United States Government Publishing Office publisher pbl distributor dst United States Congress Senate author aut Government Organization text government publication eng CRPT Congressional Committee Materials 111_cong_reports legislative 2009-10-21 U.S. Government Printing Office 2009-10-19 monographic deposited born digital 470 digital object pages Y 1.1/5: https://www.govinfo.gov/app/details/CRPT-111srpt89 P0b002ee1800d8abb 000652726 f:sr089.111.txt DGPO 2009-10-21 2024-11-09 CRPT-111srpt89 machine generated eng fdlp Report to accompany S. 1796, on PROVIDING AFFORDABLE, QUALITY HEALTH CARE FOR ALL AMERICANS AND REDUCING THE GROWTH IN HEALTH CARE SPENDING, AND FOR OTHER PURPOSES together with ADDITIONAL AND minority views __________ COMMITTEE ON FINANCE UNITED STATES SENATE <GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT> October 19, 2009.--Ordered to be printed C O N T E N T S ---------- Page I. Background and Need for Legislation..............................1 II. Explanation of the Bill..........................................9 TITLE I--HEALTH CARE COVERAGE.................................... 9 Subtitle A--Insurance Market Reforms......................... 9 Sec. 1001. insurance Market Reforms in the individual and Small Group Markets.................................... 9 Sec. 2200. Ensuring Essential and Affordable Health Benefits Coverage for All Americans................ 9 Sec. 2201. General Requirements and Definitions...... 10 Sec. 2202. Prohibition on Preexisting Condition Exclusions......................................... 12 Sec. 2203. Guaranteed Issue and Renewal for insured Plans.............................................. 12 Sec. 2204. Premium Rating Rules...................... 12 Sec. 2205. Use of Uniform Outline of Coverage Documents.......................................... 13 Sec. 2211. Rating Areas; Pooling of Risks; Phase in of Rating Rules in Small Group Markets............. 14 Sec. 2212. Risk Adjustment........................... 14 Sec. 2213. Establishment of Transitional Reinsurance Program for individual Markets in Each State....... 14 Sec. 2214. Establishment of Risk Corridors for Plans in individual and Small Group Markets.............. 15 Sec. 2215. Temporary High Risk Pools for individuals with Preexisting Conditions........................ 16 Sec. 2216. Reinsurance for Retirees Covered by Employer-Based Plans etc........................... 17 Sec. 2221. Grandfathered Health Benefit Plans........ 17 Sec. 2225. Continued State Enforcement of insurance Regulations........................................ 18 Sec. 2226. Waiver of Health insurance Reform Requirements....................................... 19 Sec. 2227. Provisions Relating to Offering of Plans in More Than One State............................. 20 Sec. 2228. State Flexibility to Establish Basic Health Plans for Low-Income individuals not Eligible for Medicaid.............................. 21 Sec. 2230. Other Definitions and Rules............... 23 Subtitle B--Exchanges and Consumer Assistance................ 24 Sec. 1101. Establishment of Qualified Health Benefits Plans Exchanges........................................ 24 Sec. 2231. Rights and Responsibilities Regarding Choice of Coverage Through Exchange................ 24 Sec. 2232. Qualified individuals and Small Employers: Access Limited to Citizens and Lawful Residents.... 25 Sec. 2235. Establishment of Exchanges by States...... 26 Sec. 2236. Functions Performed by Secretary, States, and Exchanges...................................... 26 Sec. 2237. Duties of the Secretary to Facilitate Exchanges.......................................... 27 Sec. 2238. Procedures for Determining Eligibility for Exchange Participation, Premium Credits, and Cost- Sharing Subsidies.................................. 27 Sec. 2239. Streamlining of Procedures for Enrollment through an Exchange and State Medicaid and CHIP Programs........................................... 28 Sec. 1102. Encouraging Meaningful Use of Electronic Health Records......................................... 29 Subtitle C--Making Coverage Affordable....................... 29 PART I--ESSENTIAL BENEFITS COVERAGE...................... 29 Sec. 1201. Provisions to Ensure Coverage to Essential Benefits............................................... 29 Sec. 2241. Requirements for Qualified Health Benefits Plan............................................... 30 Sec. 2242. Essential Benefits Package Defined........ 30 Sec. 2243. Levels of Coverage........................ 32 Sec. 2244. Application of Certain Rules to Plans in Group Markets...................................... 33 Sec. 2245. Special Rules Relating to Coverage of Abortion Services.................................. 33 Sec. 1202. Application of State and Federal Laws Regarding Abortion..................................... 34 Sec. 1203. Application of Emergency Services Laws........ 35 PART II--LOW INCOME AND SMALL BUSINESS CREDITS AND SUBSIDIES.............................................. 35 Sec. 1205. Premium Tax Credits and Cost-sharing Subsidies 35 Sec. 1206. Cost-sharing Subsidies and Advance Payments of Premium Credits and Cost-Sharing Subsidies............. 40 Sec. 2246. Premium Credits for Low-Income individuals 42 Sec. 2247. Cost-sharing Subsidies for Low-Income individuals Enrolling in Qualified Health Benefit Plans.............................................. 42 Sec. 2248. Advance Determination and Payment of Premium Credits and Cost-sharing Subsides.......... 43 Sec. 1207. Disclosures to Carry Out Eligibility Requirements for Certain Programs...................... 44 Sec. 1208. Premium Credits and Subsidy Refunds and Payments Disregarded for Federal and Federally-Assisted Programs............................................... 46 Sec. 1209. Fail-safe Mechanism to Prevent increase in Federal Budget Deficit................................. 46 Sec. 1221. Small Business Tax Credit..................... 47 Subtitle D--Shared Responsibility............................ 50 PART I--INDIVIDUAL RESPONSIBILITY........................ 50 Sec. 1301. Penalty on individuals Without Essential Health Benefits Coverage............................... 50 Sec. 1302. Reporting of Health insurance Coverage........ 53 PART II--EMPLOYER RESPONSIBILITY......................... 54 Sec. 1306. Employer-Provided Health insurance Coverage... 54 Subtitle E--Federal Program for Health Care Cooperatives..... 57 Sec. 1401. Establishment of Federal Program for Health Care Cooperatives...................................... 57 Sec. 2251. Federal Program to Assist Establishment and Operation of Nonprofit, Member-Run Health insurance Issuers.................................. 59 Subtitle F--Transparency and Accountability.................. 62 Sec. 1501. Provisions Ensuring Transparency and Accountability......................................... 62 Sec. 2229. Requirements Relating to Transparency and Accountability..................................... 62 Sec. 1502. Reporting on Utilization of Premium Dollars and Standard Hospital Charges.......................... 62 Sec. 1503. Development and Utilization of Uniform Outline of Coverage Documents.................................. 62 Sec. 1504. Development of Standard Definitions, Personal Scenarios, and Annual Personalized Statements.......... 64 Subtitle G--Role of Public Programs.......................... 64 PART I--MEDICAID COVERAGE FOR THE LOWEST INCOME POPULATIONS............................................ 64 Sec. 1601. Eligibility Standards and Methodologies....... 64 Sec. 1602. income Eligibility for Nonelderly Determined Using Modified Gross income............................ 71 Sec. 1603. Requirement to Offer Premium Assistance for Employer-Sponsored insurance........................... 72 Sec. 1604. Treatment of the Territories.................. 73 Sec. 1605. Medicaid Improvement Fund Rescission.......... 73 PART II--CHILDREN'S HEALTH INSURANCE PROGRAM............. 74 Sec. 1611. Additional Federal Financial Participation for CHIP................................................... 74 Sec. 1612. Technical Corrections......................... 75 PART III--ENROLLMENT SIMPLIFICATION...................... 76 Sec. 1621. Enrollment Simplification and Coordination with State Health insurance Exchanges.................. 76 Sec. 1622. Permitting Hospitals to Make Presumptive Eligibility Determinations for All Medicaid Eligible Populations............................................ 78 Sec. 1623. Promoting Transparency in the Development, Implementation, and Evaluation of Medicaid and CHIP Waivers and Section 1937 State Plan Amendments......... 79 Sec. 1624. Standards and Best Practices to Improve Enrollment of Vulnerable and Underserved Populations... 81 PART IV--MEDICAID SERVICES............................... 82 Sec. 1631. Coverage of Free-standing Birth Centers....... 82 Sec. 1632. Concurrent Care for Children.................. 82 Sec. 1633. Funding to Expand State Aging and Disability Resource Centers....................................... 83 Sec. 1634. Community First Choice Option................. 83 Sec. 1635. Protection for Recipients of Home and Community-Based Services Against Spousal Impoverishment 85 Sec. 1636. incentives for States to Offer Home and Community-Based Services as a Long-Term Care Alternative to Nursing Homes........................... 86 Sec. 1636A. Removal of Barriers to Providing Home and Community-Based Services............................... 87 Sec. 1637. Money Follows the Persons Rebalancing Demonstration.......................................... 88 Sec. 1638. Clarification of Definition of Medical Assistance............................................. 89 Sec. 1639. State Eligibility Option for Family Planning Services............................................... 89 Sec. 1640. Grants for School-Based Health Centers........ 90 Sec. 1641. Therapeutic Foster Care....................... 90 Sec. 1642. Sense of the Senate Regarding Long-Term Care.. 91 PART V--MEDICAID PRESCRIPTION DRUG COVERAGE.............. 91 Sec. 1651. Prescription Drug Rebates..................... 91 Sec. 1652. Elimination of Exclusion of Coverage of Certain Drugs.......................................... 93 Sec. 1653. Providing Adequate Pharmacy Reimbursement..... 94 Sec. 1654. Study of Barriers to Appropriate Utilization of Generic Medicine in Medicaid........................ 95 PART VI--MEDICAID DISPROPORTIONATE SHARE PAYMENTS........ 96 Sec. 1655. Disproportionate Share Hospital Payments...... 96 PART VII--DUAL ELIGIBLES................................. 97 Sec. 1661. 5-Year Period for Demonstration Projects...... 97 Sec. 1662. Providing Federal Coverage and Payment Coordination for Low-Income Medicare Beneficiaries..... 97 PART VIII--MEDICAID QUALITY.............................. 99 Sec. 1671. Adult Health Quality Measures................. 99 Sec. 1672. Payment Adjustment for Health Care-Acquired Conditions............................................. 100 Sec. 1673. Demonstration Project to Evaluate integrated Care Around a Hospitalization.......................... 101 Sec. 1674. Medicaid Global Payment System Demonstration Project................................................ 102 Sec. 1675. Pediatric Accountable Care Organization Demonstration Project.................................. 102 Sec. 1676. Medicaid Emergency Psychiatric Demonstration Project................................................ 103 PART IX--MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSION. 104 Sec. 1681. MACPAC Assessment of Policies Affecting All Medicaid Beneficiaries................................. 104 PART X--AMERICAN INDIANS AND ALASKA NATIVES.............. 105 Sec. 1691. Special Rules Relating to indians............. 105 Sec. 1692. Elimination of Sunset for Reimbursement for All Medicare Part B Services Furnished by Certain indian Hospitals and Clinics........................... 106 Subtitle H--Addressing Health Disparities.................... 107 Sec. 1701. Standardized Collection of Data............... 107 Sec. 1702. Required Collection of Data................... 108 Sec. 1703. Data Sharing and Protection................... 109 Sec. 1704. inclusion of information about the Importance of Having a Health Care Power of Attorney in Transition Planning for Children Aging out of Foster Care and independent Living Programs............................ 109 Subtitle I--Maternal and Child Health Services............... 111 Sec. 1801. Maternal, infant, and Early Childhood Home Visiting Programs...................................... 111 Sec. 1802. Support, Education, and Research for Postpartum Depression.................................. 113 Sec. 1803. Personal Responsibility Education for Adulthood Training..................................... 114 Sec. 1804. Restoration of Funding for Abstinence Education.............................................. 115 Subtitle J--Programs of Health Promotion and Disease Prevention................................................. 116 Sec. 1901. Programs of Health Promotion and Disease Prevention............................................. 116 Subtitle K--Elder Justice Act................................ 119 Sec. 1911. Short Title................................... 121 Sec. 1912. Definitions................................... 121 Sec. 1913. Elder Justice................................. 122 Subtitle L--Provisions of General Application................ 135 Sec. 1921. Protecting Americans and Ensuring Taxpayer Funds in Government Health Care Plans Do Not Support or Fund Physician-Assisted Suicide; Prohibition Against Discrimination on Assisted Suicide..................... 135 Sec. 1922. Protection of Access to Quality Health Care Through the Department of Veterans Affairs and the Department of Defense.................................. 136 Sec. 1923. Continued Application of Antitrust Law........ 136 TITLE II--PROMOTING DISEASE PREVENTION AND WELLNESS.............. 137 Subtitle A--Medicare......................................... 137 Sec. 2001. Coverage of Annual Wellness Visit Providing a Personalized Prevention Plan........................... 137 Sec. 2002. Removal of Barriers to Preventive Services.... 138 Sec. 2003. Evidence-Based Coverage of Preventive Services 140 Sec. 2004. GAO Study and Report on Medicare Beneficiary Access to Vaccines..................................... 140 Sec. 2005. incentives for Healthy Lifestyles............. 140 Subtitle B--Medicaid......................................... 141 Sec. 2101. Improving Access to Preventive Services for Eligible Adults........................................ 141 Sec. 2102. Coverage of Comprehensive tobacco Cessation Services for Pregnant Women............................ 142 Sec. 2103. incentives for Healthy Lifestyles............. 143 Sec. 2104. State Option to Provide Health Homes for Enrollees with Chronic Conditions...................... 145 Sec. 2105. Funding for Childhood Obesity Demonstration Project................................................ 146 Sec. 2106. Public Awareness of Preventive and Obesity- related Services....................................... 147 TITLE III--IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE... 147 Subtitle A--Transforming the Health Care Delivery System..... 147 PART I--LINKING PAYMENT TO QUALITY OUTCOMES UNDER THE MEDICARE PROGRAM....................................... 147 Sec. 3001. Hospital Value-Based Purchasing Program....... 147 Sec. 3002. Improvements to the Physician Quality Reporting System....................................... 152 Sec. 3003. Improvements to the Physician Feedback Program 153 Sec. 3004. Quality Reporting for Long-term Care Hospitals, inpatient Rehabilitation Hospitals, and Hospice Programs....................................... 154 Sec. 3005. Quality Reporting for PPS-exempt Cancer Hospitals.............................................. 156 Sec. 3006. Plans for a Value-Based Purchasing Program for Skilled Nursing Facilities and Home Health Agencies.... 156 Sec. 3007. Value-based Payment Modifier Under the Physician Fee Schedule................................. 157 Sec. 3008. Payment Adjustment for Conditions Acquired in Hospitals.............................................. 158 PART II--STRENGTHENING THE QUALITY INFRASTRUCTURE........ 159 Sec. 3011. National Strategy............................. 159 Sec. 3012. interagency Working Group on Health Care Quality................................................ 161 Sec. 3013. Quality Measure Development................... 161 Sec. 3014. Quality Measure Endorsement................... 163 PART III--ENCOURAGING DEVELOPMENT OF NEW PATIENT CARE MODELS................................................. 165 Sec. 3021. Establishment of Center for Medicare and Medicaid innovation within CMS......................... 165 Sec. 3022. Medicare Shared Savings Program............... 168 Sec. 3023. National Pilot Program on Payment Bundling.... 170 Sec. 3024. independence at Home Pilot Program............ 174 Sec. 3025. Hospital Readmissions Reduction Program....... 177 Sec. 3026. Community-Based Care Transitions Program...... 179 Sec. 3027. Extension of Gainsharing Demonstration........ 180 PART IV--STRENGTHENING PRIMARY CARE AND OTHER WORKFORCE IMPROVEMENTS........................................... 181 Sec. 3031. Expanding Access to Primary Care Services and General Surgery Services............................... 181 Sec. 3031A. Medicare Federally Qualified Health Center Improvements........................................... 182 Sec. 3032. Distribution of Additional Residency Positions 183 Sec. 3033. Counting Resident Time in Outpatient Settings and Allowing Flexibility for Jointly Operated Residency Training Programs...................................... 186 Sec. 3034. Rules for Counting Resident Time for Didactic and Scholarly Activities and Other Activities.......... 187 Sec. 3035. Preservation of Resident Cap Positions from Closed and Acquired Hospitals.......................... 188 Sec. 3036. Workforce Advisory Committee.................. 189 Sec. 3037. Demonstration Projects to Address Health Professions Workforce Needs; Extension of Family-to- Family Health information Centers...................... 190 Sec. 3038. increasing Teaching Capacity.................. 192 Sec. 3039. Graduate Nurse Education Demonstration Program 195 PART V--HEALTH INFORMATION TECHNOLOGY.................... 197 Sec. 3041. Free Clinics and Certified EHR Technology..... 197 Subtitle B--Improving Medicare for Patients and Providers.... 198 PART I--ENSURING BENEFICIARY ACCESS TO PHYSICIAN CARE AND OTHER SERVICES......................................... 198 Sec. 3101. increase in the Physician Payment Update...... 198 Sec. 3102. Extension of the Work Geographic index Floor and Revisions to the Practice Expense Geographic Adjustment Under the Medicare Physician Fee Schedule... 198 Sec. 3103. Extension of Exceptions Process for Medicare Therapy Caps........................................... 200 Sec. 3104. Extension of Payment for Technical Component of Certain Physician Pathology Services................ 200 Sec. 3105. Extension of Ambulance Add-Ons................ 200 Sec. 3106. Extension of Certain Payment Rules for Long- term Care Hospital Services and of Moratorium on the Establishment of Certain Hospitals and Facilities...... 201 Sec. 3107. Extension of Physician Fee Schedule Mental Health Add-on.......................................... 202 Sec. 3108. Permitting Physician Assistants to Order Post- Hospital Extended Care Services and to Provide for Recognition of Attending Physician Assistants as Attending Physicians to Serve Hospice Patients......... 202 Sec. 3109. Recognition of Certified Diabetes Educators as Certified Providers for Purposes of Medicare Diabetes Outpatient Self-Management Training Services........... 203 Sec. 3110. Exemption of Certain Pharmacies from Accreditation Requirements............................. 204 Sec. 3111. Part B Special Enrollment Period for Disabled TRICARE Beneficiaries.................................. 205 Sec. 3112. Payment for Bone Density Tests................ 206 Sec. 3113. Revision to the Medicare Improvement Fund..... 207 Sec. 3114. Treatment of Certain Complex Diagnostic Laboratory Tests....................................... 207 Sec. 3115. Improved Access for Certified-Midwife Services 208 Sec. 3116. Working Group on Access to Emergency Medical Care................................................... 209 PART II--RURAL PROTECTIONS............................... 210 Sec. 3121. Extension of Outpatient Hold Harmless Provision.............................................. 210 Sec. 3122. Extension of Medicare Reasonable Costs Payments for Certain Clinical Diagnostic Laboratory Tests Furnished to Hospital Patients in Certain Rural Areas.................................................. 210 Sec. 3123. Extension of the Rural Community Hospital Demonstration Program.................................. 211 Sec. 3124. Extension of the Medicare-Dependent Hospital (MDH) Program.......................................... 211 Sec. 3125. Temporary Improvements to the Medicare inpatient Hospital Payment Adjustment for Low-Volume Hospitals.............................................. 211 Sec. 3126. Improvements to the Demonstration Project on Community Health integration Models in Certain Rural Counties............................................... 212 Sec. 3127. MedPAC Study on Adequacy of Medicare Payments for Health Care Providers Serving in Rural Areas....... 213 Sec. 3128. Technical Correction Related to Critical Access Hospital Services............................... 213 Sec. 3129. Extension of and Revisions to Medicare Rural Hospital Flexibility Program........................... 214 PART III--IMPROVING PAYMENT ACCURACY..................... 214 Sec. 3131. Payment Adjustments for Home Health Care...... 214 Sec. 3132. Hospice Reform................................ 217 Sec. 3133. Improvement to Medicare Disproportionate Share Hospital (DSH) Payments................................ 219 Sec. 3134. Misvalued Codes Under the Physician Fee Schedule............................................... 220 Sec. 3135. Modification of Equipment Utilization Factor for Advanced Imaging Services.......................... 221 Sec. 3136. Revision of Payment for Power-Driven Wheelchairs............................................ 222 Sec. 3137. Hospital Wage index Improvement............... 223 Sec. 3138. Treatment of Certain Cancer Hospitals......... 225 Sec. 3139. Payment for Biosimilar Biological Products.... 225 Sec. 3140. Public Meeting and Report on Payment Systems for New Clinical Laboratory Diagnostic Tests........... 226 Sec. 3141. Medicare Hospice Concurrent Care Demonstration Program................................................ 226 Sec. 3142. Application of Budget Neutrality on a National Basis in the Calculation of the Medicare Hospital Wage index Floor for Each All-Urban and Rural State......... 227 Sec. 3143. HHS Study on Urban Medicare-Dependent Hospitals.............................................. 228 Subtitle C--Provisions Relating to Part C.................... 228 Sec. 3201. Medicare Advantage Payment.................... 228 Sec. 3202. Benefit Protection and Simplification......... 235 Sec. 3203. Application of Coding intensity Adjustment During MA Payment Transition........................... 237 Sec. 3204. Simplification of Annual Beneficiary Election Periods................................................ 237 Sec. 3205. Extension for Specialized MA Plans for Special Needs individuals...................................... 238 Sec. 3206. Extension of Reasonable Cost Contracts........ 240 Sec. 3207. Technical Correction to MA Private Fee-For- Service Plans.......................................... 240 Sec. 3208. Making Senior Housing Facility Demonstration Permanent.............................................. 241 Sec. 3209. Development of New Standards for Certain Medigap Plans.......................................... 242 Subtitle D--Medicare Part D Improvements for Prescription Drug Plans and MA-PD Plans................................. 242 Sec. 3301. Medicare Prescription Drug Discount Program for Brand-Name Drugs................................... 242 Sec. 3302. Improvement in Determination of Medicare Part D Low-income Benchmark Premium......................... 245 Sec. 3303. Voluntary de minimus Policy for Subsidy Eligible individuals Under Prescription Drug Plans and MA-PD Plans............................................ 246 Sec. 3304. Special Rule for Widows and Widowers Regarding Eligibility for Low-Income Assistance.................. 246 Sec. 3305. Improved information for Subsidy Eligible individuals reassigned to Prescription Drug Plans and MA-PD Plans............................................ 248 Sec. 3306. Funding Outreach and Assistance for Low-Income Programs............................................... 248 Sec. 3307. Improving Formulary Requirements for Prescription Drug Plans and MA-PD Plans with Respect to Certain Categories or Classes of Drugs................. 249 Sec. 3308. Reducing Part D Premium Subsidy for High- income Beneficiaries................................... 250 Sec. 3309. Simplification of Plan information............ 253 Sec. 3310. Limitation on Removal or Change of Coverage of Covered Part D Drugs Under a Formulary Under a Prescription Drug Plan or an MA-PD Plan................ 253 Sec. 3311. Elimination of Cost Sharing for Certain Dual Eligible individuals................................... 255 Sec. 3312. Reducing Wasteful Dispensing of Outpatient Prescription Drugs in Long-term Care Facilities Under Prescription Drug Plans and MA-PD Plans................ 255 Sec. 3313. Improved Medicare Prescription Drug Plan and MA-PD Plan Complaint System............................ 256 Sec. 3314. Uniform Exceptions and Appeals Process for Prescription Drug Plans and MA-PD Plans................ 257 Sec. 3315. Office of the inspector General Studies and Reports................................................ 258 Sec. 3316. HHS Study and Annual Reports on Coverage for Dual Eligibles......................................... 259 Sec. 3317. including Costs incurred by AIDS Drug Assistance Programs and indian Health Service in Providing Prescription Drugs toward the Annual Out-of- Pocket Threshold Under Part D.......................... 260 Subtitle E--Ensuring Medicare Sustainability................. 260 Sec. 3401. Revision of Certain Market Basket Updates and incorporation of Productivity Improvements into Market Basket Updates that Do Not Already incorporate Such Improvements........................................... 260 Sec. 3402. Temporary Adjustment to the Calculation of Part B Premiums........................................ 264 Sec. 3403. Medicare Commission........................... 264 Sec. 3404. Ensuring Medicare Savings are Kept in the Medicare Program....................................... 270 Subtitle F--Patient-Centered Outcomes Research............... 270 Sec. 3501. Patient-Centered Outcomes Research............ 270 Sec. 3502. Coordination with Federal Coordinating Council for Comparative Effectiveness Research................. 280 Sec. 3503. GAO Report on National Coverage Determinations Process................................................ 281 Subtitle G--Administrative Simplification.................... 281 Sec. 3601. Administrative Simplification................. 281 Subtitle H--Sense of the Senate Regarding Medical Malpractice 285 Sec. 3701. Sense of the Senate Regarding Medical Malpractice............................................ 285 TITLE IV--TRANSPARENCY AND PROGRAM INTEGRITY..................... 286 Subtitle A--Limitation on Medicare Exception to the Prohibition on Certain Physician Referrals for Hospitals... 286 Sec. 4001. Limitation on Medicare Exception to the Prohibition on Certain Physician Referrals for Hospitals.............................................. 286 Subtitle B--Physician Ownership and Other Transparency....... 288 Sec. 4101. Transparency Reports and Reporting of Physician Ownership or investment interests............ 288 Sec. 4102. Disclosure Requirements for in-office Ancillary Services Exception to the Prohibition on Physician Self-referral for Certain Imaging Services... 290 Sec. 4103. Prescription Drug Sample Transparency......... 290 Sec. 4104. Pharmacy Benefit Managers Transparency Requirements........................................... 291 Subtitle C--Nursing Home Transparency and Improvement........ 292 PART I--IMPROVING TRANSPARENCY OF INFORMATION............ 292 Sec. 4201. Required Disclosure of Ownership and Additional Disclosable Parties information............. 292 Sec. 4202. Accountability Requirements for Skilled Nursing Facilities and Nursing Facilities.............. 294 Sec. 4203. Nursing Home Compare Medicare Website......... 295 Sec. 4204. Reporting of Expenditures..................... 296 Sec. 4205. Standardized Complaint Form................... 297 Sec. 4206. Ensuring Staffing Accountability.............. 297 Sec. 4207. GAO Study and Report on Five-Star Quality Rating System.......................................... 298 PART II--TARGETING ENFORCEMENT........................... 298 Sec. 4211. Civil Monetary Penalties...................... 298 Sec. 4212. National independent Monitor Pilot Program.... 299 Sec. 4213. Notification of Facility Closure.............. 300 Sec. 4214. National Demonstration Projects on Culture Change and Use of information Technology in Nursing Homes.................................................. 301 PART III--IMPROVING STAFF TRAINING....................... 301 Sec. 4221. Dementia and Abuse Prevention Training........ 301 Subtitle D--Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long-Term Care Facilities and Providers.................... 302 Sec. 4301. Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long-Term Care Facilities and Providers................ 302 TITLE V--FRAUD, WASTE, AND ABUSE................................. 303 Subtitle A--Medicare, Medicaid, and CHIP Provisions.......... 303 Sec. 5001. Provider Screening and Other Enrollment Requirements Under Medicare and Medicaid............... 303 Sec. 5002. Enhanced Medicare and Medicaid Program integrity Provisions................................... 305 Sec. 5003. Elimination of Duplication Between the Healthcare integrity and Protection Data Bank and the National Practitioner Data Bank........................ 310 Sec. 5004. Maximum Period of Submission of Medicare Claims Reduced to not More Than 12 Months.............. 311 Sec. 5005. Physicians who Order Items and Services Required to be Medicare Enrolled Physicians or Eligible Professionals.......................................... 312 Sec. 5006. Requirement for Physicians to Provide Documentation on Referrals to Programs at High Risk of Waste and Abuse........................................ 312 Sec. 5007. Face-to-Face Encounter with Patient Required Before Physicians May Certify Eligibility for Home Health Services or Durable Medical Equipment Under Medicare............................................... 312 Sec. 5008. Enhanced Penalties............................ 313 Sec. 5009. Medicare Self-Referral Disclosure Protocol.... 314 Sec. 5010. Adjustments to the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Acquisition Program........................ 316 Sec. 5011. Expansion of the Recovery Audit Contractor (RAC) Program.......................................... 316 Subtitle B--Additional Medicaid Provisions................... 318 Sec. 5101. Termination of Provider Participation Under Medicaid if Terminated Under Medicare or Other State Plan................................................... 318 Sec. 5102. Medicaid Exclusion from Participation Relating to Certain Ownership, Control, and Management Affiliations........................................... 318 Sec. 5103. Billing Agents, Clearinghouses, or Other Alternate Payees Required to Register Under Medicaid... 319 Sec. 5104. Requirement to Report Expanded Set of Data Elements Under MMIS to Detect Fraud and Abuse.......... 319 Sec. 5105. Prohibition on Payments to institutions or Entities Located Outside of the United States.......... 320 Sec. 5106. Overpayments.................................. 320 Sec. 5107. Mandatory State Use of National Correct Coding initiative............................................. 320 Sec. 5108. General Effective Date........................ 321 TITLE VI--REVENUE PROVISIONS..................................... 321 Sec. 6001. Excise Tax on High Cost insurance............. 321 Sec. 6002. Employer Health insurance Reporting........... 328 Sec. 6003. Modify the Definition of Qualified Medical Expenses............................................... 329 Sec. 6004. increase in Additional Tax on Distributions from HSAs not Used for Medical Expenses................ 331 Sec. 6005. Limitation on Health Flexible Spending Arrangements Under Cafeteria Plans..................... 332 Sec. 6006. Require information Reporting on Payments to Corporations........................................... 334 Sec. 6007. Requirements for Section 501(c)(3) Hospitals.. 336 Sec. 6008. Imposition of Annual Fee on Branded Prescription Pharmaceutical Manufacturers and Importers 340 Sec. 6009. Imposition of Annual Fee on Medical Device Manufacturers and Importers............................ 343 Sec. 6010. Imposition of Annual Fee on Health insurance Providers.............................................. 345 Sec. 6011. Study and Report of Effect on Veterans Health Care................................................... 348 Sec. 6012. Elimination of Deduction for Expenses Allocable to Medicare Part D Subsidy................... 349 Sec. 6013. Modify the Itemized Deduction for Medical Expenses............................................... 350 Sec. 6014. Limitation on Deduction for Remuneration Paid by Health insurance Providers.......................... 351 Sec. 6021. Provide income Exclusion for indian Tribe Health Benefits........................................ 356 Sec. 6022. Establishment of SIMPLE Cafeteria Plans for Small Businesses....................................... 358 Sec. 6023. investment Credit for Qualifying Therapeutic Discovery Project...................................... 361 III. Budget Effects of the Bill....................................364 IV. Votes of the Committee........................................410 V. Changes in Existing Law.......................................430 VI. Additional Views..............................................431 VII. Minority Views................................................448 SRPT CRPT-111srpt89 SENATE 111 89 1 false true https://www.govinfo.gov/app/details/CRPT-111srpt89 https://www.govinfo.gov/content/pkg/CRPT-111srpt89/html/CRPT-111srpt89.htm https://www.govinfo.gov/content/pkg/CRPT-111srpt89/pdf/CRPT-111srpt89.pdf S. Rept. 111-89 The Committee on Finance, having considered an original bill, S. 1796, to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes, reports favorably thereon and recommends that the bill do pass. AMERICA'S HEALTHY FUTURE ACT OF 2009;S. Rept. 111-89 Ordered to be printed FIRSTPART CRPT-111srpt89 Ordered to be printed 1 The Committee on Finance, having considered an original bill, S. 1796, to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes, reports favorably thereon and recommends that the bill do pass. Mr. Baucus, from the Committee on Finance, submitted the following Committee on Finance Finance Mr. Baucus Max Baucus Baucus, Max Max Sieben Baucus

S. 1796, 111th Max Baucus United States Senate sponsor spn United States Congress Member United States Congress Senate Committee on Finance associated name asn Government Organization S. 1380 111 OTHER S. 1796 111 OTHER S. 1796 111 PRIMARY Title 2 Section 601-688 2 U.S.C. 601-688 Title 5 Section 802 5 U.S.C. 802 Title 10 Section 1086(d) 10 U.S.C. 1086(d) Title 15 Section 12(a) Title 15 Section 45 15 U.S.C. 12(a) 15 U.S.C. 45 Title 25 Section 450b(1) 25 U.S.C. 450b(1) Title 42 Section 1395 Title 42 Section 1395m(e)(1)(B) Title 42 Section 1395w-132 Title 42 Section 1395w-132(a)(2) Title 42 Section 1395x(s)(3) Title 42 Section 299b-8 Title 42 Section 301et seq. 42 U.S.C. 1395 42 U.S.C. 1395m(e)(1)(B) 42 U.S.C. 1395w-132 42 U.S.C. 1395w-132(a)(2) 42 U.S.C. 1395x(s)(3) 42 U.S.C. 299b-8 42 U.S.C. 301et seq. Title 43 Section 1601et seq. 43 U.S.C. 1601et seq. Public Law 86-382 Public Law No 86-382 Public Law 92-203 Public Law No 92-203 Public Law 93-344 Public Law No 93-344 Public Law 93-406 Public Law No 93-406 Public Law 94-437 Public Law No 94-437 Public Law 95-452 Public Law No 95-452 Public Law 98-417 Public Law No 98-417 Public Law 99-272 Public Law No 99-272 Public Law 99-660 Public Law No 99-660 Public Law 100-203 Public Law No 100-203 Public Law 100-293 Public Law No 100-293 Public Law 100-504 Public Law No 100-504 Public Law 104-4 Public Law No 104-4 Public Law 104-191 Public Law No 104-191 Public Law 104-193 Public Law No 104-193 Public Law 105-12 Public Law No 105-12 Public Law 105-33 Public Law No 105-33 Public Law 106-398 Public Law No 106-398 Public Law 106-554 Public Law No 106-554 Public Law 107-105 Public Law No 107-105 Public Law 108-173 Public Law No 108-173 Public Law 109-171 Public Law No 109-171 Public Law 109-432 Public Law No 109-432 Public Law 110-173 Public Law No 110-173 Public Law 110-252 Public Law No 110-252 Public Law 110-271 Public Law No 110-271 Public Law 110-275 Public Law No 110-275 Public Law 110-343 Public Law No 110-343 Public Law 111-3 Public Law No 111-3 Public Law 111-5 Public Law No 111-5 Title 42 Part 136.61 42 CFR Part 136.61 Title 42 Part 413.79 42 CFR Part 413.79 Title 42 Part 423.100, 42 CFR Part 423.100, Title 42 Part 483.152 42 CFR Part 483.152 Title 42 Part 483.75(e)(2) 42 CFR Part 483.75(e)(2) Title 42 Part 483.75, 42 CFR Part 483.75, Title 42 Part 423.120 42 CFR Part 423.120 S. Rept. 111-89