<enum>I</enum><header>Physician Payment
Update Commission</header>
<section id="S1" section-type="section-one"><enum>1.</enum><header>Short
title</header><text display-inline="no-display-inline">This title may be cited
as the <quote><short-title>Physician Payment Update
Commission Act</short-title></quote>.</text>
</section><section id="ID522301C657484C14A8409FAC789E3C2B"><enum>2.</enum><header>Establishment of
Physician Payment Update Commission</header>
<subsection id="IDFF26917619E146A894A6DDD0521C8CC3"><enum>(a)</enum><header>Medicare
Physician Fee Schedule Update and sunset of Medicare sustainable growth rate
formula</header>
<paragraph id="idDA7EEA7E87E74088846EA6AFCBC33B3A"><enum>(1)</enum><header>Update for 2010
and 2011</header><text>Section 1848(d)(10) of the Social Security Act (42
U.S.C. 1395w–4(d)(10)) is amended to read as follows:</text>
<quoted-block act-name="" id="idA5E27769EA294F098BD1E5119F9EDFBA" style="OLC">
<paragraph id="id97FFAF8D8B4A4A21B0F0B25F08801194"><enum>(10)</enum><header>Update for
2010 and 2011</header>
<subparagraph id="id1B2425C17143430F943FCBA888CE6AC2"><enum>(A)</enum><header>In
general</header><text>The update to the single conversion factor established in
paragraph (1)(C) for 2010 and 2011 shall be 0 percent.</text>
</subparagraph><subparagraph id="id3EEF79B2E988470497FD7EA780710196"><enum>(B)</enum><header>No effect on
computation of conversion factor for 2012 and subsequent
years</header><text>The conversion factor under this subsection shall be
computed under paragraph (1)(A) for 2012 and subsequent years as if
subparagraph (A) had never
applied.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="id9AA63625535D4AEFA50555D011D4488F"><enum>(2)</enum><header>Sunset of
Medicare sustainable growth rate formula</header><text>Effective January 1,
2012, subsection (f) of section 1848 of the Social Security Act (42 U.S.C.
1395w–4) is repealed.</text>
</paragraph></subsection><subsection id="id04D3AB3A42B5437AB22ECFCD0A1DA357"><enum>(b)</enum><header>Establishment
of Physician Payment Update Commission</header>
<paragraph id="id9895D684468247B98FF840489573BCE9"><enum>(1)</enum><header>In
general</header><text>There is established a commission to be known as the
<quote>Physician Payment Update Commission</quote> (referred to in this section
as the <quote>Commission</quote>).</text>
</paragraph><paragraph id="IDE66DED6B9FD448588D810E13AEF3D4FD"><enum>(2)</enum><header>Membership</header>
<subparagraph id="ID85686DDB8C2C416F8A8E7FAB7C30F02E"><enum>(A)</enum><header>Composition</header><text>The
Commission shall be composed of 17 members appointed by the Comptroller General
of the United States, upon the recommendation of the majority and minority
leaders of the Senate and the Speaker and minority leader of the House of
Representatives.</text>
</subparagraph><subparagraph id="IDB5942B77FDCE4CDB9FEC39AC096739C9"><enum>(B)</enum><header>Date of
Appointments</header><text>Members of the Commission shall be appointed not
later than 2 months after the date of enactment of this Act.</text>
</subparagraph></paragraph><paragraph id="idDA613BBAAFE84A3AB050E0B3784471B3"><enum>(3)</enum><header>Qualifications</header>
<subparagraph id="id8397F39930234EC7948BE37A5A745E85"><enum>(A)</enum><header>In
general</header><text>The membership of the Commission shall include
individuals with national recognition for their expertise in health finance and
economics, actuarial science, integrated delivery systems, allopathic and
osteopathic medicine and other areas of health services, and other related
fields, who provide a mix of different professionals, broad geographic
representation, and a balance between urban and rural representatives.</text>
</subparagraph><subparagraph id="id01CBC885A9984A20A7E6ABAF61204561"><enum>(B)</enum><header>Inclusion</header><text>The
members of the Commission shall include (but not be limited to) physicians and
other health professionals, employers, third-party payers, individuals skilled
in the conduct and interpretation of biomedical, health services, and health
economics research and technology assessment. Such membership shall also
include representatives of consumers and the elderly.</text>
</subparagraph><subparagraph id="idC380246A55E247529E33D4898E0B60EA"><enum>(C)</enum><header>Majority
physicians and other health professionals</header><text>Individuals who are
physicians or other health professionals shall constitute a majority of the
membership of the Commission.</text>
</subparagraph></paragraph><paragraph id="ID3273B8FC42DA4116888CF5C5B78C3EE2"><enum>(4)</enum><header>Term;
vacancies</header>
<subparagraph id="IDB24D11E1E20D4B2395171A2E56662091"><enum>(A)</enum><header>Term</header><text>A
member shall be appointed for the life of the Commission.</text>
</subparagraph><subparagraph id="IDF9EBBD586A6D43A2814C9D7D8FAF76A8"><enum>(B)</enum><header>Vacancies</header><text>A
vacancy on the Commission—</text>
<clause id="IDA9631872155B4CE58B499962B1D0217B"><enum>(i)</enum><text>shall not affect
the powers of the Commission; and</text>
</clause><clause id="ID22AE9E5E9568490B908023D1C2BCBD2E"><enum>(ii)</enum><text>shall be filled
in the same manner as the original appointment was made.</text>
</clause></subparagraph></paragraph><paragraph id="IDD209FD1ED0F9443ABD8B94A9D757B60B"><enum>(5)</enum><header>Meetings</header><text>The
Commission shall meet at the call of the Chairperson.</text>
</paragraph><paragraph id="IDFA8C485DEF7E44919228ECD7C7403119"><enum>(6)</enum><header>Quorum</header><text>A
majority of the members of the Commission shall constitute a quorum, but a
lesser number of members may hold hearings.</text>
</paragraph><paragraph id="ID1E82C49D916F4B068A2D96CD14B3CCEF"><enum>(7)</enum><header>Chairperson</header><text>The
Comptroller General shall designate a member of the Commission, at the time of
the appointment of the member, as Chairperson.</text>
</paragraph></subsection><subsection id="IDB7C043BB83214712B28C0E9FD1A77847"><enum>(c)</enum><header>Duties</header>
<paragraph id="ID28ABCDCE8A0F46EC8107C8B841C9DFCD"><enum>(1)</enum><header>Study</header><text>The
Commission shall conduct a study of all matters relating to payment rates under
the Medicare physician fee schedule under section 1848 of the Social Security
Act (42 U.S.C. 1395w–4).</text>
</paragraph><paragraph id="IDB0884C8E282242119A7C1045E27AC0A2"><enum>(2)</enum><header>Recommendations</header><text>The
Commission shall develop recommendations on the establishment of a new
physician payment system under the Medicare program that would appropriately
reimburse physicians by keeping pace with increases in medical practice costs
and providing stable, positive Medicare updates.</text>
</paragraph><paragraph id="ID7D240A7538A64ACD9B6004A70C5C8C19"><enum>(3)</enum><header>Report</header><text>Not
later than December 1, 2010, the Commission shall submit to the appropriate
Committees of Congress and the Medicare Payment Advisory Commission—</text>
<subparagraph id="IDEA7E4F851EB14AF1AA932D540CE1EE33"><enum>(A)</enum><text>a detailed
statement of the findings and conclusions of the Commission;</text>
</subparagraph><subparagraph id="ID3ADFC9E9908547549EE8AC7CAB05C161"><enum>(B)</enum><text>the
recommendations of the Commission for such legislation and administrative
actions as the Commission considers appropriate (including proposed legislative
language to carry out such recommendations); and</text>
</subparagraph><subparagraph id="id75762DFFB10247D3AA3E6126A2B8B9BA"><enum>(C)</enum><text>a long-term CBO
cost estimate regarding such recommendations (as described under subsection
(i)).</text>
</subparagraph></paragraph></subsection><subsection id="IDF07ACC39769C491DB68AA3328182CA9D"><enum>(d)</enum><header>Powers</header>
<paragraph id="ID1618657E01794A3CBD30B1CA7C721E46"><enum>(1)</enum><header>Hearings</header><text>The
Commission may hold such hearings, meet and act at such times and places, take
such testimony, and receive such evidence as the Commission considers advisable
to carry out this section.</text>
</paragraph><paragraph id="ID9F2DFF4FD67B4848850FB6A9D5163A41"><enum>(2)</enum><header>Information
from Federal agencies</header>
<subparagraph id="IDC441D234895B4B08BF9511974F6BE278"><enum>(A)</enum><header>In
general</header><text>The Commission may secure directly from a Federal agency
such information as the Commission considers necessary to carry out this
section.</text>
</subparagraph><subparagraph id="IDAD56F68235BE45E78F03E5540FE7301A"><enum>(B)</enum><header>Provision of
information</header><text>On request of the Chairperson of the Commission, the
head of the agency shall provide the information to the Commission.</text>
</subparagraph></paragraph><paragraph id="ID628DFFD3FCE443AFBBA043B8634B7263"><enum>(3)</enum><header>Postal
services</header><text>The Commission may use the United States mails in the
same manner and under the same conditions as other agencies of the Federal
Government.</text>
</paragraph></subsection><subsection id="IDCF2AFC6016204C4992172D7E1050ACA9"><enum>(e)</enum><header>Commission
personnel matters</header>
<paragraph id="ID40CD19C2755743E0A877328695537261"><enum>(1)</enum><header>Compensation of
members</header>
<subparagraph id="id5ED4E29C99FF4D0E99B5FCF9343F6495"><enum>(A)</enum><header>In
general</header><text>Members of the Commission shall serve without
compensation in addition to the compensation received for the services of the
member as an officer or employee of the Federal Government.</text>
</subparagraph><subparagraph id="ID2806C7831D624B0282FF382049442273"><enum>(B)</enum><header>Travel
expenses</header><text>A member of the Commission shall be allowed travel
expenses, including per diem in lieu of subsistence, at rates authorized for an
employee of an agency under subchapter I of chapter 57 of title 5, United
States Code, while away from the home or regular place of business of the
member in the performance of the duties of the Commission.</text>
</subparagraph></paragraph><paragraph id="ID0C94A54F18724CA78604561BDE2A59AC"><enum>(2)</enum><header>Staff and
support services</header>
<subparagraph id="id82240D89A8D34683AE5FA50310E72B34"><enum>(A)</enum><header>Executive
director</header><text>The Chairperson shall appoint an executive director of
the Commission.</text>
</subparagraph><subparagraph id="id2C9521949A084F219DFA2B5E434491F8"><enum>(B)</enum><header>Staff</header><text>With
the approval of the Commission, the executive director may appoint such
personnel as the executive director considers appropriate.</text>
</subparagraph><subparagraph id="idEBE7713A441B44679440FF48C2CC8750"><enum>(C)</enum><header>Applicability
of civil service laws</header><text>The staff of the Commission shall be
appointed without regard to the provisions of title 5, United States Code,
governing appointments in the competitive service, and shall be paid without
regard to the provisions of chapter 51 and subchapter III of chapter 53 of such
title (relating to classification and General Schedule pay rates).</text>
</subparagraph><subparagraph id="id767050149AFE4A828F7248E3A35A6378"><enum>(D)</enum><header>Experts and
consultants</header><text>With the approval of the Commission, the executive
director may procure temporary and intermittent services under section 3109(b)
of title 5, United States Code.</text>
</subparagraph></paragraph></subsection><subsection id="ID40C4CF80B47148A39F0845C973A627D3"><enum>(f)</enum><header>Termination of
Commission</header><text display-inline="yes-display-inline">The Commission
shall terminate 30 days after the date on which the Commission submits its
report under subsection (c)(3).</text>
</subsection><subsection id="id5372D635522C4807A8CBA0045D08ED43"><enum>(g)</enum><header>Review and
response to recommendations by the medicare payment advisory
commission</header>
<paragraph id="idEB306C4B27BD49358CEF7E0E42885DDD"><enum>(1)</enum><header>In
general</header><text>Not later than February 1, 2011, the Medicare Payment
Advisory Commission shall—</text>
<subparagraph id="id9C37BD68B0CA48F19AD7A5D92A4C387A"><enum>(A)</enum><text>review the
recommendations included in the report submitted under subsection
(c)(3);</text>
</subparagraph><subparagraph id="id2352BE5915FF45CA85126B1CF74A3D80"><enum>(B)</enum><text>examine the
budget consequences of such recommendations, directly or through consultation
with appropriate expert entities; and</text>
</subparagraph><subparagraph id="idE7939F1651D14BBA8CC549A059A0C06A"><enum>(C)</enum><text>submit to the
appropriate Committees of Congress a report on such review.</text>
</subparagraph></paragraph><paragraph id="id9E40A70178574989959236266EEFBF31"><enum>(2)</enum><header>Contents of
report on review of Commission recommendations</header><text>The report
submitted under paragraph (1)(C) shall include—</text>
<subparagraph id="id45AE5E1E38514D22A688C3838912E1D2"><enum>(A)</enum><text>if the Medicare
Payment Advisory Commission supports the recommendations of the Commission, the
reasons for such support; or</text>
</subparagraph><subparagraph id="id59B8505494BF4A05A7E8F4936B36D6E9"><enum>(B)</enum><text>if the Medicare
Payment Advisory Commission does not support such recommendations, the
recommendations of the Medicare Payment Advisory Commission, together with an
explanation as to why the Medicare Payment Advisory Commission does not support
the recommendations of the Commission.</text>
</subparagraph></paragraph></subsection><subsection id="ID25A6EB519DDD44C08D519751B984DF19"><enum>(h)</enum><header>Authorization
of appropriations</header><text display-inline="yes-display-inline">There are
authorized to be appropriated such sums as may be necessary for the Commission
to carry out this section. Such appropriation shall be payable from the Federal
Supplementary Medical Insurance Trust Fund under section 1841 of the Social
Security Act (42 U.S.C. 1395t).</text>
</subsection><subsection id="HA5B97CB12D974F99A18107358DB35993"><enum>(i)</enum><header>Long-Term CBO
cost estimate</header>
<paragraph id="HF64719FBED0448E08541246F94109336"><enum>(1)</enum><header>Preparation and
submission</header><text display-inline="yes-display-inline">When the
Commission submits a written request to the Director of the Congressional
Budget Office for a long-term CBO cost estimate of recommended legislation or
administrative actions (as described under subsection (c)(3)), the Director
shall prepare the estimate and have it published in the Congressional Record as
expeditiously as possible.</text>
</paragraph><paragraph id="HC2A54C213C2C4C9F940079DCDC4D4D17"><enum>(2)</enum><header>Content</header><text>A
long-term CBO cost estimate shall include—</text>
<subparagraph id="HC3493174EEB04145B24538680602B314"><enum>(A)</enum><text>an estimate of the
cost of each provision (if practicable) or group of provisions of the
recommended legislation or administrative actions for first fiscal year it
would take effect and for each of the 49 fiscal years thereafter; and</text>
</subparagraph><subparagraph id="HBF395CB13ED54E95ADA2A56FBE35BCD3"><enum>(B)</enum><text>a statement of any
estimated future costs not reflected by the estimate described in subparagraph
(A).</text>
</subparagraph></paragraph><paragraph id="HA0F106BAAEB645338F3F3C0010CEEA35"><enum>(3)</enum><header>Form</header><text display-inline="yes-display-inline">To the extent that a long-term CBO cost
estimate presented in dollars is impracticable, the Director of the
Congressional Budget Office may instead present the estimate in terms of
percentages of gross domestic product, with rounding to the nearest
<fraction>1/10</fraction> of 1 percent of gross domestic product.</text>
</paragraph><paragraph id="HECC0F7DE40F440B6B39C7E1FA8A31E23"><enum>(4)</enum><header>Limitations on
discretionary spending</header><text display-inline="yes-display-inline">A
long-term CBO cost estimate shall only consider the effects of provisions
affecting revenues and direct spending (as defined by the Balanced Budget and
Emergency Deficit Control Act of 1985), and shall not assume that any changes
in outlays will result from limitations on, or reductions in, annual
appropriations.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id100cb793-715b-4ccd-b865-606c36bdd92e"><enum>(j)</enum><header>Expedited
consideration of commission recommendations</header>
<paragraph id="id03752a76-d4f8-4cc1-a2aa-58e855ab331d"><enum>(1)</enum><header>Introduction</header>
<subparagraph commented="no" display-inline="no-display-inline" id="idE0C007F2E8224995A14C2E769649CF51"><enum>(A)</enum><header>In
general</header><text>The proposed legislative language contained in the report
submitted pursuant to subsection (c)(3) (referred to in this subsection as the
<quote>Commission bill</quote>) shall be introduced within the first 10
calendar days of the 112th Congress (or on the first session day thereafter) in
the House of Representatives and in the Senate by the majority leader of each
House of Congress, for himself, the minority leader of each House of Congress,
for himself, or any member of the House designated by the majority leader or
minority leader. If the Commission bill is not introduced in accordance with
the preceding sentence in either House of Congress, then any Member of that
House may introduce the Commission bill on any day thereafter. Upon
introduction, the Commission bill shall be referred to the appropriate
committees under subparagraph (B).</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idEEA1A722CF3B4D03AAF35AF598E5A4C9"><enum>(B)</enum><header>Committee
consideration</header><text>A Commission bill introduced in either House of
Congress shall be jointly referred to the committee or committees of
jurisdiction, which shall report the bill without any revision and with a
favorable recommendation, an unfavorable recommendation, or without
recommendation, not later than 10 calendar days after the date of introduction
of the bill in that House. If any committee fails to report the bill within
that period, that committee shall be automatically discharged from
consideration of the bill, and the bill shall be placed on the appropriate
calendar.</text>
</subparagraph></paragraph><paragraph id="ID620e2ae7411046ad9512fe251ab9ce3f"><enum>(2)</enum><header>Expedited
procedure</header>
<subparagraph id="IDd35a2f234c4a425d921fb399a3f3fa43"><enum>(A)</enum><header>In the house of
representatives</header>
<clause id="ID2c7ca40b582e485395361afb767dcfcc"><enum>(i)</enum><header>In
general</header><text>Not later than 5 days of session after the date on which
a Commission bill is reported or discharged from all committees to which it was
referred, the majority leader of the House of Representatives or the majority
leader’s designee shall move to proceed to the consideration of the Commission
bill. It shall also be in order for any Member of the House of Representatives
to move to proceed to the consideration of the Commission bill at any time
after the conclusion of such 5-day period.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="IDbfe7bd79fa30410e812b9797da6e62ce"><enum>(ii)</enum><header>Motion to
proceed</header><text>A motion to proceed to the consideration of the
Commission bill is highly privileged in the House of Representatives and is not
debatable. The motion is not subject to amendment or to a motion to postpone
consideration of the Commission bill. A motion to proceed to the consideration
of other business shall not be in order. A motion to reconsider the vote by
which the motion to proceed is agreed to or not agreed to shall not be in
order. If the motion to proceed is agreed to, the House of Representatives
shall immediately proceed to consideration of the Commission bill without
intervening motion, order, or other business, and the Commission bill shall
remain the unfinished business of the House of Representatives until disposed
of.</text>
</clause><clause id="IDDA0C8DD098144425ACD019087C8751FA"><enum>(iii)</enum><header>Limits on
debate</header><text>Debate in the House of Representatives on a Commission
bill under this paragraph shall not exceed a total of 100 hours, which shall be
divided equally between those favoring and those opposing the bill. A motion
further to limit debate is in order and shall not be debatable. It shall not be
in order to move to recommit a Commission bill under this paragraph or to move
to reconsider the vote by which the bill is agreed to or disagreed to.</text>
</clause><clause id="ID6CDA95C911254DAC8998A26601A6107D"><enum>(iv)</enum><header>Appeals</header><text>Appeals
from decisions of the chair relating to the application of the Rules of the
House of Representatives to the procedure relating to a Commission bill shall
be decided without debate.</text>
</clause><clause id="ID38AFA23271174F93BDF3611F89A4C4AE"><enum>(v)</enum><header>Application of
house rules</header><text>Except to the extent specifically provided in this
paragraph, consideration of a Commission bill shall be governed by the Rules of
the House of Representatives. It shall not be in order in the House of
Representatives to consider any Commission bill introduced pursuant to the
provisions of this subsection under a suspension of the rules or under a
special rule.</text>
</clause><clause id="id06DEF2F5A3BF4198AE3E67F56388D7B1"><enum>(vi)</enum><header>No
amendments</header><text>No amendment to the Commission bill shall be in order
in the House of Representatives.</text>
</clause><clause id="id38D148CA3EB64A5C933DED5B20F4EF21"><enum>(vii)</enum><header>Vote on final
passage</header><text>In the House of Representatives, immediately following
the conclusion of consideration of the Commission bill, the vote on final
passage of the Commission bill shall occur without any intervening action or
motion, requiring an affirmative vote of <fraction>3/5</fraction> of the
Members, duly chosen and sworn. If the Commission bill is passed, the Clerk of
the House of Representatives shall cause the bill to be transmitted to the
Senate before the close of the next day of session of the House.</text>
</clause></subparagraph><subparagraph id="id02B23FA0BD474084BBE3E7339C091685"><enum>(B)</enum><header>In the
Senate</header>
<clause id="idF0FE3F12632648A3BB0C366E4F8434E5"><enum>(i)</enum><header>In
general</header><text>Not later than 5 days of session after the date on which
a Commission bill is reported or discharged from all committees to which it was
referred, the majority leader of the Senate or the majority leader’s designee
shall move to proceed to the consideration of the Commission bill. It shall
also be in order for any Member of the Senate to move to proceed to the
consideration of the Commission bill at any time after the conclusion of such
5-day period.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="idDC413CAE256D43B682DFB0F50D3BA5A3"><enum>(ii)</enum><header>Motion to
proceed</header><text>A motion to proceed to the consideration of the
Commission bill is privileged in the Senate and is not debatable. The motion is
not subject to amendment or to a motion to postpone consideration of the
Commission bill. A motion to proceed to consideration of the Commission bill
may be made even though a previous motion to the same effect has been disagreed
to. A motion to proceed to the consideration of other business shall not be in
order. A motion to reconsider the vote by which the motion to proceed is agreed
to or not agreed to shall not be in order. If the motion to proceed is agreed
to, the Senate shall immediately proceed to consideration of the Commission
bill without intervening motion, order, or other business, and the Commission
bill shall remain the unfinished business of the Senate until disposed
of.</text>
</clause><clause id="idA263ACDDFAF742E89483D8159C484F38"><enum>(iii)</enum><header>Limits on
debate</header><text>In the Senate, consideration of the Commission bill and on
all debatable motions and appeals in connection therewith shall not exceed a
total of 100 hours, which shall be divided equally between those favoring and
those opposing the Commission bill. A motion further to limit debate on the
Commission bill is in order and is not debatable. Any debatable motion or
appeal is debatable for not to exceed 1 hour, to be divided equally between
those favoring and those opposing the motion or appeal. All time used for
consideration of the Commission bill, including time used for quorum calls and
voting, shall be counted against the total 100 hours of consideration.</text>
</clause><clause id="IDc08f240ffff84a8086cdf4e1fc22613b"><enum>(iv)</enum><header>No
amendments</header><text>No amendment to the Commission bill shall be in order
in the Senate.</text>
</clause><clause id="id0B505E6DD3CB4CDEAFFDB02788D609C2"><enum>(v)</enum><header>Motion to
recommit</header><text>A motion to recommit a Commission bill shall not be in
order under this paragraph.</text>
</clause><clause id="ID5d00dd1c24254baeadc4a0b9f34998bd"><enum>(vi)</enum><header>Vote on final
passage</header><text>In the Senate, immediately following the conclusion of
consideration of the Commission bill and a request to establish the presence of
a quorum, the vote on final passage of the Commission bill shall occur and
shall require an affirmative vote of <fraction>3/5</fraction> of the Members,
duly chosen and sworn.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="ID723fa6c18829473ead553780aeeddf7e"><enum>(vii)</enum><header>Other motions
not in order</header><text>A motion to postpone or a motion to proceed to the
consideration of other business is not in order in the Senate. A motion to
reconsider the vote by which the Commission bill is agreed to or not agreed to
is not in order in the Senate.</text>
</clause><clause id="ID0B583314D2A3441F9E8BC1B77AE22BED"><enum>(viii)</enum><header>Consideration
of the house bill</header>
<subclause id="IDC113885B8F994584989A695AE8808C5F"><enum>(I)</enum><header>In
general</header><text>If the Senate has received the House companion bill to
the Commission bill introduced in the Senate prior to the vote required under
clause (vi) and the House companion bill is identical to the Commission bill
introduced in the Senate, then the Senate shall consider, and the vote under
clause (vi) shall occur on, the House companion bill.</text>
</subclause><subclause id="ID5D61E70292724EAE89E132C47E72EDB5"><enum>(II)</enum><header>Procedure
after vote on senate bill</header><text>If the Senate votes, pursuant to clause
(vi), on the bill introduced in the Senate, the Senate bill shall be held
pending receipt of the House message on the bill. Upon receipt of the House
companion bill, if the House bill is identical to the Senate bill, the House
bill shall be deemed to be considered, read for the third time, and the vote on
passage of the Senate bill shall be considered to be the vote on the bill
received from the House.</text>
</subclause></clause></subparagraph><subparagraph id="idC6C4647EF94F4A948F1A8C1B996DCA75"><enum>(C)</enum><header>No
suspension</header><text>No motion to suspend the application of this paragraph
shall be in order in the Senate or in the House of Representatives.</text>
</subparagraph></paragraph></subsection></section><enum>II</enum><header>Medical Care
Access Protection</header>
<section id="id2CCB88A811014A5597F6B1D439D6F180"><enum>101.</enum><header>Short
title</header><text display-inline="no-display-inline">This title may be cited
as the <quote><short-title>Medical Care Access Protection
Act of 2009</short-title></quote> or the <quote><short-title>MCAP Act</short-title></quote>.</text>
</section><section id="IDE3173CCF526941E8B14DB790B49036C8"><enum>102.</enum><header>Findings and
purpose</header>
<subsection id="IDB8F039374C1B40E982226376B3ACF6FF"><enum>(a)</enum><header>Findings</header>
<paragraph id="ID263FDE45253B4C08963F28073E65D49F"><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="ID5ED89DEB50D1427E83198EECAF5E00D4"><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="IDA36A20E0B298499493A210209100008B"><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="IDF9E3AFA4D5EE457F8D72D3889EA47100"><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="ID9AE50F9978CF4FF89F001E16752772C0"><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="ID02F8059996984FCD8523F8703197D240"><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="ID2FA6190902B340A2B2007CAC5DEEEA85"><enum>(b)</enum><header>Purpose</header><text>It
is the purpose of this title to implement reasonable, comprehensive, and
effective health care liability reforms designed to—</text>
<paragraph id="ID171D0BCDBE424A8FBD8E2887D2A915F8"><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="IDB30D8E19D9FA46E09565C3B3FE40E0BC"><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="IDF0638CB6FDC94E9298AFC2C67B77C1CB"><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="IDED8A55F8845640FFB5AA77C05DCE397C"><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="IDC6B4220D16564F40A3F23039261F3700"><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="ID27C8C7A90D484E8000D362B393B16400"><enum>103.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text>
<paragraph id="IDC808E49AE65F4246B696704FE8990910"><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="IDE404B5EA7B814647BB93BC52DA2FA298"><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="ID7BC1BC471CB94E4B8BF4DA90185FC015"><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="IDEFEBA0F5FEF845C6000079E9876810ED"><enum>(A)</enum><text>any State or
Federal health, sickness, income-disability, accident, or workers’ compensation
law;</text>
</subparagraph><subparagraph id="ID6A756DB739B44C01B483CEE9421D2C99"><enum>(B)</enum><text>any health,
sickness, income-disability, or accident insurance that provides health
benefits or income-disability coverage;</text>
</subparagraph><subparagraph id="IDD3220C91037548AAA7DB9465B4042946"><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="IDF427C3BFDB5A462E976352AACCB6C0F9"><enum>(D)</enum><text>any other
publicly or privately funded program.</text>
</subparagraph></paragraph><paragraph id="ID0996E20EAD7A4FDC00A893EED0CD90FF"><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. Such term includes economic damages and noneconomic damages, as
such terms are defined in this section.</text>
</paragraph><paragraph id="ID4AB189ED9B564DF18155B9E86DCF77AA"><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="ID84DFFA8BB07D43C29B057E6C13ADB92D"><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="IDB5E4A336FA6F4AB886203C2183FABC3E"><enum>(7)</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
institution, provider, or by any individual working under the supervision of a
health care provider, that relates to the diagnosis, prevention, care, or
treatment of any human disease or impairment, or the assessment of the health
of human beings.</text>
</paragraph><paragraph id="ID71293FC36DE244DD80A318342702B19E"><enum>(8)</enum><header>Health care
institution</header><text>The term <term>health care institution</term> means
any entity licensed under Federal or State law to provide health care services
(including but not limited to ambulatory surgical centers, assisted living
facilities, emergency medical services providers, hospices, hospitals and
hospital systems, nursing homes, or other entities licensed to provide such
services).</text>
</paragraph><paragraph id="ID84A1E4863CCC4D90B0A33FB8C9B82551"><enum>(9)</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 affecting interstate commerce, or any health care liability action
concerning the provision of (or the failure to provide) health care goods or
services affecting interstate commerce, brought in a State or Federal court or
pursuant to an alternative dispute resolution system, against a health care
provider or a health care institution 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.</text>
</paragraph><paragraph id="ID89228B4AFF34419FABB17F0008887C87"><enum>(10)</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 or a health care institution 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="ID5CE677BBEB5D47C4A42D6E2E7E00B2FB"><enum>(11)</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 or health care institution, including 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, 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="IDA2BCA58209EC49F1B15860DBC09BA584"><enum>(12)</enum><header>Health care
provider</header>
<subparagraph id="id926BB6187B064C298EC7F61A2AD14BB8"><enum>(A)</enum><header>In
general</header><text>The term <term>health care provider</term> means any
person (including but not limited to a physician (as defined by section 1861(r)
of the Social Security Act (42 U.S.C. 1395x(r)), registered nurse, dentist,
podiatrist, pharmacist, chiropractor, or optometrist) required by State or
Federal law 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>
</subparagraph><subparagraph id="id33EE54EC519D4AFCA7B9F48C60B167F7"><enum>(B)</enum><header>Treatment of
certain professional associations</header><text>For purposes of this title, a
professional association that is organized under State law by an individual
physician or group of physicians, a partnership or limited liability
partnership formed by a group of physicians, a nonprofit health corporation
certified under State law, or a company formed by a group of physicians under
State law shall be treated as a health care provider under subparagraph
(A).</text>
</subparagraph></paragraph><paragraph id="IDE0A735A2F7FB487CB554BDC459E9E721"><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="IDB3E6794CD8874E61B3069300FED14794"><enum>(14)</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="ID008193BD17AA40E580CB5456005B8095"><enum>(15)</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 or health care
institution. Punitive damages are neither economic nor noneconomic
damages.</text>
</paragraph><paragraph id="ID9A420C24FA2145108BA7304B294CD036"><enum>(16)</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="ID46ABCF072EF94C17B589AE5B53F29B46"><enum>(17)</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="ID5076125248894FD6A94D987BD3A4E75C"><enum>104.</enum><header>Encouraging
speedy resolution of claims</header>
<subsection id="ID226D95B4DA2342169D34C4632D7F49ED"><enum>(a)</enum><header>In
general</header><text>Except as otherwise provided for in this section, 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.</text>
</subsection><subsection id="IDB5E5E7ABBE0E458FB8F098C9DA65083F"><enum>(b)</enum><header>General
exception</header><text>The time for the commencement of a health care lawsuit
shall not exceed 3 years after the date of manifestation of injury unless the
tolling of time was delayed as a result of—</text>
<paragraph id="IDC3771A83F3AA4C60AB61DB11BEF498A3"><enum>(1)</enum><text>fraud;</text>
</paragraph><paragraph id="IDE52BCB0F006140559E41038B31E93B4E"><enum>(2)</enum><text>intentional
concealment; or</text>
</paragraph><paragraph id="IDB2FD4420C22747948EEC57CE6D48D644"><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></subsection><subsection id="ID0809CDCE6F064F2CB5274DF6E93B00C0"><enum>(c)</enum><header>Minors</header><text>An
action by a minor shall be commenced within 3 years from the date of the
alleged manifestation of injury except that if such minor is under the full age
of 6 years, such action shall be commenced within 3 years of the manifestation
of injury, or prior to the eighth birthday of the minor, 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
institution have committed fraud or collusion in the failure to bring an action
on behalf of the injured minor.</text>
</subsection><subsection id="id1BA5B1BDB813426FB7889037C6A04230"><enum>(d)</enum><header>Rule 11
sanctions</header><text>Whenever a Federal or State court determines (whether
by motion of the parties or whether on the motion of the court) that there has
been a violation of Rule 11 of the Federal Rules of Civil Procedure (or a
similar violation of applicable State court rules) in a health care liability
action to which this title applies, the court shall impose upon the attorneys,
law firms, or pro se litigants that have violated Rule 11 or are responsible
for the violation, an appropriate sanction, which shall include an order to pay
the other party or parties for the reasonable expenses incurred as a direct
result of the filing of the pleading, motion, or other paper that is the
subject of the violation, including a reasonable attorneys' fee. Such sanction
shall be sufficient to deter repetition of such conduct or comparable conduct
by others similarly situated, and to compensate the party or parties injured by
such conduct.</text>
</subsection></section><section id="ID4B3AE21E5C63401894B6CD8549D7429D"><enum>105.</enum><header>Compensating
patient injury</header>
<subsection id="ID5C4D895CEED8430D8181348C8F564245"><enum>(a)</enum><header>Unlimited
amount of damages for actual economic losses in health care
lawsuits</header><text>In any health care lawsuit, nothing in this title shall
limit the recovery by a claimant of the full amount of the available economic
damages, notwithstanding the limitation contained in subsection (b).</text>
</subsection><subsection id="ID37A9D0AAA7414A66BF09C5006D2538D0"><enum>(b)</enum><header>Additional
noneconomic damages</header>
<paragraph id="id5CCCE46C974C4F4BB9587287429DC2F1"><enum>(1)</enum><header>Health care
providers</header><text>In any health care lawsuit where final judgment is
rendered against a health care provider, the amount of noneconomic damages
recovered from the provider, if otherwise available under applicable Federal or
State law, may be as much as $250,000, regardless of the number of parties
other than a health care institution against whom the action is brought or the
number of separate claims or actions brought with respect to the same
occurrence.</text>
</paragraph><paragraph id="idE843C015DC214DA394A5CD19225D52CF"><enum>(2)</enum><header>Health care
institutions</header>
<subparagraph id="id8D32D2A8FF674C39B03B63DDD1208E49"><enum>(A)</enum><header>Single
institution</header><text>In any health care lawsuit where final judgment is
rendered against a single health care institution, the amount of noneconomic
damages recovered from the institution, if otherwise available under applicable
Federal or State law, 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 occurrence.</text>
</subparagraph><subparagraph id="id800CC5C3633248FC9B61F00161D0C864"><enum>(B)</enum><header>Multiple
institutions</header><text>In any health care lawsuit where final judgment is
rendered against more than one health care institution, the amount of
noneconomic damages recovered from each institution, if otherwise available
under applicable Federal or State law, 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 occurrence, except
that the total amount recovered from all such institutions in such lawsuit
shall not exceed $500,000.</text>
</subparagraph></paragraph></subsection><subsection id="IDFBC85C183344400E96FD91EC97E4B8E6"><enum>(c)</enum><header>No discount of
award for noneconomic damages</header><text>In any health care lawsuit—</text>
<paragraph id="IDE7B3B9FBEE124D728F54E6781F637231"><enum>(1)</enum><text>an award for
future noneconomic damages shall not be discounted to present value;</text>
</paragraph><paragraph id="ID9AF9A503FEF44FAFA372567F83B51FDB"><enum>(2)</enum><text>the jury shall
not be informed about the maximum award for noneconomic damages under
subsection (b);</text>
</paragraph><paragraph id="ID16C984C55C0F47D68EDF721D9D8E0574"><enum>(3)</enum><text>an award for
noneconomic damages in excess of the limitations provided for in subsection (b)
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; and</text>
</paragraph><paragraph id="ID99E6DCBF40F44E1696BCA91F73334108"><enum>(4)</enum><text>if separate
awards are rendered for past and future noneconomic damages and the combined
awards exceed the limitations described in subsection (b), the future
noneconomic damages shall be reduced first.</text>
</paragraph></subsection><subsection id="ID51D34B38E99141B8906397C93F520001"><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. 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="IDEA06301A666049E9AB9160A003AD517E"><enum>106.</enum><header>Maximizing
patient recovery</header>
<subsection id="ID1C987430706B4140AFC76E68F89446A8"><enum>(a)</enum><header>Court
supervision of share of damages actually paid to claimants</header>
<paragraph id="IDC621C29B130349AC8E25F08CE431A1ED"><enum>(1)</enum><header>In
general</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.</text>
</paragraph><paragraph id="ID06482F8EAC584FF783CD081D58C00419"><enum>(2)</enum><header>Contingency
fees</header>
<subparagraph id="ID475929F59A664055A7B639D488D2A356"><enum>(A)</enum><header>In
general</header><text>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.</text>
</subparagraph><subparagraph id="ID5E54F8E911A24163B9ED6B39583B9657"><enum>(B)</enum><header>Limitation</header><text>The
total of all contingent fees for representing all claimants in a health care
lawsuit shall not exceed the following limits:</text>
<clause id="IDD8084C0B29E14F82922DF2197CFBD1B4"><enum>(i)</enum><text>40
percent of the first $50,000 recovered by the claimant(s).</text>
</clause><clause id="ID41970F0025B8448F8612406218E70200"><enum>(ii)</enum><text>33<fraction>1/3</fraction>
percent of the next $50,000 recovered by the claimant(s).</text>
</clause><clause id="IDF350FA26CB10441E91001E6064072907"><enum>(iii)</enum><text>25 percent of
the next $500,000 recovered by the claimant(s).</text>
</clause><clause id="ID064F9D83971647A196A5E31914A4E8A6"><enum>(iv)</enum><text>15
percent of any amount by which the recovery by the claimant(s) is in excess of
$600,000.</text>
</clause></subparagraph></paragraph></subsection><subsection id="ID0E9FB2B895DA4B989C80CD70B822F901"><enum>(b)</enum><header>Applicability</header>
<paragraph id="ID2FDCAF919CE04BB295C0CABA109522F9"><enum>(1)</enum><header>In
general</header><text>The limitations in subsection (a) shall apply whether the
recovery is by judgment, settlement, mediation, arbitration, or any other form
of alternative dispute resolution.</text>
</paragraph><paragraph id="ID0560AEE373AD420EBDB68E93FE373389"><enum>(2)</enum><header>Minors</header><text>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.</text>
</paragraph></subsection><subsection id="ID3B12A925E37A452D00A8B0481C194FEE"><enum>(c)</enum><header>Expert
witnesses</header>
<paragraph id="ID88BA0FE9A1534166B2AEBCD0D63DE514"><enum>(1)</enum><header>Requirement</header><text>No
individual shall be qualified to testify as an expert witness concerning issues
of negligence in any health care lawsuit against a defendant unless such
individual—</text>
<subparagraph id="ID05B7E4211C514CDEA3894532CF67B9D6"><enum>(A)</enum><text>except as
required under paragraph (2), is a health care professional who—</text>
<clause id="ID664D85FD85C549B196C3002B000458D7"><enum>(i)</enum><text>is
appropriately credentialed or licensed in 1 or more States to deliver health
care services; and</text>
</clause><clause id="IDB8FDFC86B28D432FBA5F3900373C95B1"><enum>(ii)</enum><text>typically treats
the diagnosis or condition or provides the type of treatment under review;
and</text>
</clause></subparagraph><subparagraph id="ID59FFE6946F2B49FB9B74636DA1E49984"><enum>(B)</enum><text>can demonstrate
by competent evidence that, as a result of training, education, knowledge, and
experience in the evaluation, diagnosis, and treatment of the disease or injury
which is the subject matter of the lawsuit against the defendant, the
individual was substantially familiar with applicable standards of care and
practice as they relate to the act or omission which is the subject of the
lawsuit on the date of the incident.</text>
</subparagraph></paragraph><paragraph id="ID9AA7E2EBA9314F6100E7D483E57611A5"><enum>(2)</enum><header>Physician
review</header><text>In a health care lawsuit, if the claim of the plaintiff
involved treatment that is recommended or provided by a physician (allopathic
or osteopathic), an individual shall not be qualified to be an expert witness
under this subsection with respect to issues of negligence concerning such
treatment unless such individual is a physician.</text>
</paragraph><paragraph id="ID35107ECC77604E988F5FFA7D69D52D54"><enum>(3)</enum><header>Specialties and
subspecialties</header><text>With respect to a lawsuit described in paragraph
(1), a court shall not permit an expert in one medical specialty or
subspecialty to testify against a defendant in another medical specialty or
subspecialty unless, in addition to a showing of substantial familiarity in
accordance with paragraph (1)(B), there is a showing that the standards of care
and practice in the two specialty or subspecialty fields are similar.</text>
</paragraph><paragraph id="IDB639EB0717AF4E6F8464C2481C4D23E6"><enum>(4)</enum><header>Limitation</header><text>The
limitations in this subsection shall not apply to expert witnesses testifying
as to the degree or permanency of medical or physical impairment.</text>
</paragraph></subsection></section><section id="IDDC7E1D8CA71A4350AEB0CBA9E813634F"><enum>107.</enum><header>Additional
health benefits</header>
<subsection id="IDA2D1A64420F84672BB2CAB93CA7000C0"><enum>(a)</enum><header>In
general</header><text>The amount of any damages received by a claimant in any
health care lawsuit shall be reduced by the court by the amount of any
collateral source benefits to which the claimant is entitled, less any
insurance premiums or other payments made by the claimant (or by the spouse,
parent, child, or legal guardian of the claimant) to obtain or secure such
benefits.</text>
</subsection><subsection id="ID8C93C320A9954A1C904800A8BBE2DE64"><enum>(b)</enum><header>Preservation of
current law</header><text>Where a payor of collateral source benefits has a
right of recovery by reimbursement or subrogation and such right is permitted
under Federal or State law, subsection (a) shall not apply.</text>
</subsection><subsection id="ID60B2D15B8DD64BFF9E3787E3C2CE7CC8"><enum>(c)</enum><header>Application of
provision</header><text>This section shall apply to any health care lawsuit
that is settled or resolved by a fact finder.</text>
</subsection></section><section id="ID3A76354DA69C4C1187356781002B33DF"><enum>108.</enum><header>Punitive
damages</header>
<subsection id="ID9517867D2BB44ED8A4B44D4607D1008B"><enum>(a)</enum><header>Punitive
damages permitted</header>
<paragraph id="ID62E9439F946B4DE791ED2661646E6F61"><enum>(1)</enum><header>In
general</header><text>Punitive damages may, if otherwise available under
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.</text>
</paragraph><paragraph id="IDE78D89E491CE4C7084FDCB7296DF45F8"><enum>(2)</enum><header>Filing of
lawsuit</header><text>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.</text>
</paragraph><paragraph id="IDD9BE16E239984E08BB043E3CE9F25399"><enum>(3)</enum><header>Separate
proceeding</header><text>At the request of any party in a health care lawsuit,
the trier of fact shall consider in a separate proceeding—</text>
<subparagraph id="ID69B93B42572641CEBF54EB53542B88B9"><enum>(A)</enum><text>whether punitive
damages are to be awarded and the amount of such award; and</text>
</subparagraph><subparagraph id="ID1C2232A52FAE4F358E8B254C331F23CF"><enum>(B)</enum><text>the amount of
punitive damages following a determination of punitive liability.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">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></paragraph><paragraph id="ID2DD43DA402B04DFCA099DE5392ADE4C0"><enum>(4)</enum><header>Limitation
where no compensatory damages are awarded</header><text>In any health care
lawsuit where no judgment for compensatory damages is rendered against a
person, no punitive damages may be awarded with respect to the claim in such
lawsuit against such person.</text>
</paragraph></subsection><subsection id="ID488BB463043F4B8E883EEB1BF372514C"><enum>(b)</enum><header>Determining
amount of punitive damages</header>
<paragraph id="ID5895EBE5D3194492B669F581B3B508DC"><enum>(1)</enum><header>Factors
considered</header><text>In determining the amount of punitive damages under
this section, the trier of fact shall consider only the following:</text>
<subparagraph id="IDABE5EFC84A324DA2AA621C2333F4397B"><enum>(A)</enum><text>the severity of
the harm caused by the conduct of such party;</text>
</subparagraph><subparagraph id="IDFA2B37164DC64E2B9314A19F3D995E6F"><enum>(B)</enum><text>the duration of
the conduct or any concealment of it by such party;</text>
</subparagraph><subparagraph id="ID7EE19261A1E54613A0C433D5714E9052"><enum>(C)</enum><text>the profitability
of the conduct to such party;</text>
</subparagraph><subparagraph id="ID432218A267C8425687D34BC561F64BF7"><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="ID893BE235960845139F86669095F6EA12"><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="IDB9A11D10747847F6989500959B1D7427"><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="ID744CC8EDE1574FA5800307ACC56BA1B7"><enum>(2)</enum><header>Maximum
award</header><text>The amount of punitive damages awarded in a health care
lawsuit may not exceed an amount equal to two times the amount of economic
damages awarded in the lawsuit or $250,000, whichever is greater. The jury
shall not be informed of the limitation under the preceding sentence.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="ID9C0E86F37D7A4409B1514724C14DDDDD"><enum>(c)</enum><header>Liability of
health care providers</header>
<paragraph commented="no" display-inline="no-display-inline" id="idC737821F74D54CF68144CA162D9D80D5"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">A health care
provider who prescribes, or who dispenses pursuant to a prescription, a drug,
biological product, or medical device approved by the Food and Drug
Administration, for an approved indication of the drug, biological product, or
medical device, shall not be named as a party to a product liability lawsuit
invoking such drug, biological product, or medical device and shall not be
liable to a claimant in a class action lawsuit against the manufacturer,
distributor, or product seller of such drug, biological product, or medical
device.</text>
</paragraph><paragraph id="IDFE70F1EFC69C4BFAADD55EB76B5E3C7C"><enum>(2)</enum><header>Medical
product</header><text>The term <term>medical product</term> means a drug or
device intended for humans. The terms <term>drug</term> and <term>device</term>
have the meanings given such terms in sections 201(g)(1) and 201(h) of the
Federal Food, Drug and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/321">21 U.S.C. 321</external-xref>), respectively,
including any component or raw material used therein, but excluding health care
services.</text>
</paragraph></subsection></section><section id="ID5D208E4A816D4C3BAE79B605D177F206"><enum>109.</enum><header>Authorization
of payment of future damages to claimants in health care lawsuits</header>
<subsection id="ID351F5B4B8D22426886D7496BA03EDEB8"><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 accordance with the Uniform Periodic Payment of Judgments Act
promulgated by the National Conference of Commissioners on Uniform State
Laws.</text>
</subsection><subsection id="IDC27FEB2AC6A94FF99C19343F699DD83E"><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 title.</text>
</subsection></section><section id="IDCD894FC2BBF54A22B79D9C19F5283ED6"><enum>110.</enum><header>Effect on
other laws</header>
<subsection id="IDB95782A750E0467E8B06229D27A1EF64"><enum>(a)</enum><header>General vaccine
injury</header>
<paragraph id="IDA98214C44ED84EE7A62CBC015CAEDBA5"><enum>(1)</enum><header>In
general</header><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="IDA4D009995F354A939159A7C9DB82C199"><enum>(A)</enum><text>this title shall
not affect the application of the rule of law to such an action; and</text>
</subparagraph><subparagraph id="IDBC1D1F29C7544330884366969ECA1E2F"><enum>(B)</enum><text>any rule of law
prescribed by this title in conflict with a rule of law under title XXI shall
not apply to such action.</text>
</subparagraph></paragraph><paragraph id="IDCBB0D5E9B56B4EA49BD0A64FD496F2F0"><enum>(2)</enum><header>Exception</header><text>If
there is an aspect of a civil action brought for a vaccine-related injury or
death to which a Federal rule of law under title XXI of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> does not
apply, then this title or otherwise applicable law (as determined under this
title) will apply to such aspect of such action.</text>
</paragraph></subsection><subsection id="ID6479806911144C669A011171995231E0"><enum>(b)</enum><header>Smallpox
vaccine injury</header>
<paragraph id="IDD4D950C25B5F42BEB2C62AEF95CE4AB9"><enum>(1)</enum><header>In
general</header><text>To the extent that part C of title II 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 smallpox
vaccine-related injury or death—</text>
<subparagraph id="IDAAA6B15C7BF34169BD58EFDEA05646D5"><enum>(A)</enum><text>this title shall
not affect the application of the rule of law to such an action; and</text>
</subparagraph><subparagraph id="IDFD1228E7B6FB423AB24C8740D4A29822"><enum>(B)</enum><text>any rule of law
prescribed by this title in conflict with a rule of law of such part C shall
not apply to such action.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDDD3C82EF3D034FB1A959BEA417705CA1"><enum>(2)</enum><header>Exception</header><text>If
there is an aspect of a civil action brought for a smallpox vaccine-related
injury or death to which a Federal rule of law under part C of title II of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> does not
apply, then this title or otherwise applicable law (as determined under this
title) will apply to such aspect of such action.</text>
</paragraph></subsection><subsection id="ID21AC62A4DC7D468884F71B92B5E9E5A4"><enum>(c)</enum><header>Other Federal
law</header><text>Except as provided in this section, nothing in this title
shall be deemed to affect any defense available, or any limitation on liability
that applies to, a defendant in a health care lawsuit or action under any other
provision of Federal law.</text>
</subsection></section><section id="ID225A415FBC3F40B28F65D8EF24D461E2"><enum>111.</enum><header>State
flexibility and protection of states’ rights</header>
<subsection id="IDFE8D772B35964112897E274948193852"><enum>(a)</enum><header>Health care
lawsuits</header><text>The provisions governing health care lawsuits set forth
in this title shall preempt, subject to subsections (b) and (c), State law to
the extent that State law prevents the application of any provisions of law
established by or under this title. The provisions governing health care
lawsuits set forth in this title supersede chapter 171 of title 28, United
States Code, to the extent that such chapter—</text>
<paragraph id="IDB2F711F9DFBD4056A035265DBF1EAEB9"><enum>(1)</enum><text>provides for a
greater amount of damages or contingent fees, a longer period in which a health
care lawsuit may be commenced, or a reduced applicability or scope of periodic
payment of future damages, than provided in this title; or</text>
</paragraph><paragraph id="IDB3A843AA6D3248469062F19E80F07990"><enum>(2)</enum><text>prohibits the
introduction of evidence regarding collateral source benefits.</text>
</paragraph></subsection><subsection id="ID9FD46538A8DC40B893BC4CCDA1FFC97F"><enum>(b)</enum><header>Preemption of
certain State laws</header><text>No provision of this title shall be construed
to preempt any State law (whether effective before, on, or after the date of
the enactment of this Act) that specifies a particular monetary amount of
compensatory or punitive damages (or the total amount of damages) that may be
awarded in a health care lawsuit, regardless of whether such monetary amount is
greater or lesser than is provided for under this title, notwithstanding
section 105(a).</text>
</subsection><subsection id="ID7679463446FA4E62A038B7C469FE4FAF"><enum>(c)</enum><header>Protection of
state’s rights and other laws</header>
<paragraph id="ID4A9168992AD546D4A89C13A3CB5044B6"><enum>(1)</enum><header>In
general</header><text>Any issue that is not governed by a provision of law
established by or under this title (including the State standards of
negligence) shall be governed by otherwise applicable Federal or State
law.</text>
</paragraph><paragraph id="ID3511F33F9B1840A3B9D1886F3DB395AB"><enum>(2)</enum><header>Rule of
construction</header><text>Nothing in this title shall be construed to—</text>
<subparagraph id="ID843C2F9503A2459FB80060A05DBCD584"><enum>(A)</enum><text>preempt or
supersede any Federal or State law that imposes greater procedural or
substantive protections (such as a shorter statute of limitations) for a health
care provider or health care institution from liability, loss, or damages than
those provided by this title;</text>
</subparagraph><subparagraph id="idF9035E12E7E3421AA9C4B885BD722F4D"><enum>(B)</enum><text>preempt or
supercede any State law that permits and provides for the enforcement of any
arbitration agreement related to a health care liability claim whether enacted
prior to or after the date of enactment of this Act;</text>
</subparagraph><subparagraph id="IDBBB9890B263F4E13834102C3A0E210B2"><enum>(C)</enum><text>create a cause of
action that is not otherwise available under Federal or State law; or</text>
</subparagraph><subparagraph id="IDDBBF8A6C3DF44D319D4E4CF7D0AB345C"><enum>(D)</enum><text>affect the scope
of preemption of any other Federal law.</text>
</subparagraph></paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="ID2CA4306A5A8A4937AC73FF94DAEA618C" section-type="subsequent-section"><enum>112.</enum><header>Applicability;
effective date</header><text display-inline="no-display-inline">This title
shall apply to any health care lawsuit brought in a Federal or State court, or
subject to an alternative dispute resolution system, that is initiated on or
after the date of the enactment of this Act, except that any health care
lawsuit arising from an injury occurring prior to the date of enactment of this
Act shall be governed by the applicable statute of limitations provisions in
effect at the time the injury occurred.</text>
</section><enum>III</enum><header>Rescission of
Unused Stimulus Funds</header>
<section id="id9086819D6A0B49C49AC1AC9E32EBBA2C"><enum>201.</enum><header>Rescission in
ARRA</header><text display-inline="no-display-inline">Effective as of October
1, 2010, 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) are rescinded.</text>
</section>