[Congressional Record (Bound Edition), Volume 154 (2008), Part 9]
[Senate]
[Pages 12157-12161]
[From the U.S. Government Publishing Office, www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. ENZI:
  S. 3112. A bill to reauthorize the Javits-Wagner-O'Day Act and the 
Randolph-Sheppard Act, and for other purposes; to the Committee on 
Health, Education, Labor, and Pensions.
  Mr. ENZI. Mr. President, I rise today to introduce the Javits-Wagner-
O'Day and Randolph-Sheppard Modernization Act of 2008. This legislation 
was drafted after thousands of hours were spent listening to the 
concerns of persons with disabilities and other affected parties.
  The Randolph-Sheppard Act, enacted in 1936, gives persons who are 
legally blind training, support and contracting priority to fulfill 
certain Government food service contracts.
  The Wagner-O'Day Act, enacted in 1938, required the Federal 
Government

[[Page 12158]]

to make certain commodities purchases from organizations, 75 percent of 
whose direct laborers were blind. In 1971, Senator Jacob Javits fought 
to include individuals with other severe disabilities in the law. The 
amended law--the Javits-Wagner-O'Day Act--now requires the Federal 
Government to purchase over 11,000 commodities from organizations, 75 
percent of whose workers have a severe disability.
  Javits-Wagner-O'Day and Randolph-Sheppard are the two main Federal 
employment and training programs for persons with significant 
disabilities. Congress has paid them little attention, and has not 
revised them, since their creation.
  Beginning in 2003, Randolph-Sheppard and JWOD stakeholders approached 
Congress to seek our attention and help. Each group complained the 
other was getting too big a share of lucrative military dining 
contracts.
  In 2003 and 2004, the offices of Senators Gregg, Kennedy, Ensign and 
Dodd tried to informally mediate. Neither the blind vendors nor the 
JWOD vendors would budge. The dispute intensified in the courts and in 
Congress, with each side accusing the other of waste, fraud and abuse.
  When I assumed the chairmanship of the HELP Committee in 2005, I 
decided to honor the stakeholders' longstanding request, and 
investigate their claims. My staff's initial findings were troubling, 
so I worked with my good friend Senator Kennedy to hold a bipartisan 
oversight hearing.
  Our hearing, in October 2005, documented several troubling facts. 
First and foremost, we discovered that the programs had produced bad 
quantitative results for persons with disabilities. There are about 15 
million unemployed persons with disabilities between the ages of 16 and 
64. Javits-Wagner-O'Day and Randolph-Sheppard together had created only 
about 48,000 jobs. Clearly we can--and must--do much better.
  Second, the programs had stayed the same while the law, technology, 
commercial customs and social norms had changed dramatically over the 
past decades. Since JWOD was enacted, Congress, through the Americans 
with Disabilities Act, ADA, Individuals with Disabilities Education 
Act, IDEA and Rehabilitation Act reauthorizations of 1992 and 1998, had 
mandated equal access, inclusion, choice, anti-discrimination and 
control by individuals with disabilities over their own lives. The 
Supreme Court in its Olmstead decision held that the unnecessary 
segregation of individuals with disabilities was an impermissible form 
of discrimination. Corporate good citizens such as Marriott had taken a 
leadership role in the community to employ persons with severe 
disabilities in integrated work settings. New technologies made it 
possible for persons who were legally blind to use the Internet. These 
and countless other examples highlight how Randolph-Sheppard and JWOD 
had become ancient statutes. The world had changed dramatically since 
1971. Persons with disabilities needed and deserved better treatment 
than the law was providing.
  Third, regulatory neglect had given rise to waste, fraud and abuse. 
The Randolph-Sheppard program was supposed to create good jobs and 
increased opportunities for the many persons who are blind. Instead, we 
found that 38 blind vendors were taking the lion's share of profits 
from huge military cafeteria contracts with an approximate total dollar 
value of $1.203 billion. Just as troublesome was the fact that less 
than 5 percent of the employees hired to fulfill those contracts were 
actually blind. In addition, we found nonprofit executives were using 
JWOD to exploit persons with disabilities for improper financial gain. 
The FBI and other Federal law enforcement officials raided a Texas JWOD 
nonprofit and discovered some shocking abuses that underscored the need 
for Congress to act.
  In 2006, I worked with Senators Kennedy, Ensign, Dodd, Burr, Clinton, 
Isakson, Reed, Hatch, Harkin, Roberts, Mikulski, Coburn, Bingaman, 
Collins, and Obama to develop solutions to these problems. The HELP 
Committee staff spent thousands of hours meeting with hundreds of 
stakeholders, and listening to their ideas about how to fix these 
programs. Then we drafted this legislation.
  In 2007, the momentum we had set in motion for a reauthorization bill 
stalled and other priorities began to take precedence. I continued to 
talk to and work with all of the stakeholders we could find, including 
those representing small business.
  Recent events put these issues back on the front burner where they 
belong. On April 15, the Department of Defense and Department of 
Education Inspectors General collaborated on a report, ``Assessment of 
Contracting With Blind Vendors and Employers of Persons Who Are Blind 
or Have Other Severe Disabilities.'' In addition, the Committee for 
Purchase From People Who Are Blind or Severely Disabled--the principal 
regulator of the JWOD program--proposed modest tweaks to its 
authorizing statute. I sincerely applaud the Committee for their hard 
work in coming up with consensus fixes, but its proposal does not go 
nearly far enough.
  As an alternative, I have updated the bill that the bipartisan HELP 
Committee produced in collaboration with stakeholder groups in 2006. It 
fulfills the promise I made to the disability community to try to solve 
the problems we found. The bill vitalizes and expands both programs. It 
creates much more flexibility to provide real job training and real 
skill development so persons with disabilities can develop marketable 
skills and make meaningful career choices. The bill also empowers a 
strong regulator to police both programs and make sure workers are no 
longer exploited.
  Finally, I have tried to stay out of the military dining facility 
debate for years. But it has become a significant distraction to our 
military. Accordingly, this bill establishes an even playing field in a 
way that will be clear and easy for the military to administer and 
participants in the process to understand.
  Our main goal here is to create more and better jobs for persons with 
disabilities. My bill moves us in the direction Congress should take to 
modify these two important programs. I look forward to continued 
discussions with my colleagues and the stakeholders on all these 
issues.
                                 ______
                                 
      By Mr. GRASSLEY (for himself, Mr. McConnell, Mr. Kyl, Mr. Hatch, 
        Mr. Sununu, Mr. Bunning, Mr. Crapo, Mr. Burr, Mr. Ensign, and 
        Mr. Enzi):
  S. 3118. A bill to amend titles XVIII and XIX of the Social Security 
Act to preserve beneficiary access to care by preventing a reduction in 
the Medicare physician fee schedule, to improve the quality of care by 
advancing value based purchasing, electronic health records, and 
electronic prescribing, and to maintain and improve access to care in 
rural areas, and for other purposes; read the first time.
  Mr. GRASSLEY. Mr. President, I am pleased to introduce today the 
Preserving Access to Medicare Act of 2008.
  If we do not act very quickly, the physicians who treat Medicare 
patients will face a 10.6 percent pay cut, effective July 1.
  It is not in the best interest of America's seniors who depend on 
Medicare for their doctors to take such a significant cut.
  Such a dramatic cut will affect access that seniors have to their 
doctors.
  The bill we are introducing today provides a 0.5 percent physician 
update for the remainder of 2008 and a 1.1 percent update for 2009.
  This increase is identical to the one the majority is looking to 
proceed to tomorrow.
  Preserving access to health care for Medicare beneficiaries is a 
first priority, but it is not the only thing we are accomplishing in 
this bill.
  The bill will also improve the quality of care in Medicare. It 
increases the physician quality reporting bonus from 1.5 percent to 2 
percent for 2009 and 2010.
  The bill retains the Physician Assistance and Quality Improvement 
(PAQI) fund to specifically help avert future physician cuts.
  It promotes value-based purchasing, e-prescribing, and electronic 
health records.

[[Page 12159]]

  It includes a responsible rural package, including a rural home 
health add-on payment.
  It returns the ownership of oxygen equipment to the supplier, not the 
beneficiary.
  The bill extends section 1011 of the Medicare Modernization Act for 
two years at a total of $400 million.
  It phases out the duplicative Indirect Medical Education payments 
from Medicare Advantage.
  The bill makes reforms to Medicare Advantage marketing practices to 
curb abusive activities. It requires all MA plans to report on quality.
  I also want to devote a moment to what the bill we are introducing 
today does not do.
  Unlike the bill the majority wants to proceed to tomorrow, the bill 
we are introducing today does not make cuts to payments for power 
wheelchairs.
  Unlike the bill the majority wants to proceed to tomorrow, the bill 
we are introducing today does not reduce payments for oxygen.
  Unlike the bill the majority wants to proceed to tomorrow, the bill 
we are introducing today does not make large, unwarranted cuts to 
Medicare Advantage, altering policy decisions designed to maximize 
patient choice.
  Unlike the bill the majority wants to proceed to tomorrow, the bill 
we are introducing today does not eliminate the PAQI fund, which 
Congress specifically created to help avert future physician cuts.
  Unlike the bill the majority wants to proceed to tomorrow, the bill 
we are introducing today does not expand eligibility for low-income 
Medicare programs, which would increase long-term entitlement spending 
and expand coverage under an already unsustainable program.
  While well intentioned, this is not the right time for entitlement 
expansions like this.
  The Medicare program is headed for a fiscal crisis that demands 
comprehensive reform.
  Many would also like to add income-relating Part D subsidies to this 
bill as well. That change would make high income seniors shoulder a 
greater share of their Part D premium just like already happens today 
with premiums under Part B of Medicare.
  These kind of changes need to be done. The other side has told us 
that they cannot support increasing premiums on high income seniors in 
order to provide greater assistance to lower income seniors.
  Many on our side are disappointed by their position.
  So it seems we will need to reserve those reforms on premiums until 
we are working on comprehensive Medicare reform in some future bill.
  Finally, let me turn to the most critical difference between the bill 
we are introducing today and the bill the majority wants to proceed to 
tomorrow.
  The bill we are introducing today can be signed into law. The 
President will sign our bill.
  The bill the majority wants to proceed to tomorrow--if it somehow 
were to make it to the President's desk--will be vetoed.
  Republicans were not the ones that walked away from the negotiations 
and put a timely outcome of this effort in jeopardy.
  I am ready to sit down on a bipartisan basis to find a compromise 
that protects seniors' access to Medicare and that can be signed into 
law.
  Today we are introducing a bill that accomplishes that.
  Tomorrow we are voting to proceed to a bill that does not.
  I hope we can move beyond this political exercise soon to accomplish 
what seniors are counting on us to do.
  Mr. President, I ask unanimous consent that a bill summary be printed 
in the Record.
  There being no objection, the material was ordered to be placed in 
the Record, as follows:

               Preserving Access to Medicare Act of 2008

                     TITLE I--MEDICARE IMPROVEMENTS

Subtitle A--Craig Thomas Rural Hospital and Provider Equity Act of 2008


  Sec. 101. Temporary Improvements to the Medicare Inpatient Hospital 
              Payment Adjustment for Low-volume Hospitals

       In FY2009 hospitals that are located more than 15 road 
     miles from another comparable hospital and have 2,000 
     discharges of individuals entitled to or enrolled for 
     Medicare Part A benefits would receive a low-volume payment 
     adjustment for Medicare inpatient hospital services. The 
     Secretary would determine the applicable percentage increase 
     using a linear sliding scale ranging from 25 percent for low-
     volume hospitals below a certain threshold to no adjustment 
     for hospitals with greater than 2,000 discharges of 
     individuals with Medicare Part A benefits.


   Section 102. Improvement to the Medicare Dependent Hospital (MDH) 
                                Program

       For discharges in FY 2009, MDH payments would not be 
     adjusted for area wages unless it would result in improved 
     payments.


                    Section 103. Ambulance Services

       Provides for an add-on payment for ground ambulance 
     services of 3 percent in rural areas and 2 percent in urban 
     areas for the period July 1, 2008-December 31, 2009. Provides 
     an 18 month hold harmless for air ambulance areas previously 
     designated as rural and clarifies the medically necessary 
     requirement for air ambulance services.


    Section 104. Extension and Improvement of Medicare FLEX Program

       The provision would extend the Medicare Rural Hospital 
     Flexibility Grant Program through FY2010, increases 
     authorization for appropriations and provides for grants for 
     quality improvement and performance measurement activities.


       Section 105. Rebasing for Sole Community Hospitals (SCHs)

       Starting for discharges on January 1, 2009, SCHs would be 
     able to elect payment based on their FY2006 hospital-specific 
     payment amount per discharge.


     Section 106. Extension and Expansion of the Medicare Hospital 
Outpatient Department Hold Harmless Provision for Small Rural Hospitals

       The provision would establish that in CY 2009, small rural 
     hospitals, including Medicare Dependent Hospitals and Sole 
     Community Hospitals under 100 beds, would receive 85 percent 
     of the difference between payments made under the Medicare 
     Hospital Outpatient Prospective Payment System and those made 
     under the prior reimbursement system.


  Section 107. Clarification of Payment for Clinical Laboratory Tests 
             Furnished by Critical Access Hospitals (CAHs)

       Under this provision, clinical diagnostic laboratory 
     services furnished by a CAH starting in July 1, 2009 would be 
     reimbursed at 101 percent of costs as outpatient hospital 
     services without regard to whether the specimen was collected 
     from a patient of the CAH so long as the individual from whom 
     the specimen was collected was in the same county as the CAH.


              Section 108. Extension of Floor on Work GPCI

       Extends for eighteen months the work geographic index 
     (GPCI) floor of 1.0 through December 31, 2009.


  Section 109. Extension of Treatment of Certain Physician Pathology 
                                Services

       Extends for eighteen months the provision that allows 
     independent laboratories to continue to bill Medicare 
     directly for the technical component of certain physician 
     pathology services provided to hospitals as authorized by the 
     Balanced Budget Act of 1997 through December 31, 2009.


     Section 110. Adding Hospital-Based Renal Dialysis Centers as 
               Originating Sites for Telehealth Services

       The provision would permit a hospital-based or critical 
     access hospital-based renal dialysis center (including 
     satellites) to be an originating site for the provision of 
     telehealth services as of January 1, 2009.


Section 111. Adding Skilled Nursing Facilities as Originating Sites for 
                          Telehealth Services

       The provision would permit otherwise qualifying skilled 
     nursing facilities to be an originating site for the 
     provision of telehealth services as of January 1, 2009.


     Section 112. Applying Rural Home Health Add-on Policy for 2009

       Reinstates the five percent home health add-on payment for 
     rural home health agencies in 2009.

                Subtitle B--Other Provisions Related to
                                 Part A


 Section 121. Extension of Reclassification of Certain Hospitals Under 
                          the Medicare Program

       Extends until September 30, 2009, provisions that have 
     allowed certain hospitals to be eligible for wage index 
     reclassification that were otherwise unable to qualify for 
     administrative wage index reclassification.


 Section 122. Institute of Medicine Study and Report on Post-Acute Care

       Requires the Secretary would enter into a contract with the 
     Institute of Medicine (IOM) of the National Academy of 
     Sciences to conduct a study on short-term and long-term steps 
     to reform Medicare's current post-acute care payment and 
     delivery system.


   Section 123. Revocation of Unique Deeming Authority of the Joint 
                               Commission

       This provision would revoke the unique statutory authority 
     granted to the Joint

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     Commission of Healthcare Organizations (JCAHO) to accredit 
     hospitals for participation in Medicare. Hospitals, like 
     other Medicare provider entities, would be accredited by 
     national accrediting organizations approved by the Secretary. 
     The Secretary would have the authority to recognize JCAHO as 
     a national accreditation body.


          Section 124. MedPAC Study and Report on Hospice Care

       The provision would require the Medicare Payment Advisory 
     Commission (MedPAC) to submit a report to Congress on 
     payments for hospice services. The report should include 
     recommendations for potential changes in payment 
     methodologies, including revisions to the aggregate cap.


Section 125. Introducing the Principles of Value-Based Health Care into 
                          the Medicare Program

       The provision would require the Secretary to design and 
     implement a system under which a portion of Medicare provider 
     payments for hospitals would be based on the quality of 
     provider performance.

            Subtitle C--Other Provisions Relating to Part B


                 Section 131. Physician Payment Update

       Replaces the scheduled 10.1 percent cut to the Medicare 
     physician reimbursement rate with an 18-month update. 
     Continues the 0.5 percent increase through December 31, 2008 
     and provides an additional 1.1 percent update for 2009 as 
     recommended by the Medicare Payment Advisory Commission 
     (MedPAC). Revises the Physician Assistance and Quality 
     Initiative fund in 2013 and deposits excess savings to help 
     fund a physician update in subsequent years.


                          Quality Improvements

       Extends and improves the physician quality reporting system 
     through 2010 and increases PQRI incentive payments to 2.0 
     percent in 2009 and 2010. Requires Secretary to accept 
     aggregate data from group practices on PQRI measures that 
     target high-cost chronic conditions and preventive care. 
     Includes changes enacted in MMSEA to allow reporting on 
     groups of measures for certain conditions, alternative 
     reporting periods, and reporting via registries. Includes 
     audiologists as eligible professionals for PQRI. Requires the 
     Secretary to establish a confidential physician feedback 
     program regarding resource use as of 2009. Requires the 
     Secretary to develop a value-based purchasing plan for 
     physicians and other professionals and submit a report to 
     Congress.


           Section 132. Incentives for Electronic Prescribing

       Provides positive incentive payments for the use of a 
     qualified e-prescribing system by eligible professionals from 
     2009 through 2013. Requires the use of a qualified e-
     prescribing system in 2010 and reduces payment for eligible 
     physicians who fail to use e-prescribing beginning in 2011. 
     Incentive payments are based on allowed charges for all 
     covered Medicare services. Allows for significant hardship 
     exceptions, such as professionals in rural areas without 
     sufficient Internet access, and excludes those who write a 
     small number of prescriptions.


   Section 133. Increasing the Number of Sites for Electronic Health 
                         Records Demonstration

       Provides funding for a demonstration project on electronic 
     health records.


                 Section 134. Primary Care Improvements

       Establishes new Physician Scarcity Area incentive payments 
     for primary care services furnished in Physician Scarcity 
     Areas, as of January 1, 2011. Expands the Medicare Medical 
     Home Demonstration Project established in the Tax Relief and 
     Health Care Act of 2006. Authorizes the Secretary to expand 
     the duration and scope of the project if certain quality of 
     care or spending conditions are met and provides additional 
     funding. Reapplies the budget-neutrality adjustment to the 
     conversion factor rather than to work relative value units 
     with respect to the most recent 5-year review of work RVUs, 
     effective January 1, 2009.


     Section 135. Medicare Anesthesia Teaching Program Improvements

       Eliminates the 50 percent teaching rule and requires CMS to 
     provide 100 percent payment for teaching anesthesiologists. 
     Requires payment for teaching certified registered nurse 
     anesthetists to be consistent with adjustments made for 
     teaching anesthesiologists.


   Section 136. Medicare Coordinated Care Practice Research Network 
                             Demonstration

       Requires the Secretary to establish a demonstration project 
     to test best practices and innovative coordinated care 
     projects for Medicare beneficiaries with multiple chronic 
     conditions, no later than October 1, 2009. Sites include 
     organizations which were participants in the Medicare 
     Coordinated Care Demonstration project and may include other 
     organizations as determined by the Secretary.


  Section 137. Imaging Accreditation, Appropriateness, and Disclosure 
                              Requirements

       Requires that facilities and other providers who furnish 
     the technical component of advanced diagnostic imaging 
     services (MRI, CT, and nuclear medicine, including PET) be 
     accredited as of January 1, 2012. Establishes an 
     accreditation process and requires the Secretary to designate 
     accreditation organizations as of January 1, 2010.
       Establishes a two-year demonstration project to be 
     implemented by January 1, 2010 to assess the appropriate use 
     of advanced diagnostic imaging services by collecting data 
     regarding physician compliance with clinical appropriateness 
     criteria. Requires referring physician to disclose ownership 
     interest and provide beneficiary with a list of providers.


Section 138. Accommodation of Physicians Ordered to Active Duty in the 
                            Armed Services.

       Makes permanent a provision permitting physicians in the 
     armed services to engage in substitute billing arrangements 
     for longer than 60 days when they are ordered to active duty.


 Section 139. Extension of Exceptions Process for Medicare Therapy Caps

       Ensures Medicare beneficiaries access to therapy services 
     through December 31, 2009.


            Section 140. Speech-Language Pathology Services

       Allows speech-language pathologists practicing 
     independently to bill Medicare directly for their services.


  Section 141. Coverage of Items and Services Under Cardiac Pulmonary 
                        Rehabilitation Programs

       The provision would provide coverage for items and services 
     furnished under a cardiac rehabilitation program or under a 
     pulmonary rehabilitation program within the definition of 
     covered medical and other health services, as of January 1, 
     2009.


    Section 142. Repeal of Transfer of Ownership of Oxygen Equipment

       Repeals title transfer after 36 months and allows oxygen 
     suppliers to retain ownership of oxygen equipment, effective 
     January 1, 2009.


     Section 143. Extension of Payment Rule for Brachytherapy and 
                          Radiopharmaceuticals

       Extends the current ``charges to cost'' methodology which 
     provides a separate payment for brachytherapy services and 
     therapeutic radiopharmaceuticals.


                 Section 144. Clinical Laboratory Tests

       Repeals the competitive bidding demonstration program for 
     clinical laboratory services. Reduces payments for clinical 
     laboratory tests by -0.5% for 2009-2013.


 Section 145. Sense of the Senate on Delayed Implementation of DMEPOS 
                      Competitive Bidding Program

       Implementation of competitive bidding for durable medical 
     equipment, prosthetics, orthotics, and supplies should be 
     delayed by 18 months to address concerns and ensure 
     beneficiaries continued access to quality medical equipment 
     and supplies.

          Subtitle D--End Stage Renal Disease Program Reforms


     Section 151. Kidney Disease Education and Awareness Provisions

       Establishes pilot projects to increase awareness of chronic 
     kidney disease in at least three states. Provides coverage of 
     kidney disease patient education services furnished by 
     qualified providers to those requiring dialysis or a kidney 
     transplant consisting of comprehensive information on 
     managing comorbidities, preventing complications, and 
     explaining options for renal replacement therapy, including 
     home dialysis.


                 Section 152. Renal Dialysis Provisions

       Provides a 1.0 percent update to the composite rate for 
     renal dialysis services as of January 1, 2009, and another 
     1.0 percent update as of January 1, 2010. Creates a site-
     neutral composite rate for dialysis services furnished on or 
     after January 1,2009 to equalize payments for hospital 
     outpatient departments providing dialysis services and 
     freestanding dialysis facilities.
       Establishes a fully bundled payment system for renal 
     dialysis services, effective January 1, 2011, for dialysis 
     and related drugs, laboratory tests, and other items and 
     services furnished to individuals for the treatment of end 
     stage renal disease (ESRD). Establishes an annual update for 
     providers and renal dialysis facilities (of MB minus 1.0 
     percent) as of 2012. Requires case mix adjusters as well as 
     additional payments for high cost outliers and costs incurred 
     by rural, low volume providers and facilities. Allows other 
     payment adjustments the Secretary determines appropriate, 
     such as pediatric and rural add-on payments. Provides an 
     optional four year phase-in to bundling for providers and 
     facilities, trom 2011 to 2014.
       Establishes a quality incentive program for providers and 
     renal dialysis facilities, effective January 1, 2012. 
     Requires that providers of ESRD services and renal dialysis 
     facilities meet performance standards with respect to renal 
     dialysis measures endorsed by a consensus-based organization.

               Subtitle E--Provisions Relating to Part C


  Section 161. Phase-out of Indirect Medicare Education Payments from 
                  Payments to Medicare Advantage Plans

       Phases out inclusion of payments for indirect medical 
     education (IME) in Medicare Advantage payments. The IME 
     payments are phased out by reducing the Medicare Advantage 
     payment rate by .6 percent each year until the amount 
     accounted for by IME is exhausted.

[[Page 12161]]




         Section 162. Revisions to Quality Improvement Programs

       Requires Medicare Advantage private fee-for-service (PFFS) 
     plans and MSA plans to submit data for quality analysis and 
     reporting, whether the services are provided under contract 
     or not. Specifies that to the extent services are provided by 
     non-contracted providers, the data required for analysis and 
     reporting on quality is limited to administrative data and 
     beneficiary survey data.


Section 163. Revisions Relating to Specialized Medicare Advantage Plans 
                     for Special Needs Individuals

       Extends the authority of specialized plans to target 
     enrollment to certain populations through 2009. Lifts the 
     moratorium on new plans and expanded service areas for 
     special needs plans serving institutionalized populations and 
     beneficiaries who are eligible for both Medicare and Medicaid 
     (``dual-eligibles''). All special needs plans must meet 
     additional requirements; 90 percent of new enrollment for all 
     plans would have to be special needs individuals and special 
     needs plans would have to have models of care targeted to the 
     special needs populations they served. Special needs plans 
     for dual Medicare- and Medicaid-eligibles would have three 
     years to reach agreement with the states in which they 
     operated. SNPs targeting dual-eligibles would have to protect 
     enrollees from cost-sharing the state would have covered had 
     these enrollees remained in fee-for-service Medicare. Retains 
     the moratorium for special needs plans serving those with 
     severe or disabling chronic conditions.


  Section 164. Adjustment to the Medicare Advantage Stabilization Fund

       Removes $1.3 billion from the stabilization fund for 
     regional preferred provider organizations in 2013.


     Section 165. Access to Medicare Reasonable Cost Contract Plans

       Extends section 1876 authority for cost contracts through 
     December 31, 2009. Requires that there be two unaffiliated 
     Medicare Advantage plans in an area before the obligation for 
     a cost plan to withdraw is triggered; clarifies that the 
     minimum enrollment requirements for the MA plans would have 
     to be met in the overlapping service area, not the MA plans' 
     entire service area; and clarifies that a Medicare cost plan 
     offered to beneficiaries in one MSA would not be forced to 
     withdraw because of enrollment in Medicare Advantage plans in 
     an adjoining MSA.


  Section 166. MedPAC Study and Report on Medicare Advantage Payments

       Instructs MedPAC to study and report to Congress on ways to 
     reimburse Medicare Advantage plans that do not rely on 
     county-level Medicare payment area equivalents.


  Section 167. Marketing of Medicare Advantage Plans and Prescription 
                               Drug Plans

       Prohibits Medicare Advantage and prescription drug plans 
     from: paying cash for enrollment; offering gifts to potential 
     enrollees; door-to-door sales, cold-calling, or other such 
     personal contact; marketing non-health related products to 
     potential enrollees; conducting a marketing appointment 
     without an advance agreement; marketing in healthcare-
     provider offices; or any marketing activity prohibited by the 
     Secretary. In addition, MA and prescription drug plans must 
     confirm that individuals have enrolled in and understand the 
     plan. MA and prescription drug plans must use state-licensed 
     and appointed marketing representatives. MA and prescription 
     drug plans must comply with state requests for information 
     about licensed agent or brokers. Requires the Secretary to 
     issue rules governing commissions and other compensation. 
     Requires training and testing of marketing representatives. 
     Effective for marketing for plan year 2009 and on.

                      Subtitle F--Other Provisions


     Section 171. Contract with a Consensus-based Entity Regarding 
                        Performance Measurement

       Requires the Secretary to contract with a consensus-based 
     standards setting organization such as the National Quality 
     Forum for four years to develop priorities for performance 
     measurement, endorsement of measures, and maintenance of 
     measures, and provides funding from 2009 through 2012.


                    Section 172. Use of Part D Data

       Gives the Secretary authority to use Medicare Part D data 
     for improving public health and conducting congressional 
     oversight.


 Section 173. Inclusion of Medicare Providers and Suppliers in Federal 
             Payment Levy and Administrative Offset Program

       Allows Treasury Department to levy a proportion of a 
     Medicare provider's reimbursement against outstanding tax 
     debt.

                           TITLE II--MEDICAID


     Section 201. Extension of Transitional Medical Assistance and 
                     Abstinence Education Programs

       Extends the Transitional Medical Assistance program (TMA) 
     through September 30, 2009. This program helps low-income 
     individuals transition from welfare to work by maintaining 
     healthcare for their children. Extends the current 
     abstinence-only education program until September 30, 2009.


      Section 202. Extension of Qualifying Individual (QI) Program

       Provides assistance through Medicaid for low-income seniors 
     and individuals who need help meeting their Medicare 
     premiums. Extends this program through September 30, 2009 to 
     continue serving current populations.


                  Section 203. Medicaid DSH Extension

       Extends authority for disproportionate share hospital 
     funding under section 1923 of the Social Security Act for 
     Tennessee and Hawaii through December 31, 2009.


Section 204. Extension of Supplemental Security Income (SSI) Web-Based 
          Asset Demonstration Project to the Medicaid Program

       Extends the existing SSI Web-based asset demonstration 
     program to Medicaid to all 50 States.


  Section 205. Application of Medicare Payment Adjustment for Certain 
    Hospital-acquired Conditions to Payments for Inpatient Hospital 
                        Services Under Medicaid

       Requires states to develop Medicaid payment systems that 
     reduce payments for certain hospital-acquired conditions 
     consistent with the payment system used in Medicare.


      Section 206. Elimination of Duplicative Administrative Costs

       Reduces payments for Administrative costs to prevent 
     duplication of payments under Title IV (the Temporary 
     Assistance for Needy Families)


   Section 207. Clarification of Treatment of Regional Medical Center

       Clarifies that a regional medical center located on the 
     border of multiple States may receive Medicaid reimbursement 
     from any of those States.


            Section 208. Outreach and Enrollment in Medicaid

       Provides $25 million for outreach efforts to enroll 
     eligible but uninsured children into Medicaid

                        TITLE III--MISCELLANEOUS


           Section 301 Extension of TANF Supplemental Grants

       Extends the Temporary Assistance for Needy Families (TANF) 
     supplemental grants through September 30, 2009


           Section 302. Extension of Special Diabetes Program

       Extends the Special Diabetes Program through September 30, 
     2011 to fund type 1 diabetes research and type 2 treatment 
     and prevention programs for Native Americans and Alaska 
     Natives


              Section 303. Medicare Enrollment Assistance

       Provides $19 million for grants to states for state health 
     insurance assistance programs and $6 million for grants to 
     states for area agencies on aging and to Aging and Disability 
     Resource Centers. Such funds will be allocated to states 
     based on a combination of the state's low-income 
     beneficiaries and the state's rural beneficiaries. Most of 
     the grant money must be used to provide outreach to 
     beneficiaries who may be eligible for Medicare savings 
     programs or low-income subsidies.


  Section 304. Extension of Federal Reimbursement of Emergency Health 
               Services Furnished to Undocumented Aliens

       Extends Federal reimbursement of emergency health services 
     furnished to undocumented aliens under section 1011 of the 
     MMA through FY 2010 for $200 million per year.

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