Table of Contents of Senate Majority Leader Reid’s Health Care Bill, HR 3590

SENATE  HEALTHCARE  BILL — H.R. 3590

“Patient Protection and Affordable Care Act”

November 18, 2009

http://democrats.senate.gov/reform/patient-protection-affordable-care-act.pdf

(The version of the Senate Bill on Senator Reid’s website does not include page numbers on the Table of Contents.  This document — created by a private citizen who laboriously entered the page numbers on the attached Table of Contents — was provided by Texas education advocate Donna Warner. We apologize that the Page Numbers on the right side are not flush with the right side of the page.)

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Table  of  Contents

Page #

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Patient Protection and Affordable Care Act’’.

6 (b) TABLE OF CONTENTS.—The table of contents of

7 this Act is as follows:

Sec. 1. Short title; table of contents.

2

TITLE I—QUALITY, AFFORDABLE HEALTH CARE FOR ALL

AMERICANS

Subtitle A—Immediate Improvements in Health Care Coverage for All                                       15

Americans

Sec. 1001. Amendments to the Public Health Service Act.                                                                15

‘‘PART A—INDIVIDUAL AND GROUP MARKET REFORMS 15

‘‘SUBPART II—IMPROVING COVERAGE 16

‘‘Sec. 2711. No lifetime or annual limits                                                                                                      16

‘‘Sec. 2712. Prohibition on rescissions.                                                                                                       16

‘‘Sec. 2713. Coverage of preventive health services.                                                                             17

‘‘Sec. 2714. Extension of dependent coverage.                                                                                        18

‘‘Sec. 2715. Development and utilization of uniform explanation of coverage                          19

documents and standardized definitions.

‘‘Sec. 2716. Prohibition of discrimination based on salary.                                                               26

‘‘Sec. 2717. Ensuring the quality of care.                                                                                                   26

‘‘Sec. 2718. Bringing down the cost of health care coverage.                                                            30

‘‘Sec. 2719. Appeals process.                                                                                                                          33

Sec. 1002. Health insurance consumer information.                                                                           34

Sec. 1003. Ensuring that consumers get value for their dollars.                                                     37

Sec. 1004. Effective dates.                                                                                                                               40

Subtitle B—Immediate Actions to Preserve and Expand Coverage 41

Sec. 1101. Immediate access to insurance for uninsured individuals with a preexisting     41

condition.

Sec. 1102. Reinsurance for early retirees.                                                                                                48

Sec. 1103. Immediate information that allows consumers to identify affordable                   54

coverage options.

Sec. 1104. Administrative simplification.                                                                                                 57

Sec. 1105. Effective Date                                                                                                                                   77

Subtitle C—Quality Health Insurance Coverage for All Americans 78

PART I—HEALTH INSURANCE MARKET REFORMS 78

Sec. 1201. Amendment to the Public Health Service Act.                                                                  78

‘‘SUBPART I—GENERAL REFORM 78

‘‘Sec. 2701. Fair health insurance premiums.                                                                                          80

‘‘Sec. 2702. Guaranteed availability of coverage.                                                                                  82

‘‘Sec. 2703. Guaranteed renewability of coverage.                                                                               83

‘‘Sec. 2704. Prohibition of preexisting condition exclusions or other discrimination          78

based on health status.

‘‘Sec. 2705. Prohibiting discrimination against individual participants and                             83

beneficiaries based on health status.

‘‘Sec. 2706. Non-discrimination in health care.                                                                                     95

‘‘Sec. 2707. Comprehensive health insurance coverage.                                                                   96

‘‘Sec. 2708. Prohibition on excessive waiting periods.                                                                       97

PART II—OTHER PROVISIONS 97

Sec. 1251. Preservation of right to maintain existing coverage.                                                     97

3

Sec. 1252. Rating reforms must apply uniformly to all health insurance issuers                    99

and group health plans.

Sec. 1253. Effective dates.                                                                                                                               99

Subtitle D—Available Coverage Choices for All Americans 100

PART I—ESTABLISHMENT OF QUALIFIED HEALTH PLANS 100

Sec. 1301. Qualified health plan defined.                                                                                                  100

Sec. 1302. Essential health benefits requirements.                                                                              102

Sec. 1303. Special rules.                                                                                                                                   116

Sec. 1304. Related definitions.                                                                                                                      124

PART II—CONSUMER CHOICES AND INSURANCE COMPETITION THROUGH 128

HEALTH BENEFIT EXCHANGES

Sec. 1311. Affordable choices of health benefit plans.                                                                         128

Sec. 1312. Consumer choice.                                                                                                                          153

Sec. 1313. Financial integrity.                                                                                                                        160

PART III—STATE FLEXIBILITY RELATING TO EXCHANGES 164

Sec. 1321. State flexibility in operation and enforcement of Exchanges and related             164

requirements.

Sec. 1322. Federal program to assist establishment and operation of nonprofit,                    168

member-run health insurance issuers.

Sec. 1323. Community health insurance option.                                                                                   182

Sec. 1324. Level playing field.                                                                                                                        200

PART IV—STATE FLEXIBILITY TO ESTABLISH ALTERNATIVE PROGRAMS 201

Sec. 1331. State flexibility to establish basic health programs for low-income individuals  201

not eligible for Medicaid.

Sec. 1332. Waiver for State innovation.                                                                                                    212

Sec. 1333. Provisions relating to offering of plans in more than one State.                               219

PART V—REINSURANCE AND RISK ADJUSTMENT 226

Sec. 1341. Transitional reinsurance program for individual and small group                          226

markets in each State.

Sec. 1342. Establishment of risk corridors for plans in individual and small                            233

group markets.

Sec. 1343. Risk adjustment.                                                                                                                            236

Subtitle E—Affordable Coverage Choices for All Americans 238

PART I—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS 238

SUBPART A—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS 238

Sec. 1401. Refundable tax credit providing premium assistance for coverage                       238

under a qualified health plan.

Sec. 1402. Reduced cost-sharing for individuals enrolling in qualified health                        259

plans.

SUBPART B—ELIGIBILITY DETERMINATIONS 269

4

Sec. 1411. Procedures for determining eligibility for Exchange participation,                        269

premium tax credits and reduced cost-sharing , and individual

responsibility exemptions.

Sec. 1412. Advance determination and payment of premium tax credits and                         290

cost-sharing reductions.

Sec. 1413. Streamlining of procedures for enrollment through an exchange and                   295

State Medicaid, CHIP, and health subsidy programs.

Sec. 1414. Disclosures to carry out eligibility requirements for certain programs.               302

Sec. 1415. Premium tax credit and cost-sharing reduction payments disregarded               306

for Federal and Federally-assisted programs.

PART II—SMALL BUSINESS TAX CREDIT 307

Sec. 1421. Credit for employee health insurance expenses of small businesses.                     307

Subtitle F—Shared Responsibility for Health Care 320

PART I—INDIVIDUAL RESPONSIBILITY 320

Sec. 1501. Requirement to maintain minimum essential coverage.                                             320

Sec. 1502. Reporting of health insurance coverage.                                                                           340

PART II—EMPLOYER RESPONSIBILITIES 346

Sec. 1511. Automatic enrollment for employees of large employers.                                         346

Sec. 1512. Employer requirement to inform employees of coverage options.                        347

Sec. 1513. Shared responsibility for employers.                                                                                   348

Sec. 1514. Reporting of employer health insurance coverage.                                                       357

Sec. 1515. Offering of Exchange-participating qualified health plans through                         362

cafeteria plans.

Subtitle G—Miscellaneous Provisions 364

Sec. 1551. Definitions.                                                                                                                                      364

Sec. 1552. Transparency in government.                                                                                                364

Sec. 1553. Prohibition against discrimination on assisted suicide.                                              364

Sec. 1554. Access to therapies.                                                                                                                    366

Sec. 1555. Freedom not to participate in Federal health insurance programs.                      367

Sec. 1556. Equity for certain eligible survivors.                                                                                  367

Sec. 1557. Nondiscrimination.                                                                                                                    368

Sec. 1558. Protections for employees.                                                                                                     369

Sec. 1559. Oversight.                                                                                                                                       371

Sec. 1560. Rules of construction.                                                                                                               371

Sec. 1561. Health information technology enrollment standards and protocols.                 373

Sec. 1562. Conforming amendments.                                                                                                       377

TITLE II—ROLE OF PUBLIC PROGRAMS 396

Subtitle A—Improved Access to Medicaid 396

Sec. 2001. Medicaid coverage for the lowest income populations.                                           396

Sec. 2002. Income eligibility for nonelderly determined using modified gross income.     418

Sec. 2003. Requirement to offer premium assistance for employer-sponsored insurance.    427

Sec. 2004. Medicaid coverage for former foster care children.                                                   428

Sec. 2005. Payments to territories.                                                                                                          430

5

Sec. 2006. Special adjustment to FMAP determination for certain States recovering       432

from a major disaster.

Sec. 2007. Medicaid Improvement Fund rescission.                                                                      436

Subtitle B—Enhanced Support for the Children’s Health Insurance Program 436

Sec. 2101. Additional federal financial participation for CHIP.                                                    436

Sec. 2102. Technical corrections.                                                                                                             442

Subtitle C—Medicaid and CHIP Enrollment Simplification 445

Sec. 2201. Enrollment Simplification and coordination with State Health Insurance       445

Exchanges.

Sec. 2202. Permitting hospitals to make presumptive eligibility determinations               451

for all Medicaid eligible populations.

Subtitle D—Improvements to Medicaid Services 453

Sec. 2301. Coverage for freestanding birth center services.                                                         453

Sec. 2302. Concurrent care for children.                                                                                               456

Sec. 2303. State eligibility option for family planning services.                                                  457

Sec. 2304. Clarification of definition of medical assistance.                                                          466

Subtitle E—New Options for States to Provide Long-Term Services and

Supports                                                                                                                                                            466

Sec. 2401. Community First Choice Option.                                                                                         466

Sec. 2402. Removal of barriers to providing home and community-based services.        479

Sec. 2403. Money Follows the Person Rebalancing Demonstration.                                         488

Sec. 2404. Protection for recipients of home and community-based services                     489

against spousal impoverishment.

Sec. 2405. Funding to expand State Aging and Disability Resource Centers.                        490

Sec. 2406. Sense of the Senate regarding long-term care.                                                             490

Subtitle F—Medicaid Prescription Drug Coverage 492

Sec. 2501. Prescription drug rebates.                                                                                                    492

Sec. 2502. Elimination of exclusion of coverage of certain drugs.                                            502

Sec. 2503. Providing adequate pharmacy reimbursement.                                                         503

Subtitle G—Medicaid Disproportionate Share Hospital (DSH) Payments 510

Sec. 2551. Disproportionate share hospital payments.                                                                  510

Subtitle H—Improved Coordination for Dual Eligible Beneficiaries 515

Sec. 2601. 5-year period for demonstration projects.                                                                   515

Sec. 2602. Providing Federal coverage and payment coordination for dual eligible       517

beneficiaries.

Subtitle I—Improving the Quality of Medicaid for Patients and Providers 522

Sec. 2701. Adult health quality measures.                                                                                        522

Sec. 2702. Payment Adjustment for Health Care-Acquired Conditions.                              526

Sec. 2703. State option to provide health homes for enrollees with chronic conditions.        528

Sec. 2704. Demonstration project to evaluate integrated care around a hospitalization.       538

6

Sec. 2705. Medicaid Global Payment System Demonstration Project.                                  542

Sec. 2706. Pediatric Accountable Care Organization Demonstration Project.                   544

Sec. 2707. Medicaid emergency psychiatric demonstration project.                                   547

Subtitle J—Improvements to the Medicaid and CHIP Payment and Access 553

Commission (MACPAC)

Sec. 2801. MACPAC assessment of policies affecting all Medicaid beneficiaries.              553

Subtitle K—Protections for American Indians and Alaska Natives 565

Sec. 2901. Special rules relating to Indians.                                                                                     565

Sec. 2902. Elimination of sunset for reimbursement for all medicare part B                     567

services furnished by certain indian hospitals and clinics.

Subtitle L—Maternal and Child Health Services 568

Sec. 2951. Maternal, infant, and early childhood home visiting programs.                        568

Sec. 2952. Support, education, and research for postpartum depression.                         595

Sec. 2953. Personal responsibility education.                                                                                604

Sec. 2954. Restoration of funding for abstinence education.                                                    618

Sec. 2955. Inclusion of information about the importance of having a health                  619

care power of attorney in transition planning for children aging

out of foster care and independent living programs.

TITLE III—IMPROVING THE QUALITY AND EFFICIENCY OF

HEALTH CARE                                                                                                                                         621

Subtitle A—Transforming the Health Care Delivery System 621

PART I—LINKING PAYMENT TO QUALITY OUTCOMES UNDER THE

MEDICARE PROGRAM                                                                                                                        621

Sec. 3001. Hospital Value-Based purchasing program.                                                               622

Sec. 3002. Improvements to the physician quality reporting system.                                 652

Sec. 3003. Improvements to the physician feedback program.                                               658

Sec. 3004. Quality reporting for long-term care hospitals, inpatient rehabilitation

hospitals, and hospice programs.                                                                                                           663

Sec. 3005. Quality reporting for PPS-exempt cancer hospitals.                                               673

Sec. 3006. Plans for a Value-Based purchasing program for skilled nursing facilities

and home health agencies.                                                                                                                         676

Sec. 3007. Value-based payment modifier under the physician fee schedule.                   680

Sec. 3008. Payment adjustment for conditions acquired in hospitals.                                   687

PART II—NATIONAL STRATEGY TO IMPROVE HEALTH CARE QUALITY 692

Sec. 3011. National strategy.                                                                                                                     692

Sec. 3012. Interagency Working Group on Health Care Quality.                                               699

Sec. 3013. Quality measure development.                                                                                          702

Sec. 3014. Quality measurement.                                                                                                            709

Sec. 3015. Data collection; public reporting.                                                                                     717

PART III—ENCOURAGING DEVELOPMENT OF NEW PATIENT CARE MODELS 723

Sec. 3021. Establishment of Center for Medicare and Medicaid Innovation

within CMS.                                                                                                                                                        723

Sec. 3022. Medicare shared savings program.                                                                                   739

Sec. 3023. National pilot program on payment bundling.                                                            751

7

Sec. 3024. Independence at home demonstration program.                                                      764

Sec. 3025. Hospital readmissions reduction program.                                                                  775

Sec. 3026. Community-Based Care Transitions Program.                                                            789

Sec. 3027. Extension of gainsharing demonstration.                                                                     795

Subtitle B—Improving Medicare for Patients and Providers 796

PART I—ENSURING BENEFICIARY ACCESS TO PHYSICIAN CARE AND OTHER

SERVICES                                                                                                                                                       796

Sec. 3101. Increase in the physician payment update.                                                                  796

Sec. 3102. Extension of the work geographic index floor and revisions to the                   797

practice expense geographic adjustment under the Medicare

physician fee schedule.

Sec. 3103. Extension of exceptions process for Medicare therapy caps.                              801

Sec. 3104. Extension of payment for technical component of certain physician              801

pathology services.

Sec. 3105. Extension of ambulance add-ons.                                                                                   802

Sec. 3106. Extension of certain payment rules for long-term care hospital services     803

and of moratorium on the establishment of certain hospitals

and facilities.

Sec. 3107. Extension of physician fee schedule mental health add-on.                                803

Sec. 3108. Permitting physician assistants to order post-Hospital extended care          803

services.

Sec. 3109. Exemption of certain pharmacies from accreditation requirements.             804

Sec. 3110. Part B special enrollment period for disabled TRICARE beneficiaries.           808

Sec. 3111. Payment for bone density tests.                                                                                       810

Sec. 3112. Revision to the Medicare Improvement Fund.                                                          813

Sec. 3113. Treatment of certain complex diagnostic laboratory tests.                                 813

Sec. 3114. Improved access for certified nurse-midwife services.                                         816

PART II—RURAL PROTECTIONS 817

Sec. 3121. Extension of outpatient hold harmless provision.                                                   817

Sec. 3122. Extension of Medicare reasonable costs payments for certain clinical          818

diagnostic laboratory tests furnished to hospital patients in certain

rural areas.

Sec. 3123. Extension of the Rural Community Hospital Demonstration Program.          818

Sec. 3124. Extension of the Medicare-dependent hospital (MDH) program.                      821

Sec. 3125. Temporary improvements to the Medicare inpatient hospital payment       822

adjustment for low-volume hospitals.

Sec. 3126. Improvements to the demonstration project on community health integration              824

models in certain rural counties.

Sec. 3127. MedPAC study on adequacy of Medicare payments for health care                825

providers serving in rural areas.

Sec. 3128. Technical correction related to critical access hospital services.                     826

Sec. 3129. Extension of and revisions to Medicare rural hospital flexibility program.  826

PART III—IMPROVING PAYMENT ACCURACY 828

Sec. 3131. Payment adjustments for home health care.                                                                828

Sec. 3132. Hospice reform.                                                                                                                        836

Sec. 3133. Improvement to medicare disproportionate share hospital (DSH)                   842

payments.

8

Sec. 3134. Misvalued codes under the physician fee schedule.                                                 846

Sec. 3135. Modification of equipment utilization factor for advanced imaging                  852

services.

Sec. 3136. Revision of payment for power-driven wheelchairs.                                                857

Sec. 3137. Hospital wage index improvement.                                                                                 858

Sec. 3138. Treatment of certain cancer hospitals.                                                                           861

Sec. 3139. Payment for biosimilar biological products.                                                                863

Sec. 3140. Medicare hospice concurrent care demonstration program.                               865

Sec. 3141. Application of budget neutrality on a national basis in the calculation            867

of the Medicare hospital wage index floor.

Sec. 3142. HHS study on urban Medicare-dependent hospitals.                                               867

Subtitle C—Provisions Relating to Part C 869

Sec. 3201. Medicare Advantage payment.                                                                                          869

Sec. 3202. Benefit protection and simplification.                                                                            903

Sec. 3203. Application of coding intensity adjustment during MA payment                      908

transition.

Sec. 3204. Simplification of annual beneficiary election periods.                                            909

Sec. 3205. Extension for specialized MA plans for special needs individuals.                     911

Sec. 3206. Extension of reasonable cost contracts.                                                                        918

Sec. 3207. Technical correction to MA private fee-for-service plans.                                   918

Sec. 3208. Making senior housing facility demonstration permanent.                                  919

Sec. 3209. Authority to deny plan bids.                                                                                              920

Sec. 3210. Development of new standards for certain Medigap plans.                                   921

Subtitle D—Medicare Part D Improvements for Prescription Drug

Plans and MA–PD Plans                                                                                                                        923

Sec. 3301. Medicare coverage gap discount program.                                                                   923

Sec. 3302. Improvement in determination of Medicare part D low-income                        943

benchmark premium.

Sec. 3303. Voluntary de minimis policy for subsidy eligible individuals under                 943

prescription drug plans and MA–PD plans.

Sec. 3304. Special rule for widows and widowers regarding eligibility for low income    945

assistance.

Sec. 3305. Improved information for subsidy eligible individuals reassigned to              946

prescription drug plans and MA–PD plans.

Sec. 3306. Funding outreach and assistance for low-income programs.                               947

Sec. 3307. Improving formulary requirements for prescription drug plans and               950

MA–PD plans with respect to certain categories or classes of drugs.

Sec. 3308. Reducing part D premium subsidy for high-income beneficiaries.                     952

Sec. 3309. Elimination of cost sharing for certain dual eligible individuals.                         961

Sec. 3310. Reducing wasteful dispensing of outpatient prescription drugs in                      962

long-term care facilities under prescription drug plans and

MA–PD plans.

Sec. 3311. Improved Medicare prescription drug plan and MA–PD plan complaint         963

system.

Sec. 3312. Uniform exceptions and appeals process for prescription drug plans               964

and MA–PD plans.

Sec. 3313. Office of the Inspector General studies and reports.                                                  965

Sec. 3314. Including costs incurred by AIDS drug assistance programs and Indian         970

Health Service in providing prescription drugs toward the

annual out-of-pocket threshold under part D.

Sec. 3315. Immediate reduction in coverage gap in 2010.                                                           972

9

Subtitle E—Ensuring Medicare Sustainability 974

Sec. 3401. Revision of certain market basket updates and incorporation of productivity                    974

improvements into market basket updates that do not

already incorporate such improvements.

Sec. 3402. Temporary adjustment to the calculation of part B premiums.                            999

Sec. 3403. Independent Medicare Advisory Board.                                                                        1,000

Subtitle F—Health Care Quality Improvements                                                                                 1,053

Sec. 3501. Health care delivery system research; Quality improvement technical           1,053

assistance.

Sec. 3502. Establishing community health teams to support the patient-centered           1,067

medical home.

Sec. 3503. Medication management services in treatment of chronic disease.                   1,075

Sec. 3504. Design and implementation of regionalized systems for emergency                  1,081

care.

Sec. 3505. Trauma care centers and service availability.                                                              1,091

Sec. 3506. Program to facilitate shared decision making.                                                              1,105

Sec. 3507. Presentation of prescription drug benefit and risk information.                          1,113

Sec. 3508. Demonstration program to integrate quality improvement and patient           1,115

safety training into clinical education of health professionals.

Sec. 3509. Improving women’s health.                                                                                                   1,118

Sec. 3510. Patient navigator program.                                                                                                    1,132

Sec. 3511. Authorization of appropriations.                                                                                          1,133

TITLE IV—PREVENTION OF CHRONIC DISEASE AND IMPROVING                    1,134

PUBLIC HEALTH

Subtitle A—Modernizing Disease Prevention and Public Health Systems 1,134

Sec. 4001. National Prevention, Health Promotion and Public Health Council.                    1,134

Sec. 4002. Prevention and Public Health Fund.                                                                                   1,141

Sec. 4003. Clinical and community preventive services.                                                                1,142

Sec. 4004. Education and outreach campaign regarding preventive benefits.                      1,150

Subtitle B—Increasing Access to Clinical Preventive Services 1,156

Sec. 4101. School-based health centers.                                                                                                 1,156

Sec. 4102. Oral healthcare prevention activities.                                                                               1,167

Sec. 4103. Medicare coverage of annual wellness visit providing a personalized                1,174

prevention plan.

Sec. 4104. Removal of barriers to preventive services in Medicare.                                        1,184

Sec. 4105. Evidence-based coverage of preventive services in Medicare.                             1,189

Sec. 4106. Improving access to preventive services for eligible adults in Medicaid.        1,190

Sec. 4107. Coverage of comprehensive tobacco cessation services for pregnant              1,192

women in Medicaid.

Sec. 4108. Incentives for prevention of chronic diseases in Medicaid.                                   1,195

Subtitle C—Creating Healthier Communities 1,203

Sec. 4201. Community transformation grants.                                                                                  1,203

Sec. 4202. Healthy aging, living well; evaluation of community-based prevention          1,209

and wellness programs for Medicare beneficiaries.

10

Sec. 4203. Removing barriers and improving access to wellness for individuals              1,220

with disabilities.

Sec. 4204. Immunizations.                                                                                                                        1,221

Sec. 4205. Nutrition labeling of standard menu items at chain restaurants.                       1,228

Sec. 4206. Demonstration project concerning individualized wellness plan.                     1,237

Sec. 4207. Reasonable break time for nursing mothers.                                                              1,239

Subtitle D—Support for Prevention and Public Health Innovation 1,240

Sec. 4301. Research on optimizing the delivery of public health services.                          1,240

Sec. 4302. Understanding health disparities: data collection and analysis.                        1,241

Sec. 4303. CDC and employer-based wellness programs.                                                           1,252

Sec. 4304. Epidemiology-Laboratory Capacity Grants.                                                              1,255

Sec. 4305. Advancing research and treatment for pain care management.                       1,257

Sec. 4306. Funding for Childhood Obesity Demonstration Project.                                      1,265

Subtitle E—Miscellaneous Provisions 1,265

Sec. 4401. Sense of the Senate concerning CBO scoring.                                                            1,265

Sec. 4402. Effectiveness of Federal health and wellness initiatives.                                     1,265

TITLE V—HEALTH CARE WORKFORCE 1,266

Subtitle A—Purpose and Definitions 1,266

Sec. 5001. Purpose.                                                                                                                                   1,266

Sec. 5002. Definitions.                                                                                                                             1,267

Subtitle B—Innovations in the Health Care Workforce 1,278

Sec. 5101. National health care workforce commission.                                                          1,278

Sec. 5102. State health care workforce development grants.                                                 1,297

Sec. 5103. Health care workforce assessment.                                                                            1,309

Subtitle C—Increasing the Supply of the Health Care Workforce 1,316

Sec. 5201. Federally supported student loan funds.                                                                 1,316

Sec. 5202. Nursing student loan program.                                                                                   1,318

Sec. 5203. Health care workforce loan repayment programs.                                             1,319

Sec. 5204. Public health workforce recruitment and retention programs.                    1,324

Sec. 5205. Allied health workforce recruitment and retention programs.                     1,329

Sec. 5206. Grants for State and local programs.                                                                         1,331

Sec. 5207. Funding for National Health Service Corps.                                                          1,333

Sec. 5208. Nurse-managed health clinics.                                                                                    1,334

Sec. 5209. Elimination of cap on commissioned Corps.                                                         1,336

Sec. 5210. Establishing a Ready Reserve Corps.                                                                        1,336

Subtitle D—Enhancing Health Care Workforce Education and Training 1,339

Sec. 5301. Training in family medicine, general internal medicine,

general pediatrics, and physician assistantship.                                                                        1,339

Sec. 5302. Training opportunities for direct care workers.                                                  1,346

Sec. 5303. Training in general, pediatric, and public health dentistry.                           1,349

Sec. 5304. Alternative dental health care providers demonstration project.              1,355

Sec. 5305. Geriatric education and training; career awards;

comprehensive geriatric education.                                                                                               1,359

Sec. 5306. Mental and behavioral health education and training grants.                       1,368

11

Sec. 5307. Cultural competency, prevention, and public health and individuals       1,374

with disabilities training.

Sec. 5308. Advanced nursing education grants.                                                                        1,377

Sec. 5309. Nurse education, practice, and retention grants.                                                1,378

Sec. 5310. Loan repayment and scholarship program.                                                           1,382

Sec. 5311. Nurse faculty loan program.                                                                                          1,384

Sec. 5312. Authorization of appropriations for parts B through D of Title VIII.           1,389

Sec. 5313. Grants to promote the community health workforce.                                        1,389

Sec. 5314. Fellowship training in public health.                                                                          1,395

Sec. 5315. United States Public Health Sciences Track.                                                            1,397

Subtitle E—Supporting the Existing Health Care Workforce 1,411

Sec. 5401. Centers of excellence.                                                                                                      1,411

Sec. 5402. Health care professionals training for diversity.                                                 1,416

Sec. 5403. Interdisciplinary, community-based linkages.                                                    1,417

Sec. 5404. Workforce diversity grants.                                                                                         1,430

Sec. 5405. Primary care extension program.                                                                             1,431

Subtitle F—Strengthening Primary Care and Other Workforce Improvements 1,440

Sec. 5501. Expanding access to primary care services and general surgery services.      1,440

Sec. 5502. Medicare Federally qualified health center improvements.                          1,446

Sec. 5503. Distribution of additional residency positions.                                                   1,449

Sec. 5504. Counting resident time in outpatient settings and allowing flexibility      1,458

for jointly operated residency training programs.

Sec. 5505. Rules for counting resident time for didactic and scholarly activities      1,461

and other activities.

Sec. 5506. Preservation of resident cap positions from closed hospitals.                     1,465

Sec. 5507. Demonstration projects To address health professions workforce            1,469

needs; extension of family-to-family health information centers.

Sec. 5508. Increasing teaching capacity.                                                                                     1,485

Sec. 5509. Graduate nurse education demonstration.                                                           1,500

Subtitle G—Improving Access to Health Care Services 1,508

Sec. 5601. Spending for Federally Qualified Health Centers (FQHCs).                             1,508

Sec. 5602. Negotiated rulemaking for development of methodology and criteria     1,510

for designating medically underserved populations and health

professions shortage areas.

Sec. 5603. Reauthorization of the Wakefield Emergency Medical Services for            1,514

Children Program.

Sec. 5604. Co-locating primary and specialty care in community-based mental       1,515

health settings.

Sec. 5605. Key National indicators.                                                                                               1,518

Subtitle H—General Provisions 1,528

Sec. 5701. Reports.                                                                                                                               1,528

TITLE VI—TRANSPARENCY AND PROGRAM INTEGRITY 1,529

Subtitle A—Physician Ownership and Other Transparency 1,529

Sec. 6001. Limitation on Medicare exception to the prohibition

on certain physician referrals for hospitals.                                                                              1,529

12

Sec. 6002. Transparency reports and reporting of physician                                           1,542

ownership or investment interests.

Sec. 6003. Disclosure requirements for in-office ancillary services exception to      1,564

the prohibition on physician self-referral for certain imaging services.

Sec. 6004. Prescription drug sample transparency.                                                              1,564

Sec. 6005. Pharmacy benefit managers transparency requirements.                            1,567

Subtitle B—Nursing Home Transparency and Improvement 1,571

PART I—IMPROVING TRANSPARENCY OF INFORMATION 1,571

Sec. 6101. Required disclosure of ownership and additional disclosable parties             1,571

information.

Sec. 6102. Accountability requirements for skilled nursing facilities and nursing           1,579

facilities.

Sec. 6103. Nursing home compare Medicare website.                                                             1,585

Sec. 6104. Reporting of expenditures.                                                                                            1,603

Sec. 6105. Standardized complaint form.                                                                                      1,605

Sec. 6106. Ensuring staffing accountability.                                                                                 1,607

Sec. 6107. GAO study and report on Five-Star Quality Rating System.                            1,609

PART II—TARGETING ENFORCEMENT 1610

Sec. 6111. Civil money penalties.                                                                                                      1,610

Sec. 6112. National independent monitor demonstration project.                                    1,619

Sec. 6113. Notification of facility closure.                                                                                     1,625

Sec. 6114. National demonstration projects on culture change and use of information         1,628

technology in nursing homes.

PART III—IMPROVING STAFF TRAINING 1,630

Sec. 6121. Dementia and abuse prevention training.                                                                1,630

Subtitle C—Nationwide Program for National and State Background Checks              1,632

on Direct Patient Access Employees of Long-term Care Facilities and Providers

Sec. 6201. Nationwide program for National and State background checks on              1,632

direct patient access employees of long-term care facilities and

providers.

Subtitle D—Patient-Centered Outcomes Research 1,648

Sec. 6301. Patient-Centered Outcomes Research.                                                                    1,648

Sec. 6302. Federal coordinating council for comparative effectiveness research.    1,702

Subtitle E—Medicare, Medicaid, and CHIP Program Integrity Provisions 1,703

Sec. 6401. Provider screening and other enrollment requirements under Medicare,     1,703

Medicaid, and CHIP.

Sec. 6402. Enhanced Medicare and Medicaid program integrity provisions.                 1,720

Sec. 6403. Elimination of duplication between the Healthcare Integrity and                  1,747

Protection Data Bank and the National Practitioner Data

Bank.

Sec. 6404. Maximum period for submission of Medicare claims reduced to not             1,760

more than 12 months.

13

Sec. 6405. Physicians who order items or services required to be Medicare enrolled      1,762

physicians or eligible professionals.

Sec. 6406. Requirement for physicians to provide documentation on referrals to             1,764

programs at high risk of waste and abuse.

Sec. 6407. Face to face encounter with patient required before physicians may                1,765

certify eligibility for home health services or durable medical

equipment under Medicare.

Sec. 6408. Enhanced penalties.                                                                                                                 1,768

Sec. 6409. Medicare self-referral disclosure protocol.                                                                   1,773

Sec. 6410. Adjustments to the Medicare durable medical equipment, prosthetics,           1,775

orthotics, and supplies competitive acquisition program.

Sec. 6411. Expansion of the Recovery Audit Contractor (RAC) program.                              1,777

Subtitle F—Additional Medicaid Program Integrity Provisions 1,778

Sec. 6501. Termination of provider participation under Medicaid if terminated                1,783

under Medicare or other State plan.

Sec. 6502. Medicaid exclusion from participation relating to certain ownership,              1,783

control, and management affiliations.

Sec. 6503. Billing agents, clearinghouses, or other alternate payees required to                1,784

register under Medicaid.

Sec. 6504. Requirement to report expanded set of data elements under MMIS                   1,785

to detect fraud and abuse.

Sec. 6505. Prohibition on payments to institutions or entities located outside of              1,786

the United States.

Sec. 6506. Overpayments.                                                                                                                           1,786

Sec. 6507. Mandatory State use of national correct coding initiative.                                     1,788

Sec. 6508. General effective date.                                                                                                             1,790

Subtitle G—Additional Program Integrity Provisions 1,791

Sec. 6601. Prohibition on false statements and representations.                                                1,791

Sec. 6602. Clarifying definition.                                                                                                                 1,793

Sec. 6603. Development of model uniform report form.                                                                1,793

Sec. 6604. Applicability of State law to combat fraud and abuse.                                               1,794

Sec. 6605. Enabling the Department of Labor to issue administrative summary                 1,795

cease and desist orders and summary seizures orders against

plans that are in financially hazardous condition.

Sec. 6606. MEWA plan registration with Department of Labor.                                                  1,797

Sec. 6607. Permitting evidentiary privilege and confidential communications.                 1,797

Subtitle H—Elder Justice Act 1,798

Sec. 6701. Short title of subtitle.                                                                                                               1,798

Sec. 6702. Definitions.                                                                                                                                   1,799

Sec. 6703. Elder Justice.                                                                                                                              1,799

Subtitle I—Sense of the Senate Regarding Medical Malpractice                                                   1,858

Sec. 6801. Sense of the Senate regarding medical malpractice.                                                   1,858

TITLE VII—IMPROVING ACCESS TO INNOVATIVE MEDICAL                             1,859

THERAPIES

Subtitle A—Biologics Price Competition and Innovation 1,859

Sec. 7001. Short title.                                                                                                                                    1,859

Sec. 7002. Approval pathway for biosimilar biological products.                                            1,859

14

Sec. 7003. Savings.                                                                                                                                        1,906

Subtitle B—More Affordable Medicines for Children and Underserved            1,906

Communities

Sec. 7101. Expanded participation in 340B program.                                                                    1,906

Sec. 7102. Improvements to 340B program integrity.                                                                  1,913

Sec. 7103. GAO study to make recommendations on improving the 340B program.       1,924

TITLE VIII—CLASS ACT 1,925

Sec. 8001. Short title of title.                                                                                                                     1,925

Sec. 8002. Establishment of national voluntary insurance program for purchasing        1,925

community living assistance services and support.

TITLE IX—REVENUE PROVISIONS 1,979

Subtitle A—Revenue Offset Provisions 1,979

Sec. 9001. Excise tax on high cost employer-sponsored health coverage.                           1,979

Sec. 9002. Inclusion of cost of employer-sponsored health coverage on W–2.                  1,996

Sec. 9003. Distributions for medicine qualified only if for prescribed drug or insulin.     1,997

Sec. 9004. Increase in additional tax on distributions from HSAs and Archer                     1,998

MSAs not used for qualified medical expenses.

Sec. 9005. Limitation on health flexible spending arrangements under cafeteria              1,999

plans.

Sec. 9006. Expansion of information reporting requirements.                                                    1,999

Sec. 9007. Additional requirements for charitable hospitals.                                                       2,001

Sec. 9008. Imposition of annual fee on branded prescription pharmaceutical                     2,010

manufacturers and importers.

Sec. 9009. Imposition of annual fee on medical device manufacturers and importers.        2,020

Sec. 9010. Imposition of annual fee on health insurance providers.                                          2,026

Sec. 9011. Study and report of effect on veterans health care.                                                      2,033

Sec. 9012. Elimination of deduction for expenses allocable to Medicare Part D                    2,034

subsidy.

Sec. 9013. Modification of itemized deduction for medical expenses.                                       2,034

Sec. 9014. Limitation on excessive remuneration paid by certain health insurance           2,035

providers.

Sec. 9015. Additional hospital insurance tax on high-income taxpayers.                                2,040

Sec. 9016. Modification of section 833 treatment of certain health organizations.              2,044

Sec. 9017. Excise tax on elective cosmetic medical procedures.                                                 2,045

Subtitle B—Other Provisions 2,047

Sec. 9021. Exclusion of health benefits provided by Indian tribal governments.                  2,047

Sec. 9022. Establishment of simple cafeteria plans for small businesses.                                  2,050

Sec. 9023. Qualifying therapeutic discovery project credit                                                            2,057

(Note – Page 2074 is the last page of the document.)

(11/19/09)

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Text of HR 3590: http://democrats.senate.gov/reform/patient-protection-affordable-care-act.pdf