[Congressional Record (Bound Edition), Volume 155 (2009), Part 24]
[Senate]
[Pages 32722-32727]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 3265. Mr. VITTER 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 179, line 5, add at the end the following: ``Of the 
     amount appropriated under this subsection, there shall be 
     made available $100,000,000 for each of fiscal years 2010 
     through 2019 to carry out section 4101 (and the amendments 
     made by such section),

[[Page 32723]]

     $1,000,000,000 for each of fiscal years 2010 through 2013 for 
     the National Cancer Institute (in addition to amounts 
     otherwise appropriated to such Institute), and $120,000,000 
     for each of fiscal years 2010 through 2019 for the Maternal 
     and Child Health Services Block Grant program under title V 
     of the Social Security Act.''.
                                 ______
                                 
  SA 3266. 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 1798, between lines 21 and 22, insert the 
     following:

     SEC. 6608. REQUIRED INVESTIGATION OF OUTLIERS.

       Section 1862 of the Social Security Act (42 U.S.C. 1395y), 
     as amended by section 6402(h), is amended by adding at the 
     end the following new subsection:
       ``(p) Required Investigation of Outliers.--The Secretary 
     shall conduct an investigation (in consultation with the 
     Inspector General of the Department of Health and Human 
     Services) or other appropriate review of a provider of 
     services or supplier if the Secretary determines that the 
     provider of services or supplier is an outlier in terms of 
     utilization or payment under this title over a period of not 
     less than 2 years.''.
                                 ______
                                 
  SA 3267. 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 1783, between lines 2 and 3, insert the following:

     SEC. 6412. REQUIRING INDIVIDUALS OR ENTITIES THAT PARTICIPATE 
                   IN OR CONDUCT ACTIVITIES UNDER FEDERAL HEALTH 
                   CARE PROGRAMS TO COMPLY WITH CERTAIN 
                   CONGRESSIONAL REQUESTS.

       (a) In General.--Section 1128J of the Social Security Act, 
     as added by section 6402, is amended by adding at the end the 
     following new subsection:
       ``(f) Compliance With Certain Requests by Individuals and 
     Entities That Participate in or Conduct Activities Under 
     Federal Health Care Programs.--
       ``(1) In general.--Any individual or entity that 
     participates in or conducts activities under a Federal health 
     care program (as defined in section 1128B(f)) shall, as a 
     condition of such participation or such conduct, comply (at a 
     time and in a manner specified by the Chairman or ranking 
     member) with any request submitted by the Chairman or the 
     ranking member of a relevant committee of Congress to the 
     individual or entity for the following:
       ``(A) Documents.
       ``(B) Information.
       ``(C) Interviews.
       ``(2) Relevant committee of congress defined.--In this 
     subsection, the term `relevant committee of Congress' means 
     the Committees on Ways and Means and Energy and Commerce of 
     the House of Representatives and the Committee on Finance of 
     the Senate.''.
       (b) Effective Date.--The amendments made by this section 
     shall take effect on the date that is 2 years after the date 
     of enactment of this Act.
                                 ______
                                 
  SA 3268. 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 1798, between lines 21 and 22, insert the 
     following:

     SEC. 6608. MEDICAL ID THEFT INFORMATION SHARING PROGRAM AND 
                   CLEARINGHOUSE.

       (a) Establishment.--Not later than 24 months after the date 
     of enactment of this Act, the Secretary of Health and Human 
     Services (in this section referred to as the ``Secretary''), 
     acting through the Administrator of the Centers for Medicare 
     & Medicaid Services and in coordination with the Chairman of 
     the Federal Trade Commission, shall establish an information 
     sharing program regarding beneficiary medical ID theft under 
     the programs under titles XVIII, XIX, and XXI of the Social 
     Security Act (in this section referred to as the 
     ``program'').
       (b) Contents of Program.--The program shall include--
       (1) the establishment of methods to identify and detect 
     relevant warning signs of medical ID theft; and
       (2) the establishment of appropriate responses to such 
     warning signs that would mitigate and prevent beneficiary 
     medical ID theft; and
       (3) the development of a detailed plan to update the 
     program as appropriate, taking into consideration such 
     warning signs and appropriate responses.
       (c) Establishment of Clearinghouse.--The Secretary, in 
     coordination with the Chairman of the Federal Trade 
     Commission, shall establish a clearinghouse at the Centers 
     for Medicare & Medicaid Services that collects reports of ID 
     theft against beneficiaries under the programs under titles 
     XVIII, XIX, and XXI of the Social Security Act from the 
     Federal Trade Commission and other sources determined 
     appropriate by the Secretary. Such clearinghouse shall be 
     used to fight medical ID theft against beneficiaries and to 
     prevent the improper payment of claims under such programs.
                                 ______
                                 
  SA 3269. 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 1740, strike lines 1 through 16, and insert the 
     following:
       ``(o) Suspension Authority.--
       ``(1) In general.--The Secretary shall suspend payment to a 
     provider of services or supplier under this title pending an 
     investigation of credible allegations of fraud against the 
     provider of services or supplier, unless the Secretary finds 
     good cause not to suspend such payment.
       ``(2) Consultation.--The Secretary shall consult with the 
     Inspector General of the Department of Health and Human 
     Services in determining whether there is a credible 
     allegation of fraud against a provider of services or 
     supplier.''.
                                 ______
                                 
  SA 3270. 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 1798, between lines 21 and 22, insert the 
     following:

     SEC. 6608. PERMISSIVE EXCLUSION AUTHORITY.

       Clauses (i) and (ii) of section 1128(b)(15)(A) of the 
     Social Security Act (42 U.S.C. 1320a-7(b)(15)(A)) are amended 
     to read as follows:
       ``(i) who has or had a direct or indirect ownership or 
     control interest in the sanctioned entity and who knew or 
     should have known (as defined in section 1128A(i)(7)) of the 
     action constituting the basis for the conviction or exclusion 
     described in subparagraph (B); or
       ``(ii) who is or was an officer or managing employee (as 
     defined in section 1126(b)) of such an entity at the time of 
     the action constituting the basis for the conviction or 
     exclusion so described.''.
                                 ______
                                 
  SA 3271. 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 1783, between lines 2 and 3, insert the following:

     SEC. 6412. REQUIREMENTS FOR THE TRANSMISSION OF MANAGEMENT 
                   IMPLICATION REPORTS BY THE HHS OIG.

       Section 1128J of the Social Security Act, as added by 
     section 6402, is amended by adding at the end the following 
     new subsection:
       ``(f) Transmission of Management Implication Reports by the 
     HHS OIG.--
       ``(1) Congressional notification.--Not later than 30 days 
     after the transmission by the Inspector General of the 
     Department of Health and Human Services to another agency of 
     the Department of Health and Human Services of a management 
     implication report, the Inspector General shall notify the 
     relevant committees of Congress of such transmission.
       ``(2) Secretarial response.--The Secretary shall respond to 
     a management implication report transmitted under paragraph

[[Page 32724]]

     (1) not later than 90 days after such transmission.
       ``(3) Relevant committees of congress defined.--In this 
     subsection, the term `relevant committees of Congress' means 
     the Committees on Ways and Means and Energy and Commerce of 
     the House of Representatives and the Committee on Finance of 
     the Senate.''.
                                 ______
                                 
  SA 3272. Mr. LeMIEUX submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1798, between lines 21 and 22, insert the 
     following:

     SEC. 6608. OTHER MISCELLANEOUS PROVISIONS.

       (a) Increased Civil Money Penalties and Criminal Fines and 
     Sentences for Medicare Fraud and Abuse.--
       (1) Increased civil penalties and criminal fines.--
       (A) Increased civil money penalties.--Section 1128A of the 
     Social Security Act (42 U.S.C. 1320a-7a) is amended--
       (i) in subsection (a), in the flush matter following 
     paragraph (7)--

       (I) by striking ``$10,000''' each place it appears and 
     inserting ``$20,000'';
       (II) by striking ``$15,000'' and inserting ``$30,000''; and
       (III) by striking ``$50,000'' and inserting ``$100,000''; 
     and

       (ii) in subsection (b)--

       (I) in paragraph (1), in the flush matter following 
     subparagraph (B), by striking ``$2,000'' and inserting 
     ``$4,000'';
       (II) in paragraph (2), by striking ``$2,000'' and inserting 
     ``$4,000''; and
       (III) in paragraph (3)(A)(i), by striking ``$5,000'' and 
     inserting ``$10,000''.

       (B) Increased criminal fines.--Section 1128B of the Social 
     Security Act (42 U.S.C. 1320a-7b) is amended--
       (i) in subsection (a), in the flush matter following 
     paragraph (6)--

       (I) by striking ``$25,000'' and inserting ``$100,000''; and
       (II) by striking ``$10,000'' and inserting ``$20,000'';

       (ii) in subsection (b)--

       (I) in paragraph (1), in the flush matter following 
     subparagraph (B), by striking ``$25,000'' and inserting 
     ``$100,000''; and
       (II) in paragraph (2), in the flush matter following 
     subparagraph (B), by striking ``$25,000'' and inserting 
     ``$100,000'';

       (iii) in subsection (c), by striking ``$25,000'' and 
     inserting ``$100,000'';
       (iv) in subsection (d), in the second flush matter 
     following subparagraph (B), by striking ``$25,000'' and 
     inserting ``$100,000''; and
       (v) in subsection (e), by striking ``$2,000'' and inserting 
     ``$4,000''.
       (C) Effective date.--The amendments made by this subsection 
     shall apply to civil money penalties and fines imposed for 
     actions taken on or after the date of enactment of this Act.
       (2) Increased sentences for felonies involving medicare 
     fraud and abuse.--
       (A) False statements and representations.--Section 1128B(a) 
     of the Social Security Act (42 U.S.C. 1320a-7b(a)) is 
     amended, in clause (i) of the flush matter following 
     paragraph (6), by striking ``not more than 5 years'' and 
     inserting ``not more than 10 years''.
       (B) Anti-kickback.--Section 1128B(b) of the Social Security 
     Act (42 U.S.C. 1320a-7b(b)) is amended--
       (i) in paragraph (1), in the flush matter following 
     subparagraph (B), by striking ``not more than 5 years'' and 
     inserting ``not more than 10 years''; and
       (ii) in paragraph (2), in the flush matter following 
     subparagraph (B), by striking ``not more than 5 years'' and 
     inserting ``not more than 10 years''.
       (C) False statement or representation with respect to 
     conditions or operations of facilities.--Section 1128B(c) of 
     the Social Security Act (42 U.S.C. 1320a-7b(c)) is amended by 
     striking ``not more than 5 years'' and inserting ``not more 
     than 10 years''.
       (D) Excess charges.--Section 1128B(d) of the Social 
     Security Act (42 U.S.C. 1320a-7b(d)) is amended, in the 
     second flush matter following subparagraph (B), by striking 
     ``not more than 5 years'' and inserting ``not more than 10 
     years''.
       (E) Minimum sentence.--Section 1128B of the Social Security 
     Act (42 U.S.C. 1320a-7b) is amended by adding at the end 
     thereof the following:
       ``(g) Notwithstanding any other provision of this section, 
     the minimum period of imprisonment for a conviction under 
     this section relating to Medicare fraud and abuse (if such 
     imprisonment is otherwise provided for under this section) 
     shall be 1 year and 1 day.''.
       (F) Effective date.--The amendments made by this subsection 
     shall apply to criminal penalties imposed for actions taken 
     on or after the date of enactment of this Act.
       (b) Consumer Right-to-Know.--At the end of title I, insert 
     the following:

     ``SEC. 1563. CONSUMER RIGHT TO KNOW.

       ``(a) Development of Information System.--Not later than 1 
     year after the date of enactment of this Act, the Secretary 
     of Health and Human Services shall develop a system for the 
     collection of quality and pricing information related to the 
     provision of health care services. Through the use of such 
     information, the Secretary shall, to the extent practicable--
       ``(1) determine the lowest, median, average, and highest 
     charged amount and reimbursed amount for each outpatient and 
     inpatient health care procedure conducted at each facility in 
     the United States;
       ``(2) provide comparisons of such prices with respect to 
     procedures in similar facilities in the same county, city, 
     State and on a national basis; and
       ``(3) develop quality of care data, including data on 
     consumer satisfaction, coordination and continuity of care, 
     infrastructure, the results of accreditation, Medicare-
     related information, and other survey information, and 
     combine such data with price information to enable consumers 
     to make informed choices.
       ``(b) Use of Existing Sources.--To the extent that the 
     information required under subsection (a) is being collected 
     by the Centers for Medicare & Medicaid Services, States, 
     State medical societies, or private sector entities, the 
     Secretary, to the extent practicable, utilize such 
     information to carry out such subsection.
       ``(c) Availability of Information.--The Secretary, either 
     directly or through contract, shall make the information and 
     data collected and developed under this section available on 
     an Internet website. Such information and data shall be 
     displayed by payer (such as Medicare, Medicaid, health 
     insurance plans, employer-based health plans, and other types 
     of health care coverage).''.
       (c) Productivity Award Program.--After section 3027, insert 
     the following:

     ``SEC. 3028. PRODUCTIVITY AWARD PROGRAM.

       ``Not later than 1 year after the date of enactment of this 
     Act, the Secretary of Health and Human Services shall 
     establish a Productivity Award Program to recognize 
     employees, work units, and contractors of the Centers for 
     Medicare & Medicaid whose work significantly and measurably 
     increases productivity and promotes innovation to improve the 
     delivery of services and achieving savings for taxpayers. The 
     amount of any such award shall be equal to 10 percent of the 
     amount of the estimated saving to the Federal Government as a 
     result of the action resulting in the award (as determined by 
     the Secretary), but not to exceed $50,000.''.
                                 ______
                                 
  SA 3273. Mrs. SHAHEEN (for herself, Mr. Bennet, 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 796, between lines 5 and 6, insert the following:

     SEC. 3028. IMPROVEMENTS TO COMMUNITY-BASED CARE TRANSITIONS 
                   PROGRAM.

       Section 3026 is amended--
       (1) in subsection (a), by inserting ``evidence-based'' 
     before ``care transition services'';
       (2) in subsection (b)--
       (A) in paragraph (1), in the matter preceding subparagraph 
     (A), by striking ``The term'' and inserting ``Subject to 
     paragraph (7), the term''; and
       (B) by adding at the end the following new paragraph:
       ``(7) Limitation.--The term `eligible entity' includes a 
     subsection (d) hospital described in paragraph (1)(A) or a 
     community-based organization described in paragraph (1)(B) 
     only if the provider of services or organization demonstrates 
     to the Secretary relevant training and experience in the 
     delivery of care transition services, including for 
     individuals providing such services under the program.'';
       (3) in subsection (c)--
       (A) in paragraph (1)--
       (i) by redesignating subparagraph (B) as subparagraph (C);
       (ii) by inserting after subparagraph (A) the following new 
     subparagraph:
       ``(B) Evaluation.--
       ``(i) In general.--The Secretary shall conduct an 
     evaluation of the program, and shall take such evaluation 
     into account in determining whether to expand the program 
     under subparagraph (C).
       ``(ii) Determination of criteria.--The Secretary shall 
     determine the criteria used under such evaluation, taking 
     into account hospital readmission rates and the experiences 
     of primary caregivers and high-risk Medicare beneficiaries 
     under the program, including the quality of care transition 
     interventions and health outcomes.'';
       (iii) in subparagraph (C), as redesignated by subparagraph 
     (A), by striking ``that such

[[Page 32725]]

     expansion'' and all that follows through the period at the 
     end and inserting ``that such expansion would--
       ``(i) reduce spending under title XVIII of the Social 
     Security Act without reducing quality of care;
       ``(ii) improve quality of care and reduce such spending; or
       ``(iii) improve quality of care without increasing such 
     spending.''; and
       (iv) by adding at the end the following new subparagraph:
       ``(D) Required elements of program during expansion 
     period.--If the Secretary expands the program under 
     subparagraph (C), the following shall apply with respect to 
     such expansion:
       ``(i) Evidence-based services.--The Secretary shall require 
     the use of only evidence-based care transition services 
     during such expansion.
       ``(ii) Expansion of eligible entities.--The Secretary shall 
     expand the type of providers of services or organizations 
     that may qualify as eligible entities for the provision of 
     care transition services under subsection (b)(1), such as a 
     home health agency, primary health care practice, or a 
     Federally qualified health center. Any provider of services 
     or organization that so qualifies under the preceding 
     sentence shall be required to demonstrate to the Secretary 
     relevant training and experience in the delivery of evidence-
     based care transition services, including for individuals 
     providing such services under the program.'';
       (B) in paragraph (2)(B)--
       (i) in the matter preceding clause (i), by striking ``, 
     which may include the following:'' and inserting ``. Each 
     care transition intervention proposed shall include, at a 
     minimum, the following:'';
       (ii) in clause (i)--

       (I) by inserting ``(and, as appropriate, the primary 
     caregiver of the beneficiary)'' after ``high-risk Medicare 
     beneficiary'';
       (II) by striking ``not later than 24 hours''; and
       (III) by inserting ``, with a recommendation that such 
     services should be initiated not less than 24 hours prior to 
     such discharge and, whenever possible, earlier in the stay at 
     the eligible entity'' before the period at the end; and

       (iii) by adding at the end the following new clauses:
       ``(vi) Providing care transition services to the high-risk 
     Medicare beneficiary (and, as appropriate, the primary 
     caregiver of the beneficiary) under the care transition 
     intervention after admission and prior to the discharge of 
     the beneficiary from the eligible entity and for a period of 
     up to 90 days after such discharge.
       ``(vii) Providing at least some of the care transition 
     services provided to the high-risk Medicare beneficiary under 
     the care transition intervention in-person.''; and
       (C) in paragraph (3)--
       (i) in subparagraph (A), by striking ``or'' at the end;
       (ii) in subparagraph (B), by striking the period at the end 
     and inserting ``; or''; and
       (iii) by adding at the end the following new subparagraph:
       ``(C) support inpatient and ambulatory health care 
     providers in improving the safety and quality of care, with a 
     governing body that is not comprised of a majority of any 
     type of provider or profession.'';
       (4) by redesignating subsection (f) as subsection (g); and
       (5) by inserting after subsection (e) the following new 
     subsection:
       ``(f) Provision of De-Identified Data to Providers of 
     Services and Suppliers.--
       ``(1) In general.--Notwithstanding any other provision of 
     law, subject to paragraph (3), an eligible entity 
     participating in the program may make available to providers 
     of services and suppliers participating in a care transition 
     intervention under the program de-identified data with 
     respect to high-risk Medicare beneficiaries.
       ``(2) Data.--Data made available under paragraph (1) shall 
     identify services provided by providers of services and 
     suppliers to high-risk Medicare beneficiaries, for the 
     purposes of--
       ``(A) improving the safety, quality, and effectiveness of 
     care transition services provided to those beneficiaries 
     under the program; and
       ``(B) measuring the safety, quality, and effectiveness of 
     such services provided by a provider of services or supplier 
     to the safety, quality, and effectiveness of such services 
     provided by another provider of services or supplier.
       ``(3) Privacy standards.--Nothing in this subsection shall 
     be construed to limit, alter, or affect the requirements 
     imposed by the regulations promulgated under section 264(c) 
     of the Health Insurance Portability and Accountability Act of 
     1996.''.
                                 ______
                                 
  SA 3274. Mr. MERKLEY 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 144, between lines 23 and 24, insert the following:
       (3) Standards for offering plans through exchange.--In 
     carrying out its responsibilities under paragraph (1)(B), an 
     Exchange may--
       (A) set standards under which health plans may be offered 
     through the Exchange, including the authority to negotiate 
     bids; and
       (B) enforce such standards, including by refusing to 
     certify a health plan as a qualified health plan that may be 
     offered through the Exchange.
                                 ______
                                 
  SA 3275. 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 816, after line 20, insert the following:

     SEC. 3115. ACCREDITATION REQUIREMENT FOR ROTARY WING AIR 
                   AMBULANCE SERVICES.

       Section 1834 of the Social Security Act (42 U.S.C. 1395m), 
     as amended by this Act, is amended by adding at the end the 
     following new subsection:
       ``(p) Establishment of Rotary Wing Air Ambulance 
     Accreditation Process.--
       ``(1) In general.--
       ``(A) Establishment of process.--The Secretary, in 
     consultation with the Secretary of Transportation (acting 
     through the Administrator of the Federal Aviation 
     Administration), shall establish a process for the 
     accreditation of suppliers and providers of rotary wing air 
     ambulance services reimbursed under the fee schedule 
     established under subsection (l).
       ``(B) Requirement.--On or after January 1, 2012, payment 
     may only be made to a supplier or provider of rotary wing air 
     ambulance services (whether provided directly or under 
     arrangement with a provider under this part) under the fee 
     schedule established under subsection (l) if such supplier or 
     provider is accredited by an organization designated by the 
     Secretary pursuant to the process described in paragraph (2).
       ``(2) Accreditation organizations.--
       ``(A) Designation.--Not later than June 30, 2011, the 
     Secretary shall designate organizations to accredit suppliers 
     and providers of rotary wing air ambulance services under the 
     process established under paragraph (1).
       ``(B) Factors for designation.--The Secretary shall 
     consider the following factors in designating accreditation 
     organizations under subparagraph (A):
       ``(i) The ability of the organization to provide timely 
     reviews of applications.
       ``(ii) Whether the organization uses random site visits, 
     site audits, or other strategies for ensuring adherence to 
     the criteria developed under paragraphs (3), (4), and (5).
       ``(iii) The ability of the organization to take into 
     account the capacities of and special circumstances 
     applicable to suppliers and providers of rural air ambulance 
     services (as defined in subsection (l)(14)(C)).
       ``(iv) The ability of the organization to take into account 
     the capacities of and special circumstances applicable to 
     suppliers and providers of air ambulance services that are 
     owned and operated by units of State or local government, 
     including those that utilize a single aircraft for both air 
     ambulance services and public safety purposes.
       ``(v) Whether the organization has established reasonable 
     fees to be charged to suppliers and providers applying for 
     accreditation.
       ``(vi) With respect to application of the criteria 
     developed under paragraphs (3), (4), and (5), whether the 
     organization has applicable experience in the accreditation 
     of suppliers and providers.
       ``(vii) Whether the organization has developed an 
     accreditation program that is adequate and appropriate to the 
     goal of ensuring high caliber rotary wing air ambulance 
     services.
       ``(viii) Such additional factors as are specified by the 
     Secretary (acting through the Administrator of the Centers 
     for Medicare & Medicaid Services) with respect to quality, 
     medical services, and emergency medical services integration 
     considerations under paragraph (3)(A)(i).
       ``(ix) Such additional aviation safety-related factors as 
     are developed by the Administrator of the Federal Aviation 
     Administration under paragraph (4)(A).
       ``(x) The ability of the organization to effectively 
     enforce the criteria developed under paragraphs (3), (4), and 
     (5).
       ``(xi) Such other factors as the Secretary determines 
     appropriate.
       ``(C) Review and modification of list of accreditation 
     organizations.--The Secretary, in consultation with the 
     Secretary of Transportation (acting through the Administrator 
     of the Federal Aviation Administration) shall review on a 
     regular basis the list

[[Page 32726]]

     of organizations designated under subparagraph (A) with 
     reference to the factors described in subparagraph (B) and, 
     as a result of such review, may modify the list of 
     organizations so designated by adding or removing 
     organizations from such list.
       ``(3) Development of quality, medical services, and ems 
     integration-related designation factors and accreditation 
     criteria.--
       ``(A) Development of designation factors and accreditation 
     criteria by administrator of cms.--Not later than January 1, 
     2011, subject to subparagraphs (B) and (C), the Secretary 
     (acting through the Administrator of the Centers for Medicare 
     & Medicaid Services) shall--
       ``(i) develop and transmit to the Secretary the additional 
     quality, medical services, and integration with State 
     emergency medical services systems related factors considered 
     under paragraph (2)(B)(viii) in designating accreditation 
     organizations under paragraph (2)(A); and
       ``(ii) develop and provide to the Secretary high-caliber 
     quality, medical services, and emergency medical services 
     integration criteria that accreditation organizations 
     designated under paragraph (2)(A) shall utilize in the 
     accreditation process established under paragraph (1).
       ``(B) Consultation with federal aviation administration.--
     The Secretary (acting through the Administrator of the 
     Centers for Medicare & Medicaid Services) shall consult with 
     the Administrator of the Federal Aviation Administration in 
     the development of the factors and criteria under clauses (i) 
     and (ii), respectively, of subparagraph (A).
       ``(C) Scope of quality, medical services, and ems 
     integration-related criteria.--
       ``(i) Considerations.--In developing the criteria under 
     subparagraph (A)(ii), the Secretary (acting through the 
     Administrator of the Centers for Medicare & Medicaid 
     Services) shall consider National Transportation Safety Board 
     Recommendations A-09-102 through A-09-103 and A-09-106 
     through A-09-107.
       ``(ii) Criteria.--Such criteria shall address--

       ``(I) the presence and qualifications of medical personnel 
     on board the air ambulance;
       ``(II) real-time coordination between suppliers and 
     providers and 911 systems and integration with State 
     emergency medical systems;
       ``(III) medical oversight of paramedics, flight nurses, or 
     other medical personnel on board air ambulances;
       ``(IV) quality assurance;
       ``(V) design of the air ambulance medical bay for the 
     provision of patient care;
       ``(VI) minimum medically related service requirements;
       ``(VII) medical equipment and supplies on board the air 
     ambulance;
       ``(VIII) the need to obtain licensure of the air ambulance 
     by the State within which it is based, consistent with 
     paragraph (8)(C); and
       ``(IX) such other matters as the Secretary (acting through 
     the Administrator of the Centers for Medicare & Medicaid 
     Services determines appropriate.

       ``(4) Development of aviation safety-related designation 
     factors and accreditation criteria by administrator of the 
     faa.--
       ``(A) Development of designation factors and accreditation 
     criteria.--Not later than January 1, 2011, subject to 
     subparagraphs (B) and (C), the Administrator of the Federal 
     Aviation Administration shall--
       ``(i) develop and transmit to the Secretary the additional 
     aviation safety-related factors to be used under paragraph 
     (2)(B)(ix) in designating accreditation organizations under 
     paragraph (2)(A); and
       ``(ii) develop and provide to the Secretary aviation 
     safety-related criteria that accreditation organizations 
     designated under paragraph (2)(A) shall utilize in the 
     accreditation process established under paragraph (1).
       ``(B) Sole authority of faa over development of aviation 
     safety-related designation factors and accreditation 
     criteria.--The Administrator of the Federal Aviation 
     Administration shall have sole authority over the development 
     of designation factors and accreditation criteria under 
     subparagraph (A).
       ``(C) Scope of aviation safety-related criteria.--
       ``(i) In general.--The criteria developed by the 
     Administrator of the Federal Aviation Administration under 
     subparagraph (A) shall comprise minimum safety requirements 
     for suppliers and providers of rotary wing air ambulance 
     services to address aviation safety considerations particular 
     to the transportation of patients between health care 
     facilities and from emergency response locations for purposes 
     of medical care and treatment that augment the operating 
     standards under part 135 of title 14, Code of Federal 
     Regulations and other statutory and regulatory requirements 
     pertaining to aviation safety of helicopter aircraft used for 
     emergency medical service.
       ``(ii) Criteria.--Such criteria shall consist of--

       ``(I) those criteria that the Administrator of the Federal 
     Aviation Administration adopts based upon consideration of 
     any National Transportation Safety Board Recommendations 
     regarding the use of helicopter aircraft for emergency 
     medical service that are not otherwise required by statute or 
     regulation; and
       ``(II) such other matters as the Administrator of the 
     Federal Aviation Administration determines appropriate.

       ``(5) Requirements for criteria development process.--
       ``(A) Consideration of impacts on patient and rural access 
     and government owned and operated service providers; 
     requirement for stakeholder participation.--In developing 
     accreditation criteria under paragraphs (3) and (4), the 
     Secretary (acting through the Administrator of the Centers 
     for Medicare & Medicaid Services) and the Administrator of 
     the Federal Aviation Administration, respectively, shall--
       ``(i) ensure that such criteria avoid adversely impacting 
     beneficiaries under this title and other patient access to 
     medically necessary and reasonable rotary wing air ambulance 
     services, particularly in rural areas;
       ``(ii) expressly consider--

       ``(I) the particular needs and circumstances of suppliers 
     and providers of rural air ambulance services (as defined in 
     subsection (l)(14)(C);
       ``(II) the particular needs and circumstances of those 
     suppliers and providers of air ambulance services that are 
     owned and operated by units of State or local government 
     (including those that utilize a single aircraft for both air 
     ambulance services and public safety purposes);
       ``(III) the extent to which any such criteria is 
     economically feasible to ensure continued access to rotary 
     wing air ambulance services, particularly in rural areas;
       ``(IV) the extent to which any such criteria is technically 
     feasible, taking into account the ability of existing 
     aircraft to comply with any such standards, as well as the 
     market availability and future development of equipment and 
     products that can be installed on or carried aboard existing 
     rotary wing aircraft; and
       ``(V) the incorporation of any such criteria during 
     appropriate implementation timeframes with the goal of 
     transitioning toward higher caliber criteria for 
     beneficiaries under this title over a reasonable period of 
     time and in a manner that does not impede access to rotary 
     wing air ambulance services, particularly in rural areas; and

       ``(iii) ensure that the process of developing such criteria 
     is undertaken through a transparent process that provides for 
     input from various stakeholders, including organizations 
     representing physicians and other medical professionals, 
     State, or local governments that own and operate air 
     ambulance services, organizations representing air medical 
     suppliers or providers, patient organizations, State 
     emergency medical services, public health officials, and any 
     other stakeholders determined appropriate by the Secretary 
     (acting through the Administrator of the Centers for Medicare 
     & Medicaid Services) or the Administrator of the Federal 
     Aviation Administration, respectively.
       ``(B) Regular updating of criteria.--The Secretary (acting 
     through the Administrator of the Centers for Medicare & 
     Medicaid Services) and the Administrator of the Federal 
     Aviation Administration shall ensure that the criteria 
     developed under paragraphs (3) and (4), respectively, are 
     reviewed not less than frequently than every 2 years and 
     updated as appropriate to reflect consideration of new 
     medical and aviation standards, technologies, and equipment.
       ``(6) Incorporation of accreditation criteria.--
       ``(A) In general.--The Secretary shall combine the criteria 
     developed by the Secretary (acting through the Administrator 
     of the Centers for Medicare & Medicaid Services) under 
     paragraph (3) and the criteria developed by the Administrator 
     of the Federal Aviation Administration under paragraph (4) 
     into a single set of final criteria and ensure that 
     accreditation organizations designated under paragraph (2)(A) 
     apply such set of final criteria as substantive requirements 
     in the accreditation process established under paragraph (1).
       ``(B) Review.--The Secretary shall review such set of final 
     criteria to ensure that, taken as a whole, such criteria are 
     consistent with the requirements of clauses (i) and (ii) of 
     paragraph (5)(A). If the Secretary determines that such set 
     of final criteria is not consistent with such requirements, 
     the Secretary shall request that the Secretary (acting 
     through the Administrator of the Centers for Medicare & 
     Medicaid Services) and the Administrator of the Federal 
     Aviation Administration modify such criteria in accordance 
     with the process described in paragraphs (3), (4), and (5).
       ``(7) Grandfather protection for aircraft presently 
     providing rotary wing air ambulance services.--
       ``(A) In general.--Subject to subparagraph (B), the 
     Secretary shall exempt any rotary wing air ambulance listed 
     on a currently valid operating certificate with A021 air 
     ambulance operations specifications pursuant to parts 119 and 
     135 of title 14, Code of Federal Regulations or any air 
     ambulance for which a contractual obligation to purchase such 
     air ambulance had been entered into prior to the date of 
     enactment of the Patient Protection and Affordable Care Act, 
     from

[[Page 32727]]

     compliance with any accreditation criteria developed under 
     paragraphs (3), (4), and (5) or incorporated under paragraph 
     (6), if, as determined by the Administrator of the Federal 
     Aviation Administration in consultation with the Secretary 
     (acting through the Administrator of the Centers for Medicare 
     & Medicaid Services), compliance with such criteria would 
     require the replacement of such aircraft or impose an undue 
     economic burden on a supplier or provider of rotary wing air 
     ambulance services with respect to compliance costs.
       ``(B) Limitation.--The exemption authority under 
     subparagraph (A) shall not apply to any new or used aircraft 
     purchased after the date of enactment of the Patient 
     Protection and Affordable Care Act (including aircraft 
     purchased as a replacement for an existing aircraft) unless 
     the supplier or provider was under contractual obligation to 
     purchase such air ambulance prior to such date of enactment.
       ``(8) Relationship to other laws and authorities.--Nothing 
     in this section shall--
       ``(A) limit the authority of the Federal Aviation 
     Administration over civil aviation or infringe upon any 
     regulations or guidance respecting civil aviation safety;
       ``(B) affect the provisions of or requirements under 
     section 41713(b) of title 49, United States Code; or
       ``(C) affect the authority of States to license providers 
     of air ambulance services or medical personnel aboard such 
     air ambulances, except to the extent otherwise prohibited by 
     law, including such section 41713(b).''.

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