Professional Documents
Culture Documents
3590
An Act
Entitled The Patient Protection and Affordable Care Act.
(d) REQUIREMENTS.
(1) IN GENERAL.An Exchange shall be a governmental
agency or nonprofit entity that is established by a State.
(2) OFFERING OF COVERAGE.
(A) IN GENERAL.An Exchange shall make available
qualified health plans to qualified individuals and qualified
employers.
(B) LIMITATION.
(i) IN GENERAL.An Exchange may not make
available any health plan that is not a qualified health
plan.
(ii) OFFERING OF STAND-ALONE DENTAL BENEFITS.
Each Exchange within a State shall allow an issuer
of a plan that only provides limited scope dental bene-
fits meeting the requirements of section 9832(c)(2)(A)
of the Internal Revenue Code of 1986 to offer the
plan through the Exchange (either separately or in
conjunction with a qualified health plan) if the plan
provides pediatric dental benefits meeting the require-
ments of section 1302(b)(1)(J)).
(3) RULES RELATING TO ADDITIONAL REQUIRED BENEFITS.
(A) IN GENERAL.Except as provided in subparagraph
(B), an Exchange may make available a qualified health
plan notwithstanding any provision of law that may require
benefits other than the essential health benefits specified
under section 1302(b).
(B) STATES MAY REQUIRE ADDITIONAL BENEFITS.
(i) IN GENERAL.Subject to the requirements of
clause (ii), a State may require that a qualified health
plan offered in such State offer benefits in addition
to the essential health benefits specified under section
1302(b).
(ii) STATE MUST ASSUME COST.A State shall make
payments to or on behalf of an individual eligible for
the premium tax credit under section 36B of the
Internal Revenue Code of 1986 and any cost-sharing
reduction under section 1402 to defray the cost to
the individual of any additional benefits described in
clause (i) which are not eligible for such credit or
reduction under section 36B(b)(3)(D) of such Code and
section 1402(c)(4).
(4) FUNCTIONS.An Exchange shall, at a minimum
(A) implement procedures for the certification, recertifi-
cation, and decertification, consistent with guidelines devel-
oped by the Secretary under subsection (c), of health plans
as qualified health plans;
(B) provide for the operation of a toll-free telephone
hotline to respond to requests for assistance;
(C) maintain an Internet website through which
enrollees and prospective enrollees of qualified health plans
may obtain standardized comparative information on such
plans;
(D) assign a rating to each qualified health plan offered
through such Exchange in accordance with the criteria
developed by the Secretary under subsection (c)(3);
(E) utilize a standardized format for presenting health
benefits plan options in the Exchange, including the use
H. R. 359059
1412 and not the taxable year for which the credit under
section 36B of such Code is allowed.
Subpart BEligibility Determinations
SEC. 1411. PROCEDURES FOR DETERMINING ELIGIBILITY FOR
EXCHANGE PARTICIPATION, PREMIUM TAX CREDITS AND
REDUCED COST-SHARING, AND INDIVIDUAL RESPONSI-
BILITY EXEMPTIONS.
(a) ESTABLISHMENT OF PROGRAM.The Secretary shall estab-
lish a program meeting the requirements of this section for deter-
mining
(1) whether an individual who is to be covered in the
individual market by a qualified health plan offered through
an Exchange, or who is claiming a premium tax credit or
reduced cost-sharing, meets the requirements of sections
1312(f)(3), 1402(e), and 1412(d) of this title and section 36B(e)
of the Internal Revenue Code of 1986 that the individual be
a citizen or national of the United States or an alien lawfully
present in the United States;
(2) in the case of an individual claiming a premium tax
credit or reduced cost-sharing under section 36B of such Code
or section 1402
(A) whether the individual meets the income and cov-
erage requirements of such sections; and
(B) the amount of the tax credit or reduced cost-
sharing;
(3) whether an individuals coverage under an employer-
sponsored health benefits plan is treated as unaffordable under
sections 36B(c)(2)(C) and 5000A(e)(2); and
(4) whether to grant a certification under section
1311(d)(4)(H) attesting that, for purposes of the individual
responsibility requirement under section 5000A of the Internal
Revenue Code of 1986, an individual is entitled to an exemption
from either the individual responsibility requirement or the
penalty imposed by such section.
(b) INFORMATION REQUIRED TO BE PROVIDED BY APPLICANTS.
(1) IN GENERAL.An applicant for enrollment in a qualified
health plan offered through an Exchange in the individual
market shall provide
(A) the name, address, and date of birth of each indi-
vidual who is to be covered by the plan (in this subsection
referred to as an enrollee); and
(B) the information required by any of the following
paragraphs that is applicable to an enrollee.
(2) CITIZENSHIP OR IMMIGRATION STATUS.The following
information shall be provided with respect to every enrollee:
(A) In the case of an enrollee whose eligibility is based
on an attestation of citizenship of the enrollee, the enrollees
social security number.
(B) In the case of an individual whose eligibility is
based on an attestation of the enrollees immigration status,
the enrollees social security number (if applicable) and
such identifying information with respect to the enrollees
immigration status as the Secretary, after consultation
with the Secretary of Homeland Security, determines
appropriate.
H. R. 3590107
(3) Based on CBO estimates, this Act will extend the sol-
vency of the Medicare HI Trust Fund.
(4) This Act will increase the surplus in the Social Security
Trust Fund, which should be reserved to strengthen the
finances of Social Security.
(5) The initial net savings generated by the Community
Living Assistance Services and Supports (CLASS) program are
necessary to ensure the long-term solvency of that program.
(b) SENSE OF THE SENATE.It is the sense of the Senate that
(1) the additional surplus in the Social Security Trust
Fund generated by this Act should be reserved for Social Secu-
rity and not spent in this Act for other purposes; and
(2) the net savings generated by the CLASS program should
be reserved for the CLASS program and not spent in this
Act for other purposes.
for the fiscal year without regard to this subsection and sub-
section (y), is less than the Federal medical assistance percent-
age determined for the State for the preceding fiscal year
under this subsection.
(2) In this subsection, the term disaster-recovery FMAP
adjustment State means a State that is one of the 50 States
or the District of Columbia, for which, at any time during the
preceding 7 fiscal years, the President has declared a major disaster
under section 401 of the Robert T. Stafford Disaster Relief and
Emergency Assistance Act and determined as a result of such
disaster that every county or parish in the State warrant individual
and public assistance or public assistance from the Federal Govern-
ment under such Act and for which
(A) in the case of the first fiscal year (or part of a fiscal
year) for which this subsection applies to the State, the Federal
medical assistance percentage determined for the State for
the fiscal year without regard to this subsection and subsection
(y), is less than the Federal medical assistance percentage
determined for the State for the preceding fiscal year after
the application of only subsection (a) of section 5001 of Public
Law 1115 (if applicable to the preceding fiscal year) and
without regard to this subsection, subsection (y), and sub-
sections (b) and (c) of section 5001 of Public Law 1115, by
at least 3 percentage points; and
(B) in the case of the second or any succeeding fiscal
year for which this subsection applies to the State, the Federal
medical assistance percentage determined for the State for
the fiscal year without regard to this subsection and subsection
(y), is less than the Federal medical assistance percentage
determined for the State for the preceding fiscal year under
this subsection by at least 3 percentage points.
(3) The Federal medical assistance percentage determined for
a disaster-recovery FMAP adjustment State under paragraph (1)
shall apply for purposes of this title (other than with respect to
disproportionate share hospital payments described in section 1923
and payments under this title that are based on the enhanced
FMAP described in 2105(b)) and shall not apply with respect to
payments under title IV (other than under part E of title IV)
or payments under title XXI..
SEC. 2007. MEDICAID IMPROVEMENT FUND RESCISSION.
(a) RESCISSION.Any amounts available to the Medicaid
Improvement Fund established under section 1941 of the Social
Security Act (42 U.S.C. 1396w1) for any of fiscal years 2014
through 2018 that are available for expenditure from the Fund
and that are not so obligated as of the date of the enactment
of this Act are rescinded.
(b) CONFORMING AMENDMENTS.Section 1941(b)(1) of the Social
Security Act (42 U.S.C. 1396w1(b)(1)) is amended
(1) in subparagraph (A), by striking $100,000,000 and
inserting $0; and
(2) in subparagraph (B), by striking $150,000,000 and
inserting $0.
H. R. 3590168
occurs after fiscal year 2012 for which the Secretary deter-
mines, on the basis of the most recent American Commu-
nity Survey of the Bureau of the Census, that the percent-
age of uncovered individuals residing in the State is at
least 45 percent less than the percentage of such individ-
uals determined for the State for fiscal year 2009.
(D) EXCLUSION OF PORTIONS DIVERTED FOR COVERAGE
EXPANSIONS.For purposes of applying the applicable
percentage reduction under subparagraph (A) to the DSH
allotment for a State for a fiscal year, the DSH allotment
for a State that would be determined under this subsection
for the State for the fiscal year without the application
of this paragraph (and prior to any such reduction) shall
not include any portion of the allotment for which the
Secretary has approved the States diversion to the costs
of providing medical assistance or other health benefits
coverage under a waiver that is in effect on July 2009.
(E) MINIMUM ALLOTMENT.In no event shall the DSH
allotment determined for a State in accordance with this
paragraph for fiscal year 2013 or any succeeding fiscal
year be less than the amount equal to 35 percent of the
DSH allotment determined for the State for fiscal year
2012 under this subsection (and after the application of
this paragraph, if applicable), increased by the percentage
change in the consumer price index for all urban consumers
(all items, U.S. city average) for each previous fiscal year
occurring before the fiscal year.
(F) UNCOVERED INDIVIDUALS.In this paragraph, the
term uncovered individuals means individuals with no
health insurance coverage at any time during a year (as
determined by the Secretary based on the most recent
data available)..
(b) EFFECTIVE DATE.The amendments made by subsection
(a) take effect on October 1, 2011.
if their care had not been subject to payment under the dem-
onstration project.
(5) Hospitals participating in the demonstration project
shall have or establish robust discharge planning programs
to ensure that Medicaid beneficiaries requiring post-acute care
are appropriately placed in, or have ready access to, post-
acute care settings.
(6) The Secretary and each State selected to participate
in the demonstration project shall ensure that the demonstra-
tion project does not result in the Medicaid beneficiaries whose
care is subject to payment under the demonstration project
being provided with less items and services for which medical
assistance is provided under the State Medicaid program than
the items and services for which medical assistance would
have been provided to such beneficiaries under the State Med-
icaid program in the absence of the demonstration project.
(c) WAIVER OF PROVISIONS.Notwithstanding section 1115(a)
of the Social Security Act (42 U.S.C. 1315(a)), the Secretary may
waive such provisions of titles XIX, XVIII, and XI of that Act
as may be necessary to accomplish the goals of the demonstration,
ensure beneficiary access to acute and post-acute care, and maintain
quality of care.
(d) EVALUATION AND REPORT.
(1) DATA.Each State selected to participate in the dem-
onstration project under this section shall provide to the Sec-
retary, in such form and manner as the Secretary shall specify,
relevant data necessary to monitor outcomes, costs, and quality,
and evaluate the rationales for selection of the episodes of
care and services specified by States under subsection (b)(3).
(2) REPORT.Not later than 1 year after the conclusion
of the demonstration project, the Secretary shall submit a report
to Congress on the results of the demonstration project.
SEC. 2705. MEDICAID GLOBAL PAYMENT SYSTEM DEMONSTRATION
PROJECT.
(a) IN GENERAL.The Secretary of Health and Human Services
(referred to in this section as the Secretary) shall, in coordination
with the Center for Medicare and Medicaid Innovation (as estab-
lished under section 1115A of the Social Security Act, as added
by section 3021 of this Act), establish the Medicaid Global Payment
System Demonstration Project under which a participating State
shall adjust the payments made to an eligible safety net hospital
system or network from a fee-for-service payment structure to a
global capitated payment model.
(b) DURATION AND SCOPE.The demonstration project con-
ducted under this section shall operate during a period of fiscal
years 2010 through 2012. The Secretary shall select not more than
5 States to participate in the demonstration project.
(c) ELIGIBLE SAFETY NET HOSPITAL SYSTEM OR NETWORK.
For purposes of this section, the term eligible safety net hospital
system or network means a large, safety net hospital system or
network (as defined by the Secretary) that operates within a State
selected by the Secretary under subsection (b).
(d) EVALUATION.
(1) TESTING.The Innovation Center shall test and
evaluate the demonstration project conducted under this section
H. R. 3590207
(B) APPLICATION.
(i) PHYSICIAN REPORTING SYSTEM RULES.Para-
graphs (5), (6), and (8) of subsection (k) shall apply
for purposes of this paragraph in the same manner
as they apply for purposes of such subsection.
(ii) INCENTIVE PAYMENT VALIDATION RULES.
Clauses (ii) and (iii) of subsection (m)(5)(D) shall apply
for purposes of this paragraph in a similar manner
as they apply for purposes of such subsection.
(C) DEFINITIONS.For purposes of this paragraph:
(i) ELIGIBLE PROFESSIONAL; COVERED PROFES-
SIONAL SERVICES.The terms eligible professional and
covered professional services have the meanings given
such terms in subsection (k)(3).
(ii) PHYSICIAN REPORTING SYSTEM.The term
physician reporting system means the system estab-
lished under subsection (k).
(iii) QUALITY REPORTING PERIOD.The term
quality reporting period means, with respect to a year,
a period specified by the Secretary..
(c) MAINTENANCE OF CERTIFICATION PROGRAMS.
(1) IN GENERAL.Section 1848(k)(4) of the Social Security
Act (42 U.S.C. 1395w4(k)(4)) is amended by inserting or
through a Maintenance of Certification program operated by
a specialty body of the American Board of Medical Specialties
that meets the criteria for such a registry after Database).
(2) EFFECTIVE DATE.The amendment made by paragraph
(1) shall apply for years after 2010.
(d) INTEGRATION OF PHYSICIAN QUALITY REPORTING AND EHR
REPORTING.Section 1848(m) of the Social Security Act (42 U.S.C.
1395w4(m)) is amended by adding at the end the following new
paragraph:
(7) INTEGRATION OF PHYSICIAN QUALITY REPORTING AND
EHR REPORTING.Not later than January 1, 2012, the Secretary
shall develop a plan to integrate reporting on quality measures
under this subsection with reporting requirements under sub-
section (o) relating to the meaningful use of electronic health
records. Such integration shall consist of the following:
(A) The selection of measures, the reporting of which
would both demonstrate
(i) meaningful use of an electronic health record
for purposes of subsection (o); and
(ii) quality of care furnished to an individual.
(B) Such other activities as specified by the Sec-
retary..
(e) FEEDBACK.Section 1848(m)(5) of the Social Security Act
(42 U.S.C. 1395w4(m)(5)) is amended by adding at the end the
following new subparagraph:
(H) FEEDBACK.The Secretary shall provide timely
feedback to eligible professionals on the performance of
the eligible professional with respect to satisfactorily
submitting data on quality measures under this sub-
section..
(f) APPEALS.Such section is further amended
(1) in subparagraph (E), by striking There shall and
inserting Except as provided in subparagraph (I), there shall;
and
H. R. 3590248
the Administrator) for use under this Act. In developing such meas-
ures, the Administrator shall consult with the Director of the
Agency for Healthcare Research and Quality..
(c) FUNDING.There are authorized to be appropriated to the
Secretary of Health and Human Services to carry out this section,
$75,000,000 for each of fiscal years 2010 through 2014. Of the
amounts appropriated under the preceding sentence in a fiscal
year, not less than 50 percent of such amounts shall be used
pursuant to subsection (e) of section 1890A of the Social Security
Act, as added by subsection (b), with respect to programs under
such Act. Amounts appropriated under this subsection for a fiscal
year shall remain available until expended.
SEC. 3014. QUALITY MEASUREMENT.
(a) NEW DUTIES FOR CONSENSUS-BASED ENTITY.
(1) MULTI-STAKEHOLDER GROUP INPUT.Section 1890(b) of
the Social Security Act (42 U.S.C. 1395aaa(b)), as amended
by section 3003, is amended by adding at the end the following
new paragraphs:
(7) CONVENING MULTI-STAKEHOLDER GROUPS.
(A) IN GENERAL.The entity shall convene multi-
stakeholder groups to provide input on
(i) the selection of quality measures described in
subparagraph (B), from among
(I) such measures that have been endorsed
by the entity; and
(II) such measures that have not been consid-
ered for endorsement by such entity but are used
or proposed to be used by the Secretary for the
collection or reporting of quality measures; and
(ii) national priorities (as identified under section
399HH of the Public Health Service Act) for improve-
ment in population health and in the delivery of health
care services for consideration under the national
strategy established under section 399HH of the Public
Health Service Act.
(B) QUALITY MEASURES.
(i) IN GENERAL.Subject to clause (ii), the quality
measures described in this subparagraph are quality
measures
(I) for use pursuant to sections 1814(i)(5)(D),
1833(i)(7), 1833(t)(17), 1848(k)(2)(C), 1866(k)(3),
1881(h)(2)(A)(iii), 1886(b)(3)(B)(viii), 1886(j)(7)(D),
1886(m)(5)(D), 1886(o)(2), and 1895(b)(3)(B)(v);
(II) for use in reporting performance informa-
tion to the public; and
(III) for use in health care programs other
than for use under this Act.
(ii) EXCLUSION.Data sets (such as the outcome
and assessment information set for home health serv-
ices and the minimum data set for skilled nursing
facility services) that are used for purposes of classifica-
tion systems used in establishing payment rates under
this title shall not be quality measures described in
this subparagraph.
(C) REQUIREMENT FOR TRANSPARENCY IN PROCESS.
H. R. 3590267
QUALITY MEASUREMENT
(2) LIMITATION.
(A) IN GENERAL.Subject to subparagraph (B), in pro-
viding for such implementation, the Secretary shall not
receive or distribute any funds of a manufacturer under
the program.
(B) EXCEPTION.The limitation under subparagraph
(A) shall not apply to the Secretary with respect to drugs
dispensed during the period beginning on July 1, 2010,
and ending on December 31, 2010, but only if the Secretary
determines that the exception to such limitation under
this subparagraph is necessary in order for the Secretary
to begin implementation of this section and provide
applicable beneficiaries timely access to discounted prices
during such period.
(3) CONTRACT WITH THIRD PARTIES.The Secretary shall
enter into a contract with 1 or more third parties to administer
the requirements established by the Secretary in order to carry
out this section. At a minimum, the contract with a third
party under the preceding sentence shall require that the third
party
(A) receive and transmit information between the Sec-
retary, manufacturers, and other individuals or entities
the Secretary determines appropriate;
(B) receive, distribute, or facilitate the distribution
of funds of manufacturers to appropriate individuals or
entities in order to meet the obligations of manufacturers
under agreements under this section;
(C) provide adequate and timely information to manu-
facturers, consistent with the agreement with the manufac-
turer under this section, as necessary for the manufacturer
to fulfill its obligations under this section; and
(D) permit manufacturers to conduct periodic audits,
directly or through contracts, of the data and information
used by the third party to determine discounts for
applicable drugs of the manufacturer under the program.
(4) PERFORMANCE REQUIREMENTS.The Secretary shall
establish performance requirements for a third party with a
contract under paragraph (3) and safeguards to protect the
independence and integrity of the activities carried out by the
third party under the program under this section.
(5) IMPLEMENTATION.The Secretary may implement the
program under this section by program instruction or otherwise.
(6) ADMINISTRATION.Chapter 35 of title 44, United States
Code, shall not apply to the program under this section.
(e) ENFORCEMENT.
(1) AUDITS.Each manufacturer with an agreement in
effect under this section shall be subject to periodic audit by
the Secretary.
(2) CIVIL MONEY PENALTY.
(A) IN GENERAL.The Secretary shall impose a civil
money penalty on a manufacturer that fails to provide
applicable beneficiaries discounts for applicable drugs of
the manufacturer in accordance with such agreement for
each such failure in an amount the Secretary determines
is commensurate with the sum of
H. R. 3590348
assistance for such services and vaccines and for items and
services described in subsection (a)(4)(D).
(c) EFFECTIVE DATE.The amendments made under this section
shall take effect on January 1, 2013.
SEC. 4107. COVERAGE OF COMPREHENSIVE TOBACCO CESSATION
SERVICES FOR PREGNANT WOMEN IN MEDICAID.
(a) REQUIRING COVERAGE OF COUNSELING AND
PHARMACOTHERAPY FOR CESSATION OF TOBACCO USE BY PREGNANT
WOMEN.Section 1905 of the Social Security Act (42 U.S.C. 1396d),
as amended by sections 2001(a)(3)(B) and 2303, is further
amended
(1) in subsection (a)(4)
(A) by striking and before (C); and
(B) by inserting before the semicolon at the end the
following new subparagraph: ; and (D) counseling and
pharmacotherapy for cessation of tobacco use by pregnant
women (as defined in subsection (bb)); and
(2) by adding at the end the following:
(bb)(1) For purposes of this title, the term counseling and
pharmacotherapy for cessation of tobacco use by pregnant women
means diagnostic, therapy, and counseling services and
pharmacotherapy (including the coverage of prescription and non-
prescription tobacco cessation agents approved by the Food and
Drug Administration) for cessation of tobacco use by pregnant
women who use tobacco products or who are being treated for
tobacco use that is furnished
(A) by or under the supervision of a physician; or
(B) by any other health care professional who
(i) is legally authorized to furnish such services under
State law (or the State regulatory mechanism provided
by State law) of the State in which the services are fur-
nished; and
(ii) is authorized to receive payment for other services
under this title or is designated by the Secretary for this
purpose.
(2) Subject to paragraph (3), such term is limited to
(A) services recommended with respect to pregnant women
in Treating Tobacco Use and Dependence: 2008 Update: A
Clinical Practice Guideline, published by the Public Health
Service in May 2008, or any subsequent modification of such
Guideline; and
(B) such other services that the Secretary recognizes to
be effective for cessation of tobacco use by pregnant women.
(3) Such term shall not include coverage for drugs or biologicals
that are not otherwise covered under this title..
(b) EXCEPTION FROM OPTIONAL RESTRICTION UNDER MEDICAID
PRESCRIPTION DRUG COVERAGE.Section 1927(d)(2)(F) of the Social
Security Act (42 U.S.C. 1396r8(d)(2)(F)), as redesignated by section
2502(a), is amended by inserting before the period at the end
the following: , except, in the case of pregnant women when rec-
ommended in accordance with the Guideline referred to in section
1905(bb)(2)(A), agents approved by the Food and Drug Administra-
tion under the over-the-counter monograph process for purposes
of promoting, and when used to promote, tobacco cessation.
H. R. 3590443
(2) MEMBERSHIP.
(A) IN GENERAL.The Committee shall be composed
of the following voting members:
(i) Not more than 7 voting Federal representatives
appoint by the Secretary from agencies that conduct
pain care research and treatment.
(ii) 12 additional voting members appointed under
subparagraph (B).
(B) ADDITIONAL MEMBERS.The Committee shall
include additional voting members appointed by the Sec-
retary as follows:
(i) 6 non-Federal members shall be appointed from
among scientists, physicians, and other health profes-
sionals.
(ii) 6 members shall be appointed from members
of the general public, who are representatives of
leading research, advocacy, and service organizations
for individuals with pain-related conditions.
(C) NONVOTING MEMBERS.The Committee shall
include such nonvoting members as the Secretary deter-
mines to be appropriate.
(3) CHAIRPERSON.The voting members of the Committee
shall select a chairperson from among such members. The
selection of a chairperson shall be subject to the approval
of the Director of NIH.
(4) MEETINGS.The Committee shall meet at the call of
the chairperson of the Committee or upon the request of the
Director of NIH, but in no case less often than once each
year.
(5) DUTIES.The Committee shall
(A) develop a summary of advances in pain care
research supported or conducted by the Federal agencies
relevant to the diagnosis, prevention, and treatment of
pain and diseases and disorders associated with pain;
(B) identify critical gaps in basic and clinical research
on the symptoms and causes of pain;
(C) make recommendations to ensure that the activi-
ties of the National Institutes of Health and other Federal
agencies are free of unnecessary duplication of effort;
(D) make recommendations on how best to dissemi-
nate information on pain care; and
(E) make recommendations on how to expand partner-
ships between public entities and private entities to expand
collaborative, cross-cutting research.
(6) REVIEW.The Secretary shall review the necessity of
the Committee at least once every 2 years..
(c) PAIN CARE EDUCATION AND TRAINING.Part D of title VII
of the Public Health Service Act (42 U.S.C. 294 et seq.) is amended
by adding at the end the following new section:
SEC. 759. PROGRAM FOR EDUCATION AND TRAINING IN PAIN CARE.
(a) IN GENERAL.The Secretary may make awards of grants,
cooperative agreements, and contracts to health professions schools,
hospices, and other public and private entities for the development
and implementation of programs to provide education and training
to health care professionals in pain care.
H. R. 3590469
year 2010, and such sums as may be necessary for each of fiscal
years 2011 through 2015..
SEC. 5205. ALLIED HEALTH WORKFORCE RECRUITMENT AND RETEN-
TION PROGRAMS.
(a) PURPOSE.The purpose of this section is to assure an ade-
quate supply of allied health professionals to eliminate critical
allied health workforce shortages in Federal, State, local, and tribal
public health agencies or in settings where patients might require
health care services, including acute care facilities, ambulatory
care facilities, personal residences and other settings, as recognized
by the Secretary of Health and Human Services by authorizing
an Allied Health Loan Forgiveness Program.
(b) ALLIED HEALTH WORKFORCE RECRUITMENT AND RETENTION
PROGRAM.Section 428K of the Higher Education Act of 1965 (20
U.S.C. 107811) is amended
(1) in subsection (b), by adding at the end the following:
(18) ALLIED HEALTH PROFESSIONALS.The individual is
employed full-time as an allied health professional
(A) in a Federal, State, local, or tribal public health
agency; or
(B) in a setting where patients might require health
care services, including acute care facilities, ambulatory
care facilities, personal residences and other settings
located in health professional shortage areas, medically
underserved areas, or medically underserved populations,
as recognized by the Secretary of Health and Human Serv-
ices.; and
(2) in subsection (g)
(A) by redesignating paragraphs (1) through (9) as
paragraphs (2) through (10), respectively; and
(B) by inserting before paragraph (2) (as redesignated
by subparagraph (A)) the following:
(1) ALLIED HEALTH PROFESSIONAL.The term allied health
professional means an allied health professional as defined
in section 799B(5) of the Public Heath Service Act (42 U.S.C.
295p(5)) who
(A) has graduated and received an allied health profes-
sions degree or certificate from an institution of higher
education; and
(B) is employed with a Federal, State, local or tribal
public health agency, or in a setting where patients might
require health care services, including acute care facilities,
ambulatory care facilities, personal residences and other
settings located in health professional shortage areas, medi-
cally underserved areas, or medically underserved popu-
lations, as recognized by the Secretary of Health and
Human Services..
SEC. 5206. GRANTS FOR STATE AND LOCAL PROGRAMS.
(a) IN GENERAL.Section 765(d) of the Public Health Service
Act (42 U.S.C. 295(d)) is amended
(1) in paragraph (7), by striking ; or and inserting a
semicolon;
(2) by redesignating paragraph (8) as paragraph (9); and
(3) by inserting after paragraph (7) the following:
(8) public health workforce loan repayment programs; or.
H. R. 3590494
SEC. 1182. (a) The Secretary may only use evidence and
findings from research conducted under section 1181 to make a
determination regarding coverage under title XVIII if such use
is through an iterative and transparent process which includes
public comment and considers the effect on subpopulations.
(b) Nothing in section 1181 shall be construed as
(1) superceding or modifying the coverage of items or
services under title XVIII that the Secretary determines are
reasonable and necessary under section 1862(l)(1); or
(2) authorizing the Secretary to deny coverage of items
or services under such title solely on the basis of comparative
clinical effectiveness research.
(c)(1) The Secretary shall not use evidence or findings from
comparative clinical effectiveness research conducted under section
1181 in determining coverage, reimbursement, or incentive pro-
grams under title XVIII in a manner that treats extending the
life of an elderly, disabled, or terminally ill individual as of lower
value than extending the life of an individual who is younger,
nondisabled, or not terminally ill.
(2) Paragraph (1) shall not be construed as preventing the
Secretary from using evidence or findings from such comparative
clinical effectiveness research in determining coverage, reimburse-
ment, or incentive programs under title XVIII based upon a
comparison of the difference in the effectiveness of alternative treat-
ments in extending an individuals life due to the individuals age,
disability, or terminal illness.
(d)(1) The Secretary shall not use evidence or findings from
comparative clinical effectiveness research conducted under section
1181 in determining coverage, reimbursement, or incentive pro-
grams under title XVIII in a manner that precludes, or with the
intent to discourage, an individual from choosing a health care
treatment based on how the individual values the tradeoff between
extending the length of their life and the risk of disability.
(2)(A) Paragraph (1) shall not be construed to
H. R. 3590623
at any time in such form and manner as the Secretary and the
Secretary of the Treasury shall prescribe.
(c) INDIVIDUAL DESCRIBED.For purposes of enrolling in the
CLASS program, an individual described in this paragraph is an
individual
(1) who has attained age 18;
(2) who
(A) receives wages on which there is imposed a tax
under section 3201(a) of the Internal Revenue Code of
1986; or
(B) derives self-employment income on which there
is imposed a tax under section 1401(a) of the Internal
Revenue Code of 1986;
(3) who is actively employed; and
(4) who is not
(A) a patient in a hospital or nursing facility, an
intermediate care facility for the mentally retarded, or
an institution for mental diseases and receiving medical
assistance under Medicaid; or
(B) confined in a jail, prison, other penal institution
or correctional facility, or by court order pursuant to convic-
tion of a criminal offense or in connection with a verdict
or finding described in section 202(x)(1)(A)(ii) of the Social
Security Act (42 U.S.C. 402(x)(1)(A)(ii)).
(d) RULE OF CONSTRUCTION.Nothing in this title shall be
construed as requiring an active enrollee to continue to satisfy
subparagraph (B) or (C) of subsection (c)(1) in order to maintain
enrollment in the CLASS program.
(e) PAYMENT.
(1) PAYROLL DEDUCTION.An amount equal to the monthly
premium for the enrollment in the CLASS program of an indi-
vidual shall be deducted from the wages or self-employment
income of such individual in accordance with such procedures
as the Secretary, in coordination with the Secretary of the
Treasury, shall establish for employers who elect to deduct
and withhold such premiums on behalf of enrolled employees.
(2) ALTERNATIVE PAYMENT MECHANISM.The Secretary,
in coordination with the Secretary of the Treasury, shall estab-
lish alternative procedures for the payment of monthly pre-
miums by an individual enrolled in the CLASS program
(A) who does not have an employer who elects to
deduct and withhold premiums in accordance with subpara-
graph (A); or
(B) who does not earn wages or derive self-employ-
ment income.
(f) TRANSFER OF PREMIUMS COLLECTED.
(1) IN GENERAL.During each calendar year the Secretary
of the Treasury shall deposit into the CLASS Independence
Fund a total amount equal, in the aggregate, to 100 percent
of the premiums collected during that year.
(2) TRANSFERS BASED ON ESTIMATES.The amount depos-
ited pursuant to paragraph (1) shall be transferred in at least
monthly payments to the CLASS Independence Fund on the
basis of estimates by the Secretary and certified to the Sec-
retary of the Treasury of the amounts collected in accordance
with subparagraphs (A) and (B) of paragraph (5). Proper adjust-
ments shall be made in amounts subsequently transferred to
H. R. 3590718
The percentage of
With respect to a covered entitys net pre- net premiums writ-
miums written during the calendar year that ten that are taken
are: into account is:
The percentage of
With respect to a covered entitys third party third party admin-
administration agreement fees during the istration agreement
calendar year that are: fees that are taken
into account is:
such tax is not collected, such tax shall be paid by the person
who performs the procedure..
(b) CLERICAL AMENDMENT.The table of chapters for subtitle
D of the Internal Revenue Code of 1986, as amended by this
Act, is amended by inserting after the item relating to chapter
48 the following new item:
CHAPTER 49ELECTIVE COSMETIC MEDICAL PROCEDURES.
(c) EFFECTIVE DATE.The amendments made by this section
shall apply to procedures performed on or after January 1, 2010.
are lower than 3:1, the State may require that Exchanges
operating in such State only permit the offering of such multi-
State qualified health plans if such plans comply with the
States more protective age rating requirements.
(d) PLANS DEEMED TO BE CERTIFIED.A multi-State qualified
health plan that is offered under a contract under subsection (a)
shall be deemed to be certified by an Exchange for purposes of
section 1311(d)(4)(A).
(e) PHASE-IN.Notwithstanding paragraphs (1) and (2) of sub-
section (b), the Director shall enter into a contract with a health
insurance issuer for the offering of a multi-State qualified health
plan under subsection (a) if
(1) with respect to the first year for which the issuer
offers such plan, such issuer offers the plan in at least 60
percent of the States;
(2) with respect to the second such year, such issuer
offers the plan in at least 70 percent of the States;
(3) with respect to the third such year, such issuer offers
the plan in at least 85 percent of the States; and
(4) with respect to each subsequent year, such issuer
offers the plan in all States.
(f) APPLICABILITY.The requirements under chapter 89 of title
5, United States Code, applicable to health benefits plans under
such chapter shall apply to multi-State qualified health plans pro-
vided for under this section to the extent that such requirements
do not conflict with a provision of this title.
(g) CONTINUED SUPPORT FOR FEHBP.
(1) MAINTENANCE OF EFFORT.Nothing in this section
shall be construed to permit the Director to allocate fewer
financial or personnel resources to the functions of the Office
of Personnel Management related to the administration of the
Federal Employees Health Benefit Program under chapter 89
of title 5, United States Code.
(2) SEPARATE RISK POOL.Enrollees in multi-State quali-
fied health plans under this section shall be treated as a
separate risk pool apart from enrollees in the Federal
Employees Health Benefit Program under chapter 89 of title
5, United States Code.
(3) AUTHORITY TO ESTABLISH SEPARATE ENTITIES.The
Director may establish such separate units or offices within
the Office of Personnel Management as the Director determines
to be appropriate to ensure that the administration of multi-
State qualified health plans under this section does not inter-
fere with the effective administration of the Federal Employees
Health Benefit Program under chapter 89 of title 5, United
States Code.
(4) EFFECTIVE OVERSIGHT.The Director may appoint such
additional personnel as may be necessary to enable the Director
to carry out activities under this section.
(5) ASSURANCE OF SEPARATE PROGRAM.In carrying out
this section, the Director shall ensure that the program under
this section is separate from the Federal Employees Health
Benefit Program under chapter 89 of title 5, United States
Code. Premiums paid for coverage under a multi-State qualified
health plan under this section shall not be considered to be
Federal funds for any purposes.
H. R. 3590788
(d) Section 738(a)(3) of the Public Health Service Act (42 U.S.C.
293b(a)(3)) is amended by inserting schools offering physician
assistant education programs, after public health,.
(e) Subtitle D of title V of this Act is amended by adding
at the end the following:
SEC. 5316. DEMONSTRATION GRANTS FOR FAMILY NURSE PRACTI-
TIONER TRAINING PROGRAMS.
(a) ESTABLISHMENT OF PROGRAM.The Secretary of Health
and Human Services (referred to in this section as the Secretary)
shall establish a training demonstration program for family nurse
practitioners (referred to in this section as the program) to employ
and provide 1-year training for nurse practitioners who have grad-
uated from a nurse practitioner program for careers as primary
care providers in Federally qualified health centers (referred to
in this section as FQHCs) and nurse-managed health clinics
(referred to in this section as NMHCs).
(b) PURPOSE.The purpose of the program is to enable each
grant recipient to
(1) provide new nurse practitioners with clinical training
to enable them to serve as primary care providers in FQHCs
and NMHCs;
(2) train new nurse practitioners to work under a model
of primary care that is consistent with the principles set forth
by the Institute of Medicine and the needs of vulnerable popu-
lations; and
(3) create a model of FQHC and NMHC training for nurse
practitioners that may be replicated nationwide.
(c) GRANTS.The Secretary shall award 3-year grants to
eligible entities that meet the requirements established by the
Secretary, for the purpose of operating the nurse practitioner pri-
mary care programs described in subsection (a) in such entities.
(d) ELIGIBLE ENTITIES.To be eligible to receive a grant under
this section, an entity shall
(1)(A) be a FQHC as defined in section 1861(aa) of the
Social Security Act (42 U.S.C. 1395x(aa)); or
(B) be a nurse-managed health clinic, as defined in section
330A1 of the Public Health Service Act (as added by section
5208 of this Act); and
(2) submit to the Secretary an application at such time,
in such manner, and containing such information as the Sec-
retary may require.
(e) PRIORITY IN AWARDING GRANTS.In awarding grants under
this section, the Secretary shall give priority to eligible entities
that
(1) demonstrate sufficient infrastructure in size, scope,
and capacity to undertake the requisite training of a minimum
of 3 nurse practitioners per year, and to provide to each awardee
12 full months of full-time, paid employment and benefits con-
sistent with the benefits offered to other full-time employees
of such entity;
(2) will assign not less than 1 staff nurse practitioner
or physician to each of 4 precepted clinics;
(3) will provide to each awardee specialty rotations,
including specialty training in prenatal care and womens
health, adult and child psychiatry, orthopedics, geriatrics, and
at least 3 other high-volume, high-burden specialty areas;
H. R. 3590878
The percentage of
With respect to a covered entitys net pre- net premiums writ-
miums written during the calendar year that ten that are taken
are: into account is: