[House Report 111-448]
[From the U.S. Government Publishing Office]


111th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     111-448

======================================================================



 
PROVIDING FOR CONSIDERATION OF THE SENATE AMENDMENTS 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, AND PROVIDING 
FOR CONSIDERATION OF THE BILL (H.R. 4872) TO PROVIDE FOR RECONCILIATION 
PURSUANT TO SECTION 202 OF THE CONCURRENT RESOLUTION ON THE BUDGET FOR 
                            FISCAL YEAR 2010

                                _______
                                

 March 21, 2010 (legislative day of March 20, 2010).--Referred to the 
                House Calendar and ordered to be printed

                                _______
                                

  Ms. Slaughter, from the Committee on Rules, submitted the following

                              R E P O R T

                      [To accompany H. Res. 1203]

    The Committee on Rules, having had under consideration 
House Resolution 1203, by a record vote of 8 to 5, 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 of the Senate 
amendments to H.R. 3590, the ``Patient Protection and 
Affordable Care Act,'' and H.R. 4872, the ``Reconciliation Act 
of 2010.''
    The resolution provides two hours of debate on the topic of 
the Senate amendments and the topic of H.R. 4872 equally 
divided and controlled by the Majority Leader and Minority 
Leader or their designees.
    With respect to the Senate amendments to H.R. 3590, the 
resolution makes in order a motion offered by the Majority 
Leader or a designee that the House concur in the Senate 
amendments. The motion shall be in order without intervention 
of any point of order except those arising under clause 10 of 
rule XXI. The Senate amendments and the motion shall be 
considered as read.
    If the motion to concur in the Senate amendments is 
adopted, the resolution provides for consideration of H.R. 4872 
under a closed rule. The resolution waives all points of order 
against consideration of H.R. 4872 except those arising under 
clause 10 of rule XXI. It provides that the amendment in the 
nature of a substitute printed in part A of this report, 
modified by the amendment printed in part B of this report, 
shall be considered as adopted and the bill, as amended, shall 
be considered as read. The resolution waives all points of 
order against H.R. 4872, as amended. The resolution provides 
one motion to recommit H.R. 4872 with or without instructions.
    Until completion of proceedings enabled by the first three 
sections of this resolution, (a) the Chair may decline to 
entertain any intervening motion (except as expressly provided 
herein), resolution, question, or notice; (b) the Chair may 
decline to entertain the question of consideration; (c) the 
Chair may postpone such proceedings to such time as may be 
designated by the Speaker; (d) the second sentence of clause 
1(a) of rule XIX shall not apply (regarding 40 minutes of 
debate on non-debatable questions); and (e) any proposition 
admissible under the first three sections of this resolution 
shall be considered as read.
    Finally, the resolution directs the Clerk, in the 
engrossment of H.R. 4872, to amend the title to read: ``An act 
to provide for reconciliation pursuant to title II of the 
concurrent resolution on the budget for fiscal year 2010 (S. 
Con. Res. 13).''

                         EXPLANATION OF WAIVERS

    Although the rule waives all points of order against 
consideration of the motion to concur in the Senate amendments 
to H.R. 3590 (except those arising under clause 10 of rule 
XXI), the Committee is not aware of any points of order against 
the motion. The waiver of all points of order against the 
motion is prophylactic.
    The waiver of all points of order against consideration of 
H.R. 4872 (except those arising under clause 10 of rule XXI) 
includes a waiver of clause 9 of rule XXI (regarding earmark 
disclosure) and clause 3(d)(2) of rule XIII (cost estimate). 
The waiver of all points of order against provisions in H.R. 
4872, as amended, includes a waiver of clause 4 of rule XXI 
(appropriations-in-legislation) and clause 5(a) of rule XXI 
(tax or tariff reported by committee without that 
jurisdiction).

                            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. 330

    Date: March 20, 2010.
    Measure: H.R. 4872 and Senate Amendments to H.R. 3590.
    Motion by: Mr. Dreier.
    Summary of motion: To report an open rule.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 331

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Dreier.
    Summary of motion: To amend the rule to provide that for 
any record vote demanded on passage to H.R. 4872, the Speaker 
shall use her authority pursuant to clause 3 of rule 26 to 
direct the Clerk to conduct such vote by call of the roll.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Arcuri--Nay; 
Perlmutter--Nay; Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-
Balart, L.--Yea; Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 332

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Dreier.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Barton (TX), #53, which would 
prevent this bill from taking effect until the Office of 
Management and Budget certifies that the federal budget deficit 
has been eliminated.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 333

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Dreier.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Shimkus (IL), #55, which would 
require a certification that the bill would lower national 
health costs.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay: 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 334

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Dreier.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Barton (TX), #68, which would 
strike all taxes in the bill.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 335

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Dreier.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Barton (TX) and Rep. Johnson 
(TX), #48, which would remove the provision which provides 
extra funds to Louisiana's Medicaid program.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 336

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Dreier.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Barton (TX) and Rep. Johnson 
(TX), #49, which would remove the provision which provides 
funds for a medical facility in Connecticut.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 337

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Dreier.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Barton (TX) and Rep. Johnson 
(TX), #50, which would remove the provision that would allow 
certain hospitals to benefit from Section 508 if it means 
higher Medicare payments.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 338

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Dreier.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Barton (TX) and Rep. Johnson 
(TX), #54, which would remove the provision that provides for 
increased Medicare payments to hospitals and doctors in 
frontier states.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 339

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Dreier.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Barton (TX) and Rep. Johnson 
(TX), #70, which would repeal a provision providing Medicare 
coverage to certain individuals exposed to environmental health 
hazards.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 340

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Dreier.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Barton (TX) and Rep. Johnson 
(TX), #76, which would repeal section 6001 of the bill, 
Limitation on Medicare exception to the prohibition on certain 
physician referrals for hospitals.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 341

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Dreier.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Scalise (LA), #65, which would 
strike the individual health care mandate.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 342

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Dreier.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Shadegg (AZ) and Rep. Broun 
(GA) and Rep. Blackburn (TN), #84, which would add a section on 
interstate purchasing of health insurance.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 343

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Dreier.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Broun (GA), #88, which would 
allow for 100% deductibility of individual medical expenses.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 344

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Lincoln Diaz-Balart of Florida.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Brown-Waite (FL), #82, which 
would eliminate any cuts to Medicare in the bill.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 345

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Lincoln Diaz-Balart of Florida.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Cassidy (LA), #91, which would 
clarify that high-deductible health plans with an HSA meet the 
definition of adequate coverage. Furthermore, any new standards 
adopted by the Secretary shall not apply to high-deductible 
health plans and health savings accounts if such standards 
would have the effect of disqualifying such plans from meeting 
the essential benefit package requirements.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay, Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 346

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Lincoln Diaz-Balart of Florida.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Cole (OK), #3, which would 
require that savings resulting from spending reductions in 
Medicare will stay in Medicare to pay down long-term unfunded 
financial obligations.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 347

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Lincoln Diaz-Balart of Florida.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Rogers (MI), #32, which would 
express the sense of Congress that any new Social Security 
payroll tax revenue that results from this legislation could 
only be used for future Social Security benefit payments.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 348

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Lincoln Diaz-Balart of Florida.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Franks (AZ), #43, which would 
prohibit cuts to Medicare Advantage plans.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay, Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 349

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Lincoln Diaz-Balart of Florida.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Rogers (MI), #73, which would 
require there to be no changes to Medicare Advantage for a 
given year until the HHS Secretary certifies that no senior 
will be forced away from or losing their enrollment in the MA 
plan they were enrolled on as of the day before enactment of 
the bill.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 350

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Lincoln Diaz-Balart of Florida.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Herger (CA) and Rep. Boustany 
Jr. (LA) and Rep. Broun (GA), #45, would prohibit CMS from 
making coverage determinations using Comparative Effectiveness 
Research solely on the basis of cost.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 351

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Lincoln Diaz-Balart of Florida.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Burgess (TX), #19, which would 
require that to have a qualified state plan under the Medicaid 
program states must pay providers at least 75% of the payment 
rate paid to a provider under the state employees plan or the 
Federal Employees Health Benefit Plan (FEHBP) most chosen by 
families. For dental & vision services, in the case where 
such services are covered under a state employee plan, 
providers must be paid at 75% of the rate paid under the plan. 
In the case where supplemental dental and vision services are 
not offered to a state employee providers must be paid at a 
rate of 75% of the rate paid by the supplemental (vision & 
dental) FEHBP plan most often chosen by families.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 352

    Date March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Lincoln Diaz-Balart of Florida.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Burgess (TX), #20, which would 
establish a utilization review and appeals process for 
qualified health plans.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 353

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Lincoln Diaz-Balart of Florida.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Terry (NE), #79, which would 
strike Medicare payment cuts to disproportionate share 
hospitals.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 354

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Lincoln Diaz-Balart of Florida.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Terry (NE), #52, which would 
strike market basket update reductions.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 355

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Lincoln Diaz-Balart of Florida.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Upton (MI), #78, which would 
prohibit the bill from taking effect until the Medicare 
Trustees publish projections that show that Medicare is solvent 
for the next 30 years.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 356

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Lincoln Diaz-Balart of Florida.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Whitfield (KY), #56, which 
would remove the ``prompt pay'' discount from the Medicare part 
B reimbursement formula.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 357

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Lincoln Diaz-Balart of Florida.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Whitfield (KY), #57, which 
which would place a moratorium on the cuts to reimbursement for 
procedure performed by interventional pain physicians.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 358

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Lincoln Diaz-Balart of Florida.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Lummis (WY) and Rep. Johnson 
(TX), #41, which would allow States to opt out of any 
provisions of the bill to the extent that they mandate the 
purchasing of health insurance by residents in such State, 
mandate the provision of health insurance by employers in such 
State, or interfere with the ability of patients to privately 
contract with medical providers and insurers under the laws of 
such State.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 359

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Lincoln Diaz-Balart of Florida.
    Summary of motion: To make in order and provide appropriate 
waivers for substitute amendment #95, offered by Rep. Issa 
(CA), which would strike all after the enacting clause and 
insert language that would allow every American to obtain the 
same health insurance that members of Congress have by using 
the existing framework of the Federal Employees Health Benefits 
Plan (FEHBP). The Office of Personnel Management (OPM) would 
contract with insurance providers to make private health 
insurance plans available to all Americans.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 360

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Buyer (IN) and Rep. McKeon 
(CA), #31, which would protect the integrity and independence 
of the Department of Defense (DOD) and the Department of 
Veterans Affairs (VA) health care systems and state that the 
TRICARE program and veterans' health care programs meet all of 
the requirements for individual health insurance under the 
bill.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 361

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Blackburn (TN), #12, which 
would prohibit exchange plans from being established until the 
HHS Secretary certifies that the establishment of exchange 
plans will not cause the cost of the average price of private 
health insurance premiums to increase.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 362

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Blackburn (TN), #8, which 
would provide that if OMB submits a report saying that the 
costs of title I of the bill and the Patient Protection and 
Affordable Care Act are 25% or greater than the Federal budget, 
than the Congress shall consider a joint resolution to repeal 
such provisions.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 363

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Flake (AZ), #106, which would 
strike the employer mandate to provide health insurance for 
employees.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 364

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Broun (GA), #85, which would 
require any business that is characterized as a minority owned 
business or small business concern (as defined by section 3 of 
the Small Business Act, 15 U.S.C. 632) is exempt from all 
employer mandates.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 365

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Broun (GA), #86, which would 
exempt any business whose gross revenues per year do not exceed 
$500,000 from all employer mandates.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 366

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Paulsen (MN), #42, which would 
exclude temporary workers from the employer mandate.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 367

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for amendment to be separately debatable for 10 minutes 
each by Rep. Heller (NV), #97, prevents the $2,000 per employee 
tax from impacting employers in states where unemployment is 
greater than 6 percent.; and the amendment by Rep. Upton (MI), 
#77, would prohibit the employer mandate from going into effect 
if unemployment is over 7%.; and the amendment by Rep. Kingston 
(GA), #99, would suspend the employer mandate for every year 
that the national unemployment rate is at or above 9%.; and the 
amendment by Rep. Rogers (MI), #64, would prohibit the employer 
mandate from going into effect if national unemployment is over 
10%.; and the amendment by Rep. Rogers (MI), #51, would 
prohibit the employer mandate from going into effect if in a 
state where unemployment is over 10%
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 368

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Shimkus (IL), #58, which would 
allow states to opt-out of the Medicaid expansion.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 369

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Shimkus (IL), #47, which would 
provide funds to Medicaid recipients so they can buy into 
employer-sponsored insurance.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 370

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Paulsen (MN) and Rep. Lance 
(NJ) and Rep. Dent (PA) and Rep. Gerlach (PA), #30, which would 
remove the medical innovation tax and replace it with 
unobligated stimulus funds.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 371

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Dent (PA), #89, which would 
add a new division titled, ending defensive medicine and 
encouraging innovation.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 372

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Shadegg (AZ) and Rep. Broun 
(GA), #83, which adds a section to establish universal access 
programs to improve high risk pools and reinsurance markets.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 373

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Broun (GA), #46, which would 
provide individuals 100% deductibility for all medical 
expenses; reform EMTALA; provide for cooperative governing of 
individual health insurance coverage; and provide for 
Association Health Plans. The amendment is the same as H.R. 
3889.
    Results: Defeated 3-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Sessions--Yea; Foxx--
Yea; Slaughter--Nay.

Rules Committee record vote No. 374

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Burgess (TX), #61, which would 
add a division based on the medical liability reforms adopted 
in Texas.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 375

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for amendments Rep. Hall (TX), #69, would require a 
social security number for eligibility for participation in an 
exchange; and the amendment by Rep. Hall (TX), #80, would 
require a valid photo ID when applying for Medicaid or SCHIP.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 376

    Date: March 2, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Heller (NV) and Rep. Johnson 
(TX), #96, which strikes the individual mandate exemption for 
illegal immigrants.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 377

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for amendment to be separately debatable for 10 minutes 
each and considered: by Rep. Hinojosa (TX), #105, would add a 
Hold Harmless Amendment for those hospitals that serve High 
Poverty Areas and are subject to reductions in their Medicare 
and Medicaid Disproportionate Share Hospital Payments. Would 
require MEDPAC to conduct a study that determines the continued 
operability of hospitals in High Poverty Areas. The Secretary 
of Health and Human Services would enact recommendations based 
on the study to ensure continued access to care by individuals 
served by such hospitals; and the amendment by Rep. Jackson Lee 
(TX), #92, would strike Medicare limits on expanding physician-
owned hospitals; and the amendment by Rep. Jackson Lee (TX), 
#93, would provide an exception to Medicare limits on 
physician- owned hospitals by providing an exception for safety 
net hospitals (meets criteria for disproportionate share 
hospital or high number of emergency room visits).; and the 
amendment by Rep. Jackson Lee (TX), #94, would amend the 
definition for ``high Medicaid facility.''
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 378

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Dr. Foxx.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Foxx (NC), #6, which would 
strike the entire Student Aid and Fiscal Responsibility Act 
(SAFRA) from the Amendment in the Nature of a Substitute to 
H.R. 4872.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 379

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Dr. Foxx.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Broun (GA) and Rep. Johnson 
(TX) and Rep. Franks (AZ), #98, which would provide that 
nothing in the Patient Protection and Affordable Care Act or 
this Act may authorize or permit access to or coverage of 
abortions except in the case of a woman who suffers a physical 
disorder, physical injury, or physical illness that would, as 
certified by a physician, place the woman in danger of death 
unless an abortion is performed; or if the pregnancy is the 
result of an act of forcible rape or incest.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 380

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Dr. Foxx.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Brown-Waite (FL), #67, which 
would repeal the sections of the bill that require the IRS to 
enforce the individual mandate.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 381

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Dr. Foxx.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Blackburn (TN), #13, which 
would prohibit the Federal government from passing any law that 
would give it authority to ration health care for the American 
people.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 382

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Dr. Foxx.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Roskam (IL), #90, which would 
strike the current section 1302, Essential Health Benefits 
Requirements, and replace with a new section, Medicare Waste, 
Fraud, and Abuse Prevention Pilot Program.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 383

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Dr. Foxx.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Kingston (GA), #101, which 
would suspend new taxes unless Medicare fraud is below 1%.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 384

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Dr. Foxx.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Lee (NY), #11, which would 
create a 3 year/5 state medical tribunal pilot program to be 
administered by the Secretary of HHS.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 385

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Dr. Foxx.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Roe (TN), #44, which would 
repeal the enactment of the Independent Medicare Advisory 
Board.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 386

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Dr. Foxx.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Gingrey (GA), #29, which would 
state that nothing in H.R. 4872 shall be construed to allow any 
Federal employee or political appointee to dictate how a 
medical provider practices medicine.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 387

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Dr. Foxx.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Stearns (FL), #17, which would 
require that any written, visual or audio materials distributed 
through a covered official, entity or program shall be in 
English only.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 388

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Dr. Foxx.
    Summary of motion: To make in order and provide appropriate 
waivers for amendments by Rep. Sullivan (OK), #22, which would 
require the HHS Secretary to conduct a study on new and old 
programs affected by this legislation to determine if there is 
any program duplication. Would require the Secretary to write a 
report on the study within one year of the enactment of this 
bill. After writing that report, the Secretary would be 
required to eliminate any duplicative programs within one year; 
and the amendment by Rep. Sullivan (OK), #23, which would 
require the HHS Secretary to conduct a study on new and old 
grant programs affected by this legislation to determine if 
there is any program duplication. Would require the Secretary 
to write a report on the study within one year of the enactment 
of this bill. After writing that report, the Secretary would be 
required to eliminate any duplicative programs within one year.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 389

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Dr. Foxx.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Terry (NE), #21, which would 
establish the Citizen's Congressional Health Benefits Program 
(CCHBP).
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 390

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Dr. Foxx.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Blackburn (TN), #4, which 
would require the HHS Secretary to certify that no American 
will lose access to his or her current health insurance due to 
the establishment and operation of health plans offered through 
a state Exchange. This will be an annual certification. Until 
certification is made, no State is required or penalized for 
the failure to establish plans in an Exchange.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 391

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Dr. Foxx.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Blackburn (TN), #7, which 
would provide that nothing in the Act shall preclude an 
individual from purchasing or maintaining insurance qualifying 
for Health Savings Account deposits and nothing shall interfere 
with their ability to continue to make deposits according to 
the schedule created in the 2006 HSA legislation.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 392

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Dr. Foxx.
    Summary of motion: To make in order and provide appropriate 
waivers for amendment en bloc by Rep. Walden (OR), #63, which 
would ensure proportional representation of interest of rural 
areas on IPAB.; and the amendment by Rep. Walden (OR), #71, 
would ensure that MEDPAC has adequate rural representation.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 393

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Dr. Foxx.
    Summary of motion: To make in order and provide appropriate 
waivers for amendments by Rep. Moore (WI), #9, would change the 
date when insurers would need to comply with the new Medical 
Loss Ratio requirements from 2011 to 2014, to conform to when 
the American Health Benefits Exchanges will be established. 
Redirects MLR rebates to the Treasury; and the amendment by 
Rep. Moore (WI), #10, would change the date when insurers would 
be required to comply with new Medical Loss Ratio (MLR) 
requirements from the current draft date of 2011 to 2014, 
synchronizing it with the year when the American Health Benefit 
Exchanges will be established. Redirects the MLR rebates to the 
Treasury to be made available for the funding of premium 
assistance credits.
    Results: Defeated 4-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Arcuri--Nay; Perlmutter--Nay; 
Pingree--Nay; Polis--Nay; Dreier--Yea; Diaz-Balart, L.--Yea; 
Sessions--Yea; Foxx--Yea; Slaughter--Nay.

Rules Committee record vote No. 394

    Date: March 20, 2010.
    Measure: H.R. 4872.
    Motion by: Ms. Slaughter.
    Summary of motion: To report the rule.
    Results: Adopted 8-5.
    Vote by Members: McGovern--Yea; Hastings (FL)--Yea; 
Matsui--Yea; Cardoza--Yea; Arcuri--Nay; Perlmutter--Yea; 
Pingree--Yea; Polis--Yea; Dreier--Nay; Diaz-Balart, L.--Nay; 
Sessions--Nay; Foxx--Nay; Slaughter--Yea.

SUMMARY OF THE AMENDMENT IN THE NATURE OF A SUBSTITUTE TO H.R. 4872 IN 
                   PART A TO BE CONSIDERED AS ADOPTED

    Improves the financing for premiums and cost sharing for 
individuals with incomes up to 400% of the federal poverty 
level. Modifies the assessment that individuals who choose to 
remain uninsured pay in three ways: (a) exempts the income 
below the filing threshold, (b) lowers the flat payment from 
$495 to $325 in 2015 and from $750 to $695 in 2016 and (c) 
raises the percent of income that is an alternative payment 
amount from 0.5 to 1.0% in 2014, 1.0 to 2.0% in 2015, and 2.0 
to 2.5% for 2016 and subsequent years to make the assessment 
more progressive. Improves the transition to the employer 
responsibility policy for employers with 50 or more full-time 
equivalent workers (FTE) by subtracting the first 30 full time 
employees from the payment calculation. Modifies the definition 
of income that is used for purposes of subsidy eligibility and 
the individual responsibility requirement. Provides a $250 
rebate for all Medicare Part D enrollees who enter the donut 
hole in 2010. Builds on pharmaceutical manufacturers' 50% 
discount on brand-name drugs beginning in 2011 to completely 
close the donut hole with 75% discounts on brand-name and 
generic drugs by 2020. Freezes Medicare Advantage payments in 
2011. Beginning in 2012, the provision reduces Medicare 
Advantage benchmarks relative to current levels. Ensures 
Medicare Advantage plans spend at least 85% of revenue on 
medical costs or activities that improve quality of care, 
rather than profit and overhead. Strikes the provision for a 
permanent 100% federal matching rate for Nebraska for the 
Medicaid costs of expansion populations. Provides federal 
Medicaid matching payments for the costs of services to 
expansion populations at the following rates in all states: 
100% in 2014, 2015, and 2016; 95% in 2017; 94% in 2018; 93% in 
2019; and 90% thereafter. In the case of expansion states, 
reduces the state share of the costs of covering nonpregnant 
childless adults by 50% in 2014, 60% in 2015, 70% in 2016, 80% 
in 2017, 90% in 2018. Requires that Medicaid payment rates to 
primary care physicians for furnishing primary care services be 
no less than 100% of Medicare payment rates in 2013 and 2014. 
Lowers the reduction in federal Medicaid DSH payments from 
$18.1 billion to $14.1 billion and advances the reductions to 
begin in fiscal year 2014. Delays the application of the high-
cost plan excise tax until 2018, which gives the plans time to 
implement and realize the cost savings of reform; increasing 
the dollar thresholds to $10,200 for single coverage and 
$27,500 for family coverage ($11,850 and $30,950 for retirees 
and employees in high risk professions). Amends the Higher 
Education Act to include mandatory funding for the Pell Grant. 
Terminates the FFEL program for federal consolidation loans. 
This section also provides that, for a 1 year period, borrowers 
who have loans under both the Direct Lending program and the 
FFEL program, or who have loans under either program as well as 
loans that have been sold to the Secretary, may consolidate 
such loans under the Direct Lending program regardless of 
whether such borrowers have entered repayment on such loans. 
Directs the Secretary to award contracts for servicing federal 
Direct Loans to eligible non-profit servicers. Permits the 
Secretary to reallocate, increase, reduce or terminate an 
eligible non-profit servicer's allocation based on the 
performance of such servicer. Extends the prohibition of 
lifetime limits, prohibition on rescissions, and a requirement 
to provide coverage for non-dependent children up to age 26 to 
all existing health insurance plans starting six months after 
enactment. Starting in 2014, extends the prohibition on 
excessive waiting periods to existing health plans. For group 
health plans, prohibits pre-existing condition exclusions in 
2014 (for children, they are prohibited starting six months 
after enactment), restricts annual limits beginning six months 
after enactment, and prohibits them starting in 2014. Increases 
mandatory funding for community health centers to $11 billion 
over five years (FY 2011-FY 2015).

SUMMARY OF THE AMENDMENT TO THE AMENDMENT IN THE NATURE OF A SUBSTITUTE 
           TO H.R. 4872 IN PART B TO BE CONSIDERED AS ADOPTED

    Would (1) reduce the growth rate of the Part D spending 
threshold for catastrophic benefits between 2014 and 2019, 
providing additional benefits for seniors with high drug costs; 
(2) add a transitional phase up period for the coding intensity 
adjustment for Medicare Advantage plans; (3) strike a provision 
that would have deposited funds collected from Medicare 
Advantage plans for failing to meet the medical loss ratio into 
the CMS Program Management Account; (4) insert a new section 
1108 that accelerates phase-in of Medicare physician practice 
expense adjustment for areas with below average practice 
expense payment rates. In 2010, national blend would be 
increased from \1/4\ to \1/2\. Inserts a new Section 1109 that 
provides an additional payment under the Medicare inpatient 
prospective payment systems to hospitals located in counties in 
the bottom quartile of counties as ranked by risk adjusted 
spending per Medicare enrollee; (5) clarify the timing for the 
election period for territories to choose to establish 
Exchanges; (6) clarify new requirements for community mental 
health centers to be eligible to participate in the Medicare 
partial hospitalization benefit; (7) strike section 1303 of the 
legislation (CMS-IRS Data Match to Identify Fraudulent 
Providers); (8) delete a provision providing for transfers of 
amounts collected from the supplementary medical insurance 
trust fund; (9) modify the pharmaceutical industry annual fee 
schedule; (10) modify the excise tax on importers and 
manufacturers of medical devices by lowering the rate to 2.3 
percent and by eliminating the exclusion for Class I medical 
devices (except if such devices are of a type which is 
purchased by the general public at retail and for individual 
use.); (11) strike section 1411 of the legislation (No Impact 
on Social Security Trust Funds); (12) amend section 1501 to 
incorporate the funds into the Trade Act and strikes the 
provision in section 1501 that expands the focus of programs to 
individuals eligible for unemployment insurance; (13) move the 
$13.5 billion in additional Pell funding for fiscal year 2011 
into section 401 of the Higher Education Act; (14) strike 
section 2102 of the legislation (Student Financial Assistance); 
and (15) strike section 2213 of the legislation (Agreements 
with State-Owned Banks.)

  PART A: TEXT OF THE AMENDMENT IN THE NATURE OF A SUBSTITUTE TO H.R. 
                    4872 TO BE CONSIDERED AS ADOPTED

  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

  (a) Short Title.--This Act may be cited as the ``Health Care 
and Education Affordability Reconciliation Act of 2010''.
  (b) Table of Contents.--The table of contents of this Act is 
as follows:

Sec. 1. Short title; table of contents.

           TITLE I--COVERAGE, MEDICARE, MEDICAID, AND REVENUES

                          Subtitle A--Coverage

Sec. 1001. Affordability.
Sec. 1002. Individual responsibility.
Sec. 1003. Employer responsibility.
Sec. 1004. Income definitions.
Sec. 1005. Implementation funding.

                          Subtitle B--Medicare

Sec. 1101. Closing the medicare prescription drug ``donut hole''.
Sec. 1102. Medicare Advantage payments.
Sec. 1103. Savings from limits on MA plan administrative costs.
Sec. 1104. Disproportionate share hospital (DSH) payments.
Sec. 1105. Market basket updates.
Sec. 1106. Physician ownership-referral.
Sec. 1107. Payment for imaging services.

                          Subtitle C--Medicaid

Sec. 1201. Federal funding for States.
Sec. 1202. Payments to primary care physicians.
Sec. 1203. Disproportionate share hospital payments.
Sec. 1204. Funding for the territories.
Sec. 1205. Delay in Community First Choice option.
Sec. 1206. Drug rebates for new formulations of existing drugs.

              Subtitle D--Reducing Fraud, Waste, and Abuse

Sec. 1301. Community mental health centers.
Sec. 1302. Medicare prepayment medical review limitations .
Sec. 1303. CMS-IRS data match to identify fraudulent providers.
Sec. 1304. Funding to fight fraud, waste, and abuse.
Sec. 1305. 90-day period of enhanced oversight for initial claims of DME 
          suppliers.

               Subtitle E--Provisions Relating to Revenue

Sec. 1401. High-cost plan excise tax.
Sec. 1402. Medicare tax.
Sec. 1403. Delay of limitation on health flexible spending arrangements 
          under cafeteria plans.
Sec. 1404. Brand name pharmaceuticals.
Sec. 1405. Excise tax on medical device manufacturers.
Sec. 1406. Health insurance providers.
Sec. 1407. Delay of elimination of deduction for expenses allocable to 
          medicare part D subsidy.
Sec. 1408. Elimination of unintended application of cellulosic biofuel 
          producer credit.
Sec. 1409. Codification of economic substance doctrine and penalties.
Sec. 1410. Time for payment of corporate estimated taxes.
Sec. 1411. No impact on Social Security trust funds.

                      Subtitle F--Other Provisions

Sec. 1501. Community college and career training grant program.

                     TITLE II--EDUCATION AND HEALTH

                          Subtitle A--Education

Sec. 2001. Short title; references.

               Part I--Investing in Students and Families

Sec. 2101. Federal Pell Grants.
Sec. 2102. Student financial assistance.
Sec. 2103. College access challenge grant program.
Sec. 2104. Investment in historically black colleges and universities 
          and minority-serving institutions.

                      Part II--Student Loan Reform

Sec. 2201. Termination of Federal Family Education Loan appropriations.
Sec. 2202. Termination of Federal loan insurance program.
Sec. 2203. Termination of applicable interest rates.
Sec. 2204. Termination of Federal payments to reduce student interest 
          costs.
Sec. 2205. Termination of FFEL PLUS Loans.
Sec. 2206. Federal Consolidation Loans.
Sec. 2207. Termination of Unsubsidized Stafford Loans for middle-income 
          borrowers.
Sec. 2208. Termination of special allowances.
Sec. 2209. Origination of Direct Loans at institutions outside the 
          United States.
Sec. 2210. Conforming amendments.
Sec. 2211. Terms and conditions of loans.
Sec. 2212. Contracts; mandatory funds.
Sec. 2213. Agreements with State-owned banks.
Sec. 2214. Income-based repayment.

                           Subtitle B--Health

Sec. 2301. Insurance reforms.
Sec. 2302. Drugs purchased by covered entities.
Sec. 2303. Community health centers.

          TITLE I--COVERAGE, MEDICARE, MEDICAID, AND REVENUES

                          Subtitle A--Coverage

SEC. 1001. AFFORDABILITY.

  (a) Premium Tax Credits.--Section 36B of the Internal Revenue 
Code of 1986, as added by section 1401 of the Patient 
Protection and Affordable Care Act and amended by section 10105 
of such Act, is amended--
          (1) in subsection (b)(3)(A)--
                  (A) in clause (i), by striking ``with respect 
                to any taxpayer'' and all that follows up to 
                the end period and inserting ``for any taxable 
                year shall be the percentage such that the 
                applicable percentage for any taxpayer whose 
                household income is within an income tier 
                specified in the following table shall 
                increase, on a sliding scale in a linear 
                manner, from the initial premium percentage to 
                the final premium percentage specified in such 
                table for such income tier:


 ``In the case of household
   income (expressed as a
  percent of poverty line)     The initial premium    The final premium
 within the following income     percentage is--       percentage is--
            tier:

Up to 133%                    2.0%                  2.0%
133% up to 150%               3.0%                  4.0%
150% up to 200%               4.0%                  6.3%
200% up to 250%               6.3%                  8.05%
250% up to 300%               8.05%                 9.5%
300% up to 400%               9.5%                  9.5%''; and


                  (B) by striking clauses (ii) and (iii), and 
                inserting the following:
                          ``(ii) Indexing.--
                                  ``(I) In general.--Subject to 
                                subclause (II), in the case of 
                                taxable years beginning in any 
                                calendar year after 2014, the 
                                initial and final applicable 
                                percentages under clause (i) 
                                (as in effect for the preceding 
                                calendar year after application 
                                of this clause) shall be 
                                adjusted to reflect the excess 
                                of the rate of premium growth 
                                for the preceding calendar year 
                                over the rate of income growth 
                                for the preceding calendar 
                                year.
                                  ``(II) Additional 
                                adjustment.--Except as provided 
                                in subclause (III), in the case 
                                of any calendar year after 
                                2018, the percentages described 
                                in subclause (I) shall, in 
                                addition to the adjustment 
                                under subclause (I), be 
                                adjusted to reflect the excess 
                                (if any) of the rate of premium 
                                growth estimated under 
                                subclause (I) for the preceding 
                                calendar year over the rate of 
                                growth in the consumer price 
                                index for the preceding 
                                calendar year.
                                  ``(III) Failsafe.--Subclause 
                                (II) shall apply for any 
                                calendar year only if the 
                                aggregate amount of premium tax 
                                credits under this section and 
                                cost-sharing reductions under 
                                section 1402 of the Patient 
                                Protection and Affordable Care 
                                Act for the preceding calendar 
                                year exceeds an amount equal to 
                                0.504 percent of the gross 
                                domestic product for the 
                                preceding calendar year.''; and
          (2) in subsection (c)(2)(C)--
                  (A) by striking ``9.8 percent'' in clauses 
                (i)(II) and (iv) and inserting ``9.5 percent'', 
                and
                  (B) by striking ``(b)(3)(A)(iii)'' in clause 
                (iv) and inserting ``(b)(3)(A)(ii)''.
  (b) Cost Sharing.--Section 1402(c) of the Patient Protection 
and Affordable Care Act is amended--
          (1) in paragraph (1)(B)(i)--
                  (A) in subclause (I), by striking ``90'' and 
                inserting ``94'';
                  (B) in subclause (II)--
                          (i) by striking ``80'' and inserting 
                        ``87''; and
                          (ii) by striking ``and''; and
                  (C) by striking subclause (III) and inserting 
                the following:
                                  ``(III) 73 percent in the 
                                case of an eligible insured 
                                whose household income is more 
                                than 200 percent but not more 
                                than 250 percent of the poverty 
                                line for a family of the size 
                                involved; and
                                  ``(IV) 70 percent in the case 
                                of an eligible insured whose 
                                household income is more than 
                                250 percent but not more than 
                                400 percent of the poverty line 
                                for a family of the size 
                                involved.''; and
          (2) in paragraph (2)--
                  (A) in subparagraph (A)--
                          (i) by striking ``90'' and inserting 
                        ``94''; and
                          (ii) by striking ``and'';
                  (B) in subparagraph (B)--
                          (i) by striking ``80'' and inserting 
                        ``87''; and
                          (ii) by striking the period and 
                        inserting ``; and''; and
                  (C) by inserting after subparagraph (B) the 
                following new subparagraph:
                  ``(C) in the case of an eligible insured 
                whose household income is more than 200 percent 
                but not more than 250 percent of the poverty 
                line for a family of the size involved, 
                increase the plan's share of the total allowed 
                costs of benefits provided under the plan to 73 
                percent of such costs.''.

SEC. 1002. INDIVIDUAL RESPONSIBILITY.

  (a) Amounts.--Section 5000A(c) of the Internal Revenue Code 
of 1986, as added by section 1501(b) of the Patient Protection 
and Affordable Care Act and amended by section 10106 of such 
Act, is amended--
          (1) in paragraph (2)(B)--
                  (A) in the matter preceding clause (i), by--
                          (i) inserting ``the excess of'' 
                        before ``the taxpayer's household 
                        income''; and
                          (ii) inserting ``for the taxable year 
                        over the amount of gross income 
                        specified in section 6012(a)(1) with 
                        respect to the taxpayer'' before ``for 
                        the taxable year'';
                  (B) in clause (i), by striking ``0.5'' and 
                inserting ``1.0'';
                  (C) in clause (ii), by striking ``1.0'' and 
                inserting ``2.0''; and
                  (D) in clause (iii), by striking ``2.0'' and 
                inserting ``2.5''; and
          (2) in paragraph (3)--
                  (A) in subparagraph (A), by striking ``$750'' 
                and inserting ``$695'';
                  (B) in subparagraph (B), by striking ``$495'' 
                and inserting ``$325''; and
                  (C) in subparagraph (D)--
                          (i) in the matter preceding clause 
                        (i), by striking ``$750'' and inserting 
                        ``$695''; and
                          (ii) in clause (i), by striking 
                        ``$750'' and inserting ``$695''.
  (b) Threshold.--Section 5000A of such Code, as so added and 
amended, is amended--
          (1) by striking subsection (c)(4)(D); and
          (2) in subsection (e)(2)--
                  (A) by striking ``under 100 percent of 
                poverty line'' and inserting ``below filing 
                threshold''; and
                  (B) by striking all that follows ``less 
                than'' and inserting ``the amount of gross 
                income specified in section 6012(a)(1) with 
                respect to the taxpayer.''.

SEC. 1003. EMPLOYER RESPONSIBILITY.

  (a) Payment Calculation.--Subparagraph (D) of subsection 
(d)(2) of section 4980H of the Internal Revenue Code of 1986, 
as added by section 1513 of the Patient Protection and 
Affordable Care Act and amended by section 10106 of such Act, 
is amended to read as follows:
                  ``(D) Application of employer size to 
                assessable penalties.--
                          ``(i) In general.--The number of 
                        individuals employed by an applicable 
                        large employer as full-time employees 
                        during any month shall be reduced by 30 
                        solely for purposes of calculating--
                                  ``(I) the assessable payment 
                                under subsection (a), or
                                  ``(II) the overall limitation 
                                under subsection (b)(2).
                          ``(ii) Aggregation.--In the case of 
                        persons treated as 1 employer under 
                        subparagraph (C)(i), only 1 reduction 
                        under subclause (I) or (II) shall be 
                        allowed with respect to such persons 
                        and such reduction shall be allocated 
                        among such persons ratably on the basis 
                        of the number of full-time employees 
                        employed by each such person.''.
  (b) Applicable Payment Amount.--Section 4980H of such Code, 
as so added and amended, is amended--
          (1) in the flush text following subsection (c)(1)(B), 
        by striking ``400 percent of the applicable payment 
        amount'' and inserting ``an amount equal to \1/12\ of 
        $3,000'';
          (2) in subsection (d)(1), by striking ``$750'' and 
        inserting ``$2,000''; and
          (3) in subsection (d)(5)(A), in the matter preceding 
        clause (i), by striking ``subsection (b)(2) and 
        (d)(1)'' and inserting ``subsection (b) and paragraph 
        (1)''.
  (c) Counting Part-time Workers in Setting the Threshold for 
Employer Responsibility.--Section 4980H(d)(2) of such Code, as 
so added and amended and as amended by subsection (a), is 
amended by adding at the end the following new subparagraph:
                  ``(E) Full-time equivalents treated as full-
                time employees.--Solely for purposes of 
                determining whether an employer is an 
                applicable large employer under this paragraph, 
                an employer shall, in addition to the number of 
                full-time employees for any month otherwise 
                determined, include for such month a number of 
                full-time employees determined by dividing the 
                aggregate number of hours of service of 
                employees who are not full-time employees for 
                the month by 120.''.
  (d) Eliminating Waiting Period Assessment.--Section 4980H of 
such Code, as so added and amended and as amended by the 
preceding subsections, is amended by striking subsection (b) 
and redesignating subsections (c), (d), and (e) as subsections 
(b), (c), and (d), respectively.

SEC. 1004. INCOME DEFINITIONS.

  (a) Modified Adjusted Gross Income.--
          (1) In general.--The following provisions of the 
        Internal Revenue Code of 1986 are each amended by 
        striking ``modified gross'' each place it appears and 
        inserting ``modified adjusted gross'':
                  (A) Clauses (i) and (ii) of section 
                36B(d)(2)(A), as added by section 1401 of the 
                Patient Protection and Affordable Care Act.
                  (B) Section 6103(l)(21)(A)(iv), as added by 
                section 1414 of such Act.
                  (C) Clauses (i) and (ii) of section 
                5000A(c)(4), as added by section 1501(b) of 
                such Act.
          (2) Definition.--
                  (A) Section 36B(d)(2)(B) of such Code, as so 
                added, is amended to read as follows:
                  ``(B) Modified adjusted gross income.--The 
                term `modified adjusted gross income' means 
                adjusted gross income increased by--
                          ``(i) any amount excluded from gross 
                        income under section 911, and
                          ``(ii) any amount of interest 
                        received or accrued by the taxpayer 
                        during the taxable year which is exempt 
                        from tax.''.
                  (B) Section 5000A(c)(4)(C) of such Code, as 
                so added, is amended to read as follows:
                  ``(C) Modified adjusted gross income.--The 
                term `modified adjusted gross income' means 
                adjusted gross income increased by--
                          ``(i) any amount excluded from gross 
                        income under section 911, and
                          ``(ii) any amount of interest 
                        received or accrued by the taxpayer 
                        during the taxable year which is exempt 
                        from tax.''.
  (b) Modified Adjusted Gross Income Definition.--
          (1) Medicaid.--Section 1902 of the Social Security 
        Act (42 U.S.C. 1396a) is amended by striking ``modified 
        gross income'' each place it appears in the text and 
        headings of the following provisions and inserting 
        ``modified adjusted gross income'':
                  (A) Paragraph (14) of subsection (e), as 
                added by section 2002(a) of the Patient 
                Protection and Affordable Care Act.
                  (B) Subsection (gg)(4)(A), as added by 
                section 2001(b) of such Act.
          (2) Chip.--
                  (A) State plan requirements.--Section 
                2102(b)(1)(B)(v) of the Social Security Act (42 
                U.S.C. 1397bb(b)(1)(B)(v)), as added by section 
                2101(d)(1) of the Patient Protection and 
                Affordable Care Act, is amended by striking 
                ``modified gross income'' and inserting 
                ``modified adjusted gross income''.
                  (B) Plan administration.--Section 
                2107(e)(1)(E) of the Social Security Act (42 
                U.S.C. 1397gg(e)(1)(E)), as added by section 
                2101(d)(2) of the Patient Protection and 
                Affordable Care Act, is amended by striking 
                ``modified gross income'' and inserting 
                ``modified adjusted gross income''.
  (c) No Excess Payments.--Section 36B(f) of the Internal 
Revenue Code of 1986, as added by section 1401(a) of the 
Patient Protection and Affordable Care Act, is amended by 
adding at the end the following new paragraph:
          ``(3) Information requirement.--Each Exchange (and 
        any other person specified by the Secretary) shall 
        provide the following information to the Secretary and 
        to the taxpayer with respect to any health plan 
        provided through the Exchange:
                  ``(A) The level of coverage described in 
                section 1302(d) of the Patient Protection and 
                Affordable Care Act and the period such 
                coverage was in effect.
                  ``(B) The total premium for the coverage 
                without regard to the credit under this section 
                or cost-sharing reductions under section 1402 
                of such Act.
                  ``(C) The aggregate amount of any advance 
                payment of such credit or reductions under 
                section 1412 of such Act.
                  ``(D) The name, address, and TIN of the 
                primary insured and the name and TIN of each 
                other individual obtaining coverage under the 
                policy.
                  ``(E) Any information provided to the 
                Exchange, including any change of 
                circumstances, necessary to determine 
                eligibility for, and the amount of, such 
                credit.
                  ``(F) Any other similar information necessary 
                to carry out this subsection and determine 
                whether a taxpayer has received excess advance 
                payments.''.
  (d) Adult Dependents.--
          (1) Exclusion of amounts expended for medical care.--
        The first sentence of section 105(b) of the Internal 
        Revenue Code of 1986 (relating to amounts expended for 
        medical care) is amended--
                  (A) by striking ``and his dependents'' and 
                inserting ``his dependents''; and
                  (B) by inserting before the period the 
                following: ``, and any child (as defined in 
                section 152(f)(1)) of the taxpayer who as of 
                the end of the taxable year has not attained 
                age 27''.
          (2) Self-employed health insurance deduction.--
        Section 162(l)(1) of such Code is amended to read as 
        follows:
          ``(1) Allowance of deduction.--In the case of a 
        taxpayer who is an employee within the meaning of 
        section 401(c)(1), there shall be allowed as a 
        deduction under this section an amount equal to the 
        amount paid during the taxable year for insurance which 
        constitutes medical care for--
                  ``(A) the taxpayer,
                  ``(B) the taxpayer's spouse,
                  ``(C) the taxpayer's dependents, and
                  ``(D) any child (as defined in section 
                152(f)(1)) of the taxpayer who as of the end of 
                the taxable year has not attained age 27.''.
          (3) Conforming amendments.--
                  (A) Internal revenue code.--Section 
                162(l)(2)(B) of such Code is amended by 
                inserting ``, or any dependent, or individual 
                described in subparagraph (D) of paragraph (1) 
                with respect to,'' after ``spouse of''.
                  (B) Public health service act.--Section 2714 
                of the Public Health Service Act, as added by 
                section 1001(5) of the Patient Protection and 
                Affordable Care Act, is amended by striking 
                subsection (c).
          (4) Sick and accident benefits provided to members of 
        a voluntary employees' beneficiary association and 
        their dependents.--Section 501(c)(9) of such Code is 
        amended by adding at the end the following new 
        sentence: ``For purposes of providing for the payment 
        of sick and accident benefits to members of such an 
        association and their dependents, the term `dependent' 
        shall include any individual who is a child (as defined 
        in section 152(f)(1)) of a member who as of the end of 
        the calendar year has not attained age 27.''.
          (5) Medical and other benefits for retired 
        employees.--Section 401(h) of such Code is amended by 
        adding at the end the following: ``For purposes of this 
        subsection, the term `dependent' shall include any 
        individual who is a child (as defined in section 
        152(f)(1)) of a retired employee who as of the end of 
        the calendar year has not attained age 27.''.
  (e) Five Percent Income Disregard for Certain Individuals.--
Section 1902(e)(14) of the Social Security Act (42 U.S.C. 
1396a(e)(14)), as amended by subsection (b)(1), is further 
amended--
          (1) in subparagraph (B), by striking ``No type'' and 
        inserting ``Subject to subparagraph (I), no type''; and
          (2) by adding at the end the following new 
        subparagraph:
                  ``(I) Treatment of portion of modified 
                adjusted gross income.--For purposes of 
                determining the income eligibility of an 
                individual for medical assistance whose 
                eligibility is determined based on the 
                application of modified adjusted gross income 
                under subparagraph (A), the State shall--
                          ``(i) determine the dollar equivalent 
                        of the difference between the upper 
                        income limit on eligibility for such an 
                        individual (expressed as a percentage 
                        of the poverty line) and such upper 
                        income limit increased by 5 percentage 
                        points; and
                          ``(ii) notwithstanding the 
                        requirement in subparagraph (A) with 
                        respect to use of modified adjusted 
                        gross income, utilize as the applicable 
                        income of such individual, in 
                        determining such income eligibility, an 
                        amount equal to the modified adjusted 
                        gross income applicable to such 
                        individual reduced by such dollar 
                        equivalent amount.''.

SEC. 1005. IMPLEMENTATION FUNDING.

  (a) In General.--There is hereby established a Health 
Insurance Reform Implementation Fund (referred to in this 
section as the ``Fund'') within the Department of Health and 
Human Services to carry out the Patient Protection and 
Affordable Care Act and this Act (and the amendments made by 
such Acts).
  (b) Funding.--There is appropriated to the Fund, out of any 
funds in the Treasury not otherwise appropriated, 
$1,000,000,000 for Federal administrative expenses to carry out 
such Act (and the amendments made by such Acts).

                          Subtitle B--Medicare

SEC. 1101. CLOSING THE MEDICARE PRESCRIPTION DRUG ``DONUT HOLE''.

  (a) Coverage Gap Rebate for 2010.--
          (1) In general.--Section 1860D-42 of the Social 
        Security Act (42 U.S.C. 1395w-152) is amended by adding 
        at the end the following new subsection:
  ``(c) Coverage Gap Rebate for 2010.--
          ``(1) In general.--In the case of an individual 
        described in subparagraphs (A) through (D) of section 
        1860D-14A(g)(1) who as of the last day of a calendar 
        quarter in 2010 has incurred costs for covered part D 
        drugs so that the individual has exceeded the initial 
        coverage limit under section 1860D-2(b)(3) for 2010, 
        the Secretary shall provide for payment from the 
        Medicare Prescription Drug Account of $250 to the 
        individual by not later than the 15th day of the third 
        month following the end of such quarter.
          ``(2) Limitation.--The Secretary shall provide only 1 
        payment under this subsection with respect to any 
        individual.''.
          (2) Repeal of provision.--Section 3315 of the Patient 
        Protection and Affordable Care Act (including the 
        amendments made by such section) is repealed, and any 
        provision of law amended or repealed by such sections 
        is hereby restored or revived as if such section had 
        not been enacted into law.
  (b) Closing the Donut Hole.--Part D of title XVIII of the 
Social Security Act (42 U.S.C. 1395w-101 et seq.), as amended 
by section 3301 of the Patient Protection and Affordable Care 
Act, is further amended--
          (1) in section 1860D-43--
                  (A) in subsection (b), by striking ``July 1, 
                2010'' and inserting ``January 1, 2011''; and
                  (B) in subsection (c)(2), by striking ``July 
                1, 2010, and ending on December 31, 2010,'' and 
                inserting ``January 1, 2011, and December 31, 
                2011,'';
          (2) in section 1860D-14A--
                  (A) in subsection (a)--
                          (i) by striking ``July 1, 2010'' and 
                        inserting ``January 1, 2011''; and
                          (ii) by striking ``April 1, 2010'' 
                        and inserting ``180 days after the date 
                        of the enactment of this section'';
                  (B) in subsection (b)(1)(C)--
                          (i) in the heading, by striking 
                        ``2010 and'';
                          (ii) by striking ``July 1, 2010'' and 
                        inserting ``January 1, 2011''; and
                          (iii) by striking ``May 1, 2010'' and 
                        inserting ``not later than 30 days 
                        after the date of the establishment of 
                        a model agreement under subsection 
                        (a)'';
                  (C) in subsection (c)--
                          (i) in paragraph (1)(A)(iii), by 
                        striking ``July 1, 2010, and ending on 
                        December 31, 2011'' and inserting 
                        ``January 1, 2011, and ending on 
                        December 31, 2011''; and
                          (ii) in paragraph (2), by striking 
                        ``2010'' and inserting ``2011'';
                  (D) in subsection (d)(2)(B), by striking 
                ``July 1, 2010, and ending on December 31, 
                2010'' and inserting ``January 1, 2011, and 
                ending on December 31, 2011''; and
                  (E) in subsection (g)(1)--
                          (i) in the matter before subparagraph 
                        (A), by striking ``an applicable drug'' 
                        and inserting ``a covered part D 
                        drug'';
                          (ii) by adding ``and'' at the end of 
                        subparagraph (C);
                          (iii) by striking subparagraph (D); 
                        and
                          (iv) by redesignating subparagraph 
                        (E) as subparagraph (D); and
          (3) in section 1860D-2(b) --
                  (A) in paragraph (2)(A), by striking ``The 
                coverage'' and inserting ``Subject to 
                subparagraphs (C) and (D), the coverage'';
                  (B) in paragraph (2)(B), by striking 
                ``subparagraph (A)(ii)'' and inserting 
                ``subparagraphs (A)(ii), (C), and (D)'';
                  (C) by adding at the end of paragraph (2) the 
                following new subparagraphs:
                  ``(C) Coverage for generic drugs in coverage 
                gap.--
                          ``(i) In general.--Except as provided 
                        in paragraph (4), the coverage for an 
                        applicable beneficiary (as defined in 
                        section 1860D-14A(g)(1)) has 
                        coinsurance (for costs above the 
                        initial coverage limit under paragraph 
                        (3) and below the out-of-pocket 
                        threshold) for covered part D drugs 
                        that are not applicable drugs under 
                        section 1860D-14A(g)(2) that is--
                                  ``(I) equal to the generic-
                                gap coinsurance percentage 
                                (specified in clause (ii)) for 
                                the year, or
                                  ``(II) actuarially equivalent 
                                (using processes and methods 
                                established under section 
                                1860D-11(c)) to an average 
                                expected payment of such 
                                percentage of such costs for 
                                covered part D drugs that are 
                                not applicable drugs under 
                                section 1860D-14A(g)(2).
                          ``(ii) Generic-gap coinsurance 
                        percentage.--The generic-gap 
                        coinsurance percentage specified in 
                        this clause for--
                                  ``(I) 2011 is 93 percent;
                                  ``(II) 2012 and each 
                                succeeding year before 2020 is 
                                the generic-gap coinsurance 
                                percentage under this clause 
                                for the previous year decreased 
                                by 7 percentage points; and
                                  ``(III) 2020 and each 
                                subsequent year is 25 percent.
                  ``(D) Coverage for applicable drugs in 
                coverage gap.--
                          ``(i) In general.--Except as provided 
                        in paragraph (4), the coverage for an 
                        applicable beneficiary (as defined in 
                        section 1860D-14A(g)(1)) has 
                        coinsurance (for costs above the 
                        initial coverage limit under paragraph 
                        (3) and below the out-of-pocket 
                        threshold) for the negotiated price (as 
                        defined in section 1860D-14A(g)(6)) of 
                        covered part D drugs that are 
                        applicable drugs under section 1860D-
                        14A(g)(2) that is--
                                  ``(I) equal to the difference 
                                between the applicable gap 
                                percentage (specified in clause 
                                (ii) for the year) and the 
                                discount percentage specified 
                                in section 1860D-14A(g)(4)(A) 
                                for such applicable drugs, or
                                  ``(II) actuarially equivalent 
                                (using processes and methods 
                                established under section 
                                1860D-11(c)) to an average 
                                expected payment of such 
                                percentage of such costs, for 
                                covered part D drugs that are 
                                applicable drugs under section 
                                1860D-14A(g)(2).
                          ``(ii) Applicable gap percentage.--
                        The applicable gap percentage specified 
                        in this clause for--
                                  ``(I) 2013 and 2014 is 97.5 
                                percent;
                                  ``(II) 2015 and 2016 is 95 
                                percent;
                                  ``(III) 2017 is 90 percent;
                                  ``(IV) 2018 is 85 percent;
                                  ``(V) 2019 is 80 percent; and
                                  ``(VI) 2020 and each 
                                subsequent year is 75 
                                percent.'';
                  (D) in paragraph (3)(A), as restored under 
                subsection (a)(2), by striking ``paragraph 
                (4)'' and inserting ``paragraphs (2)(C), 
                (2)(D), and (4)'';
                  (E) in paragraph (4)(E), by inserting before 
                the period at the end the following: ``, except 
                that incurred costs shall not include the 
                portion of the negotiated price that represents 
                the reduction in coinsurance resulting from the 
                application of paragraph (2)(D)''; and
          (4) in section 1860D-22(a)(2)(A), by inserting before 
        the period at the end the following: ``, not taking 
        into account the value of any discount or coverage 
        provided during the gap in prescription drug coverage 
        that occurs between the initial coverage limit under 
        section 1860D-2(b)(3) during the year and the out-of-
        pocket threshold specified in section 1860D-
        2(b)(4)(B)''.
  (c) Conforming Amendment to AMP Under Medicaid.--Section 
1927(k)(1)(B)(i) of the Social Security Act (42 U.S.C. 1396r-
8(k)(1)(B)(i)), as amended by section 2503(a)(2)(B) of the 
Patient Protection and Affordable Care Act, is amended--
          (1) by striking ``and'' at the end of subclause 
        (III);
          (2) by striking the period at the end of subclause 
        (IV); and
          (3) by adding at the end the following new subclause:
                                  ``(V) discounts provided by 
                                manufacturers under section 
                                1860D-14A.''.

SEC. 1102. MEDICARE ADVANTAGE PAYMENTS.

  (a) Repeal.--Effective as if included in the enactment of the 
Patient Protection and Affordable Care Act, sections 3201 and 
3203 of such Act (and the amendments made by such sections) are 
repealed.
  (b) Phase-in of Modified Benchmarks.--Section 1853 of the 
Social Security Act (42 U.S.C. 1395w-23) is amended--
          (1) in subsection (j)(1)(A), by striking ``(or, 
        beginning with 2007, \1/12\ of the applicable amount 
        determined under subsection (k)(1)) for the area for 
        the year'' and inserting `` for the area for the year 
        (or, for 2007, 2008, 2009, and 2010, \1/12\ of the 
        applicable amount determined under subsection (k)(1) 
        for the area for the year; for 2011, \1/12\ of the 
        applicable amount determined under subsection (k)(1) 
        for the area for 2010; and, beginning with 2012, \1/12\ 
        of the blended benchmark amount determined under 
        subsection (n)(1) for the area for the year)''; and
          (2) by adding at the end the following new 
        subsection:
  ``(n) Determination of Blended Benchmark Amount.--
          ``(1) In general.--For purposes of subsection (j), 
        subject to paragraphs (3), (4), and (5), the term 
        `blended benchmark amount' means for an area--
                  ``(A) for 2012 the sum of--
                          ``(i) \1/2\ of the applicable amount 
                        for the area and year; and
                          ``(ii) \1/2\ of the amount specified 
                        in paragraph (2)(A) for the area and 
                        year; and
                  ``(B) for a subsequent year the amount 
                specified in paragraph (2)(A) for the area and 
                year.
          ``(2) Specified amount.--
                  ``(A) In general.--The amount specified in 
                this subparagraph for an area and year is the 
                product of--
                          ``(i) the base payment amount 
                        specified in subparagraph (E) for the 
                        area and year adjusted to take into 
                        account the phase-out in the indirect 
                        costs of medical education from 
                        capitation rates described in 
                        subsection (k)(4); and
                          ``(ii) the applicable percentage for 
                        the area for the year specified under 
                        subparagraph (B).
                  ``(B) Applicable percentage.--Subject to 
                subparagraph (D), the applicable percentage 
                specified in this subparagraph for an area for 
                a year in the case of an area that is ranked--
                          ``(i) in the highest quartile under 
                        subparagraph (C) for the previous year 
                        is 95 percent;
                          ``(ii) in the second highest quartile 
                        under such subparagraph for the 
                        previous year is 100 percent;
                          ``(iii) in the third highest quartile 
                        under such subparagraph for the 
                        previous year is 107.5 percent; or
                          ``(iv) in the lowest quartile under 
                        such subparagraph for the previous year 
                        is 115 percent.
                  ``(C) Periodic ranking.--For purposes of this 
                paragraph in the case of an area located--
                          ``(i) in 1 of the 50 States or the 
                        District of Columbia, the Secretary 
                        shall rank such area in each year 
                        specified under subsection 
                        (c)(1)(D)(ii) based upon the level of 
                        the amount specified in subparagraph 
                        (A)(i) for such areas; or
                          ``(ii) in a territory, the Secretary 
                        shall rank such areas in each such year 
                        based upon the level of the amount 
                        specified in subparagraph (A)(i) for 
                        such area relative to quartile rankings 
                        computed under clause (i).
                  ``(D) 1-year transition for changes in 
                applicable percentage.--If, for a year after 
                2012, there is a change in the quartile in 
                which an area is ranked compared to the 
                previous year, the applicable percentage for 
                the area in the year shall be the average of--
                          ``(i) the applicable percentage for 
                        the area for the previous year; and
                          ``(ii) the applicable percentage that 
                        would otherwise apply for the area for 
                        the year.
                  ``(E) Base payment amount.--Subject to 
                subparagraph (F), the base payment amount 
                specified in this subparagraph--
                          ``(i) for 2012 is the amount 
                        specified in subsection (c)(1)(D) for 
                        the area for the year; or
                          ``(ii) for a subsequent year that--
                                  ``(I) is not specified under 
                                subsection (c)(1)(D)(ii), is 
                                the base amount specified in 
                                this subparagraph for the area 
                                for the previous year, 
                                increased by the national per 
                                capita MA growth percentage, 
                                described in subsection (c)(6) 
                                for that succeeding year, but 
                                not taking into account any 
                                adjustment under subparagraph 
                                (C) of such subsection for a 
                                year before 2004; and
                                  ``(II) is specified under 
                                subsection (c)(1)(D)(ii), is 
                                the amount specified in 
                                subsection (c)(1)(D) for the 
                                area for the year.
                  ``(F) Application of indirect medical 
                education phase-out.--The base payment amount 
                specified in subparagraph (E) for a year shall 
                be adjusted in the same manner under paragraph 
                (4) of subsection (k) as the applicable amount 
                is adjusted under such subsection.
          ``(3) Alternative phase-ins.--
                  ``(A) 4-year phase-in for certain areas.--If 
                the difference between the applicable amount 
                (as defined in subsection (k)) for an area for 
                2010 and the projected 2010 benchmark amount 
                (as defined in subparagraph (C)) for the area 
                is at least $30 but less than $50, the blended 
                benchmark amount for the area is--
                          ``(i) for 2012 the sum of--
                                  ``(I) \3/4\ of the applicable 
                                amount for the area and year; 
                                and
                                  ``(II) \1/4\ of the amount 
                                specified in paragraph (2)(A) 
                                for the area and year;
                          ``(ii) for 2013 the sum of--
                                  ``(I) \1/2\ of the applicable 
                                amount for the area and year; 
                                and
                                  ``(II) \1/2\ of the amount 
                                specified in paragraph (2)(A) 
                                for the area and year;
                          ``(iii) for 2014 the sum of--
                                  ``(I) \1/4\ of the applicable 
                                amount for the area and year; 
                                and
                                  ``(II) \3/4\ of the amount 
                                specified in paragraph (2)(A) 
                                for the area and year; and
                          ``(iv) for a subsequent year the 
                        amount specified in paragraph (2)(A) 
                        for the area and year.
                  ``(B) 6-year phase-in for certain areas.--If 
                the difference between the applicable amount 
                (as defined in subsection (k)) for an area for 
                2010 and the projected 2010 benchmark amount 
                (as defined in subparagraph (C)) for the area 
                is at least $50, the blended benchmark amount 
                for the area is--
                          ``(i) for 2012 the sum of--
                                  ``(I) \5/6\ of the applicable 
                                amount for the area and year; 
                                and
                                  ``(II) \1/6\ of the amount 
                                specified in paragraph (2)(A) 
                                for the area and year;
                          ``(ii) for 2013 the sum of--
                                  ``(I) \2/3\ of the applicable 
                                amount for the area and year; 
                                and
                                  ``(II) \1/3\ of the amount 
                                specified in paragraph (2)(A) 
                                for the area and year;
                          ``(iii) for 2014 the sum of--
                                  ``(I) \1/2\ of the applicable 
                                amount for the area and year; 
                                and
                                  ``(II) \1/2\ of the amount 
                                specified in paragraph (2)(A) 
                                for the area and year;
                          ``(iv) for 2015 the sum of--
                                  ``(I) \1/3\ of the applicable 
                                amount for the area and year; 
                                and
                                  ``(II) \2/3\ of the amount 
                                specified in paragraph (2)(A) 
                                for the area and year; and
                          ``(v) for 2016 the sum of--
                                  ``(I) \1/6\ of the applicable 
                                amount for the area and year; 
                                and
                                  ``(II) \5/6\ of the amount 
                                specified in paragraph (2)(A) 
                                for the area and year; and
                          ``(vi) for a subsequent year the 
                        amount specified in paragraph (2)(A) 
                        for the area and year.
                  ``(C) Projected 2010 benchmark amount.--The 
                projected 2010 benchmark amount described in 
                this subparagraph for an area is equal to the 
                sum of--
                          ``(i) \1/2\ of the applicable amount 
                        (as defined in subsection (k)) for the 
                        area for 2010; and
                          ``(ii) \1/2\ of the amount specified 
                        in paragraph (2)(A) for the area for 
                        2010 but determined as if there were 
                        substituted for the applicable 
                        percentage specified in clause (ii) of 
                        such paragraph the sum of--
                                  ``(I) the applicable percent 
                                that would be specified under 
                                subparagraph (B) of paragraph 
                                (2) (determined without regard 
                                to subparagraph (D) of such 
                                paragraph) for the area for 
                                2010 if any reference in such 
                                paragraph to `the previous 
                                year' were deemed a reference 
                                to 2010; and
                                  ``(II) the applicable 
                                percentage increase that would 
                                apply to a qualifying plan in 
                                the area under subsection (o) 
                                as if any reference in such 
                                subsection to 2012 were deemed 
                                a reference to 2010 and as if 
                                the determination of a 
                                qualifying county under 
                                paragraph (3)(B) of such 
                                subsection were made for 2010.
          ``(4) Cap on benchmark amount.--In no case shall the 
        blended benchmark amount for an area for a year 
        (determined taking into account subsection (o)) be 
        greater than the applicable amount that would (but for 
        the application of this subsection) be determined under 
        subsection (k)(1) for the area for the year.
          ``(5) Non-application to pace plans.--This subsection 
        shall not apply to payments to a PACE program under 
        section 1894.''.
  (c) Applicable Percentage Quality Increases.--Section 1853 of 
such Act (42 U.S.C. 1395w-23), as amended by subsection (b), is 
amended--
          (1) in subsection (j), by inserting ``subject to 
        subsection (o),'' after ``For purposes of this part,'';
          (2) in subsection (n)(2)(B), as added by subsection 
        (b), by inserting ``, subject to subsection (o)'' after 
        ``as follows''; and
          (3) by adding at the end the following new 
        subsection:
  ``(o) Applicable Percentage Quality Increases.--
          ``(1) In general.--Subject to the succeeding 
        paragraphs, in the case of a qualifying plan with 
        respect to a year beginning with 2012, the applicable 
        percentage under subsection (n)(2)(B) shall be 
        increased on a plan or contract level, as determined by 
        the Secretary--
                  ``(A) for 2012, by 1.5 percentage points;
                  ``(B) for 2013, by 3.0 percentage points; and
                  ``(C) for 2014 or a subsequent year, by 5.0 
                percentage points.
          ``(2) Increase for qualifying plans in qualifying 
        counties.--The increase applied under paragraph (1) for 
        a qualifying plan located in a qualifying county for a 
        year shall be doubled.
          ``(3) Qualifying plans and qualifying county defined; 
        application of increases to low enrollment and new 
        plans.--For purposes of this subsection:
                  ``(A) Qualifying plan.--
                          ``(i) In general.--The term 
                        `qualifying plan' means, for a year and 
                        subject to paragraph (4), a plan that 
                        had a quality rating under paragraph 
                        (4) of 4 stars or higher based on the 
                        most recent data available for such 
                        year.
                          ``(ii) Application of increases to 
                        low enrollment plans.--
                                  ``(I) 2012.--For 2012, the 
                                term `qualifying plan' includes 
                                an MA plan that the Secretary 
                                determines is not able to have 
                                a quality rating under 
                                paragraph (4) because of low 
                                enrollment.
                                  ``(II) 2013 and subsequent 
                                years.--For 2013 and subsequent 
                                years, for purposes of 
                                determining whether an MA plan 
                                with low enrollment (as defined 
                                by the Secretary) is included 
                                as a qualifying plan, the 
                                Secretary shall establish a 
                                method to apply to MA plans 
                                with low enrollment (as defined 
                                by the Secretary) the 
                                computation of quality rating 
                                and the rating system under 
                                paragraph (4).
                          ``(iii) Application of increases to 
                        new plans.--
                                  ``(I) In general.--A new MA 
                                plan that meets criteria 
                                specified by the Secretary 
                                shall be treated as a 
                                qualifying plan, except that in 
                                applying paragraph (1), the 
                                applicable percentage under 
                                subsection (n)(2)(B) shall be 
                                increased--
                                          ``(aa) for 2012, by 
                                        1.5 percentage points;
                                          ``(bb) for 2013, by 
                                        2.5 percentage points; 
                                        and
                                          ``(cc) for 2014 or a 
                                        subsequent year, by 3.5 
                                        percentage points.
                                  ``(II) New ma plan defined.--
                                The term `new MA plan' means, 
                                with respect to a year, a plan 
                                offered by an organization or 
                                sponsor that has not had a 
                                contract as a Medicare 
                                Advantage organization in the 
                                preceding 3-year period.
                  ``(B) Qualifying county.--The term 
                `qualifying county' means, for a year, a 
                county--
                          ``(i) that has an MA capitation rate 
                        that, in 2004, was based on the amount 
                        specified in subsection (c)(1)(B) for a 
                        Metropolitan Statistical Area with a 
                        population of more than 250,000;
                          ``(ii) for which, as of December 
                        2009, of the Medicare Advantage 
                        eligible individuals residing in the 
                        county at least 25 percent of such 
                        individuals were enrolled in Medicare 
                        Advantage plans; and
                          ``(iii) that has per capita fee-for-
                        service spending that is lower than the 
                        national monthly per capita cost for 
                        expenditures for individuals enrolled 
                        under the original medicare fee-for-
                        service program for the year.
          ``(4) Quality determinations for application of 
        increase.--
                  ``(A) Quality determination.--The quality 
                rating for a plan shall be determined according 
                to a 5-star rating system (based on the data 
                collected under section 1852(e)).
                  ``(B) Plans that failed to report.--An MA 
                plan which does not report data that enables 
                the Secretary to rate the plan for purposes of 
                this paragraph shall be counted as having a 
                rating of fewer than 3.5 stars.
          ``(5) Exception for pace plans.--This subsection 
        shall not apply to payments to a PACE program under 
        section 1894.''.
          (4) Determination of medicare part d low-income 
        benchmark premium.--Section 1860D-14(b)(2)(B)(iii) of 
        the Social Security Act (42 U.S.C. 1395w-
        114(b)(2)(B)(iii)) as amended by section 3302 of the 
        Patient Protection and Affordable Care Act, is amended 
        by striking ``, determined without regard to any 
        reduction in such premium as a result of any 
        beneficiary rebate under section 1854(b)(1)(C) or bonus 
        payment under section 1853(n)'' and inserting the 
        following: ``and determined before the application of 
        the monthly rebate computed under section 
        1854(b)(1)(C)(i) for that plan and year involved and, 
        in the case of a qualifying plan, before the 
        application of the increase under section 1853(o) for 
        that plan and year involved''.
  (d) Beneficiary Rebates.--Section 1854(b)(1)(C) of such Act 
(42 U.S.C. 1395w-24(b)(1)(C)), as amended by section 3202(b) of 
the Patient Protection and Affordable Care Act, is further 
amended--
          (1) in clause (i), by inserting ``(or the applicable 
        rebate percentage specified in clause (iii) in the case 
        of plan years beginning on or after January 1, 2012)'' 
        after ``75 percent''; and
          (2) by striking clause (iii), by redesignating 
        clauses (iv) and (v) as clauses (vii) and (viii), 
        respectively, and by inserting after clause (ii) the 
        following new clauses:
                          ``(iii) Applicable rebate 
                        percentage.--The applicable rebate 
                        percentage specified in this clause for 
                        a plan for a year, based on the system 
                        under section 1853(o)(4)(A), is the sum 
                        of--
                                  ``(I) the product of the old 
                                phase-in proportion for the 
                                year under clause (iv) and 75 
                                percent; and
                                  ``(II) the product of the new 
                                phase-in proportion for the 
                                year under clause (iv) and the 
                                final applicable rebate 
                                percentage under clause (v).
                          ``(iv) Old and new phase-in 
                        proportions.--For purposes of clause 
                        (iv)--
                                  ``(I) for 2012, the old 
                                phase-in proportion is \2/3\ 
                                and the new phase-in proportion 
                                is \1/3\;
                                  ``(II) for 2013, the old 
                                phase-in proportion is \1/3\ 
                                and the new phase-in proportion 
                                is \2/3\; and
                                  ``(III) for 2014 and any 
                                subsequent year, the old phase-
                                in proportion is 0 and the new 
                                phase-in proportion is 1.
                          ``(v) Final applicable rebate 
                        percentage.--Subject to clause (vi), 
                        the final applicable rebate percentage 
                        under this clause is--
                                  ``(I) in the case of a plan 
                                with a quality rating under 
                                such system of at least 4.5 
                                stars, 70 percent;
                                  ``(II) in the case of a plan 
                                with a quality rating under 
                                such system of at least 3.5 
                                stars and less than 4.5 stars, 
                                65 percent; and
                                  ``(III) in the case of a plan 
                                with a quality rating under 
                                such system of less than 3.5 
                                stars, 50 percent.
                          ``(vi) Treatment of low enrollment 
                        and new plans.--For purposes of clause 
                        (v)--
                                  ``(I) for 2012, in the case 
                                of a plan described in 
                                subclause (I) of subsection 
                                (o)(3)(A)(ii), the plan shall 
                                be treated as having a rating 
                                of 4.5 stars; and
                                  ``(II) for 2012 or a 
                                subsequent year, in the case of 
                                a new MA plan (as defined under 
                                subclause (III) of subsection 
                                (o)(3)(A)(iii))) that is 
                                treated as a qualifying plan 
                                pursuant to subclause (I) of 
                                such subsection, the plan shall 
                                be treated as having a rating 
                                of 3.5 stars.''.
  (e) Coding Intensity Adjustment.--Section 1853(a)(1)(C)(ii) 
of such Act (42 U.S.C. 1395w-23(a)(1)(C)(ii)) is amended--
          (1) in the heading, by striking ``during phaseout of 
        budget neutrality factor'' and inserting ``of coding 
        adjustment'';
          (2) in the matter before subclause (I), by striking 
        ``through 2010'' and inserting ``and each subsequent 
        year''; and
          (3) in subclause (II)--
                  (A) in the first sentence, by inserting 
                ``annually'' before ``conduct an analysis'';
                  (B) in the second sentence--
                          (i) by inserting ``on a timely 
                        basis'' after ``are incorporated''; and
                          (ii) by striking ``only for 2008, 
                        2009, and 2010'' and inserting ``for 
                        2008 and subsequent years'';
                  (C) in the third sentence, by inserting ``and 
                updated as appropriate'' before the period at 
                the end; and
                  (D) by adding at the end the following new 
                subclauses:
                                  ``(III) In calculating each 
                                year's adjustment for 2019 and 
                                subsequent years, the 
                                adjustment factor shall be no 
                                less than 5.7 percent.
                                  ``(IV) Such adjustment shall 
                                be applied to risk scores until 
                                the Secretary implements risk 
                                adjustment using Medicare 
                                Advantage diagnostic, cost, and 
                                use data.''.
  (f) Repeal of Comparative Cost Adjustment Program.--Section 
1860C-1 of the Social Security Act (42 U.S.C. 1395w-29), as 
added by section 241(a) of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (Public Law 108-
173), is repealed.

SEC. 1103. SAVINGS FROM LIMITS ON MA PLAN ADMINISTRATIVE COSTS.

  Section 1857(e) of the Social Security Act (42 U.S.C. 1395w-
27(e)) is amended by adding at the end the following new 
paragraph:
          ``(4) Requirement for minimum medical loss ratio.--If 
        the Secretary determines for a contract year (beginning 
        with 2014) that an MA plan has failed to have a medical 
        loss ratio of at least .85--
                  ``(A) the MA plan shall remit to the 
                Secretary an amount equal to the product of--
                          ``(i) the total revenue of the MA 
                        plan under this part for the contract 
                        year; and
                          ``(ii) the difference between .85 and 
                        the medical loss ratio;
                  ``(B) for 3 consecutive contract years, the 
                Secretary shall not permit the enrollment of 
                new enrollees under the plan for coverage 
                during the second succeeding contract year; and
                  ``(C) the Secretary shall terminate the plan 
                contract if the plan fails to have such a 
                medical loss ratio for 5 consecutive contract 
                years.
        Amounts collected pursuant to subparagraph (A) shall be 
        deposited into the Centers for Medicare & Medicaid 
        Program Management Account to be available until 
        expended.''.

SEC. 1104. DISPROPORTIONATE SHARE HOSPITAL (DSH) PAYMENTS.

  Section 1886(r) of the Social Security Act (42 U.S.C. 
1395ww(r)), as added by section 3133 of the Patient Protection 
and Affordable Care Act and as amended by section 10316 of such 
Act, is amended--
          (1) in paragraph (1), by striking ``2015'' and 
        inserting ``2014''; and
          (2) in paragraph (2)--
                  (A) in the matter preceding subparagraph (A), 
                by striking ``2015'' and inserting ``2014'';
                  (B) in subparagraph (B)(i)--
                          (i) in the heading, by inserting 
                        ``2014,'' after ``years'';
                          (ii) in the matter preceding 
                        subclause (I), by inserting ``2014,'' 
                        after ``each of fiscal years'';
                          (iii) in subclause (I), by striking 
                        ``on such Act'' and inserting ``on the 
                        Health Care and Education Affordability 
                        Reconciliation Act of 2010''; and
                          (iv) in the matter following 
                        subclause (II), by striking ``minus 1.5 
                        percentage points'' and inserting 
                        ``minus 0.1 percentage points for 
                        fiscal year 2014 and minus 0.2 
                        percentage points for each of fiscal 
                        years 2015, 2016, and 2017''; and
                  (C) in subparagraph (B)(ii), in the matter 
                following subclause (II), by striking ``and, 
                for each of 2018 and 2019, minus 1.5 percentage 
                points'' and inserting ``minus 0.2 percentage 
                points for each of fiscal years 2018 and 
                2019''.

SEC. 1105. MARKET BASKET UPDATES.

  (a) IPPS.--Section 1886(b)(3)(B) of the Social Security Act 
(42 U.S.C. 1395ww(b)(3)(B)), as amended by sections 3401(a)(4) 
and 10319(a) of the Patient Protection and Affordable Care Act, 
is amended--
          (1) in clause (xii)--
                  (A) by placing the subclause (II) (inserted 
                by section 10319(a)(3) of the Patient 
                Protection and Affordable Care Act) immediately 
                after subclause (I) and, in such subclause 
                (II), by striking ``and'' at the end; and
                  (B) by striking subclause (III) and inserting 
                the following:
          ``(III) for fiscal year 2014, by 0.3 percentage 
        point;
          ``(IV) for each of fiscal years 2015 and 2016, by 0.2 
        percentage point; and
          ``(V) for each of fiscal years 2017, 2018, and 2019, 
        by 0.75 percentage point.''; and
          (2) by striking clause (xiii).
  (b) Long-term Care Hospitals.--Section 1886(m)(4) of the 
Social Security Act (42 U.S.C. 1395ww(m)(4)), as added by 
section 3401(c) of the Patient Protection and Affordable Care 
Act and amended by section 10319(b) of such Act, is amended--
          (1) in subparagraph (A)--
                  (A) in clause (iii), by striking ``and'' at 
                the end; and
                  (B) by striking clause (iv) and inserting the 
                following:
                          ``(iv) for rate year 2014, 0.3 
                        percentage point;
                          ``(v) for each of rate years 2015 and 
                        2016, 0.2 percentage point; and
                          ``(vi) for each of rate years 2017, 
                        2018, and 2019, 0.75 percentage 
                        point.'';
          (2) by striking subparagraph (B); and
          (3) by striking ``(4) Other adjustment.--'' and all 
        that follows through ``For purposes'' and inserting 
        ``(4) Other adjustment.--For purposes'' (and 
        redesignating clauses (i) through (vi) as subparagraphs 
        (A) through (F), respectively, with appropriate 
        indentation).
  (c) Inpatient Rehabilitation Facilities.--Section 
1886(j)(3)(D) of the Social Security Act (42 U.S.C. 
1395ww(j)(3)(D)), as added by section 3401(d)(2) of the Patient 
Protection and Affordable Care Act and amended by section 
10319(c) of such Act, is amended--
          (1) in clause (i)--
                  (A) by placing the subclause (II) (inserted 
                by section 10319(c)(3) of the Patient 
                Protection and Affordable Care Act) immediately 
                after subclause (I) and, in such subclause 
                (II), by striking ``and'' at the end; and
                  (B) by striking subclause (III) and inserting 
                the following:
                                  ``(III) for fiscal year 2014, 
                                0.3 percentage point;
                                  ``(IV) for each of fiscal 
                                years 2015 and 2016, 0.2 
                                percentage point; and
                                  ``(V) for each of fiscal 
                                years 2017, 2018, and 2019, 
                                0.75 percentage point.'';
          (2) by striking clause (ii); and
          (3) by striking ``(D) Other adjustment.--'' and all 
        that follows through ``For purposes'' and inserting 
        ``(D) Other adjustment.--For purposes'' (and 
        redesignating subclauses (I) through (V) as clauses (i) 
        through (v), respectively, with appropriate 
        indentation).
  (d) Psychiatric Hospitals.--Section 1886(s)(3) of the Social 
Security Act, as added by section 3401(f) of the Patient 
Protection and Affordable Care Act and amended by section 
10319(e) of such Act, is amended--
          (1) in subparagraph (A)--
                  (A) by placing the clause (ii) (inserted by 
                section 10319(e)(3) of the Patient Protection 
                and Affordable Care Act) immediately after 
                clause (i) and, in such clause (ii), by 
                striking ``and'' at the end; and
                  (B) by striking clause (iii) and inserting 
                the following:
                          ``(iii) for the rate year beginning 
                        in 2014, 0.3 percentage point;
                          ``(iv) for each of the rate years 
                        beginning in 2015 and 2016, 0.2 
                        percentage point; and
                          ``(v) for each of the rate years 
                        beginning in 2017, 2018, and 2019, 0.75 
                        percentage point.'';
          (2) by striking subparagraph (B); and
          (3) by striking ``(3) Other adjustment.--'' and all 
        that follows through ``For purposes'' and inserting 
        ``(3) Other adjustment.--For purposes'' (and 
        redesignating clauses (i) through (v) as subparagraphs 
        (A) through (E), respectively, with appropriate 
        indentation).
  (e) Outpatient Hospitals.--Section 1833(t)(3)(G) of the 
Social Security Act (42 U.S.C. 1395l(t)(3)(G)), as added by 
section 3401(i)(2) of the Patient Protection and Affordable 
Care Act and amended by section 10319(g) of such Act, is 
amended--
          (1) in clause (i)--
                  (A) by placing the subclause (II) (inserted 
                by section 10319(g)(3) of the Patient 
                Protection and Affordable Care Act) immediately 
                after subclause (I) and, in such subclause 
                (II), by striking ``and'' at the end; and
                  (B) by striking subclause (III) and inserting 
                the following:
                                  ``(III) for 2014, 0.3 
                                percentage point;
                                  ``(IV) for each of 2015 and 
                                2016, 0.2 percentage point; and
                                  ``(V) for each of 2017, 2018, 
                                and 2019, 0.75 percentage 
                                point.'';
          (2) by striking clause (ii); and
          (3) by striking ``(G) Other adjustment.--'' and all 
        that follows through ``For purposes'' and inserting 
        ``(G) Other adjustment.--For purposes'' (and 
        redesignating subclauses (I) through (V) as clauses (i) 
        through (v), respectively, with appropriate 
        indentation).

SEC. 1106. PHYSICIAN OWNERSHIP-REFERRAL.

  Section 1877(i) of the Social Security Act (42 U.S.C. 
1395nn(i)), as added by section 6001(a)(3) of the Patient 
Protection and Affordable Care Act and as amended by section 
10601(a) of such Act, is amended--
          (1) in paragraph (1)(A)(i), by striking ``August 1, 
        2010'' and inserting ``December 31, 2010''; and
          (2) in paragraph (3)--
                  (A) in subparagraph (A)(i), by striking ``an 
                applicable hospital (as defined in subparagraph 
                (E))'' and inserting ``a hospital that is an 
                applicable hospital (as defined in subparagraph 
                (E)) or is a high Medicaid facility described 
                in subparagraph (F)'';
                  (B) in subparagraph (C)(iii), by inserting 
                after ``date of enactment of this subsection'' 
                the following: ``(or, in the case of a hospital 
                that did not have a provider agreement in 
                effect as of such date but does have such an 
                agreement in effect on December 31, 2010, the 
                effective date of such provider agreement)'';
                  (C) by redesignating subparagraphs (F) 
                through (H) as subparagraphs (G) through (I), 
                respectively; and
                  (D) by inserting after subparagraph (E) the 
                following new subparagraph:
                  ``(F) High medicaid facility described.--A 
                high Medicaid facility described in this 
                subparagraph is a hospital that--
                          ``(i) is not the sole hospital in a 
                        county;
                          ``(ii) with respect to each of the 3 
                        most recent years for which data are 
                        available, has an annual percent of 
                        total inpatient admissions that 
                        represent inpatient admissions under 
                        title XIX that is estimated to be 
                        greater than such percent with respect 
                        to such admissions for any other 
                        hospital located in the county in which 
                        the hospital is located; and
                          ``(iii) meets the conditions 
                        described in subparagraph (E)(iii).''.

SEC. 1107. PAYMENT FOR IMAGING SERVICES.

  Section 1848 of the Social Security Act (42 U.S.C. 1395w-4), 
as amended by section 3135(a) of the Patient Protection and 
Affordable Care Act, is amended--
          (1) in subsection (b)(4)--
                  (A) in subparagraph (B), by striking ``this 
                paragraph'' and inserting ``subparagraph (A)''; 
                and
                  (B) by amending subparagraph (C) to read as 
                follows:
                  ``(C) Adjustment in imaging utilization 
                rate.--With respect to fee schedules 
                established for 2011 and subsequent years, in 
                the methodology for determining practice 
                expense relative value units for expensive 
                diagnostic imaging equipment under the final 
                rule published by the Secretary in the Federal 
                Register on November 25, 2009 (42 CFR 410, et 
                al.), the Secretary shall use a 75 percent 
                assumption instead of the utilization rates 
                otherwise established in such final rule.''; 
                and
          (2) in subsection (c)(2)(B)(v), by striking 
        subclauses (III), (IV), and (V) and inserting the 
        following new subclause:
                                  ``(III) Change in utilization 
                                rate for certain imaging 
                                services.--Effective for fee 
                                schedules established beginning 
                                with 2011, reduced expenditures 
                                attributable to the change in 
                                the utilization rate applicable 
                                to 2011, as described in 
                                subsection (b)(4)(C).''.

                          Subtitle C--Medicaid

SEC. 1201. FEDERAL FUNDING FOR STATES.

  Section 1905 of the Social Security Act (42 U.S.C. 1396d), as 
amended by sections 2001(a)(3) and 10201(c) of the Patient 
Protection and Affordable Care Act, is amended--
          (1) in subsection (y)--
                  (A) by redesignating subclause (II) of 
                paragraph (1)(B)(ii) as paragraph (5) of 
                subsection (z) and realigning the left margins 
                accordingly; and
                  (B) by striking paragraph (1) and inserting 
                the following:
          ``(1) Amount of increase.--Notwithstanding subsection 
        (b), the Federal medical assistance percentage for a 
        State that is one of the 50 States or the District of 
        Columbia, with respect to amounts expended by such 
        State for medical assistance for newly eligible 
        individuals described in subclause (VIII) of section 
        1902(a)(10)(A)(i), shall be equal to--
                  ``(A) 100 percent for calendar quarters in 
                2014, 2015, and 2016;
                  ``(B) 95 percent for calendar quarters in 
                2017;
                  ``(C) 94 percent for calendar quarters in 
                2018;
                  ``(D) 93 percent for calendar quarters in 
                2019; and
                  ``(E) 90 percent for calendar quarters in 
                2020 and each year thereafter.''; and
          (2) in subsection (z)--
                  (A) in paragraph (1), by striking ``September 
                30, 2019'' and inserting ``December 31, 2015'' 
                and by striking ``subsection 
                (y)(1)(B)(ii)(II)'' and inserting ``paragraph 
                (3)'';
                  (B) by striking paragraphs (2) through (4) 
                and inserting the following:
          ``(2)(A) For calendar quarters in 2014 and each year 
        thereafter, the Federal medical assistance percentage 
        otherwise determined under subsection (b) for an 
        expansion State described in paragraph (3) with respect 
        to medical assistance for individuals described in 
        section 1902(a)(10)(A)(i)(VIII) who are nonpregnant 
        childless adults with respect to whom the State may 
        require enrollment in benchmark coverage under section 
        1937 shall be equal to the percent specified in 
        subparagraph (B)(i) for such year.
          ``(B)(i) The percent specified in this subparagraph 
        for a State for a year is equal to the Federal medical 
        assistance percentage (as defined in the first sentence 
        of subsection (b)) for the State increased by a number 
        of percentage points equal to the transition percentage 
        (specified in clause (ii) for the year) of the number 
        of percentage points by which--
                  ``(I) such Federal medical assistance 
                percentage for the State, is less than
                  ``(II) the percent specified in subsection 
                (y)(1) for the year.
          ``(ii) The transition percentage specified in this 
        clause for--
                  ``(I) 2014 is 50 percent;
                  ``(II) 2015 is 60 percent;
                  ``(III) 2016 is 70 percent;
                  ``(IV) 2017 is 80 percent;
                  ``(V) 2018 is 90 percent; and
                  ``(VI) 2019 and each subsequent year is 100 
                percent.''; and
                  (C) by redesignating paragraph (5) (as added 
                by paragraph (1)(A) of this section) as 
                paragraph (3), realigning the left margins to 
                align with paragraph (2), and striking the 
                heading and all that follows through ``a State 
                is'' and inserting ``A State is''.

SEC. 1202. PAYMENTS TO PRIMARY CARE PHYSICIANS.

  (a) In General.--
          (1) Fee-for-service payments.--Section 1902 of the 
        Social Security Act (42 U.S.C. 1396a), as amended by 
        section 2303(a)(2) of the Patient Protection and 
        Affordable Care Act, is amended--
                  (A) in subsection (a)(13)--
                          (i) by striking ``and'' at the end of 
                        subparagraph (A);
                          (ii) by adding ``and'' at the end of 
                        subparagraph (B); and
                          (iii) by adding at the end the 
                        following new subparagraph:
                  ``(C) payment for primary care services (as 
                defined in subsection (jj)) furnished in 2013 
                and 2014 by a physician with a primary 
                specialty designation of family medicine, 
                general internal medicine, or pediatric 
                medicine at a rate not less than 100 percent of 
                the payment rate that applies to such services 
                and physician under part B of title XVIII (or, 
                if greater, the payment rate that would be 
                applicable under such part if the conversion 
                factor under section 1848(d) for the year 
                involved were the conversion factor under such 
                section for 2009);''; and
                  (B) by adding at the end the following new 
                subsection:
  ``(jj) Primary Care Services Defined.--For purposes of 
subsection (a)(13)(C), the term `primary care services' means--
          ``(1) evaluation and management services that are 
        procedure codes (for services covered under title 
        XVIII) for services in the category designated 
        Evaluation and Management in the Healthcare Common 
        Procedure Coding System (established by the Secretary 
        under section 1848(c)(5) as of December 31, 2009, and 
        as subsequently modified); and
          ``(2) services related to immunization administration 
        for vaccines and toxoids for which CPT codes 90465, 
        90466, 90467, 90468, 90471, 90472, 90473, or 90474 (as 
        subsequently modified) apply under such System.''.
          (2) Under medicaid managed care plans.--Section 
        1932(f) of such Act (42 U.S.C. 1396u-2(f)) is amended--
                  (A) in the heading, by adding at the end the 
                following: ``; Adequacy of Payment for Primary 
                Care Services''; and
                  (B) by inserting before the period at the end 
                the following: ``and, in the case of primary 
                care services described in section 
                1902(a)(13)(C), consistent with the minimum 
                payment rates specified in such section 
                (regardless of the manner in which such 
                payments are made, including in the form of 
                capitation or partial capitation)''.
  (b) Increase in Payment Using Increased FMAP.--Section 1905 
of the Social Security Act, as amended by section 1004(b) of 
this Act and section 10201(c)(6) of the Patient Protection and 
Affordable Care Act, is amended by adding at the end the 
following new subsection:
  ``(dd) Increased FMAP for Additional Expenditures for Primary 
Care Services.--Notwithstanding subsection (b), with respect to 
the portion of the amounts expended for medical assistance for 
services described in section 1902(a)(13)(C) furnished on or 
after January 1, 2013, and before January 1, 2015, that is 
attributable to the amount by which the minimum payment rate 
required under such section (or, by application, section 
1932(f)) exceeds the payment rate applicable to such services 
under the State plan as of July 1, 2009, the Federal medical 
assistance percentage for a State that is one of the 50 States 
or the District of Columbia shall be equal to 100 percent. The 
preceding sentence does not prohibit the payment of Federal 
financial participation based on the Federal medical assistance 
percentage for amounts in excess of those specified in such 
sentence.''.

SEC. 1203. DISPROPORTIONATE SHARE HOSPITAL PAYMENTS.

  (a) In General.--Section 1923(f) of the Social Security Act 
(42 U.S.C. 1396r-4(f)), as amended by sections 2551(a)(4) and 
10201(e)(1) of the Patient Protection and Affordable Care Act, 
is amended--
          (1) in paragraph (6)(B)(iii), in the matter preceding 
        subclause (I), by striking ``or paragraph (7)''; and
          (2) by striking paragraph (7) and inserting the 
        following:
          ``(7) Medicaid dsh reductions.--
                  ``(A) Reductions.--
                          ``(i) In general.--For each of fiscal 
                        years 2014 through 2020 the Secretary 
                        shall effect the following reductions:
                                  ``(I) Reduction in dsh 
                                allotments.--The Secretary 
                                shall reduce DSH allotments to 
                                States in the amount specified 
                                under the DSH health reform 
                                methodology under subparagraph 
                                (B) for the State for the 
                                fiscal year.
                                  ``(II) Reductions in 
                                payments.--The Secretary shall 
                                reduce payments to States under 
                                section 1903(a) for each 
                                calendar quarter in the fiscal 
                                year, in the manner specified 
                                in clause (iii), in an amount 
                                equal to \1/4\ of the DSH 
                                allotment reduction under 
                                subclause (I) for the State for 
                                the fiscal year.
                          ``(ii) Aggregate reductions.--The 
                        aggregate reductions in DSH allotments 
                        for all States under clause (i)(I) 
                        shall be equal to--
                                  ``(I) $500,000,000 for fiscal 
                                year 2014;
                                  ``(II) $600,000,000 for 
                                fiscal year 2015;
                                  ``(III) $600,000,000 for 
                                fiscal year 2016;
                                  ``(IV) $1,800,000,000 for 
                                fiscal year 2017;
                                  ``(V) $5,000,000,000 for 
                                fiscal year 2018;
                                  ``(VI) $5,600,000,000 for 
                                fiscal year 2019; and
                                  ``(VII) $4,000,000,000 for 
                                fiscal year 2020.
                        The Secretary shall distribute such 
                        aggregate reductions among States in 
                        accordance with subparagraph (B).
                          ``(iii) Manner of payment 
                        reduction.--The amount of the payment 
                        reduction under clause (i)(II) for a 
                        State for a quarter shall be deemed an 
                        overpayment to the State under this 
                        title to be disallowed against the 
                        State's regular quarterly draw for all 
                        spending under section 1903(d)(2). Such 
                        a disallowance is not subject to a 
                        reconsideration under subsections (d) 
                        and (e) of section 1116.
                          ``(iv) Definition.--In this 
                        paragraph, the term `State' means the 
                        50 States and the District of Columbia.
                  ``(B) DSH health reform methodology.--The 
                Secretary shall carry out subparagraph (A) 
                through use of a DSH Health Reform methodology 
                that meets the following requirements:
                          ``(i) The methodology imposes the 
                        largest percentage reductions on the 
                        States that--
                                  ``(I) have the lowest 
                                percentages of uninsured 
                                individuals (determined on the 
                                basis of data from the Bureau 
                                of the Census, audited hospital 
                                cost reports, and other 
                                information likely to yield 
                                accurate data) during the most 
                                recent year for which such data 
                                are available; or
                                  ``(II) do not target their 
                                DSH payments on--
                                          ``(aa) hospitals with 
                                        high volumes of 
                                        Medicaid inpatients (as 
                                        defined in subsection 
                                        (b)(1)(A)); and
                                          ``(bb) hospitals that 
                                        have high levels of 
                                        uncompensated care 
                                        (excluding bad debt).
                          ``(ii) The methodology imposes a 
                        smaller percentage reduction on low DSH 
                        States described in paragraph (5)(B).
                          ``(iii) The methodology takes into 
                        account the extent to which the DSH 
                        allotment for a State was included in 
                        the budget neutrality calculation for a 
                        coverage expansion approved under 
                        section 1115 as of July 31, 2009.''.
  (b) Extension of DSH Allotment.--Section 1923(f)(6)(A) of the 
Social Security Act (42 U.S.C. 1396r-4(f)(6)(A)) is amended by 
adding at the end the following:
                          ``(v) Allotment for 2d, 3rd, and 4th 
                        quarters of fiscal year 2012 and for 
                        fiscal year 2013.--Notwithstanding the 
                        table set forth in paragraph (2):
                                  ``(I) 2d, 3rd, and 4th 
                                quarters of fiscal year 2012.--
                                In the case of a State that has 
                                a DSH allotment of $0 for the 
                                2d, 3rd, and 4th quarters of 
                                fiscal year 2012, the DSH 
                                allotment shall be $47,200,000 
                                for such quarters.
                                  ``(II) Fiscal year 2013.--In 
                                the case of a State that has a 
                                DSH allotment of $0 for fiscal 
                                year 2013, the DSH allotment 
                                shall be $53,100,000 for such 
                                fiscal year.''.

SEC. 1204. FUNDING FOR THE TERRITORIES.

  (a) In General.--Part III of subtitle D of title I of the 
Patient Protection and Affordable Care Act, as amended by 
section 10104(m) of such Act, is amended by inserting after 
section 1322 the following section:

``SEC. 1323. FUNDING FOR THE TERRITORIES.

  ``(a) In General.--A territory that--
          ``(1) elects consistent with subsection (b) to 
        establish an Exchange in accordance with part II of 
        this subtitle and establishes such an Exchange in 
        accordance with such part shall be treated as a State 
        for purposes of such part and shall be entitled to 
        payment from the amount allocated to the territory 
        under subsection (c); or
          ``(2) does not make such election shall be entitled 
        to an increase in the dollar limitation applicable to 
        the territory under subsections (f) and (g) of section 
        1108 of the Social Security Act (42 U.S.C. 1308) for 
        such period in such amount for such territory and such 
        increase shall not be taken into account in computing 
        any other amount under such subsections.
  ``(b) Terms and Conditions.--An election under subsection 
(a)(1) shall--
          ``(1) not be effective unless the election is 
        consistent with a form and manner specified by the 
        Secretary and is received not later than October 1, 
        2013; and
          ``(2) be contingent upon entering into an agreement 
        between the territory and the Secretary that requires 
        that--
                  ``(A) funds provided under the agreement 
                shall be used only to provide premium and cost-
                sharing assistance to residents of the 
                territory obtaining health insurance coverage 
                through the Exchange; and
                  ``(B) the premium and cost-sharing assistance 
                provided under such agreement shall be 
                structured in such a manner so as to prevent 
                any gap in assistance for individuals between 
                the income level at which medical assistance is 
                available through the territory's Medicaid plan 
                under title XIX of the Social Security Act and 
                the income level at which premium and cost-
                sharing assistance is available under the 
                agreement.
  ``(c) Appropriation and Allocation.--
          ``(1) Appropriation.--Out of any funds in the 
        Treasury not otherwise appropriated, there is 
        appropriated for purposes of payment pursuant to 
        subsection (a) $1,000,000,000, to be available during 
        the period beginning with 2014 and ending with 2019.
          ``(2) Allocation.--The Secretary shall allocate the 
        amount appropriated under paragraph (1) among the 
        territories for purposes of carrying out this section 
        as follows:
                  ``(A) For Puerto Rico, $925,000,000.
                  ``(B) For another territory, the portion of 
                $75,000,000 specified by the Secretary.''.
  (b) Medicaid Funding.--
          (1) Increase in funding caps.--Section 1108(g) of the 
        Social Security Act (42 U.S.C. 1308(g)), as amended by 
        section 2005(a) of the Patient Protection and 
        Affordable Care Act, is amended--
                  (A) in paragraph (2), by inserting ``and 
                section 1323(a)(2) of the Patient Protection 
                and Affordable Care Act'' after ``subject to''; 
                and
                  (B) by striking paragraph (5) and inserting 
                the following:
          ``(5) Additional increase.--The Secretary shall 
        increase the amounts otherwise determined under this 
        subsection for Puerto Rico, the Virgin Islands, Guam, 
        the Northern Mariana Islands, and American Samoa (after 
        the application of subsection (f) and the preceding 
        paragraphs of this subsection) for the period beginning 
        July 1, 2011, and ending on September 30, 2019, by such 
        amounts that the total additional payments under title 
        XIX to such territories equals $6,300,000,000 for such 
        period. The Secretary shall increase such amounts in 
        proportion to the amounts applicable to such 
        territories under this subsection and subsection (f) on 
        the date of enactment of this paragraph.''.
          (2) Disregard of payments; increased fmap.--Section 
        2005 of the Patient Protection and Affordable Care Act 
        is amended--
                  (A) by repealing subsection (b) (and the 
                amendments made by that subsection) and section 
                1108(g)(4) of the Social Security Act shall be 
                applied as if such amendments had never been 
                enacted; and
                  (B) in subsection (c)(2), by striking 
                ``January'' and inserting ``July''.

SEC. 1205. DELAY IN COMMUNITY FIRST CHOICE OPTION.

  Section 1915(k)(1) of the Social Security Act (42 U.S.C. 
1396n(k)), as added by section 2401 of the Patient Protection 
and Affordable Care Act, is amended by striking ``October 1, 
2010'' and inserting ``October 1, 2011''.

SEC. 1206. DRUG REBATES FOR NEW FORMULATIONS OF EXISTING DRUGS.

  (a) Treatment of New Formulations.--Subparagraph (C) of 
section 1927(c)(2) of the Social Security Act (42 U.S.C. 1396r-
8(c)(2)), as added by section 2501(d) of the Patient Protection 
and Affordable Care Act, is amended to read as follows:
                  ``(C) Treatment of new formulations.--In the 
                case of a drug that is a line extension of a 
                single source drug or an innovator multiple 
                source drug that is an oral solid dosage form, 
                the rebate obligation with respect to such drug 
                under this section shall be the amount computed 
                under this section for such new drug or, if 
                greater, the product of--
                          ``(i) the average manufacturer price 
                        of the line extension of a single 
                        source drug or an innovator multiple 
                        source drug that is an oral solid 
                        dosage form;
                          ``(ii) the highest additional rebate 
                        (calculated as a percentage of average 
                        manufacturer price) under this section 
                        for any strength of the original single 
                        source drug or innovator multiple 
                        source drug; and
                          ``(iii) the total number of units of 
                        each dosage form and strength of the 
                        line extension product paid for under 
                        the State plan in the rebate period (as 
                        reported by the State).
                In this subparagraph, the term `line extension' 
                means, with respect to a drug, a new 
                formulation of the drug, such as an extended 
                release formulation.''.
  (b) Effective Date.--The amendment made by subsection (a) 
shall take effect as if included in the enactment of the 
Patient Protection and Affordable Care Act.

              Subtitle D--Reducing Fraud, Waste, and Abuse

SEC. 1301. COMMUNITY MENTAL HEALTH CENTERS.

  (a) In General.--Section 1861(ff)(3)(B) of the Social 
Security Act (42 U.S.C. 1395x(ff)(3)(B)) is amended--
          (1) in clause (ii), by striking ``and'' at the end;
          (2) by redesignating clause (iii) as clause (iv); and
          (3) by inserting after clause (ii) the following:
          ``(iii) provides a significant share of its services 
        to individuals who are not eligible for benefits under 
        this title; and''.
  (b) Restriction.--Section 1861(ff)(3)(A) of such Act (42 
U.S.C. 1395x(ff)(3)(A)) is amended by inserting ``other than in 
an individual's home or in an inpatient or residential 
setting'' before the period.
  (c) Effective Date.--The amendments made by this section 
shall apply to items and services furnished on or after the 
first day of the first calendar quarter that begins at least 12 
months after the date of the enactment of this Act.

SEC. 1302. MEDICARE PREPAYMENT MEDICAL REVIEW LIMITATIONS.

  Section 1874A(h) of the Social Security Act (42 U.S.C. 1395w-
3a(h)) is repealed.

SEC. 1303. CMS-IRS DATA MATCH TO IDENTIFY FRAUDULENT PROVIDERS.

  (a) Authority To Disclose Return Information Concerning 
Outstanding Tax Debts for Purposes of Enhancing Medicare 
Program Integrity.--
          (1) In general.--Section 6103(l) of the Internal 
        Revenue Code of 1986 is amended by adding at the end 
        the following new paragraph:
          ``(22) Disclosure of return information to department 
        of health and human services for purposes of enhancing 
        medicare program integrity.--
                  ``(A) In general.--The Secretary shall, upon 
                written request from the Secretary of Health 
                and Human Services, disclose to officers and 
                employees of the Department of Health and Human 
                Services return information with respect to a 
                taxpayer who has applied to enroll, or 
                reenroll, as a provider of services or supplier 
                under the Medicare program under title XVIII of 
                the Social Security Act. Such return 
                information shall be limited to--
                          ``(i) the taxpayer identity 
                        information with respect to such 
                        taxpayer;
                          ``(ii) the amount of the seriously 
                        delinquent tax debt owed by that 
                        taxpayer; and
                          ``(iii) the taxable year to which the 
                        seriously delinquent tax debt pertains.
                  ``(B) Restriction on disclosure.--Return 
                information disclosed under subparagraph (A) 
                may be used by officers and employees of the 
                Department of Health and Human Services for the 
                purposes of, and to the extent necessary in, 
                establishing the taxpayer's eligibility for 
                enrollment or reenrollment in the Medicare 
                program, or in any administrative or judicial 
                proceeding relating to, or arising from, a 
                denial of such enrollment or reenrollment, or 
                in determining the level of enhanced oversight 
                to be applied with respect to such taxpayer 
                pursuant to section 1866(j)(3) of the Social 
                Security Act.
                  ``(C) Seriously delinquent tax debt.--For 
                purposes of this paragraph, the term `seriously 
                delinquent tax debt' means an outstanding debt 
                under this title for which a notice of lien has 
                been filed pursuant to section 6323, but the 
                term does not include a debt that is being paid 
                in a timely manner pursuant to an agreement 
                under section 6159 or 7122, or a debt with 
                respect to which a collection due process 
                hearing under section 6330, or relief under 
                subsection (a), (b), or (f) of section 6015, is 
                requested or pending.''.
          (2) Conforming amendments.--Section 6103(p)(4) of 
        such Code, as amended by sections 1414 and 3308 the 
        Patient Protection and Affordable Care Act, in the 
        matter preceding subparagraph (A) and in subparagraph 
        (F)(ii), is amended by striking ``or (17)'' and 
        inserting ``(17), or (22)'' each place it appears.
  (b) Secretary's Authority To Use Information From the 
Department of the Treasury in Medicare Enrollments and 
Reenrollments.--Section 1866(j)(2) of the Social Security Act 
(42 U.S.C. 1395cc(j)), as inserted by section 6401(a) of the 
Patient Protection and Affordable Care Act, is further 
amended--
          (1) by redesignating subparagraph (E) as subparagraph 
        (F); and
          (2) by inserting after subparagraph (D) the following 
        new subparagraph:
                  ``(E) Use of information from the department 
                of the treasury concerning tax debts.--In 
                reviewing the application of a provider of 
                services or supplier to enroll or reenroll 
                under the program under this title, the 
                Secretary shall determine, on the basis of 
                information supplied by the Secretary of the 
                Treasury pursuant to section 6103(l)(22) of the 
                Internal Revenue Code of 1986, whether to deny 
                such application or to apply enhanced oversight 
                to such provider of services or supplier 
                pursuant to paragraph (3) if the Secretary 
                determines such provider of services or 
                supplier owes such a debt.''.
  (c) Authority To Adjust Payments of Providers of Services and 
Suppliers With the Same Tax Identification Number for Medicare 
Obligations.--Section 1866(j)(5) of the Social Security Act (42 
U.S.C. 1395cc(j)(5)), as inserted by section 6401(a) of the 
Patient Protection and Affordable Care Act, is amended--
          (1) in the paragraph heading, by striking ``past-
        due'' and inserting ``medicare'';
          (2) in subparagraph (A), by striking ``past-due 
        obligations described in subparagraph (B)(ii) of an'' 
        and inserting ``amount described in subparagraph 
        (B)(ii) due from such''; and
          (3) in subparagraph (B)(ii), by striking ``a past-due 
        obligation'' and inserting ``an amount that is more 
        than the amount required to be paid''.

SEC. 1304. FUNDING TO FIGHT FRAUD, WASTE, AND ABUSE.

  (a) Funding To Fight Fraud, Waste, and Abuse.--
          (1) In general.--Section 1817(k) of the Social 
        Security Act (42 U.S.C. 1395i(k)), as amended by 
        section 6402(i) of the Patient Protection and 
        Affordable Care Act, is further amended--
                  (A) by adding at the end the following new 
                paragraph:
          ``(8) Additional funding.--
                  ``(A) In general.--In addition to the funds 
                otherwise appropriated to the Account from the 
                Trust Fund under paragraphs (3)(C) and (4)(A) 
                and for purposes described in paragraphs (3)(C) 
                and (4)(A), there are hereby appropriated to 
                such Account from such Trust Fund the following 
                additional amounts:
                          ``(i) For fiscal year 2011, 
                        $95,000,000.
                          ``(ii) For fiscal year 2012, 
                        $55,000,000.
                          ``(iii) For each of fiscal years 2013 
                        and 2014, $30,000,000.
                          ``(iv) For each of fiscal years 2015 
                        and 2016, $20,000,000.
                  ``(B) Allocation.--The funds appropriated 
                under this paragraph shall be allocated in the 
                same proportion as the total funding 
                appropriated with respect to paragraphs (3)(A) 
                and (4)(A) was allocated with respect to fiscal 
                year 2010, and shall be available without 
                further appropriation until expended.''; and
                  (B) in paragraph (4)(A), by inserting ``for 
                activities described in paragraph (3)(C) and'' 
                after ``necessary''.
  (b) Medicaid Integrity Program.--Section 1936(e)(1) of such 
Act (42 U.S.C. 1396-u6(e)(1)) is amended--
          (1) in subparagraph (B), by striking at the end 
        ``and'';
          (2) in subparagraph (C)--
                  (A) by striking ``for each fiscal year 
                thereafter'' and inserting ``for each of fiscal 
                years 2009 and 2010''; and
                  (B) by striking the period and inserting ``; 
                and''; and
          (3) by adding at the end the following new 
        subparagraph:
                  ``(D) for each fiscal year after fiscal year 
                2010, the amount appropriated under this 
                paragraph for the previous fiscal year, 
                increased by the percentage increase in the 
                consumer price index for all urban consumers 
                (all items; United States city average) over 
                the previous year.''.

SEC. 1305. 90-DAY PERIOD OF ENHANCED OVERSIGHT FOR INITIAL CLAIMS OF 
                    DME SUPPLIERS.

  Section 1866(j), as amended by section 6401 of the Patient 
Protection and Affordable Care Act, is further amended--
          (1) by redesignating paragraphs (4) through (7) as 
        paragraphs (5) through (8), respectively; and
          (2) by inserting after paragraph (3) the following 
        new paragraph:
          ``(4) 90-day period of enhanced oversight for initial 
        claims of dme suppliers.--For periods beginning after 
        January 1, 2011, if the Secretary determines  that 
        there is a significant risk of fraudulent activity 
        among suppliers of durable medical equipment, in the 
        case of a supplier of durable medical equipment who is 
        within a category or geographic area under title XVIII 
        identified pursuant to such determination and who is 
        initially enrolling under such title, the Secretary 
        shall, notwithstanding sections 1816(c), 1842(c), and 
        1869(a)(2), withhold payment under such title with 
        respect to durable medical equipment furnished by such 
        supplier during the 90-day period beginning on the date 
        of the first submission of a claim under such title for 
        durable medical equipment furnished by such 
        supplier.''.

               Subtitle E--Provisions Relating to Revenue

SEC. 1401. HIGH-COST PLAN EXCISE TAX.

  (a) In General.--Section 4980I of the Internal Revenue Code 
of 1986, as added by section 9001 of the Patient Protection and 
Affordable Care Act and amended by section 10901 of such Act, 
is amended--
          (1) in subsection (b)(3)(B)--
                  (A) by striking ``The annual'' and inserting 
                the following:
                          ``(i) In general.--Except as provided 
                        in clause (ii), the annual'', and
                  (B) by adding at the end the following new 
                clause:
                          ``(ii) Multiemployer plan coverage.--
                        Any coverage provided under a 
                        multiemployer plan (as defined in 
                        section 414(f)) shall be treated as 
                        coverage other than self-only 
                        coverage.'',
          (2) in subsection (b)(3)(C)--
                  (A) by striking ``Except as provided in 
                subparagraph (D)--''
                  (B) in clause (i)--
                          (i) by striking ``2013'' each place 
                        it appears in the heading and the text 
                        and inserting ``2018'',
                          (ii) by striking ``$8,500'' in 
                        subclause (I) and inserting ``$10,200 
                        multiplied by the health cost 
                        adjustment percentage (determined by 
                        only taking into account self-only 
                        coverage)'', and
                          (iii) by striking ``$23,000'' in 
                        subclause (II) and inserting ``$27,500 
                        multiplied by the health cost 
                        adjustment percentage (determined by 
                        only taking into account coverage other 
                        than self-only coverage)'',
                  (C) by redesignating clauses (ii) and (iii) 
                as clauses (iv) and (v), respectively, and by 
                inserting after clause (i) the following new 
                clauses:
                          ``(ii) Health cost adjustment 
                        percentage.--For purposes of clause 
                        (i), the health cost adjustment 
                        percentage is equal to 100 percent plus 
                        the excess (if any) of--
                                  ``(I) the percentage by which 
                                the per employee cost for 
                                providing coverage under the 
                                Blue Cross/Blue Shield standard 
                                benefit option under the 
                                Federal Employees Health 
                                Benefits Plan for plan year 
                                2018 (determined by using the 
                                benefit package for such 
                                coverage in 2010) exceeds such 
                                cost for plan year 2010, over
                                  ``(II) 55 percent.
                          ``(iii) Age and gender adjustment.--
                                  ``(I) In general.--The amount 
                                determined under subclause (I) 
                                or (II) of clause (i), 
                                whichever is applicable, for 
                                any taxable period shall be 
                                increased by the amount 
                                determined under subclause 
                                (II).
                                  ``(II) Amount determined.--
                                The amount determined under 
                                this subclause is an amount 
                                equal to the excess (if any) 
                                of--
                                          ``(aa) the premium 
                                        cost of the Blue Cross/
                                        Blue Shield standard 
                                        benefit option under 
                                        the Federal Employees 
                                        Health Benefits Plan 
                                        for the type of 
                                        coverage provided such 
                                        individual in such 
                                        taxable period if 
                                        priced for the age and 
                                        gender characteristics 
                                        of all employees of the 
                                        individual's employer, 
                                        over
                                          ``(bb) that premium 
                                        cost for the provision 
                                        of such coverage under 
                                        such option in such 
                                        taxable period if 
                                        priced for the age and 
                                        gender characteristics 
                                        of the national 
                                        workforce.''.
                  (D) in clause (iv), as redesignated by 
                subparagraph (C)--
                          (i) by inserting ``covered by the 
                        plan'' after ``whose employees'', and
                          (ii) by striking subclauses (I) and 
                        (II) and inserting the following:
                                  ``(I) the dollar amount in 
                                clause (i)(I) shall be 
                                increased by $1,650, and
                                  ``(II) the dollar amount in 
                                clause (i)(II) shall be 
                                increased by $3,450,'', and
                  (E) in clause (v), as redesignated by 
                subparagraph (C)--
                          (i) by striking ``2013'' and 
                        inserting ``2018'',
                          (ii) by striking ``clauses (i) and 
                        (ii)'' and inserting ``clauses (i) 
                        (after the application of clause (ii)) 
                        and (iv)'', and
                          (iii) by inserting ``in the case of 
                        determinations for calendar years 
                        beginning before 2020'' after ``1 
                        percentage point'' in subclause (II) 
                        thereof,
          (3) by striking subparagraph (D) of subsection 
        (b)(3),
          (4) in subsection (d)(1)(B), by redesignating clause 
        (ii) as clause (iii) and by inserting after clause (i) 
        the following new clause:
                          ``(ii) any coverage under a separate 
                        policy, certificate, or contract of 
                        insurance which provides benefits 
                        substantially all of which are for 
                        treatment of the mouth (including any 
                        organ or structure within the mouth) or 
                        for treatment of the eye, or'', and
          (5) in subsection (d), by adding at the end the 
        following new paragraph:
          ``(3) Employee.--The term `employee' includes any 
        former employee, surviving spouse, or other primary 
        insured individual.''.
  (b) Effective Dates.--
          (1) Section 9001(c) of the Patient Protection and 
        Affordable Care Act is amended by striking ``2012'' and 
        inserting ``2017''.
          (2) Section 10901(c) of the Patient Protection and 
        Affordable Care Act is amended by striking ``2012'' and 
        inserting ``2017''.

SEC. 1402. MEDICARE TAX.

  (a) Investment Income.--
          (1) In general.--Subtitle A of the Internal Revenue 
        Code of 1986 is amended by inserting after chapter 2 
        the following new chapter:

                       ``CHAPTER 2A--MEDICARE TAX

``Sec. 1411. Imposition of tax.

``SEC. 1411. IMPOSITION OF TAX.

  ``(a) In General.--Except as provided in subsection (e)--
          ``(1) Application to individuals.--In the case of an 
        individual, there is hereby imposed (in addition to any 
        other tax imposed by this subtitle) for each taxable 
        year a tax equal to 3.8 percent of the lesser of--
                  ``(A) net investment income for such taxable 
                year, or
                  ``(B) the excess (if any) of--
                          ``(i) the modified adjusted gross 
                        income for such taxable year, over
                          ``(ii) the threshold amount.
          ``(2) Application to estates and trusts.--In the case 
        of an estate or trust, there is hereby imposed (in 
        addition to any other tax imposed by this subtitle) for 
        each taxable year a tax of 3.8 percent of the lesser 
        of--
                  ``(A) the undistributed net investment income 
                for such taxable year, or
                  ``(B) the excess (if any) of--
                          ``(i) the adjusted gross income (as 
                        defined in section 67(e)) for such 
                        taxable year, over
                          ``(ii) the dollar amount at which the 
                        highest tax bracket in section 1(e) 
                        begins for such taxable year.
  ``(b) Threshold Amount.--For purposes of this chapter, the 
term `threshold amount' means--
          ``(1) in the case of a taxpayer making a joint return 
        under section 6013 or a surviving spouse (as defined in 
        section 2(a)), $250,000,
          ``(2) in the case of a married taxpayer (as defined 
        in section 7703) filing a separate return, \1/2\ of the 
        dollar amount determined under paragraph (1), and
          ``(3) in any other case, $200,000.
  ``(c) Net Investment Income.--For purposes of this chapter--
          ``(1) In general.--The term `net investment income' 
        means the excess (if any) of--
                  ``(A) the sum of--
                          ``(i) gross income from interest, 
                        dividends, annuities, royalties, and 
                        rents, other than such income which is 
                        derived in the ordinary course of a 
                        trade or business not described in 
                        paragraph (2),
                          ``(ii) other gross income derived 
                        from a trade or business described in 
                        paragraph (2), and
                          ``(iii) net gain (to the extent taken 
                        into account in computing taxable 
                        income) attributable to the disposition 
                        of property other than property held in 
                        a trade or business not described in 
                        paragraph (2), over
                  ``(B) the deductions allowed by this subtitle 
                which are properly allocable to such gross 
                income or net gain.
          ``(2) Trades and businesses to which tax applies.--A 
        trade or business is described in this paragraph if 
        such trade or business is--
                  ``(A) a passive activity (within the meaning 
                of section 469) with respect to the taxpayer, 
                or
                  ``(B) a trade or business of trading in 
                financial instruments or commodities (as 
                defined in section 475(e)(2)).
          ``(3) Income on investment of working capital subject 
        to tax.--A rule similar to the rule of section 
        469(e)(1)(B) shall apply for purposes of this 
        subsection.
          ``(4) Exception for certain active interests in 
        partnerships and s corporations.--In the case of a 
        disposition of an interest in a partnership or S 
        corporation--
                  ``(A) gain from such disposition shall be 
                taken into account under clause (iii) of 
                paragraph (1)(A) only to the extent of the net 
                gain which would be so taken into account by 
                the transferor if all property of the 
                partnership or S corporation were sold for fair 
                market value immediately before the disposition 
                of such interest, and
                  ``(B) a rule similar to the rule of 
                subparagraph (A) shall apply to a loss from 
                such disposition.
          ``(5) Exception for distributions from qualified 
        plans.--The term `net investment income' shall not 
        include any distribution from a plan or arrangement 
        described in section 401(a), 403(a), 403(b), 408, 408A, 
        or 457(b).
          ``(6) Special rule.--Net investment income shall not 
        include any item taken into account in determining 
        self-employment income for such taxable year on which a 
        tax is imposed by section 1401(b).
  ``(d) Modified Adjusted Gross Income.--For purposes of this 
chapter, the term `modified adjusted gross income' means 
adjusted gross income increased by the excess of--
          ``(1) the amount excluded from gross income under 
        section 911(a)(1), over
          ``(2) the amount of any deductions (taken into 
        account in computing adjusted gross income) or 
        exclusions disallowed under section 911(d)(6) with 
        respect to the amounts described in paragraph (1).
  ``(e) Nonapplication of Section.--This section shall not 
apply to--
          ``(1) a nonresident alien, or
          ``(2) a trust all of the unexpired interests in which 
        are devoted to one or more of the purposes described in 
        section 170(c)(2)(B).''.
          (2) Estimated taxes.--Section 6654 of the Internal 
        Revenue Code of 1986 is amended--
                  (A) in subsection (a), by striking ``and the 
                tax under chapter 2'' and inserting ``the tax 
                under chapter 2, and the tax under chapter 
                2A'', and
                  (B) in subsection (f)--
                          (i) by striking ``minus'' at the end 
                        of paragraph (2) and inserting 
                        ``plus'', and
                          (ii) by redesignating paragraph (3) 
                        as paragraph (4) and inserting after 
                        paragraph (2) the following new 
                        paragraph:
          ``(3) the taxes imposed by chapter 2A, minus''.
          (3) Federal supplementary medical insurance trust 
        fund.--Section 1841(a) of such Act (42 U.S.C. 1395t(a)) 
        is amended by adding at the end the following: ``There 
        are hereby appropriated to the Trust Fund, out of any 
        moneys in the Treasury not otherwise appropriated, 
        amounts equivalent to 100 per centum of the taxes 
        imposed by 1411 of the Internal Revenue Code of 1986 
        with respect to income described in such section and 
        reported to the Secretary of the Treasury or the 
        Secretary's delegate on tax returns under subtitle F of 
        such Code, as determined by the Secretary of the 
        Treasury by applying the applicable rate of tax under 
        such section to such income. The amounts appropriated 
        by the preceding sentence shall be transferred from 
        time to time from the general fund of the Treasury to 
        the Trust Fund, such amounts to be determined on the 
        basis of estimates by the Secretary of the Treasury of 
        the taxes, specified in the preceding sentence, paid to 
        or deposited into the Treasury; and proper adjustments 
        shall be made in amounts subsequently transferred to 
        the extent prior estimates were in excess of or were 
        less than the taxes specified in such sentence.''.
          (4) Clerical amendment.--The table of chapters for 
        subtitle A of chapter 1 of the Internal Revenue Code of 
        1986 is amended by inserting after the item relating to 
        chapter 2 the following new item:

                      ``Chapter 2A--Medicare Tax''.

          (5) Effective dates.--The amendments made by this 
        subsection shall apply to taxable years beginning after 
        December 31, 2012.
  (b) Earned Income.--
          (1) Threshold.--
                  (A) FICA.--Paragraph (2) of section 3101(b) 
                of the Internal Revenue Code of 1986, as added 
                by section 9015 of the Patient Protection and 
                Affordable Care Act and amended by section 
                10906 of such Act, is amended by striking 
                ``and'' at the end of subparagraph (A), by 
                redesignating subparagraph (B) as subparagraph 
                (C), and by inserting after subparagraph (A) 
                the following new subparagraph:
                  ``(B) in the case of a married taxpayer (as 
                defined in section 7703) filing a separate 
                return, \1/2\ of the dollar amount determined 
                under subparagraph (A), and''.
                  (B) SECA.--Section 1401(b)(2) of the Internal 
                Revenue Code of 1986, as added by section 9015 
                of the Patient Protection and Affordable Care 
                Act and amended by section 10906 of such Act, 
                is amended--
                          (i) in subparagraph (A), by striking 
                        ``and'' at the end of clause (i), by 
                        redesignating clause (ii) as clause 
                        (iii), and by inserting after clause 
                        (i) the following new clause:
                          ``(ii) in the case of a married 
                        taxpayer (as defined in section 7703) 
                        filing a separate return, \1/2\ of the 
                        dollar amount determined under clause 
                        (i), and'', and
                          (ii) in subparagraph (B), by striking 
                        ``under clauses (i) and (ii)'' and 
                        inserting ``under clause (i), (ii), or 
                        (iii) (whichever is applicable)''.
          (2) Estimated taxes.--Section 6654 of the Internal 
        Revenue Code of 1986 is amended by redesignating 
        subsection (m) as subsection (n) and by inserting after 
        subsection (l) the following new subsection:
  ``(m) Special Rule for Medicare Tax.--For purposes of this 
section, the tax imposed under section 3101(b)(2) (to the 
extent not withheld) shall be treated as a tax imposed under 
chapter 2.''.
          (3) Effective date.--The amendments made by this 
        subsection shall apply with respect to remuneration 
        received, and taxable years beginning after, December 
        31, 2012.

SEC. 1403. DELAY OF LIMITATION ON HEALTH FLEXIBLE SPENDING ARRANGEMENTS 
                    UNDER CAFETERIA PLANS.

  (a) In General.--Section 10902(b) of the Patient Protection 
and Affordable Care Act is amended by striking ``December 31, 
2010'' and inserting ``December 31, 2012''.
  (b) Inflation Adjustment.--Paragraph (2) of section 125(i) of 
the Internal Revenue Code of 1986, as added by section 9005 of 
the Patient Protection and Affordable Care Act and amended by 
section 10902 of such Act, is amended--
          (1) in the matter preceding subparagraph (A), by 
        striking ``December 31, 2011'' and inserting ``December 
        31, 2013'', and
          (2) in subparagraph (B), by striking ``2010'' and 
        inserting ``2012''.

SEC. 1404. BRAND NAME PHARMACEUTICALS.

  (a) In General.--Section 9008 of the Patient Protection and 
Affordable Care Act is amended--
          (1) in subsection (a)(1), by striking ``2009'' and 
        inserting ``2010'',
          (2) in subsection (b)--
                  (A) by striking ``$2,300,000,000'' in 
                paragraph (1) and inserting ``the applicable 
                amount'', and
                  (B) by adding at the end the following new 
                paragraph:
          ``(4) Applicable amount.--For purposes of paragraph 
        (1), the applicable amount shall be determined in 
        accordance with the following table:


``Calendar year                          Applicable amount
  2011.................................  $2,500,000,000
  2012.................................  $3,000,000,000
  2013.................................  $3,000,000,000
  2014.................................  $3,000,000,000
  2015.................................  $3,000,000,000
  2016.................................  $3,000,000,000
  2017.................................  $3,500,000,000.
  2018.................................  $4,200,000,000
  2019 and thereafter..................  $2,800,000,000.'',


          (3) in subsection (d), by adding at the end the 
        following new paragraph:
          ``(3) Joint and several liability.--If more than one 
        person is liable for payment of the fee under 
        subsection (a) with respect to a single covered entity 
        by reason of the application of paragraph (2), all such 
        persons shall be jointly and severally liable for 
        payment of such fee.'', and
          (4) by striking subsection (j) and inserting the 
        following new subsection:
  ``(j) Effective Date.--This section shall apply to calendar 
years beginning after December 31, 2010.''.
  (b) Effective Date.--The amendments made by this section 
shall take effect as if included in section 9008 of the Patient 
Protection and Affordable Care Act.

SEC. 1405. EXCISE TAX ON MEDICAL DEVICE MANUFACTURERS.

  (a) In General.--Chapter 32 of the Internal Revenue Code of 
1986 is amended--
          (1) by inserting after subchapter D the following new 
        subchapter:

                    ``Subchapter E--Medical Devices

``Sec. 4191. Medical devices.

``SEC. 4191. MEDICAL DEVICES.

  ``(a) In General.--There is hereby imposed on the sale of any 
taxable medical device by the manufacturer, producer, or 
importer a tax equal to 2.9 percent of the price for which so 
sold.
  ``(b) Taxable Medical Device.--For purposes of this section--
          ``(1) In general.--The term `taxable medical device' 
        means any device (as defined in section 201(h) of the 
        Federal Food, Drug, and Cosmetic Act) intended for 
        humans.
          ``(2) Exemptions.--Such term shall not include--
                  ``(A) devices classified in class I under 
                section 513 of such Act,
                  ``(B) eyeglasses,
                  ``(C) contact lenses,
                  ``(D) hearing aids, and
                  ``(E) any other medical device determined by 
                the Secretary to be of a type which is 
                generally purchased by the general public at 
                retail for individual use.'', and
          (2) by inserting after the item relating to 
        subchapter D in the table of subchapters for such 
        chapter the following new item:

                   ``subchapter e. medical devices.''.

  (b) Certain Exemptions Not to Apply.--
          (1) Section 4221(a) of the Internal Revenue Code of 
        1986 is amended by adding at the end the following new 
        sentence: ``In the case of the tax imposed by section 
        4191, paragraphs (3), (4), (5), and (6) shall not 
        apply.''.
          (2) Section 6416(b)(2) of such Code is amended by 
        adding at the end the following: ``In the case of the 
        tax imposed by section 4191, subparagraphs (B), (C), 
        (D), and (E) shall not apply.''.
  (c) Effective Date.--The amendments made by this section 
shall apply to sales after December 31, 2012.
  (d) Repeal of Section 9009 of the Patient Protection and 
Affordable Care Act.--Section 9009 of the Patient Protection 
and Affordable Care Act, as amended by section 10904 of such 
Act, is repealed effective as of the date of enactment of that 
Act.

SEC. 1406. HEALTH INSURANCE PROVIDERS.

  (a) In General.--Section 9010 of the Patient Protection and 
Affordable Care Act, as amended by section 10905 of such Act, 
is amended--
          (1) in subsection (a)(1), by striking ``2010'' and 
        inserting ``2013'',
          (2) in subsection (b)(2)--
                  (A) by striking ``For purposes of paragraph 
                (1), the net premiums'' and inserting ``For 
                purposes of paragraph (1)--
                  ``(A) In general.--The net premiums'', and
                  (B) by adding at the end the following 
                subparagraph:
                  ``(B) Partial exclusion for certain exempt 
                activities.--After the application of 
                subparagraph (A), only 50 percent of the 
                remaining net premiums written with respect to 
                health insurance for any United States health 
                risk that are attributable to the activities 
                (other than activities of an unrelated trade or 
                business as defined in section 513 of the 
                Internal Revenue Code of 1986) of any covered 
                entity qualifying under paragraph (3), (4), 
                (26), or (29) of section 501(c) of such Code 
                and exempt from tax under section 501(a) of 
                such Code shall be taken into account.'',
          (3) in subsection (c)--
                  (A) by inserting ``during the calendar year 
                in which the fee under this section is due'' in 
                paragraph (1) after ``risk'',
                  (B) in paragraph (2), by striking 
                subparagraphs (C), (D), and (E) and inserting 
                the following new subparagraphs:
                  ``(C) any entity--
                          ``(i) which is incorporated as a 
                        nonprofit corporation under a State 
                        law,
                          ``(ii) no part of the net earnings of 
                        which inures to the benefit of any 
                        private shareholder or individual, no 
                        substantial part of the activities of 
                        which is carrying on propaganda, or 
                        otherwise attempting, to influence 
                        legislation (except as otherwise 
                        provided in section 501(h) of the 
                        Internal Revenue Code of 1986), and 
                        which does not participate in, or 
                        intervene in (including the publishing 
                        or distributing of statements), any 
                        political campaign on behalf of (or in 
                        opposition to) any candidate for public 
                        office, and
                          ``(iii) more than 80 percent of the 
                        gross revenues of which is received 
                        from government programs that target 
                        low-income, elderly, or disabled 
                        populations under titles XVIII, XIX, 
                        and XXI of the Social Security Act, and
                  ``(D) any entity which is described in 
                section 501(c)(9) of such Code and which is 
                established by an entity (other than by an 
                employer or employers) for purposes of 
                providing health care benefits.'',
                  (C) in paragraph (3)(A), by striking 
                ``subparagraph (C)(i)(I), (D)(i)(I), or 
                (E)(i)'' and inserting ``subparagraph (C) or 
                (D)'', and
                  (D) by adding at the end the following new 
                paragraph:
          ``(4) Joint and several liability.--If more than one 
        person is liable for payment of the fee under 
        subsection (a) with respect to a single covered entity 
        by reason of the application of paragraph (3), all such 
        persons shall be jointly and severally liable for 
        payment of such fee.'',
          (4) by striking subsection (e) and inserting the 
        following:
  ``(e) Applicable Amount.--For purposes of subsection (b)(1)--
          ``(1) Years before 2019.--In the case of calendar 
        years beginning before 2019, the applicable amount 
        shall be determined in accordance with the following 
        table:


``Calendar year                          Applicable amount
  2014.................................  $8,000,000,000
  2015.................................  $11,300,000,000
  2016.................................  $11,300,000,000
  2017.................................  $13,900,000,000
  2018.................................  $14,300,000,000.


          ``(2) Years after 2018.--In the case of any calendar 
        year beginning after 2018, the applicable amount shall 
        be the applicable amount for the preceding calendar 
        year increased by the rate of premium growth (within 
        the meaning of section 36B(b)(3)(A)(ii) of the Internal 
        Revenue Code of 1986) for such preceding calendar 
        year.'',
          (5) in subsection (g), by adding at the end the 
        following new paragraphs:
          ``(3) Accuracy-related penalty.--
                  ``(A) In general.--In the case of any 
                understatement of a covered entity's net 
                premiums written with respect to health 
                insurance for any United States health risk for 
                any calendar year, there shall be paid by the 
                covered entity making such understatement, an 
                amount equal to the excess of--
                          ``(i) the amount of the covered 
                        entity's fee under this section for the 
                        calendar year the Secretary determines 
                        should have been paid in the absence of 
                        any such understatement, over
                          ``(ii) the amount of such fee the 
                        Secretary determined based on such 
                        understatement.
                  ``(B) Understatement.--For purposes of this 
                paragraph, an understatement of a covered 
                entity's net premiums written with respect to 
                health insurance for any United States health 
                risk for any calendar year is the difference 
                between the amount of such net premiums written 
                as reported on the return filed by the covered 
                entity under paragraph (1) and the amount of 
                such net premiums written that should have been 
                reported on such return.
                  ``(C) Treatment of penalty.--The penalty 
                imposed under subparagraph (A) shall be subject 
                to the provisions of subtitle F of the Internal 
                Revenue Code of 1986 that apply to assessable 
                penalties imposed under chapter 68 of such 
                Code.
          ``(4) Treatment of information.--Section 6103 of the 
        Internal Revenue Code of 1986 shall not apply to any 
        information reported under this subsection.'', and
          (6) by striking subsection (j) and inserting the 
        following new subsection:
  ``(j) Effective Date.--This section shall apply to calendar 
years beginning after December 31, 2013.''.
  (b) Effective Date.--The amendments made by this section 
shall take effect as if included in section 9010 of the Patient 
Protection and Affordable Care Act.

SEC. 1407. DELAY OF ELIMINATION OF DEDUCTION FOR EXPENSES ALLOCABLE TO 
                    MEDICARE PART D SUBSIDY.

  Section 9012(b) of the Patient Protection and Affordable Care 
Act is amended by striking ``2010'' and inserting ``2012''.

SEC. 1408. ELIMINATION OF UNINTENDED APPLICATION OF CELLULOSIC BIOFUEL 
                    PRODUCER CREDIT.

  (a) In General.--Section 40(b)(6)(E) of the Internal Revenue 
Code of 1986 is amended by adding at the end the following new 
clause:
                          ``(iii) Exclusion of unprocessed 
                        fuels.--The term `cellulosic biofuel' 
                        shall not include any fuel if--
                                  ``(I) more than 4 percent of 
                                such fuel (determined by 
                                weight) is any combination of 
                                water and sediment, or
                                  ``(II) the ash content of 
                                such fuel is more than 1 
                                percent (determined by 
                                weight).''.
  (b) Effective Date.--The amendment made by this section shall 
apply to fuels sold or used on or after January 1, 2010.

SEC. 1409. CODIFICATION OF ECONOMIC SUBSTANCE DOCTRINE AND PENALTIES.

  (a) In General.--Section 7701 of the Internal Revenue Code of 
1986 is amended by redesignating subsection (o) as subsection 
(p) and by inserting after subsection (n) the following new 
subsection:
  ``(o) Clarification of Economic Substance Doctrine.--
          ``(1) Application of doctrine.--In the case of any 
        transaction to which the economic substance doctrine is 
        relevant, such transaction shall be treated as having 
        economic substance only if--
                  ``(A) the transaction changes in a meaningful 
                way (apart from Federal income tax effects) the 
                taxpayer's economic position, and
                  ``(B) the taxpayer has a substantial purpose 
                (apart from Federal income tax effects) for 
                entering into such transaction.
          ``(2) Special rule where taxpayer relies on profit 
        potential.--
                  ``(A) In general.--The potential for profit 
                of a transaction shall be taken into account in 
                determining whether the requirements of 
                subparagraphs (A) and (B) of paragraph (1) are 
                met with respect to the transaction only if the 
                present value of the reasonably expected pre-
                tax profit from the transaction is substantial 
                in relation to the present value of the 
                expected net tax benefits that would be allowed 
                if the transaction were respected.
                  ``(B) Treatment of fees and foreign taxes.--
                Fees and other transaction expenses shall be 
                taken into account as expenses in determining 
                pre-tax profit under subparagraph (A). The 
                Secretary shall issue regulations requiring 
                foreign taxes to be treated as expenses in 
                determining pre-tax profit in appropriate 
                cases.
          ``(3) State and local tax benefits.--For purposes of 
        paragraph (1), any State or local income tax effect 
        which is related to a Federal income tax effect shall 
        be treated in the same manner as a Federal income tax 
        effect.
          ``(4) Financial accounting benefits.--For purposes of 
        paragraph (1)(B), achieving a financial accounting 
        benefit shall not be taken into account as a purpose 
        for entering into a transaction if the origin of such 
        financial accounting benefit is a reduction of Federal 
        income tax.
          ``(5) Definitions and special rules.--For purposes of 
        this subsection--
                  ``(A) Economic substance doctrine.--The term 
                `economic substance doctrine' means the common 
                law doctrine under which tax benefits under 
                subtitle A with respect to a transaction are 
                not allowable if the transaction does not have 
                economic substance or lacks a business purpose.
                  ``(B) Exception for personal transactions of 
                individuals.--In the case of an individual, 
                paragraph (1) shall apply only to transactions 
                entered into in connection with a trade or 
                business or an activity engaged in for the 
                production of income.
                  ``(C) Determination of application of 
                doctrine not affected.--The determination of 
                whether the economic substance doctrine is 
                relevant to a transaction shall be made in the 
                same manner as if this subsection had never 
                been enacted.
                  ``(D) Transaction.--The term `transaction' 
                includes a series of transactions.''.
  (b) Penalty for Underpayments Attributable to Transactions 
Lacking Economic Substance.--
          (1) In general.--Subsection (b) of section 6662 is 
        amended by inserting after paragraph (5) the following 
        new paragraph:
          ``(6) Any disallowance of claimed tax benefits by 
        reason of a transaction lacking economic substance 
        (within the meaning of section 7701(o)) or failing to 
        meet the requirements of any similar rule of law.''.
          (2) Increased penalty for nondisclosed 
        transactions.--Section 6662 is amended by adding at the 
        end the following new subsection:
  ``(i) Increase in Penalty in Case of Nondisclosed Noneconomic 
Substance Transactions.--
          ``(1) In general.--In the case of any portion of an 
        underpayment which is attributable to one or more 
        nondisclosed noneconomic substance transactions, 
        subsection (a) shall be applied with respect to such 
        portion by substituting `40 percent' for `20 percent'.
          ``(2) Nondisclosed noneconomic substance 
        transactions.--For purposes of this subsection, the 
        term `nondisclosed noneconomic substance transaction' 
        means any portion of a transaction described in 
        subsection (b)(6) with respect to which the relevant 
        facts affecting the tax treatment are not adequately 
        disclosed in the return nor in a statement attached to 
        the return.
          ``(3) Special rule for amended returns.--In no event 
        shall any amendment or supplement to a return of tax be 
        taken into account for purposes of this subsection if 
        the amendment or supplement is filed after the earlier 
        of the date the taxpayer is first contacted by the 
        Secretary regarding the examination of the return or 
        such other date as is specified by the Secretary.''.
          (3) Conforming amendment.--Subparagraph (B) of 
        section 6662A(e)(2) is amended--
                  (A) by striking ``section 6662(h)'' and 
                inserting ``subsections (h) or (i) of section 
                6662''; and
                  (B) by striking ``gross valuation 
                misstatement penalty'' in the heading and 
                inserting ``certain increased underpayment 
                penalties''.
  (c) Reasonable Cause Exception Not Applicable to Noneconomic 
Substance Transactions.--
          (1) Reasonable cause exception for underpayments.--
        Subsection (c) of section 6664 is amended--
                  (A) by redesignating paragraphs (2) and (3) 
                as paragraphs (3) and (4), respectively;
                  (B) by striking ``paragraph (2)'' in 
                paragraph (4)(A), as so redesignated, and 
                inserting ``paragraph (3)''; and
                  (C) by inserting after paragraph (1) the 
                following new paragraph:
          ``(2) Exception.--Paragraph (1) shall not apply to 
        any portion of an underpayment which is attributable to 
        one or more transactions described in section 
        6662(b)(6).''.
          (2) Reasonable cause exception for reportable 
        transaction understatements.--Subsection (d) of section 
        6664 is amended--
                  (A) by redesignating paragraphs (2) and (3) 
                as paragraphs (3) and (4), respectively;
                  (B) by striking ``paragraph (2)(C)'' in 
                paragraph (4), as so redesignated, and 
                inserting ``paragraph (3)(C)''; and
                  (C) by inserting after paragraph (1) the 
                following new paragraph:
          ``(2) Exception.--Paragraph (1) shall not apply to 
        any portion of a reportable transaction understatement 
        which is attributable to one or more transactions 
        described in section 6662(b)(6).''.
  (d) Application of Penalty for Erroneous Claim for Refund or 
Credit to Noneconomic Substance Transactions.--Section 6676 is 
amended by redesignating subsection (c) as subsection (d) and 
inserting after subsection (b) the following new subsection:
  ``(c) Noneconomic Substance Transactions Treated as Lacking 
Reasonable Basis.--For purposes of this section, any excessive 
amount which is attributable to any transaction described in 
section 6662(b)(6) shall not be treated as having a reasonable 
basis.''.
  (e) Effective Date.--
          (1) In general.--Except as otherwise provided in this 
        subsection, the amendments made by this section shall 
        apply to transactions entered into after the date of 
        the enactment of this Act.
          (2) Underpayments.--The amendments made by 
        subsections (b) and (c)(1) shall apply to underpayments 
        attributable to transactions entered into after the 
        date of the enactment of this Act.
          (3) Understatements.--The amendments made by 
        subsection (c)(2) shall apply to understatements 
        attributable to transactions entered into after the 
        date of the enactment of this Act.
          (4) Refunds and credits.--The amendment made by 
        subsection (d) shall apply to refunds and credits 
        attributable to transactions entered into after the 
        date of the enactment of this Act.

SEC. 1410. TIME FOR PAYMENT OF CORPORATE ESTIMATED TAXES.

  The percentage under paragraph (1) of section 202(b) of the 
Corporate Estimated Tax Shift Act of 2009 in effect on the date 
of the enactment of this Act is increased by 14.5 percentage 
points.

SEC. 1411. NO IMPACT ON SOCIAL SECURITY TRUST FUNDS.

  (a) Estimate of Secretary.--The Secretary of the Treasury 
shall annually estimate the impact that the enactment of this 
Act has on the income and balances of the trust funds 
established under section 201 of the Social Security Act (42 
U.S.C. 401).
  (b) Transfer of Funds.--If, under subsection (a), the 
Secretary of the Treasury estimates that the enactment of this 
Act has a negative impact on the income and balances of the 
trust funds established under section 201 of the Social 
Security Act (42 U.S.C. 401), the Secretary shall transfer, not 
less frequently than quarterly, from the general revenues of 
the Federal Government an amount sufficient so as to ensure 
that the income and balances of such trust funds are not 
reduced as a result of the enactment of this Act.

                      Subtitle F--Other Provisions

SEC. 1501. COMMUNITY COLLEGE AND CAREER TRAINING GRANT PROGRAM.

  There are authorized to be appropriated, and there are 
appropriated, $500,000,000, for each of the fiscal years 2011, 
2012, 2013, and 2014, to award Community College and Career 
Training Grants authorized under section 278 of the Trade Act 
of 1974 (19 U.S.C. 2372), provided that--
          (1) the limitations contained in subsection (a)(2) of 
        such section shall not apply for such fiscal years;
          (2) in addition to workers eligible for training 
        under section 236 of the Trade Act of 1974 (19 U.S.C. 
        2296) such Grants may be used to develop, offer, or 
        improve an educational or career training program that 
        is suited to individuals who are, or may become, 
        eligible for unemployment compensation as defined in 
        section 85(b) of the Internal Revenue Code of 1986; and
          (3) each State shall receive not less than 0.5 
        percent of the amount appropriated pursuant to this 
        section for each such fiscal year.

                     TITLE II--EDUCATION AND HEALTH

                         Subtitle A--Education

SEC. 2001. SHORT TITLE; REFERENCES.

  (a) Short Title.--This subtitle may be cited as the ``SAFRA 
Act''.
  (b) References.--Except as otherwise expressly provided, 
whenever in this subtitle an amendment or repeal is expressed 
in terms of an amendment to, or repeal of, a section or other 
provision, the reference shall be considered to be made to a 
section or other provision of the Higher Education Act of 1965 
(20 U.S.C. 1001 et seq.).

               PART I--INVESTING IN STUDENTS AND FAMILIES

SEC. 2101. FEDERAL PELL GRANTS.

  (a) Amount of Grants.--Section 401(b) (20 U.S.C. 1070a(b)) is 
amended--
          (1) by amending paragraph (2)(A) to read as follows:
                  ``(A) The amount of the Federal Pell Grant 
                for a student eligible under this part shall 
                be--
                          ``(i) the maximum Federal Pell Grant, 
                        as specified in the last enacted 
                        appropriation Act applicable to that 
                        award year, plus
                          ``(ii) the amount of the increase 
                        calculated under paragraph (8)(B) for 
                        that year, less
                          ``(iii) an amount equal to the amount 
                        determined to be the expected family 
                        contribution with respect to that 
                        student for that year.''; and
          (2) in paragraph (8)--
                  (A) in subparagraph (A)--
                          (i) in clause (ii), by striking the 
                        semicolon and inserting ``; and''; and
                          (ii) by striking clauses (iii) 
                        through (x) and inserting the 
                        following:
                          ``(iii) such sums as may be necessary 
                        for fiscal year 2010 and each 
                        subsequent fiscal year to provide the 
                        amount of increase of the maximum 
                        Federal Pell Grant required by clauses 
                        (ii) and (iii) of subparagraph (B).'';
                  (B) in subparagraph (B)--
                          (i) in clause (ii), by striking ``and 
                        2011-2012'' and inserting ``, 2011-
                        2012, and 2012-2013''; and
                          (ii) by striking clause (iii) and 
                        inserting the following:
                          ``(iii) the amount determined under 
                        subparagraph (C) for each succeeding 
                        award year.'';
                  (C) by striking subparagraph (C) and 
                inserting the following:
                  ``(C) Adjustment amounts.--
                          ``(i) Award year 2013-2014.--For 
                        award year 2013-2014, the amount 
                        determined under this subparagraph for 
                        purposes of subparagraph (B)(iii) shall 
                        be equal to--
                                  ``(I) $5,550 or the total 
                                maximum Federal Pell Grant for 
                                the preceding award year (as 
                                determined under clause 
                                (v)(II)), whichever is greater, 
                                increased by a percentage equal 
                                to the annual adjustment 
                                percentage for award year 2013-
                                2014; reduced by
                                  ``(II) $4,860 or the maximum 
                                Federal Pell Grant for which a 
                                student was eligible for the 
                                preceding award year, as 
                                specified in the last enacted 
                                appropriation Act applicable to 
                                that year, whichever is 
                                greater; and
                                  ``(III) rounded to the 
                                nearest $5.
                          ``(ii) Award years 2014-2015 through 
                        2017-2018.--For each of the award years 
                        2014-2015 through 2017-2018, the amount 
                        determined under this subparagraph for 
                        purposes of subparagraph (B)(iii) shall 
                        be equal to--
                                  ``(I) the total maximum 
                                Federal Pell Grant for the 
                                preceding award year (as 
                                determined under clause 
                                (v)(II)), increased by a 
                                percentage equal to the annual 
                                adjustment percentage for the 
                                award year for which the amount 
                                under this subparagraph is 
                                being determined; reduced by
                                  ``(II) $4,860 or the maximum 
                                Federal Pell Grant for which a 
                                student was eligible for the 
                                preceding award year, as 
                                specified in the last enacted 
                                appropriation Act applicable to 
                                that year, whichever is 
                                greater; and
                                  ``(III) rounded to the 
                                nearest $5.
                          ``(iii) Subsequent award years.--For 
                        award year 2018-2019 and each 
                        subsequent award year, the amount 
                        determined under this subparagraph for 
                        purposes of subparagraph (B)(iii) shall 
                        be equal to the amount determined under 
                        clause (ii) for award year 2017-2018.
                          ``(iv) Limitation on decreases.--
                        Notwithstanding clauses (i), (ii), and 
                        (iii), if the amount determined under 
                        clause (i), (ii), or (iii) for a 
                        particular award year is less than the 
                        amount determined under this paragraph 
                        for the award year preceding that 
                        particular award year, then the amount 
                        determined under such clause for that 
                        particular award year shall be the 
                        amount determined under this paragraph 
                        for the preceding award year.
                          ``(v) Definitions.--For purposes of 
                        this subparagraph--
                                  ``(I) the term `annual 
                                adjustment percentage' as 
                                applied to an award year, is 
                                equal to the estimated 
                                percentage change in the 
                                Consumer Price Index (as 
                                determined by the Secretary, 
                                using the definition in section 
                                478(f)) for the most recent 
                                calendar year ending prior to 
                                the beginning of that award 
                                year; and
                                  ``(II) the term `total 
                                maximum Federal Pell Grant' as 
                                applied to a preceding award 
                                year, is equal to the sum of--
                                          ``(aa) the maximum 
                                        Federal Pell Grant for 
                                        which a student is 
                                        eligible during an 
                                        award year, as 
                                        specified in the last 
                                        enacted appropriation 
                                        Act applicable to that 
                                        preceding award year; 
                                        and
                                          ``(bb) the amount of 
                                        the increase in the 
                                        maximum Federal Pell 
                                        Grant required by this 
                                        paragraph for that 
                                        preceding award 
                                        year.'';
                  (D) by striking subparagraph (E); and
                  (E) by redesignating subparagraph (F) as 
                subparagraph (E).
  (b) Conforming Amendments.--Title IV (20 U.S.C. 1070 et seq.) 
is further amended--
          (1) in section 401(b) (20 U.S.C. 1070a(b))--
                  (A) in paragraph (4)--
                          (i) by striking ``maximum basic grant 
                        level specified in the appropriate 
                        appropriation Act'' and inserting 
                        ``maximum amount of a Federal Pell 
                        Grant award determined under paragraph 
                        (2)(A)''; and
                          (ii) by striking ``such level'' each 
                        place it appears and inserting ``such 
                        Federal Pell Grant amount'' in each 
                        such place; and
                  (B) in paragraph (6), by striking ``the grant 
                level specified in the appropriate 
                Appropriation Act for this subpart for such 
                year'' and inserting ``the maximum amount of a 
                Federal Pell Grant award determined under 
                paragraph (2)(A), for which a student is 
                eligible during such award year'';
          (2) in section 402D(d)(1) (20 U.S.C. 1070a-14(d)(1)), 
        by striking ``exceed the maximum'' and all that follows 
        through ``Grant, for'' and inserting ``exceed the 
        Federal Pell Grant amount, determined under section 
        401(b)(2)(A), for which a student is eligible, or be 
        less than the minimum Federal Pell Grant amount 
        described in section 401(b)(4), for'';
          (3) in section 435(a)(5)(A)(i)(I) (20 U.S.C. 
        1085(a)(5)(A)(i)(I)), by striking ``one-half the 
        maximum Federal Pell Grant award for which a student 
        would be eligible'' and inserting ``one-half the 
        Federal Pell Grant amount, determined under section 
        401(b)(2)(A), for which a student would be eligible'';
          (4) in section 483(e)(3)(A)(ii) (20 U.S.C. 
        1090(e)(3)(A)(ii)), by striking ``based on the maximum 
        Federal Pell Grant award at the time of application'' 
        and inserting ``based on the Federal Pell Grant amount, 
        determined under section 401(b)(2)(A), for which a 
        student is eligible at the time of application'';
          (5) in section 485E(b)(1)(A) (20 U.S.C. 
        1092f(b)(1)(A)), by striking ``of such students' 
        potential eligibility for a maximum Federal Pell Grant 
        under subpart 1 of part A'' and inserting ``of such 
        students' potential eligibility for the Federal Pell 
        Grant amount, determined under section 401(b)(2)(A), 
        for which the student would be eligible''; and
          (6) in section 894(f)(2)(C)(ii)(I) (20 U.S.C. 
        1161y(f)(2)(C)(ii)(I)), by striking ``the maximum 
        Federal Pell Grant for each award year'' and inserting 
        ``the Federal Pell Grant amount, determined under 
        section 401(b)(2)(A), for which a student may be 
        eligible for each award year''.
  (c) Effective Date.--The amendments made by subsections (a) 
and (b) shall take effect on July 1, 2010.

SEC. 2102. STUDENT FINANCIAL ASSISTANCE.

  (a) In General.--There are authorized to be appropriated, and 
there are appropriated, to carry out subpart 1 of part A of 
title IV of the Higher Education Act of 1965 (20 U.S.C. 1070 et 
seq.) (in addition to any other amounts appropriated to carry 
out such subpart and out of any money in the Treasury not 
otherwise appropriated) $13,500,000,000.
  (b) Availability of Funds.--Funds appropriated under this 
section shall be available as of the date of enactment of this 
subtitle and shall remain available until September 30, 2012.

SEC. 2103. COLLEGE ACCESS CHALLENGE GRANT PROGRAM.

  Section 781 (20 U.S.C. 1141) is amended--
          (1) in the first sentence of subsection (a), by 
        striking ``$66,000,000'' and all that follows through 
        the period and inserting ``$150,000,000 for each of the 
        fiscal years 2010 through 2014. The authority to award 
        grants under this section shall expire at the end of 
        fiscal year 2014.''; and
          (2) in subsection (c)(2), by striking ``0.5 percent'' 
        and inserting ``1.0 percent''.

SEC. 2104. INVESTMENT IN HISTORICALLY BLACK COLLEGES AND UNIVERSITIES 
                    AND MINORITY-SERVING INSTITUTIONS.

  Section 371(b)(1)(A) (20 U.S.C. 1067q(b)(1)(A)) is amended by 
striking ``and 2009.'' and all that follows and inserting 
``through 2019. The authority to award grants under this 
section shall expire at the end of fiscal year 2019.''.

                      PART II--STUDENT LOAN REFORM

SEC. 2201. TERMINATION OF FEDERAL FAMILY EDUCATION LOAN APPROPRIATIONS.

  Section 421 (20 U.S.C. 1071) is amended--
          (1) in subsection (b), in the first sentence of the 
        matter following paragraph (6), by inserting ``, except 
        that no sums may be expended after June 30, 2010, with 
        respect to loans under this part for which the first 
        disbursement is after such date'' after ``expended''; 
        and
          (2) by adding at the end the following new 
        subsection:
  ``(d) Termination of Authority to Make or Insure New Loans.--
Notwithstanding paragraphs (1) through (6) of subsection (b) or 
any other provision of law--
          ``(1) no new loans (including consolidation loans) 
        may be made or insured under this part after June 30, 
        2010; and
          ``(2) no funds are authorized to be appropriated, or 
        may be expended, under this Act or any other Act to 
        make or insure loans under this part (including 
        consolidation loans) for which the first disbursement 
        is after June 30, 2010,
except as expressly authorized by an Act of Congress enacted 
after the date of enactment of the SAFRA Act.''.

SEC. 2202. TERMINATION OF FEDERAL LOAN INSURANCE PROGRAM.

  Section 424(a) (20 U.S.C. 1074(a)) is amended by striking 
``September 30, 1976,'' and all that follows and inserting 
``September 30, 1976, for each of the succeeding fiscal years 
ending prior to October 1, 2009, and for the period from 
October 1, 2009, to June 30, 2010, for loans first disbursed on 
or before June 30, 2010.''.

SEC. 2203. TERMINATION OF APPLICABLE INTEREST RATES.

  Section 427A(l) (20 U.S.C. 1077a(l)) is amended--
          (1) in the subsection heading, by inserting ``and 
        Before July 1, 2010'' after ``2006'';
          (2) in paragraph (1), by inserting ``and before July 
        1, 2010,'' after ``July 1, 2006,'';
          (3) in paragraph (2), by inserting ``and before July 
        1, 2010,'' after ``July 1, 2006,'';
          (4) in paragraph (3), by inserting ``and that was 
        disbursed before July 1, 2010,'' after ``July 1, 
        2006,''; and
          (5) in paragraph (4)--
                  (A) in the matter preceding subparagraph (A), 
                by striking ``July 1, 2012'' and inserting 
                ``July 1, 2010''; and
                  (B) by repealing subparagraphs (D) and (E).

SEC. 2204. TERMINATION OF FEDERAL PAYMENTS TO REDUCE STUDENT INTEREST 
                    COSTS.

  (a) Higher Education Act of 1965.--Section 428 (20 U.S.C. 
1078) is amended--
          (1) in subsection (a)--
                  (A) in paragraph (1), in the matter preceding 
                subparagraph (A), by inserting ``for which the 
                first disbursement is made before July 1, 2010, 
                and'' after ``eligible institution''; and
                  (B) in paragraph (5), by striking ``September 
                30, 2014,'' and all that follows through the 
                period and inserting ``June 30, 2010.'';
          (2) in subsection (b)(1)--
                  (A) in subparagraph (G)(ii), by inserting 
                ``and before July 1, 2010,'' after ``July 1, 
                2006,''; and
                  (B) in subparagraph (H)(ii), by inserting 
                ``and that are first disbursed before July 1, 
                2010,'' after ``July 1, 2006,'';
          (3) in subsection (f)(1)(A)(ii)--
                  (A) by striking ``during fiscal years 
                beginning''; and
                  (B) by inserting ``and first disbursed before 
                July 1, 2010,'' after ``October 1, 2003,''; and
          (4) in subsection (j)(1), by inserting ``, before 
        July 1, 2010,'' after ``section 435(d)(1)(D) of this 
        Act shall''.
  (b) College Cost Reduction and Access Act.--Section 303 of 
the College Cost Reduction and Access Act (Public Law 110-84) 
is repealed.

SEC. 2205. TERMINATION OF FFEL PLUS LOANS.

  Section 428B(a)(1) (20 U.S.C. 1078-2(a)(1)) is amended by 
striking ``A graduate'' and inserting ``Prior to July 1, 2010, 
a graduate''.

SEC. 2206. FEDERAL CONSOLIDATION LOANS.

  (a) In General.--Section 428C (20 U.S.C. 1078-3) is amended--
          (1) in subsection (a)(4)(A), by inserting ``, and 
        first disbursed before July 1, 2010'' after ``under 
        this part'';
          (2) in subsection (b)--
                  (A) in paragraph (1)(E), by inserting before 
                the semicolon ``, and before July 1, 2010''; 
                and
                  (B) in paragraph (5), by striking ``In the 
                event that'' and inserting ``If, before July 1, 
                2010,'';
          (3) in subsection (c)(1)--
                  (A) in subparagraph (A)(ii), by inserting 
                ``and that is disbursed before July 1, 2010,'' 
                after ``2006,''; and
                  (B) in subparagraph (C), by inserting ``and 
                disbursed before July 1, 2010,'' after 
                ``1994,''; and
          (4) in subsection (e), by striking ``September 30, 
        2014.'' and inserting ``June 30, 2010. No loan may be 
        made under this section for which the disbursement is 
        on or after July 1, 2010.''.
  (b) Temporary Loan Consolidation Authority.--Part D of title 
IV (20 U.S.C. 1087a et seq.) is amended by inserting after 
section 459A (20 U.S.C. 1087i) the following:

``SEC. 459B. TEMPORARY LOAN CONSOLIDATION AUTHORITY.

  ``(a) Temporary Loan Consolidation Authority.--
          ``(1) In general.--A borrower who has 1 or more loans 
        in 2 or more of the categories described in paragraph 
        (2), and who has not yet entered repayment on 1 or more 
        of those loans in any of the categories, may 
        consolidate all of the loans of the borrower that are 
        described in paragraph (2) into a Federal Direct 
        Consolidation Loan during the period described in 
        paragraph (3).
          ``(2) Categories of loans that may be consolidated.--
        The categories of loans that may be consolidated under 
        paragraph (1) are--
                  ``(A) loans made under this part;
                  ``(B) loans purchased by the Secretary 
                pursuant to section 459A; and
                  ``(C) loans made under part B that are held 
                by an eligible lender, as such term is defined 
                in section 435(d).
          ``(3) Time period in which loans may be 
        consolidated.--The Secretary may make a Federal Direct 
        Consolidation Loan under this section to a borrower 
        whose application for such Federal Direct Consolidation 
        Loan is received on or after July 1, 2010, and before 
        July 1, 2011.
  ``(b) Terms of Loans.--A Federal Direct Consolidation Loan 
made under this section shall have the same terms and 
conditions as a Federal Direct Consolidation Loan made under 
section 455(g), except that--
          ``(1) in determining the applicable rate of interest 
        on the Federal Direct Consolidation Loan made under 
        this section (other than on a Federal Direct 
        Consolidation Loan described in paragraph (2)), section 
        427A(l)(3) shall be applied without rounding the 
        weighted average of the interest rate on the loans 
        consolidated to the nearest higher one-eighth of 1 
        percent as described in subparagraph (A) of section 
        427A(l)(3); and
          ``(2) if a Federal Direct Consolidation Loan made 
        under this section that repays a loan which is subject 
        to an interest rate determined under section 
        427A(g)(2), (j)(2), or (k)(2), then the interest rate 
        for such Federal Direct Consolidation Loan shall be 
        calculated--
                  ``(A) by using the applicable rate of 
                interest described in section 427A(g)(2), 
                (j)(2), or (k)(2), respectively; and
                  ``(B) in accordance with section 
                427A(l)(3).''.

SEC. 2207. TERMINATION OF UNSUBSIDIZED STAFFORD LOANS FOR MIDDLE-INCOME 
                    BORROWERS.

  Section 428H (20 U.S.C. 1078-8) is amended--
          (1) in subsection (a), by inserting ``that are first 
        disbursed before July 1, 2010,'' after ``under this 
        part'';
          (2) in subsection (b)--
                  (A) by striking ``Any student'' and inserting 
                ``Prior to July 1, 2010, any student''; and
                  (B) by inserting ``for which the first 
                disbursement is made before such date'' after 
                ``unsubsidized Federal Stafford Loan''; and
          (3) in subsection (h), by inserting ``and that are 
        first disbursed before July 1, 2010,'' after ``July 1, 
        2006,''.

SEC. 2208. TERMINATION OF SPECIAL ALLOWANCES.

  Section 438 (20 U.S.C. 1087-1) is amended--
          (1) in subsection (b)(2)(I)--
                  (A) in the subclause heading, by inserting 
                ``, and before july 1, 2010'' after ``2000'';
                  (B) in clause (i), by inserting ``and before 
                July 1, 2010,'' after ``2000,'';
                  (C) in clause (ii)(II), by inserting ``and 
                before July 1, 2010,'' after ``2006,'';
                  (D) in clause (iii), by inserting ``and 
                before July 1, 2010,'' after ``2000,'';
                  (E) in clause (iv), by inserting ``and that 
                is disbursed before July 1, 2010,'' after 
                ``2000,'';
                  (F) in clause (v)(I), by inserting ``and 
                before July 1, 2010,'' after ``2006,''; and
                  (G) in clause (vi)--
                          (i) in the clause heading, by 
                        inserting ``, and before july 1, 2010'' 
                        after ``2007''; and
                          (ii) in the matter preceding 
                        subclause (I), by inserting ``and 
                        before July 1, 2010,'' after ``2007,'';
          (2) in subsection (c)--
                  (A) in paragraph (2)(B)--
                          (i) in clause (iii), by inserting 
                        ``and'' after the semicolon;
                          (ii) in clause (iv), by striking ``; 
                        and'' and inserting a period; and
                          (iii) by striking clause (v); and
                  (B) in paragraph (6), by inserting ``and 
                first disbursed before July 1, 2010,'' after 
                ``1992,''; and
          (3) in subsection (d)(2)(B), by inserting ``, and 
        before July 1, 2010'' after ``2007''.

SEC. 2209. ORIGINATION OF DIRECT LOANS AT INSTITUTIONS OUTSIDE THE 
                    UNITED STATES.

  (a) Loans for Students Attending Institutions Outside the 
United States.--Section 452 (20 U.S.C. 1087b) is amended by 
adding at the end the following:
  ``(d) Institutions Outside the United States.--Loan funds for 
students (and parents of students) attending institutions 
outside the United States shall be disbursed through a 
financial institution located or operating in the United States 
and designated by the Secretary to serve as the agent of such 
institutions with respect to the receipt of the disbursements 
of such loan funds and the transfer of such funds to such 
institutions. To be eligible to receive funds under this part, 
an institution outside the United States shall make 
arrangements with the agent designated by the Secretary under 
this subsection to receive funds under this part.''.
  (b) Conforming Amendments.--
          (1) Amendments.--Section 102 (20 U.S.C. 1002), as 
        amended by section 102 of the Higher Education 
        Opportunity Act (Public Law 110-315) and section 101 of 
        Public Law 111-39, is amended--
                  (A) by striking ``part B'' each place the 
                term appears and inserting ``part D'';
                  (B) in subsection (a)(1)(C), by inserting ``, 
                consistent with the requirements of section 
                452(d)'' before the period at the end; and
                  (C) in subsection (a)(2)(A)--
                          (i) in the second sentence of the 
                        matter preceding clause (i), by 
                        striking ``made, insured, or 
                        guaranteed'' and inserting ``made''; 
                        and
                          (ii) in clause (iii)--
                                  (I) in subclause (III), by 
                                striking ``only Federal 
                                Stafford'' and all that follows 
                                through ``section 428B'' and 
                                inserting ``only Federal Direct 
                                Stafford Loans under section 
                                455(a)(2)(A), Federal Direct 
                                Unsubsidized Stafford Loans 
                                under section 455(a)(2)(D), or 
                                Federal Direct PLUS Loans under 
                                section 455(a)(2)(B)''; and
                                  (II) in subclause (V), by 
                                striking ``a Federal Stafford'' 
                                and all that follows through 
                                ``section 428B'' and inserting 
                                ``a Federal Direct Stafford 
                                Loan under section 
                                455(a)(2)(A), a Federal Direct 
                                Unsubsidized Stafford Loan 
                                under section 455(a)(2)(D), or 
                                a Federal Direct PLUS Loan 
                                under section 455(a)(2)(B)''.
          (2) Effective date.--The amendments made by 
        subparagraph (C) of paragraph (1) shall be effective on 
        July 1, 2010, as if enacted as part of section 
        102(a)(1) of the Higher Education Opportunity Act 
        (Public Law 110-315) and subject to section 102(e) of 
        such Act as amended by section 101(a)(2) of Public Law 
        111-39 (20 U.S.C. 1002 note).

SEC. 2210. CONFORMING AMENDMENTS.

  (a) Amendments.--Section 454 (20 U.S.C. 1087d) is amended--
          (1) in subsection (a)--
                  (A) by striking paragraph (4); and
                  (B) by redesignating paragraphs (5) through 
                (7) as paragraphs (4) through (6), 
                respectively; and
          (2) in subsection (b)(2), by striking ``(5), (6), and 
        (7)'' and inserting ``(5), and (6)''.
  (b) Effective Date.--The amendments made by subsection (a) 
shall take effect on July 1, 2010.

SEC. 2211. TERMS AND CONDITIONS OF LOANS.

  (a) In General.--Section 455 (20 U.S.C. 1087e) is amended--
          (1) in subsection (a)(1), by inserting ``, and first 
        disbursed on June 30, 2010,'' before ``under sections 
        428''; and
          (2) in subsection (g)--
                  (A) by inserting ``, including any loan made 
                under part B and first disbursed before July 1, 
                2010'' after ``section 428C(a)(4)''; and
                  (B) by striking the third sentence.
  (b) Effective Date.--The amendment made by subsection (a)(1) 
shall apply with respect to loans first disbursed under part D 
of title IV of the Higher Education Act of 1965 (20 U.S.C. 
1087a et seq.) on or after July 1, 2010.

SEC. 2212. CONTRACTS; MANDATORY FUNDS.

  (a) Contracts.--Section 456 (20 U.S.C. 1087f) is amended--
          (1) in subsection (a)--
                  (A) by inserting after paragraph (3) the 
                following new paragraph:
          ``(4) Servicing by eligible not-for-profit 
        servicers.--
                  ``(A) Servicing contracts.--
                          ``(i) In general.--The Secretary 
                        shall contract with each eligible not-
                        for-profit servicer to service loans 
                        originated under this part, if the 
                        servicer--
                                  ``(I) meets the standards for 
                                servicing Federal assets that 
                                apply to contracts awarded 
                                pursuant to paragraph (1); and
                                  ``(II) has the capacity to 
                                service the applicable loan 
                                volume allocation described in 
                                subparagraph (B).
                          ``(ii) Competitive market rate 
                        determination for first 100,000 
                        borrower accounts.--The Secretary shall 
                        establish a separate pricing tier for 
                        each of the first 100,000 borrower loan 
                        accounts at a competitive market rate.
                          ``(iii) Ineligibility.--An eligible 
                        not-for-profit servicer shall no longer 
                        be eligible for a contract under this 
                        paragraph after July 1, 2014, if--
                                  ``(I) the servicer has not 
                                been awarded such a contract 
                                before that date; or
                                  ``(II) the servicer's 
                                contract was terminated, and 
                                the servicer had not reapplied 
                                for, and been awarded, a 
                                contract under this paragraph.
                  ``(B) Allocations.--
                          ``(i) In general.--The Secretary 
                        shall (except as provided in clause 
                        (ii)) allocate to an eligible not-for-
                        profit servicer, subject to the 
                        contract of such servicer described in 
                        subparagraph (A), the servicing rights 
                        for the loan accounts of 100,000 
                        borrowers (including borrowers who 
                        borrowed loans in a prior year that 
                        were serviced by the servicer).
                          ``(ii) Servicer allocation.--The 
                        Secretary may reallocate, increase, 
                        reduce, or terminate an eligible not-
                        for-profit servicer's allocation of 
                        servicing rights under clause (i) based 
                        on the performance of such servicer, on 
                        the same terms as loan allocations 
                        provided by contracts awarded pursuant 
                        to paragraph (1).''; and
          (2) by adding at the end the following:
  ``(c) Definition of Eligible Not-for-profit Servicer.--In 
this section:
          ``(1) In general.--The term `eligible not-for-profit 
        servicer' means an entity--
                  ``(A) that is not owned or controlled in 
                whole or in part by--
                          ``(i) a for profit entity; or
                          ``(ii) a nonprofit entity having its 
                        principal place of business in another 
                        State; and
                  ``(B) that--
                          ``(i) as of July 1, 2009--
                                  ``(I) meets the definition of 
                                an eligible not-for-profit 
                                holder under section 435(p), 
                                except that such term does not 
                                include eligible lenders 
                                described in paragraph (1)(D) 
                                of such section; and
                                  ``(II) was performing, or had 
                                entered into a contract with a 
                                third party servicer (as such 
                                term is defined in section 
                                481(c)) who was performing, 
                                student loan servicing 
                                functions for loans made under 
                                part B of this title;
                          ``(ii) notwithstanding clause (i), as 
                        of July 1, 2009--
                                  ``(I) is the sole beneficial 
                                owner of a loan for which the 
                                special allowance rate is 
                                calculated under section 
                                438(b)(2)(I)(vi)(II) because 
                                the loan is held by an eligible 
                                lender trustee that is an 
                                eligible not-for-profit holder 
                                as defined under section 
                                435(p)(1)(D); and
                                  ``(II) was performing, or had 
                                entered into a contract with a 
                                third party servicer (as such 
                                term is defined in section 
                                481(c)) who was performing, 
                                student loan servicing 
                                functions for loans made under 
                                part B of this title; or
                          ``(iii) is an affiliated entity of an 
                        eligible not-for-profit servicer 
                        described in clause (i) or (ii) that--
                                  ``(I) directly employs, or 
                                will directly employ (on or 
                                before the date the entity 
                                begins servicing loans under a 
                                contract awarded by the 
                                Secretary pursuant to 
                                subsection (a)(3)(A)), the 
                                majority of individuals who 
                                perform borrower-specific 
                                student loan servicing 
                                functions; and
                                  ``(II) as of July 1, 2009, 
                                was performing, or had entered 
                                into a contract with a third 
                                party servicer (as such term is 
                                defined in section 481(c)) who 
                                was performing, student loan 
                                servicing functions for loans 
                                made under part B of this 
                                title.
          ``(2) Affiliated entity.--For the purposes of 
        paragraph (1), the term `affiliated entity'--
                  ``(A) means an entity contracted to perform 
                services for an eligible not-for-profit 
                servicer that--
                          ``(i) is a nonprofit entity or is 
                        wholly owned by a nonprofit entity; and
                          ``(ii) is not owned or controlled, in 
                        whole or in part, by--
                                  ``(I) a for-profit entity; or
                                  ``(II) an entity having its 
                                principal place of business in 
                                another State; and
                  ``(B) may include an affiliated entity that 
                is established by an eligible not-for-profit 
                servicer after the date of enactment of the 
                SAFRA Act, if such affiliated entity is 
                otherwise described in paragraph (1)(B)(iii)(I) 
                and subparagraph (A) of this paragraph.''.
  (b) Mandatory Funds.--
          (1) Amendments.--Section 458(a) (20 U.S.C. 1087h(a)) 
        is amended--
                  (A) by redesignating paragraph (5) as 
                paragraph (8);
                  (B) by redesignating paragraphs (2) through 
                (4) as paragraphs (3) through (5), 
                respectively;
                  (C) by inserting after paragraph (1) the 
                following new paragraph:
          ``(2) Mandatory funds for eligible not-for-profit-
        servicers.--For fiscal years 2010 through 2019, there 
        shall be available to the Secretary, in addition to any 
        other amounts appropriated to carry out this paragraph 
        and out of any money in the Treasury not otherwise 
        appropriated, funds to be obligated for administrative 
        costs of servicing contracts with eligible not-for-
        profit servicers as described in section 456.''; and
                  (D) by inserting after paragraph (5), as 
                redesignated by subparagraph (B) of this 
                paragraph, the following:
          ``(6) Technical assistance to institutions of higher 
        education.--
                  ``(A) Provision of assistance.--The Secretary 
                shall provide institutions of higher education 
                participating, or seeking to participate, in 
                the loan programs under this part with 
                technical assistance in establishing and 
                administering such programs.
                  ``(B) Funds.--There are authorized to be 
                appropriated, and there are appropriated, to 
                carry out this paragraph (in addition to any 
                other amounts appropriated to carry out this 
                paragraph and out of any money in the Treasury 
                not otherwise appropriated), $50,000,000 for 
                fiscal year 2010.
                  ``(C) Definition.--In this paragraph, the 
                term `assistance' means the provision of 
                technical support, training, materials, 
                technical assistance, and financial assistance.
          ``(7) Additional payments.--
                  ``(A) Provision of assistance.--The Secretary 
                shall provide payments to loan servicers for 
                retaining jobs at locations in the United 
                States where such servicers were operating 
                under part B on January 1, 2010.
                  ``(B) Funds.--There are authorized to be 
                appropriated, and there are appropriated, to 
                carry out this paragraph (in addition to any 
                other amounts appropriated to carry out this 
                paragraph and out of any money in the Treasury 
                not otherwise appropriated), $25,000,000 for 
                each of the fiscal years 2010 and 2011.''.
          (2) Conforming amendment.--Section 458 (20 U.S.C. 
        1087h) is further amended by striking ``subsection 
        (a)(3)'' in subsection (b) and inserting ``subsection 
        (a)(4)''.

SEC. 2213. AGREEMENTS WITH STATE-OWNED BANKS.

  Part D of title IV (as amended by this subtitle) (20 U.S.C. 
1087a et seq.) is further amended by adding at the end the 
following:

``SEC. 460A. AGREEMENTS WITH STATE-OWNED BANKS.

  ``(a) Definition of Eligible Lender.--In this section, the 
term `eligible lender' means a lender that, on July 1, 2009, 
was and continues to be--
          ``(1) a bank, the deposits of which are guaranteed by 
        a State;
          ``(2) owned by the State in which the lender is 
        located;
          ``(3) under the control of a board of directors that 
        includes the Governor of the State; and
          ``(4) an originator or holder of loans made under the 
        program under part B, as such part was in effect on 
        July 1, 2009.
  ``(b) Agreements.--
          ``(1) In general.--At the request of a State in which 
        an eligible lender is located, the Secretary shall 
        enter into an agreement with the eligible lender under 
        which--
                  ``(A) the eligible lender agrees to provide 
                student loans to borrowers in accordance with 
                this section; and
                  ``(B) the Secretary agrees to provide Federal 
                loan insurance on the student loans made under 
                this section by that eligible lender to 
                borrowers who--
                          ``(i) are residents of the State in 
                        which the eligible lender is located; 
                        or
                          ``(ii) attend an institution of 
                        higher education in such State.
          ``(2) Terms of loans.--Loans covered by an agreement 
        under this section shall have the same terms and 
        conditions as loans made under part B, as such part was 
        in effect on June 30, 2010.
          ``(3) Payments to eligible lender.--An agreement 
        under this section shall provide the eligible lender 
        with the equivalent payments and subsidies as those 
        provided for loans made under part B, as such part was 
        in effect on June 30, 2010.
          ``(4) FFEL program regulations.--An agreement under 
        this section, any loans made under this section, and 
        the participation of institutions of higher education 
        under this section, shall be subject to regulations 
        issued by the Secretary under part B, as such part was 
        in effect on June 30, 2010.
  ``(c) Institutions of Higher Education.--An institution of 
higher education that is located in the same State as an 
eligible lender that has an agreement with the Secretary under 
this section, or an institution of higher education that is 
located in another State and is attended by borrowers described 
in subsection (b)(1)(B)(i), may choose to participate in the 
loan program operated pursuant to the agreement. If such 
institution of higher education chooses such participation, the 
institution shall carry out the institution's responsibilities 
with respect to loans made pursuant to the agreement in 
accordance with subsection (b)(4).
  ``(d) Borrowers.--A borrower described in subsection 
(b)(1)(B) may choose to borrow a loan made pursuant to an 
agreement described in subsection (b)(1). A borrower of a loan 
made pursuant to such agreement shall be subject to the loan 
terms and conditions required by the agreement, and shall not 
be eligible to receive a loan made under this part concurrently 
with a loan made under this section.
  ``(e) Inapplicability.--Sections 451 through 460 shall not 
apply to this section.''.

SEC. 2214. INCOME-BASED REPAYMENT.

  Section 493C (20 U.S.C. 1098e) is amended by adding at the 
end the following new subsection:
  ``(e) Special Terms for New Borrowers on and After July 1, 
2014.--With respect to any loan made to a new borrower on or 
after July 1, 2014--
          ``(1) subsection (a)(3)(B) shall be applied by 
        substituting `10 percent' for `15 percent'; and
          ``(2) subsection (b)(7)(B) shall be applied by 
        substituting `20 years' for `25 years'.''.

                           Subtitle B--Health

SEC. 2301. INSURANCE REFORMS.

  (a) Extending Certain Insurance Reforms to Grandfathered 
Plans.--Section 1251(a) of the Patient Protection and 
Affordable Care Act, as added by section 10103(d) of such Act, 
is amended by adding at the end the following:
          ``(4) Application of certain provisions.--
                  ``(A) In general.--The following provisions 
                of the Public Health Service Act (as added by 
                this title) shall apply to grandfathered health 
                plans for plan years beginning with the first 
                plan year to which such provisions would 
                otherwise apply:
                          ``(i) Section 2708 (relating to 
                        excessive waiting periods).
                          ``(ii) Those provisions of section 
                        2711 relating to lifetime limits.
                          ``(iii) Section 2712 (relating to 
                        rescissions).
                          ``(iv) Section 2714 (relating to 
                        extension of dependent coverage).
                  ``(B) Provisions applicable only to group 
                health plans.--
                          ``(i) Provisions described.--Those 
                        provisions of section 2711 relating to 
                        annual limits and the provisions of 
                        section 2704 (relating to pre-existing 
                        condition exclusions) of the Public 
                        Health Service Act (as added by this 
                        subtitle) shall apply to grandfathered 
                        health plans that are group health 
                        plans for plan years beginning with the 
                        first plan year to which such 
                        provisions otherwise apply.
                          ``(ii) Adult dependent coverage.--For 
                        plan years beginning before January 1, 
                        2014, the provisions of section 2714 of 
                        the Public Health Service Act (as added 
                        by this subtitle) shall apply in the 
                        case of an adult dependent with respect 
                        to a grandfathered health plan that is 
                        a group health plan only if such 
                        dependent is not eligible to enroll in 
                        an eligible employer-sponsored health 
                        plan (as defined in section 5000A(f)(2) 
                        of the Internal Revenue Code of 1986) 
                        other than such grandfathered health 
                        plan.''.
  (b) Clarification Regarding Dependent Coverage.--Section 
2714(a) of the Public Health Service Act, as added by section 
1001(5) of the Patient Protection and Affordable Care Act, is 
amended by striking ``(who is not married)''.

SEC. 2302. DRUGS PURCHASED BY COVERED ENTITIES.

  Section 340B of the Public Health Service Act (42 U.S.C. 
256b), as amended by sections 7101 and 7102 of the Patient 
Protection and Affordable Care Act, is amended--
          (1) in subsection (a)--
                  (A) in paragraphs (1), (2), (5), (7), and 
                (9), by striking the terms ``covered drug'' and 
                ``covered drugs'' each place either term 
                appears and inserting ``covered outpatient 
                drug'' or ``covered outpatient drugs'', 
                respectively;
                  (B) in paragraph (4)(L)--
                          (i) in clause (i), by striking 
                        ``and'' at the end;
                          (ii) in clause (ii), by striking the 
                        period and inserting ``; and''; and
                          (iii) by inserting after clause (ii), 
                        the following:
                          ``(iii) does not obtain covered 
                        outpatient drugs through a group 
                        purchasing organization or other group 
                        purchasing arrangement.''; and
                  (C) in paragraph (5)--
                          (i) by striking subparagraph (C);
                          (ii) by redesignating subparagraphs 
                        (D) and (E) as subparagraphs (C) and 
                        (D), respectively; and
                          (iii) in subparagraph (D), as so 
                        redesignated, by striking 
                        ``subparagraph (D)'' and inserting 
                        ``subparagraph (C)'';
          (2) by striking subsection (c);
          (3) in subsection (d)--
                  (A) by striking ``covered drugs'' each place 
                it appears and inserting ``covered outpatient 
                drugs'';
                  (B) by striking ``(a)(5)(D)'' each place it 
                appears and inserting ``(a)(5)(C)''; and
                  (C) by striking ``(a)(5)(E)'' each place it 
                appears and inserting ``(a)(5)(D)''; and
          (4) by inserting after subsection (d) the following:
  ``(e) Exclusion of Orphan Drugs for Certain Covered 
Entities.--For covered entities described in subparagraph (M), 
(N), or (O) of subsection (a)(4), the term `covered outpatient 
drug' shall not include a drug designated by the Secretary 
under section 526 of the Federal Food, Drug, and Cosmetic Act 
for a rare disease or condition.''.

SEC. 2303. COMMUNITY HEALTH CENTERS.

  Section 10503(b)(1) of the Patient Protection and Affordable 
Care Act is amended--
          (1) in subparagraph (A), by striking ``700,000,000'' 
        and inserting ``1,000,000,000'';
          (2) in subparagraph (B), by striking ``800,000,000'' 
        and inserting ``1,200,000,000'';
          (3) in subparagraph (C), by striking 
        ``1,000,000,000'' and inserting ``1,500,000,000'';
          (4) in subparagraph (D), by striking 
        ``1,600,000,000'' and inserting ``2,200,000,000''; and
          (5) in subparagraph (E), by striking 
        ``2,900,000,000'' and inserting ``3,600,000,000''.

   PART B: TEXT OF THE AMENDMENT TO THE AMENDMENT IN THE NATURE OF A 
          SUBSTITUTE TO H.R. 4872 TO BE CONSIDERED AS ADOPTED

  Page 1, line 3, strike ``Affordability''.
  Page 3, line 4, strike ``AFFORDABILITY'' and insert ``TAX 
CREDITS''.
  Page 14, lines 21 and 22, strike ``(and any other person 
specified by the Secretary)'' and insert ``(or any person 
carrying out 1 or more responsibilities of an Exchange under 
section 1311(f)(3) or 1321(c) of the Patient Protection and 
Affordable Care Act)''.
  Page 15, lines 20 and 21, strike ``Any other similar 
information necessary to carry out this subsection and'' and 
insert ``Information necessary to''.
  Page 17, strike lines 4 through 14, and insert the following:
          (3) Coverage under self-employed deduction.--Section 
        162(l)(2)(B) of such Code is amended by inserting ``, 
        or any dependent, or individual described in 
        subparagraph (D) of paragraph (1) with respect to,'' 
        after ``spouse of''.
  Page 27, after line 22, insert the following:

  (d) Reducing Growth Rate of Out-of-pocket Cost Threshold.--
Section 1860D-2(b) of the Social Security Act (42 U.S.C. 1395w-
102(b)) is amended--
          (1) in paragraph (4)(B)(i)--
                  (A) in subclause (I), by striking ``or'' at 
                the end;
                  (B) by redesignating subclause (II) as 
                subclause (VI); and
                  (C) by inserting after subclause (I) the 
                following new subclauses:
                                  ``(II) for each of years 2007 
                                through 2013, is equal to the 
                                amount specified in this 
                                subparagraph for the previous 
                                year, increased by the annual 
                                percentage increase described 
                                in paragraph (6) for the year 
                                involved;
                                  ``(III) for 2014 and 2015, is 
                                equal to the amount specified 
                                in this subparagraph for the 
                                previous year, increased by the 
                                annual percentage increase 
                                described in paragraph (6) for 
                                the year involved, minus 0.25 
                                percentage point;
                                  ``(IV) for each of years 2016 
                                through 2019, is equal to the 
                                amount specified in this 
                                subparagraph for the previous 
                                year, increased by the lesser 
                                of--
                                          ``(aa) the annual 
                                        percentage increase 
                                        described in paragraph 
                                        (7) for the year 
                                        involved, plus 2 
                                        percentage points; or
                                          ``(bb) the annual 
                                        percentage increase 
                                        described in paragraph 
                                        (6) for the year;
                                  ``(V) for 2020, is equal to 
                                the amount that would have been 
                                applied under this subparagraph 
                                for 2020 if the amendments made 
                                by section 1101(d)(1) of the 
                                Health Care and Education 
                                Reconciliation Act of 2010 had 
                                not been enacted; or''; and
          (2) by adding at the end the following new paragraph:
          ``(7) Additional annual percentage increase.--The 
        annual percentage increase specified in this paragraph 
        for a year is equal to the annual percentage increase 
        in the consumer price index for all urban consumers 
        (United States city average) for the 12-month period 
        ending in July of the previous year.''.
  Page 46, amend lines 3 through 6 to read as follows:
                                  ``(III) In calculating each 
                                year's adjustment, the 
                                adjustment factor shall be for 
                                2014, not less than the 
                                adjustment factor applied for 
                                2010, plus 1.3 percentage 
                                points; for each of years 2015 
                                through 2018, not less than the 
                                adjustment factor applied for 
                                the previous year, plus 0.25 
                                percentage point; and for 2019 
                                and each subsequent year, not 
                                less than 5.7 percent.''.
  Page 47, strike lines 16 through 19.
  Page 48, line 14, strike ``Affordability''.
  Page 57, after line 3, insert the following:

SEC. 1108. PE GPCI ADJUSTMENT FOR 2010.

  Effective as if included in the enactment of the Patient 
Protection and Affordable Care Act, section 1848(e)(1)(H)(i) of 
the Social Security Act (42 U.S.C. 1395w-4(e)(1)(H)(i)), as 
added by section 3102(b)(2) of the Patient Protection and 
Affordable Care Act, is amended by striking ``\3/4\'' and 
inserting ``\1/2\''.

SEC. 1109. PAYMENT FOR QUALIFYING HOSPITALS.

  (a) In General.--From the amount available under subsection 
(b), the Secretary of Health and Human Services shall provide 
for a payment to qualifying hospitals (as defined in subsection 
(d)) for fiscal years 2011 and 2012 of the amount determined 
under subsection (c).
  (b) Amounts Available.--There shall be available from the 
Federal Hospital Insurance Trust Fund $400,000,000 for payments 
under this section for fiscal years 2011 and 2012.
  (c) Payment Amount.--The amount of payment under this section 
for a qualifying hospital shall be determined, in a manner 
consistent with the amount available under subsection (b), in 
proportion to the portion of the amount of the aggregate 
payments under section 1886(d) of the Social Security Act to 
the hospital for fiscal year 2009 bears to the sum of all such 
payments to all qualifying hospitals for such fiscal year.
  (d) Qualifying Hospital Defined.--In this section, the term 
``qualifying hospital'' means a subsection (d) hospital (as 
defined for purposes of section 1886(d) of the Social Security 
Act) that is located in a county that ranks, based upon its 
ranking in age, sex, and race adjusted spending for benefits 
under parts A and B under title XVIII of such Act per enrollee, 
within the lowest quartile of such counties in the United 
States.
  Page 69, strike lines 7 through 10, and insert the following:
          ``(1) not be effective unless the election is 
        consistent with section 1321 and is received not later 
        than October 1, 2013; and''.
  Page 74, line 11, strike ``a significant share'' and insert 
``at least 40 percent''.
  Page 75, beginning on line 5, strike section 1303 (and 
redesignate the succeeding sections accordingly).
  Page 87, line 20, strike ``medicare tax'' and insert 
``unearned income medicare contribution''.
  Page 88, line 1, strike ``MEDICARE TAX'' and insert 
``UNEARNED INCOME MEDICARE CONTRIBUTION''.
  Page 93, beginning with line 7, strike all through page 94, 
line 5.
  Page 94, line 6, strike ``(4)'' and insert ``(3)''.
  Page 94, strike the matter between lines 10 and 11 and insert 
the following:

         ``Chapter 2A--Unearned Income Medicare Contribution''.

  Page 94, line 11, strike ``(5)'' and insert ``(4)''.
  Page 97, amend the table after line 16 to read as follows:



``Calendar year                          Applicable amount
  2011.................................  $2,500,000,000
  2012.................................  $2,800,000,000
  2013.................................  $2,800,000,000
  2014.................................  $3,000,000,000
  2015.................................  $3,000,000,000
  2016.................................  $3,000,000,000
  2017.................................  $4,000,000,000.
  2018.................................  $4,100,000,000
  2019 and thereafter..................  $2,800,000,000.'',



'',  Page 98, line 22, strike ``2.9 percent'' and insert ``2.3 
percent''.
  Page 99, strike lines 9 and 10.
  Page 99, line 11, strike ``(B)'' and insert ``(A)''.
  Page 99, line 12, strike ``(C)'' and insert ``(B)''.
  Page 99, line 13, strike ``(D)'' and insert ``(C)''.
  Page 99, line 14, strike ``(E)'' and insert ``(D)''.
  Page 114, line 8, strike ``14.5'' and insert ``15.75''
  Page 114, beginning on line 9, strike section 1411.
  Page 115, line 12, insert ``and'' after the semicolon.
  Page 115, strike lines 4 through 23 and insert the following:
  Section 279(b) of the Trade Act of 1974 (19 U.S.C. 2372a(b)) 
is amended by striking ``Supplement'' and all that follows 
through ``Funds'' and inserting ``There are'' and by striking 
``pursuant'' and all that follows and inserting ``$500,000,000 
for each of fiscal years 2011, 2012, 2013, and 2014 to carry 
out this subchapter, except that the limitations contained in 
section 278(a)(2) shall not apply to such funds and each State 
shall receive not less than 0.5 percent of the amount 
appropriated pursuant to this subsection for each such fiscal 
year.''.
  Page 117, beginning on line 9, strike subparagraphs (A) and 
(B) and insert the following:

                  (A) in subparagraph (A)--
                          (i) in the matter preceding clause 
                        (i), by striking ``, to carry out 
                        subparagraph (B) of this paragraph''; 
                        and
                          (ii) by striking clauses (iii) 
                        through (x) and inserting the 
                        following:
                          ``(iii) to carry out subparagraph (B) 
                        of this paragraph, such sums as may be 
                        necessary for fiscal year 2010 and each 
                        subsequent fiscal year to provide the 
                        amount of increase of the maximum 
                        Federal Pell Grant required by clauses 
                        (ii) and (iii) of subparagraph (B); and
                          ``(iv) to carry out this section, 
                        $13,500,000,000 for fiscal year 
                        2011.'';
                  (B) in subparagraph (B)--
                          (i) in the matter preceding clause 
                        (i), by striking ``subparagraph (A)'' 
                        and inserting ``clauses (i) through 
                        (iii) of subparagraph (A)'';
                          (ii) in clause (ii), by striking 
                        ``and 2011-2012'' and inserting ``, 
                        2011-2012, and 2012-2013''; and
                          (iii) by striking clause (iii) and 
                        inserting the following:
                          ``(iii) the amount determined under 
                        subparagraph (C) for each succeeding 
                        award year.'';
  Page 124, beginning on line 3, strike section 2102 (and 
redesignate the succeeding sections accordingly).
  Page 145, beginning on line 18, strike section 2213 (and 
redesignate the succeeding section accordingly).
  Page 150, line 11, strike ``dependent'' and insert ``child''.
  Page 150, line 16, strike ``dependent'' and insert ``child''.
  Page 150, line 18, strike ``dependent'' and insert ``adult 
child''.

                                  
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