[Congressional Record Volume 155, Number 182 (Monday, December 7, 2009)]
[Senate]
[Pages S12621-S12645]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 2953. Mr. UDALL of Colorado submited an amendment intended to be 
proposed to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. 
Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the 
Internal Revenue Code of 1986 to modify the first-time homebuyers 
credit in the case of members of the Armed Forces and certain other 
Federal employees, and for other purposes; which was ordered to lie on 
the table; as follows:

       Strike line 11 on page 1204 and all that follows through 
     line 16 on page 1206, insert the following:
       (B) a local government agency, including municipal, county, 
     and regional public health departments;
       (C) a national network of community-based organizations;
       (D) a State or local nonprofit organization;
       (E) an Indian tribe; or
       (F) a nonprofit hospital, clinic, or entity involved in 
     health care delivery or health promotion; and
       (2) submit to the Director an application at such time, in 
     such a manner, and containing such information as the 
     Director may require, including a description of the program 
     to be carried out under the grant; and
       (3) demonstrate a history or capacity, if funded, to 
     develop relationships necessary to

[[Page S12622]]

     engage key stakeholders from multiple sectors within and 
     beyond health care and across a community, such as healthy 
     futures corps and health care providers.
       (d) Diversity.--In awarding grants under this section, the 
     Secretary shall ensure, to the extent practicable, that such 
     grants equitably serve racially, economically, and 
     geographically diverse populations and include grants to 
     rural local government agencies or organizations located in, 
     and focused on serving, rural communities.
       (e) Use of Funds.--
       (1) In general.--An eligible entity shall use amounts 
     received under a grant under this section to carry out 
     programs described in this subsection.
       (2) Community transformation plan.--
       (A) In general.--An eligible entity that receives a grant 
     under this section shall submit to the Director (for 
     approval) a detailed plan that includes the policy, 
     environmental, programmatic, and infrastructure changes 
     needed to promote healthy living and reduce disparities.
       (B) Activities.--Activities within the plan shall focus on 
     (but not be limited to)--
       (i) creating healthier school environments, including 
     increasing healthy food options, physical activity 
     opportunities, promotion of healthy lifestyle, emotional 
     wellness, and prevention curricula, and activities to prevent 
     chronic diseases;
       (ii) creating the infrastructure to support active living 
     and access to nutritious foods in a safe environment;
       (iii) developing and promoting programs targeting a variety 
     of age levels to increase access to nutrition, physical 
     activity, and smoking cessation, enhance safety in a 
     community, or address any other chronic disease priority area 
     identified by the grantee;
       (iv) assessing and implementing worksite wellness 
     programming and incentives;
       (v) working to highlight healthy options at restaurants and 
     other food venues;
       (vi) prioritizing strategies to reduce racial, ethnic, and 
     geographic disparities, including social determinants of 
     health; and
                                 ______
                                 
  SA 2954. Mr. UDALL of Colorado (for himself and Mr. Udall of New 
Mexico) submitted an amendment intended to be proposed to amendment SA 
2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 1265, between lines 8 and 9, insert the following:

     SEC. 4307. PILOT PROGRAM TO REDUCE THE INCREASING PREVALENCE 
                   OF OVERWEIGHT/OBESITY AMONG CHILDREN FROM BIRTH 
                   THROUGH 5 YEARS OF AGE.

       (a) Findings.--Congress makes the following findings:
       (1) Life-long food preferences, eating habits, and activity 
     levels develop early in childhood.
       (2) Preschool years are a critical time for determining 
     whether or not an individual will develop obesity later in 
     life.
       (3) Aerobic fitness and healthy eating patterns support 
     enhanced behavioral, emotional, and academic performance in 
     school.
       (4) Recent studies indicate that children who are 
     overweight at age 5 are more likely to be more overweight at 
     age 9.
       (5) Obese preschool children already exhibit signs of 
     cardiovascular disease and diabetes.
       (6) According to a 2007 Centers for Disease Control and 
     Prevention study, 12.4 percent of children in the United 
     States ages 2 through 6 are obese.
       (7) The 2001 National Household Education Survey found that 
     74 percent of children in the United States ages 3 through 6 
     are in some form of non-parental child care, and 56 percent 
     are in center-based child care.
       (8) According to a 2009 analysis of child care center 
     licensing regulations, only 12 States have a policy 
     prohibiting or limiting foods of low nutritional value in 
     child care centers, only 8 States require vigorous or 
     moderate physical activity, only one of which has a policy 
     quantifying a required number of minutes of physical activity 
     by day or week, and only 7 States quantify a maximum amount 
     of time for media (television and electronic) each day or 
     week.
       (9) In July 2009, the Centers for Disease Control and 
     Prevention released recommended community strategies and 
     measures to prevent obesity in the United States that 
     includes child care specific policy and environmental 
     initiatives to achieve healthy eating and active living among 
     children from birth to 5 years of age.
       (10) In September 2009, The Institute of Medicine released 
     findings supporting local governments' ability to play a 
     crucial role in creating environments that make it easier for 
     children to eat healthy diets and remain active.
       (11) States should strive to adopt nutrition standards, 
     practices, and policies for childcare centers that are 
     consistent with the 2005 Dietary Guidelines for Americans.
       (12) The Child and Adult Care Food Program is a Federal 
     initiative that provides States with grants to provide 
     children and adults in care settings with nutritious meals 
     and snacks.
       (13) Childcare centers should serve as settings where 
     children adopt healthy eating habits, have opportunities for 
     age appropriate physical activity, and set screen time 
     limits.
       (b) Purposes.--It is the purpose of this Act to--
       (1) establish a 3-year pilot program in 5 States that will 
     focus on reducing the increasing prevalence of overweight/
     obesity among children between birth and 5 years of age in 
     child care settings;
       (2) enhance the focus of child care centers serving the 
     birth to 5 years of age population on children's healthy 
     development through evidence-based or data-informed policies 
     and practices to improve healthy eating, physical activity, 
     and screen time limits; and
       (3) identify emerging and expand existing evidence-based 
     practices and understanding of healthy eating, physical 
     activity, and screen time limits, as appropriate, as well as 
     replicate curricula, interventions, practices, and policy 
     changes that are most effective in promoting nutrition and 
     physical activity among the birth to 5 years of age 
     population in the child care setting.
       (c) Definitions.--In this section:
       (1) Child care center.--The term ``child care center'' 
     means a nonresidential facility that generally provides child 
     care services for fewer than 24 hours per day per child, 
     unless care in excess of 24 hours is due to the nature of the 
     parents' work, and that is certified, registered, or licensed 
     in the State in which it is located.
       (2) Early learning council.--The term ``early learning 
     council'' means an early childhood assembly that is 
     established to advise governors, State legislators, or State 
     agency administrators on how best to meet the needs of young 
     children and their families specifically through improvement 
     of programs and services.
       (3) Family child care home.--The term ``family child care 
     home'' means a private family home where home-based child 
     care is provided for a portion of the day, unless care in 
     excess of 24 hours is due to the nature of the parents' work, 
     and that is certified, registered, or licensed in the State 
     in which it is located.
       (4) Screen time limits.--The term ``screen time limits'' 
     means policies or guidelines, such as those developed by the 
     American Academy of Pediatrics, designed to reduce the daily 
     amount of time that children spend watching or looking at 
     digital monitors or displays, including television sets, 
     computer monitors, or hand-held gaming devices.
       (5) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (d) Grants.--
       (1) In general.--The Secretary, acting through the Director 
     of the Centers for Disease Control and Prevention, shall 
     award 3-year competitive grants to 5 State health departments 
     (or other appropriate State agency administering the Child 
     and Adult Care Food Program or other child care programs) to 
     help reduce and prevent obesity among the birth to 5 year old 
     population of the State in child care centers and family 
     child care homes.
       (2) Use of funds.--State grantees shall use amounts 
     received under a grant under this subsection to--
       (A) provide, or enter into contracts to provide, training 
     (that meets the requirements of paragraph (3)) to the staff 
     of national, State, or community-based organizations with 
     networks of child care centers, or a consortium of childcare 
     centers and family child care homes consisting of at least 10 
     child care centers or family child care homes, for the 
     purpose of implementing evidence-based or data-informed 
     healthy eating and physical activity policies and practices, 
     including curricula and other interventions; and
       (B) provide grants to child care centers and family child 
     care homes, whose staff received the training described in 
     subparagraph (A), to implement practice, curricula, and 
     policy changes (that meet the requirements of paragraph (4)) 
     that promote healthy eating and physical activity among the 
     birth to 5 years of age population.

     In determining who receives grant funds, a State shall 
     consider, but not be limited to, child care centers and 
     family child care homes that receive funds under the Child 
     and Adult Care Food Program administered by the Department of 
     Agriculture. Preference shall be given to those States that 
     demonstrate collaboration between relevant State entities 
     related to child care and health and with key stakeholders, 
     such as State early learning councils and other community 
     based organizations working with child care centers or family 
     child care homes.
       (3) Training requirements.--
       (A) In general.--Training provided under paragraph (2) 
     shall--
       (i) include the provision of information concerning age-
     appropriate healthy eating and physical activity 
     interventions and curricula for the birth to 5 years of age 
     population in the State involved;
       (ii) identify, improve upon, and expand nutrition and 
     physical activity best practices targeted to the birth to 5 
     years of age population in the State involved and identify 
     strategies for incorporating parental education and other 
     parental involvement; and
       (iii) provide instruction on how to appropriately model, 
     direct, and encourage child care staff behavior to apply the 
     best practices and strategies identified under clause (ii).

[[Page S12623]]

       (B) Training entities.--A grantee may conduct the training 
     required under this subsection directly, or may provide such 
     training through a contract with--
       (i) an appropriate national, State, or community 
     organization with relevant expertise;
       (ii) a health care provider or professional organization 
     with relevant expertise;
       (iii) a university or research center that employs faculty 
     with relevant expertise; or
       (iv) any other entity determined appropriate by the State 
     and approved by the Secretary.
       (C) Requirement of contract.--If a grantee elects to 
     provide the training under this subsection through a 
     contract, the grantee shall ensure that a consistent healthy 
     eating and physical activity curriculum is being developed 
     for all child care entities that provide care for 10 or more 
     children throughout the State.
       (4) Practice, curricula, and policy changes.--After 
     training is provided as required under paragraph (3), a State 
     grantee shall ensure that the organizations and consortium 
     involved--
       (A) implement, in child care settings, evidence-based or 
     data-informed policy changes that promote healthy eating, 
     physical activity, and appropriate screen time limits among 
     the birth to 5 years of age population;
       (B) utilize an evidence-based or data-informed healthy 
     eating and physical activity curriculum in child care 
     settings focusing on such birth to 5 age population;
       (C) implement programs, activities, and procedures for 
     incorporating parental education and involvement of parents 
     in programs, including disseminating a written parental 
     involvement policy, and coordinating and integrating parental 
     involvement strategies under this section, to the extent 
     feasible and appropriate, with parental involvement 
     strategies under other programs, such as the Head Start 
     program and the Early Head Start Program; and
       (D) find innovative ways to remove barriers that exist to 
     providing opportunities for healthy eating and physical 
     activity.
     All activities described in this paragraph shall be evidence-
     based or data-informed and be consistent with the curriculum 
     presented through training activities described in paragraph 
     (3).
       (e) Grants for the Evaluation of Pilot Programs.--The 
     Secretary, acting through the Director of the Centers for 
     Disease Control and Prevention, shall award competitive 
     grants to Prevention Research Centers or universities to 
     evaluate the programs carried out with grants under 
     subsection (d), including baseline, process, and outcome 
     measurements.
       (f) Coordination.--
       (1) Interagency coordination.--To the extent practicable, 
     the Secretary, acting through the Centers for Disease Control 
     and Prevention, shall coordinate activities conducted under 
     this section with activities undertaken by the National 
     Prevention, Health Promotion and Public Health Council 
     established under section 4001. Where possible, such 
     coordination should--
       (A) include the sharing of current and emerging best 
     practices concerning healthy eating, physical activity, and 
     screen time limits that have a population-level impact in 
     promoting nutrition and physical activity in child care 
     settings;
       (B) promote the effective implementation and sustainability 
     of such programs; and
       (C) avoid unnecessary duplication of effort.
       (2) Pilot coordination.--The Director of the Centers for 
     Disease Control and Prevention shall designate an individual 
     (directly or through contract) to provide technical 
     assistance to States and pilot centers in the development, 
     implementation, and evaluation of activities and 
     dissemination of information described in subparagraphs (A), 
     (B), and (C) of paragraph (1).
       (g) Evaluation and Reporting.--
       (1) Technical assistance and information.--The Secretary, 
     acting through the Director of the Centers for Disease 
     Control and Prevention, shall--
       (A) provide technical assistance to grantees and other 
     entities providing training under a grant under this section; 
     and
       (B) disseminate to health departments and trainers under 
     grants under this section information concerning evidence-
     based or data-informed approaches, including dissemination of 
     existing toolkits, curricula, and existing or emerging best 
     practices that can be expanded or improved upon through a 
     program conducted under this section.
       (2) Evaluation requirements.--With respect to evaluations 
     conducted under subsection (e), the Secretary, acting through 
     the Director of the Center for Disease Control and 
     Prevention, shall ensure that--
       (A) evaluation metrics are consistent across all programs 
     funded under this section;
       (B) interim outcomes are measured by the number of centers 
     that have implemented policy and environmental strategies 
     that support use of curricula and practices supporting 
     healthy eating, physical activity, and screen time limits;
       (C) interim outcomes are measured, to the extent possible, 
     by behavior changes in healthy eating, physical activity, and 
     screen time; and
       (D) upon completion of the program, the evaluation shall 
     include an identification of best practices relating to 
     behavior change and reductions in the increasing prevalence 
     of overweight and obesity that could be replicated in other 
     settings.
       (3) Dissemination of information.--Upon the conclusion of 
     the programs carried out under this section, the Secretary, 
     acting through the Director of the Centers for Disease 
     Control and Prevention, shall disseminate evidence, best 
     practices, and lessons learned from grantees and shall submit 
     to Congress a report concerning the evaluation of such 
     programs, including recommendations as to how lessons learned 
     from such programs can be incorporated into future guidance 
     documents developed and provided by the Director for States 
     and communities funded for nutrition, physical activity, and 
     obesity prevention.
       (h) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $7,500,000 for 
     each of fiscal years 2011, 2012 and 2013.
                                 ______
                                 
  SA 2955. Mr. UDALL of Colorado (for himself, Mrs. Hagan, Ms. 
Klobuchar, Mr. Begich, Mr. Kaufman, Mr. Udall of New Mexico, Mr. Kirk, 
Mr. Kohl, Mr. Franken, Mr. Specter, and Mr. Casey) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 1507, after line 19, insert the following:

     SEC. 5510. RURAL PHYSICIAN TRAINING GRANTS.

       Part C of title VII of the Public Health Service Act (42 
     U.S.C. 293k et seq.) is amended--
       (1) after the part heading, by inserting the following:

               ``Subpart I--Medical Training Generally'';

     and
       (2) by inserting at the end the following:

           ``Subpart II--Training in Underserved Communities

     ``SEC. 749B. RURAL PHYSICIAN TRAINING GRANTS.

       ``(a) In General.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, shall establish a program to make grants to 
     eligible entities for the purposes of--
       ``(1) assisting eligible entities in recruiting students 
     most likely to practice medicine in underserved rural 
     communities;
       ``(2) providing rural-focused training and experience; and
       ``(3) increasing the number of recent allopathic and 
     osteopathic medical school graduates who practice in 
     underserved rural communities.
       ``(b) Eligible Entities.--In order to be eligible to 
     receive a grant under this section, an entity shall--
       ``(1) be a school of allopathic or osteopathic medicine 
     accredited by a nationally recognized accrediting agency or 
     association approved by the Secretary for this purpose, or 
     any combination or consortium of such schools; and
       ``(2) submit an application to the Secretary at such time, 
     in such form, and containing such information as the 
     Secretary may require, including a certification that such 
     entity--
       ``(A) will use amounts provided to the institution to--
       ``(i) establish and carry out a Rural Physician Training 
     Program described in subsection (d);
       ``(ii) improve an existing rural-focused training program 
     to meet the requirements described in subsection (d) and 
     carry out such program; or
       ``(iii) expand and carry out an existing rural-focused 
     training program that meets the requirements described in 
     subsection (d); and
       ``(B) employs, or will employ within a timeframe sufficient 
     to implement the Program (as described by a timetable and 
     supporting documentation in the application of the eligible 
     entity), faculty with experience or training in rural 
     medicine or with experience in training rural physicians.
       ``(c) Priority.--In awarding grant funds under this 
     section, the Secretary shall give priority to eligible 
     entities that--
       ``(1) demonstrate a record of successfully training 
     students, as determined by the Secretary, who practice 
     medicine in underserved rural communities;
       ``(2) demonstrate that an existing academic program of the 
     eligible entity produces a high percentage, as determined by 
     the Secretary, of graduates from such program who practice 
     medicine in underserved rural communities;
       ``(3) demonstrate rural community institutional 
     partnerships, through such mechanisms as matching or 
     contributory funding, documented in-kind services for 
     implementation, or existence of training partners with 
     interprofessional expertise (such as dental, vision, or 
     mental health services) in community health center training 
     locations or other similar facilities; or
       ``(4) submit, as part of the application of the entity 
     under subsection (b), a plan for the long-term tracking of 
     where the graduates of such entity are practicing medicine.
       ``(d) Use of Funds.--
       ``(1) Establishment.--An eligible entity receiving a grant 
     under this section shall use the funds made available under 
     such grant to--

[[Page S12624]]

       ``(A) establish and carry out a `Rural Physician Training 
     Program' (referred to in this section as the `Program');
       ``(B) improve an existing rural-focused training program to 
     meet the Program requirements described in this subsection 
     and carry out such program; or
       ``(C) expand and carry out an existing rural-focused 
     training program that meets the Program requirements 
     described in this subsection.
       ``(2) Structure of program.--An eligible entity shall--
       ``(A) enroll no fewer than 10 students per class year into 
     the Program; and
       ``(B) develop criteria for admission to the Program that 
     gives priority to students--
       ``(i) who have originated from or lived for a period of 2 
     or more years in an underserved rural community; and
       ``(ii) who express a commitment to practice medicine in an 
     underserved rural community.
       ``(3) Curricula.--The Program shall require students to 
     enroll in didactic coursework and clinical experience 
     particularly applicable to medical practice in underserved 
     rural communities, including--
       ``(A) clinical rotations in underserved rural communities, 
     and in specialties including family medicine, internal 
     medicine, pediatrics, surgery, psychiatry, and emergency 
     medicine;
       ``(B) in addition to core school curricula, additional 
     coursework or training experiences focused on medical issues 
     prevalent in underserved rural communities, including in 
     areas such as trauma, obstetrics, ultrasound, oral health, 
     and behavioral health; and
       ``(C) any coursework or clinical experience that--
       ``(i) may be developed as a result of the Symposium 
     described in subsection (f); or
       ``(ii) the Secretary finds appropriate.
       ``(4) Residency placement assistance.--Where available, the 
     Program shall assist all students of the Program in obtaining 
     clinical training experiences in locations with postgraduate 
     programs offering residency training opportunities in 
     underserved rural communities, or in local residency training 
     programs that support and train physicians to practice in 
     underserved rural communities, as well as assist all students 
     of the Program in obtaining postgraduate residency training 
     in such programs.
       ``(5) Program student cohort support.--The Program shall 
     provide and require all students of the Program to 
     participate in social, educational, and other group 
     activities designed to further develop, maintain, and 
     reinforce the original commitment of such students to 
     practice in an underserved rural community.
       ``(e) Annual Reporting Requirement.--On an annual basis, an 
     eligible entity receiving a grant under this section shall 
     submit a report to the Secretary on--
       ``(1) the overall success of the Program established by the 
     entity, based on criteria the Secretary determines 
     appropriate;
       ``(2) the number of students participating in the Program;
       ``(3) the number of graduating students who participated in 
     the Program;
       ``(4) the residency program selection of graduating 
     students who participated in the Program;
       ``(5) the number of graduates who participated in the 
     Program who are practicing in underserved rural communities 
     not less than one year after completing residency training; 
     and
       ``(6) the number of graduates who participated in the 
     Program who are not practicing in underserved rural 
     communities not less than one year after completing residency 
     training.
       ``(f) Rural Training Program Symposium.--
       ``(1) Purposes of symposium.--To assist the Secretary in 
     carrying out the Program and making grant determinations 
     under this section, the Secretary shall convene a Rural 
     Training Program Symposium (referred to in this section as 
     the `Symposium') to--
       ``(A) develop best practices that may be incorporated into 
     consideration of applications under subsection (b); and
       ``(B) establish a network of allopathic and osteopathic 
     medical schools that have developed or will develop rural 
     training programs in accordance with subsection (d).
       ``(2) Composition.--The Symposium shall include--
       ``(A) representatives from eligible entities with existing 
     rural training programs;
       ``(B) representatives from all eligible entities interested 
     in developing the Program;
       ``(C) representatives from area health education centers;
       ``(D) representatives from the Health Resources and 
     Services Administration; and
       ``(E) any other experts or individuals with experience in 
     practicing medicine in underserved rural communities the 
     Secretary determines appropriate.
       ``(g) Regulations.--Not later than 60 days after the date 
     of enactment of this section, the Secretary shall by 
     regulation define `underserved rural community' for purposes 
     of this section.
       ``(h) Supplement Not Supplant.--Any eligible entity 
     receiving funds under this section shall use such funds to 
     supplement, not supplant, any other Federal, State, and local 
     funds that would otherwise be expended by such entity to 
     carry out the activities described in this section.
       ``(i) Maintenance of Effort.--With respect to activities 
     for which funds awarded under this section are to be 
     expended, the entity shall agree to maintain expenditures of 
     non-Federal amounts for such activities at a level that is 
     not less than the level of such expenditures maintained by 
     the entity for the fiscal year preceding the fiscal year for 
     which the entity receives a grant under this section.
       ``(j) Authorization of Appropriations.--There are 
     authorized to be appropriated--
       ``(1) to carry out this section (other than subsection 
     (f))--
       ``(A) $4,000,000 for fiscal year 2010;
       ``(B) $8,000,000 for fiscal year 2011;
       ``(C) $12,000,000 for fiscal year 2012;
       ``(D) $16,000,000 for fiscal year 2013; and
       ``(2) to carry out subsection (f), such sums as may be 
     necessary.''.
                                 ______
                                 
  SA 2956. Mr. UDALL of Colorado (for himself, Mr. Harkin, and Mr. 
Warner) submitted an amendment intended to be proposed to amendment SA 
2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590 to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for the 
purposes; which was ordered to lie on the table; as follows:

       On page 1266, between lines 17 and 18, insert the 
     following:

        Subtitle F--Physical Activity Guidelines and Foundation

                  PART I--PHYSICAL ACTIVITY GUIDELINES

     SEC. 4501. ESTABLISHMENT OF PHYSICAL ACTIVITY GUIDELINES.

       (a) Report.--
       (1) In general.--At least every 5 years, the Secretary of 
     Health and Human Services (in this section referred to as the 
     ``Secretary'') shall publish a report entitled ``Physical 
     Activity Guidelines for Americans''. Each such report shall 
     contain physical activity information and guidelines for the 
     general public, and shall be promoted by each Federal agency 
     in carrying out any Federal health program.
       (2) Basis of guidelines.--The information and guidelines 
     contained in each report required under paragraph (1) shall 
     be based on the preponderance of the scientific and medical 
     knowledge which is current at the time the report is 
     prepared.
       (b) Approval by Secretary.--
       (1) Review.--Any Federal agency that proposes to issue any 
     physical activity guidance for the general population or 
     identified population subgroups shall submit the text of such 
     guidance to the Secretary for a 60-day review period.
       (2) Basis of review.--
       (A) In general.--During the 60-day review period 
     established in paragraph (1), the Secretary shall review and 
     approve or disapprove such guidance to assure that the 
     guidance either is consistent with the ``Physical Activity 
     Guidelines for Americans'' or that the guidance is based on 
     medical or new scientific knowledge which is determined to be 
     valid by the Secretary. If after such 60-day review period 
     the Secretary has not notified the proposing agency that such 
     guidance has been disapproved, then such guidance may be 
     issued by the agency. If the Secretary disapproves such 
     guidance, it shall be returned to the agency. If the 
     Secretary finds that such guidance is inconsistent with the 
     ``Physical Activity Guidelines for Americans'' and so 
     notifies the proposing agency, such agency shall follow the 
     procedures set forth in this subsection before disseminating 
     such proposal to the public in final form. If after such 60-
     day period, the Secretary disapproves such guidance as 
     inconsistent with the ``Physical Activity Guidelines for 
     Americans'' the proposing agency shall--
       (i) publish a notice in the Federal Register of the 
     availability of the full text of the proposal and the 
     preamble of such proposal which shall explain the basis and 
     purpose for the proposed physical activity guidance;
       (ii) provide in such notice for a public comment period of 
     30 days; and
       (iii) make available for public inspection and copying 
     during normal business hours any comment received by the 
     agency during such comment period.
       (B) Review of comments.--After review of comments received 
     during the comment period, the Secretary may approve for 
     dissemination by the proposing agency a final version of such 
     physical activity guidance along with an explanation of the 
     basis and purpose for the final guidance which addresses 
     significant and substantive comments as determined by the 
     proposing agency.
       (C) Announcement.--Any such final physical activity 
     guidance to be disseminated under subparagraph (B) shall be 
     announced in a notice published in the Federal Register, 
     before public dissemination along with an address where 
     copies may be obtained.
       (D) Notification of disapproval.--If after the 30-day 
     period for comment as provided under subparagraph (A)(ii), 
     the Secretary disapproves a proposed physical activity 
     guidance, the Secretary shall notify the Federal agency 
     submitting such guidance of such disapproval, and such 
     guidance may not be issued, except as provided in 
     subparagraph (E).
       (E) Review of disapproval.--If a proposed physical activity 
     guidance is disapproved by the Secretary under subparagraph 
     (D), the Federal agency proposing such guidance

[[Page S12625]]

     may, within 15 days after receiving notification of such 
     disapproval under subparagraph (D), request the Secretary to 
     review such disapproval. Within 15 days after receiving a 
     request for such a review, the Secretary shall conduct such 
     review. If, pursuant to such review, the Secretary approves 
     such proposed physical activity guidance, such guidance may 
     be issued by the Federal agency.
       (3) Definitions.--In this subsection:
       (A) The term ``physical activity guidance for the general 
     population'' does not include any rule or regulation issued 
     by a Federal agency.
       (B) The term ``identified population subgroups'' shall 
     include, but not be limited to, groups based on factors such 
     as age, sex, race, or physical disability.
       (c) Existing Authority Not Affected.--This section does not 
     place any limitations on--
       (1) the conduct or support of any scientific or medical 
     research by any Federal agency; or
       (2) the presentation of any scientific or medical findings 
     or the exchange or review of scientific or medical 
     information by any Federal agency.

      PART II--NATIONAL FOUNDATION ON PHYSICAL FITNESS AND SPORTS

     SEC. 4511. ESTABLISHMENT AND PURPOSE OF FOUNDATION.

       (a) Establishment.--There is established the National 
     Foundation on Physical Fitness and Sports (hereinafter in 
     this part referred to as the ``Foundation''). The Foundation 
     is a charitable and nonprofit corporation and is not an 
     agency or establishment of the United States.
       (b) Purposes.--The purposes of the Foundation are--
       (1) in conjunction with the President's Council on Physical 
     Fitness and Sports, to develop a list and description of 
     programs, events and other activities which would further the 
     goals outlined in Executive Order 12345 and with respect to 
     which combined private and governmental efforts would be 
     beneficial; and
       (2) to encourage and promote the participation by private 
     organizations in the activities referred to in subsection 
     (b)(1) and to encourage and promote private gifts of money 
     and other property to support those activities.
       (c) Disposition of Money and Property.--At least annually 
     the Foundation shall transfer, after the deduction of the 
     administrative expenses of the Foundation, the balance of any 
     contributions received for the activities referred to in 
     subsection (b), to the United States Public Health Service 
     Gift Fund pursuant to section 2701 of the Public Health 
     Service Act (42 U.S.C. 300aaa) for expenditure pursuant to 
     the provisions of that section and consistent with the 
     purposes for which the funds were donated.

     SEC. 4512. BOARD OF DIRECTORS OF THE FOUNDATION.

       (a) Establishment and Membership.--The Foundation shall 
     have a governing Board of Directors (hereinafter referred to 
     in this part as the ``Board''), which shall consist of 9 
     members each of whom shall be a United States citizen and--
       (1) 3 of whom must be knowledgeable or experienced in one 
     or more fields directly connected with physical fitness, 
     sports, or the relationship between health status and 
     physical exercise; and
       (2) 6 of whom must be leaders in the private sector with a 
     strong interest in physical fitness, sports, or the 
     relationship between health status and physical exercise.

     The membership of the Board, to the extent practicable, shall 
     represent diverse professional specialties relating to the 
     achievement of physical fitness through regular participation 
     in programs of exercise, sports, and similar activities. The 
     Assistant Secretary for Health, the Executive Director of the 
     President's Council on Physical Fitness and Sports, the 
     Director for the National Center for Chronic Disease 
     Prevention and Health Promotion, the Director of the National 
     Heart, Lung, and Blood Institute, and the Director for the 
     Centers for Disease Control and Prevention shall be ex 
     officio, nonvoting members of the Board. Appointment to the 
     Board or its staff shall not constitute employment by, or the 
     holding of an office of, the United States for the purposes 
     of any Federal employment or other law.
       (b) Appointments.--Within 90 days from the date of 
     enactment of this Act, the members of the Board will be 
     appointed. Three members of the Board will be appointed by 
     the Secretary (hereinafter referred to in this part as the 
     ``Secretary''), 2 by the majority leader of the Senate, 1 by 
     the minority leader of the Senate, 2 by the Speaker of the 
     House of Representatives, 1 by the minority leader of the 
     House of Representatives.
       (c) Terms.--The members of the Board shall serve for a term 
     of 6 years. A vacancy on the Board shall be filled within 60 
     days of the vacancy in the same manner in which the original 
     appointment was made and shall be for the balance of the term 
     of the individual who was replaced. No individual may serve 
     more than 2 consecutive terms as a member.
       (d) Chairman.--The Chairman shall be elected by the Board 
     from its members for a 2-year term and will not be limited in 
     terms or service.
       (e) Quorum.--A majority of the current membership of the 
     Board shall constitute a quorum for the transaction of 
     business.
       (f) Meetings.--The Board shall meet at the call of the 
     Chairman at least once a year. If a member misses 3 
     consecutive regularly scheduled meetings, that member may be 
     removed from the Board and the vacancy filled in accordance 
     with subsection (c).
       (g) Reimbursement of Expenses.--Members of the Board shall 
     serve without pay, but may be reimbursed for the actual and 
     necessary traveling and subsistence expenses incurred by them 
     in the performance of the duties of the Foundation, subject 
     to the same limitations on reimbursement that are imposed 
     upon employees of Federal agencies.
       (h) Limitations.--The following limitations apply with 
     respect to the appointment of officers and employees of the 
     Foundation:
       (1) Officers and employees may not be appointed until the 
     Foundation has sufficient funds to pay them for their 
     service. No individual so appointed may receive pay in excess 
     of the annual rate of basic pay in effect for Executive Level 
     V in the Federal service.
       (2) The first officer or employee appointed by the Board 
     shall be the Secretary of the Board who shall serve, at the 
     direction of the Board, as its chief operating officer and 
     shall be knowledgeable and experienced in matters relating to 
     physical fitness and sports.
       (3) No Public Health Service employee nor the spouse or 
     dependent relative of such an employee may serve as an 
     officer or member of the Board of Directors or as an employee 
     of the Foundation.
       (4) Any individual who is an officer, employee, or member 
     of the Board of the Foundation may not (in accordance with 
     the policies developed under subsection (i)) personally or 
     substantially participate in the consideration or 
     determination by the Foundation of any matter that would 
     directly or predictably affect any financial interest of the 
     individual or a relative (as such term is defined in section 
     109(16) of the Ethics in Government Act, 1978) of the 
     individual, of any business organization, or other entity, or 
     of which the individual is an officer or employee, is 
     negotiating for employment, or in which the individual has 
     any other financial interest.
       (i) General Powers.--The Board may complete the 
     organization of the Foundation by--
       (1) appointing officers and employees;
       (2) adopting a constitution and bylaws consistent with the 
     purposes of the Foundation and the provision of this part; 
     and
       (3) undertaking such other acts as may be necessary to 
     carry out the provisions of this part.
     In establishing bylaws under this subsection, the Board shall 
     provide for policies with regard to financial conflicts of 
     interest and ethical standards for the acceptance, 
     solicitation and disposition of donations and grants to the 
     Foundation.

     SEC. 4513. RIGHTS AND OBLIGATIONS OF THE FOUNDATION.

       (a) In General.--The Foundation--
       (1) shall have perpetual succession;
       (2) may conduct business throughout the several States, 
     territories, and possessions of the United States;
       (3) shall have its principal offices in or near the 
     District of Columbia; and
       (4) shall at all times maintain a designated agent 
     authorized to accept service of process for the Foundation.

     The serving of notice to, or service of process upon, the 
     agent required under paragraph (4), or mailed to the business 
     address of such agent, shall be deemed as service upon or 
     notice to the Foundation.
       (b) Seal.--The Foundation shall have an official seal 
     selected by the Board which shall be judicially noticed.
       (c) Powers.--To carry out its purposes under section 4511, 
     and subject to the specific provisions thereof, the 
     Foundation shall have the usual powers of a corporation 
     acting as a trustee in the District of Columbia, including 
     the power--
       (1) except as otherwise provided herein, to accept, 
     receive, solicit, hold, administer and use any gift, devise, 
     or bequest, either absolutely or in trust, of real or 
     personal property or any income therefrom or other interest 
     therein;
       (2) to acquire by purchase or exchange any real or personal 
     property or interest therein;
       (3) unless otherwise required by the instrument of 
     transfer, to sell, donate, lease, invest, reinvest, retain or 
     otherwise dispose of any property or income therefrom;
       (4) to sue and be sued, and complain and defend itself in 
     any court of competent jurisdiction, except for gross 
     negligence;
       (5) to enter into contracts or other arrangements with 
     public agencies and private organizations and persons and to 
     make such payments as may be necessary to carry out its 
     functions; and
       (6) to do any and all acts necessary and proper to carry 
     out the purposes of the Foundation.
     For purposes of this part, an interest in real property shall 
     be treated as including easements or other rights for 
     preservation, conservation, protection, or enhancement by and 
     for the public of natural, scenic, historic, scientific, 
     educational inspirational or recreational resources. A gift, 
     devise, or bequest may be accepted by the Foundation even 
     though it is encumbered, restricted, or subject to beneficial 
     interests of private persons if any current or future 
     interest therein is for the benefit of the Foundation.

     SEC. 4514. PROTECTION AND USES OF TRADEMARKS AND TRADE NAMES.

       (a) Protection.--Without the consent of the Foundation in 
     conjunction with the President's Council on Physical Fitness 
     and Sports, any person who uses for the purpose

[[Page S12626]]

     of trade, uses to induce the sale of any goods or services, 
     or uses to promote any theatrical exhibition, athletic 
     performance or competition--
       (1) the official seal of the President's Council on 
     Physical Fitness and Sports consisting of the eagle holding 
     an olive branch and arrows with shield breast encircled by 
     name ``President's Council on Physical Fitness and Sports'' 
     and consisting, depending upon placement, of diagonal 
     stripes;
       (2) the official seal of the Foundation; or
       (3) any trademark, trade name, sign, symbol, or insignia 
     falsely representing association with or authorization by the 
     President's Council on Physical Fitness and Sports or the 
     Foundation;
     shall be subject in a civil action by the Foundation for the 
     remedies provided in the Act of July 9, 1946 (60 Stat. 427; 
     popularly known as the Trademark Act of 1946).
       (b) Uses.--The Foundation, in conjunction with the 
     President's Council on Physical Fitness and Sports, may 
     authorize contributors and suppliers of goods or services to 
     use the trade name or the President's Council on Physical 
     Fitness and Sports and the Foundation as well as any 
     trademark, seal, symbol, insignia, or emblem of the 
     President's Council on Physical Fitness and Sports or the 
     Foundation in advertising that the contributors, goods, or 
     services when donated, supplied, or furnished to or for the 
     use of, or approved, selected, or used by the President's 
     Council on Physical Fitness and Sports or the Foundation.

     SEC. 4515. VOLUNTEER STATUS.

       The Foundation may accept, without regard to the civil 
     service classification laws, rules, or regulations, the 
     services of volunteers in the performance of the functions 
     authorized herein, in the manner provided for under section 
     7(c) of the Fish and Wildlife Act of 1956 (16 U.S.C. 
     742f(c)).

     SEC. 4516. AUDIT, REPORT REQUIREMENTS, AND PETITION OF 
                   ATTORNEY GENERAL FOR EQUITABLE RELIEF.

       (a) Audits.--For purposes of the Act entitled ``An Act for 
     audit of accounts of private corporations established under 
     Federal law'', approved August 30, 1964 (Public Law 88-504, 
     36 U.S.C. 1101-1103), the Foundation shall be treated as a 
     private corporation under Federal law. The Inspector General 
     of the Department of Health and Human Services and the 
     Comptroller General of the United States shall have access to 
     the financial and other records of the Foundation, upon 
     reasonable notice.
       (b) Report.--The Foundation shall, as soon as practicable 
     after the end of each fiscal year, transmit to the Secretary 
     of Health and Human Services and to Congress a report of its 
     proceedings and activities during such year, including a full 
     and complete statement of its receipts, expenditures, and 
     investments.
       (c) Relief With Respect to Certain Foundation Acts or 
     Failure To Act.--If the Foundation--
       (1) engages in, or threatens to engage in, any act, 
     practice or policy that is inconsistent with its purposes set 
     forth in section 4511(b); or
       (2) refuses, fails, or neglects to discharge its 
     obligations under this part, or threaten to do so;
     the Attorney General of the United States may petition in the 
     United States District Court for the District of Columbia for 
     such equitable relief as may be necessary or appropriate.

     SEC. 4517. AUTHORIZATION OF APPROPRIATIONS.

       For fiscal year 2010, there are authorized to be 
     appropriated such sums as may be necessary, to be made 
     available to the Foundation for organizational costs.
                                 ______
                                 
  SA 2957. Mr. BENNET (for himself and Ms. Stabenow) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       At the end of section 4101, insert the following:
       (c) Amendments to School-Based Health Centers Program.--
     Section 399Z-1 of the Public Health Service Act, as added by 
     subsection (b), is amended--
       (1) in subsection (f)(1)(A)(iii), by inserting ``, 
     including programs to promote healthy, active lifestyles and 
     wellness for students'' after ``programs'';
       (2) by redesignating subsection (l) as subsection (m); and
       (3) by inserting after subsection (k) the following:
       ``(l) Regulations Regarding Reimbursement for Health 
     Services.--The Secretary shall issue regulations regarding 
     the reimbursement for health services provided by SBHCs to 
     individuals eligible to receive such services through the 
     program under this section, including reimbursement under any 
     insurance policy or any Federal or State health benefits 
     program (including titles XIX and XXI of the Social Security 
     Act).''.
                                 ______
                                 
  SA 2958. Mr. BENNET submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of title VII, insert the following:

            Subtitle C--Rural Health Access and Improvement

     SEC. 7201. GRANTS TO PROMOTE HOSPITAL HEALTH INFORMATION 
                   TECHNOLOGY.

       Section 3013 of the Public Health Service Act (42 U.S.C. 
     300jj-33) is amended by adding at the end the following:
       ``(j) Priority.--In awarding a grant under this section, 
     the Secretary shall give priority to qualified State-
     designated entities that are critical access hospitals, as 
     defined in section 1861(mm) of the Social Security Act.''.

     SEC. 7202. EXPANDED PARTICIPATION IN SECTION 340B PROGRAM.

       Section 340B(a)(4) of the Public Health Service Act (42 
     U.S.C. 256b(a)(4)), as amended by section 7101(a), is further 
     amended by adding at the end the following:
       ``(P) An entity that is a rural health clinic, as defined 
     in section 1861(aa)(2) of the Social Security Act.''.

     SEC. 7203. GAO STUDY AND REPORT ON DISPENSING FEES.

       (a) Study.--The Comptroller General of the United States 
     shall conduct a study of the cost in each State of dispensing 
     prescription drugs under the Medicaid program under title XIX 
     of the Social Security Act (42 U.S.C. 1396a et seq.), which 
     shall consider--
       (1) any reasonable costs associated with pharmacists--
       (A) checking for information regarding Medicaid coverage of 
     individuals; and
       (B) performing necessary clinical review and quality 
     assurance activities, such as--
       (i) activities to identify and reduce the frequency of 
     patterns of fraud, abuse, gross overuse, and inappropriate or 
     medically unnecessary care among physicians, pharmacists, and 
     patients;
       (ii) activities associated with specific drugs or groups of 
     drugs, including potential and actual severe adverse 
     reactions to drugs, including education on therapeutic 
     appropriateness, over-utilization and under-utilization of 
     drugs, appropriate use of generic products, therapeutic 
     duplication, drug-disease contraindications, drug 
     interactions, incorrect drug dosage or duration of drug 
     treatment, drug-allergy interactions, and clinical abuse or 
     misuse; and
       (iii) any other clinical review and quality assurance 
     activities required under Federal or State law;
       (2) the costs incurred by a pharmacy that are associated 
     with--
       (A) the measurement or mixing of a drug covered by 
     Medicaid;
       (B) filling the container for such a drug;
       (C) physically transferring the prescription to the 
     patient, including any costs of delivering the medication to 
     the home of such patient;
       (D) special packaging of drugs;
       (E) overhead costs of the pharmacy, or the section of the 
     facility that is devoted to a pharmacy, and maintenance of 
     the pharmacy or section of the facility (including the 
     equipment necessary to operate such pharmacy or such section 
     and the salaries of pharmacists and other pharmacy workers);
       (F) geographic factors that impact operational costs;
       (G) compounding such prescription if necessary; and
       (H) uncollectability of Medicaid prescription copayments;
       (3) the variation in costs described in paragraph (2) based 
     on--
       (A) whether a product dispensed is a rural or urban 
     pharmacy;
       (B) whether the product dispensed is a specialty pharmacy 
     product; and
       (C) whether the pharmacy is located in, or contracts with, 
     a long-term care facility; and
       (4) the increase in dispensing fees, including the costs 
     described in paragraphs (1), (2), and (3), that would be 
     sufficient to create an incentive for a pharmacist to promote 
     the use of generic medications.
       (b) Report.--Not later than December 1, 2010, the 
     Comptroller General of the United States shall submit to the 
     Secretary of Health and Human Services and to each State a 
     report describing the study conducted under subsection (a). 
     The report shall include--
       (1) the average cost in each State of dispensing a 
     prescription drug under Medicaid;
       (2) the findings of the study conducted under subsection 
     (a) with respect to--
       (A) the variation in costs studied under subparagraphs (A) 
     and (B) of paragraph (3) of such subsection; and
       (B) the increase in dispensing fees described in paragraph 
     (4) of such subsection.
       (c) Use of Study.--Each State shall use the report 
     described in subsection (b) to assess the adequacy of 
     Medicaid pharmacy dispensing fees. The Secretary of Health 
     and Human Services shall use such report to approve State 
     plan amendments for States that submit such amendments for 
     the purposes of increasing Medicaid pharmacy dispensing fees.

[[Page S12627]]

     SEC. 7204. STATE OFFICES OF RURAL HEALTH.

       Section 338J of the Public Health Service Act (42 U.S.C. 
     254r) is amended by striking subsection (k).
                                 ______
                                 
  SA 2959. Mr. LEAHY (for himself and Mr. Brown) submitted an amendment 
intended to be proposed to amendment SA 2786 proposed by Mr. Reid (for 
himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, 
to amend the Internal Revenue Code of 1986 to modify the first-time 
homebuyers credit in the case of members of the Armed Forces and 
certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 1266, between lines 17 and 18, insert the 
     following:

     SEC. 4403. EXTENSION OF MEDICAL MALPRACTICE COVERAGE TO FREE 
                   CLINICS.

       (a) In General.--Section 224(o)(1) of the Public Health 
     Service Act (42 U.S.C. 233(o)(1)) is amended by inserting 
     after ``to an individual'' the following: ``, or an officer, 
     governing board member, employee, or contractor of a free 
     clinic shall in providing services for the free clinic,''.
       (b) Effective Date.--The amendment made by this section 
     shall take effect on the date of enactment of this Act and 
     apply to any act or omission which occurs on or after that 
     date.
                                 ______
                                 
  SA 2960. Mrs. SHAHEEN submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 816, after line 20, insert the following:

     SEC. 3115. RECOGNITION OF CERTIFIED DIABETES EDUCATORS AS 
                   CERTIFIED PROVIDERS FOR PURPOSES OF MEDICARE 
                   DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING 
                   SERVICES.

       (a) In General.--Section 1861(qq) of the Social Security 
     Act (42 U.S.C. 1395x(qq)) is amended--
       (1) in paragraph (1), by inserting ``or by a certified 
     diabetes educator (as defined in paragraph (3))'' after 
     ``paragraph (2)(B)''; and
       (2) by adding at the end the following new paragraphs:
       ``(3) For purposes of paragraph (1), the term `certified 
     diabetes educator' means an individual who--
       ``(A) is licensed or registered by the State in which the 
     services are performed as a health care professional;
       ``(B) specializes in teaching individuals with diabetes to 
     develop the necessary skills and knowledge to manage the 
     individual's diabetic condition; and
       ``(C) is certified as a diabetes educator by a recognized 
     certifying body (as defined in paragraph (4)).
       ``(4)(A) For purposes of paragraph (3)(C), the term 
     `recognized certifying body' means--
       ``(i) the National Certification Board for Diabetes 
     Educators, or
       ``(ii) a certifying body for diabetes educators, which is 
     recognized by the Secretary as authorized to grant 
     certification of diabetes educators for purposes of this 
     subsection pursuant to standards established by the 
     Secretary, if the Secretary determines such Board or body, 
     respectively, meets the requirement of subparagraph (B).
       ``(B) The National Certification Board for Diabetes 
     Educators or a certifying body for diabetes educators meets 
     the requirement of this subparagraph, with respect to the 
     certification of an individual, if the Board or body, 
     respectively, is incorporated and registered to do business 
     in the United States and requires as a condition of such 
     certification each of the following:
       ``(i) The individual has a qualifying credential in a 
     specified health care profession.
       ``(ii) The individual has professional practice experience 
     in diabetes self-management training that includes a minimum 
     number of hours and years of experience in such training.
       ``(iii) The individual has successfully completed a 
     national certification examination offered by such entity.
       ``(iv) The individual periodically renews certification 
     status following initial certification.''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply to diabetes outpatient self-management training 
     services furnished on or after the first day of the first 
     calendar year that is at least 6 months after the date of the 
     enactment of this Act.
                                 ______
                                 
  SA 2961. Mrs. SHAHEEN submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1925, between lines 14 and 15, insert the 
     following:

            Subtitle C--Provisions Relating to Generic Drugs

     SEC. 7201. LABELING CHANGES.

       Section 505(j) of the Federal Food, Drug, and Cosmetic Act 
     (21 U.S.C. 355(j)) is amended by adding at the end the 
     following:
       ``(10)(A) If the proposed labeling of a drug that is the 
     subject of an application under this subsection differs from 
     the listed drug due to a labeling revision described under 
     clause (i), the drug that is the subject of such application 
     shall, notwithstanding any other provision of this Act, be 
     eligible for approval and shall not be considered misbranded 
     under section 502 if--
       ``(i) the application is otherwise eligible for approval 
     under this subsection but for expiration of patent, an 
     exclusivity period, or of a delay in approval described in 
     paragraph (5)(B)(iii), and a revision to the labeling of the 
     listed drug has been approved by the Secretary within 60 days 
     of such expiration;
       ``(ii) the labeling revision described under clause (i) 
     does not include a change to the `Warnings' section of the 
     labeling;
       ``(iii) the sponsor of the application under this 
     subsection agrees to submit revised labeling of the drug that 
     is the subject of such application not later than 60 days 
     after the notification of any changes to such labeling 
     required by the Secretary; and
       ``(iv) such application otherwise meets the applicable 
     requirements for approval under this subsection.
       ``(B) If, after a labeling revision described in 
     subparagraph (A)(i), the Secretary determines that the 
     continued presence in interstate commerce of the labeling of 
     the listed drug (as in effect before the revision described 
     in subparagraph (A)(i)) adversely impacts the safe use of the 
     drug, no application under this subsection shall be eligible 
     for approval with such labeling.''.
                                 ______
                                 
  SA 2962. Mr. NELSON of Nebraska (for himself, Mr. Hatch, Mr. Casey, 
Mr. Brownback, Mr. Thune, Mr. Enzi, Mr. Coburn, Mr. Johanns, Mr. 
Vitter, Mr. Barrasso, Mr. Wicker, Mr. Bond, Mr. Bennett, and Mr. 
Inhofe) submitted an amendment intended to be proposed to amendment SA 
2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; as follows:

       Beginning on page 116, strike line 15 and all that follows 
     through line 15 on page 123, and insert the following:
       (a) Special Rules Relating to Coverage of Abortion 
     Services.--
       (1) In general.--Subject to paragraph (2), nothing in this 
     Act (or any amendment made by this Act) shall be construed to 
     require any health plan to provide coverage of abortion 
     services or to allow the Secretary or any other person or 
     entity implementing this Act (or amendment) to require 
     coverage of such services.
       (2) Community health insurance option.--The Secretary may 
     not provide coverage of abortion services in the community 
     health insurance option established under section 1323, 
     except in the case where use of funds authorized or 
     appropriated by this Act is permitted for such services under 
     subsection (b)(1).
       (3) No discrimination on the basis of provision of 
     abortion.--No Exchange participating health benefits plan may 
     discriminate against any individual health care provider or 
     health care facility because of its unwillingness to provide, 
     pay for, provide coverage of, or refer for abortions.
       (b) Limitation on Abortion Funding.--
       (1) In general.--No funds authorized or appropriated by 
     this Act (or an amendment made by this Act) may be used to 
     pay for any abortion or to cover any part of the costs of any 
     health plan that includes coverage of abortion, except in the 
     case where a woman suffers from a physical disorder, physical 
     injury, or physical illness that would, as certified by a 
     physician, place the woman in danger of death unless an 
     abortion is performed, including a life-endangering physical 
     condition caused by or arising from the pregnancy itself, or 
     unless the pregnancy is the result of an act of rape or 
     incest.
       (2) Option to purchase separate supplemental coverage or 
     plan.--Nothing in this subsection shall be construed as 
     prohibiting any non-Federal entity (including an individual 
     or a State or local government) from purchasing separate 
     supplemental coverage for abortions for which funding is 
     prohibited under this subsection, or a plan that includes 
     such abortions, so long as--
       (A) such coverage or plan is paid for entirely using only 
     funds not authorized or appropriated by this Act; and
       (B) such coverage or plan is not purchased using--
       (i) individual premium payments required for a qualified 
     health plan offered through the Exchange towards which a 
     credit is applied under section 36B of the Internal Revenue 
     Code of 1986; or

[[Page S12628]]

       (ii) other non-Federal funds required to receive a Federal 
     payment, including a State's or locality's contribution of 
     Medicaid matching funds.
       (3) Option to offer supplemental coverage or plan.--Nothing 
     in this subsection shall restrict any non-Federal health 
     insurance issuer offering a qualified health plan from 
     offering separate supplemental coverage for abortions for 
     which funding is prohibited under this subsection, or a plan 
     that includes such abortions, so long as--
       (A) premiums for such separate supplemental coverage or 
     plan are paid for entirely with funds not authorized or 
     appropriated by this Act;
       (B) administrative costs and all services offered through 
     such supplemental coverage or plan are paid for using only 
     premiums collected for such coverage or plan; and
       (C) any such non-Federal health insurance issuer that 
     offers a qualified health plan through the Exchange that 
     includes coverage for abortions for which funding is 
     prohibited under this subsection also offers a qualified 
     health plan through the Exchange that is identical in every 
     respect except that it does not cover abortions for which 
     funding is prohibited under this subsection.
                                 ______
                                 
  SA 2963. Mr. COBURN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 2074, after line 25, add the following:

     SEC. 90__. OPT-OUT OF TAXES AND FEES IMPOSED ON STATES AND 
                   INDIVIDUALS.

       (a) In General.--An individual or State may elect to opt 
     out of any fee or tax imposed or increased under this Act or 
     any amendment made by this Act, including the application 
     of--
       (1) the amendments made by section 9003 (relating to 
     distributions for medicine qualified only if for prescribed 
     drug or insulin), and
       (2) the amendments made by section 9013 (relating to the 
     modification of itemized deduction for medical expenses).
       (b) Process for Election; Notification of Opt-Out.--
       (1) In general.--Any election under subsection (a) shall be 
     made by filing a statement (on line, by mail, or in such 
     other manner as specified by the appropriate Secretary)--
       (A) in the case of any tax provision, with the Secretary of 
     the Treasury, and
       (B) in the case of any other provision, with the Secretary 
     of Health and Human Services.
     The Secretary of the Treasury, in consultation with the 
     Secretary of Health and Human Services, shall establish a 
     form that may be used for making an election under subsection 
     (a) and shall make such form available on the Internet.
       (2) Notification.--
       (A) In general.--Not later than 1 month after the date of 
     the enactment of this Act, the Secretary of the Treasury, 
     together with the Secretary of Health and Human Services, 
     shall mail a notice to each individual who may make an 
     election under subsection (a).
       (B) Content.--The notification under subparagraph (A) 
     shall--
       (i) state that this Act will create government-run health 
     care exchanges and program that will be paid for in part with 
     higher taxes and other fees, and
       (ii) a form that can be used for opting out of such fees 
     and taxes.
       (3) Revocation.--An individual may revoke an election make 
     under subsection (a) at any time in a manner similar to the 
     manner in which the election is made under paragraph (1).
       (c) Responsibility Requirements Treated as Tax 
     Provisions.--For purposes of this section, amounts imposed 
     under sections 5000A and 4980H of the Internal Revenue Code 
     of 1986, as added by this Act, shall be treated as taxes.
                                 ______
                                 
  SA 2964. Mr. COBURN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 17, strike line 11 through line 14.
       On page 396, between lines 8 and 9, insert the following:

     SEC. 1563. ENSURING THAT GOVERNMENT HEALTH CARE RATIONING 
                   DOES NOT HARM, INJURE, OR DENY MEDICALLY 
                   NECESSARY CARE.

       Notwithstanding any other provision of law--
       (1) no individual may be denied health care based on age or 
     life expectancy by any Federal health program, the community 
     health insurance option established under section 1323, or 
     any Exchange established under this Act; and
       (2) no entity of the Federal Government may develop 
     Quality-Adjusted Life Year measures or other similarly 
     designed government formulas for limiting access to 
     treatment.
       Strike section 3403.
       Strike section 4105.
       On page 1680, between lines 20 and 21, insert the 
     following:
       ``(2) Prohibition.--The findings of the Institute are 
     prohibited from being used by any government entity for 
     payment, coverage, or treatment decisions. Nothing in the 
     preceding sentence shall limit a physician or other health 
     care provider from using Institute reports and 
     recommendations when making decisions about the best 
     treatment for an individual patient in an individual 
     circumstance.''.
       At the end of subtitle G of title I, add the following:

     SEC. 15__. IDENTIFICATION OF FEDERAL GOVERNMENT HEALTH CARE 
                   RATIONING.

       (a) In General.--The Comptroller General of the United 
     States shall conduct, and submit to Congress a report 
     describing the results of, a study that compares, with regard 
     to the programs described in subsection (b)--
       (1) any restrictions or limitations regarding access to 
     health care providers (including the percentage of health 
     care providers willing or permitted to care for patients 
     insured by each program);
       (2) any restrictions, denials, or rationing relating to the 
     provision of health care, including medical procedures, tests 
     (including mammograms and cervical cancer screenings), and 
     prescription drug formularies;
       (3) average wait times to see a primary care doctor;
       (4) average wait times for medically necessary surgeries 
     and medical procedures; and
       (5) the estimated waste, fraud, and abuse (including 
     improper payments) in each program.
       (b) Programs.--The programs referred to in subsection (a) 
     are--
       (1) Medicare;
       (2) Medicaid;
       (3) the Indian Health Service;
       (4) the Department of Veterans Affairs; and
       (5) the Federal Employee Health Benefits Program.
                                 ______
                                 
  SA 2965. Mr. COBURN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       After title IX, insert the following:

 TITLE X--CERTIFICATION OF FINANCIAL SUSTAINABILITY AND FISCAL SOLVENCY

     SEC. 10001. FINANCIAL SUSTAINABILITY AND FISCAL SOLVENCY 
                   REQUIREMENT.

       Notwithstanding any other provision of law, the provisions 
     of this Act (and the amendments made by this Act), including 
     any health insurance programs created, run, or expanded by 
     the government through this Act (or the amendments made by 
     this Act), shall not take effect unless the actuary of the 
     Department of Health and Human Services and the actuary of 
     the Social Security Administration each independently 
     certify, in testimony before Congress and in an official 
     report to Congress, that, as of January 1, 2009, the Medicare 
     program under title XVIII of the Social Security Act (42 
     U.S.C. 1395 et seq.) and the Medicaid program under title XIX 
     of the Social Security Act (42 U.S.C. 1396 et seq.) are 
     financially sustainable and fiscally solvent through January 
     1, 2029.
                                 ______
                                 
  SA 2966. Mr. COBURN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 621, strike line 10 and all that follows 
     through page 1134, line 3, and insert the following:

  TITLE III--REDUCING WASTE, FRAUD, AND ABUSE IN MEDICARE AND MEDICAID

     SEC. 3001. PREVENTION AND DETECTION OF WASTE, FRAUD, AND 
                   ABUSE WITHIN THE MEDICARE AND MEDICAID 
                   PROGRAMS.

       (a) In General.--Not later than 2 years after the date of 
     enactment of this Act, the Secretary shall develop and 
     implement innovative technologies, systems, and procedures 
     (as described under subsection (b)) to reduce waste, fraud, 
     and abuse under the Medicare and Medicaid programs and ensure 
     that amounts attributed to waste, fraud, and abuse constitute 
     an amount not greater than 5 percent of all funds expended 
     under the Medicare program.
       (b) Prevention and Detection Measures.--For purposes of 
     subsection (a), the technologies, systems, and procedures to 
     be developed and implemented by the Secretary shall include 
     the following:

[[Page S12629]]

       (1) Improving the Medicare beneficiary identifier (MBI) 
     used to identify beneficiaries under the Medicare program 
     to--
       (A) ensure that the social security account numbers 
     assigned to such beneficiaries are not used;
       (B) provide such beneficiaries with machine-readable 
     identification cards that employ a unique patient number; and
       (C) establish a process for changing the MBI for an 
     individual to a different identifier in the case of the 
     discovery of fraud, including identity theft.
       (2) Comprehensive real-time data matching across Federal 
     agencies (similar to measures employed by the credit card 
     industry) that is able to determine--
       (A) whether a beneficiary under the Medicare or Medicaid 
     programs is dead, imprisoned, or otherwise not eligible for 
     benefits under such programs; and
       (B) whether a provider of services or a supplier under the 
     Medicare or Medicaid programs is dead, imprisoned, or 
     otherwise not eligible to furnish or receive payment for 
     furnishing items and services under such programs.
       (3) Imposition of direct financial penalties to facilities 
     receiving funds under the Medicare or Medicaid programs that 
     employ any physician, executive, or administrator that has 
     been convicted of an offense involving fraud relating to the 
     Medicare or Medicaid programs or reached a settlement 
     relating to such an offense with the Federal Government or 
     any State government.
       (4) Use of procedures and technology (including front-end, 
     pre-payment technology similar to that used by hedge funds, 
     investment funds, and banks) to provide real-time data 
     analysis of claims for payment under the Medicare program to 
     identify and investigate unusual billing or order practices 
     that could indicate fraud or abuse.
       (c) Investigation.--The Secretary shall, in the case where 
     a provider of services or a supplier under the Medicare or 
     Medicaid programs submits a claim for payment for items or 
     services furnished to an individual who the Secretary 
     determines, as a result of information obtained pursuant to 
     subsection (b), is not eligible for benefits under such 
     program, or where the Secretary determines, as a result of 
     such information, that such provider of services or supplier 
     is not eligible to furnish or receive payment for furnishing 
     such items or services, refer the matter to the Inspector 
     General of the Department of Health and Human Services for 
     investigation not later than 14 days after the Secretary has 
     made such a determination.
       (d) Definitions.--In this title:
       (1) Medicaid.--The term ``Medicaid'' means the program for 
     medical assistance established under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.).
       (2) Medicare.--The term ``Medicare'' means the program for 
     medical assistance established under title XVIII of the 
     Social Security Act (42 U.S.C. 1395 et seq.).
       (3) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.

     SEC. 3002. REINVESTMENT OF SAVINGS INTO MEDICARE PROGRAM.

       Any savings achieved under the Medicare program pursuant to 
     the measures developed and implemented by the Secretary under 
     section 3001 shall be reinvested into the Federal Hospital 
     Insurance Trust Fund, as established under section 1817 of 
     the Social Security Act (42 U.S.C. 1395i), or the Federal 
     Supplementary Medical Insurance Trust Fund, as established 
     under section 1841 of such Act (42 U.S.C. 1395t).

     SEC. 3003. USING HEALTH CARE PROFESSIONALS TO REDUCE FRAUD.

       (a) In General.--The Secretary shall establish a 
     demonstration project that uses practicing health care 
     professionals to conduct undercover investigations of other 
     health care professionals.
       (b) Demonstration Project.--
       (1) In general.--The Secretary, in coordination with the 
     Office of the Inspector General of the Department of Health 
     and Human Services (referred to in this section as the 
     ``Inspector General''), shall establish a demonstration 
     project in which the Secretary enters into contracts with 
     practicing health care professionals to conduct 
     investigations of health care providers that receive 
     reimbursements through any Federal public health care 
     program.
       (2) Scope.--The Secretary shall conduct the demonstration 
     project under this section in States or regions that have--
       (A) above-average rates of Medicare fraud; or
       (B) any level of Medicaid fraud.
       (c) Eligibility.--To be eligible to receive a contract 
     under subsection (b)(1), a health care professional shall--
       (1) be a licensed and practicing medical professional who 
     holds an advanced medical degree from an accredited American 
     university or college and has experience within the health 
     care industry; and
       (2) submit to the Secretary such information, at such time, 
     and in such manner, as the Secretary may require.
       (d) Activities.--Each health care professional awarded a 
     contract under subsection (b)(1) shall assist the Secretary 
     and the Inspector General in conducting random audits of the 
     practices of health care providers that receive 
     reimbursements through any Federal public health care 
     program. Such audits may include--
       (1) statistically random visits to the practices of such 
     health care providers;
       (2) attempts to purchase pharmaceutical products illegally 
     from such health care providers;
       (3) purchasing durable medical equipment from such health 
     care providers;
       (4) hospital visits; and
       (5) other activities, as the Secretary determines 
     appropriate.
       (e) Follow-up by the Inspector General.--The Inspector 
     General shall follow up on any notable findings of the 
     investigations conducted under subsection (d) in order to 
     report fraudulent practices and refer individual cases to the 
     appropriate State and local authorities.
       (f) Limitation.--The Secretary shall not contract with a 
     health care professional if, due to physical proximity or a 
     personal, familial, proprietary, or monetary relationship 
     with such health care professional to individuals that such 
     professional would be investigating, a conflict of interest 
     could be inferred.
       (g) Funding.--To carry out this section, the Secretary and 
     the Inspector General are each authorized to reserve, from 
     amounts appropriated to the Department of Health and Human 
     Services and the Office of the Inspector General of the 
     Department of Health and Human Services, respectively, 
     $500,000 for each of fiscal years 2010 through 2014.
                                 ______
                                 
  SA 2967. Mr. COBURN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 124, line 1 insert ``other'' before ``Federal''.
       On page 124, line 4, insert ``other'' before ``Federal''.
       On page 124, between lines 22 and 23, insert the following:

     SEC. 1304. NONDISCRIMINATION ON ABORTION AND RESPECT FOR 
                   RIGHTS OF CONSCIENCE.

       (a) Nondiscrimination.--A Federal agency or program, and 
     any State or local government, or institutional health care 
     entity that receives Federal financial assistance under this 
     Act (or an amendment made by this Act), shall not--
       (1) subject any individual or institutional health care 
     entity to discrimination; or
       (2) require any health care entity that is established or 
     regulated under this Act (or an amendment made by this Act) 
     to subject any individual or institutional health care entity 
     to discrimination;

     on the basis that such health care entity does not provide, 
     pay for, provide coverage of, or refer for abortions.
       (b) Definition.--In this section, the term ``health care 
     entity'' includes an individual physician or other health 
     care professional, a hospital, a provider-sponsored 
     organization, a health maintenance organization, a health 
     insurance plan, a plan sponsor, a health insurance issuer, a 
     qualified health plan or issuer offering such a plan, or any 
     other kind of health care facility, organization, or plan.
       (c) Administration.--The Office for Civil Rights of the 
     Department of Health and Human Services is designated to 
     receive complaints of discrimination based on this section, 
     and coordinate the investigation of such complaints.
                                 ______
                                 
  SA 2968. Mr. COBURN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Strike subtitle D of title IV and insert the following:

 Subtitle D--Prohibition on Comparative Effectiveness Research for the 
           Purpose of Determining Cost and Coverage Decisions

     SEC. 4301. PROHIBITION ON COMPARATIVE EFFECTIVENESS RESEARCH 
                   FOR THE PURPOSE OF DETERMINING COST AND 
                   COVERAGE DECISIONS.

       Reports and recommendations from the Patient-Centered 
     Outcomes Research Institute, established under section 1181 
     of the Social Security Act (as added by section 6301), are 
     prohibited from being used by any government entity for 
     payment, coverage, or treatment decisions based on cost. 
     Nothing in the preceding sentence shall limit a physician or 
     other health care provider from using reports and 
     recommendations of such Institute when making decisions about 
     the best treatment for an individual patient in an individual 
     circumstance.
                                 ______
                                 
  SA 2969. Mr. COBURN (for himself, Mr. Grassley, Mr. Burr, Mr. Vitter, 
Mrs. McCaskill, and Mr. Ensign) submitted an amendment intended to be 
proposed to amendment SA 2786 proposed by Mr. Reid (for himself, Mr.

[[Page S12630]]

Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the 
Internal Revenue Code of 1986 to modify the first-time homebuyers 
credit in the case of members of the Armed Forces and certain other 
Federal employees, and for other purposes; which was ordered to lie on 
the table; as follows:

       On page 156, line 4, strike all through page 157, line 7, 
     and insert the following:
       (D) Requirement of members of congress and others to enroll 
     in the public option.--
       (i) Requirement.--Notwithstanding any other provision of 
     law, all Federal officers shall be enrolled in the community 
     health insurance option when established by the Secretary.
       (ii) Ineligible for fehbp.--Effective on the date on which 
     the community health insurance option is established by the 
     Secretary, no Federal officer shall be eligible to 
     participate in a health benefits plan under chapter 89 of 
     title 5, United States Code.
       (iii) Employer contribution.--

       (I) In general.--The appropriate disbursing officer for 
     each Federal officer shall pay the amount determined under 
     subclause (II) to--

       (aa) the appropriate community health insurance option; or
       (bb) in the case of a Federal officer who resides in a 
     State which opts out of providing a community health 
     insurance option and is enrolled in a plan offered through an 
     Exchange, the appropriate Exchange.

       (II) Amount of employer contribution.--The Director of the 
     Office of Personnel Management shall determine the amount of 
     the employer contribution for each Federal officer. The 
     amount shall be equal to the employer contribution for the 
     health benefits plan under chapter 89 of title 5, United 
     States Code, with the greatest number of enrollees, except 
     that the contribution shall be actuarially adjusted for age.

       (iv) Definitions.--In this subparagraph:

       (I) Community health insurance option.--The term 
     ``community health insurance option'' means the health 
     insurance established by the Secretary under section 1323.
       (II) Congressional employee.--The term ``congressional 
     employee'' means an employee of--

       (aa) a committee of the Senate or House of Representatives;
       (bb) the office of a Member of Congress;
       (cc) the Majority Leader of the Senate;
       (dd) the Minority Leader of the Senate;
       (ee) the Speaker of the House of Representatives; or
       (ff) the Minority Leader of the House of Representatives;

       (III) Federal officer.--The term ``Federal officer'' 
     means--

       (aa) a Member of Congress;
       (bb) the President;
       (cc) the Vice President;
       (dd) a political appointee; and
       (ee) a congressional employee.

       (IV) Member of congress.--The term ``Member of Congress'' 
     means any member of the House of Representatives or the 
     Senate.
       (V) Political appointee.--The term ``political appointee'' 
     means any individual who--

       (aa) is employed in a position described under sections 
     5312 through 5316 of title 5, United States Code, (relating 
     to the Executive Schedule);
       (bb) is a limited term appointee, limited emergency 
     appointee, or noncareer appointee in the Senior Executive 
     Service, as defined under paragraphs (5), (6), and (7), 
     respectively, of section 3132(a) of title 5, United States 
     Code; or
       (cc) is employed in a position in the executive branch of 
     the Government of a confidential or policy-determining 
     character under schedule C of subpart C of part 213 of title 
     5 of the Code of Federal Regulations.
                                 ______
                                 
  SA 2970. Mr. CASEY submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place, insert the following:

         TITLE __PULMONARY HYPERTENSION RESEARCH AND EDUCATION

     SEC. _01. SHORT TITLE.

       This title may be cited as the ``Tom Lantos Pulmonary 
     Hypertension Research and Education Act of 2009''.

             Subtitle A--Research on Pulmonary Hypertension

     SEC. _11. EXPANSION AND INTENSIFICATION OF ACTIVITIES.

       (a) Sense of Congress.--It is the sense of the Congress 
     that--
       (1) the Secretary of Health and Human Services (in this Act 
     referred to as the ``Secretary''), acting through the 
     Director of the National Institutes of Health and the 
     Director of the National Heart, Lung, and Blood Institute (in 
     this title referred to as the ``Institute''), should continue 
     aggressive work on pulmonary hypertension;
       (2) as part of such work, the Director of the Institute 
     should continue research to expand the understanding of the 
     causes of, and to find a cure for, pulmonary hypertension; 
     and
       (3) activities under paragraph (1) may include conducting 
     and supporting--
       (A) basic research concerning the etiology and causes of 
     pulmonary hypertension;
       (B) basic research on the relationship between scleroderma, 
     sickle cell anemia (and other conditions identified by the 
     Director of the Institute that can lead to a secondary 
     diagnosis of pulmonary hypertension), and pulmonary 
     hypertension;
       (C) clinical research for the development and evaluation of 
     new treatments for pulmonary hypertension, including the 
     establishment of a ``Pulmonary Hypertension Clinical Research 
     Network'';
       (D) support for the training of new clinicians and 
     investigators with expertise in the pulmonary hypertension; 
     and
       (E) information and education programs for the general 
     public.
       (b) Biennial Reports.--As part of the biennial report made 
     under section 403 of the Public Health Service Act (42 U.S.C. 
     283), the Secretary shall include information on the status 
     of pulmonary hypertension research at the National Institutes 
     of Health.

       Subtitle B--Increasing Awareness of Pulmonary Hypertension

     SEC. _21. PROMOTING PUBLIC AWARENESS.

       (a) In General.--The Secretary, acting through the Director 
     of the Centers for Disease Control and Prevention, shall 
     carry out an educational campaign to increase public 
     awareness of pulmonary hypertension. Print, video, and Web-
     based materials distributed under this program may include--
       (1) basic information on pulmonary hypertension and its 
     symptoms; and
       (2) information on--
       (A) the incidence and prevalence of pulmonary hypertension;
       (B) diseases and conditions that can lead to pulmonary 
     hypertension as a secondary diagnosis;
       (C) the importance of early diagnosis; and
       (D) the availability, as medically appropriate, of a range 
     of treatment options and pulmonary hypertension.
       (b) Dissemination of Information.--The Secretary is 
     encouraged to disseminate information under subsection (a) 
     through a cooperative agreement with a national nonprofit 
     entity with expertise in pulmonary hypertension.
       (c) Report to Congress.--Not later than September 30, 2010, 
     the Secretary shall report to the Committee on Energy and 
     Commerce of the House of Representatives, the Committee on 
     Health, Education, Labor, and Pensions of the Senate, and the 
     Committee on Appropriations of the House of Representatives 
     and the Senate on the status of activities under this 
     section.
       (d) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there is authorized to be 
     appropriated $2,500,000 for each of fiscal years 2010, 2011, 
     and 2012.

     SEC. _22. PROMOTING AWARENESS AMONG HEALTH CARE 
                   PROFESSIONALS.

       (a) In General.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration and the Director of the Centers for Disease 
     Control and Prevention, shall carry out an educational 
     campaign to increase awareness of pulmonary hypertension 
     among health care providers. Print, video, and Web-based 
     materials distributed under this program may include 
     information on--
       (1) the symptoms of pulmonary hypertension;
       (2) the importance of early diagnosis;
       (3) current diagnostic criteria; and
       (4) Food and Drug Administration-approved therapies for the 
     disease.
       (b) Targeted Health Care Providers.--Health care providers 
     targeted through the campaign under subsection (a) shall 
     include, but not be limited to, cardiologists, 
     pulmonologists, rheumatologists, primary care physicians, 
     pediatricians, and nurse practitioners.
       (c) Dissemination of Information.--The Secretary is 
     encouraged to disseminate information under subsection (a) 
     through a cooperative agreement with a national nonprofit 
     entity with expertise in pulmonary hypertension.
       (d) Report to Congress.--Not later than September 30, 2010, 
     the Secretary shall report to the Committee on Energy and 
     Commerce of the House of Representatives, the Committee on 
     Health, Education, Labor, and Pensions of the Senate, and the 
     Committee on Appropriations of the House of Representatives 
     and the Senate on the status of activities under this 
     section.
       (e) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there is authorized to be 
     appropriated $2,500,000 for each of fiscal years 2010, 2011, 
     and 2012.
                                 ______
                                 
  SA 2971. Mr. CASEY submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other

[[Page S12631]]

purposes; which was ordered to lie on the table; as follows:

       On page 731, strike line 9 and all that follows through 
     line 16 and insert the following:

     clude a teaching hospital or medical school, physicians, and 
     other clinical entities, that, through their structure, 
     operations, and joint-activity deliver a full spectrum of 
     integrated and comprehensive health care services to 
     applicable individuals while also incorporating innovative 
     methods for the clinical training of future health care 
     professionals.
       ``(xix) Determining the efficacy of methods to change 
     education models and the practice of community based 
     physicians for higher quality and more cost effective care, 
     to be conducted by a new, freestanding medical school working 
     in a collaborative model with an insurer, community 
     hospitals, private practice physicians, and other health 
     professionals.
                                 ______
                                 
  SA 2972. Mr. CASEY submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 731, between lines 16 and 17, insert the following:
       ``(xvii) Funding the use of telehealth systems to 
     facilitate acute stroke therapy services furnished to 
     Medicare beneficiaries in both rural and urban areas that are 
     administered by board eligible or board certified vascular 
     neurologists and coordinated by a certified stroke center.''.
                                 ______
                                 
  SA 2973. Mrs. MURRAY (for herself and Ms. Stabenow) submitted an 
amendment intended to be proposed by her to the bill H.R. 3590, to 
amend the Internal Revenue Code of 1986 to modify the first-time 
homebuyers credit in the case of members of the Armed Forces and 
certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. COMMUNITY-BASED COLLABORATIVE CARE NETWORKS.

       Part D of title III of the Public Health Service Act (42 
     U.S.C. 254b et seq.) is amended by adding at the end the 
     following new subpart:

    ``Subpart XI--Community-Based Collaborative Care Network Program

     ``SEC. 340H. COMMUNITY-BASED COLLABORATIVE CARE NETWORK 
                   PROGRAM.

       ``(a) In General.--The Secretary may award grants to 
     eligible entities for the purpose of establishing model 
     projects to accomplish the following goals:
       ``(1) To reduce unnecessary use of items and services 
     furnished in emergency departments of hospitals (especially 
     to ensure that individuals without health insurance coverage 
     or with inadequate health insurance coverage do not use the 
     services of such department instead of the services of a 
     primary care provider) through methods such as--
       ``(A) screening individuals who seek emergency department 
     services for possible eligibility under relevant governmental 
     health programs or for subsidies under such programs; and
       ``(B) providing such individuals referrals for followup 
     care and chronic condition care.
       ``(2) To manage chronic conditions to reduce their 
     severity, negative health outcomes, and expense.
       ``(3) To encourage health care providers to coordinate 
     their efforts so that the most vulnerable patient populations 
     seek and obtain primary care.
       ``(4) To provide more comprehensive and coordinated care to 
     vulnerable low-income individuals and individuals without 
     health insurance coverage or with inadequate coverage.
       ``(5) To provide mechanisms for improving both quality and 
     efficiency of care for low-income individuals and families, 
     with an emphasis on those most likely to remain uninsured 
     despite the existence of government programs to make health 
     insurance more affordable.
       ``(6) To increase preventive services, including screening 
     and counseling, to those who would otherwise not receive such 
     screening, in order to improve health status and reduce long-
     term complications and costs.
       ``(7) To ensure the availability of community-wide safety 
     net services, including emergency and trauma care.
       ``(b) Eligibility and Grantee Selection.--
       ``(1) Application.--A community-based collaborative care 
     network described in subsection (d) shall submit to the 
     Secretary an application in such form and manner and 
     containing such information as specified by the Secretary. 
     Such information shall at least--
       ``(A) identify the health care providers participating in 
     the community-based collaborative care network proposed by 
     the applicant and, if a provider designated in paragraph 
     (d)(1)(B) is not included, the reason such provider is not so 
     included;
       ``(B) include a description of how the providers plan to 
     collaborate to provide comprehensive and integrated care for 
     low-income individuals, including uninsured and underinsured 
     individuals;
       ``(C) include a description of the organizational and joint 
     governance structure of the community-based collaborative 
     care network in a manner so that it is clear how decisions 
     will be made, and how the decisionmaking process of the 
     network will include appropriate representation of the 
     participating entities;
       ``(D) define the geographic areas and populations that the 
     network intends to serve;
       ``(E) define the scope of services that the network intends 
     to provide and identify any reasons why such services would 
     not include a suggested core service identified by the 
     Secretary under paragraph (3);
       ``(F) demonstrate the network's ability to meet the 
     requirements of this section; and
       ``(G) provide assurances that grant funds received shall be 
     used to support the entire community-based collaborative care 
     network.
       ``(2) Selection of grantees.--
       ``(A) In general.--The Secretary shall select community-
     based collaborative care networks to receive grants from 
     applications submitted under paragraph (1) on the basis of 
     quality of the proposal involved, geographic diversity 
     (including different States and regions served and urban and 
     rural diversity), and the number of low-income and uninsured 
     individuals that the proposal intends to serve.
       ``(B) Priority.--The Secretary shall give priority to 
     proposals from community-based collaborative care networks 
     that--
       ``(i) include the capability to provide the broadest range 
     of services to low-income individuals; and
       ``(ii) include providers that currently serve a high volume 
     of low-income individuals.
       ``(C) Renewal.--In subsequent years, based on the 
     performance of grantees, the Secretary may provide renewal 
     grants to prior year grant recipients.
       ``(3) Suggested core services.--For purposes of paragraph 
     (1)(E), the Secretary shall develop a list of suggested core 
     patient and core network services to be provided by a 
     community-based collaborative care network. The Secretary may 
     select a community-based collaborative care network under 
     paragraph (2), the application of which does not include all 
     such services, if such application provides a reasonable 
     explanation why such services are not proposed to be 
     included, and the Secretary determines that the application 
     is otherwise high quality.
       ``(4) Termination authority.--The Secretary may terminate 
     selection of a community-based collaborative care network 
     under this section for good cause. Such good cause shall 
     include a determination that the network--
       ``(A) has failed to provide a comprehensive range of 
     coordinated and integrated health care services as required 
     under subsection (d)(2);
       ``(B) has failed to meet reasonable quality standards;
       ``(C) has misappropriated funds provided under this 
     section; or
       ``(D) has failed to make progress toward accomplishing 
     goals set out in subsection (a).
       ``(c) Use of Funds.--
       ``(1) Use by grantees.--Grant funds are provided to 
     community-based collaborative care networks to carry out the 
     following activities:
       ``(A) Assist low-income individuals without adequate health 
     care coverage to--
       ``(i) access and appropriately use health services;
       ``(ii) enroll in applicable public or private health 
     insurance programs;
       ``(iii) obtain referrals to and see a primary care provider 
     in case such an individual does not have a primary care 
     provider; and
       ``(iv) obtain appropriate care for chronic conditions.
       ``(B) Improve health care by providing case management, 
     application assistance, and appropriate referrals such as 
     through methods to--
       ``(i) create and meaningfully use a health information 
     technology network to track patients across collaborative 
     providers;
       ``(ii) perform health outreach, such as by using 
     neighborhood health workers who may inform individuals about 
     the availability of safety net and primary care providers 
     available through the community-based collaborative care 
     network;
       ``(iii) provide for followup outreach to remind patients of 
     appointments or follow-up care instructions;
       ``(iv) provide transportation to individuals to and from 
     the site of care;
       ``(v) expand the capacity to provide care at any provider 
     participating in the community-based collaborative care 
     network, including telehealth, hiring new clinical or 
     administrative staff, providing access to services after-
     hours, on weekends, or otherwise providing an urgent care 
     alternative to an emergency department; and
       ``(vi) provide a primary care provider or medical home for 
     each network patient.
       ``(C) Provide direct patient care services as described in 
     their application and approved by the Secretary.
       ``(2) Grant funds to hrsa grantees.--The Secretary may 
     limit the percent of grant

[[Page S12632]]

     funding that may be spent on direct care services provided by 
     grantees of programs administered by the Health Resources and 
     Services Administration (in this section referred to as 
     `HRSA') or impose other requirements on HRSA grantees 
     participating in a community-based collaborative care network 
     as may be necessary for consistency with the requirements of 
     such programs.
       ``(3) Reservation of funds for national program purposes.--
     The Secretary may use not more than 7 percent of funds 
     appropriated to carry out this section for providing 
     technical assistance to grantees, obtaining assistance of 
     experts and consultants, holding meetings, developing of 
     tools, disseminating of information, and evaluation.
       ``(d) Community-Based Collaborative Care Networks.--
       ``(1) In general.--
       ``(A) Description.--A community-based collaborative care 
     network described in this subsection is a consortium of 
     health care providers with a joint governance structure that 
     provides a comprehensive range of coordinated and integrated 
     health care services for low-income patient populations or 
     medically underserved communities (whether or not such 
     individuals receive benefits under title XVIII, XIX, or XXI 
     of the Social Security Act, private or other health insurance 
     or are uninsured or underinsured) and that complies with any 
     applicable minimum eligibility requirements that the 
     Secretary may determine appropriate.
       ``(B) Required inclusion.--Each such network shall include 
     the following providers that serve the community (unless such 
     provider does not exist within the community, declines or 
     refuses to participate, or places unreasonable conditions on 
     their participation)--
       ``(i) A safety net hospital that provides services to a 
     high volume of low-income patients, as demonstrated by 
     meeting the criteria in section 1923(b)(1) of the Social 
     Security Act, or other similar criteria determined by the 
     Secretary; and
       ``(ii) All Federally qualified health centers (as defined 
     in section 1861(aa) of the Social Security Act (42 U.S.C. 
     1395x(aa))) located in the geographic area served by the 
     Coordinated Care Network;
       ``(C) Additional inclusions.--Funding preferences shall be 
     given to networks that include additional providers such as 
     the following:
       ``(i) A hospital, including a critical access hospital (as 
     defined in section 1820(c)(2) of the Social Security Act (42 
     U.S.C. 1395i-4(c)(2))).
       ``(ii) A county or municipal department of health.
       ``(iii) A rural health clinic or a rural health network (as 
     defined in sections 1861(aa) and 1820(d) of the Social 
     Security Act, respectively (42 U.S.C. 1395x(aa), 1395i-
     4(d))).
       ``(iv) A community clinic, including a mental health 
     clinic, substance abuse clinic, or a reproductive health 
     clinic.
       ``(v) A health center controlled network as defined by 
     section 330(e)(1)(C) of the Public Health Service Act.
       ``(vi) A private practice physician or group practice.
       ``(vii) A nurse or physician assistant or group practice.
       ``(viii) An adult day care center.
       ``(ix) A home health provider.
       ``(x) Any other type of provider specified by the 
     Secretary, which has a desire to serve low-income and 
     uninsured patients.
       ``(D) Construction.--
       ``(i) Nothing in this section shall prohibit a single 
     entity from qualifying as community-based collaborative care 
     network so long as such single entity meets the criteria of a 
     community-based collaborative care network. If the network 
     does not include the providers referenced in clauses (i) and 
     (ii) of subparagraph (B) of this paragraph, the application 
     must explain the reason pursuant to subsection (b)(1)(A).
       ``(ii) Participation in a community-based collaborative 
     care network shall not affect Federally qualified health 
     centers' obligation to comply with the governance 
     requirements under section 330 of the Public Health Service 
     Act (42 U.S.C. 254b).
       ``(iii) Federally qualified health centers participating in 
     a community-based collaborative care network may not be 
     required to provide services beyond their Federal Health 
     Center scope of project approved by HRSA.
       ``(iv) Nothing in this section shall be construed to expand 
     medical malpractice liability protection under the Federal 
     Tort Claims Act for Section 330-funded Federally qualified 
     health centers.
       ``(2) Comprehensive range of coordinated and integrated 
     health care services.--The Secretary shall define criteria 
     for evaluating whether the services offered by a community-
     based collaborative care network qualify as a comprehensive 
     range of coordinated and integrated health care services. 
     Such criteria may vary based on the needs of the geographic 
     areas and populations to be served by the network and may 
     include the following:
       ``(A) Requiring community-based collaborative care networks 
     to include at least the suggested core services identified 
     under subsection (b)(3), or whichever subset of the suggested 
     core services is applicable to a particular network.
       ``(B) Requiring such networks to assign each patient of the 
     network to a primary care provider responsible for managing 
     that patient's care.
       ``(C) Requiring the services provided by a community-based 
     collaborative care network to include support services 
     appropriate to meet the health needs of low-income 
     populations in the network's community, which may include 
     chronic care management, nutritional counseling, 
     transportation, language services, enrollment counselors, 
     social services and other services as proposed by the 
     network.
       ``(D) Providing that the services provided by a community-
     based collaborative care network may also include long-term 
     care services and other services not specified in this 
     subsection.
       ``(E) Providing for the approval by the Secretary of a 
     scope of community-based collaborative care network services 
     for each network that addresses an appropriate minimum scope 
     of work consistent with the setting of the network and the 
     health professionals available in the community the network 
     serves.
       ``(3) Clarification.--Participation in a community-based 
     collaborative care network shall not disqualify a health care 
     provider from reimbursement under title XVIII, XIX, or XXI of 
     the Social Security Act with respect to services otherwise 
     reimbursable under such title. Nothing in this section shall 
     prevent a community-based collaborative care network that is 
     otherwise eligible to contract with Medicare, a private 
     health insurer, or any other appropriate entity to provide 
     care under Medicare, under health insurance coverage offered 
     by the insurer, or otherwise.
       ``(e) Evaluations.--
       ``(1) Grantee reports.--Beginning in the third year 
     following an initial grant, each community-based 
     collaborative care network shall submit to the Secretary, 
     with respect to each year the grantee has received a grant, 
     an evaluation on the activities carried out by the community-
     based collaborative care network under the community-based 
     collaborative care network program and shall include--
       ``(A) the number of people served;
       ``(B) the most common health problems treated;
       ``(C) any reductions in emergency department use;
       ``(D) any improvements in access to primary care;
       ``(E) an accounting of how amounts received were used, 
     including identification of amounts used for patient care 
     services as may be required for HRSA grantees; and
       ``(F) to the extent requested by the Secretary, any quality 
     measures or any other measures specified by the Secretary.
       ``(2) Program reports.--The Secretary shall submit to 
     Congress an annual evaluation (beginning not later than 6 
     months after the first reports under paragraph (1) are 
     submitted) on the extent to which emergency department use 
     was reduced as a result of the activities carried out by the 
     community-based collaborative care network under the program. 
     Each such evaluation shall also include information on--
       ``(A) the prevalence of certain chronic conditions in 
     various populations, including a comparison of such 
     prevalence in the general population versus in the population 
     of individuals with inadequate health insurance coverage;
       ``(B) demographic characteristics of the population of 
     uninsured and underinsured individuals served by the 
     community-based collaborative care network involved; and
       ``(C) the conditions of such individuals for whom services 
     were requested at such emergency departments of participating 
     hospitals.
       ``(3) Audit authority.--The Secretary may conduct periodic 
     audits and request periodic spending reports of community-
     based collaborative care networks under the community-based 
     collaborative care network program.
       ``(f) Clarification.--Nothing in this section requires a 
     provider to report individually identifiable information of 
     an individual to government agencies, unless the individual 
     consents, consistent with HIPAA privacy and security law, as 
     defined in section 3009(a)(2).
       ``(g) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section such 
     sums as may be necessary for each of fiscal years 2011 
     through 2015.''.
                                 ______
                                 
  SA 2974. Ms. SNOWE submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 114, beginning with line 17, strike all through 
     page 116, line 6, and insert the following:
       (e) Catastrophic Plan.--
       (1) In general.--A health plan not providing a bronze, 
     silver, gold, or platinum level of coverage shall be treated 
     as meeting the requirements of subsection (d) with respect to 
     any plan year if the plan provides --
       (A) except as provided in subparagraph (B), the essential 
     health benefits determined under subsection (b), except that 
     the plan provides no benefits for any plan year until

[[Page S12633]]

     the individual has incurred cost-sharing expenses in an 
     amount equal to the annual limitation in effect under 
     subsection (c)(1) for the plan year (except as provided for 
     in section 2713); and
       (B) coverage for at least three primary care visits.
       (2) Restriction to individual market.--If a health 
     insurance issuer offers a health plan described in this 
     subsection, the issuer may only offer the plan in the 
     individual market.
       On page 155, beginning with line 22, strike all through 
     page 156, line 3, and insert the following:
       (A) Individuals allowed to enroll in any plan.--A qualified 
     individual may enroll in any qualified health plan.
       On page 250, lines 7 through 10, strike ``, except that 
     such term shall not include a qualified health plan which is 
     a catastrophic health plan described in section 1302(e) of 
     such Act''.
                                 ______
                                 
  SA 2975. Ms. SNOWE submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 348, strike line 22 and all that follows 
     through line 15 on page 349.

                                 ______
                                 
  SA 2976. Mr. CARDIN (for himself and Mr. Ensign) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 816, after line 20, insert the following:

     SEC. 3115. PERMITTING HOME HEALTH AGENCIES TO ASSIGN THE MOST 
                   APPROPRIATE SKILLED SERVICE TO MAKE THE INITIAL 
                   ASSESSMENT VISIT UNDER A MEDICARE HOME HEALTH 
                   PLAN OF CARE FOR REHABILITATION CASES.

       (a) In General.--Notwithstanding section 484.55(a)(2) of 
     title 42 of the Code of Federal Regulations or any other 
     provision of law, a home health agency may determine the most 
     appropriate skilled therapist to make the initial assessment 
     visit for an individual who is referred (and may be eligible) 
     for home health services under title XVIII of the Social 
     Security Act but who does not require skilled nursing care as 
     long as the skilled service (for which that therapist is 
     qualified to provide the service) is included as part of the 
     plan of care for home health services for such individual.
       (b) Rule of Construction.--Nothing in subsection (a) shall 
     be construed to provide for initial eligibility for coverage 
     of home health services under title XVIII of the Social 
     Security Act on the basis of a need for occupational therapy.
                                 ______
                                 
  SA 2977. Mr. BEGICH submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

     At the end of subtitle C of title IV, insert the following:

     SEC. 4208. INTERAGENCY TASK FORCE TO ASSESS AND IMPROVE 
                   ACCESS TO HEALTH CARE IN THE STATE OF ALASKA.

       (a) Findings.--Congress finds as follows:
       (1) Access to health care in the State of Alaska is 
     challenging due to geographical constraints, health care 
     workforce and treatment facility shortages, and lack of 
     certain medical specialties available in the State.
       (2) Delivery of health care to beneficiaries of Federal 
     health care programs is especially challenging in the State 
     of Alaska as a result of capacity constraints at Federal 
     treatment facilities and insufficient civilian provider 
     networks to support Federal systems.
       (3) The State of Alaska has the largest, per capita 
     population of veterans, many of whom rely on the health care 
     system of the Department of Veterans Affairs.
       (4) The State of Alaska has a large population of active-
     duty military personnel, military retirees, and dependents of 
     military personnel and retirees who rely on the military 
     health care system. This population will increase as a result 
     of Armed Forces structure initiatives during the next several 
     years.
       (5) A significant portion of Alaska's population is 
     comprised of Medicare beneficiaries.
       (6) Almost \1/4\ of Alaska's population is comprised of 
     Medicaid beneficiaries.
       (7) Federal agencies have undertaken efforts to improve and 
     increase access to health care in the State of Alaska for 
     Federal health care system beneficiaries, but there are 
     finite medical resources in the State for which such 
     beneficiaries must compete.
       (8) To ensure improved and increased access to health care 
     for beneficiaries of Federal health care systems in the State 
     of Alaska, comprehensive policies and interagency 
     collaboration are required.
       (b) Interagency Access to Health Care in Alaska Task 
     Force.--
       (1) Establishment.--There is established a task force to be 
     known as the ``Interagency Access to Health Care in Alaska 
     Task Force'' (referred to in this section as the ``Task 
     Force'').
       (2) Activities.--The Task Force shall--
       (A) assess access to health care for beneficiaries of 
     Federal health care systems in Alaska, which shall include 
     consideration of, with regard to the State of Alaska--
       (i) current Federal health care delivery methods at Federal 
     treatment facilities and through civilian provider networks;
       (ii) shortfalls in delivering health care to beneficiaries 
     of Federal health care systems at Federal treatment 
     facilities and through civilian provider networks; and
       (iii) the impact of reimbursement rates and claims 
     processing on civilian provider participation; and
       (B) develop a strategy for the Federal Government to 
     improve delivery of health care to Federal beneficiaries in 
     the State of Alaska, which shall include--
       (i) interagency collaboration opportunities for addressing 
     shortfalls in delivering health care to beneficiaries of 
     Federal health care systems;
       (ii) increasing Federal Government primary care and 
     specialty care capability practices in the State of Alaska at 
     Federal treatment facilities and in the civilian provider 
     community.
       (c) Membership.--
       (1) Appointment.--
       (A) Federal members.--The Task Force shall be comprised of 
     Federal members who shall be appointed as follows:
       (i) One member shall be a representative of the Department 
     of Health and Human Services and shall be appointed by the 
     Secretary of Health and Human Services.
       (ii) One member shall be a representative of the Centers 
     for Medicare and Medicaid Services and shall be appointed by 
     the Secretary of Health and Human Services.
       (iii) One member shall be a representative of the Indian 
     Health Service and shall be appointed by the Secretary of 
     Health and Human Services.
       (iv) One member shall be a representative of the TRICARE 
     Management Activity and shall be appointed by the Secretary 
     of Defense.
       (v) One member shall be a representative of the Army 
     Medical Department and shall be appointed by the Secretary of 
     the Army.
       (vi) One member shall be a representative of the Air Force 
     and shall be appointed by the Secretary of the Air Force from 
     among officers at the Air Force performing medical service 
     functions.
       (vii) One member shall be a representative of the 
     Department of Veterans Affairs and shall be appointed by the 
     Secretary of Veterans Affairs.
       (viii) One member shall be a representative of the Veterans 
     Health Administration and shall be appointed by the Secretary 
     of Veterans Affairs.
       (ix) One member shall be a representative of the United 
     States Coast Guard and shall be appointed by the Secretary of 
     Homeland Security.
       (B) Non-federal members.--Individuals appointed by the 
     Secretary of Health and Human Services to the Task Force from 
     outside the agencies may include officers or employees of 
     other departments and agencies of the Federal Government and 
     individuals from the private medical community in Alaska and, 
     at the election of the Governor of the State of Alaska, shall 
     include at least one employee representative of the State of 
     Alaska.
       (2) Timeframe for appointment.--All appointments of 
     individuals to the Task Force, as described in paragraph (2), 
     shall be made not later than 45 days after the date of 
     enactment of this Act.
       (3) Co-chairpersons.--There shall be 2 co-chairpersons of 
     the Task Force, appointed at the time of appointment of 
     members under paragraph (1). One co-chairperson shall be 
     designated by the Secretary of Health and Human Services from 
     among the representatives of the Department of Health and 
     Human Services who are appointed to the Task Force under 
     clauses (i) through (iii) of paragraph (2), and one co-
     chairperson shall be designated by the Secretary of Health 
     and Human Services from among the members appointed under 
     clauses (iv) through (ix) of such paragraph.
       (4) Vacancies.--A vacancy in the Task Force shall be filled 
     in the manner in which the original appointment was made.
       (5) Compensation.--
       (A) In general.--Except as provided in subparagraph (B), 
     members of the Task Force may not receive pay, allowances, or 
     benefits by reason of such member's service on the Task 
     Force.
       (B) Travel expenses.--The members of the Task Force shall 
     be allowed travel expenses, including per diem in lieu of 
     subsistence, at rates authorized for employees of agencies 
     under subchapter I of chapter 57 of title 5, United States 
     Code, while away from their homes or regular places of 
     business in the performance of services for the Task Force.

[[Page S12634]]

       (d) Meetings.--The Task Force shall meet at the call of the 
     chairperson.
       (e) Report.--
       (1) In general.--Not later than 180 days after the date of 
     enactment of this Act, the Task Force shall submit to 
     Congress a report detailing the activities of the Task Force 
     and containing the findings, strategies, recommendations, 
     policies, and initiatives developed pursuant to the duties of 
     the Task Force under subsection (b)(2).
       (2) Consideration of other efforts.--In preparing the 
     report described in paragraph (1), the Task Force shall 
     consider completed and ongoing efforts by Federal agencies to 
     improve access to health care in the State of Alaska.
       (f) Termination.--The Task Force shall be terminated on the 
     date of submission of the report described in subsection (e).
                                 ______
                                 
  SA 2978. Mr. BEGICH submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       After section 3510, insert the following:

     SEC. 3511. ASSISTANCE FOR FRONTIER CLINICS.

       Title III of the Public Health Service Act (42 U.S.C. 241 
     et seq.), as amended by section 4303, is further amended by 
     adding at the end the following:

               ``PART V--ASSISTANCE FOR FRONTIER CLINICS

     ``SEC. 399NN. ASSISTANCE FOR FRONTIER CLINICS.

       ``(a) In General.--The Secretary of Health and Human 
     Services (referred to in this section as the `Secretary'), 
     acting through the Administrator of the Health Resources and 
     Services Administration, shall award grants to eligible 
     health clinics for the purpose of ensuring access to needed 
     emergency care in frontier areas 24-hours per day, 7 days per 
     week, and to ensure the health and safety of patients at such 
     clinics.
       ``(b) Eligibility.--To be eligible to receive a grant under 
     subsection (a), an entity shall be--
       ``(1) located in a community where the closest short-term 
     acute care hospital or critical access hospital is--
       ``(A) at least 60 miles or one hour usual travel time from 
     such community; or
       ``(B) inaccessible by public road; and
       ``(2) designed to address the needs of--
       ``(A) seriously or critically ill or injured patients for 
     stabilization prior to transport to definitive care; or
       ``(B) patients who need monitoring and observation for a 
     limited period of time.
       ``(c) Priority.--In awarding grants under this section, the 
     Secretary shall ensure that not less than 25 percent of the 
     entities receiving such a grant are located in communities 
     from which the nearest short-term acute care hospital or 
     critical access hospital is at least 75 miles or is 
     inaccessible by public road.
       ``(d) Use of Funds.--Entities receiving a grant under this 
     section shall use such grant funds to meet quality standards 
     established for the staffing, equipment, or health care 
     facility of such entity.
       ``(e) Authorization of Appropriations.--To carry out this 
     section, there is authorized to be appropriated $20,000,000 
     for each of fiscal years 2011 through 2015.''.
                                 ______
                                 
  SA 2979. Mr. BEGICH submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       After title IX, insert the following:

          TITLE X--INCREASING ACCESS TO PRIMARY CARE SERVICES

     SEC. 10001. STATE GRANTS TO HEALTH CARE PROVIDERS WHO PROVIDE 
                   SERVICES TO A HIGH PERCENTAGE OF MEDICALLY 
                   UNDERSERVED POPULATIONS OR OTHER SPECIAL 
                   POPULATIONS.

       (a) In General.--A State may award grants to health care 
     providers who treat a high percentage, as determined by such 
     State, of medically underserved populations or other special 
     populations in such State.
       (b) Source of Funds.--A grant program established by a 
     State under subsection (a) may not be established within a 
     department, agency, or other entity of such State that 
     administers the Medicaid program under title XIX of the 
     Social Security Act (42 U.S.C. 1396 et seq.), and no Federal 
     or State funds allocated to such Medicaid program, the 
     Medicare program under title XVIII of the Social Security Act 
     (42 U.S.C. 1395 et seq.), or the TRICARE program under 
     chapter 55 of title 10, United States Code, may be used to 
     award grants or to pay administrative costs associated with a 
     grant program established under subsection (a).

     SEC. 10002. INCENTIVE PAYMENTS FOR PRIMARY CARE PHYSICIANS 
                   WHO TREAT A CERTAIN PERCENTAGE OF NEW MEDICARE 
                   PATIENTS.

       (a) In General.--Section 1833 of the Social Security Act 
     (42 U.S.C. 1395l), as amended by section 5501, is further 
     amended by adding at the end the following new subsection:
       ``(z) Incentive Payments for Primary Care Services Provided 
     to New Medicare Patients.--
       ``(1) In general.--In the case of primary care services 
     furnished on or after January 1, 2011, and before January 1, 
     2016, by an eligible primary care practitioner in a calendar 
     year, in addition to the amount of payment that would 
     otherwise be made for such services under this part, 
     including any payment available under subsection (x), there 
     also shall be paid (on a monthly or quarterly basis) an 
     amount equal to 5 percent of the payment amount for the 
     service under this part.
       ``(2) Definitions.--In this subsection--
       ``(A) the term `eligible primary care provider' means a 
     primary care practitioner for whom, of all patients for whom 
     such practitioner provides primary care services in a 
     calendar year and for whom such practitioner did not provide 
     such services in the previous calendar year, 10 percent of 
     such patients are enrollees under this part;
       ``(B) the terms `primary care practitioner' and `primary 
     care services' have the meanings given such terms in 
     subsection (x)(2).
       ``(3) Coordination with other payments.--The amount of the 
     additional payment for a service under this subsection and 
     subsections (m) and (x) shall be determined without regard to 
     any additional payment for the service under subsection (m), 
     subsection (x), and this subsection, respectively.
       ``(4) Limitation on review.--There shall be no 
     administrative or judicial review under section 1869, 1878, 
     or otherwise, respecting the identification of primary care 
     practitioners under this subsection.''.
       (b) Conforming Amendments.--
       (1) Section 1834(g)(2)(B) of the Social Security Act (42 
     U.S.C. 1395m(g)(2)(B)), as amended by section 5501(b)(2), is 
     further amended by striking ``(x) and (y)'' in the last 
     sentence and inserting ``(x), (y), and (z)''.
       (2) Section 1834(x)(3) of such Act, as added by section 
     5501, is amended--
       (A) by striking ``subsection (m)'' the first place it 
     appears and inserting ``subsections (m) and (z)''; and
       (B) by striking ``subsection (m) and'' and inserting 
     ``subsection (m), subsection (z), and''.

     SEC. 10003. FACULTY LOAN REPAYMENT FOR PHYSICIAN ASSISTANTS.

       Section 738(a)(3) of the Public Health Service Act (42 
     U.S.C.293b(a)(3)) is amended by inserting ``schools offering 
     physician assistant education programs,'' after ``public 
     health,''.

     SEC. 10004. ACCOUNTABLE CARE ORGANIZATION DEMONSTRATION 
                   PROGRAM.

       Section 1899(b)(2)(D) of the Social Security Act, as added 
     by section 3022, is amended by adding at the end: 
     ``Notwithstanding the preceding sentence, the Secretary may 
     approve for participation in the program any ACO, with any 
     number of Medicare fee-for-service beneficiaries assigned to 
     such ACO, that proposes a plan that would improve 
     efficiencies and provide cost savings.''

     SEC. 10005. AMERICAN PRIMARY CARE CORPS.

       (a) In General.--The Secretary of Health and Human Services 
     (referred to in this section as the ``Secretary'') shall 
     establish an American Primary Care Corps (referred to in this 
     section as the ``program'') for the purpose of encouraging 
     health care practitioners who are recent graduates of a 
     health care program to enter into primary care practice, by 
     providing incentive payments to eligible primary care 
     practitioners.
       (b) Definitions.--In this section:
       (1) Primary care practitioner.--The term ``primary care 
     practitioner'' means a health care provider, including a 
     physician, dentist, nurse practitioner, and physician 
     assistant, who primarily provides primary health services.
       (2) Primary care services.--The term ``primary health 
     services'' has the meaning given such term in section 
     331(a)(3)(D) of the Public Health Service Act (42 U.S.C. 
     254d(a)(3)(D)).
       (c) Program.--
       (1) In general.--The Secretary shall select recipients of 
     the incentive payment awards under this section from among 
     eligible primary care practitioners. Each recipient of such 
     an award shall receive incentive payments, as described in 
     paragraph (2), for a period of 3 years, provided such 
     recipient continues to maintain active employment as a 
     primary care practitioner.
       (2) Incentive payments.--The Secretary shall award 
     incentive payments, on a competitive basis, to eligible 
     primary care practitioners as follows:
       (A) In the first year that a practitioner receives an award 
     under the program, such practitioner shall receive an 
     incentive payment in an amount that is equal to 75 percent of 
     the salary for such year received by such practitioner for 
     employment as a primary care practitioner.
       (B) In the second year that a practitioner receives an 
     award under the program, such practitioner shall receive an 
     incentive payment in an amount that is equal to 50 percent of 
     the salary for such year received by such practitioner for 
     employment as a primary care practitioner.
       (C) In the third year that a practitioner receives an award 
     under the program, such

[[Page S12635]]

     practitioner shall receive an incentive payment in an amount 
     that is equal to 25 percent of the salary for such year 
     received by such practitioner for employment as a primary 
     care practitioner.
       (d) Eligible Primary Care Practitioners.--To be eligible to 
     receive an incentive payment under this section, an 
     individual shall--
       (1) be actively employed as a primary care practitioner, or 
     have arrangements to commence active employment as a primary 
     care practitioner;
       (2) have graduated, not more than 2 years after the date on 
     which such individual would begin receiving incentive 
     payments under this program, from an accredited program that 
     qualifies such individual to maintain employment as a primary 
     care practitioner; and
       (3) submit to the Secretary an application, at such time, 
     in such manner, and containing such information as the 
     Secretary may require.
       (e) Duration of Program.--The Secretary shall make awards 
     under this section for each of fiscal years 2011 through 
     2015. Each such recipient shall remain in the program for a 
     3-year period, as described in subsection (c), provided such 
     recipient continues to maintain active employment as a 
     primary care practitioner.
       (f) Authorization of Appropriations.--To carry out this 
     section, there are authorized to be appropriated $50,000,000 
     for each of fiscal years 2011 through 2015, and such sums as 
     may be necessary for fiscal years 2016 and 2017.
                                 ______
                                 
  SA 2980. Ms. MIKULSKI submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 84, line 10, insert ``sterilization'' after 
     ``including''.
       On page 95, between lines 7 and 8, insert the following:

     ``SEC. 2705A. PROHIBITING CONSIDERATION OF PRIOR HISTORY OF 
                   STERILIZATION, DOMESTIC VIOLENCE, OR MEDICALLY 
                   NECESSARY CESAREAN SECTION AS A CONDITION FOR 
                   ISSUING HEALTH INSURANCE COVERAGE.

       ``A group health plan and a health insurance issuer 
     offering group or individual health insurance coverage shall 
     not, with respect to an individual desiring to enroll in 
     coverage, take any of the following actions based on evidence 
     of sterilization, domestic violence, or medically necessary 
     cesarean section with respect to such individual:
       ``(1) Decline to offer coverage to such individual.
       ``(2) Deny enrollment of such individual in the lan or 
     coverage.
       ``(3) Establish rules of eligibility (including continued 
     eligibility) for such individual under the plan or coverage.
       ``(4) Require such individual to pay an additional premium 
     or contribution amount based solely on evidence of 
     sterilization.
       ``(5) Require sterilization as a condition to offer 
     coverage.''.
       On page 99, line 23, insert before the period the 
     following: ``, except that the provisions of section 2705A of 
     the Public Health Service Act (as added by such amendments) 
     shall become effective for plan years beginning on or after 
     the date that is 6 months after the date of enactment of this 
     Act''.
                                 ______
                                 
  SA 2981. Ms. SNOWE submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 19, line 19, insert before the period the 
     following: ``and for form and rate filings with respect to 
     issuers''.
       On page 24, line 14, insert ``(including standards relating 
     to form and rate fillings)'' after ``section''.
                                 ______
                                 
  SA 2982. Mr. REID (for Mr. Byrd) submitted an amendment intended to 
be proposed to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. 
Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the 
Internal Revenue Code of 1986 to modify the first-time homebuyers 
credit in the case of members of the Armed Forces and certain other 
Federal employees, and for other purposes; which was ordered to lie on 
the table; as follows:

       On page 621, between lines 9 and 10, insert the following:

     SEC. 2956. INFANT EYE AND VISION ASSESSMENT.

       (a) Inclusion in Maternal and Child Health Services 
     Program.--Subsection (a)(2) of section 501 of the Social 
     Security Act (42 U.S.C. 701) is amended--
       (1) by striking ``and'' after ``without regard to age,''; 
     and
       (2) by inserting after ``follow-up services'' the 
     following: ``, and for infant eye and vision assessment 
     promotion''.
       (b) Definition.--Subsection (b) of such section is amended 
     by adding at the end the following new paragraph:
       ``(5) The term `infant eye and vision assessment promotion' 
     means a nationally established program for the promotion of--
       ``(A) comprehensive eye and vision assessments provided to 
     infants who have attained 6 months, but not 12 months, in age 
     without charge;
       ``(B) the development and dissemination of parental 
     information and education materials on infant eye and vision 
     health;
       ``(C) increased participation by optometrists to perform 
     infant eye and vision assessments; and
       ``(D) public and private partnerships at the State and 
     local levels for the provision of such eye and vision 
     assessments.''.
       (c) Effective Date.--The amendments made by this section 
     take effect on January 1, 2010.
                                 ______
                                 
  SA 2983. Mr. REID (for Mr. Byrd) submitted an amendment intended to 
be proposed to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. 
Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the 
Internal Revenue Code of 1986 to modify the first-time homebuyers 
credit in the case of members of the Armed Forces and certain other 
Federal employees, and for other purposes; which was ordered to lie on 
the table; as follows:

       On page 1265, between lines 8 and 9, insert the following:

     SEC. 4307. SCREENING, BRIEF INTERVENTION, REFERRAL, AND 
                   TREATMENT FOR MENTAL HEALTH AND SUBSTANCE ABUSE 
                   DISORDERS.

       Part D of title V of the Public Health Service Act (42 
     U.S.C. 290dd et seq.) is amended by adding at the end the 
     following:

     ``SEC. 544. SCREENING, BRIEF INTERVENTION, REFERRAL, AND 
                   TREATMENT FOR MENTAL HEALTH AND SUBSTANCE ABUSE 
                   DISORDERS.

       ``(a) Program.--The Secretary, acting through the 
     Administrator, shall establish a program (consisting of 
     awarding grants, contracts, and cooperative agreements under 
     subsection (b)) on mental health and substance abuse 
     screening, brief intervention, referral, and recovery 
     services for individuals in primary health care settings.
       ``(b) Use of Funds.--The Secretary may award grants to, or 
     enter into contracts or cooperative agreements with, 
     entities--
       ``(1) to provide mental health and substance abuse 
     screening, brief interventions, referral, and recovery 
     services;
       ``(2) to coordinate such services with primary health care 
     services in the same program and setting;
       ``(3) to develop a network of facilities to which patients 
     may be referred if needed;
       ``(4) to purchase needed screening and other tools that 
     are--
       ``(A) necessary for providing such services; and
       ``(B) supported by evidence-based research; and
       ``(5) to maintain communication with appropriate State 
     mental health and substance abuse agencies.
       ``(c) Eligibility.--To be eligible for a grant, contract, 
     or cooperative agreement under this section, an entity shall 
     be a public or private nonprofit entity that--
       ``(1) provides primary health services;
       ``(2) seeks to integrate mental health and substance abuse 
     services into its service system;
       ``(3) has developed a working relationship with providers 
     of mental health and substance abuse services;
       ``(4) demonstrates a need for the inclusion of mental 
     health and substance abuse services in its service system; 
     and
       ``(5) agrees--
       ``(A) to prepare and submit to the Secretary at the end of 
     the grant, contract, or cooperative agreement period an 
     evaluation of all activities funded through the grant, 
     contract, or cooperative agreement; and
       ``(B) to use such performance measures as may be stipulated 
     by the Secretary for purposes of such evaluation.
       ``(d) Preference.--In awarding grants, contracts, and 
     cooperative agreements under this section, the Secretary 
     shall give preference to entities that--
       ``(1) provide services in rural or underserved areas of the 
     United States;
       ``(2) provide services to entities in States that have high 
     percentages of populations with substance abuse or mental 
     health problems; or
       ``(3) provide services in school-based health clinics or on 
     university and college campuses.
       ``(e) Duration.--The period of a grant, contract, or 
     cooperative agreement under this section may not exceed 5 
     years.
       ``(f) Report.--Not later than 4 years after the first 
     appropriation of funds to carry out this section, the 
     Secretary shall submit a report to the Congress on the 
     program under this section--
       ``(1) that includes an evaluation of the benefits of 
     integrating mental health and substance abuse care within 
     primary health care; and

[[Page S12636]]

       ``(2) focusing on the performance measures stipulated by 
     the Secretary under subsection (c)(5).
       ``(g) Authorization of Appropriations.--
       ``(1) In general.--To carry out this section, there are 
     authorized to be appropriated $30,000,000 for fiscal year 
     2011 and such sums as may be necessary for each of fiscal 
     years 2012 through 2015.
       ``(2) Program management.--Of the funds appropriated to 
     carry out this section for a fiscal 5 year, the Secretary may 
     use not more than 5 percent to manage the program under this 
     section.''.
                                 ______
                                 
  SA 2984. Mr. BARRASSO submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 816, after line 20, insert the following:

     SEC. 3115. USE OF PRIVATE CONTRACTS BY MEDICARE BENEFICIARIES 
                   FOR PROFESSIONAL SERVICES.

       (a) In General.--Section 1802(b) of the Social Security Act 
     (42 U.S.C. 1395a) is amended to read as follows:
       ``(b) Clarification of Use of Private Contracts by Medicare 
     Beneficiaries for Professional Services.--
       ``(1) In general.--Nothing in this title shall prohibit a 
     medicare beneficiary from entering into a private contract 
     with a physician or health care practitioner for the 
     provision of medicare covered professional services (as 
     defined in paragraph (5)(C)) if--
       ``(A) the services are covered under a private contract 
     that is between the beneficiary and the physician or 
     practitioner and meets the requirements of paragraph (2);
       ``(B) under the private contract no claim for payment for 
     services covered under the contract is to be submitted (and 
     no payment made) under part A or B, under a contract under 
     section 1876, or under an MA plan (other than an MSA plan); 
     and
       ``(C)(i) the Secretary has been provided with the minimum 
     information necessary to avoid any payment under part A or B 
     for services covered under the contract, or
       ``(ii) in the case of an individual enrolled under a 
     contract under section 1876 or an MA plan (other than an MSA 
     plan) under part C, the eligible organization under the 
     contract or the MA organization offering the plan has been 
     provided the minimum information necessary to avoid any 
     payment under such contract or plan for services covered 
     under the contract.
       ``(2) Requirements for private contracts.--The requirements 
     in this paragraph for a private contract between a medicare 
     beneficiary and a physician or health care practitioner are 
     as follows:
       ``(A) General form of contract.--The contract is in writing 
     and is signed by the medicare beneficiary.
       ``(B) No claims to be submitted for covered services.--The 
     contract provides that no party to the contract (and no 
     entity on behalf of any party to the contract) shall submit 
     any claim for (or request) payment for services covered under 
     the contract under part A or B, under a contract under 
     section 1876, or under an MA plan (other than an MSA plan).
       ``(C) Scope of services.--The contract identifies the 
     medicare covered professional services and the period (if 
     any) to be covered under the contract, but does not cover any 
     services furnished--
       ``(i) before the contract is entered into; or
       ``(ii) for the treatment of an emergency medical condition 
     (as defined in section 1867(e)(1)(A)), unless the contract 
     was entered into before the onset of the emergency medical 
     condition.
       ``(D) Clear disclosure of terms.--The contract clearly 
     indicates that by signing the contract the medicare 
     beneficiary--
       ``(i) agrees not to submit a claim (or to request that 
     anyone submit a claim) under part A or B (or under section 
     1876 or under an MA plan, other than an MSA plan) for 
     services covered under the contract;
       ``(ii) agrees to be responsible, whether through insurance 
     or otherwise, for payment for such services and understands 
     that no reimbursement will be provided under such part, 
     contract, or plan for such services;
       ``(iii) acknowledges that no limits under this title 
     (including limits under paragraphs (1) and (3) of section 
     1848(g)) will apply to amounts that may be charged for such 
     services;
       ``(iv) acknowledges that medicare supplemental policies 
     under section 1882 do not, and other supplemental health 
     plans and policies may elect not to, make payments for such 
     services because payment is not made under this title; and
       ``(v) acknowledges that the beneficiary has the right to 
     have such services provided by (or under the supervision of) 
     other physicians or health care practitioners for whom 
     payment would be made under such part, contract, or plan.

     Such contract shall also clearly indicate whether the 
     physician or practitioner involved is excluded from 
     participation under this title.
       ``(3) Modifications.--The parties to a private contract may 
     mutually agree at any time to modify or terminate the 
     contract on a prospective basis, consistent with the 
     provisions of paragraphs (1) and (2).
       ``(4) No requirements for services furnished to msa plan 
     enrollees.--The requirements of paragraphs (1) and (2) do not 
     apply to any contract or arrangement for the provision of 
     services to a medicare beneficiary enrolled in an MSA plan 
     under part C.
       ``(5) Definitions.--In this subsection:
       ``(A) Health care practitioner.--The term `health care 
     practitioner' means a practitioner described in section 
     1842(b)(18)(C).
       ``(B) Medicare beneficiary.--The term `medicare 
     beneficiary' means an individual who is enrolled under part 
     B.
       ``(C) Medicare covered professional services.--The term 
     `medicare covered professional services' means--
       ``(i) physicians' services (as defined in section 1861(q), 
     and including services described in section 1861(s)(2)(A)), 
     and
       ``(ii) professional services of health care practitioners, 
     including services described in section 1842(b)(18)(D),

     for which payment may be made under part A or B, under a 
     contract under section 1876, or under a Medicare Advantage 
     plan but for the provisions of a private contract that meets 
     the requirements of paragraph (2).
       ``(D) MA plan; msa plan.--The terms `MA plan' and `MSA 
     plan' have the meanings given such terms in section 1859.
       ``(E) Physician.--The term `physician' has the meaning 
     given such term in section 1861(r).''.
       (b) Conforming Amendments Clarifying Exemption From 
     Limiting Charge and From Requirement for Submission of 
     Claims.--Section 1848(g) of the Social Security Act (42 
     U.S.C. 1395w-4(g)) is amended--
       (1) in paragraph (1)(A), by striking ``In'' and inserting 
     ``Subject to paragraph (8), in'';
       (2) in paragraph (3)(A), by striking ``Payment'' and 
     inserting ``Subject to paragraph (8), payment'';
       (3) in paragraph (4)(A), by striking ``For'' and inserting 
     ``Subject to paragraph (8), for''; and
       (4) by adding at the end the following new paragraph:
       ``(8) Exemption from requirements for services furnished 
     under private contracts.--
       ``(A) In general.--Pursuant to section 1802(b)(1), 
     paragraphs (1), (3), and (4) do not apply with respect to 
     physicians' services (and services described in section 
     1861(s)(2)(A)) furnished to an individual by (or under the 
     supervision of) a physician if the conditions described in 
     section 1802(b)(1) are met with respect to the services.
       ``(B) No restrictions for enrollees in msa plans.--Such 
     paragraphs do not apply with respect to services furnished to 
     individuals enrolled with MSA plans under part C, without 
     regard to whether the conditions described in subparagraphs 
     (A) through (C) of section 1802(b)(1) are met.
       ``(C) Application to enrollees in other plans.--Subject to 
     subparagraph (B) and section 1852(k)(2), the provisions of 
     subparagraph (A) shall apply in the case of an individual 
     enrolled under a contract under section 1876 or under an MA 
     plan (other than an MSA plan) under part C, in the same 
     manner as they apply to individuals not enrolled under such a 
     contract or plan.''.
       (c) Conforming Amendments.--(1) Section 1842(b)(18) of the 
     Social Security Act (42 U.S.C. 1395u(b)(18)) is amended by 
     adding at the end the following:
       ``(E) The provisions of section 1848(g)(8) shall apply with 
     respect to exemption from limitations on charges and from 
     billing requirements for services of health care 
     practitioners described in this paragraph in the same manner 
     as such provisions apply to exemption from the requirements 
     referred to in section 1848(g)(8)(A) for physicians' 
     services.''.
       (2) Section 1866(a)(1)(O) of such Act (42 U.S.C. 
     1395cc(a)(1)(O)) is amended by striking ``enrolled with a 
     Medicare Advantage organization under part C'' and inserting 
     ``enrolled with an MA organization under part C (other than 
     under an MSA plan)''.
       (d) Effective Date.--The amendments made by this section 
     shall take effect on the date that is 6 months after the date 
     of the enactment of this Act and apply to contracts entered 
     into on or after that date.
                                 ______
                                 
  SA 2985. Mr. BARRASSO submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place in title I, insert the following:

     SEC. __. CONTINUED ABILITY TO PAY FOR HEALTH CARE.

       Nothing in this title (or an amendment made by this title) 
     shall be construed to prohibit an individual from purchasing 
     or otherwise paying for health care items or services on an 
     out-of-pocket basis.
                                 ______
                                 
  SA 2986. Mr. BARRASSO submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr.

[[Page S12637]]

Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 201, between lines 6 and 7, insert the following:

     SEC. 1325. PROVIDER CHOICE.

       Notwithstanding any other provision of this title, a 
     Consumer Operated and Oriented Plan under section 1322 and a 
     community health insurance option under section 1323 shall 
     not require the participation of health care providers. The 
     participation of such providers shall be on a voluntary 
     basis.
                                 ______
                                 
  SA 2987. Mr. BARRASSO submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place in title I, insert the following:

     SEC. __. PROTECTING THE TAXPAYERS.

       The provisions of this title (and the amendments made by 
     this title) shall not apply with respect to a fiscal year if 
     the Director of the Office of Management and Budget fails to 
     certify to Congress that the application of such provisions 
     (and amendments) in such fiscal year will not increase the 
     Federal budget deficit.
                                 ______
                                 
  SA 2988. Mr. BARRASSO submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 320, beginning with line 19, strike all through 
     page 340, line 21.
                                 ______
                                 
  SA 2989. Mr. MENENDEZ (for himself, Mr. Schumer, Mr. Dodd, Mrs. 
Gillibrand, Mr. Kerry, and Mr. Bingaman) submitted an amendment 
intended to be proposed to amendment SA 2786 proposed by Mr. Reid (for 
himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, 
to amend the Internal Revenue Code of 1986 to modify the first-time 
homebuyers credit in the case of members of the Armed Forces and 
certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 128, line 6, insert ``, and includes, as elected 
     under and subject to section 10001, Puerto Rico, the Virgin 
     Islands, Guam, American Samoa, and the Northern Mariana 
     Islands''.
       Strike section 2005.
       On page 2074, after line 25, add the following:

            TITLE X--PROVISIONS RELATING TO THE TERRITORIES

     SEC. 10001. SPECIAL RULES FOR APPLICATION OF TITLE I TO 
                   TERRITORIES.

       (a) One-Time Election for Treatment and Application of 
     Funding.--
       (1) In general.--A territory may elect, in a form and 
     manner specified by the Secretary of Health and Human 
     Services jointly with the Secretary of the Treasury, and not 
     later than October 1, 2013, either--
       (A) to be treated as a State for purposes of applying title 
     I (including establishing an Exchange for such territory); or
       (B) not to be so treated but instead, to have the dollar 
     limitation otherwise applicable to the territory under 
     subsections (f) and (g) of section 1108 of the Social 
     Security Act (42 U.S.C. 1308) for a fiscal year increased by 
     a dollar amount equivalent to the cap amount determined under 
     subsection (c)(2) for the territory as applied by the 
     Secretary for the fiscal year involved.
       (2) Conditions for acceptance.--The Secretary of Health and 
     Human Services has the nonreviewable authority to accept or 
     reject an election described in paragraph (1)(A). Any such 
     acceptance is--
       (A) contingent upon entering into an agreement described in 
     subsection (b) between the Secretary of Health and Human 
     Services and the territory and subsection (c); and
       (B) subject to the approval of the Secretary of Health and 
     Human Services and the Secretary of the Treasury and subject 
     to such other terms and conditions as the Secretaries may 
     specify.
       (3) Default rule.--A territory failing to make such an 
     election (or having an election under paragraph (1)(A) not 
     accepted under paragraph (2)) shall be treated as having made 
     the election described in paragraph (1)(B).
       (b) Agreement for Substitution of Percentages for Reduction 
     in Cost-Sharing.--
       (1) Negotiation.--In the case of a territory making an 
     election under subsection (a)(1)(A) (in this section referred 
     to as an ``electing territory''), the Secretaries of Health 
     and Human Services and the Treasury shall enter into 
     negotiations with the government of such territory so that, 
     prior to January 1, 2014, there is an agreement reached 
     between the parties on the percentages that shall be applied 
     under paragraph (2) for that territory. The Secretary of 
     Health and Human Services shall not enter into such an 
     agreement unless--
       (A) payments made under title I (and the amendments made by 
     such title) with respect to residents of the territory are 
     consistent with the cap established under subsection (c) for 
     such territory and with subsection (d); and
       (B) the requirements of paragraphs (3) and (4) are met.
       (2) Application of substitute percentages and dollar 
     amounts.--In the case of an electing territory, there shall 
     be substituted in section 1402(b)(2) and section 36B of the 
     Internal Revenue Code of 1986 for 400 percent, 133 percent, 
     and other percentages and dollar amounts specified in such 
     sections, such respective percentages and dollar amounts as 
     are established under the agreement under paragraph (1) 
     consistent with the following:
       (A) No income gap between medicaid and reduction in cost-
     sharing.--The substituted percentages shall be specified in a 
     manner so as to prevent any gap in coverage for individuals 
     between the income level at which medical assistance is 
     available through Medicaid and the income level at which 
     reduced cost-sharing is available under section 1402.
       (B) Adjustment for out-of-pocket responsibility for 
     premiums and cost-sharing in relation to income.--The 
     substituted percentages of the Federal poverty line for 
     income tiers under such sections shall be specified in a 
     manner so that--
       (i) individuals eligible for reduced cost-sharing under 
     section 1402 residing in the territory bear the same out-of-
     pocket responsibility for premiums and cost-sharing in 
     relation to average income for residents in that territory, 
     as
       (ii) the out-of-pocket responsibility for premiums and 
     cost-sharing for individuals eligible for reduced cost-
     sharing under section 1402 residing in the 50 States or the 
     District of Columbia in relation to average income for such 
     residents.

     In the case of a territory with a mirror code tax system, the 
     Internal Revenue Code of 1986 shall be applied as if the 
     substitutions permitted under this paragraph were included in 
     such Code.
       (3) Special rules with respect to application of tax and 
     penalty provisions.--The electing territory shall enact one 
     or more laws under which provisions similar to the following 
     provisions apply with respect to such territory:
       (A) Section 5000A of the Internal Revenue Code of 1986, 
     except that any resident of the territory who is not eligible 
     for reduced cost-sharing under section 1402 but who would be 
     so eligible if such resident were a resident of one of the 50 
     States (and any qualifying child residing with such 
     individual) may be treated as covered by minimum essential 
     coverage.
       (B) Section 502(c)(11) of the Employee Retirement Income 
     Security Act of 1974.
       (C) Section 3121(c) of the Internal Revenue Code of 1986.
       (4) Implementation of insurance reform and consumer 
     protection requirements.--The electing territory shall enact 
     and implement such laws and regulations as may be required to 
     apply the requirements of subtitles A and C of title I (and 
     the amendments made by such subtitles) with respect to health 
     insurance coverage offered in the territory.
       (c) Cap on Additional Expenditures.--
       (1) In general.--In entering into an agreement with an 
     electing territory under subsection (b), the Commissioner 
     shall ensure that the aggregate expenditures under this 
     section with respect to residents of such territory during 
     the period beginning on January 1, 2014 and ending with 2019 
     will not exceed the cap amount specified in paragraph (2) for 
     such territory. The Commissioner shall adjust from time to 
     time the percentages applicable under such agreement as 
     needed in order to carry out the previous sentence.
       (2) Cap amount.--
       (A) In general.--The cap amount specified in this 
     paragraph--
       (i) for Puerto Rico is $3,700,000,000 increased by the 
     amount (if any) elected under subparagraph (C); or
       (ii) for another territory is the portion of $300,000,000 
     negotiated for such territory under subparagraph (B).
       (B) Negotiation for certain territories.--The Secretary of 
     Health and Human Services shall negotiate with the 
     governments of the territories (other than Puerto Rico) to 
     allocate the amount specified in subparagraph (A)(ii) among 
     such territories.
       (C) Optional supplementation for puerto rico.--
       (i) In general.--Puerto Rico may elect, in a form and 
     manner specified by the Secretary of Health and Human 
     Services to increase the dollar amount specified in 
     subparagraph (A)(i) by up to $1,000,000,000.
       (ii) Offset in medicaid cap.--If Puerto Rico makes the 
     election described in clause (i), the Secretary shall 
     decrease the dollar

[[Page S12638]]

     limitation otherwise applicable to Puerto Rico under 
     subsections (f) and (g) of section 1108 of the Social 
     Security Act (42 U.S.C. 1308) for a fiscal year by the 
     additional aggregate payments the Secretary estimates will be 
     payable under this section for the fiscal year because of 
     such election.
       (d) Limitation on Funding.--In no case shall this section 
     (including the agreement under subsection (b)) permit--
       (1) the obligation of funds for expenditures under this 
     section for periods beginning on or after January 1, 2020; or
       (2) any increase in the dollar limitation described in 
     subsection (a)(1)(B) for any portion of any fiscal year 
     occurring on or after such date.

     SEC. 10002. MEDICAID PAYMENTS TO TERRITORIES.

       (a) Increase in Cap.--Section 1108 of the Social Security 
     Act (42 U.S.C. 1308) is amended--
       (1) in subsection (f), by striking ``subsection (g)'' and 
     inserting ``subsections (g) and (h)'';
       (2) in subsection (g)(1), by striking ``With respect to'' 
     and inserting ``Subject to subsection (h), with respect to''; 
     and
       (3) by adding at the end the following new subsection:
       ``(h) Additional Increase for Fiscal Years 2011 Through 
     2019.--Subject to section 10002(b)(1) of the Patient 
     Protection and Affordable Care Act, with respect to fiscal 
     years 2011 through 2019, the amounts otherwise determined 
     under subsections (f) and (g) for Puerto Rico, the Virgin 
     Islands, Guam, the Northern Mariana Islands and American 
     Samoa shall be increased by the following amounts:
       ``(1) For Puerto Rico, for fiscal year 2011, $727,600,000; 
     for fiscal year 2012, $775,000,000; for fiscal year 2013, 
     $850,000,000; for fiscal year 2014, $925,000,000; for fiscal 
     year 2015, $1,000,000,000; for fiscal year 2016, 
     $1,075,000,000; for fiscal year 2017, $1,150,000,000; for 
     fiscal year 2018, $1,225,000,000; and for fiscal year 2019, 
     $1,396,400,000.
       ``(2) For the Virgin Islands, for fiscal year 2011, 
     $34,000,000; for fiscal year 2012, $37,000,000; for fiscal 
     year 2013, $40,000,000; for fiscal year 2014, $43,000,000; 
     for fiscal year 2015, $46,000,000; for fiscal year 2016, 
     $49,000,000; for fiscal year 2017, $52,000,000; for fiscal 
     year 2018, $55,000,000; and for fiscal year 2019, 
     $58,000,000.
       ``(3) For Guam, for fiscal year 2011, $34,000,000; for 
     fiscal year 2012, $37,000,000; for fiscal year 2013, 
     $40,000,000; for fiscal year 2014, $43,000,000; for fiscal 
     year 2015, $46,000,000; for fiscal year 2016, $49,000,000; 
     for fiscal year 2017, $52,000,000; for fiscal year 2018, 
     $55,000,000; and for fiscal year 2019, $58,000,000.
       ``(4) For the Northern Mariana Islands, for fiscal year 
     2011, $13,500,000; fiscal year 2012, $14,500,000; for fiscal 
     year 2013, $15,500,000; for fiscal year 2014, $16,500,000; 
     for fiscal year 2015, $17,500,000; for fiscal year 2016, 
     $18,500,000; for fiscal year 2017, $19,500,000; for fiscal 
     year 2018, $21,000,000; and for fiscal year 2019, 
     $22,000,000.
       ``(5) For American Samoa, fiscal year 2011, $22,000,000; 
     fiscal year 2012, $23,687,500; for fiscal year 2013, 
     $24,687,500; for fiscal year 2014, $25,687,500; for fiscal 
     year 2015, $26,687,500; for fiscal year 2016, $27,687,500; 
     for fiscal year 2017, $28,687,500; for fiscal year 2018, 
     $29,687,500; and for fiscal year 2019, $30,687,500.''.
       (b) Report on Achieving Medicaid Parity Payments Beginning 
     With Fiscal Year 2020.--
       (1) In general.--Not later than October 1, 2013, the 
     Secretary of Health and Human Services shall submit to 
     Congress a report that details a plan for the transition of 
     each territory to full parity in Medicaid with the 50 States 
     and the District of Columbia in fiscal year 2020 by modifying 
     their existing Medicaid programs and outlining actions the 
     Secretary and the governments of each territory must take by 
     fiscal year 2020 to ensure parity in financing. Such report 
     shall include what the Federal medical assistance percentages 
     would be for each territory if the formula applicable to the 
     50 States were applied. Such report shall also include any 
     recommendations that the Secretary may have as to whether the 
     mandatory ceiling amounts for each territory provided for in 
     section 1108 of the Social Security Act (42 U.S.C. 1308) 
     should be increased any time before fiscal year 2020 due to 
     any factors that the Secretary deems relevant.
       (2) Per capita data.--As part of such report the Secretary 
     shall include information about per capita income data that 
     could be used to calculate Federal medical assistance 
     percentages under section 1905(b) of the Social Security Act, 
     under section 1108(a)(8)(B) of such Act, for each territory 
     on how such data differ from the per capita income data used 
     to promulgate Federal medical assistance percentages for the 
     50 States. The report under this subsection shall include 
     recommendations on how the Federal medical assistance 
     percentages can be calculated for the territories beginning 
     in fiscal year 2020 to ensure parity with the 50 States.
       (3) Subsequent reports.--The Secretary shall submit 
     subsequent reports to Congress in 2015, 2017, and 2019 
     detailing the progress that the Secretary and the governments 
     of each territory have made in fulfilling the actions 
     outlined in the plan submitted under paragraph (1).
       (c) Application of FMAP for Additional Funds.--Section 
     1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by adding 
     at the end the following sentence: ``Notwithstanding the 
     first sentence of this subsection and any other provision of 
     law, for fiscal years 2011 through 2019, the Federal medical 
     assistance percentage for Puerto Rico, the Virgin Islands, 
     Guam, the Northern Mariana Islands, and American Samoa shall 
     be the highest Federal medical assistance percentage 
     applicable to any of the 50 States or the District of 
     Columbia for the fiscal year involved, taking into account 
     the application of subsections (a) and (b)(1) of section 5001 
     of division B of the American Recovery and Reinvestment Act 
     of 2009 (Public Law 111-5) to such States and the District 
     for calendar quarters during such fiscal years for which such 
     subsections apply.''.
       (d) Waivers.--
       (1) In general.--Section 1902(j) of the Social Security Act 
     (42 U.S.C. 1396a(j)) is amended--
       (A) by striking ``American Samoa and the Northern Mariana 
     Islands'' and inserting ``Puerto Rico, the Virgin Islands, 
     Guam, the Northern Mariana Islands, and American Samoa''; and
       (B) by striking ``American Samoa or the Northern Mariana 
     Islands'' and inserting ``Puerto Rico, the Virgin Islands, 
     Guam, the Northern Mariana Islands, or American Samoa''.
       (2) Effective date.--The amendments made by paragraph (1) 
     shall apply beginning with fiscal year 2011.
       (e) Technical Assistance.--The Secretary shall provide 
     nonmonetary technical assistance to the governments of Puerto 
     Rico, the Virgin Islands, Guam, the Northern Mariana Islands, 
     and American Samoa in upgrading their existing computer 
     systems in order to anticipate meeting reporting requirements 
     necessary to implement the plan contained in the report under 
     subsection (b)(1).

     SEC. 10003. MEDICARE PROVISIONS RELATING TO PUERTO RICO.

       (a) Modification of Medicare Inpatient Hospital Payment 
     Rate for Puerto Rico Hospitals.--Section 1886(d)(9)(E) of the 
     Social Security Act (42 U.S.C. 1395ww(d)(9)(E)) is amended--
       (1) by striking ``and'' at the end of clause (iii);
       (2) in clause (iv), by inserting ``and before April 1, 
     2010,'' after ``2004,'' and by striking the period at the end 
     and inserting ``; and''; and
       (3) by adding at the end the following new clause:
       ``(v) on or after April 1, 2010, the applicable Puerto Rico 
     percentage is 0 percent and the applicable Federal percentage 
     is 100 percent.''.
       (b) Application of Deemed Part B Medicare Enrollment Rules 
     to Residents of Puerto Rico.--
       (1) In general.--Section 1837(f)(3) of the Social Security 
     Act (42 U.S.C. 1395p(f)(3)) is amended by striking ``, 
     exclusive of Puerto Rico''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall apply to individuals whose initial enrollment period 
     under section 1837(d) of the Social Security Act (42 U.S.C. 
     1395p(d)) begins on or after the first day of the first month 
     that begins more than 60 days after the date of the enactment 
     of this Act.
                                 ______
                                 
  SA 2990. Mr. MENENDEZ submitted an amendment intended to be proposed 
by him to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. EXPANDING ACCESS TO VACCINES.

       (a) In General.--Paragraph (10) of section 1861(s) of the 
     Social Security Act (42 U.S.C. 1395w(s)) is amended to read 
     as follows:
       ``(10) federally approved and recommended vaccines (as 
     defined in subsection (hhh)) and their respective 
     administration;''.
       (b) Federally Approved and Recommended Vaccines Defined.--
     Section 1861 of such Act is amended by adding at the end the 
     following new subsection:

             ``Federally Approved and Recommended Vaccines

       ``(hhh) The term `federally approved and recommended 
     vaccine' means a vaccine that--
       ``(1) is licensed under section 351 of the Public Health 
     Service Act, approved under the Federal Food, Drug, and 
     Cosmetic Act, or authorized for emergency use under section 
     564 of the Federal, Food, Drug, and Cosmetic Act; and
       ``(2) is recommended by the Director of the Centers for 
     Disease Control and Prevention.''.
       (c) Conforming Amendments.--
       (1) Section 1833 of such Act (42 U.S.C. 1395l) is amended, 
     in each of subsections (a)(1)(B), (a)(2)(G), and (a)(3)(A), 
     by striking ``1861(s)(10)(A)'' and inserting ``1861(s)(10)'' 
     each place it appears.
       (2) Section 1842(o)(1)(A)(iv) of such Act (42 U.S.C. 
     1395u(o)(1)(A)(iv)) is amended--
       (A) by striking ``subparagraph (A) or (B) of''; and
       (B) by inserting before the period the following: ``and 
     before January 1, 2011, and influenza vaccines furnished on 
     or after January 1, 2011''.

[[Page S12639]]

       (3) Section 1847A(c)(6) of such Act (42 U.S.C. 1395w-
     3a(c)(6)) is amended--
       (A) in subparagraph (D)(i), by inserting ``, including a 
     vaccine furnished on or after January 1, 2010''; and
       (B) by the following new paragraph:
       ``(H) Implementation.--Chapter 35 of title 44, United 
     States Code shall not apply to manufacturer provision of 
     information pursuant to section 1927(b)(3)(A)(iii) or 
     subsection (f)(2) for purposes of implementation of this 
     section.''.
       (4) Section 1860D-2(e)(1) of such Act (42 U.S.C. 1395w-
     102(e)(1)) is amended by striking ``such term includes a 
     vaccine'' and all that follows through ``its administration) 
     and''.
       (5) Section 1861(ww)(2)(A) of such Act (42 U.S.C. 
     1395x(ww)(2)(A))) is amended by striking ``Pneumococcal, 
     influenza, and hepatitis B vaccine and administration'' and 
     inserting ``federally approved or authorized vaccines (as 
     defined in subsection (hhh)) and their respective 
     administration''.
       (6) Section 1927(b)(3)(A)(iii) of such Act (42 U.S.C. 
     1396r-8(b)(3)(A)(iii)) is amended, in the matter following 
     subclause (III), by inserting ``(A)(iv) (including influenza 
     vaccines furnished on or after January 1, 2011),'' after 
     ``described in subparagraph''.
       (7) Section 1847A(f) of such Act (42 U.S.C. 1395w-3a(f)) is 
     amended--
       (A) by striking ``For'' and inserting ``(1) In general.--
     For'';
       (B) by indenting paragraph (1), as redesignated in 
     subparagraph (A), 2 ems to the left; and--
       (C) by adding at the end the following new paragraph:
       ``(2) Treatment of certain manufacturers.--In the case of a 
     manufacturer of a drug or biological described in 
     subparagraphs (A)(iv), (C), (D), (E), or (G) of section 
     1842(o)(1) that does not have a rebate agreement under 
     section 1927(a), no payment may be made under this part for 
     such drug or biological if such manufacturer does not submit 
     the information described in section 1927(b)(3)(A)(iii) in 
     the same manner as if the manufacturer had such a rebate 
     agreement in effect. Subparagraphs (C) and (D) of section 
     1927(b)(3) shall apply to information reported pursuant to 
     the previous sentence in the same manner as such 
     subparagraphs apply with respect to information reported 
     pursuant to such section.''.''.
       (d) Effective Dates.--The amendments made--
       (1) by this section (other than by subsection (c)(6)) shall 
     apply to vaccines administered on or after January 1, 2011; 
     and
       (2) by subsection (c)(6) shall apply to calendar quarters 
     beginning on or after January 1, 2010.
                                 ______
                                 
  SA 2991. Mr. MENENDEZ (for himself, Mr. Rockefeller, Mr. Bingaman, 
and Mr. Durbin) submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 436, between lines 14 and 15, insert the following:

     SEC. 2008. PERMITTING STATES TO ENSURE COVERAGE WITHOUT A 5-
                   YEAR DELAY OF LAWFULLY RESIDING NONCITIZEN 
                   NONPREGNANT ADULTS UNDER MEDICAID.

       (a) State Option.--
       (1) In general.--Section 1903(v)(4)(A) of the Social 
     Security Act (42 U.S.C. 1396b(v)(4)(A)) is amended--
       (A) in the matter preceding clause (i)--
       (i) by striking ``children and pregnant women'' and 
     inserting ``individuals''; and
       (ii) by striking ``either or both'' and inserting ``any or 
     all''; and
       (B) by adding at the end the following:
       ``(iii) Other lawfully residing individuals.--Individuals 
     who are not described in clause (i) or (ii).''.
       (2) Effective date.--The amendments made by paragraph (1) 
     take effect on January 1, 2014.
       (b) Conforming Amendment.--Effective as if enacted on 
     October 1, 2009, subparagraph (H) of section 2107(e)(1) of 
     the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended 
     by striking ``Paragraph (4) of section 1903(v)'' and 
     inserting ``Clauses (i) and (ii) of section 1903(v)(4)''.
                                 ______
                                 
  SA 2992. Mr. MENENDEZ submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 867, strike line 15 and all that follows 
     through page 869, line 14, and insert the following:

     SEC. 3142. TREATMENT OF URBAN MEDICARE-DEPENDENT HOSPITALS.

       Section 1886(d)(5) of the Social Security Act (42 U.S.C. 
     1395ww(d)(5)) is amended by adding at the end the following 
     new subparagraph:
       ``(M) Authorization of adjustment in amount of payment for 
     urban medicare-dependent hospitals.--
       ``(i) Study.--The Secretary shall conduct a study on the 
     need for a payment adjustment under the prospective payment 
     system under this section for urban Medicare-dependent 
     hospitals similar to the adjustment available (as of the date 
     of enactment of this subparagraph) to medicare-dependent, 
     small rural hospitals under subparagraph (G). Such study 
     shall compare the Medicare inpatient operating margins of 
     urban Medicare-dependent hospitals to the Medicare inpatient 
     operating margins of subsection (d) hospitals that receive 
     one or more additional payments or adjustments (as defined in 
     clause (iv)). The Secretary shall finish conducting such 
     study by not later than June 1, 2010.
       ``(ii) Authorization of adjustment.--If the Secretary 
     determines under clause (i) that the average Medicare 
     inpatient operating margin of urban Medicare-dependent 
     hospitals is materially lower than the average Medicare 
     inpatient operating margin of subsection (d) hospitals that 
     receive one or more additional payments or adjustments (as so 
     defined), the Secretary shall provide for an adjustment to 
     the payment amounts to urban Medicare-dependent hospitals 
     under this section similar to the adjustment available to 
     medicare-dependent, small rural hospitals under subparagraph 
     (G). Any such adjustment shall be effective for discharges 
     occurring on or after October 1, 2010.
       ``(iii) Definition or urban medicare-dependent hospital.--
     In this subparagraph, the term `urban Medicare-dependent 
     hospital' means a subsection (d) hospital--

       ``(I) located in an urban area;
       ``(II) that does not receive any additional payments or 
     adjustments (as so defined);
       ``(III) that is not a physician-owned hospital, as defined 
     in section 489.3 of title 42, Code of Federal Regulations (as 
     in effect as of the date of the enactment of this 
     subparagraph); and
       ``(IV) for which not less than 60 percent of its inpatient 
     days or discharges during the cost reporting period beginning 
     in fiscal year 2006, or 2 of the 3 most recently audited cost 
     reporting periods for which the Secretary has a settled cost 
     report, were attributable to inpatients entitled to benefits 
     under part A.

       ``(iv) Additional payments or adjustments defined.--The 
     term `additional payments or adjustments' means payments or 
     adjustments--

       ``(I) under subparagraph (C) as a rural referral center;
       ``(II) under subparagraph (D) as a sole community hospital;
       ``(III) under subparagraph (B) for indirect medical 
     education costs;
       ``(IV) under subsection (h) for direct graduate medical 
     education costs;
       ``(V) under subparagraph (F) for disproportionate share 
     hospital payments; or
       ``(VI) under subparagraph (G) as a medicare-dependent, 
     small rural hospital.''.

                                 ______
                                 
  SA 2993. Mr. SCHUMER (for himself and Mrs. Lincoln) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 1999, strike lines 9 through 17 and insert the 
     following:
       ``(i) Limitation on Health Flexible Spending 
     Arrangements.--
       ``(1) In general.--For purposes of this section, if a 
     benefit is provided under a cafeteria plan through employer 
     contributions to a health flexible spending arrangement, such 
     benefit shall not be treated as a qualified benefit unless 
     the cafeteria plan provides that an employee may not elect 
     for any taxable year to have salary reduction contributions 
     in excess of $2,500 made to such arrangement.
       ``(2) Adjustment for inflation.--In the case of a taxable 
     year beginning in any calendar year after 2011, the dollar 
     amount in paragraph (1) shall be increased to the amount 
     equal to such amount as in effect for taxable years beginning 
     in the calendar year preceding such calendar year, increased 
     by an amount equal to the product of--
       ``(A) such amount as so in effect, multiplied by
       ``(B) the cost-of-living adjustment determined under 
     section 1(f)(3) for such calendar year by substituting the 
     calendar year that is 2 years before such calendar year for 
     `calendar year 1992' in subparagraph (B) thereof, increased 
     by 1 percentage point.

     If any increase determined under this paragraph is not a 
     multiple of $50, such increase shall be rounded to the 
     nearest multiple of $50.''.
                                 ______
                                 
  SA 2994. Mr. SCHUMER (for himself, Mr. Akaka, Mr. Brown, Mr. 
Lautenberg, Mr. Merkley, Ms. Cantwell, Mr. Kerry, Mr. Leahy, Mr. 
Menendez, and Mr. Whitehouse) submitted an amendment intended to be 
proposed to amendment SA 2786 proposed by Mr.

[[Page S12640]]

Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 2074, after line 25, insert the following:

          Subtitle C--Tax Equity for Health Plan Beneficiaries

     SEC. 9031. APPLICATION OF ACCIDENT AND HEALTH PLANS TO 
                   ELIGIBLE BENEFICIARIES.

       (a) Exclusion of Contributions.--Section 106 of the 
     Internal Revenue Code of 1986, as amended by section 9003, is 
     amended by adding at the end the following new subsection:
       ``(g) Coverage Provided for Eligible Beneficiaries of 
     Employees.--
       ``(1) In general.--Subsection (a) shall apply with respect 
     to any eligible beneficiary of the employee.
       ``(2) Eligible beneficiary.--For purposes of this 
     subsection, the term `eligible beneficiary' means any 
     individual who is eligible to receive benefits or coverage 
     under an accident or health plan.''.
       (b) Exclusion of Amounts Expended for Medical Care.--The 
     first sentence of section 105(b) of the Internal Revenue Code 
     of 1986 is amended--
       (1) by striking ``and his dependents'' and inserting ``his 
     dependents'', and
       (2) by inserting before the period the following: ``and any 
     eligible beneficiary (within the meaning of section 106(g)) 
     with respect to the taxpayer''.
       (c) Payroll Taxes.--
       (1) Section 3121(a)(2) of the Internal Revenue Code of 1986 
     is amended--
       (A) by striking ``or any of his dependents'' in the matter 
     preceding subparagraph (A) and inserting ``, any of his 
     dependents, or any eligible beneficiary (within the meaning 
     of section 106(g)) with respect to the employee'',
       (B) by striking ``or any of his dependents,'' in 
     subparagraph (A) and inserting ``, any of his dependents, or 
     any eligible beneficiary (within the meaning of section 
     106(g)) with respect to the employee,'', and
       (C) by striking ``and their dependents'' both places it 
     appears and inserting ``and such employees' dependents and 
     eligible beneficiaries (within the meaning of section 
     106(g))''.
       (2) Section 3231(e)(1) of such Code is amended--
       (A) by striking ``or any of his dependents'' and inserting 
     ``, any of his dependents, or any eligible beneficiary 
     (within the meaning of section 106(g)) with respect to the 
     employee,'', and
       (B) by striking ``and their dependents'' both places it 
     appears and inserting ``and such employees' dependents and 
     eligible beneficiaries (within the meaning of section 
     106(g))''.
       (3) Section 3306(b)(2) of such Code is amended--
       (A) by striking ``or any of his dependents'' in the matter 
     preceding subparagraph (A) and inserting ``, any of his 
     dependents, or any eligible beneficiary (within the meaning 
     of section 106(g)) with respect to the employee,'',
       (B) by striking ``or any of his dependents'' in 
     subparagraph (A) and inserting ``, any of his dependents, or 
     any eligible beneficiary (within the meaning of section 
     106(g)) with respect to the employee'', and
       (C) by striking ``and their dependents'' both places it 
     appears and inserting ``and such employees' dependents and 
     eligible beneficiaries (within the meaning of section 
     106(g))''.
       (4) Section 3401(a) of such Code is amended by striking 
     ``or'' at the end of paragraph (22), by striking the period 
     at the end of paragraph (23) and inserting ``; or'', and by 
     inserting after paragraph (23) the following new paragraph:
       ``(24) for any payment made to or for the benefit of an 
     employee or any eligible beneficiary (within the meaning of 
     section 106(g)) if at the time of such payment it is 
     reasonable to believe that the employee will be able to 
     exclude such payment from income under section 106 or under 
     section 105 by reference in section 105(b) to section 
     106(g).''.
       (d) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2009.

     SEC. 9032. EXPANSION OF DEPENDENCY FOR PURPOSES OF DEDUCTION 
                   FOR HEALTH INSURANCE COSTS OF SELF-EMPLOYED 
                   INDIVIDUALS.

       (a) In General.--Paragraph (1) of section 162(l) of the 
     Internal Revenue Code of 1986 is amended to read as follows:
       ``(1) Allowance of deduction.--In the case of a taxpayer 
     who is an employee within the meaning of section 401(c)(1), 
     there shall be allowed as a deduction under this section an 
     amount equal to the amount paid during the taxable year for 
     insurance which constitutes medical care for--
       ``(A) the taxpayer,
       ``(B) the taxpayer's spouse,
       ``(C) the taxpayer's dependents, and
       ``(D) any individual who--
       ``(i) satisfies the age requirements of section 
     152(c)(3)(A),
       ``(ii) bears a relationship to the taxpayer described in 
     section 152(d)(2)(H), and
       ``(iii) meets the requirements of section 152(d)(1)(C), and
       ``(E) not more than one individual who--
       ``(i) does not satisfy the age requirements of section 
     152(c)(3)(A),
       ``(ii) bears a relationship to the taxpayer described in 
     section 152(d)(2)(H),
       ``(iii) meets the requirements of section 152(d)(1)(D), and
       ``(iv) is not the spouse of the taxpayer and does not bear 
     any relationship to the taxpayer described in subparagraphs 
     (A) through (G) of section 152(d)(2).''.
       (b) Conforming Amendment.--Subparagraph (B) of section 
     162(l)(2) of the Internal Revenue Code of 1986 is amended by 
     inserting ``, any dependent, or individual described in 
     subparagraph (D) or (E) of paragraph (1) with respect to'' 
     after ``spouse''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2009.

     SEC. 9033. EXTENSION TO ELIGIBLE BENEFICIARIES OF SICK AND 
                   ACCIDENT BENEFITS PROVIDED TO MEMBERS OF A 
                   VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION 
                   AND THEIR DEPENDENTS.

       (a) In General.--Section 501(c)(9) of the Internal Revenue 
     Code of 1986 is amended by adding at the end the following 
     new sentence: ``For purposes of providing for the payment of 
     sick and accident benefits to members of such an association 
     and their dependents, the term `dependents' shall include any 
     individual who is an eligible beneficiary (within the meaning 
     of section 106(g)), as determined under the terms of a 
     medical benefit, health insurance, or other program under 
     which members and their dependents are entitled to sick and 
     accident benefits.''.
       (b) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2009.

     SEC. 9034. FLEXIBLE SPENDING ARRANGEMENTS AND HEALTH 
                   REIMBURSEMENT ARRANGEMENTS.

       The Secretary of Treasury shall issue guidance of general 
     applicability providing that medical expenses that otherwise 
     qualify--
       (1) for reimbursement from a flexible spending arrangement 
     under regulations in effect on the date of the enactment of 
     this Act may be reimbursed from an employee's flexible 
     spending arrangement, notwithstanding the fact that such 
     expenses are attributable to any individual who is not the 
     employee's spouse or dependent (within the meaning of section 
     105(b) of the Internal Revenue Code of 1986) but is an 
     eligible beneficiary (within the meaning of section 106(g) of 
     such Code) under the flexible spending arrangement with 
     respect to the employee, and
       (2) for reimbursement from a health reimbursement 
     arrangement under regulations in effect on the date of the 
     enactment of this Act may be reimbursed from an employee's 
     health reimbursement arrangement, notwithstanding the fact 
     that such expenses are attributable to an individual who is 
     not a spouse or dependent (within the meaning of section 
     105(b) of such Code) but is an eligible beneficiary (within 
     the meaning of section 106(g) of such Code) under the health 
     reimbursement arrangement with respect to the employee.
                                 ______
                                 
  SA 2995. Mr. SCHUMER (for himself and Ms. Mikulski) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 466, between lines 5 and 6, insert the following:

     SEC. 2305. REQUIRING COVERAGE OF SERVICES OF PODIATRISTS.

       (a) In General.--Section 1905(a)(5)(A) of the Social 
     Security Act (42 U.S.C. 1396d(a)(5)(A)) is amended by 
     striking ``section 1861(r)(1)'' and inserting ``paragraphs 
     (1) and (3) of section 1861(r)''.
       (b) Effective Date.--
       (1) In general.--Except as provided in paragraph (2), the 
     amendment made by subsection (a) shall apply to services 
     furnished on or after January 1, 2010.
       (2) Delay if needed for state legislation.--In the case of 
     a State plan for medical assistance under title XIX of the 
     Social Security Act which the Secretary of Health and Human 
     Services determines requires State legislation (other than 
     legislation appropriating funds) in order for the plan to 
     meet the additional requirement imposed by the amendment made 
     by subsection (a), the State plan shall not be regarded as 
     failing to comply with the requirements of such title solely 
     on the basis of its failure to meet this additional 
     requirement before the first day of the first calendar 
     quarter beginning after the close of the first regular 
     session of the State legislature that begins after the date 
     of the enactment of this Act. For purposes of the previous 
     sentence, in the case of a State that has a 2-year 
     legislative session, each year of such session shall be 
     deemed to be a separate regular session of the State 
     legislature.
                                 ______
                                 
  SA 2996. Mr. KOHL (for himself, Mr. Wyden, and Ms. Klobuchar) 
submitted an amendment intended to be proposed

[[Page S12641]]

to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1979, between lines 15 and 16, insert the 
     following:

                  Subtitle B--Long-Term Care Insurance

PART I--NATIONAL MARKET SURVEY; MODEL DISCLOSURES AND DEFINITIONS; LTC 
                           INSURANCE COMPARE

     SEC. 8101. NAIC NATIONAL MARKET SURVEY.

       (a) In General.--The Secretary shall request the NAIC to 
     conduct reviews of the national and State-specific markets 
     for long-term care insurance policies and to submit reports 
     to the Secretary on the results of such reviews every 5 
     years.
       (b) Content.--The Secretary shall request that the reviews 
     include, with respect to the period occurring since any prior 
     review, analysis of the following:
       (1) Information on key market parameters, including the 
     number of carriers offering long-term care insurance, and the 
     scope of coverage offered under those policies (such as 
     policies offering nursing-home only benefits, policies 
     offering comprehensive coverage, cash plans, and 
     reimbursement plans, and hybrid products in which long-term 
     care benefits are present).
       (2) The number of complaints received and resolved, 
     including benefit denials.
       (3) The number of policies that have lapsed.
       (4) The number of agents trained and whether the training 
     included competency tests.
       (5) The number of policyholders exhausting benefits.
       (6) The number of premium rate increases filed by carriers 
     on a policy basis with the States, including the ranges of 
     the increases approved for or finally used.
       (7) The number of policyholders affected by any premium 
     rate increases.
       (8) Requests for exceptions to State permitted accounting 
     practices, as defined by the NAIC.
       (c) Timing for Reviews and Reports.--The Secretary shall 
     request the NAIC to--
       (1) complete the initial market review under this section 
     not later than 2 years after the date of enactment of this 
     Act;
       (2) submit a report to the Secretary on the results of the 
     initial review not later than December 31, 2011; and
       (3) complete each subsequent review and submit each 
     subsequent report not later than December 31 of the fifth 
     succeeding year.
       (d) Consultation Required.--The Secretary shall request the 
     NAIC to consult with State insurance commissioners, 
     appropriate Federal agencies, issuers of long-term care 
     insurance, States with experience in long-term care insurance 
     partnership plans, other States, representatives of consumer 
     groups, consumers of long-term care insurance policies, and 
     such other stakeholders as the Secretary or the NAIC 
     determine appropriate, to conduct the market reviews 
     requested under this section.
       (e) Definitions.--In this section and section 8102:
       (1) Long-term care insurance policy.--The term ``long-term 
     care insurance policy''--
       (A) means--
       (i) a qualified long-term care insurance contract (as 
     defined in section 7702B(b) of the Internal Revenue Code of 
     1986); and
       (ii) a qualified long-term care insurance contract that 
     covers an insured who is a resident of a State with a 
     qualified State long-term care insurance partnership under 
     clause (iii) of section 1917(b)(1)(C) of the Social Security 
     Act (42 U.S.C. 1396p(b)(1)(C)) or a long-term care insurance 
     policy offered in connection with a State plan amendment 
     described in clause (iv) of such section; and
       (B) includes any other insurance policy or rider described 
     in the definition of ``long-term care insurance'' in section 
     4 of the model Act promulgated by the National Association of 
     Insurance Commissioners (as adopted December 2006).
       (2) NAIC.--The term ``NAIC'' means the National Association 
     of Insurance Commissioners.
       (3) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.

     SEC. 8102. MODEL DISCLOSURE FORM.

       (a) NAIC Study and Report on State Disclosure Requirements 
     for Long-Term Care Insurance.--
       (1) In general.--The Secretary shall request the NAIC to 
     carry out the activities described in paragraph (2) and issue 
     the report described in paragraph (3).
       (2) Review and development of proposed model disclosure 
     requirements.--The activities described in this paragraph are 
     the following:
       (A) Model act and regulation disclosure requirements.--
     Review and describe disclosure requirements for long-term 
     care insurance policies under the Model Act and regulation.
       (B) State law disclosure requirements.--Review and describe 
     disclosure requirements for long-term care insurance policies 
     under State laws, including as part of such description an 
     analysis of the effectiveness of the various existing 
     disclosures.
       (C) Long-term care services.--Review and describe 
     differences in long-term care services, including with 
     respect to providers of such services and the settings in 
     which such services are provided among States and develop 
     standardized definitions for long-term care services.
       (D) Identification of key issues for development of model 
     disclosure marketing form.--Identify and describe key issues 
     to consider in the development of a proposed form for 
     marketing long-term care insurance policies.
       (3) Report.--The report described in this paragraph is an 
     NAIC White Paper that is issued not later than 12 months 
     after the date of enactment of this Act and contains the 
     results of the reviews conducted under paragraph (2) and the 
     descriptions required under that paragraph.
       (b) NAIC Working Group to Develop Model Disclosure Form for 
     Long-Term Care Insurance.--
       (1) In general.--The Secretary shall request the NAIC to 
     establish, not later than 60 days after the date on which the 
     NAIC White Paper described in subsection (a)(3) is issued and 
     in consultation with the Secretary and the Secretary of the 
     Treasury, a Working Group to develop a model disclosure form 
     for marketing long-term care insurance policies.
       (2) Working group members.--The Working Group established 
     under paragraph (1) shall be composed of the following:
       (A) Representatives from State Departments of Health (or 
     the most appropriate State agencies with responsibility for 
     oversight of the provision of long-term care).
       (B) Representatives of long-term care providers and 
     facilities.
       (C) Consumer advocates.
       (D) Representatives of issuers of long-term care insurance 
     policies.
       (E) Representatives of the NAIC or State insurance 
     commissioners.
       (F) Other experts in long-term care and long-term care 
     insurance policies selected by the Secretary and Secretary of 
     the Treasury or the NAIC.
       (3) Requirements for development of form.--
       (A) Considerations.--In developing the model form, the 
     Working Group shall consider the following:
       (i) Variations among providers, services, and facilities in 
     the long-term care and long-term care insurance markets.
       (ii) The results of the reviews and the descriptions 
     included in the NAIC White Paper issued under subsection 
     (a)(3).
       (iii) Such other information and factors as the Working 
     Group determines appropriate.
       (B) Minimum standards.--The Working Group shall ensure that 
     the model has--
       (i) minimum standard definitions for coverage of the 
     various types of services and benefits provided under long-
     term care insurance policies;
       (ii) minimum standard language for use by issuers of such 
     policies, and for agents selling such policies, in explaining 
     the services and benefits covered under the policies and 
     restrictions on the services and benefits;
       (iii) minimum standard format, color and type size for 
     disclosure documents; and
       (iv) such other minimum standards as the Working Group 
     determines appropriate.
       (4) Deadline for development.--The Working Group shall 
     issue a proposed model disclosure form for marketing long-
     term care insurance policies not later than 1 year after the 
     date on which the Working Group is established.
       (5) Adoption and incorporation into model act and 
     regulation.--The Secretary shall request the NAIC to amend 
     the Model Act and regulation to incorporate the use of the 
     proposed model disclosure form issued by the Working Group, 
     not later than 1 year after the date on which the Working 
     Group issues the form.
       (c) Required Use of Model Disclosure Form in Marketing 
     Long-Term Care Insurance Policies.--
       (1) Application to tax-qualified and medicaid partnership 
     policies.--Not later than 1 year after the date on which the 
     Working Group issues the proposed model disclosure form for 
     marketing long-term care insurance policies under subsection 
     (b):
       (A) Tax-qualified policies.--The Secretary of the Treasury 
     shall promulgate a regulation requiring, not later than 1 
     year after the date on which the regulation is final, any 
     issuer of a qualified long-term care insurance contract (as 
     defined in section 7702B(b) of the Internal Revenue Code of 
     1986) to use the proposed model disclosure form for marketing 
     such contracts, to the extent such disclosure is not 
     inconsistent with State law.
       (B) Medicaid partnership policies.--The Secretary shall 
     promulgate a regulation requiring, not later than 1 year 
     after the date on which the regulation is final, any issuer 
     that markets a qualified long-term care insurance contract 
     intended to cover an insured who is a resident of a State 
     with a qualified State long-term care insurance partnership 
     under clause (iii) of section 1917(b)(1)(C) of the Social 
     Security Act (42 U.S.C. 1396p(b)(1)(C)) or a long-term care 
     insurance policy offered in connection with a State plan 
     amendment described in clause (iv) of such section to use the 
     proposed model disclosure form for marketing such contracts.
       (2) Application to all other long-term care insurance 
     policies.--Not later than 18 months, or the earliest date on 
     which an amendment could be enacted for those

[[Page S12642]]

     States with legislatures which meet only every other year, 
     after the date on which the NAIC adopts an amended Model Act 
     and regulation to require the use of the proposed model 
     disclosure form issued by the Working Group under subsection 
     (b), each State shall require by statute or regulation any 
     issuer of a long-term care insurance policy to use the 
     proposed model disclosure form when marketing such a policy 
     in the State.

     SEC. 8103. LTC INSURANCE COMPARE.

       (a) In General.--Section 6021(d) of the Deficit Reduction 
     Act of 2005 (42 U.S.C. 1396p note) is amended--
       (1) in paragraph (2)--
       (A) in subparagraph (A)--
       (i) in clause (ii), by striking ``and'' at the end;
       (ii) in clause (iii), by striking the period at the end and 
     inserting ``; and''; and
       (iii) by adding at the end the following:
       ``(iv) establish an Internet directory of information 
     regarding long-term care insurance, to be known as `LTC 
     Insurance Compare', that shall include the following:

       ``(I) Comparison tools to assist consumers in evaluating 
     long-term care insurance policies (as defined in subparagraph 
     (D)) with different benefits and features and that allow 
     consumers to compare the price, long-term premium stability, 
     and carrier financial strength of such policies.
       ``(II) State-specific information about the long-term care 
     insurance policies marketed in a State, including the 
     following:

       ``(aa) Whether a State has promulgated rate stability 
     provisions or has rate stability procedures in place, and how 
     the standards or procedures work.
       ``(bb) The rating history for at least the most recent 
     preceding 5 years for issuers selling long-term care 
     insurance policies in the State.
       ``(cc) An appropriate sampling of the policy forms marketed 
     in the State.

       ``(III) Links to State information regarding long-term care 
     under State Medicaid programs (which may be provided, as 
     appropriate, through Internet linkages to the websites of 
     State Medicaid programs) that includes the following:

       ``(aa) The medical assistance provided under each State's 
     Medicaid program for nursing facility services and other 
     long-term care services (including any functional criteria 
     imposed for receipt of such services, as reported in 
     accordance with section 1902(a)(28)(D) of the Social Security 
     Act) and any differences from benefits and services offered 
     under long-term care insurance policies in the State and the 
     criteria for triggering receipt of such benefits and 
     services.
       ``(bb) If the State has a qualified State long-term care 
     insurance partnership under section 1917(b)(1)(C)(iii) of the 
     Social Security Act, information regarding how and when an 
     individual with a partnership long-term care insurance policy 
     who is receiving benefits under the policy should apply for 
     medical assistance for nursing facility services or other 
     long-term care services under the State Medicaid program and 
     information regarding about how Medicaid asset protection is 
     accumulated over time.''; and
       (B) by adding at the end the following:
       ``(C) Current information.--The Secretary of Health and 
     Human Services shall ensure that, to the greatest extent 
     practicable, the information maintained in the National 
     Clearinghouse for Long-Term Care Information, including the 
     information required for LTC Insurance Compare, is the most 
     recent information available.
       ``(D) Long-term care insurance policy defined.--In 
     subparagraph (A)(iv), the term `long-term care insurance 
     policy' means a qualified long-term care insurance contract 
     (as defined in section 7702B(b) of the Internal Revenue Code 
     of 1986), a qualified long-term care insurance contract that 
     covers an insured who is a resident of a State with a 
     qualified State long-term care insurance partnership under 
     clause (iii) of section 1917(b)(1)(C) of the Social Security 
     Act (42 U.S.C. 1396p(b)(1)(C)) or a long-term care insurance 
     policy offered in connection with a State plan amendment 
     described in clause (iv) of such section, and includes any 
     other insurance policy or rider described in the definition 
     of `long-term care insurance' in section 4 of the model Act 
     promulgated by the National Association of Insurance 
     Commissioners (as adopted December 2006).'';
       (2) by redesignating paragraph (3) as paragraph (4); and
       (3) by inserting after paragraph (2) the following:
       ``(3) Consultation on ltc insurance compare.--The Secretary 
     of Health and Human Services shall consult with the National 
     Association of Insurance Commissioners and the entities and 
     stakeholders specified in section 8101(d) of the Patient 
     Protection and Affordable Care Act in designing and 
     implementing the LTC Insurance Compare required under 
     paragraph (2)(A)(iv).''.
       (b) Medicaid State Plan Requirement To Submit Nursing 
     Facility Services Functional Criteria Data.--Section 
     1902(a)(28) of the Social Security Act (42 U.S.C. 
     1396a(a)(28)) is amended--
       (1) in subparagraph (C), by striking ``and'' after the 
     semicolon;
       (2) in subparagraph (D)(iii), by adding ``and'' after the 
     semicolon; and
       (3) by inserting after subparagraph (D)(iii), the following 
     new subparagraph:
       ``(E) for the annual submission of data relating to 
     functional criteria for the receipt of nursing facility 
     services under the plan (in such form and manner as the 
     Secretary shall specify);''.
       (c) Effective Date.--
       (1) In general.--Except as provided in paragraph (2), the 
     amendments made by this section take effect on the date of 
     enactment of this Act.
       (2) Extension of effective date for state law amendment.--
     In the case of a State plan under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.) which the Secretary of 
     Health and Human Services determines requires State 
     legislation or State regulation in order for the plan to meet 
     the additional requirements imposed by the amendments made by 
     subsection (b), the State plan shall not be regarded as 
     failing to comply with the requirements of such title solely 
     on the basis of its failure to meet these additional 
     requirements before the first day of the first calendar 
     quarter beginning after the close of the first regular 
     session of the State legislature that begins after the date 
     of enactment of this Act. For purposes of the previous 
     sentence, in the case of a State that has a 2-year 
     legislative session, each year of the session is considered 
     to be a separate regular session of the State legislature.

 PART II--IMPROVED STATE CONSUMER PROTECTIONS FOR QUALIFIED LONG-TERM 
       CARE INSURANCE CONTRACTS AND MEDICAID PARTNERSHIP POLICIES

     SEC. 8121. APPLICATION OF MEDICAID PARTNERSHIP REQUIRED MODEL 
                   PROVISIONS TO ALL TAX-QUALIFIED LONG-TERM CARE 
                   INSURANCE CONTRACTS.

       (a) In General.--Section 7702B(g)(1) of the Internal 
     Revenue Code of 1986 (relating to consumer protection 
     provisions) is amended--
       (1) in subparagraph (A), by inserting ``(but only to the 
     extent such requirements do not conflict with requirements 
     applicable under subparagraph (B)),'' after ``paragraph 
     (2)'',
       (2) by redesignating subparagraphs (B) and (C) as 
     subparagraphs (C) and (D), respectively, and
       (3) by inserting after subparagraph (A), the following new 
     subparagraph:
       ``(B) the requirements of the model regulation and model 
     Act described in section 1917(b)(5) of the Social Security 
     Act,''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply to contracts issued on or after the date that is 
     1 year after the date of enactment of this Act.

     SEC. 8122. STREAMLINED PROCESS FOR APPLYING NEW OR UPDATED 
                   MODEL PROVISIONS.

       (a) Secretarial Review.--
       (1) Tax-qualified policies.--
       (A) 2000 and 2006 model provisions.--Not later than 12 
     months after the date of enactment of this Act, the Secretary 
     of the Treasury, in consultation with the Secretary of Health 
     and Human Services, shall review the model provisions 
     specified in subsection (c)(1) for purposes of determining 
     whether updating any such provisions for a provision 
     specified in section 7702B(g)(2) of the Internal Revenue Code 
     of 1986, or the inclusion of any such provisions in such 
     section, for purposes of an insurance contract qualifying for 
     treatment as a qualified long-term care insurance contract 
     under such Code, would improve consumer protections for 
     insured individuals under such contracts.
       (B) Subsequent model provisions.--Not later than 12 months 
     after model provisions described in paragraph (2) or (3) of 
     subsection (c) are adopted by the National Association of 
     Insurance Commissioners, the Secretary of the Treasury, in 
     consultation with the Secretary of Health and Human Services, 
     shall review the model provisions to determine whether the 
     application of such provisions to an insurance contract for 
     purposes of qualifying for treatment as a qualified long-term 
     care insurance contract under section 7702B(g)(2) of the 
     Internal Revenue Code of 1986, would improve consumer 
     protections for insured individuals under such contracts.
       (2) Medicaid partnership policies.--
       (A) Subsequent model provisions.--Not later than 12 months 
     after model provisions described in paragraph (2) or (3) of 
     subsection (c) are adopted by the National Association of 
     Insurance Commissioners, the Secretary of Health and Human 
     Services, in consultation with the Secretary of the Treasury, 
     shall review the model provisions to determine whether the 
     application of such provisions to an insurance contract for 
     purposes of satisfying the requirements for participation in 
     a qualified State long-term care insurance partnership under 
     section 1917(b)(1)(C)(iii) of such Act (42 U.S.C. 
     1396p(b)(1)(C)(iii)) would improve consumer protections for 
     insured individuals under such contracts.
       (B) Review of other partnership requirements.--The 
     Secretary of Health and Human Services, in consultation with 
     the Secretary of the Treasury, shall review clauses (iii) and 
     (iv) of section 1917(b)(1)(C) for purposes of determining 
     whether the requirements specified in such clauses should be 
     modified to provide improved consumer protections or, as 
     appropriate, to resolve any conflicts with the application of 
     the 2006 model provisions under paragraph (5) of section 
     1917(b) (as amended by section 302(a)) or with the 
     application of any model provisions that the Secretary 
     determines should apply to an insurance contract as a result 
     of a review required under subparagraph (A).
       (b) Expedited Rulemaking.--
       (1) Tax-qualified policies.--Subject to paragraph (3), if 
     the Secretary of the Treasury determines that any model 
     provisions reviewed under subsection (a)(1) should apply

[[Page S12643]]

     for purposes of an insurance contract qualifying for 
     treatment as a qualified long-term care insurance contract 
     under the Internal Revenue Code of 1986, the Secretary shall 
     promulgate an interim final rule applying such provisions for 
     such purposes not later than 3 months after making such 
     determination.
       (2) Medicaid partnership policies.--Subject to paragraph 
     (3), if the Secretary of Health and Human Services determines 
     that any model provisions or requirements reviewed under 
     subsection (a)(2) should apply for purposes of an insurance 
     contract satisfying the requirements for participation in a 
     qualified State long-term care insurance partnership under 
     section 1917(b)(1)(C)(iii) of such Act (42 U.S.C. 
     1396p(b)(1)(C)(iii)), the Secretary shall promulgate an 
     interim final rule applying such provisions for such purposes 
     not later than 3 months after making such determination.
       (3) Consultation required.--The Secretary of the Treasury 
     and the Secretary of Health and Human Services, respectively, 
     shall consult with the National Association of Insurance 
     Commissioners and the entities and stakeholders specified in 
     section 101(d) regarding the extent to which it is 
     appropriate to apply the model provisions described in 
     paragraph (1) or (2) (as applicable) to insurance contracts 
     described in such paragraphs through promulgation of an 
     interim final rule. If, after such consultation--
       (A) the Secretary of the Treasury determines it would be 
     appropriate to promulgate an interim final rule, the 
     Secretary of the Treasury shall use notice and comment 
     rulemaking to promulgate a rule applying such provisions to 
     insurance contracts described in paragraph (1); and
       (B) the Secretary of Health and Human Services determines 
     it would be appropriate to promulgate an interim final rule, 
     the Secretary of Health and Human Services shall use notice 
     and comment rulemaking to promulgate a rule applying such 
     provisions to insurance contracts described in paragraph (2).
       (4) Rule of construction relating to application of 
     congressional review act.--Nothing in paragraphs (1), (2), or 
     (3) shall be construed as affecting the application of the 
     sections 801 through 808 of title 5, United States Code 
     (commonly known as the ``Congressional Review Act'') to any 
     interim final rule issued in accordance with such paragraphs.
       (5) Technical amendment eliminating prior review standard 
     made obsolete.--Section 1917(b)(5) of the Social Security Act 
     (42 U.S.C. 1396p(b)(5)) is amended by striking subparagraph 
     (C).
       (c) Model Provisions.--In this section, the term ``model 
     provisions'' means--
       (1) each provision of the long-term care insurance model 
     regulation, and the long-term care insurance model Act, 
     respectively, promulgated by the National Association of 
     Insurance Commissioners (as adopted as of October 2000 and as 
     of December 2006);
       (2) each provision of the model language relating to 
     marketing disclosures and definitions developed under section 
     102(b)(1); and
       (3) each provision of any long-term care insurance model 
     regulation, or the long-term care insurance model Act, 
     respectively, promulgated by the National Association of 
     Insurance Commissioners and adopted after December 2006.

   PART III--IMPROVED CONSUMER PROTECTIONS FOR MEDICAID PARTNERSHIP 
                                POLICIES

     SEC. 8131. BIENNIAL REPORTS ON IMPACT OF MEDICAID LONG-TERM 
                   CARE INSURANCE PARTNERSHIPS.

       Section 6021(c) of the Deficit Reduction Act of 2005 (42 
     U.S.C. 1396p note) is amended to read as follows:
       ``(c) Biennial Reports.--
       ``(1) In general.--Not later than January 1, 2011, and 
     biennially thereafter, the Secretary of Health and Human 
     Services (in this subsection referred to as the `Secretary') 
     shall issue a report to States and Congress on the long-term 
     care insurance partnerships established in accordance with 
     section 1917(b)(1)(C)(ii) of the Social Security Act (42 
     U.S.C. 1396p(b)(1)(C)(ii)). Each report shall include (with 
     respect to the period the report addresses) the following 
     information, nationally and on a State-specific basis:
       ``(A) Analyses of the extent to which such partnerships 
     improve access of individuals to affordable long-term care 
     services and benefits and the impact of such partnerships on 
     Federal and State expenditures on long-term care under the 
     Medicare and Medicaid programs.
       ``(B) Analyses of the impact of such partnerships on 
     consumer decisionmaking with respect to purchasing, 
     accessing, and retaining coverage under long-term care 
     insurance policies (as defined in subsection (d)(2)(D)), 
     including a description of the benefits and services offered 
     under such policies, the average premiums for coverage under 
     such policies, the number of policies sold and at what ages, 
     the number of policies retained and for how long, the number 
     of policies for which coverage was exhausted, and the number 
     of insured individuals who were determined eligible for 
     medical assistance under the State Medicaid program.
       ``(2) Data.--The reports by issuers of partnership long-
     term care insurance policies required under section 
     1917(b)(1)(C)(iii)(VI) of the Social Security Act shall 
     include such data as the Secretary shall specify in order to 
     conduct the analyses required under paragraph (1).
       ``(3) Public availability.--The Secretary shall make each 
     report issued under this subsection publicly available 
     through the LTC Insurance Compare website required under 
     subsection (d).
       ``(4) Rule of construction.--Nothing in this section shall 
     be construed as requiring the Secretary to conduct an 
     independent review of each long-term care insurance policy 
     offered under or in connection with such a partnership.''.

     SEC. 8132. ADDITIONAL CONSUMER PROTECTIONS FOR MEDICAID 
                   PARTNERSHIPS.

       (a) Application of 2006 Model Provisions.--
       (1) Updating of 2000 requirements.--
       (A) In general.--Section 1917(b)(5)(B)(i) of the Social 
     Security Act (42 U.S.C. 1396p(b)(5)(B)(i)) is amended by 
     striking ``October 2000'' and inserting ``December 2006''.
       (B) Conforming amendments.--
       (i) Subclause (XVII) of such section is amended by striking 
     ``section 26'' and inserting ``section 28''.
       (ii) Subclause (XVIII) of such section is amended by 
     striking ``section 29'' and inserting ``section 31''.
       (iii) Subclause (XIX) of such section is amended by 
     striking ``section 30'' and inserting ``section 32''.
       (2) Application to grandfathered partnerships.--Section 
     1917(b)(1)(C)(iv) of such Act (42 U.S.C. 1396p(b)(1)(C)(iv)) 
     is amended by inserting ``, and the State satisfies the 
     requirements of paragraph (5)'' after ``2005''.
       (b) Application of Producer Training Model Act 
     Requirements.--Section 1917(b)(1)(C) of such Act (42 U.S.C. 
     1396p(b)(1)(C)) is amended--
       (1) in clause (iii)(V), by inserting ``and satisfies the 
     producer training requirements specified in section 9 of the 
     model Act specified in paragraph (5)'' after ``coverage of 
     long-term care''; and
       (2) in clause (iv), as amended by subsection (a)(2), by 
     inserting ``clause (iii)(V) and'' before ``paragraph (5)''.
       (c) Application of Additional Requirements for All 
     Partnerships.--Section 1917(b) of the Social Security Act (42 
     U.S.C. 1396p(b)) is amended--
       (1) in paragraph (1)(C)--
       (A) in clause (iii)--
       (i) by inserting after subclause (VII) the following new 
     subclause:
       ``(VIII) The State satisfies the requirements of paragraph 
     (6).''; and
       (ii) in the flush sentence at the end, by striking 
     ``paragraph (5)'' and inserting ``paragraphs (5) and (6)''; 
     and
       (B) in clause (iv), as amended by subsections (a)(2) and 
     (b)(2), by striking ``paragraph (5)'' and inserting 
     ``paragraphs (5) and (6)''; and
       (2) by adding at the end the following new paragraph:
       ``(6) For purposes of clauses (iii)(VIII) and (iv) of 
     paragraph (1)(C), the requirements of this paragraph are the 
     following:
       ``(A) The State requires issuers of long-term care 
     insurance policies to--
       ``(i) use marketing materials filed with the State for 
     purposes of the partnership in all sales and marketing 
     activities conducted or supported by the issuers in the State 
     with respect to any long-term care insurance policies 
     marketed by the issuer in the State;
       ``(ii) provide such materials to all agents selling long-
     term care insurance policies in the State;
       ``(iii) ensure that agent training and education courses 
     conducted or supported by the issuers incorporate discussion 
     of marketing materials; and
       ``(iv) make such materials available to any consumer upon 
     request, and to make such materials available to all 
     prospective purchasers of a policy offered under a qualified 
     State long-term care insurance partnership before submission 
     of an application for coverage under that policy.
       ``(B) The State requires issuers of long-term care 
     insurance policies sold in the State to require agents to use 
     any inflation protection comparison form developed by the 
     National Association of Insurance Commissioners when selling 
     the policies in the State.
       ``(C) The State requires issuers of long-term care 
     insurance policies sold in the State to comply with the 
     provisions of section 8 of the model Act specified in 
     paragraph (5) relating to contingent nonforfeiture benefits.
       ``(D) The State enacts legislation, not later than January 
     1, 2012, that establishes rating standards for all issuers of 
     long-term care insurance policies sold in the State that 
     result in rates over the life of the policy that are no less 
     protective of consumers than those produced by the premium 
     rate schedule increase standards specified in section 20 of 
     the model regulation specified in paragraph (5), unless the 
     State has more stringent procedures or requirements.
       ``(E) The State develops and updates marketing materials 
     filed with the State whenever changes are made under the 
     State plan that relate to eligibility for medical assistance 
     for nursing facility services, including other long-term care 
     services or the amount, duration, or scope of medical 
     assistance for nursing facility services, and also provides 
     to

[[Page S12644]]

     individuals at the time of application for medical assistance 
     under the State plan, or under a waiver of the plan materials 
     that describe in clear, simple language the terms of 
     eligibility, the benefits and services provided as such 
     assistance, and rules relating to adjustment or recovery from 
     the estate of an individual who receives such assistance. 
     Such materials shall include a clear disclosure that medical 
     assistance is not guaranteed to partnership policyholders who 
     exhaust benefits under a partnership policy, and that Federal 
     changes to the program under this title or State changes to 
     the State plan may affect an individual's eligibility for, or 
     receipt of, such assistance.
       ``(F) The State--
       ``(i) through the State Medicaid agency under section 
     1902(a)(5) and in consultation with the State insurance 
     department, develops materials explaining how the benefits 
     and rules of long-term care policies offered by issuers 
     participating in the partnership interact with the benefits 
     and rules under the State plan under this title;
       ``(ii) requires agents to use such materials when selling 
     or otherwise discussing how long-term care policies offered 
     by issuers participating in the partnership work with 
     potential purchasers and to provide the materials to any such 
     purchasers upon request;
       ``(iii) informs holders of such policies of any changes in 
     eligibility requirements under the State plan under this 
     title and of any changes in estate recovery rules under the 
     State plan as soon as practicable after such changes are made 
     at the time or at the time of application for medical 
     assistance; and
       ``(iv) agrees to honor the asset protections of any such 
     policy that were provided under the policy when purchased, 
     regardless of whether the State subsequently terminates a 
     partnership program under the State plan.
       ``(G) The State Medicaid agency under section 1902(a)(5) 
     and the State insurance department enter into a memorandum of 
     understanding to--
       ``(i) inform consumers about long-term care policies 
     offered by issuers participating in the partnership, the 
     amount, duration, or scope of medical assistance for nursing 
     facility services or other long-term care services offered 
     under the State plan, consumer protections, and any other 
     issues such agency and department determine appropriate 
     through such means as the State determines appropriate; and
       ``(ii) jointly facilitate coordination in eligibility 
     determinations for medical assistance under the State plan 
     and the provision of benefits or other services under such 
     policies and medical assistance provided under the State plan 
     that includes--
       ``(I) the number of policyholders applying for medical 
     assistance under the State plan; and
       ``(II) the number of policyholders deemed eligible (and, if 
     applicable, ineligible) for such assistance.
       ``(H) Subject to subparagraph (I), the State enters into 
     agreements with other States that have established qualified 
     State long-term care insurance partnerships under which such 
     States agree to provide reciprocity for policyholders under 
     such partnerships, including providing guaranteed asset 
     protection to all individuals covered under a policy offered 
     under a qualified State long-term care insurance partnership 
     who bought such a policy in the State or in another State 
     with such a partnership and with which the State has a 
     reciprocity agreement.
       ``(I)(i) In the case of a State described in paragraph 
     (1)(C)(iv) (in this subparagraph referred to as a 
     `grandfathered partnership State') --
       ``(I) the grandfathered partnership State may, in lieu of 
     entering into agreements that satisfy subparagraph (I), enter 
     into individual reciprocity agreements with other States that 
     have established qualified State long-term care insurance 
     partnerships; and
       ``(II) if the grandfathered partnership State has not, as 
     of January 1, 2013, entered into a reciprocity agreement with 
     each State that has a qualified State long-term care 
     insurance partnership, the grandfathered partnership State 
     shall enter into and comply with a reciprocity agreement 
     developed by the Secretary in accordance with clause (ii) for 
     each partnership State that the grandfathered State does not 
     have a reciprocity agreement with and, with respect to each 
     such State, for so long as the grandfathered partnership 
     State does not have an individual reciprocity agreement with 
     that State.
       ``(ii) In developing a reciprocity agreement for purposes 
     of clause (i)(II), the Secretary shall take into account--
       ``(I) the difference in consumer protections under the 
     partnership program of the grandfathered partnership State 
     and the other partnership State that will be covered by the 
     agreement, and, to the greatest extent possible, preserve the 
     more protective requirements; and
       ``(II) the impact the reciprocity agreement will have on 
     expenditures under the State plan under this title (including 
     under any waivers of such plan) of each such State and, to 
     the greatest extent possible, minimize any negative impact on 
     such expenditures and States.''.
       (d) Effective Date.--
       (1) In general.--Except as provided in paragraph (2), the 
     amendments made by this section take effect on the date that 
     is 1 year after the date of enactment of this Act.
       (2) Extension of effective date for state law amendment.--
     In the case of a State plan under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.) which the Secretary of 
     Health and Human Services determines requires State 
     legislation in order for the plan to meet the additional 
     requirements imposed by the amendments made by this section, 
     the State plan shall not be regarded as failing to comply 
     with the requirements of such title solely on the basis of 
     its failure to meet these additional requirements before the 
     first day of the first calendar quarter beginning after the 
     close of the first regular session of the State legislature 
     that begins after the date of enactment of this Act. For 
     purposes of the previous sentence, in the case of a State 
     that has a 2-year legislative session, each year of the 
     session is considered to be a separate regular session of the 
     State legislature.

     SEC. 8133. REPORT TO CONGRESS REGARDING NEED FOR MINIMUM 
                   ANNUAL COMPOUND INFLATION PROTECTION.

       Not later than 18 months after the date of enactment of 
     this Act, the Secretary of Health and Human Services (in this 
     section referred to as the ``Secretary'') shall submit a 
     report to Congress that includes the Secretary's 
     recommendation regarding whether legislative or other 
     administrative action should be taken to require all long-
     term care insurance policies sold after a date determined by 
     the Secretary in connection with a qualified State long-term 
     care insurance partnership under clause (iii) of section 
     1917(b)(1)(C) of the Social Security Act (42 U.S.C. 
     1396p(b)(1)(C)) or a long-term care insurance policy offered 
     in connection with a State plan amendment described in clause 
     (iv) of such section, provide a minimum level of annual 
     compound inflation protection, and if so, whether such 
     requirements should be imposed on a basis related to the age 
     of the policyholder at the time of purchase. The Secretary 
     shall include in the report information on the various levels 
     of inflation protection available under such long-term care 
     insurance partnerships and the methodologies used by issuers 
     of such policies to calculate and present various inflation 
     protection options under such policies, including policies 
     with a future purchase option feature.

                PART IV--PRESERVATION OF STATE AUTHORITY

     SEC. 8141. PRESERVATION OF STATE AUTHORITY.

       Nothing in this title, any amendments made by this title, 
     or any rules promulgated to carry out this title or such 
     amendments, shall be construed to limit the authority of a 
     State to enact, adopt, promulgate, and enforce any law, rule, 
     regulation, or other measure with respect to long-term care 
     insurance that is in addition to, or more stringent than, 
     requirements established under this title and the amendments 
     made by this title.
                                 ______
                                 
  SA 2997. Ms. KLOBUCHAR (for herself, Mr. Brown, and Ms. Collins) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 1441, line 5, strike ``or pediatric medicine'' and 
     insert ``neurology, or pediatric medicine''.

                                 ______
                                 
  SA 2998. Ms. KLOBUCHAR (for herself and Ms. Snowe) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 1783, between lines 2 and 3, insert the following:

     SEC. 6412. PROVIDER AND SUPPLIER PAYMENTS UNDER MEDICARE AND 
                   MEDICAID THROUGH DIRECT DEPOSIT OR ELECTRONIC 
                   FUNDS TRANSFER (EFT) AT INSURED DEPOSITORY 
                   INSTITUTIONS.

       (a) Medicare.--
       (1) In general.--Section 1874 of the Social Security Act 
     (42 U.S.C. 1395kk) is amended by adding at the end the 
     following new subsection:
       ``(i) Limitation on Payment to Providers of Services and 
     Suppliers.--No payment shall be made under this title for 
     items and services furnished by a provider of services or 
     supplier unless each payment to the provider of services or 
     supplier is in the form of direct deposit or electronic funds 
     transfer to the provider of services' or supplier's account, 
     as applicable, at a depository institution (as defined in 
     section 19(b)(1)(A) of the Federal Reserve Act (12 U.S.C. 
     461(b)(1)(A))).''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall apply to each payment made to a provider of services, 
     provider, or supplier on or after such date (not later than 
     July 1, 2012) as the Secretary of

[[Page S12645]]

     Health and Human Services shall specify, regardless of when 
     the items and services for which such payment is made were 
     furnished.
       (b) Medicaid Pilot Project.--
       (1) Authority to establish.--The Secretary shall establish 
     a Medicaid pilot project under which payment for items and 
     services furnished by providers or suppliers of items or 
     services under the Medicaid programs of the States selected 
     to participate in the project is in the form of a direct 
     deposit or electronic funds transfer to the provider's or 
     supplier's account, as applicable, at a depository 
     institution (as defined in section 19(b)(1)(A) of the Federal 
     Reserve Act (12 U.S.C. 461(b)(1)(A))).
       (2) Deadline for implementation.--The pilot project 
     established under paragraph (1) shall begin in fiscal year 
     2012.
       (3) Report.--Not later than September 30, 2014, the 
     Secretary of Health and Human Services shall report to 
     Congress on the pilot project established under this 
     subsection. The report shall include an analysis of the 
     extent to which the project is effective in improving 
     efficiency, reducing administrative costs, and preventing 
     fraud in the Medicaid program and a recommendation as to 
     whether the project should be expanded to additional or all 
     State Medicaid programs.
                                 ______
                                 
  SA 2999. Ms. SNOWE (for herself, Mr. Kerry, and Ms. Landrieu) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 2057, between lines 6 and 7, insert the following:

     SEC. __. APPLICATION OF CAFETERIA PLANS TO SELF-EMPLOYED 
                   INDIVIDUALS.

       (a) In General.--
       (1) Application to self-employed individuals.--Section 
     125(d) of the Internal Revenue Code of 1986 (defining 
     cafeteria plan) is amended by adding at the end the following 
     new paragraph:
       ``(3) Employee to include self-employed.--
       ``(A) In general.--The term `employee' includes an 
     individual who is an employee within the meaning of section 
     401(c)(1) (relating to self-employed individuals).
       ``(B) Limitations.--
       ``(i) In general.--The amount which may be excluded under 
     subsection (a) with respect to a participant in a cafeteria 
     plan by reason of being an employee under subparagraph (A) 
     shall not exceed the employee's earned income (within the 
     meaning of section 401(c)) derived from the trade or business 
     with respect to which the cafeteria plan is established.
       ``(ii) Limitations on certain flexible spending 
     arrangements.--No amount shall be excluded under subsection 
     (a) with respect to any plan which provides benefits in the 
     form of a health flexible spending arrangement or a dependent 
     care flexible spending arrangement and in which an individual 
     described in subparagraph (A) participates unless such plan 
     is administered by a person other than the employer.
       ``(C) Additional tax on unreimbursed amounts.--
       ``(i) In general.--The tax imposed by this chapter on any 
     person who is described in subparagraph (A) and who is a 
     participant in a cafeteria plan which provides benefits in 
     the form of a health flexible spending arrangement or a 
     dependent care flexible spending arrangement shall be 
     increased by an amount equal to 100 percent of the excess (if 
     any) of--

       ``(I) the maximum value of the qualified benefit with 
     respect to such person, over
       ``(II) the amount of covered expenses both incurred during 
     the coverage period for the qualified benefit, and any grace 
     period, and reimbursed during that period or during any 
     appropriate run-out period.

       ``(ii) Collection.--The tax imposed by this subparagraph 
     shall be collected by the person administering the flexible 
     spending arrangement, and to the extent that such person 
     fails to collect such tax, the tax shall be paid by such 
     person.''.
       (2) Application to benefits which may be provided under 
     cafeteria plan.--
       (A) Group-term life insurance.--Section 79 of the Internal 
     Revenue Code of 1986 (relating to group-term life insurance 
     provided to employees) is amended by adding at the end the 
     following new subsection:
       ``(f) Employee Includes Self-Employed.--
       ``(1) In general.--For purposes of this section, the term 
     `employee' includes an individual who is an employee within 
     the meaning of section 401(c)(1) (relating to self-employed 
     individuals).
       ``(2) Limitation.--The amount which may be excluded under 
     the exceptions contained in subsection (a) or (b) with 
     respect to an individual treated as an employee by reason of 
     paragraph (1) shall not exceed the employee's earned income 
     (within the meaning of section 401(c)) derived from the trade 
     or business with respect to which the individual is so 
     treated.''.
       (B) Accident and health plans.--Subsection (g) of section 
     105 of such Code (relating to amounts received under accident 
     and health plans) is amended to read as follows:
       ``(g) Employee Includes Self-Employed.--
       ``(1) In general.--For purposes of this section, in the 
     case of any coverage under an accident or health plan which 
     is provided through a simple cafeteria plan under section 
     125(j), the term `employee' includes an individual who is an 
     employee within the meaning of section 401(c)(1) (relating to 
     self-employed individuals).
       ``(2) Limitation.--The amount which may be excluded under 
     this section by reason of subsection (b) or (c) with respect 
     to an individual treated as an employee by reason of 
     paragraph (1) shall not exceed the employee's earned income 
     (within the meaning of section 401(c)) derived from the trade 
     or business with respect to which the accident or health 
     insurance was established.''.
       (C) Contributions by employers to accident and health 
     plans.--
       (i) In general.--Section 106 of such Code is amended by 
     inserting after subsection (e) the following new subsection:
       ``(f) Special Rule for Benefits Provided Through Simple 
     Cafeteria Plans.--
       ``(1) In general.--For purposes of this section, in the 
     case of any coverage under an accident or health plan which 
     is provided through a simple cafeteria plan under section 
     125(j), the term `employee' includes an individual who is an 
     employee within the meaning of section 401(c)(1) (relating to 
     self-employed individuals).
       ``(2) Limitation.--The amount which may be excluded under 
     subsection (a) with respect to an individual treated as an 
     employee by reason of paragraph (1) shall not exceed the 
     employee's earned income (within the meaning of section 
     401(c)) derived from the trade or business with respect to 
     which the accident or health insurance was established.''.
       (ii) Clarification of limitations on other coverage.--The 
     first sentence of section 162(l)(2)(B) of such Code is 
     amended to read as follows: ``Paragraph (1) shall not apply 
     to any taxpayer for any calendar month for which the taxpayer 
     participates in any subsidized health plan maintained by any 
     employer (other than an employer described in section 
     401(c)(4)) of the taxpayer or the spouse of the taxpayer.''.
       (b) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2010.
                                 ______
                                 
  SA 3000. Mr. COBURN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of subtitle D of title VI insert the following:

     SEC. 6303. PROHIBITION ON COMPARATIVE EFFECTIVENESS RESEARCH 
                   FOR THE PURPOSE OF DETERMINING COST AND 
                   COVERAGE DECISIONS.

       Reports and recommendations from the Patient-Centered 
     Outcomes Research Institute, established under section 1181 
     of the Social Security Act (as added by section 6301), or any 
     other government entity are prohibited from being used by any 
     government entity for payment, coverage, or treatment 
     decisions based on costs. Nothing in the preceding sentence 
     shall limit a physician or other health care provider from 
     using reports and recommendations of such Institute or other 
     government entity when making decisions about the best 
     treatment for an individual patient in an individual 
     circumstance.

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