[Congressional Record (Bound Edition), Volume 155 (2009), Part 24]
[Senate]
[Pages 32611-32616]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 3259. Mr. UDALL of Colorado 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:

     SEC. 1__. STATE COURT INNOVATION PROJECT.

       (a) Grant.--
       (1) In general.--
       (A) Grant program.--The Attorney General shall develop and 
     implement a competitive grant program to improve the 
     efficiency and lessen the costs and burdens of medical 
     malpractice civil litigation for plaintiffs and defendants.
       (B) Elements of program.--The grant program under 
     subparagraph (A) shall be designed--
       (i) to give State courts a mechanism for improving court 
     rules and procedures, allowing parties to go to trial in more 
     cost-effective ways and reducing the complexity and cost of 
     litigation; and

[[Page 32612]]

       (ii) to fund research and objective measurement, 
     evaluation, and reporting of outcomes to identify innovative 
     ways of promoting the resolution of medical malpractice cases 
     in court or tried by jury in a more cost-effective and timely 
     manner pursuant to clause (i).
       (C) Eligible entity.--To be eligible to receive a grant 
     under subparagraph (A), an entity shall--
       (i) be a nonprofit State court improvement organization 
     that was incorporated or in existence before December 31, 
     2009, and which is experienced in developing State court 
     improvement programs; and
       (ii) submit to the Attorney General an application at such 
     time, in such manner, and containing such information as the 
     Attorney General may require.
       (2) Use of funds.--A grant recipient under paragraph (1) 
     shall use amounts awarded under the grant to conduct research 
     and evaluations, develop rules and procedures designed to 
     improve the efficiency and lessen the costs of medical 
     malpractice litigation for plaintiffs and defendants, and to 
     award subgrants to eligible entities to carry out 
     activities--
       (A) to conduct pilot projects;
       (B) to increase the operating efficiency of State courts 
     with respect to medical malpractice litigation;
       (C) to conduct research to seek innovative ways to resolve 
     medical malpractice litigation in State courts in a more 
     cost-effective and timely manner; and
       (D) to measures and report on outcomes with respect to 
     activities funded under the subgrant.
       (3) Eligible subgrant entity.--To be eligible to receive a 
     subgrant under paragraph (2), an entity shall--
       (A)(i) be a State or local governmental entity in a 
     jurisdiction that permits jury trials for civil medical 
     malpractice actions; or
       (ii) be an academic institution; and
       (B) submit an application at such time, in such manner, and 
     containing such information as required by the recipient of 
     the grant under paragraph (1), in accordance with any rules 
     established by the Attorney General.
       (4) Reporting.--Not later than 2 years after receiving 
     grant funds under this subsection, each grant recipient under 
     paragraph (1) shall submit to the Attorney General a report 
     that describes the activities conducted by the recipient 
     under this section, including the activities of any 
     subgrantees of such grant recipient under paragraph (2).
       (b) Authorization of Appropriations.--There is authorized 
     to be appropriated $10,000,000 to carry out this section.
                                 ______
                                 
  SA 3260. Mr. GRASSLEY 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 522, between lines 2 and 3, insert the following:

     SEC. 2603. PAYMENT FOR ILLEGAL UNAPPROVED DRUGS.

       (a) Findings.--Congress finds that each year, the Medicaid 
     program under title XIX of the Social Security Act (42 U.S.C. 
     1396 et seq.) pays millions of dollars in reimbursement for 
     covered outpatient drugs that are not approved by the Food 
     and Drug Administration under a new drug application under 
     section 505(b) of the Federal Food, Drug, and Cosmetic Act 
     (21 U.S.C. 355(b)) or an abbreviated new drug application 
     under section 505(j) of such Act, or that such drug is not 
     subject such section 505 or section 512 due to the 
     application of section 201(p) of such Act (21 U.S.C. 321(p)).
       (b) Listing of Drugs and Devices.--Section 510 of the Food, 
     Drug and Cosmetic Act (21 U.S.C. 360) is amended--
       (1) in subsection (j)(1)(B)--
       (A) in clause (i), by inserting ``in the case of a drug, 
     the authority under this Act that does not require such drug 
     to be subject to section 505 and section 512,'' after 
     ``labeling for such drug or device,''; and
       (B) in clause (ii), by inserting ``, in the case of a drug, 
     the authority under this Act that does not require such drug 
     to be subject to section 505 and section 512,'' after ``for 
     such drug or device''; and
       (2) in subsection (f)--
       (A) by striking ``(f) The Secretary'' and inserting the 
     following:
       ``(f) Inspection by Public of Registration.--
       ``(1) In general.--The Secretary''; and
       (B) by adding at the end the following:
       ``(2) List of drugs that are not approved under section 505 
     or 512.--Not later than January 1, 2011, the Secretary shall 
     make available to the public on the Internet website of the 
     Food and Drug Administration a list that includes, for each 
     drug described in subsection (j)(1)(B)--
       ``(A) the drug;
       ``(B) the person who listed such drug; and
       ``(C) the authority under this Act that does not require 
     such drug to be subject to section 505 and section 512, as 
     provided by such person in such list.''.
       (c) Payment for Covered Outpatient Drugs.--Section 1927 of 
     the Social Security Act (42 U.S.C. 1396r-8) is amended by 
     inserting at the end the following:
       ``(l) Condition.--Beginning January 1, 2011, no State shall 
     make any payment under this section for any covered 
     outpatient drug unless such State first verifies with the 
     Food and Drug Administration that such covered outpatient 
     drug has been approved by the Food and Drug Administration 
     under a new drug application under section 505(b) of the 
     Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355(b)) or an 
     abbreviated new drug application under section 505(j) of such 
     Act, or that such drug is not subject such section 505 or 
     section 512 due to the application of section 201(p) of such 
     Act (21 U.S.C. 321(p)). The Secretary shall have the 
     authority to proscribe regulations to create an information 
     sharing protocol to allow States to verify that a covered 
     outpatient drug has been approved by the Food and Drug 
     Administration.''.
                                 ______
                                 
  SA 3261. 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 722, after line 20, insert the following:

     SEC. 3016. CULTURE OF SAFETY HOSPITAL ACCOUNTABILITY STUDY 
                   AND DEMONSTRATION PROGRAM.

       (a) Study.--
       (1) In general.--The Secretary shall conduct a study that--
       (A) examines existing activities and programs in hospitals 
     for quality assurance, patient safety, and performance 
     improvement and provides an analysis regarding best practices 
     with respect to such activities and programs; and
       (B) identifies best practices that should be replicated in 
     hospitals to improve patient safety and quality of care, 
     consistent with the provisions included under the quality 
     assessment and performance improvement program, as required 
     under the conditions of participation for hospitals under 
     Medicare.
       (2) Report.--Not later than 2 years after the date of 
     enactment of this Act, the Secretary shall prepare a report 
     containing the results of the study conducted under paragraph 
     (1). Such report shall be made available on the Internet 
     website of the Centers for Medicare & Medicaid Services.
       (b) Demonstration Program.--
       (1) In general.--The Secretary shall establish the Culture 
     of Safety Hospital Accountability demonstration program to 
     provide support for establishing partnerships and other 
     cooperative approaches between hospitals, State health care 
     agencies, and the Department of Health and Human Services to 
     promote and implement the best practices identified under 
     subsection (a), with the goal of improving the safety and 
     quality of care provided to Medicare beneficiaries and 
     enhance compliance with the conditions of participation for 
     hospitals under Medicare.
       (2) Duration.--The demonstration program shall operate 
     during a period of 3 years, beginning not later than 12 
     months after completion of the report described in subsection 
     (a)(2).
       (3) Scope.--
       (A) States.--The Secretary shall select not less than 4 
     States, but not more than 6 States, to participate in the 
     demonstration program.
       (B) Hospitals.--The Secretary shall select not more than 24 
     hospitals, within the States selected under subparagraph (A), 
     to participate in the demonstration program. The hospitals 
     selected under this subparagraph shall satisfy criteria, as 
     developed by the Secretary, indicating a need for substantial 
     improvement in quality of care and patient safety.
       (4) Application.--A State or hospital that desires to 
     participate in the demonstration program shall submit to the 
     Secretary an application at such time, in such manner, and 
     containing such information as the Secretary may require.
       (5) Implementation.--
       (A) Technical assistance.--The Secretary shall provide 
     participating hospitals with technical assistance in 
     implementation of the best practices identified through the 
     study under subsection (a).
       (B) Hospital surveyors.--For each State participating in 
     the demonstration program, the Secretary shall provide 
     training to State surveyors that is designed to--
       (i) enhance knowledge of the disciplines of patient safety, 
     quality assessment, and performance improvement;
       (ii) increase skill in evaluating compliance with quality 
     assessment and performance improvement programs required 
     under the conditions of participation for hospitals under 
     Medicare; and

[[Page 32613]]

       (iii) focus investigations of complaints regarding hospital 
     care on the hospital's quality assessment and performance 
     improvement program.
       (6) Evaluation.--For each State and hospital participating 
     in the demonstration program, the Secretary shall evaluate 
     the following:
       (A) The level of implementation of the best practices 
     identified under subsection (a) by the participating 
     hospitals and whether adoption of such practices--
       (i) improved quality and patient safety (including an 
     analysis of changes in quality measures and other indicators 
     of outcome and performance); and
       (ii) resulted in a decrease in the seriousness or number of 
     citations for deficiencies under the conditions of 
     participation for hospitals under Medicare.
       (B) The training provided to State surveyors and whether 
     such training resulted in enhanced proficiency in evaluations 
     of hospital quality assessment and performance improvement 
     programs.
       (7) Report.--Not later than 12 months after completion of 
     the demonstration project, the Secretary shall submit to 
     Congress a report containing an evaluation of the 
     demonstration program, including--
       (A) the findings of the evaluation under paragraph (6); and
       (B) recommendations--
       (i) in regard to whether the best practices identified 
     under the demonstration program should be adopted by other 
     hospitals, and how the Secretary can best promote adoption of 
     such best practices;
       (ii) in regard to whether the training for State surveyors 
     developed under the demonstration program should be provided 
     to all State surveyors; and
       (iii) for such legislation and administrative action as the 
     Secretary determines appropriate.
       (8) Waiver authority.--The Secretary may waive such 
     requirements under titles XI and XVIII of the Social Security 
     Act as may be necessary to carry out the demonstration 
     program.
       (c) Funding.--For purposes of carrying out this section, 
     the Secretary shall provide for the transfer from the Federal 
     Hospital Insurance Trust Fund under section 1817 of the 
     Social Security Act (42 U.S.C. 1395i) of $25,000,000, to the 
     Centers for Medicare & Medicaid Services Program Management 
     Account for the period of fiscal years 2010 through 2017. 
     Amounts transferred under the preceding sentence shall remain 
     available until expended.
       (d) Alternative Remedies.--Section 1866(b) of the Social 
     Security Act (42 U.S.C. 1395cc(b)) is amended by adding at 
     the end the following new paragraph:
       ``(5)(A) The Secretary is authorized to promulgate 
     regulations that establish enforcement remedies that are in 
     addition to, or in lieu of, termination of an agreement under 
     this section for hospitals or critical access hospitals for 
     violations of health and safety requirements under this 
     title. Such remedies may include directed plans of correction 
     that are designed to--
       ``(i) ensure compliance with requirements under this title 
     (including conditions of participation for hospitals or 
     critical access hospitals);
       ``(ii) prevent recurrence of non-compliance with such 
     requirements; and
       ``(iii) improve the internal structures and processes 
     within the hospital or critical access hospital for provision 
     of continuous quality and safety enhancement.
       ``(B) The regulations described under subparagraph (A) may 
     be promulgated by the Secretary before, during, or after the 
     evaluation described under section 3016(b)(6) of the Patient 
     Protection and Affordable Care Act.''.
       (e) Non-Application of Paperwork Reduction Act.--Chapter 35 
     of title 44, United States Code (commonly referred to as the 
     `Paperwork Reduction Act of 1995') shall not apply to this 
     section.
       (f) Definitions.--In this section:
       (1) Demonstration program.--The term ``demonstration 
     program'' means the Culture of Safety Hospital Accountability 
     demonstration program conducted under this section.
       (2) Hospital.--The term ``hospital'' means--
       (A) an institution described under section 1861(e) of the 
     Social Security Act (42 U.S.C. 1395x(e)); or
       (B) a critical access hospital (as described under section 
     1861(mm)(1) of such Act (42 U.S.C. 1395x(mm)(1)).
       (3) Medicare.--The term ``Medicare'' 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.
                                 ______
                                 
  SA 3262. 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 796, between lines 5 and 6, insert the following:

     SEC. 3028. VOLUNTARY ACCELERATED SHARED SAVINGS PROGRAM.

       (a) Establishment.--
       (1) In general.--The Secretary of Health and Human Services 
     (referred to in this section as the ``Secretary'') shall 
     establish the Voluntary Accelerated Shared Savings Program 
     (referred to in this section as the ``shared savings 
     program'') under which health care providers that voluntarily 
     report on quality measures, adopt quality-improving protocols 
     or strategies, and achieve quality benchmarks are eligible 
     for a shared savings payment.
       (2) Duration.--The shared savings program shall be 
     conducted during the following periods:
       (A) The hospital readmission reduction program, as 
     described under subsection (d), shall--
       (i) begin on such date as determined appropriate by the 
     Secretary for implementation of the program, but not later 
     than 6 months after the date of enactment of this Act; and
       (ii) end not later than October 1, 2012.
       (B) The hospital-acquired conditions reduction program, as 
     described under subsection (e), shall--
       (i) begin on such date as determined appropriate by the 
     Secretary for implementation of the program, but not later 
     than 6 months after the date of enactment of this Act; and
       (ii) shall end not later than October 1, 2015.
       (b) Eligibility; Participation Requirements.--
       (1) Eligibility.--A hospital described in section 
     1886(q)(5)(C) of the Social Security Act, as added by section 
     3025, shall be eligible to participate in the shared savings 
     program.
       (2) Application.--A provider seeking to participate in the 
     shared savings program shall submit an application to the 
     Secretary, in such manner and containing such information as 
     the Secretary may require, that includes a detailed 
     description of the methods through which the provider expects 
     to--
       (A) reduce readmissions or hospital-acquired condition 
     rates, as applicable;
       (B) reduce costs; and
       (C) integrate and coordinate such quality improvement 
     efforts with post-acute providers.
       (3) Participation requirements.--A participating provider 
     shall be required to--
       (A) report on quality measures (as determined by the 
     Secretary under subsection (c));
       (B) satisfy applicable benchmarks for such quality 
     measures; and
       (C) demonstrate savings (as described in subsection (f)).
       (c) Quality and Other Reporting Requirements.--
       (1) In general.--The Secretary shall determine appropriate 
     measures to assess the quality of care furnished by 
     participating providers, such as measures of--
       (A) clinical processes and outcomes;
       (B) patient and, where practicable, caregiver experience of 
     care; and
       (C) utilization rates.
       (2) Incorporation of measures.--For purposes of the 
     measures described under paragraph (1), the Secretary may 
     incorporate measures established--
       (A) under sections 1848(k) and 1886(b) of the Social 
     Security Act; and
       (B) pursuant to any provision of this Act or amendment made 
     by this Act.
       (3) Reporting requirement.--A participating provider shall 
     submit data in a form and manner specified by the Secretary 
     on measures the Secretary determines necessary for the 
     participating provider to report in order to evaluate the 
     quality of care furnished by such provider.
       (4) Quality performance standards.--The Secretary shall 
     establish quality performance standards to assess the quality 
     of care furnished by participating providers. The Secretary 
     shall seek to improve the quality of care furnished by 
     participating providers over time by specifying higher 
     standards, new measures, or both for purposes of assessing 
     such quality of care.
       (d) Hospital Readmission Reduction Program.--
       (1) Hospital readmissions rate measures.--For purposes of 
     establishing measures under subsection (c) for the hospital 
     readmission reduction program, the Secretary shall include 
     measures for readmission rates established under 1886(b) of 
     the Social Security Act (42 U.S.C. 1395ww(b)).
       (2) Benchmark.--The Secretary shall establish a benchmark 
     for reduction in the readmission rate for a hospital that is 
     adjusted for geographic area, patient population 
     characteristics, and such other factors as determined 
     appropriate by the Secretary. The Secretary may establish a 
     higher benchmark for hospitals with an annual readmission 
     rate that is above the mean nationwide readmission rate.
       (3) Shared savings requirements.--A participating provider 
     shall be eligible for a shared savings payment under 
     subsection (f) if such provider--
       (A) achieves the applicable benchmark established by the 
     Secretary under paragraph (2); and

[[Page 32614]]

       (B) has an annual readmission rate that is below the risk 
     adjusted expected readmissions rate as determined under 
     section 1886(q)(4)(C)(i)(II) of the Social Security Act (as 
     added by section 3025).
       (4) Community-based organizations.--The Secretary may 
     permit a community-based organization, as described in 
     section 3026(b)(1)(B), to receive shared savings payments 
     under the hospital readmission reduction program if such an 
     organization--
       (A) satisfies the requirements described under section 
     3026; and
       (B) is associated with a subsection (d) hospital (as 
     described in section 3026(b)(1)(A)) that would be eligible 
     for a shared savings payment under this section.
       (e) Hospital-Acquired Conditions Reduction Program.--
       (1) Hospital-acquired conditions rate measures.--For 
     purposes of establishing measures under subsection (c) for 
     the hospital-acquired conditions program, the Secretary shall 
     establish measures that accurately determine rates of 
     hospital-acquired conditions (as defined in section 1886(p) 
     of the Social Security Act, as added by section 3008).
       (2) Reduction in hospital-acquired conditions benchmark.--
     The Secretary shall establish a benchmark for reduction in 
     the hospital-acquired conditions rate for a participating 
     provider that is adjusted for geographic area, patient 
     population characteristics, and such other factors as 
     determined appropriate by the Secretary. The Secretary may 
     establish a higher benchmark for hospitals with an annual 
     hospital-acquired conditions rate that is above the mean 
     nationwide hospital-acquired conditions rate.
       (3) Shared savings requirements.--A participating provider 
     shall eligible for a shared savings payment under subsection 
     (f) if such provider achieves the applicable benchmark 
     established by the Secretary under paragraph (2).
       (f) Shared Savings Payments.--
       (1) In general.--Under the shared savings program, payments 
     shall continue to be made to participating providers under 
     the original Medicare fee-for-service program under parts A 
     and B in the same manner as they would otherwise be made 
     except that a participating provider is eligible to receive 
     payment for shared savings under paragraph (3) if--
       (A) the provider meets quality performance standards 
     established by the Secretary under subsection (c); and
       (B) the provider meets the requirement under paragraph 
     (2)(A).
       (2) Savings requirement and benchmark.--
       (A) Determining savings.--Subject to subparagraph (C), in 
     each year of the period under subsection (a)(2), a 
     participating provider shall be eligible to receive payment 
     for shared savings under paragraph (3) only if the estimated 
     average per capita Medicare expenditures for such provider 
     for Medicare fee-for-service beneficiaries for parts A and B 
     services, adjusted for beneficiary characteristics, is at 
     least the percent specified by the Secretary below the 
     applicable benchmark under subparagraph (B).
       (B) Establish and update benchmark.--The Secretary shall 
     estimate a benchmark for each period under subsection (a)(2) 
     for each participating provider using the most recent 
     available 3 years of per-beneficiary expenditures for parts A 
     and B services for Medicare fee-for-service beneficiaries 
     served by the provider. Such benchmark shall be adjusted for 
     beneficiary characteristics and such other factors as the 
     Secretary determines appropriate and updated by the projected 
     absolute amount of growth in national per capita expenditures 
     for parts A and B services under the original Medicare fee-
     for-service program, as estimated by the Secretary.
       (C) Higher benchmark.--For purposes of subparagraph (A), 
     the Secretary may require a greater percentage in savings 
     below the benchmark established under subparagraph (B) for a 
     participating provider with an annual readmission or 
     hospital-acquired conditions rate, as applicable, that is 
     above the mean nationwide rate (as described in subsections 
     (e)(2) and (f)(2)).
       (3) Payments for shared savings.--Subject to performance 
     with respect to the quality performance standards established 
     by the Secretary under subsection (c), if a participating 
     provider meets the requirements under paragraphs (1) and (2), 
     a percent (as determined appropriate by the Secretary) of the 
     difference between such estimated average per capita Medicare 
     expenditures in a year, adjusted for beneficiary 
     characteristics, for the provider and such benchmark for the 
     provider may be paid to the provider as shared savings and 
     the remainder of such difference shall be retained by the 
     Medicare program under title XVIII of the Social Security 
     Act. The Secretary shall establish limits on the total amount 
     of shared savings that may be paid to a participating 
     provider under this paragraph.
       (g) Early Participation in Medicare Shared Savings Program 
     and National Pilot Program on Payment Bundling.--
       (1) In general.--For purposes of section 1866D of the 
     Social Security Act (as added by section 3023) and section 
     1899 of such Act (as added by section 3022), the Secretary 
     may establish a program to provide for early participation 
     payments under such sections to eligible providers or groups 
     of providers.
       (2) Eligibility.--
       (A) In general.--Providers eligible for the early 
     participation program under this subsection shall include--
       (i) providers described under section 1866D(a)(2)(G) of the 
     Social Security Act; and
       (ii) providers that meet the requirements in section 
     1899(b) of such Act.
       (B) Waiver of requirements.--Subject to subparagraph (C), 
     for purposes of the early participation program under this 
     subsection, the Secretary may waive--
       (i) any requirements under section 1899 of the Social 
     Security Act, except that the Secretary shall not waive--

       (I) the requirements under subsection (b) of such section 
     (with the exception of subparagraphs (B) and (D) of 
     subsection (b)(2)); or
       (II) the provisions under subsection (d) of such section.

       (ii) any requirements under section 1866D of the Social 
     Security Act, provided that the proposal submitted by the 
     provider (as described under subparagraph (C)) adequately 
     provides for--

       (I) a plan for quality improvement that is consistent with 
     subsection (c)(4) of such section; and
       (II) a valid payment methodology that is consistent with 
     subsection (c)(3) of such section.

       (C) Application.--Providers seeking to participate in the 
     early participation program under this section shall submit a 
     proposal, in such manner and containing such information as 
     the Secretary may require, that includes, for purposes of 
     determining applicable payments under this section, a 
     methodology for calculation of savings or determination of 
     bundled payments.
       (3) Medicare shared savings program.--For purposes of 
     section 1899 of the Social Security Act, a provider seeking 
     to participate in the early participation program under this 
     section shall, as part of the proposal described under 
     paragraph (2)(C), provide a detailed plan for quality 
     improvement that is consistent with the goals described under 
     subsections (a) and (b)(3) of section 1899 of the Social 
     Security Act.
       (4) National pilot program on payment bundling.--For 
     purposes of section 1866D of the Social Security Act, a 
     provider seeking to participate in the early participation 
     program under this section shall, as part of the proposal 
     described under paragraph (2)(C), provide a detailed plan in 
     regard to the methods by which such provider will satisfy the 
     objectives described under subsection (a)(1) of section 1866D 
     of the Social Security Act, which shall include--
       (A) a bundled payment methodology;
       (B) methods by which quality of care will be improved; and
       (C) a description of the conditions and services that are 
     to be covered through the bundled payment.
       (5) Applicable period.--Any payments made to providers 
     pursuant to early participation program under this section 
     shall cease upon establishment of the programs described 
     under sections 1866D and 1899 of the Social Security Act, 
     except to the extent that providers are determined to be 
     eligible for, and continue to participate in, the programs 
     established under such sections.
                                 ______
                                 
  SA 3263. Mr. BAUCUS (for himself, Ms. Snowe, Mr. Carper, Mrs. 
Lincoln, 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:

       At the appropriate place, insert the following:

            TITLE __--ALTERNATIVE TO MEDICAL TORT LITIGATION

     SEC. _01. SHORT TITLE.

       This title may be cited as the ``Fair and Reliable Medical 
     Justice Act''.

     SEC. _02. PURPOSES.

       The purposes of this title are--
       (1) to restore fairness and reliability to the medical 
     justice system by fostering alternatives to current medical 
     tort litigation that promote disclosure of health care errors 
     and provide prompt, fair, and reasonable compensation to 
     patients who are injured by health care errors;
       (2) to promote patient safety through disclosure of health 
     care errors; and
       (3) to support and assist States in developing such 
     alternatives.

     SEC. _03. STATE DEMONSTRATION PROGRAMS TO EVALUATE 
                   ALTERNATIVES TO CURRENT MEDICAL TORT 
                   LITIGATION.

       Part P of title III of the Public Health Service Act (42 
     U.S.C. 280g et seq.), as amended by this Act, is further 
     amended by adding at the end the following:

[[Page 32615]]



     ``SEC. 399V-2. STATE DEMONSTRATION PROGRAMS TO EVALUATE 
                   ALTERNATIVES TO CURRENT MEDICAL TORT 
                   LITIGATION.

       ``(a) In General.--The Secretary is authorized to award 
     demonstration grants to States for the development, 
     implementation, and evaluation of alternatives to current 
     tort litigation for resolving disputes over injuries 
     allegedly caused by health care providers or health care 
     organizations. In awarding such grants, the Secretary shall 
     ensure the diversity of the alternatives so funded.
       ``(b) Duration.--The Secretary may award grants under 
     subsection (a) for a period not to exceed 5 years.
       ``(c) Conditions for Demonstration Grants.--
       ``(1) Requirements.--Each State desiring a grant under 
     subsection (a) shall develop an alternative to current tort 
     litigation that--
       ``(A) allows for the resolution of disputes over injuries 
     allegedly caused by health care providers or health care 
     organizations; and
       ``(B) promotes a reduction of health care errors by 
     encouraging the collection and analysis of patient safety 
     data related to disputes resolved under subparagraph (A) by 
     organizations that engage in efforts to improve patient 
     safety and the quality of health care.
       ``(2) Alternative to current tort litigation.--Each State 
     desiring a grant under subsection (a) shall demonstrate how 
     the proposed alternative described in paragraph (1)(A)--
       ``(A) makes the medical liability system more reliable by 
     increasing the availability of prompt and fair resolution of 
     disputes;
       ``(B) encourages the efficient resolution of disputes;
       ``(C) encourages the disclosure of health care errors;
       ``(D) enhances patient safety by detecting, analyzing, and 
     helping to reduce medical errors and adverse events;
       ``(E) improves access to liability insurance;
       ``(F) fully informs patients about the differences in the 
     alternative and current tort litigation;
       ``(G) provides patients the ability to opt out of or 
     voluntarily withdraw from participating in the alternative at 
     any time and to pursue other options, including litigation, 
     outside the alternative;
       ``(H) would not conflict with State law at the time of the 
     application in a way that would prohibit the adoption of an 
     alternative to current tort litigation; and
       ``(I) would not limit or curtail a patient's existing legal 
     rights, ability to file a claim in or access a State's legal 
     system, or otherwise abrogate a patient's ability to file a 
     medical malpractice claim.
       ``(3) Sources of compensation.--Each State desiring a grant 
     under subsection (a) shall identify the sources from and 
     methods by which compensation would be paid for claims 
     resolved under the proposed alternative to current tort 
     litigation, which may include public or private funding 
     sources, or a combination of such sources. Funding methods 
     shall to the extent practicable provide financial incentives 
     for activities that improve patient safety.
       ``(4) Scope.--
       ``(A) In general.--Each State desiring a grant under 
     subsection (a) shall establish a scope of jurisdiction (such 
     as Statewide, designated geographic region, a designated area 
     of health care practice, or a designated group of health care 
     providers or health care organizations) for the proposed 
     alternative to current tort litigation that is sufficient to 
     evaluate the effects of the alternative. No scope of 
     jurisdiction shall be established under this paragraph that 
     is based on a health care payer or patient population.
       ``(B) Notification of patients.--A State shall demonstrate 
     how patients would be notified that they are receiving health 
     care services that fall within such scope, and the process by 
     which they may opt out of or voluntarily withdraw from 
     participating in the alternative. The decision of the patient 
     whether to participate or continue participating in the 
     alternative process shall be made at any time and shall not 
     be limited in any way.
       ``(5) Preference in awarding demonstration grants.--In 
     awarding grants under subsection (a), the Secretary shall 
     give preference to States--
       ``(A) that have developed the proposed alternative through 
     substantive consultation with relevant stakeholders, 
     including patient advocates, health care providers and health 
     care organizations, attorneys with expertise in representing 
     patients and health care providers, medical malpractice 
     insurers, and patient safety experts;
       ``(B) that make proposals that are likely to enhance 
     patient safety by detecting, analyzing, and helping to reduce 
     medical errors and adverse events; and
       ``(C) that make proposals that are likely to improve access 
     to liability insurance.
       ``(d) Application.--
       ``(1) In general.--Each State desiring a grant under 
     subsection (a) shall submit to the Secretary an application, 
     at such time, in such manner, and containing such information 
     as the Secretary may require.
       ``(2) Review panel.--
       ``(A) In general.--In reviewing applications under 
     paragraph (1), the Secretary shall consult with a review 
     panel composed of relevant experts appointed by the 
     Comptroller General.
       ``(B) Composition.--
       ``(i) Nominations.--The Comptroller General shall solicit 
     nominations from the public for individuals to serve on the 
     review panel.
       ``(ii) Appointment.--The Comptroller General shall appoint, 
     at least 9 but not more than 13, highly qualified and 
     knowledgeable individuals to serve on the review panel and 
     shall ensure that the following entities receive fair 
     representation on such panel:

       ``(I) Patient advocates.
       ``(II) Health care providers and health care organizations.
       ``(III) Attorneys with expertise in representing patients 
     and health care providers.
       ``(IV) Medical malpractice insurers.
       ``(V) State officials.
       ``(VI) Patient safety experts.

       ``(C) Chairperson.--The Comptroller General, or an 
     individual within the Government Accountability Office 
     designated by the Comptroller General, shall be the 
     chairperson of the review panel.
       ``(D) Availability of information.--The Comptroller General 
     shall make available to the review panel such information, 
     personnel, and administrative services and assistance as the 
     review panel may reasonably require to carry out its duties.
       ``(E) Information from agencies.--The review panel may 
     request directly from any department or agency of the United 
     States any information that such panel considers necessary to 
     carry out its duties. To the extent consistent with 
     applicable laws and regulations, the head of such department 
     or agency shall furnish the requested information to the 
     review panel.
       ``(e) Reports.--
       ``(1) By state.--Each State receiving a grant under 
     subsection (a) shall submit to the Secretary an annual report 
     evaluating the effectiveness of activities funded with grants 
     awarded under such subsection. Such report shall, at a 
     minimum, include the impact of the activities funded on 
     patient safety and on the availability and price of medical 
     liability insurance.
       ``(2) By secretary.--The Secretary shall submit to Congress 
     an annual compendium of the reports submitted under paragraph 
     (1) and an analysis of the activities funded under subsection 
     (a) that examines any differences that result from such 
     activities in terms of the quality of care, number and nature 
     of medical errors, medical resources used, length of time for 
     dispute resolution, and the availability and price of 
     liability insurance.
       ``(f) Technical Assistance.--
       ``(1) In general.--The Secretary shall provide technical 
     assistance to the States applying for or awarded grants under 
     subsection (a).
       ``(2) Requirements.--Technical assistance under paragraph 
     (1) shall include--
       ``(A) guidance on non-economic damages, including the 
     consideration of individual facts and circumstances in 
     determining appropriate payment, guidance on identifying 
     avoidable injuries, and guidance on disclosure to patients of 
     health care errors and adverse events; and
       ``(B) the development, in consultation with States, of 
     common definitions, formats, and data collection 
     infrastructure for States receiving grants under this section 
     to use in reporting to facilitate aggregation and analysis of 
     data both within and between States.
       ``(3) Use of common definitions, formats, and data 
     collection infrastructure.--States not receiving grants under 
     this section may also use the common definitions, formats, 
     and data collection infrastructure developed under paragraph 
     (2)(B).
       ``(g) Evaluation.--
       ``(1) In general.--The Secretary, in consultation with the 
     review panel established under subsection (d)(2), shall enter 
     into a contract with an appropriate research organization to 
     conduct an overall evaluation of the effectiveness of grants 
     awarded under subsection (a) and to annually prepare and 
     submit a report to Congress. Such an evaluation shall begin 
     not later than 18 months following the date of implementation 
     of the first program funded by a grant under subsection (a).
       ``(2) Contents.--The evaluation under paragraph (1) shall 
     include--
       ``(A) an analysis of the effects of the grants awarded 
     under subsection (a) with regard to the measures described in 
     paragraph (3);
       ``(B) for each State, an analysis of the extent to which 
     the alternative developed under subsection (c)(1) is 
     effective in meeting the elements described in subsection 
     (c)(2);
       ``(C) a comparison among the States receiving grants under 
     subsection (a) of the effectiveness of the various 
     alternatives developed by such States under subsection 
     (c)(1);
       ``(D) a comparison, considering the measures described in 
     paragraph (3), of States receiving grants approved under 
     subsection (a) and similar States not receiving such grants; 
     and
       ``(E) a comparison, with regard to the measures described 
     in paragraph (3), of--
       ``(i) States receiving grants under subsection (a);
       ``(ii) States that enacted, prior to the date of enactment 
     of the Patient Protection and

[[Page 32616]]

     Affordable Care Act, any cap on non-economic damages; and
       ``(iii) States that have enacted, prior to the date of 
     enactment of the Patient Protection and Affordable Care Act, 
     a requirement that the complainant obtain an opinion 
     regarding the merit of the claim, although the substance of 
     such opinion may have no bearing on whether the complainant 
     may proceed with a case.
       ``(3) Measures.--The evaluations under paragraph (2) shall 
     analyze and make comparisons on the basis of--
       ``(A) the nature and number of disputes over injuries 
     allegedly caused by health care providers or health care 
     organizations;
       ``(B) the nature and number of claims in which tort 
     litigation was pursued despite the existence of an 
     alternative under subsection (a);
       ``(C) the disposition of disputes and claims, including the 
     length of time and estimated costs to all parties;
       ``(D) the medical liability environment;
       ``(E) health care quality;
       ``(F) patient safety in terms of detecting, analyzing, and 
     helping to reduce medical errors and adverse events;
       ``(G) patient and health care provider and organization 
     satisfaction with the alternative under subsection (a) and 
     with the medical liability environment; and
       ``(H) impact on utilization of medical services, 
     appropriately adjusted for risk.
       ``(4) Funding.--The Secretary shall reserve 5 percent of 
     the amount appropriated in each fiscal year under subsection 
     (k) to carry out this subsection.
       ``(h) MedPAC and MACPAC Reports.--
       ``(1) MedPAC.--The Medicare Payment Advisory Commission 
     shall conduct an independent review of the alternatives to 
     current tort litigation that are implemented under grants 
     under subsection (a) to determine the impact of such 
     alternatives on the Medicare program under title XVIII of the 
     Social Security Act, and its beneficiaries.
       ``(2) MACPAC.--The Medicaid and CHIP Payment and Access 
     Commission shall conduct an independent review of the 
     alternatives to current tort litigation that are implemented 
     under grants under subsection (a) to determine the impact of 
     such alternatives on the Medicaid or CHIP programs under 
     titles XIX and XXI of the Social Security Act, and their 
     beneficiaries.
       ``(3) Reports.--Not later than December 31, 2016, the 
     Medicare Payment Advisory Commission and the Medicaid and 
     CHIP Payment and Access Commission shall each submit to 
     Congress a report that includes the findings and 
     recommendations of each respective Commission based on 
     independent reviews conducted under paragraphs (1) and (2), 
     including an analysis of the impact of the alternatives 
     reviewed on the efficiency and effectiveness of the 
     respective programs.
       ``(i) Option To Provide for Initial Planning Grants.--Of 
     the funds appropriated pursuant to subsection (k), the 
     Secretary may use a portion not to exceed $500,000 per State 
     to provide planning grants to such States for the development 
     of demonstration project applications meeting the criteria 
     described in subsection (c). In selecting States to receive 
     such planning grants, the Secretary shall give preference to 
     those States in which State law at the time of the 
     application would not prohibit the adoption of an alternative 
     to current tort litigation.
       ``(j) Definitions.--In this section:
       ``(1) Health care services.--The term `health care 
     services' means any services provided by a health care 
     provider, or by any individual working under the supervision 
     of a health care provider, that relate to--
       ``(A) the diagnosis, prevention, or treatment of any human 
     disease or impairment; or
       ``(B) the assessment of the health of human beings.
       ``(2) Health care organization.--The term `health care 
     organization' means any individual or entity which is 
     obligated to provide, pay for, or administer health benefits 
     under any health plan.
       ``(3) Health care provider.--The term `health care 
     provider' means any individual or entity--
       ``(A) licensed, registered, or certified under Federal or 
     State laws or regulations to provide health care services; or
       ``(B) required to be so licensed, registered, or certified 
     but that is exempted by other statute or regulation.
       ``(k) Authorization of Appropriations.--There are 
     authorized to be appropriated, such sums as may be necessary 
     to carry out this section for each of fiscal years 2011 
     through 2015.
       ``(l) Current State Efforts to Establish Alternative to 
     Tort Litigation.--Nothing in this section shall be construed 
     to limit any prior, current, or future efforts of any State 
     to establish any alternative to tort litigation.
       ``(m) Rule of Construction.--Nothing in this section shall 
     be construed as limiting states' authority over or 
     responsibility for their state justice systems.''.
                                 ______
                                 
  SA 3264. Mr. WYDEN (for himself, Mr. Brown, Mr. Specter, Mr. Kohl, 
and Ms. Collins) submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 999, between lines 16 and 17, insert the following:

     SEC. 3402. LIMITATION ON HOSPICE SPENDING.

       Section 1814(i)(1)(C) of the Social Security Act, as 
     amended by sections 3132 and 3401, is further amended--
       (1) in each of clauses (ii)(VII) and (iii), by striking 
     ``clause (iv)'' and inserting ``clauses (iv) and (v)'';
       (2) in clause (iv)--
       (A) in subclause (II)--
       (i) by striking ``subject to clause (v),''; and
       (ii) by striking ``0.5 percentage point'' and inserting 
     ``0.25 percentage point''; and
       (B) by striking the flush sentence following subclause 
     (II); and
       (3) by striking clause (v) and inserting the following new 
     clauses:
       ``(v) After determining the market basket percentage 
     increase under clause (ii)(VII) or (iii), as applicable, with 
     respect to fiscal years 2014 through 2019, if the Secretary 
     determines there is excess hospice spending (as defined in 
     clause (vi)) for the fiscal year, the Secretary shall reduce 
     such percentage by the amount of such excess hospice 
     spending. The application of this clause may not result in 
     the market basket percentage increase under clause (ii)(VII) 
     or (iii), as applicable, being less than 0.0 for a fiscal 
     year.
       ``(vi) For purposes of clause (v), the term `excess hospice 
     spending' means--

       ``(I) for fiscal year 2014, the excess (expressed as a 
     percentage) of--

       ``(aa) the aggregate amount of payments for hospice care 
     under this title for fiscal year 2011; over
       ``(bb) the aggregate amount of such payments for fiscal 
     year 2010 increased by the medical care component of the 
     Consumer Price Index for fiscal year 2011, plus 3.0 
     percentage points; and

       ``(II) for fiscal year 2015 through 2019, the excess 
     (expressed as a percentage) between--

       ``(aa) the aggregate amounts of such payments for the 
     fiscal year 3 years prior to the fiscal year involved; over
       ``(bb) the aggregate amount of such payments for the fiscal 
     year 4 years prior to the fiscal year involved increased by 
     the medical care component of the Consumer Price Index for 
     the fiscal year 3 years prior to the fiscal year involved, 
     plus 3.0 percentage points.''.

                          ____________________