18194A1B9"><enum>(1)</enum><header>Health care
services</header><text>The term <term>health care services</term> means any
lawful service intended to diagnose, cure, prevent, or mitigate the adverse
effects of any disease, injury, infirmity, or physical or mental disability,
including the provision of any lawful product the use of which is so
intended.</text>
</paragraph><paragraph id="H59351E81607E49069C2856F6C3A1C848"><enum>(2)</enum><header>Physician</header><text display-inline="yes-display-inline">The term “physician” means—</text>
<subparagraph id="H6F9CCAA2903642AF9316F6AC2DD41F00"><enum>(A)</enum><text>a doctor of
medicine or osteopathy legally authorized to practice medicine and surgery by
the State in which he performs such practice and surgery;</text>
</subparagraph><subparagraph id="HB0640E76F1B34125824D48BD2237C4E1"><enum>(B)</enum><text>a doctor of dental
surgery or of dental medicine who is legally authorized to practice dentistry
by the State in which he performs such function and who is acting within the
scope of his license when he performs such functions;</text>
</subparagraph><subparagraph id="H97DFC596965C496A8F033471B8BCDF01"><enum>(C)</enum><text display-inline="yes-display-inline">a doctor of podiatric medicine but only
with respect to functions which he is legally authorized to perform as such by
the State in which he performs them;</text>
</subparagraph><subparagraph id="HD1CF1A60C809467B9C2D7D2E26702FEE"><enum>(D)</enum><text display-inline="yes-display-inline">a doctor of optometry with respect to the
provision of items or services which he is legally authorized to perform as a
doctor of optometry by the State in which he performs them; or</text>
</subparagraph><subparagraph id="H06E8EAE886464A74836338C50FDB1604"><enum>(E)</enum><text display-inline="yes-display-inline">a chiropractor who is licensed as such by
the State (or in a State which does not license chiropractors as such, is
legally authorized to perform the services of a chiropractor in the
jurisdiction in which he performs such services), but only with respect to
treatment which he is legally authorized to perform by the State or
jurisdiction in which such treatment is provided.</text>
</subparagraph></paragraph><paragraph id="H6513A47A8F794293AC8F81FDE96EBB24"><enum>(3)</enum><header>Practice of
medicine</header><text>The term <term>practice of medicine</term> means—</text>
<subparagraph id="H3204EE0E9B92494C96AB88CC9E08AFA4"><enum>(A)</enum><text display-inline="yes-display-inline">health care services that are performed by
physicians; and</text>
</subparagraph><subparagraph id="HDF7B3C32136D416FA6B0680EA9E6C597"><enum>(B)</enum><text>services and
supplies furnished as an incident to a physician’s professional service.</text>
</subparagraph></paragraph><paragraph id="HFF6A2E28B8194DB09C0E02E685E7DAB4"><enum>(4)</enum><header>Health care
practitioner</header><text display-inline="yes-display-inline">The term
<term>health care practitioner</term> means a physician assistant, registered
nurse, nurse practitioner, psychologist, clinical social worker, midwife, or
other individual (other than a physician) licensed or legally authorized to
perform health care services in the State in which the individual performs such
services.</text>
</paragraph><paragraph id="HF8F422E9F32947B5A568448DF3F2463E"><enum>(5)</enum><header>Practice of
other health care professions</header><text>The term <term>practice of other
health care professions</term> means—</text>
<subparagraph id="H759373CF2CCE4F57AF82E3486EA9FFF4"><enum>(A)</enum><text>health care
services performed by a health care practitioner; and</text>
</subparagraph><subparagraph id="H671509948C594B2E85A68CEA604A85C7"><enum>(B)</enum><text display-inline="yes-display-inline">services and supplies furnished as an
incident to a health care practitioner’s professional service.</text>
</subparagraph></paragraph><paragraph id="H3830FA904B5C4AEBB9C338D3D9CE2513"><enum>(6)</enum><header>Group health
plan</header><text>The term <term>group health plan</term> has the meaning
given such term in section 733(a)(1) of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1191b(a)(1)).</text>
</paragraph><paragraph id="H192385B0A3414EE49F80197FFC3FF4A9"><enum>(7)</enum><header>Health insurance
issuer</header><text>The term <term>health insurance issuer</term> has the
meaning given such term in section 733(b)(2) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1191b(b)(2)).</text>
</paragraph><paragraph id="H40D76F6400DE4D42AEAE77B91530884E"><enum>(8)</enum><header>Business</header><text>The
term <term>business</term> means any sole proprietorship, partnership,
for-profit corporation, or not-for-profit corporation.</text>
</paragraph><paragraph id="H207D53AE76D3472C990A543438ABEFEE"><enum>(9)</enum><header>State</header><text display-inline="yes-display-inline">The term <term>State</term> means any of
the United States, the Commonwealth of Puerto Rico, the Commonwealth of the
Northern Mariana Islands, the United States Virgin Islands, Guam, American
Samoa, or the District of Columbia.</text>
</paragraph></section><section id="HFFD957F93413460E97F9F4A84B8BC159"><enum>107.</enum><header>Effective
date</header><text display-inline="no-display-inline">The provisions of this
title shall apply to Federal entities, including employees and officials of
such entities, beginning on January 1, 2009.</text>
</section><enum>II</enum><header>Improving quality
and lowering the cost of health care</header>
<subtitle id="HC833A86E0714435D8C77301029A48407"><enum>A</enum><header>Equity for Our
Nation’s Self-Employed</header>
<section id="H006E81AE75874C84A3602F4EC372A245"><enum>201.</enum><header>SECA tax
deduction for health insurance costs</header>
<subsection id="H2C48869F6615451AA0A70DE646C26112"><enum>(a)</enum><header>In
general</header><text>Subsection (l) of section 162 of the Internal Revenue
Code of 1986 (relating to special rules for health insurance costs of
self-employed individuals) is amended by striking paragraph (4) and by
redesignating paragraph (5) as paragraph (4).</text>
</subsection><subsection id="HA6FCBCA065DD4D4CB69B3073DCAAE809"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by this section shall apply to taxable
years beginning after the date of the enactment of this subtitle.</text>
</subsection></section></subtitle><subtitle id="H1761D00C0F64456BAD37B98004DF02BE"><enum>B</enum><header>Help Efficient,
Accessible, Low-cost, Timely Healthcare </header>
<section id="H2C76D7DBBC824D5488690A6D7B6F80B0"><enum>211.</enum><header>Findings and
purpose</header>
<subsection id="H660E7CF389AC489F8484FBC6E86B756B"><enum>(a)</enum><header>Findings</header>
<paragraph id="H33941F3E337449BEBAF3A882BE71634C"><enum>(1)</enum><header>Effect on health
care access and costs</header><text>Congress finds that our current civil
justice system is adversely affecting patient access to health care services,
better patient care, and cost-efficient health care, in that the health care
liability system is a costly and ineffective mechanism for resolving claims of
health care liability and compensating injured patients, and is a deterrent to
the sharing of information among health care professionals which impedes
efforts to improve patient safety and quality of care.</text>
</paragraph><paragraph id="H6EBE1AEA61F647B38B0124BEDD8E13E2"><enum>(2)</enum><header>Effect on
interstate commerce</header><text>Congress finds that the health care and
insurance industries are industries affecting interstate commerce and the
health care liability litigation systems existing throughout the United States
are activities that affect interstate commerce by contributing to the high
costs of health care and premiums for health care liability insurance purchased
by health care system providers.</text>
</paragraph><paragraph id="HB483D787F84A4E348C669D751729D358"><enum>(3)</enum><header>Effect on
Federal spending</header><text>Congress finds that the health care liability
litigation systems existing throughout the United States have a significant
effect on the amount, distribution, and use of Federal funds because of—</text>
<subparagraph id="HBB79B4E1DC3042869CD4247EBE01BBFE"><enum>(A)</enum><text>the large number
of individuals who receive health care benefits under programs operated or
financed by the Federal Government;</text>
</subparagraph><subparagraph id="H966143C09C61455883655B302AD3333E"><enum>(B)</enum><text>the large number
of individuals who benefit because of the exclusion from Federal taxes of the
amounts spent to provide them with health insurance benefits; and</text>
</subparagraph><subparagraph id="H004FE789D30A45F88D65389117DB8ECC"><enum>(C)</enum><text>the large number
of health care providers who provide items or services for which the Federal
Government makes payments.</text>
</subparagraph></paragraph></subsection><subsection id="H6FB39E632E23420E9711DC489D1C8BCD"><enum>(b)</enum><header>Purpose</header><text>It
is the purpose of this subtitle to implement reasonable, comprehensive, and
effective health care liability reforms designed to—</text>
<paragraph id="HC16E2EBF6DA94AA5B2681D94E8BA8B10"><enum>(1)</enum><text>improve the
availability of health care services in cases in which health care liability
actions have been shown to be a factor in the decreased availability of
services;</text>
</paragraph><paragraph id="HC7A4715641594D7596C1DF1C4BC84117"><enum>(2)</enum><text>reduce the
incidence of <quote>defensive medicine</quote> and lower the cost of health
care liability insurance, all of which contribute to the escalation of health
care costs;</text>
</paragraph><paragraph id="H9260E253DC5C447096AB57B3C7A809A2"><enum>(3)</enum><text>ensure that
persons with meritorious health care injury claims receive fair and adequate
compensation, including reasonable noneconomic damages;</text>
</paragraph><paragraph id="HE6393F40EE7C4555B9B776537E39AA37"><enum>(4)</enum><text>improve the
fairness and cost-effectiveness of our current health care liability system to
resolve disputes over, and provide compensation for, health care liability by
reducing uncertainty in the amount of compensation provided to injured
individuals; and</text>
</paragraph><paragraph id="HF4249E394AB34131A29D3C0CD77594AF"><enum>(5)</enum><text>provide an
increased sharing of information in the health care system which will reduce
unintended injury and improve patient care.</text>
</paragraph></subsection></section><section id="H673BC603D9C84DC0A61CC88253CDCE9B"><enum>212.</enum><header>Encouraging
speedy resolution of claims</header><text display-inline="no-display-inline">The time for the commencement of a health
care lawsuit shall be 3 years after the date of manifestation of injury or 1
year after the claimant discovers, or through the use of reasonable diligence
should have discovered, the injury, whichever occurs first. In no event shall
the time for commencement of a health care lawsuit exceed 3 years after the
date of manifestation of injury unless tolled for any of the following—</text>
<paragraph id="H784DBF084F4C4F48A6AA9D7AF8557219"><enum>(1)</enum><text>upon proof of
fraud;</text>
</paragraph><paragraph id="H40168BF765A04943887C8269C275DA19"><enum>(2)</enum><text>intentional
concealment; or</text>
</paragraph><paragraph id="H594478A87F3B4A028F7D73DD4BC4EBA4"><enum>(3)</enum><text>the presence of a
foreign body, which has no therapeutic or diagnostic purpose or effect, in the
person of the injured person.</text>
</paragraph><continuation-text continuation-text-level="section">Actions by a
minor shall be commenced within 3 years from the date of the alleged
manifestation of injury except that actions by a minor under the full age of 6
years shall be commenced within 3 years of manifestation of injury or prior to
the minor’s 8th birthday, whichever provides a longer period. Such time
limitation shall be tolled for minors for any period during which a parent or
guardian and a health care provider or health care organization have committed
fraud or collusion in the failure to bring an action on behalf of the injured
minor.</continuation-text></section><section id="HA6B731C236A64CCBAF4D0B2574AF4AD3"><enum>213.</enum><header>Compensating
patient injury</header>
<subsection id="H1C9388A0B7D5460D8739822C478DB3B6"><enum>(a)</enum><header>Unlimited Amount
of Damages for Actual Economic Losses in Health Care Lawsuits</header><text>In
any health care lawsuit, nothing in this subtitle shall limit a claimant’s
recovery of the full amount of the available economic damages, notwithstanding
the limitation in
<internal-xref idref="H17913958E5984F6090FE58540A050325" legis-path="4.(b)">subsection (b)</internal-xref>.</text>
</subsection><subsection id="H17913958E5984F6090FE58540A050325"><enum>(b)</enum><header>Additional
Noneconomic Damages</header><text>In any health care lawsuit, the amount of
noneconomic damages, if available, may be as much as $250,000, regardless of
the number of parties against whom the action is brought or the number of
separate claims or actions brought with respect to the same injury.</text>
</subsection><subsection id="H02BE32E72E0446B5AADB2835A2CDB800"><enum>(c)</enum><header>No Discount of
Award for Noneconomic Damages</header><text>For purposes of applying the
limitation in
<internal-xref idref="H17913958E5984F6090FE58540A050325" legis-path="4.(b)">subsection (b)</internal-xref>, future noneconomic damages
shall not be discounted to present value. The jury shall not be informed about
the maximum award for noneconomic damages. An award for noneconomic damages in
excess of $250,000 shall be reduced either before the entry of judgment, or by
amendment of the judgment after entry of judgment, and such reduction shall be
made before accounting for any other reduction in damages required by law. If
separate awards are rendered for past and future noneconomic damages and the
combined awards exceed $250,000, the future noneconomic damages shall be
reduced first.</text>
</subsection><subsection id="H5FBB7D57A74F45C1994AADEEAE11EEBD"><enum>(d)</enum><header>Fair Share
Rule</header><text>In any health care lawsuit, each party shall be liable for
that party’s several share of any damages only and not for the share of any
other person. Each party shall be liable only for the amount of damages
allocated to such party in direct proportion to such party’s percentage of
responsibility. Whenever a judgment of liability is rendered as to any party, a
separate judgment shall be rendered against each such party for the amount
allocated to such party. For purposes of this section, the trier of fact shall
determine the proportion of responsibility of each party for the claimant’s
harm.</text>
</subsection></section><section id="HBB1A680322EC4DDA90D75E345664DF2A"><enum>214.</enum><header>Maximizing
patient recovery</header>
<subsection id="HC1A61568CA854C88B38DCF37C3891380"><enum>(a)</enum><header>Court
Supervision of Share of Damages Actually Paid to Claimants</header><text>In any
health care lawsuit, the court shall supervise the arrangements for payment of
damages to protect against conflicts of interest that may have the effect of
reducing the amount of damages awarded that are actually paid to claimants. In
particular, in any health care lawsuit in which the attorney for a party claims
a financial stake in the outcome by virtue of a contingent fee, the court shall
have the power to restrict the payment of a claimant’s damage recovery to such
attorney, and to redirect such damages to the claimant based upon the interests
of justice and principles of equity. In no event shall the total of all
contingent fees for representing all claimants in a health care lawsuit exceed
the following limits:</text>
<paragraph id="HA589E6E395F5450EA35D88D6BD4020D8"><enum>(1)</enum><text>40 percent of the
first $50,000 recovered by the claimant(s).</text>
</paragraph><paragraph id="HA031BB9072464999A218BA5F7374A07C"><enum>(2)</enum><text>33<fraction>1/3</fraction>
percent of the next $50,000 recovered by the claimant(s).</text>
</paragraph><paragraph id="H2059B1BE158B42A0A8831F8F367599DC"><enum>(3)</enum><text>25 percent of the
next $500,000 recovered by the claimant(s).</text>
</paragraph><paragraph id="HC261BA0459DF44A0AF2B5A9888718A72"><enum>(4)</enum><text>15 percent of any
amount by which the recovery by the claimant(s) is in excess of
$600,000.</text>
</paragraph></subsection><subsection id="H5AAAA18CE48A466A88B9B7FE53650577"><enum>(b)</enum><header>Applicability</header><text>The
limitations in this section shall apply whether the recovery is by judgment,
settlement, mediation, arbitration, or any other form of alternative dispute
resolution. In a health care lawsuit involving a minor or incompetent person, a
court retains the authority to authorize or approve a fee that is less than the
maximum permitted under this section. The requirement for court supervision in
the first two sentences of
<internal-xref idref="HC1A61568CA854C88B38DCF37C3891380" legis-path="5.(a)">subsection (a)</internal-xref> applies only in civil
actions.</text>
</subsection></section><section id="H348DA97B06934F908F834FA77A8B963C"><enum>215.</enum><header>Additional
HEALTH benefits</header><text display-inline="no-display-inline">In any health
care lawsuit involving injury or wrongful death, any party may introduce
evidence of collateral source benefits. If a party elects to introduce such
evidence, any opposing party may introduce evidence of any amount paid or
contributed or reasonably likely to be paid or contributed in the future by or
on behalf of the opposing party to secure the right to such collateral source
benefits. No provider of collateral source benefits shall recover any amount
against the claimant or receive any lien or credit against the claimant’s
recovery or be equitably or legally subrogated to the right of the claimant in
a health care lawsuit involving injury or wrongful death. This section shall
apply to any health care lawsuit that is settled as well as a health care
lawsuit that is resolved by a fact finder. This section shall not apply to
section 1862(b) (42 U.S.C. 1395y(b)) or section 1902(a)(25) (42 U.S.C.
1396a(a)(25)) of the <act-name parsable-cite="SSA">Social Security
Act</act-name>.</text>
</section><section id="H2F3AE948E6244D46A6C355CF7A592866"><enum>216.</enum><header>Punitive
damages</header>
<subsection id="H21AFBAA8DDDA4E9EA7B4AD97E0EFE8FF"><enum>(a)</enum><header>In
General</header><text>Punitive damages may, if otherwise permitted by
applicable State or Federal law, be awarded against any person in a health care
lawsuit only if it is proven by clear and convincing evidence that such person
acted with malicious intent to injure the claimant, or that such person
deliberately failed to avoid unnecessary injury that such person knew the
claimant was substantially certain to suffer. In any health care lawsuit where
no judgment for compensatory damages is rendered against such person, no
punitive damages may be awarded with respect to the claim in such lawsuit. No
demand for punitive damages shall be included in a health care lawsuit as
initially filed. A court may allow a claimant to file an amended pleading for
punitive damages only upon a motion by the claimant and after a finding by the
court, upon review of supporting and opposing affidavits or after a hearing,
after weighing the evidence, that the claimant has established by a substantial
probability that the claimant will prevail on the claim for punitive damages.
At the request of any party in a health care lawsuit, the trier of fact shall
consider in a separate proceeding—</text>
<paragraph id="H01D630F4B70A4D2D98FEF86FCFEFC606"><enum>(1)</enum><text>whether punitive
damages are to be awarded and the amount of such award; and</text>
</paragraph><paragraph id="H57ACF9D9878E4CB0AA02B6FEE57D684C"><enum>(2)</enum><text>the amount of
punitive damages following a determination of punitive liability.</text>
</paragraph><continuation-text continuation-text-level="subsection">If a
separate proceeding is requested, evidence relevant only to the claim for
punitive damages, as determined by applicable State law, shall be inadmissible
in any proceeding to determine whether compensatory damages are to be
awarded.</continuation-text></subsection><subsection id="H160DD0CEF42F4CE89014E14E8E7EC829"><enum>(b)</enum><header>Determining
Amount of Punitive Damages</header>
<paragraph id="H725464D3214D40A1A48A2321DF32C542"><enum>(1)</enum><header>Factors
considered</header><text>In determining the amount of punitive damages, if
awarded, in a health care lawsuit, the trier of fact shall consider only the
following—</text>
<subparagraph id="H04B20F68B965435F94EEF54AA4F432DA"><enum>(A)</enum><text>the severity of
the harm caused by the conduct of such party;</text>
</subparagraph><subparagraph id="H7355FEBDF9994A51A5E58C7516E77C32"><enum>(B)</enum><text>the duration of
the conduct or any concealment of it by such party;</text>
</subparagraph><subparagraph id="H5F069BBE19F948BC9A6DC7BC3A778855"><enum>(C)</enum><text>the profitability
of the conduct to such party;</text>
</subparagraph><subparagraph id="H359D661F3146407CA41B697002C7EAF9"><enum>(D)</enum><text>the number of
products sold or medical procedures rendered for compensation, as the case may
be, by such party, of the kind causing the harm complained of by the
claimant;</text>
</subparagraph><subparagraph id="HFED9D42BC2B94A5B8395D26A2323031E"><enum>(E)</enum><text>any criminal
penalties imposed on such party, as a result of the conduct complained of by
the claimant; and</text>
</subparagraph><subparagraph id="H77420B2AFF0F41BDB5EB8691DE10377B"><enum>(F)</enum><text>the amount of any
civil fines assessed against such party as a result of the conduct complained
of by the claimant.</text>
</subparagraph></paragraph><paragraph id="H3D68F93195B74C999D18088CD311A83B"><enum>(2)</enum><header>Maximum
award</header><text>The amount of punitive damages, if awarded, in a health
care lawsuit may be as much as $250,000 or as much as two times the amount of
economic damages awarded, whichever is greater. The jury shall not be informed
of this limitation.</text>
</paragraph></subsection><subsection id="H7F1A4A2535594D2FA7913D6578DA113C"><enum>(c)</enum><header>No Punitive
Damages for Products That Comply With FDA Standards</header>
<paragraph id="H9A28A6159112401681AC7F894589147C"><enum>(1)</enum><header>In
general</header>
<subparagraph id="H683806CE1B7B453C9DFE173E9BCC9B7B"><enum>(A)</enum><text>No punitive
damages may be awarded against the manufacturer or distributor of a medical
product, or a supplier of any component or raw material of such medical
product, based on a claim that such product caused the claimant’s harm
where—</text>
<clause id="HD8B386FD315D4BE98EAFD094AD5F54A2"><enum>(i)</enum><subclause commented="no" display-inline="yes-display-inline" id="H41B28690D9CE4D15A327B388EA97A6F4"><enum>(I)</enum><text>such medical product was
subject to premarket approval, clearance, or licensure by the Food and Drug
Administration with respect to the safety of the formulation or performance of
the aspect of such medical product which caused the claimant’s harm or the
adequacy of the packaging or labeling of such medical product; and</text>
</subclause><subclause id="H0E754998E58B4E01AF67896C04CDE0C7" indent="up1"><enum>(II)</enum><text>such medical product was so approved,
cleared, or licensed; or</text>
</subclause></clause><clause id="HFA3F06FADFB44F19872078337D7A724F"><enum>(ii)</enum><text>such medical
product is generally recognized among qualified experts as safe and effective
pursuant to conditions established by the Food and Drug Administration and
applicable Food and Drug Administration regulations, including without
limitation those related to packaging and labeling, unless the Food and Drug
Administration has determined that such medical product was not manufactured or
distributed in substantial compliance with applicable Food and Drug
Administration statutes and regulations.</text>
</clause></subparagraph><subparagraph id="H703FAEFA94FA491DB15528758496D1EE"><enum>(B)</enum><header>Rule of
construction</header><text><internal-xref idref="H683806CE1B7B453C9DFE173E9BCC9B7B" legis-path="7.(c)(1)(A)">Subparagraph
(A)</internal-xref> may not be construed as establishing the obligation of the
Food and Drug Administration to demonstrate affirmatively that a manufacturer,
distributor, or supplier referred to in such subparagraph meets any of the
conditions described in such subparagraph.</text>
</subparagraph></paragraph><paragraph id="HC47AC13A32A24740B70496F8B2DC8024"><enum>(2)</enum><header>Liability of
health care providers</header><text>A health care provider who prescribes, or
who dispenses pursuant to a prescription, a medical product approved, licensed,
or cleared by the Food and Drug Administration shall not be named as a party to
a product liability lawsuit involving such product and shall not be liable to a
claimant in a class action lawsuit against the manufacturer, distributor, or
seller of such product. Nothing in this paragraph prevents a court from
consolidating cases involving health care providers and cases involving
products liability claims against the manufacturer, distributor, or product
seller of such medical product.</text>
</paragraph><paragraph id="HB035F473337F40E0BDE450F3F42789EA"><enum>(3)</enum><header>Packaging</header><text>In
a health care lawsuit for harm which is alleged to relate to the adequacy of
the packaging or labeling of a drug which is required to have tamper-resistant
packaging under regulations of the Secretary of Health and Human Services
(including labeling regulations related to such packaging), the manufacturer or
product seller of the drug shall not be held liable for punitive damages unless
such packaging or labeling is found by the trier of fact by clear and
convincing evidence to be substantially out of compliance with such
regulations.</text>
</paragraph><paragraph id="H5F4304AD4CFC4DD3BC86C88A2C7E38EB"><enum>(4)</enum><header>Exception</header><text><internal-xref idref="H9A28A6159112401681AC7F894589147C" legis-path="7.(c)(1)">Paragraph
(1)</internal-xref> shall not apply in any health care lawsuit in which—</text>
<subparagraph id="HA2835034EA0543708052F44B468CFD0B"><enum>(A)</enum><text>a person, before
or after premarket approval, clearance, or licensure of such medical product,
knowingly misrepresented to or withheld from the Food and Drug Administration
information that is required to be submitted under the
<act-name parsable-cite="FFDCA">Federal Food, Drug, and Cosmetic Act</act-name>
(21 U.S.C. 301 et seq.) or section 351 of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (42 U.S.C. 262) that
is material and is causally related to the harm which the claimant allegedly
suffered; or</text>
</subparagraph><subparagraph id="HF02AD4F9D06847EEB499BB64FD2C3F2E"><enum>(B)</enum><text>a person made an
illegal payment to an official of the Food and Drug Administration for the
purpose of either securing or maintaining approval, clearance, or licensure of
such medical product.</text>
</subparagraph></paragraph></subsection></section><section id="HA48CD7721BD142719F05B12C5BE6EAB4"><enum>217.</enum><header>Authorization
of payment of future damages to claimants in HEALTH care lawsuits</header>
<subsection id="H60DD7B2A6634481DBE43187EB4674A7C"><enum>(a)</enum><header>In
General</header><text>In any health care lawsuit, if an award of future
damages, without reduction to present value, equaling or exceeding $50,000 is
made against a party with sufficient insurance or other assets to fund a
periodic payment of such a judgment, the court shall, at the request of any
party, enter a judgment ordering that the future damages be paid by periodic
payments. In any health care lawsuit, the court may be guided by the Uniform
Periodic Payment of Judgments Act promulgated by the National Conference of
Commissioners on Uniform State Laws.</text>
</subsection><subsection id="H76F039ACB9334A9AB38DFE28D2A229F7"><enum>(b)</enum><header>Applicability</header><text>This
section applies to all actions which have not been first set for trial or
retrial before the effective date of this subtitle.</text>
</subsection></section><section id="HC97A459C88AB46DB971629ABF0A92CB2"><enum>218.</enum><header>Definitions</header><text display-inline="no-display-inline">In this subtitle:</text>
<paragraph id="H455B000A1E0B445D8FB330F426E9F386"><enum>(1)</enum><header>Alternative
dispute resolution system; ADR</header><text>The term <term>alternative dispute
resolution system</term> or <term>ADR</term> means a system that provides for
the resolution of health care lawsuits in a manner other than through a civil
action brought in a State or Federal court.</text>
</paragraph><paragraph id="HC0C9F1B6F54249E1BAD717DA54DB2413"><enum>(2)</enum><header>Claimant</header><text>The
term <term>claimant</term> means any person who brings a health care lawsuit,
including a person who asserts or claims a right to legal or equitable
contribution, indemnity, or subrogation, arising out of a health care liability
claim or action, and any person on whose behalf such a claim is asserted or
such an action is brought, whether deceased, incompetent, or a minor.</text>
</paragraph><paragraph id="H0CA45F3A37FE4AB48912E124528EE5BB"><enum>(3)</enum><header>Collateral
source benefits</header><text>The term <term>collateral source benefits</term>
means any amount paid or reasonably likely to be paid in the future to or on
behalf of the claimant, or any service, product, or other benefit provided or
reasonably likely to be provided in the future to or on behalf of the claimant,
as a result of the injury or wrongful death, pursuant to—</text>
<subparagraph id="H1017A47F25AC4EE2ABFB1A7A6EB05BE2"><enum>(A)</enum><text>any State or
Federal health, sickness, income-disability, accident, or workers’ compensation
law;</text>
</subparagraph><subparagraph id="HFF483F2E14CC4A0A82A5013573F3352C"><enum>(B)</enum><text>any health,
sickness, income-disability, or accident insurance that provides health
benefits or income-disability coverage;</text>
</subparagraph><subparagraph id="H881860F160514AD49B5CC22717064D32"><enum>(C)</enum><text>any contract or
agreement of any group, organization, partnership, or corporation to provide,
pay for, or reimburse the cost of medical, hospital, dental, or
income-disability benefits; and</text>
</subparagraph><subparagraph id="HF3A327F8640B438C96D228A3AFCBAEE1"><enum>(D)</enum><text>any other publicly
or privately funded program.</text>
</subparagraph></paragraph><paragraph id="HDA84279CC4EC4AA5A24EEB92687BA398"><enum>(4)</enum><header>Compensatory
damages</header><text>The term <term>compensatory damages</term> means
objectively verifiable monetary losses incurred as a result of the provision
of, use of, or payment for (or failure to provide, use, or pay for) health care
services or medical products, such as past and future medical expenses, loss of
past and future earnings, cost of obtaining domestic services, loss of
employment, and loss of business or employment opportunities, damages for
physical and emotional pain, suffering, inconvenience, physical impairment,
mental anguish, disfigurement, loss of enjoyment of life, loss of society and
companionship, loss of consortium (other than loss of domestic service),
hedonic damages, injury to reputation, and all other nonpecuniary losses of any
kind or nature. The term <term>compensatory damages</term> includes economic
damages and noneconomic damages, as such terms are defined in this
section.</text>
</paragraph><paragraph id="HE8D6227AF6C34DF489784A33ABE383E5"><enum>(5)</enum><header>Contingent
fee</header><text>The term <term>contingent fee</term> includes all
compensation to any person or persons which is payable only if a recovery is
effected on behalf of one or more claimants.</text>
</paragraph><paragraph id="H0A2AFE1D3B5C4922A0DE1D7571F1F2ED"><enum>(6)</enum><header>Economic
damages</header><text>The term <term>economic damages</term> means objectively
verifiable monetary losses incurred as a result of the provision of, use of, or
payment for (or failure to provide, use, or pay for) health care services or
medical products, such as past and future medical expenses, loss of past and
future earnings, cost of obtaining domestic services, loss of employment, and
loss of business or employment opportunities.</text>
</paragraph><paragraph id="H83D766A244D640F9B21212801EBA93A8"><enum>(7)</enum><header>Health care
lawsuit</header><text>The term <term>health care lawsuit</term> means any
health care liability claim concerning the provision of health care goods or
services or any medical product affecting interstate commerce, or any health
care liability action concerning the provision of health care goods or services
or any medical product affecting interstate commerce, brought in a State or
Federal court or pursuant to an alternative dispute resolution system, against
a health care provider, a health care organization, or the manufacturer,
distributor, supplier, marketer, promoter, or seller of a medical product,
regardless of the theory of liability on which the claim is based, or the
number of claimants, plaintiffs, defendants, or other parties, or the number of
claims or causes of action, in which the claimant alleges a health care
liability claim. Such term does not include a claim or action which is based on
criminal liability; which seeks civil fines or penalties paid to Federal,
State, or local government; or which is grounded in antitrust.</text>
</paragraph><paragraph id="HC9BE2FE818F44DF9B334613642FF136C"><enum>(8)</enum><header>Health care
liability action</header><text>The term <term>health care liability
action</term> means a civil action brought in a State or Federal court or
pursuant to an alternative dispute resolution system, against a health care
provider, a health care organization, or the manufacturer, distributor,
supplier, marketer, promoter, or seller of a medical product, regardless of the
theory of liability on which the claim is based, or the number of plaintiffs,
defendants, or other parties, or the number of causes of action, in which the
claimant alleges a health care liability claim.</text>
</paragraph><paragraph id="H513DE4F93BA54B79B9BF7EAEA4C90219"><enum>(9)</enum><header>Health care
liability claim</header><text>The term <term>health care liability claim</term>
means a demand by any person, whether or not pursuant to ADR, against a health
care provider, health care organization, or the manufacturer, distributor,
supplier, marketer, promoter, or seller of a medical product, including, but
not limited to, third-party claims, cross-claims, counter-claims, or
contribution claims, which are based upon the provision of, use of, or payment
for (or the failure to provide, use, or pay for) health care services or
medical products, regardless of the theory of liability on which the claim is
based, or the number of plaintiffs, defendants, or other parties, or the number
of causes of action.</text>
</paragraph><paragraph id="H64FA83045D8249D699E0098AFD17DC50"><enum>(10)</enum><header>Health care
organization</header><text>The term <term>health care organization</term> means
any person or entity which is obligated to provide or pay for health benefits
under any health plan, including any person or entity acting under a contract
or arrangement with a health care organization to provide or administer any
health benefit.</text>
</paragraph><paragraph id="H15D8B0AC29004BB8878585B58F528531"><enum>(11)</enum><header>Health care
provider</header><text>The term <term>health care provider</term> means any
person or entity required by State or Federal laws or regulations to be
licensed, registered, or certified to provide health care services, and being
either so licensed, registered, or certified, or exempted from such requirement
by other statute or regulation.</text>
</paragraph><paragraph id="H9F566F351E1343D096380657E608E120"><enum>(12)</enum><header>Health care
goods or services</header><text>The term <term>health care goods or
services</term> means any goods or services provided by a health care
organization, provider, or by any individual working under the supervision of a
health care provider, that relates to the diagnosis, prevention, or treatment
of any human disease or impairment, or the assessment or care of the health of
human beings.</text>
</paragraph><paragraph id="H540A7FA8C9424C7B97A12E7538D86337"><enum>(13)</enum><header>Malicious
intent to injure</header><text>The term <term>malicious intent to injure</term>
means intentionally causing or attempting to cause physical injury other than
providing health care goods or services.</text>
</paragraph><paragraph id="H0B34CBA0F66745FF86FDF08E0CBB5767"><enum>(14)</enum><header>Medical
product</header><text>The term <term>medical product</term> means a drug,
device, or biological product intended for humans, and the terms
<term>drug</term>, <term>device</term>, and <term>biological product</term>
have the meanings given such terms in sections 201(g)(1) and 201(h) of the
Federal Food, Drug and Cosmetic Act (21 U.S.C. 321(g)(1) and (h)) and section
351(a) of the <act-name parsable-cite="PHSA">Public Health Service
Act</act-name> (42 U.S.C. 262(a)), respectively, including any component or raw
material used therein, but excluding health care services.</text>
</paragraph><paragraph id="HBFE54797D25B4645B5058F100213F9BE"><enum>(15)</enum><header>Noneconomic
damages</header><text>The term <term>noneconomic damages</term> means damages
for physical and emotional pain, suffering, inconvenience, physical impairment,
mental anguish, disfigurement, loss of enjoyment of life, loss of society and
companionship, loss of consortium (other than loss of domestic service),
hedonic damages, injury to reputation, and all other nonpecuniary losses of any
kind or nature.</text>
</paragraph><paragraph id="HD8F052A58A2F47A2B5365669A69601FA"><enum>(16)</enum><header>Punitive
damages</header><text>The term <term>punitive damages</term> means damages
awarded, for the purpose of punishment or deterrence, and not solely for
compensatory purposes, against a health care provider, health care
organization, or a manufacturer, distributor, or supplier of a medical product.
Punitive damages are neither economic nor noneconomic damages.</text>
</paragraph><paragraph id="H6CD2F035689A486F91B01E63682E2C1E"><enum>(17)</enum><header>Recovery</header><text>The
term <term>recovery</term> means the net sum recovered after deducting any
disbursements or costs incurred in connection with prosecution or settlement of
the claim, including all costs paid or advanced by any person. Costs of health
care incurred by the plaintiff and the attorneys’ office overhead costs or
charges for legal services are not deductible disbursements or costs for such
purpose.</text>
</paragraph><paragraph id="H83DD285695B546289F91290B02394301"><enum>(18)</enum><header>State</header><text>The
term <term>State</term> means each of the several States, the District of
Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American
Samoa, the Northern Mariana Islands, the Trust Territory of the Pacific
Islands, and any other territory or possession of the United States, or any
political subdivision thereof.</text>
</paragraph></section><section id="H9C0B7DEC27A34572BFCCFE7AA5D3751E"><enum>219.</enum><header>Effect on other
laws</header>
<subsection id="HEB73CC23ED3E4BF28943E1C167513924"><enum>(a)</enum><header>Vaccine
Injury</header>
<paragraph id="HCBA2C119098D49469BF3DC2E542AE423"><enum>(1)</enum><text>To the extent that
title XXI of the <act-name parsable-cite="PHSA">Public Health Service
Act</act-name> establishes a Federal rule of law applicable to a civil action
brought for a vaccine-related injury or death—</text>
<subparagraph id="H2D5F3D611C624B3CA295696A149F8DB1"><enum>(A)</enum><text>this subtitle does
not affect the application of the rule of law to such an action; and</text>
</subparagraph><subparagraph id="HD90E14A682DD4214AAB15B4865E8219B"><enum>(B)</enum><text>any rule of law
prescribed by this subtitle in conflict with a rule of law of such title XXI
shall not apply to such action.</text>
</subparagraph></paragraph><paragraph id="H1D3B2996310143B6B391D12B1AF411F7"><enum>(2)</enum><text>If there is an
aspect of a civil action brought for a vaccine-related injury or death to which
a Federal rule of law under title XXI of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> does not apply, then
this subtitle or otherwise applicable law (as determined under this subtitle)
will apply to such aspect of such action.</text>
</paragraph></subsection><subsection id="H65F0E222606746A5A8CE7B0EBECCC1DA"><enum>(b)</enum><header>Other Federal
Law</header><text>Except as provided in this section, nothing in this subtitle
shall be deemed to affect any defense available to a defendant in a health care
lawsuit or action under any other provision of Federal law.</text>
</subsection></section><section id="H414ECA57FF8D412AA1811C67D5BE1217"><enum>220.</enum><header>State
flexibility and protection of States’ rights</header>
<subsection id="H46E623E9CB614ABD950EA9FE1788C50E"><enum>(a)</enum><header>Health Care
Lawsuits</header><text>The provisions governing health care lawsuits set forth
in this subtitle preempt, subject to subsections (b) and (c), State law to the
extent that State law prevents the application of any provisions of law
established by or under this subtitle. The provisions governing health care
lawsuits set forth in this subtitle supersede chapter 171 of title 28, United
States Code, to the extent that such chapter—</text>
<paragraph id="H182178F2F4684CCB82B8666CDDD710EF"><enum>(1)</enum><text>provides for a
greater amount of damages or contingent fees, a longer period in which a health
care lawsuit may be commenced, or a reduced applicability or scope of periodic
payment of future damages, than provided in this subtitle; or</text>
</paragraph><paragraph id="H68EA2C46ED81465486D77613ED418695"><enum>(2)</enum><text>prohibits the
introduction of evidence regarding collateral source benefits, or mandates or
permits subrogation or a lien on collateral source benefits.</text>
</paragraph></subsection><subsection id="H1048D0BCF2964A109635563B1FD1E56E"><enum>(b)</enum><header>Protection of
States’ Rights and Other Laws</header><paragraph commented="no" display-inline="yes-display-inline" id="HDC4D8090D5124E1BA8C6D7AEAFB02722"><enum>(1)</enum><text>Any issue that is not
governed by any provision of law established by or under this subtitle
(including State standards of negligence) shall be governed by otherwise
applicable State or Federal law.</text>
</paragraph><paragraph id="HF4BDDFEC54084510AA3220367D5A9E2F" indent="up1"><enum>(2)</enum><text>This subtitle shall not preempt or
supersede any State or Federal law that imposes greater procedural or
substantive protections for health care providers and health care organizations
from liability, loss, or damages than those provided by this subtitle or create
a cause of action.</text>
</paragraph></subsection><subsection id="H8964C6ED4E9647C98C72B144E52F1AAF"><enum>(c)</enum><header>State
Flexibility</header><text>No provision of this subtitle shall be construed to
preempt—</text>
<paragraph id="HE37BB309BD484FE0974F747AC86CA5C0"><enum>(1)</enum><text>any State law
(whether effective before, on, or after the date of the enactment of this
subtitle) that specifies a particular monetary amount of compensatory or
punitive damages (or the total amount of damages) that may be awarded in a
health care lawsuit, regardless of whether such monetary amount is greater or
lesser than is provided for under this subtitle, notwithstanding
<internal-xref idref="H1C9388A0B7D5460D8739822C478DB3B6" legis-path="4.(a)">section 4(a)</internal-xref>; or</text>
</paragraph><paragraph id="H354AF819A687444EB9D1FD0D1D18192C"><enum>(2)</enum><text>any defense
available to a party in a health care lawsuit under any other provision of
State or Federal law.</text>
</paragraph></subsection></section><section id="HAFC24DE9018E4DA284AC4DF66FD13EBF"><enum>221.</enum><header>Applicability;
effective date</header><text display-inline="no-display-inline">This subtitle
shall apply to any health care lawsuit brought in a Federal or State court, or
subject to an alternative dispute resolution system, that is initiated on or
after the date of the enactment of this subtitle, except that any health care
lawsuit arising from an injury occurring prior to the date of the enactment of
this subtitle shall be governed by the applicable statute of limitations
provisions in effect at the time the injury occurred.</text>
</section><section id="H257D9FF7E16E49B1B03FF033207D71D4"><enum>222.</enum><header>Sense of
Congress</header><text display-inline="no-display-inline">It is the sense of
Congress that a health insurer should be liable for damages for harm caused
when it makes a decision as to what care is medically necessary and
appropriate.</text>
</section></subtitle><subtitle id="HBB06B2A318A046CF80921C11ADABE439"><enum>C</enum><header>Accelerating the
Deployment of Health Information Technology</header>
<part id="H8C32B5DB18074011860F3E5A2268393E"><enum>1</enum><header>Enhanced
coordination and adoption of health information technology</header>
<section commented="no" id="H8E232A1E8A354FC2A8CE7F5466A642DF"><enum>231.</enum><header>Strategic plan
for coordinating implementation of Medicare and Medicaid health information
technology incentive payments</header><text display-inline="no-display-inline">Section 3001(c) of the Public Health Service
Act (42 U.S.C. 300jj–11(c)) is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HF95B147F5661464E876A79B7429E5BE9" style="OLC">
<paragraph commented="no" id="H719D203599DE4B1CB3DCB01FB6DA3CBC"><enum>(9)</enum><header>Strategic plan
for Medicare and Medicaid EHR payment incentives and adjustments</header><text display-inline="yes-display-inline">Not later than 90 days after the date of
the enactment of the <short-title>Medical Rights and
Reform Act of 2009</short-title>, the National Coordinator shall publish a
strategic plan including—</text>
<subparagraph commented="no" id="H68A399A06BAC4ED99CEFBA2B3BE1F694"><enum>(A)</enum><text>timelines for
applying the incentive payments and incentive adjustments applicable to
eligible providers, eligible hospitals, and eligible professionals under
sections 1848(a), 1848(o), 1853(l), 1853(m), 1886(n), 1814(l)(3),
1886(b)(3)(B)(ix), and 1903(a)(3)(F) during the 18-month period following such
date of enactment, including specifying specific steps by date that providers
and hospitals must take to be eligible for such incentive payments; and</text>
</subparagraph><subparagraph commented="no" id="H2A5FE93D6ED54FD49BAD55775264EDBE"><enum>(B)</enum><text>a specific plan to
educate health care providers, consumers, and vendors of health information
technology about how eligible providers, eligible hospitals, and eligible
professionals may become compliant with requirements under such sections for
purposes of eligibility for incentive payments under such
sections.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="H7CFB03F3B7EF452C9DE8311C8F3650D8"><enum>232.</enum><header>Procedures to
ensure timely updating of standards that enable electronic
exchanges</header><text display-inline="no-display-inline">Section 1174(b) of
the Social Security Act (42 U.S.C. 1320d–3(b)) is amended—</text>
<paragraph id="H89D55E06C3CB4DDB84463852822CFDCA"><enum>(1)</enum><text>in paragraph
(1)—</text>
<subparagraph id="HB9F380E826C64941A7D1279830D3F8F1"><enum>(A)</enum><text>in the first
sentence, by inserting <quote>and in accordance with paragraph (3)</quote>
before the period; and</text>
</subparagraph><subparagraph id="H8EEABEDC8E3440AAB2256C8C28C04936"><enum>(B)</enum><text>by adding at the
end the following new sentence: <quote>For purposes of this subsection and
section 1173(c)(2), the term <quote>modification</quote> includes a new version
or a version upgrade </quote>; and</text>
</subparagraph></paragraph><paragraph id="HDF2D53EA5B484275BCF92C1A25220FAB"><enum>(2)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block id="HD707D1998E1B4C978698C5A1B493E279" style="OLC">
<paragraph id="HE5813B93204A4DC2A4F016128B37C9D9"><enum>(3)</enum><header>Expedited
procedures for adoption of additions and modifications to standards</header>
<subparagraph id="HF2B1B3BA599241F4BCEA39D0E3367F98"><enum>(A)</enum><header>In
general</header><text>For purposes of paragraph (1), the Secretary shall
provide for an expedited upgrade program (in this paragraph referred to as the
<quote>upgrade program</quote>), in accordance with this paragraph, to develop
and approve additions and modifications to the standards adopted under section
1173(a) to improve the quality of such standards or to extend the functionality
of such standards to meet evolving requirements in health care.</text>
</subparagraph><subparagraph id="H28078EAC6BC14B0782D4A910C4AB8DEA"><enum>(B)</enum><header>Publication of
notices</header><text>Under the upgrade program:</text>
<clause id="HFD3C025C06D74F20B9078D2E9030FEBE"><enum>(i)</enum><header>Voluntary notice
of initiation of process</header><text>Not later than 30 days after the date
the Secretary receives a notice from a standard setting organization that the
organization is initiating a process to develop an addition or modification to
a standard adopted under section 1173(a), the Secretary shall publish a notice
in the Federal Register that—</text>
<subclause id="H3E441E78F73240389A778265FB37054F"><enum>(I)</enum><text>identifies the
subject matter of the addition or modification;</text>
</subclause><subclause id="H6B83DE2AA8C344A6951D942B9559C3D8"><enum>(II)</enum><text>provides a
description of how persons may participate in the development process;
and</text>
</subclause><subclause id="H7B0F592AC35745899C24219149C016FE"><enum>(III)</enum><text>invites public
participation in such process.</text>
</subclause></clause><clause id="H30C80A618C954E4FAEB2F024BD954C1C"><enum>(ii)</enum><header>Voluntary
notice of preliminary draft of additions or modifications to
standards</header><text>Not later than 30 days after the date the Secretary
receives a notice from a standard setting organization that the organization
has prepared a preliminary draft of an addition or modification to a standard
adopted by section 1173(a), the Secretary shall publish a notice in the Federal
Register that—</text>
<subclause id="HA34D1A7864FD4CCFA507C3655A6B95FA"><enum>(I)</enum><text>identifies the
subject matter of (and summarizes) the addition or modification;</text>
</subclause><subclause id="H02D85F532A0942C88DAE407B7B0E2B8A"><enum>(II)</enum><text>specifies the
procedure for obtaining the draft;</text>
</subclause><subclause id="HBA60382B52F346158C6D5CAD4BD4417C"><enum>(III)</enum><text>provides a
description of how persons may submit comments in writing and at any public
hearing or meeting held by the organization on the addition or modification;
and</text>
</subclause><subclause id="HBC8A5E57FEBD40FD9B76FDBB406FFD8C"><enum>(IV)</enum><text>invites
submission of such comments and participation in such hearing or meeting
without requiring the public to pay a fee to participate.</text>
</subclause></clause><clause id="H19F386FFD5CE48499DB5F65289438241"><enum>(iii)</enum><header>Notice of
proposed addition or modification to standards</header><text>Not later than 30
days after the date the Secretary receives a notice from a standard setting
organization that the organization has a proposed addition or modification to a
standard adopted under section 1173(a) that the organization intends to submit
under subparagraph (D)(iii), the Secretary shall publish a notice in the
Federal Register that contains, with respect to the proposed addition or
modification, the information required in the notice under clause (ii) with
respect to the addition or modification.</text>
</clause><clause id="H3D4F6B6EC74F4472AFBB00AEBE387E89"><enum>(iv)</enum><header>Construction</header><text>Nothing
in this paragraph shall be construed as requiring a standard setting
organization to request the notices described in clauses (i) and (ii) with
respect to an addition or modification to a standard in order to qualify for an
expedited determination under subparagraph (C) with respect to a proposal
submitted to the Secretary for adoption of such addition or
modification.</text>
</clause></subparagraph><subparagraph id="HBEB7632A3EB84D13B81119E84ED06D3B"><enum>(C)</enum><header>Provision of
expedited determination</header><text>Under the upgrade program and with
respect to a proposal by a standard setting organization for an addition or
modification to a standard adopted under section 1173(a), if the Secretary
determines that the standard setting organization developed such addition or
modification in accordance with the requirements of subparagraph (D) and the
National Committee on Vital and Health Statistics recommends approval of such
addition or modification under subparagraph (E), the Secretary shall provide
for expedited treatment of such proposal in accordance with subparagraph
(F).</text>
</subparagraph><subparagraph id="HBEF8F3E8A37340199CE526838012E63C"><enum>(D)</enum><header>Requirements</header><text>The
requirements under this subparagraph with respect to a proposed addition or
modification to a standard by a standard setting organization are the
following:</text>
<clause id="HE26D64B6BA744AA192FEB33A3CF3A446"><enum>(i)</enum><header>Request for
publication of notice</header><text>The standard setting organization submits
to the Secretary a request for publication in the Federal Register of a notice
described in subparagraph (B)(iii) for the proposed addition or
modification.</text>
</clause><clause id="H8C38495D77D84F9B9E040303C6B3FA8F"><enum>(ii)</enum><header>Process for
receipt and consideration of public comment</header><text>The standard setting
organization provides for a process through which, after the publication of the
notice referred to under clause (i), the organization—</text>
<subclause id="HEFDBDE00BA0043D2B5D3BF99C712D24B"><enum>(I)</enum><text>receives and
responds to public comments submitted on a timely basis on the proposed
addition or modification before submitting such proposed addition or
modification to the National Committee on Vital and Health Statistics under
clause (iii);</text>
</subclause><subclause id="H8AB5211CE25D433ABB7677E2979E8894"><enum>(II)</enum><text>makes publicly
available a written explanation for its response in the proposed addition or
modification to comments submitted on a timely basis; and</text>
</subclause><subclause id="HFF6BE7A99DE34FD18D7ED44F2B790035"><enum>(III)</enum><text>makes public
comments received under clause (I) available, or provides access to such
comments, to the Secretary.</text>
</subclause></clause><clause id="H956E393F6CF444B2AB6EB349EF257AC8"><enum>(iii)</enum><header>Submittal of
final proposed addition or modification to ncvhs</header><text>After completion
of the process under clause (ii), the standard setting organization submits the
proposed addition or modification to the National Committee on Vital and Health
Statistics for review and consideration under subparagraph (E). Such submission
shall include information on the organization’s compliance with the notice and
comment requirements (and responses to those comments) under clause
(ii).</text>
</clause></subparagraph><subparagraph id="HCBD052529FB24CC3BF577D893CF09A9E"><enum>(E)</enum><header>Hearing and
recommendations by national committee on vital and health
statistics</header><text>Under the upgrade program, upon receipt of a proposal
submitted by a standard setting organization under subparagraph (D)(iii) for
the adoption of an addition or modification to a standard, the National
Committee on Vital and Health Statistics shall provide notice to the public and
a reasonable opportunity for public testimony at a hearing on such addition or
modification. The Secretary may participate in such hearing in such capacity
(including presiding ex officio) as the Secretary shall determine appropriate.
Not later than 90 days after the date of receipt of the proposal, the Committee
shall submit to the Secretary its recommendation to adopt (or not adopt) the
proposed addition or modification.</text>
</subparagraph><subparagraph id="HCD8D1BC0CB2B4CDA930A54EB31602316"><enum>(F)</enum><header>Determination by
Secretary to accept or reject national committee on vital and health statistics
recommendation</header>
<clause id="HB398D88C3FD04AAD95862B93759CF2ED"><enum>(i)</enum><header>Timely
determination</header><text>Under the upgrade program, if the National
Committee on Vital and Health Statistics submits to the Secretary a
recommendation under subparagraph (E) to adopt a proposed addition or
modification, not later than 90 days after the date of receipt of such
recommendation the Secretary shall make a determination to accept or reject the
recommendation and shall publish notice of such determination in the Federal
Register not later than 30 days after the date of the determination.</text>
</clause><clause id="H73A83EFAF1B44863862F94B6FBB5C02E"><enum>(ii)</enum><header>Contents of
notice</header><text>If the determination is to reject the recommendation, such
notice shall include the reasons for the rejection. If the determination is to
accept the recommendation, as part of such notice the Secretary shall
promulgate the modified standard (including the accepted proposed addition or
modification accepted).</text>
</clause><clause id="HD30773790E674F3194234FA7731E614C"><enum>(iii)</enum><header>Limitation on
consideration</header><text>The Secretary shall not consider a proposal under
this subparagraph unless the Secretary determines that the requirements of
subparagraph (D) (including publication of notice and opportunity for public
comment) have been met with respect to the proposal.</text>
</clause></subparagraph><subparagraph id="H01D2CE0F795B4EDA81B96C2C0F5CCA44"><enum>(G)</enum><header>Exemption from
paperwork reduction act</header><text>Chapter 35 of title 44, United States
Code, shall not apply to a final rule promulgated under subparagraph
(F).</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section id="H36705FD017AC4EB0BDC61AF9023280A3"><enum>233.</enum><header>Study to
improve preservation and protection of security and confidentiality of health
information</header>
<subsection id="HA024884D217D45F78C73C55C771B7B02"><enum>(a)</enum><header>In
General</header><text>The Secretary of Health and Human Services shall conduct
a study of the following:</text>
<paragraph id="HD6F2C13B4FBA42208BAB4DA8D27841A6"><enum>(1)</enum><text>Current Federal
security and confidentiality standards to determine the strengths and
weaknesses of such standards for purposes of protecting the security and
confidentiality of individually identifiable health information while taking
into account the need for timely and efficient exchanges of health information
to improve quality of care and ensure the availability of health information
necessary to make medical decisions at the location in which the medical care
involved is provided.</text>
</paragraph><paragraph id="H21FD2E6D7E32402B99E34211FBDFC497"><enum>(2)</enum><text>The extent to
which current security and confidentiality standards and State laws relating to
security and confidentiality of individually identifiable health information
should be reconciled to produce uniform standards, especially in the case of
data that is shared by health care providers for patient care and other
activities across State borders that would often result in more than one set of
such standards that would apply.</text>
</paragraph></subsection><subsection id="H8C4E432B4A744BC6914AC382B2998771"><enum>(b)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than 9 months after the date of
the enactment of this subtitle, the Secretary of Health and Human Services
shall submit to Congress a report on the study under subsection (a) and shall
include in such report recommendations for improving the current Federal
security and confidentiality standards, including recommendations for a
mechanism to track breaches to the security or confidentiality of individually
identifiable health information and for appropriate penalties to apply in the
case of such a breach and including proposals to address issues examined in
subsection (a)(2).</text>
</subsection><subsection id="HA41CFE446B3045F98F4837378AC1FF04"><enum>(c)</enum><header>Preservation of
Current Security and Confidentiality Standards Before Submittal of
Report</header><text>None of the provisions of this subtitle or amendments made
by this subtitle may limit, or require issuance of a regulation that would
limit, the effect of a current Federal security and confidentiality standard
before the date of the submittal of the report under subsection (b).</text>
</subsection><subsection id="H9A8F2940FFF74AEB8BA87ADB9DF593A0"><enum>(d)</enum><header>Current Federal
Security and Confidentiality Standards Defined</header><text>For purposes of
this section, the term <term>current Federal security and confidentiality
standards</term> means the Federal privacy standards established pursuant to
section 264(c) of the Health Insurance Portability and Accountability Act of
1996 (42 U.S.C. 1320d–2 note) and security standards established under section
1173(d) of the Social Security Act.</text>
</subsection></section><section id="H3F907AB5AD124279924B1A51728F6087"><enum>234.</enum><header>Assisting
Doctors to Obtain Proficient and Transmissible Health Information
Technology</header>
<subsection id="H17868BA57F8A4A289607F41C41D26444"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 179 of the
Internal Revenue Code of 1986 (relating to election to expense certain
depreciable assets) is amended by adding at the end the following new
subsection:</text>
<quoted-block display-inline="no-display-inline" id="H0D156DD27837478EA3B46FB591423755" style="OLC">
<subsection id="HE12F0515DF3A4DABA8B2682FB8074F39"><enum>(f)</enum><header>Health Care
Information Technology</header>
<paragraph id="H4607C33A5309464DAFEE19873B534BBF"><enum>(1)</enum><header>In
general</header><text>In the case of qualified health care information
technology purchased by a medical care provider and placed in service during a
taxable year—</text>
<subparagraph id="HEB97008603274175B3909EA0EE613830"><enum>(A)</enum><text>subsection (b)(1)
shall be applied by substituting <quote>$250,000</quote> for
<quote>$125,000</quote>;</text>
</subparagraph><subparagraph id="H3FA32AE32BC64195A471DF6D893B54BD"><enum>(B)</enum><text>subsection (b)(2)
shall be applied by substituting <quote>$600,000</quote> for
<quote>$500,000</quote>; and</text>
</subparagraph><subparagraph id="HF81AE4F1452542448B967E8F357954C1"><enum>(C)</enum><text>subsection
(b)(5)(A) shall be applied by substituting <quote>$250,000 and $600,000</quote>
for <quote>$125,000 and $500,000</quote>.</text>
</subparagraph></paragraph><paragraph id="H609486425D13481DBDF762DF9B688D7B"><enum>(2)</enum><header>Definitions</header><text>For
purposes of this subsection—</text>
<subparagraph id="HEC70A6B038204E0384DCC7CF124F3B4F"><enum>(A)</enum><header>Qualified health
care information technology</header><text>The term <term>qualified health care
information technology</term> means section 179 property which—</text>
<clause id="HDD31B15B002A46D8BCA6F33E2AD01D01"><enum>(i)</enum><text>has been certified
pursuant to section 3001(c)(3) of the Public Health Service Act; and</text>
</clause><clause id="HAB877506C62B4B1A9A3349941A53FF3A"><enum>(ii)</enum><text>is used primarily
for the electronic creation, maintenance, and exchange of medical care
information to provide or improve the quality or efficiency of medical
care.</text>
</clause></subparagraph><subparagraph id="H16DAE7962ED947699166EC93A55402BC"><enum>(B)</enum><header>Medical care
provider</header><text>The term <term>medical care provider</term> means any
person engaged in the trade or business of providing medical care.</text>
</subparagraph><subparagraph id="H6DF6AAC3E5FB450E83DF50E02040C2E9"><enum>(C)</enum><header>Medical
care</header><text>The term <term>medical care</term> has the meaning given
such term by section
213(d).</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H43964D9A3C0E4569912026419AD5377C"><enum>(b)</enum><header>Effective
date</header><text display-inline="yes-display-inline">The amendment made by
this section shall apply to property placed in service after December 31,
2009.</text>
</subsection></section><section id="H8E44B83F412847CF86C0B09870A2A748"><enum>235.</enum><header>Expansion of
Stark and anti-kickback exceptions for electronic health records
arrangements</header>
<subsection id="H74D5C84970154B61929E710A0C6D90B8"><enum>(a)</enum><header>Stark
exception</header><text display-inline="yes-display-inline">In applying section
1877(e) of the Social Security Act (42 U.S.C. 1395(e)), with respect to a
regulation implementing such section by providing an exception to the
prohibition against making certain physician referrals in the case of the
offering or payment of nonmonetary remuneration (consisting of items and
services in the form of software or information technology and training
services) necessary and used predominantly to create, maintain, transmit, or
receive electronic health records, the Secretary of Health and Human Services
shall—</text>
<paragraph id="HA4F972FC6F964DB4A04E2921FAEFCFAF"><enum>(1)</enum><text>not limit the
period in which such an exception under such a regulation applies;</text>
</paragraph><paragraph id="H1FE6DBE4948A4569B6C575CDF2F91627"><enum>(2)</enum><text>not require the
physician to pay any percentage of the cost of such nonmonetary remuneration;
and</text>
</paragraph><paragraph id="HFC23E442EDF549E6ABC251C34FF63DE8"><enum>(3)</enum><text>apply the
exception to such items and services in the form of hardware and maintenance
services, in addition to such items and services in the form of software or
information technology and training services.</text>
</paragraph></subsection><subsection id="HEEC0E598E6A34D7A945004C70F384BEF"><enum>(b)</enum><header>Anti-Kickback
exception</header><text>In applying section 1128B(b)(3)(E) of the Social
Security Act (42 U.S.C. 1320a–7b(b)(3)(E)), with respect to a regulation
implementing such section by providing an exception to the prohibition against
offering, paying, soliciting, or receiving remuneration in order to induce or
reward referrals making certain physician referrals in the case of the
offering, payment, solicitation, or receipt of remuneration (consisting of
certain arrangements involving interoperable electronic health records software
or information technology and training services) necessary and used
predominantly to create, maintain, transmit, or receive electronic health
records, the Secretary of Health and Human Services shall—</text>
<paragraph id="H7479AA9C8A6344A6BF697EF4A43C578C"><enum>(1)</enum><text>not limit the
period in which such an exception under such a regulation applies;</text>
</paragraph><paragraph id="H91AE3B9ABF694467A7AC8090CF50605D"><enum>(2)</enum><text>not require the
recipient of such remuneration to pay any percentage of the cost of such
remuneration; and</text>
</paragraph><paragraph id="H2FD73DF3AEA645DE96419E5D2A0FDA87"><enum>(3)</enum><text display-inline="yes-display-inline">apply the exception to such arrangements
involving interoperable electronic health records hardware and maintenance
services, in addition to software or information technology and training
services.</text>
</paragraph></subsection></section><section id="H15D5240889EE49C4823BF780D7911408"><enum>236.</enum><header>Application of
Medicare EHR incentives and adjustments to additional providers</header>
<subsection id="HDCDD2BEBDD2445B584D45450BC3B5DBA"><enum>(a)</enum><header>Application of
EHR Medicare incentive payments and adjustments to nurse practitioner,
physician assistants, and clinical nurse specialists</header>
<paragraph id="HC38BC3ECBCE14EB2923E253DD5A1E8B7"><enum>(1)</enum><header>Incentive
payment</header><text>Section 1848(o)(5)(C) of the Social Security Act is
amended by inserting <quote>, and a practitioner described in section
1842(b)(18)(C)(i)</quote> after <quote>1861(r)</quote>.</text>
</paragraph><paragraph id="HF12107B87C3B450C8A35541575C028C7"><enum>(2)</enum><header>Incentive
adjustment</header><text display-inline="yes-display-inline">Section
1848(a)(7)(E)(iii) of such Act is amended by inserting <quote>, and a
practitioner described in section 1842(b)(18)(C)(i)</quote> after
<quote>1861(r)</quote>.</text>
</paragraph></subsection><subsection id="H0A2933FFFB5744319BE3F0E6B021332B"><enum>(b)</enum><header>Application of
EHR Medicare incentive payments and adjustments to SNFs, home health agencies,
IRFs, LTCHs, ASCs, and long-Term care pharmacies</header>
<paragraph id="HF6F7F11B1CE248C1B70FB18705FD30EB"><enum>(1)</enum><header>In
general</header><text>The Secretary of Health and Human Services shall
establish a methodology to—</text>
<subparagraph id="H0F5B58604FF041D6A95B42E104F8A70B"><enum>(A)</enum><text display-inline="yes-display-inline">determine eligible entities described in
paragraph (2) that are to be considered meaningful EHR users in a manner
similar to how eligible hospitals are determined to be meaningful EHR users for
purposes of sections 1886(n) and 1886(b)(3)(B)(ix) of the Social Security Act;
and</text>
</subparagraph><subparagraph id="H1B1928471010442FAB56C7ACF0E60FE5"><enum>(B)</enum><text>apply the
provisions of such sections to such eligible entities in a similar manner as
they apply to hospitals under such section.</text>
</subparagraph></paragraph><paragraph id="HECEDC024B49E4CC08450DCD397FC2795"><enum>(2)</enum><header>Eligible
entities described</header><text>Eligible entities described in this paragraph
are the following:</text>
<subparagraph id="HDF33373418584EA7B2ED6FD4540DD65E"><enum>(A)</enum><text>Skilled nursing
facilities.</text>
</subparagraph><subparagraph id="H2E6AB58467C94B208B205641837B58D6"><enum>(B)</enum><text display-inline="yes-display-inline">Home health agencies.</text>
</subparagraph><subparagraph id="HC4A9BDACDE784BD6881E005F0EE9E61E"><enum>(C)</enum><text display-inline="yes-display-inline">Inpatient rehabilitation facilities
.</text>
</subparagraph><subparagraph id="H099AC8C7CE7547AFB63DA10A89107B8B"><enum>(D)</enum><text>Ambulatory
surgical centers.</text>
</subparagraph><subparagraph id="HACA3D8CEBECB409EB4ABFAF1ECB89301"><enum>(E)</enum><text>Long-term care
pharmacies.</text>
</subparagraph><subparagraph id="HC38D8F109B7A4A2D819E3477AE5B296E"><enum>(F)</enum><text>Long-term care
hospitals.</text>
</subparagraph></paragraph></subsection></section></part><part id="H9E979D4F36644AD9B9D0795EFC4738F5"><enum>2</enum><header>Telehealth
Enhancement</header>
<subpart id="H1279D1C4B10D4BB9B52C4CF3F1D34BBC"><enum>A</enum><header>Medicare
Program</header>
<section commented="no" id="HA9800D162E1E46F1BE3844A0F3A7101B"><enum>241.</enum><header>Expansion and
improvement of telehealth services</header>
<subsection commented="no" id="H4044309EBCDE4F73A09F33144A6CE452"><enum>(a)</enum><header>Expanding access
to telehealth services to all areas</header><text>Section 1834(m)(4)(C)(i) of
the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395m(m)(4)(C)(i)) is amended in paragraph (4)(C)(i) by striking <quote>and
only if such site is located</quote> and all that follows and inserting
<quote>without regard to the geographic area within the United States where the
site is located.</quote>.</text>
</subsection><subsection commented="no" id="H6A7C1E80882944B794AE629E9DBDA565"><enum>(b)</enum><header>Expansion of use
of store-and-Forward technology</header><text display-inline="yes-display-inline">The second sentence of section 1834(m)(1)
of such Act (42 U.S.C. 1395m(m)(1)) is amended by inserting <quote>and any
telehealth program that has been the recipient of any Federal support from the
Centers for Medicare & Medicaid Services, the Indian Health Service, or the
Health Services and Resources Administration</quote> after <quote>Alaska or
Hawaii</quote>.</text>
</subsection><subsection commented="no" id="H6596D418FD0540FF9A8B8004170DEABD"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to services
furnished on or after January 1, 2010.</text>
</subsection></section><section commented="no" id="H0E0BCC70838E4610A2CF3F3D407B8060"><enum>242.</enum><header>Increase in
number of types of originating sites; clarification</header>
<subsection commented="no" id="HEDCF8E30C9014A4CBBA233845263D57B"><enum>(a)</enum><header>Increase</header><text>Paragraph
(4)(C)(ii) of section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m))
is amended by adding at the end the following new subclause:</text>
<quoted-block id="H7ADDB24234CB4600803AFB57D0B26FB9" style="OLC">
<subclause commented="no" id="HCCF959B76A9A4EA3939635BF614238D3"><enum>(IX)</enum><text>A renal dialysis
facility.</text>
</subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="H7F11FFFBABC84B3794B19AF7C53CF95D"><enum>(b)</enum><header>Clarification of
Intent of the Term Originating Site</header><text>Such section is further
amended by adding at the end the following new paragraph:</text>
<quoted-block id="H307E78343909490293946D629EE9F95F" style="OLC">
<paragraph commented="no" id="HA48D872277AA4974B53ECA47655B0372"><enum>(5)</enum><header>Construction</header><text>In
applying the term <term>originating site</term> under this subsection, the
Secretary shall apply the term only for the purpose of determining whether a
site is eligible to receive a facility fee. Nothing in the application of such
term under this subsection shall be construed as affecting the ability of an
eligible practitioner to submit claims for telehealth services that are
provided to other sites that have telehealth systems and
capabilities.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H08D46DE2061C4C148650174A5C731281"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to services
furnished on or after January 1, 2010.</text>
</subsection></section><section commented="no" id="H6A766B09B9C648F595729E47D98BAE01"><enum>243.</enum><header>Expansion of
eligible telehealth providers and credentialing of telemedicine
practitioners</header>
<subsection commented="no" id="HC1B70CDFD79B4F1686017DC376182C17"><enum>(a)</enum><header>Expansion of
eligible telehealth providers</header><text>Section 1834(m)(1) of the Social
Security Act (42 U.S.C. 1395m(m)(1)) is amended—</text>
<paragraph commented="no" id="H94355E3B04BD477EA9F627457E719358"><enum>(1)</enum><text>in paragraph
(1)—</text>
<subparagraph commented="no" id="H41ACDD8846544B42B281F06A718E5623"><enum>(A)</enum><text>by striking
<quote>or a practitioner</quote> and inserting <quote>, a
practitioner</quote>;</text>
</subparagraph><subparagraph commented="no" id="HD98AD75BEF974902A3A42CEF50AAE917"><enum>(B)</enum><text>by inserting
<quote>, or other telehealth provider</quote> after
<quote>1842(b)(18)(C))</quote>; and</text>
</subparagraph><subparagraph commented="no" id="H46FC1FEF607F430CB5E7D9B0512C5E53"><enum>(C)</enum><text>by striking
<quote>or practitioner</quote> and inserting <quote>, practitioner, or
provider</quote>;</text>
</subparagraph></paragraph><paragraph commented="no" id="H8AB96E233E544FB79FC300F459672BBE"><enum>(2)</enum><text>in paragraphs (2),
(3)(A), and (4), by striking <quote>or practitioner</quote> and inserting
<quote>, practitioner, or other telehealth provider</quote> each place it
appears; and</text>
</paragraph><paragraph commented="no" id="H7D505D5191E24D07806149F787CEB8DE"><enum>(3)</enum><text>in paragraph (4),
by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H8D28748873C04DF381E3DE7A1C578E1B" style="OLC">
<subparagraph commented="no" id="H51568729E71D4A979E0576302AD729F6"><enum>(G)</enum><header>Telehealth
provider</header><text display-inline="yes-display-inline">The term
<term>telehealth provider</term> means any supplier or provider of services
(other than a physician or practitioner) that is eligible to provide other
health services under this
title.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" id="HDBECE4F39FE44C72820C72F7F526E053"><enum>(b)</enum><header>Credentialing
Telemedicine Practitioners</header><text>Section 1834(m) of such Act is amended
by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HFCDBDE80272F464AAEE5B9A3E3E2DB0A" style="OLC">
<paragraph commented="no" id="H8157BA1531ED4166AAB42D8F5AB53E2F"><enum>(5)</enum><header>Hospital
credentialing of telemedicine practitioners</header><text display-inline="yes-display-inline">A telemedicine practitioner that is
credentialed by a hospital in compliance with the Joint Commission Standards
for Telemedicine shall be considered in compliance with Medicare condition of
participation and reimbursement credentialing requirements for telemedicine
services.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section commented="no" id="HAFFD7BD77C9A42BABF644AD52EE96A2F"><enum>244.</enum><header>Access to
telehealth services in the home</header>
<subsection commented="no" id="HC505F9D04BDE47A78F13CE64FAF2687D"><enum>(a)</enum><header>In
general</header><text>Section 1895 of the Social Security Act (42 U.S.C.
1395fff(e)) is amended by adding at the end the following new
subsection:</text>
<quoted-block id="HF236CE7445D44167827FA869DFAA21F3" style="OLC">
<subsection commented="no" id="HBFF6DCFD59BD471F94128D73223DEE63"><enum>(f)</enum><header>Coverage of
Telehealth Services</header>
<paragraph commented="no" id="H6955B014B39745E4A9DAD4F3D65F0FBF"><enum>(1)</enum><header>In
general</header><text>The Secretary shall include telehealth services that are
furnished via a telecommunication system by a home health agency to an
individual receiving home health services under section 1814(a)(2)(C) or
1835(a)(2)(A) as a home health visit for purposes of eligibility and payment
under this title if the telehealth services—</text>
<subparagraph commented="no" id="HAA1F69D809DC45F4BC0EE37B08BF4ED8"><enum>(A)</enum><text>are ordered as
part of a plan of care certified by a physician pursuant to section
1814(a)(2)(C) or 1835(a)(2)(A);</text>
</subparagraph><subparagraph commented="no" id="HC0EA3C493D0546698BFA25F3390FFC8B"><enum>(B)</enum><text>do not substitute
for in-person home health services ordered as part of a plan of care certified
by a physician pursuant to such respective section; and</text>
</subparagraph><subparagraph commented="no" id="HF3B7B31C22B5475FAF43F37CE4EF82C8"><enum>(C)</enum><text>are considered the
equivalent of a visit under criteria developed by the Secretary under paragraph
(3).</text>
</subparagraph></paragraph><paragraph commented="no" id="HD535B43B67E3422EBEB2B16508030EE3"><enum>(2)</enum><header>Physician
certification</header><text>Nothing in this section shall be construed as
waiving the requirement for a physician certification under section
1814(a)(2)(C) or 1835(a)(2)(A) for the payment for home health services,
whether or not furnished via a telecommunication system.</text>
</paragraph><paragraph commented="no" id="H3B14ED7FCC354E718B1238823A4836D6"><enum>(3)</enum><header>Criteria for
visit equivalency</header>
<subparagraph commented="no" id="H23054545F44A4217A90216BD30D25518"><enum>(A)</enum><header>Standards</header><text>The
Secretary shall establish standards and qualifications for categorizing and
coding under HCPCS codes telehealth services under this subsection as
equivalent to an in-person visit for purposes of eligibility and payment for
home health services under this title. In establishing the standards and
qualifications, the Secretary may distinguish between varying modes and
modalities of telehealth services and shall consider—</text>
<clause commented="no" id="HB11A9C3574CF41B8983DA65BE0096B1E"><enum>(i)</enum><text>the nature and
amount of service time involved; and</text>
</clause><clause commented="no" id="H242263C6A6F340A0999445696FE194D0"><enum>(ii)</enum><text>the functions of
the telecommunications.</text>
</clause></subparagraph><subparagraph commented="no" id="H0F2A5A6D355A4101AA5F671F928559D5"><enum>(B)</enum><header>Limitation</header><text>A
telecommunication that consists solely of a telephone audio conversation,
facsimile, electronic text mail, or consultation between two health care
practitioners is not considered a visit under this subsection.</text>
</subparagraph></paragraph><paragraph commented="no" id="H82968B6372E14DC2A3374ECC44736BD3"><enum>(4)</enum><header>Telehealth
service</header>
<subparagraph commented="no" id="H2A653A3DBE8F463F909DE0D0586EEEDC"><enum>(A)</enum><header>Definition</header><text>For
purposes of this subsection, the term <term>telehealth service</term> means
technology-based professional consultations, patient monitoring, patient
training services, clinical observation, assessment, or treatment, and any
additional services that utilize technologies specified by the Secretary as
HCPCS codes developed under paragraph (3).</text>
</subparagraph><subparagraph commented="no" id="H7EFBCE024A354097A095620AFDFC3A50"><enum>(B)</enum><header>Update of hcpcs
codes</header><text>The Secretary shall establish a process for the updating,
not less frequently than annually, of HCPCS codes for telehealth
services.</text>
</subparagraph></paragraph><paragraph commented="no" id="H6292D0D9C3CD4F4F80DF4BD5F9147784"><enum>(5)</enum><header>Conditions for
payment and coverage</header><text>Nothing in this subsection shall be
construed as waiving any condition of payment under sections 1814(a)(2)(C) or
1835(a)(2)(A) or exclusion of coverage under section 1862(a)(1).</text>
</paragraph><paragraph commented="no" id="HEF8C7B6160D94718ABAF2C23A5F057CE"><enum>(6)</enum><header>Cost
reporting</header><text>Notwithstanding any provision to the contrary, the
Secretary shall provide that the costs of telehealth services under this
subsection shall be reported as a reimbursable cost center on any cost report
submitted by a home health agency to the
Secretary.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="HEFA89ED10E754609BB687C1C2DD6566B"><enum>(b)</enum><header>Effective
date</header>
<paragraph commented="no" id="H0E1B7B9B5E994AB3931CDF4FD9C1D411"><enum>(1)</enum><text>The amendment made
by subsection (a) shall apply to telehealth services furnished on or after
October 1, 2010. The Secretary of Health and Human Services shall develop and
implement criteria and standards under section 1895(f)(3) of the Social
Security Act, as amended by subsection (a), by no later than July 1,
2010.</text>
</paragraph><paragraph commented="no" id="H067F95ED06514B9AB2C8233A6B84C71F"><enum>(2)</enum><text>In the event that
the Secretary has not complied with these deadlines, beginning October 1, 2010,
a home health visit for purpose of eligibility and payment under title XVIII of
the Social Security Act shall include telehealth services under section 1895(f)
of such Act with the aggregate of telecommunication encounters in a 24-hour
period considered the equivalent of one in-person visit.</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="H33F9D6BC9E3F4958BA2CE6D48A5686FB" section-type="subsequent-section"><enum>245.</enum><header>Coverage of home
health remote patient management services for chronic health
conditions</header>
<subsection commented="no" id="HBD2E89422CE44447AA84D802863A3C6A"><enum>(a)</enum><header>Medicare
coverage</header>
<paragraph commented="no" id="HF91B7418AC89435DA528D3CC4AB8CB27"><enum>(1)</enum><header>In
general</header><text>Section 1861(s)(2) of the Social Security Act (42 U.S.C.
1395x(s)(2)) is amended—</text>
<subparagraph commented="no" id="H32F8D9D10DBD4037A9CF8B32D963966F"><enum>(A)</enum><text>in subparagraph
(DD), by striking <quote>and</quote> at the end;</text>
</subparagraph><subparagraph commented="no" id="HAC808A064E0048FEB60D715884707BA7"><enum>(B)</enum><text>in subparagraph
(EE), by adding <quote>and</quote> at the end; and</text>
</subparagraph><subparagraph commented="no" id="HE974027500674D08B3636BC51909DEDB"><enum>(C)</enum><text>by inserting after
subparagraph (EE) the following new subparagraph:</text>
<quoted-block id="H8DC2EA32826743869E38C389E807948E" style="OLC">
<paragraph commented="no" id="HEB26EE322D874CBDB32BD8E72B952B51"><enum>(FF)</enum><text>home health
remote patient management services (as defined in subsection
(hhh));</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" id="H0F40635B64A34913AC4708CB99AA6B03"><enum>(2)</enum><header>Services
described</header><text>Section 1861 of such Act (42 U.S.C. 1395x) is amended
by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HB803065030FD410D92C15F67332D2EFB" other-style="archaic" style="traditional">
<subsection commented="no" id="H8C0D0C4863A2492C9FB509DE059E294B"><enum>(hhh)</enum><header>Home health
remote patient management services for chronic health conditions</header><paragraph commented="no" display-inline="yes-display-inline" id="HC497983FF0B44D638AD96C21A5E9A380"><enum>(1)</enum><text display-inline="yes-display-inline">The term <term>remote patient management
services</term> means the remote monitoring, evaluation, and management of an
individual with a covered chronic health condition (as defined in paragraph
(2)) through the utilization of a system of technology that allows a remote
interface to collect and transmit clinical data between the individual and a
home health agency, in accordance with a plan of care established by a
physician, for the purposes of clinical review or response by the home health
agency. Such term, with respect to an individual, does not include any remote
monitoring, evaluation, or management of the individual if such remote
monitoring, evaluation, or management, respectively, is included as a home
health visit under section 1895(f) for purposes of payment under this
title.</text>
</paragraph><paragraph commented="no" id="HE06EEA36BA134B30AF070C89E266A0CB" indent="up1"><enum>(2)</enum><text>For purposes of paragraph (1), the
term <term>covered chronic health condition</term> means any chronic health
condition specified by the
Secretary.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" id="HE81C24BB944F4CD39295805C20D88AE8"><enum>(b)</enum><header>Payment</header>
<paragraph commented="no" id="H7763CB9B74664310A67F56482BDACC20"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1834 of such
Act (42 U.S.C. 1395l) is amended by adding at the end the following new
subsection:</text>
<quoted-block display-inline="no-display-inline" id="H6A29BD88E6754A0BBE3F1E625FC999A1" style="OLC">
<subsection commented="no" id="H6E74FA8AECA64A518DFFE04C48E52600"><enum>(n)</enum><header>Home Health
Remote Patient Management Services</header>
<paragraph commented="no" id="HF2F424D5A95D4E80B865152EE97B9303"><enum>(1)</enum><header>In
general</header><text>The Secretary shall establish a fee schedule for home
health remote patient management services (as defined in section 1861(hhh)) for
which payment is made under this part. The fee schedule shall be designed in a
manner so that, on an annual basis, the aggregate payment amounts under this
title for such services approximates 50 percent of the savings amount described
in paragraph (2) for such year.</text>
</paragraph><paragraph commented="no" id="H947E5376F70B4CC5B7B70AB240AD8665"><enum>(2)</enum><header>Savings
described</header>
<subparagraph commented="no" id="H2F34216FB3744D279B944CE6083389D5"><enum>(A)</enum><header>In
general</header><text>For purposes of paragraph (1), the savings amount
described in this paragraph for a year is the amount (if any), as estimated by
the Secretary before the beginning of the year, by which—</text>
<clause commented="no" id="H3A009E512EE44B2D9AA50B6538D5E3FF"><enum>(i)</enum><text>the product
described in subparagraph (B) for the year, exceeds</text>
</clause><clause commented="no" id="HA39CC4A599BC4D67B05C1105A1655733"><enum>(ii)</enum><text>the total
payments under this part and part A for items and services furnished to
individuals receiving home health remote patient management services at any
time during the year.</text>
</clause></subparagraph><subparagraph commented="no" id="HEB8FEB24BAEA4EC0A23BFC86754C4593"><enum>(B)</enum><header>Product
described</header><text>The product described in this subparagraph for a year
is the product of—</text>
<clause commented="no" id="HC6549CC2277E4190BA865A15549CCED6"><enum>(i)</enum><text>the average per
capita total payments under this part and part A for items and services
furnished during the year to individuals not described in subparagraph (A)(ii),
adjusted to remove case mix differences between such individuals not described
in such subparagraph and the individuals described in such subparagraph;
and</text>
</clause><clause commented="no" id="HF749EF2D77D64561A3FBDE949EACF6C6"><enum>(ii)</enum><text>the number of
individuals under subparagraph (A)(ii) for the year.</text>
</clause></subparagraph></paragraph><paragraph commented="no" id="H4C45ACD10DE2482696D09219C9C14923"><enum>(3)</enum><header>Limitation</header><text>In
no case may payments under this subsection result in the aggregate expenditures
under this title (including payments under this subsection) exceeding the
amount that the Secretary estimates would have been expended if coverage under
this title for home health patient management services was not provided.</text>
</paragraph><paragraph commented="no" id="HC86C3EEB8943490084E81636C4E63511"><enum>(4)</enum><header>Clarification</header><text>Payments
under the fee schedule under this subsection, with respect to an individual,
shall be in addition to any other payments that a home health agency would
otherwise receive under this title for items and services furnished to such
individual and shall have no effect on the amount of such other
payments.</text>
</paragraph><paragraph commented="no" id="HA286D8DB35DF4A5BB6019E6E27D8D0E2"><enum>(5)</enum><header>Payment
transfer</header><text display-inline="yes-display-inline">There shall be
transferred from the Federal Hospital Insurance Trust Fund under section 1817
to the Federal Supplementary Medical Insurance Trust Fund under section 1841
each year an amount equivalent to the product of—</text>
<subparagraph commented="no" id="HEB97CE79A45C489A91551D8914F9F192"><enum>(A)</enum><text>expenditures under
this subsection for the year, and</text>
</subparagraph><subparagraph commented="no" id="H00DADB351A804FE68A2DE52ACB984AC4"><enum>(B)</enum><text>the ratio of the
portion of the savings described in paragraph (2) for the year that are
attributable to part A, to the total savings described in such paragraph for
the
year.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph commented="no" id="HE3829FD99AB245ACB782A28525E05061"><enum>(2)</enum><header>Conforming
amendment</header><text display-inline="yes-display-inline">Section 1833(a)(1)
of such Act (42 U.S.C. 1395l(1)) is amended—</text>
<subparagraph commented="no" id="H3C0B181968FB458A9E7A2A4DD6031F1C"><enum>(A)</enum><text>by striking
<quote>and (W)</quote> and inserting <quote>(W)</quote>; and</text>
</subparagraph><subparagraph commented="no" id="H1240CFC7640843A5B3820A2224FC31A6"><enum>(B)</enum><text>by inserting
before the semicolon at the end the following: <quote>, (X) with respect to
home health remote patient management services (as defined in section
1861(hhh)), the amounts paid shall be the amount determined under the fee
schedule established under section 1834(n)</quote>.</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="HF08AEEF994754BA4A0FF83503CD69016"><enum>(c)</enum><header>Expansion of
Home Health Remote Patient Management Services Coverage to Additional Chronic
Health Conditions</header><text display-inline="yes-display-inline">The
Secretary of Health and Human Services is authorized to carry out pilot
projects for purposes of determining the extent to which the coverage under
title XVIII of the Social Security Act of home health remote patient management
services (as defined in paragraph (1) of section 1861(hhh) of such Act, as
added by subsection (a)) should be extended to individuals with chronic health
conditions other than those initially specified by the Secretary under
paragraph (2) of such section.</text>
</subsection><subsection commented="no" id="H339377D3DADD42A7AED6FAE85FA6EDAB"><enum>(d)</enum><header>Effective
date</header><text display-inline="yes-display-inline">The amendments made by
subsections (a), (b), and (c) shall apply to services furnished on or after
January 1, 2010.</text>
</subsection></section><section commented="no" id="HF5CB83C4755D47CE9104417D0F1EC8A6"><enum>246.</enum><header>Sense of
Congress on the use of remote patient management services</header>
<subsection commented="no" id="HAF5BD8529E4447C0913D3E24DC4A18AD"><enum>(a)</enum><header>Findings</header><text>Congress
finds as follows:</text>
<paragraph commented="no" id="HE0F76CD0F90E4063A7E5E1A88F7986E4"><enum>(1)</enum><text>Remote patient
management services can make chronic disease management more effective and
efficient for patients and for the health care system.</text>
</paragraph><paragraph commented="no" id="HF451BBA289034B2DAE3D805C1509F08E"><enum>(2)</enum><text>By collecting,
analyzing, and transmitting clinical health information to a health care
provider, remote patient management services allow patients and providers to
manage the medical condition of patients in a consistent and real time
fashion.</text>
</paragraph><paragraph commented="no" id="H2233D51755004DBEA1690EAB6FF00B5D"><enum>(3)</enum><text>Utilization of
remote patient management services not only improves the quality of care given
to patients, it also reduces the need for frequent office appointments, costly
emergency room visits, and unnecessary hospitalizations.</text>
</paragraph><paragraph commented="no" id="H8DC914C61D084FE0826545E83909BB1F"><enum>(4)</enum><text>Management the
medical condition or disease of a patient from the patient's home reduces the
need for face to face provider interactions. Use of remote patient management
services minimizes unnecessary travel and missed work and provides particular
value to patients residing in rural or underserved communities who would
otherwise face potentially significant access barriers to receiving needed
care.</text>
</paragraph><paragraph commented="no" id="HD617F83797CC40C1BDC39D1CF7CD73A1"><enum>(5)</enum><text>Among the areas in
which remote patient management services are emerging in health care are the
treatment of congestive heart failure, diabetes, cardiac arrhythmia, epilepsy,
and sleep apnea. Prompt transmission of clinical data on each of these
conditions, to the health care provider or the patient as appropriate, is
essential to providing timely and appropriate therapeutic interventions which
can then reduce expensive hospitalizations.</text>
</paragraph><paragraph commented="no" id="HE39FCF0974814442AF69E5EACAEFB0BA"><enum>(6)</enum><text>Despite these
benefits, remote patient management services have failed to diffuse rapidly. A
significant barrier to wider adoption is the relative lack of payment
mechanisms in fee for service Medicare to reimburse for remote, non face to
face patient management.</text>
</paragraph><paragraph commented="no" id="H479C9C34302444328919DAAABE3CF60D"><enum>(7)</enum><text>Elimination of
this barrier to new remote patient management services should be encouraged by
requiring reimbursement under the Medicare program for providers’ time spent
analyzing and responding to patient data transmitted by remote
technologies.</text>
</paragraph><paragraph commented="no" id="H516AC43DFBA442CD97817DCFD072FF4D"><enum>(8)</enum><text>Reimbursement
under the Medicare program for health care providers’ time spent analyzing and
responding to data transmitted to providers by remote technologies should be
made on a separate basis and should not be combined with payments for others
services (also referred to as <quote>bundled payments</quote>).</text>
</paragraph><paragraph commented="no" id="H491456B344904930951DCEA32202862E"><enum>(9)</enum><text>Payment codes used
for reporting and billing for payment for providers’ remote patient management
services should be revised or adjusted, as appropriate, to encourage the
application of such services for other medical conditions.</text>
</paragraph></subsection><subsection commented="no" id="HF94821D4267A4785840EE1E7FED2F9C2"><enum>(b)</enum><header>Sense of
congress</header><text>It is the sense of the Congress that—</text>
<paragraph commented="no" id="H8BD9EDB6504C41B59A6EAD8454191489"><enum>(1)</enum><text>remote patient
management services are integral to improvement in the delivery, care, and
efficiency of health care services furnished in the United States; and</text>
</paragraph><paragraph commented="no" id="HA5A5058C11F2490C823D51AB8868F73F"><enum>(2)</enum><text>the Administrator
of the Centers for Medicare & Medicaid Services should be encouraged
to—</text>
<subparagraph commented="no" id="H8A4B62DCF7794550B5B16C1379DA6439"><enum>(A)</enum><text>expand the types
of medical conditions for which the use of remote patient management services
are reimbursed under the Medicare program;</text>
</subparagraph><subparagraph commented="no" id="H34E16800C7D242D4946195C98DD8EBCE"><enum>(B)</enum><text>provide for
separate, non-bundled payment under the Medicare program for remote patient
management services; and</text>
</subparagraph><subparagraph commented="no" id="H28A0BC39FEB24320931D9E746FEB96C5"><enum>(C)</enum><text>create, revise and
adjust, as appropriate, codes for the accurate reporting and billing for
payment for remote patient management services.</text>
</subparagraph></paragraph></subsection></section><section commented="no" id="HAD753252B9F64A6FA45C4E04B26D644C"><enum>247.</enum><header>Telehealth
Advisory Committee</header>
<subsection commented="no" id="H0978E5B3FEB64501A14A49A2A427F414"><enum>(a)</enum><header>In
general</header><text>Section 1834(m)(4)(F)(ii) of the Social Security Act (42
U.S.C. 1395m(m)(4)(F)(ii)) is amended by adding at the end the following
sentences: <quote>Such process shall require the Secretary to take into account
the recommendations of the Telehealth Advisory Committee (as established under
section 247(b) of the <short-title>Medical Rights and
Reform Act of 2009</short-title>) when adding or deleting services (and HCPCS
codes) and in establishing policies of the Centers for Medicare & Medicaid
Services regarding the delivery of telehealth services. If the Secretary does
not implement a recommendation of the Telehealth Advisory Committee, the
Secretary shall publish in the Federal Register a statement regarding the
reason such recommendation was not implemented.</quote>.</text>
</subsection><subsection commented="no" id="HC45FA7C488F74A839E11FF40F85A470B"><enum>(b)</enum><header>Telehealth
Advisory Committee</header>
<paragraph commented="no" id="HEFA67C44E01F4FA3B3EE6A7F4424EC07"><enum>(1)</enum><header>Establishment</header><text>On
and after the date that is 6 months after the date of enactment of this
subtitle, the Secretary of Health and Human Services (in this subsection
referred to as the <quote>Secretary</quote>) shall have in place a Telehealth
Advisory Committee (in this subsection referred to as the <quote>Advisory
Committee</quote>) to make recommendations to the Secretary on—</text>
<subparagraph commented="no" id="H8DE9A0D3F51B41DCB1531AD9FA2820D5"><enum>(A)</enum><text display-inline="yes-display-inline">policies of the Centers for Medicare &
Medicaid Services regarding the delivery of telehealth services; and</text>
</subparagraph><subparagraph commented="no" id="H6CA166C5DA1D41BB980A58067293958D"><enum>(B)</enum><text>the appropriate
addition or deletion of services (and HCPCS codes) to those specified in
paragraph (4)(F)(i) of section 1834(m) of the Social Security Act (42 U.S.C.
1395m(m)) for authorized payment under paragraph (1) of such section.</text>
</subparagraph></paragraph><paragraph commented="no" id="HFAAF4E855CBC49C48C126EE798BB189E"><enum>(2)</enum><header>Membership;
terms</header>
<subparagraph commented="no" id="H9CB90569C9BD49C69A1E609B59CD339D"><enum>(A)</enum><header>Membership</header>
<clause commented="no" id="H2FA3F7E621DA4D5A86345BCCF5CE9DCC"><enum>(i)</enum><header>In
general</header><text>The Advisory Committee shall be composed of 9 members, to
be appointed by the Secretary, of whom—</text>
<subclause commented="no" id="HED209D2F3A6647D19563555F4B1C6B02"><enum>(I)</enum><text>five shall be
practicing physicians;</text>
</subclause><subclause commented="no" id="HEC4AB97B55C64AA1AAA18FDC9243DA4C"><enum>(II)</enum><text>two shall be
practicing non-physician health care providers; and</text>
</subclause><subclause commented="no" id="H7616AEA9F6E44C7AA18E6CF2A45B38E3"><enum>(III)</enum><text display-inline="yes-display-inline">two shall be administrators of telehealth
programs.</text>
</subclause></clause><clause commented="no" id="H7421E3744A6B4999A15EDCE3696996FD"><enum>(ii)</enum><header>Requirements
for appointing members</header><text>In appointing members of the Advisory
Committee, the Secretary shall—</text>
<subclause commented="no" id="HA5CF349800F24E8EBF57BEFF3D0A88F9"><enum>(I)</enum><text>ensure that each
member has prior experience with the practice of telemedicine or
telehealth;</text>
</subclause><subclause commented="no" id="HE0A3AC3702E448E39CD5B1A41DAE35CB"><enum>(II)</enum><text display-inline="yes-display-inline">give preference to individuals who are
currently providing telemedicine or telehealth services or who are involved in
telemedicine or telehealth programs;</text>
</subclause><subclause commented="no" id="H911ACCF4EA8345BCA282A455B522F23D"><enum>(III)</enum><text>ensure that the
membership of the Advisory Committee represents a balance of specialties and
geographic regions; and</text>
</subclause><subclause commented="no" id="H4D7D9FAAABD4449EA6E3EAF1615D16E9"><enum>(IV)</enum><text>take into account
the recommendations of stakeholders.</text>
</subclause></clause></subparagraph><subparagraph commented="no" id="H319DC43DE5D74B9887943811306C1AEC"><enum>(B)</enum><header>Terms</header><text>The
members of the Advisory Committee shall serve for such term as the Secretary
may specify.</text>
</subparagraph><subparagraph commented="no" id="HAB41ED55BFF74BD68F9E8569AFED63DA"><enum>(C)</enum><header>Conflicts of
interest</header><text display-inline="yes-display-inline">An advisory
committee member may not participate with respect to a particular matter
considered in an advisory committee meeting if such member (or an immediate
family member of such member) has a financial interest that could be affected
by the advice given to the Secretary with respect to such matter.</text>
</subparagraph></paragraph><paragraph commented="no" id="H03CDD2C06B2743AD82455F997FE1300E"><enum>(3)</enum><header>Meetings</header><text>The
Advisory Committee shall meet twice per year and at such other times as the
Advisory Committee may provide.</text>
</paragraph><paragraph commented="no" id="H5B67C46B7C5F463B8E69932F2B9FC2CF"><enum>(4)</enum><header>Permanent
committee</header><text>Section 14 of the Federal Advisory Committee Act (5
U.S.C. App.) shall not apply to the Advisory Committee.</text>
</paragraph><paragraph commented="no" id="HBFACA139FA28405BBA3C5662619BE054"><enum>(5)</enum><header>Waiver of
administrative limitation</header><text>The Secretary shall establish the
Advisory Committee notwithstanding any limitation that may apply to the number
of advisory committees that may be established (within the Department of Health
and Human Services or otherwise).</text>
</paragraph></subsection></section></subpart><subpart id="H81BFD8E33B684486B025E57B646D4B0C"><enum>B</enum><header>HRSA Grant
Program</header>
<section commented="no" id="H087E9B8C73F54059A3549B9ABB9B2E61"><enum>250.</enum><header>Grant program
for the development of telehealth networks</header>
<subsection commented="no" id="H674234400E8342B0AEC7CE7EC2DF8C93"><enum>(a)</enum><header>In
general</header><text>The Secretary of Health and Human Services (in this
section referred to as the <quote>Secretary</quote>), acting through the
Director of the Office for the Advancement of Telehealth (of the Health
Resources and Services Administration), shall make grants to eligible entities
(as described in subsection (b)(2)) for the purpose of expanding access to
health care services for individuals in rural areas, frontier areas, and urban
medically underserved areas through the use of telehealth.</text>
</subsection><subsection commented="no" id="HBF0FF5A0AED54340BCD31590CF30A729"><enum>(b)</enum><header>Eligible
entities</header>
<paragraph commented="no" id="HC1FD74ADB97A46A093D202DB6612D100"><enum>(1)</enum><header>Application</header><text>To
be eligible to receive a grant under this section, an eligible entity described
in paragraph (2) shall, in consultation with the State office of rural health
or other appropriate State entity, prepare and submit to the Secretary an
application, at such time, in such manner, and containing such information as
the Secretary may require, including the following:</text>
<subparagraph commented="no" id="H92F7BA7B86404222BB6EB52C7A1489B2"><enum>(A)</enum><text>A description of
the anticipated need for the grant.</text>
</subparagraph><subparagraph commented="no" id="H58BC80B6862E43C5BBEC01DE0A5EDD96"><enum>(B)</enum><text>A description of
the activities which the entity intends to carry out using amounts provided
under the grant.</text>
</subparagraph><subparagraph commented="no" id="HFD401D6C19304D4F9246DAA2A7F7C366"><enum>(C)</enum><text>A plan for
continuing the project after Federal support under this section is
ended.</text>
</subparagraph><subparagraph commented="no" id="HDF7CBB959A694DE79F8A4283B5BE74E0"><enum>(D)</enum><text>A description of
the manner in which the activities funded under the grant will meet health care
needs of underserved rural populations within the State.</text>
</subparagraph><subparagraph commented="no" id="H91E15D38DCF24293A7E09C14DA263FC1"><enum>(E)</enum><text>A description of
how the local community or region to be served by the network or proposed
network will be involved in the development and ongoing operations of the
network.</text>
</subparagraph><subparagraph commented="no" id="HAF693A0BD8A54678B568058B6B8DE42A"><enum>(F)</enum><text>The source and
amount of non-Federal funds the entity would pledge for the project.</text>
</subparagraph><subparagraph commented="no" id="HFFA2C779064D42FA8B099E6AE4179881"><enum>(G)</enum><text>A showing of the
long-term viability of the project and evidence of health care provider
commitment to the network.</text>
</subparagraph><continuation-text commented="no" continuation-text-level="paragraph">The application should demonstrate
the manner in which the project will promote the integration of telehealth in
the community so as to avoid redundancy of technology and achieve economies of
scale.</continuation-text></paragraph><paragraph commented="no" id="H3D9C7944E8BE4632B7EF1B6C83D695D3"><enum>(2)</enum><header>Eligible
entities</header>
<subparagraph commented="no" id="HCC5122A8ECF64275BA70238BAD546D32"><enum>(A)</enum><header>In
general</header><text>An eligible entity described in this paragraph is a
hospital or other health care provider in a health care network of
community-based health care providers that includes at least—</text>
<clause commented="no" id="HF66BF3E89A3C444EA748A15D03F26324"><enum>(i)</enum><text>two of the
organizations described in subparagraph (B); and</text>
</clause><clause commented="no" id="H221D96B42EA04B46A9902D2606812953"><enum>(ii)</enum><text>one of the
institutions and entities described in subparagraph (C),</text>
</clause><continuation-text commented="no" continuation-text-level="subparagraph">if the institution or entity is
able to demonstrate use of the network for purposes of education or economic
development (as required by the Secretary).</continuation-text></subparagraph><subparagraph commented="no" id="H0719B9A0965144C6B35C72CCC07FFA4D"><enum>(B)</enum><header>Organizations
described</header><text>The organizations described in this subparagraph are
the following:</text>
<clause commented="no" id="H6C631E26DE02428C845111DCB14151F3"><enum>(i)</enum><text>Community or
migrant health centers.</text>
</clause><clause commented="no" id="H245A57B34CC6424581FF6C800F79450C"><enum>(ii)</enum><text>Local health
departments.</text>
</clause><clause commented="no" id="H701810E69D8D445D948EEC87F0005A87"><enum>(iii)</enum><text>Nonprofit
hospitals.</text>
</clause><clause commented="no" id="HAB466FEEB04A42F08E797B1A7631182A"><enum>(iv)</enum><text>Private practice
health professionals, including community and rural health clinics.</text>
</clause><clause commented="no" id="H884967D2FD074C77AA1C0FFA69A19995"><enum>(v)</enum><text>Other publicly
funded health or social services agencies.</text>
</clause><clause commented="no" id="H21D2B302361E49FBA5940CD59681AFB3"><enum>(vi)</enum><text>Skilled nursing
facilities.</text>
</clause><clause commented="no" id="HB9C003ECFD3A40C382AAEA81929C3B7C"><enum>(vii)</enum><text>County mental
health and other publicly funded mental health facilities.</text>
</clause><clause commented="no" id="HCEE5A32355B14F7295637BE4A570A2ED"><enum>(viii)</enum><text>Providers of
home health services.</text>
</clause><clause commented="no" id="H933250122D654665A6C676763EC43F29"><enum>(ix)</enum><text>Renal dialysis
facilities.</text>
</clause></subparagraph><subparagraph commented="no" id="H33327923925D48EE8B60645728E7145A"><enum>(C)</enum><header>Institutions and
entities described</header><text>The institutions and entities described in
this subparagraph are the following:</text>
<clause commented="no" id="H2BA8B68FE2C64E2A91843E25E625DEB8"><enum>(i)</enum><text>A public
school.</text>
</clause><clause commented="no" id="H971CCA16A2CD4E43B2F52DF153AB61AD"><enum>(ii)</enum><text>A public
library.</text>
</clause><clause commented="no" id="HD43F083AABB7463CB9514AF67833784C"><enum>(iii)</enum><text>A university or
college.</text>
</clause><clause commented="no" id="H941F9E013FB04E93ACD8AFDC6912B0A5"><enum>(iv)</enum><text>A local
government entity.</text>
</clause><clause commented="no" id="H37E8244996D14D7A99177E36E6AFC267"><enum>(v)</enum><text>A local health
entity.</text>
</clause><clause commented="no" id="HABA08D0E761C4E1F83D5E533303F2109"><enum>(vi)</enum><text>A health-related
nonprofit foundation.</text>
</clause><clause commented="no" id="H2A500A0192784EB6AEF7AD195D46B69E"><enum>(vii)</enum><text>An academic
health center.</text>
</clause></subparagraph><continuation-text commented="no" continuation-text-level="paragraph">An eligible entity may include
for-profit entities so long as the recipient of the grant is a not-for-profit
entity.</continuation-text></paragraph></subsection><subsection commented="no" id="H7B979465F4044CA8ADE74075C1283445"><enum>(c)</enum><header>Preference</header><text>The
Secretary shall establish procedures to prioritize financial assistance under
this section based upon the following considerations:</text>
<paragraph commented="no" id="H7D4A814BC0784867A4FC5D554D6AC487"><enum>(1)</enum><text>The applicant is a
health care provider in a health care network or a health care provider that
proposes to form such a network that furnishes or proposes to furnish services
in a medically underserved area, health professional shortage area, or mental
health professional shortage area.</text>
</paragraph><paragraph commented="no" id="HF94BCB2B24C541569729393E5AA74348"><enum>(2)</enum><text>The applicant is
able to demonstrate broad geographic coverage in the rural or medically
underserved areas of the State, or States in which the applicant is
located.</text>
</paragraph><paragraph commented="no" id="HC4A998CA27C141269841930BE273CB6E"><enum>(3)</enum><text>The applicant
proposes to use Federal funds to develop plans for, or to establish, telehealth
systems that will link rural hospitals and rural health care providers to other
hospitals, health care providers, and patients.</text>
</paragraph><paragraph commented="no" id="H78E0477567BE42C0A867CC2A8D75CED0"><enum>(4)</enum><text>The applicant will
use the amounts provided for a range of health care applications and to promote
greater efficiency in the use of health care resources.</text>
</paragraph><paragraph commented="no" id="HCF9B2CB0882049A9AD2459EDFD67ADAE"><enum>(5)</enum><text>The applicant is
able to demonstrate the long-term viability of projects through cost
participation (cash or in-kind).</text>
</paragraph><paragraph commented="no" id="H7858C808C9B547909D457036FA2CB874"><enum>(6)</enum><text>The applicant is
able to demonstrate financial, institutional, and community support for the
long-term viability of the network.</text>
</paragraph><paragraph commented="no" id="HDB7E4F75F65D48B1956B825497F3DB2E"><enum>(7)</enum><text>The applicant is
able to provide a detailed plan for coordinating system use by eligible
entities so that health care services are given a priority over non-clinical
uses.</text>
</paragraph></subsection><subsection commented="no" id="HE4655B8E1F3D4BD98C532BA41E1C338E"><enum>(d)</enum><header>Maximum amount
of assistance to individual recipients</header><text>The Secretary shall
establish, by regulation, the terms and conditions of the grant and the maximum
amount of a grant award to be made available to an individual recipient for
each fiscal year under this section. The Secretary shall cause to have
published in the Federal Register or the <quote>HRSA Preview</quote> notice of
the terms and conditions of a grant under this section and the maximum amount
of such a grant for a fiscal year.</text>
</subsection><subsection commented="no" id="H5DB363B1C5A04B6BB94057C6D0DEE451"><enum>(e)</enum><header>Use of
amounts</header><text>The recipient of a grant under this section may use sums
received under such grant for the acquisition of telehealth equipment and
modifications or improvements of telecommunications facilities including the
following:</text>
<paragraph commented="no" id="HC6F70AE86B494D5C8E78C7173B4CA274"><enum>(1)</enum><text>The development
and acquisition through lease or purchase of computer hardware and software,
audio and video equipment, computer network equipment, interactive equipment,
data terminal equipment, and other facilities and equipment that would further
the purposes of this section.</text>
</paragraph><paragraph commented="no" id="H4C30DCDF40A7409AA4F960DAC8909110"><enum>(2)</enum><text>The provision of
technical assistance and instruction for the development and use of such
programming equipment or facilities.</text>
</paragraph><paragraph commented="no" id="H90BF908F9F6D406084F2DD3DE505904E"><enum>(3)</enum><text>The development
and acquisition of instructional programming.</text>
</paragraph><paragraph commented="no" id="H8CEA72D5573348E0A07E4C6B0B8D1F5C"><enum>(4)</enum><text>Demonstration
projects for teaching or training medical students, residents, and other health
profession students in rural or medically underserved training sites about the
application of telehealth.</text>
</paragraph><paragraph commented="no" id="H336F01BAFAEE40D18E4ACB80797EA9A5"><enum>(5)</enum><text>The provision of
telenursing services designed to enhance care coordination and promote patient
self-management skills.</text>
</paragraph><paragraph commented="no" id="HAE695DF9E3A24068962003175108E58D"><enum>(6)</enum><text>The provision of
services designed to promote patient understanding and adherence to national
guidelines for common chronic diseases, such as congestive heart failure or
diabetes.</text>
</paragraph><paragraph commented="no" id="H61C170F3ED844581B36C10FAF23C6087"><enum>(7)</enum><text>Transmission
costs, maintenance of equipment, and compensation of specialists and referring
health care providers, when no other form of reimbursement is available.</text>
</paragraph><paragraph commented="no" id="H60BC50353E5640BAA1304920C5B8AD0D"><enum>(8)</enum><text>Development of
projects to use telehealth to facilitate collaboration between health care
providers.</text>
</paragraph><paragraph commented="no" id="H69F42CF83DE143DE8CEB200E368F2DAB"><enum>(9)</enum><text>Electronic
archival of patient records.</text>
</paragraph><paragraph commented="no" id="HD8B1FD23D9654E0F9C0B58F961543404"><enum>(10)</enum><text>Collection and
analysis of usage statistics and data that can be used to document the
cost-effectiveness of the telehealth services.</text>
</paragraph><paragraph commented="no" id="HEED0300CF0224B68AFCE6A2C328E94EA"><enum>(11)</enum><text>Such other uses
that are consistent with achieving the purposes of this section as approved by
the Secretary.</text>
</paragraph></subsection><subsection commented="no" id="HF6139ECB1294422F890F5960EA338805"><enum>(f)</enum><header>Prohibited
uses</header><text>Sums received under a grant under this section may not be
used for any of the following:</text>
<paragraph commented="no" id="HA49EA127EA14451FB4AE9DDAF467E496"><enum>(1)</enum><text>To acquire real
property.</text>
</paragraph><paragraph commented="no" id="H5D9757B272264F1AB0B28AB59BEF4EB7"><enum>(2)</enum><text>Expenditures to
purchase or lease equipment to the extent the expenditures would exceed more
than 40 percent of the total grant funds.</text>
</paragraph><paragraph commented="no" id="H31118D9A1C724453904844B92A4E293A"><enum>(3)</enum><text>To purchase or
install transmission equipment off the premises of the telehealth site and any
transmission costs not directly related to the grant.</text>
</paragraph><paragraph commented="no" id="H927ABBFBCAE649EEA50B80BE6BE02309"><enum>(4)</enum><text>For construction,
except that such funds may be expended for minor renovations relating to the
installation of equipment.</text>
</paragraph><paragraph commented="no" id="HF49423993A4645FDBBA3F3800F4611CD"><enum>(5)</enum><text>Expenditures for
indirect costs (as determined by the Secretary) to the extent the expenditures
would exceed more than 15 percent of the total grant.</text>
</paragraph></subsection><subsection commented="no" id="H13939B93DD304EC3A474C9C48A9ABBFD"><enum>(g)</enum><header>Administration</header>
<paragraph commented="no" id="HF63B69361FE34BD794CEA77E3F14AA31"><enum>(1)</enum><header>Nonduplication</header><text>The
Secretary shall ensure that facilities constructed using grants provided under
this section do not duplicate adequately established telehealth
networks.</text>
</paragraph><paragraph commented="no" id="HEC6AE54F90524DF0882347F124C3952F"><enum>(2)</enum><header>Coordination
with other agencies</header><text>The Secretary shall coordinate, to the extent
practicable, with other Federal and State agencies and not-for-profit
organizations, operating similar grant programs to pool resources for funding
meritorious proposals.</text>
</paragraph><paragraph commented="no" id="HE26DB3D2241147E7B6C5BD52A64B14E4"><enum>(3)</enum><header>Informational
efforts</header><text>The Secretary shall establish and implement procedures to
carry out outreach activities to advise potential end users located in rural
and medically underserved areas of each State about the program authorized by
this section.</text>
</paragraph></subsection><subsection commented="no" id="H99414353CE6F4470AC79557F98029D33"><enum>(h)</enum><header>Prompt
implementation</header><text>The Secretary shall take such actions as are
necessary to carry out the grant program as expeditiously as possible.</text>
</subsection><subsection commented="no" id="H23E0D48ABD82466E8736EAEECA3AD241"><enum>(i)</enum><header>Authorization of
appropriations</header><text>There are authorized to be appropriated to carry
out this section $10,000,000 for fiscal year 2010, and such sums as may be
necessary for each of the fiscal years 2011 through 2014.</text>
</subsection></section><section commented="no" id="HE6DD5283D04544E29C248C243562DAEC"><enum>251.</enum><header>Reauthorization
of telehealth network and telehealth resource centers grant
programs</header><text display-inline="no-display-inline">Subsection (s) of
section 330I of the Public Health Service Act (42 U.S.C. 254c–14) is
amended—</text>
<paragraph commented="no" id="H8FCE8B4FAF1E41129AF404C5CE2CFE2A"><enum>(1)</enum><text>in paragraph
(1)—</text>
<subparagraph commented="no" id="HF26E7699DEE244CF992FF2F5F22038BD"><enum>(A)</enum><text>by striking
<quote>and</quote> before <quote>such sums</quote>; and</text>
</subparagraph><subparagraph commented="no" id="H1DA7C92D92484033B0BE274E50CE9E2C"><enum>(B)</enum><text>by inserting
<quote>$10,000,000 for fiscal year 2010, and such sums as may be necessary for
each of fiscal years 2011 through 2014</quote> before the semicolon; and</text>
</subparagraph></paragraph><paragraph commented="no" id="HD54B57DC93DC45C683B834E10C84AB20"><enum>(2)</enum><text>in paragraph
(2)—</text>
<subparagraph commented="no" id="H9ECBA1544B3140A39DC50F3DDBA2F0CF"><enum>(A)</enum><text>by striking
<quote>and</quote> before <quote>such sums</quote>; and</text>
</subparagraph><subparagraph commented="no" id="H881872B1580B4AC38E92C6449E5D9AEC"><enum>(B)</enum><text>by inserting
<quote>$10,000,000 for fiscal year 2010, and such sums as may be necessary for
each of fiscal years 2011 through 2014</quote> before the semicolon.</text>
</subparagraph></paragraph></section></subpart></part></subtitle><subtitle id="H230024F5CD4847F0BA3C0FAD9805E2AC"><enum>D</enum><header>Eliminating Waste,
Fraud, and Abuse</header>
<section id="HF189CDAC59B54926ABE86D4F1CF549AA"><enum>261.</enum><header>Site
inspections; background checks; denial and suspension of billing
privileges</header>
<subsection id="H561D65ABFDCF4CCDB794C268A874295F"><enum>(a)</enum><header>Site Inspections
for DME Suppliers, Community Mental Health Centers, and Other Provider
Groups</header><text>Title XVIII of the <act-name parsable-cite="SSA">Social
Security Act</act-name> (42 U.S.C. 1395 et seq.) is amended by adding at the
end the following:</text>
<quoted-block act-name="Social Security Act" id="H1B94BF097EA74E9B8D4731E64A76C621" style="traditional">
<section id="H5EF12898784F4819B6AFB0BA80EB2EE8"><enum>1898.</enum><header>Site inspections for DME suppliers, community mental health
centers, and other provider groups</header><subsection commented="no" display-inline="yes-display-inline" id="H12F2AF44361147408DEA58AFF08D0C14"><enum>(a)</enum><header>Site
Inspections</header>
<paragraph id="H69FB250D1E274FDBB59ED5D161C45E01"><enum>(1)</enum><header>In
general</header><text>The Secretary shall conduct a site inspection for each
applicable provider (as defined in paragraph (2)) that applies to enroll under
this title in order to provide items or services under this title. Such site
inspection shall be in addition to any other site inspection that the Secretary
would otherwise conduct with regard to an applicable provider.</text>
</paragraph><paragraph id="H20B40C1C03D045B8A9C7267B0D685136"><enum>(2)</enum><header>Applicable
provider defined</header>
<subparagraph id="H6863D3EC5921480EB05618E23A3DD0A0"><enum>(A)</enum><header>In
general</header><text>Except as provided in subparagraph (B), in this section
the term <term>applicable provider</term> means—</text>
<clause id="H6375A3EC64E440CDB9B1B763755220BA"><enum>(i)</enum><text>a
supplier of durable medical equipment (including items described in section
1834(a)(13));</text>
</clause><clause id="H23FE49FDA8254959BAD6F8EEC40C4D84"><enum>(ii)</enum><text>a
supplier of prosthetics, orthotics, or supplies (including items described in
paragraphs (8) and (9) of section 1861(s));</text>
</clause><clause id="H0ED6DEDD91BB4B70BAC819891554DAC0"><enum>(iii)</enum><text>a community
mental health center; or</text>
</clause><clause id="H3AECA54689F8460C9A9695B86FE30232"><enum>(iv)</enum><text>any other
provider group, as determined by the Secretary (including suppliers, both
participating suppliers and non-participating suppliers, as such terms are
defined for purposes of section 1842).</text>
</clause></subparagraph><subparagraph id="HA951ECE65AFF438182B7B01FBE05074B"><enum>(B)</enum><header>Exception</header><text>In
this section, the term <term>applicable provider</term> does not
include—</text>
<clause id="H484551119A544041BB8C79EA63ABC1F5"><enum>(i)</enum><text>a
physician that provides durable medical equipment (as described in subparagraph
(A)(i)) or prosthetics, orthotics, or supplies (as described in subparagraph
(A)(ii)) to an individual as incident to an office visit by such individual;
or</text>
</clause><clause id="H4CD2E080C9664AA6ADEEC7EF479CFBAC"><enum>(ii)</enum><text>a
hospital that provides durable medical equipment (as described in subparagraph
(A)(i)) or prosthetics, orthotics, or supplies (as described in subparagraph
(A)(ii)) to an individual as incident to an emergency room visit by such
individual.</text>
</clause></subparagraph></paragraph></subsection><subsection id="H97B86F2627514A50AECDAA45F3F77775"><enum>(b)</enum><header>Standards and
Requirements</header><text>In conducting the site inspection pursuant to
subsection (a), the Secretary shall ensure that the site being inspected is in
full compliance with all the conditions and standards of participation and
requirements for obtaining billing privileges under this title.</text>
</subsection><subsection id="H2FC54F0F08DF4F4E9D7809AC4B25098E"><enum>(c)</enum><header>Time</header><text>The
Secretary shall conduct the site inspection for an applicable provider prior to
the issuance of billing privileges under this title to such provider.</text>
</subsection><subsection id="H3571281A779D40229DD0257D66F77F16"><enum>(d)</enum><header>Timely
Review</header><text>The Secretary shall provide for procedures to ensure that
the site inspection required under this section does not unreasonably delay the
issuance of billing privileges under this title to an applicable
provider.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HE882E5914E9145C3AAB2DBCBC3DC27FD"><enum>(b)</enum><header>Background
Checks</header><text>Title XVIII of the <act-name parsable-cite="SSA">Social
Security Act</act-name> (42 U.S.C. 1395 et seq.) (as amended by subsection (a))
is amended by adding at the end the following new section:</text>
<quoted-block act-name="Social Security Act" id="HE59525EB15A04568A0B255A6F1026743" style="traditional">
<section id="H64751E6090E64C3AB3A9B20C5DFA9E4E"><enum>1899.</enum><header>Background checks; denial and suspension of billing
privileges</header><subsection commented="no" display-inline="yes-display-inline" id="HB879E865B69B4A8CA7599716AB3DCEE1"><enum>(a)</enum><header>Background Check
Required</header><text display-inline="yes-display-inline">Except as provided
in subsection (b), the Secretary shall conduct a background check on any
individual or entity that enrolls under this title for the purpose of
furnishing any item or service under this title, including any individual or
entity that is a supplier, a person with an ownership or control interest, a
managing employee (as defined in section 1126(b)), or an authorized or
delegated official of the individual or entity. In performing the background
check, the Secretary shall—</text>
<paragraph id="H8925DC4D237C4B32AB99059C7208952E"><enum>(1)</enum><text>conduct the
background check before authorizing billing privileges under this title to the
individual or entity, respectively;</text>
</paragraph><paragraph id="H90ED230C098B455AAF796D3ACDFBCFEF"><enum>(2)</enum><text>include a search
of criminal records in the background check;</text>
</paragraph><paragraph id="H5C05BD5738204B5F8F77C2FDA49CE52D"><enum>(3)</enum><text>provide for
procedures that ensure the background check does not unreasonably delay the
authorization of billing privileges under this title to an eligible individual
or entity, respectively; and</text>
</paragraph><paragraph id="HB70951AE53204223BBB2FF08FEE5124B"><enum>(4)</enum><text display-inline="yes-display-inline">establish criteria for targeted reviews
when the individual or entity renews participation under this title, with
respect to the background check of the individual or entity, respectively, to
detect changes in ownership, bankruptcies, or felonies by the individual or
entity.</text>
</paragraph></subsection><subsection id="H23091642BD1949789C9B3D6CD0164BEC"><enum>(b)</enum><header>Use of State
licensing procedure</header><text>The Secretary may use the results of a State
licensing procedure as a background check under subsection (a) if the State
licensing procedure meets the requirements of such subsection.</text>
</subsection><subsection id="H2A1D03177B3644A3860FCD15FC5A670E"><enum>(c)</enum><header>Attorney General
required To provide information</header>
<paragraph id="H2AAFD4B4785841F4B4974A6B8777A708"><enum>(1)</enum><header>In
general</header><text>Upon request of the Secretary, the Attorney General shall
provide the criminal background check information referred to in subsection
(a)(2) to the Secretary.</text>
</paragraph><paragraph id="H7304109CC90E409299BF7F47CB2B0953"><enum>(2)</enum><header>Restriction on
use of disclosed information</header><text>The Secretary may only use the
information disclosed under subsection (a) for the purpose of carrying out the
Secretary’s responsibilities under this title.</text>
</paragraph></subsection><subsection id="HF0CD5BB5E6834C7C9C9FC01D0A02D2A7"><enum>(d)</enum><header>Refusal To
Authorize Billing Privileges</header>
<paragraph id="H9748F3C2DA914572A52D25841669422B"><enum>(1)</enum><header>Authority</header><text>In
addition to any other remedy available to the Secretary, the Secretary may
refuse to authorize billing privileges under this title to an individual or
entity if the Secretary determines, after a background check conducted under
this section, that such individual or entity, respectively, has a history of
acts that indicate authorization of billing privileges under this title to such
individual or entity, respectively, would be detrimental to the best interests
of the program or program beneficiaries. Such acts may include—</text>
<subparagraph id="H6D11143E58E8454FB7A2207E80443D80"><enum>(A)</enum><text>any
bankruptcy;</text>
</subparagraph><subparagraph id="H0F7038E925364EFFB30043D91AB6028E"><enum>(B)</enum><text>any act resulting
in a civil judgment against such individual or entity; or</text>
</subparagraph><subparagraph id="H8507DB4B00014FB98445C436128C91D2"><enum>(C)</enum><text>any felony
conviction under Federal or State law.</text>
</subparagraph></paragraph><paragraph id="H98E1ECC2C8B74C53957F9AD059535F22"><enum>(2)</enum><header>Reporting of
refusal to authorize billing privileges to the healthcare integrity and
protection data bank (HIPDB)</header>
<subparagraph id="H19BD3B8C7E094AF29471A214C293E8A7"><enum>(A)</enum><header>In
general</header><text>Subject to subparagraph (B), a determination under
paragraph (1) to refuse to authorize billing privileges under this title to an
individual or entity as a result of a background check conducted under this
section shall be reported to the healthcare integrity and protection data bank
established under section 1128E in accordance with the procedures for reporting
final adverse actions taken against a health care provider, supplier, or
practitioner under that section.</text>
</subparagraph><subparagraph id="HA5970323FD38486FB869CEE4E24854EA"><enum>(B)</enum><header>Exception</header><text>Any
determination described in subparagraph (A) that the Secretary specifies is not
appropriate for inclusion in the healthcare integrity and protection data bank
established under section 1128E shall not be reported to such data
bank.</text>
</subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H7B7DD9A220BB4797A60D70DFBB8ED27C"><enum>(c)</enum><header>Denial and
suspension of billing privileges</header><text display-inline="yes-display-inline">Section 1899 of the Social Security Act, as
added by subsection (b), is amended by adding at the end the following new
subsection:</text>
<quoted-block display-inline="no-display-inline" id="H319E63EB46764CBAAA9060EBE276ECCB" style="OLC">
<subsection id="HA4E54CF9906F4400AA7D712DBA5AE616"><enum>(e)</enum><header>Authority To
suspend billing privileges or refuse To authorize additional billing
privileges</header>
<paragraph id="HCB5AD1FB08E94296B713CD80ED7F136C"><enum>(1)</enum><header>In
general</header><text>The Secretary may suspend any billing privilege under
this title authorized for an individual or entity or refuse to authorize any
additional billing privilege under this title to such individual or entity
if—</text>
<subparagraph id="HC0BC0768CBF449E19C94B8536B03B072"><enum>(A)</enum><text>such individual or
entity, respectively, has an outstanding overpayment due to the Secretary under
this title;</text>
</subparagraph><subparagraph id="HC6B48EE221F04179983DC48B4FF1584C"><enum>(B)</enum><text>payments under
this title to such individual or entity, respectively, have been suspended;
or</text>
</subparagraph><subparagraph id="HAF7AFAB1D15E4D9EB9DAD9E5C2FB2B9E"><enum>(C)</enum><text>100 percent of the
payment claims under this title for such individual or entity, respectively,
are reviewed on a pre-payment basis.</text>
</subparagraph></paragraph><paragraph id="HDB1D93A3C2984A1E8D319A54351F8838"><enum>(2)</enum><header>Application to
restructured entities</header><text>In the case that an individual or entity is
subject to a suspension or refusal of billing privileges under this section, if
the Secretary determines that the ownership or management of a new entity is
under the control or management of such an individual or entity subject to such
a suspension or refusal, the new entity shall be subject to any such applicable
suspension or refusal in the same manner and to the same extent as the initial
individual or entity involved had been subject to such applicable suspension or
refusal.</text>
</paragraph><paragraph id="H82021C7E4E694977822C8B269A2C929A"><enum>(3)</enum><header>Duration of
suspension</header><text>A suspension of billing privileges under this
subsection, with respect to an individual or entity, shall be in effect
beginning on the date of the Secretary’s determination that the offense was
committed and ending not earlier than such date on which all applicable
overpayments and other applicable outstanding debts have been paid and all
applicable payment suspensions have been
lifted.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H1A150BE855554A8FA884B5A52DCD13F1"><enum>(d)</enum><header>Regulations;
Effective Date</header>
<paragraph id="HE8FDC4EFF3FA42239E7498B8BD74C765"><enum>(1)</enum><header>Regulations</header><text>Not
later than one year after the date of the enactment of this Act, the Secretary
of Health and Human Services shall promulgate such regulations as are necessary
to implement the amendments made by subsections (a), (b), and (c).</text>
</paragraph><paragraph id="HE7450C5C6881401C8B69B1248CDC3246"><enum>(2)</enum><header>Effective
dates</header>
<subparagraph id="H1D99908460CF41A6B4FF030B7084AEB0"><enum>(A)</enum><header>Site inspections
and background checks</header><text>The amendments made by subsections (a) and
(b) shall apply to applications to enroll under title XVIII of the Social
Security Act received by the Secretary of Health and Human Services on or after
the first day of the first year beginning after the date of the enactment of
this Act.</text>
</subparagraph><subparagraph id="H05DC57EBC2E74748BA62E7A337884AA4"><enum>(B)</enum><header>Denials and
suspensions of billing privileges</header><text>The amendment made by
subsection (c) shall apply to overpayments or debts in existence on or after
the date of the enactment of this Act, regardless of whether the final
determination, with respect to such overpayment or debt, was made before, on,
or after such date.</text>
</subparagraph></paragraph></subsection><subsection id="HAAF26E0F782441D192E1281DBC104D28"><enum>(e)</enum><header>Use of Medicare
Integrity Program Funds</header><text>The Secretary of Health and Human
Services may use funds appropriated or transferred for purposes of carrying out
the Medicare integrity program established under section 1893 of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395ddd) to carry out the provisions of sections 1898 and 1899 of that Act (as
added by subsections (a) and (b)).</text>
</subsection></section><section id="HFD6BFFCC894143FC96BE07A4B3D23E75"><enum>262.</enum><header>Registration
and background checks of billing agencies and individuals</header>
<subsection id="H3676FE152271485480AB9D70CF10BC4D"><enum>(a)</enum><header>In
general</header><text>Title XVIII of the <act-name parsable-cite="SSA">Social
Security Act</act-name> (42 U.S.C. 1395 et seq.) (as amended by section 2(b))
is amended by adding at the end the following new section:</text>
<quoted-block act-name="Social Security Act" id="H7D071D2676BB4AD2B5A106709811DD3A" style="traditional">
<section id="H66980E9A183549E58793AA9BB7ED53E0"><enum>1899A.</enum><header>Registration and background checks of billing agencies and
individuals; identification numbers required for providers and
suppliers</header><subsection commented="no" display-inline="yes-display-inline" id="H226B9A89B13145018D191772209C3944"><enum>(a)</enum><header>Registration</header>
<paragraph id="H85A1B0120E384DC684E548AC64933EF2"><enum>(1)</enum><header>In
general</header><text>The Secretary shall establish procedures, including
modifying the Provider Enrollment and Chain Ownership System (PECOS)
administered by the Centers for Medicare & Medicaid Services, to provide
for the registration of all applicable persons in accordance with this
section.</text>
</paragraph><paragraph id="H8C0BBBC8174344A795E8283505559C90"><enum>(2)</enum><header>Required
application</header><text>Each applicable person shall submit a registration
application to the Secretary at such time, in such manner, and accompanied by
such information as the Secretary may require.</text>
</paragraph><paragraph id="H3E5398995D694BDB8102F9A7EED4F49B"><enum>(3)</enum><header>Identification
number</header><text>If the Secretary approves an application submitted under
subsection (b), the Secretary shall assign a unique identification number to
the applicable person.</text>
</paragraph><paragraph id="H2F5161BFF3C14CCE87056D05BAD37D44"><enum>(4)</enum><header>Requirement</header><text>Every
claim for reimbursement under this title that is compiled or submitted by an
applicable person shall contain the identification number that is assigned to
the applicable person pursuant to subsection (c).</text>
</paragraph><paragraph id="H6866B9DC1F774642BF6D9F385F2B4BD4"><enum>(5)</enum><header>Timely
review</header><text>The Secretary shall provide for procedures that ensure the
timely consideration and determination regarding approval of applications under
this subsection.</text>
</paragraph><paragraph id="H6BC48217FDFA4B7CA129C7C04DBE0617"><enum>(6)</enum><header>Definition of
applicable person</header><text>In this section, the term <term>applicable
person</term> means any individual or entity that compiles or submits claims
for reimbursement under this title to the Secretary on behalf of any individual
or entity.</text>
</paragraph></subsection><subsection id="H3A3B56B7CC5E40F1A6425292AB88C46E"><enum>(b)</enum><header>Background
checks</header>
<paragraph commented="no" display-inline="no-display-inline" id="H3503DD92C90B4C419A817462F9FAD7F6" indent="up1"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Except as provided in paragraph (2), the
Secretary shall conduct a background check on any applicable person that
registers under subsection (a). In performing the background check, the
Secretary shall—</text>
<subparagraph id="HDEE9BC6D25D04ADEA8575FC2EC995AF5"><enum>(A)</enum><text>conduct the background check before
issuing a unique identification number to the applicable person;</text>
</subparagraph><subparagraph id="H65244379F4784EA99B1C93777962CEA9"><enum>(B)</enum><text>include a search of criminal records
in the background check;</text>
</subparagraph><subparagraph id="H32A7C920D86948E184DCCC26FE11EC2E"><enum>(C)</enum><text>provide for procedures that ensure the
background check does not unreasonably delay the issuance of the unique
identification number to an eligible applicable person; and</text>
</subparagraph><subparagraph id="H840163DB893A4594AB160A500CE8CFC6"><enum>(D)</enum><text display-inline="yes-display-inline">establish criteria for periodic targeted
reviews with respect to the background check of the applicable person.</text>
</subparagraph></paragraph><paragraph id="H4765E98A28754C18BC6D370E8DDD0B19" indent="up1"><enum>(2)</enum><header>Use of State licensing
procedure</header><text>The Secretary may use the results of a State licensing
procedure as a background check under paragraph (1) if the State licensing
procedure meets the requirements of such paragraph.</text>
</paragraph><paragraph id="HFB0668775FF24C469B8D9EB2E12F787E" indent="up1"><enum>(3)</enum><header>Attorney General required To
provide information</header>
<subparagraph id="H7330D5ED60E84FF08DBD274560BF7C3A"><enum>(A)</enum><header>In general</header><text>Upon
request of the Secretary, the Attorney General shall provide the criminal
background check information referred to in paragraph (1)(B) to the
Secretary.</text>
</subparagraph><subparagraph id="H3271AAD6FE844588BECB91E9EDF02406"><enum>(B)</enum><header>Restriction on use of disclosed
information</header><text>The Secretary may only use the information disclosed
under paragraph (1) for the purpose of carrying out the Secretary’s
responsibilities under this title.</text>
</subparagraph></paragraph><paragraph id="H65FE4C66F4594EEF972FCD2B65AA55BC" indent="up1"><enum>(4)</enum><header>Refusal To Issue Unique
identification number</header><text>In addition to any other remedy available
to the Secretary, the Secretary may refuse to issue a unique identification
number described in subsection (a)(3) to an applicable person if the Secretary
determines, after a background check conducted under this subsection, that such
person has a history of acts that indicate issuance of such number under this
title to such person would be detrimental to the best interests of the program
or program beneficiaries. Such acts may include—</text>
<subparagraph id="H5602A9BA906E447F87102791D970E306"><enum>(A)</enum><text>any bankruptcy;</text>
</subparagraph><subparagraph id="H34BFB2371ECF4FE797E6374DE9C46EB0"><enum>(B)</enum><text>any act resulting in a civil judgment
against such person; or</text>
</subparagraph><subparagraph id="HCCF66253CA2149DC95C3AD651AB4CA4F"><enum>(C)</enum><text>any felony conviction under Federal or
State law.</text>
</subparagraph></paragraph></subsection><subsection id="H5CA81B42FFD54EF2B3B1A4441CF9A835"><enum>(c)</enum><header>Identification
numbers for providers and suppliers</header><text>The Secretary shall establish
procedures to ensure that each provider of services and each supplier that
submits claims for reimbursement under this title to the Secretary is assigned
a unique identification
number.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H0B6CE01885AA4283BA0BAD19E4D8199F"><enum>(b)</enum><header>Permissive
Exclusion</header><text>Section 1128(b) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1320a–7(b)) is
amended by adding at the end the following:</text>
<quoted-block act-name="Social Security Act" id="H4B32B58F4FF2430CB2356668F1BD743D" style="OLC">
<paragraph id="HA95FE40937CC41FFBB6A81266729F923"><enum>(16)</enum><header>Fraud by
applicable person</header><text>An applicable person (as defined in section
1899A(a)(6)) that the Secretary determines knowingly submitted or caused to be
submitted a claim for reimbursement under title XVIII that the applicable
person knows or should know is false or
fraudulent.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H89A2EBA7E3C84461B7C0FF354863B59A"><enum>(c)</enum><header>Regulations;
Effective date</header>
<paragraph id="HE8BBE3C45CE144038A3DCE1741DAE9B1"><enum>(1)</enum><header>Regulations</header><text>Not
later than one year after the date of the enactment of this Act, the Secretary
of Health and Human Services shall promulgate such regulations as are necessary
to implement the amendments made by subsections (a) and (b).</text>
</paragraph><paragraph id="H0AA18625893648938C62E1A192300833"><enum>(2)</enum><header>Effective
date</header><text>The amendments made by subsections (a) and (b) shall apply
to applicable persons and other entities on and after the first day of the
first year beginning after the date of the enactment of this Act.</text>
</paragraph></subsection></section><section id="H4072FB53F1EE44DC8368CD6A8CAA580D"><enum>263.</enum><header>Expanded access
to the healthcare integrity and protection data bank (HIPDB)</header>
<subsection id="H5D3031E7D55B4EA8B7D3B744555368A5"><enum>(a)</enum><header>In
General</header><text>Section 1128E(d)(1) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1320a–7e(d)(1))
is amended to read as follows:</text>
<quoted-block act-name="Social Security Act" id="H3B317730902E437B9B3019338FA8D3EE" style="OLC">
<paragraph id="H2EB69A151F7848B1B10E1A6461C34D74"><enum>(1)</enum><header>Availability</header><text>The
information in the data bank maintained under this section shall be available
to—</text>
<subparagraph id="H763DDC3F600F474ABC749D73FEDD7BD6"><enum>(A)</enum><text>Federal and State
government agencies and health plans, and any health care provider, supplier,
or practitioner entering an employment or contractual relationship with an
individual or entity who could potentially be the subject of a final adverse
action, where the contract involves the furnishing of items or services
reimbursed by one or more Federal health care programs (regardless of whether
the individual or entity is paid by the programs directly, or whether the items
or services are reimbursed directly or indirectly through the claims of a
direct provider); and</text>
</subparagraph><subparagraph id="H0BCEFB6638C24983AADC09870B592895"><enum>(B)</enum><text>utilization and
quality control peer review organizations and accreditation entities as defined
by the Secretary, including but not limited to organizations described in part
B of this title and in section
1154(a)(4)(C).</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HF06731395284409DB3AFCCCACBC40DF5"><enum>(b)</enum><header>No fees for use
of HIPDB by entities contracting with Medicare</header><text>Section
1128E(d)(2) of the Social Security Act (42 U.S.C. 1320a–7e(d)(2)) is amended by
striking <quote>Federal agencies</quote> and inserting <quote>Federal agencies
or other entities, such as fiscal intermediaries and carriers, acting under
contract on behalf of such agencies</quote>.</text>
</subsection><subsection id="H82E0B2C76B84470D81508F4207650F9B"><enum>(c)</enum><header>Criminal penalty
for misuse of information</header><text>Section 1128B(b) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1320a–7b(b)) is amended by adding at the end the following:</text>
<quoted-block act-name="Social Security Act" id="H6AD8B1ECB1844615A4D2678C95F34F7F" style="OLC">
<paragraph id="H523099EE1D5D447384278718CAB0045D" indent="up1"><enum>(4)</enum><text>Whoever knowingly uses information
maintained in the healthcare integrity and protection data bank maintained in
accordance with section 1128E for a purpose other than a purpose authorized
under that section shall be imprisoned for not more than three years or fined
under title 18, United States Code, or
both.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HDBE30C8C9734405782E6FC87581CED82"><enum>(d)</enum><header>Effective
date</header><text>The amendments made by this section shall take effect on the
date of the enactment of this Act.</text>
</subsection></section><section id="H566FC003C7784DD99FF6BE79B41C19F5"><enum>264.</enum><header>Liability of
Medicare administrative contractors for claims submitted by excluded
providers</header>
<subsection id="HBA814C5D91CD47DEA0D74334E8912077"><enum>(a)</enum><header>Reimbursement to
the Secretary for amounts paid to excluded providers</header><text>Section
1874A(b) of the Social Security Act (42 U.S.C. 1395kk(b)) is amended by adding
at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H1756B0DF2845486C8134A5E12753526E" style="OLC">
<paragraph id="H897314670F1744DB8BB12C2BDCDA1D65"><enum>(6)</enum><header>Reimbursements
to Secretary for amounts paid to excluded providers</header><text display-inline="yes-display-inline">The Secretary shall not enter into a
contract with a Medicare administrative contractor under this section unless
the contractor agrees to reimburse the Secretary for any amounts paid by the
contractor for a service under this title which is furnished by an individual
or entity during any period for which the individual or entity is excluded,
pursuant to section 1128, 1128A, or 1156, from participation in the health care
program under this title if the amounts are paid after the 60-day period
beginning on the date the Secretary provides notice of the exclusion to the
contractor, unless the payment was made as a result of incorrect information
provided by the Secretary or the individual or entity excluded from
participation has concealed or altered their
identity.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HB46D4FD4A846434AABA395BA38BA29E8"><enum>(b)</enum><header>Conforming
Repeal of Mandatory Payment Rule</header><text>Section 1862(e) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395y(e)) is amended—</text>
<paragraph id="H9A1289F27A4545C28847B4DED7BCA53A"><enum>(1)</enum><text>in paragraph
(1)(B), by striking <quote>and when the person</quote> and all that follows
through <quote>person)</quote>; and</text>
</paragraph><paragraph id="H46008CDC0A05493C8D522D075175C5B1"><enum>(2)</enum><text>by amending
paragraph (2) to read as follows:</text>
<quoted-block id="HB0149FB59B294938AF707B1C2E8CB6A3" style="OLC">
<paragraph id="H704ED5B34EC24B5A8FD520E7BE67776C" indent="up1"><enum>(2)</enum><text>No individual or entity may bill (or
collect any amount from) any individual for any item or service for which
payment is denied under paragraph (1). No individual is liable for payment of
any amounts billed for such an item or service in violation of the preceding
sentence.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H443D790BA3EC44E19D311F6BA3EBFD11"><enum>(c)</enum><header>Effective
Date</header>
<paragraph id="HC257015F27CF466381F83BFAED47EF3B"><enum>(1)</enum><header>In
general</header><text>The amendments made by this section shall apply to claims
for payment submitted on or after the date of the enactment of this Act.</text>
</paragraph><paragraph id="HFFE54A9D39E74B108C74B17F626958B1"><enum>(2)</enum><header>Contract
modification</header><text>The Secretary of Health and Human Services shall
take such steps as may be necessary to modify contracts entered into, renewed,
or extended prior to the date of the enactment of this Act to conform such
contracts to the provisions of this section.</text>
</paragraph></subsection></section><section id="H3D5F56F6E6AB4B6784B09AF222BEBF3E"><enum>265.</enum><header>Community
mental health centers</header>
<subsection id="H77B72376A84E47B0AAAC6F5E916FC429"><enum>(a)</enum><header>In
General</header><text>Section 1861(ff)(3)(B) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395x(ff)(3)(B)) is amended by striking “entity that—” and all that follows and
inserting the following: “entity that—</text>
<quoted-block act-name="Social Security Act" id="HB471D20EE0CB43EBBAD44F7FE1956077" style="OLC">
<clause id="H040A09640E3E442D8BBC4D5FECF27B95" indent="up2"><enum>(i)</enum><text>provides the community mental health
services specified in paragraph (1) of section 1913(c) of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name>;</text>
</clause><clause id="HB739329808D349B3ACFD5A093B6D143C" indent="up2"><enum>(ii)</enum><text>meets applicable certification or
licensing requirements for community mental health centers in the State in
which it is located;</text>
</clause><clause id="H2494274CC99846E488904C0875541BBA" indent="up2"><enum>(iii)</enum><text>provides a significant share of its
services to individuals who are not eligible for benefits under this title;
and</text>
</clause><clause id="H079B3F153FD04CEDB8A810D94DFFB437" indent="up2"><enum>(iv)</enum><text>meets such additional standards or
requirements for obtaining billing privileges under this title as the Secretary
may specify to ensure—</text>
<subclause id="H68CE5504ADF94BFE86B7D8A31EC5095E"><enum>(I)</enum><text>the health and safety of
beneficiaries receiving such services; or</text>
</subclause><subclause id="H6547394A5F894CAA8BAB139D31D843AB"><enum>(II)</enum><text>the furnishing of such services in
an effective and efficient
manner.</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H596349B3BBF34673A7094BC92D01F4A3"><enum>(b)</enum><header>Restriction</header><text>Section
1861(ff)(3)(A) of such Act (42 U.S.C. 1395x(ff)(3)(A)) is amended by inserting
<quote>other than in an individual’s home or in an inpatient or residential
setting</quote> before the period.</text>
</subsection><subsection id="HB0FA8D4051A44C5292C4429867BB874A"><enum>(c)</enum><header>Effective
Date</header><text>The amendments made by this section shall apply to items and
services furnished on or after the first day of the sixth month that begins
after the date of the enactment of this Act.</text>
</subsection></section><section id="HE83A10B21E0844FBBBB6A424C68A2699"><enum>266.</enum><header>Limiting the
discharge of debts in bankruptcy proceedings in cases where a health care
provider or a supplier engages in fraudulent activity</header>
<subsection id="H9C7AA51C8D0245F9AD4A3DA4155F2A69"><enum>(a)</enum><header>In
General</header>
<paragraph id="H42CF2CCAB328433CA33E0582973637E6"><enum>(1)</enum><header>Civil monetary
penalties</header><text>Section 1128A(a) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1320a–7a(a)) is
amended by adding at the end the following: <quote>Notwithstanding any other
provision of law, amounts made payable under this section are not dischargeable
under section 727, 944, 1141, 1228, or 1328 of title 11, United States Code, or
any other provision of such title.</quote>.</text>
</paragraph><paragraph id="H077D5F4F01314C549AD9A61CB7E41627"><enum>(2)</enum><header>Recovery of
overpayment to providers of services under part a of
medicare</header><text>Section 1815(d) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1395g(d)) is
amended—</text>
<subparagraph id="H9E89A3B09DD14E2FB0FF500E61A37DF5"><enum>(A)</enum><text>by inserting
<quote>(1)</quote> after <quote>(d)</quote>; and</text>
</subparagraph><subparagraph id="H60A3F072A226464A95D4DD7E7D4DFB41"><enum>(B)</enum><text>by adding at the
end the following:</text>
<quoted-block id="HA6F4022198F04B99B5D5B37E247D7F92" style="OLC">
<paragraph id="H7EEB550734F94AD59D07924620F1F823" indent="up1"><enum>(2)</enum><text>Notwithstanding any other provision
of law, amounts due to the Secretary under this section are not dischargeable
under section 727, 944, 1141, 1228, or 1328 of title 11, United States Code, or
any other provision of such title if the overpayment was the result of
fraudulent activity, as may be defined by the
Secretary.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H51FDA9DB890B40BCA5D46E0BE67B9E32"><enum>(3)</enum><header>Recovery of
overpayment of benefits under part <enum-in-header>B</enum-in-header> of
medicare</header><text>Section 1833(j) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1395l(j)) is
amended—</text>
<subparagraph id="H5AAA161641034C25AEFCE4FA8D0862A8"><enum>(A)</enum><text>by inserting
<quote>(1)</quote> after <quote>(j)</quote>; and</text>
</subparagraph><subparagraph id="HC352E808C2354BEB9D9B5ADC4812FAF1"><enum>(B)</enum><text>by adding at the
end the following:</text>
<quoted-block id="HA230E42BEB9C494F8A458E74AC2315EF" style="OLC">
<paragraph id="H0C6712167660438D9E2B8DB1A9BC0850" indent="up1"><enum>(2)</enum><text>Notwithstanding any other provision
of law, amounts due to the Secretary under this section are not dischargeable
under section 727, 944, 1141, 1228, or 1328 of title 11, United States Code, or
any other provision of such title if the overpayment was the result of
fraudulent activity, as may be defined by the
Secretary.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H729632D72C4C4540B5A3F33D4D5D8989"><enum>(4)</enum><header>Collection of
past-due obligations arising from breach of scholarship and loan
contract</header><text>Section 1892(a) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1395ccc(a)) is
amended by adding at the end the following:</text>
<quoted-block act-name="Social Security Act" id="H8AD3CC12B0E5459299D33D113F1699AE" style="OLC">
<paragraph id="HA42490CF95F24F5E9EC04BE49BC26AC5"><enum>(5)</enum><text>Notwithstanding
any other provision of law, amounts due to the Secretary under this section are
not dischargeable under section 727, 944, 1141, 1228, or 1328 of title 11,
United States Code, or any other provision of such
title.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HDF31596D8CC341BDAED6DF9BD9ED6710"><enum>(b)</enum><header>Effective
Date</header><text>The amendments made by subsection (a) shall apply to
bankruptcy petitions filed after the date of the enactment of this Act.</text>
</subsection></section><section id="H324CB8D88CC0408C9A63FD23DB6AA917"><enum>267.</enum><header>Illegal
distribution of a Medicare or Medicaid beneficiary identification or billing
privileges</header><text display-inline="no-display-inline">Section 1128B(b) of
the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1320a–7b(b)), as amended by section 4(c), is amended by adding at the end the
following:</text>
<quoted-block act-name="Social Security Act" id="H0CDACF81715C44EF9A7CF3B91C2AB323" style="OLC">
<paragraph id="H6F2C90D58D1A442FB5B1D5E5580FD096" indent="up1"><enum>(5)</enum><text>Whoever knowingly, intentionally, and
with the intent to defraud purchases, sells or distributes, or arranges for the
purchase, sale, or distribution of two or more Medicare or Medicaid beneficiary
identification numbers or billing privileges under title XVIII or title XIX
shall be imprisoned for not more than three years or fined under title 18,
United States Code (or, if greater, an amount equal to the monetary loss to the
Federal and any State government as a result of such acts), or
both.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="H5095236CB31E4DE2A953894C77B2092B"><enum>268.</enum><header>Treatment of
certain <act-name parsable-cite="SSA">Social Security Act</act-name> crimes as
Federal health care offenses</header>
<subsection id="H88D70CE75C08425EA4484DE3EA3BA08C"><enum>(a)</enum><header>In
General</header><text>Section 24(a) of title 18, United States Code, is
amended—</text>
<paragraph id="HF6B564D30F1C4FD891E3A4EFEA5CB739"><enum>(1)</enum><text>by striking the
period at the end of paragraph (2) and inserting <quote>; or</quote>;
and</text>
</paragraph><paragraph id="HC1B809DE8D2E45C58581AC860A8C00C9"><enum>(2)</enum><text>by adding at the
end the following:</text>
<quoted-block id="H2967F0BB48624568AAEF811441706C40" style="OLC">
<paragraph id="H770EEDAF4D234935A27FF2851C94D035"><enum>(3)</enum><text>section 1128B of
the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1320a–7b).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H67257EF835834B2E968ED736B0F97A3A"><enum>(b)</enum><header>Effective
Date</header><text>The amendment made by subsection (a) shall take effect on
the date of the enactment of this Act and apply to acts committed on or after
the date of the enactment of this Act.</text>
</subsection></section><section id="H52905F2828134D00BD2A1F891F2D2F06"><enum>269.</enum><header>Authority of
Office of Inspector General of the Department of Health and Human
Services</header>
<subsection id="H2BC4FD73F3C947DBBBDA779432E50BDF"><enum>(a)</enum><header>Authority</header><text>Notwithstanding
any other provision of law, upon designation by the Inspector General of the
Department of Health and Human Services, any criminal investigator of the
Office of Inspector General of such department may, in accordance with
guidelines issued by the Secretary of Health and Human Services and approved by
the Attorney General, while engaged in activities within the lawful
jurisdiction of such Inspector General—</text>
<paragraph id="H44EA1A0D9A334E6C9AB87037E36C6DB2"><enum>(1)</enum><text>obtain and execute
any warrant or other process issued under the authority of the United
States;</text>
</paragraph><paragraph id="HA543AC11011B4081B193405FD9283DD9"><enum>(2)</enum><text>make an arrest
without a warrant for—</text>
<subparagraph id="H9B06F79523E64BFF8974CB3BB19C6E7A"><enum>(A)</enum><text>any offense
against the United States committed in the presence of such investigator;
or</text>
</subparagraph><subparagraph id="HDB7263AC89D5405C8ABCC4777C019F60"><enum>(B)</enum><text>any felony offense
against the United States, if such investigator has reasonable cause to believe
that the person to be arrested has committed or is committing that felony
offense; and</text>
</subparagraph></paragraph><paragraph id="H97DA345010894101A6B205D0AB353948"><enum>(3)</enum><text>exercise any other
authority necessary to carry out the authority described in paragraphs (1) and
(2).</text>
</paragraph></subsection><subsection id="HF880E606D3B14C83932D0E306C61921D"><enum>(b)</enum><header>Funds</header><text>The
Office of Inspector General of the Department of Health and Human Services may
receive and expend funds that represent the equitable share from the forfeiture
of property in investigations in which the Office of Inspector General
participated, and that are transferred to the Office of Inspector General by
the Department of Justice, the Department of the Treasury, or the United States
Postal Service. Such equitable sharing funds shall be deposited in a separate
account and shall remain available until expended.</text>
</subsection></section><section id="H67DD55D066A94655949EB76EB3712BAA"><enum>270.</enum><header>Universal
product numbers on claims forms for reimbursement under the Medicare
Program</header>
<subsection id="H9EBDDB6E75D5499787A81C134CD2E7A2"><enum>(a)</enum><header>UPNs on Claims
Forms for Reimbursement Under the Medicare Program</header>
<paragraph id="H14F79638D2A84D31AA959204A7E44C56"><enum>(1)</enum><header>Accommodation of
UPNs on medicare claims forms</header><text>Not later than February 1, 2011,
all claims forms developed or used by the Secretary of Health and Human
Services for reimbursement under the Medicare program under title XVIII of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1395 et
seq.) shall accommodate the use of universal product numbers for a UPN covered
item.</text>
</paragraph><paragraph id="H2DB527BFE10345A0B88085540803541E"><enum>(2)</enum><header>Requirement for
payment of claims</header><text>Title XVIII of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1395 et
seq.), as amended by sections 2 and 3, is amended by adding at the end the
following new section:</text>
<quoted-block act-name="Social Security Act" id="HFAEF2657534642AEB84A624C83758548" style="traditional">
<section id="H790030B2FE684015AF83959B936D540E"><enum>1899B.</enum><header>Use of universal product numbers</header><subsection commented="no" display-inline="yes-display-inline" id="H63BE4905AC9744129B39A9D6E8925413"><enum>(a)</enum><header>In
General</header><text>No payment shall be made under this title for any claim
for reimbursement for any UPN covered item unless the claim contains the
universal product number of the UPN covered item.</text>
</subsection><subsection id="HB10B868C05F748D7B587D8F6FB4A720E"><enum>(b)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="HE40CF354D3624359858657E14CBFA9CA"><enum>(1)</enum><header>UPN covered
item</header>
<subparagraph id="HD6229846EBA34A8684BAB1D7A254B8BA"><enum>(A)</enum><header>In
general</header><text>Except as provided in subparagraph (B), the term
<term>UPN covered item</term> means—</text>
<clause id="HB9080B2B62384234BCDFEE30C0E5C313"><enum>(i)</enum><text>a
covered item as that term is defined in section 1834(a)(13);</text>
</clause><clause id="H7753DAB62D844B868EC9B62D79755CAC"><enum>(ii)</enum><text>an item described
in paragraph (8) or (9) of section 1861(s);</text>
</clause><clause id="H20623B436922439F9AEE69AE8AE016A8"><enum>(iii)</enum><text>an item
described in paragraph (5) of section 1861(s); and</text>
</clause><clause id="H0A23D1127E284FE98D2EE8F2B50CA40F"><enum>(iv)</enum><text>any other item
for which payment is made under this title that the Secretary determines to be
appropriate.</text>
</clause></subparagraph><subparagraph id="H669653AC98734710B247ADB1901F9652"><enum>(B)</enum><header>Exclusion</header><text>The
term <term>UPN covered item</term> does not include a customized item for which
payment is made under this title.</text>
</subparagraph></paragraph><paragraph id="H3993C6C7252C40BEA6BCAA382739F8EE"><enum>(2)</enum><header>Universal
product number</header><text>The term <term>universal product number</term>
means a number that is—</text>
<subparagraph id="H12884DDDA7FA4724A296FC2F45AD2A3F"><enum>(A)</enum><text>affixed by the
manufacturer to each individual UPN covered item that uniquely identifies the
item at each packaging level; and</text>
</subparagraph><subparagraph id="HFD39F3EC3F1D4B17AB73CF6FC731ACA9"><enum>(B)</enum><text>based on
commercially acceptable identification standards such as, but not limited to,
standards established by the Uniform Code Council-International Article
Numbering System or the Health Industry Business Communication
Council.</text>
</subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H6216F980ED4A4E98AE2FE73C4701C5E0"><enum>(3)</enum><header>Development and
implementation of procedures</header>
<subparagraph id="H131FE27EF7A34DFF82F37726A50FD78A"><enum>(A)</enum><header>Information
included in UPN</header><text>The Secretary of Health and Human Services, in
consultation with manufacturers and entities with appropriate expertise, shall
determine the relevant descriptive information appropriate for inclusion in a
universal product number for a UPN covered item.</text>
</subparagraph><subparagraph id="H8D63E95248924AEF8B0C94D9236A7180"><enum>(B)</enum><header>Review of
procedure</header><text>From the information obtained by the use of universal
product numbers on claims for reimbursement under the Medicare program, the
Secretary of Health and Human Services, in consultation with interested
parties, shall periodically review the UPN covered items billed under the
Health Care Financing Administration Common Procedure Coding System and adjust
such coding system to ensure that functionally equivalent UPN covered items are
billed and reimbursed under the same codes.</text>
</subparagraph></paragraph><paragraph id="HF08BA2EFA36C443284D6200FFF726640"><enum>(4)</enum><header>Effective
date</header><text>The amendment made by paragraph (2) shall apply to claims
for reimbursement submitted on and after February 1, 2011.</text>
</paragraph></subsection><subsection id="HBEBDF755652C4CBBBB0F667FC0114386"><enum>(b)</enum><header>Study and
Reports to Congress</header>
<paragraph id="H9076A4A1709A487881BBA91E9C41D0C7"><enum>(1)</enum><header>Study</header><text>The
Secretary of Health and Human Services shall conduct a study on the results of
the implementation of the provisions in paragraphs (1) and (3) of subsection
(a) and the amendment to the <act-name parsable-cite="SSA">Social Security
Act</act-name> in paragraph (2) of such subsection.</text>
</paragraph><paragraph id="HC44F2764BE574F0DAFD3CD2C283C112C"><enum>(2)</enum><header>Reports</header>
<subparagraph id="H25500CEE3A0B4B899BD9AC6CC28FA31B"><enum>(A)</enum><header>Progress
report</header><text>Not later than six months after the date of the enactment
of this Act, the Secretary of Health and Human Services shall submit to
Congress a report that contains a detailed description of the progress of the
matters studied pursuant to paragraph (1).</text>
</subparagraph><subparagraph id="H8FD2155448EB4FFD8D6E5ECB3C6D9BD7"><enum>(B)</enum><header>Implementation</header><text>Not
later than 18 months after the date of the enactment of this Act, and annually
thereafter for three years, the Secretary of Health and Human Services shall
submit to Congress a report that contains a detailed description of the results
of the study conducted pursuant to paragraph (1), together with the Secretary’s
recommendations regarding the use of universal product numbers and the use of
data obtained from the use of such numbers.</text>
</subparagraph></paragraph></subsection><subsection id="H9AACF6CDC37E49A1A4BFC13572177CF6"><enum>(c)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="H5DCAD1DF57FD401EBE30E677B1334D9C"><enum>(1)</enum><header>UPN covered
item</header><text>The term <term>UPN covered item</term> has the meaning given
such term in section 1899B(b)(1) of the <act-name parsable-cite="SSA">Social
Security Act</act-name> (as added by subsection (a)(2)).</text>
</paragraph><paragraph id="H07D0BC0E493642B0860B0651CAFFCE5F"><enum>(2)</enum><header>Universal
product number</header><text>The term <term>universal product number</term> has
the meaning given such term in section 1899B(b)(2) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (as added by
subsection (a)(2)).</text>
</paragraph></subsection><subsection id="HC9E078DEBCAA49F9902292A1B9C39ECC"><enum>(d)</enum><header>Authorization of
Appropriations</header><text>There are authorized to be appropriated such sums
as may be necessary for the purpose of carrying out the provisions in
paragraphs (1) and (3) of subsection (a), subsection (b), and section 1899B of
the <act-name parsable-cite="SSA">Social Security Act</act-name> (as added by
subsection (a)(2)).</text>
</subsection></section></subtitle><subtitle id="H57D6F654390C44E796369C2739315DB5"><enum>E</enum><header>Promoting Health
and Preventing Chronic Disease through Prevention and Wellness Programs
</header>
<section id="HD568CB51C5FE4752BF7223C00CFAD017" section-type="subsequent-section"><enum>281.</enum><header>Findings</header><text display-inline="no-display-inline">Congress finds the following:</text>
<paragraph id="HE6B3188A1F8E4A3C9E68AC4CD58422B1"><enum>(1)</enum><text>Keeping people
healthy and preventing disease must be an important part of improving our
Federal health system.</text>
</paragraph><paragraph id="HD59C6BCF860A445896EB59709F86699B"><enum>(2)</enum><text>More than 133
million Americans, which accounts for 45 percent of the U.S. population, have
at least one chronic condition.</text>
</paragraph><paragraph id="HC51F4E6E001C420D8D92D445B73F3D28"><enum>(3)</enum><text>With the growth in
obesity, especially among younger Americans, the diagnosis of childhood chronic
diseases has almost quadrupled over the past four decades and is expected to
continue to rise.</text>
</paragraph><paragraph id="HB7E0001C497A4005B69705F3945245DD"><enum>(4)</enum><text>Chronic diseases
are the leading causes of preventable death and disability in the United
States, accounting for 7 out of every 10 deaths and killing more than 1,700,000
people in the United States every year.</text>
</paragraph><paragraph id="HBEC3AF58D8A0450D8582065CF92BED7A"><enum>(5)</enum><text>Two-thirds of the
increase in health care spending is due to increased prevalence of treated
chronic disease.</text>
</paragraph><paragraph id="HE01DC0824E9F4304972CB0F4EF4D593A"><enum>(6)</enum><text>Seventy-five
percent of the nation’s aggregate health care spending is on treating patients
with chronic disease, and the vast majority of these diseases are preventable.
Unfortunately, less than one percent of total health care spending goes toward
prevention.</text>
</paragraph><paragraph id="H06FD54ABC905424DA116AE1C630C6F9E"><enum>(7)</enum><text>According to a
recent study, treatment of the seven most common chronic diseases, coupled with
productivity losses, cost the U.S. economy more than $1 trillion dollars
annually. It has been estimated that modest reductions in unhealthy behaviors
could prevent or delay 40 million cases of chronic illness per year.</text>
</paragraph><paragraph id="H629DE94446BD4C5F8FC34C6454ACF5D0"><enum>(8)</enum><text>Chronic diseases
are burdensome to American businesses. Not only does a sicker American
workforce have higher health care costs, but it is also less productive.
Chronic illnesses lead to absenteeism and decreased effectiveness while at work
due to illness.</text>
</paragraph><paragraph id="H300FDDE539574FAC96F54AD20E30CC3D"><enum>(9)</enum><text>Prevention not
only saves lives, it is highly cost-effective. One study concluded that an
investment of $10 per person per year in proven community-based programs to
increase physical activity, improve nutrition, and prevent smoking and other
tobacco use could save the country more than $16 billion annually within five
years. This is a return of $5.60 for every $1 spent.</text>
</paragraph></section><section id="H75DE7AB5D55048DDB82274ACE5BB20F7"><enum>282.</enum><header>Tax credit to
employers for costs of implementing prevention and wellness programs</header>
<subsection id="HC35677AB259D40A593C09867F8FF02A2"><enum>(a)</enum><header>In
General</header><text>Subpart D of part IV of subchapter A of chapter 1 of the
Internal Revenue Code of 1986 (relating to business related credits) is amended
by adding at the end the following:</text>
<quoted-block id="HB61AE5F963A24318BE06F00AF2654A10" style="OLC">
<section id="HA2D6855648AF4414B7E223E569E0C472"><enum>45R.</enum><header>Prevention and
wellness program credit</header>
<subsection id="H279F79E56B3C42D3A350A3D0FE7E5793"><enum>(a)</enum><header>Allowance of
credit</header>
<paragraph id="HCC7749D00B464F9CADABCA2AD8592389"><enum>(1)</enum><header>In
general</header><text>For purposes of section 38, the prevention and wellness
credit determined under this section for any taxable year during the credit
period with respect to an employer is an amount equal to 50 percent of the
costs paid or incurred by the employer in connection with a qualified
prevention and wellness during the taxable year. For purposes of the preceding
sentence, in the case of any qualified prevention and wellness offered as part
of an employer-provided group health plan, including health insurance offered
in connection with such plan, only costs attributable to the qualified
prevention and wellness and not to the group health plan or health insurance
coverage may be taken into account. </text>
</paragraph><paragraph id="H7AAAD5FCDCB947C5B9D543065E37C009"><enum>(2)</enum><header>Limitation</header><text>The
amount of credit allowed under paragraph (1) for any taxable year shall not
exceed the sum of—</text>
<subparagraph id="H9AFD2238B13947A5974203C350779926"><enum>(A)</enum><text>the product of
$200 and the number of employees of the employer not in excess of 200
employees, plus</text>
</subparagraph><subparagraph id="H16CAB24BAC7348F69EA4DF527FDD7B38"><enum>(B)</enum><text>the product of
$100 and the number of employees of the employer in excess of 200
employees.</text>
</subparagraph></paragraph></subsection><subsection id="H7967C68A51EE470AB772D0FD0B437550"><enum>(b)</enum><header>Qualified
prevention and wellness</header><text>For purposes of this section—</text>
<paragraph id="H2E9DF149E47C4BC2823C7A8C7D5D1DFC"><enum>(1)</enum><header>Qualified
prevention and wellness</header><text>The term <term>qualified prevention and
wellness</term> means a program which—</text>
<subparagraph id="HF81EAFE3DAE04DC78723CA0F68C67E0E"><enum>(A)</enum><text>consists of any 3
of the prevention and wellness components described in subsection (c),
and</text>
</subparagraph><subparagraph id="HADBAE5B6C4C9437C806E5AACAC3864DF"><enum>(B)</enum><text>which is certified
by the Secretary of Health and Human Services, in coordination with the
Director of the Center for Disease Control and Prevention, as a qualified
prevention and wellness under this section.</text>
</subparagraph></paragraph><paragraph id="H89012F31266D45298E9EBFF309C39E0D"><enum>(2)</enum><header>Programs must be
consistent with research and best practices</header>
<subparagraph id="HC5091B9EA17F469BBDB3F99492C93201"><enum>(A)</enum><header>In
general</header><text>The Secretary of Health and Human Services shall not
certify a program as a qualified prevention and wellness unless the
program—</text>
<clause id="HF97E76522F204C71AC32B0132C6BCE0D"><enum>(i)</enum><text>is
consistent with evidence-based research and best practices, as identified by
persons with expertise in employer health promotion and prevention and
wellness,</text>
</clause><clause id="H0719DA3A97D742CDAFAA14D2794AB96F"><enum>(ii)</enum><text>includes
multiple, evidence-based strategies which are based on the existing and
emerging research and careful scientific reviews, including the Guide to
Community Preventive Services, the Guide to Clinical Preventive Services, and
the National Registry for Effective Programs, and</text>
</clause><clause id="H09F13C2CA13B4CBEBC38E3BAE5803BA8"><enum>(iii)</enum><text>includes
strategies which focus on employee populations with a disproportionate burden
of health problems.</text>
</clause></subparagraph><subparagraph id="H97DD14E34B12436AAB99C38A96D0AD8C"><enum>(B)</enum><header>Periodic
updating and review</header><text>The Secretary of Health and Human Services
shall establish procedures for periodic review of programs under this
subsection. Such procedures shall require revisions of programs if necessary to
ensure compliance with the requirements of this section and require updating of
the programs to the extent the Secretary, in coordination with the Director of
the Centers for Disease Control and Prevention, determines necessary to reflect
new scientific findings.</text>
</subparagraph></paragraph><paragraph id="H4549213BA20A4A479D6D501F44EB0189"><enum>(3)</enum><header>Health
literacy</header><text>The Secretary of Health and Human Services shall, as
part of the certification process, encourage employees to make the programs
culturally competent and to meet the health literacy needs of the employees
covered by the programs.</text>
</paragraph></subsection><subsection id="H303B9444A9E84D6A903260170DF53ECA"><enum>(c)</enum><header>Prevention and
wellness program components</header><text>For purposes of this section, the
prevention and wellness components described in this subsection are the
following:</text>
<paragraph id="H18E51DE82D9F4560B40636496930BB91"><enum>(1)</enum><header>Health awareness
component</header><text>A health awareness component which provides for the
following:</text>
<subparagraph id="HE0E4480A95CC4969920C690B42E0B2C2"><enum>(A)</enum><header>Health
education</header><text>The dissemination of health information which addresses
the specific needs and health risks of employees.</text>
</subparagraph><subparagraph id="H54A6A0FD5AF84D5B982DA35B66F47A0C"><enum>(B)</enum><header>Health
screenings</header><text>The opportunity for periodic screenings for health
problems and referrals for appropriate follow up measures.</text>
</subparagraph></paragraph><paragraph id="H3FB1D7405268416E9B22035EFAE27623"><enum>(2)</enum><header>Employee
engagement component</header><text>An employee engagement component which
provides for—</text>
<subparagraph id="HBC244311EA834189B761ED53742AC290"><enum>(A)</enum><text>the establishment
of a committee to actively engage employees in worksite prevention and wellness
through worksite assessments and program planning, delivery, evaluation, and
improvement efforts, and</text>
</subparagraph><subparagraph id="H5CDE8CD50F034D75B16C75EBAD36C16D"><enum>(B)</enum><text>the tracking of
employee participation.</text>
</subparagraph></paragraph><paragraph id="HAE38C86887D14CC7A29EDEC2A465F0E9"><enum>(3)</enum><header>Behavioral
change component</header><text>A behavioral change component which provides for
altering employee lifestyles to encourage healthy living through counseling,
seminars, on-line programs, or self-help materials which provide technical
assistance and problem solving skills. Such component may include programs
relating to—</text>
<subparagraph id="HA072F0416E2241838C8B3129077B2AAD"><enum>(A)</enum><text>tobacco
use,</text>
</subparagraph><subparagraph id="H36FBA8D0AFC84FF9A2E7A55BF14AD6E1"><enum>(B)</enum><text>obesity,</text>
</subparagraph><subparagraph id="H0101607B6FF84A63A3E5C45F191A8BFF"><enum>(C)</enum><text>stress
management,</text>
</subparagraph><subparagraph id="H7B51F7DFE3914F97BE242E95876B958D"><enum>(D)</enum><text>physical
fitness,</text>
</subparagraph><subparagraph id="H7DD6CB023BF04213BAD5EF248BA676F7"><enum>(E)</enum><text>nutrition,</text>
</subparagraph><subparagraph id="H737D537079CA4AD2BB0EBF0243C9E4EC"><enum>(F)</enum><text>substance
abuse,</text>
</subparagraph><subparagraph id="H14454BF0A3304ED98C1B73CD02B3E001"><enum>(G)</enum><text>depression,
and</text>
</subparagraph><subparagraph id="H3B67FE758D09400781036BAA80876333"><enum>(H)</enum><text>mental health
promotion (including anxiety).</text>
</subparagraph></paragraph><paragraph id="H2F5283B9392E49BAB9B1A530FBBEBF62"><enum>(4)</enum><header>Supportive
environment component</header><text>A supportive environment component which
includes the following:</text>
<subparagraph id="H9DA71B6D2C1B4D39AF557929F8E5599A"><enum>(A)</enum><header>On-site
policies</header><text>Policies and services at the worksite which promote a
healthy lifestyle, including policies relating to—</text>
<clause id="H34832C03215144DFB41028D94A1A04BB"><enum>(i)</enum><text>tobacco use at the
worksite,</text>
</clause><clause id="H4CF2FC67FDC64570B3856E838B2F966E"><enum>(ii)</enum><text>the nutrition of
food available at the worksite through cafeterias and vending options,</text>
</clause><clause id="H6C56DFC473294DB8B9D5D99A4E631D2B"><enum>(iii)</enum><text>minimizing
stress and promoting positive mental health in the workplace,</text>
</clause><clause id="HF2A08AD949C545169165C86C2F2ABA8A"><enum>(iv)</enum><text>where applicable,
accessible and attractive stairs, and</text>
</clause><clause id="HD0C57641D2C54004881B2412058BAB3F"><enum>(v)</enum><text>the encouragement
of physical activity before, during, and after work hours.</text>
</clause></subparagraph><subparagraph id="H88E0E16BBF274968998A8A8DA4B8BBE7"><enum>(B)</enum><header>Participation
incentives</header>
<clause id="HFC2F7EB27C8846648FB65AFB460AA052"><enum>(i)</enum><header>In
general</header><text>Qualified incentive benefits for each employee who
participates in the health screenings described in paragraph (1)(B) or the
behavioral change programs described in paragraph (3).</text>
</clause><clause id="HE148FFC468044D77B18A0C7869462F3B"><enum>(ii)</enum><header>Qualified
incentive benefit</header><text>For purposes of clause (i), the term
<term>qualified incentive benefit</term> means any benefit which is approved by
the Secretary of Health and Human Services, in coordination with the Director
of the Centers for Disease Control and Prevention.</text>
</clause></subparagraph><subparagraph id="HB7012D33FE0E4DB2B8DDAB89ABDA1D88"><enum>(C)</enum><header>Employee
input</header><text>The opportunity for employees to participate in the
management of any qualified prevention and wellness to which this section
applies.</text>
</subparagraph></paragraph></subsection><subsection id="H56CF6B6C806F4310B65047492B558C77"><enum>(d)</enum><header>Participation
requirement</header>
<paragraph id="H48E2C1DD3CA74F78A26037D70137E6D2"><enum>(1)</enum><header>In
general</header><text>No credit shall be allowed under subsection (a) unless
the Secretary of Health and Human Services, in coordination with the Director
of the Centers for Disease Control and Prevention, certifies, as a part of any
certification described in subsection (b), that each prevention and wellness
component of the qualified prevention and wellness applies to all qualified
employees of the employer. The Secretary of Health and Human Services shall
prescribe rules under which an employer shall not be treated as failing to meet
the requirements of this subsection merely because the employer provides
specialized programs for employees with specific health needs or unusual
employment requirements or provides a pilot program to test new wellness
strategies.</text>
</paragraph><paragraph id="HEE36316FF6664BC9858BF8D62CEA84E2"><enum>(2)</enum><header>Qualified
employee</header><text>For purposes of paragraph (1), the term <term>qualified
employee</term> means—</text>
<subparagraph id="HB81AD695A0D241549E6DD38EEE280551"><enum>(A)</enum><text>for employers
offering health insurance coverage, an employee who is eligible for such
coverage, or</text>
</subparagraph><subparagraph id="H02DA0B48CCF742198E5C6E5A82272B8E"><enum>(B)</enum><text>for employers not
offering health insurance coverage, an employee who works an average of not
less than 25 hours per week during the taxable year.</text>
</subparagraph></paragraph></subsection><subsection id="HEF6F66E29F464457B6B063FF47B0F69C"><enum>(e)</enum><header>Other
definitions and special rules</header><text>For purposes of this
section—</text>
<paragraph id="H4E39AC643F07485DA73C84A28867B670"><enum>(1)</enum><header>Employee and
employer</header>
<subparagraph id="H5536344C0FA748BF8244544A2D199F56"><enum>(A)</enum><header>Partners and
partnerships</header><text>The term <term>employee</term> includes a partner
and the term <term>employer</term> includes a partnership.</text>
</subparagraph><subparagraph id="H119A6B2B531C4AF787C98E1ECE0A3104"><enum>(B)</enum><header>Certain rules to
apply</header><text>Rules similar to the rules of section 52 shall
apply.</text>
</subparagraph></paragraph><paragraph id="H60764B9BB4794B5D89599D4E77DFDF4D"><enum>(2)</enum><header>Certain costs
not included</header><text>Costs paid or incurred by an employer for food or
health insurance shall not be taken into account under subsection (a).</text>
</paragraph><paragraph id="H734EAA9A079B4E0DBA51372C97A9D3CC"><enum>(3)</enum><header>No credit where
grant awarded</header><text>No credit shall be allowable under subsection (a)
with respect to any qualified prevention and wellness of any taxpayer (other
than an eligible employer described in subsection (f)(2)(A)) who receives a
grant provided by the United States, a State, or a political subdivision of a
State for use in connection with such program. The Secretary shall prescribe
rules providing for the waiver of this paragraph with respect to any grant
which does not constitute a significant portion of the funding for the
qualified prevention and wellness.</text>
</paragraph><paragraph id="H0960111886B14478990AE715FAEFB967"><enum>(4)</enum><header>Credit
period</header>
<subparagraph id="H01B4A1675F1F470CB3E9E94D5E901382"><enum>(A)</enum><header>In
general</header><text>The term <term>credit period</term> means the period of
10 consecutive taxable years beginning with the taxable year in which the
qualified prevention and wellness is first certified under this section.</text>
</subparagraph><subparagraph id="H2F9C6DEAC76247BCB1F166CEF5C127D9"><enum>(B)</enum><header>Special rule for
existing programs</header><text>In the case of an employer (or predecessor)
which operates a prevention and wellness for its employees on the date of the
enactment of this section, subparagraph (A) shall be applied by substituting
<quote>3 consecutive taxable years</quote> for <quote>10 consecutive taxable
years</quote>. The Secretary shall prescribe rules under which this subsection
shall not apply if an employer is required to make substantial modifications in
the existing prevention and wellness in order to qualify such program for
certification as a qualified prevention and wellness.</text>
</subparagraph><subparagraph id="H254F40BAE95F429EBC22FE958548E821"><enum>(C)</enum><header>Controlled
groups</header><text>For purposes of this paragraph, all persons treated as a
single employer under subsection (b), (c), (m), or (o) of section 414 shall be
treated as a single employer.</text>
</subparagraph></paragraph></subsection><subsection id="H23ACA155C61846A7848FC7DA9FCFC451"><enum>(f)</enum><header>Portion of
credit made refundable</header>
<paragraph id="H1805521F6A864878AE2219F3039BBA7A"><enum>(1)</enum><header>In
general</header><text>In the case of an eligible employer of an employee, the
aggregate credits allowed to a taxpayer under subpart C shall be increased by
the lesser of—</text>
<subparagraph id="H3189BC6A54B1441C9EDF236C9F3CDC2C"><enum>(A)</enum><text>the credit which
would be allowed under this section without regard to this subsection and the
limitation under section 38(c), or</text>
</subparagraph><subparagraph id="HE4A189092C1C46E8ABF9B3B6F805A419"><enum>(B)</enum><text>the amount by
which the aggregate amount of credits allowed by this subpart (determined
without regard to this subsection) would increase if the limitation imposed by
section 38(c) for any taxable year were increased by the amount of employer
payroll taxes imposed on the taxpayer during the calendar year in which the
taxable year begins.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">The amount
of the credit allowed under this subsection shall not be treated as a credit
allowed under this subpart and shall reduce the amount of the credit otherwise
allowable under subsection (a) without regard to section 38(c).</continuation-text></paragraph><paragraph id="HB4D9ECCECB4E45F78A663CABF03DFFAB"><enum>(2)</enum><header>Eligible
employer</header><text>For purposes of this subsection, the term <term>eligible
employer</term> means an employer which is—</text>
<subparagraph id="H35EB71E13B994E34839B58E1F8DA325A"><enum>(A)</enum><text>a State or
political subdivision thereof, the District of Columbia, a possession of the
United States, or an agency or instrumentality of any of the foregoing,
or</text>
</subparagraph><subparagraph id="H8AB6114FB5794ADE8E465ACC60561748"><enum>(B)</enum><text>any organization
described in section 501(c) of the Internal Revenue Code of 1986 which is
exempt from taxation under section 501(a) of such Code.</text>
</subparagraph></paragraph><paragraph id="H51FF81437FFC4661AFB30EAF79FD1F42"><enum>(3)</enum><header>Employer payroll
taxes</header><text>For purposes of this subsection—</text>
<subparagraph id="HEFA907C92DBE44419B65C63412AB8A72"><enum>(A)</enum><header>In
general</header><text>The term <term>employer payroll taxes</term> means the
taxes imposed by—</text>
<clause id="H75A716A8A14C4951991E677589C7FBA8"><enum>(i)</enum><text>section 3111(b),
and</text>
</clause><clause id="HD9EA42255B00405986FB45241669BE20"><enum>(ii)</enum><text>sections 3211(a)
and 3221(a) (determined at a rate equal to the rate under section
3111(b)).</text>
</clause></subparagraph><subparagraph id="H58DB8211D5CD45B5A571D048A771AF55"><enum>(B)</enum><header>Special
rule</header><text>A rule similar to the rule of section 24(d)(2)(C) shall
apply for purposes of subparagraph (A).</text>
</subparagraph></paragraph></subsection><subsection id="HDFCBD380CB9C4DDC8A8C0216E8941C87"><enum>(g)</enum><header>Termination</header><text>This
section shall not apply to any amount paid or incurred after December 31,
2017.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H21B464E92FCD4553AB178F7A25D82D1C"><enum>(b)</enum><header>Treatment as
general business credit</header><text>Subsection (b) of section 38 of the
Internal Revenue Code of 1986 (relating to general business credit) is amended
by striking <quote>plus</quote> at the end of paragraph (34), by striking the
period at the end of paragraph (35) and inserting <quote>, plus</quote>, and by
adding at the end the following:</text>
<quoted-block id="HBDFDBD742554439A9A9FFF799C61A532" style="OLC">
<paragraph id="HFC99CC5E6FAF4E3F86D07CA7FC23AD34"><enum>(36)</enum><text>the prevention
and wellness credit determined under section
45R.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H987BBEEC53B549B19154DAC64B309257"><enum>(c)</enum><header>Denial of double
benefit</header><text>Section 280C of the Internal Revenue Code of 1986
(relating to certain expenses for which credits are allowable) is amended by
adding at the end the following new subsection:</text>
<quoted-block id="H54578FB7CC7C4B3BA1D7604848B42122" style="OLC">
<subsection id="H8A74503993224B739125DD555FDF3F92"><enum>(g)</enum><header>Prevention and
wellness program credit</header>
<paragraph id="H5A66529D33084B3C9E132F7938C44B0B"><enum>(1)</enum><header>In
general</header><text>No deduction shall be allowed for that portion of the
costs paid or incurred for a qualified prevention and wellness (within the
meaning of section 45R) allowable as a deduction for the taxable year which is
equal to the amount of the credit allowable for the taxable year under section
45R.</text>
</paragraph><paragraph id="HD85607C4192643808600FAB3B7941832"><enum>(2)</enum><header>Similar rule
where taxpayer capitalizes rather than deducts
expenses</header><text>If—</text>
<subparagraph id="HD085D481BA9144049F4EF0893E0C9C0E"><enum>(A)</enum><text>the amount of the
credit determined for the taxable year under section 45R, exceeds</text>
</subparagraph><subparagraph id="H0283850F27774D4FB3A0FC6FFB7C2BA1"><enum>(B)</enum><text>the amount
allowable as a deduction for such taxable year for a qualified prevention and
wellness,</text>
</subparagraph><continuation-text continuation-text-level="paragraph">the amount
chargeable to capital account for the taxable year for such expenses shall be
reduced by the amount of such excess.</continuation-text></paragraph><paragraph id="H9AD6BAA8E11C4DCDB68194E74C7CD07B"><enum>(3)</enum><header>Controlled
groups</header><text>In the case of a corporation which is a member of a
controlled group of corporations (within the meaning of section 41(f)(5)) or a
trade or business which is treated as being under common control with other
trades or business (within the meaning of section 41(f)(1)(B)), this subsection
shall be applied under rules prescribed by the Secretary similar to the rules
applicable under subparagraphs (A) and (B) of section
41(f)(1).</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H0AFBD94C1AA040A3A5702D041488C100"><enum>(d)</enum><header>Clerical
amendment</header><text>The table of sections for subpart D of part IV of
subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by
adding at the end the following:</text>
<quoted-block id="H98388938B71E4183BE5D5BBBF99E9A22" style="OLC">
<toc regeneration="no-regeneration">
<toc-entry level="section">Sec. 45R. Prevention and wellness program
credit.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HD5D9EFFE22D3499690C45AC7D1D4CA55"><enum>(e)</enum><header>Effective
Date</header><text>The amendments made by this section shall apply to taxable
years beginning after December 31, 2009.</text>
</subsection><subsection id="H4CCB973FE03B4D8BB617C133948E8C8B"><enum>(f)</enum><header>Outreach</header>
<paragraph id="H60C1FA4971B3462DB5D3EFB1ED07A2E0"><enum>(1)</enum><header>In
general</header><text>The Secretary of the Treasury, in conjunction with the
Director of the Centers for Disease Control and members of the business
community, shall institute an outreach program to inform businesses about the
availability of the prevention and wellness credit under section 45R of the
Internal Revenue Code of 1986 as well as to educate businesses on how to
develop programs according to recognized and promising practices and on how to
measure the success of implemented programs.</text>
</paragraph><paragraph id="H6F461EADE6C142179B2506DB941E8DB0"><enum>(2)</enum><header>Authorization of
appropriations</header><text>There are authorized to be appropriated such sums
as are necessary to carry out the outreach program described in paragraph
(1).</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="H2C4B5B548C9047CE8AAD95B0756C8392" section-type="subsequent-section"><enum>283.</enum><header>Grants to increase
physical activity and emotional wellness, improve nutrition, and promote
healthy eating behaviors</header><text display-inline="no-display-inline">Part
Q of title III of the <act-name parsable-cite="PHSA">Public Health Service
Act</act-name> (42 U.S.C. 280h et seq.) is amended by striking section 399W and
inserting the following:</text>
<quoted-block act-name="Public" display-inline="no-display-inline" id="H4CD20425D0BD4D2B832F70740A65F72A" style="OLC">
<section commented="no" display-inline="no-display-inline" id="HF4768D02196F49A18B9BC9CBE32221C3" section-type="subsequent-section"><enum>399W.</enum><header>Grants to increase
physical activity and emotional wellness, improve nutrition, and promote
healthy eating behaviors and healthy living</header>
<subsection id="HDCC0C77EBE7D426892219D870571D169"><enum>(a)</enum><header>Establishment</header>
<paragraph id="HA6F6296355724E39879BCBAB26738CC5"><enum>(1)</enum><header>In
general</header><text>The Secretary, acting through the Director of the Centers
for Disease Control and Prevention and in coordination with the Administrator
of the Health Resources and Services Administration, the Director of the Indian
Health Service, the Secretary of Education, the Secretary of Agriculture, the
Secretary of the Interior, the Director of the National Institutes of Health,
the Director of the Office of Women’s Health, and the heads of other
appropriate agencies, shall award competitive grants to eligible entities to
plan and implement prevention and wellness programs that promote health and
wellness and prevent chronic disease. Such grants may be awarded to target
at-risk populations including youth, health disparity populations (as defined
in section 485E(d)), and the underserved.</text>
</paragraph><paragraph id="H1ABBCE15156D47EF90323C607A6C433A"><enum>(2)</enum><header>Term</header><text>The
Secretary shall award grants under this subsection for a period not to exceed 4
years.</text>
</paragraph></subsection><subsection id="H190E413F457846CFBCDFE7D3AD788119"><enum>(b)</enum><header>Award of
Grants</header><text>An eligible entity desiring a grant under this section
shall submit an application to the Secretary at such time, in such manner, and
containing such information as the Secretary may require, including—</text>
<paragraph id="H4BACA3D8B0A14A78992C86CE87F52E2D"><enum>(1)</enum><text>a plan describing
a comprehensive program of approaches to encourage healthy living, emotional
wellness, healthy eating behaviors, and healthy levels of physical
activity;</text>
</paragraph><paragraph id="H2ABCEB861FFD4BAAA1313882AE435764"><enum>(2)</enum><text>the manner in
which the eligible entity will coordinate with appropriate State and local
authorities and community-based organizations, including but not limited
to—</text>
<subparagraph id="H7EF7CFD7CAFA48238D3721C8A573B843"><enum>(A)</enum><text>State and local
educational agencies;</text>
</subparagraph><subparagraph id="H974576E3A4E94DBCBC4831162DC08F47"><enum>(B)</enum><text>departments of
health;</text>
</subparagraph><subparagraph id="H2E8CD7519365413CA9786CBDE7C30591"><enum>(C)</enum><text>State directors of
programs under section 17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786);
and</text>
</subparagraph><subparagraph id="HFF38373C1CE34FCC9DB6C8782EFFE1C4"><enum>(D)</enum><text>community-based
organizations serving youth; and</text>
</subparagraph></paragraph><paragraph id="H3E42A408EEC44C19868407090CC10CF9"><enum>(3)</enum><text>the manner in
which the applicant will evaluate the effectiveness of the program carried out
under this section.</text>
</paragraph></subsection><subsection id="H7BE4D0BE55E940F4B2C397827188DB38"><enum>(c)</enum><header>Coordination</header><text>In
awarding grants under this section, the Secretary shall ensure that the
proposed programs show a history of addressing these issues, have program
evaluations that show success, and are coordinated in substance and format with
programs currently funded through other Federal agencies and operating within
the community.</text>
</subsection><subsection id="H6539C3EDC82546E6B555E09A75F8FB57"><enum>(d)</enum><header>Eligible
Entity</header><text>In this section, the term <term>eligible entity</term>
means—</text>
<paragraph id="HA59067C647024100B370C4260B6E242B"><enum>(1)</enum><text>a city, county,
tribe, territory, or State;</text>
</paragraph><paragraph id="H2A1CF0D835C24CB9A9E9B83D685FC713"><enum>(2)</enum><text>a State
educational agency;</text>
</paragraph><paragraph id="HDCEFE07D2A18412A90DC8145F1F54472"><enum>(3)</enum><text>a tribal
educational agency;</text>
</paragraph><paragraph id="HB25BDA88803944AC9979323E1097E826"><enum>(4)</enum><text>a local
educational agency;</text>
</paragraph><paragraph id="HF81F2855DF59474E8C096E8963B270EF"><enum>(5)</enum><text>a federally
qualified health center (as defined in section 1861(aa)(4) of the Social
Security Act);</text>
</paragraph><paragraph id="H3BACD35FAA96493E97AADBA65FF44709"><enum>(6)</enum><text>a rural health
clinic;</text>
</paragraph><paragraph id="H60506609847743C1994AACD40C7A2703"><enum>(7)</enum><text>a health
department;</text>
</paragraph><paragraph id="H57CDCB49E0E74CBEA89D3B2D7D699CDE"><enum>(8)</enum><text>an Indian Health
Service hospital or clinic;</text>
</paragraph><paragraph id="H08FF8D04F1FE4E2EA7F8C4D710A4F534"><enum>(9)</enum><text>an Indian tribal
health facility;</text>
</paragraph><paragraph id="H81927ACE19C34EAEBECFD89E3A319CBF"><enum>(10)</enum><text>an urban Indian
facility;</text>
</paragraph><paragraph id="H4FF7F64480BD45AA84809228FFCB0E75"><enum>(11)</enum><text>any health
provider;</text>
</paragraph><paragraph id="H98D7008B421A4D179291BB0BD9B13AAD"><enum>(12)</enum><text>an accredited
university or college;</text>
</paragraph><paragraph id="H7D9812DACDEB4C13857C6B3813721211"><enum>(13)</enum><text>a youth serving
organization;</text>
</paragraph><paragraph id="HBB2FE763FBB143809B756C3CE11FB93C"><enum>(14)</enum><text>a community-based
organization; or</text>
</paragraph><paragraph id="H82490188A89146DEA12504C3C8AF92E5"><enum>(15)</enum><text>any other entity
determined appropriate by the Secretary.</text>
</paragraph></subsection><subsection id="H69C489FA9FC04014B1E1C43EAB416DB9"><enum>(e)</enum><header>Use of
Funds</header><text display-inline="yes-display-inline">An eligible entity that
receives a grant under this section shall use the funds made available through
the grant to plan and implement prevention and wellness programs that promote
health and wellness and prevent chronic disease.</text>
</subsection><subsection id="H6A035BE8A5044F28998079FABA84B30C"><enum>(f)</enum><header>Matching
Funds</header><text>In awarding grants under subsection (a), the Secretary may
give priority to eligible entities who provide matching contributions. Such
non-Federal contributions may be cash or in-kind, fairly evaluated, including
plant, equipment, training, curriculum, or a preexisting evaluation
framework.</text>
</subsection><subsection id="H43271137935A47A285CC196F93228475"><enum>(g)</enum><header>Technical
Assistance</header><text>The Secretary may set aside an amount not to exceed 10
percent of the total amount appropriated for a fiscal year under subsection (j)
to permit the Director of the Centers for Disease Control and Prevention to
provide grantees with technical support in the development, implementation, and
evaluation of prevention and wellness programs under this section and to
disseminate information about effective strategies and interventions in
promoting health and wellness and preventing chronic disease.</text>
</subsection><subsection id="HD6730F4FB71B4211953EEDBA00FD5AB4"><enum>(h)</enum><header>Limitation on
Administrative Costs</header><text>An eligible entity awarded a grant under
this section may not use more than 10 percent of funds awarded under such grant
for administrative expenses.</text>
</subsection><subsection id="H3AA6E1A06D1E4993B0AE0FAB32F4E609"><enum>(i)</enum><header>Report</header><text>Not
later than 6 years after the date of enactment of this section the Director of
the Centers for Disease Control and Prevention shall review the results of the
grants awarded under this section and other related research and identify
prevention and wellness programs that have demonstrated effectiveness in
promoting health and wellness and preventing chronic disease. Such review shall
include an identification of model curricula, best practices, and lessons
learned, as well as recommendations for next steps to promote health and
wellness and prevent chronic disease. Information derived from such review,
including model prevention and wellness program curricula, shall be
disseminated to the public.</text>
</subsection><subsection commented="no" id="HB009A43D4AC6444CA360F6374EE07C34"><enum>(j)</enum><header>Definition</header><text>In
this section, the term <term>prevention and wellness program</term> means a
program that consists of a combination of activities that are designed to
increase awareness, assess risks, educate, and promote voluntary behavior
change to improve the health of an individual, modify his or her consumer
health behavior, enhance his or her personal well-being and productivity, and
prevent illness and injury.</text>
</subsection><subsection id="H2FB4382D8BFB4784AD4799515E352BB2"><enum>(k)</enum><header>Authorization of
Appropriations</header><text>There are authorized to be appropriated to carry
out this section, $60,000,000 for fiscal year 2010, and such sums as may be
necessary for each of fiscal years 2011 through
2014.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section commented="no" id="HD505DAF5674A4A26BC1663722FBC73F5"><enum>284.</enum><header>Prevention and
wellness programs for individuals and families</header>
<subsection id="HDDF2C099CE9A4975AA99025BFB884D63"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary of
Health and Human Services shall encourage States to work with insurance
companies on ways to promote and incentivize the participation of individuals
and families in prevention and wellness programs, such as through insurance
premium reductions.</text>
</subsection><subsection commented="no" id="H89A5D1A0238B43E4AB01747B3959E92D"><enum>(b)</enum><header>Definition</header><text>In
this section, the term <term>prevention and wellness program</term> means a
program that consists of a combination of activities that are designed to
increase awareness, assess risks, educate, and promote voluntary behavior
change to improve the health of an individual, modify his or her consumer
health behavior, enhance his or her personal well-being and productivity, and
prevent illness and injury.</text>
</subsection></section></subtitle><enum>III</enum><header>Expanding Access
to Health Care</header>
<subtitle id="H85F7F348F928499BAF2F6D426730216E"><enum>A</enum><header>State Innovation
Program</header>
<section commented="no" id="HA4231D70564F4B53A87C0BEA98255D65"><enum>301.</enum><header>Ensuring
affordability and access through universal access programs</header>
<subsection commented="no" id="HB70B7EDACC2540A399F3D0E34DF65594"><enum>(a)</enum><header>State
requirement</header>
<paragraph commented="no" id="HECE08733BB3541BD927AFACD4BA1E6A6"><enum>(1)</enum><header>In
general</header><text>Not later than 2 years after the date of the enactment of
this Act, in order to qualify for preferences and increased flexibility under
<internal-xref idref="HD971972391C54EE989DDD5A90127843D" legis-path="3.(a)">section 412(a)</internal-xref>, each State shall implement
at least one of the following programs for the purposes of mitigating the cost
to insurers of providing insurance to high risk individuals in the
State:</text>
<subparagraph commented="no" id="H694250DA8DC049C68D4157D765BD30B4"><enum>(A)</enum><text>a qualified State
reinsurance program defined in
<internal-xref idref="H9479C3341B674EB09000D83FAADA3859" legis-path="2.(b)">subsection (b)</internal-xref>; or</text>
</subparagraph><subparagraph commented="no" id="H9551D0077E794369B490C68EB1D1ECEB"><enum>(B)</enum><text>a subsection (c)
qualified State high risk pool program defined in
<internal-xref idref="H93008D9878604CFEBC218D4F22D10919" legis-path="2.(c)(1)">subsection (c)(1)</internal-xref>.</text>
</subparagraph></paragraph><paragraph commented="no" id="HFB0725C40E9B49C6BE90EB6CF3F5DD6D"><enum>(2)</enum><header>Funding</header><text display-inline="yes-display-inline">As a condition of qualifying for
preferences and increased flexibility under section 412(a), a State
shall—</text>
<subparagraph id="HBE4E54AFD85C460798B0D5A2FCBD7053"><enum>(A)</enum><text>make available
non-Federal contributions, as specified by the Secretary, to ensure the
continuing stability of any program implemented by the State under paragraph
(1); and</text>
</subparagraph><subparagraph id="H6E35ECA7064A44578C7435C5E815AD3E"><enum>(B)</enum><text>at the time of
application, submit to the Secretary of Health and Human Services a budget
plan, including assurances that the State has in place a method to satisfy the
requirement under subparagraph (A).</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="H9479C3341B674EB09000D83FAADA3859"><enum>(b)</enum><header>Qualified State
reinsurance program</header>
<paragraph commented="no" id="H19CD8A31E0904950B1F3AE9C43EBB985"><enum>(1)</enum><header>Qualified State
reinsurance program defined</header><text>For purposes of this section, the
term <term>qualified State reinsurance program</term> means a program that is
operated by a State or a program authorized by the State to provide reinsurance
for health insurance coverage offered in the individual or small group
market.</text>
</paragraph><paragraph commented="no" id="H0F6E855BFB724F67B8118DB81075EB3E"><enum>(2)</enum><header>Form of
program</header><text>A qualified State reinsurance program may provide
reinsurance—</text>
<subparagraph commented="no" id="H43223E94A34A49D097EF30B683B69545"><enum>(A)</enum><text>on a prospective
or retrospective basis;</text>
</subparagraph><subparagraph commented="no" id="H5838F77ADA914F2BAC42FB455C6FA45A"><enum>(B)</enum><text>that protects
health insurance issuers against the annual aggregate spending of their
enrollees; and</text>
</subparagraph><subparagraph id="H02411796A6F34D57BF927CB405C2FA00"><enum>(C)</enum><text>that provides
purchase protection against individual catastrophic costs.</text>
</subparagraph></paragraph><paragraph id="HD470FCDE0ECB42648973C206B5C1CA7C"><enum>(3)</enum><header>Satisfaction of
HIPAA requirement</header><text>Section 2745(g)(1) of the Public Health Service
Act is amended by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H74704F4F41574F8993E528EC75159D40" style="OLC">
<subparagraph id="H0F4D03EACACC47F6971FCCFD65061F32"><enum>(B)</enum><header>Treatment of
certain reinsurance programs</header><text display-inline="yes-display-inline">For purposes of subparagraph (A), the term
<term>qualified high risk pool</term> includes a qualified State reinsurance
program under the Medical Rights and Reform Act of
2009.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" id="HF9C447C798014795B5F0CCCCCCC8D4DC"><enum>(c)</enum><header>Subsection (c)
qualifying State high risk pool</header>
<paragraph commented="no" id="H93008D9878604CFEBC218D4F22D10919"><enum>(1)</enum><header>Defined</header><text>For
purposes of this section, the term <term>subsection (c) qualified State high
risk pool program</term> means a program that operates a high risk pool
that—</text>
<subparagraph id="H2FA372E5926A4C34AD1FBF98F80DC93B"><enum>(A)</enum><text>is a qualified
high risk pool under section 2745(g)(1)(A) of the Public Health Service Act;
and</text>
</subparagraph><subparagraph id="H2F47DA53493142CBA062CEA36BB0A9F2"><enum>(B)</enum><text>meets all of the
following requirements:</text>
<clause commented="no" id="HA096DFE9990D421CA491F2E321610C17"><enum>(i)</enum><text display-inline="yes-display-inline">The high risk pool provides a variety of
types of coverage, including at least one high deductible health plan that may
be coupled with a health savings account.</text>
</clause><clause commented="no" id="HF61190726A074738B6F13E707633BABC"><enum>(ii)</enum><text>The high risk
pool is funded with a stable funding source that is not solely dependent on an
appropriation from the State legislature.</text>
</clause><clause commented="no" id="HD3D4AD9325FA4C41AAA634B176D2431F"><enum>(iii)</enum><text>The high risk
pool has no waiting list and no pre-existing condition exclusionary periods so
that all eligible residents who are seeking coverage through the pool can
receive coverage through the pool.</text>
</clause><clause commented="no" id="H6542A75C3BB04D739B6525BFD5D01BB3"><enum>(iv)</enum><text>The high risk
pool allows for coverage of individuals who, but for the 24-month disability
waiting period under section 226(b) of the Social Security Act, would be
eligible for Medicare during the period of such waiting period.</text>
</clause><clause commented="no" id="HAF9B90AE3FF64F98B174C792EAE07CBA"><enum>(v)</enum><text display-inline="yes-display-inline">The high risk pool does not charge
participants a premium that is more than 150 percent of the average premium for
coverage in the individual market in that State.</text>
</clause><clause commented="no" id="H58E3F0622174439D8C08BD371693A014"><enum>(vi)</enum><text>The high risk
pool conducts education and outreach initiatives so that residents and
insurance brokers understand that the pool is available to eligible
residents.</text>
</clause></subparagraph></paragraph><paragraph commented="no" id="H26FDA0DD429E438D9BEA4C11D2690A39"><enum>(2)</enum><header>Relation to
section 2745</header><text>Section 2745(g)(1) of the Public Health Service Act
is further amended—</text>
<subparagraph id="H415E37326E8E474BA6C8D82264916DDF"><enum>(A)</enum><text>in subparagraph
(A), by striking <quote>The term</quote> and inserting <quote>Subject to
subparagraph (C), the term</quote>; and</text>
</subparagraph><subparagraph id="HDE0F79A5CFDF4EFDAC5DABB07B274F53"><enum>(B)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HAA1CC4B11DD641C78D74C9D5240F09C5" style="OLC">
<subparagraph id="HFB300DF8215E431390F8A11CAFE1DF3B"><enum>(C)</enum><header>Updated
definition</header><text display-inline="yes-display-inline">Beginning on the
last day of the 2-year period beginning in the date of the enactment of the
Medical Rights and Reform Act of 2009, the term <term>qualified high risk
pool</term> means a pool that meets the requirements of subparagraph (A) of
this paragraph and the requirements of section 411(c)(1) of such
Act.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" id="HA785F823C8F54791A5662592C02E56B7"><enum>(3)</enum><header>Relation to
current qualified high risk pool program operating a qualified high risk
pool</header><text>In the case of a State that is operating a qualified high
risk pool under section 2745 of the Public Health Service Act as of the date of
the enactment of this Act, the State may use current funding sources to
transition from the operation of such a pool to—</text>
<subparagraph id="H247B89A79E7C4039B81EEE3DE5C282D6"><enum>(A)</enum><text>the operation of a
qualified State reinsurance program described in
<internal-xref idref="H9479C3341B674EB09000D83FAADA3859" legis-path="2.(b)">subsection (b)</internal-xref>; or</text>
</subparagraph><subparagraph id="H734AEF8C2A154A0FA3A69B26B07C9329"><enum>(B)</enum><text>a qualified high
risk pool under section 2745(g)(1)(C) of the Public Health Service Act.</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="HB3F8E4AC873348BDB0D71C246E7BCB53"><enum>(d)</enum><header>Waivers</header><text>In
order to accommodate new and innovative programs, the Secretary may waive such
requirements of this section for qualified State reinsurance programs and for
subsection (c) qualifying State high risk pools as the Secretary deems
appropriate.</text>
</subsection></section><section id="H21992E33338E4D75B14176FEA1CF397D" section-type="subsequent-section"><enum>302.</enum><header>Enhanced Federal
funding and reduced red-tape for State efforts to improve access to health
insurance coverage</header>
<subsection id="HD971972391C54EE989DDD5A90127843D"><enum>(a)</enum><header>Benefits of
operating a universal access program</header>
<paragraph id="H70F67BCDE6C746C58619E58E9C7D238D"><enum>(1)</enum><header>Increased
flexibility for States</header><text display-inline="yes-display-inline">In the
case of a State that conducts an universal access program described in
<internal-xref idref="HB70B7EDACC2540A399F3D0E34DF65594" legis-path="2.(a)">section 301(a)</internal-xref>, the requirements of section
1115 of the Social Security Act (42 U.S.C. 1315) shall not apply to activities
conducted by a State through a State innovation program described in
<internal-xref idref="HF066A3205A434F9F8F9735B8CCAFE963" legis-path="4.">section 303</internal-xref>.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H3D580AE145C04D06AB060972197643F1"><enum>(2)</enum><header>Preference for
competitive grants</header><text>Beginning 3 years after the date of the
enactment of this Act, in the case of a competitive grant for which the only
eligible entities are States, the Secretary, in awarding such grant to a State,
shall give preference to any State with a program that meets the requirements
of paragraphs (1) and (2) of section
<internal-xref idref="HB70B7EDACC2540A399F3D0E34DF65594" legis-path="2.(a)">section 301(a)</internal-xref>.</text>
</paragraph></subsection><subsection commented="no" id="H55C1F4D2D65846BCBD4D86F5B38B5284"><enum>(b)</enum><header>State incentives
for States implementing a State innovation program</header>
<paragraph id="H7E898321225545E496CBC364C11497FE"><enum>(1)</enum><header>One-time payment
for States implementing a State innovation program</header><text display-inline="yes-display-inline">The
Secretary shall make a one-time payment to a State that establishes a State
innovation program under
<internal-xref idref="HF066A3205A434F9F8F9735B8CCAFE963" legis-path="4.">section 303</internal-xref>.</text>
</paragraph><paragraph display-inline="no-display-inline" id="H3A21E380792545658406BC4EC2550B02"><enum>(2)</enum><header>Additional
payments for States implementing a State innovation program</header>
<subparagraph id="HCAD581C592144B2FA585E3D34EE71B9D"><enum>(A)</enum><header>Annual
payments</header>
<clause id="H646ABA706BE24BF18A64900EC420881A"><enum>(i)</enum><header>In
general</header><text>The Secretary shall make annual payments to a State that
meets the requirements under
<internal-xref idref="H66B87717722844E78DBCA38AC14D9D41" legis-path="3.(b)(2)(B)">subparagraph (B)</internal-xref>.</text>
</clause><clause id="H3E2E2041B3FE44B6A8697F3C1A3131E1"><enum>(ii)</enum><header>Limitation</header><text>The
Secretary may make payments under clause (i) to a State for no more than a
total period of 5 years, after which period such payments shall be subject to
review by the Secretary.</text>
</clause></subparagraph><subparagraph id="H66B87717722844E78DBCA38AC14D9D41"><enum>(B)</enum><header>Requirements for
additional payments</header><text>A State meets the requirements of this
paragraph if the State—</text>
<clause id="H22E822E5914947F5B5EE00CC71B96CBD"><enum>(i)</enum><text>operates a State
innovation program;</text>
</clause><clause id="HDAABECDD85AF47C0BCBF28BAF30AD2FA"><enum>(ii)</enum><text display-inline="yes-display-inline">conducts activities under at least 2 of the
paragraphs in
<internal-xref idref="HF066A3205A434F9F8F9735B8CCAFE963" legis-path="4.">section 30</internal-xref>3;</text>
</clause><clause commented="no" id="HF8145BFFAD7242DF9CC5CE7B341E24A1"><enum>(iii)</enum><text>operates a State
transparency program described in
<internal-xref idref="H36175C5C509E448F8AB820FD723B056E" legis-path="5.">section 304</internal-xref>; and</text>
</clause><clause id="HB5D1484ADF36414ABDE5CB7D86A9B26F"><enum>(iv)</enum><text>reduces the
number of uninsured individuals in the State without significantly expanding
programs that increase direct spending for the Federal government and State
budgets.</text>
</clause></subparagraph><subparagraph display-inline="no-display-inline" id="H83AEC61275E3406B9B8CE1ADBB9ABD0F"><enum>(C)</enum><header>Use of
funds</header><text display-inline="yes-display-inline">The State shall use
funds from a payment under
<internal-xref idref="HCAD581C592144B2FA585E3D34EE71B9D" legis-path="3.(b)(2)(A)">subparagraph (A)</internal-xref> to improve the
State’s universal access program.</text>
</subparagraph></paragraph></subsection></section><section id="HF066A3205A434F9F8F9735B8CCAFE963"><enum>303.</enum><header>State
innovation program described</header><text display-inline="no-display-inline">For purposes of this subtitle, a State
innovation program is a program operated by a State that consists of any of the
following:</text>
<paragraph id="H061D279635DC4043ABC6859AD7B1CB48"><enum>(1)</enum><text>A
health plan finder described in
<internal-xref idref="H202FF2D36F5E4B11950ED9806F09782F" legis-path="6.">section 305</internal-xref>.</text>
</paragraph><paragraph id="H600C0F2435CF47B898309665EDB9BC7C"><enum>(2)</enum><text display-inline="yes-display-inline">Assistance for small businesses jointly
purchasing health insurance coverage through small business health plans under
<internal-xref idref="H316BE61C1E9A42AAB5EAA134EA88497B" legis-path="7.">section 306</internal-xref>.</text>
</paragraph><paragraph id="H90B7D267AF7A4F8EA33C0438FEE208E7"><enum>(3)</enum><text>An interstate
compact on health insurance regulation under
<internal-xref idref="H429AE84C08014DF8B28F562121EF8AFC" legis-path="9.">section 307</internal-xref>.</text>
</paragraph><paragraph commented="no" id="HDF7AE9A06F29464C91951EF2AC6F5B3C"><enum>(4)</enum><text>The offering in
the State of a basic catastrophic health benefit plan as defined in
<internal-xref idref="H2AF23A050DA843F38EDDC5F05B55694A" legis-path="10.(1)">section 308(1)</internal-xref>.</text>
</paragraph></section><section id="H36175C5C509E448F8AB820FD723B056E"><enum>304.</enum><header>State
transparency program described</header><text display-inline="no-display-inline">For purposes of this subtitle, a State
transparency program is a program through which the State—</text>
<paragraph id="HE9E5F3ED484C4FC4A4A9522C5938BD08"><enum>(1)</enum><text>partners with
private groups (including State medical associations) and, through such
partnerships, obtains pricing and quality information related to health care
services that are provided in the State; and</text>
</paragraph><paragraph id="H241D4EDFAA9044C9AE0BA91E890859CA"><enum>(2)</enum><text>provides members
of the public with access to such information.</text>
</paragraph></section><section display-inline="no-display-inline" id="H202FF2D36F5E4B11950ED9806F09782F" section-type="subsequent-section"><enum>305.</enum><header>Health plan
finder</header><text display-inline="no-display-inline">A health plan finder
described under this section is a program, operated by a State (or a State
acting in cooperation with other States) that—</text>
<paragraph id="HDC7B5C738B2949EBA5868F872812A1FD"><enum>(1)</enum><text display-inline="yes-display-inline">provides consumers with information about
the health insurance coverage available to such consumer (including information
about basic catastrophic health benefit plans described in
<internal-xref idref="HDF7AE9A06F29464C91951EF2AC6F5B3C" legis-path="4.(5)">section 303(5)</internal-xref>);</text>
</paragraph><paragraph id="HFF7F611E998A4B1497200F809D86C108"><enum>(2)</enum><text>connects consumers
with health insurance specialists who provide advice to such consumers on which
health insurance coverage would best serve the individual needs of each such
consumer (taking into account the quality of the health care providers
participating in such in coverage); and</text>
</paragraph><paragraph id="H809612E3EFE44B73A246A433EBA1DF99"><enum>(3)</enum><text>may, at the option
of the State, enroll individuals—</text>
<subparagraph id="HD8860DA39BE54354B6FCC6B455CA1DF2"><enum>(A)</enum><text>who are eligible
for the Medicaid program under title XIX of the Social Security Act in such
program; and</text>
</subparagraph><subparagraph id="H2FDA7A5D7A614B4BB211DA10E4CFA16F"><enum>(B)</enum><text display-inline="yes-display-inline">who are eligible for the State Children’s
Health Insurance Program under title XXI of such Act in such program.</text>
</subparagraph></paragraph></section><section id="H316BE61C1E9A42AAB5EAA134EA88497B"><enum>306.</enum><header>Small business
health plans</header><text display-inline="no-display-inline">For purposes of a
State innovation program under this subtitle, a State may assist small
businesses in jointly purchasing health insurance coverage through small
business health plans that allow such businesses to combine purchasing and
negotiating power and to pool risk in order to obtain more affordable health
care benefits for the employees of such businesses.</text>
</section><section id="H429AE84C08014DF8B28F562121EF8AFC"><enum>307.</enum><header>Interstate
compacts on health insurance regulation</header><text display-inline="no-display-inline">For purposes of a State innovation program
under this subtitle, a State may establish an interstate compact with one or
more States to establish a common regulatory system for health insurance
coverage for the purpose of increasing the availability and diversity of health
insurance coverage in the State, including provisions allowing small businesses
to form small business health plans (as described in section 306) and
permitting individuals to purchase insurance across State lines.</text>
</section><section id="H3A29BBF919034C28BD5651484D662B3B"><enum>308.</enum><header>Definitions</header><text display-inline="no-display-inline">For purposes of this subtitle:</text>
<paragraph id="H2AF23A050DA843F38EDDC5F05B55694A"><enum>(1)</enum><header>Basic
catastrophic health benefit plan</header><text display-inline="yes-display-inline">The term <term>basic catastrophic health
benefits plan</term> means health insurance coverage—</text>
<subparagraph id="HD3EA6CE96DD749AFB5FCA46E2E595DEB"><enum>(A)</enum><text>that is a high
deductible plan (as defined under section 223(c)(2) of the Internal Revenue
Code of 1986); and</text>
</subparagraph><subparagraph id="H857DC764BA01420EA0613783E721EC79"><enum>(B)</enum><text>that is not
subject to benefit mandates otherwise applicable under State law.</text>
</subparagraph></paragraph><paragraph id="H82DAB5D59B90496C87315C814FFCEAF0"><enum>(2)</enum><header>Health insurance
coverage</header><text>The term <term>health insurance coverage</term> has the
meaning given such term under section 2791(b)(1) of the Public Health Service
Act.</text>
</paragraph><paragraph id="H3F1EC2FF5E704192AED4695659C629B0"><enum>(3)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</paragraph><paragraph id="H2E2B760F6AD745AD92A7F6AA077B17EC"><enum>(4)</enum><header>State</header><text display-inline="yes-display-inline">The term <term>State</term> means the
several States, the District of Columbia, Guam, the Commonwealth of Puerto
Rico, the Northern Mariana Islands, the Virgin Islands, American Samoa, and the
Trust Territory of the Pacific Islands.</text>
</paragraph><paragraph id="HA08B8A72B9384800AA0C6184C8298BB0"><enum>(5)</enum><header>State innovation
program</header><text>The term <term>State innovation program</term> means a
program described in
<internal-xref idref="HF066A3205A434F9F8F9735B8CCAFE963" legis-path="4.">section 303</internal-xref>.</text>
</paragraph><paragraph id="HBFE9B3A302154D35BA7CB99D771CD5D8"><enum>(6)</enum><header>Universal Access
program</header><text>The term <term>universal access program</term> means a
program described in
<internal-xref idref="HA4231D70564F4B53A87C0BEA98255D65" legis-path="2.">section 301</internal-xref>.</text>
</paragraph></section><section id="HB246688DAC7C47B69FB933778589DD88"><enum>309.</enum><header>Authorization
for appropriations</header><text display-inline="no-display-inline">There is
authorized to be appropriated such sums as are necessary to carry out the
provisions of this subtitle.</text>
</section></subtitle><subtitle id="H591DDE14605245FA8F58C52EFDA03BCE"><enum>B</enum><header>Interstate Market
for Health Insurance</header>
<section id="HB0C02F3143C34B9CACDC8EAB4904643C"><enum>311.</enum><header>Specification
of constitutional authority for enactment of law</header><text display-inline="no-display-inline">This subtitle is enacted pursuant to the
power granted Congress under article I, section 8, clause 3, of the United
States Constitution.</text>
</section><section id="HACA4CFA3163741ED88175C74ED82003A"><enum>312.</enum><header>Findings</header><text display-inline="no-display-inline">Congress finds the following:</text>
<paragraph id="H9F45FE0AA2A442DC85935B05AA09B88F"><enum>(1)</enum><text>The application of
numerous and significant variations in State law impacts the ability of
insurers to offer, and individuals to obtain, affordable individual health
insurance coverage, thereby impeding commerce in individual health insurance
coverage.</text>
</paragraph><paragraph id="HA03D83ED33184D0CB3F124D79B7D8C39"><enum>(2)</enum><text>Individual health
insurance coverage is increasingly offered through the Internet, other
electronic means, and by mail, all of which are inherently part of interstate
commerce.</text>
</paragraph><paragraph id="H691C391324374B92939A4A9AE922C58B"><enum>(3)</enum><text>In response to
these issues, it is appropriate to encourage increased efficiency in the
offering of individual health insurance coverage through a collaborative
approach by the States in regulating this coverage.</text>
</paragraph><paragraph id="HFC374504CB41492988447AEA99AC9B83"><enum>(4)</enum><text>The establishment
of risk-retention groups has provided a successful model for the sale of
insurance across State lines, as the acts establishing those groups allow
insurance to be sold in multiple States but regulated by a single State.</text>
</paragraph></section><section id="HDDF18965623D4F808C965328B68BE0A6"><enum>313.</enum><header>Cooperative
governing of individual health insurance coverage</header>
<subsection id="H95BECA67E4964320847726C3289337C4"><enum>(a)</enum><header>In
general</header><text>Title XXVII of the Public Health Service Act (42 U.S.C.
300gg et seq.) is amended by adding at the end the following new part:</text>
<quoted-block display-inline="no-display-inline" id="H7672677658DB41328FF154ED83C28D68" style="OLC">
<part id="H9F7A5213D7AD4F8FBE70A9AE313D2C48"><enum>D</enum><header>Cooperative
Governing of Individual Health Insurance Coverage </header>
<section id="HFA137D6AF4D3443A8CEFDD366587C95D"><enum>2795.</enum><header>Definitions</header><text display-inline="no-display-inline">In this part:</text>
<paragraph id="H6A2E3D25D3A44BABB49403DE3072977B"><enum>(1)</enum><header>Primary
State</header><text>The term <term>primary State</term> means, with respect to
individual health insurance coverage offered by a health insurance issuer, the
State designated by the issuer as the State whose covered laws shall govern the
health insurance issuer in the sale of such coverage under this part. An
issuer, with respect to a particular policy, may only designate one such State
as its primary State with respect to all such coverage it offers. Such an
issuer may not change the designated primary State with respect to individual
health insurance coverage once the policy is issued, except that such a change
may be made upon renewal of the policy. With respect to such designated State,
the issuer is deemed to be doing business in that State.</text>
</paragraph><paragraph id="H44AFE3ED30A74EC887AB0C7BB7C075BB"><enum>(2)</enum><header>Secondary
State</header><text>The term <term>secondary State</term> means, with respect
to individual health insurance coverage offered by a health insurance issuer,
any State that is not the primary State. In the case of a health insurance
issuer that is selling a policy in, or to a resident of, a secondary State, the
issuer is deemed to be doing business in that secondary State.</text>
</paragraph><paragraph id="HB55344107FD24E919BEFF0EFE641E65E"><enum>(3)</enum><header>Health insurance
issuer</header><text>The term <term>health insurance issuer</term> has the
meaning given such term in section 2791(b)(2), except that such an issuer must
be licensed in the primary State and be qualified to sell individual health
insurance coverage in that State.</text>
</paragraph><paragraph id="H266057FE083447EDA65F743BC8B1FF01"><enum>(4)</enum><header>Individual
health insurance coverage</header><text>The term <term>individual health
insurance coverage</term> means health insurance coverage offered in the
individual market, as defined in section 2791(e)(1).</text>
</paragraph><paragraph id="H7EADFF41A09F46E58BBA5261AEEEF932"><enum>(5)</enum><header>Applicable State
authority</header><text>The term <term>applicable State authority</term> means,
with respect to a health insurance issuer in a State, the State insurance
commissioner or official or officials designated by the State to enforce the
requirements of this title for the State with respect to the issuer.</text>
</paragraph><paragraph id="H6AB78AF428A4496FA18078036EBD2ED1"><enum>(6)</enum><header>Hazardous
financial condition</header><text>The term <term>hazardous financial
condition</term> means that, based on its present or reasonably anticipated
financial condition, a health insurance issuer is unlikely to be able—</text>
<subparagraph id="H71F2210418264F76BE8F2E8EAC399E0E"><enum>(A)</enum><text>to meet
obligations to policyholders with respect to known claims and reasonably
anticipated claims; or</text>
</subparagraph><subparagraph id="H48349D1D67CA42BDB58EE45C205A0588"><enum>(B)</enum><text>to pay other
obligations in the normal course of business.</text>
</subparagraph></paragraph><paragraph id="H0824C943D1564D0699C472B3AB6360FF"><enum>(7)</enum><header>Covered
laws</header>
<subparagraph id="H6622F0B4A88F4A11B67B5C1579513DA2"><enum>(A)</enum><header>In
general</header><text>The term <term>covered laws</term> means the laws, rules,
regulations, agreements, and orders governing the insurance business pertaining
to—</text>
<clause id="HAA5C525C00814288AECC010507E4D098"><enum>(i)</enum><text>individual health
insurance coverage issued by a health insurance issuer;</text>
</clause><clause id="H7F42B45F44BD496CB9A37BFA83BF5561"><enum>(ii)</enum><text>the offer, sale,
rating (including medical underwriting), renewal, and issuance of individual
health insurance coverage to an individual;</text>
</clause><clause id="H047A982EDCCC4D13B6E671BA86BBEB89"><enum>(iii)</enum><text>the provision to
an individual in relation to individual health insurance coverage of health
care and insurance related services;</text>
</clause><clause id="H0226895901204CC89793B84506F032E7"><enum>(iv)</enum><text>the provision to
an individual in relation to individual health insurance coverage of
management, operations, and investment activities of a health insurance issuer;
and</text>
</clause><clause id="HA777692088474B31B026785299442AEC"><enum>(v)</enum><text>the provision to
an individual in relation to individual health insurance coverage of loss
control and claims administration for a health insurance issuer with respect to
liability for which the issuer provides insurance.</text>
</clause></subparagraph><subparagraph id="HA26607DCC04A44D6B18636A4D648333A"><enum>(B)</enum><header>Exception</header><text>Such
term does not include any law, rule, regulation, agreement, or order governing
the use of care or cost management techniques, including any requirement
related to provider contracting, network access or adequacy, health care data
collection, or quality assurance.</text>
</subparagraph></paragraph><paragraph id="HD223CAD1AD55447790B4A5FCE6F792AB"><enum>(8)</enum><header>State</header><text>The
term <term>State</term> means the 50 States and includes the District of
Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the
Northern Mariana Islands.</text>
</paragraph><paragraph id="HB4112B3D1B474F2AA69839FB8DA29B7C"><enum>(9)</enum><header>Unfair claims
settlement practices</header><text>The term <term>unfair claims settlement
practices</term> means only the following practices:</text>
<subparagraph id="HA0F028C28E3C450DB0D4730101EE4F09"><enum>(A)</enum><text>Knowingly
misrepresenting to claimants and insured individuals relevant facts or policy
provisions relating to coverage at issue.</text>
</subparagraph><subparagraph id="H241ED8C00D7F45B48129B7C90E3DE092"><enum>(B)</enum><text>Failing to
acknowledge with reasonable promptness pertinent communications with respect to
claims arising under policies.</text>
</subparagraph><subparagraph id="H40872F7B2C564C6CA583B1538011495D"><enum>(C)</enum><text>Failing to adopt
and implement reasonable standards for the prompt investigation and settlement
of claims arising under policies.</text>
</subparagraph><subparagraph id="H3EA7CBDE68DF4F1581960D18ECC6A87F"><enum>(D)</enum><text>Failing to
effectuate prompt, fair, and equitable settlement of claims submitted in which
liability has become reasonably clear.</text>
</subparagraph><subparagraph id="H74533CB36CAA4A31B63BA75DA24EE36A"><enum>(E)</enum><text>Refusing to pay
claims without conducting a reasonable investigation.</text>
</subparagraph><subparagraph id="H22C51D80D0394B599F49688C0164F490"><enum>(F)</enum><text>Failing to affirm
or deny coverage of claims within a reasonable period of time after having
completed an investigation related to those claims.</text>
</subparagraph><subparagraph id="H5DEE110BA4624AB1A6590563EB07FD3C"><enum>(G)</enum><text>A pattern or
practice of compelling insured individuals or their beneficiaries to institute
suits to recover amounts due under its policies by offering substantially less
than the amounts ultimately recovered in suits brought by them.</text>
</subparagraph><subparagraph id="H32D2126367BC49B2AC72632F263D85E0"><enum>(H)</enum><text>A pattern or
practice of attempting to settle or settling claims for less than the amount
that a reasonable person would believe the insured individual or his or her
beneficiary was entitled by reference to written or printed advertising
material accompanying or made part of an application.</text>
</subparagraph><subparagraph id="HCB40D5C03278450CA3CF6230366F7CAF"><enum>(I)</enum><text>Attempting to
settle or settling claims on the basis of an application that was materially
altered without notice to, or knowledge or consent of, the insured.</text>
</subparagraph><subparagraph id="HF8025D479BC84FC6AC53F86D673E006B"><enum>(J)</enum><text>Failing to provide
forms necessary to present claims within 15 calendar days of a requests with
reasonable explanations regarding their use.</text>
</subparagraph><subparagraph id="H011644052CA54E609F2DBD6B20BD4C38"><enum>(K)</enum><text>Attempting to
cancel a policy in less time than that prescribed in the policy or by the law
of the primary State.</text>
</subparagraph></paragraph><paragraph id="HBD99DDEDF02B4E708626387CF685104B"><enum>(10)</enum><header>Fraud and
abuse</header><text>The term <term>fraud and abuse</term> means an act or
omission committed by a person who, knowingly and with intent to defraud,
commits, or conceals any material information concerning, one or more of the
following:</text>
<subparagraph id="HE2D51FF361FF42F0894880B44CC84AFB"><enum>(A)</enum><text>Presenting,
causing to be presented or preparing with knowledge or belief that it will be
presented to or by an insurer, a reinsurer, broker or its agent, false
information as part of, in support of or concerning a fact material to one or
more of the following:</text>
<clause id="H95D756892F8949889ED02BE0787BAF48"><enum>(i)</enum><text>An
application for the issuance or renewal of an insurance policy or reinsurance
contract.</text>
</clause><clause id="H931E9D79D18D4CF0A97FD6EED9541A7B"><enum>(ii)</enum><text>The rating of an
insurance policy or reinsurance contract.</text>
</clause><clause id="H6F9682C684D64A6DBE8C3CF1905B3389"><enum>(iii)</enum><text>A claim for
payment or benefit pursuant to an insurance policy or reinsurance
contract.</text>
</clause><clause id="HECC5569D820E4E9F8454B7C1D067BA5A"><enum>(iv)</enum><text>Premiums paid on
an insurance policy or reinsurance contract.</text>
</clause><clause id="HB7BCD9DCCA0A45A88BB9BD63C3464AD5"><enum>(v)</enum><text>Payments made in
accordance with the terms of an insurance policy or reinsurance
contract.</text>
</clause><clause id="H49517857F0484878BA7833222E64F66B"><enum>(vi)</enum><text>A
document filed with the commissioner or the chief insurance regulatory official
of another jurisdiction.</text>
</clause><clause id="H0E0BBE062ED04758B854A296D11FD356"><enum>(vii)</enum><text>The financial
condition of an insurer or reinsurer.</text>
</clause><clause id="H9677B6D7B165466B86C94FFF1D6C6FE3"><enum>(viii)</enum><text>The formation,
acquisition, merger, reconsolidation, dissolution or withdrawal from one or
more lines of insurance or reinsurance in all or part of a State by an insurer
or reinsurer.</text>
</clause><clause id="H7524572309BB453CB4CB40C2BCEA9DB1"><enum>(ix)</enum><text>The issuance of
written evidence of insurance.</text>
</clause><clause id="H4686EA7D0AF646788920B3800E371BCD"><enum>(x)</enum><text>The reinstatement
of an insurance policy.</text>
</clause></subparagraph><subparagraph id="H42821BE4A642439E905FB3BD63FBDFCD"><enum>(B)</enum><text>Solicitation or
acceptance of new or renewal insurance risks on behalf of an insurer reinsurer
or other person engaged in the business of insurance by a person who knows or
should know that the insurer or other person responsible for the risk is
insolvent at the time of the transaction.</text>
</subparagraph><subparagraph id="H59D78D1CFDE94BC2AEA1ABDB92D769EC"><enum>(C)</enum><text>Transaction of the
business of insurance in violation of laws requiring a license, certificate of
authority or other legal authority for the transaction of the business of
insurance.</text>
</subparagraph><subparagraph id="H0F20838C62B0461084E35BDCE28D6334"><enum>(D)</enum><text>Attempt to commit,
aiding or abetting in the commission of, or conspiracy to commit the acts or
omissions specified in this paragraph.</text>
</subparagraph></paragraph></section><section id="H36ADCBF5D48F4A2EAF2A0898DF31B2AA"><enum>2796.</enum><header>Application of
law</header>
<subsection id="HA34EF35DF4D04189B724D05C26132310"><enum>(a)</enum><header>In
general</header><text>The covered laws of the primary State shall apply to
individual health insurance coverage offered by a health insurance issuer in
the primary State and in any secondary State, but only if the coverage and
issuer comply with the conditions of this section with respect to the offering
of coverage in any secondary State.</text>
</subsection><subsection id="H93E76DA946114571A696ED4DA11821A9"><enum>(b)</enum><header>Exemptions from
covered laws in a secondary State</header><text>Except as provided in this
section, a health insurance issuer with respect to its offer, sale, rating
(including medical underwriting), renewal, and issuance of individual health
insurance coverage in any secondary State is exempt from any covered laws of
the secondary State (and any rules, regulations, agreements, or orders sought
or issued by such State under or related to such covered laws) to the extent
that such laws would—</text>
<paragraph id="H56D205DB19B5478CB4728B676D8C0695"><enum>(1)</enum><text>make unlawful, or
regulate, directly or indirectly, the operation of the health insurance issuer
operating in the secondary State, except that any secondary State may require
such an issuer—</text>
<subparagraph id="H44532AC3FAF24F3C9A9560E7C563060F"><enum>(A)</enum><text>to pay, on a
nondiscriminatory basis, applicable premium and other taxes (including high
risk pool assessments) which are levied on insurers and surplus lines insurers,
brokers, or policyholders under the laws of the State;</text>
</subparagraph><subparagraph id="H3AC0B6F552A04F70B8E7439A83197FE1"><enum>(B)</enum><text>to register with
and designate the State insurance commissioner as its agent solely for the
purpose of receiving service of legal documents or process;</text>
</subparagraph><subparagraph id="HBB3B4B4A9AA74A0CB466436B4816FDD8"><enum>(C)</enum><text>to submit to an
examination of its financial condition by the State insurance commissioner in
any State in which the issuer is doing business to determine the issuer’s
financial condition, if—</text>
<clause id="H0ED6DCA4A0904F88A470F859FE5AC3EF"><enum>(i)</enum><text>the State
insurance commissioner of the primary State has not done an examination within
the period recommended by the National Association of Insurance Commissioners;
and</text>
</clause><clause id="H5D6BA03E1B74423D91F35BB49661225D"><enum>(ii)</enum><text>any such
examination is conducted in accordance with the examiners’ handbook of the
National Association of Insurance Commissioners and is coordinated to avoid
unjustified duplication and unjustified repetition;</text>
</clause></subparagraph><subparagraph id="HE350E81ADB874F768333ECE00DE04B34"><enum>(D)</enum><text>to comply with a
lawful order issued—</text>
<clause id="H8F4ED7ECD1CA407A9545F239E03463C0"><enum>(i)</enum><text>in
a delinquency proceeding commenced by the State insurance commissioner if there
has been a finding of financial impairment under subparagraph (C); or</text>
</clause><clause id="HA085ABB78FC14FCF9F70A0A5C24DC74A"><enum>(ii)</enum><text>in a voluntary
dissolution proceeding;</text>
</clause></subparagraph><subparagraph id="H263AC745A6D44111878178DFD7DBB7BB"><enum>(E)</enum><text>to comply with an
injunction issued by a court of competent jurisdiction, upon a petition by the
State insurance commissioner alleging that the issuer is in hazardous financial
condition;</text>
</subparagraph><subparagraph id="H090329EC448D4CFB9AC9DF5073BDC5C6"><enum>(F)</enum><text>to participate, on
a nondiscriminatory basis, in any insurance insolvency guaranty association or
similar association to which a health insurance issuer in the State is required
to belong;</text>
</subparagraph><subparagraph id="HF57E3BE6458D43F1A14C1699A61B4258"><enum>(G)</enum><text>to comply with any
State law regarding fraud and abuse (as defined in section 2795(10)), except
that if the State seeks an injunction regarding the conduct described in this
subparagraph, such injunction must be obtained from a court of competent
jurisdiction;</text>
</subparagraph><subparagraph id="H5DD814C1EA2C41E1AFB4858C2C80B8AE"><enum>(H)</enum><text>to comply with any
State law regarding unfair claims settlement practices (as defined in section
2795(9)); or</text>
</subparagraph><subparagraph id="HD02B744340C649B48DF1ECA8EA518A89"><enum>(I)</enum><text>to comply with the
applicable requirements for independent review under section 2798 with respect
to coverage offered in the State;</text>
</subparagraph></paragraph><paragraph id="HD0EFCF2221DE45D6BFD99DBC639CD96D"><enum>(2)</enum><text>require any
individual health insurance coverage issued by the issuer to be countersigned
by an insurance agent or broker residing in that Secondary State; or</text>
</paragraph><paragraph id="H77FA37B4D9A447999DFD5C5497A4CE30"><enum>(3)</enum><text>otherwise
discriminate against the issuer issuing insurance in both the primary State and
in any secondary State.</text>
</paragraph></subsection><subsection id="H525172B8F7CA4C809C2611C6B0A7EE97"><enum>(c)</enum><header>Clear and
conspicuous disclosure</header><text>A health insurance issuer shall provide
the following notice, in 12-point bold type, in any insurance coverage offered
in a secondary State under this part by such a health insurance issuer and at
renewal of the policy, with the 5 blank spaces therein being appropriately
filled with the name of the health insurance issuer, the name of primary State,
the name of the secondary State, the name of the secondary State, and the name
of the secondary State, respectively, for the coverage concerned:</text>
<list level="paragraph">
<list-item>Notice</list-item>
<list-item><quote>This policy is issued by XXXXX and is
governed by the laws and regulations of the State of XXXXX, and it has met all
the laws of that State as determined by that State’s Department of Insurance.
This policy may be less expensive than others because it is not subject to all
of the insurance laws and regulations of the State of XXXXX, including coverage
of some services or benefits mandated by the law of the State of XXXXX.
Additionally, this policy is not subject to all of the consumer protection laws
or restrictions on rate changes of the State of XXXXX. As with all insurance
products, before purchasing this policy, you should carefully review the policy
and determine what health care services the policy covers and what benefits it
provides, including any exclusions, limitations, or conditions for such
services or benefits.</quote>.</list-item></list>
</subsection><subsection id="HB46F3926438744629788D0508F9AB657"><enum>(d)</enum><header>Prohibition on
certain reclassifications and premium increases</header>
<paragraph id="H93F69FAEE7A14F129F2D663CB15B7471"><enum>(1)</enum><header>In
general</header><text>For purposes of this section, a health insurance issuer
that provides individual health insurance coverage to an individual under this
part in a primary or secondary State may not upon renewal—</text>
<subparagraph id="H22B68889E6774A69B55800441233B6F1"><enum>(A)</enum><text>move or reclassify
the individual insured under the health insurance coverage from the class such
individual is in at the time of issue of the contract based on the
health-status related factors of the individual; or</text>
</subparagraph><subparagraph id="HF3DDD0F0B0D94C10AB88C19325264108"><enum>(B)</enum><text>increase the
premiums assessed the individual for such coverage based on a health
status-related factor or change of a health status-related factor or the past
or prospective claim experience of the insured individual.</text>
</subparagraph></paragraph><paragraph id="HF186B8C1A8424011B8CF66EAE62F9331"><enum>(2)</enum><header>Construction</header><text>Nothing
in paragraph (1) shall be construed to prohibit a health insurance
issuer—</text>
<subparagraph id="H4B98FD6F271641C5B1FDD3E92AE14227"><enum>(A)</enum><text>from terminating
or discontinuing coverage or a class of coverage in accordance with subsections
(b) and (c) of section 2742;</text>
</subparagraph><subparagraph id="H465BFE00BAD64F42A75D7A9AA14DCEC3"><enum>(B)</enum><text>from raising
premium rates for all policy holders within a class based on claims
experience;</text>
</subparagraph><subparagraph id="HB1C758052BAA4AD5BDDA0B9AE22FA53A"><enum>(C)</enum><text>from changing
premiums or offering discounted premiums to individuals who engage in wellness
activities at intervals prescribed by the issuer, if such premium changes or
incentives—</text>
<clause id="HBE68296DB7DE47F69DF57408C635F11E"><enum>(i)</enum><text>are disclosed to
the consumer in the insurance contract;</text>
</clause><clause id="H7AB7274FB9F24F26A547C2F8D0CC5DC4"><enum>(ii)</enum><text>are based on
specific wellness activities that are not applicable to all individuals;
and</text>
</clause><clause id="HE389BD8A5076412895050BEAE40E1968"><enum>(iii)</enum><text>are not
obtainable by all individuals to whom coverage is offered;</text>
</clause></subparagraph><subparagraph id="HEE02A42BA8D24D69BB8BEABEB8E05E0B"><enum>(D)</enum><text>from reinstating
lapsed coverage; or</text>
</subparagraph><subparagraph id="H486DC0A11D044CB4B34A384ACCB375F6"><enum>(E)</enum><text>from retroactively
adjusting the rates charged an insured individual if the initial rates were set
based on material misrepresentation by the individual at the time of
issue.</text>
</subparagraph></paragraph></subsection><subsection id="H9BC649E403F546589FB772ED9C8ED156"><enum>(e)</enum><header>Prior offering
of policy in primary State</header><text>A health insurance issuer may not
offer for sale individual health insurance coverage in a secondary State unless
that coverage is currently offered for sale in the primary State.</text>
</subsection><subsection id="HBB651318A18B434796D6435570003C43"><enum>(f)</enum><header>Licensing of
agents or brokers for health insurance issuers</header><text>Any State may
require that a person acting, or offering to act, as an agent or broker for a
health insurance issuer with respect to the offering of individual health
insurance coverage obtain a license from that State, with commissions or other
compensation subject to the provisions of the laws of that State, except that a
State may not impose any qualification or requirement which discriminates
against a nonresident agent or broker.</text>
</subsection><subsection id="HBD8CBE4A994E47FDAFF7F6A8C41E377E"><enum>(g)</enum><header>Documents for
submission to State insurance commissioner</header><text>Each health insurance
issuer issuing individual health insurance coverage in both primary and
secondary States shall submit—</text>
<paragraph id="H6779543C4610484B87EE48EE22220CA2"><enum>(1)</enum><text>to the insurance
commissioner of each State in which it intends to offer such coverage, before
it may offer individual health insurance coverage in such State—</text>
<subparagraph id="H3B18943E4DEF4BAF854D345E15E00245"><enum>(A)</enum><text>a copy of the plan
of operation or feasibility study or any similar statement of the policy being
offered and its coverage (which shall include the name of its primary State and
its principal place of business);</text>
</subparagraph><subparagraph id="HDA085D454BE44D64A48489EBE532C40B"><enum>(B)</enum><text>written notice of
any change in its designation of its primary State; and</text>
</subparagraph><subparagraph id="H9EBF03D212634A95B6194E07D5BAD49B"><enum>(C)</enum><text>written notice
from the issuer of the issuer’s compliance with all the laws of the primary
State; and</text>
</subparagraph></paragraph><paragraph id="HE52FBD0CD52B4960A82DE20FD782EF09"><enum>(2)</enum><text>to the insurance
commissioner of each secondary State in which it offers individual health
insurance coverage, a copy of the issuer’s quarterly financial statement
submitted to the primary State, which statement shall be certified by an
independent public accountant and contain a statement of opinion on loss and
loss adjustment expense reserves made by—</text>
<subparagraph id="HD7D35791D00C4D3595DFBA3C54C3802B"><enum>(A)</enum><text>a member of the
American Academy of Actuaries; or</text>
</subparagraph><subparagraph id="H4C192A7E344E4FEEB8D454A3446E52F6"><enum>(B)</enum><text>a qualified loss
reserve specialist.</text>
</subparagraph></paragraph></subsection><subsection id="HFB7EAAB664164108BC8428D68D8803FB"><enum>(h)</enum><header>Power of courts
To enjoin conduct</header><text>Nothing in this section shall be construed to
affect the authority of any Federal or State court to enjoin—</text>
<paragraph id="H0CD3AEC01D0A4DCBB6837712B93DB98E"><enum>(1)</enum><text>the solicitation
or sale of individual health insurance coverage by a health insurance issuer to
any person or group who is not eligible for such insurance; or</text>
</paragraph><paragraph id="H67AF4906860D4A76BFCC7B302E31542A"><enum>(2)</enum><text>the solicitation
or sale of individual health insurance coverage that violates the requirements
of the law of a secondary State which are described in subparagraphs (A)
through (H) of section 2796(b)(1).</text>
</paragraph></subsection><subsection id="H225930CF3CC14F039F16F45DD7AB691C"><enum>(i)</enum><header>Power of
Secondary States To Take Administrative Action</header><text>Nothing in this
section shall be construed to affect the authority of any State to enjoin
conduct in violation of that State’s laws described in section
2796(b)(1).</text>
</subsection><subsection id="H5D53C29F61684114A364C7724B2C4F52"><enum>(j)</enum><header>State powers To
enforce State laws</header>
<paragraph id="HD9EF0992A5B9428AA34AAEF7FDCD9FD1"><enum>(1)</enum><header>In
general</header><text>Subject to the provisions of subsection (b)(1)(G)
(relating to injunctions) and paragraph (2), nothing in this section shall be
construed to affect the authority of any State to make use of any of its powers
to enforce the laws of such State with respect to which a health insurance
issuer is not exempt under subsection (b).</text>
</paragraph><paragraph id="H96CDD3F169824AA291CD3A98EFA4ADC7"><enum>(2)</enum><header>Courts of
competent jurisdiction</header><text>If a State seeks an injunction regarding
the conduct described in paragraphs (1) and (2) of subsection (h), such
injunction must be obtained from a Federal or State court of competent
jurisdiction.</text>
</paragraph></subsection><subsection id="HB64EE695706D4184BDC3175DA74AA80B"><enum>(k)</enum><header>States’
authority To sue</header><text>Nothing in this section shall affect the
authority of any State to bring action in any Federal or State court.</text>
</subsection><subsection id="H5394CEA52EB54468BD910AA6A26FE08F"><enum>(l)</enum><header>Generally
applicable laws</header><text>Nothing in this section shall be construed to
affect the applicability of State laws generally applicable to persons or
corporations.</text>
</subsection><subsection id="HD3CB0DA5AC9341788493521316CEFCDC"><enum>(m)</enum><header>Guaranteed
Availability of Coverage to HIPAA Eligible Individuals</header><text>To the
extent that a health insurance issuer is offering coverage in a primary State
that does not accommodate residents of secondary States or does not provide a
working mechanism for residents of a secondary State, and the issuer is
offering coverage under this part in such secondary State which has not adopted
a qualified high risk pool as its acceptable alternative mechanism (as defined
in section 2744(c)(2)), the issuer shall, with respect to any individual health
insurance coverage offered in a secondary State under this part, comply with
the guaranteed availability requirements for eligible individuals in section
2741.</text>
</subsection></section><section id="HAB55B3330BC54F7F934907F94516BAC0"><enum>2797.</enum><header>Primary State
must meet Federal floor before issuer may sell into secondary
States</header><text display-inline="no-display-inline">A health insurance
issuer may not offer, sell, or issue individual health insurance coverage in a
secondary State if the State insurance commissioner does not use a risk-based
capital formula for the determination of capital and surplus requirements for
all health insurance issuers.</text>
</section><section id="HB6040ACD68F6469F97529E9A992CB5C6"><enum>2798.</enum><header>Independent
external appeals procedures</header>
<subsection id="H13F11B283D644B21978752BF41175051"><enum>(a)</enum><header>Right to
External Appeal</header><text>A health insurance issuer may not offer, sell, or
issue individual health insurance coverage in a secondary State under the
provisions of this title unless—</text>
<paragraph id="HB796BDEA75B94C40999AE5BF11EF1267"><enum>(1)</enum><text>both the secondary
State and the primary State have legislation or regulations in place
establishing an independent review process for individuals who are covered by
individual health insurance coverage, or</text>
</paragraph><paragraph id="HE31A0020FB0B43A58E41B9AD0EC668CF"><enum>(2)</enum><text>in any case in
which the requirements of subparagraph (A) are not met with respect to the
either of such States, the issuer provides an independent review mechanism
substantially identical (as determined by the applicable State authority of
such State) to that prescribed in the <quote>Health Carrier External Review
Model Act</quote> of the National Association of Insurance Commissioners for
all individuals who purchase insurance coverage under the terms of this part,
except that, under such mechanism, the review is conducted by an independent
medical reviewer, or a panel of such reviewers, with respect to whom the
requirements of subsection (b) are met.</text>
</paragraph></subsection><subsection id="H66E6166F4C724D27949A4423FACD23F9"><enum>(b)</enum><header>Qualifications
of Independent Medical Reviewers</header><text>In the case of any independent
review mechanism referred to in subsection (a)(2)—</text>
<paragraph id="H2BA5BFA6FAE94F03912EDCC2D3D69B96"><enum>(1)</enum><header>In
general</header><text>In referring a denial of a claim to an independent
medical reviewer, or to any panel of such reviewers, to conduct independent
medical review, the issuer shall ensure that—</text>
<subparagraph id="H336175B3262446A6BF2660CEB12CABA7"><enum>(A)</enum><text>each independent
medical reviewer meets the qualifications described in paragraphs (2) and
(3);</text>
</subparagraph><subparagraph id="H6AA11256C45F4B1DA4540A2999C47EE4"><enum>(B)</enum><text>with respect to
each review, each reviewer meets the requirements of paragraph (4) and the
reviewer, or at least 1 reviewer on the panel, meets the requirements described
in paragraph (5); and</text>
</subparagraph><subparagraph id="H28543D00B4204F41B57848CDFD4A6734"><enum>(C)</enum><text>compensation
provided by the issuer to each reviewer is consistent with paragraph
(6).</text>
</subparagraph></paragraph><paragraph id="H897EB137CA414E3DA91E5AC7D2B080E4"><enum>(2)</enum><header>Licensure and
expertise</header><text>Each independent medical reviewer shall be a physician
(allopathic or osteopathic) or health care professional who—</text>
<subparagraph id="H595E563C22A14A90859DB70E6E0675D1"><enum>(A)</enum><text>is appropriately
credentialed or licensed in 1 or more States to deliver health care services;
and</text>
</subparagraph><subparagraph id="H599CB90E87844D0DAEAC854C80E0DA41"><enum>(B)</enum><text>typically treats
the condition, makes the diagnosis, or provides the type of treatment under
review.</text>
</subparagraph></paragraph><paragraph id="HC766AD3249E1460A9D84D99E07505256"><enum>(3)</enum><header>Independence</header>
<subparagraph id="H7FBF4A1132DC4FE4B7E82FEA61CB784B"><enum>(A)</enum><header>In
general</header><text>Subject to subparagraph (B), each independent medical
reviewer in a case shall—</text>
<clause id="HA55C5210DBC3442F8CFB7533AF148DDD"><enum>(i)</enum><text>not be a related
party (as defined in paragraph (7));</text>
</clause><clause id="H2307F79DD5FF4B9190C457A7B6053461"><enum>(ii)</enum><text>not have a
material familial, financial, or professional relationship with such a party;
and</text>
</clause><clause id="HD55AA0CFB6254058820F7EBB6664D5D0"><enum>(iii)</enum><text>not otherwise
have a conflict of interest with such a party (as determined under
regulations).</text>
</clause></subparagraph><subparagraph id="HDCE4C7348FAE45A48963FB97E1F55AEF"><enum>(B)</enum><header>Exception</header><text>Nothing
in subparagraph (A) shall be construed to—</text>
<clause id="H633F47DF56074B898C959AE467B77434"><enum>(i)</enum><text>prohibit an
individual, solely on the basis of affiliation with the issuer, from serving as
an independent medical reviewer if—</text>
<subclause id="HD1DA84ED090147358610EFA009DA7F5B"><enum>(I)</enum><text>a non-affiliated
individual is not reasonably available;</text>
</subclause><subclause id="H4C082F81EEEF42418F1DC0224B85BB3B"><enum>(II)</enum><text>the affiliated
individual is not involved in the provision of items or services in the case
under review;</text>
</subclause><subclause id="HE163EE832A75459181AFDEA0BB31CDCD"><enum>(III)</enum><text>the fact of such
an affiliation is disclosed to the issuer and the enrollee (or authorized
representative) and neither party objects; and</text>
</subclause><subclause id="H776FB09772E64EC0A8862DFD1D3CAE23"><enum>(IV)</enum><text>the affiliated
individual is not an employee of the issuer and does not provide services
exclusively or primarily to or on behalf of the issuer;</text>
</subclause></clause><clause id="HE6485AEFA85B4D0D8A768B99599930DC"><enum>(ii)</enum><text>prohibit an
individual who has staff privileges at the institution where the treatment
involved takes place from serving as an independent medical reviewer merely on
the basis of such affiliation if the affiliation is disclosed to the issuer and
the enrollee (or authorized representative), and neither party objects;
or</text>
</clause><clause id="H26491EF0A5564044BCF1FD9191B3C7D7"><enum>(iii)</enum><text>prohibit receipt
of compensation by an independent medical reviewer from an entity if the
compensation is provided consistent with paragraph (6).</text>
</clause></subparagraph></paragraph><paragraph id="H0C41264441874F58BED7DCB9F7DA0CEE"><enum>(4)</enum><header>Practicing
health care professional in same field</header>
<subparagraph id="HCF1690091CDF479E8C6BBF61DE28FFAC"><enum>(A)</enum><header>In
general</header><text>In a case involving treatment, or the provision of items
or services—</text>
<clause id="HD86AD937452E4E58826AC74C0FC285B0"><enum>(i)</enum><text>by
a physician, a reviewer shall be a practicing physician (allopathic or
osteopathic) of the same or similar specialty, as a physician who, acting
within the appropriate scope of practice within the State in which the service
is provided or rendered, typically treats the condition, makes the diagnosis,
or provides the type of treatment under review; or</text>
</clause><clause id="HCDFB27985E57464C829D8FBBABFA3B8A"><enum>(ii)</enum><text>by a
non-physician health care professional, the reviewer, or at least 1 member of
the review panel, shall be a practicing non-physician health care professional
of the same or similar specialty as the non-physician health care professional
who, acting within the appropriate scope of practice within the State in which
the service is provided or rendered, typically treats the condition, makes the
diagnosis, or provides the type of treatment under review.</text>
</clause></subparagraph><subparagraph id="H12608896817D49A5AA9DEFB03BAE7A62"><enum>(B)</enum><header>Practicing
defined</header><text>For purposes of this paragraph, the term
<term>practicing</term> means, with respect to an individual who is a physician
or other health care professional, that the individual provides health care
services to individual patients on average at least 2 days per week.</text>
</subparagraph></paragraph><paragraph id="H23543238622A4E4A96E485DCB7BB042C"><enum>(5)</enum><header>Pediatric
expertise</header><text>In the case of an external review relating to a child,
a reviewer shall have expertise under paragraph (2) in pediatrics.</text>
</paragraph><paragraph id="H8E2699EE99964CF586AA576F78901678"><enum>(6)</enum><header>Limitations on
reviewer compensation</header><text>Compensation provided by the issuer to an
independent medical reviewer in connection with a review under this section
shall—</text>
<subparagraph id="H430B1AFE2C994C2B88467BD54D4B7168"><enum>(A)</enum><text>not exceed a
reasonable level; and</text>
</subparagraph><subparagraph id="H0F15F120CC554A118CD2FAAC266F2F4C"><enum>(B)</enum><text>not be contingent
on the decision rendered by the reviewer.</text>
</subparagraph></paragraph><paragraph id="H6B32C4998934428CBE5004CD97CDDECA"><enum>(7)</enum><header>Related party
defined</header><text>For purposes of this section, the term <term>related
party</term> means, with respect to a denial of a claim under a coverage
relating to an enrollee, any of the following:</text>
<subparagraph id="H902EE8C5F45F4764BCF854FD79F9BAAC"><enum>(A)</enum><text>The issuer
involved, or any fiduciary, officer, director, or employee of the
issuer.</text>
</subparagraph><subparagraph id="HE440534025AC4426B449F2CDCA6309D3"><enum>(B)</enum><text>The enrollee (or
authorized representative).</text>
</subparagraph><subparagraph id="HEA864B0FF05C42D18099E7E38117DCF0"><enum>(C)</enum><text>The health care
professional that provides the items or services involved in the denial.</text>
</subparagraph><subparagraph id="H7371B73D646C44458BFEE6CF5B4B5491"><enum>(D)</enum><text>The institution at
which the items or services (or treatment) involved in the denial are
provided.</text>
</subparagraph><subparagraph id="H815832FFDD4946C3AD7EEA75411E8980"><enum>(E)</enum><text>The manufacturer
of any drug or other item that is included in the items or services involved in
the denial.</text>
</subparagraph><subparagraph id="H22D22A26E31C42B9B0B95C58B2E827E5"><enum>(F)</enum><text>Any other party
determined under any regulations to have a substantial interest in the denial
involved.</text>
</subparagraph></paragraph><paragraph id="H3F0D41771AA54B1CBA1514CCB6A0D198"><enum>(8)</enum><header>Definitions</header><text>For
purposes of this subsection:</text>
<subparagraph id="H0226453B43784C53922FF39669C3C69F"><enum>(A)</enum><header>Enrollee</header><text>The
term <term>enrollee</term> means, with respect to health insurance coverage
offered by a health insurance issuer, an individual enrolled with the issuer to
receive such coverage.</text>
</subparagraph><subparagraph id="HEA59DED3FE1E4325A2EE11C5022F40A6"><enum>(B)</enum><header>Health care
professional</header><text>The term <term>health care professional</term> means
an individual who is licensed, accredited, or certified under State law to
provide specified health care services and who is operating within the scope of
such licensure, accreditation, or certification.</text>
</subparagraph></paragraph></subsection></section><section id="H57D1E4DB3B064C019267140FF0F558D2"><enum>2799.</enum><header>ENFORCEMENT</header>
<subsection id="H540BFBC7A4534D44B5C277B843867F2F"><enum>(a)</enum><header>In
general</header><text>Subject to subsection (b), with respect to specific
individual health insurance coverage the primary State for such coverage has
sole jurisdiction to enforce the primary State’s covered laws in the primary
State and any secondary State.</text>
</subsection><subsection id="H2D2E2FED34B94EB2BB8F1F3DDCA13D31"><enum>(b)</enum><header>Secondary
State’s authority</header><text>Nothing in subsection (a) shall be construed to
affect the authority of a secondary State to enforce its laws as set forth in
the exception specified in section 2796(b)(1).</text>
</subsection><subsection id="HEB2E2EC4EA224A1EBBCE14ADDB65AD70"><enum>(c)</enum><header>Court
interpretation</header><text>In reviewing action initiated by the applicable
secondary State authority, the court of competent jurisdiction shall apply the
covered laws of the primary State.</text>
</subsection><subsection id="H9D7763B7A03D49EEA016A6A72FFD9E0B"><enum>(d)</enum><header>Notice of
compliance failure</header><text>In the case of individual health insurance
coverage offered in a secondary State that fails to comply with the covered
laws of the primary State, the applicable State authority of the secondary
State may notify the applicable State authority of the primary
State.</text>
</subsection></section></part><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HEFB45E1027F74B569F230B6B7F82C62E"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall apply to
individual health insurance coverage offered, issued, or sold after the date
that is one year after the date of the enactment of this subtitle.</text>
</subsection><subsection id="H325E8153184B4FB29276D0CBE700F4FE"><enum>(c)</enum><header>GAO Ongoing
Study and Reports</header>
<paragraph id="H5876227E3846429F8088CC9DA6FC6D24"><enum>(1)</enum><header>Study</header><text>The
Comptroller General of the United States shall conduct an ongoing study
concerning the effect of the amendment made by subsection (a) on—</text>
<subparagraph id="H80F03DD331494F04A0287FCD3263B86E"><enum>(A)</enum><text>the number of
uninsured and under-insured;</text>
</subparagraph><subparagraph id="H87A5D1BAB6C8432A88B89466454DCD5B"><enum>(B)</enum><text>the availability
and cost of health insurance policies for individuals with pre-existing medical
conditions;</text>
</subparagraph><subparagraph id="HDC954A9B528148BA84C7B4915C04D22E"><enum>(C)</enum><text>the availability
and cost of health insurance policies generally;</text>
</subparagraph><subparagraph id="H390B6E555D6B4181B7A6BBD4F274ABE5"><enum>(D)</enum><text>the elimination or
reduction of different types of benefits under health insurance policies
offered in different States; and</text>
</subparagraph><subparagraph id="HD217ED7C03ED49D3B86AFA65C97440B7"><enum>(E)</enum><text>cases of fraud or
abuse relating to health insurance coverage offered under such amendment and
the resolution of such cases.</text>
</subparagraph></paragraph><paragraph id="H1A960C6333484C17865468F349C5F152"><enum>(2)</enum><header>Annual
reports</header><text>The Comptroller General shall submit to Congress an
annual report, after the end of each of the 5 years following the effective
date of the amendment made by subsection (a), on the ongoing study conducted
under paragraph (1).</text>
</paragraph></subsection></section><section id="H8196C870499F447F8EE0FA262263A30F"><enum>314.</enum><header>Severability</header><text display-inline="no-display-inline">If any provision of the Act or the
application of such provision to any person or circumstance is held to be
unconstitutional, the remainder of this subtitle and the application of the
provisions of such to any other person or circumstance shall not be
affected.</text>
</section></subtitle><subtitle id="HA4A1368690894D72A9A53CFBD98D0BC0"><enum>C</enum><header>Young Adult
Healthcare Coverage</header>
<section id="HAAD49213EDAC435694FDDFA31280AE3F" section-type="subsequent-section"><enum>321.</enum><header>Requiring the option
of extension of dependent coverage for certain unmarried, uninsured young
adults</header>
<subsection id="H88C9E57A1AF84789B64D43AA37EDE619"><enum>(a)</enum><header>Under group
health plans</header>
<paragraph id="HDE9ABDD4B3FC4C58875ACEE7E701CC94"><enum>(1)</enum><header>Employee
Retirement Income Security Act of 1974 amendments</header>
<subparagraph id="H2CC106B6B3FC470193B92EA6871BDBB1"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">The Employee
Retirement Income Security Act of 1974 is amended by inserting after section
703 the following new section:</text>
<quoted-block display-inline="no-display-inline" id="H714A8FAA3D664C1BBB53E5974BDA5B62" style="OLC">
<section id="H55E0FD3B19DF41BBB3E6B349E919AFC6"><enum>704.</enum><header>Requiring the
option of extension of dependent coverage for certain unmarried, uninsured
young adults</header>
<subsection id="H35A9CF3D265D4AE080BB9D8BE10AE292"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">A group health plan
and a health insurance issuer offering health insurance coverage in connection
with a group health plan that provides coverage for dependent children shall
make available such coverage, at the option of the participant involved, for
one or more qualified children (as defined in subsection (b)) of the
participant.</text>
</subsection><subsection id="HD7D837954113471EACF3583E1262B798"><enum>(b)</enum><header>Qualified child
defined</header><text>In this section, the term <term>qualified child</term>
means, with respect to a participant in a group health plan or group health
insurance coverage, an individual who (but for age) would be treated as a
dependent child of the participant under such plan or coverage and who—</text>
<paragraph id="HC36DC0FA841F4402862CCECDDAAE46F1"><enum>(1)</enum><text>is under 26 years
of age;</text>
</paragraph><paragraph id="H285219777F544BA1917C8800E544A3C7"><enum>(2)</enum><text display-inline="yes-display-inline">is not married;</text>
</paragraph><paragraph id="HD50F328C74334A79AD3832F0E9ACCC3C"><enum>(3)</enum><text>has no
dependents;</text>
</paragraph><paragraph id="HEA8A290711974F82A15405632886DC14"><enum>(4)</enum><text>is a citizen or
national of the United States; and</text>
</paragraph><paragraph id="H429D8286E3774E4C82BDA551581D9FF1"><enum>(5)</enum><text>is not provided
coverage as a participant, beneficiary, or enrollee (other than under this
section) under any other creditable coverage (as defined in section
701(c)(1)).</text>
</paragraph></subsection><subsection id="HD33A8858EB004983853B394DF3204827"><enum>(c)</enum><header>Premiums</header><text>Nothing
in this section shall be construed as preventing a group health plan or health
insurance issuer with respect to group health insurance coverage from
increasing the premiums otherwise required for coverage provided under this
section.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="HA610DB5F82174F6C9C15831B50086AA6"><enum>(B)</enum><header>Clerical
amendment</header><text>The table of contents of such Act is amended by
inserting after the item relating to section 703 the following new item:</text>
<quoted-block display-inline="no-display-inline" id="HC6E5356B0EEA438195B42573198D5A29" style="OLC">
<toc regeneration="no-regeneration">
<toc-entry level="section">704. Requiring the option of extension of
dependent coverage for certain unmarried young
adults.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H86AB0DF33CD744B79EBCFDDE822C69BA"><enum>(2)</enum><header>PHSA</header><text>Title
XXVII of the Public Health Service Act is amended by inserting after section
2702 the following new section:</text>
<quoted-block display-inline="no-display-inline" id="H0A82C6033B2E4984B112129CFA6B2885" style="OLC">
<section id="HC3A3F5B9A2614668B19ABC4F998DC425"><enum>2703.</enum><header>Requiring the
option of extension of dependent coverage for certain unmarried, uninsured
young adults</header><text display-inline="no-display-inline">The provisions of
section 704 of the Employee Retirement Income Security Act of 1974 shall apply
to health insurance coverage offered by a health insurance issuer in the
individual market in the same manner as they apply to health insurance coverage
offered by a health insurance issuer in connection with a group health plan in
the small or large group
market.</text>
</section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HFDBCC78C8CC743A7A6E4DD99497C05F1"><enum>(b)</enum><header>Individual
health insurance coverage</header><text>Title XXVII of the Public Health
Service Act is amended by inserting after section 2745 the following new
section:</text>
<quoted-block display-inline="no-display-inline" id="HA934B55BB1884B69A771A0C15807B364" style="OLC">
<section id="H3D7988D97A3F4CC7B92CEF147B0A865F"><enum>2746.</enum><header>Requiring the
option of extension of dependent coverage for certain unmarried young
adults</header><text display-inline="no-display-inline">The provisions of
section 2703 shall apply to health insurance coverage offered by a health
insurance issuer in the individual market in the same manner as they apply to
health insurance coverage offered by a health insurance issuer in connection
with a group health plan in the small or large group
market.</text>
</section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H4C912E5C2555401C89188320DF9B8EA9"><enum>(c)</enum><header>Effective
dates</header>
<paragraph id="H7FA515F8A7CB4F52AA98BF85B1804602"><enum>(1)</enum><header>Group health
plans</header>
<subparagraph id="HDAE5CE150EB84D7BBAF66A3E2180977A"><enum>(A)</enum><header>In
general</header><text>The amendments made by subsection (a) shall apply to
group health plans for plan years beginning on or after the date that is 90
days after the date of enactment of this Act.</text>
</subparagraph><subparagraph id="H0A3A7214EBEA44CAABAD613B179588E4"><enum>(B)</enum><header>Special rule for
collective bargaining agreements</header><text>In the case of a group health
plan maintained pursuant to 1 or more collective bargaining agreements between
employee representatives and 1 or more employers, any plan amendment made
pursuant to a collective bargaining agreement relating to the plan which amends
the plan solely to conform to any requirement added by an amendment made by
subsection (a) shall not be treated as a termination of such collective
bargaining agreement.</text>
</subparagraph></paragraph><paragraph id="H18F0827202E54A5696C5DFBDD15CB6D3"><enum>(2)</enum><header>Individual
health insurance coverage</header><text display-inline="yes-display-inline">Section 2746 of the Public Health Service
Act, as inserted by subsection (b), shall apply with respect to health
insurance coverage offered, sold, issued, renewed, in effect, or operated in
the individual market after the first day of the first month that begins more
than 90 days after the date of the enactment of this Act.</text>
</paragraph></subsection></section></subtitle><enum>IV</enum><header>Offsets</header>
<section commented="no" id="H0119270A8D66484C8B640326799FB5C0"><enum>401.</enum><header>Transfer of
unobilgated stimulus funds</header>
<subsection commented="no" id="H23E0141FFFBA476C81CA0E547D8D3C89"><enum>(a)</enum><header>Rescission</header><text>Effective
on the date of the enactment of this Act, any unobligated balances available on
such date of funds made available by division A of the American Recovery and
Reinvestment Act of 2009 (Public Law 111–5), other than under the heading
<quote>Federal Highway Administration-Highway Infrastructure Investment</quote>
in title XII of such division, are rescinded and such provisions are
repealed.</text>
</subsection><subsection commented="no" id="H0FBD624C666547129DCB7219401FAFD6"><enum>(b)</enum><header>Repeal</header><text>The
provisions of division B of the American Recovery and Reinvestment Act of 2009
(Public Law 111–5), other than titles I and II of such division are
repealed.</text>
</subsection><subsection commented="no" id="HAEDF11C00EEC488BB6F596F2A4B74A22"><enum>(c)</enum><header>Transfer of
funds</header><text>The total amount rescinded by this section shall be
deposited in the Federal Treasury.</text>
</subsection></section>