[Congressional Record (Bound Edition), Volume 155 (2009), Part 22]
[Senate]
[Pages 29814-29842]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 3001. Mrs. HAGAN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

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

     SEC. 3316. IMPROVEMENT IN PART D MEDICATION THERAPY 
                   MANAGEMENT (MTM) PROGRAMS.

       (a) In General.--Section 1860D-4(c)(2) of the Social 
     Security Act (42 U.S.C. 1395w-104(c)(2)) is amended--
       (1) by redesignating subparagraphs (C), (D), and (E) as 
     subparagraphs (E), (F), and (G), respectively; and
       (2) by inserting after subparagraph (B) the following new 
     subparagraphs:
       ``(C) Required interventions.--For plan years beginning on 
     or after the date that is 2 years after the date of the 
     enactment of the Patient Protection and Affordable Care Act, 
     prescription drug plan sponsors shall offer medication 
     therapy management services to targeted beneficiaries 
     described in subparagraph (A)(ii) that include, at a minimum, 
     the following to increase adherence to prescription 
     medications or other goals deemed necessary by the Secretary:
       ``(i) An annual comprehensive medication review furnished 
     person-to-person or using telehealth technologies (as defined 
     by the Secretary) by a licensed pharmacist or other qualified 
     provider. The comprehensive medication review--

       ``(I) shall include a review of the individual's 
     medications and may result in the creation of a recommended 
     medication action plan or other actions in consultation with 
     the individual and with input from the prescriber to the 
     extent necessary and practicable; and
       ``(II) shall include providing the individual with a 
     written or printed summary of the results of the review.

     The Secretary, in consultation with relevant stakeholders, 
     shall develop a standardized format for the action plan under 
     subclause (I) and the summary under subclause (II).
       ``(ii) Follow-up interventions as warranted based on the 
     findings of the annual medication review or the targeted 
     medication enrollment and which may be provided person-to-
     person or using telehealth technologies (as defined by the 
     Secretary).
       ``(D) Assessment.--The prescription drug plan sponsor shall 
     have in place a process to assess, at least on a quarterly 
     basis, the medication use of individuals who are at risk but 
     not enrolled in the medication therapy management program, 
     including individuals who have experienced a transition in 
     care, if the prescription drug plan sponsor has access to 
     that information.

[[Page 29815]]

       ``(E) Automatic enrollment with ability to opt-out.--The 
     prescription drug plan sponsor shall have in place a process 
     to--
       ``(i) subject to clause (ii), automatically enroll targeted 
     beneficiaries described in subparagraph (A)(ii), including 
     beneficiaries identified under subparagraph (D), in the 
     medication therapy management program required under this 
     subsection; and
       ``(ii) permit such beneficiaries to opt-out of enrollment 
     in such program.''.
       (b) Rule of Construction.--Nothing in this section shall 
     limit the authority of the Secretary of Health and Human 
     Services to modify or broaden requirements for a medication 
     therapy management program under part D of title XVIII of the 
     Social Security Act or to study new models for medication 
     therapy management through the Center for Medicare and 
     Medicaid Innovation under section 1115A of such Act, as added 
     by section 3021.
                                 ______
                                 
  SA 3002. Mrs. HAGAN 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 1722, after line 24, insert the following:
       ``(C) Use of technology.--The Secretary shall incorporate 
     the use of technologies, including analytics and predictive 
     modeling, as part of the analysis process for the purpose of 
     identifying fraud, abuse, or improper payments prior to the 
     payment of claims. Such analysis technologies shall at a 
     minimum--
       ``(i) have the capability to detect emerging fraud schemes 
     through the use of automated predictive modeling techniques; 
     and
       ``(ii) improve the efficiency and effectiveness of current 
     fraud and abuse detection methods by incorporating predictive 
     risk scoring techniques that minimize investigations that 
     result in false positive outcomes.''.
                                 ______
                                 
  SA 3003. Mrs. HAGAN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of title III, insert the following:

                   Subtitle __--Better Diabetes Care

     SEC. __1. SHORT TITLE.

       This subtitle may be cited as the ``Catalyst to Better 
     Diabetes Care Act of 2009''.

     SEC. __2. DIABETES SCREENING COLLABORATION AND OUTREACH 
                   PROGRAM.

       (a) Establishment.--With respect to diabetes screening 
     tests and for the purposes of reducing the number of 
     undiagnosed seniors with diabetes or prediabetes, the 
     Secretary of Health and Human Services (referred to in this 
     subtitle as the ``Secretary''), in collaboration with the 
     Director of the Centers for Disease Control and Prevention 
     (referred to in this section as the ``Director''), shall--
       (1) review uptake and utilization of diabetes screening 
     benefits to identify and address any existing problems with 
     regard to utilization and data collection mechanisms;
       (2) establish an outreach program to identify existing 
     efforts by agencies and by the private and nonprofit sectors 
     to increase awareness among seniors and providers of diabetes 
     screening benefits; and
       (3) maximize cost effectiveness in increasing utilization 
     of diabetes screening benefits.
       (b) Consultation.--In carrying out this section, the 
     Secretary and the Director shall consult with--
       (1) various units of the Federal Government, including the 
     Centers for Medicare & Medicaid Services, the Surgeon General 
     of the Public Health Service, the Agency for Healthcare 
     Research and Quality, the Health Resources and Services 
     Administration, and the National Institutes of Health; and
       (2) entities with an interest in diabetes, including 
     industry, voluntary health organizations, trade associations, 
     and professional societies.

     SEC. __3. ADVISORY GROUP REGARDING EMPLOYEE WELLNESS AND 
                   DISEASE MANAGEMENT BEST PRACTICES.

       (a) Establishment.--The Secretary shall establish an 
     advisory group consisting of representatives of the public 
     and private sector. The advisory group shall include--
       (1) representatives of the Department of Health and Human 
     Services;
       (2) representatives of the Department of Commerce; and
       (3) members of the public, representatives of the private 
     sector, and representatives of the small business community, 
     who have experience with diabetes or in administering and 
     operating employee wellness and disease management programs.
       (b) Duties.--The advisory group established under 
     subsection (a) shall examine and make recommendations of best 
     practices of employee wellness and disease management 
     programs in order to--
       (1) provide public and private sector entities with 
     improved information in assessing the role of employee 
     wellness and disease management programs in saving money and 
     improving quality of life for patients with chronic 
     illnesses; and
       (2) encourage the adoption of effective employee wellness 
     and disease management programs.
       (c) Report.--Not later than 1 year after the date of the 
     enactment of this Act, the advisory group established under 
     subsection (a) shall submit to the Secretary the results of 
     the examination under subsection (b)(1).

     SEC. __4. NATIONAL DIABETES REPORT CARD.

       (a) In General.--The Secretary, in collaboration with the 
     Director of the Centers for Disease Control and Prevention 
     (referred to in this section as the ``Director''), shall 
     prepare on a biennial basis a national diabetes report card 
     (referred to in this section as a ``Report Card'') and, to 
     the extent possible, for each State.
       (b) Contents.--
       (1) In general.--Each Report Card shall include aggregate 
     health outcomes related to individuals diagnosed with 
     diabetes and prediabetes including--
       (A) preventative care practices and quality of care;
       (B) risk factors; and
       (C) outcomes.
       (2) Updated reports.--Each Report Card that is prepared 
     after the initial Report Card shall include trend analysis 
     for the Nation and, to the extent possible, for each State, 
     for the purpose of--
       (A) tracking progress in meeting established national goals 
     and objectives for improving diabetes care, costs, and 
     prevalence (including Healthy People 2010); and
       (B) informing policy and program development.
       (c) Availability.--The Secretary, in collaboration with the 
     Director, shall make each Report Card publicly available, 
     including by posting the Report Card on the Internet.

     SEC. __5. IMPROVEMENT OF VITAL STATISTICS COLLECTION.

       (a) In General.--The Secretary, acting through the Director 
     of the Centers for Disease Control and Prevention and in 
     collaboration with appropriate agencies and States, shall--
       (1) promote the education and training of physicians on the 
     importance of birth and death certificate data and how to 
     properly complete these documents, including the collection 
     of such data for diabetes and other chronic diseases;
       (2) encourage State adoption of the latest standard 
     revisions of birth and death certificates; and
       (3) work with States to re-engineer their vital statistics 
     systems in order to provide cost-effective, timely, and 
     accurate vital systems data.
       (b) Death Certificate Additional Language.--In carrying out 
     this section, the Secretary may promote improvements to the 
     collection of diabetes mortality data, including the addition 
     of a question for the individual certifying the cause of 
     death regarding whether the deceased had diabetes.

     SEC. __6. STUDY ON APPROPRIATE LEVEL OF DIABETES MEDICAL 
                   EDUCATION.

       (a) In General.--The Secretary shall, in collaboration with 
     the Institute of Medicine and appropriate associations and 
     councils, conduct a study of the impact of diabetes on the 
     practice of medicine in the United States and the 
     appropriateness of the level of diabetes medical education 
     that should be required prior to licensure, board 
     certification, and board recertification.
       (b) Report.--Not later than 2 years after the date of the 
     enactment of this Act, the Secretary shall submit a report on 
     the study under subsection (a) to the Committees on Ways and 
     Means and Energy and Commerce of the House of Representatives 
     and the Committees on Finance and Health, Education, Labor, 
     and Pensions of the Senate.

     SEC. __7. AUTHORIZATION OF APPROPRIATIONS.

       There are authorized to be appropriated to carry out this 
     subtitle such sums as may be necessary.
                                 ______
                                 
  SA 3004. Mrs. HAGAN (for herself and Mr. Bennet) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 32, after line 24, add the following:
       ``(d) Clear Transparency of Health Care Charges.--

[[Page 29816]]

       ``(1) Public disclosure of reimbursement amounts.--A health 
     insurance issuer offering group or individual health 
     insurance coverage shall report at least once a year to the 
     Secretary the current allowable reimbursement that the issuer 
     will provide for all covered benefits and services (other 
     than prescription medications dispensed through a licensed 
     pharmacy), including--
       ``(A) with respect to services provided by in-network 
     providers where payment is made in part or in full on a fee 
     for service basis, the current allowed charge for specific 
     services using currently accepted procedure coding associated 
     with each provider; and
       ``(B) the expected reasonable and allowed charges made for 
     services by out-of-network providers and the amount the 
     issuer would reimburse for such charges.
       ``(2) Accessibility.--Information submitted to the 
     Secretary under paragraph (1) shall be maintained by the 
     Secretary in a manner that ensures that such information is 
     readily accessible by the public.
       ``(3) Regulations.--Not later than one year after the date 
     of enactment of the Patient Protection and Affordable Care 
     Act, the Secretary shall promulgate regulations to implement 
     the requirements of this subsection.''.
                                 ______
                                 
  SA 3005. Ms. LANDRIEU (for herself, Mrs. Shaheen, and Ms. Snowe) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 150, line 5, strike ``small business development 
     centers'' and insert ``resource partners of the Small 
     Business Administration''.
                                 ______
                                 
  SA 3006. Ms. LANDRIEU (for herself, Mrs. Shaheen, and Ms. Snowe) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 1280, between lines 18 and 19, insert the 
     following:

       (VIII) small business concerns (as defined under section 3 
     of the Small Business Act (15 U.S.C. 632)) and self-employed 
     individuals; and

                                 ______
                                 
  SA 3007. Ms. LANDRIEU (for herself, Mrs. Shaheen, and Ms. Snowe) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 163, between lines 21 and 22, insert the following:
       (4) a survey of the cost and affordability of health care 
     insurance provided under the Exchanges for owners and 
     employees of small business concerns (as defined under 
     section 3 of the Small Business Act (15 U.S.C. 632)), 
     including data on enrollees in Exchanges and individuals 
     purchasing health insurance coverage outside of Exchanges; 
     and
                                 ______
                                 
  SA 3008. Ms. LANDRIEU (for herself, Ms. Snowe, and Mrs. Shaheen) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

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

     SEC. 9024. SMALL BUSINESS PROCUREMENT.

       Part 19 of the Federal Acquisition Regulation, section 15 
     of the Small Business Act (15 U.S.C. 644), and any other 
     applicable laws or regulations establishing procurement 
     requirements relating to small business concerns (as defined 
     in section 3 of the Small Business Act (15 U.S.C. 632)) may 
     not be waived with respect to any contract awarded under any 
     program or other authority under this Act or an amendment 
     made by this Act.
                                 ______
                                 
  SA 3009. Ms. LANDRIEU (for herself, Mrs. Shaheen, and Ms. Snowe) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 54, between lines 16 and 17, insert the following:
       (f) Allocation of Funding for Small Businesses.--Of the 
     amount appropriated under subsection (e), a reasonable 
     amount, as determined by the Secretary, shall be used to 
     provide reimbursement to participating employment-based plans 
     of small employers with 50 or fewer employees.
                                 ______
                                 
  SA 3010. Ms. LANDRIEU (for herself, Mrs. Shaheen, and Ms. Snowe) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       Beginning on page 55, line 4, strike ``website,'' and all 
     that follows through line 5 on page 56 and insert the 
     following: ``website, through which a resident of, or small 
     business in, any State may identify affordable health 
     insurance coverage options in that State.
       (2) Connecting to affordable coverage.--An Internet website 
     established under paragraph (1) shall, to the extent 
     practicable, provide ways for residents of, and small 
     businesses in, any State to receive information on at least 
     the following coverage options:
       (A) Health insurance coverage offered by health insurance 
     issuers, other than coverage that provides reimbursement only 
     for the treatment or mitigation of--
       (i) a single disease or condition; or
       (ii) an unreasonably limited set of diseases or conditions 
     (as determined by the Secretary).
       (B) Medicaid coverage under title XIX of the Social 
     Security Act.
       (C) Coverage under title XXI of the Social Security Act.
       (D) A State health benefits high risk pool, to the extent 
     that such high risk pool is offered in such State; and
       (E) Coverage under a high risk pool under section 1101.
       (F) Coverage within the small group market for small 
     businesses and their employees, including reinsurance for 
     early retirees under section 1102, tax credits available 
     under section 45R of the Internal Revenue Code of 1986 (as 
     added by section 1421), and other information specifically 
     for small businesses regarding affordable health care 
     options.''.
                                 ______
                                 
  SA 3011. Ms. LANDRIEU (for herself, Mrs. Shaheen, and Mrs. Lincoln) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       Beginning on page 349, line 16, strike all through page 
     350, line 14.
                                 ______
                                 
  SA 3012. Ms. LANDRIEU (for herself, Mrs. Shaheen, and Ms. Stabenow) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

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

     SEC. 9024. EXTENSION OF SMALL BUSINESS TAX CREDIT TO 5 YEARS.

       (a) In General.--Section 45R(e)(2) of the Internal Revenue 
     Code of 1986, as added by section 1421(a), is amended by 
     striking ``2-consecutive-taxable year'' and inserting ``5-
     consecutive-taxable year''.
       (b) Conforming Amendment.--Section 45R(i)) of the Internal 
     Revenue Code of 1986, as so added, is amended by striking 
     ``2-year'' and inserting ``5-year''.

[[Page 29817]]

       (c) Effective Date.--The amendments made by this section 
     shall take effect as if included in the enactment of section 
     1421.
                                 ______
                                 
  SA 3013. Ms. LANDRIEU (for herself, Mrs. Shaheen, and Ms. Stabenow) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 274, after line 25, add the following:

     SEC. 90__. PARTIAL DEDUCTION FOR HEALTH INSURANCE COSTS IN 
                   COMPUTING SELF-EMPLOYMENT TAXES.

       (a) In General.--Paragraph (4) of section 162(l) of the 
     Internal Revenue Code of 1986 is amended to read as follows:
       ``(4) Reduced deduction for self-employment tax purposes.--
     In determining an individual's net earnings from self-
     employment (within the meaning of section 1402(a)) for 
     purposes of chapter 2, the deduction allowable by reason of 
     this subsection shall be reduced by an amount equal to 50 
     percent of the amount which would otherwise be allowable 
     (determined without regard to this paragraph).''.
       (b) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after the date of the 
     enactment of this Act.
                                 ______
                                 
  SA 3014. Ms. LANDRIEU (for herself, Mrs. Shaheen, and Ms. Stabenow) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

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

     SEC. 9024. EXTENSION OF SMALL BUSINESS TAX CREDIT TO 2010.

       (a) In General.--Subsections (d)(3)(B)(i) and (g) of 
     section 45R of the Internal Revenue Code of 1986, as added by 
     section 1421(a), is amended by striking ``2011'' each place 
     it appears and inserting ``2010, 2011''.
       (b) Conforming Amendments.--
       (1) Section 280C(h) of the Internal Revenue Code of 1986, 
     as added by section 1421(d)(1), is amended by striking 
     ``2011'' and inserting ``2010, 2011''.
       (2) Section 1421(f) is amended by striking ``2010'' both 
     places it appears and inserting ``2009''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect as if included in the enactment of section 
     1421.
                                 ______
                                 
  SA 3015. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place, insert the following:

     SEC. __. PROTECTION OF ACCESS TO QUALITY HEALTH CARE THROUGH 
                   THE DEPARTMENT OF VETERANS AFFAIRS AND THE 
                   DEPARTMENT OF DEFENSE.

       (a) Health Care Through Department of Veterans Affairs.--
     Nothing in this Act shall be construed to prohibit, limit, or 
     otherwise penalize veterans and dependents eligible for 
     health care through the Department of Veterans Affairs under 
     the laws administered by the Secretary of Veterans Affairs 
     from receiving timely access to quality health care in any 
     facility of the Department or from any non-Department health 
     care provider through which the Secretary provides health 
     care.
       (b) Health Care Through Department of Defense.--
       (1) In general.--Nothing in this Act shall be construed to 
     prohibit, limit, or otherwise penalize eligible beneficiaries 
     from receiving timely access to quality health care in any 
     military medical treatment facility or under the TRICARE 
     program.
       (2) Definitions.--In this subsection:
       (A) The term ``eligible beneficiaries'' means covered 
     beneficiaries (as defined in section 1072(5) of title 10, 
     United States Code) for purposes of eligibility for mental 
     and dental care under chapter 55 of title 10, United States 
     Code.
       (B) The term ``TRICARE program'' has the meaning given that 
     term in section 1072(7) of title 10, United States Code.
                                 ______
                                 
  SA 3016. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 246, between lines 7 and 8, insert the following:
       ``(C) Special rules to ensure citizens and nationals of the 
     united states have the same health care choices as legal 
     immigrants.--
       ``(i) In general.--Notwithstanding any other provision of 
     this Code, the Patient Protection and Affordable Care Act, or 
     any amendment made by that Act, any taxpayer who--

       ``(I) is a citizen or national of the United States; and
       ``(II) has a household income which is not greater than 133 
     percent of an amount equal to the poverty line for a family 
     of the size involved,

     may elect to enroll in a qualified health plan through the 
     Exchange established by the State under section 1311 of the 
     Patient Protection and Affordable Care Act instead of 
     enrolling in the State Medicaid plan under title XIX of the 
     Social Security, or under a waiver of such plan.
       ``(ii) Special rules.--

       ``(I) An individual making an election under clause (i) 
     shall waive being provided with medical assistance under the 
     State Medicaid plan under title XIX of the Social Security, 
     or under a waiver of such plan while enrolled in a qualified 
     health plan.
       ``(II) In the case of an individual who is a child, the 
     child's parent or legal guardian may make such an election on 
     behalf of the child.
       ``(III) Any individual making such an election, or on whose 
     behalf such an election is made, shall be treated as an 
     applicable taxpayer with a household income which is equal to 
     100 percent of the poverty line for a family of the size 
     involved.

                                 ______
                                 
  SA 3017. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of part I of subtitle C of title I, insert the 
     following:

     SEC. 1202. APPLICATION OF WELLNESS PROGRAMS PROVISIONS TO 
                   CARRIERS PROVIDING FEDERAL EMPLOYEE HEALTH 
                   BENEFITS PLANS.

       (a) In General.--Notwithstanding section 8906 of title 5, 
     United States Code (including subsections (b)(1) and (b)(2) 
     of such section), section 2705(j) of the Public Health 
     Service Act (as added by section 1201) (relating to wellness 
     programs) shall apply to carriers entering into contracts 
     under section 8902 of title 5, United States Code.
       (b) Proposals.--Carriers may submit separate proposals 
     relating to voluntary wellness program offerings as part of 
     the annual call for benefit and rate proposals to the Office 
     of Personnel Management.
       (c) Effective Date.--This subsection shall take effect on 
     the date of enactment of this Act and shall apply to 
     contracts entered into under section 8902 of title 5, United 
     States Code, that take effect with respect to calendar years 
     that begin more than 1 year after that date.
                                 ______
                                 
  SA 3018. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place, insert the following:

     SEC. __. APPOINTMENT OF HEALTH CARE CZARS.

       Notwithstanding any other provision of this Act, any 
     individual appointed by the President as a czar to handle 
     health care issues shall be subject to Senate confirmation.
                                 ______
                                 
  SA 3019. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R.

[[Page 29818]]

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 100, line 16, insert `` or meets the requirements 
     for a high deductible health plan under section 223(c)(2) of 
     the Internal Revenue Code of 1986'' after ``section 
     1302(a)''.
                                 ______
                                 
  SA 3020. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place, insert the following:

     SEC. __. EQUIVALENT BANKRUPTCY PROTECTIONS FOR HEALTH SAVINGS 
                   ACCOUNTS AS RETIREMENT FUNDS.

       (a) In General.--Section 522 of title 11, United States 
     Code, is amended by adding at the end the following new 
     subsection:
       ``(r) Treatment of Health Savings Accounts.--For purposes 
     of this section, any health savings account (as described in 
     section 223 of the Internal Revenue Code of 1986) shall be 
     treated in the same manner as an individual retirement 
     account described in section 408 of such Code.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to cases commencing under title 11, United States 
     Code, after the date of the enactment of this Act.
                                 ______
                                 
  SA 3021. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

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

     SEC. 3115. ENSURING THAT AN INDIVIDUAL WHO ELECTS TO OPT-OUT 
                   OF MEDICARE PART A BENEFITS IS NOT ALSO 
                   REQUIRED TO OPT-OUT OF SOCIAL SECURITY 
                   BENEFITS.

       Notwithstanding any other provision of law, in the case of 
     an individual who elects to opt-out of benefits under part A 
     of title XVIII of the Social Security Act, such individual 
     shall not be required to opt-out of benefits under title II 
     of such Act as a condition for making such election.
                                 ______
                                 
  SA 3022. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 923, between lines 7 and 8, insert the following:

     SEC. __. LIMITATION ON IMPLEMENTATION.

       Notwithstanding any other provision of law, the Secretary 
     of Health and Human Services (in this section referred to as 
     the ``Secretary'') shall not implement the amendments made by 
     and the provisions of this part for any year unless the 
     Secretary certifies with respect to such year that such 
     amendments and provisions will not result in any individual 
     who would otherwise be enrolled in a Medicare Advantage plan 
     under part C of title XVIII of the Social Security Act being 
     forced away from or losing their enrollment in such plan, as 
     such enrollment was in effect on the day before the date of 
     enactment of this Act.
                                 ______
                                 
  SA 3023. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1053, between lines 2 and 3, insert the following:

     SEC. 3404. ENSURING MEDICARE SAVINGS ARE KEPT IN THE MEDICARE 
                   PROGRAM.

       No reduction in outlays under the Medicare program under 
     title XVIII of the Social Security Act under the provisions 
     of and amendments made by this Act may be utilized to offset 
     any outlays under any other program or activity of the 
     Federal government.
                                 ______
                                 
  SA 3024. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place, insert the following:

     SEC. __. PROHIBITION ON USING MEDICARE SAVINGS TO OFFSET 
                   PROGRAMS UNRELATED TO MEDICARE.

       Title III of the Congressional Budget Act of 1974 (2 U.S.C. 
     621 et seq.) is amended by adding at the end the following:

     ``SEC. 316. PROHIBITION ON USING MEDICARE SAVINGS TO OFFSET 
                   PROGRAMS UNRELATED TO MEDICARE.

       ``For purposes of this title and title IV, a reduction in 
     outlays under title XVIII of the Social Security Act may not 
     be counted as an offset to any outlays under any other 
     program or activity of the Federal Government.''.
                                 ______
                                 
  SA 3025. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1050, between lines 9 and 10, insert the following:
       ``(n) Reductions in Medicare Program Spending Not Counted 
     Towards the Pay-as-you-go Scorecard.--Any reductions in 
     Medicare program spending enacted pursuant to this section 
     shall not count towards the pay-as-you-go scorecard under 
     section 201(a)(6) of S. Con. Res. 21 (110th Congress).''.
                                 ______
                                 
  SA 3026. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 2044, between lines 7 and 8, insert the following:
       (d) Additional Hospital Insurance Tax Solely Dedicated to 
     Medicare.--It is the policy of Congress that the additional 
     hospital insurance taxes resulting from the amendments made 
     by this section shall, as is the case regarding such taxes 
     under the Social Security Act as in effect on the date of the 
     enactment of this Act, be deposited into the Federal Hospital 
     Insurance Trust Fund and under the terms of that Trust Fund 
     used only for purposes of funding the medicare program under 
     part A of title XVIII of the Social Security Act.
                                 ______
                                 
  SA 3027. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

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

     SEC. 2008. STATE OPTION TO OPT-OUT OF MEDICAID COVERAGE 
                   EXPANSION TO AVOID ASSUMING UNFUNDED FEDERAL 
                   MANDATE.

       Notwithstanding any other provision of this Act (or an 
     amendment made by this Act), the Governor of a State shall 
     have the authority to opt out of any provision under this Act 
     or any amendment made by this Act that requires the State to 
     expand coverage under the Medicaid program if the State 
     agency responsible for administering the State plan under 
     title XIX certifies that such expansion would result in an 
     increase of at least 1 percent in the total amount of 
     expenditures by the State for providing medical assistance to 
     all individuals enrolled under the State plan, when compared 
     to the

[[Page 29819]]

     total amount of such expenditures for the most recently ended 
     State fiscal year.
                                 ______
                                 
  SA 3028. Mr. ENSIGN submitted an amendment intended to be proposed by 
him to the bill H.R. 3590, to amend the Internal Revenue Code of 1986 
to modify the first-time homebuyers credit in the case of members of 
the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. STUDY AND REPORT ON MEDICARE COVERAGE FOR MEDICAL 
                   EQUIPMENT USED IN THE TREATMENT OF CIRCULATORY 
                   DISEASES.

       (a) Study.--The Secretary of Health and Human Services 
     shall conduct a study on the feasibility and advisability of 
     providing for reimbursement under the Medicare program under 
     title XVIII of the Social Security Act for gradient pumps and 
     compression stockings that are used in the treatment of 
     individuals with lymphedema, chronic venous insufficiency, 
     and other circulatory diseases. Such study shall include an 
     analysis of the following:
       (1) The types of gradient pumps and compression stockings 
     that are currently available on the market.
       (2) The clinical appropriateness of providing gradient 
     pumps and compression stockings for Medicare beneficiaries 
     who have been diagnosed with lymphedema, chronic venous 
     insufficiency, and other circulatory diseases.
       (3) The financial impact on the Medicare program (including 
     a description of any resulting costs or savings) if 
     reimbursement were to be provided for gradient pumps and 
     compression stockings that are used in the treatment of 
     lymphedema, chronic venous insufficiency, and other 
     circulatory diseases.
       (b) Report.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall submit a report to Congress on the study 
     conducted under subsection (a), together with recommendations 
     for such legislation and administrative action as the 
     Secretary determines appropriate.
                                 ______
                                 
  SA 3029. Mr. THUNE 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 356, between lines 19 and 20, insert the following:
       ``(f) Limitation.--A full-time employee shall not be taken 
     into account for purposes of calculating the amount of any 
     assessable payment imposed under subsections (a), (b), or (c) 
     if such employee performs the majority of services in a 
     State--
       ``(1) the unemployment rate of which exceeds 6 percent, and
       ``(2) the Governor of which has certified that the 
     assessable penalties imposed under this section have 
     contributed to such unemployment rate.''.
                                 ______
                                 
  SA 3030. Mrs. FEINSTEIN (for herself, Mr. Rockefeller, and Mr. 
Whitehouse) submitted an amendment intended to be proposed to amendment 
SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and 
Mr. Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code 
of 1986 to modify the first-time homebuyers credit in the case of 
members of the Armed Forces and certain other Federal employees, and 
for other purposes; which was ordered to lie on the table; as follows:
       On page 37, strike line 10 through line 14 and insert the 
     following:
       ``(1) In general.--
       ``(A) Establishment.--The Secretary, in conjunction with 
     States, shall establish a uniform process for the annual 
     review, beginning with the 2010 plan year and subject to 
     subsection (b)(2)(A), of unreasonable increases in premiums 
     for health insurance coverage.
       ``(B) Electronic reporting.--The process established under 
     subparagraph (A) shall include an electronic reporting system 
     established by the Secretary through which health insurance 
     issuers shall report to the Secretary and State insurance 
     commissioners the information requested by the Secretary 
     pursuant to this subsection.

       On page 37, between lines 24 and 25, insert the following:
       ``(3) Health insurance rate authority.--
       ``(A) In general.--The Secretary shall establish a Health 
     Insurance Rate Authority (referred to in this paragraph as 
     the `Authority') to be composed of 7 members to be appointed 
     by the Secretary, of which--
       ``(i) at least 2 members shall be a consumer advocate with 
     expertise in the insurance industry;
       ``(ii) at least 1 member shall be an individual who is a 
     medical professional;
       ``(iii) at least 1 member shall be a representative of 
     health insurance issuers; and
       ``(iv) such remaining members shall be individuals who are 
     recognized for their expertise in health finance and 
     economics, actuarial science, health facility management, 
     health plans and integrated delivery systems, reimbursement 
     of health facilities, and other related fields, who provide 
     broad geographic representation and a balance between urban 
     and rural members.
       ``(B) Role.--In addition to the other duties of the 
     Authority set forth in this subsection, the Authority shall 
     advise and make recommendations to the Secretary concerning 
     the Secretary's duties under this subsection.
       ``(4) Corrective action for unjustified rate increases.--
       ``(A) In general.--Pursuant to the procedures set forth in 
     this paragraph, the Secretary or the relevant State insurance 
     commissioner shall--
       ``(i) review potentially unreasonable rate increases and 
     determine whether such increases are justified; and
       ``(ii) take action to ensure that any rate increase found 
     to be unjustified under clause (i) is corrected, through 
     mechanisms including--

       ``(I) denial of the rate increase;
       ``(II) modification of the rate increase;
       ``(III) ordering rebates to consumers; or
       ``(IV) any other actions that correct for the unjustified 
     increase.

       ``(B) Required report.--The Secretary shall ensure that, 
     not later than 6 months after the date of enactment of the 
     Patient Protection and Affordable Care Act, the National 
     Association of Insurance Commissioners (referred to in this 
     section as the `Association'), in conjunction with States, or 
     other appropriate body, will provide to the Secretary and the 
     Authority a report on--
       ``(i) State authority to review rates in each insurance 
     market, and methodologies used in such reviews;
       ``(ii) rating requests received by the State in the 
     previous 12 months and subsequent actions taken by States to 
     approve, deny, or modify such requests; and
       ``(iii) justifications by insurance issuers for rate 
     requests.
       ``(C) Determination of who conducts reviews for each 
     state.--Using the report submitted pursuant to subparagraph 
     (B), the Secretary shall determine not later than 1 year 
     after the date of enactment of the Patient Protection and 
     Affordable Care Act--
       ``(i) for which States the State insurance commissioner 
     shall undertake the actions described in subparagraph (A)--

       ``(I) based on the Secretary's determination that the State 
     has sufficient authority and capability to deny rates, modify 
     rates, provide rebates, or take other corrective actions; and
       ``(II) as a condition of receiving a grant under subsection 
     (c)(1); and

       ``(ii) for which States the Secretary shall undertake the 
     actions described in subparagraph (A), based on the 
     Secretary's determination that such States lacks the 
     authority and capability described in clause (i).
       ``(D) Transition period.--Until the Secretary makes the 
     determinations described in subparagraph (C), the relevant 
     State insurance commissioner shall, as a condition of 
     receiving a grant under subsection (c)(1), carry out the 
     action described in subparagraph (A).
       ``(E) Sunset.--Beginning on the date on which subsection 
     (b)(2)(A) applies, the requirements of this paragraph shall 
     no longer have force or effect.
       ``(5) Prioritizing proposed premium increases for review.--
     In determining which proposed premium increases to review 
     under this subsection, the Secretary or the relevant State 
     insurance commissioner may prioritize--
       ``(A) rate increases which exceed market averages;
       ``(B) rate increases that will impact large numbers of 
     consumers; and
       ``(C) rate reviews requested from States, if applicable.
       ``(6) Annual report.--
       ``(A) Uniform data collection system.--The Secretary, in 
     consultation with the Association and the Authority, shall 
     develop a uniform data collection system for rate 
     information, which shall include information on rates, 
     medical loss ratios, consumer complaints, solvency, reserves, 
     and any other relevant factors of market conduct.
       ``(B) Preparation of annual report.--Using the data 
     obtained in accordance with subparagraph (A), the Authority 
     shall annually produce a single, aggregate report on 
     insurance market behavior, which includes--
       ``(i) State-by-State information on rate increases from one 
     year to the next, including by issuer and by market and 
     including medical trends, benefit changes, and relevant 
     demographic changes; and
       ``(ii) a national growth rate percentage for every issuer, 
     which shall be based on aggregated data of such issuer from 
     premiums sold in the each market.

[[Page 29820]]

       ``(C) Distribution.--The Authority shall share the annual 
     report described in subparagraph (B) with States, and include 
     such report in the information disclosed to the public.
       ``(7) Recommendation on exchange participation.--
       ``(A) In general.--Based on the information provided 
     pursuant to this subsection and other relevant information, 
     the official described in subparagraph (B) shall make 
     recommendations to State Exchanges about whether particular 
     health insurance issuers should be excluded from 
     participation in the Exchange based on a pattern of excessive 
     premium increases, low medical loss ratios, or market 
     conduct.
       ``(B) Reviewing official.--Either the Secretary or the 
     relevant State insurance commissioner or commissioners, based 
     on the determination in paragraph (4)(C), shall make the 
     recommendations described in subparagraph (A).
       On page 144, line 12, strike ``may'' and insert ``shall''.
                                 ______
                                 
  SA 3031. Mr. WHITEHOUSE (for himself and Mr. Casey) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

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

     SEC. 5510. SUPPORT OF GRADUATE MEDICAL EDUCATION PROGRAMS IN 
                   WOMEN'S HOSPITALS.

       Subpart IX of part D of title III of the Public Health 
     Service Act (42 U.S.C. 256e et seq.) is amended--
       (1) in the subpart heading, by adding ``and Women's 
     Hospitals'' at the end; and
       (2) by adding at the end the following:

     ``SEC. 340E-1. SUPPORT OF GRADUATE MEDICAL EDUCATION PROGRAMS 
                   IN WOMEN'S HOSPITALS.

       ``(a) Payments.--The Secretary shall make two payments 
     under this section to each women's hospital for each of 
     fiscal years 2010 through 2014, one for the direct expenses 
     and the other for indirect expenses associated with operating 
     approved graduate medical residency training programs. The 
     Secretary shall promulgate regulations pursuant to the 
     rulemaking requirements of title 5, United States Code, which 
     shall govern payments made under this subpart.
       ``(b) Amount of Payments.--
       ``(1) In general.--Subject to paragraphs (2) and (3), the 
     amounts payable under this section to a women's hospital for 
     an approved graduate medical residency training program for a 
     fiscal year shall be each of the following:
       ``(A) Direct expense amount.--The amount determined in 
     accordance with subsection (c) for direct expenses associated 
     with operating approved graduate medical residency training 
     programs for a fiscal year.
       ``(B) Indirect expense amount.--The amount determined in 
     accordance with subsection (c) for indirect expenses 
     associated with the treatment of more severely ill patients 
     and the additional costs relating to teaching residents in 
     such programs for a fiscal year.
       ``(2) Capped amount.--
       ``(A) In general.--The total of the payments made to 
     women's hospitals under paragraph (1) in a fiscal year shall 
     not exceed the funds appropriated under subsection (e) for 
     such payments for that fiscal year.
       ``(B) Pro rata reductions of payments.--If the Secretary 
     determines that the amount of funds appropriated under 
     subsection (e) for a fiscal year is insufficient to provide 
     the total amount of payments otherwise due for such periods 
     under paragraph (1), the Secretary shall reduce the amounts 
     so payable on a pro rata basis to reflect such shortfall.
       ``(3) Annual reporting required.--The provisions of 
     subsection (b)(3) of section 340E shall apply to women's 
     hospitals under this section in the same manner as such 
     provisions apply to children's hospitals under such section 
     340E. In applying such provisions, the Secretary may make 
     such modifications as may be necessary to apply such 
     provisions to women's hospitals.
       ``(c) Application of Certain Provisions.--The provisions of 
     subsections (c) and (d) of section 340E shall apply to 
     women's hospitals under this section in the same manner as 
     such provisions apply to children's hospitals under such 
     section 340E. In applying such provisions, the Secretary may 
     make such modifications as may be necessary to apply such 
     provisions to women's hospitals.
       ``(d) Making of Payments.--
       ``(1) Interim payments.--The Secretary shall determine, 
     before the beginning of each fiscal year involved for which 
     payments may be made for a hospital under this section, the 
     amounts of the payments for direct graduate medical education 
     and indirect medical education for such fiscal year and shall 
     (subject to paragraph (2)) make the payments of such amounts 
     in 12 equal interim installments during such period. Such 
     interim payments to each individual hospital shall be based 
     on the number of residents reported in the hospital's most 
     recently filed Medicare cost report prior to the application 
     date for the Federal fiscal year for which the interim 
     payment amounts are established. In the case of a hospital 
     that does not report residents on a Medicare cost report, 
     such interim payments shall be based on the number of 
     residents trained during the hospital's most recently 
     completed Medicare cost report filing period.
       ``(2) Withholding.--The Secretary shall withhold up to 25 
     percent from each interim installment for direct and indirect 
     graduate medical education paid under paragraph (1) as 
     necessary to ensure a hospital will not be overpaid on an 
     interim basis.
       ``(3) Reconciliation.--Prior to the end of each fiscal 
     year, the Secretary shall determine any changes to the number 
     of residents reported by a hospital in the application of the 
     hospital for the current fiscal year to determine the final 
     amount payable to the hospital for the current fiscal year 
     for both direct expense and indirect expense amounts. Based 
     on such determination, the Secretary shall recoup any 
     overpayments made and pay any balance due to the extent 
     possible. The final amount so determined shall be considered 
     a final intermediary determination for the purposes of 
     section 1878 of the Social Security Act and shall be subject 
     to administrative and judicial review under that section in 
     the same manner as the amount of payment under section 
     1886(d) of such Act is subject to review under such section.
       ``(e) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $12,000,000 for fiscal year 2010, and such sums as may be 
     necessary for each of fiscal years 2011 through 2014.
       ``(f) Definitions.--In this section:
       ``(1) Approved graduate medical residency training 
     program.--The term `approved graduate medical residency 
     training program' has the meaning given the term `approved 
     medical residency training program' in section 1886(h)(5)(A) 
     of the Social Security Act.
       ``(2) Direct graduate medical education costs.--The term 
     `direct graduate medical education costs' has the meaning 
     given such term in section 1886(h)(5)(C) of the Social 
     Security Act.
       ``(3) Women's hospital.--The term `women's hospital' means 
     a hospital--
       ``(A) that has a Medicare provider agreement under title 
     XVIII of the Social Security Act;
       ``(B) that has an approved graduate medical residency 
     training program;
       ``(C) that has not been excluded from the Medicare 
     prospective payment system;
       ``(D) that had at least 3,000 births during 2007, as 
     determined by the Centers for Medicare & Medicaid Services; 
     and
       ``(E) with respect to which and as determined by the 
     Centers for Medicare & Medicaid Services, less than 4 percent 
     of the total discharges from the hospital during 2007 were 
     Medicare discharges of individuals who, as of the time of the 
     discharge--
       ``(i) were enrolled in the original Medicare fee-for-
     service program under part A of title XVIII of the Social 
     Security Act; and
       ``(ii) were not enrolled in--

       ``(I) a Medicare Advantage plan under part C of title XVIII 
     of that Act;
       ``(II) an eligible organization under section 1876 of that 
     Act; or
       ``(III) a PACE program under section 1894 of that Act.''.

                                 ______
                                 
  SA 3032. 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:

       On page 36, strike line 23 and insert the following: ``be 
     necessary to carry out this section.

     ``SEC. 2793A. IMPROVING OVERSIGHT OF INSURER SERVICE TO 
                   BENEFICIARIES.

       ``(a) Definitions.--In this section--
       ``(1) the term `database' means the database established 
     under subsection (b); and
       ``(2) the term `NAIC' means the National Association of 
     State Insurance Commissioners.
       ``(b) Monitoring Insurer Handling of Requests for Coverage 
     of Medical Care.--
       ``(1) Establishment.--The Secretary shall, in consultation 
     with the NAIC, establish and maintain a nationally consistent 
     database that, using standardized definitions, tracks claims 
     handling performance by--
       ``(A) all group health plans (and health insurance issuers 
     offering group health insurance coverage in connection with a 
     group health plan) and health insurance issuers that offer 
     health insurance coverage in the individual market; and
       ``(B) external review organizations that consider and 
     resolve external appeals from such plans and issuers.

[[Page 29821]]

       ``(2) Content.--The database shall include information on 
     the nature, timing, final disposal, and other relevant 
     details (as determined by the Secretary) of claims, appeals, 
     reviews, and requests for or denials of treatment by the 
     entities described in paragraph (1). The Secretary may limit 
     the content of the database to those claims that are 
     monetarily significant, as determined by the Secretary.
       ``(3) Collection of data.--The Secretary shall have the 
     authority to collect and audit data from entities described 
     in paragraph (1) necessary to implement the database, except 
     that, in the case of such plans and issuers subject to the 
     Employee Retirement Income Security Act of 1974, such data 
     shall be collected by the Secretary of Labor for use by the 
     Secretary. At the discretion of the Secretary, such data 
     collection authority may be delegated to State insurance 
     regulators.
       ``(4) Data protection and privacy.--The Secretary and the 
     Secretary of Labor shall ensure the confidentiality and 
     privacy of any claims data submitted pursuant to this 
     section. Within 1 year of the date of enactment of this 
     section, the Secretary shall promulgate a proposed regulation 
     to ensure that such data is protected against any violation 
     of the privacy and confidentiality of an individual's medical 
     records. Within 180 days of such promulgation, the 
     Comptroller General shall publish a report on the adequacy of 
     such regulation to ensure such protection. The database shall 
     not include names, unencrypted Social Security numbers, 
     addresses, or other information that may uniquely identify an 
     individual.
       ``(5) Tabulation; classification.--The Secretary shall work 
     with the NAIC to develop a procedure for centralized 
     tabulation and classification of consumer complaints related 
     to claims handling, appeals, and reviews by the entities 
     described in paragraph (1).
       ``(c) Implementation.--The Secretary shall implement the 
     database not later than 2 years after the date of enactment 
     of this section.
       ``(d) Dissemination.--The Secretary shall make the database 
     available to State insurance regulators, health exchanges, 
     and consumer assistance ombudsmen, provided that such 
     entities ensure the confidentiality and privacy of medical 
     records and comply with all existing privacy laws, and shall 
     update the database on a quarterly basis.
       ``(e) Reporting.--Not later than January 1, 2013, and on an 
     annual basis thereafter, the Secretary shall issue a public 
     report assessing the performance of the plans and issuers 
     described in subsection (b)(1)(A) regarding claims handling, 
     appeals, and reviews. Such report shall assess whether there 
     is any evidence of a pattern of denial or delay of medically 
     necessary claims or appeals.''.
                                 ______
                                 
  SA 3033. Mr. CASEY (for himself and Mr. Specter) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 1133, between lines 22 and 23, insert the 
     following:

     SEC. 3511. CONSISTENT QUALITY ACCREDITATION REQUIREMENTS FOR 
                   PROVIDERS CONTRACTING WITH MEDICARE ADVANTAGE 
                   PLANS AND STATE MEDICAID PROGRAMS.

       (a) Medicare Advantage.--Section 1854(a)(6)(B)(iii) of the 
     Social Security Act (42 U.S.C. 1395w-24(a)(6)(B)(iii)) is 
     amended--
       (1) by striking ``In order to'' and inserting the 
     following:
       ``(aa) In general.--In order to''; and
       (2) by adding at the end the following:
       ``(bb) Quality assurance.--An MA organization shall not 
     prohibit a particular hospital, physician or other entity 
     within a category of healthcare providers from eligibility to 
     contract with the MA organization because of a separate 
     policy of the MA organization that does not recognize an 
     approved nationally recognized accreditation organization 
     with the appropriate `deeming authority' from the 
     Secretary.''.
       (b) State Medicaid Plan Requirement.--Section 1902(a)(23) 
     of the Social Security Act (42 U.S.C. 1396a(a)(23)) is 
     amended by inserting ``and (C) the State plan and a primary 
     care case-management system (described in section 
     1915(b)(1)), a medicaid managed care organization, or a 
     similar entity shall not prohibit a particular hospital, 
     physician or other entity within a category of healthcare 
     providers from being qualified to perform a service or 
     services because of a separate policy of the State plan, 
     system, organization, or entity that does not recognize an 
     approved nationally recognized accreditation organization 
     with the appropriate `deeming authority' from the Secretary'' 
     after ``subsection (g) and in section 1915''.
       (c) Effective Date.--The amendments made by this section 
     take effect on the date of enactment of this Act and, in the 
     case of MA organizations under part C of title XVIII of the 
     Social Security Act, apply to plan years beginning after that 
     date.
                                 ______
                                 
  SA 3034. Mr. TESTER 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 828, between lines 3 and 4, insert the following:

     SEC. 3130. CAPITAL INFRASTRUCTURE REVOLVING LOAN PROGRAM FOR 
                   RURAL ENTITIES.

       (a) In General.--The Public Health Service Act (42 U.S.C. 
     201 et seq.) is amended by inserting after section 1602 the 
     following:

     ``SEC. 1603. CAPITAL INFRASTRUCTURE REVOLVING LOAN PROGRAM 
                   FOR RURAL ENTITIES.

       ``(a) Authority To Make and Guarantee Loans.--
       ``(1) Authority to make loans.--The Secretary may make 
     loans from the fund established under section 1602(d) to any 
     rural entity for projects for capital improvements, 
     including--
       ``(A) the acquisition of software and hardware necessary to 
     implement electronic health records as required under section 
     3011;
       ``(B) the acquisition of land necessary for the capital 
     improvements;
       ``(C) the renovation or modernization of any building;
       ``(D) the acquisition or repair of fixed or major movable 
     equipment; and
       ``(E) such other project expenses as the Secretary 
     determines appropriate.
       ``(2) Authority to guarantee loans.--
       ``(A) In general.--The Secretary may guarantee the payment 
     of principal and interest for loans made to rural entities 
     for projects for any capital improvement described in 
     paragraph (1) to any non-Federal lender.
       ``(B) Interest subsidies.--In the case of a guarantee of 
     any loan made to a rural entity under subparagraph (A), the 
     Secretary may pay to the holder of such loan, for and on 
     behalf of the project for which the loan was made, amounts 
     sufficient to reduce (by not more than 3 percent) the net 
     effective interest rate otherwise payable on such loan.
       ``(b) Amount of Loan.--The principal amount of a loan 
     directly made or guaranteed under subsection (a) for a 
     project for capital improvement may not exceed $2,500,000.
       ``(c) Funding Limitations.--
       ``(1) Government credit subsidy exposure.--The total of the 
     Government credit subsidy exposure under the Federal Credit 
     Reform Act of 1990 scoring protocol with respect to the loans 
     outstanding at any time with respect to which guarantees have 
     been issued, or which have been directly made, under 
     subsection (a) may not exceed $50,000,000 per year.
       ``(2) Total amounts.--Subject to paragraph (1), the total 
     of the principal amount of all loans directly made or 
     guaranteed under subsection (a) may not exceed $400,000,000 
     per year.
       ``(d) Capital Assessment and Planning Grants.--
       ``(1) Nonrepayable grants.--Subject to paragraph (2), the 
     Secretary may make a grant to a rural entity, in an amount 
     not to exceed $50,000, for purposes of capital assessment and 
     business planning.
       ``(2) Limitation.--The cumulative total of grants awarded 
     under this subsection may not exceed $2,500,000 per year.
       ``(e) Termination of Authority.--The Secretary may not 
     directly make or guarantee any loan under subsection (a) or 
     make a grant under subsection (d) after September 30, 
     2013.''.
       (b) Rural Entity Defined.--Section 1624 of the Public 
     Health Service Act (42 U.S.C. 300s-3) is amended by adding at 
     the end the following:
       ``(15)(A) The term `rural entity' includes--
       ``(i) a rural health clinic, as defined in section 
     1861(aa)(2) of the Social Security Act;
       ``(ii) any medical facility with at least 1 bed, but not 
     more than 49 beds, that is located in--
       ``(I) a county that is not part of a metropolitan 
     statistical area; or
       ``(II) a rural census tract of a metropolitan statistical 
     area (as determined under the most recent modification of the 
     Goldsmith Modification, originally published in the Federal 
     Register on February 27, 1992 (57 Fed. Reg. 6725)); and
       ``(iii) a hospital that is classified as a critical access 
     hospital or a rural hospital with fewer than 1,500 discharges 
     per year.
       ``(B) For purposes of subparagraph (A), the fact that a 
     clinic, facility, or hospital has been geographically 
     reclassified under the Medicare program under title XVIII of 
     the Social Security Act shall not preclude a hospital from 
     being considered a rural entity under clause (i) or (ii) of 
     subparagraph (A).''.
       (c) Conforming Amendments.--Section 1602 of the Public 
     Health Service Act (42 U.S.C. 300q-2) is amended--

[[Page 29822]]

       (1) in subsection (b)(2)(D), by inserting ``or 
     1603(a)(2)(B)'' after ``1601(a)(2)(B)''; and
       (2) in subsection (d)--
       (A) in paragraph (1)(C), by striking ``section 
     1601(a)(2)(B)'' and inserting ``sections 1601(a)(2)(B) and 
     1603(a)(2)(B)''; and
       (B) in paragraph (2)(A), by inserting ``or 1603(a)(2)(B)'' 
     after ``1601(a)(2)(B)''.
                                 ______
                                 
  SA 3035. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place, insert the following:

     SEC. __. HEALTH CARE SAFETY NET ENHANCEMENT.

       (a) Limitation on Liability.--Notwithstanding any other 
     provision of law, a health care professional shall not be 
     liable in any medical malpractice lawsuit for a cause of 
     action arising out of the provision of, or the failure to 
     provide, any medical service to a medically underserved or 
     indigent individual while engaging in the provision of pro 
     bono medical services.
       (b) Requirements.--Subsection (a) shall not apply--
       (1) to any act or omission by a health care professional 
     that is outside the scope of the services for which such 
     professional is deemed to be licensed or certified to 
     provide, unless such act or omission can reasonably be 
     determined to be necessary to prevent serious bodily harm or 
     preserve the life of the individual being treated;
       (2) if the services on which the medical malpractice claim 
     is based did not arise out of the rendering of pro bono care 
     for a medically underserved or indigent individual; or
       (3) to an act or omission by a health care professional 
     that constitutes willful or criminal misconduct, gross 
     negligence, reckless misconduct, or a conscious, flagrant 
     indifference to the rights or safety of the individual harmed 
     by such professional.
       (c) Definition.--In this section--
       (1) the term ``medically underserved individual'' means an 
     individual who does not have health care coverage under a 
     group health plan, health insurance coverage, or any other 
     health care coverage program; and
       (2) the term ``indigent individual'' means and individual 
     who is unable to pay for the health care services that are 
     provided to the individual.
                                 ______
                                 
  SA 3036. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place, insert the following:

     SEC. __. DISASTER VOLUNTEER HEALTH CARE PROFESSIONAL 
                   PROTECTION.

       (a) Limitation on Liability.--Notwithstanding any other 
     provision of law, with respect to an area in which a major 
     disaster has been declared in accordance with the Robert T. 
     Stafford Disaster Relief and Emergency Assistance Act (42 
     U.S.C. 5721 et seq.), a health care professional who is 
     providing health or dental services on a voluntary basis in 
     such area, or to a non-resident victim of the disaster 
     involved, shall not be liable for damages in a medical 
     malpractice lawsuit for a cause of action arising out of an 
     act or omission of such professional in providing the 
     services involved.
       (b) Requirements.--Subsection (a) shall not apply--
       (1) to any act or omission by a health care professional 
     that is outside the scope of the services for which such 
     professional is deemed to be licensed or certified to 
     provide, unless such act or omission can reasonably be 
     determined to be necessary to prevent serious bodily harm or 
     preserve the life of the individual being treated;
       (2) if the services on which the medical malpractice claim 
     is based did not arise out of the rendering of voluntary care 
     in the disaster area or were provided to an individual who 
     was not a victim of the disaster; or
       (3) to an act or omission by a health care professional 
     that constitutes willful or criminal misconduct, gross 
     negligence, reckless misconduct, or a conscious, flagrant 
     indifference to the rights or safety of the individual harmed 
     by such professional.
       (c) Limitation on Vicarious Liability.--An individual or a 
     health care institution that deploys or uses a volunteer 
     described in subsection (a) shall not be vicariously liable 
     in a medical malpractice lawsuit with respect to services 
     described in such subsection unless the volunteer involved is 
     determined to be liable.
       (d) Reciprocity With Respect to Licensed or Certified 
     Health Care Professionals.--A health care professional that 
     is licensed or certified in a State and who is providing 
     health or dental services on a voluntary basis in an area in 
     which a major disaster has been declared in accordance with 
     the Robert T. Stafford Disaster Relief and Emergency 
     Assistance Act (42 U.S.C. 5721 et seq.), shall be deemed to 
     be licensed or certified by the State in which such area is 
     located with respect to such health or dental services, 
     subject to any additional conditions, limitations, or 
     expansions that may be applied by the chief executive of the 
     State in which such area is located.
                                 ______
                                 
  SA 3037. Mr. JOHNSON (for himself, Mr. Franken, Mr. Burris, and Mr. 
Warner) submitted an amendment intended to be proposed to amendment SA 
2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 731, between lines 16 and 17, insert the following:
       ``(xix) Utilizing a diverse network of providers of 
     services and suppliers to improve care coordination for 
     applicable individuals described in subsection (a)(4)(A)(i) 
     with 2 or more chronic conditions and a history of prior-year 
     hospitalization through interventions developed under the 
     Medicare Coordinated Care Demonstration Project under section 
     4016 of the Balanced Budget Act of 1997 (42 U.S.C. 1395b-1 
     note).
                                 ______
                                 
  SA 3038. 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 436, between lines 14 and 15, insert the following:

     SEC. 2008. EXTENSION OF ARRA INCREASE IN FMAP.

       Section 5001 of the American Recovery and Reinvestment Act 
     of 2009 (Public Law 111-5) is amended--
       (1) in subsection (a)(3), by striking ``first calendar 
     quarter'' and inserting ``first 3 calendar quarters'';
       (2) in subsection (b)(2), by inserting before the period at 
     the end the following: ``, and such paragraph shall not apply 
     to calendar quarters beginning on or after October 1, 2010'';
       (3) in subsection (c)(4)(C)(ii), by striking ``December 
     2009'' and ``January 2010'' and inserting ``June 2010'' and 
     ``July 2010'', respectively;
       (4) in subsection (d), by inserting ``ending before October 
     1, 2010'' after ``entire fiscal years'' and after ``with 
     respect to fiscal years'';
       (5) in subsection (g)(1), by striking ``September 30, 
     2011'' and inserting ``December 31, 2011''; and
       (6) in subsection (h)(3), by striking ``December 31, 2010'' 
     and inserting ``June 30, 2011''.
                                 ______
                                 
  SA 3039. 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 436, between lines 14 and 15, insert the following:

     SEC. 2008. MANAGED CARE ORGANIZATIONS.

       (a) Minimum Medical Loss Ratio.--
       (1) Medicaid.--Section 1903(m)(2)(A) of the Social Security 
     Act (42 U.S.C. 1396b(m)(2)(A)) is amended--
       (A) by striking ``and'' at the end of clause (xi);
       (B) by striking the period at the end of clause (xii) and 
     inserting ``; and''; and
       (C) by adding at the end the following new clause:
       ``(xiii) such contract has a medical loss ratio, as 
     determined in accordance with a methodology specified by the 
     Secretary, that is a percentage (not less than 85 percent) 
     specified by the Secretary.''.
       (2) CHIP.--Section 2107(e)(1) of such Act (42 U.S.C. 
     1397gg(e)(1)), as amended by sections 2101(d)(2), 2101(e), 
     and 6401(c), is amended--

[[Page 29823]]

       (A) by redesignating subparagraphs (H) through (O) as 
     subparagraphs (I) through (P); and
       (B) by inserting after subparagraph (G) the following new 
     subparagraph:
       ``(H) Section 1903(m)(2)(A)(xiv) (relating to application 
     of minimum loss ratios), with respect to comparable contracts 
     under this title.''.
       (3) Effective date.--The amendments made by this subsection 
     shall apply to contracts entered into or renewed on or after 
     July 1, 2010.
       (b) Patient Encounter Data.--
       (1) In general.--Section 1903(m)(2)(A)(xi) of the Social 
     Security Act (42 U.S.C. 1396b(m)(2)(A)(xi)) is amended by 
     inserting ``and for the provision of such data to the State 
     at a frequency and level of detail to be specified by the 
     Secretary'' after ``patients''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall apply with respect to contract years beginning on or 
     after January 1, 2010.
                                 ______
                                 
  SA 3040. 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 436, between lines 14 and 15, insert the following:

     SEC. 2008. AUTOMATIC INCREASE IN THE FEDERAL MEDICAL 
                   ASSISTANCE PERCENTAGE DURING PERIODS OF 
                   NATIONAL ECONOMIC DOWNTURN.

       (a) National Economic Downturn Assistance FMAP.--
       (1) In general.--Section 1905 of the Social Security Act 
     (42 U.S.C. 1396d), as amended by sections 2001(a)(3), 2006, 
     4106(b), and 4107, is amended--
       (A) in subsection (b), in the first sentence--
       (i) by striking ``and (5)'' and inserting ``(5)''; and
       (ii) by inserting ``and (6) with respect to each fiscal 
     year quarter other than the first quarter of a national 
     economic downturn assistance period described in subsection 
     (cc)(1), the Federal medical assistance percentage for any 
     State described in subsection (cc)(2) shall be equal to the 
     national economic downturn assistance FMAP determined for the 
     State for the quarter under subsection (cc)(3)'' before the 
     period; and
       (B) by adding at the end the following:
       ``(cc) National Economic Downturn Assistance FMAP.--For 
     purposes of clause (6) of the first sentence of subsection 
     (b):
       ``(1) National economic downturn assistance period.--A 
     national economic downturn assistance period described in 
     this paragraph--
       ``(A) begins with the first fiscal year quarter for which 
     the Secretary determines that for at least 23 States, the 
     rolling average unemployment rate for that quarter has 
     increased by at least 10 percent over the corresponding 
     quarter for the most recent preceding 12-month period for 
     which data are available (in this subsection referred to as 
     the `trigger quarter'); and
       ``(B) ends with the first succeeding fiscal year quarter 
     for which the Secretary determines that less than 23 States 
     have a rolling average unemployment rate for that quarter 
     with an increase of at least 10 percent over the 
     corresponding quarter for the most recent preceding 12-month 
     period for which data are available.
       ``(2) Eligible state.--A State described in this paragraph 
     is a State for which the Secretary determines that the 
     rolling average unemployment rate for the State for any 
     quarter occurring during a national economic downturn 
     assistance period described in paragraph (1) has increased 
     over the corresponding quarter for the most recent preceding 
     12-month period for which data are available.
       ``(3) Determination of national economic downturn 
     assistance fmap.--
       ``(A) In general.--The national economic downturn 
     assistance FMAP for a fiscal year quarter determined with 
     respect to a State under this paragraph is equal to the 
     Federal medical assistance percentage for the State for that 
     quarter increased by the number of percentage points 
     determined by--
       ``(i) dividing--

       ``(I) the Medicaid additional unemployed increased cost 
     amount determined under subparagraph (B) for the quarter; by
       ``(II) the State's total Medicaid quarterly spending amount 
     determined under subparagraph (C) for the quarter; and

       ``(ii) multiplying the quotient determined under clause (i) 
     by 100.
       ``(B) Medicaid additional unemployed increased cost 
     amount.--For purposes of subparagraph (A)(i)(I), the Medicaid 
     additional unemployed increased cost amount determined under 
     this subparagraph with respect to a State and a quarter is 
     the product of the following:
       ``(i) State increase in rolling average number of 
     unemployed individuals from the base quarter of 
     unemployment.--

       ``(I) In general.--The amount determined by subtracting the 
     rolling average number of unemployed individuals in the State 
     for the base unemployment quarter for the State determined 
     under subclause (II) from the rolling average number of 
     unemployed individuals in the State for the quarter.
       ``(II) Base unemployment quarter defined.--

       ``(aa) In general.--For purposes of subclause (I), except 
     as provided in item (bb), the base quarter for a State is the 
     quarter with the lowest rolling average number of unemployed 
     individuals in the State in the 12-month period preceding the 
     trigger quarter for a national economic downturn assistance 
     period described in paragraph (1).
       ``(bb) Exception.--If the rolling average number of 
     unemployed individuals in a State for a quarter occurring 
     during a national economic downturn assistance period 
     described in paragraph (1) is less than the rolling average 
     number of unemployed individuals in the State for the base 
     quarter determined under item (aa), that quarter shall be 
     treated as the base quarter for the State for such national 
     economic downturn assistance period.
       ``(ii) National average amount of additional federal 
     medicaid spending per additional unemployed individual.--In 
     the case of--

       ``(I) a calendar quarter occurring in fiscal year 2012, 
     $350; and
       ``(II) a calendar quarter occurring in any succeeding 
     fiscal year, the amount applicable under this clause for 
     calendar quarters occurring during the preceding fiscal year, 
     increased by the annual percentage increase in the medical 
     care component of the consumer price index for all urban 
     consumers (U.S. city average), as rounded up in an 
     appropriate manner.

       ``(iii) State nondisabled, nonelderly adults and children 
     medicaid spending index.--

       ``(I) In general.--With respect to a State, the quotient 
     (not to exceed 1.00) of--

       ``(aa) the State expenditure per person in poverty amount 
     determined under subclause (II); divided by--
       ``(bb) the National expenditure per person in poverty 
     amount determined under subclause (III).

       ``(II) State expenditure per person in poverty amount.--For 
     purposes of subclause (I)(aa), the State expenditure per 
     person in poverty amount is the quotient of--

       ``(aa) the total amount of annual expenditures by the State 
     for providing medical assistance under the State plan to 
     nondisabled, nonelderly adults and children; divided by
       ``(bb) the total number of nonelderly adults and children 
     in poverty who reside in the State, as determined under 
     paragraph (4)(A).

       ``(III) National expenditure per person in poverty 
     amount.--For purposes of subclause (I)(bb), the National 
     expenditure per person in poverty amount is the quotient of--

       ``(aa) the sum of the total amounts determined under 
     subclause (II)(aa) for all States; divided by
       ``(bb) the sum of the total amounts determined under 
     subclause (II)(bb) for all States.
       ``(C) State's total medicaid quarterly spending amount.--
     For purposes of subparagraph (A)(i)(II), the State's total 
     Medicaid quarterly spending amount determined under this 
     subparagraph with respect to a State and a quarter is the 
     amount equal to--
       ``(i) the total amount of expenditures by the State for 
     providing medical assistance under the State plan to all 
     individuals enrolled in the plan for the most recent fiscal 
     year for which data is available; divided by
       ``(ii) 4.
       ``(4) Data.--In making the determinations required under 
     this subsection, the Secretary shall use, in addition to the 
     most recent available data from the Bureau of Labor 
     Statistics Local Area Unemployment Statistics for each State 
     referred to in paragraph (5), the most recently available--
       ``(A) data from the Bureau of the Census with respect to 
     the number of nonelderly adults and children who reside in a 
     State described in paragraph (2) with family income below the 
     poverty line (as defined in section 2110(c)(5)) applicable to 
     a family of the size involved (or, if the Secretary 
     determines it appropriate, a multiyear average of such data);
       ``(B) data reported to the Secretary by a State described 
     in paragraph (2) with respect to expenditures for medical 
     assistance under the State plan under this title for 
     nondisabled, nonelderly adults and children; and
       ``(C) econometric studies of the responsiveness of Medicaid 
     enrollments and spending to changes in rolling average 
     unemployment rates and other factors, including State 
     spending on certain Medicaid populations.
       ``(5) Definition of `rolling average number of unemployed 
     individuals', `rolling average unemployment rate'.--In this 
     subsection, the term--
       ``(A) `rolling average number of unemployed individuals' 
     means, with respect to a calendar quarter and a State, the 
     average of the 12 most recent months of seasonally adjusted 
     unemployment data for each State;
       ``(B) `rolling average unemployment rate' means, with 
     respect to a calendar quarter and a State, the average of the 
     12 most recent monthly unemployment rates for the State; and

[[Page 29824]]

       ``(C) `monthly unemployment rate' means, with respect to a 
     State, the quotient of--
       ``(i) the monthly seasonally adjusted number of unemployed 
     individuals for the State; divided by
       ``(ii) the monthly seasonally adjusted number of the labor 
     force for the State,

     using the most recent data available from the Bureau of Labor 
     Statistics Local Area Unemployment Statistics for each State,
       ``(6) Increase in cap on payments to territories.--With 
     respect to any fiscal year quarter for which the national 
     economic downturn assistance Federal medical assistance 
     percentage applies to Puerto Rico, the Virgin Islands, Guam, 
     the Northern Mariana Islands, or American Samoa, the amounts 
     otherwise determined for such commonwealth or territory under 
     subsections (f) and (g) of section 1108 shall be increased by 
     such percentage of such amounts as the Secretary determines 
     is equal to twice the average increase in the national 
     economic downturn assistance FMAP determined for all States 
     described in paragraph (2) for the quarter.
       ``(7) Scope of application.--The national economic downturn 
     assistance FMAP shall only apply for purposes of payments 
     under section 1903 for a quarter and shall not apply with 
     respect to--
       ``(A) disproportionate share hospital payments described in 
     section 1923;
       ``(B) payments under title IV or XXI; or
       ``(C) any payments under this title that are based on the 
     enhanced FMAP described in section 2105(b).
       ``(8) Additional requirement for certain states.--In the 
     case of a State described in paragraph (2) that requires 
     political subdivisions within the State to contribute toward 
     the non-Federal share of expenditures required under section 
     1902(a)(2), the State shall not require that such political 
     subdivisions pay for any fiscal year quarters occurring 
     during a national economic downturn assistance period a 
     greater percentage of the non-Federal share of such 
     expenditures, or a greater percentage of the non-Federal 
     share of payments under section 1923, than the respective 
     percentage that would have been required by the State under 
     State law in effect on the first day of the fiscal year 
     quarter occurring immediately prior to the trigger quarter 
     for the period.''.
       (2) Effective date; no retroactive application.--The 
     amendments made by paragraph (1) take effect on January 1, 
     2012. In no event may a State receive a payment on the basis 
     of the national economic downturn assistance Federal medical 
     assistance percentage determined for the State under section 
     1905(cc)(3) of the Social Security Act for amounts expended 
     by the State prior to January 1, 2012.
       (b) GAO Study and Report.--
       (1) Study.--The Comptroller General of the United States 
     shall analyze the previous periods of national economic 
     downturn, including the most recent such period in effect as 
     of the date of enactment of this Act, and the past and 
     projected effects of temporary increases in the Federal 
     medical assistance percentage under the Medicaid program with 
     respect to such periods.
       (2) Report.--Not later than April 1, 2011, the Comptroller 
     General of the United States shall submit a report to 
     Congress on the results of the analysis conducted under 
     paragraph (1). Such report shall include such recommendations 
     as the Comptroller General determines appropriate for 
     modifying the national economic downturn assistance FMAP 
     established under section 1905(cc) of the Social Security Act 
     (as added by subsection (a)) to improve the effectiveness of 
     the application of such percentage in addressing the needs of 
     States during periods of national economic downturn, 
     including recommendations for--
       (A) improvements to the factors that begin and end the 
     application of such percentage;
       (B) how the determination of such percentage could be 
     adjusted to address State and regional economic variations 
     during such periods; and
       (C) how the determination of such percentage could be 
     adjusted to be more responsive to actual Medicaid costs 
     incurred by States during such periods, as well as to the 
     effects of any other specific economic indicators that the 
     Comptroller General determines appropriate.
                                 ______
                                 
  SA 3041. 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 397, beginning on line 2, strike ``under'' and all 
     that follows through line 6, and insert ``not pregnant and 
     are''
                                 ______
                                 
  SA 3042. 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 553, between lines 14 and 15, insert the following:

     SEC. 2708. EVALUATION OF STATE COMPLIANCE WITH PROVISION OF 
                   COMMUNITY-BASED SERVICES TO INDIVIDUALS WITH 
                   DISABILITIES.

       Not later than December 31, 2010, and annually thereafter, 
     the Inspector General of the Department of Justice shall 
     prepare and submit a report to Congress that evaluates the 
     adequacy of efforts by States to provide appropriate home and 
     community-based services to individuals with disabilities in 
     accordance with the requirements under Olmstead v. L.C., 527 
     U.S. 581 (1999).
                                 ______
                                 
  SA 3043. 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:

       Beginning on page 397, strike line 15 and all that follows 
     through page 398, line 25.
                                 ______
                                 
  SA 3044. Mr. ROCKEFELLER submitted an amendment intended to be 
proposed by him to the bill H.R. 3590, to amend the Internal Revenue 
Code of 1986 to modify the first-time homebuyers credit in the case of 
members of the Armed Forces and certain other Federal employees, and 
for other purposes; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. _. PAYMENT OF MEDICARE LIABILITY TO STATES AS A RESULT 
                   OF THE SPECIAL DISABILITY WORKLOAD PROJECT.

       (a) In General.--The Secretary, in consultation with the 
     Commissioner, shall work with each State to reach an 
     agreement, not later than 6 months after the date of 
     enactment of this Act, on the amount of a payment for the 
     State related to the Medicare program liability as a result 
     of the Special Disability Workload project, subject to the 
     requirements of subsection (c).
       (b) Payments.--
       (1) Deadline for making payments.--Not later than 30 days 
     after reaching an agreement with a State under subsection 
     (a), the Secretary shall pay the State, from the amounts 
     appropriated under paragraph (2), the payment agreed to for 
     the State.
       (2) Appropriation.--Out of any money in the Treasury not 
     otherwise appropriated, there is appropriated $4,000,000,000 
     for fiscal year 2010 for making payments to States under 
     paragraph (1).
       (3) Limitations.--In no case may the aggregate amount of 
     payments made by the Secretary to States under paragraph (1) 
     exceed $4,000,000,000.
       (c) Requirements.--The requirements of this subsection are 
     the following:
       (1) Federal data used to determine amount of payments.--The 
     amount of the payment under subsection (a) for each State is 
     determined on the basis of the most recent Federal data 
     available, including the use of proxies and reasonable 
     estimates as necessary, for determining expeditiously the 
     amount of the payment that shall be made to each State that 
     enters into an agreement under this section. The payment 
     methodology shall consider the following factors:
       (A) The number of SDW cases found to have been eligible for 
     benefits under the Medicare program and the month of the 
     initial Medicare program eligibility for such cases.
       (B) The applicable non-Federal share of expenditures made 
     by a State under the Medicaid program during the time period 
     for SDW cases.
       (C) Such other factors as the Secretary and the 
     Commissioner, in consultation with the States, determine 
     appropriate.
       (2) Conditions for payments.--A State shall not receive a 
     payment under this section unless the State--
       (A) waives the right to file a civil action (or to be a 
     party to any action) in any Federal or State court in which 
     the relief sought includes a payment from the United States 
     to the State related to the Medicare liability under title 
     XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) as 
     a result of the Special Disability Workload project; and
       (B) releases the United States from any further claims for 
     reimbursement of State expenditures as a result of the 
     Special Disability Workload project (other than 
     reimbursements being made under agreements in effect on the 
     date of enactment of this Act as a result of such project, 
     including payments made pursuant to agreements entered into

[[Page 29825]]

     under section 1616 of the Social Security Act or section 
     211(1)(1)(A) of Public Law 93-66).
       (3) No individual state claims data required.--No State 
     shall be required to submit individual claims evidencing 
     payment under the Medicaid program as a condition for 
     receiving a payment under this section.
       (4) Ineligible states.--No State that is a party to a civil 
     action in any Federal or State court in which the relief 
     sought includes a payment from the United States to the State 
     related to the Medicare liability under title XVIII of the 
     Social Security Act (42 U.S.C. 1395 et seq.) as a result of 
     the Special Disability Workload project shall be eligible to 
     receive a payment under this section while such an action is 
     pending or if such an action is resolved in favor of the 
     State.
       (d) Definitions.--In this section:
       (1) Commissioner.--The term ``Commissioner'' means the 
     Commissioner of Social Security.
       (2) Medicaid program.--The term ``Medicaid program'' means 
     the program of medical assistance established under title XIX 
     of the Social Security Act (42 U.S.C. 1396a et seq.) and 
     includes medical assistance provided under any waiver of that 
     program approved under section 1115 or 1915 of such Act (42 
     U.S.C. 1315, 1396n) or otherwise.
       (3) Medicare program.--The term ``Medicare program'' means 
     the program established under title XVIII of the Social 
     Security Act (42 U.S.C. 1395 et seq.).
       (4) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (5) Sdw case.--The term ``SDW case'' means a case in the 
     Special Disability Workload project involving an individual 
     determined by the Commissioner to have been eligible for 
     benefits under title II of the Social Security Act (42 U.S.C. 
     401 et seq.) for a period during which such benefits were not 
     provided to the individual and who was, during all or part of 
     such period, enrolled in a State Medicaid program.
       (6) Special disability workload project.--The term 
     ``Special Disability Workload project'' means the project 
     described in the 2008 Annual Report of the Board of Trustees 
     of the Federal Old-Age and Survivors Insurance and Federal 
     Disability Insurance Trust Funds, H.R. Doc. No. 110-104, 
     110th Cong. (2008).
       (7) State.--The term ``State'' means each of the 50 States 
     and the District of Columbia.

     SEC. _. REQUIREMENTS FOR MEDICAID PROVIDERS TO ACCEPT IN-
                   NETWORK PAYMENT RATES FOR SERVICES PROVIDED TO 
                   MEDICAID MANAGED CARE ENROLLEES.

       (a) In General.--Section 1932(b) of the Social Security Act 
     (42 U.S.C. 1396u-2(b)) is amended by adding at the end the 
     following
       ``(9) Assuring access to services furnished by non-contract 
     providers.--Any provider of items or services for which 
     medical assistance is provided under the State plan or under 
     a waiver of the plan that does not have in effect a contract 
     with a Medicaid managed care entity that establishes payment 
     amounts for items or services furnished to a beneficiary 
     enrolled in the entity's Medicaid managed care plan shall 
     accept as payment in full no more than the amounts (less any 
     payments for indirect costs of medical education and direct 
     costs of graduate medical education) that it could collect if 
     the beneficiary received medical assistance under this title 
     other than through enrollment in such an entity. In a State 
     where rates paid to hospitals under the State plan are 
     negotiated by contract and not publicly released, the payment 
     amount applicable under this subparagraph shall be the 
     average contract rate that would apply under the State plan 
     for general acute care hospitals or the average contract rate 
     that would apply under such plan for tertiary hospitals.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     takes effect on January 1, 2010.
                                 ______
                                 
  SA 3045. Mr. KERRY (for himself, Mr. Kirk, Mr. Schumer, Mrs. 
Gillibrand, Mr. Leahy, Mr. Sanders, Mr. Carper, and Mr. Kaufman) 
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 402, strike line 15 and all that follows 
     through page 403, line 9, and insert the following:
       ``(A) Newly eligible.--The term ``newly eligible'' means an 
     individual described in subclause (VIII) of section 
     1902(a)(10)(A)(i) who, on the date of enactment of the 
     Patient Protection and Affordable Care Act, is not eligible 
     under the State plan for full benefits or for benchmark 
     coverage described in section 1937(b)(1) or benchmark 
     equivalent coverage described in section 1937(b)(2), or is 
     eligible but not enrolled (or is on a waiting list) for such 
     benefits or coverage through a waiver under the plan that has 
     a capped or limited enrollment that is full.
                                 ______
                                 
  SA 3046. Mr. KERRY (for himself, Ms. Stabenow, Ms. Collins, Ms. 
Snowe, Mr. Wyden, Mrs. Lincoln, Mr. Johnson, Mr. Specter, and Mrs. 
Gillibrand) 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 983, strike line 11 and all that follows 
     through page 984, line 3, and insert the following:
       ``(vi) Productivity adjustment.--After determining the home 
     health market basket percentage increase under clause (iii), 
     and after application of clause (v), the Secretary shall 
     reduce such percentage, for 2015 and each subsequent year, by 
     the productivity adjustment described in section 
     1886(b)(3)(B)(xi)(II). The application of the preceding 
     sentence may result in the home health market basket 
     percentage increase under clause (iii) being less than 0.0 
     for a year, and may result in payment rates under the system 
     under this subsection for a year being less than such payment 
     rates for the preceding year.''.
                                 ______
                                 
  SA 3047. Mr. KERRY (for himself, Mr. Wyden, Mr. Whitehouse, Mr. Reed) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. MEDICARE PATIENT IVIG ACCESS DEMONSTRATION PROJECT.

       (a) Establishment.--The Secretary shall establish and 
     implement a demonstration project under title XVIII of the 
     Social Security Act to evaluate the benefits of providing 
     payment for items and services needed for the administration, 
     within the homes of Medicare beneficiaries, of intravenous 
     immune globin for the treatment of primary immune deficiency 
     diseases.
       (b) Duration and Scope.--
       (1) Duration.--Beginning not later than January 1, 2011, 
     the Secretary shall conduct the demonstration project for a 
     period of 3 years.
       (2) Scope.--The Secretary shall enroll not greater than 
     4,000 Medicare beneficiaries who have been diagnosed with 
     primary immunodeficiency disease for participation in the 
     demonstration project. A Medicare beneficiary may participate 
     in the demonstration project on a voluntary basis and may 
     terminate participation at any time.
       (c) Reimbursement.--The Secretary shall establish an hourly 
     rate for payment for items and services needed for the 
     administration of intravenous immune globin based on the low-
     utilization payment adjustment under the prospective payment 
     system for home health services established under section 
     1895 of the Social Security Act (42 U.S.C. 1395fff).
       (d) Study and Report to Congress.--
       (1) Interim evaluation and report.--Not later than 24 
     months after the date of enactment of this Act, the Secretary 
     shall submit to Congress a report that contains the 
     following:
       (A) An interim evaluation of the impact of the 
     demonstration project on access for Medicare beneficiaries to 
     items and services needed for the administration of 
     intravenous immune globin within the home.
       (B) An analysis of the appropriateness of implementing a 
     new methodology for payment for intravenous immune globulins 
     in all care settings under part B of title XVIII of the 
     Social Security Act (42 U.S.C. 1395k et seq.).
       (C) An analysis of the feasability of reducing the lag time 
     with respect to data used to determine the average sales 
     price under section 1847A of the Social Security Act (42 
     U.S.C. 1395w-3a).
       (D) An update to the report entitled ``Analysis of Supply, 
     Distribution, Demand, and Access Issues Associated with 
     Immune Globulin Intravenous (IGIV)'', issued in February 2007 
     by the Office of the Assistant Secretary for Planning and 
     Evaluation of the Department of Health and Human Services.
       (2) Final evaluation and report.--Not later than July 1, 
     2014, the Secretary shall submit to Congress a report that 
     contains a final evaluation of the impact of the 
     demonstration project on access for Medicare beneficiaries to 
     items and services needed for the administration of 
     intravenous immune globin within the home.
       (e) Offset.--

[[Page 29826]]

       (1) In general.--Section 1861(n) of the Social Security Act 
     (42 U.S.C. 1395x(n)) is amended by adding at the end the 
     following: ``Such term includes disposable drug delivery 
     systems, including elastomeric infusion pumps, for the 
     treatment of colorectal cancer.''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall apply to items furnished on or after the date of 
     enactment of this Act.
       (f) Definitions.--In this section:
       (1) Demonstration project.--The term ``demonstration 
     project'' means the demonstration project conducted under 
     this section.
       (2) Medicare beneficiary.--The term ``Medicare 
     beneficiary'' means an individual who is entitled to, or 
     enrolled for, benefits under part A of title XVIII of the 
     Social Security Act or enrolled for benefits under part B of 
     such title.
       (3) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
                                 ______
                                 
  SA 3048. Mr. BARRASSO submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 172, between lines 11 and 12, insert the following:
       (E) Repayment of funds.--A person that receives Federal 
     funds under a loan or grant under this section shall be 
     required to reimburse the Federal Government for the full 
     amount received under such loan or grant on terms established 
     by the Secretary, but in no event shall such repayment be 
     made later than 10 years after the date on which such loan or 
     grant was made.
                                 ______
                                 
  SA 3049. Mr. BARRASSO submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

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

     SEC. 2008. PROTECTION OF MEDICAID WAIVER AUTHORITY.

       No provision of this Act or any amendment made by this Act 
     shall limit or otherwise restrict any authority in effect on 
     the date of enactment of this Act which the Secretary of 
     Health and Human Services may exercise under section 1915 or 
     1115 of the Social Security Act or otherwise to encourage 
     States to develop innovation programs to provide health 
     insurance to uninsured individuals or to contain health care 
     costs by granting States budget neutral Medicaid waivers Any 
     provision of this Act or an amendment of this Act that is 
     contrary to the preceding sentence is null and void.
                                 ______
                                 
  SA 3050. Mr. BARRASSO submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1998, strike lines 13 through 24.
                                 ______
                                 
  SA 3051. Mr. BARRASSO submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

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

     SEC. 3115. RURAL HEALTH CLINIC REIMBURSEMENT.

       Section 1833(f) of the Social Security Act (42 U.S.C. 
     1395l(f)) is amended--
       (1) in paragraph (1), by striking ``, and'' at the end and 
     inserting a semicolon;
       (2) in paragraph (2)--
       (A) by striking ``in a subsequent year'' and inserting 
     ``after 1988 and before 2010''; and
       (B) by striking the period at the end and inserting a 
     semicolon; and
       (3) by adding at the end the following new paragraphs:
       ``(3) in 2010, at $85 per visit; and
       ``(4) in a subsequent year, at the limit established under 
     this subsection for the previous year increased by the 
     percentage increase in the MEI (as defined in section 
     1842(i)(3)) applicable to primary care services (as defined 
     in section 1842(i)(4)) furnished as of the first day of that 
     year.''.
                                 ______
                                 
  SA 3052. Mr. BARRASSO submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

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

     SEC. 4403. RURAL HEALTH CLINIC AND COMMUNITY HEALTH CENTER 
                   COLLABORATIVE ACCESS EXPANSION.

       Section 330 of the Public Health Service Act (42 U.S.C. 
     254b), as amended by section 4206, is amended by adding at 
     the end the following:
       ``(t) Rule of Construction With Respect to Rural Health 
     Clinics.--
       ``(1) In general.--Nothing in this section shall be 
     construed to prevent a community health center from 
     contracting with a federally certified rural health clinic 
     (as defined by section 1861(aa)(2) of the Social Security 
     Act) for the delivery of primary health care services that 
     are available at the rural health clinic to individuals who 
     would otherwise be eligible for free or reduced cost care if 
     that individual were able to obtain that care at the 
     community health center. Such services may be limited in 
     scope to those primary health care services available in that 
     rural health clinic.
       ``(2) Assurances.--In order for a rural health clinic to 
     receive funds under this section through a contract with a 
     community health center under paragraph (1), such rural 
     health clinic shall establish policies to ensure--
       ``(A) nondiscrimination based upon the ability of a patient 
     to pay; and
       ``(B) the establishment of a sliding fee scale for low-
     income patients.''.
                                 ______
                                 
  SA 3053. Mr. INHOFE submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 2026, strike line 3 and insert the following:
       (i) Exclusion of Assistive Devices for People With 
     Disabilities.--
       (1) In general.--The term ``medical device sales'' shall 
     not include sales of any assistive device for people with 
     disabilities.
       (2) Reduction of aggregate fee amount.--The $2,000,000,000 
     amount in subsection (b)(1) shall be reduced in each calendar 
     year by the amount which bears the same ratio to such 
     $2,000,000,000 amount as the amount of the sales of devices 
     described in paragraph (1) for such calendar year bears to 
     the amount of total medical device sales (without regard to 
     this subsection) for such calendar year, as determined by the 
     Secretary.
       (j) Application of Section.--This section shall
                                 ______
                                 
  SA 3054. Mr. ROBERTS (for himself and Mr. Kyl) submitted an amendment 
intended to be proposed to amendment SA 2786 proposed by Mr. Reid (for 
himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, 
to amend the Internal Revenue Code of 1986 to modify the first-time 
homebuyers credit in the case of members of the Armed Forces and 
certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 1703, between lines 4 and 5, insert the following:

     SEC. 6303. PROHIBITION ON THE USE OF COST IN COMPARATIVE 
                   EFFECTIVENESS RESEARCH.

       (a) In General.--Notwithstanding any other provision of 
     law, in no case may the cost of any medical treatment, item, 
     or service described in subsection (b) be considered a factor 
     in any comparative effectiveness research conducted--
       (1) by the Federal Government; or
       (2) by any other entity using funding provided by the 
     Federal Government.
       (b) Medical Treatment, Item, or Service.--The medical 
     treatments, services, and items described in this subsection 
     are health

[[Page 29827]]

     care interventions, protocols for treatment, care management, 
     and delivery, procedures, medical devices, diagnostic tools, 
     pharmaceuticals (including drugs and biologicals), 
     integrative health practices, and any other strategies or 
     items being used in the treatment, management, and diagnosis 
     of, or prevention of illness or injury in, individuals.
       (c) Inclusion.--The comparative effectiveness research 
     described under subsection (a) includes any such research 
     conducted or funded by--
       (1) the Patient-Centered Outcomes Research Institute under 
     section 1181 of the Social Security Act (as added by section 
     6301);
       (2) the Department of Health and Human Services, including 
     the Agency for Healthcare Research and Quality and the 
     National Institutes of Health; and
       (3) the Federal Coordinating Council for Comparative 
     Effectiveness Research established under section 804 of 
     Division A of the American Recovery and Reinvestment Act of 
     2009 (42 U.S.C. 299b-8).
       (d) Application.--This section shall apply to any 
     comparative effectiveness research--
       (1) that is ongoing as of the date of enactment of this 
     Act; or
       (2) that is conducted after the date of enactment of this 
     Act.
                                 ______
                                 
  SA 3055. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1983, strike lines 1-11 and insert the following:

       ``(II) the 3-year average FEHB program premium increase for 
     such year.

     If any amount determined under this clause is not a multiple 
     of $50, such amount shall be rounded to the nearest multiple 
     of $50.
       (iv) 3-year average fehb program premium increase.--For 
     purposes of clause (iii)--

       (I) In general.--The term ``3-year average FEHB program 
     premium increase'' means, with respect to any calendar year, 
     the average of the FEHB program premium increases for the 
     preceding 3 calendar years.
       (II) FEHB premium increase.--The term ``FEHB program 
     premium increase'' means, with respect to any calendar year, 
     the average amount of the increases in premiums (if any) for 
     all plans offered under the Federal Employee Health Benefits 
     Program under chapter 89 of title 5, United States Code, 
     which were offered under such program for the preceding 
     calendar year.

                                 ______
                                 
  SA 3056. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 340, strike lines 1 through 14 and insert the 
     following:
       ``(A) Waiver of criminal and civil penalties and 
     interest.--In the case of any failure by a taxpayer to timely 
     pay any penalty imposed by this section--
       ``(i) such taxpayer shall not be subject to any criminal 
     prosecution or penalty with respect to such failure, and
       ``(ii) no penalty, addition to tax, or interest shall be 
     imposed with respect to such failure or such penalty.
       ``(B) Limited collection actions permitted.--In the case of 
     the assessment of any penalty imposed by this section, the 
     Secretary shall not take any action with respect to the 
     collection of such penalty other than--
       ``(i) giving notice and demand for such penalty under 
     section 6303,
       ``(ii) crediting under section 6402(a) the amount of any 
     overpayment of the taxpayer against such penalty, and
       ``(iii) offsetting any payment owed by any Federal agency 
     to the taxpayer against such penalty under the Treasury 
     offset program.''.
                                 ______
                                 
  SA 3057. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 334, line 19, strike all through page 
     335, line 2, and insert the following:
       ``(2) Middle income individuals and families.--Any 
     applicable individual for any month during a calendar year if 
     the individual's household income for the taxable year 
     described in section 1412(b)(1)(B) of the Patient Protection 
     and Affordable Care Act is less than $200,000 ($250,000 in 
     the case of a joint return), determined in the same manner as 
     under subsection (c)(4).
                                 ______
                                 
  SA 3058. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

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

     SEC. ____. NO FEDERAL TAX INCREASE IMPOSED ON MIDDLE INCOME 
                   INDIVIDUALS AND FAMILIES.

       (a) In General.--Notwithstanding any provision of, or 
     amendment made by this Act, no such provision or amendment 
     which, directly or indirectly, results in a Federal tax 
     increase shall be administered in such manner as to impose 
     such an increase on any middle income taxpayer.
       (b) Middle Income Taxpayer.--For purposes of this section, 
     the term ``middle income taxpayer'' means, for any taxable 
     year, any taxpayer with adjusted gross income (as defined in 
     section 62 of the Internal Revenue Code of 1986) of less than 
     $200,000 ($250,000 in the case of a joint return of tax).
                                 ______
                                 
  SA 3059. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1999, strike lines 1 through 20.
                                 ______
                                 
  SA 3060. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Strike section 9004.
                                 ______
                                 
  SA 3061. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

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

     SEC. 9024. TAXES NOT FEES, PENALTIES, OR ASSESSABLE PAYMENTS.

       (a) Taxes Not Fees.--Sections 4375, 4376, 4377, and 9511 of 
     the Internal Revenue Code of 1986 (as added by section 
     6301(e)) and sections 9008, 9009, and 9010 are each amended 
     by striking ``fee'' or ``fees'' each place they appear and 
     inserting ``tax'' or ``taxes'', respectively.
       (b) Taxes Not Penalties.--Section 5000A of the Internal 
     Revenue Code of 1986 (as added by section 1501(b)) is amended 
     by striking ``penalty'' each place it appears (other than the 
     second place in paragraphs (1) and (2)(A) of subsection (g) 
     thereof) and inserting ``tax''.
       (c) Taxes Not Assessable Payments.--Section 4980H of the 
     Internal Revenue Code of 1986 (as added by section 1513(a)) 
     and section 1513(c)(1) are each amended by striking 
     ``assessable payment'' or ``assessable payments''each place 
     they appear and inserting ``tax'' or ``taxes'', respectively.
                                 ______
                                 
  SA 3062. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:


[[Page 29828]]

       On page 357, strike line 15 and insert the following:
       (d) Report on Impact of Penalties.--Not later than 18 
     months after the date of the enactment of this Act, the 
     Comptroller General shall submit to Congress a report on the 
     assessable payments imposed under section 4980H of the 
     Internal Revenue Code of 1986 (as added by the amendments 
     made by this section). The report submitted under this 
     subsection shall include a detailed analysis of the impact of 
     such assessable penalty on--
       (1) employer profits,
       (2) Federal revenues, including any decrease in tax 
     revenues due to any decrease in employer profits as a result 
     of such assessable penalties,
       (3) the level of wages and benefits of employees,
       (4) the hours worked by employees, including whether 
     employees are classified as part-time or full-time employees, 
     and
       (5) the termination of employees.
       (e) Effective Date.--The amendments made by
                                 ______
                                 
  SA 3063. Mr. AKAKA (for himself and Mr. Inouye) 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 515 of the amendment, between lines 11 and 12, 
     insert the following:

     SEC. 2552. ESTABLISHMENT OF PERMANENT MEDICAID DSH ALLOTMENT 
                   FOR HAWAII.

       (a) In General.--Section 1923(f)(6) of the Social Security 
     Act (42 U.S.C. 1396r-4(f)(6)) is amended--
       (1) by striking the paragraph heading and inserting the 
     following: ``Allotment adjustments for tennessee and 
     hawaii''; and
       (2) in subparagraph (B), by adding at the end the 
     following:
       ``(iii) Allotment for 2d, 3rd, and 4th quarter of fiscal 
     year 2012, fiscal year 2013, and succeeding fiscal years.--
     Notwithstanding the table set forth in paragraph (2) or 
     paragraph (7):

       ``(I) 2d, 3rd, and 4th quarter of fiscal year 2012.--The 
     DSH allotment for Hawaii for the 2d, 3rd, and 4th quarters of 
     fiscal year 2012 shall be $7,500,000.
       ``(II) Treatment as a low-dsh state for fiscal year 2013 
     and succeeding fiscal years.--With respect to fiscal year 
     2013, and each fiscal year thereafter, the DSH allotment for 
     Hawaii shall be increased in the same manner as allotments 
     for low DSH States are increased for such fiscal year under 
     clauses (ii) and (iii) of paragraph (5)(B).
       ``(III) Certain hospital payments.--The Secretary may not 
     impose a limitation on the total amount of payments made to 
     hospitals under the QUEST section 1115 Demonstration Project 
     except to the extent that such limitation is necessary to 
     ensure that a hospital does not receive payments in excess of 
     the amounts described in subsection (g), or as necessary to 
     ensure that such payments under the waiver and such payments 
     pursuant to the allotment provided in this clause do not, in 
     the aggregate in any year, exceed the amount that the 
     Secretary determines is equal to the Federal medical 
     assistance percentage component attributable to 
     disproportionate share hospital payment adjustments for such 
     year that is reflected in the budget neutrality provision of 
     the QUEST Demonstration Project.''.

       (b) Conforming Amendment.--Effective October 1, 2011, 
     paragraph (7) of section 1923(f) of such Act (42 U.S.C. 
     1396r-4(f)), as added by section 2551, is amended--
       (1) in subparagraph (A), in the matter preceding clause 
     (i), by striking ``subparagraph (E)'' and inserting 
     ``subparagraphs (E) and (G)''; and
       (2) by adding at the end the following:
       ``(G) Nonapplication.--The preceding provisions of this 
     paragraph shall not apply to the DSH allotment determined for 
     the State of Hawaii for a fiscal year under paragraph (6).''.
                                 ______
                                 
  SA 3064. 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 124, between lines 16 and 17, insert the following:
       (4) Nondiscrimination on abortion and respect for rights of 
     conscience.--
       (A) Nondiscrimination.--A Federal agency or program, and 
     any State or local government that receives Federal financial 
     assistance under this Act (or an amendment made by this Act), 
     may not--
       (i) subject any individual or institutional health care 
     entity to discrimination; or
       (ii) require any health plan created or regulated under 
     this Act (or an amendment made by this Act) to subject any 
     individual or institutional health care entity to 
     discrimination,

     on the basis that the health care entity does not provide, 
     pay for, provide coverage of, or refer for abortions.
       (B) Definition.----In this section, the term ```health care 
     entity''' includes an individual physician or other health 
     care professional, a hospital, a provider-sponsored 
     organization, a health maintenance organization, a health 
     insurance plan, or any other kind of health care facility, 
     organization, or plan.
       (C) Administration.--The Office for Civil Rights of the 
     Department of Health and Human Services is designated to 
     receive complaints of discrimination based on this section, 
     and coordinate the investigation of such complaints.
                                 ______
                                 
  SA 3065. Mr. CARDIN (for himself and Mr. Brown) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 396, between lines 8 and 9, insert the following:

                    Subtitle H--Patient Protections

                     PART I--IMPROVING MANAGED CARE

                 Subpart A--Utilization Review; Claims

     SEC. 1601. UTILIZATION REVIEW ACTIVITIES.

       (a) Compliance With Requirements.--
       (1) In general.--A group health plan, and a health 
     insurance issuer that provides health insurance coverage, 
     shall conduct utilization review activities in connection 
     with the provision of benefits under such plan or coverage 
     only in accordance with a utilization review program that 
     meets the requirements of this section and section 1602.
       (2) Use of outside agents.--Nothing in this section shall 
     be construed as preventing a group health plan or health 
     insurance issuer from arranging through a contract or 
     otherwise for persons or entities to conduct utilization 
     review activities on behalf of the plan or issuer, so long as 
     such activities are conducted in accordance with a 
     utilization review program that meets the requirements of 
     this section.
       (3) Utilization review defined.--For purposes of this 
     section, the terms ``utilization review'' and ``utilization 
     review activities'' mean procedures used to monitor or 
     evaluate the use or coverage, clinical necessity, 
     appropriateness, efficacy, or efficiency of health care 
     services, procedures or settings, and includes prospective 
     review, concurrent review, second opinions, case management, 
     discharge planning, or retrospective review.
       (b) Written Policies and Criteria.--
       (1) Written policies.--A utilization review program shall 
     be conducted consistent with written policies and procedures 
     that govern all aspects of the program.
       (2) Use of written criteria.--
       (A) In general.--Such a program shall utilize written 
     clinical review criteria developed with input from a range of 
     appropriate actively practicing health care professionals, as 
     determined by the plan, pursuant to the program. Such 
     criteria shall include written clinical review criteria that 
     are based on valid clinical evidence where available and that 
     are directed specifically at meeting the needs of at-risk 
     populations and covered individuals with chronic conditions 
     or severe illnesses, including gender-specific criteria and 
     pediatric-specific criteria where available and appropriate.
       (B) Continuing use of standards in retrospective review.--
     If a health care service has been specifically pre-authorized 
     or approved for a participant, beneficiary, or enrollee under 
     such a program, the program shall not, pursuant to 
     retrospective review, revise or modify the specific 
     standards, criteria, or procedures used for the utilization 
     review for procedures, treatment, and services delivered to 
     the enrollee during the same course of treatment.
       (C) Review of sample of claims denials.--Such a program 
     shall provide for a periodic evaluation of the clinical 
     appropriateness of at least a sample of denials of claims for 
     benefits.
       (c) Conduct of Program Activities.--
       (1) Administration by health care professionals.--A 
     utilization review program shall be administered by qualified 
     health care professionals who shall oversee review decisions.
       (2) Use of qualified, independent personnel.--
       (A) In general.--A utilization review program shall provide 
     for the conduct of utilization review activities only through 
     personnel who are qualified and have received appropriate 
     training in the conduct of such activities under the program.

[[Page 29829]]

       (B) Prohibition of contingent compensation arrangements.--
     Such a program shall not, with respect to utilization review 
     activities, permit or provide compensation or anything of 
     value to its employees, agents, or contractors in a manner 
     that encourages denials of claims for benefits.
       (C) Prohibition of conflicts.--Such a program shall not 
     permit a health care professional who is providing health 
     care services to an individual to perform utilization review 
     activities in connection with the health care services being 
     provided to the individual.
       (3) Accessibility of review.--Such a program shall provide 
     that appropriate personnel performing utilization review 
     activities under the program, including the utilization 
     review administrator, are reasonably accessible by toll-free 
     telephone during normal business hours to discuss patient 
     care and allow response to telephone requests, and that 
     appropriate provision is made to receive and respond promptly 
     to calls received during other hours.
       (4) Limits on frequency.--Such a program shall not provide 
     for the performance of utilization review activities with 
     respect to a class of services furnished to an individual 
     more frequently than is reasonably required to assess whether 
     the services under review are medically necessary and 
     appropriate.

     SEC. 1602. PROCEDURES FOR INITIAL CLAIMS FOR BENEFITS AND 
                   PRIOR AUTHORIZATION DETERMINATIONS.

       (a) Procedures of Initial Claims for Benefits.--
       (1) In general.--A group health plan, or health insurance 
     issuer offering health insurance coverage, shall--
       (A) make a determination on an initial claim for benefits 
     by a participant, beneficiary, or enrollee (or authorized 
     representative) regarding payment or coverage for items or 
     services under the terms and conditions of the plan or 
     coverage involved, including any cost-sharing amount that the 
     participant, beneficiary, or enrollee is required to pay with 
     respect to such claim for benefits; and
       (B) notify a participant, beneficiary, or enrollee (or 
     authorized representative) and the treating health care 
     professional involved regarding a determination on an initial 
     claim for benefits made under the terms and conditions of the 
     plan or coverage, including any cost-sharing amounts that the 
     participant, beneficiary, or enrollee may be required to make 
     with respect to such claim for benefits.
       (2) Access to information.--
       (A) Timely provision of necessary information.--With 
     respect to an initial claim for benefits, the participant, 
     beneficiary, or enrollee (or authorized representative) and 
     the treating health care professional (if any) shall provide 
     the plan or issuer with access to information requested by 
     the plan or issuer that is necessary to make a determination 
     relating to the claim. Such access shall be provided not 
     later than 5 days after the date on which the request for 
     information is received, or, in a case described in 
     subparagraph (B) or (C) of subsection (b)(1), by such earlier 
     time as may be necessary to comply with the applicable 
     timeline under such subparagraph.
       (B) Limited effect of failure on plan or issuer's 
     obligations.--Failure of the participant, beneficiary, or 
     enrollee to comply with the requirements of subparagraph (A) 
     shall not remove the obligation of the plan or issuer to make 
     a decision in accordance with the medical exigencies of the 
     case and as soon as possible, based on the available 
     information, and failure to comply with the time limit 
     established by this paragraph shall not remove the obligation 
     of the plan or issuer to comply with the requirements of this 
     section.
       (3) Oral requests.--In the case of a claim for benefits 
     involving an expedited or concurrent determination, a 
     participant, beneficiary, or enrollee (or authorized 
     representative) may make an initial claim for benefits 
     orally, but a group health plan, or health insurance issuer 
     offering health insurance coverage, may require that the 
     participant, beneficiary, or enrollee (or authorized 
     representative) provide written confirmation of such request 
     in a timely manner on a form provided by the plan or issuer. 
     In the case of such an oral request for benefits, the making 
     of the request (and the timing of such request) shall be 
     treated as the making at that time of a claims for such 
     benefits without regard to whether and when a written 
     confirmation of such request is made.
       (b) Timeline for Making Determinations.--
       (1) Prior authorization determination.--
       (A) In general.--A group health plan, or health insurance 
     issuer offering health insurance coverage, shall make a prior 
     authorization determination on a claim for benefits (whether 
     oral or written) in accordance with the medical exigencies of 
     the case and as soon as possible, but in no case later than 
     14 days from the date on which the plan or issuer receives 
     information that is reasonably necessary to enable the plan 
     or issuer to make a determination on the request for prior 
     authorization and in no case later than 28 days after the 
     date of the claim for benefits is received.
       (B) Expedited determination.--Notwithstanding subparagraph 
     (A), a group health plan, or health insurance issuer offering 
     health insurance coverage, shall expedite a prior 
     authorization determination on a claim for benefits described 
     in such subparagraph when a request for such an expedited 
     determination is made by a participant, beneficiary, or 
     enrollee (or authorized representative) at any time during 
     the process for making a determination and a health care 
     professional certifies, with the request, that a 
     determination under the procedures described in subparagraph 
     (A) would seriously jeopardize the life or health of the 
     participant, beneficiary, or enrollee or the ability of the 
     participant, beneficiary, or enrollee to maintain or regain 
     maximum function. Such determination shall be made in 
     accordance with the medical exigencies of the case and as 
     soon as possible, but in no case later than 72 hours after 
     the time the request is received by the plan or issuer under 
     this subparagraph.
       (C) Ongoing care.--
       (i) Concurrent review.--

       (I) In general.--Subject to clause (ii), in the case of a 
     concurrent review of ongoing care (including 
     hospitalization), which results in a termination or reduction 
     of such care, the plan or issuer must provide by telephone 
     and in printed form notice of the concurrent review 
     determination to the individual or the individual's designee 
     and the individual's health care provider in accordance with 
     the medical exigencies of the case and as soon as possible.
       (II) Contents of notice.--Such notice shall include, with 
     respect to ongoing health care items and services, the number 
     of ongoing services approved, the new total of approved 
     services, the date of onset of services, and the next review 
     date, if any, as well as a statement of the individual's 
     rights to further appeal.

       (ii) Rule of construction.--Clause (i) shall not be 
     construed as requiring plans or issuers to provide coverage 
     of care that would exceed the coverage limitations for such 
     care.
       (2) Retrospective determination.--A group health plan, or 
     health insurance issuer offering health insurance coverage, 
     shall make a retrospective determination on a claim for 
     benefits in accordance with the medical exigencies of the 
     case and as soon as possible, but not later than 30 days 
     after the date on which the plan or issuer receives 
     information that is reasonably necessary to enable the plan 
     or issuer to make a determination on the claim, or, if 
     earlier, 60 days after the date of receipt of the claim for 
     benefits.
       (c) Notice of a Denial of a Claim for Benefits.--Written 
     notice of a denial made under an initial claim for benefits 
     shall be issued to the participant, beneficiary, or enrollee 
     (or authorized representative) and the treating health care 
     professional in accordance with the medical exigencies of the 
     case and as soon as possible, but in no case later than 2 
     days after the date of the determination (or, in the case 
     described in subparagraph (B) or (C) of subsection (b)(1), 
     within the 72-hour or applicable period referred to in such 
     subparagraph).
       (d) Requirements of Notice of Determinations.--The written 
     notice of a denial of a claim for benefits determination 
     under subsection (c) shall be provided in printed form and 
     written in a manner calculated to be understood by the 
     participant, beneficiary, or enrollee and shall include--
       (1) the specific reasons for the determination (including a 
     summary of the clinical or scientific evidence used in making 
     the determination); and
       (2) the procedures for obtaining additional information 
     concerning the determination.
       (e) Definitions.--For purposes of this part:
       (1) Authorized representative.--The term ``authorized 
     representative'' means, with respect to an individual who is 
     a participant, beneficiary, or enrollee, any health care 
     professional or other person acting on behalf of the 
     individual with the individual's consent or without such 
     consent if the individual is medically unable to provide such 
     consent.
       (2) Claim for benefits.--The term ``claim for benefits'' 
     means any request for coverage (including authorization of 
     coverage), for eligibility, or for payment in whole or in 
     part, for an item or service under a group health plan or 
     health insurance coverage.
       (3) Denial of claim for benefits.--The term ``denial'' 
     means, with respect to a claim for benefits, a denial (in 
     whole or in part) of, or a failure to act on a timely basis 
     upon, the claim for benefits and includes a failure to 
     provide benefits (including items and services) required to 
     be provided under this part.
       (4) Treating health care professional.--The term ``treating 
     health care professional'' means, with respect to services to 
     be provided to a participant, beneficiary, or enrollee, a 
     health care professional who is primarily responsible for 
     delivering those services to the participant, beneficiary, or 
     enrollee.

                       Subpart B--Access to Care

     SEC. 1611. CHOICE OF HEALTH CARE PROFESSIONAL.

       (a) Primary Care.--If a group health plan, or a health 
     insurance issuer that offers health insurance coverage, 
     requires or provides for designation by a participant, 
     beneficiary, or enrollee of a participating primary care 
     provider, then the plan or issuer

[[Page 29830]]

     shall permit each participant, beneficiary, and enrollee to 
     designate any participating primary care provider who is 
     available to accept such individual.
       (b) Specialists.--
       (1) In general.--Subject to paragraph (2), a group health 
     plan and a health insurance issuer that offers health 
     insurance coverage shall permit each participant, 
     beneficiary, or enrollee to receive medically necessary and 
     appropriate specialty care, pursuant to appropriate referral 
     procedures, from any qualified participating health care 
     professional who is available to accept such individual for 
     such care.
       (2) Limitation.--Paragraph (1) shall not apply to specialty 
     care if the plan or issuer clearly informs participants, 
     beneficiaries, and enrollees of the limitations on choice of 
     participating health care professionals with respect to such 
     care.
       (3) Construction.--Nothing in this subsection shall be 
     construed as affecting the application of section 114 
     (relating to access to specialty care).

     SEC. 1612. ACCESS TO EMERGENCY CARE.

       (a) Coverage of Emergency Services.--
       (1) In general.--If a group health plan, or health 
     insurance coverage offered by a health insurance issuer, 
     provides or covers any benefits with respect to services in 
     an emergency department of a hospital, the plan or issuer 
     shall cover emergency services (as defined in paragraph 
     (2)(B))--
       (A) without the need for any prior authorization 
     determination;
       (B) whether the health care provider furnishing such 
     services is a participating provider with respect to such 
     services;
       (C) in a manner so that, if such services are provided to a 
     participant, beneficiary, or enrollee--
       (i) by a nonparticipating health care provider with or 
     without prior authorization, or
       (ii) by a participating health care provider without prior 
     authorization, the participant, beneficiary, or enrollee is 
     not liable for amounts that exceed the amounts of liability 
     that would be incurred if the services were provided by a 
     participating health care provider with prior authorization; 
     and
       (D) without regard to any other term or condition of such 
     coverage (other than exclusion or coordination of benefits, 
     or an affiliation or waiting period, permitted under section 
     2701 of the Public Health Service Act, section 701 of the 
     Employee Retirement Income Security Act of 1974, or section 
     9801 of the Internal Revenue Code of 1986, and other than 
     applicable cost-sharing).
       (2) Definitions.--In this section:
       (A) Emergency medical condition.--The term ``emergency 
     medical condition'' means a medical condition manifesting 
     itself by acute symptoms of sufficient severity (including 
     severe pain) such that a prudent layperson, who possesses an 
     average knowledge of health and medicine, could reasonably 
     expect the absence of immediate medical attention to result 
     in a condition described in clause (i), (ii), or (iii) of 
     section 1867(e)(1)(A) of the Social Security Act.
       (B) Emergency services.--The term ``emergency services'' 
     means, with respect to an emergency medical condition--
       (i) a medical screening examination (as required under 
     section 1867 of the Social Security Act) that is within the 
     capability of the emergency department of a hospital, 
     including ancillary services routinely available to the 
     emergency department to evaluate such emergency medical 
     condition, and
       (ii) within the capabilities of the staff and facilities 
     available at the hospital, such further medical examination 
     and treatment as are required under section 1867 of such Act 
     to stabilize the patient.
       (C) Stabilize.--The term ``to stabilize'', with respect to 
     an emergency medical condition (as defined in subparagraph 
     (A)), has the meaning give in section 1867(e)(3) of the 
     Social Security Act (42 U.S.C. 1395dd(e)(3)).
       (b) Reimbursement for Maintenance Care and Post-
     Stabilization Care.--A group health plan, and health 
     insurance coverage offered by a health insurance issuer, must 
     provide reimbursement for maintenance care and post-
     stabilization care in accordance with the requirements of 
     section 1852(d)(2) of the Social Security Act (42 U.S.C. 
     1395w-22(d)(2)). Such reimbursement shall be provided in a 
     manner consistent with subsection (a)(1)(C).
       (c) Coverage of Emergency Ambulance Services.--
       (1) In general.--If a group health plan, or health 
     insurance coverage provided by a health insurance issuer, 
     provides any benefits with respect to ambulance services and 
     emergency services, the plan or issuer shall cover emergency 
     ambulance services (as defined in paragraph (2)) furnished 
     under the plan or coverage under the same terms and 
     conditions under subparagraphs (A) through (D) of subsection 
     (a)(1) under which coverage is provided for emergency 
     services.
       (2) Emergency ambulance services.--For purposes of this 
     subsection, the term ``emergency ambulance services'' means 
     ambulance services (as defined for purposes of section 
     1861(s)(7) of the Social Security Act) furnished to transport 
     an individual who has an emergency medical condition (as 
     defined in subsection (a)(2)(A)) to a hospital for the 
     receipt of emergency services (as defined in subsection 
     (a)(2)(B)) in a case in which the emergency services are 
     covered under the plan or coverage pursuant to subsection 
     (a)(1) and a prudent layperson, with an average knowledge of 
     health and medicine, could reasonably expect that the absence 
     of such transport would result in placing the health of the 
     individual in serious jeopardy, serious impairment of bodily 
     function, or serious dysfunction of any bodily organ or part.

     SEC. 1613. TIMELY ACCESS TO SPECIALISTS.

       (a) Timely Access.--
       (1) In general.--A group health plan or health insurance 
     issuer offering health insurance coverage shall ensure that 
     participants, beneficiaries, and enrollees receive timely 
     access to specialists who are appropriate to the condition 
     of, and accessible to, the participant, beneficiary, or 
     enrollee, when such specialty care is a covered benefit under 
     the plan or coverage.
       (2) Rule of construction.--Nothing in paragraph (1) shall 
     be construed--
       (A) to require the coverage under a group health plan or 
     health insurance coverage of benefits or services;
       (B) to prohibit a plan or issuer from including providers 
     in the network only to the extent necessary to meet the needs 
     of the plan's or issuer's participants, beneficiaries, or 
     enrollees; or
       (C) to override any State licensure or scope-of-practice 
     law.
       (3) Access to certain providers.--
       (A) In general.--With respect to specialty care under this 
     section, if a participating specialist is not available and 
     qualified to provide such care to the participant, 
     beneficiary, or enrollee, the plan or issuer shall provide 
     for coverage of such care by a nonparticipating specialist.
       (B) Treatment of nonparticipating providers.--If a 
     participant, beneficiary, or enrollee receives care from a 
     nonparticipating specialist pursuant to subparagraph (A), 
     such specialty care shall be provided at no additional cost 
     to the participant, beneficiary, or enrollee beyond what the 
     participant, beneficiary, or enrollee would otherwise pay for 
     such specialty care if provided by a participating 
     specialist.
       (b) Referrals.--
       (1) Authorization.--Subject to subsection (a)(1), a group 
     health plan or health insurance issuer may require an 
     authorization in order to obtain coverage for specialty 
     services under this section. Any such authorization--
       (A) shall be for an appropriate duration of time or number 
     of referrals, including an authorization for a standing 
     referral where appropriate; and
       (B) may not be refused solely because the authorization 
     involves services of a nonparticipating specialist (described 
     in subsection (a)(3)).
       (2) Referrals for ongoing special conditions.--
       (A) In general.--Subject to subsection (a)(1), a group 
     health plan or health insurance issuer shall permit a 
     participant, beneficiary, or enrollee who has an ongoing 
     special condition (as defined in subparagraph (B)) to receive 
     a referral to a specialist for the treatment of such 
     condition and such specialist may authorize such referrals, 
     procedures, tests, and other medical services with respect to 
     such condition, or coordinate the care for such condition, 
     subject to the terms of a treatment plan (if any) referred to 
     in subsection (c) with respect to the condition.
       (B) Ongoing special condition defined.--In this subsection, 
     the term ``ongoing special condition'' means a condition or 
     disease that--
       (i) is life-threatening, degenerative, potentially 
     disabling, or congenital; and
       (ii) requires specialized medical care over a prolonged 
     period of time.
       (c) Treatment Plans.--
       (1) In general.--A group health plan or health insurance 
     issuer may require that the specialty care be provided--
       (A) pursuant to a treatment plan, but only if the treatment 
     plan--
       (i) is developed by the specialist, in consultation with 
     the case manager or primary care provider, and the 
     participant, beneficiary, or enrollee, and
       (ii) is approved by the plan or issuer in a timely manner, 
     if the plan or issuer requires such approval; and
       (B) in accordance with applicable quality assurance and 
     utilization review standards of the plan or issuer.
       (2) Notification.--Nothing in paragraph (1) shall be 
     construed as prohibiting a plan or issuer from requiring the 
     specialist to provide the plan or issuer with regular updates 
     on the specialty care provided, as well as all other 
     reasonably necessary medical information.
       (d) Specialist Defined.--For purposes of this section, the 
     term ``specialist'' means, with respect to the condition of 
     the participant, beneficiary, or enrollee, a health care 
     professional, facility, or center that has adequate expertise 
     through appropriate training and experience (including, in 
     the case of a child, appropriate pediatric expertise) to 
     provide high quality care in treating the condition.

     SEC. 1614. ACCESS TO PEDIATRIC CARE.

       (a) Pediatric Care.--In the case of a person who has a 
     child who is a participant, beneficiary, or enrollee under a 
     group health

[[Page 29831]]

     plan, or health insurance coverage offered by a health 
     insurance issuer, if the plan or issuer requires or provides 
     for the designation of a participating primary care provider 
     for the child, the plan or issuer shall permit such person to 
     designate a physician (allopathic or osteopathic) who 
     specializes in pediatrics as the child's primary care 
     provider if such provider participates in the network of the 
     plan or issuer.
       (b) Construction.--Nothing in subsection (a) shall be 
     construed to waive any exclusions of coverage under the terms 
     and conditions of the plan or health insurance coverage with 
     respect to coverage of pediatric care.

     SEC. 1615. PATIENT ACCESS TO OBSTETRICAL AND GYNECOLOGICAL 
                   CARE.

       (a) General Rights.--
       (1) Direct access.--A group health plan, or health 
     insurance issuer offering health insurance coverage, 
     described in subsection (b) may not require authorization or 
     referral by the plan, issuer, or any person (including a 
     primary care provider described in subsection (b)(2)) in the 
     case of a female participant, beneficiary, or enrollee who 
     seeks coverage for obstetrical or gynecological care provided 
     by a participating health care professional who specializes 
     in obstetrics or gynecology.
       (2) Obstetrical and gynecological care.--A group health 
     plan or health insurance issuer described in subsection (b) 
     shall treat the provision of obstetrical and gynecological 
     care, and the ordering of related obstetrical and 
     gynecological items and services, pursuant to the direct 
     access described under paragraph (1), by a participating 
     health care professional who specializes in obstetrics or 
     gynecology as the authorization of the primary care provider.
       (b) Application of Section.--A group health plan, or health 
     insurance issuer offering health insurance coverage, 
     described in this subsection is a group health plan or 
     coverage that--
       (1) provides coverage for obstetric or gynecologic care; 
     and
       (2) requires the designation by a participant, beneficiary, 
     or enrollee of a participating primary care provider.
       (c) Construction.--Nothing in subsection (a) shall be 
     construed to--
       (1) waive any exclusions of coverage under the terms and 
     conditions of the plan or health insurance coverage with 
     respect to coverage of obstetrical or gynecological care; or
       (2) preclude the group health plan or health insurance 
     issuer involved from requiring that the obstetrical or 
     gynecological provider notify the primary care health care 
     professional or the plan or issuer of treatment decisions.

     SEC. 1616. CONTINUITY OF CARE.

       (a) Termination of Provider.--
       (1) In general.--If--
       (A) a contract between a group health plan, or a health 
     insurance issuer offering health insurance coverage, and a 
     treating health care provider is terminated (as defined in 
     subsection (e)(4)), or
       (B) benefits or coverage provided by a health care provider 
     are terminated because of a change in the terms of provider 
     participation in such plan or coverage,
     the plan or issuer shall meet the requirements of paragraph 
     (3) with respect to each continuing care patient.
       (2) Treatment of termination of contract with health 
     insurance issuer.--If a contract for the provision of health 
     insurance coverage between a group health plan and a health 
     insurance issuer is terminated and, as a result of such 
     termination, coverage of services of a health care provider 
     is terminated with respect to an individual, the provisions 
     of paragraph (1) (and the succeeding provisions of this 
     section) shall apply under the plan in the same manner as if 
     there had been a contract between the plan and the provider 
     that had been terminated, but only with respect to benefits 
     that are covered under the plan after the contract 
     termination.
       (3) Requirements.--The requirements of this paragraph are 
     that the plan or issuer--
       (A) notify the continuing care patient involved, or arrange 
     to have the patient notified pursuant to subsection (d)(2), 
     on a timely basis of the termination described in paragraph 
     (1) (or paragraph (2), if applicable) and the right to elect 
     continued transitional care from the provider under this 
     section;
       (B) provide the patient with an opportunity to notify the 
     plan or issuer of the patient's need for transitional care; 
     and
       (C) subject to subsection (c), permit the patient to elect 
     to continue to be covered with respect to the course of 
     treatment by such provider with the provider's consent during 
     a transitional period (as provided for under subsection (b)).
       (4) Continuing care patient.--For purposes of this section, 
     the term ``continuing care patient'' means a participant, 
     beneficiary, or enrollee who--
       (A) is undergoing a course of treatment for a serious and 
     complex condition from the provider at the time the plan or 
     issuer receives or provides notice of provider, benefit, or 
     coverage termination described in paragraph (1) (or paragraph 
     (2), if applicable);
       (B) is undergoing a course of institutional or inpatient 
     care from the provider at the time of such notice;
       (C) is scheduled to undergo non-elective surgery from the 
     provider at the time of such notice;
       (D) is pregnant and undergoing a course of treatment for 
     the pregnancy from the provider at the time of such notice; 
     or
       (E) is or was determined to be terminally ill (as 
     determined under section 1861(dd)(3)(A) of the Social 
     Security Act) at the time of such notice, but only with 
     respect to a provider that was treating the terminal illness 
     before the date of such notice.
       (b) Transitional Periods.--
       (1) Serious and complex conditions.--The transitional 
     period under this subsection with respect to a continuing 
     care patient described in subsection (a)(4)(A) shall extend 
     for up to 90 days (as determined by the treating health care 
     professional) from the date of the notice described in 
     subsection (a)(3)(A).
       (2) Institutional or inpatient care.--The transitional 
     period under this subsection for a continuing care patient 
     described in subsection (a)(4)(B) shall extend until the 
     earlier of--
       (A) the expiration of the 90-day period beginning on the 
     date on which the notice under subsection (a)(3)(A) is 
     provided; or
       (B) the date of discharge of the patient from such care or 
     the termination of the period of institutionalization, or, if 
     later, the date of completion of reasonable follow-up care.
       (3) Scheduled non-elective surgery.--The transitional 
     period under this subsection for a continuing care patient 
     described in subsection (a)(4)(C) shall extend until the 
     completion of the surgery involved and post-surgical follow-
     up care relating to the surgery and occurring within 90 days 
     after the date of the surgery.
       (4) Pregnancy.--The transitional period under this 
     subsection for a continuing care patient described in 
     subsection (a)(4)(D) shall extend through the provision of 
     post-partum care directly related to the delivery.
       (5) Terminal illness.--The transitional period under this 
     subsection for a continuing care patient described in 
     subsection (a)(4)(E) shall extend for the remainder of the 
     patient's life for care that is directly related to the 
     treatment of the terminal illness or its medical 
     manifestations.
       (c) Permissible Terms and Conditions.--A group health plan 
     or health insurance issuer may condition coverage of 
     continued treatment by a provider under this section upon the 
     provider agreeing to the following terms and conditions:
       (1) The treating health care provider agrees to accept 
     reimbursement from the plan or issuer and continuing care 
     patient involved (with respect to cost-sharing) at the rates 
     applicable prior to the start of the transitional period as 
     payment in full (or, in the case described in subsection 
     (a)(2), at the rates applicable under the replacement plan or 
     coverage after the date of the termination of the contract 
     with the group health plan or health insurance issuer) and 
     not to impose cost-sharing with respect to the patient in an 
     amount that would exceed the cost-sharing that could have 
     been imposed if the contract referred to in subsection (a)(1) 
     had not been terminated.
       (2) The treating health care provider agrees to adhere to 
     the quality assurance standards of the plan or issuer 
     responsible for payment under paragraph (1) and to provide to 
     such plan or issuer necessary medical information related to 
     the care provided.
       (3) The treating health care provider agrees otherwise to 
     adhere to such plan's or issuer's policies and procedures, 
     including procedures regarding referrals and obtaining prior 
     authorization and providing services pursuant to a treatment 
     plan (if any) approved by the plan or issuer.
       (d) Rules of Construction.--Nothing in this section shall 
     be construed--
       (1) to require the coverage of benefits which would not 
     have been covered if the provider involved remained a 
     participating provider; or
       (2) with respect to the termination of a contract under 
     subsection (a) to prevent a group health plan or health 
     insurance issuer from requiring that the health care 
     provider--
       (A) notify participants, beneficiaries, or enrollees of 
     their rights under this section; or
       (B) provide the plan or issuer with the name of each 
     participant, beneficiary, or enrollee who the provider 
     believes is a continuing care patient.
       (e) Definitions.--In this section:
       (1) Contract.--The term ``contract'' includes, with respect 
     to a plan or issuer and a treating health care provider, a 
     contract between such plan or issuer and an organized network 
     of providers that includes the treating health care provider, 
     and (in the case of such a contract) the contract between the 
     treating health care provider and the organized network.
       (2) Health care provider.--The term ``health care 
     provider'' or ``provider'' means--
       (A) any individual who is engaged in the delivery of health 
     care services in a State and who is required by State law or 
     regulation to be licensed or certified by the State to engage 
     in the delivery of such services in the State; and

[[Page 29832]]

       (B) any entity that is engaged in the delivery of health 
     care services in a State and that, if it is required by State 
     law or regulation to be licensed or certified by the State to 
     engage in the delivery of such services in the State, is so 
     licensed.
       (3) Serious and complex condition.--The term ``serious and 
     complex condition'' means, with respect to a participant, 
     beneficiary, or enrollee under the plan or coverage--
       (A) in the case of an acute illness, a condition that is 
     serious enough to require specialized medical treatment to 
     avoid the reasonable possibility of death or permanent harm; 
     or
       (B) in the case of a chronic illness or condition, is an 
     ongoing special condition (as defined in section (b)(2)(B)).
       (4) Terminated.--The term ``terminated'' includes, with 
     respect to a contract, the expiration or nonrenewal of the 
     contract, but does not include a termination of the contract 
     for failure to meet applicable quality standards or for 
     fraud.

         Subpart C--Protecting the Doctor-Patient Relationship

     SEC. 1621. PROHIBITION OF INTERFERENCE WITH CERTAIN MEDICAL 
                   COMMUNICATIONS.

       (a) General Rule.--The provisions of any contract or 
     agreement, or the operation of any contract or agreement, 
     between a group health plan or health insurance issuer in 
     relation to health insurance coverage (including any 
     partnership, association, or other organization that enters 
     into or administers such a contract or agreement) and a 
     health care provider (or group of health care providers) 
     shall not prohibit or otherwise restrict a health care 
     professional from advising such a participant, beneficiary, 
     or enrollee who is a patient of the professional about the 
     health status of the individual or medical care or treatment 
     for the individual's condition or disease, regardless of 
     whether benefits for such care or treatment are provided 
     under the plan or coverage, if the professional is acting 
     within the lawful scope of practice.
       (b) Nullification.--Any contract provision or agreement 
     that restricts or prohibits medical communications in 
     violation of subsection (a) shall be null and void.

                         Subpart D--Definitions

     SEC. 1631. DEFINITIONS.

       (a) Incorporation of General Definitions.--Except as 
     otherwise provided, the provisions of section 2791 of the 
     Public Health Service Act shall apply for purposes of this 
     part in the same manner as they apply for purposes of title 
     XXVII of such Act.
       (b) Secretary.--Except as otherwise provided, the term 
     ``Secretary'' means the Secretary of Health and Human 
     Services, in consultation with the Secretary of Labor and the 
     term ``appropriate Secretary'' means the Secretary of Health 
     and Human Services in relation to carrying out this part 
     under sections 2706 and 2751 of the Public Health Service Act 
     and the Secretary of Labor in relation to carrying out this 
     part under section 713 of the Employee Retirement Income 
     Security Act of 1974.
       (c) Additional Definitions.--For purposes of this part:
       (1) Applicable authority.--The term ``applicable 
     authority'' means--
       (A) in the case of a group health plan, the Secretary of 
     Health and Human Services and the Secretary of Labor; and
       (B) in the case of a health insurance issuer with respect 
     to a specific provision of this part, the applicable State 
     authority (as defined in section 2791(d) of the Public Health 
     Service Act), or the Secretary of Health and Human Services, 
     if such Secretary is enforcing such provision under section 
     2722(a)(2) or 2761(a)(2) of the Public Health Service Act.
       (2) Enrollee.--The term ``enrollee'' means, with respect to 
     health insurance coverage offered by a health insurance 
     issuer, an individual enrolled with the issuer to receive 
     such coverage.
       (3) Group health plan.--The term ``group health plan'' has 
     the meaning given such term in section 733(a) of the Employee 
     Retirement Income Security Act of 1974, except that such term 
     includes a employee welfare benefit plan treated as a group 
     health plan under section 732(d) of such Act or defined as 
     such a plan under section 607(1) of such Act.
       (4) Health care professional.--The term ``health care 
     professional'' means an individual who is licensed, 
     accredited, or certified under State law to provide specified 
     health care services and who is operating within the scope of 
     such licensure, accreditation, or certification.
       (5) Health care provider.--The term ``health care 
     provider'' includes a physician or other health care 
     professional, as well as an institutional or other facility 
     or agency that provides health care services and that is 
     licensed, accredited, or certified to provide health care 
     items and services under applicable State law.
       (6) Network.--The term ``network'' means, with respect to a 
     group health plan or health insurance issuer offering health 
     insurance coverage, the participating health care 
     professionals and providers through whom the plan or issuer 
     provides health care items and services to participants, 
     beneficiaries, or enrollees.
       (7) Nonparticipating.--The term ``nonparticipating'' means, 
     with respect to a health care provider that provides health 
     care items and services to a participant, beneficiary, or 
     enrollee under group health plan or health insurance 
     coverage, a health care provider that is not a participating 
     health care provider with respect to such items and services.
       (8) Participating.--The term ``participating'' means, with 
     respect to a health care provider that provides health care 
     items and services to a participant, beneficiary, or enrollee 
     under group health plan or health insurance coverage offered 
     by a health insurance issuer, a health care provider that 
     furnishes such items and services under a contract or other 
     arrangement with the plan or issuer.
       (9) Prior authorization.--The term ``prior authorization'' 
     means the process of obtaining prior approval from a health 
     insurance issuer or group health plan for the provision or 
     coverage of medical services.
       (10) Terms and conditions.--The term ``terms and 
     conditions'' includes, with respect to a group health plan or 
     health insurance coverage, requirements imposed under this 
     part with respect to the plan or coverage.

     SEC. 1632. PREEMPTION; STATE FLEXIBILITY; CONSTRUCTION.

       (a) Continued Applicability of State Law With Respect to 
     Health Insurance Issuers.--
       (1) In general.--Subject to paragraph (2), this part shall 
     not be construed to supersede any provision of State law 
     which establishes, implements, or continues in effect any 
     standard or requirement solely relating to health insurance 
     issuers (in connection with group health insurance coverage 
     or otherwise) except to the extent that such standard or 
     requirement prevents the application of a requirement of this 
     part.
       (2) Continued preemption with respect to group health 
     plans.--Nothing in this part shall be construed to affect or 
     modify the provisions of section 514 of the Employee 
     Retirement Income Security Act of 1974 with respect to group 
     health plans.
       (3) Construction.--In applying this section, a State law 
     that provides for equal access to, and availability of, all 
     categories of licensed health care providers and services 
     shall not be treated as preventing the application of any 
     requirement of this part.
       (b) Application of Substantially Compliant State Laws.--
       (1) In general.--In the case of a State law that imposes, 
     with respect to health insurance coverage offered by a health 
     insurance issuer and with respect to a group health plan that 
     is a non-Federal governmental plan, a requirement that 
     substantially complies (within the meaning of subsection (c)) 
     with a patient protection requirement (as defined in 
     paragraph (3)) and does not prevent the application of other 
     requirements under this subtitle (except in the case of other 
     substantially compliant requirements), in applying the 
     requirements of this part under section 2720 and 2754 (as 
     applicable) of the Public Health Service Act (as added by 
     part II), subject to subsection (a)(2)--
       (A) the State law shall not be treated as being superseded 
     under subsection (a); and
       (B) the State law shall apply instead of the patient 
     protection requirement otherwise applicable with respect to 
     health insurance coverage and non-Federal governmental plans.
       (2) Limitation.--In the case of a group health plan covered 
     under title I of the Employee Retirement Income Security Act 
     of 1974, paragraph (1) shall be construed to apply only with 
     respect to the health insurance coverage (if any) offered in 
     connection with the plan.
       (3) Definitions.--In this section:
       (A) Patient protection requirement.--The term ``patient 
     protection requirement'' means a requirement under this part, 
     and includes (as a single requirement) a group or related set 
     of requirements under a section or similar unit under this 
     part.
       (B) Substantially compliant.--The terms ``substantially 
     compliant'', substantially complies'', or ``substantial 
     compliance'' with respect to a State law, mean that the State 
     law has the same or similar features as the patient 
     protection requirements and has a similar effect.
       (c) Determinations of Substantial Compliance.--
       (1) Certification by states.--A State may submit to the 
     Secretary a certification that a State law provides for 
     patient protections that are at least substantially compliant 
     with one or more patient protection requirements. Such 
     certification shall be accompanied by such information as may 
     be required to permit the Secretary to make the determination 
     described in paragraph (2)(A).
       (2) Review.--
       (A) In general.--The Secretary shall promptly review a 
     certification submitted under paragraph (1) with respect to a 
     State law to determine if the State law substantially 
     complies with the patient protection requirement (or 
     requirements) to which the law relates.
       (B) Approval deadlines.--
       (i) Initial review.--Such a certification is considered 
     approved unless the Secretary notifies the State in writing, 
     within 90 days

[[Page 29833]]

     after the date of receipt of the certification, that the 
     certification is disapproved (and the reasons for 
     disapproval) or that specified additional information is 
     needed to make the determination described in subparagraph 
     (A).
       (ii) Additional information.--With respect to a State that 
     has been notified by the Secretary under clause (i) that 
     specified additional information is needed to make the 
     determination described in subparagraph (A), the Secretary 
     shall make the determination within 60 days after the date on 
     which such specified additional information is received by 
     the Secretary.
       (3) Approval.--
       (A) In general.--The Secretary shall approve a 
     certification under paragraph (1) unless--
       (i) the State fails to provide sufficient information to 
     enable the Secretary to make a determination under paragraph 
     (2)(A); or
       (ii) the Secretary determines that the State law involved 
     does not provide for patient protections that substantially 
     comply with the patient protection requirement (or 
     requirements) to which the law relates.
       (B) State challenge.--A State that has a certification 
     disapproved by the Secretary under subparagraph (A) may 
     challenge such disapproval in the appropriate United States 
     district court.
       (C) Deference to states.--With respect to a certification 
     submitted under paragraph (1), the Secretary shall give 
     deference to the State's interpretation of the State law 
     involved and the compliance of the law with a patient 
     protection requirement.
       (D) Public notification.--The Secretary shall--
       (i) provide a State with a notice of the determination to 
     approve or disapprove a certification under this paragraph;
       (ii) promptly publish in the Federal Register a notice that 
     a State has submitted a certification under paragraph (1);
       (iii) promptly publish in the Federal Register the notice 
     described in clause (i) with respect to the State; and
       (iv) annually publish the status of all States with respect 
     to certifications.
       (4) Construction.--Nothing in this subsection shall be 
     construed as preventing the certification (and approval of 
     certification) of a State law under this subsection solely 
     because it provides for greater protections for patients than 
     those protections otherwise required to establish substantial 
     compliance.
       (5) Petitions.--
       (A) Petition process.--Effective on the date on which the 
     provisions of this subtitle become effective, as provided for 
     in section 1652, a group health plan, health insurance 
     issuer, participant, beneficiary, or enrollee may submit a 
     petition to the Secretary for an advisory opinion as to 
     whether or not a standard or requirement under a State law 
     applicable to the plan, issuer, participant, beneficiary, or 
     enrollee that is not the subject of a certification under 
     this subsection, is superseded under subsection (a)(1) 
     because such standard or requirement prevents the application 
     of a requirement of this part.
       (B) Opinion.--The Secretary shall issue an advisory opinion 
     with respect to a petition submitted under subparagraph (A) 
     within the 60-day period beginning on the date on which such 
     petition is submitted.
       (d) Definitions.--For purposes of this section:
       (1) State law.--The term ``State law'' includes all laws, 
     decisions, rules, regulations, or other State action having 
     the effect of law, of any State. A law of the United States 
     applicable only to the District of Columbia shall be treated 
     as a State law rather than a law of the United States.
       (2) State.--The term ``State'' includes a State, the 
     District of Columbia, Puerto Rico, the Virgin Islands, Guam, 
     American Samoa, the Northern Mariana Islands, any political 
     subdivisions of such, or any agency or instrumentality of 
     such.

     SEC. 1633. REGULATIONS.

       The Secretaries of Health and Human Services and Labor 
     shall issue such regulations as may be necessary or 
     appropriate to carry out this part. Such regulations shall be 
     issued consistent with section 104 of Health Insurance 
     Portability and Accountability Act of 1996. Such Secretaries 
     may promulgate any interim final rules as the Secretaries 
     determine are appropriate to carry out this part.

     SEC. 1634. INCORPORATION INTO PLAN OR COVERAGE DOCUMENTS.

       The requirements of this part with respect to a group 
     health plan or health insurance coverage are deemed to be 
     incorporated into, and made a part of, such plan or the 
     policy, certificate, or contract providing such coverage and 
     are enforceable under law as if directly included in the 
     documentation of such plan or such policy, certificate, or 
     contract.

 PART II--APPLICATION OF QUALITY CARE STANDARDS TO GROUP HEALTH PLANS 
   AND HEALTH INSURANCE COVERAGE UNDER THE PUBLIC HEALTH SERVICE ACT

     SEC. 1641. APPLICATION TO GROUP HEALTH PLANS AND GROUP HEALTH 
                   INSURANCE COVERAGE.

       (a) In General.--Subpart 2 of part A of title XXVII of the 
     Public Health Service Act, as amended by section 1001, is 
     further amended by adding at the end the following new 
     section:

     ``SEC. 2720. PATIENT PROTECTION STANDARDS.

       ``Each group health plan shall comply with patient 
     protection requirements under part I of subtitle H of title I 
     of the Patient Protection and Affordable Care Act, and each 
     health insurance issuer shall comply with patient protection 
     requirements under such part with respect to group health 
     insurance coverage it offers, and such requirements shall be 
     deemed to be incorporated into this subsection.''.
       (b) Conforming Amendment.--Section 2721(b)(2)(A) of such 
     Act (42 U.S.C. 300gg-21(b)(2)(A)) is amended by inserting 
     ``(other than section 2720)'' after ``requirements of such 
     subparts''.

     SEC. 1642. APPLICATION TO INDIVIDUAL HEALTH INSURANCE 
                   COVERAGE.

       Part B of title XXVII of the Public Health Service Act is 
     amended by inserting after section 2753 the following new 
     section:

     ``SEC. 2754. PATIENT PROTECTION STANDARDS.

       ``Each health insurance issuer shall comply with patient 
     protection requirements under part I of subtitle H of title I 
     of the Patient Protection and Affordable Care Act with 
     respect to individual health insurance coverage it offers, 
     and such requirements shall be deemed to be incorporated into 
     this subsection.''.

     SEC. 1643. COOPERATION BETWEEN FEDERAL AND STATE AUTHORITIES.

       Part C of title XXVII of the Public Health Service Act (42 
     U.S.C. 300gg-91 et seq.), as amended by section 1002, is 
     further amended by adding at the end the following:

     ``SEC. 2795. COOPERATION BETWEEN FEDERAL AND STATE 
                   AUTHORITIES.

       ``(a) Agreement With States.--A State may enter into an 
     agreement with the Secretary for the delegation to the State 
     of some or all of the Secretary's authority under this title 
     to enforce the requirements applicable under part I of 
     subtitle H of title I of the Patient Protection and 
     Affordable Care Act with respect to health insurance coverage 
     offered by a health insurance issuer and with respect to a 
     group health plan that is a non-Federal governmental plan.
       ``(b) Delegations.--Any department, agency, or 
     instrumentality of a State to which authority is delegated 
     pursuant to an agreement entered into under this section may, 
     if authorized under State law and to the extent consistent 
     with such agreement, exercise the powers of the Secretary 
     under this title which relate to such authority.''.

PART III--AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 
                                  1974

     SEC. 1651. APPLICATION OF PATIENT PROTECTION STANDARDS TO 
                   GROUP HEALTH PLANS AND GROUP HEALTH INSURANCE 
                   COVERAGE UNDER THE EMPLOYEE RETIREMENT INCOME 
                   SECURITY ACT OF 1974.

       (a) In General.--Subpart B of part 7 of subtitle B of title 
     I of the Employee Retirement Income Security Act of 1974, as 
     amended by section 1562, is further amended by adding at the 
     end the following new section:

     ``SEC. 716. PATIENT PROTECTION STANDARDS.

       ``(a) In General.--Subject to subsection (b), a group 
     health plan (and a health insurance issuer offering group 
     health insurance coverage in connection with such a plan) 
     shall comply with the requirements of part I of subtitle H of 
     title I of the Patient Protection and Affordable Care Act (as 
     in effect as of the date of the enactment of such Act), and 
     such requirements shall be deemed to be incorporated into 
     this subsection.
       ``(b) Plan Satisfaction of Certain Requirements.--
       ``(1) Satisfaction of certain requirements through 
     insurance.--For purposes of subsection (a), insofar as a 
     group health plan provides benefits in the form of health 
     insurance coverage through a health insurance issuer, the 
     plan shall be treated as meeting the following requirements 
     of part I of subtitle H of title I of the Patient Protection 
     and Affordable Care Act with respect to such benefits and not 
     be considered as failing to meet such requirements because of 
     a failure of the issuer to meet such requirements so long as 
     the plan sponsor or its representatives did not cause such 
     failure by the issuer:
       ``(A) Section 1611 (relating to choice of health care 
     professional).
       ``(B) Section 1612 (relating to access to emergency care).
       ``(C) Section 1613 (relating to timely access to 
     specialists).
       ``(D) Section 1614 (relating to access to pediatric care).
       ``(E) Section 1615 (relating to patient access to 
     obstetrical and gynecological care).
       ``(F) Section 1616 (relating to continuity of care), but 
     only insofar as a replacement issuer assumes the obligation 
     for continuity of care.
       ``(2) Application to prohibitions.--Pursuant to rules of 
     the Secretary, if a health insurance issuer offers health 
     insurance coverage in connection with a group health plan and 
     takes an action in violation of section 1621 of the Patient 
     Protection and Affordable Care Act (relating to prohibition 
     of interference with certain medical communications), the 
     group health plan shall not be liable for such violation 
     unless the plan caused such violation.
       ``(3) Construction.--Nothing in this subsection shall be 
     construed to affect or modify

[[Page 29834]]

     the responsibilities of the fiduciaries of a group health 
     plan under part 4 of subtitle B.
       ``(4) Treatment of substantially compliant state laws.--For 
     purposes of applying this subsection, any reference in this 
     subsection to a requirement in a section or other provision 
     in subtitle H of title I of the Patient Protection and 
     Affordable Care Act with respect to a health insurance issuer 
     is deemed to include a reference to a requirement under a 
     State law that substantially complies (as determined under 
     section 1632(c) of such Act) with the requirement in such 
     section or other provisions.
       ``(c) Conforming Regulations.--The Secretary shall issue 
     regulations to coordinate the requirements on group health 
     plans and health insurance issuers under this section with 
     the requirements imposed under the other provisions of this 
     title.''.
       (b) Satisfaction of ERISA Claims Procedure Requirement.--
     Section 503 of such Act (29 U.S.C. 1133) is amended by 
     inserting ``(a)'' after ``Sec. 503.'' and by adding at the 
     end the following new subsection:
       ``(b) In the case of a group health plan (as defined in 
     section 733) compliance with the requirements of subpart A of 
     part I of subtitle H of title I of the Patient Protection and 
     Affordable Care Act, and compliance with regulations 
     promulgated by the Secretary, in the case of a claims denial 
     shall be deemed compliance with subsection (a) with respect 
     to such claims denial.''.
       (c) Conforming Amendments.--(1) Section 732(a) of such Act 
     (29 U.S.C. 1185(a)) is amended by striking ``section 711'' 
     and inserting ``sections 711 and 716''.
       (2) The table of contents in section 1 of such Act is 
     amended by inserting after the item relating to section 715 
     the following new item:

``Sec. 716. Patient protection standards''.
       (d) Effect on Collective Bargaining Agreements.--In the 
     case of health insurance coverage maintained pursuant to one 
     or more collective bargaining agreements between employee 
     representatives and one or more employers that was ratified 
     before the date of enactment of this title, the provisions of 
     this section (and the amendments made by this section) shall 
     not apply until the date on which the last of the collective 
     bargaining agreements relating to the coverage terminates. 
     Any coverage amendment made pursuant to a collective 
     bargaining agreement relating to the coverage which amends 
     the coverage solely to conform to any requirement added by 
     this section (or amendments) shall not be treated as a 
     termination of such collective bargaining agreement.

     SEC. 1652. EFFECTIVE DATE.

       This subtitle (and the amendments made by this subtitle) 
     shall become effective for plan years beginning on or after 
     the date that is 6 months after the date of enactment of this 
     Act.
                                 ______
                                 
  SA 3066. 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:

       On page 1907, after line 25, add the following:
       ``(P) An entity that is owned or operated by a unit of 
     local government which provides mental health or health care 
     services and is located in a county in which the rate of 
     uninsurance is above the national rate of uninsurance for the 
     under-65 population, based on the best available estimate of 
     the rate of uninsurance published by the Bureau of the 
     Census.''.
                                 ______
                                 
  SA 3067. Mr. PRYOR (for himself, Mrs. Boxer, and 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:

       At the appropriate place, insert the following:

     SEC. __. FEDERAL TRADE COMMISSION OVERSIGHT OVER HEALTH 
                   INSURANCE ISSUERS.

       Section 6 of the Federal Trade Commission Act (15 U.S.C. 
     46) is amended in the undesignated matter following 
     subsection (l), by striking ``Nothing'' and all that follows 
     through ``was made.'' and inserting the following:
       ``Notwithstanding the Act of March 9, 1945 (15 U.S.C. 1011 
     et seq.) and the definition of corporation in section 4, the 
     Commission may use the authority described in this section to 
     conduct studies, prepare reports, and disclose information 
     relating to insurance, without regard to whether the subject 
     of the study, report, or the information is for-profit or 
     not-for-profit.
       ``Subject to the Act of March 9, 1945 (15 U.S.C. 1011 et 
     seq.) and notwithstanding the definition of corporation in 
     section 4, the provisions of this Act shall apply to an 
     insurer without regard to whether such insurer is for-profit 
     or not-for-profit. For purposes of this paragraph, an 
     employer or membership organization not organized for its own 
     profit or that of its members that provides health care or 
     medical malpractice benefits only to its employees or members 
     shall not be deemed to be a health insurer or a medical 
     malpractice insurer, provided that this exclusion shall not 
     apply to a separate entity that issues insurance or to an 
     organization whose sole or primary membership benefit is 
     insurance.''.
                                 ______
                                 
  SA 3068. Mr. KYL (for himself, Mr. Roberts, Mr. Vitter, Mr. Grassley, 
Mr. Crapo, Mr. Coburn, Mr. Barrasso, and Mr. Johanns) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. PROHIBITION ON CERTAIN USES OF DATA OBTAINED FROM 
                   COMPARATIVE EFFECTIVENESS RESEARCH; ACCOUNTING 
                   FOR PERSONALIZED MEDICINE AND DIFFERENCES IN 
                   PATIENT TREATMENT RESPONSE.

       (a) In General.--Notwithstanding any other provision of 
     law, a Federal department, office, or representative--
       (1) shall not use data obtained from the conduct of 
     comparative effectiveness research, including such research 
     that is conducted or supported using funds appropriated under 
     the American Recovery and Reinvestment Act of 2009 (Public 
     Law 111-5), to deny coverage of an item or service under a 
     Federal health care program (as defined in section 1128B(f) 
     of the Social Security Act (42 U.S.C. 1320a-7b(f))), 
     including under plans offered under the Federal Employees 
     Health Benefits Program (under chapter 89 of title 5, United 
     States Code), or under private health insurance; and
       (2) shall ensure that comparative effectiveness research 
     conducted or supported by the Federal Government accounts for 
     factors contributing to differences in the treatment response 
     and treatment preferences of patients, including patient-
     reported outcomes, genomics and personalized medicine, the 
     unique needs of health disparity populations, and indirect 
     patient benefits.
       (b) Rule of Construction.--Nothing in this section shall be 
     construed as affecting the authority of the Commissioner of 
     Food and Drugs under the Federal Food, Drug, and Cosmetic Act 
     or the Public Health Service Act.
       (c) Patient Centered Outcomes Research Institute Board.--
     Notwithstanding section 1181(f)(1)(A) and (B) of the Social 
     Security Act (as added by section 6301(a)), no Federal 
     officer or employee (including Federally elected officials 
     and members of Congress) shall serve on the Board of 
     Governors of the Patient Centered Outcomes Research 
     Institute.
                                 ______
                                 
  SA 3069. Mr. KOHL submitted an amendment intended to be proposed by 
him to the bill H.R. 3590, to amend the Internal Revenue Code of 1986 
to modify the first-time homebuyers credit in the case of members of 
the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

           TITLE __--COMBATING ELDER ABUSE AND SILVER ALERTS

     SEC. _11. SHORT TITLE.

       This title may be cited as the ``Combating Elder Abuse and 
     National Silver Alert Act of 2009''.

              Subtitle A--Elder Abuse Victims Act of 2009

     SEC. _21. SHORT TITLE.

       This subtitle may be cited as the ``Elder Abuse Victims Act 
     of 2009''.

                      PART I--ELDER ABUSE VICTIMS

     SEC. _31. ANALYSIS, REPORT, AND RECOMMENDATIONS RELATED TO 
                   ELDER JUSTICE PROGRAMS.

       (a) In General.--Subject to the availability of 
     appropriations to carry out this section, the Attorney 
     General, in consultation with the Secretary of Health and 
     Human Services, shall carry out the following:
       (1) Study.--Conduct a study of laws and practices relating 
     to elder abuse, neglect, and exploitation, which shall 
     include--

[[Page 29835]]

       (A) a comprehensive description of State laws and practices 
     relating to elder abuse, neglect, and exploitation;
       (B) a comprehensive analysis of the effectiveness of such 
     State laws and practices; and
       (C) an examination of State laws and practices relating to 
     specific elder abuse, neglect, and exploitation issues, 
     including--
       (i) the definition of--

       (I) ``elder'';
       (II) ``abuse'';
       (III) ``neglect'';
       (IV) ``exploitation''; and
       (V) such related terms the Attorney General determines to 
     be appropriate;

       (ii) mandatory reporting laws, with respect to--

       (I) who is a mandated reporter;
       (II) to whom must they report and within what time frame; 
     and
       (III) any consequences for not reporting;

       (iii) evidentiary, procedural, sentencing, choice of 
     remedies, and data retention issues relating to pursuing 
     cases relating to elder abuse, neglect, and exploitation;
       (iv) laws requiring reporting of all nursing home deaths to 
     the county coroner or to some other individual or entity;
       (v) fiduciary laws, including guardianship and power of 
     attorney laws;
       (vi) laws that permit or encourage banks and bank employees 
     to prevent and report suspected elder abuse, neglect, and 
     exploitation;
       (vii) laws relating to fraud and related activities in 
     connection with mail, telemarketing, or the Internet;
       (viii) laws that may impede research on elder abuse, 
     neglect, and exploitation;
       (ix) practices relating to the enforcement of laws relating 
     to elder abuse, neglect, and exploitation; and
       (x) practices relating to other aspects of elder justice.
       (2) Development of plan.--Develop objectives, priorities, 
     policies, and a long-term plan for elder justice programs and 
     activities relating to--
       (A) prevention and detection of elder abuse, neglect, and 
     exploitation;
       (B) intervention and treatment for victims of elder abuse, 
     neglect, and exploitation;
       (C) training, evaluation, and research related to elder 
     justice programs and activities; and
       (D) improvement of the elder justice system in the United 
     States.
       (3) Report.--Not later than 2 years after the date of 
     enactment of this Act, submit to the chairman and ranking 
     member of the Special Committee on Aging of the Senate, and 
     the Speaker and minority leader of the House of 
     Representatives, and the Secretary of Health and Human 
     Services, and make available to the States, a report that 
     contains--
       (A) the findings of the study conducted under paragraph 
     (1);
       (B) a description of the objectives, priorities, policies, 
     and a long-term plan developed under paragraph (2); and
       (C) a list, description, and analysis of the best practices 
     used by States to develop, implement, maintain, and improve 
     elder justice systems, based on such findings.
       (b) GAO Recommendations.--Not later than 18 months after 
     the date of enactment of this Act, the Comptroller General 
     shall review existing Federal programs and initiatives in the 
     Federal criminal justice system relevant to elder justice and 
     shall submit to Congress--
       (1) a report on such programs and initiatives; and
       (2) any recommendations the Comptroller General determines 
     are appropriate to improve elder justice in the United 
     States.
       (c) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out this section $6,000,000 for 
     each of the fiscal years 2010 through 2016.

     SEC. _32. VICTIM ADVOCACY GRANTS.

       (a) Grants Authorized.--The Attorney General, after 
     consultation with the Secretary of Health and Human Services, 
     may award grants to eligible entities to study the special 
     needs of victims of elder abuse, neglect, and exploitation.
       (b) Authorized Activities.--Funds awarded pursuant to 
     subsection (a) shall be used for pilot programs that--
       (1) develop programs for and provide training to health 
     care, social, and protective services providers, law 
     enforcement, fiduciaries (including guardians), judges and 
     court personnel, and victim advocates; and
       (2) examine special approaches designed to meet the needs 
     of victims of elder abuse, neglect, and exploitation.
       (c) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out this section $3,000,000 for 
     each of the fiscal years 2010 through 2016.

     SEC. _33. SUPPORTING LOCAL PROSECUTORS AND COURTS IN ELDER 
                   JUSTICE MATTERS.

       (a) Grants Authorized.--Subject to the availability of 
     appropriations under this section, the Attorney General, 
     after consultation with the Secretary of Health and Human 
     Services, shall award grants to eligible entities to provide 
     training, technical assistance, policy development, 
     multidisciplinary coordination, and other types of support to 
     local prosecutors and courts handling elder justice-related 
     cases, including--
       (1) funding specially designated elder justice positions or 
     units in local prosecutors' offices and local courts; and
       (2) funding the creation of a Center for the Prosecution of 
     Elder Abuse, Neglect, and Exploitation to advise and support 
     local prosecutors and courts nationwide in the pursuit of 
     cases involving elder abuse, neglect, and exploitation.
       (b) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out this section $6,000,000 for 
     each of the fiscal years 2010 through 2016.

     SEC. _34. SUPPORTING STATE PROSECUTORS AND COURTS IN ELDER 
                   JUSTICE MATTERS.

       (a) In General.--Subject to the availability of 
     appropriations under this section, the Attorney General, 
     after consultation with the Secretary of Health and Human 
     Services, shall award grants to eligible entities to provide 
     training, technical assistance, multidisciplinary 
     coordination, policy development, and other types of support 
     to State prosecutors and courts, employees of State Attorneys 
     General, and Medicaid Fraud Control Units handling elder 
     justice-related matters.
       (b) Creating Specialized Positions.--Grants under this 
     section may be made for--
       (1) the establishment of specially designated elder justice 
     positions or units in State prosecutors' offices and State 
     courts; and
       (2) the creation of a position to coordinate elder justice-
     related cases, training, technical assistance, and policy 
     development for State prosecutors and courts.
       (c) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out this section $6,000,000 for 
     each of the fiscal years 2010 through 2016.

     SEC. _35. SUPPORTING LAW ENFORCEMENT IN ELDER JUSTICE 
                   MATTERS.

       (a) In General.--Subject to the availability of 
     appropriations under this section, the Attorney General, 
     after consultation with the Secretary of Health and Human 
     Services, the Postmaster General, and the Chief Postal 
     Inspector for the United States Postal Inspection Service, 
     shall award grants to eligible entities to provide training, 
     technical assistance, multidisciplinary coordination, policy 
     development, and other types of support to police, sheriffs, 
     detectives, public safety officers, corrections personnel, 
     and other first responders who handle elder justice-related 
     matters, to fund specially designated elder justice positions 
     or units designed to support first responders in elder 
     justice matters.
       (b) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out this section $8,000,000 for 
     each of the fiscal years 2010 through 2016.

     SEC. _36. EVALUATIONS.

       (a) Grants Under This Part.--
       (1) In general.--In carrying out the grant programs under 
     this part, the Attorney General shall--
       (A) require each recipient of a grant to use a portion of 
     the funds made available through the grant to conduct a 
     validated evaluation of the effectiveness of the activities 
     carried out through the grant by such recipient; or
       (B) as the Attorney General considers appropriate, use a 
     portion of the funds available under this part for a grant 
     program under this part to provide assistance to an eligible 
     entity to conduct a validated evaluation of the effectiveness 
     of the activities carried out through such grant program by 
     each of the grant recipients.
       (2) Applications.--
       (A) Submission.--To be eligible to receive a grant under 
     this part, an entity shall submit an application to the 
     Attorney General at such time, in such manner, and containing 
     such information as the Attorney General may require, which 
     shall include--
       (i) a proposal for the evaluation required in accordance 
     with paragraph (1)(A); and
       (ii) the amount of assistance under paragraph (1)(B) the 
     entity is requesting, if any.
       (B) Review and assistance.--
       (i) In general.--An employee of the Department of Justice, 
     after consultation with an employee of the Department of 
     Health and Human Services with expertise in evaluation 
     methodology, shall review each application described in 
     subparagraph (A) and determine whether the methodology 
     described in the proposal under subparagraph (A)(i) is 
     adequate to gather meaningful information.
       (ii) Denial.--If the reviewing employee determines the 
     methodology described in such proposal is inadequate, the 
     reviewing employee shall recommend that the Attorney General 
     deny the application for the grant, or make recommendations 
     for how the application should be amended.
       (iii) Notice to applicant.--If the Attorney General denies 
     the application on the basis of such proposal, the Attorney 
     General shall inform the applicant of the reasons the 
     application was denied, and offer assistance to the applicant 
     in modifying the proposal.
       (b) Other Grants.--Subject to the availability of 
     appropriations under this section, the Attorney General shall 
     award grants to appropriate entities to conduct validated 
     evaluations of grant activities that are funded by Federal 
     funds not provided under this part, or other funds, to reduce 
     elder abuse, neglect, and exploitation.

[[Page 29836]]

       (c) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out this section $7,000,000 for 
     each of the fiscal years 2010 through 2016.

     SEC. _37. DEFINITIONS.

       In this part:
       (1) Elder.--The term ``elder'' means an individual age 60 
     or older.
       (2) Elder justice.--The term ``elder justice'' means--
       (A) from a societal perspective, efforts to--
       (i) prevent, detect, treat, intervene in, and prosecute 
     elder abuse, neglect, and exploitation; and
       (ii) protect elders with diminished capacity while 
     maximizing their autonomy; and
       (B) from an individual perspective, the recognition of an 
     elder's rights, including the right to be free of abuse, 
     neglect, and exploitation.
       (3) Eligible entities.--The term ``eligible entity'' means 
     a State or local government agency, Indian tribe or tribal 
     organization, or any other public or nonprofit private entity 
     that is engaged in and has expertise in issues relating to 
     elder justice or a field necessary to promote elder justice 
     efforts.

               PART II--ELDER SERVE VICTIM GRANT PROGRAMS

     SEC. _41. ESTABLISHMENT OF ELDER SERVE VICTIM GRANT PROGRAMS.

       (a) Establishment.--The Attorney General, acting through 
     the Director of the Office of Victims of Crime of the 
     Department of Justice (in this section referred to as the 
     ``Director''), shall, subject to appropriations, carry out a 
     three-year grant program to be known as the Elder Serve 
     Victim grant program (in this section referred to as the 
     ``Program'') to provide grants to eligible entities to 
     establish programs to facilitate and coordinate programs 
     described in subsection (e) for victims of elder abuse.
       (b) Eligibility Requirements for Grantees.--To be eligible 
     to receive a grant under the Program, an entity must meet the 
     following criteria:
       (1) Eligible crime victim assistance program.--The entity 
     is a crime victim assistance program receiving a grant under 
     the Victims of Crime Act of 1984 (42 U.S.C. 1401 et seq.) for 
     the period described in subsection (c)(2) with respect to the 
     grant sought under this section.
       (2) Coordination with local community based agencies and 
     services.--The entity shall demonstrate to the satisfaction 
     of the Director that such entity has a record of community 
     coordination or established contacts with other county and 
     local services that serve elderly individuals.
       (3) Ability to create ecrt on timely basis.--The entity 
     shall demonstrate to the satisfaction of the Director the 
     ability of the entity to create, not later than 6 months 
     after receiving such grant, an Emergency Crisis Response Team 
     program described in subsection (e)(1) and the programs 
     described in subsection (e)(2).

     For purposes of meeting the criteria described in paragraph 
     (2), for each year an entity receives a grant under this 
     section the entity shall provide a record of community 
     coordination or established contacts described in such 
     paragraph through memoranda of understanding, contracts, 
     subcontracts, and other such documentation.
       (c) Administrative Provisions.--
       (1) Consultation.--Each program established pursuant to 
     this section shall be developed and carried out in 
     consultation with the following entities, as appropriate:
       (A) Relevant Federal, State, and local public and private 
     agencies and entities, relating to elder abuse, neglect, and 
     exploitation and other crimes against elderly individuals.
       (B) Local law enforcement including police, sheriffs, 
     detectives, public safety officers, corrections personnel, 
     prosecutors, medical examiners, investigators, and coroners.
       (C) Long-term care and nursing facilities.
       (2) Grant period.--Grants under the Program shall be issued 
     for a three-year period.
       (3) Locations.--The Program shall be carried out in six 
     geographically and demographically diverse locations, taking 
     into account--
       (A) the number of elderly individuals residing in or near 
     an area; and
       (B) the difficulty of access to immediate short-term 
     housing and health services for victims of elder abuse.
       (d) Personnel.--In providing care and services, each 
     program established pursuant to this section may employ a 
     staff to assist in creating an Emergency Crisis Response 
     Teams under subsection (e)(1).
       (e) Use of Grants.--
       (1) Emergency crisis response team.--Each entity that 
     receives a grant under this section shall use such grant to 
     establish an Emergency Crisis Response Team program by not 
     later than the date that is six months after the entity 
     receives the grant. Under such program the following shall 
     apply:
       (A) Such program shall include immediate, short-term 
     emergency services, including shelter, care services, food, 
     clothing, transportation to medical or legal appointment as 
     appropriate, and any other life services deemed necessary by 
     the entity for victims of elder abuse.
       (B) Such program shall provide services to victims of elder 
     abuse, including those who have been referred to the program 
     through the adult protective services agency of the local law 
     enforcement or any other relevant law enforcement or referral 
     agency.
       (C) A victim of elder abuse may not receive short-term 
     housing under the program for more than 30 consecutive days.
       (D) The entity that established the program shall enter 
     into arrangements with the relevant local law enforcement 
     agencies so that the program receives quarterly reports from 
     such agencies on elder abuse.
       (2) Additional services required to be provided.--Not later 
     than one year after the date an entity receives a grant under 
     this section, such entity shall have established the 
     following programs (and community collaborations to support 
     such programs):
       (A) Counseling.--A program that provides counseling and 
     assistance for victims of elder abuse accessing health care, 
     educational, pension, or other benefits for which seniors may 
     be eligible under Federal or applicable State law.
       (B) Mental health screening.--A program that provides 
     mental health screenings for victims of elder abuse to 
     identify and seek assistance for potential mental health 
     disorders such as depression or substance abuse.
       (C) Emergency legal advocacy.--A program that provides 
     legal advocacy for victims of elder abuse and, as 
     appropriate, their families.
       (D) Job placement assistance.--A program that provides job 
     placement assistance and information on employment, training, 
     or volunteer opportunities for victims of elder abuse.
       (E) Bereavement counseling.--A program that provides 
     bereavement counseling for families of victims of elder 
     abuse.
       (F) Other services.--A program that provides such other 
     care, services, and assistance as the entity considers 
     appropriate for purposes of the program.
       (f) Technical Assistance.--The Director shall enter into 
     contracts with private entities with experience in elder 
     abuse coordination or victim services to provide such 
     technical assistance to grantees under this section as the 
     entity determines appropriate.
       (g) Reports to Congress.--Not later than 12 months after 
     the commencement of the Program, and annually thereafter, the 
     entity shall submit a report to the Chairman and Ranking 
     Member of the Committee on the Judiciary of the House of 
     Representatives, and the Chairman and Ranking Member of the 
     Special Committee on Aging of the Senate. Each report shall 
     include the following:
       (1) A description and assessment of the implementation of 
     the Program.
       (2) An assessment of the effectiveness of the Program in 
     providing care and services to seniors, including a 
     comparative assessment of effectiveness for each of the 
     locations designated under subsection (c)(3) for the Program.
       (3) An assessment of the effectiveness of the coordination 
     for programs described in subsection (e) in contributing 
     toward the effectiveness of the Program.
       (4) Such recommendations as the entity considers 
     appropriate for modifications of the Program in order to 
     better provide care and services to seniors.
       (h) Definitions.--For purposes of this section:
       (1) Elder abuse.--The term ``elder abuse'' means any type 
     of violence or abuse, whether mental or physical, inflicted 
     upon an elderly individual, and any type of criminal 
     financial exploitation of an elderly individual.
       (2) Elderly individual.--The term ``elderly individual'' 
     means an individual who is age 60 or older.
       (i) Authorization of Appropriations.--There is authorized 
     to be appropriated for the Department of Justice to carry out 
     this section $3,000,000 for each of the fiscal years 2010 
     through 2012.

                   Subtitle B--National Silver Alert

     SEC. _51. SHORT TITLE.

       This subtitle may be cited as the ``National Silver Alert 
     Act''.

     SEC. _52. DEFINITIONS.

       For purposes of this subtitle:
       (1) State.--The term ``State'' means each of the 50 States, 
     the District of Columbia, the Commonwealth of Puerto Rico, 
     the United States Virgin Islands, Guam, American Samoa, and 
     the Commonwealth of the Northern Mariana Islands.
       (2) Missing senior.--The term ``missing senior'' refers to 
     any individual who--
       (A) is reported to, or identified by, a law enforcement 
     agency as a missing person; and
       (B) meets the requirements to be designated as a missing 
     senior, as determined by the State in which the individual is 
     reported or identified as a missing person.

     SEC. _53. SILVER ALERT COMMUNICATIONS NETWORK.

       The Attorney General shall, subject to the availability of 
     appropriations under section _57, establish a national Silver 
     Alert communications network within the Department of Justice 
     to provide assistance to regional and local search efforts 
     for missing seniors through the initiation, facilitation, and 
     promotion of local elements of the network (known as Silver 
     Alert plans) in coordination with States, units of local 
     government, law enforcement agencies, and other concerned 
     entities with expertise in providing services to seniors.

[[Page 29837]]



     SEC. _54. SILVER ALERT COORDINATOR.

       (a) National Coordinator Within Department of Justice.--The 
     Attorney General shall designate an individual of the 
     Department of Justice to act as the national coordinator of 
     the Silver Alert communications network. The individual so 
     designated shall be known as the Silver Alert Coordinator of 
     the Department of Justice (referred to in this subtitle as 
     the ``Coordinator'').
       (b) Duties of the Coordinator.--In acting as the national 
     coordinator of the Silver Alert communications network, the 
     Coordinator shall--
       (1) work with States to encourage the development of 
     additional Silver Alert plans in the network;
       (2) establish voluntary guidelines for States to use in 
     developing Silver Alert plans that will promote compatible 
     and integrated Silver Alert plans throughout the United 
     States, including--
       (A) a list of the resources necessary to establish a Silver 
     Alert plan;
       (B) criteria for evaluating whether a situation warrants 
     issuing a Silver Alert, taking into consideration the need 
     for the use of such Alerts to be limited in scope because the 
     effectiveness of the Silver Alert communications network may 
     be affected by overuse, including criteria to determine--
       (i) whether the mental capacity of a senior who is missing, 
     and the circumstances of his or her disappearance, warrant 
     the issuance a Silver Alert; and
       (ii) whether the individual who reports that a senior is 
     missing is an appropriate and credible source on which to 
     base the issuance of a Silver Alert;
       (C) a description of the appropriate uses of the Silver 
     Alert name to readily identify the nature of search efforts 
     for missing seniors; and
       (D) recommendations on how to protect the privacy, dignity, 
     independence, and autonomy of any missing senior who may be 
     the subject of a Silver Alert;
       (3) develop proposed protocols for efforts to recover 
     missing seniors and to reduce the number of seniors who are 
     reported missing, including protocols for procedures that are 
     needed from the time of initial notification of a law 
     enforcement agency that the senior is missing through the 
     time of the return of the senior to family, guardian, or 
     domicile, as appropriate, including--
       (A) public safety communications protocol;
       (B) case management protocol;
       (C) command center operations;
       (D) reunification protocol; and
       (E) incident review, evaluation, debriefing, and public 
     information procedures;
       (4) work with States to ensure appropriate regional 
     coordination of various elements of the network;
       (5) establish an advisory group to assist States, units of 
     local government, law enforcement agencies, and other 
     entities involved in the Silver Alert communications network 
     with initiating, facilitating, and promoting Silver Alert 
     plans, which shall include--
       (A) to the maximum extent practicable, representation from 
     the various geographic regions of the United States; and
       (B) members who are--
       (i) representatives of senior citizen advocacy groups, law 
     enforcement agencies, and public safety communications;
       (ii) broadcasters, first responders, dispatchers, and radio 
     station personnel; and
       (iii) representatives of any other individuals or 
     organizations that the Coordinator determines are necessary 
     to the success of the Silver Alert communications network; 
     and
       (6) act as the nationwide point of contact for--
       (A) the development of the network; and
       (B) regional coordination of alerts for missing seniors 
     through the network.
       (c) Coordination.--
       (1) Coordination with other agencies.--The Coordinator 
     shall coordinate and consult with the Secretary of 
     Transportation, the Federal Communications Commission, the 
     Assistant Secretary for Aging of the Department of Health and 
     Human Services, the head of the Missing Alzheimer's Disease 
     Patient Alert Program, and other appropriate offices of the 
     Department of Justice in carrying out activities under this 
     subtitle.
       (2) State and local coordination.--The Coordinator shall 
     consult with local broadcasters and State and local law 
     enforcement agencies in establishing minimum standards under 
     section _55 and in carrying out other activities under this 
     subtitle, as appropriate.
       (d) Annual Reports.--Not later than one year after the date 
     of enactment of this Act, and annually thereafter, the 
     Coordinator shall submit to Congress a report on the 
     activities of the Coordinator and the effectiveness and 
     status of the Silver Alert plans of each State that has 
     established or is in the process of establishing such a plan. 
     Each such report shall include--
       (1) a list of States that have established Silver Alert 
     plans;
       (2) a list of States that are in the process of 
     establishing Silver Alert plans;
       (3) for each State that has established such a plan, to the 
     extent the data is available--
       (A) the number of Silver Alerts issued;
       (B) the number of individuals located successfully;
       (C) the average period of time between the issuance of a 
     Silver Alert and the location of the individual for whom such 
     Alert was issued;
       (D) the State agency or authority issuing Silver Alerts, 
     and the process by which Silver Alerts are disseminated;
       (E) the cost of establishing and operating such a plan;
       (F) the criteria used by the State to determine whether to 
     issue a Silver Alert; and
       (G) the extent to which missing individuals for whom Silver 
     Alerts were issued crossed State lines;
       (4) actions States have taken to protect the privacy and 
     dignity of the individuals for whom Silver Alerts are issued;
       (5) ways that States have facilitated and improved 
     communication about missing individuals between families, 
     caregivers, law enforcement officials, and other authorities; 
     and
       (6) any other information the Coordinator determines to be 
     appropriate.

     SEC. _55. MINIMUM STANDARDS FOR ISSUANCE AND DISSEMINATION OF 
                   ALERTS THROUGH SILVER ALERT COMMUNICATIONS 
                   NETWORK.

       (a) Establishment of Minimum Standards.--Subject to 
     subsection (b), the Coordinator shall establish minimum 
     standards for--
       (1) the issuance of alerts through the Silver Alert 
     communications network; and
       (2) the extent of the dissemination of alerts issued 
     through the network.
       (b) Limitations.--
       (1) Voluntary participation.--The minimum standards 
     established under subsection (a) of this section, and any 
     other guidelines and programs established under section _54, 
     shall be adoptable on a voluntary basis only.
       (2) Dissemination of information.--The minimum standards 
     shall, to the maximum extent practicable (as determined by 
     the Coordinator in consultation with State and local law 
     enforcement agencies), provide that appropriate information 
     relating to the special needs of a missing senior (including 
     health care needs) are disseminated to the appropriate law 
     enforcement, public health, and other public officials.
       (3) Geographic areas.--The minimum standards shall, to the 
     maximum extent practicable (as determined by the Coordinator 
     in consultation with State and local law enforcement 
     agencies), provide that the dissemination of an alert through 
     the Silver Alert communications network be limited to the 
     geographic areas which the missing senior could reasonably 
     reach, considering the missing senior's circumstances and 
     physical and mental condition, the modes of transportation 
     available to the missing senior, and the circumstances of the 
     disappearance.
       (4) Age requirements.--The minimum standards shall not 
     include any specific age requirement for an individual to be 
     classified as a missing senior for purposes of the Silver 
     Alert communication network. Age requirements for 
     determinations of whether an individual is a missing senior 
     shall be determined by each State, and may vary from State to 
     State.
       (5) Privacy and civil liberties protections.--The minimum 
     standards shall--
       (A) ensure that alerts issued through the Silver Alert 
     communications network comply with all applicable Federal, 
     State, and local privacy laws and regulations; and
       (B) include standards that specifically provide for the 
     protection of the civil liberties and sensitive medical 
     information of missing seniors.
       (6) State and local voluntary coordination.--In carrying 
     out the activities under subsection (a), the Coordinator may 
     not interfere with the current system of voluntary 
     coordination between local broadcasters and State and local 
     law enforcement agencies for purposes of the Silver Alert 
     communications network.

     SEC. _56. TRAINING AND OTHER RESOURCES.

       (a) Training and Educational Programs.--The Coordinator 
     shall make available to States, units of local government, 
     law enforcement agencies, and other concerned entities that 
     are involved in initiating, facilitating, or promoting Silver 
     Alert plans, including broadcasters, first responders, 
     dispatchers, public safety communications personnel, and 
     radio station personnel--
       (1) training and educational programs related to the Silver 
     Alert communication network and the capabilities, 
     limitations, and anticipated behaviors of missing seniors, 
     which shall be updated regularly to encourage the use of new 
     tools, technologies, and resources in Silver Alert plans; and
       (2) informational materials, including brochures, videos, 
     posters, and websites to support and supplement such training 
     and educational programs.
       (b) Coordination.--The Coordinator shall coordinate--
       (1) with the Assistant Secretary for Aging of the 
     Department of Health and Human Services in developing the 
     training and educational programs and materials under 
     subsection (a); and
       (2) with the head of the Missing Alzheimer's Disease 
     Patient Alert Program within the Department of Justice, to 
     determine if any existing material with respect to training 
     programs or educational materials

[[Page 29838]]

     developed or used as subtitle of such Patient Alert Program 
     are appropriate and may be used for the programs under 
     subsection (a).

     SEC. _57. AUTHORIZATION OF APPROPRIATIONS FOR THE SILVER 
                   ALERT COMMUNICATIONS NETWORK.

       There are authorized to be appropriated to the Department 
     of Justice such sums as may be necessary to carry out the 
     Silver Alert communications network as authorized under this 
     subtitle.

     SEC. _58. GRANT PROGRAM FOR SUPPORT OF SILVER ALERT PLANS.

       (a) Grant Program.--Subject to the availability of 
     appropriations to carry out this section, the Attorney 
     General shall carry out a program to provide grants to States 
     for the development and enhancement of programs and 
     activities for the support of Silver Alert plans and the 
     Silver Alert communications network.
       (b) Activities.--Activities funded by grants under the 
     program under subsection (a) may include--
       (1) the development and implementation of education and 
     training programs, and associated materials, relating to 
     Silver Alert plans;
       (2) the development and implementation of law enforcement 
     programs, and associated equipment, relating to Silver Alert 
     plans;
       (3) the development and implementation of new technologies 
     to improve Silver Alert communications; and
       (4) such other activities as the Attorney General considers 
     appropriate for supporting the Silver Alert communications 
     network.
       (c) Federal Share.--The Federal share of the cost of any 
     activities funded by a grant under the program under 
     subsection (a) may not exceed 50 percent.
       (d) Distribution of Grants on Geographic Basis.--The 
     Attorney General shall, to the maximum extent practicable, 
     ensure the distribution of grants under the program under 
     subsection (a) on an equitable basis throughout the various 
     regions of the United States.
       (e) Administration.--The Attorney General shall prescribe 
     requirements, including application requirements, for grants 
     under the program under subsection (a).
       (f) Authorization of Appropriations.--
       (1) There is authorized to be appropriated to the 
     Department of Justice $5,000,000 for each of the fiscal years 
     2010 through 2014 to carry out this section and, in addition, 
     $5,000,000 for each of the fiscal years 2010 through 2014 to 
     carry out subsection (b)(3).
       (2) Amounts appropriated pursuant to the authorization of 
     appropriations in paragraph (1) shall remain available until 
     expended.

     SEC. _59. SAMMY KIRK VOLUNTARY ELECTRONIC MONITORING PROGRAM.

       (a) Program Authorized.--The Attorney General, after 
     consultation with the Secretary of Health and Human Services, 
     is authorized to award grants to States and units of local 
     government to carry out programs to provide voluntary 
     electronic monitoring services to elderly individuals to 
     assist in the location of such individuals if such 
     individuals are reported as missing.
       (b) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out this section $2,000,000 for 
     each of the fiscal years 2010 through 2014.
       (c) Designation.--The grant program authorized under this 
     section shall be referred to as the ``Sammy Kirk Voluntary 
     Electronic Monitoring Program''.

               Subtitle C--Kristen's Act Reauthorization

     SEC. _61. SHORT TITLE.

       This subtitle may be cited as ``Kristen's Act 
     Reauthorization of 2009''.

     SEC. _62. FINDINGS.

       Congress finds the following:
       (1) Every year thousands of adults become missing due to 
     advanced age, diminished mental capacity, or foul play. Often 
     there is no information regarding the whereabouts of these 
     adults and many of them are never reunited with their 
     families.
       (2) Missing adults are at great risk of both physical harm 
     and sexual exploitation.
       (3) In most cases, families and local law enforcement 
     officials have neither the resources nor the expertise to 
     undertake appropriate search efforts for a missing adult.
       (4) The search for a missing adult requires cooperation and 
     coordination among Federal, State, and local law enforcement 
     agencies and assistance from distant communities where the 
     adult may be located.
       (5) Federal assistance is urgently needed to help with 
     coordination among such agencies.

     SEC. _63. GRANTS FOR THE ASSISTANCE OF ORGANIZATIONS TO FIND 
                   MISSING ADULTS.

       (a) Grants.--
       (1) Grant program.--Subject to the availability of 
     appropriations to carry out this section, the Attorney 
     General shall make competitive grants to public agencies or 
     nonprofit private organizations, or combinations thereof, 
     to--
       (A) maintain a national resource center and information 
     clearinghouse for missing and unidentified adults;
       (B) maintain a national, interconnected database for the 
     purpose of tracking missing adults who are determined by law 
     enforcement to be endangered due to age, diminished mental 
     capacity, or the circumstances of disappearance, when foul 
     play is suspected or circumstances are unknown;
       (C) coordinate public and private programs that locate or 
     recover missing adults or reunite missing adults with their 
     families;
       (D) provide assistance and training to law enforcement 
     agencies, State and local governments, elements of the 
     criminal justice system, nonprofit organizations, and 
     individuals in the prevention, investigation, prosecution, 
     and treatment of cases involving missing adults;
       (E) provide assistance to families in locating and 
     recovering missing adults; and
       (F) assist in public notification and victim advocacy 
     related to missing adults.
       (2) Applications.--The Attorney General shall periodically 
     solicit applications for grants under this section by 
     publishing a request for applications in the Federal Register 
     and by posting such a request on the website of the 
     Department of Justice.
       (b) Other Duties.--The Attorney General shall--
       (1) coordinate programs relating to missing adults that are 
     funded by the Federal Government; and
       (2) encourage coordination between State and local law 
     enforcement and public agencies and nonprofit private 
     organizations receiving a grant pursuant to subsection (a).

     SEC. _64. AUTHORIZATION OF APPROPRIATIONS.

       There are authorized to be appropriated to carry out this 
     subtitle $4,000,000 for each of fiscal years 2010 through 
     2020.
                                 ______
                                 
  SA 3070. Mrs. HAGAN 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 510, between lines 9 and 10, insert the following:

     SEC. 2504. EXCEPTION TO MEDICAID COVERAGE EXCLUSION OF WEIGHT 
                   LOSS DRUGS AND INCLUSION OF WEIGHT LOSS DRUGS 
                   AS COVERED MEDICARE PART D DRUGS.

       (a) Elimination of Medicaid Exclusion.--Section 
     1927(d)(2)(A) of the Social Security Act (42 U.S.C. 1396r-
     8(d)(2)(A)) is amended by inserting ``, other than 
     prescription weight loss agents approved by the Food and Drug 
     Administration when used for obese patients or for overweight 
     patients with a weight-related co-morbidity, such as 
     hypertension, type 2 diabetes, or dyslipidemia'' after 
     ``weight gain''.
       (b) Inclusion of Coverage Under Medicare Part D.--Section 
     1860D-2(e)(1) of the Social Security Act (42 U.S.C. 1395w-
     102(e)(1)) is amended in the flush matter after and below 
     subparagraph (B), by inserting ``and prescription weight loss 
     agents approved by the Food and Drug Administration when used 
     for obese patients or for overweight patients with a weight-
     related co-morbidity such as hypertension, type 2 diabetes or 
     dyslipidemia,'' before the period.
       (c) Effective Date.--The amendments made by this section 
     shall apply to services furnished on or after January 1, 
     2011.
                                 ______
                                 
  SA 3071. Mrs. HAGAN 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 861, between lines 19 and 20, insert the following:

     SEC. 3137A. TREATMENT OF CERTAIN MEDICARE GEOGRAPHIC 
                   CLASSIFICATION REVIEW BOARD (MGCRB) 
                   RECLASSIFICATIONS.

       (a) In General.--Notwithstanding any other provision of 
     law, for purposes of making payments under Section 1886(d) of 
     the Social Security Act (42 U.S.C. 1395 ww (d)), the 
     Secretary of Health and Human Services shall permit any 
     hospital with Medicare Geographic Classification Review Board 
     reclassifications that overlap for one fiscal year with the 
     option to continue year three of the earlier reclassification 
     while waiving year one of the subsequent reclassification. 
     Such option shall be in addition to the option to immediately 
     transition to year one of the subsequent reclassification 
     with the loss of year three of the earlier reclassification.
       (b) Application.--
       (1) In general.--Subsection (a) shall apply to discharges 
     occurring on or after October 1, 2009.
       (2) Special rule for fy 2010.--In the case of any hospital 
     whose year three Medicare Geographic Classification Review 
     Board reclassification was lost or eliminated for fiscal 
     2010, the Secretary of Health and Human Services shall 
     establish a process under which such hospital shall have 30 
     days from the date of the enactment of this Act to notify the 
     Secretary of the hospital's election to continue

[[Page 29839]]

     for fiscal 2010 the third year of their earlier Medicare 
     Geographic Classification Review Board reclassification.
                                 ______
                                 
  SA 3072. Mrs. HAGAN 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 1255, line 14, after the first period insert the 
     following:

     ``SEC. 399MM-4. WORKPLACE DISEASE MANAGEMENT AND WELLNESS 
                   PUBLIC-PRIVATE PARTNERSHIP.

       ``(a) In General.--The Secretary, in coordination with the 
     Secretary of Labor, the Secretary of the Treasury, the 
     Secretary of Commerce, the Administrator of the Small 
     Business Administration, employers (including small, medium, 
     and large employers), employer organizations, worksite health 
     promotion organizations, State and local health departments, 
     Indian tribes and tribal organizations, and academic 
     institutions, shall provide for the implementation of a 
     national public-private partnership to--
       ``(1) promote the benefits of workplace wellness programs;
       ``(2) understand what types of disease prevention and 
     workplace wellness programs are effective, considering 
     different environments, factors, and circumstances;
       ``(3) understand the obstacles to the implementation of 
     disease prevention and workplace wellness programs, issues 
     relating to employer size and resources, and best practices 
     for the scalable implementation of such programs;
       ``(4) understand what factors influence employees to 
     participate in workplace disease prevention and wellness 
     programs;
       ``(5) emphasize an integrated and coordinated approach to 
     workplace disease management and wellness programs;
       ``(6) ensure informed decisions through the sharing of high 
     quality information and best practices; and
       ``(7) recommend policies to encourage or stimulate the 
     utilization of worksite disease management and wellness 
     programs, including specific recommendations as to the types 
     of technical and other assistance that may be necessary to 
     fully implement section 399MM.
       ``(b) Report.--Not later than 180 days after the date of 
     enactment of this Act, the Secretary shall submit to the 
     Committee on Health, Education, Labor, and Pensions of the 
     Senate and the Committee on Energy and Commerce of the House 
     of Representatives, a report that contains--
       ``(1) the findings of the public-private partnership 
     implemented under subsection (a); and
       ``(2) recommendations for statutory changes that may be 
     required or useful to implement the findings described in 
     paragraph (1) and to encourage the development of worksite 
     disease management and wellness programs.
       ``(c) Recommendations by CDC.--The Director of the Centers 
     for Disease Control and Prevention shall collect information 
     concerning workplace wellness programs and make 
     recommendations to the Secretary on ways to improve such 
     programs.''.
                                 ______
                                 
  SA 3073. Mrs. FEINSTEIN submitted an amendment intended to be 
proposed by her to the bill H.R. 3590, to amend the Internal Revenue 
Code of 1986 to modify the first-time homebuyers credit in the case of 
members of the Armed Forces and certain other Federal employees, and 
for other purposes; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. _. ADULT DAY HEALTH CARE SERVICES.

       (a) In General.--The Secretary of Health and Human Services 
     shall not--
       (1) withhold, suspend, disallow, or otherwise deny Federal 
     financial participation under section 1903(a) of the Social 
     Security Act (42 U.S.C. 1396b(a)) for the provision of adult 
     day health care services, day activity and health services, 
     or adult medical day care services, as defined under a State 
     Medicaid plan approved during or before 1994, during such 
     period if such services are provided consistent with such 
     definition and the requirements of such plan; or
       (2) withdraw Federal approval of any such State plan or 
     part thereof regarding the provision of such services (by 
     regulation or otherwise).
       (b) Effective Date.--Subsection (a) shall apply with 
     respect to services provided on or after October 1, 2008.
                                 ______
                                 
  SA 3074. Mrs. FEINSTEIN 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 453, between lines 5 and 6, insert the following:

     SEC. 2203. PERMITTING LOCAL PUBLIC AGENCIES TO ACT AS 
                   MEDICAID ENROLLMENT BROKERS.

       Section 1903(b)(4) of the Social Security Act (42 U.S.C. 
     1396b(b)(4)) is amended by adding at the end the following 
     new subparagraph:
       ``(C)(i) Subparagraphs (A) and (B) shall not apply in the 
     case of a local public agency that is acting as an enrollment 
     broker under a contract or memorandum with a State medicaid 
     agency, provided the local public agency does not have a 
     direct or indirect financial interest with any medicaid 
     managed care plan for which it provides enrollment broker 
     services.
       ``(ii) In determining whether a local public agency has a 
     direct or indirect financial interest with a medicaid managed 
     care plan under clause (i), the status of a local public 
     agency as a contractor of the plan does not constitute having 
     a direct or indirect financial interest with the plan.''.
                                 ______
                                 
  SA 3075. Mr. DURBIN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

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

       Subtitle F--Programs Relating to Congenital Heart Disease

     SEC. 4501. PROGRAMS RELATING TO CONGENITAL HEART DISEASE.

       (a) Short Title.--This subtitle may be cited as the 
     ``Congenital Heart Futures Act''.
       (b) Programs Relating to Congenital Heart Disease.--
       (1) Public education and awareness; national registry; 
     advisory committee.--Title III of the Public Health Service 
     Act (42 U.S.C. 241 et seq.), as amended by section 4303, is 
     further amended by adding at the end the following:

        ``PART V--PROGRAMS RELATING TO CONGENITAL HEART DISEASE

     ``SEC. 399NN-1. PUBLIC EDUCATION AND AWARENESS OF CONGENITAL 
                   HEART DISEASE.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention 
     and in collaboration with appropriate congenital heart 
     disease patient organizations and professional organizations, 
     may directly or through grants, cooperative agreements, or 
     contracts to eligible entities conduct, support, and promote 
     a comprehensive public education and awareness campaign to 
     increase public and medical community awareness regarding 
     congenital heart disease, including the need for life-long 
     treatment of congenital heart disease survivors.
       ``(b) Eligibility for Grants.--To be eligible to receive a 
     grant, cooperative agreement, or contract under this section, 
     an entity shall be a State or private nonprofit entity and 
     shall submit to the Secretary an application at such time, in 
     such manner, and containing such information as the Secretary 
     may require.''.

     ``SEC. 399NN-2. NATIONAL CONGENITAL HEART DISEASE REGISTRY.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     may--
       ``(1) enhance and expand infrastructure to track the 
     epidemiology of congenital heart disease and to organize such 
     information into a nationally-representative surveillance 
     system with development of a population-based registry of 
     actual occurrences of congenital heart disease, to be known 
     as the `National Congenital Heart Disease Registry'; or
       ``(2) award a grant to one eligible entity to undertake the 
     activities described in paragraph (1).
       ``(b) Purpose.--The purpose of the Congenital Heart Disease 
     Registry shall be to facilitate further research into the 
     types of health services patients use and to identify 
     possible areas for educational outreach and prevention in 
     accordance with standard practices of the Centers for Disease 
     Control and Prevention.
       ``(c) Content.--The Congenital Heart Disease Registry--
       ``(1) may include information concerning the incidence and 
     prevalence of congenital heart disease in the United States;
       ``(2) may be used to collect and store data on congenital 
     heart disease, including data concerning--
       ``(A) demographic factors associated with congenital heart 
     disease, such as age, race, ethnicity, sex, and family 
     history of individuals who are diagnosed with the disease;

[[Page 29840]]

       ``(B) risk factors associated with the disease;
       ``(C) causation of the disease;
       ``(D) treatment approaches; and
       ``(E) outcome measures, such that analysis of the outcome 
     measures will allow derivation of evidence-based best 
     practices and guidelines for congenital heart disease 
     patients; and
       ``(3) may ensure the collection and analysis of 
     longitudinal data related to individuals of all ages with 
     congenital heart disease, including infants, young children, 
     adolescents, and adults of all ages.
       ``(d) Coordination With Federal, State, and Local 
     Registries.--In establishing the National Congenital Heart 
     Registry, the Secretary may identify, build upon, expand, and 
     coordinate among existing data and surveillance systems, 
     surveys, registries, and other Federal public health 
     infrastructure, including--
       ``(1) State birth defects surveillance systems;
       ``(2) the State birth defects tracking systems of the 
     Centers for Disease Control and Prevention;
       ``(3) the Metropolitan Atlanta Congenital Defects Program; 
     and
       ``(4) the National Birth Defects Prevention Network.
       ``(e) Public Access.--The Congenital Heart Disease Registry 
     shall be made available to the public, as appropriate, 
     including congenital heart disease researchers.
       ``(f) Patient Privacy.--The Secretary shall ensure that the 
     Congenital Heart Disease Registry is maintained in a manner 
     that complies with the regulations promulgated under section 
     264 of the Health Insurance Portability and Accountability 
     Act of 1996.
       ``(g) Eligibility for Grant.--To be eligible to receive a 
     grant under subsection (a)(2), an entity shall--
       ``(1) be a public or private nonprofit entity with 
     specialized experience in congenital heart disease; and
       ``(2) submit to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require.
       ``(h) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section such 
     sums as may be necessary for each of fiscal years 2010 
     through 2014.''.

     ``SEC. 399NN-3. ADVISORY COMMITTEE ON CONGENITAL HEART 
                   DISEASE.

       ``(a) Establishment.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     may establish an advisory committee, to be known as the 
     `Advisory Committee on Congenital Heart Disease' (referred to 
     in this section as the `Advisory Committee').
       ``(b) Membership.--The members of the Advisory Committee 
     may be appointed by the Secretary, acting through the Centers 
     for Disease Control and Prevention, and shall include--
       ``(1) at least one representative from--
       ``(A) the National Institutes of Health;
       ``(B) the Centers for Disease Control and Prevention; and
       ``(C) a national patient advocacy organization with 
     experience advocating on behalf of patients living with 
     congenital heart disease;
       ``(2) at least one epidemiologist who has experience 
     working with data registries;
       ``(3) clinicians, including--
       ``(A) at least one with experience diagnosing or treating 
     congenital heart disease; and
       ``(B) at least one with experience using medical data 
     registries; and
       ``(4) at least one publicly or privately funded researcher 
     with experience researching congenital heart disease.
       ``(c) Duties.--The Advisory Committee may review 
     information and make recommendations to the Secretary 
     concerning--
       ``(1) the development and maintenance of the National 
     Congenital Heart Disease Registry established under section 
     399NN-2;
       ``(2) the type of data to be collected and stored in the 
     National Congenital Heart Disease Registry;
       ``(3) the manner in which such data is to be collected;
       ``(4) the use and availability of such data, including 
     guidelines for such use; and
       ``(5) other matters, as the Secretary determines to be 
     appropriate.
       ``(d) Report.--Not later than 180 days after the date on 
     which the Advisory Committee is established and annually 
     thereafter, the Advisory Committee shall submit a report to 
     the Secretary concerning the information described in 
     subsection (c), including recommendations with respect to the 
     results of the Advisory Committee's review of such 
     information.''.
       (2) Congenital heart disease research.--Subpart 2 of part C 
     of title IV of the Public Health Service Act (42 U.S.C. 285b 
     et seq.) is amended by adding at the end the following:

     ``SEC. 425. CONGENITAL HEART DISEASE.

       ``(a) In General.--The Director of the Institute may 
     expand, intensify, and coordinate research and related 
     activities of the Institute with respect to congenital heart 
     disease, which may include congenital heart disease research 
     with respect to--
       ``(1) causation of congenital heart disease, including 
     genetic causes;
       ``(2) long-term outcomes in individuals with congenital 
     heart disease, including infants, children, teenagers, 
     adults, and elderly individuals;
       ``(3) diagnosis, treatment, and prevention;
       ``(4) studies using longitudinal data and retrospective 
     analysis to identify effective treatments and outcomes for 
     individuals with congenital heart disease; and
       ``(5) identifying barriers to life-long care for 
     individuals with congenital heart disease.
       ``(b) Coordination of Research Activities.--The Director of 
     the Institute may coordinate research efforts related to 
     congenital heart disease among multiple research institutions 
     and may develop research networks.
       ``(c) Minority and Medically Underserved Communities.--In 
     carrying out the activities described in this section, the 
     Director of the Institute shall consider the application of 
     such research and other activities to minority and medically 
     underserved communities.''.
       (c) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out the amendments made by this 
     section such sums as may be necessary for each of fiscal 
     years 2010 through 2014.
                                 ______
                                 
  SA 3076. Mr. DURBIN (for himself and Mr. Sanders) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       Strike section 4107 and insert the following:

     SEC. 4107. COVERAGE OF COMPREHENSIVE TOBACCO CESSATION 
                   SERVICES IN MEDICAID.

       (a) Requiring Coverage of Counseling and Pharmacotherapy 
     for Cessation of Tobacco Use.--Section 1905 of the Social 
     Security Act (42 U.S.C. 1396d), as amended by sections 
     2001(a)(3)(B) and 2303, is further amended--
       (1) in subsection (a)(4)--
       (A) by striking ``and'' before ``(C)''; and
       (B) by inserting before the semicolon at the end the 
     following new subparagraph: ``; and (D) counseling and 
     pharmacotherapy for cessation of tobacco use (as defined in 
     subsection (bb))''; and
       (2) by adding at the end the following:
       ``(bb)(1) For purposes of this title, the term `counseling 
     and pharmacotherapy for cessation of tobacco use' means 
     diagnostic, therapy, and counseling services and 
     pharmacotherapy (including the coverage of prescription and 
     nonprescription tobacco cessation agents approved by the Food 
     and Drug Administration) for cessation of tobacco use by 
     individuals who use tobacco products or who are being treated 
     for tobacco use that is furnished--
       ``(A) by or under the supervision of a physician; or
       ``(B) by any other health care professional who--
       ``(i) is legally authorized to furnish such services under 
     State law (or the State regulatory mechanism provided by 
     State law) of the State in which the services are furnished; 
     and
       ``(ii) is authorized to receive payment for other services 
     under this title or is designated by the Secretary for this 
     purpose.
       ``(2) Subject to paragraph (3), such term is limited to--
       ``(A) services recommended with respect to individuals in 
     `Treating Tobacco Use and Dependence: 2008 Update: A Clinical 
     Practice Guideline', published by the Public Health Service 
     in May 2008, or any subsequent modification of such 
     Guideline; and
       ``(B) such other services that the Secretary recognizes to 
     be effective for cessation of tobacco use.
       ``(3) Such term shall not include coverage for drugs or 
     biologicals that are not otherwise covered under this 
     title.''.
       (b) Exception From Optional Restriction Under Medicaid 
     Prescription Drug Coverage.--Section 1927(d)(2)(F) of the 
     Social Security Act (42 U.S.C. 1396r-8(d)(2)(F)), as 
     redesignated by section 2502(a), is amended by inserting 
     before the period at the end the following: ``, except when 
     recommended in accordance with the Guideline referred to in 
     section 1905(bb)(2)(A), agents approved by the Food and Drug 
     Administration under the over-the-counter monograph process 
     for purposes of promoting, and when used to promote, tobacco 
     cessation''.
       (c) Removal of Cost-Sharing for Counseling and 
     Pharmacotherapy for Cessation of Tobacco Use.--
       (1) General cost-sharing limitations.--Section 1916 of the 
     Social Security Act (42 U.S.C. 1396o) is amended in each of 
     subsections (a)(2)(D) and (b)(2)(D) by inserting ``and 
     counseling and pharmacotherapy for cessation of tobacco use 
     (as defined in section 1905(bb)) and covered outpatient drugs 
     (as defined in subsection (k)(2) of section 1927 and 
     including nonprescription drugs described in subsection 
     (d)(2) of such section)

[[Page 29841]]

     that are prescribed for purposes of promoting, and when used 
     to promote, tobacco cessation in accordance with the 
     Guideline referred to in section 1905(bb)(2)(A)'' after 
     ``section 1905(a)(4)(C),''.
       (2) Application to alternative cost-sharing.--Section 
     1916A(b)(3)(B) of such Act (42 U.S.C. 1396o-1(b)(3)(B)) is 
     amended by adding at the end the following:
       ``(xi) Counseling and pharmacotherapy for cessation of 
     tobacco use (as defined in section 1905(bb)) and covered 
     outpatient drugs (as defined in subsection (k)(2) of section 
     1927 and including nonprescription drugs described in 
     subsection (d)(2) of such section) that are prescribed for 
     purposes of promoting, and when used to promote, tobacco 
     cessation in accordance with the Guideline referred to in 
     section 1905(bb)(2)(A).''.
       (d) Effective Date.--The amendments made by this section 
     shall take effect on October 1, 2010.
                                 ______
                                 
  SA 3077. Mr. DURBIN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

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

     SEC. 3115. MEDICARE PASS-THROUGH PAYMENTS FOR CRNA SERVICES.

       (a) Treatment of Critical Access Hospitals as Rural in 
     Determining Eligibility for CRNA Pass-Through Payments.--
     Section 9320(k) of the Omnibus Budget Reconciliation Act of 
     1986 (42 U.S.C. 1395k note), as added by section 608(c)(2) of 
     the Family Support Act of 1988 and amended by section 6132 of 
     the Omnibus Budget Reconciliation Act of 1989, is amended by 
     adding at the end the following:
       ``(3) Any facility that qualifies as a critical access 
     hospital (as defined in section 1861(mm)(1) of the Social 
     Security Act) shall be treated as being located in a rural 
     area for purposes of paragraph (1) regardless of any 
     geographic reclassification of the facility, including such a 
     reclassification of the county in which the facility is 
     located as an urban county (also popularly known as a Lugar 
     county) under section 1886(d)(8)(B) of the Social Security 
     Act (42 U.S.C. 1395ww(d)(8)(B)).''.
       (b) Treatment of Standby and On-Call Costs.--Such section 
     9320(k), as amended by subsection (a), is further amended by 
     adding at the end the following:
       ``(4) In determining the reasonable costs incurred by a 
     hospital or critical access hospital for the services of a 
     certified registered nurse anesthetist under this subsection, 
     the Secretary shall include standby costs and on-call costs 
     incurred by the hospital or critical access hospital, 
     respectively, with respect to such nurse anesthetist.''.
       (c) Effective Dates.--
       (1) Treatment of cahs as rural in determining crna pass-
     through eligibility.--The amendment made by subsection (a) 
     shall apply to calendar years beginning on or after the date 
     of the enactment of this Act (regardless of whether the 
     geographic reclassification of a critical access hospital 
     occurred before, on, or after such date).
       (2) Inclusion of standby costs and on-call costs in 
     determining reasonable costs of crna services.--The amendment 
     made by subsection (b) shall apply to costs incurred in cost 
     reporting periods beginning in fiscal years after fiscal year 
     2003.
                                 ______
                                 
  SA 3078. Ms. KLOBUCHAR (for herself and Ms. Snowe) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

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

     SEC. __. YOUNG WOMEN'S BREAST HEALTH AWARENESS AND SUPPORT OF 
                   YOUNG WOMEN DIAGNOSED WITH BREAST CANCER.

       (a) Short Title.--This section may be cited as the ``Young 
     Women's Breast Health Education and Awareness Requires 
     Learning Young Act of 2009'' or ``EARLY Act''.
       (b) Amendment.--Title III of the Public Health Service Act 
     (42 U.S.C. 241 et seq.) is amended by adding at the end the 
     following:

        ``PART S--PROGRAMS RELATING TO BREAST HEALTH AND CANCER

     ``SEC. 399HH. YOUNG WOMEN'S BREAST HEALTH AWARENESS AND 
                   SUPPORT OF YOUNG WOMEN DIAGNOSED WITH BREAST 
                   CANCER.

       ``(a) Public Education Campaign.--
       ``(1) In general.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     shall conduct a national evidence-based education campaign to 
     increase awareness of young women's knowledge regarding--
       ``(A) breast health in young women of all racial, ethnic, 
     and cultural backgrounds;
       ``(B) breast awareness and good breast health habits;
       ``(C) the occurrence of breast cancer and the general and 
     specific risk factors in women who may be at high risk for 
     breast cancer based on familial, racial, ethnic, and cultural 
     backgrounds such as Ashkenazi Jewish populations;
       ``(D) evidence-based information that would encourage young 
     women and their health care professional to increase early 
     detection of breast cancers; and
       ``(E) the availability of health information and other 
     resources for young women diagnosed with breast cancer on--
       ``(i) fertility preservation;
       ``(ii) support, including social, emotional, psychosocial, 
     financial, lifestyle, and caregiver support;
       ``(iii) familial risk factors; and
       ``(iv) prevention and early detection strategies to reduce 
     recurrence or metastasis;
       ``(2) Evidence-based, age appropriate messages.--The 
     campaign shall provide evidence-based, age-appropriate 
     messages and materials as developed by the Centers for 
     Disease Control and Prevention and the Advisory Committee 
     established under paragraph (4).
       ``(3) Media campaign.--In conducting the education campaign 
     under paragraph (1), the Secretary shall award grants to 
     entities to establish national multimedia campaigns oriented 
     to young women that may include advertising through 
     television, radio, print media, billboards, posters, all 
     forms of existing and especially emerging social networking 
     media, other Internet media, and any other medium determined 
     appropriate by the Secretary.
       ``(4) Advisory committee.--
       ``(A) Establishment.--Not later than 60 days after the date 
     of the enactment of this section, the Secretary, acting 
     through the Director of the Centers for Disease Control and 
     Prevention, shall establish an advisory committee to assist 
     in creating and conducting the education campaigns under 
     paragraph (1) and subsection (b)(1).
       ``(B) Membership.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     shall appoint to the advisory committee under subparagraph 
     (A) such members as deemed necessary to properly advise the 
     Secretary, and shall include organizations and individuals 
     with expertise in breast cancer, disease prevention, early 
     detection, diagnosis, public health, social marketing, 
     genetic screening and counseling, treatment, rehabilitation, 
     palliative care, and survivorship in young women.
       ``(b) Health Care Professional Education Campaign.--
       ``(1) In general.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     and in consultation with the Administrator of the Health 
     Resources and Services Administration, shall conduct an 
     education campaign among physicians and other health care 
     professionals to increase awareness--
       ``(A) of breast health, symptoms, and early diagnosis and 
     treatment of breast cancer in young women, including specific 
     risk factors such as family history of cancer and women that 
     may be at high risk for breast cancer, such as Ashkenazi 
     Jewish population;
       ``(B) on how to provide counseling to young women about 
     their breast health, including knowledge of their family 
     cancer history and importance of providing regular clinical 
     breast examinations;
       ``(C) concerning the importance of discussing healthy 
     behaviors, and increasing awareness of services and programs 
     available to address overall health and wellness, and making 
     patient referrals to address tobacco cessation, good 
     nutrition, and physical activity;
       ``(D) on when to refer patients to a health care provider 
     with genetics expertise;
       ``(E) on how to provide counseling that addresses long-term 
     survivorship and health concerns of young women diagnosed 
     with breast cancer; and
       ``(F) on when to provide referrals to organizations and 
     institutions that provide credible health information and 
     substantive assistance and support to young women diagnosed 
     with breast cancer, including--
       ``(i) re-entry into the workforce or school;
       ``(ii) infertility as a result of treatment;
       ``(iii) neuro-cognitive effects;
       ``(iv) important effects of cardiac, vascular, muscle, and 
     skeletal complications; and
       ``(v) secondary malignancies.
       ``(2) Materials.--The education campaign under paragraph 
     (1) may include the distribution of print, video, and Web-
     based materials on assisting physicians and other health care 
     professionals in achieving the goals of this section.
       ``(c) Prevention Research Activities.--The Secretary, 
     acting through--
       ``(1) the Director of the Centers for Disease Control and 
     Prevention, shall conduct prevention research on breast 
     cancer in younger women, including--

[[Page 29842]]

       ``(A) behavioral, survivorship studies, and other research 
     on the impact of breast cancer diagnosis on young women;
       ``(B) formative research to assist with the development of 
     educational messages and information for the public, targeted 
     populations, and their families about breast health, breast 
     cancer, and healthy lifestyles;
       ``(C) testing and evaluating existing and new social 
     marketing strategies targeted at young women; and
       ``(D) surveys of health care providers and the public 
     regarding knowledge, attitudes, and practices related to 
     breast health and breast cancer prevention and control in 
     high-risk populations; and
       ``(2) the Director of the National Institutes of Health, 
     shall conduct research to develop and validate new screening 
     tests and methods for prevention and early detection of 
     breast cancer in young women.
       ``(d) Support for Young Women Diagnosed With Breast 
     Cancer.--
       ``(1) In general.--The Secretary shall award grants to 
     organizations and institutions to provide health information 
     from credible sources and substantive assistance directed to 
     young women diagnosed with breast cancer and pre-neoplastic 
     breast diseases on issues such as--
       ``(A) education and counseling regarding fertility 
     preservation;
       ``(B) support, including social, emotional, psychosocial, 
     financial, lifestyle, and caregiver support;
       ``(C) familial risk factors; and
       ``(D) prevention and early education strategies to reduce 
     recurrence or metastasis.
       ``(2) Priority.--In making grants under paragraph (1), the 
     Secretary shall give priority to applicants that deal 
     specifically with young women diagnosed with breast cancer 
     and pre-neoplastic breast disease.
       ``(e) No Duplication of Effort.--In conducting an education 
     campaign or other program under subsections (a), (b), (c), or 
     (d), the Secretary shall avoid duplicating other existing 
     Federal breast cancer education efforts.
       ``(f) Measurement; Reporting.--The Secretary, acting 
     through the Director of the Centers for Disease Control and 
     Prevention, shall--
       ``(1) measure--
       ``(A) young women's awareness regarding breast health, 
     including knowledge of family cancer history, specific risk 
     factors and early warning signs, and young women's proactive 
     efforts at early detection;
       ``(B) the number or percentage of young women utilizing 
     information regarding lifestyle interventions that foster 
     healthy behaviors such as tobacco cessation, nutrition, and 
     physical activity;
       ``(C) the number or percentage of young women receiving 
     regular clinical breast exams; and
       ``(D) the number or percentage of young women who perform 
     breast self exams, and the frequency of such exams, before 
     the implementation of this section;
       ``(2) establish quantitative benchmarks to measure the 
     impact of activities under this section;
       ``(3) not less than every 3 years, measure the impact of 
     such activities; and
       ``(4) submit reports to the Congress on the results of such 
     measurements.
       ``(g) Definitions.--In this section--
       ``(1) the term `State' means each of the several States, 
     the District of Columbia, the Commonwealth of Puerto Rico, 
     American Samoa, Guam, the Commonwealth of the Northern 
     Mariana Islands, the United States Virgin Islands, and the 
     Trust Territory of the Pacific Islands; and
       ``(2) the term `young women' means women 15 to 44 years of 
     age.
       ``(h) Authorization of Appropriations.--To carry out 
     subsections (a), (b), (c)(1), and (d), there are authorized 
     to be appropriated $9,000,000 for each of the fiscal years 
     2010 through 2014.''.

                          ____________________