[House Report 110-285]
[From the U.S. Government Publishing Office]
110th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 110-285
======================================================================
PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 3162) TO AMEND TITLES
XVIII, XIX, AND XXI OF THE SOCIAL SECURITY ACT TO EXTEND AND IMPROVE
THE CHILDREN'S HEALTH INSURANCE PROGRAM, TO IMPROVE BENEFICIARY
PROTECTIONS UNDER THE MEDICARE, MEDICAID, AND THE CHIP PROGRAM, AND FOR
OTHER PURPOSES
_______
August 1, 2007 (legislative day of July 31, 2007).--Referred to the
House Calendar and ordered to be printed
_______
Mr. Castor, from the Committee on Rules, submitted the following
R E P O R T
[To accompany H. Res. 594]
The Committee on Rules, having had under consideration
House Resolution 594, by a record vote of 8 to 4, report the
same to the House with the recommendation that the resolution
be adopted.
SUMMARY OF PROVISIONS OF THE RESOLUTION
The resolution provides for consideration H.R. 3162, the
Children's Health and Medicare Protection Act of 2007, under a
closed rule providing two hours of general debate in the House,
with one hour to be equally divided and controlled by the
chairman and ranking minority member of the Committee on Ways &
Means and one hour to be equally divided and controlled by the
chairman and ranking minority member of the Committee on Energy
and Commerce.
The rule waives all points of order against consideration
of the bill except for clauses 9 and 10 of Rule XXI. The
amendment in the nature of a substitute recommended by the
Committee on Ways & Means now printed in the bill, modified by
the amendment printed in this report, shall be considered as
adopted. The rule waives all points of order against provisions
in the bill as amended and provides that the bill, as amended,
shall be considered as read. The rule provides one motion to
recommit with or without instructions. Finally, the rule
provides that the Chair may postpone further consideration of
the bill to a time designated by the Speaker.
EXPLANATION OF WAIVERS
The waiver of all points of order against consideration of
the bill (except for clauses 9 and 10 of Rule XXI) includes the
following: a waiver of Rule XIII, clause 4(a), requiring a
three-day layover of the committee report and a waiver of Rule
XIII, clause 3(e), requiring the inclusion of a comparative
print of any part of the bill or joint resolution proposing to
amend the statute and of the statute or part thereof proposed
to be amended. Although the rule waives all points of order
against provisions in the bill, as amended, the committee is
not aware of any points of order against the bill, as amended.
The waiver is prophylactic in nature.
COMMITTEE VOTES
The results of each record vote on an amendment or motion
to report, together with the names of those voting for and
against, are printed below:
Rules Committee record vote No. 273
Date: August 1, 2007 (legislative day of July 31, 2007).
Measure: H.R. 3162.
Motion by: Mr. Dreier.
Summary of motion: To grant an open rule.
Results: Defeated 4-8.
Vote by Members: McGovern--Nay; Hastings (FL)--Nay;
Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--
Nay; Dreier--Yea; Diaz-Balart--Yea; Hastings (WA)--Yea;
Sessions--Yea; Slaughter--Nay.
Rules Committee record vote No. 274
Date: August 1, 2007 (legislative day of July 31, 2007).
Measure: H.R. 3162.
Motion by: Mr. Dreier.
Summary of motion: To grant a modified open rule.
Results: Defeated 4-8.
Vote by Members: McGovern--Nay; Hastings (FL)--Nay;
Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--
Nay; Dreier--Yea; Diaz-Balart--Yea; Hastings (WA)--Yea;
Sessions--Yea; Slaughter--Nay.
Rules Committee record vote No. 275
Date: August 1, 2007 (legislative day of July 31, 2007).
Measure: H.R. 3162.
Motion by: Mr. Diaz-Balart.
Summary of motion: To make in order en bloc and provide
appropriate waivers for all 43 amendments submitted to Rules on
H.R. 3162.
Results: Defeated 4-8.
Vote by Members: McGovern--Nay; Hastings (FL)--Nay;
Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--
Nay; Dreier--Yea; Diaz-Balart--Yea; Hastings (WA)--Yea;
Sessions--Yea; Slaughter--Nay.
Rules Committee record vote No. 276
Date: August 1, 2007 (legislative day of July 31, 2007).
Measure: H.R. 3162.
Motion by: Mr. Sessions.
Summary of motion: To make in order en bloc and provide
appropriate waivers for amendments #8, 9, 10, and 11 by Rep.
Burgess to prohibit the Secretary of Health and Human Services
from approving future state waivers that would cover adults
other than pregnant adults under the State Children's Health
Insurance Program; to modify Title III of HR 3162 that
addresses Medicare physician reimbursement; to modify section
704 of HR 3162 that would require the Secretary of HHS to
develop a plan to implement for never events; and to require a
State submitting a SCHIP waiver request to the Secretary of
Health and Human Services to certify that children in that
state have access to an adequate level of pediatricians,
pediatric specialists and pediatric sub-specialists for
targeted low-income children covered under the State's child
health plan.
Results: Defeated 4-8.
Vote by Members: McGovern--Nay; Hastings (FL)--Nay;
Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--
Nay; Dreier--Yea; Diaz-Balart--Yea; Hastings (WA)--Yea;
Sessions--Yea; Slaughter--Nay.
Rules Committee record vote No. 277
Date: August 1, 2007 (legislative day of July 31, 2007).
Measure: H.R. 3162.
Motion by: Mr. Sessions.
Summary of motion: To make in order en bloc and provide
appropriate waivers for amendments #25, 26, 27, and 28 by Rep.
Blackburn, to strike Section 902 from the bill, which repeals
the trigger provision; to prevent employers within a State from
dropping the option to have employer-sponsored health insurance
coverage for their employees' children; to prohibit SCHIP
eligibility for adults for consecutive years; and to prohibit
adults convicted of a ``drug-related'' crime from SCHIP
eligibility.
Results: Defeated 4-8.
Vote by Members: McGovern--Nay; Hastings (FL)--Nay;
Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--
Nay; Dreier--Yea; Diaz-Balart--Yea; Hastings (WA)--Yea;
Sessions--Yea; Slaughter--Nay.
Rules Committee record vote No. 278
Date: August 1, 2007 (legislative day of July 31, 2007).
Measure: H.R. 3162.
Motion by: Mr. Sessions.
Summary of motion: To strike Section 651 regarding
specialty hospitals.
Results: Defeated 4-8.
Vote by Members: McGovern--Nay; Hastings (FL)--Nay;
Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--
Nay; Dreier--Yea; Diaz-Balart--Yea; Hastings (WA)--Yea;
Sessions--Yea; Slaughter--Nay.
Rules Committee record vote No. 279
Date: August 1, 2007 (legislative day of July 31, 2007).
Measure: H.R. 3162.
Motion by: Mr. Hastings (WA).
Summary of motion: To make in order and provide appropriate
waivers for an amendment offered by Rep. Hastings (WA) #29 to
strike clause (i) of subparagraph (D) in subsection (i)(l)
added by section 651 (a)(3).
Results: Defeated 4-8.
Vote by Members: McGovern--Nay; Hastings (FL)--Nay;
Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--
Nay; Dreier--Yea; Diaz-Balart--Yea; Hastings (WA)--Yea;
Sessions--Yea; Slaughter--Nay.
Rules Committee record vote No. 280
Date: August 1, 2007 (legislative day of July 31,2007).
Measure: H.R. 3162.
Motion by: Mr. Hastings (WA).
Summary of motion: To extend general debate to four hours.
Results: Defeated 4-8.
Vote by Members: McGovern--Nay; Hastings (FL)--Nay;
Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--
Nay; Dreier--Yea; Diaz-Balert--Yea; Hastings (WA)--Yea;
Sessions--Yea; Slaughter--Nay.
Rules Committee record vote No. 281
Date: August 1, 2007 (legislative day of July 31, 2007).
Measure: H.R. 3162.
Motion by: Mr. McGovern.
Summary of motion: To report the rule.
Results: Adopted 8-4.
Vote by Members: McGovern--Yea; Hastings (FL)--Yea;
Cardoza--Yea; Welch--Yea; Castor--Yea; Arcuri--Yea; Sutton--
Yea; Dreier--Nay; Diaz-Balart--Nay; Hastings (WA)--Nay;
Sessions--Nay; Slaughter--Yea.
SUMMARY OF AMENDMENT CONSIDERED AS ADOPTED
The following changes are reflected in the amendment.
Amendments to Title I--Children's Health Insurance Program
8. Amends Sec. 104 to increase the percentage of CHIP
allotment ``qualifying States'' may spend from 30 percent to
100 percent.
9. Adds section 115 to require States with Separate State
CHIP programs to provide 12 months of continuous eligibility
for targeted low income children in families with incomes under
200% of the federal poverty level under XXI.
10. Amends section 111(a)(3)(A) to sunset the outreach
performance bonus at the end of FY 2013 and require a GAO study
of the effectiveness of the outreach bonus at enrolling
eligible but uninsured children.
11. Amends section 131 to allow for coverage of children
under CHIP to age 21.
12. Adds a new section 135 to make clear that nothing in
the act allows Federal payment for individuals who are not
legal residents.
13. Adds a new section 136 to require audits to enforce
citizenship restrictions on eligibility for Medicaid and CHIP
benefits. This replaces the previous audit requirement in
section 143.
14. Amends 151(a)(2)(B) to require the new pediatric health
quality measurement program to collect data on efforts to
reduce hospitalization rate of premature infants.
Amendments to Title II--Medicare Beneficiary Improvements
8. Amends section 211(a)(2)(D) by changing the indexing of
the asset test from $1000 and $2000 per year to the consumer
price index.
9. Amends section 213(a) to clarify applicants' ability to
self-certify income and resources for purposes of qualifying
for the Part D low-income subsidy. Also clarifies that SSA can
verify eligibility with existing data, but without the need for
additional documentation from applicants, except in
extraordinary circumstances. Also makes required technical
changes to account for this clarification.
10. Amends section 213(d) to clarify that SSA will provide
beneficiaries with a simplified application form and will
accept and deliver these applications to the states.
11. Amends section 217 to increase the cost-sharing
limitation from 2.5 percent of annual income to 5 percent of
annual income.
12. Amends effective date of section 223.
13. Changes paragraph (c)(3) of section 231 to clarify the
definition of future patient record systems; adds a new
subparagraph (f)(2)(E) to facilitate the collection of racial
and ethnicity data.
14. Amends section 233 to clarify the scope of the
demonstration.
Amendments to Title III--Physicians' Service Payment Reform
Amends section 301 by clarifying the formula for excluding
services not covered under the physician fee schedule from the
target growth rates, changing the allowable growth rate for the
primary care and preventive services category from three
percent to two-and-a-half percent, and by freezing the update
in years after 2012. Amends section 304 to clarify the
definition of efficient areas; conforms language in section 309
to reflect changes made in the bill as reported by the
Committee on Ways and Means; adds language in section 905
directing CMS to report on the specific needs of communities
serving vulnerable populations;
Amendments to Title IV--Medicare Advantage Reform
4. Amends section 431 by adding authority for Severe and
Disabling Chronic Condition Special Needs Plans (SDCC-SNPs).
Provides that SDCC-SNPS must enroll 90% beneficiaries with
specific chronic conditions as indicated by MA risk adjustment
data; serve beneficiaries with one or more of six specific
severe chronic conditions; have an average risk score of 1.35
or greater; manage a MA chronic care improvement program that
excels such programs in regular MA plans; and maintain a
network of providers to meet the needs of enrollees with severe
and disabling conditions.
5. Amends section 431 to clarify a provision referring to
Medicare-Medicaid demonstration programs in Massachusetts,
Minnesota and Wisconsin.
6. Amends section 411(h) to clarify a provision that
provides financial support for State Health Insurance
Assistance Programs.
Amendments to Title V--Provisions Relating to Medicare Part A
5. Amends section 503(c) to clarify the treatment of
satellites facilities for long-stay cancer hospitals. Modifies
the title for the section setting forth Medicare payments for
long-stay cancer hospitals.
6. Amends section 504 to modify the formula for
disproportionate share hospital payments for hospitals located
in Puerto Rico.
7. Amends section 505(b) to streamline language pertaining
to one PPS-exempt cancer hospital.
8. Amends section 508(c) to streamline language pertaining
to geographic reclassifications and to allow for geographic
reclassification of certain hospitals.
Amendments to Title VI--Other Provisions Relating to Medicare Part B
4. Amends sections 608(b) and 609(c) to extend the date by
which contracts entered into under the competitive acquisition
program are exempt from these sections. The date for the
exemption is extended to October 1, 2007.
5. Amends section 612(c) to clarify that certain inhalation
drugs are appropriately reimbursed. Specifically, the amendment
clarifies that generic albuterol be reimbursed at the lower of
its current or historic level, and that brand name levalbuterol
be reimbursed at the lower of its current or historic level.
6. Amends section 612(b) to clarify that Competitive
Acquisition Program vendors may deliver drugs to a main office
or satellite office as designated by the prescribing physician,
and that physicians may be allowed to transport drugs to the
site of administration if all applicable laws and regulations
are followed.
Amendments to Title VII--Provisions Relating to Medicare Parts A and B
4. Amends section 705 to modify criteria for reallocation
of graduate medical education residency slots from hospital
closures and provision of additional residency slots.
5. Adds section 706 providing for a study of the effect of
home health remote monitoring on patient outcomes.
6. Adds section 707 providing for a demonstration project
testing effectiveness of home health telemonitoring and other
telehealth technologies.
Amendments to Title VIII--Medicaid
5. Amends section 801(a)(1) to extend the TMA program until
2011, rather than 2009.
6. Amends section 812(a) to change the applicable
percentage to 22.1.
7. Strikes section 812(b).
8. Adds a new section 812 to extend the automated web-based
asset verification demonstration to Medicaid, in the States in
which the demonstration is operating.
Amendments to Title IX--Miscellaneous
5. Amends section 904(a) to clarify the number of members
and their terms of appointment on the Comparative Effectiveness
Research Commission, and to clarify the terms of appointment of
the members of the Coordinating Council for Health Services
Research.
6. Amends section 904(b) to clarify that the term
`specified health insurance policy' does not include any
insurance if substantially all of its coverage is of excepted
benefits described in section 9832(c).
7. Adds a new section 909 to the act allowing Congressional
Support Agencies (MedPAC, GAO, and CBO) to obtain from CMS
necessary data about the Medicare Part D program.
8. Adds a new section 910 to reauthorize the Title V Social
Security Act abstinence education programs with provisions to
ensure that medically or scientifically accurate information is
provided; that States have the flexibility to teach abstinence-
only education programs OR abstinence-plus education programs;
and that funded programs are proven effective at decreasing
teen pregnancy rates and rates of STDs and HIV/AIDS.
TEXT OF AMENDMENTS CONSIDERED AS ADOPTED
In the matter inserted by section 104, strike ``30 percent''
and insert ``100 percent''.
Add at the end of subtitle B of title I the following:
SEC. 115. CONTINUOUS COVERAGE UNDER CHIP.
(a) In General.--Section 2102(b) of the Social Security Act
(42 U.S.C. 1397bb(b)) is amended by adding at the end the
following new paragraph:
``(5) 12-months continuous eligibility.--In the case
of a State child health plan that provides child health
assistance under this title through a means other than
described in section 2101(a)(2), the plan shall provide
for implementation under this title of the 12-months
continuous eligibility option described in section
1902(e)(12) for targeted low-income children whose
family income is below 200 percent of the poverty
line.''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply to determinations (and redeterminations) of
eligibility made on or after January 1, 2008.
In the paragraph (3)(A) added by section 111, insert ``and
ending with fiscal year 2013'' after ``beginning with fiscal
year 2008''.
In section 111, insert ``(a) In General.--'' before ``Section
2105(a)'', and add at the end the following:
(b) GAO Study.--
(1) In general.--The Comptroller General of the
United States shall conduct a study on the
effectiveness of the performance bonus payment program
under the amendment made by subsection (a) on the
enrollment and retention of eligible children under the
Medicaid and CHIP programs and in reducing the rate of
uninsurance among such children.
(2) Report.--Not later than January 1, 2013, the
Comptroller General shall submit a report to Congress
on such study and shall include in such report such
recommendations for extending or modifying such program
as the Comptroller General determines appropriate.
Amend section 131 to read as follows:
SEC. 131. OPTIONAL COVERAGE OF CHILDREN UP TO AGE 21 UNDER CHIP.
(a) In General.--Section 2110(c)(1) of the Social Security
Act (42 U.S.C. 1397jj(c)(1)) is amended by inserting ``(or, at
the option of the State, under 20 or 21 years of age)'' after
``19 years of age''.
(b) Effective Date.--The amendment made by subsection (a)
shall take effect on January 1, 2008.
Add at the end of subtitle D of title I the following (and in
section 143(a), strike paragraph (2) and redesignate paragraph
(3) as paragraph (2)):
SEC. 135. NO FEDERAL FUNDING FOR ILLEGAL ALIENS.
Nothing in this Act allows Federal payment for individuals
who are not legal residents.
SEC. 136. AUDITING REQUIREMENT TO ENFORCE CITIZENSHIP RESTRICTIONS ON
ELIGIBILITY FOR MEDICAID AND CHIP BENEFITS.
Section 1903(x) of the Social Security Act (as amended by
section 405(c)(1)(A) of division B of the Tax Relief and Health
Care Act of 2006 (Public Law 109-432)) is amended by adding at
the end the following new paragraph:
``(4)(A) Each State shall audit a statistically-based sample
of cases of individuals whose eligibility for medical
assistance (or child health assistance) is determined under
section 1902(a)(46)(B) or under subsection (v)(4)(A) in order
to demonstrate to the satisfaction of the Secretary that
Federal funds under this title or title XXI are not unlawfully
spent for benefits for individuals who are not legal residents.
In conducting such audits, a State may rely on case reviews
regularly conducted pursuant to its Medicaid Quality Control or
Payment Error Rate Measurement (PERM) eligibility reviews under
subsection (u) and the provisions of subsection (e) of section
1137 shall apply under this paragraph in the same manner as
they apply under subsection (b) of such section.
``(B) The State shall remit to the Secretary the Federal
share of any unlawful expenditures for benefits, for aliens who
are not legal residents, which are identified under an audit
conducted under subparagraph (A).''.
In section 151(a)(2)(B), insert after clause (vi) the
following new clause:
(vii) Data on State efforts to reduce
hospitalization rate of premature
infants under the age of 12 months who
were born prior to 35 weeks.
In the subclause (IV) inserted by section 211(a)(2)(D),
strike ``increased by $1,000 (or $2,000 in the case of the
combined value referred to in subclause (III))'' and insert
``increased by the annual percentage increase in the consumer
price index (all items; U.S. city average) as of September of
such previous year''.
In section 211(a)(2), strike ``and'' at the end of
subparagraph (C), strike the last period at the end of the
matter inserted by subparagraph (D) and insert ``; and'', and
add at the end the following:
(E) in the last sentence, by inserting ``or
(IV)'' after ``subclause (II)''.
Amend subsection (a) of section 213 to read as follows:
(a) Administrative Verification of Income and Resources Under
the Low-Income Subsidy Program.--Clause (iii) of section 1860D-
14(a)(3)(E) of the Social Security Act (42 U.S.C. 1395w-
114(a)(3)(E)) is amended to read as follows:
``(iii) Certification of income and
resources.--For purposes of applying
this section--
``(I) an individual shall be
permitted to apply on the basis
of self-certification of income
and resources; and
``(II) matters attested to in
the application shall be
subject to appropriate methods
of verification without the
need of the individual to
provide additional
documentation, except in
extraordinary situations as
determined by the
Commissioner.''.
In section 213(b), strike ``, as amended by subsection (a),
is further amended'' and insert ``is amended'' and redesignate
the subparagraph added by such section as subparagraph (G).
In the paragraph (7) added by section 213(c), strike
``clauses (iii) and (iv) of section 1860D-14(a)(3)(C)'' and
inserting ``subparagraphs (C)(iii) and (G) of section 1860D-
14(a)(3)''.
In the subsection (c)(1)(B) added by section 213(d), strike
``an application form'' and insert ``a simplified application
form''.
In the subsection (c)(3) added by section 213(d), strike
``completed'' in the heading and ``completed'' in the text.
In the clause added by section 217(a)(1) and in the
subparagraph added by section 217(a)(2), strike ``2.5 percent''
and insert ``5 percent''.
In section 223(b), strike ``January 1, 2009'' and insert
``January 1, 2013''.
In section 231(c)(3), insert after ``systems'' the following:
``, including electronic health records, electronic medical
records and patient health records,''.
In section 231(f)(2), strike ``and'' at the end of
subparagraph (C), strike the period at the end of subparagraph
(D) and insert ``; and'', and add at the end the following new
subparagraph:
(E) provide for the revision of existing
HIPAA claims-related code sets to mandate the
collection of racial and ethnicity data, and to
provide a code set for primary language.
In section 233(a), strike ``limited English proficient'' and
insert ``living in communities where racial and ethnic
minorities, including populations that face language barriers,
are underserved with respect to such services''.
In the matter inserted by section 301(c)(1), strike ``and
(8)'' and insert ``(8), and (9)''.
In the paragraph (8) added by section 301(c)(4), in the
heading insert ``and ending with 2012'' after ``beginning with
2008'' and in the matter in subparagraph (A) before clause (i),
insert ``and ending with 2012'' after ``beginning with 2008''.
In the paragraph (8)(B) added by section 301(c)(4), amend
clause (i) to read as follows:
``(i) For 2008.--For 2008:
``(I) Total 2007 allowed
expenditures for all services
included in sgr computation.--
Compute total allowed
expenditures for physicians'
services (as defined in
subsection (f)(4)(A)) for 2007
that would otherwise be
calculated under subsection (d)
but for this paragraph.
``(II) Total 2007 allowed
expenditures for physician fee
schedule services.--Compute
total allowed expenditures for
services furnished under the
physician fee schedule for 2007
by subtracting, from the total
allowed expenditures computed
under subclause (I), the
Secretary's estimate of the
amount of the actual
expenditures for 2007 for
services included in such
subclause for which payment is
not made under the fee schedule
established pursuant to this
section.
``(III) Allocation of 2007
allowed expenditures to service
category.--Compute allowed
expenditures for the service
category involved for 2007 by
multiplying the total allowed
expenditures computed under
subclause (II) by the overhang
allocation factor for the
service category (as defined in
subparagraph (C)(iii)).
``(IV) Increase by growth
rate to obtain 2008 allowed
expenditures for service
category.--Compute allowed
expenditures for the service
category for 2008 by increasing
the allowed expenditures for
the service category for 2007
computed under subclause (III)
by the target growth rate for
such service category under
subsection (f) for 2008.
In the paragraph (8)(D) added by section 301(c)(4), strike
``Floor for updates'' and insert ``Updates'' and strike ``not
less than'' and insert ``equal to''.
In the matter added by section 301(c)(4), add at the end the
following:
``(9) No update for service categories beginning with
2013.--The update to the conversion factor for each of
the service categories established under paragraph (8)
for 2013 and each succeeding year shall be 0
percent.''.
In the paragraph (5)(B) added by section 301(d)(1), strike
``0.03'' and insert ``0.025''.
In the subsection (v)(2)(A) added by section 304, insert
before the period at the end the following: ``as standardized
to eliminate the effect of geographic adjustments in payment
rates''.
In the subsection (m)(4) inserted by section 309(a)(2), in
subparagraph (F) strike ``(n)(3)(G)'' and insert ``(n)'' and
strike subparagraph (B) and redesignate succeeding
subparagraphs accordingly.
In section 411(h)(2), add ``and'' at the end of subparagraph
(A), strike ``; and'' at the end of subparagraph (B) and insert
a period, and strike subparagraph (C).
Amend the clause (ii) inserted by section 431(b)(1)(A) to
read as follows:
``(ii) as of January 1, 2009--
``(I) at least 90 percent of
the enrollees in which are
described in subparagraph
(B)(i), as determined under
regulations in effect as of
July 1, 2007;
``(II) at least 90 percent of
the enrollees in which are
described in subparagraph
(B)(ii) and are full-benefit
dual eligible individuals (as
defined in section 1935(c)(6))
or qualified medicare
beneficiaries (as defined in
section 1905(p)(1)); or
``(III) at least 90 percent
of the enrollees in which have
a severe or disabling chronic
condition of the type that the
plan is committed to serve as
indicated by the data submitted
for the risk-adjustment of plan
payments; and''.
In section 431(b)(1), add ``and'' at the end of subparagraph
(A), strike subparagraph (B), and redesignate subparagraph (C)
as subparagraph (B).
At the end of the paragraphs added by section
431(b)(1)(B)(iii), as so redesignated, add the following
additional paragraph:
``(4) Additional requirements for severe or disabling
chronic condition snps.--In the case of a specialized
MA plan for special needs individuals described in
subsection (b)(6)(A)(ii)(III), the applicable
requirements of this subsection are as follows:
``(A) The plan is designated to serve, and
serves, Medicare beneficiaries with one or more
of the following specific severe or disabling
chronic conditions:
``(i) Cardiovascular.
``(ii) Cerebrovascular.
``(iii) Congestive health failure.
``(iv) Diabetes.
``(v) Chronic obstructive pulmonary
disease.
``(vi) HIV/AIDS.
``(B) The plan has an average risk score
under section 1853(a)(1)(C) of 1.35 or greater.
``(C) The plan has established and actively
manages a chronic care improvement program
under section 1852(e)(2) for each of the
conditions that it serves under subparagraph
(A) that significantly exceeds the features and
results of such programs established and
managed by Medicare Part C plans that are not
specialized Medicare Part C plans for special
needs individuals of the type described in this
paragraph.
``(D) The plan has a network of a sufficient
number of primary care and specialty
physicians, hospitals, and other health care
providers under contract to the plan so that
the plan can clearly meet the routine and
specialty needs of the severely ill and
disabled enrollees of the plan throughout the
service area of the plan.
``(E) The plan reports to the Secretary
information on additional quality measures
specified by the Secretary under section
1852(e)(3)(D)(iv)(III) for such plans.''.
In the matter inserted by section 431(b)(2)(A), strike ``or
(3)'' and insert ``, (3), or (4)''.
In the clause (iii) added by section 431(b)(2)(B), strike
``and'' at the end of subclause (I), strike the period at the
end of subclause (II) and insert ``; and'', and add at the end
the following new subclause:
``(III) beneficiaries
enrolled in specialized
Medicare Part C plans for
special needs individuals
(described in section
1859(b)(6)(A)(ii)(III)) that
serve predominantly individuals
with severe or disabling
chronic conditions by measuring
the special needs for care of
such individuals.''.
Amend subparagraph (A) of section 431(b)(3) to read as
follows:
(A) to a Medicare Advantage plan with a
contract with a State Medicaid integrated
Medicare-Medicaid plan program that had been
approved by the Centers for Medicare & Medicaid
Services as of January 1, 2004; and
Add at the end of section 431 the following:
(c) Sunset of Additional Designation Authority.--
(1) In general.--Subsection (d) of section 231 of the
Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173) is
repealed.
(2) Effective date.--The repeal made by paragraph (1)
shall take effect on January 1, 2009, and shall apply
to plans offered on or after such date.
In section 503(c)(4), strike ``Transition rule'' and insert
``In general''.
In section 503(c)(5), insert ``without regard to section
412.22(h)(2)(i) of title 42, Code of Federal Regulations,''
after ``of this Act'' and strike ``of title 42, Code of Federal
Regulations'' and insert ``of such title''.
In section 504, insert ``(a) In General.--'' before ``Section
1886(d)(5)(F)(xiv)'' and add at the end the following:
(b) Special Rule in Computing Disproportionate Patient
Percentage.--
(1) In general.--Section 1886(d)(5)(F)(vi) of such
Act (42 U.S.C. 1395ww(d)(5)(F)(vi)) is amended by
adding at the end the following: ``In applying this
clause in the case of hospitals located in Puerto Rico,
the Secretary shall substitute for the fraction
described in subclause (I) one-half of the national
average of such fraction for all subsection (d)
hospitals, as estimated by the Secretary.''.
(2) Effective date.--The amendment made by paragraph
(1) shall apply to discharges in cost reporting periods
of hospitals beginning on or after January 1, 2008.
In the clause (vii) inserted by section 505(b)(1)(B), strike
subclauses (I), (V), and (VIII) and redesignate subclauses
(II), (III), (IV), (VI), and (VII) as subclauses (I) through
(V), respectively, and in subclause (IV), as so redesignated,
add ``and'' at the end and in subclause (V), as so
redesignated, strike ``and'' at the end.
In section 508, strike subsections (c) and (d).
Redesignate subsection (e) of section 508 as subsection (c)
and, in such subsection, in paragraph (3)(A), insert
``greater'' after ``and no'', in paragraph (4), strike
``Notwithstanding paragraph (6), in'' and insert ``In'' and
strike ``of this section'' and insert ``of this paragraph'',
and redesignate paragraph (8) as paragraph (13) and insert
after paragraph (7) the following:
(8) For purposes of making payment under section
1886(d) of the Social Security Act (42 U.S.C.
1395ww(d)), the Nashville-Davidson-Murfreesboro core
based statistical area is deemed to include Cumberland
County, Tennessee.
(9) For purposes of making payment under section
1886(d) of the Social Security Act (42 U.S.C.
1395ww(d)), any hospital that is co-located in
Marinette, Wisconsin and the Menominee, Michigan is
deemed to be located in Chicago, Illinois.
(10) In the case of a hospital located in
Massachusetts or Clinton County, New York, that is
reclassified based on wages under paragraph (8) or (10)
of section 1886(d) of the Social Security Act into an
area the area wage index for which is increased under
section 4410(a) of the Balanced Budget Act of 1997
(Public Law 105-33), such increased area wage index
shall also apply to such hospital under such section
1886(d).
(11) For purposes of applying the area wage index
under section 1886(d) of the Social Security Act (42
U.S.C. 1395ww(d)), hospital provider numbers 360112 and
23005 shall be treated as located in the same urban
area as Ann Arbor, Michigan.
(12) For purposes of making payment under section
1886(d) of the Social Security Act (42 U.S.C.
1395ww(d)), any hospital that is located in Columbia
County, New York, with less 250 beds is deemed to be
located in the New York-White Plains-Wayne, NY-NJ core
based statistical area.
In sections 608(b)(2) and 609(b)(3), strike ``July 21, 2007''
and insert ``October 1, 2007''.
In section 612(b), amend paragraph (2) to read as follows:
(2) Permitting appropriate delivery and transport of
drugs.--Subsection (b)(4)(E) of such section is
amended--
(A) by striking ``or'' at the end of clause
(i);
(B) by striking the period at the end of
clause (ii) and inserting a semicolon; and
(C) by adding at the end the following new
clauses:
``(iii) prevent a contractor from
delivering drugs to a satellite office
designated by the prescribing
physician; or
``(iv) prevent a contractor from
allowing a selecting physician to
transport drugs or biologicals to the
site of administration consistent with
State law and other applicable laws and
regulations.''.
In section 612(b)(4), insert before the period at the end the
following: ``, except in the case of a contractor terminated as
a result of the application of section 1847B(b)(2)(B) of such
Act''.
Amend the paragraph (6) added by section 612(c)(2) to read as
follows:
``(6) Special rule.--Beginning with January 1, 2008,
the payment amount for--
``(A) each single source drug or biological
described in section 1842(o)(1)(G) (including a
single source drug or biological that is
treated as a multiple source drug because of
the application of subsection (c)(6)(C)(ii)) is
the lower of--
``(i) the payment amount that would
be determined for such drug or
biological applying such subsection; or
``(ii) the payment amount that would
have been determined for such drug or
biological if such subsection were not
applied; and
``(B) a multiple source drug (excluding a
drug or biological that is treated as a
multiple source drug because of the application
of such subsection) is the lower of--
``(i) the payment amount that would
be determined for such drug or
biological taking into account the
application of such subsection; or
``(ii) the payment amount that would
have been determined for such drug or
biological if such subsection were not
applied.''.
In the clause (v) added by section 705(a)(1), strike
``division of the core based'' each place it appears before
subclause (I) and insert after subclause (IV) the following:
``(V) The hospital maintains
no more than 400 beds.
In section 705(a)(1), strike ``the following new clause:''
and insert ``the following new clauses:'' and add after clause
(v) (as added by such section, and after ``exceed 10.'' ) the
following new clause:
``(vi) Increase in residency slots.--
In the case of a hospital located in
Peoria County, Illinois, that has more
than 500 beds, the Secretary shall
increase by two the otherwise
applicable resident limit under
subparagraph (F) for such hospital.''.
At the end of title VII add the following:
SEC. 706. STUDIES RELATING TO HOME HEALTH.
(a) In General.--The Medicare Payment Advisory Commission
shall conduct a study of Medicare beneficiaries utilizing home
health care services to determine--
(1) the impact that remote monitoring equipment and
related services have on improving health care outcomes
in the home health care setting for beneficiaries with
chronic conditions;
(2) the differences in the percentage of inpatient
hospital admissions and emergency room visits for
beneficiaries with a similar health care risk profile
who utilize remote monitoring equipment and services
compared to those who do not use such equipment and
services;
(3) the percentage of Medicare beneficiaries
currently utilizing remote monitoring equipment and
related services;
(4) the estimated reduction in aggregate expenditures
under parts A and B of title XVIII of the Social
Security Act expenditures if home health agencies
increased their utilization of remote monitoring
equipment and related services for patients with
chronic disease conditions; and
(5) the variation of utilization of remote monitoring
equipment and related services within geographic
regions and by size of home health agency.
(b) Data Collection.--As a condition of a home health
agency's participation in the program under title XVIII of the
Social Security Act, beginning no later than January 1, 2008,
the Secretary of Health and Human Services shall require such
agencies to collect, in a form and manner determined by the
Secretary, the following data:
(1) The extent of home health agency's usage of
remote monitoring equipment and related services for
beneficiaries with chronic conditions.
(2) Whether such equipment and services are used to
monitor patients' with chronic conditions vital signs
on a daily basis.
(3) Whether standing physician orders accompany the
use of remote monitoring equipment and services.
(4) The costs of remote monitoring equipment and
related services.
(c) Report to Congress.--Not later than June 1, 2010, the
Commission shall report to Congress on its findings on the
study conducted under subsection (a). Such report shall include
recommendations regarding how Congress may enact reimbursement
policies that increase the appropriate utilization of remote
monitoring equipment and services under the home health program
for Medicare beneficiaries with chronic conditions in a manner
that facilitates health care outcomes and leads to the long-
term reduction of aggregate expenditures under the Medicare
program.
SEC. 707. RURAL HOME HEALTH QUALITY DEMONSTRATION PROJECTS.
(a) In General.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Health and Human
Services (in this section referred to as the ``Secretary'')
shall make grants to eligible entities for demonstration
projects to assist home health agencies to better serve their
Medicare populations while aiming to reduce costs to the
Medicare program through utilization of technologies, including
telemonitoring and other telehealth technologies, health
information technologies, and telecommunications technologies
that--
(1) implement procedures and standards that reduce
the need for inpatient hospital services and health
center visits; and
(2) address the aims of safety, effectiveness,
patient- or community-centeredness, timeliness,
efficiency, and equity identified by the Institute of
Medicine of the National Academies in its report
entitled ``Crossing the Quality Chasm: A New Health
System for the 21st Century'' released on March 1,
2001, when determining when and what care is needed.
(b) Eligible Entities.--In this section, the term ``eligible
entity'' means a State that includes--
(1) a rural academic medical center;
(2) no urban regional medical center; and
(3) a Medicare population whose enrollees in the
Medicare Part C program is less than 3 percent.
(c) Consultation.--In developing the program for awarding
grants under this section, the Secretary shall consult with the
Administrator of the Centers for Medicare & Medicaid Services,
home health agencies, rural health care researchers, and
private and non-profit groups (including national associations)
which are undertaking similar efforts.
(d) Duration.--Each demonstration project under this section
shall be for a period of 2 years.
(e) Report.--Not later than one year after the conclusion of
all of the demonstration projects funded under this section,
the Secretary shall submit a report to the Congress on the
results of such projects. The report shall include--
(1) an evaluation of technologies utilized and
effects on patient access to home health care, patient
outcomes, and an analysis of the cost effectiveness of
each such project; and
(2) recommendations on Federal legislation,
regulations, or administrative policies to enhance
rural home health quality and outcomes.
(f) Funding.--Out of any funds in the Treasury not otherwise
appropriated, there are appropriated to the Secretary for
fiscal year 2008, $3,000,000 to carry out this section. Funds
appropriated under this subsection shall remain available until
expended.
In section 801(a), strike ``Two-Year'' and insert ``Four-
Year'' and in the matter inserted by section 801(a)(1) strike
``September 30, 2009'' and insert ``September 30, 2011''.
In the subclause (VI) added by section 812(a)(3), strike
``20.1 percent'' and insert ``22.1 percent''.
In section 812, strike ``(a) Brand.--'' and strike subsection
(b).
At the end of subtitle B of title VIII, add the following:
SEC. 817. EXTENSION OF SSI WEB-BASED ASSET DEMONSTRATION PROJECT TO THE
MEDICAID PROGRAM.
(a) In General.--The Secretary of Health and Human Services
shall provide for the application to asset eligibility
determinations under the Medicaid program under title XIX of
the Social Security Act of the automated, secure, web-based
asset verification request and response process being applied
for determining eligibility for benefits under the Supplemental
Security Income (SSI) program under title XVI of such Act under
a demonstration project conducted under the authority of
section 1631(e)(1)(B)(ii) of such Act (42 U.S.C.
1383(e)(1)(B)(ii)).
(b) Limitation.--Such application shall only extend to those
States in which such demonstration project is operating and
only for the period in which such project is otherwise
provided.
(c) Rules of Application.--For purposes of carrying out
subsection (a), notwithstanding any other provision of law,
information obtained from a financial institution that is used
for purposes of eligibility determinations under such
demonstration project with respect to the Secretary of Health
and Human Services under the SSI program may also be shared and
used by States for purposes of eligibility determinations under
the Medicaid program. In applying section 1631(e)(1)(B)(ii) of
the Social Security Act under this subsection, references to
the Commissioner of Social Security and benefits under title
XVI of such Act shall be treated as including a reference to a
State described in subsection (b) and medical assistance under
title XIX of such Act provided by such a State.
In the section 1822 added by section 904(a), in subsection
(b)(3)(A)(iii) strike ``up to 15'' and insert ``15''; in
subsection (b)(6)(B) strike ``10'' and ``9'' and insert ``8''
and ``7'', respectively; and in subsection (g)(2)(B)(ii) strike
``8'' and ``7'' and insert ``10'' and ``9'', respectively.
Amend paragraph (2) of the section 4375(c) added by section
904(b)(2)(A) to read as follows:
``(2) Exemption for certain policies.--The term
`specified health insurance policy' does not include
any insurance if substantially all of its coverage is
of excepted benefits described in section 9832(c).
At the end of title IX add the following:
SEC. 909. ACCESS TO DATA ON PRESCRIPTION DRUG PLANS AND MEDICARE
ADVANTAGE PLANS.
(a) In General.--Section 1875 of the Social Security Act (42
U.S.C. 1395ll) is amended--
(1) in the heading, by inserting ``to congress;
providing information to congressional support
agencies'' after ``and recommendations''; and
(2) by adding at the end the following new
subsection:
``(c) Providing Information to Congressional Support
Agencies.--
``(1) In general.--Notwithstanding any provision
under part D that limits the use of prescription drug
data collected under such part, upon the request of a
Congressional support agency, the Secretary shall
provide such agency with information submitted to, or
compiled by, the Secretary under part D (subject to the
restriction on disclosure under paragraph (2)),
including--
``(A) only with respect to Congressional
support agencies that make official baseline
spending projections, conduct oversight studies
mandated by Congress, or make official
recommendations on the program under this title
to Congress--
``(i) aggregate negotiated prices for
drugs covered under prescription drug
plans and MA-PD plans;
``(ii) negotiated rebates, discounts,
and other price concessions by drug and
by contract or plan (as reported under
section 1860D-2(d)(2));
``(iii) bid information (described in
section 1860D-11(b)(2)(C)) submitted by
such plans;
``(iv) data or a representative
sample of data regarding drug claims
and other data submitted under section
1860D-15(c)(1)(C) (as determined
necessary and appropriate by the
Congressional support agency to carry
out the legislatively mandated duties
of the agency);
``(v) the amount of reinsurance
payments paid under section 1860D-
15(a)(2), provided at the plan level;
and
``(vi) the amount of any adjustments
of payments made under subparagraph (B)
or (C) of section 1860D-15(e)(2),
provided at the plan level aggregate
negotiated prices for drugs covered
under prescription drug plans and MA-PD
plans; and
``(B) access to drug event data submitted by
such plans under section 1860D-15(d)(2)(A),
except, with respect to data that reveals
prices negotiated with drug manufacturers, such
data shall only be available to Congressional
support agencies that make official baseline
spending projections, conduct oversight studies
mandated by Congress, or make official
recommendations on the program under this title
to Congress.
``(2) Restriction on data disclosure.--
``(A) In general.--Data provided to a
Congressional support agency under this
subsection shall not be disclosed, reported, or
released in identifiable form.
``(B) Identifiable form.--For purposes of
subparagraph (A), the term `identifiable form'
means any representation of information that
permits identification of a specific
prescription drug plan, MA-PD plan, pharmacy
benefit manager, drug manufacturer, drug
wholesaler, or individual enrolled in a
prescription drug plan or an MA-PD plan under
part D.
``(3) Timing.--The Secretary shall release data under
this subsection in a timeframe that enables
Congressional support agencies to complete
congressional requests.
``(4) Use of the data provided.--Data provided to a
Congressional support agency under this subsection
shall only be used by such agency for carrying out the
functions and activities of the agency mandated by
Congress.
``(5) Confidentiality.--The Secretary shall establish
safeguards to protect the confidentiality of data
released under this subsection. Such safeguards shall
not provide for greater disclosure than is permitted
under any of the following:
``(A) The Federal regulations (concerning the
privacy of individually identifiable health
information) promulgated under section 264(c)
of the Health Insurance Portability and
Accountability Act of 1996.
``(B) Sections 552 or 552a of title 5, United
States Code, with regard to the privacy of
individually identifiable beneficiary health
information.
``(6) Definitions.--In this subsection:
``(A) Congressional support agency.--The term
`Congressional support agency' means--
``(i) the Medicare Payment Advisory
Commission;
``(ii) the Government Accountability
Office; and
``(iii) the Congressional Budget
Office.
``(B) Ma-pd plan.--The term `MA-PD plan' has
the meaning given such term in section 1860D-
1(a)(3)(C).
``(C) Prescription drug plan.--The term
`prescription drug plan' has the meaning given
such term in section 1860D-41(a)(14).''.
(b) Conforming Amendment.--Section 1805(b)(2) of the Social
Security Act (42 U.S.C. 1395b-6(b)(2)) is amended by adding at
the end the following new subparagraph:
``(D) Part d.--Specifically, the Commission
shall review payment policies with respect to
the Voluntary Prescription Drug Benefit Program
under part D, including--
``(i) the factors affecting
expenditures;
``(ii) payment methodologies; and
``(iii) their relationship to access
and quality of care for Medicare
beneficiaries.''.
SEC. 910. ABSTINENCE EDUCATION.
Section 510 of the Social Security Act (42 U.S.C. 710) is
amended to read as follows:
``SEC. 510. SEPARATE PROGRAM FOR ABSTINENCE EDUCATION.
``(a) In General.--For the purpose described in subsection
(b), the Secretary shall, for fiscal year 2008 and fiscal year
2009, allot to each State which has transmitted an application
for the fiscal year under section 505(a) an amount equal to the
product of--
``(1) the amount appropriated in subsection (d) for
the fiscal year; and
``(2) the percentage determined for the State under
section 502(c)(1)(B)(ii).
``(b) Purpose of Allotment.--
``(1) Purpose.--The purpose of an allotment under
subsection (a) to a State is to enable the State to
provide abstinence education, and where appropriate,
mentoring, counseling, and adult supervision to promote
abstinence from sexual activity, with a focus on those
groups which are most likely to bear children out-of-
wedlock.
``(2) Definition; state option.--For purposes of this
section, the term `abstinence education' has, at the
option of each State receiving an allotment under
subsection (a), the meaning given such term in
subparagraph (A), or the meaning given such term in
subparagraph (B), as follows:
``(A) Such term means a medically and
scientifically accurate educational or
motivational program which--
``(i) has as its exclusive purpose,
teaching the social, psychological, and
health gains to be realized by
abstaining from sexual activity;
``(ii) teaches abstinence from sexual
activity outside marriage as the
expected standard for all school age
children;
``(iii) teaches that abstinence from
sexual activity is the only certain way
to avoid out-of-wedlock pregnancy,
sexually transmitted diseases, and
other associated health problems;
``(iv) teaches that a mutually
faithful monogamous relationship in
context of marriage is the expected
standard of human sexual activity;
``(v) teaches that sexual activity
outside of the context of marriage is
likely to have harmful psychological
and physical effects;
``(vi) teaches that bearing children
out-of-wedlock is likely to have
harmful consequences for the child, the
child's parents, and society;
``(vii) teaches young people how to
reject sexual advances and how alcohol
and drug use increases vulnerability to
sexual advances; and
``(viii) teaches the importance of
attaining self-sufficiency before
engaging in sexual activity.
``(B) Such term means a medically and
scientifically accurate educational or
motivational program which promotes abstinence
and educates those who are currently sexually
active or at risk of sexual activity about
additional methods to prevent unintended
pregnancy or reduce other health risks.
``(3) Certain requirements.--
``(A) Limitation regarding inaccurate
information.--None of the funds made available
under this section may be used to provide
abstinence education that includes information
that is medically and scientifically
inaccurate. For purposes of this section, the
term `medically and scientifically inaccurate'
means information that is unsupported or
contradicted by a preponderance of peer-
reviewed research by leading medical,
psychological, psychiatric, and public health
publications, organizations and agencies.
``(B) Effectiveness regarding certain
matters.--None of the funds made available
under this section may be used for a program
unless the program is based on a model that has
been demonstrated to be effective in preventing
unintended pregnancy, or in reducing the
transmission of a sexually transmitted disease,
including the human immunodeficiency virus. The
preceding sentence does not apply to any
program that was approved and funded under this
section on or before September 30, 2007.
``(c) Applicability of Certain Sections.--
``(1) Requirements.--Sections 503, 507, and 508 apply
to allotments under subsection (a) to the same extent
and in the same manner as such sections apply to
allotments under section 502(c).
``(2) Discretion of secretary.--Sections 505 and 506
apply to allotments under subsection (a) to the extent
determined by the Secretary to be appropriate.
``(d) Authorization of Appropriations.--For the purpose of
allotments under subsection (a), there is authorized to be
appropriated $50,000,000 for each of fiscal years 2008 and
2009.''.
In the matter proposed to be inserted by section 1001(d)(1),
strike ``44.63 percent'' and insert ``40 percent (33 percent on
cigars removed after December 31, 2007, and before October 1,
2013)''.
Conform the table of contents accordingly.