ABDOMINAL aortic aneurysm for certain individuals ; Ultrasound screening for
Index of Sec 1305. ...ACCEPTABLE coverage ; State entering into Medicaid memorandum of understanding described in section 204(e)(4) of America's Affordable Health Choices acting of 2009 with Health Choices Commissioner with respect to coordinating implementation of provisions of division A of Act with State plan under title in order to ensure enrollment of Medicaid eligible individuals in
Index of Sec 1702. ...ACCEPTABLE coverage ; End of period referred in subparagraph being not otherwise covered under
Index of Sec 1702. ...ACCEPTABLE coverage ; Employers having procedures in effect to ensure timely transition without interruption of coverage of Chip enrollees from assistance under title XXI to
Index of Sec 1703. ...ACCOUNT impact of health care reforms carried out under division A in reducing number of uninsured individuals ; 2016 Secretary of Health and Human Services submitting to Congress report on Medicare dss taking into
Index of Sec 1112. ...ACCOUNT under pilot program ; Secretary of Health and Human Services applying difference in updating under paragraph on claim-by-claim or lump sum basis and payment to be taken into
Index of Sec 1121. ...ACCOUNT recommendations making in report under section 1157(d) ; Taking into
Index of Sec 1158. ...ACCOUNT phase out ; Amount specified in paragraph for area and year being amount specified in subsection for area and year adjusted to take into
Index of Sec 1161. ...ACCOUNT evaluation under subsection ; 2012 Secretary implementing necessary improvements to risk adjustment system under section 1853(a)(1)(c) of Social Security Act 42 USC 1395-23(a)(1)(c), taking into
Index of Sec 1167. ...ACCOUNT meaning given term by Health Choices Commissioner under section 116 of America's Affordable Health Choices acting of 2009 ; Taking into
Index of Sec 1173. ...ACCOUNT recommendations of Telehealth Advisory Committee when adding or deleting services and establishing policies of Centers for Medicare and Medicaid Services regarding delivery of telehealth services ; Secretary taking into
Index of Sec 1191. ...ACCOUNT extent to which prescription drugging necessary for individual covered in case of PDP sponsor of prescription drug plan using formulary ; Process taking into
Index of Sec 1205. ...ACCOUNT for 50 percent of physician or practitioner's total allowed charges under section 1848 ;
Index of Sec 1303. ...ACCOUNT in computing payments under subsection ; Provisions of subsection not to be taken into account in applying subsections and payment under subsections not to be taken into
Index of Sec 1303. ...ACCOUNT in determining amounts otherwise to be paid under part for purposes of section 1834(g)(2)(b) ; Payments under subsection not to be taken into
Index of Sec 1303. ...ACCOUNT in computing payments under subsection ; Provisions of subsection not to be taken into account in applying subsections or payment under subsections not to be taken into
Index of Sec 1303. ...ACCOUNT potential for differences in effectiveness of health care items and services used with various subpopulations ; Designing to take into
Index of Sec 1401. ...ACCOUNT pending resolution of subsequent appeals ; Providing that amounts collected kept in
Index of Sec 1421. ...ACCOUNT pending resolution of subsequent appeals ; Providing that amounts collected kept in
Index of Sec 1421. ...ACCOUNT pending resolution of subsequent appeals ; Providing that amounts collected kept in
Index of Sec 1421. ...ACCOUNT application of subclauses and subparagraph ; Determining without regard whether positions in excess of otherwise applicable resident limit for period but taking into
Index of Sec 1501. ...ACCOUNT demonstrated likelihood of hospital filling positions within first 3 cost reporting periods beginning after July 1, 2011 determined by Secretary ; Secretary taking into
Index of Sec 1501. ...ACCOUNT under direction of Secretary on earlier of date on which informal dispute resolution process under item completed or date being 90 days after date of imposition of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow
Index of Sec 1421. ...ACCOUNT under direction of State on earlier of date on which informal dispute resolution process under subclause completed or date being 90 days after date of imposition of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow
Index of Sec 1421. ...ACCOUNT under direction of Secretary on earlier of date on which informal dispute resolution process under item completed or date being 90 days after date of imposition of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow
Index of Sec 1421. ...ACCOUNT costs of acquiring necessary equipment ; Assessment of adequacy of Medicare payment rates for services taking into
Index of Sec 1149. ...ACCOUNT recommendations of Advisory Committee and goals for approved medical residency training programs described in section 1886(h)(1)(b) ; Taking into
Index of Sec 1744. ...ACCOUNT variations in empirical justification for Medicare dss attributable to hospital characteristics ; Amount of Medicare dss to be adjusted based on recommendations of report under subsection and taking into
Index of Sec 1112. ...ACCOUNT workforce mobility between urban and rural areas ; Recruitment and retention taking into
Index of Sec 1157. ...ACCOUNTING or financial services to facility ; Providing management or administrative services, clinical consulting services or
Index of Sec 1411. ...ACCOUNTING period to recognize expansion of existing Programs ; Use of recent
Index of Sec 1501. ...ACCREDITATION described in clause not applying for purposes of supplying diabetic testing supplies, canes and crutches in case of pharmacy enrolled under section 1866(j) as supplier of durable medical equipment, prosthetics, orthotics and supplies ; Requirement for
Index of Sec 1148. ...ACCREDITATION for program for additional resident positions ; Hospital's residency programs in primary care fully accredited or hospital actively applying for
Index of Sec 1501. ...ACCREDITATION organization taking action on supplier's application ; Deeming as meeting applicable standards and accreditation requirement under subparagraph until timing as independent
Index of Sec 1148. ...ACCREDITATION processes of Accreditation Council for Graduate Medical Education and American Osteopathic Association and effectiveness of processes in accrediting medical residency programs meeting goals referred in paragraph ; Assessment of
Index of Sec 1505. ...ACCREDITATION organization taking action on supplier's application ; Deeming as meeting applicable standards and accreditation requirement under subparagraph until timing as independent
Index of Sec 1148. ...HEALTH care program ; Management, administrative or other item or servicing used in connection with directly indirectly related to Federal
Index of Sec 1645. ...ADMINISTRATIVE burden on persons required to collect data and adequately protecting privacy of patients' personal health information and providing data security ; Data collection efforts under system use efficient and cost-effective means in manner minimizing
Index of Sec 1442. ...ADMINISTRATIVE costs associated with provision of competent language services and reporting required under subsection ; Grantee using up to 10 percent of grant funds to pay for
Index of Sec 1222. ...ADMINISTRATIVE expenditure For which payment being made under section 1903(a) or 2105(a) of Act after date of enactment of Act ; Nothing in amendments making by section to be construed as affecting ability of State under title XIX or XXI of Social Security Act to provide nurse home visitation services as part of another class of items and services falling within definition of medical assistance or child health assistance under respective title or
Index of Sec 1713. ...ADMINISTRATIVE obligations ; Repayment of overpayments by provider of services or supplier not otherwise limiting provider or supplier's potential liability for
Index of Sec 1641. ...ADMINISTRATIVE procedures ; Infusion or injectable drug or Secretary determining as allowed in Agency
Index of Sec 1741. ...ADMINISTRATIVE requirements relating to reimbursements ;
Index of Sec 1204. ...ACCOUNTING or financial services to facility ; Providing management or administrative services, clinical consulting services or
Index of Sec 1411. ...AFFILIATION and affiliation or affiliations of provider or supplier posing serious risk of fraud, waste or abuse ;
Index of Sec 1632. ...AFFILIATION of provider or supplier posing risk of fraud, waste or abuse ; Secretary determining that previous
Index of Sec 1632. ...AFFILIATIONS ; Sec 1757, medicaid and Chip exclusion from participation relating to certain ownership, Control and management
Index of Sec 1757. ...AFFILIATIONS ; Enhancing medicare, medicaid and Chip Program disclosure requirements relating to previous
Index of Sec 1632. ...AFFILIATION agreement ; Filling additional resident slots allocated to other hospitals through
Index of Sec 1501. ...AFFORDABILITY credits under subtitle C of title II of division A of America's Affordable Health Choices acting of 2009 as specified under memorandum ; Redeterminations of eligibility for individuals unless periodicity of redeterminations being consistent with periodicity for redeterminations by Commissioner of eligibility for
Index of Sec 1702. ...AFFORDABILITY credits under subtitle C of title II of division A of America's Affordable Health Choices acting of 2009 ; Commissioner determining that State Medicaid agency having capacity to make determinations of eligibility for
Index of Sec 1702. ...AFFORDABILITY credits ; State Medicaid agency determining that Exchange-eligible individual being not eligible for
Index of Sec 1702. ...ALL-condition measure of readmissions as determined appropriate by Secretary ; Secretary expanding applicable conditions beyond 3 conditions For which measures endorsed as described in subparagraph as of date of enactment of subsection to additional 4 conditions so identified by Medicare Payment Advisory Commission in report to Congress in June 2007 and other conditions and procedures including
Index of Sec 1151. ...AMBULATORY services offered by freestanding birth center and otherwise included in plan ; Freestanding birth center services and other
Index of Sec 1724. ...AMBULATORY surgical center to hospital after date of enactment of subsection ; Hospital not converted from
Index of Sec 1156. ...AMBULATORY surgical center meeting requirements of titles XVIII or XIX participating in programs established under titles only if hospital or center reporting information on health care-associated infections developing in hospital or center as Secretary specifying ; Secretary providing that hospital or
Index of Sec 1461. ...AMBULATORY surgical center ; Nothing in section to be construed as preempting or otherwise affecting provision of State law relating to disclosure of information on health care-associated infections or patient safety procedures for hospital or
Index of Sec 1461. ...AMBULATORY surgical Centers on health Care-associated infections ; Sec 1461, requirement for public reporting by hospitals and
Index of Sec 1461. ...AMBULATORY surgical Centers on health Care-associated infections ; Sec 1138a, requirement for public reporting by hospitals and
Index of Sec 1461. ...AMBULATORY surgical centers during year ; Number and types of health care-associated infections reported under subsection in hospitals and
Index of Sec 1461. ...AMBULATORY surgical centers ; Best practices to eliminate rates of occurrence type of infection in hospitals and
Index of Sec 1461. ...AMBULATORY surgical centers submitting reports taking effect on date as Secretary of Health and Human Services specifying ; Requirement under sectioning that hospitals and
Index of Sec 1461. ...AMBULATORY surgical facility as Secretary specifying ; Subparagraph Secretary requiring reporting of additional data relating to quality of services furnished in
Index of Sec 1144. ...ANALYTIC contractors to identify and analyzing services identified under clause ; Secretary using
Index of Sec 1122. ...ANGIOGRAPHIES, angiograms and endoscopies furnished ; Term procedure rooms including rooms in which catheterizations,
Index of Sec 1156. ...APPOINTMENT ; Considering appointment to Commission or clinical perspective advisory panel described paragraph Secretary or Commission reviewing expertise of individual and financial disclosure report filed by individual pursuant to Ethics in Government Act of 1978 for individual under consideations for
Index of Sec 1401. ...APPOINTMENT of independent monitors under pilot program ; Chain to be responsible for portion of costs associated with
Index of Sec 1422. ...APPOINTMENT of temporary management to oversee operation of hospice program and protecting and assuring health and safety of individuals under care of program when improvements being made ;
Index of Sec 1614. ...APPROPRIATION until expended ; Funds appropriated under paragraph to be allocated in same proportion as total funding appropriated with respect to paragraphs and allocated with respect to fiscal year 2010 and available without further
Index of Sec 1601. ...ASSESSMENT of not more than 3 timing amount claimed as result of false statement, omission or misrepresenations of material fact claimed by provider of services or supplier whose application to participate containing false statement, omission or misrepresenations ;
Index of Sec 1611. ...ASSESSMENT of not more than 3 timing amount claimed by plan or plan sponsor based upon misrepresenations or falsified information involved ;
Index of Sec 1616. ...ASSESSMENT of not more than 3 timing total amount of obligation to which false record or statment being material or avoided or decreased ;
Index of Sec 1645. ...ASSESSMENT and assurance activities conducted under clause ; Coordinating implementation of plan with quality
Index of Sec 1412. ...ASSESSMENT and assurance activities conducted under clause ; Coordinating implementation of plan with quality
Index of Sec 1412. ...ASSESSMENT and assurance activities conducted under clause of sections ; Coordinating implementation of plan with quality
Index of Sec 1412. ...ACCOUNT costs of acquiring necessary equipment ; Assessment of adequacy of Medicare payment rates for services taking into
Index of Sec 1149. ...ASSESSMENT of communication strategies for dual eligibles to determine whether additional informational materials or outreach ;
Index of Sec 1905. ...ASSESSMENT of factors related to enrollee satisfaction with services and care delivery ; Research and evaluation of areas where service utilization, quality and access to cost sharing protection to be improved and
Index of Sec 1905. ...ASSESSMENT of sources of data on costs of home infusion therapy to be used to construct payment mechanisms in Medicare program ;
Index of Sec 1143. ...ASSESSMENT of following with respect to adjustment factors ; Study including evaluation and
Index of Sec 1157. ...ASSET or resource test in determining eligibility of individual after first day under following ; State applying
Index of Sec 1703. ...ASSET or resource test described in subparagraph waived ; Provisions of title preventing waiver of
Index of Sec 1703. ...ATTESTATION to Administrator of Centers for Medicare and Medicaid Services of total amount of reimbursement plan providing to beneficiaries for premiums and cost-sharing ;
Index of Sec 1204. ...AUDITABLE data in uniform format ; Beginning not later than 2 years after date of enactment of subparagraph and consulting with State long-term care ombudsman programs, consumer advocacy groups, provider stakeholder groups, employees and representatives and other parties Secretary deeming appropriate Secretary requiring skilled nursing facility electronically to submit to Secretary direct care staffing information based on payroll and other verifiable and
Index of Sec 1416. ...AUDITABLE data in uniform format ; Beginning not later than 2 years after date of enactment of subparagraph and consulting with State long-term care ombudsman programs, consumer advocacy groups, provider stakeholder groups, employees and representatives and other parties Secretary deeming appropriate Secretary requiring nursing facility electronically to submit to Secretary direct care staffing information based on payroll and other verifiable and
Index of Sec 1416. ...AUTHORIZATION or other restrictions on access to coverage of prescription drugs sponsor and overall quality of prescription drug plan as measured by quality ratings established by Secretary ; Use of prior
Index of Sec 1205. ...INFORMATION required to be filed with plan by beneficiary ; Reimbursement to be made automatically by plan upon receipt of appropriate notice beneficiary being eligible for assistance described in subsection without further
Index of Sec 1204. ...DRUG plan or Ma-pd plan making reimbursement under subsection to retroactive lis enrollment beneficiary with respect to claim ; Prescription
Index of Sec 1204. ...BENEFICIARY filing claim with plan ; Date on which
Index of Sec 1204. ...TITLE ; Costs incurred by beneficiary during retroactive coverage period of beneficiary for covered part D drugs, premiums and cost-sharing under
Index of Sec 1204. ...DRUG costs incurred by beneficiary during retroactive coverage period of beneficiary ; Organization or other third party owed payment on behalf of beneficiary for covered
Index of Sec 1204. ...BENEFICIARY meaning individual entitled to benefits under part A of title XVIII of Social Security Act or enrolled under part B of title ; Term Medicare
Index of Sec 1224. ...HOSPITAL insurance benefits under part A under section 226(b) or sectioning 226a and eligible to enroll ; Case of individual being covered beneficiary at time individual entitled to
Index of Sec 1234. ...HOSPITAL insurance benefits under part A of title XVIII of Social Security Act under section 226(b) or 226a of Act and eligible to enroll ; No increase in premium to be effected for month in case of individual being covered beneficiary at time individual entitled to
Index of Sec 1234. ...MEDICAL care of condition involved and assisting beneficiary in thinking ; Eligible provider participating in program routinely scheduling Medicare beneficiaries for counseling visit after viewing patient decision aid to answer questions beneficiary with respect to
Index of Sec 1236. ...BENEFICIARY meaning high need beneficiary being generally within upper 50th percentile of Medicare beneficiaries ; Term targeted high need
Index of Sec 1302. ...RISK beneficiaries ; Use appropriate risk-adjustment in determining amount of per beneficiary per month payment under paragraph in manner ensuring that higher payments being made for higher
Index of Sec 1302. ...BENEFICIARY meaning individual requiring regular medical monitoring, advising or treatment ; Term high need
Index of Sec 1302. ...RISK-adjustment in determining amount of per beneficiary per month payment under paragraph ; Use appropriate
Index of Sec 1302. ...BENEFICIARY access to bone mass measurement benefits in general and rural and minority communities specifically ; Impact of Medicare payment changes since 2006 on
Index of Sec 1149. ...BENEFICIARY access to care, utilization of services, efficiency and cost-effectiveness of health care delivery, patient satisfaction and selecting health outcomes ; Culturally and linguistically appropriate services on
Index of Sec 1222. ...BENEFICIARY coinsurance described in section 1860d-2(b)(2) ; Elimination of
Index of Sec 1202. ...BENEFICIARY data ; Need and feasibility of including further gradations of diseases or conditions and multiple years of
Index of Sec 1167. ...BENEFICIARY payment ; Discount not to be applied against negotiated price for purpose of calculating
Index of Sec 1182. ...BENEFICIARY programs ; 15 additional members representing broad constituencies of stakeholders including clinicians, patients, researchers, third-party payers, consumers of Federal and State
Index of Sec 1401. ...BENEFICIARY risk scores to ensure that higher payments being made for higher risk beneficiaries ; Secretary adjusting payments to medical homes based on
Index of Sec 1302. ...BENEFICIARY'S record ; Friends or other persons untrained in interpretation or translation and grantee documenting request in
Index of Sec 1222. ...PROFICIENCY in two languages and ensuring effective communication occurring in languages ; Term bilingual with respect to individual meaning person having sufficient degree of
Index of Sec 1224. ...BILINGUAL staff or competent interpreter or translation services ; Payments to be provided under section only to grantees utilizing competent
Index of Sec 1222. ...REBATE agreement described in paragraph ; Term covered part D drug not including drug or biologic manufactured by manufacturer not entering and effect
Index of Sec 1181. ...DRUG not including drug or biologic manufactured by manufacturer not entering and effect for qualifying drugs discount agreement described in paragraph ; Term covered part D
Index of Sec 1182. ...HEALTH care entity reporting physician ownership under subsection ; Accuracy of information submitted under subsections and making available under paragraph to be responsibility of applicable manufacturer or distributor of covered drug, device, biological or medical supply reporting under subsection or hospital or other
Index of Sec 1451. ...INFORMATION during year ; Biological or medical supply submitting
Index of Sec 1451. ...DISTRIBUTION of covered drug, device, biological or medical supply ; Conversion, processing, marketing or
Index of Sec 1451. ...COMPENSATION paid by manufacturer or distributor of covered drug, device, biological or medical supply to covered recipient directly employed and works solely for manufacturer or distributor ;
Index of Sec 1451. ...DRUG, device or medical supply ; Term applicable manufacturer meaning manufacturer of covered drug, device, biological or medical supply and term applicable distributor meaning distributor of covered
Index of Sec 1451. ...ACCOUNT under pilot program ; Secretary of Health and Human Services applying difference in updating under paragraph on claim-by-claim or lump sum basis and payment to be taken into
Index of Sec 1121. ...CANCER ; Inserting and medical assistance making available to individual described in subsection to be limited to family planning services and supplies described in section 1905(a)(4)(c) including medical diagnosis and treatment services provided pursuant to family planning service in family planning setting after cervical
Index of Sec 1714. ...CANCER screening tests ; Colorectal
Index of Sec 1305. ...CANCER screening Tests regardless of coding, subsequent diagnosis or ancillary Tissue removal ; Sec 1306, waiver of deductible for colorectal
Index of Sec 1306. ...CANCER screening test regardless of code billed for establishment of diagnosis as result of test or removal of tissue or other matter or other procedure furnished in connection as result ; Clause of first sentence of subsection applying with respect to colorectal
Index of Sec 1306. ...CANCER screening tests ; Prostate
Index of Sec 1305. ...CAPITAL contributions making at time ownership or investment interest obtained ; Investment interest of owner or investor being directly proportional to owner or investor's
Index of Sec 1156. ...CAPITALIATIONS ; Requirements relating to surety bonds, liability insurance or minimum
Index of Sec 1412. ...CAPITATION model to ACOS highly integrated systems of care and ACOS capable of bearing risk as determined to be appropriate by Secretary ; Risk physicians' services or items and services under part B Secretary limiting partial
Index of Sec 1301. ...CAPITATION model to be established in manner not resulting in spending more for ACO for beneficiaries ; Payments to qualifying ACO for applicable beneficiaries for year under partial
Index of Sec 1301. ...CAPITATION rates described in subsection ; Indirect costs of medical education from
Index of Sec 1161. ...ANGIOGRAPHIES, angiograms and endoscopies furnished ; Term procedure rooms including rooms in which catheterizations,
Index of Sec 1156. ...CERTIFICATION or other reasonable timeframe as determined by Secretary ; Prior to making certification physician documenting that physician having face-to-face encounter with individual during 6-month period preceding
Index of Sec 1639. ...CERTIFICATION or recertification or other reasonable timeframe as determined by Secretary ; 2010 prior to making certification physician documenting that physician having face-to-face encounter with individual during 6-month period preceding
Index of Sec 1639. ...CERTIFICATION of program and providing for 1 or more of other remedies described in subsection ; Secretary taking immediate action to remove jeopardy and correct deficiencies through remedy specified in subsection or terminating
Index of Sec 1614. ...CERTIFICATION of program ; Lieu of terminating
Index of Sec 1614. ...CERTIFICATION of medical practices as meeting standards ; Initially providing for review and
Index of Sec 1302. ...CERTIFICATION making respecting skilled nursing facility to Secretary not later than date on which State sending information to facility ; State submitting information respecting survey or
Index of Sec 1413. ...CERTIFICATION making respecting nursing facility to Secretary not later than date on which State sending information to facility ; State submitting information respecting survey or
Index of Sec 1413. ...CERTIFICATION as referred in section 208(b)(3) of title 18, United States Code or waiver as referred in subparagraph for service on Commission at meeting of Commission ; Written
Index of Sec 1401. ...CERTIFICATIONS for home health services or referrals for other items or servicing written or ordered by physician or supplier under title as specified by Secretary ; Physician or supplier under section 1866(j) if physician or supplier failing to maintain and provide access to documentation relating to written orders or requests for payment for durable medical equipment,
Index of Sec 1638. ...CERTIFICATIONS for home health services or referrals for other items or servicing written or ordered by provider under title as specified by Secretary ; Maintaining and providing access to documentation relating to written orders or requests for payment for durable medical equipment,
Index of Sec 1638. ...CERTIFICATIONS and referrals making after January 1 ; Amendments making by section applying to orders,
Index of Sec 1638. ...CERTIFICATIONS under title XVIII of Act ; Same manner and same extent as requirements applying in case of physicians making
Index of Sec 1639. ...CERTIFICATIONS and complaint investigations making respecting facility during 3 preceding years available for individual to review upon request ; Reports with respect to surveys,
Index of Sec 1413. ...CERTIFICATIONS and complaint investigations making respecting facility during 3 preceding years available for individual to review upon request ; Reports with respect to surveys,
Index of Sec 1413. ...CERTIFICATIONS making after July 1 ; Amendments making by section applying to written orders and
Index of Sec 1637. ...CERTIFICATION agency and State long-term care ombudsman program with respect to skilled nursing facility ; Secretary developing standardized complaint form for use by resident in filing complaint with State survey and
Index of Sec 1415. ...CERTIFICATION agency and State long-term care ombudsman program with respect to nursing facility ; Secretary developing standardized complaint form for use by resident in filing complaint with State survey and
Index of Sec 1415. ...CERTIFICATION programs ; Links to State Internet websites with information regarding State survey and
Index of Sec 1413. ...CERTIFICATION programs ; Links to State Internet websites with information regarding State survey and
Index of Sec 1413. ...CHARITY care ; Kind items used for provision of
Index of Sec 1451. ...HEALTH services, income supports and other related assistance ; State promoting coordination and collaboration with other home visitation programs and other child and family services,
Index of Sec 1904. ...CHILD maltreatment ; Effect of home visitation programs on child and parent outcomes including
Index of Sec 1904. ...CHILD health and development ; Reducing abuse and neglect and improving
Index of Sec 1904. ...CHILD health and pregnancy outcomes or increasing birth intervals between pregnancies ; Improving maternal or
Index of Sec 1713. ...ADMINISTRATIVE expenditure For which payment being made under section 1903(a) or 2105(a) of Act after date of enactment of Act ; Nothing in amendments making by section to be construed as affecting ability of State under title XIX or XXI of Social Security Act to provide nurse home visitation services as part of another class of items and services falling within definition of medical assistance or child health assistance under respective title or
Index of Sec 1713. ...CHILD health assistance under title through means other than described in section 2101(a)(2) ; Case of State child health plan providing
Index of Sec 1733. ...CHILD health assistance or pregnancy-related assistance under State child health plan referred in paragraph ; Eligible for
Index of Sec 1703. ...CHILD health plan under title XXI ; Applying subsection for purposes of title XIX and XXI Secretary requiring State to carry out provisions of subsection as requirement of State plan under title XIX or
Index of Sec 1631. ...CHILD health plan including description of procedures to be used by State ; State
Index of Sec 1631. ...CHILD health plan under title XXI being more restrictive than eligibility standards, methodologies or procedures under plan as in effect on June 16 ; Subject to paragraph State not in effect eligibility standards, methodologies or procedures under State
Index of Sec 1703. ...CHILD health plan under title XXI ; Paragraph not to be construed as preventing State from imposing limitation described in section 2110(b)(5)(c)(i) for fiscal year in order to limit expenditures under State
Index of Sec 1703. ...CHILD health plan referred in paragraph ; Eligible for child health assistance or pregnancy-related assistance under State
Index of Sec 1703. ...CHILD health assistance under title through means other than described in section 2101(a)(2) ; Case of State child health plan providing
Index of Sec 1733. ...CHILD health Plan ; Sec 1756, termination of Provider participation under medicaid and Chip if terminated under medicare or other State Plan or
Index of Sec 1756. ...CHILD health plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirement before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year legislative session ; State plan or
Index of Sec 1756. ...CHILD health plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirement before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year legislative session ; State plan or
Index of Sec 1757. ...CHILD health plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirement before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year legislative session ; State plan or
Index of Sec 1759. ...CHILD involvement in criminal justice system ; Improving family stability or reducing maternal and
Index of Sec 1713. ...CHILD maltreatment ; Identify and prioritizing serving communities in high need of services, especially communities with high proportion of low-income families or high incidence of
Index of Sec 1904. ...CHILD maltreatment ; Effect of home visitation programs on child and parent outcomes including
Index of Sec 1904. ...CHILD'S enrollment ceasing for reason ; Model ensuring that patient-centered medical home services received by child providing for continuous involvement and education of parent or caregiver and assistance to child in obtaining necessary transitional care if
Index of Sec 1722. ...HEALTH condition of individual including diagnosis of chronic ; Significant change in
Index of Sec 1233. ...INCOME beneficiaries ; Secretary of Health and Human Services submitting to Congress report evaluating adequacy of risk adjustment system under section 1853(a)(1)(c) of Social Security Act 42 USC 1395-23(a)(1)(c) in predicting costs for beneficiaries with chronic or co-morbid conditions, beneficiaries dually-eligible for Medicare and Medicaid and non-Medicaid eligible low-
Index of Sec 1167. ...CHRONIC conditions requiring subspecialist's expertise subspecialist assuming care management ; Accessible health care provided by physician being medical subspecialist addressing majority of personal health care needs of patients with
Index of Sec 1302. ...CHRONIC diseases ; Measures of health functioning and survival for patients with
Index of Sec 1162. ...CHRONIC diseases or help beneficiaries accessing health care and community-based resources in local geographic area ; Medication therapy management services for patients with multiple
Index of Sec 1302. ...CHRONIC illnesses, transitional care services, care plan ; Teaching self-care skills for managing
Index of Sec 1302. ...CITIZENSHIP of parties and jurisdiction to grant complete relief ; Jurisdiction over action without regard to amount in controversy or
Index of Sec 1415. ...CITIZENSHIP of parties and jurisdiction to grant complete relief ; Jurisdiction over action without regard to amount in controversy or
Index of Sec 1415. ...ADMINISTRATIVE violations under Act and promoting quality of care consistent with regulations developed under clause ; Skilled nursing facility in operation compliance and ethics program being effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act and promoting quality of care ; Effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Organization to have established compliance standards and procedures to be followed by employees, contractors and other agents being reasonably capable of reducing prospect of criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Propensity to engage in criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act by employees and other agents and place and publicizing reporting system whereby employees and other agents reporting violations by others within organization without fear of retribution ; Utilizing monitoring and auditing systems reasonably designed to detect criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act and promoting quality of care consistent with regulations developed under clause ; Nursing facility in operation compliance and ethics program being effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act and promoting quality of care ; Effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Organization to have established compliance standards and procedures to be followed by employees and other agents being reasonably capable of reducing prospect of criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Propensity to engage in criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act by employees and other agents and place and publicizing reporting system whereby employees and other agents reporting violations by others within organization without fear of retribution ; Utilizing monitoring and auditing systems reasonably designed to detect criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE proceeding ; Discovery or admissibility of information described in section in criminal, civil or
Index of Sec 1451. ...CRIMINAL sanctions involving same claim if determined later ; Applicable interests, fines and specialties or civil or
Index of Sec 1641. ...CIVIL money penalties under subsection of section 1128a imposed and collected under section ; Penalty to be imposed and collected in same manner as
Index of Sec 1451. ...CIVIL money penalties imposed under subparagraph with respect to annual submission of information under subsection by applicable manufacturer or distributor or other entity not exceeding $150,000 ; Total amount of
Index of Sec 1451. ...CIVIL money penalties under subsection of section 1128a imposed and collected under section ; Penalty to be imposed and collected in same manner as
Index of Sec 1451. ...CIVIL money penalties imposed under subparagraph with respect to annual submission of information under subsection or applicable manufacturer, distributor or entity not exceeding $1,000,000 or greater ; Total amount of
Index of Sec 1451. ...CIVIL money penalties in amount not to exceed $10,000 for day of noncompliance or not to exceed $25,000 ;
Index of Sec 1614. ...CIVIL money penalty under subparagraphs and same manner as provisions applying to penalty or proceeding under section 1128a(a) ; Provisions of section 1128a and other than subsection applying to
Index of Sec 1156. ...CIVIL money penalty under subparagraph in same manner as provisions applying to penalty or proceeding under section 1128a(a) ; Applying to
Index of Sec 1181. ...CIVIL money penalty imposed under clause ; Case of
Index of Sec 1421. ...CIVIL money penalty under clause in same manner as provisions applying to penalty or proceeding under section 1128a(a) ; Provisions requiring hearing prior to imposition of civil money penalty applying to
Index of Sec 1421. ...CIVIL money penalty imposed under subparagraph ; Case of
Index of Sec 1421. ...CIVIL money penalty in amount not to exceed $10,000 for daying or instance of noncompliance ; Secretary imposing
Index of Sec 1421. ...CIVIL money penalty imposed under clause ; Case of
Index of Sec 1421. ...CIVIL money penalty applying to civil money penalty under clause in same manner as provisions applying to penalty or proceeding under section 1128a(a) ; Provisions requiring hearing prior to imposition of
Index of Sec 1421. ...CIVIL money penalty of not less than $1,000 but not more than $10,000 for payment or other transfer of value or ownership or investment interest not reported as required under subsection ; Applicable manufacturer or distributor failing to submit information required under subsection in timely manner in accordance with regulations promulgated to carry out subsection and hospital or other entity failing to submit information required under subsection in timely manner in accordance with regulations promulgated to carry out subsection to be subject to
Index of Sec 1451. ...CIVIL money penalty under subsection to be used to carry out that section ; Funds collected by Secretary as result of imposition of
Index of Sec 1451. ...CIVIL money penalty under clause in same manner as provisions applying to penalty or proceeding under section 1128a(a) ; Applying to
Index of Sec 1614. ...ACCOUNT under direction of Secretary on earlier of date on which informal dispute resolution process under item completed or date being 90 days after date of imposition of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow
Index of Sec 1421. ...ACCOUNT under direction of State on earlier of date on which informal dispute resolution process under subclause completed or date being 90 days after date of imposition of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow
Index of Sec 1421. ...ACCOUNT under direction of Secretary on earlier of date on which informal dispute resolution process under item completed or date being 90 days after date of imposition of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow
Index of Sec 1421. ...CLASSIFIATIONS groups exceeding costs incurred by other hospitals furnishing services under subsection ; Secretary conducting study to determine if costs incurred by hospitals described in section 1886(d)(1)(b)(v) with respect to ambulatory payment
Index of Sec 1145. ...CLASSIFIATIONS system as Secretary determining appropriate based on analysis conducted pursuant to subparagraph ; Secretary implementing changes to payments for non-therapy ancillary services under future skilled nursing facility servicing
Index of Sec 1111. ...CLASSIFIATIONS system for yearing without changes ; Estimated expenditures under future skilled nursing facility servicing classifiations system for fiscal year beginning with fiscal year 2011 with changes to be equal to estimated expenditures otherwise occurring under title XVIII of Social Security Act under future skilled nursing facility servicing
Index of Sec 1111. ...CLASSIFIATIONS system for payment of skilled nursing facility services under section 1888(e) of Social Security Act 42 USC 1395yy(e) ; Changes in payment described in subparagraph applying for days after January 1, 2010 and Secretary implementing alternative case mix
Index of Sec 1111. ...CLASSIFIATIONS system to ensure accuracy of payment for non-therapy ancillary services ; Secretary of Health and Human Services analyzing payments for non-therapy ancillary services under future skilled nursing facility
Index of Sec 1111. ...CLASSIFIATIONS system implemented to apply to services furnished during fiscal year beginning with fiscal year 2011 ; Future skilled nursing facility
Index of Sec 1111. ...HEALTH records ; 2012 Secretary developing plan to integrate clinical reporting on quality measures under subsection with reporting requirements under subsection relating to meaningful use of electronic
Index of Sec 1124. ...ACCOUNTING or financial services to facility ; Providing management or administrative services, clinical consulting services or
Index of Sec 1411. ...EDUCATION and training in linguistically appropriate service delivery ; Ensuring that appropriate clinical and support staff receiving ongoing
Index of Sec 1222. ...CLINICAL care ; Other health care practitioners engaged in
Index of Sec 1401. ...CLINICAL decision support, appropriate professional associations and Federal and private health plans and other relevant stakeholders ; Center providing for dissemination of appropriate findings produced by research supported, conducted or synthesized under section to health care providers, patients, vendors of health information technology focused on
Index of Sec 1401. ...CLINICAL decision support to promote timely incorporation of findings into clinical practices and promoting ease of use of incorpoations ; Assisting users of health information technology focused on
Index of Sec 1401. ...CLINICAL effectiveness research data networks from electronic health records, post marketing drug and medical device surveillance efforts and other forms of electronic health data ; Encouraging development and use of clinical registries and development of
Index of Sec 1401. ...CLINICAL investigation regarding new drug ; Case of payment or other transfer of value making to covered recipient by applicable manufacturer or distributor in connection with
Index of Sec 1451. ...CLINICAL investigation registered on website maintained by National Institutes of Health pursuant to section 671 of Food and drugging Administration Amendments acting of 2007 ;
Index of Sec 1451. ...CLINICAL investigation meaning experiment involving one or more human subjects or materials derived from human subjects in which drug or device administered, dispensed or used ; Term
Index of Sec 1451. ...CLINICAL investigations ; Delaying reporting for payments making PURSUANT to
Index of Sec 1451. ...CLINICAL outcomes for specific research inquiry to be examined with respect to priority to ensure that information produced from research being clinically relevant to decisions making by clinicians and patients at point of care ; Consulting with patients and advising Center on research questions, methods and evidence gaps in terms of
Index of Sec 1401. ...CLINICAL perspective advisory panel for research priority determined under subparagraph ; Appointing
Index of Sec 1401. ...CLINICAL perspective advisory panel described in paragraph ; Appointing members of Commission or
Index of Sec 1401. ...APPOINTMENT ; Considering appointment to Commission or clinical perspective advisory panel described paragraph Secretary or Commission reviewing expertise of individual and financial disclosure report filed by individual pursuant to Ethics in Government Act of 1978 for individual under consideations for
Index of Sec 1401. ...CLINICAL perspective advisory panel being full-time Government employee or special Government employee disclosing to Secretary financial interests in accordance with subsection of section 208 ; Member of Commission or
Index of Sec 1401. ...CLINICAL perspective advisory panel if member having financial interest to be affected by advice given to Secretary with respect to matter ; Member of Commission or clinical perspective advisory panel described in paragraph not participating with respect to particular matter considered in meeting of Commission or
Index of Sec 1401. ...CLINICAL perspective advisory panel described in paragraph 2(h) essential expertise ; Secretary determining necessary to afford Commission or
Index of Sec 1401. ...CLINICAL perspective advisory panel meeting ; Participating as non-voting member with respect to particular matter considered in Commission or
Index of Sec 1401. ...CLINICAL perspective advisory panel meeting ; Participating as voting member with respect to particular matter considered in Commission or
Index of Sec 1401. ...CLINICAL perspective advisory panel receiving waiver ; No more than two nonvoting members of
Index of Sec 1401. ...CLINICAL perspective advisory panel for national research priority ; Research meeting national research priority determined under subsection and considering advice given to Center by
Index of Sec 1401. ...CLINICAL practices and promoting ease of use of incorpoations ; Assisting users of health information technology focused on clinical decision support to promote timely incorporation of findings into
Index of Sec 1401. ...CLINICAL quality measures endorsed by entity with contract with Secretary under section 1890(a) ; Secretary providing preference to
Index of Sec 1162. ...CLINICAL effectiveness research data networks from electronic health records, post marketing drug and medical device surveillance efforts and other forms of electronic health data ; Encouraging development and use of clinical registries and development of
Index of Sec 1401. ...CLINICAL research including original research conducted subsequent to date of enactment of section ; Conduct and support systematic reviews of
Index of Sec 1401. ...CLINICAL research ; Separately listed information as funding for
Index of Sec 1451. ...MARRIAGE and family therapy ; Obtaining degree performed 2 years of clinical supervised experience in
Index of Sec 1308. ...CLINICAL work and practice expenses involved in providing medical home services provided by independent patient-centered medical home For which payment being not made under title as of date of enactment of section ;
Index of Sec 1302. ...CLINICAL work and practice expenses involved in providing medical home services provided by community-based medical home For which payment being not made under title as of date of enactment of section ;
Index of Sec 1302. ...CANCER screening Tests regardless of coding, subsequent diagnosis or ancillary Tissue removal ; Sec 1306, waiver of deductible for colorectal
Index of Sec 1306. ...COMMISSION ; Transfering individual enrolled under part from one plan to another without prior consent of individual or designee of individual or solely for purpose of earning
Index of Sec 1617. ...COMPARATIVE effectiveness of full spectrum of health care items, services and systems including pharmaceuticals ; Conducting, supporting and synthesizing research relevant to
Index of Sec 1401. ...COMPARATIVE effectiveness research determined to be national priority under subparagraph ; Monitoring appropriateness of use of CERTF described in subsection with respect to timely production of
Index of Sec 1401. ...COMPARATIVE effectiveness research and studies conducted by Center under subsection ; Make recommendations for priority for periodic reviews of previous
Index of Sec 1401. ...COMPARATIVE effectiveness studies and using methodologies appropriately ; Continuously developing rigorous scientific methodologies for conducting
Index of Sec 1401. ...COMPARATIVE effectiveness studies reviewed by Commission ; Ensuring that comments from patients regarding proposed
Index of Sec 1401. ...COMPENSATION ; Providing transportation and subsistence for persons serving without
Index of Sec 1401. ...COMPENSATION, gift, honorarium, speaking fee, consulting fee, travel, services, dividend, profit distribution, stock or stock option grant or ownership or investment interest holding by physician in manufacturer ; Term payment or other transfer of value including
Index of Sec 1451. ...COMPENSATION paid by manufacturer or distributor of covered drug, device, biological or medical supply to covered recipient directly employed and works solely for manufacturer or distributor ;
Index of Sec 1451. ...COMPENSATION arrangements ; Entity providing covered items or services For which payment to be made under title providing Secretary with information concerning entity's ownership, investment and
Index of Sec 1156. ...COMPLIANCE with regulations pursuant to section 1866 ; Nothing in subsection to be construed as preventing Secretary from terminating hospital's provider agreement if hospital being not in
Index of Sec 1156. ...COMPLIANCE with requirements ; Secretary using unannounced site reviews of hospitals and audits to verify
Index of Sec 1156. ...COMPLIANCE ; Secretary establishing terming and conditioning of agreement including terming and conditions relating to
Index of Sec 1182. ...COMPLIANCE with standards ; Organization taking reasonable steps to achieve
Index of Sec 1412. ...COMPLIANCE with standards ; Organization taking reasonable steps to achieve
Index of Sec 1412. ...COMPLIANCE with State and Federal laws and regulations applicable to facilities ; Conduct periodic reviews and preparing root-cause quality and deficiency analyses of chain to assess if facilities of chain in
Index of Sec 1422. ...COMPLIANCE by facilities of chain with State and Federal laws and regulations applicable to facilities ; Publicly holding, involving owners of chain and principal business partners of owners in facilitating
Index of Sec 1422. ...COMPLIANCE with reporting requirements, success of validity procedures established and conflicting or overlapping between reporting required under sectioning and other reporting systems mandated by States or Federal Government ; Report including analysis of appropriateness of types of information required for submission,
Index of Sec 1461. ...COMPLIANCE with requirements ; Secretary determining that hospice program certified for participation under title in
Index of Sec 1614. ...COMPLIANCE with requirements referred in clause ; Temporary management under clause not to be terminated until Secretary determining that program having management capability to ensure continued
Index of Sec 1614. ...COMPLIANCE with subsection ; Report including discussion of Center's
Index of Sec 1401. ...COMPLIANCE with rules for plans under part ; Secretary determining not to identify Medicare Advantage plan if Secretary identified deficiencies in plan's
Index of Sec 1162. ...COMPLIANCE program containing core elements established under paragraph ; Establish
Index of Sec 1635. ...COMPLIANCE program described in paragraph of section in accordance with section ; Providing that provider or supplier providing services under plan establishing
Index of Sec 1753. ...COMPLIANCE program ; Promulgating regulations for effective compliance and ethics program for operating organizations including model
Index of Sec 1412. ...COMPLIANCE program ; Developing regulations for effective compliance and ethics program for operating organizations including model
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Organization to have established compliance standards and procedures to be followed by employees, contractors and other agents being reasonably capable of reducing prospect of criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Organization to have established compliance standards and procedures to be followed by employees and other agents being reasonably capable of reducing prospect of criminal, civil and
Index of Sec 1412. ...CONFIDENTIALITY agreements making with respect to use of data under section ; Dissemination of which violating privacy of research participants or violating
Index of Sec 1401. ...COMMISSION ; Transfering individual enrolled under part from one plan to another without prior consent of individual or designee of individual or solely for purpose of earning
Index of Sec 1617. ...CONSPIRACY involved ; $50,000 for violation described in section committed in furtherance of
Index of Sec 1645. ...CONSPIRACY involved or cases under paragraph ; Assessment of not more than 3 timing total amount otherwise applying for violation described in section committed in furtherance of
Index of Sec 1645. ...INFORMATION to consumers regarding skilled nursing facilities and nursing facilities in State forming 2567 State inspection reports ; State maintaining consumer-oriented website providing useful
Index of Sec 1413. ...HEALTH care decisions improving quality and value ; Make recommendations to center for broad dissemination of findings of research conducted and supported under section enabling clinicians, patients, consumers and payers to make more informed
Index of Sec 1401. ...BENEFICIARY programs ; 15 additional members representing broad constituencies of stakeholders including clinicians, patients, researchers, third-party payers, consumers of Federal and State
Index of Sec 1401. ...INFORMATION on staffing turnover and tenure in format being clearly understandable to consumers of long-term care servicing and allowing consumers to compare differences in staffing between facilities and State and national averages for facilities ; Including
Index of Sec 1413. ...INFORMATION on staffing turnover and tenure in format being clearly understandable to consumers of long-term care servicing and allowing consumers to compare differences in staffing between facilities and State and national averages for facilities ; Including
Index of Sec 1413. ...PLANNING including national toll-free hotline ; Provision by practitioner of list of national and State-specific resources to assist consumers and families with advance care
Index of Sec 1233. ...AUDITABLE data in uniform format ; Beginning not later than 2 years after date of enactment of subparagraph and consulting with State long-term care ombudsman programs, consumer advocacy groups, provider stakeholder groups, employees and representatives and other parties Secretary deeming appropriate Secretary requiring skilled nursing facility electronically to submit to Secretary direct care staffing information based on payroll and other verifiable and
Index of Sec 1416. ...AUDITABLE data in uniform format ; Beginning not later than 2 years after date of enactment of subparagraph and consulting with State long-term care ombudsman programs, consumer advocacy groups, provider stakeholder groups, employees and representatives and other parties Secretary deeming appropriate Secretary requiring nursing facility electronically to submit to Secretary direct care staffing information based on payroll and other verifiable and
Index of Sec 1416. ...CONSUMER involvement in assuring quality care in facilities and facility improvement initiatives approved by Secretary ; Support resident and family councils and other
Index of Sec 1421. ...CONSUMER involvement in assuring quality care in facilities and facility improvement initiatives approved by Secretary ; Support resident and family councils and other
Index of Sec 1421. ...CONSUMER involvement in assuring quality care in facilities and facility improvement initiatives approved by Secretary ; Support resident and family councils and other
Index of Sec 1421. ...CONSUMER price index as of September of previous year ; Dollar amounting specified in subclause for previous year increased by annual percentage increase in
Index of Sec 1201. ...CONSUMER price index for 12-month period ending with April of preceding fiscal year ; Subsequent year being equal to default amount under clause for preceding fiscal year increased by annual percentage increase in medical care component of
Index of Sec 1802. ...CONTRACT under section 1890(a) of Social Security Act but adopting and applying measures under paragraph without ; Secretary seeking endorsement of measures by entity with
Index of Sec 1151. ...CONTRACT with Institute of Medicine of National Academy of Science to conduct comprehensive empirical study and providing recommendations as appropriate ; Secretary of Health and Human Services entering into
Index of Sec 1157. ...CONTRACT with Secretary under section 1890(a) ; Secretary providing preference to clinical quality measures endorsed by entity with
Index of Sec 1162. ...CONTRACT with Ma organization under section including terms informing organization of provisions in subsection ; Secretary requiring that
Index of Sec 1174. ...CONTRACT entered with PDP sponsor under part with respect to prescription drug plan requiring that sponsor complying with subparagraphs ;
Index of Sec 1181. ...CONTRACT ; Prescription drug plan offered by sponsor of plan awarding
Index of Sec 1204. ...CONTRACT entered between Secretary and sponsor of prescription drug plan pursuant to Centers for Medicare and Medicaid Services' request for proposals issued on February 17, 2009 relating to Medicare part D retroactive coverage for certain low income beneficiaries ; Rfp contract described in section being
Index of Sec 1204. ...CONTRACT to provide coverage, items or services under part of title XVIII of Social Security Act ; Term service provider including suppliers, providers of services or entities under
Index of Sec 1224. ...CONTRACT for services terminated in violation of clause complaint filed in violation of clause bringing action at law or equity in appropriate district court of United States ; Person believing person penalized, discriminated or retaliated or
Index of Sec 1415. ...CONTRACT or other agreement and nothing in paragraph to be construed to diminish greater or additional protection provided by Federal or State law or contract or other agreement ; Rights protected by paragraph not to be diminished by
Index of Sec 1415. ...CONTRACT for services terminated in violation of clause complaint filed in violation of clause bringing action at law or equity in appropriate district court of United States ; Person believing person penalized, discriminated or retaliated or
Index of Sec 1415. ...CONTRACT or other agreement and nothing in paragraph to be construed to diminish greater or additional protection provided by Federal or State law or contract or other agreement ; Rights protected by paragraph not to be diminished by
Index of Sec 1415. ...CONTRACT with Secretary to participate in conduct of program ; Independent monitor entering into
Index of Sec 1422. ...CONTRACT with Secretary under section 1890 ; Term consensus-based entity meaning entity with
Index of Sec 1441. ...CONTRACT under section 1890 convening multi-stakeholder groups to provide recommendations on selection of individual or composite quality measures for use in reporting performance information to public or use in public health care programs ; Consensus-based entity entering into
Index of Sec 1443. ...CONTRACT provided under section 1890 ; Recommendations to be included in transmissions consensus-based entity makes to Secretary under
Index of Sec 1443. ...CONTRACT with Secretary under section 1890(a) ; Quality measuring specified under clause to be measures selected by Secretary from measures endorsed by entity with
Index of Sec 1444. ...CONTRACT under section 1890(a) ; Case of specified area or medical topic determined appropriate by Secretary For which feasible and practical quality measure not endorsed by entity with
Index of Sec 1444. ...CONTRACT ; Contract requiring Ma organization or PDP sponsor to require provider of services under
Index of Sec 1636. ...CONTRACT providing that entity reporting to State ;
Index of Sec 1743. ...CONTRACT to participate or enroll as provider of services or supplier under Federal health care program ; Made false statement, omission or misrepresenations of material fact in application, agreement, bid or
Index of Sec 1611. ...CONTRACT or other agreement ; Rights protected by paragraph not to be diminished by contract or other agreement and nothing in paragraph to be construed to diminish greater or additional protection provided by Federal or State law or
Index of Sec 1415. ...CONTRACT or other agreement ; Rights protected by paragraph not to be diminished by contract or other agreement and nothing in paragraph to be construed to diminish greater or additional protection provided by Federal or State law or
Index of Sec 1415. ...CONTRACT if plan failing to have medical loss ratio for 5 consecutive contract years ; Secretary terminating plan
Index of Sec 1173. ...CONTRACT for services terminated in good faith whether using form developed under subsection or other method for submitting complaint ; Privileges of employment or
Index of Sec 1415. ...CONTRACT for services terminated in good faith whether using form developed under subsection or other method for submitting complaint ; Privileges of employment or
Index of Sec 1415. ...CONTRACT ; Clause, striking service area for year and inserting portion of plan's service area for year within service area of reasonable cost reimbursement
Index of Sec 1165. ...CONTRACT described in clause ; Pursuant to rfp
Index of Sec 1204. ...CONTRACT described in section being contract entered between Secretary and sponsor of prescription drug plan pursuant to Centers for Medicare and Medicaid Services' request for proposals issued on February 17, 2009 relating to Medicare part D retroactive coverage for certain low income beneficiaries ; Rfp
Index of Sec 1204. ...CONTRACTS entered under section 1847 of Social Security Act 42 USC 1395w-3 pursuant to bid submitted under section before October 1, 2010 ; Amendments not applying to
Index of Sec 1141. ...CONTRACTS or making other arrangements ; Entering into
Index of Sec 1401. ...CONTRACTS entered or renewed after July 1 ; Amendments making by subsection applying to
Index of Sec 1755. ...CONTRACTS with private payers ; Nothing in section to be construed as preventing qualifying ACOS participating in pilot program from negotiating similar
Index of Sec 1301. ...CONTRACT with State having State program to operate integrated Medicaid-Medicare program approved by Centers for Medicare and Medicaid Services as of January 1 ; Plan described in paragraph being plan having
Index of Sec 1177. ...CONTRACT year ; Secretary not permitting enrollment of new enrollees under plan for coverage during second succeeding
Index of Sec 1173. ...CONTRACT year beginning in 2011 and subsequent contract year ;
Index of Sec 1634. ...CONTRACT year beginning in 2011 and subsequent contract year ;
Index of Sec 1752. ...CONTRACT year ; Contract year beginning in 2011 and subsequent
Index of Sec 1634. ...CONTRACT year ; Contract year beginning in 2011 and subsequent
Index of Sec 1752. ...CONTRACT years beginning with 2012 of data necessary for calculation of medical loss ratio for Ma plans ; Secretary developing and implement standardized data elements and definitions for reporting under subsection for
Index of Sec 1173. ...CONTRACT years beginning after January 1 ; Amendments making by section taking effect on date of enactment of Act and applying to audits and activities conducted for
Index of Sec 1174. ...CONTRACT years beginning after January 1 ; Amendments making by section applying to bids for
Index of Sec 1175. ...CONTRACT years beginning with 2010 ; Amendments making by section applying for
Index of Sec 1183. ...CONTRACT years beginning with 2012 ; Amendment making by subsection taking effect for
Index of Sec 1205. ...CONTRACT years ; Secretary terminating plan contract if plan failing to have medical loss ratio for 5 consecutive
Index of Sec 1173. ...COOPERATIVE entity including State government and one other health care provider being set up for purpose of testing shared decision making and patient decision aids ; State
Index of Sec 1236. ...INTEREST in corporation being equal or exceeding 5 percent ; Shareholders of corporation having ownership
Index of Sec 1411. ...INTEREST in corporation being equal or exceeding 5 percent ; Shareholders of corporation having ownership
Index of Sec 1411. ...ADMINISTRATIVE violations under Act and promoting quality of care consistent with regulations developed under clause ; Skilled nursing facility in operation compliance and ethics program being effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act and promoting quality of care ; Effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Organization to have established compliance standards and procedures to be followed by employees, contractors and other agents being reasonably capable of reducing prospect of criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Propensity to engage in criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act by employees and other agents and place and publicizing reporting system whereby employees and other agents reporting violations by others within organization without fear of retribution ; Utilizing monitoring and auditing systems reasonably designed to detect criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act and promoting quality of care consistent with regulations developed under clause ; Nursing facility in operation compliance and ethics program being effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act and promoting quality of care ; Effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Organization to have established compliance standards and procedures to be followed by employees and other agents being reasonably capable of reducing prospect of criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Propensity to engage in criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act by employees and other agents and place and publicizing reporting system whereby employees and other agents reporting violations by others within organization without fear of retribution ; Utilizing monitoring and auditing systems reasonably designed to detect criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE proceeding ; Discovery or admissibility of information described in section in criminal, civil or
Index of Sec 1451. ...CRIMINAL justice system ; Improving family stability or reducing maternal and child involvement in
Index of Sec 1713. ...CRIMINAL sexual abuse or other violations or crimes resulted in serious bodily injury ; Respect to instances of violations or crimes committed inside of facility being violations or crimes of abuse, neglect and exploitation,
Index of Sec 1413. ...DEBT ; Increase Medicare dss for hospital by additional amount based on amount of uncompensated care provided by hospital based on criteria for uncompensated care as determined by Secretary excluding bad
Index of Sec 1112. ...HEALTH or safety of resident or residents of facility or penalty imposed for deficiency described in subclause ; Secretary not reducing under subclause amount of penalty if penalty imposed for deficiency described in subclause or actual harm or widespread harm immediately jeopardizing
Index of Sec 1421. ...HEALTH or safety of resident or residents of facility or penalty imposed for deficiency described in clause ; State not reducing under clause amount of penalty if penalty imposed for deficiency described in clause or actual harm or widespread harm immediately jeopardizing
Index of Sec 1421. ...IMPOSITION ; Case where facility self-reports and promptly corrects deficiency For which penalty imposed under clause not later than 10 calendar days after date of
Index of Sec 1421. ...JEOPARDY ; Case of deficiency where facility cited for actual harm or immediate
Index of Sec 1421. ...JEOPARDY ; Case of deficiency where facility cited for actual harm or immediate
Index of Sec 1421. ...JEOPARDY ; Case of deficiency where facility cited for actual harm or immediate
Index of Sec 1421. ...JEOPARDY ; Case of deficiency where facility cited for actual harm or immediate
Index of Sec 1421. ...COMPLIANCE with State and Federal laws and regulations applicable to facilities ; Conduct periodic reviews and preparing root-cause quality and deficiency analyses of chain to assess if facilities of chain in
Index of Sec 1422. ...DEFICIENCY citations, changes in quality performance or changes in other metrics of resident quality of care ; Evaluation determining if programs leading to changes in
Index of Sec 1412. ...DEFICIENCY citations, changes in quality performance or changes in other metrics of resident quality of care ; Evaluation determining if programs leading to changes in
Index of Sec 1412. ...DEMENTIA management training and resident abuse prevention training after curriculum ;
Index of Sec 1431. ...DEMENTIA management training and resident abuse prevention training after curriculum ;
Index of Sec 1431. ...SOCIAL ; Skills to recognize and seek help for issues related to health, developmental delays and
Index of Sec 1904. ...DIABETES screening tests ;
Index of Sec 1305. ...PROSTHETICS, orthotics and supplies ; Requirement for accreditation described in clause not applying for purposes of supplying diabetic testing supplies, canes and crutches in case of pharmacy enrolled under section 1866(j) as supplier of durable medical equipment,
Index of Sec 1148. ...IMAGING equipment ; Computing number of practice expense relative value units under subsection with respect to advanced diagnostic imaging services presumed rate of utilization of
Index of Sec 1147. ...DIAGNOSTIC code described in section 1886(d)(4)(d)( iv and health care acquired condition determined as non-covered service under title XVIII ; Respect to amounts expended for services related to presence of condition to be identified by secondary
Index of Sec 1751. ...DIAGNOSTIC mammograms and Medicare covered preventive services ; Section 1833(t)(1)(b)( iv of Social Security Act 42 USC 1395l(t)(1)(b)( iv amended by striking screening mammography and diagnostic mammography and inserting
Index of Sec 1305. ...DIFFERENTIAL payments based on capabilities of independent patient-centered medical home ; Allowing for
Index of Sec 1302. ...DISCHARGE ; Base operating DRG payment amount for
Index of Sec 1151. ...DISCHARGE if subsection not ; Payment amount otherwise to be made under subsection for
Index of Sec 1151. ...DISCHARGE relating to applicable condition ;
Index of Sec 1151. ...DISCHARGE from hospital or critical access hospital ; Creating new code and payment amount under fee schedule in section 1848 of Social Security Act for services furnished by appropriate physician seeing individual within first week after
Index of Sec 1151. ...DISCHARGE of individual from hospital and other services determined appropriate by Secretary ; Term post acute services meaning services For which payment to be made under Medicare program furnished by skilled nursing facilities, inpatient rehabilitation facilities, long term care hospitals, hospital based outpatient rehabilitation facilities and home health agencies to individual after
Index of Sec 1152. ...DISCHARGE ; No person working at skilled nursing facility to be penalized, discriminated or retaliated with respect to aspect of employment including
Index of Sec 1415. ...DISCHARGE ; No person working at nursing facility to be penalized, discriminated or retaliated with respect to aspect of employment including
Index of Sec 1415. ...DISCHARGE ; Admission of individual to same or another applicable hospital within time period specified by Secretary from date of
Index of Sec 1151. ...DISCHARGE from applicable hospital or critical access hospital ; Claim submitted post-acute care provider under title XVIII of Social Security Act indicating that individual readmitted to hospital post-acute care provider or admitted from home and care of home health agency within 30 days of initial
Index of Sec 1151. ...DISCHARGE by amount equal to product ; Secretary reducing payments otherwise to be made to hospital under subsection
Index of Sec 1151. ...DISCHARGES for hospital ; Annual percentage increase factor applying to base rate for
Index of Sec 1103. ...DISCHARGES for hospital or unit ; Annual percentage increase factor applying to base rate for
Index of Sec 1103. ...DISCHARGES from applicable hospital occurring during fiscal year beginning after October 1 ; Respect to payment for
Index of Sec 1151. ...DISCHARGES for conditions from hospital for fiscal year ; Term aggregate payments for discharges meaning sum of base operating DRG payment amounts for
Index of Sec 1151. ...DISCHARGES occurring after January 1 ; Amendments making by section applying to
Index of Sec 1751. ...DISCHARGES or services furnished after first day of fiscal year or rate year beginning after October 1 ; Subparagraph applying to
Index of Sec 1151. ...DISCHARGES for applicable condition for applicable period and hospital ; Excess readmissions not including readmissions for applicable condition For which fewer than minimum number of
Index of Sec 1151. ...DISCHARGES ; Bundle to be applied across categories of providers of inpatient services and post acute care services or limited to certain categories of providers, services or
Index of Sec 1152. ...DISCIPLINARY mechanisms as appropriate ; Standards to be consistently enforced through appropriate
Index of Sec 1412. ...DISCIPLINARY mechanisms as appropriate ; Standards to be consistently enforced through appropriate
Index of Sec 1412. ...DISCIPLINARY team-based models in provider and nonprovider settings to enhance safety and improving quality of patient care ; Work in inter-professional teams and multi-
Index of Sec 1505. ...DISCLOSING entity ; Term facility meaning
Index of Sec 1411. ...DISCLOSURE under section 552 of title 5, United States Code or other similar Federal ; Information described in paragraph or considered confidential and not subject to
Index of Sec 1451. ...DISCLOSURE or reporting of information not of type required to be disclosed or reported under section ;
Index of Sec 1451. ...DISCLOSURE or reporting of type of information required to be disclosed or reported under section to Federal ;
Index of Sec 1451. ...DISCLOSURE of ownership and additional DISCLOSABLE partying information ; Requiring
Index of Sec 1411. ...DISCLOSURE of ownership and additional DISCLOSABLE partying information ; Requiring
Index of Sec 1411. ...DISCLOSURES to facilitate identification of Individuals likely to be ineligible for low-income assistance under medicare prescription Drug Program to Assist social security administration's outreach to eligible Individuals ;
Index of Sec 1203. ...DISCLOSURES to facilitate identification of Individuals likely to be ineligible for low-income assistance under medicare prescription Drug Program to Assist social security administration's outreach to eligible Individuals ;
Index of Sec 1801. ...DISCLOSURES to facilitate identification of Individuals likely to be ineligible for low-income Subsidies under medicare prescription Drug Program to Assist social security administration's outreach to eligible Individuals ;
Index of Sec 1801. ...DISCLOSURES making after date being 12 months after date of enactment of Act ; Amendments making by section applying to
Index of Sec 1801. ...APPOINTMENT ; Considering appointment to Commission or clinical perspective advisory panel described paragraph Secretary or Commission reviewing expertise of individual and financial disclosure report filed by individual pursuant to Ethics in Government Act of 1978 for individual under consideations for
Index of Sec 1401. ...DISCRETIONARY authority to individuals organization knowing or known through exercise of due diligence ; Organization to have used due care not to delegate substantial
Index of Sec 1412. ...DISCRETIONARY authority to individuals organization knowing or known through exercise of due diligence ; Organization to have used due care not to delegate substantial
Index of Sec 1412. ...DISPROPORTIONATE share hospitals ; Term Medicare dss meaning adjustments in payments under section 1886(d)(5)(f) of Social Security Act 42 USC 1395ww(d)(5)(f) for inpatient hospital services furnished by
Index of Sec 1112. ...DISPROPORTIONATE share hospitals ; Term Medicaid dss meaning adjustments in payments under section 1923 of Social Security Act for inpatient hospital services furnished by
Index of Sec 1704. ...DISPROPORTIONATE share payments using latest available data as estimated by Secretary ; Eligible to receive $10,000,000 or more in
Index of Sec 1151. ...CLINICAL decision support, appropriate professional associations and Federal and private health plans and other relevant stakeholders ; Center providing for dissemination of appropriate findings produced by research supported, conducted or synthesized under section to health care providers, patients, vendors of health information technology focused on
Index of Sec 1401. ...CONFIDENTIALITY agreements making with respect to use of data under section ; Dissemination of which violating privacy of research participants or violating
Index of Sec 1401. ...DISSEMINATION to individuals with limited English proficiency ; Center consulting with stakeholders concerning types of dissemination to be useful to end users of information and providing for utilization of multiple formats for conveying findings to different audiences including
Index of Sec 1401. ...DISSEMINATION of best practices in early childhood home visitation ; Amount equal to 5 percent of amounts to pay cost of evaluation provided in subsection and provision to States of training and technical assistance including
Index of Sec 1904. ...DISSEMINATION of findings of research conducted and supported under section enabling clinicians, patients, consumers and payers to make more informed health care decisions improving quality and value ; Make recommendations to center for broad
Index of Sec 1401. ...DISSEMINATION of research findings in order to ensure effective communication of findings and use and incorporation of findings into relevant activities for purpose of informing higher quality and more effective and efficient decisions regarding medical items and services ; Center developing protocols and strategies for appropriate
Index of Sec 1401. ...CONVEYING findings to different audiences including dissemination to individuals with limited English proficiency ; Center consulting with stakeholders concerning types of dissemination to be useful to end users of information and providing for utilization of multiple formats for
Index of Sec 1401. ...DISTRIBUTION of covered drug, device or medical supply ; Term distributor of covered drug, device or medical supply meaning entity engaged in marketing or
Index of Sec 1451. ...DISTRIBUTION of covered drug, device, biological or medical supply ; Conversion, processing, marketing or
Index of Sec 1451. ...DISTRIBUTION of grants so as to betting target Medicare beneficiaries in greatest need of language services ; Designing and carrying out demonstration Secretary taking into consideations results of study conducted under section 1221(a) and adjusting
Index of Sec 1222. ...DISTRIBUTION of Medicare dss to compensate for higher Medicare costs associated with serving low-income beneficiaries ; Appropriate amount and
Index of Sec 1112. ...DISTRIBUTION of Medicare dss to hospitals given continued uncompensated care costs ; Appropriate amount and
Index of Sec 1112. ...DISTRIBUTION, stock or stock option grant or ownership or investment interest holding by physician in manufacturer ; Term payment or other transfer of value including compensation, gift, honorarium, speaking fee, consulting fee, travel, services, dividend, profit
Index of Sec 1451. ...DISTRIBUTION, stock or stock option grant or ownership or investment interest holding by physician in manufacturer ; Term payment or other transfer of value including compensation, gift, honorarium, speaking fee, consulting fee, travel, services, dividend, profit
Index of Sec 1451. ...CERTIFICATION as marriage and family therapist pursuant to State law ; Possessing master or doctoral degree qualifying for licensure or
Index of Sec 1308. ...DOCUMENTATION on Referrals to Programs at high Risk of wasting and abusing ; Sec 1638, requirement for Physicians to provide
Index of Sec 1638. ...CERTIFICATIONS for home health services or referrals for other items or servicing written or ordered by physician or supplier under title as specified by Secretary ; Physician or supplier under section 1866(j) if physician or supplier failing to maintain and provide access to documentation relating to written orders or requests for payment for durable medical equipment,
Index of Sec 1638. ...CERTIFICATIONS for home health services or referrals for other items or servicing written or ordered by provider under title as specified by Secretary ; Maintaining and providing access to documentation relating to written orders or requests for payment for durable medical equipment,
Index of Sec 1638. ...DOCUMENTATION excepting in extraordinary situations as determined by Commissioner ; Matters attested in application to be subject to appropriate methods of verification without need of individual to provide additional
Index of Sec 1203. ...DRUG or biologic manufactured by manufacturer not entering and effect rebate agreement described in paragraph ; Term covered part D drug not including
Index of Sec 1181. ...DRUG or biologic manufactured by manufacturer not entering and effect for qualifying drugs discount agreement described in paragraph ; Term covered part D drug not including
Index of Sec 1182. ...DRUG ; Sponsor or plan providing discount to enrollee at time enrollee paying for
Index of Sec 1182. ...DRUG application approved by Food and drugging Administration ; Drug produced or distributed under original new
Index of Sec 1182. ...DRUG application approved by Food and drugging Administration ; Drug originally marketed under original new
Index of Sec 1182. ...DRUG being therapeutic equivalent or utilization management applied ; Drug replaced with generic
Index of Sec 1185. ...DRUG whose labeling including boxed warning required by Food and drugging Administration under section 210.57 of title 21, Code of Federal Regulations ;
Index of Sec 1185. ...DRUG required under subsection of section 505-1 of Federal Food, Drug and Cosmetic Act to have Risk Evaluation and Management Strategy including elements under subsection of section ;
Index of Sec 1185. ...DRUG and medical device surveillance efforts and other forms of electronic health data ; Encouraging development and use of clinical registries and development of clinical effectiveness research data networks from electronic health records, post marketing
Index of Sec 1401. ...DRUG ; Term covered means with respect to
Index of Sec 1451. ...DRUG ; Price concessions in order to obtain accurate amp for
Index of Sec 1741. ...DRUG or product ; Rebate obligation with respect to drug under section to be amount computed under section for new
Index of Sec 1742. ...DRUG or device administered, dispensed or used ; Term clinical investigation meaning experiment involving one or more human subjects or materials derived from human subjects in which
Index of Sec 1451. ...DRUG or product ; Rebate obligation with respect to drug under section to be amount computed under section for new
Index of Sec 1742. ...DRUG under plan ; Formulary of plan materially changed so to reduce coverage of
Index of Sec 1185. ...DRUG, device, biological or medical supply reporting under subsection or hospital or other health care entity reporting physician ownership under subsection ; Accuracy of information submitted under subsections and making available under paragraph to be responsibility of applicable manufacturer or distributor of covered
Index of Sec 1451. ...DRUG ; Information submitted under section during preceding year aggregated for applicable manufacturer or distributor of covered
Index of Sec 1451. ...DRUG, device or medical supply ; Term applicable manufacturer meaning manufacturer of covered drug, device, biological or medical supply and term applicable distributor meaning distributor of covered
Index of Sec 1451. ...DRUG, device or medical supply ; Term distributor of covered drug, device or medical supply meaning entity engaged in marketing or distribution of covered
Index of Sec 1451. ...DRUG, device, biological or medical supply ; Conversion, processing, marketing or distribution of covered
Index of Sec 1451. ...DRUG, device, biological or medical supply to covered recipient directly employed and works solely for manufacturer or distributor ; Compensation paid by manufacturer or distributor of covered
Index of Sec 1451. ...DRUG ; Not later than 30 days after last day of month of rebate period under agreement on manufacturer's total number of units used to calculate monthly average manufacturer price for covered outpatient
Index of Sec 1741. ...DRUG of manufacturer dispensed after December 31, 2010 ; Amount specified in paragraph for covered part D
Index of Sec 1181. ...DRUG provided by manufacturer for rebate period ; Respect to dosage form and strength of covered part D
Index of Sec 1181. ...DRUG provided by manufacturer for rebate period ; Term average Medicare drug program full-benefit dual eligible rebate amount means with respect to dosage form and strength of covered part D
Index of Sec 1181. ...DRUG when so enrolled ; Case of individual enrolled in prescription drug plan prescribed and using covered part D
Index of Sec 1185. ...DRUG being therapeutic equivalent or utilization management applied ; Drug replaced with generic
Index of Sec 1185. ...ADMINISTRATIVE procedures ; Infusion or injectable drug or Secretary determining as allowed in Agency
Index of Sec 1741. ...DRUG ; Case of payment or other transfer of value making to covered recipient by applicable manufacturer or distributor pursuant to product development agreement for services furnished in connection with development of new
Index of Sec 1451. ...DRUG ; Case of payment or other transfer of value making to covered recipient by applicable manufacturer or distributor in connection with clinical investigation regarding new
Index of Sec 1451. ...DRUG dispensed during rebate period to full-benefit dual eligible individuals enrolled in prescription drug plans administered by PDP sponsor or Ma-pd plans administered by Ma-pd organization ; Number of units of dosage and strength of
Index of Sec 1181. ...DRUG ; Case of other covered outpatient
Index of Sec 1181. ...DRUG not including drug or biologic manufactured by manufacturer not entering and effect rebate agreement described in paragraph ; Term covered part D
Index of Sec 1181. ...DRUG not including drug or biologic manufactured by manufacturer not entering and effect for qualifying drugs discount agreement described in paragraph ; Term covered part D
Index of Sec 1182. ...DRUG ; Term drug-component negotiated price means with respect to qualifying
Index of Sec 1182. ...DRUG issued by Food and drugging Administration ; Drug removed from formulary of plan because of recall or withdrawal of
Index of Sec 1185. ...DRUG of manufacturer dispensed to full-benefit dual eligible Medicare drug plan enrollees under prescription drug plan operated by PDP sponsor during rebate period ; Information on total number of units of dosageing, forming and strength of
Index of Sec 1181. ...DRUG dispensed during rebate period to full-benefit dual eligible individuals enrolled in prescription drug plans administered by PDP sponsors and Ma-pd plans administered by Ma-pd organizations ; Total number of units of dosage and strength of
Index of Sec 1181. ...DRUG so provided and dispensed For which payment being made by PDP sponsor under part D or Ma organization under part C for rebate period ; Total number of units of dosage form and strength of
Index of Sec 1181. ...DRUG application ; Including drug product marketed by cross-licensed producers or distributors operating under new
Index of Sec 1182. ...DRUG application approved by Food and drugging Administration ; Drug produced or distributed under original new
Index of Sec 1182. ...DRUG application approved by Food and drugging Administration ; Drug originally marketed under original new
Index of Sec 1182. ...DRUG costs meaning amount ; Term covered
Index of Sec 1204. ...DRUG costs incurred by beneficiary during retroactive coverage period of beneficiary in accordance with subsection and case beneficiary described in subsection ; Beneficiary entitled to reimbursement by plan for covered
Index of Sec 1204. ...DRUG costs incurred by beneficiary during retroactive coverage period of beneficiary ; Organization or other third party owed payment on behalf of beneficiary for covered
Index of Sec 1204. ...DRUG coverage occuring between initial coverage limit of subsection and annual out-of-pocket threshold of subsection ; Term actual gap in coverage meaning gap in prescription
Index of Sec 1182. ...DRUG coverage occurring between initial coverage limit ; Term original in gap coverage meaning gap in prescription
Index of Sec 1182. ...DRUG means with respect to prescription drug plan or Ma-pd plan ; Term qualifying
Index of Sec 1182. ...DRUG plan or Ma-pd plan ; Term qualifying drug means with respect to prescription
Index of Sec 1182. ...DRUG plan or Ma-pd plan other than individual being subsidy-eligible individual ; Term qualifying enrollee meaning individual enrolled in prescription
Index of Sec 1182. ...DRUG plan or Ma-pd plan under subsection including line-item description of items For which reimbursement being made ; Reimbursement making by prescription
Index of Sec 1204. ...DRUG plan or Ma-pd plan making reimbursement under subsection to retroactive lis enrollment beneficiary with respect to claim ; Prescription
Index of Sec 1204. ...DRUG plan using formulary ; Process taking into account extent to which prescription drugging necessary for individual covered in case of PDP sponsor of prescription
Index of Sec 1205. ...DRUG plan enrollees and drugs dispensed to PDP and Ma-pd enrollees being not full-benefit dual eligible individuals ; Rebateing, discounting or other price concession applying equally to drugs dispensed to full-benefit dual eligible Medicare
Index of Sec 1181. ...DRUG plan enrollees under prescription drug plan operated by PDP sponsor during rebate period ; Information on total number of units of dosageing, forming and strength of drug of manufacturer dispensed to full-benefit dual eligible Medicare
Index of Sec 1181. ...DRUG plan enrollees ; Information on extent to which price discounts, price concessions and rebates applying equally to full-benefit dual eligible Medicare drug plan enrollees and PDP enrollees being not full-benefit dual eligible Medicare
Index of Sec 1181. ...DRUG plan as measured by quality ratings established by Secretary ; Use of prior authorization or other restrictions on access to coverage of prescription drugs sponsor and overall quality of prescription
Index of Sec 1205. ...DRUG plan requiring that sponsor complying with subparagraphs ; Contract entered with PDP sponsor under part with respect to prescription
Index of Sec 1181. ...DRUG plan operated by PDP sponsor during rebate period ; Information on total number of units of dosageing, forming and strength of drug of manufacturer dispensed to full-benefit dual eligible Medicare drug plan enrollees under prescription
Index of Sec 1181. ...DRUG plan offered by PDP sponsor or Ma-pd plan offered by Ma organization ; Case of discount provided under subsection with respect to prescription
Index of Sec 1182. ...DRUG plan prescribed and using covered part D drug when so enrolled ; Case of individual enrolled in prescription
Index of Sec 1185. ...DRUG plan under part D of title XVIII of Social Security Act ; Case of retroactive lis enrollment beneficiary enrolled under prescription
Index of Sec 1204. ...DRUG plan under part D of title XVIII of Social Security Act and subsequently becoming eligible as full-benefit dual eligible individual ; Enrolling in prescription
Index of Sec 1204. ...CONTRACT ; Prescription drug plan offered by sponsor of plan awarding
Index of Sec 1204. ...DRUG plan pursuant to Centers for Medicare and Medicaid Services' request for proposals issued on February 17, 2009 relating to Medicare part D retroactive coverage for certain low income beneficiaries ; Rfp contract described in section being contract entered between Secretary and sponsor of prescription
Index of Sec 1204. ...DRUG plans and Ma-pd planing instead of State plans under title XIX ; Discounts to be applied under subsection to prescription
Index of Sec 1182. ...DRUG plans under part D ; Provision applying amendment making by paragraph to prescription
Index of Sec 1174. ...DRUG plans administered by PDP sponsor or Ma-pd plans administered by Ma-pd organization ; Number of units of dosage and strength of drug dispensed during rebate period to full-benefit dual eligible individuals enrolled in prescription
Index of Sec 1181. ...DRUG plans administered by PDP sponsors and Ma-pd plans administered by Ma-pd organizations ; Total number of units of dosage and strength of drug dispensed during rebate period to full-benefit dual eligible individuals enrolled in prescription
Index of Sec 1181. ...DRUG plan sponsors under part D of title XVIII and entities applying to participate as providers of services or suppliers in managed care organizations and plans ; Including managed care organizations under title XIX, Medicare Advantage organizations under part C of title XVIII, prescription
Index of Sec 1611. ...DRUG application ; Including drug product marketed by cross-licensed producers or distributors operating under new
Index of Sec 1182. ...DRUG program full-benefit dual eligible rebate amount of section and determining amount of rebate required under section and period ; Secretary determining being necessary to enable Secretary to calculate average Medicare
Index of Sec 1181. ...DRUG program ; Provision authorizing disclosure of return information to facilitate identification of individuals likely to be ineligible for low-income subsidies under Medicare prescription
Index of Sec 1203. ...DRUG program full-benefit dual eligible rebate amount means with respect to dosage form and strength of covered part D drug provided by manufacturer for rebate period ; Term average Medicare
Index of Sec 1181. ...DRUG subsidy under section 1860d-14 of Social Security Act and not applying for subsidy ; Eligible for low-income prescription
Index of Sec 1801. ...DRUG subsidy under section 1860d-14 of Social Security Act for use in outreach efforts under section 1144 of Social Security Act ; Return information disclosed under paragraph to be used only by officers and employees of Social Security Administration solely for purposes of identifying individuals likely to be ineligible for low-income prescription
Index of Sec 1801. ...DRUG-component negotiated price for qualifying drugs for period involved ; Amount of discount specified in paragraph for discount period for plan being equal to 50 percent of amount of
Index of Sec 1182. ...DRUG-component negotiated price means with respect to qualifying drug ; Term
Index of Sec 1182. ...PROSTHETICS, orthotics and supplies and issued provider number for 5 years and final adverse action of title 42, Code of Federal Regulations never imposed ; Requirement for surety bond described in subparagraph not applying in case of pharmacy enrolled under section 1866(j) as supplier of durable medical equipment,
Index of Sec 1148. ...PROSTHETICS, orthotics and supplies ; Requirement for accreditation described in clause not applying for purposes of supplying diabetic testing supplies, canes and crutches in case of pharmacy enrolled under section 1866(j) as supplier of durable medical equipment,
Index of Sec 1148. ...FRAUD and abuse ; Furnishing or ordering of durable medical equipment in order to enable better monitoring of claims for payment for additional services under title or ordering, furnishing or prescribing of other items and services determined by Secretary to pose high risk of waste,
Index of Sec 1633. ...CERTIFICATIONS for home health services or referrals for other items or servicing written or ordered by physician or supplier under title as specified by Secretary ; Physician or supplier under section 1866(j) if physician or supplier failing to maintain and provide access to documentation relating to written orders or requests for payment for durable medical equipment,
Index of Sec 1638. ...CERTIFICATIONS for home health services or referrals for other items or servicing written or ordered by provider under title as specified by Secretary ; Maintaining and providing access to documentation relating to written orders or requests for payment for durable medical equipment,
Index of Sec 1638. ...MEDICARE ; Sec 1639, Face to Face Encounter with patient required before Physicians certifying eligibility for Home health Services or durable medical equipment under
Index of Sec 1639. ...DUTY ; Term obligation meaning established
Index of Sec 1645. ...ECONOMIC self-sufficiency, employment advancement, school-readiness and educational achievement or reducing dependence on public assistance ; Increasing
Index of Sec 1713. ...ECONOMY-wide private nonfarm business multi-factor productivity ; Productivity offset equal to percentage change in 10-year moving average of annual
Index of Sec 1103. ...EDUCATION of children ; Activities designed to help parents becoming full partners in
Index of Sec 1904. ...EDUCATION pertaining to fraud, waste and abuse for organization's employees and contractors ; Effective training and
Index of Sec 1635. ...EDUCATION and payments used for graduate medical education ; Information on total payments for graduate medical
Index of Sec 1744. ...CHILD'S enrollment ceasing for reason ; Model ensuring that patient-centered medical home services received by child providing for continuous involvement and education of parent or caregiver and assistance to child in obtaining necessary transitional care if
Index of Sec 1722. ...CAPITATION rates described in subsection ; Indirect costs of medical education from
Index of Sec 1161. ...EDUCATION costs under section 1886(h) of Act ; Jurisdictionally proper appeal pending as of date of enactment of Act on issue of payment for indirect costs of medical education under section 1886(d)(5)(b) of Social Security Act or direct graduate medical
Index of Sec 1503. ...EDUCATION consistent with subsection whether provided or outside of hospital ; Term medical assistance including payment for costs of graduate medical
Index of Sec 1744. ...EDUCATION ; Information on total payments for graduate medical education and payments used for graduate medical
Index of Sec 1744. ...EDUCATION ; Rates including payment for graduate medical
Index of Sec 1744. ...EDUCATION ; Amendments making by section taking effect on date of enactment of Act Nothing in section to be construed as affecting payments making before date under State plan under title XIX of Social Security Act for graduate medical
Index of Sec 1744. ...EDUCATION and training in linguistically appropriate service delivery ; Ensuring that appropriate clinical and support staff receiving ongoing
Index of Sec 1222. ...EDUCATION costs under section 1886(h) of Act ; Jurisdictionally proper appeal pending as of date of enactment of Act on issue of payment for indirect costs of medical education under section 1886(d)(5)(b) of Social Security Act or direct graduate medical
Index of Sec 1503. ...EDUCATIONAL achievement or reducing dependence on public assistance ; Increasing economic self-sufficiency, employment advancement, school-readiness and
Index of Sec 1713. ...EDUCATIONAL tool helping patients if appropriate ; Term patient decision aid meaning
Index of Sec 1236. ...ELECTRONIC versions of Medicare ; Secretary including information described in subparagraph in paper and
Index of Sec 1233. ...ELIGIBILITY, benefit and cost-sharing assistance available to dual eligibles by State ; Collection of data and database describing
Index of Sec 1905. ...ELIGIBILITY for Home health Services or durable medical equipment under medicare ; Sec 1639, Face to Face Encounter with patient required before Physicians certifying
Index of Sec 1639. ...ELIGIBILITY of individual after first day under following ; State applying asset or resource test in determining
Index of Sec 1703. ...ELIGIBILITY for services under subsection ; Option of State, purposes of subsection, determining
Index of Sec 1714. ...AFFORDABILITY credits under subtitle C of title II of division A of America's Affordable Health Choices acting of 2009 as specified under memorandum ; Redeterminations of eligibility for individuals unless periodicity of redeterminations being consistent with periodicity for redeterminations by Commissioner of eligibility for
Index of Sec 1702. ...ELIGIBILITY in same manner ; State providing for making medical assistance available during presumptive eligibility period and promptly making determination of
Index of Sec 1702. ...AFFORDABILITY credits under subtitle C of title II of division A of America's Affordable Health Choices acting of 2009 ; Commissioner determining that State Medicaid agency having capacity to make determinations of eligibility for
Index of Sec 1702. ...ELIGIBILITY making after January 1 ; Amendment making by subsection applying to determinations of
Index of Sec 1733. ...ELIGIBILITY for enrollment during special enrollment period described in paragraph ; Secretary of Defense establishing method for identifying individuals described in paragraph and providing notice of
Index of Sec 1234. ...AFFORDABILITY credits under subtitle C of title II of division A of America's Affordable Health Choices acting of 2009 as specified under memorandum ; Redeterminations of eligibility for individuals unless periodicity of redeterminations being consistent with periodicity for redeterminations by Commissioner of eligibility for
Index of Sec 1702. ...ELIGIBILITY of individual consistent with sectioning and memorandum ; Redeterminations of
Index of Sec 1702. ...ELIGIBILITY determination under subtitle C of title II of division A of America's Affordable Health Choices acting of 2009 ; Including erroneous payments making being attributable to error in
Index of Sec 1702. ...ELIGIBILITY determination to maximum extent feasible ; Individual applied directly to State for assistance excepting that State using income-related information used by Commissioner and provided to State under memorandum in making presumptive
Index of Sec 1702. ...ELIGIBILITY option described in section 1902(e) for targeted low-income children whose family income below 200 percent of poverty line ; Plan providing for implementation under title of 12-month continuous
Index of Sec 1733. ...ELIGIBILITY in same manner ; State providing for making medical assistance available during presumptive eligibility period and promptly making determination of
Index of Sec 1702. ...ELIGIBILITY period ; State plan approved under section 1902 providing for making medical assistance available to individual described in section 1902( hh during presumptive
Index of Sec 1714. ...ELIGIBILITY period in accordance with section ; Providing for making medical assistance available to individuals described in subsection of section 1920c during presumptive
Index of Sec 1714. ...ELIGIBILITY period under section ; Medical assistance provided to individual described in subsection of section 1920c during presumptive
Index of Sec 1714. ...ELIGIBILITY standards, methodologies or procedures under plan as in effect on June 16 ; Subject to paragraph State not in effect eligibility standards, methodologies or procedures under State child health plan under title XXI being more restrictive than
Index of Sec 1703. ...ELIGIBILITY standards, methodologies or procedures under plan as in effect on June 16 ; State being not eligible for payment under subsection for calendar quarter beginning after date of enactment of subsection if eligibility standards, methodologies or procedures under plan under title being more restrictive than
Index of Sec 1703. ...CHILD health plan under title XXI being more restrictive than eligibility standards, methodologies or procedures under plan as in effect on June 16 ; Subject to paragraph State not in effect eligibility standards, methodologies or procedures under State
Index of Sec 1703. ...FINANCIAL interests in accordance with subsection of section 208 ; Member of Commission or clinical perspective advisory panel being full-time Government employee or special Government employee disclosing to Secretary
Index of Sec 1401. ...INFORMATION under subsection ; Term not including physician being employee of applicable manufacturer required to submit
Index of Sec 1451. ...ADMINISTRATIVE violations under Act ; Organization to have established compliance standards and procedures to be followed by employees, contractors and other agents being reasonably capable of reducing prospect of criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act by employees and other agents and place and publicizing reporting system whereby employees and other agents reporting violations by others within organization without fear of retribution ; Utilizing monitoring and auditing systems reasonably designed to detect criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Organization to have established compliance standards and procedures to be followed by employees and other agents being reasonably capable of reducing prospect of criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act by employees and other agents and place and publicizing reporting system whereby employees and other agents reporting violations by others within organization without fear of retribution ; Utilizing monitoring and auditing systems reasonably designed to detect criminal, civil and
Index of Sec 1412. ...CIVIL monetary penalties levied against facility, employees, contractors and other agents ; Number of
Index of Sec 1413. ...AUDITABLE data in uniform format ; Beginning not later than 2 years after date of enactment of subparagraph and consulting with State long-term care ombudsman programs, consumer advocacy groups, provider stakeholder groups, employees and representatives and other parties Secretary deeming appropriate Secretary requiring skilled nursing facility electronically to submit to Secretary direct care staffing information based on payroll and other verifiable and
Index of Sec 1416. ...AUDITABLE data in uniform format ; Beginning not later than 2 years after date of enactment of subparagraph and consulting with State long-term care ombudsman programs, consumer advocacy groups, provider stakeholder groups, employees and representatives and other parties Secretary deeming appropriate Secretary requiring nursing facility electronically to submit to Secretary direct care staffing information based on payroll and other verifiable and
Index of Sec 1416. ...EDUCATION pertaining to fraud, waste and abuse for organization's employees and contractors ; Effective training and
Index of Sec 1635. ...ADMINISTRATIVE obligations ; Repayment of overpayments by provider of services or supplier not otherwise limiting provider or supplier's potential liability for
Index of Sec 1641. ...DRUG subsidy under section 1860d-14 of Social Security Act for use in outreach efforts under section 1144 of Social Security Act ; Return information disclosed under paragraph to be used only by officers and employees of Social Security Administration solely for purposes of identifying individuals likely to be ineligible for low-income prescription
Index of Sec 1801. ...TENURE and hours of care provided by category of certified employees referenced in clause per resident per day ; Including information on employee turnover and
Index of Sec 1416. ...TENURE and hours of care provided by category of certified employees referenced in clause per resident per day ; Including information on employee turnover and
Index of Sec 1416. ...ACCEPTABLE coverage ; Employers having procedures in effect to ensure timely transition without interruption of coverage of Chip enrollees from assistance under title XXI to
Index of Sec 1703. ...DISCHARGE ; No person working at skilled nursing facility to be penalized, discriminated or retaliated with respect to aspect of employment including
Index of Sec 1415. ...DISCHARGE ; No person working at nursing facility to be penalized, discriminated or retaliated with respect to aspect of employment including
Index of Sec 1415. ...EDUCATIONAL achievement or reducing dependence on public assistance ; Increasing economic self-sufficiency, employment advancement, school-readiness and
Index of Sec 1713. ...ENDORSEMENT described in subparagraph but applying measures without ; Secretary seeking
Index of Sec 1151. ...CONTRACT under section 1890(a) of Social Security Act but adopting and applying measures under paragraph without ; Secretary seeking endorsement of measures by entity with
Index of Sec 1151. ...ENDOSCOPIES furnished ; Term procedure rooms including rooms in which catheterizations, angiographies, angiograms and
Index of Sec 1156. ...ENGLISH proficiency by providing reimbursement for culturally and linguistically appropriate Services ; Sec 1222, demonstration to promote Access for medicare Beneficiaries with limited
Index of Sec 1222. ...ENTITLEMENT under part ; During individual's initial enrollment period and enrolling under part within 12-month period begining on first day of month after month of notification of
Index of Sec 1234. ...EQUITY in appropriate district court of United States ; Person believing person penalized, discriminated or retaliated or contract for services terminated in violation of clause complaint filed in violation of clause bringing action at law or
Index of Sec 1415. ...EQUITY in appropriate district court of United States ; Person believing person penalized, discriminated or retaliated or contract for services terminated in violation of clause complaint filed in violation of clause bringing action at law or
Index of Sec 1415. ...EQUIVALENCY ; Time so spent by resident to be counted towards determination of full-time
Index of Sec 1502. ...EQUIVALENCY if hospital incuring costs of stipends and fringe benefits of intern or resident during time intern or resident spends in setting ; Time spent by intern or resident in patient care activities at entity in nonprovider setting to be counted towards determination of full-time
Index of Sec 1502. ...EQUIVALENCY ; Time defined by Secretary and not prolonging total time resident participating in approved program beyond normal duration of program to be counted toward determination of full-time
Index of Sec 1503. ...EQUIVALENCY if hospital ; Occuring in hospital to be counted toward determination of full-time
Index of Sec 1503. ...ADMINISTRATIVE violations under Act and promoting quality of care consistent with regulations developed under clause ; Skilled nursing facility in operation compliance and ethics program being effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act and promoting quality of care consistent with regulations developed under clause ; Nursing facility in operation compliance and ethics program being effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...COMPLIANCE and ethics program for operating organizations including model compliance program ; Promulgating regulations for effective
Index of Sec 1412. ...COMPLIANCE and ethics program for operating organizations including model compliance program ; Developing regulations for effective
Index of Sec 1412. ...COMPLIANCE and ethics programs required to be established under subparagraph ; Secretary completeing evaluation of
Index of Sec 1412. ...COMPLIANCE and ethics programs required to be established under subparagraph ; Not later than 3 years after date of promulgation of regulations under clause Secretary completeing evaluation of
Index of Sec 1412. ...EXEMPTION from funding limitation for territories ;
Index of Sec 1731. ...EXPENDITURE for services furnished in one payment year ; No more than one-half of amounts to be available for
Index of Sec 1158. ...EXPENDITURE with respect to which State submitting claim for payment under other provision of Federal law ; Not including
Index of Sec 1904. ...EXPENDITURE For which State receiving payment under section ; State to which grant being made under section not expending Federal funds to meet State share of cost of eligible
Index of Sec 1904. ...EXPENDITURE targeting and updating for practitioners that consistent with methodologies described in subsection ; Allowing organization to have own
Index of Sec 1121. ...EXPENDITURES for Service category ; Increase by growth Rate to obtain 2010 allowed
Index of Sec 1121. ...EXPENDITURES attributable to multiple procedure payment reduction applicable to technical component for imaging under final rule published by Secretary in Federal Register on November 21 ; Secretary increasing reduction in
Index of Sec 1147. ...EXPENDITURES at benefits being available under paragraph ; Continations of coverage from initial coverage limit for expenditures incurred through total amount of
Index of Sec 1181. ...EXPENDITURES for items and services covered under parts A and B ; Resulting from normal variation in
Index of Sec 1301. ...EXPENDITURES from period of base amount to current year representing appropriate performance target for applicable beneficiaries ; Adjustment factor in clause equalling annual per capita amount reflecting changes in
Index of Sec 1301. ...EXPENDITURES, access and quality under title ; Report addressing impact of use of authorities on
Index of Sec 1301. ...EXPENDITURES ; Sec 1414 reporting of
Index of Sec 1414. ...EXPENDITURES for wages and benefits for direct care staff registered nurses, licensed professional nurses, certified nurse assistants and other medical and therapy staff ; Skilled nursing facilities separately reporting
Index of Sec 1414. ...EXPENDITURES listed on cost reports ; Taking
Index of Sec 1414. ...EXPENDITURES submitted under subsection readily available to interested parties upon request ; Secretary establishing procedures to make information on
Index of Sec 1414. ...CHILD health plan under title XXI ; Paragraph not to be construed as preventing State from imposing limitation described in section 2110(b)(5)(c)(i) for fiscal year in order to limit expenditures under State
Index of Sec 1703. ...EXPENDITURES making after July 1 ; Amendment making by subsection to be applying to
Index of Sec 1704. ...EXPENDITURES for calendar quarters beginning after date of enactment of Act and January 1, 2013 ; Amendments making by section applying to
Index of Sec 1731. ...EXPENDITURES being made consistent with goals and requirements as established under paragraph ;
Index of Sec 1744. ...EXPENDITURES for Services included in SGR compuations for Service category ; Total 2009 actual
Index of Sec 1121. ...EXPENDITURES resulting from application of percentages to be equal to $10,350,000,000 ; Period beginning with 2011 and ending with 2019 total estimated additional Federal
Index of Sec 1771. ...EXPENDITURES with respect to applicable beneficiaries for ACOS under title not exceeding amount ; Secretary limiting incentive payments to qualifying ACO under paragraph as necessary to ensure that aggregate
Index of Sec 1301. ...EXPENDITURES for 2nd preceding fiscal year ; Aggregate expenditures by State from State and local sources for programs of home visitation for families with young children and families expecting children for preceding fiscal year being not less than 100 percent of aggregate
Index of Sec 1904. ...EXPENDITURES for service category for 2009 computed under subclause by target growth rate for service category under subsection for 2010 ; Computing allowed expenditures for service category for 2010 by increasing allowed
Index of Sec 1121. ...EXPENDITURES based on Service categories ; Compuations of allowed and actual
Index of Sec 1121. ...EXPENDITURES, program integrity and other mattering Secretary deeming appropriate ; Secretary creating separate incentive arrangements for different categories of qualifying ACOS to reflect natural variations in data availability, variation in average annual attributable
Index of Sec 1301. ...EXPENDITURES for fiscal year to extent ; State for fiscal year being attributable to cost of programs not adhering to model of home visitation with strongest evidence of effectiveness not to be considered eligible
Index of Sec 1904. ...CLASSIFIATIONS system for yearing without changes ; Estimated expenditures under future skilled nursing facility servicing classifiations system for fiscal year beginning with fiscal year 2011 with changes to be equal to estimated expenditures otherwise occurring under title XVIII of Social Security Act under future skilled nursing facility servicing
Index of Sec 1111. ...EXPENDITURES and improving health outcomes in provision of items and services under title to applicable beneficiaries by qualifying accountable care organizations in order ; Designing to reduce growth of
Index of Sec 1301. ...EXPENDITURES under title ; Readmissions representing conditions or procedures being high volume or high
Index of Sec 1151. ...EXPENDITURES to provide voluntary home visitation as families with young children and families expecting children as practicable ; Means
Index of Sec 1904. ...ACCOUNT ; Proportion to total expenditures during fiscal year being made under title XVIII of Act from respective trust fund or
Index of Sec 1802. ...EXPENDITURES at benefits being available under paragraph ; Continations of coverage from initial coverage limit for expenditures incurred through total amount of
Index of Sec 1181. ...EXPENDITURES exceeding applicable percentage for fiscal year of allotment of State under subsection for fiscal year ; Total of
Index of Sec 1904. ...EXPENDITURE amount described in clause ; Model Secretary periodically rebasing base
Index of Sec 1301. ...EXPENDITURES and expansion of pilot program resulting in estimated spending to be less ; Demonstration program and pilot program reducing program
Index of Sec 1152. ...EXPENDITURES and quality of services under title after applicable beneficiary discontinuing receiving services under title through qualifying ACO ; Secretary monitoring data on
Index of Sec 1301. ...EXPENDITURES by State from State and local sources for programs of home visitation for families with young children and families expecting children for preceding fiscal year being not less than 100 percent of aggregate expenditures for 2nd preceding fiscal year ; Aggregate
Index of Sec 1904. ...FEASABILITY and advisability of reimbursing medical homes for medical home services under title on permanent basis ;
Index of Sec 1302. ...ON-site interpretation ; Feasibility of adopting payment methodolology for on-site interpreters including interpreters working as independent contractors and interpreters working for agencies providing
Index of Sec 1221. ...RELATIVE value scale by using adjustments when patient being LEP ; Feasibility of modifying existing Medicare resource-based
Index of Sec 1221. ...HOME services to high need beneficiaries and targeted high need beneficiaries ; Secretary establishing medical home pilot program for purpose of evaluating feasibility and advisability of reimbursing qualified patient-centered medical homes for furnishing medical
Index of Sec 1302. ...CONTRACTING directly with agencies providing off-site interpretation including telephonic and video interpretation pursuant to which contractors directly billing Medicare for services provided in support of physician office services for LEP Medicare patient ; Feasibility of Medicare
Index of Sec 1221. ...BENEFICIARY data ; Need and feasibility of including further gradations of diseases or conditions and multiple years of
Index of Sec 1167. ...MANAGERIAL control over facility or part or providing policies or procedures for operations of facility or providing financial or cash management services to facility ; Financial or
Index of Sec 1411. ...MANAGERIAL control over facility or part or providing policies or procedures for operations of facility or providing financial or cash management services to facility ; Financial or
Index of Sec 1411. ...FINANCIAL assistance under title VI of Civil Rights acting of 1964 42 USC 2000(d) et seq ; Nothing in section to be construed to limit otherwise existing obligations of recipients of Federal
Index of Sec 1222. ...FINANCIAL interest to be affected by advice given to Secretary with respect to matter ; Advisory committee member not participating with respect to particular matter considered in advisory committee meeting if member having
Index of Sec 1191. ...FINANCIAL interest to be affected by advice given to Secretary with respect to matter ; Member of Commission or clinical perspective advisory panel described in paragraph not participating with respect to particular matter considered in meeting of Commission or clinical perspective advisory panel if member having
Index of Sec 1401. ...FINANCIAL interest under section 208(a) of title 18, United States coding ; Term financial interest meaning
Index of Sec 1401. ...FINANCIAL interests in accordance with subsection of section 208 ; Member of Commission or clinical perspective advisory panel being full-time Government employee or special Government employee disclosing to Secretary
Index of Sec 1401. ...FINANCIAL participation resulting from implementation of pilot program under section not exceeding in aggregate $1,235,000,000 over 5-year period of program ; Additional Federal
Index of Sec 1722. ...FINANCIAL participation based on Federal medical assistance percentage for amounts in excess of specified under subparagraphs ; Subparagraphs not to be construed as preventing payment of Federal
Index of Sec 1721. ...FINANCIAL participation for payments ; Specific upper limit under section 447.332 of title 42, Code of Federal Regulations applicable to payments making by State for multiple source drugs under State Medicaid plan continuing to apply through December 31, 2010 for purposes of availability of Federal
Index of Sec 1741. ...FINANCIAL recoveries ; Secretary authorized to take actions including pursuit of
Index of Sec 1174. ...FINANCIAL relationships with Manufacturers and Distributors of covered Drugs, devices, biologicals or medical Supplies under medicare, medicaid or Chip and entities billing for Services under medicare ; Sec 1128h, financial Reports on Physicians'
Index of Sec 1451. ...FINANCIAL relationships with Manufacturers and Distributors of covered Drugs, devices, biologicals or medical Supplies under medicare, medicaid or Chip and entities billing for Services under medicare ; Sec 1128h, financial Reports on Physicians'
Index of Sec 1451. ...FINANCIAL risk ; Partial capitation model described in paragraph being model in which qualifying ACO at
Index of Sec 1301. ...FINANCIAL services to facility ; Providing management or administrative services, clinical consulting services or accounting or
Index of Sec 1411. ...FINANCING for physician owner or investor in hospital ; Hospital not directly or indirectly providing loans or
Index of Sec 1156. ...FISCAL year involved ; Rate computed for previous fiscal year increased by skilled nursing facility market basket percentage change for
Index of Sec 1101. ...FISCAL year 2011 ; Future skilled nursing facility classifiations system implemented to apply to services furnished during fiscal year beginning with
Index of Sec 1111. ...FISCAL year ; Secretary including result of analysis under subparagraph in fiscal year 2011 rulemaking cycle for purposes of implementation beginning for
Index of Sec 1111. ...CLASSIFIATIONS system for yearing without changes ; Estimated expenditures under future skilled nursing facility servicing classifiations system for fiscal year beginning with fiscal year 2011 with changes to be equal to estimated expenditures otherwise occurring under title XVIII of Social Security Act under future skilled nursing facility servicing
Index of Sec 1111. ...FISCAL year ; Total amount of additional payments or payment adjustments for outliers making under paragraph with respect to fiscal year not exceeding 2 percent of total payments projected or estimated to be made based on prospective payment system under subsection for
Index of Sec 1111. ...FISCAL year not exceeding 50 percent of aggregate reduction in Medicare dss estimated by Secretary for fiscal year ; Aggregate amount of increase for
Index of Sec 1112. ...FISCAL year to be available until expended ; Amounts appropriated under paragraph for
Index of Sec 1122. ...FISCAL year beginning after October 1 ; Respect to payment for discharges from applicable hospital occurring during
Index of Sec 1151. ...FISCAL year ; Ratio described in subparagraph for hospital for applicable period for
Index of Sec 1151. ...FISCAL year for condition ; Base operating DRG payment amount for hospital for
Index of Sec 1151. ...FISCAL year ; Term aggregate payments for discharges meaning sum of base operating DRG payment amounts for discharges for conditions from hospital for
Index of Sec 1151. ...FISCAL year ; 2011 Secretary making payment adjustment for hospital described in subparagraph, respect
Index of Sec 1151. ...FISCAL year and without application of adjustment factor described in paragraph and applied pursuant to paragraph ; Aggregate amount of payment adjustment under paragraph for fiscal year not exceeding 5 percent of estimated difference in spending occurring for
Index of Sec 1151. ...FISCAL year for hospital and without application of adjustment factor described in paragraph and applied pursuant to paragraph ; Aggregate amount of payment adjustment for hospital under paragraph not exceeding estimated difference in spending occurring for
Index of Sec 1151. ...FISCAL year to applicable hospital as described in section 1886(p)(2) ; Adjustment factor described in section 1886(p)(3) applying to payments with respect to critical access hospital with respect to cost reporting period beginning in fiscal year 2012 and subsequent fiscal year of subsection in manner similar to manner in which section applying with respect to
Index of Sec 1151. ...FISCAL year to be available until expended ; Amounts appropriated under subsection for
Index of Sec 1151. ...FISCAL year to be available until expended ; Amounts appropriated under paragraph for
Index of Sec 1152. ...FISCAL year to be available until expended ; Amounts appropriated under paragraph for
Index of Sec 1156. ...FISCAL year to be available until expended ; Amounts appropriated under paragraph for
Index of Sec 1301. ...FISCAL year to be available until expended ; Amounts appropriated under paragraph for
Index of Sec 1302. ...FISCAL year ; Amount reserved under subsection for
Index of Sec 1904. ...FISCAL year remaining after making reservations required by subsection ; Amount appropriated under subsection for
Index of Sec 1904. ...FISCAL year ; Aggregate expenditures by State from State and local sources for programs of home visitation for families with young children and families expecting children for preceding fiscal year being not less than 100 percent of aggregate expenditures for 2nd preceding
Index of Sec 1904. ...FISCAL year For which funds appropriated under subsection ;
Index of Sec 1904. ...EXPENDITURES for fiscal year to extent ; State for fiscal year being attributable to cost of programs not adhering to model of home visitation with strongest evidence of effectiveness not to be considered eligible
Index of Sec 1904. ...FISCAL year under subsection ; Amounts appropriated for
Index of Sec 1904. ...FISCAL year after fiscal year during that Act enacted ; Subsection taking effect on earlier of date specified in paragraph or first day of second succeeding
Index of Sec 1652. ...CHILD health plan under title XXI ; Paragraph not to be construed as preventing State from imposing limitation described in section 2110(b)(5)(c)(i) for fiscal year in order to limit expenditures under State
Index of Sec 1703. ...FISCAL year decreased by $1,500,000,000 ; Total dss allotments otherwise to be determined under subsection for
Index of Sec 1704. ...FISCAL year decreased by $2,500,000,000 ; Total dss allotments otherwise to be determined under subsection for
Index of Sec 1704. ...FISCAL year decreased by $6,000,000,000 ; Total dss allotments otherwise to be determined under subsection for
Index of Sec 1704. ...FISCAL year 2019 ; Percentage specified under section 1771(c) of America's Affordable Health Choices acting of 2009 for purposes of clause for fiscal year and subsequent fiscal years percentage so specified for
Index of Sec 1771. ...FISCAL year 2013 ; Fiscal year beginning with
Index of Sec 1802. ...FISCAL year ; Amount equivalent to net revenues received in Treasury from fees imposed under subchapter B of chapter 34 for
Index of Sec 1802. ...ACCOUNT ; Proportion to total expenditures during fiscal year being made under title XVIII of Act from respective trust fund or
Index of Sec 1802. ...FISCAL year being amount computed by Secretary of Health and Human Services for fiscal year resulting in revenues to CERTF of $375,000,000 for fiscal year ; Fair share per capita amount under paragraph for
Index of Sec 1802. ...FISCAL year to be default amount determined under clause for fiscal year ; Fair share per capita amount under paragraph for
Index of Sec 1802. ...FISCAL year exceeding $90,000,000 ; No case amount transferred under subsection for
Index of Sec 1802. ...FISCAL year to be available to carry out activities of Comparative Effectiveness Research Commission established under section 1181(b) of Social Security Act for fiscal year ; Not less than following amounts in CERTF for
Index of Sec 1802. ...FISCAL year of allotment of State under subsection for fiscal year ; Total of expenditures exceeding applicable percentage for
Index of Sec 1904. ...FISCAL year of subsection in manner similar to manner in which section applying with respect to fiscal year to applicable hospital as described in section 1886(p)(2) ; Adjustment factor described in section 1886(p)(3) applying to payments with respect to critical access hospital with respect to cost reporting period beginning in fiscal year 2012 and subsequent
Index of Sec 1151. ...FISCAL year or rate year beginning after October 1 ; Subparagraph applying to discharges or services furnished after first day of
Index of Sec 1151. ...EXPENDITURES for 2nd preceding fiscal year ; Aggregate expenditures by State from State and local sources for programs of home visitation for families with young children and families expecting children for preceding fiscal year being not less than 100 percent of aggregate
Index of Sec 1904. ...FISCAL year for respective territory increased by percentage increase referred in paragraph ; Northern Mariana Islands and American Samoa for fiscal year 2020 and succeeding fiscal year to be amount provided in paragraph or paragraph for preceding
Index of Sec 1771. ...CONSUMER price index for 12-month period ending with April of preceding fiscal year ; Subsequent year being equal to default amount under clause for preceding fiscal year increased by annual percentage increase in medical care component of
Index of Sec 1802. ...FISCAL year increased by skilled nursing facility market basket percentage change for fiscal year involved ; Rate computed for previous
Index of Sec 1101. ...FISCAL year ; Rate computed for previous
Index of Sec 1101. ...FISCAL year specified in subparagraph ; Secretary publishing in Federal registering notice specifying dss allotment to State under 1923(f) of Social Security Act for respective
Index of Sec 1704. ...FISCAL year to extent otherwise authorized under section 1819(b)(1)(b) or 1819(d)(1)(c) of Social Security Act or other statutory or regulatory authority, one or more proposals for skilled nursing facilities to modify and strengthen quality assurance and performance improvement programs in facilities ; Secretary including in proposed rule published under section 1888(e) of Social Security Act 42 USC 1395yy(e)(5)(a)) for subsequent
Index of Sec 1412. ...FISCAL year ; Purposes of reporting data on quality measures for inpatient hospital services furnished during fiscal year 2012 and subsequent
Index of Sec 1444. ...FISCAL year 2019 to be increased by percentage specified under section 1771(c) of America's Affordable Health Choices acting of 2009 for purposes of paragraph of amounts otherwise determined under section ; Northern Mariana Islands and American Samoa for fiscal year 2011 and succeeding fiscal year through
Index of Sec 1771. ...FISCAL year for respective territory increased by percentage increase referred in paragraph ; Northern Mariana Islands and American Samoa for fiscal year 2020 and succeeding fiscal year to be amount provided in paragraph or paragraph for preceding
Index of Sec 1771. ...FISCAL year 2010 ; Applying to annual increases effected for fiscal years beginning with
Index of Sec 1103. ...FISCAL years beginning after October 1 ; Purposes of providing funds to applicable hospitals to take steps described in subparagraph to address factors impacting readmissions of individuals discharged hospital,
Index of Sec 1151. ...FISCAL year 2019 ; Percentage specified under section 1771(c) of America's Affordable Health Choices acting of 2009 for purposes of clause for fiscal year and subsequent fiscal years percentage so specified for
Index of Sec 1771. ...FISCAL year 2009 and $12,000,000 for fiscal years 2010 through 2012 ; Section 1890(d) of Social Security Act 42 USC 1395aaa(d) amended by striking for fiscal years 2009 through 2012 and inserting for
Index of Sec 1445. ...FISCAL year 2010 ; Applying to annual increases effected for fiscal years beginning with
Index of Sec 1103. ...FISCAL year 2010 by appropriate recalibration factor as proposed in proposed rule for Medicare skilled nursing facilities issued by Secretary ; Secretary adjusting case mix indexes under section 1888(e)(4)(g)(i) of Social Security Act 42 USC 1395yy(e)(4)(g)(i) for
Index of Sec 1111. ...FISCAL year 2010 ; Funds in Treasury not otherwise appropriated appropriated to Secretary of Health and Human Services for Centers for Medicare and Medicaid Services programming Management Account $5,000,000 for fiscal year beginning with
Index of Sec 1156. ...FISCAL year 2010, $1,600,000 ; Subsection of section amended by inserting and
Index of Sec 1903. ...APPROPRIATION until expended ; Funds appropriated under paragraph to be allocated in same proportion as total funding appropriated with respect to paragraphs and allocated with respect to fiscal year 2010 and available without further
Index of Sec 1601. ...FISCAL year 2011 ; Future skilled nursing facility classifiations system implemented to apply to services furnished during fiscal year beginning with
Index of Sec 1111. ...CLASSIFIATIONS system for yearing without changes ; Estimated expenditures under future skilled nursing facility servicing classifiations system for fiscal year beginning with fiscal year 2011 with changes to be equal to estimated expenditures otherwise occurring under title XVIII of Social Security Act under future skilled nursing facility servicing
Index of Sec 1111. ...FISCAL year 2011 and ending with fiscal year 2019 ; Period beginning with
Index of Sec 1146. ...FISCAL year 2011 and succeeding fiscal year through fiscal year 2019 to be increased by percentage specified under section 1771(c) of America's Affordable Health Choices acting of 2009 for purposes of paragraph of amounts otherwise determined under section ; Northern Mariana Islands and American Samoa for
Index of Sec 1771. ...FISCAL year 2011 rulemaking cycle for purposes of implementation beginning for fiscal year ; Secretary including result of analysis under subparagraph in
Index of Sec 1111. ...FISCAL year 2012 and subsequent fiscal year of subsection in manner similar to manner in which section applying with respect to fiscal year to applicable hospital as described in section 1886(p)(2) ; Adjustment factor described in section 1886(p)(3) applying to payments with respect to critical access hospital with respect to cost reporting period beginning in
Index of Sec 1151. ...FISCAL year 2012 and subsequent fiscal year ; Purposes of reporting data on quality measures for inpatient hospital services furnished during
Index of Sec 1444. ...FISCAL year 2012 ; Amendments making by section applying to quality measures applied for payment years beginning with 2012 or
Index of Sec 1444. ...FISCAL year 2013 ; Fiscal year beginning with
Index of Sec 1802. ...FISCAL year 2017, $2,500,000,000 in fiscal year 2018 and $6,000,000,000 in fiscal year 2019 ; Secretary reducing Medicaid dss so as to reducing total Federal payments to States for purpose by $1,500,000,000 in
Index of Sec 1704. ...FISCAL year 2017 ; Respect to dss allotments described in subparagraph for
Index of Sec 1704. ...FISCAL year 2018 ; Respect to dss allotments described in subparagraph for
Index of Sec 1704. ...FISCAL year 2018 and $6,000,000,000 in fiscal year 2019 ; Secretary reducing Medicaid dss so as to reducing total Federal payments to States for purpose by $1,500,000,000 in fiscal year 2017, $2,500,000,000 in
Index of Sec 1704. ...FISCAL year 2019 ; Period beginning with fiscal year 2011 and ending with
Index of Sec 1146. ...FISCAL year 2019 ; Secretary reducing Medicaid dss so as to reducing total Federal payments to States for purpose by $1,500,000,000 in fiscal year 2017, $2,500,000,000 in fiscal year 2018 and $6,000,000,000 in
Index of Sec 1704. ...FISCAL year 2019 ; Respect to dss allotments described in subparagraph for
Index of Sec 1704. ...FISCAL year 2019 to be increased by percentage specified under section 1771(c) of America's Affordable Health Choices acting of 2009 for purposes of paragraph of amounts otherwise determined under section ; Northern Mariana Islands and American Samoa for fiscal year 2011 and succeeding fiscal year through
Index of Sec 1771. ...FISCAL year 2019 ; Percentage specified under section 1771(c) of America's Affordable Health Choices acting of 2009 for purposes of clause for fiscal year and subsequent fiscal years percentage so specified for
Index of Sec 1771. ...FISCAL year 2020 and succeeding fiscal year to be amount provided in paragraph or paragraph for preceding fiscal year for respective territory increased by percentage increase referred in paragraph ; Northern Mariana Islands and American Samoa for
Index of Sec 1771. ...FISCAL year limitation to Secretary to carry out that section ; Need for further appropriations and without
Index of Sec 1401. ...FISCAL year limitation to Secretary of Health and Human Services for carrying out section 1181 of Social Security Act ; Need for further appropriations and without
Index of Sec 1802. ...FISCAL year 2009 and $12,000,000 for fiscal years 2010 through 2012 ; Section 1890(d) of Social Security Act 42 USC 1395aaa(d) amended by striking for fiscal years 2009 through 2012 and inserting for
Index of Sec 1445. ...FISCAL years 2010 through 2014 ; Transferring from Federal Supplementary Medical Insurance Trust Fund under section 1841 to Secretary for Centers for Medicare and Medicaid Services programming Management Account $6,000,000 for
Index of Sec 1302. ...FISCAL years 2010 through 2014 ; $25,000,000 to Secretary for purposes of carrying out that section for
Index of Sec 1442. ...FISCAL years 2010 through 2014 ; $1,000,000 to Secretary for purposes of carrying out that subsection for
Index of Sec 1443. ...FISCAL years 2010 through 2012 ; Section 1890(d) of Social Security Act 42 USC 1395aaa(d) amended by striking for fiscal years 2009 through 2012 and inserting for fiscal year 2009 and $12,000,000 for
Index of Sec 1445. ...FISCAL years 2011 through 2019 ; Section 1905(b)(2) of Social Security Act 42 USC 1396d(b)(2)) amended by striking 50 per centum and inserting for
Index of Sec 1771. ...FRAUD, waste and abuse for organization's employees and contractors ; Effective training and education pertaining to
Index of Sec 1635. ...FRAUD by provider or supplier or employees or agents of provider or supplier ; Reason for overpayment related to
Index of Sec 1641. ...FRAUD, Waste and Abuse ; Subtitle D across Access to information needed to prevent
Index of 0FRAUD and abuse ; Furnishing or ordering of durable medical equipment in order to enable better monitoring of claims for payment for additional services under title or ordering, furnishing or prescribing of other items and services determined by Secretary to pose high risk of waste,
Index of Sec 1633. ...FRAUD and abuse before implementing requirements of subsection to providers of services and suppliers described in paragraph ; Secretary determining to be category at high risk for waste,
Index of Sec 1635. ...FRAUD and abuse ; Narrowing window for claims processing not overburdening providers and reducing
Index of Sec 1636. ...FRAUD and abuse ; Nothing in paragraph to be construed as preventing State from limiting classes of entities becoming qualified entities in order to prevent
Index of Sec 1714. ...FRAUD and Abuse ; Sec 1758, requirement to Report expanded Set of data elements under MMIS to detect
Index of Sec 1758. ...FRAUD or abuse ; Secretary applying face-to-face encounter requirement described in amendments making by subsections and other items and services For which payment provided under title XVIII of Social Security Act based upon finding that decision reducing risk of waste,
Index of Sec 1639. ...FRAUD, waste or abuse ; Secretary determining that previous affiliation of provider or supplier posing risk of
Index of Sec 1632. ...FRAUD, waste or abuse ; Affiliation and affiliation or affiliations of provider or supplier posing serious risk of
Index of Sec 1632. ...FRAUD schemes in which processing patterns of Centers for Medicare and Medicaid Services to be observed and exploited ; D of title XVIII of Social Security Act presenting opportunities for
Index of Sec 1636. ...FRAUDULENT activity with respect to category of provider of services or supplier of items or services under title XVIII, XIX or XXI Secretary imposing following requirements with respect to provider of services or supplier ; Secretary determining being significant risk of
Index of Sec 1631. ...FRAUDULENT claim for payment for items and services furnished under Federal health care program ; False record or statement material to false or
Index of Sec 1612. ...FUNCTIONAL accounts on annual basis ; Submitting by skilled nursing facilities and categorizing expenditures for skilled nursing facility into following
Index of Sec 1414. ...FUNCTIONAL status where applicable ; Improvement in health outcomes including patient
Index of Sec 1302. ...INTEREST in limited partnership being equal or exceeding 10 percent ; General partners and limited partners of limited partnership having ownership
Index of Sec 1411. ...GEOGRAPHIC adjustment factors established under sections 1848(e) and 1886(d)(3)(e) of Social Security Act 42 USC 1395w-4(e) ; Accuracy of
Index of Sec 1157. ...GEOGRAPHIC adjustment factors for payment systems for services furnished under Medicare program ; Proposals to revise
Index of Sec 1158. ...GEOGRAPHIC adjustments in payment rates ; Counties or equivalent areas in United States in lowest fifth percentile of utilization based on per capita spending under part and parting A for services provided in recent year For which data being available as of date of enactment of subsection as standardized to eliminate effect of
Index of Sec 1123. ...GEOGRAPHIC adjustments factoring established under sections 1848(e) and 1886(d)(3)(e) of Social Security Act ; Available to Secretary to make changes to
Index of Sec 1158. ...GEOGRAPHIC area ; Medication therapy management services for patients with multiple chronic diseases or help beneficiaries accessing health care and community-based resources in local
Index of Sec 1302. ...GEOGRAPHIC areas proposing to coordinate health care services for chronically ill beneficiaries across variety of health care settings ; Applications from
Index of Sec 1302. ...GEOGRAPHIC areas and additional conditions ; Pilot program under subsection including additional
Index of Sec 1152. ...GEOGRAPHIC areas ; Rates to be established on national basis or different
Index of Sec 1152. ...MALPRACTICE geographic indices described in clauses ; Calculating work, practice expense and
Index of Sec 1125. ...PERIODIC review of adjustment factoring required under paragraph for California for 2012 and subsequent periods ; Revision described in clause to be made effective concurrently with application of
Index of Sec 1125. ...GEOGRAPHIC regions ; Ensuring that membership of Advisory Committee representing balance of specialties and
Index of Sec 1191. ...DISTRIBUTION, stock or stock option grant or ownership or investment interest holding by physician in manufacturer ; Term payment or other transfer of value including compensation, gift, honorarium, speaking fee, consulting fee, travel, services, dividend, profit
Index of Sec 1451. ...GRIEVANCE and appeals processing under parts A and B of title XVIII under Medicare Advantage program under part C of title and title XIX ; Review Medicare and Medicaid policies related to enrollment, benefits, service delivery, payment and
Index of Sec 1905. ...GUIDANCE to States regarding improving coordination and protection ; Issue
Index of Sec 1905. ...GUIDANCE ; Failing to comply with marketing restrictions described in subsections and section 1851 or applicable implementing regulations or
Index of Sec 1617. ...HEALTH of patient ; Case of medical emergency where delay directly associated with obtaining competent interpreter or translation services jeopardizing
Index of Sec 1222. ...HEALTH professional shortage area ; Section 1848(o)(1)(b)( iv of Act 42 USC 1395w-4(o)(1)(b)( iv amended by inserting primary care before
Index of Sec 1303. ...HEALTH benefiting plan ; Health insurance issuer, group health plan or other entity offering
Index of Sec 1451. ...HEALTH, developmental delays and social ; Skills to recognize and seek help for issues related to
Index of Sec 1904. ...HEALTH professional needs area ; Place greater emphasis upon training in health professional shortage area or
Index of Sec 1501. ...HEALTH and substance abuse needs of individuals ; State not requiring under paragraph enrollment in managed care entity of individual described in section 1902(a) unless State demonstrating that entity having capacity to meet health, mental
Index of Sec 1701. ...HEALTH and health-related terminolology and providing accurate interpretations by choosing equivalent expressions conveying best matching and meaning to source language and capturing nuances intended in source message ; Interpreter knowing
Index of Sec 1224. ...HEALTH and health-related terminolology and providing accurate translations by choosing equivalent expressions conveying best matching and meaning to source language and capturing nuances intended in source document ; Translator knowing
Index of Sec 1224. ...HEALTH and safety of individuals program furnishing items and servicing ; Deficiencies involved immediately jeopardizing
Index of Sec 1614. ...HEALTH and safety of individuals program furnishing items and servicing ; Deficiencies involved not immediately jeopardizing
Index of Sec 1614. ...HEALTH and safety of individuals under care of program when improvements being made ; Appointment of temporary management to oversee operation of hospice program and protecting and assuring
Index of Sec 1614. ...HEALTH and safety of individuals provided care and services by agency or organization involved and determining ; Hospice program certified for participation under title demonstrating substandard quality of care and failed to meet other requirements as Secretary finding necessary in interest of
Index of Sec 1614. ...HEALTH and safety of individuals provided care and services by agency or organization involved ; Denial of payment under subparagraph terminating when Secretary determining that hospice program no longer demonstrating substandard quality of care and meeting other requirements as Secretary finding necessary in interest of
Index of Sec 1614. ...HEALTH or safety of resident or residents of facility or penalty imposed for deficiency described in subclause ; Secretary not reducing under subclause amount of penalty if penalty imposed for deficiency described in subclause or actual harm or widespread harm immediately jeopardizing
Index of Sec 1421. ...HEALTH or safety of resident or residents of facility or penalty imposed for deficiency described in clause ; State not reducing under clause amount of penalty if penalty imposed for deficiency described in clause or actual harm or widespread harm immediately jeopardizing
Index of Sec 1421. ...HEALTH workers including nurses or other non-physician practitioners ; Organization employing community
Index of Sec 1302. ...CHRONIC diseases ; Measures of health functioning and survival for patients with
Index of Sec 1162. ...HEALTH professionals signing orders for life sustaining treatment ; Orders to physicians and other
Index of Sec 1233. ...HEALTH care practitioners in delivery of health care services ; Term quality measure meaning national consensus standard for measuring performance and improvement of population health or institutional providers of services, physicians and other
Index of Sec 1441. ...HEALTH professional shortage area ; Addition to amount otherwise paid under part to be paid to practitioner of section 1842(b)(6)) from Federal Supplementary Medical Insurance Trust Fund amount equal 5 percent as primary care
Index of Sec 1303. ...HEALTH professional needs area ; Place greater emphasis upon training in health professional shortage area or
Index of Sec 1501. ...HEALTH official if recommendations submitted not later than 180 days after date of hospital closure involved in case of hospital closed after date being 2 years before date of enactment of clause ; Process taking into consideations recommendations submitted to Secretary by senior
Index of Sec 1504. ...HEALTH care ; Term health care-related services meaning human or social services programing or activities providing access, referrals or links to
Index of Sec 1224. ...HEALTH care professionals across continuum of care about goals and use of orders for life sustaining treatment ; Providing training for
Index of Sec 1233. ...HEALTH care provider what treatments being best for based on treatment options, scientific evidence, circumstances, beliefs and preferences ; Family caregiver of patient understanding and communicating beliefs and preferences related to treatment options and deciding with
Index of Sec 1236. ...HEALTH care provided by physician or nurse practitioner practicing in field of family medicine, general internal medicine, geriatric medicine or pediatric medicine ; Term primary care meaning
Index of Sec 1302. ...CLINICAL decision support, appropriate professional associations and Federal and private health plans and other relevant stakeholders ; Center providing for dissemination of appropriate findings produced by research supported, conducted or synthesized under section to health care providers, patients, vendors of health information technology focused on
Index of Sec 1401. ...HEALTH Care-associated infections ; Sec 1461, requirement for public reporting by hospitals and ambulatory surgical Centers on
Index of Sec 1461. ...HEALTH Care-associated infections ; Sec 1138a, requirement for public reporting by hospitals and ambulatory surgical Centers on
Index of Sec 1461. ...HEALTH care-associated infections developing in hospital or center as Secretary specifying ; Secretary providing that hospital or ambulatory surgical center meeting requirements of titles XVIII or XIX participating in programs established under titles only if hospital or center reporting information on
Index of Sec 1461. ...HEALTH care-associated infections ; Information to be set forth in manner allowing for comparison of information on
Index of Sec 1461. ...HEALTH care worker immunization rates ; Factors contributing to occurrence of infections including
Index of Sec 1461. ...AMBULATORY surgical center ; Nothing in section to be construed as preempting or otherwise affecting provision of State law relating to disclosure of information on health care-associated infections or patient safety procedures for hospital or
Index of Sec 1461. ...HEALTH care ; Term health care-associated infection meaning infection developing in patient received care in institutional setting where health care delivered and related to receiving
Index of Sec 1461. ...HEALTH care meaning that infection not incubating or present at time health care provided ; Term related to receiving
Index of Sec 1461. ...HEALTH care at childbirth and providing care within scope of practice under which individual legally authorized to perform care under State law ; Term licensed birth attendant meaning individual licensed or registered by State involved to provide
Index of Sec 1724. ...HEALTH care and access to care and reduced medical error ; Description of effect of providing language access services on quality of
Index of Sec 1223. ...GEOGRAPHIC area ; Medication therapy management services for patients with multiple chronic diseases or help beneficiaries accessing health care and community-based resources in local
Index of Sec 1302. ...HEALTH care or health care-related services ; Term effective communication meaning exchange of information between provider of health care or health care-related services and limited English proficient recipient of services enabling limited English proficient individuals to access, understand and benefit from
Index of Sec 1224. ...HEALTH care or health care related services by bilingual health care provider ; Competent interpreter services to be provided through on-site interpretation, telephonic interpretation or video interpretation or direct provision of
Index of Sec 1222. ...HEALTH care or health care-related services and limited English proficient recipient of services enabling limited English proficient individuals to access, understand and benefit from health care or health care-related services ; Term effective communication meaning exchange of information between provider of
Index of Sec 1224. ...CHRONIC conditions requiring subspecialist's expertise subspecialist assuming care management ; Accessible health care provided by physician being medical subspecialist addressing majority of personal health care needs of patients with
Index of Sec 1302. ...HEALTH care-acquired conditions for non-payment in Medicaid program under title XIX of Social Security Act ; Nothing in section preventing State from including additional
Index of Sec 1751. ...CENTEREDNESS of health care including due to variations in care ; Greatest potential for improving performance, affordability and patient-
Index of Sec 1441. ...HEALTH care professional to be described in subparagraph if furnished by physician ; Including services furnished by another
Index of Sec 1303. ...HEALTH care provider to be registered with Secretary in form and manner specified by Secretary ; Agent, clearinghouse or other alternate payee submiting claims on behalf of
Index of Sec 1644. ...HEALTH care provider registering with State and Secretary in form and manner specified by Secretary under section 1866(j)(1)(d) ; Providing that agent, clearinghouse or other alternate payee submiting claims on behalf of
Index of Sec 1759. ...HEALTH care provider ; Competent interpreter services to be provided through on-site interpretation, telephonic interpretation or video interpretation or direct provision of health care or health care related services by bilingual
Index of Sec 1222. ...AMBULATORY surgical centers during year ; Number and types of health care-associated infections reported under subsection in hospitals and
Index of Sec 1461. ...HEALTH care provider being set up for purpose of testing shared decision making and patient decision aids ; State cooperative entity including State government and one other
Index of Sec 1236. ...CLINICAL care ; Other health care practitioners engaged in
Index of Sec 1401. ...HEALTH care practitioners in delivery of health care services ; Term quality measure meaning national consensus standard for measuring performance and improvement of population health or institutional providers of services, physicians and other
Index of Sec 1441. ...HEALTH care providers and payers ; Determining national priorities for research described in subsection and making determinations consulting with broad array of public and private stakeholders including patients and
Index of Sec 1401. ...HEALTH care provider and portion of reasonable costs of infrastructure of eligible provider ; Single payment amount for servicing that including professional time of
Index of Sec 1236. ...HEALTH care acquired condition determined as non-covered service under title XVIII ; Respect to amounts expended for services related to presence of condition to be identified by secondary diagnostic code described in section 1886(d)(4)(d)( iv and
Index of Sec 1751. ...HEALTH care-related services meaning human or social services programing or activities providing access, referrals or links to health care ; Term
Index of Sec 1224. ...HEALTH care delivered and related to receiving health care ; Term health care-associated infection meaning infection developing in patient received care in institutional setting where
Index of Sec 1461. ...HEALTH care provided ; Term related to receiving health care meaning that infection not incubating or present at time
Index of Sec 1461. ...HEALTH care costs resulted from increases or decreases in rates of occurrence type of infection during year ; Total increases or decreases in
Index of Sec 1461. ...HEALTH care decisions improving quality and value ; Make recommendations to center for broad dissemination of findings of research conducted and supported under section enabling clinicians, patients, consumers and payers to make more informed
Index of Sec 1401. ...HEALTH care delivery and implementing systematic solutions in case of errors ; Knowledgeable in methods of identifying systematic errors in
Index of Sec 1505. ...HEALTH care delivery, patient satisfaction and selecting health outcomes ; Culturally and linguistically appropriate services on beneficiary access to care, utilization of services, efficiency and cost-effectiveness of
Index of Sec 1222. ...HEALTH care entity billing Secretary under part A or part B of title XVIII for services reporting on ownership shares of physician owning interest in entity ; Hospital or other
Index of Sec 1451. ...HEALTH care entity reporting physician ownership under subsection ; Accuracy of information submitted under subsections and making available under paragraph to be responsibility of applicable manufacturer or distributor of covered drug, device, biological or medical supply reporting under subsection or hospital or other
Index of Sec 1451. ...HEALTH care items and services used with various subpopulations ; Designing to take into account potential for differences in effectiveness of
Index of Sec 1401. ...HEALTH care items or services under pilot program or entity to administer program unless entity guarantees not denying, limiting or conditioning coverage or provision of benefits under program based on health status-related factor described in section 2702(a)(1) of Public Health Service Act ; Secretary not entering into agreement with entity to provide
Index of Sec 1301. ...HEALTH care items, services and systems including pharmaceuticals ; Conducting, supporting and synthesizing research relevant to comparative effectiveness of full spectrum of
Index of Sec 1401. ...HEALTH care needs or take responsibility for appropriately arranging care with other qualified providers for stages of life ; Providing patient's
Index of Sec 1302. ...CHRONIC conditions requiring subspecialist's expertise subspecialist assuming care management ; Accessible health care provided by physician being medical subspecialist addressing majority of personal health care needs of patients with
Index of Sec 1302. ...HEALTH care program ; Made false statement, omission or misrepresenations of material fact in application, agreement, bid or contract to participate or enroll as provider of services or supplier under Federal
Index of Sec 1611. ...HEALTH care program ; False record or statement material to false or fraudulent claim for payment for items and services furnished under Federal
Index of Sec 1612. ...HEALTH care program and person knowing or knowing that claim for iteming or servicing to be presented program ; During period when person excluded from participation in Federal
Index of Sec 1615. ...HEALTH care program with respect to item or service furnished ; Effect of exclusion being no payment to be made by Federal
Index of Sec 1619. ...HEALTH care program ; Item or service paid by Federal
Index of Sec 1619. ...HEALTH care program for emergency items or services furnished by excluded individual or entity or medical direction or prescription of excluded physician or other authorized individual during period of individual's exclusion ; Payment to be made under Federal
Index of Sec 1619. ...HEALTH care program contractor provided inaccurate or misleading information resulted in waiver of overpayment under clause ; Federal
Index of Sec 1619. ...HEALTH care program ; Striking participating in program under title XVIII or State health care program and inserting participating in Federal
Index of Sec 1645. ...HEALTH care program ; Subparagraph, striking title XVIII or State health care program and inserting Federal
Index of Sec 1645. ...HEALTH care program ; False record or statement material to obligation to pay or transmit money or property to Federal health care program or knowingly concealing or knowingly improperly avoiding or decreaseing obligation to pay or transmit money or property to Federal
Index of Sec 1645. ...HEALTH care program ; Management, administrative or other item or servicing used in connection with directly indirectly related to Federal
Index of Sec 1645. ...HEALTH care program or contractor ; Claim for payment for items or services furnished by excluded individual or entity submitted by individual or entity other than individual eligible for benefits under title XVIII or XIX or excluded individual or entity and Secretary determining that individual or entity submitting claim taking reasonable steps to learn of exclusion and reasonably relied upon inaccurate or misleading information from relevant Federal
Index of Sec 1619. ...HEALTH care programs and not permitting physicians practicing at hospital to discriminate against beneficiaries ; Not discriminating against beneficiaries of Federal
Index of Sec 1156. ...HEALTH care programs ; Consensus-based entity entering into contract under section 1890 convening multi-stakeholder groups to provide recommendations on selection of individual or composite quality measures for use in reporting performance information to public or use in public
Index of Sec 1443. ...HEALTH care program interest ; Made to contractor, grantee or other recipient if money or property to be spent or used on Federal health care program's behalf or advancing Federal
Index of Sec 1645. ...HEALTH care program interest ; Made to contractor, grantee or other recipient if money or property to be spent or used on Federal health care program's behalf or advancing Federal
Index of Sec 1645. ...HEALTH care quality and patient safety ; Order to improve
Index of Sec 1461. ...HEALTH care reforms carried out under division A in reducing number of uninsured individuals ; 2016 Secretary of Health and Human Services submitting to Congress report on Medicare dss taking into account impact of
Index of Sec 1112. ...HEALTH care reforms carried out under division A in reducing number of uninsured individuals ; 2016 Secretary of Health and Human Services submitting to Congress report concerning extent, based upon impact of
Index of Sec 1704. ...HEALTH care services in medical emergencies in place systems to provide competent interpreter and translation servicing without undue delay ; Nothing in clause to be construed to exempt emergency rooms or similar entities regularly providing
Index of Sec 1222. ...HEALTH care services for chronically ill beneficiaries across variety of health care settings ; Applications from geographic areas proposing to coordinate
Index of Sec 1302. ...HEALTH care services for individuals enrolled under title, individuals enrolled under title XIX and full-benefit dual eligible individuals ; Applications from States proposing to use medical home model to coordinate
Index of Sec 1302. ...HEALTH care services in United States needed ; Secretary determining areas in which quality measures for assessing
Index of Sec 1442. ...HEALTH care services and share in incentive payments under program ; Model of organization under which physicians entering into agreements with other providers for purposes of participation in pilot program in order to provide high quality and efficient
Index of Sec 1301. ...HEALTH care services ; Collecting as part of health information technologies supporting better delivery of
Index of Sec 1442. ...HEALTH care services in United States ; Secretary ensuring that priority given to areas in delivery of
Index of Sec 1441. ...HEALTH care services ; Term quality measure meaning national consensus standard for measuring performance and improvement of population health or institutional providers of services, physicians and other health care practitioners in delivery of
Index of Sec 1441. ...HEALTH care services in United States ; Secretary entering into agreements with qualified entities to develop quality measures for delivery of
Index of Sec 1442. ...HEALTH care services directly in non-English language, interpretation, translation and non-English signage ; Term language services meaning provision of
Index of Sec 1224. ...HEALTH care services meaning services ; Term
Index of Sec 1224. ...HEALTH care services and improving quality of life of beneficiaries ; Final report including evaluation of impact of use of program on health quality, utilization of
Index of Sec 1236. ...HEALTH care settings ; Applications from geographic areas proposing to coordinate health care services for chronically ill beneficiaries across variety of
Index of Sec 1302. ...HEALTH center contracting with accredited teaching hospital to carry out inpatient responsibilities of primary care residency program of hospital involved and responsible for payment to hospital for hospital's costs of salary and fringe benefits for residents in program ; Approved teaching
Index of Sec 1502. ...HEALTH center meaning nonprovider setting ; Term approved teaching
Index of Sec 1502. ...HEALTH centers, rural health clinics and other settings ; Primary care physician practices with fewer than 10 physicians, specialty physicians, nurse practitioner practices, federally qualified
Index of Sec 1302. ...HEALTH Centers ; Coverage of marriage and Family Therapist Services provided in rural health clinics and federally qualified
Index of Sec 1308. ...HEALTH Centers ; Coverage of mental health counselor Services provided in rural health clinics and federally qualified
Index of Sec 1308. ...HEALTH centers, rural health clinics and other nonprovider settings and hospitals receiving additional payments under subsection and emphasizing training in outpatient department ; Place greater emphasis upon training in federally qualified
Index of Sec 1501. ...HEALTH clinics and other settings ; Primary care physician practices with fewer than 10 physicians, specialty physicians, nurse practitioner practices, federally qualified health centers, rural
Index of Sec 1302. ...HEALTH Centers ; Coverage of marriage and Family Therapist Services provided in rural health clinics and federally qualified
Index of Sec 1308. ...HEALTH Centers ; Coverage of mental health counselor Services provided in rural health clinics and federally qualified
Index of Sec 1308. ...HEALTH clinics and other nonprovider settings and hospitals receiving additional payments under subsection and emphasizing training in outpatient department ; Place greater emphasis upon training in federally qualified health centers, rural
Index of Sec 1501. ...HEALTH condition of individual including diagnosis of chronic ; Significant change in
Index of Sec 1233. ...ACCIDENT or health coverage ; Term applicable self-insured health plan meaning plan for providing
Index of Sec 1802. ...ACCIDENT or health coverage to residents of United States ; Arrangement fixed payments or premiums received as consideations for person's agreement to provide or arrange for provision of
Index of Sec 1802. ...ACCIDENT and health coverage meaning coverage causing policy to be specified health insurance policy ; Term
Index of Sec 1802. ...HEALTH data ; Encouraging development and use of clinical registries and development of clinical effectiveness research data networks from electronic health records, post marketing drug and medical device surveillance efforts and other forms of electronic
Index of Sec 1401. ...HEALTH disparities ; Improvement in reducing
Index of Sec 1302. ...HEALTH disparities including associated with individual race ; Assessing
Index of Sec 1442. ...HEALTH facility ; Term freestanding birth center meaning
Index of Sec 1724. ...HEALTH market basket percentage increases for years beginning with 2010 ; Amendment making by subsection applying to home
Index of Sec 1155. ...HEALTH outcomes ; Culturally and linguistically appropriate services on beneficiary access to care, utilization of services, efficiency and cost-effectiveness of health care delivery, patient satisfaction and selecting
Index of Sec 1222. ...HEALTH outcomes in provision of items and services under title to applicable beneficiaries by qualifying accountable care organizations in order ; Designing to reduce growth of expenditures and improving
Index of Sec 1301. ...FUNCTIONAL status where applicable ; Improvement in health outcomes including patient
Index of Sec 1302. ...HEALTH outcomes of population physicians serving ; Including experience and participation in continuous quality improvement projects to improve
Index of Sec 1505. ...ACCIDENT or health coverage ; Term applicable self-insured health plan meaning plan for providing
Index of Sec 1802. ...HEALTH benefiting plan ; Health insurance issuer, group health plan or other entity offering
Index of Sec 1451. ...HEALTH plans and other relevant stakeholders ; Center providing for dissemination of appropriate findings produced by research supported, conducted or synthesized under section to health care providers, patients, vendors of health information technology focused on clinical decision support, appropriate professional associations and Federal and private
Index of Sec 1401. ...HEALTH plans for provision of home infusion therapy and applicability to Medicare program ; Recommendations on structure of payment system under Medicare program for home infusion therapy including analysis of payment methodologies used under Medicare Advantage plans and private
Index of Sec 1143. ...HEALTH Plans ; B insured and self-insured
Index of Sec 1802. ...HEALTH care services and improving quality of life of beneficiaries ; Final report including evaluation of impact of use of program on health quality, utilization of
Index of Sec 1236. ...HEALTH records ; 2012 Secretary developing plan to integrate clinical reporting on quality measures under subsection with reporting requirements under subsection relating to meaningful use of electronic
Index of Sec 1124. ...HEALTH records and other similar initiatives under section 1848 and using alternative criteria ; Electronic
Index of Sec 1301. ...DRUG and medical device surveillance efforts and other forms of electronic health data ; Encouraging development and use of clinical registries and development of clinical effectiveness research data networks from electronic health records, post marketing
Index of Sec 1401. ...HEALTH Service in providing prescription drugging toward annual out ; Including Costs incurred by Aids Drug assistance Programs and indian
Index of Sec 1184. ...HEALTH services, income supports and other related assistance ; State promoting coordination and collaboration with other home visitation programs and other child and family services,
Index of Sec 1904. ...HEALTH services provided outside United States or entities ; Requirement of subsection not applying to designated
Index of Sec 1156. ...HEALTH services furnished outside United States or entities ; Requirements of paragraph not applying to designated
Index of Sec 1156. ...HEALTH Services required to be medicare enrolled Physicians or eligible Professionals ; Order durable medical equipment or Home
Index of Sec 1637. ...HEALTH Services ; Incorporating productivity improvements into Market basket updating for Home
Index of Sec 1155. ...HEALTH Services or durable medical equipment under medicare ; Sec 1639, Face to Face Encounter with patient required before Physicians certifying eligibility for Home
Index of Sec 1639. ...HEALTH status-related factor described in section 2702(a)(1) of Public Health Service Act ; Secretary not entering into agreement with entity to provide health care items or services under pilot program or entity to administer program unless entity guarantees not denying, limiting or conditioning coverage or provision of benefits under program based on
Index of Sec 1301. ...CIVIL money penalty applying to civil money penalty under clause in same manner as provisions applying to penalty or proceeding under section 1128a(a) ; Provisions requiring hearing prior to imposition of
Index of Sec 1421. ...CIVIL money penalty applying to civil money penalty under clause in same manner as provisions applying to penalty or proceeding under section 1128a(a) ; Provisions requiring hearing prior to imposition of
Index of Sec 1421. ...HH amended by striking and other than services furnished to inpatient of skilled nursing facility ; Section 1861( hh of Social Security Act 42 USC 1395x(
Index of Sec 1307. ...ELIGIBILITY period ; State plan approved under section 1902 providing for making medical assistance available to individual described in section 1902( hh during presumptive
Index of Sec 1714. ...HH ; Begining with date on which qualified entity determining that individual described in section 1902(
Index of Sec 1714. ...HH amended by striking and other than services furnished to inpatient of skilled nursing facility ; Section 1861( hh of Social Security Act 42 USC 1395x(
Index of Sec 1307. ...HOME and community-based setting ; State ensuring that residents of facility successfully relocated to another facility or alternative
Index of Sec 1423. ...HOME and community-based setting ; State ensuring that residents of facility successfully relocated to another facility or alternative
Index of Sec 1423. ...HOME pursuant to paragraph for high need beneficiaries ; Secretary making payments for furnishing of medical home services by community-based medical
Index of Sec 1302. ...HOME meaning nonprofit community-based or State-based organization certified under paragraph as meeting following requirements ; Term community-based medical
Index of Sec 1302. ...HOME For which payment being not made under title as of date of enactment of section ; Clinical work and practice expenses involved in providing medical home services provided by community-based medical
Index of Sec 1302. ...HOME pursuant to paragraph for targeted high need beneficiaries ; Secretary making payments for medical home services furnished by independent patient-centered medical
Index of Sec 1302. ...HOME meaning physician-directed or nurse-practitioner-directed practice qualified under paragraph ; Term independent patient-centered medical
Index of Sec 1302. ...HOME For which payment being not made under title as of date of enactment of section ; Clinical work and practice expenses involved in providing medical home services provided by independent patient-centered medical
Index of Sec 1302. ...HOME ; Allowing for differential payments based on capabilities of independent patient-centered medical
Index of Sec 1302. ...HOME so long ; Nothing in section to be construed as preventing nurse practitioner from leading patient centered medical
Index of Sec 1302. ...HOME so long ; Nothing in section to be construed as preventing physician assistant from participating in patient centered medical
Index of Sec 1302. ...HOME ; Secretary paying independent patient-centered medical homing monthly fee for targeted high need beneficiary consenting to receive medical home services through medical
Index of Sec 1302. ...HOME ; Secretary making two separate monthly payments for high need beneficiary consenting to receive medical home services through medical
Index of Sec 1302. ...HOME services to individual ; Secretary not making payments under section under more than one model or more than one medical home under model for furnishing of medical
Index of Sec 1302. ...DISCHARGE from applicable hospital or critical access hospital ; Claim submitted post-acute care provider under title XVIII of Social Security Act indicating that individual readmitted to hospital post-acute care provider or admitted from home and care of home health agency within 30 days of initial
Index of Sec 1151. ...HOME concept under title XIX of Social Security Act pilot program operating for period of up to 5 years ; Secretary of Health and Human Services establishing under section medical home pilot program under which State applying to Secretary for approval of medical home pilot project described in subsection for application of medical
Index of Sec 1722. ...HOME demonstration implemented of section to be available to independent patient-centered medical home model described in subsection ; Funding for medical home services otherwise to be available if section 204 medical
Index of Sec 1302. ...HEALTH, skilled nursing facility and other services ; Cost-sharing for post acute care bundle to be treated relative to current rules for cost-sharing for inpatient hospital, home
Index of Sec 1152. ...HEALTH care ; Ordering or prescribing item or service including without limitation home
Index of Sec 1615. ...HEALTH services or referrals for other items or servicing written or ordered by physician or supplier under title as specified by Secretary ; Physician or supplier under section 1866(j) if physician or supplier failing to maintain and provide access to documentation relating to written orders or requests for payment for durable medical equipment, certifications for home
Index of Sec 1638. ...HEALTH services or referrals for other items or servicing written or ordered by provider under title as specified by Secretary ; Maintaining and providing access to documentation relating to written orders or requests for payment for durable medical equipment, certifications for home
Index of Sec 1638. ...HEALTH services under title XIX or XXI of Social Security Act ; Requirements pursuant to amendments making by subsections and applying in case of physicians making certifications for home
Index of Sec 1639. ...HEALTH services to other categories of items or services under title ; Secretary extending requirement applied by amendments making by subsections and durable medical equipment and home
Index of Sec 1637. ...HOME infusion therapy providers to patients in programs ; Scope of coverage for home infusion therapy in fee-for-service Medicare program under title XVIII of Social Security Act, Medicare Advantage under part C of title united States Code and private payers including analysis of scope of services provided by
Index of Sec 1143. ...HEALTH plans for provision of home infusion therapy and applicability to Medicare program ; Recommendations on structure of payment system under Medicare program for home infusion therapy including analysis of payment methodologies used under Medicare Advantage plans and private
Index of Sec 1143. ...HOME infusion therapy and applicability to Medicare program ; Recommendations on structure of payment system under Medicare program for home infusion therapy including analysis of payment methodologies used under Medicare Advantage plans and private health plans for provision of
Index of Sec 1143. ...HOME infusion therapy to be used to construct payment mechanisms in Medicare program ; Assessment of sources of data on costs of
Index of Sec 1143. ...HOME infusion therapy ; Benefits and costs of providing coverage under Medicare program including calculation of potential savings achieved through avoided or shortened hospital and nursing home stays as result of Medicare coverage of
Index of Sec 1143. ...FOR-service Medicare program under title XVIII of Social Security Act, Medicare Advantage under part C of title united States Code and private payers including analysis of scope of services provided by home infusion therapy providers to patients in programs ; Scope of coverage for home infusion therapy in fee-
Index of Sec 1143. ...HOME model described in subsection ; Funding for medical home services otherwise to be available if section 204 medical home demonstration implemented of section to be available to independent patient-centered medical
Index of Sec 1302. ...HEALTH care services for individuals enrolled under title, individuals enrolled under title XIX and full-benefit dual eligible individuals ; Applications from States proposing to use medical home model to coordinate
Index of Sec 1302. ...HOME models ; Pilot program evaluating following medical
Index of Sec 1302. ...HOME models described in section 1866e(a)(3) of Social Security Act or other model as Secretary approving ; Pilot project being project applying one or more of medical
Index of Sec 1722. ...HOME pilot program for purpose of evaluating feasibility and advisability of reimbursing qualified patient-centered medical homes for furnishing medical home services to high need beneficiaries and targeted high need beneficiaries ; Secretary establishing medical
Index of Sec 1302. ...HOME concept under title XIX of Social Security Act pilot program operating for period of up to 5 years ; Secretary of Health and Human Services establishing under section medical home pilot program under which State applying to Secretary for approval of medical home pilot project described in subsection for application of medical
Index of Sec 1722. ...HOME pilot program under section 1866e of Act ; High need beneficiaries being eligible for medical assistance under title XIX of Social Security Act Secretary providing for appropriate coordination of pilot program under section with medical
Index of Sec 1722. ...HOME concept under title XIX of Social Security Act pilot program operating for period of up to 5 years ; Secretary of Health and Human Services establishing under section medical home pilot program under which State applying to Secretary for approval of medical home pilot project described in subsection for application of medical
Index of Sec 1722. ...HOME services meaning services ; Term patient-centered medical
Index of Sec 1302. ...CHILD'S enrollment ceasing for reason ; Model ensuring that patient-centered medical home services received by child providing for continuous involvement and education of parent or caregiver and assistance to child in obtaining necessary transitional care if
Index of Sec 1722. ...HOME services to high need beneficiaries and targeted high need beneficiaries ; Secretary establishing medical home pilot program for purpose of evaluating feasibility and advisability of reimbursing qualified patient-centered medical homes for furnishing medical
Index of Sec 1302. ...HOME pursuant to paragraph for targeted high need beneficiaries ; Secretary making payments for medical home services furnished by independent patient-centered medical
Index of Sec 1302. ...HOME services furnished by independent patient-centered medical homes ; Secretary establishing methodolology for payment for medical
Index of Sec 1302. ...HOME services through medical home ; Secretary paying independent patient-centered medical homing monthly fee for targeted high need beneficiary consenting to receive medical
Index of Sec 1302. ...HOME For which payment being not made under title as of date of enactment of section ; Clinical work and practice expenses involved in providing medical home services provided by independent patient-centered medical
Index of Sec 1302. ...HOME services ; Organization providing beneficiaries with medical
Index of Sec 1302. ...HOME services under supervision in close collaboration with primary care or principal care physician or nurse practitioner designated by beneficiary ; Organization providing medical
Index of Sec 1302. ...HOME services for chronically ill patients covered by payors ; Applications including other payors furnishing medical
Index of Sec 1302. ...HOME services furnished under CBMH model ; Secretary establishing methodolology for payment for medical
Index of Sec 1302. ...HOME services through medical home ; Secretary making two separate monthly payments for high need beneficiary consenting to receive medical
Index of Sec 1302. ...HOME For which payment being not made under title as of date of enactment of section ; Clinical work and practice expenses involved in providing medical home services provided by community-based medical
Index of Sec 1302. ...HOME services under title on permanent basis ; Feasability and advisability of reimbursing medical homes for medical
Index of Sec 1302. ...HOME services to individual ; Secretary not making payments under section under more than one model or more than one medical home under model for furnishing of medical
Index of Sec 1302. ...HOME demonstration implemented of section to be available to independent patient-centered medical home model described in subsection ; Funding for medical home services otherwise to be available if section 204 medical
Index of Sec 1302. ...HOME pursuant to paragraph for high need beneficiaries ; Secretary making payments for furnishing of medical home services by community-based medical
Index of Sec 1302. ...HOME infusion therapy ; Benefits and costs of providing coverage under Medicare program including calculation of potential savings achieved through avoided or shortened hospital and nursing home stays as result of Medicare coverage of
Index of Sec 1143. ...HOME visitation demonstrated positive effects on important program-determined child and parenting outcomes ; Adhering to clear evidence-based models of
Index of Sec 1904. ...HOME visitation ; Amount equal to 5 percent of amounts to pay cost of evaluation provided in subsection and provision to States of training and technical assistance including dissemination of best practices in early childhood
Index of Sec 1904. ...HOME visitation for families with young children and families expecting children to be supported by grant making to State under section ; Description of high quality programs of
Index of Sec 1904. ...EXPENDITURES for fiscal year to extent ; State for fiscal year being attributable to cost of programs not adhering to model of home visitation with strongest evidence of effectiveness not to be considered eligible
Index of Sec 1904. ...EXPENDITURES for 2nd preceding fiscal year ; Aggregate expenditures by State from State and local sources for programs of home visitation for families with young children and families expecting children for preceding fiscal year being not less than 100 percent of aggregate
Index of Sec 1904. ...HOME visitation for families with young children and families expecting children ; Development of children by enabling establishment and expansion of high quality programs providing voluntary
Index of Sec 1904. ...HOME visitation as families with young children and families expecting children as practicable ; Means expenditures to provide voluntary
Index of Sec 1904. ...HOME visitation programs using funds provided under section ; Supporting
Index of Sec 1904. ...HOME visitation programs using funds ; State reserving 5 percent of grant funds for training and technical assistance to
Index of Sec 1904. ...HOME visitation programs using funds provided under section ; Supporting
Index of Sec 1904. ...HOME visitation programs supported using funds providing referrals to other programs serving children and families ;
Index of Sec 1904. ...CHILD maltreatment ; Effect of home visitation programs on child and parent outcomes including
Index of Sec 1904. ...HOME visitation programs receiving funds provided under section ; Secretary providing for conduct of independent evaluation of effectiveness of
Index of Sec 1904. ...HEALTH services, income supports and other related assistance ; State promoting coordination and collaboration with other home visitation programs and other child and family services,
Index of Sec 1904. ...ADMINISTRATIVE expenditure For which payment being made under section 1903(a) or 2105(a) of Act after date of enactment of Act ; Nothing in amendments making by section to be construed as affecting ability of State under title XIX or XXI of Social Security Act to provide nurse home visitation services as part of another class of items and services falling within definition of medical assistance or child health assistance under respective title or
Index of Sec 1713. ...HOME visitation services meaning home visits by trained nurses to families with first-time pregnant woman or child ; Term nurse
Index of Sec 1713. ...HOME visits by trained nurses to families with first-time pregnant woman or child ; Term nurse home visitation services meaning
Index of Sec 1713. ...DISTRIBUTION, stock or stock option grant or ownership or investment interest holding by physician in manufacturer ; Term payment or other transfer of value including compensation, gift, honorarium, speaking fee, consulting fee, travel, services, dividend, profit
Index of Sec 1451. ...HOSPITAL ; Annual percentage increase factor applying to base rate for discharges for
Index of Sec 1103. ...HOSPITAL characteristics ; Amount of Medicare dss to be adjusted based on recommendations of report under subsection and taking into account variations in empirical justification for Medicare dss attributable to
Index of Sec 1112. ...DEBT ; Increase Medicare dss for hospital by additional amount based on amount of uncompensated care provided by hospital based on criteria for uncompensated care as determined by Secretary excluding bad
Index of Sec 1112. ...DISCHARGE by amount equal to product ; Secretary reducing payments otherwise to be made to hospital under subsection
Index of Sec 1151. ...FISCAL year ; Ratio described in subparagraph for hospital for applicable period for
Index of Sec 1151. ...HOSPITAL for applicable period being equal to 1 minus ratio ; Ratio described in subparagraph for
Index of Sec 1151. ...FISCAL year for condition ; Base operating DRG payment amount for hospital for
Index of Sec 1151. ...FISCAL year ; Term aggregate payments for discharges meaning sum of base operating DRG payment amounts for discharges for conditions from hospital for
Index of Sec 1151. ...HOSPITAL for condition with respect to applicable period ; Risk adjusted expected readmissions for
Index of Sec 1151. ...HOSPITAL-specific limit under paragraph and form of payment making by Secretary under paragraph ;
Index of Sec 1151. ...HOSPITAL to undertake action to alleviate steps ; Secretary determining that hospital taking step, notice to hospital and opportunity for
Index of Sec 1151. ...FISCAL year ; 2011 Secretary making payment adjustment for hospital described in subparagraph, respect
Index of Sec 1151. ...HOSPITAL and without application of adjustment factor described in paragraph and applied pursuant to paragraph ; Aggregate amount of payment adjustment for hospital under paragraph not exceeding estimated difference in spending occurring for fiscal year for
Index of Sec 1151. ...HOSPITAL or critical access hospital ; Creating new code and payment amount under fee schedule in section 1848 of Social Security Act for services furnished by appropriate physician seeing individual within first week after discharge from
Index of Sec 1151. ...HOSPITAL and other services determined appropriate by Secretary ; Term post acute services meaning services For which payment to be made under Medicare program furnished by skilled nursing facilities, inpatient rehabilitation facilities, long term care hospitals, hospital based outpatient rehabilitation facilities and home health agencies to individual after discharge of individual from
Index of Sec 1152. ...HOSPITAL meeting requirements of paragraph ;
Index of Sec 1156. ...HOSPITAL meeting requirements described in subsection ;
Index of Sec 1156. ...HOSPITAL ; Percentage of total value of ownership or investment interests holding in hospital or entity whose asseal including
Index of Sec 1156. ...HOSPITAL ; Hospital offers to physician not offered on more favorable terms than terms offered to person being not in position to refer patients or otherwise generating business for
Index of Sec 1156. ...FINANCING for physician owner or investor in hospital ; Hospital not directly or indirectly providing loans or
Index of Sec 1156. ...HOSPITAL not directly or indirectly guaranteeing loan ;
Index of Sec 1156. ...HOSPITAL in amount being directly proportional to ownership or investment interest of owner or investor in hospital ; Ownership or investment returns distributed to owner or investor in
Index of Sec 1156. ...HOSPITAL or located nearing premises of hospital ; Including purchase or lease of property under control of other owners or investors in
Index of Sec 1156. ...HOSPITAL on more favorable terms than terms offered to person being not physician owner or investor ; Hospital not offering physician owner or investor opportunity to purchase or lease property under control of hospital or other owner or investor in
Index of Sec 1156. ...HOSPITAL ; Hospital not conditioning physician ownership or investment interests directly or indirectly on physician owner or investor making or influencing referrals to hospital or otherwise generating business for
Index of Sec 1156. ...HOSPITAL lacking additional capabilities required to treat emergency ;
Index of Sec 1156. ...HOSPITAL after date of enactment of subsection ; Hospital not converted from ambulatory surgical center to
Index of Sec 1156. ...HOSPITAL applying for exception from requirement under paragraph ; Secretary establishing and implementing process under which
Index of Sec 1156. ...HOSPITAL applying for exception located with opportunity to provide input with respect to application ; Process under clause providing persons and entities in community in which
Index of Sec 1156. ...HOSPITAL to apply for exception up to once every 2 years ; Process described in subparagraph permitting
Index of Sec 1156. ...HOSPITAL after application of recent increase exception ; Procedure rooms or beds of hospital if hospital granting previous exception under paragraph or beds of
Index of Sec 1156. ...HOSPITAL ; Secretary granting exception under process described in subparagraph only to
Index of Sec 1156. ...HOSPITAL located during that period as estimated by Bureau of Census and available to Secretary ; Locating in county in which percentage increase in population during recent 5-year period For which data being available estimated to be 150 percent of percentage increase in population growth of State in which
Index of Sec 1156. ...HOSPITAL located ; Whose annual percent of total inpatient admissions representing inpatient admissions under program under title XIX estimated to be equal or greater than average percent with respect to admissions for hospitals located in county in which
Index of Sec 1156. ...HOSPITAL to discriminate against beneficiaries ; Not discriminating against beneficiaries of Federal health care programs and not permitting physicians practicing at
Index of Sec 1156. ...HOSPITAL located ; Average bed occupancy rate estimated to be greater than average bed occupancy rate in State in which
Index of Sec 1156. ...HOSPITAL admiting patient and not physician available on premises 24 hours per day ;
Index of Sec 1156. ...HOSPITAL disclosing fact to patient ;
Index of Sec 1156. ...COMPLIANCE with regulations pursuant to section 1866 ; Nothing in subsection to be construed as preventing Secretary from terminating hospital's provider agreement if hospital being not in
Index of Sec 1156. ...HOSPITAL or remaining at current care setting ; Individual's desire regarding transfer to
Index of Sec 1233. ...HOSPITAL or other provider of services or supplier furnishing items or services For which payment to be made under title affiliated with ACO under arrangement structured so that provider or supplier participating in pilot program and shares in incentive payments under pilot program ; Nothing in subsection to be construed as preventing qualifying ACO from including
Index of Sec 1301. ...HEALTH care entity billing Secretary under part A or part B of title XVIII for services reporting on ownership shares of physician owning interest in entity ; Hospital or other
Index of Sec 1451. ...HOSPITAL or other entity reporting under subsection or regard to information making public with respect to covered recipient and corrections to be transmitted to Secretary ; Secretary establishing procedures to ensure that covered recipient provided with opportunity to submit corrections to manufacturer, distributor,
Index of Sec 1451. ...AMBULATORY surgical center meeting requirements of titles XVIII or XIX participating in programs established under titles only if hospital or center reporting information on health care-associated infections developing in hospital or center as Secretary specifying ; Secretary providing that hospital or
Index of Sec 1461. ...AMBULATORY surgical center ; Nothing in section to be construed as preempting or otherwise affecting provision of State law relating to disclosure of information on health care-associated infections or patient safety procedures for hospital or
Index of Sec 1461. ...HOSPITAL For which cost report settled if not determined by Secretary ; Recent cost reporting periods of
Index of Sec 1501. ...ACCOUNTING period to recognize expansion of existing Programs ; Use of recent
Index of Sec 1501. ...HOSPITAL assigning additional resident positions for primary care residents ;
Index of Sec 1501. ...ACCREDITATION for program for additional resident positions ; Hospital's residency programs in primary care fully accredited or hospital actively applying for
Index of Sec 1501. ...HOSPITAL ; More than 20 full-time equivalent additional residency positions to be made available under subparagraph with respect to
Index of Sec 1501. ...HOSPITAL ; Approved FTE resident amounts deemed to be equal to hospital per resident amounts for primary care and nonprimary care computed under paragraph for
Index of Sec 1501. ...HOSPITAL under subsection, indirect teaching adjustment factor to be computed in same manner as provided under clause with respect to resident positions ; 2011 insofar as additional payment amount under subparagraph being attributable to resident positions distributed to
Index of Sec 1501. ...HOSPITAL claiming under subparagraph for time spent in nonprovider setting maintaining and make available to Secretary records regarding amount of timing and amount in comparison with amounts of time in base year as Secretary specifying ;
Index of Sec 1502. ...HOSPITAL incuring costs of stipends and fringe benefits of intern or resident during time intern or resident spends in setting ; Time spent by intern or resident in patient care activities at entity in nonprovider setting to be counted towards determination of full-time equivalency if
Index of Sec 1502. ...HOSPITAL to operate program ; Manner similar to manner in which payments to be made to hospital if
Index of Sec 1502. ...HOSPITAL ; Occuring in hospital to be counted toward determination of full-time equivalency if
Index of Sec 1503. ...HOSPITAL and opportunity for hospital to undertake action to alleviate steps ; Secretary determining that hospital taking step, notice to
Index of Sec 1151. ...HOSPITAL and post-acute provider groups participating in pilot program ; Nothing in subsection to be construed as limiting number of hospital and physician groups or number of
Index of Sec 1152. ...HOSPITAL and readmission having meanings given terms in section 1886(p)(5) of Social Security Act ; Terms applicable condition, applicable
Index of Sec 1151. ...HEALTH care-associated infections developing in hospital or center as Secretary specifying ; Secretary providing that hospital or ambulatory surgical center meeting requirements of titles XVIII or XIX participating in programs established under titles only if hospital or center reporting information on
Index of Sec 1461. ...HOSPITAL or entity whose asseal including hospital ; Percentage of total value of ownership or investment interests holding in
Index of Sec 1156. ...HOSPITAL or hospital paid under section 1814(b)(3) ; Term applicable hospital meaning subsection
Index of Sec 1151. ...HOSPITAL or unit ; Annual percentage increase factor applying to base rate for discharges for
Index of Sec 1103. ...HOSPITAL for hospital's costs of salary and fringe benefits for residents in program ; Approved teaching health center contracting with accredited teaching hospital to carry out inpatient responsibilities of primary care residency program of hospital involved and responsible for payment to
Index of Sec 1502. ...FISCAL year beginning after October 1 ; Respect to payment for discharges from applicable hospital occurring during
Index of Sec 1151. ...HOSPITAL meaning subsection hospital or hospital paid under section 1814(b)(3) ; Term applicable
Index of Sec 1151. ...DISCHARGE ; Admission of individual to same or another applicable hospital within time period specified by Secretary from date of
Index of Sec 1151. ...HOSPITAL ; Subparagraph applying to applicable
Index of Sec 1151. ...HOSPITAL as described in section 1886(p)(2) ; Adjustment factor described in section 1886(p)(3) applying to payments with respect to critical access hospital with respect to cost reporting period beginning in fiscal year 2012 and subsequent fiscal year of subsection in manner similar to manner in which section applying with respect to fiscal year to applicable
Index of Sec 1151. ...HOSPITAL or critical access hospital ; Claim submitted post-acute care provider under title XVIII of Social Security Act indicating that individual readmitted to hospital post-acute care provider or admitted from home and care of home health agency within 30 days of initial discharge from applicable
Index of Sec 1151. ...HOSPITAL ; Excess readmissions not including readmissions for applicable condition For which fewer than minimum number of discharges for applicable condition for applicable period and
Index of Sec 1151. ...HOME infusion therapy ; Benefits and costs of providing coverage under Medicare program including calculation of potential savings achieved through avoided or shortened hospital and nursing home stays as result of Medicare coverage of
Index of Sec 1143. ...HOSPITAL paid under section 1814(b)(3) ; Case of
Index of Sec 1151. ...HOSPITAL meeting requirements described in subsection ; Case of
Index of Sec 1156. ...HOSPITAL not offering emergency services ; Case of
Index of Sec 1156. ...HOSPITAL described in paragraph ; Case of
Index of Sec 1501. ...HOSPITAL closed after date being 2 years before date of enactment of clause ; Process taking into consideations recommendations submitted to Secretary by senior health official if recommendations submitted not later than 180 days after date of hospital closure involved in case of
Index of Sec 1504. ...CONTRACTING hospital's resident limit ; Number of primary care residents of center not counting against
Index of Sec 1502. ...CONTRACTING hospital agreeing not to diminish number of residents in primary care residency training program ;
Index of Sec 1502. ...HOSPITAL on more favorable terms than terms offered to person being not physician owner or investor ; Hospital not offering physician owner or investor opportunity to purchase or lease property under control of hospital or other owner or investor in
Index of Sec 1156. ...FISCAL year 2012 and subsequent fiscal year of subsection in manner similar to manner in which section applying with respect to fiscal year to applicable hospital as described in section 1886(p)(2) ; Adjustment factor described in section 1886(p)(3) applying to payments with respect to critical access hospital with respect to cost reporting period beginning in
Index of Sec 1151. ...HOSPITAL ; Claim submitted post-acute care provider under title XVIII of Social Security Act indicating that individual readmitted to hospital post-acute care provider or admitted from home and care of home health agency within 30 days of initial discharge from applicable hospital or critical access
Index of Sec 1151. ...HOSPITAL ; Creating new code and payment amount under fee schedule in section 1848 of Social Security Act for services furnished by appropriate physician seeing individual within first week after discharge from hospital or critical access
Index of Sec 1151. ...HOSPITAL ; Term hospital including critical access
Index of Sec 1461. ...HOSPITAL or essential access hospital ; No hospital to be defined or deemed as disproportionate share
Index of Sec 1704. ...HOSPITAL ; No hospital to be defined or deemed as disproportionate share hospital or essential access
Index of Sec 1704. ...HEALTH, skilled nursing facility and other services ; Cost-sharing for post acute care bundle to be treated relative to current rules for cost-sharing for inpatient hospital, home
Index of Sec 1152. ...HOSPITAL ; Submitting to Secretary initial report and periodic updating at frequency determined by Secretary containing detailed description of identity of physician owner and physician investor and other owners or investors of
Index of Sec 1156. ...HOSPITAL ; Procedure rooms or beds of hospital pursuant to paragraph only occurring in facilities on main campus of
Index of Sec 1156. ...DISPROPORTIONATE share hospital or essential access hospital ; No hospital to be defined or deemed as
Index of Sec 1704. ...HOSPITAL and physician groups or number of hospital and post-acute provider groups participating in pilot program ; Nothing in subsection to be construed as limiting number of
Index of Sec 1152. ...HOSPITAL ; Respect to additional preventive services furnished by outpatient department of
Index of Sec 1305. ...HOSPITAL ; Term medical assistance including payment for costs of graduate medical education consistent with subsection whether provided or outside of
Index of Sec 1744. ...HOSPITAL after application of recent increase exception ; Procedure rooms or beds of hospital if hospital granting previous exception under paragraph or beds of
Index of Sec 1156. ...HOSPITAL For which cost report settled if not determined by Secretary ; Recent cost reporting periods of
Index of Sec 1501. ...HOSPITAL ; Including purchase or lease of property under control of other owners or investors in hospital or located nearing premises of
Index of Sec 1156. ...HOSPITAL for hospital's costs of salary and fringe benefits for residents in program ; Approved teaching health center contracting with accredited teaching hospital to carry out inpatient responsibilities of primary care residency program of hospital involved and responsible for payment to
Index of Sec 1502. ...HOSPITAL after application of recent increase exception ; Procedure rooms or beds of hospital if hospital granting previous exception under paragraph or beds of
Index of Sec 1156. ...HOSPITAL exceeding 200 percent of baseline number of operating ; Procedure rooms or beds of
Index of Sec 1156. ...HOSPITAL pursuant to paragraph only occurring in facilities on main campus of hospital ; Procedure rooms or beds of
Index of Sec 1156. ...HOSPITAL submiting application under subparagraph by numbering as Secretary approving for portions of cost reporting periods occurring after July 1 ; Secretary increasing otherwise applicable resident limit for qualifying
Index of Sec 1501. ...CIVIL money penalty of not less than $1,000 but not more than $10,000 for payment or other transfer of value or ownership or investment interest not reported as required under subsection ; Applicable manufacturer or distributor failing to submit information required under subsection in timely manner in accordance with regulations promulgated to carry out subsection and hospital or other entity failing to submit information required under subsection in timely manner in accordance with regulations promulgated to carry out subsection to be subject to
Index of Sec 1451. ...HOSPITAL or other entity failing to submit information required under subsection in timely manner in accordance with regulations promulgated to carry out subsection ; Applicable manufacturer or distributor knowingly failing to submit information required under subsection in timely manner in accordance with regulations promulgated to carry out subsection and
Index of Sec 1451. ...HEALTH care entity reporting physician ownership under subsection ; Accuracy of information submitted under subsections and making available under paragraph to be responsibility of applicable manufacturer or distributor of covered drug, device, biological or medical supply reporting under subsection or hospital or other
Index of Sec 1451. ...HOSPITAL to other settings ; Providing care coordination services to assist in transitions from targeted
Index of Sec 1151. ...HOSPITAL including critical access hospital ; Term
Index of Sec 1461. ...HOSPITAL closed after date being 2 years before date of enactment of clause ; Process taking into consideations recommendations submitted to Secretary by senior health official if recommendations submitted not later than 180 days after date of hospital closure involved in case of
Index of Sec 1504. ...HOSPITAL cost reports ; Amendments making by section not to be applied in manner requiring reopening of settled
Index of Sec 1503. ...HOSPITAL filling positions within first 3 cost reporting periods beginning after July 1, 2011 determined by Secretary ; Secretary taking into account demonstrated likelihood of
Index of Sec 1501. ...HOSPITAL for hospital's costs of salary and fringe benefits for residents in program ; Approved teaching health center contracting with accredited teaching hospital to carry out inpatient responsibilities of primary care residency program of hospital involved and responsible for payment to
Index of Sec 1502. ...HOSPITAL offers to physician not offered on more favorable terms than terms offered to person being not in position to refer patients or otherwise generating business for hospital ;
Index of Sec 1156. ...HOSPITAL payment meaning additional payment amount under subsection ; Term disproportionate share
Index of Sec 1151. ...DISCHARGE from applicable hospital or critical access hospital ; Claim submitted post-acute care provider under title XVIII of Social Security Act indicating that individual readmitted to hospital post-acute care provider or admitted from home and care of home health agency within 30 days of initial
Index of Sec 1151. ...HOSPITAL READMISSIONS ; Sec 1151 reducing potentially preventable
Index of Sec 1151. ...HOSPITAL services furnished by psychiatric hospitals of subsection and psychiatric units of subsection, see section 124 of Medicare, Medicaid and SCHIP balanced Budget Refinement Act of 1999 ; Provisions related to establishment and implementation of prospective payment system for payments under title for inpatient
Index of Sec 1103. ...DISPROPORTIONATE share hospitals ; Term Medicare dss meaning adjustments in payments under section 1886(d)(5)(f) of Social Security Act 42 USC 1395ww(d)(5)(f) for inpatient hospital services furnished by
Index of Sec 1112. ...FISCAL year 2012 and subsequent fiscal year ; Purposes of reporting data on quality measures for inpatient hospital services furnished during
Index of Sec 1444. ...HOSPITAL services ; Provisions of clause of section 1886(b)(3)(c) applying to quality measures for covered OPD services under paragraph in same manner as provisions applying to quality measures for inpatient
Index of Sec 1444. ...DISPROPORTIONATE share hospitals ; Term Medicaid dss meaning adjustments in payments under section 1923 of Social Security Act for inpatient hospital services furnished by
Index of Sec 1704. ...HOSPITAL stay to qualify for services furnished by skilled nursing facilities and coordination of payments and care under Medicare program and Medicaid program ; Post-acute transfer policy, three-day
Index of Sec 1152. ...HOSPITAL'S FTE cap under section 413.79 of title 42, Code of Federal Regulations and not affecting application of section 1886(h)(4)(h)(v) of Social Security Act ; Amendments making by section not effecting temporary adjustment to
Index of Sec 1504. ...ACCREDITATION for program for additional resident positions ; Hospital's residency programs in primary care fully accredited or hospital actively applying for
Index of Sec 1501. ...IDENTICAL GAFS ; Iterative process continuing until ratio of GAF of highest-cost remaining msa to weighted-average of remaining lower-cost msas being less than 1.05 and remaining group of lower cost msas forming single fee schedule area if two msas having
Index of Sec 1125. ...IDENTIFICATION of high quality Plans in Top quintile based on projected enrollment ;
Index of Sec 1162. ...IDENTIFICATION of improved quality Plans in Top quintile based on projected enrollment ;
Index of Sec 1162. ...DRUG program ; Provision authorizing disclosure of return information to facilitate identification of individuals likely to be ineligible for low-income subsidies under Medicare prescription
Index of Sec 1203. ...IDENTIFICATION of Individuals likely to be ineligible for low-income assistance under medicare prescription Drug Program to Assist social security administration's outreach to eligible Individuals ; Disclosures to facilitate
Index of Sec 1801. ...IDENTIFICATION of Individuals likely to be ineligible for low-income Subsidies under medicare prescription Drug Program to Assist social security administration's outreach to eligible Individuals ; Disclosures to facilitate
Index of Sec 1801. ...IDENTIFICATION of deficiencies and imposition of sanctions and providing for imposition of incrementally more severe fines for repeated or uncorrected deficiencies ; Procedures to be designed so as to minimizing time between
Index of Sec 1614. ...IDENTIFICATION for year and quality performance payment adjustment for plan for year ; Notifying Medicare Advantage organization offering high quality plan or improved quality plan of
Index of Sec 1162. ...HOSPITAL ; Submitting to Secretary initial report and periodic updating at frequency determined by Secretary containing detailed description of identity of physician owner and physician investor and other owners or investors of
Index of Sec 1156. ...IMMUNOSUPPRESSIVE drugs furnished after date of enactment of America's Affordable Health Choices acting of 2009 ; Regard to
Index of Sec 1232. ...IMPLEMENTATION improving quality of care as determined by Secretary ; Including that
Index of Sec 1302. ...ELIGIBILITY option described in section 1902(e) for targeted low-income children whose family income below 200 percent of poverty line ; Plan providing for implementation under title of 12-month continuous
Index of Sec 1733. ...IMPLEMENTATION of pilot program under section not exceeding in aggregate $1,235,000,000 over 5-year period of program ; Additional Federal financial participation resulting from
Index of Sec 1722. ...ASSESSMENT and assurance activities conducted under clause ; Coordinating implementation of plan with quality
Index of Sec 1412. ...ASSESSMENT and assurance activities conducted under clause ; Coordinating implementation of plan with quality
Index of Sec 1412. ...ASSESSMENT and assurance activities conducted under clause of sections ; Coordinating implementation of plan with quality
Index of Sec 1412. ...IMPLEMENTATION of program and training and technical assistance contributed to outcomes achieved through program ; Training and technical assistance provided to aid
Index of Sec 1904. ...ACCEPTABLE coverage ; State entering into Medicaid memorandum of understanding described in section 204(e)(4) of America's Affordable Health Choices acting of 2009 with Health Choices Commissioner with respect to coordinating implementation of provisions of division A of Act with State plan under title in order to ensure enrollment of Medicaid eligible individuals in
Index of Sec 1702. ...IMPLEMENTATION of rbrvs ; Codes not being subject to review since
Index of Sec 1122. ...IMPLEMENTATION of section ; Chapter 35 of title 44, United States Code not applying to manufacturer provision of information pursuant to section 1927(b)(3)(a)( iii for purposes of
Index of Sec 1310. ...IMPLEMENTATION funding to community based or State-based organization or State participating in pilot program under subsection ; Secretary making available initial
Index of Sec 1302. ...HOSPITAL services furnished by psychiatric hospitals of subsection and psychiatric units of subsection, see section 124 of Medicare, Medicaid and SCHIP balanced Budget Refinement Act of 1999 ; Provisions related to establishment and implementation of prospective payment system for payments under title for inpatient
Index of Sec 1103. ...IMPLEMENTATION funding under subsection ; Without regard to receipt of initial
Index of Sec 1302. ...IMPLEMENTATION to ensure that services delivered according to specified model ; Monitor fidelity of program
Index of Sec 1904. ...FISCAL year ; Secretary including result of analysis under subparagraph in fiscal year 2011 rulemaking cycle for purposes of implementation beginning for
Index of Sec 1111. ...IMPLEMENTATION phase ; Demonstration site under pilot program operating for period of up to 5 years after initial
Index of Sec 1302. ...IMPLEMENTATION plan including funds to be used ; Organization providing Secretary with detailed
Index of Sec 1302. ...CIVIL money penalty applying to civil money penalty under clause in same manner as provisions applying to penalty or proceeding under section 1128a(a) ; Provisions requiring hearing prior to imposition of
Index of Sec 1421. ...CIVIL money penalty applying to civil money penalty under clause in same manner as provisions applying to penalty or proceeding under section 1128a(a) ; Provisions requiring hearing prior to imposition of
Index of Sec 1421. ...IMPOSITION of incrementally more severe fines for repeated or uncorrected deficiencies ; Procedures to be designed so as to minimizing time between identification of deficiencies and imposition of sanctions and providing for
Index of Sec 1614. ...IMPOSITION of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow account under direction of Secretary on earlier of date on which informal dispute resolution process under item completed or date being 90 days after date of
Index of Sec 1421. ...IMPOSITION of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow account under direction of State on earlier of date on which informal dispute resolution process under subclause completed or date being 90 days after date of
Index of Sec 1421. ...IMPOSITION of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow account under direction of Secretary on earlier of date on which informal dispute resolution process under item completed or date being 90 days after date of
Index of Sec 1421. ...IMPOSITION of penalty and ending on day on which informal dispute resolution process under item completed ; Not imposing penalty for day during period beginning on initial day of
Index of Sec 1421. ...IMPOSITION of penalty and ending on day on which informal dispute resolution process under subclause completed ; Not imposing penalty for day during period beginning on initial day of
Index of Sec 1421. ...IMPOSITION of penalty and ending on day on which informal dispute resolution process under item completed ; Not imposing penalty for day during period beginning on initial day of
Index of Sec 1421. ...IMPOSITION of sanctions ; Appropriate procedures for appealing determinations relating to
Index of Sec 1614. ...IMPOSITION ; Case where facility self-reports and promptly corrects deficiency For which penalty imposed under clause not later than 10 calendar days after date of
Index of Sec 1421. ...CIVIL money penalty under subsection to be used to carry out that section ; Funds collected by Secretary as result of imposition of
Index of Sec 1451. ...INAPPROATIONS political or stakeholder influence ; Establishment of agenda and conduct of research to be insulated from
Index of Sec 1401. ...EXPENDITURES, program integrity and other mattering Secretary deeming appropriate ; Secretary creating separate incentive arrangements for different categories of qualifying ACOS to reflect natural variations in data availability, variation in average annual attributable
Index of Sec 1301. ...INCENTIVE model for qualifying ACO under pilot program to assess impacts on beneficiaries, providers of services, suppliers and program under title ; Secretary evaluating payment
Index of Sec 1301. ...INCENTIVE models ; Secretary conducting pilot program to test different payment
Index of Sec 1301. ...INCENTIVE models with respect to qualifying ACOS ; Secretary entering into agreements under pilot program with additional qualifying ACOS to furthing test and refining payment
Index of Sec 1301. ...INCENTIVE models described in subsection ; Including specific payment
Index of Sec 1301. ...INCENTIVE models described in subsection following ; Specific payment
Index of Sec 1301. ...EXPENDITURES for items and services covered under parts A and B ; Resulting from normal variation in
Index of Sec 1301. ...INCENTIVE payment for year equal to portion of amount by which payments under title for year relative estimated below performance target for year as determined by Secretary ; Meet or exceeding annual quality and performance targets for year receiving
Index of Sec 1301. ...INCENTIVE payment being made under subsection ; Secretary treating receipt of incentive payment for year by organization under physician group practice demonstration pursuant to section 1866a as year For which
Index of Sec 1301. ...INCENTIVE payment being made under subsection ; Secretary treating receipt of incentive payment for year by organization under physician group practice demonstration pursuant to section 1866a as year For which
Index of Sec 1301. ...INCENTIVE payments under pilot program ; Nothing in subsection to be construed as preventing qualifying ACO from including hospital or other provider of services or supplier furnishing items or services For which payment to be made under title affiliated with ACO under arrangement structured so that provider or supplier participating in pilot program and shares in
Index of Sec 1301. ...INCENTIVE payments under program ; Model of organization under which physicians entering into agreements with other providers for purposes of participation in pilot program in order to provide high quality and efficient health care services and share in
Index of Sec 1301. ...INCENTIVE payments under section ; Group having legal structure allowing group to receive and distribute
Index of Sec 1301. ...EXPENDITURES with respect to applicable beneficiaries for ACOS under title not exceeding amount ; Secretary limiting incentive payments to qualifying ACO under paragraph as necessary to ensure that aggregate
Index of Sec 1301. ...INCENTIVE payments described in subparagraph not to be included in limit described in subparagraph or performance target model described in paragraph ;
Index of Sec 1301. ...INCENTIVE payments with respect to first 4 years of pilot agreement and consistently meeting quality standards ; ACO receiving
Index of Sec 1301. ...INCENTIVE payments or consistently failed to meet quality standards in first 3 years under program ; Secretary terminating agreement with qualifying ACO under pilot program if ACO not receiving
Index of Sec 1301. ...INCENTIVE payments and penalties related to physician quality reporting initiative ; Secretary incorporating reporting requirements,
Index of Sec 1301. ...INCOME beneficiaries ; Appropriate amount and distribution of Medicare dss to compensate for higher Medicare costs associated with serving low-
Index of Sec 1112. ...INCOME beneficiaries ; Secretary of Health and Human Services submitting to Congress report evaluating adequacy of risk adjustment system under section 1853(a)(1)(c) of Social Security Act 42 USC 1395-23(a)(1)(c) in predicting costs for beneficiaries with chronic or co-morbid conditions, beneficiaries dually-eligible for Medicare and Medicaid and non-Medicaid eligible low-
Index of Sec 1167. ...INCOME not exceeding 200 percent of poverty line bears to total number of children in Indian tribes whose families having income not exceeding 200 percent of poverty line ; Bearing same ratio to amount so reserved as number of children in Indian tribe whose families having
Index of Sec 1904. ...INCOME not exceeding 200 percent of poverty line bears to total number of children in States whose families having income not exceeding 200 percent of poverty line ; Bearing same ratio to remainder of amount so appropriated as number of children in State whose families having
Index of Sec 1904. ...ELIGIBILITY determination to maximum extent feasible ; Individual applied directly to State for assistance excepting that State using income-related information used by Commissioner and provided to State under memorandum in making presumptive
Index of Sec 1702. ...INCOME child or otherwise ; Term Chip enrollee meaning targeted low-
Index of Sec 1703. ...INCOME below 200 percent of poverty line ; Plan providing for implementation under title of 12-month continuous eligibility option described in section 1902(e) for targeted low-income children whose family
Index of Sec 1733. ...INCOME and families whose income not exceeding 133 1/3 percent of income official poverty line applicable to family of size involved ;
Index of Sec 1701. ...INCOME official poverty line applicable to family of size involved ; Families whose income not exceeding 133 1/3 percent of
Index of Sec 1701. ...INCOME official poverty line applicable to family of size involved ; Income and families whose income not exceeding 133 1/3 percent of
Index of Sec 1701. ...INCOME beneficiaries ; Rfp contract described in section being contract entered between Secretary and sponsor of prescription drug plan pursuant to Centers for Medicare and Medicaid Services' request for proposals issued on February 17, 2009 relating to Medicare part D retroactive coverage for certain low
Index of Sec 1204. ...INCOME-related subsidies and medicare cost-sharing furnished for periods beginning after January 1 ; Amendments making by subsection applying to eligibility determinations for
Index of Sec 1201. ...INCOME below 200 percent of poverty line ; Plan providing for implementation under title of 12-month continuous eligibility option described in section 1902(e) for targeted low-income children whose family
Index of Sec 1733. ...INCOME disabled individual described in subsection and obtaining medical assistance under plan ; Whose income not exceeding maximum amount of
Index of Sec 1731. ...INCOME-related premium ; Exception for Use of more recent Tax year in Case of Gains from sale of primary residence in computing Part B
Index of Sec 1235. ...INCOME not exceeding 133 1/3 percent of income official poverty line applicable to family of size involved ; Families whose
Index of Sec 1701. ...INCOME not exceeding 133 1/3 percent of income official poverty line applicable to family of size involved ; Income and families whose
Index of Sec 1701. ...INCOME disabled individual described in subsection and obtaining medical assistance under plan ; Whose income not exceeding maximum amount of
Index of Sec 1731. ...INCOME assistance under medicare prescription Drug Program to Assist social security administration's outreach to eligible Individuals ; Disclosures to facilitate identification of Individuals likely to be ineligible for low-
Index of Sec 1203. ...INCOME assistance under medicare prescription Drug Program to Assist social security administration's outreach to eligible Individuals ; Disclosures to facilitate identification of Individuals likely to be ineligible for low-
Index of Sec 1801. ...CHILD maltreatment ; Identify and prioritizing serving communities in high need of services, especially communities with high proportion of low-income families or high incidence of
Index of Sec 1904. ...INCOME Subsidies under medicare prescription Drug Program to Assist social security administration's outreach to eligible Individuals ; Disclosures to facilitate identification of Individuals likely to be ineligible for low-
Index of Sec 1801. ...INCOME subsidy under section 1860d-14 of Social Security Act to which individual entitled ; Costs to be incurred by beneficiary during period if beneficiary enrolled in plan and recognized by planning as qualified during period for low
Index of Sec 1204. ...INCOME Subsidy enrollment ; Enhancing oversight relating to reimbursements for retroactive low
Index of Sec 1204. ...INCOME Subsidy Program ; Sec 1201 improving asseal testing for medicare savings Program and low-
Index of Sec 1201. ...INCOME subsidy program to constitute date of filing for benefits under Medicare Savings Program ; State considering date of individual's application for low
Index of Sec 1781. ...INCOME supports and other related assistance ; State promoting coordination and collaboration with other home visitation programs and other child and family services, health services,
Index of Sec 1904. ...INCORPOATIONS ; Assisting users of health information technology focused on clinical decision support to promote timely incorporation of findings into clinical practices and promoting ease of use of
Index of Sec 1401. ...INCORPORATION of patient preferences and values into medical plan ; Providing patients with information about trade-offing among treatment options and facilitating
Index of Sec 1236. ...CLINICAL practices and promoting ease of use of incorpoations ; Assisting users of health information technology focused on clinical decision support to promote timely incorporation of findings into
Index of Sec 1401. ...INCORPORATION of findings into relevant activities for purpose of informing higher quality and more effective and efficient decisions regarding medical items and services ; Center developing protocols and strategies for appropriate dissemination of research findings in order to ensure effective communication of findings and use and
Index of Sec 1401. ...HEPATITIS B and administration and inserting federally recommended vaccines and respective administration ; Influenza and
Index of Sec 1310. ...COMPENSATION arrangements ; Entity providing covered items or services For which payment to be made under title providing Secretary with information concerning entity's ownership, investment and
Index of Sec 1156. ...INFORMATION to be provided in form, manner and times as Secretary specifying ;
Index of Sec 1156. ...INFORMATION to be reported or disclosed under paragraph to be provided in form, manner and times as Secretary specifying ;
Index of Sec 1156. ...INFORMATION submitted by hospitals under paragraph on public Internet website of Centers for Medicare and Medicaid Services ;
Index of Sec 1156. ...INFORMATION ; Failure to report or disclose
Index of Sec 1156. ...DRUG of manufacturer dispensed to full-benefit dual eligible Medicare drug plan enrollees under prescription drug plan operated by PDP sponsor during rebate period ; Information on total number of units of dosageing, forming and strength of
Index of Sec 1181. ...DRUG plan enrollees and PDP enrollees being not full-benefit dual eligible Medicare drug plan enrollees ; Information on extent to which price discounts, price concessions and rebates applying equally to full-benefit dual eligible Medicare
Index of Sec 1181. ...INFORMATION disclosed by manufacturers or wholesalers under section ; Provisions applying to
Index of Sec 1181. ...INFORMATION reported under paragraph to be used by Inspector General of Department of Health and Human Services for statutorily authorized purposes of audit, investigation and evaluations ;
Index of Sec 1181. ...INFORMATION required under subparagraph on timely basis ; Failing to provide
Index of Sec 1181. ...INFORMATION needed for individual or legal surrogate to make informed decisions regarding completion order ;
Index of Sec 1233. ...ELECTRONIC versions of Medicare ; Secretary including information described in subparagraph in paper and
Index of Sec 1233. ...INFORMATION as Secretary requiring ; Eligible provider seeking to participate in program submitting to Secretary application at time and containing
Index of Sec 1236. ...INFORMATION required by Secretary for reporting purposes ; Necessary information technology infrastructure to collect
Index of Sec 1236. ...INCORPORATION of patient preferences and values into medical plan ; Providing patients with information about trade-offing among treatment options and facilitating
Index of Sec 1236. ...INFORMATION to Center on agreed upon schedule ; Head of department or agency furnishing that
Index of Sec 1401. ...INFORMATION for use by Center and Commission under subsection in making reports and recommendations ; Interesting party to submit
Index of Sec 1401. ...INFORMATION produced through data being timely and credible ; Make recommendations for policies allowing for public access of data produced under section when ensuring that
Index of Sec 1401. ...INFORMATION produced from research being clinically relevant to decisions making by clinicians and patients at point of care ; Consulting with patients and advising Center on research questions, methods and evidence gaps in terms of clinical outcomes for specific research inquiry to be examined with respect to priority to ensure that
Index of Sec 1401. ...INFORMATION produced by research being objective ; Routinely review processes of Center with respect to research to confirm that
Index of Sec 1401. ...INFORMATION ; Requiring disclosure of ownership and additional DISCLOSABLE partying
Index of Sec 1411. ...INFORMATION ; Requiring disclosure of ownership and additional DISCLOSABLE partying
Index of Sec 1411. ...INFORMATION described in paragraph available ; Facility to have
Index of Sec 1411. ...INFORMATION ; State or State long-term care ombudsman requesting
Index of Sec 1411. ...INFORMATION described in subparagraph after effective date of final regulations promulgated under paragraph ; Nothing in subparagraph to be construed as authorizing facility to dispose or delete
Index of Sec 1411. ...INFORMATION ; Making information described in paragraph available to public upon request and updating
Index of Sec 1411. ...INFORMATION described in subsections ;
Index of Sec 1411. ...INFORMATION described in clauses ; Information submitted by facility to Securities and exchanging Commission or information otherwise submitted to Secretary or other Federal agency containing
Index of Sec 1411. ...INFORMATION reported by facility in accordance with final regulations being accurate and current ; Final regulations ensuring that facility certifying that
Index of Sec 1411. ...INFORMATION reported in accordance with final regulations to be made available to public in accordance with procedures established by Secretary ;
Index of Sec 1411. ...INFORMATION reported to Secretary under section 1124(c)(4) ;
Index of Sec 1413. ...INFORMATION on Special Focus Facility program established by Centers for Medicare and Medicaid Services according to procedures established by Secretary ;
Index of Sec 1413. ...INFORMATION on staffing turnover and tenure in format being clearly understandable to consumers of long-term care servicing and allowing consumers to compare differences in staffing between facilities and State and national averages for facilities ; Including
Index of Sec 1413. ...CERTIFICATION programs ; Links to State Internet websites with information regarding State survey and
Index of Sec 1413. ...INFORMATION described in subparagraph included on website not later than 1 year after date of enactment of subsection ; Secretary ensuring that
Index of Sec 1413. ...INFORMATION described in subparagraph and included on website not later than date on which requirements under section 1124(c)(4) and subsection implemented ; Secretary ensuring that
Index of Sec 1413. ...INFORMATION provided on Nursing Home comparing Medicare website ; Secretary using information submitted under preceding sentence to update
Index of Sec 1413. ...INFORMATION on staffing turnover and tenure in format being clearly understandable to consumers of long-term care servicing and allowing consumers to compare differences in staffing between facilities and State and national averages for facilities ; Including
Index of Sec 1413. ...CERTIFICATION programs ; Links to State Internet websites with information regarding State survey and
Index of Sec 1413. ...INFORMATION described in subparagraph included on website not later than 1 year after date of enactment of subsection ; Secretary ensuring that
Index of Sec 1413. ...INFORMATION described in subparagraph and included on website not later than date on which requirements under section 1124(c)(4) and subsection implemented ; Secretary ensuring that
Index of Sec 1413. ...INFORMATION provided on Nursing Home comparing Medicare website ; Secretary using information submitted under preceding sentence to update
Index of Sec 1413. ...INFORMATION about complainants or residents ; Facility not making available under clause identifying
Index of Sec 1413. ...INFORMATION about complainants or residents ; Facility not making available under clause identifying
Index of Sec 1413. ...INFORMATION on Nursing Home comparing ; Complaint investigation reports and facility's plan of correction or other response to Form 2567 State inspection reports on Internet website of State providing information on skilled nursing facilities and nursing facilities and Secretary including
Index of Sec 1413. ...EXPENDITURES submitted under subsection readily available to interested parties upon request ; Secretary establishing procedures to make information on
Index of Sec 1414. ...INFORMATION reported or disclosed in complaint being true ;
Index of Sec 1415. ...INFORMATION ; Violation of title occurring or occurring in relation to
Index of Sec 1415. ...INFORMATION reported or disclosed in complaint being true ;
Index of Sec 1415. ...INFORMATION ; Violation of title occurring or occurring in relation to
Index of Sec 1415. ...INFORMATION submitted under preceding sentence ; Specifications requiring that
Index of Sec 1416. ...INFORMATION on employee turnover and tenure and hours of care provided by category of certified employees referenced in clause per resident per day ; Including
Index of Sec 1416. ...INFORMATION submitted under preceding sentence ; Specifications requiring that
Index of Sec 1416. ...INFORMATION on employee turnover and tenure and hours of care provided by category of certified employees referenced in clause per resident per day ; Including
Index of Sec 1416. ...INFORMATION as Secretary requiring ; Secretary selecting chains of skilled nursing facilities and nursing facilities described in paragraph to participate in pilot program among chains submitting application to Secretary at time and containing
Index of Sec 1422. ...INFORMATION submitted by applicable manufacturer or distributor under paragraph including aggregate amount of payments or other transfers of value provided by manufacturer or distributor to covered recipients during year ;
Index of Sec 1451. ...DISCLOSURE under section 552 of title 5, United States Code or other similar Federal ; Information described in paragraph or considered confidential and not subject to
Index of Sec 1451. ...INFORMATION submitted under subsections ;
Index of Sec 1451. ...INFORMATION presented by name of applicable manufacturer or distributor ; Containing
Index of Sec 1451. ...CLINICAL research ; Separately listed information as funding for
Index of Sec 1451. ...INFORMATION making available to public with respect to covered recipient ; Providing covered recipient opportunity to submit corrections to
Index of Sec 1451. ...INFORMATION making public with respect to covered recipient and corrections to be transmitted to Secretary ; Secretary establishing procedures to ensure that covered recipient provided with opportunity to submit corrections to manufacturer, distributor, hospital or other entity reporting under subsection or regard to
Index of Sec 1451. ...INFORMATION relating to drug samples provided under subsection not to be made available to public by Secretary ;
Index of Sec 1451. ...INFORMATION relating to national provider identifiers provided under subsection not to be made available to public by Secretary ;
Index of Sec 1451. ...CIVIL money penalty of not less than $1,000 but not more than $10,000 for payment or other transfer of value or ownership or investment interest not reported as required under subsection ; Applicable manufacturer or distributor failing to submit information required under subsection in timely manner in accordance with regulations promulgated to carry out subsection and hospital or other entity failing to submit information required under subsection in timely manner in accordance with regulations promulgated to carry out subsection to be subject to
Index of Sec 1451. ...INFORMATION required under subsection in timely manner in accordance with regulations promulgated to carry out subsection ; Applicable manufacturer or distributor knowingly failing to submit information required under subsection in timely manner in accordance with regulations promulgated to carry out subsection and hospital or other entity failing to submit
Index of Sec 1451. ...INFORMATION during year ; Biological or medical supply submitting
Index of Sec 1451. ...INFORMATION under subsection ; Term not including physician being employee of applicable manufacturer required to submit
Index of Sec 1451. ...INFORMATION not of type required to be disclosed or reported under section ; Disclosure or reporting of
Index of Sec 1451. ...HEALTH care-associated infections developing in hospital or center as Secretary specifying ; Secretary providing that hospital or ambulatory surgical center meeting requirements of titles XVIII or XIX participating in programs established under titles only if hospital or center reporting information on
Index of Sec 1461. ...INFORMATION to be reported in accordance with reporting protocols established by Secretary through Director of Centers for Disease Control and Prevention and National Healthcare Safety Network of CDC or another reporting system of Centers as determined appropriate by Secretary in consulations with Director ;
Index of Sec 1461. ...INFORMATION appropriately compared across hospitals and centers ; Secretary establishing procedures regarding validity of information submitted under subsection in order to ensure that
Index of Sec 1461. ...INFORMATION reported under subsection ; Secretary promptly posting
Index of Sec 1461. ...INFORMATION on service model used by program and performance of program ; Characteristics program including
Index of Sec 1904. ...INFORMATION involved ; Assessment of not more than 3 timing amount claimed by plan or plan sponsor based upon misrepresenations or falsified
Index of Sec 1616. ...COMPENSATION arrangement between facilitying and medical director of facilitying or facilitying and physician ; Renal dialysis facility providing to Secretary access to information relating to ownership or
Index of Sec 1643. ...FRAUD, Waste and Abuse ; Subtitle D across Access to information needed to prevent
Index of 0INFORMATION required to be reported under preceding provisions of section in npdb ; Secretary ceasing operation of HIPDB and collecting
Index of Sec 1652. ...INFORMATION described in paragraph to be available from National Practitioner Data Bank to Secretary of Veterans Affairs without charging ;
Index of Sec 1652. ...INFORMATION described in paragraph being information to be available to Secretary of Veterans Affairs from Healthcare Integrity and Protection Data Bank ;
Index of Sec 1652. ...INFORMATION on basis of which determination being made to Commissioner ; Agency forwarding
Index of Sec 1702. ...INFORMATION on covered outpatient drugs dispensed to individuals eligible for medical assistance enrolled with entity and entity being responsible for coverage of drugs under subsection ; State requiring in order to include
Index of Sec 1743. ...EDUCATION and payments used for graduate medical education ; Information on total payments for graduate medical
Index of Sec 1744. ...INFORMATION submitted under paragraph ; Secretary and Advisory Committee independently reviewing
Index of Sec 1744. ...INFORMATION being available in Internal Revenue Service's taxpayer information records ; Applicable year meaning recent taxable year For which
Index of Sec 1801. ...INFORMATION and Provision of false information ; Penalties for failure to provide timely
Index of Sec 1181. ...DRUG, device, biological or medical supply reporting under subsection or hospital or other health care entity reporting physician ownership under subsection ; Accuracy of information submitted under subsections and making available under paragraph to be responsibility of applicable manufacturer or distributor of covered
Index of Sec 1451. ...INFORMATION as Secretary requiring ; Manner and accompanied by additional
Index of Sec 1222. ...INFORMATION ; Secretary of Health and Human Services submitting to Congress report on appropriateness of expanding requirements under section to include additional
Index of Sec 1461. ...BOND ; Requiring or unannounced site visits or inspections, additional information reporting requirements and conditioning enrollment on provision of surety
Index of Sec 1632. ...COMPLIANCE with reporting requirements, success of validity procedures established and conflicting or overlapping between reporting required under sectioning and other reporting systems mandated by States or Federal Government ; Report including analysis of appropriateness of types of information required for submission,
Index of Sec 1461. ...INFORMATION under subsection by applicable manufacturer or distributor or other entity not exceeding $150,000 ; Total amount of civil money penalties imposed under subparagraph with respect to annual submission of
Index of Sec 1451. ...INFORMATION under subsection or applicable manufacturer, distributor or entity not exceeding $1,000,000 or greater ; Total amount of civil money penalties imposed under subparagraph with respect to annual submission of
Index of Sec 1451. ...INFORMATION contained in report to be posted on official public Internet site of Center and Commission as applicable ; Appropriate
Index of Sec 1401. ...INFORMATION as Secretary determining to be necessary to carry out that section ; Made in manner and containing agreements, assurances and
Index of Sec 1442. ...INFORMATION submitted with respect to payment or other transfer of value described in subsection, lists ; Case of
Index of Sec 1451. ...INFORMATION described in clauses ; Information submitted by facility to Securities and exchanging Commission or information otherwise submitted to Secretary or other Federal agency containing
Index of Sec 1411. ...HEALTH care-associated infections ; Information to be set forth in manner allowing for comparison of information on
Index of Sec 1461. ...CONFIDENTIALITY of information ; Excepting for provisions related to
Index of Sec 1122. ...INFORMATION reported under subparagraph to Secretary for purpose of audit oversight and evaluation ; PDP sponsor promptly transmitting copy of
Index of Sec 1181. ...INFORMATION resulting from research ; Ensuring activities resulting in highly credible research and
Index of Sec 1401. ...INFORMATION described in section 1860d-12(b)(7) ; Rebate to be paid by manufacturer to Secretary not later than 30 days after date of receipt of
Index of Sec 1181. ...AMBULATORY surgical center ; Nothing in section to be construed as preempting or otherwise affecting provision of State law relating to disclosure of information on health care-associated infections or patient safety procedures for hospital or
Index of Sec 1461. ...DRUG program ; Provision authorizing disclosure of return information to facilitate identification of individuals likely to be ineligible for low-income subsidies under Medicare prescription
Index of Sec 1203. ...ADMINISTRATIVE proceeding ; Discovery or admissibility of information described in section in criminal, civil or
Index of Sec 1451. ...HEALTH care or health care-related services and limited English proficient recipient of services enabling limited English proficient individuals to access, understand and benefit from health care or health care-related services ; Term effective communication meaning exchange of information between provider of
Index of Sec 1224. ...INFORMATION ; Penalties for failure to provide timely information and Provision of false
Index of Sec 1181. ...INFORMATION ; Sponsor being subject to civil money penalty in amount not to exceed $100,000 for item of false
Index of Sec 1181. ...INFORMATION ; Report including following
Index of Sec 1222. ...INFORMATION described in paragraph ; Following
Index of Sec 1411. ...INFORMATION to meet requirements of paragraph submitted in manner specified by Secretary ; Secretary allowing Form or
Index of Sec 1411. ...INFORMATION required to be filed with plan by beneficiary ; Reimbursement to be made automatically by plan upon receipt of appropriate notice beneficiary being eligible for assistance described in subsection without further
Index of Sec 1204. ...INFORMATION resulted in waiver of overpayment under clause ; Federal health care program contractor provided inaccurate or misleading
Index of Sec 1619. ...INFORMATION with respect ; Procedures providing for inclusion of
Index of Sec 1413. ...IMPLEMENTATION of section ; Chapter 35 of title 44, United States Code not applying to manufacturer provision of information pursuant to section 1927(b)(3)(a)( iii for purposes of
Index of Sec 1310. ...INFORMATION described in previous sentence ; Secretary providing for publication on website for Medicare program of
Index of Sec 1162. ...INFORMATION submitted under subsection and designating ; Information separately from other
Index of Sec 1451. ...INFORMATION Secretary determining to be helpful to average consumer ; Containing other
Index of Sec 1451. ...INFORMATION as Secretary determining assisting in carrying out paragraphs ; Other
Index of Sec 1744. ...INFORMATION relating to individual as prescribed by Secretary by regulation ; Other return
Index of Sec 1801. ...INFORMATION specified in section ; Other treatment of
Index of Sec 1652. ...HEALTH care programs ; Consensus-based entity entering into contract under section 1890 convening multi-stakeholder groups to provide recommendations on selection of individual or composite quality measures for use in reporting performance information to public or use in public
Index of Sec 1443. ...HEALTH information and providing data security ; Data collection efforts under system use efficient and cost-effective means in manner minimizing administrative burden on persons required to collect data and adequately protecting privacy of patients' personal
Index of Sec 1442. ...INFORMATION with respect to manner of filing complaint ; Employee filing complaint with Secretary against skilled nursing facility violating provisions of paragraph and
Index of Sec 1415. ...INFORMATION with respect to manner of filing complaint ; Employee filing complaint with Secretary against nursing facility violating provisions of paragraph and
Index of Sec 1415. ...ELIGIBILITY determination to maximum extent feasible ; Individual applied directly to State for assistance excepting that State using income-related information used by Commissioner and provided to State under memorandum in making presumptive
Index of Sec 1702. ...DRUG subsidy under section 1860d-14 of Social Security Act for use in outreach efforts under section 1144 of Social Security Act ; Return information disclosed under paragraph to be used only by officers and employees of Social Security Administration solely for purposes of identifying individuals likely to be ineligible for low-income prescription
Index of Sec 1801. ...INFORMATION with respect to specific categories ; Nothing in subparagraph to be construed as preventing Secretary from requiring submission of
Index of Sec 1416. ...INFORMATION with respect to specific categories ; Nothing in subparagraph to be construed as preventing Secretary from requiring submission of
Index of Sec 1416. ...INFORMATION submitted under subsections and during preceding year with respect to covered recipients or other hospitals and entities in State ; Secretary submitting to States report including summary of
Index of Sec 1451. ...INFORMATION reported on websiteing as of day before date of enactment of subsection ; Clarity of presentation, timeliness and comprehensiveness of
Index of Sec 1413. ...INFORMATION reported on websiteing as of day before date of enactment of subsection ; Clarity of presentation, timeliness and comprehensiveness of
Index of Sec 1413. ...INFORMATION making available to public under subparagraph and provided on Nursing Home comparing Medicare website under subsection ; Improving timeliness of
Index of Sec 1413. ...INFORMATION making available to public under subparagraph and provided on Nursing Home comparing Medicare website under subsection ; Improving timeliness of
Index of Sec 1413. ...INFORMATION under subsection coordinated with systems established under HITECH Act where appropriate ; Ensuring that transmission of
Index of Sec 1461. ...INFORMATION ; Acts in reckless disregarding of truth or falsity of
Index of Sec 1645. ...INFORMATION regarding payment or other transfer of value provided by manufacturer to covered recipient ; 2011 subject to paragraph, provisions of section preempting law or regulation of State or political subdivision of State requiring applicable manufacturer and applicable distributor to disclose or report type of
Index of Sec 1451. ...INFORMATION required to be disclosed or reported under section to Federal ; Disclosure or reporting of type of
Index of Sec 1451. ...INFORMATION necessary to enable to carry out that section ; Center securing directly from department or agency of United States
Index of Sec 1401. ...INFORMATION on participating patients enabling practice to treat patients comprehensively ; Clinically useful
Index of Sec 1302. ...INFORMATION to consumers regarding skilled nursing facilities and nursing facilities in State forming 2567 State inspection reports ; State maintaining consumer-oriented website providing useful
Index of Sec 1413. ...CONVEYING findings to different audiences including dissemination to individuals with limited English proficiency ; Center consulting with stakeholders concerning types of dissemination to be useful to end users of information and providing for utilization of multiple formats for
Index of Sec 1401. ...INFORMATION ; Procedures to ensure validity of
Index of Sec 1461. ...DRUG-component negotiated price instead of other manufacturer prices ; Sponsors and Ma organizations to be responsible for reporting information on
Index of Sec 1182. ...INFORMATION records ; Applicable year meaning recent taxable year For which information being available in Internal Revenue Service's taxpayer
Index of Sec 1801. ...INFORMATION systems security requirements enacted by law or otherwise required by Secretary ; Subject to
Index of Sec 1651. ...HEALTH care services ; Collecting as part of health information technologies supporting better delivery of
Index of Sec 1442. ...CLINICAL decision support to promote timely incorporation of findings into clinical practices and promoting ease of use of incorpoations ; Assisting users of health information technology focused on
Index of Sec 1401. ...CLINICAL decision support, appropriate professional associations and Federal and private health plans and other relevant stakeholders ; Center providing for dissemination of appropriate findings produced by research supported, conducted or synthesized under section to health care providers, patients, vendors of health information technology focused on
Index of Sec 1401. ...INFORMATION required by Secretary for reporting purposes ; Necessary information technology infrastructure to collect
Index of Sec 1236. ...INSTEAD of State plans under title XIX ; Discounts to be applied under subsection to prescription drug plans and Ma-pd planing
Index of Sec 1182. ...HEALTH care practitioners in delivery of health care services ; Term quality measure meaning national consensus standard for measuring performance and improvement of population health or institutional providers of services, physicians and other
Index of Sec 1441. ...INSTITUTIONAL providers of services to review and correct findings ; Standards under system providing for appropriate opportunity for physicians and other clinicians and
Index of Sec 1442. ...HEALTH care delivered and related to receiving health care ; Term health care-associated infection meaning infection developing in patient received care in institutional setting where
Index of Sec 1461. ...INSURANCE if substantially of coverage of excepted benefits described in section 9832(c) ; Term specified health insurance policy not including
Index of Sec 1802. ...CONTRACT of insurance issued, renewed or extended ; Term insurance policy meaning policy or other instrument whereby
Index of Sec 1802. ...HEALTH benefiting plan ; Health insurance issuer, group health plan or other entity offering
Index of Sec 1451. ...CAPITALIATIONS ; Requirements relating to surety bonds, liability insurance or minimum
Index of Sec 1412. ...HOSPITAL insurance benefits under part A under section 226(b) or sectioning 226a and eligible to enroll ; Case of individual being covered beneficiary at time individual entitled to
Index of Sec 1234. ...HOSPITAL insurance benefits under part A of title XVIII of Social Security Act under section 226(b) or 226a of Act and eligible to enroll ; No increase in premium to be effected for month in case of individual being covered beneficiary at time individual entitled to
Index of Sec 1234. ...HEALTH insurance policy issued with respect to individuals residing in United States ; Term specified health insurance policy meaning accident or
Index of Sec 1802. ...ACCIDENT or health insurance policy issued with respect to individuals residing in United States ; Term specified health insurance policy meaning
Index of Sec 1802. ...HEALTH insurance policy not including insurance if substantially of coverage of excepted benefits described in section 9832(c) ; Term specified
Index of Sec 1802. ...HEALTH insurance policy for policy year fee equal to fair share per capita amount determined under section 9511(c)(1) multiplied by average number of lives covered under policy ; Imposing on specified
Index of Sec 1802. ...HEALTH insurance policy ; Arrangement to be treated as specified
Index of Sec 1802. ...HEALTH insurance policy ; Term accident and health coverage meaning coverage causing policy to be specified
Index of Sec 1802. ...CONTRACT of insurance issued, renewed or extended ; Term insurance policy meaning policy or other instrument whereby
Index of Sec 1802. ...INSURANCE program established under title XVIII of Social Security Act ;
Index of Sec 1802. ...INTEREST being equal or exceeding 5 percent of total property or asseal of entirety ;
Index of Sec 1411. ...INTEREST in entity ; Hospital or other health care entity billing Secretary under part A or part B of title XVIII for services reporting on ownership shares of physician owning
Index of Sec 1451. ...CAPITAL contributions making at time ownership or investment interest obtained ; Investment interest of owner or investor being directly proportional to owner or investor's
Index of Sec 1156. ...INTEREST ; Subsection including owner of whole or part
Index of Sec 1411. ...INTEREST equal or exceeding 5 percent of total value of real property ; Leasing or subleasing real property to facility or owning whole or part
Index of Sec 1411. ...INTERNAL organization and operation of Commission ; Prescribing rules and regulations as deeming necessary with respect to
Index of Sec 1401. ...CERTIFICATION of program and providing for 1 or more of other remedies described in subsection ; Secretary taking immediate action to remove jeopardy and correct deficiencies through remedy specified in subsection or terminating
Index of Sec 1614. ...JEOPARDY ; Case of deficiency where facility cited for actual harm or immediate
Index of Sec 1421. ...JEOPARDY ; Case of deficiency where facility cited for actual harm or immediate
Index of Sec 1421. ...JEOPARDY ; Case of deficiency where facility cited for actual harm or immediate
Index of Sec 1421. ...JEOPARDY ; Case of deficiency where facility cited for actual harm or immediate
Index of Sec 1421. ...CITIZENSHIP of parties and jurisdiction to grant complete relief ; Jurisdiction over action without regard to amount in controversy or
Index of Sec 1415. ...CITIZENSHIP of parties and jurisdiction to grant complete relief ; Jurisdiction over action without regard to amount in controversy or
Index of Sec 1415. ...HOSPITAL characteristics ; Amount of Medicare dss to be adjusted based on recommendations of report under subsection and taking into account variations in empirical justification for Medicare dss attributable to
Index of Sec 1112. ...LEAD to betting coordination of community-based care ;
Index of Sec 1905. ...LEASE agreement for covered device ; Items or services provided under contractual warranty where terms of warranty being set forth in purchase or
Index of Sec 1451. ...LEGISLATIVE session ; State plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirement before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year
Index of Sec 1705. ...LEGISLATIVE session ; State plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirements before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year
Index of Sec 1711. ...LEGISLATIVE session ; State plan or child health plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirement before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year
Index of Sec 1756. ...LEGISLATIVE session ; State plan or child health plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirement before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year
Index of Sec 1757. ...LEGISLATIVE session ; State plan or child health plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirement before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year
Index of Sec 1759. ...LEGISLATIVE session ; State plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirement before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year
Index of Sec 1705. ...LEGISLATIVE session ; State plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirements before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year
Index of Sec 1711. ...LEGISLATIVE session ; State plan or child health plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirement before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year
Index of Sec 1756. ...LEGISLATIVE session ; State plan or child health plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirement before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year
Index of Sec 1757. ...LEGISLATIVE session ; State plan or child health plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirement before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year
Index of Sec 1759. ...LEGISLATURE ; Year of session to be deemed to be separate regular session of State
Index of Sec 1705. ...LEGISLATURE ; Year of session to be deemed to be separate regular session of State
Index of Sec 1711. ...LEGISLATURE ; Year of session to be deemed to be separate regular session of State
Index of Sec 1756. ...LEGISLATURE ; Year of session to be deemed to be separate regular session of State
Index of Sec 1757. ...LEGISLATURE ; Year of session to be deemed to be separate regular session of State
Index of Sec 1759. ...ADMINISTRATIVE obligations ; Repayment of overpayments by provider of services or supplier not otherwise limiting provider or supplier's potential liability for
Index of Sec 1641. ...CERTIFICATION as marriage and family therapist pursuant to State law ; Possessing master or doctoral degree qualifying for licensure or
Index of Sec 1308. ...CERTIFICATION for practice of mental health counseling in State in which services performed ; Possessing master or doctor's degree qualifying individual for licensure or
Index of Sec 1308. ...LIQUIDATION more than 24 months of rental payments made ; Supplier of oxygen to individual declared bankrupt and asseal liquidated and time of declaration and
Index of Sec 1148. ...LOAN ; Hospital not directly or indirectly guaranteeing
Index of Sec 1156. ...LOAN of covered device for short-term trial period to permit evaluation of covered device by covered recipient ;
Index of Sec 1451. ...DRUG destruction ; Damaging, expired or otherwise unsalable returned goods reversing logistics and
Index of Sec 1741. ...MALPRACTICE geographic indices described in clauses ; Calculating work, practice expense and
Index of Sec 1125. ...DIAGNOSTIC mammograms and Medicare covered preventive services ; Section 1833(t)(1)(b)( iv of Social Security Act 42 USC 1395l(t)(1)(b)( iv amended by striking screening mammography and diagnostic mammography and inserting
Index of Sec 1305. ...DIAGNOSTIC mammograms and Medicare covered preventive services ; Section 1833(t)(1)(b)( iv of Social Security Act 42 USC 1395l(t)(1)(b)( iv amended by striking screening mammography and diagnostic mammography and inserting
Index of Sec 1305. ...MARRIAGE and family therapist for diagnosis and treatment of mental illnesses ; Term marriage and family therapist services meaning services performed by
Index of Sec 1308. ...MARRIAGE and family therapist pursuant to State law ; Possessing master or doctoral degree qualifying for licensure or certification as
Index of Sec 1308. ...MARRIAGE and family therapy ; Obtaining degree performed 2 years of clinical supervised experience in
Index of Sec 1308. ...MARRIAGE and family therapist services For which payment to be made directly to marriage and family therapist under part B of title XVIII of Social Security Act 42 USC 1395j et seq ; Secretary of Health and Human Services developing criteria with respect to payment for
Index of Sec 1308. ...HEALTH Centers ; Coverage of marriage and Family Therapist Services provided in rural health clinics and federally qualified
Index of Sec 1308. ...MARRIAGE and family therapist for diagnosis and treatment of mental illnesses ; Term marriage and family therapist services meaning services performed by
Index of Sec 1308. ...MEDICAID managed care organization if organization being responsible for coverage of drugs ; Including drugs dispensed to individuals enrolled with
Index of Sec 1743. ...CHILD health Plan ; Sec 1756, termination of Provider participation under medicaid and Chip if terminated under medicare or other State Plan or
Index of Sec 1756. ...AFFILIATIONS ; Sec 1757, medicaid and Chip exclusion from participation relating to certain ownership, Control and management
Index of Sec 1757. ...AFFILIATIONS ; Enhancing medicare, medicaid and Chip Program disclosure requirements relating to previous
Index of Sec 1632. ...MEDICAID managed Care organizations ; Extension of prescription Drug Discounts to Enrollees of
Index of Sec 1743. ...MEDICAID integrity Program ; Sec 1752, evaluations and Reports required under
Index of Sec 1752. ...MEDICAID or Chip and entities billing for Services under medicare ; Sec 1128h, financial Reports on Physicians' financial relationships with Manufacturers and Distributors of covered Drugs, devices, biologicals or medical Supplies under medicare,
Index of Sec 1451. ...CHRONIC conditions requiring subspecialist's expertise subspecialist assuming care management ; Accessible health care provided by physician being medical subspecialist addressing majority of personal health care needs of patients with
Index of Sec 1302. ...MEDICAL residents in training in nonprovider settings as result of amendments making by section ; Increase in time spent by
Index of Sec 1502. ...MEDICAL director of facilitying or facilitying and physician ; Renal dialysis facility providing to Secretary access to information relating to ownership or compensation arrangement between facilitying and
Index of Sec 1643. ...EXPENDITURES for wages and benefits for direct care staff registered nurses, licensed professional nurses, certified nurse assistants and other medical and therapy staff ; Skilled nursing facilities separately reporting
Index of Sec 1414. ...HOME services through medical home ; Secretary paying independent patient-centered medical homing monthly fee for targeted high need beneficiary consenting to receive medical
Index of Sec 1302. ...BENEFICIARY meaning individual requiring regular medical monitoring, advising or treatment ; Term high need
Index of Sec 1302. ...MEDICAL assistance under title XIX ; Term dual eligible meaning individual being dually eligible for benefits under title XVIII and
Index of Sec 1905. ...MEDICAL assistance for individuals described in subclause of section 1902(a) ; Amounts expended for
Index of Sec 1701. ...MEDICAL assistance under title XIX of Act under demonstration waiver approved under section 1115 of acting or State funds ; Individual provided
Index of Sec 1701. ...MEDICAL assistance under title XIX of Act under demonstration waiver approved under section 1115 of acting or State funds ; Individual provided
Index of Sec 1701. ...MEDICAL assistance for children described in section 203(d)(1)(a) of America's Affordable Health Choices acting of 2009 during time period specified in section ; Amounts expended for
Index of Sec 1701. ...ELIGIBILITY in same manner ; State providing for making medical assistance available during presumptive eligibility period and promptly making determination of
Index of Sec 1702. ...ADMINISTRATIVE expenditure For which payment being made under section 1903(a) or 2105(a) of Act after date of enactment of Act ; Nothing in amendments making by section to be construed as affecting ability of State under title XIX or XXI of Social Security Act to provide nurse home visitation services as part of another class of items and services falling within definition of medical assistance or child health assistance under respective title or
Index of Sec 1713. ...CANCER ; Inserting and medical assistance making available to individual described in subsection to be limited to family planning services and supplies described in section 1905(a)(4)(c) including medical diagnosis and treatment services provided pursuant to family planning service in family planning setting after cervical
Index of Sec 1714. ...ELIGIBILITY period ; State plan approved under section 1902 providing for making medical assistance available to individual described in section 1902( hh during presumptive
Index of Sec 1714. ...MEDICAL assistance required to be made by not later than last day of month following month during that determination being made ; Application for
Index of Sec 1714. ...MEDICAL assistance by not later than last day of month following month during that determination being made ; Individual applying for
Index of Sec 1714. ...MEDICAL assistance provided by plan for purposes of clause of first sentence of section 1905(b) ; Treating as
Index of Sec 1714. ...ELIGIBILITY period in accordance with section ; Providing for making medical assistance available to individuals described in subsection of section 1920c during presumptive
Index of Sec 1714. ...ELIGIBILITY period under section ; Medical assistance provided to individual described in subsection of section 1920c during presumptive
Index of Sec 1714. ...MEDICAL assistance for family planning services and supplies in accordance with section ; State not providing for medical assistance through enrollment of individual with benchmark coverage or benchmark-equivalent coverage under section unless coverage including for individual described in section 1905(a)(4)(c),
Index of Sec 1714. ...MEDICAL assistance for services described in section 1902(a) furnished after January 1, 2010 ; Portion of amounts expended for
Index of Sec 1721. ...HOME pilot program under section 1866e of Act ; High need beneficiaries being eligible for medical assistance under title XIX of Social Security Act Secretary providing for appropriate coordination of pilot program under section with medical
Index of Sec 1722. ...MEDICAL assistance under plan ; Whose income not exceeding maximum amount of income disabled individual described in subsection and obtaining
Index of Sec 1731. ...MEDICAL assistance under plan ; Whose resources not exceeding maximum amount of resources disabled individual described in subsection and obtaining
Index of Sec 1731. ...MEDICAL assistance for individuals described in section 1902( ii being only eligible for assistance on basis of section 1902(a) ; Limitations under subsection and previous provisions of subsection not applying to amounts expended for
Index of Sec 1731. ...MEDICAL assistance enrolled with entity and entity being responsible for coverage of drugs under subsection ; State requiring in order to include information on covered outpatient drugs dispensed to individuals eligible for
Index of Sec 1743. ...EDUCATION consistent with subsection whether provided or outside of hospital ; Term medical assistance including payment for costs of graduate medical
Index of Sec 1744. ...MEDICAL assistance with reasonable promptness ; Purpose of State's obligation under section 1902(a)(8) to furnish
Index of Sec 1781. ...MEDICAL assistance to be made available ; Purpose of determining when
Index of Sec 1781. ...MEDICAL assistance provided under State plan and provisions of Act not explicitly waived in approving project remaining fully applicable to individuals receiving benefits under State plan ; Medical assistance provided on behalf of individuals affected by project to be
Index of Sec 1781. ...MEDICAL assistance percentage for amounts in excess of specified under subparagraphs ; Subparagraphs not to be construed as preventing payment of Federal financial participation based on Federal
Index of Sec 1721. ...MEDICAL assistance percentage to be equal to 100 percent ; Subsection, striking furnished in State and following and inserting Federal
Index of Sec 1782. ...MEDICAL assistance program established by title XIX or XXI of Social Security Act ;
Index of Sec 1802. ...MEDICAL assistance under State plan ; Forms as necessary for application to be made by individual described in subsection for
Index of Sec 1714. ...MEDICAL assistance under State plan ; Case of individual described in subsection determined by qualified entity to be presumptively eligible for
Index of Sec 1714. ...MEDICAL care ; Preferences and concerns relating to
Index of Sec 1236. ...MEDICAL care to individuals by reason of individuals ; Program established by Federal law for providing
Index of Sec 1802. ...MEDICAL care to members of Indian tribes ; Program established by Federal law for providing
Index of Sec 1802. ...MEDICAL care of condition involved and assisting beneficiary in thinking ; Eligible provider participating in program routinely scheduling Medicare beneficiaries for counseling visit after viewing patient decision aid to answer questions beneficiary with respect to
Index of Sec 1236. ...CONSUMER price index for 12-month period ending with April of preceding fiscal year ; Subsequent year being equal to default amount under clause for preceding fiscal year increased by annual percentage increase in medical care component of
Index of Sec 1802. ...CANCER ; Inserting and medical assistance making available to individual described in subsection to be limited to family planning services and supplies described in section 1905(a)(4)(c) including medical diagnosis and treatment services provided pursuant to family planning service in family planning setting after cervical
Index of Sec 1714. ...MEDICAL diagnosis and treatment services provided in conjunction with family planning service in family planning setting ; Medical assistance to be limited to family planning services and supplies described in 1905(a)(4)(c) and
Index of Sec 1714. ...MEDICAL direction or prescription of physician or other authorized individual when person submitting claim for item or service knowing or reason to know of exclusion of individual ;
Index of Sec 1619. ...MEDICAL direction or prescription of excluded physician or other authorized individual during period of individual's exclusion ; Payment to be made under Federal health care program for emergency items or services furnished by excluded individual or entity or
Index of Sec 1619. ...MEDICAL emergencies in place systems to provide competent interpreter and translation servicing without undue delay ; Nothing in clause to be construed to exempt emergency rooms or similar entities regularly providing health care services in
Index of Sec 1222. ...HEALTH of patient ; Case of medical emergency where delay directly associated with obtaining competent interpreter or translation services jeopardizing
Index of Sec 1222. ...MEDICAL error ; Description of effect of providing language access services on quality of health care and access to care and reduced
Index of Sec 1223. ...BENEFICIARY risk scores to ensure that higher payments being made for higher risk beneficiaries ; Secretary adjusting payments to medical homes based on
Index of Sec 1302. ...HOME services under title on permanent basis ; Feasability and advisability of reimbursing medical homes for medical
Index of Sec 1302. ...MEDICAL homes under subsection starting no later than 2 years after date of enactment of section ; Pilot program for community-based
Index of Sec 1302. ...HOME services to high need beneficiaries and targeted high need beneficiaries ; Secretary establishing medical home pilot program for purpose of evaluating feasibility and advisability of reimbursing qualified patient-centered medical homes for furnishing medical
Index of Sec 1302. ...MEDICAL Homes ; Standard setting and qualification Process for patient-centered
Index of Sec 1302. ...MEDICAL homes ; Establishing standards to enable medical practices to qualify as patient-centered
Index of Sec 1302. ...MEDICAL homes ; Secretary establishing methodolology for payment for medical home services furnished by independent patient-centered
Index of Sec 1302. ...MEDICAL items and services ; Center developing protocols and strategies for appropriate dissemination of research findings in order to ensure effective communication of findings and use and incorporation of findings into relevant activities for purpose of informing higher quality and more effective and efficient decisions regarding
Index of Sec 1401. ...MEDICAL loss ratio on timely basis ; Data necessary for Secretary to publish
Index of Sec 1173. ...MEDICAL loss ratio for year to be submitted based on standardized elements and definitions developed under paragraph ; Data to be submitted under subparagraph relating to
Index of Sec 1173. ...MEDICAL loss ratio for Ma plans ; Secretary developing and implement standardized data elements and definitions for reporting under subsection for contract years beginning with 2012 of data necessary for calculation of
Index of Sec 1173. ...MEDICAL loss ratio having meaning given term by Secretary ; Term
Index of Sec 1173. ...MEDICAL loss ratio ; Ma plan failing to have
Index of Sec 1173. ...CONTRACT years ; Secretary terminating plan contract if plan failing to have medical loss ratio for 5 consecutive
Index of Sec 1173. ...MEDICAL need for remainder of reasonable useful lifetime of equipment as determined by Secretary ; Supplier furnishing equipment as of month continuing to furnish equipment to individual during subsequent period of
Index of Sec 1148. ...MEDICAL orders respected across care settings ; Legal barriers addressed for enabling orders for life sustaining treatment to constitute set of
Index of Sec 1233. ...MEDICAL plan ; Providing patients with information about trade-offing among treatment options and facilitating incorporation of patient preferences and values into
Index of Sec 1236. ...MEDICAL homes ; Establishing standards to enable medical practices to qualify as patient-centered
Index of Sec 1302. ...CERTIFICATION of medical practices as meeting standards ; Initially providing for review and
Index of Sec 1302. ...MEDICAID or Chip and entities billing for Services under medicare ; Sec 1128h, financial Reports on Physicians' financial relationships with Manufacturers and Distributors of covered Drugs, devices, biologicals or medical Supplies under medicare,
Index of Sec 1451. ...MEDICAL supply ; Term applicable manufacturer meaning manufacturer of covered drug, device, biological or medical supply and term applicable distributor meaning distributor of covered drug, device or
Index of Sec 1451. ...MEDICAL supply ; Term distributor of covered drug, device or medical supply meaning entity engaged in marketing or distribution of covered drug, device or
Index of Sec 1451. ...MEDICAL technologies ; Patient access to providers and needed
Index of Sec 1157. ...CONTRACT under section 1890(a) ; Case of specified area or medical topic determined appropriate by Secretary For which feasible and practical quality measure not endorsed by entity with
Index of Sec 1444. ...MEDICAL treatment options as compared to comparable Medicare beneficiaries not participating in shared decision making process using patient decision aids ; Secretary of Health and Human Services establishing shared decision making demonstration program under Medicare program using patient decision aids to meet objective of improving understanding by Medicare beneficiaries of
Index of Sec 1236. ...MEDICARE ; Sec 1221 ensuring effective communication in
Index of Sec 1221. ...ENGLISH proficiency by providing reimbursement for culturally and linguistically appropriate Services ; Sec 1222, demonstration to promote Access for medicare Beneficiaries with limited
Index of Sec 1222. ...MEDICARE skilled nursing facility prospective payment system and consolidated payment ; Sec 1307 excluding clinical social worker Services from coverage under
Index of Sec 1307. ...MEDICARE ; Sec 1128h, financial Reports on Physicians' financial relationships with Manufacturers and Distributors of covered Drugs, devices, biologicals or medical Supplies under medicare, medicaid or Chip and entities billing for Services under
Index of Sec 1451. ...AFFILIATIONS ; Enhancing medicare, medicaid and Chip Program disclosure requirements relating to previous
Index of Sec 1632. ...MEDICARE enrolled Physicians or eligible Professionals ; Order durable medical equipment or Home health Services required to be
Index of Sec 1637. ...MEDICARE ; Sec 1639, Face to Face Encounter with patient required before Physicians certifying eligibility for Home health Services or durable medical equipment under
Index of Sec 1639. ...CHILD health Plan ; Sec 1756, termination of Provider participation under medicaid and Chip if terminated under medicare or other State Plan or
Index of Sec 1756. ...MEDICARE Advantage and Part D marketing violations ; Enhancing penalties for
Index of Sec 1617. ...MEDICARE Claims reduced to not more than 12 months ; Maximum period for submission of
Index of Sec 1636. ...MEDICARE cost-sharing furnished for periods beginning after January 1 ; Amendments making by subsection applying to eligibility determinations for income-related subsidies and
Index of Sec 1201. ...MEDICARE Drug Plan Enrollees ; Reporting requirement for determination and payment of Rebates by manufacturing related to Rebate for full-Benefit dual eligible
Index of Sec 1181. ...MEDICARE Drug Plan Enrollees ; Reporting requirement for determination and payment of Rebates by Manufacturers related to Rebate for full-Benefit dual eligible
Index of Sec 1181. ...MEDICARE Drug Plan Enrollees ; Reporting requirement related to Rebate for full-Benefit dual eligible
Index of Sec 1181. ...MEDICARE exceptions to prohibition on certain Physician Referrals making to hospitals ; Limitation on
Index of Sec 1156. ...MEDICARE integrity Program ; Sec 1634, evaluations and Reports required under
Index of Sec 1634. ...MEDICARE prescription Drug Program to Assist social security administration's outreach to eligible Individuals ; Disclosures to facilitate identification of Individuals likely to be ineligible for low-income assistance under
Index of Sec 1203. ...MEDICARE prescription Drug Program to Assist social security administration's outreach to eligible Individuals ; Disclosures to facilitate identification of Individuals likely to be ineligible for low-income assistance under
Index of Sec 1801. ...MEDICARE prescription Drug Program to Assist social security administration's outreach to eligible Individuals ; Disclosures to facilitate identification of Individuals likely to be ineligible for low-income Subsidies under
Index of Sec 1801. ...INCOME Subsidy Program ; Sec 1201 improving asseal testing for medicare savings Program and low-
Index of Sec 1201. ...MEDICINE or pediatric medicine ; Term primary care meaning health care provided by physician or nurse practitioner practicing in field of family medicine, general internal medicine, geriatric
Index of Sec 1302. ...MEDICINE or pediatric medicine ; Term primary care meaning health care provided by physician or nurse practitioner practicing in field of family medicine, general internal medicine, geriatric
Index of Sec 1302. ...MEDICINE or pediatric medicine ; Term primary care meaning health care provided by physician or nurse practitioner practicing in field of family medicine, general internal medicine, geriatric
Index of Sec 1302. ...MEDICINE ; Term primary care meaning health care provided by physician or nurse practitioner practicing in field of family medicine, general internal medicine, geriatric medicine or pediatric
Index of Sec 1302. ...MEI ; Updating to single conversion factor established in paragraph for 2010 to be percentage increase in
Index of Sec 1121. ...HEALTH counselor for diagnosis and treatment of mental illnesses ; Term mental health counselor services meaning services performed by mental
Index of Sec 1308. ...HEALTH counseling in State in which services performed ; Possessing master or doctor's degree qualifying individual for licensure or certification for practice of mental
Index of Sec 1308. ...HEALTH counselor services For which payment to be made directly to mental health counselor under part B of title XVIII of Social Security Act 42 USC 1395j et seq ; Secretary of Health and Human Services developing criteria with respect to payment for mental
Index of Sec 1308. ...HEALTH Centers ; Coverage of mental health counselor Services provided in rural health clinics and federally qualified
Index of Sec 1308. ...HEALTH and substance abuse needs of individuals ; State not requiring under paragraph enrollment in managed care entity of individual described in section 1902(a) unless State demonstrating that entity having capacity to meet health, mental
Index of Sec 1701. ...HEALTH counselor practice ; Obtaining degree performed 2 years of supervised mental
Index of Sec 1308. ...MENTAL illnesses ; Term marriage and family therapist services meaning services performed by marriage and family therapist for diagnosis and treatment of
Index of Sec 1308. ...MENTAL illnesses ; Term mental health counselor services meaning services performed by mental health counselor for diagnosis and treatment of
Index of Sec 1308. ...MENTAL status, ability to perform activities of daily ; Analysis considering use of appropriate indicators including age, physical and
Index of Sec 1111. ...MISCONDUCT ; Reimbursing managed care entity for payment of legal expenses associated with action in which court imposing sanctions on managed care entity for litigation-related
Index of Sec 1760. ...INFORMATION involved ; Assessment of not more than 3 timing amount claimed by plan or plan sponsor based upon misrepresenations or falsified
Index of Sec 1616. ...MISREPRESENATIONS, cases under paragraph ; Second sentence, striking false statement or misrepresenations and inserting false statement or
Index of Sec 1645. ...CONTRACT to participate or enroll as provider of services or supplier under Federal health care program ; Made false statement, omission or misrepresenations of material fact in application, agreement, bid or
Index of Sec 1611. ...MISREPRESENATIONS ; Assessment of not more than 3 timing amount claimed as result of false statement, omission or misrepresenations of material fact claimed by provider of services or supplier whose application to participate containing false statement, omission or
Index of Sec 1611. ...CIVIL monetary penalties levied against facility, employees, contractors and other agents ; Number of
Index of Sec 1413. ...CIVIL monetary penalties to false Claims Act amendments ; Sec 1645 conforming
Index of Sec 1645. ...CIVIL monetary penalty not to exceed $50,000 for violation ; Administrator for Centers of Medicare and Medicaid Services to have authority to determine whether provider of services or supplier described in subparagraph meeting requirement of subsection and imposing
Index of Sec 1635. ...HEALTH care program ; False record or statement material to obligation to pay or transmit money or property to Federal health care program or knowingly concealing or knowingly improperly avoiding or decreaseing obligation to pay or transmit money or property to Federal
Index of Sec 1645. ...HEALTH care program interest ; Made to contractor, grantee or other recipient if money or property to be spent or used on Federal health care program's behalf or advancing Federal
Index of Sec 1645. ...MORATORIUM not adversely impacting access of individuals to care under program ;
Index of Sec 1631. ...MORATORIUM under section 1128g(a)(4) applied during period of moratorium ; Person or entity to which
Index of Sec 1631. ...MORATORIUM ; Person or entity to which moratorium under section 1128g(a)(4) applied during period of
Index of Sec 1631. ...EXPENDITURES, program integrity and other mattering Secretary deeming appropriate ; Secretary creating separate incentive arrangements for different categories of qualifying ACOS to reflect natural variations in data availability, variation in average annual attributable
Index of Sec 1301. ...NONPATIENT care activities ; Rules providing that time spent by intern or resident in approved medical residency training program in nonprovider setting primarily engaged in furnishing patient care in
Index of Sec 1503. ...NONPATIENT care activities ; Time spent by intern or resident in approved medical residency training program in
Index of Sec 1503. ...NONPROFIT community-based or State-based organization certified under paragraph as meeting following requirements ; Term community-based medical home meaning
Index of Sec 1302. ...CLINICAL perspective advisory panel receiving waiver ; No more than two nonvoting members of
Index of Sec 1401. ...NOTIFICATION submiting and ending on date on which resident successfully relocated ;
Index of Sec 1423. ...NOTIFICATION under subparagraph during period beginning on date ; Secretary continuing to make payments under title with respect to residents of facility submitting
Index of Sec 1423. ...NOTIFICATION submitted ; Ensuring that facility not admitting new residents after date on which written
Index of Sec 1423. ...NOTIFICATION submitted ; Ensuring that facility not admitting new residents after date on which written
Index of Sec 1423. ...OF-pocket threshold from amounts otherwise computed ; Consistent with paragraph progressively increase initial coverage limit and decreaseing annual out-
Index of Sec 1181. ...OF-pocket threshold otherwise computed without regard to paragraph to be decreased and #189 ; Annual out-
Index of Sec 1181. ...OF-pocket threshold specified in paragraph for year ; Annual out-
Index of Sec 1181. ...OF-pocket threshold of subsection ; Term actual gap in coverage meaning gap in prescription drug coverage occuring between initial coverage limit of subsection and annual out-
Index of Sec 1182. ...OF-State fee schedule area using msas as defined by Director of Office of Management and Budget and iterative methodolology described in subparagraph ; Secretary reviewing and updating California Rest-
Index of Sec 1125. ...ON-site interpretation ; Feasibility of adopting payment methodolology for on-site interpreters including interpreters working as independent contractors and interpreters working for agencies providing
Index of Sec 1221. ...ON-site interpretation ; Feasibility of adopting payment methodolology for on-site interpreters including interpreters working as independent contractors and interpreters working for agencies providing
Index of Sec 1221. ...HEALTH care or health care related services by bilingual health care provider ; Competent interpreter services to be provided through on-site interpretation, telephonic interpretation or video interpretation or direct provision of
Index of Sec 1222. ...TITLE 42, Code of Federal Regulations never imposed ; Requirement for surety bond described in subparagraph not applying in case of pharmacy enrolled under section 1866(j) as supplier of durable medical equipment, prosthetics, orthotics and supplies and issued provider number for 5 years and final adverse action of
Index of Sec 1148. ...ACCREDITATION described in clause not applying for purposes of supplying diabetic testing supplies, canes and crutches in case of pharmacy enrolled under section 1866(j) as supplier of durable medical equipment, prosthetics, orthotics and supplies ; Requirement for
Index of Sec 1148. ...OUTPATIENT department ; Place greater emphasis upon training in federally qualified health centers, rural health clinics and other nonprovider settings and hospitals receiving additional payments under subsection and emphasizing training in
Index of Sec 1501. ...MEDICAL assistance enrolled with entity and entity being responsible for coverage of drugs under subsection ; State requiring in order to include information on covered outpatient drugs dispensed to individuals eligible for
Index of Sec 1743. ...COMPENSATION arrangement between facilitying and medical director of facilitying or facilitying and physician ; Renal dialysis facility providing to Secretary access to information relating to ownership or
Index of Sec 1643. ...INTEREST including direct or indirect interests including interests in intermediate entities ; Ownership or control
Index of Sec 1411. ...HOSPITAL ; Making payment toward loan or otherwise subsidizing loan for physician owner or investor or group of physician owners or investors related to acquiring ownership or investment interest in
Index of Sec 1156. ...HOSPITAL ; Ownership or investment returns distributed to owner or investor in hospital in amount being directly proportional to ownership or investment interest of owner or investor in
Index of Sec 1156. ...INTEREST obtained ; Investment interest of owner or investor being directly proportional to owner or investor's capital contributions making at time ownership or investment
Index of Sec 1156. ...INTEREST not reported as required under subsection ; Applicable manufacturer or distributor failing to submit information required under subsection in timely manner in accordance with regulations promulgated to carry out subsection and hospital or other entity failing to submit information required under subsection in timely manner in accordance with regulations promulgated to carry out subsection to be subject to civil money penalty of not less than $1,000 but not more than $10,000 for payment or other transfer of value or ownership or investment
Index of Sec 1451. ...INTEREST not reported as required under subsection ; Not more than $100,000 for payment or other transfer of value or ownership or investment
Index of Sec 1451. ...INTEREST holding by physician in manufacturer ; Term payment or other transfer of value including compensation, gift, honorarium, speaking fee, consulting fee, travel, services, dividend, profit distribution, stock or stock option grant or ownership or investment
Index of Sec 1451. ...HOSPITAL or entity whose asseal including hospital ; Percentage of total value of ownership or investment interests holding in
Index of Sec 1156. ...HOSPITAL or otherwise generating business for hospital ; Hospital not conditioning physician ownership or investment interests directly or indirectly on physician owner or investor making or influencing referrals to
Index of Sec 1156. ...HOSPITAL in amount being directly proportional to ownership or investment interest of owner or investor in hospital ; Ownership or investment returns distributed to owner or investor in
Index of Sec 1156. ...AFFILIATIONS ; Sec 1757, medicaid and Chip exclusion from participation relating to certain ownership, Control and management
Index of Sec 1757. ...COMPENSATION arrangements ; Entity providing covered items or services For which payment to be made under title providing Secretary with information concerning entity's ownership, investment and
Index of Sec 1156. ...OWNERSHIP under subsection ; Accuracy of information submitted under subsections and making available under paragraph to be responsibility of applicable manufacturer or distributor of covered drug, device, biological or medical supply reporting under subsection or hospital or other health care entity reporting physician
Index of Sec 1451. ...HOSPITAL ownership exceptions to self-referral prohibition ; Requirements to qualify for rural Provider and
Index of Sec 1156. ...INTEREST in corporation being equal or exceeding 5 percent ; Shareholders of corporation having ownership
Index of Sec 1411. ...INTEREST in limited partnership being equal or exceeding 10 percent ; General partners and limited partners of limited partnership having ownership
Index of Sec 1411. ...INTEREST in entity ; Hospital or other health care entity billing Secretary under part A or part B of title XVIII for services reporting on ownership shares of physician owning
Index of Sec 1451. ...LIQUIDATION more than 24 months of rental payments made ; Supplier of oxygen to individual declared bankrupt and asseal liquidated and time of declaration and
Index of Sec 1148. ...OXYGEN equipment described in section 1834(a)(5)(f) of Social Security Act occuring after July 1 ; Amendments making by paragraph taking effect as of date of enactment of Act and applying to furnishing of equipment to individuals 27th month of continuous period of use of
Index of Sec 1148. ...PARENTING outcomes ; Adhering to clear evidence-based models of home visitation demonstrated positive effects on important program-determined child and
Index of Sec 1904. ...PARTNERSHIP being equal or exceeding 10 percent ; General partners and limited partners of limited partnership having ownership interest in limited
Index of Sec 1411. ...PELVIC exam ; Screening pap smear and screening
Index of Sec 1305. ...HOSPITAL ; Submitting to Secretary initial report and periodic updating at frequency determined by Secretary containing detailed description of identity of physician owner and physician investor and other owners or investors of
Index of Sec 1156. ...PERIODIC basis on plan described in subsection ; Secretary issuing interim public reports on
Index of Sec 1152. ...PERIODIC evaluations of effectiveness of activities carried out by entity under Program and submitting to Secretary annual report on activities ; Entity conducting
Index of Sec 1634. ...PERIODIC evaluations of effectiveness of activities carried out by entity under Program and submitting to Secretary annual report on activities ; Entity conducting
Index of Sec 1752. ...PERIODIC review described in subparagraph ; Secretary coordinating review and appropriate adjustment described in clause with
Index of Sec 1122. ...PERIODIC review of adjustment factoring required under paragraph for California for 2012 and subsequent periods ; Revision described in clause to be made effective concurrently with application of
Index of Sec 1125. ...COMPARATIVE effectiveness research and studies conducted by Center under subsection ; Make recommendations for priority for periodic reviews of previous
Index of Sec 1401. ...COMPLIANCE with State and Federal laws and regulations applicable to facilities ; Conduct periodic reviews and preparing root-cause quality and deficiency analyses of chain to assess if facilities of chain in
Index of Sec 1422. ...AFFORDABILITY credits under subtitle C of title II of division A of America's Affordable Health Choices acting of 2009 as specified under memorandum ; Redeterminations of eligibility for individuals unless periodicity of redeterminations being consistent with periodicity for redeterminations by Commissioner of eligibility for
Index of Sec 1702. ...AFFORDABILITY credits under subtitle C of title II of division A of America's Affordable Health Choices acting of 2009 as specified under memorandum ; Redeterminations of eligibility for individuals unless periodicity of redeterminations being consistent with periodicity for redeterminations by Commissioner of eligibility for
Index of Sec 1702. ...PHARMACY manufacturers for drugs provided to individuals enrolled with Medicaid managed care organizations contracting under section 1903(m) ; State reporting to Secretary total amount of rebates in dollars received from
Index of Sec 1743. ...PROSTHETICS, orthotics and supplies and issued provider number for 5 years and final adverse action of title 42, Code of Federal Regulations never imposed ; Requirement for surety bond described in subparagraph not applying in case of pharmacy enrolled under section 1866(j) as supplier of durable medical equipment,
Index of Sec 1148. ...PROSTHETICS, orthotics and supplies ; Requirement for accreditation described in clause not applying for purposes of supplying diabetic testing supplies, canes and crutches in case of pharmacy enrolled under section 1866(j) as supplier of durable medical equipment,
Index of Sec 1148. ...PLANNING and advance directives ; Description of Federal and State resources available to assist individuals and families with advance care
Index of Sec 1233. ...PLANNING including national toll-free hotline ; Provision by practitioner of list of national and State-specific resources to assist consumers and families with advance care
Index of Sec 1233. ...PLANNING ; Available State legal service organizations to assist individuals with advance care
Index of Sec 1233. ...PLANNING adopted or endorsed by consensus-based organization if appropriate ; Secretary including quality measures on end of life care and advanced care
Index of Sec 1233. ...PLANNING ; Secretary publishing in Federal Register proposed quality measures on end of life care and advanced care
Index of Sec 1233. ...CANCER ; Inserting and medical assistance making available to individual described in subsection to be limited to family planning services and supplies described in section 1905(a)(4)(c) including medical diagnosis and treatment services provided pursuant to family planning service in family planning setting after cervical
Index of Sec 1714. ...PLANNING setting ; Medical assistance to be limited to family planning services and supplies described in 1905(a)(4)(c) and medical diagnosis and treatment services provided in conjunction with family planning service in family
Index of Sec 1714. ...PLANNING including key questions and considerations ; Explanation by practitioner of advance care
Index of Sec 1233. ...PLANNING consulations for purposes of applying 5-year limitation under paragraph ; Considering advance care
Index of Sec 1233. ...PLANNING consulations with respect to individual to be conducted more frequently than provided under paragraph ; Advance care
Index of Sec 1233. ...PLANNING consultations performed more frequently than covered under section ; Case of advance care
Index of Sec 1233. ...CANCER ; Inserting and medical assistance making available to individual described in subsection to be limited to family planning services and supplies described in section 1905(a)(4)(c) including medical diagnosis and treatment services provided pursuant to family planning service in family planning setting after cervical
Index of Sec 1714. ...PLANNING service in family planning setting ; Medical assistance to be limited to family planning services and supplies described in 1905(a)(4)(c) and medical diagnosis and treatment services provided in conjunction with family
Index of Sec 1714. ...CANCER ; Inserting and medical assistance making available to individual described in subsection to be limited to family planning services and supplies described in section 1905(a)(4)(c) including medical diagnosis and treatment services provided pursuant to family planning service in family planning setting after cervical
Index of Sec 1714. ...MEDICAL diagnosis and treatment services provided in conjunction with family planning service in family planning setting ; Medical assistance to be limited to family planning services and supplies described in 1905(a)(4)(c) and
Index of Sec 1714. ...PLANNING services and supplies in accordance with section ; State not providing for medical assistance through enrollment of individual with benchmark coverage or benchmark-equivalent coverage under section unless coverage including for individual described in section 1905(a)(4)(c), medical assistance for family
Index of Sec 1714. ...INFORMATION regarding payment or other transfer of value provided by manufacturer to covered recipient ; 2011 subject to paragraph, provisions of section preempting law or regulation of State or political subdivision of State requiring applicable manufacturer and applicable distributor to disclose or report type of
Index of Sec 1451. ...POLITICAL subdivision of State requiring following ; Paragraph not preempting law or regulation of State or
Index of Sec 1451. ...HOSPITAL located during that period as estimated by Bureau of Census and available to Secretary ; Locating in county in which percentage increase in population during recent 5-year period For which data being available estimated to be 150 percent of percentage increase in population growth of State in which
Index of Sec 1156. ...HOSPITAL located during that period as estimated by Bureau of Census and available to Secretary ; Locating in county in which percentage increase in population during recent 5-year period For which data being available estimated to be 150 percent of percentage increase in population growth of State in which
Index of Sec 1156. ...POSSESSION of United States ; Term united States including
Index of Sec 1802. ...POSSESSION of United States ; No amount collected under subchapter to be covered to
Index of Sec 1802. ...POVERTY line ; Bearing same ratio to amount so reserved as number of children in Indian tribe whose families having income not exceeding 200 percent of poverty line bears to total number of children in Indian tribes whose families having income not exceeding 200 percent of
Index of Sec 1904. ...POVERTY line ; Bearing same ratio to remainder of amount so appropriated as number of children in State whose families having income not exceeding 200 percent of poverty line bears to total number of children in States whose families having income not exceeding 200 percent of
Index of Sec 1904. ...POVERTY line ; Plan providing for implementation under title of 12-month continuous eligibility option described in section 1902(e) for targeted low-income children whose family income below 200 percent of
Index of Sec 1733. ...POVERTY line applicable to family of size involved ; Families whose income not exceeding 133 1/3 percent of income official
Index of Sec 1701. ...POVERTY line applicable to family of size involved ; Income and families whose income not exceeding 133 1/3 percent of income official
Index of Sec 1701. ...INCOME not exceeding 200 percent of poverty line ; Bearing same ratio to amount so reserved as number of children in Indian tribe whose families having income not exceeding 200 percent of poverty line bears to total number of children in Indian tribes whose families having
Index of Sec 1904. ...INCOME not exceeding 200 percent of poverty line ; Bearing same ratio to remainder of amount so appropriated as number of children in State whose families having income not exceeding 200 percent of poverty line bears to total number of children in States whose families having
Index of Sec 1904. ...POWER-driven wheelchair and inserting complex rehabilitative power-driven wheelchair recognized by Secretary as classified within group 3 or higher ; Striking
Index of Sec 1141. ...POWER-driven wheelchair recognized by Secretary as classified within group 3 or higher ; Striking power-driven wheelchair and inserting complex rehabilitative
Index of Sec 1141. ...PREVENTIVE services meaning following ; Term Medicare covered
Index of Sec 1305. ...PREVENTIVE services ; Respect to specific Medicare covered
Index of Sec 1305. ...PREVENTIVE services ; Respect to Medicare covered
Index of Sec 1305. ...PREVENTIVE services ; Section 1833(t)(1)(b)( iv of Social Security Act 42 USC 1395l(t)(1)(b)( iv amended by striking screening mammography and diagnostic mammography and inserting diagnostic mammograms and Medicare covered
Index of Sec 1305. ...PREVENTIVE services ; Clause, striking items and services described in section 1861(s) and inserting Medicare covered
Index of Sec 1305. ...PREVENTIVE services ; Section 1866(a)(2)(a)( ii of Act 42 USC 1395cc(a)(2)(a)( ii amended by inserting other than Medicare covered
Index of Sec 1305. ...PREVENTIVE services described in subsection ;
Index of Sec 1711. ...PREVENTIVE services described in subsection being services not otherwise described in subsection or Secretary determining ;
Index of Sec 1711. ...HOSPITAL ; Respect to additional preventive services furnished by outpatient department of
Index of Sec 1305. ...PRIMARY activity being care and treatment of patients as defined by Secretary ; Term nonprovider setting primarily engaged in furnishing patient care meaning nonprovider setting in which
Index of Sec 1503. ...PRIMARY care physicians for applicable beneficiaries for whose care group being accountable ; Group including sufficient number of
Index of Sec 1301. ...PRIMARY care or principal care by physician or nurse practitioner accepting responsibility for providing first contact, continuous and comprehensive care to beneficiary ; Providing beneficiaries with direct and ongoing access to
Index of Sec 1302. ...HEALTH care provided by physician or nurse practitioner practicing in field of family medicine, general internal medicine, geriatric medicine or pediatric medicine ; Term primary care meaning
Index of Sec 1302. ...PRIMARY care or principal care physician or nurse practitioner designated by beneficiary ; Organization providing medical home services under supervision in close collaboration with
Index of Sec 1302. ...HEALTH centers, rural health clinics and other settings ; Primary care physician practices with fewer than 10 physicians, specialty physicians, nurse practitioner practices, federally qualified
Index of Sec 1302. ...HEALTH professional shortage area ; Section 1848(o)(1)(b)( iv of Act 42 USC 1395w-4(o)(1)(b)( iv amended by inserting primary care before
Index of Sec 1303. ...PRIMARY care residents ; Hospital assigning additional resident positions for
Index of Sec 1501. ...ACCREDITATION for program for additional resident positions ; Hospital's residency programs in primary care fully accredited or hospital actively applying for
Index of Sec 1501. ...HOSPITAL ; Approved FTE resident amounts deemed to be equal to hospital per resident amounts for primary care and nonprimary care computed under paragraph for
Index of Sec 1501. ...PRIMARY care residents in residency training programs ; Number of
Index of Sec 1501. ...CONTRACTING hospital's resident limit ; Number of primary care residents of center not counting against
Index of Sec 1502. ...PRIMARY care and other specialties ; Range of residency programs including
Index of Sec 1505. ...PRIMARY care services furnished by physicians at rate not less than 80 percent of payment rate applicable to services and physicians or professionals under part B of title XVIII for services furnished in 2010 ; Payment for
Index of Sec 1721. ...PRIMARY care services described in section 1902(a) ; Case of
Index of Sec 1721. ...PRIMARY language in manner determined by Secretary to yield accurate data and data shows greater numbers of limited English proficient individuals than data listed in subparagraph ; Grantee's own data if grantee routinely collects data on Medicare beneficiaries'
Index of Sec 1222. ...PRIMARY language ; Notifying Medicare beneficiaries of right to receive language services in
Index of Sec 1222. ...PRIMARY language data collected for recipients of language services ;
Index of Sec 1222. ...INCOME-related premium ; Exception for Use of more recent Tax year in Case of Gains from sale of primary residence in computing Part B
Index of Sec 1235. ...PRIMARY residence ; Section 1839(i)(4)(c)( ii of Social Security Act 42 USC 1395r(i)(4)(c)( ii amended by inserting sale of
Index of Sec 1235. ...COMPLIANCE by facilities of chain with State and Federal laws and regulations applicable to facilities ; Publicly holding, involving owners of chain and principal business partners of owners in facilitating
Index of Sec 1422. ...PRINCIPAL care by physician or nurse practitioner accepting responsibility for providing first contact, continuous and comprehensive care to beneficiary ; Providing beneficiaries with direct and ongoing access to primary care or
Index of Sec 1302. ...PRINCIPAL care physician or nurse practitioner designated by beneficiary ; Organization providing medical home services under supervision in close collaboration with primary care or
Index of Sec 1302. ...HEALTH information and providing data security ; Data collection efforts under system use efficient and cost-effective means in manner minimizing administrative burden on persons required to collect data and adequately protecting privacy of patients' personal
Index of Sec 1442. ...CONFIDENTIALITY agreements making with respect to use of data under section ; Dissemination of which violating privacy of research participants or violating
Index of Sec 1401. ...PRIVACY protections provided under regulations promulgated pursuant to section 264(c) of Health Insurance Portability and Accountability Act of 1996 42 USC 1320d-2 note ; Consistent with
Index of Sec 1222. ...COMPARATIVE effectiveness research determined to be national priority under subparagraph ; Monitoring appropriateness of use of CERTF described in subsection with respect to timely production of
Index of Sec 1401. ...PRODUCTION, preparation, propagation ; Term manufacturer of covered drug, device, biological or medical supply meaning entity engaged in
Index of Sec 1451. ...ECONOMY-wide private nonfarm business multi-factor productivity ; Productivity offset equal to percentage change in 10-year moving average of annual
Index of Sec 1103. ...PRODUCTIVITY ; Productivity offset equal to percentage change in 10-year moving average of annual economy-wide private nonfarm business multi-factor
Index of Sec 1103. ...PRODUCTIVITY adjustment described in subclause ; Subject to
Index of Sec 1103. ...PRODUCTIVITY adjustment described in subclause or other annual period ;
Index of Sec 1103. ...PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii as calculated by Secretary ; Section 1888(e)(5)(b) of Act 42 USC 1395yy(e)(5)(b) amended by inserting subject to
Index of Sec 1103. ...PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii ; Factor to be subject to
Index of Sec 1103. ...PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii ;
Index of Sec 1103. ...PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii ; Subject to
Index of Sec 1131. ...PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii ; Factor to be subject to
Index of Sec 1131. ...PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii ; Annual adjustment in fee scheduling determined under clause for years beginning with 2010 to be subject to
Index of Sec 1131. ...PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii ; Subject to
Index of Sec 1131. ...PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii ; Subject to
Index of Sec 1131. ...PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii ; Subject to
Index of Sec 1131. ...PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii ; Subject to
Index of Sec 1131. ...PRODUCTIVITY improvements into Market basket updating not already incorporating improvements ; Incorporating
Index of Sec 1103. ...PRODUCTIVITY improvements into Market basket updating not already incorporating improvements ; Incorporating
Index of Sec 1131. ...HEALTH Services ; Incorporating productivity improvements into Market basket updating for Home
Index of Sec 1155. ...HEALTH plans and other relevant stakeholders ; Center providing for dissemination of appropriate findings produced by research supported, conducted or synthesized under section to health care providers, patients, vendors of health information technology focused on clinical decision support, appropriate professional associations and Federal and private
Index of Sec 1401. ...PROFESSIONAL capacity of covered recipient ; Transfer of anything of value to covered recipient when covered recipient being patient and not acting in
Index of Sec 1451. ...PROFESSIONAL development and show strong organizational capacity to implement program ; Providing for ongoing training and
Index of Sec 1904. ...PROFESSIONAL needs area ; Place greater emphasis upon training in health professional shortage area or health
Index of Sec 1501. ...PROFESSIONAL nurses, certified nurse assistants and other medical and therapy staff ; Skilled nursing facilities separately reporting expenditures for wages and benefits for direct care staff registered nurses, licensed
Index of Sec 1414. ...PROFESSIONAL services furnished during 2011 and subsequent year ; Purposes of reporting data on quality measures for covered
Index of Sec 1233. ...PROFESSIONAL shortage area ; Addition to amount otherwise paid under part to be paid to practitioner of section 1842(b)(6)) from Federal Supplementary Medical Insurance Trust Fund amount equal 5 percent as primary care health
Index of Sec 1303. ...PROFESSIONAL shortage area ; Section 1848(o)(1)(b)( iv of Act 42 USC 1395w-4(o)(1)(b)( iv amended by inserting primary care before health
Index of Sec 1303. ...DISCIPLINARY team-based models in provider and nonprovider settings to enhance safety and improving quality of patient care ; Work in inter-professional teams and multi-
Index of Sec 1505. ...PROFICIENCY ; Extent to which providers under parts A and B of title XVIII of Social Security Act, Ma organizations offering Medicare Advantage plans under part C of title and PDP sponsors of prescription drug plan under part D of title utilizing, offering or make available language services for beneficiaries with limited English
Index of Sec 1221. ...PROFICIENCY at points of contact in timely manner during hours of operation ; Offering and providing appropriate language services at no additional charge to patient with limited English
Index of Sec 1222. ...PROFICIENCY ; Center consulting with stakeholders concerning types of dissemination to be useful to end users of information and providing for utilization of multiple formats for conveying findings to different audiences including dissemination to individuals with limited English
Index of Sec 1401. ...PROFICIENCY in two languages and ensuring effective communication occurring in languages ; Term bilingual with respect to individual meaning person having sufficient degree of
Index of Sec 1224. ...HOSPITAL on more favorable terms than terms offered to person being not physician owner or investor ; Hospital not offering physician owner or investor opportunity to purchase or lease property under control of hospital or other owner or investor in
Index of Sec 1156. ...PROPERTY or asseal ; Deed of trust, note or other obligation secured by entity or
Index of Sec 1411. ...HOSPITAL or located nearing premises of hospital ; Including purchase or lease of property under control of other owners or investors in
Index of Sec 1156. ...PROPERTY ; Leasing or subleasing real property to facility or owning whole or part interest equal or exceeding 5 percent of total value of real
Index of Sec 1411. ...PROPERTY or asseal of entirety ; Interest being equal or exceeding 5 percent of total
Index of Sec 1411. ...HOSPITAL ; Ownership or investment returns distributed to owner or investor in hospital in amount being directly proportional to ownership or investment interest of owner or investor in
Index of Sec 1156. ...CAPITAL contributions making at time ownership or investment interest obtained ; Investment interest of owner or investor being directly proportional to owner or investor's
Index of Sec 1156. ...PROSTHETICS, orthotics and supplies and issued provider number for 5 years and final adverse action of title 42, Code of Federal Regulations never imposed ; Requirement for surety bond described in subparagraph not applying in case of pharmacy enrolled under section 1866(j) as supplier of durable medical equipment,
Index of Sec 1148. ...PROSTHETICS, orthotics and supplies ; Requirement for accreditation described in clause not applying for purposes of supplying diabetic testing supplies, canes and crutches in case of pharmacy enrolled under section 1866(j) as supplier of durable medical equipment,
Index of Sec 1148. ...ASSESSMENT of factors related to enrollee satisfaction with services and care delivery ; Research and evaluation of areas where service utilization, quality and access to cost sharing protection to be improved and
Index of Sec 1905. ...PROTECTION improving care and costs ; Identify areas of policies where better coordination and
Index of Sec 1905. ...PROTECTION ; Issue guidance to States regarding improving coordination and
Index of Sec 1905. ...CONTRACT or other agreement ; Rights protected by paragraph not to be diminished by contract or other agreement and nothing in paragraph to be construed to diminish greater or additional protection provided by Federal or State law or
Index of Sec 1415. ...CONTRACT or other agreement ; Rights protected by paragraph not to be diminished by contract or other agreement and nothing in paragraph to be construed to diminish greater or additional protection provided by Federal or State law or
Index of Sec 1415. ...PROTECTION under section including efforts ; Improved coordination and
Index of Sec 1905. ...PROTECTION in case of dual eligibles ; Secretary providing for focused effort to provide for improved coordination between Medicare and Medicaid and
Index of Sec 1905. ...HOSPITAL or unit described in paragraph ; Implementing system described in paragraph for discharges occurring during rate year ending in 2011 or subsequent rate year for psychiatric
Index of Sec 1103. ...PSYCHIATRIC hospitals of subsection and psychiatric units of subsection, see section 124 of Medicare, Medicaid and SCHIP balanced Budget Refinement Act of 1999 ; Provisions related to establishment and implementation of prospective payment system for payments under title for inpatient hospital services furnished by
Index of Sec 1103. ...PSYCHIATRIC units of subsection, see section 124 of Medicare, Medicaid and SCHIP balanced Budget Refinement Act of 1999 ; Provisions related to establishment and implementation of prospective payment system for payments under title for inpatient hospital services furnished by psychiatric hospitals of subsection and
Index of Sec 1103. ...HEALTH care providers and payers ; Determining national priorities for research described in subsection and making determinations consulting with broad array of public and private stakeholders including patients and
Index of Sec 1401. ...REIMBURSEMENT or other policies for public or private payer ; Nothing in section to be construed to permit Commission or Center to mandate coverage,
Index of Sec 1401. ...INFORMATION being made available to public under section 1411(b) of America's Affordable Health Choices acting of 2009 for submission to Secretary ;
Index of Sec 1411. ...INFORMATION ; Making information described in paragraph available to public upon request and updating
Index of Sec 1411. ...INFORMATION reported in accordance with final regulations to be made available to public in accordance with procedures established by Secretary ;
Index of Sec 1411. ...INFORMATION making available to public under subparagraph and provided on Nursing Home comparing Medicare website under subsection ; Improving timeliness of
Index of Sec 1413. ...INFORMATION making available to public under subparagraph and provided on Nursing Home comparing Medicare website under subsection ; Improving timeliness of
Index of Sec 1413. ...INFORMATION making available to public with respect to covered recipient ; Providing covered recipient opportunity to submit corrections to
Index of Sec 1451. ...HOSPITAL or other entity reporting under subsection or regard to information making public with respect to covered recipient and corrections to be transmitted to Secretary ; Secretary establishing procedures to ensure that covered recipient provided with opportunity to submit corrections to manufacturer, distributor,
Index of Sec 1451. ...INFORMATION relating to drug samples provided under subsection not to be made available to public by Secretary ;
Index of Sec 1451. ...INFORMATION relating to national provider identifiers provided under subsection not to be made available to public by Secretary ;
Index of Sec 1451. ...HEALTH care programs ; Consensus-based entity entering into contract under section 1890 convening multi-stakeholder groups to provide recommendations on selection of individual or composite quality measures for use in reporting performance information to public or use in public
Index of Sec 1443. ...INFORMATION produced through data being timely and credible ; Make recommendations for policies allowing for public access of data produced under section when ensuring that
Index of Sec 1401. ...PUBLIC assistance ; Increasing economic self-sufficiency, employment advancement, school-readiness and educational achievement or reducing dependence on
Index of Sec 1713. ...PUBLIC comment on measure ; Secretary publishing in Federal registering measure and providing for period of
Index of Sec 1162. ...PUBLIC comment on methods and findings of research ; Center providing opportunities for stakeholders involved to review and provide
Index of Sec 1401. ...PUBLIC comment ; Regulations becoming effective on interim final basis pending opportunity for
Index of Sec 1741. ...PUBLIC comment ; Rule to be effective on interim basis pending revision after opportunity for
Index of Sec 1744. ...PUBLIC Internet site of Center and Commission as applicable ; Appropriate information contained in report to be posted on official
Index of Sec 1401. ...PUBLIC Internet website of Centers for Medicare and Medicaid Services ; Information submitted by hospitals under paragraph on
Index of Sec 1156. ...PUBLIC Internet website of Centers for Medicare and Medicaid servicing final decision with respect to application ; Secretary publishing on
Index of Sec 1156. ...NOMINATIONS ; Process under paragraph ensuring that selection of representatives of multi-stakeholder groups including provision for public
Index of Sec 1443. ...PERIODIC basis on plan described in subsection ; Secretary issuing interim public reports on
Index of Sec 1152. ...CLASSIFIATIONS system as Secretary determining appropriate based on analysis conducted pursuant to subparagraph ; Secretary implementing changes to payments for non-therapy ancillary services under future skilled nursing facility servicing
Index of Sec 1111. ...IDENTIFYING potentially misvalued services pursuant to clause ; Purposes of
Index of Sec 1122. ...RELATIVE value units making pursuant to subparagraph in same manner as provisions applying to adjustments under subparagraph ; Provisions of subparagraph applying to adjustments to
Index of Sec 1122. ...RELATIVE value units making pursuant to subparagraph in same manner as provisions applying to adjustments under subparagraph ; Provisions of subparagraph applying to adjustments to
Index of Sec 1122. ...CONTRACTS entered under section 1847 of Social Security Act 42 USC 1395w-3 pursuant to bid submitted under section before October 1, 2010 ; Amendments not applying to
Index of Sec 1141. ...FISCAL year and without application of adjustment factor described in paragraph and applied pursuant to paragraph ; Aggregate amount of payment adjustment under paragraph for fiscal year not exceeding 5 percent of estimated difference in spending occurring for
Index of Sec 1151. ...FISCAL year for hospital and without application of adjustment factor described in paragraph and applied pursuant to paragraph ; Aggregate amount of payment adjustment for hospital under paragraph not exceeding estimated difference in spending occurring for
Index of Sec 1151. ...HOSPITAL ; Procedure rooms or beds of hospital pursuant to paragraph only occurring in facilities on main campus of
Index of Sec 1156. ...COMPLIANCE with regulations pursuant to section 1866 ; Nothing in subsection to be construed as preventing Secretary from terminating hospital's provider agreement if hospital being not in
Index of Sec 1156. ...CONTRACT described in clause ; Pursuant to rfp
Index of Sec 1204. ...INCOME beneficiaries ; Rfp contract described in section being contract entered between Secretary and sponsor of prescription drug plan pursuant to Centers for Medicare and Medicaid Services' request for proposals issued on February 17, 2009 relating to Medicare part D retroactive coverage for certain low
Index of Sec 1204. ...CONTRACTING directly with agencies providing off-site interpretation including telephonic and video interpretation pursuant to which contractors directly billing Medicare for services provided in support of physician office services for LEP Medicare patient ; Feasibility of Medicare
Index of Sec 1221. ...PRIVACY protections provided under regulations promulgated pursuant to section 264(c) of Health Insurance Portability and Accountability Act of 1996 42 USC 1320d-2 note ; Consistent with
Index of Sec 1222. ...INCENTIVE payment being made under subsection ; Secretary treating receipt of incentive payment for year by organization under physician group practice demonstration pursuant to section 1866a as year For which
Index of Sec 1301. ...HOME pursuant to paragraph for targeted high need beneficiaries ; Secretary making payments for medical home services furnished by independent patient-centered medical
Index of Sec 1302. ...HOME pursuant to paragraph for high need beneficiaries ; Secretary making payments for furnishing of medical home services by community-based medical
Index of Sec 1302. ...IMPLEMENTATION of section ; Chapter 35 of title 44, United States Code not applying to manufacturer provision of information pursuant to section 1927(b)(3)(a)( iii for purposes of
Index of Sec 1310. ...APPOINTMENT ; Considering appointment to Commission or clinical perspective advisory panel described paragraph Secretary or Commission reviewing expertise of individual and financial disclosure report filed by individual pursuant to Ethics in Government Act of 1978 for individual under consideations for
Index of Sec 1401. ...TRANSPARENT process for activities conducted pursuant to convening ; Consensus-based entity described in paragraph providing for open and
Index of Sec 1443. ...DRUG ; Case of payment or other transfer of value making to covered recipient by applicable manufacturer or distributor pursuant to product development agreement for services furnished in connection with development of new
Index of Sec 1451. ...DRUGGING Administration Amendments acting of 2007 ; Clinical investigation registered on website maintained by National Institutes of Health pursuant to section 671 of Food and
Index of Sec 1451. ...TITLE with respect to items and services furnished by hospice program after date on which Secretary determining that intermediate sanctions to be imposed pursuant to subsection ; Denial or part of payments to which hospice program otherwise to be entitled under
Index of Sec 1614. ...TO-face encounter with individual involved during 6-month period preceding written order or other reasonable timeframe as determined by Secretary ; Requiring that order to be written pursuant to physician documenting that physician having face-
Index of Sec 1639. ...CERTIFICATIONS for home health services under title XIX or XXI of Social Security Act ; Requirements pursuant to amendments making by subsections and applying in case of physicians making
Index of Sec 1639. ...TITLE pursuant to section ; Case of child deemed under section 205(d)(1) of America's Affordable Health Choices acting of 2009 to be non-traditional Medicaid eligible individual and enrolled under
Index of Sec 1702. ...CANCER ; Inserting and medical assistance making available to individual described in subsection to be limited to family planning services and supplies described in section 1905(a)(4)(c) including medical diagnosis and treatment services provided pursuant to family planning service in family planning setting after cervical
Index of Sec 1714. ...CERTIFICATION as marriage and family therapist pursuant to State law ; Possessing master or doctoral degree qualifying for licensure or
Index of Sec 1308. ...RAPID improvement due to existing evidence, standards of care or other reasons ; Potential for
Index of Sec 1441. ...HOSPITAL from post acute care provider and readmission not governed by section 412.531 of title 42 ; Respect to readmission to applicable hospital or critical access
Index of Sec 1151. ...READMISSION ; Applying payment reduction for physicians treating patient during initial admission resulting in
Index of Sec 1151. ...READMISSION not governed by section 412.531 of title 42 ; Respect to readmission to applicable hospital or critical access hospital from post acute care provider and
Index of Sec 1151. ...READMISSIONS based on actual readmissions ; Risk adjusted
Index of Sec 1151. ...HOSPITAL for condition with respect to applicable period ; Risk adjusted expected readmissions for
Index of Sec 1151. ...DISCHARGES for applicable condition for applicable period and hospital ; Excess readmissions not including readmissions for applicable condition For which fewer than minimum number of
Index of Sec 1151. ...EXPENDITURES under title ; Readmissions representing conditions or procedures being high volume or high
Index of Sec 1151. ...READMISSIONS for applicable conditions ; Secretary monitoring activities of applicable hospitals to determine if hospitals taking steps to avoid patients at risk in order to reduce likelihood of increasing
Index of Sec 1151. ...FISCAL years beginning after October 1 ; Purposes of providing funds to applicable hospitals to take steps described in subparagraph to address factors impacting readmissions of individuals discharged hospital,
Index of Sec 1151. ...READMISSIONS ; Risk adjusted readmissions based on actual
Index of Sec 1151. ...READMISSIONS meaning sum ; Term aggregate payments for excess
Index of Sec 1151. ...DISCHARGES for applicable condition for applicable period and hospital ; Excess readmissions not including readmissions for applicable condition For which fewer than minimum number of
Index of Sec 1151. ...READMISSIONS ; Period as Secretary specifying for purposes of determining excess
Index of Sec 1151. ...READMISSIONS as described in paragraph ; Measures of
Index of Sec 1151. ...READMISSIONS for applicable conditions ; Order to promote reduction over time in overall rate of
Index of Sec 1151. ...READMISSION measure methodolology endorsed under paragraph ; Determining consistent with
Index of Sec 1151. ...READMISSION rates ; Funding under paragraph to be used by targeted hospitals for transitional care activities designed to address patient noncompliance issues resulting in higher than normal
Index of Sec 1151. ...READMISSION rates ; Developing quality improvement plan to assess and remedy preventable
Index of Sec 1151. ...READMISSION ratios normalized to benchmark being lower than 50th percentile ; Determination of excess readmissions ratio under subparagraph to be based on ranking of hospitals by
Index of Sec 1151. ...READMISSIONS policy described in previous subsections to be applied to physicians ; Secretary of Health and Human Services conducting study to determine
Index of Sec 1151. ...READMISSION ratios normalized to benchmark being lower than 50th percentile ; Determination of excess readmissions ratio under subparagraph to be based on ranking of hospitals by
Index of Sec 1151. ...COMPLIANCE program to identify changing necessary to reflect changes within organization and facilities ; Organization periodically undertaking reassessment of
Index of Sec 1412. ...COMPLIANCE program to identify changing necessary to reflect changes within organization and facilities ; Organization periodically undertaking reassessment of
Index of Sec 1412. ...REBATE for rebate period ending after December 31, 2010 ; Rebate agreement under subsection requiring manufacturer to provide to Secretary
Index of Sec 1181. ...REBATE computed under section 1854(b)(1)(c)(i) for plan and year involved ; Application of monthly
Index of Sec 1207. ...REBATE of premiums under part by amounting ; Secretary requiring Medicare Advantage organization offering plan to give enrollees
Index of Sec 1173. ...REBATE period to be equal to product ; Amount of rebate specified under paragraph for manufacturer for
Index of Sec 1181. ...REBATE required under section and period ; Secretary determining being necessary to enable Secretary to calculate average Medicare drug program full-benefit dual eligible rebate amount of section and determining amount of
Index of Sec 1181. ...REBATES, discounts or price concessions not passed to retail pharmacies ; Providing that
Index of Sec 1741. ...REBATES, discounts and other price concessions required to be provided under agreements under subsections and section 1860d-2(f) ;
Index of Sec 1741. ...REBATES of premium increases paid for months after January 1, 2005 and month of enactment of Act For which penalty applied and collected ; Secretary of Health and Human Services establishing method for providing
Index of Sec 1234. ...DRUG plan enrollees and PDP enrollees being not full-benefit dual eligible Medicare drug plan enrollees ; Information on extent to which price discounts, price concessions and rebates applying equally to full-benefit dual eligible Medicare
Index of Sec 1181. ...PHARMACY manufacturers for drugs provided to individuals enrolled with Medicaid managed care organizations contracting under section 1903(m) ; State reporting to Secretary total amount of rebates in dollars received from
Index of Sec 1743. ...REBATE agreement described in paragraph ; Term covered part D drug not including drug or biologic manufactured by manufacturer not entering and effect
Index of Sec 1181. ...REBATE agreement under subsection requiring manufacturer to provide to Secretary rebate for rebate period ending after December 31, 2010 ;
Index of Sec 1181. ...REBATE agreement under section ; Provisions of paragraph of section 1927(b) of subparagraph applying to rebate agreements under subsection in same manner as paragraph applying to
Index of Sec 1181. ...REBATE agreement under section 1860d-2(f) to be deposited into Account and used to pay or part of gradual elimination of coverage gap under section 1860d-2(b)(7) ; Amounts paid under
Index of Sec 1181. ...REBATE amount of section and determining amount of rebate required under section and period ; Secretary determining being necessary to enable Secretary to calculate average Medicare drug program full-benefit dual eligible
Index of Sec 1181. ...DRUG provided by manufacturer for rebate period ; Term average Medicare drug program full-benefit dual eligible rebate amount means with respect to dosage form and strength of covered part D
Index of Sec 1181. ...DRUG or product ; Rebate obligation with respect to drug under section to be amount computed under section for new
Index of Sec 1742. ...REBATE period ending after December 31, 2010 ; Rebate agreement under subsection requiring manufacturer to provide to Secretary rebate for
Index of Sec 1181. ...REBATE period to be equal to product ; Amount of rebate specified under paragraph for manufacturer for
Index of Sec 1181. ...REBATE period ; Total number of units of dosage form and strength of drug so provided and dispensed For which payment being made by PDP sponsor under part D or Ma organization under part C for
Index of Sec 1181. ...REBATE period ; Respect to dosage form and strength of covered part D drug provided by manufacturer for
Index of Sec 1181. ...REBATE period ; Term average Medicare drug program full-benefit dual eligible rebate amount means with respect to dosage form and strength of covered part D drug provided by manufacturer for
Index of Sec 1181. ...DRUG plans administered by PDP sponsor or Ma-pd plans administered by Ma-pd organization ; Number of units of dosage and strength of drug dispensed during rebate period to full-benefit dual eligible individuals enrolled in prescription
Index of Sec 1181. ...DRUG plans administered by PDP sponsors and Ma-pd plans administered by Ma-pd organizations ; Total number of units of dosage and strength of drug dispensed during rebate period to full-benefit dual eligible individuals enrolled in prescription
Index of Sec 1181. ...REBATE period ; Information on total number of units of dosageing, forming and strength of drug of manufacturer dispensed to full-benefit dual eligible Medicare drug plan enrollees under prescription drug plan operated by PDP sponsor during
Index of Sec 1181. ...REBATE period ; Total number of units of dosage form and strength of line extension product paid under State plan in
Index of Sec 1742. ...DRUG ; Not later than 30 days after last day of month of rebate period under agreement on manufacturer's total number of units used to calculate monthly average manufacturer price for covered outpatient
Index of Sec 1741. ...REBATE period having meaning given term in section 1927(k)(8) ; Term
Index of Sec 1181. ...RECALIBRATION factor as proposed in proposed rule for Medicare skilled nursing facilities issued by Secretary ; Secretary adjusting case mix indexes under section 1888(e)(4)(g)(i) of Social Security Act 42 USC 1395yy(e)(4)(g)(i) for fiscal year 2010 by appropriate
Index of Sec 1111. ...CERTIFICATION or recertification or other reasonable timeframe as determined by Secretary ; 2010 prior to making certification physician documenting that physician having face-to-face encounter with individual during 6-month period preceding
Index of Sec 1639. ...INFORMATION ; Acts in reckless disregarding of truth or falsity of
Index of Sec 1645. ...REGULATORY authority ; Time of publication of proposed rule and extent otherwise authorized under section 1919(b)(1)(b) or 1919(d)(1)(c) of Act or other
Index of Sec 1412. ...REGULATORY authority, one or more proposals for skilled nursing facilities to modify and strengthen quality assurance and performance improvement programs in facilities ; Secretary including in proposed rule published under section 1888(e) of Social Security Act 42 USC 1395yy(e)(5)(a)) for subsequent fiscal year to extent otherwise authorized under section 1819(b)(1)(b) or 1819(d)(1)(c) of Social Security Act or other statutory or
Index of Sec 1412. ...DISCHARGE of individual from hospital and other services determined appropriate by Secretary ; Term post acute services meaning services For which payment to be made under Medicare program furnished by skilled nursing facilities, inpatient rehabilitation facilities, long term care hospitals, hospital based outpatient rehabilitation facilities and home health agencies to individual after
Index of Sec 1152. ...DISCHARGE of individual from hospital and other services determined appropriate by Secretary ; Term post acute services meaning services For which payment to be made under Medicare program furnished by skilled nursing facilities, inpatient rehabilitation facilities, long term care hospitals, hospital based outpatient rehabilitation facilities and home health agencies to individual after
Index of Sec 1152. ...INFORMATION required to be filed with plan by beneficiary ; Reimbursement to be made automatically by plan upon receipt of appropriate notice beneficiary being eligible for assistance described in subsection without further
Index of Sec 1204. ...REIMBURSEMENT being made ; Reimbursement making by prescription drug plan or Ma-pd plan under subsection including line-item description of items For which
Index of Sec 1204. ...REIMBURSEMENT under subsection to retroactive lis enrollment beneficiary with respect to claim ; Prescription drug plan or Ma-pd plan making
Index of Sec 1204. ...REIMBURSEMENT for culturally and linguistically appropriate Services ; Sec 1222, demonstration to promote Access for medicare Beneficiaries with limited english proficiency by providing
Index of Sec 1222. ...REIMBURSEMENT or other policies for public or private payer ; Nothing in section to be construed to permit Commission or Center to mandate coverage,
Index of Sec 1401. ...REIMBURSEMENT under title for services provided to eligible beneficiaries under title ;
Index of Sec 1704. ...REIMBURSEMENT plan providing to beneficiaries for premiums and cost-sharing ; Attestation to Administrator of Centers for Medicare and Medicaid Services of total amount of
Index of Sec 1204. ...INCOME Subsidy enrollment ; Enhancing oversight relating to reimbursements for retroactive low
Index of Sec 1204. ...REIMBURSEMENTS ; Administrative requirements relating to
Index of Sec 1204. ...REIMBURSEMENT limit established under paragraph as 130 percent of weighted average of monthly average manufacturer prices ; Secretary calculating Federal upper
Index of Sec 1741. ...REIMBURSEMENT system authorized under section 1814(b)(3) ; Reimbursing under
Index of Sec 1503. ...HEALTH, skilled nursing facility and other services ; Cost-sharing for post acute care bundle to be treated relative to current rules for cost-sharing for inpatient hospital, home
Index of Sec 1152. ...RELATIVE value scale by using adjustments when patient being LEP ; Feasibility of modifying existing Medicare resource-based
Index of Sec 1221. ...RELATIVE value units making pursuant to subparagraph in same manner as provisions applying to adjustments under subparagraph ; Provisions of subparagraph applying to adjustments to
Index of Sec 1122. ...RELATIVE value units under fee schedule under subsection ; Secretary establishing process to validate
Index of Sec 1122. ...RELATIVE value units including sampling of codes for services being same as codes listed under subparagraph ; Validation of work
Index of Sec 1122. ...RELATIVE value units making pursuant to subparagraph in same manner as provisions applying to adjustments under subparagraph ; Provisions of subparagraph applying to adjustments to
Index of Sec 1122. ...IMAGING equipment ; Computing number of practice expense relative value units under subsection with respect to advanced diagnostic imaging services presumed rate of utilization of
Index of Sec 1147. ...RELATIVE values established under paragraph for services identified as potentially misvalued under subclause ; Review and making appropriate adjustments to
Index of Sec 1122. ...RELATIVE values initially established for codes ; Codes for new technologies or services within appropriate period after
Index of Sec 1122. ...RELATIVE values described in clause ; Including with respect to codes with low
Index of Sec 1122. ...DIALYSIS facilities for items and services under section under paragraph ; Purposes of evaluating or auditing payments making to renal
Index of Sec 1643. ...COMPENSATION arrangement between facilitying and medical director of facilitying or facilitying and physician ; Renal dialysis facility providing to Secretary access to information relating to ownership or
Index of Sec 1643. ...RENTAL payments made ; Supplier of oxygen to individual declared bankrupt and asseal liquidated and time of declaration and liquidation more than 24 months of
Index of Sec 1148. ...RESERVATION required by paragraph ; Making
Index of Sec 1904. ...RESIDENCY training programs ; Number of primary care residents in
Index of Sec 1501. ...NONPATIENT care activities ; Rules providing that time spent by intern or resident in approved medical residency training program in nonprovider setting primarily engaged in furnishing patient care in
Index of Sec 1503. ...RESIDENCY training program on vacation, sick leave or other approved leave ; Time spent by intern or resident in approved medical
Index of Sec 1503. ...NONPATIENT care activities ; Time spent by intern or resident in approved medical residency training program in
Index of Sec 1503. ...RESIDENCY training program in research activities not associated with treatment or diagnosis of particular patient ; Time spent by intern or resident in approved medical
Index of Sec 1503. ...RESIDENCY training programs described in section 1886(h)(1)(b) ; Taking into account recommendations of Advisory Committee and goals for approved medical
Index of Sec 1744. ...RESIDENCY training program not reflected on recent settled or submitted cost report, audit and subject to discretion of Secretary ; Existing
Index of Sec 1501. ...RESIDENCY training programs to foster physician workforce so ; Goals of medical
Index of Sec 1505. ...RESIDENCY training programs ; Comptroller General of United States conducting study to evaluate extent to which medical
Index of Sec 1505. ...RESIDENCY training programs to be further encouraged to meet goals through means ; Medical
Index of Sec 1505. ...RESIDENCY training program ; Contracting hospital agreeing not to diminish number of residents in primary care
Index of Sec 1502. ...HOSPITAL attributable to increase provided under subparagraph ; Respect to additional residency positions in
Index of Sec 1501. ...HOSPITAL ; More than 20 full-time equivalent additional residency positions to be made available under subparagraph with respect to
Index of Sec 1501. ...RESIDENCY programs closed after date described in subclause ; Estimated aggregate number of increases in otherwise applicable resident limits for hospitals under clause to be equal to estimated number of resident positions in approved medical
Index of Sec 1504. ...RESIDENCY programs meeting goals referred in paragraph ; Assessment of accreditation processes of Accreditation Council for Graduate Medical Education and American Osteopathic Association and effectiveness of processes in accrediting medical
Index of Sec 1505. ...PRIMARY care and other specialties ; Range of residency programs including
Index of Sec 1505. ...HOSPITAL for hospital's costs of salary and fringe benefits for residents in program ; Approved teaching health center contracting with accredited teaching hospital to carry out inpatient responsibilities of primary care residency program of hospital involved and responsible for payment to
Index of Sec 1502. ...RESPONSIBILITY for continuing to furnish equipment during remainder of period ; Another supplier accepted
Index of Sec 1148. ...RESPONSIBILITY for providing first contact, continuous and comprehensive care to beneficiary ; Providing beneficiaries with direct and ongoing access to primary care or principal care by physician or nurse practitioner accepting
Index of Sec 1302. ...DRUG, device, biological or medical supply reporting under subsection or hospital or other health care entity reporting physician ownership under subsection ; Accuracy of information submitted under subsections and making available under paragraph to be responsibility of applicable manufacturer or distributor of covered
Index of Sec 1451. ...RESPONSIBILITY of State survey agency for making final recommendations for penalties ; Opportunity not affecting
Index of Sec 1421. ...RESPONSIBILITY of State survey agency for making final recommendations for penalties ; Opportunity not affecting
Index of Sec 1421. ...ELIGIBILITY standards, methodologies or procedures under plan as in effect on June 16 ; Subject to paragraph State not in effect eligibility standards, methodologies or procedures under State child health plan under title XXI being more restrictive than
Index of Sec 1703. ...ELIGIBILITY standards, methodologies or procedures under plan as in effect on June 16 ; State being not eligible for payment under subsection for calendar quarter beginning after date of enactment of subsection if eligibility standards, methodologies or procedures under plan under title being more restrictive than
Index of Sec 1703. ...INCOME beneficiaries ; Rfp contract described in section being contract entered between Secretary and sponsor of prescription drug plan pursuant to Centers for Medicare and Medicaid Services' request for proposals issued on February 17, 2009 relating to Medicare part D retroactive coverage for certain low
Index of Sec 1204. ...RETROACTIVE coverage period of beneficiary in accordance with subsection and case beneficiary described in subsection ; Beneficiary entitled to reimbursement by plan for covered drug costs incurred by beneficiary during
Index of Sec 1204. ...RETROACTIVE coverage period of beneficiary for covered part D drugs, premiums and cost-sharing under title ; Costs incurred by beneficiary during
Index of Sec 1204. ...RETROACTIVE coverage period of beneficiary ; Organization or other third party owed payment on behalf of beneficiary for covered drug costs incurred by beneficiary during
Index of Sec 1204. ...DRUG plan under part D of title XVIII of Social Security Act ; Case of retroactive lis enrollment beneficiary enrolled under prescription
Index of Sec 1204. ...RETROACTIVE lis enrollment beneficiary with respect to claim ; Prescription drug plan or Ma-pd plan making reimbursement under subsection to
Index of Sec 1204. ...RETROACTIVE lis enrollment beneficiary described in paragraph ; Respect to
Index of Sec 1204. ...RETROACTIVE lis enrollment beneficiary described in paragraph ; Respect to
Index of Sec 1204. ...READMISSIONS based on actual readmissions ; Risk adjusted
Index of Sec 1151. ...HOSPITAL for condition with respect to applicable period ; Risk adjusted expected readmissions for
Index of Sec 1151. ...READMISSIONS for applicable conditions ; Secretary monitoring activities of applicable hospitals to determine if hospitals taking steps to avoid patients at risk in order to reduce likelihood of increasing
Index of Sec 1151. ...RISK as determined appropriate by Secretary ; Adjustment factor to be adjusted for
Index of Sec 1301. ...RISK as determined to be appropriate by Secretary ; Risk physicians' services or items and services under part B Secretary limiting partial capitation model to ACOS highly integrated systems of care and ACOS capable of bearing
Index of Sec 1301. ...RISK associated with provider or supplier enrolling or participating in program under title XVIII, XIX or XXI ; Enhancing safeguards as Secretary determining necessary to reduce
Index of Sec 1632. ...RISK of waste ; Secretary determining that application helping to reduce
Index of Sec 1637. ...FRAUD or abuse ; Secretary applying face-to-face encounter requirement described in amendments making by subsections and other items and services For which payment provided under title XVIII of Social Security Act based upon finding that decision reducing risk of waste,
Index of Sec 1639. ...FRAUD and abuse ; Furnishing or ordering of durable medical equipment in order to enable better monitoring of claims for payment for additional services under title or ordering, furnishing or prescribing of other items and services determined by Secretary to pose high risk of waste,
Index of Sec 1633. ...FRAUD and abuse before implementing requirements of subsection to providers of services and suppliers described in paragraph ; Secretary determining to be category at high risk for waste,
Index of Sec 1635. ...RISK beneficiaries ; Secretary adjusting payments to medical homes based on beneficiary risk scores to ensure that higher payments being made for higher
Index of Sec 1302. ...RISK beneficiaries ; Use appropriate risk-adjustment in determining amount of per beneficiary per month payment under paragraph in manner ensuring that higher payments being made for higher
Index of Sec 1302. ...FRAUDULENT activity with respect to category of provider of services or supplier of items or services under title XVIII, XIX or XXI Secretary imposing following requirements with respect to provider of services or supplier ; Secretary determining being significant risk of
Index of Sec 1631. ...ACCOUNT evaluation under subsection ; 2012 Secretary implementing necessary improvements to risk adjustment system under section 1853(a)(1)(c) of Social Security Act 42 USC 1395-23(a)(1)(c), taking into
Index of Sec 1167. ...INCOME beneficiaries ; Secretary of Health and Human Services submitting to Congress report evaluating adequacy of risk adjustment system under section 1853(a)(1)(c) of Social Security Act 42 USC 1395-23(a)(1)(c) in predicting costs for beneficiaries with chronic or co-morbid conditions, beneficiaries dually-eligible for Medicare and Medicaid and non-Medicaid eligible low-
Index of Sec 1167. ...CAPITATION model to ACOS highly integrated systems of care and ACOS capable of bearing risk as determined to be appropriate by Secretary ; Risk physicians' services or items and services under part B Secretary limiting partial
Index of Sec 1301. ...RISK beneficiaries ; Use appropriate risk-adjustment in determining amount of per beneficiary per month payment under paragraph in manner ensuring that higher payments being made for higher
Index of Sec 1302. ...RISK-adjustment in determining amount of per beneficiary per month payment under paragraph ; Use appropriate
Index of Sec 1302. ...BENEFICIARY access to bone mass measurement benefits in general and rural and minority communities specifically ; Impact of Medicare payment changes since 2006 on
Index of Sec 1149. ...HOSPITAL ownership exceptions to self-referral prohibition ; Requirements to qualify for rural Provider and
Index of Sec 1156. ...RURAL areas ; Recruitment and retention taking into account workforce mobility between urban and
Index of Sec 1157. ...SAFETY and improving quality of patient care ; Work in inter-professional teams and multi-disciplinary team-based models in provider and nonprovider settings to enhance
Index of Sec 1505. ...SAFETY ; Order to improve health care quality and patient
Index of Sec 1461. ...SAFETY and quality of care deficiencies ; Criteria including evaluation of chain including one or more facilities participating in Special Focus Facility program or one or more facilities with record of repeated serious
Index of Sec 1422. ...SAFETY and quality of care problems ; Including where evidence suggesting that one or more facilities of chain experiencing serious
Index of Sec 1422. ...AMBULATORY surgical center ; Nothing in section to be construed as preempting or otherwise affecting provision of State law relating to disclosure of information on health care-associated infections or patient safety procedures for hospital or
Index of Sec 1461. ...SAVINGS related to provision of language access services ; Description of costs associated or
Index of Sec 1223. ...SAVINGS being greater ; Incentive payment to be made only if
Index of Sec 1301. ...SAVINGS achieved and amount of savings ; Determinations with respect whether
Index of Sec 1301. ...HOME infusion therapy ; Benefits and costs of providing coverage under Medicare program including calculation of potential savings achieved through avoided or shortened hospital and nursing home stays as result of Medicare coverage of
Index of Sec 1143. ...SAVINGS program ; Individual to be responsible for providing for payment of portion of premium under section 1839 not covered under Medicare
Index of Sec 1232. ...CODING intensity adjustment authority ; Extension of secretarial
Index of Sec 1163. ...SECURITY ; Data collection efforts under system use efficient and cost-effective means in manner minimizing administrative burden on persons required to collect data and adequately protecting privacy of patients' personal health information and providing data
Index of Sec 1442. ...SOCIAL ; Skills to recognize and seek help for issues related to health, developmental delays and
Index of Sec 1904. ...SECURITY administration's outreach to eligible Individuals ; Disclosures to facilitate identification of Individuals likely to be ineligible for low-income assistance under medicare prescription Drug Program to Assist social
Index of Sec 1203. ...SECURITY administration's outreach to eligible Individuals ; Disclosures to facilitate identification of Individuals likely to be ineligible for low-income assistance under medicare prescription Drug Program to Assist social
Index of Sec 1801. ...SECURITY administration's outreach to eligible Individuals ; Disclosures to facilitate identification of Individuals likely to be ineligible for low-income Subsidies under medicare prescription Drug Program to Assist social
Index of Sec 1801. ...HEALTH care ; Term health care-related services meaning human or social services programing or activities providing access, referrals or links to
Index of Sec 1224. ...SPECIFIC basis and determined on per capita basis ; Local or organization-
Index of Sec 1301. ...SPECIFIC case and providing Secretary with opportunity to bring action under subsection and Secretary declining opportunity ; Providing notice to Secretary of intent to proceed under paragraph in
Index of Sec 1451. ...SPECIFIC categories ; Nothing in subparagraph to be construed as preventing Secretary from requiring submission of information with respect to
Index of Sec 1416. ...SPECIFIC categories ; Nothing in subparagraph to be construed as preventing Secretary from requiring submission of information with respect to
Index of Sec 1416. ...SPECIFIC elements or formality of program varying with size of organization ; Regulations with respect to
Index of Sec 1412. ...SPECIFIC elements or formality of program varying with size of organization ; Regulations with respect to
Index of Sec 1412. ...HOSPITAL-specific limit under paragraph and form of payment making by Secretary under paragraph ;
Index of Sec 1151. ...PREVENTIVE services ; Respect to specific Medicare covered
Index of Sec 1305. ...INFORMATION produced from research being clinically relevant to decisions making by clinicians and patients at point of care ; Consulting with patients and advising Center on research questions, methods and evidence gaps in terms of clinical outcomes for specific research inquiry to be examined with respect to priority to ensure that
Index of Sec 1401. ...PLANNING including national toll-free hotline ; Provision by practitioner of list of national and State-specific resources to assist consumers and families with advance care
Index of Sec 1233. ...SPECIFIC target growth rate for accountable care organization under section for purposes of section 1848 ; Nothing in section to be construed to compel or require organization to use organization-
Index of Sec 1301. ...FINANCIAL participation for payments ; Specific upper limit under section 447.332 of title 42, Code of Federal Regulations applicable to payments making by State for multiple source drugs under State Medicaid plan continuing to apply through December 31, 2010 for purposes of availability of Federal
Index of Sec 1741. ...ASSESSMENT of not more than 3 timing total amount of obligation to which false record or statment being material or avoided or decreased ;
Index of Sec 1645. ...DISCLOSURE under section 552 of title 5, United States Code or other similar Federal ; Information described in paragraph or considered confidential and not subject to
Index of Sec 1451. ...SUBSIDIES available under section 1860d-14 of Social Security Act ; Number of claims plan readjudicated during month due to beneficiary becoming retroactively eligible for
Index of Sec 1204. ...DRUG program ; Provision authorizing disclosure of return information to facilitate identification of individuals likely to be ineligible for low-income subsidies under Medicare prescription
Index of Sec 1203. ...SUBSIDY eligible individual ; Case of individual determined under subparagraph of section 1860d-14(a)(3) to be
Index of Sec 1206. ...SUBSIDY ; Eligible for low-income prescription drug subsidy under section 1860d-14 of Social Security Act and not applying for
Index of Sec 1801. ...SUBSIDY-eligible individual ; Term qualifying enrollee meaning individual enrolled in prescription drug plan or Ma-pd plan other than individual being
Index of Sec 1182. ...SUPERVISORY staff of skilled nursing facilities and nursing facilities ; Secretary conducting study on content of training for certified nurse aides and
Index of Sec 1432. ...BOND described in subparagraph not applying in case of pharmacy enrolled under section 1866(j) as supplier of durable medical equipment, prosthetics, orthotics and supplies and issued provider number for 5 years and final adverse action of title 42, Code of Federal Regulations never imposed ; Requirement for surety
Index of Sec 1148. ...BOND ; Requiring or unannounced site visits or inspections, additional information reporting requirements and conditioning enrollment on provision of surety
Index of Sec 1632. ...CAPITALIATIONS ; Requirements relating to surety bonds, liability insurance or minimum
Index of Sec 1412. ...HEALTH data ; Encouraging development and use of clinical registries and development of clinical effectiveness research data networks from electronic health records, post marketing drug and medical device surveillance efforts and other forms of electronic
Index of Sec 1401. ...TAX imposed by chapter 1 resulting from fees imposed by subchapter ; Decrease in
Index of Sec 1802. ...TEACHING adjustment factor to be computed in same manner as provided under clause with respect to resident positions ; 2011 insofar as additional payment amount under subparagraph being attributable to resident positions distributed to hospital under subsection, indirect
Index of Sec 1501. ...CHRONIC illnesses, transitional care services, care plan ; Teaching self-care skills for managing
Index of Sec 1302. ...TELEHEALTH services as established under section 1834(m) ; Secretary appointing Telehealth Advisory Committee to make recommendations to Secretary on policies of Centers for Medicare and Medicaid Services regarding
Index of Sec 1191. ...TELEHEALTH services ; Secretary taking into account recommendations of Telehealth Advisory Committee when adding or deleting services and establishing policies of Centers for Medicare and Medicaid Services regarding delivery of
Index of Sec 1191. ...TELEHEALTH programs ; Giving preference to individuals providing telemedicine or telehealth services or involved in telemedicine or
Index of Sec 1191. ...TELEHEALTH programs ; Giving preference to individuals providing telemedicine or telehealth services or involved in telemedicine or
Index of Sec 1191. ...TENURE in format being clearly understandable to consumers of long-term care servicing and allowing consumers to compare differences in staffing between facilities and State and national averages for facilities ; Including information on staffing turnover and
Index of Sec 1413. ...TENURE in format being clearly understandable to consumers of long-term care servicing and allowing consumers to compare differences in staffing between facilities and State and national averages for facilities ; Including information on staffing turnover and
Index of Sec 1413. ...THEMSELVES ; Section 1905(a) of Social Security Act 42 USC 1396d(a) amended by inserting or care and servicing
Index of Sec 1781. ...HOSPITAL services furnished by psychiatric hospitals of subsection and psychiatric units of subsection, see section 124 of Medicare, Medicaid and SCHIP balanced Budget Refinement Act of 1999 ; Provisions related to establishment and implementation of prospective payment system for payments under title for inpatient
Index of Sec 1103. ...TITLE ; Readmissions representing conditions or procedures being high volume or high expenditures under
Index of Sec 1151. ...TITLE for post-acute care provider if subsection not applying ; Payment under title on claim to be applicable percent specified in subparagraph of payment otherwise to be made under respective payment system under
Index of Sec 1151. ...TITLE ; Demonstration program under section 1866c and pilot program under section maintaining or increasing quality of care received by individuals enrolled under
Index of Sec 1152. ...COMPENSATION arrangements ; Entity providing covered items or services For which payment to be made under title providing Secretary with information concerning entity's ownership, investment and
Index of Sec 1156. ...TITLE very infrequently ; Secretary determining providing services For which payment to be made under
Index of Sec 1156. ...TITLE very infrequently ; Secretary determining providing services For which payment to be made under
Index of Sec 1156. ...TITLE ; Costs incurred by beneficiary during retroactive coverage period of beneficiary for covered part D drugs, premiums and cost-sharing under
Index of Sec 1204. ...TITLE to applicable beneficiaries by qualifying accountable care organizations in order ; Designing to reduce growth of expenditures and improving health outcomes in provision of items and services under
Index of Sec 1301. ...INCENTIVE payments under pilot program ; Nothing in subsection to be construed as preventing qualifying ACO from including hospital or other provider of services or supplier furnishing items or services For which payment to be made under title affiliated with ACO under arrangement structured so that provider or supplier participating in pilot program and shares in
Index of Sec 1301. ...TITLE for year relative estimated below performance target for year as determined by Secretary ; Meet or exceeding annual quality and performance targets for year receiving incentive payment for year equal to portion of amount by which payments under
Index of Sec 1301. ...TITLE not exceeding amount ; Secretary limiting incentive payments to qualifying ACO under paragraph as necessary to ensure that aggregate expenditures with respect to applicable beneficiaries for ACOS under
Index of Sec 1301. ...TITLE through qualifying ACO ; Secretary monitoring data on expenditures and quality of services under title after applicable beneficiary discontinuing receiving services under
Index of Sec 1301. ...TITLE ; Secretary evaluating payment incentive model for qualifying ACO under pilot program to assess impacts on beneficiaries, providers of services, suppliers and program under
Index of Sec 1301. ...TITLE ; Report addressing impact of use of authorities on expenditures, access and quality under
Index of Sec 1301. ...TITLE as of date of enactment of section ; Clinical work and practice expenses involved in providing medical home services provided by independent patient-centered medical home For which payment being not made under
Index of Sec 1302. ...TITLE XIX and full-benefit dual eligible individuals ; Applications from States proposing to use medical home model to coordinate health care services for individuals enrolled under title, individuals enrolled under
Index of Sec 1302. ...TITLE as of date of enactment of section ; Clinical work and practice expenses involved in providing medical home services provided by community-based medical home For which payment being not made under
Index of Sec 1302. ...TITLE on permanent basis ; Feasability and advisability of reimbursing medical homes for medical home services under
Index of Sec 1302. ...TITLE ; Payment for evaluation and management services making under
Index of Sec 1302. ...TITLE for cost reporting periods beginning after date being 3 years after date of enactment of subsection ; Cost reports submitted under
Index of Sec 1414. ...TITLE ; Case of facility where Secretary terminating facility's participation under
Index of Sec 1423. ...NOTIFICATION under subparagraph during period beginning on date ; Secretary continuing to make payments under title with respect to residents of facility submitting
Index of Sec 1423. ...TITLE ; Case of facility where Secretary terminating facility's participation under
Index of Sec 1423. ...NOTIFICATION under subparagraph during period beginning on date ; Secretary continuing to make payments under title with respect to residents of facility submitting
Index of Sec 1423. ...TITLE beginning in payment year beginning in yearing and payment systems beginning in calendar year following year ; Selection for quality measurement by Secretary in rulemaking with respect to payment systems under
Index of Sec 1443. ...HEALTH and safety of individuals provided care and services by agency or organization involved and determining ; Hospice program certified for participation under title demonstrating substandard quality of care and failed to meet other requirements as Secretary finding necessary in interest of
Index of Sec 1614. ...COMPLIANCE with requirements ; Secretary determining that hospice program certified for participation under title in
Index of Sec 1614. ...TITLE with respect to items and services furnished by hospice program after date on which Secretary determining that intermediate sanctions to be imposed pursuant to subsection ; Denial or part of payments to which hospice program otherwise to be entitled under
Index of Sec 1614. ...TITLE in same manner as provisions applying to hospice program providing hospice care under title XVIII ; Provisions of section 1819a applying to hospice program providing hospice care under
Index of Sec 1614. ...TITLE in same manner ; Provisions of section 1819a applying to hospice program providing hospice care under
Index of Sec 1614. ...TITLE ; Provisions of section 1128g(a) applying to enrollments and renewals of enrollments of providers of services and suppliers under
Index of Sec 1631. ...FRAUD and abuse ; Furnishing or ordering of durable medical equipment in order to enable better monitoring of claims for payment for additional services under title or ordering, furnishing or prescribing of other items and services determined by Secretary to pose high risk of waste,
Index of Sec 1633. ...TITLE ; Secretary extending requirement applied by amendments making by subsections and durable medical equipment and home health services to other categories of items or services under
Index of Sec 1637. ...TITLE as specified by Secretary ; Physician or supplier under section 1866(j) if physician or supplier failing to maintain and provide access to documentation relating to written orders or requests for payment for durable medical equipment, certifications for home health services or referrals for other items or servicing written or ordered by physician or supplier under
Index of Sec 1638. ...TITLE as specified by Secretary ; Maintaining and providing access to documentation relating to written orders or requests for payment for durable medical equipment, certifications for home health services or referrals for other items or servicing written or ordered by provider under
Index of Sec 1638. ...ACCEPTABLE coverage ; State entering into Medicaid memorandum of understanding described in section 204(e)(4) of America's Affordable Health Choices acting of 2009 with Health Choices Commissioner with respect to coordinating implementation of provisions of division A of Act with State plan under title in order to ensure enrollment of Medicaid eligible individuals in
Index of Sec 1702. ...TITLE pursuant to section ; Case of child deemed under section 205(d)(1) of America's Affordable Health Choices acting of 2009 to be non-traditional Medicaid eligible individual and enrolled under
Index of Sec 1702. ...TITLE and titling XIX ; Clause of section 1903(u)(1)(d) applying with respect to application of requirements under
Index of Sec 1702. ...ELIGIBILITY standards, methodologies or procedures under plan as in effect on June 16 ; State being not eligible for payment under subsection for calendar quarter beginning after date of enactment of subsection if eligibility standards, methodologies or procedures under plan under title being more restrictive than
Index of Sec 1703. ...TITLE for services provided to eligible beneficiaries under title ; Reimbursement under
Index of Sec 1704. ...TITLE ; Eligible for payments under State plan approved under
Index of Sec 1714. ...TITLE through means other than described in section 2101(a)(2) ; Case of State child health plan providing child health assistance under
Index of Sec 1733. ...TITLE during period determining by Secretary or State agency to be delinquent ; Unpaid overpayments under
Index of Sec 1757. ...TITLE during period ; Suspending or excluded from participation or whose participation terminated under
Index of Sec 1757. ...TITLE during period ; Affiliating with individual or entity suspended or excluded from participation under title or whose participation terminated under
Index of Sec 1757. ...INCENTIVE payments under subsection ; Other than payments for items and services furnished under title and
Index of Sec 1301. ...TITLE and title XI in manner Secretary determining necessary in order implement pilot program ; Secretary waiving provisions of
Index of Sec 1301. ...TITLE and title XIX ; Review Medicare and Medicaid policies related to enrollment, benefits, service delivery, payment and grievance and appeals processing under parts A and B of title XVIII under Medicare Advantage program under part C of
Index of Sec 1905. ...ELIGIBILITY option described in section 1902(e) for targeted low-income children whose family income below 200 percent of poverty line ; Plan providing for implementation under title of 12-month continuous
Index of Sec 1733. ...TITLE ; Term Medicare beneficiary meaning individual entitled to benefits under part A of title XVIII of Social Security Act or enrolled under part B of
Index of Sec 1224. ...TITLE and inserting beneficiaries ; Section 1128(c)(3)(b) of Social Security Act 42 USC 1320a-7(c)(3)(b) amended by striking individuals entitled to benefits under part A of title XVIII or enrolled under part B of
Index of Sec 1642. ...HOME infusion therapy providers to patients in programs ; Scope of coverage for home infusion therapy in fee-for-service Medicare program under title XVIII of Social Security Act, Medicare Advantage under part C of title united States Code and private payers including analysis of scope of services provided by
Index of Sec 1143. ...TITLE ; Part C organization offering Medicare part C plan under part C of
Index of Sec 1222. ...PROFICIENCY ; Extent to which providers under parts A and B of title XVIII of Social Security Act, Ma organizations offering Medicare Advantage plans under part C of title and PDP sponsors of prescription drug plan under part D of title utilizing, offering or make available language services for beneficiaries with limited English
Index of Sec 1221. ...ASSET or resource test described in subparagraph waived ; Provisions of title preventing waiver of
Index of Sec 1703. ...LEGISLATIVE session ; State plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirement before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year
Index of Sec 1705. ...LEGISLATIVE session ; State plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirements before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year
Index of Sec 1711. ...LEGISLATIVE session ; State plan or child health plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirement before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year
Index of Sec 1756. ...LEGISLATIVE session ; State plan or child health plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirement before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year
Index of Sec 1757. ...LEGISLATIVE session ; State plan or child health plan not to be regarded as failing to comply with requirements of title solely on basis of failure to meet additional requirement before first day of first calendar quarter beginning after close of first regular session of State legislature begining after date of enactment of Act for purposes of previous sentence in case of State having 2-year
Index of Sec 1759. ...ADMINISTRATIVE expenditure For which payment being made under section 1903(a) or 2105(a) of Act after date of enactment of Act ; Nothing in amendments making by section to be construed as affecting ability of State under title XIX or XXI of Social Security Act to provide nurse home visitation services as part of another class of items and services falling within definition of medical assistance or child health assistance under respective title or
Index of Sec 1713. ...INFORMATION ; Violation of title occurring or occurring in relation to
Index of Sec 1415. ...INFORMATION ; Violation of title occurring or occurring in relation to
Index of Sec 1415. ...TITLE 18, United States coding ; Term financial interest meaning financial interest under section 208(a) of
Index of Sec 1401. ...TITLE 18 ; Later requiring written determination as referred in section 208(b)(1) of
Index of Sec 1401. ...TITLE 18, United States Code or waiver as referred in subparagraph for service on Commission at meeting of Commission ; Written certification as referred in section 208(b)(3) of
Index of Sec 1401. ...TITLE 21, Code of Federal Regulations ; Drug whose labeling including boxed warning required by Food and drugging Administration under section 210.57 of
Index of Sec 1185. ...TITLE 31, United States coding ; Term knowingly having meaning given term in section 3729(b) of
Index of Sec 1451. ...TITLE 31 of United States coding ; Term knowing having meaning given terms knowing and knowingly in section 3729(b) of
Index of Sec 1641. ...TITLE 31 of United States coding ; Known overpayment retained later than applicable date specified in paragraph creating obligation as defined in section 3729(b)(3) of
Index of Sec 1641. ...TITLE 42, Code of Federal Regulations never imposed ; Requirement for surety bond described in subparagraph not applying in case of pharmacy enrolled under section 1866(j) as supplier of durable medical equipment, prosthetics, orthotics and supplies and issued provider number for 5 years and final adverse action of
Index of Sec 1148. ...TITLE 42 ; Respect to readmission to applicable hospital or critical access hospital from post acute care provider and readmission not governed by section 412.531 of
Index of Sec 1151. ...TITLE 42, Code of Federal Regulations and not affecting application of section 1886(h)(4)(h)(v) of Social Security Act ; Amendments making by section not effecting temporary adjustment to hospital's FTE cap under section 413.79 of
Index of Sec 1504. ...FINANCIAL participation for payments ; Specific upper limit under section 447.332 of title 42, Code of Federal Regulations applicable to payments making by State for multiple source drugs under State Medicaid plan continuing to apply through December 31, 2010 for purposes of availability of Federal
Index of Sec 1741. ...TITLE 42 ; Respect to case mix adjustments established in section 484.220 of
Index of Sec 1154. ...TITLE 44, United States Code and provisions of Federal Advisory Committee Act not applying to section or amendment making by section ; Chapter 35 of
Index of Sec 1122. ...TITLE 44, United States Code not applying to section ; Chapter 35 of
Index of Sec 1152. ...TITLE 44, United States Code not applying to section ; Chapter 35 of
Index of Sec 1301. ...TITLE 44, United States Code not applying to section ; Chapter 35 of
Index of Sec 1302. ...IMPLEMENTATION of section ; Chapter 35 of title 44, United States Code not applying to manufacturer provision of information pursuant to section 1927(b)(3)(a)( iii for purposes of
Index of Sec 1310. ...TITLE 5, United States Code or other similar Federal ; Information described in paragraph or considered confidential and not subject to disclosure under section 552 of
Index of Sec 1451. ...DRUG plan under part D of title utilizing, offering or make available language services for beneficiaries with limited English proficiency ; Extent to which providers under parts A and B of title XVIII of Social Security Act, Ma organizations offering Medicare Advantage plans under part C of title and PDP sponsors of prescription
Index of Sec 1221. ...TITLE II of division A of America's Affordable Health Choices acting of 2009 as specified under memorandum ; Redeterminations of eligibility for individuals unless periodicity of redeterminations being consistent with periodicity for redeterminations by Commissioner of eligibility for affordability credits under subtitle C of
Index of Sec 1702. ...TITLE II of division A of America's Affordable Health Choices acting of 2009 ; Commissioner determining that State Medicaid agency having capacity to make determinations of eligibility for affordability credits under subtitle C of
Index of Sec 1702. ...TITLE II of division A of America's Affordable Health Choices acting of 2009 ; Including erroneous payments making being attributable to error in eligibility determination under subtitle C of
Index of Sec 1702. ...TITLE IV of Social Security Act 42 USC 621-629i amended by adding at end following ; Part B of
Index of Sec 1904. ...TITLE for post-acute care provider if subsection not applying ; Payment under title on claim to be applicable percent specified in subparagraph of payment otherwise to be made under respective payment system under
Index of Sec 1151. ...TITLE VI of Civil Rights acting of 1964 42 USC 2000(d) et seq ; Nothing in section to be construed to limit otherwise existing obligations of recipients of Federal financial assistance under
Index of Sec 1222. ...TITLE VIII of Medicare Prescription Drug, Improvement and Modernization Act of 2003 repealed and provisions of law amended by subtitle restored ; Subtitle A of
Index of Sec 1901. ...TITLE XI of Social Security Act amended by adding at end following new part ;
Index of Sec 1401. ...TITLE XI of Social Security Act being further amended by adding at end following new part ;
Index of Sec 1441. ...TITLE XI of Social Security Act amended by inserting after section 1138 following section ;
Index of Sec 1461. ...TITLE XI of Social Security Act amended by inserting after section 1150 following new section ;
Index of Sec 1905. ...TITLE XI of Social Security Act amended by adding at end following new sections ; Part E of
Index of Sec 1442. ...HOSPITAL located ; Whose annual percent of total inpatient admissions representing inpatient admissions under program under title XIX estimated to be equal or greater than average percent with respect to admissions for hospitals located in county in which
Index of Sec 1156. ...TITLE XIX ; Discounts to be applied under subsection to prescription drug plans and Ma-pd planing instead of State plans under
Index of Sec 1182. ...TITLE XIX of Social Security Act and extent to which services to be utilized by beneficiaries and providers under title XVIII of Act ; Nature and type of language services provided by States under
Index of Sec 1221. ...TITLE XIX and full-benefit dual eligible individuals ; Applications from States proposing to use medical home model to coordinate health care services for individuals enrolled under title, individuals enrolled under
Index of Sec 1302. ...TITLE XIX ; Term dual eligible meaning individual being dually eligible for benefits under title XVIII and medical assistance under
Index of Sec 1905. ...DRUG plan sponsors under part D of title XVIII and entities applying to participate as providers of services or suppliers in managed care organizations and plans ; Including managed care organizations under title XIX, Medicare Advantage organizations under part C of title XVIII, prescription
Index of Sec 1611. ...CHILD health plan under title XXI ; Applying subsection for purposes of title XIX and XXI Secretary requiring State to carry out provisions of subsection as requirement of State plan under title XIX or
Index of Sec 1631. ...TITLE XIX of Social Security Act amended by adding at end following new section ;
Index of Sec 1702. ...TITLE XIX of Social Security Act pilot program operating for period of up to 5 years ; Secretary of Health and Human Services establishing under section medical home pilot program under which State applying to Secretary for approval of medical home pilot project described in subsection for application of medical home concept under
Index of Sec 1722. ...HOME pilot program under section 1866e of Act ; High need beneficiaries being eligible for medical assistance under title XIX of Social Security Act Secretary providing for appropriate coordination of pilot program under section with medical
Index of Sec 1722. ...EDUCATION ; Amendments making by section taking effect on date of enactment of Act Nothing in section to be construed as affecting payments making before date under State plan under title XIX of Social Security Act for graduate medical
Index of Sec 1744. ...TITLE XIX of Social Security Act ; Nothing in section preventing State from including additional health care-acquired conditions for non-payment in Medicaid program under
Index of Sec 1751. ...CHILD health plan under title XXI ; Applying subsection for purposes of title XIX and XXI Secretary requiring State to carry out provisions of subsection as requirement of State plan under title XIX or
Index of Sec 1631. ...TITLE XIX of Act under demonstration waiver approved under section 1115 of acting or State funds ; Individual provided medical assistance under
Index of Sec 1701. ...TITLE XIX of Act under demonstration waiver approved under section 1115 of acting or State funds ; Individual provided medical assistance under
Index of Sec 1701. ...TITLE XIX or XXI of Social Security Act ; Requirements pursuant to amendments making by subsections and applying in case of physicians making certifications for home health services under
Index of Sec 1639. ...ADMINISTRATIVE expenditure For which payment being made under section 1903(a) or 2105(a) of Act after date of enactment of Act ; Nothing in amendments making by section to be construed as affecting ability of State under title XIX or XXI of Social Security Act to provide nurse home visitation services as part of another class of items and services falling within definition of medical assistance or child health assistance under respective title or
Index of Sec 1713. ...TITLE XIX or XXI of Social Security Act ; Medical assistance program established by
Index of Sec 1802. ...CLASSIFIATIONS system for yearing without changes ; Estimated expenditures under future skilled nursing facility servicing classifiations system for fiscal year beginning with fiscal year 2011 with changes to be equal to estimated expenditures otherwise occurring under title XVIII of Social Security Act under future skilled nursing facility servicing
Index of Sec 1111. ...HOME infusion therapy providers to patients in programs ; Scope of coverage for home infusion therapy in fee-for-service Medicare program under title XVIII of Social Security Act, Medicare Advantage under part C of title united States Code and private payers including analysis of scope of services provided by
Index of Sec 1143. ...DISCHARGE from applicable hospital or critical access hospital ; Claim submitted post-acute care provider under title XVIII of Social Security Act indicating that individual readmitted to hospital post-acute care provider or admitted from home and care of home health agency within 30 days of initial
Index of Sec 1151. ...TITLE XVIII of Social Security Act ; Secretary of Health and Human Services developing detailed plan to reform payment for post acute care services under Medicare program under
Index of Sec 1152. ...TITLE XVIII of Social Security Act amended by inserting after section 1866d as inserted by section 1301 ;
Index of Sec 1302. ...MEDICAL assistance under title XIX ; Term dual eligible meaning individual being dually eligible for benefits under title XVIII and
Index of Sec 1905. ...TITLE XVIII ; Provisions of section 1819a applying to hospice program providing hospice care under title in same manner as provisions applying to hospice program providing hospice care under
Index of Sec 1614. ...TITLE XVIII ; Provisions applying to hospice program providing hospice care under
Index of Sec 1614. ...TITLE XVIII, XIX or XXI Secretary imposing following requirements with respect to provider of services or supplier ; Secretary determining being significant risk of fraudulent activity with respect to category of provider of services or supplier of items or services under
Index of Sec 1631. ...TITLE XVIII, XIX or XXI ; Screening against list of individuals and entities excluded from program under
Index of Sec 1631. ...TITLE XVIII ; Application for enrollment and renewing enrollment in program under
Index of Sec 1632. ...TITLE XVIII, XIX or XXI ; Enhancing safeguards as Secretary determining necessary to reduce risk associated with provider or supplier enrolling or participating in program under
Index of Sec 1632. ...FRAUD or abuse ; Secretary applying face-to-face encounter requirement described in amendments making by subsections and other items and services For which payment provided under title XVIII of Social Security Act based upon finding that decision reducing risk of waste,
Index of Sec 1639. ...TITLE XVIII ; Respect to amounts expended for services related to presence of condition to be identified by secondary diagnostic code described in section 1886(d)(4)(d)( iv and health care acquired condition determined as non-covered service under
Index of Sec 1751. ...FISCAL year ; Title XVIII of Social Security Act during
Index of Sec 1802. ...TITLE XVIII of Social Security Act ; Insurance program established under
Index of Sec 1802. ...TITLE XVIII and entities applying to participate as providers of services or suppliers in managed care organizations and plans ; Including managed care organizations under title XIX, Medicare Advantage organizations under part C of title XVIII, prescription drug plan sponsors under part D of
Index of Sec 1611. ...TITLE XVIII of Act ; Nature and type of language services provided by States under title XIX of Social Security Act and extent to which services to be utilized by beneficiaries and providers under
Index of Sec 1221. ...TITLE XVIII of Act ; Same manner and same extent as requirements applying in case of physicians making certifications under
Index of Sec 1639. ...ACCOUNT ; Proportion to total expenditures during fiscal year being made under title XVIII of Act from respective trust fund or
Index of Sec 1802. ...HEALTH care program and inserting participating in Federal health care program ; Striking participating in program under title XVIII or State
Index of Sec 1645. ...HEALTH care program and inserting Federal health care program ; Subparagraph, striking title XVIII or State
Index of Sec 1645. ...TITLE XVIII or XIX submiting claim for payment for items or services furnished by excluded individual or entity and individual eligible for benefits not knowing or reason to know that excluded individual or entity so excluding ; Individual eligible for benefits under
Index of Sec 1619. ...HEALTH care program or contractor ; Claim for payment for items or services furnished by excluded individual or entity submitted by individual or entity other than individual eligible for benefits under title XVIII or XIX or excluded individual or entity and Secretary determining that individual or entity submitting claim taking reasonable steps to learn of exclusion and reasonably relied upon inaccurate or misleading information from relevant Federal
Index of Sec 1619. ...TITLE XVIII of Social Security Act ; Different types of language services provided and service providers and organizations under parts A through D of
Index of Sec 1222. ...TITLE XVIII of Social Security Act ; Term Medicare program meaning programs under parts A through D of
Index of Sec 1224. ...FRAUD schemes in which processing patterns of Centers for Medicare and Medicaid Services to be observed and exploited ; D of title XVIII of Social Security Act presenting opportunities for
Index of Sec 1636. ...TITLE XVIII of Social Security Act or enrolled under part B of title ; Term Medicare beneficiary meaning individual entitled to benefits under part A of
Index of Sec 1224. ...TITLE XVIII of Social Security Act under section 226(b) or 226a of Act and eligible to enroll ; No increase in premium to be effected for month in case of individual being covered beneficiary at time individual entitled to hospital insurance benefits under part A of
Index of Sec 1234. ...TITLE XVIII of Social Security Act amended by inserting after section 1819 following new section ; Part A of
Index of Sec 1614. ...TITLE and inserting beneficiaries ; Section 1128(c)(3)(b) of Social Security Act 42 USC 1320a-7(c)(3)(b) amended by striking individuals entitled to benefits under part A of title XVIII or enrolled under part B of
Index of Sec 1642. ...INTEREST in entity ; Hospital or other health care entity billing Secretary under part A or part B of title XVIII for services reporting on ownership shares of physician owning
Index of Sec 1451. ...TITLE XVIII of Social Security Act 42 USC 1395j et seq ; Secretary of Health and Human Services developing criteria with respect to payment for marriage and family therapist services For which payment to be made directly to marriage and family therapist under part B of
Index of Sec 1308. ...TITLE XVIII of Social Security Act 42 USC 1395j et seq ; Secretary of Health and Human Services developing criteria with respect to payment for mental health counselor services For which payment to be made directly to mental health counselor under part B of
Index of Sec 1308. ...TITLE XVIII for services furnished in 2010 ; Payment for primary care services furnished by physicians at rate not less than 80 percent of payment rate applicable to services and physicians or professionals under part B of
Index of Sec 1721. ...DRUG plan sponsors under part D of title XVIII and entities applying to participate as providers of services or suppliers in managed care organizations and plans ; Including managed care organizations under title XIX, Medicare Advantage organizations under part C of title XVIII, prescription
Index of Sec 1611. ...TITLE XVIII of Social Security Act ; Case of retroactive lis enrollment beneficiary enrolled under prescription drug plan under part D of
Index of Sec 1204. ...TITLE XVIII of Social Security Act and subsequently becoming eligible as full-benefit dual eligible individual ; Enrolling in prescription drug plan under part D of
Index of Sec 1204. ...TITLE XVIII of Social Security Act amended by inserting after section 1866c following new section ; Part E of
Index of Sec 1152. ...TITLE XVIII of Social Security Act ; Term service provider including suppliers, providers of services or entities under contract to provide coverage, items or services under part of
Index of Sec 1224. ...DRUG plan under part D of title utilizing, offering or make available language services for beneficiaries with limited English proficiency ; Extent to which providers under parts A and B of title XVIII of Social Security Act, Ma organizations offering Medicare Advantage plans under part C of title and PDP sponsors of prescription
Index of Sec 1221. ...TITLE and title XIX ; Review Medicare and Medicaid policies related to enrollment, benefits, service delivery, payment and grievance and appeals processing under parts A and B of title XVIII under Medicare Advantage program under part C of
Index of Sec 1905. ...TITLE XXI of Social Security Act amended by adding at end following new section ;
Index of Sec 1614. ...TITLE XXI ; Applying subsection for purposes of title XIX and XXI Secretary requiring State to carry out provisions of subsection as requirement of State plan under title XIX or child health plan under
Index of Sec 1631. ...ELIGIBILITY standards, methodologies or procedures under plan as in effect on June 16 ; Subject to paragraph State not in effect eligibility standards, methodologies or procedures under State child health plan under title XXI being more restrictive than
Index of Sec 1703. ...TITLE XXI ; Paragraph not to be construed as preventing State from imposing limitation described in section 2110(b)(5)(c)(i) for fiscal year in order to limit expenditures under State child health plan under
Index of Sec 1703. ...ACCEPTABLE coverage ; Employers having procedures in effect to ensure timely transition without interruption of coverage of Chip enrollees from assistance under title XXI to
Index of Sec 1703. ...CERTIFICATION or other reasonable timeframe as determined by Secretary ; Prior to making certification physician documenting that physician having face-to-face encounter with individual during 6-month period preceding
Index of Sec 1639. ...CERTIFICATION or recertification or other reasonable timeframe as determined by Secretary ; 2010 prior to making certification physician documenting that physician having face-to-face encounter with individual during 6-month period preceding
Index of Sec 1639. ...TO-face encounter with individual involved during 6-month period preceding written order or other reasonable timeframe as determined by Secretary ; Requiring that order to be written pursuant to physician documenting that physician having face-
Index of Sec 1639. ...FRAUD or abuse ; Secretary applying face-to-face encounter requirement described in amendments making by subsections and other items and services For which payment provided under title XVIII of Social Security Act based upon finding that decision reducing risk of waste,
Index of Sec 1639. ...TOLL-free hotline ; Provision by practitioner of list of national and State-specific resources to assist consumers and families with advance care planning including national
Index of Sec 1233. ...INCORPORATION of patient preferences and values into medical plan ; Providing patients with information about trade-offing among treatment options and facilitating
Index of Sec 1236. ...DEMENTIA management training and resident abuse prevention training after curriculum ;
Index of Sec 1431. ...DEMENTIA management training and resident abuse prevention training after curriculum ;
Index of Sec 1431. ...HOME visitation programs using funds ; State reserving 5 percent of grant funds for training and technical assistance to
Index of Sec 1904. ...IMPLEMENTATION of program and training and technical assistance contributed to outcomes achieved through program ; Training and technical assistance provided to aid
Index of Sec 1904. ...DISSEMINATION of best practices in early childhood home visitation ; Amount equal to 5 percent of amounts to pay cost of evaluation provided in subsection and provision to States of training and technical assistance including
Index of Sec 1904. ...TRAINING hours for certified nurse aides required under sections 1819(f)(2)(a)(i) and 1919(f)(2)(a)(i) of Social Security Act 42 USC 1395i-3(f)(2)(a)(i) ; Number of initial
Index of Sec 1432. ...TRAINING positions to qualifying hospitals under subparagraph not later than July 1 ; Secretary distributing increase in resident
Index of Sec 1501. ...TRAINING programs or disseminating publications explaining in practical manner what required ; Requiring participation in
Index of Sec 1412. ...TRAINING programs or disseminating publications explaining in practical manner what required ; Requiring participation in
Index of Sec 1412. ...RESIDENCY training programs to foster physician workforce so ; Goals of medical
Index of Sec 1505. ...RESIDENCY training programs ; Comptroller General of United States conducting study to evaluate extent to which medical
Index of Sec 1505. ...RESIDENCY training programs to be further encouraged to meet goals through means ; Medical
Index of Sec 1505. ...ACCOUNT recommendations of Advisory Committee and goals for approved medical residency training programs described in section 1886(h)(1)(b) ; Taking into
Index of Sec 1744. ...TRANSPARENT process including consultations with appropriate stakeholders ; Consistent with standards of evidence established under section and developed through
Index of Sec 1401. ...TRANSPARENT process for activities conducted pursuant to convening ; Consensus-based entity described in paragraph providing for open and
Index of Sec 1443. ...COMPENSATION ; Providing transportation and subsistence for persons serving without
Index of Sec 1401. ...PROPERTY or asseal ; Deed of trust, note or other obligation secured by entity or
Index of Sec 1411. ...ACCOUNT ; Proportion to total expenditures during fiscal year being made under title XVIII of Act from respective trust fund or
Index of Sec 1802. ...ABDOMINAL aortic aneurysm for certain individuals ; Ultrasound screening for
Index of Sec 1305. ...UNDERCAPITALIZATION ; Options to address
Index of Sec 1412. ...UNINSURANCE from 2012 to 2014 exceeding 8 percentage points ; Decrease in national rate of
Index of Sec 1112. ...USABILITY of proposed measures ; Testing funded under paragraph including testing of feasibility and
Index of Sec 1442. ...VACCINE meaning approved vaccine recommended by Advisory Committee on Immunization Practices ; Term federally recommended
Index of Sec 1310. ...VACCINE and following through administration ; Section 1860d-2(e)(1)(b) of Act 42 USC 1395w-102(e)(1)(b) amended by striking term including
Index of Sec 1310. ...VACCINE recommended by Advisory Committee on Immunization Practices ; Term federally recommended vaccine meaning approved
Index of Sec 1310. ...VALIDATION of pre ; Process described in clause including validation of work elements involved with furnishing service and including
Index of Sec 1122. ...VALIDATION under subparagraph using methods described in subclauses ; Secretary conducting
Index of Sec 1122. ...VALIDATION of data as relevant and scientifically credible ; System for collection of data for quality measures providing for
Index of Sec 1442. ...RELATIVE value units including sampling of codes for services being same as codes listed under subparagraph ; Validation of work
Index of Sec 1122. ...VALIDATION of pre ; Process described in clause including validation of work elements involved with furnishing service and including
Index of Sec 1122. ...DOCUMENTATION excepting in extraordinary situations as determined by Commissioner ; Matters attested in application to be subject to appropriate methods of verification without need of individual to provide additional
Index of Sec 1203. ...VIDEO interpretation pursuant to which contractors directly billing Medicare for services provided in support of physician office services for LEP Medicare patient ; Feasibility of Medicare contracting directly with agencies providing off-site interpretation including telephonic and
Index of Sec 1221. ...HEALTH care or health care related services by bilingual health care provider ; Competent interpreter services to be provided through on-site interpretation, telephonic interpretation or video interpretation or direct provision of
Index of Sec 1222. ...CLINICAL perspective advisory panel meeting ; Participating as non-voting member with respect to particular matter considered in Commission or
Index of Sec 1401. ...CLINICAL perspective advisory panel meeting ; Participating as voting member with respect to particular matter considered in Commission or
Index of Sec 1401. ...CONTRACTUAL warranty where terms of warranty being set forth in purchase or lease agreement for covered device ; Items or services provided under
Index of Sec 1451. ...LEASE agreement for covered device ; Items or services provided under contractual warranty where terms of warranty being set forth in purchase or
Index of Sec 1451. ...WELL from recently available data from Bureau of Census or other State-based study Secretary determining likely to yield accurate data regarding number of individuals served by grantee ; Data on numbers of limited English proficient individuals speaking English less than very
Index of Sec 1222. ...IMMUNIZATION rates ; Factors contributing to occurrence of infections including health care worker
Index of Sec 1461. ...MEDICARE skilled nursing facility prospective payment system and consolidated payment ; Sec 1307 excluding clinical social worker Services from coverage under
Index of Sec 1307. ...SOCIAL worker services ; Section 1888(e)(2)(a)( ii of Social Security Act 42 USC 1395yy(e)(2)(a)( ii amended by inserting clinical
Index of Sec 1307. ...1st Session |
To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.
Mr. Dingell (for himself, Mr. Rangel, Mr. Waxman, Mr. George Miller of California, Mr. Stark, Mr. Pallone, and Mr. Andrews) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Labor, Oversight and Government Reform, and the Budget, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
The table of contents for this division is as follows:
(a) In general.—Section 1888(e)(4)(E)(ii) of the Social Security Act (42 U.S.C. 1395yy(e)(4)(E)(ii)) is amended—
(1) in subclause (III), by striking “and” at the end;
(2) by redesignating subclause (IV) as subclause (VI); and
(3) by inserting after subclause (III) the following new subclauses:
“(IV) for each of fiscal years 2004 through 2009, the rate computed for the previous fiscal year increased by the skilled nursing facility market basket percentage change for the fiscal year involved;
“(V) for fiscal year 2010, the rate computed for the previous fiscal year; and”.
(b) Delayed effective date.—Section 1888(e)(4)(E)(ii)(V) of the Social Security Act, as inserted by subsection (a)(3), shall not apply to payment for days before January 1, 2010.
(a) In general.—Section 1886(j)(3)(C) of the Social Security Act (42 U.S.C. 1395ww(j)(3)(C)) is amended by striking “and 2009” and inserting “through 2010”.
(b) Delayed effective date.—The amendment made by subsection (a) shall not apply to payment units occurring before January 1, 2010.
(a) Inpatient acute hospitals.—Section 1886(b)(3)(B) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)) is amended—
(A) by striking “(iii) For purposes of this subparagraph,” and inserting “(iii)(I) For purposes of this subparagraph, subject to the productivity adjustment described in subclause (II),”; and
(B) by adding at the end the following new subclause:
“(II) The productivity adjustment described in this subclause, with respect to an increase or change for a fiscal year or year or cost reporting period, or other annual period, is a productivity offset equal to the percentage change in the 10-year moving average of annual economy-wide private nonfarm business multi-factor productivity (as recently published before the promulgation of such increase for the year or period involved). Except as otherwise provided, any reference to the increase described in this clause shall be a reference to the percentage increase described in subclause (I) minus the percentage change under this subclause.”;
(2) in the first sentence of clause (viii)(I), by inserting “(but not below zero)” after “shall be reduced”; and
(3) in the first sentence of clause (ix)(I)—
(A) by inserting “(determined without regard to clause (iii)(II)” after “clause (i)” the second time it appears; and
(B) by inserting “(but not below zero)” after “reduced”.
(b) Skilled nursing facilities.—Section 1888(e)(5)(B) of such Act (42 U.S.C. 1395yy(e)(5)(B)) is amended by inserting “subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II)” after “as calculated by the Secretary”.
(c) Long-Term care hospitals.—Section 1886(m) of the Social Security Act (42 U.S.C. 1395ww(m)) is amended by adding at the end the following new paragraph:
“(3) PRODUCTIVITY ADJUSTMENT.—In implementing the system described in paragraph (1) for discharges occurring during the rate year ending in 2010 or any subsequent rate year for a hospital, to the extent that an annual percentage increase factor applies to a base rate for such discharges for the hospital, such factor shall be subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II).”.
(d) Inpatient rehabilitation facilities.—The second sentence of section 1886(j)(3)(C) of the Social Security Act (42 U.S.C. 1395ww(j)(3)(C)) is amended by inserting “(subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II))” after “appropriate percentage increase”.
(e) Psychiatric hospitals.—Section 1886 of the Social Security Act (42 U.S.C. 1395ww) is amended by adding at the end the following new subsection:
“(o) Prospective payment for psychiatric hospitals.—
“(1) REFERENCE TO ESTABLISHMENT AND IMPLEMENTATION OF SYSTEM.—For provisions related to the establishment and implementation of a prospective payment system for payments under this title for inpatient hospital services furnished by psychiatric hospitals (as described in clause (i) of subsection (d)(1)(B)) and psychiatric units (as described in the matter following clause (v) of such subsection), see section 124 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999.
“(2) PRODUCTIVITY ADJUSTMENT.—In implementing the system described in paragraph (1) for discharges occurring during the rate year ending in 2011 or any subsequent rate year for a psychiatric hospital or unit described in such paragraph, to the extent that an annual percentage increase factor applies to a base rate for such discharges for the hospital or unit, respectively, such factor shall be subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II).”.
(f) Hospice care.—Subclause (VII) of section 1814(i)(1)(C)(ii) of the Social Security Act (42 U.S.C. 1395f(i)(1)(C)(ii)) is amended by inserting after “the market basket percentage increase” the following: “(which is subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II))”.
(g) Effective date.—The amendments made by subsections (a), (b), (d), and (f) shall apply to annual increases effected for fiscal years beginning with fiscal year 2010.
(a) Change in recalibration factor.—
(1) ANALYSIS.—The Secretary of Health and Human Services shall conduct, using calendar year 2006 claims data, an initial analysis comparing total payments under title XVIII of the Social Security Act for skilled nursing facility services under the RUG–53 and under the RUG–44 classification systems.
(2) ADJUSTMENT IN RECALIBRATION FACTOR.—Based on the initial analysis under paragraph (1), the Secretary shall adjust the case mix indexes under section 1888(e)(4)(G)(i) of the Social Security Act (42 U.S.C. 1395yy(e)(4)(G)(i)) for fiscal year 2010 by the appropriate recalibration factor as proposed in the proposed rule for Medicare skilled nursing facilities issued by such Secretary on May 12, 2009 (74 Federal Register 22214 et seq.).
(b) Change in payment for nontherapy ancillary (NTA) services and therapy services.—
(1) CHANGES UNDER CURRENT SNF CLASSIFICATION SYSTEM.—
(A) IN GENERAL.—Subject to subparagraph (B), the Secretary of Health and Human Services shall, under the system for payment of skilled nursing facility services under section 1888(e) of the Social Security Act (42 U.S.C. 1395yy(e)), increase payment by 10 percent for non-therapy ancillary services (as specified by the Secretary in the notice issued on November 27, 1998 (63 Federal Register 65561 et seq.)) and shall decrease payment for the therapy case mix component of such rates by 5.5 percent.
(B) EFFECTIVE DATE.—The changes in payment described in subparagraph (A) shall apply for days on or after January 1, 2010, and until the Secretary implements an alternative case mix classification system for payment of skilled nursing facility services under section 1888(e) of the Social Security Act (42 U.S.C. 1395yy(e)).
(C) IMPLEMENTATION.—Notwithstanding any other provision of law, the Secretary may implement by program instruction or otherwise the provisions of this paragraph.
(2) CHANGES UNDER A FUTURE SNF CASE MIX CLASSIFICATION SYSTEM.—
(i) IN GENERAL.—The Secretary of Health and Human Services shall analyze payments for non-therapy ancillary services under a future skilled nursing facility classification system to ensure the accuracy of payment for non-therapy ancillary services. Such analysis shall consider use of appropriate indicators which may include age, physical and mental status, ability to perform activities of daily living, prior nursing home stay, broad RUG category, and a proxy for length of stay.
(ii) APPLICATION.—Such analysis shall be conducted in a manner such that the future skilled nursing facility classification system is implemented to apply to services furnished during a fiscal year beginning with fiscal year 2011.
(B) CONSULTATION.—In conducting the analysis under subparagraph (A), the Secretary shall consult with interested parties, including the Medicare Payment Advisory Commission and other interested stakeholders, to identify appropriate predictors of nontherapy ancillary costs.
(C) RULEMAKING.—The Secretary shall include the result of the analysis under subparagraph (A) in the fiscal year 2011 rulemaking cycle for purposes of implementation beginning for such fiscal year.
(D) IMPLEMENTATION.—Subject to subparagraph (E) and consistent with subparagraph (A)(ii), the Secretary shall implement changes to payments for non-therapy ancillary services (which may include a separate rate component for non-therapy ancillary services and may include use of a model that predicts payment amounts applicable for non-therapy ancillary services) under such future skilled nursing facility services classification system as the Secretary determines appropriate based on the analysis conducted pursuant to subparagraph (A).
(E) BUDGET NEUTRALITY.—The Secretary shall implement changes described in subparagraph (D) in a manner such that the estimated expenditures under such future skilled nursing facility services classification system for a fiscal year beginning with fiscal year 2011 with such changes would be equal to the estimated expenditures that would otherwise occur under title XVIII of the Social Security Act under such future skilled nursing facility services classification system for such year without such changes.
(c) Outlier policy for NTA and therapy.—Section 1888(e) of the Social Security Act (42 U.S.C. 1395yy(e)) is amended by adding at the end the following new paragraph:
“(13) OUTLIERS FOR NTA AND THERAPY.—
“(A) IN GENERAL.—With respect to outliers because of unusual variations in the type or amount of medically necessary care, beginning with October 1, 2010, the Secretary—
“(i) shall provide for an addition or adjustment to the payment amount otherwise made under this section with respect to non-therapy ancillary services in the case of such outliers; and
“(ii) may provide for such an addition or adjustment to the payment amount otherwise made under this section with respect to therapy services in the case of such outliers.
“(B) OUTLIERS BASED ON AGGREGATE COSTS.—Outlier adjustments or additional payments described in subparagraph (A) shall be based on aggregate costs during a stay in a skilled nursing facility and not on the number of days in such stay.
“(C) BUDGET NEUTRALITY.—The Secretary shall reduce estimated payments that would otherwise be made under the prospective payment system under this subsection with respect to a fiscal year by 2 percent. The total amount of the additional payments or payment adjustments for outliers made under this paragraph with respect to a fiscal year may not exceed 2 percent of the total payments projected or estimated to be made based on the prospective payment system under this subsection for the fiscal year.”.
(d) Conforming amendments.—Section 1888(e)(8) of such Act (42 U.S.C. 1395yy(e)(8)) is amended—
(1) in subparagraph (A), by inserting “and adjustment under section 1111(b) of the America’s Affordable Health Choices Act of 2009;
(2) in subparagraph (B), by striking “and”;
(3) in subparagraph (C), by striking the period and inserting “; and”; and
(4) by adding at the end the following new subparagraph:
“(D) the establishment of outliers under paragraph (13).”.
(1) IN GENERAL.—Not later than January 1, 2016, the Secretary of Health and Human Services shall submit to Congress a report on Medicare DSH taking into account the impact of the health care reforms carried out under division A in reducing the number of uninsured individuals. The report shall include recommendations relating to the following:
(A) The appropriate amount, targeting, and distribution of Medicare DSH to compensate for higher Medicare costs associated with serving low-income beneficiaries (taking into account variations in the empirical justification for Medicare DSH attributable to hospital characteristics, including bed size), consistent with the original intent of Medicare DSH.
(B) The appropriate amount, targeting, and distribution of Medicare DSH to hospitals given their continued uncompensated care costs, to the extent such costs remain.
(2) COORDINATION WITH MEDICAID DSH REPORT.—The Secretary shall coordinate the report under this subsection with the report on Medicaid DSH under section 1704(a).
(b) Payment adjustments in response to coverage expansion.—
(1) IN GENERAL.—If there is a significant decrease in the national rate of uninsurance as a result of this Act (as determined under paragraph (2)(A)), then the Secretary of Health and Human Services shall, beginning in fiscal year 2017, implement the following adjustments to Medicare DSH:
(A) The amount of Medicare DSH shall be adjusted based on the recommendations of the report under subsection (a)(1)(A) and shall take into account variations in the empirical justification for Medicare DSH attributable to hospital characteristics, including bed size.
(B) Subject to paragraph (3), increase Medicare DSH for a hospital by an additional amount that is based on the amount of uncompensated care provided by the hospital based on criteria for uncompensated care as determined by the Secretary, which shall exclude bad debt.
(2) SIGNIFICANT DECREASE IN NATIONAL RATE OF UNINSURANCE AS A RESULT OF THIS ACT.—For purposes of this subsection—
(A) IN GENERAL.—There is a “significant decrease in the national rate of uninsurance as a result of this Act” if there is a decrease in the national rate of uninsurance (as defined in subparagraph (B)) from 2012 to 2014 that exceeds 8 percentage points.
(B) NATIONAL RATE OF UNINSURANCE DEFINED.—The term “national rate of uninsurance” means, for a year, such rate for the under-65 population for the year as determined and published by the Bureau of the Census in its Current Population Survey in or about September of the succeeding year.
(3) UNCOMPENSATED CARE INCREASE.—
(A) COMPUTATION OF DSH SAVINGS.—For each fiscal year (beginning with fiscal year 2017), the Secretary shall estimate the aggregate reduction in Medicare DSH that will result from the adjustment under paragraph (1)(A).
(B) STRUCTURE OF PAYMENT INCREASE.—The Secretary shall compute the increase in Medicare DSH under paragraph (1)(B) for a fiscal year in accordance with a formula established by the Secretary that provides that—
(i) the aggregate amount of such increase for the fiscal year does not exceed 50 percent of the aggregate reduction in Medicare DSH estimated by the Secretary for such fiscal year; and
(ii) hospitals with higher levels of uncompensated care receive a greater increase.
(c) Medicare DSH.—In this section, the term “Medicare DSH” means adjustments in payments under section 1886(d)(5)(F) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)) for inpatient hospital services furnished by disproportionate share hospitals.
(a) Transitional update for 2010.—Section 1848(d) of the Social Security Act (42 U.S.C. 1395w–4(d)) is amended by adding at the end the following new paragraph:
“(10) UPDATE FOR 2010.—The update to the single conversion factor established in paragraph (1)(C) for 2010 shall be the percentage increase in the MEI (as defined in section 1842(i)(3)) for that year.”.
(b) Rebasing SGR using 2009; limitation on cumulative adjustment period.—Section 1848(d)(4) of such Act (42 U.S.C. 1395w–4(d)(4)) is amended—
(1) in subparagraph (B), by striking “subparagraph (D)” and inserting “subparagraphs (D) and (G)”; and
(2) by adding at the end the following new subparagraph:
“(G) REBASING USING 2009 FOR FUTURE UPDATE ADJUSTMENTS.—In determining the update adjustment factor under subparagraph (B) for 2011 and subsequent years—
“(i) the allowed expenditures for 2009 shall be equal to the amount of the actual expenditures for physicians’ services during 2009; and
“(ii) the reference in subparagraph (B)(ii)(I) to ‘April 1, 1996’ shall be treated as a reference to ‘January 1, 2009 (or, if later, the first day of the fifth year before the year involved)’.”.
(c) Limitation on physicians’ services included in target growth rate computation to services covered under physician fee schedule.—Effective for services furnished on or after January 1, 2009, section 1848(f)(4)(A) of such Act is amended striking “(such as clinical” and all that follows through “in a physician’s office” and inserting “for which payment under this part is made under the fee schedule under this section, for services for practitioners described in section 1842(b)(18)(C) on a basis related to such fee schedule, or for services described in section 1861(p) (other than such services when furnished in the facility of a provider of services)”.
(d) Establishment of separate target growth rates for categories of services.—
(1) ESTABLISHMENT OF SERVICE CATEGORIES.—Subsection (j) of section 1848 of the Social Security Act (42 U.S.C. 1395w–4) is amended by adding at the end the following new paragraph:
“(5) SERVICE CATEGORIES.—For services furnished on or after January 1, 2009, each of the following categories of physicians’ services (as defined in paragraph (3)) shall be treated as a separate ‘service category’:
“(A) Evaluation and management services that are procedure codes (for services covered under this title) for—
“(i) services in the category designated Evaluation and Management in the Health Care Common Procedure Coding System (established by the Secretary under subsection (c)(5) as of December 31, 2009, and as subsequently modified by the Secretary); and
“(ii) preventive services (as defined in section 1861(iii)) for which payment is made under this section.
“(B) All other services not described in subparagraph (A).
Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service.”.
(2) ESTABLISHMENT OF SEPARATE CONVERSION FACTORS FOR EACH SERVICE CATEGORY.—Subsection (d)(1) of section 1848 of the Social Security Act (42 U.S.C. 1395w–4) is amended—
(i) by designating the sentence beginning “The conversion factor” as clause (i) with the heading “Application of single conversion factor.—” and with appropriate indentation;
(ii) by striking “The conversion factor” and inserting “Subject to clause (ii), the conversion factor”; and
(iii) by adding at the end the following new clause:
“(ii) APPLICATION OF MULTIPLE CONVERSION FACTORS BEGINNING WITH 2011.—
“(I) IN GENERAL.—In applying clause (i) for years beginning with 2011, separate conversion factors shall be established for each service category of physicians’ services (as defined in subsection (j)(5)) and any reference in this section to a conversion factor for such years shall be deemed to be a reference to the conversion factor for each of such categories.
“(II) INITIAL CONVERSION FACTORS.—Such factors for 2011 shall be based upon the single conversion factor for the previous year multiplied by the update established under paragraph (11) for such category for 2011.
“(III) UPDATING OF CONVERSION FACTORS.—Such factor for a service category for a subsequent year shall be based upon the conversion factor for such category for the previous year and adjusted by the update established for such category under paragraph (11) for the year involved.”; and
(B) in subparagraph (D), by striking “other physicians’ services” and inserting “for physicians’ services described in the service category described in subsection (j)(5)(B)”.
(3) ESTABLISHING UPDATES FOR CONVERSION FACTORS FOR SERVICE CATEGORIES.—Section 1848(d) of the Social Security Act (42 U.S.C. 1395w–4(d)), as amended by subsection (a), is amended—
(A) in paragraph (4)(C)(iii), by striking “The allowed” and inserting “Subject to paragraph (11)(B), the allowed”; and
(B) by adding at the end the following new paragraph:
“(11) UPDATES FOR SERVICE CATEGORIES BEGINNING WITH 2011.—
“(A) IN GENERAL.—In applying paragraph (4) for a year beginning with 2011, the following rules apply:
“(i) APPLICATION OF SEPARATE UPDATE ADJUSTMENTS FOR EACH SERVICE CATEGORY.—Pursuant to paragraph (1)(A)(ii)(I), the update shall be made to the conversion factor for each service category (as defined in subsection (j)(5)) based upon an update adjustment factor for the respective category and year and the update adjustment factor shall be computed, for a year, separately for each service category.
“(ii) COMPUTATION OF ALLOWED AND ACTUAL EXPENDITURES BASED ON SERVICE CATEGORIES.—In computing the prior year adjustment component and the cumulative adjustment component under clauses (i) and (ii) of paragraph (4)(B), the following rules apply:
“(I) APPLICATION BASED ON SERVICE CATEGORIES.—The allowed expenditures and actual expenditures shall be the allowed and actual expenditures for the service category, as determined under subparagraph (B).
“(II) APPLICATION OF CATEGORY SPECIFIC TARGET GROWTH RATE.—The growth rate applied under clause (ii)(II) of such paragraph shall be the target growth rate for the service category involved under subsection (f)(5).
“(B) DETERMINATION OF ALLOWED EXPENDITURES.—In applying paragraph (4) for a year beginning with 2010, notwithstanding subparagraph (C)(iii) of such paragraph, the allowed expenditures for a service category for a year is an amount computed by the Secretary as follows:
“(I) TOTAL 2009 ACTUAL EXPENDITURES FOR ALL SERVICES INCLUDED IN SGR COMPUTATION FOR EACH SERVICE CATEGORY.—Compute total actual expenditures for physicians’ services (as defined in subsection (f)(4)(A)) for 2009 for each service category.
“(II) INCREASE BY GROWTH RATE TO OBTAIN 2010 ALLOWED EXPENDITURES FOR SERVICE CATEGORY.—Compute allowed expenditures for the service category for 2010 by increasing the allowed expenditures for the service category for 2009 computed under subclause (I) by the target growth rate for such service category under subsection (f) for 2010.
“(ii) FOR SUBSEQUENT YEARS.—For a subsequent year, take the amount of allowed expenditures for such category for the preceding year (under clause (i) or this clause) and increase it by the target growth rate determined under subsection (f) for such category and year.”.
(4) APPLICATION OF SEPARATE TARGET GROWTH RATES FOR EACH CATEGORY.—
(A) IN GENERAL.—Section 1848(f) of the Social Security Act (42 U.S.C. 1395w–4(f)) is amended by adding at the end the following new paragraph:
“(5) APPLICATION OF SEPARATE TARGET GROWTH RATES FOR EACH SERVICE CATEGORY BEGINNING WITH 2010.—The target growth rate for a year beginning with 2010 shall be computed and applied separately under this subsection for each service category (as defined in subsection (j)(5)) and shall be computed using the same method for computing the target growth rate except that the factor described in paragraph (2)(C) for—
“(A) the service category described in subsection (j)(5)(A) shall be increased by 0.02; and
“(B) the service category described in subsection (j)(5)(B) shall be increased by 0.01.”.
(B) USE OF TARGET GROWTH RATES.—Section 1848 of such Act is further amended—
(I) in paragraph (1)(E)(ii), by inserting “or target” after “sustainable”; and
(II) in paragraph (4)(B)(ii)(II), by inserting “or target” after “sustainable”; and
(ii) in the heading of subsection (f), by inserting “and target growth rate” after “sustainable growth rate”;
(I) by striking “and” at the end of subparagraph (A);
(II) in subparagraph (B), by inserting “before 2010” after “each succeeding year” and by striking the period at the end and inserting “; and”; and
(III) by adding at the end the following new subparagraph:
“(C) November 1 of each succeeding year the target growth rate for such succeeding year and each of the 2 preceding years.”; and
(iv) in subsection (f)(2), in the matter before subparagraph (A), by inserting after “beginning with 2000” the following: “and ending with 2009”.
(e) Application to accountable care organization pilot program.—In applying the target growth rate under subsections (d) and (f) of section 1848 of the Social Security Act to services furnished by a practitioner to beneficiaries who are attributable to an accountable care organization under the pilot program provided under section 1866D of such Act, the Secretary of Health and Human Services shall develop, not later than January 1, 2012, for application beginning with 2012, a method that—
(1) allows each such organization to have its own expenditure targets and updates for such practitioners, with respect to beneficiaries who are attributable to that organization, that are consistent with the methodologies described in such subsection (f); and
(2) provides that the target growth rate applicable to other physicians shall not apply to such physicians to the extent that the physicians’ services are furnished through the accountable care organization.
In applying paragraph (1), the Secretary of Health and Human Services may apply the difference in the update under such paragraph on a claim-by-claim or lump sum basis and such a payment shall be taken into account under the pilot program.(a) In general.—Section 1848(c)(2) of the Social Security Act (42 U.S.C. 1395w–4(c)(2)) is amended by adding at the end the following new subparagraphs:
“(K) POTENTIALLY MISVALUED CODES.—
“(i) IN GENERAL.—The Secretary shall—
“(I) periodically identify services as being potentially misvalued using criteria specified in clause (ii); and
“(II) review and make appropriate adjustments to the relative values established under this paragraph for services identified as being potentially misvalued under subclause (I).
“(ii) IDENTIFICATION OF POTENTIALLY MISVALUED CODES.—For purposes of identifying potentially misvalued services pursuant to clause (i)(I), the Secretary shall examine (as the Secretary determines to be appropriate) codes (and families of codes as appropriate) for which there has been the fastest growth; codes (and families of codes as appropriate) that have experienced substantial changes in practice expenses; codes for new technologies or services within an appropriate period (such as three years) after the relative values are initially established for such codes; multiple codes that are frequently billed in conjunction with furnishing a single service; codes with low relative values, particularly those that are often billed multiple times for a single treatment; codes which have not been subject to review since the implementation of the RBRVS (the so-called ‘Harvard-valued codes’); and such other codes determined to be appropriate by the Secretary.
“(iii) REVIEW AND ADJUSTMENTS.—
“(I) The Secretary may use existing processes to receive recommendations on the review and appropriate adjustment of potentially misvalued services described clause (i)(II).
“(II) The Secretary may conduct surveys, other data collection activities, studies, or other analyses as the Secretary determines to be appropriate to facilitate the review and appropriate adjustment described in clause (i)(II).
“(III) The Secretary may use analytic contractors to identify and analyze services identified under clause (i)(I), conduct surveys or collect data, and make recommendations on the review and appropriate adjustment of services described in clause (i)(II).
“(IV) The Secretary may coordinate the review and appropriate adjustment described in clause (i)(II) with the periodic review described in subparagraph (B).
“(V) As part of the review and adjustment described in clause (i)(II), including with respect to codes with low relative values described in clause (ii), the Secretary may make appropriate coding revisions (including using existing processes for consideration of coding changes) which may include consolidation of individual services into bundled codes for payment under the fee schedule under subsection (b).
“(VI) The provisions of subparagraph (B)(ii)(II) shall apply to adjustments to relative value units made pursuant to this subparagraph in the same manner as such provisions apply to adjustments under subparagraph (B)(ii)(II).
“(L) VALIDATING RELATIVE VALUE UNITS.—
“(i) IN GENERAL.—The Secretary shall establish a process to validate relative value units under the fee schedule under subsection (b).
“(ii) COMPONENTS AND ELEMENTS OF WORK.—The process described in clause (i) may include validation of work elements (such as time, mental effort and professional judgment, technical skill and physical effort, and stress due to risk) involved with furnishing a service and may include validation of the pre, post, and intra-service components of work.
“(iii) SCOPE OF CODES.—The validation of work relative value units shall include a sampling of codes for services that is the same as the codes listed under subparagraph (K)(ii).
“(iv) METHODS.—The Secretary may conduct the validation under this subparagraph using methods described in subclauses (I) through (V) of subparagraph (K)(iii) as the Secretary determines to be appropriate.
“(v) ADJUSTMENTS.—The Secretary shall make appropriate adjustments to the work relative value units under the fee schedule under subsection (b). The provisions of subparagraph (B)(ii)(II) shall apply to adjustments to relative value units made pursuant to this subparagraph in the same manner as such provisions apply to adjustments under subparagraph (B)(ii)(II).”.
(1) FUNDING.—For purposes of carrying out the provisions of subparagraphs (K) and (L) of 1848(c)(2) of the Social Security Act, as added by subsection (a), in addition to funds otherwise available, out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services for the Center for Medicare & Medicaid Services Program Management Account $20,000,000 for fiscal year 2010 and each subsequent fiscal year. Amounts appropriated under this paragraph for a fiscal year shall be available until expended.
(A) Chapter 35 of title 44, United States Code and the provisions of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to this section or the amendment made by this section.
(B) Notwithstanding any other provision of law, the Secretary may implement subparagraphs (K) and (L) of 1848(c)(2) of the Social Security Act, as added by subsection (a), by program instruction or otherwise.
(C) Section 4505(d) of the Balanced Budget Act of 1997 is repealed.
(D) Except for provisions related to confidentiality of information, the provisions of the Federal Acquisition Regulation shall not apply to this section or the amendment made by this section.
(3) FOCUSING CMS RESOURCES ON POTENTIALLY OVERVALUED CODES.—Section 1868(a) of the Social Security Act (42 U.S.C. 1395ee(a)) is repealed.
Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended by adding at the end the following new subsection:
“(x) Incentive Payments for Efficient areas.—
“(1) IN GENERAL.—In the case of services furnished under the physician fee schedule under section 1848 on or after January 1, 2011, and before January 1, 2013, by a supplier that is paid under such fee schedule in an efficient area (as identified under paragraph (2)), in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid (on a monthly or quarterly basis) an amount equal to 5 percent of the payment amount for the services under this part.
“(2) IDENTIFICATION OF EFFICIENT AREAS.—
“(A) IN GENERAL.—Based upon available data, the Secretary shall identify those counties or equivalent areas in the United States in the lowest fifth percentile of utilization based on per capita spending under this part and part A for services provided in the most recent year for which data are available as of the date of the enactment of this subsection, as standardized to eliminate the effect of geographic adjustments in payment rates.
“(B) IDENTIFICATION OF COUNTIES WHERE SERVICE IS FURNISHED.—For purposes of paying the additional amount specified in paragraph (1), if the Secretary uses the 5-digit postal ZIP Code where the service is furnished, the dominant county of the postal ZIP Code (as determined by the United States Postal Service, or otherwise) shall be used to determine whether the postal ZIP Code is in a county described in subparagraph (A).
“(C) LIMITATION ON REVIEW.—There shall be no administrative or judicial review under section 1869, 1878, or otherwise, respecting—
“(i) the identification of a county or other area under subparagraph (A); or
“(ii) the assignment of a postal ZIP Code to a county or other area under subparagraph (B).
“(D) PUBLICATION OF LIST OF COUNTIES; POSTING ON WEBSITE.—With respect to a year for which a county or area is identified under this paragraph, the Secretary shall identify such counties or areas as part of the proposed and final rule to implement the physician fee schedule under section 1848 for the applicable year. The Secretary shall post the list of counties identified under this paragraph on the Internet website of the Centers for Medicare & Medicaid Services.”.
(a) Feedback.—Section 1848(m)(5) of the Social Security Act (42 U.S.C. 1395w–4(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 subsection.”.
(b) Appeals.—Such section is further amended—
(1) in subparagraph (E), by striking “There shall be” and inserting “Subject to subparagraph (I), there shall be”; and
(2) by adding at the end the following new subparagraph:
“(I) INFORMAL APPEALS PROCESS.—Notwithstanding subparagraph (E), by not later than January 1, 2011, the Secretary shall establish and have in place an informal process for eligible professionals to appeal the determination that an eligible professional did not satisfactorily submit data on quality measures under this subsection.”.
(c) Integration of physician quality reporting and EHR reporting.—Section 1848(m) of such Act 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 clinical reporting on quality measures under this subsection with reporting requirements under subsection (o) relating to the meaningful use of electronic health records. Such integration shall consist of the following:
“(A) The development of measures, the reporting of which would both demonstrate—
“(i) meaningful use of an electronic health record for purposes of subsection (o); and
“(ii) clinical quality of care furnished to an individual.
“(B) The collection of health data to identify deficiencies in the quality and coordination of care for individuals eligible for benefits under this part.
“(C) Such other activities as specified by the Secretary.”.
(d) Extension of incentive payments.—Section 1848(m)(1) of such Act (42 U.S.C. 1395w–4(m)(1)) is amended—
(1) in subparagraph (A), by striking “2010” and inserting “2012”; and
(2) in subparagraph (B)(ii), by striking “2009 and 2010” and inserting “for each of the years 2009 through 2012”.
(a) In general.—Section 1848(e) of the Social Security Act (42 U.S.C.1395w–4(e)) is amended by adding at the end the following new paragraph:
“(6) TRANSITION TO USE OF MSAS AS FEE SCHEDULE AREAS IN CALIFORNIA.—
“(i) REVISION.—Subject to clause (ii) and notwithstanding the previous provisions of this subsection, for services furnished on or after January 1, 2011, the Secretary shall revise the fee schedule areas used for payment under this section applicable to the State of California using the Metropolitan Statistical Area (MSA) iterative Geographic Adjustment Factor methodology as follows:
“(I) The Secretary shall configure the physician fee schedule areas using the Core-Based Statistical Areas-Metropolitan Statistical Areas (each in this paragraph referred to as an ‘MSA’), as defined by the Director of the Office of Management and Budget, as the basis for the fee schedule areas. The Secretary shall employ an iterative process to transition fee schedule areas. First, the Secretary shall list all MSAs within the State by Geographic Adjustment Factor described in paragraph (2) (in this paragraph referred to as a ‘GAF’) in descending order. In the first iteration, the Secretary shall compare the GAF of the highest cost MSA in the State to the weighted-average GAF of the group of remaining MSAs in the State. If the ratio of the GAF of the highest cost MSA to the weighted-average GAF of the rest of State is 1.05 or greater then the highest cost MSA becomes a separate fee schedule area.
“(II) In the next iteration, the Secretary shall compare the MSA of the second-highest GAF to the weighted-average GAF of the group of remaining MSAs. If the ratio of the second-highest MSA’s GAF to the weighted-average of the remaining lower cost MSAs is 1.05 or greater, the second-highest MSA becomes a separate fee schedule area. The iterative process continues until the ratio of the GAF of the highest-cost remaining MSA to the weighted-average of the remaining lower-cost MSAs is less than 1.05, and the remaining group of lower cost MSAs form a single fee schedule area, If two MSAs have identical GAFs, they shall be combined in the iterative comparison.
“(ii) TRANSITION.—For services furnished on or after January 1, 2011, and before January 1, 2016, in the State of California, after calculating the work, practice expense, and malpractice geographic indices described in clauses (i), (ii), and (iii) of paragraph (1)(A) that would otherwise apply through application of this paragraph, the Secretary shall increase any such index to the county-based fee schedule area value on December 31, 2009, if such index would otherwise be less than the value on January 1, 2010.
“(i) PERIODIC REVIEW AND ADJUSTMENTS IN FEE SCHEDULE AREAS.—Subsequent to the process outlined in paragraph (1)(C), not less often than every three years, the Secretary shall review and update the California Rest-of-State fee schedule area using MSAs as defined by the Director of the Office of Management and Budget and the iterative methodology described in subparagraph (A)(i).
“(ii) LINK WITH GEOGRAPHIC INDEX DATA REVISION.—The revision described in clause (i) shall be made effective concurrently with the application of the periodic review of the adjustment factors required under paragraph (1)(C) for California for 2012 and subsequent periods. Upon request, the Secretary shall make available to the public any county-level or MSA derived data used to calculate the geographic practice cost index.
“(C) REFERENCES TO FEE SCHEDULE AREAS.—Effective for services furnished on or after January 1, 2010, for the State of California, any reference in this section to a fee schedule area shall be deemed a reference to an MSA in the State.”.
(b) Conforming amendment to definition of fee schedule area.—Section 1848(j)(2) of the Social Security Act (42 U.S.C. 1395w(j)(2)) is amended by striking “The term” and inserting “Except as provided in subsection (e)(6)(C), the term”.
(1) IN GENERAL.—The first sentence of section 1833(t)(3)(C)(iv) of the Social Security Act (42 U.S.C. 1395l(t)(3)(C)(iv)) is amended—
(A) by inserting “(which is subject to the productivity adjustment described in subclause (II) of such section)” after “1886(b)(3)(B)(iii)”; and
(B) by inserting “(but not below 0)” after “reduced”.
(2) EFFECTIVE DATE.—The amendments made by paragraph (1) shall apply to increase factors for services furnished in years beginning with 2010.
(b) Ambulance services.—Section 1834(l)(3)(B) of such Act (42 U.S.C. 1395m(l)(3)(B))) is amended by inserting before the period at the end the following: “and, in the case of years beginning with 2010, subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II)”.
(c) Ambulatory surgical center services.—Section 1833(i)(2)(D) of such Act (42 U.S.C. 1395l(i)(2)(D)) is amended—
(1) by redesignating clause (v) as clause (vi); and
(2) by inserting after clause (iv) the following new clause:
“(v) In implementing the system described in clause (i), for services furnished during 2010 or any subsequent year, to the extent that an annual percentage change factor applies, such factor shall be subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II).”.
(d) Laboratory services.—Section 1833(h)(2)(A) of such Act (42 U.S.C. 1395l(h)(2)(A)) is amended—
(1) in clause (i), by striking “for each of years 2009 through 2013” and inserting “for 2009”; and
(A) by striking “and” at the end of subclause (III);
(B) by striking the period at the end of subclause (IV) and inserting “; and”; and
(C) by adding at the end the following new subclause:
“(V) the annual adjustment in the fee schedules determined under clause (i) for years beginning with 2010 shall be subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II).”.
(e) Certain durable medical equipment.—Section 1834(a)(14) of such Act (42 U.S.C. 1395m(a)(14)) is amended—
(1) in subparagraph (K), by inserting before the semicolon at the end the following: “, subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II)”;
(2) in subparagraph (L)(i), by inserting after “June 2013,” the following: “subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II),”;
(3) in subparagraph (L)(ii), by inserting after “June 2013” the following: “, subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II)”; and
(4) in subparagraph (M), by inserting before the period at the end the following: “, subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II)”.
(a) In general.—Section 1834(a)(7)(A)(iii) of the Social Security Act (42 U.S.C. 1395m(a)(7)(A)(iii)) is amended—
(1) in the heading, by inserting “certain complex rehabilitative” after “option for”; and
(2) by striking “power-driven wheelchair” and inserting “complex rehabilitative power-driven wheelchair recognized by the Secretary as classified within group 3 or higher”.
(b) Effective date.—The amendments made by subsection (a) shall take effect on January 1, 2011, and shall apply to power-driven wheelchairs furnished on or after such date. Such amendments shall not apply to contracts entered into under section 1847 of the Social Security Act (42 U.S.C. 1395w–3) pursuant to a bid submitted under such section before October 1, 2010, under subsection (a)(1)(B)(i)(I) of such section.
Section 1833(t)(16)(C) of the Social Security Act (42 U.S.C. 1395l(t)(16)(C)), as amended by section 142 of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110–275), is amended by striking, the first place it appears, “January 1, 2010” and inserting “January 1, 2012”.
Not later than 12 months after the date of enactment of this Act, the Medicare Payment Advisory Commission shall submit to Congress a report on the following:
(1) The scope of coverage for home infusion therapy in the fee-for-service Medicare program under title XVIII of the Social Security Act, Medicare Advantage under part C of such title, the veteran’s health care program under chapter 17 of title 38, United States Code, and among private payers, including an analysis of the scope of services provided by home infusion therapy providers to their patients in such programs.
(2) The benefits and costs of providing such coverage under the Medicare program, including a calculation of the potential savings achieved through avoided or shortened hospital and nursing home stays as a result of Medicare coverage of home infusion therapy.
(3) An assessment of sources of data on the costs of home infusion therapy that might be used to construct payment mechanisms in the Medicare program.
(4) Recommendations, if any, on the structure of a payment system under the Medicare program for home infusion therapy, including an analysis of the payment methodologies used under Medicare Advantage plans and private health plans for the provision of home infusion therapy and their applicability to the Medicare program.
(1) IN GENERAL.—Section 1833(i) of the Social Security Act (42 U.S.C. 1395l(i)) is amended by adding at the end the following new paragraph:
“(8) The Secretary shall require, as a condition of the agreement described in section 1832(a)(2)(F)(i), the submission of such cost report as the Secretary may specify, taking into account the requirements for such reports under section 1815 in the case of a hospital.”.
(2) DEVELOPMENT OF COST REPORT.—Not later than 3 years after the date of the enactment of this Act, the Secretary of Health and Human Services shall develop a cost report form for use under section 1833(i)(8) of the Social Security Act, as added by paragraph (1).
(3) AUDIT REQUIREMENT.—The Secretary shall provide for periodic auditing of cost reports submitted under section 1833(i)(8) of the Social Security Act, as added by paragraph (1).
(4) EFFECTIVE DATE.—The amendment made by paragraph (1) shall apply to agreements applicable to cost reporting periods beginning 18 months after the date the Secretary develops the cost report form under paragraph (2).
(b) Additional data on quality.—
(1) IN GENERAL.—Section 1833(i)(7) of such Act (42 U.S.C. 1395l(i)(7)) is amended—
(A) in subparagraph (B), by inserting “subject to subparagraph (C),” after “may otherwise provide,”; and
(B) by adding at the end the following new subparagraph:
“(C) Under subparagraph (B) the Secretary shall require the reporting of such additional data relating to quality of services furnished in an ambulatory surgical facility, including data on health care associated infections, as the Secretary may specify.”.
(2) EFFECTIVE DATE.—The amendment made by paragraph (1) shall to reporting for years beginning with 2012.
Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) is amended by adding at the end the following new paragraph:
“(18) AUTHORIZATION OF ADJUSTMENT FOR CANCER HOSPITALS.—
“(A) STUDY.—The Secretary shall conduct a study to determine if, under the system under this subsection, costs incurred by hospitals described in section 1886(d)(1)(B)(v) with respect to ambulatory payment classification groups exceed those costs incurred by other hospitals furnishing services under this subsection (as determined appropriate by the Secretary).
“(B) AUTHORIZATION OF ADJUSTMENT.—Insofar as the Secretary determines under subparagraph (A) that costs incurred by hospitals described in section 1886(d)(1)(B)(v) exceed those costs incurred by other hospitals furnishing services under this subsection, the Secretary shall provide for an appropriate adjustment under paragraph (2)(E) to reflect those higher costs effective for services furnished on or after January 1, 2011.”.
Section 1898(b)(1)(A) of the Social Security Act (42 U.S.C. 1395iii(b)(1)(A)) is amended to read as follows:
“(A) the period beginning with fiscal year 2011 and ending with fiscal year 2019, $8,000,000,000; and”.
(a) Adjustment in practice expense to reflect higher presumed utilization.—Section 1848 of the Social Security Act (42 U.S.C. 1395w) is amended—
(A) in subparagraph (B), by striking “subparagraph (A)” and inserting “this paragraph”; and
(B) by adding at the end the following new subparagraph:
“(C) ADJUSTMENT IN PRACTICE EXPENSE TO REFLECT HIGHER PRESUMED UTILIZATION.—In computing the number of practice expense relative value units under subsection (c)(2)(C)(ii) with respect to advanced diagnostic imaging services (as defined in section 1834(e)(1)(B)), the Secretary shall adjust such number of units so it reflects a 75 percent (rather than 50 percent) presumed rate of utilization of imaging equipment.”; and
(2) in subsection (c)(2)(B)(v)(II), by inserting “and other provisions” after “OPD payment cap”.
(b) Adjustment in technical component “discount” on single-session imaging to consecutive body parts.—Section 1848(b)(4) of such Act is further amended by adding at the end the following new subparagraph:
“(D) ADJUSTMENT IN TECHNICAL COMPONENT DISCOUNT ON SINGLE-SESSION IMAGING INVOLVING CONSECUTIVE BODY PARTS.—The Secretary shall increase the reduction in expenditures attributable to the multiple procedure payment reduction applicable to the technical component for imaging under the final rule published by the Secretary in the Federal Register on November 21, 2005 (part 405 of title 42, Code of Federal Regulations) from 25 percent to 50 percent.”.
(c) Effective date.—Except as otherwise provided, this section, and the amendments made by this section, shall apply to services furnished on or after January 1, 2011.
(a) Waiver of surety bond requirement.—Section 1834(a)(16) of the Social Security Act (42 U.S.C. 1395m(a)(16)) is amended by adding at the end the following: “The requirement for a surety bond described in subparagraph (B) shall not apply in the case of a pharmacy (i) that has been enrolled under section 1866(j) as a supplier of durable medical equipment, prosthetics, orthotics, and supplies and has been issued (which may include renewal of) a provider number (as described in the first sentence of this paragraph) for at least 5 years, and (ii) for which a final adverse action (as defined in section 424.57(a) of title 42, Code of Federal Regulations) has never been imposed.”.
(b) Ensuring supply of oxygen equipment.—
(1) IN GENERAL.—Section 1834(a)(5)(F) of the Social Security Act (42 U.S.C. 1395m(a)(5)(F)) is amended—
(A) in clause (ii), by striking “After the” and inserting “Except as provided in clause (iii), after the”; and
(B) by adding at the end the following new clause:
“(iii) CONTINUATION OF SUPPLY.—In the case of a supplier furnishing such equipment to an individual under this subsection as of the 27th month of the 36 months described in clause (i), the supplier furnishing such equipment as of such month shall continue to furnish such equipment to such individual (either directly or though arrangements with other suppliers of such equipment) during any subsequent period of medical need for the remainder of the reasonable useful lifetime of the equipment, as determined by the Secretary, regardless of the location of the individual, unless another supplier has accepted responsibility for continuing to furnish such equipment during the remainder of such period.”.
(2) EFFECTIVE DATE.—The amendments made by paragraph (1) shall take effect as of the date of the enactment of this Act and shall apply to the furnishing of equipment to individuals for whom the 27th month of a continuous period of use of oxygen equipment described in section 1834(a)(5)(F) of the Social Security Act occurs on or after July 1, 2010.
(c) Treatment of current accreditation applications.—Section 1834(a)(20)(F) of such Act (42 U.S.C. 1395m(a)(20)(F)) is amended—
(A) by striking “clause (ii)” and inserting “clauses (ii) and (iii)”; and
(B) by striking “and” at the end;
(2) by striking the period at the end of clause (ii)(II) and by inserting “; and”; and
(3) by adding at the end the following:
“(iii) the requirement for accreditation described in clause (i) shall not apply for purposes of supplying diabetic testing supplies, canes, and crutches in the case of a pharmacy that is enrolled under section 1866(j) as a supplier of durable medical equipment, prosthetics, orthotics, and supplies.
Any supplier that has submitted an application for accreditation before August 1, 2009, shall be deemed as meeting applicable standards and accreditation requirement under this subparagraph until such time as the independent accreditation organization takes action on the supplier’s application.”.
(d) Restoring 36-Month oxygen rental period in case of supplier bankruptcy for certain individuals.—Section 1834(a)(5)(F) of such Act (42 U.S.C. 1395m(a)(5)(F)) is amended by adding at the end the following new clause:
“(iii) EXCEPTION FOR BANKRUPTCY.—If a supplier of oxygen to an individual is declared bankrupt and its assets are liquidated and at the time of such declaration and liquidation more than 24 months of rental payments have been made, the individual may begin under this subparagraph a new 36-month rental period with another supplier of oxygen.”.
(a) In general.—The Medicare Payment Advisory Commission shall conduct a study regarding bone mass measurement, including computed tomography, duel-energy x-ray absorptriometry, and vertebral fracture assessment. The study shall focus on the following:
(1) An assessment of the adequacy of Medicare payment rates for such services, taking into account costs of acquiring the necessary equipment, professional work time, and practice expense costs.
(2) The impact of Medicare payment changes since 2006 on beneficiary access to bone mass measurement benefits in general and in rural and minority communities specifically.
(3) A review of the clinically appropriate and recommended use among Medicare beneficiaries and how usage rates among such beneficiaries compares to such recommendations.
(4) In conjunction with the findings under (3), recommendations, if necessary, regarding methods for reaching appropriate use of bone mass measurement studies among Medicare beneficiaries.
(b) Report.—The Commission shall submit a report to the Congress, not later than 9 months after the date of the enactment of this Act, containing a description of the results of the study conducted under subsection (a) and the conclusions and recommendations, if any, regarding each of the issues described in paragraphs (1), (2), (3), and (4) of such subsection.
(1) IN
GENERAL.—Section 1886 of the
Social Security Act (42 U.S.C. 1395ww), as amended by section 1103(a), is
amended by adding at the end the following new subsection: “(p) Adjustment to
hospital payments for excess readmissions.— “(1) IN
GENERAL.—With respect to
payment for discharges from an applicable hospital (as defined in paragraph
(5)(C)) occurring during a fiscal year beginning on or after October 1, 2011,
in order to account for excess readmissions in the hospital, the Secretary
shall reduce the payments that would otherwise be made to such hospital under
subsection (d) (or section 1814(b)(3), as the case may be) for such a discharge
by an amount equal to the product of— “(A) the base operating
DRG payment amount (as defined in paragraph (2)) for the discharge; and “(B) the adjustment factor (described in
paragraph (3)(A)) for the hospital for the fiscal year.
“(2) BASE OPERATING DRG PAYMENT AMOUNT.—
“(A) IN GENERAL.—Except as provided in subparagraph (B), for purposes of this subsection, the term ‘base operating DRG payment amount’ means, with respect to a hospital for a fiscal year, the payment amount that would otherwise be made under subsection (d) for a discharge if this subsection did not apply, reduced by any portion of such amount that is attributable to payments under subparagraphs (B) and (F) of paragraph (5).
“(B) ADJUSTMENTS.—For purposes of subparagraph (A), in the case of a hospital that is paid under section 1814(b)(3), the term ‘base operating DRG payment amount’ means the payment amount under such section.
“(A) IN GENERAL.—For purposes of paragraph (1), the adjustment factor under this paragraph for an applicable hospital for a fiscal year is equal to the greater of—
“(i) the ratio described in subparagraph (B) for the hospital for the applicable period (as defined in paragraph (5)(D)) for such fiscal year; or
“(ii) the floor adjustment factor specified in subparagraph (C).
“(B) RATIO.—The ratio described in this subparagraph for a hospital for an applicable period is equal to 1 minus the ratio of—
“(i) the aggregate payments for excess readmissions (as defined in paragraph (4)(A)) with respect to an applicable hospital for the applicable period; and
“(ii) the aggregate payments for all discharges (as defined in paragraph (4)(B)) with respect to such applicable hospital for such applicable period.
“(C) FLOOR ADJUSTMENT FACTOR.—For purposes of subparagraph (A), the floor adjustment factor specified in this subparagraph for—
“(i) fiscal year 2012 is 0.99;
“(ii) fiscal year 2013 is 0.98;
“(iii) fiscal year 2014 is 0.97; or
“(iv) a subsequent fiscal year is 0.95.
“(4) AGGREGATE PAYMENTS, EXCESS READMISSION RATIO DEFINED.—For purposes of this subsection:
“(A) AGGREGATE PAYMENTS FOR EXCESS READMISSIONS.—The term ‘aggregate payments for excess readmissions’ means, for a hospital for a fiscal year, the sum, for applicable conditions (as defined in paragraph (5)(A)), of the product, for each applicable condition, of—
“(i) the base operating DRG payment amount for such hospital for such fiscal year for such condition;
“(ii) the number of admissions for such condition for such hospital for such fiscal year; and
“(iii) the excess readmissions ratio (as defined in subparagraph (C)) for such hospital for the applicable period for such fiscal year minus 1.
“(B) AGGREGATE PAYMENTS FOR ALL DISCHARGES.—The term ‘aggregate payments for all discharges’ means, for a hospital for a fiscal year, the sum of the base operating DRG payment amounts for all discharges for all conditions from such hospital for such fiscal year.
“(C) EXCESS READMISSION RATIO.—
“(i) IN GENERAL.—Subject to clauses (ii) and (iii), the term ‘excess readmissions ratio’ means, with respect to an applicable condition for a hospital for an applicable period, the ratio (but not less than 1.0) of—
“(I) the risk adjusted readmissions based on actual readmissions, as determined consistent with a readmission measure methodology that has been endorsed under paragraph (5)(A)(ii)(I), for an applicable hospital for such condition with respect to the applicable period; to
“(II) the risk adjusted expected readmissions (as determined consistent with such a methodology) for such hospital for such condition with respect to such applicable period.
“(ii) EXCLUSION OF CERTAIN READMISSIONS.—For purposes of clause (i), with respect to a hospital, excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the Secretary) of discharges for such applicable condition for the applicable period and such hospital.
“(iii) ADJUSTMENT.—In order to promote a reduction over time in the overall rate of readmissions for applicable conditions, the Secretary may provide, beginning with discharges for fiscal year 2014, for the determination of the excess readmissions ratio under subparagraph (C) to be based on a ranking of hospitals by readmission ratios (from lower to higher readmission ratios) normalized to a benchmark that is lower than the 50th percentile.
“(5) DEFINITIONS.—For purposes of this subsection:
“(A) APPLICABLE CONDITION.—The term ‘applicable condition’ means, subject to subparagraph (B), a condition or procedure selected by the Secretary among conditions and procedures for which—
“(i) readmissions (as defined in subparagraph (E)) that represent conditions or procedures that are high volume or high expenditures under this title (or other criteria specified by the Secretary); and
“(ii) measures of such readmissions—
“(I) have been endorsed by the entity with a contract under section 1890(a); and
“(II) such endorsed measures have appropriate exclusions for readmissions that are unrelated to the prior discharge (such as a planned readmission or transfer to another applicable hospital).
“(B) EXPANSION OF APPLICABLE CONDITIONS.—Beginning with fiscal year 2013, the Secretary shall expand the applicable conditions beyond the 3 conditions for which measures have been endorsed as described in subparagraph (A)(ii)(I) as of the date of the enactment of this subsection to the additional 4 conditions that have been so identified by the Medicare Payment Advisory Commission in its report to Congress in June 2007 and to other conditions and procedures which may include an all-condition measure of readmissions, as determined appropriate by the Secretary. In expanding such applicable conditions, the Secretary shall seek the endorsement described in subparagraph (A)(ii)(I) but may apply such measures without such an endorsement.
“(C) APPLICABLE HOSPITAL.—The term ‘applicable hospital’ means a subsection (d) hospital or a hospital that is paid under section 1814(b)(3).
“(D) APPLICABLE PERIOD.—The term ‘applicable period’ means, with respect to a fiscal year, such period as the Secretary shall specify for purposes of determining excess readmissions.
“(E) READMISSION.—The term ‘readmission’ means, in the case of an individual who is discharged from an applicable hospital, the admission of the individual to the same or another applicable hospital within a time period specified by the Secretary from the date of such discharge. Insofar as the discharge relates to an applicable condition for which there is an endorsed measure described in subparagraph (A)(ii)(I), such time period (such as 30 days) shall be consistent with the time period specified for such measure.
“(6) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of—
“(A) the determination of base operating DRG payment amounts;
“(B) the methodology for determining the adjustment factor under paragraph (3), including excess readmissions ratio under paragraph (4)(C), aggregate payments for excess readmissions under paragraph (4)(A), and aggregate payments for all discharges under paragraph (4)(B), and applicable periods and applicable conditions under paragraph (5);
“(C) the measures of readmissions as described in paragraph (5)(A)(ii); and
“(D) the determination of a targeted hospital under paragraph (8)(B)(i), the increase in payment under paragraph (8)(B)(ii), the aggregate cap under paragraph (8)(C)(i), the hospital-specific limit under paragraph (8)(C)(ii), and the form of payment made by the Secretary under paragraph (8)(D).
“(7) MONITORING INAPPROPRIATE CHANGES IN ADMISSIONS PRACTICES.—The Secretary shall monitor the activities of applicable hospitals to determine if such hospitals have taken steps to avoid patients at risk in order to reduce the likelihood of increasing readmissions for applicable conditions. If the Secretary determines that such a hospital has taken such a step, after notice to the hospital and opportunity for the hospital to undertake action to alleviate such steps, the Secretary may impose an appropriate sanction.
“(8) ASSISTANCE TO CERTAIN HOSPITALS.—
“(A) IN GENERAL.—For purposes of providing funds to applicable hospitals to take steps described in subparagraph (E) to address factors that may impact readmissions of individuals who are discharged from such a hospital, for fiscal years beginning on or after October 1, 2011, the Secretary shall make a payment adjustment for a hospital described in subparagraph (B), with respect to each such fiscal year, by a percent estimated by the Secretary to be consistent with subparagraph (C).
“(B) TARGETED HOSPITALS.—Subparagraph (A) shall apply to an applicable hospital that—
“(i) received (or, in the case of an 1814(b)(3) hospital, otherwise would have been eligible to receive) $10,000,000 or more in disproportionate share payments using the latest available data as estimated by the Secretary; and
“(ii) provides assurances satisfactory to the Secretary that the increase in payment under this paragraph shall be used for purposes described in subparagraph (E).
“(i) AGGREGATE CAP.—The aggregate amount of the payment adjustment under this paragraph for a fiscal year shall not exceed 5 percent of the estimated difference in the spending that would occur for such fiscal year with and without application of the adjustment factor described in paragraph (3) and applied pursuant to paragraph (1).
“(ii) HOSPITAL-SPECIFIC LIMIT.—The aggregate amount of the payment adjustment for a hospital under this paragraph shall not exceed the estimated difference in spending that would occur for such fiscal year for such hospital with and without application of the adjustment factor described in paragraph (3) and applied pursuant to paragraph (1).
“(D) FORM OF PAYMENT.—The Secretary may make the additional payments under this paragraph on a lump sum basis, a periodic basis, a claim by claim basis, or otherwise.
“(E) USE OF ADDITIONAL PAYMENT.—Funding under this paragraph shall be used by targeted hospitals for transitional care activities designed to address the patient noncompliance issues that result in higher than normal readmission rates, such as one or more of the following:
“(i) Providing care coordination services to assist in transitions from the targeted hospital to other settings.
“(ii) Hiring translators and interpreters.
“(iii) Increasing services offered by discharge planners.
“(iv) Ensuring that individuals receive a summary of care and medication orders upon discharge.
“(v) Developing a quality improvement plan to assess and remedy preventable readmission rates.
“(vi) Assigning discharged individuals to a medical home.
“(vii) Doing other activities as determined appropriate by the Secretary.
“(F) GAO REPORT ON USE OF FUNDS.—Not later than 3 years after the date on which funds are first made available under this paragraph, the Comptroller General of the United States shall submit to Congress a report on the use of such funds.
“(G) DISPROPORTIONATE SHARE HOSPITAL PAYMENT.—In this paragraph, the term ‘disproportionate share hospital payment’ means an additional payment amount under subsection (d)(5)(F).”.
(b) Application to critical access hospitals.—Section 1814(l) of the Social Security Act (42 U.S.C. 1395f(l)) is amended—
(A) by striking “and” at the end of subparagraph (C);
(B) by striking the period at the end of subparagraph (D) and inserting “; and”;
(C) by inserting at the end the following new subparagraph:
“(E) The methodology for determining the adjustment factor under paragraph (5), including the determination of aggregate payments for actual and expected readmissions, applicable periods, applicable conditions and measures of readmissions.”; and
(D) by redesignating such paragraph as paragraph (6); and
(2) by inserting after paragraph (4) the following new paragraph:
“(5) The adjustment factor described in section 1886(p)(3) shall apply to payments with respect to a critical access hospital with respect to a cost reporting period beginning in fiscal year 2012 and each subsequent fiscal year (after application of paragraph (4) of this subsection) in a manner similar to the manner in which such section applies with respect to a fiscal year to an applicable hospital as described in section 1886(p)(2).”.
(c) Post acute care providers.—
(A) IN GENERAL.—With respect to a readmission to an applicable hospital or a critical access hospital (as described in section 1814(l) of the Social Security Act) from a post acute care provider (as defined in paragraph (3)) and such a readmission is not governed by section 412.531 of title 42, Code of Federal Regulations, if the claim submitted by such a post-acute care provider under title XVIII of the Social Security Act indicates that the individual was readmitted to a hospital from such a post-acute care provider or admitted from home and under the care of a home health agency within 30 days of an initial discharge from an applicable hospital or critical access hospital, the payment under such title on such claim shall be the applicable percent specified in subparagraph (B) of the payment that would otherwise be made under the respective payment system under such title for such post-acute care provider if this subsection did not apply.
(B) APPLICABLE PERCENT DEFINED.—For purposes of subparagraph (A), the applicable percent is—
(i) for fiscal or rate year 2012 is 0.996;
(ii) for fiscal or rate year 2013 is 0.993; and
(iii) for fiscal or rate year 2014 is 0.99.
(C) EFFECTIVE DATE.—Subparagraph (1) shall apply to discharges or services furnished (as the case may be with respect to the applicable post acute care provider) on or after the first day of the fiscal year or rate year, beginning on or after October 1, 2011, with respect to the applicable post acute care provider.
(2) DEVELOPMENT AND APPLICATION OF PERFORMANCE MEASURES.—
(A) IN GENERAL.—The Secretary of Health and Human Services shall develop appropriate measures of readmission rates for post acute care providers. The Secretary shall seek endorsement of such measures by the entity with a contract under section 1890(a) of the Social Security Act but may adopt and apply such measures under this paragraph without such an endorsement. The Secretary shall expand such measures in a manner similar to the manner in which applicable conditions are expanded under paragraph (5)(B) of section 1886(p) of the Social Security Act, as added by subsection (a).
(B) IMPLEMENTATION.—The Secretary shall apply, on or after October 1, 2014, with respect to post acute care providers, policies similar to the policies applied with respect to applicable hospitals and critical access hospitals under the amendments made by subsection (a). The provisions of paragraph (1) shall apply with respect to any period on or after October 1, 2014, and before such application date described in the previous sentence in the same manner as such provisions apply with respect to fiscal or rate year 2014.
(C) MONITORING AND PENALTIES.—The provisions of paragraph (7) of such section 1886(p) shall apply to providers under this paragraph in the same manner as they apply to hospitals under such section.
(3) DEFINITIONS.—For purposes of this subsection:
(A) POST ACUTE CARE PROVIDER.—The term “post acute care provider” means—
(i) a skilled nursing facility (as defined in section 1819(a) of the Social Security Act);
(ii) an inpatient rehabilitation facility (described in section 1886(h)(1)(A) of such Act);
(iii) a home health agency (as defined in section 1861(o) of such Act); and
(iv) a long term care hospital (as defined in section 1861(ccc) of such Act).
(B) OTHER TERMS.—The terms “applicable condition”, “applicable hospital”, and “readmission” have the meanings given such terms in section 1886(p)(5) of the Social Security Act, as added by subsection (a)(1).
(1) STUDY.—The Secretary of Health and Human Services shall conduct a study to determine how the readmissions policy described in the previous subsections could be applied to physicians.
(2) CONSIDERATIONS.—In conducting the study, the Secretary shall consider approaches such as—
(A) creating a new code (or codes) and payment amount (or amounts) under the fee schedule in section 1848 of the Social Security Act (in a budget neutral manner) for services furnished by an appropriate physician who sees an individual within the first week after discharge from a hospital or critical access hospital;
(B) developing measures of rates of readmission for individuals treated by physicians;
(C) applying a payment reduction for physicians who treat the patient during the initial admission that results in a readmission; and
(D) methods for attributing payments or payment reductions to the appropriate physician or physicians.
(3) REPORT.—The Secretary shall issue a public report on such study not later than the date that is one year after the date of the enactment of this Act.
(e) Funding.—For purposes of carrying out the provisions of this section, in addition to funds otherwise available, out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services for the Center for Medicare & Medicaid Services Program Management Account $25,000,000 for each fiscal year beginning with 2010. Amounts appropriated under this subsection for a fiscal year shall be available until expended.
(1) IN GENERAL.—The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall develop a detailed plan to reform payment for post acute care (PAC) services under the Medicare program under title XVIII of the Social Security Act (in this section referred to as the “Medicare program)”. The goals of such payment reform are to—
(A) improve the coordination, quality, and efficiency of such services; and
(B) improve outcomes for individuals such as reducing the need for readmission to hospitals from providers of such services.
(2) BUNDLING POST ACUTE SERVICES.—The plan described in paragraph (1) shall include detailed specifications for a bundled payment for post acute services (in this section referred to as the “post acute care bundle”), and may include other approaches determined appropriate by the Secretary.
(3) POST ACUTE SERVICES.—For purposes of this section, the term “post acute services” means services for which payment may be made under the Medicare program that are furnished by skilled nursing facilities, inpatient rehabilitation facilities, long term care hospitals, hospital based outpatient rehabilitation facilities and home health agencies to an individual after discharge of such individual from a hospital, and such other services determined appropriate by the Secretary.
(b) Details.—The plan described in subsection (a)(1) shall include consideration of the following issues:
(1) The nature of payments under a post acute care bundle, including the type of provider or entity to whom payment should be made, the scope of activities and services included in the bundle, whether payment for physicians’ services should be included in the bundle, and the period covered by the bundle.
(2) Whether the payment should be consolidated with the payment under the inpatient prospective system under section 1886 of the Social Security Act (in this section referred to as MS–DRGs) or a separate payment should be established for such bundle, and if a separate payment is established, whether it should be made only upon use of post acute care services or for every discharge.
(3) Whether the bundle should be applied across all categories of providers of inpatient services (including critical access hospitals) and post acute care services or whether it should be limited to certain categories of providers, services, or discharges, such as high volume or high cost MS–DRGs.
(4) The extent to which payment rates could be established to achieve offsets for efficiencies that could be expected to be achieved with a bundle payment, whether such rates should be established on a national basis or for different geographic areas, should vary according to discharge, case mix, outliers, and geographic differences in wages or other appropriate adjustments, and how to update such rates.
(5) The nature of protections needed for individuals under a system of bundled payments to ensure that individuals receive quality care, are furnished the level and amount of services needed as determined by an appropriate assessment instrument, are offered choice of provider, and the extent to which transitional care services would improve quality of care for individuals and the functioning of a bundled post-acute system.
(6) The nature of relationships that may be required between hospitals and providers of post acute care services to facilitate bundled payments, including the application of gainsharing, anti-referral, anti-kickback, and anti-trust laws.
(7) Quality measures that would be appropriate for reporting by hospitals and post acute providers (such as measures that assess changes in functional status and quality measures appropriate for each type of post acute services provider including how the reporting of such quality measures could be coordinated with other reporting of such quality measures by such providers otherwise required).
(8) How cost-sharing for a post acute care bundle should be treated relative to current rules for cost-sharing for inpatient hospital, home health, skilled nursing facility, and other services.
(9) How other programmatic issues should be treated in a post acute care bundle, including rules specific to various types of post-acute providers such as the post-acute transfer policy, three-day hospital stay to qualify for services furnished by skilled nursing facilities, and the coordination of payments and care under the Medicare program and the Medicaid program.
(10) Such other issues as the Secretary deems appropriate.
(c) Consultations and analysis.—
(1) CONSULTATION WITH STAKEHOLDERS.—In developing the plan under subsection (a)(1), the Secretary shall consult with relevant stakeholders and shall consider experience with such research studies and demonstrations that the Secretary determines appropriate.
(2) ANALYSIS AND DATA COLLECTION.—In developing such plan, the Secretary shall—
(A) analyze the issues described in subsection (b) and other issues that the Secretary determines appropriate;
(B) analyze the impacts (including geographic impacts) of post acute service reform approaches, including bundling of such services on individuals, hospitals, post acute care providers, and physicians;
(C) use existing data (such as data submitted on claims) and collect such data as the Secretary determines are appropriate to develop such plan required in this section; and
(D) if patient functional status measures are appropriate for the analysis, to the extent practical, build upon the CARE tool being developed pursuant to section 5008 of the Deficit Reduction Act of 2005.
(1) FUNDING.—For purposes of carrying out the provisions of this section, in addition to funds otherwise available, out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary for the Center for Medicare & Medicaid Services Program Management Account $15,000,000 for each of the fiscal years 2010 through 2012. Amounts appropriated under this paragraph for a fiscal year shall be available until expended.
(2) EXPEDITED DATA COLLECTION.—Chapter 35 of title 44, United States Code shall not apply to this section.
(1) INTERIM REPORTS.—The Secretary shall issue interim public reports on a periodic basis on the plan described in subsection (a)(1), the issues described in subsection (b), and impact analyses as the Secretary determines appropriate.
(2) FINAL REPORT.—Not later than the date that is 3 years after the date of the enactment of this Act, the Secretary shall issue a final public report on such plan, including analysis of issues described in subsection (b) and impact analyses.
(f) Conversion of Acute Care Episode Demonstration to Pilot Program and Expansion To Include Post Acute Services.—
(1) IN GENERAL.—Part E of title XVIII of the Social Security Act is amended by inserting after section 1866C the following new section:
“(a) In general.—By not later than January 1, 2011, the Secretary shall, for the purpose of promoting the use of bundled payments to promote efficient and high quality delivery of care—
“(1) convert the acute care episode demonstration program conducted under section 1866C to a pilot program; and
“(2) subject to subsection (c), expand such program as so converted to include post acute services and such other services the Secretary determines to be appropriate, which may include transitional services.
“(b) Scope.—The pilot program under subsection (a) may include additional geographic areas and additional conditions which account for significant program spending, as defined by the Secretary. Nothing in this subsection shall be construed as limiting the number of hospital and physician groups or the number of hospital and post-acute provider groups that may participate in the pilot program.
“(c) Limitation.—The Secretary shall only expand the pilot program under subsection (a)(2) if the Secretary finds that—
“(1) the demonstration program under section 1866C and pilot program under this section maintain or increase the quality of care received by individuals enrolled under this title; and
“(2) such demonstration program and pilot program reduce program expenditures and, based on the certification under subsection (d), that the expansion of such pilot program would result in estimated spending that would be less than what spending would otherwise be in the absence of this section.
“(d) Certification.—For purposes of subsection (c), the Chief Actuary of the Centers for Medicare & Medicaid Services shall certify whether expansion of the pilot program under this section would result in estimated spending that would be less than what spending would otherwise be in the absence of this section.
“(e) Voluntary participation.—Nothing in this paragraph shall be construed as requiring the participation of an entity in the pilot program under this section.”.
(2) CONFORMING AMENDMENT.—Section 1866C(b) of the Social Security Act (42 U.S.C. 1395cc–3(b)) is amended by striking “The Secretary” and inserting “Subject to section 1866D, the Secretary”.
Section 1895(b)(3)(B)(ii) of the Social Security Act (42 U.S.C. 1395fff(b)(3)(B)(ii)) is amended—
(1) in subclause (IV), by striking “and”;
(2) by redesignating subclause (V) as subclause (VII); and
(3) by inserting after subclause (IV) the following new subclauses:
(a) Acceleration of adjustment for case mix changes.—Section 1895(b)(3)(B) of the Social Security Act (42 U.S.C. 1395fff(b)(3)(B)) is amended—
(1) in clause (iv), by striking “Insofar as” and inserting “Subject to clause (vi), insofar as”; and
(2) by adding at the end the following new clause:
“(vi) SPECIAL RULE FOR CASE MIX CHANGES FOR 2011.—
“(I) IN GENERAL.—With respect to the case mix adjustments established in section 484.220(a) of title 42, Code of Federal Regulations, the Secretary shall apply, in 2010, the adjustment established in paragraph (3) of such section for 2011, in addition to applying the adjustment established in paragraph (2) for 2010.
“(II) CONSTRUCTION.—Nothing in this clause shall be construed as limiting the amount of adjustment for case mix for 2010 or 2011 if more recent data indicate an appropriate adjustment that is greater than the amount established in the section described in subclause (I).”.
(b) Rebasing home health prospective payment amount.—Section 1895(b)(3)(A) of the Social Security Act (42 U.S.C. 1395fff(b)(3)(A)) is amended—
(A) in subclause (III), by inserting “and before 2011” after “after the period described in subclause (II)”; and
(B) by inserting after subclause (III) the following new subclauses:
“(IV) Subject to clause (iii)(I), for 2011, such amount (or amounts) shall be adjusted by a uniform percentage determined to be appropriate by the Secretary based on analysis of factors such as changes in the average number and types of visits in an episode, the change in intensity of visits in an episode, growth in cost per episode, and other factors that the Secretary considers to be relevant.
“(V) Subject to clause (iii)(II), for a year after 2011, such a amount (or amounts) shall be equal to the amount (or amounts) determined under this clause for the previous year, updated under subparagraph (B).”; and
(2) by adding at the end the following new clause:
“(iii) SPECIAL RULE IN CASE OF INABILITY TO EFFECT TIMELY REBASING.—
“(I) APPLICATION OF PROXY AMOUNT FOR 2011.—If the Secretary is not able to compute the amount (or amounts) under clause (i)(IV) so as to permit, on a timely basis, the application of such clause for 2011, the Secretary shall substitute for such amount (or amounts) 95 percent of the amount (or amounts) that would otherwise be specified under clause (i)(III) if it applied for 2011.
“(II) ADJUSTMENT FOR SUBSEQUENT YEARS BASED ON DATA.—If the Secretary applies subclause (I), the Secretary before July 1, 2011, shall compare the amount (or amounts) applied under such subclause with the amount (or amounts) that should have been applied under clause (i)(IV). The Secretary shall decrease or increase the prospective payment amount (or amounts) under clause (i)(V) for 2012 (or, at the Secretary’s discretion, over a period of several years beginning with 2012) by the amount (if any) by which the amount (or amounts) applied under subclause (I) is greater or less, respectively, than the amount (or amounts) that should have been applied under clause (i)(IV).”.
(a) In general.—Section 1895(b)(3)(B) of the Social Security Act (42 U.S.C. 1395fff(b)(3)(B)) is amended—
(1) in clause (iii), by inserting “(including being subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II))” after “in the same manner”; and
(2) in clause (v)(I), by inserting “(but not below 0)” after “reduced”.
(b) Effective date.—The amendment made by subsection (a) shall apply to home health market basket percentage increases for years beginning with 2010.
(a) In general.—Section 1877 of the Social Security Act (42 U.S.C. 1395nn) is amended—
(A) in subparagraph (A), by striking “and” at the end;
(B) in subparagraph (B), by striking the period at the end and inserting “; and”; and
(C) by adding at the end the following new subparagraph:
“(C) in the case where the entity is a hospital, the hospital meets the requirements of paragraph (3)(D).”;
(A) in subparagraph (B), by striking “and” at the end;
(B) in subparagraph (C), by striking the period at the end and inserting “; and”; and
(C) by adding at the end the following new subparagraph:
“(D) the hospital meets the requirements described in subsection (i)(1).”;
(3) by amending
subsection (f) to read as follows: “(f) Reporting and
disclosure requirements.— “(1) IN
GENERAL.—Each entity providing covered items or services for which
payment may be made under this title shall provide the Secretary with the
information concerning the entity's ownership, investment, and compensation
arrangements, including— “(A) the covered items
and services provided by the entity, and “(B) the names and
unique physician identification numbers of all physicians with an ownership or
investment interest (as described in subsection (a)(2)(A)), or with a
compensation arrangement (as described in subsection (a)(2)(B)), in the entity,
or whose immediate relatives have such an ownership or investment interest or
who have such a compensation relationship with the entity. Such
information shall be provided in such form, manner, and at such times as the
Secretary shall specify. The requirement of this subsection shall not apply to
designated health services provided outside the United States or to entities
which the Secretary determines provide services for which payment may be made
under this title very infrequently.
“(2) REQUIREMENTS FOR HOSPITALS WITH PHYSICIAN OWNERSHIP OR INVESTMENT.—In the case of a hospital that meets the requirements described in subsection (i)(1), the hospital shall—
“(A) submit to the Secretary an initial report, and periodic updates at a frequency determined by the Secretary, containing a detailed description of the identity of each physician owner and physician investor and any other owners or investors of the hospital;
“(B) require that any referring physician owner or investor discloses to the individual being referred, by a time that permits the individual to make a meaningful decision regarding the receipt of services, as determined by the Secretary, the ownership or investment interest, as applicable, of such referring physician in the hospital; and
“(C) disclose the fact that the hospital is partially or wholly owned by one or more physicians or has one or more physician investors—
“(i) on any public website for the hospital; and
“(ii) in any public advertising for the hospital.
The information to be reported or disclosed under this paragraph shall be provided in such form, manner, and at such times as the Secretary shall specify. The requirements of this paragraph shall not apply to designated health services furnished outside the United States or to entities which the Secretary determines provide services for which payment may be made under this title very infrequently.
“(3) PUBLICATION OF INFORMATION.—The Secretary shall publish, and periodically update, the information submitted by hospitals under paragraph (2)(A) on the public Internet website of the Centers for Medicare & Medicaid Services.”;
(4) by amending subsection (g)(5) to read as follows:
“(5) FAILURE TO REPORT OR DISCLOSE INFORMATION.—
“(A) REPORTING.—Any person who is required, but fails, to meet a reporting requirement of paragraphs (1) and (2)(A) of subsection (f) is subject to a civil money penalty of not more than $10,000 for each day for which reporting is required to have been made.
“(B) DISCLOSURE.—Any physician who is required, but fails, to meet a disclosure requirement of subsection (f)(2)(B) or a hospital that is required, but fails, to meet a disclosure requirement of subsection (f)(2)(C) is subject to a civil money penalty of not more than $10,000 for each case in which disclosure is required to have been made.
“(C) APPLICATION.—The provisions of section 1128A (other than the first sentence of subsection (a) and other than subsection (b)) shall apply to a civil money penalty under subparagraphs (A) and (B) in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).”; and
(5) by adding at the
end the following new subsection: “(i) Requirements To
qualify for rural provider and hospital ownership exceptions to self-referral
prohibition.— “(1) REQUIREMENTS
DESCRIBED.—For purposes of subsection (d)(3)(D), the requirements
described in this paragraph are as follows: “(A) PROVIDER
AGREEMENT.—The hospital had— “(i) physician
ownership or investment on January 1, 2009; and “(ii) a
provider agreement under section 1866 in effect on such date.
“(B) PROHIBITION ON PHYSICIAN OWNERSHIP OR INVESTMENT.—The percentage of the total value of the ownership or investment interests held in the hospital, or in an entity whose assets include the hospital, by physician owners or investors in the aggregate does not exceed such percentage as of the date of enactment of this subsection.
“(C) PROHIBITION ON EXPANSION OF FACILITY CAPACITY.—Except as provided in paragraph (2), the number of operating rooms, procedure rooms, or beds of the hospital at any time on or after the date of the enactment of this subsection are no greater than the number of operating rooms, procedure rooms, or beds, respectively, as of such date.
“(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT.—
“(i) Any ownership or investment interests that the hospital offers to a physician are not offered on more favorable terms than the terms offered to a person who is not in a position to refer patients or otherwise generate business for the hospital.
“(ii) The hospital (or any investors in the hospital) does not directly or indirectly provide loans or financing for any physician owner or investor in the hospital.
“(iii) The hospital (or any investors in the hospital) does not directly or indirectly guarantee a loan, make a payment toward a loan, or otherwise subsidize a loan, for any physician owner or investor or group of physician owners or investors that is related to acquiring any ownership or investment interest in the hospital.
“(iv) Ownership or investment returns are distributed to each owner or investor in the hospital in an amount that is directly proportional to the ownership or investment interest of such owner or investor in the hospital.
“(v) The investment interest of the owner or investor is directly proportional to the owner’s or investor’s capital contributions made at the time the ownership or investment interest is obtained.
“(vi) Physician owners and investors do not receive, directly or indirectly, any guaranteed receipt of or right to purchase other business interests related to the hospital, including the purchase or lease of any property under the control of other owners or investors in the hospital or located near the premises of the hospital.
“(vii) The hospital does not offer a physician owner or investor the opportunity to purchase or lease any property under the control of the hospital or any other owner or investor in the hospital on more favorable terms than the terms offered to a person that is not a physician owner or investor.
“(viii) The hospital does not condition any physician ownership or investment interests either directly or indirectly on the physician owner or investor making or influencing referrals to the hospital or otherwise generating business for the hospital.
“(E) PATIENT SAFETY.—In the case of a hospital that does not offer emergency services, the hospital has the capacity to—
“(i) provide assessment and initial treatment for medical emergencies; and
“(ii) if the hospital lacks additional capabilities required to treat the emergency involved, refer and transfer the patient with the medical emergency to a hospital with the required capability.
“(F) LIMITATION ON APPLICATION TO CERTAIN CONVERTED FACILITIES.—The hospital was not converted from an ambulatory surgical center to a hospital on or after the date of enactment of this subsection.
“(2) EXCEPTION TO PROHIBITION ON EXPANSION OF FACILITY CAPACITY.—
“(i) ESTABLISHMENT.—The Secretary shall establish and implement a process under which a hospital may apply for an exception from the requirement under paragraph (1)(C).
“(ii) OPPORTUNITY FOR COMMUNITY INPUT.—The process under clause (i) shall provide persons and entities in the community in which the hospital applying for an exception is located with the opportunity to provide input with respect to the application.
“(iii) TIMING FOR IMPLEMENTATION.—The Secretary shall implement the process under clause (i) on the date that is one month after the promulgation of regulations described in clause (iv).
“(iv) REGULATIONS.—Not later than the first day of the month beginning 18 months after the date of the enactment of this subsection, the Secretary shall promulgate regulations to carry out the process under clause (i). The Secretary may issue such regulations as interim final regulations.
“(B) FREQUENCY.—The process described in subparagraph (A) shall permit a hospital to apply for an exception up to once every 2 years.
“(i) IN GENERAL.—Subject to clause (ii) and subparagraph (D), a hospital granted an exception under the process described in subparagraph (A) may increase the number of operating rooms, procedure rooms, or beds of the hospital above the baseline number of operating rooms, procedure rooms, or beds, respectively, of the hospital (or, if the hospital has been granted a previous exception under this paragraph, above the number of operating rooms, procedure rooms, or beds, respectively, of the hospital after the application of the most recent increase under such an exception).
“(ii) 100 PERCENT INCREASE LIMITATION.—The Secretary shall not permit an increase in the number of operating rooms, procedure rooms, or beds of a hospital under clause (i) to the extent such increase would result in the number of operating rooms, procedure rooms, or beds of the hospital exceeding 200 percent of the baseline number of operating rooms, procedure rooms, or beds of the hospital.
“(iii) BASELINE NUMBER OF OPERATING ROOMS, PROCEDURE ROOMS, OR BEDS.—In this paragraph, the term ‘baseline number of operating rooms, procedure rooms, or beds’ means the number of operating rooms, procedure rooms, or beds of a hospital as of the date of enactment of this subsection.
“(D) INCREASE LIMITED TO FACILITIES ON THE MAIN CAMPUS OF THE HOSPITAL.—Any increase in the number of operating rooms, procedure rooms, or beds of a hospital pursuant to this paragraph may only occur in facilities on the main campus of the hospital.
“(E) CONDITIONS FOR APPROVAL OF AN INCREASE IN FACILITY CAPACITY.—The Secretary may grant an exception under the process described in subparagraph (A) only to a hospital—
“(i) that is located in a county in which the percentage increase in the population during the most recent 5-year period for which data are available is estimated to be at least 150 percent of the percentage increase in the population growth of the State in which the hospital is located during that period, as estimated by Bureau of the Census and available to the Secretary;
“(ii) whose annual percent of total inpatient admissions that represent inpatient admissions under the program under title XIX is estimated to be equal to or greater than the average percent with respect to such admissions for all hospitals located in the county in which the hospital is located;
“(iii) that does not discriminate against beneficiaries of Federal health care programs and does not permit physicians practicing at the hospital to discriminate against such beneficiaries;
“(iv) that is located in a State in which the average bed capacity in the State is estimated to be less than the national average bed capacity;
“(v) that has an average bed occupancy rate that is estimated to be greater than the average bed occupancy rate in the State in which the hospital is located; and
“(vi) that meets other conditions as determined by the Secretary.
“(F) PROCEDURE ROOMS.—In this subsection, the term ‘procedure rooms’ includes rooms in which catheterizations, angiographies, angiograms, and endoscopies are furnished, but such term shall not include emergency rooms or departments (except for rooms in which catheterizations, angiographies, angiograms, and endoscopies are furnished).
“(G) PUBLICATION OF FINAL DECISIONS.—Not later than 120 days after receiving a complete application under this paragraph, the Secretary shall publish on the public Internet website of the Centers for Medicare & Medicaid Services the final decision with respect to such application.
“(H) LIMITATION ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of the exception process under this paragraph, including the establishment of such process, and any determination made under such process.
“(3) PHYSICIAN OWNER OR INVESTOR DEFINED.—For purposes of this subsection and subsection (f)(2), the term ‘physician owner or investor’ means a physician (or an immediate family member of such physician) with a direct or an indirect ownership or investment interest in the hospital.
“(4) PATIENT SAFETY REQUIREMENT.—In the case of a hospital to which the requirements of paragraph (1) apply, insofar as the hospital admits a patient and does not have any physician available on the premises 24 hours per day, 7 days per week, before admitting the patient—
“(A) the hospital shall disclose such fact to the patient; and
“(B) following such disclosure, the hospital shall receive from the patient a signed acknowledgment that the patient understands such fact.
“(5) CLARIFICATION.—Nothing in this subsection shall be construed as preventing the Secretary from terminating a hospital’s provider agreement if the hospital is not in compliance with regulations pursuant to section 1866.”.
(b) Verifying compliance.—The Secretary of Health and Human Services shall establish policies and procedures to verify compliance with the requirements described in subsections (i)(1) and (i)(4) of section 1877 of the Social Security Act, as added by subsection (a)(5). The Secretary may use unannounced site reviews of hospitals and audits to verify compliance with such requirements.
(1) FUNDING.—For purposes of carrying out the amendments made by subsection (a) and the provisions of subsection (b), in addition to funds otherwise available, out of any funds in the Treasury not otherwise appropriated there are appropriated to the Secretary of Health and Human Services for the Centers for Medicare & Medicaid Services Program Management Account $5,000,000 for each fiscal year beginning with fiscal year 2010. Amounts appropriated under this paragraph for a fiscal year shall be available until expended.
(2) ADMINISTRATION.—Chapter 35 of title 44, United States Code, shall not apply to the amendments made by subsection (a) and the provisions of subsection (b).
(a) In general.—The Secretary of Health and Human Services shall enter into a contract with the Institute of Medicine of the National Academy of Science to conduct a comprehensive empirical study, and provide recommendations as appropriate, on the accuracy of the geographic adjustment factors established under sections 1848(e) and 1886(d)(3)(E) of the Social Security Act (42 U.S.C. 1395w–4(e), 11395ww(d)(3)).
(b) Matters included.—Such study shall include an evaluation and assessment of the following with respect to such adjustment factors:
(1) Empirical validity of the adjustment factors.
(2) Methodology used to determine the adjustment factors.
(3) Measures used for the adjustment factors, taking into account—
(A) timeliness of data and frequency of revisions to such data;
(B) sources of data and the degree to which such data are representative of costs; and
(C) operational costs of providers who participate in Medicare.
(c) Evaluation.—Such study shall, within the context of the United States health care marketplace, evaluate and consider the following:
(1) The effect of the adjustment factors on the level and distribution of the health care workforce and resources, including—
(A) recruitment and retention that takes into account workforce mobility between urban and rural areas;
(B) ability of hospitals and other facilities to maintain an adequate and skilled workforce; and
(C) patient access to providers and needed medical technologies.
(2) The effect of the adjustment factors on population health and quality of care.
(3) The effect of the adjustment factors on the ability of providers to furnish efficient, high value care.
(d) Report.—The contract under subsection (a) shall provide for the Institute of Medicine to submit, not later than one year after the date of the enactment of this Act, to the Secretary and the Congress a report containing results and recommendations of the study conducted under this section.
(e) Funding.—There are authorized to be appropriated to carry out this section such sums as may be necessary.
(a) In general.—The Secretary of Health and Human Services, taking into account the recommendations made in the report under section 1157(d), shall include in the proposed rules published to implement changes to payment systems for physicians and hospitals under sections 1848(e) and 1886(d)(3)(E), respectively, of the Social Security Act, proposals to revise geographic adjustment factors for such payment systems for services furnished under the Medicare program. Such proposed rules shall be published in the rulemaking period immediately following submission of the report under section 1157(d).
(1) FUNDING FOR IMPROVEMENTS.—In making any changes to the geographic adjustment factors in accordance with subsection (a), the Secretary shall use funds made available for such purposes under subsection (c).
(2) ENSURING FAIRNESS.—In carrying out this subsection, the Secretary shall not change payment rates to be less than they would have been had this section not been enacted.
(c) Funding.—Amounts in the Medicare Improvement Fund under section 1898 of the Social Security Act (42 U.S.C. 1395iii), as amended by section 1146, shall be available to the Secretary to make changes to the geographic adjustments factors established under sections 1848(e) and 1886(d)(3)(E) of the Social Security Act. For such purpose, such funds shall be available for expenditure for services furnished before January 1, 2014, and shall not exceed the total amounts available under such Fund for such period. No more than one-half of such amounts shall be available for expenditure for services furnished in any one payment year.
Section 1853 of the Social Security Act (42 U.S.C. 1395w–23) is amended—
(A) by striking “beginning with 2007” and inserting “for 2007, 2008, 2009, and 2010”; and
(B) by inserting after “(k)(1)” the following: “, or, beginning with 2011, 1⁄12 of the blended benchmark amount determined under subsection (n)(1)”; and
(2) by adding at the
end the following new subsection: “(n) Determination of
blended benchmark amount.— “(1) IN
GENERAL.—For purposes of subsection (j), subject to paragraphs (3)
and (4), the term ‘blended benchmark amount’ means for an
area— “(i) 2⁄3
of the applicable amount (as defined in subsection (k)) for the area and year;
and “(ii) 1⁄3
of the amount specified in paragraph (2) for the area and year;
“(i) 1⁄3 of the applicable amount for the area and year; and
“(ii) 2⁄3 of the amount specified in paragraph (2) for the area and year; and
“(C) for a subsequent year the amount specified in paragraph (2) for the area and year.
“(2) SPECIFIED AMOUNT.—The amount specified in this paragraph for an area and year is the amount specified in subsection (c)(1)(D)(i) for the area and year adjusted (in a manner specified by the Secretary) to take into account the phase-out in the indirect costs of medical education from capitation rates described in subsection (k)(4).
“(3) FEE-FOR-SERVICE PAYMENT FLOOR.—In no case shall the blended benchmark amount for an area and year be less than the amount specified in paragraph (2).
“(4) EXCEPTION FOR PACE PLANS.—This subsection shall not apply to payments to a PACE program under section 1894.”.
(a) In general.—Section 1853 of the Social Security Act (42 U.S.C. 1395w–23), as amended by section 1161, is amended—
(1) in subsection (j), by inserting “subject to subsection (o),” after “For purposes of this part”; and
(2) by adding at the
end the following new subsection: “(o) Quality based
payment adjustment.— “(1) HIGH QUALITY
PLAN ADJUSTMENT.—For years
beginning with 2011, in the case of a Medicare Advantage plan that is
identified (under paragraph (3)(E)(ii)) as a high quality MA plan with respect
to the year, the blended benchmark amount under subsection (n)(1) shall be
increased— “(A) for 2011, by 1.0
percent; “(B) for 2012, by 2.0
percent; and “(C) for a subsequent
year, by 3.0 percent.
“(2) IMPROVED QUALITY PLAN ADJUSTMENT.—For years beginning with 2011, in the case of a Medicare Advantage plan that is identified (under paragraph (3)(E)(iii)) as an improved quality MA plan with respect to the year, blended benchmark amount under subsection (n)(1) shall be increased—
“(A) for 2011, by 0.33 percent;
“(B) for 2012, by 0.66 percent; and
“(C) for a subsequent year, by 1.0 percent.
“(3) DETERMINATIONS OF QUALITY.—
“(A) QUALITY PERFORMANCE.—The Secretary shall provide for the computation of a quality performance score for each Medicare Advantage plan to be applied for each year beginning with 2010.
“(i) FOR YEARS BEFORE 2014.—For years before 2014, the quality performance score for a Medicare Advantage plan shall be computed based on a blend (as designated by the Secretary) of the plan’s performance on—
“(I) HEDIS effectiveness of care quality measures;
“(II) CAHPS quality measures; and
“(III) such other measures of clinical quality as the Secretary may specify.
Such measures shall be risk-adjusted as the Secretary deems appropriate.
“(ii) ESTABLISHMENT OF OUTCOME-BASED MEASURES.—By not later than for 2013 the Secretary shall implement reporting requirements for quality under this section on measures selected under clause (iii) that reflect the outcomes of care experienced by individuals enrolled in Medicare Advantage plans (in addition to measures described in clause (i)). Such measures may include—
“(I) measures of rates of admission and readmission to a hospital;
“(II) measures of prevention quality, such as those established by the Agency for Healthcare Research and Quality (that include hospital admission rates for specified conditions);
“(III) measures of patient mortality and morbidity following surgery;
“(IV) measures of health functioning (such as limitations on activities of daily living) and survival for patients with chronic diseases;
“(V) measures of patient safety; and
“(VI) other measure of outcomes and patient quality of life as determined by the Secretary.
Such measures shall be risk-adjusted as the Secretary deems appropriate. In determining the quality measures to be used under this clause, the Secretary shall take into consideration the recommendations of the Medicare Payment Advisory Commission in its report to Congress under section 168 of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110–275) and shall provide preference to measures collected on and comparable to measures used in measuring quality under parts A and B.
“(iii) RULES FOR SELECTION OF MEASURES.—The Secretary shall select measures for purposes of clause (ii) consistent with the following:
“(I) The Secretary shall provide preference to clinical quality measures that have been endorsed by the entity with a contract with the Secretary under section 1890(a).
“(II) Prior to any measure being selected under this clause, the Secretary shall publish in the Federal Register such measure and provide for a period of public comment on such measure.
“(iv) TRANSITIONAL USE OF BLEND.—For payments for 2014 and 2015, the Secretary may compute the quality performance score for a Medicare Advantage plan based on a blend of the measures specified in clause (i) and the measures described in clause (ii) and selected under clause (iii).
“(v) USE OF QUALITY OUTCOMES MEASURES.—For payments beginning with 2016, the preponderance of measures used under this paragraph shall be quality outcomes measures described in clause (ii) and selected under clause (iii).
“(C) DATA USED IN COMPUTING SCORE.—Such score for application for—
“(i) payments in 2011 shall be based on quality performance data for plans for 2009; and
“(ii) payments in 2012 and a subsequent year shall be based on quality performance data for plans for the second preceding year.
“(D) REPORTING OF DATA.—Each Medicare Advantage organization shall provide for the reporting to the Secretary of quality performance data described in subparagraph (B) (in order to determine a quality performance score under this paragraph) in such time and manner as the Secretary shall specify.
“(i) INITIAL RANKING.—Based on the quality performance score described in subparagraph (B) achieved with respect to a year, the Secretary shall rank plan performance—
“(I) from highest to lowest based on absolute scores; and
“(II) from highest to lowest based on percentage improvement in the score for the plan from the previous year.
A plan which does not report quality performance data under subparagraph (D) shall be counted, for purposes of such ranking, as having the lowest plan performance and lowest percentage improvement.
“(ii) IDENTIFICATION OF HIGH QUALITY PLANS IN TOP QUINTILE BASED ON PROJECTED ENROLLMENT.—The Secretary shall, based on the scores for each plan under clause (i)(I) and the Secretary’s projected enrollment for each plan and subject to clause (iv), identify those Medicare Advantage plans with the highest score that, based upon projected enrollment, are projected to include in the aggregate 20 percent of the total projected enrollment for the year. For purposes of this subsection, a plan so identified shall be referred to in this subsection as a ‘high quality MA plan’.
“(iii) IDENTIFICATION OF IMPROVED QUALITY PLANS IN TOP QUINTILE BASED ON PROJECTED ENROLLMENT.—The Secretary shall, based on the percentage improvement score for each plan under clause (i)(II) and the Secretary’s projected enrollment for each plan and subject to clause (iv), identify those Medicare Advantage plans with the greatest percentage improvement score that, based upon projected enrollment, are projected to include in the aggregate 20 percent of the total projected enrollment for the year. For purposes of this subsection, a plan so identified that is not a high quality plan for the year shall be referred to in this subsection as an ‘improved quality MA plan’.
“(iv) AUTHORITY TO DISQUALIFY CERTAIN PLANS.—In applying clauses (ii) and (iii), the Secretary may determine not to identify a Medicare Advantage plan if the Secretary has identified deficiencies in the plan’s compliance with rules for such plans under this part.
“(F) NOTIFICATION.—The Secretary, in the annual announcement required under subsection (b)(1)(B) in 2011 and each succeeding year, shall notify the Medicare Advantage organization that is offering a high quality plan or an improved quality plan of such identification for the year and the quality performance payment adjustment for such plan for the year. The Secretary shall provide for publication on the website for the Medicare program of the information described in the previous sentence.”.
Section 1853(a)(1)(C)(ii) of the Social Security Act (42 U.S.C. 1395w–23(a)(1)(C)(ii)) is amended—
(1) in the matter before subclause (I), by striking “through 2010” and inserting “and each subsequent year”; and
(A) by inserting “periodically” before “conduct an analysis”;
(B) by inserting “on a timely basis” after “are incorporated”; and
(C) by striking “only for 2008, 2009, and 2010” and inserting “for 2008 and subsequent years”.
(a) 2 week processing period for annual enrollment period (AEP).—Paragraph (3)(B) of section 1851(e) of the Social Security Act (42 U.S.C. 1395w–21(e)) is amended—
(1) by striking “and” at the end of clause (iii);
(A) by striking “and succeeding years” and inserting “, 2008, 2009, and 2010”; and
(B) by striking the period at the end and inserting “; and”; and
(3) by adding at the end the following new clause:
“(v) with respect to 2011 and succeeding years, the period beginning on November 1 and ending on December 15 of the year before such year.”.
(b) Elimination of 3-month additional open enrollment period (OEP).—Effective for plan years beginning with 2011, paragraph (2) of such section is amended by striking subparagraph (C).
Section 1876(h)(5)(C) of the Social Security Act (42 U.S.C. 1395mm(h)(5)(C)) is amended—
(1) in clause (ii), by striking “January 1, 2010” and inserting “January 1, 2012”; and
(2) in clause (iii), by striking “the service area for the year” and inserting “the portion of the plan’s service area for the year that is within the service area of a reasonable cost reimbursement contract”.
(a) In general.—The first sentence of paragraph (2) of section 1857(i) of the Social Security Act (42 U.S.C. 1395w–27(i)) is amended by inserting before the period at the end the following: “, but only if 90 percent of the Medicare Advantage eligible individuals enrolled under such plan reside in a county in which the MA organization offers an MA local plan”.
(b) Effective date.—The amendment made by subsection (a) shall apply for plan years beginning on or after January 1, 2011, and shall not apply to plans which were in effect as of December 31, 2010.
(a) Report to Congress.—Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report that evaluates the adequacy of the risk adjustment system under section 1853(a)(1)(C) of the Social Security Act (42 U.S.C. 1395–23(a)(1)(C)) in predicting costs for beneficiaries with chronic or co-morbid conditions, beneficiaries dually-eligible for Medicare and Medicaid, and non-Medicaid eligible low-income beneficiaries; and the need and feasibility of including further gradations of diseases or conditions and multiple years of beneficiary data.
(b) Improvements to Risk Adjustment.—Not later than January 1, 2012, the Secretary shall implement necessary improvements to the risk adjustment system under section 1853(a)(1)(C) of the Social Security Act (42 U.S.C. 1395–23(a)(1)(C)), taking into account the evaluation under subsection (a).
(a) In general.—Section 1858 of the Social Security Act (42 U.S.C. 1395w–27a) is amended by striking subsection (e).
(b) Transition.—Any amount contained in the MA Regional Plan Stabilization Fund as of the date of the enactment of this Act shall be transferred to the Federal Supplementary Medical Insurance Trust Fund.
(a) In general.—Section 1852(a)(1) of the Social Security Act (42 U.S.C. 1395w–22(a)(1)) is amended—
(1) in subparagraph (A), by inserting before the period at the end the following: “with cost-sharing that is no greater (and may be less) than the cost-sharing that would otherwise be imposed under such program option”;
(2) in subparagraph (B)(i), by striking “or an actuarially equivalent level of cost-sharing as determined in this part”; and
(3) by amending clause (ii) of subparagraph (B) to read as follows:
“(ii) PERMITTING USE OF FLAT COPAYMENT OR PER DIEM RATE.—Nothing in clause (i) shall be construed as prohibiting a Medicare Advantage plan from using a flat copayment or per diem rate, in lieu of the cost-sharing that would be imposed under part A or B, so long as the amount of the cost-sharing imposed does not exceed the amount of the cost-sharing that would be imposed under the respective part if the individual were not enrolled in a plan under this part.”.
(b) Limitation for dual eligibles and qualified medicare beneficiaries.—Section 1852(a) of such Act is amended by adding at the end the following new paragraph:
“(7) LIMITATION ON COST-SHARING FOR DUAL ELIGIBLES AND QUALIFIED MEDICARE BENEFICIARIES.—In the case of a individual who is a full-benefit dual eligible individual (as defined in section 1935(c)(6)) or a qualified medicare beneficiary (as defined in section 1905(p)(1)) who is enrolled in a Medicare Advantage plan, the plan may not impose cost-sharing that exceeds the amount of cost-sharing that would be permitted with respect to the individual under this title and title XIX if the individual were not enrolled with such plan.”.
(1) The amendments made by subsection (a) shall apply to plan years beginning on or after January 1, 2011.
(2) The amendments made by subsection (b) shall apply to plan years beginning on or after January 1, 2011.
Section 1851(e)(4) of the Social Security Act (42 U.S.C. 1395w(e)(4)) is amended—
(1) in subparagraph (C), by striking at the end “or”;
(A) by inserting “, taking into account the health or well-being of the individual” before the period; and
(B) by redesignating such subparagraph as subparagraph (E); and
(3) by inserting after subparagraph (C) the following new subparagraph:
“(D) the individual is enrolled in an MA plan and enrollment in the plan is suspended under paragraph (2)(B) or (3)(C) of section 1857(g) because of a failure of the plan to meet applicable requirements; or”.
(a) Disclosure of medical loss ratios and other expense data.—Section 1851 of the Social Security Act (42 U.S.C. 1395w–21), as previously amended by this subtitle, is amended by adding at the end the following new subsection:
“(p) Publication of medical loss ratios and other cost-related information.—
“(1) IN GENERAL.—The Secretary shall publish, not later than November 1 of each year (beginning with 2011), for each MA plan contract, the medical loss ratio of the plan in the previous year.
“(A) IN GENERAL.—Each MA organization shall submit to the Secretary, in a form and manner specified by the Secretary, data necessary for the Secretary to publish the medical loss ratio on a timely basis.
“(B) DATA FOR 2010 AND 2011.—The data submitted under subparagraph (A) for 2010 and for 2011 shall be consistent in content with the data reported as part of the MA plan bid in June 2009 for 2010.
“(C) USE OF STANDARDIZED ELEMENTS AND DEFINITIONS.—The data to be submitted under subparagraph (A) relating to medical loss ratio for a year, beginning with 2012, shall be submitted based on the standardized elements and definitions developed under paragraph (3).
“(3) DEVELOPMENT OF DATA REPORTING STANDARDS.—
“(A) IN GENERAL.—The Secretary shall develop and implement standardized data elements and definitions for reporting under this subsection, for contract years beginning with 2012, of data necessary for the calculation of the medical loss ratio for MA plans. Not later than December 31, 2010, the Secretary shall publish a report describing the elements and definitions so developed.
“(B) CONSULTATION.—The Secretary shall consult with the Health Choices Commissioner, representatives of MA organizations, experts on health plan accounting systems, and representatives of the National Association of Insurance Commissioners, in the development of such data elements and definitions.
“(4) MEDICAL LOSS RATIO TO BE DEFINED.—For purposes of this part, the term ‘medical loss ratio’ has the meaning given such term by the Secretary, taking into account the meaning given such term by the Health Choices Commissioner under section 116 of the America’s Affordable Health Choices Act of 2009.”.
(b) Minimum medical loss ratio.—Section 1857(e) of the Social Security Act (42 U.S.C. 1395w–27(e)) is amended by adding at the end the following new paragraph:
“(4) REQUIREMENT FOR MINIMUM MEDICAL LOSS RATIO.—If the Secretary determines for a contract year (beginning with 2014) that an MA plan has failed to have a medical loss ratio (as defined in section 1851(p)(4)) of at least .85—
“(A) the Secretary shall require the Medicare Advantage organization offering the plan to give enrollees a rebate (in the second succeeding contract year) of premiums under this part (or part B or part D, if applicable) by such amount as would provide for a benefits ratio of at least .85;
“(B) for 3 consecutive contract years, the Secretary shall not permit the enrollment of new enrollees under the plan for coverage during the second succeeding contract year; and
“(C) the Secretary shall terminate the plan contract if the plan fails to have such a medical loss ratio for 5 consecutive contract years.”.
(a) For part C payments risk adjustment.—Section 1857(d)(1) of the Social Security Act (42 U.S.C. 1395w–27(d)(1)) is amended by inserting after “section 1858(c))” the following: “, and data submitted with respect to risk adjustment under section 1853(a)(3)”.
(b) Enforcement of audits and deficiencies.—
(1) IN GENERAL.—Section 1857(e) of such Act, as amended by section 1173, is amended by adding at the end the following new paragraph:
“(5) ENFORCEMENT OF AUDITS AND DEFICIENCIES.—
“(A) INFORMATION IN CONTRACT.—The Secretary shall require that each contract with an MA organization under this section shall include terms that inform the organization of the provisions in subsection (d).
“(B) ENFORCEMENT AUTHORITY.—The Secretary is authorized, in connection with conducting audits and other activities under subsection (d), to take such actions, including pursuit of financial recoveries, necessary to address deficiencies identified in such audits or other activities.”.
(2) APPLICATION UNDER PART D.—For provision applying the amendment made by paragraph (1) to prescription drug plans under part D, see section 1860D–12(b)(3)(D) of the Social Security Act.
(c) Effective date.—The amendments made by this section shall take effect on the date of the enactment of this Act and shall apply to audits and activities conducted for contract years beginning on or after January 1, 2011.
(a) In general.—Section 1854(a)(5) of the Social Security Act (42 U.S.C. 1395w–24(a)(5)) is amended by adding at the end the following new subparagraph:
“(C) REJECTION OF BIDS.—Nothing in this section shall be construed as requiring the Secretary to accept any or every bid by an MA organization under this subsection.”.
(b) Application under part D.—Section 1860D–11(d) of such Act (42 U.S.C. 1395w–111(d)) is amended by adding at the end the following new paragraph:
“(3) REJECTION OF BIDS.—Paragraph (5)(C) of section 1854(a) shall apply with respect to bids under this section in the same manner as it applies to bids by an MA organization under such section.”.
(c) Effective date.—The amendments made by this section shall apply to bids for contract years beginning on or after January 1, 2011.
Section 1859(f)(4) of the Social Security Act (42 U.S.C. 1395w–28(f)(4)) is amended by adding at the end the following new subparagraph:
“(C) The plan does not enroll an individual on or after January 1, 2011, other than during an annual, coordinated open enrollment period or when at the time of the diagnosis of the disease or condition that qualifies the individual as an individual described in subsection (b)(6)(B)(iii).”.
(a) In general.—Section 1859(f)(1) of the Social Security Act (42 U.S.C. 1395w–28(f)(1)) is amended by striking “January 1, 2011” and inserting “January 1, 2013 (or January 1, 2016, in the case of a plan described in section 1177(b)(1) of the America’s Affordable Health Choices Act of 2009)”.
(b) Grandfathering of certain plans.—
(1) PLANS DESCRIBED.—For purposes of section 1859(f)(1) of the Social Security Act (42 U.S.C. 1395w–28(f)(1)), a plan described in this paragraph is a plan that had a contract with a State that had a State program to operate an integrated Medicaid-Medicare program that had been approved by the Centers for Medicare & Medicaid Services as of January 1, 2004.
(2) ANALYSIS; REPORT.—The Secretary of Health and Human Services shall provide, through a contract with an independent health services evaluation organization, for an analysis of the plans described in paragraph (1) with regard to the impact of such plans on cost, quality of care, patient satisfaction, and other subjects as specified by the Secretary. Not later than December 31, 2011, the Secretary shall submit to Congress a report on such analysis and shall include in such report such recommendations with regard to the treatment of such plans as the Secretary deems appropriate.
(a) In general.—Section 1860D–2(b) of such Act (42 U.S.C. 1395w–102(b)) is amended—
(1) in paragraph (3)(A), by striking “paragraph (4)” and inserting “paragraphs (4) and (7)”;
(2) in paragraph (4)(B)(i), by inserting “subject to paragraph (7)” after “purposes of this part”; and
(3) by adding at the end the following new paragraph:
“(7) PHASED-IN ELIMINATION OF COVERAGE GAP.—
“(A) IN GENERAL.—For each year beginning with 2011, the Secretary shall consistent with this paragraph progressively increase the initial coverage limit (described in subsection (b)(3)) and decrease the annual out-of-pocket threshold from the amounts otherwise computed until there is a continuation of coverage from the initial coverage limit for expenditures incurred through the total amount of expenditures at which benefits are available under paragraph (4).
“(B) INCREASE IN INITIAL COVERAGE LIMIT.—For a year beginning with 2011, the initial coverage limit otherwise computed without regard to this paragraph shall be increased by ½ of the cumulative phase-in percentage (as defined in subparagraph (D)(ii) for the year) times the out-of-pocket gap amount (as defined in subparagraph (E)) for the year.
“(C) DECREASE IN ANNUAL OUT-OF-POCKET THRESHOLD.—For a year beginning with 2011, the annual out-of-pocket threshold otherwise computed without regard to this paragraph shall be decreased by ½ of the cumulative phase-in percentage of the out-of-pocket gap amount for the year multiplied by 1.75.
“(D) PHASE–IN.—For purposes of this paragraph:
“(i) ANNUAL PHASE-IN PERCENTAGE.—The term ‘annual phase-in percentage’ means—
“(I) for 2011, 13 percent;
“(II) for 2012, 2013, 2014, and 2015, 5 percent;
“(III) for 2016 through 2018, 7.5 percent; and
“(IV) for 2019 and each subsequent year, 10 percent.
“(ii) CUMULATIVE PHASE-IN PERCENTAGE.—The term ‘cumulative phase-in percentage’ means for a year the sum of the annual phase-in percentage for the year and the annual phase-in percentages for each previous year beginning with 2011, but in no case more than 100 percent.
“(E) OUT-OF-POCKET GAP AMOUNT.—For purposes of this paragraph, the term ‘out-of-pocket gap amount’ means for a year the amount by which—
“(i) the annual out-of-pocket threshold specified in paragraph (4)(B) for the year (as determined as if this paragraph did not apply), exceeds
“(I) the annual deductible under paragraph (1) for the year; and
“(II) 1⁄4 of the amount by which the initial coverage limit under paragraph (3) for the year (as determined as if this paragraph did not apply) exceeds such annual deductible.”.
(b) Requiring drug manufacturers To provide drug rebates for full-Benefit dual eligibles.—
(1) IN GENERAL.—Section 1860D–2 of the Social Security Act (42 U.S.C. 1396r–8) is amended—
(A) in subsection (e)(1), in the matter before subparagraph (A), by inserting “and subsection (f)” after “this subsection”; and
(B) by adding at the end the following new subsection:
“(f) Prescription drug rebate agreement for full-Benefit dual eligible individuals.—
“(1) IN GENERAL.—In this part, the term ‘covered part D drug’ does not include any drug or biologic that is manufactured by a manufacturer that has not entered into and have in effect a rebate agreement described in paragraph (2).
“(2) REBATE AGREEMENT.—A rebate agreement under this subsection shall require the manufacturer to provide to the Secretary a rebate for each rebate period (as defined in paragraph (6)(B)) ending after December 31, 2010, in the amount specified in paragraph (3) for any covered part D drug of the manufacturer dispensed after December 31, 2010, to any full-benefit dual eligible individual (as defined in paragraph (6)(A)) for which payment was made by a PDP sponsor under part D or a MA organization under part C for such period. Such rebate shall be paid by the manufacturer to the Secretary not later than 30 days after the date of receipt of the information described in section 1860D–12(b)(7), including as such section is applied under section 1857(f)(3).
“(3) REBATE FOR FULL-BENEFIT DUAL ELIGIBLE MEDICARE DRUG PLAN ENROLLEES.—
“(A) IN GENERAL.—The amount of the rebate specified under this paragraph for a manufacturer for a rebate period, with respect to each dosage form and strength of any covered part D drug provided by such manufacturer and dispensed to a full-benefit dual eligible individual, shall be equal to the product of—
“(i) the total number of units of such dosage form and strength of the drug so provided and dispensed for which payment was made by a PDP sponsor under part D or a MA organization under part C for the rebate period (as reported under section 1860D–12(b)(7), including as such section is applied under section 1857(f)(3)); and
“(ii) the amount (if any) by which—
“(I) the Medicaid rebate amount (as defined in subparagraph (B)) for such form, strength, and period, exceeds
“(II) the average Medicare drug program full-benefit dual eligible rebate amount (as defined in subparagraph (C)) for such form, strength, and period.
“(B) MEDICAID REBATE AMOUNT.—For purposes of this paragraph, the term ‘Medicaid rebate amount’ means, with respect to each dosage form and strength of a covered part D drug provided by the manufacturer for a rebate period—
“(i) in the case of a single source drug or an innovator multiple source drug, the amount specified in paragraph (1)(A)(ii) of section 1927(b) plus the amount, if any, specified in paragraph (2)(A)(ii) of such section, for such form, strength, and period; or
“(ii) in the case of any other covered outpatient drug, the amount specified in paragraph (3)(A)(i) of such section for such form, strength, and period.
“(C) AVERAGE MEDICARE DRUG PROGRAM FULL-BENEFIT DUAL ELIGIBLE REBATE AMOUNT.—For purposes of this subsection, the term ‘average Medicare drug program full-benefit dual eligible rebate amount’ means, with respect to each dosage form and strength of a covered part D drug provided by a manufacturer for a rebate period, the sum, for all PDP sponsors under part D and MA organizations administering a MA–PD plan under part C, of—
“(i) the product, for each such sponsor or organization, of—
“(I) the sum of all rebates, discounts, or other price concessions (not taking into account any rebate provided under paragraph (2) for such dosage form and strength of the drug dispensed, calculated on a per-unit basis, but only to the extent that any such rebate, discount, or other price concession applies equally to drugs dispensed to full-benefit dual eligible Medicare drug plan enrollees and drugs dispensed to PDP and MA–PD enrollees who are not full-benefit dual eligible individuals; and
“(II) the number of the units of such dosage and strength of the drug dispensed during the rebate period to full-benefit dual eligible individuals enrolled in the prescription drug plans administered by the PDP sponsor or the MA–PD plans administered by the MA–PD organization; divided by
“(ii) the total number of units of such dosage and strength of the drug dispensed during the rebate period to full-benefit dual eligible individuals enrolled in all prescription drug plans administered by PDP sponsors and all MA–PD plans administered by MA–PD organizations.
“(4) LENGTH OF AGREEMENT.—The provisions of paragraph (4) of section 1927(b) (other than clauses (iv) and (v) of subparagraph (B)) shall apply to rebate agreements under this subsection in the same manner as such paragraph applies to a rebate agreement under such section.
“(5) OTHER TERMS AND CONDITIONS.—The Secretary shall establish other terms and conditions of the rebate agreement under this subsection, including terms and conditions related to compliance, that are consistent with this subsection.
“(6) DEFINITIONS.—In this subsection and section 1860D–12(b)(7):
“(A) FULL-BENEFIT DUAL ELIGIBLE INDIVIDUAL.—The term ‘full-benefit dual eligible individual’ has the meaning given such term in section 1935(c)(6).
“(B) REBATE PERIOD.—The term ‘rebate period’ has the meaning given such term in section 1927(k)(8).”.
(2) REPORTING REQUIREMENT FOR THE DETERMINATION AND PAYMENT OF REBATES BY MANUFACTURES RELATED TO REBATE FOR FULL-BENEFIT DUAL ELIGIBLE MEDICARE DRUG PLAN ENROLLEES.—
(A) REQUIREMENTS FOR PDP SPONSORS.—Section 1860D–12(b) of the Social Security Act (42 U.S.C. 1395w–112(b)) is amended by adding at the end the following new paragraph:
“(7) REPORTING REQUIREMENT FOR THE DETERMINATION AND PAYMENT OF REBATES BY MANUFACTURERS RELATED TO REBATE FOR FULL-BENEFIT DUAL ELIGIBLE MEDICARE DRUG PLAN ENROLLEES.—
“(A) IN GENERAL.—For purposes of the rebate under section 1860D–2(f) for contract years beginning on or after January 1, 2011, each contract entered into with a PDP sponsor under this part with respect to a prescription drug plan shall require that the sponsor comply with subparagraphs (B) and (C).
“(B) REPORT FORM AND CONTENTS.—Not later than 60 days after the end of each rebate period (as defined in section 1860D–2(f)(6)(B)) within such a contract year to which such section applies, a PDP sponsor of a prescription drug plan under this part shall report to each manufacturer—
“(i) information (by National Drug Code number) on the total number of units of each dosage, form, and strength of each drug of such manufacturer dispensed to full-benefit dual eligible Medicare drug plan enrollees under any prescription drug plan operated by the PDP sponsor during the rebate period;
“(ii) information on the price discounts, price concessions, and rebates for such drugs for such form, strength, and period;
“(iii) information on the extent to which such price discounts, price concessions, and rebates apply equally to full-benefit dual eligible Medicare drug plan enrollees and PDP enrollees who are not full-benefit dual eligible Medicare drug plan enrollees; and
“(iv) any additional information that the Secretary determines is necessary to enable the Secretary to calculate the average Medicare drug program full-benefit dual eligible rebate amount (as defined in paragraph (3)(C) of such section), and to determine the amount of the rebate required under this section, for such form, strength, and period.
Such report shall be in a form consistent with a standard reporting format established by the Secretary.
“(C) SUBMISSION TO SECRETARY.—Each PDP sponsor shall promptly transmit a copy of the information reported under subparagraph (B) to the Secretary for the purpose of audit oversight and evaluation.
“(D) CONFIDENTIALITY OF INFORMATION.—The provisions of subparagraph (D) of section 1927(b)(3), relating to confidentiality of information, shall apply to information reported by PDP sponsors under this paragraph in the same manner that such provisions apply to information disclosed by manufacturers or wholesalers under such section, except—
“(i) that any reference to ‘this section’ in clause (i) of such subparagraph shall be treated as being a reference to this section;
“(ii) the reference to the Director of the Congressional Budget Office in clause (iii) of such subparagraph shall be treated as including a reference to the Medicare Payment Advisory Commission; and
“(iii) clause (iv) of such subparagraph shall not apply.
“(E) OVERSIGHT.—Information reported under this paragraph may be used by the Inspector General of the Department of Health and Human Services for the statutorily authorized purposes of audit, investigation, and evaluations.
“(F) PENALTIES FOR FAILURE TO PROVIDE TIMELY INFORMATION AND PROVISION OF FALSE INFORMATION.—In the case of a PDP sponsor—
“(i) that fails to provide information required under subparagraph (B) on a timely basis, the sponsor is subject to a civil money penalty in the amount of $10,000 for each day in which such information has not been provided; or
“(ii) that knowingly (as defined in section 1128A(i)) provides false information under such subparagraph, the sponsor is subject to a civil money penalty in an amount not to exceed $100,000 for each item of false information.
Such civil money penalties are in addition to other penalties as may be prescribed by law. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under this subparagraph in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).”.
(B) APPLICATION TO MA ORGANIZATIONS.—Section 1857(f)(3) of the Social Security Act (42 U.S.C. 1395w–27(f)(3)) is amended by adding at the end the following:
“(D) REPORTING REQUIREMENT RELATED TO REBATE FOR FULL-BENEFIT DUAL ELIGIBLE MEDICARE DRUG PLAN ENROLLEES.—Section 1860D–12(b)(7).”.
(3) DEPOSIT OF REBATES INTO MEDICARE PRESCRIPTION DRUG ACCOUNT.—Section 1860D–16(c) of such Act (42 U.S.C. 1395w–116(c)) is amended by adding at the end the following new paragraph:
“(6) REBATE FOR FULL-BENEFIT DUAL ELIGIBLE MEDICARE DRUG PLAN ENROLLEES.—Amounts paid under a rebate agreement under section 1860D–2(f) shall be deposited into the Account and shall be used to pay for all or part of the gradual elimination of the coverage gap under section 1860D–2(b)(7).”.
Section 1860D–2 of the Social Security Act (42 U.S.C. 1395w–102), as amended by section 1181(a), is amended—
(1) in subsection (b)(4)(C)(ii), by inserting “subject to subsection (g)(2)(C),” after “(ii)”;
(2) in subsection (e)(1), in the matter before subparagraph (A), by striking “subsection (f)” and inserting “subsections (f) and (g)” after “this subsection”; and
(3) by adding at the
end the following new subsection: “(g) Requirement for
manufacturer discount agreement for certain qualifying drugs.— “(1) IN
GENERAL.—In this part, the
term ‘covered part D drug’ does not include any drug or biologic
that is manufactured by a manufacturer that has not entered into and have in
effect for all qualifying drugs (as defined in paragraph (5)(A)) a discount
agreement described in paragraph (2). “(A) PERIODIC
DISCOUNTS.—A discount
agreement under this paragraph shall require the manufacturer involved to
provide, to each PDP sponsor with respect to a prescription drug plan or each
MA organization with respect to each MA–PD plan, a discount in an amount
specified in paragraph (3) for qualifying drugs (as defined in paragraph
(5)(A)) of the manufacturer dispensed to a qualifying enrollee after December
31, 2010, insofar as the individual is in the original gap in coverage (as
defined in paragraph (5)(E)). “(B) DISCOUNT
AGREEMENT.—Insofar as not
inconsistent with this subsection, the Secretary shall establish terms and
conditions of such agreement, including terms and conditions relating to
compliance, similar to the terms and conditions for rebate agreements under
paragraphs (2), (3), and (4) of section 1927(b), except that— “(i) discounts shall be applied under this subsection to prescription drug plans and
MA–PD plans instead of State plans under title XIX; “(ii) PDP sponsors and
MA organizations shall be responsible, instead of States, for provision of
necessary utilization information to drug manufacturers; and “(iii) sponsors and MA organizations shall be
responsible for reporting information on drug-component negotiated price,
instead of other manufacturer prices.
“(C) COUNTING DISCOUNT TOWARD TRUE OUT-OF-POCKET COSTS.—Under the discount agreement, in applying subsection (b)(4), with regard to subparagraph (C)(i) of such subsection, if a qualified enrollee purchases the qualified drug insofar as the enrollee is in an actual gap of coverage (as defined in paragraph (5)(D)), the amount of the discount under the agreement shall be treated and counted as costs incurred by the plan enrollee.
“(3) DISCOUNT AMOUNT.—The amount of the discount specified in this paragraph for a discount period for a plan is equal to 50 percent of the amount of the drug-component negotiated price (as defined in paragraph (5)(C)) for qualifying drugs for the period involved.
“(4) ADDITIONAL TERMS.—In the case of a discount provided under this subsection with respect to a prescription drug plan offered by a PDP sponsor or an MA–PD plan offered by an MA organization, if a qualified enrollee purchases the qualified drug—
“(A) insofar as the enrollee is in an actual gap of coverage (as defined in paragraph (5)(D)), the sponsor or plan shall provide the discount to the enrollee at the time the enrollee pays for the drug; and
“(B) insofar as the enrollee is in the portion of the original gap in coverage (as defined in paragraph (5)(E)) that is not in the actual gap in coverage, the discount shall not be applied against the negotiated price (as defined in subsection (d)(1)(B)) for the purpose of calculating the beneficiary payment.
“(5) DEFINITIONS.—In this subsection:
“(A) QUALIFYING DRUG.—The term ‘qualifying drug’ means, with respect to a prescription drug plan or MA–PD plan, a drug or biological product that—
“(i)(I) is a drug produced or distributed under an original new drug application approved by the Food and Drug Administration, including a drug product marketed by any cross-licensed producers or distributors operating under the new drug application;
“(II) is a drug that was originally marketed under an original new drug application approved by the Food and Drug Administration; or
“(III) is a biological product as approved under Section 351(a) of the Public Health Services Act;
“(ii) is covered under the formulary of the plan; and
“(iii) is dispensed to an individual who is in the original gap in coverage.
“(B) QUALIFYING ENROLLEE.—The term ‘qualifying enrollee’ means an individual enrolled in a prescription drug plan or MA–PD plan other than such an individual who is a subsidy-eligible individual (as defined in section 1860D–14(a)(3)).
“(C) DRUG-COMPONENT NEGOTIATED PRICE.—The term ‘drug-component negotiated price’ means, with respect to a qualifying drug, the negotiated price (as defined in subsection (d)(1)(B)), as determined without regard to any dispensing fee, of the drug under the prescription drug plan or MA–PD plan involved.
“(D) ACTUAL GAP IN COVERAGE.—The term ‘actual gap in coverage’ means the gap in prescription drug coverage that occurs between the initial coverage limit (as modified under subparagraph (B) of subsection (b)(7)) and the annual out-of-pocket threshold (as modified under subparagraph (C) of such subsection).
“(E) ORIGINAL GAP IN COVERAGE.—The term ‘original in gap coverage’ means the gap in prescription drug coverage that would occur between the initial coverage limit (described in subsection (b)(3)) and the out-of-pocket threshold (as defined in subsection (b)(4))(B) if subsection (b)(7) did not apply.”.
(a) Part D submission.—Section 1860D–12(b) of the Social Security Act (42 U.S.C. 1395w–112(b)), as amended by section 172(a)(1) of Public Law 110–275, is amended by striking paragraph (5) and redesignating paragraph (6) and paragraph (7), as added by section 1181(b)(2), as paragraph (5) and paragraph (6), respectively.
(b) Submission to MA–PD plans.—Section 1857(f)(3) of the Social Security Act (42 U.S.C. 1395w–27(f)(3)), as added by section 171(b) of Public Law 110–275 and amended by section 172(a)(2) of such Public Law, is amended by striking subparagraph (B) and redesignating subparagraph (C) as subparagraph (B).
(c) Effective date.—The amendments made by this section shall apply for contract years beginning with 2010.
(a) In general.—Section 1860D–2(b)(4)(C) of the Social Security Act (42 U.S.C. 1395w–102(b)(4)(C)) is amended—
(1) in clause (i), by striking “and” at the end;
(A) by striking “such costs shall be treated as incurred only if” and inserting “subject to clause (iii), such costs shall be treated as incurred only if”;
(B) by striking “, under section 1860D–14, or under a State Pharmaceutical Assistance Program”; and
(C) by striking the period at the end and inserting “; and”; and
(3) by inserting after clause (ii) the following new clause:
“(iii) such costs shall be treated as incurred and shall not be considered to be reimbursed under clause (ii) if such costs are borne or paid—
“(I) under section 1860D–14;
“(II) under a State Pharmaceutical Assistance Program;
“(III) by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act); or
“(IV) under an AIDS Drug Assistance Program under part B of title XXVI of the Public Health Service Act.”.
(b) Effective date.—The amendments made by subsection (a) shall apply to costs incurred on or after January 1, 2011.
(a) In general.—Section 1860D–1(b)(3) of the Social Security Act (42 U.S.C. 1395w–101(b)(3)) is amended by adding at the end the following new subparagraph:
“(F) CHANGE IN FORMULARY RESULTING IN INCREASE IN COST-SHARING.—
“(i) IN GENERAL.—Except as provided in clause (ii), in the case of an individual enrolled in a prescription drug plan (or MA–PD plan) who has been prescribed and is using a covered part D drug while so enrolled, if the formulary of the plan is materially changed (other than at the end of a contract year) so to reduce the coverage (or increase the cost-sharing) of the drug under the plan.
“(ii) EXCEPTION.—Clause (i) shall not apply in the case that a drug is removed from the formulary of a plan because of a recall or withdrawal of the drug issued by the Food and Drug Administration, because the drug is replaced with a generic drug that is a therapeutic equivalent, or because of utilization management applied to—
“(I) a drug whose labeling includes a boxed warning required by the Food and Drug Administration under section 210.57(c)(1) of title 21, Code of Federal Regulations (or a successor regulation); or
“(II) a drug required under subsection (c)(2) of section 505–1 of the Federal Food, Drug, and Cosmetic Act to have a Risk Evaluation and Management Strategy that includes elements under subsection (f) of such section.”.
(b) Effective date.—The amendment made by subsection (a) shall apply to contract years beginning on or after January 1, 2011.
(a) Additional telehealth site.—
(1) IN GENERAL.—Paragraph (4)(C)(ii) of section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is amended by adding at the end the following new subclause:
“(IX) A renal dialysis facility.”
(2) EFFECTIVE DATE.—The amendment made by paragraph (1) shall apply to services furnished on or after January 1, 2011.
(b) Telehealth Advisory Committee.—
(1) ESTABLISHMENT.—Section 1868 of the Social Security Act (42 U.S.C. 1395ee) is amended—
(A) in the heading, by adding at the end the following: “telehealth advisory committee”; and
(B) by adding at the end the following new subsection:
“(c) Telehealth advisory committee.—
“(1) IN GENERAL.—The Secretary shall appoint a Telehealth Advisory Committee (in this subsection referred to as the ‘Advisory Committee’) to make recommendations to the Secretary on policies of the Centers for Medicare & Medicaid Services regarding telehealth services as established under section 1834(m), including the appropriate addition or deletion of services (and HCPCS codes) to those specified in paragraphs (4)(F)(i) and (4)(F)(ii) of such section and for authorized payment under paragraph (1) of such section.
“(i) IN GENERAL.—The Advisory Committee shall be composed of 9 members, to be appointed by the Secretary, of whom—
“(I) 5 shall be practicing physicians;
“(II) 2 shall be practicing non-physician health care practitioners; and
“(III) 2 shall be administrators of telehealth programs.
“(ii) REQUIREMENTS FOR APPOINTING MEMBERS.—In appointing members of the Advisory Committee, the Secretary shall—
“(I) ensure that each member has prior experience with the practice of telemedicine or telehealth;
“(II) give preference to individuals who are currently providing telemedicine or telehealth services or who are involved in telemedicine or telehealth programs;
“(III) ensure that the membership of the Advisory Committee represents a balance of specialties and geographic regions; and
“(IV) take into account the recommendations of stakeholders.
“(B) TERMS.—The members of the Advisory Committee shall serve for such term as the Secretary may specify.
“(C) CONFLICTS OF INTEREST.—An advisory committee member may not participate with respect to a particular matter considered in an advisory committee meeting if such member (or an immediate family member of such member) has a financial interest that could be affected by the advice given to the Secretary with respect to such matter.
“(3) MEETINGS.—The Advisory Committee shall meet twice each calendar year and at such other times as the Secretary may provide.
“(4) PERMANENT COMMITTEE.—Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the Advisory Committee.”
(2) FOLLOWING RECOMMENDATIONS.—Section 1834(m)(4)(F) of such Act (42 U.S.C. 1395m(m)(4)(F)) is amended by adding at the end the following new clause:
“(iii) RECOMMENDATIONS OF THE TELEHEALTH ADVISORY COMMITTEE.—In making determinations under clauses (i) and (ii), the Secretary shall take into account the recommendations of the Telehealth Advisory Committee (established under section 1868(c)) when adding or deleting services (and HCPCS codes) and in establishing policies of the Centers for Medicare & Medicaid Services regarding the delivery of telehealth services. If the Secretary does not implement such a recommendation, the Secretary shall publish in the Federal Register a statement regarding the reason such recommendation was not implemented.”
(3) WAIVER OF ADMINISTRATIVE LIMITATION.—The Secretary of Health and Human Services shall establish the Telehealth Advisory Committee under the amendment made by paragraph (1) notwithstanding any limitation that may apply to the number of advisory committees that may be established (within the Department of Health and Human Services or otherwise).
Section 1833(t)(7)(D)(i) of the Social Security Act (42 U.S.C. 1395l(t)(7)(D)(i)) is amended—
(A) in the first sentence, by striking `“2010”and inserting “2012”; and
(B) in the second sentence, by striking “or 2009” and inserting “, 2009, 2010, or 2011”; and
(2) in subclause (III), by striking “January 1, 2010” and inserting “January 1, 2012”.
Subsection (a) of section 106 of division B of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395 note), as amended by section 117 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110–173) and section 124 of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110–275), is amended by striking “September 30, 2009” and inserting “September 30, 2011”.
Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w–4(e)(1)(E)) is amended by striking “before January 1, 2010” and inserting “before January 1, 2012”.
Section 542(c) of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (as enacted into law by section 1(a)(6) of Public Law 106–554), as amended by section 732 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (42 U.S.C. 1395w–4 note), section 104 of division B of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395w–4 note), section 104 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110–173), and section 136 of the Medicare Improvements for Patients and Providers Act of 1008 (Public Law 110–275), is amended by striking “and 2009” and inserting “2009, 2010, and 2011”.
(a) In general.—Section 1834(l)(13) of the Social Security Act (42 U.S.C. 1395m(l)(13)) is amended—
(A) in the matter preceding clause (i), by striking “before January 1, 2010” and inserting “before January 1, 2012”; and
(B) in each of clauses (i) and (ii), by striking “before January 1, 2010” and inserting “before January 1, 2012”.
(b) Air Ambulance Improvements.—Section 146(b)(1) of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110–275) is amended by striking “ending on December 31, 2009” and inserting “ending on December 31, 2011”.
(a) Application of highest level permitted under LIS to all subsidy eligible individuals.—
(1) IN GENERAL.—Section 1860D–14(a)(1) of the Social Security Act (42 U.S.C. 1395w–114(a)(1)) is amended in the matter before subparagraph (A), by inserting “(or, beginning with 2012, paragraph (3)(E))” after “paragraph (3)(D)”.
(2) ANNUAL INCREASE IN LIS RESOURCE TEST.—Section 1860D–14(a)(3)(E)(i) of such Act (42 U.S.C. 1395w–114(a)(3)(E)(i)) is amended—
(A) by striking “and” at the end of subclause (I);
(B) in subclause (II), by inserting “(before 2012)” after “subsequent year”;
(C) by striking the period at the end of subclause (II) and inserting a semicolon;
(D) by inserting after subclause (II) the following new subclauses:
“(III) for 2012, $17,000 (or $34,000 in the case of the combined value of the individual's assets or resources and the assets or resources of the individual's spouse); and
“(IV) for a subsequent year, the dollar amounts specified in this subclause (or subclause (III)) for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.”; and
(E) in the last sentence, by inserting “or (IV)” after “subclause (II)”.
(3) APPLICATION OF LIS TEST UNDER MEDICARE SAVINGS PROGRAM.—Section 1905(p)(1)(C) of such Act (42 U.S.C. 1396d(p)(1)(C)) is amended—
(A) by striking “effective beginning with January 1, 2010” and inserting “effective for the period beginning with January 1, 2010, and ending with December 31, 2011”; and
(B) by inserting before the period at the end the following: “or, effective beginning with January 1, 2012, whose resources (as so determined) do not exceed the maximum resource level applied for the year under subparagraph (E) of section 1860D–14(a)(3) (determined without regard to the life insurance policy exclusion provided under subparagraph (G) of such section) applicable to an individual or to the individual and the individual’s spouse (as the case may be)”.
(b) Effective date.—The amendments made by subsection (a) shall apply to eligibility determinations for income-related subsidies and medicare cost-sharing furnished for periods beginning on or after January 1, 2012.
(a) In general.—Section 1860D–14(a)(1)(D)(i) of the Social Security Act (42 U.S.C. 1395w–114(a)(1)(D)(i)) is amended—
(1) by striking “Institutionalized individuals.—In” and inserting “Elimination of cost-sharing for certain full-benefit dual eligible individuals.—
“(I) INSTITUTIONALIZED INDIVIDUALS.—In”; and
(2) by adding at the end the following new subclause:
“(II) CERTAIN OTHER INDIVIDUALS.—In the case of an individual who is a full-benefit dual eligible individual and with respect to whom there has been a determination that but for the provision of home and community based care (whether under section 1915, 1932, or under a waiver under section 1115) the individual would require the level of care provided in a hospital or a nursing facility or intermediate care facility for the mentally retarded the cost of which could be reimbursed under the State plan under title XIX, the elimination of any beneficiary coinsurance described in section 1860D–2(b)(2) (for all amounts through the total amount of expenditures at which benefits are available under section 1860D–2(b)(4)).”.
(b) Effective date.—The amendments made by subsection (a) shall apply to drugs dispensed on or after January 1, 2011.
(a) Administrative verification of income and resources under the low-income subsidy program.—
(1) IN GENERAL.—Clause (iii) of section 1860D–14(a)(3)(E) of the Social Security Act (42 U.S.C. 1395w–114(a)(3)(E)) is amended to read as follows:
“(iii) CERTIFICATION OF INCOME AND RESOURCES.—For purposes of applying this section—
“(I) an individual shall be permitted to apply on the basis of self-certification of income and resources; and
“(II) matters attested to in the application shall be subject to appropriate methods of verification without the need of the individual to provide additional documentation, except in extraordinary situations as determined by the Commissioner.”.
(2) EFFECTIVE DATE.—The amendment made by paragraph (1) shall apply beginning January 1, 2010.
(b) Disclosures To facilitate identification of individuals likely To be ineligible for the low-income assistance under the medicare prescription drug program To assist social security administration’s outreach to eligible individuals.—For provision authorizing disclosure of return information to facilitate identification of individuals likely to be ineligible for low-income subsidies under Medicare prescription drug program, see section 1801.
(a) In general.—In the case of a retroactive LIS enrollment beneficiary who is enrolled under a prescription drug plan under part D of title XVIII of the Social Security Act (or an MA–PD plan under part C of such title), the beneficiary (or any eligible third party) is entitled to reimbursement by the plan for covered drug costs incurred by the beneficiary during the retroactive coverage period of the beneficiary in accordance with subsection (b) and in the case of such a beneficiary described in subsection (c)(4)(A)(i), such reimbursement shall be made automatically by the plan upon receipt of appropriate notice the beneficiary is eligible for assistance described in such subsection (c)(4)(A)(i) without further information required to be filed with the plan by the beneficiary.
(b) Administrative Requirements Relating to Reimbursements.—
(1) LINE-ITEM DESCRIPTION.—Each reimbursement made by a prescription drug plan or MA–PD plan under subsection (a) shall include a line-item description of the items for which the reimbursement is made.
(2) TIMING OF REIMBURSEMENTS.—A prescription drug plan or MA–PD plan must make a reimbursement under subsection (a) to a retroactive LIS enrollment beneficiary, with respect to a claim, not later than 45 days after—
(A) in the case of a beneficiary described in subsection (c)(4)(A)(i), the date on which the plan receives notice from the Secretary that the beneficiary is eligible for assistance described in such subsection; or
(B) in the case of a beneficiary described in subsection (c)(4)(A)(ii), the date on which the beneficiary files the claim with the plan.
(3) REPORTING REQUIREMENT.—For each month beginning with January 2011, each prescription drug plan and each MA–PD plan shall report to the Secretary the following:
(A) The number of claims the plan has readjudicated during the month due to a beneficiary becoming retroactively eligible for subsidies available under section 1860D–14 of the Social Security Act.
(B) The total value of the readjudicated claim amount for the month.
(C) The Medicare Health Insurance Claims Number of beneficiaries for whom claims were readjudicated.
(D) For the claims described in subparagraphs (A) and (B), an attestation to the Administrator of the Centers for Medicare & Medicaid Services of the total amount of reimbursement the plan has provided to beneficiaries for premiums and cost-sharing that the beneficiary overpaid for which the plan received payment from the Centers for Medicare & Medicaid Services.
(c) Definitions.—For purposes of this section:
(1) COVERED DRUG COSTS.—The term “covered drug costs” means, with respect to a retroactive LIS enrollment beneficiary enrolled under a prescription drug plan under part D of title XVIII of the Social Security Act (or an MA–PD plan under part C of such title), the amount by which—
(A) the costs incurred by such beneficiary during the retroactive coverage period of the beneficiary for covered part D drugs, premiums, and cost-sharing under such title; exceeds
(B) such costs that would have been incurred by such beneficiary during such period if the beneficiary had been both enrolled in the plan and recognized by such plan as qualified during such period for the low income subsidy under section 1860D–14 of the Social Security Act to which the individual is entitled.
(2) ELIGIBLE THIRD PARTY.—The term “eligible third party” means, with respect to a retroactive LIS enrollment beneficiary, an organization or other third party that is owed payment on behalf of such beneficiary for covered drug costs incurred by such beneficiary during the retroactive coverage period of such beneficiary.
(3) RETROACTIVE COVERAGE PERIOD.—The term “retroactive coverage period” means—
(A) with respect to a retroactive LIS enrollment beneficiary described in paragraph (4)(A)(i), the period—
(i) beginning on the effective date of the assistance described in such paragraph for which the individual is eligible; and
(ii) ending on the date the plan effectuates the status of such individual as so eligible; and
(B) with respect to a retroactive LIS enrollment beneficiary described in paragraph (4)(A)(ii), the period—
(i) beginning on the date the individual is both entitled to benefits under part A, or enrolled under part B, of title XVIII of the Social Security Act and eligible for medical assistance under a State plan under title XIX of such Act; and
(ii) ending on the date the plan effectuates the status of such individual as a full-benefit dual eligible individual (as defined in section 1935(c)(6) of such Act).
(4) RETROACTIVE LIS ENROLLMENT BENEFICIARY.—
(A) IN GENERAL.—The term “retroactive LIS enrollment beneficiary” means an individual who—
(i) is enrolled in a prescription drug plan under part D of title XVIII of the Social Security Act (or an MA–PD plan under part C of such title) and subsequently becomes eligible as a full-benefit dual eligible individual (as defined in section 1935(c)(6) of such Act), an individual receiving a low-income subsidy under section 1860D–14 of such Act, an individual receiving assistance under the Medicare Savings Program implemented under clauses (i), (iii), and (iv) of section 1902(a)(10)(E) of such Act, or an individual receiving assistance under the supplemental security income program under section 1611 of such Act; or
(ii) subject to subparagraph (B)(i), is a full-benefit dual eligible individual (as defined in section 1935(c)(6) of such Act) who is automatically enrolled in such a plan under section 1860D–1(b)(1)(C) of such Act.
(B) EXCEPTION FOR BENEFICIARIES ENROLLED IN RFP PLAN.—
(i) IN GENERAL.—In no case shall an individual described in subparagraph (A)(ii) include an individual who is enrolled, pursuant to a RFP contract described in clause (ii), in a prescription drug plan offered by the sponsor of such plan awarded such contract.
(ii) RFP CONTRACT DESCRIBED.—The RFP contract described in this section is a contract entered into between the Secretary and a sponsor of a prescription drug plan pursuant to the Centers for Medicare & Medicaid Services' request for proposals issued on February 17, 2009, relating to Medicare part D retroactive coverage for certain low income beneficiaries, or a similar subsequent request for proposals.
(a) In general.—Section 1860D–1(b)(1)(C) of the Social Security Act (42 U.S.C. 1395w–101(b)(1)(C)) is amended by adding after “PDP region” the following: “or through use of an intelligent assignment process that is designed to maximize the access of such individual to necessary prescription drugs while minimizing costs to such individual and to the program under this part to the greatest extent possible. In the case the Secretary enrolls such individuals through use of an intelligent assignment process, such process shall take into account the extent to which prescription drugs necessary for the individual are covered in the case of a PDP sponsor of a prescription drug plan that uses a formulary, the use of prior authorization or other restrictions on access to coverage of such prescription drugs by such a sponsor, and the overall quality of a prescription drug plan as measured by quality ratings established by the Secretary.”
(b) Effective date.—The amendment made by subsection (a) shall take effect for contract years beginning with 2012.
(a) Special enrollment period.—Section 1860D–1(b)(3)(D) of the Social Security Act (42 U.S.C. 1395w–101(b)(3)(D)) is amended to read as follows:
“(D) SUBSIDY ELIGIBLE INDIVIDUALS.—In the case of an individual (as determined by the Secretary) who is determined under subparagraph (B) of section 1860D–14(a)(3) to be a subsidy eligible individual.”.
(b) Automatic enrollment.—Section 1860D–1(b)(1) of the Social Security Act (42 U.S.C. 1395w–101(b)(1)) is amended by adding at the end the following new subparagraph:
“(D) SPECIAL RULE FOR SUBSIDY ELIGIBLE INDIVIDUALS.—The process established under subparagraph (A) shall include, in the case of an individual described in section 1860D–1(b)(3)(D) who fails to enroll in a prescription drug plan or an MA–PD plan during the special enrollment established under such section applicable to such individual, the application of the assignment process described in subparagraph (C) to such individual in the same manner as such assignment process applies to a part D eligible individual described in such subparagraph (C). Nothing in the previous sentence shall prevent an individual described in such sentence from declining enrollment in a plan determined appropriate by the Secretary (or in the program under this part) or from changing such enrollment.”.
(c) Effective date.—The amendments made by this section shall apply to subsidy determinations made for months beginning with January 2011.
(a) In general.—Section 1860D–14(b)(2)(B)(iii) of the Social Security Act (42 U.S.C. 1395w–114(b)(2)(B)(iii)) is amended by inserting before the period the following: “before the application of the monthly rebate computed under section 1854(b)(1)(C)(i) for that plan and year involved”.
(b) Effective date.—The amendment made by subsection (a) shall apply to subsidy determinations made for months beginning with January 2011.
(a) Ensuring effective communication by the Centers for Medicare & Medicaid Services.—
(1) STUDY ON MEDICARE PAYMENTS FOR LANGUAGE SERVICES.—The Secretary of Health and Human Services shall conduct a study that examines the extent to which Medicare service providers utilize, offer, or make available language services for beneficiaries who are limited English proficient and ways that Medicare should develop payment systems for language services.
(2) ANALYSES.—The study shall include an analysis of each of the following:
(A) How to develop and structure appropriate payment systems for language services for all Medicare service providers.
(B) The feasibility of adopting a payment methodology for on-site interpreters, including interpreters who work as independent contractors and interpreters who work for agencies that provide on-site interpretation, pursuant to which such interpreters could directly bill Medicare for services provided in support of physician office services for an LEP Medicare patient.
(C) The feasibility of Medicare contracting directly with agencies that provide off-site interpretation including telephonic and video interpretation pursuant to which such contractors could directly bill Medicare for the services provided in support of physician office services for an LEP Medicare patient.
(D) The feasibility of modifying the existing Medicare resource-based relative value scale (RBRVS) by using adjustments (such as multipliers or add-ons) when a patient is LEP.
(E) How each of options described in a previous paragraph would be funded and how such funding would affect physician payments, a physician’s practice, and beneficiary cost-sharing.
(F) The extent to which providers under parts A and B of title XVIII of the Social Security Act, MA organizations offering Medicare Advantage plans under part C of such title and PDP sponsors of a prescription drug plan under part D of such title utilize, offer, or make available language services for beneficiaries with limited English proficiency.
(G) The nature and type of language services provided by States under title XIX of the Social Security Act and the extent to which such services could be utilized by beneficiaries and providers under title XVIII of such Act.
(3) VARIATION IN PAYMENT SYSTEM DESCRIBED.—The payment systems described in paragraph (2)(A) may allow variations based upon types of service providers, available delivery methods, and costs for providing language services including such factors as—
(A) the type of language services provided (such as provision of health care or health care related services directly in a non-English language by a bilingual provider or use of an interpreter);
(B) type of interpretation services provided (such as in-person, telephonic, video interpretation);
(C) the methods and costs of providing language services (including the costs of providing language services with internal staff or through contract with external independent contractors or agencies, or both);
(D) providing services for languages not frequently encountered in the United States; and
(E) providing services in rural areas.
(4) REPORT.—The Secretary shall submit a report on the study conducted under subsection (a) to appropriate committees of Congress not later than 12 months after the date of the enactment of this Act.
(5) EXEMPTION FROM PAPERWORK REDUCTION ACT.—Chapter 35 of title 44, United States Code (commonly known as the “Paperwork Reduction Act”), shall not apply for purposes of carrying out this subsection.
(6) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be appropriated to carry out this subsection such sums as are necessary.
(b) Health plans.—Section 1857(g)(1) of the Social Security Act (42 U.S.C. 1395w–27(g)(1)) is amended—
(1) by striking “or” at the end of subparagraph (F);
(2) by adding “or” at the end of subparagraph (G); and
(3) by inserting after subparagraph (G) the following new subparagraph:
“(H) fails substantially to provide language services to limited English proficient beneficiaries enrolled in the plan that are required under law;”.
(a) In general.—Not later than 6 months after the date of the completion of the study described in section 1221(a), the Secretary, acting through the Centers for Medicare & Medicaid Services, shall carry out a demonstration program under which the Secretary shall award not fewer than 24 3-year grants to eligible Medicare service providers (as described in subsection (b)(1)) to improve effective communication between such providers and Medicare beneficiaries who are living in communities where racial and ethnic minorities, including populations that face language barriers, are underserved with respect to such services. In designing and carrying out the demonstration the Secretary shall take into consideration the results of the study conducted under section 1221(a) and adjust, as appropriate, the distribution of grants so as to better target Medicare beneficiaries who are in the greatest need of language services. The Secretary shall not authorize a grant larger than $500,000 over three years for any grantee.
(1) ELIGIBILITY.—To be eligible to receive a grant under subsection (a) an entity shall—
(i) a provider of services under part A of title XVIII of the Social Security Act;
(ii) a service provider under part B of such title;
(iii) a part C organization offering a Medicare part C plan under part C of such title; or
(iv) a PDP sponsor of a prescription drug plan under part D of such title; and
(B) prepare and submit to the Secretary an application, at such time, in such manner, and accompanied by such additional information as the Secretary may require.
(A) DISTRIBUTION.—To the extent feasible, in awarding grants under this section, the Secretary shall award—
(i) at least 6 grants to providers of services described in paragraph (1)(A)(i);
(ii) at least 6 grants to service providers described in paragraph (1)(A)(ii);
(iii) at least 6 grants to organizations described in paragraph (1)(A)(iii); and
(iv) at least 6 grants to sponsors described in paragraph (1)(A)(iv).
(B) FOR COMMUNITY ORGANIZATIONS.—The Secretary shall give priority to applicants that have developed partnerships with community organizations or with agencies with experience in language access.
(C) VARIATION IN GRANTEES.—The Secretary shall also ensure that the grantees under this section represent, among other factors, variations in—
(i) different types of language services provided and of service providers and organizations under parts A through D of title XVIII of the Social Security Act;
(ii) languages needed and their frequency of use;
(iii) urban and rural settings;
(iv) at least two geographic regions, as defined by the Secretary; and
(v) at least two large metropolitan statistical areas with diverse populations.
(1) IN GENERAL.—A grantee shall use grant funds received under this section to pay for the provision of competent language services to Medicare beneficiaries who are limited English proficient. Competent interpreter services may be provided through on-site interpretation, telephonic interpretation, or video interpretation or direct provision of health care or health care related services by a bilingual health care provider. A grantee may use bilingual providers, staff, or contract interpreters. A grantee may use grant funds to pay for competent translation services. A grantee may use up to 10 percent of the grant funds to pay for administrative costs associated with the provision of competent language services and for reporting required under subsection (e).
(2) ORGANIZATIONS.—Grantees that are part C organizations or PDP sponsors must ensure that their network providers receive at least 50 percent of the grant funds to pay for the provision of competent language services to Medicare beneficiaries who are limited English proficient, including physicians and pharmacies.
(3) DETERMINATION OF PAYMENTS FOR LANGUAGE SERVICES.—Payments to grantees shall be calculated based on the estimated numbers of limited English proficient Medicare beneficiaries in a grantee’s service area utilizing—
(A) data on the numbers of limited English proficient individuals who speak English less than “very well” from the most recently available data from the Bureau of the Census or other State-based study the Secretary determines likely to yield accurate data regarding the number of such individuals served by the grantee; or
(B) the grantee’s own data if the grantee routinely collects data on Medicare beneficiaries’ primary language in a manner determined by the Secretary to yield accurate data and such data shows greater numbers of limited English proficient individuals than the data listed in subparagraph (A).
(A) REPORTING.—Payments shall only be provided under this section to grantees that report their costs of providing language services as required under subsection (e) and may be modified annually at the discretion of the Secretary. If a grantee fails to provide the reports under such section for the first year of a grant, the Secretary may terminate the grant and solicit applications from new grantees to participate in the subsequent two years of the demonstration program.
(i) IN GENERAL.—Subject to clause (ii), payments shall be provided under this section only to grantees that utilize competent bilingual staff or competent interpreter or translation services which—
(I) if the grantee operates in a State that has statewide health care interpreter standards, meet the State standards currently in effect; or
(II) if the grantee operates in a State that does not have statewide health care interpreter standards, utilizes competent interpreters who follow the National Council on Interpreting in Health Care’s Code of Ethics and Standards of Practice.
(ii) EXEMPTIONS.—The requirements of clause (i) shall not apply—
(I) in the case of a Medicare beneficiary who is limited English proficient (who has been informed in the beneficiary’s primary language of the availability of free interpreter and translation services) and who requests the use of family, friends, or other persons untrained in interpretation or translation and the grantee documents the request in the beneficiary’s record; and
(II) in the case of a medical emergency where the delay directly associated with obtaining a competent interpreter or translation services would jeopardize the health of the patient.
Nothing in clause (ii)(II) shall be construed to exempt emergency rooms or similar entities that regularly provide health care services in medical emergencies from having in place systems to provide competent interpreter and translation services without undue delay.
(d) Assurances.—Grantees under this section shall—
(1) ensure that appropriate clinical and support staff receive ongoing education and training in linguistically appropriate service delivery;
(2) ensure the linguistic competence of bilingual providers;
(3) offer and provide appropriate language services at no additional charge to each patient with limited English proficiency at all points of contact, in a timely manner during all hours of operation;
(4) notify Medicare beneficiaries of their right to receive language services in their primary language;
(5) post signage in the languages of the commonly encountered group or groups present in the service area of the organization; and
(A) primary language data are collected for recipients of language services; and
(B) consistent with the privacy protections provided under the regulations promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d–2 note), if the recipient of language services is a minor or is incapacitated, the primary language of the parent or legal guardian is collected and utilized.
(e) Reporting requirements.—Grantees under this section shall provide the Secretary with reports at the conclusion of the each year of a grant under this section. Each report shall include at least the following information:
(1) The number of Medicare beneficiaries to whom language services are provided.
(2) The languages of those Medicare beneficiaries.
(3) The types of language services provided (such as provision of services directly in non-English language by a bilingual health care provider or use of an interpreter).
(4) Type of interpretation (such as in-person, telephonic, or video interpretation).
(5) The methods of providing language services (such as staff or contract with external independent contractors or agencies).
(6) The length of time for each interpretation encounter.
(7) The costs of providing language services (which may be actual or estimated, as determined by the Secretary).
(f) No cost sharing.—Limited English proficient Medicare beneficiaries shall not have to pay cost-sharing or co-pays for language services provided through this demonstration program.
(g) Evaluation and report.—The Secretary shall conduct an evaluation of the demonstration program under this section and shall submit to the appropriate committees of Congress a report not later than 1 year after the completion of the program. The report shall include the following:
(1) An analysis of the patient outcomes and costs of furnishing care to the limited English proficient Medicare beneficiaries participating in the project as compared to such outcomes and costs for limited English proficient Medicare beneficiaries not participating.
(2) The effect of delivering culturally and linguistically appropriate services on beneficiary access to care, utilization of services, efficiency and cost-effectiveness of health care delivery, patient satisfaction, and select health outcomes.
(3) Recommendations, if any, regarding the extension of such project to the entire Medicare program.
(h) General provisions.—Nothing in this section shall be construed to limit otherwise existing obligations of recipients of Federal financial assistance under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d) et seq.) or any other statute.
(i) Authorization of appropriations.—There are authorized to be appropriated to carry out this section $16,000,000 for each fiscal year of the demonstration program.
(a) In general.—The Secretary of Health and Human Services shall enter into an arrangement with the Institute of Medicine under which the Institute will prepare and publish, not later than 3 years after the date of the enactment of this Act, a report on the impact of language access services on the health and health care of limited English proficient populations.
(b) Contents.—Such report shall include—
(1) recommendations on the development and implementation of policies and practices by health care organizations and providers for limited English proficient patient populations;
(2) a description of the effect of providing language access services on quality of health care and access to care and reduced medical error; and
(3) a description of the costs associated with or savings related to provision of language access services.
In this subtitle:
(1) BILINGUAL.—The term “bilingual” with respect to an individual means a person who has sufficient degree of proficiency in two languages and can ensure effective communication can occur in both languages.
(2) COMPETENT INTERPRETER SERVICES.—The term “competent interpreter services” means a trans-language rendition of a spoken message in which the interpreter comprehends the source language and can speak comprehensively in the target language to convey the meaning intended in the source language. The interpreter knows health and health-related terminology and provides accurate interpretations by choosing equivalent expressions that convey the best matching and meaning to the source language and captures, to the greatest possible extent, all nuances intended in the source message.
(3) COMPETENT TRANSLATION SERVICES.—The term “competent translation services” means a trans-language rendition of a written document in which the translator comprehends the source language and can write comprehensively in the target language to convey the meaning intended in the source language. The translator knows health and health-related terminology and provides accurate translations by choosing equivalent expressions that convey the best matching and meaning to the source language and captures, to the greatest possible extent, all nuances intended in the source document.
(4) EFFECTIVE COMMUNICATION.—The term “effective communication” means an exchange of information between the provider of health care or health care-related services and the limited English proficient recipient of such services that enables limited English proficient individuals to access, understand, and benefit from health care or health care-related services.
(5) INTERPRETING/INTERPRETATION.—The terms “interpreting” and “interpretation” mean the transmission of a spoken message from one language into another, faithfully, accurately, and objectively.
(6) HEALTH CARE SERVICES.—The term “health care services” means services that address physical as well as mental health conditions in all care settings.
(7) HEALTH CARE-RELATED SERVICES.—The term “health care-related services” means human or social services programs or activities that provide access, referrals or links to health care.
(8) LANGUAGE ACCESS.—The term “language access” means the provision of language services to an LEP individual designed to enhance that individual’s access to, understanding of or benefit from health care or health care-related services.
(9) LANGUAGE SERVICES.—The term “language services” means provision of health care services directly in a non-English language, interpretation, translation, and non-English signage.
(10) LIMITED ENGLISH PROFICIENT.—The term “limited English proficient” or “LEP” with respect to an individual means an individual who speaks a primary language other than English and who cannot speak, read, write or understand the English language at a level that permits the individual to effectively communicate with clinical or nonclinical staff at an entity providing health care or health care related services.
(11) MEDICARE BENEFICIARY.—The term “Medicare beneficiary” means an individual entitled to benefits under part A of title XVIII of the Social Security Act or enrolled under part B of such title.
(12) MEDICARE PROGRAM.—The term “Medicare program” means the programs under parts A through D of title XVIII of the Social Security Act.
(13) SERVICE PROVIDER.—The term “service provider” includes all suppliers, providers of services, or entities under contract to provide coverage, items or services under any part of title XVIII of the Social Security Act.
Section 1833(g)(5) of the Social Security Act (42 U.S.C. 1395l(g)(5)), as amended by section 141 of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110–275), is amended by striking “December 31, 2009” and inserting “December 31, 2011”.
(a) Provision of appropriate coverage of immunosuppressive drugs under the medicare program for kidney transplant recipients.—
(1) CONTINUED ENTITLEMENT TO IMMUNOSUPPRESSIVE DRUGS.—
(A) KIDNEY TRANSPLANT RECIPIENTS.—Section 226A(b)(2) of the Social Security Act (42 U.S.C. 426–1(b)(2)) is amended by inserting “(except for coverage of immunosuppressive drugs under section 1861(s)(2)(J))” before “, with the thirty-sixth month”.
(B) APPLICATION.—Section 1836 of such Act (42 U.S.C. 1395o) is amended—
(i) by striking “Every individual who” and inserting “(a) In General.—Every individual who”; and
(ii) by adding at the end the following new subsection:
“(b) Special Rules Applicable to Individuals Only Eligible for Coverage of Immunosuppressive Drugs.—
“(1) IN GENERAL.—In the case of an individual whose eligibility for benefits under this title has ended on or after January 1, 2012, except for the coverage of immunosuppressive drugs by reason of section 226A(b)(2), the following rules shall apply:
“(A) The individual shall be deemed to be enrolled under this part for purposes of receiving coverage of such drugs.
“(B) The individual shall be responsible for providing for payment of the portion of the premium under section 1839 which is not covered under the Medicare savings program (as defined in section 1144(c)(7)) in order to receive such coverage.
“(C) The provision of such drugs shall be subject to the application of—
“(i) the deductible under section 1833(b); and
“(ii) the coinsurance amount applicable for such drugs (as determined under this part).
“(D) If the individual is an inpatient of a hospital or other entity, the individual is entitled to receive coverage of such drugs under this part.
“(2) ESTABLISHMENT OF PROCEDURES IN ORDER TO IMPLEMENT COVERAGE.—The Secretary shall establish procedures for—
“(A) identifying individuals that are entitled to coverage of immunosuppressive drugs by reason of section 226A(b)(2); and
“(B) distinguishing such individuals from individuals that are enrolled under this part for the complete package of benefits under this part.”.
(C) TECHNICAL AMENDMENT TO CORRECT DUPLICATE SUBSECTION DESIGNATION.—Subsection (d) of section 226A of such Act (42 U.S.C. 426–1), as added by section 201(a)(3)(D)(ii) of the Social Security Independence and Program Improvements Act of 1994 (Public Law 103–296; 108 Stat. 1497), is redesignated as subsection (d).
(2) EXTENSION OF SECONDARY PAYER REQUIREMENTS FOR ESRD BENEFICIARIES.—Section 1862(b)(1)(C) of such Act (42 U.S.C. 1395y(b)(1)(C)) is amended by adding at the end the following new sentence: “With regard to immunosuppressive drugs furnished on or after the date of the enactment of the America’s Affordable Health Choices Act of 2009, this subparagraph shall be applied without regard to any time limitation.”.
(b) Medicare coverage for ESRD patients.—Section 1881 of such Act is further amended—
(1) in subsection (b)(14)(B)(iii), by inserting “, including oral drugs that are not the oral equivalent of an intravenous drug (such as oral phosphate binders and calcimimetics),” after “other drugs and biologicals”;
(2) in subsection (b)(14)(E)(ii)—
(i) by striking “a one-time election to be excluded from the phase-in” and inserting “an election, with respect to 2011, 2012, or 2013, to be excluded from the phase-in (or the remainder of the phase-in)”; and
(ii) by adding at the end the following: “for such year and for each subsequent year during the phase-in described in clause (i)”; and
(i) by striking “January 1, 2011” and inserting “the first date of such year”; and
(ii) by inserting “and at a time” after “form and manner”; and
(3) in subsection (h)(4)(E), by striking “lesser” and inserting “greater”.
(1) IN GENERAL.—Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—
(i) by striking “and” at the end of subparagraph (DD);
(ii) by adding “and” at the end of subparagraph (EE); and
(iii) by adding at the end the following new subparagraph:
“(FF) advance care planning consultation (as defined in subsection (hhh)(1));”; and
(B) by adding at the end the following new subsection:
“(hhh) (1) Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:
“(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
“(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
“(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
“(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
“(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
“(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—
“(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;
“(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
“(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).
“(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State—
“(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and
“(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).
“(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that—
“(I) ensures such orders are standardized and uniquely identifiable throughout the State;
“(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;
“(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and
“(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.
“(2) A practitioner described in this paragraph is—
“(A) a physician (as defined in subsection (r)(1)); and
“(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign orders for life sustaining treatments.
“(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).
“(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.
“(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.
“(5)(A) For purposes of this section, the term ‘order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that—
“(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;
“(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;
“(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and
“(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.
“(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items—
“(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;
“(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;
“(iii) the use of antibiotics; and
“(iv) the use of artificially administered nutrition and hydration.”.
(2) PAYMENT.—Section 1848(j)(3) of such Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting “(2)(FF),” after “(2)(EE),”.
(3) FREQUENCY LIMITATION.—Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended—
(i) in subparagraph (N), by striking “and” at the end;
(ii) in subparagraph (O) by striking the semicolon at the end and inserting “, and”; and
(iii) by adding at the end the following new subparagraph:
“(P) in the case of advance care planning consultations (as defined in section 1861(hhh)(1)), which are performed more frequently than is covered under such section;”; and
(B) in paragraph (7), by striking “or (K)” and inserting “(K), or (P)”.
(4) EFFECTIVE DATE.—The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011.
(b) Expansion of physician quality reporting initiative for end of life care.—
(1) PHYSICIAN’S QUALITY REPORTING INITIATIVE.—Section 1848(k)(2) of the Social Security Act (42 U.S.C. 1395w–4(k)(2)) is amended by adding at the end the following new paragraphs:
“(3) PHYSICIAN’S QUALITY REPORTING INITIATIVE.—
“(A) IN GENERAL.—For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.
“(B) PROPOSED SET OF MEASURES.—The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary. The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.”.
(c) Inclusion of information in Medicare & You handbook.—
(A) IN GENERAL.—Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall update the online version of the Medicare & You Handbook to include the following:
(i) An explanation of advance care planning and advance directives, including—
(I) living wills;
(II) durable power of attorney;
(III) orders of life-sustaining treatment; and
(IV) health care proxies.
(ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including—
(I) available State legal service organizations to assist individuals with advance care planning, including those organizations that receive funding pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.);
(II) website links or addresses for State-specific advance directive forms; and
(III) any additional information, as determined by the Secretary.
(B) UPDATE OF PAPER AND SUBSEQUENT VERSIONS.—The Secretary shall include the information described in subparagraph (A) in all paper and electronic versions of the Medicare & You Handbook that are published on or after the date that is 1 year after the date of the enactment of this Act.
(a) Part B special enrollment period.—
(1) IN
GENERAL.—Section 1837 of the Social Security Act (42 U.S.C. 1395p)
is amended by adding at the end the following new subsection: “(l)(1) In the case of any individual who is a
covered beneficiary (as defined in section 1072(5) of title 10, United States
Code) at the time the individual is entitled to hospital insurance benefits
under part A under section 226(b) or section 226A and who is eligible to enroll
but who has elected not to enroll (or to be deemed enrolled) during the
individual’s initial enrollment period, there shall be a special enrollment
period described in paragraph (2). “(2) The special enrollment period described in
this paragraph, with respect to an individual, is the 12-month period beginning
on the day after the last day of the initial enrollment period of the
individual or, if later, the 12-month period beginning with the month the
individual is notified of enrollment under this section. “(3) In the case of an individual who
enrolls during the special enrollment period provided under paragraph (1), the
coverage period under this part shall begin on the first day of the month in
which the individual enrolls or, at the option of the individual, on the first
day of the second month following the last month of the individual’s initial
enrollment period. “(4) The Secretary of Defense shall
establish a method for identifying individuals described in paragraph (1) and
providing notice to them of their eligibility for enrollment during the special
enrollment period described in paragraph
(2).”.
(2) EFFECTIVE DATE.—The amendment made by paragraph (1) shall apply to elections made on or after the date of the enactment of this Act.
(b) Waiver of increase of premium.—
(1) IN GENERAL.—Section 1839(b) of the Social Security Act (42 U.S.C. 1395r(b)) is amended by striking “section 1837(i)(4)” and inserting “subsection (i)(4) or (l) of section 1837”.
(A) IN GENERAL.—The amendment made by paragraph (1) shall apply with respect to elections made on or after the date of the enactment of this Act.
(B) REBATES FOR CERTAIN DISABLED AND ESRD BENEFICIARIES.—
(i) IN GENERAL.—With respect to premiums for months on or after January 2005 and before the month of the enactment of this Act, no increase in the premium shall be effected for a month in the case of any individual who is a covered beneficiary (as defined in section 1072(5) of title 10, United States Code) at the time the individual is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act under section 226(b) or 226A of such Act, and who is eligible to enroll, but who has elected not to enroll (or to be deemed enrolled), during the individual’s initial enrollment period, and who enrolls under this part within the 12-month period that begins on the first day of the month after the month of notification of entitlement under this part.
(ii) CONSULTATION WITH DEPARTMENT OF DEFENSE.—The Secretary of Health and Human Services shall consult with the Secretary of Defense in identifying individuals described in this paragraph.
(iii) REBATES.—The Secretary of Health and Human Services shall establish a method for providing rebates of premium increases paid for months on or after January 1, 2005, and before the month of the enactment of this Act for which a penalty was applied and collected.
(a) In general.—Section 1839(i)(4)(C)(ii)(II) of the Social Security Act (42 U.S.C. 1395r(i)(4)(C)(ii)(II)) is amended by inserting “sale of primary residence,” after “divorce of such individual,”.
(b) Effective date.—The amendment made by subsection (a) shall apply to premiums and payments for years beginning with 2011.
(a) In general.—The Secretary of Health and Human Services shall establish a shared decision making demonstration program (in this subsection referred to as the “program”) under the Medicare program using patient decision aids to meet the objective of improving the understanding by Medicare beneficiaries of their medical treatment options, as compared to comparable Medicare beneficiaries who do not participate in a shared decision making process using patient decision aids.
(1) ENROLLMENT.—The Secretary shall enroll in the program not more than 30 eligible providers who have experience in implementing, and have invested in the necessary infrastructure to implement, shared decision making using patient decision aids.
(2) APPLICATION.—An eligible provider seeking to participate in the program shall submit to the Secretary an application at such time and containing such information as the Secretary may require.
(3) PREFERENCE.—In enrolling eligible providers in the program, the Secretary shall give preference to eligible providers that—
(A) have documented experience in using patient decision aids for the conditions identified by the Secretary and in using shared decision making;
(B) have the necessary information technology infrastructure to collect the information required by the Secretary for reporting purposes; and
(C) are trained in how to use patient decision aids and shared decision making.
(c) Follow-up counseling visit.—
(1) IN GENERAL.—An eligible provider participating in the program shall routinely schedule Medicare beneficiaries for a counseling visit after the viewing of such a patient decision aid to answer any questions the beneficiary may have with respect to the medical care of the condition involved and to assist the beneficiary in thinking through how their preferences and concerns relate to their medical care.
(2) PAYMENT FOR FOLLOW-UP COUNSELING VISIT.—The Secretary shall establish procedures for making payments for such counseling visits provided to Medicare beneficiaries under the program. Such procedures shall provide for the establishment—
(A) of a code (or codes) to represent such services; and
(B) of a single payment amount for such service that includes the professional time of the health care provider and a portion of the reasonable costs of the infrastructure of the eligible provider such as would be made under the applicable payment systems to that provider for similar covered services.
(d) Costs of aids.—An eligible provider participating in the program shall be responsible for the costs of selecting, purchasing, and incorporating such patient decision aids into the provider’s practice, and reporting data on quality and outcome measures under the program.
(e) Funding.—The Secretary shall provide for the transfer from the Federal Supplementary Medical Insurance Trust Fund established under section 1841 of the Social Security Act (42 U.S.C. 1395t) of such funds as are necessary for the costs of carrying out the program.
(f) Waiver authority.—The Secretary may waive such requirements of titles XI and XVIII of the Social Security Act (42 U.S.C. 1301 et seq. and 1395 et seq.) as may be necessary for the purpose of carrying out the program.
(g) Report.—Not later than 12 months after the date of completion of the program, the Secretary shall submit to Congress a report on such program, together with recommendations for such legislation and administrative action as the Secretary determines to be appropriate. The final report shall include an evaluation of the impact of the use of the program on health quality, utilization of health care services, and on improving the quality of life of such beneficiaries.
(h) Definitions.—In this section:
(1) ELIGIBLE PROVIDER.—The term “eligible provider” means the following:
(A) A primary care practice.
(B) A specialty practice.
(C) A multispecialty group practice.
(D) A hospital.
(E) A rural health clinic.
(F) A federally qualified health center (as defined in section 1861(aa)(4) of the Social Security Act (42 U.S.C. 1395x(aa)(4)).
(G) An integrated delivery system.
(H) A State cooperative entity that includes the State government and at least one other health care provider which is set up for the purpose of testing shared decision making and patient decision aids.
(2) PATIENT DECISION AID.—The term “patient decision aid” means an educational tool (such as the Internet, a video, or a pamphlet) that helps patients (or, if appropriate, the family caregiver of the patient) understand and communicate their beliefs and preferences related to their treatment options, and to decide with their health care provider what treatments are best for them based on their treatment options, scientific evidence, circumstances, beliefs, and preferences.
(3) SHARED DECISION MAKING.—The term “shared decision making” means a collaborative process between patient and clinician that engages the patient in decision making, provides patients with information about trade-offs among treatment options, and facilitates the incorporation of patient preferences and values into the medical plan.
Title XVIII of the Social Security Act is amended by inserting after section 1866C the following new section:
“Accountable Care Organization pilot program
“Sec. 1866D. (a) In general.—The Secretary shall conduct a pilot program (in this section referred to as the ‘pilot program’) to test different payment incentive models, including (to the extent practicable) the specific payment incentive models described in subsection (c), designed to reduce the growth of expenditures and improve health outcomes in the provision of items and services under this title to applicable beneficiaries (as defined in subsection (d)) by qualifying accountable care organizations (as defined in subsection (b)(1)) in order to—
“(1) promote accountability for a patient population and coordinate items and services under parts A and B;
“(2) encourage investment in infrastructure and redesigned care processes for high quality and efficient service delivery; and
“(3) reward physician practices and other physician organizational models for the provision of high quality and efficient health care services.
(a) In general.—Title XVIII of the Social Security Act is amended by inserting after section 1866D, as inserted by section 1301, the following new section:
“Medical home pilot program
“Sec. 1866E. (a) Establishment and medical home models.—
“(1) ESTABLISHMENT OF PILOT PROGRAM.—The Secretary shall establish a medical home pilot program (in this section referred to as the ‘pilot program’) for the purpose of evaluating the feasibility and advisability of reimbursing qualified patient-centered medical homes for furnishing medical home services (as defined under subsection (b)(1)) to high need beneficiaries (as defined in subsection (d)(1)(C)) and to targeted high need beneficiaries (as defined in subsection (c)(1)(C)).
“(2) SCOPE.—Subject to subsection (g), the pilot program shall include urban, rural, and underserved areas.
“(3) MODELS OF MEDICAL HOMES IN THE PILOT PROGRAM.—The pilot program shall evaluate each of the following medical home models:
“(A) INDEPENDENT PATIENT-CENTERED MEDICAL HOME MODEL.—Independent patient-centered medical home model under subsection (c).
“(B) COMMUNITY-BASED MEDICAL HOME MODEL.—Community-based medical home model under subsection (d).
“(4) PARTICIPATION OF NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS.—
“(A) Nothing in this section shall be construed as preventing a nurse practitioner from leading a patient centered medical home so long as—
“(i) all the requirements of this section are met; and
“(ii) the nurse practitioner is acting consistently with State law.
“(B) Nothing in this section shall be construed as preventing a physician assistant from participating in a patient centered medical home so long as—
“(i) all the requirements of this section are met; and
“(ii) the physician assistant is acting consistently with State law.
“(1) EVALUATION OF COST AND QUALITY.—The Secretary shall evaluate the pilot program to determine—
“(A) the extent to which medical homes result in—
“(i) improvement in the quality and coordination of health care services, particularly with regard to the care of complex patients;
“(ii) improvement in reducing health disparities;
“(iii) reductions in preventable hospitalizations;
“(iv) prevention of readmissions;
“(v) reductions in emergency room visits;
“(vi) improvement in health outcomes, including patient functional status where applicable;
“(vii) improvement in patient satisfaction;
“(viii) improved efficiency of care such as reducing duplicative diagnostic tests and laboratory tests; and
“(ix) reductions in health care expenditures; and
“(B) the feasability and advisability of reimbursing medical homes for medical home services under this title on a permanent basis.
“(2) REPORT.—Not later than 60 days after the date of completion of the evaluation under paragraph (1), the Secretary shall submit to Congress and make available to the public a report on the findings of the evaluation under paragraph (1).
“(A) IN GENERAL.—Subject to the results of the evaluation under paragraph (1) and subparagraph (B), the Secretary may issue regulations to implement, on a permanent basis, one or more models, if, and to the extent that such model or models, are beneficial to the program under this title, including that such implementation will improve quality of care, as determined by the Secretary.
“(B) CERTIFICATION REQUIREMENT.—The Secretary may not issue such regulations unless the Chief Actuary of the Centers for Medicare & Medicaid Services certifies that the expansion of the components of the pilot program described in subparagraph (A) would result in estimated spending under this title that would be no more than the level of spending that the Secretary estimates would otherwise be spent under this title in the absence of such expansion.
(b) Effective date.—The amendment made by this section shall apply to services furnished on or after the date of the enactment of this Act.
(c) Conforming repeal.—Section 204 of division B of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395b–1 note), as amended by section 133(a)(2) of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110–275), is repealed.
(a) In general.—Section 1833 of the Social Security Act is amended by inserting after subsection (o) the following new subsection:
“(p) Primary care payment incentives.—
“(1) IN GENERAL.—In the case of primary care services (as defined in paragraph (2)) furnished on or after January 1, 2011, by a primary care practitioner (as defined in paragraph (3)) for which amounts are payable under section 1848, in addition to the amount otherwise paid under this part there shall also be paid to the practitioner (or to an employer or facility in the cases described in clause (A) of section 1842(b)(6)) (on a monthly or quarterly basis) from the Federal Supplementary Medical Insurance Trust Fund an amount equal 5 percent (or 10 percent if the practitioner predominately furnishes such services in an area that is designated (under section 332(a)(1)(A) of the Public Health Service Act) as a primary care health professional shortage area.
“(2) PRIMARY CARE SERVICES DEFINED.—In this subsection, the term ‘primary care services’—
“(A) means services which are evaluation and management services as defined in section 1848(j)(5)(A); and
“(B) includes services furnished by another health care professional that would be described in subparagraph (A) if furnished by a physician.
“(3) PRIMARY CARE PRACTITIONER DEFINED.—In this subsection, the term ‘primary care practitioner’—
“(A) means a physician or other health care practitioner (including a nurse practitioner) who—
“(i) specializes in family medicine, general internal medicine, general pediatrics, geriatrics, or obstetrics and gynecology; and
“(ii) has allowed charges for primary care services that account for at least 50 percent of the physician’s or practitioner’s total allowed charges under section 1848, as determined by the Secretary for the most recent period for which data are available; and
“(B) includes a physician assistant who is under the supervision of a practitioner described in subparagraph (A).
“(4) LIMITATION ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, or otherwise, respecting—
“(A) any determination or designation under this subsection;
“(B) the identification of services as primary care services under this subsection; and
“(C) the identification of a practitioner as a primary care practitioner under this subsection.
“(5) COORDINATION WITH OTHER PAYMENTS.—
“(A) WITH OTHER PRIMARY CARE INCENTIVES.—The provisions of this subsection shall not be taken into account in applying subsections (m) and (u) and any payment under such subsections shall not be taken into account in computing payments under this subsection.
“(B) WITH QUALITY INCENTIVES.—Payments under this subsection shall not be taken into account in determining the amounts that would otherwise be paid under this part for purposes of section 1834(g)(2)(B).”.
(1) Section 1833 of such Act (42 U.S.C. 1395l(m)) is amended by redesignating paragraph (4) as paragraph (5) and by inserting after paragraph (3) the following new paragraph:
“(4) The provisions of this subsection shall not be taken into account in applying subsections (m) or (u) and any payment under such subsections shall not be taken into account in computing payments under this subsection.”.
(2) Section 1848(m)(5)(B) of such Act (42 U.S.C. 1395w–4(m)(5)(B)) is amended by inserting “, (p),” after “(m)”.
(3) Section 1848(o)(1)(B)(iv) of such Act (42 U.S.C. 1395w–4(o)(1)(B)(iv)) is amended by inserting “primary care” before “health professional shortage area”.
(a) In general.—Section 1833(a)(1)(K) of the Social Security Act (42 U.S.C.1395l(a)(1)(K)) is amended by striking “(but in no event” and all that follows through “performed by a physician)”.
(b) Effective date.—The amendment made by subsection (a) shall apply to services furnished on or after January 1, 2011.
(a) Medicare covered preventive services defined.—Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by section 1235(a)(2), is amended by adding at the end the following new subsection:
“(iii) (1) Subject to the succeeding provisions of this subsection, the term ‘Medicare covered preventive services’ means the following:
“(A) Prostate cancer screening tests (as defined in subsection (oo)).
“(B) Colorectal cancer screening tests (as defined in subsection (pp) and when applicable as described in section 1305).
“(C) Diabetes outpatient self-management training services (as defined in subsection (qq)).
“(D) Screening for glaucoma for certain individuals (as described in subsection (s)(2)(U)).
“(E) Medical nutrition therapy services for certain individuals (as described in subsection (s)(2)(V)).
“(F) An initial preventive physical examination (as defined in subsection (ww)).
“(G) Cardiovascular screening blood tests (as defined in subsection (xx)(1)).
“(H) Diabetes screening tests (as defined in subsection (yy)).
“(I) Ultrasound screening for abdominal aortic aneurysm for certain individuals (as described in described in subsection (s)(2)(AA)).
“(J) Pneumococcal and influenza vaccines and their administration (as described in subsection (s)(10)(A)) and hepatitis B vaccine and its administration for certain individuals (as described in subsection (s)(10)(B)).
“(K) Screening mammography (as defined in subsection (jj)).
“(L) Screening pap smear and screening pelvic exam (as defined in subsection (nn)).
“(M) Bone mass measurement (as defined in subsection (rr)).
“(N) Kidney disease education services (as defined in subsection (ggg)).
“(O) Additional preventive services (as defined in subsection (ddd)).
“(2) With respect to specific Medicare covered preventive services, the limitations and conditions described in the provisions referenced in paragraph (1) with respect to such services shall apply.”.
(b) Payment and Elimination of Cost-sharing.—
(A) IN GENERAL.—Section 1833(a) of the Social Security Act (42 U.S.C. 1395l(a)) is amended by adding after and below paragraph (9) the following:
“With respect to Medicare covered preventive services, in any case in which the payment rate otherwise provided under this part is computed as a percent of less than 100 percent of an actual charge, fee schedule rate, or other rate, such percentage shall be increased to 100 percent.”.(B) APPLICATION TO SIGMOIDOSCOPIES AND COLONOSCOPIES.—Section 1834(d) of such Act (42 U.S.C. 1395m(d)) is amended—
(i) in paragraph (2)(C), by amending clause (ii) to read as follows:
“(ii) NO COINSURANCE.—In the case of a beneficiary who receives services described in clause (i), there shall be no coinsurance applied.”; and
(ii) in paragraph (3)(C), by amending clause (ii) to read as follows:
“(ii) NO COINSURANCE.—In the case of a beneficiary who receives services described in clause (i), there shall be no coinsurance applied.”.
(2) ELIMINATION OF COINSURANCE IN OUTPATIENT HOSPITAL SETTINGS.—
(A) EXCLUSION FROM OPD FEE SCHEDULE.—Section 1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is amended by striking “screening mammography (as defined in section 1861(jj)) and diagnostic mammography” and inserting “diagnostic mammograms and Medicare covered preventive services (as defined in section 1861(iii)(1))”.
(B) CONFORMING AMENDMENTS.—Section 1833(a)(2) of the Social Security Act (42 U.S.C. 1395l(a)(2)) is amended—
(i) in subparagraph (F), by striking “and” after the semicolon at the end;
(ii) in subparagraph (G)(ii), by adding “and” at the end; and
(iii) by adding at the end the following new subparagraph:
“(H) with respect to additional preventive services (as defined in section 1861(ddd)) furnished by an outpatient department of a hospital, the amount determined under paragraph (1)(W);”.
(3) WAIVER OF APPLICATION OF DEDUCTIBLE FOR ALL PREVENTIVE SERVICES.—The first sentence of section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) is amended—
(A) in clause (1), by striking “items and services described in section 1861(s)(10)(A)” and inserting “Medicare covered preventive services (as defined in section 1861(iii))”;
(B) by inserting “and” before “(4)”; and
(C) by striking clauses (5) through (8).
(4) APPLICATION TO PROVIDERS OF SERVICES.—Section 1866(a)(2)(A)(ii) of such Act (42 U.S.C. 1395cc(a)(2)(A)(ii)) is amended by inserting “other than for Medicare covered preventive services and” after “for such items and services (”.
(c) Effective date.—The amendments made by this section shall apply to services furnished on or after January 1, 2011.
(a) In general.—Section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)), as amended by section 1305(b)(3), is amended by adding at the end the following new sentence: “Clause (1) of the first sentence of this subsection shall apply with respect to a colorectal cancer screening test regardless of the code that is billed for the establishment of a diagnosis as a result of the test, or for the removal of tissue or other matter or other procedure that is furnished in connection with, as a result of, and in the same clinical encounter as, the screening test.”.
(b) Effective date.—The amendment made by subsection (a) shall apply to items and services furnished on or after January 1, 2011.
(a) In general.—Section 1888(e)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting “clinical social worker services,” after “qualified psychologist services,”.
(b) Conforming amendment.—Section 1861(hh)(2) of the Social Security Act (42 U.S.C. 1395x(hh)(2)) is amended by striking “and other than services furnished to an inpatient of a skilled nursing facility which the facility is required to provide as a requirement for participation”.
(c) Effective date.—The amendments made by this section shall apply to items and services furnished on or after July 1, 2010.
(a) Coverage of marriage and family therapist services.—
(1) COVERAGE OF SERVICES.—Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as amended by section 1235, is amended—
(A) in subparagraph (EE), by striking “and” at the end;
(B) in subparagraph (FF), by adding “and” at the end; and
(C) by adding at the end the following new subparagraph:
“(GG) marriage and family therapist services (as defined in subsection (jjj));”.
(2) DEFINITION.—Section
1861 of the Social Security Act (42
U.S.C. 1395x), as amended by sections 1235 and 1305, is amended by adding at
the end the following new subsection:
“(jjj) (1) The term ‘marriage and family therapist services’ means services performed by a marriage and family therapist (as defined in paragraph (2)) for the diagnosis and treatment of mental illnesses, which the marriage and family therapist is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) of the State in which such services are performed, as would otherwise be covered if furnished by a physician or as incident to a physician’s professional service, but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services.
“(2) The term ‘marriage and family therapist’ means an individual who—
“(A) possesses a master’s or doctoral degree which qualifies for licensure or certification as a marriage and family therapist pursuant to State law;
“(B) after obtaining such degree has performed at least 2 years of clinical supervised experience in marriage and family therapy; and
“(C) is licensed or certified as a marriage and family therapist in the State in which marriage and family therapist services are performed.”.
(3) PROVISION FOR PAYMENT UNDER PART B.—Section 1832(a)(2)(B) of the Social Security Act (42 U.S.C. 1395k(a)(2)(B)) is amended by adding at the end the following new clause:
“(v) marriage and family therapist services;”.
(A) IN GENERAL.—Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—
(i) by striking “and” before “(W)”; and
(ii) by inserting before the semicolon at the end the following: “, and (X) with respect to marriage and family therapist services under section 1861(s)(2)(GG), the amounts paid shall be 80 percent of the lesser of the actual charge for the services or 75 percent of the amount determined for payment of a psychologist under clause (L)”.
(B) DEVELOPMENT OF CRITERIA WITH RESPECT TO CONSULTATION WITH A HEALTH CARE PROFESSIONAL.—The Secretary of Health and Human Services shall, taking into consideration concerns for patient confidentiality, develop criteria with respect to payment for marriage and family therapist services for which payment may be made directly to the marriage and family therapist under part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) under which such a therapist must agree to consult with a patient’s attending or primary care physician or nurse practitioner in accordance with such criteria.
(5) EXCLUSION OF MARRIAGE AND FAMILY THERAPIST SERVICES FROM SKILLED NURSING FACILITY PROSPECTIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)), as amended by section 1307(a), is amended by inserting “marriage and family therapist services (as defined in subsection (jjj)(1)),” after “clinical social worker services,”.
(6) COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES PROVIDED IN RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS.—Section 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 1395x(aa)(1)(B)) is amended by striking “or by a clinical social worker (as defined in subsection (hh)(1)),” and inserting “, by a clinical social worker (as defined in subsection (hh)(1)), or by a marriage and family therapist (as defined in subsection (jjj)(2)),”.
(7) INCLUSION OF MARRIAGE AND FAMILY THERAPISTS AS PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following new clause:
“(vii) A marriage and family therapist (as defined in section 1861(jjj)(2)).”.
(b) Coverage of mental health counselor services.—
(1) COVERAGE OF SERVICES.—Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as previously amended, is further amended—
(A) in subparagraph (FF), by striking “and” at the end;
(B) in subparagraph (GG), by inserting “and” at the end; and
(C) by adding at the end the following new subparagraph:
“(HH) mental health counselor services (as defined in subsection (kkk)(1));”.
(2) DEFINITION.—Section
1861 of the Social Security Act (42
U.S.C. 1395x), as previously amended, is amended by adding at the end the
following new subsection:
“(kkk) (1) The term ‘mental health counselor services’ means services performed by a mental health counselor (as defined in paragraph (2)) for the diagnosis and treatment of mental illnesses which the mental health counselor is legally authorized to perform under State law (or the State regulatory mechanism provided by the State law) of the State in which such services are performed, as would otherwise be covered if furnished by a physician or as incident to a physician’s professional service, but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services.
“(2) The term ‘mental health counselor’ means an individual who—
“(A) possesses a master’s or doctor’s degree which qualifies the individual for licensure or certification for the practice of mental health counseling in the State in which the services are performed;
“(B) after obtaining such a degree has performed at least 2 years of supervised mental health counselor practice; and
“(C) is licensed or certified as a mental health counselor or professional counselor by the State in which the services are performed.”.
(3) PROVISION FOR PAYMENT UNDER PART B.—Section 1832(a)(2)(B) of the Social Security Act (42 U.S.C. 1395k(a)(2)(B)), as amended by subsection (a)(3), is further amended—
(A) by striking “and” at the end of clause (iv);
(B) by adding “and” at the end of clause (v); and
(C) by adding at the end the following new clause:
“(vi) mental health counselor services;”.
(A) IN GENERAL.—Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)), as amended by subsection (a), is further amended—
(i) by striking “and”before “(X)”; and
(ii) by inserting before the semicolon at the end the following: “, and (Y), with respect to mental health counselor services under section 1861(s)(2)(HH), the amounts paid shall be 80 percent of the lesser of the actual charge for the services or 75 percent of the amount determined for payment of a psychologist under clause (L)”.
(B) DEVELOPMENT OF CRITERIA WITH RESPECT TO CONSULTATION WITH A PHYSICIAN.—The Secretary of Health and Human Services shall, taking into consideration concerns for patient confidentiality, develop criteria with respect to payment for mental health counselor services for which payment may be made directly to the mental health counselor under part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) under which such a counselor must agree to consult with a patient’s attending or primary care physician in accordance with such criteria.
(5) EXCLUSION OF MENTAL HEALTH COUNSELOR SERVICES FROM SKILLED NURSING FACILITY PROSPECTIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)), as amended by section 1307(a) and subsection (a), is amended by inserting “mental health counselor services (as defined in section 1861(kkk)(1)),” after “marriage and family therapist services (as defined in subsection (jjj)(1)),”.
(6) COVERAGE OF MENTAL HEALTH COUNSELOR SERVICES PROVIDED IN RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS.—Section 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 1395x(aa)(1)(B)), as amended by subsection (a), is amended by striking “or by a marriage and family therapist (as defined in subsection (jjj)(2)),” and inserting “by a marriage and family therapist (as defined in subsection (jjj)(2)), or a mental health counselor (as defined in subsection (kkk)(2)),”.
(7) INCLUSION OF MENTAL HEALTH COUNSELORS AS PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)), as amended by subsection (a)(7), is amended by adding at the end the following new clause:
“(viii) A mental health counselor (as defined in section 1861(kkk)(2)).”.
(c) Effective Date.—The amendments made by this section shall apply to items and services furnished on or after January 1, 2011.
Section 138(a)(1) of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110–275) is amended by striking “December 31, 2009” and inserting “December 31, 2011”.
(a) In general.—Paragraph (10) of section 1861(s) of the Social Security Act (42 U.S.C. 1395w(s)) is amended to read as follows:
“(10) federally recommended vaccines (as defined in subsection (lll)) and their respective administration;”.
(b) Federally Recommended Vaccines Defined.—Section 1861 of such Act is further amended by adding at the end the following new subsection:
“(lll) The term ‘federally recommended vaccine’ means an approved vaccine recommended by the Advisory Committee on Immunization Practices (an advisory committee established by the Secretary, acting through the Director of the Centers for Disease Control and Prevention).”.
(1) Section 1833 of such Act (42 U.S.C. 1395l) is amended, in each of subsections (a)(1)(B), (a)(2)(G), (a)(3)(A), and (b)(1) (as amended by section 1305(b)), by striking “1861(s)(10)(A)” or “1861(s)(10)(B)” and inserting “1861(s)(10)” each place it appears.
(2) Section 1842(o)(1)(A)(iv) of such Act (42 U.S.C. 1395u(o)(1)(A)(iv)) is amended—
(A) by striking “subparagraph (A) or (B) of”; and
(B) by inserting before the period the following: “and before January 1, 2011, and influenza vaccines furnished on or after January 1, 2011”.
(3) Section 1847A(c)(6) of such Act (42 U.S.C. 1395w–3a(c)(6)) is amended by striking subparagraph (G) and inserting the following:
“(G) IMPLEMENTATION.—Chapter 35 of title 44, United States Code shall not apply to manufacturer provision of information pursuant to section 1927(b)(3)(A)(iii) for purposes of implementation of this section.”.
(4) Section 1860D–2(e)(1)(B) of such Act (42 U.S.C. 1395w–102(e)(1)(B)) is amended by striking “such term includes a vaccine” and all that follows through “its administration) and”.
(5) Section 1861(ww)(2)(A) of such Act (42 U.S.C. 1395x(ww)(2)(A))) is amended by striking “Pneumococcal, influenza, and hepatitis B and administration” and inserting “Federally recommended vaccines (as defined in subsection (lll)) and their respective administration”.
(6) Section 1861(iii)(1) of such Act, as added by section 1305(a), is amended by amending subparagraph (J) to read as follows:
“(J) Federally recommended vaccines (as defined in subsection (lll)) and their respective administration.”.
(7) Section 1927(b)(3)(A)(iii) of such Act (42 U.S.C. 1396r–8(b)(3)(A)(iii)) is amended, in the matter following subclause (III), by inserting “(A)(iv) (including influenza vaccines furnished on or after January 1, 2011),” after “described in subparagraph.”
(d) Effective dates.—The amendments made by—
(1) this section (other than by subsection (c)(7)) shall apply to vaccines administered on or after January 1, 2011; and
(2) by subsection (c)(7) shall apply to calendar quarters beginning on or after January 1, 2010.
(a) In general.—title XI of the Social Security Act is amended by adding at the end the following new part:
“Comparative effectiveness research
“Sec. 1181. (a) Center for comparative effectiveness research established.—
“(1) IN GENERAL.—The Secretary shall establish within the Agency for Healthcare Research and Quality a Center for Comparative Effectiveness Research (in this section referred to as the ‘Center’) to conduct, support, and synthesize research (including research conducted or supported under section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.
“(2) DUTIES.—The Center shall—
“(A) conduct, support, and synthesize research relevant to the comparative effectiveness of the full spectrum of health care items, services and systems, including pharmaceuticals, medical devices, medical and surgical procedures, and other medical interventions;
“(B) conduct and support systematic reviews of clinical research, including original research conducted subsequent to the date of the enactment of this section;
“(C) continuously develop rigorous scientific methodologies for conducting comparative effectiveness studies, and use such methodologies appropriately;
“(D) submit to the Comparative Effectiveness Research Commission, the Secretary, and Congress appropriate relevant reports described in subsection (d)(2); and
“(E) encourage, as appropriate, the development and use of clinical registries and the development of clinical effectiveness research data networks from electronic health records, post marketing drug and medical device surveillance efforts, and other forms of electronic health data.
“(A) OBTAINING OFFICIAL DATA.—The Center may secure directly from any department or agency of the United States information necessary to enable it to carry out this section. Upon request of the Center, the head of that department or agency shall furnish that information to the Center on an agreed upon schedule.
“(B) DATA COLLECTION.—In order to carry out its functions, the Center shall—
“(i) utilize existing information, both published and unpublished, where possible, collected and assessed either by its own staff or under other arrangements made in accordance with this section,
“(ii) carry out, or award grants or contracts for, original research and experimentation, where existing information is inadequate, and
“(iii) adopt procedures allowing any interested party to submit information for the use by the Center and Commission under subsection (b) in making reports and recommendations.
“(C) ACCESS OF GAO TO INFORMATION.—The Comptroller General shall have unrestricted access to all deliberations, records, and nonproprietary data of the Center and Commission under subsection (b), immediately upon request.
“(D) PERIODIC AUDIT.—The Center and Commission under subsection (b) shall be subject to periodic audit by the Comptroller General.
(b) Comparative Effectiveness Research Trust Fund; financing for the trust fund.—For provision establishing a Comparative Effectiveness Research Trust Fund and financing such Trust Fund, see section 1802.
(a) In general.—Section 1124 of the Social Security Act (42 U.S.C. 1320a–3) is amended by adding at the end the following new subsection:
“(c) Required Disclosure of Ownership and Additional Disclosable Parties Information.—
“(1) DISCLOSURE.—A facility (as defined in paragraph (7)(B)) shall have the information described in paragraph (3) available—
“(A) during the period beginning on the date of the enactment of this subsection and ending on the date such information is made available to the public under section 1411(b) of the America’s Affordable Health Choices Act of 2009, for submission to the Secretary, the Inspector General of the Department of Health and Human Services, the State in which the facility is located, and the State long-term care ombudsman in the case where the Secretary, the Inspector General, the State, or the State long-term care ombudsman requests such information; and
“(B) beginning on the effective date of the final regulations promulgated under paragraph (4)(A), for reporting such information in accordance with such final regulations.
Nothing in subparagraph (A) shall be construed as authorizing a facility to dispose of or delete information described in such subparagraph after the effective date of the final regulations promulgated under paragraph (4)(A).
“(2) PUBLIC AVAILABILITY OF INFORMATION.—During the period described in paragraph (1)(A), a facility shall—
“(A) make the information described in paragraph (3) available to the public upon request and update such information as may be necessary to reflect changes in such information; and
“(B) post a notice of the availability of such information in the lobby of the facility in a prominent manner.
“(A) IN GENERAL.—The following information is described in this paragraph:
“(i) The information described in subsections (a) and (b), subject to subparagraph (C).
“(ii) The identity of and information on—
“(I) each member of the governing body of the facility, including the name, title, and period of service of each such member;
“(II) each person or entity who is an officer, director, member, partner, trustee, or managing employee of the facility, including the name, title, and date of start of service of each such person or entity; and
“(III) each person or entity who is an additional disclosable party of the facility.
“(iii) The organizational structure of each person and entity described in subclauses (II) and (III) of clause (ii) and a description of the relationship of each such person or entity to the facility and to one another.
“(B) SPECIAL RULE WHERE INFORMATION IS ALREADY REPORTED OR SUBMITTED.—To the extent that information reported by a facility to the Internal Revenue Service on Form 990, information submitted by a facility to the Securities and Exchange Commission, or information otherwise submitted to the Secretary or any other Federal agency contains the information described in clauses (i), (ii), or (iii) of subparagraph (A), the Secretary may allow, to the extent practicable, such Form or such information to meet the requirements of paragraph (1) and to be submitted in a manner specified by the Secretary.
“(C) SPECIAL RULE.—In applying subparagraph (A)(i)—
“(i) with respect to subsections (a) and (b), ‘ownership or control interest’ shall include direct or indirect interests, including such interests in intermediate entities; and
“(ii) subsection (a)(3)(A)(ii) shall include the owner of a whole or part interest in any mortgage, deed of trust, note, or other obligation secured, in whole or in part, by the entity or any of the property or assets thereof, if the interest is equal to or exceeds 5 percent of the total property or assets of the entirety.
“(A) IN GENERAL.—Not later than the date that is 2 years after the date of the enactment of this subsection, the Secretary shall promulgate regulations requiring, effective on the date that is 90 days after the date on which such final regulations are published in the Federal Register, a facility to report the information described in paragraph (3) to the Secretary in a standardized format, and such other regulations as are necessary to carry out this subsection. Such final regulations shall ensure that the facility certifies, as a condition of participation and payment under the program under title XVIII or XIX, that the information reported by the facility in accordance with such final regulations is accurate and current.
“(B) GUIDANCE.—The Secretary shall provide guidance and technical assistance to States on how to adopt the standardized format under subparagraph (A).
“(5) NO EFFECT ON EXISTING REPORTING REQUIREMENTS.—Nothing in this subsection shall reduce, diminish, or alter any reporting requirement for a facility that is in effect as of the date of the enactment of this subsection.
“(6) DEFINITIONS.—In this subsection:
“(A) ADDITIONAL DISCLOSABLE PARTY.—The term ‘additional disclosable party’ means, with respect to a facility, any person or entity who—
“(i) exercises operational, financial, or managerial control over the facility or a part thereof, or provides policies or procedures for any of the operations of the facility, or provides financial or cash management services to the facility;
“(ii) leases or subleases real property to the facility, or owns a whole or part interest equal to or exceeding 5 percent of the total value of such real property;
“(iii) lends funds or provides a financial guarantee to the facility in an amount which is equal to or exceeds $50,000; or
“(iv) provides management or administrative services, clinical consulting services, or accounting or financial services to the facility.
“(B) FACILITY.—The term ‘facility’ means a disclosing entity which is—
“(i) a skilled nursing facility (as defined in section 1819(a)); or
“(ii) a nursing facility (as defined in section 1919(a)).
“(C) MANAGING EMPLOYEE.—The term ‘managing employee’ means, with respect to a facility, an individual (including a general manager, business manager, administrator, director, or consultant) who directly or indirectly manages, advises, or supervises any element of the practices, finances, or operations of the facility.
“(D) ORGANIZATIONAL STRUCTURE.—The term ‘organizational structure’ means, in the case of—
“(i) a corporation, the officers, directors, and shareholders of the corporation who have an ownership interest in the corporation which is equal to or exceeds 5 percent;
“(ii) a limited liability company, the members and managers of the limited liability company (including, as applicable, what percentage each member and manager has of the ownership interest in the limited liability company);
“(iii) a general partnership, the partners of the general partnership;
“(iv) a limited partnership, the general partners and any limited partners of the limited partnership who have an ownership interest in the limited partnership which is equal to or exceeds 10 percent;
“(v) a trust, the trustees of the trust;
“(vi) an individual, contact information for the individual; and
“(vii) any other person or entity, such information as the Secretary determines appropriate.”.
(b) Public Availability of Information.—
(1) IN GENERAL.—Not later than the date that is 1 year after the date on which the final regulations promulgated under section 1124(c)(4)(A) of the Social Security Act, as added by subsection (a), are published in the Federal Register, the information reported in accordance with such final regulations shall be made available to the public in accordance with procedures established by the Secretary.
(2) DEFINITIONS.—In this subsection:
(A) NURSING FACILITY.—The term “nursing facility” has the meaning given such term in section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a)).
(B) SECRETARY.—The term “Secretary” means the Secretary of Health and Human Services.
(C) SKILLED NURSING FACILITY.—The term “skilled nursing facility” has the meaning given such term in section 1819(a) of the Social Security Act (42 U.S.C. 1395i–3(a)).
(1) SKILLED NURSING FACILITIES.—Section 1819(d)(1) of the Social Security Act (42 U.S.C. 1395i–3(d)(1)) is amended by striking subparagraph (B) and redesignating subparagraph (C) as subparagraph (B).
(2) NURSING FACILITIES.—Section 1919(d)(1) of the Social Security Act (42 U.S.C. 1396r(d)(1)) is amended by striking subparagraph (B) and redesignating subparagraph (C) as subparagraph (B).
(a) Effective Compliance and Ethics Programs.—
(1) SKILLED NURSING FACILITIES.—Section 1819(d)(1) of the Social Security Act (42 U.S.C. 1395i–3(d)(1)), as amended by section 1411(c)(1), is amended by adding at the end the following new subparagraph:
“(C) COMPLIANCE AND ETHICS PROGRAMS.—
“(i) REQUIREMENT.—On or after the date that is 36 months after the date of the enactment of this subparagraph, a skilled nursing facility shall, with respect to the entity that operates the facility (in this subparagraph referred to as the ‘operating organization’ or ‘organization’), have in operation a compliance and ethics program that is effective in preventing and detecting criminal, civil, and administrative violations under this Act and in promoting quality of care consistent with regulations developed under clause (ii).
“(ii) DEVELOPMENT OF REGULATIONS.—
“(I) IN GENERAL.—Not later than the date that is 2 years after such date of the enactment, the Secretary, in consultation with the Inspector General of the Department of Health and Human Services, shall promulgate regulations for an effective compliance and ethics program for operating organizations, which may include a model compliance program.
“(II) DESIGN OF REGULATIONS.—Such regulations with respect to specific elements or formality of a program may vary with the size of the organization, such that larger organizations should have a more formal and rigorous program and include established written policies defining the standards and procedures to be followed by its employees. Such requirements shall specifically apply to the corporate level management of multi-unit nursing home chains.
“(III) EVALUATION.—Not later than 3 years after the date of promulgation of regulations under this clause, the Secretary shall complete an evaluation of the compliance and ethics programs required to be established under this subparagraph. Such evaluation shall determine if such programs led to changes in deficiency citations, changes in quality performance, or changes in other metrics of resident quality of care. The Secretary shall submit to Congress a report on such evaluation and shall include in such report such recommendations regarding changes in the requirements for such programs as the Secretary determines appropriate.
“(iii) REQUIREMENTS FOR COMPLIANCE AND ETHICS PROGRAMS.—In this subparagraph, the term ‘compliance and ethics program’ means, with respect to a skilled nursing facility, a program of the operating organization that—
“(I) has been reasonably designed, implemented, and enforced so that it generally will be effective in preventing and detecting criminal, civil, and administrative violations under this Act and in promoting quality of care; and
“(II) includes at least the required components specified in clause (iv).
“(iv) REQUIRED COMPONENTS OF PROGRAM.—The required components of a compliance and ethics program of an organization are the following:
“(I) The organization must have established compliance standards and procedures to be followed by its employees, contractors, and other agents that are reasonably capable of reducing the prospect of criminal, civil, and administrative violations under this Act.
“(II) Specific individuals within high-level personnel of the organization must have been assigned overall responsibility to oversee compliance with such standards and procedures and have sufficient resources and authority to assure such compliance.
“(III) The organization must have used due care not to delegate substantial discretionary authority to individuals whom the organization knew, or should have known through the exercise of due diligence, had a propensity to engage in criminal, civil, and administrative violations under this Act.
“(IV) The organization must have taken steps to communicate effectively its standards and procedures to all employees and other agents, such as by requiring participation in training programs or by disseminating publications that explain in a practical manner what is required.
“(V) The organization must have taken reasonable steps to achieve compliance with its standards, such as by utilizing monitoring and auditing systems reasonably designed to detect criminal, civil, and administrative violations under this Act by its employees and other agents and by having in place and publicizing a reporting system whereby employees and other agents could report violations by others within the organization without fear of retribution.
“(VI) The standards must have been consistently enforced through appropriate disciplinary mechanisms, including, as appropriate, discipline of individuals responsible for the failure to detect an offense.
“(VII) After an offense has been detected, the organization must have taken all reasonable steps to respond appropriately to the offense and to prevent further similar offenses, including repayment of any funds to which it was not entitled and any necessary modification to its program to prevent and detect criminal, civil, and administrative violations under this Act.
“(VIII) The organization must periodically undertake reassessment of its compliance program to identify changes necessary to reflect changes within the organization and its facilities.
“(v) COORDINATION.—The provisions of this subparagraph shall apply with respect to a skilled nursing facility in lieu of section 1874(d).”.
(2) NURSING FACILITIES.—Section 1919(d)(1) of the Social Security Act (42 U.S.C. 1396r(d)(1)), as amended by section 1411(c)(2), is amended by adding at the end the following new subparagraph:
“(C) COMPLIANCE AND ETHICS PROGRAM.—
“(i) REQUIREMENT.—On or after the date that is 36 months after the date of the enactment of this subparagraph, a nursing facility shall, with respect to the entity that operates the facility (in this subparagraph referred to as the ‘operating organization’ or ‘organization’), have in operation a compliance and ethics program that is effective in preventing and detecting criminal, civil, and administrative violations under this Act and in promoting quality of care consistent with regulations developed under clause (ii).
“(ii) DEVELOPMENT OF REGULATIONS.—
“(I) IN GENERAL.—Not later than the date that is 2 years after such date of the enactment, the Secretary, in consultation with the Inspector General of the Department of Health and Human Services, shall develop regulations for an effective compliance and ethics program for operating organizations, which may include a model compliance program.
“(II) DESIGN OF REGULATIONS.—Such regulations with respect to specific elements or formality of a program may vary with the size of the organization, such that larger organizations should have a more formal and rigorous program and include established written policies defining the standards and procedures to be followed by its employees. Such requirements may specifically apply to the corporate level management of multi-unit nursing home chains.
“(III) EVALUATION.—Not later than 3 years after the date of promulgation of regulations under this clause the Secretary shall complete an evaluation of the compliance and ethics programs required to be established under this subparagraph. Such evaluation shall determine if such programs led to changes in deficiency citations, changes in quality performance, or changes in other metrics of resident quality of care. The Secretary shall submit to Congress a report on such evaluation and shall include in such report such recommendations regarding changes in the requirements for such programs as the Secretary determines appropriate.
“(iii) REQUIREMENTS FOR COMPLIANCE AND ETHICS PROGRAMS.—In this subparagraph, the term ‘compliance and ethics program’ means, with respect to a nursing facility, a program of the operating organization that—
“(I) has been reasonably designed, implemented, and enforced so that it generally will be effective in preventing and detecting criminal, civil, and administrative violations under this Act and in promoting quality of care; and
“(II) includes at least the required components specified in clause (iv).
“(iv) REQUIRED COMPONENTS OF PROGRAM.—The required components of a compliance and ethics program of an organization are the following:
“(I) The organization must have established compliance standards and procedures to be followed by its employees and other agents that are reasonably capable of reducing the prospect of criminal, civil, and administrative violations under this Act.
“(II) Specific individuals within high-level personnel of the organization must have been assigned overall responsibility to oversee compliance with such standards and procedures and has sufficient resources and authority to assure such compliance.
“(III) The organization must have used due care not to delegate substantial discretionary authority to individuals whom the organization knew, or should have known through the exercise of due diligence, had a propensity to engage in criminal, civil, and administrative violations under this Act.
“(IV) The organization must have taken steps to communicate effectively its standards and procedures to all employees and other agents, such as by requiring participation in training programs or by disseminating publications that explain in a practical manner what is required.
“(V) The organization must have taken reasonable steps to achieve compliance with its standards, such as by utilizing monitoring and auditing systems reasonably designed to detect criminal, civil, and administrative violations under this Act by its employees and other agents and by having in place and publicizing a reporting system whereby employees and other agents could report violations by others within the organization without fear of retribution.
“(VI) The standards must have been consistently enforced through appropriate disciplinary mechanisms, including, as appropriate, discipline of individuals responsible for the failure to detect an offense.
“(VII) After an offense has been detected, the organization must have taken all reasonable steps to respond appropriately to the offense and to prevent further similar offenses, including repayment of any funds to which it was not entitled and any necessary modification to its program to prevent and detect criminal, civil, and administrative violations under this Act.
“(VIII) The organization must periodically undertake reassessment of its compliance program to identify changes necessary to reflect changes within the organization and its facilities.
“(v) COORDINATION.—The provisions of this subparagraph shall apply with respect to a nursing facility in lieu of section 1902(a)(77).”.
(b) Quality Assurance and Performance Improvement Program.—
(1) SKILLED NURSING FACILITIES.—Section 1819(b)(1)(B) of the Social Security Act (42 U.S.C. 1396r(b)(1)(B)) is amended—
(A) by striking “assurance” and inserting “assurance and quality assurance and performance improvement program”;
(B) by designating the matter beginning with “A nursing facility” as a clause (i) with the heading “In general.—” and the appropriate indentation; and
(C) by adding at the end the following new clause:
“(ii) QUALITY ASSURANCE AND PERFORMANCE IMPROVEMENT PROGRAM.—
“(I) IN GENERAL.—Not later than December 31, 2011, the Secretary shall establish and implement a quality assurance and performance improvement program (in this clause referred to as the ‘QAPI program’) for skilled nursing facilities, including multi-unit chains of such facilities. Under the QAPI program, the Secretary shall establish standards relating to such facilities and provide technical assistance to such facilities on the development of best practices in order to meet such standards. Not later than 1 year after the date on which the regulations are promulgated under subclause (II), a skilled nursing facility must submit to the Secretary a plan for the facility to meet such standards and implement such best practices, including how to coordinate the implementation of such plan with quality assessment and assurance activities conducted under clause (i).
“(II) REGULATIONS.—The Secretary shall promulgate regulations to carry out this clause.”.
(2) NURSING FACILITIES.—Section 1919(b)(1)(B) of the Social Security Act (42 U.S.C. 1396r(b)(1)(B)) is amended—
(A) by striking “assurance” and inserting “assurance and quality assurance and performance improvement program”;
(B) by designating the matter beginning with “A nursing facility” as a clause (i) with the heading “In general.—” and the appropriate indentation; and
(C) by adding at the end the following new clause:
“(ii) QUALITY ASSURANCE AND PERFORMANCE IMPROVEMENT PROGRAM.—
“(I) IN GENERAL.—Not later than December 31, 2011, the Secretary shall establish and implement a quality assurance and performance improvement program (in this clause referred to as the ‘QAPI program’) for nursing facilities, including multi-unit chains of such facilities. Under the QAPI program, the Secretary shall establish standards relating to such facilities and provide technical assistance to such facilities on the development of best practices in order to meet such standards. Not later than 1 year after the date on which the regulations are promulgated under subclause (II), a nursing facility must submit to the Secretary a plan for the facility to meet such standards and implement such best practices, including how to coordinate the implementation of such plan with quality assessment and assurance activities conducted under clause (i).
“(II) REGULATIONS.—The Secretary shall promulgate regulations to carry out this clause.”.
(3) PROPOSAL TO REVISE QUALITY ASSURANCE AND PERFORMANCE IMPROVEMENT PROGRAMS.—The Secretary shall include in the proposed rule published under section 1888(e) of the Social Security Act (42 U.S.C. 1395yy(e)(5)(A)) for the subsequent fiscal year to the extent otherwise authorized under section 1819(b)(1)(B) or 1819(d)(1)(C) of the Social Security Act or other statutory or regulatory authority, one or more proposals for skilled nursing facilities to modify and strengthen quality assurance and performance improvement programs in such facilities. At the time of publication of such proposed rule and to the extent otherwise authorized under section 1919(b)(1)(B) or 1919(d)(1)(C) of such Act or other regulatory authority.
(4) FACILITY PLAN.—Not later than 1 year after the date on which the regulations are promulgated under subclause (II) of clause (ii) of sections 1819(b)(1)(B) and 1919(b)(1)(B) of the Social Security Act, as added by paragraphs (1) and (2), a skilled nursing facility and a nursing facility must submit to the Secretary a plan for the facility to meet the standards under such regulations and implement such best practices, including how to coordinate the implementation of such plan with quality assessment and assurance activities conducted under clause (i) of such sections.
(c) GAO study on nursing facility undercapitalization.—
(1) IN GENERAL.—The Comptroller General of the United States shall conduct a study that examines the following:
(A) The extent to which corporations that own or operate large numbers of nursing facilities, taking into account ownership type (including private equity and control interests), are undercapitalizing such facilities.
(B) The effects of such undercapitalization on quality of care, including staffing and food costs, at such facilities.
(C) Options to address such undercapitalization, such as requirements relating to surety bonds, liability insurance, or minimum capitalization.
(2) REPORT.—Not later than 18 months after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report on the study conducted under paragraph (1).
(3) NURSING FACILITY.—In this subsection, the term “nursing facility” includes a skilled nursing facility.
(a) Skilled Nursing Facilities.—
(1) IN GENERAL.—Section 1819 of the Social Security Act (42 U.S.C. 1395i–3) is amended—
(A) by redesignating subsection (i) as subsection (j); and
(B) by inserting after subsection (h) the following new subsection:
“(i) Nursing Home Compare Website.—
“(1) INCLUSION OF ADDITIONAL INFORMATION.—
“(A) IN GENERAL.—The Secretary shall ensure that the Department of Health and Human Services includes, as part of the information provided for comparison of nursing homes on the official Internet website of the Federal Government for Medicare beneficiaries (commonly referred to as the ‘Nursing Home Compare’ Medicare website) (or a successor website), the following information in a manner that is prominent, easily accessible, readily understandable to consumers of long-term care services, and searchable:
“(i) Information that is reported to the Secretary under section 1124(c)(4).
“(ii) Information on the ‘Special Focus Facility program’ (or a successor program) established by the Centers for Medicare and Medicaid Services, according to procedures established by the Secretary. Such procedures shall provide for the inclusion of information with respect to, and the names and locations of, those facilities that, since the previous quarter—
“(I) were newly enrolled in the program;
“(II) are enrolled in the program and have failed to significantly improve;
“(III) are enrolled in the program and have significantly improved;
“(IV) have graduated from the program; and
“(V) have closed voluntarily or no longer participate under this title.
“(iii) Staffing data for each facility (including resident census data and data on the hours of care provided per resident per day) based on data submitted under subsection (b)(8)(C), including information on staffing turnover and tenure, in a format that is clearly understandable to consumers of long-term care services and allows such consumers to compare differences in staffing between facilities and State and national averages for the facilities. Such format shall include—
“(I) concise explanations of how to interpret the data (such as a plain English explanation of data reflecting ‘nursing home staff hours per resident day’);
“(II) differences in types of staff (such as training associated with different categories of staff);
“(III) the relationship between nurse staffing levels and quality of care; and
“(IV) an explanation that appropriate staffing levels vary based on patient case mix.
“(iv) Links to State Internet websites with information regarding State survey and certification programs, links to Form 2567 State inspection reports (or a successor form) on such websites, information to guide consumers in how to interpret and understand such reports, and the facility plan of correction or other response to such report.
“(v) The standardized complaint form developed under subsection (f)(8), including explanatory material on what complaint forms are, how they are used, and how to file a complaint with the State survey and certification program and the State long-term care ombudsman program.
“(vi) Summary information on the number, type, severity, and outcome of substantiated complaints.
“(vii) The number of adjudicated instances of criminal violations by employees of a a nursing facility—
“(I) that were committed inside the facility;
“(II) with respect to such instances of violations or crimes committed inside of the facility that were the violations or crimes of abuse, neglect, and exploitation, criminal sexual abuse, or other violations or crimes that resulted in serious bodily injury; and
“(III) the number of civil monetary penalties levied against the facility, employees, contractors, and other agents.
“(B) DEADLINE FOR PROVISION OF INFORMATION.—
“(i) IN GENERAL.—Except as provided in clause (ii), the Secretary shall ensure that the information described in subparagraph (A) is included on such website (or a successor website) not later than 1 year after the date of the enactment of this subsection.
“(ii) EXCEPTION.—The Secretary shall ensure that the information described in subparagraph (A)(i) and (A)(iii) is included on such website (or a successor website) not later than the date on which the requirements under section 1124(c)(4) and subsection (b)(8)(C)(ii) are implemented.
“(2) REVIEW AND MODIFICATION OF WEBSITE.—
“(A) IN GENERAL.—The Secretary shall establish a process—
“(i) to review the accuracy, clarity of presentation, timeliness, and comprehensiveness of information reported on such website as of the day before the date of the enactment of this subsection; and
“(ii) not later than 1 year after the date of the enactment of this subsection, to modify or revamp such website in accordance with the review conducted under clause (i).
“(B) CONSULTATION.—In conducting the review under subparagraph (A)(i), the Secretary shall consult with—
“(i) State long-term care ombudsman programs;
“(ii) consumer advocacy groups;
“(iii) provider stakeholder groups; and
“(iv) any other representatives of programs or groups the Secretary determines appropriate.”.
(2) TIMELINESS OF SUBMISSION OF SURVEY AND CERTIFICATION INFORMATION.—
(A) IN GENERAL.—Section 1819(g)(5) of the Social Security Act (42 U.S.C. 1395i–3(g)(5)) is amended by adding at the end the following new subparagraph:
“(E) SUBMISSION OF SURVEY AND CERTIFICATION INFORMATION TO THE SECRETARY.—In order to improve the timeliness of information made available to the public under subparagraph (A) and provided on the Nursing Home Compare Medicare website under subsection (i), each State shall submit information respecting any survey or certification made respecting a skilled nursing facility (including any enforcement actions taken by the State) to the Secretary not later than the date on which the State sends such information to the facility. The Secretary shall use the information submitted under the preceding sentence to update the information provided on the Nursing Home Compare Medicare website as expeditiously as practicable but not less frequently than quarterly.”.
(B) EFFECTIVE DATE.—The amendment made by this paragraph shall take effect 1 year after the date of the enactment of this Act.
(3) SPECIAL FOCUS FACILITY PROGRAM.—Section 1819(f) of such Act is amended by adding at the end the following new paragraph:
“(8) SPECIAL FOCUS FACILITY PROGRAM.—
“(A) IN GENERAL.—The Secretary shall conduct a special focus facility program for enforcement of requirements for skilled nursing facilities that the Secretary has identified as having substantially failed to meet applicable requirement of this Act.
“(B) PERIODIC SURVEYS.—Under such program the Secretary shall conduct surveys of each facility in the program not less than once every 6 months.”.
(1) IN GENERAL.—Section 1919 of the Social Security Act (42 U.S.C. 1396r) is amended—
(A) by redesignating subsection (i) as subsection (j); and
(B) by inserting after subsection (h) the following new subsection:
“(i) Nursing Home Compare Website.—
“(1) INCLUSION OF ADDITIONAL INFORMATION.—
“(A) IN GENERAL.—The Secretary shall ensure that the Department of Health and Human Services includes, as part of the information provided for comparison of nursing homes on the official Internet website of the Federal Government for Medicare beneficiaries (commonly referred to as the ‘Nursing Home Compare’ Medicare website) (or a successor website), the following information in a manner that is prominent, easily accessible, readily understandable to consumers of long-term care services, and searchable:
“(i) Staffing data for each facility (including resident census data and data on the hours of care provided per resident per day) based on data submitted under subsection (b)(8)(C)(ii), including information on staffing turnover and tenure, in a format that is clearly understandable to consumers of long-term care services and allows such consumers to compare differences in staffing between facilities and State and national averages for the facilities. Such format shall include—
“(I) concise explanations of how to interpret the data (such as plain English explanation of data reflecting ‘nursing home staff hours per resident day’);
“(II) differences in types of staff (such as training associated with different categories of staff);
“(III) the relationship between nurse staffing levels and quality of care; and
“(IV) an explanation that appropriate staffing levels vary based on patient case mix.
“(ii) Links to State Internet websites with information regarding State survey and certification programs, links to Form 2567 State inspection reports (or a successor form) on such websites, information to guide consumers in how to interpret and understand such reports, and the facility plan of correction or other response to such report.
“(iii) The standardized complaint form developed under subsection (f)(10), including explanatory material on what complaint forms are, how they are used, and how to file a complaint with the State survey and certification program and the State long-term care ombudsman program.
“(iv) Summary information on the number, type, severity, and outcome of substantiated complaints.
“(v) The number of adjudicated instances of criminal violations by employees of a nursing facility—
“(I) that were committed inside of the facility; and
“(II) with respect to such instances of violations or crimes committed outside of the facility, that were the violations or crimes that resulted in the serious bodily injury of an elder.
“(B) DEADLINE FOR PROVISION OF INFORMATION.—
“(i) IN GENERAL.—Except as provided in clause (ii), the Secretary shall ensure that the information described in subparagraph (A) is included on such website (or a successor website) not later than 1 year after the date of the enactment of this subsection.
“(ii) EXCEPTION.—The Secretary shall ensure that the information described in subparagraph (A)(i) and (A)(iii) is included on such website (or a successor website) not later than the date on which the requirements under section 1124(c)(4) and subsection (b)(8)(C)(ii) are implemented.
“(2) REVIEW AND MODIFICATION OF WEBSITE.—
“(A) IN GENERAL.—The Secretary shall establish a process—
“(i) to review the accuracy, clarity of presentation, timeliness, and comprehensiveness of information reported on such website as of the day before the date of the enactment of this subsection; and
“(ii) not later than 1 year after the date of the enactment of this subsection, to modify or revamp such website in accordance with the review conducted under clause (i).
“(B) CONSULTATION.—In conducting the review under subparagraph (A)(i), the Secretary shall consult with—
“(i) State long-term care ombudsman programs;
“(ii) consumer advocacy groups;
“(iii) provider stakeholder groups;
“(iv) skilled nursing facility employees and their representatives; and
“(v) any other representatives of programs or groups the Secretary determines appropriate.”.
(2) TIMELINESS OF SUBMISSION OF SURVEY AND CERTIFICATION INFORMATION.—
(A) IN GENERAL.—Section 1919(g)(5) of the Social Security Act (42 U.S.C. 1396r(g)(5)) is amended by adding at the end the following new subparagraph:
“(E) SUBMISSION OF SURVEY AND CERTIFICATION INFORMATION TO THE SECRETARY.—In order to improve the timeliness of information made available to the public under subparagraph (A) and provided on the Nursing Home Compare Medicare website under subsection (i), each State shall submit information respecting any survey or certification made respecting a nursing facility (including any enforcement actions taken by the State) to the Secretary not later than the date on which the State sends such information to the facility. The Secretary shall use the information submitted under the preceding sentence to update the information provided on the Nursing Home Compare Medicare website as expeditiously as practicable but not less frequently than quarterly.”.
(B) EFFECTIVE DATE.—The amendment made by this paragraph shall take effect 1 year after the date of the enactment of this Act.
(3) SPECIAL FOCUS FACILITY PROGRAM.—Section 1919(f) of such Act is amended by adding at the end of the following new paragraph:
“(10) SPECIAL FOCUS FACILITY PROGRAM.—
“(A) IN GENERAL.—The Secretary shall conduct a special focus facility program for enforcement of requirements for nursing facilities that the Secretary has identified as having substantially failed to meet applicable requirements of this Act.
“(B) PERIODIC SURVEYS.—Under such program the Secretary shall conduct surveys of each facility in the program not less often than once every 6 months.”.
(c) Availability of Reports on Surveys, Certifications, and Complaint Investigations.—
(1) SKILLED NURSING FACILITIES.—Section 1819(d)(1) of the Social Security Act (42 U.S.C. 1395i–3(d)(1)), as amended by sections 1411 and 1412, is amended by adding at the end the following new subparagraph:
“(D) AVAILABILITY OF SURVEY, CERTIFICATION, AND COMPLAINT INVESTIGATION REPORTS.—A skilled nursing facility must—
“(i) have reports with respect to any surveys, certifications, and complaint investigations made respecting the facility during the 3 preceding years available for any individual to review upon request; and
“(ii) post notice of the availability of such reports in areas of the facility that are prominent and accessible to the public.
The facility shall not make available under clause (i) identifying information about complainants or residents.”.
(2) NURSING FACILITIES.—Section 1919(d)(1) of the Social Security Act (42 U.S.C. 1396r(d)(1)), as amended by sections 1411 and 1412, is amended by adding at the end the following new subparagraph:
“(D) AVAILABILITY OF SURVEY, CERTIFICATION, AND COMPLAINT INVESTIGATION REPORTS.—A nursing facility must—
“(i) have reports with respect to any surveys, certifications, and complaint investigations made respecting the facility during the 3 preceding years available for any individual to review upon request; and
“(ii) post notice of the availability of such reports in areas of the facility that are prominent and accessible to the public.
The facility shall not make available under clause (i) identifying information about complainants or residents.”.
(3) EFFECTIVE DATE.—The amendments made by this subsection shall take effect 1 year after the date of the enactment of this Act.
(d) Guidance to States on Form 2567 State Inspection Reports and Complaint Investigation Reports.—
(1) GUIDANCE.—The Secretary of Health and Human Services (in this subtitle referred to as the “Secretary”) shall provide guidance to States on how States can establish electronic links to Form 2567 State inspection reports (or a successor form), complaint investigation reports, and a facility’s plan of correction or other response to such Form 2567 State inspection reports (or a successor form) on the Internet website of the State that provides information on skilled nursing facilities and nursing facilities and the Secretary shall, if possible, include such information on Nursing Home Compare.
(2) REQUIREMENT.—Section 1902(a)(9) of the Social Security Act (42 U.S.C. 1396a(a)(9)) is amended—
(A) by striking “and” at the end of subparagraph (B);
(B) by striking the semicolon at the end of subparagraph (C) and inserting “, and”; and
(C) by adding at the end the following new subparagraph:
“(D) that the State maintain a consumer-oriented website providing useful information to consumers regarding all skilled nursing facilities and all nursing facilities in the State, including for each facility, Form 2567 State inspection reports (or a successor form), complaint investigation reports, the facility’s plan of correction, and such other information that the State or the Secretary considers useful in assisting the public to assess the quality of long term care options and the quality of care provided by individual facilities;”.
(3) DEFINITIONS.—In this subsection:
(A) NURSING FACILITY.—The term “nursing facility” has the meaning given such term in section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a)).
(B) SECRETARY.—The term “Secretary” means the Secretary of Health and Human Services.
(C) SKILLED NURSING FACILITY.—The term “skilled nursing facility” has the meaning given such term in section 1819(a) of the Social Security Act (42 U.S.C. 1395i–3(a)).
Section 1888 of the Social Security Act (42 U.S.C. 1395yy) is amended by adding at the end the following new subsection:
(a) Skilled Nursing Facilities.—
(1) DEVELOPMENT BY THE SECRETARY.—Section 1819(f) of the Social Security Act (42 U.S.C. 1395i–3(f)), as amended by section 1413(a)(3), is amended by adding at the end the following new paragraph:
“(9) STANDARDIZED COMPLAINT FORM.—The Secretary shall develop a standardized complaint form for use by a resident (or a person acting on the resident’s behalf) in filing a complaint with a State survey and certification agency and a State long-term care ombudsman program with respect to a skilled nursing facility.”.
(2) STATE REQUIREMENTS.—Section 1819(e) of the Social Security Act (42 U.S.C. 1395i–3(e)) is amended by adding at the end the following new paragraph:
“(6) COMPLAINT PROCESSES AND WHISTLE-BLOWER PROTECTION.—
“(A) COMPLAINT FORMS.—The State must make the standardized complaint form developed under subsection (f)(9) available upon request to—
“(i) a resident of a skilled nursing facility;
“(ii) any person acting on the resident’s behalf; and
“(iii) any person who works at a skilled nursing facility or is a representative of such a worker.
“(B) COMPLAINT RESOLUTION PROCESS.—The State must establish a complaint resolution process in order to ensure that a resident, the legal representative of a resident of a skilled nursing facility, or other responsible party is not retaliated against if the resident, legal representative, or responsible party has complained, in good faith, about the quality of care or other issues relating to the skilled nursing facility, that the legal representative of a resident of a skilled nursing facility or other responsible party is not denied access to such resident or otherwise retaliated against if such representative party has complained, in good faith, about the quality of care provided by the facility or other issues relating to the facility, and that a person who works at a skilled nursing facility is not retaliated against if the worker has complained, in good faith, about quality of care or services or an issue relating to the quality of care or services provided at the facility, whether the resident, legal representative, other responsible party, or worker used the form developed under subsection (f)(9) or some other method for submitting the complaint. Such complaint resolution process shall include—
“(i) procedures to assure accurate tracking of complaints received, including notification to the complainant that a complaint has been received;
“(ii) procedures to determine the likely severity of a complaint and for the investigation of the complaint;
“(iii) deadlines for responding to a complaint and for notifying the complainant of the outcome of the investigation; and
“(iv) procedures to ensure that the identity of the complainant will be kept confidential.
“(C) WHISTLEBLOWER PROTECTION.—
“(i) PROHIBITION AGAINST RETALIATION.—No person who works at a skilled nursing facility may be penalized, discriminated, or retaliated against with respect to any aspect of employment, including discharge, promotion, compensation, terms, conditions, or privileges of employment, or have a contract for services terminated, because the person (or anyone acting at the person’s request) complained, in good faith, about the quality of care or services provided by a nursing facility or about other issues relating to quality of care or services, whether using the form developed under subsection (f)(9) or some other method for submitting the complaint.
“(ii) RETALIATORY REPORTING.—A skilled nursing facility may not file a complaint or a report against a person who works (or has worked at the facility with the appropriate State professional disciplinary agency because the person (or anyone acting at the person’s request) complained in good faith, as described in clause (i).
“(iii) COMMENCEMENT OF ACTION.—Any person who believes the person has been penalized, discriminated, or retaliated against or had a contract for services terminated in violation of clause (i) or against whom a complaint has been filed in violation of clause (ii) may bring an action at law or equity in the appropriate district court of the United States, which shall have jurisdiction over such action without regard to the amount in controversy or the citizenship of the parties, and which shall have jurisdiction to grant complete relief, including, but not limited to, injunctive relief (such as reinstatement, compensatory damages (which may include reimbursement of lost wages, compensation, and benefits), costs of litigation (including reasonable attorney and expert witness fees), exemplary damages where appropriate, and such other relief as the court deems just and proper.
“(iv) RIGHTS NOT WAIVABLE.—The rights protected by this paragraph may not be diminished by contract or other agreement, and nothing in this paragraph shall be construed to diminish any greater or additional protection provided by Federal or State law or by contract or other agreement.
“(v) REQUIREMENT TO POST NOTICE OF EMPLOYEE RIGHTS.—Each skilled nursing facility shall post conspicuously in an appropriate location a sign (in a form specified by the Secretary) specifying the rights of persons under this paragraph and including a statement that an employee may file a complaint with the Secretary against a skilled nursing facility that violates the provisions of this paragraph and information with respect to the manner of filing such a complaint.
“(D) RULE OF CONSTRUCTION.—Nothing in this paragraph shall be construed as preventing a resident of a skilled nursing facility (or a person acting on the resident’s behalf) from submitting a complaint in a manner or format other than by using the standardized complaint form developed under subsection (f)(9) (including submitting a complaint orally).
“(E) GOOD FAITH DEFINED.—For purposes of this paragraph, an individual shall be deemed to be acting in good faith with respect to the filing of a complaint if the individual reasonably believes—
“(i) the information reported or disclosed in the complaint is true; and
“(ii) the violation of this title has occurred or may occur in relation to such information.”.
(1) DEVELOPMENT BY THE SECRETARY.—Section 1919(f) of the Social Security Act (42 U.S.C. 1395i–3(f)), as amended by section 1413(b), is amended by adding at the end the following new paragraph:
“(11) STANDARDIZED COMPLAINT FORM.—The Secretary shall develop a standardized complaint form for use by a resident (or a person acting on the resident’s behalf) in filing a complaint with a State survey and certification agency and a State long-term care ombudsman program with respect to a nursing facility.”.
(2) STATE REQUIREMENTS.—Section 1919(e) of the Social Security Act (42 U.S.C. 1395i–3(e)) is amended by adding at the end the following new paragraph:
“(8) COMPLAINT PROCESSES AND WHISTLEBLOWER PROTECTION.—
“(A) COMPLAINT FORMS.—The State must make the standardized complaint form developed under subsection (f)(11) available upon request to—
“(i) a resident of a nursing facility;
“(ii) any person acting on the resident’s behalf; and
“(iii) any person who works at a nursing facility or a representative of such a worker.
“(B) COMPLAINT RESOLUTION PROCESS.—The State must establish a complaint resolution process in order to ensure that a resident, the legal representative of a resident of a nursing facility, or other responsible party is not retaliated against if the resident, legal representative, or responsible party has complained, in good faith, about the quality of care or other issues relating to the nursing facility, that the legal representative of a resident of a nursing facility or other responsible party is not denied access to such resident or otherwise retaliated against if such representative party has complained, in good faith, about the quality of care provided by the facility or other issues relating to the facility, and that a person who works at a nursing facility is not retaliated against if the worker has complained, in good faith, about quality of care or services or an issue relating to the quality of care or services provided at the facility, whether the resident, legal representative, other responsible party, or worker used the form developed under subsection (f)(11) or some other method for submitting the complaint. Such complaint resolution process shall include—
“(i) procedures to assure accurate tracking of complaints received, including notification to the complainant that a complaint has been received;
“(ii) procedures to determine the likely severity of a complaint and for the investigation of the complaint;
“(iii) deadlines for responding to a complaint and for notifying the complainant of the outcome of the investigation; and
“(iv) procedures to ensure that the identity of the complainant will be kept confidential.
“(C) WHISTLEBLOWER PROTECTION.—
“(i) PROHIBITION AGAINST RETALIATION.—No person who works at a nursing facility may be penalized, discriminated, or retaliated against with respect to any aspect of employment, including discharge, promotion, compensation, terms, conditions, or privileges of employment, or have a contract for services terminated, because the person (or anyone acting at the person’s request) complained, in good faith, about the quality of care or services provided by a nursing facility or about other issues relating to quality of care or services, whether using the form developed under subsection (f)(11) or some other method for submitting the complaint.
“(ii) RETALIATORY REPORTING.—A nursing facility may not file a complaint or a report against a person who works (or has worked at the facility with the appropriate State professional disciplinary agency because the person (or anyone acting at the person’s request) complained in good faith, as described in clause (i).
“(iii) COMMENCEMENT OF ACTION.—Any person who believes the person has been penalized, discriminated, or retaliated against or had a contract for services terminated in violation of clause (i) or against whom a complaint has been filed in violation of clause (ii) may bring an action at law or equity in the appropriate district court of the United States, which shall have jurisdiction over such action without regard to the amount in controversy or the citizenship of the parties, and which shall have jurisdiction to grant complete relief, including, but not limited to, injunctive relief (such as reinstatement, compensatory damages (which may include reimbursement of lost wages, compensation, and benefits), costs of litigation (including reasonable attorney and expert witness fees), exemplary damages where appropriate, and such other relief as the court deems just and proper.
“(iv) RIGHTS NOT WAIVABLE.—The rights protected by this paragraph may not be diminished by contract or other agreement, and nothing in this paragraph shall be construed to diminish any greater or additional protection provided by Federal or State law or by contract or other agreement.
“(v) REQUIREMENT TO POST NOTICE OF EMPLOYEE RIGHTS.—Each nursing facility shall post conspicuously in an appropriate location a sign (in a form specified by the Secretary) specifying the rights of persons under this paragraph and including a statement that an employee may file a complaint with the Secretary against a nursing facility that violates the provisions of this paragraph and information with respect to the manner of filing such a complaint.
“(D) RULE OF CONSTRUCTION.—Nothing in this paragraph shall be construed as preventing a resident of a nursing facility (or a person acting on the resident’s behalf) from submitting a complaint in a manner or format other than by using the standardized complaint form developed under subsection (f)(11) (including submitting a complaint orally).
“(E) GOOD FAITH DEFINED.—For purposes of this paragraph, an individual shall be deemed to be acting in good faith with respect to the filing of a complaint if the individual reasonably believes—
“(i) the information reported or disclosed in the complaint is true; and
“(ii) the violation of this title has occurred or may occur in relation to such information.”.
(c) Effective date.—The amendments made by this section shall take effect 1 year after the date of the enactment of this Act.
(a) Skilled nursing facilities.—Section 1819(b)(8) of the Social Security Act (42 U.S.C. 1395i–3(b)(8)) is amended by adding at the end the following new subparagraph:
“(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT.—Beginning not later than 2 years after the date of the enactment of this subparagraph, and after consulting with State long-term care ombudsman programs, consumer advocacy groups, provider stakeholder groups, employees and their representatives, and other parties the Secretary deems appropriate, the Secretary shall require a skilled nursing facility to electronically submit to the Secretary direct care staffing information (including information with respect to agency and contract staff) based on payroll and other verifiable and auditable data in a uniform format (according to specifications established by the Secretary in consultation with such programs, groups, and parties). Such specifications shall require that the information submitted under the preceding sentence—
“(i) specify the category of work a certified employee performs (such as whether the employee is a registered nurse, licensed practical nurse, licensed vocational nurse, certified nursing assistant, therapist, or other medical personnel);
“(ii) include resident census data and information on resident case mix;
“(iii) include a regular reporting schedule; and
“(iv) include information on employee turnover and tenure and on the hours of care provided by each category of certified employees referenced in clause (i) per resident per day.
Nothing in this subparagraph shall be construed as preventing the Secretary from requiring submission of such information with respect to specific categories, such as nursing staff, before other categories of certified employees. Information under this subparagraph with respect to agency and contract staff shall be kept separate from information on employee staffing.”.
(b) Nursing facilities.—Section 1919(b)(8) of the Social Security Act (42 U.S.C. 1396r(b)(8)) is amended by adding at the end the following new subparagraph:
“(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT.—Beginning not later than 2 years after the date of the enactment of this subparagraph, and after consulting with State long-term care ombudsman programs, consumer advocacy groups, provider stakeholder groups, employees and their representatives, and other parties the Secretary deems appropriate, the Secretary shall require a nursing facility to electronically submit to the Secretary direct care staffing information (including information with respect to agency and contract staff) based on payroll and other verifiable and auditable data in a uniform format (according to specifications established by the Secretary in consultation with such programs, groups, and parties). Such specifications shall require that the information submitted under the preceding sentence—
“(i) specify the category of work a certified employee performs (such as whether the employee is a registered nurse, licensed practical nurse, licensed vocational nurse, certified nursing assistant, therapist, or other medical personnel);
“(ii) include resident census data and information on resident case mix;
“(iii) include a regular reporting schedule; and
“(iv) include information on employee turnover and tenure and on the hours of care provided by each category of certified employees referenced in clause (i) per resident per day.
Nothing in this subparagraph shall be construed as preventing the Secretary from requiring submission of such information with respect to specific categories, such as nursing staff, before other categories of certified employees. Information under this subparagraph with respect to agency and contract staff shall be kept separate from information on employee staffing.”.
(a) Skilled Nursing Facilities.—
(1) IN GENERAL.—Section 1819(h)(2)(B)(ii) of the Social Security Act (42 U.S.C. 1395i–3(h)(2)(B)(ii)) is amended to read as follows:
“(ii) AUTHORITY WITH RESPECT TO CIVIL MONEY PENALTIES.—
“(I) AMOUNT.—The Secretary may impose a civil money penalty in the applicable per instance or per day amount (as defined in subclause (II) and (III)) for each day or instance, respectively, of noncompliance (as determined appropriate by the Secretary).
“(II) APPLICABLE PER INSTANCE AMOUNT.—In this clause, the term ‘applicable per instance amount’ means—
“(aa) in the case where the deficiency is found to be a direct proximate cause of death of a resident of the facility, an amount not to exceed $100,000;
“(bb) in each case of a deficiency where the facility is cited for actual harm or immediate jeopardy, an amount not less than $3,050 and not more than $25,000; and
“(cc) in each case of any other deficiency, an amount not less than $250 and not to exceed $3050.
“(III) APPLICABLE PER DAY AMOUNT.—In this clause, the term ‘applicable per day amount’ means—
“(aa) in each case of a deficiency where the facility is cited for actual harm or immediate jeopardy, an amount not less than $3,050 and not more than $25,000; and
“(bb) in each case of any other deficiency, an amount not less than $250 and not to exceed $3,050.
“(IV) REDUCTION OF CIVIL MONEY PENALTIES IN CERTAIN CIRCUMSTANCES.—Subject to subclauses (V) and (VI), in the case where a facility self-reports and promptly corrects a deficiency for which a penalty was imposed under this clause not later than 10 calendar days after the date of such imposition, the Secretary may reduce the amount of the penalty imposed by not more than 50 percent.
“(V) PROHIBITION ON REDUCTION FOR CERTAIN DEFICIENCIES.—
“(aa) REPEAT DEFICIENCIES.—The Secretary may not reduce under subclause (IV) the amount of a penalty if the deficiency is a repeat deficiency.
“(bb) CERTAIN OTHER DEFICIENCIES.—The Secretary may not reduce under subclause (IV) the amount of a penalty if the penalty is imposed for a deficiency described in subclause (II)(aa) or (III)(aa) and the actual harm or widespread harm immediately jeopardizes the health or safety of a resident or residents of the facility, or if the penalty is imposed for a deficiency described in subclause (II)(bb).
“(VI) LIMITATION ON AGGREGATE REDUCTIONS.—The aggregate reduction in a penalty under subclause (IV) may not exceed 35 percent on the basis of self-reporting, on the basis of a waiver or an appeal (as provided for under regulations under section 488.436 of title 42, Code of Federal Regulations), or on the basis of both.
“(VII) COLLECTION OF CIVIL MONEY PENALTIES.—In the case of a civil money penalty imposed under this clause, the Secretary—
“(aa) subject to item (cc), shall, not later than 30 days after the date of imposition of the penalty, provide the opportunity for the facility to participate in an independent informal dispute resolution process which generates a written record prior to the collection of such penalty, but such opportunity shall not affect the responsibility of the State survey agency for making final recommendations for such penalties;
“(bb) in the case where the penalty is imposed for each day of noncompliance, shall not impose a penalty for any day during the period beginning on the initial day of the imposition of the penalty and ending on the day on which the informal dispute resolution process under item (aa) is completed;
“(cc) may provide for the collection of such civil money penalty and the placement of such amounts collected in an escrow account under the direction of the Secretary on the earlier of the date on which the informal dispute resolution process under item (aa) is completed or the date that is 90 days after the date of the imposition of the penalty;
“(dd) may provide that such amounts collected are kept in such account pending the resolution of any subsequent appeals;
“(ee) in the case where the facility successfully appeals the penalty, may provide for the return of such amounts collected (plus interest) to the facility; and
“(ff) in the case where all such appeals are unsuccessful, may provide that some portion of such amounts collected may be used to support activities that benefit residents, including assistance to support and protect residents of a facility that closes (voluntarily or involuntarily) or is decertified (including offsetting costs of relocating residents to home and community-based settings or another facility), projects that support resident and family councils and other consumer involvement in assuring quality care in facilities, and facility improvement initiatives approved by the Secretary (including joint training of facility staff and surveyors, technical assistance for facilities under quality assurance programs, the appointment of temporary management, and other activities approved by the Secretary).
“(VIII) PROCEDURE.—The provisions of section 1128A (other than subsections (a) and (b) and except to the extent that such provisions require a hearing prior to the imposition of a civil money penalty) shall apply to a civil money penalty under this clause in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).”.
(2) CONFORMING AMENDMENT.—The second sentence of section 1819(h)(5) of the Social Security Act (42 U.S.C. 1395i–3(h)(5)) is amended by inserting “(ii),” after “(i),”.
(1) PENALTIES IMPOSED BY THE STATE.—
(A) IN GENERAL.—Section 1919(h)(2) of the Social Security Act (42 U.S.C. 1396r(h)(2)) is amended—
(i) in subparagraph (A)(ii), by striking the first sentence and inserting the following: “A civil money penalty in accordance with subparagraph (G).”; and
(ii) by adding at the end the following new subparagraph:
“(i) IN GENERAL.—The State may impose a civil money penalty under subparagraph (A)(ii) in the applicable per instance or per day amount (as defined in subclause (II) and (III)) for each day or instance, respectively, of noncompliance (as determined appropriate by the Secretary).
“(ii) APPLICABLE PER INSTANCE AMOUNT.—In this subparagraph, the term ‘applicable per instance amount’ means—
“(I) in the case where the deficiency is found to be a direct proximate cause of death of a resident of the facility, an amount not to exceed $100,000;
“(II) in each case of a deficiency where the facility is cited for actual harm or immediate jeopardy, an amount not less than $3,050 and not more than $25,000; and
“(III) in each case of any other deficiency, an amount not less than $250 and not to exceed $3,050.
“(iii) APPLICABLE PER DAY AMOUNT.—In this subparagraph, the term ‘applicable per day amount’ means—
“(I) in each case of a deficiency where the facility is cited for actual harm or immediate jeopardy, an amount not less than $3,050 and not more than $25,000; and
“(II) in each case of any other deficiency, an amount not less than $250 and not to exceed $3,050.
“(iv) REDUCTION OF CIVIL MONEY PENALTIES IN CERTAIN CIRCUMSTANCES.—Subject to clauses (v) and (vi), in the case where a facility self-reports and promptly corrects a deficiency for which a penalty was imposed under subparagraph (A)(ii) not later than 10 calendar days after the date of such imposition, the State may reduce the amount of the penalty imposed by not more than 50 percent.
“(v) PROHIBITION ON REDUCTION FOR CERTAIN DEFICIENCIES.—
“(I) REPEAT DEFICIENCIES.—The State may not reduce under clause (iv) the amount of a penalty if the State had reduced a penalty imposed on the facility in the preceding year under such clause with respect to a repeat deficiency.
“(II) CERTAIN OTHER DEFICIENCIES.—The State may not reduce under clause (iv) the amount of a penalty if the penalty is imposed for a deficiency described in clause (ii)(II) or (iii)(I) and the actual harm or widespread harm that immediately jeopardizes the health or safety of a resident or residents of the facility, or if the penalty is imposed for a deficiency described in clause (ii)(I).
“(III) LIMITATION ON AGGREGATE REDUCTIONS.—The aggregate reduction in a penalty under clause (iv) may not exceed 35 percent on the basis of self-reporting, on the basis of a waiver or an appeal (as provided for under regulations under section 488.436 of title 42, Code of Federal Regulations), or on the basis of both.
“(iv) COLLECTION OF CIVIL MONEY PENALTIES.—In the case of a civil money penalty imposed under subparagraph (A)(ii), the State—
“(I) subject to subclause (III), shall, not later than 30 days after the date of imposition of the penalty, provide the opportunity for the facility to participate in an independent informal dispute resolution process which generates a written record prior to the collection of such penalty, but such opportunity shall not affect the responsibility of the State survey agency for making final recommendations for such penalties;
“(II) in the case where the penalty is imposed for each day of noncompliance, shall not impose a penalty for any day during the period beginning on the initial day of the imposition of the penalty and ending on the day on which the informal dispute resolution process under subclause (I) is completed;
“(III) may provide for the collection of such civil money penalty and the placement of such amounts collected in an escrow account under the direction of the State on the earlier of the date on which the informal dispute resolution process under subclause (I) is completed or the date that is 90 days after the date of the imposition of the penalty;
“(IV) may provide that such amounts collected are kept in such account pending the resolution of any subsequent appeals;
“(V) in the case where the facility successfully appeals the penalty, may provide for the return of such amounts collected (plus interest) to the facility; and
“(VI) in the case where all such appeals are unsuccessful, may provide that such funds collected shall be used for the purposes described in the second sentence of subparagraph (A)(ii).”.
(B) CONFORMING AMENDMENT.—The second sentence of section 1919(h)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1396r(h)(2)(A)(ii)) is amended by inserting before the period at the end the following: “, and some portion of such funds may be used to support activities that benefit residents, including assistance to support and protect residents of a facility that closes (voluntarily or involuntarily) or is decertified (including offsetting costs of relocating residents to home and community-based settings or another facility), projects that support resident and family councils and other consumer involvement in assuring quality care in facilities, and facility improvement initiatives approved by the Secretary (including joint training of facility staff and surveyors, providing technical assistance to facilities under quality assurance programs, the appointment of temporary management, and other activities approved by the Secretary)”.
(2) PENALTIES IMPOSED BY THE SECRETARY.—
(A) IN GENERAL.—Section 1919(h)(3)(C)(ii) of the Social Security Act (42 U.S.C. 1396r(h)(3)(C)) is amended to read as follows:
“(ii) AUTHORITY WITH RESPECT TO CIVIL MONEY PENALTIES.—
“(I) AMOUNT.—Subject to subclause (II), the Secretary may impose a civil money penalty in an amount not to exceed $10,000 for each day or each instance of noncompliance (as determined appropriate by the Secretary).
“(II) REDUCTION OF CIVIL MONEY PENALTIES IN CERTAIN CIRCUMSTANCES.—Subject to subclause (III), in the case where a facility self-reports and promptly corrects a deficiency for which a penalty was imposed under this clause not later than 10 calendar days after the date of such imposition, the Secretary may reduce the amount of the penalty imposed by not more than 50 percent.
“(III) PROHIBITION ON REDUCTION FOR REPEAT DEFICIENCIES.—The Secretary may not reduce the amount of a penalty under subclause (II) if the Secretary had reduced a penalty imposed on the facility in the preceding year under such subclause with respect to a repeat deficiency.
“(IV) COLLECTION OF CIVIL MONEY PENALTIES.—In the case of a civil money penalty imposed under this clause, the Secretary—
“(aa) subject to item (bb), shall, not later than 30 days after the date of imposition of the penalty, provide the opportunity for the facility to participate in an independent informal dispute resolution process which generates a written record prior to the collection of such penalty;
“(bb) in the case where the penalty is imposed for each day of noncompliance, shall not impose a penalty for any day during the period beginning on the initial day of the imposition of the penalty and ending on the day on which the informal dispute resolution process under item (aa) is completed;
“(cc) may provide for the collection of such civil money penalty and the placement of such amounts collected in an escrow account under the direction of the Secretary on the earlier of the date on which the informal dispute resolution process under item (aa) is completed or the date that is 90 days after the date of the imposition of the penalty;
“(dd) may provide that such amounts collected are kept in such account pending the resolution of any subsequent appeals;
“(ee) in the case where the facility successfully appeals the penalty, may provide for the return of such amounts collected (plus interest) to the facility; and
“(ff) in the case where all such appeals are unsuccessful, may provide that some portion of such amounts collected may be used to support activities that benefit residents, including assistance to support and protect residents of a facility that closes (voluntarily or involuntarily) or is decertified (including offsetting costs of relocating residents to home and community-based settings or another facility), projects that support resident and family councils and other consumer involvement in assuring quality care in facilities, and facility improvement initiatives approved by the Secretary (including joint training of facility staff and surveyors, technical assistance for facilities under quality assurance programs, the appointment of temporary management, and other activities approved by the Secretary).
“(V) PROCEDURE.—The provisions of section 1128A (other than subsections (a) and (b) and except to the extent that such provisions require a hearing prior to the imposition of a civil money penalty) shall apply to a civil money penalty under this clause in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).”.
(B) CONFORMING AMENDMENT.—Section 1919(h)(8) of the Social Security Act (42 U.S.C. 1396r(h)(5)(8)) is amended by inserting “and in paragraph (3)(C)(ii)” after “paragraph (2)(A)”.
(c) Effective date.—The amendments made by this section shall take effect 1 year after the date of the enactment of this Act.
(1) IN GENERAL.—The Secretary, in consultation with the Inspector General of the Department of Health and Human Services, shall establish a pilot program (in this section referred to as the “pilot program”) to develop, test, and implement use of an independent monitor to oversee interstate and large intrastate chains of skilled nursing facilities and nursing facilities.
(2) SELECTION.—The Secretary shall select chains of skilled nursing facilities and nursing facilities described in paragraph (1) to participate in the pilot program from among those chains that submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
(3) DURATION.—The Secretary shall conduct the pilot program for a two-year period.
(4) IMPLEMENTATION.—The Secretary shall implement the pilot program not later than one year after the date of the enactment of this Act.
(b) Requirements.—The Secretary shall evaluate chains selected to participate in the pilot program based on criteria selected by the Secretary, including where evidence suggests that one or more facilities of the chain are experiencing serious safety and quality of care problems. Such criteria may include the evaluation of a chain that includes one or more facilities participating in the “Special Focus Facility” program (or a successor program) or one or more facilities with a record of repeated serious safety and quality of care deficiencies.
(c) Responsibilities of the independent monitor.—An independent monitor that enters into a contract with the Secretary to participate in the conduct of such program shall—
(1) conduct periodic reviews and prepare root-cause quality and deficiency analyses of a chain to assess if facilities of the chain are in compliance with State and Federal laws and regulations applicable to the facilities;
(2) undertake sustained oversight of the chain, whether publicly or privately held, to involve the owners of the chain and the principal business partners of such owners in facilitating compliance by facilities of the chain with State and Federal laws and regulations applicable to the facilities;
(3) analyze the management structure, distribution of expenditures, and nurse staffing levels of facilities of the chain in relation to resident census, staff turnover rates, and tenure;
(4) report findings and recommendations with respect to such reviews, analyses, and oversight to the chain and facilities of the chain, to the Secretary and to relevant States; and
(5) publish the results of such reviews, analyses, and oversight.
(d) Implementation of recommendations.—
(1) RECEIPT OF FINDING BY CHAIN.—Not later than 10 days after receipt of a finding of an independent monitor under subsection (c)(4), a chain participating in the pilot program shall submit to the independent monitor a report—
(A) outlining corrective actions the chain will take to implement the recommendations in such report; or
(B) indicating that the chain will not implement such recommendations and why it will not do so.
(2) RECEIPT OF REPORT BY INDEPENDENT MONITOR.—Not later than 10 days after the date of receipt of a report submitted by a chain under paragraph (1), an independent monitor shall finalize its recommendations and submit a report to the chain and facilities of the chain, the Secretary, and the State (or States) involved, as appropriate, containing such final recommendations.
(e) Cost of appointment.—A chain shall be responsible for a portion of the costs associated with the appointment of independent monitors under the pilot program. The chain shall pay such portion to the Secretary (in an amount and in accordance with procedures established by the Secretary).
(f) Waiver authority.—The Secretary may waive such requirements of titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 1396 et seq.) as may be necessary for the purpose of carrying out the pilot program.
(g) Authorization of appropriations.—There are authorized to be appropriated such sums as may be necessary to carry out this section.
(h) Definitions.—In this section:
(1) FACILITY.—The term “facility” means a skilled nursing facility or a nursing facility.
(2) NURSING FACILITY.—The term “nursing facility” has the meaning given such term in section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a)).
(3) SECRETARY.—The term “Secretary” means the Secretary of Health and Human Services, acting through the Assistant Secretary for Planning and Evaluation.
(4) SKILLED NURSING FACILITY.—The term “skilled nursing facility” has the meaning given such term in section 1819(a) of the Social Security Act (42 U.S.C. 1395(a)).
(1) EVALUATION.—The Inspector General of the Department of Health and Human Services shall evaluate the pilot program. Such evaluation shall—
(A) determine whether the independent monitor program should be established on a permanent basis; and
(B) if the Inspector General determines that the independent monitor program should be established on a permanent basis, recommend appropriate procedures and mechanisms for such establishment.
(2) REPORT.—Not later than 180 days after the completion of the pilot program, the Inspector General shall submit to Congress and the Secretary a report containing the results of the evaluation conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Inspector General determines appropriate.
(a) Skilled Nursing Facilities.—
(1) IN GENERAL.—Section 1819(c) of the Social Security Act (42 U.S.C. 1395i–3(c)) is amended by adding at the end the following new paragraph:
“(7) NOTIFICATION OF FACILITY CLOSURE.—
“(A) IN GENERAL.—Any individual who is the administrator of a skilled nursing facility must—
“(i) submit to the Secretary, the State long-term care ombudsman, residents of the facility, and the legal representatives of such residents or other responsible parties, written notification of an impending closure—
“(I) subject to subclause (II), not later than the date that is 60 days prior to the date of such closure; and
“(II) in the case of a facility where the Secretary terminates the facility’s participation under this title, not later than the date that the Secretary determines appropriate;
“(ii) ensure that the facility does not admit any new residents on or after the date on which such written notification is submitted; and
“(iii) include in the notice a plan for the transfer and adequate relocation of the residents of the facility by a specified date prior to closure that has been approved by the State, including assurances that the residents will be transferred to the most appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs and best interests of each resident.
“(i) IN GENERAL.—The State shall ensure that, before a facility closes, all residents of the facility have been successfully relocated to another facility or an alternative home and community-based setting.
“(ii) CONTINUATION OF PAYMENTS UNTIL RESIDENTS RELOCATED.—The Secretary may, as the Secretary determines appropriate, continue to make payments under this title with respect to residents of a facility that has submitted a notification under subparagraph (A) during the period beginning on the date such notification is submitted and ending on the date on which the resident is successfully relocated.”.
(2) CONFORMING AMENDMENTS.—Section 1819(h)(4) of the Social Security Act (42 U.S.C. 1395i–3(h)(4)) is amended—
(A) in the first sentence, by striking “the Secretary shall terminate” and inserting “the Secretary, subject to subsection (c)(7), shall terminate”; and
(B) in the second sentence, by striking “subsection (c)(2)” and inserting “paragraphs (2) and (7) of subsection (c)”.
(1) IN GENERAL.—Section 1919(c) of the Social Security Act (42 U.S.C. 1396r(c)) is amended by adding at the end the following new paragraph:
“(9) NOTIFICATION OF FACILITY CLOSURE.—
“(A) IN GENERAL.—Any individual who is an administrator of a nursing facility must—
“(i) submit to the Secretary, the State long-term care ombudsman, residents of the facility, and the legal representatives of such residents or other responsible parties, written notification of an impending closure—
“(I) subject to subclause (II), not later than the date that is 60 days prior to the date of such closure; and
“(II) in the case of a facility where the Secretary terminates the facility’s participation under this title, not later than the date that the Secretary determines appropriate;
“(ii) ensure that the facility does not admit any new residents on or after the date on which such written notification is submitted; and
“(iii) include in the notice a plan for the transfer and adequate relocation of the residents of the facility by a specified date prior to closure that has been approved by the State, including assurances that the residents will be transferred to the most appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs and best interests of each resident.
“(i) IN GENERAL.—The State shall ensure that, before a facility closes, all residents of the facility have been successfully relocated to another facility or an alternative home and community-based setting.
“(ii) CONTINUATION OF PAYMENTS UNTIL RESIDENTS RELOCATED.—The Secretary may, as the Secretary determines appropriate, continue to make payments under this title with respect to residents of a facility that has submitted a notification under subparagraph (A) during the period beginning on the date such notification is submitted and ending on the date on which the resident is successfully relocated.”.
(c) Effective date.—The amendments made by this section shall take effect 1 year after the date of the enactment of this Act.
(a) Skilled nursing facilities.—Section 1819(f)(2)(A)(i)(I) of the Social Security Act (42 U.S.C. 1395i–3(f)(2)(A)(i)(I)) is amended by inserting “(including, in the case of initial training and, if the Secretary determines appropriate, in the case of ongoing training, dementia management training and resident abuse prevention training)” after “curriculum”.
(b) Nursing facilities.—Section 1919(f)(2)(A)(i)(I) of the Social Security Act (42 U.S.C. 1396r(f)(2)(A)(i)(I)) is amended by inserting “(including, in the case of initial training and, if the Secretary determines appropriate, in the case of ongoing training, dementia management training and resident abuse prevention training)” after “curriculum”.
(c) Effective date.—The amendments made by this section shall take effect 1 year after the date of the enactment of this Act.
(1) IN GENERAL.—The Secretary shall conduct a study on the content of training for certified nurse aides and supervisory staff of skilled nursing facilities and nursing facilities. The study shall include an analysis of the following:
(A) Whether the number of initial training hours for certified nurse aides required under sections 1819(f)(2)(A)(i)(II) and 1919(f)(2)(A)(i)(II) of the Social Security Act (42 U.S.C. 1395i–3(f)(2)(A)(i)(II); 1396r(f)(2)(A)(i)(II)) should be increased from 75 and, if so, what the required number of initial training hours should be, including any recommendations for the content of such training (including training related to dementia).
(B) Whether requirements for ongoing training under such sections 1819(f)(2)(A)(i)(II) and 1919(f)(2)(A)(i)(II) should be increased from 12 hours per year, including any recommendations for the content of such training.
(2) CONSULTATION.—In conducting the analysis under paragraph (1)(A), the Secretary shall consult with States that, as of the date of the enactment of this Act, require more than 75 hours of training for certified nurse aides.
(3) DEFINITIONS.—In this section:
(A) NURSING FACILITY.—The term “nursing facility” has the meaning given such term in section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a)).
(B) SECRETARY.—The term “Secretary” means the Secretary of Health and Human Services, acting through the Assistant Secretary for Planning and Evaluation.
(C) SKILLED NURSING FACILITY.—The term “skilled nursing facility” has the meaning given such term in section 1819(a) of the Social Security Act (42 U.S.C. 1395(a)).
(b) Report.—Not later than 2 years after the date of the enactment of this Act, the Secretary shall submit to Congress a report containing the results of the study conducted under subsection (a), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.
Title XI of the Social Security Act, as amended by section 1401(a), is further amended by adding at the end the following new part:
“Establishment of national priorities for performance improvement
“Sec. 1191. (a) Establishment of national priorities by the Secretary.—The Secretary shall establish and periodically update, not less frequently than triennially, national priorities for performance improvement.
Part E of title XI of the Social Security Act, as added by section 1441, is amended by adding at the end the following new sections:
“(a) Agreements with qualified entities.—
“(1) IN GENERAL.—The Secretary shall enter into agreements with qualified entities to develop quality measures for the delivery of health care services in the United States.
“(2) FORM OF AGREEMENTS.—The Secretary may carry out paragraph (1) by contract, grant, or otherwise.
“(3) RECOMMENDATIONS OF CONSENSUS-BASED ENTITY.—In carrying out this section, the Secretary shall—
“(A) seek public input; and
“(B) take into consideration recommendations of the consensus-based entity with a contract with the Secretary under section 1890(a).
“(b) Determination of areas where quality measures are required.—Consistent with the national priorities established under this part and with the programs administered by the Centers for Medicare & Medicaid Services and in consultation with other relevant Federal agencies, the Secretary shall determine areas in which quality measures for assessing health care services in the United States are needed.
“(c) Development of quality measures.—
“(1) PATIENT-CENTERED AND POPULATION-BASED MEASURES.—Quality measures developed under agreements under subsection (a) shall be designed—
“(A) to assess outcomes and functional status of patients;
“(B) to assess the continuity and coordination of care and care transitions for patients across providers and health care settings, including end of life care;
“(C) to assess patient experience and patient engagement;
“(D) to assess the safety, effectiveness, and timeliness of care;
“(E) to assess health disparities including those associated with individual race, ethnicity, age, gender, place of residence or language;
“(F) to assess the efficiency and resource use in the provision of care;
“(G) to the extent feasible, to be collected as part of health information technologies supporting better delivery of health care services;
“(H) to be available free of charge to users for the use of such measures; and
“(I) to assess delivery of health care services to individuals regardless of age.
“(2) AVAILABILITY OF MEASURES.—The Secretary shall make quality measures developed under this section available to the public.
“(3) TESTING OF PROPOSED MEASURES.—The Secretary may use amounts made available under subsection (f) to fund the testing of proposed quality measures by qualified entities. Testing funded under this paragraph shall include testing of the feasibility and usability of proposed measures.
“(4) UPDATING OF ENDORSED MEASURES.—The Secretary may use amounts made available under subsection (f) to fund the updating (and testing, if applicable) by consensus-based entities of quality measures that have been previously endorsed by such an entity as new evidence is developed, in a manner consistent with section 1890(b)(3).
“(d) Qualified entities.—Before entering into agreements with a qualified entity, the Secretary shall ensure that the entity is a public, nonprofit or academic institution with technical expertise in the area of health quality measurement.
“(e) Application for grant.—A grant may be made under this section only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section.
“(1) IN GENERAL.—The Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in such proportion as the Secretary determines appropriate), of $25,000,000, to the Secretary for purposes of carrying out this section for each of the fiscal years 2010 through 2014.
“(2) AUTHORIZATION OF APPROPRIATIONS.—For purposes of carrying out the provisions of this section, in addition to funds otherwise available, out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services $25,000,000 for each of the fiscal years 2010 through 2014.
“(a) GAO evaluations.—The Comptroller General of the United States shall conduct periodic evaluations of the implementation of the data collection processes for quality measures used by the Secretary.
“(b) Considerations.—In carrying out the evaluation under subsection (a), the Comptroller General shall determine—
“(1) whether the system for the collection of data for quality measures provides for validation of data as relevant and scientifically credible;
“(2) whether data collection efforts under the system use the most efficient and cost-effective means in a manner that minimizes administrative burden on persons required to collect data and that adequately protects the privacy of patients’ personal health information and provides data security;
“(3) whether standards under the system provide for an appropriate opportunity for physicians and other clinicians and institutional providers of services to review and correct findings; and
“(4) the extent to which quality measures are consistent with section 1192(c)(1) or result in direct or indirect costs to users of such measures.
“(c) Report.—The Comptroller General shall submit reports to Congress and to the Secretary containing a description of the findings and conclusions of the results of each such evaluation.”.
Section 1808 of the Social Security Act (42 U.S.C. 1395b–9) is amended by adding at the end the following new subsection:
(a) Inpatient hospital services.—Section 1886(b)(3)(B) of such Act (42 U.S.C. 1395ww(b)(3)(B)) is amended by adding at the end the following new clause:
“(x)(I) Subject to subclause (II), for purposes of reporting data on quality measures for inpatient hospital services furnished during fiscal year 2012 and each subsequent fiscal year, the quality measures specified under clause (viii) shall be measures selected by the Secretary from measures that have been endorsed by the entity with a contract with the Secretary under section 1890(a).
“(II) In the case of a specified area or medical topic determined appropriate by the Secretary for which a feasible and practical quality measure has not been endorsed by the entity with a contract under section 1890(a), the Secretary may specify a measure that is not so endorsed as long as due consideration is given to measures that have been endorsed or adopted by a consensus organization identified by the Secretary. The Secretary shall submit such a non-endorsed measure to the entity for consideration for endorsement. If the entity considers but does not endorse such a measure and if the Secretary does not phase-out use of such measure, the Secretary shall include the rationale for continued use of such a measure in rulemaking.”.
(b) Outpatient hospital services.—Section 1833(t)(17) of such Act (42 U.S.C. 1395l(t)(17)) is amended by adding at the end the following new subparagraph:
“(F) USE OF ENDORSED QUALITY MEASURES.—The provisions of clause (x) of section 1886(b)(3)(C) shall apply to quality measures for covered OPD services under this paragraph in the same manner as such provisions apply to quality measures for inpatient hospital services.”.
(c) Physicians’ services.—Section 1848(k)(2)(C)(ii) of such Act (42 U.S.C. 1395w–4(k)(2)(C)(ii)) is amended by adding at the end the following: “The Secretary shall submit such a non-endorsed measure to the entity for consideration for endorsement. If the entity considers but does not endorse such a measure and if the Secretary does not phase-out use of such measure, the Secretary shall include the rationale for continued use of such a measure in rulemaking.”.
(d) Renal dialysis services.—Section 1881(h)(2)(B)(ii) of such Act (42 U.S.C. 1395rr(h)(2)(B)(ii)) is amended by adding at the end the following: “The Secretary shall submit such a non-endorsed measure to the entity for consideration for endorsement. If the entity considers but does not endorse such a measure and if the Secretary does not phase-out use of such measure, the Secretary shall include the rationale for continued use of such a measure in rulemaking.”.
(e) Endorsement of standards.—Section 1890(b)(2) of the Social Security Act (42 U.S.C. 1395aaa(b)(2)) is amended by adding after and below subparagraph (B) the following:
“‘If the entity does not endorse a measure, such entity shall explain the reasons and provide suggestions about changes to such measure that might make it a potentially endorsable measure.’
(f) Effective date.—Except as otherwise provided, the amendments made by this section shall apply to quality measures applied for payment years beginning with 2012 or fiscal year 2012, as the case may be.
Section 1890(d) of the Social Security Act (42 U.S.C. 1395aaa(d)) is amended by striking “for each of fiscal years 2009 through 2012” and inserting “for fiscal year 2009, and $12,000,000 for each of the fiscal years 2010 through 2012.”
(a) In general.—Part A of title XI of the Social Security Act (42 U.S.C. 1301 et seq.), as amended by section 1631(a), is further amended by inserting after section 1128G the following new section:
“(a) Reporting of payments or other transfers of value.—
“(1) IN GENERAL.—Except as provided in this subsection, not later than March 31, 2011, and annually thereafter, each applicable manufacturer or distributor that provides a payment or other transfer of value to a covered recipient, or to an entity or individual at the request of or designated on behalf of a covered recipient, shall submit to the Secretary, in such electronic form as the Secretary shall require, the following information with respect to the preceding calendar year:
“(A) With respect to the covered recipient, the recipient’s name, business address, physician specialty, and national provider identifier.
“(B) With respect to the payment or other transfer of value, other than a drug sample—
“(i) its value and date;
“(ii) the name of the related drug, device, or supply, if available; and
“(iii) a description of its form, indicated (as appropriate for all that apply) as—
“(I) cash or a cash equivalent;
“(II) in-kind items or services;
“(III) stock, a stock option, or any other ownership interest, dividend, profit, or other return on investment; or
“(IV) any other form (as defined by the Secretary).
“(C) With respect to a drug sample, the name, number, date, and dosage units of the sample.
“(2) AGGREGATE REPORTING.—Information submitted by an applicable manufacturer or distributor under paragraph (1) shall include the aggregate amount of all payments or other transfers of value provided by the manufacturer or distributor to covered recipients (and to entities or individuals at the request of or designated on behalf of a covered recipient) during the year involved, including all payments and transfers of value regardless of whether such payments or transfer of value were individually disclosed.
“(3) SPECIAL RULE FOR CERTAIN PAYMENTS OR OTHER TRANSFERS OF VALUE.—In the case where an applicable manufacturer or distributor provides a payment or other transfer of value to an entity or individual at the request of or designated on behalf of a covered recipient, the manufacturer or distributor shall disclose that payment or other transfer of value under the name of the covered recipient.
“(4) DELAYED REPORTING FOR PAYMENTS MADE PURSUANT TO PRODUCT DEVELOPMENT AGREEMENTS.—In the case of a payment or other transfer of value made to a covered recipient by an applicable manufacturer or distributor pursuant to a product development agreement for services furnished in connection with the development of a new drug, device, biological, or medical supply, the applicable manufacturer or distributor may report the value and recipient of such payment or other transfer of value in the first reporting period under this subsection in the next reporting deadline after the earlier of the following:
“(A) The date of the approval or clearance of the covered drug, device, biological, or medical supply by the Food and Drug Administration.
“(B) Two calendar years after the date such payment or other transfer of value was made.
“(5) DELAYED REPORTING FOR PAYMENTS MADE PURSUANT TO CLINICAL INVESTIGATIONS.—In the case of a payment or other transfer of value made to a covered recipient by an applicable manufacturer or distributor in connection with a clinical investigation regarding a new drug, device, biological, or medical supply, the applicable manufacturer or distributor may report as required under this section in the next reporting period under this subsection after the earlier of the following:
“(A) The date that the clinical investigation is registered on the website maintained by the National Institutes of Health pursuant to section 671 of the Food and Drug Administration Amendments Act of 2007.
“(B) Two calendar years after the date such payment or other transfer of value was made.
“(6) CONFIDENTIALITY.—Information described in paragraph (4) or (5) shall be considered confidential and shall not be subject to disclosure under section 552 of title 5, United States Code, or any other similar Federal, State, or local law, until or after the date on which the information is made available to the public under such paragraph.
“(b) Reporting of ownership interest by physicians in hospitals and other entities that bill Medicare.—Not later than March 31 of each year (beginning with 2011), each hospital or other health care entity (not including a Medicare Advantage organization) that bills the Secretary under part A or part B of title XVIII for services shall report on the ownership shares (other than ownership shares described in section 1877(c)) of each physician who, directly or indirectly, owns an interest in the entity. In this subsection, the term ‘physician’ includes a physician’s immediate family members (as defined for purposes of section 1877(a)).
“(1) IN GENERAL.—The Secretary shall establish procedures to ensure that, not later than September 30, 2011, and on June 30 of each year beginning thereafter, the information submitted under subsections (a) and (b), other than information regard drug samples, with respect to the preceding calendar year is made available through an Internet website that—
“(A) is searchable and is in a format that is clear and understandable;
“(B) contains information that is presented by the name of the applicable manufacturer or distributor, the name of the covered recipient, the business address of the covered recipient, the specialty (if applicable) of the covered recipient, the value of the payment or other transfer of value, the date on which the payment or other transfer of value was provided to the covered recipient, the form of the payment or other transfer of value, indicated (as appropriate) under subsection (a)(1)(B)(ii), the nature of the payment or other transfer of value, indicated (as appropriate) under subsection (a)(1)(B)(iii), and the name of the covered drug, device, biological, or medical supply, as applicable;
“(C) contains information that is able to be easily aggregated and downloaded;
“(D) contains a description of any enforcement actions taken to carry out this section, including any penalties imposed under subsection (d), during the preceding year;
“(E) contains background information on industry-physician relationships;
“(F) in the case of information submitted with respect to a payment or other transfer of value described in subsection (a)(5), lists such information separately from the other information submitted under subsection (a) and designates such separately listed information as funding for clinical research;
“(G) contains any other information the Secretary determines would be helpful to the average consumer; and
“(H) provides the covered recipient an opportunity to submit corrections to the information made available to the public with respect to the covered recipient.
“(2) ACCURACY OF REPORTING.—The accuracy of the information that is submitted under subsections (a) and (b) and made available under paragraph (1) shall be the responsibility of the applicable manufacturer or distributor of a covered drug, device, biological, or medical supply reporting under subsection (a) or hospital or other health care entity reporting physician ownership under subsection (b). The Secretary shall establish procedures to ensure that the covered recipient is provided with an opportunity to submit corrections to the manufacturer, distributor, hospital, or other entity reporting under subsection (a) or (b) with regard to information made public with respect to the covered recipient and, under such procedures, the corrections shall be transmitted to the Secretary.
“(3) SPECIAL RULE FOR DRUG SAMPLES.—Information relating to drug samples provided under subsection (a) shall not be made available to the public by the Secretary but may be made available outside the Department of Health and Human Services by the Secretary for research or legitimate business purposes pursuant to data use agreements.
“(4) SPECIAL RULE FOR NATIONAL PROVIDER IDENTIFIERS.—Information relating to national provider identifiers provided under subsection (a) shall not be made available to the public by the Secretary but may be made available outside the Department of Health and Human Services by the Secretary for research or legitimate business purposes pursuant to data use agreements.
“(d) Penalties for Noncompliance.—
“(A) IN GENERAL.—Subject to subparagraph (B), except as provided in paragraph (2), any applicable manufacturer or distributor that fails to submit information required under subsection (a) in a timely manner in accordance with regulations promulgated to carry out such subsection, and any hospital or other entity that fails to submit information required under subsection (b) in a timely manner in accordance with regulations promulgated to carry out such subsection shall be subject to a civil money penalty of not less than $1,000, but not more than $10,000, for each payment or other transfer of value or ownership or investment interest not reported as required under such subsection. Such penalty shall be imposed and collected in the same manner as civil money penalties under subsection (a) of section 1128A are imposed and collected under that section.
“(B) LIMITATION.—The total amount of civil money penalties imposed under subparagraph (A) with respect to each annual submission of information under subsection (a) by an applicable manufacturer or distributor or other entity shall not exceed $150,000.
“(2) KNOWING FAILURE TO REPORT.—
“(A) IN GENERAL.—Subject to subparagraph (B), any applicable manufacturer or distributor that knowingly fails to submit information required under subsection (a) in a timely manner in accordance with regulations promulgated to carry out such subsection and any hospital or other entity that fails to submit information required under subsection (b) in a timely manner in accordance with regulations promulgated to carry out such subsection, shall be subject to a civil money penalty of not less than $10,000, but not more than $100,000, for each payment or other transfer of value or ownership or investment interest not reported as required under such subsection. Such penalty shall be imposed and collected in the same manner as civil money penalties under subsection (a) of section 1128A are imposed and collected under that section.
“(B) LIMITATION.—The total amount of civil money penalties imposed under subparagraph (A) with respect to each annual submission of information under subsection (a) or (b) by an applicable manufacturer, distributor, or entity shall not exceed $1,000,000, or, if greater, 0.1 percentage of the total annual revenues of the manufacturer, distributor, or entity.
“(3) USE OF FUNDS.—Funds collected by the Secretary as a result of the imposition of a civil money penalty under this subsection shall be used to carry out this section.
“(4) ENFORCEMENT THROUGH STATE ATTORNEYS GENERAL.—The attorney general of a State, after providing notice to the Secretary of an intent to proceed under this paragraph in a specific case and providing the Secretary with an opportunity to bring an action under this subsection and the Secretary declining such opportunity, may proceed under this subsection against a manufacturer or distributor in the State.
“(e) Annual report to Congress.—Not later than April 1 of each year beginning with 2011, the Secretary shall submit to Congress a report that includes the following:
“(1) The information submitted under this section during the preceding year, aggregated for each applicable manufacturer or distributor of a covered drug, device, biological, or medical supply that submitted such information during such year.
“(2) A description of any enforcement actions taken to carry out this section, including any penalties imposed under subsection (d), during the preceding year.
“(f) Definitions.—In this section:
“(1) APPLICABLE MANUFACTURER; APPLICABLE DISTRIBUTOR.—The term ‘applicable manufacturer’ means a manufacturer of a covered drug, device, biological, or medical supply, and the term ‘applicable distributor’ means a distributor of a covered drug, device, or medical supply.
“(2) CLINICAL INVESTIGATION.—The term ‘clinical investigation’ means any experiment involving one or more human subjects, or materials derived from human subjects, in which a drug or device is administered, dispensed, or used.
“(3) COVERED DRUG, DEVICE, BIOLOGICAL, OR MEDICAL SUPPLY.—The term ‘covered’ means, with respect to a drug, device, biological, or medical supply, such a drug, device, biological, or medical supply for which payment is available under title XVIII or a State plan under title XIX or XXI (or a waiver of such a plan).
“(4) COVERED RECIPIENT.—The term ‘covered recipient’ means the following:
“(A) A physician.
“(B) A physician group practice.
“(C) Any other prescriber of a covered drug, device, biological, or medical supply.
“(D) A pharmacy or pharmacist.
“(E) A health insurance issuer, group health plan, or other entity offering a health benefits plan, including any employee of such an issuer, plan, or entity.
“(F) A pharmacy benefit manager, including any employee of such a manager.
“(G) A hospital.
“(H) A medical school.
“(I) A sponsor of a continuing medical education program.
“(J) A patient advocacy or disease specific group.
“(K) A organization of health care professionals.
“(L) A biomedical researcher.
“(M) A group purchasing organization.
“(5) DISTRIBUTOR OF A COVERED DRUG, DEVICE, OR MEDICAL SUPPLY.—The term ‘distributor of a covered drug, device, or medical supply’ means any entity which is engaged in the marketing or distribution of a covered drug, device, or medical supply (or any subsidiary of or entity affiliated with such entity), but does not include a wholesale pharmaceutical distributor.
“(6) EMPLOYEE.—The term ‘employee’ has the meaning given such term in section 1877(h)(2).
“(7) KNOWINGLY.—The term ‘knowingly’ has the meaning given such term in section 3729(b) of title 31, United States Code.
“(8) MANUFACTURER OF A COVERED DRUG, DEVICE, BIOLOGICAL, OR MEDICAL SUPPLY.—The term ‘manufacturer of a covered drug, device, biological, or medical supply’ means any entity which is engaged in the production, preparation, propagation, compounding, conversion, processing, marketing, or distribution of a covered drug, device, biological, or medical supply (or any subsidiary of or entity affiliated with such entity).
“(9) PAYMENT OR OTHER TRANSFER OF VALUE.—
“(A) IN GENERAL.—The term ‘payment or other transfer of value’ means a transfer of anything of value for or of any of the following:
“(i) Gift, food, or entertainment.
“(ii) Travel or trip.
“(iii) Honoraria.
“(iv) Research funding or grant.
“(v) Education or conference funding.
“(vi) Consulting fees.
“(vii) Ownership or investment interest and royalties or license fee.
“(B) INCLUSIONS.—Subject to subparagraph (C), the term ‘payment or other transfer of value’ includes any compensation, gift, honorarium, speaking fee, consulting fee, travel, services, dividend, profit distribution, stock or stock option grant, or any ownership or investment interest held by a physician in a manufacturer (excluding a dividend or other profit distribution from, or ownership or investment interest in, a publicly traded security or mutual fund (as described in section 1877(c))).
“(C) EXCLUSIONS.—The term ‘payment or other transfer of value’ does not include the following:
“(i) Any payment or other transfer of value provided by an applicable manufacturer or distributor to a covered recipient where the amount transferred to, requested by, or designated on behalf of the covered recipient does not exceed $5.
“(ii) The loan of a covered device for a short-term trial period, not to exceed 90 days, to permit evaluation of the covered device by the covered recipient.
“(iii) Items or services provided under a contractual warranty, including the replacement of a covered device, where the terms of the warranty are set forth in the purchase or lease agreement for the covered device.
“(iv) A transfer of anything of value to a covered recipient when the covered recipient is a patient and not acting in the professional capacity of a covered recipient.
“(v) In-kind items used for the provision of charity care.
“(vi) A dividend or other profit distribution from, or ownership or investment interest in, a publicly traded security and mutual fund (as described in section 1877(c)).
“(vii) Compensation paid by a manufacturer or distributor of a covered drug, device, biological, or medical supply to a covered recipient who is directly employed by and works solely for such manufacturer or distributor.
“(viii) Any discount or cash rebate.
“(10) PHYSICIAN.—The term ‘physician’ has the meaning given that term in section 1861(r). For purposes of this section, such term does not include a physician who is an employee of the applicable manufacturer that is required to submit information under subsection (a).
“(g) Annual reports to States.—Not later than April 1 of each year beginning with 2011, the Secretary shall submit to States a report that includes a summary of the information submitted under subsections (a) and (d) during the preceding year with respect to covered recipients or other hospitals and entities in the State.
“(1) IN GENERAL.—Effective on January 1, 2011, subject to paragraph (2), the provisions of this section shall preempt any law or regulation of a State or of a political subdivision of a State that requires an applicable manufacturer and applicable distributor (as such terms are defined in subsection (f)) to disclose or report, in any format, the type of information (described in subsection (a)) regarding a payment or other transfer of value provided by the manufacturer to a covered recipient (as so defined).
“(2) NO PREEMPTION OF ADDITIONAL REQUIREMENTS.—Paragraph (1) shall not preempt any law or regulation of a State or of a political subdivision of a State that requires any of the following:
“(A) The disclosure or reporting of information not of the type required to be disclosed or reported under this section.
“(B) The disclosure or reporting, in any format, of the type of information required to be disclosed or reported under this section to a Federal, State, or local governmental agency for public health surveillance, investigation, or other public health purposes or health oversight purposes.
“(C) The discovery or admissibility of information described in this section in a criminal, civil, or administrative proceeding.”.
(b) Availability of information from the disclosure of financial relationship report (DFRR).—The Secretary of Health and Human Services shall submit to Congress a report on the full results of the Disclosure of Physician Financial Relationships surveys required pursuant to section 5006 of the Deficit Reduction Act of 2005. Such report shall be submitted to Congress not later than the date that is 6 months after the date such surveys are collected and shall be made publicly available on an Internet website of the Department of Health and Human Services.
(a) In general.—Title XI of the Social Security Act is amended by inserting after section 1138 the following section:
“(1) IN GENERAL.—The Secretary shall provide that a hospital (as defined in subsection (g)) or ambulatory surgical center meeting the requirements of titles XVIII or XIX may participate in the programs established under such titles (pursuant to the applicable provisions of law, including sections 1866(a)(1) and 1832(a)(1)(F)(i)) only if, in accordance with this section, the hospital or center reports such information on health care-associated infections that develop in the hospital or center (and such demographic information associated with such infections) as the Secretary specifies.
“(2) REPORTING PROTOCOLS.—Such information shall be reported in accordance with reporting protocols established by the Secretary through the Director of the Centers for Disease Control and Prevention (in this section referred to as the ‘CDC’) and to the National Healthcare Safety Network of the CDC or under such another reporting system of such Centers as determined appropriate by the Secretary in consultation with such Director.
“(3) COORDINATION WITH HIT.—The Secretary, through the Director of the CDC and the Office of the National Coordinator for Health Information Technology, shall ensure that the transmission of information under this subsection is coordinated with systems established under the HITECH Act, where appropriate.
“(4) PROCEDURES TO ENSURE THE VALIDITY OF INFORMATION.—The Secretary shall establish procedures regarding the validity of the information submitted under this subsection in order to ensure that such information is appropriately compared across hospitals and centers. Such procedures shall address failures to report as well as errors in reporting.
“(5) IMPLEMENTATION.—Not later than 1 year after the date of enactment of this section, the Secretary, through the Director of CDC, shall promulgate regulations to carry out this section.
“(b) Public posting of information.—The Secretary shall promptly post, on the official public Internet site of the Department of Health and Human Services, the information reported under subsection (a). Such information shall be set forth in a manner that allows for the comparison of information on health care-associated infections—
“(1) among hospitals and ambulatory surgical centers; and
“(2) by demographic information.
“(c) Annual report to Congress.—On an annual basis the Secretary shall submit to the Congress a report that summarizes each of the following:
“(1) The number and types of health care-associated infections reported under subsection (a) in hospitals and ambulatory surgical centers during such year.
“(2) Factors that contribute to the occurrence of such infections, including health care worker immunization rates.
“(3) Based on the most recent information available to the Secretary on the composition of the professional staff of hospitals and ambulatory surgical centers, the number of certified infection control professionals on the staff of hospitals and ambulatory surgical centers.
“(4) The total increases or decreases in health care costs that resulted from increases or decreases in the rates of occurrence of each such type of infection during such year.
“(5) Recommendations, in coordination with the Center for Quality Improvement established under section 931 of the Public Health Service Act, for best practices to eliminate the rates of occurrence of each such type of infection in hospitals and ambulatory surgical centers.
“(d) Non-preemption of State laws.—Nothing in this section shall be construed as preempting or otherwise affecting any provision of State law relating to the disclosure of information on health care-associated infections or patient safety procedures for a hospital or ambulatory surgical center.
“(e) Health care-associated infection.—For purposes of this section:
“(1) IN GENERAL.—The term ‘health care-associated infection’ means an infection that develops in a patient who has received care in any institutional setting where health care is delivered and is related to receiving health care.
“(2) RELATED TO RECEIVING HEALTH CARE.—The term ‘related to receiving health care’, with respect to an infection, means that the infection was not incubating or present at the time health care was provided.
“(f) Application to critical access hospitals.—For purposes of this section, the term ‘hospital’ includes a critical access hospital, as defined in section 1861(mm)(1).”.
(b) Effective date.—With respect to section 1138A of the Social Security Act (as inserted by subsection (a) of this section), the requirement under such section that hospitals and ambulatory surgical centers submit reports takes effect on such date (not later than 2 years after the date of the enactment of this Act) as the Secretary of Health and Human Services shall specify. In order to meet such deadline, the Secretary may implement such section through guidance or other instructions.
(c) GAO report.—Not later than 18 months after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the program established under section 1138A of the Social Security Act, as inserted by subsection (a). Such report shall include an analysis of the appropriateness of the types of information required for submission, compliance with reporting requirements, the success of the validity procedures established, and any conflict or overlap between the reporting required under such section and any other reporting systems mandated by either the States or the Federal Government.
(d) Report on additional data.—Not later than 18 months after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to the Congress a report on the appropriateness of expanding the requirements under such section to include additional information (such as health care worker immunization rates), in order to improve health care quality and patient safety.
(a) In general.—Section 1886(h) of the Social Security Act (42 U.S.C. 1395ww(h)) is amended—
(1) in paragraph (4)(F)(i), by striking “paragraph (7)” and inserting “paragraphs (7) and (8)”;
(2) in paragraph (4)(H)(i), by striking “paragraph (7)” and inserting “paragraphs (7) and (8)”;
(3) in paragraph (7)(E), by inserting “and paragraph (8)” after “this paragraph”; and
(4) by adding at the end the following new paragraph:
“(8) ADDITIONAL REDISTRIBUTION OF UNUSED RESIDENCY POSITIONS.—
“(A) REDUCTIONS IN LIMIT BASED ON UNUSED POSITIONS.—
“(i) PROGRAMS SUBJECT TO REDUCTION.—If a hospital's reference resident level (specified in clause (ii)) is less than the otherwise applicable resident limit (as defined in subparagraph (C)(ii)), effective for portions of cost reporting periods occurring on or after July 1, 2011, the otherwise applicable resident limit shall be reduced by 90 percent of the difference between such otherwise applicable resident limit and such reference resident level.
“(ii) REFERENCE RESIDENT LEVEL.—
“(I) IN GENERAL.—Except as otherwise provided in a subsequent subclause, the reference resident level specified in this clause for a hospital is the highest resident level for any of the 3 most recent cost reporting periods (ending before the date of the enactment of this paragraph) of the hospital for which a cost report has been settled (or, if not, submitted (subject to audit)), as determined by the Secretary.
“(II) USE OF MOST RECENT ACCOUNTING PERIOD TO RECOGNIZE EXPANSION OF EXISTING PROGRAMS.—If a hospital submits a timely request to increase its resident level due to an expansion, or planned expansion, of an existing residency training program that is not reflected on the most recent settled or submitted cost report, after audit and subject to the discretion of the Secretary, subject to subclause (IV), the reference resident level for such hospital is the resident level that includes the additional residents attributable to such expansion or establishment, as determined by the Secretary. The Secretary is authorized to determine an alternative reference resident level for a hospital that submitted to the Secretary a timely request, before the start of the 2009–2010 academic year, for an increase in its reference resident level due to a planned expansion.
“(III) SPECIAL PROVIDER AGREEMENT.—In the case of a hospital described in paragraph (4)(H)(v), the reference resident level specified in this clause is the limitation applicable under subclause (I) of such paragraph.
“(IV) PREVIOUS REDISTRIBUTION.—The reference resident level specified in this clause for a hospital shall be increased to the extent required to take into account an increase in resident positions made available to the hospital under paragraph (7)(B) that are not otherwise taken into account under a previous subclause.
“(iii) AFFILIATION.—The provisions of clause (i) shall be applied to hospitals which are members of the same affiliated group (as defined by the Secretary under paragraph (4)(H)(ii)) and to the extent the hospitals can demonstrate that they are filling any additional resident slots allocated to other hospitals through an affiliation agreement, the Secretary shall adjust the determination of available slots accordingly, or which the Secretary otherwise has permitted the resident positions (under section 402 of the Social Security Amendments of 1967) to be aggregated for purposes of applying the resident position limitations under this subsection.
“(i) IN GENERAL.—The Secretary shall increase the otherwise applicable resident limit for each qualifying hospital that submits an application under this subparagraph by such number as the Secretary may approve for portions of cost reporting periods occurring on or after July 1, 2011. The estimated aggregate number of increases in the otherwise applicable resident limit under this subparagraph may not exceed the Secretary’s estimate of the aggregate reduction in such limits attributable to subparagraph (A).
“(ii) REQUIREMENTS FOR QUALIFYING HOSPITALS.—A hospital is not a qualifying hospital for purposes of this paragraph unless the following requirements are met:
“(I) MAINTENANCE OF PRIMARY CARE RESIDENT LEVEL.—The hospital maintains the number of primary care residents at a level that is not less than the base level of primary care residents increased by the number of additional primary care resident positions provided to the hospital under this subparagraph. For purposes of this subparagraph, the ‘base level of primary care residents’ for a hospital is the level of such residents as of a base period (specified by the Secretary), determined without regard to whether such positions were in excess of the otherwise applicable resident limit for such period but taking into account the application of subclauses (II) and (III) of subparagraph (A)(ii).
“(II) DEDICATED ASSIGNMENT OF ADDITIONAL RESIDENT POSITIONS TO PRIMARY CARE.—The hospital assigns all such additional resident positions for primary care residents.
“(III) ACCREDITATION.—The hospital’s residency programs in primary care are fully accredited or, in the case of a residency training program not in operation as of the base year, the hospital is actively applying for such accreditation for the program for such additional resident positions (as determined by the Secretary).
“(iii) CONSIDERATIONS IN REDISTRIBUTION.—In determining for which qualifying hospitals the increase in the otherwise applicable resident limit is provided under this subparagraph, the Secretary shall take into account the demonstrated likelihood of the hospital filling the positions within the first 3 cost reporting periods beginning on or after July 1, 2011, made available under this subparagraph, as determined by the Secretary.
“(iv) PRIORITY FOR CERTAIN HOSPITALS.—In determining for which qualifying hospitals the increase in the otherwise applicable resident limit is provided under this subparagraph, the Secretary shall distribute the increase to qualifying hospitals based on the following criteria:
“(I) The Secretary shall give preference to hospitals that had a reduction in resident training positions under subparagraph (A).
“(II) The Secretary shall give preference to hospitals with 3-year primary care residency training programs, such as family practice and general internal medicine.
“(III) The Secretary shall give preference to hospitals insofar as they have in effect formal arrangements (as determined by the Secretary) that place greater emphasis upon training in Federally qualified health centers, rural health clinics, and other nonprovider settings, and to hospitals that receive additional payments under subsection (d)(5)(F) and emphasize training in an outpatient department.
“(IV) The Secretary shall give preference to hospitals with a number of positions (as of July 1, 2009) in excess of the otherwise applicable resident limit for such period.
“(V) The Secretary shall give preference to hospitals that place greater emphasis upon training in a health professional shortage area (designated under section 332 of the Public Health Service Act) or a health professional needs area (designated under section 2211 of such Act).
“(VI) The Secretary shall give preference to hospitals in States that have low resident-to-population ratios (including a greater preference for those States with lower resident-to-population ratios).
“(v) LIMITATION.—In no case shall more than 20 full-time equivalent additional residency positions be made available under this subparagraph with respect to any hospital.
“(vi) APPLICATION OF PER RESIDENT AMOUNTS FOR PRIMARY CARE.—With respect to additional residency positions in a hospital attributable to the increase provided under this subparagraph, the approved FTE resident amounts are deemed to be equal to the hospital per resident amounts for primary care and nonprimary care computed under paragraph (2)(D) for that hospital.
“(vi) DISTRIBUTION.—The Secretary shall distribute the increase in resident training positions to qualifying hospitals under this subparagraph not later than July 1, 2011.
“(C) RESIDENT LEVEL AND LIMIT DEFINED.—In this paragraph:
“(i) The term ‘resident level’ has the meaning given such term in paragraph (7)(C)(i).
“(ii) The term ‘otherwise applicable resident limit’ means, with respect to a hospital, the limit otherwise applicable under subparagraphs (F)(i) and (H) of paragraph (4) on the resident level for the hospital determined without regard to this paragraph but taking into account paragraph (7)(A).
“(D) MAINTENANCE OF PRIMARY CARE RESIDENT LEVEL.—In carrying out this paragraph, the Secretary shall require hospitals that receive additional resident positions under subparagraph (B)—
“(i) to maintain records, and periodically report to the Secretary, on the number of primary care residents in its residency training programs; and
“(ii) as a condition of payment for a cost reporting period under this subsection for such positions, to maintain the level of such positions at not less than the sum of—
“(I) the base level of primary care resident positions (as determined under subparagraph (B)(ii)(I)) before receiving such additional positions; and
“(II) the number of such additional positions.”.
(1) IN GENERAL.—Section 1886(d)(5)(B)(v) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(v)), in the second sentence, is amended—
(A) by striking “subsection (h)(7)” and inserting “subsections (h)(7) and (h)(8)”; and
(B) by striking “it applies” and inserting “they apply”.
(2) CONFORMING PROVISION.—Section 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by adding at the end the following clause:
“(x) For discharges occurring on or after July 1, 2011, insofar as an additional payment amount under this subparagraph is attributable to resident positions distributed to a hospital under subsection (h)(8)(B), the indirect teaching adjustment factor shall be computed in the same manner as provided under clause (ii) with respect to such resident positions.”.
(c) Conforming amendment.—Section 422(b)(2) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173) is amended by striking “section 1886(h)(7)” and all that follows and inserting “paragraphs (7) and (8) of subsection (h) of section 1886 of the Social Security Act”.
(a) Direct GME.—Section 1886(h)(4)(E) of the Social Security Act (42 U.S.C. 1395ww(h)) is amended—
(1) by designating the first sentence as a clause (i) with the heading “In general” and appropriate indentation;
(2) by striking “shall be counted and that all the time ” and inserting “shall be counted and that—
“(I) effective for cost reporting periods beginning before July 1, 2009, all the time”;
(3) in subclause (I), as inserted by paragraph (1), by striking the period at the end and inserting “; and”; and
(A) by inserting after subclause (I), as so inserted, the following:
“(II) effective for cost reporting periods beginning on or after July 1, 2009, all the time so spent by a resident shall be counted towards the determination of full-time equivalency, without regard to the setting in which the activities are performed, if the hospital incurs the costs of the stipends and fringe benefits of the resident during the time the resident spends in that setting.
Any hospital claiming under this subparagraph for time spent in a nonprovider setting shall maintain and make available to the Secretary records regarding the amount of such time and such amount in comparison with amounts of such time in such base year as the Secretary shall specify.”.
(b) IME.—Section 1886(d)(5)(B)(iv) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(iv)) is amended—
(1) by striking “(iv) Effective for discharges occurring on or after October 1, 1997” and inserting “(iv)(I) Effective for discharges occurring on or after October 1, 1997, and before July 1, 2009”; and
(2) by inserting after subclause (I), as inserted by paragraph (1), the following new subclause:
“(II) Effective for discharges occurring on or after July 1, 2009, all the time spent by an intern or resident in patient care activities at an entity in a nonprovider setting shall be counted towards the determination of full-time equivalency if the hospital incurs the costs of the stipends and fringe benefits of the intern or resident during the time the intern or resident spends in that setting.”.
(c) OIG study on impact on training.—The Inspector General of the Department of Health and Human Services shall analyze the data collected by the Secretary of Health and Human Services from the records made available to the Secretary under section 1886(h)(4)(E) of the Social Security Act, as amended by subsection (a), in order to assess the extent to which there is an increase in time spent by medical residents in training in nonprovider settings as a result of the amendments made by this section. Not later than 4 years after the date of the enactment of this Act, the Inspector General shall submit a report to Congress on such analysis and assessment.
(d) Demonstration project for approved teaching health centers.—
(1) IN GENERAL.—The Secretary of Health and Human Services shall conduct a demonstration project under which an approved teaching health center (as defined in paragraph (3)) would be eligible for payment under subsections (h) and (k) of section 1886 of the Social Security Act (42 U.S.C. 1395ww) of amounts for its own direct costs of graduate medical education activities for primary care residents, as well as for the direct costs of graduate medical education activities of its contracting hospital for such residents, in a manner similar to the manner in which such payments would be made to a hospital if the hospital were to operate such a program.
(2) CONDITIONS.—Under the demonstration project—
(A) an approved teaching health center shall contract with an accredited teaching hospital to carry out the inpatient responsibilities of the primary care residency program of the hospital involved and is responsible for payment to the hospital for the hospital’s costs of the salary and fringe benefits for residents in the program;
(B) the number of primary care residents of the center shall not count against the contracting hospital’s resident limit; and
(C) the contracting hospital shall agree not to diminish the number of residents in its primary care residency training program.
(3) APPROVED TEACHING HEALTH CENTER DEFINED.—In this subsection, the term “approved teaching health center” means a nonprovider setting, such as a Federally qualified health center or rural health clinic (as defined in section 1861(aa) of the Social Security Act), that develops and operates an accredited primary care residency program for which funding would be available if it were operated by a hospital.
(a) Direct GME.—Section 1886(h) of the Social Security Act (42 U.S.C. 1395ww(h)) is amended—
(1) in paragraph (4)(E), as amended by section 1502(a)—
(A) in clause (i), by striking “Such rules” and inserting “Subject to clause (ii), such rules”; and
(B) by adding at the end the following new clause:
“(ii) TREATMENT OF CERTAIN NONPROVIDER AND DIDACTIC ACTIVITIES.—Such rules shall provide that all time spent by an intern or resident in an approved medical residency training program in a nonprovider setting that is primarily engaged in furnishing patient care (as defined in paragraph (5)(K)) in nonpatient care activities, such as didactic conferences and seminars, but not including research not associated with the treatment or diagnosis of a particular patient, as such time and activities are defined by the Secretary, shall be counted toward the determination of full-time equivalency.”;
(2) in paragraph (4), by adding at the end the following new subparagraph:
“(I) In determining the hospital’s number of full-time equivalent residents for purposes of this subsection, all the time that is spent by an intern or resident in an approved medical residency training program on vacation, sick leave, or other approved leave, as such time is defined by the Secretary, and that does not prolong the total time the resident is participating in the approved program beyond the normal duration of the program shall be counted toward the determination of full-time equivalency.”; and
(3) in paragraph (5), by adding at the end the following new subparagraph:
“(K) NONPROVIDER SETTING THAT IS PRIMARILY ENGAGED IN FURNISHING PATIENT CARE.—The term ‘nonprovider setting that is primarily engaged in furnishing patient care’ means a nonprovider setting in which the primary activity is the care and treatment of patients, as defined by the Secretary.”.
(b) IME determinations.—Section 1886(d)(5)(B) of such Act (42 U.S.C. 1395ww(d)(5)(B)), as amended by section 1501(b), is amended by adding at the end the following new clause:
“(xi)(I) The provisions of subparagraph (I) of subsection (h)(4) shall apply under this subparagraph in the same manner as they apply under such subsection.
“(II) In determining the hospital’s number of full-time equivalent residents for purposes of this subparagraph, all the time spent by an intern or resident in an approved medical residency training program in nonpatient care activities, such as didactic conferences and seminars, as such time and activities are defined by the Secretary, that occurs in the hospital shall be counted toward the determination of full-time equivalency if the hospital—
“(aa) is recognized as a subsection (d) hospital;
“(bb) is recognized as a subsection (d) Puerto Rico hospital;
“(cc) is reimbursed under a reimbursement system authorized under section 1814(b)(3); or
“(dd) is a provider-based hospital outpatient department.
“(III) In determining the hospital’s number of full-time equivalent residents for purposes of this subparagraph, all the time spent by an intern or resident in an approved medical residency training program in research activities that are not associated with the treatment or diagnosis of a particular patient, as such time and activities are defined by the Secretary, shall not be counted toward the determination of full-time equivalency.”.
(c) Effective dates; application.—
(1) IN GENERAL.—Except as otherwise provided, the Secretary of Health and Human Services shall implement the amendments made by this section in a manner so as to apply to cost reporting periods beginning on or after January 1, 1983.
(2) DIRECT GME.—Section 1886(h)(4)(E)(ii) of the Social Security Act, as added by subsection (a)(1)(B), shall apply to cost reporting periods beginning on or after July 1, 2008.
(3) IME.—Section 1886(d)(5)(B)(x)(III) of the Social Security Act, as added by subsection (b), shall apply to cost reporting periods beginning on or after October 1, 2001. Such section, as so added, shall not give rise to any inference on how the law in effect prior to such date should be interpreted.
(4) APPLICATION.—The amendments made by this section shall not be applied in a manner that requires reopening of any settled hospital cost reports as to which there is not a jurisdictionally proper appeal pending as of the date of the enactment of this Act on the issue of payment for indirect costs of medical education under section 1886(d)(5)(B) of the Social Security Act or for direct graduate medical education costs under section 1886(h) of such Act.
(a) Direct GME.—Section 1886(h)(4)(H) of the Social Security Act (42 U.S.C. Section 1395ww(h)(4)(H)) is amended by adding at the end the following new clause:
“(vi) REDISTRIBUTION OF RESIDENCY SLOTS AFTER A HOSPITAL CLOSES.—
“(I) IN GENERAL.—The Secretary shall, by regulation, establish a process consistent with subclauses (II) and (III) under which, in the case where a hospital (other than a hospital described in clause (v)) with an approved medical residency program in a State closes on or after the date that is 2 years before the date of the enactment of this clause, the Secretary shall increase the otherwise applicable resident limit under this paragraph for other hospitals in the State in accordance with this clause.
“(II) PROCESS FOR HOSPITALS IN CERTAIN AREAS.—In determining for which hospitals the increase in the otherwise applicable resident limit described in subclause (I) is provided, the Secretary shall establish a process to provide for such increase to one or more hospitals located in the State. Such process shall take into consideration the recommendations submitted to the Secretary by the senior health official (as designated by the chief executive officer of such State) if such recommendations are submitted not later than 180 days after the date of the hospital closure involved (or, in the case of a hospital that closed after the date that is 2 years before the date of the enactment of this clause, 180 days after such date of enactment).
“(III) LIMITATION.—The estimated aggregate number of increases in the otherwise applicable resident limits for hospitals under this clause shall be equal to the estimated number of resident positions in the approved medical residency programs that closed on or after the date described in subclause (I).”.
(b) No effect on temporary FTE cap adjustments.—The amendments made by this section shall not effect any temporary adjustment to a hospital's FTE cap under section 413.79(h) of title 42, Code of Federal Regulations (as in effect on the date of enactment of this Act) and shall not affect the application of section 1886(h)(4)(H)(v) of the Social Security Act.
(1) Section 422(b)(2) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173), as amended by section 1501(c), is amended by striking “(7) and” and inserting “(4)(H)(vi), (7), and”.
(2) Section 1886(h)(7)(E) of the Social Security Act (42 U.S.C. 1395ww(h)(7)(E)) is amended by inserting “or under paragraph (4)(H)(vi)” after “under this paragraph”.
(a) Specification of goals for approved medical residency training programs.—Section 1886(h)(1) of the Social Security Act (42 U.S.C. 1395ww(h)(1)) is amended—
(1) by designating the matter beginning with “Notwithstanding” as a subparagraph (A) with the heading “In general.—” and with appropriate indentation; and
(2) by adding at the end the following new paragraph:
“(B) GOALS AND ACCOUNTABILITY FOR APPROVED MEDICAL RESIDENCY TRAINING PROGRAMS.—The goals of medical residency training programs are to foster a physician workforce so that physicians are trained to be able to do the following:
“(i) Work effectively in various health care delivery settings, such as nonprovider settings.
“(ii) Coordinate patient care within and across settings relevant to their specialties.
“(iii) Understand the relevant cost and value of various diagnostic and treatment options.
“(iv) Work in inter-professional teams and multi-disciplinary team-based models in provider and nonprovider settings to enhance safety and improve quality of patient care.
“(v) Be knowledgeable in methods of identifying systematic errors in health care delivery and in implementing systematic solutions in case of such errors, including experience and participation in continuous quality improvement projects to improve health outcomes of the population the physicians serve.
“(vi) Be meaningful EHR users (as determined under section 1848(o)(2)) in the delivery of care and in improving the quality of the health of the community and the individuals that the hospital serves.”
(b) GAO study on evaluation of training programs.—
(1) IN GENERAL.—The Comptroller General of the United States shall conduct a study to evaluate the extent to which medical residency training programs—
(A) are meeting the goals described in section 1886(h)(1)(B) of the Social Security Act, as added by subsection (a), in a range of residency programs, including primary care and other specialties; and
(B) have the appropriate faculty expertise to teach the topics required to achieve such goals.
(2) REPORT.—Not later than 18 months after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report on such study and shall include in such report recommendations as to how medical residency training programs could be further encouraged to meet such goals through means such as—
(A) development of curriculum requirements; and
(B) assessment of the accreditation processes of the Accreditation Council for Graduate Medical Education and the American Osteopathic Association and effectiveness of those processes in accrediting medical residency programs that meet the goals referred to in paragraph (1)(A).
(a) In general.—Section 1817(k) of the Social Security Act (42 U.S.C. 1395i(k)) is amended—
(1) by adding at the end the following new paragraph:
“(7) ADDITIONAL FUNDING.—In addition to the funds otherwise appropriated to the Account from the Trust Fund under paragraphs (3) and (4) and for purposes described in paragraphs (3)(C) and (4)(A), there are hereby appropriated an additional $100,000,000 to such Account from such Trust Fund for each fiscal year beginning with 2011. The funds appropriated under this paragraph shall be allocated in the same proportion as the total funding appropriated with respect to paragraphs (3)(A) and (4)(A) was allocated with respect to fiscal year 2010, and shall be available without further appropriation until expended.”.
(A) by inserting “for activities described in paragraph (3)(C) and” after “necessary”; and
(B) by inserting “until expended” after “appropriation”.
(b) Flexibility in pursuing fraud and abuse.—Section 1893(a) of the Social Security Act (42 U.S.C. 1395ddd(a)) is amended by inserting “, or otherwise,” after “entities”.
(a) In general.—Section 1128A(a) of the Social Security Act (42 U.S.C. 1320a–7a(a)) is amended—
(1) in paragraph (1)(D), by striking all that follows “in which the person was excluded” and inserting “under Federal law from the Federal health care program under which the claim was made, or”;
(2) by striking “or” at the end of paragraph (6);
(3) in paragraph (7), by inserting at the end “or”;
(4) by inserting after paragraph (7) the following new paragraph:
“(8) knowingly makes or causes to be made any false statement, omission, or misrepresentation of a material fact in any application, agreement, bid, or contract to participate or enroll as a provider of services or supplier under a Federal health care program, including managed care organizations under title XIX, Medicare Advantage organizations under part C of title XVIII, prescription drug plan sponsors under part D of title XVIII, and entities that apply to participate as providers of services or suppliers in such managed care organizations and such plans;”;
(5) in the matter following paragraph (8), as inserted by paragraph (4), by striking “or in cases under paragraph (7), $50,000 for each such act)” and inserting “in cases under paragraph (7), $50,000 for each such act, or in cases under paragraph (8), $50,000 for each false statement, omission, or misrepresentation of a material fact)”; and
(6) in the second sentence, by striking “for a lawful purpose)” and inserting “for a lawful purpose, or in cases under paragraph (8), an assessment of not more than 3 times the amount claimed as the result of the false statement, omission, or misrepresentation of material fact claimed by a provider of services or supplier whose application to participate contained such false statement, omission, or misrepresentation)”.
(b) Effective date.—The amendments made by subsection (a) shall apply to acts committed on or after January 1, 2010.
(a) In general.—Section 1128A(a) of the Social Security Act (42 U.S.C. 1320a–7a(a)), as amended by section 1611, is further amended—
(1) in paragraph (7), by striking “or” at the end;
(2) in paragraph (8), by inserting “or” at the end; and
(3) by inserting after paragraph (8), the following new paragraph:
“(9) knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim for payment for items and services furnished under a Federal health care program;”; and
(4) in the matter following paragraph (9), as inserted by paragraph (3)—
(A) by striking “or in cases under paragraph (8)” and inserting “in cases under paragraph (8)”; and
(B) by striking “a material fact)” and inserting “a material fact, in cases under paragraph (9), $50,000 for each false record or statement)”.
(b) Effective date.—The amendments made by subsection (a) shall apply to acts committed on or after January 1, 2010.
(a) In general.—Section 1128A(a) of the Social Security Act (42 U.S.C. 1320a–7a(a)), as amended by sections 1611 and 1612, is further amended—
(1) in paragraph (8), by striking “or” at the end;
(2) in paragraph (9), by inserting “or” at the end;
(3) by inserting after paragraph (9) the following new paragraph:
“(10) fails to grant timely access, upon reasonable request (as defined by the Secretary in regulations), to the Inspector General of the Department of Health and Human Services, for the purpose of audits, investigations, evaluations, or other statutory functions of the Inspector General of the Department of Health and Human Services;”; and
(4) in the matter following paragraph (10), as inserted by paragraph (3)—
(A) by striking “or” after “$50,000 for each such act,”; and
(B) by inserting “, or in cases under paragraph (10), $15,000 for each day of the failure described in such paragraph” after “false record or statement”.
(b) Ensuring timely inspections relating to contracts with MA organizations.—Section 1857(d)(2) of such Act (42 U.S.C. 1395w–27(d)(2)) is amended—
(1) in subparagraph (A), by inserting “timely” before “inspect”; and
(2) in subparagraph (B), by inserting “timely” before “audit and inspect”.
(c) Effective date.—The amendments made by subsection (a) shall apply to violations committed on or after January 1, 2010.
(a) Medicare.—Part A of title XVIII of the Social Security Act is amended by inserting after section 1819 the following new section:
“(a) In general.—If the Secretary determines on the basis of a survey or otherwise, that a hospice program that is certified for participation under this title has demonstrated a substandard quality of care and failed to meet such other requirements as the Secretary may find necessary in the interest of the health and safety of the individuals who are provided care and services by the agency or organization involved and determines—
“(1) that the deficiencies involved immediately jeopardize the health and safety of the individuals to whom the program furnishes items and services, the Secretary shall take immediate action to remove the jeopardy and correct the deficiencies through the remedy specified in subsection (b)(2)(A)(iii) or terminate the certification of the program, and may provide, in addition, for 1 or more of the other remedies described in subsection (b)(2)(A); or
“(2) that the deficiencies involved do not immediately jeopardize the health and safety of the individuals to whom the program furnishes items and services, the Secretary may—
“(A) impose intermediate sanctions developed pursuant to subsection (b), in lieu of terminating the certification of the program; and
“(B) if, after such a period of intermediate sanctions, the program is still not in compliance with such requirements, the Secretary shall terminate the certification of the program.
If the Secretary determines that a hospice program that is certified for participation under this title is in compliance with such requirements but, as of a previous period, was not in compliance with such requirements, the Secretary may provide for a civil money penalty under subsection (b)(2)(A)(i) for the days in which it finds that the program was not in compliance with such requirements.
“(1) DEVELOPMENT AND IMPLEMENTATION.—The Secretary shall develop and implement, by not later than July 1, 2012—
“(A) a range of intermediate sanctions to apply to hospice programs under the conditions described in subsection (a), and
“(B) appropriate procedures for appealing determinations relating to the imposition of such sanctions.
“(A) IN GENERAL.—The intermediate sanctions developed under paragraph (1) may include—
“(i) civil money penalties in an amount not to exceed $10,000 for each day of noncompliance or, in the case of a per instance penalty applied by the Secretary, not to exceed $25,000,
“(ii) denial of all or part of the payments to which a hospice program would otherwise be entitled under this title with respect to items and services furnished by a hospice program on or after the date on which the Secretary determines that intermediate sanctions should be imposed pursuant to subsection (a)(2),
“(iii) the appointment of temporary management to oversee the operation of the hospice program and to protect and assure the health and safety of the individuals under the care of the program while improvements are made,
“(iv) corrective action plans, and
“(v) in-service training for staff.
The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under clause (i) in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). The temporary management under clause (iii) shall not be terminated until the Secretary has determined that the program has the management capability to ensure continued compliance with all requirements referred to in that clause.
“(B) CLARIFICATION.—The sanctions specified in subparagraph (A) are in addition to sanctions otherwise available under State or Federal law and shall not be construed as limiting other remedies, including any remedy available to an individual at common law.
“(C) COMMENCEMENT OF PAYMENT.—A denial of payment under subparagraph (A)(ii) shall terminate when the Secretary determines that the hospice program no longer demonstrates a substandard quality of care and meets such other requirements as the Secretary may find necessary in the interest of the health and safety of the individuals who are provided care and services by the agency or organization involved.
“(3) SECRETARIAL AUTHORITY.—The Secretary shall develop and implement, by not later than July 1, 2011, specific procedures with respect to the conditions under which each of the intermediate sanctions developed under paragraph (1) is to be applied, including the amount of any fines and the severity of each of these sanctions. Such procedures shall be designed so as to minimize the time between identification of deficiencies and imposition of these sanctions and shall provide for the imposition of incrementally more severe fines for repeated or uncorrected deficiencies.”.
(b) Application to Medicaid.—Section 1905(o) of the Social Security Act (42 U.S.C. 1396d(o)) is amended by adding at the end the following new paragraph:
“(4) The provisions of section 1819A shall apply to a hospice program providing hospice care under this title in the same manner as such provisions apply to a hospice program providing hospice care under title XVIII.”.
(c) Application to CHIP.—Title XXI of the Social Security Act is amended by adding at the end the following new section:
“The provisions of section 1819A shall apply to a hospice program providing hospice care under this title in the same manner such provisions apply to a hospice program providing hospice care under title XVIII.”.
(a) In general.—Section 1128A(a) of the Social Security Act (42 U.S.C. 1320a–7a(a)), as amended by the previous sections, is further amended—
(1) by striking “or” at the end of paragraph (9);
(2) by inserting “or” at the end of paragraph (10);
(3) by inserting after paragraph (10) the following new paragraph:
“(11) orders or prescribes an item or service, including without limitation home health care, diagnostic and clinical lab tests, prescription drugs, durable medical equipment, ambulance services, physical or occupational therapy, or any other item or service, during a period when the person has been excluded from participation in a Federal health care program, and the person knows or should know that a claim for such item or service will be presented to such a program;”; and
(4) in the matter following paragraph (11), as inserted by paragraph (2), by striking “$15,000 for each day of the failure described in such paragraph” and inserting “$15,000 for each day of the failure described in such paragraph, or in cases under paragraph (11), $50,000 for each order or prescription for an item or service by an excluded individual”.
(b) Effective date.—The amendments made by subsection (a) shall apply to violations committed on or after January 1, 2010.
(a) In general.—Section 1857(g)(2)(A) of the Social Security Act (42 U.S.C. 1395w–27(g)(2)(A)) is amended by inserting “except with respect to a determination under subparagraph (E), an assessment of not more than 3 times the amount claimed by such plan or plan sponsor based upon the misrepresentation or falsified information involved,” after “for each such determination,”.
(b) Effective date.—The amendment made by subsection (a) shall apply to violations committed on or after January 1, 2010.
(a) In general.—Section 1857(g)(1) of the Social Security Act (42 U.S.C. 1395w–27(g)(1)), as amended by section 1221(b), is amended—
(1) in subparagraph (G), by striking “or” at the end;
(2) by inserting after subparagraph (H) the following new subparagraphs:
“(I) except as provided under subparagraph (C) or (D) of section 1860D–1(b)(1), enrolls an individual in any plan under this part without the prior consent of the individual or the designee of the individual;
“(J) transfers an individual enrolled under this part from one plan to another without the prior consent of the individual or the designee of the individual or solely for the purpose of earning a commission;
“(K) fails to comply with marketing restrictions described in subsections (h) and (j) of section 1851 or applicable implementing regulations or guidance; or
“(L) employs or contracts with any individual or entity who engages in the conduct described in subparagraphs (A) through (K) of this paragraph;”; and
(3) by adding at the end the following new sentence: “The Secretary may provide, in addition to any other remedies authorized by law, for any of the remedies described in paragraph (2), if the Secretary determines that any employee or agent of such organization, or any provider or supplier who contracts with such organization, has engaged in any conduct described in subparagraphs (A) through (L) of this paragraph.”
(b) Effective date.—The amendments made by subsection (a) shall apply to violations committed on or after January 1, 2010.
(a) In general.—Section 1128(b)(2) of the Social Security Act (42 U.S.C. 1320a–7(b)(2)) is amended—
(1) in the heading, by inserting “or audit” after “investigation”; and
(2) by striking “investigation into” and all that follows through the period and inserting “investigation or audit related to—”
“(i) any offense described in paragraph (1) or in subsection (a); or
“(ii) the use of funds received, directly or indirectly, from any Federal health care program (as defined in section 1128B(f)).”.
(b) Effective date.—The amendments made by subsection (a) shall apply to violations committed on or after January 1, 2010.
(a) In general.—Section 1128(c) of the Social Security Act, as previously amended by this division, is further amended—
(1) in the heading, by striking “and period” and inserting “, period, and effect”; and
(2) by adding at the end the following new paragraph:
“(4)(A) For purposes of this Act, subject to subparagraph (C), the effect of exclusion is that no payment may be made by any Federal health care program (as defined in section 1128B(f)) with respect to any item or service furnished—
“(i) by an excluded individual or entity; or
“(ii) at the medical direction or on the prescription of a physician or other authorized individual when the person submitting a claim for such item or service knew or had reason to know of the exclusion of such individual.
“(B) For purposes of this section and sections 1128A and 1128B, subject to subparagraph (C), an item or service has been furnished by an individual or entity if the individual or entity directly or indirectly provided, ordered, manufactured, distributed, prescribed, or otherwise supplied the item or service regardless of how the item or service was paid for by a Federal health care program or to whom such payment was made.
“(C)(i) Payment may be made under a Federal health care program for emergency items or services (not including items or services furnished in an emergency room of a hospital) furnished by an excluded individual or entity, or at the medical direction or on the prescription of an excluded physician or other authorized individual during the period of such individual’s exclusion.
“(ii) In the case that an individual eligible for benefits under title XVIII or XIX submits a claim for payment for items or services furnished by an excluded individual or entity, and such individual eligible for such benefits did not know or have reason to know that such excluded individual or entity was so excluded, then, notwithstanding such exclusion, payment shall be made for such items or services. In such case the Secretary shall notify such individual eligible for such benefits of the exclusion of the individual or entity furnishing the items or services. Payment shall not be made for items or services furnished by an excluded individual or entity to an individual eligible for such benefits after a reasonable time (as determined by the Secretary in regulations) after the Secretary has notified the individual eligible for such benefits of the exclusion of the individual or entity furnishing the items or services.
“(iii) In the case that a claim for payment for items or services furnished by an excluded individual or entity is submitted by an individual or entity other than an individual eligible for benefits under title XVIII or XIX or the excluded individual or entity, and the Secretary determines that the individual or entity that submitted the claim took reasonable steps to learn of the exclusion and reasonably relied upon inaccurate or misleading information from the relevant Federal health care program or its contractor, the Secretary may waive repayment of the amount paid in violation of the exclusion to the individual or entity that submitted the claim for the items or services furnished by the excluded individual or entity. If a Federal health care program contractor provided inaccurate or misleading information that resulted in the waiver of an overpayment under this clause, the Secretary shall take appropriate action to recover the improperly paid amount from the contractor.”.
(a) In general.—Title XI of the Social Security Act (42 U.S.C. 1301 et seq.) is amended by inserting after section 1128F the following new section:
“(a) Certain authorized screening, enhanced oversight periods, and enrollment moratoria.—
“(1) IN GENERAL.—For periods beginning after January 1, 2011, in the case that the Secretary determines there is a significant risk of fraudulent activity (as determined by the Secretary based on relevant complaints, reports, referrals by law enforcement or other sources, data analysis, trending information, or claims submissions by providers of services and suppliers) with respect to a category of provider of services or supplier of items or services, including a category within a geographic area, under title XVIII, XIX, or XXI, the Secretary may impose any of the following requirements with respect to a provider of services or a supplier (whether such provider or supplier is initially enrolling in the program or is renewing such enrollment):
“(A) Screening under paragraph (2).
“(B) Enhanced oversight periods under paragraph (3).
“(C) Enrollment moratoria under paragraph (4).
In applying this subsection for purposes of title XIX and XXI the Secretary may require a State to carry out the provisions of this subsection as a requirement of the State plan under title XIX or the child health plan under title XXI. Actions taken and determinations made under this subsection shall not be subject to review by a judicial tribunal.
“(2) SCREENING.—For purposes of paragraph (1), the Secretary shall establish procedures under which screening is conducted with respect to providers of services and suppliers described in such paragraph. Such screening may include—
“(A) licensing board checks;
“(B) screening against the list of individuals and entities excluded from the program under title XVIII, XIX, or XXI;
“(C) the excluded provider list system;
“(D) background checks; and
“(E) unannounced pre-enrollment or other site visits.
“(3) ENHANCED OVERSIGHT PERIOD.—For purposes of paragraph (1), the Secretary shall establish procedures to provide for a period of not less than 30 days and not more than 365 days during which providers of services and suppliers described in such paragraph, as the Secretary determines appropriate, would be subject to enhanced oversight, such as required or unannounced (or required and unannounced) site visits or inspections, prepayment review, enhanced review of claims, and such other actions as specified by the Secretary, under the programs under titles XVIII, XIX, and XXI. Under such procedures, the Secretary may extend such period for more than 365 days if the Secretary determines that after the initial period such additional period of oversight is necessary.
“(4) MORATORIUM ON ENROLLMENT OF PROVIDERS AND SUPPLIERS.—For purposes of paragraph (1), the Secretary, based upon a finding of a risk of serious ongoing fraud within a program under title XVIII, XIX, or XXI, may impose a moratorium on the enrollment of providers of services and suppliers within a category of providers of services and suppliers (including a category within a specific geographic area) under such title. Such a moratorium may only be imposed if the Secretary makes a determination that the moratorium would not adversely impact access of individuals to care under such program.
“(5) CLARIFICATION.—Nothing in this subsection shall be interpreted to preclude or limit the ability of a State to engage in provider screening or enhanced provider oversight activities beyond those required by the Secretary.”.
(1) MEDICAID.—Section 1902(a) of the Social Security Act (42 U.S.C. 42 U.S.C. 1396a(a)) is amended—
(A) in paragraph (23), by inserting before the semicolon at the end the following: “or by a person to whom or entity to which a moratorium under section 1128G(a)(4) is applied during the period of such moratorium”;
(B) in paragraph (72); by striking at the end “and”;
(C) in paragraph (73), by striking the period at the end and inserting “and”; and
(D) by adding after paragraph (73) the following new paragraph:
“(74) provide that the State will enforce any determination made by the Secretary under subsection (a) of section 1128G (relating to a significant risk of fraudulent activity with respect to a category of provider or supplier described in such subsection (a) through use of the appropriate procedures described in such subsection (a)), and that the State will carry out any activities as required by the Secretary for purposes of such subsection (a).”.
(2) CHIP.—Section
2102 of such Act (42 U.S.C. 1397bb) is amended by adding at the end the
following new subsection: “(d) Program
Integrity.—A State child
health plan shall include a description of the procedures to be used by the
State— “(1) to enforce any
determination made by the Secretary under subsection (a) of section 1128G
(relating to a significant risk of fraudulent activity with respect to a
category of provider or supplier described in such subsection through use of
the appropriate procedures described in such subsection); and “(2) to carry out any
activities as required by the Secretary for purposes of such
subsection.”.
(3) MEDICARE.—Section 1866(j) of such Act (42 U.S.C. 1395cc(j)) is amended by adding at the end the following new paragraph:
“(3) PROGRAM INTEGRITY.—The provisions of section 1128G(a) apply to enrollments and renewals of enrollments of providers of services and suppliers under this title.”.
(a) In general.—Section 1128G of the Social Security Act, as inserted by section 1631, is amended by adding at the end the following new subsection:
“(b) Enhanced program disclosure requirements.—
“(1) DISCLOSURE.—A provider of services or supplier who submits on or after July 1, 2011, an application for enrollment and renewing enrollment in a program under title XVIII, XIX, or XXI shall disclose (in a form and manner determined by the Secretary) any current affiliation or affiliation within the previous 10-year period with a provider of services or supplier that has uncollected debt or with a person or entity that has been suspended or excluded under such program, subject to a payment suspension, or has had its billing privileges revoked.
“(2) ENHANCED SAFEGUARDS.—If the Secretary determines that such previous affiliation of such provider or supplier poses a risk of fraud, waste, or abuse, the Secretary may apply such enhanced safeguards as the Secretary determines necessary to reduce such risk associated with such provider or supplier enrolling or participating in the program under title XVIII, XIX, or XXI. Such safeguards may include enhanced oversight, such as enhanced screening of claims, required or unannounced (or required and unannounced) site visits or inspections, additional information reporting requirements, and conditioning such enrollment on the provision of a surety bond.
“(3) AUTHORITY TO DENY PARTICIPATION.—If the Secretary determines that there has been at least one such affiliation and that such affiliation or affiliations, as applicable, of such provider or supplier poses a serious risk of fraud, waste, or abuse, the Secretary may deny the application of such provider or supplier.”.
(1) MEDICAID.—Paragraph (74) of section 1902(a) of such Act (42 U.S.C. 1396a(a)), as added by section 1631(b)(1), is amended—
(A) by inserting “or subsection (b) of such section (relating to disclosure requirements)” before “, and that the State”; and
(B) by inserting before the period the following: “and apply any enhanced safeguards, with respect to a provider or supplier described in such subsection (b), as the Secretary determines necessary under such subsection (b)”.
(2) CHIP.—Subsection (d) of section 2102 of such Act (42 U.S.C. 1397bb), as added by section 1631(b)(2), is amended—
(A) in paragraph (1), by striking at the end “and”;
(B) in paragraph (2) by striking the period at the end and inserting “; and” and
(C) by adding at the end the following new paragraph:
“(3) to enforce any determination made by the Secretary under subsection (b) of section 1128G (relating to disclosure requirements) and to apply any enhanced safeguards, with respect to a provider or supplier described in such subsection, as the Secretary determines necessary under such subsection.”.
Section 1848 of the Social Security Act (42 U.S.C. 1395w–4), as amended by section 4101 of the HITECH Act (Public Law 111–5), is amended by adding at the end the following new subsection:
“(p) Payment modifier for certain evaluation and management services.—The Secretary shall establish a payment modifier under the fee schedule under this section for evaluation and management services (as specified in section 1842(b)(16)(B)(ii)) that result in the ordering of additional services (such as lab tests), the prescription of drugs, the furnishing or ordering of durable medical equipment in order to enable better monitoring of claims for payment for such additional services under this title, or the ordering, furnishing, or prescribing of other items and services determined by the Secretary to pose a high risk of waste, fraud, and abuse. The Secretary may require providers of services or suppliers to report such modifier in claims submitted for payment.”.
(a) In general.—Section 1893(c) of the Social Security Act (42 U.S.C. 1395ddd(c)) is amended—
(1) in paragraph (3), by striking at the end “and”;
(2) by redesignating paragraph (4) as paragraph (5); and
(3) by inserting after paragraph (3) the following new paragraph:
“(4) for the contract year beginning in 2011 and each subsequent contract year, the entity provides assurances to the satisfaction of the Secretary that the entity will conduct periodic evaluations of the effectiveness of the activities carried out by such entity under the Program and will submit to the Secretary an annual report on such activities; and”.
(b) Reference to Medicaid Integrity Program.—For a similar provision with respect to the Medicaid Integrity Program, see section 1752.
(a) In general.—Section 1874 of the Social Security Act (42 U.S.C. 42 U.S.C. 1395kk) is amended by adding at the end the following new subsection:
“(d) Compliance programs for providers of services and suppliers.—
“(1) IN GENERAL.—The Secretary may disenroll a provider of services or a supplier (other than a physician or a skilled nursing facility) under this title (or may impose any civil monetary penalty or other intermediate sanction under paragraph (4)) if such provider of services or supplier fails to, subject to paragraph (5), establish a compliance program that contains the core elements established under paragraph (2).
“(2) ESTABLISHMENT OF CORE ELEMENTS.—The Secretary, in consultation with the Inspector General of the Department of Health and Human Services, shall establish core elements for a compliance program under paragraph (1). Such elements may include written policies, procedures, and standards of conduct, a designated compliance officer and a compliance committee; effective training and education pertaining to fraud, waste, and abuse for the organization’s employees and contractors; a confidential or anonymous mechanism, such as a hotline, to receive compliance questions and reports of fraud, waste, or abuse; disciplinary guidelines for enforcement of standards; internal monitoring and auditing procedures, including monitoring and auditing of contractors; procedures for ensuring prompt responses to detected offenses and development of corrective action initiatives, including responses to potential offenses; and procedures to return all identified overpayments to the programs under this title, title XIX, and title XXI.
“(3) TIMELINE FOR IMPLEMENTATION.—The Secretary shall determine a timeline for the establishment of the core elements under paragraph (2) and the date on which a provider of services and suppliers (other than physicians) shall be required to have established such a program for purposes of this subsection.
“(4) CMS ENFORCEMENT AUTHORITY.—The Administrator for the Centers of Medicare & Medicaid Services shall have the authority to determine whether a provider of services or supplier described in subparagraph (3) has met the requirement of this subsection and to impose a civil monetary penalty not to exceed $50,000 for each violation. The Secretary may also impose other intermediate sanctions, including corrective action plans and additional monitoring in the case of a violation of this subsection.
“(5) PILOT PROGRAM.—The Secretary may conduct a pilot program on the application of this subsection with respect to a category of providers of services or suppliers (other than physicians) that the Secretary determines to be a category which is at high risk for waste, fraud, and abuse before implementing the requirements of this subsection to all providers of services and suppliers described in paragraph (3).”.
(b) Reference to similar Medicaid provision.—For a similar provision with respect to the Medicaid program under title XIX of the Social Security Act, see section 1753.
(a) Purpose.—In general, the 36-month period currently allowed for claims filing under parts A, B, C, and, D of title XVIII of the Social Security Act presents opportunities for fraud schemes in which processing patterns of the Centers for Medicare & Medicaid Services can be observed and exploited. Narrowing the window for claims processing will not overburden providers and will reduce fraud and abuse.
(b) Reducing maximum period for submission.—
(1) PART A.—Section 1814(a) of the Social Security Act (42 U.S.C. 1395f(a)) is amended—
(A) in paragraph (1), by strikeing “period of 3 calendar years” and all that follows and inserting “period of 1 calendar year from which such services are furnished; and”; and
(B) by adding at the end the following new sentence: “In applying paragraph (1), the Secretary may specify exceptions to the 1 calendar year period specified in such paragraph.”.
(2) PART B.—Section 1835(a) of such Act (42 U.S.C. 1395n(a)) is amended—
(A) in paragraph (1), by strikeing “period of 3 calendar years” and all that follows and inserting “period of 1 calendar year from which such services are furnished; and”; and
(B) by adding at the end the following new sentence: “In applying paragraph (1), the Secretary may specify exceptions to the 1 calendar year period specified in such paragraph.”.
(3) PARTS C AND D.—Section 1857(d) of such Act is amended by adding at the end the following new paragraph:
“(7) PERIOD FOR SUBMISSION OF CLAIMS.—The contract shall require an MA organization or PDP sponsor to require any provider of services under contract with, in partnership with, or affiliated with such organization or sponsor to ensure that, with respect to items and services furnished by such provider to an enrollee of such organization, written request, signed by such enrollee, except in cases in which the Secretary finds it impracticable for the enrollee to do so, is filed for payment for such items and services in such form, in such manner, and by such person or persons as the Secretary may by regulation prescribe, no later than the close of the 1 calendar year period after such items and services are furnished. In applying the previous sentence, the Secretary may specify exceptions to the 1 calendar year period specified.”.
(c) Effective date.—The amendments made by subsection (b) shall be effective for items and services furnished on or after January 1, 2011.
(a) DME.—Section 1834(a)(11)(B) of the Social Security Act (42 U.S.C. 1395m(a)(11)(B)) is amended by striking “physician” and inserting “physician enrolled under section 1866(j) or an eligible professional under section 1848(k)(3)(B)”.
(1) PART A.—Section 1814(a)(2) of such Act (42 U.S.C. 1395(a)(2)) is amended in the matter preceding subparagraph (A) by inserting “in the case of services described in subparagraph (C), a physician enrolled under section 1866(j) or an eligible professional under section 1848(k)(3)(B),” before “or, in the case of services”.
(2) PART B.—Section 1835(a)(2) of such Act (42 U.S.C. 1395n(a)(2)) is amended in the matter preceding subparagraph (A) by inserting “, or in the case of services described in subparagraph (A), a physician enrolled under section 1866(j) or an eligible professional under section 1848(k)(3)(B),” after “a physician”.
(c) Discretion To expand application.—The Secretary may extend the requirement applied by the amendments made by subsections (a) and (b) to durable medical equipment and home health services (relating to requiring certifications and written orders to be made by enrolled physicians and health professions) to other categories of items or services under this title, including covered part D drugs as defined in section 1860D–2(e), if the Secretary determines that such application would help to reduce the risk of waste, fraud, and abuse with respect to such other categories under title XVIII of the Social Security Act.
(d) Effective date.—The amendments made by this section shall apply to written orders and certifications made on or after July 1, 2010.
(a) Physicians and other suppliers.—Section 1842(h) of the Social Security Act, as amended by section 1635, is further amended by adding at the end the following new paragraph:
“(10) The Secretary may disenroll, for a period of not more than one year for each act, a physician or supplier under section 1866(j) if such physician or supplier fails to maintain and, upon request of the Secretary, provide access to documentation relating to written orders or requests for payment for durable medical equipment, certifications for home health services, or referrals for other items or services written or ordered by such physician or supplier under this title, as specified by the Secretary.”.
(b) Providers of services.—Section 1866(a)(1) of such Act (42 U.S.C. 1395cc), as amended by section 1635, is further amended—
(1) in subparagraph (V), by striking at the end “and”;
(2) in subparagraph (W), by striking the period at the end and adding “; and”; and
(3) by adding at the end the following new subparagraph:
“(X) maintain and, upon request of the Secretary, provide access to documentation relating to written orders or requests for payment for durable medical equipment, certifications for home health services, or referrals for other items or services written or ordered by the provider under this title, as specified by the Secretary.”.
(c) OIG permissive exclusion authority.—Section 1128(b)(11) of the Social Security Act (42 U.S.C. 1320a–7(b)(11)) is amended by inserting “, ordering, referring for furnishing, or certifying the need for” after “furnishing”.
(d) Effective date.—The amendments made by this section shall apply to orders, certifications, and referrals made on or after January 1, 2010.
(a) Condition of payment for home health services.—
(1) PART A.—Section 1814(a)(2)(C) of such Act is amended—
(A) by striking “and such services” and inserting “such services”; and
(B) by inserting after “care of a physician” the following: “, and, in the case of a certification or recertification made by a physician after January 1, 2010, prior to making such certification the physician must document that the physician has had a face-to-face encounter (including through use of telehealth and other than with respect to encounters that are incident to services involved) with the individual during the 6-month period preceding such certification, or other reasonable timeframe as determined by the Secretary”.
(2) PART B.—Section 1835(a)(2)(A) of the Social Security Act is amended—
(A) by striking “and” before “(iii)”; and
(B) by inserting after “care of a physician” the following: “, and (iv) in the case of a certification or recertification after January 1, 2010, prior to making such certification the physician must document that the physician has had a face-to-face encounter (including through use of telehealth and other than with respect to encounters that are incident to services involved) with the individual during the 6-month period preceding such certification or recertification, or other reasonable timeframe as determined by the Secretary”.
(b) Condition of payment for durable medical equipment.—Section 1834(a)(11)(B) of the Social Security Act (42 U.S.C. 1395m(a)(11)(B)) is amended by adding at the end the following: “and shall require that such an order be written pursuant to the physician documenting that the physician has had a face-to-face encounter (including through use of telehealth and other than with respect to encounters that are incident to services involved) with the individual involved during the 6-month period preceding such written order, or other reasonable timeframe as determined by the Secretary”.
(c) Application to other areas under Medicare.—The Secretary may apply the face-to-face encounter requirement described in the amendments made by subsections (a) and (b) to other items and services for which payment is provided under title XVIII of the Social Security Act based upon a finding that such an decision would reduce the risk of waste, fraud, or abuse.
(d) Application to Medicaid and CHIP.—The requirements pursuant to the amendments made by subsections (a) and (b) shall apply in the case of physicians making certifications for home health services under title XIX or XXI of the Social Security Act, in the same manner and to the same extent as such requirements apply in the case of physicians making such certifications under title XVIII of such Act.
(a) In general.—Section 1128(f) of the Social Security Act (42 U.S.C. 1320a–7(f)) is amended by adding at the end the following new paragraph:
“(4) The provisions of subsections (d) and (e) of section 205 shall apply with respect to this section to the same extent as they are applicable with respect to title II. The Secretary may delegate the authority granted by section 205(d) (as made applicable to this section) to the Inspector General of the Department of Health and Human Services or the Administrator of the Centers for Medicare & Medicaid Services for purposes of any investigation under this section.”.
(b) Effective date.—The amendment made by subsection (a) shall apply to investigations beginning on or after January 1, 2010.
Section 1128G of the Social Security Act, as inserted by section 1631 and amended by section 1632, is further amended by adding at the end the following new subsection:
“(c) Reports on and repayment of overpayments identified through internal audits and reviews.—
“(1) REPORTING AND RETURNING OVERPAYMENTS.—If a person knows of an overpayment, the person must—
“(A) report and return the overpayment to the Secretary, the State, an intermediary, a carrier, or a contractor, as appropriate, at the correct address, and
“(B) notify the Secretary, the State, intermediary, carrier, or contractor to whom the overpayment was returned in writing of the reason for the overpayment.
“(2) TIMING.—An overpayment must be reported and returned under paragraph (1)(A) by not later than the date that is 60 days after the date the person knows of the overpayment.
Any known overpayment retained later than the applicable date specified in this paragraph creates an obligation as defined in section 3729(b)(3) of title 31 of the United States Code.
“(3) CLARIFICATION.—Repayment of any overpayments (or refunding by withholding of future payments) by a provider of services or supplier does not otherwise limit the provider or supplier’s potential liability for administrative obligations such as applicable interests, fines, and specialties or civil or criminal sanctions involving the same claim if it is determined later that the reason for the overpayment was related to fraud by the provider or supplier or the employees or agents of such provider or supplier.
“(4) DEFINITIONS.—In this subsection:
“(A) KNOWS.—The term ‘knows’ has the meaning given the terms ‘knowing’ and ‘knowingly’ in section 3729(b) of title 31 of the United States Code.
“(B) OVERPAYMENT.—The term “overpayment” means any finally determined funds that a person receives or retains under title XVIII, XIX, or XXI to which the person, after applicable reconciliation, is not entitled under such title.
“(C) PERSON.—The term ‘person’ means a provider of services, supplier, Medicaid managed care organization (as defined in section 1903(m)(1)(A)), Medicare Advantage organization (as defined in section 1859(a)(1)), or PDP sponsor (as defined in section 1860D–41(a)(13)), but excluding a beneficiary.”.
Section 1128(c)(3)(B) of the Social Security Act (42 U.S.C. 1320a–7(c)(3)(B)) is amended by striking “individuals entitled to benefits under part A of title XVIII or enrolled under part B of such title, or both” and inserting “beneficiaries (as defined in section 1128A(i)(5)) of that program”.
Section 1881(b) of the Social Security Act (42 U.S.C. 1395rr(b)) is amended by adding at the end the following new paragraph:
“(15) For purposes of evaluating or auditing payments made to renal dialysis facilities for items and services under this section under paragraph (1), each such renal dialysis facility, upon the request of the Secretary, shall provide to the Secretary access to information relating to any ownership or compensation arrangement between such facility and the medical director of such facility or between such facility and any physician.”.
(a) Medicare.—Section 1866(j)(1) of the Social Security Act (42 U.S.C. 1395cc(j)(1)) is amended by adding at the end the following new subparagraph:
“(D) BILLING AGENTS AND CLEARINGHOUSES REQUIRED TO BE REGISTER UNDER MEDICARE.—Any agent, clearinghouse, or other alternate payee that submits claims on behalf of a health care provider must be registered with the Secretary in a form and manner specified by the Secretary.”.
(b) Medicaid.—For a similar provision with respect to the Medicaid program under title XIX of the Social Security Act, see section 1759.
(c) Effective date.—The amendment made by subsection (a) shall apply to claims submitted on or after January 1, 2012.
Section 1128A of the Social Security Act, as amended by sections 1611, 1612, 1613, and 1615, is further amended—
(A) in paragraph (1), by striking “to an officer, employee, or agent of the United States, or of any department or agency thereof, or of any State agency (as defined in subsection (i)(1))”;
(i) by striking “participating in a program under title XVIII or a State health care program” and inserting “participating in a Federal health care program (as defined in section 1128B(f))”; and
(ii) in subparagraph (A), by striking “title XVIII or a State health care program” and inserting “a Federal health care program (as defined in section 1128B(f))”;
(C) by striking “or” at the end of paragraph (10);
(D) by inserting after paragraph (11) the following new paragraphs:
“(12) conspires to commit a violation of this section; or
“(13) knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to a Federal health care program, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to a Federal health care program;”; and
(E) in the matter following paragraph (13), as inserted by subparagraph (D), by striking “or in cases under paragraph (11), $50,000 for each such violation” and inserting “in cases under paragraph (11), $50,000 for each such violation, in cases under paragraph (12), $50,000 for any violation described in this section committed in furtherance of the conspiracy involved; or in cases under paragraph (13), $50,000 for each false record or statement, or concealment, avoidance, or decrease”; and
(F) in the second sentence, by striking “such false statement or misrepresentation)” and inserting “such false statement or misrepresentation, in cases under paragraph (12), an assessment of not more than 3 times the total amount that would otherwise apply for any violation described in this section committed in furtherance of the conspiracy involved, or in cases under paragraph (13), an assessment of not more than 3 times the total amount of the obligation to which the false record or statment was material or that was avoided or decreased)”.
(2) in subsection (c)(1), by striking “six years” and inserting “10 years”; and
(A) by amending paragraph (2) to read as follows:
“(2) The term “claim” means any application, request, or demand, whether under contract, or otherwise, for money or property for items and services under a Federal health care program (as defined in section 1128B(f)), whether or not the United States or a State agency has title to the money or property, that—
“(A) is presented or caused to be presented to an officer, employee, or agent of the United States, or of any department or agency thereof, or of any State agency (as defined in subsection (i)(1)); or
“(B) is made to a contractor, grantee, or other recipient if the money or property is to be spent or used on the Federal health care program’s behalf or to advance a Federal health care program interest, and if the Federal health care program—
“(i) provides or has provided any portion of the money or property requested or demanded; or
“(ii) will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded.”;
(B) by amending paragraph (3) to read as follows:
“(3) The term ‘item or service’ means, without limitation, any medical, social, management, administrative, or other item or service used in connection with or directly or indirectly related to a Federal health care program.”;
(i) in subparagraph (C), by striking at the end “or”;
(ii) in the first subparagraph (D), by striking at the end the period and inserting “; or”; and
(iii) by redesignating the second subparagraph (D) as a subparagraph (E);
(D) by amending paragraph (7) to read as follows:
“(7) The terms ‘knowing’, ‘knowingly’, and ‘should know’ mean that a person, with respect to information—
“(A) has actual knowledge of the information;
“(B) acts in deliberate ignorance of the truth or falsity of the information; or
“(C) acts in reckless disregard of the truth or falsity of the information;
and require no proof of specific intent to defraud.”; and
(E) by adding at the end the following new paragraphs:
“(8) The term ‘obligation’ means an established duty, whether or not fixed, arising from an express or implied contractual, grantor-grantee, or licensor-licensee relationship, from a fee-based or similar relationship, from statute or regulation, or from the retention of any overpayment.
“(9) The term ‘material’ means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property.”.
Section 1128G of the Social Security Act, as added by section 1631 and amended by sections 1632 and 1641, is further amended by adding at the end the following new subsection;
“(d) Access to Information Necessary To Identify Fraud, Waste, and Abuse.—For purposes of law enforcement activity, and to the extent consistent with applicable disclosure, privacy, and security laws, including the Health Insurance Portability and Accountability Act of 1996 and the Privacy Act of 1974, and subject to any information systems security requirements enacted by law or otherwise required by the Secretary, the Attorney General shall have access, facilitation by the Inspector General of the Department of Health and Human Services, to claims and payment data relating to titles XVIII and XIX, in consultation with the Centers for Medicare & Medicaid Services or the owner of such data.”.
(a) In general.—To eliminate duplication between the Healthcare Integrity and Protection Data Bank (HIPDB) established under section 1128E of the Social Security Act and the National Practitioner Data Bank (NPBD) established under the Health Care Quality Improvement Act of 1986, section 1128E of the Social Security Act (42 U.S.C. 1320a–7e) is amended—
(1) in subsection (a), by striking “Not later than” and inserting “Subject to subsection (h), not later than”;
(2) in the first sentence of subsection (d)(2), by striking “(other than with respect to requests by Federal agencies)”; and
(3) by adding at the
end the following new subsection: “(h) Sunset of the
healthcare integrity and protection data bank; transition process.—Effective upon the enactment of this
subsection, the Secretary shall implement a process to eliminate duplication
between the Healthcare Integrity and Protection Data Bank (in this subsection
referred to as the ‘HIPDB’ established pursuant to subsection (a)
and the National Practitioner Data Bank (in this subsection referred to as the
‘NPDB’) as implemented under the Health Care Quality Improvement
Act of 1986 and section 1921 of this Act, including systems testing necessary
to ensure that information formerly collected in the HIPDB will be accessible
through the NPDB, and other activities necessary to eliminate duplication
between the two data banks. Upon the completion of such process,
notwithstanding any other provision of law, the Secretary shall cease the
operation of the HIPDB and shall collect information required to be reported
under the preceding provisions of this section in the NPDB. Except as otherwise
provided in this subsection, the provisions of subsections (a) through (g)
shall continue to apply with respect to the reporting of (or failure to
report), access to, and other treatment of the information specified in this
section.”.
(b) Elimination of the responsibility of the HHS Office of the Inspector General.—Section 1128C(a)(1) of the Social Security Act (42 U.S.C. 1320a–7c(a)(1)) is amended—
(1) in subparagraph (C), by adding at the end “and”;
(2) in subparagraph (D), by striking at the end “, and” and inserting a period; and
(3) by striking subparagraph (E).
(c) Special provision for access to the National Practitioner Data Bank by the Department of Veterans Affairs.—
(1) IN GENERAL.—Notwithstanding any other provision of law, during the one year period that begins on the effective date specified in subsection (e)(1), the information described in paragraph (2) shall be available from the National Practitioner Data Bank (described in section 1921 of the Social Security Act) to the Secretary of Veterans Affairs without charge.
(2) INFORMATION DESCRIBED.—For purposes of paragraph (1), the information described in this paragraph is the information that would, but for the amendments made by this section, have been available to the Secretary of Veterans Affairs from the Healthcare Integrity and Protection Data Bank.
(d) Funding.—Notwithstanding any provisions of this Act, sections 1128E(d)(2) and 1817(k)(3) of the Social Security Act, or any other provision of law, there shall be available for carrying out the transition process under section 1128E(h) of the Social Security Act over the period required to complete such process, and for operation of the National Practitioner Data Bank until such process is completed, without fiscal year limitation—
(1) any fees collected pursuant to section 1128E(d)(2) of such Act; and
(2) such additional amounts as necessary, from appropriations available to the Secretary and to the Office of the Inspector General of the Department of Health and Human Services under clauses (i) and (ii), respectively, of section 1817(k)(3)(A) of such Act, for costs of such activities during the first 12 months following the date of the enactment of this Act.
(e) Effective date.—The amendments made—
(1) by subsection (a)(2) shall take effect on the first day after the Secretary of Health and Human Services certifies that the process implemented pursuant to section 1128E(h) of the Social Security Act (as added by subsection (a)(3)) is complete; and
(2) by subsection (b) shall take effect on the earlier of the date specified in paragraph (1) or the first day of the second succeeding fiscal year after the fiscal year during which this Act is enacted.
The provisions of sections 262(a) and 264 of the Health Insurance Portability and Accountability Act of 1996 (and standards promulgated pursuant to such sections) and the Privacy Act of 1974 shall apply with respect to the provisions of this subtitle and amendments made by this subtitle.
(a) Eligibility for non-traditional individuals with income below 133 percent of the Federal poverty level.—
(1) IN GENERAL.—Section 1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 1396b(a)(10)(A)(i) is amended—
(A) by striking “or” at the end of subclause (VI);
(B) by adding “or” at the end of subclause (VII); and
(C) by adding at the end the following new subclause:
“(VIII) who are under 65 years of age, who are not described in a previous subclause of this clause, and who are in families whose income (determined using methodologies and procedures specified by the Secretary in consultation with the Health Choices Commissioner) does not exceed 1331⁄3 percent of the income official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved;”.
(2) 100% FMAP FOR NON-TRADITIONAL MEDICAID ELIGIBLE INDIVIDUALS.—Section 1905 of such Act (42 U.S.C. 1396d) is amended—
(A) in the third sentence of subsection (b) by inserting before the period at the end the following: “and with respect to amounts described in subsection (y)”; and
(B) by adding at the end the following new subsection:
“(y) Additional expenditures subject to 100% FMAP.—For purposes of section 1905(b), the amounts described in this subsection are the following:
“(1) Amounts expended for medical assistance for individuals described in subclause (VIII) of section 1902(a)(10)(A)(i).”.
(3) CONSTRUCTION.—Nothing in this subsection shall be construed as not providing for coverage under subclause (VIII) of section 1902(a)(10)(A)(i) of the Social Security Act, as added by paragraph (1) of, and an increased FMAP under the amendment made by paragraph (2) for, an individual who has been provided medical assistance under title XIX of the Act under a demonstration waiver approved under section 1115 of such Act or with State funds.
(4) CONFORMING AMENDMENT.—Section 1903(f)(4) of the Social Security Act (42 U.S.C. 1396b(f)(4)) is amended by inserting “1902(a)(10)(A)(i)(VIII),” after “1902(a)(10)(A)(i)(VII),”.
(b) Eligibility for traditional Medicaid eligible individuals with income not exceeding 1331⁄3 percent of the Federal poverty level.—
(1) IN GENERAL.—Section 1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 1396b(a)(10)(A)(i)), as amended by subsection (a), is amended—
(A) by striking “or” at the end of subclause (VII);
(B) by adding “or” at the end of subclause (VIII); and
(C) by adding at the end the following new subclause:
“(IX) who are under 65 years of age, who would be eligible for medical assistance under the State plan under one of subclauses (I) through (VII) (based on the income standards, methodologies, and procedures in effect as of June 16, 2009) but for income and who are in families whose income does not exceed 1331⁄3 percent of the income official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved;”.
(2) 100% FMAP FOR CERTAIN TRADITIONAL MEDICAID ELIGIBLE INDIVIDUALS.—Section 1905(y) of such Act (42 U.S.C. 1396d(b)), as added by subsection (a)(2)(B), is amended by inserting “or (IX)” after “(VIII)”.
(3) CONSTRUCTION.—Nothing in this subsection shall be construed as not providing for coverage under subclause (IX) of section 1902(a)(10)(A)(i) of the Social Security Act, as added by paragraph (1) of, and an increased FMAP under the amendment made by paragraph (2) for, an individual who has been provided medical assistance under title XIX of the Act under a demonstration waiver approved under section 1115 of such Act or with State funds.
(4) CONFORMING AMENDMENT.—Section 1903(f)(4) of the Social Security Act (42 U.S.C. 1396b(f)(4)), as amended by subsection (a)(4), is amended by inserting “1902(a)(10)(A)(i)(IX),” after “1902(a)(10)(A)(i)(VIII),”.
(c) 100% matching rate for temporary coverage of certain newborns.—Section 1905(y) of such Act, as added by subsection (a)(2)(B), is amended—
(1) in paragraph (1), by inserting before the period at the end the following: “, and who is not provided medical assistance under section 1943(b)(2) of this title or section 205(d)(1)(B) of the America’s Affordable Health Choices Act of 2009”; and
(2) by adding at the end the following:
“(2) Amounts expended for medical assistance for children described in section 203(d)(1)(A) of the America’s Affordable Health Choices Act of 2009 during the time period specified in such section.”.
(d) Network adequacy.—Section 1932(a)(2) of the Social Security Act (42 U.S.C. 1396u–2(a)(2)) is amended by adding at the end the following new subparagraph:
“(D) ENROLLMENT OF NON-TRADITIONAL MEDICAID ELIGIBLES.—A State may not require under paragraph (1) the enrollment in a managed care entity of an individual described in section 1902(a)(10)(A)(i)(VIII) unless the State demonstrates, to the satisfaction of the Secretary, that the entity, through its provider network and other arrangements, has the capacity to meet the health, mental health, and substance abuse needs of such individuals.”.
(e) Effective date.—The amendments made by this section shall take effect on the first day of Y1, and shall apply with respect to items and services furnished on or after such date.
(a) In general.—Title XIX of the Social Security Act is amended by adding at the end the following new section:
“Requirements and special rules for certain Medicaid eligible individuals
“Sec. 1943. (a) Coordination with NHI Exchange through memorandum of understanding.—
“(1) IN GENERAL.—The State shall enter into a Medicaid memorandum of understanding described in section 204(e)(4) of the America’s Affordable Health Choices Act of 2009 with the Health Choices Commissioner, acting in consultation with the Secretary, with respect to coordinating the implementation of the provisions of division A of such Act with the State plan under this title in order to ensure the enrollment of Medicaid eligible individuals in acceptable coverage. Nothing in this section shall be construed as permitting such memorandum to modify or vitiate any requirement of a State plan under this title.
“(2) ENROLLMENT OF EXCHANGE-REFERRED INDIVIDUALS.—
“(A) NON-TRADITIONAL INDIVIDUALS.—Pursuant to such memorandum the State shall accept without further determination the enrollment under this title of an individual determined by the Commissioner to be a non-traditional Medicaid eligible individual. The State shall not do any redeterminations of eligibility for such individuals unless the periodicity of such redeterminations is consistent with the periodicity for redeterminations by the Commissioner of eligibility for affordability credits under subtitle C of title II of division A of the America’s Affordable Health Choices Act of 2009, as specified under such memorandum.
“(B) TRADITIONAL INDIVIDUALS.—
“(i) REGULAR ENROLLMENT OPTION.—Pursuant to such memorandum, insofar as the memorandum has selected the option described in section 205(e)(3)(A) of the America’s Affordable Health Choices Act of 2009, the State shall accept without further determination the enrollment under this title of an individual determined by the Commissioner to be a traditional Medicaid eligible individual. The State may do redeterminations of eligibility of such individual consistent with such section and the memorandum.
“(ii) PRESUMPTIVE ELIGIBILITY OPTION.—Pursuant to such memorandum, insofar as the memorandum has selected the option described in section 205(e)(3)(B) of the America’s Affordable Health Choices Act of 2009, the State shall provide for making medical assistance available during the presumptive eligibility period and shall, upon application of the individual for medical assistance under this title, promptly make a determination (and subsequent redeterminations) of eligibility in the same manner as if the individual had applied directly to the State for such assistance except that the State shall use the income-related information used by the Commissioner and provided to the State under the memorandum in making the presumptive eligibility determination to the maximum extent feasible.
“(3) DETERMINATIONS OF ELIGIBILITY FOR AFFORDABILITY CREDITS.—If the Commissioner determines that a State Medicaid agency has the capacity to make determinations of eligibility for affordability credits under subtitle C of title II of division A of the America’s Affordable Health Choices Act of 2009, under such memorandum—
“(A) the State Medicaid agency shall conduct such determinations for any Exchange-eligible individual who requests such a determination;
“(B) in the case that a State Medicaid agency determines that an Exchange-eligible individual is not eligible for affordability credits, the agency shall forward the information on the basis of which such determination was made to the Commissioner; and
“(C) the Commissioner shall reimburse the State Medicaid agency for the costs of conducting such determinations.
(b) Conforming amendments to error rate.—
(1) Section 1903(u)(1)(D) of the Social Security Act (42 U.S.C. 1396b(u)(1)(D)) is amended by adding at the end the following new clause:
“(vi) In determining the amount of erroneous excess payments, there shall not be included any erroneous payments made that are attributable to an error in an eligibility determination under subtitle C of title II of division A of the America’s Affordable Health Choices Act of 2009.”.
(2) Section 2105(c)(11) of such Act (42 U.S.C. 1397ee(c)(11)) is amended by adding at the end the following new sentence: “Clause (vi) of section 1903(u)(1)(D) shall apply with respect to the application of such requirements under this title and title XIX.”.
(a) CHIP maintenance of effort.—Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended—
(1) in subsection (a), as amended by section 1631(b)(1)(D)—
(A) by striking “and” at the end of paragraph (72);
(B) by striking the period at the end of paragraph (73) and inserting “; and”; and
(C) by inserting after paragraph (74) the following new paragraph:
“(75) provide for maintenance of effort under the State child health plan under title XXI in accordance with subsection (gg).”; and
(2) by adding at the
end the following new subsection: “(gg) CHIP
maintenance of effort requirement.— “(1) IN
GENERAL.—Subject to paragraph (2), as a condition of its State
plan under this title under subsection (a)(75) and receipt of any Federal
financial assistance under section 1903(a) for calendar quarters beginning
after the date of the enactment of this subsection and before CHIP MOE
termination date specified in paragraph (3), a State shall not have in effect
eligibility standards, methodologies, or procedures under its State child
health plan under title XXI (including any waiver under such title or under
section 1115 that is permitted to continue effect) that are more restrictive
than the eligibility standards, methodologies, or procedures, respectively,
under such plan (or waiver) as in effect on June 16, 2009. “(2) LIMITATION.—Paragraph (1) shall not be construed as
preventing a State from imposing a limitation described in section
2110(b)(5)(C)(i)(II) for a fiscal year in order to limit expenditures under its
State child health plan under title XXI to those for which Federal financial
participation is available under section 2105 for the fiscal year. “(3) CHIP MOE
TERMINATION DATE.—In paragraph
(1), the ‘CHIP MOE termination date’ for a State is the date that
is the first day of Y1 (as defined in section 100(c) of the America’s
Affordable Health Choices Act of 2009) or, if later, the first day after such
date that both of the following determinations have been made: “(A) The Health Choices Commissioner has
determined that the Health Insurance Exchange has the capacity to support the
participation of CHIP enrollees who are Exchange-eligible individuals (as
defined in section 202(b) of the America’s Affordable Health Choices Act of
2009), “(B) The Secretary has
determined that such Exchange, the State, and employers have procedures in
effect to ensure the timely transition without interruption of coverage of CHIP
enrollees from assistance under title XXI to acceptable coverage (as defined
for purposes of such Act). In this
paragraph, the term ‘CHIP enrollee’ means a targeted low-income
child or (if the State has elected the option under section 2112, a targeted
low-income pregnant woman) who is or otherwise would be (but for acceptable
coverage) eligible for child health assistance or pregnancy-related assistance,
respectively, under the State child health plan referred to in paragraph
(1).”.
(b) Medicaid maintenance of effort; simplifying and coordinating eligibility rules between Exchange and Medicaid.—
(1) IN GENERAL.—Section 1903 of such Act (42 U.S.C. 1396b) is amended by adding at the end the following new subsection:
(2) CONFORMING AMENDMENTS.—(A) Section 1902(a)(10)(A) of such Act (42 U.S.C. 1396a(a)(10)(A)) is amended, in the matter before clause (i), by inserting “subject to section 1903(aa)(2),” after “(A)”.
(B) Section 1931(b)(2) of such Act (42 U.S.C. 1396u–1(b)(1)) is amended by inserting “subject to section 1903(aa)(2)” after “and (3)”.
(c) Standards for benchmark packages.—Section 1937(b) of such Act (42 U.S.C. 1396u–7(b)) is amended—
(1) in paragraph (1), by inserting “subject to paragraph (5)”; and
(2) by adding at the end the following new paragraph:
“(5) MINIMUM STANDARDS.—Effective January 1, 2013, any benchmark benefit package (or benchmark equivalent coverage under paragraph (2)) must meet the minimum benefits and cost-sharing standards of a basic plan offered through the Health Insurance Exchange.”.
(1) IN GENERAL.—Not later than January 1, 2016, the Secretary of Health and Human Services (in this title referred to as the “Secretary”) shall submit to Congress a report concerning the extent to which, based upon the impact of the health care reforms carried out under division A in reducing the number of uninsured individuals, there is a continued role for Medicaid DSH. In preparing the report, the Secretary shall consult with community-based health care networks serving low-income beneficiaries.
(2) MATTERS TO BE INCLUDED.—The report shall include the following:
(A) RECOMMENDATIONS.—Recommendations regarding—
(i) the appropriate targeting of Medicaid DSH within States; and
(ii) the distribution of Medicaid DSH among the States.
(B) SPECIFICATION OF DSH HEALTH REFORM METHODOLOGY.—The DSH Health Reform methodology described in paragraph (2) of subsection (b) for purposes of implementing the requirements of such subsection.
(3) COORDINATION WITH MEDICARE DSH REPORT.—The Secretary shall coordinate the report under this subsection with the report on Medicare DSH under section 1112.
(4) MEDICAID DSH.—In this section, the term “Medicaid DSH” means adjustments in payments under section 1923 of the Social Security Act for inpatient hospital services furnished by disproportionate share hospitals.
(1) IN GENERAL.—The Secretary shall reduce Medicaid DSH so as to reduce total Federal payments to all States for such purpose by $1,500,000,000 in fiscal year 2017, $2,500,000,000 in fiscal year 2018, and $6,000,000,000 in fiscal year 2019.
(2) DSH HEALTH REFORM METHODOLOGY.—The Secretary shall carry out paragraph (1) through use of a DSH Health Reform methodology issued by the Secretary that imposes the largest percentage reductions on the States that—
(A) have the lowest percentages of uninsured individuals (determined on the basis of audited hospital cost reports) during the most recent year for which such data are available; or
(B) do not target their DSH payments on—
(i) hospitals with high volumes of Medicaid inpatients (as defined in section 1923(b)(1)(A) of the Social Security Act (42 U.S.C. 1396r–4(b)(1)(A)); and
(ii) hospitals that have high levels of uncompensated care (excluding bad debt).
(3) DSH ALLOTMENT PUBLICATIONS.—
(A) IN GENERAL.—Not later than the publication deadline specified in subparagraph (B), the Secretary shall publish in the Federal Register a notice specifying the DSH allotment to each State under 1923(f) of the Social Security Act for the respective fiscal year specified in such subparagraph, consistent with the application of the DSH Health Reform methodology described in paragraph (2).
(B) PUBLICATAION DEADLINE.—The publication deadline specified in this subparagraph is—
(i) January 1, 2016, with respect to DSH allotments described in subparagraph (A) for fiscal year 2017;
(ii) January 1, 2017, with respect to DSH allotments described in subparagraph (A) for fiscal year 2018; and
(iii) January 1, 2018, with respect to DSH allotments described in subparagraph (A) for fiscal year 2019.
(1) Section 1923(f) of the Social Security Act (42 U.S.C. 1396r–4(f)) is amended—
(A) by redesignating paragraph (7) as paragraph (8); and
(B) by inserting after paragraph (6) the following new paragraph:
“(7) SPECIAL RULE FOR FISCAL YEARS 2017, 2018, AND 2019.—
“(A) FISCAL YEAR 2017.—Notwithstanding paragraph (2), the total DSH allotments for all States for—
“(i) fiscal year 2017, shall be the total DSH allotments that would otherwise be determined under this subsection for such fiscal year decreased by $1,500,000,000;
“(ii) fiscal year 2018, shall be the total DSH allotments that would otherwise be determined under this subsection for such fiscal year decreased by $2,500,000,000; and
“(iii) fiscal year 2019, shall be the total DSH allotments that would otherwise be determined under this subsection for such fiscal year decreased by $6,000,000,000.”.
(2) Section 1923(b)(4) of such Act (42 U.S.C. 1396r–4(b)(4)) is amended by adding before the period the following: “or to affect the authority of the Secretary to issue and implement the DSH Health Reform methodology under section 1704(b)(2) of the America’s Health Choices Act of 2009”.
(d) Disproportionate share hospitals (DSH) and essential access hospital (EAH) non-Discrimination.—
(1) IN GENERAL.—Section 1923(d) of the Social Security Act (42 U.S.C. 1396r-4) is amended by adding at the end the following new paragraph:
“(4) No hospital may be defined or deemed as a disproportionate share hospital, or as an essential access hospital (for purposes of subsection (f)(6)(A)(iv), under a State plan under this title or subsection (b) of this section (including any waiver under section 1115) unless the hospital—
“(A) provides services to beneficiaries under this title without discrimination on the ground of race, color, national origin, creed, source of payment, status as a beneficiary under this title, or any other ground unrelated to such beneficiary’s need for the services or the availability of the needed services in the hospital; and
“(B) makes arrangements for, and accepts, reimbursement under this title for services provided to eligible beneficiaries under this title.”.
(2) EFFECTIVE DATE.—The amendment made by subsection (a) shall be apply to expenditures made on or after July 1, 2010.
(a) In general.—Section 1902(a)(55) of the Social Security Act (42 U.S.C. 1396a(a)(55)) is amended by striking “under subsection (a)(10)(A)(i)(IV), (a)(10)(A)(i)(VI), (a)(10)(A)(i)(VII), or (a)(10)(A)(ii)(IX)” and inserting “(including receipt and processing of applications of individuals for affordability credits under subtitle C of title II of division A of the America’s Affordable Health Choices Act of 2009 pursuant to a Medicaid memorandum of understanding under section 1943(a)(1)) ” .
(1) Except as provided in paragraph (2), the amendment made by subsection (a) shall apply to services furnished on or after July 1, 2010, without regard to whether or not final regulations to carry out such amendment have been promulgated by such date.
(2) In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendment made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.
(a) Coverage.—Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by section 1701(a)(2)(B), is amended—
(A) by striking “and” before “(C)”; and
(B) by inserting before the semicolon at the end the following: “and (D) preventive services described in subsection (z)”; and
(2) by adding at the
end the following new subsection: “(z) Preventive
services.—The preventive
services described in this subsection are services not otherwise described in
subsection (a) or (r) that the Secretary determines are— “(1)(A) recommended with a grade
of A or B by the Task Force for Clinical Preventive Services; or “(B) vaccines recommended for use as
appropriate by the Director of the Centers for Disease Control and Prevention;
and
“(2) appropriate for individuals entitled to medical assistance under this title.”.
(b) Conforming amendment.—Section 1928 of such Act (42 U.S.C. 1396s) is amended—
(1) in subsection (c)(2)(B)(i), by striking “the advisory committee referred to in subsection (e)” and inserting “the Director of the Centers for Disease Control and Prevention”;
(2) in subsection (e), by striking “Advisory Committee” and all that follows and inserting “Director of the Centers for Disease Control and Prevention.”; and
(3) by striking subsection (g).
(1) Except as provided in paragraph (2), the amendments made by this section shall apply to services furnished on or after July 1, 2010, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.
(2) In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.
(a) Dropping tobacco cessation exclusion from covered outpatient drugs.—Section 1927(d)(2) of the Social Security Act (42 U.S.C. 1396r–8(d)(2)) is amended—
(1) by striking subparagraph (E);
(2) in subparagraph (G), by inserting before the period at the end the following: “, except agents approved by the Food and Drug Administration for purposes of promoting, and when used to promote, tobacco cessation”; and
(3) by redesignating subparagraphs (F) through (K) as subparagraphs (E) through (J), respectively.
(b) Effective date.—The amendments made by this section shall apply to drugs and services furnished on or after January 1, 2010.
(a) In general.—Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by sections 1701(a)(2) and 1711(a), is amended—
(A) in paragraph (27), by striking “and” at the end;
(B) by redesignating paragraph (28) as paragraph (29); and
(C) by inserting after paragraph (27) the following new paragraph:
“(28) nurse home visitation services (as defined in subsection (aa)); and”; and
(2) by adding at the
end the following new subsection: “(aa) The term ‘nurse home visitation
services’ means home visits by trained nurses to families with a
first-time pregnant woman, or a child (under 2 years of age), who is eligible
for medical assistance under this title, but only, to the extent determined by
the Secretary based upon evidence, that such services are effective in one or
more of the following: “(1) Improving maternal or child health and
pregnancy outcomes or increasing birth intervals between pregnancies. “(2) Reducing the incidence of child abuse,
neglect, and injury, improving family stability (including reduction in the
incidence of intimate partner violence), or reducing maternal and child
involvement in the criminal justice system. “(3) Increasing economic self-sufficiency,
employment advancement, school-readiness, and educational achievement, or
reducing dependence on public
assistance.”.
(b) Effective date.—The amendments made by this section shall apply to services furnished on or after January 1, 2010.
(c) Construction.—Nothing in the amendments made by this section shall be construed as affecting the ability of a State under title XIX or XXI of the Social Security Act to provide nurse home visitation services as part of another class of items and services falling within the definition of medical assistance or child health assistance under the respective title, or as an administrative expenditure for which payment is made under section 1903(a) or 2105(a) of such Act, respectively, on or after the date of the enactment of this Act.
(a) Coverage as optional categorically needy group.—
(1) IN GENERAL.—Section 1902(a)(10)(A)(ii) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended—
(A) in subclause (XVIII), by striking “or” at the end;
(B) in subclause (XIX), by adding “or” at the end; and
(C) by adding at the end the following new subclause:
“(XX) who are described in subsection (hh) (relating to individuals who meet certain income standards);”.
(2) GROUP
DESCRIBED.—Section 1902 of
such Act (42 U.S.C. 1396a), as amended by section 1703, is amended by adding at
the end the following new subsection: “(hh)(1) Individuals described in
this subsection are individuals— “(A) whose income does
not exceed an income eligibility level established by the State that does not
exceed the highest income eligibility level established under the State plan
under this title (or under its State child health plan under title XXI) for
pregnant women; and “(B) who are not
pregnant. “(2) At the option of a
State, individuals described in this subsection may include individuals who,
had individuals applied on or before January 1, 2007, would have been made
eligible pursuant to the standards and processes imposed by that State for
benefits described in clause (XV) of the matter following subparagraph (G) of
section subsection (a)(10) pursuant to a waiver granted under section
1115. “(3) At the option of a
State, for purposes of subsection (a)(17)(B), in determining eligibility for
services under this subsection, the State may consider only the income of the
applicant or
recipient.”.
(3) LIMITATION ON BENEFITS.—Section 1902(a)(10) of such Act (42 U.S.C. 1396a(a)(10)) is amended in the matter following subparagraph (G)—
(A) by striking “and (XIV)” and inserting “(XIV)”; and
(B) by inserting “, and (XV) the medical assistance made available to an individual described in subsection (hh) shall be limited to family planning services and supplies described in section 1905(a)(4)(C) including medical diagnosis and treatment services that are provided pursuant to a family planning service in a family planning setting” after “cervical cancer”.
(4) CONFORMING AMENDMENTS.—Section 1905(a) of such Act (42 U.S.C. 1396d(a)), as amended by section 1731(c), is amended in the matter preceding paragraph (1)—
(A) in clause (xiii), by striking “or” at the end;
(B) in clause (xiv), by adding “or” at the end; and
(C) by inserting after clause (xiv) the following:
“(xv) individuals described in section 1902(hh),”.
(1) IN GENERAL.—Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended by inserting after section 1920B the following:
“Presumptive eligibility for family planning services
“Sec. 1920C. (a) State Option.—State plan approved under section 1902 may provide for making medical assistance available to an individual described in section 1902(hh) (relating to individuals who meet certain income eligibility standard) during a presumptive eligibility period. In the case of an individual described in section 1902(hh), such medical assistance shall be limited to family planning services and supplies described in 1905(a)(4)(C) and, at the State’s option, medical diagnosis and treatment services that are provided in conjunction with a family planning service in a family planning setting.
(A) Section 1902(a)(47) of the Social Security Act (42 U.S.C. 1396a(a)(47)) is amended by inserting before the semicolon at the end the following: “and provide for making medical assistance available to individuals described in subsection (a) of section 1920C during a presumptive eligibility period in accordance with such section”.
(B) Section 1903(u)(1)(D)(v) of such Act (42 U.S.C. 1396b(u)(1)(D)(v)) is amended—
(i) by striking “or for” and inserting “for”; and
(ii) by inserting before the period the following: “, or for medical assistance provided to an individual described in subsection (a) of section 1920C during a presumptive eligibility period under such section”.
(c) Clarification of coverage of family planning services and supplies.—Section 1937(b) of the Social Security Act (42 U.S.C. 1396u–7(b)) is amended by adding at the end the following:
“(5) COVERAGE OF FAMILY PLANNING SERVICES AND SUPPLIES.—Notwithstanding the previous provisions of this section, a State may not provide for medical assistance through enrollment of an individual with benchmark coverage or benchmark-equivalent coverage under this section unless such coverage includes for any individual described in section 1905(a)(4)(C), medical assistance for family planning services and supplies in accordance with such section.”.
(d) Effective date.—The amendments made by this section take effect on the date of the enactment of this Act and shall apply to items and services furnished on or after such date.
(1) FEE-FOR-SERVICE PAYMENTS.—Section 1902(a)(13) of the Social Security Act (42 U.S.C. 1396b(a)(13)) is amended—
(A) by striking “and” at the end of subparagraph (A);
(B) by adding “and” at the end of subparagraph (B); and
(C) by adding at the end the following new subparagraph:
“(C) payment for primary care services (as defined in section 1848(j)(5)(A), but applied without regard to clause (ii) thereof) furnished by physicians (or for services furnished by other health care professionals that would be primary care services under such section if furnished by a physician) at a rate not less than 80 percent of the payment rate applicable to such services and physicians or professionals (as the case may be) under part B of title XVIII for services furnished in 2010, 90 percent of such rate for services and physicians (or professionals) furnished in 2011, and 100 percent of such payment rate for services and physicians (or professionals) furnished in 2012 or a subsequent year;”.
(2) UNDER MEDICAID MANAGED CARE PLANS.—Section 1923(f) of such Act (42 U.S.C. 1396u–2(f)) is amended—
(A) in the heading, by adding at the end the following: “; Adequacy of payment for primary care services”; and
(B) by inserting before the period at the end the following: “and, in the case of primary care services described in section 1902(a)(13)(C), consistent with the minimum payment rates specified in such section (regardless of the manner in which such payments are made, including in the form of capitation or partial capitation)”.
(b) Increase in payment using 100% FMAP.—Section 1905(y), as added by section 1701(a)(2)(B) and as amended by section 1701(c)(2), is amended by adding at the end the following:
“(3)(A) The portion of the amounts expended for medical assistance for services described in section 1902(a)(13)(C) furnished on or after January 1, 2010, that is attributable to the amount by which the minimum payment rate required under such section (or, by application, section 1932(f)) exceeds the payment rate applicable to such services under the State plan as of June 16, 2009.
“(B) Subparagraphs (A) shall not be construed as preventing the payment of Federal financial participation based on the Federal medical assistance percentage for amounts in excess of those specified under such subparagraphs.”.
(c) Effective date.—The amendments made by this section shall apply to services furnished on or after January 1, 2010.
(a) In general.—The Secretary of Health and Human Services shall establish under this section a medical home pilot program under which a State may apply to the Secretary for approval of a medical home pilot project described in subsection (b) (in this section referred to as a “pilot project”) for the application of the medical home concept under title XIX of the Social Security Act. The pilot program shall operate for a period of up to 5 years.
(1) IN GENERAL.—A pilot project is a project that applies one or more of the medical home models described in section 1866E(a)(3) of the Social Security Act (as inserted by section 1302(a)) or such other model as the Secretary may approve, to high need beneficiaries (including medically fragile children and high-risk pregnant women) who are eligible for medical assistance under title XIX of the Social Security Act. The Secretary shall provide for appropriate coordination of the pilot program under this section with the medical home pilot program under section 1866E of such Act.
(2) LIMITATION.—A pilot project shall be for a duration of not more than 5 years.
(c) Additional incentives.—In the case of a pilot project, the Secretary may—
(1) waive the requirements of section 1902(a)(1) of the Social Security Act (relating to statewideness) and section 1902(a)(10)(B) of such Act (relating to comparability); and
(2) increase to up to 90 percent (for the first 2 years of the pilot program) or 75 percent (for the next 3 years) the matching percentage for administrative expenditures (such as those for community care workers).
(d) Medically fragile children.—In the case of a model involving medically fragile children, the model shall ensure that the patient-centered medical home services received by each child, in addition to fulfilling the requirements under 1866E(b)(1) of the Social Security Act, provide for continuous involvement and education of the parent or caregiver and for assistance to the child in obtaining necessary transitional care if a child’s enrollment ceases for any reason.
(1) EVALUATION.—The Secretary, using the criteria described in section 1866E(g)(1) of the Social Security Act (as inserted by section 1123), shall conduct an evaluation of the pilot program under this section.
(2) REPORT.—Not later than 60 days after the date of completion of the evaluation under paragraph (1), the Secretary shall submit to Congress and make available to the public a report on the findings of the evaluation under such paragraph.
(f) Funding.—The additional Federal financial participation resulting from the implementation of the pilot program under this section may not exceed in the aggregate $1,235,000,000 over the 5-year period of the program.
(a) In general.—Section 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 1396b(a)(2)), as added by section 201(b)(2)(A) of the Children’s Health Insurance Program Reauthorization Act of 2009 (Public Law 111–3), is amended by inserting “and other individuals” after “children of families”.
(b) Effective date.—The amendment made by subsection (a) shall apply to payment for translation or interpretation services furnished on or after January 1, 2010.
(a) In general.—Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by section 1713(a), is amended—
(A) by redesignating paragraph (29) as paragraph (30);
(B) in paragraph (28), by striking at the end “and”; and
(C) by inserting after paragraph (28) the following new paragraph:
“(29) freestanding birth center services (as defined in subsection (l)(3)(A)) and other ambulatory services that are offered by a freestanding birth center (as defined in subsection (l)(3)(B)) and that are otherwise included in the plan; and”; and
(2) in subsection (l), by adding at the end the following new paragraph:
“(3)(A) The term ‘freestanding birth center services’ means services furnished to an individual at a freestanding birth center (as defined in subparagraph (B)), including by a licensed birth attendant (as defined in subparagraph (C)) at such center.
“(B) The term ‘freestanding birth center’ means a health facility—
“(i) that is not a hospital; and
“(ii) where childbirth is planned to occur away from the pregnant woman’s residence.
“(C) The term ‘licensed birth attendant’ means an individual who is licensed or registered by the State involved to provide health care at childbirth and who provides such care within the scope of practice under which the individual is legally authorized to perform such care under State law (or the State regulatory mechanism provided by State law), regardless of whether the individual is under the supervision of, or associated with, a physician or other health care provider. Nothing in this subparagraph shall be construed as changing State law requirements applicable to a licensed birth attendant.”.
(b) Effective date.—The amendments made by this section shall apply to items and services furnished on or after the date of the enactment of this Act.
Section 1928(b)(2)(A)(iii)(I) of the Social Security Act (42 U.S.C. 1396s(b)(2)(A)(iii)(I)) is amended—
(1) by striking “or a rural health clinic” and inserting “, a rural health clinic”; and
(2) by inserting “or a public health clinic,” after `“1905(l)(1)),”.
(a) In General.—Section 1902 of the Social Security Act (42 U.S.C. 1396a), as amended by section 1714(a)(1), is amended—
(1) in subsection (a)(10)(A)(ii)—
(A) by striking “or” at the end of subclause (XIX);
(B) by adding “or” at the end of subclause (XX); and
(C) by adding at the end the following:
“(XXI) who are described in subsection (ii) (relating to HIV-infected individuals);”; and
(2) by adding at the
end, as amended by sections 1703 and 1714(a), the following: “(ii) individuals
described in this subsection are individuals not described in subsection
(a)(10)(A)(i)— “(1) who have HIV
infection; “(2) whose income (as
determined under the State plan under this title with respect to disabled
individuals) does not exceed the maximum amount of income a disabled individual
described in subsection (a)(10)(A)(i) may have and obtain medical assistance
under the plan; and “(3) whose resources
(as determined under the State plan under this title with respect to disabled
individuals) do not exceed the maximum amount of resources a disabled
individual described in subsection (a)(10)(A)(i) may have and obtain medical
assistance under the
plan.”.
(b) Enhanced Match.—The first sentence of section 1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by striking “section 1902(a)(10)(A)(ii)(XVIII)” and inserting “subclause (XVIII) or (XX) of section 1902(a)(10)(A)(ii)”.
(c) Conforming Amendments.—Section 1905(a) of such Act (42 U.S.C. 1396d(a)) is amended, in the matter preceding paragraph (1)—
(1) by striking “or” at the end of clause (xii);
(2) by adding “or” at the end of clause (xiii); and
(3) by inserting after clause (xiii) the following:
“(xiv) individuals described in section 1902(ii),”.
(d) Exemption From Funding Limitation for Territories.—Section 1108(g) of the Social Security Act (42 U.S.C. 1308(g)) is amended by adding at the end the following:
“(5) DISREGARDING MEDICAL ASSISTANCE FOR OPTIONAL LOW-INCOME HIV-INFECTED INDIVIDUALS.—The limitations under subsection (f) and the previous provisions of this subsection shall not apply to amounts expended for medical assistance for individuals described in section 1902(ii) who are only eligible for such assistance on the basis of section 1902(a)(10)(A)(ii)(XX).”.
(e) Effective Date; sunset.—The amendments made by this section shall apply to expenditures for calendar quarters beginning on or after the date of the enactment of this Act, and before January 1, 2013, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.
Sections 1902(e)(1)(B) and 1925(f) of the Social Security Act (42 U.S.C. 1396a(e)(1)(B), 1396r–6(f)), as amended by section 5004(a)(1) of the American Recovery and Reinvestment Act of 2009 (Public Law 111–5), are each amended by striking “December 31, 2010” and inserting “December 31, 2012”.
(a) In general.—Section 2102(b) of the Social Security Act (42 U.S.C. 1397bb(b)) is amended by adding at the end the following new paragraph:
“(6) REQUIREMENT FOR 12-MONTH CONTINUOUS ELIGIBILITY.—In the case of a State child health plan that provides child health assistance under this title through a means other than described in section 2101(a)(2), the plan shall provide for implementation under this title of the 12-month continuous eligibility option described in section 1902(e)(12) for targeted low-income children whose family income is below 200 percent of the poverty line.”.
(b) Effective date.—The amendment made by subsection (a) shall apply to determinations (and redeterminations) of eligibility made on or after January 1, 2010.
(a) Pharmacy Reimbursement Limits.—
(1) IN GENERAL.—Section 1927(e) of the Social Security Act (42 U.S.C. 1396r–8(e)) is amended—
(A) by striking paragraph (5) and inserting the following:
“(5) USE OF AMP IN UPPER PAYMENT LIMITS.—The Secretary shall calculate the Federal upper reimbursement limit established under paragraph (4) as 130 percent of the weighted average (determined on the basis of manufacturer utilization) of monthly average manufacturer prices.”.
(2) DEFINITION OF AMP.—Section 1927(k)(1)(B) of such Act (42 U.S.C. 1396r–8(k)(1)(B)) is amended—
(B) in the heading, by striking “extended to wholesalers” and inserting “and other payments”; and
(C) by striking “regard to” and all that follows through the period and inserting the following: “regard to—
“(i) customary prompt pay discounts extended to wholesalers;
“(ii) bona fide service fees paid by manufacturers;
“(iii) reimbursement by manufacturers for recalled, damaged, expired, or otherwise unsalable returned goods, including reimbursement for the cost of the goods and any reimbursement of costs associated with return goods handling and processing, reverse logistics, and drug destruction;
“(iv) sales directly to, or rebates, discounts, or other price concessions provided to, pharmacy benefit managers, managed care organizations, health maintenance organizations, insurers, mail order pharmacies that are not open to all members of the public, or long term care providers, provided that these rebates, discounts, or price concessions are not passed through to retail pharmacies;
“(v) sales directly to, or rebates, discounts, or other price concessions provided to, hospitals, clinics, and physicians, unless the drug is an inhalation, infusion, or injectable drug, or unless the Secretary determines, as allowed for in Agency administrative procedures, that it is necessary to include such sales, rebates, discounts, and price concessions in order to obtain an accurate AMP for the drug. Such a determination shall not be subject to judicial review; or
“(vi) rebates, discounts, and other price concessions required to be provided under agreements under subsections (f) and (g) of section 1860D–2(f).”.
(3) MANUFACTURER REPORTING REQUIREMENTS.—Section 1927(b)(3) of such Act (42 U.S.C. 1396r–8(b)(3)) is amended—
(A) in subparagraph (A), by adding at the end the following new clause:
“(iv) not later than 30 days after the last day of each month of a rebate period under the agreement, on the manufacturer’s total number of units that are used to calculate the monthly average manufacturer price for each covered outpatient drug.”.
(4) AUTHORITY TO PROMULGATE REGULATION.—The Secretary of Health and Human Services may promulgate regulations to clarify the requirements for upper payment limits and for the determination of the average manufacturer price in an expedited manner. Such regulations may become effective on an interim final basis, pending opportunity for public comment.
(5) PHARMACY REIMBURSEMENTS THROUGH DECEMBER 31, 2010.—The specific upper limit under section 447.332 of title 42, Code of Federal Regulations (as in effect on December 31, 2006) applicable to payments made by a State for multiple source drugs under a State Medicaid plan shall continue to apply through December 31, 2010, for purposes of the availability of Federal financial participation for such payments.
(b) Disclosure of Price Information to the Public.—Section 1927(b)(3) of such Act (42 U.S.C. 1396r–8(b)(3)) is amended—
(A) in clause (i), in the matter preceding subclause (I), by inserting “month of a” after “each”; and
(B) in the last sentence, by striking “and shall,” and all that follows through the period; and
(2) in subparagraph (D)(v), by inserting “weighted” before “average manufacturer prices”.
(a) Additional rebate for new formulations of existing drugs.—
(1) IN GENERAL.—Section 1927(c)(2) of the Social Security Act (42 U.S.C. 1396r–8(c)(2)) is amended by adding at the end the following new subparagraph:
“(C) TREATMENT OF NEW FORMULATIONS.—In the case of a drug that is a line extension of a single source drug or an innovator multiple source drug that is an oral solid dosage form, the rebate obligation with respect to such drug under this section shall be the amount computed under this section for such new drug or, if greater, the product of—
“(i) the average manufacturer price of the line extension of a single source drug or an innovator multiple source drug that is an oral solid dosage form;
“(ii) the highest additional rebate (calculated as a percentage of average manufacturer price) under this section for any strength of the original single source drug or innovator multiple source drug; and
“(iii) the total number of units of each dosage form and strength of the line extension product paid for under the State plan in the rebate period (as reported by the State).
In this subparagraph, the term ‘line extension’ means, with respect to a drug, an extended release formulation of the drug.”.
(2) EFFECTIVE DATE.—The amendment made by paragraph (1) shall apply to drugs dispensed after December 31, 2009.
(b) Increase minimum rebate percentage for single source drugs.—Section 1927(c)(1)(B)(i) of the Social Security Act (42 U.S.C. 1396r–8(c)(1)(B)(i)) is amended—
(1) in subclause (IV), by striking “and” at the end;
(A) by inserting “and before January 1, 2010” after “December 31, 1995,”; and
(B) by striking the period at the end and inserting “; and”; and
(3) by adding at the end the following new subclause:
“(VI) after December 31, 2009, is 22.1 percent.”.
(a) In general.—Section 1903(m)(2)(A) of the Social Security Act (42 U.S.C. 1396b(m)(2)(A)) is amended—
(1) in clause (xi), by striking “and” at the end;
(2) in clause (xii), by striking the period at the end and inserting “; and”; and
(3) by adding at the end the following:
“(xiii) such contract provides that the entity shall report to the State such information, on such timely and periodic basis as specified by the Secretary, as the State may require in order to include, in the information submitted by the State to a manufacturer under section 1927(b)(2)(A), information on covered outpatient drugs dispensed to individuals eligible for medical assistance who are enrolled with the entity and for which the entity is responsible for coverage of such drugs under this subsection.”.
(b) Conforming amendments.—Section 1927 of such Act (42 U.S.C. 1396r-8) is amended——
(1) in the first sentence of subsection (b)(1)(A), by inserting before the period at the end the following: “, including such drugs dispensed to individuals enrolled with a medicaid managed care organization if the organization is responsible for coverage of such drugs”;
(2) in subsection (b)(2), by adding at the end the following new subparagraph:
“(C) REPORTING ON MMCO DRUGS.—On a quarterly basis, each State shall report to the Secretary the total amount of rebates in dollars received from pharmacy manufacturers for drugs provided to individuals enrolled with Medicaid managed care organizations that contract under section 1903(m).”; and
(A) in the heading by striking “Exemption” and inserting “Special rules”; and
(B) in paragraph (1), by striking “not”.
(c) Effective date.—The amendments made by this section take effect on July 1, 2010, and shall apply to drugs dispensed on or after such date, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.
(a) In general.—Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by sections 1701(a)(2), 1711(a), and 1713(a), is amended by adding at the end the following new subsection:
“(bb) Payment for graduate medical education.—
“(1) IN GENERAL.—The term ‘medical assistance’ includes payment for costs of graduate medical education consistent with this subsection, whether provided in or outside of a hospital.
“(2) SUBMISSION OF INFORMATION.—For purposes of paragraph (1) and section 1902(a)(13)(A)(v), payment for such costs is not consistent with this subsection unless—
“(A) the State submits to the Secretary, in a timely manner and on an annual basis specified by the Secretary, information on total payments for graduate medical education and how such payments are being used for graduate medical education, including—
“(i) the institutions and programs eligible for receiving the funding;
“(ii) the manner in which such payments are calculated;
“(iii) the types and fields of education being supported;
“(iv) the workforce or other goals to which the funding is being applied;
“(v) State progress in meeting such goals; and
“(vi) such other information as the Secretary determines will assist in carrying out paragraphs (3) and (4); and
“(B) such expenditures are made consistent with such goals and requirements as are established under paragraph (4).
“(3) REVIEW OF INFORMATION.—The Secretary shall make the information submitted under paragraph (2) available to the Advisory Committee on Health Workforce Evaluation and Assessment (established under section 2261 of the Public Health Service Act). The Secretary and the Advisory Committee shall independently review the information submitted under paragraph (2), taking into account State and local workforce needs.
“(4) SPECIFICATION OF GOALS AND REQUIREMENTS.—The Secretary shall specify by rule, initially published by not later than December 31, 2011—
“(A) program goals for the use of funds described in paragraph (1), taking into account recommendations of the such Advisory Committee and the goals for approved medical residency training programs described in section 1886(h)(1)(B); and
“(B) requirements for use of such funds consistent with such goals.
Such rule may be effective on an interim basis pending revision after an opportunity for public comment.”.
(b) Conforming amendment.—Section 1902(a)(13)(A) of such Act (42 U.S.C. 1396a(a)(13)(A)) is amended—
(1) by striking “and” at the end of clause (iii);
(2) by striking “; and” and inserting “, and”; and
(3) by adding at the end the following new clause:
“(v) in the case of hospitals and at the option of a State, such rates may include, to the extent consistent with section 1905(bb), payment for graduate medical education; and”.
(c) Effective date.—The amendments made by this section shall take effect on the date of the enactment of this Act. Nothing in this section shall be construed as affecting payments made before such date under a State plan under title XIX of the Social Security Act for graduate medical education.
(a) Medicaid non-Payment for certain health care-Acquired conditions.—Section 1903(i) of the Social Security Act (42 U.S.C. 1396b(i)) is amended—
(1) by striking “or” at the end of paragraph (23);
(2) by striking the period at the end of paragraph (24) and inserting “; or”; and
(3) by inserting after paragraph (24) the following new paragraph:
“(25) with respect to amounts expended for services related to the presence of a condition that could be identified by a secondary diagnostic code described in section 1886(d)(4)(D)(iv) and for any health care acquired condition determined as a non-covered service under title XVIII.”.
(b) Application to CHIP.—Section 2107(e)(1)(G) of such Act (42 U.S.C. 1397gg(e)(1)(G)) is amended by striking “and (17)” and inserting “(17), and (25)”.
(c) Permission To include additional health care-Acquired conditions.—Nothing in this section shall prevent a State from including additional health care-acquired conditions for non-payment in its Medicaid program under title XIX of the Social Security Act.
(d) Effective date.—The amendments made by this section shall apply to discharges occurring on or after January 1, 2010.
Section 1936(c)(2)) of the Social Security Act (42 U.S.C. 1396u–7(c)(2)) is amended—
(1) by redesignating subparagraph (D) as subparagraph (E); and
(2) by inserting after subparagraph (C) the following new subparagraph:
“(D) For the contract year beginning in 2011 and each subsequent contract year, the entity provides assurances to the satisfaction of the Secretary that the entity will conduct periodic evaluations of the effectiveness of the activities carried out by such entity under the Program and will submit to the Secretary an annual report on such activities.”.
Section 1902(a) of such Act (42 U.S.C. 42 U.S.C. 1396a(a)), as amended by sections 1631(b)(1) and 1703, is further amended—
(1) in paragraph (74), by striking at the end “and”;
(2) in paragraph (75), by striking at the end the period and inserting “; and”; and
(3) by inserting after paragraph (75) the following new paragraph:
“(76) provide that any provider or supplier (other than a physician or nursing facility) providing services under such plan shall, subject to paragraph (5) of section 1874(d), establish a compliance program described in paragraph (1) of such section in accordance with such section.”.
(a) In general.—Section 1903(d)(2)(C) of the Social Security Act (42 U.S.C. 1396b(d)(2)(C)) is amended by inserting “(or 1 year in the case of overpayments due to fraud)” after “60 days”.
(b) Effective date.—In the case overpayments discovered on or after the date of the enactment of this Act.
(a) Minimum medical loss ratio.—
(1) MEDICAID.—Section 1903(m)(2)(A) of the Social Security Act (42 U.S.C. 1396b(m)(2)(A)), as amended by section 1743(a)(3), is amended—
(A) by striking “and” at the end of clause (xii);
(B) by striking the period at the end of clause (xiii) and inserting “; and”; and
(C) by adding at the end the following new clause:
“(xiv) such contract has a medical loss ratio, as determined in accordance with a methodology specified by the Secretary that is a percentage (not less than 85 percent) as specified by the Secretary.”.
(2) CHIP.—Section 2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)) is amended—
(A) by redesignating subparagraphs (H) through (L) as subparagraphs (I) through (M); and
(B) by inserting after subparagraph (G) the following new subparagraph:
“(H) Section 1903(m)(2)(A)(xiv) (relating to application of minimum loss ratios), with respect to comparable contracts under this title.”.
(3) EFFECTIVE DATE.—The amendments made by this subsection shall apply to contracts entered into or renewed on or after July 1, 2010.
(1) IN GENERAL.—Section 1903(m)(2)(A)(xi) of the Social Security Act (42 U.S.C. 1396b(m)(2)(A)(xi)) is amended by inserting “and for the provision of such data to the State at a frequency and level of detail to be specified by the Secretary” after “patients”.
(2) EFFECTIVE DATE.—The amendment made by paragraph (1) shall apply with respect to contract years beginning on or after January 1, 2010.
(a) State plan requirement.—Section 1902(a)(39) of the Social Security Act (42 U.S.C. 42 U.S.C. 1396a(a)) is amended by inserting after “1128A,” the following: “terminate the participation of any individual or entity in such program if (subject to such exceptions are are permitted with respect to exclusion under sections 1128(b)(3)(C) and 1128(d)(3)(B)) participation of such individual or entity is terminated under title XVIII, any other State plan under this title, or any child health plan under title XXI,”.
(b) Application to CHIP.—Section 2107(e)(1)(A) of such Act (42 U.S.C. 1397gg(e)(1)(A)) is amended by inserting before the period at the end the following: “and section 1902(a)(39) (relating to exclusion and termination of participation)”.
(1) Except as provided in paragraph (2), the amendments made by this section shall apply to services furnished on or after JJanuary 1, 2011, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.
(2) In the case of a State plan for medical assistance under title XIX of the Social Security Act or a child health plan under title XXI of such Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendments made by this section, the State plan or child health plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.
(a) State plan requirement.—Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), as amended by sections 1631(b)(1), 1703, and 1753, is further amended—
(1) in paragraph (75), by striking at the end “and”;
(2) in paragraph (76), by striking at the end the period and inserting “; and”; and
(3) by inserting after paragraph (76) the following new paragraph:
“(77) provide that the State agency described in paragraph (9) exclude, with respect to a period, any individual or entity from participation in the program under the State plan if such individual or entity owns, controls, or manages an entity that (or if such entity is owned, controlled, or managed by an individual or entity that)—
“(A) has unpaid overpayments under this title during such period determined by the Secretary or the State agency to be delinquent;
“(B) is suspended or excluded from participation under or whose participation is terminated under this title during such period; or
“(C) is affiliated with an individual or entity that has been suspended or excluded from participation under this title or whose participation is terminated under this title during such period.”.
(b) Child health plan requirement.—Section 2107(e)(1)(A) of such Act (42 U.S.C. 1397gg(e)(1)(A)), as amended by section 1756(b), is amended by striking “section 1902(a)(39)” and inserting “sections 1902(a)(39) and 1902(a)(77)”.
(1) Except as provided in paragraph (2), the amendments made by this section shall apply to services furnished on or after January 1, 2011, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.
(2) In the case of a State plan for medical assistance under title XIX of the Social Security Act or a child health plan under title XXI of such Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendments made by this section, the State plan or child health plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.
Section 1903(r)(1)(F) of the Social Security Act (42 U.S.C. 1396b(r)(1)(F)) is amended by inserting after “necessary” the following: “and including, for data submitted to the Secretary on or after July 1, 2010, data elements from the automated data system that the Secretary determines to be necessary for detection of waste, fraud, and abuse”.
(a) In general.—Section 1902(a) of the Social Security Act (42 U.S.C. 42 U.S.C. 1396a(a)), as amended by sections 1631(b), 1703, 1753, and 1757, is further amended—
(1) in paragraph (76); by striking at the end “and”;
(2) in paragraph (77), by striking the period at the end and inserting “and”; and
(3) by inserting after paragraph (77) the following new paragraph:
“(78) provide that any agent, clearinghouse, or other alternate payee that submits claims on behalf of a health care provider must register with the State and the Secretary in a form and manner specified by the Secretary under section 1866(j)(1)(D).”.
(b) Denial of payment.—Section 1903(i) of such Act (42 U.S.C. 1396b(i)), as amended by section 1753, is amended—
(1) by striking “or” at the end of paragraph (24);
(2) by striking the period at the end of paragraph (25) and inserting “; or”; and
(3) by inserting after paragraph (25) the following new paragraph:
“(26) with respect to any amount paid to a billing agent, clearinghouse, or other alternate payee that is not registered with the State and the Secretary as required under section 1902(a)(78).”.
(1) Except as provided in paragraph (2), the amendments made by this section shall apply to claims submitted on or after January 1, 2012, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.
(2) In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendments made by this section, the State plan or child health plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.
(a) In general.—Section 1903(i) of the Social Security Act (42 U.S.C. 1396b(i)), as previously amended is amended—
(1) by striking “or” at the end of paragraph (25);
(2) by striking the period at the end of paragraph (26) and inserting a semicolon; and
(3) by inserting after paragraph (26) the following new paragraphs:
“(27) with respect to any amount expended—
“(A) on litigation in which a court imposes sanctions on the State, its employees, or its counsel for litigation-related misconduct; or
“(B) to reimburse (or otherwise compensate) a managed care entity for payment of legal expenses associated with any action in which a court imposes sanctions on the managed care entity for litigation-related misconduct.”.
(b) Effective date.—The amendments made by subsection (a) shall apply to amounts expended on or after January 1, 2010.
(1) IN GENERAL.—Section 1108(g) of the Social Security Act (42 U.S.C. 1308(g)) is amended—
(A) in paragraph (4) by striking “and (3)” and by inserting “(3), (6), and (7)”; and
(B) by inserting after paragraph (5), as added by section 1731(d), the following new paragraph:
“(6) FISCAL YEARS 2011 THROUGH 2019.—The amounts otherwise determined under this subsection for Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa for fiscal year 2011 and each succeeding fiscal year through fiscal year 2019 shall be increased by the percentage specified under section 1771(c) of the America’s Affordable Health Choices Act of 2009 for purposes of this paragraph of the amounts otherwise determined under this section (without regard to this paragraph).
“(7) FISCAL YEAR 2020 AND SUBSEQUENT FISCAL YEARS.—The amounts otherwise determined under this subsection for Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa for fiscal year 2020 and each succeeding fiscal year shall be the amount provided in paragraph (6) or this paragraph for the preceding fiscal year for the respective territory increased by the percentage increase referred to in paragraph (1)(B), rounded to the nearest $10,000 (or $100,000 in the case of Puerto Rico).”.
(2) COORDINATION WITH ARRA.—Section 5001(d) of the American Recovery and Reinvestment Act of 2009 shall not apply during any period for which section 1108(g)(6) of the Social Security Act, as added by paragraph (1), applies.
(1) IN GENERAL.—Section 1905(b)(2) of the Social Security Act (42 U.S.C. 1396d(b)(2)) is amended by striking “50 per centum” and inserting “for fiscal years 2011 through 2019, the percentage specified under section 1771(c) of the America’s Affordable Health Choices Act of 2009 for purposes of this clause for such fiscal year and for subsequent fiscal years the percentage so specified for fiscal year 2019”.
(2) EFFECTIVE DATE.—The amendment made by subsection (a) shall apply to items and services furnished on or after October 1, 2010.
(c) Specification of percentages.—The Secretary of Health and Human Services shall specify, before January 1, 2011, the percentages to be applied under section 1108(g)(6) of the Social Security Act, as added by subsection (a)(1), and under section 1905(b)(2) of such Act, as amended by subsection (b)(1), in a manner so that for the period beginning with 2011 and ending with 2019 the total estimated additional Federal expenditures resulting from the application of such percentages will be equal to $10,350,000,000.
(a) Technical correction to section 1144 of the Social Security Act.—The first sentence of section 1144(c)(3) of the Social Security Act (42 U.S.C. 1320b—14(c)(3)) is amended—
(1) by striking “transmittal”; and
(2) by inserting before the period the following: “as specified in section 1935(a)(4)”.
(b) Clarifying amendment to section 1935 of the Social Security Act.—Section 1935(a)(4) of the Social Security Act (42 U.S.C. 1396u—5(a)(4)), as amended by section 113(b) of Public Law 110–275, is amended—
(1) by striking the second sentence;
(2) by redesignating the first sentence as a subparagraph (A) with appropriate indentation and with the following heading: “In general”;
(3) by adding at the end the following subparagraphs:
“(B) FURNISHING MEDICAL ASSISTANCE WITH REASONABLE PROMPTNESS.—For the purpose of a State’s obligation under section 1902(a)(8) to furnish medical assistance with reasonable promptness, the date of the electronic transmission of low-income subsidy program data, as described in section 1144(c), from the Commissioner of Social Security to the State Medicaid Agency, shall constitute the date of filing of such application for benefits under the Medicare Savings Program.
“(C) DETERMINING AVAILABILITY OF MEDICAL ASSISTANCE.—For the purpose of determining when medical assistance will be made available, the State shall consider the date of the individual’s application for the low income subsidy program to constitute the date of filing for benefits under the Medicare Savings Program.”.
(c) Effective date relating to Medicaid agency consideration of low-income subsidy application and data transmittal.—The amendments made by subsections (a) and (b) shall be effective as if included in the enactment of section 113(b) of Public Law 110–275.
(d) Technical correction to section 605 of CHIPRA.—Section 605 of the Children’s Health Insurance Program Reauthorization Act of 2009 (Public Law 111–3) is amended by striking “legal residents” and inserting “lawfully residing in the United States”.
(e) Technical correction to section 1905 of the Social Security Act.—Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended by inserting “or the care and services themselves, or both” before “(if provided in or after”.
(f) Clarifying amendment to section 1115 of the Social Security Act.—Section 1115(a) of the Social Security Act (42 U.S.C. 1315(a)) is amended by adding at the end the following: “If an experimental, pilot, or demonstration project that relates to title XIX is approved pursuant to any part of this subsection, such project shall be treated as part of the State plan, all medical assistance provided on behalf of any individuals affected by such project shall be medical assistance provided under the State plan, and all provisions of this Act not explicitly waived in approving such project shall remain fully applicable to all individuals receiving benefits under the State plan.”.
(a) In general.—Section 1902(a)(10)(E)(iv) of the Social Security Act (42 U.S.C. 1396b(a)(10)(E)(iv)) is amended—
(1) by striking “sections 1933 and” and by inserting “section”; and
(2) by striking “December 2010” and inserting “December 2012”.
(b) Elimination of funding limitation.—
(1) IN GENERAL.—Section 1933 of such Act (42 U.S.C. 1396u–3) is amended—
(A) in subsection (a), by striking “who are selected to receive such assistance under subsection (b)”;
(B) by striking subsections (b), (c), (e), and (g);
(C) in subsection (d), by striking “furnished in a State” and all that follows and inserting “the Federal medical assistance percentage shall be equal to 100 percent.”; and
(D) by redesignating subsections (d) and (f) as subsections (b) and (c), respectively.
(2) CONFORMING AMENDMENT.—Section 1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by striking “1933(d)” and inserting “1933(b)”.
(3) EFFECTIVE DATE.—The amendments made by paragraph (1) shall take effect on January 1, 2011.
(a) In general.—Paragraph (19) of section 6103(l) of the Internal Revenue Code of 1986 is amended to read as follows:
“(19) DISCLOSURES TO FACILITATE IDENTIFICATION OF INDIVIDUALS LIKELY TO BE INELIGIBLE FOR LOW-INCOME SUBSIDIES UNDER MEDICARE PRESCRIPTION DRUG PROGRAM TO ASSIST SOCIAL SECURITY ADMINISTRATION’S OUTREACH TO ELIGIBLE INDIVIDUALS.—
“(A) IN GENERAL.—Upon written request from the Commissioner of Social Security, the following return information (including such information disclosed to the Social Security Administration under paragraph (1) or (5)) shall be disclosed to officers and employees of the Social Security Administration, with respect to any taxpayer identified by the Commissioner of Social Security—
“(i) return information for the applicable year from returns with respect to wages (as defined in section 3121(a) or 3401(a)) and payments of retirement income (as described in paragraph (1) of this subsection),
“(ii) unearned income information and income information of the taxpayer from partnerships, trusts, estates, and subchapter S corporations for the applicable year,
“(iii) if the individual filed an income tax return for the applicable year, the filing status, number of dependents, income from farming, and income from self-employment, on such return,
“(iv) if the individual is a married individual filing a separate return for the applicable year, the social security number (if reasonably available) of the spouse on such return,
“(v) if the individual files a joint return for the applicable year, the social security number, unearned income information, and income information from partnerships, trusts, estates, and subchapter S corporations of the individual’s spouse on such return, and
“(vi) such other return information relating to the individual (or the individual’s spouse in the case of a joint return) as is prescribed by the Secretary by regulation as might indicate that the individual is likely to be ineligible for a low-income prescription drug subsidy under section 1860D–14 of the Social Security Act.
“(B) APPLICABLE YEAR.—For the purposes of this paragraph, the term ‘applicable year’ means the most recent taxable year for which information is available in the Internal Revenue Service’s taxpayer information records.
“(C) RESTRICTION ON INDIVIDUALS FOR WHOM DISCLOSURE MAY BE REQUESTED.—The Commissioner of Social Security shall request information under this paragraph only with respect to—
“(i) individuals the Social Security Administration has identified, using all other reasonably available information, as likely to be eligible for a low-income prescription drug subsidy under section 1860D–14 of the Social Security Act and who have not applied for such subsidy, and
“(ii) any individual the Social Security Administration has identified as a spouse of an individual described in clause (i).
“(D) RESTRICTION ON USE OF DISCLOSED INFORMATION.—Return information disclosed under this paragraph may be used only by officers and employees of the Social Security Administration solely for purposes of identifying individuals likely to be ineligible for a low-income prescription drug subsidy under section 1860D–14 of the Social Security Act for use in outreach efforts under section 1144 of the Social Security Act.”.
(b) Safeguards.—Paragraph (4) of section 6103(p) of such Code is amended—
(1) by striking “(l)(19)” each place it appears, and
(2) by striking “or (17)” each place it appears and inserting “(17), or (19)”.
(c) Conforming amendment.—Paragraph (3) of section 6103(a) of such Code is amended by striking “(19),”.
(d) Effective date.—The amendments made by this section shall apply to disclosures made after the date which is 12 months after the date of the enactment of this Act.
(a) Establishment of trust fund.—
(1) IN GENERAL.—Subchapter A of chapter 98 of the Internal Revenue Code of 1986 (relating to trust fund code) is amended by adding at the end the following new section:
“(a) Creation of Trust Fund.—There is established in the Treasury of the United States a trust fund to be known as the ‘Health Care Comparative Effectiveness Research Trust Fund’ (hereinafter in this section referred to as the ‘CERTF’), consisting of such amounts as may be appropriated or credited to such Trust Fund as provided in this section and section 9602(b).
“(b) Transfers to Fund.—There are hereby appropriated to the Trust Fund the following:
“(1) For fiscal year 2010, $90,000,000.
“(2) For fiscal year 2011, $100,000,000.
“(3) For fiscal year 2012, $110,000,000.
“(4) For each fiscal year beginning with fiscal year 2013—
“(A) an amount equivalent to the net revenues received in the Treasury from the fees imposed under subchapter B of chapter 34 (relating to fees on health insurance and self-insured plans) for such fiscal year; and
“(B) subject to subsection (c)(2), amounts determined by the Secretary of Health and Human Services to be equivalent to the fair share per capita amount computed under subsection (c)(1) for the fiscal year multiplied by the average number of individuals entitled to benefits under part A, or enrolled under part B, of title XVIII of the Social Security Act during such fiscal year.
The amounts appropriated under paragraphs (1), (2), (3), and (4)(B) shall be transferred from the Federal Hospital Insurance Trust Fund and from the Federal Supplementary Medical Insurance Trust Fund (established under section 1841 of such Act), and from the Medicare Prescription Drug Account within such Trust Fund, in proportion (as estimated by the Secretary) to the total expenditures during such fiscal year that are made under title XVIII of such Act from the respective trust fund or account.“(c) Fair share per capita amount.—
“(A) IN GENERAL.—Subject to subparagraph (B), the fair share per capita amount under this paragraph for a fiscal year (beginning with fiscal year 2013) is an amount computed by the Secretary of Health and Human Services for such fiscal year that, when applied under this section and subchapter B of chapter 34 of the Internal Revenue Code of 1986, will result in revenues to the CERTF of $375,000,000 for the fiscal year.
“(B) ALTERNATIVE COMPUTATION.—
“(i) IN GENERAL.—If the Secretary is unable to compute the fair share per capita amount under subparagraph (A) for a fiscal year, the fair share per capita amount under this paragraph for the fiscal year shall be the default amount determined under clause (ii) for the fiscal year.
“(ii) DEFAULT AMOUNT.—The default amount under this clause for—
“(I) fiscal year 2013 is equal to $2; or
“(II) a subsequent year is equal to the default amount under this clause for the preceding fiscal year increased by the annual percentage increase in the medical care component of the consumer price index (United States city average) for the 12-month period ending with April of the preceding fiscal year.
Any amount determined under subclause (II) shall be rounded to the nearest penny.
“(2) LIMITATION ON MEDICARE FUNDING.—In no case shall the amount transferred under subsection (b)(4)(B) for any fiscal year exceed $90,000,000.
“(1) IN GENERAL.—Subject to paragraph (2), amounts in the CERTF are available, without the need for further appropriations and without fiscal year limitation, to the Secretary of Health and Human Services for carrying out section 1181 of the Social Security Act.
“(2) ALLOCATION FOR COMMISSION.—Not less than the following amounts in the CERTF for a fiscal year shall be available to carry out the activities of the Comparative Effectiveness Research Commission established under section 1181(b) of the Social Security Act for such fiscal year:
“(A) For fiscal year 2010, $7,000,000.
“(B) For fiscal year 2011, $9,000,000.
“(C) For each fiscal year beginning with 2012, $10,000,000.
Nothing in this paragraph shall be construed as preventing additional amounts in the CERTF from being made available to the Comparative Effectiveness Research Commission for such activities.
“(e) Net Revenues.—For purposes of this section, the term ‘net revenues’ means the amount estimated by the Secretary based on the excess of—
“(1) the fees received in the Treasury under subchapter B of chapter 34, over
“(2) the decrease in the tax imposed by chapter 1 resulting from the fees imposed by such subchapter.”.
(2) CLERICAL
AMENDMENT.—The table of sections for such subchapter A is amended
by adding at the end thereof the following new item:
(b) Financing for Fund from fees on insured and Self-Insured health plans.—
(1) GENERAL RULE.—Chapter 34 of the Internal Revenue Code of 1986 is amended by adding at the end the following new subchapter:
“(a) Imposition of Fee.—There is hereby imposed on each specified health insurance policy for each policy year a fee equal to the fair share per capita amount determined under section 9511(c)(1) multiplied by the average number of lives covered under the policy.
“(b) Liability for Fee.—The fee imposed by subsection (a) shall be paid by the issuer of the policy.
“(c) Specified Health Insurance Policy.—For purposes of this section:
“(1) IN GENERAL.—Except as otherwise provided in this section, the term ‘specified health insurance policy’ means any accident or health insurance policy issued with respect to individuals residing in the United States.
“(2) EXEMPTION FOR CERTAIN POLICIES.—The term ‘specified health insurance policy’ does not include any insurance if substantially all of its coverage is of excepted benefits described in section 9832(c).
“(3) TREATMENT OF PREPAID HEALTH COVERAGE ARRANGEMENTS.—
“(A) IN GENERAL.—In the case of any arrangement described in subparagraph (B)—
“(i) such arrangement shall be treated as a specified health insurance policy, and
“(ii) the person referred to in such subparagraph shall be treated as the issuer.
“(B) DESCRIPTION OF ARRANGEMENTS.—An arrangement is described in this subparagraph if under such arrangement fixed payments or premiums are received as consideration for any person’s agreement to provide or arrange for the provision of accident or health coverage to residents of the United States, regardless of how such coverage is provided or arranged to be provided.
“(a) Imposition of Fee.—In the case of any applicable self-insured health plan for each plan year, there is hereby imposed a fee equal to the fair share per capita amount determined under section 9511(c)(1) multiplied by the average number of lives covered under the plan.
“(1) IN GENERAL.—The fee imposed by subsection (a) shall be paid by the plan sponsor.
“(2) PLAN SPONSOR.—For purposes of paragraph (1) the term ‘plan sponsor’ means—
“(A) the employer in the case of a plan established or maintained by a single employer,
“(B) the employee organization in the case of a plan established or maintained by an employee organization,
“(i) a plan established or maintained by 2 or more employers or jointly by 1 or more employers and 1 or more employee organizations,
“(ii) a multiple employer welfare arrangement, or
“(iii) a voluntary employees’ beneficiary association described in section 501(c)(9),
the association, committee, joint board of trustees, or other similar group of representatives of the parties who establish or maintain the plan, or
“(D) the cooperative or association described in subsection (c)(2)(F) in the case of a plan established or maintained by such a cooperative or association.
“(c) Applicable Self-Insured Health Plan.—For purposes of this section, the term ‘applicable self-insured health plan’ means any plan for providing accident or health coverage if—
“(1) any portion of such coverage is provided other than through an insurance policy, and
“(2) such plan is established or maintained—
“(A) by one or more employers for the benefit of their employees or former employees,
“(B) by one or more employee organizations for the benefit of their members or former members,
“(C) jointly by 1 or more employers and 1 or more employee organizations for the benefit of employees or former employees,
“(D) by a voluntary employees’ beneficiary association described in section 501(c)(9),
“(E) by any organization described in section 501(c)(6), or
“(F) in the case of a plan not described in the preceding subparagraphs, by a multiple employer welfare arrangement (as defined in section 3(40) of Employee Retirement Income Security Act of 1974), a rural electric cooperative (as defined in section 3(40)(B)(iv) of such Act), or a rural telephone cooperative association (as defined in section 3(40)(B)(v) of such Act).
“(a) Definitions.—For purposes of this subchapter—
“(1) ACCIDENT AND HEALTH COVERAGE.—The term ‘accident and health coverage’ means any coverage which, if provided by an insurance policy, would cause such policy to be a specified health insurance policy (as defined in section 4375(c)).
“(2) INSURANCE POLICY.—The term ‘insurance policy’ means any policy or other instrument whereby a contract of insurance is issued, renewed, or extended.
“(3) UNITED STATES.—The term ‘United States’ includes any possession of the United States.
“(b) Treatment of Governmental Entities.—
“(1) IN GENERAL.—For purposes of this subchapter—
“(A) the term ‘person’ includes any governmental entity, and
“(B) notwithstanding any other law or rule of law, governmental entities shall not be exempt from the fees imposed by this subchapter except as provided in paragraph (2).
“(2) TREATMENT OF EXEMPT GOVERNMENTAL PROGRAMS.—In the case of an exempt governmental program, no fee shall be imposed under section 4375 or section 4376 on any covered life under such program.
“(3) EXEMPT GOVERNMENTAL PROGRAM DEFINED.—For purposes of this subchapter, the term ‘exempt governmental program’ means—
“(A) any insurance program established under title XVIII of the Social Security Act,
“(B) the medical assistance program established by title XIX or XXI of the Social Security Act,
“(C) any program established by Federal law for providing medical care (other than through insurance policies) to individuals (or the spouses and dependents thereof) by reason of such individuals being—
“(i) members of the Armed Forces of the United States, or
“(ii) veterans, and
“(D) any program established by Federal law for providing medical care (other than through insurance policies) to members of Indian tribes (as defined in section 4(d) of the Indian Health Care Improvement Act).
“(c) Treatment as Tax.—For purposes of subtitle F, the fees imposed by this subchapter shall be treated as if they were taxes.
“(d) No Cover Over to Possessions.—Notwithstanding any other provision of law, no amount collected under this subchapter shall be covered over to any possession of the United States.”.
(A) Chapter 34 of such Code is amended by striking the chapter heading and inserting the following:
(B) The table of chapters for subtitle D of such Code is amended by striking the item relating to chapter 34 and inserting the following new item:
(3) EFFECTIVE DATE.—The amendments made by this subsection shall apply with respect to policies and plans for portions of policy or plan years beginning on or after October 1, 2012.
Subtitle A of title VIII of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173) is repealed and the provisions of law amended by such subtitle are restored as if such subtitle had never been enacted.
Section 1860C–1 of the Social Security Act (42 U.S.C. 1395w–29), as added by section 241(a) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173), is repealed.
(a) In general.—Subsection (d)(3) of section 5007 of the Deficit Reduction Act of 2005 (Public Law 109–171) is amended by inserting “(or September 30, 2011, in the case of a demonstration project in operation as of October 1, 2008)” after “December 31, 2009”.
(1) IN GENERAL.—Subsection (f)(1) of such section is amended by inserting “and for fiscal year 2010, $1,600,000,” after “$6,000,000,”.
(2) AVAILABILITY.—Subsection (f)(2) of such section is amended by striking “2010” and inserting “2014 or until expended”.
(1) QUALITY IMPROVEMENT AND SAVINGS.—Subsection (e)(3) of such section is amended by striking “December 1, 2008” and inserting “March 31, 2011”.
(2) FINAL REPORT.—Subsection (e)(4) of such section is amended by striking “May 1, 2010” and inserting “March 31, 2013”.
Part B of title IV of the Social Security Act (42 U.S.C. 621–629i) is amended by adding at the end the following:
“(a) Purpose.—The purpose of this section is to improve the well-being, health, and development of children by enabling the establishment and expansion of high quality programs providing voluntary home visitation for families with young children and families expecting children.
“(b) Grant application.—A State that desires to receive a grant under this section shall submit to the Secretary for approval, at such time and in such manner as the Secretary may require, an application for the grant that includes the following:
“(1) DESCRIPTION OF HOME VISITATION PROGRAMS.—A description of the high quality programs of home visitation for families with young children and families expecting children that will be supported by a grant made to the State under this section, the outcomes the programs are intended to achieve, and the evidence supporting the effectiveness of the programs.
“(2) RESULTS OF NEEDS ASSESSMENT.—The results of a statewide needs assessment that describes—
“(A) the number, quality, and capacity of home visitation programs for families with young children and families expecting children in the State;
“(B) the number and types of families who are receiving services under the programs;
“(C) the sources and amount of funding provided to the programs;
“(D) the gaps in home visitation in the State, including identification of communities that are in high need of the services; and
“(E) training and technical assistance activities designed to achieve or support the goals of the programs.
“(3) ASSURANCES.—Assurances from the State that—
“(A) in supporting home visitation programs using funds provided under this section, the State shall identify and prioritize serving communities that are in high need of such services, especially communities with a high proportion of low-income families or a high incidence of child maltreatment;
“(B) the State will reserve 5 percent of the grant funds for training and technical assistance to the home visitation programs using such funds;
“(C) in supporting home visitation programs using funds provided under this section, the State will promote coordination and collaboration with other home visitation programs (including programs funded under title XIX) and with other child and family services, health services, income supports, and other related assistance;
“(D) home visitation programs supported using such funds will, when appropriate, provide referrals to other programs serving children and families; and
“(E) the State will comply with subsection (i), and cooperate with any evaluation conducted under subsection (j).
“(4) OTHER INFORMATION.—Such other information as the Secretary may require.
“(1) INDIAN TRIBES.—From the amount reserved under subsection (l)(2) for a fiscal year, the Secretary shall allot to each Indian tribe that meets the requirement of subsection (d), if applicable, for the fiscal year the amount that bears the same ratio to the amount so reserved as the number of children in the Indian tribe whose families have income that does not exceed 200 percent of the poverty line bears to the total number of children in such Indian tribes whose families have income that does not exceed 200 percent of the poverty line.
“(2) STATES AND TERRITORIES.—From the amount appropriated under subsection (m) for a fiscal year that remains after making the reservations required by subsection (l), the Secretary shall allot to each State that is not an Indian tribe and that meets the requirement of subsection (d), if applicable, for the fiscal year the amount that bears the same ratio to the remainder of the amount so appropriated as the number of children in the State whose families have income that does not exceed 200 percent of the poverty line bears to the total number of children in such States whose families have income that does not exceed 200 percent of the poverty line.
“(3) REALLOTMENTS.—The amount of any allotment to a State under a paragraph of this subsection for any fiscal year that the State certifies to the Secretary will not be expended by the State pursuant to this section shall be available for reallotment using the allotment methodology specified in that paragraph. Any amount so reallotted to a State is deemed part of the allotment of the State under this subsection.
“(d) Maintenance of effort.—Beginning with fiscal year 2011, a State meets the requirement of this subsection for a fiscal year if the Secretary finds that the aggregate expenditures by the State from State and local sources for programs of home visitation for families with young children and families expecting children for the then preceding fiscal year was not less than 100 percent of such aggregate expenditures for the then 2nd preceding fiscal year.
“(1) IN GENERAL.—The Secretary shall make a grant to each State that meets the requirements of subsections (b) and (d), if applicable, for a fiscal year for which funds are appropriated under subsection (m), in an amount equal to the reimbursable percentage of the eligible expenditures of the State for the fiscal year, but not more than the amount allotted to the State under subsection (c) for the fiscal year.
“(2) REIMBURSABLE PERCENTAGE DEFINED.—In paragraph (1), the term ‘reimbursable percentage’ means, with respect to a fiscal year—
“(A) 85 percent, in the case of fiscal year 2010;
“(B) 80 percent, in the case of fiscal year 2011; or
“(C) 75 percent, in the case of fiscal year 2012 and any succeeding fiscal year.
“(1) IN GENERAL.—In this section, the term ‘eligible expenditures’—
“(A) means expenditures to provide voluntary home visitation for as many families with young children (under the age of school entry) and families expecting children as practicable, through the implementation or expansion of high quality home visitation programs that—
“(i) adhere to clear evidence-based models of home visitation that have demonstrated positive effects on important program-determined child and parenting outcomes, such as reducing abuse and neglect and improving child health and development;
“(ii) employ well-trained and competent staff, maintain high quality supervision, provide for ongoing training and professional development, and show strong organizational capacity to implement such a program;
“(iii) establish appropriate linkages and referrals to other community resources and supports;
“(iv) monitor fidelity of program implementation to ensure that services are delivered according to the specified model; and
“(I) knowledge of age-appropriate child development in cognitive, language, social, emotional, and motor domains (including knowledge of second language acquisition, in the case of English language learners);
“(II) knowledge of realistic expectations of age-appropriate child behaviors;
“(III) knowledge of health and wellness issues for children and parents;
“(IV) modeling, consulting, and coaching on parenting practices;
“(V) skills to interact with their child to enhance age-appropriate development;
“(VI) skills to recognize and seek help for issues related to health, developmental delays, and social, emotional, and behavioral skills; and
“(VII) activities designed to help parents become full partners in the education of their children;
“(B) includes expenditures for training, technical assistance, and evaluations related to the programs; and
“(C) does not include any expenditure with respect to which a State has submitted a claim for payment under any other provision of Federal law.
“(2) PRIORITY FUNDING FOR PROGRAMS WITH STRONGEST EVIDENCE.—
“(A) IN GENERAL.—The expenditures, described in paragraph (1), of a State for a fiscal year that are attributable to the cost of programs that do not adhere to a model of home visitation with the strongest evidence of effectiveness shall not be considered eligible expenditures for the fiscal year to the extent that the total of the expenditures exceeds the applicable percentage for the fiscal year of the allotment of the State under subsection (c) for the fiscal year.
“(B) APPLICABLE PERCENTAGE DEFINED.—In subparagraph (A), the term ‘applicable percentage’ means, with respect to a fiscal year—
“(i) 60 percent for fiscal year 2010;
“(ii) 55 percent for fiscal year 2011;
“(iii) 50 percent for fiscal year 2012;
“(iv) 45 percent for fiscal year 2013; or
“(v) 40 percent for fiscal year 2014.
“(g) No use of other federal funds for state match.—A State to which a grant is made under this section may not expend any Federal funds to meet the State share of the cost of an eligible expenditure for which the State receives a payment under this section.
“(1) IN GENERAL.—The Secretary may waive or modify the application of any provision of this section, other than subsection (b) or (f), to an Indian tribe if the failure to do so would impose an undue burden on the Indian tribe.
“(2) SPECIAL RULE.—An Indian tribe is deemed to meet the requirement of subsection (d) for purposes of subsections (c) and (e) if—
“(A) the Secretary waives the requirement; or
“(B) the Secretary modifies the requirement, and the Indian tribe meets the modified requirement.
“(i) State reports.—Each State to which a grant is made under this section shall submit to the Secretary an annual report on the progress made by the State in addressing the purposes of this section. Each such report shall include a description of—
“(1) the services delivered by the programs that received funds from the grant;
“(2) the characteristics of each such program, including information on the service model used by the program and the performance of the program;
“(3) the characteristics of the providers of services through the program, including staff qualifications, work experience, and demographic characteristics;
“(4) the characteristics of the recipients of services provided through the program, including the number of the recipients, the demographic characteristics of the recipients, and family retention;
“(5) the annual cost of implementing the program, including the cost per family served under the program;
“(6) the outcomes experienced by recipients of services through the program;
“(7) the training and technical assistance provided to aid implementation of the program, and how the training and technical assistance contributed to the outcomes achieved through the program;
“(8) the indicators and methods used to monitor whether the program is being implemented as designed; and
“(9) other information as determined necessary by the Secretary.
“(1) IN GENERAL.—The Secretary shall, by grant or contract, provide for the conduct of an independent evaluation of the effectiveness of home visitation programs receiving funds provided under this section, which shall examine the following:
“(A) The effect of home visitation programs on child and parent outcomes, including child maltreatment, child health and development, school readiness, and links to community services.
“(B) The effectiveness of home visitation programs on different populations, including the extent to which the ability of programs to improve outcomes varies across programs and populations.
“(2) REPORTS TO THE CONGRESS.—
“(A) INTERIM REPORT.—Within 3 years after the date of the enactment of this section, the Secretary shall submit to the Congress an interim report on the evaluation conducted pursuant to paragraph (1).
“(B) FINAL REPORT.—Within 5 years after the date of the enactment of this section, the Secretary shall submit to the Congress a final report on the evaluation conducted pursuant to paragraph (1).
“(k) Annual reports to the congress.—The Secretary shall submit annually to the Congress a report on the activities carried out using funds made available under this section, which shall include a description of the following:
“(1) The high need communities targeted by States for programs carried out under this section.
“(2) The service delivery models used in the programs receiving funds provided under this section.
“(3) The characteristics of the programs, including—
“(A) the qualifications and demographic characteristics of program staff; and
“(B) recipient characteristics including the number of families served, the demographic characteristics of the families served, and family retention and duration of services.
“(4) The outcomes reported by the programs.
“(5) The research-based instruction, materials, and activities being used in the activities funded under the grant.
“(6) The training and technical activities, including on-going professional development, provided to the programs.
“(7) The annual costs of implementing the programs, including the cost per family served under the programs.
“(8) The indicators and methods used by States to monitor whether the programs are being been implemented as designed.
“(l) Reservations of funds.—From the amounts appropriated for a fiscal year under subsection (m), the Secretary shall reserve—
“(1) an amount equal to 5 percent of the amounts to pay the cost of the evaluation provided for in subsection (j), and the provision to States of training and technical assistance, including the dissemination of best practices in early childhood home visitation; and
“(2) after making the reservation required by paragraph (1), an amount equal to 3 percent of the amount so appropriated, to pay for grants to Indian tribes under this section.
“(m) Appropriations.—Out of any money in the Treasury of the United States not otherwise appropriated, there is appropriated to the Secretary to carry out this section—
“(1) $50,000,000 for fiscal year 2010;
“(2) $100,000,000 for fiscal year 2011;
“(3) $150,000,000 for fiscal year 2012;
“(4) $200,000,000 for fiscal year 2013; and
“(5) $250,000,000 for fiscal year 2014.
“(n) Indian tribes treated as States.—In this section, paragraphs (4), (5), and (6) of section 431(a) shall apply.”.
Title XI of the Social Security Act is amended by inserting after section 1150 the following new section:
“Improved coordination and protection for dual eligibles
“Sec. 1150A. (a) In general.—The Secretary shall provide, through an identifiable office or program within the Centers for Medicare & Medicaid Services, for a focused effort to provide for improved coordination between Medicare and Medicaid and protection in the case of dual eligibles (as defined in subsection (e)). The office or program shall—
“(1) review Medicare and Medicaid policies related to enrollment, benefits, service delivery, payment, and grievance and appeals processes under parts A and B of title XVIII, under the Medicare Advantage program under part C of such title, and under title XIX;
“(2) identify areas of such policies where better coordination and protection could improve care and costs; and
“(3) issue guidance to States regarding improving such coordination and protection.