[Congressional Record Volume 155, Number 184 (Wednesday, December 9, 2009)]
[Senate]
[Pages S12819-S12833]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 3079. Mr. ROBERTS (for himself 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; which was 
ordered to lie on the table; as follows:

       Beginning on page 1997, strike line 1 and all that follows 
     through page 1998, line 12.
                                 ______
                                 
  SA 3080. Mr. ENSIGN (for himself and 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 152, after line 24, add the following:
       (l) Public Reporting of Patient Wait Times.--
       (1) In general.--A qualified health plan offered through 
     the Exchange, including the community health insurance option 
     under section 1323 and any other health insurance option 
     established under this Act, shall collect and make available 
     on an Internet website a description of--
       (A) the average waiting times (between diagnosis and 
     treatment), listed by individual hospital and health care 
     provider, for specific health care items or services covered 
     under the plan or option, including--
       (i) general surgery;
       (ii) cancer surgery;
       (iii) cardiac procedures;
       (iv) ophthalmic surgery;
       (v) orthopedic surgery; and
       (vi) diagnostic scans; and
       (B) the average waiting times that patients are in an 
     emergency room being diagnosed, receiving treatment, or 
     waiting for admission to a hospital bed under the plan or 
     option.
       (2) Annual updates.--A qualified health plan offered 
     through the Exchange, including the community health 
     insurance option under section 1323 and any other health 
     insurance option established under this Act, shall annually 
     update the information made available under paragraph (1).
                                 ______
                                 
  SA 3081. 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 271, between lines 15 and 16, insert the following:

     For purposes of this section, the term ``social security 
     number'' means a social security number issued to an 
     individual by the Social Security Administration. Such term 
     shall not include a taxpayer identification number or TIN 
     issued by the Internal Revenue Service.
                                 ______
                                 
  SA 3082. Mr. BURR (for himself and Mr. Roberts) 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 1999, strike lines 1 through 20 and 
     insert the following:

     SEC. 9005. LIMITATION ON HEALTH FLEXIBLE SPENDING 
                   ARRANGEMENTS UNDER CAFETERIA PLANS.

       (a) In General.--Section 125 of the Internal Revenue Code 
     of 1986 is amended--
       (1) by redesignating subsections (i) and (j) as subsections 
     (k) and (l), respectively, and
       (2) by inserting after subsection (h) the following new 
     subsection:
       ``(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 $5,000 made to such arrangement.
       ``(2) Adjustment for medical inflation.--In the case of any 
     taxable year beginning after December 31, 2010, the dollar 
     amount in paragraph (1) shall be increased by the medical 
     care cost adjustment of such amount (within the meaning of 
     section 213(d)(10)(B)(ii)) for the calendar year in which 
     such taxable year begins. If any increase determined under 
     the preceding sentence is not a multiple of $50, such 
     increase shall be rounded to the nearest multiple of $50.''.
       (b) Modification of Reimbursement Rules.--Section 106 of 
     the Internal Revenue Code of 1986, as amended by section 
     9003, is amended by striking subsection (f).
       (c) Effective Dates.--
       (1) In general.--The amendments made by subsection (a) 
     shall apply to taxable years beginning after December 31, 
     2009.
       (2) Reimbursement.--The amendment made by subsection (b) 
     shall apply in the same manner as the amendment made by 
     section 9003(c).

[[Page S12820]]

     SEC. 9006. LIMITATION ON DEPENDENT CARE FLEXIBLE SPENDING 
                   ARRANGEMENTS UNDER CAFETERIA PLANS.

       (a) In General.--Section 125 of the Internal Revenue Code 
     of 1986, as amended by section 9005, is amended by inserting 
     after subsection (i) the following new subsection:
       ``(j) Indexing of Limitation on Dependent Care Flexible 
     Spending Arrangements.--For purposes of this section, if a 
     benefit is provided under a cafeteria plan through employer 
     contributions to a dependent care flexible spending 
     arrangement in a taxable year beginning after calendar year 
     2010, the dollar amount of the limitation under section 
     129(2)(A) which applies to such flexible spending arrangement 
     shall be increased by an amount equal to--
       ``(1) such dollar amount, multiplied by
       ``(2) the cost-of-living adjustment determined under 
     section 1(f)(3) for the calendar year in which such taxable 
     year begins, determined by substituting `calendar year 2009' 
     for `calendar year 1992' in subparagraph (B) thereof.

     If any increase determined under the preceding sentence is 
     not a multiple of $50, such increase shall be rounded to the 
     nearest multiple of $50.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2009.
                                 ______
                                 
  SA 3083. Mr. BURR 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 V, insert the following:

     SEC. __. DEFINITION OF ECONOMIC HARDSHIP.

       (a) In General.--Section 435(o) of the Higher Education Act 
     of 1965 (20 U.S.C. 1085(o)) is amended--
       (1) in paragraph (1)--
       (A) in subparagraph (A)(ii), by striking ``or'' after the 
     semicolon;
       (B) by redesignating subparagraph (B) as subparagraph (C); 
     and
       (C) by inserting after subparagraph (A) the following:
       ``(B) such borrower is working full-time and has a Federal 
     educational debt burden that equals or exceeds 20 percent of 
     such borrower's adjusted gross income, and the difference 
     between such borrower's adjusted gross income minus such 
     burden is less than 220 percent of the greater of--
       ``(i) the annual earnings of an individual earning the 
     minimum wage under section 6 of the Fair Labor Standards Act 
     of 1938; or
       ``(ii) 150 percent of the poverty line, as defined under 
     section 673(2) of the Community Services Block Grant Act, 
     applicable to such borrower's family size; or''; and
       (2) in paragraph (2), by striking ``(1)(B)'' and inserting 
     ``(1)(C)''.
       (b) Funding.--The Secretary of Health and Human Services 
     shall transfer to the Secretary of Education, from amounts 
     appropriated to the Prevention and Public Health Fund under 
     section 4002, amounts necessary to carry out the amendments 
     made by this section.
                                 ______
                                 
  SA 3084. Mr. AKAKA (for himself, Mr. Inouye, Mrs. Lincoln, 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 436, between lines 14 and 15, insert the following:

     SEC. 2008. MEDICAID ELIGIBILITY FOR CITIZENS OF FREELY 
                   ASSOCIATED STATES.

       (a) In General.--Section 402(b)(2) of the Personal 
     Responsibility and Work Opportunity Reconciliation Act of 
     1996 (8 U.S.C. 1612(b)(2)) is amended by adding at the end 
     the following:
       ``(G) Medicaid exception for citizens of freely associated 
     states.--With respect to eligibility for benefits for the 
     program defined in paragraph (3)(C) (relating to medicaid), 
     paragraph (1) shall not apply to any individual who lawfully 
     resides in the United States (including territories and 
     possessions of the United States) in accordance with--
       ``(i) section 141 of the Compact of Free Association 
     between the Government of the United States and the 
     Government of the Federated States of Micronesia, approved by 
     Congress in the Compact of Free Association Amendments Act of 
     2003;
       ``(ii) section 141 of the Compact of Free Association 
     between the Government of the United States and the 
     Government of the Republic of the Marshall Islands, approved 
     by Congress in the Compact of Free Association Amendments Act 
     of 2003; or
       ``(iii) section 141 of the Compact of Free Association 
     between the Government of the United States and the 
     Government of Palau, approved by Congress in Public Law 99-
     658 (100 Stat. 3672).''.
       (b) Qualified Alien.--Section 431(b) of the Personal 
     Responsibility and Work Opportunity Reconciliation Act of 
     1996 (8 U.S.C. 1641(b)) is amended--
       (1) in paragraph (6), by striking ``or'' at the end;
       (2) in paragraph (7), by striking the period at the end and 
     inserting ``; or''; and
       (3) by adding at the end the following:
       ``(8) an individual who lawfully resides in the United 
     States (including territories and possessions of the United 
     States) in accordance with a Compact of Free Association 
     referred to in section 402(b)(2)(G).''.
       (c) Conforming Amendments.--Section 1108 of the Social 
     Security Act (42 U.S.C. 1308) is amended--
       (1) in subsection (f), in the matter preceding paragraph 
     (1), by striking ``subsection (g)'' and inserting 
     ``subsections (g) and (h)''; and
       (2) by adding at the end the following:
       ``(h) The limitations of subsections (f) and (g) shall not 
     apply with respect to medical assistance provided to an 
     individual described in section 431(b)(8) of the Personal 
     Responsibility and Work Opportunity Reconciliation Act of 
     1996.''.
       (d) Effective Date.--The amendments made by this section 
     take effect on the date of enactment of this Act and apply to 
     benefits and assistance provided on or after that date.
                                 ______
                                 
  SA 3085. Mrs. LINCOLN (for herself, Mr. Durbin, Mr. Kerry, Ms. 
Landrieu, and Mr. Bayh) 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. 9024. INCREASE IN SMALL BUSINESS TAX CREDIT AVERAGE 
                   ANNUAL WAGE THRESHOLD.

       (a) In General.--Subparagraph (B) of section 45R(d)(3)(B) 
     of the Internal Revenue Code of 1986, as added by section 
     1421(a), is amended by striking ``$20,000'' both places it 
     appears and inserting ``$25,000''.
       (b) Effective Date.--The amendment made by this section 
     shall take effect as if included in the enactment of section 
     1421.
                                 ______
                                 
  SA 3086. Ms. CANTWELL (for herself and Mr. Kohl) 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 492, between lines 15 and 16, insert the following:

     SEC. 2407. INCENTIVES FOR STATES TO OFFER HOME AND COMMUNITY-
                   BASED SERVICES AS A LONG-TERM CARE ALTERNATIVE 
                   TO NURSING HOMES.

       (a) State Balancing Incentive Payments Program.--
     Notwithstanding section 1905(b) of the Social Security Act 
     (42 U.S.C. 1396d(b)), in the case of a balancing incentive 
     payment State, as defined in subsection (b), that meets the 
     conditions described in subsection (c), during the balancing 
     incentive period, the Federal medical assistance percentage 
     determined for the State under section 1905(b) of such Act 
     and increased under section 1902(gg)(5) shall be increased by 
     the applicable percentage points determined under subsection 
     (d) with respect to eligible medical assistance expenditures 
     described in subsection (e).
       (b) Balancing Incentive Payment State.--A balancing 
     incentive payment State is a State--
       (1) in which less than 50 percent of the total expenditures 
     for medical assistance under the State Medicaid program for a 
     fiscal year for long-term services and supports (as defined 
     by the Secretary under subsection (f))(1)) are for non-
     institutionally-based long-term services and supports 
     described in subsection (f)(1)(B);
       (2) that submits an application and meets the conditions 
     described in subsection (c); and
       (3) that is selected by the Secretary to participate in the 
     State balancing incentive payment program established under 
     this section.
       (c) Conditions.--The conditions described in this 
     subsection are the following:
       (1) Application.--The State submits an application to the 
     Secretary that includes, in addition to such other 
     information as the Secretary shall require--
       (A) a proposed budget that details the State's plan to 
     expand and diversify medical assistance for non-
     institutionally-based long-term services and supports 
     described in subsection (f)(1)(B) under the State Medicaid 
     program during the balancing incentive period and achieve the 
     target spending percentage applicable to the State under 
     paragraph

[[Page S12821]]

     (2), including through structural changes to how the State 
     furnishes such assistance, such as through the establishment 
     of a ``no wrong door - single entry point system'', optional 
     presumptive eligibility, case management services, and the 
     use of core standardized assessment instruments, and that 
     includes a description of the new or expanded offerings of 
     such services that the State will provide and the projected 
     costs of such services; and
       (B) in the case of a State that proposes to expand the 
     provision of home and community-based services under its 
     State Medicaid program through a State plan amendment under 
     section 1915(i) of the Social Security Act, at the option of 
     the State, an election to increase the income eligibility for 
     such services from 150 percent of the poverty line to such 
     higher percentage as the State may establish for such 
     purpose, not to exceed 300 percent of the supplemental 
     security income benefit rate established by section 
     1611(b)(1) of the Social Security Act (42 U.S.C. 1382(b)(1)).
       (2) Target spending percentages.--
       (A) In the case of a balancing incentive payment State in 
     which less than 25 percent of the total expenditures for home 
     and community-based services under the State Medicaid program 
     for fiscal year 2009 are for such services, the target 
     spending percentage for the State to achieve by not later 
     than October 1, 2015, is that 25 percent of the total 
     expenditures for home and community-based services under the 
     State Medicaid program are for such services.
       (B) In the case of any other balancing incentive payment 
     State, the target spending percentage for the State to 
     achieve by not later than October 1, 2015, is that 50 percent 
     of the total expenditures for home and community-based 
     services under the State Medicaid program are for such 
     services.
       (3) Maintenance of eligibility requirements.--The State 
     does not apply eligibility standards, methodologies, or 
     procedures for determining eligibility for medical assistance 
     for non-institutionally-based long-term services and supports 
     described in subsection (f)(1)(B) under the State Medicaid 
     program that are more restrictive than the eligibility 
     standards, methodologies, or procedures in effect for such 
     purposes on December 31, 2010.
       (4) Use of additional funds.--The State agrees to use the 
     additional Federal funds paid to the State as a result of 
     this section only for purposes of providing new or expanded 
     offerings of non-institutionally-based long-term services and 
     supports described in subsection (f)(1)(B) under the State 
     Medicaid program.
       (5) Structural changes.--The State agrees to make, not 
     later than the end of the 6-month period that begins on the 
     date the State submits an application under this section, the 
     following changes:
       (A) ``No wrong door''--single entry point system.--
     Development of a statewide system to enable consumers to 
     access all long-term services and supports through an agency, 
     organization, coordinated network, or portal, in accordance 
     with such standards as the State shall establish and that 
     shall provide information regarding the availability of such 
     services, how to apply for such services, and referral 
     services for services and supports otherwise available in the 
     community ; and determinations of financial and functional 
     eligibility for such services and supports, or assistance 
     with assessment processes for financial and functional 
     eligibility.
       (B) Conflict-free case management services.--Conflict-free 
     case management services to develop a service plan, arrange 
     for services and supports, support the beneficiary (and, if 
     appropriate, the beneficiary's caregivers) in directing the 
     provision of services and supports, for the beneficiary, and 
     conduct ongoing monitoring to assure that services and 
     supports are delivered to meet the beneficiary's needs and 
     achieve intended outcomes.
       (C) Core standardized assessment instruments.--Development 
     of core standardized assessment instruments for determining 
     eligibility for non-institutionally-based long-term services 
     and supports described in subsection (f)(1)(B), which shall 
     be used in a uniform manner throughout the State, to 
     determine a beneficiary's needs for training, support 
     services, medical care, transportation, and other services, 
     and develop an individual service plan to address such needs.
       (6) Data collection.--The State agrees to collect from 
     providers of services and through such other means as the 
     State determines appropriate the following data:
       (A) Services data.--Services data from providers of non-
     institutionally-based long-term services and supports 
     described in subsection (f)(1)(B) on a per-beneficiary basis 
     and in accordance with such standardized coding procedures as 
     the State shall establish in consultation with the Secretary.
       (B) Quality data.--Quality data on a selected set of core 
     quality measures agreed upon by the Secretary and the State 
     that are linked to population-specific outcomes measures and 
     accessible to providers.
       (C) Outcomes measures.--Outcomes measures data on a 
     selected set of core population-specific outcomes measures 
     agreed upon by the Secretary and the State that are 
     accessible to providers and include--
       (i) measures of beneficiary and family caregiver experience 
     with providers;
       (ii) measures of beneficiary and family caregiver 
     satisfaction with services; and
       (iii) measures for achieving desired outcomes appropriate 
     to a specific beneficiary, including employment, 
     participation in community life, health stability, and 
     prevention of loss in function.
       (d) Applicable Percentage Points Increase in FMAP.--The 
     applicable percentage points increase is--
       (1) in the case of a balancing incentive payment State 
     subject to the target spending percentage described in 
     subsection (c)(2)(A), 5 percentage points; and
       (2) in the case of any other balancing incentive payment 
     State, 2 percentage points.
       (e) Eligible Medical Assistance Expenditures.--
       (1) In general.--Subject to paragraph (2), medical 
     assistance described in this subsection is medical assistance 
     for non-institutionally-based long-term services and supports 
     described in subsection (f)(1)(B) that is provided by a 
     balancing incentive payment State under its State Medicaid 
     program during the balancing incentive payment period.
       (2) Limitation on payments.--In no case may the aggregate 
     amount of payments made by the Secretary to balancing 
     incentive payment States under this section during the 
     balancing incentive period exceed $3,000,000,000.
       (f) Definitions.--In this section:
       (1) Long-term services and supports defined.--The term 
     ``long-term services and supports'' has the meaning given 
     that term by Secretary and may include any of the following 
     (as defined with for purposes of State Medicaid programs 
     under title XIX of the Social Security Act):
       (A) Institutionally-based long-term services and 
     supports.--Services provided in an institution, including the 
     following:
       (i) Nursing facility services.
       (ii) Services in an intermediate care facility for the 
     mentally retarded described in subsection (a)(15) of section 
     1905 of such Act.
       (B) Non-institutionally-based long-term services and 
     supports.--Services not provided in an institution, including 
     the following:
       (i) Home and community-based services provided under 
     subsection (c), (d), or (i), of section 1915 of such Act or 
     under a waiver under section 1115 of such Act.
       (ii) Home health care services.
       (iii) Personal care services.
       (iv) Services described in subsection (a)(26) of section 
     1905 of such Act (relating to PACE program services).
       (v) Self-directed personal assistance services described in 
     section 1915(j) of such Act.
       (2) Balancing incentive period.--The term ``balancing 
     incentive period'' means the period that begins on October 1, 
     2011, and ends on September 30, 2015.
       (3) Poverty line.--The term ``poverty line'' has the 
     meaning given that term in section 2110(c)(5) of the Social 
     Security Act (42 U.S.C. 1397jj(c)(5)).
       (4) State medicaid program.--The term ``State Medicaid 
     program'' means the State program for medical assistance 
     provided under a State plan under title XIX of the Social 
     Security Act and under any waiver approved with respect to 
     such State plan.
                                 ______
                                 
  SA 3087. Mr. CORKER 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:

     SEC. __. REQUIRING MEMBERS OF CONGRESS TO ACCEPT THE SAME 
                   CHOICES FOR HEALTH INSURANCE COVERAGE AS THOSE 
                   GIVEN TO AMERICAN CITIZENS WITH INCOME AT OR 
                   BELOW 133 PERCENT OF THE POVERTY LINE.

       (a) Findings.--Congress makes the following findings:
       (1) Congress has stated that health care reform legislation 
     should ensure all Americans have choices of affordable, 
     quality health insurance coverage.
       (2) Americans have overwhelmingly voiced their desire to 
     receive the same types of choices for health insurance 
     coverage that Members of Congress receive.
       (3) This Act and the amendments made by this Act are 
     estimated to place nearly half of the newly insured in a 
     government program without the choices of private coverage 
     that individuals with income above 133 percent of the poverty 
     line receive.
       (4) This Act provides legal immigrants with income at or 
     below 133 percent of the poverty line with a choice of 
     private coverage while American citizens with income at or 
     below 133 percent of the poverty line have no choice of 
     private coverage.
       (b) Members of Congress Required to Have Coverage Under 
     Medicaid.--
       (1) In general.--The Director of the Office of Personnel 
     Management shall, in consultation with the Secretary of 
     Health and Human Services, ensure that, on and after January 
     1, 2014, notwithstanding chapter 89 of title 5, United States 
     Code, title XIX of the Social Security Act, or any provision 
     of this Act--
       (A) each Member of Congress shall be eligible for medical 
     assistance under the Medicaid plan of the State in which the 
     Member resides; and
       (B) any employer contribution under chapter 89 of title 5 
     of such Code on behalf of the

[[Page S12822]]

     Member may be paid only to the State agency responsible for 
     administering the Medicaid plan in which the Member enrolls 
     and not to the offeror of a plan offered through the Federal 
     employees health benefit program under such chapter.
       (2) Payments by federal government.--The Secretary of 
     Health and Human Services, in consultation with the Director 
     of the Office of Personnel Management, shall establish 
     procedures under which the employer contributions that would 
     otherwise be made on behalf of a Member of Congress if the 
     Member were enrolled in a plan offered through the Federal 
     employees health benefit program may be made directly to the 
     State agencies described in paragraph (1)(B).
       (3) Ineligible for fehbp.--Effective January 1, 2014, no 
     Member of Congress shall be eligible to obtain health 
     insurance coverage under the program chapter 89 of title 5, 
     United States Code.
       (4) Definition.--In this section, the term ``Member of 
     Congress'' means any member of the House of Representatives 
     or the Senate.
                                 ______
                                 
  SA 3088. Ms. COLLINS (for herself 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 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. ASSESSMENT OF MEDICARE COST-INTENSIVE DISEASES AND 
                   CONDITIONS.

       (a) Initial Assessment.--
       (1) In general.--The Secretary of Health and Human Services 
     (in this section referred to as the ``Secretary'') shall 
     conduct an assessment of the diseases and conditions that are 
     the most cost-intensive for the Medicare program under title 
     XVIII of the Social Security Act and, to the extent possible, 
     assess the diseases and conditions that could become cost-
     intensive for the Medicare program in the future.
       (2) Report.--Not later than January 1, 2011, the Secretary 
     shall transmit a report to the Committees on Energy and 
     Commerce, Ways and Means, and Appropriations of the House of 
     Representatives and the Committees on Health, Education, 
     Labor and Pensions, Finance, and Appropriations of the Senate 
     on the assessment conducted under paragraph (1). Such report 
     shall--
       (A) include the assessment of current and future trends of 
     cost-intensive diseases and conditions described in such 
     paragraph;
       (B) address whether current research priorities are 
     appropriately addressing current and future cost-intensive 
     conditions so identified;
       (C) include the input of relevant research agencies, 
     including the National Institutes of Health, the Agency for 
     Healthcare Research and Quality, and the Food and Drug 
     Administration; and
       (D) include recommendations concerning research in the 
     Department of Health and Human Services that should be funded 
     to improve the prevention, treatment, or cure of such cost-
     intensive diseases and conditions.
       (b) Updates of Assessment.--Not later than January 1, 2013, 
     and biennially thereafter, the Secretary shall--
       (1) review and update the assessment and recommendations 
     described in subsection (a)(1); and
       (2) submit a report described in subsection (a)(2) to the 
     Committees specified in subsection (a)(2) on such updated 
     assessment and recommendations.
       (c) CMS Medicare Cost-Intensive Research Fund.--
       (1) In general.--There is established in the Treasury of 
     the United States a fund to be known as the ``CMS Medicare 
     Cost-Intensive Research Fund'', in this subsection referred 
     to as the ``Fund''. The Administrator of the Centers for 
     Medicare & Medicaid Services shall administer the Fund. The 
     Fund shall consist of such amounts as may be appropriated or 
     credited to such Fund for the purposes described in paragraph 
     (2). The Administrator shall not transfer appropriations to 
     or from other relevant research agencies, including the 
     National Institutes of Health, the Agency for Healthcare 
     Research and Quality, and the Food and Drug Administration.
       (2) Purposes of fund.--From amounts in the Fund, the 
     Administrator of the Centers for Medicare & Medicaid Services 
     shall make available, without further appropriation, grants, 
     contracts, and other funding mechanisms, as recommended by 
     the reports under this subsection, to facilitate research 
     into the prevention, treatment, or cure of cost-intensive 
     diseases and conditions under the Medicare program.
                                 ______
                                 
  SA 3089. Mr. BENNETT 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:

     SEC. __. PRESERVATION OF MEDICARE.

       Notwithstanding any other provision of this Act (or an 
     amendment made by this Act), the amendments made by title III 
     to expand Medicare eligibility under title XVIII of the 
     Social Security Act shall not take effect until the Secretary 
     certifies to Congress that premiums assessed for coverage 
     under non-Federal health insurance coverage will not increase 
     in any manner to compensate for lower premiums assessed under 
     the Medicare program.
                                 ______
                                 
  SA 3090. Mr. BENNETT 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 102, strike line 19 and all that follows 
     through line 6 on page 108, and insert the following:
       (a) No Definition by Secretary of Essential Health 
     Benefits.--
       (1) In general.--Notwithstanding any other provision of 
     this Act (or any amendment made by this Act), in no case 
     shall the Secretary define the benefit categories required 
     for essential health benefits or specify the covered 
     treatments, items, and services within such categories 
     through regulations or other guidance.
       (2) Authority by states.--Nothing in this section shall be 
     construed to limit the ability of States to define benefit 
     categories or specific covered treatments, items, and 
     services within such categories.
       (b) Rule of Construction.--Nothing in this
                                 ______
                                 
  SA 3091. Mr. BENNETT 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 16 and all that follows 
     through line 17 on page 357.
                                 ______
                                 
  SA 3092. Mr. BENNETT 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 1323, insert the following:
       (i) Limitation.--Notwithstanding any other provision of 
     this section, the Secretary shall ensure that no coverage is 
     offered under this section until such time as the Secretary 
     certifies that premiums assessed for qualified health plans 
     will not increase in any manner to compensate for lower 
     premiums assessed under the coverage described under this 
     section.
                                 ______
                                 
  SA 3093. Mr. BENNETT 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:

     SEC. __. LIMITATION ON NEW ENTITLEMENT SPENDING.

       Notwithstanding any other provision of this Act (or an 
     amendment made by this Act), no entitlement program 
     established under this Act (or amendments) shall be 
     implemented until the Secretary of the Treasury certifies to 
     Congress that total Federal mandatory spending will not 
     exceed total Federal outlays for the first 5 years of the 
     implementation of this Act.
                                 ______
                                 
  SA 3094. Mr. BENNETT 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

[[Page S12823]]

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. __. LIMITATION ON NEW ENTITLEMENT SPENDING.

       Notwithstanding any other provision of this Act (or an 
     amendment made by this Act), no entitlement program 
     established under this Act (or amendments) shall be 
     implemented until the Secretary of the Treasury certifies to 
     Congress that total Federal revenues exceed total Federal 
     outlays.
                                 ______
                                 
  SA 3095. Mr. BENNETT 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:

     SEC. __. LIMITATION ON ENTITLEMENT SPENDING.

       (a) Certification.--Notwithstanding any other provision of 
     this Act, this Act (and the amendments made by this Act) 
     shall not take effect until the Secretary of the Treasury 
     certifies to Congress that entitlement spending for the 
     Medicare, Medicaid, and Social Security programs under titles 
     XVIII, XIX, or II of the Social Security Act, and spending 
     under other new entitlement programs provided for in this Act 
     will not exceed 10 percent of the Gross Domestic Product (as 
     estimated by the Secretary of Commerce) between fiscal years 
     2014 and 2019.
       (b) Termination.--If the Secretary of the Treasury at any 
     time determines that the spending referred to in subsection 
     (a) exceeds 10 percent of the Gross Domestic Program during 
     any of fiscal years 2014 through 2019, new entitlement 
     spending programs provided for under this Act shall not be 
     implemented.
                                 ______
                                 
  SA 3096. Mr. BENNETT 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:

     SEC. __. IMPLEMENTATION OF MANDATORY SPENDING PROGRAMS.

       (a) In General.--If Federal mandatory spending (minus 
     interest expense) exceeds 50 percent of Federal outlays in a 
     fiscal year, it shall not be in order in the Senate or the 
     House of Representatives to consider any legislation 
     resulting in new mandatory spending for such fiscal year or 
     any fiscal year thereafter until such spending is less than 
     50 percent of such outlays for a fiscal year.
       (b) Waiver.--This section may be waived or suspended in the 
     Senate or House of Representatives only by an affirmative 
     vote of 3/5 of the members, duly chosen and sworn.
       (c) Appeal.--An affirmative vote of 3/5 of the members of 
     the Senate or House of Representatives, duly chosen and 
     sworn, shall be required to sustain an appeal of the ruling 
     of the Chair on a point of order raised under this section.
                                 ______
                                 
  SA 3097. Mr. KYL 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 __--MEDICAL LIABILITY REFORM

     SEC. __1. SHORT TITLE.

       This title may be cited as the ``Medical Liability Reform 
     Act of 2009''.

     SEC. __2. FINDINGS.

       Congress makes the following findings:
       (1) Medical liability laws create a significant portion of 
     the overall costs of health care, and contribute to 
     Americans' lack of access to health care.
       (2) A 2006 study by PriceWaterhouse Coopers found that 
     medical liability laws and the practice of defensive medicine 
     contribute to 10 percent of all health care costs.
       (3) The non-partisan Congressional Budget Office estimated 
     that the Federal Government could directly save about 
     $5,600,000,000 by enacting certain medical liability reforms, 
     and that total health care spending could be reduced even 
     further if these reforms reduced the practice of defensive 
     medicine.
       (4) According to economists Daniel P. Kessler and Mark B. 
     McClellan, defensive medicine alone costs Americans more than 
     $100,000,000,000 every year.
       (5) Medicaid and Medicare costs must be lowered to keep 
     these crucial programs solvent.
       (6) In part because of the costs of medical liability, 40 
     percent of physicians refuse to see new Medicaid patients.
       (7) Reform of the medical liability laws has been proven to 
     increase access to doctors and specialists while lowering 
     health care costs.
       (8) In 2003, Texas adopted medical liability reforms that 
     placed a cap on non-economic damages in medical liability 
     cases and combated junk science by raising the standards of 
     qualification for expert witnesses.
       (9) After Texas passed this reform, premiums for medical 
     malpractice liability insurance fell by 27 percent on 
     average, and in some cases, by more than 50 percent.
       (10) Because the Texas reforms led to more affordable 
     health insurance premiums, more than 400,000 additional 
     Texans are covered by health insurance than if reform had not 
     passed.
       (11) Because of the Texas reforms, Texas saw an overall 
     growth rate of 31 percent in the number of new physicians.
       (12) The growth rate in the number of physicians in Texas 
     was particularly pronounced in long-underserved geographic 
     areas such as the rural and border regions, and in key 
     specialties such as obstetrics, neurosurgery, and orthopedic 
     surgery.
       (13) Arizona adopted medical liability reforms that 
     deterred frivolous litigation by requiring expert opinion 
     testimony at the threshold of medical liability suits and by 
     raising the standards of qualification for expert witnesses.
       (14) The health care and insurance industries are 
     industries affecting interstate commerce and the health care 
     liability litigation systems existing throughout the United 
     States are activities that affect interstate commerce by 
     contributing to the high costs of health care and premiums 
     for health care liability insurance purchased by health care 
     system providers.
       (15) The health care liability litigation systems existing 
     throughout the United States have a significant effect on the 
     amount, distribution, and use of Federal funds because of--
       (A) the large number of individuals who receive health care 
     benefits under programs operated or financed by the Federal 
     Government;
       (B) the large number of individuals who benefit because of 
     the exclusion from Federal taxes of the amounts spent to 
     provide them with health insurance benefits; and
       (C) the large number of health care providers who provide 
     items or services for which the Federal Government makes 
     payments.

     SEC. __3. DEFINITIONS.

       In this title:
       (1) Alternative dispute resolution system; adr.--The term 
     ``alternative dispute resolution system'' or ``ADR'' means a 
     system that provides for the resolution of health care 
     lawsuits in a manner other than through a civil action 
     brought in a State or Federal court.
       (2) Claimant.--The term ``claimant'' means any person who 
     brings a health care lawsuit, including a person who asserts 
     or claims a right to legal or equitable contribution, 
     indemnity or subrogation, arising out of a health care 
     liability claim or action, and any person on whose behalf 
     such a claim is asserted or such an action is brought, 
     whether deceased, incompetent, or a minor.
       (3) Compensatory damages.--The term ``compensatory 
     damages'' means objectively verifiable monetary losses 
     incurred as a result of the provision of, use of, or payment 
     for (or failure to provide, use, or pay for) health care 
     services or medical products, such as past and future medical 
     expenses, loss of past and future earnings, cost of obtaining 
     domestic services, loss of employment, and loss of business 
     or employment opportunities, damages for physical and 
     emotional pain, suffering, inconvenience, physical 
     impairment, mental anguish, disfigurement, loss of enjoyment 
     of life, loss of society and companionship, loss of 
     consortium (other than loss of domestic service), hedonic 
     damages, injury to reputation, and all other nonpecuniary 
     losses of any kind or nature. Such term includes economic 
     damages and noneconomic damages, as such terms are defined in 
     this section.
       (4) Economic damages.--The term ``economic damages'' means 
     objectively verifiable monetary losses incurred as a result 
     of the provision of, use of, or payment for (or failure to 
     provide, use, or pay for) health care services or medical 
     products, such as past and future medical expenses, loss of 
     past and future earnings, cost of obtaining domestic 
     services, loss of employment, and loss of business or 
     employment opportunities.
       (5) Health care goods or services.--The term ``health care 
     goods or services'' means any goods or services provided by a 
     health care institution, provider, or by any individual 
     working under the supervision of a health care provider, that 
     relates to the diagnosis, prevention, care, or treatment of 
     any human disease or impairment, or the assessment of the 
     health of human beings.
       (6) Health care institution.--The term ``health care 
     institution'' means any entity licensed under Federal or 
     State law to provide health care services (including but not

[[Page S12824]]

     limited to ambulatory surgical centers, assisted living 
     facilities, emergency medical services providers, hospices, 
     hospitals and hospital systems, nursing homes, or other 
     entities licensed to provide such services).
       (7) Health care lawsuit.--The term ``health care lawsuit'' 
     means any health care liability claim concerning the 
     provision of health care goods or services affecting 
     interstate commerce, or any health care liability action 
     concerning the provision of (or the failure to provide) 
     health care goods or services affecting interstate commerce, 
     brought in a State or Federal court or pursuant to an 
     alternative dispute resolution system, against a health care 
     provider or a health care institution regardless of the 
     theory of liability on which the claim is based, or the 
     number of claimants, plaintiffs, defendants, or other 
     parties, or the number of claims or causes of action, in 
     which the claimant alleges a health care liability claim.
       (8) Health care liability action.--The term ``health care 
     liability action'' means a civil action brought in a State or 
     Federal Court or pursuant to an alternative dispute 
     resolution system, against a health care provider or a health 
     care institution regardless of the theory of liability on 
     which the claim is based, or the number of plaintiffs, 
     defendants, or other parties, or the number of causes of 
     action, in which the claimant alleges a health care liability 
     claim.
       (9) Health care liability claim.--The term ``health care 
     liability claim'' means a demand by any person, whether or 
     not pursuant to ADR, against a health care provider or health 
     care institution, including third-party claims, cross-claims, 
     counter-claims, or contribution claims, which are based upon 
     the provision of, use of, or payment for (or the failure to 
     provide, use, or pay for) health care services, regardless of 
     the theory of liability on which the claim is based, or the 
     number of plaintiffs, defendants, or other parties, or the 
     number of causes of action.
       (10) Health care provider.--
       (A) In general.--The term ``health care provider'' means 
     any person (including but not limited to a physician (as 
     defined by section 1861(r) of the Social Security Act (42 
     U.S.C. 1395x(r)), registered nurse, dentist, podiatrist, 
     pharmacist, chiropractor, or optometrist) required by State 
     or Federal law to be licensed, registered, or certified to 
     provide health care services, and being either so licensed, 
     registered, or certified, or exempted from such requirement 
     by other statute or regulation.
       (B) Treatment of certain professional associations.--For 
     purposes of this title, a professional association that is 
     organized under State law by an individual physician or group 
     of physicians, a partnership or limited liability partnership 
     formed by a group of physicians, a nonprofit health 
     corporation certified under State law, or a company formed by 
     a group of physicians under State law shall be treated as a 
     health care provider under subparagraph (A).
       (11) Noneconomic damages.--The term ``noneconomic damages'' 
     means damages for physical and emotional pain, suffering, 
     inconvenience, physical impairment, mental anguish, 
     disfigurement, loss of enjoyment of life, loss of society and 
     companionship, loss of consortium (other than loss of 
     domestic service), hedonic damages, injury to reputation, and 
     all other nonpecuniary losses of any kind or nature.
       (12) State.--The term ``State'' means each of the several 
     States, the District of Columbia, the Commonwealth of Puerto 
     Rico, the Virgin Islands, Guam, American Samoa, the Northern 
     Mariana Islands, the Trust Territory of the Pacific Islands, 
     and any other territory or possession of the United States, 
     or any political subdivision thereof.

     SEC. __4. COMPENSATING PATIENT INJURY.

       (a) Unlimited Amount of Damages for Actual Economic Losses 
     in Health Care Lawsuits.--In any health care lawsuit, nothing 
     in this title shall limit the recovery by a claimant of the 
     full amount of the available economic damages, 
     notwithstanding the limitation contained in subsection (b).
       (b) Additional Noneconomic Damages.--
       (1) Health care providers.--In any health care lawsuit 
     where final judgment is rendered against a health care 
     provider, the amount of noneconomic damages recovered from 
     the provider, if otherwise available under applicable Federal 
     or State law, may be as much as $250,000, regardless of the 
     number of parties other than a health care institution 
     against whom the action is brought or the number of separate 
     claims or actions brought with respect to the same 
     occurrence.
       (2) Health care institutions.--
       (A) Single institution.--In any health care lawsuit where 
     final judgment is rendered against a single health care 
     institution, the amount of noneconomic damages recovered from 
     the institution, if otherwise available under applicable 
     Federal or State law, may be as much as $250,000, regardless 
     of the number of parties against whom the action is brought 
     or the number of separate claims or actions brought with 
     respect to the same occurrence.
       (B) Multiple institutions.--In any health care lawsuit 
     where final judgment is rendered against more than one health 
     care institution, the amount of noneconomic damages recovered 
     from each institution, if otherwise available under 
     applicable Federal or State law, may be as much as $250,000, 
     regardless of the number of parties against whom the action 
     is brought or the number of separate claims or actions 
     brought with respect to the same occurrence, except that the 
     total amount recovered from all such institutions in such 
     lawsuit shall not exceed $500,000.
       (c) No Discount of Award for Noneconomic Damages.--In any 
     health care lawsuit--
       (1) an award for future noneconomic damages shall not be 
     discounted to present value;
       (2) the jury shall not be informed about the maximum award 
     for noneconomic damages under subsection (b);
       (3) an award for noneconomic damages in excess of the 
     limitations provided for in subsection (b) shall be reduced 
     either before the entry of judgment, or by amendment of the 
     judgment after entry of judgment, and such reduction shall be 
     made before accounting for any other reduction in damages 
     required by law; and
       (4) if separate awards are rendered for past and future 
     noneconomic damages and the combined awards exceed the 
     limitations described in subsection (b), the future 
     noneconomic damages shall be reduced first.
       (d) Fair Share Rule.--In any health care lawsuit, each 
     party shall be liable for that party's several share of any 
     damages only and not for the share of any other person. Each 
     party shall be liable only for the amount of damages 
     allocated to such party in direct proportion to such party's 
     percentage of responsibility. A separate judgment shall be 
     rendered against each such party for the amount allocated to 
     such party. For purposes of this section, the trier of fact 
     shall determine the proportion of responsibility of each 
     party for the claimant's harm.

     SEC. __5. ENSURING RELIABLE EXPERT TESTIMONY.

       (a) Expert Witness Qualifications.--
       (1) In general.--In any health care lawsuit, an individual 
     shall not give expert testimony on the appropriate standard 
     of practice or care involved unless the individual is 
     licensed as a health professional in 1 or more States and the 
     individual meets the following criteria:
       (A) If the party against whom or on whose behalf the 
     testimony is to be offered is or claims to be a specialist, 
     the expert witness shall specialize at the time of the 
     occurrence that is the basis for the lawsuit in the same 
     specialty or claimed specialty as the party against whom or 
     on whose behalf the testimony is to be offered. If the party 
     against whom or on whose behalf the testimony is to be 
     offered is or claims to be a specialist who is board 
     certified, the expert witness shall be a specialist who is 
     board certified in that specialty or claimed specialty.
       (B) During the 1-year period immediately preceding the 
     occurrence of the action that gave rise to the lawsuit, the 
     expert witness shall have devoted a majority of the 
     individual's professional time to one or more of the 
     following:
       (i) The active clinical practice of the same health 
     profession as the defendant and, if the defendant is or 
     claims to be a specialist, in the same specialty or claimed 
     specialty.
       (ii) The instruction of students in an accredited health 
     professional school or accredited residency or clinical 
     research program in the same health profession as the 
     defendant and, if the defendant is or claims to be a 
     specialist, in an accredited health professional school or 
     accredited residency or clinical research program in the same 
     specialty or claimed specialty.
       (C) If the defendant is a general practitioner, the expert 
     witness shall have devoted a majority of the witness's 
     professional time in the 1-year period preceding the 
     occurrence of the action giving rise to the lawsuit to one or 
     more of the following:
       (i) Active clinical practice as a general practitioner.
       (ii) Instruction of students in an accredited health 
     professional school or accredited residency or clinical 
     research program in the same health profession as the 
     defendant.
       (2) Health care institutions.--If the defendant in a health 
     care lawsuit is a health care institution that employs a 
     health professional against whom or on whose behalf the 
     testimony is offered, the provisions of paragraph (1) apply 
     as if the health professional were the party or defendant 
     against whom or on whose behalf the testimony is offered.
       (3) Power of court.--Nothing in this subsection shall limit 
     the power of the trial court in a health care lawsuit to 
     disqualify an expert witness on grounds other than the 
     qualifications set forth under this subsection.
       (4) Limitation.--An expert witness in a health care lawsuit 
     shall not be permitted to testify if the fee of the witness 
     is in any way contingent on the outcome of the lawsuit.
       (b) Preliminary Expert Opinion Testimony Against Health 
     Care Professionals.--
       (1) Certification.--In any health care lawsuit, the 
     claimant (or its attorney) shall certify in a written 
     statement that is filed and served with the claim whether or 
     not expert opinion testimony is necessary to prove the health 
     care professional's standard of care or liability for the 
     claim.
       (2) Preliminary expert opinion.--
       (A) In general.--If the claimant in any health care lawsuit 
     certifies that expert opinion testimony is necessary as 
     required under paragraph (1), the claimant shall serve a 
     preliminary expert opinion affidavit. The claimant may 
     provide affidavits from as many experts as the claimant 
     determines to be necessary.
       (B) Requirements.--A preliminary expert opinion affidavit 
     under subparagraph (A)

[[Page S12825]]

     shall contain at least the following information:
       (i) The expert's qualifications to express an opinion on 
     the health care professionals standard of care or liability 
     for the claim.
       (ii) The factual basis for each claim against a health care 
     professional.
       (iii) The health care professional's acts, errors or 
     omissions that the expert considers to be a violation of the 
     applicable standard of care resulting in liability.
       (iv) The manner in which the health care professional's 
     acts, errors, or omissions caused or contributed to the 
     damages or other relief sought by the claimant.
       (3) Disputes.--If the claimant in any health care lawsuit 
     or its attorney certifies that expert testimony is not 
     required for the claim and the defendant disputes that 
     certification in good faith, the defendant may apply by 
     motion to the court for an order requiring the claimant to 
     obtain and serve a preliminary expert opinion affidavit under 
     this subsection, and such motion may be granted by the court.
       (4) Dismissals.--The court in a health care lawsuit, on its 
     own motion or the motion of the defendant, shall dismiss the 
     claim against the defendant without prejudice if the claimant 
     fails to file and serve a preliminary expert opinion 
     affidavit after the claimant (or its attorney) has certified 
     that an affidavit is necessary or the court has ordered the 
     claimant to file and serve an affidavit.

     SEC. __6. EFFECT ON OTHER LAWS.

       (a) General Vaccine Injury.--
       (1) In general.--To the extent that title XXI of the Public 
     Health Service Act establishes a Federal rule of law 
     applicable to a civil action brought for a vaccine-related 
     injury or death--
       (A) this title shall not affect the application of the rule 
     of law to such an action; and
       (B) any rule of law prescribed by this title in conflict 
     with a rule of law of such title XXI shall not apply to such 
     action.
       (2) Exception.--If there is an aspect of a civil action 
     brought for a vaccine-related injury or death to which a 
     Federal rule of law under title XXI of the Public Health 
     Service Act does not apply, then this title or otherwise 
     applicable law (as determined under this title) will apply to 
     such aspect of such action.
       (b) Smallpox Vaccine Injury.--
       (1) In general.--To the extent that part C of title II of 
     the Public Health Service Act establishes a Federal rule of 
     law applicable to a civil action brought for a smallpox 
     vaccine-related injury or death--
       (A) this title shall not affect the application of the rule 
     of law to such an action; and
       (B) any rule of law prescribed by this title in conflict 
     with a rule of law of such part C shall not apply to such 
     action.
       (2) Exception.--If there is an aspect of a civil action 
     brought for a smallpox vaccine-related injury or death to 
     which a Federal rule of law under part C of title II of the 
     Public Health Service Act does not apply, then this title or 
     otherwise applicable law (as determined under this title) 
     will apply to such aspect of such action.
       (c) Other Federal Law.--Except as provided in this section, 
     nothing in this title shall be deemed to affect any defense 
     available, or any limitation on liability that applies to, a 
     defendant in a health care lawsuit or action under any other 
     provision of Federal law.

     SEC. __7. STATE FLEXIBILITY AND PROTECTION OF STATES' RIGHTS.

       (a) Health Care Lawsuits.--The provisions governing health 
     care lawsuits set forth in this title shall preempt, subject 
     to subsections (b) and (c), State law to the extent that 
     State law prevents the application of any provisions of law 
     established by or under this title. The provisions governing 
     health care lawsuits set forth in this title supersede 
     chapter 171 of title 28, United States Code, to the extent 
     that such chapter provides for a greater amount of damages 
     than provided in this title.
       (b) Preemption of Certain State Laws.--No provision of this 
     title shall be construed to preempt any State law (whether 
     effective before, on, or after the date of the enactment of 
     this Act) that specifies a particular monetary amount of 
     compensatory or punitive damages (or the total amount of 
     damages) that may be awarded in a health care lawsuit, 
     regardless of whether such monetary amount is greater or 
     lesser than is provided for under this title, notwithstanding 
     section __4(a).
       (c) Protection of State's Rights and Other Laws.--
       (1) In general.--Any issue that is not governed by a 
     provision of law established by or under this title 
     (including the State standards of negligence) shall be 
     governed by otherwise applicable Federal or State law.
       (2) Rule of construction.--Nothing in this title shall be 
     construed to--
       (A) preempt or supersede any Federal or State law that 
     imposes greater procedural or substantive protections for a 
     health care provider or health care institution from 
     liability, loss, or damages than those provided by this 
     title;
       (B) preempt or supercede any State law that permits and 
     provides for the enforcement of any arbitration agreement 
     related to a health care liability claim whether enacted 
     prior to or after the date of enactment of this Act;
       (C) create a cause of action that is not otherwise 
     available under Federal or State law; or
       (D) affect the scope of preemption of any other Federal 
     law.

     SEC. __8. APPLICABILITY; EFFECTIVE DATE.

       This title shall apply to any health care lawsuit brought 
     in a Federal or State court, or subject to an alternative 
     dispute resolution system, that is initiated on or after the 
     date of the enactment of this Act.
                                 ______
                                 
  SA 3098. Mr. CASEY (for himself and Ms. Klobuchar) 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 __--SUPPORT FOR PREGNANT AND PARENTING TEENS AND WOMEN

     SEC. _001. DEFINITIONS.

       In this title:
       (1) Accompaniment.--The term ``accompaniment'' means 
     assisting, representing, and accompanying a woman in seeking 
     judicial relief for child support, child custody, restraining 
     orders, and restitution for harm to persons and property, and 
     in filing criminal charges, and may include the payment of 
     court costs and reasonable attorney and witness fees 
     associated therewith.
       (2) Eligible institution of higher education.--The term 
     ``eligible institution of higher education'' means an 
     institution of higher education (as such term is defined in 
     section 101 of the Higher Education Act of 1965 (20 U.S.C. 
     1001)) that has established and operates, or agrees to 
     establish and operate upon the receipt of a grant under this 
     title, a pregnant and parenting student services office.
       (3) Community service center.--The term ``community service 
     center'' means a non-profit organization that provides social 
     services to residents of a specific geographical area via 
     direct service or by contract with a local governmental 
     agency.
       (4) High school.--The term ``high school'' means any public 
     or private school that operates grades 10 through 12, 
     inclusive, grades 9 through 12, inclusive or grades 7 through 
     12, inclusive.
       (5) Intervention services.--The term ``intervention 
     services'' means, with respect to domestic violence, sexual 
     violence, sexual assault, or stalking, 24-hour telephone 
     hotline services for police protection and referral to 
     shelters.
       (6) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (7) State.--The term ``State'' includes the District of 
     Columbia, any commonwealth, possession, or other territory of 
     the United States, and any Indian tribe or reservation.
       (8) Supportive social services.--The term ``supportive 
     social services'' means transitional and permanent housing, 
     vocational counseling, and individual and group counseling 
     aimed at preventing domestic violence, sexual violence, 
     sexual assault, or stalking.
       (9) Violence.--The term ``violence'' means actual violence 
     and the risk or threat of violence.

     SEC. _002. ESTABLISHMENT OF PREGNANCY ASSISTANCE FUND.

       (a) In General.--The Secretary, in collaboration and 
     coordination with the Secretary of Education (as 
     appropriate), shall establish a Pregnancy Assistance Fund to 
     be administered by the Secretary, for the purpose of awarding 
     competitive grants to States to assist pregnant and parenting 
     teens and women.
       (b) Use of Fund.--A State may apply for a grant under 
     subsection (a) to carry out any activities provided for in 
     section _003.
       (c) Applications.--To be eligible to receive a grant under 
     subsection (a), a State shall submit to the Secretary an 
     application at such time, in such manner, and containing such 
     information as the Secretary may require, including a 
     description of the purposes for which the grant is being 
     requested and the designation of a State agency for receipt 
     and administration of funding received under this title.

     SEC. _003. PERMISSIBLE USES OF FUND.

       (a) In General.--A State shall use amounts received under a 
     grant under section _001 for the purposes described in this 
     section to assist pregnant and parenting teens and women.
       (b) Institutions of Higher Education.--
       (1) In general.--A State may use amounts received under a 
     grant under section _001 to make funding available to 
     eligible institutions of higher education to enable the 
     eligible institutions to establish, maintain, or operate 
     pregnant and parenting student services. Such funding shall 
     be used to supplement, not supplant, existing funding for 
     such services.
       (2) Application.--An eligible institution of higher 
     education that desires to receive funding under this 
     subsection shall submit an application to the designated 
     State agency at such time, in such manner, and containing 
     such information as the State agency may require.
       (3) Matching requirement.--An eligible institution of 
     higher education that receives

[[Page S12826]]

     funding under this subsection shall contribute to the conduct 
     of the pregnant and parenting student services office 
     supported by the funding an amount from non-Federal funds 
     equal to 25 percent of the amount of the funding provided. 
     The non-Federal share may be in cash or in-kind, fairly 
     evaluated, including services, facilities, supplies, or 
     equipment.
       (4) Use of funds for assisting pregnant and parenting 
     college students.--An eligible institution of higher 
     education that receives funding under this subsection shall 
     use such funds to establish, maintain or operate pregnant and 
     parenting student services and may use such funding for the 
     following programs and activities:
       (A) Conduct a needs assessment on campus and within the 
     local community--
       (i) to assess pregnancy and parenting resources, located on 
     the campus or within the local community, that are available 
     to meet the needs described in subparagraph (B); and
       (ii) to set goals for--

       (I) improving such resources for pregnant, parenting, and 
     prospective parenting students; and
       (II) improving access to such resources.

       (B) Annually assess the performance of the eligible 
     institution in meeting the following needs of students 
     enrolled in the eligible institution who are pregnant or are 
     parents:
       (i) The inclusion of maternity coverage and the 
     availability of riders for additional family members in 
     student health care.
       (ii) Family housing.
       (iii) Child care.
       (iv) Flexible or alternative academic scheduling, such as 
     telecommuting programs, to enable pregnant or parenting 
     students to continue their education or stay in school.
       (v) Education to improve parenting skills for mothers and 
     fathers and to strengthen marriages.
       (vi) Maternity and baby clothing, baby food (including 
     formula), baby furniture, and similar items to assist parents 
     and prospective parents in meeting the material needs of 
     their children.
       (vii) Post-partum counseling.
       (C) Identify public and private service providers, located 
     on the campus of the eligible institution or within the local 
     community, that are qualified to meet the needs described in 
     subparagraph (B), and establishes programs with qualified 
     providers to meet such needs.
       (D) Assist pregnant and parenting students, fathers or 
     spouses in locating and obtaining services that meet the 
     needs described in subparagraph (B).
       (E) If appropriate, provide referrals for prenatal care and 
     delivery, infant or foster care, or adoption, to a student 
     who requests such information. An office shall make such 
     referrals only to service providers that serve the following 
     types of individuals:
       (i) Parents.
       (ii) Prospective parents awaiting adoption.
       (iii) Women who are pregnant and plan on parenting or 
     placing the child for adoption.
       (iv) Parenting or prospective parenting couples.
       (5) Reporting.--
       (A) Annual report by institutions.--
       (i) In general.--For each fiscal year that an eligible 
     institution of higher education receives funds under this 
     subsection, the eligible institution shall prepare and submit 
     to the State, by the date determined by the State, a report 
     that--

       (I) itemizes the pregnant and parenting student services 
     office's expenditures for the fiscal year;
       (II) contains a review and evaluation of the performance of 
     the office in fulfilling the requirements of this section, 
     using the specific performance criteria or standards 
     established under subparagraph (B)(i); and
       (III) describes the achievement of the office in meeting 
     the needs listed in paragraph (4)(B) of the students served 
     by the eligible institution, and the frequency of use of the 
     office by such students.

       (ii) Performance criteria.--Not later than 180 days before 
     the date the annual report described in clause (i) is 
     submitted, the State--

       (I) shall identify the specific performance criteria or 
     standards that shall be used to prepare the report; and
       (II) may establish the form or format of the report.

       (B) Report by state.--The State shall annually prepare and 
     submit a report on the findings under this subsection, 
     including the number of eligible institutions of higher 
     education that were awarded funds and the number of students 
     served by each pregnant and parenting student services office 
     receiving funds under this section, to the Secretary.
       (c) Support for Pregnant and Parenting Teens.--A State may 
     use amounts received under a grant under section _001 to make 
     funding available to eligible high schools and community 
     service centers to establish, maintain or operate pregnant 
     and parenting services in the same general manner and in 
     accordance with all conditions and requirements described in 
     subsection (b), except that paragraph (3) of such subsection 
     shall not apply for purposes of this subsection.
       (d) Improving Services for Pregnant Women Who Are Victims 
     of Domestic Violence, Sexual Violence, Sexual Assault, and 
     Stalking.--
       (1) In general.--A State may use amounts received under a 
     grant under section _001 to make funding available to its 
     State Attorney General to assist Statewide offices in 
     providing--
       (A) intervention services, accompaniment, and supportive 
     social services for eligible pregnant women who are victims 
     of domestic violence, sexual violence, sexual assault, or 
     stalking.
       (B) technical assistance and training (as described in 
     subsection (c)) relating to violence against eligible 
     pregnant women to be made available to the following:
       (i) Federal, State, tribal, territorial, and local 
     governments, law enforcement agencies, and courts.
       (ii) Professionals working in legal, social service, and 
     health care settings.
       (iii) Nonprofit organizations.
       (iv) Faith-based organizations.
       (2) Eligibility.--To be eligible for a grant under 
     paragraph (1), a State Attorney General shall submit an 
     application to the designated State agency at such time, in 
     such manner, and containing such information, as specified by 
     the State.
       (3) Technical assistance and training described.--For 
     purposes of paragraph (1)(B), technical assistance and 
     training is--
       (A) the identification of eligible pregnant women 
     experiencing domestic violence, sexual violence, sexual 
     assault, or stalking;
       (B) the assessment of the immediate and short-term safety 
     of such a pregnant woman, the evaluation of the impact of the 
     violence or stalking on the pregnant woman's health, and the 
     assistance of the pregnant woman in developing a plan aimed 
     at preventing further domestic violence, sexual violence, 
     sexual assault, or stalking, as appropriate;
       (C) the maintenance of complete medical or forensic records 
     that include the documentation of any examination, treatment 
     given, and referrals made, recording the location and nature 
     of the pregnant woman's injuries, and the establishment of 
     mechanisms to ensure the privacy and confidentiality of those 
     medical records; and
       (D) the identification and referral of the pregnant woman 
     to appropriate public and private nonprofit entities that 
     provide intervention services, accompaniment, and supportive 
     social services.
       (4) Eligible pregnant woman.--In this subsection, the term 
     ``eligible pregnant woman'' means any woman who is pregnant 
     on the date on which such woman becomes a victim of domestic 
     violence, sexual violence, sexual assault, or stalking or who 
     was pregnant during the one-year period before such date.
       (e) Public Awareness and Education.--A State may use 
     amounts received under a grant under section _001 to make 
     funding available to increase public awareness and education 
     concerning any services available to pregnant and parenting 
     teens and women under this title, or any other resources 
     available to pregnant and parenting women in keeping with the 
     intent and purposes of this title. The State shall be 
     responsible for setting guidelines or limits as to how much 
     of funding may be utilized for public awareness and education 
     in any funding award.

     SEC. _004. AUTHORIZATION OF APPROPRIATIONS.

       There is authorized to be appropriated, $25,000,000 for 
     each of fiscal years 2010 through 2019, to carry out this 
     title.
                                 ______
                                 
  SA 3099. 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 in title IX, insert the following:

   Subtitle __--Expansion of Adoption Credit and Adoption Assistance 
                                Programs

     SEC. _01. EXPANSION OF ADOPTION CREDIT AND ADOPTION 
                   ASSISTANCE PROGRAMS.

       (a) Increase in Dollar Limitation.--
       (1) Adoption credit.--
       (A) In general.--Paragraph (1) of section 23(b) of the 
     Internal Revenue Code of 1986 (relating to dollar limitation) 
     is amended by striking ``$10,000'' and inserting ``$15,000''.
       (B) Child with special needs.--Paragraph (3) of section 
     23(a) of such Code (relating to $10,000 credit for adoption 
     of child with special needs regardless of expenses) is 
     amended--
       (i) in the text by striking ``$10,000'' and inserting 
     ``$15,000'', and
       (ii) in the heading by striking ``$10,000'' and inserting 
     ``$15,000''.
       (C) Conforming amendment to inflation adjustment.--
     Subsection (h) of section 23 of such Code (relating to 
     adjustments for inflation) is amended to read as follows:
       ``(h) Adjustments for Inflation.--
       ``(1) Dollar limitations.--In the case of a taxable year 
     beginning after December 31, 2009, each of the dollar amounts 
     in subsections (a)(3) and (b)(1) shall be increased by an 
     amount equal to--
       ``(A) such dollar amount, multiplied by
       ``(B) the cost-of-living adjustment determined under 
     section 1(f)(3) for the calendar year in which the taxable 
     year begins, determined by substituting `calendar year 2008' 
     for `calendar year 1992' in subparagraph (B) thereof.

     If any amount as increased under the preceding sentence is 
     not a multiple of $10, such amount shall be rounded to the 
     nearest multiple of $10.

[[Page S12827]]

       ``(2) Income limitation.--In the case of a taxable year 
     beginning after December 31, 2002, the dollar amount in 
     subsection (b)(2)(A)(i) shall be increased by an amount equal 
     to--
       ``(A) such dollar amount, multiplied by
       ``(B) the cost-of-living adjustment determined under 
     section 1(f)(3) for the calendar year in which the taxable 
     year begins, determined by substituting `calendar year 2001' 
     for `calendar year 1992' in subparagraph (B) thereof.

     If any amount as increased under the preceding sentence is 
     not a multiple of $10, such amount shall be rounded to the 
     nearest multiple of $10.''.
       (2) Adoption assistance programs.--
       (A) In general.--Paragraph (1) of section 137(b) of the 
     Internal Revenue Code of 1986 (relating to dollar limitation) 
     is amended by striking ``$10,000'' and inserting ``$15,000''.
       (B) Child with special needs.--Paragraph (2) of section 
     137(a) of such Code (relating to $10,000 exclusion for 
     adoption of child with special needs regardless of expenses) 
     is amended--
       (i) in the text by striking ``$10,000'' and inserting 
     ``$15,000'', and
       (ii) in the heading by striking ``$10,000'' and inserting 
     ``$15,000''.
       (C) Conforming amendment to inflation adjustment.--
     Subsection (f) of section 137 of such Code (relating to 
     adjustments for inflation) is amended to read as follows:
       ``(f) Adjustments for Inflation.--
       ``(1) Dollar limitations.--In the case of a taxable year 
     beginning after December 31, 2009, each of the dollar amounts 
     in subsections (a)(2) and (b)(1) shall be increased by an 
     amount equal to--
       ``(A) such dollar amount, multiplied by
       ``(B) the cost-of-living adjustment determined under 
     section 1(f)(3) for the calendar year in which the taxable 
     year begins, determined by substituting `calendar year 2008' 
     for `calendar year 1992' in subparagraph (B) thereof.

     If any amount as increased under the preceding sentence is 
     not a multiple of $10, such amount shall be rounded to the 
     nearest multiple of $10.
       ``(2) Income limitation.--In the case of a taxable year 
     beginning after December 31, 2002, the dollar amount in 
     subsection (b)(2)(A) shall be increased by an amount equal 
     to--
       ``(A) such dollar amount, multiplied by
       ``(B) the cost-of-living adjustment determined under 
     section 1(f)(3) for the calendar year in which the taxable 
     year begins, determined by substituting `calendar year 2001' 
     for `calendar year 1992' in subparagraph thereof.

     If any amount as increased under the preceding sentence is 
     not a multiple of $10, such amount shall be rounded to the 
     nearest multiple of $10.''.
       (b) Credit Made Refundable.--
       (1) Credit moved to subpart relating to refundable 
     credits.--The Internal Revenue Code of 1986 is amended--
       (A) by redesignating section 23, as amended by subsection 
     (a), as section 36B, and
       (B) by moving section 36B (as so redesignated) from subpart 
     A of part IV of subchapter A of chapter 1 to the location 
     immediately before section 37 in subpart C of part IV of 
     subchapter A of chapter 1.
       (2) Conforming amendments.--
       (A) Section 24(b)(3)(B) of such Code is amended by striking 
     ``23,''.
       (B) Section 25(e)(1)(C) of such Code is amended by striking 
     ``23,'' both places it appears.
       (C) Section 25A(i)(5)(B) of such Code is amended by 
     striking ``23, 25D,'' and inserting ``25D''.
       (D) Section 25B(g)(2) of such Code is amended by striking 
     ``23,''.
       (E) Section 26(a)(1) of such Code is amended by striking 
     ``23,''.
       (F) Section 30(c)(2)(B)(ii) of such Code is amended by 
     striking ``23, 25D,'' and inserting ``25D''.
       (G) Section 30B(g)(2)(B)(ii) of such Code is amended by 
     striking ``23,''.
       (H) Section 30D(c)(2)(B)(ii) of such Code is amended by 
     striking ``sections 23 and'' and inserting ``section''.
       (I) Section 36B of such Code, as so redesignated, is 
     amended--
       (i) by striking paragraph (4) of subsection (b), and
       (ii) by striking subsection (c).
       (J) Section 137 of such Code is amended--
       (i) by striking ``section 23(d)'' in subsection (d) and 
     inserting ``section 36B(d)'', and
       (ii) by striking ``section 23'' in subsection (e) and 
     inserting ``section 36B''.
       (K) Section 904(i) of such Code is amended by striking 
     ``23,''.
       (L) Section 1016(a)(26) is amended by striking ``23(g)'' 
     and inserting ``36B(g)''.
       (M) Section 1400C(d) of such Code is amended by striking 
     ``23,''.
       (N) The table of sections for subpart A of part IV of 
     subchapter A of chapter 1 of such Code of 1986 is amended by 
     striking the item relating to section 23.
       (O) Paragraph (2) of section 1324(b) of title 31, United 
     States Code, is amended by inserting ``36B,'' after ``36A,''.
       (P) The table of sections for subpart C of part IV of 
     subchapter A of chapter 1 of the Internal Revenue Code of 
     1986 is amended by inserting after the item relating to 
     section 36A the following new item:

``Sec. 36B. Adoption expenses.''.

       (c) Extension of Credit and Adoption Assistance Programs.--
       (1) In general.--Section 36B of the Internal Revenue Code 
     of 1986, as redesignated by subsection (b), is amended by 
     adding at the end the following new subsection:
       ``(i) Termination.--This section shall not apply to 
     expenses paid or incurred in taxable years beginning after 
     December 31, 2019.''.
       (2) In general.--Section 137 of the Internal Revenue Code 
     of 1986 is amended by adding at the end the following new 
     subsection:
       ``(g) Termination.--This section shall not apply to 
     expenses paid or incurred in taxable years beginning after 
     December 31, 2019.''.
       (3) Sunset for modifications made by egtrra to adoption 
     credit removed.--Title IX of the Economic Growth and Tax 
     Relief Reconciliation Act of 2001 shall not apply to the 
     amendments made by section 202 of such Act.
       (d) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2009.
                                 ______
                                 
  SA 3100. Mr. WHITEHOUSE 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, between lines 6 and 7, insert the following:
       (e) Educated Health Care Consumers.--The term ``educated 
     health care consumer'' means an individual who is 
     knowledgeable about the health care system, and has 
     background or experience in making informed decisions 
     regarding health, medical, and scientific matters.
       On page 142, line 15, insert ``educated'' before ``health 
     care''.
       On page 192, line 23, insert ``educated'' before ``health 
     care''.
                                 ______
                                 
  SA 3101. Mr. FRANKEN 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 692, between lines 14 and 15, insert the following:

     SEC. 3009. RULE OF CONSTRUCTION.

       Nothing in the provisions of, or amendments made by, this 
     Act shall be construed as prohibiting the application of 
     value-based purchasing reforms under the Medicare program 
     under title XVIII of the Social Security Act under such 
     provisions or amendments to items and services furnished to 
     individuals eligible for benefits under the Medicare program 
     as a result of any expansion of such eligibility under the 
     provisions of, or amendments made by, this Act.
                                 ______
                                 
  SA 3102. Mr. DURBIN (for himself 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 816, after line 20, insert the following:

     SEC. 3115. EXTENDED MONTHS OF COVERAGE OF IMMUNOSUPPRESSIVE 
                   DRUGS FOR KIDNEY TRANSPLANT PATIENTS AND OTHER 
                   RENAL DIALYSIS PROVISIONS.

       (a) Provision of Appropriate Coverage of Immunosuppressive 
     Drugs Under the Medicare Program for Kidney Transplant 
     Recipients.--
       (1) Continued entitlement to immunosuppressive drugs.--
       (A) Kidney transplant recipients.--Section 226A(b)(2) of 
     the Social Security Act (42 U.S.C. 426-1(b)(2)) is amended by 
     inserting ``(except for coverage of immunosuppressive drugs 
     under section 1861(s)(2)(J))'' before ``, with the thirty-
     sixth month''.
       (B) Application.--Section 1836 of such Act (42 U.S.C. 
     1395o) is amended--
       (i) by striking ``Every individual who'' and inserting 
     ``(a) In General.--Every individual who''; and
       (ii) by adding at the end the following new subsection:
       ``(b) Special Rules Applicable to Individuals Only Eligible 
     for Coverage of Immunosuppressive Drugs.--
       ``(1) In general.--In the case of an individual whose 
     eligibility for benefits under this title has ended on or 
     after January 1, 2012, except for the coverage of 
     immunosuppressive drugs by reason of section 226A(b)(2), the 
     following rules shall apply:
       ``(A) The individual shall be deemed to be enrolled under 
     this part for purposes of receiving coverage of such drugs.
       ``(B) The individual shall be responsible for providing for 
     payment of the portion of the

[[Page S12828]]

     premium under section 1839 which is not covered under the 
     Medicare savings program (as defined in section 1144(c)(7)) 
     in order to receive such coverage.
       ``(C) The provision of such drugs shall be subject to the 
     application of--
       ``(i) the deductible under section 1833(b); and
       ``(ii) the coinsurance amount applicable for such drugs (as 
     determined under this part).
       ``(D) If the individual is an inpatient of a hospital or 
     other entity, the individual is entitled to receive coverage 
     of such drugs under this part.
       ``(2) Establishment of procedures in order to implement 
     coverage.--The Secretary shall establish procedures for--
       ``(A) identifying individuals that are entitled to coverage 
     of immunosuppressive drugs by reason of section 226A(b)(2); 
     and
       ``(B) distinguishing such individuals from individuals that 
     are enrolled under this part for the complete package of 
     benefits under this part.''.
       (C) Technical amendment to correct duplicate subsection 
     designation.--Subsection (c) of section 226A of such Act (42 
     U.S.C. 426-1), as added by section 201(a)(3)(D)(ii) of the 
     Social Security Independence and Program Improvements Act of 
     1994 (Public Law 103-296; 108 Stat. 1497), is redesignated as 
     subsection (d).
       (2) Extension of secondary payer requirements for esrd 
     beneficiaries.--Section 1862(b)(1)(C) of the Social Security 
     Act (42 U.S.C. 1395y(b)(1)(C)) is amended by adding at the 
     end the following new sentence: ``With regard to 
     immunosuppressive drugs furnished on or after the date of the 
     enactment of the Patient Protection and Affordable Care Act, 
     this subparagraph shall be applied without regard to any time 
     limitation.''.
       (b) Medicare Coverage for ESRD Patients.--Section 1881 of 
     the Social Security Act is amended--
       (1) in subsection (b)(14)(B)(iii), by inserting ``, 
     including oral drugs that are not the oral equivalent of an 
     intravenous drug (such as oral phosphate binders and 
     calcimimetics),'' after ``other drugs and biologicals'';
       (2) in subsection (b)(14)(E)(ii)--
       (A) in the first sentence--
       (i) by striking ``a one-time election to be excluded from 
     the phase-in'' and inserting ``an election, with respect to 
     2011, 2012, or 2013, to be excluded from the phase-in (or the 
     remainder of the phase-in)''; and
       (ii) by adding before the period at the end the following: 
     ``for such year and for each subsequent year during the 
     phase-in described in clause (i)''; and
       (B) in the second sentence--
       (i) by striking ``January 1, 2011'' and inserting ``the 
     first date of such year''; and
       (ii) by inserting ``and at a time'' after ``form and 
     manner''; and
       (3) in subsection (h)(4)(E), by striking ``lesser'' and 
     inserting ``greater''.
                                 ______
                                 
  SA 3103. Mr. CARPER 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. MANDATORY REPORTING OF FRAUD BY MEDICARE ADVANTAGE 
                   PLANS, PRESCRIPTION DRUG PLANS, AND PROVIDERS 
                   OF SERVICES AND SUPPLIERS.

       (a) Mandatory Reporting by Medicare Advantage Plans and 
     Prescription Drug Plans.--Section 1857(d) of the Social 
     Security Act (42 U.S.C. 1395w-27(d)) is amended by adding at 
     the end the following new paragraph:
       ``(7) Reporting of probable fraud.--
       ``(A) In general.--Each Medicare Advantage organization 
     and, in accordance with section 1860D-12(b)(3)(C), each PDP 
     sponsor of a prescription drug plan shall, in accordance with 
     regulations established by the Secretary under subparagraph 
     (B)--
       ``(i) self-report to the Secretary and to the appropriate 
     law enforcement or oversight agency any matter for which the 
     organization or sponsor has liability and for which the 
     organization or sponsor has identified, from any source, 
     credible evidence of fraud related to the program under this 
     part or part D; and
       ``(ii) report to the Secretary and to the appropriate law 
     enforcement or oversight agency any matter for which the 
     organization or sponsor has identified, from any source, 
     credible evidence of fraud by subcontractors or others 
     related to the program under this part or part D.
       ``(B) Regulations.--Not later than 1 year after the date of 
     enactment of this paragraph, the Secretary shall establish 
     regulations to carry out this paragraph.''.
       (b) Mandatory Reporting by Providers of Services and 
     Suppliers.--Section 1866(j)(7)(B) of the Social Security Act, 
     as inserted by section 6401, is amended by adding at the end 
     the following sentence: ``Such core elements shall include, 
     to the extent determined appropriate by the Secretary, 
     internal monitoring and auditing of, and responding to, 
     identified deficiencies. Such response shall include 
     reporting to the Secretary and to the appropriate law 
     enforcement or oversight agency credible evidence of fraud 
     related to the program under this title, title XIX, or title 
     XXI.''.
       (c) Prompt and Appropriate Action by the Secretary.--The 
     Secretary shall take prompt and appropriate action to forward 
     information on fraud reported under sections 1857(d)(7) and 
     1866(j)(7)(B) of the Social Security Act, as added by 
     subsection (a) and amended by subsection (b), respectively, 
     to the appropriate agencies.
       (d) Annual Report to Congress.--The Secretary of Health and 
     Human Services (in this section referred to as the 
     ``Secretary'') shall submit to Congress an annual report on 
     actions taken by the Secretary to address fraud during the 
     preceding year. The report shall include an analysis of 
     trends and conditions giving rise to fraud and general 
     actions taken to address such trends and conditions, together 
     with recommendations for such legislation and administrative 
     action as the Secretary determines appropriate.
                                 ______
                                 
  SA 3104. 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 426, line 14, insert ``, in cases where eligibility 
     for medical assistance under this title is not established 
     pursuant to otherwise applicable procedures under the Patient 
     Protection and Affordable Care Act, including section 1413 of 
     such Act,'' after ``shall not''.
                                 ______
                                 
  SA 3105. 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 1395, strike line 11 and all that follows through 
     ``SEC. 778.'' on line 15 and insert the following:

     SEC. 5314. FELLOWSHIP TRAINING IN PUBLIC HEALTH.

       Part B of title III of the Public Health Service Act (42 
     U.S.C. 243 et seq.) is amended by inserting after section 
     317G the following:

     ``SEC. 317G-1.

                                 ______
                                 
  SA 3106. 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 301, after line 25, add the following:

     SEC. 1413A. ASSURANCE OF EFFECTIVE IMPLEMENTATION OF 
                   STREAMLINED ENROLLMENT PROCEDURES.

       (a) Amendments to Section 1413.--Section 1413 of this Act 
     is amended--
       (1) in subsection (a), by striking the second sentence and 
     inserting ``Such system shall ensure that if an individual 
     applying to an Exchange, to a State Medicaid program under 
     title XIX of the Social Security Act, or to a State 
     children's health insurance program (CHIP) under title XXI of 
     such Act, is found to be ineligible for the program to which 
     the individual applied, the individual shall be screened for 
     eligibility for all other potentially applicable such 
     programs and shall be enrolled in the program for which the 
     individual qualifies.'';
       (2) in subsection (b)(1), by adding at the end the 
     following:
       ``(D) Relevance.--The forms described in subparagraphs (A) 
     and (B) shall not require the applicant to answer any 
     questions that are irrelevant to establishing eligibility for 
     applicable State health subsidy programs. The Secretary shall 
     establish procedures that avoid any need for such 
     requirements, which shall include determining the amounts 
     expended for medical assistance that are described in 
     subsection (y)(1) of section 1905 of the Social Security Act 
     (as added by section 2001(a)(3) of this Act) through the use 
     of the post-enrollment procedures described in section 
     1903(u)(1)(C) of the Social Security Act.'';
       (3) in subsection (c)(2)(B)(ii)(II), by striking ``by 
     requesting'' and inserting ``notwithstanding section 1411(b), 
     by requesting'';
       (4) in subsection (c)(2)(C), by inserting ``is'' before 
     ``consistent''; and
       (5) in subsection (e)(1), by striking ``enrollment in 
     qualified health plans offered through an Exchange, including 
     the'' and inserting ``determination of eligibility for''.

[[Page S12829]]

       (b) Amendment to Social Security Act.--Subparagraph (H) of 
     section 1902(e)(14) of the Social Security Act (as added by 
     section 2002 of this Act), is amended, in the matter 
     preceding clause (i), by striking ``shall not be construed'' 
     and inserting ``shall not, in cases where eligibility for 
     medical assistance under this title is not established 
     pursuant to otherwise applicable procedures under the Patient 
     Protection and Affordable Care Act, including section 1413 of 
     such Act, be construed''.
                                 ______
                                 
  SA 3107. 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:

       Strike section 1413 and insert the following:

     SEC. 1413. STREAMLINING OF PROCEDURES FOR ENROLLMENT THROUGH 
                   AN EXCHANGE AND STATE MEDICAID, CHIP, AND 
                   HEALTH SUBSIDY PROGRAMS.

       (a) In General.--The Secretary shall establish a system 
     meeting the requirements of this section under which 
     residents of each State may apply for enrollment in, receive 
     a determination of eligibility for participation in, and 
     continue participation in, applicable State health subsidy 
     programs. Such system shall ensure that if an individual 
     applying to an Exchange, to a State Medicaid program under 
     title XIX of the Social Security Act, or to a State 
     children's health insurance program (CHIP) under title XXI of 
     such Act, is found to be ineligible for the program to which 
     the individual applied, the individual shall be screened for 
     eligibility for all other potentially applicable such 
     programs and shall be enrolled in the program for which the 
     individual qualifies.
       (b) Requirements Relating to Forms and Notice.--
       (1) Requirements relating to forms.--
       (A) In general.--The Secretary shall develop and provide to 
     each State a single, streamlined form that--
       (i) may be used to apply for all applicable State health 
     subsidy programs within the State;
       (ii) may be filed online, in person, by mail, or by 
     telephone;
       (iii) may be filed with an Exchange or with State officials 
     operating one of the other applicable State health subsidy 
     programs; and
       (iv) is structured to maximize an applicant's ability to 
     complete the form satisfactorily, taking into account the 
     characteristics of individuals who qualify for applicable 
     State health subsidy programs.
       (B) State authority to establish form.--A State may develop 
     and use its own single, streamlined form as an alternative to 
     the form developed under subparagraph (A) if the alternative 
     form is consistent with standards promulgated by the 
     Secretary under this section.
       (C) Supplemental eligibility forms.--The Secretary may 
     allow a State to use a supplemental or alternative form in 
     the case of individuals who apply for eligibility that is not 
     determined on the basis of the household income (as defined 
     in section 36B of the Internal Revenue Code of 1986).
       (D) Relevance.--The forms described in subparagraphs (A) 
     and (B) shall not require the applicant to answer any 
     questions that are irrelevant to establishing eligibility for 
     applicable State health subsidy programs. The Secretary shall 
     establish procedures that avoid any need for such 
     requirements, which shall include determining the amounts 
     expended for medical assistance that are described in 
     subsection (y)(1) of section 1905 of the Social Security Act 
     (as added by section 2001(a)(3) of this Act) through the use 
     of the post-enrollment procedures described in section 
     1903(u)(1)(C) of the Social Security Act.
       (2) Notice.--The Secretary shall provide that an applicant 
     filing a form under paragraph (1) shall receive notice of 
     eligibility for an applicable State health subsidy program 
     without any need to provide additional information or 
     paperwork unless such information or paperwork is 
     specifically required by law when information provided on the 
     form is inconsistent with data used for the electronic 
     verification under paragraph (3) or is otherwise insufficient 
     to determine eligibility.
       (c) Requirements Relating to Eligibility Based on Data 
     Exchanges.--
       (1) Development of secure interfaces.--Each State shall 
     develop for all applicable State health subsidy programs a 
     secure, electronic interface allowing an exchange of data 
     (including information contained in the application forms 
     described in subsection (b)) that allows a determination of 
     eligibility for all such programs based on a single 
     application. Such interface shall be compatible with the 
     method established for data verification under section 
     1411(c)(4).
       (2) Data matching program.--Each applicable State health 
     subsidy program shall participate in a data matching 
     arrangement for determining eligibility for participation in 
     the program under paragraph (3) that--
       (A) provides access to data described in paragraph (3);
       (B) applies only to individuals who--
       (i) receive assistance from an applicable State health 
     subsidy program; or
       (ii) apply for such assistance--

       (I) by filing a form described in subsection (b); or
       (II) notwithstanding section 1411(b), by requesting a 
     determination of eligibility and authorizing disclosure of 
     the information described in paragraph (3) to applicable 
     State health coverage subsidy programs for purposes of 
     determining and establishing eligibility; and

       (C) is consistent with standards promulgated by the 
     Secretary, including the privacy and data security safeguards 
     described in section 1942 of the Social Security Act or that 
     are otherwise applicable to such programs.
       (3) Determination of eligibility.--
       (A) In general.--Each applicable State health subsidy 
     program shall, to the maximum extent practicable--
       (i) establish, verify, and update eligibility for 
     participation in the program using the data matching 
     arrangement under paragraph (2); and
       (ii) determine such eligibility on the basis of reliable, 
     third party data, including information described in sections 
     1137, 453(i), and 1942(a) of the Social Security Act, 
     obtained through such arrangement.
       (B) Exception.--This paragraph shall not apply in 
     circumstances with respect to which the Secretary determines 
     that the administrative and other costs of use of the data 
     matching arrangement under paragraph (2) outweigh its 
     expected gains in accuracy, efficiency, and program 
     participation.
       (4) Secretarial standards.--The Secretary shall, after 
     consultation with persons in possession of the data to be 
     matched and representatives of applicable State health 
     subsidy programs, promulgate standards governing the timing, 
     contents, and procedures for data matching described in this 
     subsection. Such standards shall take into account 
     administrative and other costs and the value of data matching 
     to the establishment, verification, and updating of 
     eligibility for applicable State health subsidy programs.
       (d) Administrative Authority.--
       (1) Agreements.--Subject to section 1411 and section 
     6103(l)(21) of the Internal Revenue Code of 1986 and any 
     other requirement providing safeguards of privacy and data 
     integrity, the Secretary may establish model agreements, and 
     enter into agreements, for the sharing of data under this 
     section.
       (2) Authority of exchange to contract out.--Nothing in this 
     section shall be construed to--
       (A) prohibit contractual arrangements through which a State 
     medicaid agency determines eligibility for all applicable 
     State health subsidy programs, but only if such agency 
     complies with the Secretary's requirements ensuring reduced 
     administrative costs, eligibility errors, and disruptions in 
     coverage; or
       (B) change any requirement under title XIX that eligibility 
     for participation in a State's medicaid program must be 
     determined by a public agency.
       (e) Applicable State Health Subsidy Program.--In this 
     section, the term ``applicable State health subsidy program'' 
     means--
       (1) the program under this title for the determination of 
     eligibility for premium tax credits under section 36B of the 
     Internal Revenue Code of 1986 and cost-sharing reductions 
     under section 1402;
       (2) a State medicaid program under title XIX of the Social 
     Security Act;
       (3) a State children's health insurance program (CHIP) 
     under title XXI of such Act; and
       (4) a State program under section 1331 establishing 
     qualified basic health plans.
                                 ______
                                 
  SA 3108. 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 816, after line 20, insert the following:

     SEC. 3115. IMPROVING CARE PLANNING FOR MEDICARE HOME HEALTH 
                   SERVICES.

       (a) In General.--Section 1814(a)(2) of the Social Security 
     Act (42 U.S.C. 1395f(a)(2)), in the matter preceding 
     subparagraph (A), is amended--
       (1) by inserting ``(as those terms are defined in section 
     1861(aa)(5))'' after ``clinical nurse specialist''; and
       (2) by inserting ``, or in the case of services described 
     in subparagraph (C), a physician, or a nurse practitioner or 
     clinical nurse specialist who is working in collaboration 
     with a physician in accordance with State law, or a certified 
     nurse-midwife (as defined in section 1861(gg)) as authorized 
     by State law, or a physician assistant (as defined in section 
     1861(aa)(5)) under the supervision of a physician'' after 
     ``collaboration with a physician''.
       (b) Conforming Amendments.--(1) Section 1814(a) of the 
     Social Security Act (42 U.S.C. 1395f(a)), as amended by 
     section 3108(a)(2) and section 6407, is amended--

[[Page S12830]]

       (A) in paragraph (2)(C), by inserting ``, a nurse 
     practitioner, a clinical nurse specialist, a certified nurse-
     midwife, or a physician assistant (as the case may be)'' 
     after ``physician'' each place it appears;
       (B) in the second sentence, by inserting ``certified nurse-
     midwife,'' after ``clinical nurse specialist,'';
       (C) in the third sentence--
       (i) by striking ``physician certification'' and inserting 
     ``certification'';
       (ii) by inserting ``(or on January 1, 2008, in the case of 
     regulations to implement the amendments made by section 3115 
     of the Patient Protection and Affordable Care Act)'' after 
     ``1981''; and
       (iii) by striking ``a physician who'' and inserting ``a 
     physician, nurse practitioner, clinical nurse specialist, 
     certified nurse-midwife, or physician assistant who''; and
       (D) in the fourth sentence, by inserting ``, nurse 
     practitioner, clinical nurse specialist, certified nurse-
     midwife, or physician assistant'' after ``physician''.
       (2) Section 1835(a) of the Social Security Act (42 U.S.C. 
     1395n(a)), as amended by section 6405, is amended--
       (A) in paragraph (2)--
       (i) in the matter preceding subparagraph (A), by striking 
     ``or an eligible professional under section 1848(k)(3)(B)'' 
     and inserting ``, an eligible professional under section 
     1848(k)(3)(B), or a nurse practitioner or clinical nurse 
     specialist (as those terms are defined in 1861(aa)(5)) who is 
     working in collaboration with a physician enrolled under 
     section 1866(j) or such an eligible professional in 
     accordance with State law, or a certified nurse-midwife (as 
     defined in section 1861(gg)) as authorized by State law, or a 
     physician assistant (as defined in section 1861(aa)(5)) under 
     the supervision of a physician so enrolled or such an 
     eligible professional''; and
       (ii) in each of clauses (ii) and (iii) of subparagraph (A) 
     by inserting ``, a nurse practitioner, a clinical nurse 
     specialist, a certified nurse-midwife, or a physician 
     assistant (as the case may be)'' after ``physician'';
       (B) in the third sentence, by inserting ``, nurse 
     practitioner, clinical nurse specialist, certified nurse-
     midwife, or physician assistant (as the case may be)'' after 
     physician;
       (C) in the fourth sentence--
       (i) by striking ``physician certification'' and inserting 
     ``certification'';
       (ii) by inserting ``(or on January 1, 2008, in the case of 
     regulations to implement the amendments made by section 3115 
     of the Patient Protection and Affordable Care Act)'' after 
     ``1981''; and
       (iii) by striking ``a physician who'' and inserting ``a 
     physician, nurse practitioner, clinical nurse specialist, 
     certified nurse-midwife, or physician assistant who''; and
       (D) in the fifth sentence, by inserting ``, nurse 
     practitioner, clinical nurse specialist, certified nurse-
     midwife, or physician assistant'' after ``physician''.
       (3) Section 1861 of the Social Security Act (42 U.S.C. 
     1395x) is amended--
       (A) in subsection (m)--
       (i) in the matter preceding paragraph (1)--
       (I) by inserting ``a nurse practitioner or a clinical nurse 
     specialist (as those terms are defined in subsection 
     (aa)(5)), a certified nurse-midwife (as defined in section 
     1861(gg)), or a physician assistant (as defined in subsection 
     (aa)(5))'' after ``physician'' the first place it appears; 
     and
       (II) by inserting ``a nurse practitioner, a clinical nurse 
     specialist, a certified nurse-midwife, or a physician 
     assistant'' after ``physician'' the second place it appears; 
     and
       (ii) in paragraph (3), by inserting ``a nurse practitioner, 
     a clinical nurse specialist, a certified nurse-midwife, or a 
     physician assistant'' after ``physician''; and
       (B) in subsection (o)(2)--
       (i) by inserting ``, nurse practitioners or clinical nurse 
     specialists (as those terms are defined in subsection 
     (aa)(5)), certified nurse-midwives (as defined in section 
     1861(gg)), or physician assistants (as defined in subsection 
     (aa)(5))'' after ``physicians''; and
       (ii) by inserting ``, nurse practitioner, clinical nurse 
     specialist, certified nurse-midwife, physician assistant,'' 
     after ``physician''.
       (4) Section 1895 of the Social Security Act (42 U.S.C. 
     1395fff) is amended--
       (A) in subsection (c)(1), by inserting ``, the nurse 
     practitioner or clinical nurse specialist (as those terms are 
     defined in section 1861(aa)(5)), the certified nurse-midwife 
     (as defined in section 1861(gg)), or the physician assistant 
     (as defined in section 1861(aa)(5)),'' after ``physician''; 
     and
       (B) in subsection (e)--
       (i) in paragraph (1)(A), by inserting ``, a nurse 
     practitioner or clinical nurse specialist (as those terms are 
     defined in section 1861(aa)(5)), a certified nurse-midwife 
     (as defined in section 1861(gg)), or a physician assistant 
     (as defined in section 1861(aa)(5))'' after ``physician''; 
     and
       (ii) in paragraph (2)--
       (I) in the heading, by striking ``Physician certification'' 
     and inserting ``Rule of construction regarding requirement 
     for certification''; and
       (II) by striking ``physician''.
       (c) Requirement of Face-to-Face Encounter.--
       (1) Part a.--Section 1814(a)(2)(C) of the Social Security 
     Act, as amended by subsection (b) and section 6407(a), is 
     further amended by striking ``, and, in the case of a 
     certification made by a physician'' and all that follows 
     through ``face-to-face encounter'' and inserting ``, and, in 
     the case of a certification made by a physician after January 
     1, 2010, or by a nurse practitioner, clinical nurse 
     specialist, certified nurse-midwife, or physician assistant 
     (as the case may be), prior to making such certification the 
     physician, nurse practitioner, clinical nurse specialist, 
     certified nurse-midwife, or physician assistant must document 
     that the physician, nurse practitioner, clinical nurse 
     specialist, certified nurse-midwife, or physician assistant 
     himself or herself has had a face-to-face encounter''.
       (2) Part b.--Section 1835(a)(2)(A)(iv) of the Social 
     Security Act, as added by section 6407(a), is amended by 
     striking ``after January 1, 2010'' and all that follows 
     through ``face-to-face encounter'' and inserting ``made by a 
     physician after January 1, 2010, or by a nurse practitioner, 
     clinical nurse specialist, certified nurse-midwife, or 
     physician assistant (as the case may be), prior to making 
     such certification the physician, nurse practitioner, 
     clinical nurse specialist, certified nurse-midwife, or 
     physician assistant must document that the physician, nurse 
     practitioner, clinical nurse specialist, certified nurse-
     midwife, or physician assistant has had a face-to-face 
     encounter''.
       (d) Effective Date.--The amendments made by this section 
     shall apply to items and services furnished on or after 
     January 1, 2010.
                                 ______
                                 
  SA 3109. Mr. AKAKA 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 974, between lines 9 and 10, insert the following:

     SEC. 3316. PHARMACY ACCESS FOR CHRONIC CARE TARGETED 
                   INDIVIDUALS.

       (a) Purpose.--The purpose of this section is to provide for 
     the establishment of chronic care pharmacy programs under the 
     Medicare prescription drug program under part D of title 
     XVIII of the Social Security Act that utilize available 
     technologies and efficiencies to improve the safety, 
     convenience, and affordability of prescription drug coverage 
     under such part with respect to long-term maintenance 
     medication refills for enrollees with a chronic disease or 
     condition.
       (b) Establishment and Implementation of Program.--Section 
     1860D-4 of the Social Security Act (42 U.S.C. 1395w-104) is 
     amended by adding at the end the following new subsection:
       ``(m) Pharmacy Access for Targeted Beneficiaries.--
       ``(1) In general.--
       ``(A) Establishment and implementation of program.--The PDP 
     sponsor of a prescription drug plan shall--
       ``(i) identify (not less frequently than on a quarterly 
     basis) targeted beneficiaries who are enrolled in the 
     prescription drug plan; and
       ``(ii) establish and maintain a chronic care pharmacy 
     program that meets the requirements of this subsection.
       ``(B) Definitions.--In this subsection:
       ``(i) Chronic care pharmacy program.--The term `chronic 
     care pharmacy program' means the program established and 
     maintained by a PDP sponsor under subparagraph (A)(ii).
       ``(ii) Targeted beneficiary.--The term `targeted 
     beneficiary' means a part D eligible individual who is 
     identified by the PDP sponsor as taking at least 1 long-term 
     maintenance medication.
       ``(iii) Long-term maintenance medication.--The term `long-
     term maintenance medication' means a covered part D drug 
     that--

       ``(I) has a common indication (obtained from product 
     labeling) for the treatment of a chronic disease or 
     condition; and
       ``(II) is used for the treatment of a chronic disease or 
     condition when the duration of continuous therapy can 
     reasonably be expected to exceed 1 year.

       ``(2) Enrollment.--
       ``(A) Automatic enrollment.--The PDP sponsor shall 
     automatically enroll targeted beneficiaries identified under 
     paragraph (1)(A)(i) in a chronic care pharmacy program.
       ``(B) Written notice and process to opt out of program.--
       ``(i) Written notice.--The PDP sponsor shall provide 
     written notice to targeted beneficiaries automatically 
     enrolled in the chronic care pharmacy program under 
     subparagraph (A).
       ``(ii) Process to decline enrollment and opt out of 
     program.--The written notice provided under clause (i) shall 
     include procedures under which the targeted beneficiary may 
     decline such automatic enrollment and opt-out of the chronic 
     care pharmacy program.
       ``(3) Chronic care pharmacy program requirements.--The PDP 
     sponsor shall establish and maintain procedures to ensure 
     that each of the following requirements is met by a chronic 
     care pharmacy program:
       ``(A) A targeted beneficiary is (not less frequently than 
     on an annual basis) provided a claims-based comprehensive 
     written summary of the targeted beneficiary's drug therapy 
     that includes an analysis of--
       ``(i) poly-pharmacy and other safety issues, including the 
     identification of duplicative or excessive drug therapy in 
     order to reduce

[[Page S12831]]

     harmful adverse drug reactions and unnecessary 
     hospitalizations; and
       ``(ii) clinically appropriate alternative formulary 
     treatment options and lower cost alternatives, if any, for 
     consideration by the treating physician of the targeted 
     beneficiary.
       ``(B) Any chronic care pharmacy under the program is 
     accredited by a private accrediting organization as meeting 
     standards appropriate for pharmacies that dispense long-term 
     maintenance medications, including a process for quality and 
     safety improvement.
       ``(C) The program makes available, 24 hours a day, 7 days a 
     week, to a targeted beneficiary confidential pharmacist 
     counseling, based on the targeted beneficiary's drug therapy.
       ``(D) The program delivers to the address specified by the 
     targeted beneficiary an extended supply (such as 90-days) of 
     long-term maintenance medications where permitted by law and 
     when indicated to be clinically appropriate.
       ``(E) The program provides, after filling a prescription 
     for a targeted beneficiary for 2 consecutive months, only an 
     extended supply of a long-term maintenance medication, except 
     that a 1-time 30-day supply of such a medication may be 
     provided to the targeted beneficiary at a retail pharmacy in 
     order to transition a targeted beneficiary into the program.
       ``(4) Access to covered part d drugs.--The requirements of 
     subsection (b)(1) shall apply to a chronic care pharmacy 
     program, except that the requirements of subparagraphs (A) 
     and (D) of such subsection shall apply only in the case of an 
     individual who opts out of the chronic care pharmacy program 
     under paragraph (2)(A)(ii).
       ``(5) Facilitating affordable payment arrangements.--With 
     respect to an extended supply of part D covered drugs for a 
     targeted beneficiary under the chronic care pharmacy program, 
     the PDP sponsor shall offer to the targeted beneficiary an 
     option to arrange for the payment of any required cost-
     sharing by a targeted beneficiary on an alternative basis 
     (including more affordable payments in installments) over the 
     period of the extended supply.
       ``(6) Continuity of election.--In the case where a targeted 
     beneficiary changes enrollment to a different prescription 
     drug plan (including a prescription drug plan offered by a 
     different sponsor)--
       ``(A) the PDP sponsor of the plan from which the targeted 
     beneficiary disenrolls shall notify the Secretary (as part of 
     the disenrollment process)--
       ``(i) that the individual is a targeted beneficiary to whom 
     the requirements of this subsection apply; and
       ``(ii) whether the targeted beneficiary elected to opt out 
     of the chronic care pharmacy program under paragraph 
     (2)(A)(ii); and
       ``(B) the Secretary shall ensure that, in the case where 
     the targeted beneficiary has not elected to opt out as 
     described in subparagraph (A)(ii), the continuation of the 
     enrollment of the targeted beneficiary in the chronic care 
     pharmacy program of the PDP sponsor offering the prescription 
     drug plan in which the targeted beneficiary has enrolled.
       ``(7) Providing information to beneficiaries.--The 
     Secretary shall include information regarding chronic care 
     pharmacy programs in the activities required under section 
     1860D-1(c) (relating to the provision of information to 
     beneficiaries with respect to informed choice, and other 
     information), including any consumer satisfaction surveys 
     under subsection (d).
       ``(8) Exception for long-term care facilities.--This 
     subsection shall not apply to a long-term care facility or a 
     pharmacy located in, or having a contract with, a long-term 
     care facility.''.
       (c) Effective Date.--The amendment made by this section 
     shall apply for contract years beginning with 2011.
                                 ______
                                 
  SA 3110. 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:

       On page 974, between lines 9 and 10, insert the following:

     SEC. 3316. PERFORMANCE BASED PHARMACY REIMBURSEMENT PROGRAM.

       (a) In General.--Section 1860D-4 of the Social Security Act 
     (42 U.S.C. 1395w-104) is amended by adding at the end the 
     following new subsection:
       ``(m) Performance Based Pharmacy Reimbursement Program.--
       ``(1) In general.--The PDP sponsor shall have in place a 
     program that identifies omission gaps and adherence gaps (as 
     defined in paragraph (2)) for specified beneficiaries (as 
     described in paragraph (3)) and makes payments to 
     participating pharmacies (as described in paragraph (4)) that 
     close such gaps through clinical counseling.
       ``(2) Omission and adherence gaps defined.--In this 
     subsection:
       ``(A) Omission gaps.--The term `omission gaps' refers to 
     cases when the patient is not receiving a medication that 
     evidenced-based protocols or clinical practice standards 
     indicate is a best practice for treatment of their disease.
       ``(B) Adherence gaps.--The term `adherence gaps' refers to 
     cases when a patient is not taking their medication the way 
     it was prescribed, including failure to fill, failure to 
     renew, stopping or not starting medications, or not taking a 
     medication the way it was intended.
       ``(3) Specified beneficiaries described.--Beneficiaries 
     described in this paragraph are part D eligible individuals 
     taking medications for one of the following conditions:
       ``(A) Diabetes.
       ``(B) Cardiovascular disease.
       ``(C) Pulmonary disease.
       ``(4) Participating pharmacies.--The PDP sponsor shall 
     contract with any pharmacy that is willing to participate in 
     such program and meet the standard terms and conditions of 
     the PDP sponsor. To the extent practicable, the PDP sponsor 
     shall use a specified beneficiary's primary pharmacy to close 
     gaps in care. If such pharmacy does not participate in such 
     program or is unable to close a gap in care, the PDP sponsor 
     may use other participating pharmacies. The primary pharmacy 
     selected by the PDP sponsor shall advise the specified 
     beneficiary of his or her right to select another 
     participating pharmacy.
       ``(5) Gaps in medication adherence.--The Secretary shall 
     require PDP sponsors to follow uniform standards in 
     identifying gaps in medication adherence. The Secretary shall 
     develop such standards based on current treatment protocols 
     for the conditions described in paragraph (2).
       ``(6) Payments to pdp sponsors.--
       ``(A) In general.--The Secretary shall pay each PDP sponsor 
     a per member monthly amount to administer such program. Such 
     payments shall be for operational and administrative 
     activities only and shall not include the cost of any covered 
     part D drug. The per member monthly payment to a PDP sponsor 
     may not exceed an amount that equals $0.85 in 2012, increased 
     in subsequent years by the annual percentage increase in the 
     consumer price index (all items; U.S. city average) as of 
     September of the previous year.
       ``(B) Special rule.--The Secretary shall ensure that PDP 
     sponsors use greater than 50 percent of the aggregate amount 
     paid to the PDP sponsor under subparagraph (A) to compensate 
     pharmacies for counseling activities under such program.
       ``(C) Not in bids.--PDP sponsors shall not include the 
     payments described in subparagraph (A) in the bids submitted 
     by the PDP sponsor under section 1860D-11.
       ``(D) Source.--The payment described in subparagraph (A) 
     shall be made from the Federal Hospital Insurance Trust Fund 
     under section 1817 and the Federal Supplementary Medical 
     Insurance Trust Fund under section 1841, in such proportion 
     as the Secretary determines appropriate.
       ``(7) Payments to participating pharmacies from pdp 
     sponsors.--Under such program, PDP sponsors shall negotiate 
     payment structures with pharmacies, and pharmacists shall 
     receive remuneration based on success in closings gaps in 
     care. Payments under paragraph (6)(A) shall be made when it 
     is determined that the adherence and omission gaps have been 
     closed, or when billable activity by the pharmacy occurs, by 
     contract.
       ``(8) Bonuses and penalties for pdp sponsors based on 
     estimated changes in medical costs.--
       ``(A) Projected costs.--Beginning in 2012, the Secretary 
     shall, on an annual basis, project the anticipated costs for 
     individuals enrolled in the program under parts A and B for 
     the current year and the succeeding 2 years, based on risk-
     adjusted historical costs under such parts.
       ``(B) Comparison.--
       ``(i) In general.--At the end of each 3-year period 
     described in subparagraph (A), for each PDP sponsor under the 
     program, the Secretary shall compare the actual spending for 
     such individuals to the costs projected under subparagraph 
     (A).
       ``(ii) Incentive payment.--For each year during the 3-year 
     period described in clause (i), to the extent the actual 
     costs are lower than the costs projected under subparagraph 
     (A), the Secretary will pay to the PDP sponsor an incentive 
     based on a graduated scale, under which the PDP sponsor 
     receives an incremental 10 percent of the per member monthly 
     amount paid to the PDP sponsor under paragraph (6) for every 
     10 percent of savings above the projection, not to exceed 50 
     percent of the aggregate amounts paid to the PDP sponsor 
     under such paragraph for the initial year of the 3-year 
     period.
       ``(iii) Penalties.--For each year during the 3-year period 
     described in clause (i), to the extent the actual costs are 
     higher than the costs projected under subparagraph (A), the 
     PDP sponsor shall make a payment to the Secretary in an 
     amount based on a graduated scale, under which the PDP 
     sponsor pays to the Secretary 10 percent of the per member 
     monthly amount paid to the PDP sponsor under paragraph (6) 
     for every 10 percent of costs above the projection, not to 
     exceed 50 percent of the aggregate amounts paid to the PDP 
     sponsor under such paragraph for the initial year of the 3-
     year period.
       ``(C) Guidance on methodology used.--The Secretary shall 
     issue guidance on the methodology that the Secretary uses to 
     project costs as described in subparagraph (A), measure 
     actual costs for purposes of the comparison under 
     subparagraph (B), and calculate

[[Page S12832]]

     incentive payment and penalties under clauses (ii) and (iii), 
     respectively, of such subparagraph.
       ``(D) Pharmacies not liable for fees.--A participating 
     pharmacy shall not be required to pay any penalties under 
     subparagraph (B)(iii).
       ``(E) Reconciliation.--Any financial reconciliation under 
     the program under this subsection shall be incorporated into 
     the annual reconciliation process under this part.
       ``(9) Limitation.--The requirements of this subsection 
     shall not apply to an MA-PD plan.
       ``(10) Construction.--The provisions of this subsection 
     shall not modify or relieve PDP sponsors of their 
     responsibilities under subsection (c)(2).''.
       (b) Effective Date.--The amendment made by this section 
     shall take effect on January 1, 2012.
                                 ______
                                 
  SA 3111. Mr. SESSIONS 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 245, beginning with line 15, strike all through 
     page 246, line 7.
       On page 254, strike lines 11 through 20.
       On page 260, strike lines 14 through 17.
       On page 267, strike lines 17 through 25.
       On page 268, between lines 13 and 14, insert the following:
       (3) Subsidies treated as public benefit.--Notwithstanding 
     any other provision of this Act or any other provision of 
     law, for purposes of section 403 of the Personal 
     Responsibility and Work Opportunity Reconciliation Act of 
     1996 (8 U.S.C. 1613), the following shall be considered a 
     Federal means-tested public benefit:
       (A) The ability of an individual to purchase a qualified 
     health plan offered through an Exchange.
       (B) The premium tax credit established under section 1401 
     of this Act (and any advance payment thereof).
       (C) The cost sharing reductions established under this 
     section (and any advance payment thereof).
       On page 269, strike lines 7 through 9, and insert the 
     following:
       (a) Verification Process.--The Secretary shall ensure that 
     eligibility determinations required by this Act are conducted 
     in accordance with the following requirements, including 
     requirements for determining:
       On page 269, line 18, insert ``eligible'' before ``alien''.
       On page 270, line 16, strike ``provide'' and insert 
     ``appear in person to provide the Exchange with the 
     following''.
       On page 270, between lines 20 and 21, insert the following:
       (B) A sworn statement, under penalty of perjury, 
     specifically attesting to the fact that each enrollee is 
     either a citizen or national of the United States or an 
     eligible lawful permanent resident meeting the requirements 
     of section 1402(f)(3) of this Act and identifying the 
     applicable eligibility status for each enrollee; and
       On page 270, line 21, insert ``and documentation'' after 
     ``information''.
       On page 271, strike lines 4 through 15, and insert the 
     following:
       (A) In the case of an enrollee whose eligibility is based 
     on attestation of citizenship of the enrollee, the enrollee 
     shall provide satisfactory evidence of citizenship or 
     nationality (within the meaning of section 1903(x) of the 
     Social Security Act (42 U.S.C. 1396b)).
       (B) In the case of an individual whose eligibility is based 
     on attestation of the enrollee's immigration status--
       (i) such information as is necessary for the individual to 
     demonstrate they are in ``satisfactory immigration status'' 
     as defined and in accordance with the Systematic Alien 
     Verification for Entitlements (SAVE) program established by 
     section 1137 of the Social Security Act (42 U.S.C. 1320b-7), 
     and
       (ii) any other additional identifying information as the 
     Secretary, in consultation with the Secretary of Homeland 
     Security, may require in order for the enrollee to 
     demonstrate satisfactory immigration status.
       On page 274, beginning with line 12, strike all through 
     page 276, line 17, and insert the following:
       (c) Verification of Eligibility Through Documentation.--
       (1) In general.--Each Exchange shall conduct eligibility 
     verification, using the information provided by an applicant 
     under subsection (b), in accordance with this subsection.
       (2) Verification of citizenship or immigration status.--
       (A) Verification of attestation of citizenship.--Each 
     Exchange shall verify the eligibility of each enrollee who 
     attests that they are a citizen or national of the United 
     States, as required by subsection (b)(1)(A) of this section, 
     in accordance with the provisions of section 1903(x) of the 
     Social Security Act.
       (B) Verification of attestation of eligible immigration 
     status.--Each Exchange shall verify the eligibility of each 
     enrollee who attests that they are eligible to participate in 
     the exchange by virtue of having been a lawful permanent 
     resident for not less than 5 years, as required by subsection 
     (b)(l)(B) of this section, in accordance with the provisions 
     of section 1137 of the Social Security Act.
       On page 277, beginning with line 19, strike all through 
     page 278, line 16.
       On page 280, strike lines 8 and 9 and insert ``in 
     accordance with the secondary verification process 
     established consistent with section 1137 of the Social 
     Security Act (as is in effect as of January 1, 2009).''
                                 ______
                                 
  SA 3112. Ms. CANTWELL (for herself, Ms. Snowe, Ms. Landrieu, 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:

       On page 354, between lines 18 and 19, insert the following:
       (B) Certain employees treated as full-time.--Solely for 
     purposes of applying subsections (a) and (c), an employee not 
     otherwise treated as a full-time employee under subparagraph 
     (A) shall be treated as a full-time employee if the employee 
     is employed at least 390 hours of service per calendar 
     quarter.
                                 ______
                                 
  SA 3113. Mr. SPECTER 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 869, between lines 14 and 15, insert the following:

     SEC. 3143. REVISION TO PAYMENT FOR CONSULTATION CODES.

       (a) Temporary Delay of Elimination of Payment for 
     Consultation Codes.--Notwithstanding any other provision of 
     law, the Secretary of Health and Human Services shall not, 
     prior to January 1, 2011, implement a final rule relating 
     payment policies under the physician fee schedule and part B 
     of title XVIII of the Social Security Act that contains a 
     provision that eliminates or discontinues payment for 
     consultation codes.
       (b) Evaluation Period.--During the period prior to January 
     1, 2011, the Secretary of Health and Human Services shall 
     consult with the Current Procedural Terminology Editorial 
     Panel of the American Medical Association for the purpose of 
     developing proposals to--
       (1) modify existing consultation codes or establish new 
     consultation codes to more accurately reflect the value 
     provided through such consultation services; and
       (2) minimize coding errors.
                                 ______
                                 
  SA 3114. Mr. GRASSLEY (for himself, Mr. Coburn, Mr. Brownback, Mr.  
Chambliss, Mr. Isakson, Ms. Murkowski, Mr. Bunning, Mr. Bennett, Mr. 
LeMieux, Mr. Barrasso, and Mr. Enzi) 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 30, between lines 2 and 3, insert the following:
       ``(c) Protection of Second Amendment Rights.--
       ``(1) Finding.--Congress finds that the second amendment to 
     the Constitution of the United States protects a fundamental 
     right for individuals, including those who are not members of 
     a militia or engaged in military service or training, to keep 
     and bear arms.
       ``(2) Wellness and prevention programs.--A wellness and 
     health promotion activity implemented under subsection 
     (a)(1)(D) may not require the disclosure or collection of any 
     information relating to--
       ``(A) the presence or storage of a lawfully-possessed 
     firearm or ammunition in the residence or on the property of 
     an individual; or
       ``(B) the lawful use, possession, or storage of a firearm 
     or ammunition by an individual.
       ``(3) Limitation on data collection.--None of the 
     authorities provided to the Secretary under the Patient 
     Protection and Affordable Care Act or an amendment made by 
     that Act shall be construed to authorize or may be used for 
     the collection of any information relating to--
       ``(A) the lawful ownership or possession of a firearm or 
     ammunition;
       ``(B) the lawful use of a firearm or ammunition; or
       ``(C) the lawful storage of a firearm or ammunition.

[[Page S12833]]

       ``(4) Limitation on databases or data banks.--None of the 
     authorities provided to the Secretary under the Patient 
     Protection and Affordable Care Act or an amendment made by 
     that Act shall be construed to authorize or may be used to 
     maintain records of individual ownership or possession of a 
     firearm or ammunition.
       ``(5) Limitation on determination of premium rates or 
     eligibility for health insurance.--A premium rate may not be 
     increased, health insurance coverage may not be denied, and a 
     discount, rebate, or reward offered for participation in a 
     wellness program may not be reduced or withheld under any 
     health benefit plan issued pursuant to or in accordance with 
     the Patient Protection and Affordable Care Act or an 
     amendment made by that Act on the basis of, or on reliance 
     upon--
       ``(A) the lawful ownership or possession of a firearm or 
     ammunition; or
       ``(B) the lawful use or storage of a firearm or ammunition.
       ``(6) Limitation on data collection requirements for 
     individuals.--No individual shall be required to disclose any 
     information under any data collection activity authorized 
     under the Patient Protection and Affordable Care Act or an 
     amendment made by that Act relating to--
       ``(A) the lawful ownership or possession of a firearm or 
     ammunition; or
       ``(B) the lawful use, possession, or storage of a firearm 
     or ammunition.

                          ____________________