[Congressional Record (Bound Edition), Volume 155 (2009), Part 22]
[Senate]
[Pages 29610-29619]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 2940. Mr. SPECTER (for himself, Mr. Merkley, Mr. Wyden, Mr. Casey, 
Ms. Stabenow, Mr. Levin, and Mr. Brown) submitted an amendment intended 
to be proposed to amendment SA 2786 proposed by Mr. Reid (for himself, 
Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend 
the Internal Revenue Code of 1986 to modify the first-time homebuyers 
credit in the case of members of the Armed Forces and certain other 
Federal employees, and for other purposes; which was ordered to lie on 
the table; as follows:

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

     SEC. 2305. EXTENSION OF DELAY IN APPLICATION OF MEDICAID 
                   PROVIDER TAX PROVISIONS TO CERTAIN MANAGED CARE 
                   ORGANIZATIONS.

       Effective as if included in the enactment of the Deficit 
     Reduction Act of 2005 (Public Law 109-171), section 
     6051(b)(2)(A) of that Act of 2005 42 U.S.C. 1396b note) is 
     amended by striking ``2009'' and inserting ``2011''.
                                 ______
                                 
  SA 2941. Mr. SPECTER (for himself, Mr. Wyden, 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 857, strike lines 5 through 25 and insert the 
     following:
       (a) In General.--Section 1834(a)(7)(A)(iii) of the Social 
     Security Act (42 U.S.C. 1395m(a)(7)(A)(iii)) is amended--
       (1) by inserting ``complex rehabilitative power-driven 
     wheelchair and any other'' after ``in the case of a'' and
       (2) by adding at the end the following: ``In the case of a 
     power-driven wheelchair that is not a complex rehabilitative 
     power-driven wheelchair, the following rules shall apply:
       ``(aa) The first sentence of this clause shall only apply 
     if the length of need is at least 13 months, as certified by 
     a physician.
       ``(bb) If the individual exercises the option under the 
     first sentence of this clause and the individual discontinues 
     use of the item prior to end of the 13-month period that 
     begins on the date the individual exercises such option, the 
     supplier shall be subject to recovery by the Secretary of an 
     amount equal to the amount (if any) by which the lump-sum 
     payment for the purchase for the wheelchair exceeds the total 
     of the monthly payments for the wheelchair that would have 
     been made on a rental basis for continuous use of less than 
     13 months.
       ``(cc) If the Secretary recovers any payments under item 
     (bb), the title for the wheelchair shall revert to the 
     supplier at the option of the supplier.''.
                                 ______
                                 
  SA 2942. Mr. GREGG (for himself, Mr. Corker, Mr. Thune, Mr. Coburn, 
Mr. Ensign, Mr. Isakson, Mr. Burr, Mr. Enzi, Mr. Alexander, Mr. 
Barrasso, Mr. Cornyn, Mr. McCain, and Mr. LeMieux) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; as 
follows:

       At the appropriate place, insert the following:

[[Page 29611]]



     SEC. ___. PREVENTING THE IMPLEMENTATION OF NEW ENTITLEMENTS 
                   THAT WOULD RAID MEDICARE.

       (a) Ban on New Spending Taking Effect.--
       (1) Purpose.--The purpose of this section is to require 
     that savings resulting from this Act must fully offset the 
     increase in Federal spending and reductions in revenues 
     resulting from this Act before any such Federal spending 
     increases or revenue reductions can occur.
       (2) In general.--Notwithstanding any other provision of 
     this Act, the Secretary of the Treasury and the Secretary of 
     Health and Human Service are prohibited from implementing the 
     provisions of, and amendments made by, sections 1401, 1402, 
     2001, and 2101, or any other spending increase or revenue 
     reduction provision in this Act until both the Director of 
     the Office of Management and Budget (referred to in this 
     section as ``OMB'') and the Chief Actuary of the Centers for 
     Medicare and Medicaid Services Office of the Actuary 
     (referred to in this section as`` CMS OACT'') each certify 
     that they project that all of the projected Federal spending 
     increases and revenue reductions resulting from this Act will 
     be offset by projected savings from this Act.
       (3) Calculations.--For purposes of this section, projected 
     savings shall exclude any projected savings or other offsets 
     directly resulting from changes to Medicare and Social 
     Security made by this Act.
       (b) Limit on Future Spending.--On September 1 of each year 
     (beginning with 2013), the CMS OACT and the OMB shall each 
     issue an annual report that--
       (1) certifies whether all of the projected Federal spending 
     increases and revenue reductions resulting from this Act, 
     starting with the next fiscal year and for the following 9 
     fiscal years, are fully offset by projected savings resulting 
     from this Act (as calculated under subsection (a)); and
       (2) provides detailed estimates of such spending increases, 
     revenue reductions, and savings, year by year, program by 
     program and provision by provision.
                                 ______
                                 
  SA 2943. Mr. CARPER (for himself and Mr. Conrad) 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 722, after line 20, insert the following:

     SEC. 3016. ADVANCING IMPLEMENTATION OF CERTAIN VALUE-BASED 
                   PURCHASING PROGRAMS.

       (a) Advancing Implementation of Hospital Value-Based 
     Purchasing Program.--
       (1) In general.--Section 1886(o) of the Social Security 
     Act, as added by section 3001, is amended--
       (A) in paragraph (1)(B--
       (i) in the subparagraph heading, by striking ``2013'' and 
     inserting ``2012''; and
       (ii) by striking ``2012'' and inserting ``2011'';
       (B) in paragraph (2)(B)--
       (i) in clause (i), by striking ``2013'' each place it 
     appears and inserting ``2012''; and
       (ii) in clause (ii), by striking ``2014'' and inserting 
     ``2013''; and
       (C) in paragraph (7)--
       (i) in subparagraph (B)(i), by striking ``2013'' and 
     inserting ``2012'';
       (ii) in subparagraph (C)--

       (I) in clause (i), by striking ``2013'' and inserting 
     ``2012'';
       (II) in clause (ii), by striking ``2014'' and inserting 
     ``2013'';
       (III) in clause (iii), by striking ``2015'' and inserting 
     ``2014'';
       (IV) in clause (iv), by striking ``2016'' and inserting 
     ``2015''; and
       (V) in clause (v), by striking ``2017'' and inserting 
     ``2016''; and

       (iii) in subparagraph (D)(ii)(I), by striking ``2012 and 
     2013'' and inserting ``2011, 2012, and 2013''.
       (2) Conforming amendment.--Section 1886(b)(3)(B)(viii) of 
     the Social Security Act, as amended by section 3001, is 
     further amended--
       (A) in subclause (V), by striking ``2012'' and inserting 
     ``2011''; and
       (B) in each of subclauses (VIII) and (IX), by striking 
     ``2013'' each place it appears and inserting ``2012''.
       (b) Advancing Implementation of National Pilot Program on 
     Payment Bundling.--Section 1866D(a)(3) of the Social Security 
     Act, as added by section 3023, is amended by striking 
     ``2013'' and inserting ``2012''.

     SEC. 3017. INTEGRATED HEALTH CARE SYSTEM COLLABORATION 
                   INITIATIVE.

       (a) In General.--In order to improve health care quality 
     and reduce costs, the Secretary of Health and Human Services 
     (in this section referred to as the ``Secretary'') shall 
     develop, in consultation with major integrated health systems 
     that have consistently demonstrated high quality and low cost 
     (as determined by the Secretary and verified by a third 
     party) a collaboration initiative (referred to in this 
     section as ``the Collaborative''). The Collaborative shall 
     develop an exportable model of optimal health care delivery 
     to apply value-based measurement, integrated information 
     technology infrastructure, standard care pathways, and 
     population-based payment models, to measurably improve health 
     care quality, outcomes, and patient satisfaction and achieve 
     cost savings.
       (b) Participation.--Prior to January 1, 2010, the Secretary 
     shall determine 5 initial participants who will form the 
     Collaborative and at least 6 additional participants who will 
     join the Collaborative beginning in the fourth year that the 
     Collaborative is in effect.
       (1) Initial participants.--Initial participants selected by 
     the Secretary shall meet the following criteria:
       (A) Be integrated health systems organized for the purpose 
     of providing health care services.
       (B) Have demonstrated a record of providing high value 
     health care for at least the 5 previous years, as determined 
     by the Secretary in accordance with the Dartmouth Atlas of 
     Health Care.
       (C) Any additional criteria specified by the Secretary.
       (2) Additional participants.--Beginning January 1, 2013, 
     the Secretary shall select 6 or more additional participants 
     who represent diverse geographic areas and are situated in 
     areas of differing population densities who agree to comply 
     with the guidelines, processes, and requirements set forth 
     for the Collaborative. Such additional participants shall 
     meet the following additional criteria:
       (A) Be organized for the provision of patient medical care.
       (B) Be capable of implementing infrastructure and health 
     care delivery modifications necessary to enhance health care 
     quality and efficiency, as determined by the Secretary in 
     accordance with the Dartmouth Atlas of Health Care.
       (C) The participant's cost and intensity of care do not 
     meet the definition of high value health care.
       (3) Additional criteria.--In addition to the criteria 
     described in paragraphs (1) and (2), the participants in the 
     Collaborative shall meet the following criteria:
       (A) Have a legal structure that would allow the participant 
     to receive incentive payments under this section.
       (B) Agree to report on quality, cost, and efficiency in 
     such form, manner, and frequency as specified by the 
     Secretary.
       (C) Provide care to patients enrolled in the Medicare 
     program.
       (D) Agree to contribute to a best practices network and 
     website, that is maintained by the Collaborative for sharing 
     strategies on quality improvement, care coordination, 
     efficiency, and effectiveness.
       (E) Use patient-centered processes of care, including those 
     that emphasize patient and caregiver involvement in shared 
     decision-making for treatment decisions.
       (F) Meet other criteria determined to be appropriate by the 
     Secretary.
       (c) Collaborative Initiative.--
       (1) In general.--Beginning January 1, 2010, the 
     Collaborative shall begin a 2 year development phase in which 
     initial participants share the quantitative and qualitative 
     methods through which they have developed high value health 
     care followed by a dissemination of that learning model to 
     additional participants of the Collaborative.
       (2) Coordinating member.--In consultation with the 
     Secretary, the Collaborative shall select a coordinating 
     member organization (hereafter identified as the Coordinating 
     Organization) of the Collaborative.
       (3) Qualifications.--The Coordinating Organization will 
     have in place a comprehensive Medicare database and possess 
     experience using and analyzing Medicare data to measure 
     health care utilization, cost, and variation, such as The 
     Dartmouth Institute for Health Policy and Clinical Practice. 
     The Coordinating Organization shall be responsible for 
     reporting to the Secretary as required and for any other 
     requirements deemed necessary by the Secretary.
       (4) Responsibilities.--The Coordinating Member shall--
       (A) lead efforts to develop each aspect of the learning 
     model;
       (B) organize efforts to disseminate the learning model for 
     high value health care, including educating participant 
     institutions; and
       (C) provide administrative, technical, accounting, 
     reporting, organizational and infrastructure support needed 
     to carry out the goals of the Collaborative.
       (5) Development of learning model.--
       (A) In general.--Initial participants in the Collaborative 
     shall work together to develop a learning model based on 
     their experience that includes a reliance on evidence based 
     care that emphasizes quality and practice techniques that 
     emphasize efficiency, joint development and implementation of 
     health information technology, introduction of clinical 
     microsystems of care, shared decision-making, outcomes and 
     measurement, and the establishment of an e-learning 
     distributive network, which have been put into practice at 
     their respective institutions.
       (B) Responsibilities.--The Coordinating Member shall do the 
     following:

[[Page 29612]]

       (i) Partner with initial participants to comprehensively 
     understand each institution's contribution to providing 
     value-based health care.
       (ii) Provide and measure value-based health care in a 
     manner that ensures that measures are aligned with current 
     measures approved by a consensus-based organization, such as 
     the National Quality Forum, or other measures as determined 
     appropriate by the Secretary, while also incorporating 
     patient self-reported status and outcomes.
       (iii) Create a replicable and scalable infrastructure for 
     common measurement of value-based care that can be broadly 
     disseminated across the Collaborative and other institutions.
       (iv) Implement care pathways for common conditions using 
     standard measures for assessment across institutions, 
     targeting high variation and high cost conditions, including 
     but not limited to--

       (I) acute myocardial infarction (AMI) and angioplasty;
       (II) coronary artery bypass graft surgery and percutaneous 
     coronary intervention;
       (III) hip or knee replacement;
       (IV) spinal surgery; and
       (V) care for chronic diseases including, but not limited 
     to, diabetes, heart disease, and high blood pressure.

       (v) Deploy and disseminate the comprehensive learning model 
     across initial participant institutions, achieving 
     improvements in care delivery and lowering costs, and 
     demonstrating the portability and viability of the processes.
       (6) Additional best practices.--As additional methods of 
     improving health care quality and efficiency are identified 
     by members of the Collaborative or by other institutions, 
     Initial Participants in the Collaborative shall incorporate 
     those practices into the learning model.
       (d) Implementation of Learning Model.--
       (1) In general.--Beginning January 1, 2013, as additional 
     participants are selected by the Secretary, Initial 
     Participants in the Collaborative shall actively engage in 
     the deployment of the learning model to educate each 
     additional participant in the common conditions that have 
     been identified.
       (A) Dissemination of learning model.--Dissemination methods 
     shall include but not be limited to the following methods:
       (i) Specialized teams deployed by the Initial Participants 
     to teach and facilitate implementation on site.
       (ii) Distance-learning, taking advantage of latest 
     interactive technologies.
       (iii) On-line, fully accessible repositories of shared 
     learning and information related to best practices.
       (iv) Advanced population health information technology 
     models.
       (B) Evaluation of participants.--Evaluation of initial 
     participants shall be based on documented success in meeting 
     quality and efficiency targets. Specific statistically valid 
     measures of evaluation shall be determined by the Secretary.
       (e) Efficiency and Quality Targets.--
       (1) Efficiency target based on growth rate.--Initial 
     participants shall implement techniques under the 
     comprehensive learning model to meet a growth rate target 
     equal to, as selected by the Secretary with respect to the 
     participant--
       (A) the percentage increase in the consumer price index for 
     all urban consumers (all items; United States city average) 
     over the previous year, plus 2 percentage points; or
       (B) the percentage increase in the projected per capita 
     amount of National Health Expenditures from the calendar year 
     in which the previous fiscal year ends to the calendar year 
     in which the fiscal year involved ends, as most recently 
     published by the Secretary before the beginning of the fiscal 
     year, minus 1.5 percentage points.
       (2) Quality target.--The Secretary shall establish a 
     quality target, based on measures endorsed by a consensus-
     based quality organization, for the initial participants in 
     the first year and subsequently for the additional 
     participants.
       (f) Payments.--
       (1) Base payment.--With respect to each participant in the 
     Collaborative, the Secretary shall determine a base amount on 
     a per capita basis for the participant for purposes of 
     measuring the growth rate in total payments for common 
     conditions, based on the reimbursement amount paid to the 
     participant under title XVIII of the Social Security Act for 
     furnishing items and services with respect to such 
     conditions.
       (2) Bonus payment.--If the growth rate in total payments 
     for services for common conditions does not exceed the growth 
     rate target selected for the participant under subsection 
     (e)(1), and the participant satisfies the quality target 
     established by the Secretary under subsection (e)(2), the 
     Secretary shall provide a bonus payment equal to 50 percent 
     of any per capita payment reductions that are below the 
     capita base amounts determined under paragraph (1).
       (3) Penalty payment.--If the growth rate in total per 
     capita payments for furnishing items and services for common 
     conditions exceeds the growth rate target, the Secretary 
     shall pay only 25 percent of any additional expenses that 
     exceed the base amounts determined under paragraph (1).
       (4) Budget neutrality limitation.--The Secretary shall 
     limit incentive payments to each of the participating 
     organizations under this section as necessary to ensure that 
     the aggregate expenditures with respect to applicable 
     beneficiaries under title XVIII of the Social Security Act 
     (inclusive of incentive payments described in this 
     subsection) do not exceed the amount that the Secretary 
     estimates would be expended for such beneficiaries if the 
     Collaborative under this section were not implemented.
       (g) Administrative Payment.--Out of funds not otherwise 
     obligated in the Treasury, there are appropriated 
     $228,000,000, to remain available until expended, to be 
     distributed in the following manner:
       (1) The Coordinating Organization shall receive $10,000,000 
     per year for program development related to the 
     Collaborative, including for health information technology 
     and other infrastructure, project evaluations, analysis, and 
     measurement, compliance, auditings and other reporting. Not 
     less than $5,000,000 of such funds shall be provided for 
     education and training, including for support for the 
     establishment of training teams for the Collaborative, to 
     assist in the integration of new health information 
     technology, best practices of care delivery, microsystems of 
     care delivery, and a distributive e-learning network for the 
     Collaborative.
       (2) Each Initial Participant shall receive $4,000,000 per 
     year for internal program development for health information 
     technology and other infrastructure, education and training, 
     project evaluations, analysis, and measurement, and 
     compliance, auditing, and other reporting.
       (3) Beginning in 2013, the Secretary may provide funding to 
     additional participants in the Collaborative in an amount not 
     to exceed $4,000,000 per participant per year under the same 
     use guidelines as apply to the Initial Participants.
       (h) Continuation or Expansion.--
       (1) Termination.--Subject to paragraph (2), the 
     Collaborative shall terminate on the date that is 6 years 
     after the date on which the Collaborative is established.
       (2) Expansion.--The Secretary may continue or expand the 
     Collaborative if--
       (A) participants meet the established growth rate targets 
     and consistently receive bonus payments during the first 4 
     years of the Collaborative and are consistently meeting 
     quality standards; or
       (B) the Collaborative is consistently exceeding quality 
     standards and is not increasing spending under the program.
       (i) Termination.--The Secretary may terminate an agreement 
     with the Collaborative or a participating organization under 
     the Collaborative if such organization did not qualify for 
     incentive payments or consistently failed to meet quality 
     standards in any of the first 3 years of the Collaborative.
       (j) Reports.--
       (1) Performance results reports.--The Secretary shall 
     provide such data as is necessary for the Collaborative to 
     measure the efficacy of the Collaborative and facilitate 
     regular reporting on spending and cost savings results 
     relative to a value-based program initiative.
       (2) Reports to congress.--Not later than 2 years after the 
     date the first agreement is entered into under this section, 
     and annually thereafter, the Secretary shall submit to 
     Congress and make publicly available a report on the 
     authority granted to the Secretary to carry out the 
     Collaborative under this section. Each report shall address 
     the impact of the use of such authority on expenditures for, 
     access to, and quality of, care under title XVIII of the 
     Social Security Act.
       (k) Definitions.--In this section:
       (1) Beneficiary.--The term ``beneficiary'' means a Medicare 
     beneficiary enrolled under part B and entitled to benefits 
     under part A who is not enrolled in Medicare Advantage under 
     Part C or a PACE program under section 1894, and meets other 
     criteria as the Secretary determines appropriate.
       (2) High value health care.--The term ``high value health 
     care'' means the care delivered by organizations shown by 
     statistically valid methods to meet the highest quality 
     measures established by the Secretary as of or after the date 
     of enactment of this Act and to be delivering low-cost care 
     with high patient satisfaction and clinical outcomes.
       (3) Learning model.--The term ``learning model'' means a 
     standardized model developed by the Initial Participants in 
     the Collaborative and based on best practices, as jointly 
     developed and put into practice at the Initial Participant's 
     respective institutions.
       (4) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (l) Additional Monitoring.--The Secretary may monitor data 
     on expenditures and quality of services under title XVIII of 
     the Social Security Act with respect to a beneficiary after 
     the beneficiary discontinues receiving services under the 
     Collaborative.
       (m) Other Provisions.--
       (1) Limitations on review.--There shall be no 
     administrative or judicial review under this section or 
     otherwise of--
       (A) the elements, parameters, scope, and duration of the 
     Collaborative, including the selection of participants in the 
     Collaborative;

[[Page 29613]]

       (B) the establishment of targets, measurement of 
     performance;
       (C) determinations with respect to whether savings have 
     been achieved and the amount of savings;
       (D) determinations regarding whether, to whom, and in what 
     amounts incentive payments are paid; and
       (E) decisions about the extension or expansion of the 
     Collaborative.
       (2) Administration.--Chapter 35 of title 44, 4 United 
     States Code shall not apply to this section.
       (3) Evaluation.--The Secretary shall evaluate the payment 
     incentive model for the Collaborative to assess impacts on 
     beneficiaries and on the Medicare program under title XVIII 
     of the Social Security Act. The Secretary shall make such 
     evaluation publicly available within 60 days of the date of 
     completion of such report.
       (4) Monitoring.--The Inspector General of the Department of 
     Health and Human Services shall provide for monitoring of the 
     operation of the Collaborative with regard to violations of 
     section 1877 of the Social Security Act (popularly known as 
     the ``Stark law'').
       (5) Anti-discrimination.--The Secretary shall not enter 
     into an agreement with an entity to provide health care items 
     or services under the Collaborative, or with an entity to 
     administer the Collaborative, unless such entity guarantees 
     that it will not deny, limit, or condition the coverage or 
     provision of benefits under the Collaborative for 
     beneficiaries to participate in the Collaborative, based on 
     any health status-related factor described in section 
     2702(a)(1) of the Public Health Service Act.
                                 ______
                                 
  SA 2944. Mrs. BOXER submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of subtitle D of title V, add the following:

     SEC. 5316. GERIATRIC HEALTH CARE WORKFORCE.

       (a) Investment in Tomorrow's Geriatric Health Care 
     Workforce.--Part E of title VII of the Public Health Service 
     Act (42 U.S.C. 294n et seq.), as amended by section 5314, is 
     further amended by adding at the end the following:

     ``SEC. 779. INVESTMENT IN TOMORROW'S GERIATRIC HEALTH CARE 
                   WORKFORCE.

       ``(a) Establishment.--The Secretary shall establish and 
     carry out a Geriatric and Gerontology Loan Repayment Program 
     under which the eligible individual agrees to be employed 
     full-time for a specified period (which shall not be less 
     than 2 years) as a physician, physician assistant, nurse 
     practitioner, clinical nurse specialist, pharmacist, 
     psychologist, physical therapist, or social worker in 
     geriatric care practice.
       ``(b) Program Administration.--Under the program 
     established under subsection (a), the Secretary shall enter 
     into contracts with qualified health professionals described 
     in subsection (c) under which--
       ``(1) such qualified health professionals agree to provide 
     full-time clinical practice and service to older adults 
     through work serving, or for a provider serving--
       ``(A) an area with shortage of the specified geriatric or 
     gerontology specialty that has a sufficient population of 
     older adults to support such geriatric or gerontology 
     speciality, as determined by the Secretary; and
       ``(B) a medically underserved community (including a health 
     professional shortage area), or a medically underserved 
     population; and
       ``(2) the Secretary agrees to make payments on the 
     principal and interest of the graduate medical education 
     loans of professionals described in paragraph (1) that--
       ``(A) are not more than $35,000 a year for each year of 
     agreed upon service under such paragraph for a period of not 
     more than 4 years; and
       ``(B) are not more than 1/4 of the total of such principal 
     and interest, for each year of the service, for a period of 
     not more than 4 years.
       ``(c) Qualified Health Professionals.--
       ``(1) In general.--A qualified health professional 
     described in this subsection is an individual--
       ``(A) who--
       ``(i) is a physician, including an osteopathic physician, 
     who--

       ``(I) is entering or enrolled in an accredited fellowship 
     in geriatric medicine or geriatric psychiatry; or
       ``(II) has completed (but not prior to the calendar year in 
     which this section is enacted) an accredited fellowship in 
     geriatric medicine or geriatric psychiatry; or

       ``(ii) is a nurse practitioner or clinical nurse 
     specialist, pharmacist, social worker, physician assistant, 
     physical therapist, or psychologist who has completed 
     specialty training in geriatrics or gerontology;
       ``(B) who has obtained an educational loan for costs 
     associated with graduate training in medicine, pharmacy, 
     psychology, physical therapy, or social work, or costs 
     associated with training to become a nurse practitioner, 
     clinical nurse specialist, or physician assistant;
       ``(C) who is appropriately licensed or certified in the 
     State in which the individual practices, or who meets other 
     qualifications as determined by the Secretary;
       ``(D) who agrees to provide clinical services to older 
     adults for a period of not less than 2 years in a setting 
     determined appropriate by the Secretary; and
       ``(E) who has demonstrated the capability through education 
     or training to work with frail older adults and older adults 
     with disabilities, including individuals with dementia, 
     urinary incontinence, and problems with balance or mobility, 
     and medication regimes for older adults.
       ``(2) Additional eligibility requirements.--The Secretary 
     may not enter into a contract under this subsection with an 
     individual unless--
       ``(A) the individual is a United States citizen or a 
     permanent legal United States resident;
       ``(B) if the individual is enrolled in a graduate program, 
     the program is accredited, and the individual has an 
     acceptable level of academic standing (as determined by the 
     Secretary); and
       ``(C) the individual is not participating in any other 
     Federal undergraduate or graduate medical education loan 
     repayment program.
       ``(d) Priority.--In entering into contracts under this 
     section, the Secretary shall give priority to qualified 
     health professionals who demonstrate financial need.
       ``(e) Applicability of Certain Provisions.--With respect to 
     the National Health Service Corps Loan Repayment Program 
     established in subpart III of part D of title III, the 
     provisions of such subpart shall, except as inconsistent with 
     this section, apply to the program established in this 
     section in the same manner and to the same extent as such 
     provisions apply to the National Health Service Corps Loan 
     Repayment Program.
       ``(f) Definition.--In this section:
       ``(1) Geriatrics.--The term `geriatrics' means the branch 
     of medicine that deals with the problems and diseases of 
     older adults and aging, including chronic conditions and 
     geriatric syndromes such as dementia, delirium, urinary 
     incontinence, osteoporosis, falls or gait disorders, or sleep 
     disorders.
       ``(2) Gerontology.--The term `gerontology' means the 
     interdisciplinary study of the aging process and individuals 
     as they grow from middle age through later life. Such term 
     encompasses the social, cognitive, psychological, biological, 
     and economic aspects of aging.
       ``(3) Graduate medical education.--The term `graduate 
     medical education' means a graduate program in medicine, 
     pharmacy, psychology, physical therapy, or social work, or a 
     graduate program that trains individuals to become nurse 
     practitioners, clinical nurse specialists, or physician 
     assistants.
       ``(4) Specialty training.--The term `specialty training' 
     means a concentration in coursework in geriatrics or 
     gerontology or clinical training, including internships, 
     residency programs, or fellowships, in a geriatric setting, 
     or other requirements, as determined by the Secretary.
       ``(g) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $4,000,000 for 
     fiscal year 2010, $9,500,000 for fiscal year 2011, 
     $16,000,000 for fiscal year 2012, $24,000,000 for fiscal year 
     2013, and $30,500,000 for fiscal year 2014.''.
       (b) Expansion of Nursing Education Loan Repayment 
     Program.--Section 846 of the Public Health Service Act (42 
     U.S.C. 297n) is amended--
       (1) by redesignating subsection (i) as subsection (j); and
       (2) by inserting after subsection (h), the following:
       ``(i) Geriatric Care Practice in Long-Term Care Settings.--
       ``(1) Loan repayments.--In providing for loan repayments 
     under this section, the Secretary shall ensure that eligible 
     individuals include registered nurses who complete specialty 
     training in geriatrics or gerontology and who elect to 
     provide nursing services to older adults in home and 
     community-based or facility-based long-term care settings, or 
     any other program determined appropriate by the Secretary.
       ``(2) Definition.--In this subsection, the term `specialty 
     training' means coursework in geriatrics or gerontology or 
     clinical training, including internships or fellowships, in a 
     geriatric setting.
       ``(3) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection, $1,500,000 
     for fiscal year 2010, $3,000,000 for fiscal year 2011, 
     $5,000,000 for fiscal year 2012, $7,000,000 for fiscal year 
     2013, and $8,500,000 for fiscal year 2014.''.
                                 ______
                                 
  SA 2945. Mrs. BOXER 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

[[Page 29614]]

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. __. REPORT ON IMPACT OF NURSE STAFFING.

       Not later than 18 months after the date of the enactment of 
     this Act, the Director of the Agency for Healthcare Research 
     and Quality shall submit to Congress a report on the impact 
     of the nurse-to-patient ratio on the quality of care and 
     patient outcomes, including recommendations for further 
     integration into quality measurement and quality improvement 
     activities as determined appropriate.
                                 ______
                                 
  SA 2946. 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 330, line 9, insert after ``1402(g)(1)'' the 
     following: ``, or an individual who would be eligible for an 
     exemption under such section if the individual were self-
     employed,''.
                                 ______
                                 
  SA 2947. 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:

       On page 1411, between lines 5 and 6, insert the following:

     SEC. 5316. GRANTS FOR EMERGENCY MEDICAL SERVICES PERSONNEL 
                   TRAINING FOR VETERANS.

       Section 330J of the Public Health Service Act (42 U.S.C. 
     254c-15) is amended--
       (1) in subsection (b)(1)--
       (A) in subparagraph (E), by striking ``or'' at the end;
       (B) by redesignating subparagraph (F) as subparagraph (G); 
     and
       (C) by inserting after subparagraph (E), the following:
       ``(F) an entity providing training for emergency medical 
     services personnel, including institutions of higher 
     education, technical colleges, community colleges, and other 
     State-certified training entities; or''; and
       (2) in subsection (c)--
       (A) in paragraph (7), by striking ``and'' at the end;
       (B) in paragraph (8), by striking the period and inserting 
     ``; and''; and
       (C) by adding at the end the following:
       ``(9) provide to military veterans required coursework and 
     training that take into account, and are not duplicative of, 
     previous medical coursework and training received when such 
     veterans were active members of the Armed Forces, to enable 
     such veterans to satisfy emergency medical services personnel 
     certification requirements, as determined by the appropriate 
     State regulatory entity.''.
                                 ______
                                 
  SA 2948. Ms. SNOWE submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Strike subtitle I of title VI and insert the following:

             Subtitle I--State Medical Malpractice Programs

     SEC. 6801. PRE-LITIGATION SCREENING AND MEDIATION PANELS.

       (a) In General.--As a condition for receiving Federal funds 
     under the Medicaid program under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.), each State and 
     territory shall, not later than 3 years after the date of 
     enactment of this Act, create a pre-litigation screening and 
     mediation panel which shall provide timely review of each 
     medical malpractice claim before such claim is filed in a 
     State or Federal court in such State.
       (b) Requirements.--
       (1) In general.--Each medical malpractice claim shall be 
     heard by such panel before such claim may be filed in a State 
     or Federal court and before litigation of such case may 
     commence.
       (2) Reports.--The panel shall issue a report containing the 
     findings and recommendations of such panel, based on the 
     evidence presented to the panel. The report described in this 
     paragraph shall not affect a claimant's right to bring a 
     medical malpractice claim in State or Federal court. 
     Notwithstanding any other provision of State or Federal law, 
     such report may be admissible in such court.
       (c) Duties.--Each panel established under subsection (a) 
     shall--
       (1) review medical malpractice claims;
       (2) assess the evidence offered by the parties; and
       (3) render professional judgment on the validity of claims.
       (d) Membership.--Each panel established under subsection 
     (a) shall be comprised of lawyers, retired judges, doctors, 
     and medical professionals. Members of the panel shall serve 
     on a volunteer basis, unless a State chooses to arrange for 
     compensation of, or reimbursement of expenses for, such 
     members.
       (e) Exempted States.--A State that, on the day before the 
     date of enactment of this Act, has enacted laws that require 
     medical malpractice claims to be heard by a pre-litigation 
     panel, in a manner similar to the requirements of this 
     section, may, at the discretion of the Secretary, be exempt 
     from the requirements of this section for as long as such 
     State maintains such panel.
       (f) Rule of Construction.--Nothing in this section shall be 
     construed to interfere with or restrict an individual's right 
     to bring a lawsuit in civil courts.

     SEC. 6802. STANDARDS FOR MEDICAL LIABILITY EXPERT WITNESSES.

       As a condition for receiving Federal funds under the 
     Medicaid program under title XIX of the Social Security Act 
     (42 U.S.C. 1396 et seq.), each State and territory shall 
     require that an individual wishing to present evidence 
     through an expert witness in a medical malpractice case 
     demonstrate that such expert witness--
       (1) be credentialed or licensed in one or more States to 
     deliver health care services;
       (2) typically treat the diagnosis or condition at issue in 
     the case, or provide the type of treatment under review; and
       (3) is substantially familiar with applicable standards of 
     care and practice as they relate to the act or omission that 
     is the subject of the lawsuit.

     SEC. 6803. ENCOURAGING SETTLEMENT OF MEDICAL MALPRACTICE 
                   LAWSUITS.

       As a condition for receiving Federal funds under the 
     Medicaid program under title XIX of the Social Security Act 
     (42 U.S.C. 1396 et seq.), each State and territory shall 
     require that a party in a medical malpractice lawsuit that 
     refuses a settlement offer in an amount that is significantly 
     greater than the amount awarded by a jury after trial 
     reimburse the party that made such settlement offer for the 
     costs of the trial, including attorney's fees associated with 
     the trial.
                                 ______
                                 
  SA 2949. Mr. ROCKEFELLER (for himself and Mr. Brown) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       Beginning on page 182, strike line 8 and all that follows 
     through page 200, line 5, and insert the following:

     SEC. 1323. CONSUMERS CHOICE HEALTH PLAN.

       (a) Findings.--Congress makes the following findings:
       (1) Americans need health care coverage that is always 
     affordable.
       (2) Americans need health care coverage that is always 
     adequate.
       (3) Americans need health care coverage that is always 
     accountable.
       (4) A public health insurance plan option that can compete 
     with private insurance plans is the only way to guarantee 
     that all consumers have affordable, adequate, and accountable 
     options available in the insurance marketplace.
       (b) Office of Health Plan Management.--
       (1) Establishment.--Not later than July 1, 2010, there 
     shall be established within the Department of Health and 
     Human Services an Office of Health Plan Management (referred 
     to in this section as the ``Office''). The Office shall be 
     headed by a Director (referred to in this section as the 
     ``Director'') who shall be appointed by the President, by and 
     with the advice and consent of the Senate.
       (2) Compensation.--The Director shall be paid at the annual 
     rate of pay for a position at level II of the Executive 
     Schedule under section 5313 of title 5, United States Code.
       (3) Limitation.--Neither the Director nor the Office shall 
     participate in the administration of the Exchanges 
     established under this title or the promulgation or 
     administration of any regulation regarding the health 
     insurance industry.

[[Page 29615]]

       (4) Personnel and operations authority.--The Director shall 
     have the same general authorities with respect to personnel 
     and operations of the Office as the heads of other agencies 
     and departments of the Federal Government have with respect 
     to such agencies and departments.
       (c) Consumer Choice Health Plan.--
       (1) In general.--The Office shall establish and administer 
     the Consumer Choice Health Plan (referred to in this section 
     as the ``Plan'') to provide for health insurance coverage 
     that is made available to all eligible individuals (as 
     described in paragraph (4)(A)) in the United States and its 
     territories.
       (2) Regulatory compliance.--The Plan shall comply with--
       (A) all regulations and requirements that are applicable 
     with respect to other qualified health plans that are offered 
     through the Exchanges; and
       (B) any additional regulations and requirements, as 
     determined by the Director.
       (3) Benefits.--
       (A) In general.--The Plan shall offer health insurance 
     coverage at different benefit levels, provided that such 
     benefits are commensurate with the required benefit levels to 
     be provided by a qualified health plan through the Exchanges.
       (B) Minimum benefits for children.--
       (i) In general.--The minimum benefit level available under 
     the Plan for children shall include at least the services 
     described in the most recently published version of the 
     ``Maternal and Child Health Plan Benefit Model'' developed by 
     the National Business Group on Health.
       (ii) Amendment of benefit level.--The Secretary of Health 
     and Human Services, acting through the Director of the Agency 
     for Healthcare Research and Quality, may amend the benefits 
     described in clause (i) based on the most recent peer-
     reviewed and evidence-based data.
       (4) Eligibility and enrollment.--
       (A) Eligibility.--An individual who is eligible to purchase 
     coverage from a qualified health plan through an Exchange 
     shall be eligible to enroll in the Plan.
       (B) Enrollment process.--An individual may enroll in the 
     Plan only in such manner and form as may be prescribed by 
     applicable regulations, and only during an enrollment period 
     as prescribed by the Director.
       (C) Employer enrollment.--An employer shall be eligible to 
     purchase health insurance coverage for their employees and 
     the employees' dependents to the extent provided for all 
     qualified health plans under the Exchanges.
       (D) Satisfaction of individual mandate requirement.--An 
     individual's enrollment with the Plan shall be treated as 
     satisfying any requirement under Federal law for such 
     individual to demonstrate enrollment in health insurance or 
     benefits coverage, including the requirement under section 
     5000A of the Internal Revenue Code of 1986.
       (5) Providers.--
       (A) Network requirement.--
       (i) Medicare.--A participating provider who is voluntarily 
     providing health care services under the Medicare program 
     established under title XVIII of the Social Security Act (42 
     U.S.C. 1395 et seq.) shall be required to provide services to 
     any individual enrolled in the Plan.
       (ii) Medicaid and chip.--A provider of health care services 
     under the Medicaid program established under title XIX of the 
     Social Security Act (42 U.S.C. 1396 et seq.), or the CHIP 
     program established under title XXI of such Act (42 U.S.C. 
     1397aa et seq.), shall be required to provide services to any 
     individual enrolled in the Plan.
       (B) Exception.--Subparagraph (A) shall not be construed as 
     requiring a provider to accept new patients due to bona fide 
     capacity limitations of the provider.
       (C) Opt-out provision.--
       (i) Medicare.--A participating provider as described under 
     subparagraph (A)(i) shall be required to provide services to 
     any individual enrolled in the Plan for the 3-year period 
     following the establishment of the Plan. Upon the expiration 
     of the 3-year period, a participating provider in the Plan 
     may elect to become a non-participating provider without 
     affecting their status as a participating provider under the 
     Medicare program.
       (ii) Medicaid and chip.--A provider as described under 
     subparagraph (A)(ii) shall be required to provide services to 
     any individual enrolled in the Plan for the 3-year period 
     following the establishment of the Plan. Upon the expiration 
     of the 3-year period, a provider in the Plan may elect to 
     cease provision of services under the Plan without affecting 
     their status as a provider under the Medicaid program or the 
     CHIP program.
       (D) Payment rates.--
       (i) Initial payment rates.--

       (I) In general.--During the 2-year period following the 
     establishment of the Plan, providers shall be reimbursed at 
     such payment rates as are applicable under the Medicare 
     program.
       (II) Adjustment.--The Director may reimburse providers at 
     rates lower or higher than applicable under the Medicare 
     program if the Director determines that the adjusted rates 
     are appropriate and ensure that enrollees in the Plan are 
     provided with adequate access to health care services.

       (ii) Subsequent payment rates.--Subject to clause (iii), 
     upon the expiration of the 2-year period following the 
     establishment of the Plan, the Director shall develop payment 
     rates for reimbursement of providers in order to maintain an 
     adequate provider network necessary to assure that enrollees 
     in the Plan have adequate access to health care. In 
     determining such payment rates, the Director shall consider--

       (I) competitive provider payment rates in both the public 
     and private sectors;
       (II) best practices among providers;
       (III) integrated models of care delivery (including medical 
     home and chronic care coordination models);
       (IV) geographic variation in health care costs;
       (V) evidence-based practices;
       (VI) quality improvement;
       (VII) use of health information technology; and
       (VIII) any additional measures, as determined by the 
     Director.

       (iii) Payment rate consultation.--The Director shall 
     determine payment rates under clause (ii) in consultation 
     with providers participating under the Plan, the Director of 
     the Office of Personnel Management, the Medicare Payment 
     Advisory Commission, and the Medicaid and CHIP Payment and 
     Access Commission.
       (E) Adoption of medicare reforms.--The Plan may adopt 
     Medicare system delivery reforms that provide patients with a 
     coordinated system of care and make changes to the provider 
     payment structure.
       (6) Subsidies.--The Plan shall be eligible to accept 
     subsidies, including subsidies for the enrollment of 
     individuals under the Plan, in the same manner and to the 
     same extent as other qualified health plans offered through 
     an Exchange (including credits under section 36B of the 
     Internal Revenue Code of 1986).
       (7) Financing.--
       (A) Transitional funding.--
       (i) In general.--In order to provide for adequate funding 
     of the Plan in advance of receipt of payments as described in 
     subparagraph (B), beginning July 1, 2010, there are 
     transferred to the Plan from the general fund of the Treasury 
     such amounts as may be necessary for operation of the Plan 
     until the end of the 3-year period following the 
     establishment of the Plan.
       (ii) Return of funds.--Upon the expiration of the 3-year 
     period following the establishment of the Plan, the Director 
     shall enter into a repayment schedule with the Secretary of 
     the Treasury to provide for repayment of funds provided under 
     clause (i). Any expenditures made by the Plan pursuant to a 
     repayment schedule established under this subparagraph shall 
     not constitute administrative expenses as described in 
     subparagraph (B)(ii).
       (B) Self-financing.--
       (i) In general.--The Plan shall be financially self-
     sustaining insofar as funds used for operation of the Plan 
     (including benefits, administration, and marketing) shall be 
     derived from--

       (I) insurance premium payments and subsidies for 
     individuals enrolled in the Plan; and
       (II) assessable payments made pursuant to section 4980H of 
     the Internal Revenue Code of 1986 (as added by section 1513) 
     by employers that fail to offer their full-time employees 
     (and their dependents) the opportunity to enroll in minimum 
     essential coverage under an eligible employer-sponsored plan.

       (ii) Limitation on administrative expenses.--Not more than 
     5 percent of the amounts provided under clause (i) may be 
     used for the annual administrative costs of the Plan.
       (C) Contingency reserve.--
       (i) In general.--The Director shall establish and fund a 
     contingency reserve for the Plan in a form similar to the 
     contingency reserve provided for health benefits plans under 
     the Federal Employees Health Benefits Program under chapter 
     89 of title 5, United States Code.
       (ii) Revenue.--Any revenue generated through the 
     contingency reserve established in clause (i) shall be 
     transferred to the Plan for the purpose of reducing enrollee 
     premiums, reducing enrollee cost-sharing, increasing enrollee 
     benefits, or any combination thereof.
       (D) GAO financial audit and report.--Beginning not later 
     than October 1, 2011, the Comptroller General shall conduct 
     an annual audit of the financial statements and records of 
     the Plan, in accordance with generally accepted government 
     auditing standards, and submit an annual report on such audit 
     to the Congress.
       (E) Supermajority requirement for supplemental funding.--
     Upon certification by the Comptroller General that the 
     financial audit described in subparagraph (D) indicates that 
     the Plan is insolvent, supplemental funding may be 
     appropriated for the Plan if such measure receives not less 
     than a three-fifths vote of approval of the total number of 
     Members of the House of Representatives and the Senate.
       (8) Transparency.--
       (A) In general.--Beginning with the first year of operation 
     of the Plan through the Exchanges, the Director shall provide 
     standards and undertake activities for promoting transparency 
     in costs, benefits, and other

[[Page 29616]]

     factors for health insurance coverage provided under the 
     Plan.
       (B) Standard definitions of insurance and medical terms.--
       (i) In general.--The Director shall provide for the 
     development of standards for the definitions of terms used in 
     health insurance coverage under the Plan, including 
     insurance-related terms (including the insurance-related 
     terms described in clause (ii)) and medical terms (including 
     the medical terms described in clause (iii)).
       (ii) Insurance-related terms.--The insurance-related terms 
     described in this clause are premium, deductible, co-
     insurance, co-payment, out-of-pocket limit, preferred 
     provider, non-preferred provider, out-of-network co-payments, 
     UCR (usual, customary and reasonable) fees, excluded 
     services, grievance and appeals, and such other terms as the 
     Director determines are important to define so that consumers 
     may compare health insurance coverage and understand the 
     terms of their coverage.
       (iii) Medical terms.--The medical terms described in this 
     clause are hospitalization, hospital outpatient care, 
     emergency room care, physician services, prescription drug 
     coverage, durable medical equipment, home health care, 
     skilled nursing care, rehabilitation services, hospice 
     services, emergency medical transportation, and such other 
     terms as the Director determines are important to define so 
     that consumers may compare the medical benefits offered by 
     health insurance plans and understand the extent of those 
     medical benefits (or exceptions to those benefits).
       (C) Disclosure.--
       (i) In general.--In carrying out this paragraph, the 
     Director shall disclose to Plan enrollees, potential 
     enrollees, in-network health care providers, and others 
     (through a publically available Internet website and other 
     appropriate means) relevant information regarding each policy 
     of health insurance coverage marketed or in force (in such 
     standardized manner as determined by the Director), 
     including--

       (I) full policy contract language; and
       (II) a summary of the information described in subparagraph 
     (D).

       (ii) Personalized statement.--The Director shall disclose 
     to enrollees (in such standardized manner as determined by 
     the Director) an annual personalized statement that 
     summarizes use of health care services and payment of claims 
     with respect to an enrollee (and covered dependents) under 
     health insurance coverage provided through the Plan in the 
     preceding year.
       (D) Required information.--The information described in 
     this subparagraph includes, but is not limited to, the 
     following:
       (i) Data on the price of each new policy of health 
     insurance coverage and renewal rating practices.
       (ii) Claims payment policies and practices, including how 
     many and how quickly claims were paid.
       (iii) Provider fee schedules and usual, customary, and 
     reasonable fees (for both in-network and out-of-network 
     providers).
       (iv) Provider participation and provider directories.
       (v) Loss ratios, including detailed information about 
     amount and type of non-claims expenses.
       (vi) Covered benefits, cost-sharing, and amount of payment 
     provided toward each type of service identified as a covered 
     benefit, including preventive care services recommended by 
     the United States Preventive Services Task Force.
       (vii) Civil or criminal actions successfully concluded 
     against the Plan by any governmental entity.
       (viii) Benefit exclusions and limits.
       (E) Development of patient claims scenarios.--
       (i) In general.--In order to improve the ability of 
     individuals and employers to compare the coverage and 
     relative value provided under the Plan, the Director shall 
     develop and make publically available a series of patient 
     claims scenarios under which benefits (including out-of-
     pocket costs) under the Plan are simulated for certain common 
     or expensive conditions or courses of treatment (including 
     maternity care, breast cancer, heart disease, diabetes 
     management, and well-child visits).
       (ii) Consultation.--The Director shall develop the patient 
     claims scenarios described in clause (i)--

       (I) in consultation with the Secretary of Health and Human 
     Services, the National Institutes of Health, the Centers for 
     Disease Control and Prevention, the Agency for Healthcare 
     Research and Quality, health professional societies, patient 
     advocates, and other entities as deemed necessary by the 
     Director; and
       (II) based upon recognized clinical practice guidelines.

       (F) Manner of disclosure.--The Director shall disclose the 
     information under this paragraph--
       (i) with all marketing materials;
       (ii) on the website for the Plan; and
       (iii) at other times upon request.
       (d) Conforming Amendments.--
       (1) Community health insurance option.--
       (A) In general.--Title I of this Act is amended by striking 
     ``community health insurance option'' each place it appears 
     and inserting ``Consumer Choice Health Plan''.
       (B) Annual fee on health insurance providers.--Section 
     9010(c)(2)(B) is amended by striking ``community health 
     insurance option'' and inserting ``Consumer Choice Health 
     Plan''.
       (2) Special rules.--Section 1303(a)(1)(C) is amended by--
       (A) in clause (i)(III), striking ``section 1323(e)(1)(C) 
     or''; and
       (B) in clause (ii), striking ``section 1323(b)(3)(A)'' and 
     inserting ``section 1323(c)(3)(A)''.

     SEC. 1323A. ESTABLISHMENT OF AMERICA'S HEALTH INSURANCE 
                   TRUST.

       (a) Establishment.--As of the date of enactment of this 
     Act, there is authorized to be established a non-profit 
     corporation that shall be known as the ``America's Health 
     Insurance Trust'' (referred to in this section and section 
     1323B as the ``Trust''), which is neither an agency nor 
     establishment of the United States Government.
       (b) Location; Service of Process.--The Trust shall maintain 
     its principal office within the District of Columbia and have 
     a designated agent in the District of Columbia to receive 
     service of process for the Trust. Notice to or service on the 
     agent shall be deemed as notice to or service on the 
     corporation.
       (c) Application of Provisions.--The Trust shall be subject 
     to the provisions of this section and, to the extent 
     consistent with this section, to the District of Columbia 
     Nonprofit Corporation Act.
       (d) Tax Exempt Status.--The Trust shall be treated as a 
     nonprofit organization described under section 170(c)(2)(B) 
     and section 501(c)(3) of the Internal Revenue Code of 1986 
     that is exempt from taxation under section 501(a) of the 
     Internal Revenue Code of 1986.
       (e) Board of Directors.--
       (1) In general.--The Board of Directors of the Trust 
     (referred to in this section as the ``Board'') shall consist 
     of 19 voting members appointed by the Comptroller General.
       (2) Terms.--
       (A) In general.--Subject to subparagraph (C), each member 
     of the Board shall serve for a term of 6 years.
       (B) Limitation.--No individual shall be appointed to the 
     Board for more than 2 consecutive terms.
       (C) Initial members.--The initial members of the Board 
     shall be appointed by the Comptroller General not later than 
     October 1, 2010, and shall serve terms as follows:
       (i) 8 members shall be appointed for a term of 5 years.
       (ii) 8 members shall be appointed for a term of 3 years.
       (iii) 3 members shall be appointed for a term of 1 year.
       (D) Expiration of term.--Any member of the Board whose term 
     has expired may serve until such member's successor has taken 
     office, or until the end of the calendar year in which such 
     member's term has expired, whichever is earlier.
       (E) Vacancies.--
       (i) In general.--Any member appointed to fill a vacancy 
     prior to the expiration of the term for which such member's 
     predecessor was appointed shall be appointed for the 
     remainder of such term.
       (ii) Vacancies not to affect power of board.--A vacancy on 
     the Board shall not affect its powers, but shall be filled in 
     the same manner as the original appointment was made.
       (3) Chairperson and vice-chairperson.--
       (A) In general.--The Comptroller General shall designate a 
     Chairperson and Vice-Chairperson of the Board from among the 
     members of the Board.
       (B) Term.--The members designated as Chairperson and Vice-
     Chairperson shall serve for a period of 3 years.
       (4) Conflicts of interest.--An individual may not serve on 
     the Board if such individual (or an immediate family member 
     of such individual) is employed by or has a financial 
     interest in--
       (A) an organization that provides a health insurance plan;
       (B) a pharmaceutical manufacturer; or
       (C) any subsidiary entities of an organization described in 
     subparagraphs (A) or (B).
       (5) Composition of the board.--
       (A) Political parties.--Not more than 10 members of the 
     Board may be affiliated with the same political party.
       (B) Diversity.--In appointing members under this paragraph, 
     the Comptroller General shall ensure that such members 
     provide appropriately diverse representation with respect to 
     race, ethnicity, age, gender, and geography.
       (C) Consumer representation.--10 members of the Board shall 
     be independent and non-conflicted individuals representing 
     the interests of health care consumers. Each member selected 
     under this subparagraph shall represent 1 of the 10 
     Department of Health and Human Services regions in the United 
     States.
       (D) Remaining representation.--
       (i) In general.--9 members of the Board shall be selected 
     based on relevant experience, including expertise in--

       (I) community affairs;
       (II) Federal, State, and local government;
       (III) health professions and administration;
       (IV) business, finance, and accounting;
       (V) legal affairs;

[[Page 29617]]

       (VI) insurance;
       (VII) trade unions;
       (VIII) social services; and
       (IX) any additional areas as determined by the Comptroller 
     General.

       (ii) Income from health care industry.--Not more than 4 of 
     the members selected under this subparagraph shall earn more 
     than 10 percent of their income from the health care 
     industry.
       (6) Meetings and hearings.--The Board shall meet and hold 
     hearings at the call of the Chairperson or a majority of its 
     members. Meetings of the Board on matters not related to 
     personnel shall be open to the public and advertised through 
     public notice at least 7 days prior to the meeting.
       (7) Quorum.--A majority of the members of the Board shall 
     constitute a quorum for purposes of conducting the duties of 
     the Trust, but a lesser number of members may meet and hold 
     hearings.
       (8) Executive director and staff; performance of duties.--
     The Board may--
       (A) employ and fix the compensation of an Executive 
     Director and such other personnel as may be necessary to 
     carry out the duties of the Trust;
       (B) seek such assistance and support as may be required in 
     the performance of the duties of the Trust from appropriate 
     departments and agencies of the Federal Government;
       (C) enter into contracts or other arrangements and make 
     such payments as may be necessary for performance of the 
     duties of the Trust;
       (D) provide travel, subsistence, and per diem compensation 
     for individuals performing the duties of the Trust, including 
     members of the Advisory Council (as described in subsection 
     (f)); and
       (E) prescribe such rules, regulations, and bylaws as the 
     Board determines necessary with respect to the internal 
     organization and operation of the Trust.
       (9) Lobbying cooling-off period for members of the board.--
     Section 207(c) of title 18, United States Code, as amended by 
     section 3403(a)(2), is amended by inserting at the end the 
     following:
       ``(4) Members of the board of directors of the america's 
     health insurance trust.--Paragraph (1) shall apply to a 
     member of the Board of Directors of the America's Health 
     Insurance Trust who was appointed to the Board as of the day 
     before the date of enactment of the Patient Protection and 
     Affordable Care Act.''.
       (f) Advisory Council.--
       (1) Establishment.--The Board shall establish an advisory 
     council that shall be comprised of the insurance 
     commissioners of each State (including the District of 
     Columbia) to advise the Board on the development and impact 
     of measures to improve the transparency and accountability of 
     qualified health plans provided through the Exchanges 
     established under this title.
       (2) Meetings.--The advisory council shall meet not less 
     than twice a year and at the request of the Board.
       (g) Financial Oversight.--
       (1) Contract for audits.--The Trust shall provide for 
     financial audits of the Trust on an annual basis by a private 
     entity with expertise in conducting financial audits.
       (2) Review and report on audits.--The Comptroller General 
     shall--
       (A) review and evaluate the results of the audits conducted 
     pursuant to paragraph (1); and
       (B) submit a report to Congress containing the results and 
     review of such audits, including an analysis of the adequacy 
     and use of the funding for the Trust and its activities.
       (h) Rules on Gifts and Outside Contributions.--
       (1) Gifts.--The Trust (including the Board and any staff 
     acting on behalf of the Trust) shall not accept gifts, 
     bequeaths, or donations of services or property.
       (2) Prohibition on outside funding or contributions.--The 
     Trust shall not--
       (A) establish a corporation other than as provided under 
     this section; or
       (B) accept any funds or contributions other than as 
     provided under this section.
       (i) America's Health Insurance Trust Fund.--
       (1) In general.--There is established in the Treasury a 
     trust fund to be known as the ``America's Health Insurance 
     Trust Fund'' (referred to in this section as the ``Trust 
     Fund''), consisting of such amounts as may be credited to the 
     Trust Fund as provided under this subsection.
       (2) Transfer.--The Secretary of the Treasury shall transfer 
     to the Trust Fund out of the general fund of the Treasury 
     amounts determined by the Secretary to be equivalent to the 
     amounts received into such general fund that are attributable 
     to the fees collected under sections 4385 and 4386 of the 
     Internal Revenue Code of 1986 (relating to fees on health 
     insurance policies and self-insured health plans).
       (3) Financing for fund from fees on insured and self-
     insured health plans.--
       (A) General rule.--Chapter 34 of the Internal Revenue Code 
     of 1986 is amended by adding at the end the following new 
     subchapter:

  ``Subchapter C--Additional Fees on Insured and Self-Insured Health 
                                 Plans

``Sec. 4385. Health insurance.
``Sec. 4386. Self-insured health plans.
``Sec. 4387. Definitions and special rules.

     ``SEC. 4385. HEALTH INSURANCE.

       ``(a) Imposition of Fee.--In the case of any specified 
     health insurance policy issued after October 1, 2009, there 
     is hereby imposed a fee equal to--
       ``(1) for policies issued during fiscal years 2010 through 
     2013, 50 cents multiplied by the average number of lives 
     covered under the policy; and
       ``(2) for policies issued after September 30, 2013, $1 
     multiplied by the average number of lives covered under the 
     policy.
       ``(b) Liability for Fee.--The fee imposed by subsection (a) 
     shall be paid by the issuer of the policy.
       ``(c) Specified Health Insurance Policy.--For purposes of 
     this section:
       ``(1) In general.--Except as otherwise provided in this 
     section, the term `specified health insurance policy' means 
     any accident or health insurance policy (including a policy 
     under a group health plan) issued with respect to individuals 
     residing in the United States.
       ``(2) Exemption for certain policies.--The term `specified 
     health insurance policy' does not include any insurance if 
     substantially all of its coverage is of excepted benefits 
     described in section 9832(c).
       ``(3) Treatment of prepaid health coverage arrangements.--
       ``(A) In general.--In the case of any arrangement described 
     in subparagraph (B)--
       ``(i) such arrangement shall be treated as a specified 
     health insurance policy, and
       ``(ii) the person referred to in such subparagraph shall be 
     treated as the issuer.
       ``(B) Description of arrangements.--An arrangement is 
     described in this subparagraph if under such arrangement 
     fixed payments or premiums are received as consideration for 
     any person's agreement to provide or arrange for the 
     provision of accident or health coverage to residents of the 
     United States, regardless of how such coverage is provided or 
     arranged to be provided.
       ``(d) Adjustments for Increases in Health Care Spending.--
     In the case of any policy issued in any fiscal year beginning 
     after September 30, 2014, the dollar amount in effect under 
     subsection (a) for such policy shall be equal to the sum of 
     such dollar amount for policies issued in the previous fiscal 
     year (determined after the application of this subsection), 
     plus an amount equal to the product of--
       ``(1) such dollar amount for policies issued in the 
     previous fiscal year, multiplied by
       ``(2) the percentage increase in the projected per capita 
     amount of National Health Expenditures from the calendar year 
     in which the previous fiscal year ends to the calendar year 
     in which the fiscal year involved ends, as most recently 
     published by the Secretary of Health and Human Services 
     before the beginning of the fiscal year.
       ``(e) Termination.--This section shall not apply to policy 
     years ending after September 30, 2019.

     ``SEC. 4386. SELF-INSURED HEALTH PLANS.

       ``(a) Imposition of Fee.--In the case of any applicable 
     self-insured health plan issued after October 1, 2009, there 
     is hereby imposed a fee equal to--
       ``(1) for plans issued during fiscal years 2010 through 
     2013, 50 cents multiplied by the average number of lives 
     covered under the plan; and
       ``(2) for plans issued after September 30, 2013, $1 
     multiplied by the average number of lives covered under the 
     plans.
       ``(b) Liability for Fee.--
       ``(1) In general.--The fee imposed by subsection (a) shall 
     be paid by the plan sponsor.
       ``(2) Plan sponsor.--For purposes of paragraph (1) the term 
     `plan sponsor' means--
       ``(A) the employer in the case of a plan established or 
     maintained by a single employer,
       ``(B) the employee organization in the case of a plan 
     established or maintained by an employee organization,
       ``(C) in the case of--
       ``(i) a plan established or maintained by 2 or more 
     employers or jointly by 1 or more employers and 1 or more 
     employee organizations,
       ``(ii) a multiple employer welfare arrangement, or
       ``(iii) a voluntary employees' beneficiary association 
     described in section 501(c)(9),
     the association, committee, joint board of trustees, or other 
     similar group of representatives of the parties who establish 
     or maintain the plan, or
       ``(D) the cooperative or association described in 
     subsection (c)(2)(F) in the case of a plan established or 
     maintained by such a cooperative or association.
       ``(c) Applicable Self-Insured Health Plan.--For purposes of 
     this section, the term `applicable self-insured health plan' 
     means any plan for providing accident or health coverage if--
       ``(1) any portion of such coverage is provided other than 
     through an insurance policy, and
       ``(2) such plan is established or maintained--
       ``(A) by one or more employers for the benefit of their 
     employees or former employees,
       ``(B) by one or more employee organizations for the benefit 
     of their members or former members,

[[Page 29618]]

       ``(C) jointly by 1 or more employers and 1 or more employee 
     organizations for the benefit of employees or former 
     employees,
       ``(D) by a voluntary employees' beneficiary association 
     described in section 501(c)(9),
       ``(E) by any organization described in section 501(c)(6), 
     or
       ``(F) in the case of a plan not described in the preceding 
     subparagraphs, by a multiple employer welfare arrangement (as 
     defined in section 3(40) of Employee Retirement Income 
     Security Act of 1974), a rural electric cooperative (as 
     defined in section 3(40)(B)(iv) of such Act), or a rural 
     telephone cooperative association (as defined in section 
     3(40)(B)(v) of such Act).
       ``(d) Adjustments for Increases in Health Care Spending.--
     In the case of any plan issued in any fiscal year beginning 
     after September 30, 2014, the dollar amount in effect under 
     subsection (a) for such plan shall be equal to the sum of 
     such dollar amount for plans issued in the previous fiscal 
     year (determined after the application of this subsection), 
     plus an amount equal to the product of--
       ``(1) such dollar amount for plans issued in the previous 
     fiscal year, multiplied by
       ``(2) the percentage increase in the projected per capita 
     amount of National Health Expenditures from the calendar year 
     in which the previous fiscal year ends to the calendar year 
     in which the fiscal year involved ends, as most recently 
     published by the Secretary of Health and Human Services 
     before the beginning of the fiscal year.
       ``(e) Termination.--This section shall not apply to plans 
     issued after September 30, 2019.

     ``SEC. 4387. DEFINITIONS AND SPECIAL RULES.

       ``(a) Definitions.--For purposes of this subchapter--
       ``(1) Accident and health coverage.--The term `accident and 
     health coverage' means any coverage which, if provided by an 
     insurance policy, would cause such policy to be a specified 
     health insurance policy (as defined in section 4385(c)).
       ``(2) Insurance policy.--The term `insurance policy' means 
     any policy or other instrument whereby a contract of 
     insurance is issued, renewed, or extended.
       ``(3) United states.--The term `United States' includes any 
     possession of the United States.
       ``(b) Treatment of Governmental Entities.--
       ``(1) In general.--For purposes of this subchapter--
       ``(A) the term `person' includes any governmental entity, 
     and
       ``(B) notwithstanding any other law or rule of law, 
     governmental entities shall not be exempt from the fees 
     imposed by this subchapter except as provided in paragraph 
     (2).
       ``(2) Treatment of exempt governmental programs.--In the 
     case of an exempt governmental program, no fee shall be 
     imposed under section 4385 or section 4386 on any covered 
     policy or plan under such program.
       ``(3) Exempt governmental program defined.--For purposes of 
     this subchapter, the term `exempt governmental program' 
     means--
       ``(A) any insurance program established under title XVIII 
     of the Social Security Act,
       ``(B) the medical assistance program established by title 
     XIX or XXI of the Social Security Act,
       ``(C) the Federal Employees Health Benefits Program under 
     chapter 89 of title 5, United States Code,
       ``(D) the Consumer Choice Health Plan established under 
     section 1323 of the Patient Protection and Affordable Care 
     Act,
       ``(E) any program established by Federal law for providing 
     medical care (other than through insurance policies) to 
     individuals (or the spouses and dependents thereof) by reason 
     of such individuals being--
       ``(i) members of the Armed Forces of the United States, or
       ``(ii) veterans, and
       ``(F) any program established by Federal law for providing 
     medical care (other than through insurance policies) to 
     members of Indian tribes (as defined in section 4(d) of the 
     Indian Health Care Improvement Act).
       ``(c) Treatment as Tax.--For purposes of subtitle F, the 
     fees imposed by this subchapter shall be treated as if they 
     were taxes.
       ``(d) No Cover Over to Possessions.--Notwithstanding any 
     other provision of law, no amount collected under this 
     subchapter shall be covered over to any possession of the 
     United States.''.
       (B) Clerical amendments.--
       (i) Chapter 34 of such Code is amended by striking the 
     chapter heading and inserting the following:

           ``CHAPTER 34--TAXES ON CERTAIN INSURANCE POLICIES

          ``subchapter a. policies issued by foreign insurers

         ``subchapter b. insured and self-insured health plans

  ``subchapter c. additional fees on insured and self-insured health 
                                 plans

         ``Subchapter A--Policies Issued By Foreign Insurers''.

       (ii) The table of chapters for subtitle D of such Code is 
     amended by striking the item relating to chapter 34 and 
     inserting the following new item:

          ``Chapter 34--Taxes on Certain Insurance Policies''.

     SEC. 1323B. DUTIES OF AMERICA'S HEALTH INSURANCE TRUST.

       (a) Insurance Plan Rankings and Website.--
       (1) Web-based materials.--The Trust shall establish and 
     maintain a website that provides informational materials 
     regarding the qualified health plans provided through the 
     Exchanges established under this title, including appropriate 
     links for all available State insurance commissioner 
     websites.
       (2) Plan rankings.--The Trust shall develop and publish 
     annual rankings of the qualified health plans provided 
     through the Exchanges, based on the assignment of a letter 
     grade between ``grade A'' (highest) and ``grade F'' (lowest). 
     The Trust shall provide for a comparative evaluation of each 
     plan based upon--
       (A) administrative expenditures;
       (B) affordability of coverage;
       (C) adequacy of coverage;
       (D) timeliness and adequacy of consumer claims processing;
       (E) available consumer complaint systems;
       (F) grievance and appeals processes;
       (G) transparency;
       (H) consumer satisfaction; and
       (I) any additional measures as determined by the Board.
       (3) Information available on website by zip code.--The 
     annual rankings of the qualified health plans (as described 
     in paragraph (2)) shall be available on the website for the 
     Trust (as described in paragraph (1)), and websites for the 
     Exchanges, in a manner that is searchable and sortable by zip 
     code.
       (4) Consumer feedback.--
       (A) Consumer complaints.--The Trust shall develop written 
     and web-based methods for individuals to provide 
     recommendations and complaints regarding the qualified health 
     plans provided through the Exchanges.
       (B) Consumer surveys.--The Trust shall obtain meaningful 
     consumer input, including consumer surveys, that measure the 
     extent to which an individual receives the services and 
     supports described in the individual's health insurance plan 
     and the individual's satisfaction with such services and 
     supports.
       (b) Data Sharing.--
       (1) In general.--An organization that provides a qualified 
     health plan through an Exchange shall provide the Trust with 
     all information and data that is necessary for improving 
     transparency, monitoring, and oversight of such plans.
       (2) Annual disclosure.--Beginning with the first full year 
     for which Exchanges are required to be operational under this 
     title, an organization that provides a qualified health plan 
     through an Exchange shall annually provide the Trust with 
     appropriate information regarding the following:
       (A) Name of the plan.
       (B) Levels of available plan benefits.
       (C) Description of plan benefits.
       (D) Number of enrollees under the plan.
       (E) Demographic profile of enrollees under the plan.
       (F) Number of claims paid to enrollees.
       (G) Number of enrollees that terminated their coverage 
     under the plan.
       (H) Total operating cost for the plan (including 
     administrative costs).
       (I) Patterns of utilization of the plan's services.
       (J) Availability, accessibility, and acceptability of the 
     plan's services.
       (K) Such information as the Trust may require demonstrating 
     that the organization has a fiscally sound operation.
       (L) Any additional information as determined by the Trust.
       (3) Form and manner of information.--Information to be 
     provided to the Trust under paragraphs (1) and (2) shall be 
     provided--
       (A) in such form and manner as specified by the Trust; and
       (B) within 30 days of the date of receipt of the request 
     for such information, or within such extended period as the 
     Trust deems appropriate.
       (4) Information from the department of health and human 
     services.--
       (A) In general.--Any information regarding the qualified 
     health plans that are offered through the Exchanges that has 
     been provided to the Secretary of Health and Human Services 
     shall also be made available (as deemed appropriate by the 
     Secretary) to the Trust for the purpose of improving 
     transparency, monitoring, and oversight of such plans. Such 
     information may include, but is not limited to, the 
     following:
       (i) Underwriting guidelines to ensure compliance with 
     applicable Federal health insurance requirements.
       (ii) Rating practices to ensure compliance with applicable 
     Federal health insurance requirements.
       (iii) Enrollment and disenrollment data, including 
     information the Secretary may need to detect patterns of 
     discrimination against individuals based on health status or 
     other characteristics, to ensure compliance with applicable 
     Federal health insurance requirements (including non-
     discrimination in group coverage, guaranteed issue, and 
     guaranteed renewability requirements applicable in all 
     markets).

[[Page 29619]]

       (iv) Post-claims underwriting and rescission practices to 
     ensure compliance with applicable Federal health insurance 
     requirements relating to guaranteed renewability.
       (v) Marketing materials and agent guidelines to ensure 
     compliance with applicable Federal health insurance 
     requirements.
       (vi) Data on the imposition of pre-existing condition 
     exclusion periods and claims subjected to such exclusion 
     periods.
       (vii) Information on issuance of certificates of creditable 
     coverage.
       (viii) Information on cost-sharing and payments with 
     respect to any out-of-network coverage.
       (ix) The application to issuers of penalties for violation 
     of applicable Federal health insurance requirements 
     (including failure to produce requested information).
       (x) Such other information as the Trust may determine to be 
     necessary to verify compliance with the requirements of this 
     section.
       (B) Required disclosure.--The Secretary of Health and Human 
     Services shall provide the Trust with all consumer claims 
     data or information that has been provided to the Secretary 
     by any qualified health plan that is offered through an 
     Exchange.
       (C) Period for providing information.--Information to be 
     provided to the Trust under this paragraph shall be provided 
     by the Secretary within 30 days of the date of receipt of the 
     request for such information, or within such extended period 
     as the Secretary and the Trust mutually deem appropriate.
       (5) Non-disclosure of health insurance data.--The Trust 
     shall prevent disclosure of any data or information provided 
     under this paragraph that the Trust determines is proprietary 
     or qualifies as a trade secret subject to withholding from 
     public dissemination. Any data or information provided under 
     this paragraph shall not be subject to disclosure under 
     section 552 of title 5, United States Code (commonly referred 
     to as the Freedom of Information Act).
                                 ______
                                 
  SA 2950. Mr. Rockefeller 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 34, between lines 4 and 5, insert the following:

     ``SEC. 2720. LIMITATION ON ANNUAL GROWTH IN HEALTH INSURANCE 
                   PREMIUMS.

       ``(a) In General.--A group health plan and a health 
     insurance issuer offering group or individual health 
     insurance coverage may not increase the health insurance 
     premium rates for such plan or coverage in any year by a 
     percentage that is greater than the percentage increase in 
     the Medical Care Component of the Consumer Price Index for 
     all urban consumers for year involved.
       ``(b) Effect.--If a plan or an issuer increases the health 
     insurance premium rate by a percentage greater than the 
     percentage described in subsection (a), that plan or issuer 
     shall refund the excess premium dollars back to the enrollee 
     or to the Federal treasury, in amounts equal to the 
     respective premium contributions of the enrollee and the 
     Federal Government, taking into account premium subsidies 
     provided to individuals or families for coverage purchased in 
     an Exchange.''.
                                 ______
                                 
  SA 2951. Mr. Rockefeller 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 112, between lines 8 and 9, insert the following:
       (5) Maximum total out-of-pocket expenses.--
       (A) In general.--Notwithstanding any other provision of 
     this Act (or any amendments made by this Act), in no case may 
     out-of-pocket expenses incurred under a health plan with 
     respect to self-only coverage or coverage other than self-
     only exceed the following limits for any plan year beginning 
     in or after 2014:
       (i) 7.5 percent of annual household income for an 
     individual with household income under 200 percent of the 
     poverty line for the size of the family involved.
       (ii) 10 percent of annual household income for an 
     individual with household income between 200 and 400 percent 
     of the poverty line for the size of the family involved.
       (iii) 12 percent of annual household income for an 
     individual with household income above 400 percent of the 
     poverty line for the size of the family involved.
       (B) Out-of-pocket expenses.--In this paragraph, the term 
     ``out-of-pocket expenses'' includes deductibles, coinsurance, 
     copayments, premiums, balance billing amounts for non-network 
     providers, and similar charges.
                                 ______
                                 
  SA 2952. Mr. Rockefeller submitted an amendment intended to be 
proposed to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. 
Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the 
Internal Revenue Code of 1986 to modify the first-time homebuyers 
credit in the case of members of the Armed Forces and certain other 
Federal employees, and for other purposes; which was ordered to lie on 
the table; as follows:

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

      Subtitle C--Provisions Relating to Authorized Generic Drugs

     SEC. 7201. PROHIBITION OF AUTHORIZED GENERICS.

       (a) In General.--Section 505 of the Federal Food, Drug, and 
     Cosmetic Act (21 U.S.C. 355) is amended by adding at the end 
     the following:
       ``(w) Prohibition of Authorized Generic Drugs.--
       ``(1) In general.--Notwithstanding any other provision of 
     this Act, no holder of a new drug application approved under 
     subsection (c) shall manufacture, market, sell, or distribute 
     an authorized generic drug, direct or indirectly, or 
     authorize any other person to manufacture, market, sell, or 
     distribute an authorized generic drug.
       ``(2) Authorized generic drug.--For purposes of this 
     subsection, the term `authorized generic drug'--
       ``(A) means any version of a listed drug (as such term is 
     used in subsection (j)) that the holder of the new drug 
     application approved under subsection (c) for that listed 
     drug seeks to commence marketing, selling, or distributing, 
     directly or indirectly, after receipt of a notice sent 
     pursuant to subsection (j)(2)(B) with respect to that listed 
     drug; and
       ``(B) does not include any drug to be marketed, sold, or 
     distributed--
       ``(i) by an entity eligible for exclusivity with respect to 
     such drug under subsection (j)(5)(B)(iv); or
       ``(ii) after expiration or forfeiture of any exclusivity 
     with respect to such drug under such subsection 
     (j)(5)(B)(iv).''.
       (b) Conforming Amendment.--Section 505(t)(3) of the Federal 
     Food, Drug, and Cosmetic Act (21 U.S.C. 355(t)(3)) is amended 
     by striking ``In this section'' and inserting ``In this 
     subsection''.

                          ____________________